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GP Exams > MSK > Flashcards

MSK Flashcards

1
Q

DDx of limp in childhood

A
  1. Perthes disease
  2. Transient synovitis (irritable hip)
  3. Fracture
  4. Septic arthritis
  5. Osteomyelitis
  6. Slipped upper femoral epiphysis (SUFE)
  7. Juvenille idiopathic arthritis
  8. Non-accidental injury
  9. Overuse injury
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2
Q

Risk factors for developing Dupuytren’s contracture

A
  1. Alcoholism
  2. Family history
  3. Diabetes mellitus
  4. Liver disease
  5. Epilepsy on anticonvulsant medications
  6. Smoking
  7. Male gender
  8. Age > 50
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3
Q

Saturday night palsy

A

Radial nerve palsy
- wrist drop + sensory loss over dorsum of hand

Conservative tx
Physical therapy, wrist splint, analgesia
Complete recovery 3-4 months

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4
Q

de Quervain tendinopathy ex findings

A
  • tenderness over radial styloid

- pain at radial styloid with stretch of thumb / thumb flexion = Finkelstein maneuver

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5
Q

Mx of de Quervain tendinopathy

A
  • resting wrist / thumb
  • thumb spica splint to immobilise wrist
  • ibuprofen 400mg TDS PRN
  • local long acting corticosteroid to tendon sheath
  • referral to hand therapist for splint application
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6
Q

Clinical presentation of Paget’s disease of bone

A
  1. Incidental finding on radiology
  2. Bone pain
  3. Arthropathy
  4. Deformity
  5. Fracture
  6. Deafness
  7. Neurological complications
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7
Q

First line mx of Paget’s disease of bone

A

Bisphosphonates

- Zoledronic acid 5mg IV infusion

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8
Q

IV Zoledronic acid is safe in primary care provided what 4 patient factors are addressed?

A
  1. Serum Vit D > 50
  2. Corrected Ca is within normal range
  3. eGFR > 35
  4. Well hydrated patient
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9
Q

Typical clinical features of OA

A
  • aged >45 years
  • joint pain related to activity (for >3 months)
  • presence of short-lived, self-limiting stiffness (≤30 minutes in duration)
  • no atypical features (ie persistent night time pain, prolonged early morning stiffness, fevers, weight-loss, and a hot swollen joint)
  • an alternative diagnosis is unlikely
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10
Q

Examination findings to suggest OA

A
  • bony enlargement, weakness/wasting of the muscles around the joint
  • crepitus
  • minimal or no redness, warmth or swelling
  • periarticular and joint line tenderness
  • reduced range of motion
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11
Q

DDx for monoarthritis presentation

A
  • OA
  • Crystal arthropathy (gout)
  • Other inflammatory arthritis (RA, psoriatic arthritis)

Less commonly - septic arthritis, insufficiency fracture, avascular necrosis, or malignancy

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12
Q

DDx knee pain

A
  • OA
  • pes anserine bursitis
  • patellofemoral pain syndrome
  • patellar tendinopathy
  • iliotibial band friction syndrome
  • meniscal/ligament tear
  • referred pain from spine or hip
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13
Q

Non-pharmacological management of OA

A
  • weight mx / loss
  • exercise
  • education
  • assistive devices: orthotics, braces
  • walking aids
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14
Q

Pharmacological management of OA

A
  1. Topical NSAIDs
  2. Oral NSAIDs
  3. Intermittent Paracetamol
  4. Duloxetine
  5. Intra-articular corticosteroid
  6. Opioids if severe, disabling pain
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15
Q

Mx plantar fasciitis

A
  • avoiding activities that aggravate the condition, or use of ice after aggravating activities that cannot be avoided
  • avoiding walking in flat shoes or bare feet
  • exercises to stretch and strengthen the calf muscles
  • stretching the fascia
  • use of a heel cup or cushion
  • pharmacotherapy for pain relief NSAID
  • corticosteroid injection into region of attachment.
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16
Q

Description of OA changes in x-ray

A
  • marginal osteophyte formation
  • subchondral sclerosis and cysts
  • joint space narrowing
17
Q

DDx shoulder pain

A
  1. Subacromial pain syndrome (SAPS) / impingement syndrome
    - including rotator cuff tendinopathies
    - biceps tendinopathies
    - bursitis
  2. Adhesive capsulitis
  3. Cervical radiculopathy
18
Q

Rotator cuff physical examination

A
  1. Empty can test
  2. Lift-off test
  3. External rotation: internal rotation strength ratio in
    comparison to the unaffected side
19
Q

Mx rotator cuff shoulder injuries

A
  1. Conservative tx - specific rehabilitative exercises
  2. Paracetamol
  3. Short term NSAIDs
  4. Modifications for workplace
  5. Consider corticosteroid injection
20
Q

Physical examination findings to confirm lateral epicondylalgia

A

• pain with gripping
• reduction in grip strength
• pain with resisted extension of the wrist with the elbow
extended - middle finger or third metacarpal
• pain on resisted supination of the forearm
• terminal resistance with passive extension elbow
• pain in passive stretching of common extensor origin
• tenderness distal and anterior lateral epicondyle
• tenderness lateral supracondylar ridge
• negative findings examination of the neck and shoulder

21
Q

Mx lateral epicondylalgia

A
  • Education about pathology and natural history
  • Picking up objects with the palm facing upwards and elbow flexed rather than extended
  • Reduce repetitive gripping and overall tension gripping
  • Working with the elbow in a flexed rather than
    extended position
  • Using tennis elbow braces
  • Enlarging the gripping surface of tools or rackets
  • Modifying the workstation to reduce wrist extension and preferential use of the unaffected arm
  • Topical NSAIDs
22
Q

Mx of greater trochanter pain syndrome (GTPS)

A
  1. Explanation of the pathophysiology and natural history of tendon problems
  2. Modify tendon load with alternative forms of exercise
  3. Refer to physio for specific stengthening, gluteal muscle groups associated with tendinopathy
  4. Intermittent NSAID use
  5. Avoiding lying on the symptomatic side, sleeping
    with a small cushion between the legs and avoiding crossing of the legs
  6. Smoking cessation
  7. Weight loss
  8. Corticosteroid injection if no improvement
23
Q

Mx chronic LBP without red flags

A
  1. Providing pain education, which involves looking at all the pain. Including nutrition, movement patterns, pacing, sleep, relationships and vocational aspects
  2. Explain the link between neuroplasticity and pain mx
  3. Creating a supervised exercise program with referral to physio or exercise physiologist
  4. Treat somatic dysfunction - combination of manual therapy techniques and dry needling
  5. Monitor psychological state, closely and arrange interventions if any signs of low mood / anxiety

GP Exams (15 decks)

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