MSK Flashcards
1
Q
chronic pain at multiple sites - 'pain all over' lethargy cognitive impairment sleep disturbance dizziness headache
A
fibromyalgia
2
Q
diagnosis of fibromyalgia
A
11/18 tender points
3
Q
management of fibromyalgia
A
Gabapentin and amitriptyline
CBT and aerobic exercise can also be useful
4
Q
severe pain
erythema
swelling
usually the 1st MTP joint affected
hx of high purine diet, thiazide use and excessive alcohol/dehydration
A
gout
5
Q
investigation for gout
A
joint aspiration and crystal analysis
negatively birefringent crystals
6
Q
management for gout
A
acute = NSAIDs (& appropriate gastroprotection)
colchicine can be given but slower to act
chronic = allopurinol, might start with colchicine
second line = febuxostat
7
Q
pain mainly in the hip and shoulder pain/aching in the morning stiffness in the proximal limbs polyarthralgia lethargy depression low grade fever
A
polymyalgia rheumatica
8
Q
Ix for PMR
A
ESR/CRP
9
Q
management of PMR
A
prednisolone
10
Q
episodic attacks of hot, swollen joints. Typically knee is affected
A
pseudogout
11
Q
investigation of pseudogout
A
aspiration = positively birefringent crystals - rhomboid
(exclude septic arthritis)
calcium pyrophosphate
12
Q
management of pseudogout
A
IA steroid injection
NSAIDs
13
Q
arthritis uveitis urethritis fever dactylitis
hx of GI/GU infection 1-4 weeks prior
usually male and HLA-B27
A
reactive arthritis/reiter’s syndrome
14
Q
management of reactive arthritis/reiter’s syndrome
A
NSAIDs first line
steroid second line
persistent disease = sulfasalazine and methotrexate
15
Q
usually in 20-30s , more common in females
multiple, peripheral joins - MCPs and PIPs
symmterical, joint pain and stiffness
stiffness worse in the morning - improves with as the day goes on
positive squeeze test
A
rheumatoid arthritis
16
Q
Diagnosis of rheumatoid arthritis
A
anti-CCP
X - rays = erosions
17
Q
management of rheumatoid arthritis
A
DMARDs - methotrexate/sulfasalazine
- usually taken with folic acid
start with bridging steroids
give steroids IM/PO in acute flares
TNF-a/biologics in inadequate responses
18
Q
Fever, malaise and arthralgia HTN peripheral motor neuropathy livedo reticularis weight loss
commonly with 40-60yrs old and Hep B infections
A
polyarteritis nodosa
19
Q
Ix for polyarteritis nodosa
A
biopsy = full thickness necrotizing inflammation
raised ESR/CRP
normocytic, normochromic anaemia
20
Q
management of polyarteritis nodosa
A
steroids
+/- DMARDs
21
Q
common in knee and DIPs
usually mono/oligoarthritis - asymmetrical
dactylitis
pitting nails
swelling of associated tendons - enthesis
dry erythematous skin
A
psoriatic arthritis
22
Q
Ix of psoriatic arthritis
A
X-ray hands and feet = pencil in cup deformity
ESR/CRP raised
23
Q
management for psoriatic arthritis
A
mild cases = NSAIDs
DMARDs and immunosuppressants - TNFa inhibitors
24
Q
severe dry eyes and dry mouth fatigue arthralgia Raynauds phenomenon vaginal dryness recurrent parotitis positive schimer's test
A
Sjogren’s syndrome
25
Ix for sjogren's
diagnostic = parotid gland biopsy
| +SSRA/Ro, +SSA/La antibodies
26
treatment for sjogren's
symptomatic relief from eye drops
sialogogues
punctal plugs
27
```
C= calcinosis
R = raynauds
E = esophageal dysmotility
S = sclerodactyly
T = telangiectasia
```
scleroderma (fibrosis of skin)
28
Ix for scleroderma
Scl-70, anti-topoisomerase I
29
management of scleroderma
relieve symptoms
| steroids, immunosuppressants
30
```
fatigue, fever and mouth ulcers
lympahdenopathy
malar/butterfly discoid rash - spares nose
raynaud's phenomenon
livedo reticularis
arthralgia
pericarditis
glomerulonephritis
```
systemic lupus erythematous
31
Ix for SLE
anti-dsDNA, anti-smith
| complement C3/4
32
management of SLE
hydroxychloroquine (anti-malarial) - retinal toxicity
| NSAIDs and steroids
33
weakness in the proximal muscles
weakness>pain
complains of trouble getting out of chair, trouble brushing hair
usually age >40
polymyositis
34
Ix for polymyositis
CK massively elevated
EMG
definitive dx = muscle biopsy
35
management of polymyositis
steroids
36
aged under 16 with arthritis for over 6 weeks
more common in women
joint pain and swelling, commonly in the knee
intermittebn spiking fevers (1-2 a day)
extra articular - uveitis
juvenile rheumatoid arthritis
37
Ix for JRA
elevated CRP/ESR
| possibly positive for RF/ANA
38
management of JRA
NSAIDs first line
| DMARDs second line
39
joint pain following use, improves with rest
DIPs and PIPs joints - herberden and bouchard nodes
joint crepitus
affects mainly the weight bearing joints
older age
Osteoarthritis
40
Ix for OA
X-ray = loss of joint space, subchondral sclerosis and osteophyte formation
41
Management of OA
pt ed, weight loss, exercise
pain control - analgesia, joint aspirations/steroid injection
replace joint as last resort
42
Osteoporosis risk factors
```
menopausal women
increased age
smoking
steroid use (long term)
low BMI
```
43
Diagnosis for osteoporosis
T-score on DEXA scan = - 2.5 SD or below
44
presentation of osteoporosis
usually asymptomatic until a fracture appears
45
management of osteoporosis
bisphosphonates - osteonecrosis of the jaw/atypical femoral fractures
give a 'drug holiday' = come off medication every 3-5yrs
46
older male with bone pain
isolated ALP elevation
bowing of tibia, bossing of skull
Paget's disease
47
skull x-ray: thickened vault, osteoporosis circumscripta
paget's disease
48
management for paget's disease
bisphosphonate (either oral risedronate or IV zoledronate)
49
```
usually a single area
non-specific pain
fever
malaise/fatigue
inflammation
swelling
```
hx of IC drug use, HIV and penetrating injuries
acute osteomyelitis
50
management of osteomyelitis
high dose antibiotics - flucloxacillin
51
screening of choice for osteomyelitis
MRI
52
acute hot swollen and erythematous swelling of joint
tender
restricted ROM
systemically unwell with a fever
septic arthritis
53
diagnosis of septic arthritis
Aspirate - culture and gram stain
| if prosthetic joint - refer to ortho specialist
54
management of septic arthritis
IV vancomycin
55
```
typically elderly
frail
hx of osteoporosis
pain in groin
shortened and externally rotated leg
unable to bear weight
```
femoral neck fracture
56
Ix for femoral neck fracture
X-ray
MRI
disruption to shenton's line
57
management of femoral neck fracture
intramedullary screws/dynamic hip screws
58
```
major trauma
hip pain
inability to bear weight
obvious deformity
leg shorter
internal rotation
```
hip dislocation
59
Diagnosis of hip dislocation
X-Ray
60
management of hip dislocation
ABCDE approach + analgesia
reduce within 4hrs under GA
long term mx may involve physiotherapy
61
thick cord-like strand forming in the palm of hand
closer to the ring finger
finger 'gets caught on things'
no pain typically
commonly in men, 40-60s
diabetics and smokers often affected
positive tabletop test
dupuytren's contracture
62
management for dupuytren's contracture
monitor in early cases
corticosteroid injection for certain cases
surgery in later stages
63
fracture in the 5th metatarsal joint after punching someone or something
boxer's fracture
64
unable to straighten finger - can lead to avulsion fracture
| often referred to as basketball fracture
mallet finger
65
management of mallet finger
splint & surgery
66
more common in the thumb, middle, or ring finger
initially stiffness and snapping when extending
nodule may be felt at the base of the affected finger
trigger finger
67
management of trigger finger
```
<3months = steroid injection and hand therapy 2-4 weeks
>3months = inject and consider surgical referral
```
68
pain in anatomical snuffbox
| hx of FOOSH
scaphoid fracture
69
Scaphoid fracture diagnosis
normal X-ray
| MRI better
70
Management of scaphoid fracture
immobilise/splint ASAP to avoid risk of AVN
71
dinner fork deformity
dorsal displacement of distal radius
hx of FOOSH
colles fracture
72
management of colles fracture
straighten deformity & immobilise in 6 weeks
73
pain/pins and needles in thumb, index, middle finger
unusually the symptoms may 'ascend' proximally
patient shakes his hand to obtain relief, classically at night
carpal tunnel
74
tests for carpal tunnel
phalen's and tinel's test
| diagnostic = nerve conduction studies
75
management of carpal tunnel
NSAIDs, splints and steroid injections
| surgical decompression
76
discomfort and pain everytime the patient turns wrist, grasps anything or makes fist
Finkelsteins test positive
de Quervain's tenosynovitis
77
management of de Quervain's tenosynovitis
analgesia, splint, steroid injection and surgery
78
opposite to colles fracture but less common
distal radius displaced vetrally
caused by falling on flexed wrists
smiths fracture
79
common in 5yrs and most often from swinging by the arm
usually child will not use the affected arm
distressed only on elbow movement
marked resistance and pain with supination of the forearm
pulled/nursemaid's elbow
80
Ix of pulled/nursemaid's elbow
X-ray
81
management of nursemaid's/pulled
reduction and mobilisation
82
point tenderness on the lateral aspect of the elbow
lateral epicondylitis
83
point tenderness on the medial aspect of the elbow
medial epicondylitis
84
epicondylitis management
Rest, physio and NSAIDs
85
shoulder pain
painful arc abduction from 60-120°
tenderness over anterior acromion
sub-acromial impingement
86
other rotator cuff injuries
calcific tendonitis
rotator cuff tears
rotator cuff arthropathy
87
most commonly after FOOSH
affected arm externally rotated and close to body
loss of round and greater fullness
anterior dislocation of shoulder
88
which nerve should be checked in anterior dislocation
axillary nerve - sensation of deltoid checked
89
usually due to seizures of electrocution
affected arm medially rotated and locked
shoulder looks flat
swollen
prominent coracoid process
Posterior dislocation of shoulder
90
management of shoulder dislocations
check neurovascular status before and after and do a closed reduction.
91
slow progressive passive loss of ROM of shoulder joint
affects adls
severe stiffness in shoulder
+ve coracoid pain test
can be a complication of shoulder injury/surgery
more common in women compared to men, typically in 40-70yr olds
RFs = DM, thyroid disease
adhesive capsulitis (aka frozen capsulitis)
92
management of adhesive capsulitis
first line = NSAIDS and physio
| second line = IA steroid injection
93
back pain red flags
```
significant injury/trauma
bowel or bladder incontinence
history of metastatic cancer
major neuro deficit
saddle anaesthesia
suspected spinal infection
```
94
management of back pain
patient ed, NSAIDs, paracetamol, muscle relaxants
| avoid bed rest, most cases resolve
95
insidious morning stiffness
relieved by exercise
positive schober's test - <5cm increase
typically in young (~25), caucasian male, HLA-B27
ankylosing spondylitis
96
Ix for ankylosing spondylitis
sacroiliitis, squaring of lumbar vertebrae, 'bamboo spine'
syndesmophytes
CXR = apical fibrosis
97
saddle anaesthesia/paresthesia
recent onset of bladder or faecal incontinence
progressive/severe neurodeficit in the lower limbs
cauda equina
98
Ix for cauda equina
immediate MRI
99
management for cauda equine
Urgent surgical decompression
100
what is compressed in cauda equina
nerves L1-S5
101
management for ankylosing spondylitis
NSAIDs and regular exercise & physio
| DMARDs - peripheral joint involvement
102
groin pain radiating to the leg
pain despite analgesia
RFs = alcoholism, steroid/chemo and sickle cell anaemia
avascular necrosis in the hip
103
AVN in hip Ix
MRI and orthopaedic referral for 6 weeks of pain with normal X-rays
104
management of AVN in hip
hip replacement
105
limp, externally rotated leg
knee pain
groin pain
restricted ROM
typically boys aged 10-17, obese and hypogonadism
Slipped Capped femoral epiphysis (SCFE)
106
Ix for SCFE
X-ray
107
management for SCFE
surgical fixation with screws
| done on both side prophylactically
108
```
painless limp
complains of hip and knee pain
sometimes painful after activity but relieved by rest
reduced ROM
typically presents unilaterally
```
legg calve perthes
109
legg calves perthes Ix
X-rays - AP and frog leg views
110
management of legg calves perthes
cast/braces
<6yrs - observe
>6yrs - surgically manage
111
localised pinpoint tenderness on the outside of the hip (laterally)
pain on movement
moves down the thigh
pain on palpating the greater trochanter
typically on women aged 50-70yrs
trochanteric bursitis
112
management of trochanteric bursitis
exercises
| steroid injection into the affected site/bursa
113
```
insidious back pain
bilateral leg pain
better when leaning forward
relieved lying supine
paresthesia on ambulation - worse standing /walking
```
spinal stenosis
114
Ix for spinal stenosis
MRI scanning
115
management of spinal stenosis
laminectomy (surgery in which a surgeon removes part or all of the vertebral bone (lamina)).
116
kyphosis
hunchback - usually seen in osteoporotic/elderly
117
scoliosis
the spine twists and curves to the side
118
lordosis
usually seen in pregnancy - spine protrudes forwards
119
management of spinal deformities
dependent on the degree of curvature - <20° = exercise and monitoring
21-45° = exercise and monitoring
>45 = surgery
120
hypermobile patella with significant crepitus
pain aggravated by deep bending
typically >50 years and overweight
chondromalacia patella
| loss of cartilage under the patella
121
Ix for chondromalacia patella
bone on bone patella and femur
122
```
twisting injuries
transient locking of knee
severe knee pain
knee effusion/swelling
knee giving way
```
meniscal injuries
123
special tests for meniscal injury
McMurray and Apley
| MRI definitive
124
management of meniscal injury
conservative management = ICE, analgesia, physio and rest
| If torn = open or arthroscopic surgery
125
loss of anterior or posterior stability
swollen and painful knee
audible 'pop' at the time of injury
instability on ambulation
anterior is usually more common
positive draw tests
cruciate injury
126
ortolani test = characteristic clunk that is felt as the femoral head slides over the posterior rim of the acetabulum and is reduced.
barlow test = mild adduction and applying a slight forward pressure with the thumb. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, again producing a palpable sensation of subluxation or dislocation.
RF = fist born girls, breech baby, oligohydromnios, L>R hip and a family history
developmental hip dysplasia
127
diagnosis of developmental hip dysplasia
```
<6months = ultrasound
>6months = X-ray
```
128
management of developmental hip dysplasia
observe and consider splinting
| if hip dislocated = reduce and then splint
129
pain and swelling over the tibial tuberosity
point tenderness
pain usually aggravated by loaded knee extension
typically in growing teenagers aged 10-14years
usually active/play football
osgood sclater
| tibial tuberosity opophysitis
130
management of osgood sclater
modification of exercises, physio and NSAIDs
131
recent trauma + ankle pain and swelling
inability to bear weight
swollen malleolus
tender on palpation
ankle fractures
132
what rules are used to decide is X-ray is indicated in ankle injuries
bony tenderness on either to medial or lateral malleolus
| unable to bear weight for 4 steps
133
management for ankle fractures
open fracture = surgical fixation
| closed fracture = reduce and splint
134
swelling, bruising and pain after injury around an ankle
| ottawa rules don't apply
ankle sprain/strain
135
Investigation for ankle sprain/strain
no fracture seen on X-ray
| MRI/US = better for soft tissue
136
heel pain with a gradual onset - worse following activity
morning pain and stiffness common
RFs = quinolone use & hypercholesterolemia
Aschilles tendinitis
137
management of achilles tendinitis
simple analgesia, calf, muscle eccentric exercises
138
audible pop in the ankle with sudden onset of significant pain
uanble to tiptoe
positive simmons test/thompson's test
absence plantar reflec on calf squeeze
achilles tendon rupture
139
stabbing heel pain and on pressure point under foot
most painful in the first few steps in the mornign
typically in runners and also in obese, aged 40-60yrs
plantar fascitis
140
plantar fascitis management
heel padding, insoles, exercises
physiotherapy
NSAIDs
141
pain between the 3rd and 4th toes
described to be like walking on a marble
elicit pain by squeezing toes from the side
palpate web space
more common in women more than men
mortons neuroma
142
```
rocker foot deformity
swelling
pain
redness
altered shape in the foot
```
hx of severe peripheral neuropathy = diabetes, peripheral
charcot's joint
143
```
unilateral leg pain
back pain
leg pain > back pain
usually radiates to foot/toes
worse on sitting down
numbness and paresthesia
```
herniated nucleus pulposus
144
Ix for herniated nucleus pulposus
MRI
