MSK Flashcards
(172 cards)
1
Q
What is epicondylitis
A
inflammation at the point where the tendons of the forearm insert into the epicondyles at the elbow
2
Q
What are the 2 epicondyle and what movement are they responsible for
A
medial and lateral epicondyle
medial= flex the wrist
Lateral= extend
3
Q
Why do you get epicondylitis
A
it is a result of repetitive use and injury to the tendons at the point of insertion
4
Q
What are the names of the 2 epicondylitis
A
Medial is known as golfers elbow and lateral is known as tennis elbow
5
Q
What do patient typically present with in golfers elbow
A
they report gradual-onset medial elbow pain exacerbated by activity, particularly flexion of the wrist
6
Q
Treatment for golfers elbow
A
self-limiting, Rest, physiotherapy, NSAIDS
7
Q
presentation of tennis elbow
A
pain in outer elbow , the pain often radiates down to forearms
8
Q
what tests are done for tennis elbow
A
Mill’s test and cozens test
9
Q
Treatment for tennis elbow
A
self-limiting, Rest, physiotherapy, NSAIDS
10
Q
What is osgood - schlatter disease
A
it is caused by the inflammation at the tibial tuberosity where the patella ligament inserts. It is a common cause of anterior knee pain in adolescents
11
Q
is osgood-schlatter more common unilateral or bilateral
A
unilateral
12
Q
What age group and gender is osgood schlatter disease common in
A
10-15 year olds
male
13
Q
Pathophysiology of Osgood Schlatter disease
A
The patella tendon inserts into the tibial tuberosity. In patients with osgood-schlatter disease multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially, this lump is tender due to inflammation. As the bone heals and inflammation settles, the lump becomes hard and non-tender.
A hard, non-tender lump is then permanently present at the tibial tuberosity.
14
Q
Presentation of osgood-schlatter disease(3)
A
presents with a gradual onset of symptoms :
-Visible or palpable hard and tender lump at the tibial tuberosity
- Pain in the anterior aspect of the knee
- pain exacerbated by physical activity, kneeling and on extension of the knee
15
Q
Management of osgood-schlatter disease
A
Initial management focuses on reducing pain and inflammation.
Reduction in physical activity
Ice
NSAIDS (e.g., ibuprofen) for symptomatic relief
Once symptoms settle, stretching and physiotherapy can be used to strengthen the joint and improve function.
16
Q
What is fibromyalgia
A
it is a chronic pain syndrome characterised by widespread body pain
17
Q
presentation of fibromyalgia
A
Widespread body pain
tiredness
other possible symptoms:
- headaches
-IBS
- Bladder issues
-restless leg syndrome
-depression/anxitey
-cognitive impairment
-sleep disturbances
18
Q
What are the risk factors fibromyalgia
A
FHx
Rheumatological conditions
20-60yrs
female
19
Q
Treatment options for fibromyalgia
A
- antidepressants , painkiller
CBT, counselling
Lifestyle changes
20
Q
What is gout
A
type of crystal arthropathy associated with chronically raised uric acid levels
21
Q
What happens in gout
A
urate crystal are deposited in the joint causing it to become hot, swollen and painful
22
Q
Name 7 risk factors for gout
A
Male
Obesity
High purine diet (e.g. meat and seafood)
Alcohol
Diuretics
Existing cardiovascular or kidney disease
FHx
23
Q
Name 3 typical joints where gout occurs
A
base of big toe( metatarsophalangeal joint)
Wrists
Base of thumb ( carpometacarpal joints)
24
Q
What emergency condition should you exclude if you suspect gout
A
septic arthritis
25
What will an aspiration fluid show in gout
No bacterial growth
needle shaped crystal
Monosodium urate crystals
26
X-ray finding in gout
lytic lesions
punched out erosions
27
Acute flare management of gout
NSAIDs
Colchicine
Steroids
28
Prophylactic management of gout
Allopurinol
Lifestyle changes- losing weight , staying hydrated and minimising alcohol and purine based food
29
What is polymyalgia rheumatica
chronic inflammatory disease characterised by aching and morning stiffness in the neck, shoulder and pelvic girdle
30
Name 4 risk factors for polymyalgia rheumatica
age over 50 years
Prior history of giant cell arteritis
Female
Fhx
31
Clinical features of polymyalgia rheumatica
Pain, stiffness and weakness in the muscles of their neck shoulders , buttocks and hips
symptoms are worse first thing in the morning
32
What other condition is strongly linked with polymyalgia rheumatica
Giant cell arteritis
33
Clinical examination features of polymyalgia rheumatica
proximal muscles tender to touch
active and passive range of motion is limited by pain
34
what are the 2 lab investigations done in polymyalgia rheumatica and what are their typical findings
Full blood count (FBC): normocytic anaemia or thrombocytosis
Inflammatory markers: ESR and CRP are elevated
35
What are the 3 relevant imaging done in polymyalgia rheumatica
ultrasound
MRI
FDU PET
36
Medical management for Polymyalgia rheumatica
Glucocorticoids (e.g. prednisolone)
37
What is osteoarthritis
often described as wear and tear, it is not an inflammatory condition
it is progressive, degenerative joint disorder
38
name 4 risk factors for osteoarthritis
increasing age
female sex
obesity
Less commonly, articular congenital deformities or trauma to the joint
39
symptoms of osteoarthritis
Joint pain
stiffness
limitation in day to day activities
40
3 typical clinical finding for osteoarthritis
Reduced active and passive range of movement
Tenderness over the joint line
Crepitus on movement
41
Is CRP/ESR normal or abnormal in osteoarthritis
normal
42
What imaging is used for osteoarthritis and what are the findings
X-ray
Mnemonic = LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
43
Diagnostic criteria for osteoarthritis
more than or equal to 45 year old
Has activity-related joint pain
has either no morning joint0related stiffness or morning stiffness that lasts no longer than 30 min
44
First line Management for osteoarthritis
conservative management
45
what are the conservative management for osteoarthritis
Education and advice about condition
Exercise
weight loss if obese
46
Medical management for osteoarthritis
1st line :NSAIDs
2nd line: Paracetamol and topical analgesia
47
management for acute exacerbation of osteoarthritis
Corticosteroid injections
48
surgical option for osteoarthritis
Joint replacement or fusion of the joint
49
What is osteoporosis
a condition where there is a reduction in the density of the bones
50
Risk factors for osteoporosis
Older age
female
low BMI
Rheumatoid arthritis
Alcohol and smoking
Long term use of corticosteroids
Post-menopausal women
51
Name of tool used to asses likelihood of a fragility fracture due to osteoprorosis
FRAX tool
52
diagnostic investigation for osteoporosis
DEXA scan
53
T score meanings on DEXA scan for osteoporosis
T score = 0, normal bone density. Your bones are as strong as people your sex/age
T score >0, good bone density. Your bones are stronger than people your age/sex
T score between -2.5 and 0, osteopenia
T score <-2.5, osteoporosis
54
symptoms of osteoporosis
ASYMPTOMATIC UNTIL A FRACTURE APPEARS. Osteoporosis does not cause any
pain! It leads to fractures which can cause pain
55
Treatment for osteoporosis
Lifestyle changes
Vitamin D and calcium
Bisphosphonate
56
Most common shoulder dislocation
anterior dislocation
57
what are posterior dislocations associated with
electric shock and seizures
58
How do patients with anterior shoulder dislocation often present
The patient with anterior dislocation keeps the arm at the side of body in external
rotation
59
How do patients with posterior shoulder dislocation often present
Posterior dislocation is diagnosed clinically as the arm is held in medial rotation and is locked in that position
60
What is adhesive capsulitis
aka frozen shoulder
it is a complication of shoulder injury or surgery
61
4 risk factors for frozen shoulder
middle age
diabetes
women more than men
thyroid disease
62
2 classification of frozen shoulder
Adhesive capsulitis can be:
Primary – occurring spontaneously without any trigger
Secondary – occurring in response to trauma, surgery or immobilisation
63
Signs and symptoms of frozen shoulder
Affect ADLs, severe stiffness shoulder + coracoid pain test
64
Treatment for frozen shoulder
Physiotherapy and NSAID first line
IA steroid injection
65
What is colles' fracture
distal radial fracture with dorsal displacement of the distal fragment
has a dinner fork deformity
66
Who are at higher risk for colles fracture
elderly and osteoporotic pt
67
What type of injury is likely to lead to colles fracture
FOOSH
68
Treatment for colles fracture
Straightening the deformity and immobilisation for six weeks
69
What is a smiths fracture
aka reverse colles fracture
a fracture of the distal radius caused by falling onto flexed wrist
70
What age is pulled elbow common
in children under 5 years
71
How does pulled elbow happen
when swinging children by hands
72
Signs and symptoms of pulled elbow
not using the arm, elbow in extension, forearm in pronation, no swelling
marked resistance and pain with supination of the forearm
73
how is a pulled elbow diagnosed
X-ray
74
Tx for pulled elbow
Reduction and mobilisation
75
where is the scaphoid bone located
in the anatomical snuffbox
76
is scaphoid fractures usually diagnosed by X ray or MRI
MRI
It often shows a normal XRAY
77
Treatment for scaphoid fracture
Immobilise
78
Common type of injury that cause scaphoid fracture
FOOSH
79
What is a major risk/complication of a scaphoid fracture
Avascular necrosis
80
What is carpal tunnel syndrome
caused by compression of the medial nerve as it travels through the carpal tunnel in the wrist
81
7 risk factors for carpal tunnel syndrome
repetitive strain
obesity
perimenopause
rheumatoid arthritis
Diabetes
Acromegaly
Hypothyroidism
82
Presentation of carpal tunnel syndrome
gradual onset
intermittent symptoms
worse at night
numbness, pins and needles, burning sensation and pain
83
name the 2 special test for carpal tunnel syndrome
Phalen's test
Tinel's test
84
which fingers are effected in carpal tunnel syndrome
thumb, index, middle and part of the ring finger
85
What investigation is used to diagnose carpal tunnel syndrome
nerve conduction studies
86
Treatment for carpal tunnel syndrome
NSAID
Splints
Steroid injection
Surgical decompression
87
What is dupuytrens contracture
flexion contracture of the hand , patient often describe finger getting caught on things
88
What test is used for dupytrens contracture
tabletop test
89
Risk factors for dupuytrens contracture
Men 40-60
diabetes
Smoking
90
Management for dupuytrens contracture
Monitor in early cases
Corticosteroid injection
Surgery
91
What happens in de quervain's tenosynovitis
the sheath of the tendons on the thumb side of the wrist becomes inflamed or swollen,
restricting the tendons' movement
92
what test is used for de quervain
Finklestein
93
Treatment for de quervain
Analgesia, splint, steroid injection and surgery
94
What is scoliosis
curvature of the back - left to right
95
difference between a back strain and sprain
back sprain overstretching or tearing of ligament around the spine
back strain is the overstretching or tearing of muscles or tendons
96
Recommendation for back sprain/strain
try to keep active as possible
offer NSAID
97
How does a strain/sprain present
Pain around affected joint, tenderness, swelling, bruising, functional loss
98
Conservative management for sprains and strains
RICE
Rest
Ice
Compression
Elevation
99
What is osteomyelitis
an inflammation of the bone as result of an infection
100
What is the most common causative of osteomyelitis
Staph aureus
101
Risk factor for osteomyelitis
Penetrating injury
Surgical contamination
IV drug use
Diabetes
Periodontitis
102
When should a diagnosis of primary or recurring osteomyelitis be considered
If a patient presents with a vague history of non-specific pain and low grade fever of 1-3 months
103
What is the typical presentation of haematogenous osteomyelitis
malaise , fatigue, local inflammation and a low grade fever
104
Management for acute osteomyelitis (conservative and medical )
Conservative: affected limb should be immobilised and pain management with analgesia administered.
Medical: high dose empirical antibiotics following local guidelines.
105
Management for chronic osteomyelitis
Surgical debridement of the affected area and iv antibiotics
106
What is bursitis
inflammation of the small fluid sacs called bursa which are localised near joints
107
what are 2 common types of bursitis
clergyman’s (infrapatellar) and housemaid’s (prepatellar) knee.
108
Risk factors for bursitis
Age
occupation
Rheumatoid arthritis
Gout
Diabetes
Wound/skin tears on the knees
109
Presentation of bursitis
Swelling and erythema of the knee
Pain and tenderness
Reduced range of movement
Hx may include recent trauma or repetitive knee movement
110
Conservative management for bursitis
Rest ice and elevation
cushion or padding when kneeling
physiotherapy
111
Medical/ surgical management in bursitis
ibuprofen with ppi in elderly
incision and drainage
corticosteroid injection
112
What is chondromalacia
aka runner's knee. a condition where the cartilage on the under surface of the patella deteriorates and softens
113
Presentation of chondromalacia
Vague occurring pain that is felt behind the knee Worse after every day activities including:
prolonged sitting
walking up and downstairs
after squatting or kneeling
Worse after repetitive use i.e. physical sport
114
Conservative management for chondromalacia
Avoid strenuous and overuse of the knee
Physiotherapy
Physio taping
115
Medical and surgical management for chondromalacia
Paracetamol, ibuprofen, naproxen
arthroscopy
Shaving of cartilage behind patella patellectomy
116
What will x-rays show in chronic osteomyelitis
intramedullary scalloping , cavities and a 'fallen leaf' signs indicating section of endosteal sequestrum fallen into the medullary canal
117
What is a herniated disk pulposis
occurs when a portion of the nucleus pushes through a crack in the annulus
118
Presentation of a herniated disc
Pain
Sensation changes
Weakness
Incontinence if severe
119
Management for herniated disc
Heat and massage, avoid activities that worsen pain
Pain relief
120
What is meniscal injury
Injury/degenerative changes of the knee joint
121
Presentation of meniscal injury
Pain- worse on activity
popping and clicking
Unstable knee
Locking of knee
Limited ROM of knee
Slow swelling
122
Which test is used to determine presence of meniscal tear
McMurrays test
123
How to know to which menisci is injured
Pain during external rotation = medial meniscus injury
Pain during internal rotation = lateral meniscus injury
124
Gold standard investigation for meniscal injury
MRI
125
Management for meniscal injury
Conservative - RICE
Physiotherapy
126
What is metabolic bone disease
Broad spectrum of disorders affecting the bone
Metabolic bone disorders can be caused by osteoporosis, osteomalacia (due to CKD, Malnutrition, malabsorption) Pagets disease.
The underlying pathogenesis involves bone demineralization due to imbalance between osteoblasts and osteoclasts
127
Risk factors for metabolic bone disease
Medications e.g steroids
Family history
Endocrine e.g Hypopituitarism
CKD
Diet (vegetarian)
Dark skinned
128
Presentation of metabolic bone disease
Weakness
Reduced height
Fractures
Gait problems
Reduced ROM
reduced power
129
pathophys of paget's disease
Osteoclasts are bone resorbing cells while osteoblasts are bone forming cells.
Pagets disease occurs when there is an increase in bone resorption (osteoclasts), there is a compensatory increase in osteoblasts which results in abnormal bone formation.
130
Risk factors for pagets disease
Mechanical stress
Enviromental factors
Genetic factors
Infections (paramyxovirus)
131
presentation of pagets disease
Bone pain
bone deformity
fracture
increased bleeding
weakness
gait abnormality
132
blood investigations and it's findings for pagets disease
Alkaline phosphatase -raised
FBC- anemic
calcium/parathyroids hormone
133
what imaging is done in pagets disease and what is its findings
x-ray- may appear as radiolucent chnages or ;cotton wool' pattern in the skull
134
Management of pagets disease
walking stick
analgesia
Bisphosphonates
135
Pathophysiology of renal bone disease
Parathyroid hormone helps calcium absorption but inhibit phosphate absorption from kidney but helps reabsorption of phosphate from intestine
In renal osteodystrophy, the kidney is unable to produce vit D which results in low levels of calcium in the body and rise in PTH as result of positive feedback mechanism. A rise in PTH causes there is increased absorption of phosphate from kidneys
136
Risk factors for renal bone disease
Diabetes
autoimmune disease
family history
hypertension
HIV
cancer
Immunosuppression
137
Presentation of renal bone disease
Limb/abdominal swelling
Tetany,parasthesia
Pruritus
SOB
138
Investigation and its finding in renal bone disease
Bloods:
FBC (Anaemia)
Phosphate (High] Calcium (Low),Vitamin D (Low)
Alkaline phosphatase (may be high or normal depending on concomitant pathology)
Albumin (Low if nephrotic syndrome)
Creatinine and urea (raised)
X-ray/Imaging:
Parathyroid ultrasound. DEXA scan. Nuclear bone scan
139
Management for renal bone disease
Bisphosphonate
Manage vit D deficiency
High phosphonate managed by diet or phosphate binders
140
What is septic arthritis
infection of one or more joints either by direct inoculation or haematogenous spread of infectious organism
141
2 Most common causative agent for septic arthritis
staphylococcus or streptococcus
142
Name some risk factors for septic arthritis
RA
OA
Joint prosthesis
IVDU
Diabetes
Cutaneous ulcers
143
Presentation of septic arthritis
hot swollen and painful joint
less than 2 week hx
fever and other signs of systemic infection
144
What are the Ix (6)for septic arthritis ad its finding
FBC- raised inflam markers
ESR- elevated
CRP- raised
Blood culture- to check organism
Synovial fluid WBC- >100,000 = sepsis
X-ray and ultrasound
145
Management for suspected gram positive organism in septic arthritis
Vancomycin
146
Management for suspected gram negative organism in septic arthritis
ceftriaxone
147
What is slipped upper femoral epiphysis
most common hip disorder amongst adolescents
its a weakness in the proximal femoral growth plate, which leads to a fracture displacing the metaphysis anteriorly and superiorly
148
Grading system for a slipped upper femoral epiphysis
grade 1: 0-33% slippage
grade 2: 34-50% slippage
grade 3: >50% slippage
149
Risk factors for slipped femoral epiphysis
Trauma to hip/femoral area
obesity
Puberty
Growth hormone deficiency
150
Presentation of slipped upper femoral epiphysis
may have recent trauma
limping
poorly localised pain
antalgic gait and externally rotated hip
maybe be unable to bare weight
151
Examination finding in slipped upper femoral epiphysis (4)
-Reduced internal rotation of hip
-Problematic leg is shortened and externally rotated
-Trendelenburg's gait positive
-possible antalgic gait
152
Ix for slipped upper femoral epiphysis
Bloods to rule out endocrine causes
X-rays- draw klein line - trethowan sign is when the klein line passes above the femoral head confirming a slipped upper femoral epiphysis
153
2 signs u look out for in slipped upper femoral epiphysis and what are they
trethowan sign- when the klein line passes above the femoral head confirming the diagnosis
Steel sign - crescent shaped line of increased density over the metaphysis
154
Conservative, medical and surgical management for slipped upper femoral epiphysis
conservative- rest and immobilisation( crutches or wheelchair)
Medical- analgesia
Surgical:
- percutaneous in situ fixation
- open fixation of growth plate using bone graft
155
what is pseudogout
its a form of arthritis characterised by sudden painful swelling in one or more of your joints
156
what crystal are deposited in pseudogout
calcium pyrophosphate crystal
157
Risk factors for pseudogout
Older age
Trauma to joint
Mineral imbalance
Hyperparathyroidism
Acromegaly
Haemochromatosis
Wilsons disease
158
Presentation of pseudogout
Sudden onset
pain and swelling in the affected joint
lasts for 7-14 days
159
Ix for pseudogout
to rule out imbalances do tsh, parathyroid test and U+E
Joint X-rays and ultrasound : detect calcification
Joint fluid analysis
160
Management for pseudogout
rest, ice, elevate
NSAIDs
Colchicine
Prednisolone
Corticosteroid injection
161
What is Rheumatoid arthritis
a form of inflammatory arthritis
162
Risk factors for RA
women
Aged 70 and over
Smoking
HLA DR4 and DR1
Winter
163
Presentation of RA
Gradual onset
Symmetrical symptoms
pain, swelling and stiffness of joints
Early morning stiffness lasting more than 30 min
164
Examination finding on RA
Join swelling B/L
Pain on palpation
swan neck
Boutonnieres - PIP and DIP hyperextension
Ulnar deviation
RH nodules
165
Ix for RA
FBC, ESR,CRP,LFT
ANA- positive
anti-ccp antibodies
Rhaeumatoid factor
x-ray
166
Management for RA
Refer to rheumatologist
give nsaids at low dose
methotrexate
flare up- glucocorticoids
167
What is ankylosing spondylitis
type of arthritis that mainly affects the back , by causing inflammation in the spine
168
risk factors for ankylosing spondylitis
HLA B-27 positive
FHx
169
Presentation of ankylosing spondylitis
Dull ache /pain
SOB if ribs affected
Fever
Weight loss
Paraspinal tenderness
Reduced ROM
Kyphosis
170
what is spinal stenosis
narrowing of the spinal canal which puts stress on the nerves running through.
more common in the lower back and the neck
171
presentation and history of spinal stenosis
Pain(relived by leaning forward or lying supine)
weakness/fatigue
Changes in sensation
172
What is rotator cuff
group of four muscles that are positioned around the shoulder joint
