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!

We have 207 bones in the body and breaking of any one of them can be extremely painful. Broken bones are called fractures and are most often a result of accidents. The risk of breaking a bone depends largely on your age and fractures are most commonly suffered by children and elderly people. There are many types of fractures. The most important amongst these are:

Complete or incomplete fractures: This refers to the way a bone breaks. A complete fracture involves the breaking of a bone into two or more separate pieces while in an incomplete fracture, the bone does not break all the way through and may only be cracked.
Compound fractures: Compound fractures are also known as open fractures. This refers to fractures where the bone tears through the skin.
Simple fractures: Fractures where the bone does not tear through the skin are known as simple fractures. This can be further categorized as greenstick fractures, transverse fractures, oblique fractures and impacted fractures.
Severe pain is one of the most common symptoms of a fracture. Other symptoms include swelling or bruising over the bone area, loss of function and deformity. Any form of a fracture needs medical attention. In most cases, using a splint to reset and support the broken bones can help heal them. This process can be surgical or non-surgical depending on the extent of the fracture. In some cases a pin or metal plate may need to be implanted along with the bone to give them support while they heal.

Fractures can be easily prevented. In your home look out for things you could trip over or bang into. Keep all stairways clear of obstructions and do not use them when wet. Advise your children not to run in the house as tiles are slippery and they could fall and hurt themselves this way.

Follow general safety precautions like wearing a seatbelt while driving or wearing a helmet while riding a bike or bicycle. This can significantly reduce your chances of breaking a bone if caught in an automobile accident. 

The weaker your bones, the easier they are to break. Eat food rich in calcium and vitamin D to build stronger bones. Milk and other dairy products are rich in calcium while the best way to get vitamin D is by exposing yourself to the early morning sunlight.

If you suffer from osteoporosis, exercise regularly to improve your balance and increase the strength of your bones and muscles. Your doctor may also prescribe medication for the same.

Fractures - How They Can Be Prevented?

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?

Pregnancy places a lot of demand on the expectant mother. While the emotional demands are not very evident, the physical ones are. The mother has to ensure that the developing baby gets all the required nutrients through her. Some of them are very critical, and not getting adequate amounts of these manifest as problems, which cannot be rectified later. Calcium supply and associated problems that may arise is one such example.
If there is a reduced supply of calcium and the bones and teeth are not formed properly, taking any amount of calcium is not going to correct the situation later, after delivery.

The bones which are forming in the developing baby are dependent on the mother for adequate supply of calcium. It is common knowledge that calcium is an integral component of bones, teeth, and skeleton. Hypocalcemia, which is a condition where there is reduced amounts of calcium in the body, can be quite severe during pregnancy.
In addition to the growing baby s needs, calcium also plays a vital role in the pregnant mother for muscular contractions, nerve conduction, hormone secretion, and blood clotting. So adequate intake of calcium during pregnancy is essential.
Now, the question arises as to how much calcium is good enough. For a normal female, about 1000 mg of calcium is required on a daily basis. This goes up by another 200 to 300 mg for a pregnant woman, especially during the third trimester when the bone and teeth formation is in full speed. This extra amount of calcium should be continued even after pregnancy, as calcium continues to be provided to the baby during the lactation phase.

Some of the symptoms of reduced calcium intake during pregnancy are aching muscles, brittle nails, weakened bones, severe cramping, and dry skin. If there is suspected hypocalcemia, it is best to seek medical advice. It is not advisable to take supplements without medical supervision. Increased amounts of calcium can produce a different set of symptoms.

While these are evident symptoms, there are other detrimental effects on the baby too. Calcium deficiency affects development of heart and associated structures and puts the newborn at a higher risk of developing hypertension. The baby s fat percentage and triglycerides are also increased. The bone mineral density is reduced. The delivery period could be prolonged, as muscular contractions and nerve conduction are severely impacted when there is less calcium in the system. Recovery from labor is also delayed.

It is possible that you are taking adequate amounts of calcium, but its absorption is affected. Reducing caffeine intake helps in better absorption of calcium. Iron, which is often given during pregnancy, prevents calcium absorption and so needs to be spaced out.

Calcium & Bone Disorders - How to Know If Your Are Suffering From Them?

Your knee is a very complex structure consisting of bones, ligaments, cartilage, tendons, muscles and meniscus. Most people encounter knee pain at some point in their lives. If your knee pain is chronic in nature, then it may last for a prolonged period.

Many causes may be responsible for your knee pain. Some of the causes are stated as follows:
1. Your knee is very much prone to injuries. Knee injuries may happen due to accidents, falling down carelessly or while playing sports. The most common knee injuries that may be the cause for your knee pain are mentioned as follows: 
a) Fractures may cause you to feel pain in the areas of your knee bones.
b) Anterior Cruciate Ligament injury (ligament injury caused by twisting and a sudden motion) or Medial Collateral Ligament injury (injury to the tissue in the insides of your knee) is very common to sportspersons and may be the reason for severe knee pain.
c) Sometimes your knee bones may get dislocated from their usual alignment. This can also make you experience severe knee pain.
d) Ligament injuries, meniscus tear or tendon tear can also be responsible for your knee pain.

2. Sometimes pain in your buttock or foot region can also result in mild knee pain.

3. At times chronic problems like osteoarthritis that affects the cartilage can cause the problem of knee pain. Other chronic problems like Gout, rheumatoid arthritis can also cause severe knee pain.

4. Being overweight can also result in knee pain.
The symptoms of knee pain may be different in each case. The most common symptoms are mentioned below:
a) Stiffness of knee
b) Swelling of your knee
c) You may also feel unstable
d) Difficulty in walking or bending of your knee.
e) You may notice redness in your knee area.

Knee pain must not be ignored. It is highly recommended for you to seek advice from an orthopedic as soon as you encounter any of the above mentioned symptoms.

Suffering from Knee Pain - Know What Causes it? 

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