This document discusses various musculoskeletal conditions seen in orthopedic practice including osteoarthritis, rheumatoid arthritis, trigger finger, tennis elbow, ganglion cysts, fractures, and low back pain. For each condition, it provides details on symptoms, causes, diagnostic approach and treatment options. Non-surgical treatments discussed include medications, bracing, exercise, and physical therapy. Surgical interventions like injections, arthroscopy and joint replacement are mentioned for more severe cases.

1. Dr. S.V. Khond

2.  Osteoarthritis
 Low back pain
 Trigger thumb
 Tennis elbow
 Ganglion /Wrist cyst
 Fractures

3.  Osteoarthritis is the most common, and it is a
degenerative disease that affects the cartilage.
Rheumatoid arthritis, which also affects the
cartilage, is characterized by swollen, inflamed
joints. It is important to note, however, that
overlap between the two does exist.
 Osteoarthritis
 Pain and stiffness worsens with use (symptons
worse later in the day)
 Older age of onset
 Inflammation and swelling is minor
 Often non-symmetrical

4.  Rheumatoid Arthritis
 Pain and stiffness often better with use
(symptoms worse beginning of the day)
 Younger age of onset
 Inflammation and swelling is apparent
 Often symmetrical

6. Some of the treatments for knee arthritis include; lifestyle modifications
such as losing weight, changing your sport from high-impact sports like
running to cycling and swimming, exercise, braces and other supportive
devices, anti-inflammatory medications, glucosamine and chondroitin
sulfate (which help alleviate osteoarthritic pain), among other medications.
 Severe Arthritis
 For severe arthritis that does not respond to the above therapies, surgery
may be indicated. At this point, the knee cartilage is often very worn and
damaged.
 Arthroscopic surgery which repairs torn cartilage and cleans up the
joint.
 Knee arthroplasty - after the joint is cleaned, metal and plastic parts
are used to partially or completely rebuild the knee.
 Osteotomy - a bone or bones in the leg are trimmed to improve
alignment of the knee.
 Cartilage graft - a relatively new procedure, it involves replacing the
damaged cartilage with new cartilage.

7.  Finger keeps locking & hurts to touch my palm
 "My finger is stuck and locks in the morning and I have
to force it straight"
 "My finger is clicking and locking"
 Trigger finger is a condition affecting the tendons involved
in bending the fingers which connect the muscles of the
forearm to the bones of the fingers. It results in a finger
bent into a “trigger” position, and is more common in
people over age 40 with a history of rheumatoid arthritis
or diabetes.
 The exact cause of trigger finger is unknown, but it
involves swelling and thickening of the tendon sheath. As
the sheath becomes inflamed, the tendon can no longer
glide back and forth smoothly and catches with bending of
the finger, causing further irritation. Eventually, the finger
may become locked into place.

8.  Resting the affected finger, often in a splint,
to allow the inflammation to go down
 Anti-inflammatory medications may also be
useful
 If these initial therapies do not relieve your
symptoms, a steroid injection into the
tendon sheath may prove helpful
 For those patients with rheumatoid arthritis
or diabetes, an outpatient surgical procedure
may be necessary.

9.  Tennis elbow is an inflammation of the
tendons that join the forearm muscles on the
outside of the elbow.
 Tennis elbow, or lateral epicondylitis, is a
painful condition of the elbow that can be
caused by overuse or instigated by trauma. It
can caused by playing tennis or other racquet
sports but many people who play no sports at
all suffer from tennis elbow.
 Dishwasher , washing clothes


10.  Pain and tenderness on the outside of the elbow.
 simplest of tasks painful and debilitating including
lifting a cup of coffee, shaking hands, writing and
typing.
 Typically any kind of lifting is extremely painful.
 Lateral epicondylitis, or tennis elbow, involves the
muscles and tendons of your forearm. Your forearm
muscles extend your wrist and fingers. Your forearm
tendons -- often called extensors -- attach the
muscles to bone. They attach on the lateral
epicondyle. The tendon usually involved in tennis
elbow is called the Extensor Carpi Radialis Brevis
(ECRB).

11.  Non surgical treatment typically involves
Splinting, tennis elbow brace
 Exercises and medicine either by mouth or
injection
 Intralesional steroid injections
 Physical or Occupational Therapy is needed.
 Shockwave therapy, Arthroscopic
Surgery and Open Surgery.

12.  A ganglion is a balloon like structure that
grows out of a joint, formed by connective
tissue.
 Ganglion cysts are benign lumps growing
typically on the top of the wrist, though they
may appear on the underside of the wrist or
at the tip or base of a finger.
 Although the exact cause of ganglion cysts is
unknown, they are more common in people
applying frequent pressure to the wrist, such
as gymnasts. They are more common in men
than in women.

13.  Both a physical exam
 And imaging studies, such as MRIs and X-rays, to
rule out other causes of growths in the wrist
region.
 There are several treatment options for wrist
cysts, and most are quite non-invasive:
 Simply wait and see if the cyst goes away on its
own.
 Wrist brace to reduce pain and pressure on the
affected region.
 Draining the fluid from the cyst,
 A simple surgical procedure may be performed to
removed the ganglion cyst, although it may still
reappear in some cases.

14.  C/o :
 Acute onset pain while lifting heavy
object,getting up from sitting position,
 LBP radiating to posterior thigh ,buttocks and
calf muscles
 Difficulty in bending forwards,

15.  Xray lumbar spine AP and Lateral views with
bowel preparation

16.  Lumbar strengthening exercises,
 Flexion and extension exercises ,
 Short wave diathermy SWD,
 Lumbar traction and use of lumbar belt,
 NSAIDS and muscle relaxants for spasm of
paraspinal muscles,
 Calcium supplements,
 Vitamin D3 injections and capsules.

17.  c/o
 Pain and swelling
 Tenderness over fracture site
 Abnormal mobility

18.  Wrist and lower end radius, ulna fracture
should be given below elbow POP
slab/splint/ brace immobilization and limb
elevation
 Fracture radius ulna shaft , both bone
forearm fracture, supracondylar humerus TY
type should be given above elbow slab
 Fracture shaft humerus –U slab
 Ankle sprain and swelling should be given
below knee POP slab and limb elevation