Ergonomic injuries

Ergonomic Injuries

1) What are ergonomic injuries and how are they caused?

Most people these days have desk jobs that require them to be seated at their desks for 8-10 hours straight. People often fail to realize how much havoc a simple desk job can create in their life. People tend to disregard a lot of simple symptoms by confusing them with symptoms of other conditions and fail to realize that they could be caused by seemingly harmless factors like sitting on a chair for prolonged hours. A lot of health conditions have been said to be caused because of sitting for prolonged hours. Ergonomic injuries affect the muscles, spinal disc, nerves, ligaments, joints etc. Hinged back, back pain, pain in the wrist, stiff neck and shoulder aches are a few of the most common health issues seen due to poor seating posture and continued sitting.

The most commonly suffered ergonomic injuries are;

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orthopedic

What is Minimally Invasive Surgery (MIS)?

In the ever-changing field of medicine, newer inventions and orthopedic techniques have enabled us to perform better and faster with each passing day. Whether it be the medicines or the implants we use, the focus is always on returning the patient to their pre-disease status at the earliest. In this aspect, mention must be made about the vast recent advances made in the field of Minimally Invasive Surgery (MIS). The objective of MIS is to perform complex and highly demanding surgeries through the smallest incisions possible thereby decreasing the immediate post-operative, as well as the long-term morbidity of the surgery significantly. Just like all other branches of modern surgery, trauma surgery too, has put MIS techniques to fruitful use.

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Healthy Joints For a Healthy Living

A joint also called an articulation, is any place where adjacent bones come together (articulate with each other) to form a connection.  The joint allows the bones to move freely but within controlled limits.

There are various types of joints in the body but among them, the synovial joints are the most common joint.

A key structural characteristic for a synovial joint is its joint cavity. This fluid-filled space is the site at which the articulating surfaces of the bones come into contact with each other. This gives the bones of a synovial joint the ability to move smoothly against each other, allowing for increased joint mobility.

Some joints, such as the knee, elbow, and shoulder, are self-lubricating, almost frictionless, and are able to withstand compression and maintain heavy loads while still executing smooth and precise movements. Other joints such as sutures between the bones of the skull permit very little movement (only during birth) in order to protect the brain and the sense organs.

In a joint, bones do not directly come into contact with each other. They are cushioned by cartilage that lines your joints (articular cartilage), synovial membranes around the joint and a lubricating fluid inside your joints (synovial fluid).

Muscles provide the force and strength to move the body. Coordination is directed by the brain but is affected by changes in the muscles and joints. Changes in the muscles, joints, and bones affect the posture and walk, and lead to weakness and slowed movement.

AGING CHANGES ON JOINTS AND MUSCLES

From about age 30, the density of bones begins to diminish in men and women. This loss of bone density accelerates in women after menopause. As a result, bones become more fragile and are more likely to break, especially in old age.

As people age, their joints are affected by changes in cartilage and in connective tissue. The cartilage inside a joint becomes thinner, and components of the cartilage (the proteoglycans—substances that help provide the cartilage’s resilience) become altered, which may make the joint less resilient and more susceptible to damage. Thus, in some people, the surfaces of the joint do not slide as well over each other as they used to. This process may lead to osteoarthritis or osteoarthrosis. Additionally, joints become stiffer because the connective tissue within ligaments and tendons becomes more rigid and brittle. This change also limits the range of motion of joints.

Loss of muscle (sarcopenia) is a process that starts around age 30 and progresses throughout life. In this process, the amount of muscle tissue and the number and size of muscle fibres gradually decrease. The result of sarcopenia is a gradual loss of muscle mass and muscle strength. This mild loss of muscle strength places increased stress on certain joints (such as the knees) and may predispose a person to arthritis or falling.

Symptoms of osteoarthritis can include:

  • Painstiffnessa grating or grinding sensation (crepitus) when the joint movesswelling (either hard or soft)not being able to use the affected

Joint normally, which can make it difficult to do certain activities

(For example climbing stairs).

PREVENTION

Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones. A moderate exercise program can help you maintain strength, balance, and flexibility. Exercise helps the bones stay strong.

A Harvard Alumni Study has published a report that a caloric expenditure of >2000 kcal/day associated with 25% reduction in mortality, they even suggested that physical activity levels must be maintained THROUGHOUT life

Research shows that:

  • Exercise can make bones stronger and help slow the rate of bone loss.
  • Older people can increase muscle mass and strength through muscle-strengthening activities.
  • Balance and coordination exercises, such as tai chi, can help reduce the risk of falls.
  • Physical activity in later life may delay the progression of osteoporosis as it slows down the rate at which bone mineral density is reduced.
  • Weight-bearing exercise, such as walking or weight training, is the best type of exercise for maintenance of bone mass. There is a suggestion that twisting or rotational movements, where the muscle attachments pull on the bone, are also beneficial.
  • Older people who exercise in water (which is not weight bearing) may still experience increases in bone and muscle mass compared to sedentary older people.

Aerobic exercise is any exercise that increases your pulse rate and makes you short of breath (for example a brisk walk, swimming or using an exercise bike). Regular aerobic exercise should help you sleep better, is good for your general health and well-being, and can also reduce pain by raising the levels of pain-relieving hormones called endorphins.

  • Stretching is another excellent way to help maintain joint flexibility.

See your doctor before you start any new physical activity program. If you haven’t exercised for a long time, are elderly or have a chronic disease (such as arthritis), your doctor, physiotherapist or exercise physiologist can help tailor an appropriate and safe exercise program for you.

To summarize

Older adults are the fastest-growing segment of the population

  • As the older adult population increases in number, there is considerable impact on health care and economic aspects of society
  • Observational studies suggest that physical activity may increase the quantity and quality of life

It’s never too late to start living an active lifestyle and enjoying the benefits.

Dr. Ashwin Narasimhaprasad 

Specialist in Orthopaedics  

Aster Clinic, Muteena (DMPC)

Dr. Ashwin - Muteena

http://asterclinic.ae/doctor/dr-ashwin-narasimhaprasad/

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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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