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‘Where does it hurt?’: Primary care tips for common ortho problems


Knee and shoulder ache are widespread complaints for sufferers within the main care workplace.

However figuring out the supply of the ache will be difficult,

and an correct prognosis of the underlying reason for discomfort is essential to applicable administration – whether or not that entails easy residence care choices of ice and relaxation or a advice for a follow-up with a specialist.

Talking on the annual assembly of the American Faculty of Physicians, Greg Nakamoto, MD, division of orthopedics, Virginia Mason Medical Middle, Seattle, mentioned widespread knee and shoulder issues that sufferers usually current with within the main care setting, and provided recommendations on prognosis and applicable administration.

The commonest situations inflicting knee ache are osteoarthritis and meniscal tears. “The differential for knee ache is broad,” Dr. Nakamoto mentioned. “You need to have a approach to divide it down, comparable to if it’s acute or power.”

The preliminary workup has a number of key elements. The primary steps: Decide the placement of the ache – anterior, medial, lateral, posterior – after which whether or not it stems from an harm or is atraumatic.

“If you must ask one query – ask the place it hurts,” he mentioned. “And is it from an harm or simply put on and tear? That helps me when deciding if surgical procedure is required.”

Ache within the knee typically localizes effectively to the positioning of pathology, and knee ache of acute traumatic onset requires extra scrutiny for issues greatest handled with early surgical procedure. “This additionally helps set up whether or not radiographic findings are as a consequence of harm or degeneration,” Dr. Nakamoto mentioned. “The presence of swelling guides the necessity for anti-inflammatories or cortisone.”

Palpating for tenderness alongside the joint line is vital, as is palpating above and beneath the joint line, Dr. Nakamoto mentioned.

“Tenderness restricted to the joint line, mixed with a meniscal examination maneuver that reproduces joint-line ache, is suggestive of ache from meniscal pathology,” he mentioned.

Imaging is a vital part of evaluating knee signs, and the query usually arises as to when to order an MRI.

Dr. Nakamoto provided the next state of affairs: If important osteoarthritis is clear on weight-bearing x-ray, deal with the affected person for the situation. Nevertheless, if little or no osteoarthritis seems on x-ray, and if the onset of signs was traumatic and each affected person historical past and bodily examination recommend a meniscal tear, order an MRI.

An early MRI additionally is required if the affected person has had both atraumatic or traumatic onset of signs and their historical past and bodily exams are suspicious for a mechanically locked or locking meniscus. For suspicion of a ruptured quadriceps or patellar tendon or a stress fracture, an MRI is required urgently.

An MRI can be ordered later if the affected person’s signs haven’t improved considerably after 3 months of conservative administration.

Dr. Nakamoto pressured how widespread undiagnosed meniscus tears are within the basic inhabitants. A 3rd of males aged 50-59 years and practically 20% of ladies in that age group have a tear, he mentioned. “That quantity goes as much as 56% and 51% in women and men aged 70-90 years, and 61% of those tears have been in sufferers who have been asymptomatic within the final month.”

Within the setting of osteoarthritis, 76% of asymptomatic sufferers had a meniscus tear, and 91% of sufferers with symptomatic osteoarthritis had a meniscus tear, he added.



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