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.

What is a wrist fracture?

The term 'wrist' is commonly used to describe the area where the forearm meets (or articulates with) the hand, this is an importnant link that affords you the ability to place or use your hand in a vast possibility of positions in space. The term ‘wrist fracture’ is commonly used to describe a fracture of any of the bones involved in the articulation between the hand and the forearm, but most often the bones involved are the ‘radius’ and the ‘ulna’

How is a wrist fracture treated?

The aim of the treatment is to

• relieve your pain
• ensure the fracture heals, and heals in a good position
• regain function of the affected part

If the fracture fragments are displaced then they may require reduction back into a normal position, this can be done by manipulation (so called ‘closed reduction’) or by open surgical means for more complex fractures (so called ‘open reduction’). Internal fixation devices (such as plates and screws) are often used in open reduction cases. These devices are contoured to your bone and often will not require removal, their other advantage is that they often allow you to commence movements/physiotherapy exercises soon after the surgery.

The fracture then needs to be immobilised in place, usually with a plaster or a splint, and Dr Ihsheish will recommend physiotherapy at some point to minimise the stiffness that results after such injuries.

How long will the fracture take to heal ?

Fracture healing is an ongoing process that begins from the moment of the injury, and takes several weeks, the duration of 6 weeks is adequate for most, but many factors are involved in determining the speed with which a fracture heals (also called ‘fracture union’). Younger patients generally heal faster, and an immobilised fracture generally heals faster than one that is moving.

Dr Ihsheish can talk with you about any specific factors that may affect your injury healing rate.He will also keep you updated about the progress of your injury, which is generally monitored clinically and radiologically.

What happens after the cast has been removed?

Generally when the cast or splint is removed you will experience some stiffness and discomfort of the joint, this is normal, and physiotherapy is beneficial in helping you to regain movement and function. Do not be surprised if your wrist has some ongoing discomfort, this may be related to stiffness and soft tissue injuries that heal slower than bone and are not obvious on the xray.

If there is a plate/screws holding the fracture, will they BE removed?

Dr Ihsheish uses plates and screws that are made of a metal that is well tolerated (titanium), and contoured to the shape and size of your bone. It is uncommon for them to be removed routinely. They may require removal if they are thought to be infected, if they are thought to be impinging on your joint movement or function, or in growing younger patients. There are other indications to remove them but they are less common.Dr Ihsheish can discuss with you your individual case details.

What is carpal tunnel syndrome?

The ‘carpal tunnel’ is an area in the palm of the hand that is bound by bone and strong ligaments to form a 'tunnel', through which the median nerve travels to reach the hand and fingers. This is one of the important nerves supplying sensation to the hand skin and nerve supply to hand muscles. The tunnel also contains many tendons that attach to the fingers. If the nerve is under pressure from any cause as it travels through the carpal tunnel then this results in pain or altered sensation, and sometimes weakness in the hand.

Patients often feel paraesthesia (a feeling of ‘pins and needles’ or ‘burning sensation’), sometimes during the night.

Carpal tunnel syndrome is most often not associated with any specific illness, but Dr Ihsheish will identify any specific illnesses or medications that may be causing or contributing to the symptoms. It may be associated with injuries around the wrist, the type of work that you do with your hands, inflammatory diseases, or certain medications etc.

How is carpal tunnel syndrome managed?

It is important that you see your surgeon to have the condition accurately clinically diagnosed, this may require tests such as xrays or nerve conduction tests etc.

Dr Ihsheish will be able to gauge the severity of the condition and recommend suitable treatment. In the early less severe stages you may only require activity modification or an injection, some patients also find relief  from using a light splint,  and later on surgery may be indicated.

How is surgery for carpal tunnel syndrome performed?

The surgery is called ‘carpal tunnel release’. It may be done under local anaesthetic or general anaesthetic. A small incision is made in the palm and through this the strong ligament is released and the nerve inspected. The surgery is quick and you are allowed to leave the hospital the same day. Your surgeon will ask you to leave the bandage on your hand and keep the area dry for two weeks. At two weeks you will see Dr Ihsheish and have the wound inspected, there will often be no sutures to remove as they are absorbable.

Gentle exercise and wound area massage will be prescribed to help you regain hand function.

Can carpal tunnel syndrome re-occur?

Scar tissue is the normal response in the body around sites of surgery or injury. If the scar tissue is enough to cause nerve compression, or the underlying causes or risk factors continue, this may end up causing carpal tunnel syndrome again. This is uncommon. It is best to talk to Dr Ihsheish as soon as possible if you think your symptoms are re-emerging.

Please be aware that the symptoms of carpal tunnel are the result of nerve compression and damage, and that the rate and degree of recovery after surgery mirrors the degree of compression and nerve damage that exist.