What We Treat ?

• fracture around shoulder – clavicle, proximal humerus, humerus shaft and scapula fracture
• Shoulder dislocation
• Frozen shoulder / adhesive capsulitis- it occurs due to inflammation and scaring of capsule around the shoulder joint. Common in female, diabetic or after fracture or surgery of shoulder. It causes night pain and restricted movement of the shoulder. Treatment involves physiotherapy, oral medicine, injection therapy, hydro dilation and arthroscopic capsular release.
• Rotator cuff tear/tendinosis- Rotator cuff muscles (supraspinatus, infraspinatus, subscapularis and teres minor) are stabilizer of the shoulder joint and help in the shoulder movement. Tear or tendinosis(inflammation)occurs due to trauma or degeneration with aging. patient have night pain and weakness of the shoulder. Diagnosis requires x ray and MRI. Treatment includes physiotherapy, injection and Arthroscopic cuff repair.
• Rotator cuff arthropathy- it is the complication of rotator cuff tear if not treated for long time. It is type of arthritis of the shoulder joint. Treatment includes the reverse shoulder replacement.
• shoulder instability/recurrent dislocation- Bankart lesion- if shoulder dislocate frequently, it is associated with tear in the labrum (Bankart) or with bone loss of glenoid. Patient have fear of instability and not able to do overhead activity. The surgery with arthroscopic repair required to prevent the dislocation in the future. Sometime with greater bone loss on glenoid, bony procedure (latarjet) is required.
• Labrum tear (SLAP)- Biceps tendon attaches with superior labrum in the shoulder. It will damage due to fall or throwing injury. patient have pain and difficult in throwing object. It is treated with physiotherapy, oral medicine and arthroscopy surgery for labrum repair.
• Shoulder arthritis- reduction in the joint space either due to wear, post trauma or inflammation. Common after 60 years of age. Patient has pain, stiffness, weakness in the shoulder. Treatment includes physiotherapy, oral medication, arthroscopy, shoulder replacement(surface/total/reverse)
• Acromioclavicular joint arthritis- arthritis of ac joint common after 60 years and causes pain at the shoulder tip and more common at sleeping on the same side. Treatment with physiotherapy, injection and arthroscopy debridement.
• Acromioclavicular joint dislocation- occur after fall on the shoulder and common in young person. It can be treated with immobilization for 4-6 weeks but severe injury requires open or arthroscopic ligament reconstruction.
• Biceps tendinitis – inflammation in the biceps tendon causes pain in the shoulder. Common in young person and in throwing sports. Treatment involves physiotherapy, injection and arthroscopic biceps tenotomy /tenodesis.
• Shoulder impingement/painful arc syndrome- patient have pain in the shoulder movement in 60-120 degree. It occurs due to contact in bone between humerus head and acromion. It can be associated with bursitis. Treatment includes physiotherapy, injection and arthroscopy debridement.
• Scapular dyskinesia-scapula moves in the rhythm with shoulder movement. If this rhythm disturbed then patient has pain while shoulder movement. Treatment requires posture correction and retraining of the muscle with physiotherapy
• Radial nerve injury- common after humerus shaft fracture. Patient develops wrist drop (not able to lift the hand). Diagnosis confirmed with special test like EMG/NCV.It can recover within 6-9 months or sometime may require surgery like nerve transfer / tendon transfer.

• fracture around elbow olecranon/distal humerus/radial head/forearm (radius – ulna fracture) and Elbow dislocation
• Tennis elbow/ lateral epicondylitis -main cause is repeated activity which involves the gripping of hand like racket sports, lifting bucket etc.… there is an inflammation of the tendon attaching on lateral epicondyle of elbow. patient has pain and swelling over outer side of elbow joint. Treatment includes splint, ice pack, rest, medicines, physiotherapy and rarely surgery.
• Golfer elbow- main cause is repeated activity which involves the gripping of hand like racket sports, lifting bucket etc.… there is an inflammation of the tendon attaching on medial epicondyle of elbow. patient has pain and swelling over inner side of elbow joint. Treatment includes splint, ice pack, rest, medicines, physiotherapy and rarely surgery.
• Elbow arthritis/stiffness – it may be due to injury, aging or infection. patient feel pain and stiffness in the elbow joint. Initially treated with medicine, injection and physiotherapy. In later stages may require arthroscopic surgery or total elbow replacement
• Ulnar nerve compression/cubital tunnel syndrome- compression of the nerve on the inner side of elbow below bony prominence. Patient has pai in forearm and hand, tingling and numbness of 4 th and 5 th finger. Diagnosis made with special test like NCV and EMG. Treatment with oral medicine, injection, physiotherapy and rarely surgical decompression.
• Elbow instability/ligament injury- patient has ligament injury due to fall, fracture or dislocation near elbow joint. Patient has elbow pain, weakness and reduced range of motion. Treatment involves special brace for support and surgical reconstruction of damaged ligament.
• Cartilage injury- it is associated either with fracture around the elbow or arthritis. Patient feels pain, stiffness and locking sensation in the elbow. Diagnosis require MRI. Treatment involves physiotherapy, injection (PRP) or arthroscopic procedures.
• Green stick fracture – common in pediatric age group due to fall. There is a break in the long bone with bending. Treatment requires the correction in fracture alignment and application of the cast.
• Cubitus varus/gun stock deformity- it may be congenital or after supracondylar fracture. Patient has angular deformity at elbow with forearm is more near to body then other side. It is a cosmetic deformity but patient may have pain and stiffness of elbow. Treatment involves the corrective osteotomy with fixation.
• Cubitus valgus – similar to cubitus varus deformity but the forearm is angulate more outward compared the opposite normal side.

Volkmann’s ischemic contracture- complication of fracture around the elbow joint due to compartment syndrome in the forearm. Forearm muscles and nerves are affected which leads to contracture, weakness, stiffness and numbness in the wrist and hand. Treatment requires tendon and nerve transfer.

• fracture around wrist- distal radius/scaphoid
• Ganglion – it occurs due to fluid collection in the synovial sheath around the tendon. Common in person with typing work and housewife. patient has swelling over wrist joint with or without pain. Treatment involves medicine, steroid injection, aspiration or surgery.
• Dequervein disease- it occurs due to inflammation of the tendon of thumb near wrist joint. Patient has pain while moving thumb. Treatment involves splint, injection or surgery.
• Arthritis- it is common after fracture around wrist or associated with systemic arthritis or aging process. Patient has pain, swelling and stiffness in the wrist. Treatment require medicine, injection, splint, physiotherapy and surgery sos.
• TFCC (triangular fibrocartilage complex) injury- it is the injury of ligament and cushion in the wrist joint that leads to pain during the wrist movement. MRI required for diagnosis. Treatment involves the splint, injection or repair of the complex.
• Carpal tunnel syndrome – compression of the median nerve in the carpal tunnel of the wrist leads to pain, tingling and numbness in the hand which is more at night. Common in female, obese, pregnancy, thyroid disease and arthritis. Treatment includes splint, injection or surgical decompression.
• AVN (avascular necrosis) scaphoid, lunate- occurs due to reduced blood supply to the bone either due to injury, streroid use, sickle cell disease or other unknown reason. Patient has pain and stiffness in the wrist. Depending on the stage treatment involves medicine, injection or surgery.
• Epiphyseal injury – it is the injury of growth plate of bone which is common in the children due to fall. Treatment require immobilization with splint or fixation with wire.

• fractures- metacarpal / phalanx
• Dislocation
• Trigger finger/thumb- thumb or finger movement become restricted and painful due to inflammation of the tendon of finger/thumb. Treatment is in form of physiotherapy, injection or surgical release of tendon.
• Mallet finger – damage to the tendon of the tip of finger. Common after cricket ball injury. Patient is not able to straight the tip of the finger. Treatment requires
• Tendon injury – common after accident or injury after sharp object. It requires detailed examination to know the tendon involvement and its retraction. Treatment depends on the type, site of injury, overlying skin condition and severity of injury.
• Small joint arthritis – patient has pain, swelling and stiffness in the finger joints. It may be due to rheumatoid arthritis or seronegative arthritis. Diagnosis require blood test and treatment involves oral medicine and physiotherapy.
• Deformity – common in rheumatoid arthritis and osteoarthritis due to involvement of various small joint and tendons. patient has Swelling and deviation of the fingers and wrist joint. It involves single or multiple fingers at the same time. Treatment can be done with physiotherapy and splints or may require corrective surgery.

• fracture pelvis and acetabulum / fracture around hip (neck femur/ intertrochanter, femur),
• Hip dislocation
• osteoarthritis
• infection – tuberculosis/ bacteria- infection of hip joint is rare. It is also called septic hip. Tuberculosis (TB) of hip joint is always secondary to lung/other systemic TB. It involves the joint at early stages and associated with joint destruction, limb shortening or lengthening depending on various stage. Treatment includes anti-Koch’s (AKT) treatment for 9-12 months and sometime surgical debridement or total hip replacement. Bacterial infection is common after infection in the body or after surgery. Treatment is with antibiotic therapy and joint debridement.
• FAI- (femoro -acetabular impingement) – in the hip joint ball moves freely in the socket because of round smooth surface. When this round shape is disturbed by any bony/soft tissue bump on either femoral head (cam) or acetabulum side (pincer), patient had pain in the particular movement like getting out from car or standing up from the chair. MRI required to confirm disease. Treatment involves physotherapy, medicines and arthroscopic procedure to smooth the surface.
• GTPS- gluteus trochanter pain syndrome- patient has pain on the outer aspect of the hip joint while standing / lying down on the same side.it is due to inflammation /tear around the muscle of the hip or bursa (soft covering). treatment includes rest, medicine and physiotherapy and rarely surgery for tendon repair.
• AVN (avascular necrosis) of hip joint- it occurs due to reduced blood supply of the femoral head due to frature, steroid use, sickle cell, alcohol or unknown reason. It causes the arthritis of the joint later on. Treatment includes medicine, physiotherapy, drill hole surgery for blood supply or hip replacement surgery.
• Snapping hip- patient feels the clicking sound and sometime with movement of hip joint. most common tendon is the iliopsoas tendon which slides on the neck of femur. Treatment includes rest, medicine and physiotherapy.
• Meralgia parasthetica- patient has pain, tingling or numbness over anterior aspect of thigh due to compression of the nerve at the waist area. Treatment includes medicine or local injection at the compression site and avowing tight belt or pants.
• Synovial chondromatosis/ loose bodies- it is a disease of the lining of the joint called synovium which leads to the formation of the rice like free bodies inside the joint that can cause pain, locking or clicking in the hip joint. treatment requires removal of these loose bodies either with arthroscopic surgery or open surgery.
• Stress fracture- stress fracture results from the over-activity or repeated activity without prior training. It starts with microcracks in the bone but due to repeated activity it gradually progresses in the size.it commonly affect 2 nd metatarsal in foot (march fracture), tibia or femur. Diagnosis is difficult on x ray and may require bone scan or MRI. Treatment includes rest and non-weight bearing for 6-8 weeks with medicines. Sometime it may require surgery if involving femur neck or tibia.
• Perthes disease- common in the children age group of 4-8 years due to reduced blood supply in the femur head. It leads to pain, swelling, difficulty in walking and sitting cross leg and shortening. Treatment includes rest with traction for 6-8 weeks or surgery in advance cases
• Congenital dislocation of hip- hip joint is dislocated since birth. It involves one or both joint.it is common in male and after breach delivery. Treatment includes casting to keep the joint in place or sometime surgery.
• Slipped capital epiphysis – it is seen obese children between 10-14 years of age. Growth plate of upper end of femur is displaced from its normal position due to fall or injury. Child has pain in hip while walking, sitting cross leg, squatting and knee pain. Treatment involves rest, brace or cast application or pinning of femur head in severe cases. Complication includes growth disturbance in leg, shortening of leg, avascular necrosis of femur head and hip joint arthritis.