MSK Flashcards
Golfer’s elbow (medial epicondylitis)
Risk factors: age 40-60, repetitive elbow/forearm activities, inadequate physical conditioning, smoking. Symptoms: elbow pain during/after flexion and extension, exacerbation of pain with repetitive activity, decreased grip strength, - pain at medial aspect of elbow - increased pain with resisted for arm pronation or wrist flexion
Gout
Risk factors: older age, male sex, consumption of meat/seafood/alcohol; use of diuretics; - Rapid onset severe pain - Joint stiffness - First metatarsal joint most commonly involved - Monoarticular or oligoarticular (<4 joints) - Swelling, tenderness, erythema, warmth - Tophi may be present
Iliotibial band syndrome
Risk factors: female, HLA polymorphism, age <6, FHx autoimmunity Sx: - onset <16 years - objective arthritis in 1 or more joints for at least 6 weeks - swelling / effusion, increased warmth +/- limited movement with or without tenderness - morning stiffness - limp
Meniscal tear
Risk factors: acute knee trauma (twisting injury), knee arthritis, knee instability, history of aCL injury, rough/uneven playing surface, poor weather conditions Symptoms: Knee swelling and pain Sensation of instability / buckling/catching Tenderness at joint line and crepitus Positive McMurray’s, Apley’s and hyperextension test
Olecranon bursitis
Pain and usually significant swelling around elbow Can occur following trauma, prolonged pressure (leaning on table), bony spur. XR - fat pad sign
Osgood-Schlatter’s disease
Pain at the tibial tubercle. Worsened by forceful extension; relieved with ice/rest/NSAIDs. Tender to palpation. May see prominence over the tibial tubercle. Typically affects young athletes during adolescent growth spurt Risk factors: male, athletic, history of same condition in contralateral knee
Gluteus medius tendonitis
Lateral hip pain, muscle stiffness. Pain worse with use (running / hopping) Painful to lie on affected hip Tender over greater trochanter; may be misdiagnosed as trochanteric bursitis
Glenoid labrum injury
Shoulder pain with overhead activity May follow trauma –fall onto outstretched hand, direct blow shoulder, sudden pull, or with chronic use (eg. shot putters) Popping, grinding, catching, locking Sensation of instability in shoulder Decreased ROM and strength
Pseudogout
acute onset mono or oligoarthralgia may be preceded by trauma, surgery, intercurrent illness knee most often affected, also wrists MCP, shoulders, elbows joints warm, swollen often with effusions chondrocalcinosis on x-ray
Psoriatic arthritis
joint pain and stiffness dactylitis history of scalp or nail problems personal or family history of psoriasis
Raynaud’s phenomenon
digital parasthesia, pain, discomfort pallor, red and or blue discoloration of digits dilated capillaries at naibeds more common in females, patients with connective tissue disease
Reflex sympathetic dystrophy/CRPS 1
chronic limb pain with radiation allodynia and hyperalgesia oedema trophic skin and nail changes erythema or bluish appearance local sweating changes/sweating asymmetry muscle weakness more common in females, after immobilisation, trauma
polymyositis
gradual onset muscle weakness, atrophy, difficulty with motor tasks affects people in 30-50s
Reactive arthritis
peripheral and axial arthritis more common in males preceding chlamydial or GI infection
Osteoarthritis
Advancing age Symmetrical joint pain Often large weight bearing joints affected May affect the joints of the hands, particularly CMC of thumb and DIPJ Pain worse with activity, relieved by rest Stiffness <30mins Heberdens and Bouchards nodes Decreased joint mobility and crepitus
Osteochondritis dissecans
Adolescent or young athlete Main joints effected - knee, ankle, radiocapitellar joint of elbow Insidious onset Pain with exercise, particularly stairs or hill climbing Recurrent effusion, catching or locking Pain at anteromedial aspect of the knee when flexed at 90 degrees
Osteoid osteoma
Onset during teenage years More common in males Typically affects lower limbs Worsening pain, particularly at night Relieved by aspirin, worsened by alcohol
Osteomyelitis
Risk factors - IVDU, immunosuppression, DM, surgery, trauma Malaise, fatigue, fevers Non specific pain at affected site Commonly effects spine in adults and long bones in children Local inflammation, erythema or swelling
Paget’s disease
Older people of European descent Positive family history Asymptomatic / incidental finding in most cases Unable to fit hat on head Bone pain, arthropathy, deformity, fractures Commonly effects femur, pelvis or skull Deafness May present with complications such as heart failure
Patellar tendonitis
Usually athletes - basketball, volleyball Anterior knee pain Exacerbated by jumping Localised tenderness over patella tendon
Patellofemoral syndrome
Teenagers More common in females Pain in anterior knee Particularly after sitting for prolonged periods or with stairs or squatting Clicking or grinding sensation when bending knee Patella crepitus Squinting patellae Atrophy of VMO, tight ITB
Perthe’s Disease
Age 4-8yrs M:F 4:1 Tend to be short stature, hyperactive Limping gait Aching groin or hip pain. May have knee pain Limited abduction and internal rotation of hip May be flexion deformity of hip in acute stage
Plantar fasciitis
RF: obesity, pes planus, runner, prolonged standing, age 40-60yrs Intense sharp pain anterior aspect of plantar heel Worse with first steps in the morning or after periods of inactivity (post-static dyskinesia) Relieved with rest Exacerbated by walking barefoot May radiate proximally or into sole Tender at medial tuberosity Positive windlass test Negative tinel’s test
Polymyalgia Rheumatica
Advancing age, 75% are women Pain and stiffness at shoulder girdle and hip Morning stiffness >60mins Pain classically at night Difficulty rising from chair or raising arms above head Malaise, anorexia, weight loss May have low grade fever Associated with GCA
Scheuermann’s disease (kyphosis)
- RFs; family history, 10-15 years old, M>F - Increased rounding of the spine - Symptoms; back pain & stiffness, decreased flexibility - X-ray diagnostic criteria - wedging of 3 consecutive vertebrae, presence of Schmori’s nodes, curve >45 degrees
Scleroderma (systemic sclerosis)
Arthralgia + Raynauds + GORD +/ skin changes - RF’s; family hx, immune dysregulation - Skin (digital pits/ulcers, swelling of hands/feet, thickened skin, localized thickening and tightness of the skin of the fingers or toes) -GI symptoms, arthralgias, fatigue, SOB, basal lung crackles, dry cough
Septic arthritis
Hot, painful, swollen, restricted joint, fever, rapid onset - RFs; IVDU, diabetes, cutaneous ulcers, prosthetic joint, underlying joint disease
Sever’s disease
M>F - 8-14 years old (puberty) - RFs; high impact activity (running, jumping) - Uni or bilateral heel pain worse with activity, better with rest - Tenderness on palpation at Achilles insertion at calcaneus
Sjogren’s syndrome
Dry eyes + dry mouth + arthritis - RF’s; female, SLE, RA, scleroderma, 20-30 yo then after menopause - Fatigue, sicca symptoms, arthralgia, myalgia, arthritis, vasculitis
Slipped capital femoral epiphysis (SCFE)
- RFs; 10-15 yo (puberty), obesity, endocrine disorders - Feature; limp, irritability in anterior groin, knee pain - Exam; hip rotates into external rotation on flexion, restricted internal rotation
Spinal stenosis
- RFs; >40 yo, previous back surgery/injury, acromegaly, achondroplasia - Features; pain with activity, sciatica pain, leg numbness, bowel/bladder dysfunction
Systemic lupus erythematosus (SLE)
Fatigue + polyarthritis + fever/skin lesions - RFs; F>M, 15-40yo, asian/african, drugs (terbinafine, phenytoin) - Malar rash, photosensitivity rash, discoid rash, fatigue, weight loss, fever, oral ulcers, alopecia, arthritis, raynauds, GI symptoms, HTN
Tarsal tunnel syndrome Compression of posterior tibial nerve
- Causes; flat feet, ganglion, varicose vein, tendinitis, spur - Tingling, burning, numbness, pain inner ankle & bottom of foot - Brought on with activity
Tennis elbow (epicondylitis)
- RFs; 40-60yo, repetitive activities, poor conditioning, smoker - Elbow pain at lateral aspect after movement - poor grip strength - Tender lateral epicondyle, pain on resisted wrist extension
Tibialis posterior tendonitis
Pain along the inside of the foot and ankle -worse with activity Swelling from the lower leg to the inside of the foot and ankle A change in the shape of the foot. The heel may be tilted outward and the arch will have collapsed. Single limb heel rise -Unable to go from standing on one foot to lifting heel off the ground
Transient synovitis
Risk factors: -2 to 12 years of age -Male > Female -Recent upper respiratory infection Clinical findings: Limp/difficulty crawling Pain - hip, groin, thigh or knee - Usually one side Positive log roll - Supine patient - leg rolled from side to side causing involuntary muscle guarding Abducted and externally rotated hip
Trochanteric bursitis
RF: Scoliosis, Unequal leg length, Weak hip muscles, Osteoarthritis, Rheumatoid arthritis Clinical findings: Pain and swelling occurring over the lateral hip - may radiate to front of thigh and knee Pain when sleeping on your side Pain when climbing stairs Aggravated - Walking, Cycling, Standing long periods
Ulnar nerve entrapment syndrome (Cubital Tunnel Syndrome)
Numbness and tingling of medial 1.5 fingers Exacerbated by flexion at the elbow Decreased grip strength Late - Muscle wasting of intrinsic muscles of hand -Ulnar claw Froment’s sign - 1.Grip paper between their thumb and index finger 2. Pull the object out of the subject’s hand 3. Positive if flexing the flexor pollicis longus - Flexion at DIP rather than adduction of thumb
Discogenic back pain
- increasing incidence with increasing age - association with occupations that involve excessive axial loads - pain usually lower back - worsens with axial loading and improves with rest - restriction in lumbar motion - positive straight leg raise
Developmental dysplasia of the hip
Risk factors: breech birth, restricted intrauterine space, family history Can present with: - delayed crawling/walking - toe walking esp unilateral + Barlow test + Ortolani test
de Quervain’s tenosynovitis
- pain primarily over radial edge of the wrist with weakness in grasp - often present in new mothers - repetitive lifting - tenderness to palpation over and just proximal to radial styloid, - firm tender localised swelling in area of radial styloid - Finklestein’s tests +ve
Costochondritis
Risk factors: microtrauma, F>M, age >40yrs, IV drug use - prolonged coughing - chest pain, usually worse with deep inspiration and exacerbated by stretching chest wall -usually unilateral Examination: some tenderness on palpation of costochondral joints
Carpal Tunnel Syndrome
- M>F - positive family history - lower back pain <3 months - age <50yrs (usually late teens and early 20s) - morning stiffness >30min - improvement of back pain with exercise - awakening during 2nd half of the night - anterior uveitis - modified Schober’s test +ve - occipit to wall distance increased
Adhesive capsulitis (Frozen shoulder)
- restriction/stiffness of shoulder - pain in shoulder movement (both passive and active) - pain constant day and night - risk factors: diabetes, previous trauma and or surgery to affected shoulder - has 3 stages: freezing, frozen, thawing - positive coracoid pain test - positive shoulder shrug test
Golfer’s elbow (medial epicondylitis)
Risk factors: age 40-60, repetitive elbow/forearm activities, inadequate physical conditioning, smoking. Symptoms: elbow pain during/after flexion and extension, exacerbation of pain with repetitive activity, decreased grip strength, - pain at medial aspect of elbow - increased pain with resisted for arm pronation or wrist flexion
Gout
Risk factors: older age, male sex, consumption of meat/seafood/alcohol; use of diuretics; - Rapid onset severe pain - Joint stiffness - First metatarsal joint most commonly involved - Monoarticular or oligoarticular (<4 joints) - Swelling, tenderness, erythema, warmth - Tophi may be present
Iliotibial band syndrome
Risk factors: athlete; long-distance / downhill / high weekly milage running, lack of running experience Symptoms: Sharp burning pain 2cm superior to lateral knee joint line. Begins after a reproducible time / distance. Subsides upon cessation of activities. Signs: Positive Noble’s test, Ober’s test, Thomas test.
Fibromyalgia
- at least 3 months in duration - age between 20-60 - chronic pain - diffuse tenderness on examination - fatigue unrelieved by rest - sleep disturbance - mood disturbance - stiffness - cognitive dysfunction
Dermatomyositis
Risk factors: family history of same dx or autoimmune disease, children and age >40, female, black race - Gottron’s papules (violaceous papules over dorsal surface of knuckles, wrists, elbows), - heliotrope rash involving peri-orbital region, - macular violaceous erythema - proximal muscle weakness
Dermatomyositis
Risk factors: family history of same dx or autoimmune disease, children and age >40, female, black race - Gottron’s papules (violaceous papules over dorsal surface of knuckles, wrists, elbows), - heliotrope rash involving peri-orbital region, - macular violaceous erythema - proximal muscle weakness
