Author: Dr. Manpal Singh Narula

Dr. MS Narula is a main orthopedic general practitioner in Chandigarh. He has over 21 years of experience. Having accomplished over 2000 a success joint replacement and backbone surgical procedures. He is likewise a visiting general practitioner at New Yorkshire hospitals, U.K. (England).
He is presently the director of Narula Institute of Centre for Orthopedics Excellence (NICE) at Chandigarh City Hospital and Senior Consultant, Orthopedics Spine and Joint Replacement, Apollo Clinic Sector 8-C Chandigarh.

His expertise includes:

1.) Trauma management
2.) Joint alternative
3.) Surgical procedures backbone ailment
4.) Sports activities accidents
5.) Usage of minimally invasive techniques & technology

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Apollo Clinic Chandigarh Orthopedic

Knee Crepitus Treatment & Causes | घुटने की क्रेपिटस का उपचार और कारण

Knee Crepitus Treatment

Knee Crepitus Treatment | घुटने से आवाज आना का सफल इलाज

In this video, Dr. MS Narula, discusses common causes of knee crepitus treatment. 

What is knee crepitus or knee popping sound ?

It is a popping, clicking, or cracking sound from the knees. It can be a grating sensation. But, mostly, it’s a harmless condition. Mostly it is arthritis. 

What are the probable causes of knee crepitus?

One of the prevalent reasons for sound in the knees or the soft tissue is because of air bubbles. There is entrapment of air bubbles inside the joint fluid, and when they pop, they make a sound coming from the knees. Another principal reason for this sound is the rubbing of rough cartilage. Bone-to-bone rubbing may also cause this. In addition, if the tendon and cartilage are snapping through the bone, this sound may also pop. 

How to diagnose?

Most of these reasons are unharmful unless and until they give away with time. But if they are paining or causing swelling, then it might be arthritis. It is a normal condition of wear and tear of cartilage lining, or the cartilage gets rough from various places. Consequently. bone to bone touches, causing popping sounds and pain. It may indicate the initiation of arthritis. Another condition is when the piece of cartilage loses out and moves in the fluid. It may cause pain, make sound and even lock the knee joint.  

Treatment of knee crepitus | Knee Crepitus Treatment

Often people panic when hearing noise from their knees, especially in the morning. Popping sound from knee  harmless condition. Suppose you feel a strange noise from your knees after a specific exercise. In addition, if you have pain and inflammation, one can always do RICE treatment—Rest, Icing, compression, and elevation. And one may need mild anti-inflammatory. But if the knee is  painful and swelling, you must see a doctor. Most probably the doctor will examine the knee by X-ray.

How X-Ray helps in diagnosing knee crepitus?

In X-Ray, doctors will look for conditions like eroded cartilage or the space from bone to the joint is receding. In addition, few cartilaginous supplements help in uplifting the arthritis pain. In addition, injections to the knee to treat arthritis. If there is a loose body condition, then we need to diagnose the condition by MRI. If it causes pain, especially locking the knee, then we remove this loose body outside. Also,doctors treat infection or inflammation with antibiotics or anti-inflammatories. So one must seek a doctor’s advice if it’s paining, swelling and pain, discomfort, and locking the knee. 

Exercise for knee popping

Mild knee crepitus is harmless, and one may take anti-inflammatories, icing, and gentle exercise to heal the pain. Often people are asked which type of knee exercise may help in this condition. As such, there is no exercise, especially for knee crepitus. But yes, it signals the onset of arthritis. Sometimes it may occur as the first symptom of arthritis. Then gentle knee stretching exercises may help in this condition. Collagen and vitamin D  supplement is also essential for the knee. Avoid cross legs sitting on the floor, over-exercise, and scooting. Chronic overuse injury may also cause this condition. So I would advise you to cut down on the exercise and give rest to the knee. 

Knee crepitus and Children | Knee Crepitus Treatment

In a few cases, popping noise comes from the children’s joints. This entity of joints is snapping joints. Under these circumstances, doctors advise parents not to panic. Often parents complain in panic mode that their children’s joints are making noise. It’s harmless. However, some develop the habit of crunching their knuckles but avoid this habit. Knee crepitus is a benign condition. However, one must reduce their weight and keep exercising. In addition, one must include vitamin D in their diet. Beyond that, it is harmless. Keep exercising regularly and have nutritious food. Thank you.

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Apollo Clinic Chandigarh Orthopedic

Calf Muscle Pain Causes and Management | काफ पेन | पैरों की पिंडलियों में (मांसपेशियों) में दर्द के कारण और प्रबंधन

Calf Muscle Pain

Calf Muscle Pain : Causes and Management

In this video, Dr. MS Narula, Senior Consultant Orthopaedic Spine, and joint replacement Surgeon at Apollo Clinics and CHD City Hospital, Sector 8 Chandigarh, talks about common reasons for calf muscle pain or swelling. 

What are the probable causes of calf pain? 

The most common reason for calf pain is muscle cramps in the calf area. And usually, it occurs during some sports activity or any other activity, which leads to dehydration or electrolyte loss. In addition, one may have muscle strain after doing any uncustomized exercise. All these activities might cause soreness in the leg resulting in cramps. 

Nocturnal cramps are one type of calf muscle pain.

Sudden and inclining pain at night is one of the most common indications of calf pain. Under these situations, one should get up from bed and stand. Otherwise, it would take a lot of time to heal. 

Other reasons 

Deep vein thrombosis is also one of the reasons for calf muscle pain. It often occurs in prolonged postures, like on flights. There are clots in the legs, which leads to swelling and pain. In atrial claudication, the arteries carrying blood narrow. It affects smokers more. 

Neurogenic defects:

Another reason is neurogenic claudication. Pressure on spinal cord nerves or in the back causes narrowing of the diameter of the nerve. 

Can diabetes lead to pain in legs?

During diabetes also, nerves get weak, resulting in muscle pain and swelling. In addition, due to chronic compartment syndrome, insufficient blood supply fluid accumulates and causes pain and swelling. 

Which supplements can help in relieving  pain?

Vitamin E in Evion or levocarnitine can help reduce nocturnal cramps. One must keep themselves hydrated, especially during workouts. 

How do you manage acute pain and swelling in the calf?

PRICE is the most effective mode of treatment. P P is protection, and as rest goes like RICE (Rest, immobilise, cold compress, and elevation), Bandage will soothe a bit. With anti-inflammatory medicines, a simple icing, 15-20 minutes 3-4 times daily, can work wonders.

Which type of exercise helps ?

Gentle calf stretching exercises help in relieving the soreness of the calf muscles pain. If you have a tear or soreness in the calf muscles, let it heal, alleviate your leg a bit, consult a doctor, and take some anti-inflammatory medicines.

Reason for leg pain during walking

If you have more calf muscle pain while walking, one needs to rule out the Achilles tendon, the tendon of heels that sometimes gets inflamed. 

Bottom line :

It is a prevalent condition of pain and swelling in muscles. Usually, sports people or people during strenuous activity face this condition. One should always keep themselves hydrated. Lastly, one may follow PRICE treatment.

To know more, watch the full video.

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Apollo Clinic Chandigarh Orthopedic

Water On The Knee Swelling and Pain | घुटने में पानी भर गया है? कारण, प्रबंधन और उपचार? | Fluid on Knee Cap

Water On The Knee

Water On The Knee | Swelling and Pain | Fluid on Knee Cap | घुटने में पानी सूजन और दर्द?

Water on the knee, In this video, Dr. MS Narula, Senior Consultant Orthopaedic Spine and Joint replacement at Apollo Clinic and City Hospital Sector 8 Chandigarh discusses some common reasons for knee swelling and ways to manage it. 

What is knee swelling?

It is a condition where there is an accumulation of fluid around the knee which we call knee effusion in medical terminology. It is a common problem that affects all age groups. 

Most common reasons for knee swelling | Water On The Knee

Injury is the most common reason for knee swelling. It can be acute trauma or a chronic overuse injury. In addition, an underlying condition like arthritis or bleeding disorder is possible. In some cases, there can be a fracture or internal bleeding disorder. Hence, the damage which occurs because of injury causes swelling. 

Reasons for knee swelling without injury | Water On The Knee

If there is no injury, there is always a possibility of over-repetitive damage, like sitting in the wrong posture for a long time. Such conditions lead to microtrauma or minor injuries to the knees. 

What leads to fluid accumulation in the knees?

Continuous minor injuries lead to the pooling of fluid. One indication of any lingering micro-injury is whenever fluid accumulates in the knee. In some cases, there are underlying conditions like rheumatoid arthritis or type of arthritis in young people or middle age. 

Osteoarthritis | Water On The Knee

One type is osteoarthritis in aged people, in which the inflammatory swelling occurs due to a tear of knee joints. It might come at the backside of the knee or Becker cyst in a few cases. 

Can poor clotting mechanisms lead to knee pain?

Bleeding disorder or poor blood clotting mechanisms can lead to knee pain. So in these cases, there is blood somewhat then fluid around the knee, which causes swelling. 

How do we manage knee swelling? | Water On The Knee

Of course, when there is an underlying condition, like on diagnosis, if one has arthritis or injury, doctors need to address it.

Steps of RICE treatment

Standard and immediate RICE treatment helps relieve pain in knee effusion. In this, doctors’ first advice is to take a rest. Then, immediately stop the exercise causing this knee swelling. The second is to immobilise or elevate it by keeping two pillows below. The third provides compression; one can apply light bandages to protect it and elevate it. By elevating, one can use a pillow; lastly, icing is an essential part. Icing for 15-20 minutes, 3-4 times daily, helps reduce inflammation. 

How to diagnose knee Swelling?

It’s essential to diagnose this condition. Specific blood tests and X-ray helps to diagnose any injury. However, in a few cases, MRI helps to understand the texture of fluid and the presence of any cartilaginous or ligament damage.

Is this a serious condition?

If this is a transient swelling and it’s not painful, then there is nothing serious in it. It’s just that one should diagnose it. But it’s serious if there is redness or infection with a fever. However, one always seeks a proper diagnosis from the doctor. 

So can we exercise or massage? 

Apart from RICE treatment, anti-inflammatory medicines also help in reducing inflammation. One can do gentle exercises like walking or leg stretching. Doctors advise doing only light activity. Avoid excessive folding of knees like sitting cross leg on the floor, gently locking—gentle massage, not deep tissue massage. One can always opt for a soft massage with icing.  

Will it go away on its own?

It would go away on its own. See, this is the most common query among the patients. But, if there is swelling because of increased uric acid or gout, then if we reduce uric acid, swelling will reduce automatically. So if we treat these underlying conditions, this swelling will subside. But it will heal in time with anti-inflammatories. 

What is Joint Aspiration?

It is a procedure to aspirate out the fluid in the knees. Doctors perform this procedure when the swelling is very intense and painful. It is also known as arthrocentesis. But repeating the needle for aspiration is not advisable.

How often can one go for Joint aspiration?

Often, we see patients say that they have their swelling every 2 or 3 months, and the doctor aspirates the liquid out with the needle. But this is not advisable. It increases the chances of inducing infection. So in this procedure, doctors only reduce the symptomatic pain, remove the fluid, and apply a compression bandage.

Advantages of joint aspiration

It has two advantages: the extended joint capsule gets relaxed, and the pain is gone; secondly, we can test the fluid for any infection, like uric acid or arthritis. So this joint fluid examination also gives a clue about the knee condition. 

Which treatment is better: Icing or heat compression?

When there is acute swelling, especially during injury, a swollen joint, or a fall, you must do icing for the first 2 -3 days of RICE treatment. After that, it would significantly reduce the swelling and, therefore, the pain. Icing for 15-20 minutes, 4-5 times daily, reduces swelling and pain. 

Heat compression | Water On The Knee

If there is a chronic injury that irritates you and there is stiffness there, hot treatment helps because it will increase blood flow in the injured area, healing will be better, reduce the pain as more blood will flow, and reduce the stiffness. So for chronic problems where you want more healing hot compression helps, and if you have pain and swelling, then we must do the icing. So both treatments help, and please don’t get confused over icing or hot compression.

Bottom line : 

Various reasons may contribute to knee swelling and effusion. But one must always seek doctor advice to diagnose this condition properly. Also, RICE treatment with icing helps reduce pain and swelling around the knee area. But if it’s repeating and there is an accumulation of fluid in the knees, one must immediately concern the doctor. 

Thank you

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Apollo Clinic Chandigarh Orthopedic

Neck Pain Treatment | Cervical Spondylosis Treatment | गर्दन दर्द का उपचार? | How to cure neck pain fast?

Neck Pain Treatment

Neck Pain Treatment | Cervical Spondylosis Treatment By Dr. MS Narula | How to cure neck pain fast?

In this video, SimpliHealth expert,  Senior Consultant Orthopaedic Spine, and Joint Replacement Surgeon at Apollo Clinic and CHD city hospital Chandigarh, Dr. MS Narula is talking about neck pain  and neck pain treatment.

Since we have more office jobs and desk jobs, we tilt our heads often to use mobile phones, and we use laptops more, so neck pain has become a very common problem. It is more commonly seen in the younger population, as old as 10-12 years to 50-60 years. 

Neck Pain Causes | Cervical Spondylosis Treatment

In Children 

There are many reasons associated with neck pain. In younger age groups or student life, it occurs because of bad posture. As we see kids bend to read their books in incorrect posture, and we are constantly using mobile phones, so mobile phones have become a common reason for neck pain. They keep their chins below while reading and even tilt their necks toward the telephone when holding it between the ear and the shoulder. So mainly in the younger population, the wrong posture causes neck pain. 

In young adults | Neck Pain Treatment

If we move to alight forwards, then in the office often people work on laptops, file work and bend their neck for a long duration, and after 30-35 years some changes start commencing in the body we see as cervical. But I would like to tell you one thing: cervical is not a disease; it is another name for the neck. So the cervical itself is not a diagnosis. Rather cervical spondylitis is a diagnosis where some age-related changes start commencing after 30-35 years. 

Like in some situations, we call knee joint problems arthritis, so when there is wear and tear of the spine joint, we call this spondylitis. So between 30-35 years, most of us have some changes like cervical spondylitis, and of course, after 50 years, there are degenerative changes inside the body. So these are some broad reasons for neck pain.

WHEN SHOULD WE OPT FOR TREATMENT?

If you are having only neck pain, then there is nothing to worry much but most of the time, what happens is that it commences with the neck and starts spreading towards the arms. 

Next, if we don’t treat it timely, cervical pain starts spreading to the arms and hands, which may lead to dizziness, numbness, and weakness in the hands. 

So, like the spine, the first questions are: 

  • Whether the pain is confined to the neck or has passed to the arm? 
  • Are you feeling dizzy?

If the pain spreads to the arms and the patient complains of dizziness, we take this seriously. In X-Ray, we can only visualize the bony structure, and if the patient has numbness and weakness, we do MRI. 

WHAT ARE THE TREATMENT FOR NECK PAIN?

We treat these conditions mainly by advising them on good sitting posture, sleeping posture, and exercise in the younger population. If the problem persists, pain is going towards the arms, or there is numbness and weakness in the hands, and if MRI shows the presence of a big disc. Like the back disc, there is a probability of a slipped disc. So in sporadic cases, we do surgery. 

Often we treat this condition with injection and physiotherapy. But most patients, especially those suffering from cervical spondylitis, do very well with proper sitting, sleeping posture, exercise, physiotherapy, and anti-inflammatory muscles relaxant. With these, we can heal this condition.

Doctors advice 

The doctor tells the  viewers some are sitting and sleeping postures to avoid neck pain. 

  • The first thing is to avoid looking low while working like I hold my mobile phone rather than watching while keeping it below; hold like this slightly straight and use it. Use it according to your eye level. Don’t bring your chin down; you can move your eyes below but not your chin. Not lifting the chin down is the most important thing to avoid neck pain. 
  • The second thing is that when you are lying down, many people don’t use the wrong pillow. You can use a slim pillow, but when you take a side, use a heavy pillow according to shoulder width and keep it below the shoulder to avoid neck hanging. 
  • Finally, avoid keeping your hand over your head while asleep. If you can do these three things and won’t keep your hand below if you have a heavy pillow around your shoulder, you need two or three pillows, a light for the head, and a heavy pillow. If you follow these tips, you can avoid neck pain to a much greater extent.

How is neck pain diagnosed? 

 For diagnosis, mostly when the patient complains about neck pain, we diagnose this condition by X-Ray most of the time. If it is cervical or cervical spondylitis, an X-Ray shows the required changes. And if the pain is spreading towards the arms and there is numbness and tingling in the hands, we advise MRI to determine the probability of nerve compression. If the patient is feeling dizzy, many patients say they feel dizzy when they do; I would like to add that dizziness can be another reason. 

So we need to rule them out, and if we suspect that it is occurring because of cervical pain, we do doppler, which is a type of ultrasound. It tells us about any vessel damage. So broadly, we do these three tests to diagnose cervical pain.

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Apollo Clinic Chandigarh Orthopedic

Rheumatoid Arthritis Treatment & Symptoms | गठिया का उपचार कैसे करें? How to cure rheumatoid arthritis permanently?

Rheumatoid Arthritis Treatment

Rheumatoid Arthritis Treatment & Symptoms | रूमेटोइड गठिया को स्थायी रूप से कैसे ठीक करें? क्या रुमेटीइड गठिया वंशानुगत है?

In this video, Our SimpliHealth expert and Senior Consultant Orthopedic Spine and Joint Specialist, Dr. MS Narula, is talking about a very common problem, Rheumatoid Arthritis(Rheumatoid Arthritis Treatment & Symptoms) or gathiya. 

You must have commonly seen this disease among your relatives or friends. Since it is a chronic debilitating condition, patients usually get frustrated. As it requires lifelong treatment, the doctor would like to give some information about Rheumatoid arthritis using this platform.

WHAT IS RHEUMATOID ARTHRITIS OR GATHIYA?

It is a chronic inflammation of joints. It is different from osteoarthritis. Osteoarthritis commences with age; there is wear and tear on joints. The patient may have bowel, urine, or viral infection, resulting in arthritis in other conditions or some skin condition. 

There are some criteria for Rheumatoid arthritis. It is chronic; by chronic, the doctor means long standing; in some cases, it lasts life long. There is a chronic inflammation of the joint lining, due to which there are some symptoms that we consider a condition of Rheumatoid arthritis. 

There are some criteria for this 

  1. It affects multiple joints, mostly small joints like fingers, wrist, elbow, feet, and ankle. So this condition involves small and multiple joints.
  2. It can affect both bilateral or symmetrical; it’s not like if you have arthritis, on the one hand, it will not affect the other; it will simultaneously affect both sides. 
  3. There are specific blood markers like RA factor and anti-CCP. These are present in high amounts in Rheumatoid arthritis patients, and 
  4. It may lead to deformities in later stages, majorly in the hands and legs. 
  5. Other clinical symptoms like light or low-grade fever, malaise, weakness, and fatigue are very common and early symptoms of this condition. The patient feels malaise, uncomfortable feeling, weak, and fatigued. 
  6. Early morning stiffness is another very important criterion in Rheumatoid arthritis. Patients complain about stiffness in joints in the early morning. So, there is pain and stiffness, especially in the early morning. If any patients present the above symptoms, we encamp them in Rheumatoid arthritis.

HOW CAN WE MAKE A DIAGNOSIS OF RHEUMATOID ARTHRITIS? 

There are specific criteria for this condition’s clinical symptoms. Usually, we see signs in patients aged 30-60 years. However, there is a variety of Rheumatoid arthritis where it can commence early or late. But most patients are between the age of 30 to 50 years. Females are more prone to Rheumatoid arthritis, and they show symptoms of bilateral or symmetrical joints on both sides. 

Some clinical signs are early morning stiffness in the legs and hands, pain, swelling, inflammation, fatigue, and malaise. In addition, there are some clinical signs like nodule formation on the skin, and if we suspect it is Rheumatoid arthritis, and the symptoms have persisted for the last six weeks; then, we perform a blood markers examination.

Under lab investigation, we screen the RA factor test, but please remember this comes positive in only 80% of cases, and we perform another test which is anti-CCP. So it is very important to understand one thing about these tests.

Often patients come to us and say that their RA factor is negative. See RA factor is not positive in all the cases. There are 20-30% of cases that show negative RA test in blood but are a patient of Rheumatoid arthritis, which we call a seronegative variety of an  Rheumatoid arthritis. So next, we do further investigation to confirm our doubt by doing X-Ray of hands and feet. Erosion of joints seen in X-Ray helps in diagnosis. 

So it is the combination of clinical symptoms, lab tests, and Radiological Features.

WHAT IS RHEUMATOID ARTHRITIS? HOW DOES IT OCCUR? | Rheumatoid Arthritis Treatment & Symptoms

It is a genetic problem. Instead, it is a combination of genetic, hormonal, and environmental issues. We have specific markers or genes present in the blood which causes the autoimmune disorder. Our body has its immunity which fights against germs and infections. 

In the case of  Rheumatoid arthritis, the body generates immunity against its cells. Since it acts on its own cells, we call this condition an autoimmune disorder. In Rheumatoid arthritis, the body develops an excessive immune response against its cells. This immune response attacks the synovial lining of joints and causes inflammation. This response results in pain, stiffness, swelling in joints, nodule formation, and gradually, there is destruction in joints, and ultimately, a deformity stage commences in the hands and legs. 

One very common myth is associated with Rheumatoid arthritis. People assume that Rheumatoid arthritis only involves bones. Please remember that Rheumatoid arthritis is a disease of bones, muscles, connective tissue, and nerves, so much so that it affects the heart and lungs. Rheumatoid arthritis is like diabetes; it is a chronic condition that affects many organs. However, it is marked more commonly in joints and bones.

WHAT IS THE PROGNOSIS OF RHEUMATOID ARTHRITIS?

Rheumatoid arthritis is a chronic inflammation condition. Our purpose is to explain to the patient that we can control this condition, but we can’t cure it. It is just like diabetes; if their sugar is under control, the patient can lead an everyday life; the same goes with Rheumatoid arthritis. 

We can control Rheumatoid arthritis but can’t cure it. Because it is associated with genetic factors. Some risk factors are related to Rheumatoid arthritis like smoking, obesity, patients with a family history of Rheumatoid arthritis, and those who have long-standing problems. So these are a few risk factors, but primarily the prescribed medicines run lifelong. 

This disease does not remain the same, you will not have the same condition for a whole year. Like in the Raining season or winters, or changes in weather, the attack of pain and stiffness in joints comes suddenly. So we call this condition a relapse or flare-up. It can stay low grade for a few weeks or months, or a year, called remission. 

So the treatment of Rheumatoid arthritis runs between this flare-up and remission. This is why we callthis condition a long-standing chronic problem. Also, you that since it is a long-standing condition, people often get frustrated and search for other remedies, which most common is the consumption of desi dawai, which is nothing more than a high-dose steroid. So one should always be cautious. And definitely, one can try other treatments, but you must consult your physician first.

TREATMENT OF RHEUMATOID ARTHRITIS

We treat Rheumatoid arthritis in various categories: physical, rehabilitation, and occupational therapy. 

It commences with stiffness and deformities in joints. So physical therapy remains the mainstay of the treatment. Then comes the medical treatment. We have perfect drugs for Rheumatoid arthritis, but our purpose is not to relieve the pain. However, we wish to make the patient mobile and physically active and prevent the permanent deformities as much as possible or stop their progression. 

So the first line of treatment is pain killers or nonsteroidal anti-inflammatory drugs. We prescribe them during the initial stage of Rheumatoid arthritis, but we abstain from long-term use as regular painkillers consumption imposes side effects on the kidney and liver. So painkillers are the initial and first line of treatment in which we prescribe steroids. We prescribe steroids in low doses, and pulse-like meaning given in breaks are effective in this condition but avoid the consumption of a high amount of steroids. 

Although people take high-dose steroids in desi dawai, it may show its effect like magic, but it would lead to hollowness in bones, and you may suffer from multiple issues. So Steroid, when consumed only in proper doses, is effective for Rheumatoid arthritis.

Medications 

Next are disease-modifying drugs, or DMARDs are the primary medicine used for the sole purpose of preventing deformities in the legs and hands. Different medications, like methotrexate, vasospasm, and Hqtor, were used very commonly in COVID times. So these medicines are quite safe and effective, and we must use them in combination; with at least two drugs so that their side effects are minimal. 

Another thing we must understand today is that the doctor prescribes you the combination drug for Rheumatoid arthritis. However, it may stop showing its effect after a few months, so we need to be cautious and shift to the next level. So we must give drug holidays. We must give a break so that the body can recover from the side effects. And when we use the drugs in combination, these DMARDs are very effective. 

Then we have Biologics. These DMARDs and biologics bring change in the body’s immune response; they act like immunosuppressants so that we can control autoimmune disorders. Biologics are an expensive and stronger class of drugs. We use them widely. Then, of course, we have surgical management. 

Since rheumatoid affects mainly the main joint like the knee or hips, we surgically replace these joints with hip joint replacement or knee replacement. So there are specific indications of surgeries in the late stages of this, but by enlarging the combination of physical, occupational, and nutritional therapy, there are certain foods that we can aggravate so we tell the patient to avoid them. 

Surgical Treatment 

Apart from that, we have surgical and medical treatment whenever required. 

The doctor wants to explain to you about surgeries we perform for Rheumatoid arthritis. Suppose there are deformities in small joints like fingers. In that case, we should prevent them as their surgical correction is not very satisfactory. 

Surgical management comes when there is the involvement of big joints like the knee or hips. However, osteoarthritis also affects the knee. In this condition, knee damage relatively occurs at an early stage, so we need to do knee replacement at an early age group, somewhere between 40 and 50. 

If there is a complete deterioration of the joint and medicines are not giving relief, making you immobile, you should opt for knee replacement surgery. As knee replacement surgery is very successful, it modifies the quality of life. It is bloodless, painless surgery, and wherever your doctor examines that there is a complete deterioration of the knee with, please opt for knee replacement surgery. 

But yes, you must continue with your anti-rheumatoid drugs. This does not only affect bones; it affects muscles, nerves, pins, needles, and tissue, so the drug would help in combating the damage, and wherever needed, opt for surgical options.

Bottom Line 

So, in the end, I will advise my patients that they don’t get disheartened or frustrated because of Rheumatoid arthritis; you need to take long-term medicine for which you must consult your physician. Because when you are in a flare-up, there is an increase in the dose of medication. 

Otherwise, we maintain this with one or two drugs. Be cautious while consuming desi dawai as it has a high amount of steroids. Patients must continue their physical rehabilitation therapy, and a nutritional diet. Avoid smoking. Patients must take care of regular medicine and monitor their side effects simultaneously.

Thank You. Take care and stay safe.

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Apollo Clinic Chandigarh Orthopedic

Total Hip Replacement Surgery | टोटल हिप (कुल्हा) रिप्लेसमेंट सर्जरी पूर्ण इलाज

Total Hip Replacement

Total Hip Replacement Surgery and its types by Dr. MS Narula 

In this video, SimpliHealth expert,  Senior Consultant Orthopaedic Spine, and Joint Replacement Surgeon at Apollo Clinic and CHD city hospital Chandigarh, Dr. MS Narula is talking about total hip replacement surgery and it’s types. 

This procedure is known as kulhe (the hip joint) replacement surgery in a more familiar language. It is unique and challenging because unlike knee replacement is a very common surgery; everyone is aware of it. But hip replacement surgery is slightly rare as compared to knee replacement. We see it more commonly in younger age groups than knee replacement. There are a few challenges to the longevity and efficiency of this procedure. 

So today, the doctor discusses some developments pertaining to this topic. Our hip joint is like a ball-socket joint. This socket is mobile in the joint and is comparatively a strong joint. It is also like the knee and ankle weight-bearing joint and is a central axis of our body weight. Some reasons leave us with a choice of hip replacement. As I told you, hip replacement surgery is less common in comparison to knee replacement, and it occurs more in younger age groups. That’s why we face a few challenges during this surgery. 

WHAT REASON COMPELS US TO GO FOR HIP REPLACEMENT SURGERY?

Fracture in elderly people | Total Hip Replacement Surgery

One reason is injury or trauma; more commonly, we see the aged 40-50 have fractures near the hip joint. Furthermore, we can’t construct the fractures with the aid of implants or screws, or after a particular age, we opt for hip replacement. Another thing is if we have any old pelvis or acetabulum fracture that we could not reconstruct appropriately and is causing trouble now. So trauma is one of the main reasons. It can be an old injury or a fresh injury. 

Wear and tear of the hip joint 

The second is the wear and tear of the hip joint, like the knee joint. This condition is called osteoarthritis, and it is one of the indications for hip joint replacement. Finally, at a younger age, we see avascular necrosis. In this condition, the ball of the ball-socket joint becomes dead for some reason; there is a complete loss of blood supply to this joint. 

Lifestyle choices 

Many factors contribute to this condition, like alcohol, smoking, and intake of steroids, and in 80-90 percent, it occurs without any reason. In the younger age group, in their mid 40-50 start feeling pain in their hip joint, and after diagnosis by X-Ray, we infer that there is a loss of blood supply to that joint. 

So when the joint is dead, we suggest hip replacement surgery. There can be other reasons like infection and some diseases like arthritis, but broadly these are the most common reasons to opt for hip replacement surgery.

TYPES OF HIP REPLACEMENT SURGERY

Hip replacements are of two types: 

  • One type is a partial hip replacement or hemiarthroplasty, and 
  • Another type is a total hip replacement in which both ball and socket

As mentioned before it is ball and socket joint, so sometimes we only require to replace the ball, but it is scarce. Mostly we replace both the ball and socket joint. This type of replacement is called total hip replacement. This is how hip replacement in the younger population is done. 

Unlike previous replacements, which don’t stay for much time, only 10-15 years, the patient takes time to walk. But with the new advances, we make small incisions for surgery which is more commonly known as minimally invasive procedures. It is bloodless, painless surgery, and we make patients walk the next day after surgery. 

Different varieties | Total Hip Replacement Surgery

There are different varieties in this, like whether it is replaced by cement or not. In younger age groups, we prefer uncemented replacement because it is comparatively more straightforward if we need to change it after 15-20 years. 

These days we insert big-sized balls in ball-socket joints, and there is a change in the quality of metal that we use these days to increase the life of the hip by 25-30 years. 

New advancements 

With the new advances, this surgery has become very successful, a minimally invasive, bloodless, painless procedure. A patient can resume their regular activity within one month to 45 days. Hip replacement surgery is a very successful surgery if done timely. One more myth that I want to clear regarding hip replacement surgery is that earlier, people used to think that after surgery, they couldn’t sit on the floor or cross their legs. 

New techniques and implants 

As the doctor mentioned, they do this in the younger population, and with the newer techniques and implants, one can do all their activities like sitting on the floor cross leg and can do other similar work. You won’t face any problems in nearly 25-30 years. And God forbid if we need to change it again, it can change quickly. 

Thank you

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Shoulder Dislocation Treatment Surgery | कंधे की हड्डी खिसकने का उपचार

Shoulder Dislocation Treatment

Shoulder Dislocation Treatment Surgery

In this video, our SimpliHealth expert, Dr. MS Narula, Senior Consultant Orthopedic Spine and Joint Replacement Surgeon at Apollo Clinics and CHD City Hospital, Sector 8, Chandigarh, is talking about the traumatic injury: Shoulder dislocation. He also explains the shoulder dislocation treatment surgery. 

Mostly we see it in younger people with a history of falling; it could be an accident or any fall or very common in sports injury; often, sportsmen say they had shoulder dislocation. The patient comes to go to the doctor with intense pain and a frozen shoulder (inability to move). 

Usually, they come go to the doctor in an emergency by supporting their arm with another hand, keeping it a little farther from the body and slightly tilted upwards.

TYPES OF SHOULDER DISLOCATION | Shoulder Dislocation Treatment Surgery

Anterior dislocation

There are two most common types of shoulder dislocation: anterior dislocation, seen in 90% of cases. Anterior dislocation means our shoulder joint is like a ball-socket joint, so when this ball comes towards the front, the doctors call it anterior dislocation. 

Posterior dislocation

And if this ball moves backward, leaving the socket behind, which we call this posterior dislocation. This ball may sometimes move towards the bottom (inferior), but we often see anterior dislocation followed by the posterior and inferior. As Dr. Manpal mentioned, it usually occurs due to an injury which could be due to an accident or fall or sports injury, and the patient has severe pain. 

Anterior dislocation is a more common type of dislocation after an injury or fall, whereas posterior dislocation is rare. It usually occurs after convulsions, like if the patient has an epileptic fit or ECT therapy, their arm moves inside for any reason. 

So the ball rolls towards the backside, which we call posterior dislocation. Clinically patient comes to us with severe pain, unable to lift their arm, and the shoulder becomes slightly flat as the ball comes towards the front. If the patient is very lean, we can easily visualize the ball coming out in the front.

Diagnosis 

Usually, patients present their arms like this. It is a severe condition. So in an emergency, when we see the patient after an injury or fall, the first thing we do is manage the pain by administering a pain killer, and then we go for an X-Ray scan. There is a clinical test in which we can diagnose anterior dislocation quickly since they cannot touch their other shoulder.

The patient cannot move their twisted hand, so clinically, when we see a condition where the patient cannot touch the opposite shoulder, we suspect it could be shoulder dislocation. In X-Ray, we can visualize the dislocation of the ball from its socket. And then, we plan for treatment.

TREATMENT OF ANTERIOR DISLOCATION

In 90 % of the cases, we perform a close reduction. By that, I mean we fix it with particular maneuvers, but here I would like to request you to please visit your orthopedic surgeon because I often hear patients saying they had a shoulder dislocation, went to quack, and healed it.

Sometimes there is no dislocation. Instead, it is soft tissue injury, but quack people interpret soft tissue injury as shoulder dislocation and treat it. So please beware of all this. I want to caution you all about this. Whether you have an injury, it could be a rotator cuff or any damage, they visit the quack, consider everything as dislocation, and treat it accordingly.

But this is very untrue. A shoulder dislocation is an acute event; it’s not like it occurs without reason. There is always a history of injury or fall, or trauma. We can diagnose shoulder dislocation by X-ray. Once we diagnose it, we make a closed reduction. We perform this procedure under anesthesia, and there are some maneuvers, and we stretch retraction or press our foot over the armpit and pull the arm. you can reduce it with a click. It’s a 15-20 minutes procedure that the doctor performs under anesthesia.  

Then we tie the patient’s arm with the chest for 3-4 weeks. So this treatment works in 90-95% of cases. First, we immobilize the injured arm. In scarce situations, it doesn’t reduce; then we plan a surgery. We do open reduction surgery in which we make an incision and fix the ball in a socket. If the patient comes to us at an early stage in the first 4-5 days or roughly 2-3 days, we can heal it by closed reduction. Only if the patient comes to us very late or the patient is very muscular or obese then the ball doesn’t fix in the socket on its own. 

COMPLICATION OF SHOULDER DISLOCATION

There can be some fractures associated with shoulder dislocation. As I mentioned earlier, it’s a ball and socket joint, and when there is dislocation of the ball, there is a tear in nearby ligaments, muscles, soft tissues, and capsules. Only then the ball would dislocate. Otherwise, it is a solid joint wrapped firmly inside muscles and ligaments. So there can be an injury to muscles and ligaments. 

Along with this, there can be fractures in some portions of the ball. There might be fractures in the cup. But most of the time, these fragrant fractures heal on their own when we fix the ball into the socket. Again under these circumstances, we don’t require surgery after reduction.

When we do an X-Ray, we see the ball inside the socket. And the part of the fracture has come back to its original position. So most of the time, surgery is an option. 

But we operate in some cases where the fracture doesn’t sit in its original place. Or the dislocation does not reduce.

 WHAT IS THE COMPLICATION OF ANTI-DISLOCATION? | Shoulder Dislocation Treatment Surgery

  1. When there is unreduced dislocation for whatever reason, we are unable to reduce the dislocation. 
  2. When there are fractures associated with a dislocation. Under these circumstances, we need to operate it to fix it. 
  3. Recurrent dislocation, which we often see in our OPD practices. Often we hear patients saying that they had shoulder dislocation 2-3 years back. And it gets dislocated again after one year while doing some particular activity. 

Further, they complain of repeated dislocation about 3-4 times. And if they take their hand towards the backside like combing hair or picking something from above, there is dislocation. The shoulder gradually starts to dislocate with minimal force. So they always feel that either there is a dislocation or they have the feeling that the shoulder will fall. 

So the doctors call this condition a recurrent dislocation. It is a prevalent complication. And it often occurs when we don’t immobilize it adequately with a splint during the first incidence of shoulder dislocation. The primary purpose to use splint is to heal the soft tissues adjacent to the joint. If we don’t immobilize it for enough time, then shoulder dislocation turns into recurrent dislocation. 

And please remember that once the doctor labels your shoulder injury as a recurrent dislocation. You will require the need of surgery. We have a perfect surgical option for this. These days we repair it with arthroscopy with the help of an endoscope. It gives good results, especially in athletes who require an excellent functioning shoulder. 

So recurrent dislocation is widespread, and we can treat them with arthroscopic repair, which yields good results. Please don’t ignore these injuries whether you need closed reduction or operative.

Consult your orthopedics surgeon when you have an injury and must go for a follow-up. One must follow Post-operative rehabilitation and physiotherapy very regularly and carefully.

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Sprained Ankle Treatment | एड़ी टखने की मोच का इलाज पूर्ण उपचार | Management, Recovery Time & Ankle Ligament Surgery

sprained ankle treatment

Sprained Ankle Treatment | एड़ी टखने की मोच का इलाज पूर्ण उपचार 

In this video SimpliHealth expert Dr. MS Narula, Senior Consultant Orthopedic Spine and Joint Replacement at Apollo Clinic and City Hospital, Chandigarh, is talking about ankle sprain (एड़ी में मोच), its management, recovery time and sprained ankle treatment. 

Our experts talks about the most missed entity, a Muscle tear. People oftent miss it because often, thay ignore this condition; and the ankle ligament injury is not correctly diagnosed. And more importantly, we either overlook its treatment or treat them wrongly, and a few times, there is a delay in treatment. So it’s a nagging injury that may seem harmless, but it is not very pleasant. And it may last for years.

Almost every day, patient come in with a twisted ankle. They say they twisted their ankle six months ago, but now they are having muscle tears, swelling, and pain. The ankle has become unstable, which might irritate the patient for years. That’s why it is a missed entity. So we call this condition an ankle sprain. 

WHAT IS AN ANKLE SPRAIN? | Sprained Ankle Treatment 

The Ankle sprain is a ligament injury. Ligaments are soft tissue, but these are our elastic and intricate structures that connect our bone to another bone. We call them ligaments. And they hold significance in the legs because they connect our leg bone to the ankle. As you can see in this model, here is our foot, and this arrow is our leg. These ligaments connect our legs to our ankle and hold great importance; since they provide movement and stability to the ankle. 

A tear in a ligament happens to be very painful for the patients. Most patients come to us and say that they twist their ankles while walking on uneven surfaces or women wearing heels, and this condition is very common in sports. 

Complete or partial ligament tear 

As mentioned earlier, ankle sprains occur when you miss your step while running, jumping, and skipping. Also, we twist our ankles while climbing the stairs upwards or wearing heels. So the ankle twists slightly inside. So all these things lead to slight movement of the ankle towards the inner side. And when they twist inside, there is a tear in the ligaments. 

It can be a partial or complete tear or a simple sprain. So as mentioned, these are the elastic structures that contract, but if we stretch beyond the limit, they will break. It will allow movements like a rubber band, but it will break if you try to push beyond its limit. Similarly, a tear in ligaments is commonly called an ankle sprain.

HOW CAN WE DIAGNOSE IT?

Often patients with twisted ankles complain that they have sore ankles, difficulty in putting pressure, and there is swelling outside the ankle. Naturally, they are in much pain. 

Unfortunately, we can’t visualize these ankle sprains or ligament injuries in X-Rays. Only bones are visible in X-Rays, due to which these injuries are either ignored or overlooked. Often patients get X-Rays from local areas, and then they say that the X-Ray doesn’t show any bone injury. They think it is not a big deal if we do not have any bone injury. 

Please note that the ankle or knee is our weight-bearing joint, and this ankle is a tiny joint that has to bear all the body’s weight throughout the day. The ligament delicately balances the ankle joint. If there is an injury in the weight-bearing joints, it will hurt more than the fracture. Fractures may heal, but the damage to the ligaments is bothersome. After ligament injury, please don’t sit at home.

The doctor usually applies crepe bandages for two days, thinking it will be fine and the patient can go back to work. Untreated ankle sprain might irritate you for months to years. What you do in the first three weeks matters the most. We mostly don’t need an X-Ray, but we advise the patient for an X-Ray to rule out the possibility of a fracture. So this is a clinical diagnosis where we examine the patient’s activity, ankle movement, and whether there is a complete tear or a partial tear. Ligament injury is a clinical assessment, and an X-ray can’t diagnose this condition. After diagnosing an ankle sprain, the second step is its treatment. 

ANKLE SPRAIN TREATMENT | Sprained Ankle Treatment 

The treatment depends on the extent of the injury and whether there is a partial or a complete tear. How much is the pain and swelling at the same time? Remember that you must follow RICE treatment wherever there is a muscle tear, or you have some injury. If we follow RICE treatment for initial 24-48 hours, all the symptoms will reduce. R stands for Rest, I for Icing, C for Compression, and E for Elevation. 

After any muscle injury or similar injury, you may start RICE treatment by yourself within 24 hours of injury before coming to the doctor. RICE treatment will reduce the course of injury and symptoms. It is necessary to rest in this, and if your ankle is hurt, then the only way to relax is to either sit on the bed or rest on the chair so that it doesn’t bear the body’s weight. 

As mentioned before, I stand for Icing; it is the most critical factor to reduce your pain and inflammation. No amount of pain reliever can help you ease the pain compared to icing. One should do icing for at least 48-72 hours. The next question is how long we should do the icing.

HOW LONG SHOULD WE DO ICING?

One should never apply direct icing to the injury. You can either use ice wrapped in cloth or ice packs readily available in the market. Direct ice application may cause skin burn, so you must use ice packs or ice wrap in cloth for 10 to 15 minutes, and repeat this four to five times. You can do it six to seven times on the first day of injury. 

Otherwise, repeat for 4 to 5 times for 10 to 15 minutes; you will get much relief. As mentioned, R stands for rest, I stands for icing, and now C stands for compression; otherwise, we can also use a splint. 

Usually, the patient may apply a crepe bandage after injury before going to the Doctor. And they can use braces too. E means Elevation. The more we keep the ankle elevated, it will reduce the swelling. The idea of ​​​​elevation is to keep it above the level of the heart. You can keep two pillows below the ankle. So if you do all these things for 48 hours, it can shorten the symptoms upto a great level. 

WHEN SHOULD WE SEEK THE DOCTOR? | Sprained Ankle Treatment 

Ideally, you shouldn’t ignore any ankle sprain. As the doctor said earlier, this is a missed injury. You must always consult a doctor. Initial treatment will remain the same, i.e., RICE which we can do at our respective homes. In today’s era, we treat ankle sprains just like fractures. We advise the patient to take a plaster because we need to immobilize it. 

Like instructed, I in RICE stands for icing, but there is immobilization also. If you broke something, then it is necessary to keep it in one place; if the same thing keeps on moving, if you keep putting on weight, then an injury that would cure in three to 4 weeks might take 3 to 4 months to fix and  even longer. Either you can use a brace or ankle splint.

In most cases, the doctor does recommend plaster for 3-4 weeks. And these days, there are fiber cast plaster which allows a little weight so we can even walk easily with the help of a walker. So if you do all these things, you can treat ankle sprain to a much greater extent. 

HOW LONG IS THE ANKLE SPRAIN RECOVERY TIME?

It depends on the muscle tear; is it a partial or complete tear. According to the doctor, we can’t diagnose ligament injury by X-ray. However, you can interpret this by MRI, but there is no need to do MRI in every case. At first, the doctor does plaster, but if it is not working, the pain has not receded in the first 3 to 4 weeks, then he feels that there is a pervasive injury in which the ankle has become unstable. 

Then the doctor does MRI, but the MRI is not required as much. These ligament injuries heal in a few weeks if they are partial or minor injuries, but it may take more than three months or even years to recover. For three months, you have to take care of yourself; even if the plaster is removed, you need to take care of yourself, walk properly, and exercise. 

WHAT IS THE FUTURE TREATMENT? | Sprained Ankle Treatment 

When we put plaster for 3 to 4 weeks, it is not that we can immediately put weight on it; we advise them to do gradual strengthening exercises. Just like I gave an example of a rubber band. While stretching, we break the rubber band; then it will recover in an extended position; if it does not get the rest, then our rubber band will remain loose; so the same thing happens with our ligament. 

If the ligament remains loose, they either will not join again or might join in an extended position that will be painful. So this type of ligament will lead to two things: pain or swelling, or the ankle will remain unstable and may twist every 2-3 weeks. So after we remove the plaster, you should do some ankle strengthening exercises to avoid this recurrent ankle twisting.

WHEN DO WE NEED THE SURGERY?

Only 2% of the cases require surgery for an ankle sprain. However, where there is an extensive ligament tear or ankle stability, even after plaster and exercise, the pain is not receding, then we recommend surgery in 5% of cases. 

But in most cases, it can be healed by the RICE treatment followed by plaster and exercise. So please don’t ignore your ankle sprain; we can cure it very well if it is treated well in time, and anytime you feel that there is a muscle tear, you must seek the  Doctor who will advise you correctly. Follow their advice.

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Fracture Treatment In the Elderly People | बुजुर्ग लोगों में फ्रैक्चर का उपचार

Fracture Treatment

Fracture Treatment In the Elderly People | Fractures in elderly patients

Fracture treatment in the elderly people, In this video SimpliHealth expert orthopedic doctor Dr. M.S Narula is talking about Fracture management in elderly people. Also, he is talking about

  • When do fractures occur in older people?
  • What are the problems, and how do we treat them?

As you know, our life expectancy is increasing with every passing year. So the population of older people is also growing, as the percentage of elderly people is rising, so we have to deal with old age-related problems. As an orthopedic surgeon, the most common and most challenging situation that comes into our practice is fractures in elderly people.

How are the bones in elderly people, and what are the challenges we face? | Most Common Fracture Type In Elderly | Fracture Treatment In the Elderly People

When we talk about their bone health, especially when they are 55 or 60 in women and after the age of 60-65 in men, their bones get osteoporotic. Our experts mean bones become more fragile by osteoporosis, and their bone mass reduces. Eventually, they become soft. Due to softness, the bones break off easily. Hence, they are more fragile at a certain age and more delicate, so there is always a fear of breakage. So whenever there is slight trauma or an accident like foot slips, there is a fracture, especially around the hips. As you must have heard often, there was a little foot slip and a fracture in the hip, fracture in the wrist or spine, so they have fragile bones which break off easily.

CHALLENGE 2 | Fracture Treatment

Second, what happens when we operate on them naturally because their healing power is low? As (our experts) said in the first lecture, how efficient bone connecting will depend on the healing power of nature and how robust their bones are. So, naturally, the healing process is slow in the case of weak bones. That’s why the fractures take more time to heal in elderly people, and their healing is slow.

CHALLENGE 3

Third, when we operate on them by putting any plate, screw, or nail, due to weak bones, there is always a fear that the nail or screw will back out. Like (our experts) give you an example, there is a wall, and (our experts) we put a nail on it. If that wall is hollow from behind or weak, it will come out whenever you hang something on that nail. So, in the same way, the bones are so soft that if we do surgery, there is always a fear that nails or plates will come out before healing in the bones.

CHALLENGE 4

The fourth challenge is that they always have one or another medical condition like a heart problem or sugar or a problem with blood pressure, making surgeries more challenging. Also, there are problems giving anesthesia to them. So there are a few challenges that we face in elderly people. But remember, our emphasis is on providing mobility to the old people who have fractures. So they should be able to stand or move on their own as soon as possible. Because if they keep lying in bed, their osteoporosis will get worse.

Do we need surgery for fractures in the elderly? | Fracture Treatment

So in all our practices, our emphasis, especially on elderly people who have a fracture, is to make them stand up early and use their body parts. This could be possible with good surgery. Like (our experts) told you before, our primary emphasis is that fractures heal as early as possible. The second thing is we prefer to join limbs in the normal position. So that the patients are in a mobile state and use their limbs as early as possible, so for this, we like to operate on these fractures. Few fractures don’t require hairline treatment. However, we do provide them with plasters. But we try to operate in most cases since the healing rate is very low in elderly people. So in this, as (our experts) told you before, giving anaesthesia is one challenge, so we need to control BP and sugar as much as possible before any surgery. 

TREATING FRACTURES IN ADULTS | Fracture Treatment

It is a multidisciplinary approach for elderly people. We must operate on them where all the disciplines are available like a cardiologist must be on standby, a reasonable anesthesiologist, and one must have a nice ICU unit. Even God forbid, all these specialists should be at hand if there is any complication. So elderly people (our experts) will always insist that if they are going through any trauma fracture surgery or any other surgery, they should select a hospital with all the disciplines, especially a cardiologist and intensive care unit. So this is the first challenge that we should operate in an atmosphere that caters to all these specialties. 

IMPLANTS USED FOR FRACTURES IN ELDERLY

Now we will talk about the implants. Now we have specialised orthopedic implants for trauma cases. As (our experts) told you before in a previous lecture, these are locking plates. If our bones are weak and we use standard plate screws, they will back out. So these days, we have special screws and plates for trauma and elderly people. These plates have a locking mechanism inside them, which locks the screw into the plate so that it doesn’t come out. So what happens with this? There are fewer chances of failure of implants. As (our experts) said, whenever there is a fracture, whether it’s in the spine or hip or hollow bone or bone with no strength in them. For this, we have artificial cement, which we put inside the bone and then implant or screw in the bone so that the hold of that implant increases.

Hip Fractures Among Older Adults

Then again, as (our experts) told us earlier, today we use nails. Like if there was a hip fracture earlier, then we put a plate, but nowadays, we have these specialised nails that we use, especially in hip fractures; there are long nails available. (our experts) emphasise this hip fracture because this is the most common fracture in elderly people. And if we don’t operate, the situation may worsen if left in bed for more than two months. 

Why is opting for surgery important in older patients?

(our experts) always advise my patients, even if it has a bit of high risk, please opt for surgery. Because of this beauty, we can make the patient walk on the very next day, and it is possible only with these new implants. So these are unique nails that we insert by giving a small incision around the hip and locking it. The purpose of these nails is to make the patient able to stand the very next day. Also, we do small incisions. The use of nails in hip fractures, especially for elderly people, is one of the most significant advancements for orthopedic trauma.

Bone graft

And another thing (our experts) would say is that God has given us something that works like Stepney is a bone graft. So even in young people whose fracture is old, more than three weeks old, or in elderly people where we know the bones are less intense and fracture won’t last with plates or nails, we take a bone from where we tie our belt; there is one bone there called an iliac crest. 

The procedure of bone graft 

From the iliac crest, we take tiny slivers of bones and put them with the fracture along with nails and plate, which enhances the ability and speed of bones to join. So these are called bone grafts, and we use them when we anticipate a fracture that heals slowly. And at three months old, fractures, so the bone graft is the big savior in these situations. So there is some advancement in this field of bone graft. We have some artificial bones that we mix with the natural bones and put in the fracture.

Bottom Line

So friends, as (our experts) told you, the management of fractures in elderly people is quite a challenge. Still, with the new techniques and implants and with the aid of a multidisciplinary approach, it is a very safe surgery. And wherever possible, we should opt for surgical options keeping all the risks in mind. But if the surgery is well done, with an experienced hand, we can give a new bone of life to the elderly people who need to be on their feet as early as possible. So stay safe, stay healthy.

 Thank you

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Fracture Management In Children | छोटे बच्चों में फ्रैक्चर का उपचार | What are the types of fractures? And how are they managed?

Fracture Management In Children

Fracture Management In Children | छोटे बच्चों में फ्रैक्चर का उपचार | फ्रैक्चर कितने प्रकार के होते हैं? | और उनका उपचार कैसे किया जाता है?

In this video, SimpliHealth expert orthopedic doctor Dr. M.S Narula is talking about fracture management in children.  

  • How are these fractures managed? 
  • What are the types of fractures in children? 

How are fractures in children managed?

Fracture management in children, As you all know, children are pretty mischievous. They play here and there, and sometimes it gets complicated to save them from any injury. But as a parent, if we think this type of injury requires doctors’ treatment or it seems they might have a fracture, we must seek doctors’ advice. Children less than 15 years old have different bone structures compared to adults. Children’s bones are relatively soft.

Like a branch of a tree, if we bend it, it breaks. And the bones in children are like the soft green ones, which do not break completely when bent. So children’s bones are very soft and pliable. And they are half cartilage and half bones. Since they are growing, they have more soft tissue cartilage, and the maximum we miss such cartilage Injuries in children. 

So they are harmful because of certain other factors, but they are less dangerous because of other factors. So today, we will talk about pediatric fracture and how we deal with it.

Children often come with pain and swelling with a history of falls while playing. And very young can’t tell exactly where it hurts. Under these circumstances, we have to interpret their actions like we can diagnose where they are swelling and pain. If it’s on the leg, they cannot put weight on it, and if it is in the hands, there will be swelling, and obviously, the child won’t be able to use that area. So the first thing we advise the parents to do is X-Ray. If the fracture in the cartilaginous part is not visible in X-Ray, mostly known as epiphyseal injury. 

We usually miss these injuries, so to avoid missing these injuries, we often perform the XRay of the opposite arm because the growing end of children often seems like a fracture and is often overlooked. To avoid this, we do complete the X-Ray of the opposite arm. In a few cases where we can’t see the fracture, we opt for an MRI. But mainly, we can interpret the kind of fracture by X-Ray. And like I said, sometimes we need to do an X-Ray of both sides.

WHAT TYPE OF FRACTURE OCCURS IN CHILDREN?

One is buckle fracture with no crack; however, it bends slightly. Another one is greenstick fracture, in which it bends and barely breaks, so it’s an incomplete fracture. There are other known fractures. There are some known areas among children, like when they fall, they fall on their palm, so there is a fracture in the forearm which could be a green stick or complete fracture. Again a prevalent fracture occurs around the elbow, more commonly called a supracondylar fracture. The child falls with the outstretched hand with pain or swelling around the elbow. In the leg, fractures are common in the leg bone, thigh bone, or middle ankle leg, and if there is a significant fall or accident, then thigh bones may crack too. So we mainly diagnose these fractures by X-Ray; in the rare case, we opt for MRI. 

Fracture Management in Children: HOW DO WE MANAGE CHILDREN’S FRACTURES?

The good thing about children’s fractures is that they heal efficiently and fast. This is because children have a high capacity for bone healing. In adults, when we heal fractures, our prime aim is to connect the bones either by plaster, nails, or plates. In children, if the bone is lying distant, it still heals, so healing is faster and is much quicker. This factor quite favors the children. That’s why most fractures can be managed with simple plaster unless it is a buckle or incomplete fracture. Then, we put plaster in the same positions to have less or no pain and swelling.

Within 3 to 4 weeks and in some cases in two weeks, the bone heals, and we don’t require any further treatment except for plaster. In a few cases where fractures are displaced a lot, as I told you, their bones heal faster, but one thing you should keep in mind is that even if they lie distant, they will recover but if we allow them to heal in the wrong position it could result in deformity. 

Like if the fracture in the leg, there can be an overriding of bones, bones will heal; however, a similar thing is not possible in adults, but there will be shortening of legs, and of course parents nowadays are very anxious, and in children also it is certainly not acceptable. In some cases, if it heals in different angulations, the bone might recover in the crook position, which is also not permissible by the parents. 

But I would like to tell you that some sort of angulation is acceptable because there is remodelling in bones as they grow. The crooked part automatically heals in the correct position to some extent at right angles. They remodelled themselves. This angulation is not visible in the thigh bones, where there is muscle mass. 

In a few cases, it might generate a cosmetic problem, but it doesn’t cause many problems in children. The main problem is when we miss injuries like epiphyseal injuries, which usually occur around the joint made of half cartilaginous and bones. If we can diagnose it correctly, sometimes we may need an MRI. Since it’s a joint fracture, we need to set it in its normal position. We don’t require an incision, but we fix it by putting some wires with the minor surgery. We can pull these wires after 3 -4 weeks. So in a few cases, we need to operate, especially when there is epiphyseal injury or injury around the joint or a displaced fracture; bones are lying in an unacceptable position, and we operate under these conditions. 

Most children can do very well with the plaster. However, there is a word of caution that some children can’t express their issues with plasters, like if it’s tight or they are having some problems, so as an orthopedic surgeon and as a parent, you have to be very alert. An adult may tell you that the plaster got wet, painful, or tight. However, in children, we need to be alert that there are no blue fingers, the plaster is not tight, and sometimes children put coins or something else inside the plaster to itch, so we must take care of all these things since they are different than in adults. We can open plaster after 3-4 maximum six weeks, start the exercises, and injuries in children heal very well.

The only problem is that we miss them, but we diagnose them appropriately. You should be very careful and immediately rush children to the doctor because the bones heal very fast, and if they recover in the wrong position, it limits the option for doctors. So friends, look after your children, be alert towards children, and whenever you feel the need, please go to a nearby orthopedic surgeon and get treated accordingly.

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Types of Bone Fractures | Which type of fracture requires surgery? | किस प्रकार के फ्रैक्चर के लिए सर्जरी की आवश्यकता होती है?

Types of Bone Fractures | Which type of fracture requires surgery? | किस प्रकार के फ्रैक्चर के लिए सर्जरी की आवश्यकता होती है?

Types of Bone Fractures | What fracture requires surgery?

In this video SimpliHealth expert orthopedic Dr. MS Narula is talking about Which types of bone fractures usually requires surgery?. So a very important question patients ask the orthopedic surgeon is. Which types of bone fractures to operate on and which fractures we can manage non-operatively. As our experts told you, we emphasise using the limb as early as possible, or they can stand. If we keep the plaster, the fracture may join in two to a half months, but it might lead to stiffness; the patients can’t do their work. So nowadays, we fix it. But there are some fractures in which we recommend surgeries if it is a joint fracture.

  • Closer to the joint or involved: Maybe it is a knee or shoulders joint. 
  • Joint fracture: We wish it fixes like a normal surface joint like a ball and socket.
  • Smooth: It will work well; otherwise, if it’s connected in the wrong way, it will irritate us later and lead to early arthritis. It will heal but will irritate. In that case, we advise the patients to opt for surgery. 

Let us get all the pieces together whatever we can do, and as much as possible, we call it fixing in natural alignment. It has two advantages: one, they can use their limb and restore its natural function as its shape would be normal, and very importantly, the patient’s function will be much more satisfactory than the plaster. So in these intra-articular fractures that involve the joint surfaces, one should always operate on them. Although they will unite without fractures, the results of fixing it, with operative management, are much better than not fixing, which is a conservative method. This is my advice to all of you.

NAILS OR PLATES 

And the other thing now that we have shifted from the use of implants to screw nails. As you may have heard before, hip fractures are very common in old age. We have these long bones in the leg called the femur, and the other is the tibia. Earlier, we used to fix long bones with plates. There was the usage of bulky plates, and even after plates, we could not put weight on them. Because there was always a fear of breaking the plates, their screws irritate, and we had to give a long incision. So in the case of these long bones like the femur and tibia, we must fix them with nails instead of plates. 

However, in some cases, we fix them with plates. But most of the time, we fix it with nails. Now, what are these nails or plates? Patients often ask the doctor if they are going for this operation. Patients are very aware, well-read and want to know which implant we will use, so they ask whether you insert a plate or nail. The plates are fixed on the surface of the bones. As you can see here, the bone is on the plate.The disadvantage is that we need to give a big incision, and plates used to trouble a lot. There was always a fear of breaking, and we couldn’t put weight on it until it did not connect the bones.

Today you all must know the bone is like a hollow structure like a tube. Hence, we insert nails using that hollow structure, especially in the femur and tibia with a small incision. The advantage of the use of nails is the small incision. With the small incision, we insert these nails into the tubes. Think of it as like one tube is going inside another, and when we put weight on it, nails also take some weight.

So because of this, we can quickly put weight on it. And there are some screws inside nails called interlocking nails at the top and bottom. And with this, we fix these long bones, and the patient can stand on the second day or the same day of surgery and put his total weight on it. So this is the advantage of putting the nails. So especially in long bones and wherever possible we would like to put nails. The advantage is the small incision; with the locking screw, we gave stability to it, and the patient can walk the next day after surgery. And, of course, the recovery time is much faster. 

It is bloodless and painless since the incision is small, the recovery is speedy, and we can discharge the patients in two-three days. But very important you must understand whether we put nails or plates, the bone is not uniting because of nails or plates. This is what I tell all my patients. It doesn’t matter if I put nails or plates. They have their advantages and disadvantages but what will matter is that the healing will be from bone to bone. And the purpose of an orthopedic surgeon or orthopedic surgery is to connect the broken bones or pieces and stabilise them with either nail or plate, but the healing is natural. The fracture healing will depend upon their bones; how strong they are, how broken the fracture is, they are fixed in which shape. 

So the plates or nails don’t unite. So remember, if the fracture fails, it is not because we have put plates in it or not; it is because the healing was poor. Of course, we need to give the best atmosphere to give the best healing. So we need to put all the pieces together so that nature can connect one bone to another, but bones unite by natural healing, not by plates or nails. If the bones are not connected, and I start walking the patient on the plate, then after a few months, the plate or nails will break. So it’s the bones that have to bear the weight; it is the bones that have to unite. So please remember that healing happens with nature’s process, and the surgeon will only facilitate that healing with the nail or plate.

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Orthopedic Implants | हड्डी रोग के ऑपरेशन थियेटर में उन्नति

Orthopedic Implants

Orthopedic Implants & Advancement in operation theatre in Orthopedic

In this video SimpliHealth expert orthopedic Dr. MS Narula is talking about the advancement in operation theatre in orthopedic implants. Like in any surgery, infection is one complication that both the surgeon and the patient are afraid of, in fact the surgeon is more fearful than the patient, especially in orthopedic surgeries. Infections are troublesome, lingering, and don’t get better quickly if we talk about orthopedic surgeries. So our emphasis is that the operation theatre in which we do these surgeries should be sterile and as clean as possible. The more they are clean, the better.

We pay great attention to sterility, and the same advice I would like to give you is whenever you plan any orthopedic surgeries for yourself, make sure the OT is very clean and sterile. Once an orthopedic infection occurs, it is difficult to handle. So the new technique is the introduction of laminar airflow in the OTs in which the directions are such that the infected air doesn’t enter the operation theatre. 

We have a new sterilisation technique. We have a specific entrance for OTs so that our orthopaedic OTs remain sterile and minimise the probability of infection, preferably 0-1% . Also, we would be very happy if we could control the orthopedics infection inside.

So this was all about operation theatre techniques now, we will talk about our operating techniques.

OPERATING TECHNIQUES

The difference in new operating techniques is that now they are minimally invasive. Minimal invasive is a very common word. Still, if I tell you in a simple layman’s language, it is performed with small incisions; a minimal cut is given, unlike in previous fractures where we used to provide a big incision. Now we give a small incision; we introduce the implant inside, and for this, we have one valuable piece of equipment: C-arm.

It is a specific X-ray machine used in operation theatres. And under fluoroscopic control, we put the implant inside. The advantage of this equipment is that we can see the X-ray along with the implant insertion. So these are minimally invasive. In these surgeries, we give a minimal incision. The recovery is faster since the incision is small. 

The cosmetic scar will be more minor. It is bloodless, or there will be minimal blood loss, and of course, it will be painless. So these are some advantages of minimally invasive. The emphasis of all newer orthopaedic techniques is as far as possible; we operate bones in a closed way; it shouldn’t be opened too much, or we need to perform it in a closed manner. So it can be minimally invasive, treating fractures with small incisions.

Types of orthopedic implants

We have newer implants like nails, plates, or screws to fix the fractures. Advanced implants have made orthopedic surgeries very effective, safe, and quick both for the patients and surgeons. Indeed these implants are expensive. But, still, it has been a great boon to orthopedic surgeons. 

TITANIUM IMPLANTS 

So first, experts will talk about metal allergy Metallurgy; earlier, we used to put steel implants, but now we have titanium implants. The titanium implants are solid, conducive for fracture healing, and have a low infection rate. So for most surgeries, wherever patients can afford, we would like to use titanium implants. Talking about implants, I would like to tell you about the implants’ shape and structure. These days, we have pre-contour plates, which means pre-design plates for every bone. If you notice, this is our collar bone. We used to fix the collar bone or, say, shoulder bone by bending the plate a little bit, but now we have pre-contour plates that are already bent. So if you pay attention, this is the plate for collar bone, and this is for shoulder bone, so they are already turned, and we just need to put this with the bone and fix it. So it makes our surgeries very quick and increases the chances of fracture healing.

LOCKING PLATES

Talking about the design of plates, today we have locking plates. By this, we mean when the bones are weak, there is always a  fear of screw coming out, so nowadays, such screws have become locked inside the plates. So the condition in which the implants may back out or nails or screws come out before the bone is attached doesn’t happen. So these pre-contour titanium plates are a very important advancement in our orthopedic trauma, which we take advantage of, and the patient’s healing and recovery are faster.

BIODEGRADABLE SCREWS

Next, we have some biodegradable screws, as you must have heard about ACL reconstruction, or in other surgeries, we insert such implants which dissolve inside, which we call biodegradable. So they dissolve after a few months or in years, and there is no need to remove them. Now some implants have a profile. Like earlier, the plates were thick, and due to scarcity of muscle below the skin, these plates used to prick. Now the plates have become very thin; these are low profile plates. The patient used to have problems with the older implants, the bones get healed, but they complained about the prick caused by screws or implants. And then, after a year or two, we had to remove these implants. But with these newer implants, we don’t find the reason to remove them unless in a few cases where those implants irritate them.

This is the typical question asked by the patients that doctor. Since the operation is complete, can we remove these screws or plates? So I would like to tell all my patients that unless the implants are irritating you, we don’t find the need to remove them. There are some indications that it should be inside only in a few cases, and it doesn’t affect us anywhere; they are inert. Many people think since it’s a metal, it might get rusty. But nothing like this used to happen. Then, of course, they become part of your body in many cases we recommend. But most of the time, they remain inside; they are very safe and do not damage the tissues.

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Fracture Plaster Types | आधुनिक तकनीक वाले फ्रैक्चर प्लास्टर के प्रकार | Fracture Management

Fracture Plaster Types | आधुनिक तकनीक वाले फ्रैक्चर प्लास्टर के प्रकार | Fracture Management

Fracture Plaster Types | Everything about fracture(फ्रैक्चर) management

Fracture plaster types, In this video SimpliHealth expert Orthopaedic and Spine Specialist Dr. MS Narula is talking about fracture(फ्रैक्चर) management. Also he is answering some questions like:

  • What is the treatment of different orthopedic fractures? 
  • What are the latest advancements to manage fractures?

As you know, in earlier days, experts put the fractures together with plaster or with the help of traction. With the advancement in orthopedic practices, we gradually inclined towards surgery. So many advances have come from the last few years, making orthopedic surgery more quick, with remarkable recovery, bloodless, painless, and minimal invasive. I would say we make a minimal incision. With the help of new techniques and better implants, the patients recover fast. It’s painless, and the patient’s joint function is much better. Today we will talk about this a little.

Fracture Management by Plaster

Among various ways of fracture management, plaster is the most common. We apply the plaster with little stretching; which is a standard OPD procedure. We opt for plasters when the fracture is not well-displaced. If it is a minor fracture, we need to plaster for one to one-half months, or there are some small bones, or else I said earlier that the fracture does not move much from its place.

What are the advantages of new plaster?

But nowadays, very good modifications have come in plaster too,we now have lightweight plaster, which has fiber cast. The plaster used in old times caused allergies, sweating, it was heavy, gets wet, and breaks easily.  So to bypass all this, we have a lightweight fibre cast that comes in many colors. But, as you must have seen, it is available in blue or pink. That plaster is tough enough so that if we apply it on the foot or ankle, it won’t break even if the patient puts some weight on it. It doesn’t get wet easily and has no issues with skin. So this is one of the advancements in fracture management as far as plaster is concerned. 

So the advancement among fractures is that earlier, the lightweight cast replaced the heavy white cast, which we used earlier times.

Cast Bracing Method of Plastering

Now we have another cast bracing method in which we use special braces, made of plastic material and are removable. When we strap them on, they are hinges inside, which helps the joints move. And they can be loose or removed for a short time to allow the skin to breathe. So this, too, is a small indication that, unlike previously used plasters, it doesn’t allow stiffness in the joints and doesn’t lead to any skin issues. And the latest that has come is the breathable plaster on which there is mesh-like material inside, you can observe the skin for any rashes, and we can do an X-ray on the same plaster. 

So all the previous issues of plaster-like skin rashes or joint stiffness have been sorted. With the new technique, the plaster is easy to apply, remove, and convenient for the patients.

So, as I said in previous times, more emphasis was on staying on the bed, not moving their limb, which usually leads to stiffness in joints or muscle atrophy. But nowadays, emphasis is made on the fact that the patient stands as early as possible, his joints are mobile, and can restore the patient’s limb function. 

These days, we treat most of the fractures by operative management, especially those displaced from their original position or are complicated or comminuted, or are multiple fractures. Our emphasis is to fix it as early as possible so that the patient can use their arms or legs or fracture body parts. There have been newer advances, so first, I would like to talk about the advancement in operation theatre where we perform all the orthopedic surgeries.

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Tennis Elbow Treatment | कोहनी के दर्द लक्षण, कारण और उपचार

Tennis elbow

Tennis Elbow Treatment | Symptoms, Causes and Diagnosis

In this video SimpliHealth exert Orthopaedic Spine and joint Dr. M.S Narula is talking about a critical common condition that experts frequently encounter in OPD: Tennis Elbow Treatment (कोहनी का दर्द). You must have heard this commonly used term  

क्या है ये टेनिस एल्बो (कोहनी का दर्द)?

It is a condition that is medically known as lateral epicondylitis. This pain occurs in the outer portion of the elbow. This pain may start from the elbow and come down to the forearm, so the pain which happens in the elbow is called a tennis elbow. 

Tennis elbow Causes and Diagnosis

The history of tennis elbow is reported by the patients as a pain which happens when they are doing a particular activity like they pick something heavy like a bag or suitcase. Ladies complain that when they wring the clothes to squeeze out water in that position or pick a pan, it starts paining severely . So it is termed as tennis elbow because during tennis, players use a very heavy racket, and especially those who play with the back hand, their muscles get strained, it hurts, and that’s how the name Tennis elbow derives its name

In addition, there is also another condition which is a golfer’s elbow. It is similar to the tennis elbow, but this pain comes from the inner area of the elbow. Often, patients complain that when they pick up something, it starts paining from inside; this is called a Golfer’s elbow. And this is tennis elbow. There are wrist muscles. If you see the wrist muscles help in an upward movement. If they move their wrist a little upwards, there is movement in elbow muscles. So all these muscles help in grip and attach themselves here (elbow). 

So in the overuse injury, which means when we use that muscle repeatedly, like picking up something heavy, that muscle which is attached to bone, comes under strain, sometimes  it may result in a tear also, and there is inflammation; that’s why it hurts on the outer side of the elbow. Hence it’s called a tennis elbow. Its history is very typical; as our experts toldtell,m,,lk you, it hurts when patients pick up things from the overhand grip, like picking up the pan or bag, especially those who lift weights in the gym. When they pick up anything in this position it starts hurting.

From its history, we can diagnose that it is a tennis elbow. We perform some clinical tests like asking the patient to move their wrist against resistance and or we put a stretch on their wrist; the pain can be seen on the elbow. It is a simple clinical diagnosis. We don’t require an X-ray as this is a muscle and tendon problem. It doesn’t come in an X-ray. In a  rare case, an MRI is done. It’s a clinical diagnosis, and it’s a very straightforward diagnosis.

Which category of people suffer most from this problem? As I told you,  this is an overuse or repetitive use  injury. It happens when ladies wring the clothes to squeeze  water or while picking up a heavy pan.   or men who  take a heavy bag while they are traveling, lift heavy bags or when tennis players  make frequent use of the backhand. Also, weightlifters bodybuilders, while using  their hands  to grip the weights can also be affected.

Treatment for tennis elbow

Initially, when the pain begins, we prescribe mild anti-inflammatory or pain killers to patients. One can do icing to avoid inflammation. We often advise the patients to not  do that particular activity that causes them pain. Most importantly, a patient should not  pick up things  with the overhand grip. Pick up like this. It strains our elbow muscles when we pick up stuff from the overhand grip. So we need activity modification, painkillers, and little icing to get relief in the initial stages. Also,a  brace called a tennis elbow band can be placed around  for  relief. In the initial stages this treatment is enough. Suppose a patient doesn’t respond to this treatment an injection is given in his elbow.

It is a very safe and effective treatment. One injection heals the entire pain. It is a locally active steroid. Only one injection does the work. Still, we may repeat this injection in a few cases after one month. The injection is usually given in these areas; it’s just a steroid mixed with local anesthesia. Most of the time it works very well and a patient does not require any further treatment. Less than 5% rather  less than 2% cases require surgery for this. But that is very rare. Most people respond to the conservative treatment, which includes an initial period of anti-inflammatories followed by Physio.

As our experts previously mentioned, there is muscle strain, so we recommend Physiotherapy in these patients. To strengthen these muscles, gradual stretching is essential. Physiotherapy combined with  injections works in most conditions. So if you are having chronic or recurrent pain on the outer portion of your elbow or in the inner side of the elbow, you must consult your Orthopaedic surgeon. 

Don’t fear the injections if you are not getting relief from the routine anti-inflammatory. Please get it done. It is one hundred percent curable. Stay safe, happy, and healthy. Thank you very much.

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Spinal Cord Injuries Treatment, Causes & Success Rate | रीढ़ की हड्डी का इलाज

Spinal Cord Injuries

Spinal Cord Injuries Treatment | रीढ़ की हड्डी की चोट का इलाज

In this video our expert Dr. M. S Narula is talking about spinal cord injuries treatment & its causes, treatment & success rate. Also he is answering some common question that people ask in OPD like:

  • What are the treatment options?
  • Why are we operating? 
  • What is the patient recovery rate? 

Unfortunately, these injuries are very severe today because of high moving traffic and so much rush on roads with speedy vehicles. As spine surgeons, our experts often see these spine injuries or spine fractures, or polytrauma patients very commonly. These injuries are considered severe injuries not in terms of mortality but the disability and the mobility that they cause.

As our expert told you, these spine injuries are mostly seen after a roadside accident or fall from a height. These are the two most familiar modes of injuries. If someone falls from height, they land on either their spine or heels, due to which intense pressure is observed on the spine or crushing force is seen; hence there is a fracture in the spine. It can happen anywhere from the neck to the bottom. Any vertebrae can get a fracture. The second reason is that our bodies fall in different postures during accidents, resulting in fractures. There is also another injury in which the bones don’t get fractured. 

The spinal cord doesn’t get fractured; instead, the nerves press down because of jerks, more commonly called by doctors a whiplash injury. What happens in whiplash injury like if our car is standing and some other vehicle hits us from the back, then a sudden shock to the neck is felt. When doctors perform X-Ray, they don’t find any bones fractured, but the nerves are compressed.  So spine injury can be with a fracture or without fracture, and the standard two modes are fall from height and roadside accident. 

Spinal Cord Injuries Treatment (स्पाइनल कॉर्ड इन्जुरी का इलाज): What are the treatment for spine injury? 

But before talking about the treatment, the doctors would like to sensitize you about that if you see an accident victim on the roadside where you suspect it could be a spine injury, the very important part is that we must keep the neck and the body in an immobilised state. Often you must have seen the paramedics bind the collar around the neck and keep pillows on both sides, and with the straight fixed, they shift the patients. So one must take precautions very much during shifting spine injury patients from the accident site to the hospital. We shouldn’t move their spine, there shouldn’t be any twisting sprains, or the neck should not fall back or move. 

So this is the golden period in which one can damage the spine injury if it has happened earlier. So when the patient is brought to the hospital, and the doctors think that he has a spine injury, the doctor performs an X-ray and MRI. Like our expert told you before, spine injuries can be very debilitated. Most spine injuries have their weakness like their upper Limb or legs, so either all four limbs are paralyzed, or one limb or both legs is paralyzed depending upon which part is injured. If it is in midthoracic, i.e., there is fracture or nerve pressing in the midway of the back.

Then there is fear of weakness or paralysis in both legs. And if one has a neck injury, then it’s a possibility that there can be weakness or paralysis in all four limbs. So the doctor does an X-ray and MRI of the patients; after providing a first-aid, the doctor plans its definitive treatment.

As you can see in  this model of the spinal cord the bones spinal cord bones and how nature has delicate sieve of nerves around our spine. So our nature has provided us with this structure. So these are the spinal cord bones, and if you focus on this bone cage or column, there going our nerves.

These nerves are protected inside the vertebrae column bones, so whenever there is a fracture in the spinal cord, the crushed part moves back and may press the nerve or damage it. As our expert told you before, such a sudden shock is felt that the spine doesn’t get fractured, but due to intense trauma, the nerves press down. So this is to understand that nature has provided us with the vertebrae column, which is like a cage of the spinal cord in which nerves are always protected. Unfortunately, during any injury or fracture, the broken portion presses the nerves.

Before we discuss the treatment option, Our expert would like to discuss the basic anatomy of the spinal cord. This is the model of our spine, and this is the bone of the spinal cord stacked on one other, and there is this vertebrae column in which nerves are going from neck to down. So our nature has protected the delicate structure of the spinal cord in a rigid structure of the vertebral column. During injury or in an accident, this broken portion of the bones moves back and presses the nerve. Usually, the spinal cord is protected by the bones around it, but when these bones get fractured. The crushed area moves back and presses the nerve, cutting it, or may damage it.

What are the treatment options?

Of course, when the suspected patients with spine injuries come, doctors’ first and foremost purpose is to give them pain relief because these spine injuries are very, very painful. So doctors plan their treatment after giving them painkillers and doing their X-rays and MRIs. If the fracture is stable and the vertebrae are not that much compressed , there is not much damage to weakness; the patient doesn’t have any weakness. The doctor simply recommends simple bed rest for 3-4 weeks, giving them a belt for slow mobilization.

The patients do very well in the conservation treatment. This is done only in those cases where the fracture is not that bad or not too much, which the doctor commonly calls a stable fracture, and there is no weakness in the hands or legs. And the doctor doesn’t see any compression in the MRI. But in most of these patients, there is damage to nerves. 

Either their legs are weak, or there may be weakness or numbness in their hands. In MRI, it is seen that the broken bones are giving pressure to the nerves. So in these cases, the doctor plans a surgery and advises the patients. In this surgery, this spin surgery has to be done with a very skilled spine surgeon that is why it is very specialized surgery.

The broken portion is removed from the nerve by the doctor and fixed with rods, plates, or screws. If it is a neck injury, the doctor may go from the back or front. If it is a spinal cord injury, the doctor may go back or front, the broken area is stabilized from up, and bottom, the bones pressing the nerve are removed to mobilize the patients as early as possible.

Success Rate of Spinal Cord Injuries Treatment

Now, this is the most challenging question and biggest dilemma every spine surgeon faces frequently in their practices. Now, what happens when there is a spine injury and when there is minor damage to the bone? That damage is usually permanent. In a sense, the time the nerves got pressed left some damage during an accident. Yet, doctors need to operate on it, so this is the question that if it’s permanent and the nerves won’t be able to recover,  our expert have seen so many cases in which the patient is paralyzed for life.

Why is an operation needed for spinal cord injuries treatment

See, you have to understand that there is pressure on nerves, and there is no way through which a doctor can predict whether it is permanent or not. Still, it’s essential to remove the pressure so that we can give the patient the chance of recovery of nerves and the patient. And if it is an incomplete injury, there is no total paralysis then, so the chances of recovery among them are very nice. Another significant advantage of operation is that even if there is permanent damage to the nerve, the doctor can make the patient stand up, mobilize, or at least ambulatory or even on the bed, on a wheelchair after surgery.

If the doctor fixes the spine, then on the next day, the doctor can make the patient sit on their bedside and mobilize them on a wheelchair so that the patient doesn’t have a bed zoned. Otherwise, the patient is in bed for 1 to 1 half months. So the surgery definitely has its advantages provided the patients and relatives understand that the injury, recovery of nerve, recovery of leg nerve is not so much in the hand of the doctor; it is in the hands of God. Yes, the doctor can remove the pressure to give them a chance of recovery. As the doctor mentioned after the operation, they can mobilize it quickly on a wheelchair or crutches or by sitting on a bed, but this is possible only after surgery. The specialized surgery is long, but the doctor sees good results wherever indicated in expert hands.

Of course, the next question is, doctor, what happens now? Now what? 

What is the patient recovery rate? | Spinal Cord Injuries Treatment

Like our expert  said, if it is an incomplete nerve injury, there is no complete paralysis, and there is little weakness, and the MRI report conveys significantly less damage. So, the chance of recovery is very fast, so much so that a few weeks the patient recovers, so that the recovery can take a few days to almost one year. The nerve recovery may last a long one year. So it is a lengthy recovery period in which the patient first has to mobilize. They may sit up or in a wheelchair or on crutches to improve the patient’s quality of life. So this can, and he will need a very good rehabilitation.  

After every surgery, there is a role of physiotherapy rehabilitation. Still, post-operative patients’ spine rehabilitation is of great importance in spine injury patients. So with good rehabilitation, the quality of life can be improved, and slowly, with the nerve recovery. Patients start feeling good so that the healing can last from 1 to one and half years, and the second thing is, what are its results? 

As our expert told you before, its effects are very good if done timely. If the surgery is performed timely and by expert hands and when there is not too much damage, then the results of spine injury fixation are very good. So take care. Be safe, and please drive carefully and slowly. 

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Distal Radius Fracture | Wrist Fracture Treatment Complications | कलाई फ्रैक्चर का उपचार

Distal Radius Fracture

Distal Radius Fracture | Wrist Fracture Treatment & Complications

In this video SimpliHealth expert Orthopaedic joint and Spine replacement Surgeon Dr. MS Narula is talking about distal radius fracture & wrist fracture treatment.

Wrist Fracture/कलाई की हड्डी का टूटना

The wrist fracture most commonly occurs in the radius bone. Here (forearm) has two bones, one small bone (ulna) and one larger bone (radius), so the larger portion of the radius bone close to the wrist gets fractured. And mostly, the history of the injury is that we had a fall with our outstretched hand. 

Like when we fall, we stop ourselves by keeping our hands stretched to cushion a fall on the ground. So all the impact comes around the wrist, due to which there is pain and swelling in this region. There is the history of fall on an outstretched hand and a patient comes to us with swelling and pain around the wrist joint, also known as a distal radial fracture.

So roughly, they are of two types:  extra-articular and intra-articular. Extra-articular happens little above the wrist joint whilst intra-articular fractures the bones inside the wrist joint. So accordingly, we plan the treatment.

Wrist Fracture Treatment | Distal Radius Fracture

Usually, the patients come with pain and swelling in the wrist with no movement or a very slight movement in the wrist. And the patient holds the wrist with the other hand. This fracture can easily be diagnosed on the plain X-Ray when we do the X-ray we see the wrist bone fracture on the slight upper side of the radius bone.

Most of the fractures are managed with plaster in the initial treatment. After we do an x-ray, we diagnose it, and if we see that there is no intense pain and swelling the plaster is reduced at this stage

How to treat these radius fractures? 

As our experts told you before, the treatment will depend upon whether the fracture is inside the joint or outside the joint, age of the patient. The condition of the patients’ bone, and most importantly, the amount of displacement that has happened due to the fracture. 

How much is this fracture displaced from its original position? 

Please remember that this fracture commonly happens in postmenopausal women after 45 years, especially those with osteoporotic bones. So this fracture is most commonly seen in weak bones. Naturally, weak bones take more time to heal. So it depends on the X-ray report that shows the extent of displacement or nondisplacement. If it is undisplaced, that means it has not moved not much from its original position. So most of these fractures can be managed by simple plaster.

In many cases, this plaster can be given under anesthesia. If we think we need to set it a little bit or reduce it a bit, otherwise we immobilise these fractures in the OPD practices with the plaster, i.e., POP cast. Most of these fractures heal well with the pop cast in 4 to 6 weeks, followed by good physiotherapy to avoid wrist stiffness. And in a few cases where the fracture is displaced and has moved farther away from its original position, we recommend the operative method. 

In operative, if the fracture is not much displaced, we simply reduce it by putting some wires followed by plasters on it but yes, in a few cases, where the fracture is inside the joint a plate is put because we wish that it sticks to its original position as much as possible because it is better for the wrist movement If it joins wrongly it will lead to restriction in the wrist movement and may lead to stiffness and a weak grip. 

So we wish that if it is a joint fracture, it should join as much as in its original anatomic position as possible. if we can achieve it with that plaster good enough. A proper surgery is performed and we insert a special plate in it too. The patient is in the hospital for one or two days, and the movements start after 4 to 6 weeks.

Most of these  fractures heal very well. Of course, you have to treat your osteoporosis. You need to have calcium and Vitamin D supplements and start the mobilisation as early as possible, sometimes as early as three weeks, and in some cases, we may delay it for six weeks. 

So please remember if you have a history of falls and have sudden pain and swelling in the wrist. do not ignore it could be a simple soft tissue injury, but if it is a distal radial fracture, it needs a plaster or surgery, which your orthopaedic surgeon will recommend. Thank you 

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Frozen Shoulder Treatment, Symptoms, Exercise & Risk फ्रोजन शोल्डर | एडहेसिव कैप्सूलाइटिस

Frozen Shoulder Treatment

Frozen Shoulder Treatment | Adhesive Capsulitis

In this video SimpliHealth expert orthopedic Dr. MS Narula is talking about frozen shoulder treatment(फ्रोज़न शोल्डर).

What is a frozen shoulder?  

People often confuse all kinds of shoulder pains with frozen shoulders which is generally not true. In this video our experts would like to share with you that a frozen shoulder is a particular entity ; there is a specific  pattern to it. Our shoulder joint is like a ball and socket joint surrounded by muscles and ligaments, and there is a connective tissue that helps in the binding, called a capsule. So in a frozen shoulder, there is a tightening in the connective tissue or capsule. Because of some inflammation or some scarring. This capsule gets tight, which causes pain and stiffness.This particular disease is called a frozen shoulder.

Adhesive Capsulitis | Frozen Shoulder Treatment

The frozen shoulder is also known as adhesive capsulitis. It is periarthritis.In arthritis, there is a  tear in the bones of the joints.  There is no problem in the bone however, there is a formation of adhesion in the soft tissue envelope around the bones, which is known as adhesive capsulitis. 

Frozen Shoulder Symptoms

Broadly in Orthopaedic practices, experts discuss them in three stages: 

  1. Freezing 
  2. Frozen
  3. Thawing

In the freezing stage, there is a pain in a specific or particular position like when you are reaching out to something or doing some overhead movements or especially when you are taking your hand to your back, turning the shoulder towards the backside,, then you feel this pain. So it starts paining when you do a particular moment, and this pain can get very severe and is eventually worse at night,, and this pain limits the movement of the shoulder. And please remember the frozen shoulder doesn’t need to only remain in the shoulder. 

It can go down the arm, or it can go up till the neck,, even in the back of the shoulder, so it is a diffused pain that  gradually gets worse, especially at night, which further restricts your movement . This is the first called a freezing stage. The second stage is the frozen stage. 

In the frozen stage, this pain starts receding a little but there is an increase in the stiffness, so the pain begins to reduce, but it restricts the movement of the shoulder joint. So a patient cannot sleep on that shoulder, and all over the joint movements are limited, especially, when you take the hand to your back. And of course, the last stage is thawing. Simultaneously,, there is a reduction in the pain and stiffness. The frozen shoulder is mostly a self-limiting condition. It heals in one to one and a half years in most cases.

Who is at risk of a frozen shoulder? and, How is it diagnosed? 

Usually, this condition happens after 40 and between 45 to 55 years old. Mostly in females. Its occurrence varies from 70%percent in females to 30% in males. There are certain risk factors for example, people who have diabetes may have a very intense frozen shoulder and may last longer. Then there are specific hormonal changes like hypothyroidism, then of course there are certain neurological symptoms like cervical disease or there is some muscle problem in the shoulder. And of course do remember this there is a secondary frozen shoulder in which whatever be the reason if there is no movement in the shoulder could be an injury due to which we have tied our shoulder, could be some surgery around the shoulder, could be some neuromuscular weakness due to which we are not able to move our shoulder for a long period of time. 

In these people above the age of 45 to 65  may develop this frozen shoulder .Mostly it is diagnosed clinically. The symptoms cannot (as I mentioned before) be diagnosed in the X-ray because in x-ray, only the bones are visible. I explained earlier that there is no problem in the bones. So the X-ray of the frozen shoulder is usually normal. It is diagnosed either by ultrasound,, and of course the most specific technique used these days  is MRI. MRI clearly diagnoses it. 

Frozen Shoulder Treatment

Now we come to treatment. As our expert told you before, frozen shoulder usually subsides in 1-1.5 years on its own but  it may last longer, especially in diabetes. The purpose of our treatment is to reduce the pain and restore the movements at the earliest possible time, and the patient does not have to suffer any disability. 

In the initial stages experts prescribe anti-inflammatory or routine painkillers to reduce the inflammation and perform hot or cold therapy. Physiotherapy remains the mainstay of the treatment.Almost 80% of the role is played by physiotherapy. There are some exercises as I told you there is reduction in the pain but there is gradual increase in stiffness. To control the stiffness and keep the joint mobile as much as possible in the frozen shoulder experts specially tell the patient  not to  restrict the movement of the shoulder. 

Yes, if a particular exercise is hurting your shoulder, don’t do it but keep the shoulder mobile. Visit your physiotherapist for some sessions. And if you are experiencing a lot of pain due to which you are not able to do exercise then experts give them steroid injections which are very successful and effective in  treating this. The purpose of the steroid is to reduce the inflammation so that there is reduction in the pain so that you can perform exercise. 

So please remember the medicines and injection treatment is only successful if you continue or follow it up with the exercises. So in the initial stage, this treatment is enough and most people recover in a few months. In very rare cases surgery is required in which arthroscopy which uses a lighted telescope and is used to break the adhesions and scars. In a few cases experts may manipulate the adhesions under anaesthesia. So these frozen shoulders can be managed conservatively just with physical rehabilitation and mild anti-inflammatory.

Frozen Shoulder Exercises(फ्रोजन शोल्डर की एक्सरसाइजेज)

Next very common question asked to us in the OPDs is  regarding the exercises that help in frozen Shoulders. As I have told you before, Physiotherapy will  remain  a very important part. There are some exercises which you can do at your home but I will insist that you visit your Physiotherapist and do some sessions with them. And the exercises   that they teach; can be done at home  after hot/cold therapy. Initially the exercises experts recommend  is the pendulum exercise  in which the patient bends down and moves his shoulder in a pendulum style. Besides that some forward movements and circular motions are also recommended.


Then, another movement is to lie on the back and take the  arm behind the back. Then there is a towel stretch exercise in which you hold the  towel and stretch it behind the back. Few are crossbody stretches in which one takes the arm across the chest and outward external rotation in which you take a band and rotate it externally. These are a set of exercises – another one where one hand supports the upward movement of the shoulder, take the hand up against the wall.  

So these are some set of exercises which you should do regularly and remember it is not like that you went to a physiotherapist for  exercise and came home .You must do  these exercises at home as well .Remember that the  frozen shoulder is making our body stiff and we have to fight it to open it. So keep doing the exercises and take some anti-inflammatories .If  it is severe then do consult an Orthopaedic surgeon. 

Thank you .

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Plantar Fasciitis Treatment | प्लांटर फ़ेसियाइटिस (एड़ी का दर्द) का उपचार Can Plantar Fasciitis Go Away?

plantar fasciitis treatment

Plantar Fasciitis Treatment | Can plantar fasciitis go away? ( क्या प्लांटर फैसीसाइटिस दूर हो सकता है?)

In this video SimpliHealth expert Dr. M.S Narula is talking about a very common OPD problem named plantar fasciitis treatment(एड़ी का दर्द). This is a condition in which usually patients complain about pain in heels. This pain has a typical character when we wake up in the morning. When we get up from bed the first few steps, severe pain in the heel is observed. And as we start walking the pain recedes. It could be first thing in the morning or when we are sitting for a longer period or we are in a lie-down position and we get up from a chair or bed, initial or starting pain irritates us. 

This pain mostly occurs in the heel but it may go up to the calf and may reach to toes but mostly it is localized to the heel part. This is named plantar fasciitis. And it is so named because the heel has a soft tissue named fascia which covers the entire sole and gets inflamed. That’s why it is called plantar fasciitis.

So which people may be seen more, than anyone can but people who are walking barefoot, have a long-standing work, or those whose muscles are weak and those who do long-standing or walking for their occupation. Through the medium, then this could be the heel pan in them.

It has a history as I told you to get up in the morning and your pain is worse. This is mostly a clinical diagnostic, in which we do not need any investigations.   A doctor who is experienced in Orthopaedic surgeons does it immediately with diagnosis. Yes in X-ray we may see many times a small bony spur can be seen in it but under this is not mostly the cause it’s an inflammation of the phase and it is a clinical diagnosis.

Plantar Fasciitis Treatment

Look, our plantar fascia, which is our sole, works like cushions, like our shock. When we walk, he puts our body weight on the heels all day. The heel is the shock absorber himself, who is made to protect the deep nerve, and he becomes informed. Like for me. Our pillow is the new one, nice and soft, fluffy, with the time that pillow flattens out.

In the same way, the one who is stuck in our heels, who is a fat bed, becomes soft inflamed and does not do its job properly. Its treatment at initial stages, we tell the patients that yes, I’m going to walk barefoot, which are your shoes, it should be very very soft, because if our own fat has been removed, then we give it an extra cushion, which is artificial. 

Silicone heel cushions come built-in. You put on sports shoes, daily soft-soled shoes. And don’t stand for too long, the initial stage and with small painkillers this thing which is inflammation becomes good. If he is not responding, then what do we do in such cases, call the patient ice and cold massage.

How it is done, you take a bottle of water, keep it in the fridge for a while and cool it, and take it out and roll it under your feet. What happens to it, you also have a cold affect and also a message effect, due to which these inflammations get improvised to a great extent.

If your heel pain is not getting better through the routine things, like pain killers,  cold massages, soft cushions heels, then in those cases we recommend an injection, it’s a very locally active steroid, which is applied in the heels. Please remember it’s a very safe and effective treatment, people should not get scared by it, it’s a little painful, but I always tell my patients that the pain of those 2-3 seconds is better than the day and night pain you are tolerating. So please do not be afraid, if you are not getting a response to the medicines, then please get the injections. 

Plantar Fasciitis causes

And in very rare cases, we need to do surgeries in this if we feel some bone is increased, then we trim it. But most of the time, anti-inflammatories and combined with injection, yes physiotherapy is a very important part if you go to the physiotherapist. So we do that with ultrasonic massage or laser, and plus that is the plantar fascia stretching exercise where our sole is stretched under a very controlled condition. And its exercise is told.

So physiotherapy Combined with Injections works in most of the conditions so stay safe, stay happy, stay healthy and heal under heel not by yourself but by going to your doctor.

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Rotator Cuff Injury Treatment | रोटेटर कफ इंजरी | Test & Risk Factors | कंधे के अंदर कैसे करें इससे बचाव?

Rotator Cuff Injury Treatment | रोटेटर कफ इंजरी | Test & Risk Factors | कंधे के अंदर कैसे करें इससे बचाव?

Rotator Cuff Injury Treatment, test & risk factors | सर्जरी या सर्जरी के बिना रोटेटर कफ उपचार | फिजियोथेरेपी

In this video SimpliHealth expert in Orthopaedics Dr. M.S Narula is talking about rotator cuff injury treatment, test & risk factors. Also he is answering some very common questions that people usually ask like:

  • When do we go to see the doctor?
  • When are its tests done? 
  • What are the risk factors of rotator cuff injury?

Its symptoms are similar to those of other diseases. The first question is when do you need to go to the doctor as you feel that you are getting a lot of pain. or who is not going to take a week’s rest with yeh normal pain reliever. Your pain is going inside the branch then movement becomes very limited in which you are not able to do a special activity, it is because your muscles are too weak. In this condition, as per our experts you must definitely consult your orthopaedic doctor. He will tell you the ways to treat and manage it.

Rotator cuff injury treatment

Treatment of the rotator cuff depends on whether the type of injury is acute or repetitive overuse, a repetitive injury, or a degenerative injury. 

In an acute injury, we are told to take a rest in the initial period so that the hand is placed inside the sling work up to 4-6 weeks from work. When we talk about physiotherapy doctors mean by doing exercises the muscles get stronger. 

Rotator cuff injury exercises

Exercise helps to increase the range of motion of the shoulder muscles. Then there are some special stretching exercises that your physiotherapist will do for you which assist you to exercise. Exercise with elastic bands is the backbone of this therapy. That’s why physiotherapy is the backbone of the treatment of rotator cuff injury. Therefore physiotherapy and stretching are the backbones of rotator cuff injury treatment. Most of the time people respond to this treatment. Depending on how chronic the pain is, we can apply ice packs or heat, this will help in reducing the swelling around the shoulder muscles. 

The fourth option is the use of injections. For injections let me tell you a little Steroids Corticosteroids injection injected into the shoulder joint to reduce pain and swelling. So you can fix it with exercise, 80% of people get better after two or three injections. Of course in a final treatment, there are surgical options that the doctor will discuss with you first.

Rotator cuff surgery

There are some specific signs of its bad for which we recommend surgery. When to tell your doctor to have surgery. Always remember that 80% of the population does not require surgical treatment for a rotator cuff injury to the shoulder. Many people ask me can I be healed on my own? The answer is no. 

The tendons inside the rotator cuff do not contain blood, so they do not heal on their own. 80% of people manage with non-operative treatment. Only 20% require surgery. 

When do you need surgery? 

You have taken pain relievers, physiotherapy for six months but still, you are not seeing any results. In this case, we use surgical treatment. Like if you are a professional athlete and you have to do any movement which you are not able to do here again there is an acute injury, a very big tear, you have fallen suddenly..Here again, there is an acute injury, there is a very big tear, it has fallen suddenly and you have become very big on the carriage instead of old or degenerative tears Like I told earlier, the tendons that are attached to the muscles in the rotator cuff tear, so what do we do?

Its results are very good in a young patient who has chronic and degenerative tears, more so in elderly patients in that the results of surgery are not so good so we use first pain reliever and exercise physiotherapy in their case. The second treatment is debridement therapy where small broken pieces of tendons are removed surgically.

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Rotator Cuff Tear Symptoms | कंधे के अंदर रोटेटर कफ टीयर लक्षण और कारण | Rotator Cuff Injury (रोटेटर कफ इंजरी)

Rotator Cuff Tear Symptoms | कंधे के अंदर रोटेटर कफ टीयर लक्षण और कारण | Rotator Cuff Injury (रोटेटर कफ इंजरी)

Rotator Cuff Tear Symptoms | Rotator Cuff Injury

Rotator cuff tear symptoms, In this video SimpliHealth expert in Orthopaedics Dr. M.S Narula is talking about rotator cuff injury and its symptoms and causes. According to our expert there are 4 muscles around the shoulder that stabilise our tendon and also help in its movement. Our shoulder joint is a ball or socket type of joint. As if you are holding the top ball of a tee, those who play golf will understand it, and there are 4 big muscles in front and on the pitch to move it. These muscles act like a tendon (tendon) when in contact with bone. These tendons also stabilise the shoulder and also speed up karate. 

So when there is any injury inside them, such as swelling in the tendon or it becomes thick (tear) from somewhere, then we call it injury in the shoulder joint.

Rotator Cuff Injury Symptoms

The first symptom is pain, now the pain is also caused by two types: first, it hurts, or as soon as it hurts, and secondly, the pain increases gradually. You have pain in the beginning when you do some activity like taking something from the top of the head or taking your hand in the waist or raising your hand to comb your hair. Even if you are taking a rest, the pain becomes intense. And one of its special things is that the pain gets worse at night. 

Why does rotator cuff injury hurt more at night?

The first reason for this is that because there is no movement in the shoulder, then the muscles become even more rigid. And the second thing is that due to gravity when we are talking in a situation, our muscles get pulled, the bones are also pulled, due to which the pain of this shoulder injury becomes more at night. 

Then it becomes difficult to sleep on that shoulder. And its symptoms are that there are limitations in our activity, such as not being able to comb or getting hands on the waist, muscle weakness, muscle wastage, and sometimes there is a loud noise while doing any work, these are just some of the symptoms. Shoulder injury and as I said it gets worse at night and limits our movements. 

Rotator cuff Injury Causes

It is of two types, one is 

  • Acute
  • Chronic

So there are also risk factors in this. Most of the time it is above 40 years of age. Apart from this, those who do sports, who do the same activity, and those who smoke, it is more common if your shoulder pain is going on for a long time due to age and if it is not treated, which can also be called minor tendonitis. It is said that they grow from partial to complete tear, these are some reasons for our rotator cuff.

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Osteoarthritis Treatment & Symptoms | ऑस्टियोआर्थराइटिस का मुख्य कारण क्या है?

Osteoarthritis Treatment Symptoms

Osteoarthritis Treatment & Symptoms | ऑस्टियोआर्थराइटिस किसकी कमी से होता है? व कैसे ठीक होता है?

Osteoarthritis treatment & symptoms, In this video SimpliHealth Orthopaedics, Joint Replacement & Spine Specialist Dr. MS Narula is talking about Osteoarthritis(ऑस्टियोआर्थराइटिस) and its Symptoms, Causes, Risk & Treatment. Also he is answering some questions that people usually ask like:

  • Who is most at risk for osteoarthritis?
  • What is osteoarthritis and what type of joints does it affect?
  • Exercises for Knee Osteoarthritis and Joint

It is an age-related degenerative disease. Primary osteoarthritis should be differentiated from secondary osteoarthritis. Primary is the wear and tear caused due to growing age. And secondary osteoarthritis is because of some injury, trauma or it could be because of some disease. So these have to be differentiated. Like there is inflammatory arthritis, Which we call Rheumatoid Arthritis, which is not osteoarthritis. So today, we will only talk about osteoarthritis. 

Who is most at risk for osteoarthritis? | Osteoarthritis Treatment & Symptoms

Our expert compares it to the graying of hair or needing specs. Everyone after a particular age is predisposed to osteoarthritis. Usually, we used to see this disease after 50-55. But nowadays we see it in people above the age of 40-45. 

This could happen because of multiple reasons—lack of exercise. Obesity, being overweight, is the single most important risk factor of osteoarthritis. Then it can be seen in people who do not eat healthily and in people who don’t do any physical activity. If you have any osteoarthritis history in your family, you are predisposed to osteoarthritis. These were the risk factors of osteoarthritis of the knee. 

What are the signs and symptoms of osteoarthritis? 

People in their 40s or 50s complain that they find it difficult to get up from a low sitting position. This is the first sign of osteoarthritis. Later on, climbing the stairs, especially coming down, is painful. And then the walking starts to become painful. After that, the patient could walk longer miles without knee pain. In the next stage, resting pain also starts. Your knees may hurt even if you are just sitting and doing nothing. 

So these are the various stages of osteoarthritis, depending on the level of degeneration. So what is osteoarthritis? Like I said it is an age-related degeneration. A normal knee joint looks like this. It has these two bones and cartilage in between them and a lining. This together forms a complete knee joint. 

With age, the cartilage starts to wear out. The joint fluid decreases. And the lining starts to erode. In simple terms, the joint starts to rub, and the fluid reduces. 

Patients often hear from someone that their knee ran out of grease. And he doesn’t like to use the term ‘grease depletion.’ Because when earlier we used to tell the patient this, they used to go home and start eating greasy food and oils. Which resulted in weight gain and worsened the condition. So this is not the grease. It is a natural joint fluid that starts to reduce. 

What is osteoarthritis and what type of joints does it affect?

The most common joint that we see of osteoarthritis is the knees. Because we are used to sitting cross-legged on the floor, sitting on an Indian toilet, and of course, there’s obesity. The knee is the most common joint as it is a weight-bearing joint. 

And there are also cases of osteoarthritis of the hip and a few cases of osteoarthritis of the shoulder and hand. But the knee followed by the hips is the common joint that is affected by osteoarthritis in an obese patient. 

What are the Osteoarthritis Treatments? | Osteoarthritis Treatment & Symptoms

Early-stage

When you go to an orthopedic doctor, they first take an X-ray. And in that X-ray, we see the gap between the bones lessen. The cartilage is seen as a gap in the x-ray, and we can see the bones coming closer together. The inner part of the joint comes closer, and therefore the patients always complain about pain in the inner part of the joint. Later there comes a stage where the bones come so close that they start to rub against each other. And as there is no gap now, we can see a bowing of the knee in the elderly. And it also starts to hurt. 

So there are different treatment options depending on what stage the osteoarthritis is. 

In the early stage, weight reduction is a very important part. There is a certain factor that we cannot control, like age. So controlling our body weight is the only option we have. The wear and tear cannot be stopped or reversed. But it can be slowed down. The thing which will take 2 years to deteriorate, we can delay it for 5 or 10years. 

After weight reduction, the other thing is physical exercise. There are muscle exercises for the knees that we suggest to the patient. There are certain do’s and don’ts to this. 

Don’ts: 

One should avoid sitting cross-legged on the floor, switch to western toilets, avoid standing for long hours. Prolonged standing worsens the knee. So all these things should be avoided as they may worsen the pain. 

Do’s: 

Appropriate weight loss knee exercises can help improve the pain and delay the degeneration process. So at the early stage, we suggest weight loss, exercises, and prescribed cartilage supplements and pain killers. 

Middle-stage 

When osteoarthritis reaches the next stage. Where these conservative treatments don’t work, and the patient’s pain keeps increasing. We resort to injections, which can be synthetic as well as natural. This helps lubricate the joints. This can delay the problem for 1-2 years. But this treatment method is for the in-between stage, not too early, not too late. 

Late-stage

The late-stage is when there is no gap between the bones, and they are rubbing against each other. In this case, we opt for a very safe, bloodless, painless surgery. As you must be aware, total knee replacement surgery is very safe and very effective. 

When to get this surgery? 

If you have:

  • A severe knee damage, 
  • Are above the age of 50-55, 
  • Your X-ray shows that your bones are rubbing into each other, 
  • You have to have a painkiller each morning

The patient asks me when to get this surgery. My answer is very simple. This surgery is for your quality of life. If your knee doesn’t allow you to do your normal chores, or you have trouble walking, and you have to take a painkiller daily and if your pain is unbearable, then you must consult your orthopedic doctor about this. 

If he examines your X-rays and sees that your knee is in bad condition, it could be 50 years or 65 years,  and then he would suggest knee replacement surgery accordingly. Go to a good, experienced surgeon and get it done in good time.  We would consider the surgery a success if the patient comes to us walking and pain-free. 

High motion resurfacing 

Our expert would Like to tell the patients about the new technique and better implants called High motion resurfacing. Instead of replacing the entire joint,  they just change the topmost layer. The patient can walk the next day after the surgery. On the fifth day, the patient can walk home. But we stress not waiting this long for the knee to get to this point. And they don’t suggest not getting the surgery done. If they get the surgery done at the right time, there is very less bone cutting required. And it ensures faster recovery. 

Exercises for Knee Osteoarthritis and Joint

A lot of patients ask me which exercise, yoga, or cycling is better for our knee osteoarthritis. Any exercise that requires being the knee too much, like Padmasana and Vajrayana, should be avoided. The rest of the yoga exercises that do not require bending the knee so much are very helpful. Cycling is a very good exercise for you. Swimming is very good. You can walk depending on how much pain you are in. Running, skipping, and jumping should be avoided. Like he mentioned before, prolonged standing should be avoided. Cycling is the best, the muscles would become stronger, and it won’t put too much pressure on the knee. 

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ACL Injury Treatment | Anterior Cruciate Ligament एसीएल इंजरी कारण, लक्षण और उपचार

ACL Injury Treatment

ACL Injury Treatment (Anterior Cruciate Ligament): Signs, Symptoms & Risk Factors | लिगामेंट इंजरी को कैसे ठीक किया जा सकता है?

In this video SimpliHealth expert Orthopaedics Dr. Manpal Singh Narula will talk about ACL injury treatment(anterior cruciate ligament) and its Signs, Symptoms & Risk Factors. This ligament(ACL) is found in the knee and mostly gets injured during sports. According to our expert this injury occurs in sports like cricket, football, kabaddi, basketball, and other contact sports that require the player to move fast and twist and turn. 

ACL Injury Signs & Symptoms

Many patients tell me that they were just playing and suddenly turn to twist their knee with a popping sound. The patient may have swelling and pain in the knee for about a week. Then after that, the patient may start walking, even if the tear is not diagnosed. But they can feel the difference and lack of strength in their knees. They feel like the knee would displace itself and fall off, along with pain and swelling. 

These are the symptoms that the patient comes to us with. And after investigation, we trace back to the injury where they hurt their knee or fell. And that is causing pain, swelling, and instability. 

What is ACL(Anterior Cruciate Ligament)?

We have certain ligaments in our knee joints. Some are on the inside and some on the outside. There are cross-shaped ligaments that provide stability to the knee, one on the back and one in front. The one in the front is the anterior cruciate ligament, and the one in the back is the posterior cruciate ligament. These ligaments go from one bone to the other. And are placed in a criss-cross fashion. And when there is a tear in the anterior cruciate ligament, we call it ACL injury. 

What are the risk factors of this ACL Injury Treatment | Anterior Cruciate Ligament

An ACL injury can happen to anyone. However, sportsmen who play rough contact sports and the people who are overweight are at risk of getting this injury. 

But mostly,  people who play high-intensity sports are at high risk of ACL injury. When people come to us complaining about the limp in the knee and pain, we clinically examine them. In this clinical examination, we check for the stability of the knee. The ligament holds the knee in place, but the knee moves front and back instead of rotating without the ligament. Various diagnostic tests like the Lachman test, which check the pivot shift. We see if the knee is moving outwards. This is an acute injury. If the injury is a few days old, then we prescribe anti-inflammatory and provide a knee brace. 

These ligament injuries cannot be detected in an X-ray. It has to be clinically examined by a doctor, or it can be diagnosed with an MRI. Once the MRI has confirmed the tear, we have to determine whether it is a partial or complete tear. 

Partial ligament tear

If it is a partial tear, not very serious. We provide the patient with a knee brace. It is like a belt to keep the knee straight. We suggest the patient rest for 4-6 weeks. Followed by gradual physiotherapy rehabilitation and mild pain killers. A partial ACL injury and some other ligament tears heal very well with the knee brace and some anti-inflammatory. We suggest an initial period of rest and we give some cooling time of 3-weeks so that the other ligaments heal. 

Total ligament tear | ACL Injury Treatment | Anterior Cruciate Ligament

If it is a total ligament tear then we suggest getting an ACL reconstruction. This ligament cannot be repaired. We have to make a new ligament inside the body. And this is called ACL reconstruction. And this minimal invasive procedure is done with a telescope called arthroscopy. It is a bloodless, painless surgery. The patient can start walking from the third day. Of course, there is a knee brace required. In 5-6 weeks, he’s walking normally, and by three months, he can resume normal sporting activity. So it is recommended to get a reconstruction surgery done for a total ligament tear. 

There could be a few complications if the knee is not treated. First, it will always be unstable. Second, the person can get arthritis sooner than expected. This is a very safe surgery. We take a ligament from the inside of the knee and fold it multiple times to give it strength. And then, we attach it to the original place of the ligament. There are new implants available now to fix this, which dissolve inside the body, they are called biodegradable screws. We can take this ligament from anywhere, like the round T ankle. We call this ACL reconstruction surgery. 

So we are making a new ligament from ligament from your own body. And the results are so satisfying. 

Like our expert said, professional players suffer from an ACL injury, and after this surgery, they can resume their professional game just after 3-6 months, which is a very demanding activity. So this is the extent of the success of this surgery. You can regain the normal strength of your knee. 

And he advises you not to ignore this injury at all. If it is a partial tear, then rest and rehabilitation are a must. And if it is a total tear then you should go for ACL reconstruction surgery, which is a very safe and predictable surgery. 

People who suffer from a partial ACL tear,  people who we suggest not to get the ACL surgery, people who are past 50-55 years, people who have a desk job, for them, exercise becomes a very important part of the treatment. 

When he says exercise, He means you should strengthen your quadriceps and hamstrings. So it is very important that you strengthen the muscle surrounding both the knee joints. This will reduce the work of the ACL. And the stronger we make the muscles with good exercise and good rehabilitation, the more helpful it will be to overcome the partial tear. 

Please do not ignore exercises whether you opt for surgery or not. Exercise before and after the surgery remains a very important part of your treatment. 

In the end, he would like to give you this message: stay safe, stay healthy, and do not ignore these sports injuries. Consult a specialist if you have these injuries because what you do in the early stage of the injury determines the quality of your life. 

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Apollo Clinic Chandigarh Orthopedic

Lower Back Pain Treatment | Neck Pain | Slipped Disc Treatment कारण, लक्षण और उपचार | कमर दर्द का कारण

Lower Back Pain Treatment

Lower Back Pain Treatment | Neck Pain | Slipped Disc Treatment Causes &Prevention | यदि आपकी कमर का दर्द टांगो में जा रहा है तो हो जाएँ सावधान!

लोअर बैक पेन क्यों होता है?

Lower back pain treatment, In this video SimpliHealth expert in Orthopaedics Dr. Manpal Singh Narula will talk about Back Pain(कमर दर्द) in young people and its causes, prevention, treatment and when to see a doctor. Ouch, doc, I think I just pulled my back. Any orthopedic doctor sees this problem as very common in their practice. They say that backache is the price we pay for our erect posture. Animals don’t have backaches. This is because we stand on our legs and walk erect. And this wrong posture becomes the cause of backache and back sprains. 

Lower Backache & Neck Pain

Let’s talk about lower backache and neck pain, prevalent conditions in orthopedic practice. There are various reasons for this. And the causes are different in different age groups. So, for example, in a young patient, this is because of bad posture, long sitting hours, lack of exercise, etc. When we go to a slightly older age group, the cause can be long sitting hours, sitting jobs, lack of exercise, and wrong posture. Now in the elderly or old age, it can be because of weak bones (osteoporosis), the muscle power is less, and then, later on, there can be spondylosis and other age-related problems. 

Back Pain(कमर दर्द) in young people

The topic I will be discussing with you all today is backache in young people. And what causes it, how we can prevent it, and when to see a doctor. The common complaint that the patients come to us is that they tried to lift something or bent over and felt an acute spasm in their back. And sometimes, this pain moves lower towards the legs as well. 

Is your leg ache a sign of a slip disc? 

If it is only back pain, it is not that big of a problem. But if the pain is going to the legs, it should not be taken lightly. A muscle sprain or a back sprain always starts with simple back pain. And then, after 1-2 weeks, the pain moves towards the legs. The third stage is when the legs start feeling numb, and there is a tingling sensation in the legs, which we call paresthesia. And after that, there is a stage where the legs fail to work or other conditions like bladder and bowel. 

We will discuss a very common condition called slip disc. Back pain is a very layman term for slip disc. Keep in mind, not every slip disc causes back pain and not every back pain is a slip disc. 

What is Slip disc?(स्लिप क्या है?)

This is a model of our vertebrate column. And these are the vertebrate bones. Between every two vertebrae, there is an intravertebral disc. Inside this goes the spinal cord and at every end comes out nerves that go to our legs. 

Back Pain Causes(कमर दर्द का कारण)

Sudden movements, like bending or picking up heavy weight, as the youngsters who go to the gym do. This is a point to note that this happens in very extreme people, those who do not exercise, who are overweight or against working out, and those who do intense workouts like lifting very heavy weights. In both cases, the person may suffer from a slip disc. 

In the start, you see this jelly-like thing comes out like the paste from the toothpaste tube. And this jelly touches the nerves. When the tear is significantly less, then it only causes back pain. This back pain can be very severe. When the material from the inside leaks out, this starts to compress the nerve, which causes the pain to move from the back to the legs. 

Back Pain Symptoms(कमर दर्द के  लक्षण)

The first question I ask my patients is if the pain is moving in the legs or not. When the legs are paining then it is definitely because of the slip disc, which is the second stage. The third stage is the numbness and the tingling sensation in the legs due to the pressure on the nerves. And if this is not controlled, it can cause weakness in the legs. 

Back Pain Diagnosis | Lower Back Pain Treatment 

The first thing we ask the patient is whether the pain is going down the leg. If yes then, we ask the patient to get an X-ray. But from an X-ray, we only see the posture in the young person and not the nerves or the disc. We do not get a lot of information, in young people. If the pain is going down the leg, then there is only one investigation for this and that is MRI. so this problem with the disc is mostly diagnosed only by an MRI. 

Back Pain Treatment (कमर दर्द का इलाज) 

95% of disc patients do not need any major treatment. They need rest for 5-7 days and then physiotherapy and some mild anti-inflammatory. In the 5% of cases that we see any abnormality in the MRI, like pressure on the nerves, is too much, we talk about surgery, which is very safe. 

It is a very safe and minimally invasive surgery. The next day the patient goes home walking. And there are no complications, no blood, and no pain. There is also a small category of patients that do not respond to medications or physiotherapy. These patients can be helped with an injection called an epidural injection to block the nerve. 

So there are three main Treatments | Lower Back Pain Treatment 

Conservative | Lower Back Pain Treatment 

This is nonoperative. In this, we prescribe medication and the initial period of bed rest. 

I would like to tell you that the thought process from before was if someone has slip disc, they should lie down. But this is a very obsolete concept. People who exercise recover much faster than people who do not. So the concept of bed rest is very obsolete. Bed rest is required only for the first 5-7 days if the pain is too much. After that, the physiotherapy should be started; 80-90% of the patients get better only with the help of physiotherapy. Physiotherapy is back strengthening exercises and of course, overall exercises. 

The right posture plays a very important role. As you see, I am sitting on a chair right now. Whenever you sit on a chair, try to sit very erect. Either you sit on the edge of the seat or sit at the back like this to erect your posture. Try to have a raised stool under your feet to elevate your legs. If you have a long sitting job, this is the best posture to sit. Legs a little elevated, back supported, and try to sit erect. 

If you keep your posture correct and exercise regularly, back strengthening exercises is a special regime that you must learn from your physiotherapist. So you can get rid of 95% of your back pain and avoid disc problems. 

And if your problems escalate, and in the MRI it suggests that you should get surgery, then I would suggest you go to a specialist who is trained in spine problems. Suppose the MRI shows that your disc is not normal and the doctor suggests surgery. Then you should go for the surgery. It is very safe. If done in good time, you will have 100% recovery. There are no long-term complications. 

A good healthy diet, regular exercise, and weight reduction will always remain a very important part of the treatment in every age group. In older adults, I suggest they take calcium and vitamin supplements and control or maintain their weight. 

Prolonged standing and prolonged sitting in one place should be avoided. Walking is good, exercise is good. However, sitting in one place, especially working from home, can cause back issues. 

Stay healthy, stay safe. And visit your doctor whenever you have prolonged back problems. 

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