What is Sundowning syndrome?

This medical condition is a type of sleep or mood disorder. It is also called sundowners syndrome. It is often associated with the early stages of Alzheimer’s and dementia but not everyone who has these medical conditions will display symptoms of sundowning syndrome. One of the biggest risks with a person having sundowning syndrome is that could become agitated and upset enough to wander away.

What are the Symptoms ?

When a person has sundowning syndrome they experience extreme confusion and agitation during the early evening or late afternoon hours. Some other symptoms they might experience can include:

• Visual hallucinations
• Paranoia
• Aggressiveness
• Mood swings
• Physical and mental fatigue
• Tremors that could become uncontrollable as they increase
• An increase in their restlessness while they are trying to sleep, which could lead to wandering or pacing

They may also experience other behavioral changes that are out of character for them.

Triggers

When a person has sundowning syndrome there are some things that could possibly trigger an episode like a specific issue or event such as:

When they are hungry
When the sun goes down causing a light change that creates shadows, making the environment look different.

Causes

The exact causes for a person to have sundowning syndrome is not known but researchers have found that this syndrome is seen in dementia patients and those that suffer from other conditions like degenerative eye conditions. There are some who feel that sundowning syndrome happens because of sleep disturbances or changes in lighting conditions. Because the symptoms occur around sundown it is thought that there is a link with your body’s natural night and day cycles. Some researchers feel there is a possibility of more organic causes like stress that is associated with cognitive functions that are diminishing or drug interactions.

Treatment

One common form of treatment is to recognize what triggers an episode of sundowning syndrome and learning to manage them before the syndrome occurs. In addition to managing the triggers the underlying condition needs to be managed. To help lessen the severity of the confusion the person may be prescribed anti-depressions. To help reduce the agitation that may occur in the evenings the person may take an over-the-counter herbal medication called melatonin, which is a hormone that increases sleepiness.

A big part of sundowning treatment is light so when these people are in care facilities or hospitals they may not be exposed to enough sunlight during the day and this could upset their body’s natural night and day rhythms. It is important to make sure that they are getting enough sunlight during the day along with extra light in the evening. To help reduce triggering an episode of sundowning syndrome due to the shifting and changing light at twilight make sure the interior lights are increased or turned on before it becomes dusk.

Caring for someone with sundowning syndrome

A caregiver of someone with this syndrome has to be very vigilant because of the wide range of symptoms they can display. It is also very important to remain calm and be patient because the agitation they experience may come on quickly accompanied by using strong language, shouting, and may be even violent actions. You need to make sure that you know how to calm them down without anyone getting hurt.

When caring for someone with this syndrome there are many different ways in which to accomplish this. Some of the suggestions include:

• Limit stimulating activities to the morning
• Encouraging them to take several naps throughout the day but make sure they do not sleep too much so they do not want to sleep at night
• Making positive lifestyle and environmental changes
• Limiting their intake of caffeine after morning may help to prevent feeling of agitation in the late afternoon
• In the morning and early afternoon engage in outdoor activities can help them feel less agitated and more tired in the evenings
• Have a consistent daily routine to make them feel more secure and safe in their environment and help to reduce instances of distress or panic.
• Having a snack in the afternoon could help to reduce triggers that are hunger-related
• Make sure that their bed is comfortable so when they do nap they are resting comfortably
• Make sure that they are served nutritious meals at the same time each day.

What is Wellen’s syndrome?

This is a pattern of electrocardiogram waves (ECG). The electrocardiogram is a medical test that is normally done to examine the electrical activity in your heart. It records the electrical signals that cause your heart to beat. These electrocardiogram waves come before a very serious stenosis, which is an abnormal and possibly dangerous narrowing of your proximal left anterior descending (LAD) artery. This is the artery that supplies blood to the large areas of your heart. If they are completely blocked it will cause a massive heart attack and can lead to sudden death. It is often referred to as the widow maker. The pattern is normally observed in the T-wave portion of the test in patients who are not currently experiencing pain but do have a history of angina, which is a temporary, painful heart condition that is caused by the constriction of your arteries and veins. Although most patients are not experiencing pain at the time of the test there have been some patients that are experiencing pain.

It was first observed in 1982 by Dr. Hein Wellens. It is very important that physicians and nurses be familiar with this ECG pattern because it usually precedes a very serious heart condition that needs immediate medical attention.

Risks

People who have had recent chest pain or angina are at risk for developing Wellen’s syndrome.

Indications of Wellen’s syndrome

Wellen’s syndrome is usually indicated when the T-way drops into the negative at a sixty to ninety degree angle. It often comes before a stenosis in their LAD artery. In addition to the T-waves there are other wave patterns that can help to indicate that a person may have Wellen’s syndrome, which include:

• The Q wave that normally comes before the large R wave will often go away along with the possibility of a slight elevation in the ST wave portion or lack of change in this wave.

Treatment

When a patient is displaying early signs of Wellen’s syndrome surgery or medical care must be done as soon as possible. If you are in your physician’s office when this abnormality is noted you will need to be transported to the nearest hospital. Because it can be life-threatening it is best if you are transported by ambulance as they can check your vital signs and give you supplemental oxygen. The physician may have you take an aspirin and you may also be given a nitroglycerin pill to help with the pain.

Once you have been stabilized you should see a cardiologist, a specialist in treating heart conditions. It is a medical condition that can be treated with surgery.

What is Mal de Debarquement syndrome?

This is a syndrome that appears related to motion sickness and is a very rare neurological syndrome. It is also a very poorly understood disorder. Another name for this syndrome is disembarkment syndrome. It can be traced back to the times of Darwin but it has only been recently that it has started to receive increased attention. Unfortunately, there has been very little scientific research done on this syndrome. The phrase mal de debarquement is French for disembarkation sickness. Most people

Symptoms/Characteristics

The characteristics of this syndrome are a persistent feeling of rocking, bobbing, or swaying after leaving something that has continual motion like an airplane flight. In addition, the person experiences extreme fatigue, difficulty in concentrating, and difficulty maintaining their balance. These symptoms will usually appear shortly after you debark or lands, from an airplane, cruise ship, etc. The symptoms are similar to what a person feels with motion sickness but last longer and there are no feelings of dull head pain or nausea present as with motion sickness.

Some other common symptoms can include:

• The feeling as if the land is swaying backward, forward, or sideways as it might feel on a boat
• Inability to walk a straight line
• Needing to hold onto a stationary object to keep from losing their balance and falling
• Dizziness
• Visual disturbances such as inability to focus, seeing motion, etc
• Migraine and/or headaches
• Feeling of pressure in their brain
• Anxiety
• Confusion
• Ear symptoms such as pain, decrease in hearing, a fullness in their ears, hearing of sound when no external sound is present or ringing (tinnitus), oversensitivity to certain volume and frequency ranges of sound (hyperacusis)
• Difficulty concentration such as short term memory loss, inability to recall words, inability to multi-task, inability to use a computer for any length of time
• Unable to watch television

The above symptoms will vary from person to person. There are some who experience these symptoms even when they are lying down or sitting still. These are debilitating symptoms and can vary on a daily basis, affecting social and daily activities. It appears as if the symptoms can increase from lack of sleep, flickering lights, sudden or fast movements, stress, crowds, busy patterns, and enclosed areas.

Causes

It is thought that is caused by a motion trigger such as being on an airplane, a cruise, or some other unstable, quickly moving transportation but it can happen spontaneously. Research has been done on this syndrome but they have not been able to tie this syndrome to any obvious problem in your brain or inner ear. There may be a chemical or physical deficiency in your brain or a genetic component but they are still researching these theories.

Diagnosis

Mal de debarquement syndrome is normally diagnosed when someone reports a persistent feeling of rocking even if they are not doing anything to cause these feeling. There are not definitive tests to diagnosis mal de debarquement syndrome but they can run tests to rule out other medical conditions that can cause these same symptoms such as an audiogram to test for hearing loss, posturography to see if they have the ability to maintain their balance, neurological exam such as a CT or MRI scan. Your physician will also do a medical exam and take your medical history, especially to see if you have been on a cruise or airplane trip.

Treatment

The symptoms/characteristics will often go away or lessen when they are in motion such as riding in a car. The treatment for mal de debarquement syndrome is palliative, which means helping to alleviate but not cure the symptoms. The medications that are used for motion sickness are ineffective in treating mal de debarquement syndrome.

Prognosis

Many people do feel unsteady for a few minutes but the symptoms of mal de debarquement syndrome can persist for more than thirty days and sometimes for years. If the symptoms have lasted longer than six months, there is less chance of remitting or going away. In some people the symptoms may diminish or disappear periodically only to reappear later after days, months, or even years. Sometimes the symptoms will come back after another cruise or airplane trip.

What are Mediastinal lymph nodes?

Lymph nodes, in general, are small bean shaped structures that are a very important part of your lymphatic system. Your lymphatic system is part of your immune system. The lymphatic system is an interconnected system of spaces, nodes, and vessels in your body that circulates lymph, which is a fluid made of various liquids and proteins. Your immune system is what keeps your body healthy and disease free. Lymph nodes are what acts as filters in your body fighting off bacteria and removing harmful particles. They also produce white blood cells to help fight infections. Because you are unable to notice when these lymph nodes are swollen if it is from cancer this medical condition can spread quickly through the mediastinal lymph nodes due to the location of adjoining lymph nodes.

Anatomy

Mediastinal lymph nodes are found in the region of your body called the mediastinum. This is the central compartment of your chest cavity between your heart and lungs. These lymph nodes surround your esophagus, pulmonary veins, and the central portion of your lungs, trachea, and aorta. The mediastinal lymph nodes are responsible for helping the thymus gland produce mature lymphocytes, which are a type of white blood cells, and helping to produce bone marrow. There are two major groups of mediastinal lymph nodes, which are, your:

• Anterior – these are located posterior, or behind, your sternum (breastbone) and anterior, or in front of, your heart. These lymph nodes surround the major vessels of your heart, thymus, and pericardium, the sac of fibrous tissue that surrounds your heart.
• Posterior – these are located posterior, or behind, your heart and anterior, in front of, your spinal column. These run in a vertical string along your thoracic cavity near your aorta, trachea, and esophagus.

Causes of enlargement

These particular lymph nodes can become enlarged due to various conditions that can include:

• Infection
• Cancer – chronic lymphocytic lymphoma, non-Hodgkin’s lymphoma, testicular cancer and other cancers of your lungs, esophagus, and stomach
• Sarcoidosis – this is an inflammatory disease that affects multiple organs in your body but mostly your lymph glands, skin, eyes, and lungs
  Lung diseases—these can be caused by a number of pathologic agents that include different types of fungi and bacteria

Diagnosis

Most lymph nodes in your body can be felt through your skin but mediastinal lymph nodes cannot. They can be evaluated only by using radiographic techniques. When using x-rays taken of your chest they can show a widening of your mediastinal region. To get a more definitive diagnosis they would need to do a CT scan of your chest. If you are being evaluated to see if the mediastinal lymph nodes are enlarged secondary to the spread of cancer the radiologist will use a positron emission technology scan (PET) to identify these lymph nodes.

Because mediastinal lymph nodes are not noticeable as they swell they may also do a procedure called a mediastinoscopy to see if these lymph nodes are swollen. When this procedure is done a tube will be inserted into your chest to look for the swelling of these lymph nodes and tumors. This procedure is done under general anesthesia as an outpatient procedure.

Why do a biopsy?

When mediastinal lymph nodes are abnormal they may be access surgically for a variety of reasons such as the suspicion of cancer. They may do a biopsy of the lymph node to see if it has been affected by the spread of cancer along with the prognosis. It can also help to determine what treatment would be best used. If a patient has enlarged mediastinal lymph nodes and a biopsy is done under a microscopic examination it can help the physician known what the underlying medical condition is for them being abnormally enlarged.

Treatment

If the mediastinal lymph nodes are cancerous what treatment used will depend on the stage and location of the cancer. If it is decided to treat these lymph nodes the surgeon can do a mediastinal lymphadenectomy, which was first performed in 1951. Although it can be used to stage lung cancer they have still not decided if the benefits from the surgery are worth the risks of the procedure, such as not increasing the survival rate and accuracy in staging the cancer. Because mediastinal lymph nodes cannot be treated easily it is best to detect any cancers of your esophagus, stomach, and lungs early.

What is an Aneurysmal bone cyst?

This is a fibrous blood-filled bone lesion and can potentially destroy bone tissue. It can also grow rapidly and is usually benign. They are called aneurysmal because they resemble an aneurysm when they are viewed on an x-ray. It is a rare type of bone cysts and of all bone tumors (cyst) they account for one to six percent. An aneurysmal bone cyst can grow in any bone in your body but the most likely location is the bones of your knee, your skull, your spinal vertebrae, and your limbs. They are more commonly found in teenagers with approximately eighty-six percent of them developing in those younger than twenty years of age. They can develop in any age group but on average most are between the ages of thirteen and seventeen. Females are more likely to have these than males.

Symptoms

Many times an aneurysmal bone cyst does not cause symptoms because they are so small but if they do, what they will be depends on where these aneurysmal bone cysts are located. If there are symptoms they will be at the site of the cyst and can include:

• Bone deformity
• Bone pain
• Swelling
• Feeling of warmth in the area that is affected
• Joint stiffness, reduced range of motion, or weakness if it located near a joint
• Neurological symptoms if it grows in your spinal bones
• Weaken bone tissue that can lead to an increased risk of a fracture if the cyst grows rapidly

Causes

It is unknown what the exact underlying cause of aneurysmal bone cysts are. Some will develop in areas:

That is in conjunction with other types of malignant or benign bone tumors
Where bone trauma has occurred previously
That are absence of any other trauma or disease

Diagnosis

When an aneurysmal bone cyst is so small it does not cause any symptoms they are usually only discovered when they have x-rays for an unrelated cause.

Treatment

If it is necessary to treat an aneurysmal bone cyst it will usually include surgery to remove the cyst and to repair the bone that is affected but surgery is not always required. The treatment most commonly used is cottage of the aneurysmal bone cyst followed by bone grafting. This procedure involves opening the cyst and scraping out the contents using a scooped instrument called a curette. Once it has been cleaned out it will be filled in with a bone graft or other synthetic filler. This procedure is done under general anesthesia and generally will require an overnight stay in the hospital but may be done as an outpatient surgery. It takes approximately sixty minutes to do the surgery. Unfortunately, this procedure has the highest potential for recurrence. The reason is because of the difficulty in removing all the contents of the aneurysmal bone cyst.

Sometimes after curettage, they will use cryotherapy to help reduce the possibility of recurrence. This is a form of cold therapy but this therapy can cause nerve damage or bone fractures so it is not a common form of treatment. If the cyst is located in a bone that is non-weight bearing it can be removed via complete excision instead of curettage of the interior of the cyst. If it is possible to completely remove the aneurysmal bone cyst it will reduce the risk of recurrence.

If the aneurysmal bone cyst is growing very slowly or not growing at all it is not treated. In these cases you will be monitored for any signs that the rate of the growth of the cyst is increasing. Monitoring can include regular MRI or CT scans to evaluate the size of the cyst.

Follow-up Care

After having the surgery you will follow up with your orthopedic surgeon in seven to fourteen days, then again at three months and six months. You will also be check once a year to see if the cysts are recurring.

What is a Salter-Harris fracture?

This is a break nearby or in the bone’s growth plate. The growth plate is also referred to as the physis or epiphyseal plate. A growth plate is the anatomical structure that you find at the ends of the long bones of adolescents and children. It lies between your epiphysis at the bottom and your metaphysis at the top. In these plates are cells that are rapidly dividing and allowing the bones to become longer until the end of puberty is reached. It is a fracture you will only find in children and adolescents who are still growing. When these damaged bone cells grow it could be at a decelerated or accelerated rate. This can cause a noticeable different in the length of the bones. A Salter-Harris fracture accounts for approximately fifteen percent of all long bone fractures in children and adolescents.

This type of fracture was first described in 1963 by Robert B. Salter and W Robert Harris. A Salter-Harris fracture occurs most often in the lower leg or arm or the fingers.

Classification

With Salter Harris fractures they are classified from one to nine according to the growth plate damage and the area of the bone that is fractured. Using this classification system it can help to indicate if surgery will be necessary to realign the fractured bone and stabilize it. Classification one through five are mainly the ones used and the last four classifications are rarely used.

• Type one – the fracture passes through the growth plate but affects no other surrounding bones. It occurs in approximately six percent of these fractures and is usually seen in younger children.
• Type two – the fracture passes above the growth plate and up through the wide portion of the long bone, called the metaphysis, but not the rounded end of the long bone at its joint, called the epiphysis. This occurs in approximately seventy-five percent of these fractures and is the most common type of this fracture, especially in older children.
• Type three – the fracture passes below the growth plate and the epiphysis, exiting through the end of the bone and into the adjacent joint but not the metaphysis. Because the joint cartilage has been disrupted this fracture can be concerning. This occurs in approximately eight percent of these fractures. It happens more in older children.
• Type four – the fracture starts above your growth plate then passes through it, the metaphysic, and the epiphysis, exiting through the joint cartilage. It is often associated with disrupted bone growth patterns. It can result in having a lasting disability. This occurs in approximately ten percent of these fractures
• Type five – when this fracture occurs their growth plate is crushed between the metaphysic and the epiphysis. This fracture can cause a severe decrease in their bone growth. If it permanently injures the growth plate further treatment later may be needed to restore the alignment of the limb. This occurs in approximately one percent of these fractures.

Symptoms

• Swelling
• Pain
• Tenderness
• Change in the shape of the area that is different than what it normally looks like
• Not being able to put weight on the leg
• Not being able to move the injured area

Risks

Any child who is still growing can be at risk for having a Salter-Harris fracture. The highest risk groups are teenage males. Other risks can include:

• Those involved in sports such as basketball, soccer, and football players, wrestlers, and gymnasts
• Falls from skis, skateboards, bikes
• Motor vehicle accidents
• Abuse or assaults such as twists or hard pulls to the leg, arm, or fingers

Diagnosis

When it is thought that the child or adolescent has a Salter-Harris fracture they will do an x-ray but at first they may not be seen on the x-ray. In some cases it can take up to fourteen days before the physician can see them on an x-ray.

Treatment

Because a Salter-Harris fracture may take up to fourteen days to appear on an x-ray they may put a child or adolescent in a splint or cast if it suspected they have this type of fracture to prevent any further injuring to the surrounding bone and growth plate. Once it identified as a definite Salter-Harris fracture how it is treated depends on the age of the child and on which classification it is.

• Type one – to treat this classification they will cast it to prevent any movement of the bone. Once it has healed there is no residual bone growth problems
• Type two – this fracture is also requires casting to prevent movement. Once it has healed, the bone growth will continue normally. The growth plates will need to be repositioned and is done under anesthesia.
• Type three – because it goes through the epiphysis some of it may break off and require surgery to correctly realign the bone. Once it is correctly set then it will be put into a cast to immobilize it.
• Type four – it is often necessary to have it surgically aligned to hold the fragments of bone into place before they can put the bone into a cast.
• Type five – to stabilize the bone and resurface the joint it may be necessary to have surgery. After the cast is removed it may be necessary to do physical therapy to encourage easier mobility.

With any classification you should make sure that you are keeping the splint or cast above the level of their heart as often as you can for one to three days. Using an ice pack can also help to decrease the swelling and pain. Make sure that you do not get the cast or splint wet and check circulation often. If the child starts to feel tingling in their fingers or toes or they start to look blue or feel cold, elevate the limb and call the orthopedic doctor or family position as these can signal something is wrong.

Recovery time

The recovery time will also depend on the classification of the fracture.

• Type one, type four, and type five – approximately four to six weeks healing time
• Type two – approximately six weeks healing time
• Type three – up to six weeks healing time

Complications

When a child or adolescent has a Salter-Harris fracture there is a chance that the bone may not heal at all or heal poorly. Over time the bone growth could stop or slow down with some types of these fractures. The limb that was affected could become shortened or bent and have a limited range of motion, or movement. There is also a change of developing an infection and it could also damage the blood vessels, muscles, and nerves around the bone.

What is a torus fracture?

This is a bone deformity that only occurs in children in which a bone buckles and bends but does not fracture completely. It breaks on one side, buckles outward on the other side, and does not completely break. The reason that it occurs only in children is that their bones are softer than an adult’s bones. This type of fracture commonly occurs in the ulna, which is a bone in your lower arm, or your radius, which is one of the large bones in your forearm. It is also known as a buckle fracture. The word torus is derived from the Latin word tori, which means protrusion.

Symptoms of a Torus Fracture

• The wrist is swollen and painful
• Tenderness
• Redness
• Inflammation and swelling that can cause reduced movement and stiffness of the wrist joint
• In babies and toddlers they may cry and be inconsolable
• In older children they may be very protective about the part that is fractured

Causes

Many of these fractures occur when a child falls and stretches out their hand during the fall to catch themselves but the impact is too great. This can happen if a child falls off their bicycle, roller skating, using a skateboard, or falling off furniture, bed, or playground equipment.

Diagnosis

If the physician feels there may be a torus fracture, they will order x-rays to be taken to see if there are any signs of buckling. When doing the x-rays they will take x-rays of the elbow and wrist to rule out any dislocations. If it does not show a torus fracture on the first set of x-rays but there still seems to be a problem they will normally do a second set of x-rays two weeks after the first set.

Treatment

This type of fracture is normally treated by casting the fracture for three to four weeks in a short arm cast to help prevent further injury. The main reason for casting and immobilizing the fracture is to help with the discomfort and pain. This type of fracture is the one that is quickest to heal so that is why it usually only takes three to four weeks of wearing a cast to heal a torus fracture. Some physicians will put a splint on the fracture instead of a cast if the fracture is a minor wrist fracture. Most physicians prefer to cast the fracture because the child cannot take it off as easy as they can a splint. If they remove the splint, it will delay their recovery. To make sure that the bone has healed properly there will be a second set of x-rays done before they remove the immobilization device.

If the child is in pain, the physician will have them to take over-the-counter pain medication. They should also keep the arm elevated when sitting down. For the first few days after applying a cast the physician may have the child wear a sling to give the arm some support.

What is your deltoid ligament?

This triangular shaped band binds your tibia to the inner bony protrusions on the side of your ankle. It helps to prevent your ankle from rotating to the outside and offers support to your ankle. Your tibia is the scientific name for your shinbone, which is the largest of the two bones that are located between your ankle and knee and is considered to be the strongest weight-bearing bone in your body. This ligament is also known as your medial ligament. Because of the strength of the deltoid ligament and the anatomical structure of your bones, injuries and sprains to this ligament are rare but they can happen and is very common in athletes who run long distances on soft or uneven surfaces.

Anatomy

Your deltoid ligament is made of both deep and superficial fibers and is one of the strongest ligaments in your body. It is the ligament that helps support the arch of your foot. The fibers connect your medial malleolus of your tibia bone to the four areas of your foot. Your medial malleolus is the spherical bony protrusion on the inner side of your leg just above your ankle joint. The deep fibers of the deltoid ligament extend from your medial malleolus to the surface of your talus medial surface. The superficial fibers attach at three of the four points, which are the anterior, posterior, and middle aspects of your talus. Your talus is the bone that is between your leg and foot and is Latin for ankle bone.

Injuries that can occur to your deltoid ligament

Although injuries and sprains are rare, you can suffer from ligament sprains. Only five to ten percent of all ankle sprains are sprains of your deltoid ligament.

Symptoms

When you have an injury to your deltoid ligament due to a tear or sprain you may feel pain on the inside of your ankle. You make also see rapid swelling in some cases. If you have torn the deltoid ligament, you may see some bruising. It may also become difficult to bear any weight on the joint and make walking difficult. How severe the symptoms are will depend on the extent of the deltoid ligament injury and the grade. With Grade one, you may see no or mild instability with some pain and stiffness in the joint and little swelling. With Grade two, you may have moderate instability, swelling, stiffness in the joints, and moderate to severe pain. With Grade three, there is severe pain and swelling.

Grades

The injuries to your deltoid ligament are put into different grades, which helps to know which type of treatment to use. Grade one is normally caused by the stretching of the deltoid ligament and has minor symptoms. Grade two usually involves a partial tear and more pain. Grade three is usually a complete tear of your deltoid ligament.

Causes

This type of injury can happen for two reasons. One is your fibula bone, which is the bone that helps to make sure that your ankle joint does not move too far, could become torn or strained due to a sudden movement, causing your foot to be twisted outward. It can also happen if there is a fracture of some bone that is located in your ankle joint or your fibula and tear the ligament. These types of injuries are often referred to as an eversion sprain or medial ankle sprain. You can also injure your deltoid ligament just from overuse or general wear and tear. Your deltoid ligament supports your arch so if a person has knocked knees or flat feet they may find themselves more susceptible to injuring the ligament.

Diagnosis

If you see your physician for an injury they will order x-rays to see if you have a fracture in the area in addition to the deltoid ligament injury.

Treatment

With general treatment the first part is to give your ankle sufficient rest so the deltoid ligament can heal on its own. To help with the swelling you can use an ice pack every two to three hours for fifteen minutes at a time or a compression bandage. You also need to make sure that you do not carry any heavy weights. To keep the swelling to a medium keep your leg elevated. To help regain full mobility you may need to undergo physical therapy, which can also help to strengthen your ankle joint. If the injury takes more than forty-eight hours to heal you should talk to your physician to make sure there is no internal injury to your deltoid ligament. Some may have to undergo deltoid ligament repair surgery, which will require prolonged immobilization as a postoperative treatment. Sometimes a person can wear specialized orthopedic shoes to help prevent painful strains on their deltoid ligament and help them to recover from a minor injury.

Diet

To help repair the tear in a deltoid ligament you should make sure that you are eating foods rich in protein. The amino acids that are converted from proteins are very important in new tissue assembly. You should make sure that you are eating two three servings of foods rich in protein each day such as beans, shellfish and regular fish, and skinless poultry. One of the main components that make up ligaments is collagen so you should also increase your intake of vitamin C to help stimulate collagen development. Pineapples and oranges are rich in vitamin C.

What is a Bankart lesion?

This is an injury to your shoulder joint, which leads to having shoulder instability. It is also may be referred to as a labral tear. The reason is that it is characterized by having a tear in you labrum, which is a ring of cartilage that stabilizes the bone of your upper arm where it articulates with your shoulder. These types of injuries are especially common in younger people under the age of thirty. When you have this type of lesion you may experience recurrent dislocations of your shoulder. Your shoulder may also feel slippery or loose. Depending on what caused your Bankart lesion you may also have other injuries in the joint.

This type of lesion is named after Arthur Sydney Blundell Bankart, who was an English orthopedic surgeon.

Symptoms of Bankart Lesion

When you have a Bankart lesion, your shoulder joint will feel unstable and is extremely painful. Some of the other symptoms you might experience can include:

• Having a sense of instability
• Repeat dislocations
• Aching of your shoulder
• Catching sensations

Causes

The most common reason to have this injury is due to a shoulder dislocation. If your shoulder is pushed too far forward and down you can tear the cartilage in the joint as it dislocates. It can also happen due to repetitive movement of your shoulder, such as being a baseball pitcher.

Diagnosis

To determine if you have a Bankart lesion or not the physician will order medical imaging studies such as an x-ray or MRI. The physician will also do a physical examination and take a full medical history to learn more about what symptoms you are experiencing. When the physician is doing a physical exam and tries to place the arm behind the head you may have the sensation of your shoulder about to dislocate.

Treatment

Once you have been diagnosed with a Bankart lesion there are two treatment options, which include conservative care or surgery.

Conservative care

With this treatment, your shoulder will be rested and the strain on it will be reduced to allow your shoulder to heal on its own. To help rest it your shoulder it is usually supported using a sling. You will also take over-the-counter anti-inflammatory medications for the inflammation and pain. Sometimes, with sufficient rest, the cartilage will be able to repair itself, resolving the tear but with this treatment there is always the chance of another dislocation.

Surgery

Usually most patients will require surgery, referred to as a Bankart lesion repair, to correct the tear. After you have surgery you will need to wear a sling and follow the aftercare instructions to help reduce the risk of reinjury.

Rehabilitation

After having surgery your rehabilitation begins almost immediately because within the first few days you will start doing passive range of motion of your shoulder. Following surgery for the first four to six weeks the focus will on getting back as much range of motion that you can while you are protecting the surgical repair. During this period you should start to see the strength of your shoulder improving and a decrease in pain. Sometime during this time frame you will start to focus on increasing the strength of your shoulder but when will depend on your progress. As the strength in your shoulder improves your functional level will also. When following this program and time frame you should be able to return to your full level of activity as before you had a Bankart lesion without having the risk of shoulder dislocation. Over ninety percent of patients who have chosen surgery do not have further dislocations.

Aftercare

Whether you use conservative care or have to have surgery once the Bankart lesion is repaired you should have physical therapy. Having physical therapy will help to strengthen your shoulder joint so you are less likely to experience injury again. By undergoing physical therapy you can also help to resolve the stiffness and pain in the joint that can develop after prolonged disuse.

What is a femoral neck fracture?

This is a break that occurs in the femur bone of your leg. The femoral neck fracture occurs just under the ball-shaped head that fits into your hip socket. It is a fracture that is commonly found in older individuals who are suffering from osteoporosis and athletes who play contact sports. When a person has a femoral neck fracture the ball will become disconnected from the rest of your femur. This type of fracture causes more hospitalizations than any other broken bone injury. It is an injury that occurs more in females than males and in Caucasians than other ethnic groups.

Anatomy

The femur is the strongest, thickest, and longest bone in your body and extends from your pelvis to the top of your knee. For an average size person this bone will typically measure about twenty inches. It is a critical component of the human body that ensures energy is distributed downward to your foot and gives support to your entire upper body. It has an essential role in someone walking, jumping, standing, and running. The main shaft of your femur is connected to the round head by the femoral neck. The femoral neck is a relatively thin section of bone.

Symptoms

When a person suffers from a femoral neck fracture there is immediate stiffness and pain. You will also be unable to bear weight on the leg or move it without extreme discomfort. The joint will usually swell.

Causes

The cause is usually due to direct trauma to the hip such as:

• An athlete being hit from the side or falls awkwardly due to the sheer force of impact on their hip joint
• Osteoporosis, which is a condition that leads to the fragility and erosion of bone tissue, even if the fall is minor or because of a sudden twist
• Malnutrition
• Poor vision
• Disorders that affect your muscle stability
• Obesity

Diagnosis

A femoral neck fracture is normally diagnosed by having x-rays taken.

Complications

With this type of fracture there is a primary concern that the damaged blood supply to the bone will lead to non-healing, even with surgery or other treatment. It can also lead to hip osteonecrosis, which is death of the femoral head. If this happens you may require hip replacement surgery later. When you have a femoral neck fracture you should not expect to regain the same level of physical activity that you had before the injury. Having one femoral neck fracture increases your risk of having another. Some suffer from depression because of the length of recovery and from the changes to your lifestyle and activity levels.

Treatment

When someone suffers a hip injury, it is essential to call an ambulance to take them to the hospital instead of someone else transporting them. The reason is that the leg should be immobilized to prevent damage to nearby tendons, ligaments, and the rest of their hip joint so it is best if they are placed on a stretcher to be transported. After the x-ray is taken, it will carefully analyzed to make sure that the blood supply has not been cut off and if it has then emergency surgery will be done to restore the flow of blood and prevent muscle and bone tissue death.

In order to prevent further damage to your hip socket it is important to have an emergency evaluation. This will also help determine the most appropriate treatment. The surgeon can try to manually set the bone back into place and then wrap it in protective padding but usually you will have to undergo a surgical procedure in order to promote proper healing. It all depends on the severity of the injury. What treatment is used also depends on the age of the person. If you are under sixty to sixty-five years of age, the surgeon will try to avoid doing a partial hip replacement. The reason is that the prosthetic used in partial hip replacements seem to wear out in people who are younger and more active.

Surgery

There are two ways in which a surgeon can fix your femoral neck fracture. If it is a severe break or the bones are fragile because of osteoporosis the surgeon may need to replace your hip joint.

Hip pinning

he surgeon can pin your hip socket together using two or three metal screws through your hip joint and femoral head to keep your leg in place while it heals. This is normally done if the femoral neck fracture is minimally displaced and well aligned. In younger patients this may be attempted even if the bones do not properly aligned to avoid doing a partial hip replacement. If it does not work then a partial hip replacement might be necessary. When this method of treatment is used it is done under either spinal or general anesthesia. On the outside of your thigh the surgeon will make a small incision. Using x-ray the surgeon will pass several screws across the femoral neck fracture to stabilize the broken bones.

Hip hemiarthroplasty

This is a partial hip replacement and involves removing the surrounding hip socket and femoral head and inserting a lightweight metal prosthesis in their place. Many times this is the procedure that is used to treat a femoral neck fracture because of the problems with blood supply that is diminished when a person has this type of fracture. This procedure is also performed under spinal or general anesthesia. There will be an incision made over the outside of your hip to do the surgery. For patients with thinner, more osteoporotic bone the prosthetic stem can be cemented into the bone. If you have better bone quality it can be press-fit into the bone.

Prognosis

Even with physical therapy and careful monitoring it will usually take several months to recover from a hip injury. In most cases you can regain the ability to engage in a limited level of regular physical activity.