Tag Archives: Hand

Pilonidal sinus

 

Alternative Names:pilonidal cyst, pilonidal abscess or sacrococcygeal fistula

Definition:
A pilonidal sinus is a dimple in the skin in the crease of your child’s buttocks.

This may be noted at birth as a depression or hairy dimple and be present for many years without any symptoms.
Pilonidal sinus affect men more often and most commonly occur in young adults.


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Two pilonidal cysts in the natal cleft
A pilonidal sinus may also occur due to a blockage in the hair follicles, often associated with an ingrown hair.
In both situations, hair acts as a foreign body, which may produce an infection. The infection may spread into the tissues of your child’s buttocks and produce an abscess (collection of pus under the skin) at a site several inches away from the sinus.

Pilonidal means “nest of hair”, and is derived from the Latin words for hair (“pilus”) and nest (“nidus”).The term was used by Herbert Mayo as early as 1830. R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880.

Symptoms:
A pilonidal sinus may cause no noticeable symptoms (asymptomatic). The only sign of its presence may be a small pit on the surface of the skin.

When it’s infected, a pilonidal sinus becomes a swollen mass (abscess). Signs and symptoms of an infected pilonidal cyst include:

*Pain
*Localized swelling
*Reddening of the skin
*Drainage of pus or blood from an opening in the skin (pilonidal sinus)
*Foul smell from draining pus

Hair protruding from a passage (tract) below the surface of the skin that connects the infected pilonidal cyst to the opening on the skin’s surface (a pilonidal sinus) — more than one sinus tract may form
Fever (uncommon)

Causes:
Quite why it happens isn’t entirely clear. When they occur in the cleft between the buttocks, one popular explanation is that there’s a developmental defect in the direction that the hair grows – that is, the hair grows inwards rather than outwards.

One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple. Excessive sweating can also contribute to the cause of a pilonidal cyst.

The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.  It was termed “jeep seat or “Jeep riders’ disease”, because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the coccyx.

Risk Factors:
Certain factors can make you more susceptible to developing pilonidal cysts. These include:

*Obesity
*Inactive lifestyle
*Occupation or sports requiring prolonged sitting
*Excess body hair
*Stiff or coarse hair
*Poor hygiene
*Excess sweating

Complications:
If a chronically infected pilonidal cyst isn’t treated properly, there may be an increased risk of developing a type of skin cancer called squamous cell carcinoma.

Differential diagnosis
A pilonidal sinus can resemble a dermoid cyst, a kind of teratoma (germ cell tumor). In particular, a pilonidal cyst in the gluteal cleft can resemble a sacrococcygeal teratoma. Correct diagnosis is important because all teratomas require complete surgical excision, if possible without any spillage, and consultation with an oncologist.

Treatment :
Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.

In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, one year may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialization.

Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.

Picture of Pilonidal cyst two days after surgery.

A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.

Pilonidal cysts recur and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress.

Prevention:
To prevent future pilonidal sinus from developing:

*Clean the area daily with glycerin soap, which tends to be less irritating. Rinse the area thoroughly to remove any soapy residue. Washing briskly with a washcloth helps keep the area free of hair accumulation.

*Keep the area clean and dry. Powders may help, but avoid using oils or herbal remedies.
Avoid sitting for long periods of time.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Pilonidal_sinus
http://www.mayoclinic.com/health/pilonidal-cyst/DS00747
http://www.bbc.co.uk/health/physical_health/conditions/pilonidalsinus.shtml
http://www.childrenshospital.org/az/Site923/mainpageS923P0.html

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Dupuytren’s contracture

Definition:
Dupuytren’s contracture is a painless thickening and contracture of tissue beneath the skin on the palm of the hand and fingers.
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It is  a disease of the palmar fascia (thin but tough layer of fibrous tissue between the skin of the palm and the underlying flexor tendons of the fingers) resulting in progressive thickening and contracture of fibrous bands on the palmar surface of the hand and fingers.  Fasciitis implies inflammation of the fascia, and contracture implies thickening and tightening of the diseased fascia.  Basically, the tissue on the palm side of the hand thickens (can become as thick as 0.5cm) and essentially “shrinks” and produces a tightness in the area of the hand which the diseased tissue overlies.  It occurs most often in the fourth and fifth digits (ring and small fingers).  It is a very common problem and often arises in the hands of middle aged persons;  however, it can be seen as early as the twenties.  This entity does run in families in some cases.  It is seven times more common in men than women.  It has been associated with diabetes and can be seen in alcoholics with cirrhosis of the liver.  It has also been associated with epilepsy but may be a result of the use of anticonvulsant drugs rather than the presence of epilepsy itself.  The underlying cause is unknown.

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Dupuytren contracture varies in its rate of progression from minor skin puckering for many years to rapid contracture (fixed flexed position) of fingers.

People of northern European descent are more often affected and it can run in families. Men are affected more often than women and the condition is most likely to occur over the age of 40.

Causes:
The cause is unknown, but minor injury and your genes may make you more likely to develop this condition. It can run in families. It’s not caused by a person’s type of job or work environment, manual work or vibrating tools.

One or both hands may be affected. The ring finger is affected most often, followed by the little, middle, and index fingers.

A small, painless nodule develops in the connective tissue on the palm side of the hand and eventually develops into a cord-like band. In severe cases, it’s difficult or even impossible to extend the fingers.

The condition becomes more common after the age of 40. Men are affected more often than women. Risk factors are alcoholism, epilepsy, pulmonary tuberculosis, diabetes, and liver disease.

Symptoms:
Dupuytren contracture initially may cause only a minor painless lump in the palm of the hand near the base of the finger(s). Dupuytren contracture most commonly affects the ring (fourth) finger, but it can affect any and all fingers.Pain and the position of the fingers may make it difficult to perform everyday activities with the hand.The appearance of the deformity can cause distress.Dupuytren contracture can also affect one or both hands.

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Dupuytren contracture is seldom associated with much, if any, pain unless the affected fingers are inadvertently forcefully hyperextended.

The ring finger is affected most often, although any finger can be involved. In 50 per cent of cases both hands are affected. It can affect the toes and soles of the feet, but this is rare.

Diagnosis:
Dupuytren’s contracture is diagnosed by the doctor during the physical examination of the affected hand.

A physical examination of the palm by touch (palpation) confirms the presence of thickened scar tissue (fibrosis) and contracture. Restriction of motion is common.

Previous burns or hand injury can lead to scar formation in the palm of the hand which can mimic true Dupuytren contracture.

Treatment:
Often, treatment isn’t needed if the symptoms are mild. Exercises, warm water baths, or splints may be helpful.

If normal hand function is affected, surgery is usually recommended to release the contracture and improve the hand’s function.

There are three main surgical options:
•Open fasciotomy – opening the skin and cutting the thickened tissue
•Needle fasciotomy – pushing a needle through the skin to cut the thickened tissue
•Open fasciectomy – cutting open the skin and removing the thickened tissue

Prognosis: The disorder progresses at an unpredictable rate. Surgical treatment can usually restore normal movement to the fingers. The disease can recur following surgery in some cases.

Prevention:
Since the precise cause of Dupuytren’s contracture is unknown, it’s difficult to prevent.
Awareness of risk factors may allow early detection and treatment.
Avoiding excessive intake of alcohol may help to reduce the risk of it developing in susceptible individuals.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/dupuytrens1.shtml
http://www.med.und.edu/users/jwhiting/dupdef.html
http://www.nlm.nih.gov/medlineplus/ency/article/001233.htm
http://www.medicinenet.com/dupuytren_contracture/article.htm

http://www.prlog.org/10501551-who-first-described-dupuytrens-contracture.html

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Stretch Away Stress at Your Desk

Here’s a great way to reduce tension in the upper back, neck and shoulders. Practice this stretch at your desk after long hours of sitting in front of the computer or talking on the telephone.
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Sit upright toward the front edge of a sturdy chair. Place your feet below your knees, hip-width apart. Hook your left elbow over your right elbow and wrap your forearms, pressing the palms of your hands together as much as you can. Inhale and raise your arms as you arch your upper back. Pause for a few breaths.

On an exhale, bring your chin in toward your throat, press your navel to your spine and move your elbows down toward your waist. Pause with your back in this C-curve position. Feel a deep stretch in your entire back and across the back of your shoulders. Inhale, raise your arms to repeat the arch and exhale again to repeat the C-curve. Return to center, then switch your arms and repeat.


Source :
The Losangles Times

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A Proper Downward-facing Dog

STEP-1.

Push back on your feet and straighten your legs as you raise your hips.


STEP-2.

Focus on feeling an evenness over both hands. Then slowly shift your weight onto your left leg. Raise your right leg up as high as you can without twisting your shoulders and hips. Keep the front of your body facing the floor.

If you practice yoga, you’re familiar with downward-facing dog. It’s a traditional pose that requires strength and energy in your arms and shoulders, extension of the spine, and power and stamina in your legs.

From a kneeling position, sit back on your heels. Take your arms to the floor and walk your hands as far forward as possible, keeping them shoulder-width apart. Now come up to all fours, moving your feet hip-width apart. Push back on your feet and straighten your legs as you raise your hips. Lower your head between your upper arms and move your chest toward your thighs, maintaining a straight spine. Lower your heels to the floor as you lift your sitting bones toward the ceiling. Pause for 10 to 20 seconds. Release down to the start position or continue to the more advanced variation.

Focus on feeling an evenness over both hands. Then slowly shift your weight onto your left leg. Raise your right leg up as high as you can without twisting your shoulders and hips. Keep the front of your body facing the floor. Pause for two to three breaths, lower your right leg, shift your weight over it and raise your left leg. Pause for two to three breaths. Lower your leg, bend your knees to all fours and return to the start position.

Source: : Los Angeles Times

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Simple Exercise for the Back

Strengthen your entire back with this one simple move. The first variation, in which your legs are on the floor, targets the upper and mid-back muscles. The second variation kicks up the intensity by also training your buttocks and legs.
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Lie face down on a level, padded surface. Straighten your legs behind you with your toes down and your inner ankles facing each other. Place the palms of your hands flat on the floor near your rib cage, elbows bent and tucked in close to your body. Inhale, contract your upper back muscles to raise your chest, shoulders and head off the floor. Pause for three breaths.

Exhale while you keep your upper back raised. Inhale again, but this time extend your arms back, reaching your fingertips toward your feet. Now raise your legs off the floor. Keep your knees straight and your feet close together. Hold this position for three breaths, release and rest face-down on the floor for 15 seconds. Repeat two or three times.


Source:
Los Angeles Times

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