Knee
The knee carries load in a straight line but fails in rotation, which is why arthritis and ligament injuries produce such different stories. Wear-related pain builds over years and is worst on stairs; ligament injury arrives in a single moment with swelling to match. Both are diagnosed by examination first, with imaging used to answer a specific question.
Osteoarthritis of the Knee
Cartilage wear shows up as pain on stairs, stiffness in the first few minutes of moving, and swelling after a long day. First-line treatment is not an injection or a scan: it is a structured strengthening program for the quadriceps, hamstrings and hip muscles, load management, and weight reduction where that applies, with simple analgesia checked against your other medicines. A corticosteroid injection can open a useful window when the joint is inflamed, and knee replacement is considered only when pain limits sleep and walking despite all of that.
ACL Tear
An ACL tear usually announces itself: a twist or an awkward landing, a pop, swelling within a few hours, and a knee that feels like it will give way. Early treatment is the same for everyone, whatever happens later. Control the swelling, restore full extension, and wake the quadriceps up, then re-examine once the joint has settled. Reconstruction is a decision rather than a foregone conclusion, generally recommended for people returning to cutting and pivoting sport or living with instability, while others do well on rehabilitation alone.
Hip
Hip pain is frequently blamed on the back, and back pain is frequently blamed on the hip. The examination sorts the two by testing rotation under load and by asking what the pain does when you sit, walk and put on socks.
Hip Osteoarthritis
Hip arthritis is usually felt in the groin rather than the buttock, and difficulty putting on socks and shoes is an early giveaway. First-line treatment is graded strengthening of the glutes and trunk, a walking aid used in the opposite hand when the joint is irritable, activity pacing, and pain relief reviewed at intervals rather than left open-ended. Total hip replacement is among the more predictable operations in orthopedics, but it is offered when conservative measures stop holding, not on the strength of X-ray severity alone.
Shoulder
Shoulder complaints divide broadly into painful weakness and painful stiffness, and telling them apart changes everything about the plan. A shoulder that can be moved passively but not actively suggests a cuff problem; one that will not move in any direction suggests the capsule.
Rotator Cuff Tear
Cuff tears run from partial fraying to a full-thickness gap, and tear size correlates poorly with how much it hurts. Most degenerative tears are treated first with a three-month rotator cuff and scapular strengthening program, with a subacromial injection where pain is blocking the exercises. Acute traumatic tears in younger patients, and weakness severe enough that the arm cannot hold itself up, are assessed promptly for repair. Sleep position advice matters more than patients expect, since night pain is often what drives the referral.
Frozen Shoulder
Adhesive capsulitis follows a recognizable pattern: a painful freezing phase, a stiff frozen phase, then slow thawing, typically over 12 to 30 months and often longer in people with diabetes. Treatment is matched to the phase. Pain control and gentle range work come first, an intra-articular corticosteroid injection is most useful early, and a structured stretching program takes over once pain settles. Hydrodilatation or capsular release is reserved for stiffness that has not moved after months of honest rehabilitation.
Spine and Lower Back
Back pain is the most common musculoskeletal reason people miss work, and the great majority of episodes improve without surgery or a scan. Imaging early tends to find degenerative changes that are just as common in people with no symptoms, which is why the examination and the red flag screen come first.
Herniated Disc
A disc herniation presses on a nerve root and usually produces leg pain, numbness or weakness that outweighs the back pain itself. Most settle over six to twelve weeks with continued activity, a nerve-tolerant exercise program and time, while bed rest reliably makes things worse. Imaging is reserved for red flags or for pain persistent enough to consider an epidural injection or microdiscectomy. Surgery speeds up relief of leg pain in selected cases but has not been shown to change the long-term picture for everyone.
Sciatica
Sciatica names the symptom, pain travelling along the sciatic nerve into the buttock, thigh and calf, rather than the cause, which may be a disc, a narrowed exit foramen or spinal stenosis. First-line treatment is staying as active as pain allows, a graded nerve-tolerant exercise program, and analgesia selected with your other prescriptions in mind. New or worsening foot drop, spreading numbness, or loss of bladder or bowel control changes the plan immediately and needs emergency assessment rather than a clinic appointment.
Hand and Wrist
Hand problems rarely stop people working, so they tend to arrive late and well established. Night symptoms, grip failure and dropped objects are the details that move a case up the list.
Carpal Tunnel Syndrome
Carpal tunnel syndrome wakes people at night with numbness in the thumb, index and middle fingers, often eased by shaking the hand. A neutral wrist splint worn overnight is the standard first step, alongside adjustments to grip, vibration exposure and keyboard position. A corticosteroid injection can give temporary relief and helps confirm the diagnosis. Nerve conduction studies are used when the picture is unclear or surgery is planned, and carpal tunnel release is considered for constant numbness, weakness or wasting of the thumb muscles.
Elbow
Elbow tendon pain is an overload problem rather than an inflammation to be rested away, which is why the treatment looks counterintuitive at first: controlled loading, not avoidance.
Tennis Elbow
Lateral epicondylalgia produces pain at the outer elbow on gripping, lifting a kettle or shaking hands, and it affects far more office workers than tennis players. First-line treatment is load management plus progressive isometric and eccentric wrist extensor work over 8 to 12 weeks, with a counterforce brace for the tasks that flare it. Most cases improve substantially within a year. Corticosteroid injection gives short-term relief but performs no better, and in some trials worse, than exercise at twelve months.
Foot and Ankle
Foot pain responds to volume more than to any single treatment. How far you walked, in what shoes, on what surface, and how quickly you increased it usually explains more than the scan does.
Plantar Fasciitis
The giveaway is pain under the heel for the first steps out of bed that eases as you move and returns after sitting. First-line treatment is plantar fascia and calf stretching, a cushioned heel or off-the-shelf insole, a temporary reduction in running and standing volume, then a gradual rebuild of load. The majority resolve within twelve months, though progress is rarely smooth. Imaging and injection are reserved for cases that stall or where the diagnosis is genuinely in doubt.
Symptoms That Need Emergency Care, Not an Appointment
Nearly everything in this library can wait for a clinic slot. A short list cannot, because delay costs tissue, nerve or limb. If any of the following applies, go to the nearest emergency department or call emergency services rather than booking with us.
- An open fracture, with bone visible through a wound
- A limb that is visibly deformed, or a joint that has dislocated and will not go back in
- A limb that is cold, pale, numb or has no pulse after an injury
- A hot, swollen, exquisitely painful joint with fever, which may be joint infection
- New numbness around the groin or inner thighs, or loss of bladder or bowel control with back pain
- Calf pain with swelling and redness after surgery or immobilization, which may be a blood clot
Frequently asked questions
My scan shows arthritis but my knee barely hurts. Should I be worried?
Not on the strength of the report alone. Radiographic wear and symptoms track each other loosely: plenty of people with marked changes on film walk comfortably, and some with mild changes hurt a great deal. We treat the person in front of us, using the scan to rule things in or out rather than to set the plan. Strength, load tolerance and function guide what happens next.
How long should I wait before booking about a new ache?
For a minor strain without swelling or loss of function, two to three weeks of sensible self-care is reasonable. Book sooner if the joint is swollen, locking or giving way, if pain wakes you at night, if numbness or weakness is spreading, or if you cannot bear weight. Anything on our emergency list above should bypass the clinic entirely and go straight to emergency care.
Do I need an MRI before my first appointment?
No, and arriving without one is perfectly normal. The examination narrows the diagnosis to one or two possibilities, and imaging is then chosen to answer a specific question rather than ordered by default. If you already have recent films from elsewhere, bring the images rather than only the report. Scans that will not change the plan mainly add cost and anxiety.