Orthopaedics

MUSCLE TEAR IN THE SHOULDER

It is a common problem in the shoulder joint. Surgical or non-surgical treatment options are evaluated by taking into account the type, time of occurrence, size of the tear, the patient’s age, expectation, the condition of the muscle to be repaired (whether there is fatty degeneration), whether there is arthrosis (calcification) in the shoulder, whether there is nerve damage, and the presence of chronic infection. Surgical treatment can be performed with closed (arthroscopic) or open technique. Physiotherapy is required after the operation.

RUPTURE OF THE MENISCUS WITH CALCIFICATION

Meniscus tears occur from time to time in knees with osteoarthritis (calcification). These tears do not occur with great strain, unlike those in athletes. They can occur during daily activities (such as climbing stairs, getting on and off public transport). If the knee does not feel stuck or locked as a result of these injuries, the pain can be relieved with simple measures. Arthroscopy is necessary in the presence of snapping or locking.

If the following complaints have arisen due to hip or knee pain, you may benefit from prosthesis surgery:

a) the person is using painkillers at an increasing level over time

b) Pain during movement or rest, even at night, enough to interrupt sleep

c) Decrease in walking distance over time

d) Inability to walk without pain

e) Changes in daily activities (difficulty or inability to wear shoes, socks, difficulty going up and down stairs, difficulty sitting up and down)

f) Difficulty in meeting their needs alone

Stress Fracture

Stress fractures, a problem that is sometimes overlooked, are micro fractures that occur due to overload on the bone. It is frequently seen in people involved in sports. It occurs as a fatigue fracture in healthy bones or as a failure fracture in bones with structural disorders. In people with stress fractures, pain occurs with movement in the fracture area or as a result of weight bearing on the fractured extremity. The diagnosis is made by tomography, MRI or scintigraphy. Treatment is provided by resting and preventing the broken bone from bearing weight. Surgical treatment may be required in some fractures.

Cubital Tunnel Syndrome

The ulnar nerve is the nerve that runs an important part of the muscles in our hand. Cubital tunnel syndrome occurs when the ulnar nerve is compressed in the tunnel in the inner part of the elbow for various reasons. Working with vibrating instruments, playing musical instruments, bone deformity around the elbow, subcutaneous adhesions caused by burns or other causes, masses formed close to the nerve, calcification in the elbow joint can lead to cubital tunnel syndrome. Cubital tunnel syndrome manifests itself with pain, numbness, tingling, and loss of strength in advanced periods in the area where the ulnar nerve is distributed along the arm. Treatment should be directed to the cause. Surgical treatment methods should be considered in patients who do not benefit from drug treatment and night splinting.

Specific for Children TORUS FRACTURE, DADI’S ELBOW

Torus Fracture

It is a partial fracture of the bone. On X-rays, one side of the bone is broken and the other side is flexed. Therefore, it is also called green tree fracture. It is treated by applying plaster after the fracture ends are brought to the appropriate position.

Nanny Elbow

It is usually seen in children younger than five years of age. It occurs when the arm is pulled away from the trunk and a ligament neighbouring the joint of the radius bone with the elbow is compressed. Pain prevents the use of the elbow. The treatment is to replace the partial dislocation of the elbow. It may recur occasionally under five years of age. It rarely recurs over the age of five.

Which fractures should be operated on?

• Fractures that do not give adequate results with closed treatment (putting the fracture in the correct position)
• Fractures extending into the joint (if there is more than an acceptable distance between the fragments)
• Fractures that cannot be held in the correct position with plaster or splint
• Fractures that will not union well if not operated due to the nature of the area where they occur
• Non-union or malunion fractures after non-surgical treatment
• Fractures that may cause growth problems in bone growth areas in children
• Large rupture fractures that may cause muscle or ligament problems that may impair joint function
• Pathological fractures due to causes such as tumours
• Fractures that make sitting or care difficult in patients with multiple fractures
• Moderate and severe open fractures
• Patients whose prolonged hospitalisation may cause other health problems (especially the elderly)

WHAT should be considered in the treatment of meniscus tears?

1. a) Not all tears detected on MRI cause complaints.
2. b) In some of the tears that cause complaints, conservative (non-surgical) treatment can be successful.
3. c) If surgery is decided, the first choice should be to repair the meniscus.
4. d) If the meniscal tear is not suitable for repair, the surgery should be completed by removing as small a portion as possible. This is an important step towards preserving the articular cartilage.

Hallux Valgus

It can be defined as an outward orientation of the big toe. It is more common in women. The same problem has been found in the families of 70% of people complaining of hallux valgus. In addition to heredity, it can also occur due to rheumatoid arthritis, some connective tissue diseases and cerebral palsy. Patients complain of pain, redness of the skin, numbness in the first toe and calluses formed due to the bone protrusion in the foot when wearing shoes. X-rays are needed along with a careful examination during the evaluation. In non-surgical treatment; appropriate shoe selection, devices that correct the orientation of the first toe can be used. Flat feet and calluses can also be seen with hallux valgus. These should also be taken into consideration when the device is given. Surgical treatment should be directed to the area causing deformity in the foot.

Patellofemoral Plica Syndrome

Patellofemoral plika sendromu dizin ön tarafında ağrıya neden olur. Diz kapağı (patella) çevresinde ağrı ve takılma hissi ile kendini gösterir. Nedeni, embriyonik dönemden kalan bir zarın (plika) çevresinde, tekrarlayan harekete bağlı oluşan sinoviyal dokudur. MRI incelemesi patellofemoral plika için sık yapılan bir tetkik olmakla birlikte, zaman zaman MRI plikayı gözden kaçırabilmektedir. Bu nedenle şüphelenilen durumlarda MR artrografi (eklem içine kontrast madde verilerek çekilen MRI) yapılması daha yararlıdır. Çeşitli cerrahi olmayan tedavi yöntemleri tanımlanmıştır. Bunlardan yarar görmeyen hastalarda artroskopik olarak plikanın alınması önerilir.

Arthrosis (calcification) of the first carpometacarpal joint

It is calcification of the joint at the base of the thumb in the hand. Patients have difficulty in some daily tasks. Opening a jar, opening a door with a key becomes very painful in advanced stages. The diagnosis is made by careful examination and x-rays. Splints are used for treatment in the early period. Anti-inflammatory drugs and steroid injection may be useful. Surgical treatment options should be considered in patients who do not get results with non-surgical treatment.

Ganglion Cyst

It is usually seen around the hand and wrist. It also occurs less frequently around the foot and ankle. They are benign cysts. The exact cause of formation is not known. The cyst is filled with a dense fluid. Ganglion cysts can sometimes cause pain. They may even restrict joint movement depending on their size. The diagnosis is made by examination, various imaging techniques or aspiration. In treatment; if there is pain, the cyst is tried to be reduced by using splint and anti-inflammatory drugs. The cyst can be drained with an injector. The cyst treated with this method is likely to recur. In patients who do not benefit from these methods, the cyst can be surgically removed. Even in surgically removed cysts, there is a small chance of recurrence.