Orthopaedic Mount Elizabeth Singapore

Osteoporosis Risk Check

October 14, 2021 by Lenny Ariany

Could you be at risk of osteoporosis and fractures?

Are you 60 years old or older? Yes / No

Have you broken a bone after the age of 50? Yes / No

Are you underweight i.e. BMI < 19? Yes / No

After the age of 40, have you lost more than 4 cm in height? Yes / No / I don’t know

Have either of your parents had a hip fracture? Yes / No

Do you have any of the following disorders?

Rheumatoid arthritis
Digestive tract disease
Prostate or breast cancer
Diabetes
Chronic kidney disease
Hyper or hypothyroidism
Chronic lung disease
Low testosterone
Early menopause
Immobility

Have you been treated with long-term steroid or thyroid hormone? Yes / No

Do you drink excessive amounts of alcohol (more than 3 units a day) and/or currently smoke? Yes / No

If you have answered ‘yes’ to any of the questions, you may have risk factors for osteoporosis and fractures. You can discuss the status of your bone health with your doctor.

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

Cardiac Arrest While Exercising

June 17, 2021 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Christian Eriksen, a Danish Player, suddenly collapsed on the field in the midst of a soccer match. If the medics didn’t come on time and perform CPR, Eriksen’s life may not have been saved. He suffered from cardiac arrest. This condition can occur during exercise or when a person is not doing exercise. It can also happen in people who never exercise.

Eriksen had a sudden cardiac arrest with no warning signs. Most cases of cardiac arrest occur suddenly and unexpectedly.

What is cardiac arrest?

Our heart functions to pump blood throughout the body so that our organs can function properly. During cardiac arrest, the heart suddenly stops pumping or it pumps extremely fast and irregular that it can’t pump blood properly. As a result, the oxygen level decreases. The consciousness will also decrease and eventually, the person passes out and collapses as happened to Eriksen.

CPR is the ultimate thing that saved Eriksen’s life. It pumped blood to Eriksen’s body again.

According to research, the rate of mortality after cardiac arrest is very high despite CPR. If the cardiac arrest occurs outside hospital settings, the chance of survival is only below 10%. Christian Eriksen’s odd of surviving is among those under 10%. He is very lucky. If it happens in a hospital setting, the survival rate increases but it is still less than 20%. The CPR performed immediately after cardiac arrest increases the survival rate between 2-3-fold.

The probability of cardiac arrest in athletes is very small – 0.76 per 100,000 athlete-years.

Unfortunately, there is no effective way to detect cardiac arrest or the risk of cardiac arrest before it happens. Even with a very comprehensive medical examination for world-class athletes like Eriksen, this cannot be picked up with certainty. So even if the medical check-up is perfect, it doesn’t mean someone has zero chance of having a cardiac arrest. It can still happen.

Most cases of cardiac arrest occur without any warning signs in people who are really fit and are exercising every day. Like Christian Eriksen before he collapsed, he played well with no signs of anything was going to go wrong. Although in most cases, there are no warning signs, sometimes there are some subtle signs such as a fainting feeling, chest pain, shortness of breath and heart palpitations before cardiac arrest happens. These signs should not be ignored. If you are exercising and suddenly you experience things like these, you have to stop your exercises. Quickly ask people around you to bring you to the nearest doctor or hospital.

For bystanders, if someone collapses near you, quickly call 995 if you are in Singapore and immediately check ABC – airway breathing and circulation and start CPR if it is needed. You may save someone’s life.

I hope this information is useful to all of you.

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore.

Chronic Back Pain and Neuropathic Pain

June 1, 2021 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Back pain is a very common problem in our society. Most of them are self-limited. Some become chronic back pain which is disturbing and difficult to treat. I am going to explain how neuropathy contributes to the development of chronic back pain.

Neuropathic pain is distinct from other types of pain. If a person breaks a bone or got a cut, pain signals are carried via nerves from the site of the trauma to the brain. That is how we can feel pain when we have an injury. With neuropathic pain, however, pain signals originate in the nerves themselves.

How Neuropathic Pain Develops

In many cases, the nerves become damaged or dysfunctional after responding to an injury or trauma, causing hypersensitivity to pain. The nerves then send faulty signals of pain even when the injury has healed. Neuropathic pain or neuropathy, is a chronic condition, meaning it does not go away. Instead, the pain becomes the disease process. An estimated 7 to 10% of people have neuropathic pain. Chronic back pain is a common example of neuropathic pain.

When Back Pain Causes Neuropathy

Neuropathy can result from any type of pain that compresses or impinges on a nerve. A slipped disc, for example, could press against a nearby nerve, causing pain. Neuropathic pain originating from the back or spine may include:

Chronic pain radiating down the leg (sciatica) or the arm (cervical radiculoapthy)
Chronic back pain

Why Early Treatment is Crucial

Early treatment is important, since more aggressive treatment may be needed if symptoms are not addressed soon. Over time, exposure to significant pain can cause changes to the central nervous system that make the body become more sensitive to even a slight touch. This phenomenon is known as central sensitization.

As with other types of chronic pain, delays in treatment may also make other health problems more likely. Depression, anxiety, difficulty sleeping, and an inability to work and take part in other activities are some health issues associated with untreated neuropathy.

Managing Chronic Pain

Chronic back pain does not go away completely even with the right treatment. The treatment aims to manage the pain so that the person can be functional. The first step is to get a thorough medical evaluation to determine the cause of the pain. It can be muscle strain, arthritis, slipped disc, or other things.

The medical treatment depends on the cause of the pain. Whatever the problem is, there are a number of effective strategies for coping with chronic back pain.

Reduce the stresses in your life. It may be your job or problems in the family. You have to try your best to sort out this problem
Have enough sleep. Our body carries out repair work when we are asleep.
Avoid activities that worsen your pain. E.g. bending down, prolonged sitting, and carrying heavy things.

I hope this information is useful to all of you.

5 Facts Parents Should Know About Scoliosis

September 30, 2019 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

80% of all scoliosis occur during adolescent. This type of scoliosis is called Adolescent Idiopathic Scoliosis. Sometimes, parents and doctors face challenges in treating teenagers. They are undergoing psychological changes to find their identity. They may refuse to accept that they have scoliosis. They may also refuse treatment. This can cause anxiety in the parents.

Here is the 5 things parents need to know about scoliosis.

Scoliosis Needs Regular Follow-Up. Scoliosis tends to get worse as the child is growing. Regular follow up is required to monitor the progression of the scoliosis. When there is no more growth and the scoliosis is stable after serial X-rays, follow-up is no longer required.
Scoliosis Get Worse but Cannot Get Better. But parents don’t need to be alarmed. No treatment modalities other than surgery can reduce the severity of scoliosis. It doesn’t mean that surgery needs to be done for all cases of scoliosis. Brace can be useful to slow down the progression of the scoliosis (not to reduce the severity). You need to be careful if someone promise they can do something to reduce the severity of scoliosis. It is safe to leave the mild scoliosis alone without specific treatment. Children can live normal lives with mild scoliosis.
Scoliosis Is Not Caused by Heavy Schoolbag. The cause of Adolescent Idiopathic Scoliosis is unknown. Although carrying a heavy schoolbag is not good for the growing spine and can cause other problems, it is not the cause of scoliosis. Sporting activities, injury or wrong sitting posture also are not the cause of scoliosis.
Not All Scoliosis Need Treatment. A very mild scoliosis in growing children or scoliosis that does not progress during adulthood does not need any specific treatment other than follow up. Only 30% of scoliosis need bracing and only 10% of scoliosis need surgery.
If Surgery Needed, The Earlier The Better. Surgery is required for severe deformity. The risks of surgery increase with the degree of the severity of the curves. Therefore, it is best to do scoliosis surgery earlier than later if it is required.

Problem in Your Buttock Can Cause Low Back Pain

June 4, 2018 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

80% of the population suffer from low back pain at least once in their life time. Sometimes, low back pain is caused by injury to the muscles, joints or the discs in the lumbar region. Other time, it is related to subtle wear and tear changes that cause gradual wearing down of the cartilage or the disc.

When there is significant pain in the buttock, it may be originating from the sacroiliac joint which is a joint that connects the spine and the hip bones. Sacroiliac joint is a common cause of low back pain. However, the diagnosis may not be obvious and often requires thorough physical examination.

There are two sacroiliac joints, one on each side of the spine. These joints transfer the weight of the upper body to the lower limbs. This joint operates under tremendous strain during activities like running, jumping and sitting. Unlike the knee joint which wide range of motions, sacroiliac joint has a very little movement.

Problem in Your Buttock Can Cause Low Back Pain

Anatomy of sacroiliac joint

Problems related to the sacroiliac joint is called Sacroiliac Joint Dysfunction (SIJ dysfunction). It affects both men and women but women tend to get it more. The ligaments stabilising the sacroiliac joint become lax during childbirth causing it to be prone to injury.

Apart from injury, weak muscles surrounding the joint are often the cause of SIJ dysfunction. If this is not addressed, the pain persists and becomes chronic. The nerves supplying the joint constantly send pain signal to the brain causing discomfort. Sometimes, the pain signal process continues independently of the original issue. This means after all identifiable problems are addressed, the pain can still persist.

People with SIJ dysfunction complain of low back pain very close to the buttock. It can affect one side or both sides of sacroiliac joints. The pain may radiate to the hips, thighs and calves especially when the nerves crossing in front of the sacroiliac joint are irritated. Initially, the pain comes on after prolonged sitting. When it gets worse, other activities like walking, climbing and running can trigger the pain.

SIJ dysfunction can be treated with medications and physical therapy. Strengthening the surrounding muscles and the core muscles helps to stabilise the sacroiliac joint. More severe form of SIJ dysfunction may require more invasive procedures like steroid injections or radiofrequency ablation. Radiofrequency ablation is done by passing heat in the form of electric current to desensitise the nerves supplying the sacroiliac joint. It can provide an excellent pain-relief. Operation to fuse the sacroiliac joint is rarely required. It is reserved for severe debilitating problems in the sacroiliac joint that do not respond well to less invasive forms of treatment.

Early Surgery in Spinal Cord Compression from Spine Tumor Gives in Better Outcome

May 5, 2018 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Actor Dan Haggerty passed away from his long battle with spine cancer in Jan 2016.

Spine cancer rarely begins in the spine itself but instead is spread to the spine from other part of the body. Spread of cancer cells to the spine is common. The spine is the third most common site for cancer cells to spread after the lung and the liver. When the spine cancer compresses the spinal cord (major nerve in the spine), the neurological function can deteriorate very rapidly resulting in paralysis.

Spine cancer more commonly occurs in people older than 40 years of age. Pain in the back and neck are the most common signs of spine cancer. Not to alarm you, but if you are above 40 and complain of back pain or neck pain that does not seem to go away, spine cancer is something you should consider getting checked for.

In spine cancer, paralysis does not occur suddenly but it can develop rapidly over few days or weeks. There are other signs and symptoms preceeding paralysis that you should look out for including:

Numbness, tingling in the arms and legs
Loss of hand coordination
Problems balancing and walking
Issues with bowel and bladder control.
Poor appetite and weight loss
Pain that is worse at night or when resting.

If you have any of these symptoms, you need see a doctor to get it checked.

When spine cancer and spinal cord compression are detected, operation to remove the spine cancer and to free up the spinal cord should be done as early as possible within 48 hours to give better outcomes according to an article published by Quraishi in European Spine Journal.

Do not wait until the neurological function is badly compromised before getting treatment. Some cancer progresses very rapidly, some slowly. Early diagnosis and treatment including surgery give much better chance of survival, faster recovery and better outcomes. When the signs and symptoms above are ignored, the cancer may be found in much worse state. Once paralysis occurs, the chance of recovery with surgery drops very significantly.

Could Long Run Lead to Osteoarthritis?

November 30, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Could Long Run Lead to Osteoarthritis?

Many people believe that running is bad for the knee and hip joints. In contrast to what many people believe, running is not only good for our hearts and lungs, it is great for our muscles, bones, and brains as well. In fact, people who run regularly are less likely to develop knee osteoarthritis compared to people with sedentary lifestyle.

Here are some of the benefits of running.

People who run regularly have more ideal body weight. Over weight puts a lot of pressure to the joint and muscles thus they wear out faster.
People who run regularly have stronger muscles. Quadriceps muscles are the stabiliser of the knee joint. The knee joint is more stable and has less wear and tear when the quadriceps muscles are strong.
Exercise helps to release the body anti-inflammatory substances. Osteoarthritis is caused by inflammation in the joint. Thus, exercise can slow down osteoarthritis by reducing the inflammation in the joint.
Exercises helps to produce greater supply of joint fluid (synovial fluid). It acts like a lubricant to the joint reducing the rate of osteoarthritis.

It does not mean that people who run regularly don’t get osteoarthritis. However, they are at a lower risk of getting one.

What can you do to reduce that chance of osteoarthritis if you like running?

Have adequate warm up before exercise so that you don’t strain your muscles
Have proper shoe wear appropriate for running
Run in even surface to reduce the risk of injury

Tumor Tulang Belakang – Salah Satu Penyebab Sakit Pinggang

November 1, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Pernahkan anda mengalami sakit pinggang?

Kebanyakan kita menyepelekan sakit pinggang yang sebagian besar akan sembuh sendiri jika beristirahat. Padahal, bisa jadi itu bukan sakit pinggang biasa. Untuk sakit pinggang yang berhubungan dengan masalah otot dan degenerative memang tidak serius. Tapi, sakit pinggang ini bisa menjadi masalah serius jika disebabkan oleh tumor.

Berikut ini adalah contoh kasus tumor tulang belakang.

Ibu Maria (bukan nama sebenarnya), 42 tahun, mengeluh sakit pinggang selama 3 bulan. Berat badan turun 5 kg. Dua hari sebelum ke dokter, secara tiba-tiba beliau tidak bisa jalan karena kaki merasa sangat lemah. Hasil pemeriksaan lengkap menunjukkan ibu Maria menderita tumor tulang belakang yang menjepit saraf. Tumor ini menyebar dari usus besar (tumor primari). Saraf yang terjepit menyebabkan kelemahan di otot kaki sampai pasien tidak kuat berjalan. Beliau menjalani operasi untuk mengambil tumor, membebaskan saraf dan menstabilkan tulang belakang. Setelah operasi ibu Maria bisa berjalan kembali dengan normal. Pasien menjalani chemotherapy dan radiotherapy untuk membasmi tumor lebih lanjut.

Tumor di tulang belakang adalah penyebab sakit pinggang yang berbahaya yang memerlukan penanganan segera. Tumor ini dapat membesar secara cepat dan tiba-tiba. Jika menjepit saraf, pasien bisa mengalami kelumpuhan secara tiba-tiba. Sering kali tumor di tulang belakang terjadi karena penyebaran sel tumor dari tempat lain seperti di usus, prostat, payudara dan lain-lain. Banyak sekali pasien yang mengeluh sakit pinggang tanpa keluhan lain seperti kasus Ibu Maria. Dengan pemeriksaan lengkap, tumor di tulang belakang dan asal tumor (tumor primari) bisa ditemukan dan ditangani secara keseluruhan. Jika pasien mengabaikan keluhan sakit pinggang, tumor ini tidak akan terdeteksi atau mungkin akan terdeteksi dalam kondisi yang lebih parah.

Jenis sakit pinggang seperti apa yang tidak boleh diabaikan?

Sebagian besar sakit pinggang tidak berbahaya. Jika sakit pinggang disertai berat badan menurun secara drastis, sakit pinggang lebih parah saat beristirahat, atau sakit pinggang yang terus menerus dan tidak pulih lebih dari satu bulan, pasien perlu segera periksa ke dokter untuk menegakkan diagnosa apakah hal ini berhubungan dengan tumor.

Mengapa tumor tulang belakang mengakibatkan sakit pinggang?

Tumor tulang belakang dapat menyebabkan sakit pinggang karena beberapa hal.

Tumor membuat tulang belakang menjadi tidak stabil.
Tumor membuat tulang belakang rapuh dan gampang patah. Sakit pinggang meningkat secara tiba-tiba jika ada patah tulang di punggung.
Tumor bisa menjepit saraf. Hal ini menyebabkan sakit pinggang terkadang menjalar ke kaki atau ke perut dan dada.

Apakah pentingnya untuk mendeteksi tumor tulang belakang secara dini?

Dengan berjalan waktu tumor bisa makin membesar, jika masih berukuran kecil tentu saja lebih gampang dioperasi dari pada sudah berukuran besar. Lebih baik lagi dioperasi sebelum tumor menjepit saraf dan mengakibatkan kelumpuhan.

Jadi jangan menyepelekan sakit pinggang yang tidak kunjung membaik apalagi jika berat badan menurun dan sakit pinggang memburuk saat istirahat. Segera periksalah ke dokter untuk mencari penyebabnya.

Dr Tony Setiobudi adalah spesialis bedah tulang dan super-spesialis bedah tulang belakang di Mount Elizabeth Hospital (Orchard), Singapore. Dr Tony menangani masalah tulang, sendi, saraf, otot dan ligamen pada orang dewasa dan anak. Dr Tony mempunyai keahlian khusus dalam penanganan saraf terjepit (HNP & spinal stenosis) & masalah tulang belakang seperti nyeri punggung & leher, scoliosis, postur bungkuk (kyphosis), tumor & infeksi tulang belakang, cedera saraf besar (spinal cord) & patah tulang osteoporosis.

Operasi Postur Bungkuk Dapat Menambah Tinggi Badan

August 18, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Postur bungkuk adalah masalah medis dan masalah estetika. Orang dengan postur bungkuk sering jatuh karena pandangan ke depan terganggu.

Postur bungkuk bisa disebabkan oleh bermacam-macam masalah medis:

Ankylosing spondylitis
Scheuermann’s disease
Proses penuaan (ageing)
Patah tulang belakang
TBC tulang belakang.

Postur bungkuk yang disebabakan oleh ankylosing spondylitis, Scheuermann’s disease dan TBC tulang belakang sering kali parah. Karena terlalu parah, sering kali pasien tidak dapat beraktifitas dengan baik. Operasi untuk menegakkan postur bungkuk ini perlu dilakukan. Dengan teknologi modern, operasi tulang belakang untuk menegakkan postur bungkuk menjadi jauh lebih aman.

Postur bungkuk ini memerlukan pemeriksaan yang menyeluruh. Ada beberapa kriteria untuk operasi terutama untuk postur bungkuk yang parah. Operasi dilakukan dengan bius total. Tulang belakang ditegakkan dengan menggunakan rods dan screws. Selain pandangan ke depan lebih normal, setelah postur lebih tegak pasien juga akan lebih tinggi. Secara estetika, pasien juga terlihat lebih tegap dan percaya diri.

Operasi menegakkan postur bungkuk ini lebih baik dilakukan secara dini semasa pasien masih muda dan sehat. Terkadang untuk pasien manula, operasi ini tidak mungkin untuk dilakukan terutama jika pasien menderita banyak penyakit kronis lain seperti diabetes, tekanan darah tinggi, sakit jantung dan lain-lain yang membuat resiko operasi lebih tinggi.

Pasien perlu tinggal di rumah sakit selama 5-7 hari. Setelah operasi pasien dirawat di ICU atau high dependency unit selama 1 malam. 2 hari setelah operasi pasien melakukan fisioterapi untuk berjalan. Setelah operasi, rasa nyeri dihilangkan dengan obat analgesik sehingga pasien tetap merasa nyaman.

Anak Saya Pendek | Apa Yang Bisa Dilakukan?

July 22, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Orang tua kuatir kalau anaknya tergolong pendek di kelas. Secara medis definisi tubuh pendek adalah ketinggian di bawah 3 percentile dibanding dengan anak dengan umur dan jenis kelamin yang sama. Secara awam artinya jika ada 100 anak dengan umur dan jenis kelamin yang sama, 3 orang terpendek, secara medis tergolong mempunyai tubuh pendek (short stature). Tetapi bukan berarti anak itu mempunyai masalah medis. Asal anak itu bertumbuh secara parallel, hal ini secara medis dianggap normal.

Apa yang mempengaruhi tinggi badan anak?

Genetik – Ketinggian anak juga tergantung ketinggian orang tuanya. Tinggi tubuh kita dipengaruhi genetik.
Late Bloomer – Kadang anak mengalami pertumbuhan terlambat. Anak ini terlihat kecil dibanding dengan teman-teman sekelasnya. Tapi saat dewasa anak dengan pertumbuhan terlambat sering kali lebih tinggi dibanding dengan mereka yang mengalami pertumbuhan lebih cepat. Ini terjadi karena anak ini masih bertumbuh tinggi di saat anak lain sudah berhenti bertumbuh tinggi.
Medical Problems – anak susah makan atau makan tidak bergizi, masalah pencernaan, masalah hormon, syndrome genetik, penyakit kronis.

Apa yang bisa dilakukan supaya pertumbuhan maximal?

Makan yang bergizi, olahraga yang teratur dan tidur yang cukup dapat membantu pertumbuhan secara maximal
Jika ada masalah medis, hal ini harus ditangani dengan baik supaya dampak terhadap pertumbuhan badan minimal.

Osteoporosis Risk Check

Could you be at risk of osteoporosis and fractures?

Cardiac Arrest While Exercising

What is cardiac arrest?

Chronic Back Pain and Neuropathic Pain

How Neuropathic Pain Develops

When Back Pain Causes Neuropathy

Why Early Treatment is Crucial

Managing Chronic Pain

5 Facts Parents Should Know About Scoliosis

Problem in Your Buttock Can Cause Low Back Pain

Early Surgery in Spinal Cord Compression from Spine Tumor Gives in Better Outcome

Could Long Run Lead to Osteoarthritis?

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Tumor Tulang Belakang – Salah Satu Penyebab Sakit Pinggang

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Operasi Postur Bungkuk Dapat Menambah Tinggi Badan

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Anak Saya Pendek | Apa Yang Bisa Dilakukan?

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

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