Dr. Shailesh Mishra

Rotator Cuff Tear is one of the most common disabilities observed amongst adults above 40 years of age. Rotator Cuff is a group of four muscles that keep the Humerus (arm bone) attached to the socket of the Shoulder. The Rotator Cuff keeps the Shoulder Blade attached to the arm, and when there’s a damage (tear) in one of these muscles, excruciating pain is felt by the patient.

Kinds of Rotator Cuff Tear-

• Partial Tear: This happens when one of the Tendons amongst the four Tendons is damaged or torn.
• Full Tear: This occurs when all the Tendons are torn; this is also called Complete Tear. Severe pain is experienced in this type of tear and surgery might be required.

Symptoms-

● A person may experience excruciating pain while performing daily tasks like Combing hair, Picking up Laundry, etc.
● Muscle weakness and stiffness on Shoulder.

Diagnosis of Rotator Cuff Tear-

● Ultrasound is used to check the internal structure of the shoulder and the damaged muscle pattern. The waves directed into the shoulder create images of the Tendons and ligaments of the shoulder. This allows the doctor to access the severity of the damage on the shoulder.
● MRI: When the doctor needs a better look at the Tendon damage, radio waves provide a better imagery than Ultrasound.

Treatment of Rotator Cuff Tear-

• RICE (Rest Ice Compression Elevation): In Case of partial rotator cuff injuries with very little damage, RICE is a good treatment option to treat temporary partial damage in the shoulder. Applying cold water and moving the hands slowly helps the muscles to get into shape.

• Injections: Non-inflammatory drugs are prescribed to the patient suffering from Full Rotator Cuff injury to deal with the pain. A Tendon tear can cause extreme pain, which might give the patient some sleepless nights. Non-inflammatory painkillers temporarily numb the shoulder, allowing the patient to sleep.

• Physical Therapies: Physical therapy is one of the most sought out treatment option. Physical therapy allows a person to recover from a rotator cuff injury through exercises and mild movements of the arms and shoulders.

• Surgery: When the injury is too severe for conventional treatment and medication, a patient might have to go through some complex surgeries.

A) Arthroscopic Tendon Repair: In this surgery, the doctor makes a small incision on the shoulders and then inserts a Laparoscope type instrument (Arthroscope) into the muscles, with a camera attached on the top. This instrument allows the surgeon to see the muscle structure and also helps in re-joining the tendons.

B) Open Tendon Repair: Arthroscopic Tendon Repair can be a bit complex, that’s why an open tendon repair is preferred by most doctors. In this surgery, the surgeon makes a bigger incision and attaches the Tendons surgically.

Conclusion-
Rotator Cuff Tears is a severe problem for the locomotion of body, but it is treatable, as long as one doesn’t delay going to an experienced doctor.

Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. During knee replacement, a surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Why is it done?

The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have moderate or severe knee pain at rest.

The Procedure

The procedure begins with you being administered general anesthesia, after which, an incision of 9-12 inches is made on the knee. The part of the joint that has been damaged is gotten rid of, following which the surfaces of the bone are redesigned to hold an artificial joint. Cement is used to attach the artificial joint to the shin, knee cap and the thigh bone. Once the fitting is complete, the artificial joint is supported by the surrounding muscles.

Results

For most people, knee replacement provides pain relief, improved mobility and a better quality of life. Talk with your doctor about what you can expect from knee replacement surgery.

Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car and if you have enough muscle control to operate the brakes and accelerator.

After you've recovered, you can enjoy a variety of low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.

Aftercare

The duration of the hospital stay is around 2-3 days. The effects of the surgery start becoming noticeable within a month of the surgery being carried out. Initially, you may require walking aids. It takes about 5-6 weeks to regain your ability to walk without any external or physical support.

You will have to undergo physical therapy after the surgery to improve your muscle strength. The physiotherapist may prescribe various exercises to strengthen the muscles around the knees. You need to follow certain precautions after the surgery; squatting and kneeling become certain activities which you should avoid. Avoid activities that places undue stress on the knees.

With recent advances in technology, better metals and designs have become available which increase the life of replaced knee and with greater mobility. Many patients due to knee pain loose mobility, hense start putting on weight which inturn increases knee pain by increasing load on the knee. Knee replacement restores mobility, helps patient to manage their weight, diabetes better.

The shoulder is one of the most important joints in the body that uses a ball and socket to join the arm to the rest of the body. Any pain can make it difficult to carry out motion in a comfortable manner. The shoulder consists of the long arm bone called the humerus, the collarbone or the clavicle, as well as the shoulder blade called the scapula. A layer of cartilage provides essential padding to the bones in this area and its two main joints. There are a number of issues that can cause shoulder pain.

Let us get to know the six most common ones. 

1. Rotator Cuff Injury: This is the most common cause of shoulder pain and it occurs when the four muscles or the tendons are injured. These muscles and tendons usually control the movement of the arm. This injury can involve strains and tears which may also be caused by constant lifting of heavy objects. 
2. Rotator Cuff Tendonitis: This condition affects the tendons and muscles that help in moving the arm freely. This usually happens due to inflammation in the tendons. It is commonly experienced by patients who are actively involved in sports and other heavy physical pursuits in their line of work. 
3. Frozen Shoulder: This is a debilitating condition that restricts the free movement of the arm and is also known as adhesive capsulitis. When the shoulder tissues become too thick, it leads to the growth of scar tissue that hinders proper movement and causes pain. 
4. Osteoarthritis: Osteoarthritis is a condition that comes as part of aging bones that also become hollow and brittle over the passage of time, which leads to joint and bone pains in various parts of the body. It is a degenerative disease that is caused due to prolonged wear and tear as well as other factors including family history and sports injury.
5. Bursitis: This condition is known to affect the fluid-filled sacs that lie in between the joints. These are known as bursae. When the bursae suffers from swelling, the effect usually shows up as pain in the joints. 
6. Tendon Sheath Inflammation: The fibrous tissue that connects the bones and the muscles is called a tendon. The presence of the tendon makes it possible to pursue activities like running, jumping, lifting, gripping and more. It is protected by a sheath known as synovium, which also lubricates the same. Any injury or tear to this sheath can cause shoulder pain.

Acute and persistent pain that does not abate and gets even worse should be treated with immediate medical intervention.

Rotator cuff tendinosis, Frozen shoulder and Tendon sheath inflammation are more common in Diabetic patients. Essential part of treatment of these conditions include diabetes control and physiotherapy. However in chronic and refractory cases Arthroscopy may be required. Many times chronic rotator cuff tendinosis ends up in rotator cuff tear as a result of minor trauma.

One of the most common knee injuries is an anterior cruciate ligament sprain or tear. If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

A tear in the anterior cruciate ligament or ACL is a common injury in people involved in sports. Any activity that involves sudden stops, jumping or sudden changes in direction have a chance of causing a tear in the ACL. Here is a look at some of the causes, symptoms, and treatment for the ACL injury.

Causes of the ACL injury
While the ACL injury is common in sportspersons, it can occur in others as well, due to sudden or excessive stain on the knee region. Common causes include-

1. Suddenly slowing your pace and changing directions.
2. Improper landing after a jump
3. Suddenly stopping movement
4. A direct and forceful blow to the knees, which is common in some sports, such as football, rugby, etc.

In some cases, the injury is mild enough to simply strain the ligament. However, a tear results when the force of impact on the ligament is high intensity.

Symptoms of the ACL injury

1. A click or popping sensation in the knees during movement
2. Extreme pain, which forces the patient to stop the strenuous activity
3. Limited range of motion
4. Swelling in the knee region
5. Loss of balance when weight is put on the injured leg

Treatment for ACL injury

1. Minor injuries can be treated with an ice pack. Rest can also alleviate the pain associated with such an injury.
2. Anti-inflammatory drugs may be prescribed if there is considerable swelling and pain
3. A knee brace is often required for people who intend to play sports despite an injury to the ACL.
4. Physical therapy and exercises devised to strengthen the knee may also be effective in curing the condition.
5. A severely torn ACL needs to be replaced using surgical procedure. People undergoing this surgery can often return to sports in a year or so.

In case of ACL injuries, prevention is often better than the cure. If you are into sports, make sure you exercise your knees and legs regularly, so that they are able to withstand the intense pressure put on them. In case you have a concern or query you can always consult an expert & get answers to your questions!

Hip replacement surgery is a method wherein a defective hip joint is removed and replaced with an artificial hip joint. This procedure is only opted for after all the other treatments have failed to yield the desired effects. Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to:

• Relieve pain

• Help the hip joint work better

• Improve walking and other movements.

Who Should Have Hip Replacement Surgery?

The most common reason for hip replacement is osteoarthritis in the hip joint. Your doctor might also suggest this surgery if you have:

1. Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)

2. Osteonecrosis (a disease that causes the bone in joints to die)

3. Injury of the hip joint

4. Bone tumors that break down the hip joint.

Your doctor will likely suggest other treatments first, including:

1. Walking aids, such as a cane

2. An exercise program

3. Physical therapy

4. Medications.

These treatments may decrease hip pain and improve function. Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x ray to look at the damage to the joint. If the x ray shows damage and your hip joint hurts, you may need a hip replacement.

The Procedure-

Hip replacement surgery is a procedure that can either be performed by traditional means or a minimally invasive procedure. The primary difference between the two procedures is the size of the incision. The procedure begins with the doctor administering local anesthesia, though in certain cases, general anesthesia is also administered.

1. An incision is then made along the hip and the muscles that are connected to the thigh bone are shifted, so that the hip joint is exposed.

2. An equipment is then used to remove the ball socket of the joint by cutting the thighbone.

3. The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.

4. Once the joint is fixed, the ball of the thighbone is then put in the hip socket.

5. The fluids from the incision area are then allowed to drain.

6. The hip muscles are then put in place and the incision is closed.

Post -surgery-

After the surgery, the recovery stage begins. The period of hospital stay post-surgery usually lasts for 4-6 days. A drainage tube is attached to the bladder to get rid of waste products from the body. Physical therapy begins immediately after the surgery and you will be able to walk after a few days with walking aids. The physical therapy continues for a few months after the surgery.

After care-

It is advised to avoid activities that involve twisting your leg for at least half a year. You should also avoid crossing the leg along the mid portion of your body. Your physiotherapist will provide you with exercises that aid to help you recover. Avoid climbing stairs and sit on chairs that have strong back support. In case you have a concern or query you can always consult an expert & get answers to your questions!

Shoulder impingement occurs when there is impingement or change in the position of the tendons or a bursa (fluid filled sac or cavity, which causes friction in the joints) in your shoulder. Repeated overhead exercises or intense physical activity concentrated around your shoulder is a common risk factor for shoulder impingement. The examples of such activity would include playing outdoor sports like tennis, swimming etc. or painting for long hours.

How it may affect your daily life?
Shoulder impingement pain is severe in many cases and may affect your everyday activities. In fact, any activity, which involves your shoulders can cause intense pain. You should visit a doctor or a professional medical facility to get relief from pain as well as to avoid aggravating the injury.

Symptoms of shoulder impingement:

• You will have difficulty in completing tasks which involve your back.
• There may be a weakness in your shoulder muscles.
• Pain associated with overhead use of your arm. Anytime you lift your arm there would be pain and would make many day to day activities difficult.
• Intense injury to the tendons can cause them to tear into two and would result in a rotator cuff injury and would make your arm movements next to impossible.

Diagnosis of shoulder impingement:
Physical exam and review of medical injury previously sustained on some other occasion is the first step of treatment. Your doctor may also diagnose shoulder impingement by X-rays or MRI of shoulder to see changes in the bone that may indicate any injury. Other changes in the normal contour of the bone may also be checked which may help in further diagnosis and treatment.

Treatment of shoulder impingement:

NSAIDs are anti-inflammatory medicines that are commonly prescribed for shoulder impingement syndrome. These are prescribed for two weeks. Shoulder impingement requires a long time to heal and would require regular consultation with your doctor. If the medications fail to provide any relief in a span of maximum two weeks it may compel your doctor to change the course of treatment. Shoulder impingement is a serious injury and requires proper rest for your shoulder as well as patience as it may take quite some time to come back to normal.

Physiotherapy for Impingement-

Physiotherapy is usually the first line of treatment for subacromial impingement (tendonitis, bursitis) of the shoulder; along with anti-inflammatories and analgesia. It is very successful in treating shoulder impingement syndrome. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

1. Pain Management
2. Manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches to get your shoulder moving properly.
3. You will learn exercises and stretches to help your shoulder and shoulder blade move properly.
4. Strengthening Exercises
5. The therapist will teach you the proper posture which is an important part of rehabilitation

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