Elbow Conditions
Friday, 14 November 2014 11:00

Ligamentous Laxity

Ligaments are strong soft-tissue structures in your body that attach one bone to another, they play a vital role in stabilising bones or joints in the body. These structures are very tough and have limited elasticity, and in conjuction with the muscles, tendons, and bones in your body allow you to stand upright and mobilise or function day to day.

In younger people, more commonly in females, the ligaments in the body may have greater laxity, and this often disappears with age. Certain soft-tissue disorders can also result in overly lax ligamnets, but these are quite uncommon, and Dr Ihsheish will be able to assess for these and discuss them with you accordingly.

The term ‘ligamentous laxity’ is a specific medical diagnosis that can be made by the surgeon depending on the patient's ligaments fulfilling a defined and recognised set of findings in the clinical examination, in many cases this is not associated with any specific disease. It is importnant to recognise, as it may result in loose joints, and this may manifest clinically as instability (for example a joint may dislocate easily). Dr Ihsheish will also discuss with you the importance of this in relation to treatment options.


Published in Conditions List
Friday, 14 November 2014 11:00


A ‘bursa’ is a normal anatomical structure. It is a collection of fluid found over parts of the body that may be frequently exposed to physical pressure, such as over the knee cap (prepatella bursa) or over the point of the elbow (olecranon bursa). The bursa can be thought of as a small ‘lubricant bag’ that cushions parts of the body, and allows the skin to glide smoothly as the joint is moved.

Bursitis – is inflammation of this bursa. It can result from excessive pressure (eg excessive kneeling such as in a carpet layer) or actual infections (bacteria may get into a bursa and cause infections after skin cuts or abrasions). These result in pain and dysfunction, and may cause the patient to be unwell if an infection reaches an underlying joint or spreads into the body.

Treatment of bursitis aims to reduce the symptoms (such as by the use of anti-inflammatory medications) and treat any possible infections (this usually needs antibiotics, and for severe cases may require surgery). Dr Ihsheish can assess and provide the appropriate management, although for severe cases the patient is advised to present to the local hospital for assesment.

Published in Conditions List
Friday, 14 November 2014 11:00

Septic arthritis

A joint is the site of articlation of two or more bones in the body, it allows mobility and function, whilst being stable at the same time and allowing weight bearing, an example of this is the knee joint or the hip joint. Septic arthritis is an infection involving one of the joints in the body, most commonly infection involves only one joint, but it can affect more than one joint simultaneously.  All native joints and prosthetic joints are at risk of infection.

What is it caused by?

Most cases of septic arthritis in humans are caused by a bacteria called staphylococcus aureus. This bacteria is normally found on human skin (is is part of the normal bacteria found on human skin and is therefor termed comensal bacteria). It may entre the body through a break in the integrity of the skin (such as cuts or scratches). Septic arthritis can also be caused by other types of bacteria, viruses, or fungal organisms. The very old, very young, or those with suppression of the immune system or certain disease (such as diabetes) are at greater risk of infections in general.

How does it present?

Infections anywhere in the body generally make the patient unwell, often they are associated with temperatures. Locally the infected part is painful and swollen, and thus impedes function (for example an infected knee will make it difficult to walk). In severe infections the patients may become unstable and require hospitalisation.

It is important to diagnose and treat septic arthritis early, to avoid local damage to the joint from these infections, and harmful effects to the patient in general.

Many cases of septic arthritis require urgent surgery. Surgery aims to remove fluid build-up in the affected joint and lavage the joint, and relevant medications (ie antibiotics for the specific bacteria). Further surgery may be required to wash out infected joints, or to replace prosthetic components, Dr Ihsheish can discuss your case individually with you, it is important to be aware that the treatment with antibiotics is for several weeks at least.

Not all infected joints make the patient severely unwell, some low grade infections will be relatively mild in presentation, but if you have any concerns you are advised to make an apointment as soon as possible.

Published in Conditions List
Monday, 03 November 2014 11:00

Cubital tunnel syndrome

What is cubital tunnel syndrome?

This is one of the ‘peripheral compression neuropathies’, a number of syndromes that result from compression of nerves outside the central nervous system. Cubital tunnel syndrome is cause by compression of the ulnar nerve near the elbow, as it passes through an anatomical region called the 'cubital tunnel'. The ulnar nerve is one of the most important nerves in the arm/hand as it supplies a number of arm and hand muscles vital for function, and sensation to the skin.

This syndrome, ulnar nerve compression, results in altered sensation in the little and ring fingers and adjacent side of the hand, there may also weakness and a deformity of the fingers (the fingers may appear to be curling up). Fine movements of the hand may be affected as this nerve supplies many small hand muscles.

What is CUBITAL TUNNEL syndrome caused by?

There are a number of recognised bone or soft tissue factors that can result in excessive compression or stretching of the ulnar nerve and give rise to the syndrome. Repetitive activities, nearby injuries, arthritis in the adjacent elbow joint, or other abnormal structures that may develop in the area can all cause compression and damage to this important nerve. Dr Ihsheish can assess your symptoms clinically, and may also use nerve conduction studies and radiological imaging to help diagnose the syndrome and work out causative factors.


Ultimately the nerve compression will need to be relieved. Less severe cases may improve with non surgical measures such as activity modification, however surgical decompression is generally required for more advanced cases to avoid permanent nerve damage and muscle weakness/sensory loss. The surgery is called cubital tunnel release and is done in the operating theatre. This will relieve the compression on the ulnar nerve and allow it to recover, the timing and amount of recovery generally mirrors the severity and duration of compression.

In most individuals this is day surgery and you will be allowed to leave hospital the same day, and will be followed up in two weeks for a wound check. Dr Ihsheish generally uses absorable sutures and so no suture removal is required.

Dr Ihsheish will discuss with you the recovery phase that is expected, but it is likely that it will involve physiotherapy and some reduction in your normal activities while the wound heals.

Published in Conditions List