Musculoskeletal Orthopaedics in Bangkok Thailand

Orthopaedic surgery provides treatment for debilitating musculoskeletal disorders, such as sports- or strain-related injuries of the knee, shoulder, hip or hand, or other joints, bone fractures, trauma, joint diseases and injuries, and spinal injuries.

ThaiMed offers international patients an affordable means to diagnosis and treat musculoskeletal disorders. Dedicated to providing comprehensive, individualized care, board-certified physicians provide patients with a higher level quality of care that is unsurpassed by what many travelers are accustomed to back home.

Adult Orthopaedic management is provided for complex fractures in the multiply-injured patient, spine trauma, deformities, and sports medicine including arthroscopy, joint replacement and reconstruction, and musculoskeletal injury and diseases.

Management of scoliosis (spinal deformities), neuromuscular congenital and development diseases, foot deformities, and hip dysplasia are included in the total care of musculoskeletal problems in children.

Orthopaedic surgeons are available around the clock to treat the most seriously injured adults and children who are victims of trauma, and offering others opprotunities of return or improved mobility with elective surgeries.

Elicitation of history and performance of physical examination. Special attention to presence or absence of "red flags" to include: age <18 or >55; history of malignancy, steroid use, or HIV positivity; weight loss or constitutional symptoms; structural deformity; anal or urethral sphincter disturbance; saddle anesthesia; gait disturbance; or widespread neurologic deficit.

If red flags are present, diagnostic testing may include plain radiographs; CBC; ESR; bone scan; CT scan and/or MRI scan and electrodiagnosis as indicated.

If red flags are absent a diagnostic workup is generally not necessary.

Initial treatment for the first 2 weeks consists of: reassurance that most episodes resolve uneventfully within 6 weeks; encouragement to maintain as close to normal activity as is tolerable; avoidance of bed rest greater than 24 hours; NSAIDS (unless contraindicated); muscle relaxants for up to one week; acetaminophen as needed; weak opiates (codeine; propoxyphene) unless contraindicated; passive modalities (e.g. ice, heat) for symptomatic relief. Read more...

Thailand Orthopedic Hand Surgery

Dramatic advances have been made in recent years in treating patients with hand injuries, degenerative disorders, and birth defects of the hand. At the forefront of these advances have been plastic surgeons-specialists whose major interest is improving both function and appearance. Plastic surgeons undergo intensive training in hand surgery, and they (along with orthopedic surgeons and general surgeons) treat patients with a wide range of hand problems.

This information is designed to give you a basic understanding of the most common hand problems-what they are, what plastic surgeons can do for them, and the results you can expect. It can't answer all of your questions, since each problem is unique and a great deal depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

If you're considering hand surgery, a consultation with a plastic surgeon is a good place to start. The surgeon will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, the surgeon will discuss the procedure in detail, including where the surgery will be performed (in the surgeon's office, an outpatient surgery center, or a hospital), the anesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.

Don't hesitate to ask your surgeon any questions you may have during the initial consultation-including any concerns you have about the recommended treatment and the costs involved. (Since hand surgery is performed primarily to correct physical abnormalities, it usually is covered by insurance. Check your policy or call your carrier to be sure.)

Thousands of successful hand operations are performed each year. While the procedures are generally safe when performed by a qualified and experienced plastic surgeon, complications can arise.

In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anesthesia. These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified surgeon and by closely following his or her advice.

Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery. Your surgeon can prescribe injections or oral medication to make you more comfortable. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of surgery and on how fast you heal.

To enhance your recovery and give you the fullest possible use of your hand, your surgeon may recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist. Your therapy may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It's crucial that you follow the therapist's instructions and complete the entire course of therapy if you want to regain the maximum use of your hand. Read more...

Thailand Orthopedic Foot Surgery.

Considering bunion surgery can be very confusing. There is a tremendous amount of information available and much of it is contradictory. You may get information from your doctor, friends, internet and/or family members. This section is designed to cut through the clutter, help you identify the false information, and assist you in making an informed decision.

In most cases, we can treat the pain caused by bunions conservatively. In fact, we feel strongly that surgery should be a last resort. We surprise many bunion patients with our ability to help them avoid surgery when they have been told previously they have no choice but surgery. If you have tried all conservative treatment, however, and bunion pain is causing pain or limiting your activity, surgery can be a very effective option.

Most bunions can be treated without surgery. But when nonsurgical treatments are not enough, surgery can relieve your pain, correct any related foot deformity, and help you resume your normal activities. An orthopaedic surgeon can help you decide if surgery is the best option for you. Whether you've just begun exploring treatment for bunions or have already decided with your orthopaedic surgeon to have surgery, this page will assist with providing you insight.

An important factor in deciding whether to have bunion surgery is understanding what the procedure can and can not do. The vast majority of patients who undergo bunion surgery experience a dramatic reduction of foot pain after surgery, along with a significant improvement in the alignment of their big toe.

Bunion surgery will not allow you to wear a smaller shoe size or narrow-pointed shoes. In fact, you will have some shoe restrictions for the rest of your life. Always follow the recommendations for shoe fit presented in this booklet.

Remember that the main cause of the bunion deformity is a tight fitting shoe. If you return to that type of shoe wear, your bunion will reappear.

Almost all bunion surgery is done on an outpatient basis. You will most likely be asked to arrive at the hospital or surgical center one or two hours prior to surgery.

After admission, you will be evaluated by a member of the anesthesia team. Most bunion surgery is performed under ankle block anesthesia, in which your foot is numb, but you are awake. General or spinal anesthesia is used occasionally. The anesthesiologist will stay with you throughout the procedure to administer other medications, if necessary, and to make sure you are comfortable.

The surgery takes about one hour. Afterwards, you will be moved to the recovery room. You will be ready to go home in one or two hours. Read more...

Thailand Orthopedic Elbow Joint Surgery.

What is elbow replacement?

In elbow replacement surgery, the painful surfaces of the damaged elbow are replaced with artificial elbow parts. One part fits into the humerus (upper arm), and the other part fits into the ulna (forearm). The two parts are then connected and held together by a pin. The resulting hinge allows the elbow to bend.

How do I prepare for elbow replacement surgery?
If you and your surgeon decide that total elbow replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will ensure that other health problems you may have, such as diabetes or high blood pressure, will be treated before surgery. Your doctor, or a staff member, will advise you about the things you can do to prepare for your hospital stay, and your rehabilitation after surgery.

What happens during elbow replacement surgery?
On the day of surgery, an intravenous tube will be inserted into your unaffected arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia. After the anesthesia takes effect, your elbow will be scrubbed and sterilized with special solution.

The procedure is performed through an incision over the elbow that will expose the joint. Special, precision guides and instruments will be used to cut the ends of the humerus (upper arm bone) and ulna (forearm bone), and prepare the bone to accept the implant. The implants are then inserted and fixated in place with a special kind of opoxy cement for bones. The two parts of the hinge are then brought together and secured with a pin. When the surgeon is satisfied with the fit and function, the incision will be closed and covered with dressings. The surgery usually takes one to three hours, although this depends on the severity of the arthritis in your elbow.

A sterile bandage will be placed over the wound, and you will be sent to the recovery room where you will be carefully monitored. As the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. Your arm will be in a splint, and it may be wrapped in an ice pack to help control pain and swelling. You will also be given pain medication. When you are fully conscious, you will be taken back to your hospital room. Read more...

Thailand Orthopedic Shoulder Surgery.

A joint is formed by the ends of 2 or more bones that are connected by thick bands of tissue called ligaments. The shoulder typically involves 2 bones:

The scapula (shoulder blade)
The humerus (upper arm bone)
The rotator cuff – 4 muscles connecting the humerus with the scapula – supplies stability and balance to the shoulder joint. Proper rotator cuff balance is essential for arm raising and rotation. When you raise your arm, the rotator cuff holds the humeral head tightly within the socket (glenoid) of the scapula.

A smooth substance called articular cartilage covers the surface of the bones where they touch each other within a joint. This articular cartilage acts as a cushion between the bones. In addition, lubricated sacs of tissue called bursae (singular: bursa) also protect muscles and tendons, allowing them to slide against each other with less friction.

In the shoulder, one of these bursae is located between the rotator cuff and the acromion – the part of the scapula that "roofs" the shoulder. As with other joints, the remainder of the shoulder joint surface is covered by a thin, smooth tissue liner called synovial membrane, which makes a small amount of fluid that acts as a lubricant so that the joint bones will not rub against each other.

One of the most common causes of shoulder pain is arthritis. The most common types of arthritis are:

Osteoarthritis (OA) — sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. The most common cause of shoulder replacement, OA can occur without a shoulder injury, but this seldom happens since the shoulder is not a weight-bearing joint like the knee or shoulder. Instead, shoulder OA commonly occurs many years following a shoulder injury, such as a dislocation, that has led to joint instability and repeated shoulder dislocations, damaging the shoulder joint so that OA develops. When the resulting joint pain and stiffness become severe enough to affect a person's daily life and comfort, shoulder replacement may be recommended.

Post-traumatic Arthritis — may develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth, and these irregularities lead to more wear on the joint surfaces.

Rheumatoid Arthritis (RA) — produces chemical changes in the synovium that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men, and may affect other organs of the body.

Other shoulder pain causes include avascular necrosis, which can result when bone is deprived of its normal blood supply (for example, after organ transplantation or long-term cortisone treatment), and deformity or direct injury, such as a fracture, to the joint.

In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move.

What's causing your shoulder joint pain? Is getting relief through joint replacement an option for you? These are just some of the answers that an orthopaedic surgeon can provide. But first, it's a good idea to be sure you have information about joint replacement that will help you understand what the surgeon tells you. Read more...

Thailand Orthopedic Ankle Surgery

Several different operations have been developed to perform an ankle fusion. The basic procedure in each operation remains the same, however. The most common way that an ankle fusion is done is by making an incision through the skin to open the joint. Once the joint is opened, the articular cartilage surfaces of the joint must be removed.

Once the articular cartilage is removed on both sides of the joint, the body will try to heal the two surfaces together just as if it were fractured or broken.
Once the cuts are made the bones must be held in place while they fuse. This can be done using large metal screws and metal plates if necessary. The screws are usually under the skin and are not removed unless they begin to rub and cause pain.

In some cases, especially if the fusion is being done because of an infection or a failed initial fusion, an apparatus called an 'external fixator' is used to hold the bones together while they heal. This apparatus has metal pins that are inserted through the skin and into the bone. The metal pins are connected to metal rods and bolts outside the skin that hold the bones in position while the ankle fuses. The fixator is removed after the bones have healed, usually in twelve to fifteen weeks.

Some surgeons have performed ankle fusions with the help of the arthroscope. The arthroscope is a miniature TV camera that is inserted into the ankle joint through a small incision. Using the arthroscope to watch, other instruments are inserted into the ankle joint to remove the cartilage surface. The cartilage surface is removed using a small rotary cutting tool. Once the surfaces are prepared, screws are placed through small incisions in the skin to hold the bones together as they heal, or fuse. This procedure is not significantly different from the open procedure except that the incisions are smaller.

As with any medical treatment, individual results may vary. Only an orthopaedic surgeon can determine whether an orthopaedic implant is an appropriate course of treatment. There are potential risks, and recovery takes time. The performance of the new joint depends on weight, activity level, age and other factors. These need to be discussed with your doctor. Read more...

Thailand Orthopaedic Spine Surgery

The spine consists of bones (vertebrae) separated by soft cushions (disks). Pressure on the nerves that branch off the spinal cord can produce pain, numbness, tingling, or weakness.

Lumbar spinal surgery is done while you are under general anesthesia (unconscious and pain-free). A surgical cut is made over the area of the problem. The bone that curves around and covers the spinal cord and the tissue that presses on the nerve or spinal cord are removed.

The hole through which the nerve passes may be widened to prevent further pressure on the nerve. Sometimes, spinal fusion is necessary to stabilize the area.

The Orthopaedic Spine Surgery Program also provides surgical and nonsurgical consultation for second opinions for surgery and Workmen's compensation claims.

The Orthopaedic Spine Surgery Program works closely with non-operative spine specialists including physiatrists, pain management physicians, neurologists, rheumatologists, physical therapists, acupuncturists and chiropractors to maximize non-operative care prior to surgery.

Read more...

Thailand Orthopedic Hip Replacement Surgery

Serious complications may occur with any surgical procedure. These include but are not limited to: problems with anesthesia, cardiovascular problems including heart attack, vascular problems including thrombus, bronchopulmonary problems including emboli, genitourinary problems, and gastrointestinal problems. Certain additional complications related to joint replacement surgery in particular may include but are not limited to: bleeding problems, blood clots in the legs and/or lungs, wound healing problems, damage to nerves and blood vessels, limb length discrepancy, bone erosion or abnormal bone formation, dislocation, infection, pain, bone fracture or non-union, component wear or fracture, component loosening. Complications may require medical intervention including additional surgery and, in rare instances, may lead to death. Your doctor should discuss these potential complications with you.

As successful as most of these procedures are, over the years, an artificial joint can become loose and unstable or wear out, requiring a revision (repeat) surgery. These issues — together with the fact that increasing numbers of younger and more active patients are receiving total joint replacement, and patients are living longer — have challenged the orthopaedic industry to try to extend the life cycle of total joint replacements.

Recent improvements in surgical techniques and instrumentation will help to further the success of your treatment. The availability of advanced materials, such as titanium and ceramic, and new plastic joint liners provides orthopaedic surgeons with options that may help to increase the longevity of the artificial joint.
Read more...

Thailand Orthopedic Knee Replacement Surgery

If you have persistent pain, catching, or swelling in your knee, a procedure known as arthroscopy may help relieve these problems.

Arthroscopy allows an orthopedic surgeon to diagnose and treat knee disorders by providing a clear view of the inside of the knee with small incisions, using a pencil-sized instrument called an arthroscope. The scope allows transmission of an image of your knee through a small camera to a television monitor. The image allows the surgeon to thoroughly examine the interior of the knee and determine the source of the problem. During the procedure, the surgeon also can insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues.

With improvements of arthroscopes and higher resolution cameras, the procedure has become highly effective for both the accurate diagnosis and proper treatment of knee problems.

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue-the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments-connect the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.

The surfaces where the femur, tibia, and patella touch are covered with articular cartilage. Articular cartilage is a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous cartilage tissue, called the lateral and medial menisci, act as shock absorbers and stabilizers.

The bones of the knee are surrounded by a thin, smooth tissue capsule lined by a thin synovial membrane. The synovium releases a special fluid that lubricates the knee, reducing friction to nearly zero in a healthy knee. Read more...