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Musculoskeletal System > Approach to MSK Pain > Flashcards

Approach to MSK Pain Flashcards

1
Q

How are (i) articular (ii) periarticular and (iii) non-articular cause of MSK pain differentiated?

A

1) Location
- A: in joint
- P: near joint
- N: “All over”

2) Pain on movement
- A: in all directions
- P: in some directions
- N: unrelated

3) Passive and active movement
- A: Active=Passive
- P: Active > Passive
- N: Unrelated

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2
Q

What are some characteristics of MSK pain that allude to a referred pain pathology?

A

1) Visceral
2) Colic
3) Joint above/below affected

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3
Q

What are some characteristics of MSK pain that allude to a vascular pathology?

A

1) Limb claudication
2) Ischaemic pain at rest
3) Features of peripheral vascular disease (eg. absent/weak pulse, ulcers)

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4
Q

What are some characteristics of MSK pain that allude to a neurological pathology?

A

1) Burning/electric shock in character
2) Numbness/weakness
3) Specific distribution (eg. hand in carpal tunnel syndrom, back in radiculopathies eg. PID, Cauda Equina)

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5
Q

What are 10 anatomical causes/sites of joint pain?

A

Ben & - Bone
Jerry’s - Joint
Makes - Muscle
Truly - Tendon
Luscious - Ligament
Beautiful - Bursa
Fancy - Fascia
Snacks - Skin and soft tissue
Really - Referred
Very - Vascular
Nice - Neurologic

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6
Q

What are 8 rheumatic causes of inflammatory articular MSK pain?

A

Inflammatory Arthritides:
1) RA
2) Crystal arthropathies (Gout, CPPD)
3) Spondyloarthropathies (eg. AS, PsA, IBD related, ReA)

Connective tissue diseases:
4) SLE
5) Sjogren’s syndrome
6) Systemic sclerosis
7) Idiopathic inflammatory myopathies
8) Mixed CTD

Others:
9) Vasculitis
10) Polymyalgia Rheumatica
11) Sarcoidosis
12) Adult Onset Still’s Disease

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7
Q

What are 4 infective causes of inflammatory articular MSK pain?

A

Direct infection (Septic arthritis):
1) Bacterial: SA, Gonococcus, GBS, TB
2) Fungal

Indirect infection:
3) Viral: Parvovirus B19, HIV, Hep B/C
4) Bacterial: TB, Whipple’s disease Lyme disease

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8
Q

What are 2 mechanical causes of articular MSK pain?

A

1) OA
2) Trauma (± hemarthrosis, fracture)

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9
Q

What is an endocrinological cause of articular MSK pain?

A

1) Haematochromatosis
2) Hyper/Hypocalcemia

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10
Q

What is a neuropathic cause of articular MSK pain?

A

Charcot’s joint

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11
Q

What are 3 tendon/ligament causes of periarticular MSK pain?

A

1) Tendonitis/Tenosynovitis
2) Ligamentous sprain
3) Tear/rupture

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12
Q

What are 2 bursae causes of periarticular MSK pain?

A

1) Bursitis
2) Rupture (eg. Baker’s cyst)

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13
Q

What are 2 soft tissue causes of periarticular MSK pain?

A

1) Cellulitis
2) Oedema

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14
Q

What are 4 bone causes of periarticular MSK pain?

A

1) Fracture
2) Tumour
3) Infection (Osteomyelitis)
4) Avascular necrosis

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15
Q

What are 3 muscular causes of periarticular MSK pain?

A

1) Contusion
2) Localised myositis
3) Myofascial pain syndrome

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16
Q

What are 2 vascular causes of non-articular MSK pain?

A

1) Peripheral vascular disease
2) Acute limb ischaemia

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17
Q

What are 3 neurological causes of non-articular MSK pain?

A

1) Compressive neuropathies
2) Spinal cord compression/Cauda Equina syndrome
3) Complex region pain syndrome

18
Q

What are 3 systemic causes of diffuse pain?

A

1) Infection
2) Inflammatory
3) Malignancy

19
Q

What are 3 endocrine/metabolic causes of diffuse pain?

A

1) Osteomalacia
2) Paget’s disease of bone
3) Hypo/Hyperthyroidism
4) Hyperparathyroidism

20
Q

What are 2 pharmacological causes of diffuse pain?

A

1) Statins
2) Bisphosphonates
3) Aromatase inhibitors

21
Q

What are 10 DDx for diffuse pain?

A

DIRECTION:

Degenerative
- Generalised OA

Infection
- Viral, bacterial, endocarditis

Rheumatic
- Crystal arthopathies
- RA
- CTDs
- PMR
- Vasculitides

Endocrine
- Hypothyroidism
- Hyperparathyroidism
- Hyper/hypocalcemia
- Paget’s
- Addison’s

Congenital
- Joint hypermobility syndrome
- Metabolic myopathies

Traumatic

Iatrogenic
- statins, bisphosphonates, aromatase inhibitors

Ouch (psych/neuro)
- Depression, Anxiety
- Multiple sclerosis, neuropathic pain
- Fibromyalgia, Myofascial pain syndrome

Neoplastic
- solid organ, haematological cancers
- bony metastases

22
Q

What does a burning MSK pain indicate?

A

Inflammatory processes

23
Q

Inflammatory or non-inflammatory?:

Pain worse in morning

A

Inflammatory

24
Q

Inflammatory or non-inflammatory?:
Pain worse at end of day

A

Non-inflammatory

25
Q

Inflammatory or non-inflammatory?:
Wakes up in middle of night due to pain

A

Unlikely non-inflammatory

26
Q

Inflammatory or non-inflammatory?:
Pain worse after prolonged rest

A

Inflammatory

27
Q

Inflammatory or non-inflammatory?:
Pain worse after activity

A

Non-inflammatory

28
Q

How does the classic description of stiffness differ in inflammatory vs non-inflammatory causes?

A

Inflammatory
- >1hr
- better w activity

Non-inflammatory:
- <30min
- recurrent after rest

29
Q

Which joint is most commonly affected in gouty podagra?

A

1st MTPJ

30
Q

What are 2 distributive features of Spondyloarthropathies?

A

1) Enthesitis (eg. achilles tendonitis)
2) Dactylitis (Sausage-like swelling of digits)

31
Q

What is a MSK disorder that is associated with the following extra-articular manifestations:
i) Raynaud’s
ii) Alopecia
iii) Oral ulcers
iv) Sicca symptoms (dry mouth and eyes)
v) Frothy urine

A

Connective tissue disease
eg. SLE

32
Q

What is a MSK disorder that is associated with the following extra-articular manifestations:
i) Dry cough
ii) SOB

A

Interstitial lung disease
A/w: RA, Systemic sclerosis, Inflammatory myopathies

32
Q

What is a MSK disorder that is associated with the following extra-articular manifestations:
i) Red eyes
ii) Photophobia
iii) Eye pain
iv) Vision blur

A

Uveitis
A/w: SpA

33
Q

What is a MSK disorder that is associated with the following extra-articular manifestations:
i) Epistaxis
ii) Sinusitis
iii) Haematuria
iv) Haemoptysis

A

Vasculitis

34
Q

In a patient with lower back pain, what is the most likely cause given:
1) Hx of preceding fall/trauma
2) Risk factor for osteoporosis including advanced age, corticosteroid use

A

Vertebral fracture

35
Q

In a patient with lower back pain, what is the most likely cause given:
- pain is worse with bending forwards, coughing, sneezing

A

Discogenic pain

36
Q

In a patient with lower back pain, what is the most likely cause given:
- constitutional symptoms

A

1) Infection
2) Malignancy
3) Inflammatory

37
Q

In a patient with lower back pain, what is the most likely cause given:
- Hx of IVDU

A

Infection:
- spondylodiscitis/ osteomyelitis

38
Q

In a patient with lower back pain, what is the most likely cause given:
- Hx of malignancy or symptoms suggestive of cancer?

A

Bony metastasis to the spine

39
Q

In a patient with lower back pain, what is the most likely cause given:
- pain that radiates down leg
- numbness/tingling in legs
- positive straight leg raise test

A

L4/L5/S1 nerve root impingement (radiculopathy)

40
Q

In a patient with lower back pain, what is the most likely cause given:
i) Weakness of lower limbs
ii) Difficulty walking/inability to walk
iii) Bladder/bowel incontinence/Urinary retention (LUTS)
iv) Reduced sensation around anal region
v) Reduced anal tone on DRE

A

Spinal cord compression / Cauda Equina syndrome

Musculoskeletal System (22 decks)

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