The shoulder is a complex joint consisting of a number of bones, ball, socket, and cartilage. For people suffering from arthritis of the shoulder joint, a total replacement of the shoulder joint is often a successful procedure. It significantly improves pain and range of motion. However, in case the patient is suffering from a special type of arthritis of the joint known as  cuff tear arthropathy , a total shoulder replacement often does not produce the desired result. These people suffer from large rotator cuff tear as well as arthritis. For such patients, a reverse shoulder arthroplasty often show better results. 

Reverse Shoulder Arthroplasty 

In traditional total shoulder replacement, the device put into the joint consists of a plastic cup fitted into the glenoid bone, also known as the socket, and a metal ball attached to the top of the humerus, the upper arm bone. In a way, it mimics the configuration of the original shoulder joint. However, in case of reverse shoulder arthroplasty, the positions of the metal ball and the socket are interchanged. The plastic cup is attached to the humeral head whereas the metal ball is attached to the glenoid bone. 

Benefits of the Procedure 

A reverse shoulder arthroplasty works better for patients who have a large rotator cuff tear along with arthritis. There are a number of rotator cuff muscles in the shoulder and they help to hold the arm in position as well as provide power to the arm during extreme movements. In case of people with large rotator cuff tear and arthropathy, the upper arm has to rely on different muscles for movement because the rotator cuff muscles don t function. Hence, the arm has to depend on other muscles such as the deltoid muscles, to position and power the arm. This is why a reverse arthroplasty is carried out.

Who Can Undergo This Surgery?

Every patient with cuff tear arthropathy is not a candidate for reverse shoulder arthroplasty. Surgeons recommend this surgery when the patient is suffering from: 

  A total tear of the rotator cuff which cannot be repaired 

  A special type of shoulder arthritis known as cuff tear arthropathy 

  An unsuccessful shoulder replacement surgery 

  Extreme shoulder pain along with difficulty in lifting the arm over the head or away from the body 

  A complex type of fracture in shoulder joint 

  A chronic dislocation of the shoulder 

  A tumor in shoulder joint 

Doctors can also suggest this procedure if the patient had previously tried other remedial measures such as medications, rest, physical therapy, injections, etc., but was not successful in alleviating the pain and improving the range of motion of the shoulder. 

Conclusion 

There are some medications that you need to stop before the surgery since they may cause excessive bleeding after the surgery. Some of these medicines are blood-thinning medicines and Non-steroidal anti-inflammatory medicines.

Revision Replacement - What Should You Know?

Most bone fractures mend very easily with proper medical treatment and rest. However, in rare cases, a fracture caused by trauma may not mend even after adequate treatment. When a broken bone fails to heal, it is known as non-union. There are two major reasons for non-union:

  Bone lacks adequate stability

All broken bones require stability to heal. In case of a fracture, doctors place the dislocated bone in its original place and use an external device to hold the broken part in place. Usually, this stability is provided by a splint or cast, but can also be offered by frames and rods as well. However, if the broken bone lacks the required support, it may not set or heal properly, leading to the non-union.

  Fracture lacks proper blood supply

Even with proper stability, a broken bone requires a proper blood supply to start the healing process. The blood carries oxygen and other chemicals that aid in the repair of the bone and makes it crucial during the recovery stage. However, if the blood supply is disrupted, the bone cannot heal and leads to non-union.



Risk factors of non-union:

You are more likely to suffer from non-union if one or more of the following is true in your case-

  People who engage in cigarette smoking and any other form of nicotine addiction have a higher risk of non-unions after a fracture
  Older people can often face non-union, which is why fractures may take longer to heal in these people
  Severe anaemia can often restrict proper blood flow to the broken bone, thus inhibiting the healing procedure
  Similarly, people suffering from diabetes face a greater risk of non-unions
  Lack of proper nutrition may also be blamed for the non-union
  Non-union risks may increase because of side effects from certain medication, such as prednisone, ibuprofen, and aspirin. Consult your doctor in such a case, so that proper precautions can be taken accordingly.

Non-surgical treatment can be used for treating the non-union. Electromagnetic and ultrasound waves are passed through the skin and into the affected bone, in order to treat the non-union. In most cases, this treatment is very effective in curing the fracture. However, if the non-surgical treatment proves ineffective, surgical procedures, such as bone grafts and allograft can be utilized.

Trauma And Nonunion - The Various Risks Involved With It!

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-

Fracture- In case of a fracture usually the patella gets affected. But sometimes the ends of femur or tibia can also get fractured.
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.
Dislocation- Sometimes bones like femur or tibia gets displaced from their usual alignment.
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.
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:

Immobilization: Your doctor may recommend a brace to prevent your knee from moving.
Physical Therapy: Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
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-

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

Sports Injury - Its Surgical And Non-Surgical Treatment!

Clubfoot is a deformity of the foot in infants. The condition is usually present from birth. This happens when the tissues linking the muscles to the tendons are shorter than usual, as a result of which the infant s foot appears twisted and out of shape. The condition can be mild or severe, depending on the symptoms. Often times, babies who are born with clubfoot have it in both the legs.

How to identify if your child has clubfoot?

Since the condition is present from birth, the symptoms are also easily observable. Identifying the following signs can help detect if your child is born with clubfoot-

  A foot that turns downward and inward and toes that point towards the opposite foot
  The affected foot may appear half an inch shorter than the normal foot size
  The heel of the affected foot may be smaller in size than it normally should be
  The calf muscle on the affected leg will be underdeveloped (appear slightly smaller)
  If the condition is severe, the foot may be twisted upside down

Despite its unusual shape, clubfoot does not cause pain or discomfort. The doctor will most likely notice the symptoms after the infant s birth. He/she will recommend appropriate treatment of the condition, or refer to an orthopaedic who specializes in muscle and bone ailments.

What is the treatment of clubfoot?

Clubfoot is curable so parents need not worry about their child living with a lifelong deformity.

Depending on the severity of the condition, the orthopaedic will either use devices, resort to stretching methods, or will recommend surgery.

  Ponseti Method (stretching and casting) - It is the standard treatment worldover. It starts at birth or anytime within two weeks of age and has best results in younger kids. It involves stretching the clubfoot and casting it in correct position several times over the months to restore the foot shape.
  French Functional Method (stretching and taping) - The doctor will stretch the affected foot and tape it in position several times over a couple of months to realign the shape. It, however, has very limites following.
  Surgery - Surgeries may be needed in older neglected kids or adults. The surgeon performs a surgical procedure (Achilles tenotomy) to lengthen the tendon of the clubfoot and realigns the joints and bones. Following the surgery, the child will need to be in a cast for about 2 months. Further, to prevent the recurrence of the condition, the child will be advised to wear braces for a year at least.
  Devices - They are adjunctive maintenance devices which are used by doctors in treatment of clubfoot. They are applied to the body to stabilize and limit or protect the movement of the damaged joint.

Parents should seek medical intervention if their baby is born with clubfoot. If the condition is not treated early, the child may face difficulty walking, or may even develop other disorders affecting the joints, like arthritis.

Clubfoot - Ways To Identify & Treat It Well!

Osteoporosis is a disease that affects the bones of a patient. This is most commonly found in women, especially in those women 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 include 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 beam 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.

Why is the DEXA scan important for osteoporosis patients?

Majority of bone tumours are benign, meaning they are localised and do not spread. Since benign tumours do not metastasize, they are not forms of cancer. Despite not being malignant, the severity of their presence should not be ignored as they may cause a lot of pain and lead to other problems such as damaged bones and fractures.

Benign Bone Tumors

Osteochondromas: These form over 40 per cent of all benign bone tumours. They are mostly found in children and teenagers. Osteochondroma is a growth abnormality and they are found in the growing ends of long bones. An osteochondroma might grow separately or might be accompanied by other similar tumours.
Osteoclastomas: They are also called giant cell tumours of the bone. They are common and are found in the epiphysis of long bones and around the knee.
Osteoid Osteoma: These grow mostly in adolescents and very rarely in adults above 50. They primarily grow in the legs but they might also be found in other bones in the body.
Enchondroma: It is a bone tumour that starts in the cartilage. It is mostly found in the cartilage of the inner lining of bones. Small long bones of the feet and the hands are affected the most. Teenagers get more affected than other age group.
Osteoblastoma: These are slow growing tumours that take about two years to get diagnosed. An osteoblastoma makes the surrounding bones weaker as they dissolve them and make them more susceptible to fracture caused by small injuries. Men are twice as more likely to be affected by an osteoblastoma than women. Surgery is essential in all cases of osteoblastoma as they destroy healthy functional bone and grow in size with time.
In rare cases, these have also known to become malignant over time, despite their benign nature. It affects people under 30 mostly.

Malignant Bone Tumours

Osteosarcoma: It affects the hip, knees and shoulders of mostly children and teenagers. It is also referred to as osteogenic sarcoma.
Ewing Sarcoma Family of Tumours: These generate from medullary cavities and can also grow in blood vessels and adipose tissues. It primarily affects children and teenagers.
Chondrosarcoma: It usually affects the hips, pelvis and shoulders of middle aged people.

5 Most Common Types Of Benign Tumours!

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