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CP3 MDD > Joint Pain > Flashcards

Joint Pain Flashcards

1
Q

Describe the differentials of shoulder pain?

A
  • 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
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2
Q

What are the distinguishing features of OA of the shoulder?

A
  • Shoulder/ upper arm pain
  • Global wasting
  • Morning stiffness
  • Limited ROM (ER for GH, Add for ACJ)
  • Crepitus
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3
Q

What are the distinguishing features of a rotator cuff tear?

A
  • 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
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4
Q

What are the distinguishing features of septic arthritis?

A

Extremely painful usually at the sternoclavicular joint

Red, hot and tender.

Systemically unwell

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5
Q

What are the distinguishing features of an AC dislocation?

A

Pain over the acromion

May be a visible deformity

Pain on scarf test

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6
Q

What are the distinguishing features of bicipital tendonitis?

A

Upper arm pain on the anterior aspect

Tenderness when pressing in the bicipital groove

Worsening of pain on resisted supination

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7
Q

What are the main differentials of hip pain?

A 
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
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8
Q

What are the distinguishing features of hip fracture?

A

Elderly or high impact

Shortened externally rotated hip.

Painful.

May be able to weight bear or may have a pseudoparalysis.

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9
Q

What are the distinguishing features of OA of the hip?

A

Pain deep in the joint line.

Morning stiffness.

Reduced range of movement both passive and active.

Worse with activity.

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10
Q

What are the distinguishing features of acetabular labrum tear?

A

Following trauma

Groin pain

Locking and clicking.

Pain worse on internal rotation

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11
Q

What are the distinguishing features of femoral acetabular impingement syndrome?

A

Sharp pain over the front and outside of the hip

Pain worse on pivoting or prolonged sitting.

Pain tends to worsen over time.

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12
Q

What are the distinguishing features of trochanteric bursitis?

A

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

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13
Q

What are the distinguishing features of a groin strain?

A

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.

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14
Q

What are the main differentials of knee pain?

A 
Ligamentous tear.
Meniscal tear.
Osteoarthritis.
Patellar tendonitis
Patellar burisitis.
Crystal arthropathy
Septic arthritis
Chondromalacia patella (teenage girl)
Osgood Schlatter disease
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15
Q

What are the distinguishing features of a ligamentous tear?

A

Pain over the affected ligament (collaterals)
Large amounts of initial swelling (haemoarthrosis)

PCL - subluxation
ACL - anterior draw/ lachmans
MCL/LCL - collateral lig test

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16
Q

What are the distinguishing features of a meniscal tear?

A

Pain within the knee may not be very severe initially but will worsen with inflammation.

Knee swelling.

Classically knee locks and gives way.

17
Q

What are the distinguishing features of osteoarthritis of the knee?

A

Pain within the knee.

Increased stiffness in the morning.

Pain worsens on exertion.

Reduced ROM.

Crepitus

18
Q

Describe how you can differentiate between crystal arthropathy, septic arthritis and patellar bursitis?

A 
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

19
Q

What are the distinguishing features of patellar tendonitis?

A

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.

20
Q

How is a rotator cuff tear treated?

A

Acute phase: heat, exercises and local anaesthetic injection

Young - surgery
Old - leave it

21
Q

Describe the presentation of frozen shoulder

A
  • Initial severe pain (months)
  • Pain subsides then stiffness
  • Limited ROM (Especially ER)
22
Q
  1. What are the causes of frozen shoulder

2. Describe the management of frozen shoulder

A
  1. Spontaneous idiopathic, fall or injury, more common in DM/ thyroid, renal
    (true frozen shoulder rare)
  2. NSAIDs, steroid injection, recovers spontaneously in two years
23
Q

Describe rotator cuff tendinitis (cause and symptoms)

A

Chronic vascular response to over use or minor tears

  • Pain on active elevation (60-120 degrees) worse at night
  • Normal Power
24
Q

How is rotator cuff tendonitis treated?

A
  • NSAID
  • steroid inj if severe
  • physio
  • Surgery if impingement- athroscopic decompression
25
Q

Which shoulder conditions can cause:

  • Impingement
  • Reduced active range of movement (abduction) but normal passive
A

Rotator cuff tear, rotator cuff tendonitis (including) calcific tendonitis

26
Q

What are the specific tests for the following problems:

  1. Rotator cuff tendonitis
  2. Rotator cuff tear
  3. Frozen shoulder
  4. ACJ dislocation
  5. Shoulder dislocation instability
  6. Cervical spondylitis
  7. Bicep tendonitis
  8. OA of shoulder
A
  1. abduction 60-120 degrees
  2. abduction 0-90 degrees
  3. external rotation
  4. scarf test
  5. apprehension test
  6. C spine movements
  7. Resisted soupination
  8. scarf test (ACJ) external rotation (GH)
27
Q

Describe the mechanism of injury of the following injuries:

  1. ACL
  2. PCL
  3. Meniscal tear
A
  1. Twisting in weight bearing flexion
  2. Anterior force to tibia (dashboard)
  3. Twisting in weight bearing flexion (usually medial)

CP3 MDD (17 decks)

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