Joint Pain Flashcards
Describe the differentials of shoulder pain?
- Osteoarthritis
- Rotator Cuff tear
- Rotator Cuff tendonitis
- Shoulder dislocation
- Acromio-clavicular dislocation
- Subacromoid bursitis
- Bicipital tendonitis
- Other arthritis (Septic, rheumatoid etc)
- Adhesive caspculitis
- Calcific tendonitis
What are the distinguishing features of OA of the shoulder?
- Shoulder/ upper arm pain
- Global wasting
- Morning stiffness
- Limited ROM (ER for GH, Add for ACJ)
- Crepitus
What are the distinguishing features of a rotator cuff tear?
- Upper arm pain like sprain
- Painful middle arc
- Weakness 0-90 degrees but past that can hold using deltoid, drops on lowering
- Tenderness over ant acromian
What are the distinguishing features of septic arthritis?
Extremely painful usually at the sternoclavicular joint
Red, hot and tender.
Systemically unwell
What are the distinguishing features of an AC dislocation?
Pain over the acromion
May be a visible deformity
Pain on scarf test
What are the distinguishing features of bicipital tendonitis?
Upper arm pain on the anterior aspect
Tenderness when pressing in the bicipital groove
Worsening of pain on resisted supination
What are the main differentials of hip pain?
Hip fracture Osteoarthritis Acetabular labrum tear Femoral Acetabular Impingement Syndrome Trochanteric bursitis Adductor longus strain (groin strain) Avascular necrosis Referred lumbar spine pain Pubic symphysis dysfunction
What are the distinguishing features of hip fracture?
Elderly or high impact
Shortened externally rotated hip.
Painful.
May be able to weight bear or may have a pseudoparalysis.
What are the distinguishing features of OA of the hip?
Pain deep in the joint line.
Morning stiffness.
Reduced range of movement both passive and active.
Worse with activity.
What are the distinguishing features of acetabular labrum tear?
Following trauma
Groin pain
Locking and clicking.
Pain worse on internal rotation
What are the distinguishing features of femoral acetabular impingement syndrome?
Sharp pain over the front and outside of the hip
Pain worse on pivoting or prolonged sitting.
Pain tends to worsen over time.
What are the distinguishing features of trochanteric bursitis?
Pain over the trochanteric bursae on the outside of the hip - radiates over later thigh
It is usually swollen, tender and often red.
Pain tends to be worse with activity.
Pain on adduction passed midline with flexed hip
What are the distinguishing features of a groin strain?
Caused by a sudden change in direction, slip or fall causing overstretching.
Pain starts in the groin extending into the leg.
Pain is a dull ache at rest with a sharp pain on movement of the hip joint.
What are the main differentials of knee pain?
Ligamentous tear. Meniscal tear. Osteoarthritis. Patellar tendonitis Patellar burisitis. Crystal arthropathy Septic arthritis Chondromalacia patella (teenage girl) Osgood Schlatter disease
What are the distinguishing features of a ligamentous tear?
Pain over the affected ligament (collaterals)
Large amounts of initial swelling (haemoarthrosis)
PCL - subluxation
ACL - anterior draw/ lachmans
MCL/LCL - collateral lig test
What are the distinguishing features of a meniscal tear?
Pain within the knee may not be very severe initially but will worsen with inflammation.
Knee swelling.
Classically knee locks and gives way.
What are the distinguishing features of osteoarthritis of the knee?
Pain within the knee.
Increased stiffness in the morning.
Pain worsens on exertion.
Reduced ROM.
Crepitus
Describe how you can differentiate between crystal arthropathy, septic arthritis and patellar bursitis?
Crystal arthropathy: Very acute onset Extremely painful Will improve over time Systemically well
Septic arthritis:
Acute but progressively worsening
Systemic illness
Bursitis:
Not as acute
May have some systemic illness but not as severe
What are the distinguishing features of patellar tendonitis?
Gradual onset of anterior pain exacerbated by running, jumping and sometimes prolonged sitting
Tenderness over the patellar tendon
Often associated with an increase sporting activity.
How is a rotator cuff tear treated?
Acute phase: heat, exercises and local anaesthetic injection
Young - surgery
Old - leave it
Describe the presentation of frozen shoulder
- Initial severe pain (months)
- Pain subsides then stiffness
- Limited ROM (Especially ER)
- What are the causes of frozen shoulder
2. Describe the management of frozen shoulder
- Spontaneous idiopathic, fall or injury, more common in DM/ thyroid, renal
(true frozen shoulder rare) - NSAIDs, steroid injection, recovers spontaneously in two years
Describe rotator cuff tendinitis (cause and symptoms)
Chronic vascular response to over use or minor tears
- Pain on active elevation (60-120 degrees) worse at night
- Normal Power
How is rotator cuff tendonitis treated?
- NSAID
- steroid inj if severe
- physio
- Surgery if impingement- athroscopic decompression
Which shoulder conditions can cause:
- Impingement
- Reduced active range of movement (abduction) but normal passive
Rotator cuff tear, rotator cuff tendonitis (including) calcific tendonitis
What are the specific tests for the following problems:
- Rotator cuff tendonitis
- Rotator cuff tear
- Frozen shoulder
- ACJ dislocation
- Shoulder dislocation instability
- Cervical spondylitis
- Bicep tendonitis
- OA of shoulder
- abduction 60-120 degrees
- abduction 0-90 degrees
- external rotation
- scarf test
- apprehension test
- C spine movements
- Resisted soupination
- scarf test (ACJ) external rotation (GH)
Describe the mechanism of injury of the following injuries:
- ACL
- PCL
- Meniscal tear
- Twisting in weight bearing flexion
- Anterior force to tibia (dashboard)
- Twisting in weight bearing flexion (usually medial)
