If you notice, the shoulder moves in more directions than any other joint in the body. Since it is capable of so many movements, the shoulder is vulnerable to stress and injury. Hence, shoulder injuries are very common especially among those who play sports with overhead arm motions. The same is true even among work-related musculoskeletal disorders in Singapore, where the shoulders come in second place among the list of body parts with the highest reports of pain.
Strong tendons and ligaments hold the shoulder together. But, stretched or ruptured tissues make the shoulder weak and unstable. Conditions such as bursitis, impingement syndrome, and rotator cuff injuries can cause pain, stiffness, and weakness. Because of these, your shoulder may feel unstable and you may experience some difficulty in doing some regular activities.
Most shoulder conditions heal with rest, medication, and rehabilitation. However, Shoulder Arthroscopy is recommended when such treatments provide minimal or no relief. This procedure involves using an arthroscope, which is a thin instrument that can help visualise the joint to make surgical repairs or remove damaged tissue and bone without having to open the joint. This reduces the risk of infection and it causes less pain and bleeding.
Following your surgery, a therapist will help you in executing arm movements and then progress to strengthening exercises. Your shoulder will need several weeks to heal. Your recovery will depend on the extent of your condition and the surgery that you had. A/Professor Dutton will explain to you what to expect.
Hip issues can be debilitating whether it is caused by an injury, degenerative effects of certain bone conditions, or as a result of a lifetime of wear and tear. When any of the support structures of the hips are damaged in some way, hip movement can be affected. Eventually, pain, instability, weakness, and loss of function set in.
A/Professor Dutton treats different types of hip injuries and conditions, including those related to:
This is a minimally invasive surgical procedure that is often done on an outpatient basis. Similar to shoulder arthroscopy, a flexible fibre optic arthroscope is also used to visualise and treat problems in the hip joint, without being too invasive.
Some of the hip conditions that can be treated by our clinic arthroscopically include the following:
- Loose cartilage and bone spurs that come loose or break off can get caught in the hip when you move.
- Hip Impingement, which occurs when soft tissue around the hip joint gets pinched or compressed between the top of the thigh bone and the hip socket.
- Hip labral tears, which is common among active adults.
In this procedure two to five small incisions, which is less than one centimeter long, are made around the hip through which the arthroscope and other surgical instruments will be inserted. A sterile solution also irrigates and fills the joint space so that it can be viewed properly. Meanwhile, an X-ray machine is used to guide the tools into the hip joint. A/Professor Dutton evaluates the joint before he starts with any specific treatment. Once the problem has been identified, small instruments will be inserted through separate incisions to start with repair.
Hip Replacement Surgery
In this procedure, a worn out or injured hip joint is removed and replaced with implants. It is done mainly to relieve hip pain and stiffness due to hip arthritis. But in some cases, it can also be used to treat injuries such as a broken hip and other conditions. Some patients would need a total replacement, but for others, a partial replacement would suffice.
A hip replacement is one of the surgical considerations if hip pain is not relieved by medication and it interferes with your work, sleep, or daily activities. It is also a treatment of choice to address hip stiffness that can make it difficult for you to walk.
Since patients come in with their hip concerns in varying degrees of severity. If a replacement is needed there are three different types, and these are total hip replacement, partial hip replacement, and hip resurfacing.
A traditional hip replacement generally involves an incision over the front or side of your hip and right through the layers of tissue. The surgeon removes the damaged bone and cartilage, leaving the bone intact. To replace the damaged socket, a prosthetic is implanted into your hip bone. The ball portion of the joint is removed by cutting the thigh bone, then an artificial joint is attached.
In recent years, doctors now use minimally invasive techniques. Instead of an 8-10 inch incision, some can go between 2-5 inches long. This can help lessen blood loss, minimise pain after surgery, shorten hospital stay and reduce scar formation.
A/Professor Dutton conducts an exhaustive evaluation to ensure that he uses an approach that is suitable for you. It is a systematic process where conservative treatments are always considered before a full-blown surgery becomes the final option.
One of the specialised treatments available today which A/Professor Dutton adapts, such is the Birmingham Hip Arthroplasty (BHA) or Resurfacing (BHR). It is a bone-conserving approach where an all-metal bearing couple that can help preserve rather than replace the femoral head and neck. There have been almost 200,000 BHA implantations worldwide.
The reason for its continued success is its capacity to restore the natural shape of the joint, which means better stability, longevity, and higher levels of patient activity than a traditional hip replacement.
According to a local survey, there are nearly half of elderly Singaporeans who suffer from knee pain. Unfortunately, they choose to suffer in silence or self-medicate. It helps to know that there are conservative treatments that could have been used early on in the disease process, so that extensive surgery can be prevented.
Knee pain treatment today is not just a linear approach as several tools and techniques are now available. In his practice, A/Professor Dutton is not just focused solely on surgical treatment, especially if a knee problem can be corrected using non-invasive methods, and if the problem is addressed early on.
Knee replacement, also called KNEE ARTHROPLASTY or TOTAL KNEE REPLACEMENT, is a surgical procedure to resurface a knee ravaged by arthritis. The joint is then replaced by metal and plastic parts that will cap the ends of the bones that form the knee joint, along with the kneecap.
The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and relieve knee pain that is unresponsive to other treatments. A common condition that results in the need for knee replacement is osteoarthritis, which is characterised by the breakdown of joint cartilage. It is a degenerative joint disease which can limit movement and cause pain making it hard to bend the knee or even walk up and down the stairs.
Generally, this procedure often requires a hospital stay, but this may vary depending on your condition and your doctor’s practices. For instance, knee arthroplasty can be a same-day knee replacement, which allows qualified patients to return home on the same day of the operation.
This treatment is enhanced further with the likes of Computer-Assisted Knee Surgery, which is a total knee replacement that uses specialised instruments and computer imaging to improve visibility and accuracy of the surgical field.
The articular cartilage provides cushion between bone endings. When this structure gets damaged or worn down, bone hits bone which can be painful since this is where sensitive nerve endings are located. With no blood supply, the cartilage has limited ability to repair itself. Hence, Cartilage Regeneration can help some patients delay joint replacement surgery in the face of joint damage.
In cartilage regeneration, healthy cartilage cells from the damaged knee are cultured and then injected into the knee joint to regenerate the surrounding cartilage. This minimally invasive procedure is an option for some patients with one or two areas of isolated cartilage loss. It will not be appropriate when the patient has more extensive damage which would require knee replacement.
The articular cartilage As a doctor who also specialises in sports medicine, torn ligaments are common injuries. But they are feared by a lot of athletes because these can be career-enders. When ligaments are damaged, the knee joint can become unstable. It also limits knee movement as it becomes unable to pivot, turn, or twist the leg.
The anterior cruciate ligament (ACL) is located toward the front of the knee, hence it is the most common ligament to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.
The posterior cruciate ligament (PCL) is located toward the back of the knee. It is also a common knee ligament to be injured. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.
Knee ligament repair or reconstruction is a treatment for a complete tear of a knee ligament that results in instability in the knee. People with a torn knee ligament may be unable to do normal activities that involve twisting or turning at the knee. The knee may buckle or “give-way.” If medical treatments are not satisfactory, ligament repair or reconstruction surgery may be an effective treatment.
The surgery to correct a torn knee ligament involves replacing the ligament with a piece of healthy tendon. A tendon from the kneecap or hamstring, for example, is grafted into place to hold the knee joint together. The tendon graft may come from the person (autograft) or from an organ donor (allograft).
Thirty years ago, an ACL injury was career-ending, but today, thanks to arthroscopy and refined surgical techniques, most athletes are able to return to sports. Happily, the answer to the above question is most likely a yes – but with qualifications.
If you are dealing with unrelenting pain that is already holding you back in using any of these joints, and is already affecting your quality of life, you can help restore movement and preserve good function the soonest that you have it checked.
What’s hard is living in pain. Fortunately, you don’t have to suffer because there are solutions and we offer them here at the A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic. Consider what your level of play or movement is right now and how long you can afford to stay that way and still get the job done.
So, do something about what’s holding you back. You may call our clinic today at +65 6836 8000.
Read: Patient’s Guide When Seeking Orthopaedic Care in Singapore