MSK

Question 1

What are some red flags that would indicate an urgent referral for shoulder pain?

Answer 1

1. Trauma, pain, weakness (acute rotator cuff tear)
2. Mass or swelling (tumour)
3. Red skin, fever/systemically unwell (infection)
4. Loss of rotation and abnormal shape (unreduced dislocation)

Question 2

High arc pain around 140-170 degrees of shoulder elevation indicates pathology of which joint?

Answer 2

Acromioclavicular joint

Question 3

What is a positive cross arm test?

Answer 3

This is when pain is felt in the acromioclavicular joint when the arm is pulled across the body- this indicates AC joint disease

Question 4

What are lateral and medial epicondylitis also known as?

Answer 4

Lateral (tennis elbow)

Medial (golfers elbow)

Question 5

What is the Mills test?

Answer 5

The Mills test helps to diagnose tennis elbow (lateral epicondylitis), while palpating the lateral epicondyle fully flex the wrist, pronate their forearm while their elbow is extended. Pain over lateral epicondyle is positive result

Question 6

What is the Cozen’s test?

Answer 6

Test for tennis elbow. Patients elbow is extended, forearm pronated and wrist abducted radially with hand in a fist. Resisted extension of wrist gives pain in lateral epicondyle

Question 7

What is the management of tennis/golfers elbow?

Answer 7

Apply heat/ice, activity restriction, rehabilitation exercises, forearm strap/brace, analgesia, topical NSAIDs, steroid injection

Question 8

What are some features of axillary nerve palsy?

Answer 8

Loss of sensation over lateral deltoid region, deltoid muscle weakness, biceps and brachialis weakness (loss of shoulder abduction and elbow flexion)

Question 9

What is a typical presentation of adhesive capsulitis?

Answer 9

Gradually progressive stiffness and pain on movement of shoulder joint associated with a significant reduction in the range of active and passive movement. Age 40-60

Question 10

The empty can test in a shoulder examination is used to assess which tendon?

Answer 10

Supraspinatus tendon

Question 11

What features of joint pain would make it more likely that it has a non-inflammatory cause?

Answer 11

• pain after use/at end of the day
• morning stiffness for <30 minutes
• no systemic symptoms
• chronic symptoms

Question 12

What features of joint pain would make it more likely to have an inflammatory cause?

Answer 12

• pain worse in morning/after rest
• morning stiffness for >30 minutes
• systemic symptoms
• acute/subacute presentation

Question 13

How can synovitis feel on examination of the elbow?

Answer 13

A fullness between the olecranon and lateral epicondyle

Question 14

Loss of external rotation on shoulder examination can indicate what?

Answer 14

Adhesive capsulitis or other glenohumeral joint problems