tag:blogger.com,1999:blog-10954315362574227312024-02-02T17:42:35.603+08:00The Orthopedics Malaysia blogOrthopedics, Hand Surgery, Joint Replacement Surgery in Klang Valley MalaysiaBomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.comBlogger34125tag:blogger.com,1999:blog-1095431536257422731.post-86888851054632914032012-01-19T16:00:00.002+08:002012-01-20T07:43:53.698+08:00Happy Chinese New Year 2012As we bid goodbye to the year of the rabbit, on the 22nd of February we usher in yet another year on the Chinese calendar, the Dragon year. A mythical creature, the dragon symbolizes power and therefore represents the ultimate in success and happiness. <br />
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The Bomoh Tulang would like like to wish all celebrating a very Happy Chinese New Year and Gong Xi Fa Cai! May this Year of the Dragon be an auspicious one, filled with love, health, prosperity and happiness for everyone.<br />
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For the rest of us, many of whom are heading home for the long holidays, enjoy your holidays and have a safe trip home.<br />
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-The Bomoh Tulang -Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-65708093879981494142012-01-10T15:45:00.001+08:002012-01-18T11:35:25.295+08:00Gastrocnemius Muscle Tear (Calf Tear)The patient was a 46 year old man, referred from his neighborhood GP.<br />
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The story was that he was helping a friend push a stalled car. While doing so, he heard a "snapping" sound from the back of his right leg. This was accompanied by pain; however he still managed to limp back. Back home, he applied some ice onto the leg (good for him), the swelling and bruising didn't appear until the next morning.<br />
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He related the story to me on the initial visit, nine days after the injury. Why nine days? Well apparently I was the fourth medical professional he has sought, the 3rd one being the GP who finally referred him here.<br />
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Listening to his story carefully, my initial suspicion was that he <i>may have torn his achilles tendon</i>. However a complete tear would render him almost incapable to walk; he was limping to my clinic, sure, but not to the extent that he had to be wheeled into the room.<br />
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Examination of his leg showed some swelling of his lower leg, with bruising around the ankle and foot. Tenderness could be felt around the calf muscles. There was no palpable defect on his achilles tendon indicating a torn tendon nor was Simmons test positive for achilles cut.<br />
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So that rules out an achilles tendon injury.<br />
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Hmmm...<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivVxC02ZuXefUPdAWlPo-7-vWqvWes_F4AXmFY_n6hmF4uBSGYVNKL3tX9MLLAKyXeH4BDhUvTzGIAq_jRlX-nO2y4NVOMjIfUsAvNYQNHM9xaujKjwv28vBhsZeRhV_Prn_VgfiPUQLAI/s1600/IMG_8460.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivVxC02ZuXefUPdAWlPo-7-vWqvWes_F4AXmFY_n6hmF4uBSGYVNKL3tX9MLLAKyXeH4BDhUvTzGIAq_jRlX-nO2y4NVOMjIfUsAvNYQNHM9xaujKjwv28vBhsZeRhV_Prn_VgfiPUQLAI/s320/IMG_8460.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Bruising lower leg</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP1PGCMg3vp_fbgaG7nsuWlfUS61rYQc4_G4ratfBUHOIW7VDVbqRr47Gkg2W0iaRuIDsjPRCOUt85m5Ccr7N1nW-enLqiMTJRY_TSlZKHPMuLVFAnx_odDa6xpPOTQbDYqS8hp4Sd67Jh/s1600/IMG_8461.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP1PGCMg3vp_fbgaG7nsuWlfUS61rYQc4_G4ratfBUHOIW7VDVbqRr47Gkg2W0iaRuIDsjPRCOUt85m5Ccr7N1nW-enLqiMTJRY_TSlZKHPMuLVFAnx_odDa6xpPOTQbDYqS8hp4Sd67Jh/s320/IMG_8461.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">with swelling of the lower leg</td></tr>
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<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: left;">An ultrasound or MRI scan would help in this matter. I promptly sent him across the hallway to see the radiologist requesting for an ultrasound of his calf muscle, failing which we may proceed on to do a MRI scan.</div><div class="separator" style="clear: both; text-align: left;"><br />
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<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-XSL70A90LCuKZFeBDePy2e7vRrDCtzzx74iRFxCylnha6OV1ioG6ZyRsIAD2pR2S2PdSDFxTPaHoFnhdnlQAovzeqAtNkk9ZB7gUTU9_5yLSaRnEKM7Ubk_cBjUkfGVPMWixp7MnTCBH/s1600/Daud+Samdin+11723+Usound1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-XSL70A90LCuKZFeBDePy2e7vRrDCtzzx74iRFxCylnha6OV1ioG6ZyRsIAD2pR2S2PdSDFxTPaHoFnhdnlQAovzeqAtNkk9ZB7gUTU9_5yLSaRnEKM7Ubk_cBjUkfGVPMWixp7MnTCBH/s320/Daud+Samdin+11723+Usound1.jpg" width="320" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxNuaVBkJ3YSMdLN9fzaczould1dDH3NvnqDt2S9ADpshRf-kq-tY6xNWxHllOZbjcmqozF_oWxAJazeFsOjiS5-Z9rCzS8p-keGXuXnruRlhP5Jt7AzhPe5JDWgXc6iK4LHgiXIb8iG-H/s1600/Daud+Samdin+11723+Usound2.jpg..jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxNuaVBkJ3YSMdLN9fzaczould1dDH3NvnqDt2S9ADpshRf-kq-tY6xNWxHllOZbjcmqozF_oWxAJazeFsOjiS5-Z9rCzS8p-keGXuXnruRlhP5Jt7AzhPe5JDWgXc6iK4LHgiXIb8iG-H/s320/Daud+Samdin+11723+Usound2.jpg..jpg" width="320" /></a></div><br />
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</div>The ultrasound report noted fluid/blood collection within the medial gastrocnemius (calf) muscle, which in the light of the patients history, confirmed the patient's diagnosis:<br />
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</div><div class="separator" style="clear: both; text-align: left;"><b>G</b><b>astrocnemius muscle tear (calf tear)</b></div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">A tear of the gastrocnemius muscle most commonly occurs in the middle-aged, male athlete (the "weekend warrior") when the muscle actively contracts against a foot which is dorsiflexed with an extended knee, as may occur in tennis or jogging; in this particular case, the patient was loading the calf muscles while pushing the car.</div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">As in this patient, the diagnosis can be confused with an achilles tendon rupture. However as explained above, palpation of the achilles tendon should demonstrate an intact tendon. In any case, imaging studies such as ultrasound and magnetic resonance imaging (MRI) can be useful to ascertain the diagnosis. </div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">Only conservative management is required to treat ruptures of the gastrocnemius muscle. </div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">RICE (Rest, Ice, Compression , Elevation) therapy together with adequate analgesics are the mainstay of treatment for the first 24-72 hours after injury . Ambulation with crutches is advised with gradual weight bearing in the following weeks. A walker-type brace can be used. Physiotherapy is initiated as soon as the patient feels comfortable out of the walker.</div><div class="separator" style="clear: both; text-align: left;"><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0jJe_D1Vn7iB_5SFwfYBm8I1XYPIIvdWRAIUsyz0wMjjAcx_L3C9Qqo6TFu7itViLHG87TI6tbsg0cLxk5b_CScSc0hsFnFTorIJU1UYY7jdtxrBa-qB3Ex5yPtw5edFtCKBUQgBJrL1M/s1600/IMG_8448.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0jJe_D1Vn7iB_5SFwfYBm8I1XYPIIvdWRAIUsyz0wMjjAcx_L3C9Qqo6TFu7itViLHG87TI6tbsg0cLxk5b_CScSc0hsFnFTorIJU1UYY7jdtxrBa-qB3Ex5yPtw5edFtCKBUQgBJrL1M/s320/IMG_8448.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A walker type brace - patient would need a longer version</td></tr>
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</div><div class="separator" style="clear: both; text-align: left;">Swelling and bruising should gradually decrease over the next couple of weeks. Recovery may take up to 6 weeks or more depending on the severity of the injury. Patients can expect a full recovery provided that the rehabilitation protocol is followed.</div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">- the BomohTulang -</div><div class="separator" style="clear: both; text-align: left;"><br />
</div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-53989994653122003022011-12-29T11:00:00.009+08:002012-01-01T07:53:47.449+08:00Merry Christmas and a Happy New Year - 2012Well we have come to that time of the year where we bid adieu to 2011 and look forward to another awesome year ahead.<br />
The Bomoh Tulang would like to wish all loyal readers a very happy new year and one that's filled with peace, prosperity and happiness always. <br />
For those celebrating, a very Merry Christmas and happy holidays for the rest of us!<br />
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- the BomohTulang -<br />
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</div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-47961472531424538512011-11-18T11:20:00.032+08:002011-12-31T01:11:07.091+08:00Congratulations to Dr Mel<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><br />
The Bomoh Tulang would like to congratulate Dr Mel for passing her part 1 masters exam for Orthopedics in UM recently. It was tough but u made it! Wishing you continued success in your journey to become a certified Orthopod!<br />
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<tr><td class="tr-caption" style="text-align: center;">L-R: FerrariBoy, BomohTulang, Aishah, Mel</td></tr>
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Dr Mel is a photography enthusiast too, mainly dabbling in retro <strike>analog</strike> film cameras and has quite a collection of vintage cameras. So if film cameras are your thing, head on to <a href="http://coolgirlsshootfilm.tumblr.com/" target="_blank">CGSF</a> where Mel blogs about her film collection!<br />
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- The BomohTulang -Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-18856411063529909342011-09-10T07:25:00.031+08:002012-01-19T20:08:31.636+08:00SAFETY AT THE PLAYGROUND<div style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;"><br />
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</style> </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;">Due to its location in a residential area, the hospital sees a fair amount of injuries involving children. The numbers seen in the emergency room usually correspond to the school holidays, where we see an increase in the number of children being brought in due to some kind of injury, usually due to a fall while playing. I suppose the holidays are the time children are given more freedom to play outdoor, free from the pressures of homework and tuition.</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq9zJHiUrMnVedz5zYU1HFGvYye7UeB2aKc5s_bGYOb08PifwwJImXYV8mygjTYkJldeCo2E9UVTZwBrTOyh3QCSfiF_gD0r3sHH8plfC8KPuHBI9MyaYjZ26jhyphenhyphenIo95aJUocWACry-VHF/s1600/IMG_7953.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
</a></div><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"> </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq9zJHiUrMnVedz5zYU1HFGvYye7UeB2aKc5s_bGYOb08PifwwJImXYV8mygjTYkJldeCo2E9UVTZwBrTOyh3QCSfiF_gD0r3sHH8plfC8KPuHBI9MyaYjZ26jhyphenhyphenIo95aJUocWACry-VHF/s1600/IMG_7953.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq9zJHiUrMnVedz5zYU1HFGvYye7UeB2aKc5s_bGYOb08PifwwJImXYV8mygjTYkJldeCo2E9UVTZwBrTOyh3QCSfiF_gD0r3sHH8plfC8KPuHBI9MyaYjZ26jhyphenhyphenIo95aJUocWACry-VHF/s400/IMG_7953.jpg" width="300" /></a><span style="font-size: small;">The neighbourhood playground is a natural spot for children to congregate, interact and play; at the same time it helps to build their physical skills, co-ordination and strength. It is also a wonderful place for families to get some fresh air and exercise. It may look like a safe place, but hidden dangers do lurk. The hospital had a <a href="http://orthopedicsmalaysia.blogspot.com/2011/05/smart-parents-safe-kids-campaign.html" target="_blank">“Smart Parent Safe Kids”</a> campaign earlier this year where I gave a talk on prevention of playground injuries. Why playground injuries? Well, apart from the home, accidents occur more frequently on the playground than any other places. </span><br />
<span style="font-size: small;">In the US, more than 200,000 playground-related injuries occur annually. Similarly in Malaysia, a recent study has shown that 17% of childhood fractures occur in the parks, second only to the home (35%). Now scrapes and bruises are a normal part of growing up, but injuries that are brought to the hospital are usually of a more severe kind. We see sprains, fractures, dislocations, and rarely, amputated fingertips.</span></div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"> </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><br />
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<span style="font-size: small;">Children can injure themselves at the playground in a variety of ways. As I have explained above, the majority of the injuries result from a fall from playground equipment. They might slip, lose their grip while climbing, or lose balance while playing on the “monkey bars”. Another way is by improper usage of equipment. </span></div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"> </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;">The onus is on parents and caregivers to create a safe environment for children to play. One should firstly choose a safe playground based on the location and surrounding hazards. Watch out for open drains, exposed electrical wires and busy roads among other things.</span></div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"> </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;">Close supervision by a responsible adult may be the most important factor in preventing playground injuries. For young children, adults should be with them the whole time they are playing on play equipment. The word is “Active supervision” – one should not be distracted by other activities such as reading a book, talking on the phone or texting. Although I do agree that sometimes adult supervision might be a problem in urban areas as both parents may be working, delegating this responsibility to the grandparents, housemaids or elder children might not be as effective. Educating the child on the correct usage of play equipment not only decreases the chance of injuries but also goes a long way in preserving the lifespan of the play equipment.</span><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaEoY8SApQdCpbt35uff6cg7Z0saLZJjFeEwq2FmXEeIGjFBq6bHrl2Ee9Epsu5NIGb3Ji54Mouu3IssJVrp7WG-_IPoi55Lb_WdRkubFGkOqeDrZHZeJp7tfM5cDZjIhrFfDkKtwty1E0/s1600/IMG_7971.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaEoY8SApQdCpbt35uff6cg7Z0saLZJjFeEwq2FmXEeIGjFBq6bHrl2Ee9Epsu5NIGb3Ji54Mouu3IssJVrp7WG-_IPoi55Lb_WdRkubFGkOqeDrZHZeJp7tfM5cDZjIhrFfDkKtwty1E0/s400/IMG_7971.jpg" width="400" /></a></div><br />
</div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: small;"> </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;">All these might sound frightening, so should you stop sending your children to the playground? My thoughts are that the benefits of fresh air and exercise far outweigh the danger, and so long as mummy and daddy keep an eye and play an actively supervise, time spent at the playground need not end up a tearful experience.</span><br />
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<span style="font-size: small;">-The BomohTulang </span><br />
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</span></div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-37307904863492493462011-08-29T09:55:00.049+08:002011-12-31T00:51:06.500+08:00Eid-Ul Fitri and Happy Independence Day 2011<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>The end of August this year coincides with the two largest celebration for Malaysians.<br />
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Muslims throughout the country, according to calculation, will observe <b>Eid-ul Fitri</b> on Tuesday the 30th of August, marking the end of Ramadhan, where muslims fasted daily for a month from dawn till dusk. Traditionally the eid holidays (also known as Hari Raya Aidil Fitri) run for two consecutive days but this year, the second day coincides with <b>Malaysia's 54th Independence Day</b>.<br />
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So this year is indeed a double celebration for Malaysians in general and especially for the muslims throughout; the Bomoh Tulang would like to take this oppurtunity to wish a Selamat Hari Raya and Happy Independence day to all Malaysians! <br />
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Happy Holidays and have a safe journey home!<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNsk8_Yx1q5Zd38guGttP3f8AWQ4A8Q0ydXedE63cZinOsQpn6puf741fG_dGogpZcoA4xXbAMyK30ZQs-pzFpFt-bTlee8ymgRCN0ypwR8xdyhPTlngt2i53iuQev1D0WGTDhYOpjx6XK/s1600/DSC_0359.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNsk8_Yx1q5Zd38guGttP3f8AWQ4A8Q0ydXedE63cZinOsQpn6puf741fG_dGogpZcoA4xXbAMyK30ZQs-pzFpFt-bTlee8ymgRCN0ypwR8xdyhPTlngt2i53iuQev1D0WGTDhYOpjx6XK/s400/DSC_0359.jpg" width="265" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Selamat Hari Merdeka!</td></tr>
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</div><div class="separator" style="clear: both; text-align: left;">- the BomohTulang -</div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-81228625681918767632011-08-15T12:19:00.000+08:002011-12-27T14:37:23.162+08:00ACHILLES TENDON CUT due to TOILET BOWL INJURYThe patient slipped in the bathroom and his foot crashed into the toilet bowl. (no he was not squatting on the edge of the toilet seat - see bottom pic)<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhajRF9_TJ3KQOMGaL9nVrvfU0RRYxBLDTChECG9Q8VSwVQdK897T4GuYM1uSTNiQzc2q05k3me0VYPz5jhhaglx53xD1aCaI2a7bPeecuDElwmzvg3bwzOkv4B-v8p-fUF9AA8EX2vpm7e/s1600/IMG_8089+copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhajRF9_TJ3KQOMGaL9nVrvfU0RRYxBLDTChECG9Q8VSwVQdK897T4GuYM1uSTNiQzc2q05k3me0VYPz5jhhaglx53xD1aCaI2a7bPeecuDElwmzvg3bwzOkv4B-v8p-fUF9AA8EX2vpm7e/s320/IMG_8089+copy.jpg" width="320" /></a></div><br />
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He sustained a deep laceration over his calf and a <a href="http://en.wikipedia.org/wiki/Simmonds%27_test" target="_blank">clinical examination</a> showed that the achilles tendon was torn.<br />
This was confirmed intra-operatively, where an emergency debridement, exploration and tendon repair was done the same day.<br />
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<tr><td class="tr-caption" style="text-align: center;">Intra-op findings</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Wound blurred out as deemed too gory for public viewing :</td></tr>
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Post operatively, a backslab with the ankle in equinus was applied so as to relieve the tension on the operated tendon. This will be replaced later with a special walking boot allowing range of motion exercises to the ankle, with partial weight bearing of the affected limb. Total rehabilitation would take about 4-6 weeks<br />
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Apparently a group of doctors reported on this seemingly "rare" case and got it published in <a href="http://www.footanklesurgery-journal.com/article/PIIS1268773110001402/abstract" target="_blank">the foot and ankle journal.</a><br />
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On another related note, have you been to the toilets in the malls? you would probably come across this sign:<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifuv0vNFI558moWjIew79iNNmKEDtfFbCDU3tcQEkYW0XuCslS3yLuS_7QYDNZGHjiPDy5XDVRT1y2UWdlbXZtNr3lrqQ9_NilhEGE1W991GLxRvlu_DCJ5h59suVNSkTrgnWzM7uNGKc9/s1600/l_72651bc05c2b48c5a1fac22e6b6a44f9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifuv0vNFI558moWjIew79iNNmKEDtfFbCDU3tcQEkYW0XuCslS3yLuS_7QYDNZGHjiPDy5XDVRT1y2UWdlbXZtNr3lrqQ9_NilhEGE1W991GLxRvlu_DCJ5h59suVNSkTrgnWzM7uNGKc9/s320/l_72651bc05c2b48c5a1fac22e6b6a44f9.jpg" width="320" /></a></div><br />
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The bottom right symbol is an apt reminder of what not to do if one wishes to avoid getting the injury that our friend above had... perhaps the mall management might want to use the picture above to illustrate the consequences of slipping into a toilet bowl.. hmm...<br />
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- the Bomoh Tulang -<br />
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<span style="font-size: x-small;">reference:</span><br />
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<span style="font-size: x-small;">the AAOS </span><a href="http://www.aaos.org/research/guidelines/atrguideline.asp" target="_blank"><span style="font-size: x-small;">Clinical Practice Guideline on the Diagnosis and Treatment of Acute Achilles Tendon Rupture 2009</span></a>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-61452215136776321382011-08-08T11:07:00.069+08:002012-02-06T19:23:44.671+08:00FALL PREVENTION IN THE ELDERLY - KEMUNING NEWS magazine articleBroken bones are a very real risk in the elderly, partly due to the fact that bones are brittle at that age, and minor falls could lead to a catastrophic fracture.<br />
The Bomoh Tulang was featured in the July-September 2011 edition of Kemuning News the other day, featuring a write up on do's and dont's on fall prevention in the elderly.<br />
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Kemuning News is published on a quarterly basis, exclusively for the residents of Kota Kemuning, which is the housing area adjacent to the hospital.<br />
If you are a resident of Kota Kemuning (or just happened to be in the vicinity), do pick up a copy as the publication is freely available at the convenience stores and the Petronas stations.<br />
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In case you have missed it, I have appended the article on my website <a href="http://www.orthopaedicsmalaysia.com/osteoporosis-and-fall-prevention.html" target="_blank">here.</a><br />
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- the Bomoh Tulang -Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-12050213423765120362011-07-28T15:42:00.000+08:002011-12-28T17:01:04.575+08:00SCUBA DIVING - Dr Asri's OW dive certification<div class="separator" style="clear: both; text-align: center;"></div>As you know I'm an <a href="http://mycolumbiaasia.blogspot.com/2011/03/dr-saiful-akhtar-shamsudin-consultant.html" target="_blank">avid diver</a>, having had my PADI dive certification in 2005. Since then I have had the opportunity to log numerous dives around the islands off Malaysia's coast.<br />
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I managed to "racun" <a href="http://mycolumbiaasia.blogspot.com/2011/02/dr-mohamed-asri-is-kelantanese.html" target="_blank">Dr Asri, our Anesthetist</a> in the hospital to take the <a href="http://www.padi.com/scuba/padi-courses/diver-level-courses/view-all-padi-courses/open-water-diver/default.aspx" target="_blank">Open Water Diver Certification</a>, which is basically a "licence" to scuba dive and the first step to experience what the wonderful world beneath the waves has to offer.<br />
Part of the certification is to do a few dives in the open water (as opposed to the confined waters of the pool)<br />
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So one fine July weekend, we took a flight to Kuala Terengganu and met up with Divemaster Halimi of <a href="http://oceanelements.my/" target="_blank">Ocean Elements</a>.The speedboat brought us to Pulau Perhentian where we spent the weekend and for Dr Asri to practice his ability to breathe underwater :P<br />
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More pics after the jump..<br />
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<tr><td class="tr-caption" style="text-align: center;">Before the first dive </td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Dr Asri striking a pose</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">What are these two guys doing underwater. Dr Asri on the right giving the "OK" sign.</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Yes we found Nemo</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh46pL5PHI_eBQaXkW8QFWrx7iZhyphenhyphen9znFiOe1PP08v3tYYtGzdtjIhW7VDfhcfno4JJEhGJPOkSAynUx2bnUMI_3y7PLYPA2AD6vsn6G6v9zJjCdqdQ6ryE5X3GwnkJuw6NZDeXAe7F2TTD/s1600/IMG_6057+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh46pL5PHI_eBQaXkW8QFWrx7iZhyphenhyphen9znFiOe1PP08v3tYYtGzdtjIhW7VDfhcfno4JJEhGJPOkSAynUx2bnUMI_3y7PLYPA2AD6vsn6G6v9zJjCdqdQ6ryE5X3GwnkJuw6NZDeXAe7F2TTD/s320/IMG_6057+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Blue Spotted sting-ray</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgk1qvzlWVaoVuex5PBftnQJm5DaX_EkTxzoi9IJg4p4v2d_-7GwjurSV4RKdJQrlMXOUZfkNYsFrpoVRpujJO7qjQPNmZEtI59JbeGFqSmsC7P5VklnXa6Qq1ZrCSr1dwNN7-RgNjcLa8O/s1600/IMG_5939+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgk1qvzlWVaoVuex5PBftnQJm5DaX_EkTxzoi9IJg4p4v2d_-7GwjurSV4RKdJQrlMXOUZfkNYsFrpoVRpujJO7qjQPNmZEtI59JbeGFqSmsC7P5VklnXa6Qq1ZrCSr1dwNN7-RgNjcLa8O/s320/IMG_5939+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Map of Pulau Perhentian</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSbVMhDYjCPihhhcJe-Qft-OIsc386rQorpS43a7Ns-sX07VbNkBstaAOdr4Q6IY9JTps5A9w_gIHIJb5in_abVkF5w5WqK2L64i8bgijuCNeIR82TrP3pmBKlWilakoZz9LOBc4UL0IAQ/s1600/IMG_5963+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSbVMhDYjCPihhhcJe-Qft-OIsc386rQorpS43a7Ns-sX07VbNkBstaAOdr4Q6IY9JTps5A9w_gIHIJb5in_abVkF5w5WqK2L64i8bgijuCNeIR82TrP3pmBKlWilakoZz9LOBc4UL0IAQ/s320/IMG_5963+copy.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Thats where we stayed</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpTKll_MJYmWVKXMMcgyYwnXYZNOdQl8I9S9l43zvFT_LMrUqiBJVZTiMDVyvZTyBdtFOhA3TA7Id707uW8l2NdqfhemAgt7w-Tmq_CRflj7-SlRa13tVq5zUpPj3-Q2D9mCzAq8jGITIm/s1600/IMG_5916+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpTKll_MJYmWVKXMMcgyYwnXYZNOdQl8I9S9l43zvFT_LMrUqiBJVZTiMDVyvZTyBdtFOhA3TA7Id707uW8l2NdqfhemAgt7w-Tmq_CRflj7-SlRa13tVq5zUpPj3-Q2D9mCzAq8jGITIm/s320/IMG_5916+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">White sandy beach</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBkHCvbWOxVJXn8E8ZL8xnEy07RmavKn5lCRGCj-cqgznqS9CudovyLdDsY8JC5s4py2EMxpGoH11TqtNT4clsh_v8uvNt5unZT6EU0XVxdKOozEYFDmUjdlyH4MVC_D1dfowD-LeJLWWI/s1600/IMG_5940+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBkHCvbWOxVJXn8E8ZL8xnEy07RmavKn5lCRGCj-cqgznqS9CudovyLdDsY8JC5s4py2EMxpGoH11TqtNT4clsh_v8uvNt5unZT6EU0XVxdKOozEYFDmUjdlyH4MVC_D1dfowD-LeJLWWI/s320/IMG_5940+copy.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Pristine waters of the south china sea</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhu83e4dhKMX7vA-n6bpErs9pkHVrTWxSAYqrktnAZUkoRR_zPK0KZF7Eg5cc38ZyHt3ifwZGbVR5HgGzj1AFXOin4JfJKY7agYiU3oHFXy4w9BAHSo96JEilmA50-VvNjsF_Rs3jPCGYgB/s1600/IMG_5838+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhu83e4dhKMX7vA-n6bpErs9pkHVrTWxSAYqrktnAZUkoRR_zPK0KZF7Eg5cc38ZyHt3ifwZGbVR5HgGzj1AFXOin4JfJKY7agYiU3oHFXy4w9BAHSo96JEilmA50-VvNjsF_Rs3jPCGYgB/s320/IMG_5838+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Guess who</td></tr>
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</div><div class="separator" style="clear: both; text-align: left;">The Bomoh Tulang would like to congratulate Dr Asri as he is now an officially certified open water diver! Happy blowing bubbles dude and here's to more dive trips to come!</div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>- the BomohTulang -<br />
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<div class="separator" style="clear: both; text-align: center;"></div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-17777093847031491092011-06-06T13:05:00.000+08:002011-12-28T12:47:56.066+08:00SYNDACTYLY - joined together<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>Syndactyly, or "webbed fingers," is caused by the failure of the fingers to separate during embryological development. It is the most common congenital anomaly of the hand, with an occurrence of 1 per 2000 births. Hereditary causes has been suggested, with up to 40% of patients having a positive family history of syndactily.<br />
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Syndactyly can also be associated with a variety of other syndromes, some of them rare - for example in the patient below with <a href="http://emedicine.medscape.com/article/941723-overview" target="_blank">Apert Syndrome.</a><br />
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<tr><td class="tr-caption" style="text-align: center;">Syndactyly in an infant - part of a larger problem - the Apert Syndrome</td></tr>
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvkJfga3alg3jvRtqqktJ2B5J6vl9q7e172ypMamRuf8N_1KUcG6QlYM_4iDMmbRoDjJ_Q1L_gbxtENQ4yxpab3OwEZ_cA_zcNVBjLjIl-2_iwdpzrIm0yQKtBRMQLCeSRMeR1KBiYuYPU/s1600/DSCN0543+copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvkJfga3alg3jvRtqqktJ2B5J6vl9q7e172ypMamRuf8N_1KUcG6QlYM_4iDMmbRoDjJ_Q1L_gbxtENQ4yxpab3OwEZ_cA_zcNVBjLjIl-2_iwdpzrIm0yQKtBRMQLCeSRMeR1KBiYuYPU/s320/DSCN0543+copy.jpg" width="320" /></a></div><br />
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Syndactyly is most commonly seen in the middle and ring fingers; it can be classified as simple when it involves soft tissues only and complex when it involves the bone or nail of adjacent fingers. It can also be classified as complete or incomplete depending on the degree of soft tissue union between the fingers. <br />
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Timing of separation of the digits depends on the fingers affected. If the affected digits grow at unequal lengths (for example the little and ring fingers) then separation should ideally be done within the first few months of life as the tethering of the skin will cause the fingers to deviate and cause contractures.<br />
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Ring and mddle finger syndactyly usually does not pose functional problems, as in the case of the older child below. In this case, it is a simple, complete syndactyly of the ring and middle fingers. Since both fingers grow at equal lengths, surgery to separate the fingers can be delayed later in life. <br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9c8307wL0sYqaTFexXPFjgVvSli0yH4AisLOZSxQktdfb5pqmGoTNftKZpsnu0bt1vqBh4G7IK_67d1agPfw0URTAZlpv-cdvuAOI-QioZwcRSgbLph5sERfkexIxxlclGU8gOqo8pC2T/s1600/DSCN0559+copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9c8307wL0sYqaTFexXPFjgVvSli0yH4AisLOZSxQktdfb5pqmGoTNftKZpsnu0bt1vqBh4G7IK_67d1agPfw0URTAZlpv-cdvuAOI-QioZwcRSgbLph5sERfkexIxxlclGU8gOqo8pC2T/s320/DSCN0559+copy.jpg" width="320" /></a></div><br />
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<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>- the BomohTulang -<br />
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<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-13077588432870663942011-05-18T15:44:00.000+08:002011-12-22T19:44:21.305+08:00Smart Parents Safe Kids campaignColumbia Asia Hospitals, in collaboration with the parenting website <a href="http://parenting2u.org/" target="_blank">parenting2u</a>, organized a series of talks on children safety at CAHBR recently. This event kicks off a nationwide campaign themed<strong><em> </em><em>"Smart Parents, Safe Kids". </em></strong><br />
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The aim is to educate parents and caregivers on the importance of children's safety and also highlight the hidden dangers found at home, the parks and in the water.<br />
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Given the fact that the ortho surgeons deal a lot with children's fracture, guess who was<strike></strike> honoured with the chance to talk on playground safety?.. <br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnl8XnXjKkPuYv-e_LuJViz8e9KvlvaSoyEbAvde_J83-mPd5I0wosv5bUG6rFT4ucCAXq7az8WLwIQNH2r8zrrqFtAsMvkxmNkbJa9RQ3wiJtSNjuvsZnq0PiQSAY9DKgw_5f4GOiOfvN/s1600/IMG_7991+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnl8XnXjKkPuYv-e_LuJViz8e9KvlvaSoyEbAvde_J83-mPd5I0wosv5bUG6rFT4ucCAXq7az8WLwIQNH2r8zrrqFtAsMvkxmNkbJa9RQ3wiJtSNjuvsZnq0PiQSAY9DKgw_5f4GOiOfvN/s320/IMG_7991+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Earnestly talking</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ5Z4DkVwp3OIuqYkWP910ETE3AkKkrg0uIn9i3vCCUA8Pr6EyuIBFGsQwrCFbjQhN3RhwZmODWnh8Clu6Pzexlbx2iEqeTD__ferLgV9Q48O-7O2rMuKzqD4KPqepkW8Ld6-FAuSw39nr/s1600/IMG_7994+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ5Z4DkVwp3OIuqYkWP910ETE3AkKkrg0uIn9i3vCCUA8Pr6EyuIBFGsQwrCFbjQhN3RhwZmODWnh8Clu6Pzexlbx2iEqeTD__ferLgV9Q48O-7O2rMuKzqD4KPqepkW8Ld6-FAuSw39nr/s320/IMG_7994+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">what's this about</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp_uWzhyphenhyphenl2JPdAkINqzY9gUQ8kjVWHSE0lFhwPuuaPCjKslLaxjXeczEMjhgHiDB-wpk3Nd4bqjHqzOQvXXwRyW3cxYIoBz7qYMqI6Y__FhiibvTEijsgn0R2jRshOfOKY3cWreH0nMcdZ/s1600/IMG_7999+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp_uWzhyphenhyphenl2JPdAkINqzY9gUQ8kjVWHSE0lFhwPuuaPCjKslLaxjXeczEMjhgHiDB-wpk3Nd4bqjHqzOQvXXwRyW3cxYIoBz7qYMqI6Y__FhiibvTEijsgn0R2jRshOfOKY3cWreH0nMcdZ/s320/IMG_7999+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Part of the audience</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfwFB7j9C7HGKbP4PB7glV6N7_YUT7-qVxrBJVIVdSVFqIDEB_FDVwPYm-jln-7_I_YXwbmPw-uj9DoxCvpZo8h04M5Shw_SyBCh9tDFmutXruqIPtxH1wgPB33cX6RBmDH34zw8Qp02bV/s1600/IMG_7987+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfwFB7j9C7HGKbP4PB7glV6N7_YUT7-qVxrBJVIVdSVFqIDEB_FDVwPYm-jln-7_I_YXwbmPw-uj9DoxCvpZo8h04M5Shw_SyBCh9tDFmutXruqIPtxH1wgPB33cX6RBmDH34zw8Qp02bV/s320/IMG_7987+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">activities for kids</td></tr>
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The talks will be held at the Columbia Asia Hospitals nationwide, so check out your nearest hospital for the date of the roadshow.<br />
<br />
More on the campaign can be found <a href="http://parenting2u.org/article_detail.php?d=17&y=S" target="_blank">here</a><br />
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- the BomohTulang - Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-14555759699869904762011-05-16T00:22:00.000+08:002011-12-22T08:07:28.520+08:00In appreciation of our Nightingales - HAPPY NURSES' DAY<div class="separator" style="clear: both; text-align: left;">International Nurses' Day is celebrated between 6-12 May every year. </div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">CAHBR had a celebration on the 11th of May this year- where the agenda was "speech, makan and more makan":P</div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">Ehem.. on a more serious note - this year's theme was <span style="font-size: small;">"<i>Closing the Gap: Increasing Access and Equity</i>". The International Council of Nurses notes that there are still some areas of the population that has minimal or non existent access to health care - they believe that nurses, as a frontliner in the provision of healthcare, have an important role in bridging the gap to reduce health inequities and providing better access to healthcare for the general population- hence the theme for this year's International Nurses' Day.</span></div><div class="separator" style="clear: both; text-align: left;"><br />
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</div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: small;">okay, enough of the ceramah dudes! on to the pics..</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: small;"><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYZaH3e4Vyzjjf1kWAhZaeLNFwJVwms43fVnEmlijIVnwljUf6KgWFunxKAwlBOjgCAolOrQolMp6yHpDzZdMtJJX1qmayEiVZIY0RYffAyYfj4NA2q0mObBrNY6FLjhBKnQcPc5-MH4lG/s1600/IMG_7928+copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYZaH3e4Vyzjjf1kWAhZaeLNFwJVwms43fVnEmlijIVnwljUf6KgWFunxKAwlBOjgCAolOrQolMp6yHpDzZdMtJJX1qmayEiVZIY0RYffAyYfj4NA2q0mObBrNY6FLjhBKnQcPc5-MH4lG/s320/IMG_7928+copy.jpg" width="320" /></a></div><br />
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<tr><td class="tr-caption" style="text-align: center;">The nurses day cake</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Matron with the staff</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8RldiuxS-WMgvOHh7YEfSoJK10SY47obgGA2sVYv56VwwEmA2b3WqLLAUp_9B35sED0frTRdXH0icPNVq51jAfA6ejDRId8yU2sJHVkxgSPLdM8xevwBNcFXRtSsdqvy195zXSjsCUcYv/s1600/IMG_7945+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8RldiuxS-WMgvOHh7YEfSoJK10SY47obgGA2sVYv56VwwEmA2b3WqLLAUp_9B35sED0frTRdXH0icPNVq51jAfA6ejDRId8yU2sJHVkxgSPLdM8xevwBNcFXRtSsdqvy195zXSjsCUcYv/s320/IMG_7945+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">More makan</td></tr>
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</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: small;"> - the BomohTulang -</span></div><div class="separator" style="clear: both; text-align: left;"><br />
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</div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: x-small;">sources:</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: x-small;"><br />
</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: x-small;">the international Nurses Day <a href="http://en.wikipedia.org/wiki/International_Nurses_Day" target="_blank">Wiki</a></span></div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: x-small;">International Council of Nurses, <a href="http://www.icn.ch/" target="_blank">ICN </a></span></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><br />
<div class="separator" style="clear: both; text-align: center;"></div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-894924472964491252011-04-25T15:46:00.000+08:002011-12-23T22:10:08.263+08:00Elbow fractures in Children - Supracondylar fracture of the humerusWe see a fair number of children's injuries in the hospital, the reason being that the hospital is situated in a residential neighbourhood. <br />
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Children frequently fall, and in the process, has the tendency to extend their arms out to protect themselves. <br />
This fact makes injuries involving the upper limbs more frequently seen in the ER (Emergency Room) as compared to the lower limb. The force from the fall, if large enough, can fracture the bone in two common places - the wrist or the elbow.<br />
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For the elbow, the forces from the fall travel through the forearm, levers the elbow joint in extension and the bone breaks at the weakest part of the arm - the supracondylar part of the humerus.<br />
This is the so-called <b>supracondylar fracture of the humerus</b> and is the commonest elbow injury seen in children, seen most frequently in the 3 to 8 year old age group. It is also the 2nd most common children's fracture, second only to wrist fractures.<br />
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Patients with a suspected <b>supracondylar fracture of the humerus</b> frequently present to the ER with a history of fall, with associated swelling of the elbow and inability to bend the elbow.<br />
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*For the parent, if there is a suspicion of an elbow injury or fracture, one should ideally immobilize the limb in a sling prior to bringing to the ER. Besides providing comfort to your child, it limits further movement and displacement (moving out of alignment) of the suspected fracture. Dont know how to do it? <a href="http://www.videojug.com/film/how-to-make-an-arm-sling" target="_blank">look it up here</a>. *<br />
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And that was how I met my 7 year old patient in the ER a couple of months ago. He had a nasty fall and was brought to the ER by his parents. His left elbow was deformed and swollen, and painful to the touch.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlqIxlP7y_f0p9qqn8NSMrabc1MFsJOXnwM4uAZ-QZTW23MiN2Ge8KEjS3SqXt_4ravdCcOINRQZyp83BWW3EUwKIPiFTkGvjkm2D58wTPIKDTrCZWSI9n3BtSOXTwA3y9fdHMhIznIuB2/s1600/IMG_8221+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlqIxlP7y_f0p9qqn8NSMrabc1MFsJOXnwM4uAZ-QZTW23MiN2Ge8KEjS3SqXt_4ravdCcOINRQZyp83BWW3EUwKIPiFTkGvjkm2D58wTPIKDTrCZWSI9n3BtSOXTwA3y9fdHMhIznIuB2/s320/IMG_8221+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Swollen left elbow</td></tr>
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X rays confirmed my suspicions: a <b>supracondylar fracture of the left humerus.</b><br />
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Now fractures which are minimally displaced, or better yet, undisplaced, can be treated with nothing more than a plaster slab and an armsling. However our patient had what is known as a <a href="http://www.wheelessonline.com/ortho/type_iii_supracondylar_frx" target="_blank">type III Gartlands fracture</a>, where the fracture ends are totally not in contact with each other. This necessitates an operative reduction (where the surgeon manipulates the fracture ends into place) and <a href="http://www.wheelessonline.com/ortho/supracondylar_fractures_percutaneous_pin_fixation" target="_blank">fixation with wires.</a><br />
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Fortunately the parents understood the gravity of the situation and agreed for surgery that night. Here are the before and after pics of the X rays:<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwU_sDNyTqn6_AeBppLyklUWTqGAXquO5YSI0l5G2K-QSxbBRNAHJK3yrjzXTDL6Pn3hHDkEVD9kXXGD5uiS443qiMWMlbt8gbPZ8c4eR6DfSTS8SQwQTBSxTc6BsRGzuECKdF_uimQTta/s1600/SC+hum+frac+1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwU_sDNyTqn6_AeBppLyklUWTqGAXquO5YSI0l5G2K-QSxbBRNAHJK3yrjzXTDL6Pn3hHDkEVD9kXXGD5uiS443qiMWMlbt8gbPZ8c4eR6DfSTS8SQwQTBSxTc6BsRGzuECKdF_uimQTta/s320/SC+hum+frac+1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">fracture site (arrowed)</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCMGBUxNrWZ7ARiZRFkdC5L7qXreYWGb6fz0rx6iDBkwEYCI2Xra8ku74u6Odb3Gnc-sAI5fB9xvPqFmCIb4kGCCX7xmR-s8tkg5UpwIJxhbEVzBOPyWV-xti_FGJvTLrQMdS8_rDDTqwm/s1600/SC+hum+frac+2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCMGBUxNrWZ7ARiZRFkdC5L7qXreYWGb6fz0rx6iDBkwEYCI2Xra8ku74u6Odb3Gnc-sAI5fB9xvPqFmCIb4kGCCX7xmR-s8tkg5UpwIJxhbEVzBOPyWV-xti_FGJvTLrQMdS8_rDDTqwm/s320/SC+hum+frac+2.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">frontal view of the elbow showing the fracture</td></tr>
</tbody></table><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmeEN6WzeEhcnLmTwyEeiYFNKEi1KnhXCjYomfIcJ1O0t343yY48rOLBAutolgWmkitV5ZRVtK5ZsScXELogi_2SMWPrTZpxJCiDhb7tFixSycoLElBstZtqy-ddTUtx8U0aqeMrga6RjG/s1600/SC+hum+frac+6.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmeEN6WzeEhcnLmTwyEeiYFNKEi1KnhXCjYomfIcJ1O0t343yY48rOLBAutolgWmkitV5ZRVtK5ZsScXELogi_2SMWPrTZpxJCiDhb7tFixSycoLElBstZtqy-ddTUtx8U0aqeMrga6RjG/s320/SC+hum+frac+6.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fracture reduced (put back) and temporary wires in place. Compare with the first picture</td></tr>
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You can see that <strike>humpty-dumpty</strike> the bone ends has been put back together again.<br />
The wires were removed after a month - on the x rays below you will note that the fracture is healing well with new bone around the fracture site.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWsngA8KzUY9HAZ8NjYBvmlCgGJFBD0Y3S4i1R9mj06s-SXjAxqRc8MOl8FkSqN1CjD133-HufdNsIl6K5ZZZAAZUptNDQllxfvD7YphOryo3jMNIlZKrM9v45Qo5KpwBUKj57Pex_zDTE/s1600/SC+hum+frac+8.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWsngA8KzUY9HAZ8NjYBvmlCgGJFBD0Y3S4i1R9mj06s-SXjAxqRc8MOl8FkSqN1CjD133-HufdNsIl6K5ZZZAAZUptNDQllxfvD7YphOryo3jMNIlZKrM9v45Qo5KpwBUKj57Pex_zDTE/s320/SC+hum+frac+8.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">after 2 months</td></tr>
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<br />
There was still some slight stiffness of the elbow on the last day of treatment which should go away after some physiotherapy. Now our patient is well on his way to playing football again and probably has a nice story to tell his kids later!<br />
<br />
- the BomohTulang - <br />
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<span style="font-size: x-small;">references:</span><br />
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<span style="font-size: x-small;"></span><br />
<span style="font-size: x-small;">Clinical Practice Guidelines</span><br />
<span style="font-size: x-small;"><a href="http://www.aaos.org/research/guidelines/SupracondylarFracture/SupracondylarFracture_Guideline.asp" target="_blank">The Treatment Of Pediatric Supracondylar Humerus Fractures</a> </span><br />
<span style="font-size: x-small;">American Academy of Orthopaedic Surgeons</span><span style="font-size: x-small;"> </span><span style="font-size: x-small;">2011</span><br />
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<span style="font-size: x-small;">Current Concepts Review Supracondylar Humeral Fractures in Children</span><br />
<span style="font-size: x-small;">J Bone Joint Surg Am. 2008;90:1121-32 </span><br />
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<span style="font-size: x-small;">Crossed-pin versus lateral-pin fixation in pediatric supracondylar humeral fractures.</span><br />
<span style="font-size: x-small;">Shamsuddin SA, Penafort R, Sharaf I. Med J Malaysia. 2001; 56(Suppl D):38–44.</span><br />
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<span style="font-size: x-small;">Wheeless' Textbook of Orthopaedics (<a href="http://www.wheelessonline.com/ortho/pediatric_supracondylar_fractures_of_the_humerus" target="_blank">online</a>)</span>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com2tag:blogger.com,1999:blog-1095431536257422731.post-64720175487837899272011-04-17T20:00:00.000+08:002011-12-24T22:07:15.714+08:00DE QUERVAIN's TENOSYNOVITIS - Pain at the side of the wristWrist pain has multiple causes and can be localized to various areas around the wrist; one of the common ones being pain at the side of the wrist near the base of the thumb. This can be attributed to <b>De Quervains tenosynovitis</b><br />
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De Quervain's tenosynovitis refers to inflammation of tendons together with their enclosing sheath on the side of the wrist at the base of the thumb. These tendons, the<i> extensor pollicis brevis</i> and the <i>abductor pollicis longus</i> tendons, help move the thumb a certain way - to extend and to abduct the thumb (hence their names). On their way to the thumb, the tendons passes through a tunnel (the extensor retinaculum) which helps hold the tendons in place. Much like <a href="http://orthopedicsmalaysia.blogspot.com/2011/03/trigger-finger-your-finger-is-catching.html" target="_blank">trigger finger,</a> irritation of the tendon causes the lining (synovium) around the tendon to swell, which makes it difficult for the tendons to move and glide into the tunnel. However, unlike trigger finger, there is no 'catching' sensation - just pain at the side of the wrist during certain positions of the hand.<br />
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Patients with De Quervain's frequently complain of pain with certain movements of the wrist, for example when pouring tea from a teapot, using a watering can and lifting the grocery bags during shopping. These particular wrist movements will cause a strain on the said tendons - leading to the wrist pain.<br />
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The pain can be replicated by bending your thumb inwards into your palm and making a fist - this is the basis of the eponymous Finkelsteins test. (if you can read Thai, <a href="http://www.youtube.com/watch?v=OxIIm0E89dI&feature=related" target="_blank">here's a DIY video</a> of the test :P)<br />
Here's a picture of the test - it can be quite painful for the patients to perform so I would proceed slowly if I were to conduct the examination.<br />
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Patients are commonly women aged 30 to 50, and frequently mothers of infants. Indeed sometimes when the patients of a child bearing age sees me in the clinic for the problem, my usual interview question would include "have you recently had a baby?" Apparently picking up and carrying of the baby puts the wrist in an awkward position, putting strain to the tendon, and hormonal changes in the tissues further aggravates this situation.<br />
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Other conditions that may mimic this would include basal thumb arthritis or the intersection syndrome (most commonly confused with) <br />
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Treatment is basically conservative. A period of splinting would help to rest the inflamed tissue; there are smaller splints now which are more comfortable to wear, do ask your therapist about it. Non-steroidal anti-inflammatory medications (NSAIDs), ultrasound therapy and ice all help to relieve the inflammation. These conservative means are all that is needed for the majority of patients <br />
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Steroid injection directly into the sheath can be given for more severe cases, although there is a risk of discolouration of the skin at the injection site.<br />
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Failed conservative management would necessitate a surgical release of the constricting sheath of the tendon ( the 1st dorsal compartment ). This could be done on an outpatient basis, ideally under general anaesthesia.<br />
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- the Bomoh Tulang -<br />
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<span style="font-size: x-small;">references:</span><br />
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<table class="citation-block"><tbody>
<tr><td><span style="font-size: x-small;">Treatment of </span><span class="bibrecord-highlight-user" style="font-size: x-small;">de</span><span style="font-size: x-small;"> Quervain's disease:role of conservative management.</span></td></tr>
</tbody></table><span style="font-size: x-small;"> Journal of Hand Surgery - British Volume. 26(3):258-60, 2001 Jun.</span><br />
<table class="citation-block"><tbody>
<tr><td><span style="font-size: x-small;"><br />
</span></td><td><span style="font-size: x-small;"><br />
</span></td><td><span style="font-size: x-small;"><br />
</span></td></tr>
<tr><th><span style="font-size: x-small;"><br />
</span></th><td style="text-align: left;"><span style="font-size: x-small;">Ilyas AM "de Quervain Tenosynovitis of the Wrist" J. Am. Acad. Ortho. Surg., December 2007; 15: 757 - 764. </span></td></tr>
</tbody></table>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-8041476413367298822011-04-04T11:00:00.000+08:002011-12-21T21:24:04.877+08:00BOMOH TULANG talks about Back Pain - RAPI magazineRAPI magazine contacted the Bomoh Tulang the other day, and enquired whether would he be kind enough to write about back pain and prolapsed disc? Well of course I obliged.<br />
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The April issue of RAPI mag is already at the newsstands and features a four-page spread on all you need to know about back pain and prolapsed disc. So ladies and gents, if you have any questions about back pain, head over to your nearest newsagent and get your copy now. <strike>I'll be signing copies at MPH</strike>. ;)<br />
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..and no, this is not an April Fool's joke..<br />
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- the BomohTulang -Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-31896966071292875542011-03-27T19:57:00.000+08:002011-12-20T23:01:57.835+08:00TRIGGER FINGER - your finger is catching<b>Trigger finger (stenosing tenosynovitis)</b>, is one of the common causes of pain and dysfunction in the hand.<br />
The initial symptom is of a painless "click" in the hand on moving the fingers which might eventually progress into a locked finger. The finger might be locked in flexion, whereby a forceful extension of the finger is required to unlock the finger , causing a feeling of "triggering" at the base of the finger (the metacarpo-phalangeal joint). Patients may or may not notice a lump or knot in the palm of the hand, again typically at the base of finger.<br />
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The problem occurs when there is a constriction where the finger flexor tendon enters the tendon sheath at the base of the finger. It is caused either by a thickening (hypertrophy) of the tendon sheath, or a nodular swelling of the tendon itself just proximal to the sheath. Either way, the basic problem lies in the discrepancy between the size of the tendon nodule and the thickened tendon sheath.<span style="font-size: small;"> This means that the tendon can no longer slide easily through it and it becomes harder to bend or straighten the affected finger or thumb as a result. </span><br />
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Trigger finger occurs two or three times more frequently in women than in men and has a peak incidence of around 40- 60 years of age (the demographics sounds similar to carpal tunnel syndrome... ) The ring finger is the most frequently involved, followed by thumb and ring finger.Frequently one finds that multiple fingers are affected and bilateral hand involvements are not uncommon.<br />
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As many as 85% of trigger finger can be successfully treated <b>non-operatively</b>. These include activity modification, splinting, anti-inflammatory drugs (NSAIDs) and steroid injections.<br />
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Steroid injection around the flexor sheath can be an effective treatment, and in my experience, for the patients with mild triggering and short duration of symptoms, one can expect a complete resolution of symptoms.<br />
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<b>Surgical release</b> of trigger finger is reserved for patients not responding to conservative management, the chronically locked finger, long duration of symptoms, and multiple digit involvement. As with most of my minor hand surgery cases, this can be done as a daycare procedure under local anaesthesia and takes about 15 minutes. However, in instances where multiple fingers need to be operated upon, general anaesthesia may be a more comfortable option.<br />
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Similar to carpal tunnel release, a small incision about 1cm is made at the base of the affected finger and the constricting sheath is then cut open longitudinally under direct vision. Care is taken to ensure that the nerves running alongside the tendon is not disturbed, and this can only be done if the surrounding structures are well visualized; this is the reason that I am not in favour of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267599/" target="_blank">percutaneous release of trigger finger</a>, although the proponents say that it is a reasonably safe option.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimqrz0if304sOr_KpyXnK5JARKkV_pRhOy3P8KWRgU19DJhcb0a3Y_hSymBpLgvqtlkCBl2RHUJmUwuJLWWsQrfKyXpfbd0yl7CetDIpY8ikCPuyq1UZdfNITTJCMv0APV2h0ImKfhrZ9F/s1600/IMG_1247.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimqrz0if304sOr_KpyXnK5JARKkV_pRhOy3P8KWRgU19DJhcb0a3Y_hSymBpLgvqtlkCBl2RHUJmUwuJLWWsQrfKyXpfbd0yl7CetDIpY8ikCPuyq1UZdfNITTJCMv0APV2h0ImKfhrZ9F/s320/IMG_1247.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A surgical loupe is frequently needed to identify the structures</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgokEA5EoQPoBgoIxvPawxa8B0FuKP6IJMTEA0mPG4mE14FkSeiPl6l2XibgowfHl2QS7zVQMnBFmHo6B_JhyphenhyphenPi2P1PNoA2UaomtnwuVx6LfRWfyKWo9f8DoDw_-0U_SUYLF86FulJLRQAB/s1600/IMG_1248.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgokEA5EoQPoBgoIxvPawxa8B0FuKP6IJMTEA0mPG4mE14FkSeiPl6l2XibgowfHl2QS7zVQMnBFmHo6B_JhyphenhyphenPi2P1PNoA2UaomtnwuVx6LfRWfyKWo9f8DoDw_-0U_SUYLF86FulJLRQAB/s320/IMG_1248.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Incision at the base of the finger</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">the constricting sheath (A1 pulley) is visualized and divided</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPOTqq10lGNLZgGHnd9thCK0tq8S0HDrm0Sp5FGdcbQKNGZBAUdoTibJ5MBkQIyPvw3jO7wmFfRtmJRlOOgLA0bMdvYDrrQzhtUN3gdFDylaGrMUR5MvXKJ26cTTpUdicfKrDUCrAc7Ayk/s1600/IMG_1254.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPOTqq10lGNLZgGHnd9thCK0tq8S0HDrm0Sp5FGdcbQKNGZBAUdoTibJ5MBkQIyPvw3jO7wmFfRtmJRlOOgLA0bMdvYDrrQzhtUN3gdFDylaGrMUR5MvXKJ26cTTpUdicfKrDUCrAc7Ayk/s320/IMG_1254.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">sutured up</td></tr>
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</div><div class="" style="clear: both; text-align: left;">Trigger finger in infants or children almost always involves the thumb and could be a different entity from the adult type. Most authors recommend observation as children below 6 months can have spontaneous resolution of symptoms ( I know, because my nephew had the same problem - it resolved spontaneously!). Surgery, as with adults, could be considered if symptoms persist.</div><div class="" style="clear: both; text-align: left;"><br />
</div><div class="" style="clear: both; text-align: left;">- the BomohTulang - </div><div class="" style="clear: both; text-align: left;"><br />
</div><div class="" style="clear: both; text-align: left;">References:<span style="font-size: x-small;"> </span></div><div class="" style="clear: both; text-align: left;"><br />
</div><div class="" style="clear: both; text-align: left;"><span style="font-size: x-small;">Trigger digits: diagnosis and treatment. J Am Acad Orthop Surg. 2001 Jul-Aug;9(4):246-52.</span></div><div class="" style="clear: both; text-align: left;"><br />
</div><div class="" style="clear: both; text-align: left;"><span style="font-size: x-small;">Trigger digits: principles, management, and complications. J Hand Surg Am. 2006 Jan;31(1):135-46.</span><br />
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<div class="fulltext-SOURCEFULL"><span style="font-size: x-small;">The Natural History of Pediatric Trigger Thumb</span><span style="font-size: x-small;">. The Journal of Bone and Joint Surgery-American Volume</span></div><div><span style="font-size: x-small;">Issue: Volume 90-A(5), May 2008, pp 980-985</span></div></div><h1 class="parseasinTitle "><span id="btAsinTitle"><span style="font-size: x-small;"><span style="font-weight: normal;">Core Knowledge in Orthopaedics: Hand, Elbow, and Shoulder. Trumble, Budoff, Cornwall. Mosby 2005</span></span></span></h1><div class="separator" style="clear: both; text-align: left;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-45146226244660155932011-03-14T11:41:00.000+08:002011-12-02T07:26:13.238+08:00BOMOH TULANG - a bit about me*ehem* I have taken the liberty to "cekup" my profile from the ColumbiaAsia's blog and put it here, just for you loyal readers.<br />
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<h3 class="post-title entry-title">Dr Saiful Akhtar Shamsuddin - Consultant Orthopedic Surgeon </h3><div class="post-header"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdpc9-U6xlEIb05IaRf3WtJbN3Nhi4iMUMfJl70uAslCZNM1l5sAY_9gxB4w-L78Gdmz05CbMIWB1R7Jxe3ODXOyF5jmkbEXy9RU7gd-16BSa9emjEk3zHnmh_TjUZGq5uTYo8yBPH2cA/s1600/2.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdpc9-U6xlEIb05IaRf3WtJbN3Nhi4iMUMfJl70uAslCZNM1l5sAY_9gxB4w-L78Gdmz05CbMIWB1R7Jxe3ODXOyF5jmkbEXy9RU7gd-16BSa9emjEk3zHnmh_TjUZGq5uTYo8yBPH2cA/s200/2.jpg" width="200" /></a></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;"><span class="Apple-style-span" style="color: #333333; font-family: Arial,Tahoma,Helvetica,FreeSans,sans-serif; font-size: 13px; line-height: 18px;"><b><span class="Apple-style-span" style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">Dr Saiful Akhtar Shamsuddin</span></span></b></span></span></div><div class="MsoNoSpacing"><span class="Apple-style-span" style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">Consultant Orthopedic Surgeon</span></span></div><div class="MsoNoSpacing"><span class="Apple-style-span" style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">Columbia Asia Hospital, Bukit Rimau, Malaysia</span></span></div><div class="MsoNoSpacing"><span class="Apple-style-span" style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">MBBS (UM), MS Ortho (UKM), CMIA (NIOSH)</span></span></div><div class="MsoNoSpacing"><span class="Apple-style-span" style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">Fellowship in Lower Limb Arthroplasty & Reconstruction (Aus)</span></span></div><div class="MsoNoSpacing"><span class="Apple-style-span" style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US">AO Fellowship in Hand Surgery (USA)</span></span></div><span lang="EN-US" style="font-family: Arial,Helvetica,sans-serif;"><a href="mailto:saiful.akhtar@columbiaasia.com" style="color: #29aae1; text-decoration: none;">saiful.akhtar@columbiaasia.com</a></span><br />
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</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;">Dr Saiful Akhtar Shamsuddin is </span><span lang="EN-US" style="font-family: Arial,sans-serif;">an orthopedic surgeon, with a keen interest in Hand surgery and also Arthroplasty surgery as a sub-specialty.</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;">He brings to Columbia Hospitals a wealth of experience and knowledge in orthopedics, having had 18 years of orthopedic experience and more than a decade of specialist orthopedic experience, serving in one of the busiest hospitals in Malaysia.</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;">Dr Saiful was born, raised and schooled in Klang, Selangor, making him a native Klang-ite. After Form Five, he furthered his studies in Pusat Asasi Sains and henceforth continued to study medicine in University Malaya.</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;">Having completed his undergraduate studies, he went on to work mainly in the Orthopedic and Surgical departments throughout his career. His first ever posting as a houseman was in the Orthopedic Department in Hospital Kuala Lumpur, where he made the decision to pursue Orthopedics as a career. He had the priviledge to work in various hospitals throughout his career; namely Hospital Seremban, Hospital Kuala Pilah, Hospital Kuala Lumpur and Hospital UKM, prior to completing his Masters Progamme in Orthopedic surgery. </span><span lang="EN-US" style="font-family: Arial,sans-serif;">He last served Hospital Tengku Ampuan Rahimah Klang before joining Columbia Asia Hospital, Bukit Rimau as a Consultant Orthopedic Surgeon</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;">During the earlier part of his career as a specialist, he was attached to the Hand and Micro-Surgery Department of Hospital Selayang, under the guidance of Dato’ Dr Pathmanathan, where he developed a keen interest in Hand Surgery as a sub-specialty. He continued his involvement in hand surgery while in Hospital Klang and was instrumental in setting up the hand services there.</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;"><br />
</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;">Dr Saiful later obtained a fellowship in Lower Limb Arthroplasty and Reconstruction from the Gold Coast Hospital, Australia to strengthen his knowledge in Joint replacement surgery.</span></div><div class="MsoNormal" style="text-align: justify;"><span lang="EN-US" style="font-family: Arial,sans-serif;">Besides hand surgery and arthroplasty surgery, he also manages various orthopedic problems, ranging from simple backache to congenital deformities to severe limb and spine trauma.</span><br />
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</div><div class="MsoNormal" style="text-align: justify;"></div><span lang="EN-US" style="font-family: Arial,sans-serif;">Dr Saiful is married, and is blessed with three wonderful children. In his spare time he can be found scuba diving beneath the tropical waters off Malaysia’s east coast islands. He is also passionate about photography, a hobby he picked up during his student days.</span><br />
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<span lang="EN-US" style="font-family: Arial,sans-serif;">Contacts or appointments?</span><br />
<span lang="EN-US" style="font-family: Arial,sans-serif;"> <a href="http://orthopedicsmalaysia.blogspot.com/2011/01/clinic-hours-contact-me.html">click here</a></span><br />
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</span><br />
<span lang="EN-US" style="font-family: Arial,sans-serif;">- the BOMOH TULANG -</span>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com1tag:blogger.com,1999:blog-1095431536257422731.post-13449039131717303552011-03-11T13:44:00.000+08:002011-12-26T11:59:43.071+08:00At the AO principles course 2011<div class="" style="clear: both; text-align: left;"><br />
The <b>AO principles</b> and<b> advanced course Malaysia 2011</b> was held at the Dorsett Regency, Subang, and attended by more than 70 local and international participants. Held over a period of two days, it encompasses lectures, case discussions and hands-on workshops on fixation techniques.</div><div class="" style="clear: both; text-align: left;"><br />
<i>The Bomoh Tulang has been fortunate to be a part of the teaching faculty for past few years, and this year was not an exception. </i><br />
<i><br />
</i></div><div class="separator" style="clear: both; text-align: left;">The <a href="http://www.aofoundation.org/Pages/home.aspx" target="_blank"><b>AO Foundation</b></a> - Arbeitsgemeinschaft für Osteosynthesefragen (German for: Association for the Study of Internal Fixation) - is a non-profit organization based in Davos Switzerland, dedicated to the advancement of the treatment of musculoskeletal injuries. Founded in 1958, the AO foundation promotes the understanding of fracture management through research, meetings and education. </div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">As an integral part of education, the AO foundation through AO Education conducts courses on the principles and techniques of fracture fixation, for Orthopedic surgeons and also operating room personnel. These courses are held on a regular basis throughout the world and is a great place for trainee orthopedic surgeons or even senior surgeons to learn, exchange notes and at the same time update their skills on the latest fixation techniques.</div><div class="separator" style="clear: both; text-align: left;"><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcGHofKzp0DfPuRNMyQCeXx5b8SAxXLPxY1WQOvGlpJfR2tRqNfxnzYx_CIBQ0r-wKvLjcsBT5n1zricnRdnntdyxZtZokAIsjlThaE2jHiRwt_Ri-DQpqlJpvYHv65MOvmk6mPtB-68tZ/s1600/08032011185+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcGHofKzp0DfPuRNMyQCeXx5b8SAxXLPxY1WQOvGlpJfR2tRqNfxnzYx_CIBQ0r-wKvLjcsBT5n1zricnRdnntdyxZtZokAIsjlThaE2jHiRwt_Ri-DQpqlJpvYHv65MOvmk6mPtB-68tZ/s320/08032011185+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr Ivan explaining the finer points of external fixation to the participants</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Plating the fibula</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Dr Rashdeen and Dr Hazrin trying out some fixation techniques. This was at the 2010 course.</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmmBCGGs5iS4Ycxa6EhTQ3spvUhJr4PALobI-0rmZA6PpkcGluGsm6gAVR6wUeRHDoUW9uEv9EVP8xgLT7IOtBOmJTAS66WIZb0l79ESmSmzVybBft-lQ28Ice1y-3fj2q5kJ20nWxtb9b/s1600/03032010080+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmmBCGGs5iS4Ycxa6EhTQ3spvUhJr4PALobI-0rmZA6PpkcGluGsm6gAVR6wUeRHDoUW9uEv9EVP8xgLT7IOtBOmJTAS66WIZb0l79ESmSmzVybBft-lQ28Ice1y-3fj2q5kJ20nWxtb9b/s320/03032010080+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Also at the 2010 course. Dr Azfar was a participant.</td></tr>
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Interested in next year's AO course?<br />
Click <a href="http://aotrauma.org/eventdetails.aspx?id=1599&from=PG_COURSEDIRECTORY" target="_blank">here</a> for registration. Spaces are limited so better hurry!<br />
<br />
- the BOMOH TULANG -<br />
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</div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-56363197240389673572011-02-24T22:47:00.000+08:002011-12-20T12:44:19.236+08:00Surgery for CARPAL TUNNEL SYNDROMEContinuing from the previous post, lets talk a bit about SURGERY for CARPAL TUNNEL SYNDROME.<br />
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Surgery entails cutting or transecting the transverse carpal ligaments that overlies the median nerve and can be done as an outpatient basis or a day care procedure in the OT. <br />
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The surgery itself can be accomplished in two ways:<br />
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The traditional approach is by open carpal tunnel surgery, whereby a longitudinal skin incision is made in the wrist and the carpal ligament cut to relieve the pressure on the median nerve. Incisions generally have become smaller over the years, and the so-called "mini" 2cm skin incision have become the standard length now.<br />
<i></i> <br />
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Surgery takes about 20 minutes and can be done under local anaesthesia although my preference is to do it under general anaesthesia, unless there are contraindications.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5D5exHscSVFyD32GE_NlGH6a1guN4XLYU2fMXvpmSoH5n9c915dQYVCAGR-Plof-zC1eklEfWrft_VMnihABeBoZ_S4QJNGvBGM9NqNrXj-__hFWkARt76Y-Vfnc7K4V4ygX9vnxSjEXW/s1600/2+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5D5exHscSVFyD32GE_NlGH6a1guN4XLYU2fMXvpmSoH5n9c915dQYVCAGR-Plof-zC1eklEfWrft_VMnihABeBoZ_S4QJNGvBGM9NqNrXj-__hFWkARt76Y-Vfnc7K4V4ygX9vnxSjEXW/s320/2+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Torniquet applied to prevent bleeding</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRiTMnGIn2jxZazxLKSivAPBJ4-ehJAW-HiIS8pe6ZxVSQfZVMzyNNjBSEgr-3CxyJoZFqPhgD9WQjfqABnbIB2LFqaTXpgx0xcjzv3IJI5jm5By9lZihcgd_EpKWmIyDFqIgseX-SZoIb/s1600/3+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRiTMnGIn2jxZazxLKSivAPBJ4-ehJAW-HiIS8pe6ZxVSQfZVMzyNNjBSEgr-3CxyJoZFqPhgD9WQjfqABnbIB2LFqaTXpgx0xcjzv3IJI5jm5By9lZihcgd_EpKWmIyDFqIgseX-SZoIb/s320/3+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Local anaesthesia injected</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcpB7UXVcNwfjGNMVQxYaiOkolEQtJQNLLzdm1xnk398MgE7tyHROBh5bzp9R5-Ub_Vfz8pC6bcLnPs_znyu5uZxLVQIe5nAlyzZ0Y7x0yCTIimzXaYeHi3Uc6qCCy6wy8A7g5p9Nf73K_/s1600/4+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcpB7UXVcNwfjGNMVQxYaiOkolEQtJQNLLzdm1xnk398MgE7tyHROBh5bzp9R5-Ub_Vfz8pC6bcLnPs_znyu5uZxLVQIe5nAlyzZ0Y7x0yCTIimzXaYeHi3Uc6qCCy6wy8A7g5p9Nf73K_/s320/4+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Checking for the landmarks</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjFzqEUeP3qBV1H3jkzbyRS5cJGzd379OAcDvl4720na5bMLNOwgZMzK0bVwq952ernwcqGTF-h66hvR7xc-f66Nx7enKJN4v28CyGyBOQ_d1jJdcag3ILHEKkfI3VxLreIK4zJ64xzveq/s1600/5+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjFzqEUeP3qBV1H3jkzbyRS5cJGzd379OAcDvl4720na5bMLNOwgZMzK0bVwq952ernwcqGTF-h66hvR7xc-f66Nx7enKJN4v28CyGyBOQ_d1jJdcag3ILHEKkfI3VxLreIK4zJ64xzveq/s320/5+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Incision over the wrist</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSpcQnRMVTXAphF52T7tooB3uJZZdpMCuMHDJ6cyexDTlnWY_7CrVUCsgTQN6a0d-kygty1TQwk0tJUGayzlftfzkOZQCCD0V-NJ-zJLuFXn1IB4lTqAVuo713hYnNq22yzLeZLM3dT-BD/s1600/6+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSpcQnRMVTXAphF52T7tooB3uJZZdpMCuMHDJ6cyexDTlnWY_7CrVUCsgTQN6a0d-kygty1TQwk0tJUGayzlftfzkOZQCCD0V-NJ-zJLuFXn1IB4lTqAVuo713hYnNq22yzLeZLM3dT-BD/s320/6+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Incision deepened</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9uqLo3o4Ha37hmjEhhJaL_QzimYhoC9uUSo19ONTRERueTUC-ry9WZty3IPuoL0IgX03GnCI_ufug0yBEYI8dfXsI0m6G25sYvlpkvUXxd6T1qJUc0BS20_rOFjmufwDk0bCU6jCSn0Fz/s1600/7+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9uqLo3o4Ha37hmjEhhJaL_QzimYhoC9uUSo19ONTRERueTUC-ry9WZty3IPuoL0IgX03GnCI_ufug0yBEYI8dfXsI0m6G25sYvlpkvUXxd6T1qJUc0BS20_rOFjmufwDk0bCU6jCSn0Fz/s320/7+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The carpal ligament is cut</td></tr>
</tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFva8_5JQiGfWmC9kAq6PF9BHB1SM6l6VvfiJAn2F6BtSe7HyoHIeR6lW3Qe9DxK5l237Ngk2f4gpLNMoAsHXfKk4sfA1RM5KK29i1NgAmO0nMZNM6nxt69-SQjeZmHsEwBGdOJP9TcpKc/s1600/8+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFva8_5JQiGfWmC9kAq6PF9BHB1SM6l6VvfiJAn2F6BtSe7HyoHIeR6lW3Qe9DxK5l237Ngk2f4gpLNMoAsHXfKk4sfA1RM5KK29i1NgAmO0nMZNM6nxt69-SQjeZmHsEwBGdOJP9TcpKc/s320/8+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The underlying median nerve could be seen</td></tr>
</tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9WsZn25qJVOsSYyJe-UCNjJ-60HXmB9jiJ5gBpcYKpeKo8_5NJfunfaHVyICO5Ricehxcwgx0CgsgsNFXgspvoTNibn9fxdnP4gBg61DA1zfSE2xgwAM4kETGhZZSYGTyqHj5aFakjObp/s1600/9+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9WsZn25qJVOsSYyJe-UCNjJ-60HXmB9jiJ5gBpcYKpeKo8_5NJfunfaHVyICO5Ricehxcwgx0CgsgsNFXgspvoTNibn9fxdnP4gBg61DA1zfSE2xgwAM4kETGhZZSYGTyqHj5aFakjObp/s320/9+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Wound washed and closed </td></tr>
</tbody></table><br />
Post operatively, the patient will feel relief from the night pain, as early as the day after surgery. Numbness of the fingers will take a bit more time to disappear, as is wasting of the hand muscles which will be the last to recover.<br />
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Sutures are usually taken off at two weeks and patients are advised not to lift heavy objects or to grip tightly for the next 4-6 weeks. There might be some weakness of the hand grip but this will also recover over time. <br />
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Another, more minimally invasive method would be through the endoscopic method. A small incision is made at the wrist and a small camera, together with a knife, introduced into the wound to see the carpal tunnel. The ligament is then cut below the skin by the knife. Proponents of this technique claim shorter recovery time and less post operative pain. The downside is the complexity of the procedure as it necessitates more (expensive) equipment and has a steeper learning curve on the part of the surgeon.<br />
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<span lang="EN-US" style="font-family: Arial,sans-serif;">- the BOMOH TULANG -</span>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-69145939522025421752011-02-14T09:20:00.000+08:002011-12-03T08:17:38.221+08:00Numbness in your hand - CARPAL TUNNEL SYNDROME?Do you have numbness in your hands? Worse in the early hours of the morning, painful too? pain wakes you up at night? Or, do you notice that sometimes your hands get all clumsy and you start dropping things, like a coffee cup for instance?<br />
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Well, you have come to the right place. Today let's talk a bit about CARPAL TUNNEL SYNDROME, a condition that affects between 1 to 10% of the population.<br />
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</div><div style="font-family: inherit;"><span style="font-size: small;">Lets start with the textbook description:</span></div><div style="font-family: inherit;"><br />
</div><div style="font-family: inherit;"><span style="font-size: small;">CARPAL TUNNEL SYNDROME (CTS) , by definition, is a syndrome characterized by <span style="color: black;">pain, tingling, and numb sensations in your hand</span><span style="color: #2da2bf;">, </span><span style="color: black;">typically involving the lateral (radial) 3 ½ digits</span><span style="color: black;"> (ie the thumb, index and middle fingers) caused by compression of the median nerve at the wrist, by whatever reasons. </span></span></div><span style="font-size: small;"><span style="font-family: inherit;"> </span></span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL4ODp2qlRac7Ocjo1nfuWia5ERVEEWIqqiwUvKmtg1DssobIehuAd_PBGcxifYLYcqGEYttXwHJrXULk_HNsOovgOT-KH4sbq4RqMQypa5VLAwtmoWKqGUjIpNtD8ElkujUISsG-FMriq/s1600/numbness+distribution.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL4ODp2qlRac7Ocjo1nfuWia5ERVEEWIqqiwUvKmtg1DssobIehuAd_PBGcxifYLYcqGEYttXwHJrXULk_HNsOovgOT-KH4sbq4RqMQypa5VLAwtmoWKqGUjIpNtD8ElkujUISsG-FMriq/s1600/numbness+distribution.jpg" /> </a></div><div class="separator" style="clear: both; text-align: center;"><br />
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</div><div style="font-family: inherit;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTX0k-2M6dBWSA3ay6Xp49j98bdR9KRC3j-uz8IlJIVNvTDZZQfvn1mRYhi8RovmgAhNLNPQFWaoF6XxkuSO5GaogCxVt689ofIeOUahy1y5ICkMmDliVLfjiZo8sUhC8HSQUn7LAG-uBR/s1600/wrist+pain+copy.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTX0k-2M6dBWSA3ay6Xp49j98bdR9KRC3j-uz8IlJIVNvTDZZQfvn1mRYhi8RovmgAhNLNPQFWaoF6XxkuSO5GaogCxVt689ofIeOUahy1y5ICkMmDliVLfjiZo8sUhC8HSQUn7LAG-uBR/s200/wrist+pain+copy.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Shaking the hands to make it better</td></tr>
</tbody></table><span style="font-size: small;"></span><br />
<span style="font-size: small;"> </span></div><div style="font-family: inherit;"><span style="font-size: small;">Patients usually complain of numbness and tingling at night that wakes them up; they </span><span style="font-size: small;">often</span><span style="font-size: small;"> find that they have to shake their hands to make it better. They can also experience numbness when driving, reading the newspaper or a book, when typing on a keyboard, or any activity that requires the hands to be kept flexed for a period of time. Sometimes they can also have referred pain radiating to the forearm and arm, in which case the condition could be misdiagnosed by other health care professionals.</span><br />
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<span style="font-size: small;">Where is the </span><span style="font-size: small;">CARPAL TUNNEL? </span><br />
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<span style="font-size: small;">The carpal tunnel is located at the wrist; the concave bottom part is created by the bony structures of your small bones of the wrist (the carpal bones), and tunnel completed on the top by a non-yielding structure called the transverse carpal ligament.</span> Traversing the crowded tunnel are the tendons that go to your fingers and the median nerve, which supplies sensation to the thumb, index finger, middle finger, and the radial side (thumb side) of the ring finger</div><div style="font-family: inherit;"><span style="font-size: small;"><br />
</span></div><div style="font-family: inherit;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieQoIcYjbhT1pPx4s5wOhI1gk5YF9v-g1fcHCS2jAU_WQKPqS2ehvJM3SWZeDha0E2_PGLHJW8bjKR9bXQjCw03wOo-36nU5TJ_uel6oY2w2uiHRrGTLWti8IUu6NLeegZM5rprnxlBn2t/s1600/carpal+tunnel+wrist.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieQoIcYjbhT1pPx4s5wOhI1gk5YF9v-g1fcHCS2jAU_WQKPqS2ehvJM3SWZeDha0E2_PGLHJW8bjKR9bXQjCw03wOo-36nU5TJ_uel6oY2w2uiHRrGTLWti8IUu6NLeegZM5rprnxlBn2t/s320/carpal+tunnel+wrist.jpg" width="320" /></a></div><span style="font-size: small;"><br />
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</span></div><div style="font-family: inherit;"><span style="font-size: small;"></span>What causes <span style="font-size: small;">CARPAL TUNNEL SYNDROME</span>?<br />
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Carpal tunnel syndrome is due to median nerve compression within the carpal tunnel, as increased pressure causes decreased blood flow to the nerve. This increased pressure comes from swelling (edema) of the tissues surrounding the tendons called the synovium. This swelling may be due to injury to the synovium from overuse, trauma, or other causes such as metabolic disturbances (endocrine disorders, pregnancy, menopause). Increased pressure in the tunnel could also be due to anything that decreases the volume available in the tunnel, such as a lipoma or neuroma.</div><div style="font-family: inherit;"><div align="left">Having said that, do keep in mind that most of the time no cause could be found.<br />
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How does the doctor know I have <span style="font-size: small;">CARPAL TUNNEL SYNDROME?</span><br />
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Well, as per the usual way, through questioning and thorough clinical examination.<br />
A variety of special tests involving the wrist could be performed ie the Tinel's test and Phalen's test.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2i27DiQjI18XXGz65aa4cDR80TDrd2o7pNhncZTSbmlJCAnXTPaTqG-aOC-zeoVVjnsB0_p2dx7qOt2VfTXvgD-VTm6hPFcZCLnTrZT_ylHtr5zQjtK9OBireuywvM-Amn0mJeJuiJGcx/s1600/compression+test+copy.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2i27DiQjI18XXGz65aa4cDR80TDrd2o7pNhncZTSbmlJCAnXTPaTqG-aOC-zeoVVjnsB0_p2dx7qOt2VfTXvgD-VTm6hPFcZCLnTrZT_ylHtr5zQjtK9OBireuywvM-Amn0mJeJuiJGcx/s200/compression+test+copy.jpg" width="150" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTtPmD32Q5tHAFPgXO1YSj3wVtEuY3zYYcOrbAXJFqQsjw3kS5UL6ytgU5PsoyLCjpHFVcFQLU9qoQFCiuM-c5yuigBKoBWjhLQCXx-zCNJ7XWsT3UVEpsg8WvhlRq4VPo3Yf-JZZ8QNkE/s1600/Tinel%2527s+copy.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTtPmD32Q5tHAFPgXO1YSj3wVtEuY3zYYcOrbAXJFqQsjw3kS5UL6ytgU5PsoyLCjpHFVcFQLU9qoQFCiuM-c5yuigBKoBWjhLQCXx-zCNJ7XWsT3UVEpsg8WvhlRq4VPo3Yf-JZZ8QNkE/s200/Tinel%2527s+copy.jpg" width="180" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjECdpkFG55Y-3OcbqfcVixFRhz-wSOTBPuJb3fGXs2Had0DXrm_Q1K6CLWQ5UzKW_TxfLzjWeEPm8aqSUFoI4T7CNLZQ471rANbCnx68c3OrndV1JedUIyKSFbMMBkOV6cDpVa9UIdvDVt/s1600/Phalen%2527s+copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjECdpkFG55Y-3OcbqfcVixFRhz-wSOTBPuJb3fGXs2Had0DXrm_Q1K6CLWQ5UzKW_TxfLzjWeEPm8aqSUFoI4T7CNLZQ471rANbCnx68c3OrndV1JedUIyKSFbMMBkOV6cDpVa9UIdvDVt/s200/Phalen%2527s+copy.jpg" width="150" /></a></div><br />
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Additional tests such as X rays, MRI and nerve conduction tests could be called upon to make the diagnosis or rule out other conditions<br />
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</div><div align="center"><div style="text-align: left;">What happens next</div><div style="text-align: left;"><br />
</div><div style="text-align: left;">Usually once a firm diagnosis is made, the doctor could start the patient on a trial of conservative measures, typically lasting a month or two, and best results are obtained with early onset of symptoms. These might include:</div><ul style="text-align: left;"><li>Activity modification</li>
<li>Splinting - to rest the joint, and keep it in a neutral position</li>
<li>Addressing the primary cause of CTS - treating hypothroidism for example</li>
<li>Oral medications - NSAIDS and oral steroids</li>
<li>injections into the carpal tunnel</li>
</ul></div><div align="left"><b> </b><span style="font-size: small;"> </span><br />
<span style="font-size: small;">W</span>ell, I have I tried all that, and it still doesnt seem to work..<br />
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Failed conservative treatment indicates that the patient is a candidate for the next step: SURGERY.<br />
Surgery is also indicated for worsening symptoms and evidence of atrophy of the small muscles of the hand.<br />
There are various techniques in doing surgery on the carpal tunnel , which i will discuss in the next entry.<br />
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Till then,<br />
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-The BomohTulang - <b></b></div><div align="left"><br />
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NB: there a literally tons of info on the net about CTS, so I have compiled some links which i think could be useful:<i></i></div></div><div style="font-family: inherit;"><span style="font-size: small;"><br />
</span></div>The American Academy of Orthopedic Surgeons (AAOS) <a href="http://orthoinfo.aaos.org/topic.cfm?topic=A00005" target="_blank">has an article about CTS here</a><br />
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Additionally, you can download the American Society for Surgery of the Hand (ASSH) <a href="http://www.assh.org/Public/HandConditions/Documents/CarpalTunnel.pdf" target="_blank">brochure on CTS here</a> (PDF file)<br />
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Closer to home, the Arthritis Foundation Malaysia (AFM) has an <a href="http://www.afm.org.my/info/tunnel.htm" target="_blank">article on CTS here </a>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-58455119218000318432011-02-02T21:01:00.000+08:002011-12-01T11:41:37.621+08:00Happy CNY!!So we are about to celebrate the dawn of another year (reader: err I thought we already did, about a month ago?)<br />
February 3 this year marks another year on the Chinese calendar, and this year we usher in the year of the rabbit, with 2011 being the year of the metal rabbit. If you are a believer of Feng Shui, head on <a href="http://worldofengshui.blogspot.com/2011/01/year-of-metal-rabbit-2011.html" target="_blank">here</a> to see what the future holds for you. Otherwise, I would like to wish all our Chinese readers a happy and prosperous year ahead!<br />
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Speaking of prosperity, we had Yee Sang for lunch the other day - down the road at Kota Kemuning.<br />
This dish is traditionally available during the new year and is symbolic of good luck, prosperity, health and all things auspicious.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOTMvcj8SwAxps0HwF23Z-8sWWekYnpMPECbPPZjjqof_h9yfmBx90ObVga9iC-cGNUI_d1UWwLe-0puRSrQvLmgN76amT3LhDbKufvNIwoZeRTilqq5h5JKBJPTdoWCKtnqqMR8ki9pvk/s1600/IMG_7858+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOTMvcj8SwAxps0HwF23Z-8sWWekYnpMPECbPPZjjqof_h9yfmBx90ObVga9iC-cGNUI_d1UWwLe-0puRSrQvLmgN76amT3LhDbKufvNIwoZeRTilqq5h5JKBJPTdoWCKtnqqMR8ki9pvk/s320/IMG_7858+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The ingredients - err can you see the salmon?</td></tr>
</tbody></table><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggsjjX2tzVyBeGVRsoJofLx74z5l9lD8UGJJ-XGj5ceGdvHXN0QJE1uGeJkxy7OlfGadUtaxRB8Kwkj5oJwQx1Nt0ReGHWe0nnBIlEFvz7DXLswPcg7I3uh5F3jWQPBL9rv1D8_WxAGT_3/s1600/IMG_7859+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggsjjX2tzVyBeGVRsoJofLx74z5l9lD8UGJJ-XGj5ceGdvHXN0QJE1uGeJkxy7OlfGadUtaxRB8Kwkj5oJwQx1Nt0ReGHWe0nnBIlEFvz7DXLswPcg7I3uh5F3jWQPBL9rv1D8_WxAGT_3/s320/IMG_7859+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">You toss em and mix them up real good. </td><td class="tr-caption" style="text-align: center;"><br />
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</tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6OGkMHkoP6pWUU-ha63qR2j2B-Ou1V6jITOJemXpu06i-vgvR4H_IGk0GBGrdDxROrbAIODfehfr23vXQV07lnR-PQoMupGcDKjL0v5TEL3pgzzwypCAU2_0p4_dkhNcirzmqpiwTqkiY/s1600/IMG_7860+copy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6OGkMHkoP6pWUU-ha63qR2j2B-Ou1V6jITOJemXpu06i-vgvR4H_IGk0GBGrdDxROrbAIODfehfr23vXQV07lnR-PQoMupGcDKjL0v5TEL3pgzzwypCAU2_0p4_dkhNcirzmqpiwTqkiY/s320/IMG_7860+copy.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Apa lagi.. makan time!</td></tr>
</tbody></table>Yes you (together with your friends / family members) need to mix the ingredients together and toss them up real high - the significance of the tossing is to wish for abundant luck and happiness for all.<br />
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Yee Sang Wiki can be found <a href="http://en.wikipedia.org/wiki/Yusheng" target="_blank">here</a><br />
Someone was busy <a href="http://www.friedchillies.com/index.php/articles/detail/where-yee-sang-came-from/" target="_blank">researching the origins of Yee Sang</a><br />
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Happy CNY to all!<br />
<br />
-the Bomoh Tulang - <br />
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<div class="separator" style="clear: both; text-align: center;"></div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-84043149666459650352011-01-30T22:38:00.000+08:002011-12-01T11:53:59.034+08:00CLINIC HOURS / CONTACT MEI realized that maybe there are some important bits of info that I have not included in the blog; mainly for those who want to set an appointment or just want to contact me.<br />
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Clinic hours.<br />
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Monday - Friday: 9am to 5pm with an hours lunch break at 1pm.<br />
Saturday : 9am to 12:30 noon<br />
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Contact:<br />
<div style="text-align: left;"><br />
</div><div style="text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK48F24eMOZFmriRYYrKCIsUJNUSdMPa4AKCgl84I5nucv39V2-IhRbVslC6BDDcfYXPrcoLmWf52y6t87Os1I3METM0a0LFuy886zksJYDSUcAutee0_Shc__L-Ie239Y_lCikliABsgq/s1600/hospitalphoto2.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK48F24eMOZFmriRYYrKCIsUJNUSdMPa4AKCgl84I5nucv39V2-IhRbVslC6BDDcfYXPrcoLmWf52y6t87Os1I3METM0a0LFuy886zksJYDSUcAutee0_Shc__L-Ie239Y_lCikliABsgq/s200/hospitalphoto2.JPG" width="200" /></a><b>Columbia Asia Hospital - Bukit Rimau</b></div><div style="text-align: left;">No3, Persiaran Anggerik Eria, Bukit Rimau, Seksyen 32</div><div style="text-align: left;">40460 Shah Alam, Selangor Darul Ehsan</div><div style="text-align: left;"> </div><div style="text-align: left;">Tel: 603-51259999 extension is 9819</div><div style="text-align: left;">Fax: 603-51259998</div><div style="text-align: left;"> </div><div style="text-align: left;">You can also email me:</div><div style="text-align: left;"> </div><div style="text-align: left;"> <span class="login">saifulakhtar (at) gmail.com</span></div><div style="text-align: left;"><span class="login"> </span></div><div style="text-align: left;"><span class="login">saiful.akhtar (at) columbiaasia.com</span></div><div style="text-align: left;"><span class="login"><br />
</span></div><div style="text-align: left;"><span class="login">hope to see you.</span></div><div style="text-align: left;"><span class="login"><br />
</span></div><div style="text-align: left;"><span class="login">- the Bomoh Tulang -</span></div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-79312299234983295732011-01-25T19:56:00.000+08:002011-12-01T19:12:20.997+08:00BOMOH TULANG in the news - Berita Minggu articleStill on the topic of heel pain this month, Berita Minggu featured my article about "Heel Pain" on their 23rd January issue.<br />
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For those of you who missed it, I have scanned the article here.<br />
Read about it below:<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimUBq0YXawUY1KWoIRXJvM9DuXm2O2zyU4vOQ5Be_rdoZqG6LQ4ZoNaBTOOZV490enAB7vKEDfmBfbKkwI87TZOH6r946Ep7IiCzrofDLdMg9aUmWN5YObXI_AwK9X3S0-fMCbW3VJ4kuT/s1600/BM230111+copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="322" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimUBq0YXawUY1KWoIRXJvM9DuXm2O2zyU4vOQ5Be_rdoZqG6LQ4ZoNaBTOOZV490enAB7vKEDfmBfbKkwI87TZOH6r946Ep7IiCzrofDLdMg9aUmWN5YObXI_AwK9X3S0-fMCbW3VJ4kuT/s400/BM230111+copy.jpg" width="400" /></a></div><br />
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Since it's "heel pain month" I have also written an article in Bahasa Malaysia and it's in my other blog, Bomoh Tulang Malaysia, <a href="http://bomohtulang.blogspot.com/2011/02/sakit-tumit.html" target="_blank">here</a><br />
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- the BomohTulang -Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-18029045215576021592011-01-19T09:25:00.000+08:002011-12-01T19:11:52.644+08:00ESWT for Plantar Fasciitis - the videoLet me share with you a bit more on the extra-corporeal shock wave treatment (ESWT).<br />
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ESWT works by bombarding the tissue with high-pressure sound waves and is thought to stimulate blood flow for a beneficial immune response; it also causes microtrauma to the tissue to stimulate healing.<br />
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Typically each session lasts about 15-20 minutes; the patients do not experience any pain, with most reporting a tingling feeling. The heel is iced after the session to prevent soreness.<br />
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So okay, ready for the video? Just hit the "play button"..<br />
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</div><div class="separator" style="clear: both; text-align: left;">- the BomohTulang - </div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0tag:blogger.com,1999:blog-1095431536257422731.post-27007288275123520782011-01-15T08:43:00.000+08:002011-12-01T19:11:15.688+08:00PLANTAR FASCIITIS - heel painPatients often come to me complaining of heel pain, the usual story being that they have pain in the heel right after getting out of bed or after taking the first few steps in the morning. The pain will ease somewhat, but tend to be progressively worse throughout the day when they are constantly on their feet.<br />
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Now there are many causes of heel pain but PLANTAR FASCIITIS ( interpreted as inflammation of the PLANTAR FASCIA - this is a misnomer, as I would explain later) remains the most common cause of heel pain.<br />
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<div style="text-align: right;"></div>The PLANTAR FASCIA is a thickened fibrous band of tissue that stretches from the heel (calcaneum bone) to the head of the metatarsals of the foot. Likened to a bowstring, it acts to maintain the arch of the foot and also helps in shock absorption when the foot strikes the ground.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGxV0tkpwX2rvsQxGv2Cd3hqQQcBIvOXz2-xBOTJmK1lgqMoo2EKbwMlVMP_z_23TxxblsO-j0M_8WLuKo5e4ikiei-qgU8JhIb-yvt9_rvpWqCWV0aCuAc5hdf8AdfX32efFF4DBtJhEf/s1600/Plantar+fascia.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGxV0tkpwX2rvsQxGv2Cd3hqQQcBIvOXz2-xBOTJmK1lgqMoo2EKbwMlVMP_z_23TxxblsO-j0M_8WLuKo5e4ikiei-qgU8JhIb-yvt9_rvpWqCWV0aCuAc5hdf8AdfX32efFF4DBtJhEf/s320/Plantar+fascia.jpg" width="229" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Plantar Fascia </td></tr>
</tbody></table>It was thought that inflammatory changes was the cause of this pain; however we now know it is mainly due to degenerative changes in the fascia, especially at the interface where the fascia attaches to the bone, hence the misnomer in the "fasciitis" as I informed earlier.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_DGCTZGCVzhBgVeXk7mlzIqdetgokn_200G7P-uN6Gt27mzjBWx2Y4v5SoukuGMheynq4_rYmmITqcNMQF9Hz08QeKenwdSEemHIjlPd0GeGp0rlNLwC9v_d-TjdqEAjiA6Ik-dpWCE4U/s1600/fasciitis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_DGCTZGCVzhBgVeXk7mlzIqdetgokn_200G7P-uN6Gt27mzjBWx2Y4v5SoukuGMheynq4_rYmmITqcNMQF9Hz08QeKenwdSEemHIjlPd0GeGp0rlNLwC9v_d-TjdqEAjiA6Ik-dpWCE4U/s200/fasciitis.jpg" width="166" /></a></div><br />
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Causes<br />
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Tight heel cord ie the gastrocnemeus, soleus and the Achilles tendon, high arch feet, flat feet are some of the incriminating causes of plantar fasciitis, as is obesity, occupations requiring prolonged standing and weight-bearing, and heel spurs. Talking about heel spurs, one does not necessarily have plantar fasciitis if the heel spurs are present on x rays.<br />
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Seeking relief from the pain<br />
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There are a variety of measures that one can do to alleviate this problem:<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8VO0H9yQG4ngsN5qELOuu0XAqnZeQKE6oVmRC1i9sn-3J1e-xWA0QB0Y1Y27PTJwMpV_vS2lKGeTyto-Gj2JdDPhEsoaddpZfbqk5h5yULENX1cCxmYVh0YEcQZh8_eEIiATq9RbLC1-g/s1600/Plantar+fascia+stretch.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="166" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8VO0H9yQG4ngsN5qELOuu0XAqnZeQKE6oVmRC1i9sn-3J1e-xWA0QB0Y1Y27PTJwMpV_vS2lKGeTyto-Gj2JdDPhEsoaddpZfbqk5h5yULENX1cCxmYVh0YEcQZh8_eEIiATq9RbLC1-g/s200/Plantar+fascia+stretch.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Stretching your plantar fascia</td></tr>
</tbody></table><ul><li>usage of a well fitting shoe, with adequate arch support and well cushioned heel</li>
<li>adding insole into the shoe - the soft silicone ones applied to the heel area are the best </li>
<li>stretching exercises - this can be done first thing in the morning or anytime before starting any prolonged activity </li>
<li>ice helps to soothe the pain after a painful episode</li>
</ul><br />
Seeing the doctor<br />
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This condition is typically self-limiting with the majority of patients having resolution of symptoms with simple measures described above.<br />
If the problems still persist, your friendly orthopedic surgeon can rule out other causes of heel pain and maybe order some imaging studies to help in making a diagnosis.<br />
Along with the measures above, the good doctor could try any of these modalities to help you along:<br />
<ul><li>Anti-inflammatory medications (NSAIDS)</li>
<li>Splints and orthoses - typically to be used at night</li>
<li>Physiotherapy</li>
<li>Steroid / platelet rich plasma (PRP) injection</li>
<li>Extra-corporeal shock wave therapy (ESWT) </li>
<li>Radiofrequency (RF) microdebridement (TOPAZ)- a relatively new technique in which a wand like instrument is inserted percutaneously under the heel and a bipolar radiofrequency pulse applied to the plantar fascia</li>
</ul><br />
Whew. Now that's a lot of choice innit? Do contact your orthopedic surgeon if you have any more questions or need to know more about this or any foot-related problems.<br />
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<div style="text-align: center;">You know how to contact me:</div><div style="text-align: center;"><br />
</div><div style="text-align: center;">Dr Saiful Akhtar Shamsuddin</div><div style="text-align: center;"><b>Columbia Asia Hospital - Bukit Rimau</b></div><div style="text-align: center;">No3, Persiaran Anggerik Eria, Bukit Rimau, Seksyen 32</div><div style="text-align: center;">40460 Shah Alam, Selangor Darul Ehsan</div><div style="text-align: center;"><div id="postListLink"><a href="http://www.blogger.com/posts.g?blogID=1095431536257422731">Return to list of posts</a></div></div><div style="text-align: center;">Tel: 603-51259999 Fax: 603-51259998<br />
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- the Bomoh Tulang - </div>Bomoh Tulanghttp://www.blogger.com/profile/02290903836444549695noreply@blogger.com0