Know more about the symptoms and types for frozen shoulder
Good morning everybody, I am doctor Rakesh Kumar, I am senior consultant in orthopedics in Apollo hospital, Jivan mala and MGS hospital. Today I am going to give health tips on frozen shoulder. Frozen shoulder is named as Adhesive Capsulitis. Adhesive Capsulitis is a condition in which contracted thickened joint capsules that seem to be drawn tightly around a humeral head in the absence of synovial fluid and chronic inflammatory changes within the subsynovial layer of the capsule occurs. The underlying pathological change in adhesive capsulitis are sinonasal inflammation, with subsequent reactive capsular fibrosis, cytokines and metaloprotanysis have been implicated in the process but the initial triggering event in the cascades is unknown. Incidence is 2%, but several conditions are specified with increased incidence, includes gender—i.e more common in females, more common in older ages—between 40 to 70 years, 5 times more common in diabetes mellitus, cervical disc diseases, prolonged immobilization, hyperthyroidism, stroke, or myocardial infections, the presence of autoimmune disease and trauma.
Individuals between ages 40 to 70 are more commonly affected, approximately 70% patients are females. 20% to 30% of affected individuals develop adhesive capsulitis in the opposite shoulder. Frozen shoulder in patients who report no inciting event and with no abnormality are designated as primary whereas in patients with precipitant traumatic injuries are designated as secondary. We have noted that internal rotation frequently is lost in sleep followed by loss of fluctuation and external rotation, most often our patients can internally rotate only upto the sacrum, have 50% loss of external rotation and have less than 90 degree of abduction.
We include these patients in the diagnosis of frozen shoulder.
Primary frozen shoulder have three phases-
Phase 1 is a phase of pain, patients usually have a gradual onset of diffused shoulder pain which is progressive over weeks to months, the pain usually is worse at night, and is exacerbated by lying on the affected side as the patient uses the arm less leading to stiffness.
Phase 2 is stiffness, Patient seeks pain relief by restricting movements this heralds the beginning of stiffness phase which usually lasts for 4 to 12 months. Patients describe difficulty in activity of daily living, men have trouble getting to their wallets in their back pockets while females have trouble with fastening their brassieres.
Phase 3 is pain thawing phase, this phase lasts for weeks or months. And as motion increases pain diminishes without treatment other than benign neglect motion return is gradual in most but may never objectively return to normal. Although most patients subjectively feels near normal, they make adjustments in ways of performing activities of daily livings.
Treatments- Frozen shoulder has been considered as self limiting condition lasting 12 to 18 months without long term sick leave. Approximately 10% of patients have long term problems. The best treatment of frozen shoulder is prevention. But early intervention is paramount. A good understanding of the pathological process by the patient and the physician also is important.
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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:
- If you are 40 years or older, your chances of a frozen shoulder are higher than others
- Recovering from a damage or surgery
- Hormonal imbalance
- Ladies are more prone to a frozen shoulder
- Cervical disc infection that influences the nerves around the shoulder
- Not moving your arm because of other pain or wounds
- Having a previous medical condition like diabetes or other heart diseases
- Open-heart surgery or spinal surgeries
- Poor diet and unhealthy lifestyle
The most widely recognized symptoms of a frozen shoulder include:
- 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.
- Restricted scope of movement
- Having difficulty moving and using the shoulders or arms ordinarily, (for example, experiencing difficulty in getting dressed, driving, holding objects before you, and gestures.)
- 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.
- 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.
- 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.
- 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.
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.
Knee replacement is mainly of two main types:
- Total knee replacement where both the sides of knee joints are replaced
- Partial knee replacement where only single side of the joint is replaced
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:
- Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
- Replacement with metal components, which help as a recreated surface of the joint
- Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
- 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!
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:
- Minimal or no hospitalisation
- Minimal recovery time
- Minimally invasive
- Minimally painful procedure
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:
- Nonsurgical methods including physical and rehab therapy have not provided sufficient relief
- The patient’s overall health status should be good to sustain the surgery and recovery
- Financial and overall health risks are explained and understood
What to expect during surgery?:
- A presurgical evaluation is done to ensure that the tear can be treated arthroscopically
- X-rays and MRI may be required to confirm the diagnosis
- The procedure is done under local anaesthesia, and the procedure is done in a seated position
- General anaesthesia can be used though if the patient and the doctor chose to
- Depending on where the injury is, incisions are planned to ensure good access to the rotator cuff
- If there are foreign bodies like bone spurs, they are removed or trimmed
- The procedure usually takes about 2 to 3 hours, and the repair is carried out
- Though the complete recovery may take longer, initial recovery with relief of pain and stiffness happens quite soon after the procedure
- The incisions are closed using absorbable sutures
- The patient is given a sling for immediate postop use
The patient can go home after a couple of hours when the anaesthetic effect has worn off, driving is not possible though.
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:
- With natural ageing, the hip joint can lose its ability to move, due to normal wear and tear of the hip and thigh bones
- Diseases of the hips (infectious or autoimmune) can also lead to hip replacement
- Injury or trauma is another major cause that requires hip replacement
- Joint problems, leading to repeated dislocations
- Tumours of the relevant bones
Understanding the procedure in detail
- The affected bones (whether diseases or worn out) are replaced with a prosthesis which is compatible with the normal body tissue.
- While some materials fuse to the natural bone, others do not and are simply placed as a separate unit
- This is a surgery which requires hospitalisation and stays for up to 5 days depending on patient’s overall health condition
- The entire procedure may take a couple of hours and is usually done under general anaesthesia
- An incision is made through the side of the hip
- Both the hip and the thigh joints are prepared, diseased tissue removed, re-shaped, etc. to make way for the prosthesis
- The prosthesis is introduced through the same incision and positioned into place
- As noted earlier, there are two types. The ones which fuse to the bone have pores in them into which normal bone eventually grows.
- The other variety is the cemented version, and a glue is used to keep it in place
- Most doctors now use a combination, that is cement a porous prosthesis, into which bone will grow, and the incisions are closed
- The patient stays in the hospital for 1 to 4 days depending on overall health
- Once discharged, infection and pain control are continued
- Exercise and physiotherapy play a major role in restoring normal function
- 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!
Knee replacement surgery is a procedure that is used to replace a worn out knee joint with an artificial knee joint. Such a surgery is advised if your knee is causing pain and limiting your daily activities, provided other treatments have failed to cause the desired impact.
Once the knee replacement surgery is completed, the focus shifts to the recovery phase.
The duration of the recovery depends on the type of surgery and the individual.
After the surgery, painkillers are administered to provide relief from the pain.
In some cases, oxygen is administered through various tubes if required.
A blood transfusion may also be required after a knee replacement surgery.
The surgical wound will require a dressing to allow it to heal faster and prevent infection.
A drain will be attached to the wound to drain out the blood from it and prevent accumulation of blood in the wound.
The dressing of the wound should be changed regularly.
Post- Surgery Care
Post-surgery, you will need assistance to help you walk. If the surgery that you underwent was minimally invasive, then you should be able to walk on the very same day. Your physiotherapist will prescribe and show you some exercises to strengthen the knee. It is important that you follow his/her instructions to avoid complications.
A passive motion machine is sometimes prescribed as it helps to restore the movement of the knee. It helps in reducing the swelling by keeping your leg elevated and moving the knee when you are lying down.
Here are some knee replacement recovery tips:
Avoid doing any work that puts pressure on the knees.
Eat nutritious meals so that the body receives proper nourishment, thus allowing your leg to heal faster.
Avoid heavy exercises which can strain your knees.
Perform all the exercises prescribed by your physiotherapist to speed up the recovery process.
- Do not sit with your legs crossed for a few months after the surgery. Consult an expert & get answers to your questions!
The shoulder is one of the most intricate joints in the body and given that it is subjected to a lot of lifting and movements, there are chances for it to tear or dislocate. The shoulder is a ball-and-socket joint with the socket in the shoulder, and the ball in the upper arm. The joint space between the two bones is surrounded by cartilage, and the space between the two is filled with fluid. Especially in athletes, due to forceful movement, this joint could get dislocated or the cartilage could tear.
The Bankart lesion is when there is a tear of the cartilage in the central anterior shoulder. This causes the cartilage to be damaged, allowing the humeral head to slip down from the socket. When the arm is extended down or to the side, it is commonly dislocated. This can happen posteriorly also, but this movement and so the injury is less likely than an anterior dislocation. If there is also a fracture of the shoulder bone with this dislocation, then it is known as bony or osseous Bankart lesion.
Causes: Bankart lesions can be acute or chronic. Acute is when there is sudden dislocation due to sports activity or accidents. Repetitive use of the shoulder can also lead to chronic Bankart lesions. This is usually seen in sportspersons like swimmers, tennis players, and weightlifters.
Signs and Symptoms:
- Pain: The most common symptom with Bankart is shoulder pain that restricts any kind of movement. One may find it difficult pick up things or lifting your hands and in some cases, it is difficult to even sit straight.
- Weakness: The shoulder feels weak and one is unable to perform normal activities
- Instability: One may lose the grip and strength.
- Limited movement: The range of motion of the shoulder may be reduced compared to before the injury.
- Crackling: The damage to the fibrous cartilage produces a crackling sound, which can be heard during the movement of the shoulder.
Diagnosis: A combination of symptoms, physical examination, X-ray, and MRI can help in confirming the diagnosis.
The course of treatment depends on the cause and condition of the patient. An exercise regimen is prescribed as the first step in the treatment process. If there is inadequate progress, or if the pain seems to be recurrent, open or closed shoulder surgery may be recommended to include the following:
- Arthroscopy (closed surgery) to repair the cartilage damage
- Ligament re-attachment
- Bone reshaping
- Cartilage build up and reshaping
- Ligament repair to improve stability
Any of these shoulder surgeries would be followed up with measures to reduce further injury. It is therefore advised to visit a doctor in case of any such discomfort as he/she will be able to find out the severity of the situation and devise a treatment plan accordingly.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Human bones are continuously being removed and formed which is necessary for its proper maintenance. However, in certain cases, especially with aging, some bones and joints will be worn down to an extent where the body will not be able to reform them. This is especially true in the case of hips which may become worn due to age or other problems within the body.
Hip replacement surgery
When this happens, a hip replacement surgery can be performed to replace the original joints with a prosthesis or artificial hip which is usually made out of metal or a specially formed composite material or even a combination of the two. Along with other parts, it replaces the natural hip with an artificial hip to restore mobility and other related functions.
Benefits of hip replacement surgery:
- Lessening hip pain - This is one of the major factors as well as symptoms of requiring hip replacement surgery. Due to the grinding down of the bones, even the slightest movement causes pain and after the surgery and the recovery period, the pain is lessened.
- Correction of bone deformity - When the bones grind down and are abnormally reformed, deformities may occur reducing mobility. Artificial hips will ensure that deformities are corrected and resulting problems are thus eliminated.
- Return to normal activities and resumption of normal activities - This is possibly one of the primary advantages of this surgery, although it entails a long recovery period. However, most patients can get back to their normal activities and are able to resume a pain free life.
- Ability to have painless sleep - Many people who suffer from hip displacements or bone deformities are not able to sleep properly due to pain. After the surgery and the recovery period, they can return to normal functions and habits, thus are able to sleep properly.
- Leg strength increase - Many patients tend to have an increase in their leg strength as one side of the hip tends to become very weak due to bone problems before surgery. After surgery and recovery, the same side tends to have an increased strength due to the implant.
- In most cases a lifelong solution to hip problems - As the hip replacement prosthesis is made out of metal and if the operation is successful, it usually tends to last till the end of a person's life and this area usually doesn't tend to have problems again. If you wish to discuss about any specific problem, you can consult an Orthopedist.
When it comes to contact sports like football or basketball, orthopaedic injuries are unavoidable. Given the high risk of falling and accidents and wear and tear of muscles, injuries like stress fractures, torn ligaments, ACL tears and chronic pain are common complaints a sports doctor comes across. Not all orthopaedic doctors can deal with sports injuries. Sports medicine is a specialisation of this field that deals exclusively with the prevention, diagnosis and treatment of injuries sustained while playing sports. A sports doctor must not only treat an injury but must also speed up the healing process so as to allow their patients to return to the field as quickly as possible.
When it comes to surgeries for sports injuries, the smaller the incision made, the faster an injury will heal. This has led to the popularisation of minimally invasive surgeries. Arthroscopy is one such type of minimally invasive surgery that is used by doctors to diagnose and treat joint injuries and musculoskeletal conditions.
This procedure is typically performed on a patient under general or spinal anaesthesia. When being used to diagnose a condition, it involves the insertion of a thin fibre optic tube with a light, magnifying lens and camera into the body through a small incision no bigger than a button hole. This allows the doctors to examine the bone and joint in detail. In cases where this type of surgery is being used to treat a patient, specially designed instruments may also be inserted through an additional small incision to repair the injury.
Arthroscopic surgeries for sports injuries are often used in combination with other approaches or open surgery. One of the most common conditions, this type of surgery is used to treat are tendon tears in the knee. Other conditions that can also be treated with arthroscopic surgeries are torn ligaments and cartilage, inflammation of the joint lining, carpal tunnel syndrome, tears in the rotator cuffs and loosening of bones and cartilage.
After the surgery, the incision will be stitched shut and a dressing will be placed over it. In most cases, patients require almost no pain medication as compared to the medication needed to recover from open surgery.
However, it can take several days for the joint to recover and for the incision to heal. Some of the benefits of this kind of surgery are:
- Faster healing
- Minimal scarring
- Lesser blood loss
- No danger of cutting muscles or tendons
- More comfortable rehabilitation
- Faster return to the sports field
If you wish to discuss about any specific problem, you can consult an Orthopedist.
Lack of proper mobility due to stiffness and significant pain can be due to a number of bone and joint problems. Osteoarthritis, arthritis, rheumatoid arthritis, as well as injuries, trauma and inflammation of the knees are only some of the reasons why a patient may be experiencing joint pain. Apart from rest and medication, various surgical procedures may be considered as an option for particularly severe cases. Partial knee replacement surgery is one such option. So, here are the five questions that you must ask an orthopaedic specialist about partial knee replacement surgery.
- What is partial knee replacement surgery: This kind of surgery usually seeks only to replace the damaged part of the knee where the movements of the patient get restricted to a great degree. With the help of this surgery, the orthopaedic surgeon can replace the medial or inner part of the knee; or the lateral or outer part of the knee. When the surgeon conducts a surgery to replace the entire knee, this is called knee replacement.
- How to prepare for the procedure: The doctor will advise you to stay away from any medication and dietary supplements that may hinder the work of the anaesthesia that will be administered before the surgery. Before the surgery, the orthopaedic specialist will understand your medical history.
- What is the procedure: The surgical procedure for partial knee replacement surgery usually involves keeping the knee in a bent position so that all the joint surfaces are well exposed. The surgeon will start by making an incision that is about six to ten inches in length, before removing the knee cap in order to remove the joint surfaces that have faced damage. Once this has been done, the surgeon will attach artificial joint pieces and close the knee. Then, the doctor will bend and rotate to test for balance and proper functioning of the knee. This procedure usually takes close to two hours.
- How long does recovery take: The recovery process usually takes about three to four weeks following the surgery.
- What to do after the surgery: Pain medication will help the patient in coping with the initial discomfort and after effects of the surgery. Right after the surgery, the patient will be shown exercises before he or she is put onto a graduated walking program where walking indoors and then outdoors will be practiced. The patient will be required to take on physiotherapy for four to six months following this procedure so as to recover in a better manner and have a better functioning knee.
Get a complete check-up done in case you are facing persistent knee problems. If you wish to discuss about any specific problem, you can consult an Orthopedist.
A bone may break due to several reasons starting from a fall or an injury or a condition like osteoporosis that makes the bones brittle and leaves them susceptible to fractures. The fracture usually takes a few weeks to get fixed as the broken bones grow back together with the help of various forms of treatment including a plaster and sling applied by the orthopaedic specialist or general physician. Find out more about how bones heal with this article.
Types of fracture: Before we get to the subject of how bones heal, it is important to understand the various kinds of fractures recognised by doctors. The first kind is the complete fracture where the bone breaks into two distinct parts. The next kind is the greenstick fracture or hairline fracture where there is simply a crack on one side of the bone due to pressure. Further, there is the single fracture which occurs where there is breakage of the bone only in one place. A bowing fracture may occur when the bones bend instead of breaking completely. This kind of fracture is pretty common for children. The comminuted fracture happens when the bone is crushed or broken in many places. And finally, the open fracture is one where the bone ends up protruding from the skin.
Treatment: Once you have broken a bone, the doctor will conduct an X ray which will help in understanding the type of fracture and the extent of the damage caused. The doctor will then apply a cast and plaster that will help in bringing the bone back to its normal position so that it grows back with the main bone. In case the bone has broken into various parts or there is a complete fracture, then the doctor may even insert metal pins.
- Natural healers: Bones are known as natural healers that can heal with the process of new cells and vessel production which rebuilds the bone by covering the broken ends and closing the gap caused due to the damage or the crack.
- Clot: Once a bone has broken, a blood clot or a callus forms in the surrounding region, which kind of acts towards sealing the area.
- Threads: Once these clots have formed, the new threads of the bone cells begin to grow slowly from the ends of the broken bones. This will grow on both sides of the affected and fractured bones, almost as if drawing a line from one broken end to another.
- Absorption: Finally, the callus will be absorbed by the new cell and the gap will close.
See a doctor is you are experiencing any noticeable symptoms that may point towards bone fractures. If you wish to discuss about any specific problem, you can consult an Orthopedist.