Chondromalacia Patellae or Patellofemoral Syndrome

Dr Anurag Awasthi, Orthopaedic Specialist, Sohna Road, Gurgaon; 9718112112

Chondromalacia of the patella occurs in adolescents and young adults. This condition is more common in females. It can be related to the abnormal position of the knee.

Chondromalacia patella is abnormal softening of the cartilage of the under the kneecap (patella). Chondromalacia patella is the most common cause of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap as it slides over the lower end of the thigh bone (femur). This process is, therefore, sometimes referred to as patellofemoral syndrome.

Selective strengthening of the inner portion of the quadriceps muscle will help normalize the tracking of the patella.

If patient's symptoms do not improve with conservative therapy, arthroscopy of the knee may be performed to look for possible lesions, and treatment.

Osgood Schlatter Disease of the Adolescent knee

Osgood Schlatter disease is the osteochondritis of the tibial tuberosity occurring in adolescent knees.
It causes pain and mild swelling just below the knee joint over the prominence in the front of the upper leg.
Patients complain of difficulty in running activities.
It is a developmental affection of the tibial tuberosity apophysis, and settles with completion of growth maturity, and fusion of the apophysis.
In severe case, patients may be offered splintage in the form of brace or plaster cast.
For those not responding to conservative trials, needling of the lesion triggers the cure.

Shoulder Injuries and Disorders- Frozen Shoulder

Frozen shoulder or the technical name Adhesive Capsulitis of Shoulder, mostly seen in middle aged women and diabetics, causes global loss of shoulder movements in all directions.
Usually a self limiting disease, but the prolonged disease course causes much disability.
Early cases should be managed by a course of physiotherapy.
In non- responding patients, manipulation under anesthesia after injecting and inflating the shoulder joint capsule with saline is an alternative.
Prolonged supervised physiotherapy is almost always necessary.

Shoulder Injuries and Disorders- Impingement Syndrome

Shoulder impingement syndrome causes limitation of shoulder movements in one or more directions, but never complete global loss of movements.
Also known as a "Painful arc syndrome"; when the arm is taken overhead in the window cleaning position, patient catches pain. Pain is reproduced on every attempt to do this manoeuvre.
The patholy lies in the reduction of space for the free excursion of the rotator cuff tendons mainly Supraspinatus, beneath the acromion process.
This may occur due to inflammation of tendon itself, due to thickening of acromion process of shoulder blade (scapula); or due to repetitive stress injuries of the rotator cuff.
Treatment of this disorder is mostly conservative.
Most patients respond to suitable modification of activity or local steroid infiltration.
In patients who are resistant to conservative trials, decompression of the sub-acromial space may be performed surgically (Acromioplasty).

Shoulder Injuries & Disorders : Acromioclavicular Joint Injuries

AC Joint injuries are common due to fall on out-stretched hand. They have significant impact in overhead activities and sports.
Patients with AC joint injuries have been classified into six types, with severity ranging from simple sprain to complete destruction of all supporting ligaments and marked displacement of the collar bone from its normal position.
Not all patients with AC joint injury need surgery.
Most patients wherein the AC joint remains even in partial contact may be managed by a sling support. For more severe injuries, a reconstruction of ligaments may be taken immediately after the injury or at a later date.

Collar Bone fracture : Is operation necessary ??

Collar bone (Clavicle) fracture occurs commonly due to indirect forces with fall on the out-stretched hand.
Most comon area of fractur is at the junction of inner 2/3 and outer 1/3. However, at times, the fracture occurs more outwards and closer to the shoulder joint. The latter presents a technically challenging scenario.

Most collar bone fractures can be treated without surgery. Usually a cuff and collar sing is provided for pain relief, and exercises are started after 4 weeks.
In certain situations, wherein the vascular or neural structures are in jeopardy due to pressure by fracture fragments, operation may be required. Surgery is also indicated in fractures occurring close to the shoulder joint.

With greater emphasis on cosmetic appearance, surgery is often demanded by young girls, who do not want a fracture bump. In such cases, a plate may be used with minimum surgical scar.

Non discogenic Backache : Facet joint Arthropathy

Most Sciatica is labelled to be because of a protruding disc (disc prolapse). However, there are other reasons to it. Making a correct diagnosis, is therefore important to correctly relieve the symptoms.
Pain due to disc disease are usually aggravated with forward bending; however, pain of facetal arthropathy is worsened by backward bending.
In case of Facetal Arthropathy, the facet joints become more blurred on the MRI images, with some enlargement and irregularity of the surrounding bones.
The treatment varies from supervised physiotherapy, to local injections to fusion surgery.
Physiotherapy focusses on building the tone of abdominal and back muscles, and general postural training.
Injection therapy includes local steroid infiltration in the facet joints; this procedure is performed with the help of portable xray control images. It offers rlief in 60-80 percent of patients.
The last resort to a troublesome facetal arthropathy is fusion surgery.

Gout and Pseudogout: Arthritis of crystal deposition

Gout is characterized by excessive uric acid levels in blood and deposition of sodium monourate crystals in the joint and subcutaneous tissues (tophi). The deposition of urate crystals and reaction with the white blood cells (phagocytes) incites the release of inflammatory mediators, which cause the characteristic pain and inflammation.

During an acute attack, the involved joint is red, inflamed and tender. The site of predilection is the 1st Meta-tarso-phalangeal joint of the great toe. However, in late stages other joints may be affected, particularly knee and ankle. Besides, there may be tophi deposition around elbow, or toes.

Treatment of an acute attack is primarily NSAIDs like Ibuprofen, Naproxen etc. Corticosteroids may be used orally or injected into the inflamed joint, provided there are no signs of infection. Another drug used to control acute attacks is Colchicine; use limited due to incidence of diarrhoea. For chronic attacks, the frequency may be reduced using Colchicine or other drugs like Probenecid and Allopurinol.

Another condition that sometimes mimics Gout, is Pseudogout.
The latter is characterized by deposition of CPPD crystals in the joints; and primarily involves the knee.

Ankylosing Spondylitis- Disease of the Young

Ankylosing spondylitis  or AS, is a form of arthritis that primarily affects the Sacroiliac joints and the spine, although other joints may become involved at advanced stages.
Progreesive stiffness and ossification of ligaments produces the characteristic forward stooped posture.AS can also cause inflammation, pain and stiffness in other areas of the body such as the  hip joints, ribs, heels etc. Sometimes the eyes may become involved (known as Iritis or Uveitis). 
Most patients complain of early morning stiffness that typically lasts for 30 minutes to 2 hours; improvement occurs with activity and stretching. AS is clinically characterized by exacerbations and remissions. Patient may remain symptom free for a long duration before the recurrence of symptoms. AS can be very debilitating, and in some cases, lead to disability.
Patients with positive HLA B-27 factor and a positive family history are at risk.
Treatment of AS depends upon the severity of symptoms. Patients with early and mild symptoms are best managed by supervised physiotherapy and stretching programmes.
Medications that reduce pain include NSAIDs ( Indomethacin, Naproxen ). TNF-blocking medications (Etanercept , Infliximab , Adalimumab ),  have been shown to be extremely effective for treating ankylosing spondylitis by stopping disease activity, decreasing inflammation, and improving spinal mobility.
Surgical treatment for AS is required in patients with severe Kyphosis (excessive dorsal curvature of spine), limitation of neck movement, or with ankylosed hips. 
Pedicle subtraction osteotomy may be performed at the spine to improve posture.


http://www.medicinenet.com/ankylosing_spondylitis/article.htm 

Ganglion Cysts

Ganglion cysts appear to arise often on the extensor aspect of the wrist and hand. They may be associated with the degenerative conditions of the joints. They may occur adjacent to joints, tendons, fascial planes, and within bone.

Usually soft in consistency, they may be firm to hard at times. These cysts are filled with gelatinous substance, which can be removed by a thick needle aspiration.The aspiration may be followed by steroid injection, or sometime hylase injection.

Surgery is required in recurrent cases, and it is important to excise the tail of the cyst up to the joint from which it seems to arise.


http://www.bonetumor.org/tumors-foot-and-ankle/ganglion-cyst-foot-and-ankle