CITY DENTAL CLINIC, Madiwala

The human hand is made up of 27 bones and a number of tendons and ligaments. An injury to any one of these bones or a disease that affects the bones and ligaments can make you experience excruciating pain in your hands. This pain can affect your ability to perform simple day to day tasks like holding a spoon or writing. Some common reasons your hand may pain are muscle strains, fractures, arthritis and carpal tunnel syndrome. Apart from pain relieving medication, there are a number of ways you can deal with this pain.

1. Hot and cold compresses: Hot and cold therapy is ideal for any type of muscle or ligament injury. A cold compress helps in reducing the pain and inflammation by constricting blood vessels and numbing the area. On the other hand, a hot compress dilates blood vessels and increases the flow of blood and oxygen to the affected area. Ideally, the two should be used alternatively for 10 to 20 minutes each. A bag of frozen vegetables or ice wrapped in a towel makes an easy cold compress. To treat your hand with heat, use a moist heating pad or a hot water bottle. You could also dip your hands in warm water.
2. Massage: A massage is a great way to treat hand pain that results from carpal tunnel syndrome. If the exact cause of pain is not known, massage the entire hand, wrist and forearm. A massage enhances blood flow to the area and hence improves flexibility and opens locked tendons. Using a few drops of essential oils such as lavender or rosemary can also aid in relieving hand pain.
3. Hand exercises: If your work involves repetitive actions like typing, knitting or embroidery, the muscles in your hand can get locked into position thereby, causing pain and discomfort. To relieve this it is important to take a break from this repetitive exercise every hour and flex your hand. Try bending your fingers forwards and backwards and rotating your wrists in both directions to ensure that your joints remain smooth.
4. Epsom salt water bath: For instant relief from intense hand pain, soak your hands in a bath made of hot water and epsom salts for 10 to 20 minutes. Follow this by wrapping your hands in a warm, wet washcloth and applying gentle pressure over the hand for 5-10 minutes. You should instantly feel relief from the pain and experience increased the flexibility of hand.

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

The human spine has 33 vertebrae. However, some conditions can fuse these vertebrae. Ankylosing Spondylitis is one such condition. This disease may also be known as AS or Bechterew's disease. It is an inflammatory disease that can make the spine less flexible by fusing the vertebrae of the lower back together. In some cases, it can also affect the rib cage and make it difficult to breathe. This disease typically affects more men as compared to women. Most patients begin showing symptoms in early adulthood.

Ankylosing Spondylitis affects the sacroiliac joints. These joints are located just above the tailbone. It causes inflammation of the spinal bones that in turn cause pain and stiffness. With time, this inflammation spreads to the entire spine and the vertebrae begin fusing together. This can make movement difficult and painful. In severe cases, it can also lead to the development of a hunchback. This disease also affects the other tissues of the body. For example, it can affect other joints and aggravate arthritis or affect organs such as the kidney, heart, lungs, and eyes.

A specific cause has not yet been identified for Ankylosing Spondylitis. However, studies show that genetic factors can be a trigger. In particular, the presence of the HLA-B27 gene increases a person’s risk of developing symptoms pertaining to this condition. However, it is important to note that merely the presence of this gene does not make Ankylosing Spondylitis inevitable. Other genes that are associated with this disease are ARTS1 and IL23R. These genes influence the functioning of the immune system. While it can affect people of all ages, adults are at a higher risk of suffering from this condition.

In many cases, the initial inflammation of the spine is due to a bacterial infection of microbial infection. Though the infection itself may be treated and cured, it may cause the immune system to react and trigger inflammation. Once activated, if the immune system cannot be turned off, this inflammation will continue and can trigger Ankylosing Spondylitis. In each case, the disease presents a unique pattern of progression.

There is presently no cure for this condition, but with an early diagnosis and treatment, the symptoms can be managed and progression can be slowed. This treatment usually takes the form of medication to relieve pain, inflammation and discomfort and physical therapy. Surgery cannot be used to treat Ankylosing Spondylitis but in cases where it has caused severe joint damage, surgery may be advised to replace the damaged joint.

Frozen shoulder (also known as adhesive capsulitis) is a condition in which the shoulder is stiff, painful, and has limited motion in all directions. A person suffering from a frozen shoulder can be pretty uncomfortable.

Frozen shoulder treatment should be done immediately once it has been detected. Stretching exercises are considered as the best-frozen shoulder treatment exercises. A proper warm up becomes very necessary before any exercise. Making the area warm by using a heating pad is one of the warm-up methods. However, a warm shower covers it all. Physiotherapy for frozen shoulder includes various exercises that should be first confirmed by a doctor. There are a number of exercises for frozen shoulder.

Some very important frozen shoulder exercises are listed below:

1. Pendulum Stretch: To start with, you can do the pendulum stretch. This dictates that the shoulders should be in a state of relaxation, initially, following which the arm which is affected should be allowed to hang down slightly. Once this is done, the arm is to be swung in a small circle i.e. about a foot in diameter. This is to be done consistently so that there can be a gradual improvement in the condition. As there is an improvement, the size of the circle can be increased and once the shoulder can take sufficient weight again, minor weights (up to five pounds) can be used.
2. Finger Walk: A simple exercise which can be done almost anywhere is the finger walk. What this exercise entails is that the person stands about three-fourths of an arm’s length away from a wall and then places his or her fingers on the wall itself, at around the level of the waist. The fingers are to crawl or walk up the wall till the point that it becomes a little uncomfortable. While this is just one repetition, after the fingers have been lowered, it is to be done again. In order to have the best results in combating frozen shoulder, the finger walk exercise is to be repeated about twenty times in a day.
3. Towel Stretches: Towels do not serve a greater role apart from drying up post a bath or over the course of a visit to the spa, right? Well, this is not really true due to the fact that they can be used to even help with frozen shoulder! Indeed, towel stretches done by holding the towel with each hand across one’s back. The arm which is normal should then pull the affected arm so it is stretched. As is the case with the finger walk, about 20 repetitions a day is ideal for good results.

If one goes a step forward and follows a regime of with all these exercises, the person suffering due to frozen shoulder will be back to normal in almost no time at all!

Rotator cuff constitutes the muscles and tendons that hold the shoulder in position. It is a crucial component of the shoulder as it helps in lifting the arm to complete any task. Repetitive actions, deterioration with age or an outstretched hand can lead to a sudden tear.

4 Important Things To Know About Rotator Cuff Repair
An injured rotator cuff can be repaired surgically. Arthroscopy and open surgery are among the techniques used to fix a tear of the rotator cuff surgically. An arthroscope is a tube-shaped apparatus made of a system of lenses, a light and a small video camera. The camera is linked with a monitoring system to view a joint via a tiny incision.

1. Before the surgery:

Blood tests and other diagnostic tests might be carried out by a healthcare provider to ensure that the patient is in good health prior to the procedure.

2. Things to inform the healthcare provider before the surgery-

The healthcare provider must be informed of a few things prior to the surgery:

• Details of allergy or reaction to latex, any medicines, tape or anaesthetic agents
• Information related to bleeding disorders or the intake of anticoagulant or blood-thinning medicines

3. Details of the procedure:
During the rotator cuff repair procedure, anaesthesia is administered as per the patient`s requirement. The details of the procedure are mentioned below:

• The patient is made to wear a gown.
• An intravenous (IV) line is started on the arm of one of the hands.
• The anaesthesiologist monitors various aspects such as the blood pressure, heart rate and blood oxygen level of the patient throughout the procedure.
• The skin above the surgical site is then cleansed, using an antiseptic solution.
• An incision is made in the shoulder area as per the kind of surgical procedure required such as open surgery or an arthroscopy.
• The arthroscope is then inserted via the incision.
• A graft tendon will be taken from another part of the patient’s body to repair the wounded tendons and muscles.
• Stitches or surgical staples are used to close the incisions after which a sterile bandage or dressing is applied.

4. After the procedure:

1. The sensation on the arm is monitored after the procedure. The patient can go home once his/her pulse, blood pressure and breathing are stable.
2. The surgical area must be kept dirt-free and dry after the procedure. A pain reliever is usually prescribed for soreness.
3. Arthroscopic rotator cuff repair is an effective treatment if a patient is not satisfied with alternative medical treatments, such as anti-inflammatory medicines and steroid injections. The procedure is usually done as part of the patient’s stay in a hospital or on an outpatient basis.

If you are about to undergo a knee replacement surgery, it is important to know the extent of pain that it involves, and the recovery period that follows. A knee replacement surgery is a major surgery, and a patient needs a lot of time to adjust to the replacement of his knee. The time of recovery depends on the patient and form of surgery that has been undertaken. The steps of recovery after a knee replacement surgery are as follows:

After surgery

• After the surgery, you will be given painkillers which you can self-administer using a switch. You may also require an oxygen mask or blood transfusion.
• You may require crutches and should walk within a frame. The ability to get back to walking without any help depends on the patient.
• You will be taught exercises for strengthening your knees in the hospital by a physiotherapist.
• It is likely for you to experience some initial discomfort during exercising and walking, as your legs may become swollen.
• Putting on a passive motion machine may be beneficial in restoring movement in your knees when you are lying in bed.
• It is likely for you to spend a period of three to five days in the hospital, based on your condition and its progress.
• An enhanced recovery program may be suggested by your surgeon in which you may start walking from the surgery day itself.

Recovery at home

• It is normal for you to feel tired and fatigued at home in the beginning. A knee replacement surgery is a major surgery, and the tissues and muscles around your knees require time to heal properly.
• You should arrange for a person who would help you while you go out for a few weeks after the surgery.
• It is very important for you to practice the exercises prescribed by your physiotherapist. This is a vital part of speedy recovery and you should not avoid them.
• You will be able to stop depending on crutches or walking frames and go back to your regular activities and schedule, six weeks after the surgery.
• The swelling and pain associated with the surgery may take around three months to depart.

The recovery process usually continues for two years after undergoing the surgery. During this period, scar tissue heals and your muscles get restored through exercises. It is recommended for you to avoid any kind of extreme sports or movements in which there is a risk of falling, such as mountain biking, or skiing.