MSK + Osteo

Question 1

Osteoarthritis
- disease burden
- diagnosis
- role of imaging
- managmeent
- medications with evidence
- medications to avoid

Answer 1

high disease burden
diagnosis is clinical
no role for imaging unless excluding alternate pathology
management: exercise, weight loss, CBT, education
Evidence for NSAIDs, Duloxetine, short lived benefits for intra-articular steroids
No evidence for paracetamol, opioids, pregabalin, intra-articular injections

Question 2

Rotator cuff tear
- frequency
- do symptoms correlate to US findings / severity?
- management

Answer 2

common and increase with advancing age
symptoms do not correlate with US findings
usually self resolving episodes
Manage with NSAIDs, time, physical therapy
Steroid injections have little evidence, no greater effect with US guidance

Question 3

Low back pain
- burden of disease
- diagnosis
- management

Answer 3

highest cause of disability
clinical
movement, education, avoid imaging
evidence for NSAIDs but risk ++
avoid everything else

Question 4

Fibromyalgia
clinical features
cause
management

Answer 4

widespread pain, non-pain symptoms are prominent
central sensitisation, “nosiplastic” pain
movement practice, education, CBT, attention to sleep
Can try TCA, duloxetine for mood prominent symptoms or pregabalin for sleep prominent symptoms
No evidence for opioids