Block 14: Musculoskeletal conditions. Dr.P.T.Kenny, Dept. Family Medicine,U.P.

What is the importance of this block for the generalist? Patient complaints due to problems experienced with the musculoskeletal system are very common. It occurs “from womb to tomb” and nobody escapes these problems! Let us briefly look at the reasons why this block is important to you.

Babies They may be born with clubfeet, spina bifida, congenital hip dislocation or sometimes with a fractured clavicle. These conditions must be managed without delay and every doctor must be able to diagnose it and to manage it appropriately.

Toddlers Knock-knees (genu valgus), bowlegs (genu varus), flat feet, curly or overriding toes, as well as greenstick fractures of the long bones are frequently seen during this phase of life. It is very important to know about Perthe’s disease and other causes of limping in a child. You should know which conditions will resolve spontaneously and which ones require immediate action, etc. These conditions usually cause great concern for the parents and grandparents. Knowledge regarding these conditions is very important for any doctor in order to act confidently and to be able to explain to the parents what progress can be expected. Worried parents usually travel from doctor to doctor and even from specialist to specialist with these children, because their fears and expectations are not addressed.

Young children Due to competitive sports, even at primary school level, young children often suffer from conditions like "growing pains", osteochondritis and osteochondroses, various types of fractures, soft tissue injuries, sprains, etc. Other conditions, e.g. scoliosis, kyphosis, infective arthritis, osteomielitis and even bone cancers are seen in these children. Knowledge regarding these conditions is essential to any doctor.

Adolescents / young adults Sports injuries are very common in this group of patients, but they may suffer from various other orthopaedic problems. These days more and more young people pursue a career in professional sport and they often seek advice or treatment from their GPs. Advice regarding vitamins, supplements or special diets is often sought. Young women wearing platform-type shoes easily sustain sprains, which the generalist has to manage. Stress fractures and other conditions due to over-exercising are also seen frequently in this group. Bursitis, tendonitis, knee or ankle injuries, neck injuries, torn muscles or ligaments, etc. need to be treated correctly and/or referred appropriately. You will one day experience a lot of pressure from patients who expect of you to solve their orthopaedic problems immediately.  

Middle aged patients These patients can develop any type of orthopaedic problem, because these days people are more conscious of their health and therefore participate in various physical activities. Chances of sustaining injuries are therefore much higher than some years ago. Age related problems viz. osteoarthritis, osteoporosis, rheumatologic conditions, backache, neck pain, gout, tennis elbow, trigger finger, night cramps, rotator cuff tendonitis (shoulder), etc. now also begin to appear. Ganglions are fairly often seen in this group and the family bible is no longer an appropriate form of management! Metastatic carcinomas e.g. Ca prostate or breast causing pathologic fractures may start in this age group. Bunions, metatarsalgia and other foot problems are also encountered and need to be managed effectively. Hand injuries are seen in all age groups and require special care. It is however manual labourers who are injured most frequently. The correct management of hand injuries is of utmost importance. Traumatic amputations are fairly common and even children can sustain this type of injury. You have to be able to manage these injuries correctly!

Old age These patients can of course suffer from any orthopaedic condition, but problems such as osteoporosis, osteoarthrosis, injuries due to a fall resulting from poor balance, muscle atrophy or weakness, etc. are common. Muscle cramps also cause a lot of discomfort. Hip and/or knee replacements are performed often these days and you should at least be able to advise your patients about this. In order to provide your patients with a good quality of life, a sound knowledge of orthopaedics is very important.

Other conditions There are many other conditions which are important to a generalist. Think of a pregnant patient with a carpal tunnel syndrome, or a patient that may need a neck or back operation. Only a good knowledge of orthopaedics will enable you to ensure that the correct management is given.

In conclusion This block is very important to the generalist. Some extra attention will be an investment for your future practice. Don’t just "LOOK, FEEL, MOVE"! Manage the patient!