Posterior cruciate ligament injury

Symptoms

Posterior Cruciate ligament injury may include:

Mild to moderate pain in the knee
Rapid onset of knee swelling and tenderness (within three hours of the injury)
Pain with kneeling or squatting
A slight limp or difficulty walking
Feeling of instability or looseness in the knee, or the knee gives way during activities
Pain with running, slowing down, or walking up or down stairs or ramps
Most people with a posterior cruciate ligament injury don't feel a "pop" — the classic sign of an ACL tear — at the time of the injury. Signs and symptoms may be mild or vague, and you might not even notice anything wrong. Over time, the pain may worsen and your knee may feel more unstable. If other parts of the knee are affected, your signs and symptoms will likely be more severe.


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

Wrist Arthroscopy

What is it?
Arthroscopy is a minimally invasive technique of visualizing the inside of a joint. The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The wrist is a complex joint made up of many bones and ligaments, which hold the bones together (see Figure 1). Wrist arthroscopy allows the surgeon to diagnose and treat many problems of the wrist through a series of very small incisions (portals). In the last several years, the wrist has become the third most common joint to undergo arthroscopy, after the knee and shoulder. Because the incisions used with wrist arthroscopy are smaller and disrupt less soft tissue than conventional open surgery, pain, swelling and stiffness are minimized and recovery is often faster.

When is wrist arthroscopy performed?
Wrist arthroscopy allows the visualization of the cartilage surfaces of all bones in the wrist and better evaluation of the ligaments between the various bones of the wrist. After an injury, pain, clicks, and swelling may be frequently indicative of an internal problem in the wrist. Arthroscopy is often the best way of assessing the integrity of the ligaments, cartilage, and bone. When wrist problems are encountered, many are treated through these small incisions using specialized instruments available for wrist arthroscopy. Often arthroscopy is used to aid in the reduction of fractures of the bones of the wrist. Wrist arthroscopy is also used to assess the integrity of the TFCC (triangular fibrocartilage or meniscus of the wrist). Wrist arthroscopy can be used to remove some ganglions of the wrist and to assess and treat various types of arthritis of the wrist.

How is this performed?
The procedure is performed under general, regional, or local anesthesia. A small camera fixed to the end of a narrow fiber optic tube, 2.7mm wide, is inserted through a small incision, about 5mm long, in the skin directly into the back of the wrist joint. The camera lens magnifies and projects the small structures in the wrist onto a television monitor, allowing for more accurate diagnosis. Several small incisions (portals) are used to allow the surgeon to place the camera in different positions to see different structures inside the joint as well as to place various small instruments into the wrist joint to help diagnose and treat various problems in the wrist (see Figure 3). The wrist is usually distracted and filled with fluid to expand the joint and allow improved visualization during the procedure. Sometimes wrist arthroscopy is combined with open procedures.

After wrist arthroscopy
After your arthroscopy, you will most likely be placed into a wrist splint that allows full mobility of your fingers. The period of immobilization will vary depending on what was performed at the time of surgery. Elevating the involved extremity is important to prevent excessive swelling and pain after your surgery.

Risks and limitations
As with any surgery, wrist arthroscopy has risks. These include infection and potential damage to nerves and tendons, usually less than 1%. Stiffness may need to be addressed through post operative rehabilitation. Wrist arthroscopy is not appropriate for all wrist conditions and is dependent on the surgeon’s training, expertise, and comfort level.


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

ELBOW ARTHROSCOPY

INTRODUCTION
The field of arthroscopy has experienced remarkable growth and advance in the treatment of elbow disorders in recent years. It is now being performed by an ever increasing number of surgeons for a wide variety of conditions. Useful both for diagnosis and treatment, arthroscopic techniques are demanding, and potentially devastating neurovascular injuries are a concern. As elbow arthroscopy assumes a greater role in the diagnosis and management of elbow problems, new indications continue to emerge.
INDICATIONS / CONTRE-INDICATIONS
The indications for elbow arthroscopy include: removal of osteophytes due to impingement or osteoarthritis, synovectomy in patients with inflammatory arthritis, removal of adhesions and capsular release in patients with contractures, resection of symptomatic plicae, removal of loose bodies, and evaluation of patients with chronic elbow pain. In addition, elbow arthroscopy has been used to treat patients with osteochondritis dissecans, septic arthritis, epicondylitis and elbow fractures.
GENERAL TECHNIQUES
The operative techniques in general have been well described elsewhere. I prefer the lateral decubitus position with the forearm allowed to swing free. A soft elastic bandage is then wrapped around the hand and forearm to within ten centimeters of the olecranon. The tourniquet, which is used routinely, is inflated to 250 mm/Hg. The elastic bandage is left on until the end of the procedure to limit the periarticular swelling to the elbow area. When the bandage and tourniquet were removed, any accumulated edema rapidly dissipated into the tissues of the forearm and arm.
With the increasing complexity of the procedures performed, the number of portals used has increased (Figure 1). In addition, more of an emphasis has been placed on utilizing the more proximal portals (proximal anterolateral and anteromedial) portals.
The method and sequence of portal placement varied and evolved over the years. Currently, we generally start in the direct midlateral portal and establish access through the posterior portals immediately as well. Open drainage outflow through one or more sites is immediately instituted and maintained throughout the procedure. The posterior compartment is usually treated first and then the anterior portals established for correction of anterior compartment pathology. Portal placement is determined by careful palpation of the underlying bony structures and we do not rely on skin markings, as the skin markings do not correctly indicate the underlying structures after swelling occurs. We now rely on the use of retractors to permit visualization in the anterior compartment, rather than pressurization to accomplish joint distention. This reduces the risk of edema and even more greatly expands the complexity of surgical procedures that can be performed inside the elbow.
Anterior portal placement has been accomplished using both the outside-in and inside-out techniques, but over time the outside-in technique has become the preferred one. Initially, we believed that edema could be minimized by placing a cannula in each portal and keeping it there throughout the duration of the procedure, but our practice has been changed. Currently, cannulae are used only in one or two of the anterior portals. The proximal anterolateral portal is usually used for a retractor and the anterolateral and proximal anteromedial portals for the scope and working instruments. The bulkiness of the cannulae can outweigh their advantages except in the working instrument portal. In more complicated procedures such as those in which extensive bone and capsular work are required, the cannulae may be discarded as periarticular edema develops. This edema actually permits retention of the portal pathway and permits instruments to be readily moved in and out of the elbow, which is usually required.
A previously described system for pressurized irrigation was routinely used and recommended. The system is a modified pulsatile lavage system that is used to lavage the canal during joint replacement and for the irrigation of open fractures. The spray nozzle is cut off from its connecting tubing, which is then connected to the arthroscope via a standard intravenous line. The driving pressure is set at fifty mm/Hg and flow is controlled by the assistant using the intravenous flow control knob. The auditory feedback (“putt-putt”) of the pulsatile lavage system is invaluable in permitting the surgeon to monitor the fluid flow into the joint without having to consult others or a display panel. Edema is controlled by always maintaining direct outflow through one or more portals and also through the shaver device. No drainage tubings are connected to the outflow cannulas or shaver, so that the flow can simply drain to the floor where it is collected by suction.
Entry into a contracted joint is best accomplished using a custom made switching stick that has been machined to a taper-point at the end. This is machined from a Steinmann pin such that the point is blunt enough so that it will not cut into tissues, yet tapered enough so that it can be used to penetrate the capsule without deflecting off it. Once this blunted Steinmann pin has been placed, the arthroscope sheath is slid into the joint over the pin and the pin withdrawn. We believe this to be easier, safer, and more effective than trying to place the arthroscope sheath containing an obturator into the joint. It also obviates the problem of not being able to distend the capsule in stiff elbows, a step that moves the radial nerve away from the instruments in a normal elbow.

For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

Hip Injury

The hip is one of the body's largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.

The bone surfaces of the ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.

A thin, smooth tissue called synovial membrane covers all remaining surfaces of the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint.

Common Causes of Hip Pain and Loss of Hip Mobility

The most common cause of hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

Osteoarthritis usually occurs in people 50 years of age and older and often individuals with a family history of arthritis. It may be caused or accelerated by subtle irregularities in how the hip developed. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.

Rheumatoid arthritis is an autoimmune disease in which the synovial membrane becomes inflamed, produces too much synovial fluid, and damages the articular cartilage, leading to pain and stiffness.

Traumatic arthritis can follow a serious hip injury or fracture. A hip fracture can cause a condition known as osteonecrosis. The articular cartilage becomes damaged and, over time, causes hip pain and stiffness.

Whether to have hip replacement surgery should be a cooperative decision made by you, your family,& your orthopaedic surgeon at A+ clinic.

Although many patients who undergo hip replacement surgery are 60 to 80 years of age, orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability, and general health status-not solely on age.

Hip replacement surgery may benefit you if: if:

Hip pain limits your everyday activities such as walking or bending.

Hip pain continues while resting, either day or night.

Stiffness in a hip limits your ability to move or lift your leg.

You have little pain relief from anti-inflammatory drugs or glucosamine sulfate.

Other treatments such as physical therapy or the use of a gait aid such as a cane do not relieve hip pain.

The Orthopaedic Evaluation

Your orthopaedic surgeon at A+ clinic ask you about your general health the extent of your hip pain and how it affects your ability to perform every day activities.

A physical examination to assess hip mobility, strength, and alignment.

X-rays (radiographs) to determine the extent of damage or deformity in your hip.

Occasionally, blood tests or other tests such as MRI (magnetic resonance imaging or bone scanning may be needed to determine the condition of the bone and soft tissues of your hip.

What to Expect From Hip Replacement Surgery
· An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do.

· Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. However, hip replacement surgery will not enable you to do more than you could before your hip problem developed.

· Following surgery, you will be advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life. You may be asked to avoid specific positions of the joint that could lead to dislocation.

· Even with normal use and activities, an artificial joint (prosthesis) develops some wear over time. If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.

Surgery



The surgical procedure takes a few hours. The orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic joint surfaces to restore the alignment and function of your hip.



Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal or ceramic material) and the socket component (a durable cup made of plastic, ceramic or metal, which may have an outer metal shell).

Special surgical cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint.

A noncemented prosthesis has also been developed and is used most often in younger, more active patients with strong bone. The prosthesis may be coated with textured metal or a special bone-like substance, which allows bone to grow into the prosthesis.

You will usually stay in the hospital for a few days. After surgery, you will feel pain in your hip. Pain medication will be given to make you as comfortable as possible.

To avoid lung congestion after surgery, you will be asked to breathe deeply and cough frequently.

To protect your hip during early recovery, a positioning splint, or a pillow is placed between your legs.

Walking and light activity are important to your recovery and will begin a day after your surgery. Most patients who undergo total hip replacement begin standing and walking with the help of a walking support and a physical therapist the day after surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.

Recovery

The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.

Avoid getting the wound wet until it has thoroughly sealed and dried. A bandage may be placed over the wound.

Diet

A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Drink plenty of fluids.

Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.

Your activity program should include:

A graduated walking program, initially in your home and later outside

A walking program to slowly increase your mobility and endurance

Resuming other normal household activities

Resuming sitting, standing, and walking up and down stairs

Specific exercises several times a day to restore movement

Specific exercises several times a day to strengthen your hip joint

You may wish to have a physical therapist help you at home.

Other precautionary measures

Avoiding Falls

· A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs climbing is avoided until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.

· Your orthopaedic surgeon and physical therapist at A+ clinic will decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

Special Precautions:

Do not cross your legs.

Do not bend your hips more than a right angle (90°).

Do not turn your feet excessively inward or outward.

Use a pillow between your legs at night when sleeping until you are advised by your orthopaedic surgeon that you can remove it.

What changes at home will help a patient with THR

The following is a list of home modifications that will make your return home easier during your recovery:

Securely fastened safety bars or handrails in your shower or bath

Secure handrails along all stairways

A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms

A raised toilet seat

A stable shower bench or chair for bathing

A long-handled sponge and shower hose

A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip

A reacher that will allow you to grab objects without excessive bending of your hips

Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips

Removal of all loose carpets and electrical cords from the areas where you walk in your home


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

Meniscus Injury

Tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee, called menisci. When doctors refer to "torn cartilage" in the knee, they are actually referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during activities such as walking. They can also be torn by traumatic force encountered in forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In adults, the meniscus can be damaged following prolonged 'wear and tear'. This is called a degenerative tear.
Tears can lead to pain and/or swelling of the knee joint. A tear of the medial meniscus can occur as part of the unhappy triad, together with a tear of the anterior cruciate ligament and medial collateral ligament.


Symptoms

Most complaints from patients are usually knee pain and swelling. These are worse when the knee bears more weight. Another typical complaint is joint locking. This can be accompanied by a clicking feeling. Sometimes, a meniscal tear also causes a sensation that the knee gives way.
A tear of the meniscus commonly follows rotation of the knee while it was slightly bent. These also excite the pain after the injury; for example, getting out of a car is often reported as painful.
A physician performs clinical tests to determine if the pain is caused by compression and impingement of a torn meniscus. The knee is examined for swelling. In meniscal tears, pressing on the joint line on the affected side typically produces tenderness.

Diagnosis

X-ray images can be obtained to rule out other conditions or to see if the patient also has osteoarthritis. The menisci themselves cannot be visualized with plain radiographs. If the diagnosis is not clear from the history and examination, the menisci can be imaged with MRI scan (Magnetic Resonance Imaging).This technique has replaced previous arthrography, which involved injecting contrast medium into the joint space. Recent survey shows that MRI and clinical testing are comparable in sensitivity and specificity when looking for a meniscal tear.

Surgery

If this does not resolve cases of a locked knee, then surgical intervention may be required. Depending on the location of the tear, a repair may be possible. In the outer third of the meniscus, required blood supply exists and a repair will likely heal.
The meniscus has fewer vessels and blood flow towards the unattached, thin interior edge. In most of the cases, the tear is far away from the meniscus' blood supply, and a repair is unlikely to heal. In these cases arthroscopic surgery allows for a partial meniscectomy, removing the torn tissue and allowing the knee to function with some of the meniscus missing. In situations where the meniscus is damaged beyond repair or partial removal, a total menisectomy is performed.
For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

Shoulder Replacement Surgery

When arthritis gets worse that the “non-operative" or "conservative" measures work to relieve the pain, your surgeon may recommend you to have shoulder replacement surgery.
This can either be a "hemiarthroplasty"(only the humerus is replaced), or a "total shoulder arthroplasty"(both the humerus and glenoid socket) are replaced.

While surgery should relieve pain, but it may not necessarily improve your motion. Also, any mechanical device, like a shoulder replacement, will wear out with time (generally 20-25 years, or so, in the shoulder, and varying on whether the replacement was a total or hemi shoulder arthroplasty). For this reason, surgeons usually recommend delaying surgery as long as tolerable.
Shoulder replacement is done in the hospital. Usually patients need to stay in the hospital around 3 days after surgery for their recovery. Unlike knee or hip replacements, usually there is no need for blood transfusions after surgery, except for unusually complicated cases.

After surgery, the following products will be useful:
 Cryotherapy unit. Cold therapy is an ice machine that can decrease your pain after surgery. Hospitals used to provide them to patients all the time; but, because insurance companies stopped reimbursing for them, the hospitals have stopped this practice. We offer state-of-the art equipment, such as the DonJoy Iceman and the PolarCare Cub so you do not have to be in pain. Place your order before surgery, so you can bring the device to the hospital with you. Believe it or not, the nurses will actually appreciate this, as these units are far easier to maintain and much less messy than the ice bags they typically would place on you. Take the unit home with you to help decrease pain and swelling for the weeks after surgery.
Rehabilitation of the shoulder will be necessary. It is very important to follow your surgeon's exact directions. You will find that doing your exercises routinely at home, under your surgeon's or physical therapist's guidance, will get you the best results possible after your joint replacement.


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com