Scribd Logo
Upload

Welcome to Scribd!

  • 20 views

    15.2 Orthopaedics Diseases II - Management of Common Diseases

    Uploaded by

    s14214lsc
    The document provides an overview of common orthopedic diseases and their management according to western medicine perspectives. It covers various musculoskeletal conditions affecting the neck, shoulders, elbows, wrists, back, hips, knees, ankles, and feet. For each condition, it discusses causes, investigations, and treatment approaches including medications, physical therapy, braces, injections, and sometimes surgery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    15.2 Orthopaedics Diseases II - Management of Common Diseases

    Uploaded by

    s14214lsc
    20 views24 pages
    The document provides an overview of common orthopedic diseases and their management according to western medicine perspectives. It covers various musculoskeletal conditions affecting the neck, shoulders, elbows, wrists, back, hips, knees, ankles, and feet. For each condition, it discusses causes, investigations, and treatment approaches including medications, physical therapy, braces, injections, and sometimes surgery.

    Original Title

    15.2 Orthopaedics diseases II - Management of common diseases

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document provides an overview of common orthopedic diseases and their management according to western medicine perspectives. It covers various musculoskeletal conditions affecting the neck, shoulders, elbows, wrists, back, hips, knees, ankles, and feet. For each condition, it discusses causes, investigations, and treatment approaches including medications, physical therapy, braces, injections, and sometimes surgery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    20 views24 pages

    15.2 Orthopaedics Diseases II - Management of Common Diseases

    Uploaded by

    s14214lsc
    The document provides an overview of common orthopedic diseases and their management according to western medicine perspectives. It covers various musculoskeletal conditions affecting the neck, shoulders, elbows, wrists, back, hips, knees, ankles, and feet. For each condition, it discusses causes, investigations, and treatment approaches including medications, physical therapy, braces, injections, and sometimes surgery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 24

    Orthopaedic Diseases II —

    Management of Common Diseases

    Dr Tse Sut Yee


    BDS (HK), MBBS (HK), Dip Med (CUHK), DCH (Sydney), FHKCFP, FRACGP,
    FHKAM (Family Medicine)
    Consultant
    Department of Family Medicine
    CUHK Medical Centre

    School of Chinese Medicine, CUHK


    Content
    • NECK PAIN • KNEE PAIN 足底筋膜炎
    • CERVICAL 頸椎神經根病症 • PLANTAR FASCIITIS
    RADICULOPATHY • ANKLE SPRAIN
    • SHOULDER PAIN • CONTUSION INJURY
    • TENNIS ELBOW • OSTEOARTHRITIS
    • GANGLION 腱鞘囊肿 • GOUT
    • CARPAL TUNNEL • RHEUMATOID
    SYNDROME ARTHRITIS
    • BACK PAIN • OSTEOPOROSIS
    NECK PAIN
    • Acute vs chronic
    • Muscle strain, soft tissue injury
    • Any injury? Working posture?
    • Any upper limb numbness/ weakness/ clumsiness?
    NECK PAIN
    Management
    • Analgesics (e.g. paracetamol, NSAIDs, opioid analgesics) +/- muscle
    relaxant
    • Neck collar in acute phase
    • Physiotherapy
    • Need MRI for prolonged/ chronic cases or cases with neurological
    deficits
    • Surgery is highly selective
    CERVICAL RADICULOPATHY
    • Common in middle age to later life
    • Neck pain radiating to shoulder and upper arms
    • May associate with upper limb numbness/ weakness/ clumsiness
    • Remission and relapse
    • Neck collar for acute exacerbation
    • Surgery considered in selected cases
    SHOULDER PAIN
    • Rotator cuff muscles:
    – Supraspinatus
    – Infraspinatus
    – Teres Minor
    – Subscapularis 肩關節夾擠症候群
    • Shoulder impingement syndrome – pain on
    abduction, painful arc
    • Frozen shoulder – stiffness with pain on movement
    • Usually after middle age
    • Manual laborer, athletes more common

    Management
    • Physiotherapy
    • Analgesics (e.g. NSAID)
    • Intra-lesional injection of steroid
    • Other injections: e.g. dextrose, platelet rich plasma
    TENNIS ELBOW
    • Pain over lateral epicondyle of humerus

    Management
    • Analgesics
    • Physiotherapy
    • Tennis elbow band
    • May try injection or rarely surgery
    GANGLION
    • Common on dorsum of hand, wrist or
    foot
    • Associated with tendon or joint
    • May disappear spontaneously but
    Recurrence common
    • Myxomatous degeneration of tendon
    sheath or joint capsule

    Management
    • Observation (it does not turn malignant)
    • Surgery (recurrence rate ~10%)
    • Aspiration/ rupture for small or recurrent
    cases
    CARPAL TUNNEL SYNDROME
    • Nocturnal numbness
    • Tinel’s sign 叩診輕敲神經損傷部位可引起刺痛
    • Phalen’s test 手背貼手背

    Management
    • Rest the affected hand
    • Avoid extreme
    dorsiflexion/ palmarflexion
    • Analgesics
    • Surgery
    BACK PAIN
    Causes:
    • Lumbar degeneration in elderlies
    • Prolapsed intervertebral disc
    • Ankylosing spondylitis
    • Injuries
    • Infection
    • Referred pain
    • Psychosomatic
    – Chronic low back pain tends to be seen in
    cases of injury on duty (IOD), depressed patients
    BACK PAIN
    Management:
    • Most improved with conservative treatment
    • Symptomatic treatment – analgesics
    • Physiotherapy / manipulation
    • Acupuncture

    For chronic back pain:


    • Look for any underlying mood problems
    • Occupational therapy
    • Try to terminate the vicious cycle
    of prolonged sick role
    KNEE PAIN
    Many different causes:
    • Trauma – ligament, bone or cartilage injuries
    • Degeneration - osteoarthritis
    • Gout/ pseudogout
    • Rheumatoid arthritis
    • Septic arthritis
    • Consider patellar mal-tracking/ subluxation in young
    KNEE PAIN
    Investigations
    • X-ray
    • MRI
    • Arthroscopy

    Management
    • Analgesics
    • Physiotherapy
    • Knee straps and bands (elastic brace)
    ANKLE SPRAIN
    • Inversion injury most common
    • Exclude fracture or torn ligaments
    • Anterior talofibular ligament injury
    most common
    • Don’t forget to examine the foot:
    5th metatarsal fracture common in
    sprained ankle
    • Sign of significant injury: Ottawa
    ankle and foot rule
    • Check stability of joint
    ANKLE SPRAIN
    Management
    • Analgesics
    • Strapping/ brace
    • RICE – rest, ice, compression,
    elevation
    • Surgery for displaced fracture
    PLANTAR FASCILLITIS
    • Inferior heel pain affecting walking
    • Need to distinguish from posterior
    heel pain by history and examination
    • Comes and goes but may last for
    months

    Management
    • Analgesics and rest
    • Heel pad, arch support, insole,
    comfortable shoes
    • Self massage
    • Home exercise
    • Physiotherapy
    • Steroid injection
    CONTUSION INJURY
    • Simple contusion very common
    • Soft tissue injury from a blunt force such as fall, blow or kick
    • Bruise – painful swelling, discolouration (change with time)

    Management
    • RICE – rest, ice, compression, elevation
    • Bandaging and analgesics
    • Avoid vigorous massage in early phase
    OSTEOARTHRITIS
    • Degeneration or injury
    • Knee, hip, hand, back and neck most common
    • Pain with intermittent exacerbation
    • Reduced range of movement affecting ADL
    • Crepitus, deformity
    • Soft tissue/ bony swelling
    • Different concept of 風濕 in TCM and Western Medicine
    OSTEOARTHRITIS
    Management
    • Analgesics
    • Exercise
    • Weight control
    • Lift style modification
    • Physiotherapy
    • Occupational therapy
    • Hydrotherapy
    • Heat treatment
    • Surgery
    GOUT
    • Big toe, ankle or knee most common
    • Seldom affects young women
    • May be secondary, e.g. diuretics,
    chemotherapy

    Management
    • Avoid alcohol
    • Diet control (Low purine diet)
    • Drug treatment
    – Acute attack – colchicine (diarrhoea),
    NSAIDs
    – Allopurinol/ Febuxostat for
    hyperuricaemia as prophylactic
    treatment
    RHEUMATOID ARTHRITIS
    • Predominant in women, usually after 40
    years of age
    • Symmetrical joint pain, morning stiffness
    • Small joints of limbs, deformity
    • General malaise, weight loss
    • Rheumatoid factor (can be negative), anti-
    CCP, ESR, CRP

    Management
    夾板
    • Splint, joint protection/ energy conserving
    education, adaptive aids
    • NSAID, (paracetamol usually
    unsatisfactory in pain control)
    • Disease-modifying drugs
    – e.g. hydroxychloroquine, sulfasalazine,
    penicillamine, methotrexate
    OSTEOPOROSIS
    • Post-menopausal women
    • Usually asymptomatic until fractured hip, wrist or spine
    • Dual-energy X-ray absorptiometry (DEXA) standard for assessment
    • WHO criteria T score within -1 SD normal, -1 to -2.5 SD osteopenia,
    below -2.5 SD osteoporosis
    • Other means of assessment: quantitative calcaneal ultrasound
    • Calcium + vitamin D
    • Anti-resorptive agents and others (bisphosphonates group e.g.
    Fosamax, denusumab e.g. Prolia, etc)
    Take home message

    • Orthopaedic diseases are commonly encountered in primary care


    setting

    • Knowing how western medical doctors manage those problems may


    facilitate collaborative care for patients
    Thank you

    You might also like