• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

Category Archives: Bone & Joint

Tennis Elbow

Tennis elbow, medically known as lateral epicondylitis, is a form of tendinitis that affects the tendons of the elbow area. These tendons connect the forearm muscles to the bone. It is a painful condition resulting from the weakening of the tendons due to repetitive arm movement, especially the elbow area. Tennis elbow accounts for only 5% of cases and usually requires only minor treatment.

Symptoms of tennis elbow

A patient with tennis elbow may experience shooting pain in the bony knob located on the outside of the elbow. This bony knob connects the wounded tendons to the bone. The pain, though concentrated on the bony knob, may even extend to the upper or lower arm. The patient is likely to suffer excruciating pain while performing tasks with their hands. This could include –

  • Lifting objects, especially any heavy object
  • Making a fist or gripping objects like a tennis racket that requires making a fist
  • Opening a door, particularly doors with a cylindrical or ball knob that needs to be turned to open
  • Holding a coffee mug
  • Shaking hands
  • Raising hands
  • Straightening the wrist

When to see a doctor

If you find no relief from self-care methods, especially the R.I.C.E method, which stands for Rest, Ice Pack, Compression, and Elevation, and even over-the-counter pain relievers such as Advil, Motrin IB, etc. have had no effect, it may be a good time to visit a doctor.

Causes

Notwithstanding its name, you can get tennis elbow even if you haven’t been near a tennis court in your life, let alone played a game in it. This is because there are several other causes responsible for this type of tendinitis besides repetitive tennis play. The condition seldom occurs abruptly, but gradually develops over time. Repetitive motions and constant tugging lead to microscopic tears in the tissue.

The causes behind tennis elbow include –

  • Grabbing a swing
  • Fencing
  • Weightlifting
  • Repetitive use of computer mouse
  • Playing games like racquetball and squash
  • Jobs that involve repetitive arm movements or require constant gripping – raking, knitting, carpentry, typing, plumbing, and painting, cutting up cooking ingredients, especially meat

Risk factors

Certain factors may increase the risk of developing the condition. These factors include –

  • Age – Though tennis elbow can affect people of all age groups, it is most commonly observed in adults between the ages of 30 and 50.
  • Occupation – People involved in occupations that demand constant movement of their arms are at a higher risk of developing tennis elbow. This includes plumbers, carpenters, painters, butchers, typists, among others.
  • Certain sports – Of all sports, racket sports like tennis and badminton make one more susceptible to the condition. The risk is higher among those who frequently employ the poor stroke technique.

Diagnosis and treatment

To diagnose a person with tennis elbow, a doctor will generally ask for the patient’s medical history and symptoms. Then, the patient might be asked to do some simple arm movements such as straightening of the wrist and folding of the arm to check for any pain while doing so. In some cases, the doctor might opt for imaging tests like X-ray and MRI scans to take a better look at what’s going on inside the arm. The doctor may also suggest a test called Electromyography (EMG) to rule out any nerve problems.

Post-diagnosis, the patient will be asked to stop playing sports or do certain kinds of work like typing, painting, etc. to give the arm proper rest. However, since “absolute rest leads to rust,” the patient may need to learn the use of the shoulder and upper arm muscles so that there is some movement but no strain on the elbow. The doctor may recommend the following treatment options based on the severity of the condition –

  • Physical therapy or physiotherapy – This is perhaps the first resort and is generally an effective one. Treatments may include exercises or stretches guided by the therapist, massage, heat and cold therapy, ultrasound to ease muscle pain and increase blood flow, etc.
  • Use of splint or braces – Such tools are beneficial in relaxing the wounded tendons and muscles. 
  • Corticosteroid medications – These will be injected into the injured or affected area to reduce the swelling and pain.
  • Orthopaedic surgery – In extreme cases, the damaged tendon will have to be removed through surgery. This surgery can be performed in two ways – open surgery where the surgeon makes a cut above the bone on the side of the elbow, removes the damaged tendon, and reattaches the healthy part of the bone, or arthroscopic surgery wherein few tiny cuts are made into the skin over the elbow, small instruments and a camera are inserted through these holes which guide the surgeon in removing the damaged parts of the tendon.

Post-treatment, the condition should become better within a few short weeks; however, it may take longer for those with surgical removal of the damaged tendon. During this period, it is recommended to abstain from sports and constant arm movements, take plenty of rest, and use an ice pack for 15 minutes three times a day to speed up the healing process.

Arthroscopy: Reasons, Procedure and Benefits

Introduction-

Arthroscopy is a surgical technique in which a tube-like instrument is inserted into a joint to inspect, diagnose, and repair tissues.

Arthroscopy is advised if you have inflammation in a joint, in cases of injury or trauma to a joint, or have damaged a joint due to wear and tear. You can have arthroscopy on any joint. Most often, it’s done on the knee, shoulder, elbow, ankle, hip, or wrist.

Reasons for damage of joints –

  • Osteoarthritis is the most common form of arthritis.
  • Gout is a type of inflammatory arthritis that occurs in some people with high levels of uric acid in their blood.
  • Septic Arthritis – a condition in which a joint becomes infected,
  • Viral Arthritis – arthritis due to viral infection
  • Rheumatoid Arthritis – RA is a chronic, autoimmune disease
  • Spondylarthritis – An inflammatory rheumatic disease
  • Systemic Lupus Erythematosus – joint inflammation, especially of the knees, wrists, and finger joints, is common in systemic lupus erythematosus
  • Fibromyalgia –  The predominant symptom of fibromyalgia, a chronic pain condition, is widespread muscle tenderness, along with crippling fatigue.
  • Hemarthrosis – A bleeding into a joint due to a number of reasons including trauma.

An Overview

Arthroscopic surgery can treat inflammation, torn ligaments and tendons, loose bones or cartilage issues. If you have a joint issue, there is a good chance arthroscopic surgery can diagnose and treat it. While knee and shoulder arthroscopies are the most common surgeries, the procedure can be performed on any joint.

It can be used to treat conditions of knees, shoulders, ankles, elbows, wrists like:

  • Tendonitis Bursitis
  • Arthritis
  • Frozen shoulder
  • Cartilage damage
  • Bone spurs
  • Arthrofibrosis
  • Ganglion cysts
  • Ligament injury
  • Fractures

Arthroscopy Procedure-

Preparation of patient-

Many doctors will recommend a tailored preparation plan, which includes gentle exercises and medications

The patient may need to stop eating up to 12 hours before the procedure, especially if general anaesthesia has to be applied

Positioning and Scope Insertion

  • The type of anesthetic used to numb pain will depend on the extent of the arthroscopy.
  • A doctor may inject a local anaesthetic to numb the affected joint. In some cases, doctors will use a general anesthetic. In this case, the person will be completely asleep during the procedure
  • The procedure starts with a few small cuts in the joint. Surgeons use a pump to push saline solution into the area. This will expand the joint, making it easier for the doctors to view the affected area and operate it with ease
  • The patient is placed supine with ability to flex the joint.
  • The medical team places a tourniquet (important for safety, but often not inflated).
  • The doctors then make anterolateral incision over a soft spot of the joint. Vertical incisions have the advantage of increased superior-inferior mobility of instruments and   horizontal incisions have advantage of increased medial-lateral mobility of instruments.
  • Next, the doctors insert a trocar into a capsule
  • Advance blade into the capsule with the trocar
  • Advance trochar into suprapatellar pouch to strengthen or fix the joint

Benefits of Arthroscopy

While every surgery is different and every person responds to surgery differently, arthroscopic surgery tends to have many advantages over traditional surgery.

  • Lesser complications: Since arthroscopy uses tiny incisions instead of large cuts, the chance of infection or other complications is much less.
  • Less post-operative pain: No muscles or tendons have to be cut to repair the joint, so pain is usually much more manageable. Fewer cuts also mean that recovery goes much quicker.
  • There is less scarring: The minimally invasive nature of arthroscopic surgery means that scarring is kept to a minimum.
  • Recovering from arthroscopy is usually quicker than recovering from open surgery.
  • Most people leave the hospital on the day of the operation with specific instructions about how to handle recovery. Arthroscopically treated patients tend to heal faster and begin rehabilitation earlier and, subsequently, return to normal activity and work sooner.

General recovery tips include:

  • Applying ice packs to the dressing and surrounding area to reduce swelling and pain
  • Keeping the leg elevated for several days after surgery
  • Resting well and often
  • Changing the dressing regularly
  • Using crutches and following the doctor’s recommendations about applying weight to the knee.

Lumbar Spine Surgery

Lumbar surgery or Laminectomy refers to any type of surgery in the lumbar spine, or lower back, between one or more of the lumbar vertebrae.

The lumbar region of the spine, more commonly known as the lower back, consists of five vertebrae labeled L1 through L5. The lumbar region is situated between the thoracic, or chest, region of the spine, and the sacrum. The lumbar spine typically has a slight inward curve.

Common ailments associated with lumbar Spine-

Most cases of lumbar degenerative disc disease consist of a low-grade, continuous but tolerable back pain that will occasionally intensify for a few days or more.

Symptoms can vary, but general characteristics usually include:

  • Moderate, continuous low back pain. Painful aches at the site of a damaged disc is the most common symptom of a degenerative disc. Pain may spread to the buttocks, groin, and upper thighs.
  • Occasional pain flare-ups, back pain may intensify for several days or weeks then return to a more moderate level. Flare-ups happen as the disc continues to degenerate and the spine gradually stabilizes. Pain flare-ups can be severe and sudden, and can temporarily reduce mobility.
  • Local tenderness, the area of the low back surrounding the degenerated disc may be sensitive to touch.
  • Leg pain and neurological symptoms including numbness, weakness, or sharp, shooting pains in the buttocks, hips, and/or back of the leg may be felt if the disc space collapses enough to pinch a nerve root exiting the spine.

Common types of lumbar spine surgery-

  • Vertebroplasty and kyphoplasty are procedures used to repair compression fractures of the vertebrae caused by osteoporosis
  • Spinal laminectomy/spinal decompression: These are performed when spinal stenosis causes a narrowing of the spinal canal that results in pain, numbness or weakness
  • Discectomy is a procedure used to remove a disc when it has herniated and presses on a nerve root or the spinal cord
  • Foraminotomy: In this procedure, the surgeon enlarges the bony hole where a nerve root exits the spinal canal to prevent bulging discs or joints thickened with age from pressing on the nerve
  • Nucleoplasty: Also called plasma disk decompression, it is a laser surgery which uses radiofrequency energy to treat people with low back pain associated with a mildly herniated disk
  • Spinal fusion: In this procedure, the surgeon removes the spinal disc between two or more vertebrae, then fuses the adjacent vertebrae using bone grafts or metal devices secured by screws
  • Artificial disk replacement is considered an alternative to spinal fusion for the treatment of people with severely damaged disks

Pre-conditions to consider before lumbar spine surgery?

Preparing for Lumbar spine surgery goes beyond preparing yourself mentally and physically.

  • Stop taking medications, pain relievers and vitamin supplements two weeks prior to surgery. If there are medications or supplements you must keep a log of these to review with your surgeon prior to surgery
  • If you smoke, stop two weeks prior to surgery. Smoking increases the risk of serious complications with any surgery
  • Prepare your hospital stay
  • You should stop eating any solid foods after midnight before your surgery.

Post-operative precautions after lumbar spine surgery?

  • Following your surgery, you may not be able to sit for extended amounts of time, because your spine and back muscles need to heal first
  • In the first two to three days after any type of lumbar surgery, sitting for minimal amounts of time is recommended, basically only to get in and out of bed and to use the toilet
  • After that first few days of extremely restricted activity, you should still try to minimize the amount of time you spend sitting. If you need to sit, only use straight-backed chairs to minimize the pressure on your lumbar region–no sofas or recliners that will put strain on your low back and lumbar area. If you need to lie down, you may only do so in a bed
  • Follow your surgeon’s specific instructions tailored to your individual needs
  • Avoid lifting (nothing more than 5 Kgs or above shoulder level), stooping, pushing, bending, or straining for a minimum of six weeks. Depending on the surgery and how fast you are healing this could extend into a few months.

Lumbar spine surgery recovery time-

Even the least invasive surgery may cause a great deal of pain as your muscles, bones, and nerves recover. Total recovery time can take anywhere from eight weeks to six months, depending on a number of factors like severity of condition, age, health, and type of surgery performed. Post-surgery, you will be prescribed pain medication. If you do not feel your pain diminishing, or you notice unexplained or increased leg pain, unusual swelling, bruises, changes in behavior, or a high-grade fever in the first two to three weeks of recovery, contact your doctor immediately. These symptoms may indicate an infection or a more serious condition.

What is Total Knee Replacement or Arthroplasty?

Total knee arthroplasty or popularly known as the knee replacement surgery is a surgical procedure to relieve pain and restore normal function in the severely ailing knee joint. The surgery resurfaces a knee damaged by injury or arthritis. It involves separating the damaged bone and cartilage from the thighbone, shinbone, and knee cap and substituting it with an artificial joint also called prosthesis. This artificial joint is made of high-quality metal and high-grade plastics.

This surgery is recommended for patients who face extreme difficulty in taking any function from the knee joint such as climbing stairs, walking, sitting or lying. Foremost, non-surgical methods such as medications and mobility aids such as walkers, sticks, etc. are used; if even post such methods, the functioning is hard and these methods prove unsuccessful, the doctors might recommend a total knee arthroplasty in such cases. A total knee arthroplasty is an effective and safe procedure that enables the person to resume normal activity by correcting the leg deformity and relieving pain. With increasing advancement in technology and the medical field, today a total knee arthroplasty is considered one of the safest surgical procedures in all of medicine. 

To assess if a total knee arthroplasty is the best alternative for you, the orthopaedic surgeon will analyze the knee’s motion ability, stability, and strength and also conduct several tests including X-rays to determine the damage and assess the present condition. The doctor might also run some tests on the blood and urine, as well as do an electrocardiogram to plan the surgery. The choice of prostheses and surgical techniques will depend on the person’s age, weight, activity level, overall health, and the condition and shape of the knee.

Reason for total knee arthroplasty

The prime reason for a total knee arthroplasty is the severe pain because of osteoarthritis or injury. Both conditions might damage the knee joint, making simple movement and activities – such as walking, sitting, lying down, climbing stairs, getting up and sitting back, etc. – difficult to do.

Types of arthritis affecting the knee joint

Osteoarthritis: A type of degenerative arthritis that causes a breakdown of joint cartilage and corresponding knee bone. This mostly occurs in middle-aged and older adults.

Rheumatoid Arthritis: This type of arthritis causes pain and stiffness in the knee joint because of excess synovial fluid which is caused due to inflammation of the synovial membrane.

Traumatic arthritis: A type of arthritis that occurs because of injury and causes heavy damage to the knee joint.

Risks involved in total knee arthroplasty

While a total knew arthroplasty or knee surgery is a very safe surgical procedure, yet like all normal surgeries, this too is susceptible to some risks such as:

  • Blood clotting in legs or lungs
  • Stroke
  • Heart attack
  • Infection
  • Nerve or blood vessel damage
  • Infection 
  • Implant problems
  • Continued pain

That said, the most common and likely to occur factor is an infection post a total knee arthroplasty. A person suffering from an infection after the surgery might display symptoms such as high fever, chills, shivering, swelling, leakage from the surgical area, tenderness, acute joint pain, and increasing redness. Apart from this, the artificial joint used to replace the original knee joint can also wear out causing the total knee arthroplasty to completely fail. This happens over time when the artificial joint wears away due to excessive and stressful physical activity, weight lifting, etc.

That said, some of the essentials that one must know and take note of before deciding on the total knee arthroplasty are:

Food and medications: To prepare for the surgery, the doctor might suggest you avoid certain medications or supplements. Also, the doctor may ask you to not eat anything post-midnight on the day of the surgery.

Post-surgery preparations: Post the total knee arthroplasty, one might need to use crutches or a walker or even take some rest. Make sure to make all arrangements before in hand to ensure a smooth recovery process. Make arrangements such that you avoid taking the stairs, have safety bars and handrail for support in the washroom, keep your leg elevated while sitting, sit while taking a shower and take a higher toilet seat.

The recovery from a total knee arthroplasty is slow but effective. In most cases, it relieves pain, improves mobility while enhancing the quality of life. A knee replacement can last for as long as 15 years if proper care is taken. A person can resume everyday activities almost after three to six weeks post the total knee replacement surgery. More strenuous activities such as swimming, golfing, biking, can be engaged post full recovery, although for activities such as jogging, jumping, skiing, tennis, sports, you must consult your doctor before undertaking any activity which might involve stress on the replaced knee.

During the recovery period and post the recovery, the doctor might advise you undergo some physical therapy to strengthen the replaced joints and maintain smooth movement of the replaced knee. Depending on case-to-case, special recommendations for diet, physical activity, the recovery process, follow-ups, may be made. Total knee arthroplasty is a collective decision and one that must be made will full consideration of the current condition, the need, as well as the after-effects. 

UNDERSTAND KNEE REPLACEMENT SURGERY

Knee replacement surgery or more commonly known as total knee arthroplasty is one of the most common surgical procedures, which involves relieving of pain and restoring normal function in the critically ailing knee joint. The surgery involves resurfacing a knee which has either been damaged by age related arthritis or by injury. The doctor separates the damaged cartilage and bone defects from the thighbone, shinbone and kneecap and replaces it with an imitation joint, made of top-quality metal and plastic, also known as prosthesis.

A knee replacement surgery is appropriate for people that suffer from acute or chronic pain in knee joints, due to damage, weakening, wear-tear, injury, etc. of the bone and cartilage of the joint. A problematic knee joint makes it extremely difficult to make any movement such as climbing stairs, walking, sitting cross-legged or squatting. A person experiencing problems with knee functioning is advised medications and physical therapy before being recommended a total knee replacement surgery. In fact, efforts are made to restore mobility and functionality through the usage of walkers, sticks, etc.

A knew replacement surgery is a safe, effective and non-complicated procedure that helps a person to gain the functionality and relieving pain of the problematic knee joint and resume normal activity by correcting the leg deformity. Moreover, with developments in medical technology and procedures, knee replacement surgery is performed with precision and hence, it is one of the safest surgical procedures today.

However, a critical assessment of the need for a knee replacement surgery must be done before making a final decision. All alternative courses of treatment – including medications, physiotherapy, non-invasive medical aids – should be tapped while analyzing the need for a knee replacement surgery. An evaluation of the knee’s motion ability, stability, strength, flexibility, structure, etc. will be conducted by the orthopaedic surgeon. Before planning the surgery, the surgeon may also conduct some tests to gain deeper insights such as X-rays, CT-scans or MRI to assess the damage of the present condition. Moreover, the selection of prostheses and surgical method will be made as per the patient’s age, weight, physical activeness, general health and most importantly the present and the expected future form and shape of the knee.

Reason for a knee replacement surgery

The most important reason for undertaking a knee replacement surgery is to relieve the pain and restore the normal functionality and movement of the knee, which has been hampered due to osteoarthritis because of increasing age, any trauma, injury etc. A chronic knee problem can cause extreme difficulty in performing even simple activities such as walking, sitting, lying down, climbing stairs, getting up and sitting back, etc.

Types of arthritis affecting the knee 

Osteoarthritis: Degenerative arthritis that is prominent in people in the middle age or beyond; this type of arthritis breaks down the cartilage of the knee joint.

Rheumatoid Arthritis: This type of arthritis is caused when the joints synovial membrane having chronic inflammation leading to accumulation of excess synovial fluid, causing extreme pain and stiffness in the knee joint.

Traumatic arthritis: Traumatic arthritis is caused because of injury or trauma to the knee joint leading to excessive pain or damage.

Risks involved in knee replacement surgery

A knee replacement surgery is considered one of the safest surgical procedures in the medical world today and hence, is characterized with barely any risks apart from the general risks that are linked to any normal surgery. Some of the risks involved in knee replacement or in any other orthopaedic surgery are:

  • Blood clots in legs or lungs
  • Heart failure or heart attack
  • Infection
  • Damage of nerves or blood vessels
  • Implant troubles
  • Extensive pain even after surgery

Two other important risks that specifically pertain to knee replacement surgery are:

  • A postoperative infection characterized by symptoms such as high fever, chills, swelling, seepage from the surgical site, tenderness, extreme joint pain, and redness.
  • Wear out of the artificial joint put in place of the original knee joint. This can lead to a revision replacement surgery. However, this is not experienced immediately after the surgery but instead it occurs over a long period of time (15-20 yrs.) due to wear-tear of the knee joint because of excessive and rigorous physical activity.

Preparation of the surgery

A knee replacement surgery is a critical surgery and the pre-operative preparation, consultations and tests usually begins few days before and need to be conducted carefully to ensure complete success.

Pre-operative tests: A doctor will conduct several tests to assess the blood count, existing blood clots, and heart health (through echocardiography (2D echo)).

Food and medications: You would be advised to refrain from consuming specific medications and supplements. And on the day of the surgery, you will be asked not to eat anything post-midnight.

Post-surgery preparations: After the knee replacement surgery, the patient would need walker to walk around or in some cases, may be advised complete bed rest for a time period. Hence, all arrangements need to be made after considerable consideration with the doctor to ensure speedy and effective recovery. Also, little things – such as safety bars, handrail for support in the washroom, the elevation of legs while sitting, sitting while bathing, placing a higher toilet seat, etc. – should be prepared for in advance.

Recovery post a knee replacement surgery

A knee replacement surgery is a major surgical procedure and it will take some time for the new knee joint to recover and assume normal functionality. A knee replacement surgery is a boon for people suffering from lack of mobility and functioning or excessive pain in knee joints; the surgery enhances the quality of life and can even last for more than 15 years, provided care is taken. In general cases, a patient can resume normal routine activities almost after three to six weeks after the knee replacement surgery. However, it is advisable to refrain from rigorous activities such as swimming, golfing, biking, etc. which can be undertaken once complete recovery and a go-ahead from the doctor is acquired. Although activities such as jogging, jumping, skiing, tennis, sports, etc. can be resumed slowly. It is important to keep the doctor involved in the undertaking of any new physical activity that might stress the newly replaced knee joint.

Moreover, the patient may be advised to undergo some physical therapy, which is essential for the strengthening of the muscles of replaced joints and maintenance of the smooth movement of the replaced knee joint. Also, special diets, physical exercises, follow-up appointment and tests, might be suggested by the doctor to fasten the process of recovery.

In all, a knee replacement surgery is a shared decision and one that must be made after careful analyses of the current condition of the knee, the need of the surgery, the intensity of symptoms and problems, as well as the after-effects of the surgery.

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