Segment Overview: In this segment, Dr. Murthi talks about the challenges of Elbow Replacement and related issues.
Guest: Dr. Anand Murthi, MD
Presenter: Neal Howard
Guest Bio: Dr. Murthi is a board certified orthopaedic surgeon. He is a specialist, fellowship trained in shoulder and elbow surgery. Dr. Murthi’s special interests include arthroscopic shoulder and elbow surgery; minimally invasive shoulder replacement, including reverse shoulder replacement; and elbow reconstruction. Chosen for Castle Connolly America’s Top Doctors 2015.
Neal Howard: Welcome to Health Professional Radio. I’m your host Neal Howard. Thank you so much for joining us today. Our guest is Dr. Anand Murthi. Here with us as a shoulder and elbow surgery expert specializing in throwing injuries, shoulder surgery as I said and elbow surgery. Welcome to the program Dr. Murthi.
Dr. Anand Murthi: Thank you very much for having me.
N: You’re there at MedStar Union Memorial Hospital. Where exactly is that located?
M: That’s North to the City, right by Johns Hopkins under that large footprint right there.
N: You’re an orthopedic surgeon and you specialize not only in elbow surgery but shoulder replacement, reverse shoulder replacement and things of that nature, but we’re here today to focus on elbow surgery. What is it about the elbow that makes it a little bit more problematic sometimes than some of the other surgeries that you may be involved in?
M: The elbow joint is very complex it has a lot of bony to that can occur it’s a very hinge type of joint and when the injuries occur such as in a throwing athlete or a pitcher and they can disrupt this ligament it’s very hard for it to heal on its own due to the repetitive nature of throwing. Then often then we have to reconstruct that ligand, there are multiple nerves that cross the elbow joints that have to be protected and taken care of. It’s a very complex joint that we work on.
N: You mentioned tearing ligaments due to repetitive pitching sports when the bone is actually broken is that even more problematic or are you know the tearing of ligaments and the breaking of a bone pretty much equal as far as the difficulty in making those repairs?
M: Interesting enough, when a patient fractures their elbow it’s often easier to repair that so it’s healed very easily especially in young patients. There is a good vascular supply and there’s own seriously. When ligaments tear it is your chronic issue, it’s very difficult to get those patients back with just rehabilitation or some sort of a treatment of ligament healing when they tear much more difficult than bones.
N: Are there several types of breaks in the elbow itself I mean the elbow is very small. How many different types of breaks can you actually get there?
M: It actually a multiple fracture the end of your arm bone, that’s called a distal humerus fracture. A fracture the radial head that’s the circular bone that allows your arm to rotate. There’s also what’s called the ulna or the electrode on which is the back of the elbow or the forearm and that often breaks attached to your triceps and then. When people fall they easy commonly zero micro knocks.
N: Are these isolated breaks or can they be a combination based on the trauma that the elbow endures?
M: It’s definitely related to the trauma. Simple fall they usually break one bone but when they have a high energy or a traumatic injury or motor vehicle accident or fall from height they can often break multiple bones and dislocate the elbow too all at one.
N: Your surgery always a requirement when it comes to a bone fracture or even a severe ligament tear.
M: Most commonly if the fractures are well aligned and they haven’t displaced which means they’ve moved out of alignment and those patients are usually treated with a short period of immobilization and then therapy they you should do very well same with ligaments. It really depends on how much they’ve moved or displaced or away from their normal alignment that depends on whether they need surgery or not.
N: Are these non-surgical options something that can be performed? Pretty readily by a non specialist or is it usually advised to seek out a specialist when you sustained such an injury?
M: My part is to always seek out a specialist with the elbow. It’s a very complex surgery. Before you can treat it you have to have a very diagnosis and maybe that’s probably even more important to understand that the diagnosis of some of these even common injuries can usually be done very well by a specialist to the specializes at the elbow or the shoulder or whatever joint seeking care for.
N: Do you ever find yourself working with someone who sustained an injury, a small fracture and it healed on its own without coming to see a specialist? But now they’re having problems 10-15 years later and those problems are persisting to the point where they actually have to have surgery to repair or relieve the discomfort.
M: Sure. I mean that use to term that a post-traumatic arthritis or post-traumatic malunion which means they had it a fracture or an injury which they treated racing or rehab. It’s wasn’t align properly or functional in the way. When they go on over five or ten years, they’ll develop disease on the elbow or contractures or actually arthritic joint at which point the surgery then is needed a little bit more complex whether it’s an arthroscopy to clean out the elbow or replacement of the elbow or realignment of the elbow. Those become much more complex when you’re taking care of them later on.
N: In the case of complex trauma, would you treat the shoulder or the elbow first based on how you want your patient to regain mobility?
M: The patient comes in a multi-trauma in the shoulder and how we using fix those at the same time especially in the upper extremity. Because the key is to start mobilizing them or to start moving that extremity. When anyone has a fractured both the shoulder and the elbow those joints become very stiff. If not treated and then move really quickly. If you repair them or don’t treat them very difficult to get ahead of the game and get their motion back treat both that same time.
N: Is this something that you went into deliberately or was something that something happened in the course of your medical training that steered you toward this area of expertise?
M: I was trained by my mentor, my chairman was a world-renowned shoulder surgeon and shoulder renowned specialists. He really mentored me and guided me down this pathway and then I did that fellowship and shoulder and elbow surgery and another world renowned surgeon up in New York and I enjoyed the surgery. I enjoyed this type of patients at the pathology, those not diagnosed these injuries. If you will you know I get to take care of patients from Pediatrics or lift grandmothers and grandfathers and it’s a great experience.
N: We’d like to learn some more about MedStar. Where can we get some more information?
M: MedStar, you can go online that medstar.org, the Union Memorial Hospital as well. Those websites are available and there are some really good information on all our specialties and in all the physicians and physician extenders that work there and there’s a lot of information online as well.
N: Dr. Murthi, thank you so much for taking the time and joining us here today.
M: Great. Thank you.
N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of the program are available at hpr.fm also at healthprofessionalradio.com.au. You can subscribe to this podcast on iTunes, listen in and download at SoundCloud and sure and visit our affiliates page at hpr.fm.