MSK Flashcards
(111 cards)
1
Q
What type of muscle weakness does osteomalacia cause
A
Proximal
2
Q
What are the blood test associated with osteomalacia
A
Low serum calcium
Elevated alk phosphate
3
Q
What is Lateral Epicondylitis commonly known as?
A
Tennis elbow
4
Q
Where is Lateral Epicondylitis located?
A
Lateral epicondyle (elbow extensor origin)
5
Q
What are the main causes of Lateral Epicondylitis?
A
Overuse - repetitive wrist extension, manual labour, racket sports
6
Q
What are the symptoms of Lateral Epicondylitis?
A
Preserved ROM
Weak hand grip-worse with gripping or lifting
Lateral elbow pain
Pain on resisted middle finger extension (Maudsley’s test)
7
Q
What signs are indicative of Lateral Epicondylitis?
A
- Tender over lateral epicondyle
- Pain on resisted wrist extension
8
Q
What is the initial management for Lateral Epicondylitis?
A
- Activity modification
- Topical/PO NSAIDs
- Physio
9
Q
What is Medial Epicondylitis commonly known as?
A
Golfer’s elbow
10
Q
Where is Medial Epicondylitis located?
A
Medial epicondyle (elbow flexor origin)
11
Q
What are the main causes of Medial Epicondylitis?
A
Overuse - repetitive wrist flexion (e.g., golf, DIY)
12
Q
What are the symptoms of Medial Epicondylitis?
A
Medial elbow pain, worse with flexion/gripping
13
Q
What signs are indicative of Medial Epicondylitis?
A
- Tender over medial epicondyle
- Pain on resisted wrist flexion
14
Q
What is Olecranon Bursitis?
A
Swelling over olecranon +/- pain
Elbow
15
Q
What are the causes of Olecranon Bursitis?
A
- Repetitive trauma/pressure
- Infection
- Gout
16
Q
What are the signs of Olecranon Bursitis?
A
- Fluctuant swelling
- Redness, warmth
17
Q
What is the initial management for Olecranon Bursitis?
A
Rest, NSAIDs, physiotherapy if non-infected
18
Q
What is Subacromial Bursitis?
A
Shoulder pain - especially abduction
19
Q
What are the causes of Subacromial Bursitis?
A
Overuse or rotator cuff impingement
20
Q
What are the symptoms of Subacromial Bursitis?
A
Painful arc, pain at night/overhead activity
21
Q
What signs are indicative of Subacromial Bursitis?
A
- Painful arc (60-120°)
- Tender subacromially
- Weakness on resisted abduction
22
Q
What is the initial management for Subacromial Bursitis?
A
- Rest
- NSAIDs
- Physio
23
Q
What is Rotator Cuff Tendinopathy?
A
Pain at shoulder, particularly with overhead activities
24
Q
What are the causes of Rotator Cuff Tendinopathy?
A
Overuse, age-related degeneration, diabetes, post-trauma, hypothyroid
25
What are the symptoms of Rotator Cuff Tendinopathy?
Shoulder pain, especially during abduction
26
What signs are indicative of Rotator Cuff Tendinopathy?
* Weakness on resisted abduction
* Loss of active & passive movement
27
What is Frozen Shoulder also known as?
Adhesive Capsulitis
28
Where is Frozen Shoulder located?
Glenohumeral joint capsule
29
What are the symptoms of Frozen Shoulder?
Global shoulder stiffness & pain
30
What is Cubital Tunnel Syndrome?
Ulnar nerve compression at elbow
31
What are the symptoms of Cubital Tunnel Syndrome?
Numbness/tingling in ring/little fingers, grip weakness
32
What is the initial management for Cubital Tunnel Syndrome?
* Night splinting
* Activity modification
* Physio
* NSAIDs
33
True or False: Olecranon Bursitis can be caused by infection.
True
34
Fill in the blank: Prolonged elbow flexion can lead to _______.
Cubital Tunnel Syndrome
35
When is X-ray indicated in patients with lumbar back pain?
If presentation suggests osteoporotic collapse
## Footnote
X-ray is not indicated if there are no clinical or serological indicators of infection or neoplasia.
36
In sciatica, how does the severity of leg pain compare to back pain?
Leg pain is usually more severe than back pain
37
What test is very specific for disc prolapse in sciatica?
Straight leg raise test
## Footnote
Pain on the affected side when the opposite side is lifted indicates disc prolapse.
38
Between which vertebrae does sciatica usually occur due to disc prolapse?
Between L4 and S1
39
At which vertebra does the spinal cord end?
At L1/2
40
What should be done if new or progressive cauda equina syndrome symptoms occur within 14 days?
Refer to A+E
41
What is the referral protocol for stable cauda equina syndrome that lasts more than 14 days?
Refer to urgent MSK clinic within 2 weeks
42
What criteria suggest inflammatory back pain in individuals under 45 with low back pain lasting over 3 months?
4 or more of the following:
* Onset before age 35
* Waking in the second half of the night with symptoms
* Buttock pain
* Improvement with movement
* Improvement within 48h of NSAIDs
* First degree relative with spondyloarthritis
* Current or past arthritis or enthesitis
* Current or past psoriasis
43
What should be done if 4 or more criteria for inflammatory back pain are present?
Refer to rheumatology
If 3+ then do HLAB27
44
What is the advice from NICE regarding imaging for back pain and sciatica in primary care?
We should not image
45
What are the components of sciatica treatment?
* Safety net
* Advise self-care
* Keep active
* Physiotherapy
* Limited evidence for NSAIDs
* Mild opiates in the first 12w
* Epidural injection of local anaesthetic/steroid
* Microdiscectomy for few
46
What is the STarT Back tool used for?
Risk stratification for non-specific low back pain
47
What is the low-risk score for non-specific low back pain using the STarT Back tool?
Score <3 (no physio just self help)
48
What treatment is recommended for medium-risk non-specific low back pain?
* Reassurance
* Information
* Guided self-help
* Physiotherapy ***
49
What defines high risk in the STarT Back tool?
Total score 4+ AND sub score 4+
These people get combined supported exercise/physio therapy and psychological approach
50
What drug treatments are recommended for non-specific back pain?
* NSAIDs +/- gastroprotection
* Do not offer paracetamol alone
* Consider low dose opioids if NSAIDs contraindicated/ineffective
51
What is the role of spinal manipulation in treatment?
No better (or worse) than other recommended treatments
## Footnote
Should be used alongside an exercise program.
52
What are the criteria for immediate assessment in children with an acute unexplained limp?
* Age <3
* Unable to weight bear
* Fever or systemically unwell
* Aged >9 with hip pain or restricted hip movements
53
What is the management for a child aged 3-9 who is well but limping for less than 48 hours?
Short period of observation for 48hours
If symptoms worsen or fail to recover in 7 days then need to start investigations
54
What are the symptoms that suggest inflammatory arthritis or acute rheumatological condition?
* Joint pain and synovitis
* Early morning stiffness lasting >30 minutes
* Relieved by exercise
* Fatigue and systemic upset
55
What is the urgent referral protocol for giant cell arthritis with visual disturbance?
Same day referral and ophthalmology assessment
(If no visual disturbance then can commence high dose steroids and refer urgently for outpatients for confirmation of diagnosis)
56
What are the symptoms that may raise suspicion for giant cell arthritis?
* Age 50+
* New onset headache
* High ESR
* Abnormal temporal artery on palpation
* Changes consistent with GCA on biopsy
57
What is the protocol for unexplained bone pain?
Urgent X-ray within 48 hours to investigate for sarcoma
58
What is the investigation protocol for an unexplained soft tissue lump in adults and children?
* Adults: urgent USS within 2 weeks
* Children: urgent USS within 48 hours
59
What confirms the diagnosis of gout?
Serum uric acid of 360+
60
What medications can manage gout flares?
* Colchicine
* NSAID +/- PPI
* Corticosteroid
61
What therapy should be considered for chronic gout?
* Urate lowering therapy
* Start 2-4 weeks after flare settles
62
What are the characteristics of gout?
* Sudden monoarthritis (1st MTP)
* Needle-shaped negatively birefringent urate crystals
* Tophi
63
What distinguishes pseudogout from gout?
* Older adult
* Knees/wrists
* Rhomboid-shaped positively birefringent CPPD crystals
* Chondrocalcinosis on X-ray
64
What is the best single test for confirming rheumatoid arthritis?
Anti-CCP
65
What are the characteristics of polymyalgia rheumatica?
* symmetrical Shoulder and hip girdle stiffness
* Affects people over 50
* Associated with raised ESR and CRP
* Responds dramatically to steroids
66
What defines fibromyalgia?
Chronic widespread pain for more than three months with at least 11 out of 18 specified tender points
(Usually age 30-50 and any bloods would be normal)
67
What is the typical treatment for fibromyalgia?
* Exercise
* CBT
* Amitriptyline
68
What is pelvic girdle pain syndrome?
Pain on sacroiliac palpation in pregnancy/postpartum
It’s normal and people can do physio or use support belt
69
What is greater trochanteric pain syndrome also known as?
Trochanteric bursitis
If rest and NSAID have not helped then can have a corticosteroid injection
70
What cancers are known to metastasise to bone?
**Breast** most common in women
* Kidney
**Prostate** most common in men
Bowel
Lung
Thyroid
Myeloma (as part of the disease not a met)
71
What are the mortality rates for hip fractures?
10% at 1 month, rising to 30% at 1 year
72
What defines osteopenia and osteoporosis based on T-score?
* Osteopenia: T-score -1.0 to -2.5
* Osteoporosis: T-score < -2.5
73
What does NICE state regarding the use of analgesics in chronic primary pain (CPP) management?
Well-established analgesics should not be used
Antidepressants may be considered though in those over 18
74
What is the primary investigation for seronegative arthritis?
Clinical presentation and certain investigations such as **MRI** for suspected axial spondyloarthritis
75
What are the symptoms of osteomalacia?
Proximal muscle weakness, suggested by difficulty rising from a chair, associated with low serum calcium and elevated alkaline phosphatase
76
What qualifies for ankle radiographs according to the Ottawa ankle rules?
PAIN IN THE MALLEOLAR AREA AND
any one of the following
*inability to weight bear immediately and at initial assessment for four steps
* bone tenderness over the posterior edge of tibia /fibula or medial/lateral malleolus
77
What are the typical findings in osteoarthritis?
* Joint space narrowing
* Osteophyte formation
* Subchondral sclerosis Or Cysts
Remembered by LOSS
78
What is a characteristic finding in rheumatoid arthritis?
Periarticular erosions
79
What does diabetic amyotrophy present with?
Painful thigh weakness, asymmetric, quad wasting in older diabetics
80
How are ligament injuries graded?
* Grade 1: a few torn fibers with stable joint
* Grade 2: larger tear with increased laxity
* Grade 3: complete tear with instability
81
What characterizes an ACL injury?
Non-contact twisting injury, audible pop, large swelling, inability to continue activity
82
What is the presentation of bucket handle meniscal injuries?
Locked knee requiring urgent referral for arthroscopic surgery
83
What is the typical cause of collateral ligament injuries?
Direct blow to the side of the knee
84
What is the presentation of patellar/quadriceps tendon rupture?
Acute pain during jumping, acute swelling, difficulty weight-bearing, requires urgent referral
85
What is the most common cause of knee pain in general practice?
Osteoarthritis
86
What test examines the integrity of the cruciate ligaments?
Anterior drawer test
87
What does the modified Schober’s test measure?
Flexion of the back
88
How does the incidence of osteoarthritis differ by gender under 45 years?
More common in men; women have greater incidence after menopause
89
What is the treatment aim level with gout?
Urate <360 (<300 if trophi, chronic gouty arthritis or flare despite being <360)
90
What qualifies for foot radiographs according to the Ottawa ankle rules?
PAIN IN THE MIDFOOT AND
any one of the following
*inability to weight bear immediately and at initial assessment for four steps
* bony tenderness at the navicular bone or base of the 5th metatarsal
91
What can be used to relive the pain of bony mets
Bisphosphonates
92
The disability act defines long term as being at least…?
12 months
93
What is the current DHSC advice for vitamin D intake during winter months in the UK?
All adults should consider taking 400 iu daily
## Footnote
People with darker skin should take 400 iu each day throughout the year.
94
According to NICE, in which groups should fracture risk be assessed?
Women ≥65 and men ≥75, Women <65 and men <75 with risk factors
## Footnote
Risk factors include previous fracture, steroids, parental hip fracture, BMI <18.5, smoking, alcohol, RA.
95
When should treatment be started for patients with fragility fractures?
Treat without risk calculation
## Footnote
All patients with a fragility fracture should start treatment.
96
What is the FRAX score threshold for hip fracture risk to start treatment?
Hip fracture risk ≥3%
## Footnote
Major osteoporotic risk ≥20% or NOGG age-dependent thresholds.
97
What should be considered after 3–5 years of oral bisphosphonates?
Drug holiday may be considered if fracture risk reduced
## Footnote
No drug holiday with denosumab.
98
What is the recommendation for patients ≥50 years with a fragility fracture?
They should receive a DXA scan without needing FRAX® or QFracture® risk assessment.
99
What treatment should be offered to patients aged ≥65 years with a hip fracture and osteopenia?
Zoledronic acid infusion every 18 months for 6 years.
100
How often should a DEXA scan be conducted to monitor response?
Every 3–5 years
## Footnote
Unless new fracture or treatment change occurs.
101
What is the minimum eGFR required before each zoledronic acid infusion?
>35 mL/min
102
How often should calcium/vitamin D levels be checked if on supplements or high-risk?
Annually
103
What is the recommended frequency for adherence checks for oral bisphosphonates?
Every 6–12 months
104
When should a dental check be conducted in relation to IV bisphosphonates/denosumab?
Before treatment to assess osteonecrosis risk
105
When should a DEXA scan be considered for children and young people underweight?
After one year of being underweight or earlier if they have bone pain or recurrent fractures.
106
What comorbid conditions are associated with rheumatoid arthritis?
Hypertension, ischaemic heart disease, osteoporosis, depression
107
What is the contraindication for Alendronate?
eGFR < 35 mL/min/1.73 m²
108
What relieves neurogenic claudication associated with spinal stenosis?
Rest and lumbar flexion
109
What does pain in the leg and lower back between 30-70 degrees of straight leg raising indicate?
Lumbar disc herniation
110
What may pain at more than 70 degrees of straight leg raising indicate?
Hip pathology
111
What does pain that increases with neck flexion or foot dorsiflexion suggest?
A lesion in the spinal cord
