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Joint Problems

Though there isn’t yet a cure for arthritis, there is still a great deal that can be done to relieve pain

What is Arthritis?

Arthritis affects millions of people worldwide and has a considerable impact on the lives of those with arthritis. The word rheumatism is a term used in a broader sense to describe aches and pains in joints, bones, and muscles. Arthritis refers to inflammation within the joint but it can also be due to inflammation of the tendons and ligaments surrounding the joint.

What are the symptoms?

The most common symptom is a pain in the joints, which can be mild to severe causing disability. The pain can be associated with stiffness of the joints, which is worse in the morning on waking up. Some may have pain and stiff- ness in the entire body too, and at times there can be swelling of the affected joints also. Arthritis dam- ages the surface of the joint and at times the underlying bone. If not treated, the disease progresses and causes a destruction of the joint that can result in deformities. Arthritis can also affect the skin and multiple organs.

The most common symptom is a pain in the joints, which can be mild to severe causing disability. The pain can be associated with stiffness of the joints, which is worse in the morning on waking up. Some may have pain and stiff- ness in the entire body too, and at times there can be swelling of the affected joints also. Arthritis dam- ages the surface of the joint and at times the underlying bone. If not treated, the disease progresses and causes the destruction of the joint that can result in deformities. Arthritis can also affect the skin and multiple organs.

Types of Arthritis

There are over 100 different types of arthritis. The two most common ones are osteoarthritis and rheumatoid arthritis. Oth- ers include gout, ankylosing spondylitis, juvenile arthritis, and systemic lupus erythematosus (lupus). Arthritis can be caused by infections too, though such cases have been extremely rare.

 

  • The most common arthritis — osteoarthritis (degenerative joint disease), also referred to as OA affects middle age to elderly people. The spine and weight-bearing joints such as the knees, ankles and hips are more frequently affected by osteoarthritis. Osteoarthritis of the fingers thumbs and wrists reduces grip strength and ability to perform everyday tasks such as writing, picking up things household work, etc. OA is a leading cause of disability in the elderly.
  • Rheumatoid arthritis is the commonest type of inflammatory arthritis affecting nearly one percent of the population, of which three-fourth are women. The wrist, joints of the fingers and feet involved more than others. Rheumatoid arthritis tends to strike in the prime of life between the ages of 30 and 50 years and can have a devastating impact on quality of life and one’s ability to carry out everyday tasks.
  • Ankylosing spondylitis (AS) is another form of inflammatory arthritis that affects the joints of the spine. It causes back pain and stiffness and usually affects young men.
  • Psoriatic arthritis is a type of arthritis that occurs in people who have a skin rash called psoriasis. This usually develops between the ages of 35 and 50 years but can begin in childhood also.
  • Arthritis in children is termed as juvenile arthritis and can start as early as infancy.

Treatment

Though there isn’t yet a cure for arthritis, there is still a great deal that can be done to relieve the symptoms of arthritis and enable one to live with arthritis. The ear- lier the treatment is begun, themore effective it is. Treatment has to be tailored to the needs of each individual because the severity, impact, and type of arthritis are different from person to person. Drug therapy treats various symptoms of arthritis like analgesics and anti- inflammatory, which eventually relieves pain and stiffness. Drugs, which suppress inflammation, the disease modifying drugs, and the DMARDS are the mainstay in the treatment of inflammatory arthritis. These include oral and inject- able preparations. The medications are beneficial but have to be taken under the regular supervision of the rheumatologist.

Lifestyle Changes in Arthritis

For those with arthritis, regular ex- exercise is very important. The joints should be put through a full range of movement at least once a day. This retains mobility, reduces pain, relieves stress, keeps the muscles strong and protects the joints. Stiff joints, if not exercised regularly, become stiffer and end in deformity, which may require surgical correction. Instructions for the exercise regimen can be obtained from the physiotherapist because improper exercise can damage the joints. Rest is also important, especially during flares when there is a lot of inflammation. Exercise and rest have to be balanced.

For people with arthritis, it is important to maintain the body weight within the normal range, overweight puts extra strain on the joints. Following a healthy diet with plenty of fibre and fruit, avoiding too much of meat or ani- mal fat helps maintain the weight and feel better. It is better to avoid or limit alcohol as the drugs pre- scribed for arthritis can interact with alcohol.

 

Kirthi  Dr.Kirthi Raju

MBBS,MD,DM

Specialist Rheumatologist

 

 

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Recurrent Dislocation Shoulder

Chronic anterior shoulder instability following a first time shoulder dislocation reduced and treated conservatively varies in incidence from 100% to 0.24%, depending upon variables like capsular laxity, competitive or non-competitive athletes and bony defects acquired during the prior dislocation.

The chronic anterior shoulder instability can be very much and painful to the patient and leads to fear in sing the affected arm in overhead activities. Surgery is indicated if patients are unable or unwilling to change their occupation or avoid participating in high-risk sports or they have recurrent dislocations.

Surgical options vary from simple labral reattachment, capsular plication or capsular shaft procedures arthroscopic or open. With new surgical techniques and improved anchor design the outcome has improved much better or equal to traditional open surgeries.

But in patients with high recurrence or fracture following capsular procedures is associated pre-operatively like bony bankarts lesion, large hill sachs lesion etc. where the bony defect has to be addressed for the success. The procedure for failed capsular procedure and high risk category procedure of choice is to modify latarject.

In our hospital past one and half year, we have done three cases of modified latarjet, where all the patients had a history of dislocation of the shoulder. More than 20 times previous years and has radiologic evidence of bony bankarts, lesion in one, large hill sachs lesion in one and combined in one.

All these patients have been operated by modified latarjets procedure in which a 7cm incision in the anterior shoulder and coracoid bone block with short head Coracobrachialis biceps is transferred to the prepared anterior inferior glenoid and fixed with two screws along with repair of the anterior-inferior shoulder capsule with coracoaromial ligament. In this procedure, we get extended glenoid surface for translation of humeral head.

Coracobrachialis biceps acting as a dynamic sling in the anterior inferior part when joint is in abduction and external rotation position and reinforcement of anterior capsule by the corache acromial ligament.

 

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knee and joint pain

Comprehensive overview of knee and joint pain, its symptoms, causes and relief measures

 

What is the prevalence of knee and joint conditions in the UAE?

Knee Pain is one of the most common complaints these days among people of all age groups. Every individual experiences this issue at some point in their life. The level of pain also varies in each individual. For some, the pain may be so extreme that it limits daily activities and in others, it may not be as severe and may not be so much of a hindrance in their daily life. In both cases, what people fail to realize is that they are dealing with a condition that needs to be attended to and not ignored at all.

 

In your opinion, what are the main causes of these problems?

Knee pain is a very common issue that can happen at either the knee joint, the knee cap or the ligaments of the knee. There is not just one particular reason for the cause of knee pain because the knee has various parts. It could be caused due to physical injuries that occurred during some physical activity, continuous injury, a mechanical problem like dislocation of the knee cap, obesity or because of a certain condition like arthritis. Arthritis is a very common cause of knee pain which is further divided into different kinds like Septic Arthritis caused by a bacteria attacking the joint, Post-traumatic Arthritis which may develop years after having a knee injury etc. Most of the time body movements do not pose  a problem but constant wear and tear or injury are what leads to severe pain. The knee is the largest joint in the body. The bones inside the knee joint are covered by an articular cartilage which provides a smooth gliding surfacing for joint movements. When any of this is disturbed the body reacts in the form of pain.

 

Does the lack of exposure to sun rays and vitamin D deficiency play a role in the prevalence of knee and joint conditions?

Vitamin D is extremely necessary for the body to absorb calcium and promote bone growth. Deficiency of Vitamin D results in soft and fragile bones in children which lead to rickets causing bowed legs and other skeletal deformities whereas in adults misshapen bones leads to a condition called Osteomalacia. Vitamin D deficiency also causes a lot of other health problems including obesity. Since knee and joint conditions are prevalent in people of all ages, the amount of Vitamin D requirement also varies. Aged people need more Vitamin D than the younger ones, dark-skinned people need more than the fair skinned, overweight people also need it more. Vitamin D is not a vitamin because a vitamin is something our body cannot make and hence needs to be provided by something we eat or with supplements. Our body can make Vitamin D from exposure to sunlight. People with very low Vitamin D are more likely to develop bone or joint pains. Rickets, Osteomalacia, and Osteoporosis are the most common bone disorders found in adults. Osteomalacia is caused by a defect in the bone-building process and Osteoporosis results from the weakening of a previously constructed bone.

 

How many patients visit Aster Hospital for these types of consultations? And what is the percentage of these patients who undergo surgical procedures?

Aster provides comprehensive Orthopedic care including surgical and non-surgical care. We are equipped with state of the art equipment and procedures and offer advanced procedures in various fields to give our patients the best treatment. Aster has a number of experienced and respected orthopedic specialists who have to their credit the knowledge and expertise in their field.

 

What are the precautionary measures to avoid knee and joint injuries?

Staying physically active and keeping the body fit is the best way to avoid the risk of knee pain or injury. However, in certain cases, knee problems caused by a particular activity or by accident cannot be avoided as they can’t be foreseen. There are certain preventive measures that can be taken to avoid any serious knee or joint issue. Firstly, being healthy by eating a balanced diet and maintaining a healthy weight to avoid excess stress on the knee. Secondly, always wearing sensible shoes that fit perfectly and offer the right kind of support because this helps maintain the leg alignment when walking. Wearing insoles in shoes to maintain a balanced body posture is also advisable. These are two things that people generally tend to ignore because they don’t realize how wearing the right fit shoe helps avoid serious consequences. Stretching the thigh muscles before beginning an activity reduces tension on the tendons and relieves pressure on the knee during the activity. Certain exercise routines can be followed that aid in strengthening the leg muscles. Taking the stairs up is a very good practice, riding a bicycle is a good way to make the leg muscles stronger. Weights are also a way to strengthen the leg muscles supporting the knee but these workouts need to be done under the supervision of a trainer. Sudden change in workout routines should be avoided, the intensity and duration of the activity should always be changed with a gradual build up. Opting for workouts that are strong but of low impact to the knee is recommended. A physiotherapist should be consulted for exercises.

 

What are the symptoms that patients need to be aware of that call for consulting a specialist?

Knee Pain that is caused as a result of a strenuous activity and that is usual could be managed at home itself or one that is caused because of a minor injury could be self- observed for a day or two and then the required steps can be taken. However, if you are suffering from extreme pain it is better to seek medical help. When unsure of whether or not to consult a doctor, some symptoms that need to be taken into consideration are continuous pain that lasts for days or weeks, any form of swelling or redness around the knee, any feeling of instability in the joints, acute injuries discomfort or difficulty in walking etc. On experiencing any of these symptoms it is best to consult an orthopedic specialist who as per diagnosis will suggest the necessary treatment.

 

UAE residents and medical tourists complain of the high costs associated with orthopedic surgery especially if they do not have insurance. What is your comment on that? (Might be good to highlight that Aster provides affordable high-quality health care which is in line with the group’s vision.)

The Department of Orthopaedics at Aster Hospital is a state-of-the-art facility offering comprehensive care to patients of all ages. We have an exceptional team of doctors comprising orthopedic surgeons and physical medicine experts who have the experience and expertise to handle various cases and are supported by specialty-trained nurses, patient counselors and physical rehabilitation therapists. They follow international treatment protocols to ensure optimal, evidence-based care to patients, at affordable prices as compared to the other hospitals in Dubai.

Orthopedic surgery procedures performed in Aster Hospital are cost effective compared to the surgery cost in other developed nations. Besides the cost, patients save time and getting the treatment is very convenient and fast. Countries that operate public health-care systems, such as Canada, U.S., and the U.K. often have long waiting periods for certain operations.

Aster DM Healthcare is committed to providing world-class Healthcare, at affordable costs. Lack of insurance cover or its limitations is faced by citizens in all countries. Patients are finding that insurance either does not cover orthopedic surgery (such as knee or hip replacement), or limits the choice of the facility, surgeon, or prosthetics to be used.

 

Does Aster Hospital provide attractive healthcare packages that encourage medical tourism?

Aster Hospital offers comprehensive treatment plans and wellness packages for patients that are coming from other countries. The packages have detailed inclusions and exclusions, making it easy for medical tourists to select a treatment that is suited to their budget. To further assist overseas medical tourists, we assist with travel requirements including visa requirements (if needed) and the option of booking both hotel stays and return flights. Patients can Skype with our doctors and discuss their treatment plans before they plan their travel. On arrival, a representative of the team will receive the patient at the Airport and we provide transport to Hospital or Hotel as per the admission plan. A Guest Relation Executive will complete formalities like registration, admission and signing of the consent forms and so on. Interpretation and translation services are also available on request. Post treatment, patients can keep in touch with our medical team for follow-up once they are back in their country.

 

Knee and joint pain is now common among the youth as well and is not restricted to the elderly, what are the causes for this?

Knee pain is very generic, it doesn’t limit itself to people of a particular age. Knee and joint pain are rather common among the youth because of various underlying reasons. A lot of young individuals who are involved in any form of physical activity or those who are very actively involved in sports suffer from knee and joint pain.  The pain will be experienced gradually and will flare up on repeated flexing on the knee. In such cases the causes may be inappropriate training (gym) techniques or excess sports activities, ignoring certain injuries leaving them to recover on their own, inflexibility of the thigh muscles supporting knee movement etc. There are also other causes for knee pain in teenagers and young adults. In today’s day and age, children prefer to stay at home and watch TV or play on their mobiles rather than going out for some physical activity which leads to obesity. An inactive lifestyle is a core contributor to aches and pain. Physical demands at home and work have become lesser owing to technological advancements and conveniences.

 

Dr. Ranjith Narayan

Orthopaedic Specialist, Aster Hospital

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orthopaedic

Orthopaedic Surgery FAQs

What is the prevalence of Orthopaedic issues in the  UAE? Do you witness more patients with orthopaedic issues caused by injuries or diseases?

 

Though however there is no exact prevalence or studies scientifically done in this regard at UAE. In general reviews and individual assessments; the prevalence of orthopaedic degenerative diseases associated with work  are amicable. Secondary to misuse or use too much of the body parts irrelevant to the physical fitness of an individual are more compared to trauma or sports injuries. As the foreign workers are more at all the categories of the jobs including hard manual laborers in UAE concentrating on time, job, earnings and ignoring the quality of life and health at present and future.

What are/is the most common Orthopaedic issue you witness at the hospital or clinic  – knee pain, osteoporosis, sports injuries etc.?

Degenerative diseases involving the axial skeleton are witnessed mainly at the healthcare sectors. Like for Eg: Knee, Hip, Shoulders, Elbows, Spine, and Limbs are more witnessed both at clinics & hospital. Osteoporosis, Occupation induced injuries or hazards and sports injuries are mainly  undiagnosed generally as the accessibility of a common labour worker to the specialist is hindered due to inadequate time and work constraints apart from the insurance restrictions and policies. All of this leads to the advancement or worsening of the diseases.

Can you share more information on why patients should opt for Laparoscopic surgery, rather than traditional? (Can we have specifics)

In Orthopaedics; Arthroscopic Surgeries / Key hole Surgeries / MIS (Minimally Invasive Surgery) should have opted for patients in view of benefits for a patient and the company. As patient can be rehabilitated early, less stay in the hospital and back to work at the earliest which is beneficial to the either. And in overall, the cost expenditure will be comparably less.

  • For instance traditional might require 5 days of hospital stay, whereas arthroscopic surgeries would allow for next day recovery and treated as a day care surgery and discharged on the same day of admission most often.
  •  Is it more cost-effective? Of course, it’s more Cost-effective when taken only the surgical charges into consideration but when compared to the traditional surgeries the cost or expenditure will be less or nearly the same in overall as keeping in view of the hospital stay, Expenses on medicines. Etc having an impact in the Physical, Mental, Financial, Psychological and Occupational stress to the patient and its family.
  •  Is it more reliable? Does it have a higher chance of preventing future re-occurrences? It is reliable; Prevention of future recurrences can be done but in orthopaedics, the problems are the structural damages or changes occurring within the body. Henceforth with age and time subtle variations are expected and can be addressed accordingly.
  • Is post-operative pain management better? Yes, Post-operation pain management is easier and much better when compared to the traditional method of management as its less invasive, less tissue damage, less loss of blood and hence less pain. It is also better manageable and easily acceptable by the patients.

What are some recent studies you have come across that justify the case of minimal invasive or laparoscopic?

 

I have come across with many studies and few links are mentioned below for detailed knowledge on the topic.

–   www.ncbi.nlm.nih.gov/pmc/articles/PMC3117522/

–   orthoinfo.aaos.org/topic.cfm?topic=A00543

–   jbjs.org/content/85/11/2069

 

Following are the benefits of  MIS Spine Surgeries and  Arthroscopic Joint surgeries. 

  • Day care procedure less hospital stay,
  • Early rehabilitation,
  • More cosmetic,
  • Back to work at earliest,
  • Less morbidity in experienced hands,
  • Generally acceptable by the majority of population.

Do you have two patients that could speak on this?

 

I do have two knee replacement patients could speak about; but there’s nothing like MIS in knee replacement.

 

 Is there something different that Aster provides in laparoscopic technology?

 

We have dedicated Orthopaedic Operation Theatre and advanced Radiological facilities, Physiotherapy and rehabilitation centre which ensures faster recovery and post-operative care.

 

Dr. Manjunatha Ganiga Srinivasaiah

Orthopaedics

Aster Clinic

 

 

 

 

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Arthiroscopy 1

Keyhole Knee Surgery Arthroscopy

What is keyhole knee surgery?

Keyhole knee surgery uses 2 small incisions to allow the surgeon to place a telescope and a micro-instrument inside the knee joint. The telescope (arthroscope) allows the surgeon to diagnose and treat the following:

  • Torn meniscal cartilage
  • Damaged joint surface cartilage
  • Torn anterior cruciate ligament
  • Loose bodies

As with all types of keyhole surgery there is less pain, faster recovery and less risk of infection when compared with open surgery.

Who is suitable?

Your Orthopaedic surgeon will assess whether your knee will benefit from keyhole surgery. He is likely to use plain X-rays and an MRI scan to help with this assessment. The conditions listed above are the most common reasons to recommend keyhole surgery.

At arthroscopy, loose and damaged pieces of joint can be removed, and if the main symptom is acute sharp pains with catching and locking, then an arthroscopy may well provide lasting relief.

Risks

Overall, keyhole knee surgery is very safe and has one of the highest satisfaction rates of any surgical procedure.

What to expect afterwards

You will need to rest for a few hours until the effects of the anaesthetic have passed. The nurses and physiotherapists will help get you out of bed and start getting you walking, sometimes with the aid of crutches. In virtually all cases you will be allowed to place full weight the operated knee.

  • You may need pain relief to help with any discomfort as the anaesthetic wears off.
  • You can home as soon as you feel ready.
  • You should try to have a friend or relative stay with you for the first 24 hours.
  • Your nurse will give you some advice about caring for your healing wounds before you go home.
  • You will need to see your surgeon after the operation, anytime between 2 and 6 weeks.

Recovering from knee arthroscopy

  • It is normal for your knee joint to feel sore and swollen for at least a week.
  • You shouldn’t drive until you’re confident that you could perform an emergency stop without discomfort.
  • You should be able to resume your usual activities after three to eight weeks depending on the severity of your knee problems and your level of fitness.

 

Is my condition bad enough for an operation?

We measure how bad things are in a number of ways:

Firstly, how much pain are you in? Is it steadily getting worse?

Secondly how much trouble do you get in everyday life and doing the things you enjoy?

Before your operation your condition will be analyzed using a variety of functional scores. These will help us put your problems in perspective. They also give a helpful comparison for your progress following surgery.

 

Dr. Ranjith Narayan

Specialist in Orthopaedics

Aster Hospital,  Mankhool

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