Dr. Goyal's Bone & Joint Centre

Hi,

I am Dr. Darsh Goyal, Orthopedist. Mai aaj aap ko frozen shoulder ke baarein mein btaunga. Ye bahut hi common problem hai jise hum kandha jaam hone ke naam se bhi jaante hain. Iska dusra naam adhesive capsulitis bhi hai. Ismein patient ko shoulder joint mein severe pain hota hai. Patient ke shoulder joint ki movement restricts bhi ho jaati hai. Movements uski kam ho jaati hai. Iske lia humein kandhe ki banavat ko samjhana hoga aur usmein aisa kya hota hai ki kandha stiff hone lagta hai and kandha stiff ho jata hai. Ek bone hoti hai jiska naam humerus hai aur dusri bone scapula ka glenoid surface. Ye dono bones milke shoulder jint banati hain. Iske aas pass aap muscles ki tendon belly dekhenge. Iske around ek capsule hota hai. Ismein ek synovial fluid hota hai jismein humara joint smoothly move karta hai. Frozen shoulder mein jhilli numa capsule motta ho jata hai.

Capsule tight bhi ho jata hai. Patient humse aake puchta hai ki frozen shoulder kyun ho gaya hai? Iske kayi karan ho sakte hain. Pehla karan hai ki agar diabetic patients mein agar shouler ki thodi bhi injury ho jaaye, internal bleeding ke karan vahan pe stiffness aani shuru ho jaati hai. Dusra karan hai diabetes ke sath thyoid, prostate ho toh inmein bhi frozen shoulder ki problem ho jaati hai. Ab hum baat kareinge ki iske kya sympoms hote hain. Pain and stiffness bahut common hai. Frozen shoulder basically 3 stages mein hota hai. Pehli stage ko hum freezing stage kehte hain, dusri stage ko hum frozen stage kehte hain and tisri ko thione phase kaha jaata hai. First stage mein kandha jaam hona shuru hota hai. Usmien patient ko pain jyada hota hai. 2nd stage mein kandha puri taraha jaam ho jata hai. Is phase mein patient ke shoulder ki movement baut kam hoti hai.

Ye phase 8 moths to 3 years tak continue ho sakta hai. 3rd phase mein patient ki recovery honi shuru hoti hai lekin movement full nahi aa paati hai. Ladies complanit karti hain ki agar vo upar koi saman rakhane ya nikalne ki koshish karte hain toh pain hota hai. Basically, patient haath ko upar le jaane mein capable nahi ho paate hain. Daily activities mein patient ko severe pain hota hai. Ab hum baat karenge ki hamare pass kya treatment option available hain. Commonly hum x-ray screening karate hain. Rarely humein kisi x-ray mein lagata hai ki koi injury hai but most of the time x-rays are normal. First treatment mein hum patient ko anti-inflammatory medicines dete hain aur gentle physiotherapy exercises samjhate hain jis se ki patient ki return or motion aati hai.

Kuch patients jo late aate hain ya fir is treatment se jinko result nahi milta hai, next stage treatment hota hai injections. Ismein shoulder mein hum injection dete hain. aur sath mein mobilization karte hain jis se stiff capsule release hota hai. Agar ismein bhi koi success na mile toh 3rd treatment hai arthroscopic shoulder capsular release. Matalb durbin ke through tight capsule ko nikalte hain. Toh jo bhi is problem se garasat hai use apne Dr se milna chaiye. Iske lia kargar treatments available hain. So, me WHO ki ek famous line bolke samapt karunga, movement is life, life is movement.

Thank You!

Hello,

My name is Dr. Darsh Goyal. I am an orthopedic surgeon by profession aur meri specialization knee replacement or arthroscopic sports injury management hain. jiska matlab hai doorbin dwara knee ke or shoulder ke ligament ki injuries ka ilaj karna. To friends aaj hum baat karenge sports injuries ke baare me. Sports injuries bahut hi common types of injuries hogyi hain aajkal. Mostly sports se related injuries ko hi hum kehte hain sports injuries but iske andar jo ligaments hote hain unki injuries road traffic accidents, stairs se fall hone ke karan or accident hone ke karan bhi ho sakti hai. To ise samajhne ke liye hume pehle knee joint ke andar ligaments ki banawat ko samajhna hoga tabhi hum samajh payenge ki sports injuries kis kis prakar ki ho sakti hain. To humare knee joint ke andar agar hum dekhen. To ye upar ki haddi ko hum femur bone kehete hain or neeche ki bone ko tibia bone kehte hain, in dono bones ke beech me ek jheeli-numa shock absorbers hote hain jinhe hum meniscus kehte hain.

To ye bahar ki side ka shock absorber hain or ye andar ki side ka shock absorber hai. Basically do shock absorber hote hain jise hum meniscus kehte hain. Ye apas me haddiyon ko ragadne se rokte hain or jo ligaments hote hain wo ek hota hai ACL, ye ghutne ka main ligament hai, jo ki knee joint ko stability provide karta hain. Ek ligament age ki taraf hota hai jise hum ACL ligament kehte hain or ek ligament picche ki taraf hota hai jise hum PCL ligament kehte hain. To doston do ligaments side me hote hain , ek MCL, medial collateral ligament or ek LCL, Lateral collateral ligament. To ye side ki stability dete hai knee joint ko. Most commonly jo sports injuries hoti hai wo jyadatar ACL ligament jo ki center me hota hai knee joint ko stability dene ke liye, or shock absorbers, jo meniscus hote hain inki injuries are one of the most common injuries.

To aaj kal humare pass latest techniques available hain jinse hum in injuries ko theek kar sakte hain or patients dobora se sports fir se khel sakte hain, after a period of six months we advise that patients can return to their active sports. To ye jo sports injuries ki management hai arthroscopy dwara iska kya matlab hai? Iska matlab hai, Bina ghutne ke age pura cheera lgaye specially doorbin ke through do chhote se incisions se hum ligaments ko reconstruct kar te hain taki patient ke knee ki stability jo hai woh fir se return ho sake. To jaise eki ACL ligament toot jata hai to patient ko feeling ati hai hai ki uska ligament na hone karan uska knee is tarah se twist hota hai. To mostly patient ki ye complaint hoti hai ki mai jab running ki koshish karta hun to mujhe aisa lagta hai ki main gir jaunga. Patient kehta hai ki mujhe me ab woh confidence nhi rha jo pehle hota tha ki mai ab bhaag sakta hun or mereko knee ke andar stability feel nhi hoti hai.

Kuch patient ka ye bhi symptom hota hai ki jab wo ubad-khbad jameen pe chalte hain to unhe lgta hai ki unka knee jo hai wo buckle ho jayega jisko giveaway bhi kehte hain. Jaise ki hum kehte hain ki knee jo hai woh nikal jayega is tarah ki unhe sensation ati hai. To patient ko severe pain hota hai or in injuries ke karan neglect kar denge to baar baar knee ki unnatural twisting ke karan jo humari ye jheeli-numma cartilage bhi kharab hona shuru ho jaati hai. To jab ye cartilage kharab hoti hai to ye kuch is tarah se hoti hai or iski regeneration bahut hi difficult hai. Isiliye timely treatment of sports injuries specially ACL, meniscal tears or PCL tears are very important. To baat karte hain ki kis kis prakar ki surgery hmare pass available hain. To arthroscopy ke liye aap baat karenge to ACL reconstruction, single bundle, double bundle or anatomical ACL reconstruction karte hain. Specialy pehle is meniscus ko, jo tear hota tha, iske phate hue part ko hum nikal dete the taki woh ghutne ke beech me, dono haddiyon ke beech me ragad na khaye. 

Lekin aajkal poori koshish ki jati hai ki hum is shock absorber meniscus ko kisi tarah repair kar sakein taki knee ki jo shock absorbing capacity hai woh hum fir se restore kar sakein, isse patient ka jo arthritis ka process hai wo delay hota hai. To meniscal repair is possible which I mostly try ki agar meniscus repairable hai to we do not remove the meniscus hum meniscus ko repair karte hain, bahut rare cases me agar complex tear hai meniscus ka to hum meniscus ko wahan se remove karke balance bhi krte hai jisko hum meniscectomy kehete hain. Doosri injuries jo hoti hain wo PCL ligament ki hoti hain iske andar jo hmare nicche ki haddi hai ye picche ki taraf is tarah se sag krne lagti hai, ye bhi ligamet jo hai wo knee ki stability ke liye bahut zaroori hai is ligament ko bhi doorbin dwara successfully hum restore kar sakte hain, reconstrust kar sakte hain.

Lastly jo injuries knee ki sports se related hoti hain, wo hoti hain is cartilage ko damage hone jo kehete hai usko hum cartilage injuries kehete hain, us ke andar impact ke karan bahut baar cartilage fracture ho jaati hain jis ke karan defect ajata hai. Unfortunately cartilage me regeneration capacity bahut kam hoti hai lekin iski bhi kuch advanced techniques ab humare pass available hain. Jaise ki ACI, autologous chondrocyte implantation, mosaicplasty or oats jaisi humare pass techniques available hai. jisme microfracture ke dwara bhi cartilage ko restore kar sakte hain, to friends I will advise ki sabse pehle sports injury ko avoid kiya jaye. Prevention ke liye agar koi bhi high competitive athlete ho jisne ki sports khelni ho high level pe ya normal sports khelni ho usko apni muscle tone up jaroor karni chahiye, before taking up of sports proper warm up hona chaiye, the proper action of the sports should be followed. In case fir bhi injuries ho jaati hain to there are techniques available arthroscopically we can fix those injuries and patients can return to their normal sports activities and routine, so I will say by concluding the WHO line that movement is life and life is movement.

To doston apna dhyan rakhein, khush rahein, thanks .

Hi,

I am Dr. Darsh Goyal, Orthopedist. Aaj hum baat karenge osteoarthritis of the knee joint or knee replacement ke baare mein. Knee humari body ka bohut important part hai because of humara pura weight iske upar aata hai. Ek normal knee joint mein upar ki haddi hoti hai jise hum femur kehte hain, ek niche ki haddi hai jisko hum tibia kehte hain. In dono haddiyon ke joint ko knee joint kaha jaata hai. Ye jod ek jhilli noma se cover hota hai jise hum cartilage kehte hain. Inke bich mein ek meniscus hota hai. Ye aapas mein haddi ke ragadav ko rokta hai. Osteoarthritis is cartilage ka distortion hina shuru h jaata hai. Jis se haddi mein ragad aati hai jise hum osteoarthritis kehte hain. Iski problem dheere dheere develop hoti hai. STarting mein halka halka gisav aata hai fir cracks aane shuru ho jaate hain or fir puri tarah nashat ho jaati hai. Haddi ki ragad se humein dard aata hai. Jab bhi patient aata hai and kehta hai ki knee mein pain haii to uska pehla question hota hai ki osteoarthritis ke karan kya hain. Iske kayi karan ho sakte haian like hereditary ek karan hai. Iske alawa hemophilia, infection, overweight. Weight jayada hone se ghisav bohut jaldi hota hai. Jis se cartilage bohut jaldi destroy hoti hai.

Aur bhi kayi karan hai jaise ki osteoporosis, calcium ki kami hona, thyroid ki problem, diabetes, ye sab treatable karan hote hain. Fir iske symptoms ki baat karte hain friends. Kaise symptoms gradually develop karte hain. Iske lakshan bohut dheere dheere develop hote hain. Jameen pe baithna, althi palthi marna, bohut der tak baithne ke baad khade hona. Aise patients mein jyada taklif and preshani aati hai. Lekin normal chalne mein patient ko itni jyada preshani nahi aati hai. So, grade 1 & 2 ke symptoms ye hote hain. Patient ko normal walk mein bhi problem aani shuru ho jaati hai. Patient slowly apni sari activities karne mein preshani feel karta hai. Advance cases mein bed ridden ki bhi naobat aa sakti hai. Patient ki hum investigation karte hain x-ray se. Iske 4 grades hote hain. Garde 1, 2, 3 & 4. Grade 1 mein x-ray mein bohut jyada changes nahi aate hain. Garde 2 mein haddi ghisani shuru ho jaati hai. Grade 3 mein ghisav jyada hone se side mein chonch nikal kjaati hai. Grade 4 advance arthritis hai jismein haddi tedi and ghisav bohut jyada hota hai. Grade 1 & 2 curable hai. Ismein patient ko jyada symptom nahi hote hain and agar hum kuch simple tarike apnayein toh patient vapas pre-level activity pe aa sakta hai. Hum patient ko exercises karne ke liya advice karte hain. Pani ki garam bottle se sekayi hum suggest karte hain.

Weight reduction bohut important hai jis se patient ko kafi relief aata hai. Kuch medicines claim karti hai pain relief ka lekin vo garde 1 & 2 mein hi kam karti hain. Grade 3 & 4 mein inka koi use nahi hai. Grade 3 & 4 ka ilaj sirf operation hai. Ismein koi medicine help nahi karti hai. Kuch log medicines ko over use karte hain jis se medicine ka side-effect liver and kidney pe aata hai. Knee replacement ko knee surfacing kehna chahiyai. Kyuki ismein hum knee ko resurface karte hain. Ismein ek type ki polythene daali jaati hai jis se haddi ka ragdav band ho jaata hai. Patient lubricates gels bhi use kar sakte hain operation se pehle. Kafi patients mein inka beneficial effect bhi aata hai. Is se knee ke andar ki fluid ki density badh jaati hai. Ghutne mein ghisavat ka process slow ho jaata hai aur life lambi hoti hai. Ye bhi grade 1, 2 & 3 tak hi effective rehta hai.

Patients ko myth rehta hai ki operation ke baad kya vo chal payenge ya nahi. Patients kehte hain ki aur koi treatment bta do lekin knee replacement nahi karana hai. Ye dharna bilkul galat hai. Kyuki knee replacement kafi advance stage pe hai. Iska success rate 95-98% hai. Almost, 20L per year knee replacement kiya jaate hain. WHO ki famous line hai ki movement is life and life is movement. Knee replacement mein koi darr vali baat nahi hai. Is se humare ghutnon ki alignment bhi correct ho jaati hai. Tedhe ghutnon ke karan patient ki chaal mein kafi frak aa jata hai. Jis se spine pain aana shuru ho jaata hai. Pain hip mein aana shuru ho jaata hai. Humari overall body better feel karti hai. Like agar humari car ka ek tyre khrab ho gaya hai and humne use replace karane ki bajaye garage mein khada kar dia hai. Jis se uska engine bhi khrab hona shuru ho gaya hai. Usi tarah humara sharir hai. Agar hum apni movement band kar denge toh humari body ke dusre organs bhi effect hone lag jaate hain. Hum depression mein jaane lagate hain. So, I will conclude by saying, movement is life and life is movement. Surgery se dariye mat. Befikre hoke is operation ko apnaiye. Khush rahiye, sawasth rahiye.

Thanks!