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MSK conditions Flashcards

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1
Q

Describe Achilles tendinopathy

A

Pain, swelling and impaired function of the Achilles tendon
Common in active people

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2
Q

List complications of Achilles tendon injury

A

Tendon rupture
Negative impact on a person’s ability to work and carry out their usual activities
Limitation in sporting activity

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3
Q

Describe the signs and symptoms of Achilles tendinopathy

A

Aching pain in the heel
-pain is aggravated by activity or pressure to the area
Stiffness in the tendon
-may occur in the morning or after a period of prolonged sitting
Tenderness, swelling & crepitus along the tendon

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4
Q

Describe the diagnosis of Achilles tendinopathy

A

Usually a clinical diagnosis (imaging is not routinely recommended)
Examination – exclude Achilles tendon rupture:
1) Tenderness on palpation
2) Evaluate the range of motion of the ankle, pain worsens with passive dorsiflexion of the ankle

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5
Q

List differentials for Achilles tendinopathy

A

Retrocalcaneal bursitis
Plantaris tendinopathy
Dislocation of the peroneal/other plantar flexor tendons
Posterior ankle impingement

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6
Q

Describe the management of Achilles tendinopathy

A

Arrange admission/same-day referral to orthopaedics if Achilles tendon rupture is suspected
Most common causes:
1) Fluoroquinolone antibiotics – discontinue
2) Hypercholesterolemia
3) Diabetes mellitus
Advice: cold packs, paracetamol, rest, can weight bear
Refer to physio for assessment if their symptoms fail to improve within 7-10 days
DO NOT INJECT CORTICOSTEROIDS INTO/AROUND THE TENDON

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7
Q

Describe ankylosing spondylitis

A

Axial spondyloarthritis characterised by sacroiliitis (inflammation of the sacroiliac joints) on x-ray

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8
Q

List the signs and symptoms of ankylosing spondylitis

A

Chronic back pain and stiffness that improves with exercise, not rest
Sacroiliac joint and spinal fusion
Arthritis and enthesitis
Dactylitis
Fatigue
Extra-articular manifestations – anterior uveitis, psoriasis, IBD

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9
Q

List complications of ankylosing spondylitis

A

Spinal fractures
Hip involvement
Osteoporosis
Anterior uveitis

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10
Q

Describe the diagnosis of ankylosing spondylitis

A

Chronic or recurrent low back pain, fatigue and stiffness:
-45 years or younger
- > 3 months
-worse in the morning, improving with movement
Refer to a rheumatologist for confirmation of the diagnosis

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11
Q

Describe the criteria for diagnosing ankylosing spondylitis

A

Modified New York criteria:
Clinical criteria:
-low back pain: present for more than 3 months, improvement by exercise but not relieved by rest
-limitation of lumbar spine motion in both the sagittal and frontal planes
-limitation of chest expansion relative to normal values for age and sex
Radiological criteria: sacroiliitis on x-ray
Diagnose: if the radiological criterion is present & at least one clinical criterion
Other: ASAS classification criteria for axial spondyloarthritis

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12
Q

List differential diagnosis for ankylosing spondylitis

A

Degenerative/mechanical problems eg. degenerative disc disease, spondylosis, congenital vertebral anomalies
Fractures
Infectious sacroiitis
Bone metastasis

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13
Q

Describe the management of ankylosing spondylitis

A

NSAIDs, if contraindicated standard analgesic
Confirmed diagnosis: flare management plan, NSAIDs, TNF-alpha inhibitors (may be greater risk of skin cancer)

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14
Q

Describe Baker’s cysts

A

Not true cysts
Distension of the gastrocneumius-semimembranosus bursa behind the knee
Primary cysts: not associated with underlying disease of the knee joint & found mainly in children
Secondary cysts: associated with underlying disease of the knee joint

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15
Q

Describe the diagnosis of a Baker’s cyst

A

Swelling and pain, may be aggravated by walking
Present with acute symptoms – if the cyst dissects/ruptures, history of a sudden ‘pop’
Examine the person standing and in the supine position – inspect and palpate the popliteal fossa for masses (bulge in medial popliteal fossa)

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16
Q

List differential diagnosis for a Baker’s cyst

A

DVT
Superficial thrombophlebitis
Popliteal artery aneurysm
Lipoma

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17
Q

Describe the management of a Baker’s cyst

A

Arrange a same-day assessment in secondary care if any red flags are identified
Identify & optimise management of any underlying condition
Asymptomatic – no treatment
Simple analgesia

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18
Q

Describe bunions

A

A toe deformity when the great toe laterally deviates away from the midline towards the lesser toes
Causes medial prominence of the first metatarsal head & overlying bursa may also become inflamed

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19
Q

Describe the diagnosis of bunions

A

Progressive pain at the medial aspect of the first MTP and/or medial aspect of the forefoot
Difficulty wearing shoes
Lateral deviation of the hallux at the first MTP joint
Medial prominence of the first metatarsal head

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20
Q

List complications of bunion deformity

A

MTP joint pain
Difficulty finding comfortable footwear
OA of the first MTP joint
Impaired balance and increased risk of falls

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21
Q

List differential diagnosis for bunions

A

Hallux rigidus
Gout
Fracture
Inflammatory joint disease
Osteomyelitis

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22
Q

Describe the management of bunions

A

Self-care: wear low-heeled, wide-fitting shoes with a soft sole
Offer referral to podiatry for a footwear assessment
Consider referral to the local MSK service

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23
Q

Describe carpal tunnel syndrome

A

Entrapment neuropathy caused by compression of the median nerve in the carpal tunnel at the wrist
Majority of cases are idiopathic

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24
Q

Describe the diagnosis of carpal tunnel syndrome

A

Intermittent paraesthesia
Numbness
Altered sensation
Burning/pain
All in the distribution of the median nerve
Examination – wasting of the thenar eminence muscles, weakness of median nerve movements, positive Phalen’s & Tinel’s test

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25
List differentials for carpal tunnel syndrome
Cubital tunnel syndrome Cervical nerve root entrapment De Quervains tenosynovitis Osteoarthritis
26
Describe the management of carpal tunnel syndrome
6-week trial of conservative treatment in primary care: 1) Use of wrist splint in a neutral position at night 2) A single corticosteroid injection into the carpal tunnel 3) Hand exercises and median nerve mobilisation techniques Review after 6 weeks, arrange referral if seems appropriate
27
Describe giant cell arteritis
Chronic vasculitis characterised by granulomatous inflammation in the walls of medium and large arteries Usually affects people over 50 years of age
28
List complications of giant cell arteritis
Vision loss Large artery complications – aortic aneurysm, aortic dissection & large artery stenosis Cardiovascular disease
29
Describe the diagnosis of giant cell arteritis
Age > 50 and one of the following: 1) New-onset headache, usually in the temporal region 2) Temporal artery abnormality, occasionally the overlying skin is red & pulsation may be reduced/absent Other symptoms include: visual disturbances, scalp tenderness, intermittent jaw claudication
30
List differentials for giant cell arteritis
Herpes zoster Cluster headache or migraine Acute angle closure glaucoma
31
Describe the management of giant cell arteritis
Medical emergency – early treatment with effective doses of glucocorticoids may prevent serious complications If new visual loss -> urgent same day assessment by an ophthalmologist Urgently discuss with a specialist & refer using a fast track local GCA pathway (diagnosis will be confirmed in secondary care)
32
Describe gout
Type of arthritis caused by monosodium urate crystals forming inside and around joints Causes sudden flares of severe pain, heat & swelling
33
List risk factors for gout
Hyperuricaemia Increasing age Excess body weight or obesity Male sex Diet – excess alcohol, sugary drinks, meat & seafood
34
List complications of gout
CVS disease Chronic arthritis CKD Joint damage Renal stones Tophi
35
Describe the diagnosis of gout
Rapid onset of severe pain together with redness and swelling in one or both MTPJs Tophi History of previous self-limiting attacks supports the diagnosis Examination – warm, red and swollen joints, tophi
36
List differentials for gout
Bursitis Haemochromatosis Pseudogout Osteoarthritis
37
Describe the management of gout
Acute flare-ups: NSAID at the maximum dose, colchicine, short course of oral corticosteroid Prevention: urate-lowering therapy, offer allopurinol or febuxostat first-line, colchicine
38
Describe Lyme disease
Infection caused by bacteria called Borrelia burgdorferi which are transmitted to humans following a bite from an infected tick
39
List complications of Lyme disease
Severe neurological symptoms Lyme arthritis
40
Describe the diagnosis of Lyme disease
Clinical diagnosis of Lyme disease in people with erythema migrans (at the site of a tick bite, round or oval in shape, pinkish in colour, usually flat, expands over days to weeks) Without erythema migrans -> clinical presentation & laboratory testing is used to guide diagnosis and treatment
41
List differentials for Lyme disease
Tick bite hypersensitivity reaction Cellulitis Erythema multiforme
42
Describe the management of Lyme disease
Prescribe oral antibiotics – doxycycline first line, amoxicillin & azithromycin second line NB: a Jarisch-Herxheimer reaction may develop in the first 24 hours of treatment with any abx for Lyme disease
43
What is Morton’s neuroma?
Compression neuropathy of the common digital plantar nerve Occurs mostly in the third intermetatarsal space Not a true neuroma, but a benign fibrotic thickening of the nerve due to constant irritation
44
Describe the diagnosis of Morton’s neuroma
Pain in the forefoot, most commonly in the third intermetatarsal space -> sharp, stabbing, burning, shooting Altered sensations & feeling a ‘lump’ in the show on weight bearing Pain is intermittent as episodes occur with long intervals between attacks Examination – pain is elicited on applying pressure to the involved inter-metatarsophalangeal space
45
List differentials for Morton’s neuroma
Biomechanical problems – anomalies of the forefoot bone structure, instability issues, obesity Soft tissue problems – focal plantar keratosis, plantar fibromatosis, plantar fat pad atrophy Bone and joint disease – stress fractures, OA
46
Describe the management of Morton’s neuroma
Advice: avoid high heels & shoes with a constricting tow box/thin soles, use a metatarsal pad, avoid impact activities Consider NSAIDs if necessary Consider referral if symptoms persist
47
Describe olecranon bursitis
Occurs when the bursa is irritated and inflamed: 1) Non-septic: sterile inflammation resulting from various causes including trauma or overuse 2) Septic: infection resulting from seeding of the bursal sac with micro-organisms
48
Describe the diagnosis of olecranon bursitis
Swelling over the olecranon process thar appears over several hours to several days, may be tender of warm, is fluctuant Movement at elbow is painless except on full flexion History of preceding trauma or bursal disease
49
List differentials of olecranon bursitis
Rheumatoid arthritis Septic arthritis Gout Cellulitis
50
Describe the management of olecranon bursitis
Rest, ice and reduced activity Compressive bandaging Consider aspiration to improve function and comfort If none of the above works = corticosteroid injection Give oral abx if aspiration not possible in septic bursitis
51
Describe Osgood-Schlatter disease
Apophysitis of the tibial tuberosity that causes anterior knee pain during adolescence and is usually self-limiting -result of repetitive strain from the patella tendon at its insertion on the ossification centre of the tibial tuberosity
52
Describe the diagnosis of Osgood-Schlatter disease
If there are no features suggestive of another cause of knee pain, OSD may be diagnosed clinically Pain starts in adolescence and is: 1) Localised to tibial tuberosity 2) Gradual in onset & initially mild and intermittent 3) Unilateral (bilateral in 30%) 4) Relieved by rest Examination – tenderness over the tibial tuberosity, pain provoked by resisted knee extension
53
List the differentials of Osgood-Schlatter disease
Tumour Inflammatory arthritis Trauma Infection
54
Describe the management of Osgood-Schlatter disease
Symptoms usually resolve over time Pain relief Reduction in activity may be sufficient to control pain
55
Describe osteoporosis
Disease characterised by low bone mass and structural deterioration of bone tissue -> increase in bone fragility and susceptibility Asymptomatic, often remains undiagnosed until a fragility fracture occurs
56
Describe plantar fasciitis
Condition in which there is persistent pain associated with degeneration of the plantar fascia as a result of repetitive microtears in the contracted fascia Common condition, especially in people aged 40-60 years
57
Describe the diagnosis of plantar fasciitis
Usually diagnosed by the history and physical examination findings alone History – initial insidious onset of heel pain, intense heel pain during the first steps after waking/after a period of inactivity; pain reduces with moderate activity Examination – tenderness on palpation of the plantar heel area, limited ankle dorsiflexion range, positive ‘windlass test’ (pain by extension of the first MTPJ)
58
List differentials of plantar fasciitis
Achilles tendonitis Flexor hallucis longus tendinopathy Calcaneal stress fracture
59
Describe the management of plantar fasciitis
Most people will make a complete recovery within a year Self-care advice: rest the foot, wear shoes with good arch support & cushioned heels Simple analgesics to provide symptom relief
60
Describe polymyalgia rheumatica
Chronic, systemic rheumatic inflammatory disease characterised by aching and morning stiffness in the neck, shoulder and pelvic girdle Cause of PMR is unknown
61
List complications of polymyalgia rheumatica
Giant cell arteritis Complications of long-term corticosteroid treatment
62
Describe the diagnosis of polymyalgia rheumatica
Age > 50 years presenting with at least 2 weeks of: 1) Bilateral shoulder and/or pelvic girdle pain 2) Stiffness lasting for at least 45 minutes after waking or periods of rest Other features: low-grade fever, fatigue, anorexia, weight loss & depression, peripheral musculoskeletal signs: carpal tunnel syndrome, peripheral arthritis, swelling with pitting oedema
63
List differentials of polymyalgia rheumatica
Cervical and lumbar spondylosis Osteoarthritis Bilateral adhesive capsulitis and rotator cuff disorders Thyroid disease
64
Describe the management of polymyalgia rheumatica
Reduce the dose of prednisolone slowly when symptoms are fully controlled (typically treatment is required for between 1-2 years) Ensure the person is provided with a blue steroid card Arrange routine reviews one week after any change in dose and at least every 3 months in the first year following diagnosis Ask about symptoms of GCA
65
What is tennis elbow?
Tendinosis (chronic symptomatic degeneration of the tendon) that affects the common attachment of the tendons of the extensor muscles of the forearm to the lateral epicondyle of the humerus Women and men are affected equally, peak incidence between 35-54 years of age
66
Describe the diagnosis of tennis elbow
History – pain present in the dominant arm in the region of the lateral epicondyle with radiation down the extensor aspect of the forearm, symptoms exacerbated by wrist extension Examination – localised point tenderness on palpation over and/or distal to the lateral epicondyle & along the common extensor tendon, resisted middle finger extension may be painful (Maudsley’s test), grip strength may be reduced
67
List differentials of tennis elbow
Rheumatoid arthritis Septic arthritis Cervical radiculopathy Elbow osteoarthritis
68
Describe the management of tennis elbow
Advice: heat/ice, rest the arm, analgesia No response to initial treatment after 6 weeks = consider arranging referral to physio, do not routinely offer corticosteroid injection No response to treatment 6-12 months after initial presentation, consider referral to an orthopaedic surgeon for evaluation

Yr3 GP (4 decks)

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