Hand2Shoulder Clinic

Hello! I am Dr. Vikas Gupta. I am an orthopedic surgeon specializing in the treatment of Upper Extremity that means we treat everything all the diseases from hand to shoulder region.

Today we will be talking about shoulder instability that means shoulder which gets repeatedly dislocated or is unstable. We will be talking about what are the ailments and the treatment. See whenever there is an instability of the shoulder usually there is an injury could be and if all accident or any kind of injury in the gym lifting heavy weights which results in trauma or injury to the ligament which makes the shoulder unstable. Many times it’s a full dislocation that shoulder joints opt out of the cup and it is dislocated and you have to take medical attention to get it reduced or sometimes it gets just partially dislocated that means it comes out a little bit and goes back in.

So these 2 are different problems of shoulder instability. Single dislocation usually we treat them conservatively but whenever the dislocations are more than one time repeated dislocations we have to treat them surgically reason been every time shoulder dislocates one thing it is very painful inconvenient to the patient and every time whenever shoulder dislocates it tears more tissues and it grinds a few bones. So repeated dislocation there is a bone loss also both from the Lenard as well as the himbriss. With the new techniques, the shoulder can be repaired with the help of arthroscopy that is a minimally invasive thing in which we put in a telescope and instruments through the keyhole and just like any laparoscopy surgery arthroscopy is also minimally invasive in which patient does not have any big scar patient can be mobilized early. And we can treat the problems specifically as wherever there is a tear we can repair it.

And these patients they do very good after surgeries but if there is dislocation which is happening many times and because of which there is a grinding of bone or bone loss which is significant bone loss then these cases we have to open up and do the surgery by putting in a bone graft or by replacing a bone from somewhere else to give the stability to the shoulder. In arthroscopy what we do we put in an anchor. Anchor is a type of screws on which there are threads so we just drill a hole into the glenard and once we have drilled the hole everything happens arthroscopically so threads come out so these are the threads the screw is inside the bone and threads are coming out and tail of these threads what we do we tie the ligaments with the help of instruments inside the joint. So once we have tied these knots inside the joint so what happens the ligament is now attached to the bone.

So this is the ligament this is the bone and everything is done arthroscopically so there is no big cut no blood loss and patients can be mobilized very early. Another type of instability is where there is no trauma there is no injury but because of the generalized laxity the ligaments the shoulder gets dislocated. In such cases we usually ask the patient to undergo rehab to make the muscles very strong increase the tone of the muscles so that they can have more stability but if that is not successful again the surgery can be done arthroscopically in which we have to repair ligaments all around the joint or maybe tighten them so that patient gets stability and good movement. So with the advent of arthroscopy, most of our patients can undergo treatment for instability by arthroscopy alone except for few chronic or multiple dislocation cases where there is a bone loss which requires open surgery. So most of the cases can be treated arthroscopically.

Therefore in arthroscopy there is a very short duration of stay in the hospital. They can be mobilized early rehabilitated early and if the sports person they can go back to sports as early as 3 to 4 months after the surgery. So that is a big advantage of arthroscopy. Round a decade ago whenever there was a patient with shoulder instability we used to ask them to undergo physiotherapy and open surgery and again long physiotherapy which used to have restrictions on movements also but nowadays with the help of arthroscopy we can expect very good range of motions in very short duration and patients can undergo whatever activities they were doing before surgeries. So this is one of the very good advancement in orthopedic surgery arthroscopy for the patients of the instability of the shoulder. Thank you.

Hi,

I am Dr. Vikas Gupta, Orthopedist, Max Hospital Saket (Smart Super Speciality). Today we will talk about new techniques in shoulder surgery. Shoulder arthroscopy is something which has come up in last decade. It is a minimally invasive technique to treat shoulder elements. So, shoulder instability and rotator cuff injury are treated by this surgery. Instability happens after shoulder dislocation. But is shoulder dislocation is happening multiple times, it requires surgery. Before surgery we do MRI.

Through small incision, we go inside and see through the telescope to perform the surgery. After surgery, we ask the patient to undergo physiotherapy and gain back all the movements possible by good rehabilitation. Rotator cuff injury gives instability to the joint. Usually, it happens because of trauma and degenerative condition because of old age. Hospital stay for this surgery is only for a day or 2. During the surgery the blood loss is minimal. Less painful surgeries because of only small incisions.

Patient can start exercising after a day or 2 of the surgery. Result of this surgery is more predictable and much conventional compared to open surgery. Sometimes, surgery is not possible with minimally invasive surgery then only we go and do the open surgery. One of the major advantages of this surgery is small scars which are usually is not visible. They are cosmetically much better than open surgery. Open surgeries are becoming rare day by day. Whenever you have such kind of elements, you should ask doctor to perform surgery by minimally invasive techniques.

Thank You!

Hello! I am Dr. Vikas Gupta from Hand2Shoulder Clinic. Today we will be talking about elbow stiffness.

How do we define elbow stiffness? Elbow stiffness is the loss of elbow movement or restriction in elbow movement. There are many causes of elbow stiffness. Common ones are prolonged immobilization, any injury to the elbow joint , arthritis or new bone formation around the joint.

How do we treat elbow stiffness? It can be treated in many ways. First one is Arthroscopy. Arthroscopy is a minimally invasive procedure in which we make keyholes around the joint and insert a camera through one of the holes and instruments through another and we take care of all the adhesion and tissues which are preventing movements.

Once we have removed these tissues , we can mobilize the joint and after the surgery , again physiotherapy is done to regain the movements and maintain the movements. The second kind of treatment in which Arthroscopy cannot be done or if there is a new bone formation or if there are any scar tissues around the joint or there is a pre-implant from the previous surgery then we have to do open surgery or we call it Arthrolysis. In Arthrolysis we open the joint, remove all the scar tissues, implants and new bone formation around the joint which is blocking the movement. Once we have removed all the things which are blocking the movement we regain the movements and which is maintained again by physiotherapy. For some weeks physiotherapy is done so that we can initiate the movements and patient can have movements for lifelong.

If these two procedures are not working or the joint is destroyed completely like in the Arthritis in which the whole of the joint are destroyed or the articulate surfaces are gone. The articulate surface is a smooth lining of the joint on which the bone moves, the joint moves. If that is gone then we don't have any other option but to do a joint replacement. In joint replacement, we use the artificial component metal and plastic inside the body and regain the joint movements and if these movements are good then the patient can lead a normal lifestyle after joint replacement. So today we have talked about elbow stiffness. But again I will repeat that physiotherapy is the most important component of treatment of elbow stiffness.

Hello!

I am Dr. Vikas Gupta from Hand2Shoulder Clinic. Today we will be talking about elbow problems. One of the most common problems of elbow is stiffness. By stiffness, we mean that there is a decreased movement. There could be many causes for the stiffness- it could be after injury, could be after arthritis or it could be just simple swelling which resulted in immobilization and stiffness. So each of the causes can be treated differently. Commonly simple stiffness can be treated by physiotherapy. Good amount of physiotherapy and exercises can relieve most of the patients. But some of the patients who cannot become better by physiotherapy would require surgery.

There are many types of surgery we do. One is Arthroscopy which is a minimally invasive surgery or we can say keyhole surgery in which we use the camera and few instruments, make few holes around the joint and go inside the joint, locate the things which are causing the stiffness and remove them. Sometimes what happens is stiffness is very severe and their causes are newborn formation or there is an extra bone which is formed around the joint which cannot be tackled by arthroscopy or minimal invasive surgery.

In such cases, we do open surgery or we called arthrolysis of the elbow. In such cases, we have to open up the whole joint and remove all the causes of stiffness, all the particle which are causing the movement restriction are removed and we make the joint mobile which is followed by physiotherapy and movement is restored. But many time the joint is completely destroyed like Arthritis. In such cases, it is very difficult to restore movements in the normal joint. In such cases, we go for the replacement arthroplasty where we replace whole of the joint with artificial joint and start the movements after physiotherapy and we expect good movement after joint replacement.

Hi, I am Vikas Gupta, Director and the head shoulder and hand division Max Hospital Saket. Today we would be talking about being free of shoulder problems. How do we tackle them when do we required surgery and what type of surgeries we require but before I say, I would like to stress upon one thing nearly 80% off the shoulder problems can be treated non operatively that is by physiotherapy and good medication. Patients can come back to normal without surgery but there are some problems where surgery is required. First of all, I will touch upon repeated shoulder dislocation which usually happens after the injury and rotator cuff injuries where there is a complete care in the rotator cuff. Rotator cuffs are the muscles which are moving on the shoulder joint. When these 2 conditions happened most of the time patients would require surgery and in these cases where do shoulder arthroscopic or arthroscopic surgery is on the shoulder. These are minimally invasive surgeries in which will pass the camera in to the joint through multiple keyholes we put the camera and instrument in to the joint and prepared the torn ligaments and the muscles and bring that shoulder on its normal anatomy, so that person can move his or her shoulder after surgery with good to have rehabilitation. In a shoulder arthroscopy, the advantages are the patient come back to the normal routine very fast as compared to the conventional surgeries. The stay in the hospital is usually same discharge the patient or next day discharge the patient. So where that point if were asked patient can expect to go home in most of the cases. Other condition in which we do surgery the shoulder arthritis with the effect of new prospective designs the shoulder replacement after arthritis has become very predictable. So after arthritis or any severe trauma in old age, shoulder replacement is being done very commonly being done. So in these cases we expect the good result after replacement in the last I will say in severe trauma we can fix the shoulder joint even in very soft bones because there are new plate designs which are there fix the fractures fragments very rigidly so that we can mobilize them early and expect the good results and I would like to conclude that with the effect of knowledge of biomechanics of shoulder joint. Our rehabilitation and physiotherapy after surgery have become so good that we can expect the near normal results after the shoulder surgery.

Thank You.