MSK Flashcards

1
Q

MSK history important points

A
  1. Joint/soft tissue? x-rays
  2. Acute/ Chronic >6wks ?
    is it - sudden, cause (infection/trauma), treatments its responded too?
    chronic - exacerbations w remission
  3. inflammatory or not?
    - Inflammatory RA (prolonged early-morning stiffness, pain at rest, joint swelling)
    - non - inflammatory OA (Pain>localised stiffness, activity exacerbates)
  4. symptoms
    - SQUITARS, numbness tingling usually involves nerves
    - mechanical symptoms - locking, joint giving way
    - occupational triggers - repetitive movements, posture. lifting
  5. pattern of affected joints
    - number - (1 - septic arthritis , few - psoriatic arthritis , polyarticular many - RA )
    - symmetrical RA /asymmetrical psoriatic
    - OA affects weightbearing joints
  6. Impact on pt’s life
    - ICE
    - functional issues, openended q - ask to describe
    typical day, dominant hand
    - psychosocial impact
  7. PMH, FH, Other systems involved?
    fatigue and depression common
    other conditions could contraindicate drug treatment
    psoriasis, gout, cancer
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2
Q

MSK screening assessment ?

A

Gait - symmetry, smoothness, turn quickly? obs pics in notes
Arms - behind head, straighten, supination, fist, grip, finger to thumb, squeeze finger for tenderness, observe palms for bulk/abnormalities
Legs - internal rotation w hip in flexion, patellar tap, sweep/bulge test, inspect feet and squeeze MTPJ for tenderness
Spine - inspect, tilt head side-side, touch toes

3 q:

  1. pain, swelling, stiffness in muscles/joints/back
  2. dress yourself w out difficulty
  3. stairs “ “ “
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3
Q

MSK emergency conditions

A
Cauda equina 
MSCC - metastatic spinal cord compression 
Spinal infection 
septic arthritis 
1/2dary cancers
insufficiency fractures
major spinal related neuro deficit 
CSM - cervical spondylotic myelopathy 
Acute inflammatory arthritis/suspected rheumo conditions
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4
Q

early signs score of MSCC

A

Referred back pain - multisegmental/band-like
Escalating pain - poorly responsive to medication
Different character/site to previous symptoms
Funny feelings - odd sensations/heavy legs
Lying flat - increases back pain
Agonising pain - anguish/despair
Gait disturbance - unsteady, stairs
Sleep v disturbed - pain worse at night,

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5
Q

Red Flag symptoms

A

systemically unwell
escalating pain + progressively worsening symptoms - unresponsiveness to conservative management
night pain - as escalating pain/lying flat

hot, swollen, painful, multi-directional restricted movement joint - septic
sudden onset

incontinence in bowel/bladder, sciatica, saddle numbness

rash, Raynaud’s, mouth ulcers, dry eyes/mouth,
myalgia symmetrical pattern, early morning stiffness >30mins, raised ESR/CRP
new onset headache, >50, raised CRP

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6
Q

OA - prevention

A
  1. healthy weight/control blood sugar
  2. regular exercise - joint strength, avoid straining exercise
  3. good posture - avoid same position too long
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7
Q

OA - self-care

A
  1. balanced diet and lose weight overweight
  2. keeping positive mindset
  3. thermotherapy - hot/cold ice packs
  4. braces/splints/supportive footwear
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8
Q

OA - conservative M

A
  1. pharmacological order: paracetamol, add topical NSAIDs, oral NSAIDS/cox-2 inhibitors to sub topical (PPI) or opioids, steroid injections consider as adjunct
  2. structured exercise plan w physiotherapist: aerobic
    and strengthening for affected joint
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9
Q

OA - surgical M

A

order offered

  1. Arthroplasty - joint replacement - hip/knee - last <20 yrs
  2. Arthrodesis - joint fusing
  3. Osteotomy - add/remove parts of bone in/around joint - knee to realign weightbearing points –> reduce stress
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10
Q

OA diagnosis

A

> =45 yrs
activity related joint pain

NO early morning stiffness or lasts <30 mins

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11
Q

RA - diagnosis - including who to refer for investigations

A

persistent synovitis - no known cause
small joints - hand/feet affected
>1 joint
>=3mths between onset of symptoms and seeking medical advice

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12
Q

RA - investigations - to confirm diagnosis in suspected RA pts and then after diagnosis

A
  1. blood test - Rheumatoid factor
    1. b. anti - CCP antibodies - if - ve RF - do asap after diagnosis if not done before
  2. X-ray - hand/feet in all pts - look for erosions

after
3. HAQ - to measure functional ability

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13
Q

RA - management
aims
pharmacological

A

target - remission/low disease activity, target remission if complete cant be met

conventionalDMARDS
1. monotherapy - oral methotrexate - asap within 3mths of onset of symptoms
2. Consider short-term bridging treatment w glucocorticoids when starting new cDMARDs - (improve symptoms while waiting for new DMARD to take effect)
until target met:
3. increase dose as tolerated
4. step-up strategy - other DMARDS in combo - leflunomide, sulfasalazine, hydroxychloroquine

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14
Q

RA - management - symptomatic treatment

A

NSAIDS/cox II selective inhibitors if control of pain/stiffness inadequate

  • lowest effective dose
  • PPI
  • not first line if pt needs aspirin
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15
Q

RA - management - rehabilitative

A

physio - reg exercise, joint flexibility, muscle strength
occupational therapy - daily activity difficulties improve
hand exercise programmes/podiatrist - depends which affected

diet - no strong evidence - but Mediterranean

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16
Q

low back pain and sciatica - prevention and self management

A
  • encourage continuation of normal activities

- regular exercise

17
Q

sciatica and BP - conservative M

A

1a. oral NSAIDS - regular, lowest dose, short-course
1b. weak opioids/ can w paracetamol - if 1 ineffective/contraindicated

  1. epidural steroid injections can be used - reduce nerve pain short term
  2. MDT approach not resuming normal activities/off work
18
Q

sciatica and BP - surgical

A

spinal decompression - if non-surgical M not improved symptoms and radiological findings consistent w sciatica symptoms

19
Q

red flags for BP/sciatica

A

Cauda equina
spinal fracture - sudden, severe central pain, relieved on lying down, trauma history, point tenderness over vertebral body
cancer/infection - night pain, lying down, IV drug users, point tenderness over vertebral body

imaging investigations done if suspected

20
Q

yellow flags for BP/sciatica

A

psychosocial barriers to working through chronic pain:

  • believe that pain/activity + harmful
  • low mood
  • inappropriate expectations of treatment
  • work dissatisfaction/ problems w claims
  • lack of support