Dr. Suraj Prakash

Bones are similar to a porous framework which is filled with minerals that make it hard and strong. With age, there is gradual degradation and the mineralized portion is lost, thereby leading to thinning of the bone. The word osteoporosis literally translates to porous bones, which is due to the gradual demineralisation. In addition to the natural ageing process, there are other diseases that can accelerate the demineralization process.

Women are more prone to demineralisation, and after the age of 40, they should take extra precaution to slow down the onset of the condition. The following are some ways to improve bone health and halt osteoporosis in the long run-

1. Diet: Ensure that your diet has sufficient amounts of vitamin D and calcium. Though calcium is the essential mineral for bone formation, vitamin D is required for the absorption of calcium, and therefore both these elements play a vital role in maintaining the quality of the bones in our body. Most people require about 1,000 mg of calcium and about 500 units of vitamin D for optimal bone health. This requirement goes up slightly in postmenopausal women.

2. Sun Exposure: In most people, exposure to the sun allows the body to make vitamin D, but careful sun protection prevents this from happening. Also, with age, the body’s ability to form intrinsic vitamin D also declines. The body, therefore, relies on supplements. Most dairy products are good sources of calcium. In addition, spinach, salmon, turnips, and broccoli are some calcium-rich foods. Supplements of calcium carbonate or calcium citrate can be taken if your diet is lacking in calcium. Vitamin D also should be included in the supplementation. The treatment for osteoporosis is incomplete without these two supplements.

3. Exercise With Weights: The constructive tension that exercise puts on the body helps in bone building, whatever the age may be, which prevents the onset of osteoporosis. Any exercise which improves muscle mass strengthens the bones, and puts stress on the bones is advisable. Since the fractured area due to osteoporosis mainly includes the spine, lower back exercises, yoga, tai chi, and abdominal exercises all work wonders. Pick any of these and do them for 30 minutes three times a week.

4. Quit Smoking: Continuing to smoke while taking osteoporosis medications is completely useless. Nicotine negates all the effects which defeat the purpose of taking the medication and is as good as taking no medication at all. So if you want the bone thinning to stop, stop smoking.

5. Alcohol Consumption: While a drink or two per week is permissible, more than this can harm the bones significantly.

6. Constant Health Watch: Talk to your doctor about how other routine medications (if any) can affect your bone health. Also, identify how frequently you should check your bone mineral density and stick to the schedule.

Bone health and osteoporosis can be managed with some conscious efforts.

The Anterior Cruciate Ligament or ACL tear is a very common problem with athletes and with people who have an active lifestyle. In fact, this can also be caused by any accident due to sudden movement.

Importance of ACL-

The ACL is the supporting ligament, which runs diagonally from back to front right in the middle of the knee, connecting the femur bone and the tibia, and helps the tibia not to come before the femur. Thus the balance of the knee during back and forth movements and the entire stability of the knee joint is secured by this very important piece of ligament.

What leads to an injury to the ACL?

Here are a few actions that may result in a ligament tear.

1. Sudden stopping while running or slowing down from a fast speed

2. Sudden change in direction

3. Uncontrolled jumping from a height

4. Direct hitting with an object or person

What happens when the ACL is torn?

If the ACL is torn, the stability of your knee is gone, and you feel as if you have no control over the joint. Moreover, it causes extreme pain and instant swelling. Swelling usually appears within 24 hours of the injury.

Treatment of ACL Injury-

Recovery from an ACL tear is possible only after a surgery. Without surgery, the affected will not be able to return to sports or athletics, or may not be able to run and make swift movements again as before. However, to avoid surgery, there are non-invasive treatments for the aged and people who require moving less.

• Non-invasive Treatment: Bracing is one treatment where braces are given to support the knee joint during movement and also to avoid further injury. This is effective for the elderly who need minimum movement and may manage daily activities with a braced knee. Also, crutches add to the support and let the weaker knee get rest. This is followed by physical therapy. But the swelling has to reduce before starting it. Many exercises and controlled movements over a long time help in getting back agility in movement gradually.

• Surgical Treatment: Once the swelling subsides, doctors would plan for an Arthroscopic (Key-Hole Surgery) ACL reconstruction. In this Doctor make a graft of a tendon. This graft is inserted into the joint and fixed in anatomical position in femur and tibia Arthroscopically so that the newly created ACL functions like the natural one. This is the only way to get back the ligament in whole as the torn ligament cannot be stitched. Surgery is done through arthroscope and recovery time is 15 days for resuming day to day activities and 3 to 6 month for resuming sports activities with continued physical therapy after the surgery.

When a blow or a fall causes an injury, where the top of your arm bone pops out from your shoulder socket, it’s called shoulder dislocation. It is a very painful condition and you need to get this relocated to its position immediately. The tissues and bone related to that particular joint get damaged. 

If you ignore this situation or keep the shoulder like this, it will be more harmful and painful for you. There may appear a bump in front or at the back of your shoulder that hurts. 

What can lead to a dislocated shoulder injury? 

• Sharp or a very fast twist of your arm. 
• Falling down on a hard surface. 
• A sudden hurt or hit. 
• It may also happen when you fall down and try to save yourself using your hand. The force of the hit indirectly gets into the shoulder and your shoulder joint may slip from its place. 

In some of the outdoor games, there are high chances to get hurt in the shoulder. Hockey, football, rugby, rock climbing, volleyball etc. bring in high probabilities of injuring the shoulder, thereby resulting in a shoulder dislocation. 

What is the treatment or therapy of a dislocated shoulder? 

The dislocated shoulder should be very urgently treated. As this injury of the shoulder is very painful, you should go to a specialized orthopaedist as fast as possible to fix up the shoulder to its proper joint. As it is very painful and swollen, the faster the treatment, the better it is. When your doctor fixes your shoulder in its actual place or the bone of your arm comes back to the socket, most of your pain will go away and you get huge relief from pain. After the shoulder bone is relocated, you can use further conservative treatment to reduce the pain and swelling of that place. Dislocated shoulder may take 3 to 12 weeks to recover. But this is the approximate time and it depends on the seriousness of the injury. 

After the treatment, when all the symptoms are gone, the doctor will suggest some exercises for better results and normal shoulder movement and to prevent future shoulder injury. Ones the shoulder is dislocated, the chances of dislocation in future is further increased as the tissue supporting the head of humerus into its socket is torn. Such patients may land up with recurrent dislocation of shoulder wherein shoulder dislocates easily on specific movement and patients are afraid to do over-head activities. The problem is best diagnosed by MRI Scan. 

The best treatment for this is Arthroscopic (Key-Hole Surgery) Bankart's Repair. Following operation shoulder is kept at rest for 2 weeks then Physiotherapy is started. Day to day activities are started after 2 weeks and sports activity is started after 3 to 5 months. In case you have a concern or query you can always consult an expert & get answers to your questions!

Causes, symptoms and treatment for Knee Pain

Hello, I'm Dr. Duraj Prakash, Orthopedic Surgeon practicing in areas of South Delhi and specializing in the field of knee replacement surgery and Orthoscopic reconstruction procedure of knee and shoulder. Today I'll briefly talk about common problems of the knee and how to prevent degeneration of knee in people who're reaching middle age group. Knee arthritis is one of the common problems that we're facing as population ages and people want to beome and lead more and more active life. Generally knee arthritis has multiple reasons, why somebody gets knee arthritis others don't. It could be related to genetics, lifestyle, weight of the person and activity level. There is a small group of people where a neglected injury very rapidly damages the joint and gives rise to premature or early athritis.

The symptoms of knee arthritis are:
1. Pain
2. and Stiffness

Many people ust complain of morning stiffness and the issue becomes complicated if the person trips or falls because weak muscles fall in arthritis. Make sure that cause people trip and fall moee frequently. So the way to avoid is to maintain proper weight. In case someone has got early childhood deformities like bow legs and knock knees it should be appropiately corrected in younger age group. Then any injury which a person may sustain, it may look innocous, it may hurt for a couple of days and then becomes alright should never be neglected. If the problem is instability, if your knee feels it is going to slip out of the alignment on a rough surface you must go see an orthopedic surgeon.

Another group of people is ones who are suffering from Rheumatoid arthritis where the problem starts with fingers and small joints of hands and feet but gradually progresses to the knees. These people should regularly do exercise to maintain muscle strength and ensure that they take proper medication in time to prevent long term damage to the knee. Regular strengthening of the knee muscles, the thigh muscles which stabilizes the knee goes a long way in preventing any problem in knee joint. Even with mild arthritis if your knee and your thigh muscles are strong, your likelihood of getting a surgery is very rare. In addition when the muscles are strengthened not only the knee feels better, likelihood of fall also reduces to a great extent.

In those people where the knee is already damaged the technology now offers us many remedial measures starting from small penaul procedures to regenerate the cartilage to upcoming procedure like platelet rich plasma, stem cell therapy and reconstruction therapies ranging from many many ways of small surgery partial knee replacement and leading onto total knee rreplacement which everybody knows right now. The smaller procedures have a very big advantage in terms of safety, better function, smaller stay in the hospital and equally long functional life of the prosthesis. With the newer technology it is possible to treat these conditions but then the best remedy is to take step before the problem arises. So stay healthy, keep active and remain fit.

When joints get inflamed, it is known as arthritis. This causes swelling and pain in the joints of your body such as the hips and the knees. When the cartilage gets damaged at the ends of bones, a type of arthritis called osteoarthritis occurs.

There are two main types of osteoarthritis:

1. Primary: This type is more generalized. It affects the knees, fingers, hips, spine and thumb.
2. Secondary: This type can occur after injury or joint inflammation, or as a result of any disease that affects the ligament's composition, like hemochromatosis.

How is the hip affected by osteoarthritis?
Patients have difficulties walking if they have hip osteoarthritis. Diagnosing hip osteoarthritis is difficult. It is because the pain appears in varied locations, such as the groin, buttocks, knee or thigh. The pain can be a dull throb or can be sharp and stabbing. The hip is usually stiff.

What are the causes of hip osteoarthritis?
The causes of hip osteoarthritis are unknown. However, the factors that can lead to osteoarthritis are joint injury, excessive weight and rising age.
Along with the abovementioned factors, the following may contribute as well:

1. The joints may not have developed accurately
2. The cartilage may have inherited the defects
3. If the joints are too irritated due to added pressure on them, like excess body weight or stressful activities that include hip movement, osteoarthritis may develop.

What are the symptoms of hip osteoarthritis?
The symptoms of hip osteoarthritis are as follows:

1. Joints feel stiff when you get out of bed
2. Joints feel stiff if you have been sitting for some time
3. The joints feel painful, swollen or tender
4. You can hear (a "crunching" sound) or feel the bones rubbing against each other.
5. You find yourself unable to do certain things, like putting on socks, as it requires your hips to move.

How is hip osteoarthritis treated?
The main objective of treatment is to restore the patient's ability to move around. A part of this objective includes correcting the function of the hip and managing the pain. The treatment can include:

1. Joint care and rest
2. To take weight off the area affected, a cane is used
3. Pain relief that does not involve drugs
4. Shedding excess weight
5. Exercising
6. Surgery
7. Alternative and complementary therapies. If you wish to discuss about any specific problem, you can consult an Orthopedist.

Shoulder pain while lifting overhead objects might be a result of strenuous activity involving tendons impinging bones of the shoulder. Impingement syndrome is also called swimmer’s syndrome.

What causes it?
It is caused by activities involving tendons and bones of the shoulder, for example strenuous activities, such as swimming, tennis and gym activities involving muscles of the shoulder. Even reaching for overhead objects and painting might aggravate impingement syndrome. If not treated at the right time, the syndrome might become extremely painful as the tendons begin to tear.

Symptoms
General pain in the shoulder is one of the most common symptoms, especially while reaching for overhead objects or using shoulder and arm muscles in general. If it occurs for a prolonged period of time, then it might actually lead to a tendon tearing and leading to a rotator cuff tear. This would overtime lead to decreased ability to use the arm muscles and the bicep muscles might tear as a result of prolonged negligence, despite swimmers syndrome. A doctor would recommend a physical exam and x-ray to rule out possibilities for bone abnormalities and arthritis.

How to prevent and treat it? 
Those who have extreme shoulder pain and have been diagnosed with swimmer’s shoulder are referred to a physiotherapist with whom, regular sessions help restore mobility of the affected areas. The physiotherapist recommends the patient numerous stretching exercises to practise, preferably under a hot shower. In addition to physiotherapy, a doctor will prescribe powerful painkillers which have to be administered orally on a regular basis. 

These oral painkillers, such as ibuprofen have to be taken under the guidance and prescription of a doctor as they will have a host of side effects such as acidity and should be taken post meals. In case of ineffectiveness of orally administered painkillers, cortisone based injections might be given, but it is a double-edged sword as the effectiveness of these injections decrease over time and it might make the muscles and tendons weak. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

Cancer that originates in the bones of a human body is referred to as bone cancer. Any bone could come under the threat of this disease, but generally the longer bones of your body, so to say the bones of your limbs, are at a greater risk. 

A few factors that might push you an inch closer to bone cancer are:

1. Genes could jinx your health: A few typical genetic syndromes could increase a person's chances of contracting bone cancer. These syndromes could have been active in any person belonging to your lineage. One such syndrome is Li-Fraumeni.
2. Treatment for one kind of cancer can make you prone to some other kind: Radiation affects your bones adversely. A patient of breast cancer might be undergoing radiation therapy that further increases his or her risk of contracting bone cancer in future.  
3. Paget's disease can have unfavorable implications: Paget's disease is a disease that affects elderly people. This condition, if left untreated, can turn into bone cancer at a later stage. 

Several symptoms of bone cancer can be found below:

1. Sudden loss of weight: If you lose a considerable amount of weight in a few weeks time without having made any effort at all, you should probably be worried about the health of your bones. Bone cancer can result in sudden and unintentional weight loss. 
2. Unexpected bone fracture or breakage: Cancer of the bones is known to gnaw at the strength of your bones. Weakened and diseased bones can break or get fractured very easily. An unexpected fracture should not be overlooked so as to prevent chances of anything more harmful.
3. Long spans of unyielding exhaustion: Constant fatigue and sleepiness might be hinting at a more serious underlying problem. The bones in your body hold you together; cancerous bone cells can make you feel exhausted without much exertion as your bones lose their inherent potency.
4. Persistent pain in the bones: Excruciating cramps or pangs of stinging pain in a person's bones either continuously or at odd hours, could be indicative of bone cancer. Such instances require the advice and guidance of an experienced oncologist.
5. Bone swelling: The area affected by bone cancer can grow big and tender or the bone itself can swell up.