MSK Medicine Flashcards
What is a screening assessment used for MSK presentation?
GALS screen
-Gait
-Arms
-Legs
-Spine
What is synovitis?
Inflammation of a synovial membrane
What are some common causes of synovitis?
RA
Gout
Sometimes OA when degeneration causes inflammation
How does synovitis present?
Swelling
Pain
Warmth
Define stiffness
Slowness or difficulty moving one or more joints
What conditions feature early morning stiffness?
Inflammatory arthritis:
-RA
-Psoriatic Arthritis
-Ankylosing spondylitis
-Gout and pseudogout
What problem is indicated when active movement is painful/limited but has full range of passive movement?
Problem with the muscles and tendons as they are functioning in active but not passive movement
What is the WHO pain ladder?
For acute pain
Stepwise approach to analgesia, NSAIDs and stronger analgesia
What is the problem with using WHO ladder for chronic MSK pain?
Risk of side effects with prolonged use
Risk of addiction
Risk of neglecting non-pharmacological options e.g. physiotherapy
What are ‘mechanical’ symptoms of the knee?
Locking or catching of the knee on movement
What is bursitis?
Inflammation of bursa (fluid filled sacs that surround joints to reduce friction)
What is a joint effusion?
Swelling due to excess synovial fluid in joint capsule
How can you differentiate between bursitis and a joint effusion?
In an effusion, fluid can be moved across joint but bursitis the swelling is localised to bursa affected
What is lateral hip pain suggestive of?
Trochanteric bursitis
What is anterior hip pain suggestive of?
‘true’ hip pain e.g. osteoarthritis
What is posterior/posterolateral hip pain suggestive of?
Lumbosacral spine or gluteal muscle issue
What are some clinical features of plantar fasciitis?
-pain at insertion of plantar fascia into calcaneum
-occurs in people who spend lots of time on feet
-pain is marked with first few steps on getting out of bed
-worsens again at end of day
What is metatarsalgia?
Pain in mid foot
One cause is Mortons neuroma - tenderness in inter-digital space where neuroma is located
What is gout?
Form of inflammatory arthritis due to Uric acids crystal deposition in joint
What joint is most commonly affected by gout?
Great toe
How does gout present?
Rapid onset of severe pain, swelling and joint inflammation (warm)
What treatment is used to prevent gout?
Allopurinol - lowers urate levels in blood
How is acute gout managed?
-Analgesia
-NSAIDs
-Steriods if NSAIDs aren’t working
-rest
What is radicular back pain?
Pain caused by irritation or impingement of a nerve root
Felt in a dermatomal pattern
Pain described as shooting or numb
May be other neurological symptoms e.g. weakness
What is painful arc?
Pain in mid range (45-120degrees) of abduction of shoulder
Eases at greater range of abduction
What does painful arc indicate?
Impingement do the shoulder in the sub-acromial space with movement
E.g. catching of rotator cuff tendons or shoulder bursae
Pain more pronounced on active movement
What other conditions can present with shoulder pain?
-Referred pain from neck
-Cardiac -MI, angina
-Lung -Pancoast tumour
-Diaphragmatic pain - right shoulder pain from liver enlargement
-Polymyalgia rheumatica (bilateral)
How does the appearance of OA and RA differ in the hands?
OA- heberdens nodes (distal IP joints), Bouchards nodes (proximal IP joints)
RA: acute- proximal IP, MCP and wrist affected
Chronic- ulnar deviation, swan neck and boutonnière deformity
What is tennis Elbow?
Lateral epicondylitis
Pain in lateral elbow
Tenderness over common extensor origin
What is golfers elbow?
Medial epicondylitis
Pain in medial elbow
Tenderness over common flexor origin
What is olecranon bursitis?
Inflammation of olecranon bursae
Non painful swelling over olecranon process of elbow
