SUNDAY MAGAZINE

Ask the Doc

Dr. R.P Mittal, Consultant Orthopaedic Surgeon, NDMC Charak Palika Hospital, New Delhi, replies to this week's queries. I AM a 31-year-old male. Last October I met with an accident, which resulted in left hipbone dislocation and a fracture in the head of the bone. I was operated upon and a plate was put. But the accident resulted in a damaged nerve, which resulted in foot drop. Since then I have recovered all the related movements except the foot. I do regular exercises like working the ankle, standing on a platform and working the calf muscles. I use an ankle strap to walk comfortably. Recently I underwent a nerve conduction test but was not told whether the nerve is recovering. What are the possibilities for total recovery? DineshAnswer: You had fracture dislocation of left hip with partial sciatic nerve injury one year back. Foot drop has not recovered as nerve injury was of severe nature (Axonotmesis or Neurotmesis). Rate of nerve recovery (regeneration) is one mm a day, so it comes to about 35-36 cm in one year that is up to knee joint for average height. After waiting for two to three months, tendon transfer can be planned after checking muscle strength around the ankle.MY daughter, 24, years has been getting pain in the leg for the last three years. Pain occurs either on the side of hip or lateral side of knee or under side of toe. Joint is not involved, only tendons. Pain subsides with a single tab of Etoricoxib 90mg. At first the frequency was about a month but for two years it is in a three to four day interval despite treatment. No fever, rash, loss of weight or other symptoms. She had H/o urticaria associated with abdominal pain at the age of seven, frequent attacks for two years then subsided and not recurred. She was first given HCQS 1tab, Sulfasalazine 1tab and folic acid for four months. Then she was put on Methotrexate 5 mg and HCQS for six months. Now she is taking Colchicine one tablet daily, as suggested by a rheumatologist. But the pain occurs every three to four days. She has to take etoricoxib. Name WithheldAnswer: Your daughter's symptoms are intermittent pain on sides of hips (trochantric area), lateral sides of knees and below toes. The only positive investigation is ANA. Most patients of lupus (SLE) test positive for ANA. However, there are number of other causes of positive ANA besides lupus, including infection and other autoimmune disease. Occasionally it is also found in healthy people.When the cause of patient's symptoms remains unclear, a skin biopsy may be confirmatory. In any case, she does not seem to suffer from active disease, as she is afebrile and there is no involvement of other organs like kidney, lung, or the nervous system.She has to avoid stress as it may aggravate her symptoms. Topical injection of long-acting steroid (Triamcinolone) will relieve her symptoms. She may take anti-inflammatory medicines occasionally but continuous use may affect kidney function. When other organs (chest pain, abdominal pain or epilepsy) are involved, aggressive treatment with injects like glucocorticoids and immunosuppesants is indicated.I AM 31. For the last one year I am feeling pain near the ankle especially when I wake up. I get relief after some movement or after five to 10 minutes walk only. Normally I do not feel pain but if pressure is applied then there is pain. Immediately after waking, I am unable to walk properly. Is this a sign of some serious problem? Nishu SharmaAnswer: In your case, exact location of tenderness (pain) can be ascertained by clinical examination only. It appears you have morning stiffness below the ankle i.e., planter fascitis. This is not a serious problem. Planter fascitis can be treated by physiotherapy (ultra-sonic massage) and analgesics. Consult an orthopaedic surgeon for clinical examination.I AM suffering from minimal posterocentral disc protrusion at C5-C6 level and at minimal right paracentral disc protrusion L1-L2 according to my MRI report. I am having nerve pain on my left side in the shoulder, left hip (both front and back) and the left leg for almost two years. I have taken painkillers but that does not help. Is there any permanent cure for my problem? RanjithAnswer: The MRI finding is not significant, as it does not correlate with symptoms. Go for a detailed clinical examination by an orthopaedic surgeon to find the cause of pain. Shoulder pain may be due to nerve root irritation from C5-C6 disc bulge. If it is not associated with muscular weakness, it can be treated by conservative methods like cervical collar, heat application and analgesics. Send your queries toAsk the Doc, Magazine, The Hindu, Kasturi Buildings,859-860, Anna Salai,Chennai - 600 002. or e-mail: askthedoc@thehindu.co.in





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