Impingement Syndrome. What is it and how is it treated?

Impingement Syndrome is a medical condition, where the bones of the shoulder intrude or ‘impinge’ into the tendons or the bursa; the liquid filled, bag like structures, acting as a shock absorbing medium between the bones and muscles around a joint. The human shoulder joint is the most common joint that is affected by this condition.

Signs & Symptoms:

Persistent pain, along with loss of movement at the joint and a feeling of weakness, are the most common signs. Any overhead movement of the shoulder or even lying down and putting weight on the shoulder, can cause severe pain. Other symptoms include a grinding, popping sound on moving the joint. If left untreated, it causes inflammation of the bursa and the rotator cuff tendons, and even leads to tearing of the tendons.

Causes:

Age. People above 50 and older are more likely to have this condition. Though younger people involved in movement intensive sporting activities are also susceptible.

Any injury caused to the shoulder area.

Muscle imbalance. All muscles have a mechanical balance for their optimal function and when this is disturbed, i.e. muscles are too loose or too tight, problems start. 

Neurological problems. Current studies have revealed that neural structures and mechanisms and anything that disturbs them, contribute to pain and shoulder dysfunction.

Bone spurs i.e. projections that develop along the bone structure, usually in the joints, can rub into the surrounding tissue causing irritation and inflammation.

Treatment:

The most important objective here should be pain reduction and restoration of functionality, taking into account the age, general health and activity level of  the patient. Treatment is divided into two types, Non-Surgical and Surgical, with preference given to non-surgical.

Non-Surgical:

Rest - complete rest and limited activities of the shoulder and the arm.

Non-Steroidal Medication - to reduce inflammation and pain and encourage healing.

Physical Therapy - to improve the range of motion of the affected area by means of gentle exercises like stretching relieving stress and pain.

Steroid Treatment - when the above three methods are not successful, doctors may suggest treatment with steroids. This is injected directly into the affected area, usually the bursa, and can relieve the pain. 

Stem Cell Treatment - these are cells with the specialised ability to develop into a completely different type of cells. They are extracted from the patient’s body, harvested and injected into the affected area, where they grow and transform into healthy cells, boosting the healing process.

Surgical:

This is a method of last resort when everything else is ineffective. The most common is called Subacromial Decompression, where the idea is to reduce the pressure on the rotator cuff and bursa, by creating space between the shoulder joint and the shoulder blade. This is done using an arthroscope, and in joints with an endoscope.

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Sports injuries

Sports Injury / Sporting Injury - this is a very broad term and includes just about any injury caused when engaged in sporting activities. Though the benefits of exercise and sports to both the body and mind outweigh the risks involved, injuries do happen and must not be ignored, and even the smallest taken with utmost seriousness..

These can be due to: 

1.  Exerting or pushing oneself too hard, leading to body strain and injuries.
2.  Incorrect equipment or poor technique or poor application of the techniques.
3.  A fall or a slip, causing a heavy blow or a joint twist causing muscle strain or damage.
4.  Or, simply not warming up before the exercise.

In sporting injury management, they follow a rule called the R.I.C.E.R rule, which is basically a first aid for any type of sporting injury. It prevents further injury and when applied correctly and immediately, substantially reduces recovery time.

It stands for - Rest, Ice, Compression, Elevation, Referral.

• Rest - this is immediate stopping of any activity, specifically to the injured area to prevent further damage. This period can be for immediately, during treatment or afterwards, or all three.
• Ice - internal bleeding, pain and swelling can be reduced/controlled when the tissue is cooled.  Never apply ice directly to the skin, always cover it with a towel, apply for not more than 15-20 minutes and then remove. Repeat after an hour.

• Elevation - as the name implies, it is lifting the injured part higher to reduce swelling and bleeding. This decreases swelling decreasing pain. For lower limb injuries, the ankle should be held higher than the hip and 48 hours is the minimum advised time.
• Referral - this is obvious. If you do not understand the injury or even if you do, immediately refer with a doctor or specialist. Better safe than sorry.

And if you are in Bangalore, you're in luck as the city hosts quite a few specialists in this field.
And Ortho One Orthopaedic Speciality Clinic is one of the most popular and successful in this field. They have a reputation for providing world class care and the best specialists in this field.

They can be contacted at:
ORTHO ONE ORTHOPAEDIC SPECIALITY CLINIC,
3 / 4, 8TH MAIN (WATER TANK ROAD),
CHBS LAYOUT, VIJAYANAGAR,
BANGALORE,
KARNATAKA, INDIA.
PIN: 560 040.
PHONE - DR. BANARJI B.H. - 97312 74396
EMAIL   - infor@orthobangalore.com
WEB      - www.orthobangalore.com

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What To Expect During Arthroscopic Shoulder Surgery?

Shoulder arthroscopy is a minimally invasive surgical procedure used to visualize, diagnose and treat various injuries or abnormalities in the shoulder and the space surrounding the rotator cuff. This is done through a small incision in the area through which a thin tubular instrument called Arthroscope that is attached to a small camera is inserted. It helps to get a clear image of the joint on a TV monitor, allowing your surgeon to see all the structures inside your shoulder. He can make a precise examination of joint injury and decide on treatment options for recovery from the condition.

When Is It Needed?

Experts might recommend Arthroscopy for many shoulder problems such as bursitis, tendonitis, arthritis, impingement, rotator cuff tears, labral tears, and shoulder instability. They will also suggest when there is persistent joint pain, swelling or stiffness in the joint. Using arthroscopy doctors can diagnose and confirm the pain source and treat damage caused to bones, cartilage, ligaments, muscles, and tendons.

What Are The Benefits?

Benefits of arthroscopic shoulder surgery compared with older open surgical techniques include:

• Minimal scars
• Decreased pain and swelling
• Improved motion
• Quicker functional recovery
• Fewer risks and complications

How Is Shoulder Arthroscopy Is Performed?

During a shoulder arthroscopy the patient will be given an anesthetic before the procedure. The surgeon will make two or three small incisions to insert the arthroscope and any necessary instruments. The joint is filled with sterile fluid which allows the surgeon to view and diagnose the joints more clearly. 

Once the problem in the location is identified, the issue is rectified using small tools inserted through the incisions. After completing the procedure, the fluid is drained out and the incisions are closed with stitches. Most often the procedures take less than one hour. 

You may be in a sling or a special `shoulder immobilizer' after the surgery. Your expert caregiver will guide you through the post-surgery care and will recommend Rest, icing, and anti-inflammatory medications to help decrease pain and swelling. Most often you can begin light exercise in 1 week. However, return to full activities may take several weeks to months.

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Medical procedure for shoulder dislocation

The shoulder gets dislocated when an injury makes the upper arm bone come out of the shoulder blade socket. The shoulder could be dislocated partially or entirely and would cause severe pain and instability. There are mainly three ways in which shoulder gets dislocated, such as:

    1.Anterior - front of the socket  

    2.Posterior - behind the socket 

    3.Inferior - below the socket

Usually, the doctor would recommend surgery when the dislocation has caused severe damage to the joints or when the non-surgical treatments fail. An orthopedic would suggest surgery for young athletes who has frequent dislocations. Surgery could help improve joint stability and prevent dislocations in the future. 

The most common surgeries performed for shoulder dislocation are arthroscopy and open surgery. These are mainly performed to treat the torn ligaments. 

Arthroscopy

Arthroscopy is considered to be a minimally invasive surgery that helps to treat problems in the shoulder joint. The doctor will make tiny incisions to insert the arthroscope that shows the inside of the joint on the screen, and then they will correct the issue. The doctors use special pencil-thin instruments while performing arthroscopic surgery. The doctors can get a clear view of tiny details in the bones, tendons, ligaments, and labrum. 

Arthroscopic surgery is performed using general anesthesia. Doctors would perform arthroscopic shoulder surgery for several shoulder problems such as rotator cuff repair, bankart repair for recurrent shoulder dislocation, bone spur removal, removal or repair of the labrum, repair of ligaments, removal of inflamed tissue or loose cartilage, arthroscopic nerve release, arthroscopic fracture fixation, and calcific tendinitis.  

Open surgery 

Open surgery involves one large incision to access the joint. If the shoulder pain persists or if there is any change in the shape of the bones in the joints, doctors would prescribe open surgery. With the help of open surgery, doctors can repair injured tendons, ligaments, and the labrum or address the damage caused to the bones of the joint. 

Repeated injuries will cause bone loss in the glenoid socket, and with open surgery, the doctor would repair with bone graft. Usually, the bone graft is taken from the hip bone, and the doctor would shape it to fit the rim of the glenoid to create a deeper socket. Gradually, the bone graft will get fused to the shoulder socket and forms a solid bone. This could ensure additional stability for the shoulder and will allow the arm bone to be in place. 

The surgery could depend on the severity of damage to the ligaments, bone loss, and laxity of the tissues. Be it arthroscopy or open surgery, the doctor would advise physical therapy and certain medications for a few weeks to make the shoulders stable again. 

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Shoulder dislocation & surgery

Surgery for severe shoulder dislocation will always be suggested to repair the torn ligaments. It is crucial to correct the position of bones to return the regular movements of the shoulder. A dislocated shoulder is usually caused due to a fall or excessive use of the shoulder wherein the arm bone will come out of the shoulder socket.

Symptoms of shoulder dislocation

Various symptoms or signs of the dislocated shoulder are as follows:

• Severe shoulder & arm pain
• Unable to move the affected arm
• Either in the front or back there will be a bump

Treatment for a dislocated shoulder

If the dislocation of the shoulder is severe, it has to be treated immediately. The surgeon needs to get the arm bone back to the shoulder socket. There are mainly 2 types of surgery for a dislocated shoulder.

• Arthroscopic shoulder surgery - using a slim, pencil-sized tool termed arthroscope and with a tiny cut, the surgeon inserts the arm bone into the socket. This is usually performed after giving general anesthesia
• Open shoulder surgery - even after arthroscopic shoulder surgery, if the pain continuous then, open shoulder surgery is recommended. Instead of several small cuts, a single cut is made above the shoulder joint. This is performed to repair the injured joints, ligaments, tendons or any other damage on the shoulder joints

Tips to keep in mind post the treatment

Even though the surgery can treat the dislocated shoulder, there are a few tips to do to take care of the shoulder from further injuries such as:

• Keep ice pack - it is good to keep ice on the shoulder after the surgery as it can give some relief for the swelling and pain. It is advisable to keep the ice pack for 30 minutes for a week or more
• Use the sling - after the surgery, it is recommended to use a sling for a few days or weeks until the doctor asks to remove
• Medication - never skip the medicines or pain killers prescribed the doctor. There would be side effects for the medicines, so it is better to consult the doctor on time
• Exercise - if the doctor has asked for some physical activity, continue doing some simple exercises that could help the movements of hands and shoulders. Stretching and strengthening exercises can bring out good results later
  

 Never try to get back to the old routine before the doctor's advice, as it will create more injuries and issues to the shoulder.

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Getting Back to Normal After a Shoulder Replacement Surgery

Preparing yourself for an extensive joint replacement surgery can be an intimidating task. If you're considering a shoulder replacement, you should have a closer look at what you can expect throughout the recovery process.

The recovery process begins right away after the successful completion of surgery. The process usually starts with a short stay at the hospital. Your arm will be in a sling, and your incision will be covered with a dry bandage.  

Right After Surgery:

You may feel some pain after surgery, which can be managed with medication to make you feel as comfortable as possible. This will be given either by injection or pump as per the pain severity.

Ice packs will help control pain and swelling when placed on your shoulder. Inhaling profoundly and frequently coughing after surgery can help you to clear your lungs and avoid possibilities of lung congestion. 

Ortho One orthopedic specialty clinic provides you with the luxury recovery suite for ensuring a fast recovery. Our expert doctors will provide you with a list of exercises that you can do to keep your muscles active without damaging the replaced shoulder. This will help you to prevent your elbow and shoulder from getting stiff. 

First 10 Days After Surgery:

Once you have returned home, it is imperative to follow the instructions of your shoulder surgeon, to care for your incision. You may have to use pain medications and anti-inflammatory medicines which helps to prevent blood clots.

Being physically active is essential for faster recovery. When you can move your hand, start making a fist and holding it for five seconds or more and release it. This will enhance your blood circulation and should be done frequently. 

During the next three to six weeks, you need to protect the shoulder so that the muscles can heal. Experts of Ortho One orthopedic specialty clinic will help you with a physical therapy exercise plan for your shoulder. During the first few weeks of recovery, Our physical therapist will teach or help you perform specific exercises to strengthen your arm and shoulder.

1-3 Months After Surgery

In the next few months after the surgery, you'll undergo a physical therapy program including stretches and exercises that are meant to:

•     Build muscle strength
•     Increase your range of motion
•     Protect your new joint
•     And help you get back to healthy living, pain-free

Taking this part of your rehabilitation seriously is essential. These exercises will be challenging to perform in the beginning but will get more comfortable every day. Around 80% of your normal shoulder function can return over the first few months, but it takes time and effort.

The Next 9 Months

These nine months consist of less intense therapy but are still crucial to the recovery process. If 80% of the function returns in the first few months as we said earlier, the next 9 months can bring the return of the final 20%. Getting the most of your new shoulder will take time, but after a year of recovery, patients can perform all of their normal activities comfortably. 

Shoulder joint replacement surgery is a very successful operation and has an excellent recovery rate. Many patients end up with extremely functional shoulders. They were able to return to the normal activities of their life and low impact sports without pain.

According to the experts of Ortho One orthopedic specialty clinic, the best way to get the most from your new shoulder joint is to take your recovery time seriously and dedicate yourself to the therapy exercises prescribed by your caregiver. 

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Treatment Options & What Should I Know Before And After Shoulder Replacement Surgery

Multiple Options for Shoulder Replacement Surgery

Many people develop shoulder pain with increasing age and some others experience it due to injury or fracture. Such pain and stiffness in the shoulder gradually make it difficult for the people to survive. To treat such conditions shoulder replacement surgery is the right solution.

Shoulder replacement surgery is a successful procedure that has helped many patients suffering from severe shoulder joint pain. Many patients get back to the activities they love like playing tennis, swimming, golf, yoga and other personal interests after the shoulder replacement surgery. Shoulder replacement surgery brings great relief from pain and restores strength to the shoulder.

Shoulder Replacement procedure involves removing the damaged shoulder joints or caps and replacing them with artificial implants. If you are struggling with shoulder pain or arthritis, consult Dr. Banarji BH, who is one of the famous and well-experienced Orthopaedic Surgeon in Bengaluru.

And also check out the different options for shoulder replacement surgery :

Total Shoulder Replacement- It is also called traditional shoulder replacement. In this procedure, the damaged joint surface is replaced with a metal ball. Total shoulder replacement is considered to be most reliable for patients with bone on bone osteoarthritis and rotator cuff tendons.

Stemmed Hemiarthroplasty- During a partial or stemmed shoulder hemiarthroplasty, only the humeral head of the arm is removed and replaced with a prosthetic ball. Hemiarthroplasty is suggested when the humeral head is severely damaged and the socket is normal.

Resurfacing Hemiarthroplasty- Unlike a stemmed hemiarthroplasty, shoulder resurfacing does not require the complete removal of the humeral head but only the damage in the humeral head is fitted with a smooth cap-like prosthetic.

Reverse Total Shoulder Replacement- This treatment is helpful for people suffering from severe arm weakness. In this procedure, a metal ball is attached to the shoulder and socket is attached to the upper arm bone.

Things you should know before and after the shoulder replacement surgery 

Before the surgery

Days before the surgery, an Orthopaedic Surgeon may ask the patient to undergo a complete physical examination to determine the general health condition. Weeks before the procedure, a patient needs to quit smoking, drinking, and intake of certain medications. The surgery is done under general anesthesia and may take about two to three hours.

After the surgery 

A patient needs to stay in the hospital for two to five days after the surgery. Most people require around six weeks for recovering.

Pain Management- The patient may experience pain as a part of the natural healing process. Medications are prescribed to relieve from pain and antibiotics are prescribed to prevent infection. Pain management is an important part of the treatment and physiotherapy also begin soon after the treatment.

Rehabilitation- A well-planned rehabilitation program is necessary for the success of shoulder replacement. Physiotherapy is started soon after the surgery. The physiotherapist also suggests some home exercises which is necessary to strengthen the shoulders.

As with any other surgical procedures, there might be slight complications which happen only in rarest cases such as infection, bleeding, and swelling. Such complications can be avoided if you consult an experienced Orthopaedic Surgeon like Dr. Banarji BH. 

To book an appointment call @9731274396.

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