Orthopedic Clinic Online — assessment of joints, muscles, and bones

Typical age

More common with increasing age.

Background

Degenerative joint disease, cartilage breakdown.

Symptoms

Pain and stiffness, especially after rest.

What the doctor looks for

Symptom pattern, previous imaging findings.

Investigations

Often clinical, sometimes X-ray.

Diagnosis

Clinical picture ± imaging findings.

Management

Physical activity, pain relief, surgery in some cases down the line.

Follow-up

Regular.

Prognosis

Chronic but manageable, varies with severity.

What you can do yourself

Regular strength training for the muscles around the joint is the single most effective measure — better than rest.

When should you book?

For joint pain lasting more than a few weeks, or affecting your sleep and daily life.

Typical age

Becomes more common with increasing age — most people who develop hip osteoarthritis are over 45, but the condition can occur earlier, for example after a previous injury to the joint.

Background

The cartilage in the hip joint becomes thinner. The pain often sits in the groin and can radiate toward the thigh or the knee — so knee pain without findings in the knee is sometimes taken for a knee problem when the hip is the source.

Common symptoms

Pain on loading, and start-up pain when you stand up and begin to walk. Morning stiffness and stiffness after rest usually ease once you have got going. Later, pain at rest, night-time aching and a shorter walking distance can appear. Stiffness and reduced mobility, including in internal rotation, abduction and flexion, are common.

What the doctor looks for

Restricted movement in the hip, a limp, and whether the pain comes from the hip, the back or the knee — the three can resemble one another.

Investigations

Often a clinical assessment. A plain X-ray of the hip is the first choice when imaging is needed. The agreement between the X-ray findings and how much it hurts is moderate — severe osteoarthritis on imaging can cause mild symptoms, and the reverse.

How the assessment is made

From the pain pattern, the range of motion, and how walking, dressing and sleep are affected.

Management

Adapted exercise and information, preferably through a physiotherapist or an osteoarthritis school, are the foundation. Pain relief when needed. A hip replacement can become relevant if you are in a lot of pain despite regular exercise and pain relief, if you also have pain at rest or at night, or if the symptoms impair your quality of life.

Follow-up

Regular during conservative treatment; more frequent if walking or sleep worsens.

Risk factors to know

A previous injury to the joint, congenital hip abnormalities, inflammatory joint disease, and certain hip conditions in childhood.

Common misconception

That the hip should rest in order to protect the cartilage. Adapted exercise is the foundation of treatment — being sedentary does not help the joint.

What you can do yourself

Keep moving the hip within what is possible. Strength around the hip and thigh, plus regular walks, is the measure that usually does the most in everyday life. Move regularly and avoid sitting still for long periods.

When should you book?

Contact primary care or a physiotherapist if you think you have hip osteoarthritis.

Prognosis

Symptoms can lessen with exercise and with knowledge about osteoarthritis, and they can vary over time. With severe symptoms, replacement surgery can restore everyday function.

Typical age

Adults, most common 30–50 years.

Background

Disc tissue presses on a nerve root; the good news is that most cases improve with time and conservative treatment, without ever needing surgery.

Symptoms

Back pain radiating down the leg, possibly numbness.

What the doctor looks for

Radiation pattern, neurological symptoms.

Investigations

Clinical assessment, sometimes MRI.

Diagnosis

Clinical picture ± imaging findings.

Management

Pain relief, activity, surgery rarely — reserved for cases with significant neurological symptoms or ones that don't improve over time.

Follow-up

If no improvement.

Prognosis

Good, most improve without surgery.

What you can do yourself

Keep moving within the limits of pain. Bed rest makes it worse and prolongs recovery.

When should you book?

For radiating pain lasting more than two weeks. With leg weakness, altered sensation in the genital area or around the anus, or bladder or bowel involvement — emergency care.

Sudden leg weakness, altered sensation in the genital area or around the anus, or loss of bladder/bowel control with back pain is an emergency — see the safety box.

Typical age

All adult ages, more common with repetitive loading.

Background

Overuse of a tendon.

Symptoms

Pain with movement/loading of the tendon.

What the doctor looks for

Location and loading pattern.

Investigations

Clinical assessment.

Diagnosis

Clinical picture.

Management

Rest, gradual loading, physiotherapy.

Follow-up

Per progress.

Prognosis

Good but can take time.

What you can do yourself

Gradual, controlled loading heals tendons better than rest — but increase slowly; tendons respond more slowly than muscles.

When should you book?

For tendon problems that haven't improved within six weeks.

Typical age

Most common in middle age, particularly 40–60 years.

Background

Overload of the tendon attachment on the outside of the elbow, where the forearm extensor tendons attach. The inside of the elbow is a different condition, called golfer's elbow or medial epicondylitis. Despite the name tennis elbow, most cases come from repetitive gripping work — not from tennis.

Common symptoms

The pain typically sits on the outside of the elbow and gets worse with gripping, lifting or twisting, even of light things such as pouring from a jug. Aching at rest or at night can also occur, for example with pressure against the outside of the elbow.

What the doctor looks for

Tenderness over the tendon attachment on the outside, and pain when the wrist is extended against resistance.

Investigations

A typical picture is enough. An X-ray is not needed when the symptoms are typical.

How the assessment is made

Clinically, from tenderness on the outside of the elbow and from which movements trigger the pain.

Management

Adapt the work or the activity that triggered the symptoms. A physiotherapist can help with loading and exercises. With more pronounced symptoms, an offloading epicondylitis brace or a wrist orthosis can be tried. A cortisone injection sometimes gives short-term relief but can worsen the long-term prognosis and is usually avoided. Surgery is rarely relevant.

Follow-up

Per progress.

Risk factors to know

Repetitive gripping work, repeated extension and twisting movements of the wrist, and manual trades.

Common misconception

That you have to play tennis to get tennis elbow. Most people get it from one-sided work with their hands.

What you can do yourself

Reduce the grips and twists that hurt, take short breaks, and train the forearm extensor muscles gradually. Rest alone rarely heals the tendon — it needs measured loading, not inactivity.

When should you book?

For pain on the outside of the elbow that does not settle, or if everyday lifting and gripping hurt.

Prognosis

Good. Most people improve within a year, but tendon healing takes time.

Typical age

Adults, more common in women.

Background

Pressure on the median nerve at the wrist.

Symptoms

Numbness and tingling in thumb, index, and middle finger, often at night.

What the doctor looks for

Symptom pattern.

Investigations

Clinical assessment, sometimes nerve conduction testing via specialist.

Diagnosis

Clinical picture.

Management

Wrist splint, surgery in pronounced cases.

Follow-up

Per progress.

Prognosis

Good, especially with early treatment.

What you can do yourself

A night wrist splint often gives a noticeable effect within a few weeks and is a good first step.

When should you book?

For numbness that wakes you at night, or if you've started dropping things.

Typical age

All ages, more common in active people.

Background

Acute or overuse injury from sports.

Symptoms

Pain, swelling, reduced function.

What the doctor looks for

Injury mechanism, functional impairment.

Investigations

Clinical assessment, sometimes imaging if a more serious injury is suspected.

Diagnosis

Clinical picture.

Management

Rest, gradual return, physiotherapy.

Follow-up

Per progress.

Prognosis

Good with proper rehabilitation.

What you can do yourself

For the first few days — relative rest, compression, elevation. After that, gradual return rather than complete rest.

When should you book?

If you can't bear weight, with marked swelling, or if there's no improvement after a week.

Typical age

All adult ages.

Background

Often muscular or posture-related.

Symptoms

Stiffness, pain with movement.

What the doctor looks for

Movement restriction, possible radiation.

Investigations

Clinical assessment.

Diagnosis

Clinical picture.

Management

Movement exercises, pain relief.

Follow-up

If symptoms persist.

Prognosis

Good.

What you can do yourself

Range-of-motion exercises and a review of your working posture usually work better than painkillers in the long run.

When should you book?

For neck pain beyond three weeks, or if it radiates into the arm with numbness.

Typical age

Adults, more common middle-aged.

Background

Pinching of tendon tissue in the shoulder joint.

Symptoms

Pain when lifting the arm, especially above shoulder height.

What the doctor looks for

Movement pattern that triggers pain.

Investigations

Clinical assessment, sometimes imaging.

Diagnosis

Clinical picture.

Management

Physiotherapy, pain relief.

Follow-up

Per progress.

Prognosis

Good with proper rehabilitation.

What you can do yourself

Avoid repeated movements above shoulder height during the acute phase, but keep moving the shoulder within the pain-free range.

When should you book?

For shoulder pain beyond four weeks, or if you can't lift your arm.

Typical age

Most common at 40–60 years, and more common in women.

Background

The joint capsule in the shoulder becomes thickened and tight. It can come on without a clear cause, or after a period when the shoulder has not been moving — for example after an injury or an operation. It is a different condition from shoulder impingement.

Common symptoms

First increasing pain and pain at rest, then marked stiffness as the pain eases off. Both the movement you take yourself and the movement someone else takes the arm through are reduced.

What the doctor looks for

Restricted movement in both directions, particularly external rotation. In impingement the pain is often greater with active movement than with passive movement. The difference is guiding, but not decisive on its own.

Investigations

A clinical diagnosis from the course. An X-ray to rule out osteoarthritis. MRI if you have struck the shoulder, or if the course does not fit.

How the assessment is made

From the phases of pain, stiffness and recovery, and by comparing active and passive movement with the other shoulder.

Management

Pain relief and physiotherapy adapted to the phase: early on, to manage the pain; later, to regain movement. A cortisone injection into the joint can relieve symptoms early but probably does not change the long-term course. Surgery is rarely considered.

Follow-up

Through a physiotherapist. A new medical assessment if the course is atypical, or if a trauma came first.

Risk factors to know

Diabetes, thyroid disorder, and previous immobilization of the shoulder. The other shoulder can be affected later.

Common misconception

That you should stretch hard through the pain in order to thaw the shoulder faster. In the painful phase, movement is taken within what the pain allows; forced stretching does not belong there.

What you can do yourself

Follow exercises and advice adapted to the phase of the symptoms you are in. Ask a physiotherapist for exercises that suit the phase you are in — the wrong intensity can increase the pain without shortening the course. Keep using the arm for dressing and everyday tasks as far as it goes.

When should you book?

For shoulder pain with increasing stiffness over a few weeks, particularly if you cannot get dressed or lie on that side. If you have recently struck the shoulder — say so when you book.

Prognosis

The outlook is usually good, but the course is prolonged. It often takes two to three years from the start of the symptoms until the shoulder has recovered. The pain usually lessens before mobility is fully back, and some stiffness or aching can remain.

Typical age

All ages.

Background

Injury to the cartilage disc in the knee.

Symptoms at follow-up

Persistent knee pain or feeling of instability.

What the doctor looks for

Functional level, previous investigation findings.

Investigations

Review of previous imaging.

Diagnosis

Already established, this concerns follow-up.

Management

Physiotherapy, sometimes surgery.

Follow-up

Per individual plan.

Prognosis

Varies with injury type.

What you can do yourself

Strength training for the thigh muscles improves function and often reduces the need for surgery.

When should you book?

For a knee that locks, gives way, or stays swollen.

Typical age

Adults.

Background

Inflammation of a bursa near a joint.

Symptoms

Localized pain and swelling.

What the doctor looks for

Location, signs of infection.

Investigations

Clinical assessment.

Diagnosis

Clinical picture.

Management

Rest, pain relief.

Follow-up

If no improvement.

Prognosis

Good.

What you can do yourself

Avoid the pressure or movement that triggered it; cold can relieve symptoms in the acute phase.

When should you book?

If there's no improvement within two weeks. With fever and marked redness — emergency care.

Marked redness, warmth and fever around a joint can indicate infection — an emergency, see the safety box.

Typical age

All adult ages, more common with repetitive loading.

Background

Overload of the plantar fascia — the tendon sheet under the foot — where it attaches to the heel bone. A heel spur that is visible on X-ray does not always have a connection with heel pain, and it can be present without causing symptoms.

Common symptoms

Pain under the heel or on the inside of the heel with loading. Start-up pain, and stiffness or pain in the morning that lessens once you have got going, is common. Aching after loading.

What the doctor looks for

Distinct tenderness to pressure at the fascial attachment, and a clear morning pattern.

Investigations

The diagnosis is made clinically. An X-ray can be considered in order to rule out other causes, for example a stress fracture or osteoarthritis, and when there is no improvement despite treatment.

How the assessment is made

From the morning pain and the point of tenderness.

Management

Shock-absorbing shoes and offloading insoles, alternative exercise, stretching and taping. Surgery is rare.

Follow-up

The symptoms are often prolonged.

Risk factors to know

Overload during walking, running or other activity that loads the foot, hard surfaces, shoes with insufficient support, overweight, foot malalignment and a tight Achilles tendon can contribute.

Common misconception

That the heel spur on the X-ray is what hurts, and that it has to be removed by surgery. The spur is often present in people without symptoms. Treatment is directed at the loading, not at the bony outgrowth.

What you can do yourself

Use steady shoes with soft cushioning under the heel, and try shock-absorbing insoles if you need them. Offload the heel while it hurts: rest from running and from walks until you are no longer in pain. Cycling and swimming are fine in the meantime. When you can walk without heel pain, you can start with shorter walks and then increase gradually.

When should you book?

For heel pain that governs how you walk for more than a few weeks, or if the pain sits directly in the heel bone and does not ease — then another cause needs to be considered.

Prognosis

Good in the long term. Healing often takes a long time, sometimes more than a year, but it rarely leads to chronic damage to the foot.

Typical age

Adults, most common 30–50 years.

Background

Irritation or pressure on the sciatic nerve; most people see meaningful improvement within a few weeks with conservative management.

Symptoms

Pain radiating from the lower back/buttock down the leg.

What the doctor looks for

Radiation pattern, neurological signs.

Investigations

Clinical assessment, sometimes MRI.

Diagnosis

Clinical picture ± imaging findings.

Management

Pain relief, activity, surgery rarely.

Follow-up

If no improvement.

Prognosis

Good, most improve within weeks.

What you can do yourself

Keep moving. Walking is better than bed rest, even when it hurts.

When should you book?

For radiating leg pain beyond two weeks. With weakness, altered sensation in the genital area or around the anus, or bladder or bowel involvement — emergency care.

Typical age

All adult ages.

Background

Night pain is a pattern that deserves particular attention in orthopaedics. Mechanical pain is normally relieved by rest — pain that instead wakes you, or is worst at night, follows a different pattern and may point to inflammation or, rarely, a more serious cause.

Common symptoms

Pain that wakes you, or that is markedly worse in bed than during the day.

What the doctor looks for

Whether the pain eases with movement (suggesting inflammation) or worsens (suggesting a mechanical cause), and whether other warning signs are present.

Investigations

Blood tests (inflammatory markers), often imaging for persistent night pain.

How the assessment is made

By mapping the daily pattern carefully — it is often more revealing than where the pain sits.

Management

Directed at the established cause.

Follow-up

Closer than for ordinary load-related pain.

Risk factors to know

Previous cancer, unintended weight loss, fever, night sweats — these combined with night-time bone pain require prompt investigation.

Common misconception

That night pain just means a bad mattress. Sometimes it does — but the pattern always deserves an assessment.

What you can do yourself

Note exactly when the pain wakes you and whether it eases when you move — that is decisive information.

When should you book?

For pain that repeatedly wakes you, particularly alongside weight loss, fever, or if you've had cancer before.

Prognosis

Depends entirely on the cause — but most cases have a benign explanation.

Typical age

All ages, most common in people who have recently increased their training load.

Background

Overload injuries occur when loading increases faster than the tissue can adapt. It is one of the most common causes of orthopaedic problems in active people — and one of the most preventable.

Common symptoms

Gradually increasing ache with a specific movement, often in a tendon, ligament or bone; worst at the start of activity or afterwards.

What the doctor looks for

The time relationship to a change in training volume or a new activity, and whether the pain is load-dependent.

Investigations

Clinical assessment; imaging where a stress fracture or more serious injury is suspected.

How the assessment is made

From the loading history and the pain pattern.

Management

Relative rest (reduce, don't stop), technique adjustment, gradual rebuilding to a structured plan.

Follow-up

According to the return-to-activity plan.

Risk factors to know

Rapid increase in training volume, insufficient recovery, lack of variation, old injuries, unsuitable equipment.

Common misconception

That you should rest completely until it doesn't hurt at all. Total rest weakens the tissue further — controlled, progressive loading is usually right.

What you can do yourself

Reduce the load by roughly half rather than stopping altogether, then increase by no more than ten per cent a week.

When should you book?

For pain persisting beyond three weeks despite reduced loading, or if you're limping.

Prognosis

Very good with the right loading progression.

Typical age

All adult ages.

Background

Numbness indicates nerve involvement, but the source can sit anywhere along the nerve pathway — from the neck or lower back to the wrist or ankle. Where the numbness sits often tells you exactly where the problem is, which makes careful mapping more valuable than early imaging.

Common symptoms

Numbness, tingling or a crawling sensation, sometimes with weakness at the same time.

What the doctor looks for

The exact distribution — which fingers, or which part of the foot — since each nerve has a characteristic territory.

Investigations

Clinical assessment; nerve conduction studies or MRI via in-person care for persistent problems.

How the assessment is made

By mapping the distribution pattern against known nerve territories.

Management

Directed at the cause — splinting, ergonomic adjustments, physiotherapy or, in some cases, surgery.

Follow-up

According to progress; sooner where weakness is present.

Risk factors to know

Diabetes (a common cause of neuropathy), repetitive work, previous neck or back problems, B12 deficiency, high alcohol intake.

Common misconception

That numbness always comes from the place where you feel it. Numbness in the hand often originates in the neck.

What you can do yourself

Draw exactly where the numbness sits on a diagram and bring it to the visit — it's the most valuable information you can give.

When should you book?

For numbness lasting more than two weeks. With sudden weakness or rapidly increasing numbness — emergency care.

Prognosis

Good, particularly with early treatment — nerve problems recover more slowly the longer they are left.

Typical age

All ages.

Background

Bone heals, but function does not return automatically. Many people are left with stiffness, weakness or uncertainty after the cast comes off — and the rehabilitation phase is often what determines the final result, rather than the fracture treatment itself.

Common symptoms

Stiffness, reduced strength, swelling, uncertainty when loading the limb.

What the doctor looks for

Range of motion, functional level, and whether recovery is following the expected course for the fracture type.

Investigations

Review of previous X-rays and the operation report; new imaging where healing is in doubt.

How the assessment is made

From the fracture type, the time since injury and current function.

Management

Structured rehabilitation; referral to a physiotherapist where needed.

Follow-up

Regular throughout the rehabilitation phase.

Risk factors to know

Smoking (markedly impairs fracture healing), diabetes, osteoporosis, older age, inadequate rehabilitation.

Common misconception

That you're finished when the cast comes off. For most fractures, the most important part starts there.

What you can do yourself

Start range-of-motion exercises as soon as you've been cleared — stiffness is harder to fix than to prevent.

When should you book?

For persistent stiffness or weakness a few weeks after the cast comes off, or if pain is increasing rather than easing.

Prognosis

Good with structured rehabilitation; worse if rehabilitation is skipped.

Typical age

More common from middle age upwards. A joint replacement can become relevant with pronounced symptoms and functional impairment from osteoarthritis. A hip replacement can also become relevant with certain hip fractures.

Background

After a hip or knee replacement, function comes back with rehabilitation, not automatically. Most people can return to walking, cycling and swimming; when you can start running or another impact sport is a question for the person who operated on you.

Common symptoms

Persisting stiffness, swelling or uncertainty on loading during rehabilitation.

What the doctor looks for

Functional level, gait, and whether recovery is following the expected course — and signs of a complication.

Investigations

Review of the operation report and previous X-rays; a new assessment if pain, swelling or redness is increasing.

How the assessment is made

From the time since the operation, which joint was replaced, and how you function in everyday life.

Management

Structured rehabilitation; referral to a physiotherapist when needed. If an infection in the replaced joint is suspected, contact the orthopedic clinic or the hospital where you had the operation, for assessment.

Follow-up

According to the plan of the clinic that operated. Digital follow-up complements that plan; it does not replace it.

Risk factors to know

Infection in the joint is uncommon but serious. Increasing pain, swelling, redness, warmth or fluid from the wound should not be waited out.

Common misconception

That you are finished when you have come home from the hospital. Rehabilitation is relatively long, and after a knee replacement it can take up to half a year to reach the function that can be achieved.

What you can do yourself

After a hip replacement: follow the rehabilitation you were given. Walking, cycling and swimming usually suit well. Ask the clinic that operated on you, or the physiotherapist, when and whether running or another more impact-loading sport is suitable for you. After a knee replacement: follow the rehabilitation and do not increase the training faster than you have been advised. Walking, cycling and swimming usually suit well. After a total knee replacement: avoid running and other heavier impact activity. Ask the physiotherapist or the clinic that operated on you which activities suit you.

When should you book?

For stiffness or uncertainty that does not follow the plan you were given, or if you want to go through the X-rays and the restrictions. If you get a fever, increasing redness or warmth around the operation area, fluid from the wound, or increasing pain — contact, as soon as possible, the orthopedic clinic or the hospital where you had the operation. If you get worse quickly or are clearly systemically unwell, seek emergency care. Call your local emergency number for life-threatening symptoms, for example severe breathing difficulty or reduced consciousness.

Prognosis

Most people regain good everyday function with rehabilitation.

Signs of infection in a joint replacement are to be assessed by the clinic that operated on you. With rapid deterioration, or if you are clearly systemically unwell — emergency care. See the safety box.

Typical age

More common from 60 onwards, and considerably more common in women after the menopause.

Background

Osteoporosis causes no symptoms at all until a fracture occurs — and the first fracture is often what reveals the diagnosis. Since the risk of further fractures rises sharply after the first, early identification is particularly valuable.

Common symptoms

None before a fracture; then pain and loss of function. Sometimes reduced height or a stooped posture.

What the doctor looks for

Previous low-energy fractures (a fracture after a fall from standing height), risk factors, and loss of height.

Investigations

Bone density scan (DXA) via in-person care; blood tests (calcium, vitamin D, kidney function).

How the assessment is made

Bone density measurement, or clinically after a low-energy fracture in an older person.

Management

Vitamin D and calcium, strength and balance training, plus bone-specific medication where risk is raised.

Follow-up

Regular, with repeat measurement to plan.

Risk factors to know

Early menopause, corticosteroid treatment, smoking, low body weight, family history of hip fracture, high alcohol intake, inactivity.

Common misconception

That osteoporosis only affects very old women. Men are affected too, and treatment can start long before any fracture occurs.

What you can do yourself

Weight-bearing exercise (walking, strength training) stimulates bone formation. Balance training reduces the risk of falling, which matters at least as much as bone density.

When should you book?

After a fracture from a fall at standing height, or with several risk factors even without a previous fracture.

Prognosis

Good risk reduction is possible — treatment markedly lowers fracture risk.