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HAND. Carpal Tunnel
The first symptoms of CTS may appear when sleeping, and typically
include numbness and paresthesia (a burning and tingling sensation
in the fingers, especially the thumb, index, and middle fingers).[3]
These symptoms appear at night because many people sleep with bent
wrists which further compresses the carpal tunnel. If the median nerve
is already under stress, the increased compression of the bent wrist
creates the numbness and tingling. Difficulty gripping and making
a fist, dropping objects, and weakness are symptoms of progression.
In early stages of CTS individuals often mistakenly blame the tingling
and numbness on restricted blood circulation and they believe their
hands are simply "falling asleep".
It is important to note that unless numbness or paresthesia are among
the predominant symptoms, it is unlikely the symptoms are primarily
caused by carpal tunnel syndrome. In effect, pain of any type, location,
or severity with the absence of significant numbness or paresthesia
is not likely to fall under this diagnosis.
Clinical assessment by history taking and physical examination can
frequently diagnose CTS.
• Phalen's maneuver is performed by flexing the wrist gently
as far as possible, then holding this position and awaiting symptoms.
A positive test is one that results in numbness in the median
nerve distribution. The quicker the numbness starts, the more
advanced the condition.
• Tinel's sign, a classic, though less specific test, is
a way to detect irritated nerves. Tinel's is performed by lightly
tapping (percussing) the area over the nerve to elicit a sensation
of tingling or "pins and needles" in the nerve distribution.
• The carpal compression test, or applying firm pressure
of the palm over the nerve to elicit symptoms has also been proposed.
• If, based on history and physical examination, a CTS diagnosis
is suspected but not clear, patients will likely be tested electrodiagnostically
with nerve conduction studies and electromyography; MRI or ultrasound
imaging are also used.
If symptoms resolve with non-surgical interventions, surgery can
be avoided. If not, then the "carpal tunnel release" surgery
is recommended.
Find out here about your
adviced recovery period.
HAND. Dupuytren Disease
Symptoms of Dupuytren’s disease usually include a small lump
or series of lumps and pits within the palm. The lumps are generally
firm and adherent to the skin. Gradually a cord may develop, extending
from the palm into one or more fingers, with the ring and little fingers
most commonly affected. These cords may be mistaken for tendons, but
they actually lie between the skin and the tendons. In many cases,
both hands are affected, although the degree of involvement may vary.
The initial nodules may produce discomfort that usually resolves,
but Dupuytren’s disease is not typically painful. The disease
may first be noticed because of difficulty placing the hand flat on
an even surface, such as a tabletop. As the fingers are drawn into
the palm, one may notice increasing difficulty with activities such
as washing, wearing gloves, shaking hands, and putting hands into
pockets. Progression is unpredictable. Some individuals will have
only small lumps or cords while others will develop severely bent
fingers. More severe disease often occurs with an earlier age of onset.
Various surgical techniques are available in order to correct finger
position. Your treating surgeon will discuss the method most appropriate
for your condition based upon the stage of the disease and the joints
involved. The goal of surgery is to improve finger position and thereby
hand function. Despite surgery, the disease process may recur and
the fingers may begin to bend into the palm once again. Before surgery,
your treating surgeon will discuss realistic goals and results.
Find out here about your
adviced recovery period.
RECONSTRUCTIVE. Skin
cancer
While skin cancers can be found on any part of the body, about 80
percent appear on the face, head, or neck, where they can be disfiguring
as well as dangerous.
The primary cause of skin cancer is ultraviolet radiation -most often
from the sun, but also from artificial sources like sunlamps and tanning
booths.
Anyone can get skin cancer-no matter what your skin type, race or
age, no matter where you live or what you do.
Basal and squamous cell carcinomas can vary widely in appearance.
The cancer may begin as small, white or pink nodule or bumps; it can
be smooth and shiny, waxy, or pitted on the surface. Or it might appear
as a red spot that's rough, dry, or scaly...a firm, red lump that
may form a crust...a crusted group of nodules...a sore that bleeds
or doesn't heal after two to four weeks...or a white patch that looks
like scar tissue.
Malignant melanoma is usually signaled by a change in the size, shape,
or color of an existing mole, or as a new growth on normal skin. Watch
for the "ABCD" warning signs of melanoma: Asymmetry-a growth
with unmatched halves; Border irregularity-ragged or blurred edges;
Color-a mottled appearance, with shades of tan, brown, and black,
sometimes mixed with red, white, or blue; and Diameter- a growth more
than 6 millimeters across (about the size of a pencil eraser), or
any unusual increase in size.
Skin cancer is diagnosed by removing all or part of the growth and
examining its cells under a microscope.
Most skin cancers are removed surgically. The procedure may be a simple
excision, which usually leaves a thin, barely visible scar. Or curettage
and desiccation may be performed. When the lesions are larger a more
complex surguical reconstruction may be hended.
If you are in doubt you can ask for an assessment with us.
Find out here about your
adviced recovery period.
RECONSTRUCTIVE. Scar Revision
Scars -whether they're caused by accidents or by surgery- are unpredictable.
The way a scar develops depends as much on how your body heals as
it does on the original injury or on the surgeon's skills. Not all
the scars are the same and they may be treated with different methods.
If you're bothered by a scar, your first step should be to consult
us. Your surgeon will examine you and discuss the possible methods
of treating your scar, the risks and benefits involved and the possible
outcomes. Please do not hesitate to ask any questions or express any
concerns you may have.
Find out here about your
adviced recovery period.
RECONSTRUCTIVE. Breast Reconstruction
We believe that breast reconstruction begins before the cancer is
even diagnosed. You need to know that the majority of the breast cancer
develops in patients without family history of this disease. It is
only 5-10% of the breast cancer patients who are due to a genetic
mutation.
Perhaps you have heard of BRCA1 & BRCA2 genes.
In 1990, DNA linkage studies on large families with the above characteristics
identified the first gene associated with breast cancer. Scientists
named this gene “breast cancer 1” or BRCA1 (pronounced
brak-uh). BRCA1 is located on chromosome 17. Mutations in the gene
are transmitted in an autosomal dominant pattern in a family.
Since it was clear that not all breast cancer families were linked
to BRCA1, studies continued and in 1994, scientists discovered another
gene (similar to BRCA1) and named it BRCA2. BRCA2 is located on chromosome
13. Mutations in this gene are also transmitted in an autosomal dominant
pattern in a family.
When a person has one altered or mutated copy of either the BRCA1
or BRCA2 gene, their risk for various types of cancer increases:
BRCA1 Mutation
• 50 percent to 85 percent lifetime risk for breast cancer
• 40 percent to 60 percent lifetime risk for second breast
cancer (not reappearance of first tumour)
• 20 percent to 60 percent lifetime risk for ovarian cancer
• increased risk for other cancer types, such as prostate
cancer
BRCA2 Mutation
• 59 percent to 82 percent lifetime risk for breast cancer
(in females)
• 6 percent lifetime risk for breast cancer (in males)
• up to 27 percent lifetime risk for ovarian cancer
• increased risk for other cancer types, such as pancreatic,
prostate, laryngeal, stomach cancer, and melanoma
These genes can be detected in a simple blood test and it take
about 4 to 6 weeks.
• If you are younger than 50 y/o , you have family history
of both breast and ovarian cancer, prostate cancer, male breast
cancer or Ashkenazi Jewish ancestry you may be interested in having
your genes tested for BRCA1 or BRCA2.
• From the moment your blood is taken it takes about a month
to know the results.
• If you don´t have BRCA1 or 2 your risk of having
breast cancer still exists as the rest of the normal population.
As a patient who has had a
mastectomy done, we will consider
your case 4 months after your
chemotherapy is finished and
6 months after your radiotherapy
is finished. This will allow
your tissues and general health
to be fit for a reconstructive
procedure.
We will require a document form
your oncologist that states
that you are tumor free before
we consider you for reconstruction.
There is a variation of methods
that can be used for this procerure
and this will depend on your
general health, skin condition,
body constitution and your wishes
of course. Generally there are
two types of breast reconstruction,
those performed with autologous
tissue(tissue from your own),
those performed with anatomical
breast prosthesis and those
that use the two former techniques.
There are advantages and disadvantages
for each of the procedures and
as a general rule, the procedures
using breast prosthesis are
simpler, quicker and easier
to recuperate and the ones done
with your own tissues are more
complex and of longer recovery.
The surgical options will have
to be discussed between you
and your surgeon in detail.
Find
out here about your adviced
recovery period.
For more information:
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or TEL 00 34 945 467
393
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