Sarcopenia – can we measure it and how bad is it?

10th December 2023, A/Prof Chee L Khoo

Old and weak?

We don’t get old and weak. Actually, if we get weak, we become old. We all see that in practice. It doesn’t matter how old our patient is. When they become weak, they slow down. They can’t walk very far and they don’t. They become weaker and weaker. They have difficulty get off a chair.…

Foot injuries – is that a Lisfranc injury?

Foot injury

30th November, Spectrum Medical Imaging

The midfoot consist of 5 bones, cuboid, navicular and three cuneiform bones. These bones articulate with the base of the five metatarsals. In the Lisfranc injuries, it is these articulations (and their ligamemts) that are damage. Sometimes, there are fractures easily seen on plain xrays. Sometimes, one can see separation of the bones on plain xrays.…

CT-guided spinal injections – what to order?

12th September 2023, NIA Diagnostic Imaging

Back pain has to be one of the most common ailments we see in general practice. Pain may originate from nerve root irritation, facet joint dysfunction, degenerative disc disease or poor muscle function or even osteoporotic fractures. There has been numerous systematic reviews and meta-analyses and most have highlighted how ineffective cortisone injections are in relieving the symptoms in the medium and long term.…

Wrist fracture – a cautionary tale

30th August 2023, Spectrum Medical Imaging

wrist injury

68yo female patient sustained a fall on an outstretched hand. Plain x-rays revealed a closed fracture to the right distal radius and ulna. This was reduced by the orthopaedic surgeon and held in a forearm plaster of Paris. Post op x-rays showed satisfactory alignment and she was discharged to see her GP with follow up with the orthopaedic team at a later date.…

Knee MRI – the best investigation to elucidate the diagnosis

30th May, 2023, Spectrum Medical Imaging

Knee injuries are one of the most common injuries we see in general practice. We always start with history to determine the mechanism of injury. Examination is not always straight forward especially, if there is severe pain and restriction of movement. MRI is an excellent tool for demonstrating injuries of the internal soft tissue structures in the joints.…

Morton’s Neuroma – A case study

30th April, Spectrum Medical Imaging

All medical students will remember Morton’s neuroma but they never tell us what to do after you suspect the foot symptoms are suggestive of Morton’s neuroma. It also known as inter-metatarsal neuroma. It is a focal area of perineural fibrosis around plantar digital nerves of the foot. It is thought to be due to chronic entrapment of the nerve by the inter-metatarsal ligament and can be a cause of metatarsalgia.…

Giant cell arteritis – current state of play

27th February 2023, Dr Chee L Khoo

We might see one case every 5 years in primary care. It might not be common but a missed diagnosis can be devastating. Patients rarely present to emergency department or the vascular surgeon without presenting to primary care first. Giant cell arteritis (GCA) is now thought of as a systemic inflammatory disease. Although glucocorticoids remain the mainstay of treatment , in the last few decades, new knowledge have dramatically changed the way we diagnose and treat GCA.…

Denosumab – how long can you be on it for?

24th December 2022, Dr Chee L Khoo

There have been a number of contentious safety concerns regarding the prolonged used of denosumab. The original FREEDOM trial demonstrated efficacy in reducing vertebral, hip and femoral fractures over 3 years of denosumab therapy. There was a further 7 years extension to the original trial and the report was published last year. There were some suggestions a few years ago that patients might, perhaps, need a drug holiday after 5-10 years on denosumab but there is increasing evidence of rapid reduction in bone densitometry (BDM) after denosumab is stopped.…

Image guided injections

28th September 2022, Spectrum Medical Imaging

Injections around joints, tendons and bursa can be tricky. Unless you are trained to know where to insert the needle, it is all a hit and miss. If the patient doesn’t respond to the injection, you really don’t know whether it didn’t work or because it was not in the right spot. That’s when image guided injections come handy.…

Medial meniscal tears – surgery or physio or both?

30th July 2022, Dr Chee L Khoo

medial meniscal tear

I recently came across a trial comparing arthroscopic partial meniscectomy (APM) with physiotherapy (PT) in the management of medial meniscal tears in older patients. Older patients here mean patients that are older than 45 years who are supposed to have degenerated menisci. Now, meniscal tears (usually medial but sometimes can be lateral meniscal tear) in younger patients often require surgical intervention but in older patients, surgery is not necessarily better than conservative physiotherapy.…

Fibromyalgia – which drug for which symptom?

23rd May 2022, Dr Chee L Khoo


We all know that the term fibromyalgia is a wishy-washy term used to cover something rather imprecise. Don’t get me wrong. I am not doubting the syndrome but just the name used to refer to the constellation of symptoms of widespread chronic pain, easy physical exhaustion, cognitive difficulties, depressed mood, sleep problems and digestive problems.…