Transcript Common causes or Dx

Common orthopaedic symptoms
Commonly body parts
encountered
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Low back
Neck
Knee
Elbow
Shoulder
Common symptoms in
orthopaedic
• Pain: muscle spasm,strain,overuse
injury,degeneration,referred pain,past
injury,malignancy
• Joint stiffness
• Neurological: numbness,weakness
• Others:e.g.deformity,locking,instability,givi
ng way
Low back pain(LBP)
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Acute? Chronic?
Localized? Diffuse?
Other regions associated?
Reliving factors?
Occupation? Daily activity?
Age?
LBP
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Common causes or Dx
Degeneration
Sprain or incorrect posture
Overuse injury
PID,spinal stenosis
Other systems:e.g. renal colic,leaking AAA
LBP
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In P/E
Point or level of tenderness
Deformity
Bone or muscle?
Range of movement
Neurological deficit
Straight leg raising test
Management of LBP
• For simple LBP: Rest,correct posture,Ex or
physiotherapy,Analgesics(topical or oral)
• Imaging if specific problem suspected
e.g.XR,MRI
• Conservative or operative management
Neck pain
• Approach and management similar to LBP
• Note symptoms and signs of radiculopathy
or myelopathy
Knee
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Post-injury? Chronic?
Aggravating factors?
Instability?
Locking?
Giving way?
Swelling? Signs of inflammation?
How daily life is affected?
Knee
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Common causes or Dx
OA knee
Soft tissue injury e.g. ligament,meniscus
Loose body
Gouty attack(more common in MTP joint of
big toe)
Knee
• In P/E
• Deformity: Bow knee ,Knock knee,Fixed
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flexion contracture
Swelling ,Effusion
ROM
Crepitus
Instability
Management of Knee problem
• Imaging: XR,MRI
• To delay speed of degeneration e.g. weight
reduction,avoiding frequent squatting or
prolonged walking slopes or stairs
• To strengthen muscle for protecting the joint
e.g. quadricep ex,swimming
• Analgesics
• Specific measures e.g. Arthroscopy,Surgery
Tennis Elbow
• Pain and tenderness at origin of the extensor
muscles of the forearm,often radiating down to the
back of forearm
• Caused by strain of the forearm extensor muscle at
the point of their origin from the bone
• P/E : tenderness localized to the front of the lateral
epicondyle of the humerus,pain elicited by
passively stretching the extensor muscle
• Mx: Pain relive and NSAID ,avoid overuse,tennis
elbow band,ex,steroid injection
Shoulder
• Pain (from local tissue,or referred pain e.g.
cervical spine,heart,diaphragm)
• Stiffness
Shoulder
• Frozen shoulder(adhesive capsulitis)
• Severe pain + limitation of shoulder movement in
all direction
• No radiographic abnormality
• Natural course:spontaneous recovery within 6 to
12 months; with pain subsides first, then stiffness
improved with active mobilization
• Mx: in acute painful stage,rest the shoulder with
gentle assisted shoulder ex, NSAID,when pain
lessens,active ex for regaining full ROM
Shoulder
• Pain arc syndrome
• Pain in shoulder during mid-range(45-160 degree)
of shoulder abduction
• DDX: with Hx of injury—incomplete tear of
supraspinatus,crack fracture of greater tuberosity
of humerus; with spontaneous onset—
supraspinatus tendinitis,calcified deposit in
supraspinatus,subacromial bursitis
Shoulder
Painful arc syndrome
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Dx: by Hx,XR
Mx:
for crack # --analgesic,active mobilization
for tendinits,bursitis,supraspinatus tear—
analgesic,physiotherpy e.g. short-wave
diathermy,mobilization ex
• In resistant case ,may need surgery