MSK Flashcards
Difference between strain and sprain
Sprain = injury to ligament
Strain = injury to tendon
Feature of 3rd degree strain
muscle tears all the way through
‘pop’ sensation – muscle rips into 2 or shears away from tendon
Symptoms of ankle sprain/strain
- Swelling
- bruising
- pain after injury
Most common ankle sprain
inversion ankle sprain = where excessive plantar flexion and supination cause the anterior talofibular ligament (ATF) to be affected.
What imaging is used to identify fractures/dislocation?
x-ray
Management of ankle fracture/dislocation
open = surgical fixation
closed = reduce and splint
When is x-ray indicated in ankle fractures?
Clinical exam with Ottawa rules:
X-rays are only necessary if there is pain in the malleolar zone and:
1. Inability to weight bear for 4 steps
2. Tenderness over the distal tibia
3. Bone tenderness over the distal fibula
What is fibromyalgia?
Widespread pain throughout the body with tender points at specific anatomical sites.
Features of fibromyalgia
- Chronic, long term, widespread pain >3months
–> Pain in back and neck, or “all over”
–> Worsened in cold weather, stress, activity, and associated morning stiffness - Additional symptoms: fatigue, trouble sleeping, memory difficulties, mood difficulties
- O/E: diffuse tenderness, with 11/18 tender trigger points (used less and less in practice)
Diagnosis is clinical
Management of fibromyalgia
- Non-Pharm: Education, exercise, CBT
- Pharm 1st line : amitriptyline
–> Pregabalin, duloxetine
Define polymyalgia rheumatica
Inflammatory condition causing pain in the hip and shoulder girdles.
Pain NOT weakness
–> in older people characterised by muscle stiffness and raised inflammatory markers.
Features of polymyalgia rheumatica
- usually rapid onset (e.g. < 1
- aching, morning stiffness in proximal limb muscles
- also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
Investigations for polymyalgia rheumatica
Raised inflammatory markers : ESR > 40 mm/hr, elevated CRP
What symptom is not associated with polymyalgia rheumatica?
weakness
Management of polymyalgia rheumatica
Prednisolone – 15mg/OD
–> Usually dramatically resolves
- Associated Giant Cell Arteritis/Temporal Cell (Rheum Emergency : Vision loss. Must be treated with steroids!)
What is gout?
- Form of inflammatory arthritis
- Uric acid crystal deposition in joint causing episodic acute swelling/pain in joint(s).
- monosodium urate monohydrate in the synovium
Features of gout
- Painful swollen joint - can mimic septic arthritis
- Acute
- Sudden onset of pain lasting 1-2wks
- Spontaneous but may have trigger
- Big toe, ankle joint, finger joints, elbow
- Skin is red and shiny, swollen and hot, tender
- VERY PAINFUL – SHEET CANNOT TOUCH TOE
- May have associated skin findings, Tophi (stone)
- Intermittent attacks of acute joint pain, very tender, red - Typically first presentation is the 1st MTP - PODAGRA
Gold standard for gout
Joint aspiration and crystal analysis.
Negatively birefringent crystals
Other investigations for gout
- Serum uric acid levels- may be raised
- ***PEARL: Patients may have chronic raised uric acid but during an acute attack, uric concentrations may fall and uric acid during a flare is not a good diagnostic test
- Leucocytosis, raised ESR and CRP during acute attack
What are the radiological features for gout?
- joint effusion is an early sign
- well-defined ‘punched-out’ erosions with sclerotic margins in a juxta-articular distribution, often with overhanging edges
- relative preservation of joint space until late disease
- eccentric erosions
- no periarticular osteopenia (in contrast to rheumatoid arthritis)
- soft tissue tophi may be seen
Acute treatment of gout
- Resolves <2wk
- Exclude infection
- Rest, elevate, ice packs
- NSAIDS
- Colchicine 500mcg bd
- Prednisolone
- Steroid joint injection- caution need to be certain of diagnosis (cannot give if infection)
Prophylactic treatment of gout
- Allopurinol – given as a daily medication to prevent frequent attacks
- If attacks occur frequently/ needing regular doses of steroids/NSAIDs/pain medications
- PEARL Never give allopurinol during an acute attack. Will make the acute attack worse
What is pseudogout?
Form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium
Features of pseudogout
- knee, wrist and shoulders most commonly affected
- joint aspiration: weakly-positively birefringent rhomboid-shaped crystals
- Red, hot swollen, episodic attacks.