Monthly Archives: Mar 2018

Oh no! My Doctor is sending me to a Surgeon……

Being referred to a “Specialist” surgeon by a Trauma Doctor, or even your Family Doctor/ GP, can make one very anxious. Is this doctor going to operate on me? How bad is this problem, it must be really bad if my GP can’t handle it, right? Oh my gosh, my friends and family have been to see a surgeon, and they were not happy after they got “cut open……”. These are some of the thoughts that go through our minds when we need to see a specialist doctor.
Generally, the referring doctor requires a second opinion, and help with treatment of certain conditions. The human body is an amazing creation, and not all of it is fully understood. This is why it is so difficult to be an “Expert” in all fields of Medicine. Consequently, after graduating as Doctors, some Practitioners chose to concentrate their knowledge in a smaller field, essentially becoming very skilled in a very small subject, so to speak.
The first step, when preparing for an appointment with an Orthopaedic Surgeon, is to be as relaxed and calm as possible. An appointment is not a death sentence. Your GP/ Doctor is simply sending you to another medical professional who is appropriately skilled in an area/ field where you require more information regarding the possible treatment options, and essentially, advice on how to get back to your previous level of health, function, and mobility, as quickly as possible. This does not always entail surgery. Surgery is suggested only as a last resort, after appropriate alternative therapies have failed.
The assessment always begins with a thorough history of the patient’s problem, so be prepared for questions. Included, is a history of previous medical (eg: diabetes, hypertension, cardiac disease, and allergies) and surgical issues/ treatments, and chronic medications- so it is advisable to either make a list of these medications, or bring them with you. Past medial records like letters, reports, and even old xrays/ images of the problem concerned, are crucial to assist with current problems. Ninety percent of the time, a diagnosis is made just from the patient’s history, and is thereafter confirmed upon physical examination. Be prepared to be examined by your doctor. Please remember to wear comfortable, loose fitting clothing, or perhaps consider bringing a pair of loose shorts with you, to your appointment. Lastly, try to arrive ten to fifteen minutes early if possible. This will allow the patient ample opportunity to relax and acclimatize while in the doctor’s reception area, and afford sufficient time to complete the necessary paperwork, in order to maximise time during the assessment of the patient’s problem. Lastly, please remember that surgeons are often required to attend to emergencies that are brought into hospital, like people with broken bones, and other related injuries or infections, from time to time. Although every attempt is made to attend to scheduled appointments timeously, your surgeon may be delayed in his, or her, attempts to assist you on time. Kindly bear with us, we do our best to notify patients of a delay before hand, or to reschedule the appointment. In the rare event that the message does not reach you in time, please forgive us. We appreciate your patience and understanding in this regard, and we are aware that your time is just as valuable as ours is.

Is it my back or my hips?

It is sometimes very difficult, even for doctors and clinicians, to differentiate between lower back/ spine problems, and hip joint problems, as a cause for a patient’s discomfort. Patient’s themselves, often come to their doctors not knowing whether to complain of back or hip pain, and what is an even greater conundrum, is the “double crush “phenomenon. The “double crush “refers to the presence of two separate, but co-existing problems, one usually in the lower spine/ back, and another within the pelvis and hip joints.

The reason for this “diagnostic dilemma” is due to the fact that the nerves which supply the hip and legs arise from within the spinal canal in the lumbar spine, before meeting and travelling down behind the hip joint on their way to supply the legs and feet.


As a result, problems like arthritis (spondylosis) of the lumbar spine, or disc problems like herniation, may compress the exiting nerve root, causing pain along the distribution of that nerve. This is often called “Pinched nerve” or SCIATICA.

Quick reference guide to back pain and hip pain:

Back pain and Sciatica Hip pain
Type Electric shock type Stabbing and sharp
Site Lower back, sometimes radiating down buttock and back of thigh sometimes even into the calf and foot Usually the groin, less often the buttock or outer side of the hip
Disability Problem with weakness of the foot or toes, sometimes also causing urinary and/ or faecal incontinence Difficulty rising from chair/ toilet seat, entering and exiting a vehicle, clipping/ painting toe nails and putting on socks or shoes/ sandals
Aggravated by Soft bed/ mattress, Walking on flat surface or down stairs/ hill or Lifting one’s leg while keeping the knee straight- straight leg test Low chairs, walking- especially upstairs/ hill, sometimes by crossing one’s legs
Relieved by Walking while leaning forward (like using a shopping trolley “or upstairs/ uphill Sitting down or lying down sometimes by using a walking stick


When visiting your doctor, he or she will ask questions to differentiate the cause of your pain- similar to the table above. The diagnosis is usually made on the patient’s history of their symptoms, soon after, the doctor usually confirms their suspicion with findings from their examination. A very big clue to hip pain, is pain reproduced by rotating the hip joint at examination- if the same pain in the original complaint is produced, the problem lies in the hip. If however, the same pain is reproduced by stretching the sciatic nerve with the straight leg test:

Then it is more than likely, that the patient is suffering from a spinal condition, rather than a hip problem.

After appropriate history and clinical examination, a doctor should be able to either image the appropriate area, or alternatively, direct the patient to the relevant specialist, who should be able to assist the patient on his or her road to recovery.