Keeping joints smooth

Dr Ang Chia Liang, Orthopaedic Surgeon with Island Orthopaedic Consultants

What would you tell a 10-year-old to explain what you do?

I would say that my job is to help people who have injured themselves and are suffering from pain.

How painful is a bone fracture then?

A bone fracture is when a bone is broken into two or more pieces and that is generally very painful Of course, the bigger the bone, the more painful it is. A fracture of a thigh or leg bone would be more painful than a fracture of a finger. Unfortunately, one of the most painful orthopaedic conditions is cancer spreading to the bones. When the bones are affected by cancer, the patient will require strong painkillers and may need surgery to relieve the pain.

Any anecdotes about the strangest ways people manage to snap their bones?

I have had patients who are able to snap their shoulders in and out of the socket by themselves. This is because such persons have loose shoulder joints, because of prior injuries or they were born with it. Just think of gymnasts or contortionists as examples of how loose-jointed people can be.

Who are the patients you see and what are the common ailments they have?

I see a wide range, from the young child to the elderly granny. Young children and adolescents commonly have problems such as growing pains, flat feet, or painful toenails. Young adults come to me for sports injuries such as knee or ankle joint injuries. Middle-aged or elderly patients have wear-and-tear problems affecting their joints. There are a few types of ailments affecting all age groups: injuries and fractures, and growing lumps and tumours.

Knee problems are common it seems. True?

Can't be any truer. Knee problems affect all ages. In the knee, injuries to the anterior cruciate ligament or ACL - which happen to be my initials too - are very common.

A large portion of my practice is on knee problems: from knee replacements for the elderly to ligament reconstructions for the athlete, from cartilage regeneration for the middle-aged, to trauma and fractures.

Why do we get these creaking joints?

I would say that creaking without pain is quite harmless. Sometimes, when I bend my own knee or my neck I can hear some creaks.

Creaks occur mostly when a person suddenly changes his joint position, especially after remaining still for a while.

Another type of sound is soft crackling as a person moves his knee. That may be an indication of mild wear and tear of the cartilage. While largely harmless, a person with such sounds should discuss the level of activity he can undertake with an orthopaedic surgeon.

What's in your arsenal to help your patients?

Some patients benefit from a lifestyle that is appropriate to their medical conditions. Many patients try to avoid having to take painkillers, but if the condition requires it, I will advise them to take a course of anti-inflammatory medications such as Celebrex, which helps to reduce swelling and pain and speeds up the recovery with few adverse effects.

Lyrica is another potent medicine that greatly helps in pain control and the recovery process, especially for nerve conditions.

Other methods I use include therapy that targets the patient's condition, braces and external supports. Certain knee braces can help alter how a patient walks and provide effective pain relief. There are also injections, such as steroids or platelet-rich plasma. Surgery, for most people, would be the "last option", but surgery is actually the first, most effective option for many conditions, such as severe wear-and-tear of the knee joint or a badly fractured bone.

When should someone call to make an appointment with you?

If you have joint or body pain limiting your movement and affecting your lifestyle, then you should certainly consider making an appointment.

If you notice any lumps, bumps or growths on your body, you should seek help. I know many hardy folks who would refrain from seeing a doctor till the pain is unbearable. That is unwise because any condition at an advanced stage would be more difficult to treat. I remembered a patient with a massive lump on his shoulder, which he had left untreated for about 20 years. Thankfully, the lump remained benign for all those years.

What is the most difficult situation you have had to deal with?

The most difficult situation I recall was this elderly woman, who had cartilage cancer in her shoulder. My challenge was to convince her to have surgery to save her life. I found it hard when she eventually decided to accept her fate rather than go through surgery. I had to respect her decision.

You used to play squash at the national level. So how do you take care of your hip and knees? Is that why you do this job?

I miss the good old days of being fit and fast about the court. I play much less now, but when I do, I make sure I warm up and cool down properly. I jog on the spot for 10 to 15 minutes to get the muscles warm, then I stretch my arms, back, hips, knees and ankles. Otherwise, I would be at risk of injuries.

The word orthopaedic comes from the Greek word that means "to straighten a child". During my earlier years as a medical officer, I had to go through many different specialities before settling on one. I found a keen affinity for performing surgery that improves people's lives and function.

This article was first published on Aug 21, 2016.
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