What happens at the Consultation
History of the problem
At the time of the consultation, you are seen by the consultant and a history of your problem analysed. This will involve going through the details of how your problem started and whether any traumatic event or other factors are involved. Relevant past events will be asked about (ie past hobbies sports or injuries). Attention will be paid to the progression of the problem and the day to day functional loss that the you may experience. If you experience particular problems with work or sporting activity, this will be carefully assessed. Previous episodes of similar pain or difficulty will be noted as will any previous treatment or hospital visit relevant to the current problem.
A careful past medical history will be taken. This should cover any serious illness's or operations in the past. Details of any current medications or allergies will be asked about as will smoking or drinking habits. Relevant family history may be enquired about.
An examination of the affected joint will be performed. Sometimes where relevant other joints or structures may contribute to the problem and they may also be examined ie for examination of the shoulder some of the pain may originate from the neck, this would then need careful assessment. Problems with the knee may originate from either the back, hip or ankle and the style and form of walking may also influence the onset or continuation of knee pain.
Any special investigations required will then be ordered. On the day of the consultation it may be possible to arrange for X-rays to be taken and these are normally reviewed on the same day by the consultant with you. Other tests (blood tests, MRI scans, ultrasound examination or bone scans for example) may need to be booked as separate events and then reviewed at a later date.
Sometimes as part of either treatment or in the process of establishing a diagnosis injection of a joint may take place at the initial consultation. Frequently this may involve a mixture of both local anaesthetic and steroid. The steroid acts as both an anti-inflammatory and a pain relieving compound and although it may take three or four days to start working may have prolonged effects. The effects are normally localized to the joint or area injected and do not have effects on the rest of the body. Sometimes in order to distinguish between pain from a variety of closely related areas a local anaesthetic injection into one of the areas may be performed in order to remove pain from that area and clarify the diagnosis.
A treatment plan may be established after the initial consultation if the diagnosis is clear and no other investigations are needed. This may consist of either physiotherapy and rehabilitation treatment or possibly the advice that an operation may be the best way forward. If there are several different ways of treating the same problem then the merits of the various ways will be discussed.
What happens if I need an operation
The consultant will normally arrange a date that is suitable for both you and him. If there is no urgency to the operation it may be possible to schedule this at any reasonable time in the future. If there is an element of urgency then you will be fitted into the next available operative slot with the consultant. If the condition is an emergency ( for example certain fractures) then treatment will be arranged as soon as a free period of time becomes available in theatre and as soon as any of our consultant surgeons can operate on you.
Scoring of condition
For many of the conditions that we treat there are well established ways of assessing the severity of the symptoms and the degree that the condition may be interfering with lifestyle and function. These methods are known as scoring systems. At the initial consultation or the follow up consultations you may be asked a series of simple questions or asked to perform a variety of very simple physical tests to monitor your condition and its progress. These tests are important to monitor your progress and also give us information on the success of the various treatments.
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