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 • 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,giving way
Low back pain(LBP) • Acute? Chronic? • Localized? Diffuse? • Other regions associated? • Reliving factors? • Occupation? Daily activity? • Age?
LBP • Common causes or Dx • Degeneration • Sprain or incorrect posture • Overuse injury • PID,spinal stenosis • Other systems:e.g. renal colic,leaking AAA
LBP • 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 • Post-injury? Chronic? • Aggravating factors? • Instability? • Locking? • Giving way? • Swelling? Signs of inflammation? • How daily life is affected?
Knee • 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 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
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