Musculoskeletal Orthopaedics in Bangkok Thailand
Orthopaedic surgery provides treatment for debilitating musculoskeletal disorders, such as sports- or strain-related injuries of the knee, shoulder, hip or hand, or other joints, bone fractures, trauma, joint diseases and injuries, and spinal injuries.
ThaiMed offers international patients an affordable means to diagnosis and treat musculoskeletal disorders. Dedicated to providing comprehensive, individualized care, board-certified physicians provide patients with a higher level quality of care that is unsurpassed by what many travelers are accustomed to back home.
Adult Orthopaedic management is provided for complex fractures in the multiply-injured patient, spine trauma, deformities, and sports medicine including arthroscopy, joint replacement and reconstruction, and musculoskeletal injury and diseases.
Management of scoliosis (spinal deformities), neuromuscular congenital and development diseases, foot deformities, and hip dysplasia are included in the total care of musculoskeletal problems in children.
Orthopaedic surgeons are available around the clock to treat the most seriously injured adults and children who are victims of trauma, and offering others opprotunities of return or improved mobility with elective surgeries.
Acute Low Back Pain
A condition of pain in the lower (lumbar-sacral) back region, with or without radiation of symptoms to the buttocks or lower extremities, of less than 6 weeks duration, in the non-pregnant patient.
Initial Diagnosis and management
Elicitation of history and performance of physical examination. Special attention to presence or absence of "red flags" to include: age <18 or >55; history of malignancy, steroid use, or HIV positivity; weight loss or constitutional symptoms; structural deformity; anal or urethral sphincter disturbance; saddle anesthesia; gait disturbance; or widespread neurologic deficit.
If red flags are present, diagnostic testing may include plain radiographs; CBC; ESR; bone scan; CT scan and/or MRI scan and electrodiagnosis as indicated.
If red flags are absent a diagnostic workup is generally not necessary.
Initial treatment for the first 2 weeks consists of: reassurance that most episodes resolve uneventfully within 6 weeks; encouragement to maintain as close to normal activity as is tolerable; avoidance of bed rest greater than 24 hours; NSAIDS (unless contraindicated); muscle relaxants for up to one week; acetaminophen as needed; weak opiates (codeine; propoxyphene) unless contraindicated; passive modalities (e.g. ice, heat) for symptomatic relief.
Ongoing management and objectives
If pain has not improved in 2 weeks: re-evaluate for "red flags", change NSAID, and refer to Physical Therapy for evaluation and treatment while continuing to follow patient.
Indication a profile is needed
- Any limitations that affect strength, range of motion, and general efficiency of feet, legs, lower back and pelvic girdle.
- Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent hand-to-hand fighting and disqualifies for prolonged effort.
- Defects or impairments that require significant restriction of use
Specifications for the profile
- Weeks 1-2
- Run at own pace and distance
- No marching greater than 2 miles
- No sit ups
- No ruck sacks
- No lifting greater than 15lbs
- No repetitive bending
- Weeks 2-4
- Gradually return to normal activity
Patient/Soldier Education or Self care Information
- See attached sheet
- Demonstrate deficits that exist
- Describe/show soldier his/her limitations
- Explain injury and treatment methods
- Use diagram attached to describe injury, location and treatment.
- Instruct and demonstrate rehab techniques
- Demonstrate rehab exercises as shown in attached guide
- Warm up before any sports activity
- Participate in a conditioning program to build muscle strength
- Do stretching exercises daily
- Ask the patient to demonstrate newly learned techniques and repeat any other instructions.
- Fine tune patient technique
- Correct any incorrect ROM/stretching demonstrations or instructions by repeating and demonstrating information or exercise correctly.
- Encourage questions
- Ask soldier if he or she has any questions
- Give supplements such as handouts
- Schedule follow up visit
- If pain persists
- The pain does not improve as expected
- Patient is having difficulty after three days of injury
- Increased pain or swelling after the first three days
- Patient has any questions regarding care
Indications for referral to specialty care
- Focal neurologic signs with abnormal imaging studies (urgent consult if worsening) - Neurosurgery or Orthopedics referral. MRI prior to referral (without contrast unless tumor suspected).
- Focal neurologic signs with normal imaging studies (urgent if worsening) Neurology referral.
- Incapacitating radiculopathy unresponsive to therapy - Neurosurgery or Orthopedic referral. MRI of lumbar spine prior to referral (without contrast usually).
- Abnormal plain radiographs associated with red flags - Neurosurgery or Orthopedics referral. MRI of lumbar spine prior to referral (without contrast usually).
- Loss of bladder or bowel control - (urgent) Neurosurgery referral.
- Extra-spinal conditions such as, Urologic, GI, Gynecologic, Vascular, Neurologic, Rheumatologic, or Systemic - referral to subspecialty appropriate to affected organ system.
- If pain has not improved within 6 weeks, refer to Physical Medicine and Rehabilitation for evaluation and management.
Referral criteria for return to primary care
Resolution of symptoms; or, implementation of continuing treatment program that can be managed in primary care portal with periodic subspecialty follow-up.
The early treatment of a ankle sprain is the "RICE" method of treatment. If you are unsure of the severity of your ankle sprain, talk to your doctor before beginning any treatment or rehab. The following is an explanation of the RICE method of treatment for ankle sprains:
The first 24-48 hours after the injury is considered a critical treatment period and activities need to be curtailed. Gradually put as much weight on the involved ankle as tolerated and discontinue crutch use when you can walk with a normal gait (with minimal to no pain or limp).
For the first 48 hours post-injury, ice pack and elevate the ankle sprain 20 minutes at a time every 3-4 hours. The ice pack can be a bag of frozen vegetables (peas or corn), allowing you to be able to re-use the bag. Another popular treatment method is to fill paper cups with water then freeze the cup. Use the frozen cube like an ice cream cone, peeling away paper as the ice melts. Do NOT ice a ankle sprain for more than 20 minutes at a time!! You will not be helping heal the ankle sprain any faster, and you can cause damage to the tissues.
Use compression when elevating the ankle sprain in early treatment. Using an Ace bandage, wrap the ankle from the toes all the way up to the top of the calf muscle, overlapping the elastic wrap by one-half of the width of the wrap. The wrap should be snug, but not cutting off circulation to the foot and ankle. So, if your foot becomes cold, blue, or falls asleep, re-wrap!
Keep your ankle sprain higher than your heart as often as possible. Elevate at night by placing books under the foot of your mattresses--just stand up slowly in the morning.
More severe ankle sprain injuries, including complete tears of the ligaments and fractures of the bone may need different treatment and rehab than a simple ankle sprain. It is important that you see your doctor before beginning treatment or if your symptoms do not steadily improve over time.
Many patients find out they have an ankle sprain injury, they see their doctor, they have no broken bones, but the symptoms of the ankle sprain seem to persist. If you sustained an ankle sprain, and continue to have symptoms, performing some simple exercises and stretches can help you improve.
It is important that before beginning any rehab program, you have a firm understanding of your diagnosis. Patients who have persistent symptoms after an ankle sprain should be evaluated by their doctor to ensure there is no more serious injury, such as a fracture or high ankle sprain, that could be causing these problems.
For more information, please visit Foot Surgery or Ankle Surgery sections.
Anterior Knee Pain
Carpal and Cubital Syndrome
Finger and Thumb Sprain
Iliotibial Band Syndrome
Knee Pain Traumatic
Lower Leg Muscle Cramps
Lower Leg Muscle Strains
Lumbar Disc Syndrome
Psoriatic arthritis was originally defined as an inflammatory arthritis in the presence of psoriasis and in the absence of rheumatoid factor in the blood (1). More recent developments on the classification of this disorder have led to new criteria which are more sensitive and specific than the original definition of Moll and Wright. The new criteria incorporate other specific features of the disorder including dactylitis and a single radiological criterion, juxta-articular new bone (2). Within the rubric of psoriatic arthritis a number of disease sub-groups have been suggested, incorporating the diverse features of this disorder, such as peripheral and axial disease, distal inter-phalangeal involvement and the severe osteolytic form of the disease known as mutilans. None of these sub-groups incorporate the clinical features of dactylitis and enthesitis. Psoriatic arthritis is, at worst, a nasty disabling and disfiguring disease which severely impairs quality of life.
It is important to remember that treatment of this condition is not only by the use of drugs. Treatment of the arthritis is given by a multidisciplinary team of health workers including doctors, nurses, physiotherapists, occupational therapists and podiatrists. Members of the team play an important role in educating about the disease, as well as providing monitoring and treatment within their own specialist areas.
Importantly, it is also worth noting that the diverse presentations of the disease mean that several diverse treatment approaches are necessary. The intensity of the treatment depends on the severity of the disease as well as patient preference and other non-disease related factors. People with this disease may require nothing more than the occasional anti-inflammatory drug while others will require intensive and multiple treatments to stop joint deformity occurring and to control their skin condition.
Anti-inflammatory drugs are the mainstay of treatment and are effective for the synovitis, spondylitis and enthesitis found in this disease. NSAIDs can be very effective in controlling the pain and stiffness.
Disease-modifying drugs have more profound effects on the disease process. The evidence base for the drugs commonly and historically used (sulphasalazine, methotrexate and ciclosporin) is poor. From a patients point of view a drug that works for both the skin and the joints is most preferable, and methotrexate is the drug of choice in this respect. Drug combinations may be used in order to achieve this dual effect. A relative new comer, leflunomide, has been shown to be effective for both skin and joints although its’ side-effect profile may limit use.
In general, steroids are not used in this disease, as discontinuation may cause a flare of the skin disorder. However, injections of steroid are frequently given intra-articularly and at painful entheseal sites.
Shoulder Bursitis, Tendonitis & Impingement