BCME2206 Week 7b Orthopedics Diseases II - Management of Common Diseases 20190221 Tse Sut Yee2 PDF

ORTHOPEDICS DISEASES II -
MANAGEMENT OF COMMON
DISEASES
BCME2206 Introduction to Western Medicine II
Dr TSE Sut Yee

Associate Consultant
Department of Family Medicine and Primary Health Care
New Territories West Cluster
Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
Content
• OSTEOARTHRITIS • GANGLION
• BACKACHE • PLANTAR
FASCILLITIS
• PAINFUL KNEES
• TENNIS ELBOW
• NECK PAIN
• CARPAL TUNNEL
• CERVIAL SYNDROME
SPONDYLOSIS • CONTUSION
• SPRAINED ANKLE • RHEUMATOID
• GOUT ARTHRITIS
• PAINFUL SHOULDER • OSTEOPOROSIS
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
BACKACHE
Causes
• Lumbar degeneration in old
• Prolapsed intervertebral disc
• Ankylosing spondylitis
• Injuries
• Infection
• Referred pain
• Psychosomatic
– Prolonged back pain tends to be seen in
IOD, depressed patients
BACKACHE
Management
• Most improved with conservative treatment
• Symptomatic treatment – analgesics
• Physiotherapy / manipulation
• Acupuncture
For chronic backache:

• Learn to live with it
• Try to terminate the vicious cycle
of prolonged sick role
PAINFUL KNEES
• Trauma – ligament, bone or cartilage injuries
• Degeneration - osteoarthritis
• Gout/ pseudogout
• Rheumatoid arthritis
• Septic arthritis
• Consider patellar mal-tracking in young
PAINFUL KNEES
Management
• NSAID
• Physiotherapy
• Knee straps and bands (elastic brace)
Needs to look for the cause

• X-ray
• MRI
• arthroscopy
NECK PAIN
• Muscle strain, soft tissue injury
• Acute torticollis – PID, facet joints subluxation
• Degenerative change
• More in female
NECK PAIN
Management
• NSAID or other analgesics
• Neck collar in acute phase
• Physiotherapy
• May need muscle relaxant
• Need MRI for prolonged/ chronic cases

• Surgery is highly selective
CERVIAL SPONDYLOSIS
• 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
SPRAINED ANKLE
• 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
SPRAINED ANKLE
Management
• Analgesics
• Strapping/ brace
• May need plaster
• RICE – rest, ice,
compression, elevation
• Surgery for displaced fracture
GOUT
• Big toe, ankle or knee most common
• May be secondary, e.g. diuretics,
chemotherapy
Management
• Avoid alcohol
• Diet control
• Drug treatment
– Acute attack – colchicine (diarrhoea),
NSAID
– Allopurinol/febuxostat for
hyperuricaemia
PAINFUL SHOULDER
• Rotator cuff impingement – pain on abduction
• Frozen shoulder – stiffness with pain on
movement
• Usually after middle age
• Manual laborer, athletes more common
Management
• Physiotherapy
• NSAID
• Intra-lesional injection of steroid
• Other injections: e.g. dextrose, platelet rich
plasma
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
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, comfortable
shoes
• Self massage
• Physiotherapy
TENNIS ELBOW
• Pain over lateral epicondyle of humerus
Management
• NSAID
• Physiotherapy
• Tennis elbow band
• May try injection or rarely surgery
CARPAL TUNNEL SYNDROME
• Nocturnal numbness
• Tinel’s sign
• Phalen’s test
Management
• Rest the affected hand
• Avoid extreme
dorsiflexion/
palmarflexion
• NSAID
• May need surgery
CONTUSION
• 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
RHEUMATOID ARTHRITIS
• Common 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),
ESR, CRP
Management
• Splint, joint protection/ energy conserving
education, adaptive aids
• NSAID, paracetamol
• Disease-modifying drugs
– e.g. hydroxychloroquine, sulfasalazine,
penicillamine, methotrexate
OSTEOPOROSIS
• Post-menopausal women
• Usually asymptomatic until fractured hip, wrist or spine
• Bone densitometry (DEXA) standard for assessment
• Calcium + vitamin D
• Anti-resorptive agents and others

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ORTHOPEDICS DISEASES II -

Dr TSE Sut Yee

For chronic backache:

• Consider patellar mal-tracking in young

Needs to look for the cause

• Need MRI for prolonged/ chronic cases

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