Orthopaedic diseases treatment
Physiotherapy
This is a programme of exercises designed to increase the range of joint motion and muscle power using weights, springs and other devices. Physiotherapists can also reduce inflammation and swelling in injured areas by ultrasound, electrotherapy and the cautious application of ice and heat.
Electrotherapy includes pulsed electromagnetic fields (PEMF) and interferential treatment. Muscles can be made to contract by applying an intermittent current if the patient is unable to contract the muscle voluntarily (e.g. in denervation).
Occupational therapy
The role of the OT is to help facilitate a patient to live with a new disability.
Walking aids
Frames provide a firm base to lean on and are useful in the elderly, although they are cumbersome. Wheeled frames are only useful in hospitals or in places where smooth surfaces are guaranteed.
Crutches reduce the load on the lower limb, there are three types:
- Axillary crutches - big disadvantage is that it presses the radial nerve against the humerus
- Elbow crutch avoids the problems of axillary crutches although are easily broken
- Gutter crutches are useful if the patient has deforemd hands
Walking sticks again reduce the load on an injured limb if it is pushed against the ground when the injured limb is taking weight. Usually the stick should be held in the opposite hand to where the injured limb is (i.e. right leg injured, hold in left hand).
Orthoses (braces) are used to support limbs. These are useful to brace ligament damages around joints, as well as being able to position limbs into a more useful position (e.g. in a simple foot drop the orthoses can be molded to give some dorsiflexion).
Prostheses are artificial limbs that can be used in cases where the patient has had an amputation.
Collars can be used after neck trauma to support the painful neck. The term cervical collar is redundant as collars can only be cervical.
Drugs
- NSAIDs (diclofenac, ibuprofen, indomethacin)
- Steroids (prednisolone, hydroxychloroquine, sulfasalazine, methotrexate, penicillamine)
- Colchicine - used in acute Gout
- Antibiotics - prophylactically before surgeries but also cases of osteomyelitis
- Prophylaxis - flucloxacillin 500-1000mg, second line cephalosporins
- Therapeutic - Flucloxacillin 500mg or Ampicillin 500mg
- Anticoagulants - to prevent deep vein thrombosis
- Low molecular weight heparin
- Intra-articular steroids
- Hydrocortisone acetate 25 mg is common
Operative management
- Tendons
- Tenotomy - e.g. adductor spasm of cerebral palsy relieved by subcutaneous adductor tenotomy