Relevance of a. Musculoskeletal service in the tropics

Transcription

1 Relevance of a Musculoskeletal service in the tropics

2 MSK disorders Major cause of pain and physical limitation Inevitable in any individuals lifetime The most common reason for a. self medication b. entry to health care system 1/4 of adults and most common cause of long term disability

3 MSK disorders When MSK Pain sufferers express concern Regularly ignored Complaints misunderstood Lack timely and effective treatment

4 Bone And Joint Decade GLOBAL MULTIDISCIPLINARY INITIATIVE Target : MUSCULOSKELETAL CONDITIONS BONE AND JOINT DISORDERS Improve quality of life Advance understanding and treatment research prevention education

5 Bone and Joint Decade Arthritis Back pain Osteoporosis Fractures Hip knee and foot pain Cerebral palsy Clubfoot

6 MSKs Developing world Rudimentary incidence and prevalence figures But studies do show importance of MSK

7 COPCORD Community Orientated Programme for the Control of Rheumatic Disease Baseline systematic population survey : Stage 1 Identification of risk factors plus community health education : Stage 2 Prevention and control measures : Stage 3

8 Copcord India Indonesia Iran Kuwait Malaysia Pakistan Australia Bangladesh China Phillipines Thailand Vietnam Brazil Egypt

9 COPCORD sample (rural /urban) Questionnaire based interview plus examination of 15-30%r with recent rheumatic complaints. Knee back and shoulder pain dominate Osteo Arthritis soft tissue lesions, Inflammatory disorders low.

10 Copcord UK Lawrence J. Leigh & Wensleydale 1950s UK Back knee shoulder 23 % Inflammatory arthritis 2%

11 Low back Pain Same magnitude world wide Woolf 2003 In Africa 1yr 50% Life 60% now 30% Louw et al 2007

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13 Low Back Pain Mulago Hospital Kampala. Afr Health Sciences 2005 Prevalence 20% of orthopaedic referrals. Simple Back Pain 125 Nerve Root 38 Serious Pathology 35 Indeterminate 3 Total 201

14 MSK SERVICE Providers Recipients GPs 25% population Orthopaedics Rheumatology Physiotherapy Osteopathy chiropractice

15 Traditional model GP referral Waiting list (25%) Orthopaedic Surgeon Physiotherapy Podiatry Tertiary referral Rheumatology Orthopaedic Surgeon

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18 THE MUSCULO-SKELETAL TEAM IN GLASGOW ROYAL INFIRMARY

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21 Physio GP Tertiary Self-referral TRIAGE (Urgent/Routine) Rheumatology/ P McG Specialist Orthopaedic Clinics ( ESP s ) Spine EFW Shoulder JR/PT PROTOCOLS Elbow LAR Hand RGS Discharge Waiting list Review Hip RI/AS Knee MB/ BJ Foot SK Consultant

22 OUTPATIENT WAITING LIST Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06

23 TOTAL HIP/KNEE REPLACEMENTS GRI - Primary/Revision NUMBER OF JOINTS Jan-03 Mar-03 May-03 Jul-03 Sep-03 Nov-03 Jan-04 Mar-04 May-04 Jul-04 Sep-04 Nov-04 Jan-05 Mar-05 May-05 Jul-05 Sep-05 Nov-05 Jan-06 MONTH

24 UTH: here and now No rheumatologist : Orthopaedics, Gen phys Orthopaedics : Fractures++ unsatisfactory Too much non operative work Backache Solutions??

25 Allied Health Professionals Mullan F,Frehyot S. Non Physician clinicians in 47 sub Saharan African Countries. Lancet 2007,370:

26 Rheumatologist Only 20 in ssa Orthopaedic surgeons/ general physicians Role for ESP in Rheumatology?

27 Acute Rheumatic Fever

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31 HIV SYMMETRICAL POLYARTHRITIS

32 Brucellosis

33 Leprosy

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36 THE END

37 Parasites : Guinea worm

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39 Causes of serious spinal Pathology Mulago Hospital Spondylolisthesis 10 TB Spine 8 Compression fracture 7 Cauda Equina Syndrome 3 Brucellosis 2 Metastatic prostatic CA 2 Rheumatoid Arthritis 2

40 HIV Musculoskeletal manifestations Bone and Joint Infection Arthritis Symmetrical RA like Asymmetrical Reactive arthritis Psoriatic Myositis Avascular necrosis Autoantibodies

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42 Children Bone and Joint infection Osteochondrosis Limb deformities Sickle cell crises J. idiopathic arthritis Rheumatic fever Meningococcal arthritis HIV SpA

43 African Rickets Nigerian children with rickets have a low intake of calcium and have a better response to treatment with calcium alone..than to treatment with Vit D alone..thatcher et al NEJM

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46 Endemic Fluorosis All substances are a poison, there is none that is not a poison. The right dose differentiates a poison and remedy Paracelsus

47 Endemic fluorosis

48 Alpha Viruses Chikungunya Onyong-nyong Ross River Sinbis Mayaro Febrile Polyarthritis/maculopapular rash Tenosynovitis May last for months First isolated in Tanzania ,000 cases in 2005/6 In Reunion /.Comoro islands Appeared in 2 Italian villages 2007

49 Sickle Cell Disease

50 LOW BACK /KNEE PAIN PREVALENCE Lawrence LBP Harkness % 17% Knee Pain 6% 16% 3 months or more LBP F reburger et al % %