Orthopaedics for GP

Basics of Orthopedics Basics of Orthopedics for GPsfor GPs

Dr. Ahmed WalyDr. Ahmed WalyLecturer Orthopedics and Lecturer Orthopedics and Traumatology Alexandria Traumatology Alexandria

UniversityUniversity

Be SystematicBe Systematic

• HistoryHistory

Past, Present, Medical, Family, Drug…Past, Present, Medical, Family, Drug…

• ExaminationExamination

Inspection, Palpation, specific testsInspection, Palpation, specific tests

• InvestigationInvestigation

Blood tests, x-ray, CT scan, MRI, U/SBlood tests, x-ray, CT scan, MRI, U/S

When to When to refer??refer??NB:NB: there is always something you there is always something you

don’t know !!! don’t know !!! Be safeBe safeThe eyes can’t see what the mind The eyes can’t see what the mind

don’t knowdon’t know

The skeletonThe skeleton

• NeckNeck

• BackBack

• Upper limbsUpper limbs

• Lower limbsLower limbs

Neck PainNeck Pain

- Spasmodic torticolis- Spasmodic torticolis- Cervical spondylosis- Cervical spondylosis- - Nerve root irritation, entrapmentNerve root irritation, entrapment- Cervical rib- Cervical rib- Systematic: - Systematic: ankylosing, polymyalgia, ankylosing, polymyalgia,

fibromyalgia……fibromyalgia……

Low Back Pain (LBP)Low Back Pain (LBP)

• Acute - ChronicAcute - Chronic

• Aetiology: Aetiology:

Age:Age:

15-30:15-30: post, mech, ank, spond, disk post, mech, ank, spond, disk

30-50: 30-50: post, deg, disk, 2ries post, deg, disk, 2ries

> 50: > 50: post, deg, post, deg, osteoporosisosteoporosis, malig., malig.

other causes: other causes: referred, stenosis, referred, stenosis, infectioninfection

Red flags:Red flags:

• < 20y or >55y< 20y or >55y

• Non mechanicalNon mechanical

• Thoracic painThoracic pain

• Past history of malignancyPast history of malignancy

• Wide spread neurologyWide spread neurology

• DeformityDeformity

• Unwell, taking steroids, unwell, Unwell, taking steroids, unwell, weight loss, HIVweight loss, HIV

Triage back painTriage back pain

• Simple back painSimple back pain

• Nerve root painNerve root pain

• Red flagsRed flags

• Cauda equina Cauda equina syndromesyndrome

Upper limbUpper limb

Shoulder problemsShoulder problems• Rotator cuffRotator cuff - Acute or chronic tendinitis, tears - Acute or chronic tendinitis, tears

- Impingement syndrome- Impingement syndrome

• Frozen shoulderFrozen shoulder

• Acromio-clavicular problemsAcromio-clavicular problems

• Rupture long head of bicepsRupture long head of biceps

Elbow, wrist and handElbow, wrist and hand

• Tennis and golfer’s elbow Tennis and golfer’s elbow (epicondylitis)(epicondylitis)

• Pulled elbowPulled elbow• Olecranon bursitisOlecranon bursitis• Ulnar neuritisUlnar neuritis• TenosynovitisTenosynovitis• Carpal tunnel syndrome Carpal tunnel syndrome (CTS)(CTS)• GanglionGanglion• Trigger fingerTrigger finger• OAOA

Lower limbLower limbHip problemsHip problems• OAOA

• Trochanteric bursitisTrochanteric bursitis

• Fascia lata syndromeFascia lata syndrome

• Pyriformis syndromePyriformis syndrome

• Fascia lata syndromeFascia lata syndrome

• Avuscular necrosisAvuscular necrosis

Child hipChild hip

• Transient synovitisTransient synovitis

• DDHDDH

• PerthesPerthes

• SCFESCFE

Knee problemsKnee problems

Old ageOld age• OAOA• Backer’s cystBacker’s cyst• Loose BodiesLoose Bodies• Deg meniscal problemsDeg meniscal problems• SynovitisSynovitis

NB:NB: Plan x-ray important Plan x-ray important why? why?

Young ageYoung age ::

• Anterior knee painAnterior knee pain• Osgood-sclatter syndromeOsgood-sclatter syndrome• Osteochondritis dissecansOsteochondritis dissecans• Patellar dislocations, sublaxationPatellar dislocations, sublaxation and and

maltrackingmaltracking• Patellar tendinititisPatellar tendinititis

Knee problemsKnee problemsyoung age (cont)young age (cont)

• Synovitis Synovitis • Iliotibial tract Iliotibial tract

syndromesyndrome• Shin splintsShin splints• Growing painsGrowing pains• Deformities: Deformities:

genuvarum and genuvarum and valgumvalgum

Ankle problemsAnkle problems

• Achilles tendinitisAchilles tendinitis

• Rupture Achilles tendonRupture Achilles tendon

• Osteochondritis talusOsteochondritis talus

Foot problemsFoot problems

• Flat footFlat foot

• TEV, pes CavusTEV, pes Cavus

• Hammer, clow toesHammer, clow toes

• Hallux: valgus, rigidus, IGTNHallux: valgus, rigidus, IGTN

• Plantar fasciitisPlantar fasciitis

• MetatarsalgiaMetatarsalgia

• Morton’s neuromaMorton’s neuroma

• Stress fractureStress fracture

• Avuscular necrosis: navicular, head Avuscular necrosis: navicular, head mets, heelmets, heel

Rheumatological conditionsRheumatological conditions

• Multiple joint and muscle pain, ? Multiple joint and muscle pain, ? Young age, morning pains.Young age, morning pains.

• Recurrent painsRecurrent pains

• Not improving on AINot improving on AI

• Dramatic effect on steroidsDramatic effect on steroids

Investigate – refer to Investigate – refer to RheumatologyRheumatology

Infections Infections

• Septic arthritisSeptic arthritis

• OsteomyelitisOsteomyelitis

• Flexor tendinitisFlexor tendinitis

TumoursTumours

• Benign Benign

• Malignant Malignant