MSK Flashcards
Subacromial impingement - what?
Narrowing of subacromial space
Osteophytes under surface of acromion
Fraying rotator cuff muscles
Subacromial impingement - clinical features
- Restriction of overhead activities
- Low painful arc
- Drop arm sign
- Positive impingement tests
- Weak abduction if cuff tear
Subacromial impingement - treatment
Rest
NSAIDs/analgesia
Anaesthetic injection
Surgical decompression
Rotator cuff tears
Acute - following injury - repair
Chronic - degenerative changes, with impingement - subacromial decompression, rotator cuff repair
Clinicallly: weakness abduction - supraspinatus
Osteoarthritis Gleno-humoral joint
Primary Secondary - trauma, RA Pain - activity related and nocturnal Post exertional stiffness Restricted ROM
Osteoarthritis Gleno-humoral joint treatment
Xray Analgesia Physio Aneasthetic injection Shoulder replacement
Osteoarthritis acromio-clavicular joint
Pain on movement, especially overhead
Cross body abduction
X ray
HCI
Resection lateral clavical
Frozen shoulder
Following trivial injury
1 - 1.5 years cycle: pain and stiffness → stiffness → movements return
Restricted movement - especially external rotation
Frozen shoulder treatment
Analgesia
Physio - aggressive
MUA (manipulation under anaesthesia)
Arthroscopy and division tight bands
Anterior dislocation of shoulder
Hx of trauma Pain Restricted movements Flat shoulder contour/visible acromian Check circulation/nerves Chronic - apprehension
Anterior dislocation of shoulder treatment
Acute - reduce under sedation, mobilise as pain allows
Chronic - Anterior stabilisation
Tennis elbow
Degenerative changes to the extensor carpi radialis brevis tendon
Repeated overuse injury
Pain lateral epicondyle
Exacerbated by activity, eased by rest
Tennis elbow treatment
Rest Analgesia Clasp/brace HCI Surgical debridement
Osteoarthritis of the elbow
Risk factors: trauma, longterm overuse, RA
Clinical features: pain on movement, post-exertional stiffness, restricted movement
Management: Xray, analgesia, physio, debridement, RA - replacement
Ulnar nerve compression
Fibrous tunnel behind medial epicondyle Pain radiating down arm Altered sensation ulnar fingers Intrinsic muscle weakness Differential diagnosis - compression at wrist
Ulnar nerve compression management
Tenel's test Nerve conduction studies Analgesia Avoid banging elbow Surgical decompression
Scaphoid fracture
Clinical features: pain anatomical snuffbox, reduced ROM
Management: xray, repeat xray, bone scan, Colles cast, screw fixation
Distal radial fracture
How - fall on outstretched hand
Clinical features - pain, swelling, ↓ ROM
Dinnerfork deformity = Colles fracture
Management - manipulation under anaesthetic, cast, internal fixation
De Quervains
Tenosynovitis of extensor pollicis brevis and abductor pollicis longus
Overuse injury
Tender radial side of wrist
Finkelstein’s +ve
De Quervain’s treatment
Rest
NSAID
HCI
Surgical release
Osteoarthritis of the wrist
Pain, swelling, loss of function, loss of grip strength
Bouchard’s (PIP) and Heberden’s (DIP) nodes
Treatment: NSAIDs, analgesia, splints, fusion, excision arthroplasty, wrist replacement
Carpal tunnel syndrome
Hand pain radiating to arm Nocturnal and holding books Clumsiness Numbness radial side of hand Muscle wasting Phalen's and tinnel's test ?neck pain
Carpal tunnel syndrome management
Nerve conduction studies
Wrist splint
HCI
Carpal tunnel release
Rheumatoid arthritis clinical features
Produce hand and wrist deformities Function can be well preserved - document Synovitis Tendon rupture Radial/volar deviation wrist Ulnar deviation fingers Boutoniere/swan neck/Z deformities
Rheumatoid arthritis treatment
NSAID analgesia DMARDs Physio Splints Aids to daily living Synovectomy Tendon repair Joint replacement Fusion
DMARDs - disease process suppressing
Gold
Penicillamine
Sulfasalazine
DMARDs - affecting the immune process
Chloroquine and hydroxychloroquine Methotrexate Azathioprine Ciclosporin Leflunomide
DMARDs - Anti-tumour necrosis factor or biological agents
The term biological agents encompasses tumour necrosis factor (TNF)-alpha-blockers (infliximab, etanercept, and adalimumab) and other agents, including abatacept, anakinra, and rituximab.
Dupuytren’s contracture
Thickening of palmar fascia
Middle aged men
1-2 years tender nodules
Progressive contractures little/ring fingers
Palpable bands
Initially joints mobile - become stiffer later
Treatment: surgical release
Hip: Viral synovitis
History of URTI Limp Pain in groin, thigh or knee, sometimes tenderness in groin or over greater trochanter Reluctance to weight bear Systemically well or moderately unwell + pyrexia Leg lies in external rotation ROM limited Investigations normal Resolves over a few days
Hip: Septic arthritis
History of RTI Pain in groin, thigh or knee, tender Refuses to weight bear Systemically unwell + pyrexia Lies with hip flexed and in external rotation ROM restricted ↑ WCC, CRP, ESR, +ve blood cultures Immediate decompression and washout of the joint, culture fluid, high dose IV antibiotics
Osteoarthritis - xray
Articular cartilage worn away → ↓ joint space
Underlying bone becomes dense → subchondral sclerosis
Subchondral cysts at pressure area
Osteophytes
Osteoarthritis of the hip
Pain from groin to knee on weight bearing, often use a stick
Stiffness after rest, difficulty putting socks on and cutting toenails
Limp
Apparent shortening of the leg
Muscle wasting
Restricted ROM
Analgesia, NSAIDs, physio, heat, weight loss, modified activity, total hip replacement
Bursitis - hip
Extra-articular joint pain
Trochanteric, ilio-psoas, ischial
Inflammation causes bursal synovial cells to thicken
Excess fluid accumulates inside and around affected bursae
Most common causes: mechanical overload and repetitive microtrauma
Ice, analgesia, NSAIDs, weightloss, HCI, physio, decreasing activity during recovery
Nerve entrapment - hip
Lateral femoral cutaneous nerve: pain anterolateral thigh; nerve trapped at exit through ligament just inferior and medial to asis (meralgia paraesthesia)
Obturator nerve - pain in groin and down inner thigh
Fractured neck of femur
Hip pain
Inability to weight bear
Leg shortened and externally rotated
Can lead to avascular necrosis of the femoral head
Gardens classification (fractured NOF)
Grade 1: incomplete fracture of the femoral neck
Grade 2: complete fracture but undisplaced
Grade 3: complete fracture with partial displacement
Grade 4: complete fracture with total displacement
OA of the knee
Pain - gradually progressive, exacerbations, activity related and nocturnal
Stiffness - post exertional and structural
Deformity - fixed flexion or box leg
Function - reduced distance of walking and poor sleep
Welling
Warmth/tenderness/painful ROM
Anterior cruciate ligament injury
Typical injury pattern - football, skiing
Immediate swelling (sensitive indicator)
Tense swelling, anterior cruciate draw test
Meniscal tear of the knee
Previously normal joint Twisting injury of semiflexed knee - football, skiing Pain joint line Locking Giving way Valgus thrust with foot in external rotation or varus thrust with foot in internal rotation Gradual swelling (sensitive indicator) Mild - moderate swelling Fixed flexion Spongy block to extension
