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Nature-friendly surgery for joint &

muscle problems

Arthroscopic Surgery with Coblation

Dr Keyur A. Buch MSOrth,MChOrth(UK),
FRCSEd(Tr & Orth)

Consultant Upper Limb Arthroscopic
Surgeon, Wockhardt Hospitals
Description of the shoulder
The Commonest Cause of Shoulder/Arm Pain: Subacromial
What is Shoulder Impingement Syndrome?

 Friction between
muscle/gliding tissue on
one side and the bone
on the other side-
around the shoulder
Symptoms & Signs of Impingement Pain

 Pain around the shoulder, upper or lower
arm/hand, neck or chest
 More pain at night
 Difficulty in lifting the arm above the head
 Difficulty changing clothes or reaching the back
for personal toilet hygiene purposes
 Stiff shoulder
 Weakness of shoulder/arm
Diagnosis of Shoulder/Arm/Hand Pain

• If your pain has not improved with medication
and physiotherapy, then the most important,
essential, first requirement is seeing a specialist
orthopedic surgeon with specific, high quality
training and experience in assessment and
treatment of shoulder/arm/hand pain problems
How Does a Specialist Upper Limb Surgeon make an
accurate Diagnosis?

 This question is the same as a non-pilot asking how exactly
a specialist pilot flies a sophisticated airplane!

 In general, the specialist relies on skilled clinical
assessment, certain x-rays and scans such as an MRI or an
ultrasound scan
Mrs. Rina Gupta
 An active and otherwise healthy home-maker, with
shoulder/arm pain and stiffness; no benefit with medication
and physiotherapy

 After a thorough clinical assessment, the diagnosis was-
impingement pain shoulder with collar-bone arthritis and
frozen shoulder
Treatment administered

Key-hole (arthroscopy) technique with coblation technology to remove
inflamed tissue from the shoulder

Post surgery – movement of her shoulder
What is Coblation Technique

Coblation or controlled ablation works on the principle of
bipolar radio-frequency from a voltagerather than power)
driven source, generating a plasma layer around tip of the
instrument in the joint.

This plasma layers dissolves rather than burn the target
tissue within 1/10 of a mm area at body temperature, thus
no damage is caused to other tissues.
How Does Coblation work?

Coblation increases interleukin-8,
which is associated with
angiogenesis and tissue healing,
through elimination of harmful
interleukin-1. Tendinosis, caused
by 'failed tendon healing’, can be
effectively treated using RF-based
technology to induce an
angiogenic response in order to
promote healing
Coblation Vs Conventional Techniques

 Unlike the laser, cautery or mechanical means of removing
diseased tissue, Coblation works at low temperature,
removes only diseased tissue, no harm to normal tissues,
no heat damage or mechanical damage to cartilage in
shoulder or knee

 Coblation promotes healing of tendon and selected cartilage
problems, too. This is not possible with conventional,
current methods used predominantly in India at present
Coblation Video
Coblation: Patient Benefit

 Treatment of smallest areas of damaged tissue, muscle,
tendon or damaged cartilage, with no harm to normal
tissues; most natural form of technique compared to laser,
cautery or mechanical methods

 The most nature-friendly way of operative treatment of
shoulder-arm pain, frozen shoulder, tennis elbow, heel pain

 Natural and speedy recovery
What Clinical & Technical expertise is needed to use
coblation technology?

 Extensive and lengthy super-specialist training &
experience in upper limb orthopedics and arthroscopic
techniques –currently in India such expertise is available
only in a few centres

 Specific training at specialist centres( currently outside
Coblation- Bipolar Radiofrequency for various
orthopaedic problems

• With BRF we can treat patients suffering not just
from shoulder/arm pain, but also tennis elbow,
golfer’s elbow, heel pains, knee cartilage damage
reconstruction (chondroplasty), to name but a
few conditions
Treatment of Shoulder/Arm Pain

 First Line of treatment: Anti-inflammatory/pain killers, local
spray/cream, physiotherapy

 Second Line of treatment: Injection

 If pain &/or stiffness are persistent, key-hole (arthroscopy)
surgery of shoulder to remove inflamed tissue and trim any
overgrown, arthritic bone: this allows muscles and joint to
move freely without pain
Arthroscopy/Coblation: Who is eligible for

• Decision must be made on the merits of each case

• These treatments are reserved for those patients whose
pain and disability have not improved with medication
and/or physiotherapy

• Correct decision can only be made by a specialist with
extensive training and experience in these methods
The Future of Arthroscopic & Upper Limb
Surgery in India

 With increasingly westernised life-styles, we will import
their diseases, too

 There will be increasing need for treatment of
shoulder/arm, elbow, wrist, thumb pains from arthritis,
carpal tunnel syndrome, worn and painful tendons etc

 Key-hole surgery for wrist, and joint replacements for
thumb arthritis, cartilage repair treatment, will become
more common
Prevention is better than cure!
 Stretch your arms, shoulder, fingers, back and neck every
20 to 30 minutes

 Avoid food and drink that release damaging free radicals in
your body; so avoid smoking, alcohol and non-veg food at
all times; “moderation” in drinking alcohol is a harmful

 Alcohol, smoking and meat are linked with gout, weak
bones, poor circulation, stiff joints and higher risk of

 There is no minimum safe amount when it comes to
alcohol, smoking or non-veg food!
Thank You