Carpal Tunnel Syndrome CTS

Carpal tunnel syndrome is pressure on the median nerve -- the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.
Carpal tunnel syndrome is common in people who perform repetitive motions of the hand and wrist.

A number of medical problems are associated with carpal tunnel syndrome, including:
Bone fractures and arthritis of the wrist, Acromegaly, Diabetes, Alcoholism, Hypothyroidism, Kidney failure and dialysis, Menopause, premenstrual syndrome (PMS), and pregnancy, Obesity, Rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma etc.

Symptoms :
Numbness or tingling in the thumb and next two or three fingers of one or both hands.
Weakness in one or both hands.

Diagnosis may be done by Clinical Evaluation, and Electro-diagnostic tests like Electromyography and Nerve conduction velocity.

Treatment
For patient, who are not responding to conservative management, or when there is documented 
neuronal damage, surgery should be performed.
Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but recovery depends on how long the nerve compression has been occurring and its severity.

The procedure can be done under local anesthesia. The procedure involves a skin incision of approximately 1 inch, which heals in a week. The patient is discharged on the day of surgery, and can start normal activities in a week.

Shoulder Dislocations

Shoulder dislocations commonly seen in young individuals occur as a result of direct or indirect impact over the shoulder joint. There are two broad types of dislocations described; based on the position of the Humeral head.
Anterior dislocations are more common. Posterior dislocation are a rare entity; often seen in epileptics. After an impact, the patient feels sudden give way in the shoulder joint followed by inability to move the upper limb. This is associated with pain which becomes worse with attempted movements.
The common scenario is a patient supporting his affected upper limb by the other hand.
Early of a shoulder dislocation is of paramount importance. If a shoulder dislocation is neglected, it may lose its vascularity and become necrotic.
Careful clinical assessment is required to confirm the type of dislocation.
The mechanism of reduction is to reverse the order of the deforming force.
In 90 percent of cases, a shoulder dislocation may be reduced without requiring any form of anesthesia. In some cases, a mild sedative helps reduce the patient's apprehension. Rarely an open reduction is required and particularly in patients presenting late to the clinic.
Patient's co-operation is of utmost importance.
Every shoulder dislocation has a risk of re-dislocation with similar or less severe impact. This happens due to laxity of tissue surrounding the shoulder joint.
After a dislocation has been reduced, the patient must be forewarned about this complication.
The risk of re-dislocation may be substantially reduced with supervised physiotherapy and avoidance of the precipitating forces.
In a fresh dislocation occurring in a young patient; after performing a closed reduction, the shoulder joint should be splinted for a period of 2-3 weeks. In elderly patients, early passive exercises are allowed for fear of causing stiffness of immobilization.
A patient with history of shoulder dislocation should be kept under close observation.
If there are lesions in the glenoid labrum (bankart's lesions) or the Humeral head (Hill Sach's and Reverse Hill Sach's lesions), sometimes an operative intervention may be required in patients presenting with recurrent dislocations or shoulder instability that interferes with daily routine activities.
The risk of dislocation reduces with increasing age.