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Flashcards in MSK Deck (40):
1

Subacromial impingement - what?

Narrowing of subacromial space
Osteophytes under surface of acromion
Fraying rotator cuff muscles

2

Subacromial impingement - clinical features

• Restriction of overhead activities
• Low painful arc
• Drop arm sign
• Positive impingement tests
• Weak abduction if cuff tear

3

Subacromial impingement - treatment

Rest
NSAIDs/analgesia
Anaesthetic injection
Surgical decompression

4

Rotator cuff tears

Acute - following injury - repair
Chronic - degenerative changes, with impingement - subacromial decompression, rotator cuff repair
Clinicallly: weakness abduction - supraspinatus

5

Osteoarthritis Gleno-humoral joint

Primary
Secondary - trauma, RA
Pain - activity related and nocturnal
Post exertional stiffness
Restricted ROM

6

Osteoarthritis Gleno-humoral joint treatment

Xray
Analgesia
Physio
Aneasthetic injection
Shoulder replacement

7

Osteoarthritis acromio-clavicular joint

Pain on movement, especially overhead
Cross body abduction

X ray

HCI
Resection lateral clavical

8

Frozen shoulder

Following trivial injury
1 - 1.5 years cycle: pain and stiffness → stiffness → movements return
Restricted movement - especially external rotation

9

Frozen shoulder treatment

Analgesia
Physio - aggressive
MUA (manipulation under anaesthesia)
Arthroscopy and division tight bands

10

Anterior dislocation of shoulder

Hx of trauma
Pain
Restricted movements
Flat shoulder contour/visible acromian
Check circulation/nerves
Chronic - apprehension

11

Anterior dislocation of shoulder treatment

Acute - reduce under sedation, mobilise as pain allows
Chronic - Anterior stabilisation

12

Tennis elbow

Degenerative changes to the extensor carpi radialis brevis tendon
Repeated overuse injury
Pain lateral epicondyle
Exacerbated by activity, eased by rest

13

Tennis elbow treatment

Rest
Analgesia
Clasp/brace
HCI
Surgical debridement

14

Osteoarthritis of the elbow

Risk factors: trauma, longterm overuse, RA
Clinical features: pain on movement, post-exertional stiffness, restricted movement
Management: Xray, analgesia, physio, debridement, RA - replacement

15

Ulnar nerve compression

Fibrous tunnel behind medial epicondyle
Pain radiating down arm
Altered sensation ulnar fingers
Intrinsic muscle weakness
Differential diagnosis - compression at wrist

16

Ulnar nerve compression management

Tenel's test
Nerve conduction studies
Analgesia
Avoid banging elbow
Surgical decompression

17

Scaphoid fracture

Clinical features: pain anatomical snuffbox, reduced ROM
Management: xray, repeat xray, bone scan, Colles cast, screw fixation

18

Distal radial fracture

How - fall on outstretched hand
Clinical features - pain, swelling, ↓ ROM
Dinnerfork deformity = Colles fracture
Management - manipulation under anaesthetic, cast, internal fixation

19

De Quervains

Tenosynovitis of extensor pollicis brevis and abductor pollicis longus
Overuse injury
Tender radial side of wrist
Finkelstein's +ve

20

De Quervain's treatment

Rest
NSAID
HCI
Surgical release

21

Osteoarthritis of the wrist

Pain, swelling, loss of function, loss of grip strength
Bouchard's (PIP) and Heberden's (DIP) nodes
Treatment: NSAIDs, analgesia, splints, fusion, excision arthroplasty, wrist replacement

22

Carpal tunnel syndrome

Hand pain radiating to arm
Nocturnal and holding books
Clumsiness
Numbness radial side of hand
Muscle wasting
Phalen's and tinnel's test
?neck pain

23

Carpal tunnel syndrome management

Nerve conduction studies
Wrist splint
HCI
Carpal tunnel release

24

Rheumatoid arthritis clinical features

Produce hand and wrist deformities
Function can be well preserved - document
Synovitis
Tendon rupture
Radial/volar deviation wrist
Ulnar deviation fingers
Boutoniere/swan neck/Z deformities

25

Rheumatoid arthritis treatment

NSAID
analgesia
DMARDs
Physio
Splints
Aids to daily living
Synovectomy
Tendon repair
Joint replacement
Fusion

26

DMARDs - disease process suppressing

Gold
Penicillamine
Sulfasalazine

27

DMARDs - affecting the immune process

Chloroquine and hydroxychloroquine
Methotrexate
Azathioprine
Ciclosporin
Leflunomide

28

DMARDs - Anti-tumour necrosis factor or biological agents

The term biological agents encompasses tumour necrosis factor (TNF)-alpha-blockers (infliximab, etanercept, and adalimumab) and other agents, including abatacept, anakinra, and rituximab.

29

Dupuytren's contracture

Thickening of palmar fascia
Middle aged men
1-2 years tender nodules
Progressive contractures little/ring fingers
Palpable bands
Initially joints mobile - become stiffer later
Treatment: surgical release

30

Hip: Viral synovitis

History of URTI
Limp
Pain in groin, thigh or knee, sometimes tenderness in groin or over greater trochanter
Reluctance to weight bear
Systemically well or moderately unwell + pyrexia
Leg lies in external rotation
ROM limited
Investigations normal
Resolves over a few days

31

Hip: Septic arthritis

History of RTI
Pain in groin, thigh or knee, tender
Refuses to weight bear
Systemically unwell + pyrexia
Lies with hip flexed and in external rotation
ROM restricted
↑ WCC, CRP, ESR, +ve blood cultures
Immediate decompression and washout of the joint, culture fluid, high dose IV antibiotics

32

Osteoarthritis - xray

Articular cartilage worn away → ↓ joint space
Underlying bone becomes dense → subchondral sclerosis
Subchondral cysts at pressure area
Osteophytes

33

Osteoarthritis of the hip

Pain from groin to knee on weight bearing, often use a stick
Stiffness after rest, difficulty putting socks on and cutting toenails
Limp
Apparent shortening of the leg
Muscle wasting
Restricted ROM
Analgesia, NSAIDs, physio, heat, weight loss, modified activity, total hip replacement

34

Bursitis - hip

Extra-articular joint pain
Trochanteric, ilio-psoas, ischial
Inflammation causes bursal synovial cells to thicken
Excess fluid accumulates inside and around affected bursae
Most common causes: mechanical overload and repetitive microtrauma
Ice, analgesia, NSAIDs, weightloss, HCI, physio, decreasing activity during recovery

35

Nerve entrapment - hip

Lateral femoral cutaneous nerve: pain anterolateral thigh; nerve trapped at exit through ligament just inferior and medial to asis (meralgia paraesthesia)
Obturator nerve - pain in groin and down inner thigh

36

Fractured neck of femur

Hip pain
Inability to weight bear
Leg shortened and externally rotated
Can lead to avascular necrosis of the femoral head

37

Gardens classification (fractured NOF)

Grade 1: incomplete fracture of the femoral neck
Grade 2: complete fracture but undisplaced
Grade 3: complete fracture with partial displacement
Grade 4: complete fracture with total displacement

38

OA of the knee

Pain - gradually progressive, exacerbations, activity related and nocturnal
Stiffness - post exertional and structural
Deformity - fixed flexion or box leg
Function - reduced distance of walking and poor sleep
Welling
Warmth/tenderness/painful ROM

39

Anterior cruciate ligament injury

Typical injury pattern - football, skiing
Immediate swelling (sensitive indicator)
Tense swelling, anterior cruciate draw test

40

Meniscal tear of the knee

Previously normal joint
Twisting injury of semiflexed knee - football, skiing
Pain joint line
Locking
Giving way
Valgus thrust with foot in external rotation or varus thrust with foot in internal rotation
Gradual swelling (sensitive indicator)
Mild - moderate swelling
Fixed flexion
Spongy block to extension