Time to restore the stability

Shoulder instability is a condition with a loose shoulder joint that shifts around the socket after some injury or damage. Sudden dislocation, slipping would lead to severe pain and inflammation in the shoulder joints. This is associated with shoulder instability. Athletes or sportspeople are often faced with shoulder instability.

Usually, shoulder instability can be treated with physical therapy, essential medication, and rehabilitation. However, for severe conditions, the doctor would recommend surgical management to treat shoulder instability. The surgery would differ based on the patient’s condition and focuses on tightening the shoulder ligaments that are loose.

Normally, the surgery depends on the condition or the severity of the patient’s shoulder. The surgeries would include arthroscopy, capsule shift surgery, bankart repair surgery, and latarjet surgical procedure. The doctor uses an arthroscope to identify and resolve shoulder instability.

The recovery period after surgery

Any surgery would require certain painkillers or relievers for a few days. These medications can treat the pain and provide the necessary comfort for the shoulder. The doctor would advise a sling for 5 days and would be asked to extend the period based on the patient’s condition.

Depending on the patient’s condition and the surgery performed, the doctor will recommend physical therapy after 5 days. This physical therapy is performed so as to strengthen the muscles, restore flexibility, and to strengthen the shoulders. The exercises would vary from resistance to strengthening so that the shoulder gets stabilized.

In the first 4-6 weeks, limits on the range of motion will be used to protect the repair. It is recommended to drive only after the first 6 weeks or when the sling is taken. However, heavy lifting and strenuous activities need to be avoided until 12 weeks. Sportspeople and athletes should avoid weightlifting for a minimum period of 16 weeks or as per doctor’s advice. Sports physical therapists could suggest exercises that would prevent injuries in the long run and help maximize performance.

To avoid re-injury and stabilize the shoulder, the doctor would recommend certain tips for the betterment of the shoulder. Ice packs can be used to treat pain and swelling. It is recommended to apply an ice pack daily for 15-20 minutes for a few days. With this and other physical therapies, the shoulder joint will not get stiff. The recovery period will vary based on the shoulder damage, however, the full recovery would definitely take several months.

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Reverse Total Shoulder Arthroplasty

Difficulty in shoulder movements can be challenging for day-to-day activities. Treating all pains and shoulder problems is not a challenge anymore. Reverse total shoulder arthroplasty can be one of the treatments for shoulder arthritis. This is a procedure in which the normal ball and socket relationship of the glenohumeral joint is reversed, creating a more stable joint. 

Surgical procedure 

The surgical procedure can vary depending on the patient’s needs and the surgeon’s preferences. Before the surgery, the patient would be either given general anesthesia (will put the patient to sleep) or regional anesthesia (only the required area is numb).

The surgeon removes the affected or damaged bone and replaces the area with new components with the help of a prosthesis to restore the functioning of the shoulder. The components include a metal ball that is screwed into the shoulder socket and a plastic cup that is placed on the upper arm bone. This surgery will take approximately 2 hours.

Who should be treated?

Reverse total shoulder arthroplasty will be suggested for patients with the following signs or symptoms: 

• Torn rotator cuff which cannot be repaired
• Unsuccessful shoulder surgery during the past
• Complex fracture in the shoulder joint 
• Severe shoulder pain and difficulty with the shoulder movement 
• Shoulder dislocation 
• Tumour in shoulder joint 

If any surgeries, treatments, and physical therapy could not improve the problems with the shoulder, then consult a doctor.

Outcomes of reverse total shoulder arthroplasty

 With the help of an expert doctor, the shoulders can restore its comfort and stability as usual. The shoulder can return to the regular lifestyle slowly. There are more results once the surgery is completed, such as 

• Lessens pain
• Improves shoulder movement
• Ability to sleep on the affected shoulder 
• Ability to perform the daily activities with the affected shoulder 
• Complications related to the surgery 

 If the patient is not examined correctly, there could be minor risks associated with the surgery: 

• Infections
• Bleeding
• Nerve damage 
• Pain 
• Injury to blood vessels 
• Dislocation 
• Fracture 
• Need for additional surgery 

Tips during the recovery period

For a speedy recovery and comfort after the surgery, follow the below measures:  

• Mandatorily use the medications prescribed by the doctor 
• Avoid drinking & smoking while under medication
• Remain in the hospital for a few days after surgery for recovery treatments
• Advised limited use of the shoulder for a month 
• Minimal exercises for the shoulder or as instructed by the surgeon 
• Avoid lifting heavy objects 
• Avoid sports activities 
• Minimal movements until the sling is removed 

Usually, the patient can return to the ordinary or the regular lifestyle after 6 weeks of surgery. Rehabilitation and physical therapy is a must for a speedy recovery and comfort of the patient. 

Shoulder injuries are minimal, but severe damage needs to be treated at the appropriate time. The surgeries are cost-effective; hence, the process should not be delayed. At Chennai Orthopaedics, doctors provide the required guidelines and suggest the appropriate surgery for shoulder related issues or damages.

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All About Shoulder Bone Cancer and Tumors

The human shoulder is the most mobile joint in the body that provides mobility and a wide range of motion to the upper extremity. Shoulder bone tumors can occur when the cells of the bone divide abnormally and uncontrollably forming a mass or lump of tissues. Mostly shoulder bone cancers are secondary forms of tumors that develop else where in the body and spread to the bone in comparison with primary tumors that develop in the cells of the bone. 

  Types Of Bone Tumors

 

Apart from primary and secondary, tumors can either be benign or malignant. Tumors that do not spread to the other parts of the body and are not life-threating are known are benign tumors. Malignant tumors are cancerous and can spread cancer cells throughout the body.

1. Primary Benign Tumors

 

These kinds of tumors are non-cancerous.they require immediate treatment and surgery before they grow and compress the surrounding healthy tissues. Different types of benign tumors are

• Osteochondromas - It is the most common type of tumor that accounts for 35% of all benign tumors. It is the overgrowth of cartilage and bone near the growth plate. This condition is often seen in adolescents and teenagers that affect femur, tibia, and humerus.
• Giant Cell Tumors – It is a relatively uncommon tumor of the bone that occurs in adults. They develop at the lower end of the femur or upper end of the tibia
• Enchondroma – It is a cartilage cyst that grows inside the bone marrow. It affects the bones in the hands and feet as well as the long bones of the arm and thigh.
• Fibrous Dysplasia – It is an uncommon gene mutation in which scar-like (fibrous) tissue develops in place of normal bone. This condition makes the weaken bone vulnerable to fracture.

2. Primary Malignant Tumors

Most common type of malignant bone tumors are

• Osteosarcoma – It is the second most type of bone cancer that develops in shoulders, hips, and knee. It mostly occurs in teenagers and younger adults. It is more common in females than males
• Chondrosarcoma – It occurs mainly in middle-aged and older adults that develop in the cartilage of hip, shoulder, and pelvis.
• Ewing Tumor – It usually occurs in patients of age group 5-20 years. The commonly affected locations are pelvis, upper arm, ribs, upper and lower leg.

  Secondary Bone Cancer

 

Multiple myeloma is the most common type of secondary bone cancer that starts in the bone marrow. It nearly affects 20 million people every year that mostly involve adults in the age group 50-70 years. The other type of cancers that can affect the bone include breast, lung, kidney, thyroid, and prostate.

Treatment

 

The treatment options available for bone tumors are either surgery, radiation therapy, and chemotherapy based on the size and stage of cancer. Limb Salvage surgery is the most preferred procedure to remove cancer cells either from arm or leg. In this procedure, the cancerous bone will be replaced with a metal prosthesis.

If you are in search of best orthopedic surgeon to treat your bone disorders consult Dr. Bharani Kumar Dayanandam at Chennai Orthopaedics.

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Is Arthroscopy A Major Surgical Procedure?

Arthroscopy is a popular surgical procedure that doctors use to diagnose, look at, and treat issues inside a joint like shoulder joint or knee joints. The outcome and the effectiveness of the surgery are surely major but it is a minimally surgical procedure. Arthroscopic surgery can do wonders for patients who don’t want to go for painful surgery.

Arthroscopy is recommended by doctors in case of joint inflammation, joint injuries or damaged tissues over time. Arthroscopy can be done on any joints like hip, wrist, knee and shoulder joints.

Procedure:

Arthroscopy surgery procedure is quite simple and is an outpatient procedure. The patient is first given anesthesia depending on the joint and its conditions. The doctor inserts a special and thin instrument through a very minute small incision on the body. The tool that is used to conduct the procedure is known as an arthroscope which has a camera lens and a light attached to it. This instrument allows the doctor to look inside. The attached camera helps in projecting images of the site onto a screen which is monitored by the doctor.

The doctor thus looks into the joint’s condition, diagnoses the problem, and thus decides the type of surgery the patient needs. In case of requirement of surgery, the doctor inserts special tools through several other small incisions known as portals and conducts the required procedure.

After the surgery the arthroscope and any other attachments are removed and the wounds are closed with stitches or special tapes.

Recovery

The surgery can be followed by a little pain and the doctor can prescribe some medicines in such cases. The surgery reduces joint pains and stiffness and the recovery time is minimal. Certain activities need to be avoided, after the surgery, and it may take a few weeks or months to get back to normalcy.

Complications are rare

Although complications are rare, if you experience any sort of complications after an arthroscopic surgery you must consult a doctor immediately.

Complications can have symptoms as follows:

• Fever
• Numbness or tingling
• Severe swelling
• Pain that gets worse
• Discolored fluid seeping from a wound

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Can Stress Cause Joint Pain?

We always encounter stressful situations in our life. From meeting deadlines at work, managing finances, traffic jams, to managing kids, stress is something that never gives way in the fast, modern life. It also affects our physical health to a great extent which includes joint pain.

What is stress?

Stress is the body's reaction to prevent harmful situations. Chemical reactions take place in our bodies which makes us to act quickly. This process is known as flight or stress response. 

Stress in a small dose is helpful in achieving unfinished tasks. Our body is designed to handle this. But a chronic or long term stress is harmful. Our body is not equipped to handle such situations and results in health consequences. 

Stress and joint pain 

Joint pain is not a stand-alone symptom of stress. It is developed along with stress and anxiety. Stress causes several reactions that affect the creation and experience of joint pain. People might experience joint pain on a regular basis, and in some cases joint pain might alter a person's day-to-day movements. In many situations this pain is hard to control and difficult to overcome.

Stress can cause Joint Pain

Stress makes your bones to release the minerals they need for bone formation into the bloodstream for the benefit of other tissues. A high amount of these minerals can suppress the body’s repair functions and affect the joints.

Excess production of minerals like cortisol (steroid hormone produced by the adrenal gland), magnesium, zinc, and deficiency in vitamin D and oestrogen are the causes of joint pain.

• Altered Movements: stress and anxiety, especially panic attacks, can change the way you move, sit and act. These changes in a way that your body isn't used to can lead to joint pain.
• Stress Inflammation: stress and anxiety can cause inflammation inside the body. This can cause pain in the joints when you move.
• Immune system dysfunction: stress can directly affect your immune system. A poor immune system will result in joint pressure, distress and pain. 
• Muscle tension: significant muscle tension and stress is a common outcome of stress and anxiety.  Stiffness makes joint movements difficult and increases the chances of inflammation followed by joint pain. 
• Perceived pain: People might have joint pain because of several other reasons, which they usually ignore.  Anxiety and stress make one ignore the pain and concentrate on other things. This makes the pain more intense. 

If stress is the reason for your joint pain, then the only way to avoid the pain is by reducing it. Unless you control it, you are going to face a constant struggle with not only joint pain but with all of the other anxiety symptoms.

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What Are The Different Types Of Shoulder Fractures?

Shoulder fractures are common for athletes and sports people. Also sudden accidents while exercising, weight lifting or any other mishap can lead to shoulder fracture. The shoulder joint is one of the most mobile and delicate joints of the body. There are several bones in shoulder that can break or fracture. To analyse the type of fracture, X-ray & diagnostic image test are conducted. The diagnostic images can provide additional information about the fracture condition. Sometimes along with fractures, the ligaments or internal tissues can also get damaged or torn. It is through these images the condition is assessed.

Types of fractures

The shoulder has a ball and socket joint and is highly mobile. It consists 3 bones- clavicle or the collarbone, scapula or the shoulder blade and proximal humerus. The bones are interlinked.

• Clavicle or collarbone fracture- It is one of the common kind of fracture. You will feel like your shoulder is sagging down if your collarbone is fractured. Common symptoms are swelling and sharp pain.
• Scapula or shoulder blade fracture- it is a flat and triangular bone that connects the collar, clavicle and humerus. It is one of the strongest bones so doesn't break easily. A direct hit can cause this bone to break down into pieces.
• Proximal humerus fracture- this fracture can be a result of shoulder dislocation. The humerus gets popped out of the socket. 

Symptoms

Before you go for a shoulder fracture treatment in Chennai, this is how you can know that your shoulder is fractured:

• Stiffness and redness.
• Inability to move the shoulder.
• Shrill pain in the shoulder area.
• A sagged down feeling.
• Deformed shoulder.

Where should you go for a treatment?

Chennai Orthopaedics headed by Dr Bharani Kumar Dayanandam is one such orthopaedic centre which provides class service to the patients. Starting from advanced diagnosis to after surgery care, everything is conducted by the team. The team makes the best use of technology and has successfully operated more than a thousand patients. So if you are searching for a reliable clinic for shoulder injury treatment in India, contact or email us. We will be happy to help you to lead a better life!

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Repairing shoulder instability: arthroscopic or open?

Shoulder instability is a common pathology encountered in the orthopaedic and sports medicine. There are differences between a high school baseball player who feels like his shoulder is loose when throwing and a 40 year old who fell on stairs onto an outstretched arm and dislocated his shoulder? Obviously, they’re both “shoulder instability,” but there are differences, right?

There exists a wide range of symptomatic shoulder instabilities from traumatic dislocations to subtle recurrent subluxations. In general, shoulder instability develops in two different ways: traumatic (injury related) onset or atraumatic onset.  Understanding the pathology of how the instability has evolved is essential in choosing the best course of treatment.

Common ways that a shoulder can become unstable:

Traumatic onset instability begins when an injury causes a shoulder to develop recurrent (repeated) dislocations, Subluxation and labral tear (the labrum is torn or peeled off of the glenoid). Meanwhile, the patient with atraumatic instability has general laxity (looseness or spacious capsule) in the joint as a part of their normal anatomy and the shoulder can become unstable without a history of injury or repetitive strain.

The most common dislocation that leads to traumatic onset is in the anterior (forward) and posterior (downward) direction. A fall on an outstretched arm that is forced overhead, a direct blow on the shoulder, or a forced external rotation force to the arm elevated near the coronal plane are frequent causes of this type of dislocation.

An inferior or posterior(backward) dislocation is not as common as anterior traumatic instability, which is usually related to a electrocution or seizure disorder, events in which the muscular forces of the shoulder cause the dislocation.

Treatment for shoulder instability:

Recurrent or chronic Shoulder instability is often first treated with nonsurgical options. If physical therapy and activity modification do not relieve the pain and instability, surgery may be needed. In certain instances, such as in contact athletes who plan on continuing to participate in sports that put their shoulders at risk and in young persons who have a higher risk of re-dislocation, surgery may be performed after the first dislocation.

Surgical treatment is also considered in patients in whom instability occurs during routine daily activities (dressing, sleeping, etc.). There are basically two methods used in shoulder instability surgery - open and arthroscopic repairs.  A detailed discussion with the surgeon of the treatment options is essential. The rehabilitation following surgery is the same, irrespective of the technique used in the surgery.

Shoulder instability open surgery: Open surgery is often required to correct severe instability. A larger incision is made above the shoulder and the muscles are moved to gain access to the joint capsule, labrum and ligaments under direct visualization.Patients who are contact athletes with a bone defect fail with arthroscopy are better candidates for open procedures.

Arthroscopic Techniques

Although the medical literature has indicated through years of results and analyses that the open procedure is the gold standard, Instability surgery has evolved to the point where many surgeons suggest that the minimally invasive arthroscopic repair is a very viable option.

Recently, arthroscopic procedures are used in capsular shift surgery - when there is a need to tighten up the joint capsule and Bankart repair to repair the torn labrum and reduce capsular laxity. Arthroscopic surgery for Shoulder Instability are performed with visualization through a small fiberoptic scope. Through two or three small incisions, Instruments are inserted into the joint to repair the labrum and the surgical technique is similar to the one used in an open repair. A loose or spacious capsule is harder to address arthroscopically. Procedures using laser or radiofrequency energy to shrink the loose capsule have been developed (Thermal capsulorrhaphy), and are still being evaluated.

Best candidates for arthroscopic stabilization include first-time dislocators, recurrent dislocators and recurrent subluxators. Contraindications include those with large osteochondral humeral defects or significant glenoid bone loss. The results for arthroscopic surgery, in general, are equivalent to the open surgery.  

Arthroscopic vs. Open Surgery

Patients often contemplate - arthroscopic or 'open' surgery which is better? The debate about open or arthroscopic repairs for shoulder instability has been in progress for at least two decades. Open surgery, a procedure using larger incisions and enabling the surgeon to look inside the joint, may be better under certain circumstances for certain procedures. Arthroscopic surgery has also some advantages--smaller incisions, less tissue damage— short- and mid-term results of this technique have been very satisfactory. Several reports recently suggests that long-term results (>5 years follow-up) also remain quite satisfactory, particularly in the absence of significant glenoid bone loss.

The truth is that the choice to have an open or arthroscopic repair depends on patient-specific factors and surgeon specific factors such as the onset of the instability, causes, the total number of dislocations, the surgeon’s experience and preference are important considerations. Depending on these factors (or combination of factors), one surgery may be best for your particular situation. You may also discuss with your surgeon if a particular procedure can be done arthroscopically.

Chennai Orthopaedics at Vanagaram, chennai is a world class healthcare institute for Orthopaedic Treatment in Chennai and provides comprehensive healthcare services with care and dedication. The center is managed by Dr Bharani Kumar Dayanandam, a prominent Orthopaedic Surgeon and Trauma Consultant currently serving as the Consultant Trauma & Orthopaedic Surgeon at Apollo Hospitals, Ayanambakkam, Chennai. The institute has state-of-the-art technology and delivers top-notch healthcare to facilitate the best and shortest road to recovery for every patient. The center offers the entire spectrum of services in trauma and orthopaedics, and also includes shoulder arthritis treatment chennai, trauma surgery, hand surgery, paediatric orthopaedics, arthroscopic surgery and Shoulder Joint Dislocation Treatment Chennai. With world class facility at affordable cost in all orthopedic Sub-specialties, the hospital is committed to provide good quality orthopedic and trauma care to patients from simple fracture treatment to sophisticated joint replacement and arthroscopic procedures.

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