orthopedics

Hip Arthroscopy

The frequency of Hip Arthroscopies has been increasing explosively over the past years, leading to a hugely improved technique and greater understanding of the arthroscopic anatomy of the hip joint. Arthroscopic hip procedures can successfully treat conditions previously unrecognized or only treatable by open procedures. Improvements in technology have made the procedure accessible and reproducible. Arthroscopy for intra-articular conditions and endoscopy for periarticular pathologies continue to evolve. With the increased understanding of hip pathology and the onset of new concepts such as femoroacetabular impingement, the need for an arthroscopic access not only to the central compartment of the hip but also to the periphery became evident. Hip Arthroscopy is one of the most rapidly evolving arthroscopy techniques. It combines the benefits of a Minimally Invasive procedure and a short rehabilitation period. Improved instrumentation and technical skills have advanced our ability to accurately diagnose and treat various conditions. The role of this procedure continues to evolve with new indications that might change the outcome of degenerative joint disease of the hip joint. Hip arthroscopy is indicated for both traumatic and atraumatic intra and extra-articular conditions. Femoroacetabular impingement (FAI) is increasingly recognized as a disorder that can lead to progressive articular chondral and labral injury. A variety of arthroscopic techniques allows the treatment of labral and acetabular rim pathology as well as peripheral compartment femoral head-neck abnormalities. It is now recognized that labral tears that were traditionally treated with simple debridement are often associated with underlying FAI. Hip arthroscopy is also being used for surgery to the structures surrounding the hip as snapping hip syndromes, greater trochanteric pain syndrome, and arthroscopic repair of abductor tendon tears. Better understanding of the arthroscopic anatomy, improved operative techniques, lowered complication rate and objective outcome measuring tools will further define the optimal role of hip arthroscopy and improve its outcome.

 

HIP REPLACEMENT SURGERIES

TX Hospitals, India offers advanced treatment for various hip disorders, including arthritis.

Birmingham Hip Resurfacing
Birmingham Hip Resurfacing has been considered a breakthrough medical technique. TX Hospitals, India, is the pioneer of the Birmingham Hip Replacement procedure in the Asian region. BHR has come as a boon for younger patients, as it results in very little bone loss and almost normal unrestricted movements and functions. The success rate of BHR is over 99%.
What Is Birmingham Hip Replacement Or Resurfacing (BHR)?

BHR is primarily intended for use in people who are in need of a hip replacement at a younger age and therefore are likely to be more active. In Birmingham Hip Resurfacing a very small part of bone on the top of the thighbone is resurfaced. A metal head is fixed on the thighbone. It fits into a metal socket placed in the joint.

For people needing a replacement under the age of 55, regular consideration is given for this procedure. People aged between 55 and 65 who are very active and otherwise fit may also be suitable and this will be determined by their bone quality and activity level.

The BHR Advantage

Traditional Total Hip Replacements (THR) invariably have a ‘metal on plastic’ bearing. These are reasonably successful in elderly relatively inactive patients, but offer unacceptably poor long term outcomes for young, active patients often with unavoidable multiple revision surgeries and associated complications. It is to avoid this unfortunate sequence of events that Birmingham Hip Resurfacing (BHR) was developed.

Who Needs Hip Resurfacing?

CONVENTIONAL HIP REPLACEMENTBIRMINGHAM HIP REPLACEMENT
Suitable for Elderly PatientsSuitable for Younger Patients
Head of femur (thigh bone) removedBone not removed
Articulation is metal with plasticArticulation is metal with metal
Wears out rapidly in young and active patients‘Everlasting’ – based on 35 year history in Birmingham of Metal on Metal Articulation
Revision Surgery invariably necessary in younger patientsRevision Surgery not required for younger patients
Activity restriction required after Surgery for fear of dislocationActivity restriction not required after Surgery as there is hardly any risk of dislocation (can sit on floor ,squat, use Indian toilet, etc)
Sport not advised as the usage is inversely proportional the life of the hip replacementSport and High demand activities encouraged as usage is not related to life of resurfacing implant
Total Hip Replacement

The end portion of the thighbone affected by arthritis is replaced with a metal head that can be cemented with special glue to the stem of the thighbone (or) can be uncemented (in younger patients). The socket is replaced with a metallic cup and high density plastic is used as an insert into it. The socket is usually left uncemented (screws are used to connect to the thighbone). The Total Hip Replacement procedure enables restoration of the natural gliding motion of the joint.

Proximal Hip Replacement

The Proxima Hip Replacement is also ideal for young patients. In this minimally-invasive procedure, the part of thighbone at the point where it begins is shaped and replaced by a metal head. This sits in a metal cup that is fitted into the socket.

Bilateral and Revision Hip Replacements are also done at TX Hospitals, India. Some hip surgeries can also be performed using minimally-invasive techniques.

 SHOULDER SURGERIES

TX Hospitals offers advanced treatment for various shoulder disorders, and also houses a dedicated  Shoulder Surgery Unit. Some of the shoulder surgeries undertaken at TX Hospitals, India are:

Total / Partial Shoulder Replacement

Total Shoulder Replacement needs to be done if both sides of the shoulder joints are severely affected by arthritis. In Total Shoulder Replacement, the damaged end of the upper arm bone is replaced by a stem with a metal head. The diseased part of the socket is replaced by a plastic shell in which the metal head sits. In case only one part is affected, partial shoulder replacement can be done.

Shoulder Resurfacing

In Shoulder Resurfacing, the surface of the bony end is made smooth and the diseased part is removed in the process. After this, a metal cap shaped to fit into the socket is fixed on the end of the bone.

Bilateral and Revision Shoulder Replacements are also done at TX Hospitals, India. Some shoulder surgeries can also be performed using minimally-invasive techniques.

Shoulder Impingement

Shoulder impingement can be a problem with tennis players, swimmers and cricket bowlers. The repeated action of the arm going up or coming down can lead to this, especially when players do more than their usual, by trying to increase their training intensity before or during their tournaments.

The person usually complains of pain with the arm coming down, as in during a tennis serve or a bowling action. There is a tendon called the Supraspinatus tendon that gets pinched between two bony prominences at the shoulder, leading to pain and discomfort.

Precautions To Be Taken
  • Avoid sudden increase in training level.
  • Adequate in-between rest periods.
  • Proper training techniques
  • Most of the patients benefit from judicious rest and rehabilitation. A minority will end up requiring an Arthroscopic (Key Hole) procedure for effective treatment of their symptoms and return to sport.
 KNEE REPLACEMENT SURGERIES

TX Hospitals, India, offers advanced treatment for conditions of the knee joint

such as arthritis that can severely affect the knee and hamper routine activities.

What Is Arthritis?

Arthritis is inflammation of the joints. A gradual wearing away of the tissue on the ends of bones results in reduction of joint space and friction at the exposed bone surfaces, changing regular bone movement and causing severe pain. Knee Replacement Surgery is the best solution to treat the condition and allow resumption of normal activities in the knee.

The types of arthritis are:

Osteoarthritis

This occurs after the age of 50 in individuals with a family history of arthritis. The tissue that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

Rheumatoid Arthritis

This is a disease in which the inner membrane of joints is thickened and inflamed. This results in excessive production of the fluid that lubricates these joints. This chronic inflammation can damage the tissue covering the ends of the bones and eventually result in loss of the tissue, pain and stiffness.

Traumatic Arthritis

It can result from a serious knee injury. A knee fracture or severe tears of the knee’s connective tissue may damage the tissue covering the ends of the bones over time, causing knee pain and limiting knee function.

Symptoms
  • Severe pain in the joint that restricts everyday activities such as walking, climbing stairs and getting up from chairs.
  • Severe pain while resting.
  • Inflammation and swelling of the joint that does not improve with medication and rest.
  • Deformity in the joint.
  • Joint stiffness or inability to move the joint in a normal manner.
Treatments

Some of the knee surgeries and treatments performed at TX Hospitals, India are:

  • Total Knee Replacement
  • Partial Knee Replacement
  • High Tibial Osteotomy
  • Minimally Invasive Knee Replacement (Resurface) Surgery (MIKRS) using
  • OrthoGlide Medial Knee system.
  • Total knee replacement using Patient specific zigs
  • The Ideal Knee
ARTHROSCOPY

The Orthopedic surgeons at the TX Hospitals can diagnose and treat many types of bone and joint problems using minimally invasive techniques.  Most minimally invasive orthopedic surgeries are done with the use of an arthroscope, a special thin tool designed for viewing and treating problems inside a joint. The arthroscope is so slim that it can be inserted into the joint through one or more tiny “keyhole” cuts through the skin, rather than longer incisions. The arthroscope is fitted with a state-of-the-art miniature camera and a specialized lighting system that enables the structures inside the joint to be viewed on a monitor. The surgeon can attach special tools to the end of the arthroscope to shave, cut, or remove tissue or bone that are causing problems. Arthroscopic or keyhole surgeries of the joints are routinely performed. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder. TX Hospitals performs over 700 arthroscopies per year. Hip resurfacing is also done through key hole Surgery.

Meniscal Repair

Meniscus is a very important part of the Knee Joint. It mainly acts as a shock absorber for the knee.

Meniscal tears are very common and are frequently missed diagnoses for knee pains following a fall. A meniscus tear can be many types: Common tears include longitudinal, parrot – beak, flap, bucket handle and mixed/complex.

Causes And Symptoms

The causes of meniscus tears are sports injuries, fall and squatting and sudden twisting. Old degenerative knees will tear even by a simple movement like getting up from a chair.

Symptoms may be a pop like sound followed by

  • Pain
  • Stiffness and swelling
  • Catching or locking of your knee
  • The sensation of your knee “giving way”
  • You are not able to move your knee through its full range of motion.
Treatment

Clinically it manifests as tenderness in the area of the meniscus and the diagnosis is MRI.

Small tears in the inner part of the meniscus at the white zone are trimmed. The larger tears in the white red zone and the red zone are repaired with Arthroscopic Meniscal repair anchors. Rest is for few weeks and then knee bending is commenced.

Bone Tumors

TX Hospitals offers specific options for management of bone tumors.

Tumors of the bone can be either benign or malignant, the malignant variety being more of a challenge to treat. Further more malignant tumors could be either primary tumor of the bone or secondary deposits from tumors elsewhere in the body. The most common bone tumors encountered are osteosarcomas, Ewing’s sarcoma, etc. The most common sites of occurrence are around the knee joint – either distal femur or proximal tibia. The dramatic change of events from amputation to limb salvage surgeries has heralded a new hope to these patients who have this form of cancer.

When a person has cancer of the bone, Surgery forms a part of the treatment. Formerly if the malignant tumor was in the limbs, Surgery meant amputation of the limb. The entire limb or part of it would be removed. This led to marked disability and disfigurement. The person also had to suffer social stigma. In order to overcome the functional, psychological and social problems associated with amputation, the concept of limb salvage was evolved. Here, despite the Surgery and removal of the tumor, the limb is spared.

The aim of limb salvage Surgery in bone tumor management is to eradicate the disease, retain the integrity of the skeletal system and preserve a limb with useful function.

Successful limb sparing procedures consists of three phases namely

  • Bone resection: After making an accurate assessment of the stage and spread of the tumor the surgeon removes the affected part of the bone.
  • Reconstruction: The second phase of the procedure involves replacing the missing part of the patient’s body. Prosthesis or implants are made of steel or titanium.
  • Plastic Surgery: This is performed to cover the area with muscle and soft tissues.

Then customized mega prostheses are tailor made for each patient. They conform to each and every patient and fit him or her perfectly.

The prosthesis is fitted only when the surgeon feels that the disease can be controlled by removing only one portion of the bone and not the whole limb and using an implant will give the person more comfort than removing the hand or leg and fitting with an artificial limb. A patient may or may not be able to get the full use of the limb. But surely a certain amount of functionality can be restored. The main advantage will be that the cancer would be treated without major disability.

TX Hospitals India specializes in management of bone tumors and there is a specialized surgical team that focuses on the management of Bone tumors.

Achilles Tendinitis

Achilles tendinitis is a condition that causes pain on the back of your leg near your heel. The Achilles tendon is strong and can take huge amounts of stress, but it can also develop tendinitis if over used.

Achilles Tendinitis Symptoms
  • Pain after exercising
  • Thickening of the tendon
  • Pain and stiffness in the tendon in the morning
  • Pain at the back of the heel
  • Swelling
  • Bone spur
Achilles Tendinitis Risk Factors

You are more likely to develop Achilles tendinitis:

  • If you are starting a sudden exercise regimen that puts too much stress on the tendon
  • You have extra bone growth
  • You do very intense work out sessions

Achilles Tendinitis Diagnosis

Based on the symptoms, your doctor will examine your foot and look for signs of pain and discomfort or immobility. He will also run the following tests to rule out any other possibilities:

Achilles Tendinitis Treatment

Achilles tendinitis can mostly be fixed through some extra care which may include:

  • Exercising in moderation
  • Applying ice packs on inflamed areas
  • Resting plenty
  • Getting Physiotherapy
Achilles Tendinitis Medication And Surgery

Medication for Achilles tendinitis includes steroidal and non-steroidal drugs.

Surgery should be considered a last resort, only if there are no signs of the pain reducing. Types of surgery include:

  • Debridement and repair – This is recommended only if the tendon is less than 50% damaged
  • Gastrocnemius recession (surgical lengthening of the calf muscle)
  • Debridement with tend on transfer – This is recommended if the tendon is over 50% damaged

Bone Loss

Bone loss or Osteopenia occurs when the body does not create a new bone as quickly as the old bone is reabsorbed. Osteopenia is the early stage of bone loss which can eventually lead to Osteoporosis gradual weakening of the bones over time. In many cases, if a person’s bones are weak, a mere sneeze or a bout of cough is enough to break a rib.

Bone Loss Symptoms

While bone loss occurs gradually and in many cases may not show any signs at all, Osteopenia eventually leading to Osteoporosis, may have the following early signs of development:

  1. Hunching or stooped posture
  2. Frequent backaches
  3. Loss of bone in the jaw
  4. Weakness from a previous injury or fracture
Bone Loss Risk Factors

You may be at risk for Osteopenia or Osteoporosis if you:

  • Are a female
  • Consume heavy amounts of alcohol
  • Consume less calcium-rich diets
  • Smoke
  • Have a thin body frame
  • Have an early menopause
  • Have a history of anorexia nervosa (an eating disorder caused by a unexplained fear of food) in the family
  • Lead an inactive lifestyle
  • Have a history of Osteoporosis in the family

If you have any/some/all of the aforementioned symptoms, a visit to your doctor is strongly advised.

Bone Loss Diagnosis

The main way to understand and diagnose whether you have signs of Osteopenia or Osteoporosis is to have your bone density measured. 80% of the bone density can be determined by heredity and 20% by lifestyle choices. Age 30 is the peak of your bone health, where your bones reach their maximum strength this is known as peak bone mass.

There are a number of ways in which your doctor can check your bone density.

  1. DEXA Scan or a Dual X-RayAbsorptiometry
  2. Ultrasound
  3. Quantitative Computed Tomography (QCT)
  4. Bone Densitometry
  5. Blood Tests
Bone Loss Treatment

The treatment for Osteopenia and Osteoporosis ranges from making lifestyle adjustments to mild to strong medication.

Lifestyle Changes:
Medication:

Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:

  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Ibandronate (Boniva)
  • Zoledronic acid (Reclast)

Hormones, such as estrogen, and some hormone-like medications approved for preventing and treating osteoporosis, such as raloxifene (Evista), also play a role in osteoporosis treatment. However, fewer women use estrogen replacement therapy now because it may increase the risk of heart attacks and some types of cancer.

Denosumab (Prolia) is a newer medication shown to reduce the risk of osteoporotic fracture in women and men. Unrelated to bisphosphonates, denosumab might be used in people who can’t take a bisphosphonate, such as some people with reduced kidney function.

Teriparatide (Forteo) is typically reserved for men and postmenopausal women who have very low bone density, who have had fractures or whose osteoporosis is caused by steroid medication. Teriparatide is the only osteoporosis medication that has the potential to rebuild bone and actually reverse osteoporosis, at least somewhat.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that occurs in the hand or wrist due to the pressure on the median nerve which leads to numbness and tingling of the hand. Several factors that lead to carpal tunnel syndrome include patterns of using the hand, wrist anatomy and underlying health problems.

Carpal tunnel is a narrow passage on the side of the palm. It protects the nerves and tendons of the hand and fingers. Compression of this carpal tunnel leads to numbness, tingling and weakness.

Carpal Tunnel Syndrome Causes

Carpal tunnel syndrome is caused due to compression of the median nerve. The median nerve leads to the sensation of fingers and palm side of the thumb except little finger. The median nerve also affects the movement of muscles in the hand.

Carpal Tunnel Syndrome Symptoms

The symptoms of Carpal tunnel syndrome include numbness or tingling in thumb and fingers as well as weakness and discomfort in wrist.

Numbness or tingling

Numbness and tingling can be experienced in the thumb and fingers. This sensation is often felt while holding a phone, newspaper, steering wheel and waking up from sleep. This sensation may further extend from the wrist to the arm.

Weakness

Weakness in the hand may lead to reduced ability of grasping objects. The numbness in the hand of the thumb’s pinching muscles cause weakness in the hand. These muscles are controlled by the median nerve.

Carpal Tunnel Syndrome Diagnosis

The doctor may conduct tests to diagnose carpal tunnel syndrome that include physical examination, x-ray, electromyogram and the study of nerve conduction.

Physical examination

The doctor will conduct a physical examination by testing the sensation felt in fingers, pressing and tapping on the nerve and strength of muscles in hand.

X-ray

The doctor may also recommend for an x-ray for the affected area of the wrist to determine the other causes of pain.

Electromyogram

The doctor may conduct electromyogram test to evaluate the electrical activity of the muscles. It helps in determining the damage done to muscles.

Study of nerve conduction

The doctor may conduct a nerve conduction study by passing a small shock to the median nerve. In some cases, the doctor may also recommend to seek help from a neurologist or neurosurgeon.

Carpal Tunnel Syndrome Treatment

Carpal tunnel syndrome can be treated in both non-surgical as well as surgical ways.

Non- surgical treatment

The non-surgical treatments that may help in improving the condition of carpal tunnel syndrome are wrist splinting, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

Wrist splinting: A splint holds the wrist still at night to prevent tingling and numbness while sleeping.

Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs that help in relieving the pain for short period.

Corticosteroids: Corticosteroids helps in reducing the swelling and inflammation which also relieves the pressure on median nerve.

Surgical treatment

In severe cases, the surgical treatment may also be performed which include endoscopic surgery and open surgery.

Endoscopic surgery: It is a surgery conducted using the endoscope attached to see the carpal tunnel and cut the ligaments by small incisions, followed by open surgery.

Open surgery: In open surgery, large incisions are made on carpal tunnel to free the nerve.

Hip Tendinitis

  • Hip tendinitis is also known as ‘trochanteric bursitis’. Bursitis is an inflammation of the fluid sacs that lubricate the area between bones and tendons. Trochanteric bursitis generally affects the trochanter of hip and muscles of buttock and thigh.
  • Hip tendinitis is mostly common in middle aged women than men.
Hip Tendinitis Causes
  • Hip tendinitis can be caused due to prolonged pressure on bursa, injury, jogging, extensive cycling, joint movements and repetitive twisting. These rigorous activities can lead to inflammation in bursa and cause trochanteric bursitis.
  • Hip tendinitis can also be caused in the lower back resulting in arthritis of hip and iliotibial band syndrome.
  • Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.

The following risk factors have been associated with the development of hip bursitis.

  • Repetitive stress (overuse) injury.This can occur when running, stair climbing, bicycling, or standing for long periods of time.
  • Hip injury.An injury to the point of your hip can occur when you fall onto your hip, bump your hip, or lie on one side of your body for an extended period of time.
  • Spine disease.This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
  • Leg-length inequality.When one leg is significantly shorter than the other, it affects the way you walk, and can lead to irritation of a hip bursa.
  • Rheumatoid arthritis. This makes the bursa more likely to become inflamed.
  • Previous surgery.Surgery around the hip or prosthetic implants in the hip can irritate the bursa and cause bursitis.
Hip Tendinitis Symptoms

Common symptoms of hip tendinitis (trochanteric bursitis) include:

  • Warmth and redness in the affected area due to inflammation
  • Feeling of tenderness in the area affected
  • Hip and buttock pain that further extended to thigh and knee
  • Pain while walking, running or sitting cross legged
Hip Tendinitis Diagnosis

To diagnose hip bursitis, the doctor will perform a comprehensive physical examination, looking for tenderness in the area of the point of the hip. He or she may also perform additional tests to rule out other possible injuries or conditions. These tests can include imaging studies, such as x-rays, bone scanning, and magnetic resonance imaging (MRI).

Hip Tendinitis Treatment
Nonsurgical Treatment

The initial treatment for hip bursitis does not involve surgery. Many people with hip bursitis can experience relief with simple lifestyle changes, including:

  • Activity modification.Avoid the activities that worsen symptoms.
  • Non-steroidal anti-inflammatory drugs (NSAIDs).
  • Assistive devices.Use of a walking cane or crutches for a week or more when needed.
  • Physical therapy.Your doctor may prescribe exercises to increase hip strength and flexibility. Treatments such as rolling therapy (massage), ice, heat, or ultrasound may help.
  • Steroid injection.Injection of a corticosteroid along with a local anesthetic may also be helpful in relieving symptoms of hip bursitis. This is a simple and effective treatment that can be done in the doctor’s office. It involves a single injection into the bursa. The injection may provide temporary (months) or permanent relief. If pain and inflammation return, another injection or two, given a few months apart, may be needed. It is important to limit the number of injections, as prolonged corticosteroid injections may damage the surrounding tissues.
Surgical Treatment

Surgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, your doctor may recommend surgical removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can function normally without it.

A newer technique that is gaining popularity is arthroscopic removal of the bursa. In this technique, the bursa is removed through a small (1/4-inch) incision over the hip. A small camera, or arthroscope, is placed in a second incision so the doctor can guide miniature surgical instruments and cut out the bursa. This surgery is less invasive, and recovery is quicker and less painful.

Both types of surgeries are done on an outpatient (same-day) basis, so an overnight stay in the hospital is not usually necessary. Early studies show arthroscopic removal of the bursa to be quite effective, but this is still being studied.

Hip Tendinitis Prevention

Although hip bursitis cannot always be prevented, there are things you can do to prevent the inflammation from getting worse.

  • Avoid repetitive activities that put stress on the hips.
  • Lose weight if you need to.
  • Get a properly fitting shoe insert for leg-length differences.
  • Maintain strength and flexibility of the hip muscles.
Gout

Gout is a complex form of arthritis characterised by sudden and severe attacks of pain, soreness and tenderness in the joints especially at the base of the big toe. It can affect anyone irrespective of gender and age – men are more prone to gout but women are also equally prone after menopause.

Gout Symptoms

A bout of gout can happen very suddenly and without any warning, in the middle of the night with a sensation as if the big toe is on fire. The joint pain is such that it feels hot, swollen and tender that even the lightest weight feels unbearable. The symptoms are –

  • Excruciating and severe joint pain for the first 12 hours which mostly affects the large joint of the big toe, feet, ankles, knees, hands and wrists.
  • A lingering joint discomfort which can last for a few days or weeks after the severe pain subsides. Future attacks usually last longer and affect more joints.
  • The affected joints usually become inflamed, tender, hot, sore and red.
  • Joint mobility is hugely decreased with growing intensity of pain and damage of joints.
  • Tophus is a term used to describe a deposit of crystalline uric acid and other substances at the surface of joints or in skin or cartilage, typically a feature of gout.
Gout Risks

High levels of uric acid in the body cause gout and the factors that increase uric acid are the following

  • A diet high on meat, seafood, sweetened beverages, fructose or fruit sugar and alcohol
  • An overweight or obese body which tends to produce more uric acid thus putting pressure on the kidneys to eliminate uric acid
  • Certain medical conditions like high blood pressure, chronic diseases like diabetes, metabolic syndrome, kidney and heart diseases
  • Use of certain drugs like thiazide diuretics to treat hypertension, low doses of aspirin and anti-rejection drugs in case of organ transplant patients
  • Family history of gout
  • Recent surgery or trauma
Gout Diagnosis

The following tests help diagnose gout

  • Joint fluid test where a sample of fluid is taken from the affected joint to reveal presence of urate crystals
  • Blood test to measure uric acid and creatinine levels which can be misleading sometimes because not all with high uric acid levels have gout and some with normal uric acid levels have gout.
  • X-ray imaging of the joints to rule out other causes of joint problems
  • Musculoskeletal ultrasound, a technique quite popular in Europe and the US to detect urate crystals in an affected joint or a tophus
  • Dual energy CT scan is expensive and not widely used, sparingly to detect urate crystals in an affected joint even when not sore and red
Gout Treatment

Gout is totally treatable with medications that the doctor will choose depending on the current state of health and patient preferences to reduce the risk of recurrence and complications like the development of tophi from urate crystal deposits –

  • Both over-the-counter and prescriptions Non-steroidal anti-inflammatory drugs (NSAIDs) to stop acute attacks and prevent future attacks. However, these medicines carry the risks of stomach pain, bleeding and ulcers
  • Pain relievers like colchicine to reduce gout pain though there may be side effects of nausea, vomiting and diarrhoea
  • Corticosteroids are reserved for patients who cannot take NSAIDs or pain relievers and is given in pill or injectable form to control gout related inflammation and pain. Possible side effects are mood changes, increased sugar levels and high BP.
  • Medications to block and limit uric acid production in the body may create side effects like rashes, low blood count, nausea and reduced liver function.
  • Medications to aid and improve the kidneys’ ability in uric acid removal.
Lumbar Radiculopathy

Any injury, pain, muscle weakness, tingling and numbness that results in an irritated, inflamed or a compressed spinal nerve in the lower back of the leg is called lumbar radiculopathy.

Lumbar Radiculopathy Symptoms

The common symptoms of lumbar radioculopathy are:

  • Pain in the arms and legs
  • Numbness in the arms and legs
  • Tingling in the arms and legs
  • Muscle weakness in the arms and legs
  • Low back pain
  • Sciatica
Lumbar Radiculopathy Risks

The following are the risk factors for lumbar radiculopathy:

  • Any activity that places an excessive or repetitive load on the spine or lower back
  • Persons who do heavy labour or perform contact sports
  • Family history of lumbar radiculopathy
  • Spine disordersof any kind
Lumbar Radiculopathy Diagnosis

The clinical diagnosis of lumbar radiculopathy is through a combination of a lot of factors:

  • Patient’s medical history and history of pain
  • A physical examination and description of pain
  • Imaging test results like MRI and CT -myelogram to confirm or rule out lumbar radiculopathy or see the extent of impingement of the nerve root
Lumbar Radiculopathy Treatment

The first line of treatment is usually conservative and non-surgical. And, if it fails to remove or alleviate the pain , then surgery is the way. Some of the treatment options include the following:

  • Medications, painkillers and ointments
  • Selective spinal injections
  • Physical therapy and gentle exercise or rest, as applicable
  • Sometime, lumbar radiculopathy resolves on its own within 6 weeks to 3 months
  • Decompressive surgery like laminectomy, discectomy or microdiscectomy in case of failure of non-surgical methods and the severity of pain and muscle weakness go up. Surgery is totally dependent on imaging test results and severity of pain and muscle weakness
Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is a condition mostly genetic and inherited from parents, present from birth caused by a defect in the gene that produces type 1 collagen, which is an important bone building ingredient. OI results in extremely fragile bones.

Osteogenesis Imperfecta Symptoms

The common symptoms are:

  • Weak bones
  • Frequent and multiple bone fractures even as a result of minimum force or injury
  • Loose joints
  • Flat feet
  • Poor quality of teeth
  • Short stature, below average height
  • Blue sclera which is a blue tint to the whites of the eyes
  • Early hearing loss
  • Bowed (bent) arms and legs, in severe OI
Osteogenesis Imperfecta Risk Factors

Children with OI parents have 50 percent chances of contracting this condition.

Osteogenesis Imperfecta Diagnosis

A medical examination which indicates blue sclera in children is a sure shot indicator of OI. A definitive diagnosis happens when family DNA blood samples are submitted for a skin punch biopsy. For a family history with OI, at the time of pregnancy a chorionic villus sampling is done to check if the unborn baby has this condition. Severe forms of OI which happens due to family history or mutations can be seen on ultrasound even at 16 weeks into gestation.

Osteogenesis Imperfecta Treatment

Sadly, there is no cure for OI till date. There are therapies that help us deal and manage the pain and complications that come with it. Medications like bisphosphonates are prescribed to increase the strength and the density of the bones which in turn helps reduce the pain and the fracture rate, especially in the spine.

Light exercise and low impact physical activity like swimming and walking are suggested to keep the muscles strong and agile, and strengthen the bones. In severe OI cases, inserting a metal rod through surgery or bracing is suggested to strengthen the bone and reduce the risk of fractures. Surgery is also required to correct bone deformities which can impact body esteem and self-image or the ability to walk, move or run, in the case of bowed legs.

The fact though is, that despite surgery, fractures will continue to happen and will also heal as quickly. It is a good idea to reduce the time spent in a cast as bone loss may occur in parts of the body not in use.

Rotator Cuff Tendinitis

The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm (humerus) to the shoulder blade (scapula).

Rotator Cuff Tendinitis is a condition wherein the tendons and muscles which help move the shoulder joint are inflamed. It is most likely to occur in people who play strenuous sports such as swimming, tennis, baseball pitching, which require them to move their arms above their shoulders frequently.

The functionality of the shoulder is fully reversible after the treatment for Rotator Cuff Tendinitis is given and the joint regains full mobility.

Rotator Cuff Tendinitis Symptoms

The early symptoms of Rotator Cuff Tendinitis are mild but get worse over time and may persist for years to come, unless treated and managed in the right way. The following are the most common symptoms of Rotator Cuff Tendinitis:

  • Pain caused by lowering or raising your arm
  • Clicking sound while raising your arm
  • Pain, swelling on the front of your shoulder
  • Pain, swelling in the side of your arm
  • Pain forcing you to wake from sleep
  • Stiffness of the joint
  • Loss of mobility in the affected area
  • Pain while reaching behind your back
Rotator Cuff Tendinitis Risk Factors

You may be at risk for Rotator Cuff Tendinitis if you:

  • Play sports that need you to move your arms above your shoulder a lot, such as swimming, tennis or baseball pitching.
  • Have previously suffered a bad injury to the shoulder
  • Have previously suffered progressive degeneration of the tendon tissue
Rotator Cuff Tendinitis Diagnosis

Shoulder pain may be caused by a number of other conditions and this pain usually goes away without any special treatment. However, if you feel the loss of mobility after an injury, or you feel pain lasting longer than a few weeks, then medical attention must be sought, immediately.

Once you’ve met with your doctor, he will move your arms and shoulders in different directions to see where it hurts the most and how of much of an impact the rotator tendinitis has had. He will also check the strength of the muscles around your shoulder. Depending on the effect and degree of pain and damage, the following tests may be prescribed:

Rotator Cuff Tendinitis Treatment

Treatment for Rotator Cuff Tendinitis can be divided into home treatments, medication, therapy and surgery.

Home treatment:Home treatments can include ample amount of rest and placing ice packs on the affected area.

Medication:Medication for Rotator Cuff Tendinitis include injections with mild doses of steroids to ease the pain, especially if it results in lack of sleep. However, these must be used judiciously so as to not weaken the tendon.

Therapy:Physical therapy is one of best known ways to treat Rotator Cuff Tendinitis as it can completely restore mobility after an injury without any surgery.

Surgery:Surgery for Rotator Cuff Tendinitis includes bone spur removal, open tendon repair, arthroscopic tendon repair, shoulder replacement and tendon transfer, depending on the degree of pain and immobility