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Preparing for surgery

Enhanced / Accelerated recovery after Anaesthesia:

  • The concept of being kept without food and drink for hours and hours before surgery is very outdated. It is also the reason why patients have problems with a low blood pressure during surgery, often feel terrible afterwards.
  • We aim to get you in the best possible condition for surgery.
  • As food takes 6 hours to leave the stomach you must preferably eat 6 hours before surgery. That will allow you to have enough energy for surgery but the food will be out of the stomach.
  • We know that clear fluid will be out of the stomach 2 hours after drinking it. That exclude drinks like coffee or tea, taken with milk. The protein in the milk will take 6 hours to process.
  • We want you to drink 500ml Energade / Powerade 3 hours before the operation. You will be fully hydrated for the surgery. The Energade / Powerade will also provide more glucose and electrolytes.
  • If you are diabetic you must drink 500 ml of water please?

 

“Just in Time” Admission:

  • The day before the surgery we plan exactly at which time each patient will be operated.
  • We also plan the sequence in which everybody will get surgery according to each and risk factors for surgery.
  • This allows us to tell you exactly how late you will need to come into the hospital for surgery. No more waiting in the hospital for hours on end waiting to be operated, getting more hungry and thirsty by the minute.
  • You will be admitted 1h30 minutes before your scheduled theatre time. That gives the administration staff and the nurses enough time to admit you and get you ready for surgery.

Elbow pain

The first thing that comes to mind when people talk about a painful elbow; is so called Tennis Elbow. This is an over diagnosed condition. Because it is over diagnosed the treatment often fails. This is also a big reason why people think this condition cannot be cured.

If you have been exhausted by searching for a cure for your elbow pain, consider visiting a specialist that has an interest in treating conditions of the upper limb. This will allow for a thorough examination to find the exact origin of your chronic pain.

Did you know that a pinched nerve at the level of the neck and of the elbow are common reasons for elbow pain? If you experience needles and pins in association with elbow pain, you don’t not have a tennis elbow. Pain secondary to a pinched nerve is very vague and deep seated in nature.

Pain and hyper sensitivity over the funny bone on the inside of the elbow might rather indicate a problem with the ulnar nerve. You will also have needles and pins of the pinky and ring finger, sometimes even weakness of your hand.

Waking up in the morning with a painful stiff elbow, unable to fully straighten and bend it, is not old age. This is a sign that there is a problem inside the elbow joint itself. This is especially ominous if you previously dislocated your elbow or sustained a fracture. Seeing to the problem can save it from being unnecessarily damaged given problems in later years.

Tennis Elbow and Golfers Elbow are actually unfortunate misnomers as anybody is susceptible to have inflammation of the tendons of the fore arm. But before subjecting yourself to endless rounds of cortisone injections, first have the diagnosis confirmed by a sonar.

Treating conditions around the elbow successfully hinges on the fact that the correct diagnosis has been made. Only an accurate diagnosis can lead the way to successful treatment.

Injuries to the wrist and why it is important to have it investigated:

The wrist is made up of multiple small bones. These little bones move together just like ball bearings. If one of the ball bearings break, the smooth movement is disturbed. The broken bearing will then damage the smooth surface of the others.

The human wrist is much the same. The small bones are all odd shaped but they fit perfectly together, no matter in which way we are using our hand.

Because we tend to brace a fall with our hands, the wrist commonly gets injured. It is easy to dismiss an injury of the wrist, when you don’t see any deformity. That’s why people don’t have their wrist checked out after hurting it.

If your wrist does not get better after 2 weeks it is best to have it checked out.

One of the most common injuries is a fracture of the scaphoid, a small bean shaped bone. This little bone sits on the thumb’s side of the wrist and is crucial in the movements of the wrist.

This fracture might be missed on initial x-rays, but will definitely be visible after 2 weeks.

If the bean shaped bone is not treated correctly, the wrist will be damaged in time.

If the initial x-rays were normal but the pain does persists, more investigations have to be done.

Another bad injury is when the ligament between the bean shaped bone and it’s neighbour tears (scapho-lunate instability). This also disturbs the movements of the wrist bones. When these 2 bones are not connected the movement of all the bones become disjointed. As these 2 bones move apart, the wrist becomes deranged.

Another injury that can cause persistent pain can be found is tear of the triangular cartilage. This causes a lot of discomfort when one opens a bottle or performs any twisting motion.

Thus, whenever you sustain an injury that hasn’t cleared up after 2 weeks, have an x-ray taken. If it was normal, but you still have pain 6 weeks later, have it further investigated.

An untreated injury of the wrist can cause a lot of problems that can’t ever be reversed.

DR Corne

Orthopaedic Tip for Upper Limb: Rotator cuff Tear

Orthopaedic Tip for Upper Limb: Rotator cuff Tear

Shoulder pain as a common complaint in patients older than 50 years of age. And should you make the diagnosis of impingement of the Shoulder, you would be correct, in the vast majority of cases.

The trick however, is to distinguish between impingement and a rotator cuff tear.

When the patient can’t lift the elbow above shoulder height, a rotator cuff tear is present. Usually the patient will also lean over to the contra-lateral side in an effort to lift up the affected arm.

If you suspect a rotator cuff tear; have a sonar done immediately. It is far superior to an ordinary x-ray.  And you will have the answer immediately. You must have a very low tolerance to perform a sonar for shoulder pain. This examination is the workhorse for shoulder pathology.

The diagnosis a cuff tear within days or a few weeks of it happening, make it possible to successfully repair the tendon. Delaying the diagnosis could result in the muscle retracting so far that it is not possible to reconstruct it.

Tip:

Request a sonar for patients older than 50yrs who present with shoulder pain.

Reason:

Early diagnosis allows for the early repair of the rotator cuff, improving mobility of the shoulder, and a better quality of life.

Kasi FM, Radio Clinic: Shoulder Impingement – 4 June 2015, 11h00:

Gugu: We welcome our listeners to Radio Clinic, Kasi FM, 107.3 FM where we have a new guest today. She is Dr Corne Ackermann. Doc, tell us more about what you do and where you work from?

Dr Corne: Thank you Gugu. Good day to all our listeners. I am an orthopaedic surgeon. That is a specialist doctor that deals with problems of the bones, joints, muscles and nerves of the arms and legs. I practice in Mbombela at the Nelmed Forum, close to the Civic Centre.

Gugu: Dr Corne, what will we be discussing today?

Dr Corne: We will be discussing a very common shoulder problem in people older than 45 years of age. We call it “Impingement” of the shoulder muscles. It means that a muscle of the shoulder is being pinched.

Gugu: First explain to us how the shoulder works?

Dr Corne: Put your hand on top of the shoulder. The shoulder has a flat bone that covers it. Move your hand down a bit, and move the shoulder. Now you feel the ball of the shoulder. Between the flat bone and the ball is a muscle. This muscle move the arm.

Gugu: Why are the older people affected?

Dr Corne: After the age of 40 years, the body grows a sharp bony ridge underneath the flat bone.  This sharp ridge then starts to rub against the muscles of the shoulder. The muscle will become very irritated, and swollen.

Gugu: How will someone know that there is a problem?

Dr Corne: In the beginning one will only feel pain in the middle of the arm, not in the shoulder itself. As the scratching and swelling becomes worse, one will have pain when sleeping on the shoulder, or putting on clothes when one lifts up the arm higher than the shoulder.

Gugu: Can young people also get shoulder problems?

Dr Corne: Yes, they do. But young people get other types of shoulder problems. We will be discussing this in the coming weeks.

Gugu: What should a person do if they think that the muscle is being pinched like that?

Dr Corne: It is very important to go to a doctor to have it checked out. If this rubbing and scratching is not stopped the muscle can tear and cause big problems. It is best to also get a sonar to see how badly the muscles are scratched.

Gugu: What will the doctor do to help?

Dr Corne: The treatment must stop the swelling of the muscle. Once the swelling goes down there might be enough space for the muscle. The swelling is reduced with the use of medication and an injection into the shoulder. It is also important to see the physiotherapist for very specific and gentle exercises.

Gugu: If you have been visiting the doctor and the physiotherapist and the problem is not getting better, why is that? And what is the next step?

Dr Corne: If the space between the joint and the roof is too small, the problem will not resolve without having to remove the bony ridge under the roof of the shoulder. We do this by surgery.

Gugu: Does this mean you cut open the shoulder Dr Corne!

Dr Corne: No Gugu, we can do the operation through 2 very small cuts, of about 1 cm each. We use a camera and long thin instruments to work inside the shoulder and underneath the roof. That way we remove the bony ridge without disturbing the body too much. Its called an arthroscopy.

I can even take photos and a video and show it too you afterwards! You can post it on Facebook or You Tube for your friends to see.

Gugu: What happens if the muscle is scratched so much, that the muscle tears?

Dr Corne: We can fix the muscle if it is torn. But one must not wait too long. If you wait too long it might not be possible to repair it any more. And this is why it is so important that people know about this shoulder problem.

Gugu: Now I am worried. How will one know if the muscle is torn?

Dr Corne: You will not be able to pick up the arm higher than your chest, or put on the jersey or t-shirt like you would normally.

Gugu: Thank you for telling us about this problem of the pinched muscles. Where can people get more information if they are worried that they might have this problem?

Dr Corne: You can visit my website at www.drcorne.co.za. On the website you will be able to see all the other problems of the shoulder.

Listeners can also visit the Facebook Page at Dr Corne Ackermann, if they want to ask me any questions. I am also on Twitter; @dr_corne.

Gugu: Thanks Dr Corne. Our listeners are welcome to contact Dr Corne on Social Media if you have more questions.

The Benefits of Arthroscopic Surgery

What is an arthroscopy?

An arthroscopy is when the surgeon uses a camera (scope), to look inside a joint (arthro). A small incision of 1cm is made through which the camera is inserted into the joint. The lens of the camera varies between 5mm to just less than 3mm, depending on which joint one wants to gain access too. In larger joints the surgeon can use a bigger lens and in smaller joints like the wrist a lens of 2.9mm is used. The lens is situated at the end of a long thin metal tube, (like a selfie stick for joints). Other long thin instruments are also used.

Why is it advantageous to use a camera to look inside the joint? (Translation: Why is it so cool to do surgery with the help of a camera?)

Over the centuries the only way to look inside the human body was by means of cutting the body open. Yeah, yeah, just thinking about it can be pretty gross. Besides cutting through the skin the surgeon has to cut through the muscles and the thick membrane (capsule) that surrounds the joint. The view to the joint would also be limited to the side from which the surgeon cuts into the joint.

If you are feeling lightheaded by know, its ok, you can take a few deep breaths because we are getting to the end of the gory bits, but not to the end of the problems for the patient or the surgeon.

As I said, the surgeon will only get a limited view, and might therefore miss some of the problems because s/he cannot see everything that’s going on in the joint. The surgeon would be able to fix the main problem for which the surgery was indicated but that would be pretty much it.

The patient however, would still have a long road before her/him. After open surgery the muscles and the capsule of the joint, has to be allowed to heal again. Muscles and capsules should not be moved much to allow it to heal satisfactory. Having a big wound makes the surgery very painful, and the patient will find the going hard afterwards.

But arthroscopic surgery changed all that. And an excellent example of this would be anterior cruciate ligament surgery of the knee. A cruciate ligament injury is that injury of which the television commentator would say; “Oh oh…he did his knee, he is out for the rest of the season”.

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