Mumford procedure for Shanghai businessman

Acromio clavicular arthritis or collar bone arthritis is a painful condition of the shoulder. It is commoner than arthritis of the shoulder joint. It occurs in weight lifters, or after trauma or after a neglected dislocation.
Treatment is conservative to begin with pain killers and a local steroid injection. If after six months pain persists than a Mumford procedure or excision of the outer end of the collar bone relieves pain. This can be done arthroscopically or by mini open method.
REcently a businessman from Shanghai underwent this procedure.
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Partial rotator cuff repair

MR.SK had a successful mini open rotator cuff repair after arthroscopic Adhesiolysis and identification of the articular side partial thickness tear. Nearly six months after surgery, he has regained full range of movements and has started plyometric exercises.

Re-nowned American mountaineer undergoes Shoulder surgery

The re-nowned American mountaineer had successful arthroscopic surgery for a paritally damaged tendon in his shoulder in Chennai. He had injured his shoulder in a fall while moving over horizontal ice a month ago. Fearing that he had dislocated his shoulder he underwent first aid in his local hospital. Perturbed by the high cost of Orthopedic surgery in the US which he was in dire need of to preserve his physical condition, he located Dr.Venkatachalam in Chennai. He verified the surgeon's abilities from another American Mr.Dave Hurd who also had successful shoulder surgery at the same hospital in Chennai in December 2005. Dr.Venkatachalam. leading Orthopedic surgeon performed the surgery which lasted for an hour.
Three weeks earlier he underwent Knee surgery( ACL reconstruction)at the same hospital.

Controversies about Shoulder impingement

Shoulder impingment is a leading cause of pain in young and the middle aged. It results when the rotator cuff rubs against some bony or soft tissue structure overhead.Shoulder decompression is the surgery to treat impingment.
Bony spurs, thickened scar tissue,Abnormality in the shape of the acromion, excessive and abnormal moevements as in throwing sports results in impingment.

Shoulder instability

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Imagine a one day cricket match. The fielder at cover dives to catch the uppish shot. He misses and falls on his outstretched right hand. He experiences a sudden excruciating pain and is unable to move his arm. He is taken to the casualty of the nearest hospital where x rays reveal a dislocation of his right shoulder. It is put back into joint. Unfortunately he gets recurrent episodes of dislocation when taking his arm backwards at shoulder height.
SC, a scooterist applies brakes to avoid hitting a bull which suddenly decides to go for the garbage can on the other side of the road. He falls on his outstretched hand. Although he experiences a sudden momentary pain in his shoulder, he is able to move the arm. He brushes the dirt and drives off only to feel later episodes of pain when combing.
PV, an electrician gets a shock from a high voltage cable. He experiences sudden pain in the right shoulder and is unable to move the arm.
All these young men have some form of shoulder instability. The first is a frank case of recurrent dislocation, the second, a case of subtle instability, and the third a case of posterior dislocation which occurs after electrocution and in epileptics.
Anatomy
The Shoulder joint enjoys a very good range of movement at the price of stability. The shallow socket at the outer end of the shoulder blade receives the upper end of the arm bone. It is deepened by the attachment to its rim of the labrum, a band of connective tissue. After an injury, this labrum may be detached, thus leading to instability as it does not heal back in place.
Standard treatment
After confirmation of the direction of instability, the orthopedic surgeon may decide to stabilize the shoulder. More than one type of operation is available to treat this condition. However most of them do not address the anatomical abnormality. The golden standard of surgical treatment for anterior instability is a “Bankart repair”. This can be done by open methods or arthroscopically. The detached labrum is reattached back to its position.
The arthroscopic procedure is as effective as the open and has the advantage of being accomplished through minimally invasive key hole incisions.
The more subtle forms of instability as in the second case have to be differentiated from other causes of shoulder pain like impingement, rotator cuff tear, and calcium deposits and again be treated along the same line as a frank dislocation. After a very short period rehabilitation is commenced to regain the full range of movement. In anatomic repairs as above, full range of movement can be regained. However outdated and non anatomic repairs are used, some degree of movement is permanently lost.

First Arthroscopic rotator cuff repair for American in Chennai

The first Amercian citizen under went shoulder arthroscopy and a mini open rotator cuff repair for a full thickness rotator cuff tear at Chennai. A 47 year old civil engineering contractor from North Carolina put an end to his 20 year old shoulder problem at 1/ 20th of cost of treatment in the US. His friend had recently paid up 58000 US dollars for a similar surgery whereas his treatment cost him only 200 $ in Chennai.

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Reverse shoulder prosthesis- An useful option for large rotator cuff tears

Elderly people with large rotator cuff tears and unwilling to compromise on their activity levels now stand to benefit from a novel design of Shoulder replacement. This prosthesis substitutes the function of the damaged rotator cuff. The ball of the artifical joint is actually implanted into the original socket of the glenoid and the socket is recreated in the ball shaped end of the arm bone( Humerus)
Visit www.shoulderindia.com for more information on shoulder replacement

Orthopedic treatment in India for NRI's, UK, US citizens

If your shoulder hurts from rotator cuff tears, arthritis, frozen shoulder or dislocates due to a sports injury, then it is time to put your problems behind and get it operated in Chennai, India by UK trained orthopaedic surgeon, Dr.A.K.Venkatachalam. Learn more about your shoulder problem and its solution from http://www.shoulderindia.com/. Surgery is performed under regional or general anesthesia. Open and arthroscopic techniques are performed to deal with the condition effectively. Post op recovery will be painless and smooth due to effective multi modal analgesia with pain pumps, analgesics and cryotherapy. Physio therapists will be firm and gentle to help you regain full function quickly. Nursing care during your short stay will be tender. Rooms are comfortable. Recoup after surgery in sea side resorts by historic mono lithic rock carvings. Soak into the tales of the past. India is the favorite destination for orthopaedic treatment abroad and doctors and hospitals in Chennai are equal to the best in the world.

Arthroscopic surgery for shoulder dislocations, rotator cuff tears, India

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Arthroscopic shoulder surgery is done for impingement, debridement and repair of rotator cuff tears, instability, recurrent dislocations, spur formation of clavicle( collar bone). A shaver is introduced into the shoulder through tiny key hole incisions and excess bone is burred away. Torn tendons are then repaired to their original attachment with suture anchors. Recovery after shoulder arthroscopy is quick and pain free in Chennai.
Contact the surgeon at akvenkat@shoulderindia.com

Shoulder problems in Diabetics

Dr.A.K.Venkatachalam,consultant orthopaedic surgeon,Chennai Tel 00 91 9282165002,www.shoulderindia.com.Diabetics have an additional burden of joint problem in addition to their systemic problems of nerves, eyes, blood vessels, kidneys etc.
Diabetics are prone to develop a condition of the shoulders called primary frozen shoulder. It can affect both shoulders in a small percentage of people. It usually resolves over a period of time but can leave behind a lasting deficit of certain movements.
Middle aged diabetics also develop tears of the rotator cuff and this can lead to a secondary frozen shoulder. Rotator cuff is group of tendons on top of the shoulder which help to stabilize the joint.
They can develop calcium deposition in the rotator cuff tendons.
They are prone to develop Gouty arthritis in their shoulders like in any other joints since Gout has an association with diabetes. Gout is a condition due to consumption of uric acid which is a by product of the digestion of red meat.
In this article I shall discuss frozen shoulder.
Definition-
Frozen shoulder (Adhesive capsulitis, periathritis) is a condition characterized by a loss all movements at the true shoulder joint. There is pain initially. Pain settles down and there remains stiffness which sets in over a short period of time. Clever people may recall a traumatic incident. In others it may come on slowly. Stiffness may be permanent. The movement that is maximally affected is external rotation (rotating the arm outwards away from the body). This results in inability to reach behind the head with the hand to tie the hair. When both shoulders are affected elderly women are in an embarrassing situation. Overhead activities are also affected as the degree of elevation of the arm is reduced.
Anatomy
The shoulder is the most mobile joint in the body. Its function is to position the arm in space to reach out to objects and deliver them to the mouth for eating and for other actions. The shoulder is a ball and socket joint formed by the upper end of the humerus (arm bone) and the socket formed by the glenoid of the shoulder blade. It is lined by a bag like capsule. The capacity of this joint is about 15- 20 cc. In frozen shoulder the capacity is reduced to 2- 3 cc. The movements at the shoulder joint occur synchronously with that at joint between the shoulder blade and the torso and are compensated to some extent by this.
History of frozen shoulder-
Only in the last few years has the ideal treatment been suggested. It is a relatively rare disorder of the shoulder and in a population of 20 shoulder patients there may be one or two with this condition.
However many doctors and orthopaedic surgeons label any painful condition as a frozen shoulder and advice physiotherapy. This can make the condition worse.
Recent advances
It has been recently discovered that the answer to frozen shoulder lies in the genes. These genes may also be associated with Diabetes mellitus. The alterations in these genes and chromosomes lead to a distorted response to wound healing and scar tissue formation. Exuberant scar tissue forms in response to trauma. The remodeling of scar tissue collagen is less. When more scar tissue forms in the capsule of the shoulder joint, the normally possible movements are grossly reduced. Diabetics also develop nodules in their palms and feet, another evidence of the exaggerated healing process.
Standard treatment-
This is a combination of physiotherapy and steroid injections when the condition is initially painful. Physio can be done at home. The standard Orthopaedic treatment has been a manipulation under anaesthesia. This carries a theoretical risk of fracture but has not been validated in practice. Since I have pointed out that rotator cuff tears can coexist with a frozen shoulder, the ideal management would be an arthroscopic release of the contracted structures within the joint. An arthroscope is an instrument used to look into joints through tiny key hole incisions. The benefits are less pain after surgery and faster rehabilitation. Since scar tissue formation is minimized, lesser are the chances of recurrence and greater the chance of retaining the full range of movement. The range of movement achieved after the release has to be maintained with physiotherapy. In case there is some tear of the rotator cuff, repair can be done at a later stage.

Dr.A.K.Venkatachalam, MS,DNB,FRCS,MCh Orth, shoulder surgeon, Chennai

Shoulder orthopaedic surgeon treats recurrent dislocations, rotator cuff tears, labral tears,impingment frozen shoulder, calcium deposition disease, collar bone arthritis by open and arthroscopic means at Chennai, India.
He trained in the UK under eminent shoulder surgeons and has worked in India, England and the middle east.
Shoulder arthroscopic surgery is cosmetic, less painful and patients quickly recover movement.
Visit www.shoulderindia.com and www.kneeindia.com for further information.