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MSK Flashcards

1
Q

What is epicondylitis

A

inflammation at the point where the tendons of the forearm insert into the epicondyles at the elbow

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2
Q

What are the 2 epicondyle and what movement are they responsible for

A

medial and lateral epicondyle
medial= flex the wrist
Lateral= extend

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3
Q

Why do you get epicondylitis

A

it is a result of repetitive use and injury to the tendons at the point of insertion

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4
Q

What are the names of the 2 epicondylitis

A

Medial is known as golfers elbow and lateral is known as tennis elbow

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5
Q

What do patient typically present with in golfers elbow

A

they report gradual-onset medial elbow pain exacerbated by activity, particularly flexion of the wrist

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6
Q

Treatment for golfers elbow

A

self-limiting, Rest, physiotherapy, NSAIDS

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7
Q

presentation of tennis elbow

A

pain in outer elbow , the pain often radiates down to forearms

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8
Q

what tests are done for tennis elbow

A

Mill’s test and cozens test

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9
Q

Treatment for tennis elbow

A

self-limiting, Rest, physiotherapy, NSAIDS

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10
Q

What is osgood - schlatter disease

A

it is caused by the inflammation at the tibial tuberosity where the patella ligament inserts. It is a common cause of anterior knee pain in adolescents

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11
Q

is osgood-schlatter more common unilateral or bilateral

A

unilateral

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12
Q

What age group and gender is osgood schlatter disease common in

A

10-15 year olds
male

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13
Q

Pathophysiology of Osgood Schlatter disease

A

The patella tendon inserts into the tibial tuberosity. In patients with osgood-schlatter disease multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially, this lump is tender due to inflammation. As the bone heals and inflammation settles, the lump becomes hard and non-tender.

A hard, non-tender lump is then permanently present at the tibial tuberosity.

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14
Q

Presentation of osgood-schlatter disease(3)

A

presents with a gradual onset of symptoms :
-Visible or palpable hard and tender lump at the tibial tuberosity
- Pain in the anterior aspect of the knee
- pain exacerbated by physical activity, kneeling and on extension of the knee

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15
Q

Management of osgood-schlatter disease

A

Initial management focuses on reducing pain and inflammation.
Reduction in physical activity
Ice
NSAIDS (e.g., ibuprofen) for symptomatic relief

Once symptoms settle, stretching and physiotherapy can be used to strengthen the joint and improve function.

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16
Q

What is fibromyalgia

A

it is a chronic pain syndrome characterised by widespread body pain

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17
Q

presentation of fibromyalgia

A

Widespread body pain
tiredness
other possible symptoms:
- headaches
-IBS
- Bladder issues
-restless leg syndrome
-depression/anxitey
-cognitive impairment
-sleep disturbances

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18
Q

What are the risk factors fibromyalgia

A

FHx
Rheumatological conditions
20-60yrs
female

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19
Q

Treatment options for fibromyalgia

A
  • antidepressants , painkiller
    CBT, counselling
    Lifestyle changes
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20
Q

What is gout

A

type of crystal arthropathy associated with chronically raised uric acid levels

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21
Q

What happens in gout

A

urate crystal are deposited in the joint causing it to become hot, swollen and painful

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22
Q

Name 7 risk factors for gout

A

Male
Obesity
High purine diet (e.g. meat and seafood)
Alcohol
Diuretics
Existing cardiovascular or kidney disease
FHx

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23
Q

Name 3 typical joints where gout occurs

A

base of big toe( metatarsophalangeal joint)
Wrists
Base of thumb ( carpometacarpal joints)

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24
Q

What emergency condition should you exclude if you suspect gout

A

septic arthritis

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25
Q

What will an aspiration fluid show in gout

A

No bacterial growth
needle shaped crystal
Monosodium urate crystals

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26
Q

X-ray finding in gout

A

lytic lesions
punched out erosions

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27
Q

Acute flare management of gout

A

NSAIDs
Colchicine
Steroids

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28
Q

Prophylactic management of gout

A

Allopurinol
Lifestyle changes- losing weight , staying hydrated and minimising alcohol and purine based food

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29
Q

What is polymyalgia rheumatica

A

chronic inflammatory disease characterised by aching and morning stiffness in the neck, shoulder and pelvic girdle

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30
Q

Name 4 risk factors for polymyalgia rheumatica

A

age over 50 years
Prior history of giant cell arteritis
Female
Fhx

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31
Q

Clinical features of polymyalgia rheumatica

A

Pain, stiffness and weakness in the muscles of their neck shoulders , buttocks and hips
symptoms are worse first thing in the morning

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32
Q

What other condition is strongly linked with polymyalgia rheumatica

A

Giant cell arteritis

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33
Q

Clinical examination features of polymyalgia rheumatica

A

proximal muscles tender to touch
active and passive range of motion is limited by pain

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34
Q

what are the 2 lab investigations done in polymyalgia rheumatica and what are their typical findings

A

Full blood count (FBC): normocytic anaemia or thrombocytosis
Inflammatory markers: ESR and CRP are elevated

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35
Q

What are the 3 relevant imaging done in polymyalgia rheumatica

A

ultrasound
MRI
FDU PET

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36
Q

Medical management for Polymyalgia rheumatica

A

Glucocorticoids (e.g. prednisolone)

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37
Q

What is osteoarthritis

A

often described as wear and tear, it is not an inflammatory condition
it is progressive, degenerative joint disorder

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38
Q

name 4 risk factors for osteoarthritis

A

increasing age
female sex
obesity
Less commonly, articular congenital deformities or trauma to the joint

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39
Q

symptoms of osteoarthritis

A

Joint pain
stiffness
limitation in day to day activities

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40
Q

3 typical clinical finding for osteoarthritis

A

Reduced active and passive range of movement
Tenderness over the joint line
Crepitus on movement

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41
Q

Is CRP/ESR normal or abnormal in osteoarthritis

A

normal

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42
Q

What imaging is used for osteoarthritis and what are the findings

A

X-ray
Mnemonic = LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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43
Q

Diagnostic criteria for osteoarthritis

A

more than or equal to 45 year old
Has activity-related joint pain
has either no morning joint0related stiffness or morning stiffness that lasts no longer than 30 min

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44
Q

First line Management for osteoarthritis

A

conservative management

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45
Q

what are the conservative management for osteoarthritis

A

Education and advice about condition
Exercise
weight loss if obese

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46
Q

Medical management for osteoarthritis

A

1st line :NSAIDs
2nd line: Paracetamol and topical analgesia

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47
Q

management for acute exacerbation of osteoarthritis

A

Corticosteroid injections

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48
Q

surgical option for osteoarthritis

A

Joint replacement or fusion of the joint

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49
Q

What is osteoporosis

A

a condition where there is a reduction in the density of the bones

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50
Q

Risk factors for osteoporosis

A

Older age
female
low BMI
Rheumatoid arthritis
Alcohol and smoking
Long term use of corticosteroids
Post-menopausal women

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51
Q

Name of tool used to asses likelihood of a fragility fracture due to osteoprorosis

A

FRAX tool

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52
Q

diagnostic investigation for osteoporosis

A

DEXA scan

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53
Q

T score meanings on DEXA scan for osteoporosis

A

T score = 0, normal bone density. Your bones are as strong as people your sex/age
T score >0, good bone density. Your bones are stronger than people your age/sex
T score between -2.5 and 0, osteopenia
T score <-2.5, osteoporosis

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54
Q

symptoms of osteoporosis

A

ASYMPTOMATIC UNTIL A FRACTURE APPEARS. Osteoporosis does not cause any
pain! It leads to fractures which can cause pain

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55
Q

Treatment for osteoporosis

A

Lifestyle changes
Vitamin D and calcium
Bisphosphonate

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56
Q

Most common shoulder dislocation

A

anterior dislocation

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57
Q

what are posterior dislocations associated with

A

electric shock and seizures

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58
Q

How do patients with anterior shoulder dislocation often present

A

The patient with anterior dislocation keeps the arm at the side of body in external
rotation

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59
Q

How do patients with posterior shoulder dislocation often present

A

Posterior dislocation is diagnosed clinically as the arm is held in medial rotation and is locked in that position

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60
Q

What is adhesive capsulitis

A

aka frozen shoulder
it is a complication of shoulder injury or surgery

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61
Q

4 risk factors for frozen shoulder

A

middle age
diabetes
women more than men
thyroid disease

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62
Q

2 classification of frozen shoulder

A

Adhesive capsulitis can be:

Primary – occurring spontaneously without any trigger
Secondary – occurring in response to trauma, surgery or immobilisation

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63
Q

Signs and symptoms of frozen shoulder

A

Affect ADLs, severe stiffness shoulder + coracoid pain test

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64
Q

Treatment for frozen shoulder

A

Physiotherapy and NSAID first line
IA steroid injection

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65
Q

What is colles’ fracture

A

distal radial fracture with dorsal displacement of the distal fragment
has a dinner fork deformity

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66
Q

Who are at higher risk for colles fracture

A

elderly and osteoporotic pt

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67
Q

What type of injury is likely to lead to colles fracture

A

FOOSH

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68
Q

Treatment for colles fracture

A

Straightening the deformity and immobilisation for six weeks

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69
Q

What is a smiths fracture

A

aka reverse colles fracture
a fracture of the distal radius caused by falling onto flexed wrist

70
Q

What age is pulled elbow common

A

in children under 5 years

71
Q

How does pulled elbow happen

A

when swinging children by hands

72
Q

Signs and symptoms of pulled elbow

A

not using the arm, elbow in extension, forearm in pronation, no swelling
marked resistance and pain with supination of the forearm

73
Q

how is a pulled elbow diagnosed

A

X-ray

74
Q

Tx for pulled elbow

A

Reduction and mobilisation

75
Q

where is the scaphoid bone located

A

in the anatomical snuffbox

76
Q

is scaphoid fractures usually diagnosed by X ray or MRI

A

MRI
It often shows a normal XRAY

77
Q

Treatment for scaphoid fracture

A

Immobilise

78
Q

Common type of injury that cause scaphoid fracture

A

FOOSH

79
Q

What is a major risk/complication of a scaphoid fracture

A

Avascular necrosis

80
Q

What is carpal tunnel syndrome

A

caused by compression of the medial nerve as it travels through the carpal tunnel in the wrist

81
Q

7 risk factors for carpal tunnel syndrome

A

repetitive strain
obesity
perimenopause
rheumatoid arthritis
Diabetes
Acromegaly
Hypothyroidism

82
Q

Presentation of carpal tunnel syndrome

A

gradual onset
intermittent symptoms
worse at night
numbness, pins and needles, burning sensation and pain

83
Q

name the 2 special test for carpal tunnel syndrome

A

Phalen’s test
Tinel’s test

84
Q

which fingers are effected in carpal tunnel syndrome

A

thumb, index, middle and part of the ring finger

85
Q

What investigation is used to diagnose carpal tunnel syndrome

A

nerve conduction studies

86
Q

Treatment for carpal tunnel syndrome

A

NSAID
Splints
Steroid injection
Surgical decompression

87
Q

What is dupuytrens contracture

A

flexion contracture of the hand , patient often describe finger getting caught on things

88
Q

What test is used for dupytrens contracture

A

tabletop test

89
Q

Risk factors for dupuytrens contracture

A

Men 40-60
diabetes
Smoking

90
Q

Management for dupuytrens contracture

A

Monitor in early cases
Corticosteroid injection
Surgery

91
Q

What happens in de quervain’s tenosynovitis

A

the sheath of the tendons on the thumb side of the wrist becomes inflamed or swollen,
restricting the tendons’ movement

92
Q

what test is used for de quervain

A

Finklestein

93
Q

Treatment for de quervain

A

Analgesia, splint, steroid injection and surgery

94
Q

What is scoliosis

A

curvature of the back - left to right

95
Q

difference between a back strain and sprain

A

back sprain overstretching or tearing of ligament around the spine
back strain is the overstretching or tearing of muscles or tendons

96
Q

Recommendation for back sprain/strain

A

try to keep active as possible
offer NSAID

97
Q

How does a strain/sprain present

A

Pain around affected joint, tenderness, swelling, bruising, functional loss

98
Q

Conservative management for sprains and strains

A

RICE
Rest
Ice
Compression
Elevation

99
Q

What is osteomyelitis

A

an inflammation of the bone as result of an infection

100
Q

What is the most common causative of osteomyelitis

A

Staph aureus

101
Q

Risk factor for osteomyelitis

A

Penetrating injury
Surgical contamination
IV drug use
Diabetes
Periodontitis

102
Q

When should a diagnosis of primary or recurring osteomyelitis be considered

A

If a patient presents with a vague history of non-specific pain and low grade fever of 1-3 months

103
Q

What is the typical presentation of haematogenous osteomyelitis

A

malaise , fatigue, local inflammation and a low grade fever

104
Q

Management for acute osteomyelitis (conservative and medical )

A

Conservative: affected limb should be immobilised and pain management with analgesia administered.

Medical: high dose empirical antibiotics following local guidelines.

105
Q

Management for chronic osteomyelitis

A

Surgical debridement of the affected area and iv antibiotics

106
Q

What is bursitis

A

inflammation of the small fluid sacs called bursa which are localised near joints

107
Q

what are 2 common types of bursitis

A

clergyman’s (infrapatellar) and housemaid’s (prepatellar) knee.

108
Q

Risk factors for bursitis

A

Age
occupation
Rheumatoid arthritis
Gout
Diabetes
Wound/skin tears on the knees

109
Q

Presentation of bursitis

A

Swelling and erythema of the knee
Pain and tenderness
Reduced range of movement
Hx may include recent trauma or repetitive knee movement

110
Q

Conservative management for bursitis

A

Rest ice and elevation
cushion or padding when kneeling
physiotherapy

111
Q

Medical/ surgical management in bursitis

A

ibuprofen with ppi in elderly
incision and drainage
corticosteroid injection

112
Q

What is chondromalacia

A

aka runner’s knee. a condition where the cartilage on the under surface of the patella deteriorates and softens

113
Q

Presentation of chondromalacia

A

Vague occurring pain that is felt behind the knee Worse after every day activities including:
prolonged sitting
walking up and downstairs
after squatting or kneeling
Worse after repetitive use i.e. physical sport

114
Q

Conservative management for chondromalacia

A

Avoid strenuous and overuse of the knee
Physiotherapy
Physio taping

115
Q

Medical and surgical management for chondromalacia

A

Paracetamol, ibuprofen, naproxen
arthroscopy
Shaving of cartilage behind patella patellectomy

116
Q

What will x-rays show in chronic osteomyelitis

A

intramedullary scalloping , cavities and a ‘fallen leaf’ signs indicating section of endosteal sequestrum fallen into the medullary canal

117
Q

What is a herniated disk pulposis

A

occurs when a portion of the nucleus pushes through a crack in the annulus

118
Q

Presentation of a herniated disc

A

Pain
Sensation changes
Weakness
Incontinence if severe

119
Q

Management for herniated disc

A

Heat and massage, avoid activities that worsen pain
Pain relief

120
Q

What is meniscal injury

A

Injury/degenerative changes of the knee joint

121
Q

Presentation of meniscal injury

A

Pain- worse on activity
popping and clicking
Unstable knee
Locking of knee
Limited ROM of knee
Slow swelling

122
Q

Which test is used to determine presence of meniscal tear

A

McMurrays test

123
Q

How to know to which menisci is injured

A

Pain during external rotation = medial meniscus injury

Pain during internal rotation = lateral meniscus injury

124
Q

Gold standard investigation for meniscal injury

A

MRI

125
Q

Management for meniscal injury

A

Conservative - RICE
Physiotherapy

126
Q

What is metabolic bone disease

A

Broad spectrum of disorders affecting the bone

Metabolic bone disorders can be caused by osteoporosis, osteomalacia (due to CKD, Malnutrition, malabsorption) Pagets disease.

The underlying pathogenesis involves bone demineralization due to imbalance between osteoblasts and osteoclasts

127
Q

Risk factors for metabolic bone disease

A

Medications e.g steroids

Family history

Endocrine e.g Hypopituitarism

CKD

Diet (vegetarian)

Dark skinned

128
Q

Presentation of metabolic bone disease

A

Weakness
Reduced height
Fractures
Gait problems
Reduced ROM
reduced power

129
Q

pathophys of paget’s disease

A

Osteoclasts are bone resorbing cells while osteoblasts are bone forming cells.

Pagets disease occurs when there is an increase in bone resorption (osteoclasts), there is a compensatory increase in osteoblasts which results in abnormal bone formation.

130
Q

Risk factors for pagets disease

A

Mechanical stress
Enviromental factors
Genetic factors
Infections (paramyxovirus)

131
Q

presentation of pagets disease

A

Bone pain
bone deformity
fracture
increased bleeding
weakness
gait abnormality

132
Q

blood investigations and it’s findings for pagets disease

A

Alkaline phosphatase -raised
FBC- anemic
calcium/parathyroids hormone

133
Q

what imaging is done in pagets disease and what is its findings

A

x-ray- may appear as radiolucent chnages or ;cotton wool’ pattern in the skull

134
Q

Management of pagets disease

A

walking stick
analgesia
Bisphosphonates

135
Q

Pathophysiology of renal bone disease

A

Parathyroid hormone helps calcium absorption but inhibit phosphate absorption from kidney but helps reabsorption of phosphate from intestine
In renal osteodystrophy, the kidney is unable to produce vit D which results in low levels of calcium in the body and rise in PTH as result of positive feedback mechanism. A rise in PTH causes there is increased absorption of phosphate from kidneys

136
Q

Risk factors for renal bone disease

A

Diabetes
autoimmune disease
family history
hypertension
HIV
cancer
Immunosuppression

137
Q

Presentation of renal bone disease

A

Limb/abdominal swelling
Tetany,parasthesia
Pruritus
SOB

138
Q

Investigation and its finding in renal bone disease

A

Bloods:
FBC (Anaemia)
Phosphate (High] Calcium (Low),Vitamin D (Low)
Alkaline phosphatase (may be high or normal depending on concomitant pathology)
Albumin (Low if nephrotic syndrome)
Creatinine and urea (raised)

X-ray/Imaging:
Parathyroid ultrasound. DEXA scan. Nuclear bone scan

139
Q

Management for renal bone disease

A

Bisphosphonate
Manage vit D deficiency
High phosphonate managed by diet or phosphate binders

140
Q

What is septic arthritis

A

infection of one or more joints either by direct inoculation or haematogenous spread of infectious organism

141
Q

2 Most common causative agent for septic arthritis

A

staphylococcus or streptococcus

142
Q

Name some risk factors for septic arthritis

A

RA
OA
Joint prosthesis
IVDU
Diabetes
Cutaneous ulcers

143
Q

Presentation of septic arthritis

A

hot swollen and painful joint
less than 2 week hx
fever and other signs of systemic infection

144
Q

What are the Ix (6)for septic arthritis ad its finding

A

FBC- raised inflam markers
ESR- elevated
CRP- raised
Blood culture- to check organism
Synovial fluid WBC- >100,000 = sepsis
X-ray and ultrasound

145
Q

Management for suspected gram positive organism in septic arthritis

A

Vancomycin

146
Q

Management for suspected gram negative organism in septic arthritis

A

ceftriaxone

147
Q

What is slipped upper femoral epiphysis

A

most common hip disorder amongst adolescents
its a weakness in the proximal femoral growth plate, which leads to a fracture displacing the metaphysis anteriorly and superiorly

148
Q

Grading system for a slipped upper femoral epiphysis

A

grade 1: 0-33% slippage
grade 2: 34-50% slippage
grade 3: >50% slippage

149
Q

Risk factors for slipped femoral epiphysis

A

Trauma to hip/femoral area
obesity
Puberty
Growth hormone deficiency

150
Q

Presentation of slipped upper femoral epiphysis

A

may have recent trauma
limping
poorly localised pain
antalgic gait and externally rotated hip
maybe be unable to bare weight

151
Q

Examination finding in slipped upper femoral epiphysis (4)

A

-Reduced internal rotation of hip
-Problematic leg is shortened and externally rotated
-Trendelenburg’s gait positive
-possible antalgic gait

152
Q

Ix for slipped upper femoral epiphysis

A

Bloods to rule out endocrine causes
X-rays- draw klein line - trethowan sign is when the klein line passes above the femoral head confirming a slipped upper femoral epiphysis

153
Q

2 signs u look out for in slipped upper femoral epiphysis and what are they

A

trethowan sign- when the klein line passes above the femoral head confirming the diagnosis
Steel sign - crescent shaped line of increased density over the metaphysis

154
Q

Conservative, medical and surgical management for slipped upper femoral epiphysis

A

conservative- rest and immobilisation( crutches or wheelchair)
Medical- analgesia
Surgical:
- percutaneous in situ fixation
- open fixation of growth plate using bone graft

155
Q

what is pseudogout

A

its a form of arthritis characterised by sudden painful swelling in one or more of your joints

156
Q

what crystal are deposited in pseudogout

A

calcium pyrophosphate crystal

157
Q

Risk factors for pseudogout

A

Older age
Trauma to joint
Mineral imbalance
Hyperparathyroidism
Acromegaly
Haemochromatosis
Wilsons disease

158
Q

Presentation of pseudogout

A

Sudden onset
pain and swelling in the affected joint
lasts for 7-14 days

159
Q

Ix for pseudogout

A

to rule out imbalances do tsh, parathyroid test and U+E
Joint X-rays and ultrasound : detect calcification
Joint fluid analysis

160
Q

Management for pseudogout

A

rest, ice, elevate
NSAIDs
Colchicine
Prednisolone
Corticosteroid injection

161
Q

What is Rheumatoid arthritis

A

a form of inflammatory arthritis

162
Q

Risk factors for RA

A

women
Aged 70 and over
Smoking
HLA DR4 and DR1
Winter

163
Q

Presentation of RA

A

Gradual onset
Symmetrical symptoms
pain, swelling and stiffness of joints
Early morning stiffness lasting more than 30 min

164
Q

Examination finding on RA

A

Join swelling B/L
Pain on palpation
swan neck
Boutonnieres - PIP and DIP hyperextension
Ulnar deviation
RH nodules

165
Q

Ix for RA

A

FBC, ESR,CRP,LFT
ANA- positive
anti-ccp antibodies
Rhaeumatoid factor
x-ray

166
Q

Management for RA

A

Refer to rheumatologist
give nsaids at low dose
methotrexate
flare up- glucocorticoids

167
Q

What is ankylosing spondylitis

A

type of arthritis that mainly affects the back , by causing inflammation in the spine

168
Q

risk factors for ankylosing spondylitis

A

HLA B-27 positive
FHx

169
Q

Presentation of ankylosing spondylitis

A

Dull ache /pain
SOB if ribs affected
Fever
Weight loss
Paraspinal tenderness
Reduced ROM
Kyphosis

170
Q

what is spinal stenosis

A

narrowing of the spinal canal which puts stress on the nerves running through.
more common in the lower back and the neck

171
Q

presentation and history of spinal stenosis

A

Pain(relived by leaning forward or lying supine)
weakness/fatigue
Changes in sensation

172
Q

What is rotator cuff

A

group of four muscles that are positioned around the shoulder joint

PA- FCM (10 decks)

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