Arthroscopy surgery at Trichy to cure joint problems of knee, shoulder and other joints

Sports Injury Service and Advanced Arthorscopic Surgery Service At KMC Speciality Hospital

Sports is becoming more of a passion as much as a hobby in our Country. Winning World level events has attracted more of our young boys and girls to partake in sports and even take this as their profession. As each profession carries its risks, sports poses us the biggest risk to these young generation in the form of injuries.

Injuries in sports mostly affect the musculoskeletal system. The muscles, tendons, bones and the joints are the components of this system. The joints are complex structures having cartilage, ligaments attached to the bone through soft tissues.

Most sports injuries are managed initially with the following fundamental principles. Remember the mnemonic RICE whenever one gets injured. Rest the injured part, apply Ice, apply Compression and Elevate the injured part. The practice of applying warmth in the form of hot water pack/bottle to the injured part is not recommended.

Physiotherapists either at the sports arena or at the hospital can treat majority of minor injuries to the muscles and tendons. The spasm associated with the muscle and tendon injuries can be treated with stretching and local treatment as described above. Some of these injuries especially the minor ligament injuries need rehabilitation by attending a dedicated physiotherapy department.

KMC Speciality Hospital has a dedicated Physiotherapy department to treat these injuries. The devices available in the department cover all areas of the body. They are designed to treat with mobilisation, stabilisation and retraining.
Though the initial pain and suffering improve with these simple measures and physiotherapy treatment, the long term recovery depends on detection and treatment of major injuries. These major injuries often feel like minor injuries after rehabilitation. However the key to return to sports and normality relies on recognising these as needing further treatment.

Hence we need experts who can diagnose and be able to treat them with the modern treatment methods. At KMC Speciality Hospital, we have surgeons trained and practiced abroad in treating these injuries. Treating them with modern treatment methods practiced in western countries is the key for getting back to normality.

Modern methods of treatment of the sports injuries often involve keyhole surgery to the joints. This is called Arthroscopic Surgery. Arthroscopy started as far as back in 1910s, though the treatment with this technique was possible after 1970s in Japan.

The Advanced Ortho Care at KMC Speciality Hospital has a dedicated state of the art High Definition Arthroscope with HD monitor for excellent visualisation and treatment of the injured part. The supportive power instruments, electronically controlled pump system and Radiofrequency Ablation techniques are at par with the most advanced hospitals in the world.

The problems, which can be treated with these Arthroscopic techniques, are many and can only be listed as a guide as follows.
1. Cartilage injuries of the knee: Meniscus Injuries in the knee and Wrist cartilage injuries
2. Ligament Injuries: Anterior and Posterior Cruciate Ligament Injuries in the knee
3. Tendon injuries of the muscles in the shoulder: Rotator Cuff Injuries and SLAP lesions
4. Recurrent Dislocations: Dislocations of the shoulder and kneecap, which often recur in young sports people
5. Recurrent and persistent pain in joints: Impingement of the joints, which affect mostly shoulders, ankles and elbow
6. Post trauma stiffness of the joints
7. Instabilities of the joints: shoulders and ankles
8. Infections of joints
9. Arthroscopic fusions of joints especially ankle


Some of the other Advanced Ortho treatment Methods provided at KMC Speciality Hospital are as follows
1. Joint Replacements of Knee, Hip, Shoulder, Elbow and Ankle using imported implants with international standards [Swedish, UK and Australian Standard]
2. Partial joint replacements with implants originating from Oxford,UK.
3. World Class treatment methods of simple and major Trauma using principles of international Swiss [AO] and American Standards [ATLS]
4. Treatment of deformities in Children with Ponseti Method [Canada]
5. Treatment of complex trauma and deformities using Russian Technique [Ilizarov technique]
6. Treatment of Fractures in Children using French Technique [Nancy]

Doctors Day India: Modern Technology of Arthroscopic Surgery for joint problems in Trichy

Pain Relief with Modern Technology at our doorstep: Key hole surgery to the Joints [Arthroscopy]
Dr S Chockalingam
Pain is highly unpleasant physical sensation caused by illness or injury, according to Oxford Dictionary. Joint pain not only causes this unpleasant sensation, but also disables a patient. Inability to do walk, sit, squat or wash ourselves without pain is quite common among us; often we do not like to talk about them.
We attribute lot of these inabilities to our age, illness such as diabetes or arthritis. Yet most of these problems are mechanical problems of our joints and the surrounding tissues. Tendonitis, ligament injuries and cartilage problems which affect so much of our sports stars, do not leave the rest of us from causing pain and disability.
These mechanical problems causing disabilities to our knees and shoulders are very common. Technology comes to our rescue in recognizing and correctly solving these problems. Arthroscopy of the joints help us to bring the benefits of key hole treatment like laparoscopy.
Arthroscopy is the key hole surgery to most joints in our body to provide treatment with advanced equipment. This treatment reduces discomfort to the patients, increases the accuracy of surgical technique and hence often relieves a patient’s disability to return them to normality.
The technical expertise in providing such a specialized treatment is more important than the equipment itself

. The message I would like to leave on this Doctors’ Day is to “commend the efforts by the doctors who strive to provide the best to our patients by bringing the modern technology right to our doorsteps to alleviate our pain and disability”.

Chest Injuries in trauma: The major killer in India after road traffic accidents: Seat belt should be worn in cars and buses

Breathing and Chest Trauma

Dr S Chockalingam

One of the major killer injuries is Chest Trauma. In fact the chest trauma is the commonest killer for a driver behind a steering wheel especially when not wearing a seat belt. Chest trauma is one of the injuries, which is treatable in a patient who can reach a hospital alive. Appropriate treatment can save many lives if recognised promptly. This appropriate treatment is often a simple intervention as opposed to a thoracotomy. Any doctor irrespective of their specialist interest should safely perform these simple interventions.

The following content focuses briefly on the essential anatomy, physiology of the chest. The main focus is then on recognising these injuries and acting swiftly to save one’s life. Early recognition of these injuries will also help in preventing late deaths.


Essential Anatomy:

The Chest is comprised of the lungs and pleural cavity, heart and pericardium, mediastinum and its contents, chest wall with the ribs and the muscles, diaphragm.

Essential Physiology:

The function of the chest is mainly two fold, gas exchange chamber and a safe haven for the heart and major vessels.

1.The lungs with the bronchial tree and alveoli function as gas exchange chamber. Oxygen gets in to the circulation and CO2 is excreted. The Chest Wall with the pleural cavity and the diaphragm acts as the motor behind to facilitate the gas exchange.

2. A safe place to keep the important organ, the heart and the main blood vessels.

Recognition and treatment of the chest injuries:

In our Medical School, we are taught the art of clinical Medicine. These would be taking a detailed history, thorough examination and ordering appropriate investigations before instituting treatment. The management of trauma is a clear exception to this approach. Hence we have to recognise the injuries and treatment the life threatening injuries before proceeding to the next step. This is most appropriate in chest trauma.



Recognition of Chest Injuries:


A patient who had trauma should always have the primary survey starting with

Ensuring a patent Airway with Cervical Spine Protection before moving on to the chest injuries. The injuries to the airway presents with similar features to the chest injuries. Airway obstruction with
1. Strider
2. Inability to talk
3. Broken tooth
4. Secretions in the pharynx
5. Gross swelling of the neck

Should be managed before moving on to the chest injuries.

The recognition of the chest injuries is essentially two fold.

1. Assess the breathing
2. Assess the cardiac function

These are done by

1. Look
2. Feel
3. Percuss
4. Auscultate
5. Use adjuncts

Look:

1. Equal chest wall movements
2. Engorged veins in the neck
3. For open wounds
4. Abnormal chest wall movements

Feel:

1. Tenderness
2. Crepitus
3. For equal chest wall movements
4. Pulse rate
5. Tracheal position, midline or deviated



Percuss:

1. Hyper resonance
2. Dull note on percussion

Auscultate:

1. Air entry on both sides
2. Heart sounds
3. Abnormal sounds suggesting obstruction
4. Blood pressure

Adjuncts:

1. Pulse oximetry, Pulse, Blood Pressure assessments
2. Chest X ray
3. ECG

Serious Injuries to be recognised promptly:

1. Conditions which affect mainly breathing
a. Massive air collection around the lungs: massive pneumothorax
b. Massive blood collection around the lungs: massive hemothorax
c. Chest wall injuries leading to flail chest
d. Open chest wound with pneumothorax

2. Conditions which affect the heart and circulation

a. Massive blood collection around the heart: Cardiac Tamponade
b. Massive blood collection around the lungs: massive hemothorax


Treatment as you recognise these serious injuries

1. Needle decompression and chest drain for massive pneumothorax
2. Cover open wounds with air tight dressings immediately
3. Resuscitate with oxygen and blood prior to
4. Chest Drain for massive hemothorax
5. Ventilate with oxygen, ambo bag for flail chest before intubation
6. Needle decompression of pericardium in rare instances

The rest of the chest injuries can wait until we complete the primary survey and management of other major injuries.
Other Injuries, which will become life threatening in due course and hence should be recognised and treatment started. These are

1. Pneumothorax which is not massive
2. Hemothorax which is not massive
3. Major airway injury of tracheobronchial tree
4. Blunt injury to the heart
5. Major vessel injury such as aorta
6. Mediastinal often open injury
7. Injury to the diaphragm
8. Multiple rib fractures

Please remember the power cable for chest wall function is “the intercostals nerves and the phrenic nerve and the brain” ultimately. Hence any injury to the spinal cord, brain and the phrenic nerve will affect breathing even when the chest wall is not injured.

Summary

We have to be familiar with understanding of the following features associated with major chest injuries

When observing the patient

1. Chest pain and air hunger
2. Distress in breathing
3. Sucking open, but often-small wounds in the chest wall.
4. Flail chest

When eliciting the signs

5. Absent breath sounds
6. Engorged neck veins
7. Subcutaneous emphysema
8. Tachycardia and Hypotension
9. Deviated trachea
10. Muffled heart sounds
11. Cyanosis

When assessing with
12. Abnormal saturation with Pulse oximetry
13. Chest x ray abnormalities in trauma
14. ECG changes of blunt cardiac injury

The key message of this review on Chest Trauma is never underestimate these injuries as often these injuries kill a patient within few hours of injury and if not will adversely affect the outcome in the first few days of admission to the hospital

Innovation in Orthopaedics and at KMC Speciality Hospitals: 1. Epsom to Trichy: Chockalingam

This is a custom spica table for applying hip spicas in children. There are so many different methods to attach a support for the child when applying hip spicas. The best one i have used is one introduced by my predecessor and former Colleague Mr[Dr] Philip Cheong Leen. We worked at Epsom General Hospital,Epsom, Surrey, UK. This was simply a miniature iron board made of metal.

So the concept was not mine but to bring to my hospital, i felt it was necessary. I have done hip spicas for femoral fractures, DDH and so on. I gave the measurements and idea to our Theatre senior ODP Mr Jayaraj and he executed very well. What you then see is what the output of the carpenter at our hospital and painting was done aptly in a pink colour.

Regards


Chockalingam

Academic Input from chockalingam

This is the work output of nearly five years of working on knee replacements at Royal London Hospital, London on Freeman Samuelson Knees. I always treasure the time I spent with Mike Freeman and Gareth Scott

This is the work output of my association with Mike Bell, Senior Consultant Paediatric Orthopaedics at Sheffield. I will always cherish the training given by him in this area along with other consultants in UK

This is the work output of a case report on skin burns in Orthopaedics

5th June 2011: Sports Injuries and Advanced Arthroscopy Awareness meet Trichy

Since 2009 January, We have done more than 150 thereupatic Arthroscopic Surgeries. These include Knee Meniscal Surgery, meniscal repairs, Anterior and Posterior Cruciate Ligament Surgery, Shoulder Decompressions, Rotator Cuff repair and Stabilisation, Ankle , elbow and wrist thereupatic arthroscopies. the indications even included rare conditions such as arthroscopic treatment of intra articular hemangioma and removal of bomb shrapnels arthroscopically.

When such work is being done in a hospital in a city like Trichy, you feel for the people who are not aware of the facilities being available and hence this year we took Arthroscopic Surgery , in other words the key hole surgery to joints for awareness program.

Sports being increasingly taken up by the younger generation and road traffic accidents constantly presenting with joint injuries, we decided that this would be the time for us to promote the awareness.

Please go through the picture attached with the details of the awareness program and i will post few pictures as well

Regards

Chockalingam

Part 2:Doing a job vs completing a job: concept of professionalism and sincerity and how money clouds both.

When I went to pay the Electricity Bill in Trichy, there were four queues. I joined the first outer queue without giving any thought. Then I noticed the queue on the inner two queues moved swiftly and the outer queues did not move as fast as one would expect. The obvious inference anyone would make is that the persons at the desk serving the public are efficient in some counters and may be we joined the wrong queue.

But why should only the outer queues move slowly whereas the inner queues were otherwise. Chances! May be and they were not in this instance. The outer queues had constant disturbances with people getting in front by pushing themselves in. And also many people would simply give their cards and money to someone in the queue already to pay for them. Hence the person at the counter was doing as fast as the other counters but had too many transactions per person to handle.

Why I am elaborating this story so much? This is part two of my previous blog and completing a job. You can complete this job of paying the EB bill in many ways.

1. By properly standing in the queue: Be Sincere

2. You can squeeze in and pay the bill and be efficient in comparison to the one who is following the option 1. : Be Efficient

3. You can find ways to avoid the queue altogether, for example pay someone to pay for you and stand for you or log on to your account online and pay without a sweat, Be Professional.

Be efficient sounds good in option 2 but it is not acceptable to someone who stands in the queue sincerely. But be Professional sounds the best option since you find better way to do a job and acceptable and sounds right as well.

This brings me to the concept of Professionalism and Sincerity.

Though Sincerity sounds right in any thing you do, it may not be the efficient approach in competing a job. That is why Professionalism is much needed to combine sincerity and efficiency. This is why professionals score more and earn more for a given job. But you have to find professionals who show professionalism as opposed to efficiency by short cuts just like our example.

It can be difficult for anyone to differentiate the people who can complete the job efficiently as opposed to completing professionally. The latter approach may sometimes appear to take longer and costlier. I see more people who can complete a job without professionalism but efficently. In fact lots of jobs completed are done efficiently.

The efficient methods of following shortcuts are good if the outcome is for one off use or has a definite end point. For example paying an EB bill as above. But where it really hurts if the outcome has long term use. For example a building or a bridge. Here Efficiency has to give way for Professionalism. Because if you do not follow professionalism, then the lack of quality would show in the long run.

But you have to remember that everyone of us is a professional in what we do if we show professionalism.


Regards Chockalingam