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From head to toe, our body is capable of impressive processes and complex actions. The body is a structure of parts operating as a unit, serving a common purpose of growth and survival. It is a well-oiled machine that continues to function even as we sleep. Thanks to our bodies, we can move, walk, dance, play, and experience what life has to offer.

As time passes, we become more vulnerable to the hardships of life. As we face challenges and overcome struggles, our body grows and ages with us. In Singapore, it is forecasted that 25% of the population will be aged 65 and older by the year 2023 (Asian Development Bank, 2020). This demographic shift will affect the country’s current health and social infrastructure.

When we feel pain, it’s our body’s way of telling us that something is not right. The root cause of the pain may be obvious, such as a foot fracture. Other times, the root cause may be something that is indiscernible, such as h as nerve problems. Pain may be a sign of an underlying condition that necessitates medical treatment. As this ageing trend continues, Singaporeans will need advice from trained doctors to make informed decisions about their health and wellbeing.

The Basics of Pain Management and Orthopaedic Care

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The treatment of the musculoskeletal system is the focus of orthopaedic care. This system is made up of your tendons, ligaments, joints, bones, and joints. People of all ages can experience pain resulting from orthopaedic conditions. It can range from muscular pain from strains, joint pain from deterioration or injury to joints, bone pain from fractures or breaks, tissue pain from inflammation, and nerve pain.

1. Acute pain is typically characterised by a sudden and sharp pain that lasts shorter than 6 months. Acute pain can come from a specific cause, such as papercuts or childbirth.
2. Chronic pain is a long-lasting pain typically caused by an underlying issue. It lasts longer than 6 months and it can come from headaches or nerve pain.

No matter what kind of pain you are experiencing—from mild to severe—it can prevent you from experiencing the best things in life. While some people refer to them as “bone specialists”, the correct term would be orthopaedists or orthopaedic surgeons. Orthopaedists treat musculoskeletal conditions like sports injuries, joint discomfort, and back disorders using surgical and nonsurgical methods. There are several subspecialties for orthopaedic care, such as hand & upper extremity, foot & ankle, orthopaedic oncology (includes tumour and cancer treatments), paediatric orthopaedics, sports medicine, spinal surgery, trauma surgery, and joint replacement surgery (Davis, 2020).

Common Causes of Chronic Pain and Its Impact on Your Quality of Life

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Chronic pain can have a variety of causes. It can come from injuries, falls, or accidents. It may have persisted even after recovering from a previous disease or injury. It can also be rooted in a persistent source of pain, like cancer or arthritis. Many people experience pain without any prior injuries or signs of sickness. Typically, chronic pain manifests itself through symptoms such as stiffness, inflammation, soreness, and frequent pain. Since chronic pain can be misdiagnosed, it makes it difficult to determine a single course of treatment, which is why medical providers often resort to a variety of tests and treatments.

Chronic pain diminishes a person’s capacity to maintain a normal lifestyle. Living with chronic pain causes irritability, poor sleep patterns, mental health issues, exhaustion, and a predisposition to other ailments (Christiano, 2018). It is crucial for Singaporeans to be knowledgeable about the treatment options available to them. It may lead to other conditions such as anxiety, depression, fatigue, and mood swings, which raise your risk for other conditions. We must remember that chronic pain manifests differently for each person. There is no general solution for every type of chronic pain.

Risk Factors for Orthopaedic Conditions

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People of all ages, lifestyles, and backgrounds can be diagnosed with orthopaedic conditions. Even so, there are several risk factors that are associated with a higher likelihood of developing specific diseases (Mishra, 2022).

1. Age – Older individuals are more at risk for orthopaedic ailments due to the normal wear and tear of joints. Nevertheless, younger individuals may also develop these ailments due to injuries and excessive strain.
2. Heredity – The likelihood of developing arthritis may increase if there is a family history of this ailment. The same can happen to descendants of people afflicted by osteoporosis.
3. Pre-existing ailments – People who have diabetes are prone to muscle weakness. Some conditions cause joint instability, which can weaken the musculoskeletal system.
4. Weight – Being overweight places additional strain on joints and bones. Even so, underweight individuals, who have less muscle mass, are also likely to develop osteoporosis.
5. Lifestyle – People who perform repetitive tasks at work may develop carpal tunnel syndrome. One can develop bursitis through exercise by overusing or putting excessive pressure on a joint.

The Importance of a Symptom-Based Approach to Patient Diagnosis

It can be challenging for medical professionals to pinpoint the origin of pain, especially if it comes from multiple sources. It may be a difficult task to tackle chronic pain, but medical providers are well-equipped to choose the appropriate tests and procedures. The patient’s history, current symptoms, and diagnostic imaging exams can help in the decision-making process.

Advanced imaging techniques can help medical professionals investigate your condition. These techniques include ultrasounds, MRIs, and CT scans. Your doctor may also ask you to undergo other tests, such as blood tests and reflex & balance tests (Davis, 2020).

1. Team-based approach to treatment – Along with an orthopaedic surgeon, the team of healthcare providers may consist of other non-doctor specialists such as physical therapists and psychologists. A team-based approach to healthcare aims to address patients’ needs and preferences by involving professionals with different specialisations.
2. Personalised treatment plans – In orthopaedic care and pain management, treatments are tailor-made for the specific needs of the patient. It considers individual factors such as patient preferences, lifestyle, and pre-existing conditions.
3. Multi-faceted pain treatments – Pain treatments are designed to treat multiple sources of pain. This can be in the form of medicine (pills, injections, IV medication), therapy (exercises for strength and mobility), or medical procedures (minimally invasive methods and open surgery)
4. Good functional outcomes – The goal is for the patient to continue doing everyday chores, family errands, and social activities with ease. The ability to cope with everyday stressors and disease complications may enhance functional results.

Exploring and Understanding Various Orthopaedic Conditions

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Numerous musculoskeletal conditions are treated by orthopaedic surgeons. These diseases might be inherited, the result of an injury, or the natural ageing process (Mishra, 2022). Pain in the lower back, buttocks, foot, ankle, elbow, shoulder, neck, knee, hand, or wrist can be caused by injurious sources (such as sprains, fractures, or dislocations from accidents) or non-injurious sources (such as overworked muscles, tendon overuse, worn-out joints, blood supply problems, and more). Upon examination performed by your orthopaedic specialist, you may be diagnosed with the following conditions:

1. Low bone density – This condition is caused by changes in hormones, age, and correlated medical conditions. People who have low bone density experience a higher risk of fractures.
2. Fractures – This is caused by high energy injuries such as a vehicular accident or low energy injuries such as a fall from a significant height. Fractures are commonly treated using splints, casts, or slings.
3. Arthritis – There are different types of arthritis, but all of them are characterised by joint inflammation, which results in damage and loss of function. Common types are osteoarthritis, lupus, and rheumatoid arthritis.
4. Muscle atrophy – This causes difficulties in mobility because of muscle tissue loss. It may result from inactivity, such as being confined to a bed, or from harm to the nerves that control muscle movement.
5. Pinched nerve – This occurs when a spinal nerve root is irritated, which results in spinal disc ailments. This can happen in many areas throughout the body.
6. Bursitis – Bursae are protective sacs inside joints in the shoulder, elbow, and hip. When these are inflamed, it can cause severe pain and discomfort.
7. Musculoskeletal cancer – Bone cancer and cartilage cancer are examples of this ailment. It is developed through mutations that destroy tissues.
8. Orthopaedic autoimmune diseases – This happens when the immune system attacks healthy cells and tissues. Autoimmune diseases like lupus can negatively affect the musculoskeletal system and result in more complications.
9. Osteoporosis – This happens when bone mass, bone mineral density, or the composition and strength of bones change. People with osteoporosis are more likely to experience fractures and bone problems.
10. Tendonitis – A tendon is a connective tissue that connects muscles to bones. When the tendon is inflamed, it can cause swelling and discomfort.

Aside from this list, there are many other orthopaedic conditions that you may experience. Common symptoms of an orthopaedic condition are joint deformities, fatigue, joint swelling, limited range of motion, muscle spasms, numbness, pain, and inflammation in the affected area (Lewis, 2020). It is important to seek advice from a medical provider to assess your symptoms so you can get the care you deserve.

Management and Treatment of Orthopaedic Ailments

Generally, orthopaedic care focuses on the restoration of function and movement pertaining to the joints or muscles. Majority of orthopaedic surgery is focused on the management of pain and relief of related symptoms. There various methods for treating orthopaedic conditions:

1. Interventional methods
   1. Surgical treatments of the limb, spine, neck, and joints are targeted at relieving a patient’s symptoms and restoring function to the affected area.
   1. Patients can undergo pain treatments targeted at pain relief for functional improvement.
   1. Surgical procedures can include joint fusion, ligament reconstruction, spine surgery, bone grafting surgery, and more.
   1. There are also newer orthopaedic services, such as minimally invasive procedures that is characterised by using smaller incisions to improve recovery time and minimise tissue damage.
2. Non-interventional methods
   1. These methods include rest, medications, lifestyle modification advice, physiotherapy, orthotics, hormone replacement therapy, and other methods to manage pain and improve function.
   1. This can include orthotics, which can be in the form of shoe inserts and leg braces. These can provide cushion, support, and comfort.
   1. Physiotherapy is the use of massages and exercises to improve posture, prevent injury, and reduce swelling. Physiotherapists use a range of techniques, such as customised exercises, joint manipulation, muscle stretching, and more.
   1. Alternative forms of treatment include chiropractic care, yoga, exercise, and nutritional counselling.

Orthopaedic surgeons create customised treatment plans for their patients. There are numerous therapy methods available for managing pain, and these are determined by the patient’s symptoms (Dwyer, 2009). These treatment plans are often a combination of pain management techniques and orthopaedic surgery methods (Davis, 2020).

Orthopaedic Surgery: Expectations from Consultation to Aftercare

In many degenerative conditions, such as osteoarthritis, it may not be possible to completely heal from the ailment. It is only possible to relieve symptoms and manage sources of pain. The overall goal is for the patient to feel normal enough to be able to perform daily activities with ease. Additionally, the focus is on restoration of the joint’s range of motion and improvement of joint stability with muscle strengthening and therapeutic exercises (Davis, 2020).

1. Consultation and diagnosis– During this stage, the orthopaedist will attempt to diagnose the patient’s ailment during the initial visit. This may entail performing a physical exam and taking X-rays. To confirm the diagnosis, the doctor may occasionally do in-office diagnostics or request additional tests.
2. In-office procedures – Depending on the complexity of the condition and the patient’s needs, the orthopaedist may perform ultrasound scans and administer injections, such as corticosteroid injections, to reduce inflammation. In cases of severe injuries, such as fractures and dislocations, the affected area must be immobilised with a splint, cast, or brace.
3. Procedures and surgeries – In addition to in-office procedures, the orthopaedist may recommend other means such as anti-inflammatory medicine, physical therapy, home exercise routines, mobility aids, and surgery when needed. An orthopaedic surgery may last for hours at a time, depending on the complexity of the operation. For minimally invasive methods, the patient can expect a shorter duration for the procedure.
4. Recovery – Depending on the type of treatment, the patient can be discharged on the same day or stay overnight in the hospital for monitoring. Based on the specific procedure, the recovery time for surgery is around 2-3 months for upper limb injuries, 3-6 months for lower limb injuries and knee replacements. For spinal procedures, the duration varies, as it depends on the type of surgery.
5. Aftercare – Post-operative rehabilitation can include physiotherapy to manage pain and enable patients to return to everyday life. There may be periodic check-ups to keep track of the patient’s progress over time.

Numerous orthopaedic conditions can result in disability and chronic issues if patients are not properly treated and given time to recover (Orthobullets, 2016). It is best to discuss your treatment options and lifestyle changes with your doctor. It is also wise to discuss any potential side effects so you can plan ahead and avoid complications.

Reducing The Risk of Orthopaedic Conditions and Repetitive Strain Injuries

Your musculoskeletal system is comprised of tissues, tendons, bones, ligaments, and muscles. Together, they assist you in moving and supporting the weight of your body. Injuries, illness, and ageing can all lead to discomfort, stiffness, and other issues relating to function and movement. By managing your general health, you can maintain the strength of your musculoskeletal system and prevent future complications (University of California, 2019).

1. Regular movement – A sedentary lifestyle can result in adverse health effects. You can perform a warm up and stretching routine before doing prolonged or repetitive tasks.
2. Proper posture – When working or doing daily activities, you should avoid static positions such as sitting for prolonged periods of time. It may lead to muscle fatigue and a lack of blood circulation.
3. Task modification – You can reassess your workplace setup and task itinerary to change up your routine. Exercise caution when using tools and other heavy equipment.
4. Regular screening and check-ups –Early screening and detection can help eliminate or decrease risks before it is too late. There are symptoms which can only be detected by clinical tests or advanced imaging techniques.

Final Words

It is a common misconception that only older individuals experience orthopaedic conditions. It can happen to anyone, either through injurious or non-injurious sources. The main goal of orthopaedic treatments is to correct physical problems, provide relief for symptoms, and prevent future complications. It is a multi-faceted approach where interventional and noninterventional approaches are used to treat musculoskeletal conditions. Orthopaedic surgeons are well-equipped to treat a wide range of ailments, such as sports injuries, joint pain, muscle strains, and back problems. With a lot going on, we tend to forget to take care of ourselves. It is important to remember that our mental health benefits from taking proper care of our physical body. If you are experiencing chronic pain and difficulties doing daily activities, it may be time to consult an orthopaedic surgeon. Orthopaedic surgeons are devoted to diagnosing, treating, preventing, and rehabilitating those with musculoskeletal problems. With the right healthcare provider, you can receive a personalised treatment plan that will help you live life to the fullest.

Frequently asked questions

Dr Yong Ren profile

Dr Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon in Khoo Teck Puat hospital before embarking on sub-specialty training in Switzerland at the famed Inselspital in Bern.

He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as Visiting Consultant to Khoo Teck Puat Hospital.

Well versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Prior to his entry into the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.

Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well as spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.

References

• Asian Development Bank. (2020). Singapore’s Long-Term Care System: Adapting to Population Aging. Retrieved from https://www.adb.org/sites/default/files/publication/637416/singapore-care-system-population-aging.pdf
• Christiano, D. (2018). What Is Chronic Pain Syndrome?. Retrieved from https://www.healthline.com/health/chronic-pain-syndrome
• Davis, K. (2020). What is orthopedics, and what do orthopedists do?. Retrieved from https://www.medicalnewstoday.com/articles/what-is-orthopedics
• Dwyer, T. (2009). The Bone School. Retrieved from http://www.boneschool.com/
• Lewis, S. (2020). Orthopedic Conditions. Retrieved from https://www.healthgrades.com/right-care/bones-.joints-and-muscles/orthopedic-conditions
• Mishra, N. (2022). 5 common orthopedic conditions you need to know about. Retrieved from https://www.medanta.org/patient-education-blog/5-common-orthopedic-conditions-you-need-to-know-about/
• Orthobullets. (2016). Basic Science High-Yield Topics. Retrieved from https://www.orthobullets.com/
• University of California. (2019). Preventing Musculoskeletal Disorders and Repetitive Strain Injuries. Retrieved from https://ergonomics.ucla.edu/injuries-and-prevention/preventing-msd-rsi