Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA Content > MSK - Level 3 > Flashcards

MSK - Level 3 Flashcards

1
Q

Description of seronegative arthritis?

A
  • Group of conditions that present with inflammatory arthritis without a positive RF
  • Include Ankylosing spondylitis, Reiter’s syndrome, psoriatic arthritis, Behcet’s disease, JIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors of seronegative arthritis?

A

o HLAB27

o FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mean onset and symptoms of seronegative arthritis?

A 
-	Mean onset 20-40
o	Back pain
o	Sacroilitis
o	Peripheral arthritis
o	Enthesitis
o	Dactylitis
o	Non-gonococcal urethritis
o	Psoriasis
o	Anterior Uveitis 
o	IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is psoriatic arthritis?

A

o 35-45, any joints
o Psoriasis, enthesitis, dactylitis
o Occasional uveitis, aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is enteropathic arthritis?

A

o Any age
o Asymmetrical lower extremities and symmetrical sacriliitis
o Erythema nodosum, pyoderma gangrenosum
o Aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations in seronegative arthritis?

A
  • Bloods
    o ESR and CRP raised
    o Urate, RF, ANA normal
  • X-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of seronegative arthritis?

A
  • Treat the type of spondylopathy
  • Exercise, physiotherapy
  • NSAIDs
  • DMARDs
  • Surgery – joint replacements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Physiology of vitamin D?

A
  • Vitamin D is fat soluable vitamin that regulates calcium and phosphate homeostasis
  • Promotes absorption of calcium and phosphorus from bowel to mineralise newly formed osteoid bone tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Forms of vitamin D?

A

o Vitamin D3 (cholecalciferol) – synthesised from 7-dehydrocholesterol in skin by UVB radiation (sunlight)

o Both D3 and D2 (ergocalciferol) are obtained from foods
 Cod liver oil, oily fish and fortified cereals/spreads

o D2 and D3 are inactive – converted to 25-hydroxyvitamin D in liver and then to 1, 25(OH)2D in kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Regulation of vitamin D?

A

o Production regulated by PTH on kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Definition of osteomalacia and Ricket’s?

A
  • Osteomalacia – normal bone amount but mineral content low, occurs after fusion of epiphysis
  • Rickets = if this process occurs during period of growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of osteomalacia?

A

o Insufficient sunlight exposure
 Depends on latitude, season and habit of dressing
 Age
 Darker skin need more sunlight
o Inadequate dietary intake
o Intestinal malabsorption – coeliac, CF, Crohn’s
o Obesity
o Liver failure
o CKD
o Drugs – antiepileptics, corticosteroids, rifampicin, HAART

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors of osteomalacia?

A 
o	Muslim women
o	Housebound patients
o	Dark skin (African, Afro-Caribbean, Asian)
o	Vegans
o	Pregnancy
o	>65
o	Obese
o	FHx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Symptoms of Ricket’s?

A

o Growth retardation
o Hypotonia
o Apathy
o Once walking: knock knee, bow legs, rachitic rosary
o Painful wrist swelling
o Craniotabes (skull softening with frontal bossing
o Delayed tooth eruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms of osteomalacia?

A

o Bone pain – lower back, pelvis
o Fractures (esp femoral neck)
o Muscles aches
o Proximal myopathy (waddling gait)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations in child with suspected Ricket’s?

A 
o	XR of long bone – cupping, splaying, fraying of metaphysis (champagne glass wrist)
o	Bone profile
	Vitamin D if low calcium
o	U&E
o	LFT
o	TFT
o	PTH
o	FBC, ferritin
o	RA
o	CRP/ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Investigations must be done in osteomalacia?

A

o Test serum 25(OH)D levels if present with symptoms
 Diagnosis if <25nmol/L
 25-50 may be inadequate for some people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Investigations considered if underlying cause suspected in osteomalacia?

A 
	Bone profile
	U&amp;E
	LFT
	TFT
	PTH
	FBC, ferritin
	RA
	CRP/ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prevention management of osteomalacia?

A

o Take daily 400IU (10mcg) supplement daily throughout year
 If pregnant – can get free Healthy Start vitamins (has vitamin D, 400mcg folic acid and 70mg VitC)
 If <1 years old – 340-400IU of vitamin D

o Advise to intake 700mg of calcium a day
 If unable – combined calcium supplementation (Calcichew D3)
• Check Ca levels 1 months after
 If child, recommended levels are different

o Lifestyle advice
 Sun exposure – safely
 Diet – supplements, cod liver oil, oily fish, egg yolk, meat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of osteomalacia - who to treat?

A

 Serum 25(OH)D <25
 Serum 25(OH)D 25-50 if:
• Fragility fracture, osteoporosis, on antiresorptive drug treatment, symptoms, raised PTH, CKD, coeliac, Crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Management of osteomalacia - how to treat?

A

 Refer if cancer, Crohn’s to specialist

Drug treatment
 Vitamin D2 – for strict vegans (from plant sources)
 Vitamin D3 (cholecalciferol) for everyone else
• Loading dose of 300000 IU (50,000 IU once a week for 6 weeks) then daily 800IU maintenance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of osteomalacia - follow up?

A

 1 month of high-dose Vitamin D treatment
• Serum calcium levels

 3-6 months of high-dose Vitamin D treatment
• Serum 25(OH)D levels:
o IF <50 – refer to secondary care
o IF >50 and no symptoms of hypercalcaemia – maintenance dose of 800IU daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of child with Ricket’s?

A

o Refer is underlying cause
o Refer to paediatrician if symptoms of Ricket’s
o Drug Treatment
 Age 1-6 months – 3,000 IU daily for 8-12 weeks
 Age 6 months-12 years – 6,000IU daily for 8-12 weeks
 Age 12-18 years – 10,000IU daily for 8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Prognosis of osteomalacia?

A

o Correct management – restores levels and reduces risks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Complications of osteomalacia?

A 
o	Hypocalcaemia
o	20 hyperparathyroidism
o	Bone loss
o	Muscle weakness
o	Fragility fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Description of Paget’s disease of the bone?

A
  • Also called osteitis deformans
  • Increased bone turnover, increased osteoblasts and osteoclasts which results in:
    o Remodelling
    o Bone Enlargement
    o Deformity
    o Weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Epidemiology of Paget’s disease of the bone?

A
  • Incidence rises with age

- Commoner in temperate climates = England, USA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Risk factors of Paget’s disease of the bone?

A
  • Risk Factors
  • FHx
  • Paramyxoviruses
  • Male
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Symptoms of Paget’s disease of the bone?

A
  • Aymptomatic 70%
  • Deep, boring pain
  • Bony deformity and enlargement – typically pelvis, lumbar spine, skull, femur and tibia (classical bowed sabre tibia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

X-ray findings of Paget’s disease of the bone - Skull?

A

o Enlargement of bone
o Patchy cortical thickening with sclerosis, osteolysis and deformity (osteoporosis circumscripta of skull)

 Osteoporosis circumscripta – large, well-defined lytic lesions
 Cotton wool appearance – mixed lytic and sclerotic lesions
 Tam o-shanter sign – frontal bone enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

X-ray findings of Paget’s disease of the bone - spine?

A

 Picture frame sign – cortical thickening and sclerosis encasing margins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

X-ray findings of Paget’s disease of the bone - long bone?

A

 Blade of grass/candle flame – advancing tip of V-shaped osteolysis to diaphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Other tests to perform in Paget’s disease of the bone?

A
  • Bone scintigraphy
    o Hot spots of bone
  • Bloods
    o Ca and PO4 normal
    o ALP markedly raised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Management of Paget’s disease of the bone?

A
  • Analgesia – NSAIDs + paracetamol
  • Bisphosphonates
    o Salmon Calcitonin 2nd line
  • Monitor Ca & Vitmain D levels
  • Surgery – deformity, osteoarthritis, nerve compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Complications of Paget’s disease of the bone?

A 
o	Pathological fractures 
o	Osteoarthritis
o	High Calcium
o	Nerve compression
o	Osteosarcoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Types of bone tumours - benign?

A 
	Osteoid osteoma
	Chondroma, osteochondroma
	Fibroma
	Haemangioma
	Giant cell tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Types of bone tumours - malignant?

A 
	Osteosarcoma
	Chondrosarcoma
	Fibrosarcoma
	Ewing’s sarcoma, myeloma
	Angiosarcoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Description and management of osteoid osteoma?

A

o Usually <1cm in diameter and surrounded by dense osteoid
o Young adults
o Most common sites – tibia, femur, vertebrae
o Present with pain, worse at night, and relieved by NSAIDs
o X-ray – radiolucency surrounded by dense bone
o Management – local excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Description and management of osteochondroma?

A

o Sessile or pedunculated lesions arising from cortex of long bone adjacent to epiphyseal plate
o Often present in adolescence as cartilaginous overgrowth at epiphyseal plate
o Symptoms – painless lump, joint pain
o Management – excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Description and management of chondroma?

A

o Appears in tubular bones of hands and feet
o X-ray – well-defined osteopenic area in medulla
o Management – excision and bone graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Description and management of giant cell tumour?

A

o Aggressive, locally recurrent tumour with low metastatic potential
o Sub-articular cancellous region of lone bone – mostly in closed epiphyses around knee and distal radius
o Symptoms – 20-40 females
o X-ray – asymmetric rarefied area at end of long bone
o Management – wide excision and joint replacement, amputation if malignant or recurrent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Description and management of chondroblastoma?

A

o Rare, in epiphysis of long bones
o Symptoms – joint pain, muscle atrophy, tenderness
o Management – curettage and bone grafting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Description and management of osteoblastoma?

A

o Locally destructive progressive lesion found in vertebrae
o Presents with dull aching pain
o Needs biopsy to exclude malignancy
o Management – curettage/bone graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Description and management of osteosarcoma?

A

o Most common bone malignancy in children
o Occurs in metaphyses of long bone, around knee or proximal humerus
o Symptoms – painless mass, destroys bone and rapidly metastasises to lung
o X-ray – bone destruction and formation, soft-tissue calcification produces ‘sun-burst’ appearance
o Management – Surgical excision and mifamurtide and chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Description, symptoms, investigations, staging and management of Ewing’s sarcoma?

A

Common in white Caucasian <25, usually males
Symptoms – mass or swelling in long bones of arms, legs, pelvis, chest, pain in area, redness, anorexia, malaise, weight loss, paralysis, numbness, tingling if nerve affected
Investigations
 X-ray – Bone destruction with overlying onion-skin layers of periosteal bone formation
 Biopsy needed for diagnosis
 FBC and LDH prognostic markers
 CT/MRI
Management
 Chemotherapy (Vincristine, ifosfamide, doxorubicin, etoposide)
 Radiotherapy
 Surgery to remove tumour (limb saving or amputation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Symptoms of bone tumours?

A
  • Pain, swelling and localised tenderness

- Rapid growth and erythema suggest malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Referral from primary care if suspected bone sarcoma?

A

2-week (48 hours if child) X-ray if unexplained bone swelling or pain, then 2-week (48 hours if child) appointment if X-ray suggest possibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Referral from primary care if suspected soft tissue sarcoma?

A

urgent US (48 hours if child) if unexplained lump increasing in size, then 2-week (48 hours if child) appointment if US suggestive of soft tissue sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Description of SLE?

A
  • Multisystem autoimmune disease where autoantibodies are made against a variety of autoantigens (e.g. ANA)
  • Polyclonal B-cell secretion of autoantibodies causing tissue damage via immune complexes, deposition and complement activation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Epidemiology of SLE?

A
  • Women 9x, typically of child-bearing age

- More common in Afro-Caribbean, Asians

51
Q

Risk factors of SLE?

A 
o	HLA- DR3/2
o	EBV
o	Drugs
	Isoniazid, hydralazine, procainamide, quinidine, chlorpromazine, minocycline, phenytoin
	Disease remits if drugs stopped
52
Q

Symptoms of SLE?

A
  • Remitting and relapsing pattern

o Non-Specific - Malaise, fatigue, myalgia, fever, lymphadenopathy, weight loss, alopecia, non-infective endocarditis, Raynaud’s, migraine, stroke

53
Q

Criteria for diagnosis of SLE?

A 
o	If 4 or more/11 criteria:
Malar Rash (butterfly rash) - Fixed, erythema, flat or raised over malar eminences sparing  nasolabial folds

Discoid Rash - Erythematous raised patches with keratotic scales and follicular plugging +/- atrophic scarring - Affects ears, cheeks, scalp, forehead

Photosensitivity - On exposed skin, may also cause disease to flare

Oral Ulcers

Serositis - Pleuritis OR Pericarditis

Non-Erosive Arthritis - Involving 2 or more peripheral joints, reversible deforming arthropathy may occur due to capsular laxity (Jaccoud’s arthropathy) - Joint and muscle pain – early morning stiffness - Non-erosive

Renal Disorder - Persistent proteinuria OR Cellular casts

CNS disorders - Seizures OR Psychosis

Haematological disorders - Haemolytic Anaemias with reticulocytosis OR Leukopenia OR lymphopenia OR thrombocytopenia

Immunological disorders - Anti-dsDNA OR anti-Sm OR antiphospholipid antibody positive

Antinuclear antibody (ANA)

54
Q

Screening tests used in SLE?

A

o FBC
o ESR
o Plasma viscosity
o ANA

55
Q

Further tests performed in SLE?

A 
Antibodies
	ANA
	Anti-dsDNA
	Anti-Sm
	Anti-SSA/SSB
	Antiphospholipid syndrome
Complement – low C3 and C4
ESR raised
BP
Urinalysis and urine M, C &amp; S
FBC (normochromic, normocytic anaemia), U&amp;E, LFT, CRP
56
Q

Management of SLE - flare ups?

A

o IV cyclophosphamide + high-dose prednisolone

57
Q

Management of SLE - maintenance - general measures?

A

 Smoking Cessation
 Sun protection
 Exercise

58
Q

Management of SLE - maintenance - joint symptoms?

A

 NSAIDs and hydroxychloroquine
 Low-dose prednisolone
 Steroid sparing - Azathioprine, methotrexate and mycophenolate
 Cyclophosphamide reserved for life-threatening disease

59
Q

Management of SLE - maintenance - mucocutaneous disease?

A

 Sun protection
 Chlorhexadine, basic oral hygiene and dental appointments
 Artificial saliva preparations for dry mouth
 Hypromellose eye drops
 Hydroxychloroquine
 Low-dose prednisolone
 Steroid sparing - Azathioprine, methotrexate and mycophenolate

60
Q

Management of SLE - maintenance - lupus nephritis?

A

 Induction phase - prednisolone, cyclophosphamide or hydroxychloroquine
 Maintenance – azathioprine/mycophenolate + prednisolone
 BP control - ACEi, A-blockers or CCB
 Renal replacement therapy if disease progresses

61
Q

Management of SLE - maintenance - B-cell depletion?

A

 Belimumab if autoantibody positive SLE

62
Q

Prognosis of SLE?

A

o 5-year survival 95%

63
Q

Complications of SLE?

A 
o	Anaemia
o	Leucopenia
o	Thrombocytopenia
o	Steroid-related problems
o	Amenorrhoea or infertility due to cyclophosphamide
o	Pericarditis
o	Myocarditis
o	Endocarditis
o	Pleuritis
o	Pleural Effusion
64
Q

Description of systemic sclerosis?

A
  • Systemic sclerosis is multisystem autoimmune disease where there is increased fibroblast activity resulting in abnormal growth of connective tissue
    o Causes vascular damage and fibrosis in skin, GI, heart, lungs, other organs
    o Vascular manifestations unclude secondary Raynaud’s phenomenon, ischaemia of extremities, pulmonary arterial hypertension and renal disease
65
Q

Description of scleroderma?

A

o Scleroderma refers to dermatological component of systemic sclerosis
o Localised scleroderma called morphoea – excessive collagen deposition leading to thickening of dermis

66
Q

Symptoms of scleroderma?

A

 Plaques thickened, usually oval patches
 Mauve colour then change to ivory white in middles with lilac edges
 Surface is smooth and shiny

67
Q

Investigations of scleroderma?

A

 Deep punch biopsy

68
Q

Management of scleroderma?

A

 UVB phototherapy
 UVA phototherapy
 Methotrexate +/- prednisolone
 Topical tacrolimus, imiquimod

69
Q

Peak age for systemic sclerosis?

A

40-50

70
Q

Risk factors of systemic sclerosis?

A

o FHx
o CMV, parvovirus B19, HepB, EBV, Toxoplasma, H.pylori, chlamydia
o Pesticides, hair dye, silica
o Cocaine, bleomycin, penicillamine, vitamin K
o Vitamin D deficiency

71
Q

Types of systemic sclerosis?

A

o Limited cutaneous systemic sclerosis
 Areas of skin affected include only face, hands and feet
 Older term is CREST (calcinosis, Raynaud’s, oesophageal and gut dysmotility, sclerodactyly and telangiectasia)
 Associated with anticentromere antibodies

o Diffuse cutaneous systemic sclerosis
 Whole body and early organ fibrosis (lung, GI, cardiac and renal)
 Antitopoisomerase-1 & anti-RNA polymerase antibodies

72
Q

Symptoms of systemic sclerosis - the two types?

A
  • LcSSc
    o Milder disease, slow onset and slow progression
  • DcSSc
    o Rapid onset, skin thickening and Raynaud’s phenomenon occurring together and skin changes spread rapidly
    o Symptoms worse in first 3-5 years
73
Q

General features of systemic sclerosis?

A

o Fatigue

o Weight Loss

74
Q

Skin features of systemic sclerosis?

A 
o	Swelling of fingers and toes – sclerodactyly
o	Skin hard and thickened
o	Raynaud’s phenomenon
o	Calcinosis – nodules or lumps of chalky material
o	Tight facial skin and tight lips
o	Telangiectasia
o	Salt and Pepper appearance of skin
o	Dry skin
75
Q

MSK features of systemic sclerosis?

A

o Joint pain and swelling
o Myalgia
o Restricted joint movements

76
Q

GI features of systemic sclerosis?

A 
o	GORD
o	Oesophageal scarring
o	Fullness after meals
o	Reduced bowel motility
o	Constipation
77
Q

Pulmonary features of systemic sclerosis?

A 
o	Fibrosis (ILD) – exertional SOB, cough and crackles
o	Pulmonary arterial hypertension – exertional SOB, syncope, RV strain
78
Q

Cardiac features of systemic sclerosis?

A 
o	Microvascular CAD
o	Myocardial fibrosis
o	LV failure
o	Pericarditis
o	Arrhythmias
79
Q

Renal features of systemic sclerosis?

A

o Glomerulonephritis

o Reduced renal function

80
Q

GU features of systemic sclerosis?

A

o Erectile dysfunction

o Dysparenunia

81
Q

Investigations done in systemic sclerosis?

A 
-	Bloods
o	FBC
o	ESR and CRP
o	U&amp;E
-	Antibodies
o	Anti-topoisomerase 1 (anti-Scl 70)
o	Anti-centromere antibody (ACA)
o	Anti-RNA polymerase 3 antibody
-	Urine protein
82
Q

Management of acute systemic sclerosis?

A

Scleroderma Renal Crisis
 BP control – ACEi or CCB
 Renal dialysis or transplant

83
Q

Chronic management of systemic sclerosis - non-pharmacological?

A 
	Physiotherapy
	Exercise
	Stop smoking
	Emollients for skin dryness
	Maintain healthy weight
84
Q

Chronic management of systemic sclerosis - Pharmacological?

A

 Methotrexate, mycophenolate or cyclophosphamide

85
Q

Chronic management of systemic sclerosis - Raynaud’s Phenomenon?

A

 Avoid cold weather, stop smoking
 CCB (nifedipine)
 Aspirin
 If ulcers – PDE-5 inhibitors

86
Q

Chronic management of systemic sclerosis - skin?

A

 Topical emollient
 Topical/Oral prednisolone
 Antihistamine
 If thickening - Methotrexate, mycophenolate or cyclophosphamide

87
Q

Chronic management of systemic sclerosis - GI involvement?

A

 GORD – PPI

 Gastroparesis – Prokinetic agents (erythromycin, domperidone)

88
Q

Chronic management of systemic sclerosis - ILD?

A

 Prednisolone
 Azathioprine
 Continuous Oxygen therapy
 Lung transplant

89
Q

Chronic management of systemic sclerosis - pulmonary arterial hypertension?

A

 PDE-5 inhibitor
 Oxygen
 Lung transplant

90
Q

Monitoring in systemic sclerosis?

A

o Annual LFTs, Echos

o Monitor U&Es and BP closely

91
Q

Description of rotator cuff disorders?

A

o Subacromial pain which is felt in top and lateral side of shoulder
o Most common cause of shoulder pain, typically 35-75 and history of repetitive movements at shoulder height or heavy lifting
o Include:
 Tendinopathy
• Shoulder impingement – between acromion and rotator cuff tendons
 Partial rotator cuff tears

92
Q

Diagnosis of rotator cuff injury?

A

 Pain in top and lateral side of shoulder made worse by lifting arm or overhead activities
 Night pain
 Painful and restricted active movements
 Painful passive movements
 Painful arc syndrome – 70-120o of abduction

93
Q

Description of frozen shoulder?

A

o Stiffness and disability of shoulder
o Progressive restriction of both active and passive shoulder movement
o Typically 40-60, women
o Primary or secondary (trauma, rotator cuff tear, CVD, hemiparesis, diabetes, thyroid disease)

94
Q

Phases of frozen shoulder?

A

 Painful phase – lasts 2-9 months, pain on movement, severe and can disturb sleep
 Stiffness phase – lasts 4-12 months, less severe and reduced ROM
 Resolution phase – lases 12-42 months, improvement gradually

95
Q

Diagnosis of frozen shoulder?

A

 Gradual onset pain in deltoid region, worsening shoulder stiffness
 Restricted active and passive external rotation

96
Q

Description of shoulder instability?

A

o Abnormal movement of head of humerus
o Typically, <35 years, shoulder feeling out of joint or moves
o Causes pain, subluxation or dislocation

97
Q

Diagnosis of shoulder instability?

A

 Shoulder moves partly or feeling out of joint
 Ache or clicking
 Arm weakness, tingling
 Shoulder dislocation
• Anterior – fall onto outstretched hand, <20 years have 90% of further dislocation
• Posterior

98
Q

When to XR shoulder?

A
  • Anteroposterior and lateral shoulder XR:
    o History of trauma
    o Person not improving with conservative treatments
    o Movement restricted
    o Severe pain
    o Arthritis suspected
99
Q

Management of shoulder pain - when to refer urgently?

A 
	Trauma, pain and weakness, or sudden loss of ability to actively raise the arm
	Any shoulder mass or swelling
	Red skin, painful joint, fever
	Trauma leading to abnormal shape
	New inflammatory symptoms
	Systemic symptoms
	Acute rotator cuff tear
100
Q

Management of shoulder pain - initial management?

A 
	Analgesia
•	Paracetamol 1st line 
•	Oral NSAIDs or codeine added on
	Encourage carrying out normal daily activities if they are able
	Refer to physiotherapy
101
Q

Management of shoulder pain - when to refer to secondary care?

A

 Recurrent shoudler instability
 Post-traumatic pain
 Not improving after 3 months

102
Q

Management of rotator cuff disorders - general management?

A

o Rest in acute phase – avoid reaching overhead
o Resume normal activities when feel able to do so
o Analgesia
 Paracetamol 1st line
 Oral NSAIDs or codeine added on
o Exercises/Physio (6 weeks)
o Corticosteroid injection
 Give another after 6 weeks if improvement

103
Q

Management of rotator cuff disorders - referral?

A

 Not benefitted after 6 weeks of non-surgical treatment

104
Q

Management of rotator cuff disorders - surgery?

A

 Arthroscopic rotator cuff tendon repair if large

105
Q

Management of frozen shoulder?

A 
o	Avoid movements that worsen pain but continue to use to avoid stiffness
o	Heat packs
o	In bed, support arm with pillow
o	Analgesia
•	Paracetamol 1st line 
•	Oral NSAIDs or codeine added on
o	Physiotherapy (6 weeks)
o	Referral to secondary care:
	Pain or stiffness for 3 months and not benefitting from conservative measures
106
Q

Description of lateral epicondylitis (Tennis Elbow)?

A
  • Tendonosis affects attachment of tendons of extensor muscles of forearm to lateral epicondyle of humerus
107
Q

Epidemiology of lateral epicondylitis (Tennis Elbow)?

A
  • Prevalence of 1-3%, peak 35-55 years
  • Most commonly affected muscle is extensor carpi radialis brevis
  • Dominant arms in 75%
108
Q

Causes of lateral epicondylitis (Tennis Elbow)?

A

o Minor trauma – repetitive overuse causes micro-tears near origin of common extensor tendon which initiates degenerative process

109
Q

Activities associated of lateral epicondylitis (Tennis Elbow)?

A

o Tennis
o Plumbing
o Grip-tensive activities involving repetitive forceful elbow movements

110
Q

Symptoms of lateral epicondylitis (Tennis Elbow)?

A
  • Pain in lateral elbow, with wrist extension and reduced grip strength
    o Radiates down extensor aspect of forearm
    o Worsened by excessive and repetitive use of extensor muscles of forearm (strong gripping, repetitive wrist movements)
    o Occupations using vibratory machines worsen symptoms
  • Impacts on ADLs
111
Q

What is Mill’s Test?

A

o Straighten patients arm and palpate lateral epicondyle
o Fully flex wrist
o Pronate patients’ forearm
o If painful – positive test

112
Q

What is Cozen’s Test?

A

o Elbow 90 degree of flexion, patient makes a fist and deviates wrist radially with forearm pronated
o Resisted extension of wrist
o Pain in lateral epicondyle is positive result

113
Q

General management of lateral epicondylitis (Tennis Elbow)?

A

o Avoid heavy lifting, forceful gripping or twisting actions that may aggravate it
o Discuss with OH if work-related
 May mix work patterns, take more rest breaks, change handling procedures

114
Q

Further management of lateral epicondylitis (Tennis Elbow)?

A
  • Analgesia
    o Paracetamol and Ibuprofen gel 1st line
    o Oral if symptoms ongoing
    o Corticosteroid injection (may be repeated 2-3 times at 3-6 months intervals)
  • Physiotherapy
115
Q

When to refer to orthopaedics in lateral epicondylitis (Tennis Elbow)?

A

o Uncertain diagnosis
o Refractory pain
o Pain >12 months despite optimal treatment

116
Q

Prognosis of lateral epicondylitis (Tennis Elbow)?

A

Self-limiting and improves in about 80% of cases over 1-2 years

117
Q

Description of medial epicondylitis (Golfer’s elbow)?

A
  • Tendonosis of flexor forearm muscles which insert into medial epicondyle, causing medial elbow pain
118
Q

Causes of medial epicondylitis (Golfer’s elbow)?

A 
o	Golf and other sports
o	DIY
o	Computer use
o	Climbing
o	Use of vibrating tools
119
Q

Symptoms of medial epicondylitis (Golfer’s elbow)?

A
  • Pain and tenderness over medial epicondyle, radiating into forearm
    o Aggravated by wrist flexion and pronation
    o Gradual onset
120
Q

Tests done in medial epicondylitis (Golfer’s elbow)?

A
  • Golfer’s elbow test
    o Pronate and flex wrist and forearm at same time
    o Pain over medial epicondyle is positive test
121
Q

General measures of medial epicondylitis (Golfer’s elbow)?

A

o Avoid heavy lifting, forceful gripping or twisting actions that may aggravate it
o Discuss with OH if work-related
 May mix work patterns, take more rest breaks, change handling procedures

122
Q

Further management of medial epicondylitis (Golfer’s elbow)?

A
  • Analgesia
    o Paracetamol and Ibuprofen gel 1st line
    o Oral if symptoms ongoing
    o Corticosteroid injection (may be repeated 2-3 times at 3-6 months intervals)
  • Physiotherapy
123
Q

Referral to orthopaedics in medial epicondylitis (Golfer’s elbow)?

A

o Uncertain diagnosis
o Refractory pain
o Pain >12 months despite optimal treatment

MSRA Content (87 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions