All bone & Joint Issues
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?…
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 is sometimes confusing to know what injections go where for what conditions?…
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 low and therefore, not as reliable as we think in getting to the precise diagnosis.…
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 injections and what modality of imaging may assist the injections.…
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 of lumbar spinal stenosis (LSS). Yet, we all have some patients that have responded well to spinal injections.…
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”?
A 20-year prospective, longitudinal, observational study was undertaken to assess the relationship between the presence of a neonatal clicky hip and pathological CDH.…
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?…