CONDITIONS GUIDELINES

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Shoulder

Arm

Hand

Leg

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Orthopaedic Conditions

  1. Shoulder

  2. Arm

  3. Hand

  4. Leg

  5. Neck

  6. Back

  7. Hip

  8. Orthopaedic Conditions

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Shoulder

CLAVICLE FRACTURE / BROKEN COLLARBONE

This is damage to the collarbone, lying between the ribcage (sternum) and shoulder blade (scapula), that connects the arm to the body.

Causes
Direct blow to the shoulder; fall on outstretched arm.

Symptoms
Pain along the front of the shoulder; difficulty lifting the arm; sagging shoulder; bruising; swelling; a bump or deformity on the fracture site.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (non-operative)
sling; anti-inflammatories; gentle exercise programme to restore muscle strength and ease stiffness.

Treatment (surgery)
if bones are displaced: realignment of the collarbone with plates and screws.

SHOULDER INSTABILITY

The shoulder, the body’s most mobile joint, for reaching, lifting, rotating the arm, becomes unstable by a dislocation or sublimation, where the joint becomes loose and slips.

Causes
Severe injury; naturally loose ligaments; continued overhead actions such as swimming, tennis, that cause repetitive strain and stretch the shoulder.

Symptoms
Pain, repeated dislocation; slipping or unstable sensation.

Diagnosis
Medical examination for range of movement; X-ray; MRI; CT scan.

Treatment (non-operative)
lifestyle adjustment; shoulder brace; anti-inflammatories; gentle, strengthening exercise.

Treatment (surgery)
ligament repair surgery to hold joint in position using arthroscopy, particularly for athletes.

FROZEN SHOULDER / ADHESIVE CAPSULITIS

This happens when the ‘shoulder capsule’, a layer of tough connective tissue surrounding the ball part of the ball and socket shoulder joint, becomes thicker and tighter with insufficient synovial fluid for free movement.

Causes
Immobilised shoulder following injury or accident; diabetes; Parkinson’s Disease; cardiac disease; hyperthyroidism; hypothyroidism; more common in middle age.

Symptoms
Pain; stiffness making everyday activities difficult depending on the stage of development.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (non-operative)
gentle exercise; anti-inflammatories; steroid injections.

Treatment (surgery)
arthroscopy to cut through stiff parts of the shoulder capsule combined with joint manipulation.

GLENOID LABRUM TEAR, SHOULDER

This occurs when the labrum, the firm fibrous tissues around the rim of the shoulder socket (glenoid cavity) which helps to stabilise the shoulder joint, is torn.

Causes
Connected with other shoulder injuries: dislocation; repetitive shoulder motion common in athletes, weight lifters; fall on outstretched arm; forceful shoulder blow; heavy lifting.

Symptoms
Pain particularly reaching overhead; shoulder locking, clicking, grinding sensations; shoulder instability; loss of strength and mobility.

Diagnosis
Medical examination; MRI, CT scan.

Treatment (non-operative)
rest; anti-inflammatories; rotator cuff strengthening exercises.

Treatment (surgery)
depending on severity of tear: arthroscopy to remove torn flap of labrum rim; repair, re-attachment of biceps tendon; ligament re-attachment and rearrangement if the tear is in the middle of the shoulder socket area - all taking up to four months to fully heal.

ROTATOR CUFF TEARS

The rotator cuff, rising from the shoulder blade and composed of muscles and tendons blended together, holds the upper arm in place within the shoulder joint and is lubricated by a bursa (fluid filled sack). Partial tears happen when the tendons are damaged, full tears happen when the tendon has torn through where it is attached to the upper humerus.

Causes
Wear and tear; repetitive stress common in weightlifting, tennis, rowing, development of bone spurs or osteophytes causing impingement, then tears.

Symptoms
Sudden pain, snapping, weakness in injury; growing weakness, pain and difficulty lifting arms above the head; crunching; cracking, pain sleeping on the side.

Diagnosis
Medical examination; X-ray; ultrasound, MRI scan.

Treatment (non-operative)
rest; gentle exercise; anti-inflammatories; steroid injection.

Treatment (surgery)
rotator cuff repair to reattach the tendon to the head of the upper arm bone using arthroscopy.

ROTATOR CUFF TENDONITIS

This is shoulder restriction that damages the area’s tendon in three scenarios: tendonitis (irritation); bursitis (swollen fluid-filled sack); impingement (narrowing of space between the shoulder blade and rotator cuff).

Causes
Overuse of the rotator cuff common in swimmers, tennis players who engage in overhead activity.

Symptoms
Mild to more severe pain when doing overhead activities; limited movement; gradually increased pain.

Diagnosis
Medical examination; X-ray; ultrasound; MRI scan.

Treatment (non-operative)
rest; gentle stretch exercises to strengthen rotator cuff muscles; anti-inflammatories; steroid injection.

Treatment (surgery)
subacromial (referring to shoulder) decompression using arthroscopy to allow remove inflamed bursa or part of the shoulder blade to allow more space in the rotator cuff, with two-four months’ recovery time.

CALCIFIC TENDONITIS

This happens when calcium builds up in the rotator cuff reducing the space between it and the end of the shoulder blade (acromion) causing pressure and inflammation.

Causes
Wear and tear, common between 30-60 years of age.

Symptoms
Pain and irritation; pinching or rubbing when the arm is raised.

Diagnosis
Symptom check; X-ray; ultrasound to show extent of calcium build-up.

Treatment (non-operative)
gentle exercise programme; anti-inflammatories; steroid injections; ultrasound barbotage using a syringe to draw out the calcium.

Treatment (surgery)
arthroscopy to remove calcium deposit and create more space between the rotator cuff tendons and top of the shoulder blade.

SCAPULA / SHOULDER BLADE FRACTURE

The scapula, along with two other bones, clavicle (collarbone) and humerus (upper arm bone), is a strong bony plate integral to the ball and socket shoulder joint and protected by the chest and surrounding muscle so rarely brakes completely.

Causes
High-energy impact such as motorcycle accident or high intensity exercise; overuse.

Symptoms
Pain in the back especially when arms move; swelling over the back of the shoulder; bruising of the shoulder blade.

Diagnosis
Medical examination’ X-ray; CT scan.

Treatment (non-operative)
sling; pain killers; gentle exercises

Treatment (surgery)
realignment with plates and screws to hold loose bone fragments in place, especially together with a collarbone fracture.

CLAVICLE / COLLARBONE FRACTURE

The clavicle connects the arm to the body, lying between the ribcage (sternum) and shoulder blade (scapula) and is more commonly fractured than other parts of the upper body.

Causes
Direct blow to the shoulder; fall on a straight arm.

Symptoms
Pain, difficulty lifting the arm. sagging shoulder, bruising; swelling; bump.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (non-operative)
sling; anti-inflammatories; gentle exercise programme to release stiffness and strengthen muscles.

Treatment (surgery)
Displaced bones require realignment surgery with plates and screws with return to normal activity by three months.

Arm

BICEPS TENDON TEAR AT THE SHOULDER

The happens when the biceps tendon, which attaches the biceps muscle at the front of the upper arm, allowing rotation in the arm and bending in the shoulder, is torn.

Causes
Injury such as falling onto the hand when the arm is outstretched; lifting heavy weights also in sports training; wear and tear from overuse; associated should cuff impingement, rotator cuff injury or tendonitis; regular steroid injections smoking.

Symptoms
Pain; audible ‘pop’; bruising; weakness in shoulder and elbow; difficulty turning palm upwards; visible bulge in the upper arm.

Diagnosis
Visibility of swelling in upper arm; medical examination; X-ray; MRI scan.

Treatment (Non-operative)
ice pack; anti-inflammatories; rest; gentle exercise to build strength and flexibility.

Treatment (surgery)
arthroscopy to reattach torn tendon to the bone with full recovery of movement within three months.

TENDONITIS OF THE LONG BICEPS HEAD

This occurs in the upper biceps tendon that joins the biceps muscle to the shoulder bones and often accompanies rotator cuff tears, long term shoulder instability, osteoarthritis.

Causes
Wear and tear often in athletes focused on overhead activities: swimming, tennis.

Symptoms
Pain, tenderness, aching in the front shoulder and upper arm, exacerbated by overhead activity.

Diagnosis
Medical examination for range of movement; X-ray; MRI scan.

Treatment (Non-operative)
rest; ice pack; avoiding overhead activity; anti-inflammatories; steroid injection; gentle exercise strength and mobility programme.

Treatment (surgery)
more severe symptoms: tendon re-attachment to socket; biceps tenodesis to remove damaged tendon section; tenotomy to release tendon completely when excessively damaged.

DISTAL BICEPS TENDON RUPTURE

The happens when the distal biceps tendon, which attaches the biceps muscle to the elbow, allowing the arm to bend, is torn.

Causes
Extending the elbow against considerable resistance, suck as lifting a heavy weight.

Symptoms
Audible ‘pop’ with severe pain, swelling; bruising; building at the top of the upper arm.

Diagnosis
Symptom check; MRI scan.

Treatment (Non-operative)
gentle exercise; rest; anti-inflammatories.

Treatment (surgery)
more common with this rupture as tendon is not able to re-attach itself to the elbow; arthroscopy to re-attach the tendon.

ULNAR COLLATERAL LIGAMENT (UCL) INJURY

This happens when the UCL, attaching the upper arm bone to the forearm, becomes stretched, frayed, torn.

Causes
Repetitive stress on the elbow; sudden rupture during sports, especially when throwing: cricket, javelin.

Symptoms
Inside elbow pain; instability; tingling in the funny bone (ulnar nerve), difficulty in throwing.

Diagnosis
Medical examination, X-ray; MRI.

Treatment (Non-operative)
rest; ice pack; anti-inflammatories; physiotherapy.

Treatment (surgery)
UCL reconstruction surgery in severe cases and for athletes in throwing sports.

PITCHER’S ELBOW / VALGUS EXTENSION OVERLOAD (VEO)

Common injury among athletes where throwing is integral to their sport, where the olecranon (bony prominence of forearm) and humerus are forced together from twisting and the cartilage is worn away.

Causes
Repetitive throwing action.

Symptoms
Pain with elbow extension; swelling and formation of lumps around the elbow joint.

Diagnosis
Medical examination; X-ray; CT, MRI scan.

Treatment (Non-operative)
altering throwing technique; anti-inflammatories.

Treatment (surgery)
arthroscopy to remove loose bone fragments; more severe cases: ulna ligament reconstruction surgery.

FLEXOR TENDONITIS

This is swelling in the flexor tendons, bands of tissue that connect muscle and bones running from the forearm, wrist and palm allowing fingers to bend.

Causes
Repetitive activities such as throwing; rheumatoid arthritis.

Symptoms
Pain, swelling on the inside elbow.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
rest; ice packing; anti-inflammatories; avoid gripping, squeezing; cortisone injection.

Treatment (surgery)
for ruptured tendons: flexor tendon repair surgery.

ELBOW INSTABILITY

The elbow is a complex, uncompromising joint, with three major instability conditions that make the joint feel loose and insecure: posterolateral rotator instability (from injury to the ligament on the outside of the elbow); valgus instability (from injury to the ligament on the inside of the elbow); varus posteromedial rotatory instability (from injury to the ligament on the outside of the elbow along with fracture to the ulna: lower arm bone). Elbow tendinopathy comes from inflammation of the tendons in cases such as Tennis or Golfer’s Elbow.

Causes
Falling onto the hand when outstretched; accident; repetitive strain.

Symptoms
Pain; stiffness; elbow misalignment when moving or popping out of place; feeling loose.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
rest from activities that make elbow feel vulnerable; elbow brace to limit movement; physiotherapy; anti-inflammatories.

Treatment (surgery)
ligament reconstruction; fracture fixation mainly for competitive athletes.

ELBOW SPRAINS AND STRAINS

An elbow sprain is a tear or stretch of a ligament which joins the arm bones together to stabilise the joint; an elbow strain occurs when a muscle and/or tendon is injured.

Causes
Sprains: a fall on an outstretched arm causing the ligament to over stretch or rupture. Strains: repetitive muscle use, repeated twisting or overstretching, often during training and racket sport players; overweight and lack of warm-up before exercise.

Symptoms
Sprains: pain, bruising, swelling, inflammation, popping; in extreme cases ligaments separate from the bone. Strains: pain, muscle weakness; swelling; cramping; in extreme cases the muscle or tendon may rupture.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
ice pack; rest; elevation; gentle stretching exercise.

Treatment (surgery)
to reattach and align the tendons.

ELBOW STIFFNESS

This is the most common elbow condition.

Causes
Previous injury or fracture; osteoarthritis of the elbow.

Symptoms
Limited range of motion; pain; swelling; locking of the joint.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
physiotherapy.

Treatment (surgery)
arthroscopy to scrape the joint to restore movement; advanced osteoarthritis may require arthrolysis, a procedure to restore mobility of the elbow.

TENNIS ELBOW

This is inflammation of the tendons on the outside of the elbow.

Causes
Repetitive strain from racket sports.

Symptoms
Pain, tenderness gradually worsening, leading to weaker grip during racket sports.

Diagnosis
Medical examination; S-ray, MRI scan.

Treatment (Non-operative)
rest; physiotherapy; arm brace; steroid injections; extracorporeal shockwave therapy to speed recovery process.

CUBITAL TUNNEL SYNDROME / ARM NERVE ENTRAPMENT

This occurs when the ulnar nerve that runs from the neck to the hand is compressed at the elbow area, called the cubital tunnel.

Causes
Fractures; elbow bending for long periods; repetitive bending and straightening of the arm, e.g. when playing tennis.

Symptoms
Tingling in the little and/or ring finger.

Diagnosis
Medical examination; electromyography (EMG); nerve conduction test.

Treatment (Non-operative)
time; minimising bent arm activity.

Treatment (surgery)
cubital tunnel release to relieve pressure on the nerve.

CUBITAL TUNNEL SYNDROME

This happens when the long ulnar nerve, that extends from the shoulder to the hand passing through the cubital tunnel in the elbow, becomes trapped or blocked.

Causes
Fractures; long or repetitive elbow bending and straightening, especially when playing sport.

Symptoms
Tingling sensation in the little and ring finger.

Diagnosis
Medical examination; nerve conduction test.

Treatment (Non-operative)
minimising aggravating bent-arm activities; rest.

Treatment (surgery)
cubital tunnel release to relieve pressure on the nerve.

CARPAL TUNNEL SYNDROME (CTS)

This happens when the carpal tunnel, the narrow sheath formed by small bones and connective tissue inside the wrist, on the base of the palm, from forearm to hand, becomes tight and puts pressure on the medical nerve travelling through it.

Causes
Genetic; wrist fracture; conditions such as rheumatoid arthritis, diabetes; pregnancy, repeats strains on hand, typing; more common in women.

Symptoms
Pins and needles (paraesthesia), pain in arm, hand; weakened thumb, grip, developing over time, worse at night; difficulty carrying out small fiddly tasks like buttons.

Diagnosis
Medical examination; nerve conduction test; X-ray.

Treatment (Non-operative)
natural disappearance, especially post pregnancy; wrist splint while sleeping; anti-inflammatories; steroid injection.

Treatment (surgery)
arthroscopy to increase space round the nerve in the carpal tunnel

OLECRANON BURSITIS

This occurs when the bursa, a fluid-filled sac that cushions joints between tendons and bones in the elbow, becomes inflamed and swollen around the olecranon (bony elbow prominence).

Causes
Prolonged pressure; infection; conditions such as rheumatoid arthritis or gout.

Symptoms
Pain, swelling to restrict elbow movement; infected bursitis leads to heat.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
bursa aspiration; elbow pads, activity modification; anti-inflammatories; steroid injection; antibiotics for an infected bursa.

Treatment (surgery)
bursa removal so that the it regrows without inflammation.

HUMERAL SHAFT FRACTURE

This is a break on the middle of the upper arm bone.

Causes
Direct blow, such as with a bat; direct fall on the elbow when it is locked straight.

Symptoms
Pain, weakness; swelling; limited movement; visible deformity.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (Non-operative)
cracked bones (displaced fracture): immobilisation in a splint with sling followed by physiotherapy.

Treatment (surgery)
more serious cases: bone realignment procedure with plates, pins, wires.

DISTAL HUMERUS FRACTURE

This fracture occurs in the humerus bone just above the elbow in three levels of severity: non-displaced fracture where the bones remain in their usual position; unstable fracture where the bones may become displaced some time after the fracture; open or displaced fracture where bone fragments are displaced, maybe even piercing the skin.

Causes
Direct blow, often by a bat in sport; fall the elbow; fall with a straight arm and locked elbow causing the forearm to exert too much pressure on the upper arm (humerus).

Symptoms
Pain; swelling; bruising; stiffness; wobbly elbow.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
for lesser fractures: splint to straighten arm followed by a function brace to regain movement.

Treatment (surgery)
realignment procedures with plates, pins. wires to hold fragments in place.

DISTAL RADIUS / FOREARM FRACTURE

This common fracture, in the larger of the forearm bones (radius) near the wrist (distal end), occurs in different ways: colles fracture, an upward tilting bone at the place of trauma; intra-articular fracture, where the break extends into the wrist joint; extra-articular where the fracture doesn’t affect the joint; open fracture, where the bone breaks through the skin and comminuted fracture: broken bone in two places.

Causes
Falling onto an outstretched arm.

Symptoms
Pain; swelling; tenderness, deformity in the arm.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
for lesser fractures: cast, splint (six weeks); ‘reduction’- realigning the bone without opening the skin, followed by cast; gentle strengthening exercises.

Treatment (surgery)
for displaced or comminuted fractures to realign the bone with plates, pins, screws.

ULNA / FOREARM FRACTURE

This affects one or both forearm bones: ulna and/or radius.

Causes
Direct blow to the side of the arm typically from falling or when raised in self defence.

Symptoms
Pain; deformity; swelling; bruising; restricted movement; numbness or weakness in the fingers or wrist (less common).

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
for non-displaced fractures: arm splint followed by functional brace.

Treatment (surgery)
typically when both forearm bones are affected or the bone has become displaced: realignment procedure to stabilise and reset the bones, with plates, pins, wires depending on severity.

UPPER ARM / PROXIMAL HUMERUS FRACTURE

This fracture, also called a broken shoulder, affects the upper part of the upper arm bone (humerus) where it meets the shoulder socket.

Causes
Collision; fall on the hand with a straight arm; common fracture.

Symptoms
Pain, swelling, bruising of the shoulder; limited movement.

Diagnosis
Medical examination; X-ray; CT, MRI scan.

Treatment (Non-operative)
sling; anti-inflammatories; stretching exercises later.

Treatment (surgery)
for displaced bones: realignment surgery to fix bones with plates and screws.

RADIAL HEAD FRACTURE

The radial head is the top of the radial bone that connects the elbow to the wrist. It is susceptible to two types of fracture: unstable fracture with slight displacement; open or displaced fracture where bone fragments fall out of place or the joint or ligaments are damaged.

Causes
When putting out a hand to stall a fall but landing on the straightened arm while the elbow is locked

Symptoms
Pain on the outside of the elbow, swelling, limited movement; bruising; tenderness.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
for unstable fractures: splint followed by specific exercise programme.

Treatment (surgery)
for open fractures: arthroscopy to reattach bone fragments with pins, plates; artificial (new) radial head surgery in severe cases or cases of deformity; immediate surgery for elbow dislocation.

MONTEGGIA FRACTURE

This is combination fracture of the ulna (forearm) and dislocation of the radial head from the elbow joint.

Causes
Falling onto the arm when outstretched.

Symptoms
Severe pain; swelling; tenderness.

Diagnosis
Medical examination; X-ray.

Treatment (surgery)
to repair the ulnar and sometimes to slim down the radial head if it is forced tight into the elbow socket, followed by a cast.

OLECRANON STRESS FRACTURE

This is a tiny crack in the bone at the tip of the elbow in the upper end (olecranon) of the forearm (ulna).

Causes
Tired muscles unable to absorb shock normally carrying the overload to the bone. Common in sports involving throwing.

Symptoms
Intense pain on the surface of the elbow tip, gradually worsening.

Diagnosis
Movement range check; X-ray; CT, MRI scan.

Treatment (Non-operative)
rest, physiotherapy, altering throwing technique; anti-inflammatories with six-week recovery time.

Treatment (surgery)
if symptoms fail to improve: arthroscopy to remove tiny loose bone fragments, bone spurs or osteophytes (bony lumps around the joint).

LIGAMENTS AND TENDONS

They are both fibrous connective tissue. Ligaments are crisscross bands that attach bone to bone to stabilise joints. Tendons, on each end of a muscle, attach muscle to bone, also stabilise joints.

STRESS FRACTURES

Stress fractures are a small crack in the bone usually of the lower leg or foot.

Causes
Overuse, repeated stress on the limb causing muscles to become tired and less able to absorb shock; changed or increased training habits and intensity in athletes in high impact sports: tennis, track and field, football, running, dancing, jumping- which puts pressure on the feet; hard surface running; wrong style of sport shoe; osteoporosis and hormone imbalance which reduce mineralisation in bones especially female athlete with erratic oestrogen production and irregular period.

Symptoms
Pain occurring when limb is in use. It’s easy to be unaware of a stress fracture.

Diagnosis
X-ray; MRI scan.

Treatment (Non-operative)
rest from impact activity; plaster cast; rigid boot; crutches; gentle exercise such as swimming, cycling; shockwave therapy.

Treatment (surgery)
procedure to fix a pin or plate.

EXTENSION FRACTURE

This happens when bones are forcibly pulled apart.

Causes
Serious impact from car crash, during sports especially horse riding, skiing.

Symptoms
Pain.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (Non-operative)
back brace, cast for up to three months; exercise programme for strength and flexibility.

Treatment (surgery)
stabilization or ligament repair procedure.

Hand

FLEXOR TENDON INJURY

This happens when these critical tendons for flexing and bending fingers and thumbs are injured.

Causes
Cuts in the arm, hand, fingers; sports injuries such as in rock climbing; rheumatoid arthritis.

Symptoms
Inability to bend finger; pain; tenderness, numbness in injured area.

Diagnosis
Immediate doctor visit following a deep cut; medical examination; X-ray.

Treatment (Non-operative)
splint for party torn tendons; strength and movement exercises.

Treatment (Surgery)
tendon repair usually as an outpatient procedure followed by splint for up to eight weeks.

THUMB SPRAIN

This is the result of an ulnar collateral ligament injury, the main ligament in the middle of the thumb.

Causes
Fall on an outstretched hand often during skiing when strapped into a ski pole.

Symptoms
Pain; swelling; tenderness; difficulty to grasp object, pinch.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
cast, splint for joint immobilisation while healing in four-six weeks; ice packing to reduce swelling.

Treatment (Surgery)
procedure to reconnect ligament and bone with pins, screws followed by cast for six weeks.

DE QUERVAIN’S TENDINOSIS

This the swelling of tendons in the base of the thumb and tendon sheath.

Causes
Lifting young children; rheumatoid arthritis.

Symptoms
Pain, swelling, catching on the thumb side of the wrist and travelling up the forearm, worsening the hand and thumb movement; gripping or twisting in sport;

Diagnosis
Medical examination, sometimes with Finkelstein test, making fist shapes.

Treatment (Non-operative)
rest; splint; anti-inflammatories; modifying aggravating activity; steroid injection.

Treatment (Surgery)
procedure to open thumb ‘compartment’ allowing room for tendons to move.

DUPUYTREN’S CONTRACTURE

This is caused by a thickening and tightening of fibrous tissue under the skin of the palm and fingers.

Causes
Genetic; alcoholism; diabetes.

Symptoms
Small painful nodules in the palm, thinking and forming bands of tissue; fingers curling inwards to the palm with difficulty in straightening. Develops slowly over years.

Diagnosis
Medical examination and monitoring.

Treatment (Non-operative)
steroid injection to dissolve abnormal bands of tissue cord.

Treatment (Surgery)
to divide or remove the tissue.

TRIGGER FINGER / THUMB

This happens when the flexor tendon or tendon sheath in the palm develops a nodule, resulting from a catching or rigidness in the fingers and/or thumb when bent.

Causes
Common in women 40-60 years; diabetes; sports that put strain on the hand; rheumatoid arthritis; Dupuytren’s contracture when one or more fingers become permanently bent in a flexed position.

Symptoms
Small, tender lumps forming on the palm; swelling, pain, catching when bending and straightening fingers; symptoms often improve when moving the joints.

Diagnosis
Medical hand examination.

Treatment (Non-operative)
hand, finger splint; anti-inflammatories; steroid injection.

Treatment (Surgery)
procedure to widen the tendon sheath in the hand to allow the flexor tendon to slide more freely.

ULNAR TUNNEL SYNDROME OF THE WRIST

This occurs when the ulnar nerve that runs from the neck to the hand is compressed.

Causes
Ganglion (fluid-filled lump) on the wrist joint; repeated pressure on the palm where the ulnar nerve runs, such as cyclist’s grip on handle bars.

Symptoms
Numbness, affecting little finger; weakness; pain developing over time with increasing difficulty with holding or typing activity.

Diagnosis
Medical check; nerve conduction test; X-ray; CT, MRI scan.

Treatment (Non-operative)
modifying activity; anti-inflammatories; wrist splint.

Treatment (Surgery)
ganglion removal.

GANGLION CYSTS WRIST AND HAND

These are harmless lumps (fluid-filled cysts) developing in hand joints, varying in size and often disappearing.

Causes
Unknown; ore common in women: young gymnasts, older suffered of osteoarthritis.

Symptoms
Lumps that can become painful when pressing on nerves through joint.

Diagnosis
Medical examination; MRI scan.

Treatment (Non-operative)
if painful: wrist brace to help reduce ganglion; strength and flexibility exercises; aspiration with local anaesthetic.

Treatment (Surgery)
arthroscopy to remove ganglion along with its ‘root’.

BOUTONNIERE DEFORMITY

This condition, often from injuring an extensor tendon, prevents straightening of the middle joint and bends back the fingertip. Boutonniere, from ‘buttonhole’ in French, refers to the share of the tendon tear.

Causes
Direct blow to the top of the finger’s middle joint; deep finger cut separating the tendon from bone; osteoarthritis.

Symptoms
Pain, swelling; inability to straighten finger at the middle joint or fingertip.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
splint for four to six weeks.

Treatment (Surgery)
realignment procedure for fully torn tendons where the bones have become displaced.

KIENBÖCK’S DISEASE

This occurs when there is a lack of blood supply to the small lunate bone in the wrist which can cause the bone to die. The disease progresses in four stages: 1. lack of blood supply is mistaken as a sprain; 2. sclerosis (hardening) of bone due to lack of blood; 3. hard bone breaks up, displacing surrounding bones; 4. bone becomes arthritic.

Causes
One instead of two blood vessels supplying the lunate bone; different length forearm bones pressurising the wrist; past wrist fractures; extreme weight-bearing wrist positions such as in gymnastics.

Symptoms
Pain, tenderness, swelling, restricted wrist movement and ability to grip.

Diagnosis
Difficult - medical examination; X-ray; MRI scan.

Treatment (Non-operative)
wrist immobilisation in cast or splint; anti-inflammatories.

Treatment (Surgery)
options depending on the extent of the disease: 1. revascularisation: grafting healthy pieces of forearm bone with blood supply to lunate bone; 2. joint levelling: lengthening or shortening the bones especially in those with forearms of uneven length; 3. proximal row carpectomy: for advanced cases: removal of lunate and other bones to allow some wrist movement; 4. fusion of nearby wrist bones on the lunar bone to regain limited wrist movement.

MALLET FINGER / BASEBALL FINGER

This is a torn extensor tendon connecting bone to the muscle in the finger leaving it bent towards the palm.

Causes
Finger injury during sport especially when catching a ball.

Symptoms
Inability to straighten finger, swelling, pain, bruising in the finger; detached nail.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
ice pack; elevating hand above the heart; finger splint.

Treatment (Surgery)
If the nerve compression leads to a major fracture (mallet fracture): realignment surgery on the joint with pins, screws, wires.

FINGER FRACTURES

These can happen in any of the 14 bones in the fingers, with serious impact on the ability to do everyday tasks.

Causes
Putting out a hand to break a fall, finger jams: doors, playing ball.

Symptoms
Swelling; pain; tenderness; deformed finger; limited movement.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
realigning the finger without breaking the skin followed by a splint or cast for three weeks’ immobilisation; simple strengthening exercises.

Treatment (Surgery)
realignment procedure with pins, screw, wires to set the finger bones in place.

WRIST SPRAINS / FRACTURES

This occurs when the wrist ligaments are damaged, either torn or more seriously a tear that also fractures the bone, when the wrist is forcibly bent.

Causes
Fall on an outstretched hand especially on contact sports, ice skating.

Symptoms
Pain, swelling, bruising, tenderness.

Diagnosis
Medical examination; X-ray; MRI, CT scan.

Treatment (Non-operative)
rest; ice pack; elevation above the heart; splint, elasticated bandage; strength and flexibility exercises.

Treatment (Surgery)
serious sprains a procedure to reconnect the ligament to the bone; repair and strengthening are crucial to avoid onset of arthritis.

SCAPHOID FRACTURE

The scaphoid bone, just below the thumb, is the most likely bone in the wrist to break and can lead to osteoarthritis if it doesn’t heal properly.

Causes
Fall on an outstretched hand, weighted on the palm; sport; motor accident.

Symptoms
Pain, swelling at the thumb base.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
hand and arm cast for approx. eight weeks; exercise to increase strength and flexibility.

Treatment (Surgery)
screw fixture to hold scaphoid in place; more serious case: bone graft with new bone (from arm or hip) fused around scaphoid fragment.

Leg

ACHILLES TENDON PAIN / TENDINITIS

Achilles tendinitis is tissue degeneration or microscopic tears in the collagen-based fibres in the tendon in the ankle, connecting the calf muscle to the heel bone, which cause weakness, lack of flexibility and swelling.

Causes
Rapid increase or change in an athletic person’s training regime; regular training; arthritis, inflammatory disorders.

Symptoms
Pain and stiffness in tendon or back of heal, especially in the morning, after exercise or with activity; swelling/thickening, bone spurs (bony lumps), small bursa (fluid sack) in the tendon area.

Diagnosis
Medical examination; X-ray; MRI scan

Treatment (Non-operative)
reducing activity level; rest; anti-inflammatories; pain killers; physiotherapy; silicone shoe insert to raise the heal and release strain; shockwave therapy.

Treatment (Surgery)
intervention to remove damaged, inflamed tissue, bony lumps leading to tendon replacement using some tendon from the other foot, if large areas are removed.

ACHILLES TENDON RUPTURE

This is the ‘partial’ or ‘complete’ rupture of the large Achilles Tendon at the back of the ankle, connecting the calf muscle to the heel bone, and which enables downward movement of the foot, tip-toeing and momentum for movement. They are rare occurring in 1 in 5,000 people.

Causes
Excessive training during sports; ageing; long-term use of corticosteroids or steroid injections near the tendon; certain antibiotics.

Symptoms
Sudden pain in the back of the ankle; snapping; difficulty in walking; swelling; bruising.

Diagnosis
Medical examination; ultrasound; MRI scan.

Treatment (Non-operative)
plaster cast or brace allowing torn tendon ends to knit together naturally at its correct length.

Treatment (Surgery)
to stitch the tendon ends together for a quicker recovery, followed by a brace.

PATELLAR TENDINITIS / ‘JUMPER’S KNEE’

This describes pain in the patellar tendon - the band of rubbery tissue connecting the kneecap (patella) to the shin bone (tibia).

Causes
Repetitive impact activities: jumping or running.

Symptoms
Pain beneath the kneecap while running, jumping, kicking, squatting.

Diagnosis
Medical examination; MRI or ultrasound scan.

Treatment (Non-operative)
physiotherapy; injection under ultrasound; shockwave therapy.

LIGAMENT TEARS AND INJURY

There are four main knee ligaments: strong bands of soft tissue holding bones together and supporting joints to allow free range of motion.

Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) cross over on the inside of the knee.

Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) are on the sides of the knee joint.

ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES

This can happen when the ACL, a key ligament connecting the femur (thigh) to the tibia (shin) bones to stabilise the knee joint, is suddenly twisted.

Causes
A drastic change in direction with the body usually when jumping or landing during sports when the body rotates but the foot remains on the ground.

Symptoms
A ‘pop’ or ‘snap’ sound; knee gives way followed by swelling and an inability to bear weight on, straighten or bend the leg. Repetitive damage to the joint surface and cartilage can lead to early onset arthritis, over time.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
physiotherapy; muscle strength and coordination exercises’

Treatment (Surgery)
ACL reconstruction - a surgical tissue graft or replacement.

MEDIAL COLLATERAL LIGAMENT (MCL) INJURIES

This can happen when the MCL, a key ligament in the knee’s inner region working to resist the widening of the knee joint, is torn because of a blow to the knee.

Causes
When the outside of the knee is struck or when the foot is caught and the knee is forced sideways, often into an excessive knock-knee position, more common in children and teenagers.

Symptoms
Sharp pain on the inside of the knee; swelling, wobbly knee.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
hinged knee brace for 6 weeks to prevent sideways movement; physiotherapy.

Treatment (Surgery)
for professional athletes or where a chronic MCL tear is linked to an ACL injury.

LATERAL COLLATERAL LIGAMENT (LCL) INJURIES

These usually occur when the knee is forced into an excessive bow-legged position; less common than MCL injuries but if injured damage to other knee structures is likely also.

Causes
When the inside of the knee is struck; or forced sideways when the foot is fixed to the ground.

Symptoms
Pain on the outside of the knee; swelling; wobbling causing it to potentially give way.

Diagnosis
Medical examination; X-ray; MRI to reveal extent of damage.

Treatment (Non-operative)
knee brace; physiotherapy.

Treatment (Surgery)
if other knee structures also damaged; ligament reinsertion; ligament reconstruction in chronic cases.

POSTERIOR CRUCIATE LIGAMENT (PCL) INJURIES

This is most coming when the knee is bent and the shin is quickly forced backwards by sudden impact; varies from mild tear to full ligament rupture and is rarely an isolated injury.

Causes
Falling; sports injury, car accident, e.g. if the shin is forced into the dashboard.

Symptoms
Pain followed by swelling, difficulty walking.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
physiotherapy’ PCL brace.

Treatment (Surgery)
PCL reconstruction for a sever tear and following several injuries to knee ligaments.

MULTIPLE LIGAMENT INJURY

This is when two or more knee ligaments are damaged, making the joint very unstable and disruption blood and nerve supply within the leg.

Causes
Sports; traffic accidents.

Symptoms
Pain; swelling immediately following injury.

Treatment (Surgery)
most common to reconstruct damaged ligaments and repair the neuromuscular damage.

MENISCUS CARTILAGE INJURIES

The meniscus is a wedge of rubbery connective tissue, sandwiched between the end of the thigh bone (femur) and the top of the shin bone (tibia) in the middle of your knee, that helps absorb vibrations and force within the knee to enable smooth movement. The medial meniscus on the inner side of the knee, is most commonly injured. The lateral meniscus is on the outside of the knee.Causes

MEDIAL MENISCAL INJURY

This is more prone to injury than the lateral meniscus as it’s less mobile. Blood supply to both menisci is poor, making them hard to heal.

Causes
Sudden twist of the knee in a bent position while the foot remains in contact with the ground, often in rugby or football; age causes brittleness making it more likely to tear even with minimal force.

Symptoms
Pain on the inside of the knee; gradual swelling; limited movement in twisting, kneeling and deep bending; locking in position.

Diagnosis
Medical examination; confirming diagnosis with an MRI scan.

Treatment (Non-operative)
altering activity to protect know; exercises for strength and flexibility; anti-inflammatories; cortisone injections under ultrasound guidance to relieve pain especially if osteoarthritis sets in.

Treatment (Surgery)
meniscus repair or partial meniscectomy usually via arthroscopy under general anaesthetic.

LATERAL MENISCAL INJURY

This is less common than a medial meniscal injury but is often more serious, taking longer to recover.

Causes
Like a medial meniscal injury: a sudden twist of the knee in a bent position while the foot remains in contact with the ground, often in rugby or football; age causes brittleness making it more likely to tear even with minimal force.

Symptoms
Pain on the outside of the knee; gradual swelling; limited movement in twisting, kneeling and deep bending; locking in position.

Diagnosis
Medical examination, confirming diagnosis with an MRI scan.

Treatment (Non-operative)
altering activity to protect know; exercises for strength and flexibility; anti-inflammatories; cortisone injections under ultrasound guidance to relieve pain especially if osteoarthritis sets in.

Treatment (Surgery)
meniscus repair or partial meniscectomy usually via arthroscopy under general anaesthetic.

MENISCAL TEAR

The meniscus is often torn in association with an ACL injury.

Causes
The meniscus naturally degenerates over 40, becoming weak and less elastic so is more vulnerable to impacts of twists to the knee; repetitive stress for ‘degenerate tear’; accident for ‘traumatic tear’.

Symptoms
Degenerate tears: pain usually without swelling or movement restrictions.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
modify sports: avoid squatting; exercises to regain flexibility and strength; many people live active lives with a meniscal tear.

Treatment (Surgery)
meniscectomy (repair of meniscus) if activity is impaired or symptoms accompany an ACL injury.

KNEECAP (PATELLA) FRACTURE

There are four types depending on the position and force of the fracture: stable fracture, when broken bone ends are aligned to heal without treatment; displaced fracture, when broken bone ends misalign so require surgery; comminuted fracture, when the kneecap is shattered, becoming unstable and difficult to treat and open fracture, when exposed bone leads to damage risk to ligaments, muscles and tendons, taking a long time to heal.

Causes
A direct blow to the front of the knee.

Symptoms
Pain and swelling around the knee; difficulty in straightening and putting pressure on the joint.

Diagnosis
Medical examination; X-ray.

Treatment
Stable fracture: ice; knee brace; physiotherapy.

Displaced, comminuted/open fracture: surgery requiring either pins, plate or wires to hold bone fragments in place possibly resulting in osteoarthritis.

FOCAL CHONDRAL (JOINT SURFACE CARTILAGE) DAMAGE

This refers to damage to the tough, rubbery cartilage at the joint surface, namely the knee.

Causes
Knee pivot, fall or direct blow; injury accompanying ligament damage e.g. ACL tear; first stage osteoarthritis.

Symptoms
Pain, swelling although the lack of nerves on the joint surface can mean no symptoms; mechanical locking is bone fragments have sheered from the joint.

Diagnosis
Medical examination; X-ray; CT or MRI scan.

Treatment (Non-operative)
uncommon due the inability of the joint surface cartilage to self-repair unless damage area is miniscule.

Treatment (Surgery)
Arthroscopy to trim loose fragments from the joint surface; other resurfacing procedures such as micro fracture, mosaicplasty/osteochondral plugging, autologous chondrocyte implantation, focal replacement with metal implants.

BURSITIS OF THE KNEE

This is inflammation of a bursa - small fluid sac which cushions pressure points between tendons, muscles and bones the knee. There are 13 bursae in the knee leading to such conditions traditionally known as ‘housemaid’s knee’ and ‘clergyman’s knee’, due to inflammation in the patella area.

Causes
Over-used tendons (e.g. much kneeling); direct blow to the tendon.

Symptoms
Pain; swelling; tenderness to touch; sore movements.

Diagnosis
Medical examination; ultrasound scan.

Treatment (Non-operative)
aspiration to remove fluid from around the joint; injection for pain relief; anti-inflammatories; painkillers; rest.

BAKER’S CYST

This is a swelling in the back of the knee caused by knee joint or knee tissue issues, more common in women and people over 40.

Causes
Osteoarthritis (most common); sports injuries; blow to the knee; rheumatoid arthritis; gout.

Symptoms
Fluid build-up, swelling at the back of the knee; pain particularly when knee is bent and flexed.

Diagnosis
Medical examination; ultrasound, MRI scan.

Treatment (Non-operative)
rest; compression bandages (from pharmacy); anti-inflammatories; ice packs; (20 minutes, four times per day).

Treatment (Surgery)
in some cases, to drain the cyst.

THIGH BONE (FEMUR) FRACTURE

These occur in the top part of the knee (distal femur fractures) or extends into the knee joint (comminuted fracture) where the bone shatters.

Causes
Osteoporosis in older people; high energy impact or fall from height in younger people.

Symptoms
Sever pain, inability to weight bear; swelling; bruising; tenderness; deformed appearance of the knee; crooked or shortened leg.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (Non-operative)
rest, knee brace; physiotherapy; ice pack.

Treatment (Surgery)
Insertion of pins, plate, wires to stabilise bone fragments.

SHIN BONE (TIBIAL PLATEAU) FRACTURE

These occur in the weight-bearing area of upper part of the shin bone, just below the knee joint.

Causes
Sudden physical trauma such as twisting to affect the knee alignment, stability and movement.

Symptoms
Pain, swelling, inability to weight bear.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
with a ‘stable’ fracture, where the bones crack but stay in place: plaster cast or brace for three months.

Treatment (Surgery)
with ‘unstable’ or ‘displaced’ fracture, to realign the bones and hold them in place with pins, plates, wires.

RUNNER’S KNEE / ILIOTIBIAL BAND (ITB) SYNDROME

Inflammation of the ITB, a touch tendon running down the outside thigh from the hip muscle to the shin bone just below the knee.

Causes
Prolonged, repetitive exercise in athletes: runners, cyclists.

Symptoms
Aching pain in the outside knee; tenderness; swelling particularly when descending stairs or slopes or running.

Diagnosis
Medical examination; MRI; ultrasound.

Treatment (Non-operative)
rest, physiotherapy; ultrasound-guided cortisone injection; botulinum toxin injection to the hip muscle to loosen, even deactivate the ITB transferring focus on other muscles around the knee.

Treatment (Surgery)
ITB lengthening procedure.

ANKLE SPRAINS AND INSTABILITY

Ankle sprains are often caused when the foot is suddenly twisted unduly stressing the ankle joint - the hinge between the tibia and fibula and the talus - which holds these bones together with ligaments (bands of collagen tissue) and muscles.

Causes
Sudden twist to the foot tearing ligaments, commonly in sports or falling.

Symptoms
Pain in pulled ligaments; bruising; limping or inability to walk depending on severity; broken or dislocated ankle bones.

Diagnosis
Accident and Emergency if unable to stand on it; medical examination; X-ray; CT scan.

Treatment (Non-operative)
auto-recovery with rest; ice; compression and elevation with foot raised above the heart; physiotherapy, ankle sprain exercises.

Treatment (Surgery)
if pain persists after 6 months: arthroscopy, ligament reconstruction surgery.

ANKLE FRACTURE

This is a bony protrusion (lateral and medial malleolus) on the out and inside of the ankle and sometimes the back of the shin bone (tibia).

Causes
Common injury from twisting the ankle with force; direct blow to the joint (during sport); falling; jumping and landing awkwardly.

Symptoms
Cracking and acute sudden pain causing nausea and difficulty to walk on it; rapid swelling; bone protrusion, dislocation.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (Non-operative)
immediate trip to Accident and Emergency on suspicion of a broken ankle; rest and elevation of the foot; ice application; pain killers; anti-inflammatories;

Treatment (Surgery)
plaster cast, splint, crutches to relieve weight bearing for up to six weeks. If dislocated the bones may be realigned under sedation. For more serious fractures an operation to realign bones with support of a metal plate to prevent future misalignment in a weak, traumatised area. Return to normal activity gradually over six months. Some fractures lead to osteoarthritis over time.

SNOWBOARDER’S FRACTURE

A possible condition following either an ankle sprain that doesn’t settle with time and ‘normal’ X-rays.

Causes
Forced twisting upwards or outwards of the ankle, often when landing or jumping.

Symptoms
Continual pain a long time after an ankle sprain diagnosis.

Diagnosis
Commonly CT skin as this fracture is hard to see on an X-ray.

Treatment (Surgery)
fixing a screw in the fractured area; removal of bone fragment.

TARSAL TUNNEL SYNDROME

This results from compression in the tarsal tunnel, an inside ankle area below the prominent ankle bone covered by a thick soft tissue band to protect the arteries, veins, tendons and nerves that are contained within it.

Causes
Compression from varicose veins, ganglions, swollen tendons, bone spurs or soft tissue lump within the tarsal tunnel; swelling from an ankle sprain, diabetes or arthritis; fallen arches or tilting heel in flat feet.

Symptoms
Tingling or burning; numbness around the sole; pain around the arch of the foot.

Diagnosis
Medical examination; X-ray; nerve conduction tests.

Treatment (Non-operative)
rest; immobilisation of the foot in a boot; physiotherapy; anti-inflammatories; orthotic insoles; custom made shoes.

Treatment (Surgery)
removal of abnormal soft tissue mass or lump in the tarsal tunnel.

OSTEOCHONDRAL ANKLE INJURY

This is an injury or defect to the bone (osteo) or smooth cartilage (chondro) that covers the smooth joint surface in the ankle.

Causes
Severe ankle sprain that loosens bone and cartilage.

Symptoms
Pain and swelling.

Diagnosis
X-ray, more commonly CT or MRI scan.

Treatment (Surgery)
arthroscopy to remove loose bone and cartilage fragments.

PERONEAL TENDON PROBLEMS / TENDINITIS

These run down the outside of the leg, below the knee, the outside of the ankle behind the protruding ankle bone and into the foot.

Causes
Acute injury, tears, stretching through ankle strain injuries, degeneration of tendon over time and over use; more common with those with high-arched feet, rheumatoid arthritis, psoriasis, diabetes.

Symptoms
Popping/snapping of tendon on the outside of the ankle, swelling, heat; tendon dislocation on the side both shin causing weakness and clicking on the outside of the ankle, instability and pain when active, particularly high intensity activity.

Diagnosis
Important in order to differentiate from an ankle sprain; X-ray; ultrasound.

Treatment
Similar for acute tendinitis and tendonothapy (longer term)

Treatment (Non-operative)
Acute Tendinitis: rest; fitted boot to immobilise the foot; physiotherapy.

Treatment (Surgery)
to repair a tear or split tendon or tendon sheath, or relocate the tendon with 80-90% success rate; debridement to clear out the damaged tissue from the tendon area.

ADDUCTOR INJURIES

This happens when the adductor muscles - on the inner thigh, pulling the legs together - are over stretched where the muscle joins the tendon.

Causes
Playing sport, usually football or rugby when the muscles are tight, weak or tired, reminding of the importance of warm up and cool down exercises.

Symptoms
Sudden and severe pain in the inside thigh; bruising; tenderness.

Diagnosis
Medical examination; X-rays, MRI scan.

Treatment (Non-operative)
rest, ice, compression, elevation to reduce swelling; anti-inflammatories; exercise programme to increase strength and mobility - ensuring pain has gone before returning to sport usually after 3-6 weeks. For chronic injuries, where the above isn’t done: a ‘pubic cleft injection’ at the base of the tendon to repair.

Treatment (Surgery)
where the tendon is torn from the bone, surgical re-attachment or lengthening allowing return to sport in about 6 weeks following.

Neck

PINCHED NERVE / BRACHIALGIA

Pinched Nerve or Brachialgia, or cervical radiculopathy, is a nerve root injury in the neck.

Causes
Age degeneration to spinal discs and bony lumps also known as ‘bone spurs’; ‘osteophytes’ that stiffen spinal mobility.

Symptoms
Pain or pins and needles (paraesthesia) in the arm, especially when turning the head.

Diagnosis
Neck examination including reflexes, strength, range of movement; X-rays; CT, ultrasound, MRI scans.

Treatment (Non-operative)
often symptoms disappear without treatment; anti-inflammatories; gentle exercise programme to stretch and strengthen muscles; spinal steroid injections for pain and swelling release.

Treatment (Surgery)
Depending on diagnosis: anterior cervical discectomy (disc removal); spinal fusion; disc replacement.

NECK SPRAIN

Neck sprain comes from a tear in soft tissue: a muscle or ligament, which connects and supports the seven vertebrae of the neck.

Causes
Sudden movement e.g. during a car accident or sports injury.

Symptoms
Pain with neck movement (often worse 24 hours after injury); headache; sore throat; sleeping difficulty, numb or tingling arms/hand; reduced movement.

Diagnosis
Neck assessment for range of movement; X-rays to test for neck fractures or osteoarthritis.

Treatment (Non-operative)
soft collar to support the head and relieve pressure so ligaments can heal; anti-inflammatories; ice pack; gentle exercise programme. Neck sprains usually heal within 6 weeks.

NECK PAIN

Neck or ‘cervical spine’ pain comes from easy injury to the neck area which consists of seven vertebrae linking the upper body to the base of the skull and is supported by ligaments and muscles.

Causes
Common: stress (holding muscles tense over time); computer work.

Injuries: (neck flexibility makes it prone to injury) particularly from car accidents, contact sports, diving, falling; more serious injuries can cause a dislocation or cervical fracture (broken neck), potentially damaging the spinal cord; spondylosis: wear and tear over 40 years old.

Rare: a spinal infection.

Diagnosis
Post-accident examination; if NO accident but constant pain an urgent visit to the doctor.

Back

BACK PAIN

Back pain, usually in the lower (lumbar) area, is a common condition, affecting 80% of people at some point in their lives.

Causes
Poor posture; over-stretching muscles or ligaments; twisting; incorrect lifting. More serious causes include: a ligament tear; slipped disc; osteoarthritis; osteoporosis; spinal stenosis; scoliosis; even an infection.

Symptoms
Pain: either sudden resulting from injury, or developing over time, either constant or sporadic from certain movements. When pain fails to improve with rest, over time, and is accompanied by fever or weight loss, it’s a sign of a potentially more serious issue.

Diagnosis
X-rays; ultrasound; MRI, CT scans.

Treatment (Non-operative)
gentle exercise; physiotherapy; anti-inflammatories; radiofrequency; spinal injections.

Treatment (Surgery)
discectomy (disc removal); laminotomy (partial disc removal); lumbar decompression and spinal fusion.

SPINAL INSTABILITY

This is a case where there is more movement than normal between the vertebrae and bone spurs may form to put pressure on spinal nerves.

Causes
Wearing out due to age; degenerative effect of osteoarthritis; back injury.

Symptoms
Sudden back or leg pain, especially when stretching or lifting; locking or loose sensation in the back; weakness in legs, feet.

Diagnosis
Medical examination; X-ray; CT, MRI scan.

Treatment (Non-operative)
rehabilitation programme to build back muscle strength; anti-inflammatories.

Treatment (Surgery)
spinal infusion surgery.

SCIATICA

This is pressure on the sciatic nerve, the longest nerve in the body that runs from the back of the pelvis through the buttocks to the feet.

Causes
Slipped disc; pregnancy when the growing baby puts pressure on the sciatic nerve; spinal stenosis (narrowing of nerve passages in the back); infection; rarely: spinal tumour.

Symptoms
Mild to severe pain spreading from lower back down one or both legs, when standing or sitting for any length of time; muscle weakness; tingling; numbness.

Diagnosis
Medical examination using the ‘passive straight leg test’ lying down; blood test for infection; X-ray; CT, MRI scan.

Treatment (Non-operative)
pain killers; anti-inflammatories; keeping active; ice packs; gentle exercise; spinal injections (if a slipped disc).

Treatment (Surgery)
discectomy to remove all or part of an intervertebral disc; fusion surgery; laminectomy to remove one or more vertebrae from the neck, to relieve pressure on the nerves.

SCOLIOSIS (curvature of the spine)

Scoliosis is abnormal curvature of the spine either to the left or right.

Causes
None known offically; tending to develop between ages 9-14; often related to other conditions such as cerebral palsy, Marfan syndrome (genetic disorder of connective tissue) or muscular dystrophy. In adults: damage to the spine, or undiagnosed during childhood/adolescence. 7 out of 10 adults have a degree of the condition.

Symptoms
Lopsided appearance (one shoulder higher than the other); leaning to one side; slightly protruding hip.

Scoliosis can put pressure on nearby ligaments/muscles causing tenderness in hips, legs or arms.

Serious symptoms, if nerve endings are affected, include loss of bladder or bowel control, numb or weak legs, or in men, erectile dysfunction."

Diagnosis
Spinal examination; X-rays; ultrasound; MRI or CT scan.

Treatment (Non-operative)
pain killers; anti-inflammatories; nerve block anaesthetic; vitamins, diet advice, targeted weight-bearing exercise - particularly in cases of osteoporosis which can augment symptoms.

Treatment (Surgery)
spinal decompression to reduce pressure on nerves; spinal fusion to stabilise/correct curvature.

SLIPPED DISC (prolapsed or herniated disc)

Discs of rubbery cartilage between each vertebra give the spine flexibility. Slipped discs (common in lumber spine, in people, largely males, aged 30-50 and often affecting the sciatic nerve) occur when the outer part of the vertebra splits to expose the inner part onto nerve endings.

Causes
Incorrect lifting, pulling, bending or twisting movements, e.g. playing golf or tennis.

Symptoms
Pain in the area or nearby related nerves.

Diagnosis
Reflex testing, ‘straight leg-raise test’ (for pain, tingling, numbness); X-ray; MRI, CT scan.

Treatment (Non-operative)
gentle exercise such as swimming; targeted rehabilitation programme; massage; anti-inflammatories; spinal injections.

Treatment (Surgery)
micro discectomy, open discectomy, (removal of discs); lumbar decompression in cases where symptoms fail to improve with non-invasive treatment.

SPINAL STENOSIS / MYELOPATHY

Spinal stenosis is a narrowing of spaces between vertebrae, potentially putting pressure on the spinal nerves. Also known a myelopathy: compression in the spinal cord.

Causes
Spine degeneration due to ageing wear and tear (affecting over 90% of over 50s); spinal spondylosis due to osteoarthritis or osteoporosis.

Symptoms
Back pain; buttock or leg pain; numbness; weakness, more acute when standing or walking.

Diagnosis
Physical examination; X-ray; MRI scan.

Treatment
20 per cent of people find symptoms improve without treatment, 60 per cent remain the same, 20 per cent worsen.

Treatment (Non-operative)
strengthening exercise programme focussing on spine mobility (e.g. bending forward on a bike for relieving pain); anti-inflammatories; steroid spinal injections; acupuncture; osteopathic and chiropractic therapies.

Treatment (Surgery)
lumbar decompression surgery and/or spinal fusion.

DISLOCATION, SUBLUXATION

This occurs if the spine or vertebrae move out of line because the back ligaments are over-stretched or torn. A subluxation is a partial dislocation where joints at the back of the vertebrae become weak.

Causes
Injury to muscles or ligaments in the spine.

Symptoms
Pain.

Treatment (Surgery)
reduction procedure involving traction or surgical intervention to realign vertebrae; fusion surgery to join vertebrae to maintain correct position.

ORTHOPAEDIC /BACK INFECTION

This comes from a skin infection or open wound which can spread to bones and joints in the back.

Causes
Rheumatoid arthritis; diabetes; haemophilia; HIV; sickle cell anaemia; smoking; overweight; poor diet; poor hygiene.

Symptoms
Area around the wound becomes swollen, inflamed, stiff, pussy; temperature.

Diagnosis
Medical examination; X-ray; CT or MRI scan; blood tests; biopsy.

Treatment (Non-operative)
wound draining; antibiotics;

Treatment (Surgery)
to remove infected tissue, dead bone, followed by antibiotics.

WHIPLASH

Whiplash is damage to tendons and ligaments caused by sudden and forced head movements beyond normal range.

Causes
Road accident; sporting injury (fall from a horse or bike, contact sports).

Symptoms
Pain; stiffness, tenderness when moving the neck; headaches; lower back pain; numb hands and arms; dizziness; blurred vision; tiredness; muscle spasms; vertigo. In rare cases: memory loss; irritability and lack of concentration.

Diagnosis
Neck examination; X-ray; CT, MRI.

Treatment (Non-operative)
Mobility neck exercises; anti-inflammatories; recovery time: several weeks.

COCCYDYNIA

This is pain in the coccyx which consists of three bones at the tail of the spine.

Causes
Muscle, ligament damage in the area, perhaps during childbirth; heavy landing in sports, from a horse; repetitive strain injury from sports, often rowing, cycling; poor posture; overweight or underweight; wear and tear with age.

Symptoms
Pain, particularly when seated or down the legs, buttocks, hips.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
anti-inflammatories; physiotherapy; spinal injections or steroids.

Treatment (Surgery)
coccygectomy to remove the coccyx and re-attach muscles, ligament and tendons around the pelvis.

Hip

HIP FRACTURE

This can occur when the upper part of the thigh bone (femur), the ‘ball’ that fits into the socket of the hip joint, is broken. Three types of hip fracture include: intracapsular fracture: at the neck of the femur, within the ‘socket’ of the joint;’ intertrochanteric’ fracture: lower and outside the joint socket; ‘subtrochanteric fracture’: lower still at the top of the femur shaft.

Causes
Falling; impact on the side of the hip; leg twisting (more likely with those with osteoporosis.

Symptoms
Pain on the outside of the upper thigh or groin worsening with movement; shorter leg with foot and knee turned outwards.

Diagnosis
Medical examination’ X-ray; CT or MRI scan.

Treatment (Non-operative)
rare as surgical treatment of hip fractures is one of the more major medical advances.

Treatment (Surgery)
Fixing with screws/plates; intracapsular fracture with a total hip replacement.

PELVIC STRESS FRACTURE

This hairline fracture above the bone is rare.

Causes
Repetitive stress due too much weight bearing exercise: dancing, running, kicking; post-natal if core strength is not regained.

Symptoms
Lower back, buttock pain, tenderness in pelvic area, hip, groin worsening with exercise; restrictive movement.

Diagnosis
Medical examination; X-ray; bone, MRI, CT scan.

Treatment (Non-operative)
rest, ice pack; anti-inflammatories; physiotherapy programme.

SPORTSMAN’S HERNIA

This is defined by chronic groin pain from rupture of muscles and tendons in the inguinal canal - two passages in the front abdominal wall which in males convey the spermatic cords and in females the round ligament of uterus. However, no true hernia is identified.

Causes
Intense or sudden changes of direction in sports: ice hockey, football; wrestling leading to tear and strain to abdominal muscles in the pelvic area.

Symptoms
Extreme pain at time of injury, which can lead to an inguinal hernia. Chronic pain is untreated.

Diagnosis
Multidisciplinary medical examination: groin, orthopaedic surgeons and physiotherapist; ultrasound; MRI.

Treatment (Non-operative)
10 days’ rest; ice pack; anti-inflammatories; gentle rehab exercise programme for abdomen and inner thighs strength and flexibility. Return to sport in six weeks.

Treatment (Surgery)
procedure to repair torn tissues in the groin, reinforcing the inguinal canal using mesh and performed by open or keyhole surgery; mesh replacement of the main ‘conjoint’ tendon; all followed by physiotherapy and full return to sport within 2-3 months.

FERMOROACETABULAR IMPINGEMENT (FAI)

This damage occurs from an abnormal shape in the hip and bone / ‘ball and socket’ joint. Two types: ‘pincer’ where bone extends beyond the rim of the hip socket to pressurise the labrum - rubbery rim of fibrous tissue surrounding the socket; ‘cam’ where the ball section (femoral head) isn’t perfectly round so cannot move smoothly, damaging cartilage.

Causes
Mildly flattened ball in the ball and socket joint development during adolescence so that rubbing occurs; excessive active stress on the hip joint such as dance; fast-running sports, pivoting and hard sports surfaces.

Symptoms
Groin pain; outside hip or buttock pain; gradual reduction in exercise ability such as running, exercise classes and pivoting sports; stabbing pain when twisting; squatting, rising after sitting in a confined space.

Diagnosis
Medical examination’ X-ray; MRI; CT scan.

Treatment (Non-operative)
avoidance of certain exercise; exercise rehab programme to increase movement range; anti-inflammatories.

Treatment (Surgery)
arthroscopic surgery to reshape bone, repair labrum and stimulate repair of cartilage damage.

LABRAL TEARS

This is damage to the labrum - rubbery rim of fibrous tissue round the hip joint socket.

Causes
Femoral acetabular impingement (above); hyper mobility in women; falling; hip rotation in sports: running, hockey, netball, ballet; congenital hip dislocation (dysplasia).

Symptoms
Groin pain; clicking or locking sensation in the hip; joint instability.

Diagnosis
Medical examination; X-ray; MRI; CT scan.

Treatment (Non-operative)
time

Treatment (Surgery)
hip arthroscopy to repair or smooth down the tear.

SNAPPING ILIOPSOSAS TENDON

This is damage to the anterior hip (iliopsoas) tendon that moves over the bony prominence of the hip socket.

Causes
Excessive frog leg- extension movements, especially in dancing; related to FAI (above) impingement; dysplasia (congenital hip displacement0; following hip replacement surgery.

Symptoms
Pain and inflammation.

Diagnosis
Medical examination; X-ray; ultrasound; MRI.

Treatment (Non-operative)
stretching programme; ultrasound-guided steroid injection in the tendon to relieve pain.

Treatment (Surgery)
release of the tendon via arthroscopy.

SNAPPING ILIOTIBIAL BAND

This is when the iliotibial band slides forwards and backwards over the bony prominence of the hip.

Causes
Excessive, unusual movement.

Symptoms
Snapping; pain.

Diagnosis
Medical examination’ X-ray; MRI.

Treatment (Non-operative)
stretching programmes.

Treatment (Surgery)
arthroscopy or small incision to readjust the band.

HIP / TROCHANTERIC BURSITIS

This is a fluid-filled sac forming over the bony prominence of the outer hip.

Causes
Tiny tears in the tendons over the bony hip protrusion (trochanter); excessive tension on the iliotibial band in athletes; following hip surgery.

Symptoms
Pain around trochanter and buttock; worse when lying on it.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
rest from the provocative activities; anti-inflammatories; target rehab exercise programme to stretch and strengthen; steroid injections for pain relief.

Treatment (Surgery)
unusual: day-case arthroscopy to remove bursitis.

HIP DISPLASIA

Also known as acetabular dysplasia, developmental dysplasia of the hip (DDH), when the hip socket doesn’t properly develop making is shallow and more upwardly mobile than usual.

Causes
Abnormal development during childhood putting greater load through the socket and easily causing tears in the labrum (rubbery rim cartilage) leading to instability and possible arthritis; more common in female; often genetic.

Symptoms
Groin pain; outside hip and buttock pain; reduction in exercise ability; stabbing pain while twisting, rising from a chair, squatting; dull ache; inability to walk long distance.

Diagnosis
Medical examination; X-ray; CT, MRI scans.

Treatment (Surgery)
periacetabular osteotomy (PAO): changing hip socket position to cover more femoral (ball) head; arthroscopy to repair torn labrum (cartilage); total hip replacement if osteoarthritis has developed.

Orthopaedic Conditions

OSTEOARTHRITIS (OA) KNEE

This is the most common type of OA due to the complex nature of the knee joint. It is the wear and tear of cartilage (rubbery and smooth) over the lower end of the thigh bone (femur), top of the shin bone (tibia) and behind the knee cap (patella), which moves as the knee bends and straightens. It can affect all areas of the joint.

Causes
Wear and tear with age as the cartilage rubs thin; inherited traits that put pressure on the joints (e.g. bow legs); injury to the joint and surrounding ligaments (e.g. anterior cruciate ligament injury - ACL).

Symptoms
Pain; swelling; restricted movement; stiffness in the morning or after sitting; creaking sensation when walking or squatting.

Diagnosis
Medical examination; X-ray; MRI scanning when diagnosis is complex.

Treatment (Non-operative)
painkillers and anti-inflammatories; physiotherapy; low impact strength and fitness exercises, plus cycling and swimming; acupuncture; maintaining and healthy body weight; viscosupplementation: a synthetic synovial fluid injected into the joint.

Treatment (Surgery)
total (TKR) or unicompartmental (UKR) knee replacement; osteotomy: a procedure to realign the joint.

OSTEOARTHRITIS (OA) ANKLE

This happens where smooth cartilage lining the bones inside the ankle joint becomes worn and slowly causes friction during movement.

Causes
Previous ankle fracture or sprain; gout; bleeding disorder such as haemophilia; ankle infection; increasing unattended pain and stiffness.

Symptoms
Pain especially when moving; swelling; heat that increase over time; inability to wear normal shoes; deformity in severe cases.

Diagnosis
Medical examination; X-ray; MRI scan.

Treatment (Non-operative)
brace, supportive boots to stabilize; rocker-bottom or cushioned shoes to absorb impact while walking; anit-inflammatories; pain killers; steroid injections.

Treatment (Surgery)
debridement via arthroscopy to scrape clean the joint; joint replacement with less predictable outcome than ankle fusion to stiffen the ankle permanently while maintaining an active lifestyle, even jogging, running.

OSTEOARTHRITIS (OA) BIG TOE / HALLUX RIGIDUS

This happens when the big toe becomes stiff/rigid at the metatarsophalangeal joint affecting one or both feet.

Causes
Wear and tear; repetitive strain injury.

Symptoms
Pain, stiffness in the joint especially when toe bends upwards; bump on the top of the joint causing shoes to rub.

Diagnosis
Medical examination; X-ray.

Treatment (Non-operative)
special-made insoles to relieve pressure on the joint; pain killers; anti-inflammatories.

Treatment (Surgery)
cheilectomy to remove joint bumps (dorsal osteophyte or bone spur); debridement to scrape clean arthritic joint surface; fusion surgery using plate and screws to leave a pain-free yet stiff joint; big toe replacement – rare.

OSTEOARTHRITIS (OA) HINDFOOT

This section of the foot is between heel bone and midfoot area.

Causes
Post bone-fracture trauma; rheumatoid arthritis; tibilialis posterior tendon dysfunction that causes foot arch to flatten.

Symptoms
Aching in the mid or back foot when walking; loss of flexibility in the foot; ankle area swelling; changes to foot shape becoming flatter; heel bone pointing outwards; shoe rubbing.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (Non-operative)
stiff soled or rocker-bottom shoes to aid comfortable walking’ insoles; pain killers, anti-inflammatories; steroid/anaesthetic injections every six months’ physiotherapy to relax calf muscles and strengthen foot muscles.

Treatment (Surgery)
foot fusion to fuse painful joints.

OSTEOARTHRITISI (OA) MIDFOOT

This section, beginning at the Chopart joint, consists of five bones (cuboid, navicular, medial, intermediate, lateral cuneiform) connected to each other, the hindfoot and the forefoot where the metatarsal bones begin.

Causes
Bone fracture/dislocation at any of the small joints or bones; rheumatoid arthritis; tibialis posterior dysfunction where the tendon causes the foot arch to flatten – as with hindfoot arthritis also; certain types of shoe.

Symptoms
Aching, swelling of the area while active; loss of flexibility; swelling on the top of the foot; flatter looking foot.

Diagnosis
Medical examination; X-ray; CT scan.

Treatment (Non-operative)
Stiffer sole or rocker bottom shoes; avoiding certain exercise; physiotherapy to relax calf muscles and to remove overload on the area; anti-inflammatories; steroid/anaesthetic injections every six months.

Treatment (Surgery)
removal of bony lumps on the top of the foot; fusion surgery of the small painful joints.

OSTEOARTHRITIS (OA) NECK / SPONDYLOSIS

Osteoarthritis (OA) or spondylosis is the degeneration of spinal cartilage and the formation of bone spurs (bony lumps) in reaction to cartilage loss. It affects over 80% of people over 60, developing slowly over time.

Causes
Family history of neck pain; previous neck injury; smoking; depression or mental illness; excessive neck movement in work or sports.

Symptoms
Pain, stiffness and reduced range of motion in the neck area; tenderness, headaches, nausea and dizziness; ‘crunching’ or ‘clicking’ when moving (caused by rubbing bones); bony lumps (bone spurs) in the back; tingling and numbness in the arms (brachialgia).

Diagnosis
Physical examination to assess range of spinal movement, feeling and reflexes in hands and feet; X-ray; MRI.

Treatment (Non-operative)
Gentle exercise programme: swimming, walking; anti-inflammatories; spinal steroid injection (for pain relief not treatment); physiotherapy; osteopathy; chiropractics; acupuncture.

Treatment (Surgery)
anterior cervical discectomy (disc removal), laminectomy or disc replacement.

OSTEOARTHRITIS (OA) HIP

This is caused by damage to the cartilage over the joint surfaces of the hip.

Causes
Age related wear and tear; abnormal hip conditions such as dysplasia.

Symptoms
Dull hip ache; affecting groin, buttocks, thighs; difficulty in walking long distance without limping; climbing stairs; bending down; pain in the night.

Diagnosis
Medical consultation; X-ray; MRI; CT scan.

Treatment (Non-operative)
gentle exercise programme such as biking; weight loss; anti-inflammatories.

Treatment (Surgery)
total hip replacement is the only treatment for complete cure; arthroscopy to treat the ‘catching’ of the joint.

OSTEOARTHRITIS (OA) HAND

OA of the hand develops when the cartilage, covering the ends of the bones in the hand, wears down to cause friction over the joints, which begin to rub against each other.

Causes
Years of use manifesting from middle age; damage to the joints, such a fracture.

Symptoms
Pain, especially from working the joint over time; limited movement; instability; weakness when holding things; cysts near the end of the finger when OA affects this area.

Diagnosis
Medical examination; blood tests; X-ray; bone or MRI scan.

Treatment
Depending on age, state of progression, objectives and medical history.

Treatment (Non-operative)
anti-inflammatories; steroid injections; a splint to support the joint when using the hand.

Treatment (Surgery)
debridement: a procedure to scrape the joint clean, via arthroscopy in early stages; joint fusion where damaged surfaces are removed so that the joint no longer moves; arthroplasty: joint replacement, though long term success in hands and wrists is variable.

OSTEOARTHRITIS (OA) THUMB

This is the wearing away of cartilage in the thumb joints so that the bones’ rough surfaces rub together.

Causes
When ligaments, commonly from middle age, become loose at the thumb base, so that the joint slips putting extra stress on the cartilage; previous joint damage/fracture; more prevalent in women.

Symptoms
Pain, particularly when gripping; tenderness and bony bumps at the base of the thumb.

Diagnosis
Medical examination - with tests for carpal tunnel syndrome; X-ray.

Treatment
Depending on age, state of progression, objectives and medical history.

Treatment (Non-operative)
anti-inflammatories; thumb splint to allow joint to rest; steroid injection.

Treatment (Surgery)
Fusing the bones around the joint (limits movement); removing part of the joint and rebuilding it with nearby tissue, followed by 6 weeks in a splint.

OSTEOARTHRITIS (OA) WRIST

This is the wearing away of cartilage around the joints in the wrist so that the bones’ rough surfaces rub together.

Causes
Years of use, affecting those from middle age; previous damage such as fracture or ligament injury; Kienböck’s Disease (when the ‘lunate’ bone, one of 8 small bones in the wrist, loses blood supply and dies).

Symptoms
Pain and ‘grating’, worsening with movement; heat sensation; swelling, feeling of instability.

Diagnosis
Medical examination; X-ray, blood tests, MRI (if Kienböck’s Disease suspected); bone scans.

Treatment
Depending on age, state of progression, objectives and medical history.

Treatment (Non-operative)
anti-inflammatories; steroid injections; wearing a splint to support the wrist; limiting or ceasing some activities for a while; specific exercise routine.

Treatment (Surgery)
carpectomy - removal of three carpal tunnel bones to relive pain; partial (fusing some carpal joints) or complete (plus fusing the radius bone) joint fusion, both of which reduce range of motion; arthroplasty: joint replacement surgery to retain wrist movement.

OSTEOARTHRITIS (OA) SHOULDER

This is friction between the bones in the shoulder when the cartilage surrounding them is irritated, inflamed or wears down.

Causes
Years of movement, thus commonly affecting people from middle age; trauma such as dislocation or fracture.

Symptoms
Pain; stiffness; reduced range of motion.

Diagnosis
Medical examination; blood test; X-ray; MRI or CT scans for joint spurs, socket erosion and other damage.

Treatment
Depending on age, state of progression, objectives and medical history.

Treatment (Non-operative)
anti-inflammatories; steroid or joint lubricant injections (often hyaluronic acid).

Treatment (Surgery)
debridement: a procedure to scrape the joint clean, via arthroscopy in early stages; shoulder replacement.

OSTEOARTHRITIS (OA) ELBOW

Elbow OA is pain and irritation caused by the erosion of cartilage (a lubricating layer to minimise friction between joints) so that bones rub against one another in the elbow joint.

Causes
General wear and tear from age; injury such as dislocation and fracture of the elbow joint.

Symptoms
Pain; irritation, stiffness due to inflammation; a reduced range of movement.

Diagnosis
Medical examination; X-ray; blood tests, MRI scan.

Treatment
Dependent on age, future objectives and medical history.

Treatment (Non-operative)
Non-operative treatment: anti-inflammatory medication.

Treatment (Surgery)
debridement: a surgery to scrape clean the joint, via arthroscopy in early stages; arthroplasty: joint replacement, in more advanced cases.

RHEUMATOID ARTHRITIS FEET

This is chronic, auto-immune disorder, in foot and ankle joints, that progresses over time affecting more women than men.

Causes
Still under research though linked to smoking; infections; viruses; genes.

Symptoms
Ankle: discomfort and stiffness while walking or bending the joint.

Diagnosis
Monitoring symptoms; medical examination; blood tests to assess inflammation levels in the body.

Treatment (Non-operative)
pain killers; anti-inflammatories; braces/supports or orthotics/insoles to stabilise joints; steroid/anaesthetic injections; ultrasound; bespoke rigid shoe.

Treatment (Surgery)
foot or toe fusion; bunion removal, ankle replacement.

OSTEOPOROSIS

This is caused by thinning and disintegration of bones, making them susceptible to break when falling; common in 50% of women and 25% of men over 50 who are likely to suffer a fracture associated with osteoporosis.

Causes
Poor diet; low body weight; smoking; drinking more than 4 alcohol units per day; diabetes; family history; leukemia; Crohn’s disease; ankylosing spondylitis; hyperthyroidism.

Symptoms
Not until a fracture happens; menopause; vertebral compression leading to rounded upper back.

Diagnosis
X-ray; bone density (DEXA) scan.

Treatment (Non-operative)
Calcium, Vitamin D supplement, improved diet; hormone replacement therapy (HRT); bisphosphonates.