Anuraksha Specialised Orthopaedic Clinic

A shoulder dislocation is a shoulder injury which is characterized by the upper arm bone popping out of the socket of your shoulder blade. The shoulder joint is the most mobile among all the joints in the body, making it the most prone to dislocation. The dislocation of the shoulder joint can either be partial or complete depending on the injury. In a partial dislocation, the head of the upper arm is partially shifted out of the socket whereas in a complete dislocation, the head comes out of the socket in its entirety.

Symptoms-

The symptoms of shoulder dislocation are:

1. Swelling or bruising of the affected area.

2. Deformed shoulder.

3. Excruciating pain in the shoulder region.

4. Mobility of the joint is greatly reduced.

Apart from these symptoms, there may be tingling, numbness and weakness in the affected region.

Causes-

There can be multiple ways in which a shoulder can be dislocated because of its ability to move and swing in all the directions. The fibrous tissues that connect the bones of your shoulder may also get stretched or torn. These injuries occur due to a sudden blow or a strong force exerted on the shoulder joint.

It is caused by:

1. Trauma to the Shoulder Joint: Hard blows to the shoulder joint such as one suffered from a vehicle accident can lead to shoulder dislocation.

2. Sports Injuries: In contact sports such as hockey and football, the sudden forceful contractions of the shoulder region may lead to dislocation of the shoulder.

3. Falls: Tripping or falling from an elevated place and landing on the shoulder can cause shoulder joint dislocation.

Treatment-

The treatments for shoulder dislocation are –

1. Medication: Medications such as pain relievers can be prescribed by the doctor to reduce pain.

2. Surgery: Surgery of the shoulder joint can help in treating chronic shoulder dislocations. Surgery is also required if the blood vessels or the nerves along the shoulder joint are damaged.

3. Immobilization: This process involves attaching a sling or a splint to the affected area to prevent it from moving. This allows the shoulder joint to heal and recuperate faster.

Knee related problems can have many causes and the effects are no doubt very critical for one's health. You must consult a good doctor to take the right guidance and treatment.

Fibromyalgia is a musculoskeletal disorder that is characterized by pain in the muscles and the joints. This disorder leads to the development of multiple tender points on the body, wherein, a very small amount of pressure applied might result in pain. In some cases, social isolation and depression may occur as a result of this disorder.

The symptoms of fibromyalgia are:
1. You will have difficulties in sleeping at night
2. You may experience mental problems and cognitive dysfunction
3. Light and noise sensitivity
4. Irritable bowel syndrome
5. A numb feeling on your hands and feet
6. Chronic headaches
7. You may experience painful periods
8. Restless legs syndrome
9. You may be depressed

The muscles of the body tend to feel overworked, even though you may not have exercised. You may also experience deep throbbing pain and burning sensation in the muscles. In addition, it may cause symptoms similar to osteoarthritis and bursitis. You are at a higher risk of being affected by fibromyalgia if you have a family history of this particular disease.

Some other causes of this disease are:
1. Certain infections and illness may lead to fibromyalgia
2. Car accidents
3. Any repetitive motion

The treatments for this disorder include:

1. Sleep management: Optimal levels of sleep at night help in improving symptoms of fibromyalgia. Don’t drink coffee or consume spicy foods before going to bed as these have the ability to interfere with your sleep cycles.
2. Medications: The doctor may prescribe medications to manage the pain. Taking anti-depressants may be necessary if you suffer from depression.
3. Other therapies: Massage treatments help in easing the symptoms of fibromyalgia. You may continue with your exercise regimen after consulting the doctor. Relaxation techniques like mediation may help improving your mental health. You may also be asked to include various food supplements to make sure your body receives the necessary nutrients in the right amounts.

The shoulder joint is the most frequently dislocated joint of the body. Because it moves in several directions, your shoulder can dislocate forward, backward or downward, completely or partially, though most dislocations occur through the front of the shoulder. Extreme rotation of your shoulder joint can pop the ball of your upper arm bone out of your shoulder socket.

Osteopenia is a medical condition that gradually causes thinning of bone mass. While the thinning mass is not considered as severe, the real danger looms when osteopenia aggravates to osteoporosis, resulting in a bone fracture. Osteopenia is mostly witnessed in people above the age of 50. The difference between the diagnosis of osteopenia and osteoporosis lies in the measure of bone density.

Osteoporosis, on the other hand, is the loss of bone mass due to the deficiency of calcium, magnesium, vitamin D and other minerals and vitamins. Osteoporosis can lead to broken bones, height loss, acute pain and humpback. It is estimated that over 54 million people in the US suffer from osteoporosis.

Bone mineral density (BMD):
The calcium deposit in the bone is measured by the bone mineral density (BMD) test. This test rightly estimates the chances of bone fracture in a person. Furthermore, it helps a doctor to distinguish between osteopenia and osteoporosis. Being non-invasive in nature, this test can be performed anytime on areas such as hip, shin bone, spine etc. BMD can either be measured by plain radiographs or DEXA. The latter is a form of X-ray that has lesser exposure to radiation. Post the test, a score is given based on the calcium availability of the bones.

How is a BMD comprehended?
Every BMD result is evaluated in the form of T-score. The T-score is derived by comparing the result of the BMD with a normal person in the 30’s having the same race and sex. The difference of score between a healthy individual and a patient affected with osteoporosis or osteopenia is referred to as Standard Deviation. A patient with a T-score in the range of (-1SD) to (-2.5SD) is considered a prime candidate for osteopenia. A patient having a T-score lesser than -2.5SD is diagnosed with osteoporosis.

Risk factor for osteopenia or osteoporosis:
While not everyone runs the risk of getting either osteopenia or osteoporosis, there are certain risk factors attached to it:

1. Gender: Women run a higher risk of getting affected with osteopenia or osteoporosis.
2. Race: Women who belong from the Caucasian or Asian origin run a higher risk of getting these diseases.
3. Age: Most people tend to get these diseases above the age of 50. Humans have a tendency of losing close to 0.5 percent of bone every year after a certain age.
4. Family history: A person with a family history of osteopenia or osteoporosis has more than 50% chance of getting either osteopenia or osteoporosis.
5. Lifestyle: Poor diet, excessive smoking, alcohol, lack of exercising etc. goes a long way in contributing towards these diseases.

Spinal surgery becomes inevitable when back pain cannot be managed with medications and/or exercise. This is a major decision and requires planning for many things before, during, and after the surgery.

Before a spinal surgery- This preparation will help in smooth recovery, especially if you do not have a full-time caretaker.

1. Discontinue pain killers: Discontinue pain killers at least 10 to 14 days before surgery. These are blood thinners and can prolong bleeding during the surgery.

2. Prepare for blood loss: Most people experience some blood loss, but not excessive.

3. Use a toilet seat raiser: Sitting and getting up from the toilet seat may be difficult. The seat raiser is used to increase the height, making this movement easy.

4. Enable easy access to common items: Before heading for the surgery, keep things which are commonly used within easy reach. This will help reduce movement and avoid searching (especially if someone else is going to be doing it).

5. Stock it up: Cooking may not be feasible during the initial postop period, and so it is advisable to stock up food items (ready to eats, fruits, soups, etc.) which will come in handy.

6. Slip-ons: Bending down and tying shoes may not be easy, so slip-ons can be used.

7. Caregiving: It is always advisable to have someone stay over with you during the initial postop days. They could help with regular household chores, cooking, etc.

8. Lifestyle changes: Ensure you eat well in the days before surgery, quit smoking, quit/use moderate amounts of alcohol, and exercise as advised by your surgeon.

After Surgery- Post surgery, there will be some pain and limitation of movement. It is important to understand that adherence to post-op instructions will improve the success rate of the surgery. Also, recovery time for spine surgery is slightly longer and affects overall quality of life, so psychological preparation is required.

1. Postoperative medications: These will be given to control infection and pain in the immediate postop period, and should be taken without fail

2. Rehab: The surgeon will recommend physical therapy and rehab exercises which need to be followed. Complete recovery may take anywhere between 3 to 12 months. During this time, care should be taken to avoid repeat injury.

3. Support: Adequate back support should be provided using lumbar support and ergonomic chairs, and the right posture should be maintained. Ensure there is no undue strain on the back muscles.

4. Weight management: With excess weight, there is too much strain on the lower disks. Therefore, weight should be managed to reduce this strain.

5. Smoking and alcohol should be completely stopped, as healing can be hampered.

With some preparation, spinal surgery can be sailed through smoothly. In case you have a concern or query you can always consult an expert & get answers to your questions!

Frozen shoulder is a condition where the patient encounters continuous shoulder stiffness and pain. It could last for several weeks. Inflammation around the shoulder increases the inability to move or stretch properly. This happens when somebody is recovering from an injury. Frozen shoulder can also occur when somebody is wearing a sling or a cast. It also occurs if someone is recovering from surgery or experiencing joint pain. It may also be experienced as a symptom of thyroid, joint disorders or diabetes.

Some of the causes and risk factors for creating a frozen shoulder are as follows:

1. If you are 40 years or older, your chances of a frozen shoulder are higher than others
2. Recovering from a damage or surgery
3. Hormonal imbalance
4. Ladies are more prone to a frozen shoulder
5. Cervical disc infection that influences the nerves around the shoulder
6. Not moving your arm because of other pain or wounds
7. Having a previous medical condition like diabetes or other heart diseases
8. Open-heart surgery or spinal surgeries
9. Poor diet and unhealthy lifestyle

The most widely recognized symptoms of a frozen shoulder include:

1. Stiffness around the shoulder: this usually happens in one shoulder at a time (not both) and will probably return in the same shoulder. Muscle, joint and bone agony in and around the shoulders or arms may be experienced.
2. Restricted scope of movement
3. Having difficulty moving and using the shoulders or arms ordinarily, (for example, experiencing difficulty in getting dressed, driving, holding objects before you, and gestures.)

Treatment:

1. Stretch the Shoulder: Before beginning shoulder exercises for a frozen shoulder, try to warm up your shoulder by doing a few warm up exercises. This will improve the blood supply in the affected area and avoid future injuries by making your body more comfortable with the motion. The best approach is to extend and warm up the shoulder by applying heat for 10 to 15 minutes, scrubbing down or showering with Epsom salt.
2. Non-intrusive treatment: While these activities mentioned above can be easily performed at home, if pain continues and makes it difficult to move around or work ordinarily, see a physiotherapist who can appoint particular activities and can enhance your scope of movement, flexibility and strength.
3. Acupuncture: Acupuncture is considered one of the best treatment choices for any joint and nerve related problem. The treatment is based on focusing on the trigger points of the pain and putting pressure on them via needles. The treatment is not painful and is known to produce good results in the long run.
4. Dietary Supplements: Various supplements can be taken with the recommendation of a doctor, in order to improve recovery. Alfaifa (horse feed) and turmeric are two of the most regularly recommended elements that relieve swelling and repair the tissue in the shoulder.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Knee replacement is a procedure where the weight-carrying surfaces of knee joint are replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.

Surgery Types-

Knee replacement is mainly of two main types:

1. Total knee replacement where both the sides of knee joints are replaced
2. Partial knee replacement where only single side of the joint is replaced

Procedure-

In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage, and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.

In total knee replacement, four steps are performed:

1. Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
2. Replacement with metal components, which help as a recreated surface of the joint
3. Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
4. Insertion of a medical-grade plastic spacer amid the metal components. This creates an effortless gliding surface.

After general or spinal anaesthesia, an incision of 8-12inches is made in the front part of the knee. Joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin as well as knee cap is attached to the artificial joint with either cement or a special material.

After Effects of the Procedure-

After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.

There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.

Presently, over 90% of total knee replacements function well even after 15 years of surgery. Hence, knee problem is no problem at all! In case you have a concern or query you can always consult an expert & get answers to your questions!

Arthroscopic surgery is a minimally invasive procedure, wherein a viewing instrument is inserted into an area through a small incision in the skin and further work (repair or removal of foreign body) is carried out. With advancements in medical technology, more and more surgeries are being done arthroscopically. Ligament tears are one such instance, where almost all ligament tears are repaired through arthroscopy.
The most common shoulder ligament injury is the rotator cuff, which helps in moving the arm around the shoulder. The tear could be small, medium or large; it could also be partial or complete.

The rotator cuff tendon is inserted into the shoulder in the upper arm and if it gets torn, due to weakness or injury, the movement can be limited. This is repaired arthroscopically due to the following advantages:

1. Minimal or no hospitalisation
2. Minimal recovery time
3. Minimally invasive
4. Minimally painful procedure

Indications:
Rotator cuff tears are very common in, especially in athletes (hockey, wrestlers, football, etc.) and labour workers who are used to repetitive overhead activities. However, before going for a surgery, the following should be considered:

1. Nonsurgical methods including physical and rehab therapy have not provided sufficient relief
2. The patient’s overall health status should be good to sustain the surgery and recovery
3. Financial and overall health risks are explained and understood

What to expect during surgery?:

1. A presurgical evaluation is done to ensure that the tear can be treated arthroscopically
2. X-rays and MRI may be required to confirm the diagnosis
3. The procedure is done under local anaesthesia, and the procedure is done in a seated position
4. General anaesthesia can be used though if the patient and the doctor chose to
5. Depending on where the injury is, incisions are planned to ensure good access to the rotator cuff
6. If there are foreign bodies like bone spurs, they are removed or trimmed
7. The procedure usually takes about 2 to 3 hours, and the repair is carried out
8. Though the complete recovery may take longer, initial recovery with relief of pain and stiffness happens quite soon after the procedure
9. The incisions are closed using absorbable sutures
10. The patient is given a sling for immediate postop use

Recovery:
The patient can go home after a couple of hours when the anaesthetic effect has worn off, driving is not possible though.

1. Initial overuse of the shoulder must be prevented
2. Pain, infection, and swelling control immediately postop is important
3. Can take up to 6 months for complete recovery depending on the size of the tear
4. Exercise regimen and physical therapy instructions should be strictly followed

In case you have a concern or query you can always consult an expert & get answers to your questions!

Mobility for a person is very important, and when you look through, the hip is a very important component to this. It connects the upper and lower parts of the body and helps in movement. It is a ball and socket joint, where the hip bone provides a socket, into which the upper part of the thighbone (femur) sits into, allowing for free movement.

Like any other human organ, the hip also is prone to damage. Be it natural ageing, infection, injury, or diseases, hip movement can be affected, leading to limited movement and increased pain and stiffness. For these people, being able to get back a hip which will allow them to be back on their feet is a boon for sure. It helps in relieving pain and improving mobility, almost giving people a second lease of life.

Reasons for hip replacement:

1. With natural ageing, the hip joint can lose its ability to move, due to normal wear and tear of the hip and thigh bones
2. Diseases of the hips (infectious or autoimmune) can also lead to hip replacement
3. Injury or trauma is another major cause that requires hip replacement
4. Joint problems, leading to repeated dislocations
5. Tumours of the relevant bones

Understanding the procedure in detail

1. The affected bones (whether diseases or worn out) are replaced with a prosthesis which is compatible with the normal body tissue.
2. While some materials fuse to the natural bone, others do not and are simply placed as a separate unit
3. This is a surgery which requires hospitalisation and stays for up to 5 days depending on patient’s overall health condition
4. The entire procedure may take a couple of hours and is usually done under general anaesthesia
5. An incision is made through the side of the hip
6. Both the hip and the thigh joints are prepared, diseased tissue removed, re-shaped, etc. to make way for the prosthesis
7. The prosthesis is introduced through the same incision and positioned into place
8. As noted earlier, there are two types. The ones which fuse to the bone have pores in them into which normal bone eventually grows.
9. The other variety is the cemented version, and a glue is used to keep it in place
10. Most doctors now use a combination, that is cement a porous prosthesis, into which bone will grow, and the incisions are closed
11. The patient stays in the hospital for 1 to 4 days depending on overall health
12. Once discharged, infection and pain control are continued
13. Exercise and physiotherapy play a major role in restoring normal function
14. Weight management is also very important

In case you have a concern or query you can always consult an expert & get answers to your questions!