Nuggets of Wisdom

Nuggets of Wisdom

SHOULDER AND ELBOW REPLACEMENTS:

Shoulder and elbow replacements as an option for arthropathies in the upper limb have advanced greatly in the last 20 years.  There are many options, ranging from re-surfacing, total shoulders and reverse polarity shoulder replacements for rotator cuff deficient shoulders.

Nuggets of Wisdom

ROTATOR CUFF TEARS

The management of rotator cuff tears is tailored according to the needs of the patient, their expectation of physical activity, general health and age. Broadly speaking the younger the patient is the more likely we are to intervene.  The corollary of this being that in the older patient we tend to leave full-thickness rotator cuff tears without surgery as the patients can adapt well.  With modern advances, the majority of rotator cuff tears are now repaired arthroscopically.

Contact on d.h.yanni@btinternet.com (email preferable) OR telephone Caroline on 020 8460 0123

Nuggets of Wisdom

TYPES OF SHOULDER INSTABILITY:

Broadly speaking instability in the shoulder can be divided into 2 broad groups.  (a) shoulders born loose (ligamentous laxity) and (b) shoulders torn loose (post-traumatic).  The early management always consists of rehabilitation and physiotherapy.  Ultimately the post-traumatic instabilities e.g. post-sport are treatable by surgical stabilisation, which is very often arthroscopic.  The results of treatment of patients with ligamentous laxity are not as good and surgery is very much a last resort.

Nuggets of Wisdom

CO-EXISTENT NECK AND SHOULDER PROBLEMS:

Shoulder and neck problems often co-exist, which is not surprising given their close anatomical proximity. It is important to decide through the history and physical examination, which of the two is the most dominant contributor to the sum total of the symptoms.  A careful clinical examination of the cervical spine and the shoulder very often resolves this.  Imaging may not achieve this, thus further highlighting the crucial role of a thorough clinical examination.

Contact on d.h.yanni@btinternet.com (email preferable) OR telephone Caroline on 020 8460 0123

Nuggets of Wisdom

CLINICAL RELEVANCE OF ACJ PROBLEMS IN THE PAINFUL SHOULDER:

ACJ changes are often identified on imaging (X-ray and MRI).  However, they do not cause clinical symptoms as often as their radiological occurrence.  Ballotment of the ACJ, cross adduction and outer range of elevation pain at the ACJ will distinguish those patients who have a clinically relevant and painful ACJ.

Nuggets of Wisdom

CO-EXISTENT PROBLEMS WITH CARPAL TUNNEL SYNDROME:

Carpal tunnel syndrome often co-exists with neck problems, diabetic neuropathy and even multiple sclerosis.  Once the diagnosis is confirmed, it is always a good policy to remove from the sum total of the picture the contribution coming from the carpal tunnel syndrome and then to deal with the more complicated issues (MS/neck problems) after that.

Contact on d.h.yanni@btinternet.com (email preferable) OR telephone Caroline on 020 8460 0123

Nuggets of Wisdom

EVOLUTION OF DUPUYTREN TREATMENTS IN RECENT YEARS:

Dupuytren’s contracture is the condition of the Celtic and Viking diaspora. It is a genetically inherited tendency.  In the last 20 years there has been a move for less interventionalist treatment.  Broadly speaking treatment is reserved for joint contractures, rather than the appearance of Dupuytren nodules and cords.  Needle fasciotomy, splintage and injections are important aspects in the modern management.

Nuggets of Wisdom

AETIOLOGY OF GANGLIA IN THE OVER FIFTIES:

Whilst ganglia as a spontaneous event are extremely common in the young, a cause for a ganglion should always be established in the middle aged and elderly.  These are often secondary to degenerative changes in the carpus. It is also important to confirm the diagnosis for occasionally these can be confused with rare and serious sarcomas.

Contact on d.h.yanni@btinternet.com (email preferable) OR telephone Caroline on 020 8460 0123

Nuggets of Wisdom

BASE OF THUMB ARTHRITIS:

Trapeziometacarpal arthritis is a relatively common condition. It gives pain on key pinch and pin pinch.  Patients lose the first web space span (i.e cannot pull a large book from a shelf).  Early treatment consists of anti-inflammatories, injection and splintage.  The results of surgery are extremely good.

Nuggets of Wisdom

ULNAR NEURITIS:

There is anecdotal evidence that there is an increase in the incidence.  This is ascribed to the widespread availability of gymnasia and the modern habit of walking around holding a mobile phone to the ear with the elbow hyperflexed.  Whereas the thresholds for intervention in carpal tunnel syndrome are low (the results of carpal decompression are very good), the same cannot be applied to ulnar neuritis.  Surgery is a last resort. Modification of ADL, splintage and avoidance of precipitating daily activities are the mainstay of treatment.

Contact on d.h.yanni@btinternet.com (email preferable) OR telephone Caroline on 020 8460 0123

Nuggets of Wisdom

UPPER LIMB PROBLEMS IN DIABETIC PATIENTS:

Diabetic patients are susceptible to diabetic cheiropathy, so-called diabetic ‘slowing’ of the hand and upper limb.  They are more prone to getting carpal tunnel syndrome (notwithstanding diabetic neuropathy), trigger fingers, coarsening of the joints with stiffness, stiffening of the elbow, frozen shoulder and Dupuytren’s contracture.

Nuggets of Wisdom

UPPER LIMB PROBLEMS IN DIABETIC PATIENTS:

Diabetic patients are susceptible to diabetic cheiropathy, so-called diabetic ‘slowing’ of the hand and upper limb.  They are more prone to getting carpal tunnel syndrome (notwithstanding diabetic neuropathy), trigger fingers, coarsening of the joints with stiffness, stiffening of the elbow, frozen shoulder and Dupuytren’s contracture.

Contact on d.h.yanni@btinternet.com (email preferable) OR telephone Caroline on 020 8460 0123

cannot praise Mr. Yanni enough, he has been very thorough explaining the procedure from day one! Many thanks Mr. Yanni

Hand Surgery

Mr Yanni treats you like a personal friend. I felt extremely comfortable in his company & confident in his expertise. He is the utmost professional at all times.

Hand Surgery, Arthritis (Hand), Trapeziectomy

A wonderful kind person that always insures his patient is totally confident in the procedure he will perform. A totally responsible person committed to the patient and their care.

Hand Surgery