Surgeon, Wockhardt Hospitals Description of the shoulder The Commonest Cause of Shoulder/Arm Pain: Subacromial Impingement What is Shoulder Impingement Syndrome?
Friction between muscle/gliding tissue on one side and the bone on the other side- around the shoulder Symptoms & Signs of Impingement Pain Shoulder
Pain around the shoulder, upper or lower
arm/hand, neck or chest More pain at night Difficulty in lifting the arm above the head Difficulty changing clothes or reaching the back for personal toilet hygiene purposes Stiff shoulder Weakness of shoulder/arm Diagnosis of Shoulder/Arm/Hand Pain
• If your pain has not improved with medication
and physiotherapy, then the most important, essential, first requirement is seeing a specialist orthopedic surgeon with specific, high quality training and experience in assessment and treatment of shoulder/arm/hand pain problems How Does a Specialist Upper Limb Surgeon make an accurate Diagnosis?
This question is the same as a non-pilot asking how exactly
a specialist pilot flies a sophisticated airplane!
In general, the specialist relies on skilled clinical
assessment, certain x-rays and scans such as an MRI or an ultrasound scan Mrs. Rina Gupta An active and otherwise healthy home-maker, with shoulder/arm pain and stiffness; no benefit with medication and physiotherapy
After a thorough clinical assessment, the diagnosis was-
impingement pain shoulder with collar-bone arthritis and frozen shoulder Treatment administered
Key-hole (arthroscopy) technique with coblation technology to remove
inflamed tissue from the shoulder
Post surgery – movement of her shoulder
What is Coblation Technique
Coblation or controlled ablation works on the principle of
bipolar radio-frequency from a voltagerather than power) driven source, generating a plasma layer around tip of the instrument in the joint.
This plasma layers dissolves rather than burn the target
tissue within 1/10 of a mm area at body temperature, thus no damage is caused to other tissues. How Does Coblation work?
Coblation increases interleukin-8,
which is associated with angiogenesis and tissue healing, through elimination of harmful interleukin-1. Tendinosis, caused by 'failed tendon healing’, can be effectively treated using RF-based technology to induce an angiogenic response in order to promote healing Coblation Vs Conventional Techniques
Unlike the laser, cautery or mechanical means of removing
diseased tissue, Coblation works at low temperature, removes only diseased tissue, no harm to normal tissues, no heat damage or mechanical damage to cartilage in shoulder or knee
Coblation promotes healing of tendon and selected cartilage
problems, too. This is not possible with conventional, current methods used predominantly in India at present Coblation Video Coblation: Patient Benefit
Treatment of smallest areas of damaged tissue, muscle,
tendon or damaged cartilage, with no harm to normal tissues; most natural form of technique compared to laser, cautery or mechanical methods
The most nature-friendly way of operative treatment of
What Clinical & Technical expertise is needed to use coblation technology?
Extensive and lengthy super-specialist training &
experience in upper limb orthopedics and arthroscopic techniques –currently in India such expertise is available only in a few centres
Specific training at specialist centres( currently outside
India) Coblation- Bipolar Radiofrequency for various orthopaedic problems
• With BRF we can treat patients suffering not just
from shoulder/arm pain, but also tennis elbow, golfer’s elbow, heel pains, knee cartilage damage reconstruction (chondroplasty), to name but a few conditions Treatment of Shoulder/Arm Pain
First Line of treatment: Anti-inflammatory/pain killers, local
spray/cream, physiotherapy
Second Line of treatment: Injection
If pain &/or stiffness are persistent, key-hole (arthroscopy)
surgery of shoulder to remove inflamed tissue and trim any overgrown, arthritic bone: this allows muscles and joint to move freely without pain Arthroscopy/Coblation: Who is eligible for treatment?
• Decision must be made on the merits of each case
individually
• These treatments are reserved for those patients whose
pain and disability have not improved with medication and/or physiotherapy
• Correct decision can only be made by a specialist with
extensive training and experience in these methods The Future of Arthroscopic & Upper Limb Surgery in India
With increasingly westernised life-styles, we will import
their diseases, too
There will be increasing need for treatment of
shoulder/arm, elbow, wrist, thumb pains from arthritis, carpal tunnel syndrome, worn and painful tendons etc
Key-hole surgery for wrist, and joint replacements for
thumb arthritis, cartilage repair treatment, will become more common Prevention is better than cure! Stretch your arms, shoulder, fingers, back and neck every 20 to 30 minutes
Avoid food and drink that release damaging free radicals in
your body; so avoid smoking, alcohol and non-veg food at all times; “moderation” in drinking alcohol is a harmful myth
Alcohol, smoking and meat are linked with gout, weak
bones, poor circulation, stiff joints and higher risk of cancers
There is no minimum safe amount when it comes to