MSK Flashcards
1
Q
Discuss pelvic girdle pain
-Definition
-Incidence
-Clinical features (4)
-Aetiology (4)
-Risk factors (5)
A
- Definition
-Pain in the pelvic girdle commonly affecting the sacroilliac joints or the symphsis pubis - Incidence
-1:5 pregnant women - Clinical features
-Onset 14-20 weeks
-Pain in pelvic area with radiation to thighs, lower back, groin and knees
-Pain worse with movement and resolves with rest
-Grinding or clicking sensation on movement - Aetiology
-Relaxin and progesterone increase ligamentous laxitiy and pelvic instability
-Shift from maternal centre of gravity with compensatory lumbar lordosis
-Genetics
-Previous pelvic trauma - Risk factors
-Previous back or pelvic pain
-History of back or pelvic trauma
-Multiparity
-High BMI
-Physically demanding job
2
Q
Discuss the diagnosis of pelvic girdle pain
-Role of imaging
-Pain provocation tests (5)
A
- Diagnosis is based mainly of history
- Imaging with MRI of the pelvis adds nothing unless other causes for pain are suspected
- Pain provocation tests include
-Patrick’s flexion - hip flexed and external rotation
Menell’s test - straight leg with 30 abduction and pushing and pull leg away from pelvis
-Posterior pain pelvic provocation test - flex hip and knee and apply force along axis of femur
-Palpate SP and if pain continues = positive
-Modified Trendelenburg test - stand on one leg with hip and knee flexed
-Straight leg raise - give idea of degree of disability associated with pelvic girdle pain
3
Q
How should pelvic girdle pain be managed (11 points)
A
- MDT with PT, MW, Obstetrician
- Review for red flags and consider imaging +/- ref to ortho
- Manage pain
-Simple analgesia - paracetamol +/- codeine
-Heat or ice packs
-Rest +/- LMWH or TEDS - Advice about movement/modification of activties
- Pelvic girdle support braces
- Hydrotherapy
- Exercises to increase gluteal, adductor abdo and pelvic muscles
- Walking frames or crutches may be required
- Reassurance
- No contra-indication to vaginal birth but consider positioning and avoid over abduction of hips
- IOL or CS not indicated for PGP
4
Q
What is the prognosis of pelvic girdle pain (3)
A
- Resolution varies from instantly to months
- 95% of women have resolution by 3 months
- Recurrence of symptoms in subsequent pregnancies 65-85%
5
Q
Discuss scoliosis in pregnancy
-Effect of scoliosis on pregnancy (3)
-Effect of pregnancy on scoliosis (5)
-Management (4)
A
- Effect of scoliosis on pregnancy
-Increased pelvic girdle pain
-IUGR
-PTD - Effect of pregnancy on scoliosis
-In untreated scoliosis 1-2 pregnancies do not increase curve progression
-If unstable curvature can worsen in pregnancy
-Worsening of cardiorespiratory function
-Maternal mortality and morbidity are directly linked to level of respiratory compromise
-Worsening of breathlessness - Management - MDT based
-Ref for anaesthetic review
-Ref for respiratory function
-Ref for cardiac function
-Aim for vaginal delivery. CS only for obstetric grounds