Dr Mulder has a special interest in treating conditions affecting the upper limb. The following list is not all-inclusive, but it covers some of the more common injuries that Mike encounters:
- COLLARBONE (CLAVICLE)
The collarbone is a bone strut that connects the shoulder to the central skeleton via the breast bone (sternum). Its exposed position leaves it vulnerable to injury during falls and sports injuries (commonly cycling). Treatment options vary between operating to fix the bone with metal plates and screws to leaving it to heal in a sling. Options are discussed based on the specific injury and the profile of the person injured.
- COLLARBONE DISLOCATIONS (ACROMIOCLAVICULAR JOINT INJURIES)
The joint between the outer edge of the collarbone and shoulder blade is commonly damaged during sports injuries and accidents. These painful and disfiguring injuries require specialist assessment to guide treatment. Most are treated with a sling and a structured rehabilitation plan, but in some instances, surgery is required.
- SHOULDER DISLOCATIONS
The shoulder is the most commonly dislocated large joint in the body. This injury may affect both the young and old, and usually requires resetting/repositioning and reduction in hospital. A follow up assessment of the shoulder is essential in order to avoid any long term problems that could lead to long-term problems like pain, weakness or repeated dislocation.
- IMPINGEMENT (SHOULDER TENDINITIS)
This common and distressing condition can affect young and old alike. It causes pain in the shoulder and upper arm pain when the arm is lifted above shoulder height. There are a variety of causes that need to be identified and protected. While the majority of cases can be dealt with by using injections, physiotherapy and anti inflammatories, some resistant cases may need corrective surgery.
- ROTATOR CUFF TEARS
The tearing of the tendons of the rotator cuff muscle off the bone at the shoulder is a common cause of shoulder pain. This may follow an injury to the shoulder or it may simply be the result of “wear and tear”. These tears commonly cause pain when the arm is raised above shoulder height or when reaching for something. They can also be the cause of shoulder pain at night.
Depending of the severity and location of the tear a variety of treatment options are available, these include: physiotherapy, cortisone injections and surgical repair; or ultrasound and/or MRI scanning accompanying the assessment of the joint function.
- SHOULDER ARTHRITIS
Like any large joint, the shoulder (ball and socket) joint may develop arthritis. This can occur through a “wear and tear” mechanism following trauma that damages the cartilage, or as part of “disease type” arthritis like Rheumatoid Arthritis. Several treatments are available to control symptoms and preserve function before shoulder replacement surgery becomes necessary.
- PROXIMAL HUMERUS FRACTURES (SHOULDER FRACTURES)
These painful debilitating fractures are common in older individuals following a fall onto the affected shoulder. Associated osteoporosis weakens the bone and results in a shattering of the ball component of the shoulder. Surgery is frequently required for breaks and may involve either repair of the broken bone or replacement of the shoulder.
- HUMERUS FRACTURES (UPPER ARM BREAKS)
Fortunately the upper arm bone is not easily broken. It usually occurs with high energy, bad falls. These breaks are very painful and depending on the severity, they may need surgery to reset and fix the bone with a plate and screws.
- ELBOW DISLOCATIONS
The elbow joint may be injured during sporting and even work-related activities and usually requires reduction in hospital. As with the shoulder, specialist evaluation of these injuries is essential to detect and treat any associated problems that may lead to long-term pain or dysfunction of the joint. The elbow may also “unknowingly” dislocate during an injury, leading to on-going pain due to ligament or bony damage.
- RADIAL HEAD FRACTURES
These are common and frustrating injuries that follow a fall onto the affected arm. They result in progressive pain and swelling in the elbow and an inability to bend and straighten or rotate the forearm. A sling and repeated applications of ice is usually necessary for the first few days to control the pain and assist with improving movement. The decision to operate and reset the bone is made based on X-rays and examination.
- TENNIS ELBOW
This common and painful condition presents with pain over the side of the elbow. Lifting items, rotating the forearm and even shaking hands is surprisingly painful. Tennis Elbow has a variety of suspected causes, resulting tendinitis of the forearm muscles. Treatment includes rest, stretching exercises, injections into the affected tendon and in rare cases - surgery.
- BICEPS TENDON INJURIES
The biceps tendon is vulnerable to injury both where it attaches to the forearm bone and at its attachments around the shoulder. It seldom gives problems in the middle “belly” portion. With a forced jerking motion the tendon may tear completely, often requiring surgery to reattach it.
- WRIST BREAKS
These are common injuries and may occur in any age group. In younger individuals, it commonly follows a fall that happens during sporting activities or is damaged in car accidents. In the older segment of the population, the wrist may break after a “simple” fall. Treatment options vary between plaster casts, splints and surgery to reset and fix the bones. Dr Mulder will thoroughly discuss the benefits and risks of the various treatment options with anyone injured in this way.
- HAND INJURIES
The key to the management of any hand injury is rapid restoration of hand motion and function. In most cases this may be achieved with splinting and physiotherapy, however for certain fractures or dislocations, surgery may be required to repair structures before this may safely take place.
Fingers and thumbs are frequently injured in sporting activities. The seemingly straightforward finger dislocation may tear vital ligaments and tendons, which if not detected early, may result in permanent dysfunction of the digit. Assessment by Dr Mulder is essential to rule this out soon after the joint has been reset. Where the ligaments are intact, “buddy-splinting” is effective in treating these types of injuries.
The majority of hand and finger fractures are managed with splinting and physiotherapy-assisted mobilisation alone. Where the fractures are unstable however, they may need to be remedied with wires, screws or even plates. X-rays are taken at regular intervals to monitor healing progress.
- CARPAL TUNNEL SYNDROME
This common condition affects a wide spectrum of people, often without any discernible cause. It results in an intermittent numbness, tingling, burning and even pain in the thumb, index, middle and part of the ring fingers. It may wake one from sleep and can often be resolved by shaking or rubbing the hands. It is caused by a temporary pressure on one of the nerves to the hand. Initially complete recovery is possible, but with longer duration of symptoms, permanent damage to the nerve may occur.