Frequently Asked Questions

<中文版>

1. What is musculoskeletal medicine?

Musculoskeletal Medicine is a branch of medicine that deals with acute or chronic musculoskeletal injury, disease or dysfunction. Its aim is to address the somatic dysfunction, which is an impaired or altered function of the components of the somatic (body framework) system. The somatic system includes the skeletal, arthrodial and myofascial structures with their related vascular, lymphatic and neural elements. (Hospital Adaptation of International Classification of Diseases, 2nd Edition, 1973).

Musculoskeletal Medicine relies upon a carefully taken medical history and a very detailed physical examination. The objective is to localize a complaint to a specific region and, if possible, a specific anatomical structure, and to define its malfunctioning biomechanical relationship to movement and function. The physician then makes a logical analysis and develops a tailor-made management plan from the information obtained. In the majority of cases, a musculoskeletal physician can formulate a very specific diagnosis, thereby delivering very targets-oriented treatments with very high success rates. There is a growing evidence base for musculoskeletal medicine and this is an important part of our training.

Doctors with qualification in Musculoskeletal Medicine in Hong Kong are qualified Medical Practitioners that have undergone extensive university postgraduate training in Australia or New Zealand and obtained quotable Master degree or Postgraduate Diploma in Musculoskeletal Medicine recognized by the Hong Kong Medical Council.

2. Is musculoskeletal medicine similar to physiotherapy, chiropractic, osteopathy or traditional Chinese bone setting?

Whilst the various disciplines of physiotherapy, chiropractic, osteopathy and traditional Chinese bone setting have successes in their own modalities on the diagnosis and treatment of musculoskeletal problems, Musculoskeletal physicians are unique in that they are all qualified medical practitioners that have undergone extensive University postgraduate training and obtained quotable Master degree or Postgraduate Diploma in Musculoskeletal Medicine recognized by the Hong Kong Medical Council. Hence a musculoskeletal physician should be able to provide you with

• A concise medical diagnosis leading to fast results. Musculoskeletal physicians are trained to pinpoint and treat the underlying root causes of the musculoskeletal pain, sometimes with the help of bedside dynamic musculoskeletal ultrasound imaging. Therefore, Musculoskeletal Medicine treatments are extremely effective in alleviating pain and restoring function in the shortest possible time as the root causes are treated.
• A unified and tailor-made approach. Musculoskeletal Medicine often does not focus only on one part of the body. Instead, specific symptoms are examined medically, socially, emotionally, and vocationally. This allows a comprehensive plan to be developed that includes treatment, rehabilitation, and also proactive planning for the prevention of further injuries.
• Complete treatment modality. As all musculoskeletal physicians are registered doctors, they can provide a complete treatment modality, which is not limited to physical treatment alone. A musculoskeletal physician can provide, in addition to manual treatments, other therapies, such as pharmaceuticals, counseling or injection techniques to restore normal function. (See the web page on available therapies)
• Preventing recurrence. Musculoskeletal Medicine treatments are designed to prevent recurrence by prescribing specific post-treatment strengthening exercises, posture and lifestyle modifications and appropriate rehabilitation programs.
• Minimal costly extras. A thorough physical examination leads to a logical diagnosis for the vast majority of mechanical musculoskeletal dysfunctions. Therefore, the need for unnecessary costly and potentially harmful radiological or diagnostic testing is minimized. In fact studies showed that radiological images correlate poorly with the severity of pain in a lot of musculoskeletal problems.
• Medical support. All our musculoskeletal physicians are family physicians and a lot them are specialists in Family Medicine. All of them adopt a holistic approach in seeing patients. Therefore, they can quickly identify those musculoskeletal symptoms that are not biomechanical in origin by using a bio-psychosocial model in their consultation. Should there be problems out of the scope of musculoskeletal medicine, early detection and prompt referral to the relevant specialist, allows appropriate treatment to commence without delay.

3. What ailments can benefit from musculoskeletal treatment?

The aim of our Musculoskeletal Medicine treatment is to correctly diagnose somatic (bodily) dysfunctions, including restricted joint motion, muscles which are in spasm or which are hypotonic, altered muscle firing patterns and tightness or laxity in connective tissues such as ligaments, joint capsules or fascia. Such dysfunctions can cause joint laxity and instability, joint restrictions, pain, nerve hypersensitivity, or vascular and nerve entrapment.

The followings are the problems/ conditions typically responding well to the musculoskeletal treatments.

• migraine-like cervicogenic headaches
• cervicogenic dizziness, giddiness or vertigo that usually respond poorly to anti-dizziness medication.
• neck stiffness or pain, acute and chronic whiplash
• bilateral upper limbs numbness or pain that are due to cervical spines, muscles and ligaments dysfunction.
• shoulder stiffness or pain, shoulder dysfunction
• musculoskeletal chest pain, inter-scapular pain
• acute and chronic lower back pain
• musculoskeletal pelvic pain and dysfunction
• peripheral limb pain or paraesthesiae
• peripheral joint dysfunction; hip, knee, ankle, foot, shoulder, elbow, wrist, finger
• tendonitis or tendonosis; tennis elbow, golfers elbow, Achilles tendonosis
• foot pain, heel pain, ankle dysfunction and instability
• disturbance of gait or posture
• TMJ dysfunction

4. I have a disc bulge in my back - can Musculoskeletal Medicine help?

Disc bulges are a common finding in CT scans and MRIs of the lumbar region. Researches had shown that there is no direct relationship between the CT or MRI findings with the severity of pain. In other words, patients with no or minimal CT or MRI disc changes can have severe pain while patients with very severe pathologies on CT or MRIs can have only minimal symptoms. Musculoskeletal physicians can help in defining the contribution of the disc bulge to the complaints of pain in the back and /or legs, as well as in looking into the biomechanical factors which may be disordered so that the root causes of the pain can be identified. After thorough evaluation of the clinical features, those patients really benefited from surgery will be indentified and appropriately referred to; for other patients who do not need surgical treatments, a structured treatment and home exercise program can be individually formulated to stabilize and strengthen the lumbar area, and to improve function.

5. What about problems with the shoulders, elbows, wrists, hips, knees, and feet?

Peripheral joints and their performance can certainly influence our body's biomechanics. The biomechanics of our body is like a train with different compartments being linked up by joints. A defect in one joint can affect the performance of the rest of the joints. A simple example is that persistent pain in one knee will eventually be transferred to other knee because our body will help the painful knee by shifting part of its load (our body weight) to the other knee which in time will overload the other knee causing pain and dysfunction. Also pain in one joint can be transmitted to the joints above and below. An example is that an osteoarthritic knee can cause pain in the ipsilateral hip or ankle when the body attempts to ship part of the knee biomechanics to the hip above and the ankle below. Therefore to identify how the biomechanics of the body works and to identify the root cause of the peripheral joint problem is an important area of musculoskeletal medicine. Our musculoskeletal physicians are fully qualified to diagnose and treat all the peripheral joints.

常見問題

1. 什麼是“肌骼醫學”？

肌骼醫學是醫學的一個分支，以處理急性或慢性的肌肉骨骼損傷、疾病或功能失調為主。其目的是針對軀體功能障礙（somatic dysfunction）進行干預；軀體功能障礙指的是我們軀體 (soma) 組件的功能受到損害或改變。軀體包括了骨骼、滑動關節和肌筋膜的結構，以及相關的血管、淋巴管和神經元（Hospital Adaptation of International Classification of Diseases, 2nd Edition, 1973）。

肌骼醫學斷症時主要是靠小心詢問的病史，以及詳細的身體檢查；目的是找出導致病人主訴的身體特定部位，如果可以的話，甚至找出特定的解剖結構，確定其生物力學的功能失調與身體的活動及功能的關係。醫生根據所取得的資料進行邏輯性分析，制定一份治療方案。在大多數情況下，肌骼科醫生能為病人作出一個非常專注的診斷，從而制定一個針對性的治療，提高成功率。肌骼醫學的循證依據（即臨床研究與臨床實踐的證據）現正日漸增多，而循證臨床實踐正是肌骼醫學培訓裡重要的一環。

在香港，取得“肌骼醫學”資歷的醫生都是符合資格的執業西醫，他們都在澳洲或新西蘭大學的醫學院深造過，接受了肌骼醫學的培訓，並獲得由香港醫務委員會承認的肌骼科醫學碩士學位或深造醫學文憑。

2. “肌骼醫學”和物理治療、脊醫療法、整骨或傳統的跌打，是不是大同小異？

在診斷及治療肌骼問題方面，各個學科，例如物理治療、脊醫、整骨及跌打的療法都有它們的成功之處，而肌骼醫學的特別之處在於他們的醫生全部都是符合資格的執業西醫，他們都在澳洲或新西蘭的大學裡深造、訓練過，並獲得由香港醫務委員會承認的肌骼科醫學碩士學位或肌骼醫學文憑證書。因此，肌骼科的醫生應能為病人提供：

• 一個精確的醫學診斷和快速見效的治療方案
  肌骼科醫生的訓練使他們能夠準確地找出肌骼疼痛的根本原因和提供治療，有時仍需動態肌骼超聲波掃描的幫忙。因此，肌骼醫學提供的治療方案在舒緩痛症方面非常有效，並可以幫助病人在可能的最短時間內恢復身體的功能。
• 一個綜合性的治療方案
  肌骼科醫生對病人症狀的假設，一般不會只集中在身體的某一部位。肌骼科醫生會從不同的角度來查看，包括醫學、社會、心理及職業方面，從而制定出一個涵蓋了治療、康復，甚至可預防再度受傷的綜合性方案。
• 全面性的療法
  由於肌骼科醫生同時也是註冊西醫，因此可以提供西醫醫學上所有的治療方法，而不會只限於物理方面的治療。除了手法治療（manual treatment）外，肌骼科醫生也可以通過其他的療法，例如藥物治療、心理輔導、各種不同的注射療法，來幫助病人恢復正常的身體功能。（詳見網頁內的“肌骼科療法”）
• 防止復發
  肌骼醫學很注重傷患及疾病復發的預防，因此制定的治療方案一般都包括特定的療後肌肉強化運動，以及適當的康復運動。
• 減少額外的檢查費用
  在肌骼醫學，詳細的身體檢查，對大多數因生物力學功能失調引致的肌骼問題，通常都可以推斷出一個邏輯性的診斷。因此，可以減少不必要、高成本，且具有潛在放射性危險的檢驗。
• 其他的醫學支援
  所有肌骼科醫生都是合資格的西醫，其中一些更是家庭醫學的專科醫生。因此，他們能以身體、心理、社會的三維全人診斷法，很快地辨認出那些具有肌骼症狀而問題來源並不是生物力學失調的疾病，及早轉介予相關的專科醫生，讓病人接受適當的醫治，避免延誤治療。

3. 哪些疾病能夠受益於肌骼醫學的治療？

肌骼醫學治療的主要目的是正確地診斷出軀體功能障礙，包括關節活動的受限、肌痙攣或肌肉張力低、肌肉發力時的模式改變，以及結締組織如韌帶、關節囊或筋膜的緊繃。這些功能障礙可引致關節鬆弛和不穩定、關節受限、痛症、神經線過敏、神經或血管受到卡壓。

肌骼治療對下列各病例具有一定的療效：

• 類似偏頭痛的頸椎性頭痛
• 頸梗（頸僵硬）或頸痛，急性及慢性的頸骨損傷
• 肩部僵硬或肩痛，肩關節功能失調
• 肌骼性心口痛，肩胛中部疼痛
• 急性及慢性的下背痛
• 肌骼性骨盆疼痛及功能失調
• 四肢疼痛或感覺異常
• 周邊關節功能失調：臀部、膝蓋、腳踝、足部、肩部、手肘、手腕、手指
• 肌腱炎：網球肘、高爾夫球肘、跟腱炎
• 腳痛、腳跟痛、踝關節功能失調
• 步態或姿勢不當
• 顳下顎關節功能障礙（TMJ dysfunction）

4. 我背部的椎間盤突出– 肌骼治療可以幫到我嗎？

椎間盤突出是電腦斷層掃描（CT）及磁力共振造影（MRI）在檢查腰椎時的經常發現。研究表示，CT及 MRI發現的椎間盤突出與痛症的嚴重程度並沒有直接關係。換句話說，CT或 MRI結果顯示沒有出現或出現極小椎間盤突出的病人還是可以有很嚴重的痛症；而掃描結果顯示有嚴重椎間盤病變的病人可能只有輕微的症狀。肌骼科醫生可以幫助確定病人的背痛及/或腿痛多少是來於椎間盤突出，多少是因生物力學問題使椎間盤突塊的問題擴大所引致。一般來說，在詳細評估病人的臨床特點後，肌骼科醫生就可以找出背痛的根源，適當轉介需要手術的病人，對不需要手術的病人，則制定一份適合病人的治療方案及家居運動計劃，幫助病人穩固及加強腰椎的活動，並改善腰椎的功能。

5. 對於肩部、手肘、手腕、臀部、膝蓋，及足部的問題又是怎樣呢？

周邊關節以及關節活動對我們身體的生物力學無疑是有影響的。我們的軀體就像一列由不同車廂組成的火車一樣，連接這些組件的則是我們的關節。一個關節出現問題就會影響到其他關節的活動能力。舉一個簡單的例子，如果右腿的膝蓋持續疼痛，痛症最終也會轉移到左腿的膝蓋，因為我們的身體為了要幫助較痛的右腿膝蓋，會本能地把它部分的負荷（即我們的體重）轉移到左腿；久而久之，左腿膝蓋就會因為負荷過重而導致疼痛及功能失調。除此之外，一個關節的痛症也可能會影響到其上面及下面的關節，退化性膝關節炎就是其中一個例子。退化性膝關節炎常會引致同側的臀部或足踝疼痛，因為我們的身體會試圖把膝關節部分的負荷轉移到上面的髖關節或下面的踝關節。因此，認識我們身體的生物力學以及確定周邊關節問題的根源是肌骼科醫學一個很重要的範疇，因此，肌骼科醫生在診斷及治療周邊關節問題方面是完全勝任的。