Osteoporosis is a very common disorder affecting the skeleton. In a patient with osteoporosis, the bones begin losing their minerals and support beams, leaving the skeleton brittle and prone to fractures. About 80 percent of people with osteoporosis are women. This is in part because their bone mass is generally less than men, and women tend to live longer than men.

Bone fractures caused by osteoporosis have become very costly. Half of all bone fractures are related to osteoporosis. A person with a hip fracture has a 20 percent chance of dying as a result of the fracture within six months due to other complicating medical conditions such as pneumonia. Many people who have a fracture related to osteoporosis spend considerable time in the hospital and in rehabilitation. Often, they need to spend some time in a nursing home.

WHAT IS OSTEOPOROSIS?

Osteoporosis means “Porous Bone”

This happens when your bone loses too much calcium and becomes weak. This is very hard to detect clinically and is usually discovered only after a fracture occurs, or if a person shows reduced height or a humping of the back, or suffers low back pain.

A person with osteoporosis has bones that are brittle and fragile. These fragile bones can break very easily with a simple slip or fall or even with no injury at all.

Both men and women can suffer from osteoporosis, but it is most common in woman after menopause (when the monthly period ends).

WHAT CAUSES OSTEOPOROSIS…?

The bone is a living tissue. When we are young, any loss of bone is easily replaced. At around the age of 30, our bone is easily replaced. However, as we age, less bone is made and more bone is lost.

After menopause your body’s supply of estrogen decreases and the rate of bone loss increases even further. This is why post-menopausal women are more likely to suffer from osteoporosis.

There are also many other factors that contribute to bone loss such as illnesses, medication and lifestyle choices.

RISK FACTORS INCLUDE:

• Non-violent Fracture

• Early Menopause before age 45

• A member of your immediate family who has osteoporosis

• Underweight or undernourished

• Smoking /Drinking too much alcohol

• Not exercising much or not being able to move for a long period of time

• Not enough calcium or vitamin D

• Certain illnesses /medicines

HOW DO PATIENTS FIND OUT IF THEY HAVE OSTEOPOROSIS?

Osteoporosis can be easily detected through a painless procedure called dual-energy x-ray absorptiometry (DEXA). This test measures the density or solidness of the bones, known as the bone mineral density or BMD.

It uses a thin, invisible beam of low-dose X-rays through the region of interest (usually the lumbar spine and the hip) via two energy streams.

A reading is derived and is reflected as units gram per cm. this will tell us whether is there any osteoporosis.

WHAT ARE THE PREVENTION /TREATMENT OPTIONS?

Prevention

• Exercise

• Medication

• Calcium / Vitamin D Supplement

Treatment

• Hormone Replacement Therapy (HRT)

-Higher risk with long term usage

• Selective Estrogen Receptor Modulator (SERMS)

• Bisphosphonates

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DEVELOPMENT OF THE SHOCKWAVE THERAPY

Shockwave therapy as a medical application was originally developed as a means for pulverizing kidney stones. Since 1989, it has also been employed with considerable success at university clinics to treat non– or poorly healing bone fractures.

Since 1991, Extracorporeal Shockwave Therapy (ESWT) has been employed as an alternative to surgery in treating calcified shoulders and other aches and pains of the bones and tendons.

The current range of applications for orthopaedic conditions includes:

• Calcified Shoulder

• Shoulder joint aches and pains without calcium deposits

• Tennis or golfer’s elbow

• Plantar fasciitis and Heel spurs

• Inflammation of the Achilles or patella tendon

• Pseudarthrosis

SHOCKWAVE THERAPY WORKS

The therapy equipment generates high-energy shockwaves, which are transmitted to the body through a plastic membrane. The shockwave first pass through the skin and the layers of tissue underneath. They only become effective in the area at which the doctor has set the penetration depth.

The desired effects are:

• Dispersing of calcium deposits

• Stimulation of the healing mechanisms of the body (e.g. in the case of tennis elbow)

• Stimulation of bone growth (in the case of pseudarthrosis)

The course of treatment

Shockwave therapy is carried out on an outpatient basis and is mostly administered under local anaesthetic. Using our shockwave equipment, treatment generally involves one or a course of several sessions carried out at intervals of several weeks.

Depending on the condition to be treated, your physician will decide the number and strength of the shockwave to be administered. The duration of the treatment at each session is 10 to 20 minutes or, in the case of pseudarthrosis, up to one hour.

RESULTS OF THE SHOCKWAVE THERAPY

The therapy described here has been employed successfully in over 70% of cases. Recovery from the aches and pains being treated generally starts to occur immediately or soon after treatment. The therapy sessions may be repeated in individual cases to ensure that the treatment continues to be successful.

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Knee pain is a common problem in Asia, especially in individuals above the age of 40. The most common cause of knee pain is degenerative osteoarthritis. Women are more prone to the disease. It is characterized by mild to debilitating pain. The treatment ranges from physiotherapy, medication, injection and surgery. Once the condition is diagnosed, it is important to choose the treatment according to the individual’s age, and the severity of the symptoms.

WHAT IS OSTEOARTHRITIS?

Osteoarthritis is a common problem for many people after middle age. Osteoarthritis is sometimes referred to as degenerative, or wear and tear arthritis. It is the most common forms of arthritis. The disease causes cartilage breakdown found in joints. This breakdown removes the buffer between bones and the resulting bone against bone friction causes pain and eventual loss of movement. Bone spurs may form around the joint as the body’s response.

The symptoms of osteoarthritis are mainly pain, swelling, and stiffening of the knee. Osteoarthritis develops slowly, but may present with sudden attacks of knee pain. The pain of osteoarthritis is usually worse after activity. Some patients may have pain and stiffness on standing after a prolonged sitting period. Activities such as squatting and climbing of stairs become painful. In the late stages, the pain is worse with walking. The knee becomes difficult to straighten or bend fully.

HOW DO YOU GET OSTEOARTHRITIS?

There are a wide array of factors that cause the development and progression of the disease.

RISK FACTORS INCLUDE:

•             Aging

•             Obesity

•             Joint injuries (sports, work or accidents)

•             Genetics

HOW DO PATIENTS FIND OUT IF THEY HAVE OSTEOARTHRITIS?

An individual must be diagnosed by a doctor. After a physical examination and full detailing of symptoms, the physician may also recommend X-rays to confirm presence of the disease. X-rays are very helpful in the diagnosis and may be the only special test required in the majority of cases. In some cases of early osteoarthritis, the X-rays may not show changes typical of osteoarthritis. If the diagnosis is still unclear, arthroscopy may be necessary to actually look inside the knee and see if the joint surfaces are beginning to develop changes from wear and tear. Arthroscopy is a surgical procedure where a small fibre-optic television camera is inserted into the knee joint through a very small incision, about 5mm. The surgeon can then move the camera around inside the joint while watching the pictures on a TV screen. The structures inside the joint can be examined with small surgical instruments to see if there is any damage.

TREATMENT OF  OSTEOARTHRITIS

• Weight management to relieve stress on weight-bearing joints

• Glucosamine Sulphate 1500mg per day

• Anti-inflammatory drugs and analgesics

• Injection of lubricants into the knee

• Arthroscopy to wash away the inflamed fluid, debris and loose fragments inside the joint.  Abrasive-therapy to stimulate cartilage growth

• Osteotomy to straighten the leg to reduce the stress acting on the bad part of the knee.

• Partial knee replacements (unicompartmental knee replacement – replaces only the diseased portion of the joint)

• Total knee replacement (used when severe osteoarthritis is present)

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•             Rotator Cuff Tear and Tendinitis

•             Shoulder Dislocation

•             Adhesive capsulitis/ Frozen Shoulder

•             Bursitis

Treatment

•             Physiotherapy

•             Shock wave therapy

•             Anti-inflammatory Injection

•             Arthroscopy

•             Arthroscopic repair and acromioplasty

WHAT IS A ROTATOR CUFF TEAR?

The rotator cuff is the network of muscles and tendons that forms a covering around the top of the upper arm bone (humerus). The rotator cuff holds the humerus in place in the shoulder joint and enables the arm to rotate.

Rotator cuff tear is a common cause of pain and disability among adults. Most tears occur in the supraspinatus muscle, but other parts of the cuff may be involved.

WHAT IS SHOULDER IMPINGEMENT?

The most common cause of rotator cuff problems is a disorder known as impingement where the cuff impinges against the acromion, which overhangs the rotator cuff. In some people, this space is inadequate to allow the normal smooth gliding movements of the rotator cuff as it moves the arm. Every time they raise an arm, the rotator cuff is pinched between the two bones.

In other cases, impingement is caused by accident or injury. Most often, it occurs with aging. As people grow older, their shoulder muscles and tendons weaken, causing the shoulder joint to become less stable. The space between the upper arm and the acromion narrows. The rotator cuff has less room to move. The increased pressure gradually damages the rotator cuff.

Although the rotator cuff can tear suddenly as a result of a serious injury, most rotator cuff problems develop over time. Over a period of months or years, impingement causes the rotator cuff to become irritated, to tear partially, or to tear completely.

WHAT IS ROTATOR CUFF TENDINITIS?

The term tendinitis refers to chronic irritation, inflammation, or tearing of the rotator cuff that occurs as a result of impingement or overuse. Tendinitis bothers some people for a time and then seems to disappear. Their symptoms vary greatly, depending on several factors, the most important of which is how they use the affected shoulder or shoulders.

Some people with tendinitis also develop calcium deposits or abnormal bone growths called bone spurs. Both can aggravate tendons, contributing to the weakening, partial, or complete tearing of the rotator cuff.

WHAT IS SHOULDER BURSITIS?

A bursa (plural bursae) is a soft, fluid-filled sac that helps to cushion and lubricate joints. In the shoulder, there are bursae located between the rotator cuff and the shoulder blade. When a bursa becomes irritated or inflamed, it causes bursitis. Pain and swelling of the joint often accompany bursitis.

WHAT CAUSES ROTATOR CUFF PROBLEMS?

The most common cause of rotator cuff problems is shoulder impingement, in which there is a narrowing of the gap between a portion of the shoulder blade known as the acromion and the top of the upper arm bone. This causes increased friction and gradually damages the rotator cuff.

Rotator cuff tears can also happen suddenly; for example, when a person tries to lift a heavy object above the head. Repeatedly performing a strenuous task such as throwing a baseball can also damage the rotator cuff. In such cases, the excess strain on the rotator cuff causes one or more tendons to tear.

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UNDERGOING AN ORTHOPEDIC SURGICAL PROCEDURE

The range of treatments performed by an orthopaedic surgeon may cover anything from traction to hand reconstruction, spinal fusion or joint replacement. They are involved in the treatment of broken bones, ligamental strains and sprains, as well as joint dislocations.  Some specific procedures include arthroplasty, arthroscopic surgery, bone grafting, fasciotomy, and fracture fixation.

In general orthopaedic surgeons are attached to a hospital, medical center, trauma center, or free-standing surgical center where they work closely with a surgical team including an anesthesiologist and surgical nurse. Orthopedic surgery can be performed under general, regional, or local anesthesia.

YOUR PRE-OP EXAM

The doctor may ask about your medical history, do a physical exam, and order some tests to ensure your fitness for surgery.

• Blood tests provide information about your blood and body chemistry.

• An ECG (electrocardiogram) records your heart function.

• A urinalysis (analysis of urine) gives information about your kidneys and bladder function.

• A chest x-ray shows an image of your lungs.

• Other tests may also be done to make sure you are fit for surgery.

Bring any previous tests results on these or other that you may have at home before the surgery.

THINGS TO KNOW BEFORE THE SURGERY

1. Inform your doctor on your medication intake, including aspirin, anti-inflammatory medications, herbs, or vitamins.

2. Make arrangements to have someone to drive you to and from the surgery, or consider taking a taxi. Don’t drive yourself.

3. Make arrangements for someone to take care or you for at least the first 24-72 hours after the surgery

4. Fill prescriptions (especially pain medication and antibiotics) before the surgery

5. You need to fast for 6 hours prior to surgery, but may consume small amounts of plain water

6. Come to the clinic 2 hours before to collect the admission letter and preparation information.

7. Prepare for surgery fee deposit/ payment and   hospital payment (cash in sgd$, visa, master, amex, and nets.)

8. Please do not bring too many valuables.

9. Ask for a locker at the hospital

10. For day surgery procedures a two bedded ward is usually booked by our staff. Please inform us early on for changes of room type.

11. Set up a home recovery area (lots of pillows, books, magazines, journals, videos, favorite cds, etc.)

12. Consider quick snacks: protein shakes, soup, oatmeal, cottage cheese, juice etc.

13. Be sure to eat adequate amounts of protein such as meat, fish, eggs, diary products, soya (the body needs it for proper healing)

ARRIVING FOR SURGERY

• Bring your insurance card and any forms you need the doctor to fill in upon admission at the hospital, you will get an ID bracelet, and be taken to a ward to get ready.

• Your family and friends may be asked to stay in a waiting area.

ANAESTHESIA

Before the surgery, a doctor or nurse will talk you through the anaesthesia procedure (medication which blocks pain and keeps you comfortable during the surgery).

IN THE OPERATING THEATER

The operating theater (OT) is staffed by a team of trained professionals. The OT provides the most sterile and safe surgical setting possible.

YOUR SURGICAL TEAM

•   The Surgeon, who is responsible for your overall care, leads your surgical team.

•   A surgical assistant helps on many major surgeries.

•   An anaesthesiologist and nurse anaesthetic assistant provides the anaesthesia and other medications to keep you comfortable during surgery, and monitor your vital signs.

•   A surgical technologist sets up instruments and assists the surgeon.

•   A circulating nurse prepares the OT, makes sure sterile methods are followed, and helps other team members

After Surgery

After surgery, you will be brought to the recovery room to receive constant care from a post anesthesia care nurse. When you are coming out of surgery, your doctor will speak to your relatives to update them on your condition.

As the anaesthetic wears off, you will “wake up” in the recovery room.

• Noises may sound louder than normal.

• You may have slight blurry vision, a dry mouth, chills, or nausea.

• A nurse will check on your dressing and blood pressure often.

• Your surgery site may feel uncomfortable; ask your nurse for medication if you need it.

• You may be asked to do some deep breathing and coughing to help clear your lungs.

• Your nurse may ask you to move around a little in bed, because small movements will help you recover faster.

YOUR RECOVERY

Your doctor and nurses will check on you after surgery. If you feel pain or nausea, let them know.

WALKING

Walking helps your blood flow better. It also helps your body functions get back to normal. Be sure to ask for help the first time you get up out of bed, and begin walking.

BREATHING AND COUGHING

In the hospital, you may be asked to use a spirometer (deep breathing exerciser). Deep breathing clears the lungs and helps prevent pneumonia. You may also be asked to cough. This may be difficult at first.

EATING

Food may be hard to digest after surgery. So you may have an IV for nutrition when you are in the hospital. A dietitian will help decide what foods are best for your when the doctor says you may begin eating. You will start with liquids. Later, you will eat solid foods. At home, follow your doctor’s orders about eating and drinking.

GOING HOME

You are likely to spend most of your time recovering from surgery at home. Make sure to plan your home care. Also, you will need to visit your doctor’s clinic sometime after you leave the hospital. Be sure to keep these appointments, and if you have any questions you should bring these up to the doctor.

LEAVING THE HOSPITAL

A hospital staff member will take you to your ride or taxi. You won’t be allowed to drive yourself home. At home, ask your relative’s to accompany you until the wound is more or less healed. If you have any questions feel free to contact our clinic.

WHAT TO DO AFTER DISCHARGE FROM THE HOSPITAL?

The patient will only be discharged from the hospital once they are stable. They will then be given an appointment which is usually 3 days later and orthopaedic accessories/medications if necessary. These include:

•             Antibiotics

•             Anti-inflammatory medications

•             Orthopaedic accessories

ANTIBIOTICS

The purpose of antibiotics is to reduce the chances of getting wound infections. It is important that you complete the whole course.

Examples: Avelox, Rocephine, Ciprolet

ANTI-INFLAMMATORY MEDICATIONS

The role of the inflammation medication is to reduce the post-surgical inflammation and pain. It is recommended that the patient completes at least half off the prescribed quantity and adopt the “wait and see” approach. If the pain subsides substantially, then you may stop the medication without completing the whole course.

Example: Celebrex, Arcoxia etc

ORTHOPAEDIC ACCESSORIES

The accessories are often used as external applications to aid wound healing, and to protect the wound during its recovery phase.

Cold Pack

• Place Cold Pack flat in freezer for at least 30 minutes.

• Remove Cold Pack from freezer and place in a towel before applying. Never apply cold therapy longer than 30 minutes at a time.

During treatment, inspect the skin every 5 minutes where compress is applied. If any discoloration or redness occurs discontinue treatment at once.

Hot Pack

• Immerse Hot Pack in warm water for 5-7 mins

• Check the temperature of the Hot Pack. If it is too hot then let it cool down.

Always apply with a wrapping towel.

Bandage / Cast Cover

• Reusable Cover to prevent bandage / cast from getting wet during shower

• Available for Arm and Knee

Cryocuff

The Cryocuff system contains 3 basic components:

• Cuff- covers the injured area.

• Cooler- holds enough water and ice for 6 to 8 hours of cryotherapy.

• Tube- exchanges the water between the cooler and cuff.

All knee and shoulder Cryocuffs use the same cooler and fittings.

An insulated Cryocuff holds up to 4 liters of ice and water – enough for 8 hours of therapy.

• Elevating the cooler fills and pressurizes the cuff.

• Compression is controlled by gravity, and is proportional to the elevation of the cooler. For example, if the cooler is 20″ above the cuff during filling, the applied compression will be approximately 35mm Hg (1″ elevation = 1.8 mm Hg pressure).

• When body heat warms the water, it is re-chilled simply by lowering the cooler.

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