MSK

Question 1

Subacromial impingement - what?

Answer 1

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

Question 2

Subacromial impingement - clinical features

Answer 2

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

Question 3

Subacromial impingement - treatment

Answer 3

Rest
NSAIDs/analgesia
Anaesthetic injection
Surgical decompression

Question 4

Rotator cuff tears

Answer 4

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

Question 5

Osteoarthritis Gleno-humoral joint

Answer 5

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

Question 6

Osteoarthritis Gleno-humoral joint treatment

Answer 6

Xray
Analgesia
Physio
Aneasthetic injection
Shoulder replacement

Question 7

Osteoarthritis acromio-clavicular joint

Answer 7

Pain on movement, especially overhead
Cross body abduction

X ray

HCI
Resection lateral clavical

Question 8

Frozen shoulder

Answer 8

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

Question 9

Frozen shoulder treatment

Answer 9

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

Question 10

Anterior dislocation of shoulder

Answer 10

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

Question 11

Anterior dislocation of shoulder treatment

Answer 11

Acute - reduce under sedation, mobilise as pain allows

Chronic - Anterior stabilisation

Question 12

Tennis elbow

Answer 12

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

Question 13

Tennis elbow treatment

Answer 13

Rest
Analgesia
Clasp/brace
HCI
Surgical debridement

Question 14

Osteoarthritis of the elbow

Answer 14

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

Question 15

Ulnar nerve compression

Answer 15

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

Question 16

Ulnar nerve compression management

Answer 16

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

Question 17

Scaphoid fracture

Answer 17

Clinical features: pain anatomical snuffbox, reduced ROM

Management: xray, repeat xray, bone scan, Colles cast, screw fixation

Question 18

Distal radial fracture

Answer 18

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

Question 19

De Quervains

Answer 19

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

Question 20

De Quervain’s treatment

Answer 20

Rest
NSAID
HCI
Surgical release

Question 21

Osteoarthritis of the wrist

Answer 21

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

Question 22

Carpal tunnel syndrome

Answer 22

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

Question 23

Carpal tunnel syndrome management

Answer 23

Nerve conduction studies
Wrist splint
HCI
Carpal tunnel release

Question 24

Rheumatoid arthritis clinical features

Answer 24

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

Question 25

Rheumatoid arthritis treatment

Answer 25

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

Question 26

DMARDs - disease process suppressing

Answer 26

Gold Penicillamine Sulfasalazine

Question 27

DMARDs - affecting the immune process

Answer 27

``` Chloroquine and hydroxychloroquine Methotrexate Azathioprine Ciclosporin Leflunomide ```

Question 28

DMARDs - Anti-tumour necrosis factor or biological agents

Answer 28

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

Question 29

Dupuytren's contracture

Answer 29

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

Question 30

Hip: Viral synovitis

Answer 30

``` 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 ```

Question 31

Hip: Septic arthritis

Answer 31

``` 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 ```

Question 32

Osteoarthritis - xray

Answer 32

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

Question 33

Osteoarthritis of the hip

Answer 33

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

Question 34

Bursitis - hip

Answer 34

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

Question 35

Nerve entrapment - hip

Answer 35

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

Question 36

Fractured neck of femur

Answer 36

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

Question 37

Gardens classification (fractured NOF)

Answer 37

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

Question 38

OA of the knee

Answer 38

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

Question 39

Anterior cruciate ligament injury

Answer 39

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

Question 40

Meniscal tear of the knee

Answer 40

``` 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 ```