Dr. Naveen Devarajaiah

Your knees are one of the most vulnerable parts of your bodies. In case of strenuous or vigorous activities, knees are more prone to damage and injury than the other parts. Several of the knee tissues are fairly delicate and often are easily impaired. Among the other knee tissue injuries, meniscus tears are perhaps the most frequent. Meniscus is essentially a cartilage that protects and stabilizes the knee joints. However, an untoward twist or a strain can lead to a tear in the meniscus. Meniscus tears are a common phenomenon among athletes and sportsmen. They have been noted to be more recurrent in older individuals. 

Some of the early symptoms that indicate the onset of a meniscus tear are swelling and difficulty in bending or straightening of the leg. Sometimes a "locking sensation" in the knees also forebodes a torn meniscus. The inflammation potentially causes a lot of pain and irritation. While, it is fairly easy to ignore a meniscus tear for a normal knee injury, prolonged overlooking may only aggravate the pain and worsen the condition. The process of diagnosing a meniscus tear usually involves an MRI scan and an X-ray examination, over and above a detailed evaluation of the wound.

Treating meniscus tears vary according to the extent of the injury. Depending upon the location and the depth of the tear, various cures can be tried. The healing process, however, depends upon other allied factors such as age, level of physical activities and one's medical history. An external and minor injury is easily mendable. Whereas, graver injuries are resolved through surgical means. The other non-operative means include certain prescribed medicines and specific exercises. Some of the recommended ways of battling a meniscus tear can be enlisted as:

1. Resting the knee by limiting the activities that involve excessive use of the legs or they may potentially strain the leg muscles.
2. Applying ice pack can significantly bring relief to the swelling and the pain in the injured knee. Doctors advice regular use for a duration of at least 15 days.
3. Compressing the knee using an elastic bandage or neoprene sleeve reduces the swelling in the knee.
4. Prescribed medicines in the likes of non-steroidal anti-inflammatory drugs can be effective remedies for a meniscus tear. However, one must mandatorily consult a doctor before consuming such medicines.

Osteoporosis is a disease that affects the bones of its sufferers. This is most commonly found in women, especially in those who are close to, or going through, menopause. Hormonal changes around this period in a woman's life usually lead to various changes in her body. One of these changes includes loss of bone tissue which can leave the patient with brittle and weak bones, a condition that is also known as osteoporosis. This condition literally imbibes the word porous, meaning hollow bones. It is born from an acute deficiency of calcium and Vitamin D. The DEXA Scan or bone density test, also known as the Dual Energy X Ray Absorptiometry Scan, is one of the most effective tests that can help you in detecting this kind of damage or thinning bones. Here's why.

• Fractures: The DEXA Scan is an important one because it sends low energy beams to areas like your joints and tissues to show how susceptible you are to fractures. It does so by measuring the strength of the tissues as well as the bones to see how brittle they may be. 
• Other Ailments: Measuring the thinning of your bones can also point to the presence of other ailments that may have gone unnoticed or undetected, earlier. These can include kidney disease, hyperparathyroidism which happens due to overactive secretions of the said gland, as well as liver disease due a malfunctioning liver, intestinal disease and various disorders in the intestinal tract, and a serious Vitamin D deficiency. With this scan, you can get an insight into the other parts of the body affected by the bone density, and whether or not they are functioning properly. 
• Estrogen: Simply checking the estrogen levels cannot ascertain whether or not you have osteoporosis, as a high estrogen level can be credited to a particularly heavy period cycle. It does not show the bone health the way a DEXA Scan does. 
• Easy and Standardised: This method of scanning usually happens with the help of a mounted X ray machine type, hand held gadget which can be extended to conduct the scan. This is an easy and standardised method that releases low levels of radiation which also makes it a healthier option.
• Bone Density Scores: The T Scores and Z scores point towards the bone density and help in diagnosing the condition efficiently. With a systematic scoring system, it is a sure shot test for osteoporosis.

Osteoporosis is a serious condition. The first step in treating the same is to get a detailed scan like the DEXA scan done, so as to test the extent of the bone thinning to ensure that proper and timely treatment takes place. 

Extracorporeal Shock Wave Therapy (ESWT) is a highly effective and innovative treatment option in a variety of fields, from urology to cosmetology including orthopedics. This is a non-invasive method that employs high-energy shockwaves to bring about the healing of the affected tissues. It has been found to provide good results for recalcitrant orthopaedic problems like frozen shoulder to certain chronic degenerative or tendon conditions such as Achilles tendinitis (injury of the Achilles' tendon due to overuse) and plantar fasciitis in heel pain.

How does it work?

The procedure is basically an outpatient/ daycare job. It involves the application of a non-invasive probe to the affected tissue. This is followed by the external generation of shockwaves focused on the target area. The shockwaves cause a force to be created that brings about healing. Although it's still not clear as to why this kind of therapy works, the dominant understanding is that shockwaves render an improvement in the flow of blood so as to promote the body to fix and heal itself.

Depending on individual cases, high or low energy waves may be employed. While pain may occur during the transmission of high energy waves and would require short general anaesthesia, low-energy ESWT is carried out without anesthesia.

What problems can this form of therapy effectively tackle?

ESWT can be used to treat a number of musculoskeletal disorders. From plantar fasciitis (heel pain), tennis elbow, shoulder rotator cuff, degenerated tendons (Achilles' tendon) to hip and knee pain, the therapy has been found to reduce pain as well as accelerate healing in individuals.

Complications are very few and far between with this therapy. Individuals who suffer from hypersensitivity or poor sensation in the affected area are usually not recommended this procedure. Even individuals with heart conditions, seizures and open sores need to consult a doctor before going forward with the therapy.

The therapy has also been found to be very effective in bone healing as well as treatment of bone necrosis (a disease that occurs due to permanent or temporary loss of blood flow to the bones). Additionally in place of surgery, ESWT may also be a valuable option for non-healing fractures. In case you have a concern or query you can always consult an expert & get answers to your questions!

Hip replacement surgery is a method wherein a defective hip joint is removed and replaced with an artificial hip joint. This procedure is only opted for after all the other treatments have failed to yield the desired effects. Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to:

• Relieve pain

• Help the hip joint work better

• Improve walking and other movements.

Who Should Have Hip Replacement Surgery?

The most common reason for hip replacement is osteoarthritis in the hip joint. Your doctor might also suggest this surgery if you have:

1. Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)

2. Osteonecrosis (a disease that causes the bone in joints to die)

3. Injury of the hip joint

4. Bone tumors that break down the hip joint.

Your doctor will likely suggest other treatments first, including:

1. Walking aids, such as a cane

2. An exercise program

3. Physical therapy

4. Medications.

These treatments may decrease hip pain and improve function. Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x ray to look at the damage to the joint. If the x ray shows damage and your hip joint hurts, you may need a hip replacement.

The Procedure

Hip replacement surgery is a procedure that can either be performed by traditional means or a minimally invasive procedure. The primary difference between the two procedures is the size of the incision. The procedure begins with the doctor administering local anesthesia, though in certain cases, general anesthesia is also administered.

1. An incision is then made along the hip and the muscles that are connected to the thigh bone are shifted, so that the hip joint is exposed.

2. An equipment is then used to remove the ball socket of the joint by cutting the thighbone.

3. The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.

4. Once the joint is fixed, the ball of the thighbone is then put in the hip socket.

5. The fluids from the incision area are then allowed to drain.

6. The hip muscles are then put in place and the incision is closed.

Post -surgery

After the surgery, the recovery stage begins. The period of hospital stay post-surgery usually lasts for 4-6 days. A drainage tube is attached to the bladder to get rid of waste products from the body. Physical therapy begins immediately after the surgery and you will be able to walk after a few days with walking aids. The physical therapy continues for a few months after the surgery.

After care

It is advised to avoid activities that involve twisting your leg for at least half a year. You should also avoid crossing the leg along the mid portion of your body. Your physiotherapist will provide you with exercises that aid to help you recover. Avoid climbing stairs and sit on chairs that have strong back support. If you wish to discuss about any specific problem, you can consult an Orthopedist.

Incorrect posture or a sedentary lifestyle will often land you in pain in your lower back region. To control this pain, here are a few exercises which you might try out for a healthier back:

1. Bottom to Heels Stretch: This helps to stretch and mobilize the spine. Keep your knees and hands in line with your hips and shoulders. Do not over arch your back as that will just bring you a negative impact. Move your bottom backwards. Hold the stretch while you breathe in and out once. Repeat this exercise 8 to 10 times.
2. Knee Rolls: For this exercise, you have to lie down on your back. Support your head with a cushion or a book. Bend your knees and keep them together. Relax your upper body. Then roll your knees, followed by your pelvis, from one side to another. Hold your stretch while you inhale and exhale once.
3. Back Extensions: For this exercise, you need to lie on your stomach. You will have to prop yourself on your elbows. Arch your back while you put your hands on the ground and hold it for 5 to 10 seconds.
4. Deep Abdominal Strengthening: You have to lie on your back. Support your head with a cushion or a book. Keep your knees bent and your feet straight, relax your upper body and breathe in and out while stretching your stomach muscles. Hold it for 5 to 10 breaths.
5. Decompression Breathing: Stand with your heels slight apart from each other. Reach out overhead, lift your ribcage away from your hips while inhaling, and tighten your core while exhaling.

For a healthy and strong lower back you may require some other exercises, but to control the pain in your lower back you should absolutely make a point to try these out. If you wish to discuss about any specific problem, you can consult an orthopedist.

Knee is a complex structure of your body made up of bones, ligaments, tendons, articular cartilage, muscles and meniscus. Knee is a very important joint as it plays a crucial role in human movement and is also very much prone to injuries. Your shoulder like your knee is also composed of bones, ligaments, tendons and muscles. It is the most flexible joint of your body and because of its frequent movement is also vulnerable to injuries. Knee and shoulder injuries can happen due to various reasons such as while playing sports, carelessly falling down or accidents. Your knee is made up of many important structures, any of which can be injured.

Pain and swelling are the most common signs of knee injury. In addition, your knee may catch or lock up. Many knee injuries cause instability, the feeling that your knee is giving way.

The most common knee injuries are as follows-

1. Fracture- In case of a fracture usually the patella gets affected. But sometimes the ends of femur or tibia can also get fractured.
2. Sprains and Strains- This is the most common injury that can happen while playing sports. Sprains and strains refer to the injury of the ACL or MCL.
3. Dislocation- Sometimes bones like femur or tibia gets displaced from their usual alignment.
4. Ligament Injuries- Your ligaments may get injured if the position of your knee is in a bent condition during the injury. Ligament injuries are common to sportspersons and can also happen if you encounter an accident.
5. Meniscal Tear and Tendon Tear- These are very common knee injuries which can happen while playing sports or falling down carelessly.

Treatment of Knee Injuries-

When you are first injured, the RICE method — rest, ice, gentle compression and elevation – can help speed your recovery. The type of treatment your doctor recommends will depend on several factors, such as the severity of your injury, your age, general health, and activity level.

Nonsurgical Treatment-

Many knee injuries can be treated with simple measures, such as:

1. Immobilization: Your doctor may recommend a brace to prevent your knee from moving.
2. Physical Therapy: Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
3. Non-steroidal anti-inflammatory medicines: Drugs like aspirin and ibuprofen reduce pain and swelling.

Surgical Treatment-

Many fractures and injuries around the knee require surgery to fully restore function to your leg. In some cases – such as ACL, PCL, Meniscal tears, surgery can be done arthroscopically using small incisions and minimally Invasive techniques.

The most common shoulder injuries are stated below-

• Dislocation- Sometimes joints may get dislocated from their usual alignment
• Fractures- Fractures of the collar bone, humerus and scapular fracture
• Frozen Shoulder- It occurs due to the stiffness of the shoulder joint
• AC Joint Injury- The ligaments may get injured in this type of an injury. It is common in sportsperson or may also happen due to falling down
• Shoulder Impingement- In this case the muscles gets injured
• Rotator Cuff Disease (Tendinitis and Bursitis)- In tendinitis of the shoulder, tendons become inflamed (red, sore, and swollen) from being pinched by parts around the shoulder. However, Bursitis occurs when the bursa, a small fluid-filled sac that helps protect the shoulder joint is inflamed.
• Rotator Cuff Tear- Rotator cuff tendons can become inflamed from frequent use or aging. Sometimes they are injured from a fall on an outstretched hand.

Treatment of Shoulder Injuries-

1. Early detection is the key to preventing serious shoulder injuries.
2. Shoulder Exercises
3. Anti-inflammatory medication also may be prescribed to reduce pain and swelling.
4. Shoulder injuries can be treated by exercises and physiotherapy
5. Shoulder arthroscopy surgery is a small key hole, Day care surgery done for various problems like Periarthritis, Recurrent Shoulder Dislocation, Rotator Cuff Tear 

   If you wish to discuss about any specific problem, you can consult an orthopedist.