Orthopedics and GPs

1. Basics of Orthopedics
for GPs
Dr. Ahmed Waly
Lecturer Orthopedics and
Traumatology Alexandria University

3. Be Systematic
• History
Past, Present, Medical, Family, Drug…
• Examination
Inspection, Palpation, specific tests
• Investigation
Blood tests, x-ray, CT scan, MRI, U/S

4. When to refer??
NB: there is always something you don’t
know !!!
Be safe
The eyes can’t see what the mind
don’t know

5. The skeleton
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Neck
Back
Upper limbs
Lower limbs

6. Neck Pain
- Spasmodic torticolis
- Cervical spondylosis
- Nerve root irritation, entrapment
- Cervical rib
- Systematic: ankylosing, polymyalgia, fibromyalgia……

7. Low Back Pain (LBP)
• Acute - Chronic
• Aetiology:
Age:
15-30: post, mech, ank, spond, disk
30-50: post, deg, disk, 2ries
> 50: post, deg, osteoporosis, malig.
other causes: referred, stenosis, infection

8. Red flags:
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< 20y or >55y
Non mechanical
Thoracic pain
Past history of malignancy
Wide spread neurology
Deformity
Unwell, taking steroids, unwell, weight
loss, HIV

9. Triage back pain
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Simple back pain
Nerve root pain
Red flags
Cauda equina syndrome

10. Upper limb
Shoulder problems
• Rotator cuff
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- Acute or chronic tendinitis, tears
- Impingement syndrome
Frozen shoulder
Acromio-clavicular problems
Rupture long head of biceps

11. Elbow, wrist and hand
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Tennis and golfer’s elbow (epicondylitis)
Pulled elbow
Olecranon bursitis
Ulnar neuritis
Tenosynovitis
Carpal tunnel syndrome (CTS)
Ganglion
Trigger finger
OA

12. Lower limb
Hip problems
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OA
Trochanteric bursitis
Fascia lata syndrome
Pyriformis syndrome
Fascia lata syndrome
Avuscular necrosis

13. Child hip
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Transient synovitis
DDH
Perthes
SCFE

14. Knee problems
Old age
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OA
Backer’s cyst
Loose Bodies
Deg meniscal problems
Synovitis
NB: Plan x-ray important  why?

16. Young age :
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Anterior knee pain
Osgood-sclatter syndrome
Osteochondritis dissecans
Patellar dislocations, sublaxation and
maltracking
• Patellar tendinititis

17. Knee problems
young age (cont)
• Synovitis
• Iliotibial tract
syndrome
• Shin splints
• Growing pains
• Deformities:
genuvarum and
valgum

18. Ankle problems
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Achilles tendinitis
Rupture Achilles tendon
Osteochondritis talus

19. Foot problems
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Flat foot
TEV, pes Cavus
Hammer, clow toes
Hallux: valgus, rigidus, IGTN
Plantar fasciitis

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Metatarsalgia
Morton’s neuroma
Stress fracture
Avuscular necrosis: navicular, head mets,
heel

22. Rheumatological conditions
• Multiple joint and muscle pain, ? Young
age, morning pains.
• Recurrent pains
• Not improving on AI
• Dramatic effect on steroids
Investigate – refer to Rheumatology

23. Infections
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Septic arthritis
Osteomyelitis
Flexor tendinitis

24. Tumours
• Benign
• Malignant