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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 • Others:e.g.deformity,locking,instability,givi ng 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 Shoulder Painful 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