Dr. Deepak Kumar Arora

Cortisone shots are injections that help relieve pain and inflammation. They are injected directly into the joints such as the ankle, wrist, knee, hip, shoulder, elbow . These injections are a combination of corticosteroids and local anaesthetics. These corticosteroids are similar to the hormones produced by the adrenal gland. Cortisone injections are also used to treat the carpal tunnel syndrome, trigger finger, shoulder bursitis and plantar fasciitis. Though they do not cure the disease but they provide temporary relief. 

These injections may be slightly painful but provide relief in a day or two that lasts for a few weeks or months at a stretch. Hence, cortisone shots provide relief faster and have longer lasting results than other forms of anti-inflammatory medication. Another benefit of cortisone injections as compared to other drugs that need to be taken in through the mouth is that it avoids side effects of anti-inflammatory medication such as an upset stomach and systemic side effect of steroid etc. Cortisone injections can also be used to treat backaches and pain that radiates from the spine to an arm or leg. 

However, cortisone injections are associated with a number of risks. These include: 

1. Infection in the joints 
2. Thinning of tissue and skin around the injection site 
3. Pain and inflammation in the joint 
4. Weakening or rupturing of tendons 
5. Hypopigemtation of skin around the injection site 
6. Blood sugar spikes – this is seen mostly in diabetic patients 

In most cases, these side effects are short-lived. Cortisone may also be held responsible for the deterioration of cartilage inside a joint. For this reason, doctors do not advise cortisone injections to be had more than 3-4 times in a joint. The minimum interval between two cortisone injections must be 6 weeks. When used judiciously, cortisone injections can greatly improve the quality of a patient’s life. Hence it is very important to get treated only by a qualified doctor and to completely understand the pros and cons of using this form of treatment.

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

Bursitis is a disorder that is characterized by inflammation of a fluid-filled sac called the bursa. Bursa is present in between various tissues such as muscles, tendons and bones where friction may occur. This sac cushions the tissues and prevents friction. The usual areas that are affected by this condition are hip, shoulder, knee and the elbows. 

The symptoms of bursitis are: 

1. You will experience pain in the affected area 
2. Tightness and stiffness in the area 
3. Local swelling 
4. Fever and redness of the area if there is an infection 
5. Any physical contact with the area causes pain 

Bursitis may also occur due to the following reasons: 

1. Ageing results in loss of elasticity of the tendons, thus impairing their ability to tolerate any stressful activity 
2. Sports such as baseball where you are required to throw the ball with force may lead to bursitis 
3. If you do tasks that require kneeling down on a regular basis 
4. Sitting on hard surfaces for extended periods of time 
5. Inflammation from other conditions such as Tuberculosis gout, thyroid disorders and rheumatoid arthritis may lead to bursitis 

Treatment The condition is treated by using a variety of methods such as anti-inflammatory medication and physical therapy. Antibiotics are used to treat any underlying infection causing bursitis. intra-lesional steroid Injections may be administered once infection has been rule out. Steroid Injection is contraindicated in case infection. In severe cases, may resort to surgery to treat this condition.

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

Lower back pain is a very common issue and can take place due to numerous reasons. However, one of its main causes is a ligament strain or back muscle strain. Microscopic tear or excessive stretching of ligaments can take place due to lifting very heavy objects, doing enormously strenuous task or due to a sudden twisted movement. These conditions are most likely to be experienced by individuals ranging between the ages of 30 and 60. Other causes of lower back pain include back injury, arthritis of back bone joints, infections in the lower back area, and in very rare cases, tumours. 

In case of acute back pain, these are a few important things that should be definitely kept in mind. 

1. It is absolutely essential to take rest for a couple of days and avoid any sort of stressful activity. Although back pain is self-limiting, if you take proper care, it can be cured in a few days. However, if proper rest is not taken, the situation may become worse. 
2. Using the belt, also known as lumbo sacral corset, is a good idea. This can actually be of enormous help to individuals who have been suffering from lower back pain for a long period of time. 
3. As already mentioned, one of the main causes of these kinds of mishaps is sudden jerky movements, twisted movements, heavy weight lifting etc. So, it is necessary to avoid such circumstances, or else, an acute back pain situation may arise due to slipping of one of the discs from the spinal cord. As much as you like long drives and bike rides, these are a strict no. Any prolonged sitting or standing activity needs to be avoided. It is important that the tear caused in the muscles due to what-so-ever reason heals properly and prolonged stay in a tensed muscle position would definitely not help the cause. 
4. Although these back pains can be handled at home by following the discussed steps, using simple analgesics or muscle relaxants prescribed by the doctor can be a way to speed up the process of recovering the strained ligament. 

Apart from these important steps, regular exercise to strengthen the core body muscles is a great way to avoid such ligament strains in the future. However, if you feel that even after following the precautionary measures, your problem doesn’t subside, visit an experienced doctor for his advice. In case you have a concern or query you can always consult an expert & get answers to your questions!

Your bone is a living tissue that constantly undergoes the cycle of breakage and replacement. Osteoporosis is a condition wherein the rate at which new bones form cannot match up to the worn out bones, thus making the bones fragile. Osteoporosis mainly affects the wrist, hip or spine and can result in a stooped posture accompanied by height shrinkage and back pain caused due to a collapsed vertebra. 

Reasons Behind Osteoporosis Hormones: 
Lowered estrogen level in women and testosterone in men as a result of ageing or other treatments can result in this condition. Excess thyroid secretion in the body, an overactive adrenalin gland or parathyroid gland can also accelerate bone loss. Women are more vulnerable to osteoporosis during menopause. 

1. Prolonged use of steroid: Prolonged use of injected or oral steroid medications such as cortisone or prednisone messes with the bone-building process. Medicines used to combat cancer, gastric reflux and seizures can be responsible as well. 
2. Medical Conditions: Certain medical conditions such as Rheumatoid arthritis, cancer, liver or kidney disease increases the risks of acquiring osteoporosis. 
3. Sedentary Lifestyle: A sedentary lifestyle with not much physical activity along with an excessive consumption of alcohol and tobacco makes you susceptible to osteoporosis. 

Treatments for Osteoporosis: 

1. Medication: Commonly prescribed medicines for osteoporosis include vitamin D, Calcium, bisphosphonates such as Zoledronic acid, Ibandronate, Risedronate and Alendronate. However these medicines are not free of side-effects such as abdominal pain, nausea or heart burn. In case, your regular medicine doesn’t work, you can use Denosumab and Teriparatide as alternatives but only after consulting your physician. 
2. Hormone Therapy: Estrogen therapy for women after menopause helps sustain bone density. However such procedures can escalate the dangers of getting afflicted with cancer, heart diseases or conditions such as blood clotting. 
3. Alternative Medicine: Ipriflavone, a laboratory manufactured product, when combined with calcium can curb chances of bone loss and alleviate pain

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

Joint is one of the most obvious parts of our body which ages with an increase in the number of candles on our birthday cakes. As you age, joints tend to become stiffer and less flexible. The body does not recover from bumps and bruises as easily as it did before, and it becomes difficult to stand for extended time intervals. This is caused mostly by a breakdown of cartilage and inflammation of the synovium. 

What is cartilage? 
Cartilage is a thick rubbery connective tissue. It covers the ends of two bones in a joint. It is softer than bone tissue but less flexible than muscle tissue. Cartilage is responsible for the smooth movement of joints. With age, cartilage begins to degenerate. As the cartilage gets thinner, movement becomes more and more difficult. If left untreated, the cartilage may completely wear off leaving no buffer between the bones. This is one of the leading causes of knee replacement surgery. 

What is synovium? 
Synovium is a membrane responsible for keeping the cartilage healthy. It produces a thick fluid that keeps the cartilage and joint lubricated. In cases of osteoarthritis, this membrane can swell up and produce excess fluid. This in-turn causes the joint to swell as well. 

Along with age, factors like being overweight, genetics, gender and lifestyle also play a role in the condition of your joints. Being obese points towards a sedentary lifestyle and puts extra pressure on joints, leading to the thinning of cartilage. While men have higher chances of becoming osteoarthritis patients before 45, women have higher chances of developing this disease after 50. A healthy lifestyle is the easiest way to ensure that your joints work well even when you're old and grey. 

Exercise 
Movement of the joints keeps the fluid in them moving. It also prevents the cartilage from shrinking and stiffening up. Exercise also makes the bones stronger, and slows the rate of bone tissue deterioration. Stretching exercises are also a good way to maintain the flexibility of joints. 

Healthy diet 
Foods that are known as natural anti-histamines, antioxidants and foods that fight inflammation promote healthy joints. Some of these are: 

1. Green tea: It prevents the breakdown of collagen and cartilage - Nuts and seeds: These are rich in omega 3 fats that are essential for good bone health 
2. Ginger: It relieves pain and joint swelling 
3. Yogurt: It helps soothe tender joints and fights inflammation Hot and cold therapy can also help relieve joint pain and reduce inflammation. 

As you get older, avoid putting too much pressure on your joints and give them adequate rest. Lastly, avoid smoking, as people who smoke have an increased risk of cartilage loss.

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

Rheumatoid Arthritis is an autoimmune condition wherein the body’s immune system mistakenly attacks the linings of the joint. This condition affects both sides of the body including the eyes, hands and legs. Unlike the depreciating damage of osteoarthritis, rheumatoid arthritis causes a distressful swelling that consequently leads to bone deformity and even erosion. As such, it is one of the more important characteristics of the condition which distinguishes it from other forms of arthritis. It often leads to debilitating disabilities.

Risk factors and complications
Factors such as obesity, smoking, age (affects mostly after the age of 40) and many environmental factors increase the risk of Rheumatoid arthritis. In severe cases, rheumatoid arthritis can lead to a plethora of other conditions such as:

1. Dry mouth and eyes
2. Osteoporosis
3. Abnormal body composition

Treatment
Blood and imaging tests will first be carried out. Based on such diagnosis, you may be advised medications such as steroids or Nonsteroidal anti-inflammatory drugs (NSAIDS). Now in case of severe pain, one would have to take to surgery. Varying surgeries work on different joints of the body and some of these include:

1. Arthroplasty: This procedure replaces all or a part of the joint for instance, the knee or the hip.
2. Arthroscopy: A procedure which helps pull out inflamed tissue or debris from the required joint with the help of light, small instruments.
3. Cervical spinal fusion: Pressure on the median nerve is eased with this procedure.
4. Hands and foot surgeries: These procedures help correct dysfunctional joints of the hands, fingers, legs and toes.
5. Synovectomy: Synovectomy helps remove more intricate tissues which are inflamed or otherwise.

What to consider before you opt for one?
Although these various surgeries often restore almost-normal movements in the patient, they can only do so in two or possibly three joints. And of course, it goes without saying that you should consult with an orthopaedic surgeon) experienced in arthritis and joint surgeries before opting for such.

Patella dislocation is mostly found among women and people associated with the high impact sport. It refers to a condition where the kneecap gets completely displaced from its normal location. Lateral dislocation is more common that involves the damage of ligaments and muscles. An immediate response to a patellar injury should be to cut down inflammation, stop engaging the patellofemoral joint and to relieve pain. One of the best ways to do it is to follow the RICE mechanism- rest, ice, compression, and elevation. Once this is done, one should seek urgent medical attention.

Symptoms of patellar dislocation:

1. Immediate swelling of the knee area
2. Extreme tenderness around the area of the knee cap
3. Instability while bearing weight
4. Acute pain near the knee cap area
5. Quadriceps muscle weakness
6. Redness to the affected area and instant fever as a result of the pain
7. Warm feeling of the affected area

Immediate Treatment

If patella remains dislocated, consult to doctor immediately. To put the kneecap back in place, doctor may give you pain medication to relax his or her knee muscles, and then gently apply pressure to move the kneecap back into place. This process is called a "reduction."

Nonsurgical Treatment

• Immobilization. You may wear a brace for 4 to 6 weeks. This stabilizes the knee while it heals.

• Weightbearing. Because putting weight on the knee may cause pain and slow the healing process, you may require crutches for the first week or two after the injury.

• Physical therapy. Once the knee has started to heal, you doctor will require physical therapy to help you to regain normal motion. Specific exercises will strengthen the thigh muscles holding the knee joint in place. Your commitment to the exercise program is important for a successful recovery. Typically, patient return to activity 3 to 6 weeks after the injury.

Because a dislocation often damages knee tissue, the patella often remains looser, or more unstable, than it was before the injury. As a result, the patella may dislocate again. Recurrences also are common if the dislocation was caused by an irregularity in the knee structure. Ongoing exercises, such as cycling, can strengthen quadriceps muscles in the thigh and prevent future patellar dislocations.

Surgical Treatment

If your patella dislocates multiple times, or continues to be unstable despite therapy and bracing, surgery may be recommended to correct the problem. The type of surgery will depend on the cause of the unstable kneecap. Surgical treatments often involve reconstructing the ligaments that hold the patella in place.

Rehabilitation:
Post-surgical knee rehabilitation is a key step to a full recovery from patellar dislocation. The process of rehabilitation not only rebuilds the muscles but negate the chances of future dislocation. It also focuses on strength, endurance, power and full motion of the knee. The balance and agility of the limb are also focused upon.

How to prevent patellar dislocation?
Since the risk of recurrence of a patella dislocation is 50 percent, prevention procedures should be at the top of the list.

1. Refraining from high impact sports.
2. Wearing a knee cap
3. Continuing the daily exercise recommended by the physiotherapist to ensure non recurrence of the patella dislocation. If you wish to discuss any specific problem, you can consult a physiotherapist.

Posterior cruciate ligament helps to hold the knee together. If there is a ligament tear, it results in pain, swelling and redness. The cruciate ligament connects the important tibia to the femur. Any injury to the posterior cruciate ligament may take months to heal and has the potential to cause instability and disability.

Signs and symptoms: The symptoms and signs of a posterior cruciate ligament injury include moderate to severe pain resulting in difficulty in walking and limp. The knee swells to a large proportion within minutes of the injury causing the knee to feel loose. There are certain situations when a patient doesn’t feel a thing about the injury and then there is a case where the pain worsens every day.

Causes: A tear in the posterior cruciate ligament appears when the shin bone gets hit. It can also occur when a person falls down with a bent knee. Some common injuries of this sort occur during motor vehicle accidents and contact sports. Apart from this, sudden accidents hitting the back portion of the knee can also result in ligament injury of the posterior cruciate ligament. Historically, men have been found to be more risk prone to this condition as compared to women.

What are the complications?

A posterior cruciate ligament injury may result in damage to other ligaments and bones within the knee. Based on the type of injury, the long term implications are predicted by healthcare professionals. The risk of developing arthritis and long term chronic pain exists in this condition.

Diagnosis

1. X-rays. Although they will not show any injury to your posterior cruciate ligament, X-rays can show whether the ligament torn off with a piece of bone when it was injured. This is called as an avulsion fracture.
2. MRI. This study creates better images of soft tissues like the posterior cruciate ligament.

Treatment

Nonsurgical Treatment

If you have injured just your posterior cruciate ligament, your injury may heal quite well without surgery doctor recommend simple, nonsurgical options. 

1. RICE: When you are first injured, the RICE method - rest, ice, gentle compression and elevation can help speed your recovery.
2. Immobilization: You may require a brace to prevent your knee from moving. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
3. Physical therapy: As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. Strengthening the muscles in the front of your thigh (quadriceps) has been shown to be a key factor in a successful recovery.

Surgical Treatment

Your doctor may recommend surgery if you have combined injuries. For example, if you have dislocated your knee and torn multiple ligaments including the posterior cruciate ligament, surgery is almost always necessary.

1. Rebuilding the ligament: Because sewing the ligament ends back together does not usually heal, a torn posterior cruciate ligament must be rebuilt. Your doctor will replace your torn ligament with a tissue graft. This graft is taken from another part of your body. It can take several months for the graft to heal into your bone.
2. Procedure: Surgery to rebuild a posterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.

Surgical procedures to repair posterior cruciate ligaments continue to improve. More advanced techniques help patients resume a wider range of activities after rehabilitation.

Rehabilitation

Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy. If you wish to discuss about any specific problem, you can consult an Orthopedist.