Joint &
Musculoskeletal Pain

Joint Pain ( Shoulder, Hip,
Knee )

What is the treatment for joint pain due to arthritis?

Initial treatment may include physical therapy, exercises that off-load the painful joints, glucosamine supplements and oral painkillers.

What is viscosupplementation?

Viscosupplementation involves injecting a gel-like substance called hyaluronic acid into the joint to lubricate and cushion the joint. Such treatment may help reduce joint pain for about 6-12 months.

Can radiofrequency ablation help reduce joint pain?

Yes. Radiofrequency (RF) ablation uses RF energy to generate heat. This heat is targeted at nerves that supply the joint. By removing painful signals within the nerves, pain from the joint is reduced.

RF ablation has been shown to be effective in reducing shoulder, hip and knee pain, improving mobility and range of motion. The effect can last up to 2-3 years. This also avoids the surgical risk of undergoing a joint replacement surgery, especially in elderly patients who may have multiple medical problems.

Rotator Cuff Syndrome

Rotator Cuff Syndrome

It is a condition to describe degeneration or injury of the muscles and tendons surrounding the shoulder joint (rotator cuff).

What are the symptoms of rotator cuff syndrome?

It usually presents with a deep dull ache in the shoulder, making it difficult to lie on the same side and therefore affecting sleep. There may be restrictions to movement affecting your ability to raise your arm to comb your hair, to remove your shirt or to reach behind your back.

How is rotator cuff syndrome treated?

Physiotherapy to restore flexibility and strength is usually the first treatment.

Steroid injections can also give temporary relief especially if the pain is interfering with your sleep and daily activities.

Surgery may be needed if MRI shows significant tendon or muscle tears.

Shoulder Arthritis

What is shoulder arthritis?

Shoulder arthritis occurs when there is damage to the cartilage inside the shoulder joint. The arthritis can result from wear and tear or from trauma.

What are the symptoms of shoulder arthritis?

Pain is the main symptom and is usually worse with activities such as exercising, lifting or carrying heavy objects. There may also be stiffness and loss of range of motion of the shoulder. Clicking or grinding sounds are not uncommon too.

How is shoulder arthritis treated?

Range of motion exercises are important to keep the joint mobile. Lifestyle modifications are necessary to reduce the triggers that cause pain.

Non-surgical treatment includes ultrasound-guided steroid injection into the shoulder joint, as well as radiofrequency ablation to remove the painful nerves around the joint.

Severe shoulder arthritis not responding to conservative treatment will require surgery.

Hip Arthritis

What is hip arthritis?

Hip arthritis is degeneration of the cartilage within the hip joint. It occurs with ageing or after injury to the hip. Less common causes are avascular necrosis of the hip and rheumatoid arthritis causing early destruction of the hip joint.

What are the symptoms of hip arthritis?

Pain in the hip, groin or buttock which is worse with movement. Stiffness with reduced range of motion, grinding or clicking noises are also common.

How is hip arthritis treated?

Non-surgical treatments include physiotherapy, activity and lifestyle modifications, hip strengthening exercises, and taking pain medication when necessary.

Steroid injection or hyaluronic acid injection into the hip joint can be administered for short to medium term pain relief.

Radiofrequency ablation of the articular nerves of the hip joint can also effectively relieve pain for a few years without the need for hip replacement surgery.

Knee Osteoarthritis

What is knee osteoarthritis?

Osteoarthritis (OA) is a degenerative condition of the knee where the cartilage is gradually worn out. Besides ageing, previous injury, infection, and obesity are other factors that can lead to OA.

What are the symptoms of knee OA?

Pain or swelling that is worse with activity.

Stiffness, especially after sitting for a while or in the morning upon waking up.

Reduced range of motion and grinding sounds in the knee.

How is knee OA treated?

Initial treatment includes weight loss, strengthening and stretching exercises and knee brace to unload or support the knee joint.

Injection of steroid into the inflamed knee joint, or injection of hyaluronic acid to increase lubrication in the knee can give short-term relief.

Some patients will also benefit from radiofrequency ablation of the genicular nerves of the knee to reduce pain. Advanced OA with significant joint deformity or restricted movement will require joint replacement surgery.

Myofascial Pain

What is myofascial pain?

Myofascial pain is a chronic painful condition that affects muscles and the sheath (called fascia) that surrounds the muscles.

It is caused by muscle tension, trauma as well as repetitive motion due to work. Typically, knots or taut bands can be felt within the muscle and there are also sensitive areas called trigger points, which are painful when touched.

What is the treatment for myofascial pain?

Avoiding repetitive strain injury, correcting posture, stretching exercises etc. are important in preventing myofascial pain. Physiotherapy and trigger point injections are useful in breaking the vicious cycle and stop the pain from persisting.

How are trigger point injections done?

Trigger points within the muscle are identified manually and a local anaesthetic is injected into the muscle fibre. Repeated trigger point injections may be needed for chronic myofascial pain. Occasionally, Botulinum toxin injection into the trigger point can help prolong the pain relief to about 3-6 months.

Fibromyalgia

What is fibromyalgia?

People with fibromyalgia generally have chronic widespread pain and sensitivity to touch or pressure involving many parts of the body. They may also have associated symptoms of headaches, chronic fatigue, sleep problems, poor concentration and even restless legs. Anxiety, depression and other mood disorders are common too.

Unfortunately, it is a disease poorly understood even among doctors and therefore frequently missed or misdiagnosed. The cause is unknown and may result from a combination of genetic and environmental factors.

What is the treatment for fibromyalgia?

Firstly, it is important to exclude other medical conditions that can manifest with similar symptoms of generalised muscle and joint pain through relevant blood tests or imaging studies.

When the diagnosis is confirmed, a holistic treatment including medications, exercises, physiotherapy, improving sleep as well as dietary changes may be necessary. A referral to a psychologist will usually be made to help you develop skills in relaxation techniques, pacing and other behavioural modification.

Sports Injuries

What are sports injuries?

Sports injuries are divided into two broad categories: acute and chronic injuries. Acute injuries occur immediately after an aggravating incident, for example, sprains and dislocations. Chronic injuries result from overuse and develop gradually over time. They include stress fractures, tendinitis as well as ligament strains. Injuries resulting from sports or exercises are very common and affect both competitive athletes and recreational sportsmen.

What are the common types of sports injury?

Besides sprains of the neck and back, people who play racquet ball games such as tennis, badminton, or squash are prone to shoulder (rotator cuff) injuries, tennis elbow (lateral epicondylitis), or knee pain (patella tendinitis). Basketball or volleyball players who jump excessively develop injuries of the knee and ankle, e.g., patella tendinitis and Achilles tendinitis. Football players are prone to hamstring and adductor strains, anterior cruciate ligament tears, meniscus tears as well as ankle sprains.

How are sports injuries treated?

Early recognition of the condition is important. Resting and icing the painful area helps. You should not return to play without proper assessment by a doctor as incomplete healing can develop into a chronic pain condition. Appropriate rehabilitation through addressing biomechanics, progressive muscle/tendon loading, and maintain general aerobic condition are important before returning to sports. The secondary aim is also to prevent re-injury.

Tennis Elbow (Lateral epicondylitis)

What is tennis elbow?

Tennis elbow is a painful condition affecting the tendons of the forearm muscles attached to the outside of the elbow (the lateral epicondyle). It is commonly a result of repetitive overuse of the wrist and arm.

It not only affects athletes who play racquet games but is also common in other professions involving heavy work on the hands, for example, plumbers, carpenters and chefs.

What are the symptoms of tennis elbow?

Pain is localised to the outside of the elbow and actions such as turning a doorknob, shaking hands or gripping a cup can make the pain worse.

How is tennis elbow treated?

Most people will recover with rest, ice, anti-inflammatory painkillers and physiotherapy.

Wearing an elbow brace also helps.

Shockwave therapy can help by using sound waves to stimulate natural healing within the tendon.

Other non-surgical treatment include injection of steroid or platelet-rich plasma. Both procedures are performed in the outpatient clinic.

Golfer’s Elbow (Medial epicondylitis)

What is golfer’s elbow?

Golfer’s elbow is a painful condition affecting the tendons of the forearm muscles that attaches to the inside of the elbow (the medial epicondyle). It develops from repetitive twisting and clenching activities leading to overload of the tendons.

Golf, racquetball games and lifting weights are common causes. Manual work requiring the use of the wrist and arm can also lead golfer’s elbow.

What are the symptoms of golfer’s elbow?

Pain is localised to the inside of the elbow. Pain is worse when gripping, bending the wrist or lifting a heavy object with the palm facing upwards. Grip strength is also reduced.

How is golfer’s elbow treated?

Most people will recover with rest, ice, anti-inflammatory painkillers and physiotherapy. Wearing an elbow brace also helps.

Shockwave therapy can help by using sound waves to stimulate natural healing within the tendon.

Other non-surgical treatment include injection of steroid or platelet-rich plasma. Both procedures are performed in the outpatient clinic.

Patella Tendinitis

What is patella tendinitis?

Patella tendinitis is an overuse injury of the tendon between the knee cap (patella) and the shin bone.

It is also known as jumper’s knee because it is common in sports such as basketball and volleyball where a lot of jumping is involved.

What are the symptoms of patella tendinitis?

Pain at or just below the knee cap occurring during exercises. As the pain worsens, pain may even interfere with daily activities such as walking and climbing stairs.

How is patella tendinitis treated?

Initial treatment includes physiotherapy, stretching and strengthening exercises. Wearing a patella tendon strap also helps.

Occasionally pain medication is needed.

Prevention: strengthening of the thigh muscles, correct biomechanics and rest when the knee is painful are important to prevent recurrence of symptoms.

Knee Sprains: Ligament or Meniscus Injury

What can happen in a knee sprain?

The outer ligaments (medial and lateral collateral ligaments) and inner ligaments (anterior and posterior cruciate ligaments) give support to the knee. Two C-shaped cartilages (medial and lateral meniscus) within the knee joint act as cushions between the thigh and shin bones.

Knee injuries from twisting, or direct impact from a collision can damage both ligaments and menisci.

What are the symptoms of ligament or meniscus injury?

Pain, swelling, stiffness, instability and locking of the knee joint. Sometimes you may even hear a pop during the time of injury, which may suggest an anterior cruciate ligament tear.

How is ligament or meniscus injury treated?

Mild sprains are treated by rest, ice, compression, and elevation. When swelling resolves, early mobilisation is usually recommended.

Severe knee sprains may need an MRI scan for further evaluation and surgical intervention.

Ankle Sprain

What is an ankle sprain?

An ankle sprain is an injury when the ankle is twisted in an awkward angle, straining or even tearing the strong ligaments that support the ankle. Ninety percent of ankle sprains injure the ligaments on the outside of the ankle (an inversion injury where the foot turns inwards).

Tripping or falling on an uneven surface, sports such as football, basketball and running are common cause of ankle sprains.

What are the symptoms of an ankle sprain?

Pain, swelling, bruising and instability are common symptoms.

How is an ankle sprain treated?

Sprains are treated initially by rest, ice, compression, elevation, and a short period of immobilisation.

When swelling resolves, early weightbearing, range of motion exercises, balance training, calf stretches and strengthening are important for rehabilitation.

Ankle sprains with severe instability, complete ligament/tendon tears may sometimes need surgical intervention.

Achilles Tendinitis

What is Achilles tendinitis?

Achilles tendinitis occurs when overuse of the tendon between the calf muscle and the heel leads to pain, inflammation and swelling. It is common in sports that involve a lot of jumping, landing and start-stop running, e.g., basketball, volleyball, runners and dancers.

What are the symptoms of Achilles tendinitis?

Pain and swelling in the lower end of the calf muscle or heel. Pain can also be aggravated when standing on tiptoe or when stretching the calf muscle.

How is Achilles tendinitis treated?

Rest, ice and non-steroidal anti-inflammatory medications to reduce pain and swelling. Wearing shoes with a heel lift to reduce tension in the Achilles tendon.

Initial stretching exercises to loosen the calf muscles followed by strengthening. Sometimes, switching to low-impact sports is necessary.

There is also evidence that shockwave therapy can help relieve Achilles tendinitis affecting the midportion of the tendon.

Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis is a common cause of foot pain. It is caused by inflammation of the plantar fascia – the thick band of ligament stretching across the foot arch between the heel and the toes.

It commonly affects people between 40 to 60 years old; and those with high arch, flat feet or tight calf muscles. People who run, dance or participate in high-impact sports are also at risk.

What are the symptoms of plantar fasciitis?

Plantar fasciitis typically causes sharp pain at the bottom of the foot near the heel. Pain is worse when getting out of bed in the morning. Pain is also aggravated by prolonged standing.

How is plantar fasciitis treated?

Initial treatment usually involves physiotherapy to stretch the Achilles tendon and plantar fascia. Wearing a night splint and arch support may also help.

Other treatments include injection of steroid and platelet-rich plasma, shockwave therapy or ultrasonic tissue repair.