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Bone & Joints

Knee OA – A GP’s perspective

12th October 2018, Dr Chee L Khoo Imagine a 55 year gentleman come in with right knee pain. He was an active football player from years gone by and suffered the usual meniscal tears here and there over the years. He is now a storeman…

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Psoriatic Arthropathy & Metabolic Syndrome – the role of the GP

30th September 2018, Dr Chee L Khoo 10-40% of patients with psoriasis have joint manifestations as part of a multi-system inflammatory disease (1). There is a strong association between psoriasis and elements of metabolic syndrome. Recent evidence suggests that patients with psoriasis have increased cardio-metabolic…

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Morton’s Neuroma – is it a neuroma?

1st September, 2018, Dr Chee L Khoo It would seem to me that just about every doctor who graduated from Australian medical schools know about Morton’s neuroma. It’s part of the long list of differential diagnoses of forefoot pain but either I have missed many…

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Acute knee injuries – importance of history taking and simple examination

June 15, 2018 Dr Chee L Khoo Someone once said “If at the end of taking the history, you do not have the diagnosis, take the history again”. This is particularly relevant when we come to knee injuries. In 90% of the time, when I…

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ACL tears – do they all need reconstruction?

June 1, 2018, Dr Chee L Khoo For patients with anterior cruciate ligament (ACL) tears, it used to be that conservative treatment is tried first and if the knee joint is symptomatic and/or unstable, then surgery can be considered. But have you noticed that patients…

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CT and US Guided Injections – what goes where for what conditions

Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilisation of image guidance has…

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Opioids or codeine not recommended? What do we do with patients with severe back and leg pains?

May 1, 2018 Dr Chee L Khoo Chronic, persistent low back, lower extremity pain, and radicular pain may be secondary to disc herniation, disc disruption, disc degeneration, facet joint disease, spinal stenosis, or post lumbar surgery syndrome resulting in disc-related pain with or without radiculitis….

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Image Guided Glucocorticoid Injections – What goes where?

In the last issue of GPVoice we read about the what sub-type of spinal stenosis might benefit from glucocorticoid injections.  Apart from spinal stenosis, there are many other joints, bursa or soft tissue that may benefit from glucocorticoid injections. It can sometimes be confusing as…

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Glucocorticoid injection for spinal stenosis – who might benefit?

March 2018, Dr Chee L Khoo Sometimes conclusions from a landmark scientific trial may be different from what we see in our own practice. The LESS trial (2014) found that epidural injection of glucocorticoids plus lignocaine offered minimal or no short-term (6 weeks) benefit as…

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Congenital Hip Dysplasia – how useful is the “click”?

February 2018, Dr Chee L Khoo Congenital hip dysplasia (CDH)  is a common fear when we examine newborns. A clicky hip is a common reason for further investigations. CDH is actually not very common but how often does a clicky hip lead to a diagnosis…

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Subacromial Decompression – does it achieve anything?

Jan 2018 – Dr Chee L Khoo: Subacromial decompression was first introduced in 1972 as a last resort for subacromial pathology but there is no high level evidence on its efficacy. Nonetheless, it is now one of the most common surgical procedures done in orthopaedics….

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