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
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2
Q

Risk factors of seronegative arthritis?

A

o HLAB27

o FHx

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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
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4
Q

What is psoriatic arthritis?

A

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

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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

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6
Q

Investigations in seronegative arthritis?

A
  • Bloods
    o ESR and CRP raised
    o Urate, RF, ANA normal
  • X-ray
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7
Q

Management of seronegative arthritis?

A
  • Treat the type of spondylopathy
  • Exercise, physiotherapy
  • NSAIDs
  • DMARDs
  • Surgery – joint replacements
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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
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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

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10
Q

Regulation of vitamin D?

A

o Production regulated by PTH on kidneys

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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
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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

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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
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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

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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)

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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
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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

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18
Q

Investigations considered if underlying cause suspected in osteomalacia?

A
	Bone profile
	U&amp;E
	LFT
	TFT
	PTH
	FBC, ferritin
	RA
	CRP/ESR
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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

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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

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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

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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

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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

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24
Q

Prognosis of osteomalacia?

A

o Correct management – restores levels and reduces risks

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25
Complications of osteomalacia?
``` o Hypocalcaemia o 20 hyperparathyroidism o Bone loss o Muscle weakness o Fragility fractures ```
26
Description of Paget's disease of the bone?
- Also called osteitis deformans - Increased bone turnover, increased osteoblasts and osteoclasts which results in: o Remodelling o Bone Enlargement o Deformity o Weakness
27
Epidemiology of Paget's disease of the bone?
- Incidence rises with age | - Commoner in temperate climates = England, USA
28
Risk factors of Paget's disease of the bone?
- Risk Factors - FHx - Paramyxoviruses - Male
29
Symptoms of Paget's disease of the bone?
- Aymptomatic 70% - Deep, boring pain - Bony deformity and enlargement – typically pelvis, lumbar spine, skull, femur and tibia (classical bowed sabre tibia)
30
X-ray findings of Paget's disease of the bone - Skull?
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
31
X-ray findings of Paget's disease of the bone - spine?
 Picture frame sign – cortical thickening and sclerosis encasing margins
32
X-ray findings of Paget's disease of the bone - long bone?
 Blade of grass/candle flame – advancing tip of V-shaped osteolysis to diaphysis
33
Other tests to perform in Paget's disease of the bone?
- Bone scintigraphy o Hot spots of bone - Bloods o Ca and PO4 normal o ALP markedly raised
34
Management of Paget's disease of the bone?
- Analgesia – NSAIDs + paracetamol - Bisphosphonates o Salmon Calcitonin 2nd line - Monitor Ca & Vitmain D levels - Surgery – deformity, osteoarthritis, nerve compression
35
Complications of Paget's disease of the bone?
``` o Pathological fractures o Osteoarthritis o High Calcium o Nerve compression o Osteosarcoma ```
36
Types of bone tumours - benign?
```  Osteoid osteoma  Chondroma, osteochondroma  Fibroma  Haemangioma  Giant cell tumour ```
37
Types of bone tumours - malignant?
```  Osteosarcoma  Chondrosarcoma  Fibrosarcoma  Ewing’s sarcoma, myeloma  Angiosarcoma ```
38
Description and management of osteoid osteoma?
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
39
Description and management of osteochondroma?
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
40
Description and management of chondroma?
o Appears in tubular bones of hands and feet o X-ray – well-defined osteopenic area in medulla o Management – excision and bone graft
41
Description and management of giant cell tumour?
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
42
Description and management of chondroblastoma?
o Rare, in epiphysis of long bones o Symptoms – joint pain, muscle atrophy, tenderness o Management – curettage and bone grafting
43
Description and management of osteoblastoma?
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
44
Description and management of osteosarcoma?
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
45
Description, symptoms, investigations, staging and management of Ewing's sarcoma?
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)
46
Symptoms of bone tumours?
- Pain, swelling and localised tenderness | - Rapid growth and erythema suggest malignancy
47
Referral from primary care if suspected bone sarcoma?
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
48
Referral from primary care if suspected soft tissue sarcoma?
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
49
Description of SLE?
- 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
50
Epidemiology of SLE?
- Women 9x, typically of child-bearing age | - More common in Afro-Caribbean, Asians
51
Risk factors of SLE?
``` o HLA- DR3/2 o EBV o Drugs  Isoniazid, hydralazine, procainamide, quinidine, chlorpromazine, minocycline, phenytoin  Disease remits if drugs stopped ```
52
Symptoms of SLE?
- Remitting and relapsing pattern o Non-Specific - Malaise, fatigue, myalgia, fever, lymphadenopathy, weight loss, alopecia, non-infective endocarditis, Raynaud’s, migraine, stroke
53
Criteria for diagnosis of SLE?
``` 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
Screening tests used in SLE?
o FBC o ESR o Plasma viscosity o ANA
55
Further tests performed in SLE?
``` Antibodies  ANA  Anti-dsDNA  Anti-Sm  Anti-SSA/SSB  Antiphospholipid syndrome Complement – low C3 and C4 ESR raised BP Urinalysis and urine M, C & S FBC (normochromic, normocytic anaemia), U&E, LFT, CRP ```
56
Management of SLE - flare ups?
o IV cyclophosphamide + high-dose prednisolone
57
Management of SLE - maintenance - general measures?
 Smoking Cessation  Sun protection  Exercise
58
Management of SLE - maintenance - joint symptoms?
 NSAIDs and hydroxychloroquine  Low-dose prednisolone  Steroid sparing - Azathioprine, methotrexate and mycophenolate  Cyclophosphamide reserved for life-threatening disease
59
Management of SLE - maintenance - mucocutaneous disease?
 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
Management of SLE - maintenance - lupus nephritis?
 Induction phase - prednisolone, cyclophosphamide or hydroxychloroquine  Maintenance – azathioprine/mycophenolate + prednisolone  BP control - ACEi, A-blockers or CCB  Renal replacement therapy if disease progresses
61
Management of SLE - maintenance - B-cell depletion?
 Belimumab if autoantibody positive SLE
62
Prognosis of SLE?
o 5-year survival 95%
63
Complications of SLE?
``` 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
Description of systemic sclerosis?
- 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
Description of scleroderma?
o Scleroderma refers to dermatological component of systemic sclerosis o Localised scleroderma called morphoea – excessive collagen deposition leading to thickening of dermis
66
Symptoms of scleroderma?
 Plaques thickened, usually oval patches  Mauve colour then change to ivory white in middles with lilac edges  Surface is smooth and shiny
67
Investigations of scleroderma?
 Deep punch biopsy
68
Management of scleroderma?
 UVB phototherapy  UVA phototherapy  Methotrexate +/- prednisolone  Topical tacrolimus, imiquimod
69
Peak age for systemic sclerosis?
40-50
70
Risk factors of systemic sclerosis?
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
Types of systemic sclerosis?
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
Symptoms of systemic sclerosis - the two types?
- 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
General features of systemic sclerosis?
o Fatigue | o Weight Loss
74
Skin features of systemic sclerosis?
``` 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
MSK features of systemic sclerosis?
o Joint pain and swelling o Myalgia o Restricted joint movements
76
GI features of systemic sclerosis?
``` o GORD o Oesophageal scarring o Fullness after meals o Reduced bowel motility o Constipation ```
77
Pulmonary features of systemic sclerosis?
``` o Fibrosis (ILD) – exertional SOB, cough and crackles o Pulmonary arterial hypertension – exertional SOB, syncope, RV strain ```
78
Cardiac features of systemic sclerosis?
``` o Microvascular CAD o Myocardial fibrosis o LV failure o Pericarditis o Arrhythmias ```
79
Renal features of systemic sclerosis?
o Glomerulonephritis | o Reduced renal function
80
GU features of systemic sclerosis?
o Erectile dysfunction | o Dysparenunia
81
Investigations done in systemic sclerosis?
``` - Bloods o FBC o ESR and CRP o U&E - Antibodies o Anti-topoisomerase 1 (anti-Scl 70) o Anti-centromere antibody (ACA) o Anti-RNA polymerase 3 antibody - Urine protein ```
82
Management of acute systemic sclerosis?
Scleroderma Renal Crisis  BP control – ACEi or CCB  Renal dialysis or transplant
83
Chronic management of systemic sclerosis - non-pharmacological?
```  Physiotherapy  Exercise  Stop smoking  Emollients for skin dryness  Maintain healthy weight ```
84
Chronic management of systemic sclerosis - Pharmacological?
 Methotrexate, mycophenolate or cyclophosphamide
85
Chronic management of systemic sclerosis - Raynaud's Phenomenon?
 Avoid cold weather, stop smoking  CCB (nifedipine)  Aspirin  If ulcers – PDE-5 inhibitors
86
Chronic management of systemic sclerosis - skin?
 Topical emollient  Topical/Oral prednisolone  Antihistamine  If thickening - Methotrexate, mycophenolate or cyclophosphamide
87
Chronic management of systemic sclerosis - GI involvement?
 GORD – PPI |  Gastroparesis – Prokinetic agents (erythromycin, domperidone)
88
Chronic management of systemic sclerosis - ILD?
 Prednisolone  Azathioprine  Continuous Oxygen therapy  Lung transplant
89
Chronic management of systemic sclerosis - pulmonary arterial hypertension?
 PDE-5 inhibitor  Oxygen  Lung transplant
90
Monitoring in systemic sclerosis?
o Annual LFTs, Echos | o Monitor U&Es and BP closely
91
Description of rotator cuff disorders?
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
Diagnosis of rotator cuff injury?
 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
Description of frozen shoulder?
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
Phases of frozen shoulder?
 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
Diagnosis of frozen shoulder?
 Gradual onset pain in deltoid region, worsening shoulder stiffness  Restricted active and passive external rotation
96
Description of shoulder instability?
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
Diagnosis of shoulder instability?
 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
When to XR shoulder?
- 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
Management of shoulder pain - when to refer urgently?
```  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
Management of shoulder pain - initial management?
```  Analgesia • Paracetamol 1st line • Oral NSAIDs or codeine added on  Encourage carrying out normal daily activities if they are able  Refer to physiotherapy ```
101
Management of shoulder pain - when to refer to secondary care?
 Recurrent shoudler instability  Post-traumatic pain  Not improving after 3 months
102
Management of rotator cuff disorders - general management?
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
Management of rotator cuff disorders - referral?
 Not benefitted after 6 weeks of non-surgical treatment
104
Management of rotator cuff disorders - surgery?
 Arthroscopic rotator cuff tendon repair if large
105
Management of frozen shoulder?
``` 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
Description of lateral epicondylitis (Tennis Elbow)?
- Tendonosis affects attachment of tendons of extensor muscles of forearm to lateral epicondyle of humerus
107
Epidemiology of lateral epicondylitis (Tennis Elbow)?
- Prevalence of 1-3%, peak 35-55 years - Most commonly affected muscle is extensor carpi radialis brevis - Dominant arms in 75%
108
Causes of lateral epicondylitis (Tennis Elbow)?
o Minor trauma – repetitive overuse causes micro-tears near origin of common extensor tendon which initiates degenerative process
109
Activities associated of lateral epicondylitis (Tennis Elbow)?
o Tennis o Plumbing o Grip-tensive activities involving repetitive forceful elbow movements
110
Symptoms of lateral epicondylitis (Tennis Elbow)?
- 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
What is Mill's Test?
o Straighten patients arm and palpate lateral epicondyle o Fully flex wrist o Pronate patients’ forearm o If painful – positive test
112
What is Cozen's Test?
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
General management of lateral epicondylitis (Tennis Elbow)?
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
Further management of lateral epicondylitis (Tennis Elbow)?
- 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
When to refer to orthopaedics in lateral epicondylitis (Tennis Elbow)?
o Uncertain diagnosis o Refractory pain o Pain >12 months despite optimal treatment
116
Prognosis of lateral epicondylitis (Tennis Elbow)?
Self-limiting and improves in about 80% of cases over 1-2 years
117
Description of medial epicondylitis (Golfer's elbow)?
- Tendonosis of flexor forearm muscles which insert into medial epicondyle, causing medial elbow pain
118
Causes of medial epicondylitis (Golfer's elbow)?
``` o Golf and other sports o DIY o Computer use o Climbing o Use of vibrating tools ```
119
Symptoms of medial epicondylitis (Golfer's elbow)?
- Pain and tenderness over medial epicondyle, radiating into forearm o Aggravated by wrist flexion and pronation o Gradual onset
120
Tests done in medial epicondylitis (Golfer's elbow)?
- Golfer’s elbow test o Pronate and flex wrist and forearm at same time o Pain over medial epicondyle is positive test
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General measures of medial epicondylitis (Golfer's elbow)?
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
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Further management of medial epicondylitis (Golfer's elbow)?
- 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
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Referral to orthopaedics in medial epicondylitis (Golfer's elbow)?
o Uncertain diagnosis o Refractory pain o Pain >12 months despite optimal treatment