Orthopaedics

The knee is an important weight-bearing joint, and is formed by the lower end of femur, upper end of tibia (leg bone) and patella (knee cap). The knee consists of two compartments, medial (inner) and lateral (outer) compartments. The stability of the knee is provided mainly by the ligaments of knee. The knee is one of the commonly injured joint in sports as well as in other injuries.

COMMON KNEE CONDITIONS

Anterior Cruciate Ligament Tear: Anterior Cruciate ligament is torn while its ability to withstand the load is overcome by the force of injury. ACL is commonly injured with twisting injury to the knee, hyperextension injury and abnormal sideway opening of the joint ( varus or valgus).

Meniscus tears and management: Meniscus is the shock absorber of the knee. Only the outer margins of this structure has blood supply and most of the inner regions lack any blood supply. Because of this only tears occurring in outer margins have the potential to heal. Meniscus tears occurs in various patterns. Meniscus tear can produce symptoms like pain, repeated joint swellings (effusions), locking and catching.

Cartilage Injuries: Cartilage is responsible for the smooth gliding movements of the joint. Cartilage injuries can occur along with ACL ruptures at the time of injury or because of the repeated instability associated with ACL deficient knee.

Posterior Cruciate Ligament (PCL) Injury: Compared to ACL injuries, PCL injuries are rare and mostly missed. They occur in road traffic accidents and falls. PCL injuries cause the tibia to move backward abnormally.

Knee Dislocation: Knee dislocations are rare but can be devastating. They are associated with multi-ligament injuries.

Collateral Ligament Injuries: The Medial Collateral ligament which supports the inner aspect of knee is commonly injured. MCL injuries are graded according to the severity.

Patella Dislocation: The patella ( knee cap ) is also the source of many problems. The knee cap moves in a groove of the femur during knee flexion and extension. In some patients the knee cap slips out of the groove and comes to lie on the outer aspect of the knee. Many factors like, muscle imbalance, altered anatomical development and ligament laxity play a role in the causation of this problem.

Knee Pain: Knee pain is very common in young as well as old people. Not every knee pain is associated with structural damage. However, the cause of the knee pain has to be assessed clinically.

Synovitis: Synovium is the lining membrane of the joint which secretes the joint fluid. The synovium can be affected in many diseases processes leading to swelling of the membrane, fluid collection.

The shoulder joint has the widest range of movement in the body, allowing us to reach objects. It’s a ball and socket joint, where the cup is formed by the glenoid part of the shoulder blade and the ball is formed by the head of humerus (arm bone). But the cup is very shallow – almost flat and this makes it easy for the ball to come out. The stability of the joint is provided by the labrum, capsule and the ligaments of the shoulder. The labrum is a rim of fibrous tissue attached to the periphery of the cup (glenoid). The labrum deepens the cup and also behaves like a bumper against joint displacement. The capsule and ligaments of the shoulder are attached to the labrum, and thus encircle the head of humerus and prevent the head of humerus from slipping out of the joint.

Arthroscopy of the shoulder – a type of keyhole surgery – is performed using three small openings (1 cm) called portals, in the front and back of the shoulder. Delicate instruments and telescopes are passed into the joint, and the inside of the joint is visualized on a TV monitor. Most common conditions can be treated with arthroscopy.

COMMON SHOULDER CONDITIONS

Tendinitis: A tendon is a cord like tissue that connects muscles with the bone. Inflammation of rotator cuff tendons and biceps tendon due to repetitive activity or overuse is a common cause of shoulder pain.

Bursitis: A bursa is a fluid filled sac, which lubricates the movements between the tendons and bones around the shoulder. Any inflammation of this bursal tissue could also result in pain.

Rotator cuff tears: A torn rotator cuff could produce pain on elevation of shoulder and on lying on the same side. An ultrasound scan or an MRI will clearly define the tear.

Labral tear: A labral tear occurring in the front part of the shoulder is called Bankart’s lesion, which is found in dislocating shoulders. It gives rise to pain as well as fear of impending dislocation in certain arm positions. A tear of labrum in the superior portion of labrum (SLAP lesion) is also a significant cause of pain in sportspersons participating in throwing activities. It results in pain in certain positions of arm as well as clicking sounds.

Frozen shoulder: Pain along with stiffness is characteristic of this condition. The age group affected is above 40 years.

AC joint arthritis: The joint between the outer end of collar bone and the tip of the shoulder blade(acromio-clavicular joint) could get damaged due to injury or arthritis and give raise to pain.

Biceps tendonitis: Biceps is a powerful muscle present in the front of the arm. Its tendon originates from inside the joint. If the tendon is damaged by repetitive use of the arm, it can lead to pain in the shoulder.

Referred pains: Many a times shoulder pain originates from compression of nerves in the spinal cord in the neck region due to a disc prolapse or cervical spondylosis. Clinical examination and investigations will differentiate between these two. Intrathoracic and Intraabdominal conditions also produce shoulder pain due to overlapping nerve supply.

SLAP Lesions: The term SLAP stands for Superior Labrum Anterior Posterior. This refers to the damage or tear of labrum of the superior part of shoulder joint. Its diagnosis and treatment is by arthroscopy only. This lesion is commonly seen in sportspersons involved in throwing and overhead sports (volleyball, baseball).