Injections for Knee Arthritis

Sometimes knee arthritis simply does not respond to medications & physiotherapy. It becomes desirable, then to inject the knee joint to improve the symptoms of arthritis. Here are some facts you should know before getting that jab.

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1) Will it be painful?

That’s the most obvious question in everyone’s mind. The knee joint is the largest joint of the human body. It has lots of space inside to accommodate the injection & if carefully given (without the needle touching the bones of the knee), it is essentially a painless procedure after the local anaesthesia is injected in the skin. This injection (local anaesthesia) is done with such a tiny needle that its prick into the skin is virtually painless.

2) Will it be harmful to my knee & body?

This depends on the type of material injected into the knee joint. The most commonly injected material is a depot (oil based) preparation of a steroid like methylprednisolone. It works wonders for the acutely inflamed knee of inflammatory arthritis (like rheumatoid), but is merely a short term time buying procedure for the more common osteoarthritis. Repeated injections (more than 4 in a year) can be detrimental to the knee’s cartilage & will hasten its breakdown, thereby accelerating the progress of arthritis. Being oil based, very little of the steroid escapes into the body & is thus safe from that point of view, but caution is exercised in those with diabetes, glaucomas & kidney problems.

The second category of injection material actually lubricates the joint. It contains a high viscosity material that mimics the properties of healthy joint fluid & improves joint lubrication. It works best in early stages of osteoarthritis & its benefit has been shown in clinical trials (OASIS) to last upto an year (Synvisc One). It is of little use in very advanced stages of osteoarthritis & in all stages of inflammatory arthritis (rheumatoid). Apart from minor pain at the needle entry site that may occur in a few people, this injection is very safe & gaining popularity because of its joint preserving nature.

The third category of injection that is slowly emerging as a new entrant is the stem cell injection (Platelet Rich Plasma or PRP). Here 30 - 50 ml of one’s own blood is purified into 3-5 ml of platelet rich plasma & injected back into the knee. It is still in the experimental stages with inconsistent results. However since it is the patient’s own blood that is injected in a filtered manner, it does not have any side effects. The initial post-injection period is however more painful compared to the above two injections.

3) How long will the effect last & how often can it be repeated in osteoarthritis?

With the steroids, effect lasts for 2-3 weeks, synvisc one works for an year & with PRP the results are not yet known. Steroids are best not repeated, synvisc one can be repeated as many times as desired & with PRP the protocol of repeat injections has not yet been firmly established.

4) What precautions need to be taken for these injections?

If you have diabetes or glaucoma, please inform your orthopaedic surgeon. It is better not to get injected with steroids in these cases. Always get the injection in a sterile environment like the minor operation theatre. Rest for 1-2 days after the injection. Pain may temporarily increase immediately after injection, ice packs & anti-inflammatory medicines will take care of it.

Have realistic expectations from the injection, do not expect it to do magical things. Synvisc one for example starts working only after a month of injection. Do not expect the injection alone to do the trick for you, continue with exercises & lifestyle modifications (refer to my earlier blog). So if your orthopaedic surgeon recommends an injection, do not go into a panic mode, educate yourself about the injection & take a careful prepared decision that can change your lifestyle.

Knee Caps & Braces in Knee Osteoarthritis

Almost everyone with knee arthritis is wearing some sort of a contraption or the other for relieving their pain. These externally worn aids are called by various names, knee caps, braces etc. Do they really help? Let's find out.

Types of knee braces

1. Soft knee braces, like knee cap
2. Hard knee braces, like hinged knee brace
3. Offloading knee braces

Theoretically a brace should offload the diseased portion of the knee, in order for pain relief. It is therefore obvious that all soft knee braces like the knee cap are ineffective in doing so. Let's face it, something slightly thicker than socks cannot protect your knees. However they do bring about pain relief from a different mechanism. They tightly encircle the knee & the user's brain gets the feedback that my knee is tight or something is supporting my knee. What actually happens is that their wearing either takes away or distracts the brain from the knee pain or induces a reflex contraction of the thigh muscle (the quadriceps) that gives a feeling of having a stable knee. Pain after all is an unpleasant sensation conveyed by the nerves to the brain & diverting the brain's attention is the main way by which all the anti-inflammatory creams work. Most of them contain an irritant that sets up a minor pain sensation around the overlying skin, that diverts the brain's attention away from the bigger pain smouldering inside! It is a widely held myth that they actually penetrate through the intact skin & heal the hurt.

The rigid knee brace or the hinged knee brace is used in case there is injury to the collateral ligaments of the knee joint. The knee has 2 sets of ligaments called the collateral ligaments that run along the inner & outer side of the knee respectively. They usually get injured in a fall & depending on the direction of the fall either the inner (medial collateral ligament) or the outer (lateral collateral ligament) gets injured. These hinged braces are useful in helping these injured ligaments heal. They have absolutely no role in knee osteoarthritis, unless there is diagnosed ligament instability by a clinical examination.

The offloading braces are a whole new species of knee braces. These braces are designed so that once worn, they offload a certain portion of the knee & transfer that load to the other portion, something like Robin-hood (steal from rich & give to poor). They are very useful in moderate to mild stages of arthritis (decided by the x ray) in which one expects one half of the knee (usually the inner half) to be diseased & the other half of the knee (usually the outer half) to be healthy. In advanced arthritis (again decided by the x ray), wherein both sides of the knee are diseased, they have no role!

Do you need a brace?

Yes & no. You certainly don't need a knee cap or a hinged brace for arthritis. You are much better off & much more comfortable doing exercises & making subtle changes in your lifestyle (refer to my earlier blog post). If you have end stage knee arthritis, then also you won't benefit from any brace, you may be better off getting a knee replacement. 

If your doctor is able to diagnose isolated arthritis of one half of the knee, then you will benefit from an offloading brace. The problem with the offloading brace is that it also offloads your purse! Most such braces come upwards of 30000₹ per brace. Another problem is that you need to wear them throughout the day, which may be a challenge in our mostly tropical climate & if you are fond of tight clothing. Sometimes these braces simply don't fit us Indians as they are designed for Caucasians, we sometimes have a great discrepancy in the thigh & leg diameters & that causes the brace to lift off the skin in some places. An ill fitting brace will not work for you & might actually be counterproductive by constantly rubbing against the skin & eventually ulcerating it!

How soon will the brace start having its effect?

We are all in a terrible hurry to see results, especially after spending a fortune on the offloading brace. Results in term of pain relief takes time. Initially just like a new shoe, the knee may feel sore. Some people don't obtain that much relief in pain, but their mobility & joint flexibility improves. In a nutshell it is unrealistic to expect magic from the brace. Be prepared to wait out a few weeks for its effects to kick in.

Are offloading braces available in India?

Yes, but only on a doctor's prescription. All the braces available off the shelf are mostly ineffective as far as knee osteoarthritis is concerned.

Actionable advice:

1. Kick off your knee caps & exercise instead.
2. Adopt simple lifestyle changing measures (ref, my earlier post) to get relief from the pain.
3. Consult your orthopaedic surgeon to see if offloading braces will be useful to you.

Content copyright of Dr Raju Easwaran

Knee Osteoarthritis Treatment in India

Knee osteoarthritis is sometimes not considered to be a disease, it is simply a normal manifestation of ageing, like grey hair. Everyone will develop arthritis one day or the other, we are just genetically programmed to get it at different ages. Some develop it early, some develop it late. Knee arthritis is not the end of the road in terms of living an active lifestyle. With these suggested lifestyle modifications, you can delay or prevent the eventual manifestations of the disease.

Swim, swim, swim. It is a well known fact that in water we feel lighter due to the Archimedes principle. Stiff & painful joints ease up like magic in the water. If you don't know how to swim, simply walk across the length & breadth of the shallow section of the pool, or immerse your feet in the water, sitting on the edge. If you know how to swim, it is a great advantage. You know what, it is never too late to learn. If you also suffer from backache, it will improve with swimming. Another silent advantage is the amount of Vit D you make during an hour's swim with your body exposed to the sun!

Aerobic exercises for 30-60 minutes a day will keep you & your knees healthy. Brisk walking is one of the best forms of aerobic exercise. There is a lot of confusion regarding whether people with knee pain should do a regular morning walk or not. It is recommended that you walk on soft surfaces like grass or artificial turf or a high end treadmill with built in shock absorbing properties. Walking or running on hard concrete & similar surfaces can aggravate your knee pain. In case of confusion remember that apart from the knee you have a heart & a pair of lungs. They demand aerobic exercise & brisk walking is the best form of that. Exercise done properly didn't do anyone harm!

Resistance training or weight training done 2 times a week keeps your bones strong. You should do one type of exercise for the upper body like dumbbell curls & one variant for the lower body like the leg press. 8-12 repetitions should be targeted with 60-70% of the weight you can lift maximally. For example if you can do a biceps curl with 20 pounds, pick 12 pounds instead.

Let's face it. Orthopedic exercise is boring. We forget to do it often enough. One of the biggest challenges is to remember when to exercise. If we set target oriented goals like doing a set of exercises immediately before breakfast, lunch & dinner, then we are more likely to remember to do the prescribed orthopaedic exercises.

Say no to certain things, like squatting, cross legged sitting. If you have a lift don't use stairs. If you don't have a lift, use the stairs as sparingly as possible. 

Watch this space for more relevant information that may help your sore knees. Till then get up & exercise!
Know More about : Best Osteoarthritis Treatment in India
Know More : Knee Arthroscopy , Knee replacement surgery , Knee Ligament Injuries

Arthroscopy : An Effective Joint Pain Treatment

What is Arthroscopy ?

Artheroscopy is one of the modern methods for pain relief. Artheroscopy is a surgical Procedure, which allows the surgeon to view the inside of join and can inspect with a micro lens called an arthroscope. One or more micro lenses are used to diagnose and treat the diseased joint. Its equipment includes a small tube that is connected with optical fibers  and lens. The images inside the joints are relayed to the monitor and the doctor can make a diagnosis. More than 1.4 million People are performing the this world wide each year.

Arthroscopic Surgery

Benefits of Arthroscopy.

In Normal Surgery The Joint will open Completely and it will take more time to Recover from the surgery. But In Artheroscopy Did not open completely because of that the quick relief will happen.
This reduces the recovery time and increases the success rate. It is mainly used for athletes, they are frequently injured joints and require quick healing. Artheroscopy will take Less Scaring.
The instruments used in this surgery are so small compared with the normal surgery.
We can watch the joint part on a video monitor, and doctor can diagnose.Less Pain compared with normal surgery.Lower risk of complications.Pain Free Life After the Treatment. Arthroscopy, Knee Surgery. Negligible blood loss. Less Chance of infection.

Shoulder Arthroscopic Surgery

Difference Arthroscopic Surgeries

Knee Arthroscopy or KneeReplacement Surgery for Knee Joint pain.

Shoulder Arthroscopy or ShoulderReplacement Surgery for Shoulder Joint pain. 

Hip Arthroscopy or Hip Replacement Surgery for Hip Joint pain.

Wrist Arthroscopy or Wrist Replacement Surgery for Wrist joint pain.

Elbow Arthroscopy or Elbow Replacement Surgery for Elbow joint pain.

Ankle Arthroscopy or Ankle Replacement Surgery for Ankle joint pain.

One of the best Atheroscopy Treatment Center in India

Shree Meenakshi Orthopedics & Sports Medicine Clinic Delhi

Website : http://www.drraju.in/ you can schedule your treatment through our website. 

Shoulder Arthroscopy Treatment and Recovery

SHOULDER ARTHROSCOPY

What is shoulder arthroscopy

Shoulder arthroscopy like knee arthroscopy is an operative procedure wherein the interior shoulder joint is inspected with a 4 mm camera and using one or two similar sized cuts, a variety of surgical procedure can be done.

Why shoulder arthroscopy?

With advances in orthopaedic technology, modern shoulder arthroscopy allows as a patient to get a full, fast and almost painless recovery after surgical procedure. Surgeries that previously required 6 inches long incision, prolonged hospitalization and blood loss can now be managed with small 4mm cuts, day care admission and minimum blood loss. That translates in to a smooth recovery and minimum interference with your daily routine.

Do you require a shoulder arthroscopy?

Yes you do, if you have any one of the following conditions.

• Multiple shoulder dislocations
• Major tears of important shoulder muscles (rotator cuff tears) causing pain, especilaly in the night.
• Extra bone growth in the shoulder pressing on rotator cuff and causing pain & weakness (impingement syndrome)
• Frozen shoulder which has not responded to steroid injections and physiotherapy.

Are there any risks or complications that I must be aware of?

Shoulder arthroscopy is a very safe procedure, but like most surgical procedures, it has its own set of known complications:

• Swelling over the shoulder accommpanies nearly every surgery. This is because we need to pump in saline in to the joint under high pressure to see it properly and some of the saline gets collected around the joint. This will resolve over a week's time.
• Stiffness of the shoulder will be experienced by most patients initial 2-3 months after the surgery, especially if a pair has been done. Gradual physiotherapy will help you regain strength in 3-6 months after the surgery.
• Apart from these, the risks of anaesthesia, infection, bleeding, etc. Are best discussed face-to-face with your treating surgeon.

How long does it take to recover fully?

For the first 6 weeks after the surgery, your shoulder will be kept immobilized in a sling. Gentle exercises called pendulum exercises are allowed in this time period. After 6 weeks the sling is taken off, and gradual movements and strengthening are begun. Its generally takes you till 3 months after the surgery to get back to normally (the above does not apply for frozen shoulder release, where full recovery is expected in 1-2 weeks time).

RECURRENT SHOULDER DISLOCATIONS

Why surgery?

Shoulder arthroscopy in India is most commonly done for multiple shoulder dislocations. The shoulder is the most mobile joint of the human body and this mobility comes at the cost of poor stability. There is a tissue in the shoulder called the glenoid labrum, which acts like a speed breaker and prevents shoulder dislocations. Once the shoulder dislocates in any directions due to trauma (ususlly the front) this speed breaker is torn. That is the reason that once dislocated, the shoulder keeps on redislocating to the tune of 90%, if the first dislocation is sustained below 30 years of age. The patient lives in a continuous fear of his/her shoulder dislocating all the time.

What is done in surgery?

When we operate shoulder dislocations, we aim to reattach the torn portion of the labrum back to the bone (glenoid). This can be done with tiny 4mm punctures, using specialized screws called anchors (generally 2-3), which go deep inside the bone and allow us to stitch the torn tissue properly.

ROTATOR CUFF TEARS

Why surgery?

The rotator cuff is the deep muscle of the shoulder. It is responsible for the smooth movements of the shoulder joints. Patients in whom it is torn are suddenly unable to lift their shoulders, or are only able to do so with considerable pain. The arm becomes weak, and in longstanding cases stiffness and arthritis sets in. There is continuous pain especially in the night, while lying down on the affected side. It generally happens in patients who are more than 40 years old, though young people can also sustain it following an injury due to roadside accidents or sports.

What is done in surgery?

Surgery for rotator cuff tears involves removing a little bit of bone from the undersurface of the shoulder, to create room for the muscle to move smoothly. Anchors are used (generally 2-4) to reattach the torn muscle back to where it belongs.

Health Tips for Computer Users

It is very important to keep a good posture while your working with a computer. Understand about the concept of neutral body positioning will help you to set up your computer work station in a best way. This concept will help you to maintain a good and comfortable working posture, this makes your joints in to natural and proper alignment. Neutral positioning will reduce the stress and strain on your muscles, tendons and skeletal system, also reduces the risk of developing a musculoskeletal disorder (MSD). In some situations you might need the help of an orthopedic specialist. Here we have listed some important key points when trying to maintain neutral body postures while working with computer.

• Keep your hands, wrists and forearms straight, inline and roughly parallel to the floor.
• Your head position should be above screen level or bent slightly forward, forward facing, and balanced. Generally it is in-line with the torso.
• Shoulders should be relaxed and hang upper arms normally at the sides of body.
• Keep elbows close to the body and bent between 90 and 120 degrees.
• Give a complete support to the feet by the floor or foot rest.
• Use chairs with a good back support with appropriate lumbar support when sitting vertical or leaning back slightly.
• Thighs and hips are supported by a well-padded seat and generally parallel to the floor.
• Knees are about the same height as the hips with the feet slightly forward.

working in the same posture or sitting still for a long interval of time may cause health disorders, so change your working posture frequently throughout the day in the following ways.

• Make some adjustments to your chair or backrest.
• Stretch your arms, hands, fingers and torso.
• Stand up and walk around for a few minutes periodically

To know about joint pain and other orthopedic treatments consult our orthopedic doctor in New Delhi

website : www.drraju.in

email : drrajueswaran@gmail.com