Orthopaedic Surgery

The questions below were raised by visitors to the STOMP (Straits Times Online Mobile Print) website in the AskST section of the website. eMenders doctors provided the answers to the questions raised as a public health education project. The information provided below is of a general nature and should not be treated as a replacement for medical advice. You should seek consultation from a medical or healthcare professional about your specific medical condition.


In perimenopausal women with non-specific pain in the joints, the possible diagnosis considered by her doctor would be:

  1. Arthritis: This requires a blood test to assess.
  2. Osteoporosis: That is why the bone density was done. Unfortunately to interpret this adequately, we need the full report.
  3. Non-specific symptoms related to early menopause. This should be looked into by the family doctor or gynaecologist to see if medication is appropriate.

In all these conditions, the patient should remain as active physically and mentally as possible. Exercises such as Tai Chi, pilates, yoga, walks, gentle aerobics (non-impact)and breathing exercises should be considered as they improve general muscle tone and give the patient a more positive outlook.

Arthritis, depending on type and severity, may need medication. However these should be used at the judgement of a doctor as they can cause complications such as gastric/kidney disturbances and disturbances in blood pressure; especially if the patient is on blood pressure control medication.

Definitive osteoporosis should be treated with medication and appropriate exercises. If it is osteopaenia, the patient has to discuss with her doctor as to the presence of risks factors which will determine whether she requires treatment.

The internet contains a lot of information about osteoporosis. A very comprehensive but complicated paper is put out by the National Institute of Health (US) at:https://govinfo.library.unt.edu/ota/Ota_1/DATA/1994/9428.PDF.

To know more about interpretation of the bone density scores, there is a good article at:https://www2.aaos.org/aaos/archives/bulletin/aug99/osteo.htm

Dr. Yeo Khee Quan is a Consultant Orthopedic Surgeon at the Mount Elizabeth Medical Centre. He is also a Visiting Consultant at the Singapore General Hospital and a Clinical Teacher in Orthopaedics at the National University of Singapore.

Your daughters case should be assessed to be certain it is non-structural (i.e., not due to bone or joint abnormality), or due to causes such as neurological problems and ligament laxity.

The hip and back pain is most likely secondary to the flat feet. The problem is usually the footwear that causes the pain. This can be treated by podiatric care and an insole may be necessary.

Immediate trail use of good cross trainers such as those by Asics, Nike etc with good insoles may be useful.

Contributed by Dr Yeo Khee Quan, Orthopaedic Surgeon.

Age, obesity and physical injury could all contribute to degeneration of joint cartilage. Such a condition is associated with osteoarthritis. Management of osteoarthritis has been effective with the use of anti inflammatory agents and analgesics, and also, with some dietary supplements like glucosamine sulphate.

Studies performed in 2001 and 2003 showed that glucosamine effectively controlled symptoms of osteoarthritis without the side effects associated with anti inflammatory agents and analgesics when used over a period of a few months.

You should avoid going up and down slopes and especially walking down stairs.

Please see your doctor for medical advice.

Contributed by Dr Kanwaljit Soin, eMenders Orthopaedic and Hand Surgeon.

At the age of 42, you are relatively young. If your knee has been giving you significant problems for more than a month, you should find out the root of the cause.

There are two tests you can perform to determine the severity of the problem. For the first test, you have to measure the circumference of each thigh at approximately 10 cm above the top of the knee cap (the round bone in front of the knee). If the result shows a difference of more than 2 cm, the problem is significant and it is advisable for you to seek an orthopaedic opinion.

The second test is to make a comparison between the affected area on your left leg with the same area on your right leg. If the affected area is warmer and shows signs of swelling, this also indicates that the problem is significant.

On the other hand, if the two tests give negative results, you can just seek the advice of your family practitioner, sport physician or sport physiotherapist.

Contributed by Dr Yeo Khee Quan, Orthopaedic Surgeon.

Cramps in the leg can be caused by a local problem or a system (general) problem.

The local problem relates mainly to muscle strength and to pattern of usage. Warming up and warming down is only one component. This is presuming that the pre-exercise process included an adequate and correct stretching programme. The next aspect is to look at the pattern of training. From the description, it can be seen that a 24 hour rest period, which allows the muscles to recover after exercises, is followed. The next consideration is whether the workout is too intensive and whether there is a problem of “skill” involved. A trainer would help in this.

On the other hand, a general problem relates to matters such as dehydration and electrolytic imbalance and endocrinal problems. These have to be assessed by a sports physician or a general physician if the symptoms are severe.

Lastly, there is also a need to consider whether one is taking drugs that can affect muscle activity. These would include medications for high cholesterol levels.

Contributed by Dr Yeo Khee Quan, Orthopaedic Surgeon.

Numbness is usually related to an injury to a nerve. If it goes off after a week’s rest, it is probably caused by pressure or traction which can be relieved over time provided the original cause settles spontaneously. If the numbness persists, it is advisable to seek consultation with a doctor and he/she will do a clinical examination to identify the cause of the problem.

Contributed by Dr Yeo Khee Quan, Orthopaedic Surgeon.