Functions of Skin

Skin performs numerous functions and the important ones are:

  • Protection: It protects the body from physical, chemical and biological injuries
  • Perception: It perceives various sensations like pain, touch, temperature, pressure and vibrations.
  • Temperature regulation: Eccrine sweat glands and rich blood supply play a major role in thermoregulation.
  • Barrier function: Skin acts as a permeability barrier that regulates the diffusion of substances particularly water and electrolytes.
  • Secretory functions: Synthesis of vitamin D3 is an important secretory function which is achieved with the help of sunlight. Vitamin D3 is essential for bone metabolism.
  • Storage functions: The dermis and subcutaneous fat act as a storage center of energy and other compounds.
  • Excretory functions: Some of the harmful substances are excreted through the skin.
  • Immunological functions: Recognition of exogenous substances (antigens) and elicitation of antigen specific cell responses are carried out in the skin.
  • Cosmetic function: Color and texture of the skin along with the hair and nails play an important role in aesthetic appeal of an individual.

Aging Process

Aging is a natural process which starts from the day one is born. Despite this truth no one can accept getting older. The fountain of youth is
According to research there are two types of aging

  1. Instrinsic aging
  2. Extrinsic aging

Intrinsic aging: Is determined by the genes one processes. It is a continues process that normally begins as early as one mid 20’s. The changes within the skin are slow production of collagen, lesser elasticity and slower dead skin remover. Though this process gradually increases it is not shown for decades together.
One can seen fine lines wide poses , tough skin, black spots initially then as times goes there are loss of fat and have hollow in check & eye sockets.
Graying of hair is also sign of aging.

Extrinsic aging: is determined by the external factors one skins is exposed to the most culprit is the sunlight . There are many other factors which add on to aging process. Repetitive face expression, gravity, sleeping position and smoking. Smoking causes bio chemical changes in one body that
Photo aging is the dermatological caused due to exposure to sunlight. It depends on the skin colour, the light the colour more the damage and the time to skin exposure over a period of time. The noticeable changes seen on the skin are dark spots, rough leathering skin fine wrinkles, action (thick Walt like rough patches)

Few tips to avoid aging:

Intrinsic aging process cannot be stopped. But the extrinsic factors can be avoided. Protecting skin from sunlight by using a sun scream or protective clothing or avoid sunlight from to 3.00pm when the rays are the strongest. Quitting smoking, avoiding unnecessary expression on the face will also help.

With the knowledge on the process of aging and the modern equipments one can after a series of treatments to slow down and improvise the signs of aging.

Topical creams: The market is flooded with antiaging creams which promises a lot. How well do these work? It depends on what age one has started using . What you plan to treat with the cream and along with that what skin care you follow.

Never use products which sting and do not combine products to get better result as this may irritate the skin. Most product take 4 -6 weeks to show results. Using gentle cleansers and moistures if necessary. Sun protection is important in all these treatments. Several cosmetics procedure can be pick under th4 guidance of a cosmetic dermatologist.

Botuli Rejuvenation: Commonly called Botox, This procedure is used to erase lines on the face caused due to the facial muscle movement. It involve a few injections (with fine needles) on the areas where the wrinkles are there like forehead, brows feet ( around eyes) and from lines more. Chemical peeling: this is a very common procedure which can be done on face, back chest, hands and neck. There is improvement in the of the skin and colour. It improves dark spots, dull complextion, rough skin and wide poles. There are a wide range of peels to pick. Depending on what changes need to be seen the peel can be.

Chemical peeling: this is a very common procedure which can be done on face, back chest, hands and neck. There is improvement in the of the skin and colour. It improves dark spots, dull complextion, rough skin and wide poles. There are a wide range of peels to pick. Depending on what changes need to be seen the peel can be.

Management of Fractures

What is Fracture?

Bones are living tissues with nerves, blood supply and marrow inside. When the bone is broken (called fracture), there is a lot of pain, bleeding from the bone and loss of function. Fractures of different bones have to be managed differently. Also the type of fractures influences the management of fractures.

Types of Fractures:

Closed Fractures: Closed fractures are those when the bone is broken but there are no cuts on the skin through which the bone can come out.

Open Fractures:

Open fractures are those broken bone is in contact with the external atmosphere. Open fractures have to be managed as an emergency because of the contamination occurring to the bone when in contact with al the bacteria in the air, ground etc., Most open fractures of the limbs need to be operated upon immediately after cleaning with antiseptics and clean solutions. As emphasized earlier, open fractures are emergencies and need to be operated soon to prevent infection. Infection of bones is persistent and sometimes can recur again & again.

Fracture Management:

The main aim of fracture management is to get near normal anatomy and return to previous level of activity as soon as possible. These goals are possible today with advanced equipments, better materials and highly qualified orthopedic surgeons.


Plaster of Paris:

Some fractures may be treated without surgery with only a plaster of Paris cast. This may be possible in some fractures of the wrist, shoulder, collar bone & foot fractures. But in all these the broken ends must be approximated, in line in all planes and stay in position after plaster is applied. If these criteria are not satisfied then surgery is mandatory.

Metallic Implants:

In orthopedic surgery, for fractures the broken bones are held together and in proper alignment with the help of metallic plates, screws, rods, wires & nails. These are made of special grade stainless steel or titanium metal, which are compatible to the body and cause no reactions. These metallic implants can be removed after the bone has healed by minor surgeries. Some of the implants may be left in place. Newer implants called “bio degradable” implants have the capacity to dissolve inside the body one the fracture heals.


Recently more and more biological techniques have been introduced to allow the bones to heal naturally by themselves with minimal surgical trauma at the fracture site. This is possible in long bones of the lower limbs where rods are introduced inside the bone from the top of the bone or bottom with the help of special techniques and not to open the fracture site. This helps the bone to heal naturally and faster allowing movements of the adjacent joints. So the patient is up & about with crutches by second day. Also the cuts made on the skin are minimized.

Common Shoulder Joint Injuries

The shoulder joint is a ball and socket joint which allows a wide variety of movement compared to the hip joint. This is possible due to a fine set of ligaments holding it in position as well as a well functioning group of muscles around the shoulder called rotator cuff.
The injuries to the joint can be broken bone or dislocated. In sports persons and people of certain occupations the muscles holding the joints together can get injured, called rotator cuff injury. In some throwing sports a muscle can be pulled off the socket bone called as SLAP lesion (What Sachin Tendulkar had).

Dislocation of Shoulder:

The shoulder joint is prone to recurrent dislocation if this treatment is not followed. When is there recurrent dislocation while swimming, putting on a shirt or blouse then surgery is indicated? Here the torn parts of ligaments are reattached to the bone and tightened to prevent further dislocation. This can be done by keyhole surgery (Arthroscopy).

The shoulder joint is a highly mobile joint, so a compromise on stability is present. In some injuries the shoulder can dislocate i.e., the ball & socket are separated due to tearing of the muscles and ligaments holding it together. In some instance the bone can be broken as well, whenever there is a dislocation the joint has to be put back in position by an orthopedic surgeon under anesthesia. After this maneuver the joint has to be immobilized for 3 weeks for the torn ligaments and muscles to heal, after are to be started to gain movement and achieve muscle strength to prevent further dislocations.

Rotator cuff:


The rotator cuff is a fine set of muscles around the shoulder joint which helps in stabilizing the shoulder joint. As mentioned in earlier article the shoulder joint is a shallow ball & socket joint and it requires stabilization by muscles and ligaments. The rotator cuff muscles attach around the joint like a hood and acts at different movements, preventing the joint from dislocations. But in some instances the rotator cuff muscles may be injured leading to pain and loss of function of the shoulder joint. The injuries to the rotator cuff can be due to accidents during sports or road traffic accidents; or it may occur in older individuals due to wear & tear of the joints in close proximity to the rotator cuff.

Usually the tear of the rotator cuff is due to a fall on the shoulder directly and not on an outstretched hand. There is immediate pain and inability to lift the arm due to pain. The amount of tear of the cuff determines whether the person can lift his arm or not. Sometimes the tear may be small and the shoulder hurts in certain positions only. The shoulder pain may be disabling in those doing over head activities. If the tear is severe then the arm drops down when held up by the other hand, and no muscle power is present. Rotator cuff tears can be diagnosed by your orthopaedician by careful examination. Ultrasound scan or Magnetic Resonance Imaging Scan (MRI) may show the tear clearly and help in formulating the treatment plan.

In the younger individual if the tear is severe then surgery is a better option. Here the torn part of the muscle is sutured back and physiotherapy instituted to strengthen muscle and to gain full range of motion of shoulder. The surgery can be performed either by a mini incision or by keyhole surgery the results of the former being more consistent. In sports persons with overhead activities the rotator cuff is constantly put into repetitive stresses of the same kind. This may lead to inflammation and tears. These cause a lot of pain loss of form and function in professional sports persons. A well tailored physiotherapy regime of rest, hot/cold treatments, muscle strengthening, muscle training, local steroid injections and other medications suffice.

In the elderly the most common cause of this rotator cuff tear is degeneration (wear & tear) of the joint formed by the collar bone & shoulder blade which is in close proximity to the rotator cuff. The degenerated joint rubs over the rotator cuff causing tears which are very painful. Most often the older individuals do well with physiotherapy, local steroid injections & medications. However in some the pain is so severe and the bone keeps rubbing the muscles, then surgery indicated to trim the bone and repair the tear. Again this can be done by keyhole surgery or by mini-incision (mini – open) surgery.

Neck Pain

The term “ pain in the Neck” shows how much of an irritation this neck pain is. Neck pain is of different causes but most of them settles. It is also one of the most common work place diseases next only to low back ache.
The neck has a bony spinal column protecting the spinal cord and nerves. The bones are supported by muscles and ligaments which play a key role in supporting the head.
The neck is prone to lot of injuries because of its very precarious position compared to the rest of the spine. Neck pain can occur in any age groups from the third decade: it can also occur in either sexes.

How the neck pain occurs?

Neck pain can occur due to injuries, degeneration of spine, disc disorders, Postural arthritis or rarely in cancers.


Because of its very wide range of movement, the neck is prone to lot of injuries, especially in high velocity road traffic accidents, sports and games. The neck can also get injured in falling from heights. The spinal cord is tightly enclosed in the spinal canal and can be injured when the neck bones are broken or dislocated. If the spinal cord is injured then paralysis of the limbs can occur which mandates immediate surgery.

Degeneration of Spine:

The very common “ cervical spondylosis” is degeneration of neck joints and the intervertebral discs. As we age and work, there is wear and tear of the joints and the soft disc in between two bones. This often leads to pain. Pain here is due to the degenerated bones and joints pinching the nerves and muscles causing radiating pain to shoulder, upper back or even back of head. Very often pain due to degeneration decreases
with physiotherapy, medicines, exercises and modification of lifestyle. Very rarely if the pressure on a nerve is so high to cause weakness or loss of sensation, surgery may be indicated.

Disc Disorders:


There are seven neck bones and between each bone is a soft rubbery structure called as a disc. This disc acts as a shock absorber and aids in movements as well. Sometimes due to over work or lifting heavy weights or due to injury, the disc may bulge out from its original position and press on the nerve or spinal cord. When this happens there is a sharp shooting pain from the neck to shoulder, arm or even up to the finger tips.
When the compression is more on the nerve, then the pain may be associated with numbness & weakness of muscles. This is an extreme case and may require surgery. However most people with disc disease of the neck tend to live with it with occasional pain. With correct postural habits, and by not overstraining along with neck exercises prescribed by the doctor or physiotherapist, neck pain can be avoided. Most often a course of pain killers, muscle relaxants, physiotherapy and rest will suffice.


When it comes to surgery for disc disorders, the offending disc is removed and imp lace a piece of bone taken from else where is placed and fixed with plate and screws. Alternatively an artificial disc can also be kept in carefully selected individuals.
Disc disorders are very common in the general people so it is mandatory to avoid some strenuous activities. When there is shaped to cradle the head and neck. Avoid sleeping on sides which may cause strain on one side of the neck. If you are working on a computer make sure the monitor and eye level are same. Have a comfortable chair to avoid low back pain as well.

Pain due to infection:

In our country, tuberculosis can come in any form and not uncommonly it can affect the spinal bones. The tuberculosis(TB) bacteria, travels though the blood and affects the spinal bones and the disc between them. There may be destruction of bone and disc and pus formation which may press on the spinal cord and cause quadriplegia.
Severe neck pain not controlled with rest and pain killers are to be seen with a high degree of suspicion. An MRI scan will reveal if there is any infection along with some blood tests. Once TB of spine is diagnosed, surgery to remove the pus and cleaning of dead tissue is to be performed and medicines for TB is to be started.

Cancers of bone in neck:

Very rarely cancer of the bone or the spinal cord can occur in the neck which may lead to intractable pain which gradually increases and there may be weakness and numbness of hands & feet. Again x-ray, MRI and CT scan may reveal the cancer and remedial measures are to be started.
Most often neck pain arises due to strain, disc disorders or degeneration and nearly 95% of patients can be managed without surgery with medicines, physiotherapy and modification of lifestyle. However those who develop symptoms of weakness, numbness and MRI proven disorders may require surgery immediately to alleviate these symptoms.