Craniotomy

A craniotomy is a surgical procedure through which the surgeon removes a part of the bone from the skull to access the brain. The surgeon then uses specialised tools to remove the bone flap temporarily and treat the medical condition. Once the condition is treated, the surgeon places the bone flap back to cover the exposed brain.

A craniotomy might be performed to treat a brain tumour, a blood clot in the brain, an aneurysm, a traumatic head injury, swelling in the brain tissue, infection or a foreign object. A craniotomy can be small or large depending on the underlying issue. They also vary in complexity. Small craniotomies are known as burr holes; whereas larger craniotomies are known as keyhole surgeries.

A craniotomy is generally performed with the assistance of stereotactic frames, image-guiders such as MRI, ultrasound, CT scan, etc. Moreover, endoscopes can also be used for assistance.

Typically, burr and keyhole craniotomies are performed to:

Place a shunt into Craniotomy

  • the brain ventricle to flush out the excess cerebrospinal fluid
  • Place a deep brain stimulator
  • Collect a sample tissue for biopsy
  • Guide an endoscope to treat larger issues such as tumour removal
  • Drain a clot in the brain
  • Place an intracranial pressure monitor

That said, complicated skull-based craniotomies, include removing the bone supporting the bottom of the brain.

Types of craniotomy

Some of the common types of craniotomies include:

  • Extended bifrontal procedure
  • Minimally invasive supra-orbital craniotomy
  • Keyhole craniotomy
  • Orbitozygomatic Craniotomy
  • Translabyrinthine Craniotomy

Reasons for craniotomy

A craniotomy can be performed for multiple reasons. Some of the most common purposes of a craniotomy include:

  • Identifying, removing or treating tumours of the brain
  • Repairing an aneurysm
  • Eliminating blood clots or blood from a leaking blood vessel
  • Treating skull fractures
  • Curing epilepsy
  • Draining out the brain abscess
  • Removing malformations and brain fistulas
  • Reducing the pressure in the brain
  • Placing stimulator devices to cure movement issues such as dystonia, Parkinson’s disease and others

However, these are not the only reasons for a craniotomy. A doctor can also suggest a craniotomy for a specific medical case.

Risk of craniotomy

Typically, brain surgery is linked to a specific area in the brain, which will be treated. Thus, the risks and complications are associated with the area that is being treated. Such as, if there is an issue in the part of the brain that controls speech, the complications will be related to speech.

That said, some of the common risks associated with a craniotomy include:

  • Infection
  • Blood clots
  • Pneumonia
  • Bleeding
  • Fluctuating blood pressure
  • Seizures
  • Allergic reaction to anaesthesia
  • Swelling in the brain
  • Leakage of the cerebrospinal fluid
  • Weakness in the muscles

However, the below complications are more specific to a particular issue within the brain. These will apply only to individuals that have the same underlying problem.

  • Problem with memory
  • Difficulty in speech
  • An issue in balancing or coordination
  • Coma
  • Paralysis

The procedure of a craniotomy

Before the procedure, the doctor will ask the patient to sign the consent form and then will conduct a preoperative neurological exam to assess the condition after the craniotomy. The patient will be asked to not eat or drink anything starting the midnight of the procedure. Women who are pregnant or think they might be pregnant, are required to disclose the same to the doctor.

The patient should also disclose any allergies or ongoing medications, as well as health complications. Smokers would be required to quit smoking and also inform about any bleeding disorders. The patient will be given a sedative before the surgery and the place of treatment will be shaved.

During the craniotomy, an intravenous line (IV) line will be placed in the arm or the hand of the patient. After this, the surgeon will make an incision as per the specific issue to be treated. Some craniotomies will involve making an incision from behind the hairline in front of the ear, etc. For procedures that require an endoscope, the incision made will be small.

The surgeon will then pull the scalp up and clip it to control bleeding and access the brain. Then a medical drill will be used to make the required holes in the skull. Post this, the bone flap will be removed and placed aside. Then the thick covering of the brain is removed to access the target area. The surgeon uses microsurgical and special instruments to treat the issue. Once the treatment is done, the surgeon sutures the layers of the brain and places the bone flap back with plates, sutures or wires.

However, in cases, where the bone has a tumour or an infection, the surgeon may not replace the bone flap. The scalp is then sutured or stapled, and a sterile bandage is placed over the incision.

Typically, a craniotomy requires the patient to stay under observation for 3 to 7 days or more depending on the condition of the patient. After the surgery, the recovery process can take 3 to 4 weeks, during which the patient will be directed to follow precautions and take medications, as suggested by the doctor.

However, if the patient experiences any of the following problems after the surgery, immediate medical attention should be sought:

  • Fever
  • Chills
  • Confusion
  • Feeling sleepy all the time
  • Weakness in the arms and legs
  • Problem with speech
  • Changes in vision
  • Pain around the site of the incision
  • Problem in breathing
  • Chest pain
  • Issues in mental health
  • Seizure
  • Discoloured phlegm

Overall, a craniotomy is a very effective procedure, but it has its advantages and disadvantages. The suitability of a craniotomy for a patient is determined by the doctor depending on the underlying issue, general health of the patient and the medical history.

Tennis Elbow

Tennis elbow is also known as lateral epicondylitis, is a very painful medical condition. This occurs when tendons in the elbow are overburdened, majorly because of the recurring activity of the wrist and arm. A tennis elbow does not only happen to athletes but can also occur in normal individuals who stress their elbow. These include people engaged in professions such as plumbing, painters, carpenters, and butchers.

The tennis elbow occurs when the tendons of the forearm muscles link to a bony bump on the outer side of the elbow. If not treated, the tennis elbow pain can spread to the forearm and wrist. The condition is treatable if detected in time. In case, the condition causes symptoms of disability, surgery may be required.

Symptoms of tennis elbow

The pain of the tennis elbow can stretch to the forearm and wrist, which then tends to make the following motions difficult:

  • Turn a key or a doorknob
  • Hold something such as a coffee mug, glass, etc.
  • Shake hand
  • Grip an object

Causes of tennis elbow

Tennis elbow occurs when there is overuse or injury/strain of the muscle. This happens because the forearm muscle – used to straighten and raise the hand and wrist – is repeatedly contracted. The recurring motions and stress on the tissue may cause a chain of tears in the tendons. These tendons join the forearm muscles to the bony prominence outside the elbow.

Moreover, as suggested by the name, playing tennis can also cause this problem. Typically, because the backhand stroke is executed with poor technique. That said, some other motions of the arm that can cause a tennis elbow, include:

  • Painting
  • Driving screws
  • Butchering or cutting meat or other hard cooking ingredients
  • Repeated use of the computer mouse
  • Excessive typing
  • Usage of plumbing tools

Risk factors of tennis elbow

Some aspects that make a person more prone to a tennis elbow include:

  • Age: This condition is most commonly found in adults over the age of 30 but below 50 years. However, tennis elbow can occur in people of all ages.
  • Occupation: People who are employed in professions that involve repetitive motions of the wrist and arm.
  • Specific sports: Racket sports increases the risk of tennis elbow, more so in case, where a poor stroke technique is employed.

Diagnosis of tennis elbow

To diagnose a tennis elbow, the doctor applies pressure to the affected area to check for the intensity of pain. Moreover, the patient will be asked to move the elbow, wrist, and fingers in certain ways to check for the problem of tennis elbow.

Typically, a tennis elbow can be effectively diagnosed with the help of a physical exam and based on medical history. But in cases, where the doctor thinks that an underlying condition is causing the symptoms, an X-ray or other types of imaging testing can be suggested.

Treatment of tennis elbow

In general conditions, the tennis elbow heals on its own. However, over-the-counter pain medications and other self-care techniques can help. In cases, where these traditional methods do not work, physical therapy can be recommended by the doctor. Some severe cases of tennis elbow can be treated with the help of surgery.

Therapy: In case the cause of the problem is tennis, the doctor may suggest an evaluation of the tennis technique. If the problem is because of the profession, the doctor would suggest reducing the movements that stress the tennis elbow. In such situations, a physical therapist can help to reduce pain by suggesting exercises that help to stretch and strengthen the muscles of the forearm.

Injections: In severe cases that are not treatable via therapy, the doctor will suggest injecting platelet-rich plasma, botox, or any other type of irritant into the affected area, especially the tendon. Also, dry needling can be used to relieve pain. In this procedure, the doctor pierces the affected tendon in multiple places to treat the issue.

Ultrasonic tenotomy (TENEX procedure): This technique involves using ultrasound images to insert a specialized needle in the damaged part of the tendon. The ultrasonic emergency transmits quickly to the damaged tissue and liquefies it immediately, permitting the doctor to suction the affected tissue.

Surgery: For patients on whom non-operative methods of tennis elbow cure have not proved effective even after 6-12 weeks of treatment, surgery may be recommended. Surgery can either be done through a large or a small incision. No matter the invasiveness of the surgery, the treatment needs to be followed up with rehabilitation exercises.

On the other hand, several lifestyles and home remedies can also be advised to treat tennis elbow. These include:

  • Taking rest and avoiding activities that can intensify elbow pain.
  • Taking pain relievers.
  • Applying ice or a cold pack on the affected area 3-4 times a day for 15 minutes.
  • Generally, ensuring to avoid improper playing techniques or repetitive motions that stress the tendon.

Overall, a tennis elbow is not a very serious condition. However, if the pain is neglected for a long period and corrective treatment is not sought, the problem can intensify.

Trigger Finger

Trigger finger or also called the stenosing tenosynovitis is a medical condition in which a finger is stuck in a bent position. The finger can suddenly snap straight or bend drastically, imitating the pulling and releasing of a trigger.

A trigger finger occurs because of inflammation in the finger, which reduces within the sheath, surrounding the tendon of the concerned finger. The condition can be easily treated; however, if the problem is intense, it can lead the finger to become locked in a bent position for a lifetime.

People who are engaged in professions or have hobbies that require them to perform repetitive gripping actions are more prone to developing this condition. A trigger finger is very common in women and people with diabetes. The type of treatment varies per the severity of the condition.

Symptoms of trigger finger

Depending on the case, the symptoms of a trigger finger can range from mild to severe. Some common signs of a trigger finger include:

  • Stiffness in the fingers, especially in the morning after waking up
  • A pop or a click sound or sensation upon the movement of the finger
  • Tenderness at the base of the affected finger
  • A bump in the palm – at the base of the impacted finger
  • Unable to straighten a finger, which is locked in a bent position

Trigger finger can impact any of the five fingers of the hand, including the thumb. Also, it can affect more than one finger at a time and could also include both hands. The condition is usually very severe in the morning hours, typically while attempting to grasp an object or straightening the affected finger.

A person should seek immediate medical attention if the finger feels too hot or is inflamed. This could also indicate a possible infection.

Causes of trigger finger

Tendons of the fingers are cords that link the muscle of the fingers to the bones. Each tendon is covered by a protective layer, known as a sheath. A trigger finger occurs when this protective layer of the tendon is inflamed or irritated due to any reason. The problem disturbs the usual gliding of the tendon through the sheath and tends to cause pain, bending of the finger, stiffness, etc.

If the problem persists for a long period, it can lead to scarring, thickening, and development of bumps in the tendon, which will further aggravate the issue.

Risk factors of trigger finger

Some people are at a higher risk of developing trigger finger condition. However, the problem can occur in people of all ages and gender. Some risk factors include:

  • Occupations and hobbies that require regular gripping, repeated use of hands, and extensive pressure on the fingers can increase the chances of the person developing a trigger finger.
  • Trigger finger is a common issue in women. Men are less prone to this medical condition.
  • Trigger finger can also occur as a complication of the carpal tunnel syndrome surgery, especially in the first six months post the surgery.
  • People suffering from rheumatoid arthritis are at a higher risk of developing the issue.

Diagnosis of trigger finger

The doctor does not need extensive testing or diagnostic exams to detect a trigger finger. The healthcare provider can conduct an assessment based on the medical history and the physical exam. In the physical exam, the patient would be required to move the finger, bend and straighten the affected joint to identify areas of pain, the stiffness, smoothness in movements and the existence of locking.

The doctor will also apply pressure on the palm to check for a lump. If there is a lump present in the palm, it will move along with the finger since it develops in the swollen area of the tendon.

Treatment of trigger finger

Trigger finger can be easily treated provided it receives the care in due time. The type of treatment depends on the severity and duration of the problem. Some methods used to treat trigger finger include:

Therapy: Non-invasive method such as therapy can be used to treat the trigger finger condition. These include:

  • Resting the affected area and avoiding activities that involve repeated gripping, grasping or extended use of machinery that sends out vibrations.
  • The doctor can also advise wearing a splint to support the affected finger to stay in an extended position for six weeks.
  • Exercising as suggested by the doctor to restore mobility of the finger.

Steroid injection: This involves treating the affected finger or the tendon directly withsteroid medication to minimize swelling, allowing the tendon to glide smoothly like before. However, this treatment lasts for one year or slightly more in some cases. After which, a repeat procedure may be required if symptoms appear again. In the case of people with diabetes, steroid injections are not that useful.

Percutaneous release: In this method of treatment, the doctor numbs the affected palm and then inserts a strong needle into the tissue surrounding the tendon of the affected finger. The doctor then moves the finger and the needle to remove the blockage that constricts the smooth gliding of the tendon. This procedure is performed under the ultrasound guidance to help reach the right tendon, without harming the surrounding tendon sheaths.

Surgery: In most severe cases of tendon finger, the doctor can also recommend surgery to treat the condition. In this, the healthcare provider makes a small incision at the base of the affected finger to open the affected area of the tendon sheath. The constricted part is then relieved, allowing the tendon to glide smoothly.

Overall, a trigger finger is an uncommon condition but can be treated easily, if it occurs. Only in very severe and rare cases, does a patient need an invasive method such as surgery.

Golfer’s Elbow

Golfer’s elbow also called medial epicondylitis is a medical condition that causes extreme pain inflammation in the tendons connecting the forearm to the elbow. This pain can also spread to the forearm and wrist. This condition is very similar to a tennis elbow, which is not limited to the particular area and can occur on the outside of the elbow.

The pain in a golfer’s elbow is centered on the bony bump on the elbow and can spread further to the forearm. This condition is caused because of the overuse or strain of the muscles in the forearm that support gripping, rotation of the arm, and flexing of the wrist. Consistent flexing, gripping and swinging can lead to pulls or tiny tears in the tendons, which can cause a golfer’s elbow.

This condition is not limited to only golfer’s but can affect people who play tennis or do any such activity that overuses the wrists or the clenching of fingers.

Symptoms of golfer’s elbow

Some of the common symptoms of golfer’s elbow include:

  • Pain and tenderness, typically in the inner part of the elbow. The pain can also spread to the inner side of the forearm and can worsen with some specific movements.
  • Stiffness and pain in making a fist.
  • Weakness in the hands and wrists.
  • Numbness or the tingling in one or more fingers, usually the ring and little fingers.

The pain can be sudden or gradual. However, the pain can worsen with specific movements and also, if corrective treatment is not taken.

The method to relieve the pain is to over-the-counter pain killers. However, in cases, where these do not work effectively to provide the required relief, the patient can seek help from a doctor. The symptoms that will indicate the need to visit a doctor include:

  • A hot and inflamed elbow
  • Pain in the elbow that causes fever
  • The deformed appearance of the elbow
  • Chances or symptoms of a broken elbow

Causes of golfer’s elbow

This condition is caused when the muscles and tendons that control the wrist and fingers are overstressed and overused. This damage is typically caused because of forceful wrists and motions of the finger. Moreover, incorrect weight lifting, throwing or hitting, poor conditioning before exercising, can all cause a golfer’s elbow.

Apart from golf, the following things can cause a golfer’s elbow:

  • Sports that are played with can lead to a golfer’s elbow because of improper techniques and tennis strokes. Playing the topspin method consistently or using a racket, which is either too small or too heavy can also cause the issue.
  • Sports such as baseball, volleyball, etc. that involve throwing can cause a golfer’s elbow. Moreover, football, javelin, and archery can also lead to a golfer’s elbow.
  • Improper weight lifting techniques can damage the tendons and elbow muscles.
  • Occupations that involve forceful and recurring movements of the wrists and fingers. These include plumbing, carpentry, etc.

Risk factors of golfer’s elbow

Even though a golfer’s elbow can happen to anyone at any age but certain people are more prone to the risk. These include:

  • People above the age of 40 years
  • People who are obese
  • Individuals who smoke
  • Doing the straining activity at least 2 hours a day

Prevention of golfer’s elbow

A golfer’s elbow can be prevented by the following measures:

  • Strengthening the forearm muscles by squeezing a tennis ball or lifting light weights. Simpler exercises can help the muscles to absorb the sudden physical stress.
  • Stretching before any activity can help warm up the muscles.
  • Correcting the form of any sport such as tennis or golf with the help of a professional can help prevent this problem.
  • Using the correct equipment such as lighter graphite clubs for golfing, and appropriately-sized tennis rackets, etc. can help to reduce the stress on the elbow.
  • Applying proper technique while lifting free weights or anything else.
  • Taking rest between stressful activities to allow some rest to the wrist and elbow.

Diagnosis of golfer’s elbow

Golfer’s elbow is generally diagnosed by a physical exam and also concern with medical history. To check the pain and elbow stiffness, the doctor may apply pressure to the affected area. The physician might also ask the patient to move the fingers, wrist, etc. in different motions.

In certain cases, an X-ray might be conducted to eliminate other causes of pain such a fracture or arthritis. Only in rare events, the patient is advised an MRI.

Treatment of golfer’s elbow

The foremost treatment of this condition is to avoid all those activities that cause stress to the tendons or overexert the muscles. The patient can also use ice packs and over-the-counter medications to get relief from pain.

In other cases, corticosteroid injections may be given to the patient in the affected area. This is an advanced treatment method which involves injecting platelet-rich plasma and other anti-inflammatory factors into the affected part after drawing out some blood from the particular place. However, this technique is not very widely used and is a recent introduction.

Therapy in other conditions can be another alternative to a golfer’s elbow. Some of the following measures can help heal the problem:

  • Giving up activities that strain the muscles and tendons of the elbow and related areas
  • Avoid repetitive actions that overstress the concerned area
  • Using a brace to support the muscles and tendons of the particular arm
  • Stretching, warming and strengthening the impacted area to avoid any injuries
  • Applying ice on the elbow for 15-20 minutes thrice every day until the condition improves

Overall, golfer’s elbow is not a serious medical condition. If treated timely, the pain and cause can be effectively cured. However, in delayed treatment cases, the problem can intensify to cause severe pain and loss of temporary function.

Know the Post fracture/trauma diet plan

Bones are very critical to the entire function of a human being. They are the storage spaces for calcium and form the basic structure of the skeleton framework. A bone fracture occurs when there is a break in the bone, which could be caused due to multiple reasons such as trauma, injury, stress, high-force impact, or even due to medical conditions such as osteoporosis which weakens the bones and makes them highly prone to breaking even at the slightest of external force. A bone fracture, depending on the place, can affect mobility and the overall quality of life. It can be painful and also take some weeks, months or years to recover depending on the extent of the damage. While medications and supplements work effectively to heal the fracture, a healthy diet can further aid towards the refurbishment of the bone strength. A rich, well-balanced diet is the key to rebuild the fractured bone and must consist of the below:

Proteins: Proteins form half of the bone structure, which gets lost when the bone breaks. Hence, to rebuild and refurbish the strength of the broken bone, a protein-rich diet must be adopted. Foods such as meat, fish, eggs, cheese, cottage cheese, tofu, yoghurt, nuts, beans, seeds, soy, fortified cereals, pulses, etc. are enriched with protein and must be included in a post-fracture diet plan. Protein further enables the body to absorb and use calcium from food, which is another critical element of bone health.

Calcium: Calcium forms the basic essence of bones and hence, is very helpful in regaining bone strength and healing the fractured bone. On a normal day, an adult should intake between 1,000 to 1,200 mg of calcium. There are many calcium-rich foods, which can be included in the diet such as, milk, kale, broccoli, yoghurt, fortified cereals, juice, almond milk, salmon, soy, beans, etc. In many cases, the doctor will also recommend calcium supplements for patients with bone fractures.

Vitamin D: Vitamin D is required by the body to absorb calcium and use it to provide good health to the bones. It helps to heal the fractured bones by building in minerals required. Vitamin D is present in the sun rays, while it is also naturally found in some foods including egg yolks, fatty fish,salmon, cod liver oil, sardines, swordfish,milk or orange juice. Generally, adults should ideally intake 600 IU of Vitamin D per day, and for people aged 70 years or above, the intake should be at least 800 IU.

Vitamin C: Vitamin C is required to reconstruct the broken bone because it helps the body produce collagen, whichis essential for overall bone health. Vitamin C is naturally found in various fruits and foods including fresh fruits, green vegetables, peppers, tomatoes, potatoes, berries, etc.

Iron: For people with less iron and suffering a bone fracture, a diet enriched with iron foods, needs to be prioritized. Iron helps the bodymake collagen which necessarily promotes restructuring of bones, while also enabling the bones to get enough supply of oxygen. Iron can be easily obtained from red meat, dark-meat chicken, turkey, whole-grain bread, green leafy vegetables, dried fruits, nuts, oily fish, eggs, etc. People with iron deficiency and a bone fracture can suffer complications if iron intake is not increased.

Potassium: A person tends to lose a certain amount of calcium when they pee, which should be minimised in case of patients dealing with a bone fracture. Hence, adding potassium to the diet will help retain calcium in the body and eventually less calcium will be lost with the urine outflow. Fresh fruits such as bananas and oranges are very rich in potassium. The mineral is also found in potatoes, nuts, seeds, fish, meat and milk.

While the above minerals and food should be included in a post-fracture/trauma diet, here is a list of foods which must be avoided or limited to ensure proper bone recovery and adequate strength.

Alcohol: Consumption of alcohol can significantly hamper the bone rebuilding process since it can slow the process of healing. Moreover, it tends to affect the balance of a person, which can lead to another fall or stress on the existing fractured bone.

Salt: Too much salt can lead to increased loss of calcium through urine. It is always advisable to opt for a low sodium diet generally and especially for patients with a healing bone fracture. Foods such as chips, pickles, processed food, ketchup, sauces, etc, should be limited or avoided on the while, if possible.

Coffee: Excessive intake of strong coffee above a certain amount can cause the bone healing process to slow down. It could also increase the urine, leading to more loss of calcium from the body. However, a person can consume 1-2 cups of tea or coffee without guilt.

Moreover, foods which are rich in sugar (such as colas, and other caffeinated drinks) or include high preservatives should be avoided. Smoking tends to alter the flow of blood to the bone which is ultimately responsible for supplying nutrients to the bone; thus, smoking should be strictly avoided to allow the bone to heal properly.

To allow a fractured or traumatized bone to heal properly, a healthy diet is very essential to ensure the bones are supplied with all the nutrients and minerals needed for rebuilding and gaining strength. Lack of care in these times could affect the overall bone and cause long-term impacts such as pain in changing seasons, lack of strength, etc.

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