MSK Disorders

Question 1

What is sprain?

Answer 1

Sprain is stretched or torn ligament
Occurs due to falling, twisting or getting hit
Ankle and wrist sprain most commin

Question 2

What are the symptoms of sprain

Answer 2

Pain, swelling, bruising and inability to move a joint may feel a pop or tear with injury

Question 3

What is strain?

Answer 3

Stretch or torn Muscle or tendon
Sudden force of motion(twisting or pulling)

Muscle stretched beyond normal capacity
May take up to 6 weeks for muscle cells to regenerate

Could be acute or chronic injury

Common injury area are back and hamstring

Question 4

What are the symptoms of strain?

Answer 4

Pain, muscle spasms, swelling and difficulty moving muscle

Question 5

What are the differences between 1st, 2nd and 3rd degree sprain

Answer 5

1st degree sprain- mildest for , little tearing, pain and swelling and joint stability is good

2nd degree sprain: moderate instability and moderate to severe pain and swelling

3rd degree- most severe, ligament has completely ruptured. The joint is unstable, severe pain, swelling there may be other tissue damage

Question 6

Treatment of sprain and strains

Answer 6

RICE or PRICE
R = rest, restrict activity
I = ice die 1st 48-72 hrs until swelling decreases
C=compression, elastic compression wrap for 1st 24-36hrs +- may need braces
E= elevate above heat level

PRICE
P= protest from further injury and then same as above

NSAID or acetaminophen for pain control

Note severe strain or sprain may require surgery, immobilization or physical therapy

Question 7

Tendonipathy is what?

Answer 7

Tendinitis is inflammation of Tendon

Question 8

Epicondylitis is what?

Answer 8

Inflammation of tendon where it attaches to bone
Tennis elbow (lateral epicondylitis)
Golfer’s elbow (medial epicondylitis)

Question 9

What are the causes of Tendinopathy? What are the common site of injury?

Answer 9

Causes- injury, overuse, aging

Common sites of injury- elbow, heel, shoulder wrists

Question 10

What are the symptoms of tendinopathy

Answer 10

Pain (dull ache) tenderness along tendon near joint,
pain that increases with activity
Mild swelling

Question 11

What’s the treatment for tendinopathy

Answer 11

Rest, immobilize (splint, removable brace) avoid repetitive movement
NSAID (ibuprofen, asprin) steroid injection
If it does not improve in few weeks - referral to physical therapy

Question 12

What is bursa?

Answer 12

The bursa are small sac lined with a synovial membrane and filled with synovial fluid
Located between tendons, muscles and bony prominence

159 bursa in the body

Question 13

What is bursitis?

Answer 13

Inflammation of the bursal sac and is usually the result of trauma (too much friction)

Question 14

What are the common sites of bursitis

Answer 14

Knee, elbow, heel shoulder

Question 15

What is housemaid’s knee

Answer 15

Bursitis secondary to domestic work done on hands and knee

Question 16

What are the symptoms of bursitis

Answer 16

Pain occur suddenly or gradual
Redness/warmth or swelling

Evaluate for infectious vs non infectious etiology

Question 17

Septic bursitis

Answer 17

A wound (bacteria on skin) result in infection

Question 18

Traumatic bursitis

Answer 18

Often seen In athletes- football players wrestlers

Question 19

Treatment of chronic bursitis

Answer 19

Modify activity that cause injury
Immobilize extremity
Use knees/ elbow pad
Ice 2-3x per day for 20-30min each time to reduce swelling

Do NOT use heat as this will increase inflammation

Analgesic NSAID (ibuprofen)

2nd line inject corticosteroids
Physical therapy

Question 20

Infectious bursitis treatment

Answer 20

Aspirate bursa to diagnose cause
Antibiotics to prevent bacteriemia (cover streptococci and staphylococci)

Question 21

Treatment of traumatic bursitis

Answer 21

Aspirate bursa, ice, NSAIDs compress area with elastic bandage, use of padding/spots protection

Question 22

What is the cause of gout

Answer 22

Gout is the result of a defect in purine metabolism

Gout occurs due to accumulation and crystallization of Uric acid which is deposited in the tissues and fluid of the body

Uric acid is a waste product of protein metabolism and has no physiological role

Gout occur due to overproduction or under excretion of Uric acid

Majority patient has gout due to under excretion

Question 23

What is found in blood of those with gout

Answer 23

Increased levels of uric acid - hyperuremia

Question 24

What are the 4 clinical stages of gout

Answer 24

Asymptomatic tissue deposition
Acute flares
Inter critical segments
Chronic gout

Question 25

What happens in the asymptomatic tissue deposition of gout

Answer 25

Patient has no overt symptoms but does have huperuremia and crystals in tissues which cause damage

Question 26

Acute flare stage of gout

Answer 26

Affected joint will be red, warm and painful. This phase can last days, weeks.

Uric acid levels can be normal in some patient

Question 27

Inter critical segmentation stage of gout

Answer 27

Occurs after acute flare has subsided
Pt continues to have hyperuremic

Question 28

Chronic gout stage

Answer 28

Patient develops chronic arthritis
May have tophi with common site being elbow ears and distal fingers

Question 29

What is tophi

Answer 29

Crystal deposit in tissue which form small white nodules

Question 30

What is podagra?

Answer 30

50% of patient present with gout the great toe (podagra) is the presenting joint

Question 31

What are the risk factors for gout

Answer 31

ETOH (beer or spirit) high meat/ seafood diet, obesity, HTN diuretics use