BENEFITS OF LEG ELEVATION

 

Leg elevation is the practice of raising your legs above the level of your heart. Whether you're lying down or sitting up, the goal is to get your feet and legs lifted up and above your heart to allow gravity to assist circulation.  Make sure your legs are comfortably supported, without any pressure points or awkward angles.

Getting a good night’s sleep is one of the fundamental rules of good health and wellbeing. Unfortunately, for many, it is also a rare luxury. Those who suffer from chronic pain, sleep apnea, and other bothersome health conditions often struggle to maintain a healthy sleep schedule, which, in turn, increases their risk of several dangerous diseases. If you find it difficult to fall asleep or stay asleep at night, one of the first things you should consider is your sleeping position. The way you sleep may not match up with your body’s needs. A person suffering from chronic back pain, for example, will continue tossing and turning in pain all night if they sleep in a position that puts tension on their back. An often overlooked sleep position that has tremendous benefits for folks suffering from certain underlying conditions is sleeping with your legs elevated.

 

The Benefits of Sleeping With Elevated Legs

1. Relieves lower back pain

Chronic back pain can interfere with your sleep without you even realizing it. If you’re suffering from any kind of lower back pain, be it sciatic nerve pain, a pinched nerve, or joint pain, sleeping with legs elevated can be immensely helpful. Sleeping on your back, in general, is beneficial for back pain because it distributes your weight as evenly as possible, so it reduces the risk of spinal disc compression. To promote the natural curvature of the spine and reduce the pressure off the spinal column even further, put a bolster or pillow under your knees. Sleeping in this position will make sleep more comfortable for you and offers relief from lower back pain as well.

 

2. Improves blood circulation

Poor blood circulation in the legs is not uncommon, and it dramatically increases one’s risk of blood clots and potentially life-threatening conditions like deep vein thrombosis and stroke. Elevating your legs 6-12 inches (15-30 cm) above your heart will improve blood flow from your legs toward your heart, essentially boosting blood circulation in the lower extremities. It all boils down to simple physics. Whenever your legs are below the level of your heart (e.g. when standing), the blood in the leg veins must work against gravity to return to the heart. Simply elevating your legs makes gravity work for instead of against you, improving blood flow. This position also means that your heart won’t need to pump as much, which means that elevating your legs is also beneficial for heart health.

 

3. Reduces swelling in the legs

Things like inflammation or edema (fluid trapped in the tissues, usually in the feet, ankles, and legs) can lead to soreness and swelling in the lower extremities. Many health conditions, such as chronic cardiovascular or lung diseases, as well as a diet high in salt or prolonged periods of sitting or standing, can contribute to swelling in the legs. The condition can be quite painful and may interfere with your sleep. Similar to the way leg elevation improves blood circulation, it can also aid in draining away trapped fluids from your legs. If you suffer from swollen feet, this may be the best sleeping position for you. Lymphatic obstructions as seen in filarial disease can also be contained by limb elevation.  

 

4. Lowers venous pressure

If you have to stand or sit for long periods of time, it can make blood difficult to drain from the veins in the lower body. The collected blood, in turn, creates excess pressure in veins. This pressure equals soreness and tension in the legs, and it is believed to cause varicose veins too. Lowering of venous pressure is also helpful for treating spider nevi, chronic venous insufficiency, and deep vein thrombosis (DVT).

 

5. Relieves muscle tension

Leg elevation provides significant comfort and eases muscle tension, which is especially beneficial for those engaged in professions that require prolonged hours of standing or sitting.

 

6. Reduces risk of developing leg ulcers

Elevating your legs can help reduce the risk of developing leg ulcers by improving microcirculation and oxygen delivery to the affected limb. When legs are raised above heart level, gravity assists in the return of blood from the legs to the heart, which can help reduce swelling and pressure in the veins of the legs. This reduced blood pressure can help prevent the development of venous leg ulcers. Additionally, leg elevation can hasten the healing process of existing ulcers by improving oxygen delivery to the wound, promoting faster tissue repair, and lowering the risk of skin infection.

 

7. Beneficial during pregnancy

During pregnancy, women experience increased fluid retention, swelling, and fatigue in their legs due to increased blood volume and hormonal changes. Leg elevation is considered safe and beneficial during pregnancy. It helps alleviate common discomforts like leg pain, swelling, fatigue, and varicose veins due to increased weight and hormonal changes.

 

8. Helps post-operative healing

Post-operative care often involves leg elevation and for a good reason. It helps to decrease swelling, reduce discomfort, and speed up the healing process. If you've recently undergone a surgical procedure, it might be beneficial to spend some time each day with your legs raised. 

 

9. Relieves symptoms of varicose veins

Varicose veins are visibly twisted and inflamed veins that are particularly common among people who work standing jobs. Raising your legs at night will bring relief to tired feet and lower the pressure in the lower body too. Elevating your legs can help relieve the symptoms of varicose veins by improving blood circulation and reducing inflammation. The physiological reason behind this relief lies in the fact that the valves in the leg veins, responsible for returning blood to the heart, can become weak. This weakness results in blood pools in the veins, largely due to the force of gravity.

When you elevate your legs above the level of your heart, it assists these veins in overcoming gravity's effect, allowing blood to flow more efficiently in the right direction to surrounding muscles. This enhanced blood flow reduces the swelling and pressure in the veins, thereby alleviating the discomfort associated with varicose veins.

 

10. Helps to prevent blood clotting in leg veins

Elevating your legs can help prevent blood clots by improving venous circulation. This is particularly beneficial for deep vein thrombosis (DVT), a condition where blood clot forms in deep veins of the lower legs. By using a leg elevation pillow or simply raising your legs above your heart level, you can enhance blood flow and reduce the risk of clots. This position alleviates pressure in your veins, allowing blood to flow more freely and reducing the chance of blood clot formation.

 

Who can benefit from sleeping with their legs raised?

·        Lower back pain sufferers - Those who have sciatica or a pinched nerve

·        People recovering from injuries to the legs or feet

·        After surgery

·        Patients with chronic joint conditions

·        Those who have vein conditions, such as varicose veins or superficial thrombophlebitis

·        Deep vein thrombosis sufferers

·        Chronic venous insufficiency patients

·        Pregnant persons

·        Anyone suffering from edema.

 

How to safely elevate the legs during sleep?

The use of a pillow or bolster is certainly the cheapest and easiest way to elevate your legs. Automated adjustable mattresses or bed frames are an even better choice, but they can be very expensive, so we don’t recommend them to beginners. To remedy back pain, one small pillow underneath the knees will suffice, but other conditions may require using several blankets and large pillows to elevate your legs above the heart.

There's a right and a wrong way to elevate your legs. How do you make sure you're doing it correctly to reap the maximum benefits? Let's walk through it together. 

• Find a comfortable and flat surface where you can lie down, such as a bed or couch.
• Use a pillow specifically designed for leg elevation, or you can use cushions as a substitute. But avoid using a regular pillow as it may not provide the right angle and support needed.
• Lie down and put your legs up, ensuring they are above the level of your heart. This helps blood to circulate back to the heart without fighting gravity.
• Make sure your legs are not crossed or bent at the knee when elevated. This can restrict blood flow and counteract the benefits. Keep your legs straight, parallel to each other, and try to relax as much as possible. 
• Like any good health habit, consistency is vital. Make leg elevation a part of your daily routine. Consider doing it while you're watching TV, reading a book, or even while you're snoozing at night.

 

Here are a few tips to consider if you want to try sleeping with elevated legs:

1. Practice on the couch. A new sleeping position may feel unusual at first, so before you commit to a full night of sleep with your legs raised, try the position as you’re relaxing on the couch. This will help you transition more smoothly.

2. Start low. Everyone is different, and your individual needs may not require you to stack up 2-3 pillows every night before bed. Start with one pillow under your knees, get used to the position, and then add one more to see if that helps even more, and so on, until you find the best position for you.

3. You don’t need to sleep with your legs up all night. It all depends on the condition you want to address. For edema, for example, a few hours of sleep or just sitting with your legs up can help drain the excess fluids, whereas patients with lower back pain may feel that they need a whole night of sleep in this position to experience the most benefits. So we encourage you to play around with the time.

4. While leg elevation can be great, there's no need to overdo it. Long periods without movement might lead to stiffness. Aim for 15 to 30-minute sessions, several times a day. Always listen to your body and adjust as needed.

What happens if you elevate your legs for too long?

Elevating your legs for long periods could potentially lead to blood pooling in your upper body. This might result in dizziness or headaches when you sit or stand up.  It may pose potential risks in certain situations. For instance, elevating your legs too high could potentially lead to discomfort or even decreased circulation. Finding that sweet spot, where your legs are elevated just above the level of your heart, is key. 

If you have any pre-existing medical conditions like diabetes, peripheral artery disease, or any form of heart disease, it's crucial to consult with your healthcare provider before starting a regular leg elevation routine.

 

Leg elevation isn't just about relaxation. It's about maintaining your health, managing discomfort, and most importantly, investing in your quality of life. So why wait? Elevate today for a healthier tomorrow!

REMEMBERING PROF. I. D. SHARMA – EARLY DETECTION OF SKIN CANCERS

  

Prof. Indra Dev Sharma was our teacher in the Department of Surgery in King George’s Medical College, Lucknow. He was the first qualified Breast surgeon of Lucknow, trained in leading breast care centres of the U.S, U.K, Sweden and Austria. He was responsible for sensitizing the state government about the seriousness of early detection of cancers in the breast and the government sanctioned a thermography unit to the Department of Surgery on his insistence. He got it installed in the Experimental Surgery building and personally performed the investigation in all his patients. His training in Karolinska Institute of Sweden and several other Breast units in Europe shaped the researcher in him. His record keeping was meticulous and he regularly published his work and presented them in national and international conferences. He had 84 publications and was an extremely sought after thesis guide because the research often got published. I remember he authored a chapter in Recent Advances in Medical Thermology in 1984, when we were appearing for our M.S examinations.

 

Dr. Sharma joined the Department of Surgery in 1973, became a Reader in 1984. Though the clinical and research work in Surgical Oncology was started by Prof. N.C. Misra long time back, but he was a member of the undivided Department of Surgery, of which he was the Head of the Department when he retired. The Department of Surgical Oncology was created by the Government of Uttar Pradesh on 3rd September 1998 with Prof. ID Sharma as the Head of Department. He remained at the helm of the department till his retirement in January 2009.

 

After my M.Ch in Plastic Surgery he and Prof. Misra thought that I should spend some time in Tata Memorial Hospital, Mumbai and learn reconstructive oncology under Dr. Kavrana. The six months that I spent in TMH was time extremely well spent because the volume of work was of a developing country and the quality of work was world class. After returning from T.M.H I became a useful member of their team, doing all the reconstruction after they had done the surgical ablation.

 

Dr. Sharma belonged to a family of doctors. His father, Dr. D.N. Sharma, an alumnus of KGMC, was at the helm of medical administration of the state of Uttar Pradesh and his twin brother Prof. Vishnu Dev Sharma was Professor of Orthopedics in KGMC. Both brothers were very mild mannered gentlemen and they all lived as a joint family in Niralanagar opposite Vivekananda Hospital.

 

Prof. Sharma had a very busy practice both at home and at Neera Hospital. I had the privilege of assisting him in Neera Hospital for the longest period of time. He was a very generous teacher and would let me operate most of his cases. All his modified radical mastectomies were reconstructed by me and we had a very large series of breast reconstruction patents which we published in journals and presented in conferences. I did my first breast augmentation, breast reduction and correction of breast ptosis in his patients. We also operated oral cancers, skin cancers, soft tissue tumours and bone tumours in Neera Hospital and he would keenly go through the Chemotherapy journals and design his own chemotherapy programme for his patients because the city had no medical oncologist then.

 

His clinic at home would attract patients from all over the state, neighboring states and Nepal. Many of them would reach early in the morning on working days and he could not deny them the early morning darshan. This often resulted in him getting late in reaching the Surgery department in the morning. On other days this would go unnoticed, but on Thursdays we had a morning case conference in the New Surgical Block auditorium, and it was attended by surgeons from all over the city – Balarampur Hospital, Civil Hospital, Command Hospital, and all surgical departments. In this conference his absence could be felt, so he devised an ingenious plan. He would come late, slip into his room, which was next to the auditorium, change into his OT dress, powder his hands and walk into the auditorium dusting his hands so that people would get the impression that he was coming from O.T. His senior consultant in the Unit, Prof. G.P. Agarwal knew all about this but he was a very kind hearted person and never revealed his secret to anyone.

 

When the Government of Uttar Pradesh planned to establish a Cancer Institute in Lucknow, Prof. I.D. Sharma was one of the advisors to the government. He was decorated with many awards and two of them Vidya Ratan Award and Guru Shreshtha Award come to my mind.

 

Prof. I.D. Sharma’s lectures were all very well planned. He was never in the habit of confusing the MBBS students with unnecessary details. He would teach exactly what was adequate for them, and no more. He would finish his topic in 40 minutes and then revise it all over again so that the message was clear to everyone. Today, I have recovered my class notes on Early Detection of Skin Cancers, which I am sharing with you all.

 

Although skin cancers that are detected early are almost always curable, things can become a lot more serious when they evade detection, to the point where they can become deadly. Here are 9 subtle signs of skin cancer:

 

1. Repeatedly getting a sore in the same place

A sore that doesn’t heal may be a sign of basal or squamous cell carcinoma, which are the two most common types of skin cancer. They often develop in the men’s beard areas and are associated with pain during shaving. If such a sore hasn’t healed within a month, then you must visit a doctor.

 

2. Pearly bump on the skin

Basal cell carcinomas can often look like unassuming “pearly bumps”. They can be pink, red, white, tan, black or brown in color. Other signs to look out for include irritated red spots, pink growths crusted, indented centers; the aforementioned sores; and white, yellow, waxy areas that look like scars.

 

3. A red, scaly patch that just won’t quit

Both basal and squamous cell carcinomas can show up as scaly red patches. Squamous cell carcinomas, in particular, can be a little tender to the touch. Furthermore, both carcinomas can feel like “irregular sandpaper” when touched. Squamous cell carcinomas can also present as sores that won’t heal – wart-like growths or elevated growth with indented centers that bleed.

 

4. A change in one of your moles

Although melanoma is less common than the other forms of cancer, it’s by far the most lethal. It can show up either as a new sport, or it can arise within an existing mole. Always be on the lookout for a mole that has changed in size, shape or color. A suspicious mole can also be identified by multiple or unusual colors, such as red, white, blue or black.

Use this acronym to track mole changes:

•         A stands for asymmetry. In melanoma, two sides of a mole often don't match.

•         B stands for borders. A melanoma usually has irregular borders, rather than clearly defined ones.

•         C stands for colour. Melanomas are usually uneven in color.

•         D stands for diameter. An increase in a mole's size, or diameter, could indicate melanoma.

•         E stands for evolving. Watch out for moles that change over time.

 

5. Getting a new mole after 55 years of age

It’s uncommon for new moles to grow once you’re over the age of 55. If you’re over that age and experience a new one growing, be sure to head to a surgeon to have it biopsied.

 

6. Moles itching or bleeding for no apparent reason

If you have a mole that just starts bleeding without you having any recollection of injuring yourself, or if it itches persistently, then you should definitely get it checked. These should be biopsied.

 

7. Suspicious spot on a part of your body not exposed to the sun

Melanomas can present on parts of the body that are almost never exposed to the sun, and most people aren’t aware of this fact. Sun exposure does, in fact, increase the risk of developing melanoma, however, it can occur in the most surprising of places, such as a man’s penis or a woman’s vulva. A melanoma can even present on the bottom of your foot. Make sure you check your entire body when doing a skin check, including parts of it that aren’t exposed.

 

The key to the successful treatment of skin cancer is to catch it early. Even if a spot you’re concerned about turns out to be benign, it’s much better to have it checked out early rather than waiting six months only to find that the matter is actually malignant.

Skin cancer starts when skin cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells can invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

 

Risk factors

 

Factors that may increase the risk of skin cancer include:

• Skin that sunburns easily. Anyone of any skin color can get skin cancer. But the risk is higher in people with skin that sunburns easily. The risk of skin cancer also is higher in people who have blond or red hair, light-colored eyes or freckles.
• Light from the sun. Ultraviolet (U.V) light from the sun increases the risk of skin cancer. Covering the skin with clothes or sunblock / sunscreen can help lower the risk.
• Light from U.V. Lamps. People who use indoor tanning beds with U.V lamps have an increased risk of skin cancer. The lights used in tanning beds give off harmful ultraviolet light.
• A history of sunburns. Having had one or more sunburns that raised blisters increases the risk of developing skin cancer. If the sunburns happened during childhood, they increase the risk of getting skin cancer as an adult even more.
• A history of skin cancer. People who've had skin cancer once are much more likely to get it again.
• A family history of skin cancer. If a blood relative, such as a parent or sibling, had skin cancer, you may be more likely to get skin cancer.
• Staying in Ozone layer depleted zones. The ozone layer prevents harmful wavelengths of ultraviolet light from passing through the Earth's atmosphere. In places like Australia and in the South Pole this layer is depleated and so incidence of skin cancer are high
• A weakened immune system. If the body's germ-fighting immune system is weakened by medicine or disease, there might be a higher risk of skin cancer. Patients on Chemotherapy, Steroids etc. have compromised immunity.

 

 

Prevention

 

Most skin cancers can be prevented by protecting oneself from the sun. To lower the risk of skin cancer you can:

• Stay out of the sun during the middle of the day. The sun's rays are strongest between about 10 a.m. and 3 p.m. Plan outdoor activities at other times of the day. When outside, stay in shade as much as possible.
• Wear sunscreen year-round. Use a broad-spectrum sunscreen even on cloudy days. Apply sunscreen generously. Apply again every two hours, or more often if you're swimming or sweating.
• Wear protective clothing. Wear dark, tightly woven clothes that cover your arms and legs. Wear a wide-brimmed hat that shades your face and ears. Don't forget sunglasses.
• Check your skin often and report changes to your healthcare professional. Look at your skin often for new growths. Look for changes in moles, freckles, bumps and birthmarks. Use mirrors to check your face, neck, ears and scalp.

 

The most common skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma, with basal and squamous cell cancers being the most prevalent. We will discuss about these three cancers in our subsequent classes.

 

With this Dr. I.D. Sharma’s class ended. He took the next 10 minutes to revise all that he had taught that day and then walked out towards his car.

REMEMBERING PROF. J.N. KAKKER BY HIS O.P.D TEACHING - WRIST PAIN

 

Prof. J. N. Kakker was our teacher in Orthopedic Surgery in King George’s Medical College, Lucknow. He was always meticulously dressed in a suit and everything about him reflected grandeur and opulence. He was trained in the U.K and he spoke English with a British accent. With patients however, he suddenly metamorphosed into a desi Dacsaab! He was a wonderful teacher and a very sought after thesis guide among post graduates. His lectures were well planned, just enough for M.B.B.S students, and always laced with anecdotes and jokes.

 

However, it was during our posting as undergraduate students in Orthopedics wards that we came to know him better. He would leave his coat in his room, wear a new starched white apron every morning, and come out for rounds. His team of residents, Dr. Shishir Rastogi, Dr. Sanjay Rastogi, Dr. P.K. Jain, to name a few, would accompany him from his room to first the Orthopedics ward, where our ward teaching by one of his residents would be in progress. “Which Batch?” he will enquire. “F Batch, Sir” we will reply in chorus. He would then briefly enquire what was being taught and which patient was being discussed. Then go with his resident team towards his beds to continue with his rounds. Once the round of this ward was complete he would come back to our Batch and start his teaching. We were expected to write the patient history and examination in a case sheet and one of us would present the case. He would then quiz every person in the batch about the case. Looking back today, I don’t think he was testing our knowledge; he was actually interested in knowing whether his resident team was doing a good job with our ward teaching. Physical signs would be meticulously elicited and discussion would be threadbare.

 

Once the ward teaching was over, he would ask us to accompany his team for the rest of his round – to private rooms, and traumatic paraplegia unit. Then our white apron procession will march towards the Administrative Block, turn right and walk towards Sardar Patel Hostel, walk down the slope, cross the gate, turn right and walk towards the Rehabilitation & Artificial Limb Centre (RALC). Invariably a meter gauge train would be crossing the railway over-bridge and our entire white apron procession will wait for it to cross, lest some unthinkable stuff dropped from the train on us! I wonder what would be the spectacle for the onlookers in the Shahmina Road crossing, a bunch of white apron wearing adults, with their hands protecting their eyes from the sun, looking up at a passing train!

 

RALC was the crown jewel of our Orthopedics department. It was way ahead of time, with state of the art rehabilitation facilities. Even in 1978-79 they were providing highest quality Prosthetics and Orthotics and Rehabilitation Care to the physically challenged persons, and it was a pioneer institution of that era. The services offered by RALC were related to musculoskeletal problems, brain injury stroke, spinal cord injury, acute and chronic pain management, amputee, work injuries, orthopedic injuries, sports medicine, pediatric neuromuscular-skeletal problems and the developmental delays, osteoarthritis, metabolic bone diseases, osteoporosis etc. Prof. Kakker had patients in RALC and his round would complete only after greeting these patients and reviewing their progress. Every visit to this place was an eye opener for us and the so called disabled routinely mesmerized us by their ability to do exercises in a swimming pool, practice walking on artificial limbs, and getting wax bath, infra-red heat treatment and electrical stimulations.

 

Prof. J.N. Kakker stayed in River Bank Colony, very near the RALC, but he had place in Aliganj, which he had converted into a nursing home, usually managed by his son, who was not a doctor. I remember having assisted Prof. A.K. Wakhlu and Prof. Sandeep Kumar in that hospital. It was small but nice and cozy and the room which was converted into an operating theatre was big, air conditioned and well illuminated. Prof. Kakker's illustrious teaching career in KGMC, which started way back in 1965, came to an end in 1986.

 

Today I recall a case discussion in Prof. J.N. Kakker’s outpatient. The middle aged lady, who was overweight, presented with pain in her wrist. By then we had been shown a case of Carpal Tunnel Syndrome by Dr. G. Ramakrishna, a Senior Resident in Surgery and so we made the diagnosis. The patient had

• Burning, tingling or numbness, especially between the thumb and ring finger. 
• Needing to take breaks to rest during daily activities like kneeding dough or typing. 
• Sensation in the fingertips when flexing or extending the wrist. 
• Perceptions of swelling or stiffness in the wrist, hands or fingers. 

And she would wake up at night with wrist pain.

We showed him that only the sensory part of Median nerve was involved and there were no motor sighs. We planned a Nerve Conduction Velocity test to prove the diagnosis and then release the transverse carpel ligament to treat it.

 

Prof. Kakker was very impressed with our F Batch and then he started his teaching. The wrist may be only a small part of your musculoskeletal system, he said, but it’s one of the most complex and delicate structures in the human body. The wrist anatomy consists of several joints, eight bones, tendons, ligaments, nerves, and blood vessels all crammed in a very narrow area.  That’s why diagnosing wrist pain can be quite tricky. And, we use our wrists a lot - from grabbing and holding onto objects to complex movements like writing and typing. Therefore, wrist pain can be quite debilitating and certainly interferes with one’s daily life. 

 

Depending on the underlying cause, the type of wrist pain one can experience varies from tightness and lack of mobility to sharp pain. So we can expect

     ·        Sharp and sudden pain in the hand
·        Difficulty moving the wrist or gripping objects
·        Swollen wrist or fingers
·        Redness or warmth around the wrist
·        Numbness or a pins and needles sensation in the hand

These symptoms often get worse at night. But, we should not go away with the impression that all pains around the wrist are because of Carpel tunnel Syndrome, he cautioned. So let us understand the differential diagnosis of wrist pain:

1. Arthritis

Arthritis refers to joint inflammation that leads to swelling, stiffness, and pain. It's a very widespread issue, and contrary to popular belief, arthritis can affect adults of any age. There are many types of arthritis, but three particular forms known to affect the wrists are:

Rheumatoid arthritis – This is an autoimmune disease that damages and wears down the joints, typically in both wrists. Painful swelling and reduced mobility are common symptoms.

Gout - a form of arthritis where sharp uric acid crystals build up in joints and cause pain and swelling.

Osteoarthritis - the degenerative type of arthritis associated with wear and tear and advanced age. When the cartilage that surrounds the joints degrades, bones rub against each other, leading to pain and swelling.

Depending on the form of arthritis, causes and treatments vary tremendously. 

 

2. Carpal tunnel syndrome

Carpal tunnel syndrome is an extremely painful disease that affects 5% of the population. Anyone, particularly office workers, artists, and manual laborers can be affected by the condition. Carpal tunnel syndrome occurs when the median is compressed as a result of friction or inflammation. Symptoms can develop in one or both wrists and tend to get worse at night. One can experience pain, weakness, numbness, or a pins and needles sensation in the palms and fingers (except for the little finger).

Mild cases of carpal tunnel syndrome are treated by wearing a wrist brace, applying hot or cold compresses, and taking over-the-counter anti-inflammatory (NSAID) medications (e.g. ibuprofen, asperin) to reduce the pain.

More serious cases may require surgical release of the transverse carpel ligament and neurolysis of Median nerve.

Some people advocate steroid injections, but we don’t think it helps.

I have written a blog on Carpal Tunnel Syndrome in the past and if you wish to read it, please click: https://surajitbrainwaves.blogspot.com/2022/04/carpel-tunnel-syndrome.html

 

3. Ganglion

Ganglion cysts are benign lumps filled with fluid. These cysts typically appear on the back of the wrist or hand, and they can either be painless or quite bothersome. The cause of these cysts is unknown, but the American Academy of Orthopedic Surgeons points out that they appear more often in individuals aged 15-40, women, and gymnasts. Ganglion cysts can sometimes go away on their own. The most constant book in an English household is the Bible. The English try to squish their ganglion by repeatedly striking it with the Bible – the Bible treatment.. Wearing a splint, draining the ganglion cyst, or surgically excising it are other options.

 

4. Carpal boss

A bump on the dorsum of wrist that’s accompanied by wrist pain may also be a sign of a carpal boss. Also known as a carpometacarpal boss, this is a bony lump that forms where the carpal bones meet the radius. Unlike a ganglion cyst that’s mobile and somewhat squishy, carpal bosses are firm and immobile bumps. The exact cause is unknown, but they are believed to be caused by degenerative changes, repetitive stress, prior injury, or localized joint instability that leads to bone spur formation in this area. It usually occurs in younger adults - between 20 and 40 years of age. It tends to appear near the base of the index or middle finger. A carpal boss doesn’t need treatment unless it causes symptoms. Conservative treatment like splints, and analgesics are tried initially. Surgically it can be burred down to shape.

 

5. Wrist injuries

A wrist injury is one of the most widespread causes of wrist pain. We often fall on outstretched hand and use the hand and wrist to protect our body from the fall. Swelling, bruises, or disfigured joints can result from injury. But remember that an injury can occur even if pain following the fall is the only symptom; this is because nerves and other soft tissues can become injured too.  Sprains are a common ligament injury of the wrist. When a ligament is overly stretched or partially torn, your patient will experience pain while moving the wrist, and may also have swelling, bruising, or tingling.

Wearing a splint, keeping ther wrist elevated, resting, cold compresses, and taking NSAIDs to relieve pain can all help heal the sprain faster. That being said, we highly recommend an X-ray of the wrist so that we do not miss fractures around the wrist. Missing a wrist injury – bony or soft tissue, can be fatal because if the bones or ligaments don’t heal well, we may be left with chronic wrist pain.

 

6. Wrist tendonitis

Inflammation of the tendons, also known as tendonitis, is another extremely common cause of wrist pain. In the wrist area, tendons connect the muscles of the forearms with the hand and finger bones. It is these tendons that allow the hands to open and close a fist. When any of these tendons become inflamed, the result is tendonitis. The symptoms of tendonitis are:

     ·        Morning stiffness
·        Dull pain
·        Grinding sensation when moving the wrist
·        Warmth or swelling in some cases.

Tendonitis usually occurs with overuse of the wrists. This can happen with repetitive wrist movements (like typing, writing, playing golf, or tennis) or as a result of injury.

The domiciliary care of tendonitis is similar to other conditions that cause wrist pain: rest, immobilization with a splint, icing, hand exercises, and taking NSAIDs. When these home treatments are not effective, a professional may advise you to get steroid injections directly into the wrist or, in rare cases, surgery.

 

7. Cubital tunnel syndrome

Just like carpal tunnel syndrome we ca have cubital tunnel syndrome or ulnar neuropathy. This condition occurs when the ulnar nerve, while passing from upper arm to forearm gets pinched at the bend right behind the elbow, behind the medial condyle of humerus. Sufferers describe the pain they experience when the ulnar nerve is compressed as “being hit in the funny bone,” but the pain may also extend downward and cause pain, numbness, and tingling in the wrist or even the ring and little fingers.

There are many causes of cubital tunnel syndrome. These include:

     ·        Arthritis of your elbow.
·        Bending elbow for a long time.
·        Bone spurs.
·        Cysts near elbow joint.
·        Past elbow dislocation.
·        Past elbow fracture

The treatment is mainly symptomatic: rest, immobilization with a splint, icing, hand exercises, and NSAIDs. Those suffering from cubital tunnel syndrome are advised against leaning on the affected elbow, as this may increase the pain. Padding the elbow with a soft cushion may also be helpful. Depending on the severity of the condition, symptoms may go away quickly. But in some cases, they never fully resolve on their own, and surgery is required.  

 

Then Prof. Kakkar added that there are several less common causes of wrist pain too. Here are just a few: 

1.      De Quervain’s tenosynovitis - a painful condition caused by inflammation in the tendons surrounding the thumb.

2.      Kienbock's disease - an illness that affects young adults and triggers the destruction of Lunate, a carpal bone. It loses its blood supply, leading to bone  death, pain, stiffness, and potential arthritis.

3.      Benign or cancerous tumors in the wrist. - Most tumors are benign. The most common tumor types are osteoid osteoma, osteoblastoma, and giant cell tumor. Metastatic carpal tumors are most commonly from lung carcinoma. Chondrosarcoma and hemangioendothelial sarcoma are the most common primary malignancies.

4.      Wrist bursitis - the inflammation of the liquid-filled sacs that protect the joints.

5.      Systemic lupus erythematosus - a systemic autoimmune disease that can affect the joints.

 

Such case discussions and bed-side and OPD teachings were hallmark of our Orthopaedic posting. Orthopaedics always attracted graduates very high merit for post-graduation and was essentially a male domain with only one female resident.