I believe that when it comes to treating an athlete, there is no time or reason to play around. Time bound efficiency and excellence in managing them are the desired goals. From the occasional ‘weekend warrior’ to a competitive athlete, the need is to help them recover and return to the game as quickly and as safely as possible.
WHAT IS SPORTS MEDICINE?
Sports medicine deals with treatment and prevention of injuries sustained during sporting activities and during exercises. It also involves applying the knowledge of exercise medicine to focus on improving the performance of an athlete.
HOW IS SPORTS MEDICINE DIFFERENT?
When sports persons or active persons are injured, they need comprehensive management which will help them return to their sport or physical activity as quickly as possible. Therefore sports medicine involves a team of clinical and para-clinical experts like trainers, physio’s, coaches, nutritionists, psychologists and orthopedic surgeons who are trained in treating and preventing sports injuries. So the treatment starts from the field (where injury has happened) and ends on the field when the athletes recovers and goes back to his game, and not just in the hospitals wards and clinics.
WHAT ARE THE CONDITIONS NORMALLY MANAGED BY SPORTS MEDICINE SPECIALISTS?
A variety of conditions are managed ranging from simple ‘sprains’, ‘strains’, ‘tears’ to more severe joint and ligament reconstructions and instabilities. Some conditions are listed:
TENNIS ELBOW AND OTHER TENDINITIS
CARTILAGE AND MENISCUS TEARS
ACL, PCL AND OTHER LIGAMENT REPAIRS AND RECONSTRUCTIONS
IMPINGEMENT SYNDROMES AROUND HIP, SHOULDER AND ANKLE
LIGAMENT INSTABILITIES AROUND KNEE, ANKLE, ELBOW AND WRISTS
SHOULDER INSTABILITY AND ROTATOR CUFF TEARS
HAMSTRING AND OTHER MUSCLE STRAINS
WHAT IF MINE ISN’T A SPORTS INJURY AND I AM NOT AN ATHLETE?
Any injury to the Muscle, Tendon, Ligament or Bone can be treated in all levels of athletes and in non-athletes as well. Muscles ‘strains, Tendon ‘tears’, Ligament ‘sprains’ and Bone ‘breaks’ can all be managed effectively. Injury may have been sustained during your regular jog, exercise, routine work, daily activities or any accident, can all be taken care of.
IS MY SPORTS INJURY GOING TO END MY SPORTING CAREER?
Many injuries earlier were career-ending because of lack of understanding and effective preventive and managing protocols. Fortunately with modern technological advances, sports injuries are being screened and diagnosed better, prevented and treated better, and also rehabilitated better.
WHAT IS A FRACTURE AND HOW DOES IT HAPPEN?
A fracture is a complete or partial break in a bone. There are two kinds of fractures – Simple and Compound depending upon the presence of an associated break in the overlying skin and soft tissues. Fracture happens when more force is applied to the bone than the bone can withstand. It may result with minor injuries when a bone is weakened by Osteoporosis, or over a time due to continued stress as in Stress fractures in athletes resulting from overuse or following a severe trauma as in a road traffic accident or fall from height.
HOW IS A FRACTURE DIAGNOSED?
Fractures results from trauma and cause considerable Pain, Swelling and a visible Deformity of the extremity. The pain may prevent you from using or moving the limb. An X-ray, CT scan or an MRI scan may be needed to confirm and analyze any fracture
IS SURGERY NEEDED FOR ALL FRACTURES?
Surgery will allow early mobilization especially in elderly people, but it is not needed in all cases. Some cases can be effectively managed by splinting and casts application. Whatever the treatment chosen, every fracture will need to undergo rehab exercises and follow-up visits to know the progress of healing and look for possible complications.
HOW MUCH TIME DOES A FRACTURE TAKE TO HEAL?
Healing will starts immediately following a fracture. The body will try to bridge the gap and mend the bony break by forming new bone called as callus. Over few weeks (in children) and few months (in adults), the soft callus is replaced by hard bone and the fracture unites. The union of any bone however, depends on number of factures like the age, fracture pattern, location of fracture, medical complications and the treatment given, to name a few. Research has confirmed that smoking and excess use of NSAIDS (pain killers) always delays fracture healing.
WHAT ARE THE COMMON COMPLICATIONS THAT CAN HAPPEN?
Fracture complications can result from the type and nature of fracture. In general, Open fractures are more prone for Infection and delayed healing. It is important to remember that the healing of any fracture is done by our body itself, and any surgery of cast is only to maintain the fracture ends in proper alignment and facilitate healing and not ‘cause’ or ‘accelerate’ healing. Therefore, despite surgery, some fractures may be slow to unite or go for non-union. Some fractures may unite but in improper or mal-alignment. Stiffness of joints can result from intra-articular fractures or fractures which communicate of involve joint surfaces. Many acute injuries can cause complications like compartment syndrome, neuro-vascular injury, muscle and tendon tears etc.
Arthroscopy is popularly known as keyhole surgery and is used to diagnose and treat problems in and around joints.
We commonly perform arthroscopic surgeries on the hip, knees, shoulders, ankles,elbows and wrists.
The equipment used during an arthroscopy is very small, so only small cuts in the skin are needed. This means it has some advantages over traditional, "open" surgery, including:
- less pain after the operation
- faster healing time
- lower risk of infection
- you can often go home the same day
- you may be able to return to normal activities more quickly
It is used to treat a range of joint problems and conditions including:
- repairing broken ligaments
- repairing broken tendons
- excising impinging bony outgrowths
- removing fragments of loose bone or cartilage
- repairing loss of cartilage
- draining away any excess fluid or pus
How is it done?
An arthroscopy is usually carried out either under Spinal anesthesia or General anesthesia. A tiny incision is made on the joint so that a device called an arthroscope (a thin, metal tube with a light and camera at one end) can be inserted. Fluid is used to inflate the joint cavity. This helps to pass instruments and perform intra-articular procedures without damaging the joint cartilage. The arthroscope sends images to a video screen, allowing the surgeon to see inside your joint.
After the procedure, the arthroscope and any attachments are removed, along with any excess fluid from the joint. The incisions are usually closed using special tape or stitches and covered with a sterile dressing.
An arthroscopy usually takes between 30 minutes and 2 hours, depending on the type of procedure carried out. You'll either be able to go home on the same day as the surgery or the following morning. The hospital stay is maximum for 48 hours.
What are the risks?
An arthroscopy is generally considered to be a safe procedure, but like all types of surgery it does carry some risks.
It's normal to experience short-lived problems such as swelling, bruising, stiffness and discomfort after an arthroscopy. These will usually improve with physiotherapy following the procedure.
More serious problems are much less common, occurring in less than 1 % cases. They include:
- A blood clot that develops in one of the limbs – known as DVT or deep vein thrombosis. It usually causes pain and swelling of the leg
- Infection inside the joint – known as Septic Arthritis and causes fever, pain and swelling in the joint
- Bleeding inside the joint – also called hemarthrosis, which often causes severe pain and swelling
- Accidental damage to the nerves near the joint – very very rare complication. which can lead to temporary or permanent numbness and some loss of sensation
Joint Replacement Surgery
WHAT IS TOTAL JOINT REPLACEMENT?
When a joint has worn out so much that it can no longer do its job, it needs to be replaced by an artificial joint or prosthesis. This prosthesis is designed to replicate the anatomy of the normal joint and help move and work just like the healthy joint. Knee and the hip joints, most commonly need to be replaced; however shoulder, elbow, ankle and wrist can also be replaced in special circumstances involving damage to the joints
AM I A CANDIDATE FOR JOINT REPLACEMENT?
Indications for joint replacement are following:
Significant functional disability and inability to perform activities of daily living
Pain not relieved with non operative methods
Severe stiffness of joints
Radiological evidence of severe damage to joints
IS JOINT REPLACEMENT SAFE SURGERY?
Joint replacement is a very common and safe surgery. With proper screening tests and evaluations before surgery and the monitoring during the hour long surgery, it has given positive results with very minimum risks.
HOW LONG WILL A REPLACEMENT LAST?
Usually, replacement prosthesis lasts for 15-20 years at an average, but it can fail earlier in some cases. The life expectancy would also depend on age, weight, level of activity and overall health of a person. A revision surgery may be needed in such circumstances
WILL I BE IN MUCH PAIN AFTER THE SURGERY?
Pain will wean off as days pass by. Most patients, who have been suffering from joint pain for years, would have good relief. Multimodal management of pain involving nerve blocks, IV pain medicines, anti-inflammatory medicines, physical therapy and local injections will effectively aid in minimizing post-operative pain
WHEN CAN I RESUME NORMAL ACTIVITIES?
Usually routine activities like driving, working and outdoor activities can be started after 6 weeks but it may take 3 months for full function
WHAT ARE THE RISKS INVOLVED IN THE SURGERY?
All surgeries involve risks especially in elderly population. Possible complications like infection, deep vein thrombosis, joint dislocation and loosening are rare but all necessary precautions are taken before, during and after the surgery
IS REPLACEMENT THE ONLY OPTION FOR ARTHRITIS OF JOINTS?
Replacement surgery is the last resort in the management of arthritis of joints. The treatment modalities earlier in the disease involve activity modifications, weight loss, exercise programs, walking aids, intra-articular hyaluronic acid injections, physical therapy and medications. Mechanical disfunctions can be corrected by a ‘keyhole’ surgery called arthroscopic joint debridement. Similarly, mal-alignments of joints, earlier in the disease can be tackled by a corrective osteotomy.
Image Guided Injections
WHAT IS IMAGE GUIDED INJECTIONS
Intra-articular joint injections can be ‘guided’ or ‘routed’ with the help of x-rays, CT scans or Ultrasound, such office procedures are called ‘image-guided’ injections. The imaging modality will help us locate the needed and guide us to the correct spot
WHAT ARE THE ADVANTAGES OF IMAGE-GUIDED INJECTIONS?
Image-guidance helps to improve the accuracy and therefore efficiency of intra-articular and other injections. By avoiding medicine at wrong spots, it also helps in preventing complications due to extravasation of medicine. It helps prevent damage to adjacent nerves and vessels.
IS ULTRASOUND SUPERIOR TO AN X-RAY OR A CT GUIDED PROCEDURE?
Both X-ray and CT scans involve considerable exposure to radiation, whereas, Ultrasound is a safe and cost-effective modality. It is devoid of ionizing radiation and is also capable of providing real-time dynamic tissue assessment.
WHAT CONDITIONS CAN BE EFFECTIVELY MANAGED BY IMAGE-GUIDED INJECTIONS?
Ultrasound helps to reliably visualize soft-tissues like muscles, ligaments, tendons and nerves and also helps to identify any pathological changes in these structures. The following conditions are commonly treated by ultrasound guided injections:
- Tennis elbow and Golfer’s elbow
- Achillis tendinopathy
- Impingement syndrome and frozen shoulder
- Trigger finger and Dequervains’ disease
- Plantar fasciitis and calcaneal spurs
- Intra-articular injections in shoulder, knee, ankle, elbow, wrists, hip and spine.
WHAT ARE THE AVAILABLE INJECTION TREATMENT METHODS?
- Steroid & Local anaesthetic injections
- Visco-supplementation (hyaluronic acid) injections
- Platelet-rich plasma (PRP) injections
- Tendon needling therapy for Calcific tendinopathy