MSK Flashcards
IT band sx and mx
tenderness 2-3cm above the lateral joint line
Common in runners
Management
activity modification and iliotibial band stretches
if not improving then physiotherapy referral
Red flags back pain
age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
Thoracic back pain
Hip disclocation sx
shortened and internally rotated leg
Mx and complications of hip dislocation
A reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.
Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments
calcification of the articular cartilage dx
Pseudogout
Chondrocalcinosis
Spinal stenosis
Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnosis
Signs of scaphoid fracture
Point of maximal tenderness over the anatomical snuffbox
This is a highly sensitive (around 90-95%), but poorly specific test (<40%) in isolation
2. Wrist joint effusion
Hyperacute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
3. Pain elicited by telescoping of the thumb (pain on longitudinal compression)
Infrapatella bursitis
associated with kneeling as seen in clergymen
Swelling and tenderness
Psoriatic arthritis sx
symmetric polyarthritis
very similar to rheumatoid arthritis
30-40% of cases, most common type
asymmetrical oligoarthritis: typically affects hands and feet (20-30%)
Dactylitis, sometimes described as ‘sausage fingers’
periarticular disease - tenosynovitis and soft tissue inflammation resulting in:
enthesitis: inflammation at the site of tendon and ligament insertion e.g. Achilles tendonitis, plantar fascitis
tenosynovitis: typically of the flexor tendons of the hands
dactylitis: diffuse swelling of a finger or toe
nail changes
pitting
onycholysis
X ray psoriatic arthritis
‘pencil-in-cup’ appearance
Dermatomyositis sx
Skin features
photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
proximal muscle weakness +/- tenderness
ANA+
Anti Jo
Right-sided hip pain radiating to knee and joint instability, post THR
Aseptic loosening
If UGI SE from alendronate
Change to risedronate
Acute mx of gout
NSAID
Colchicine - avoid if GFR <10
Oral steroids if others CI
SE of entanjrcept
Reactivation of TB
AS mx
Ibuprofen
AS XR
sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus
Clubfoot findings
Inverted + plantar flexed foot which is not passively correctable.
PMR sx and mx
typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles
ESR>40
Pred 15mg- 1 week then reassess
Sjogren AB
Positive anti-Ro and anti-La antibodies
Sjogren’s syndrome sx
dry eyes: keratoconjunctivitis sicca
dry mouth
vaginal dryness
arthralgia
Raynaud’s, myalgia
sensory polyneuropathy
recurrent episodes of parotitis
positive Schirmer’s test
Mx of hip fracture
Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.
Displaced Fracture:
arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
total hip replacement is favoured to hemiarthroplasty if patients:
were able to walk independently out of doors with no more than the use of a stick and
are not cognitively impaired and
are medically fit for anaesthesia and the procedure.
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
AS features
reduced lateral flexion
reduced forward flexion - Schober’s test
Pain at night
Reduced chest expansion
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
Prepatellar bursitis
Associated with more upright kneeling
Bone protection if started on long term steroids
Immediate bisphosphonate prescription
Phalen sign
Flexion of wrist produces carpal tunnel signs
Sickle cell osteomyelitis organism
Salmonella- noon typhi
When is colchicine CI
he BNF advises to reduce the dose by up to 50% if creatinine clearance is less than 50 ml/min and to avoid if creatinine clearance is less than 10 ml/min.
Mx of prolapsed disc
irst-line is NSAIDs +/- proton pump inhibitors rather than using neuropathic analgesia (e.g. duloxetine)
if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate
High risk group of fragility fractures
Age >75
Glucocorticoid therapy
(People who are taking high doses of oral corticosteroids (more than or equivalent to prednisolone 7.5 mg daily for 3 months or longer)
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score <-2.5 after treatment
When should you continue/stop bisphosphonates
Any high risk- continue indefinitely
Low risk- repeat DEXA, 2 year break if >-2.5
Taking bisphosphonates
swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
Limited scleroderma sx
Raynaud’s may be the first sign
scleroderma affects face and distal limbs predominately
associated with anti-centromere antibodies
a subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
Diffuse cutaneous systemic sclerosis
scleroderma affects trunk and proximal limbs predominately
associated with anti scl-70 antibodies
the most common cause of death is now respiratory involvement, which is seen in around 80%: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
other complications include renal disease and hypertension
patients with renal disease should be started on an ACE inhibitor
poor prognosis
