MSK-SLA2

Question 1

What are the key differences between Osteoarthritis and RA?

Answer 1

OA:
-in the morning stiffness less than 30 min
-usually larger joints- knees, hips, shoulders
-usually asymmetrical

RA:
-Younger
- Morning stiffness>30min
-smaller joints- DIPJ and PIPJ

Question 2

What is the management for RA?

Answer 2

1.Monotherapy- with Methotrexate- with preds for flares
2.If not improving increase the dose of DMARDS
3. If still not improving give with another DMARD- like hydroxychloroquine
4. symptom control with NSAIDs

NON-PHARMOCOLOGICAL:
-Orthotics
-Exercise
-podiatrist assessment

Question 3

Treatment for osteoarthirtis?

Answer 3

1. NSAIDs Topical for pain control
2. consider injections only when NSAIDS arent cutting it

NON-PHARM:
-Exercise- muscle strengthening
-weight management
-walking aid

Question 4

What is the difference between mechanical and inflammatory back pain?

Answer 4

INFLAMMATORY BACK PAIN:
- insidious onset
-persistent
-<40 y/o
-improves with exercise
-worse with rest
-morning stiffness
-more common in men

MECHANICAL BACK PAIN:
-This is acute onset
-Usually the patient is older
-equally likely in men and women

Question 5

Treatment of mechanical back pain?

Answer 5

NON-pharmacological:
-Exercise
-Manual loading
-weight loss
PHARMACOLOGICAL:
-oral NSAIDs with/without PPI cover
-Weak Opioids

Question 6

What is the WHO Pain ladder?

Answer 6

Step 1- this is with basic analgesics- like Paracetamol/NSAIDs
Step 2- weak opioids- HYDROCODONE, CODEINE
Step 3- stronger opioids - MORPHINE, BUPRENORPHINE

Question 7

Why is using the WHO PAIN ladder not entirely reliable in MSK conditions?

Answer 7

-Because it does focus the treatment solely on drugs- this reduces the focus on non-pharmacological treatment
-also with long term use this can result in addictions and dependencies

Question 8

What is the difference between Knee bursitis and Knee effusions?

Answer 8

Bursitis is when there is fluid in the bursa- it does not move.
knee effusion is fluid in the synovium this does move with the patellar tap test

Question 9

What are three main places on the hips that patients experience pain in and why?

Answer 9

-Anterior to groin- true hip pain- OA
-Laterally- this is trochanteric bursitis
-Lumbosacral/ gluteal muscles

Question 10

What is trochanteric bursitis?

Answer 10

This is when there is inflammation of the bursa between the greater trochanter and muscles- as a result of trauma or overuse.

Question 11

What is plantar fasciitis?

Answer 11

This is when there’s thickening of plantar fascia- usually occurs in patients who are on their feet a lot- this tends to be worse at the beginning of the day - the first few steps and then towards the end of the day

Question 12

What is Metatarsalgia?

Answer 12

This is when the balls of the feet become painful- usually due to exercise or overuse

Question 13

What is mortons neuroma?

Answer 13

This is a thickening of skin in the interdigital space where the digital nerve travels.
CAUSE- entrapment
symptoms- swelling between digits, pain between toes when walking

Question 14

What is radicular pain?

Answer 14

This is pain that radiates from the hip to the leg through the spine- as a result of spinal nerve root compression

Question 15

MYELOPATHIC PAIN V RADICULAR PAIN

Answer 15

Myelopathic is spinal cord compression

Question 16

Symptoms of sciatica?

Answer 16

-This is shooting pain from the back to the leg
-tingling sensation
-MADE WORSE ON STRAIGHT LEG RAISE- where the sciatic nerve is stretched
-shooting/numb pain

Question 17

What is painful arc syndrome?

Answer 17

pain on abduction of the shoulder- usually active, between 45-120degrees

Question 18

GOLFERS V TENNIS ELBOW?

Answer 18

Golfers elbow - medial epichondyle inflammation-common flexor origin

Tennis elbow- Lateral epicondyle- common extensor origin

Question 19

What is metastatic spinal cord compression?

Answer 19

This is when there is a tumour in the spinal cord which compresses on the nerve

Question 20

What is the treatment/ management options for MSCC?

Answer 20

-Pain relief
-Bisphosphonates for prostate cancer mets
-Denosumab for breast cancer mets
-radiotherapy

Question 21

What is the treatment for septic arthritis?

Answer 21

Flucloaxicillin - for 4-6 weeks

Question 22

What are the red flag signs for MSCC?

Answer 22

Referred back pain
Escalating back pain
Different character to usual symptoms
Funny feeling
Lying flat increases the back pain
Agonising pain
Gait disturbances
Sleep disturbances because of pain

Question 23

What is multiple myeloma?

Answer 23

this is a type of cancer that builds up in white blood cells- which in turn build up in the bone marrow.

Question 24

What are the symptoms of Multiple myeloma?

Answer 24

Calcium elevation
Renal dysfunction
Anaemia
Back ache

Question 25

What is the treatment for multiple myeloma?

Answer 25

-High dose chemotherapy and stem cell transplantation
-bortezomib if chemo isn’t suitable

Question 25

What is POTTS spine?

Answer 25

This is also known as spinal TB- when there is haematogenous spread of TB from a central focus.

Question 26

Symptoms of spinal TB?

Answer 26

-back pain
-spinal tenderness
-weight loss
-systemic symptoms
-night sweats
-loss of apetite

Question 27

Treatment of Spinal TB?

Answer 27

-Isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months
and then isoniazid and rifampicin for 10 more months

Question 28

What is vertebral osteomyelitis?

Answer 28

This is also known as spondylodiskitis and is when there is spread of an infection to the spine

Question 29

What is the management for Cauda Equina syndrome?

Answer 29

-Spinal decompression within 48 hours- otherwise faecal and urinary incontinence can become permanent.