MSK 2

Question 1

trauma/pain and weakness/sudden ability to raise arm

Answer 1

acute rotator cuff

Question 2

shoulder mass/swelling

Answer 2

malignancy

Question 3

red/pain/fever/systemically unwell

Answer 3

septic arthritis

Question 4

trauma leading to loss of rotation and abnormal shape

Answer 4

dislocation

Question 5

symptoms of inflammatory in several joints

Answer 5

inflammatory arthritis

Question 6

why does impingement syndrome happen

Answer 6

tendons of rotator cuff are compressed in subacromial space leading to pain

Question 7

causes of impingement syndrome

Answer 7

tendonitis
subacromial bursitis
acromioclavicualr OA with inferior osteophyte
hooked acormen rotator cuff

Question 8

symptoms of impingement syndrome

Answer 8

painful arc 60-120 degrees
pain leading to deltoid and upper arm
tender below lateral edge of acronium

Question 9

investigation for impingement syndrome

Answer 9

hawkins test positive

Question 10

treatment for impingement syndrome

Answer 10

conservative: NSAIDs, analgesics, physio, steroid injection

subacromial decompression

Question 11

what is acute calcific tendonitis

Answer 11

calcium deposition in supraspinatous tendon

Question 12

what symptoms occur in acute calcific tendonitis

treatment

Answer 12

acute onset of severe shoulder pain

subacromial steroid and local anaesthetic injections
self limiitng
pain resolves as calcium gets reabsorbed

Question 13

rotator cuff tear cause 
20% in who and why 
symptoms 
ix what do the tears usually involve 
treatment

Answer 13

sudden jerk in over 40s with subsequent pain and tender

of over 60s - asymp tear due to degen

weakness of initiation of abduction, internal rotation and external rotation

MRI
supraspinatous

rest. exercise/physio. steroid injection

Question 14

adhesive capsulitis in who 
risk factors 
symptoms 
on examination 
treatment

Answer 14

middle aged female

DM, increased cholesterol, dupytrons

progressive pain/stiffness worse in bed and can disturb sleep. pain subsides after 2-9 months then stiffness increases fr 4-12 months. total resolves in 18-24 months

loss of external rotation. active and passive movements affected

physio. analgesia, NSAIDs, hot packs support in bed with pillows
steroid injection

Question 15

instability can have co existing what
treatment for under 25
25-40
if asymptomatic

Answer 15

rotator cuff tear esp if pain and weakness 2-3 w later

consider surgical input by 6 weeks

review in 3-6 months

physio

Question 16

tennis elbow where

symptoms

dx

treatment and how long does it last

Answer 16

common extensor origin. lateral epicondylitis

pain and tender lateral epi. pain on resisted middle finger and wrist extension

6m-2 years. acute pain for 6-12 weeks
rest. analgesia. physio. steroid injection. brace. surgery is rare

Question 17

golf elbow where

symptoms

dx

treatment and risk

Answer 17

medial. common flexor origin

can have ulnar nerve involvement. pain and tender at medial epi

self limiting. physic. rest. NSAIDs
steroid injection carries risk of injury to the ulnar nerve

Question 18

cubital tunnel syndrome causes
when are symptoms worse
ix
treatment

Answer 18

compression and stretching, acute or delayed trauma, OA, RA

worse when elbow is resting on hard surface

Tinnels
Froments - weak grip adductor pollicus
NCS

splint, surgical release of any tight structures

Question 19

early local complications of of fractures

Answer 19

compartment syndrome
vascular with distal ischaemic injury
nerve injury

Question 20

nerve injury types

Answer 20

neuroproxia: resolves within 28 days. temporary block/demyelination
axohotmesis: nerve cell axon dies distally from point of injury. regenerates at 1mm/day
neurotmesis: nerve transected and needs surgery

Question 21

late local complications

Answer 21

stiffness
post traumatic arthritis 
non union 
malunion
osteomyleitis 
AVN
volkmans
complex regional syndrome

Question 22

non union atrophic

hypertophic

Answer 22

atrophic: systemic disease, smoking steroids, NSAIDs, bisphosphonates

too much movement, callus response but no union

Question 23

malunion

Answer 23

healed in non anatomical position
pain
still
deformityy

Question 24

volkmans ishcaemic contracture

Answer 24

permanent flexion contracture of hand - claw like
cause - undiagnosed compartment syndrome
painfule

Question 25

CRS is what

Answer 25

exaggerated pain burning neuralgic swelling skin changes

difficult to treat