MSK Flashcards
pain in right shoulder and upper arm for 6 weeks. worsens when elevating arm above head
no deformity, tenderness or reduced range of movement. pain on abduction of right shoulder that is worse with the arm in internal rotation and when abduction is resisted. he is treated with ibuprofen
next step in management?
Refer for physiotherapy.
diagnosis = right supraspinatus tendinopathy. no further inestigations required to confirm. can be managed in primary care. general advise and home exercises or physio
Acute Gout. patient has chronic kidney disease stage 4. first line management?
oral prednisolone!!
nsaids would be option but CKD
acute gout treatment: oral steroids, NSAIDS and colchicine
classic polymyalgia rhuematica symptoms. management?
prednisolone!
Acute Gout first line treatment
Start naproxen
70 yo. 6 months increasing pain at base of left thumb. No other joint painful. 1st carpometacarpal joint swollen and tender with reduced opposition of thumb. Most likely diagnosis?
Osteoarthritis!!!
6 months not acute so less likely to be gout.
OA fits with joint affected. Not multiple joints so RA unlikely
A 73 year old man has 3 months of increasing weakness of his right hand with
reduced sensation of the forearm.
There is wasting of all the intrinsic muscles of the right hand. There is
weakness of finger abduction and adduction, and thumb adduction. Finger
flexion is normal. There is mild altered light touch sensation along the ulnar
aspect of the forearm. The biceps, supinator and triceps reflexes are normal.
The lower limbs and the left arm are normal
where is the most likely site of the lesion causing his symptoms?
T1 nerve root
The intrinsic hand muscle wasting suggests
T1. The normal reflexes and normal other arm are against a cord lesion. The
sensory loss on the forearm excludes median and ulnar nerve lesions. T1
dermatome is often thought to be higher in the arm medially.
