Common orthopaedic symptoms
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Common orthopaedic symptoms - PowerPoint PPT Presentation

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Common orthopaedic symptoms. Commonly body parts encountered . 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

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Commonly body parts encountered l.jpg
Commonly body parts encountered

  • Low back

  • Neck

  • Knee

  • Elbow

  • Shoulder

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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,giving way

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Low back pain(LBP)

  • Acute? Chronic?

  • Localized? Diffuse?

  • Other regions associated?

  • Reliving factors?

  • Occupation? Daily activity?

  • Age?

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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

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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

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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

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Neck pain

  • Approach and management similar to LBP

  • Note symptoms and signs of radiculopathy or myelopathy

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  • Post-injury? Chronic?

  • Aggravating factors?

  • Instability?

  • Locking?

  • Giving way?

  • Swelling? Signs of inflammation?

  • How daily life is affected?

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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)

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  • In P/E

  • Deformity: Bow knee ,Knock knee,Fixed flexion contracture

  • Swelling ,Effusion

  • ROM

  • Crepitus

  • Instability

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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

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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

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  • Pain (from local tissue,or referred pain e.g. cervical spine,heart,diaphragm)

  • Stiffness

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  • 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

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  • 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

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ShoulderPainful arc syndrome

  • 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