As we approach the end of the year, I would like to take this opportunity to wish all our Christian readers ( yes all 3 of you!) a very Merry Christmas! and happy holidays and a happy new year to everyone too!
Here's wishing to an awesome 2011!
I took the time to record the caroling at the hospital lobby the other day, so here's the video after the jump. Sorry its a bit shaky, recorded on my 5MP Nokia.. enjoy!
- the BomohTulang -
Saturday, December 25, 2010
Saturday, December 18, 2010
GANGLION CYST - swelling in the wrist
Patients frequently present to the clinic with a lump at the wrist, with or without associated pain. These masses are usually round, smooth, and soft to firm with pressure.
The usual diagnosis would be a GANGLION CYST.
Ganglia cyst are among the most common cause of focal masses in the hand. They are thought to arise from the joint synovium or the sheaths of the tendons transversing the joint. The cause of the cysts remain unclear although it has been hypothesized that occupational trauma plays a part.
As described above, they usually do not cause pain, although when they get bigger, the cyst might press onto the structures around the wrist joint, such as an overlying nerve or tendon. They could also catch onto clothing or watch straps giving rise to discomfort. Lastly, they could just be a nuisance from a cosmetic point of view - in which case the patient usually request for excision.
Can you leave it alone?
Yes you can, and as I have explained, if they do not cause any pain, it really is a harmless swelling. In addition, if the swelling is small, there just might be a chance that the swelling would disappear.
However, some patients would insist that the lump be removed (for various reason - large swelling, pain, disfiguring, etc) in which case the options are:
Aspiration of the cyst.
This can be done as an office procedure. A local anaesthetic is usually administered around the lump and the lump aspirated with a large bore needle. Some practitioners would instil steroid into the remaining cavity to prevent recurrence. The success rate of this procedure is about 60%. (ie 1/3 of patients will have recurrence)
Surgical excision
The procedure of choice, in my opinion, as the success rate goes up to 90% (ie only 1 in 10 surgeries will have a recurrence). This can be done as a day procedure in the OT. Although some doctors can do it under local anaesthesia, the preferred method would be under general anaesthesia or a regional block at the minimum. The reason being that the root of the ganglion is usually deep seated and to get access to the deeper structures under local anaesthesia will cause much discomfort to the patient, not to mention unsettling to the operating surgeon.
Post surgery.
There might be some discomfort and swelling around the area operated. I usually close the skin with an absorbable suture so that no removal of the sutures need be done and it leaves a nicer scar.
Sometimes, with a larger lump, some ligaments of the wrist needs to be retracted and have to repaired. In this case, the patient will be required to use a resting wrist splint for a short period of time.
The usual diagnosis would be a GANGLION CYST.
As described above, they usually do not cause pain, although when they get bigger, the cyst might press onto the structures around the wrist joint, such as an overlying nerve or tendon. They could also catch onto clothing or watch straps giving rise to discomfort. Lastly, they could just be a nuisance from a cosmetic point of view - in which case the patient usually request for excision.
Can you leave it alone?
Yes you can, and as I have explained, if they do not cause any pain, it really is a harmless swelling. In addition, if the swelling is small, there just might be a chance that the swelling would disappear.
However, some patients would insist that the lump be removed (for various reason - large swelling, pain, disfiguring, etc) in which case the options are:
Aspiration of the cyst.
This can be done as an office procedure. A local anaesthetic is usually administered around the lump and the lump aspirated with a large bore needle. Some practitioners would instil steroid into the remaining cavity to prevent recurrence. The success rate of this procedure is about 60%. (ie 1/3 of patients will have recurrence)
Surgical excision
The procedure of choice, in my opinion, as the success rate goes up to 90% (ie only 1 in 10 surgeries will have a recurrence). This can be done as a day procedure in the OT. Although some doctors can do it under local anaesthesia, the preferred method would be under general anaesthesia or a regional block at the minimum. The reason being that the root of the ganglion is usually deep seated and to get access to the deeper structures under local anaesthesia will cause much discomfort to the patient, not to mention unsettling to the operating surgeon.
There might be some discomfort and swelling around the area operated. I usually close the skin with an absorbable suture so that no removal of the sutures need be done and it leaves a nicer scar.
Sometimes, with a larger lump, some ligaments of the wrist needs to be retracted and have to repaired. In this case, the patient will be required to use a resting wrist splint for a short period of time.
Sunday, December 12, 2010
STACK THEM UP - The Mallet finger splint
A finger has a mallet finger deformity when the distal phalanx droops down, with the patient unable to actively extend the joint.
It is also known as the baseball finger, in which the ball hits the distal phalanx and forcibly flexes the joint. This will usually result in an avulsion of the attachment of extensor tendon to the distal phalanx, usually accompanied with a flake of bone.
It can be an open (ie with a wound - in which case the tendon is cut) or closed (ie no wound - implying an avulsion injury) injury.
For closed injuries, the usual treatment is non-surgical. The patient will need to use a splint - a so-called STACK splint, to keep the joint in extension (or hyperextension even) so as to allow the avulsed flake of bone to heal and to prevent stretching of the tendon.
One needs to use the splint diligently for 6 to 8 weeks to allow adequate time for healing. There is a chance of relapse if the splint is taken out for an extended period of time. At the end of the treatment period, one might find that the finger may be stiff in which case physiotherapy might help.
- the BomohTulang -
It is also known as the baseball finger, in which the ball hits the distal phalanx and forcibly flexes the joint. This will usually result in an avulsion of the attachment of extensor tendon to the distal phalanx, usually accompanied with a flake of bone.
It can be an open (ie with a wound - in which case the tendon is cut) or closed (ie no wound - implying an avulsion injury) injury.
For closed injuries, the usual treatment is non-surgical. The patient will need to use a splint - a so-called STACK splint, to keep the joint in extension (or hyperextension even) so as to allow the avulsed flake of bone to heal and to prevent stretching of the tendon.
 |
| a custom made Stack splint made by the Occupational therapy dept |
 |
| another Stack splint. bought off the shelf. nice. |
One needs to use the splint diligently for 6 to 8 weeks to allow adequate time for healing. There is a chance of relapse if the splint is taken out for an extended period of time. At the end of the treatment period, one might find that the finger may be stiff in which case physiotherapy might help.
- the BomohTulang -
Monday, December 6, 2010
COLUMBIA ASIA HOSPITAL BUKIT RIMAU - Driving directions.
Im going to write a bit about the hospital today.
CAHBR was built on the premise of it being a neighborhood hospital, serving the needs of the surrounding community, namely Bukit Rimau and Kota Kemuning plus the adjacent areas.
It is a 84 bedded multidisciplinary specialist hospital, situated in the rapidly growing southern part of Shah Alam. Facilities include specialist clinics, wards, labour rooms, 3 operating theatres, ICU, 24 hour emergency room.
How does one get here? Easy.
For those coming from Subang Jaya / PJ /KL, the easiest way is to take the Shah Alam (Kesas) highway heading south / east towards Port Klang.
You need to take exit 505 Bukit Rimau, just before the Bukit Rimau toll.
As you enter Bukit Rimau, you will see a roundabout before you.. and that's it!
The hospital is right in front of you.
If you are staying in other parts of Shah Alam, say Sec 2, 3 7, etc : you can always take the LKSA highway all the way to Kota Kemuning, then as you encounter the 1st roundabout ( yes Shah Alam is full of them I know!) take a right turn to Bukit Rimau. The hospital should be about a kilometer away.
Okay here's a map courtesy of the website:
Here's another more interactive map, courtesy of uncle Google:
View Larger Map
More info? Webby below:
http://www.columbiaasia.com/bukit-rimau/
I'll be looking forward to meeting you!
- the BomohTulang -
CAHBR was built on the premise of it being a neighborhood hospital, serving the needs of the surrounding community, namely Bukit Rimau and Kota Kemuning plus the adjacent areas.
It is a 84 bedded multidisciplinary specialist hospital, situated in the rapidly growing southern part of Shah Alam. Facilities include specialist clinics, wards, labour rooms, 3 operating theatres, ICU, 24 hour emergency room.
How does one get here? Easy.
For those coming from Subang Jaya / PJ /KL, the easiest way is to take the Shah Alam (Kesas) highway heading south / east towards Port Klang.
You need to take exit 505 Bukit Rimau, just before the Bukit Rimau toll.
As you enter Bukit Rimau, you will see a roundabout before you.. and that's it!
The hospital is right in front of you.
If you are staying in other parts of Shah Alam, say Sec 2, 3 7, etc : you can always take the LKSA highway all the way to Kota Kemuning, then as you encounter the 1st roundabout ( yes Shah Alam is full of them I know!) take a right turn to Bukit Rimau. The hospital should be about a kilometer away.
Okay here's a map courtesy of the website:
Here's another more interactive map, courtesy of uncle Google:
View Larger Map
More info? Webby below:
http://www.columbiaasia.com/bukit-rimau/
I'll be looking forward to meeting you!
- the BomohTulang -
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