All bone & Joint Issues
14th August 2021, Dr Chee L Khoo
Shoulder pain has to be one of the most common musculoskeletal complaints in general practice. Rotator cuff pathology makes up at least 70% of those cases (1). It is commonly very debilitating, causing pain the whole night, causing significant reduction in function and often last for years. Apart from rest, analgesia, non-steroidal anti-inflammatory drugs, treatment options include physiotherapy, corticosteroid injections and surgical repair.…
28th July 2021, Dr Chee L Khoo
Muscular strains especially those around the spine (low back or neck pain) are very common presentations in general practice. Apart from analgesics, muscle relaxants are commonly prescribed. Recommendations for the use of muscle relaxants have, however, conflicted between international clinical practice guidelines for low back pain (1,2). The US guideline recommends non-benzodiazepine antispasmodics as the drug of choice for acute low back pain (3) the Belgian guideline discourages such use (4) and the UK guideline does not make a recommendation (5).…
27th February 2021, Spectrum Radiology
We last reviewed Morton’s Neuroma here back in 2018. It is always refreshing to look a real case from the radiologist’s point of view. It does remind us to keep a look out for this relatively common condition which can be debilitating. The term neuroma is a misnomer because the lesion is not a neoplastic lesion such as a schwannoma or neurofibroma.…
26th February 2021, Dr Chee L Khoo
Back in medical school, we were taught that we have B-cells and T-cells. B-cells are responsible for humoral immunity and T-cells are responsible for cell-mediated immunity. T-cells could be killer cells or helper cells although we also have regulatory T-cells which tells the naïve T-cells how to behave. Of course, over the last 2-3 decades, we know more about what makes the regulatory T-cells decide what to tell these naïve cells.…
20th July 2020, Dr Chee L Khoo
This is not a riddle. I often ask my medical students and patients this question and they all look at me strangely. How does this relate to medical science? Of course, we are talking about pes anserinus (PA). For those of you who remember your anatomy, PA relates to the 3 tendons that are attached to the medial aspect of the knee.…
29th June 2020, Dr Chee L Khoo
One in three patients with diabetes will develop diabetic foot ulcers (DFU). This typically occurs in the setting of peripheral artery disease, peripheral neuropathy and trauma. Foot ulcers invariably leads to lower extremity amputation (LEA) and both are associated with significant morbidity and mortality. We know that poor glycaemic control contributes to the development of DFU and LEA.…
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 more prevalent although not exclusively, in the overweight and obese.…
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 walk most days. Yes, he’s put on some weight over the years and he has usual mild hypertension, mild hypercholesterolaemia and maybe borderline glucose.…
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 (PsA) often necessitate a referral to the specialists to manage the systemic and joint disease.…
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 else to do once diagnosed apart from referring to an orthopaedic surgeon.…
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 idea what I am looking for in the examination before I even touch the patient.…
June 1, 2018, Dr Chee L Khoo
Yikes, I must have torn my ACL!
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 conservative treatment and irrespective of what future demands on their joints may be?…