Best Ortho Doctor or Orthopedician or Ortho Surgeon or Bone Specialist in Chennai! What is the difference?

WHO IS AN ORTHO DOCTOR? IS AN ORTHOPAEDIC SURGEON DIFFERENT FROM A ORTHOAPEDICIAN?

Ortho Doctor , Bone Specialist , Orthopaedician , Ortho Specialist , Ortho Surgeon , Orthopaedic Surgeon ( or the American way of spelling Orthopedic) all mean the same.

It is a specialty that deals with the musculosketal system , that is Bones , joints , ligaments and tendons. The primary goal of orthopaedicians is to ensure that the patient gets back moving , for they believe MOVEMENT IS LIFE.

The ortho surgeons are often mocked at , in good humour , as Carpenters and Hardware specialists because of the tools and implants that we employ to achieve our goals. But there is more to the specialty than that. A good ortho surgeon has to be a good physician to diagnose , a good counsellor to advise the patient and a fine surgeon to ensure that all tissues are handled carefully and attempt for zero infection.

At SCOT (South Chennai Ortho and Trauma) Sholingnallur our expert group of Orthopedicians will ensure that your Bone , Joint and Spine are in safe hands.

For more details visit www.ScotOrtho.com .

Best Orthopaedic Doctor / Surgeon in Chennai

When it come to Bone , Joint and Spine problems the biggest problem a patient faces when he or she goes to an orthopaedic surgeon is the doubt whether what the Orthopaedician is saying is the best for the patient. So we at SCOT - South Chennai Ortho & Trauma currently operating in Sholinganallur and Navalur and soon on it's way to becoming the biggest chain of Orthopaedic out patient facility in Chennai , has brought in the system of scientifically approved protocol based standardised treatment guidelines which will deliver the best results for the patient. All these treatment protocols and plans are monitored by an expert panel and all prescriptions are peer reviewed to ensure that What our orthopedic doctors are doing is the right thing.

The aim is to be a one stop solution for your Orthopedic problems and to keep you moving without pain in an ethical and cost effective way. That is why the proud claim , come to us for the best advice and do not fall prey to bad advice.

Visit http://www.ScotOrtho.com for more details

When you Injure Yourself Have RICE , RICE and More RICE.

Hello and welcome to Orthopaedics Made Simple , Making No Bones About It! This is Naveen , your bone and joint guy and in this episode I'm going to talk to you about the benefits of RICE , the primary and immediate factor in the treatment of any trauma.

Oh wait , wait it is not this rice 

But rather this one

Now for the details.

R for REST

If a person sustains an injury , the first principle should be 

This is a Latin phrase meaning FIRST ,DO NO HARM! So for any injury the first thing to be done is that place should be RESTED. This could mean avoiding movement in that are or restricting any load or pressure falling on to that area. The reasons why this immobilisation is important are 

1) Pain reduction

2) Prevent fractured bones from displacing

3) Reduce blood loss

4) Protect soft tissues

5) Protect vital organs and structures

Neck Splint

For instance a person sustaining an injury to the neck , all efforts should be made to ensure the neck is stabilised and any movement is avoided. Even a one inch movement in the neck bone could mean the difference between full recovery and complete paralysis or maybe even life and death.

Useful method for Shoulder and Arm and ElbowIinjuries.

If the upper limbs are injured please ensure that they are splinted and immmobilised in the methods given below , even using items like newspaper or cloth that are available at home

Newspaper and cloth splint for the Forearm

Those with injuries to the spine or back are to be carried carefully , preferably on a spine stabilisation board. if that is not available , at least a flat surfaced board which is level and does not let the patient move too much

Spine Transport Board

Those with lower limb injuries too are splinted and in addition no weight bearing is allowed.

Rest is also important as a part of the treatment for some conditions to let the affected parts heal better and faster. 

Lower Limb Splinting

And an important thing to be noted is Please , please do not rub or massage or apply anything on the injured part unless and until you are sure what it is. At SCOT we have seen a lot of patients whose injuries were worsened after undergoing such unwanted manipulations. I have seen fractures that would have healed easily being complicate because the patient's family decided to rub it with oil and turmeric.

I for ICE

Ice treatment is most commonly used for acute injuries. If you have had a recent injury (within the last 48 hours) where swelling is a problem, you should be using ice. Ice packs can help minimize swelling around the injury, reduce bleeding into the tissues, and reduce muscle spasm and pain.

Ice packs are often used after injuries like ankle sprains have occurred. Applying an ice pack early and often for the first 48 hours will help minimize swelling, and decreasing swelling around an injury will help to control the pain. Ice treatments may also be used for chronic conditions, such as overuse injuries in athletes. In this case, ice the injured area after activity to help control inflammation. Never ice a chronic injury before activity.

You can make ice packs with ice cubes in a plastic bag or wet tea towel; a pack of frozen peas or our milk packets are also ideal and can go in and out of the freezer. Never place ice directly on an injury; keep the pack moving to avoid ice burns. Never treat with ice for more than 30 minutes, and remove the pack immediately if the injury appears bright pink or red.

Precautions while using Ice Packs:

Don’t use cold packs:

• over areas of skin that are in poor condition
• over areas of skin with poor sensation to heat or cold
• over areas of the body with known poor circulation
• if you have diabetes
• in the presence of infection

There is always a query from patients who come to SCOT ,whether one should use Ice or Heat. Please note that Heat is used only for long term conditions and not for recently sustained injuries .

C for COMPRESSION

1. Most injuries tend to do well with Compression and the various uses of Compression are as follows:

1. 
   

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1. Less edema - Edema is the fluid collection and the fluid buildup can also slow down the healing process and inhibit the movement if the injury is at or near a joint. Compression combined with elevation can help reduce this excess fluid in the body.

1. More oxygen - Injured tissue requires oxygen for it to repair itself. However, swelling can inhibit the flow of blood to an injury, slowing down the healing process. Active compression helps improve blood flow, thereby enhancing the delivery of oxygen to damaged tissue.

1. Faster tissue repair - The combination of reduced swelling and delivery of oxygen and nutrients to the injury site enables more rapid tissue repair and an overall faster healing.

1. Less swelling - Inflammation and swelling are not only uncomfortable, they can also inhibit the healing process. Compression therapy is proven to help reduce swelling, especially in combination with cold therapy.

1. More nutrients - Active compression helps stimulate the flow of lymph fluid, which carries vital nutrients, to the damaged tissues surrounding the injury. Lymph fluid is also important for removing waste from cells and body tissues, an important function during the tissue regeneration process.

Compression also reduces bleeding in that area. The bleeding can be external or internal where the small blood vessels known as capillaries can be damaged and the continuously leak blood in to the injured area.

But the precaution is that the compression should not be too tight so as to compromise the blood supply or cause damage to nerves or the skin. Always look out for discolouration in the part after the compression , increase in pain or any tingling sensation or numbness.

E for Elevation:

Whenever and wherever possible if there is an injury , it can be a sprain or a fracture....always keep the injured part above the level of the heart.

Lower Limb Elevation

Upper Limb Elevation

This is important so as to reduce pain and also swelling. And the benefits of reduced swelling have been explained above.  The lower limbs can be elevated with the pillows keeping the patient in a lying down position. If elevation is a part of a prolonged treatment strategy then it is better to elevate the foot end of the bed with wooden blocks.

So that's it folks. remember RICE whenever there is an injury and that is the best you can do for the person sustaining the injury.. You can also catch my podcast on www.anchor.fm/orthomadesimple . If you have any queries please do leave them in the comments section below. www.ScotOrtho.com is our website

Until the next time .Keep Moving Always .....Without Pain

Batter and Egg Yolk Make a Good Mutta (Egg) Dosa . But Why Treat Fractures With Them?

Hello and Welcome to Orthopaedics Made Simple , Making No Bones About It! And I am Naveen , Your Bone and joint Guy.

Even the greatest bone and joint surgeon  in the world cannot say "I Heal Fractures". That would be one big lie . The healing of any fracture is Nature's work. Period!

What am I trying to say? To keep it simple

Fracture . Now any break in the continuity of the bone , however small or big , is called a fracture. And bones are not some dry , dead structures. they are like any living organ and supplied with blood and nerves. So once the bone breaks the nerves that supply the outer cover of the bone called periosteum , immediately send signals to the brain in the form of pain. And the blood vessels rupture and blood accumulates. This is called fracture haematoma formation and is the first stage of fracture healing. So you can see that the fracture healing process starts right away.

The fracture haematoma has a lot of healing properties that helps in the formation of the soft tissue (callus) that converts into a hard tissue (bony callus) which then becomes bone and over a period of time that bone models into a normal bone completing the healing process.

So you can see that no man or machine is needed for fracture healing. Then what is the role of an Orthopaedician?

Now remember I have only been saying Fracture Healing is Nobody's Business , but fracture healing isn't the only aspect of patient care right? Healing happens once the fracture is stabilised or splinted but there are many conditions where one has to involve the bone and joint specialist.

Role of An Orthopaedic Surgeon

First it is in the management of open fractures known as Compound fractures where the orthopaedician's role is very very critical. These are fractures that are exposed to the outside and are prone for infections and delayed healing. These fractures could include small punctures to fractures where the entire soft tissue cover from skin to muscle can be torn apart. Washing the wound , keeping it clean , giving cover to the bone and then stabilising the fracture are some of the things that the orthopaedician needs to do. Sometimes the vessels can be damaged requiring a vascular surgeon. The skin loss could be extensive requiring a plastic surgeon's expertise to achieve cover without which healing cannot happen.

I only said bones start healing but they heal in an "as is where is" condition meaning if there is displacement , that would not be corrected. This could lead to deformity , difference in limb length and if fractures are around the joint do not heal in the correct position it could lead to reduced movement in that joint. So the next function of the orthopaedician is to see to it that the fractures heal in the right position.

Fractures heal , but they do take a considerable amount of time to do so and ideally during this time the fracture has to be immobilised and weight bearing is not allowed in the affected joint. This could mean being bed ridden for a considerable amount of time , loss of livelihood , other health problems like diabetes going out of control , bed sores , blood clots (DVT) among others and stiffness of the joints is very common. So the duty or responsibility of the orthopaedician is to get the patient on his or her feet as soon as possible and get the joint moving but making sure the fracture is stabilised and the bone union is on course. And not to forget a bed ridden patient is a burden to self and the family.

Finally in some cases the healing process takes more time than normal (Delayed Union) , sometimes the fracture unites in the wrong position (Malunion) , sometimes the fracture does not unite (Non Union) , the orthopaedician has to be called in to check out and set things right.

What does the Orthopaedician do?

Once you go to the orthopaedician with a suspected fracture , the first thing to be done will be splinting of the fracture and a painkiller will be given. If your vitals like blood pressure and pulse are alright you will be asked to get an X Ray done which would confirm the diagnosis.

Then depending on the fracture you will be treated as an out patient or be asked to get admitted. Simple fractures of the shaft that are not too displaced , especially in younger individuals and do not need prolonged immobilisation or bed rest are given a Plaster Cast and sent home and asked to review after a few days. Then again this is generalisation and is not applicable to all.

If the patient needs to get some procedure done like Wound Wash and Repair for Open fractures , fixation of fractures with rods , plates or screws , if there are signs of blood vessel or nerve damage or patients that need nursing care , they could be asked to get admitted. Each one of these is a separate blog post ,which I will talk to you in detail later.

Now coming to the core purpose of this blog . 

Where do the Traditional Bone Setters come in?

In India ,and also in other parts of the world traditional bone setters are very famous in dealing with fractures. In spite of the increase in number of hospitals , doctors and improvements in the medical field people still go to them. The reasons could be one or many of the following.

1) Fear of implants and foreign objects.
2) Faith in the spiritual powers of the bone setter.
3) Flexibility of traditional care setting. 
4) Financial cost of orthopaedic care in a hospital setting.
5) Familiarity with bone setter culture and lack of familiarity with orthopedic centers. 
6) Fear Mongering that doctors are bad.

What lets the bone setters survive?

They have to thank Nature and the Body's Own Healing Powers. Most fractures are simple ones that heal on their own. They would have healed if nothing was done to them also. So these bonesetters go tom tomming that it is because of their secret herbs and "recipes" that the bone healed.

The second reason is the ignorance of the fact that better results are possible if treated by modern orthopaedic methods . The patients going to these centres see the healing of the bone as the only goal , which would happen anyway. But they seem oblivious to the loss of time , loss of motion , loss of livelihood and loss of health.

The third reason is lack of legislative control and monitoring. The medical fraternity is hauled up even for a small minor expected complication and expected to give explanations or compensations but these bone setters are answerable to none. You do not even get a piece of paper from them and there is no proof of treatment also. Nearly impossible to question them for any complication or even get an explanation. And these people do not come under medical council or government regulation.

What Has to be Done:

The doctor community has to learn from these people. We have to question ourselves and introspect if we spend enough time with the patient , explain the condition , the various treatment options , the pro and cons of it and then let the patient make an informed decision. It is this lack of effort to communicate to the patient clearly and not giving the confidence to the patient that most of the times the patients land up there.

We all know what the traditional bone setters do ,especially the Puttur Kattu practionners , for undisplaced fractures. Some magic secret herb is rubbed on to the fracture site , some setting is done and the fracture is splinted with cloth which is strengthened using Dosa/Idly Batter and Egg. None of these items have been proven to be of any benefit in bone healing. So as doctors we should not insist on surgical fixation trying to convince the patients of the benefits of surgery. The patient need not be forced in to surgery and the doctor need be disappointed with the patient's decision. Instead the doctor should come forward and tell the patient that in case he or she doesn't want surgery , conservative methods like plaster or splinting can be done by the orthopaedician itself. There is no need to go to a bone setter. At least it would be done in accordance to modern scientific guidelines.

As a society there should be more awareness that the goal of orthopaedic treatment is to get the patient moving as fast as possible and ensuring bone healing at the same time. The benefits of this are tremendous medically and also financially. For instance a person being treated for a fracture by bone setters has to be away from work for at least two months. Now please calculate the loss of livelihood , the cost of frequent visits to the bone setter (sometimes as many as 8) and the cost of care taker. This will far exceed the cost of treatment by an orthopaedician in direct terms and I am not even calculating the indirect benefits of better and faster recovery.

Moreover , the bone setters sometimes ignore conditions like open injuries , nerve and blood vessel damage. These could lead to disastrous complications that could even result in the loss of either life or limb. Please please be aware and spread the message.

So my dear friends I would like to finish off by saying that Dosa Batter and Egg Yolk are needed to make Mutta Dosa , my favourite tiffen item and have no role in Bone Healing.  But trust the Orthopaedician to decide if Plaster of Paris or Performing Surgery is good for you. We at SCOT explain the condition in detail to the patient and leave the ultimate decision making to the patient.

Please visit www.Scot.com for more details.

And no other topic can emphasis my signing off slogan better. Keep Moving Always....Without Pain!

Problems Of The Disc - And Is it a Big Risk?

Hello and welcome to Orthopaedics Made Simple , Making No Bones About It. And this is Naveen , Your Bone and Joint Guy.

The bones that form the back (spine) are called vertebrae. And between these vertebrae , there are soft gel filled  like structures called intervertebral discs. There are 23 in number . 6 in the neck , 12 in the upper back and 5 in the lower back. These  basically act like shock absorbers for the spine.

And today we will be discussing about the problems caused by the discs and the ways to deal with it.

The Disc is actually like a jelly doughnut like structure that exactly fits the size of the vertebral body ,both above and below it, It has an outer tough layer that holds the jelly like substance inside.

As one ages the fluid content in the inner jelly reduces and the outer tough layer too becomes dry and susceptible to cracks and this leads to most of the problems in the disc.

The Degenerated disk is the one that loses the water content , becomes brittle and can get cracked , look at the picture above. And once that happens the bones lose the cushioning and can rub against each other and undergo wear and tear. 

The other type of disc problem is the jelly like inside can make it's way out of a tear in the outer layer and press up on the structures that are close by. Depending on the level of leakage and compression it can be called a bulging disc or herniated disc. The structure that is commonly compressed upon is the nerve that comes from the spinal cord and it can cause pain or symptoms due to nerve function loss like loss of power or loss of sensation to the area that the nerve supplies.

Complaints:

The most common complaint of a patient due to disc problems is Pain. This pain is of two types. One is the direct pain of damaged or degenerated disc. This is localised and also a pressure on the corresponding area elicits tenderness. Movements of the spine like bending can cause pain The other pain is the radiating pain due to the nerve compression. This pain is along the area that the nerve supplies and can be confirmed by aggravating the nerve compression. For instance lifting the patients leg can aggravate the pain along the buttocks , a sign of compression to the nerves supplying that area. This pain is what is called Sciatica.

The other complaints are all due to nerve compression and are the ones that have to be monitored closely and acted upon aggressively if needed. They include loss of sensation to specific areas supplied by the nerves. The other is loss of power or weakness in the muscles supplied by the nerves that are compressed. Sometimes Urinary problems like loss of bladder control or loss of sensation of fullness bladder can happen if the disc prolapse happens in the areas from where those nerves are.

Causes:

Now why does this happen. Firstly the degenerated disc is a part of the general ageing process. But nobody can say for sure why bulging or herniation happens. As a matter of a fact less than 10% of the patients who have disc problem will exhibit symptoms. In other words a significant percentage of the "normal" population has a disc bulge visible on imaging studies. Obesity is a contributor. The type of work which involves straining the spine like bending or lifting loads can be a contributor. And trauma also is a reason that can cause this.

When to visit a doctor:

If localised pain or discomfort are the only complaints then some over the counter pain medication for about 5 days and some rest refraining from physically hard work could settle the issue. But if the pain is severe , especially of the radiating variety and it persists beyond a week please visit the doctor.

And you have to visit the doctor immediately if there is significant loss of sensation or loss of power in the muscles. And it's a real emergency if there is bladder dysfunction and loss of emergency around the buttock area (saddle type) . This condition is called Cauda Equina syndrome which happens when the compression is slightly higher up in the lower back.

Management:

Pain medication is the starting point to handle the discomfort. And some patients get away with it. The pain killers can include ones that reduce the swelling and fluid collection (inflammation) or ones that act on the brain , opiod like drugs. Your physician is the best person to take a call. Muscle relaxants are also prescribed and in rare cases drugs that reduce anxiety and depression form a part of the prescription.

Lifestyle advice is also important and helps many people. Weight reduction , especially weight around the abdomen , has been proven to help people back issues. How to sit , how to stand , how to walk , how to lie down , how to get up , how to lift objects and what activities to avoid are all explained in great detail to the patient after evaluating their daily routine and work life.

The physiotherapist steps in various modalities like localised heat treatment to provide relief and also manipulation and massages. But the most significant thing that a physio can do is core strengthening exercises that help people overcome back pain related to disc issues.

The other modality that a physiotherapist may use is Traction. This basically is trying to pull the vertebrae apart using weights in the hope that it decompresses the pressure on the disc and helps to reduce the pain. No other treatment in orthopaedics produces as much debate as traction as some studies suggest very good results and the others say it is just a placebo (mental satisfaction) that people experience relief from as a natural subsiding of symptoms or due to pain medication and exercises.

These are all out patient procedures and most of the patients respond to this. They may have a repetition of symptoms in the future but they will respond to this and can get away from the next level of treatment that include minimally invasive and surgical procedures.

Who needs surgery?

As I have already mentioned above that a significant number of the normal population has some disc problem or the other that are visible on imaging , especially MRI. But they won't have any symptom. So this itself should be a clear indication that all discs do not cause problems and can be treated conservatively. And if at all you decide to operate , you must be absolutely sure that it is the disc which is causing the problem.

So the doctor will perform extensive clinical examinations and ask you to undergo investigations to confirm the diagnosis. The clinical examination has to be thorough so as to rule out other causes of back pain which can include kidney issues , uterus issues , infections , trauma and even Herpes in old people.

The investigations among others will include 

X Rays. - Even though the X rays would not reveal the disc , the spine alignment and other problems can like wear and tear be made out. In India TB is a cause of a lot of back pain.

CT Scan - A more detailed study on the vertebrae and joints.

Blood tests - to rule out other causes like infections and arthritis.

Nerve conduction studies - To see which nerves are affected and at which level and to what extent.

MRI - This is the confirmatory diagnostic modality and is usually prescribed when the surgeon more or less has decided to operate on the disc.

But please remember only a very few people need invasive procedures and that too only after exhausting all the conservative treatments as listed above. The only exception is the cauda equina syndrome that needs to be operated upon as soon as possible.

Epidural Steroids

This is injecting some Steroid and Local Anaesthetic in to the area of the nerve affected by the disc bulge. The logic being the symptoms of nerve compression are due to inflammation ( fluid collection  , pain , swelling ) response due to irritation and steroids are drugs that reduce the inflammation. So under X ray guidance usually in the operation room an injection is inserted in to affected area and these drugs are infiltrated. They take about 3 days to a week to act and some may need a repeat dose. How long will they provide relief is a big question. Some experience relief for a few days whereas others never have the symptoms again. If you are on blood thinners you may be asked to wait for a fw days and if there is an active infection this procedure is better avoided.

Surgery:

There are three methods of surgery that are in practise now. The most common is the Micro- Discectomy where the a small opening is made and the herniated part of the disc is removed and the compression removed. This is a near magical surgery if done on an indicated patient. They will have tremendous relief as they are wheeled out of the Operating room itself.

The next type of surgery is where the entire disc may have to be removed and is replaced by an artificial disc. Finally comes the surgery where a significant portion of the disc or multiple discs have to be removed and the spine appears unstable. In these conditions the two vertebrae are fused together and stabilised using rods and screws.

Caution:

We at SCOT believe that Disc bulge / herniation is a very common problem. Very few people with disc bulges experience symptoms. And even among those who experience symptoms very few need treatment. Among those who need treatment only a very few need surgery. To put it lightly , often it is joked the the most common indication for operating on a disc is "Surgeon needs to fund his vacation". Hope I am clear.

But remember that the patient needs to be patient as sometimes a surgeon will be forced to operate to safeguard his reputation. Any compression pain will go away immediately with surgery and the surgeon will be made to operate on a patient who is in a hurry , as he fears that the patient might go to another surgeon who will operate and provide immediate relief , making him look bad. But it could be a case where a major surgery could have been avoided , if the patient showed some patience.

That's it folks , I think I have covered nearly all aspects of Disc problems. In case you need more info please leave a comment or email to ScotBoneAndJoint@gmail.com. And you can also catch the podcast version of this topic on Anchor at www.anchor.fm/OrthoMadeSimple . At Anchor you will also find the list of other podcast channels where OrthoMadeSimple is available

www.Scotortho.com for more details.

Tennis Elbow - Play it Right for the Game ,Set and Match!

So hello and welcome to Orthopaedics Made Simple....Making No Bones About It and this is Naveen , Your Bone and Joint Guy.

So today it is Lateral Epicondylitis of the Elbow. Ouch I nearly forgot  that the aim of this blog is to keep it as simple as possible and non medical as far as possible. This painful condition around the outer aspect (palm facing upwards) of the elbow is commonly called Tennis elbow.

The Site of Pain

Despite its name, athletes and tennis players aren't the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and even parotta (paratha) cooks who have to repeatedly use the muscles of the forearm and wrist to mix the dough.

Now this happens because the muscles that help in forearm and wrist movement originate from the prominent bump on the outer aspect of the elbow. And with these muscles being repeatedly used they can cause stress to the tendons and over a period of time can cause little tears in the tendon at the point of attachment to that prominent bone. Tendons ,by the way ,are wire like structures that attach a muscle to the bone.

The Problem

What does the patient experience? Usually the only complaint is pain around the elbow that sometimes may radiate upwards or downwards. This pain is usually caused when the person uses the forearm and wrist. Everyday activities like turning a door knob , holding a glass of water and drinking from it and even shaking hands.  And the other symptom is the prominence around the outer aspect of the elbow hurts when touched.

If it isn't too alarming some Rest and a few over the counter drugs like Paracetamol should settle the issue. But if it is too troublesome and does not respond to this , please visit the doctor. The doctor will ask you a few basic questions to get the history and more or less would have confirmed the diagnosis even before touching you.

The doctor then would perform a few basic clinical tests like Touching the prominence which would hurt . He will ask you to bend your elbow and raise your wrist and fingers against resistance which again would cause pain around the prominence.

Testing for Tennis Elbow

Sometimes an X Ray will be ordered to rule out other conditions that might mimic Tennis elbow or to see if there are any bone changes in the point of insertion of the tendons.

The treatment is straightforward , but recovery can take quite some time and the patient is advised to be patient. If the patient is in a hurry , the physician will be forced to go to the next level of treatment which can be avoided if we give it some time. Let me explain.

First it is Restriction of activities that caused or would aggravate the condition. The legendary Sachin Tendulkar himself had to be off cricket for nearly six months because of this. I hope you understand the importance of this aspect of treatment now. Restriction and Rest are key elements.

Wearing a Tennis Elbow Splint can help. This is a band around the forearm muscles which is tight and it helps the muscles to start acting from that point instead of the usual spot giving the affected area some rest. Studies and clinical experience have shown that it is not 100% effective but some patients do find some relief.

Tennis Elbow Splint

Pain killers and Medicines that help reduce swelling and fluid collection , commonly called NSAIDs too are helpful if used for a brief period of time. But do not self medicate over a long period of time. Even though they help control the pain , they are harmful for your stomach and kidney.

Physiotherapy in the form of a therapy called Ultrasound Therapy is also helpful. A 15 minute procedure where the physiotherapist massages that area with a small ultrasound probe.

Ultrasound Therapy

A great percentage of patients get away with these modalties which are completely non invasive and have no side effects. But a few patients do not respond to them and may need other minimally invasive or invasive procedures. I repeat , this is only for a very few patients.

Platelet Rich Plasma

The first of the invasive procedures is injecting into that area. Two types of injections are available. One is the Steroid-Local Anaesthetic combination. This helps to reduce pain and inflammation and patients symptoms are reduced. The other is the injection where the patient's blood is drawn , processed and the part of the blood which has platelets is taken and injected into the area. This platelet rich blood is supposed to have healing properties that help to heal the damaged area. But I would like to point out it may not be 100% effective.

Then for a very very miniscule percentage , surgery is an option. The scar tissue is removed and the patient's elbow is splinted and rested for 4 to 6 weeks for recovery. There are two ways of doing it. An Open Surgery or by Key hole surgery which is called Arthroscopy. Very few centres in the world perform arthroscopic repair and the results of the two modalties are more or less similar. But again , the need for surgery in Tennis elbow is very very rare.

Tennis Elbow Arthroscopy

And the key takeaway for a patient is Patience is the key and it can take sometime to recover. And this comes from personal experience as Yours truly had to be off action for nearly three months to get back to full normal. We at SCOT always want to do as little as possible and with fewer side effects as possible.

There is a condition with similar symptoms and similar presentation needing near similar approach to treatment , but much fewer in number. It's called Medial Epicondylitis , commonly known as Golfer's elbow. This is on the inner prominence of the elbow when the palm is faced upwards.....caused by repetitive use of forearm muscles that help to lift the wrist and finger upwards or forwards , the exact opposite to Tennis Elbow.

So that is it friends , for this episode of Orthopaedics Made Simple ...Making No Bones About It for now from Naveen , the Bone and Joint Guy and catch you in the next one with yet another condition. 

Keep Moving Always ...Without Pain...Bye

Introductions , Good Beginnings and the Hope for an Everlasting Relationship !

Hello and Welcome to my blog Orthopaedics Made Simple.......Making No Bones About It. I would like to call myself Naveen , the bone and joint guy.

Now what is this blog about? Who is it addressed to? What does it want to achieve ? And how is it going to pan out?

Before all that, I am Dr. Naveen Chowdary Tummala and I am a Orthopaedic and Joint Replacement Surgeon practising for over 10 years and also the founder of SCOT , the multi centre Orthopaedic clinic chain currently in the city of Chennai India. And to develop a rapport with you all , I'd like to be known as Naveen , the bone and joint guy.

Everyday at SCOT we see hundreds of patients and in my experience I have seen patients who more than their ailment fear the medical jargon thrown at them , unknowingly , by people in the medical field. This confuses them , complicates things in their mind and that leads to unnecessary worries and trepidation. So the primary purpose of this blog is to simplify orthopaedics , make it easy to understand and let even a 10 year old process information that is thrown at them.

I will be writing or rather talking to you in a casual way , completely in a non medical way , about the various orthopaedic conditions that affect us.....in as much detail as possible without letting you feel burdened. This will help you when you meet your doctor the next time , or may be help you to avoid meeting the doctor itself ,if possible, either by letting you prevent the problem or by letting you take care of yourself.

In case you feel that you need more information on any topic you can always get in touch with me in the comments section below or by emailing me to SCOTBoneAndJoint@gmail.com. You can also write to me if there is a certain topic that you want me to write about.

I will try my best to be as regular as possible , as prolific as possible and try to cover as many topics as possible in the shortest possible time so that people wanting information on any topic regarding their Bone , Joint and Spine problems can browse through the list and get their information.

So I think that is enough for the introductions and I want this to be a long lasting relationship that I want to develop with my readers and I promise I will put in my best efforts to make it worth their time here.

You can also catch me on my podcast which goes by the name www.anchor.fm/orthomadesimple

This is Naveen , the bone and joint guy signing off

See you and Keep Moving Always......Without Pain!