Shoulder dislocation

It is an injury that happens when the top of the humerus loses contact with the socket of the scapula.

Is a shoulder dislocation the same as a shoulder separation?

No! A shoulder dislocation is often confused with a shoulder separation, but these are two different injuries. It is important to differentiate between these two problems because the issues with management, treatment, and rehabilitation are different.

What happens when you sustain a shoulder dislocation?

The shoulder joint is made of three bones. The arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle) all meet up at the top of the shoulder. A shoulder separation occurs when there is an injury to the joint between the scapula and clavicle--this is called an acromioclavicular separation. A shoulder dislocation occurs when there is an injury to the joint between the humerus and scapula.

The joint in between the humerus and scapula, also called the glenohumeral joint, is a ball-and-socket joint--the ball is on the top of the humerus, and this fits into a socket of the shoulder blade called the glenoid. This joint allows us to move our shoulder though an amazing arc of motion--no joint in the body allows more motion than the glenohumeral joint. Unfortunately, by allowing this wide range of motion, the shoulder is not as stable as other joints and because of this, shoulder dislocations are not uncommon injuries.

Symptoms of a shoulder dislocation?

Patients with a shoulder dislocation go through a severe pain. They know something is wrong, but may not know they have sustained a shoulder dislocation.

Symptoms of shoulder dislocation include:

· Loss of the normal rounded contour of the deltoid muscle

· Arm held at the side, usually slightly away from the body with the forearm turned outward

· Shoulder pain

How is the diagnosis of a shoulder dislocation made?

Diagnosis of a shoulder dislocation is usually quite apparent just by examining joint and talking to patient. Patients must be examined to determine if there is any nerve or blood vessel damage. This should be done prior to reduction of the shoulder dislocation. X-rays should be obtained to check for any fracture around the joint, and to determine the pattern of the shoulder dislocation.

For more details please contact:

Dr. Prateek Gupta (Senior Surgeon)

Arthroscopy Surgery Clinic

C2/5 Safdarjung Development Area (SDA),

Aurobindo Marg, New Delhi - 110016

INDIA

Telephones: +91 9810852876, +91 11 26517776

24 x 7 Helpline & Appointment: +91 9810633876

Email: sportsmedicinedelhi@yahoo.com,

sportsmedicineclinics@gmail.com

Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,

http://www.sportsmedicineclinicdelhi.com,

http://www.arthroscopysurgeryindia.com

Posterior cruciate ligament injury

Symptoms

Posterior Cruciate ligament injury may include:

Mild to moderate pain in the knee
Rapid onset of knee swelling and tenderness (within three hours of the injury)
Pain with kneeling or squatting
A slight limp or difficulty walking
Feeling of instability or looseness in the knee, or the knee gives way during activities
Pain with running, slowing down, or walking up or down stairs or ramps
Most people with a posterior cruciate ligament injury don't feel a "pop" — the classic sign of an ACL tear — at the time of the injury. Signs and symptoms may be mild or vague, and you might not even notice anything wrong. Over time, the pain may worsen and your knee may feel more unstable. If other parts of the knee are affected, your signs and symptoms will likely be more severe.


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

Wrist Arthroscopy

What is it?
Arthroscopy is a minimally invasive technique of visualizing the inside of a joint. The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The wrist is a complex joint made up of many bones and ligaments, which hold the bones together (see Figure 1). Wrist arthroscopy allows the surgeon to diagnose and treat many problems of the wrist through a series of very small incisions (portals). In the last several years, the wrist has become the third most common joint to undergo arthroscopy, after the knee and shoulder. Because the incisions used with wrist arthroscopy are smaller and disrupt less soft tissue than conventional open surgery, pain, swelling and stiffness are minimized and recovery is often faster.

When is wrist arthroscopy performed?
Wrist arthroscopy allows the visualization of the cartilage surfaces of all bones in the wrist and better evaluation of the ligaments between the various bones of the wrist. After an injury, pain, clicks, and swelling may be frequently indicative of an internal problem in the wrist. Arthroscopy is often the best way of assessing the integrity of the ligaments, cartilage, and bone. When wrist problems are encountered, many are treated through these small incisions using specialized instruments available for wrist arthroscopy. Often arthroscopy is used to aid in the reduction of fractures of the bones of the wrist. Wrist arthroscopy is also used to assess the integrity of the TFCC (triangular fibrocartilage or meniscus of the wrist). Wrist arthroscopy can be used to remove some ganglions of the wrist and to assess and treat various types of arthritis of the wrist.

How is this performed?
The procedure is performed under general, regional, or local anesthesia. A small camera fixed to the end of a narrow fiber optic tube, 2.7mm wide, is inserted through a small incision, about 5mm long, in the skin directly into the back of the wrist joint. The camera lens magnifies and projects the small structures in the wrist onto a television monitor, allowing for more accurate diagnosis. Several small incisions (portals) are used to allow the surgeon to place the camera in different positions to see different structures inside the joint as well as to place various small instruments into the wrist joint to help diagnose and treat various problems in the wrist (see Figure 3). The wrist is usually distracted and filled with fluid to expand the joint and allow improved visualization during the procedure. Sometimes wrist arthroscopy is combined with open procedures.

After wrist arthroscopy
After your arthroscopy, you will most likely be placed into a wrist splint that allows full mobility of your fingers. The period of immobilization will vary depending on what was performed at the time of surgery. Elevating the involved extremity is important to prevent excessive swelling and pain after your surgery.

Risks and limitations
As with any surgery, wrist arthroscopy has risks. These include infection and potential damage to nerves and tendons, usually less than 1%. Stiffness may need to be addressed through post operative rehabilitation. Wrist arthroscopy is not appropriate for all wrist conditions and is dependent on the surgeon’s training, expertise, and comfort level.


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

Wrist Arthroscopy

What is it?
Arthroscopy is a minimally invasive technique of visualizing the inside of a joint. The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The wrist is a complex joint made up of many bones and ligaments, which hold the bones together (see Figure 1). Wrist arthroscopy allows the surgeon to diagnose and treat many problems of the wrist through a series of very small incisions (portals). In the last several years, the wrist has become the third most common joint to undergo arthroscopy, after the knee and shoulder. Because the incisions used with wrist arthroscopy are smaller and disrupt less soft tissue than conventional open surgery, pain, swelling and stiffness are minimized and recovery is often faster.

When is wrist arthroscopy performed?
Wrist arthroscopy allows the visualization of the cartilage surfaces of all bones in the wrist and better evaluation of the ligaments between the various bones of the wrist. After an injury, pain, clicks, and swelling may be frequently indicative of an internal problem in the wrist. Arthroscopy is often the best way of assessing the integrity of the ligaments, cartilage, and bone. When wrist problems are encountered, many are treated through these small incisions using specialized instruments available for wrist arthroscopy. Often arthroscopy is used to aid in the reduction of fractures of the bones of the wrist. Wrist arthroscopy is also used to assess the integrity of the TFCC (triangular fibrocartilage or meniscus of the wrist). Wrist arthroscopy can be used to remove some ganglions of the wrist and to assess and treat various types of arthritis of the wrist.

How is this performed?
The procedure is performed under general, regional, or local anesthesia. A small camera fixed to the end of a narrow fiber optic tube, 2.7mm wide, is inserted through a small incision, about 5mm long, in the skin directly into the back of the wrist joint. The camera lens magnifies and projects the small structures in the wrist onto a television monitor, allowing for more accurate diagnosis. Several small incisions (portals) are used to allow the surgeon to place the camera in different positions to see different structures inside the joint as well as to place various small instruments into the wrist joint to help diagnose and treat various problems in the wrist (see Figure 3). The wrist is usually distracted and filled with fluid to expand the joint and allow improved visualization during the procedure. Sometimes wrist arthroscopy is combined with open procedures.

After wrist arthroscopy
After your arthroscopy, you will most likely be placed into a wrist splint that allows full mobility of your fingers. The period of immobilization will vary depending on what was performed at the time of surgery. Elevating the involved extremity is important to prevent excessive swelling and pain after your surgery.

Risks and limitations
As with any surgery, wrist arthroscopy has risks. These include infection and potential damage to nerves and tendons, usually less than 1%. Stiffness may need to be addressed through post operative rehabilitation. Wrist arthroscopy is not appropriate for all wrist conditions and is dependent on the surgeon’s training, expertise, and comfort level.


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

ELBOW ARTHROSCOPY

INTRODUCTION
The field of arthroscopy has experienced remarkable growth and advance in the treatment of elbow disorders in recent years. It is now being performed by an ever increasing number of surgeons for a wide variety of conditions. Useful both for diagnosis and treatment, arthroscopic techniques are demanding, and potentially devastating neurovascular injuries are a concern. As elbow arthroscopy assumes a greater role in the diagnosis and management of elbow problems, new indications continue to emerge.
INDICATIONS / CONTRE-INDICATIONS
The indications for elbow arthroscopy include: removal of osteophytes due to impingement or osteoarthritis, synovectomy in patients with inflammatory arthritis, removal of adhesions and capsular release in patients with contractures, resection of symptomatic plicae, removal of loose bodies, and evaluation of patients with chronic elbow pain. In addition, elbow arthroscopy has been used to treat patients with osteochondritis dissecans, septic arthritis, epicondylitis and elbow fractures.
GENERAL TECHNIQUES
The operative techniques in general have been well described elsewhere. I prefer the lateral decubitus position with the forearm allowed to swing free. A soft elastic bandage is then wrapped around the hand and forearm to within ten centimeters of the olecranon. The tourniquet, which is used routinely, is inflated to 250 mm/Hg. The elastic bandage is left on until the end of the procedure to limit the periarticular swelling to the elbow area. When the bandage and tourniquet were removed, any accumulated edema rapidly dissipated into the tissues of the forearm and arm.
With the increasing complexity of the procedures performed, the number of portals used has increased (Figure 1). In addition, more of an emphasis has been placed on utilizing the more proximal portals (proximal anterolateral and anteromedial) portals.
The method and sequence of portal placement varied and evolved over the years. Currently, we generally start in the direct midlateral portal and establish access through the posterior portals immediately as well. Open drainage outflow through one or more sites is immediately instituted and maintained throughout the procedure. The posterior compartment is usually treated first and then the anterior portals established for correction of anterior compartment pathology. Portal placement is determined by careful palpation of the underlying bony structures and we do not rely on skin markings, as the skin markings do not correctly indicate the underlying structures after swelling occurs. We now rely on the use of retractors to permit visualization in the anterior compartment, rather than pressurization to accomplish joint distention. This reduces the risk of edema and even more greatly expands the complexity of surgical procedures that can be performed inside the elbow.
Anterior portal placement has been accomplished using both the outside-in and inside-out techniques, but over time the outside-in technique has become the preferred one. Initially, we believed that edema could be minimized by placing a cannula in each portal and keeping it there throughout the duration of the procedure, but our practice has been changed. Currently, cannulae are used only in one or two of the anterior portals. The proximal anterolateral portal is usually used for a retractor and the anterolateral and proximal anteromedial portals for the scope and working instruments. The bulkiness of the cannulae can outweigh their advantages except in the working instrument portal. In more complicated procedures such as those in which extensive bone and capsular work are required, the cannulae may be discarded as periarticular edema develops. This edema actually permits retention of the portal pathway and permits instruments to be readily moved in and out of the elbow, which is usually required.
A previously described system for pressurized irrigation was routinely used and recommended. The system is a modified pulsatile lavage system that is used to lavage the canal during joint replacement and for the irrigation of open fractures. The spray nozzle is cut off from its connecting tubing, which is then connected to the arthroscope via a standard intravenous line. The driving pressure is set at fifty mm/Hg and flow is controlled by the assistant using the intravenous flow control knob. The auditory feedback (“putt-putt”) of the pulsatile lavage system is invaluable in permitting the surgeon to monitor the fluid flow into the joint without having to consult others or a display panel. Edema is controlled by always maintaining direct outflow through one or more portals and also through the shaver device. No drainage tubings are connected to the outflow cannulas or shaver, so that the flow can simply drain to the floor where it is collected by suction.
Entry into a contracted joint is best accomplished using a custom made switching stick that has been machined to a taper-point at the end. This is machined from a Steinmann pin such that the point is blunt enough so that it will not cut into tissues, yet tapered enough so that it can be used to penetrate the capsule without deflecting off it. Once this blunted Steinmann pin has been placed, the arthroscope sheath is slid into the joint over the pin and the pin withdrawn. We believe this to be easier, safer, and more effective than trying to place the arthroscope sheath containing an obturator into the joint. It also obviates the problem of not being able to distend the capsule in stiff elbows, a step that moves the radial nerve away from the instruments in a normal elbow.

For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com

ELBOW ARTHROSCOPY

INTRODUCTION
The field of arthroscopy has experienced remarkable growth and advance in the treatment of elbow disorders in recent years. It is now being performed by an ever increasing number of surgeons for a wide variety of conditions. Useful both for diagnosis and treatment, arthroscopic techniques are demanding, and potentially devastating neurovascular injuries are a concern. As elbow arthroscopy assumes a greater role in the diagnosis and management of elbow problems, new indications continue to emerge.
INDICATIONS / CONTRE-INDICATIONS
The indications for elbow arthroscopy include: removal of osteophytes due to impingement or osteoarthritis, synovectomy in patients with inflammatory arthritis, removal of adhesions and capsular release in patients with contractures, resection of symptomatic plicae, removal of loose bodies, and evaluation of patients with chronic elbow pain. In addition, elbow arthroscopy has been used to treat patients with osteochondritis dissecans, septic arthritis, epicondylitis and elbow fractures.
GENERAL TECHNIQUES
The operative techniques in general have been well described elsewhere. I prefer the lateral decubitus position with the forearm allowed to swing free. A soft elastic bandage is then wrapped around the hand and forearm to within ten centimeters of the olecranon. The tourniquet, which is used routinely, is inflated to 250 mm/Hg. The elastic bandage is left on until the end of the procedure to limit the periarticular swelling to the elbow area. When the bandage and tourniquet were removed, any accumulated edema rapidly dissipated into the tissues of the forearm and arm.
With the increasing complexity of the procedures performed, the number of portals used has increased (Figure 1). In addition, more of an emphasis has been placed on utilizing the more proximal portals (proximal anterolateral and anteromedial) portals.
The method and sequence of portal placement varied and evolved over the years. Currently, we generally start in the direct midlateral portal and establish access through the posterior portals immediately as well. Open drainage outflow through one or more sites is immediately instituted and maintained throughout the procedure. The posterior compartment is usually treated first and then the anterior portals established for correction of anterior compartment pathology. Portal placement is determined by careful palpation of the underlying bony structures and we do not rely on skin markings, as the skin markings do not correctly indicate the underlying structures after swelling occurs. We now rely on the use of retractors to permit visualization in the anterior compartment, rather than pressurization to accomplish joint distention. This reduces the risk of edema and even more greatly expands the complexity of surgical procedures that can be performed inside the elbow.
Anterior portal placement has been accomplished using both the outside-in and inside-out techniques, but over time the outside-in technique has become the preferred one. Initially, we believed that edema could be minimized by placing a cannula in each portal and keeping it there throughout the duration of the procedure, but our practice has been changed. Currently, cannulae are used only in one or two of the anterior portals. The proximal anterolateral portal is usually used for a retractor and the anterolateral and proximal anteromedial portals for the scope and working instruments. The bulkiness of the cannulae can outweigh their advantages except in the working instrument portal. In more complicated procedures such as those in which extensive bone and capsular work are required, the cannulae may be discarded as periarticular edema develops. This edema actually permits retention of the portal pathway and permits instruments to be readily moved in and out of the elbow, which is usually required.
A previously described system for pressurized irrigation was routinely used and recommended. The system is a modified pulsatile lavage system that is used to lavage the canal during joint replacement and for the irrigation of open fractures. The spray nozzle is cut off from its connecting tubing, which is then connected to the arthroscope via a standard intravenous line. The driving pressure is set at fifty mm/Hg and flow is controlled by the assistant using the intravenous flow control knob. The auditory feedback (“putt-putt”) of the pulsatile lavage system is invaluable in permitting the surgeon to monitor the fluid flow into the joint without having to consult others or a display panel. Edema is controlled by always maintaining direct outflow through one or more portals and also through the shaver device. No drainage tubings are connected to the outflow cannulas or shaver, so that the flow can simply drain to the floor where it is collected by suction.
Entry into a contracted joint is best accomplished using a custom made switching stick that has been machined to a taper-point at the end. This is machined from a Steinmann pin such that the point is blunt enough so that it will not cut into tissues, yet tapered enough so that it can be used to penetrate the capsule without deflecting off it. Once this blunted Steinmann pin has been placed, the arthroscope sheath is slid into the joint over the pin and the pin withdrawn. We believe this to be easier, safer, and more effective than trying to place the arthroscope sheath containing an obturator into the joint. It also obviates the problem of not being able to distend the capsule in stiff elbows, a step that moves the radial nerve away from the instruments in a normal elbow.

For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
http://www.sportsmedicineclinicdelhi.com,
http://www.arthroscopysurgeryindia.com