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Body Conditions

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a frequently painful hand and wrist condition that involves the median nerve, a nerve that allows movement and relays sensation for part of the hand. A group of nine tendons can be found near the median nerve and these are protected by synovium, a soft tissue. When the synovium swells, the median nerve becomes compressed, and numbness and pain in the hand and first four fingers can ensue. This condition is common among computer operators and others who use their hands continuously during their workday, including those who use vibrating hand tools or work on an assembly line. It can also be the result of repetitive sports activity, diabetes, rheumatoid arthritis, obesity, menopause, pregnancy, low thyroid hormone levels, and a host of other conditions. Carpal tunnel syndrome is more common in women.

A diagnosis of carpal tunnel syndrome may be made during a medical history and physical examination or through diagnostic testing, such as an electromyography (EMG). In addition to pain and numbness, some people will experience weakness while gripping objects, and the inability to freely move the fingers. Muscle damage may become evident in advanced cases. Depending on the patient’s condition, carpal tunnel syndrome may be treated with anti-inflammatory drugs, steroidal injections, pain medication, a splint to immobilize the joint, or surgery.

Cranial Fractures

A cranial fracture is a fracture of the cranium, which is the part of the skull covering the brain. Sufferers of a cranial fracture are at high risk of a brain injury. These fractures may be classified by such terms as simple, compound, depressed, linear, and open. Typical causes include falls, car crashes, sports injuries, violence, and accidents. Symptoms are frequently obvious, such as a large, bleeding wound. Other symptoms of a cranial fracture include uneven pupils, seizure, headache, slurred speech, and confusion. Diagnosis is often made with a CT scan. A neurological examination can assist the physician in determining neurological deficits due to injury to the brain. Treatment includes close observation, antibiotics, tetanus toxoid, seizure medicine, and other medications. Surgery may be required to remove bone fragments from the brain, remove blood that has collected, or perform other necessary procedures. Surgery may be performed immediately or at a later date.

Hemifacial Spasm

Hemifacial spasm is a neuromuscular disorder characterized by uncontrollable spasms of one side of the face. It typically begins with an eyelid twitch and gradually affects the lower side of the face, as well. The mouth may appear distorted. Both sexes are at risk, but the disorder is more common in older women. While it is occasionally due to facial nerve injury, multiple sclerosis, a tumor, or other condition, it is usually the result of a blood vessel pressing upon the facial nerve as it leaves the brainstem. Some cases of hemifacial spasm are treated with medication, such as muscle relaxants, or injections of botulinum toxin, but many are treated with surgery. Known as microvascular decompression, this surgical procedure can greatly alleviate symptoms in many cases. Peter Jannetta, MD, ScD, the neurosurgeon who invented the microvascular decompression procedure, trained David W. Lowry, MD, one of our Brain + Spine Center neurosurgeons, who performed many of these procedures with Dr. Jannetta personally over a seven-year neurosurgery residency.

Hip Bursitis

Bursitis is an inflammation of the bursa, which is a fluid-filled sac present where muscles are attached to the hip bone by tendons. Trochanteric bursitis is felt at the outside of the hip, while ischial bursitis may be felt in the groin or buttock area. The pain is typically described as sharp, but the hip area may become achy over time. Pain may be felt in the hip, thigh, buttock, or groin. It may be worse when lying on the hip, overusing the hip, or standing after sitting for an extended period of time. In hip bursitis, the bursa swells with too much fluid, causing discomfort. Occasionally, a bursa becomes infected. Hip bursitis is more common in women and older adults. It can be caused by overuse of the hips, a bone spur, an injury, rheumatoid arthritis, or other condition. Conservative treatment is usually attempted at first, including rest, anti-inflammatory medication, pain medicine, steroid injections, ice, stretching exercises, and/or physical therapy. Crutches or a cane may be utilized for walking. Sometimes, part of the bursa fluid is removed with a needle. Rarely, surgery is needed to remove the bursa. Bursitis with infection requires antibiotic treatment.

Knee Pain

Knee pain is a common problem that can develop at any age. The actual kneecap is called the patella, but the knee is considered to be a complex combination of structures including leg bones, ligaments, tendons, nerves, bursae, and cartilage, any of which can create pain. Knee pain may be chronic or acute, and crunching, aching, throbbing, or positional. The area may become swollen, warm to the touch, or reddened. The knee may be weak or “give out” while the sufferer is attempting to walk. Causes include overuse, arthritis, gout, pseudogout, bursitis, ACL injury, Baker cyst, tendinitis, dislocation of the kneecap, or other injury or disease. Diagnosis is typically made by x-ray, CT scan, MRI, or ultrasound. Treatment varies according to the underlying cause of the pain. Typical treatments include rest, ice, elevation of the knee, anti-inflammatory medication, pain medicine, injections into the knee area, compression bandages, exercises, and physical therapy. Occasionally, surgery is required. Common knee surgeries include arthroscopic surgery and the replacement of part or all of the knee.

Myofascial Pain

Myofascial pain is chronic muscle pain that affects one muscle or a group of muscles. It is typically an aching pain and may be accompanied by muscle stiffness. The affected muscles may have one or more trigger points, which are tender areas from which the pain seems to originate. Myofascial pain is more common in women. Repetitive sports or occupational activities, injuries, and emotional stress may increase the risk of developing myofascial pain. A diagnosis is made after a physical examination and a study of the patient’s history of symptom development. Treatment includes physical therapy, injections of anesthesia or steroids, anti-inflammatory medication, and tricyclic antidepressants.

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