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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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
OSTEOARTHRITIS
Management
• Analgesics
• Exercise
• Weight control
• Lift style modification
• Physiotherapy
• Occupational therapy
• Hydrotherapy
• Heat treatment
• Surgery

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
PAINFUL KNEES
• Trauma – ligament, bone or cartilage injuries
• Degeneration - osteoarthritis
• Gout/ pseudogout
• Rheumatoid arthritis
• Septic arthritis

• Consider patellar mal-tracking in young

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
PAINFUL KNEES
Management
• NSAID
• Physiotherapy
• Knee straps and bands (elastic brace)

Needs to look for the cause


• X-ray
• MRI
• arthroscopy

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
NECK PAIN
• Muscle strain, soft tissue injury
• Acute torticollis – PID, facet joints subluxation
• Degenerative change
• More in female

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
SPRAINED ANKLE
Management
• Analgesics
• Strapping/ brace
• May need plaster
• RICE – rest, ice,
compression, elevation
• Surgery for displaced fracture

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
TENNIS ELBOW
• Pain over lateral epicondyle of humerus

Management
• NSAID
• Physiotherapy
• Tennis elbow band
• May try injection or rarely surgery

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CARPAL TUNNEL SYNDROME
• Nocturnal numbness
• Tinel’s sign
• Phalen’s test

Management
• Rest the affected hand
• Avoid extreme
dorsiflexion/
palmarflexion
• NSAID
• May need surgery

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
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

Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong
Copyright © 2016. All Rights Reserved. Faculty of Medicine, The Chinese University of Hong Kong