MSK Flashcards
what are important aspects take in an MSK hx?
- severity of sx and impact on ADL’s, mobility, work and social roles
- distinguish inflammatory and non inflammatory causes of joint pain
- mechanical sx - locking
- previous problems - cancer, psoriasis, recurrent conditions such as gout
- family hx of MSK conditions
- occupational triggers like repetitive movements, lifting, posture
gout hx
acute attacks, starting in middle of night, excruciating and respond well to NSAIDS
inflammatory v non inflammatory hx
inflammatory such as RA- prolonged early morning stiffness>30mins, exacerbated by activity, often present at rest and varies. flares up and settles down, tenderness
non inflammatory such as OA- pain more than stiffness, the more you do the worse it gets and releived by rest
what are the common patterns of joint involvement?
monoarticular - only joint - septic arthritis
pauciarthritis/oligo - few - psoriatic arthritis
polyarticular - many - RA
axial - spine - ankylosing spondylitis
what is a screening tool using as part of investigating an MSK hx?
GALS - gait, arms, legs, spine
1. do you have any pain or stiffness in the muscles, joints or back?
2. do you dress yourself completely without any difficulty?
3. can you walk up and down stairs without any difficulty
examination - GAIT- symmetry, turning quickly then any muscle bulk - shoulder/trapezius, striaght spine, iliac crest level, gluteal muscle bulk, popliteal swelling, hindfoot defomity - posterior
then SPINE- cervical lordosis, thoracic kyphosis, lumbar lordosis - lateral
bend forward and touch toes and hold lumbar spine and two fingers apart should come together
ARMS
symmetry, pectoralis, in anatomical position (elbow extension), cervical lateral flexion, TMPJ pain (OA - open jaw), hands up behind head, elbows back, elbows in and turn hands over, hands - skin or joint changes, muscle bulk in hands, make fist and open, touch each finger together, grip strength test, MCPJ squeeze
LEGS
knee flexion, hip flexion, internal rotation, patellar tap, soles of feet, MTPJ squeeze
define synovitis
inflammation of a synovial membrane
can be a feature of arthritis in active inflammation
causes - RA, gout and sometimes OA
define stiffness and its significance
slowness or difficulty moving one or more joints
early mor ning - difficulty getting out of bed or staying in one position
indicator of inflammation
>30 mins - RA
reduction in passive v active movements
passive - joint itself - deformity, foreign body, inflammation, contracture
active - muscles and tendons
what is bursitis and how would you differentiate this from a knee effusion?
swelling localised to bursa
veruss
moved across - bulge test
what causes of hip pain would tend to produce pain in anterior, lateral and posterior hip area?
anterior to groin - true (OA)
lateral in hip - trochanteric bursitis
posterior - lumbar sacral or gluteal muscles
what are the clinical fx of plantar fasciitis and metatarsalgia? in aetatarsalgia what would make you suspect a morton’s neuroma?
plantar fasciitis - pain at insertion of plantar fascia into calcaneum, lot of time on feet, worst at firs time in morning and then at end of day
metatarsalgia - pain in mid foot and has lots of causes
mortons neuroma - tenderness in inter digital space where neuroma is located
clinical fx of gout
usually affects big toe
recurrent
rapud onset severe
marked swelling
what fx in hx identify radicular back pain?
irritation or impingement of nerve root
felt in dermatomal region area supplied by foot
eg: sciatica (commonest pattern) - radiates to buttock and psoteriro leg when sciatic nerve stretched
pain is shooting or numb in nature
other neurological sx - weakness, ankle hyporeflexia
what is the painful arc?
mid range 45-120 degrees of abduction of shoulder
impingement - catching of rotator cuff tendons or shoulder bursae in sub acromial space
besides shoulder pathology, what other problems present in one or both shoulders?
referred pain from neck - cervical spine radiculopathy
cardiac problems - MI, angina
lung - pancoast
diaphragmaitc pain - right shoulder pain from hepatomegaly
polymyalgia rheumatica - b/l
