Frozen Shoulder.

Frozen shoulder, also known as adhesive capsulitis is a disorder that cause stiffness thereby resulting in pain in the shoulder joint. This condition leads to the loss of normal range of motion of the shoulder, leaving the affected individual unable to perform even simple physical activities like reaching for objects placed on an overhead shelf. A frozen shoulder can get significantly worse if left untreated. In most cases, the problem deteriorates, and then goes away over the course of time, usually over a period of 1 to 2.5 years.

Symptoms

Dull, lingering pain in one of the shoulders or in the muscles of the outer shoulder and upper arm region accompanied by stiffness of the shoulder joint are common symptoms of frozen shoulder. The pain may worsen at night in some cases. Most patients will experience pain at the slightest movement of the shoulder.

Who all are at risk?

For reasons yet unclear, women are more likely to develop a frozen shoulder than men. People belonging to the age group of 40-60 years old and those recovering from a stroke, mastectomy and other medical conditions that restrict the movement of arms are most likely to be affected by a frozen shoulder. 

Individuals suffering from heart and thyroid related issues (hyperthyroidism/ hypothyroidism), tuberculosis, cardiovascular disorders, Parkinson’s disease and diabetes too have a high susceptibility to developing a frozen shoulder.

In addition, individuals recovering from tendinitis or injuries that cause them to wear a sling for several days are also at the risk of getting a frozen shoulder in absence of regular stretching. An estimated 10 percent of people suffering from rotator cuff disorders are affected by frozen shoulder.

Diagnosis

A physical examination is required for diagnosing a frozen shoulder. This involves active and passive movement tests. In the ‘active’ part, the doctor will have the affected individual move the shoulder on his/her own to get a measure of pain and stiffness. In the ‘passive’ leg of the examination, the doctor will move the affected individual’s shoulder to gauge the differences in discomfort and range of motion. 

In some instances, the doctor can administer anesthesia to numb the shoulder in order to carry out the physical examination. In addition, imaging tests such as X-ray, MRI or ultrasound may also be required if the doctor suspects a torn rotator cuff, arthritis or a similar condition to be the underlying cause of shoulder distress.

Treatment

In some cases, non-steroidal anti-inflammatory drugs are prescribed to alleviate the pain, especially if there’s noticeable swelling in the affected shoulder. If there is significant inflammation or pain, the doctor can prescribe different, more potent medications.

Physiotherapy has been found to be effective in improving mobility of the shoulder and is often recommended. In severe cases wherein oral medication fails to bring relief, the doctor can revert to administering a corticosteroid injection into the shoulder joint.

Some rare cases may call for a shoulder surgery. The surgery is an arthroscopic or keyhole procedure.

Knee Pain Treatment – Surgical and Non-Surgical Options

The knees are one of human body’s most utilized joints — they bear approximately 3-4 times the body weight with each step. The staggering amount of work the knees perform means that most people will invariably face knee pain at some point of their lives. This could be short term discomfort, inflammation and dislocations caused by trauma or age and weight related issues like Osteoarthritis.

Treatment of knee pain depends upon the underlying cause and the degree of damage to the joint and surrounding tissue. Inflammation and pain in the knee region can be self-managed by RICE therapy—Resting it to allow proper healing, Icing the swollen area for 20-30 minutes, 4-5 times a day, Compressing the knee using a wrap and Elevating the knee to prevent fluid buildup in the affected region. Joint deformation, puncture wounds, suspected fractures, excessive redness and swelling, fever and lack of relief from RICE therapy are indicative of conditions that require medical attention.

Non-Surgical Knee Pain Treatment: –

Oral medication

Oral medicine of various kinds can be effective against knee pain. Depending on the diagnosis, a physician may prescribe a course of analgesics for pain relief, nonsteroidal anti-inflammatory drugs for pain and inflammation or oral corticosteroids.

Arthrocentesis procedure

This procedure involves the use of a needle to remove joint fluid from the knee, primarily for lab tests. The removal of excess fluid, however, can alleviate pain and reduce inflammation by itself.

Injecting Hyaluronic Acid Supplements

Hyaluronic acid is the substance that helps absorb shocks and lubricates the knee joint, ensuring proper and safe motion. People with Osteoarthritis (a condition that alters the shape or structure of the joints) often suffer from a breakdown of hyaluronic acid. Supplementing by injecting hyaluronic acid directly into the knee joint can significantly ease pain.

Injecting Corticosteroids

Injecting corticosteroids directly into the knee joint can bring immediate relief to swollen, aching knees. The effect of these injections can last from several days to over six months. Continuous knee injections, however, can cause cartilage breakdown so this procedure should not be relied upon for long-term pain management.

Platelet Rich Plasma Injection (Click to read more)

Using patient’s blood PRP is prepared & injected into the knee joint. It is one of the safest procedures available.

Surgical Option: –

Knee surgery is usually a last resort option for when all other procedures have failed to cure knee pain. The degree of invasiveness involved varies with the extent of damage and structural modification required.

Arthroscopy 

A minimally invasive surgery performed for removal or repair of torn menisci, trimming pieces of joint cartilage, repairing torn cruciate ligament and removing inflamed joint lining or loose bodies from the knee. The surgery entails making small incisions in the knee to insert a lighted scope and small instruments to carry out the procedure.

Osteotomy – Proximal Fibular Osteotomy (Click to read more)

This surgery entails reshaping and repositioning the bones to take the load off the damaged area of the knee. Performed in cases where the damage in limited to one section of the knee or wherein the patient is unwilling to undergo total knee replacement.

Total knee Replacement

If knee damage is substantial and irreparable by means of other procedures, it requires the removal of the top of the tibia (shin bone) and the damaged part of the bone at the end of femur (thigh bone), and/or of the patella (knee-cap). The surgeon will then replace the removed parts with prosthetic components typically made from metal alloys and high-grade plastic.

Bursitis

Tender, swollen joints that ache when you move – you could be suffering from Bursitis, a painful medical condition wherein bursae – the small, fluid filled sacs that work as cushion between the bones, muscle and tendons around the joints have become inflamed. 

The human body has 150 plus bursae. Their primary function is providing lubrication to reduce friction between the tissue during physical activity. Joints like hips, shoulders and elbows that engage in frequent physical activity are the most commonly affected by Bursitis. 

Bursitis too can affect other joints, like the knee and the base of the big toe. Bursitis of the knee is commonly called “Housemaid’s knee” or “Clergyman’s knee”.

Symptoms

Bursitis is marked by easy to spot visual and physiological cues. These include – 

  • Stiffness and ache in the joint region.
  • Swelling and redness in the affected joint.
  • Experiencing increased pain when moving or putting pressure on the affected areas.

Causes

Bursitis is usually caused by repetitive movements that wear out or stress the bursae. Athletes and laborers whose daily routine involves lifting objects over their heads or kneeling for long durations are at a high risk of developing bursitis.

Something as seemingly innocuous as leaning on your elbows for long when studying or reading can also lead to bursitis. Ageing, rheumatoid arthritis, gout, infections and injuries suffered to the joint region are other common causes.

Diagnosis

Diagnosis of Bursitis involves an examination of the affected joint and inquiry into recent physical activities and injuries. In some cases, swelling and soreness in the joint can be accompanied by fever. In such an event, the doctor will draw a small quantity of fluid from the bursa close to the affected joint which will be tested.

You might have to undergo an X-ray if the doctor suspects a break or a fracture or MRI in case of torn tendons. If the doctor suspects rheumatoid arthritis, you might have to undergo some blood testing. 

Management

Minor discomfort and inflammation can be managed and cured by ice packs and rest. Raising the affected joint to reduce the blood flowing into it can also sometimes help to reduce swelling. 

If you experience a sharp pain in the joint, are unable to move, develop a rash and/or a fever, consult your doctor. Based on the underlying cause and diagnosis, the doctor may administer steroid injections at the site of the pain and/or prescribe a course of antibiotics. Some cases may require intravenous administration of antibiotics and surgical draining to reduce fluid buildup. 

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Tips for Preventing Sports-Related Injuries

Sports injuries generally occur for two different reasons: trauma and overuse.  While traumatic sports injuries are usually obvious, dramatic scenes, like when we see a player fall down clutching their knee, overuse injuries are actually more common.

Traumatic Sports Injury

Overuse injuries often occur when the body is pushed past its current physical limits or level of conditioning — but poor technique and training errors, such as running excessive distances or performing inadequate warm-ups, frequently contribute. To help keep you or your young athlete from experiencing a sports-related injury following are the prevention tips:

1. Set realistic goals.

Setting goals and work hard to achieve them but it is crucial that our goals are realistic, achievable and sustainable. Whether your goal is to swim more laps, lift a certain amount of weight or run a specific distance, set an obtainable goal and gradually work to improve.

2. Plan and prepare.

If you plan to begin exercising regularly or want to begin a new program, take the time to learn the proper techniques required for your sport. Working with a coach or a knowledgeable group is often safe and enjoyable ways to start a new activity.

3. Warm up and cool down.

It is important to warm up before physical activity because research has shown that a heated muscle is less likely to be strained. To accomplish this some light walking or jogging before you start your exercise and then again afterward to help your muscles cool down slowly. Another important way to prevent injury is to increase your flexibility. Stretching before and after a workout can do this, but it is best to do so once the body is already warm.

4. Take your time.

Don’t push yourself too hard too fast. Getting in shape or learning a new sport takes time. We need to allow for adequate time to gradually increase training levels so that our bodies have time to adjust to the stresses on our bones, joints and muscles. For instance, when running, increase mileage gradually and give yourself plenty of time to recover between workouts. 

5. Listen to your body.

Adjust your activities if your body is showing signs of too much stress. While a mild and short-lived muscle ache is generally considered ‘good pain,’ pain in your joints is not normal and is a sign that you should cut back. Always listen to your body.

Proximal Fibular Osteotomy – A breakthrough procedure for treating knee pain.

Proximal fibular osteotomy (PFO) is a simple, innovative surgical procedure that’s fast becoming the go-to pain relief solution for knee osteoarthritis patients. It’s less invasive than other prevalent surgical procedures recommended for the same medical conditions, highly effective in treating knee pain and improving the patients’ quality of life, easy to perform and has a relatively short post-surgery recovery period. 

Who’s it meant for?

If you’re affected by medial compartment osteoarthritis and suffering from debilitating knee pain that’s affecting your ability to walk and engage in even basic physical activity, you might want to consult your doctor about Proximal fibular osteotomy. Total knee arthroplasty has been one of the most recommended treatments for osteoarthritis in elderly patients. For younger patients ailed by Varus knee deformity, High tibial osteotomy (HTO) and Unicondylar knee replacement (also known as partial knee replacement) have remained the physicians’ go-to solutions for long. These procedures, in addition to being rather invasive, require lengthy recovery periods, and pose restrictions on weight bearing and even on physical activity. In Proximal fibular osteotomy, you have a novel alternative to these popular surgical procedures, with proven success rate, minus the complications that can arise with the prevalent treatments.

What to expect from a Proximal Fibular Osteotomy?

Proximal fibular osteotomy is a cost-effective procedure requiring a shorter recovery span than other conventional surgeries. Patients can expect reduced knee pain within days of undergoing the procedure, and total pain relief in the following months. They can also look forward to becoming more active and self-sufficient than they’ve been in years, to a happier, pain free future. 

Contact Dr. Manu Mengi for further information.