1. Shoulder Arthritis and Shoulder Joint Replacement

2. Shoulder Dislocation / Instability

What are the causes for shoulder arthritis?

What are the symptoms of shoulder arthritis?

How is shoulder arthritis diagnosed?

What are the treatment options for shoulder arthritis?

Does arthroscopy have any role in the treatment of shoulder arthritis?

When is shoulder replacement recommended?

When is shoulder replacement surgery not recommended?

What are the types of shoulder replacements?

What is shoulder resurfacing?

What are the benefits of shoulder replacement?

How successful is shoulder replacement?

What are the risk factors?

How is the physiotherapy after this surgery?

What are the causes for shoulder arthritis?

Three major types of arthritis generally affect the shoulder:

Osteoarthritis

Osteoarthritis, or "wear-and-tear" arthritis, is a degenerative condition that destroys the smooth outer covering (articular cartilage) of bone. It usually affects people over 50 years of age and is more common in the acromioclavicular joint than in the glenohumeral shoulder joint.

Rheumatoid Arthritis

Rheumatoid arthritis is an auto-immune systemic inflammatory condition of the joint lining, or synovium. It can affect people of any age and usually affects multiple joints on both sides of the body.

Post-traumatic Arthritis

Posttraumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder. Arthritis can also develop after a rotator cuff tear.

Avascular necrosis (AVN) is a condition in which the bone of the humeral head dies due to lack of blood supply. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease and heavy alcohol use are risk factors for avascular necrosis

What are the symptoms from shoulder arthritis?

The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens. If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the weather.

Stiffness or Limited motion is another symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a clicking or snapping sound (crepitus) as you move your shoulder. There may be associated weakness of shoulder muscles.
As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.

How is shoulder arthritis diagnosed?

Weakness (atrophy) in the muscles
Tenderness to touch
Extent of passive (assisted) and active (self-directed) range of motion
Any signs of injury to the muscles, tendons, and ligaments surrounding the joint
Signs of previous injuries
Involvement of other joints (an indication of rheumatoid arthritis)
Crepitus (a grating sensation inside the joint) with movement
Pain when pressure is placed on the joint

X-rays of an arthritic shoulder will show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).

If an injection of a local anesthetic into the joint temporarily relieves the pain, the diagnosis is supported.

What are the treatment options for shoulder arthritis?

Nonsurgical Treatment:
Initial treatment of arthritis of the shoulder is non-surgical and may involve physical therapy. In addition, some therapies you may try include:
Rest or change activities to avoid provoking pain. You may need to modify the way you move your arm to do things.

Physiotherapy: may be helpful when arthritis is in early stages. It helps maintain joint motion and strengthen the shoulder muscles.
Moist heat

Anti-inflammatory and pain-killer medications: to reduce pain and inflammation

Ice the shoulder for 20 minutes two or three times a day to reduce inflammation and ease pain
If you have rheumatoid arthritis, your doctor may prescribe a disease-modifying drug, such as methotrexate, or recommend a series of corticosteroid injections.

 
 
 

Pathbreaking radio frequency surgery ends shoulder pain :Indian Express

New Radiofrequency Device Enables surgery for Shoulder Infection : Times of India

Successful Arthroscopic Shoulder Surgery for painful and stiff shoulder : Maharashtra Times

Shoulder Surgery by Arthroscopic Surgery Technique :LokmatSamachar

First Shoulder Arthroscopy in Prime Surgical :Kesari

Success with Arthroscopic Shoulder Surgery :VishaDarpan

Difficult Shoulder Surgery made easy by Arthroscopy :Dayittya

Arthroscopic Surgery for Shoulder Pain : Prabhat

First Successful Shoulder Surgery by Radio-frequency : Pudhari

Boon for a Cricket Enthusiast Doctor - Sakaal

Chinchwad’s Dr. Anand Jadhav appointed as Players Doctor - Antarang

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Facilities at Subrata Roy Stadium are world-class: Onsite doctor - The Indian Express

Players take injuries seriously - Sakaal Times

Timely treatment - Express News Service

Rare Reverse Shoulder Replacement was Performed for the First time in India - Express Healthcare

First-of-its-kind shoulder surgery performed at pvt hospital in city - Sakal Times

First case in India of Reverse Shoulder Replacement as Revision Surgery by Dr Anand Jadhav - PRLog (Free Press Release) and PR-inside.com (News and Free PR)

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Reverse shoulder replacement as revision surgery performed for failed fracture fixation - Syndication(Indian content licensing)

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Joints clinic opens at Chinchwad - Indian Express

London Joints Clinic performs Revision Surgery - Pharmabiz

Medical miracle - The Indian Express

 

For all appointments please call :
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To speak to Dr. Anand Jadhav
please call :
+ 91 99 22 44 6272

 

Dr Anand Jadhav is Sr. Consultant for Joint Replacement and Arthroscopic Surgeries in the following hospitals.

Ruby Hall Clinic ,Sassoon Road,Pune

Jehangir Hospital, Pune

Prime Surgical Centre,Law College Road, Pune

Nova Specialty Hospital,Saras Baug, Pune.

Aditya Birla Hospital,Chinchwad, Pune

Sahyadri Hospital,Deccan, Pune

Inamdar Hospital,Fatimanagar, Pune

Sahyadri Hospital, Pune

 

PRIVATE CLINICS :

London Joints Clinic
J-1 Building, Empire Estate, Old Pune-Mumbai
Highway, Chinchwad, Pune
Mon, Tues, Thurs, Sat: 6pm to 8pm

Usha Nursing Home
M.G. Road , Near Poolgate Police Chowky,
Camp, Pune
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Wanowrie, Near NIBM Chowk,
Pune
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Aditya Birla Clinic
Aundh, Pune
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Hospital OPD Timings :

Ruby Hall Clinic, Sassoon Road, Pune
Tues and Thurs: 9am to 11am

Prime Surgical Centre, Law College Road, Pune
Mon to Sat: by Appointments

Ruby Hall Clinic, Wanowrie, Pune
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Nova Specialty Hospital, Pune
Mon: 9-11am, Tue: 11am-1pm, Fri : 5-7pm


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Does arthroscopy have any role in the treatment of shoulder arthritis?

Arthroscopy is useful only in early stages.
With this operation, the doctor will trim out the inflamed synovial lining tissue and remove debris and pieces of degenerated cartilage. This surgery can relieve many of the symptoms, at least for a while. Patients must always be counselled that arthroscopic surgery does not cure arthritis and the benefits from surgery are not permanent.

When is shoulder replacement recommended?

Shoulder replacement surgery is recommended if

There is moderate or severe shoulder pain that limits one’s everyday normal activities of daily living.
No improvement in pain after taking regular pain killers.
Harmful side-effects from pain-killer medications
No improvement in pain even after Modification / restriction of activities
When there is no improvement with physiotherapy.
X –rays confirming advanced shoulder (glenohumeral) arthritis.

When is shoulder replacement surgery not recommended?

Shoulder replacement is not advised if there is:

Active or recent infection
Paralysis of deltoid or rotator cuff muscles
Neuropathic Joint ( Charcot Joints)
Glenoid resurfacing is not done if massive rotator cuff non-repairable tears

What are the types of shoulder replacements?

In shoulder replacement surgery, the painful surfaces of the damaged shoulder are replaced with artificial shoulder parts. The part that replaces the ball consists of a stem with a rounded highly polished metal head. The part that replaces the socket consists of a durable smooth plastic concave shell that matches the round head of the ball.

There are several different types of shoulder replacements.
Conventional total shoulder replacement: involves replacing the arthritic joint surfaces with a ball attached to a stem, and a plastic socket. Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Hemiarthroplasty: Only the ball part of the shoulder joint is replaced. The socket (glenoid) is not replaced as it has good cartilage.

Sometimes, the decision to perform total shoulder arthroplasty or hemi-arthroplasty is made in the operating room at the time of the surgery.

Implantation of a glenoid component is not advised if:
The glenoid has good cartilage.
The glenoid bone is severely deficient.
The rotator cuff tendons are irreparably torn.

The shoulder replacement components come in various types and sizes. If the bone is of good quality, your surgeon may choose to use a non-cemented or press-fit humeral component. These implants have a special porous coating which allows bone to grow into it to give lasting stability. If the bone is soft, the humeral component may be implanted with a special glue – bone cement. In most cases, the all-plastic glenoid component is implanted with bone cement.

Reverse total shoulder replacement components:
Another type of shoulder replacement is called reverse total shoulder replacement. This surgery was developed in Europe in the 1980s. Reverse total shoulder replacement is used for people who have:
Completely torn rotator cuffs and
The effects of severe arthritis (cuff tear arthropathy) or
Had a previous shoulder replacement that failed
In this type of surgery the positions of ball and socket are reversed. The ball is fixed to the shoulder blade at the glenoid and is stationary. The socket is mounted on a stem inserted into the upper end of humerus bone and is mobile. The reverse shoulder replacement needs an intact deltoid muscle for movement.

What is shoulder resurfacing?

Shoulder Resurfacing Surgery is an alternative to conventional shoulder replacement for the treatment of shoulder arthritis. It provides a bone conserving shoulder hemi-arthroplasty.

Shoulder resurfacing surgery involves relining rather than replacing the damaged of the ball of shoulder joint. Unlike traditional shoulder replacements, only the worn out cartilage from the head of humerus is removed along with very minimal amount of normal bone from the neck of humerus. The joint is then relined with a metallic cap fixed by bone cement.

Shoulder resurfacing implant

X- rays of shoulder resurfacing

What are the benefits of shoulder replacement?

Patients have an improved quality of life after shoulder joint replacement surgery. Their pain is abolished or significantly reduced. They have improved motion, better strength and better function.

How successful is shoulder replacement?

Total Shoulder Replacement is considered as successful (95%) in relieving pain as total hip or knee replacement.

What are the risk factors?

Risks associated with Shoulder Replacement are:
Stiffness
Infection
Axillary nerve injury – recovers as mostly neuropraxia
Peri-prosthetic fractures
Rotator cuff tears
Glenoid loosening
Instability

How is the physiotherapy after this surgery?

Hospital stay is for 2-3 days. After surgery the arm is kept in a shoulder sling for support and comfort.

Shoulder sling is required for 6 weeks until soft tissue healing occurs.

From the day of operation movements of fingers, wrist and elbow are encouraged.

For the first six weeks patients are only allowed pendulum exercises and passive assisted exercises out of sling. This allows good tissue healing without causing stiffness. They should do the exercises thrice a day.

6th to 12th weeks: Gradual improvement in range of motion is started. Active exercises are encouraged.

After 12th weeks: Strength straining starts to build on gains from previous weeks. The physiotherapist will use different modalities to improve the strength of your shoulder muscles.

Physiotherapy & Rehabilitation must be continued for 6-12 months post-operatively for maximum benefit of shoulder replacement surgery.

How is the shoulder joint stability maintained normally?

What is Shoulder Instability?

What are the causes for Acute Shoulder Dislocation?

What are the symptoms of Acute Shoulder Dislocation?

How is a Dislocation of Shoulder diagnosed?

How an Acute Shoulder Dislocation is generally treated?

What are the chances of developing Recurrent (repeated) Shoulder Dislocations?

What causes Chronic Shoulder Instability?

What are the symptoms of Chronic Shoulder Instability?

How is shoulder Instability Diagnosed and treated?

When is surgery advised in Shoulder Instability?

What are the benefits of Shoulder Stabilization Surgery?

What is done in stabilization surgery for Shoulder Instability?

What are the advantages of arthroscopic shoulder stabilization?

When is open shoulder stabilization recommended?

How is the shoulder joint stability maintained normally?

The shoulder joint is a ‘ball and socket joint’ with a shallow socket (glenoid) and a large hemispherical ball (head of humerus) which makes it unstable. Its lining (capsule) is very loose which allows excellent mobility to the ball. A fibro cartilage tissue called the labrum (lip in Latin) is attached to the circumference of the glenoid. The labrum helps in deeping the shallow socket and forming a type of suction cup for the ball. Additional stability is provided by capsular ligaments, which are thick cord like structures that attach to the labrum, and the rotator cuff muscles. This arrangement helps in stability and movement of shoulder joint.

What is Shoulder Instability?

Shoulder instability is a term describing abnormal looseness of the shoulder joint, such that the ball part of the joint (humeral head) slides out of the socket (glenoid). It is a pathological condition, rather than a normal physiologic variant such as laxity - looseness.

A minor form of instability in shoulder ligaments is called Subluxation wherein the shoulder ball partially slips out of the socket.

A more severe case of instability can cause the shoulder to completely slip out its socket and is known as a Dislocation.

Shoulder instability can develops in two different ways.
Traumatic (injury related) or Atraumatic Instability

Traumatic instability - If the ligaments holding the shoulder ball in its socket become stretched or torn, due to trauma or overloading, the necessary stability of the ligaments throughout the shoulder's large range of motion is compromised.

In atraumatic instability there is a general laxity (looseness) in the joint that eventually causes the shoulder to become unstable.

Understanding the differences is essential in choosing the best course of treatment.

What are the causes for Acute Shoulder Dislocation?

A fall on an outstretched arm that is forced overhead, a direct blow on the shoulder, or a forced external rotation of the arm are frequent causes of anterior (forward) dislocation. This is the commonest type of dislocation.

An epileptic seizure attack or electrocution generates severe abnormal muscular forces around the shoulder which causes posterior (backward) dislocation.

What are the symptoms of Acute Shoulder Dislocation?

Patients give a history of trauma followed by immediate onset severe shoulder pain and a sense of shoulder popping out of socket. They have difficulty in moving the arm. Patients may complain of swelling, deformity, numbness or weakness.

How is a Dislocation of Shoulder diagnosed?

Shoulder dislocation is diagnosed based on patient’s history of injury, clinical examination and x-rays.

A patient with shoulder dislocation usually holds the arm still against his side and any attempts to move the shoulder are painful. A large crease under the acromion (tip of shoulder) and a bulge in the armpit are clues to the direction of the dislocation. Range of motion, strength, and sensation will be tested if possible. Any changes or loss of sensation may point to nerve damage. The physician will also check the pulses in your arm in order to detect the possibility of vascular complications.

In those cases where the shoulder has managed to relocate spontaneously, the diagnosis can be difficult. Patients may only report the feeling of the shoulder "slipping out" before the spontaneous reduction occurred.

X-rays of the shoulder joint are usually taken to confirm the dislocation, its direction, and to check for a related fracture.

X-rays may reveal a "bony Bankart", which is a fracture of the anterior-inferior glenoid (front, lower portion of the glenoid). The presence of this fracture indicates that the labrum and ligaments in the front part of the shoulder are no longer attached to the glenoid.

How an Acute Shoulder Dislocation is generally treated?

After confirming shoulder dislocation by clinical examination and x-rays, the patient is given sedation or a general anesthesia to relax the muscles around shoulder region. With the help of an assistant the doctor will give gentle traction and manipulate the arm to relocate the shoulder joint. This is called closed reduction. X-rays are done again after reduction to confirm that the joint is in place.

Patient’s pain is immediately relieved after shoulder reduction. A shoulder sling is given for support and comfort. The sling is to use for 2-4 weeks.

On discharge from the hospital, the patient is advised to see a physiotherapist and a Shoulder Specialist for follow-up.

What are the chances of developing Recurrent (repeated) Shoulder Dislocations?

Recurrent dislocations are most common in young people, athletic people and those involved in heavy physical activities.

The younger and more active the patient is at the time of first dislocation, the more likely it is that recurrent instability will develop. For example, if the first dislocation occurs during the teenage years, there is a 70-90% chance that recurrent instability will develop. However, people over 40 years of age with a first dislocation have less than a 10% risk of developing recurrent instability.

What causes Chronic Shoulder Instability?

Chronic shoulder instability is caused by:

Traumatic shoulder dislocation:
The labrum, which deepens the socket, is torn and the capsular ligaments, which hold the shoulder ball in its socket, become stretched or torn. As a result the necessary stability of the ligaments throughout the shoulder's large range of motion is compromised.

Repetitive overhead activities: (as seen in sports like Swimming, tennis, and volleyball) can stretch out the shoulder ligaments due to chronic overloading. Similar things happen to people in jobs needing repetitive overhead work. These loose ligaments cannot support the humeral head within the socket. Such patients will develop shoulder instability and pain when doing repetitive stressful activities.

Multidirectional Instability:
In a small group of patients, the shoulder can become unstable without any history of injury or repetitive strain. These patients have naturally loose ligaments throughout the body and may be "double-jointed." The shoulder can dislocate in many directions. Hence it is called Multi-directional instability (MDI). Such patients can produce a shoulder dislocation (voluntarily) at will without pain.

What are the symptoms of Chronic Shoulder Instability?

Common symptoms of chronic shoulder instability include:
Pain caused by shoulder injury
Repeated shoulder dislocations
Repeated instances of the shoulder giving out
A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just "hanging there"

How is shoulder Instability Diagnosed and treated?

A thorough history and clinical examination is done initially to diagnose instability.

Investigations like x-rays and MRI of shoulder are done to confirm the underlying pathologies.
X-rays will show fracture of rim of glenoid – Bony Bankart’s Lesion, Impaction fracture of humeral head - Hill Sach’s lesion

MRI will show: Rotator cuff tears, lesions of biceps tendon, Avulsion of labrum and capsular ligaments from the glenoid - Soft tissue Bankart’s lesion, capsular avulsion from humerus

MRI showing Bankart lesion (arrow)

 

CT scan may be required in cases where damage to the glenoid is noted on x-rays.

Treatment for shoulder instability is based on a variety of factors including the severity of the condition, and the patient's age, activity level, occupation, and natural degree of looseness in the joint.

Initial treatment for any shoulder instability relies on physiotherapy, activity modification and pain-killers as required.

Strengthening the rotator cuff muscles and periscapular muscles (those around the scapula) gives stability to the joint. The goal of physiotherapy is to help the muscles provide stability to the shoulder that the torn ligaments are not able to provide. The physiotherapy is carefully designed for each patient since this condition often causes apprehension about certain arm positions or exercises. Often physiotherapy can help regain lost motion, reduce apprehension, and restore shoulder function.

Changes to lifestyle and modification of activities are necessary to avoid repetitive stress to the shoulder and to resolve symptoms.

When is surgery advised in Shoulder Instability?

Surgery is usually recommended if recurrent instability cannot be controlled even after adequate physiotherapy and activity modification.

Surgery is recommended after the first dislocation in young persons (< 20 years) who have a higher risk of re-dislocation, in contact athletes who plan on continuing to participate in sports that put their shoulders at risk and in people involved in heavy physical activities.

What are the benefits of Shoulder Stabilization Surgery?

The shoulder becomes stable which improves patients' confidence, shoulder strength and function. The stabilization surgery allows them to return to normal work or sporting activities. It also prevents further damage to the surfaces of ball and socket due to repeated instability.

What is done in stabilization surgery for Shoulder Instability?

Shoulder instability surgery is a surgical attempt to reconstruct the normal shoulder anatomy by repairing the torn cartilage ring (labrum) and re-tensioning the stretched capsular ligaments without over tightening. The aim of surgery is to return stability to the shoulder with the least loss of motion.

Depending on the extent of damage to the labrum, 2 to 3 suture anchors ( metallic or biodegradable) may be buried at different locations on the rim of glenoid (socket). Non-absorbable sutures that are pre-loaded on these anchors are then tied to repair the labrum to its normal place and to re-tension the capsular ligaments.

Surgery will re-create the normal bumper effect of the labrum and the tension of capsular ligaments. This will help in keeping the joint in place throughout its normal range of motion.

Torn Labrum (Bankarts Lesion) being repaired with suture anchors

What are the advantages of arthroscopic shoulder stabilization?

Arthroscopic shoulder stabilization is done using a fibre-optic telescope, camera and specialized instruments via 3 to 4 tiny scars.

It has the following advantages:
Small scars give better cosmetic result
Minimal tissue trauma and pain
Less bleeding
Shorter hospitalization
Excellent visualization of shoulder joint and the associated lesions of instability
Additional shoulder pathologies like rotator cuff tears or biceps tendon lesions can be dealt within the same operation
Can give same success rate as that with open stabilization surgery

When is open shoulder stabilization recommended?

It has the following advantages:
There is co-existing fracture of the socket (glenoid) or humeral head
Glenoid is worn out into an inverted pear shape due to recurrent anterior instability
Failure of previous shoulder stabilization surgery
Surgeon is not experienced in arthroscopic stabilization techniques
Tissue transfer with bony block – done if capsular tissue is not repairable

 
 

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