General Flashcards by James Reilly

What is osteomalacia

Inadequate mineralisation of osteoid framework

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Osteomalacia Clinical presentation

Proximal muscle weakness and pain
Low bone density
In children: bowed legs and knock knees (Rickets in children)

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Pathophysiology of osteomalacia

Normal bone mineralisation depends on adequate calcium and phosphate.
Vitamin D promotes calcium absorption in intestines, promotes bone resorption (by increasing osteoclast number)

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Aetiology of osteomalacia

Profound vit D deficiency

Lack of exposure to sunlight and/or GI malabsorption

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Osteomalacia epidemiology

More common in pigmented skin and elderly

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Treatment of osteomalacia

Oral calciferol

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Diagnostic test of osteomalacia

X-ray (defective mineralisation)

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When is an illness due to work?

Symptoms improve away from work or on holiday e.g. occupational asthma
Characteristic distribution of rash eg contact dermatitis
Sensorineural deafness with characteristic pattern on audiogram caused by noise
A cluster of cases in a workplace
Exposure to hazard can be linked to disease and exposure would not have occurred away from work
An injury is said to due to work when it has been caused by work, or work has substantially contributed to the injury

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What are the epidemiological principles of causality

Bradford Hill criteria:
Strength of association (high and significant odds ratios)
Consistency in association
Exposure-response relationship
Specificity
Temporal relationship
Coherence of evidence
Biologically plausible

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Risk factors in work place for MSK problems

Heavy manual handling (>20Kg)
Lifting above shoulder height
Lifting from below knee height
Incorrect manual handling technique
Forceful movements
Fast repetitive work; poor postures; poor grip

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True or false:
Employers have a legal duty to avoid hazardous manual handling; undertake a risk assessment; reduce the risk of injury to as low as is reasonably practicable

Very True

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Examples of MSK conditions of upper limb resulting from work

Carpal Tunnel Syndrome
Hand-arm vibration syndrome (HAVS)
Tenosynovitis
Epicondylitis
Repetitive strain disorder
Rotator cuff problems
Thoracic Outlet syndrome

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Examples of MSK conditions of lower limb resulting from work

*Osteoarthritis of hip and/or knee

Plantar fasciitis, Housemaid’s knee

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Tests of Carpal Tunnel Syndrome

Tinel’s and Phalen’s provoking tests

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Aetiology of Carpal Tunnel Syndrome

May be caused by forceful and repetitive work
Extremes of flexion-extension of wrist eg painters, meat processors – Prescribed Disease IIDB (A12)
Hand-transmitted vibration (ORs 3-14) – Prescribed Disease IIDB (A12)

Associated with obesity, short stature, pregnancy, OCP, diabetes, hypothyroidism, RA, acromegaly

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What nerve is compressed in carpal tunnel syndrome

Median nerve

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Cause of Hand-arm vibration syndrome

Excessive exposure to hand-transmitted vibration (>2.5m/s2 per 8 hour day)
Chain saws, angle grinders, jack hammers, drills

Exclude other causes of neuropathy in hands

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Features of Hand-arm vibration syndrome

Cause of second Raynaud’s phenomenon
Vascular (blanching) and neural (tingling, numbness and loss of dexterity) components
Hypothenar hammer syndrome (occlusion of ulnar artery and superficial palmar arch)

cause of tenosynovitis

Most commonly caused by inflammation of APL and EPB tendon-sheath
High risk if job requires forceful and repetitive hand movements

Test of tenosynovitis

Finkelstein’s test

Treatment of tenosynovitis

NSAIDs, steroid injection, rest
Change job
Prescribed Disease for IIDB (A8)

Cause/epidemiology of epicondylitis

Common in the general population, tennis players (lateral) and golfer’s (medial)
Associated with forceful flexion-extension of the wrist or forceful pronation-supination

Main symptom of epicondylitis

Weakness of grip

Test of epicondylitis

Cozen’s test

Treatment of epicondylitis

NSAIs, steroid injection, clasp, rest, surgery | May be caused by work but NOT a Prescribed Disease for IIDB

What is Repetitive strain disorder?

Non-specific pain in the hand | e.g. Writers cramp (prescribed disease for IIDB)

Treatment of Repetitive strain disorder

Rest breaks, job rotation, reduced force, ergonomically neutral working postures

What is IIDB

Industrial Injuries Disablement Benefit

Features of Rotator Cuff problems and jobs that can cause it

Tendonitis or tear May be associated with shoulder impingement and osteoarthritis of acromioclavicular joint Painful arc Jobs which involve heavy manual handling, lifting above shoulder height and throwing are high risk

Which tendon is most commonly affected in rotator cuff problems

Supraspinatus tendon

Sign of rotator cuff problem

Hawkin's sign

What is thoracic outlet syndrome

Pain or tingling down arm or blanching of fingers related to posture of arm Compression of trunks of brachial plexus or subclavian artery in neck (under the clavicle)

Cause of thoracic outlet syndrome

Cervical rib, cervical band or other abnormalities of anatomy in neck Associated with poor posture or loading of shoulders

Sign of thoracic outlet syndrome and other diagnostic tests

Roos sign X-ray, MRI, NCTs (treat with surgery)

Causes of OA of hip

Associated with CDH, slipped epiphyses, Perthe’s disease | Occupationally associated with heavy manual work and a lot of walking eg farming

Treatment of OA of hip

Weight loss, NSAIs, paracetamol, arthroplasty | Prescribed Disease for IIDB (A13) for farmers >10 years in job

Causes of OA of knee

Associated with obesity, trauma and menisectomy Occupationally associated with heavy manual work and knee flexion-extension (eg prolonged stair climbing, squatting, kneeling)

OA of knee is a prescribed disease for IIDB for what profession

Miners | Carpet/floor layers >10 years in job

Getting person with MSK problems back to work - things to consider

Are there any barriers for the patient to returning to work? Fitnote Rehabilitation back to work (phased return, restricted duties, workplace modifications) Confidence for work may have been lost Access to Work service Does the employer have an occupational health service? (If so, and with the patient’s consent, write to them)

Causes of mechanical back pain

Associated with heavy manual handling, stooping and twisting whilst lifting, exposure to whole body vibration, psychosocial distress, smoking and dissatisfaction with work

MRI scan of mechanical back pain

Disc degeneration and bulging discs on a MRI scan are a normal finding

Treatment of mechanical back pain

Avoid prolonged inactivity and maintain normal activities within limits of back pain Simple, compound analgesics or NSAIs Spinal manipulative therapy may benefit Spinal exercises, behavioural therapy and workplace adaptations all have a small benefit

Important legal organisations or legalisations to be aware of in MSK injury

- Equality Act and reasonable adjustments for the disabled or ill - Industrial Injury Disablement Benefit (DWP) – a no fault state run compensation system for loss of earnings - Personal injury litigation for work-related injuries or illnesses – claim for compensation must be started within three years of injury/illness - Access to Medical Reports Act - A patient can be lawfully dismissed for incapability due to ill health (different from redundancy) - Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) to the HSE – CTS, HAVS or tenosynovitis

Example illnesses that need to be reported to HSE according to RIDDOR

Carpal Tunnel Syndrome Hand-arm vibration syndrome Tenosynovitis