October 2nd, 2011
young male hand pain and weakness while work out in Gymnasium. Patient heard a snapping sound from elbow and reported to nearby doctor who advised MRI after which patient was given above elbow slab. MRI was reported as distal biceps rupture with inflammation surrounding area.
patient was immobilized in above elbow slab for 3 weeks. At 4 weeks patient reported in our out patient department with weakness of flexion and supination. patient was advised repair od distal bicerps tendon. transverse incision given in cubital fossa and ruptured tendon with frayed edges delivered.
locking nonabsorbable sutures passed through distal end.
Stured delivered to dorsum of forearm into second incision. radial tuberosity identified and window made into cortex.
Through the drill hole on side of window sutures delivered inside out so that once sutures are tied over endobutton end of tendon enters into window thus giving stable fixation and better chances of healing.
Tags: biceps tendon repair, biceps tendon rupture, dr vikas gupta, elboe surgery, elbow surgery, handsurgeon, handsurgeryclinic, injuries in weight lifter, sports injury, sports injury elbow, sports surgeon, tendon repair, vikas gupta
Posted in CME hand surgery, Surgery Clinic, Uncategorized, elbow surgery, sports injuries, sports injuries hand and wrist | No Comments »
December 11th, 2009
33rd annual meeting of ISSH was held at new delhi from 4th 6th dec 2009. this meeting was attended by more than 150 handsurgeons/therapists from all over india and also from neighbourinf countries.we had overseas reputed faculty (10 people) as well as renowned national faculty (17 persons) who delivered lectures during conference and workshops. all the lectures were very informative and appreciated by all the people who had attended conference for their scientific content. Apart from acaedimically rich conference it was also appreciated for its social interaction. in next few posts i would be writing about proceedings from conference and also comments/feedback from participants.
Posted in CME hand surgery | 1 Comment »
September 19th, 2009
Ergonomics
- There should be negative tilt of the keyboard that is rows of keys farthest away from you should be slightly lower so that while typing wrists are not bent upwards.
- Height of keyboard should be such that wrists are in neutral position while shoulders are relaxed and elbows are bent less than 90degrees.
- Use arm to navigate mouse rather than side to side movements of wrists
- Mouse should be at same height as keyboard by its side.
- Keep fingers and thumb relaxed on the keyboard and don’t use excessive force to activate keys.
Posture
- Wrist should be horizontal in line with forearm so that wrist is not bent upwards or downwards. More that 15 degrees variation either way increases pressure on median nerve.
- Middle finger should be in line with the forearm, neither angled towards thumb or little finger.
Posted in Repititive strain injuries, computer related injuries | 3 Comments »
September 16th, 2009
TIPS TO REDUCE NECK, SHOULDER AND BACK STRAIN
- Position the monitor in centre, in front of the keyboard so that you are facing it directly.
- Top of the screen should be at eye level. A screen that is too high or too low will cause awkward positioning of the head, neck, shoulders and back.
- Tilt your monitor upward so that the base is slightly closer to you. This improves legibility of print and reduces eye strain.
- Install the monitor on a swivel arm so you can easily make small adjustments in height and distance. Especially if you sharing your computer height of chair must be adjustable.
Posted in Repititive strain injuries, computer related injuries | No Comments »
August 24th, 2009
In the recent years there has been lot of debate regarding what to do after first episode of anterior dislocation of the shoulder. Opinion ranged from closed reduction followed by 3 weeks immobilization to primary arthroscopic Bankart repair (repair of detached glenoid labrum). Though many surgeons have shown that arthroscopic lavage of the joint alone benefits patients. There are numerous studies which have shown that traumatic anterior dislocation of shoulder is associated with persistent deficit of shoulder function and a high risk of recurrent instability in young adults.
The above mentioned article was published from Edinburgh, United Kingdom. Authors assessed efficacy of primary arthroscopic Bankart repair and also compared the results with arthroscopic lavage. This study is very well designed double blind prospective trial. It included 84 patients aged between 15-35 years.
Authors concluded in this study in Bankart repair group risk of all instability reduced by 82%. The functional scores were better, treatment costs were lower and patient satisfaction was higher after arthroscopic repair. Regarding cost according to authors initial cost is high because of surgery but subsequently because of recurrent instability no. of working days lost and additional procedures are also required. There fore authors recommended early arthroscopic Bankart repair even after first time traumatic anterior dislocation of shoulder.
Further I would invite comments from my orthopedic colleagues regarding this study and its conclusions.
Posted in Surgery Clinic, shoulder arthroscopy | No Comments »
August 21st, 2009
I would be writing about experience during my AO hand fellowship at Freiburg, Germany. Though I would be sharing my professional experience but there may be some adulteration with my personal prejudice I will try not to adulterate.
Let me introduce you to AO Fellowships which are awarded by AO foundation through AO education. I came to know about AO Hand fellowships when I was visiting Massachusetts general hospital (Harvard University), Boston there I met AO hand fellow that time I came to know that AO institutes fellowships in hand & spine besides trauma.
I started fellowship on 10th November 2008 at “Zentrum fur ambulante Diagnostik und Chirurgie” at Freiburg, Germany with Dr. med Klaus Lowka one of the pioneers of hand surgery in Germany and practicing hand surgery since 1979.
In 2008 clinic was celebrating its 15th anniversary. At this clinic between around 2500 hand surgeries are done per year. In the subsequent submissions I would be narrating cases and surgeries we performed.
Posted in Uncategorized | 3 Comments »
May 8th, 2009
one of our patients who had nonunion of fracture scaphoid for which open reduction internal fixation with bone grafting was done. this patient had published a blog which can be visited by clicking on the link below
http://www.gabrielshadewalker.blogspot.com/
Posted in patients blog | No Comments »
February 12th, 2009
there is ongoing debate at some places that who should be treating sports injuries of hand and wrist. a small section believes that it is a domain of sports medicine subspeciality but majority believes that sports injuries of hand and wrist be treated by hand surgeoans as they are the people who are well versed with anatomy (you rightly guessed anatomy of sports person is same as that of common man) of this region, surgeries in that area and rehablitation protocols after surgeries of these region. in January 2009 issue of journal of bone and joint surgery american it has been clearly mentioned that sports injury of hand and wrist is the domain of hand surgeons and it is dealt by them.
Posted in sports injuries, sports injuries hand and wrist | No Comments »
July 1st, 2008
there was a patient, a young lady working in BPO industry having recuurent neck pain. she was started on treatment after which she would become better but after some time she would come back with same complaints. After investigating in detail we found that her pain would precipitate when there was bumpy ride and she would be back from night shaift and siiting in rear seat. this led to conclusion that cab driver who is trying to be on schedule on bumpy roads is sometimes driving fast along with employee who is half sleep and unable to sit erect gets a jerk resulting in tissue injury which cuases pain neck radiating to arms and muscle spasm. i think we can term this as “BPO cab symdrome“. treatment in such cases would be sitting properly in cab and avoiding driving fast and bumpy roads if possible.
Posted in computer related injuries | 3 Comments »