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Best Pseudoarthrosis Treatment in Delhi

Pseudoarthrosis Physiotherapy
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What is Pseudoarthrosis ?

Pseudoarthrosis, often called a “false joint,” is a condition where a bone fracture fails to heal properly, or a surgical bone fusion (like a spinal fusion) does not achieve solid union. Instead of the bone segments fusing, a fibrous tissue or cartilage forms, leading to instability and often pain at the site.

Causes of Pseudoarthrosis
  • Pseudoarthrosis can arise from various factors that hinder the natural bone healing process. These include:-
    • Inadequate Stabilization: Insufficient immobilization or stability of the fracture site. If the bone fragments move too much during healing, they can not bridge the gap. This is a common cause after both conservative and surgical treatments.
    • Poor Blood Supply (Avital Pseudarthrosis): Reduced blood flow to the fractured bone segments can deprive them of the necessary oxygen and nutrients for healing. This often results in an “atrophic” or “avital” nonunion, where bone tissue is reduced.
    • Infection: Bacterial infection at the fracture site can severely impair bone healing and lead to “infectious pseudoarthrosis.” This can occur with open fractures or after surgery.
    • Premature Weight-Bearing/Stress: Putting too much stress on the injured bone too early can disrupt the healing process.
    • Soft Tissue Interposition: Soft tissues, like muscle or fascia, getting caught between the bone fragments can prevent them from uniting.
  • Patient-Related Factors:-
    • Smoking: Nicotine significantly inhibits bone-forming cells (osteoblasts) and impairs blood supply. It’s a major risk factor.
    • Elderly Patients: Bone healing often becomes less efficient with age.
    • Underlying Medical Conditions: Diabetes mellitus, osteoporosis, rheumatoid arthritis, chronic steroid use, and other chronic illnesses can compromise bone healing.
    • Malnutrition: Inadequate intake of essential nutrients like calcium and Vitamin D can hinder bone regeneration.
    • Obesity: Can increase stress on healing bones and contribute to poor outcomes.
    • Previous Pseudoarthrosis: A history of pseudoarthrosis indicates a predisposition.
    • Certain Medications: Some medications, including non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, can interfere with bone healing.
  • Surgical Factors (especially in spinal fusion):
    • Inadequate surgical technique.
    • Insufficient bone graft material or poor quality of graft.
    • Complications like bone loss or swelling after surgery.
Symptoms of Pseudoarthrosis
  • The symptoms of pseudoarthrosis can vary in intensity, and some individuals may even be asymptomatic, especially in the spine. However, common symptoms include:-
    • Persistent Pain: This is often the most common symptom, occurring at the site of the unhealed fracture or failed fusion. The pain may worsen with movement or pressure on the affected area.
    • Instability: A feeling that the bone or joint is “giving way” or unstable.
    • Reduced Mobility/Restricted Range of Motion: Difficulty moving the affected limb or spine.
    • Swelling and Redness: May be present around the unhealed area, especially if there’s inflammation or infection.
    • False Joint Movement: Abnormal or excessive movement at the site of the nonunion, where there should be solid bone.
    • Clicking or Grinding Sensations: Sounds or sensations when moving the affected area.
    • Neurological Symptoms: In cases of spinal pseudoarthrosis, nerve irritation or compression due to instability can lead to numbness, tingling, or weakness in the arms or legs.
    • Muscle Atrophy: Weakness and wasting of muscles around the affected area due due to disuse or nerve impingement.
    • Deformity: In some long-standing cases, the false joint can lead to visible malalignment or deformity.
    • Chronic Fatigue: Persistent pain and limited activity can contribute to fatigue.
    • Fever: If an infection is present.
Advanced Physiotherapy for Pseudoarthrosis

Physiotherapy plays a crucial role in the management of pseudoarthrosis, both pre- and post-surgically, and in some cases, as a primary non-surgical intervention. The goals of advanced physiotherapy are to reduce pain, improve stability, restore range of motion, strengthen muscles, and ultimately promote bone healing.

  • Modalities to Promote Bone Healing:
    • Extracorporeal Shockwave Therapy (ESWT): High-energy acoustic waves are applied to the affected area. ESWT has been shown to stimulate tissue regeneration, increase blood flow, and promote bone healing by activating osteoblasts.
    • Ultrasound Therapy (High Intensity Focused Ultrasound): While conventional ultrasound has limited evidence for bone healing, newer high-intensity focused ultrasound (HIFU) techniques are being explored for their potential to stimulate bone regeneration.
  • Exercise –
    • Strength Training: Progressive resistance exercises for muscles surrounding the pseudoarthrosis to improve stability and support the affected bone. This includes isometric, isotonic, and later, more dynamic exercises.
    • Proprioceptive Retraining: Exercises to improve the body’s awareness of the joint’s position and movement. This is crucial for regaining stability and preventing re-injury, especially after a period of instability. Examples include balance exercises, single-leg stands, and activities on unstable surfaces.
    • Range of Motion (ROM) Exercises: Gentle, controlled movements to maintain or restore joint flexibility and prevent contractures. This may involve active, active-assisted, and passive ROM exercises.
    • Core Stability Exercises (especially for spinal pseudoarthrosis): Strengthening the deep abdominal and back muscles to provide better spinal support and reduce abnormal movement at the nonunion site. This can include exercises like abdominal bracing, pelvic tilts, and controlled movements.
    • Functional Exercises: Mimicking daily activities and sports-specific movements to prepare the patient for a return to full function.
  • Manual Therapy:
    • Joint Mobilization: Gentle techniques to restore normal joint mechanics and reduce stiffness in surrounding joints that may have become compensatory.
    • Soft Tissue Mobilization: Addressing muscle tightness, scar tissue, and fascial restrictions that can contribute to pain and limit movement.
  • Pain Management Techniques:
    • Cryotherapy/Heat Therapy: For acute pain and swelling or chronic muscle stiffness.
    • Transcutaneous Electrical Nerve Stimulation (TENS): To modulate pain signals.
    • Education on Pain Management Strategies: Including pacing activities, proper body mechanics, and self-management techniques.

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