Dr. Nargesh Agrawal

Not all people who suffer from Tennis Elbow have swung their racquets, and those who have never been affected by the problem will not be able to understand how severe the pain and discomfort can be. It is a debilitating condition that affects one’s normal lifestyle in both minor and major ways.

Platelet-rich plasma therapy is nowadays considered a promising treatment for consistent and chronic tendon problems including Tennis Elbow and Golfer’s Elbow. It is often conjugated with autologous blood injection which is a quick and minimally invasive process using the cells of the patients without any use of any drugs.

What is Tennis Elbow?
The human elbow is a joint comprising of three bones: humerus in the upper arm, ulna, and radius in the lower arm. Each part of the bone is covered with cartilage that facilitates free movements of the bones. Tennis elbow occurs at times when the epicondyle layer on the elbow joint become inflamed or torn.

Understanding platelet-rich plasma therapy
PRP is a non-surgical, in-office treatment which starts withdrawing a little amount of blood. The blood is then spun in a centrifuge for concentrating the platelets in the place. This process also segregates the red and white blood cells. Then the platelets together with some amount of plasma are injected into the body in the affected region which has some injury and is not able to heal properly.

When a person is affected with Tennis Elbow, the platelet-rich plasma is injected into the Flexor Origin present on the medial side of the wrist extensor tendon origin at the lateral epicondyle. The doctor may need to jab the needle in different places.

Why is PRP suitable for Tennis Elbow?
The primary objective of using platelet-rich plasma therapy is utilizing the cells and protein of the body along with specific healing factors that can stimulate and jumpstart the process of healing in the tendons. To begin the healing process that has either stalled or could not be completed or has never started, the PRP is the best means. The first step of beginning the healing process is dealing with the inflammation. Experts are fascinated at the way in which the platelet rich plasma can replace the conventional anti-inflammatory medical treatments of Tennis Elbow.

The arrival of platelet-rich plasma has caused the corticosteroid shots to lose their popularity. Because, though they can relieve acute pain for a short span of time, they do not promote healing and may also cause further breakdown of the affected area.

PRP therapy is known for improving the natural healing process of the body. It has ignorable side effects, and the best part is that it is minimally invasive. Since Tennis Elbow is becoming more common these days, it needs to be treated in ways that would be able to complement one's situation and restore normal functionality.

Rickets. A state of low calcium and vitamin d level in the body. Rickets leads to bony deformity of joints and bone like bow legs, knock knee. Early diagnosis can cure it effectively.Difficulty in walking or inability to walk, walk with abnormal gait like waddling (duck like) with broad base, wrist widening, pott belly abdomen, poor teeth formation, short stature, joints pain etc are early symptoms of low calcium in body.

Also referred to as runner’s knee, Patellofemoral pain commonly affects individuals who take part in sports involving jumping and running. Patellofemoral pain syndrome refers to acute pain and discomfort in the front part of the knee. The knee pain is often worse when a person is running, walking down the stairs, or sitting for a long span of time. The syndrome leads to a dull and aching pain in the front part of the knee which often gets worse with time if left untreated.

Causes of Patellofemoral Pain:
There is no certainty as to what causes patellofemoral pain and instability. Some of the most common causes include:

1. Overuse:
Jumping and running exert pressure repetitively on the knee joint which may lead to irritation under the kneecap.

2. Muscle weakness and imbalance:
Patellofemoral pain may occur when the muscles around the hip, as well as the knee, don’t allow the kneecap to be properly aligned. Also, the inward movement of the knee during a squat has been associated with this type of pain.

3. Injury:
If the kneecap has undergone any injury which may include a fracture or a dislocation, it may lead to patellofemoral pain.

4. Surgery:
If you have undergone a knee surgery, particularly relating to the anterior cruciate ligament using one’s own patellar tendon as a graft, it increases the risk of patellofemoral pain.

5. Associated problems with patellofemoral pain:
When patellofemoral pain affects a person, they are likely to suffer from other associated problems which are mentioned below:

6. Lateral patellar compression syndrome:
Chronic knee pain in the front part of the leg is often related to overload and an increase in pressure on the lateral zones of the knee. It leads to an excessive lateral tilt with reduced mobility along with miserable triad. Normally it causes acute discomfort while walking up or down the stairs.

7. Recurrent dislocation patella:
This problem is not quite common, but it can be congenital or developmental. Some of the most common causes of this disorder include ligaments laxity, lateral soft tissue contracture, and muscular imbalance. The common symptoms of recurrent dislocation patella include swelling and intense pain.

8. Patellofemoral arthritis:
Patellofemoral arthritis affects the underside of the kneecap and the groove where the patella rests in. It leads to unbearable pain in the anterior part of the knee making it difficult to kneel down or climb any stairs, or even squat. It occurs when the articular cartilage along the trochlear groove wears down and become swelled and inflamed.

For most people, the treatments of patellofemoral pain are successful in dealing with the symptoms without needing to undergo surgery. You must consider the opinion of a doctor who can help in overcoming these issues to a considerable extent. In case you have a concern or query you can always consult an expert & get answers to your questions!

It is normal and alright to feel pain in the knees occasionally after a physical activity or prolonged walking. However, it is a serious cause of concern if the pain is experienced every now and then. Not responding to your knee pain for long can lead to the extreme disability. Knee pain does not crop up in a day and it may surprise you when it first appears.

Initially, you may notice slight pain and discomfort. If you have identified knee pain at this level, managing it is easy. You can perform different exercises to prevent pain from occurring. If the pain severe, you need to go consult a doctor, who will then help identify the real cause of pain. The following exercises, along with medications, can help you overcome knee pain and restore the mobility of the joint.

1. Stair Step ups: Choose a comfortable stairway. Place your hand on the wall or banister. This is to ensure that you are balanced. Your left foot should be on the taller step. Your right foot should be on the ground. Stay in this posture for a second. Now, step back, and bring left foot to the right foot. Repeat this 6 times. Reverse the legs and continue doing for 6 times. If you want to take rest between the steps, feel free to do so.
2. Ups and Downs: You need an armless chair that is strong. Sit on the edge but comfortably. Your arms should be at your side, relaxed and loose. Sit erect and your feet should be flat. If you feel you need balance, and then cross your arms. Start standing up. This should not be instant but deliberate, controlled, and gradual movement. Stand slowly up to the full height, and hold on for 2 seconds. Again sit down. Repeat this 5 times.
3. Straight Leg Raise: This can be a part of your everyday exercise regime. This is a strengthening workout that does not put too much effort on the knees. Lie down on your back. One leg should be straight on the ground and the other one should be bent. Now, slowly lift the leg that is straight, and the toes should point upward. Raise your leg up to 30 degrees, but you can start with 15 to 20 degrees in the initial stage. Repeat 15 times and perform at least 3 sets of this exercise. Keep alternating legs. This workout strengthens the knees, thigh muscles, and the ankle joints, thus offering multifold benefits.
4. Wall Hamstring Stretch: Hamstring muscles too can be the cause of knee pain and discomfort. To strengthen the hamstring muscles and alleviate knee pain, this exercise helps a lot. Lie down on the floor flat. Your feet should be flexed. Choose a space that is close to a wall, or a sturdy table. Your right leg should be propped on the wall or table. If you don’t prefer any, a resistance band is a good alternative. When stretching, you can find your flexibility level and when you feel that you have reached the deepest point, start relaxing. Keep alternating contracting and relaxing every 5 seconds. After 10 to 15 sets, you can try the same with the left leg.
5. Knee Rolls: Use an exercise mat or a carpet that is cozy. Lie on your back. Bend the knees, and ensure your feet are flat. Your arms should be stretched on the sides. Look at the ceiling, and hold the knees together. In the same posture, slowly roll the knees towards the right. When you feel a gentle twitch or after 5 seconds, move to original position. Then lower the knees to the left. Hold and release. For each side, repeat 10 times.

These exercises strengthen the knees and improve the quality of life by bidding bye to the pain. Understanding that these are magic remedies that work overnight is the key to stay focused and keep going without quitting.

Dealing with hip pain is a daunting task. The pain can affect even walking or sitting. While alleviating pain with pills and medication can keep off the suffering, strengthening the hips is crucial. Exercises are perfect means to stay off of hip pain. The following are some of the exercises that an individual suffering from hip pain can perform to seek relief.

1. Lying March: This is an easy way to assuage the hip pain. Lie flat on your back. Choose a flat surface for this exercise. Bend your knees and keep your hands on the side. Stiffen your abdominal muscles, and raise one leg up to 4 inches. Hold in the position for a few seconds. Lower the leg slowly. Now do the same with the other leg. It is better to stay in this position for 30 seconds, and then move on to the other leg.
2. Planks: Stand on all fours. Your back should be straight. Now, start with planks by raising one knee, and there should be no bending of the back. Stay in this position for 5 seconds. Then alternate the leg. Repeat at least 5 times. If you have been doing this for long and are confident, move to the advanced level. This involves raising one leg and opposite arm simultaneously. Stay in this position for 5 seconds. Then go back to all fours position.
3. Marching on the Ball: Sit comfortably on the exercise ball. Keep your feet shoulder apart, flat on the ground. Your toes should be firm on the ground and slowly raise one heel. When you want to try an advanced level, you can raise the entire feet off the ground. Stay in this position for 10 to 15 seconds. Slowly bring the foot down and change to the other leg.
4. Half Crunch on Ball: Sit straight on the exercise ball and keep your feet flat on the floor. Keep your arms crossed on the chest. You can also keep the arms on hips. Bend the hip and raise the toes to lean around 45 degrees back. Now, push your stomach muscles to get back to the original position. Your feet should not move during this process, only then your ab muscles and hip are strengthened.
5. Workout for thighs: Often, it is only the affected area that we focus upon for pain relief. But one has to take care of the adjacent area too, if complete cure is what you are looking for. This is why exercising the thigh muscles is important. For this, lie on the side. Raise the leg, and try to reach a height of 6 inches. Hold for 3 to 4 seconds. Bring the leg down slowly. Repeat the same with the other side. Perform at least 3 sets of 10 repetitions. However, stop it immediately if you experience severe pain.
6. Flexion: Lie flat on the back. Place the leg on the ground, and start bending it slowly. Wrap your arms around the leg. Shin area should be held. Slowly pull the leg to your chest. Stay in this position for 3 to 5 seconds. Do it 10 times. Now do the same with the alternate leg.
7. Squeeze Knees: Start with rolling a soft towel. Stop when it comes to a cylindrical shape. Bend your knees as you lie back. The feet should be on the ground, and now place the towel between the knees. Squeeze the knees, and it should be hard enough to engage your butt muscles and thigh muscles in this action. Hold for 3 seconds. Release. Do again for 10 times.

When doing all these exercises, you need to be careful about two things. Always choose a flat surface to lie straight and stop immediately if you experience pain. In case you have a concern or query you can always consult an expert & get answers to your questions!

Knee injuries are the most complex injuries of bone and cartilages. A direct hit can lead to this situation. You may get this injury while doing your daily activities. An activity as simple as walking or a deadly accident can lead to this injury. You never know, when you are left with a damaged knee. In critical cases, you are advised to undertake a joint replacement surgery. According to latest studies, doctors replace more than a million knees or hips in a year in the United States. It is a life-changing procedure. But you need to know whether you are the right candidate or not? Follow the below-mentioned points to get a clear picture:

Reasons to replace your knee-

1. Pain and stiffness: If it hurts you a lot while you are walking or trying to climb stairs, it may be an indication of having a new joint. It has to be also noted that whether the pain is long-term. You know that you need a new joint when there is pain for at least 6 months.
2. Your injured knee hampers your daily life: It is not the only pain that might be a cause of worry. Your injured knee can hurt your entire life. It will limit your daily activities, hampering your office work and personal life. It will upset you and drive you towards depression. To get rid of all these issues, you can opt for a knee replacement surgery.
3. Bone damage: Before taking up the surgery, you must consult your doctor. He or she will ask you to conduct X-rays and other imaging tests first. The reports will clarify whether or not you require a surgery. The reports will show that whether you are suffering from osteoarthritis or other conditions.
4. Deformity: The surgery is needed when your knee gets severely swollen and looks deformed.

When joint replacement may not help?
There are a number of situations when the joint replacement may not help. These are as follows:

1. If there is any infection in the body, you cannot take up this surgery. 
2. It is always advised to get rid of the extra kilos, in order to get the best results of the surgery.

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

Hello!

Mera naam Dr. Nargesh Agarwal hai. Mein pediatric orthopedic and deformity correction surgeon hun. Aaj me apke samne bachon ki ek aisi bimari jo bachon me janam se upasthit hoti hai, suke baare me batane ja rha hun. Jiska naam hai clubfoot. Clubfoot ko hum usually CTE k naam se bhi jante hain. Majority of parents mere se puchte hain ki ye bilkul correctable hai ya nhi hai, iska kya illaj hai. To mera answer hai ki ye almost 100% correctable hai. Lekin isme illaj hume jitna jldi ho sake utna jdli shuru krna dena chaiye.

Iilaj me humko plaster lgane hote hian. Jisme 4-5 plaster lgte hain. Uske baad me foot correct ho jata hai. Almost 10 se 7 bachon me choti si minor surgery ki jrurat pdti hai. Jisme hum jo piche se nus hoti hai, use dhilla krte hain. Vo day care procedure hota hai. Jise hum tenotomy k naam se jante hain. Parents mere se puchte hain, is surgery ka bache ke foot pe koi effect to nhi ayega? Nhi, bache k foot pe koi effect nhi aata. Jo tendon hum release krte hain, vo almost dubara se regenerate ho jata hai without any side-effect.

Or bachon ko future me chalne se is se koi dikkat nhi hoti. Bacha bilkul normal life jita hai. Isme humko correction k baad me braces dene hote hain. Un braces ko hum bolte hain DB splint or denic browne splint or CTV braces. Ye braces shuru k 3 mahine take, 23 hours in a day pehnane hote hain. Uske baad me 4 saal ki umar tak unhe pehnane hote hain jab bacha sota hai tab, night hours me ya fir din me jab bhi bacha soyega. Usually jo clubfoot hota hai, isme bache ko correction bada acha mil jata hai, Kayi bache hmare pas kafi der se aate hain. Suppose kro 6 mahine par, 1 saal me, 2 saale me aate hain. Jitna deri se hum iska treatment krate hain, usme correction me utni hi dikkat hoti hai.

Number of plasters bhi badh jate hain. Usme volume of surgery bhi badh jati hai. To mera kewal yhi salaha hai ki iilaj jldi se jldi krayein. In fact, within a week, within a month of life treatment start kr dena chaiye. Treatment bada hi simple hai. Plaster lgte hain. 4-5 plaster lgte hain. Uske baad me jrurat pdne par ek choti si minor surgery hai jisme baad me bachon ko brace dete hain. So, success rate is almost 95-98% and the results are very good. Aap is trha ki problem k lia, aap mere clinic pe aa skte hain,  budhwar or shaniwar shaam ko 5-7 available rehta hun aur budhwar or shaniwar, 2-4 afternoon me available rehta hun.

Thank You.

Like other knee injuries, the torn meniscus can be painful and debilitating. But unfortunately, it is quite common. In fact, a torn meniscus is one of the most frequently occurring cartilage injuries of the knee.

What is Meniscus?

A meniscus is a C-shaped piece of cartilage present in the knee that acts as a cushion and stabilizes the joint. Its function is to protect the knee from wear and tear. Two menisci are present in each of the knee joints. They can get damaged or torn during activities, which puts pressure on the knee joint or may rotate it.

What causes a meniscus to tear?

A quick stop or vigorous twist may force the femur to crumble into the top of the tibia. It may potentially tear out the cartilage of the meniscus. It may also occur while doing deep squats or kneeling, especially while lifting a heavyweight. Athletic activities often result in this knee injury, particularly in the sportspersons such as footballers and hockey players. Sports that involve sudden stopping and pivoting such as tennis and basketball may also result in the torn meniscus. Meniscus tears are a special risk in elder people as the cartilage weakens and wears thin over time. As the age progresses, worn tissues become more prone to tears. Just a clumsy twist while getting up from the bed or chair is sometimes enough to cause a tear in case of weakened menisci due to aging.

Symptoms of a meniscus tear: One may hear a popping sound around the knee joint when a meniscus tear occurs. Initially, the pain may not bad but once the inflammation sets in, the knee starts hurting quite a bit. The knee may get stiff or locked. It may become difficult to move the knee in a full range of motion.

Diagnosis of a Meniscus Tear: Diagnosis of a meniscus tear starts with the patient’s history and a physical examination. The doctor inspects, palpates, and applies specific diagnostic maneuvers to diagnose a torn meniscus. The McMurray test is used to make the clinical diagnosis of a meniscus tear. The doctor flexes the knee, then straightens and rotates it to put tension on a torn meniscus. The movement will cause a clicking sound if a meniscus tear is present in the knee. A magnetic resonance imaging (MRI) scan is the preferred choice to diagnose the torn meniscus. This technique allows the doctor to evaluate the knee cartilage in a more detailed way.

Treatment of Torn Meniscus: The treatment of a torn meniscus depends on the severity and the location of the tear. If the size of the tear is small and the location is on the outer end of the meniscus, a surgical repair is usually not required. Give rest to your knee as much as possible. The doctor may advise using crutches to avoid putting weight on the legs. Icing the knee every three to four hours for 30 minutes is recommended for this injury. You may use compress bandage to reduce the inflammation. Try to keep the knee in an elevated position to reduce the swelling. NSAIDs may be prescribed to get relief from pain and inflammation. If the symptoms persist, the doctor may advise for an arthroscopic surgery.

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

About Clubfoot

Clubfoot (CTEV) is three dimensional deformity of foot involving either one or both feet since birth. The affected foot of a child looks like being rotated internally & downward at the ankle. If left untreated, can cause severe gait abnormality during walking as child walk on outer part of sole and ankle. The child further finds it difficult to place the sole of the foot flat on the surface.

Ideally treatment of clubfoot should start as early as possible without delay to avoid major problems as the child grows. Early treatment gives better results.

Causes The exact cause of clubfoot is still not known (Idiopathic). Other reasons for this could be genetic, position of baby in mother womb, neuromuscular disorders etc. The parents must get the child screened immediately to assess his health condition and identify the exact cause of the congenital deformity. There is no correlation in the deformity and other ritual myths like “GRAHAN”

Symptoms Deformity is obvious and apparent and can be diagnosed immediately after birth. The most important symptom of clubfeet is the foot looking deformed and twisted like the club of the golf stick. But the child will experience discomfort and find it difficult to walk if clubfoot is not treated properly and timely. The child may find it difficult to wear shoes and participate in physical activities. Sometimes foot size of affected side appears smaller than normal side.

Diagnosis Clubfoot can be diagnosed even before baby born (antenatal) by Ultrasound.

Orthopaedic surgeon detects the deformity after birth by observing the appearance and movement of the baby’s feet and legs.

Treatment Clubfoot can be treated Non-surgically by serial casting followed by percutaneously done tenotommy with success rate over 90%. Tenotomy is a day care procedure done on OPD basis. After tenotomy child always put on braces for sometimes. In some cases surgery require like relapse, neglected, neuropathic and muscular cause of clubfoot. Recovery The nonsurgical treatment methods require the child to wear special shoes and braces fulltime till the clubfoot is cured. Also, the child has to perform a variety of stretching exercises on a daily basis.

FAQ

Q: - Is it correctible deformity??

A: - Success rate of treatment is more than 90% without surgery by casting + Tenotomy technique.

Q: - How many cast will be needed??

A: - Usually 4-5 cast (depend upon severity of foot) followed by tenotomy.

Q: - What is tenotomy??

A: - Tenotomy is a day care procedure done under LA/GA. In this we release tight posterior structure.

Q: - Any side effect of tenotomy??

A: - No, released structure regenerate spontaneously without any side effect.

Q: - What is braces and for how long need to bear??

A: - Braces are used to prevent the recurrence of deformity. Initially put for 23 hours in a day for three months and then at nap time till four years of age.