Posts Tagged ‘pain management’
Chronic Segmental Low Back Stiffness
Most of us start off with a beautifully mobile and smooth running back and rarely are we stiff backed unless there is a reason for it. The back is well evolved to do the job it has to do and does this mostly very well. Spinal bones are separated from the vertebrae by discs which are thicker in areas of greater mobility and greater load, allowing more movement. Facet joints at the back of the spine limit and control spinal motion, stopping inappropriate spinal displacement in response to the loads placed on the spine. Muscles are strong, in balance and working in harmony to achieve the movement and stability required.
An acute episode of low back pain inhibits the core stabilising muscles from working well and can cause wasting of them with time. Segmental loss of stability control can make the occurrence of further low back pain episodes at the same level more likely. As time and injuries change the spine, degenerative changes can occur in the facet joints and discs, leading to segmental stiffness and chronic back pain. The force of gravity pushes fluid from the discs by compression and is opposed by a chemical absorption of fluid which is more powerful in lying.
As compression forces tend to be more powerful as time goes on, dehydration of the disc occurs to some extent as it narrows and stiffens. This can be imaged on x-ray but the disc is likely to show changes and painful problems long before the results can be seen on x-ray. A segment is defined as two adjacent vertebrae and the intervening intervertebral disc, an altered disc contributing to an abnormal segment which moves abnormally and pushes abnormal loads onto tissues where they are not designed to take them. Physiotherapists can feel the restrictions in spinal movements which occur when a stiff segment limits segmental excursion.
Protective muscle spasms are common after an injury and this splints the affected area and allows the process of inflammation and healing to get started. With the gradual resolution of the injury and its pain reduction the amount of back spasms normally lessens and slowly normal movements begin to be apparent again. But muscles can remain in muscle spasm in some cases, leading to a stiffened and shortened group of spinal structures which, by this adaptive shortening, leads to the production of shortened and abnormal spinal joints, ligaments and muscles.
Sitting for extended periods can increase the likelihood of suffering from increased compression of the lumbar discs with consequent fluid loss. Repeated flexion maintains the regular cycle of fluid uptake and avoidance of this movement interferes with this important process for disc health. The maintenance of abnormal posture and lack of strength in the abdominal muscles are also important factors.
Having a series of acute episodes of lumbago can predispose to developing a segmental stiffness problem, often with the stiff or abnormally moving segments of the spine having been present for a long period before they start to give pain symptoms. Actions which make this syndrome worse will tend to hold the spine in flexion for long periods or at end ranges, such as sitting for extended times and bending forwards repeatedly, actions which push joints further than their limits of comfort. The spinal facet joints develop an extension dysfunction and the spinal segment can become adaptively shortened, compromising its movement ability. My own lumbar spine has some of these back problems and limits my ability to do repeated lifting or bent over work.
Sarah Key, a physiotherapist who is well known in the UK, has produced the Sarah Key’s Back Sufferers Bible, a book in which she sets out her views of what is going on in this most common of musculoskeletal syndromes. She does acknowledge that it is hard to bring solid evidence for many of her interpretations but seems to have many good and practical therapy ideas to approach the back pain problem with. She covers the main syndromes which typically occur, giving treatment routines for self management of each one, all of which I have found very useful for my own lower back pain. Now I have something I can do about it rather than accept it as a fact of life.
Tags: alternative medicine, back injury, back pain, back pain relief, Fitness, Frozen Shoulder, Health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica
Arthritis Knee Pain Without Surgery
Do you have arthritis knee pain? Many people suffering from osteoarthritis or rheumatoid arthritis are dealing with the pain, deformity and loss of motion that arthritis can cause in the knees. Although many people end up requiring knee replacement surgery as a way of healing the damage, this can be a massive procedure that can take a long time to recover from.
The knee joint has three bones involved in its structure. They are the thigh bone (femur), the shin bone (tibia) and kneecap (patella). There is cartilage which shields the ends of the bone and a meniscus, which is a pad of cushioning tissue in the middle. Muscles and tendons keep everything in the proper alignment.
There are other ways to treat knee pain but it is important to know what kind of arthritis you have since the way they affect the joints is very different. Osteoarthritis affects the bones and cartilage because of overuse or injury. Rheumatoid arthritis is a result of the body’s immune system attacking the joints. It damages and inflames the meniscus. Osteoarthritis tends to be an ongoing process whereas rheumatoid arthritis can have periods where the disease flares up and gets worse, and other periods where it is in remission and symptoms improve.
There are a few different ways that you can treat knee pain that comes from arthritis. There are anti-inflammatory medications, pain relievers and supplements like glucosamine and chondroitin that are designed to support and repair cartilage. If you suffer from rheumatoid arthritis, there are oral medications which are designed to modify the way the disease is affecting you. They include methotrexate. Gold therapy is also used although this is much less common now that safer drug alternatives have been discovered.
You may find that if your knees are the only joints affected, the pain may be a result of a knee injury that was improperly diagnosed or treated. If you speak with your doctor, they can perform tests such as x-rays in order to check the state of the knee. If damaged cartilage is suspected, the doctor may perform a scope to check the cartilage in the knees. It can be repaired or removed if it is damaged. You want to make sure that full joint replacement is a treatment of last resort because of the length of time it takes to recover.
Other non medical means of treatment can include heat wraps and arthritis creams. These can soothe sore joints and provide some relief. Remember that you should never heat a joint that has been affected by rheumatoid arthritis. You want to calm the heat that is in the joint, not add to it. You also want to make sure you are continuing to use the joint since letting it become immobile will not help and you will end up with more severe problems down the road. Arthritis websites or a rheumatologist can help you establish a safe and effective exercise routine.
Treating arthritic knee pain does not have to be difficult but it may take trying several products before you find the ones which work best for you. Talking to a doctor or pharmacist can be a great first step to getting you on the road to recovery.
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Tags: arthritis, back pain, Fitness, gout, Health, Hip Pain, inflammation, joint, Knee Pain, pain, pain management, pain relief, pain treatment
Yellow Flags
A small but significant number of musculoskeletal patients presenting for examination are suffering from a serious medical condition or illness. To filter out these patients quickly the concept of Red Flags has been developed to increase the reliability of the history taking and examination, thereby reducing the likelihood of something being missed. The large increase in costs and disability which has accompanied the rise in low back pain absence from work has thrown the spotlight on developing tools to identity and counteract negative influences for recovery after low back pain.
Psychosocial risks for long term disability and inability to work after a low back pain episode are what yellow flags identify and their principles can likely be applied to other pain syndromes. Referral for immediate medical consultation and treatment is the goal of identifying red flags, while engaging further assessment and the necessary treatment intervention is the goal of identifying yellow flags. The effort and time expended in identifying the yellow flag risk factors is wasted if there is no accompanying plan for behavioural and cognitive interventions.
Reductions in functional ability, coping with the pain and compromise in the ability to do paid work are the three major consequences of a history of low back pain episodes. A small but significant group of back pain sufferers develop chronic pain problems and preventative measures do not seem to be very effective. Painkillers control symptoms but have no effect on the course of the pain but the best initial strategy seems to be to control the levels of the acute pain as high levels of persistent pain in the early parts of the episode increases the chances of it developing into a chronic syndrome.
Believing the Pain and Activity are Damaging: A tissue injury is likely when the initial low back pain occurs but after a short period it becomes less important and rehabilitation should commence. If the patient interprets their pain as reflecting ongoing injury in the back they might choose to avoid performing normal actions and rest in response to the pain because they are fearful. However, the better strategy is to challenge the pain when it occurs by continuing with the chosen activity and as the graded approach continues the pain should subside.
Sickness Behaviours: When confronted with pain and loss of ability some people adopt a disabled or sick role, choosing to rest for extended periods of time after an injury rather than attempting to go back towards normal. This increases the likelihood of the development of disability.
Low Mood and Social Withdrawal: The stress of a pain problem can induce low mood or depression. This can have a significant effect on a patients thinking, beliefs, attitudes and actions, tending to chose resting and poor coping strategies. A patient may also withdraw from normal social contacts, avoid going out and in some cases suffer panic attacks and become agoraphobic.
Pursuing Poor Treatment Techniques: Patients’ outcome can be significantly affected by the approach of the physiotherapist and an enabling approach to improve function should be engaged. Passive therapies applied to the patient by a therapist should be avoided along with the idea that their back pain problem can be fixed. Active therapies to engage the patient in their own functional rehabilitation should be chosen, with an explanation of the symptoms and the strategy for returning towards normal function, including remaining in work.
Good recovery from back pain can be interrupted by many factors such as having had back pain before, taking a lot of sick leave, being unhappy at work and with poor work satisfaction, undertaking heavy work in poor hours and having a family which is either over-protective or uncaring.
Other difficulties which can complicate the recovery from low back pain include a previous history of low back pain, having a lot of time off, difficulties at work, poor satisfaction at work, heavy work and poor hours and an overprotective or unsupportive family.
Tags: alternative medicine, back injury, back pain, back pain relief, Fitness, Frozen Shoulder, Health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica
Infrared Sauna Therapy May Be the Best Drug Free Relief for Fibromyalgia
Fibromyalgia is an progressively epidemic ailment which results in enduring pain all over and including aching joints, muscles, tendons, and other soft tissues. Fibromyalgia leaves its suffers with extreme fatigue, limited mobility upon rising in the morning, insomnia, migraines, insensibility to touch in hands and feet, low spirits, and anguish.
The most commonplace medical care for fibromyalgia is pain relief meds to combat the never ending complaints. It is widely publicized that there are also bad after effects related to habitual use of analgesic medications. Up to date research on extended use of over the counter painkillers like Advil, Motrin and Aleve have demonstrated that the likelihood of contracting oral cancer dropped by nearly 50%. Conversely, the danger of dying from coronary illness among ibuprofen users went up over three times as much.
Additionally, the media has had quite a bit to say over the last few years about Bextra, Vioxx and Celebrex (prescription drugs) which have left many people suffering with horrible side effects. The Food and Drug Administration in the United States has decided to give out warnings against the long-term use of all painkiller drugs.
Over the counter medications are not the only way to find relief from aches and pains. People may also get some symptomatic relief from many different natural cures that not only treat inflammation and pain, but also shield your heart from the damaging effects of prescription medications.
Using infrared sauna for fibromyalgia relief is starting to become a widely recognized compelling treatment. Studies have shown that handling the symptoms of fibromyalgia with deep heat is more effective than pain killer drugs. Infrared saunas emit heat that goes below the skin’s surface and can definitely affect the entire body.
Additionally, the detoxification side results of infrared sauna for fibromyalgia relief, help in the over all well being of the body and its natural tendency to heal.
Furthermore, employing an infrared sauna for fibromyalgia relief can also reduce the fatigue and depression that so often go with the physical discomfort of fibromyalgia. When commencing infrared sauna sessions, the quantity and quality of one’s sleep gets better. Also, it is believed that infrared sauna sessions may reduce depression by stimulating the pituitary.
The habitual use of infrared sauna for fibromyalgia can notably lessen fibromyalgia pain without the taking drugs. When you consider all the other health benefits associated with infrared sauna, using it to compliment your fibromyalgia treatments is a sensible idea.
Tags: alternative healing, fibromyalgia, Fitness, healing, Health, heat therapy, infrared sauna, infrared sauna for fibromyalgia relief, infrared saunas, NSAIDs, OTC pain killers, pain management, portable infrared saunas, self-help
Surgical Repair of Hernia ” Part Two
The description of a hernia and the need for operation or other treatment is discussed in part one. Now we review laparoscopic surgery and post operative care.
Repair via laparoscopy is advantageous if the patient has a double hernia (both groins affected) and for repeating hernias because the incisions can avoid the areas of the previous scars. Results up to five years after operation show that the success of this intervention is the same as normal open hernia repair but longer term results are not yet clear. It is possible to get back to normal activity more quickly after laparoscopic surgery but if it is a first time hernia repair the advantage of using a local anaesthetic for open surgery outweighs using a laparoscope.
Hernias can be repaired under general and local anaesthetic, the general injected into the hand and the local anaesthetic is injected into the area of the operation. During repair under local anaesthetic the patient is aware that something is happening in the area of the operation but this should not be painful. The operation usually takes 30 to 60 minutes and even under general anaesthetic the surgeon will inject some long acting local anaesthetic to make the patient more comfortable after they wake up. A long acting painkiller in the form of a suppository may also be used.
No food should be eaten for the six hours prior to the operation and no fluids for two hours before the event. Afterwards patients can get up and walk around when they feel they can with assistance from one of the staff the first time they get up. If stitches are only placed under the skin they will not need to be removed but if they or clips are used in the skin they should be removed after about seven days.
The time a patient is discharged depends on how much pain they have, whether there is someone at home with them and how fit they are. The levels of pain felt after operation vary greatly between individuals, with some having very little pain but some levels of pain are to be expected in the first few days. Pain is usually worst getting up from sitting or lying and when getting back into bed or a chair, due to the stitches in the repaired muscles pulling on these movements. Analgesics are prescribed to maintain activity and allow comfortable sleep.
There will be some pulling and aching in the operated area as the healing tissues regain their suppleness and are stretched in movements while the mesh is bedding in. Using a bath or shower to wash the wound with water and soap is acceptable once the dressing has been removed and about two days have passed. It is wise to avoid using talcum powder for about a week. A transparent dressing can be applied and remains over some days, permitting bathing and washing. At ten days from the operation the wound will be healed up and dry, allowing swimming which should not be attempted before this time.
Patients can start to walk about as much as they want although they will be quite stiff at first and probably not feel like walking long distances during the first week after the operation. Patients can start to drive the car when they feel confident to control it in an emergency which is often about ten days after the operation. Patients can return to work as soon as they feel comfortable enough to manage their job. People who work from home or who can go back part time often do so very soon after operation.
It is usual to feel stiffness in the abdomen whilst walking about although walking can be started whenever the patient feels like it. Longer distances are unlikely to be achieved until the first week has elapsed. Patients can go back to car driving when they feel sure they can perform emergency control activities and this is unlikely to occur before ten days. Work return can be attempted whenever the patient is comfy enough to get on with normal activities, although if they can work part time or from home they can re-start soon after operation.
Tags: alternative medicine, back injury, back pain, back pain relief, Fitness, Frozen Shoulder, Health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica
Stretch and Strengthen to Relieve Back Pain
If you have ever had a serious backache, you can appreciate just how vital your back is – even for activities you think don’t entail the back. For example, squeezing a tennis ball utilizes more muscles than the ones in your hand; the latissimus dorsi and other back muscles are also employed during this movement.
The latissimus dorsi or “lats” for short, are the large muscles on one’s side – in men these produce the “triangle shape” when well defined. Try squeezing a tennis ball as an exercise – do you feel it? You will experience a tensing of these muscles on the same side of your body as the arm used to squeeze the ball. If you have back pain, you can’t miss this.
Strong back muscles are key to playing any sport. They are used for coordination, balance and speed, as well as making a strong foundation for the movement of your limbs.
Following are a few easy exercises which can help you improve the strength and flexibility of these key muscles. You will see the most benefits from these exercises when they are done on a firm – not hard – surface. A hard surface will cause needless discomfort to your bony parts.
Knee to Chest: Lie on your back and clasp your hands behind one thigh. Pull slowly toward the chest, keeping the other leg flat on the ground. Vary the action by flexing the ankle – first pointing the toe, then pulling it back toward the knee – at the same time as you stretch the leg. Hold each position for 5 seconds, then switch legs and repeat. Do 10 reps.
Rotations: Do this one while lying back with your feet flat on the floor, knees together and raised. Extend your arms but keep them close to your body and keep your palms flat on the floor as well. Lift your feet just slightly off the ground and by moving your knee, rotate your torso. Move your knees a little to the left, then right. Alternate the exercise by crossing your arms over your chest, then repeat.
As you continue to practice this exercise, you will build flexibility and will be able to have a wider range of motion with this exercise. Eventually, you’ll be able to touch your knee to the floor.
Pelvic Press: While lying on your back, knees raised and feet on the floor, push the small of your back into the floor – you should feel your lower abdomen tense. Do this exercise with your feet together, then apart. Hold each press for about five seconds while continuing to breathe normally.
Pelvic Lift: Again, lie on your back with feet flat on the ground, knees raised. Cross your arms over your chest and legs and knees together. Raise your buttocks slightly off the floor and hold this position for five seconds. Lower them slowly back to the floor, count to two and repeat. Breathe slowly and normally while doing this exercise.
Dog Stretches: Starting position for this exercise is on all fours with your head raised – look forward to achieve proper posture for this exercise. As you lower your arms, arch your back and hold this position for two seconds before returning to your starting position. Extend one leg, parallel to the floor (or as close to parallel as possible). Hold this position for three seconds, then return to starting position again. This exercise can cause hip, leg or back pain in some – if it does this for you, stop this exercise immediately.
Repeat this exercise with the other leg. You can mix it up by extending your leg with toe pointed, then flex your ankle in a perpendicular direction to the leg; hold this position for two seconds, then repeat. You should do ten reps of this exercise for each leg.
A great way to supplement these exercises is with a piece of equipment known as a back stretcher. There are various kinds of back stretching equipment that you can purchase which will help make back stretches much easier to perform.
If you feel any pain while doing these exercises, stop immediately. While some mild discomfort is normal, pain is not, and you should talk to your doctor if this occurs.
Tags: back exercises, back pain, Fitness, Health, pain management, stretching
The Importance of Sensibility and Joint Position Sense
The human sensory system is designed to give us the information we need to manage the challenges of the world. We take in vast amounts of information every minute of the day, much of it not relevant, the brain deciding what is important and what is not. We are familiar with vision, hearing and touch and consciously and unconsciously use the incoming information to guide our actions and responses in daily life. However, there are two more sensory input systems, related to the others, which are vital to normal functioning. These are the sensory feedback we get from our bodies and the joint position sense.
Profound loss of sensory input is more common than we think as it happens every time we get a numb, dead feeling arm when we wake up. When I woke up with my arm completely numb I moved if off my chest grumpily twice until I began to understand, by feeling the arm gradually from the elbow up, that it was my own arm I was trying to get rid of. The loss of sensibility was so great that as far as I was concerned the arm did not exist and therefore must have belonged to someone else. Without our sensory input we are limited in our abilities.
By lying on the arm at night we can compress the arm nerves or the circulation to the arm and in this manner I had cut off all the incoming information from my arm to my brain. With this the brain concludes the body part does not exist so when we get hold of the arm there is no feedback and we don’t register the arm as ours. As I have worked as a physiotherapist for many years I have come across several incidences of the importance of sensory loss in managing normal movement. This has illustrated some important points about sensory input.
Due to the lack of sensory input a stroke patient finds it easy to make mistakes we would never make with our intact nervous systems. A patient once got hold of my hand, stretching and bending my fingers repeatedly, mystifying me for a minute or so until I deduced he could not feel anything at all from his arm. This meant the feedback from my arm to him was the same as moving his stroke arm, in this example nil. He worked it out by noticing my arm looked different to his but he couldn’t feel the difference. Try moving your dead arm the next time you have one, you will find it difficult or impossible to do anything with it.
The loss of movement is the most obvious disability we see when we observe a stroke patient, but what we don’t see is the loss of accurate sensory input, an impairment which may be more disabling overall. The joint position sense (JPS), also called proprioception, is the ability which allows our system to understand at any point where our joints are, what stresses are acting on them, how fast they are moving and how much muscle effort is being expended.
The brain is always monitoring the position of our joints so it can plan the movements we want to achieve. Without the position sense for our joints coming in normally to our brains we are unable to understand where our joints are and therefore we can’t predict what to do next. Without accurate joint position sense we cannot plan the next movement we need to do and so cannot move effectively.
The loss of the ability to feel any part of our body accurately can have profound consequences, reducing our functional independence in many normal daily activities. Typical conditions include stroke, paraplegia and direct nerve damage but more surprising injuries can reduce JPS input. A sprained ankle or ruptured anterior cruciate ligament reduces the accuracy of joint position sense and requires rehabilitation. Physiotherapists are skilled in the rehabilitation of proprioceptive ability in multiple conditions.
Tags: alternative medicine, back injury, back pain, back pain relief, Fitness, Frozen Shoulder, Health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica
Managing The Painful Joint
Joint pain can be caused by many different processes which include degeneration of the articular cartilage, infection, inflammation, trauma and deposition of crystals. Distinguishing one type of joint diagnosis from another is mostly made by taking a history and examining the joint, as this process is able to narrow down the options well. Once a provisional diagnosis is made then investigations are typically used to confirm the diagnosis and are less useful in trying to look for a cause without a narrow range of options. Clinicians try first to establish the source of the joint symptoms and then the potential underlying pathological process.
The joint itself can be the cause of the presenting pain or it can be from the structures which make up the areas around the joint or it can be a referred pain from elsewhere. Structures which can cause pain in a joint include the membrane lining the bone, the membrane lining the capsule, the joint capsule, the bone underlying the cartilage and the joint ligaments. The articular cartilage does not cause pain because it lacks the nerve endings to do so. Careful investigation to establish the exact anatomical structure responsible for the pain is important as the diagnosis and the subsequent treatment depend on the accuracy of this.
The pathological processes which result in joint damage are several and cover infections, laying down of crystals in the joint, inflammation of the junctions between tendon and bone and ligament and bone (enthesitis), synovial inflammation and joint abnormalities. Joint changes can be structural or mechanical like injury to a meniscus. The above pathologies may occur in combination and not just one at a time. Inflammatory changes in the joint linings (synovitis) are the main pathology in many arthritic conditions including rheumatoid arthritis. The growth of the synovial membrane can cause cartilage destruction and a puffy, warm and inflamed joint.
The bony insertions of the tendons and ligaments are known as entheses, which include the annular fibres of the disc inserting into the vertebra, and these areas are especially implicated in certain conditions. Inflammation makes the entheses lay down bone in the soft tissues as bony outgrowths along the ligament, tendon or disc. The deposition of crystals can occur in the synovial lining, on the articular cartilage or on other internal joint structures so the joint can be locally or generally affected. A gouty joint can be diagnosed by its puffy, warm appearance and the severe pain involved on movement.
Fungi, viruses or bacteria may cause a joint infection, with infections usually resulting from the organism being carried in the blood. Typically part of a more widespread infection, the patient may also feel unwell. The synovium is where the infections occur and there is some local tissue death and increased formation of scar and healing tissues. Toxins may be released by bacteria and these can destroy joint cartilage very quickly. In joint abnormalities the most common pathological process in joints across the world is osteoarthritis and both external and internal factors affect the severity and incidence of this.
Osteoarthritis is more likely to occur in a joint which has sustained previous trauma such as a fracture or a meniscal tear, suffers from a congenital structural abnormality or suffers from an abnormality of collagen such as hypermobility. A person’s genetic inheritance, their level of obesity and their occupation may also be relevant, although one of the strongest correlating factors is age. The deterioration of the joint surfaces in osteoarthritis is accompanied by an increase in the underlying bone’s density and by the growth of bony spurs at the margins of the joints. A synovitis may occur but often osteoarthritic change does not seem to involve inflammation.
The first stage for the examining clinician is to determine the source of the pain more precisely. The joint may be painful or there may be pain from close anatomical structures such as ligaments, tendons or muscles or it may be pain referred from a distant source. The more central joints such as the hip and the shoulder are more difficult to diagnose. Pain referred to the hip area is often not related to the hip joint itself and hip pain could be secondary to trochanteric bursitis, hip osteoarthritis, stenotic lumbar changes or intervertebral disc disease.
Tags: alternative medicine, back injury, back pain, back pain relief, Fitness, Frozen Shoulder, Health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica
Thyroid Surgical Treatment
Endocrine glands are the structures in the body which secrete hormones and the thyroid gland, anatomically placed in the front of the neck, is responsible for the production of thyroxine. Thyroxine is produced and passes into the blood and its function is to control the metabolism with some control over the functioning of all the cells in the body. More thyroxine can be stored and produced by the thyroid gland than can be used by the body so if a partial thyroid removal is the necessary operation then the patient may not need to take thyroid replacement tablets.
If the whole thyroid gland is excised then the patient will need to take tablets for thyroxine replacement throughout their life. The size of four small rice grains, the minute parathyroid glands adhere to the thyroid gland and secrete a hormone called parathyroid hormone. Parathyroid hormone is closely involved in the blood regulation of calcium concentrations, which promotes good health and the maintenance of a healthy skeletal structure. During the thyroid removal operation the surgeons take care not to affect the parathyroid glands but the secretions of the glands can be altered.
Thyroidectomy is the removal of the thyroid gland, either a total thyroidectomy or partial removal, called a sub-total thyroidectomy, hemithyroidectomy or lobectomy. There are several reasons for removing all or part of the thyroid gland. Overactivity of the thyroid gland is the main reason, known as hyperthyroidism or Graves’ disease or when goitre occurs with an enlarged thyroid. Goitres are removed either because they are causing pressure on the windpipe or gullet, are causing breathing or swallowing problems or they may look unsightly.
Thyroidectomy will be carried out under a general anaesthetic which means the patient is unconscious during the whole operation. An incision will be made in the neck, often made in the natural skin crease just above the top of the breastbone and always made symmetrically. This helps the incision to heal, leaving a scar which is usually inconspicuous and may become virtually invisible in time. The surgeon may leave a small drain tube in the neck to collect wound fluid and help speed up the healing process, removing it on the first or second day after operation. The stay in hospital will usually be two to four days.
No food is usually taken for six hours before operation and then only clear fluids until two hours before operation. The anaesthetic will be given through an injection in the arm with the operation taking one to two hours. Stitches under the skin may not need to be removed or the surgeon may use skin stitches or clips which do need to be removed after two to three days. Most people go home two to four days after operation although this varies with how people feel, and they will need to be collected and taken home by a relative. The amount of pain suffered after the operation varies greatly with some discomfort commonly around the neck.
There are various post-operative risks and many of them are rare. Infection can occur in the wound and if it develops redness and soreness then antibiotic treatment is prescribed. Wound reopening and exploration to remove any accumulated pus is also rarely required. Bleeding in the wound can occur, leading to a haematoma which necessitates wound exploration and washing out, with a one in fifty chance of this occurring. Patients will have some bruising and also swelling around the wound area caused by the bleeding under the wound.
Patients will have a vocal chord check before surgery and the surgeon will discuss the specific problems of operating so close to the voice box and its associated nerves. Bruising of the nerves during surgery may stop them working properly and as these nerves control the movements of the vocal chords if they are damaged this can cause hoarseness and weakness in the voice. The voice should recover over a period of a few weeks or months but occasionally a nerve will be permanently damaged but this is rare. Injury to both nerves is very uncommon and very serious as the voice is lost and a tracheotomy tube is placed in the windpipe to allow breathing to occur.
Tags: alternative medicine, back injury, back pain, back pain relief, Fitness, Frozen Shoulder, Health, injury management, pain management, physical fitness, physiotherapists, physiotherapy, Piriformis Syndrome, sciatica
