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Orthopaedic Conditions

With our Professional Orthopaedic Surgeons, Dr. Kevin Yip and Dr Ambrose Yung has more than 25 years experience in treating orthopedic problems ranging from common orthopedic problem, sport injuries to degenerative changes of orthopedic problem. Be assured that you will be receiving professional treatments and Cost Effective that suit your needs.

We are specialised in treating the following conditions:

Speak to our friendly patient relation officer. Call us at +65 64712744 or Email to: info@boneclinic.com.sg.

Iliopsoas Impingement

Iliopsoas impingement may be present in both natural and artificial hips.

In the case of a natural hip, it has been theorized that because of its close relationship to the anterior hip, a tight iliopsoas tendon may be a cause of anterior labral lesions. The clinical presentation of this form of iliopsoas impingement may not be accompanied by a snapping phenomenon and have positive impingement tests, log roll and mechanical hip symptoms more in accordance with symptoms related to a labral tear.

When iliopsoas impingement occurs in presence of total hip replacement (THR), affected patients typically report persisting groin pain that is exacerbated by stair climbing, getting into or out of bed or a chair and entering and exiting an automobile. A snapping phenomenon or a clunk is usually not present. Gait may be affected with the patient presenting a slight limp. It is important to remember that the patients must first be evaluated for more common causes of groin pain after THR like infection, component loosening and occult periprosthetic fractures. A typical finding at radiographs or CT is a protruding anterior implant rim uncovered by the bony anterior acetabular wall.

Conservative treatment for both conditions (iliopsoas impingement in natural and artificial hip joints) is the same including rest, NSAIDs and physical therapy. Iliopsoas injections are of limited therapeutic value, but they represent a very reliable diagnostic test. After failure of conservative treatment, surgical release of the iliopsoas tendon may be indicated.

In the case of iliopsoas impingement with a natural hip joint, hip arthroscopy will provide access for treatment of the associated lesions such as labral tears or underlying bony impingement.

When iliopsoas impingement is present in an artificial total hip joint, acetabular component revision for re-orientation and open iliopsoas release have been reported. Both techniques seem to be effective in the treatment of iliopsoas impingement with the open release of the iliopsoas tendon presenting less morbidity. It is also possible to perform endoscopic release of the iliopsoas tendon in a THR, but reported results in the peer-reviewed literature is limited.

Endoscopic release

Endoscopic release of the iliopsoas tendon has evolved over the past decade. A variety of surgical techniques is available for release of the iliopsoas tendon at different anatomical regions.

As described from proximal to distal, endoscopic release of the iliopsoas tendon may be transcapsular at two different sites: from the central compartment and from the hip periphery. It can also be performed within the iliopsoas bursa at its insertion on the lesser trochanter. For either one of these techniques, the patient is positioned for hip arthroscopy in supine or lateral decubitus.

Iliopsoas tendon from the central compartment is performed with the hip joint in traction. The anterolateral portal, as described by Byrd at the anterior superior corner of the greater trochanter, is used as the viewing portal. With a 70° arthroscope, the anterior capsule is identified. From the direct anterior portal, a radiofrequency hook probe or an arthroscopic banana knife is introduced to create an anterior hip capsulotomy relative to the 2 and 3 o’clock position of the labrum in a right hip or geographic zone 1. Fibers of the iliopsoas tendon are visualized through the capsulotomy. The tendon is further exposed using a mechanical shaver. A radiofrequency hook probe is used to release the tendon in a retrograde fashion leaving the iliacus muscle intact.

Iliopsoas tendon release from the hip periphery is performed without traction. A 70° or a 30° arthroscope is positioned into the peripheral compartment anterior and inferior to the femoral neck through the anterolateral portal. Landmarks at the hip periphery must be identified. The medial synovial fold serves as the best landmark to identify the inferior aspect of the head and neck (6 o’clock position). The proximal origin of the medial synovial fold at the inferior head-neck junction is visualized. The field of view is rotated to the anterior hip capsule. The mid anterior portal is used to introduce instruments into the peripheral compartment. Between the anterior inferior labrum and the anterior inferior zona orbicularis a capsulotomy is performed and the iliopsoas tendon fibers identified through the capsulotomy, in some cases a natural communication between the anterior hip capsule and the iliopsoas bursa is present at this level. The tendon is further exposed using a mechanical shaver. Finally, the iliopsoas tendon is released in a retrograde fashion using a radiofrequency hook probe. The iliacus muscle is left intact behind the released iliopsoas tendon.

Frozen Shoulder and Physiotherapy

Frozen shoulder is the condition of pain and stiffness in the shoulder joint accompanied by loss of motion. An inflammation in or around the shoulder may trigger the body’s normal defensive response of stiffness. When the shoulder becomes stiff, it becomes too painful too move. Someone with frozen shoulder may not be able to reach above and over the head or touch the back.

While there is no definite cause of frozen shoulder, over 90 percent of patients experience full recovery. Doctors recommend physical therapy for frozen shoulder as the best treatment.

Physical therapy for frozen shoulder starts with reducing the pain and stiffness of the shoulder and increasing blood circulation through heat. One effective way of the heating method is taking a 10-minute hot shower or bath. Alternatively, the physical therapist may apply heat to your shoulder locally with the use of heating pads, wraps or towels. Hot water bottles and heat creams and ointments may also be used.

Shoulder massage is also a good way to start physical therapy for frozen shoulder as it increases the flow of blood and oxygen into the area. Once pain is reduced either through heating or through massage, the therapist proceeds with a series of physical therapy exercises.

In physical therapy for frozen shoulder, you will first perform weight and non-weight stretching exercises to improve the flexibility of your shoulder joint. The common exercises include arm swing with weights, arm raise, overhead stretch, stretching your arms across your body, and towel stretch.

It is important to note that during these stretching exercises, you should feel tension but you should not overstretch your shoulder to the point where you feel pain or severe discomfort. These exercises are done once or twice daily until the shoulder restores its normal range of movement.

Your doctor will advise you should you need to perform other exercises to tone and strengthen your shoulder muscles such as rotation exercises. Remember not to force movement in your shoulder. This does not mean you should not move it at all but instead to limit activities that may further injure your shoulder.

If physical therapy for frozen shoulder does not work for you, your doctor may recommend surgical treatment. The good news is physical therapy for frozen shoulder is usually enough for patients to get effective results that improve with time. If you have frozen shoulder, consult a physical therapist and get the treatment that you need.

Elbow Fractures in Children

Broken elbows are common injuries in children. Many activities kids participate in make their elbows vulnerable to injury. Furthermore, there are several growth plates (areas of bone that are actively growing) around the elbow joint. These growth plates are susceptible to injury. Children who have elbow injuries should be evaluated by a physician for a fracture.
What causes an elbow fracture in children?
Many activities can cause elbow fractures in children, but jungle gyms are far and away the primary culprit! Kids falling from jungle gyms can injure their elbows as they fall to the ground. Other common activities that cause elbow injuries include gymnastics, football, jumping on beds, and rough play.

When should I have my child see a doctor about an elbow injury?
If you are unsure of the diagnosis it is always safest to have your child seen by their pediatrician or in the emergency room. Signs that should tip you off to a problem include:

  • Inability to straighten or bend the elbow
  • Swelling or discoloration (bruising) around the elbow
  • Pain around the elbow joint
How is an elbow fracture diagnosed?
Your doctor will first evaluate your child’s arm for signs of damage to the nerves and blood vessels around the elbow joint. While damage to these structures are uncommon, it is important to know if there is a problem. Injuries to blood supply of the arm may necessitate early surgical intervention.

X-rays are used to diagnose elbow fractures. In more severe injuries, the fracture will be easily seen on x-ray, but it is not uncommon to have some types of elbow fractures that do not show up on x-ray. The reason is that growth plate fractures may not show up on x-ray like normal broken bones. Therefore, your doctor may request an x-ray of the opposite elbow (your child’s uninjured side) to compare the two for differences. Often the only sign of a broken elbow in a child is swelling seen on x-ray (the so-called ‘fat-pad sign’). In this case, the elbow should be treated as having a break.

What is the treatment of an elbow fracture in a child?
Treatment of elbow fractures depends on several factors including:

    • Location of the fracture
    • Amount of displacement of the fracture
    • Age of the patient
    • Damage to nerves and blood vessels

Some common types of elbow fractures include:

  • Supracondylar Humerus Fracture: The supracondylar fractures are the most common type of elbow fracture. They occur through the growth plate of the humerus (above the elbow joint). The most common cause of these injuries is a fall onto an outstretched arm–often a jungle gym. These injuries most commonly occur in children between the ages of 5 and 7 years old.
  • Condylar Fractures: Condylar fractures also occur just above the elbow joint. When a child sustains a condylar fracture he or she has broken off just one side of the elbow joint.
  • Radial Neck Fractures: Radial neck fractures are uncommon in adults, but often occur in children. The treatment of a radial neck fracture depends on the angulation of the fracture. Treatment may consist of casting, manipulation, or possibly placing pins across the fracture.
  • Radial Head Subluxation: While not a broken bone, a radial head subluxation is a common injury in a young child’s elbow. When a radial head subluxation occurs, the elbow joint slides out of position. These injuries are usually placed back into position quite easily.
  • Olecranon Fractures: Olecranon fractures are injuries to the prominent bone over the back of the elbow. Injuries to this bone can be difficult to differentiate from normal growth plate appearances, so often x-rays of both elbows are obtained for comparison.
  • Splints
    Splinting is the treatment for many elbow fractures, especially those that have minimal displacement (are not out of place). A splint is also commonly used when there is suspicion of an elbow fracture but with normal x-rays.In the case of normal x-rays, a splint will be placed and your child will have new x-rays about a week after injury. The repeat x-rays often show signs of healing of the fracture.

    • Casts
      Casts are often used to treat elbow fractures, but not after the initial injury. More commonly the elbow will be splinted for a week, and a cast may be placed after the swelling has had time to subside.
    • Surgery
      Surgical options include:

      • Pins
        Pins are often used to stabilize the fracture in proper position. The pins are placed by an orthopedic surgery with your child under general anesthesia. The pins hold the fracture in proper position until sufficient healing has taken place, usually about 3 to 6 weeks. A small incision may be necessary to reposition the fracture and to protect the nerves around the elbow joint.
      • Screws
        In older children, sometimes a screw is used to hold the fracture in proper position. Pins are usually used in younger children, but in children who are approaching skeletal maturity a screw may be used instead.

    What are the long term complications of elbow fractures in children?
    Because the fractures are often around the growth plate, there is always a change of injury to the growth plate. This may cause early closure of the growth plate. This is uncommon, and the only way to tell is the growth plate is permanently injured is to watch the child over time.Other potential complications include restriction of motion of the elbow joint, damage to nerves and blood vessels around the elbow, and infection of the pins that are place into the elbow.

    Complications are unusual, but they do occur in a small percentage of patients. Your doctor will follow your child until fracture healing is complete, and then may ask for a follow-up to ensure growth and motion around the elbow is normal. The parent can also monitor the elbow joint and alert the doctor if there is suspicion of a problem after a fracture.

    For Appointment, please call +65 6471 2744 (24 Hours) or Email to: info@boneclinic.com.sg

Elbow Pain Tips and Prevention

Overuse or repeated pressure on the elbow joint can cause small tears to form in the soft tissue, particularly where the tendon anchors to bone. If a number of these tears occur over a period of time, they can cause pain and reduced movement of the elbow joint. Depending on the location and severity of the injury, full recovery can take months.

The most common type of elbow pain is known as ‘tennis elbow’. ‘Golfer’s elbow’ is a less common but similar overuse injury. Despite their names, these injuries can occur as a result of a range of physical activities – racquet sports, rowing, canoeing, weightlifting, hockey, wrestling, swimming – as well as repetitive work tasks undertaken in a variety of occupations.

The elbow joint
If you bend your arm, you can feel three bumps at your elbow joint. Injury to the tendons that anchor muscles to the two bumps on either side of the elbow are a common cause of elbow pain:

  • Lateral epicondyle (‘tennis elbow’) – the bump on the outer side of the elbow. The muscles on the back of your forearm, responsible for curling your wrist backwards, are anchored to this bony point. Pain in this bump is called lateral epicondylitis. This area is particularly susceptible to tennis elbow because it has a poor blood supply.
  • Medial epicondyle (‘golfer’s elbow’) – the bump on the inner side of the elbow. The muscles on the front of your forearm, responsible for curling your wrist up, are anchored to this bony point. Pain in this bump is called medial epicondylitis.

Symptoms
Some of the symptoms of elbow pain include:

  • Pain in the elbow joint, especially when straightening the arm
  • Dull ache when at rest
  • Pain when making a fist (medial epicondylitis)
  • Pain when opening the fingers (lateral epicondylitis)
  • Soreness around the affected elbow bump
  • Weak grip
  • Difficulties and pain when trying to grasp objects, especially with the arm stretched out.

A range of causes
Some of the many conditions and events that may contribute to elbow injuries include:

  • Lack of strength or flexibility in the forearm muscles
  • Lack of strength in the shoulder muscles
  • Instability of the elbow joint
  • Poor technique during sporting activities (especially tennis and golf) that puts too much strain on the elbow joint
  • Inappropriate sporting equipment, such as using a heavy tennis racquet or having the wrong sized grip on a tennis racquet or golf club
  • Repetitive movements of the hands and arms, such as working on an assembly line
  • Continuously making the muscles and joint take heavy loads
  • Other factors such as neck symptoms or nerve irritation.

First aid
Suggestions for first aid to elbow injuries include:

  • Stop whatever you are doing.
  • Rest your elbow for a few days.
  • Use icepacks every two hours, applied for 15 minutes.
  • Massage and stretch the muscles after 48 hours to relieve stress and tension.
  • See your doctor or physiotherapist for diagnosis and further treatment, if necessary
Prevention strategies
Ways to reduce the risk of elbow injury include:

  • Always warm up and cool down thoroughly when playing sport.
  • Make sure you use good technique and proper equipment when playing your chosen sports.
  • Do strengthening exercises with hand weights – your physiotherapist can prescribe the correct exercises for you.
  • Regularly stretch relevant muscles before beginning any potentially stressful activity. Your physiotherapist can prescribe the correct exercises for you.
  • Avoid or modify work tasks that put excessive pressure on muscles of the forearm or that include the use of fingers, wrists and forearms in repetitive work involving forceful movement, awkward postures and lack of rest.

About Back Pain

Most back pain, especially lower back pain, is caused by simple muscle strains.

Most back pain is caused by simple strains and the main focus of this site is how to prevent recurring back pain by strengthening the muscles that support the spine with back exercises, along with correcting posture, using proper lifting techniques, and understanding the physical limitations of the back. There is also information on a wide range of back pain treatments, including complementary treatments, for the relief of both acute and chronic back pain.

Back Pain, especially in the lower back (lumbar spine), is a problem that most people experience at some time in their lives. The muscles that support the spine are in constant use; even while simply sitting, the muscles are in use to keep one from falling over. The spine also bends, straightens and twists. This constant stress on the back can result in back strain and pain.

The lower back supports most of the weight of the body and is subject to the most mechanical stress. As a result, the lower back is commonly injured. Lower back pain caused by strained muscles or ligaments is the most common type of back pain (sometimes referred to as lumbago).

Though most back pain is caused by muscle or ligament strain, there are other causes such as damage or injury to spinal nerves, bones, or discs. Sciatica, which is not a disease in itself but radiating pain and other symptoms caused by inflammation or compression of the sciatic nerve, can be caused by many conditions. Osteoarthritis of the spine is a common cause of back pain in people over 65 years of age. The incidence of some other back conditions also increases with age. Back pain is sometimes caused by a problem with the kidneys.

If back pain persists for over 3 months, it is considered chronic back pain. That doesn’t mean wait 3 months to see a doctor – an aching back can be a symptom of something that requires immediate attention such as a kidney infection. Back pain that lasts several days should be diagnosed and treated by a physician. It the pain is severe or is accompanied by numbness or pain down the leg, a doctor should be seen immediately.

The severity of back pain does not always correlate with the severity of the injury or damage.

In many cases the cause of back pain is hard to pin down. A simple muscle strain often causes more pain that a herniated disc. Herniated discs can produce intense back pain but often do not produce any symptoms at all. Even in those with damaged discs and spinal joints, the source of the pain may be strained back muscles.

If a doctor recommends surgery to relieve back pain, a second opinion should be sought. If one has a herniated disc, for example, but the herniated disc is not actually the source of the pain, surgery will not help relieve it. (Most herniated discs improve without surgery)

Stress, anxiety, and depression are often linked to back pain. Stress causes muscles to contract, which reduces blood flow to the tissues and often leads to pain. Stress hormones also heighten the perception of pain. There are many ways to relieve stress, from exercising to learning relaxation techniques. For some people, relieving stress is the most effective way to reduce pain.

Back pain can occur suddenly, but more often develops gradually.

For example, when the muscles supporting the back are held in one position (contracted) too long, the back muscles get fatigued and strained. Byproducts of muscular activity (such as lactic acid) build up in the back muscles. High levels of these acidic waste products in the muscles cause muscle irritation and pain.

Recurring back pain is frequently the result of inadequate muscle strength, shortened muscles; poor posture, being overweight, poor bending and lifting techniques. These are all factors that can be controlled .

CURE YOUR BACK PAIN TODAY! GET A SPINE SPECIALIST TO FIND OUT THE CAUSE AND THE CURE OF YOUR BACK PAIN! CALL US +65 64712744 OR SMS TO +65 9235 7641 TO SCHEDULE FOR AN APPOINTMENT (24 HOURS).