Fast Track to Pain Relief

Musculoskeletal (MSK) conditions can affect our muscles, bones and joints, causing persistent pain or stiffness, curved spines and other postural and developmental problems, and in severe cases impaired breathing. Pinpointing the location is important for deciding treatment, but this has traditionally been a time-consuming process, requiring repeated precise measurements by hand with a tape measure, X-rays and patient history comparisons. Even very experienced doctors may require 10–15 minutes per patient for a diagnosis.

Professor Teng Grace Zhang and her team in the Department of Orthopaedics and Traumatology, School of Clinical Medicine, have developed a solution that provides accurate screening in a fraction of the time and reduces the number of personnel needed in the process. Importantly, the system does not require specialist training – it can be taught in one day, meaning patients can be treated earlier and long waiting lists reduced.

The name of their AI-enhanced digital system, mskalign®, aims to improve diagnosis and treatment. “We always say that as long as you have correct alignment, there will be no pain or deformity. Malalignment doesn’t just cause pain; it can affect your posture, your movement, and even your respiratory function,” Professor Zhang said.

mskalign® streamlines the standard clinical pathway. Currently, clinicians manually collect fragmented data – including patient histories, physical examinations and imaging results – in often unsystematic ways. mskalign® captures that information and feeds it into an AI model to improve clinical efficiency and produce high-quality, long-term data resources for clinicians.

Diagnosis and treatment

The system takes a single 3D image of each patient to screen and check for deformities, such as scapular or pelvic imbalances, shoulder rotation, or lower limb discrepancies. The AI model automatically identifies these imbalances without needing an X-ray, and the 3D image helps patients visualise their deformity and motivates them to do corrective exercises.

Treatment itself has also been automated for mild cases. Professor Zhang and her team developed a mobile app that sends out push notifications on a fixed schedule to tell patients when to do at-home exercises. This has also been enhanced with AI, so patients can don wearable sensors to monitor their performance and make personalised adjustments as needed. The latter is especially helpful because there is a shortage of physiotherapists in Hong Kong and the region.

The comprehensiveness of the system and app means a nurse could manage many mild cases with AI assistance, thus making a big dent on waiting lists where about 80 per cent of cases are mild.

For more serious cases, a specialist doctor is required, but the imaging produced by mskalign® can also reduce their workload. In moderate cases (about 10–15 per cent of the total caseload), once the doctor confirms the diagnosis, the image can be used to generate an over-correction brace through 3D printing. In severe cases that require surgery, the doctor can use the AI input to support plans of action.

Professor Zhang has conducted multiple clinical tests on real patient cohorts showing the effectiveness of the mskalign® system in comparison with real doctors. She found the AI’s measurements were 99 per cent similar to those of spine specialists with more than 20 years’ experience and even better when compared with junior trainees. Clinical recommendations from the AI were also up to 80 per cent similar to experienced surgeons.

Start-up success

The success of mskalign® was recognised in 2022 when it won a Gold Medal at the International Exhibition of Inventions of Geneva. Early in 2025, after receiving certification for use in Hong Kong and the Chinese Mainland, the system was deployed in 10 top tertiary hospitals in Hong Kong, Beijing and Shanghai. To date, it has helped manage more than 5,000 patients, including at Hong Kong’s Duchess of Kent Children’s Hospital and the private Hong Kong Sanatorium and Hospital.

A start-up, Conovo, has overseen the development of mskalign®, having completed three rounds of fundraising; it has a valuation of at least US$50 million. The plan over the coming year is to increase the use of mskalign® 10-fold and to start investigating further expansion to those most vulnerable to musculoskeletal misalignment, including youths aged 10–20, elderly people, and those who spend prolonged times sitting at a desk.

“These are not urgent cases because people don’t die of back pain. But they cannot work or play, and the majority of patients say they are in pain or discomfort that interferes with their daily life. I also have a minor lumbar malalignment, so I understand that it can be annoying to live with,” said Professor Zhang.

She noted the start-up’s success would not have been possible without strong support from her clinical collaborators and the backing of HKUMed, which provided essential resources and space to accommodate her team and equipment.