2: MSK Medicine

Question 1

what should you cover during MSK history taking

Answer 1

severity of symptoms, mobility, ADLs, work and social
mechanical symptoms
PMHx
FHx
inflammatory symptoms
systemic symptoms
occupational triggers

Question 2

what does GALS stand for

Answer 2

Gait
Arms
Legs
Spine
used to screen for significant MSK problems

Question 3

what is synovitis

Answer 3

inflammation of the synovial membrane
common in RA and gout

Question 4

define early morning stiffness

Answer 4

stiffness on getting out of bed or staying in one position
it is a indicator of inflammatory arthritis

Question 5

what can cause limited/painful active movement but full pain free passive movement

Answer 5

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

Question 6

what is the WHO pain ladder

Answer 6

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

Question 7

what are ‘mechanical symptoms’ of the knee

Answer 7

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

Question 8

describe bursitis vs knee effusion

Answer 8

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

Question 9

where is pain from OA of the hip normally felt

Answer 9

‘true hip pain’
anterior to the groin

Question 10

what can cause hip pain to be felt posterior/ posterolaterally

Answer 10

lumbosacral spine issues
or gluteal muscles

Question 11

how can plantar fascitis present

Answer 11

’ 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

Question 12

what is metatarsalgia

Answer 12

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

Question 13

what is Morton’s neuroma

Answer 13

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

Question 14

symptoms of gout

Answer 14

rapid onset, sever pain, swelling and inflammation

Question 15

what is radicular back pain

Answer 15

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)

Question 16

what is ‘painful’ arc

Answer 16

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

Question 17

outside of shoulder pathology what problems can present with shoulder pain

Answer 17

neck pain
cardiac problems
lung disease (pancoast tumours)
diaphragmatic pain (right shoulder from liver enlargement)
polymyalgia rheumatica (bilateral)

Question 18

what hand signs can you expect to see in OA

Answer 18

Heberdens nodes - on DIPJ
bouchards nodes - on PIPJ, less common

Question 19

what hand signs can you expect to see in RA

Answer 19

ulnar deviation
swan neck - hyperextension of PIPJ, flexion of DIPJ
boutonnieres - extension of MCPJ, flexion of PIPJ and DIPJ

can occur in chronic disease

Question 20

what is tennis elbow

Answer 20

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

Question 21

what is golfers elbow

Answer 21

inflammation of the flexor tendons, due to overuse
pain in the medial elbow with tenderness over the common flexor origin

Question 22

what is students elbow

Answer 22

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

Question 23

what management options are there for olecranon bursitis

Answer 23

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

Question 24

what is mechanical back pain

Answer 24

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

Question 25

symptoms of mechanical back pain

Answer 25

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