Bone & Joints

Groin pain in adolescents – is that slipped capital femoral epiphysis?

22nd April 2019, Dr Chee L Khoo One of the diagnoses I dread to miss in general practice is slipped capital femoral epiphysis (SCFE). It is not common (yet) but most general practitioners will encounter (or miss) a few of these in their life time. They are mostly seen during the adolescent years and are […]

Posted in Bone & Joints, Paediatric | Tagged , , , | Comments Off on Groin pain in adolescents – is that slipped capital femoral epiphysis?

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 in the local factory and takes his dog for a […]

Posted in Bone & Joints | Tagged , , , , , , | Comments Off on Knee OA – A GP’s perspective

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 morbidity and mortality. Like other auto-immune collagen diseases, psoriatic arthropathy […]

Posted in Bone & Joints, Diabetes, Obesity & Metabolism, Internal Medicine | Tagged , , , , , , , , | Comments Off on Psoriatic Arthropathy & Metabolic Syndrome – the role of the GP

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 or it’s not that common. I’m also not sure what […]

Posted in Bone & Joints, Surgery | Tagged , , , | Comments Off on Morton’s Neuroma – is it a neuroma?

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 see someone with a knee injury, I have a fair […]

Posted in Bone & Joints, GP Resources & Tips | Tagged , , , , | Comments Off on Acute knee injuries – importance of history taking and simple examination

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 are now routinely heading for surgery without a trial of […]

Posted in Bone & Joints | Tagged , , , , , | Comments Off on ACL tears – do they all need reconstruction?

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 dramatically improved the accuracy and safety of these interventions. It […]

Posted in Bone & Joints, Spectrum | Comments Off on CT and US Guided Injections – what goes where for what conditions

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. The specificity and sensitivity of the symptoms and signs are […]

Posted in Bone & Joints, Spectrum, Surgery | Tagged , , , , , , | Comments Off on Opioids or codeine not recommended? What do we do with patients with severe back and leg pains?

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 to what joints or soft tissue may be amenable to […]

Posted in Bone & Joints | Comments Off on Image Guided Glucocorticoid Injections – What goes where?

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 compared with epidural injection of lignocaine alone in the treatment […]

Posted in Bone & Joints, Surgery | Tagged , , | Comments Off on Glucocorticoid injection for spinal stenosis – who might benefit?

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 of CDH? In other words, how useful is the “click”? […]

Posted in Bone & Joints, Paediatric | Comments Off on Congenital Hip Dysplasia – how useful is the “click”?

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. Does it actually work?

Posted in Bone & Joints | Comments Off on Subacromial Decompression – does it achieve anything?