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MSK Flashcards

1
Q

what are the signs adn symptoms of achilles tendinopathy?

A
  • pain aggravated by acitvity or pressure to area
  • stiffness in the tendon after rest
  • crepitus, thickening, nodularity
  • pain worsens with passive dorsiflexion
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2
Q

what is the difference between mid portion and insertion tendinopathy?

A
  • gradual onset pain 2-6cm prximal to achilles tendon insertion - mid portion
  • pain and swelling in insertion to posterior calcaneus - insertional tendinopathy
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3
Q

how do you investigate fro achilles tendinopathy?

A

US or MRI - by referral

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4
Q

what are teh risk factors for achilles tendinopathy?

A
  • diabetes mellitus
  • dyslipidaemia
  • fluoroquinolone use
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5
Q

when woudl you suspect an achilles rupture?

A
  • sudden pain in back of leg asociated with audible snap (1/3 dont experience pain)
  • aching of calf, swelling, mild burising and weakness when pushing off affected foot
  • difficulty weight bearing
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6
Q

what is the improtant test used to test fro achilles tendon rupture?

A
  • Simmonds triad (angle of declination, palpation and calf squeeze test)
    pt. lies prone with feet hanging off edge of bed
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7
Q

how do you manage an achilles tendon rupture in primary care?

A

admission or same day referral to ortho

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8
Q

how do you manage achilles tendinopathy in primary care?

A
  • manage underlying causes (fluoroquinolone use, hypercholesterolaemia, diabetes)
  • ice packs apples to ease symptoms
  • paracetamol for pain relief
  • rest / reduce amount of exercise
  • weight bear as tolerated
  • if sympotms dontimrpvoe within 7-10 days refer to physio
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9
Q

what is a sprain?

A

stretch or teat of a ligament

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10
Q

what is a strain?

A

stretch and or tear of a muscle fibre or tendon

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11
Q

what are teh symptoms of a sprain?

A

pain, tenderness ,swelling, bruising, pain on weight bearing, decreased function, joint instability

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12
Q

what are the symptoms of a strain?

A

muscle pain, cramping, spasm, muscle weakness, inflammation, bruising

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13
Q

how do you manage a sprain or strain in primary care?

A
  • pain relief
  • PRICE
  • advice on safe return to sport
  • review after 5-7 days to see if improved
  • if ongoing symptoms: physio referral
    if worsenign/worrying symptoms: ortho referrral
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14
Q

what are the signs and symptoms of tennis elbow?

A
  • insidious onset that may follow injury or increased levels of activity
  • pain in lateral epicondyle of dominant arm with radiation down extensor aspect of forearm
  • grip weakness
  • localised point tenderness on palpation
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15
Q

what is the managment of tennis elbow?

A
  • apply hear or ice to help relieve pain
  • rest arm, avoid tasks that invovle high force
  • pain relief
  • if no improvment after 6 wks consider alternative diagnosis or consider referring to physio
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16
Q

what are the clinical features of raynauds?

A

demarcated pallor of the digits, followed by another colours (erythema or cyanosis)
sympotms precipitated by cold
may have parasthesia on rewarming
other extremities may be affected

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17
Q

waht is secondary raynauds?

A

occurs in association with an underlying condition (often connective tissue disorder that reduces blood flow to extremities)
= digital ulcers, gangrene, severe ischaemia, episodes are intense + painful, abnormal nail fold capillaries

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18
Q

what investigatiosn woudl you arrange if you suspected a pt. had raynauds?

A

FBC, ESR, ANA

other tests is suspect underlying cuase

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19
Q

how do you manage a pt. with raynauds in primary care?

A
  • refer to rheum if <12yo or suspected secondary raynauds
  • keep whole body warm
  • stop smoking
  • reduce stress
  • exercise regularly
  • trial of nifedipine as prophylaxis if no else works
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20
Q

what are the clinical features of plantar fasciitis?

A
  • insidious onset heel pain
  • intesne heel pain after period of rest
  • pain reduces w moderate acitivty, but worsens after long periods of standing/walking
  • tenderness on palpation of plantar heel area
  • limited dorsiflexion range
  • tightness of achilles tendon
  • antalagic gait
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21
Q

what is the management of plantar fasciitis?

A
  • most ppl make a complete recovery within a year
  • rest foot
  • wear shoes with good arch support
  • cosnider purchasing insoles and heel pads
  • lose weight
  • analgesics
  • icepack
  • self -physio stretches
  • if v serious: consider corticosteroid injeciton into plantar fascia
  • after few monhts of self care and self physio then refer to podiatrist or physio
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22
Q

what are the clinical features of RA

A
  • symmetrical synovitis of small joints of hands and feet, most commonly
  • pain (worse at rest)
  • swelling
  • heat
  • stiffness (worse in mornings fro ~1 hour)
  • rhuematoid nodules, swan neck deformity, extra-articualr features, systemic features, FHx
  • positive metocarpophalangeal squeeze test
  • DIPJS SPARED !
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23
Q

what investigatios are done when RA is suspected?

A

clinical diagnosis! in primary care
can offer blood test for rheumatoid factor, anti-CCP
ESR, CRP
x -ray to determine disease severity or possibly MRI

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24
Q

management of suspected RA in primary care?

A
  • refer urgently (wihtin 3 working days) if any of the following:
  • small joints of hands and feet affects
  • more than one joint affected
  • > 3 months of symptoms
  • consider offering low dose NSAID - ibuprofen/naproxen
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25
Q

what treatment is given in secondary care to patients with RA?

A
    1. DMARDs -methotrexate, sulfasalazine
    1. hydroxychloroquine
    1. glucocorticoids (short term bridging treatment until DMARD takes effect)
    1. biological DMARDs (infliximab, rituximab)
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26
Q

how shoudl RA flares be managed in primary care

A
  • intraarticular glucocorticoid injection for localised flare
  • IM glucocorticoid injection
  • oral glucocorticoid (14 days)
  • consider NSAID fro short time
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27
Q

what is olecranon bursitis?

A

olecranon bursa is a sac overlying the olecranon process of elbow
the bursa can become irritated and infalmed = bursitis ( septic or non septic )

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28
Q

what are the clinical features of olecranon bursitis

A
  • swelling over olecranon process
  • tender or warm
  • fluctuant (movable and compressible)
  • when elbow is in full felxion swollen bursa = compressed = pain

septic bursitis = systemic symptoms

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29
Q

when would you aspirate bursal fluid from a bursa?

A

septic bursitis or to rule out infection in persistent cases of aseptic bursitis
- sample for microscopy and gram staining

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30
Q

how shoudl you manage bursitis?

A

response to conservative treatment:

  • rest, ice, reduec activity
  • avoid trauma/direct pressure
  • compressive bandaging
  • analgesia for pain relief
  • consider aspiration if effusion is large
  • if no response to conservative or aspiration then corticosteroid injection
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31
Q

how shoudl you manage septic bursitis?

A

aspirate bursal fluid

fluclox 7 days 500mg QID

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32
Q

what are the signs and symptoms of pre patellar bursitis?

A
  • pain, swelling (warm, tender, fluctuant) and redness of knee
  • difficulty kneeling or walking
  • fever
  • history of trauma or repettive prolonged kneeling
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33
Q

what is a bakers cyst?

A

distension of teh gastrocnemius - semimembranosus bursa behind the knee

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34
Q

what can cause bakers cysts?

A
  • trauma, local irritation (chidlren)

- OA, inflammatory arthropathies, meniscal teas, ACL damage (adults )

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35
Q

what are teh clinical features of a bakers cyst?

A
  • asymptomatic swelling behind knee
  • pain
  • aggravated by walking
  • tightness behind knee
  • lump is round, smooth and fluctuant, tender
  • cyst may feel tense in full extension and soften/disappear in flexion
  • ROM may be restricted
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36
Q

what investigations need to be arranged when bakers cysts are suspected?

A
  • US scan to confirm

- MRI is suspect meniscal tear as well

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37
Q

in children, how is a bakers cyst managed?

A
  • admit to peads or A+E fro urgnet assessment

- if not underlyign disease and confirmed on US then reassure that will resolve without treatment

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38
Q

in adults, how is a bakers cysts managed?

A

identify and manage underlying condition if one
if asymptomatic: no treatment
if symptomatic: analgesia, refer to rehumatologist or ortho surgeon (aspirate or corticosteroid injection or athroscopy)

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39
Q

what are the clinical features of gout?

A
  • arthritis: swelling, redness, warmth, pain

- tophi (firm, white nodules) - develop over 10 years after first attack

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40
Q

what are some risk factors of gout?

A
  • alcohol intake,
  • dietary intakes (red meat,seafood, fructose)
  • drugs
  • FHx
  • associated co morbidity e.g. obesity, HTN, hyperlipideami, diabetes
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41
Q

what ivnestigatiosn are doen when gout is suspected?

A

diagnosis doesnt usualy need investigations but if in doubt:
joint fluid microscopy and culture - see urate crystals
serum uric acid measures after acute attack
joint xray - normal

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42
Q

when woudl you suspect septic arthritis over gotu -

A

if patient is systemically unwell e.g. fever then suspect septic

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43
Q

what is the managemnt of acute gout?

A
  1. selfcare: rest, ice, elevate, avoid trauma
  2. pharm: NSAID (+PPI) or oral colchicine
    possible joint aspirationa dn intra articular croticosteroids

^^ if noen of above possibel then consider oral or IM corticosteroids

+paracetamol

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44
Q

what follow up is recommended ater an acute attack of gout?

A
  • after 4-6 wks:

check serum uric acid elvel
measure BP, HbA1c, renal function and lipid profile
manage any underlying conditions
provide adivce on smoking, alcohol, obesity, exercise, diet
discuss use of ULT

45
Q

what treatment is recommended to prevent gout attacks?

A
  • ULT: allopurinol or febuxostat as 2nd line
  • consider prescribing colchicine (or NSAID) when initating or increasing the dose oF A ULT as prophylaxis (as initially can increase amout of gout attacks)

must check SUA and renal function regularly + CVS risk factors review annually

46
Q

what are teh symptoms of leg cramps?

A
  • sudden intense calf or foot pain most often at night
  • visible or palpable knotting or tightening of muscle
  • seconds - 10 mins
  • single muscle invovlenbt
  • good response to strecthing
47
Q

name some differential diagnoses for leg cramps?

A
  • dystonia
  • myoclonus
  • exercise associated muscle cramping
  • peripheral neuropathy
  • claudication
  • myalgia and myositis
  • restless legs syndrome
  • DVT
  • bakers cysts
  • periodic limb movement disorder
48
Q

what self care advice shoudl you give someone with leg cramps?

A
  • adivse strecthing and massaging to alleviate attack
  • stretch often and stop pointing toes downwards when sleeping
  • online info nhs
  • consider analgesia if muscle tender
49
Q

what medication could possibly be given for leg cramps?

A
  • quinine, although not generally used for idiopathic leg cramps
    trial can be done if not underlying cuases and leg crmaps are severe

prescribe 200-300mg for 4 weeks

50
Q

what are teh signs and symptoms of carpal tunnel syndrome?

A
  • intermittent parasthesia
  • burnign or pain in median nerve distribution
  • symptoms worse at nigth
  • may radiate up wrist. arm
  • loss of grip strenght, reduced manual dexterity,
  • wasting of thenar eminence
  • weakness of muscles supplied by median nerve
51
Q

how do you diagnose carpel tunnel syndrome?

A
  • correct clinical features
  • positive tinels and phalens test
  • examination of upper limb: median sensory loss and muscle weakness in hand
52
Q

how do you manage a patient with carpal tunnel syndrome?

A

lifestyle: avoid repetitive hand/wrist movements

6 week of any:

  1. wrist splint at night
  2. singel corticosteroid injection
  3. hand exercises and median nerve mobilisation techniques

if dont work: refer to rheum, ortho surgeon, hand surgeon = carpal tunnel surgery

53
Q

what clinical features would lead you to suspect temperomandibular disorder?

A
  • pain around TMJ and/or muslces of mastication, may radiate (pain provoked by palpation or jaw movement)
  • joint noise of TMK - clicking, popping, crepitus
  • headache of temporal region
  • otalgia and/or tinnitus
54
Q

what are the different types of temporomandibular disorders?

A
  • myalgia/myofascial pain
  • TMJ disc displacemnt with reduction
  • TMJ disc displacement wihtout reduction (closed lock)
  • degenerative joint disease
  • sublaxation
  • arthralgia
  • headache attribuable to TMD
55
Q

name some red flags for TMJ pain?

A
  • previous malignnayc or unexplained fever/weight loss
  • persistent or unexplained neck lump or cervical lymphadenopathy
  • persistent/worsening pain
  • concurrent infection
  • Hx of recent head or neck trauma
  • facial asymmetry/swelling/mass
  • neuro symptoms
  • ## GCS symptoms (unilater headahce, scalp enderness, jaw claudication and malaise)
56
Q

how do you manage a person with suspected TMD?

A
  • soft diet, rest jaw
  • avoid anythign that woudl exacerbate e.g. chewing gum
  • ice/heat pad
  • paracetamol or ibuprofen
  • consider short course low dose benzo e/g/ diazepam 2mg OR amitriptyline/gabapentin
  • consider physio or dentist referral
57
Q

when would you refer a patient to oral medicien or maxillofacial?

A
  • persisent or worsening symptoms for 3 months
  • severe pain and dysfunction
  • Hx trauma to TMJ
  • closed lock jaw
  • recurrent dislocation of TMJ
58
Q

what are teh secondary care managment options

A
  • botulinum toxin injection into masseter and temporalis
  • intraarticular injection by sodium hyaluronate or corticosteroid preparations
  • surgeries: athrocentesis or arthroscopy, athroplasty for severe, eminectomy/eminoplasty fro recurrent dislocation
  • total prosthetic TMJ replacemnt for end stage degenrative disease
59
Q

what is cervical radiculopathy?

A

pain and weakness/numbness in one of both upper extremities which corresponds to the dermatome of theinvolved cervical nerve root

60
Q

what are the most common cuases of cervical radiculopathy?

A

degenerative changes
cervical disc herniation
spondylosis
trauma

61
Q

what are teh symptoms of cervical radiculopathy?

A
  • pain in neck, shoulder or arm that approximates to dermatome
  • usually unilateral
  • absent/altered sensation
  • motor weakness
  • gradual onset

*most common nerve root affected - C7 followed by C6

62
Q

what are the signs of cervical radiculopathy

A
  • postural asymmetry (head tilted to one side or flexed)
  • neck movemnts = restricted or sharp pain
  • dural irritation - assess with spurlings test
  • neurological problems
63
Q

what is the management for cervical radiculopathy?

A

if present for less than 4-6 weeks and no neuro signs:

  • reassurance as can improve without surgery long term
  • encourage activity
  • advice firm pillow at night
  • analgesics (paracetamol, ibuprofen, codeine)
  • consider prescriving muscle relaxants
  • consider prescribing amitriptyline
64
Q

if cervical radiculopathy is present for more than 4-6 weeks, what is the management?

A
  • confirm diagnosis with MRI
  • indications for surgery: signs and symptoms of cervical radiculopathy, unremitting radicular pain despite 6-12 wks of conservative treatments , or progressive motor weakness, + MRI that shows nerve root compression
65
Q

what are the clinical features that would point you towards and diagnosis with OA?

A

age > 45 yo

  • acitvity related joint pain (gradual development)
  • bony swelling and joint deformity
  • joint effusions
  • joint warmth or tenderness
  • muscle wasting and weakness
  • restricted ROM, crepitus, joint instability
  • herberden and bouchards nodules in hands
  • trendelenburg gait in hip
66
Q

what is the main diagnostic test for OA?

A

X-ray (usually onyl needed to 100% confirm - mostly can tell from clinical features)

67
Q

how do you initially manage a patient with OA?

A
  • weight loss, local muscle strenghening exercises, appropriate footwear, ice packs,
  • analgesia for symptom relief (paracetamol, ibuprofen, codeine)
68
Q

when would you refer a patietn with OA to a physio?

A
  • fro advice on local muscle strengthening exercises
  • fro additional manipulation and stretching
  • for provision of joint supports, splints, braces
  • intra articular corticosteroid injections
69
Q

when would you refer a patient with OA to a ortho surgeon?

A
  • symptoms of joint pain, stiffness and functions impairmnet
  • significant impact of QOL
  • uncertianty abotu diagnosis or atypical symptoms
  • sudden worsenign of symptoms
70
Q

what are the signs and symptoms of sciatica?

A
  • unialteral leg pain radiating below the knee to foot or toes
  • low back pain
  • numbness, tingling in dermatomal distribution
  • weakness or reflex changes in myotomal distribution
  • positive result in striaghth leg raise test (pain at 60 degrees)
71
Q

what investgiations may you do to rule out other cuases of back pain? (if a patient is suected on sciatica)

A
  • FBC
  • ESR
  • CRP
  • blood vultures
  • urinalysis
72
Q

what are the sciatica red flag symtpoms and signs?

A
  • bowel/bladder dysfunction
  • progressive neuro wekaness
  • saddel anaesthesia
  • bialteral radiculopathy
  • incapacitiating pain
  • unrelenting night pain
  • use of steroids or IV drugs

*any signs of cauda equina, spinal fracture, cancer or infection

73
Q

how do you manage a patient with sciatica?

A
  • self management: carry on normal activity, local heat
  • offer analgesia
  • DO NOT offer opiods, gabapentinoids, antiepileptics, oral corticoseorids, benzos
74
Q

when woudl you refer a patient who has sciatica with no red flags ?

A
  • sevre radicualr pain at 2-6 wks
  • acute and severe sciatica
  • non tolerable radicular pain at 6 weeks
  • sciatica when non surgical treatment has not improved pain or function
75
Q

what is ankylosing spondylitis?

A

ankylosing spondylitis is axial spondyloarthritis characterised by sacroilitis on x-ray
it is an inflammator rhuematological condition

76
Q

what are the clinical features of ankylosing spondylitis?

A

age < 45 yo

  • chronic or recurrent low back pain present for >3 months
  • fatigue
  • stiffness
  • pain and stiffness worse in mornings + imrpoving w movement
  • symptoms wake them at nigth
  • buttock, thoracic or cervical spine pain
  • arthritis
  • anterior uveitis
  • psoriasis or IBD
  • symptoms respond to NSAIDs
77
Q

what investigatiosn/referrals do you do in primary care for a patient who may have ankylosing spondylitis?

A
  • ESR, CRP
  • X-ray
  • MRI - infalmmation of sacroiliiac joint detected
  • HLA - B27
  • refer to rheumatologist
78
Q

what treatment do you start on a pt. with suspected ankylosing spondylitis while waiting fro referral?

A
  • NSAID - lowest effective dose
79
Q

when shoudl you refer a person with suspected ankylosing spondylitis to rheumatologist?

A

4 or more of following:

  • low back pain starting before 35yo
  • back pain lasting > 3 months
  • symptoms waking them up at nigth
  • buttock pain
  • improvement when moving
  • improvemnt within 48 hrs of taking NSAIDs
  • spondyloarthritis in first degreee relative
  • current or past arthritis
  • current or past enthesitis
  • current or past psoriasis

if 3 present + positive HLA-B27 = refer

80
Q

what are teh drug treatment options for ankylosing spondylitis?

A
  • NSAIDs
  • DMARDs
  • biologic therapies - anti TNF therapies
  • steroid (injections)
81
Q

what is greater trochanteric pain syndrome?

A

regional pain syndrome in which chronic intermittent pain is felt around greater trochanter

  • caused by inflammation or physical trauma in muscles, tendons, fascia or bursae
  • common in women > men and age 40-60
  • frequently seen together with low back pain, OA of knee, RA and fibromyalgia
82
Q

what are the signs and symptoms of greater trochanteric pain syndrome?

A
  • chronic lateral hip/thigh/buttock pain (intermittent or persistent)
  • gradual onset that may progressively worsen
  • pain can radiate down lateral aspect of thigh
  • pain aggravated by physical activity + pressure
83
Q

what is the management of greater trochanteric pain syndrome

A
  • usually self limiting
  • rest
  • apply ice every few hours for 10 mins
  • paracetamol/ibuprofen
  • info on weight loss
  • smokign cessation advice
  • assess needs to walking aids or physio/OT referral
  • consider if all fail: peritrochnateric corticosteroid injection and referral to physio
84
Q

name some risk factors for osteoporosis?

A
  • female sex
  • increasign age
  • menopause
  • oral corticosteroids
  • smoking
  • alcohol
  • previous fragility fracture
  • rheum conditions
  • parental history of hip fracture
  • BMI<18.5
85
Q

how do you assess person for fragility fractue risk?

A
  • dual energy x ray absorptiometry (DXA) scan to measure bone mineral density
  • if have risk factors, calculate fragility frature risk, using online calculator, before ordering DXA scan
  • asses for vit D deficiency and inadequate calcium intake
86
Q

what drug treatments are recommened for people at high risk of osteoporotic fracture

A

(if T score is -2.5 or lower)

  • bisphosphonate (alendronate 10mg once daily in men or risedronate 5mg once daily in postmenopausal women)
  • calcium (need 1000mg daily) plus 10 micrograms prescribed daily (or 20 micrograms if elderly + housebound)
  • consider HRT to younger postmenopausal women
87
Q

what lfiestyle advice shoudl be given to ppl with osteoporosis?

A
  • regualr exercise to improve msucel strength
  • eat balanced diet
  • stop smoking
  • lower alcohol intake
  • provide with online sources + support
88
Q

when shoudl you test/suspect vit D deficiency in an adult?

A
  • MSK symptoms: muscle pain or weakness, and joint pain or bone pain, most often affecting the shoulders, pelvis, ribs, and spine
  • suspected bone disease(osteoamalacia or osteoporosis)
  • known bone disease, where correction of vit D is needed prior to specific treatment
89
Q

when diagnosed vit D deficiency with blood testing, which other investigatiosn may be useful to arrange?

A
  • bone profile (calcium, phosphate, alkaline phosphatase)
  • PTH level
  • FBC
  • TFTs
  • renal and liver function test s
  • coeliac serology
90
Q

treatment of vit D deficiency in adults?

A

(seek specialist if have co morbidities that would be affected by increased calcium)

  • oral vit D3
  • if rapid vit D correction needed (e.g. if have symptoms), start with fixed loading dose (300,000 IU) then maintenance (800-2000 IU daily)
  • if patient has low calcium intake then calcium supplements
91
Q

what lfiestyle advice should be given to adults with vit D deficiency?

A
  • adequate sunlight exposure
  • adequate calcium and vit d intake in diet
  • give sources online for support with diet
92
Q

when would you suspect polymyalgia rhuematica in a patient?

A
  • over 50 yrs old
  • bilateral shoudler and/or pelvic girdle pain - worsened with movement, + may radiate to elbows + knees respectively
  • stiffness lasting for at least 45 mins after waking
  • low grade fever, fatigue, weight loss, depression, capral tunnel syndrome, peripheral arteritis
93
Q

how is polymyalgia rheumatica diagnosed? which criteria

A
  • identifying core features of condition
  • excluding conditions that mimic PMR
  • positive response to oral corticosteroids (trial 15mg prednisolone daily for 1 week)
    (- ESR or CRP - supportive)
94
Q

what differentials are important to exclude when suspecting a diagnosis of polymyalgia rheumatica?

A
  • giant cell arteritis
  • active infection or cancer
  • arthritis
  • thryoid disease
  • statin induced myalgia or myositis
  • bilateral adhesive capsulitis
  • cervical and lumbar spondylosis
95
Q

how do you manage a person for whom a diagnosis of polymyalgia rheumatica has been made?

A
  • reduce the dose of prednisolone slowly when symptoms are fully controlled
  • ensure person is provided with blue steroid card
  • arrange routine reviews every 3 months for first yr follwoing diagnosis
  • provide written info
96
Q

what differentials need to be ruled out when a patient complains of low back pain?

A
  • cauda equina
  • sciatica
  • ankylosing spondylitis
  • osteoporosis
  • cancer of spine
  • spinal fracture / spinal infection
  • gastrointestinal e.g. peptic ulcer
  • genitourinary e.g. kidney stones,
  • shingles
97
Q

what are the red flags for lower back pain?

A
  • infection: fever, TB, diabetes, IV drug user, use of immunosupressants
  • cancer: weight loss, gradual onset, PMHx of cancer, aching night pain, no improvemnt with conservative treatment
  • spinal fracture: sudden onset, trauma, structural deformity, point tenderness over vertebral body
  • cauda equina: perianal or perineal sensory loss, recent onset faecal incontinence or urinary retention, bilateral neuro deficit of legs - motor
98
Q

how do you manage a patient with lower back pain?

A
  • analgesia: ibuprofen or naproxen first line, codeine second line
  • seek follow up if no improvment in 3-4 weeks or worsening
  • consider referral to physio, group exercise programme or CBT
  • keep exercising
  • local heat
99
Q

what are the signs and symptoms of non specific neck pain?

A
  • pain aggravated by particular movements, posture + activities
  • pain radiates in a non segemntal distribution down arm/shoulder/head
  • pain associated with parasthesia but no loss of sensation or muscle strenght
  • positional asymmetry, limite ROM
  • tenderness in intervertebral joints and/or hypertonic muscles
100
Q

name some red flags signs and symptoms of neck pain?

A
  • fever, night sweats, weight loss, n+V, severe headache, photophobia
  • sensory changes/loss, altered muscle tone, gait disturbance, babinski sign, hoffmans sign, bowel/bladder dysfunction
  • altered cognitive state
  • osteroporosis risk factors
  • Hx of TB, inflammatory artheritis, immunosupression, drug abuse, trauma
101
Q

what is the managemnt for non specific neck pain?

A
  • oral analgesics - ibuprofen, paracetamol, codeine
  • consider topical NSAID
  • encourage exercise
  • consider muscles relaxants e.g. diazepam
  • consider referral to physio, psychological therapy, occupational health
  • if neck pain for >12 wks then consider referral to pain clinic if failed to respond to conservative treatment
102
Q

name some differentials for shoulder pain

A
  • rotator cuff disorders
  • frozen shoulder
  • instability disorders
  • acromioclavicular joint disorders
  • glenohumeral joint OA
  • inflammatory arthritis
  • septic arthritis
  • referred pain
  • polymyalgia rheumatica
103
Q

name some red flags for shoulder pain.

A
  • trauma
  • pain and weakness
  • shoulder mass or swelling
  • red skin
  • fever
  • abnormal shape
  • new symptoms of inflammation in several joints
104
Q

how do you manage a person with frozen shoulder?

A
  • frozen shoudler is usually self limiting: symptoms are pain and stiffness
  • maintain movement but avoids movemnts that cause pain
  • take analgesia (paracetomaol then ibuprofen or codeine)
  • hot packs
  • support arm wiht pillow in bed
  • physio referral
  • intraarticular corticosteroid injection
105
Q

how do you manage a patient with a rotator cuff disorder

A
  • rest in acute phase
  • exercise/physio
  • analgesia
  • subacromial corticosteroid injection
  • referral to secondary care
106
Q

how shoudl you manage a person with a an acromioclavicular joint disorder?

A
  • activity modification + avoid heavy lifting
  • offer analgesia
  • consider physio referral
  • consider corticosteroid injection
  • arrange x-ray and ortho referral if no improvement from ^^
107
Q

how do you manage a person with glenohumeral joint OA?

A
  • strenghthenign exercised and consider physio referral
  • weight loss if overweight
  • assisted devices if needed
  • analgesia
  • corticosteroid injection
  • if ^^ dont work the refer to secondary care
108
Q

what is teh step wise strategy for managing mild-moderate pain in >16 yrs?

A

step 1 - paracetamol
step 2 - paracetom subbed with ibuprofen or weak opioid (codeine)
step 3 - paracetamol added to ibuprofen or weak opioid
step 4 - paracetamol continues and ibuprofen replaced with alternative NSAID (e.g. naproxen)
step 5 - weak opioid started in addition to paracetamol and/or NSAID

109
Q

what are the canadian c spine rules?

A
  • > or = 65 yo
  • dangerous mechanism
  • parasthesia in extremities

Y3 GP (10 decks)

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