2: MSK Medicine Flashcards
what should you cover during MSK history taking
severity of symptoms, mobility, ADLs, work and social
mechanical symptoms
PMHx
FHx
inflammatory symptoms
systemic symptoms
occupational triggers
what does GALS stand for
Gait
Arms
Legs
Spine
used to screen for significant MSK problems
what is synovitis
inflammation of the synovial membrane
common in RA and gout
define early morning stiffness
stiffness on getting out of bed or staying in one position
it is a indicator of inflammatory arthritis
what can cause limited/painful active movement but full pain free passive movement
in active movement it requires the patient to use their muscles and tendons unlike passive movement
this means if there is a problem with the muscles or tendons could cause reduced active movement only
what is the WHO pain ladder
stepwise use of simple analgesia; paracetamol, NSAIDs and stronger drugs like opiates.
can be problematic in chronic pain due to side effects of long term use, addiction and risk of neglecting non-pharmacological options
what are ‘mechanical symptoms’ of the knee
locking or catching of the knee
traditionally thought to indicate theres obstruction of the knee joint, however recently its been shown these symptoms can occur in knee disease without obvious obstruction
describe bursitis vs knee effusion
knee effusion - swelling due to excess synovial fluid in the joint capsule, the fluid can be moved across the knee
bursitis - the swelling is localised to the affected bursa
where is pain from OA of the hip normally felt
‘true hip pain’
anterior to the groin
what can cause hip pain to be felt posterior/ posterolaterally
lumbosacral spine issues
or gluteal muscles
how can plantar fascitis present
’ heel pain’
pain is often worse in the first few steps of the day and worsens again at the end of the day
people who spend a lot of time on their feet can be affected
pain is normally felt at the insertion of plantar fascia into the calcaneum
what is metatarsalgia
pain and inflammation tends to occur in the ball of the foot but can also occur in the mid-foot
pain is worse on movement
can also have numbness/tingling of the distal feet
Rx: lots of jumping/ running around
what is Morton’s neuroma
noncancerous growth of fibrous tissue around a nerve usually occurs between the third and fourth metatarsal heads. It causes symptoms that are similar to metatarsalgia and can also contribute to metatarsal stress
symptoms of gout
rapid onset, sever pain, swelling and inflammation
what is radicular back pain
caused by irritation or impingement of a nerve root
typically felt in a dermatomal area and is worse when the nerve is stretched
pain is often describes as ‘shooting’ or ‘numb’
may be other neurological symptoms (weakness, hyporeflexia)
what is ‘painful’ arc
pain in the mid-range (45-120) of abduction of the shoulder
indicates impingement of the shoulder in the sub-acromial space
pain worse on active than passive
outside of shoulder pathology what problems can present with shoulder pain
neck pain
cardiac problems
lung disease (pancoast tumours)
diaphragmatic pain (right shoulder from liver enlargement)
polymyalgia rheumatica (bilateral)
what hand signs can you expect to see in OA
Heberdens nodes - on DIPJ
bouchards nodes - on PIPJ, less common
what hand signs can you expect to see in RA
ulnar deviation
swan neck - hyperextension of PIPJ, flexion of DIPJ
boutonnieres - extension of MCPJ, flexion of PIPJ and DIPJ
can occur in chronic disease
what is tennis elbow
inflammation of the extensor tendons, can occur due to over use of the extensor muscles
pain in the lateral elbow
tenderness over the common extensor origin
what is golfers elbow
inflammation of the flexor tendons, due to overuse
pain in the medial elbow with tenderness over the common flexor origin
what is students elbow
olecranon bursitis
fluctualed (non-painful) swelling over the olecranon process of the elbow
can have pain as the bursa enlarges and stretches
can occur from trauma or repeated prolonged pressure
what management options are there for olecranon bursitis
elbow pads, activity modification, NSAIDs/anti-inflammatories
if not improving or obstructing movement it may be surgically drained
may also be operated on if infected and not responding to ABX
what is mechanical back pain
back pain that arises intrinsically from the spine, intervertebral disks, or surrounding soft tissues. It’s most commonly caused by a strain of one of the back muscles
symptoms of mechanical back pain
pain may radiate to your buttocks and thighs.
Many people may also experience spasms with mechanical back pain. The symptoms of mechanical back pain are generally more noticeable with flexion of the back and when lifting heavy objects
