Indian families are united by cultures, cuisines, historical heritage among other things. Another, not so celebratory aspect that most families in our country share are that of joint pains. At least one member in all households suffers from some kind of joint pain, especially in their hip, knee or shoulder.

These health concerns are very common, yet there is so much smog around their basic know-how. We interacted with one of the finest Orthopedic doctors, Dr. Gaurav Rastogi, from Manipal Hospitals Dwarka.

Common Questions about Shoulder, Knee and Hip Problems

Read on our discussion with Dr. Gaurav Rastogi to understand more about various orthopedic conditions and their treatment options.

Ques 1. According to a study, the prevalence of shoulder pain is higher in the middle-aged population. This population comprises of working-class people and so, may affect the productivity of our community, as a whole. What would you recommend to these people on how to prevent shoulder pain?

Ans. This concerned study has been done recently and its findings correlate with my clinical practice. Normally most patients who come with shoulder pain belong to the middle age group. These patients are also involved in working on laptops or mobile phones for long hours. Another set of patients includes the ones who work with abnormal postures, like dentists.

The most common cause of shoulder pain is the wrong posture. Particularly the posture in which we hunch forward. This is called a scapular protraction posture. Our shoulder blades are supposed to be straight so that we can maintain the balance in the front and back. But because of the wrong posture, gradually, the shoulder starts coming forward and the biomechanics alter. The muscles in the back have to work a lot and hence they get more stretched. As a result, the shoulder starts hurting.

The simple remedy is correcting your posture. If you correct it, your pain will subside. I simply tell my patients to sit properly.

Ques 2.What is meant by Frozen shoulder? What is your approach towards the management of this condition?

Ans. Frozen shoulder is a layman’s term. It simply means a shoulder that is stiff and gets frozen. So, a person is not able to move their shoulder. We generally classify frozen shoulder into two – primary and secondary frozen shoulder.

Primary frozen shoulders are unfortunately very common in India. It is directly related to diabetes. Diabetic patients have a very high tendency of frozen shoulder. And as we know that India is the diabetes capital of the world, the incidence of this condition is also very high.

But, if you get hurt in the shoulder or don’t move it frequently, resulting in your shoulder becomes stiff, then this is called a secondary frozen shoulder. It is secondary to some other problem.

The management depends upon the underlying pathology. If it is the primary one or because of diabetes, we ensure that the blood sugar is in control. After that physiotherapy is the main answer.

If the frozen shoulder is caused by something else, like an injury or an infection, then we have to deal with the secondary cause first.

Most cases of this ailment resolve with physiotherapy. Nearly 10% of patients require something more aggressive than physiotherapy, like arthroscopic surgery. But even after the surgery, you have to move the shoulder. If you don’t, it will become stiff all over again.

Ques 3. Are there different types of hip arthritis? How can one identify if they have this condition?

Ans. Hip arthritis is more common among the west. In India and Asian countries, we have a habit of squatting, which in reality is good for the hips. Squatting helps the hip out. There are broadly two types of hip arthritis. One is inflammatory hip arthritis and the other is non-inflammatory hip arthritis.

Inflammatory hip arthritis is because of some underlying condition. For instance, those who have rheumatoid arthritis or those who consume a lot of alcohol or have liver problems tend to develop this condition. Non-inflammatory is more common than inflammatory hip arthritis. Non-inflammatory occurs because of aging and wear and tear. Another common cause is a fracture.

The management depends on the stage of the problem. If you present it early and the hip is not grossly damaged, then you require just medicines and physiotherapy. But if it is in an advanced stage, the only option we have is a hip replacement.

The good news about hip replacement is that there was a study conducted by the WHO that said, out of all the surgeries conducted in all parts of the body, hip replacement surgery has the most predictable outcomes. 98% of the people are satisfied after the hip replacement.

Ques 4. Are there any latest innovations concerning technology in treatment methods of hip pain problems?

Ans. Newer things are coming up for treating hip pain. The good news is most people are presenting the problem early. The general awareness of one’s health has increased. We do have a lot of young people coming to us. They come with issues related to hip pain caused by doing power yoga. Or they notice pain after driving long distances.

In accessing their condition, the newest thing which is entering the market is hip arthroscopy. It means introducing a camera into the hip and visualizing what is wrong and addressing it. Arthroscopy was till now predominantly a domain of knee and shoulder surgeries. You would have heard about keyhole surgery of the knee or the shoulder. Hip arthroscopy is coming up now.

Orthopedic surgeons are developing skillsets for that and a lot of problems can be addressed by simple keyhole surgeries. It means that the blood loss is less, rehabilitation is faster, and people can go back to their normal life very soon.

Ques 5. What is the difference between shoulder dislocation and separation?

Ans. Honestly speaking, there is no such thing as a shoulder separation. The shoulder is a ball and socket joint. When the ball pops out of the socket it is called dislocation.

Some people confuse fractures with separation. They say that my shoulder got dislocated and also fractured, so my shoulder got separated. But there is no such thing as that.

Ques 6. What is hip dysplasia? What are the success rates of treatment for hip dysplasia?

Ans. The Latin meaning of dysplasia is the wrong formation. Hip dysplasia means that the hip has been formed incorrectly. It is a very common entity. The reported incidence in India is 1:10,000. It means that 1 in every 10,000 babies that are born can have a dysplastic hip. To us, these numbers might sound rare. But more than a million deliveries are occurring in India every week. That means that we are having over 1000 babies with dysplastic hips every week in this country.

Hip gets malformed when the baby is inside the womb or when the baby is coming out. That is called developmental dysplasia of the hip. This is the most common form of hip dysplasia.

The treatment depends on how quickly you get it checked.

Most countries including India have screening programs that happen when the baby is born. If the doctor feels that the hip is not fine, they may refer the infant to a specialist.

In such initial cases, you can put the ball back in the socket, apply plaster and the condition is treated.

The problem comes when this diagnosis gets delayed. Unfortunately, it happens quite frequently that people notice something wrong in the hip only when the kid starts walking, close to12-15 months. At that time you have already missed the golden hour and the child will require some surgeries.

Ques 7. Can knee osteoarthritis be slowed down or prevented?

Ans. Knee osteoarthritis is the most common geriatric problem. A study says that 70% of people more than 70 years of age will have osteoarthritis and almost 100% of people beyond 80 years of age will have arthritic knees. You can easily relate to what I am saying because at least 1 member in your family would be having bad knees, pain in the knee, or walking deformities.

The good news is that it can be slowed down. The key to do that is exercise. The health of your knee relies on the health of its muscles. If the muscle is healthy, your chances of developing these conditions decreases.

If this muscle is unhealthy, the exertion levels go down and the muscle loses its tone. Predominantly arthritis starts from the kneecap and then involves the inner aspect of your knee.

If you exercise regularly, then you can slow down your knee arthritis.

One very common misconception regarding knee arthritis in India is that if you have bad knees, then you should stop walking. Well, in that case, you are going to damage your knee further. So you need to continue walking.

Ques 8. How can one treat knee pain at home?

Ans. It depends upon the source or the cause of knee pain. If the knee pain is because of an injury, then ice application is the remedy. There is an acronym for this type of remedy called RICE – Rest, Ice, Compression and Elevation.

But if the knee pain is because of arthritis, then the first thing you need to do is walk, secondly avoid the positions in which your knee is under maximum pressure, normally that is a squatting position. So if you avoid squatting you will avoid having pain.

The most common reason why people squat in India is because of the toilets. So those who use Indian commodes would need to squat for their daily activities. So if you start experiencing knee pain, switch over to the western commode.

If the knee pain continues for more than two or three days then go and visit your orthopedic doctor.

Ques 9. What could be the reasons behind sudden knee pain that is caused without injury?

Ans. This is a mystery to most people. A lot of patients say that they didn’t fall or trip but their knee is hurting.

If you are having weak muscles and if you are sitting in the wrong position like cross-legged for quite a long time, your knee cap does not move properly. It gets jammed and you experience a lot of pain. That is the most common cause.

At other times, you do have degenerative tears in the meniscus. If you are in the wrong position, these tears may get locked inside your knee joint. These are, again, a cause of pain. If you have ruptured one of the roots of this meniscus, then you will need medical help. These are a few common causes of knee pain without an injury.

Check out all the article in #CrediTalk series here.

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This write-up was contributed to Credihealth by Dr. Gaurav Rastogi

About The Doctor

Dr Gaurav RastogiDr. Gaurav Rastogi is a successful orthopedist with an experience of 11 years in his field. Currently, he is working as a consultant in the orthopedics department at Manipal Hospital, Dwarka. Dr. Rastogi completed his MBBS and MS degree from Maulana Azad Medical College, New Delhi.

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