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Overview of Knee

Knee is considered to be the largest joint of a human body. As known to all of us it joints the lower leg with the thigh and comprises of two articulations. The first articulation is located between tibia and femur whereas the second one is found between the patella and femur. Being a central hinge point knee allows the body to complete the tasks of flexion as well as extension. It is a trocho-ginglymus mobile in nature and permits a slight lateral and medial rotation too. Since the weight of whole body depends on knee joints to a great extent it is very important to take care of the same. Even if a small injury or pain is experienced the same would need to get checked by the expert professional. However, in this context it is important to know the problems that may arise as far as the knee joints, ankles and braces are concerned.

KNEE PARTS - BONES AND CARTILAGES, TENDONS, MUSCLES, LIGAMEN

HOW DO THE KNEES WORK?

The knee is meeting point of the bones of the upper leg with that of the lower leg. Knees allow hinge like movement that makes human body strong and stable enough to bear the weight of the body. Knees improve the flexibility of the leg joints and also make the motions like walking, crouching, running, turning or jumping easier.

Knee Replacement

TOTAL KNEE REPLACEMENT SURGERY

Knee replacement, also known as knee Arthroplasty is especially useful for the patients who have been suffering from the problem of acute osteoarthritis for the past several years. This surgical procedure is performed aiming at the replacement of the weight bearing knee joint surfaces. This surgery proved to be beneficial for the patients as far as giving them relief from acute pain and disability are concerned. There are certain deciding factors that help a person to realize whether surgery in his case is needed or not. These factors include:

1) When a person experiences tremendous pain that gives him sleepless nights
2) When your knee pain restricts you from performing the simple yet must to do regular activities like climbing stairs, getting up from chair, or bending down to pick something up from the floor etc.
3) When your preferred activities like going out for shopping or traveling to various places, jogging and other slimming exercises are restricted
4) Last but not the least you have tried various treatments and undergone medications but with no positive outcome The above mentioned points are clear enough for a person to take decision in the context of undergoing a surgery. However, it is always a prudent idea to consult an expert professional first.
He will look into the factors like age, bone density of the patient and his overall health condition and accordingly would come to the conclusion of surgery.
Many people still tend to believe that surgery can be avoided choosing other medical alternatives or high powered drugs. However, in order to clear their notion it is very important to discuss the importance as well as benefits of a knee replacement surgery.

Overview of Shoulder

It is believed that there is no such organ or part in the human body which can be labeled as a less important structure. Each part contributes to the process of building the body stability as well as strength through a list of swift movements that are required. In case of shoulder too there is no exception.

It is one of the most movable joints that is unstable too because of the vast range of motions performed by the same. As a result shoulder is likely to get affected due to the several joint injuries some of which are major in nature and take time to show recovery.

Three bones namely the Collarbone (Clavicle), the Shoulder Blade (Scapula), the Upper Arm Bone (Humerus) and ligaments, muscles, tendons are associated with the structure of a human shoulder. The shoulder is required to be mobile enough for the various actions performed by the arms and hands. At the same time it is also essential for the human shoulder to be stable to allow the human body doing actions like lifting, pulling and pushing.

An error in the interrelation between stability and mobility sometimes affect the shoulder badly and often lead to certain problems that are not faced by other joints of the human body like hip.

Shoulder Joints -

Glen humeral Joint - Being the main joint, this ball and socket joint of human shoulder is capable enough to allow arm's rotation in circular way.

2) Acromioclavicular Joint - Arms are raised above the head with the help of this pivot joint. It mainly aims at giving the arms a greater degree of movement rotationally.
3) Sternoclavicular Joint - This saddle like joint allows Clavicular movements, especially in vertical planes and anteroposterior. This joint allows the movement of the arm and shoulder to thrust forward.

Shoulder Problems

The commonly faced problems of a human shoulder are described below -

1) Frozen shoulder

Frozen shoulder which has also been termed as Adhesive Capsulitis is a condition that is mostly faced by women aged between 40 to 60 years. Research says women are more susceptible to this problem rather than men. There is no specific reason for this condition to develop but sometimes it is experienced by the patients after meeting with a traumatic injury or an accident. Frozen shoulder mainly restricts a person's shoulder joint motion resulting in contracted capsule and formation of scar tissues. The contraction and the formation together make it difficult for a person to perform normal activities by making the shoulder joint scarred and stiff.

Dull pain, limitation in the movement of the shoulder joint, and pain while performing activities where it is needed to raise arms above the head - these are the symptoms mostly found in the patients who are suffering from this condition.

Risk factors - Patient who have been dealing with the problems of Endocrine Disorders, Type I & II Diabetes, Thyroid, Parkinson's Disease, Heart Disease or other similar systemic condition are likely to develop the condition mentioned above. This condition is also very common among those who have been taking Antiretroviral medications for a prolonged period of time.

2) Tendonitis

A bunch of fibrous tissues which are tough but flexible in nature is known as tendon. Tendon plays a crucial role by working as a connector between the muscles and the bones of a human body. Tendon mainly aims at transmitting the force originated from the muscle contraction to the bones. Depending on the shapes and sizes activities of the tendons vary from each other. For instance, tendons smaller in size are eligible for controlling the movements of fingers. At times, due to different sorts of reasons inflammation occurs in the tendons which makes the muscle pulling action painful. This inflamed condition of the tendons is known as Tendonitis.

There is one particular area inside the tendon that is comparatively more prone to injury and the same if often described as the watershed zone of tendons. In this area quantity of blood supply is very poor and this weakness results in difficulty while delivering essential nutrients as well as oxygen to heal tendons with a sooner effect. Most of the tendon injuries are experienced by the patients due to the overuse of the tendons. Usually people aged between 40 to 60 years are found complaining about this kind of condition.

Pain related to tendon and muscle movements, tendon swelling and uneasiness, a feeling of tenderness over tendons - these are some of the common symptoms of Tendonitis.

3) Bursitis

A structure that works as a protector for the soft tissues by reducing friction between tendons, bones and ligaments, is called bursa. This sac like structure is filled with lubricating fluid and mainly aims at giving protection to the soft tissues from injuries caused by immense pressure formed in the nearby bones. Bursae are found throughout the body and the joints that are more prone to get extreme pressure, experience the problem of Bursitis more frequently. Bursitis is nothing but an inflamed Bursa that becomes irritated due to the increased pressure and repetitive use in the areas of joints like elbows, knees, shoulders, feet, hip and also the one that is located in the buttocks (lower part).

There are some common reasons found for which in most of the cases patient suffer from this condition: • Problem of Arthritis in a nearby joint
• Pressure on bursa for a prolonged period of time due to long hours sitting or any other similar kind of activity
• Excessive stress on the joints which is very unusual too
• Movements of certain joints repetitively
• Any injury caused by sudden fall or due to the regular use of shoes that are imperfect for a person
• Patients suffering from Gout, Pseudo gout and Rheumatoid Arthritis are likely to experience this condition more than those who do not have the symptoms mentioned above.
• Infection is stated as the reason for which people suffers from Septic Bursitis. It mainly occurs due to several kinds of skin infections.
Pain that restricts movement of the joints, swelling, tenderness - these are known as some of the commonest Bursitis symptoms experienced by the majority of the patients.

Various types of Bursitis:

• Subacromial bursitis - affected area is shoulder
• Scapulothoracic bursitis - affected area is upper back
• Elbow bursitis
• Ischial

(pelvic) bursitis

• Hip bursitis
• Knee bursitis
• Retrocalcaneal bursitis - affects heel
• Intermetatarsal bursitis - affects foot

4) Rotator Cuff Disease

The shoulder joint is stabilized by a group of four tendons namely the Rotator Cuff. These four tendons are connected with the four muscles that allow the shoulder to move in different directions. Each of these four muscles has unique role to perform to keep the shoulder movements functional.

The Subscapularis Muscle - used for internal rotation where the arms are turned inwardly
The Supraspinatus Muscle - required for arm elevation and moving the arms away from body
The Infraspinatus Muscle - responsible for arm lifting at the time of external rotation
The Teres Minor Muscle - like the Infraspinatus Muscle, this muscle also assists when the arms are turned outwardly

When the Rotator Cuff is damaged due to an accident, repetitive strains or any other similar kind of injury, then it is defined as a Rotator Cuff disease. Inflammation and degeneration due to aging are the two main causes of this kind of condition. Inflammation may occur due to Arthritic conditions or for the problems related to Bursitis and Tendonitis. However, it is essential to mention here in this context that people getting involved in repetitive overhead motions are more affected with the Rotator Cuff disease.

Shoulder pain is considered to be the commonest symptom of the Rotator Cuff Disease. Sometimes the pain is felt all of a sudden and that too after a few days of the trauma the patient has experienced. Originating mainly from the front part of the shoulder the pain gradually increases as a result of which it becomes difficult to continue with the shoulder movement at various directions. Along with pain inflammation occurs too and most of these problems start at bedtime. However, arresting the problems at the very initial stage is important otherwise the pain and inflammation of the Rotator Cuff Disease can lead to other major issues like frozen shoulder.

5) Rotator Cuff Tear -

As stated above, Rotator Cuff is made up of four tendons that are connected with four muscles. If a tear is found in any one of those four tendons then the condition is defined as a Rotator Cuff Tear. Out of all the conditions that can affect a human shoulder Rotator Cuff Tear is known as the most common one. Torn Rotator Cuff restricts regular shoulder movement by making it painful and inflamed. If the condition is not treated properly then gradually it makes the shoulder weak and incapable of performing daily activities like combing hair, stressing out arms to hold an object, getting dressed etc.

Rotator cuff tear has become one of the common causes of disability and pain among the middle aged and old adults. This continuous pain occurs due to the torn tendon which fails to get attached to the head of humerus due to the tear. Though in most of the cases tears are found in the supraspinatus muscle and tendon but other parts too get involved in the same. Depending on the severity of the conditions two types of tears have been observed:

1) Partial tear
2) Full thickness or complete tear
Symptoms of a Rotator Cuff Tear are -
1) Pain when lying on the shoulder which is inflamed
2) Certain movements like lowering or lifting arm are painful
3) Arm rotation is weak
4) At the time of moving shoulder crackling sensation is felt

There is a noticeable difference in the pain in accordance with the type of Rotator Cuff Tear. If a tear occurs due to sudden fall it will arouse severe pain along with a weakness in the shoulder and a snapping sensation. On the contrary if the tear develops gradually and slowly then a mild pain will be experienced initially.

6) Dislocation -

When the humeral head is removed forcibly from the socket then the condition is clinically defined as shoulder dislocation. There are many reasons for which a dislocation can occur. Those who are young experience this due to severe sports injury or sudden fall. The old generation faces the same problem for some other obvious reasons like aging of the ligaments and cartilages that support a human shoulder. However, it is required to be mentioned here that only weakening of ligaments cannot make a shoulder dislocated. At this situation too some force is applied as a result of which patient experiences shoulder dislocation.

Depending on the positioning of the humerus head after it is injured there are two types of shoulder dislocation cases found in the medical history. If the humeral head is moved to the front part of the joint then the condition is medically termed as anterior dislocation. 90 - 92% shoulder dislocation cases are found to be of the anterior types. Posterior dislocation occurs when humeral head is moved backward toward the blade of human shoulder.

Apart from these two mentioned above there are certain rare sorts of dislocations found such as Intrathoracic and Luxatio Erecta.

7) Separation -

The joint of a human shoulder consists of - the clavicle, the scapula and the hummers. When the clavicle and the scapula come together the patient is diagnosed with the problem of Shoulder Separation. The joint between the clavicle and the scapula is known as the Acromioclavicular Joint where the shoulder separation mainly occurs when the AC joint is disrupted. This is why the same condition is also termed as AC Separation.

One prominent cause for the AC or shoulder separation is a sudden fall and that too onto the shoulder directly. This kind of sudden fall stabilizes the AC joint by injuring the surrounding ligaments. Initially patient complaints of having mild pain but if the deformity is severe then the pain also increases with time and takes a prolonged period of time to give pain-free movements to the patient.

Fractures -

A sudden fall, severe collision, dreadful road accidents - these are the commonest causes of getting the clavicle or proximal hummers fractured. Since the scapula remains under a protection by the chest and muscles surrounded it is only found fractured is a massive trauma is experienced by the patient.

Pain, restricted shoulder movement, bruises, swelling, deformation, grinding sensation are some common symptoms found in the patients suffering from shoulder trauma.

Total Hip Replacement Surgery

Joint replacement surgery is considered as one of the most effective as well as safe surgeries performed today. Before getting into the details of benefits a patient may get out of it, it is necessary to throw light on various important aspects related to it.

For example - normal hip activities, reasons for hip pain these are the things that should be taken into account before approaching towards the effects of a hip replacement surgery.

There could be various reasons for which a patient will be advised to go for this surgery. For instance - if he is suffering from acute arthritis or the hip is damaged due to accident or any other similar condition that is refraining regular activities to a great extent. Sometimes without having any perceptible change in the condition of the hip patients complaint about difficulty in wearing socks and shoes, running for half an hour or so etc.

Initially the patients having any one of the above mentioned complications are given medication and adequate exercises. However, if the problem does not subside then hip replacement surgery is advised.

Hip replacement surgery gives a painful hip relief from stiffness by increasing motion and chances of getting back to to the normal activities with a sooner effect.

Prosthetic components are used in the place of damaged cartilage and bone after removing the same with the help of Hip Arthroplasty or Hip Replacement Surgery.

There is no specific age limit within which this surgery can be performed.

Though most patients undergo this surgery between the age of 55 & 80 but it has been successfully performed among people of all ages too.

Knee Arthroscopy

Knee arthroscopy is a common surgical procedure in which the knee joint is viewed using a tiny camera. This procedure allows the doctors to have a proper view of the inside of the knee accordingly helping them to diagnose and treat the problem.

With technical advancement and the availability of advanced HD monitors and HRD cameras these days, arthroscopy has proved to be a very efficient tool to treat any kind of knee problems. A survey done by the American Orthopedic Society for Sports Medicine suggests that a total of 4 million arthroscopies take place every year

1) DESCRIPTION -

Arthroscopy is done by making small incisions into the body. An orthopedic surgeon inserts the arthroscope into the knee joint, which sends photographs to a monitor. The surgeon is now able to see the knee structure minutely in the monitor. The doctor can repair and remove any damage tissue if required by making other incisions around the knee and inserting small surgical instruments.

2) PREPARING FOR THE SURGERY -

If you are suggested to go for knee arthroscopy surgery, you would require getting a full body checkup done by your family physician before the operation. He would assess your physical condition and suggest accordingly if there is anything that could interfere with the surgery.

It is also important for you to let your surgeon know about any medicines or supplements that you are taking. He may have something to say and may ask you to stop or start certain medicines. It is also possible that he runs a few pre-operative tests on you including EKG or blood counts.

3) WHEN KNEE ARTHROSCOPY IS SUGGESTED?

Knee Arthroscopy is mostly suggested for:
• Repair or removal of torn meniscal cartilage
• Trimming of torn pieces of articular cartilage
• Reconstruction of a torn anterior cruciate ligament
• Removal of inflamed synovial tissue
• Removal of loose fragments of bone or cartilage

4) COMPLICATIONS AND WARNING SIGNS -

As with any kind of surgery, knee arthroscopy also has its own share of risks involved. However, the chances are quite low and mostly minor and easily treatable.

Complications

• Blood clots
• Infection
• Accumulation of blood in the knee
Warning Signs - Get in touch with your surgeon immediately if any of the following is experienced:
• Chills
• Fever
• Persistent redness and warmth around the knee
• Increased or persistent pain
• Swelling in your knee
• Growing pain in the calf muscle

5) OUTCOME

Apart from a ligament reconstruction surgery, any knee arthroscopy patient can get back to doing regular physical activities after 6 to 8 weeks and sometimes even sooner. However, activities requiring much physical strength need to be avoided for a longer period. You ought to talk to your surgeon to know when you can start intense physical activities.

The final result of the surgery would very much depend on the degree of damage to your knee. For instance, if the articular cartilage in your knee has completely worn away, it is not possible to get full recovery. Moreover, you need to make changes in your lifestyle, which means limited physical activities and doing low-impact exercises.

TRAUMA SURGERY:

Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in General Surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff as well as resident physicians in teaching hospitals.