MSK History

Question 1

What is the point of a history?

Answer 1

90% of the assessment is in the history

The examination is simply to confirm or refute the provisional diagnosis reached

Question 2

History questions

Answer 2

Who are they

What are the features of their pain

Why has it happened now

Red flags

What is likely problem they have

What are their ideas, concerns and hopes

What do they need to know now?

Question 3

Features of pain?

Answer 3

SOCRATES

Question 4

Key questions during the examination?

Answer 4

Which joint or tissue is affected

Is the pain reproduced?

Question 5

Shoulder anatomy

Answer 5

Clavicle

A-C joint

Coracoid

Acromion

Labrum

Question 6

Specific shoulder conditions

Answer 6

Frozen shoulder

Rotator cuff problems

Acromioclavicular OA

Labrum problems

Question 7

What is frozen shoulder?

Answer 7

Adhesive capsulitis

Question 8

Risk factors for FH

Answer 8

Diabetes

MI

HI

Trauma

Question 9

What nerve supplies the shoulder?

Answer 9

C5

Question 10

What is the 3 phases of frozen shoulder?

Answer 10

1-3 years

Freezing

Frozen

Defrosting

Question 11

Management of FS

Answer 11

Pain management - external rotation worse - WHO pain ladder
Paracetamol, eye drops, or naproxen instead of ibuprofen

Physiotherapy

Question 12

Possible rotator cuff problems

Answer 12

Tendinopathy - partial tea, bursitis

Supraspinatus tendinopathy

Question 13

What is the most painful motion for rotator cuff problems?

Answer 13

Maximal on resisted abduction

Painful arc

Question 14

Management of RCT

Answer 14

Activity modification

Analgesia

Refer to physio and MSK specialist

Question 15

Describe AC Joint pain

Answer 15

Trauma or overuse

C4 nerve supply

Pain at extremes at every movement

Possible associated rotator cuff problems

Local tenderness at ACJ

Question 16

Management of ACJ pain?

Answer 16

Analgesia

Refer to physio and MSK specialist

Question 17

Describe labral tears

Answer 17

Young - middle aged

Painful deep clicking and clunking

May feel unstable

Management - most require orthopaedics referral

Question 18

How to manage shoulder instability

Answer 18

Trial of physio unless obviously laxation, ma need shoulder

Question 19

Shoulder examination steps

Answer 19

General inspection - face, posture and gait

Neck movements - look up, down, over each shoulder, ears to shoulder

Inspect shoulder - post and anterior, bony deformities, colour changes, wasting, swelling

Movements - active, passive, resisted - flexion, abduction, internal rotation, external rotation,

Special tests - bursitis ( empty can test), ACJ (scarf test), shoulder instability (throwing ball test, resisted)

Palpation - not massively important - sternal notch, clavicles, ACJ, lateral edge of acromion, spine of scapula, supraspinatus and infraspinatus

Question 20

Important points in knee history?

Answer 20

Age

Red flags

Pain questions - SOCRATES

Additional questions - redness, locking, collapsing, swelling

Question 21

Knee arthritis presentation

Answer 21

Boxed shape - varus deformity bow shaped

Small effusion

Gross limitation of flexion with slight limitation of extension

Hard end feel

Question 22

Management of OA

Answer 22

Education - activity change, weight loss

Investigation - x-ray

Analgesia - paracetamol +/- anti-inflammatory

Patient expectations

Role of physio

Question 23

Describe meniscal tears

Answer 23

Acute and traumatic vs degenerative

Acte tears have effusion, locking and joint line tenderness

Degenerative tears may settle with conservative management and physiotherapy

Question 24

What are some additional soft tissue problems in the knee

Answer 24

LIgamentous tears or strains

Bursitis

Question 25

Describe anterior pain

Answer 25

Difficult to manage Patellofemoral pain syndrome MOre common in women Often recent change in activity level Pain in front/above/below patella Maltracking of patella secondary to quad muscles imbalance Need to redress this balance to improve symptoms

Question 26

Describe patellar tedinopathy?

Answer 26

More common in men Often increase in training Common in runners, jumpers and footballers Pain at patellar insertion US useful in diagnosis

Question 27

Treatment of patellar tendinopathy?

Answer 27

Physio led loading programme

Question 28

Steps in knee examination

Answer 28

Gait Observation - muscle wasting Deep knee bend Sitting - full extension, resisted extension Su[ine - hip and SLR = exclusion tests Effusion, joint line tenderness / PF Flexion/extension with end feel Ligamentous tests Meniscal provocation tests

Question 29

History of back pain

Answer 29

Infection, tumour, inflammatory or fracture Age Pain history PMH Red flags/yellow flag Nerve root symptoms Cauda equina syndrome

Question 30

Describe cauda equina syndrome

Answer 30

Rare Delayed recognition Usuallya t L4/5/S1 Acute presentation Dysfunction of bladder, bowel or sexual function Watch out for bilateral progressive sciatica

Question 31

Describe disc prolapse

Answer 31

Mainly primary postero-lateral

Question 32

Describe ankylosing spondylitis

Answer 32

Younger people Inflammatory history and good response to NSAID Early morning stiffness Markedly diminished forward/flexion Bloods/XR MRI