Treatments

TREATMENTS AVAILABLE

The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee. Every year, there are around 30 cases of ACL injuries for every 100,000 people. If the ACL is torn, surgery is commonly used to reconstruct the damaged ligament.

Ligaments

Ligaments are tough bands of connective tissue (fibres that support other tissues and organs in your body). Ligaments link two bones together at a joint. They strengthen the joint and limit its movement in certain directions.

The knee

There are three bones that meet in the knee:

  • thigh bone (femur),
  • shin bone (tibia), and
  • knee cap (patella).

The three bones are connected by four ligaments. The ligaments hold the bones together and keep the knee stable. There are two collateral ligaments on the sides of the knee, and two cruciate ligaments inside the knee.

The anterior cruciate ligament

The ACL runs diagonally through the inside of the knee. It connects the underside of the femur to the top of the tibia. The ACL prevents the tibia from moving in front of the femur and gives the knee joint stability. It also helps control the back and forth movement of the knee.

Most injuries to the ACL happen when playing sports, such as football, squash, tennis or skiing (see the box, left). ACL injuries account for 40% of all sports injuries.

If the ACL is torn, the knee becomes very unstable and loses its full range of movement. This can make it difficult to perform certain movements, such as turning on the spot, and could make some sports impossible to play.

Reconstructive surgery

It is not possible to repair the torn ACL by stitching it back together. However, it can be reconstructed by grafting (attaching) new tissue onto it. This will encourage new ligament to grow over the grafted tissue. Once new ligament has grown, the knee will be more stable.

Reconstructive surgery is successful in around 90% of cases. A few people may still have knee pain or instability after the operation. Recovery usually takes around six months, although it could be up to a year before athletes can fully return to their sport.

How the anterior cruciate ligament is torn

The ACL can be torn when the lower leg extends forwards too much. If the knee is straightened more than 10 degrees beyond its normal straight position, this can cause the ACL to tear. The ligament can also be torn when the knee and lower leg are twisted.

Some of the more common causes of an ACL injury include:

  • landing incorrectly from a jump,
  • suddenly stopping,
  • suddenly changing direction, or
  • having a collision, such as during a football tackle.

A hip replacement is a common type of surgery. A damaged hip joint is replaced with an artificial one. This is known as a prosthesis.

Adults of any age can be considered for a hip replacement. Most are carried out on people between the ages of 60 and 80.

Artificial hip joints are designed to last for at least 20 years. Most people experience a significant reduction in pain. They get some improvement in their range of movement.

When a hip replacement is needed

Hip replacement surgery is usually needed when the hip joint is worn or damaged. Your mobility is reduced and you experience pain even while resting.

The most common reason for hip replacement surgery is osteoarthritis.

Other conditions that can cause hip joint damage include:

  • rheumatoid arthritis
  • a hip fracture
  • septic arthritis
  • ankylosing spondylitis
  • disorders that cause unusual bone growth (bone dysplasias)

Who is offered hip replacement surgery

A hip replacement is major surgery. Your GP will usually recommend it if other treatments haven’t helped to reduce pain or improve mobility.

You may be offered hip replacement surgery if:

  • you have severe pain, swelling and stiffness in your hip joint and your mobility is reduced
  • your hip pain is so severe that it interferes with your quality of life and sleep
  • everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
  • you’re feeling depressed because of the pain and lack of mobility
  • you can’t work or have a normal social life

You’ll also need to be well enough to cope with a major operation and the rehabilitation.

How hip replacement surgery is performed

A hip replacement can be carried out under a general anaesthetic or an epidural.

A general anaesthetic is where you’re asleep during the procedure. An epidural is where the lower body is numbed.

The surgeon makes an incision into the hip and removes the damaged hip joint. They replace it with an artificial joint made of a metal alloy or, in some cases, ceramic.

The surgery usually takes around 60-90 minutes to complete.

Read about how a hip replacement is performed.

Alternative surgery

There is an alternative type of surgery to hip replacement, known as hip resurfacing. This involves removing the damaged surfaces of the bones inside the hip joint. They are replaced with a metal surface.An advantage of this is that it removes less bone.

This surgery may not be suitable for:

  • adults over the age of 65 years – bones tend to weaken as a person becomes older
  • women who’ve been through the menopause – bones can become weakened and brittle (osteoporosis)

Resurfacing is much less popular now. This is due to concerns about the metal surface causing damage to soft tissues around the hip.

Your surgeon should be able to tell you if you could be a suitable candidate for hip resurfacing.

Preparing for hip replacement surgery

Before you go into hospital, find out as much as you can about what’s involved in your operation.

Stay as active as you can. Strengthening the muscles around your hip will aid your recovery. Continue to take gentle exercise in the weeks and months before your operation. Walking and swimming are good options.

You may be referred to a physiotherapist, who will give you helpful exercises.

Recovering from hip replacement surgery

The rehabilitation process after surgery can be a demanding time.

For the first 4 to 6 weeks after the operation you’ll need a walking aid, such as crutches, to help support you.

You may also be enrolled on an exercise programme. It’s designed to help you regain and improve the use of your new hip joint.

Most people are able to resume normal activities within 2 to 3 months. It can take up to a year before you experience the full benefits of your new hip.

Risks of hip replacement surgery

Complications of a hip replacement can include:

  • hip dislocation
  • infection at the site of the surgery
  • injuries to the blood vessels or nerves
  • a fracture
  • differences in leg length

The risk of serious complications is low – estimated to be less than 1 in a 100. There’s also the risk that an artificial hip joint can wear out earlier than expected or go wrong in some way.

Some people may need revision surgery to repair or replace the joint.

Read more about risks of hip replacement

Metal-on-metal implants

Some metal-on-metal (MoM) hip replacements wear out sooner than expected. This can cause deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.

If you’re concerned about your hip replacement, contact your GP or orthopaedic surgeon. They can give you a record of the type of hip replacement you have and tell you if any follow-up is required.

You should also see your doctor if you have:

  • pain in the groin, hip or leg
  • swelling at or near the hip joint
  • a limp, or problems walking
  • grinding or clunking from the hip

These symptoms don’t necessarily mean your device is failing. But they do need investigating.

Any changes in your general health should also be reported, including:

  • chest pain or shortness of breath
  • numbness, weakness, change in vision or hearing
  • fatigue, feeling cold, weight gain

change in urination habits

Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make vision blurred or misty. They can develop in one or both eyes, and one eye can often be more affected than the other.

The lens

The lens is normally clear and allows light to pass through to the back of the eye.

However, if parts of the lens become cloudy (opaque), light is unable to pass through the cloudy patches.

Over time, the cloudy patches usually become bigger, and more of them develop. As less light is able to pass through the lens, the person’s vision is likely to become blurry or cloudy. The cloudier the lens becomes, the more the person’s sight will be affected.

How common are age-related cataracts?

Cataracts are the main cause of impaired vision in the world, particularly in developing countries. They affect men and women equally.

Cataracts most commonly affect older people. Cataracts that affect older people are known as age-related cataracts. In the UK, it is estimated that more than half of people who are over 65 years of age have some cataract development in one or both eyes.

Childhood cataracts

In rare cases, babies have cataracts when they are born, or children develop them at a young age. See the Health A-Z topic about Childhood cataracts for more information.

Outlook

If cataracts are mild, stronger glasses and brighter reading lights may enable people to live with the condition. However, if left untreated, cataracts can cause blindness.

Once cataracts start interfering with daily activities such as cooking or getting dressed, surgery is usually recommended. It is estimated that around 10 million cataract operations are performed around the world each year. Cataract operations are generally very successful with few complications.

If you have cataracts, it could affect your ability to drive. It is important that you inform your doctor and the Road Safety Authority (RSA) about a medical condition that could have an impact on your driving ability.

Glossary
Lens
The transparent structure at the front of your eye, just behind your pupil (the black circle in the centre of your eye).

A hysterectomy is an operation to remove your womb (uterus). After the operation you will no longer be able to have children. If you have not yet gone through the menopause, you will no longer have periods.

A hysterectomy is used to treat conditions that affect the female reproductive system, such as heavy periods (menorrhagia), chronic (long-term) pelvic pain, non-cancerous tumours (fibroids) and cancer of the ovaries, womb, cervix or fallopian tubes.

A hysterectomy is a major operation with a long recovery time. It is usually only considered after alternative, less invasive treatments have been tried.

Types of hysterectomy

There are different types of hysterectomy. The type you have depends on the reason for your surgery and how much of the womb and surrounding reproductive system can safely be left in place. The main types include:

  • Total hysterectomy: this is the most commonly performed operation. The womb and cervix (neck of the womb) are removed.
  • Subtotal hysterectomy: the main body of the womb is removed leaving the cervix (neck of the womb) in place.
  • Total hysterectomy with bilateral salpingo-oophorectomy: the womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed.
  • Radical hysterectomy: the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue.

There are three ways to perform a hysterectomy:

  • Vaginal hysterectomy: the womb is removed through a cut in the top of the vagina.
  • Abdominal hysterectomy: the womb is removed through a cut in the lower abdomen.
  • Laparoscopic hysterectomy (keyhole surgery): the womb is removed through a number of small cuts in the abdomen.

For more information see How it is performed.

Surgical menopause

If you have a hysterectomy that also removes your ovaries, you will go through the menopause immediately following your operation, regardless of your age. This is known as a surgical menopause.

If a hysterectomy leaves one or both of your ovaries intact, there is a chance you will go through the menopause within five years of your operation. Hysterectomy is a common operation. Most hysterectomies are performed on women aged between 40 and 50.

Fallopian tubes

Fallopian tubes (also called oviducts or uterine tubes) are the two tubes that connect the uterus to the ovaries in the female reproductive system.

Womb

The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Hysterectomy

A hysterectomy is surgery to remove the uterus (womb), cervix and sometimes the fallopian tubes and ovaries.

HRT

Hormone replacement therapy (HRT) involves giving hormones to women when the menopause starts to replace those that the body no longer produces.

Ovaries

Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.

The female reproductive organs

The female reproductive system is made up of the following.

  • Womb (uterus): a pear-shaped organ in the middle of your pelvis where a baby develops. During a period the lining of the womb is shed.
  • Cervix: the neck of the womb, where the womb meets the vagina. The cervix is the lower part of the womb and not separate.
  • Vagina: a muscular tube below the cervix.
  • Fallopian tubes: tubes that connect the womb to the ovaries.
  • Ovaries: small organs by the fallopian tubes that release an egg each month.

Tonsillitis is a common childhood illness but teenagers and adults can get it too.

Most children and adults get viral tonsillitis. This type has to run its course and antibiotics won’t help. It usually goes away on its own after a few days.

Symptoms of tonsillitis

Tonsillitis can feel like a bad cold or flu. The tonsils at the back of your throat will be red and swollen.

The main symptoms are:

  • a sore throat
  • difficulty swallowing
  • hoarse or no voice
  • a high temperature of 38 degrees Celsius or above
  • coughing
  • headache
  • feeling sick
  • earache
  • feeling tired

Sometimes the symptoms can be more severe and include:

  • swollen painful glands in your neck – feels like a lump on the side of your neck
  • white pus-filled spots on your tonsils at the back of your throat
  • bad breath

Symptoms will usually go away after 3 to 4 days.

You may need to stay off work or keep your child at home until you or your child feel better.

You should:

  • use tissues when you cough or sneeze and throw them away after
  • wash your hands after coughing or sneezing

Treatment for tonsillitis

Tonsillitis usually has to run its course.

To help ease the symptoms:

  • get plenty of rest
  • drink cool drinks to soothe the throat
  • take paracetamol or ibuprofen which are available without prescription
  • gargle with warm salty water – children should not try this

How to gargle with salty water

  1. Dissolve half a teaspoon of salt in a glass of warm water – warm water helps salt dissolve.
  2. Gargle with the solution then spit it out – don’t swallow it.
  3. Repeat as often as you like.

This is not suitable for younger children.

Do not give aspirin to children under 16.

A pharmacist can help with tonsillitis

Speak to a pharmacist about tonsillitis. They can give advice and suggest treatments to ease a sore throat. Treatments can include lozenges, throat sprays and antiseptic solutions.

See a GP if:

  • you have white pus-filled spots on the tonsils at the back of your throat
  • the sore throat is so painful it’s difficult to eat or drink
  • the symptoms don’t go away after 4 days

What happens at your appointment

Your doctor can usually tell its tonsillitis by asking about your symptoms and looking at the back of your throat.

Sometimes they might wipe a cotton bud at the back of your throat to test for bacteria. Your GP might organise a blood test to rule out glandular fever.

You’ll get any test results back within a week.

Treatment from a GP

Treatment will depend on what caused your tonsillitis. Most children and adults get viral tonsillitis. This type has to run its course and antibiotics won’t help. Your GP may prescribe antibiotics for bacterial tonsillitis.

Usually, your GP will have to wait for the test results to tell which type you have.

It’s very rare that someone needs to have their tonsils taken out (tonsillectomy). This is usually only the case if you have severe tonsillitis that keeps coming back.

Complications with tonsillitis

Complications with tonsillitis are very rare. If they happen they mostly affect young children aged 2 to 4.

Sometimes you can get a pocket filled with pus (abscess) between your tonsils and the wall of your throat. This is called quinsy (peritonsillar abscess).

Antibiotics are the most common form of treatment for a peritonsillar abscess. Drainage of the pus may also be carried out by a specialist.

An endoscopy is a procedure where the inside of your body is examined using an instrument called an endoscope.

An endoscope is a long, thin, flexible tube that has a light source and camera at one end. Images of the inside of your body are relayed to a television screen.

Endoscopy

Endoscopes can be inserted into the body through a natural opening, such as the mouth and down the throat, or through the bottom.

An endoscope can also be inserted through a small cut (incision) made in the skin when keyhole surgery is being carried out.

When an endoscopy is used

An endoscopy can be used to:

  • investigate unusual symptoms
  • help perform certain types of surgery

An endoscopy can be used as part of the bowel screening process. For example, if you have taken a bowel screening home test and got a ‘not normal’ result.

An endoscope can also be used to remove a small sample of tissue for further analysis. This is known as a biopsy.

Investigating symptoms

An endoscopy might be recommended to investigate the following symptoms:

  • difficulty swallowing (dysphagia)
  • persistent abdominal pain
  • chest pain that isn’t caused by heart-related conditions
  • persistent nausea and vomiting
  • unexplained weight loss
  • vomiting blood
  • persistent diarrhoea
  • blood in your stools

Other types of endoscopies used to investigate symptoms include:

  • gastroscopy – used to examine the gullet (oesophagus), stomach or first part of the small intestine
  • colonoscopy – used to examine the bowel
  • bronchoscopy – used to examine the airways if you have a persistent cough or you’re coughing up blood
  • hysteroscopy – used to examine the inside of the womb (uterus) if there are problems such as unusual vaginal bleeding or repeated miscarriages
  • cystoscopy – used to examine the inside of the bladder if there are problems such as urinary incontinence or blood in your urine
  • endoscopic ultrasound – used to create images of internal organs, such as the pancreas, and take tissue samples
  • arthroscopy – used to examine and treat problems with your joints.

Therapeutic endoscopy

Modified endoscopes with surgical instruments attached to them or passed through them can be used to carry out certain types of surgery.

For example, they may be used to:

  • remove gallstones, bladder stones or kidney stones – the procedure used to remove gallstones is known as an endoscopic retrograde cholangiopancreatography
  • repair damage inside joints (arthroscopy)
  • repair a bleeding stomach ulcer
  • place a stent across an area that has become narrowed or blocked
  • tie and seal the fallopian tubes – a technique carried out during female sterilisation
  • remove small tumours from the lungs or digestive system
  • remove fibroids, non-cancerous growths that can develop inside the womb

Laparoscopic surgery

A laparoscope is a type of endoscope used by surgeons as a visual aid when carrying out keyhole surgery (laparoscopic surgery).

Only small incisions are made during laparoscopic surgery, this means it’s less painful afterwards and you’ll recover more quickly.

Common types of keyhole surgery include:

  • removing an inflamed appendix in cases of appendicitis
  • removing the gallbladder, which is often used to treat gallstones
  • removing a section of the intestine, which is often used to treat digestive conditions, such as Crohn’s disease or diverticulitis, that don’t respond to medication
  • repairing hernias
  • removal of the womb (hysterectomy)
  • removing some or all of an organ affected by cancer

Laparoscopies are also often used to investigate certain symptoms and help diagnose many different conditions.

What happens during an endoscopy

Endoscopies are usually carried out in hospitals.

Before having an endoscopy

Depending on what part of your body is being examined, you may be asked to avoid eating and drinking for several hours beforehand.

You may be given a laxative to help clear stools from your bowels if you are having :

  • a colonoscopy to examine the large intestine
  • a sigmoidoscopy to examine the rectum and lower part of the bowel

In some cases, you may also need antibiotics to reduce the risk of an infection.

If you’re taking a medicine to thin your blood, such as warfarin or clopidogrel, you may need to stop taking it for a few days before having an endoscopy. This is to prevent excessive bleeding during the procedure.

However, don’t stop taking any prescribed medicine unless your GP or specialist advises you to do so.

The endoscopy procedure

An endoscopy isn’t usually painful. Most people only experience some mild discomfort, like indigestion or a sore throat.

The procedure is usually carried out while you’re conscious. You may be given a local anaesthetic to numb a specific area of your body. This may be in the form of a spray or lozenge to numb your throat, for example.

You may also be offered a sedative to help you relax and make you less aware of what’s going on around you.

The endoscope will be carefully inserted into your body. Exactly where it’s inserted will depend on the part of your body being examined.

For example, it may be inserted into your:

  • throat
  • anus – the opening stools are passed out of the body through
  • urethra – the tube urine passes through out of the body

If you’re having keyhole surgery (laparoscopy), the endoscope will be inserted into a small incision your surgeon makes in your skin.

An endoscopy usually takes between 15 and 60 minutes, depending on what it’s being used for. It will usually be carried out on an outpatient basis. This means you won’t have to stay in hospital overnight.

Wireless capsule endoscopy

A wireless capsule endoscopy is a relatively new type of endoscopy. It involves swallowing a capsule that’s able to wirelessly transmit images of the inside of your stomach and digestive system.

The capsule is the size of a large pill and leaves your body naturally when you go to the toilet.

It’s often used to investigate internal bleeding in the digestive system when there’s no obvious cause.

There are some risks of complications with wireless capsule endoscopy. Swallowing the capsule can be difficult, as can passing it naturally. The capsule can also get caught in the narrow areas of your bowel, causing a blockage.

After an endoscopy

After having an endoscopy, you’ll probably need to rest for about an hour until the effects of the local anaesthetic or sedative have worn off.

If you decide to have a sedative, a friend or relative will need to take you home after the procedure.

If you’ve had a cystoscopy to examine your bladder, you may have blood in your urine for 24 hours afterwards. This should settle, but contact your GP if you still notice it after 24 hours.

Risks of an endoscopy

An endoscopy is usually a safe procedure, and the risk of serious complications is very low.

Possible complications include:

  • an infection in a part of the body the endoscope is used to examine – this may require treatment with antibiotics
  • piercing or tearing (perforation) of an organ, or excessive bleeding – you may need surgery to repair tissue or organ damage; sometimes a blood transfusion may also be needed

Sedation

Sedation is usually safe, but it can occasionally cause complications, including:

  • feeling or being sick
  • a burning sensation at the site of the injection
  • saliva or, rarely, small particles of food falling into the lungs, triggering an infection (aspiration pneumonia)
  • irregular heartbeat or low blood pressure
  • breathing difficulties

When to seek medical help

Contact your GP if you notice any signs of infection in the area where the endoscope was inserted.

Signs of infection include:

  • redness, pain or swelling
  • a discharge of fluids or pus
  • a high temperature (fever) of 38 degrees Celsius or above

Other signs of a possible complication after having an endoscopy include:

  • black or very dark-coloured poo
  • shortness of breath
  • severe and persistent abdominal pain
  • vomiting blood
  • chest pain

Contact your GP or visit your nearest Emergency Department (ED) immediately if you notice any of these signs and symptoms.

Carpal tunnel syndrome (CTS) is a relatively common condition that causes pain, numbness and a burning or tingling sensation in the hand and fingers. Symptoms of CTS can range from mild to severe.

The carpal tunnel

The carpal tunnel is a small tunnel that runs from the bottom of the wrist to the lower palm.

Several tendons that help to move the fingers pass through the carpal tunnel. So does the median nerve, which controls sensation and movement of your hand.

On the inner side of the wrist the carpal tunnel is enclosed within tissue called the transverse carpal ligament.

In cases of CTS, the space inside the tunnel is made smaller by the increased tissue pressure and a build-up of fluid in the tissue (oedema). This places pressure on the median nerve. The pressure is increased further when the wrist and fingers are bent (flexion). Compression of the median nerve causes the symptoms of pain and numbness.

How common is CTS?

CTS is more common in women than men. In Ireland each year, around 60 to 120 women out of every 100,000 are affected by the condition compared with 35 to 60 men out of every 100,000.

The two most common age-ranges for developing CTS are between 50 to 54 and 75 to 84.

CTS is also a common condition during pregnancy, affecting up to 50% of pregnant women. It is thought that this may be due to the fluid retention that often occurs during pregnancy, which places additional pressure on the carpal tunnel and causes symptoms.

Outlook

The outlook for CTS depends on the severity of the symptoms. People with mild to moderate symptoms usually respond well to non-surgical treatments, such as wrist splints and corticosteroid injections. In more severe cases of CTS, surgery is usually required to reduce the pressure on the median nerve.

Cases of CTS during pregnancy are usually less severe than those where the cause is unknown cause (idiopathic). It is less likely that CTS during pregnancy will require surgical treatment.

CTS in pregnant women often gets better with three months of the baby being born. However, in some women, symptoms can continue for over a year.

If CTS is recognised early it can usually be treated. However, if it is left untreated it can lead to chronic weakness of the hand, numbness and nerve damage.

ADDITIONAL TREATMENTS AVAILABLE

Generally, if a procedure is available on the public healthcare system, your treatment will be covered when you travel abroad.

Below are examples of some of the most common healthcare procedures that patients are currently travelling for.

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