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.read more
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.
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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Patient Review Highlights
It's been so long, I have lost all hope, as I was suffering from hip pain from quite long but then I met Dr Rakesh Kumar and I am hopeful again that I will be fine. I was having this problem, but the symptoms were not very visible. Not only he is very calm and composed, but is also a very understanding doctor. The nurses at the Apollo Spectra Hospitals were really helpful. Thanks to him I am totally satisfied with the results.
Apollo Hospitals can handle all types of emergency cases. It's been more than a year now, and I have noticed considerable change in myself after Dr Rakesh's treatment for knee pain. I was panicked, because I never thought I will suffer from knee pain like this. I remember, I read an article of Rakesh Kumar in the paper and made contact. In order to diagnose my problem completely he asked me a number of questions.
I was suffering from shoulder pain for which I consulted Dr Rakesh. My problem was such that it required a number of sessions, and I must say after all the sessions, I am feeling much better now. Almost all doctors suggested surgery for it, but I did not wanted to go for it for my shoulder pain. But thanks to Dr Rakesh for the perfect advice. I am back to my normal self post treatment.
I have had this tendonitis from quite some time. But due to Dr Rakesh and the tendonitis treatment I didn't lose hope. I owe hi a big thamnks for making me fine again. The facilities available in the Apollo Spectra Hospitals are very nice.
I am happy with my Arthroscopy with dr Rakesh Kumar fully. Was suffering for 5-6 yrs but got good relief only after his treatment and quick too within 7 days . he can be consulted at Apollo Spectra Hospitals in Delhi.
Dr. Rakesh is one of the best orthopaedic surgeons in Delhi NCR .I would like to recommend him to all the people in need .
The experience is good and nature, medications, are effective.
Sunil Kumar Bhatnagar
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:
- 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.
- Medications: The doctor may prescribe medications to manage the pain. Taking anti-depressants may be necessary if you suffer from depression.
- 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:
- Gender: Women run a higher risk of getting affected with osteopenia or osteoporosis.
- Race: Women who belong from the Caucasian or Asian origin run a higher risk of getting these diseases.
- 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.
- Family history: A person with a family history of osteopenia or osteoporosis has more than 50% chance of getting either osteopenia or osteoporosis.
- 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.
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.
Prepare for blood loss: Most people experience some blood loss, but not excessive.
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.
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).
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.
Slip-ons: Bending down and tying shoes may not be easy, so slip-ons can be used.
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.
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.
Postoperative medications: These will be given to control infection and pain in the immediate postop period, and should be taken without fail
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.
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.
Weight management: With excess weight, there is too much strain on the lower disks. Therefore, weight should be managed to reduce this strain.
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:
- 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.
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.
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! 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:
- 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.
- Initial overuse of the shoulder must be prevented
- Pain, infection, and swelling control immediately postop is important
- Can take up to 6 months for complete recovery depending on the size of the tear
- 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:
- 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.
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.
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.