Principles of management

• Provide explanation and reassurance including patient education handouts.

• Control pain and maintain function with appropriate drugs.

• Suggest judicious activity, exercise and physical therapy.

• Consider factors lowering the coping threshold, e.g. stress, depression, anxiety, overactivity.

• Refer for surgical intervention for debilitating and intractable pain or disability. Examples include OA of hip, knee, shoulder, first CMC joint of thumb, and first MTP joint where surgery is now very successful. Osteotomies still have a limited place for a varus or valgus deformity of the knee.

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