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Year 2 > MSK: Part 6 > Flashcards

MSK: Part 6 Flashcards

1
Q

Why do we need to be precautioned with Mechanical Lower Back pain

A
  1. Very common

2. Sinister causes of backspin include malignancy, infection or inflammatory causes

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2
Q

What are the red flags for serious lower back pain/spinal pathology

A
  1. Age of onset less than 20 or greater than 55
  2. Violent trauma (car accident)
  3. Constant, progressive, non-mechanical pain
  4. Thoracic pain
  5. Systemic steroids, drug abuse or HIV
  6. Systemically unwell, weight loss
  7. Persisting severe restriction of lumbar flexion
  8. Widespread neurology
  9. Structural deformity
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3
Q

What activities can cause common back pain

A
  1. Stooping
  2. Twisting whilst lifting
  3. Exposure to whole body vibration
  4. Psychosocial distress
  5. Smoking
  6. Dissatisfaction with work
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4
Q

Main causes of back pain

A
  1. Lumbar disc prolapse
  2. Osteoarthritis
  3. Fractures
  4. Spondylolisthesis
  5. Heavy manual handling
  6. Stooping and twisting whilst lifting
  7. Exposure to whole body vibration
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5
Q

Risk factors for back pain

A
  1. Smoking
  2. Work
  3. FEMALE (recurrent)
  4. AGE (recurrent)
  5. Pre-existing chronic widespread pain - fibromyalgia (recurrent)
  6. Psychosocial factors
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6
Q

Clinical presentation for back pain

A
  1. Back is stiff and a scoliosis (where spine twists and curves to the side) may be present when patient is standing
  2. Muscular spasm is visible and palpable + causes local pain and tenderness
  3. Pain is unilateral
  4. Episodes are short-lived and self-limiting
  5. Sudden onset
  6. Morning stiffness is absent
  7. Excersise aggravates pain
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7
Q

What structures can be a source of lower back pain

A
  1. Spinal movement occurs at the disc and posterior facet joints - stability achieved by spinal ligaments and muscles
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8
Q

Where do lesions in lumbar spondylosis occur

A

Intervertebral disc

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9
Q

Role of the intervertebral disc

A

Rotation and bending of spine

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10
Q

Describe the structure of an intervertebral disc

A

Fibrous structure whose tough capsule inserts into the rime of the adjacent vertebra

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11
Q

At what age do changes in the disc start to happen in lumbar spondylosis

A
  1. Teenage years or early twenties and increases in age
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12
Q

What happens to the inner gel layer of the intervertebral disc

A

Gel changes chemically, breaks up, shrinks and loses its compliance

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13
Q

What happens to the surrounding fibrous zone of the intervertebral disc

A

Develops circumferential issues

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14
Q

Clinical presentation of Lumbar spondylosis

A

Initially asymptomatic but visible on MRI as decreased hydration

Later - discs become thinner and less compliant

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15
Q

How does the changes in the intervertebral disc effect the intervertebral ligaments

A

Causes circumferential bulging

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16
Q

What happen in the adjacent vertebra of lumbar spondylosis

A

Reactive changes develop: bone becomes sclerotic and osteophytes form around the rim of the vertebra

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17
Q

What are the most common sites for lumbar spondylosis

A

L5/S1 and L4/L5

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18
Q

What is seen in young people with lumbar spondylosis

A
  1. Disc prolapse through adjacent vertebral end-plate produces SCHMORL’s NODE on X-ray
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19
Q

Consequence of Schmrol’s node

A

Painless but accelerates disc degeneration

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20
Q

What can lumbar spondylosis cause if not asymptomatic

A
  1. Episodic spinal pain
  2. Progressive spinal stiffening
  3. Facet joint pain
  4. Acute disc prolapse, with or without nerve too irritation
  5. Spinal stenosis
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21
Q

What syndrome is caused by lumbar spondylosis

A
  1. Secondary osteoarthritis of misaligned facet joints
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22
Q

When is pain in facet joints worse

A

Bending backwards and when straightening from flexion

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23
Q

Where is pain felt in facet joint syndrome

A

Lumbar

Uni or bilateral and radiates to the buttocks

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24
Q

Diagnosis of facet joint syndrome

A

MRI - shows facet joints and osteoarthritis, an effusion or ganglion cyst

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25
Q

Treatment of facet joint syndrome

A

Direct corticosteroids injections under imaging

Physiotherapy to reduce weight

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26
Q

What is fibrositic nodulous

A
  1. Tender nodules in upper buttock and along iliac crest
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27
Q

Where is pain felt in fibrositic nodulous

A
  1. Unilateral and bilateral low back and buttock pain
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28
Q

Treatment of fibrositic nodulous

A
  1. Local intraleisonal corticosteroid injections
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29
Q

Why is low back pain common in pregnancy

A
  1. Altered spinal posture and increased ligamentous laxity
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30
Q

How is low back pain in pregnancy treated

A
  1. Weight control, pre and postnatal excursuses are helpful + settles after delivery
  2. AVOID analgesics and NSAIDs
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31
Q

How does posture cause chronic back pain

A

Poor sitting posture - obesity and muscular weakness

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32
Q

Differential diagnosis of lower back pain

A

Raised ESR and CRP could show polymyalgia rheumatica

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33
Q

How is back pain diagnosed if red flags are present

A
  1. Spinal X-rays
  2. MRI over CT (better for bone pathology )
  3. Bone scans
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34
Q

How is lower back pain treated if red flags are present

A

1, Urgent neurosurgical referral

  1. Analgesia (PARACETAMOL or CODEIEN)
  2. Combined physiotherapy, back muscle trainmen regimens and manipulations
  3. Acupuncture
  4. Excessive rest AVOIDED
  5. Re-edcation in lifting and exercises to prevent further attacks of pain
  6. Comfortable sleeping position using a mattress of medium (not hard) firmness
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35
Q

What are high risk activities for MSK problems

A
  1. Heavy manual handling
  2. Lifting above shoulder height
  3. Lifting below knee height
  4. Incorrect manual handling technique
  5. Forceful repetitive work
  6. Poor posture
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36
Q

After back pain, what is he most common type of MSK pain

A

Mechanical tension neck

37
Q

What define chronic mechanical tension neck

A

More than 6 months

38
Q

What is thoracic outlet syndrome

A

Pain or tingling down arms or blanching of fingers related to posture of arms

Wasting of hands

39
Q

What causes thoracic outlet syndrome

A
  1. Compression of the brachial plexus or subclavian artery/vein in th neck
  2. Cervical rib, cervical band or other abnormalities in the neck
40
Q

What environmental factors are associated with thoracic outlet syndrome

A
  1. Poor posture, loading of shoulders and working at a keyboard
  2. Roos sign
  3. X-ray neck, MRI scan
41
Q

How is thoracic outlet syndrome treated

A

Surgery

42
Q

What is rotator cuff tendonitis

A
  1. Rotator cuff tendon tears leading to swelling and further impingement beneath arch
43
Q

Risk factors for rotator cuff tendonitis

A
  1. Heavy manual handling
  2. Lifting above shoulder height
  3. Thorwing
44
Q

What gender is carpal tunnel syndrome more common in

A

Females

45
Q

How is carpal tunnel syndrome caused

A
  1. Compression of median nerve by flexor tendons - gives pain, numbness, tingling and weakness + wasting of muscles supplied by median nerve
46
Q

What diseases are associated with carpal tunnel syndrome

A
  1. Obesity
  2. Short stature
  3. Pregnancy
  4. Diabetes
  5. Hypothyroidism
    .6. RA
47
Q

What occupations have th biggest risk for carpal tunnel syndrome

A
  1. Repetitive work with abnormal wrist postures - extremes of flexion-extension of wrist
48
Q

In which gender is tenosynovitis more common

A

FEMALES

49
Q

What is tenosynovitis

A

Local tenderness and swelling of tendons in the wrist

50
Q

Clinical presentation of tenosynovitis

A

Crepitus

  1. Pain on resisted movements
  2. High risk job is one with forceful and repetitive hand movements (hammering)
  3. Finkelstein’s test (Pull thumb in ulnar devaluation and should cause pain along extensor policies brevis)
51
Q

How is tenosynovitis treated

A

NSAIDs, steroid injections and rest

52
Q

What is hand-arm vibration syndrome

A

Raynaud’s phenomenon of industrial origin caused by hand-transmitted vibration

Eligible for state benefit

53
Q

What is medial and lateral epicondylitis

A
  1. Medial - pain against flexion of wrist

2. Lateral - pain against resisted extension of the wrist

54
Q

Risk factors for epicondylitis

A
  1. Tennis (lateral epicondylitis)

2. Golfers

55
Q

treatment of epicondylitis

A
  1. NSAIDs
  2. Steroid injection
  3. Rest and surgery
56
Q

What are infections of the joint usually caused by

A

Bacteria

57
Q

What is septic arthritis

A

Acutely inflamed joints that can destroy a joint in under 24 hours!!

58
Q

What joint tends to be affected in septic arthritis

A

Knee

59
Q

how do joints become infected in septic arthritis

A

Direct injury or blood-bourne infection from infected skin lesion or other site

60
Q

Main causes of septic arthritis

A
  1. STAPHYLOCOCCUS AUREUS
  2. Streptococci
  3. Neisseria gonorrhoea
  4. Haemophilus influenza in children
  5. Grma-negative bacteria (e.coli or pseudomonas aerguinosa)
61
Q

Risk factors for epic arthritis

A
  1. Pre-existing joint disease - especially RA (chronically inflamed joints are at more risk of infection than normal joints)
  2. Diabetes mellitus
  3. Immunosuprresion
  4. Chronic renal failure
  5. Recent joint surgery
  6. Prosthetic joints
  7. IV drug abuse
  8. Over 8- and infants
  9. Recent intra-articular steroid injection
  10. Direct/penetrating trauma
62
Q

Clinical presentation of septic arthritis

A
  1. PAIN, red, swollen and hot joint in young
  2. In elderly, signs are muted
  3. Might not use joint - children (limping)
  4. Fever
  5. Monoarthritis
  6. Knee, hip and shoulder
63
Q

What is seen in early infection of septic arthritis

A
  1. Wound inflammation/discharge, joint effusion, loss of function and pain
64
Q

What is seen in late infection of septic arthritis

A

Presents with pain or mechanical dysfunction

65
Q

Differential diagnosis of septic arthritis

A
  1. Gout - monosodium urate crystals

2. Pseudogout - calcium pyrophosphate crystals

66
Q

Diagnostics of septic arthritis

A
  1. JOINT ASPIRATION
  2. FBC
  3. Polarised light microscopy
  4. X-ray
67
Q

Results of joint aspiration in septic arthritis

A
  1. Send fluid for urgent gram-stating and culture

2. Thick fluid due though WCC

68
Q

When are antibiotics given for septic arthritis

A

After ASPIRATION of joint

69
Q

FBC result for septic arthritis

A

ESR, CRP and WCC raised (CRP may not always be raised)

70
Q

X-ray results for septic arthritis

A
  1. Loosening or bone loss around a previously well fixed implant will suggest infection
71
Q

Treatment for septic arthritis

A
  1. STOP methotrexate and anti-TNF alpha
  2. DOUBLE prednisolone dose if already on prednisolon
  3. Joint should be IMMOBILISED early with physiotherapy to prevent stiffness and muscle wasting
  4. DOUBLE IV ANTIBIOTICS after aspiration
  5. Joint drainage repeatedly oil effusion stops - PAIN RELIEF
  6. NSAIDS
72
Q

What antibiotics are given in septic arthritis

A
  1. IV FLUCLOXACILLIN (gram-negatives)
  2. IV ERYTHROMYCIN/CLINDAMYCIN (if allergic to penicciln)
  3. IV CEFOTAXIME (gram-NEGATIVES or gonococcal)
  4. IV VANCOMYCIN (MRSA)
73
Q

If immunocompromised, what antibiotics are given in septic arthritis

A

IV FLUCLOXACILLIN + GENTAMYCIN

74
Q

How long are antibitotcsi given for

A

2 weeks

75
Q

How is antibiotics effecacity monitored

A

ESR and CRP

76
Q

Surgical washout vs joint drainage repeatedly

A

More pleasant and comfortable

77
Q

What is a rare cause for joint infection in INFANTS due to standard childhood immunisation schedule in the UK

A

Haemophilus influenza

78
Q

What causes gonococcal arthritis

A

GRAM NEGATIVE

Neisseria Gonorrhoea

79
Q

What joints does gonococcal arthritis involve

A

Joints secondary to genital,r ectal or oral infections

80
Q

What is the most common cause of septic arthritis in fit young adults

A

gonorrhoea infection

81
Q

Clinical presentation of gonococcal arthritis

A

Fever

Characteristic pustules on distal limbs as well as polyarthralgia and tenosynovitis

82
Q

Diagnosis of gonococcal arthritis

A
  1. Culture blood + fluid
83
Q

Treatment of gonococcal arthritis

A
  1. ORAL PENICILLIN
  2. CIPROFLOXACIN
  3. DOXYCYCLINE

for 2 weeks

84
Q

What is meningococcal arthritis

A
  1. migrating polyarthritis

2. results from deposition of circulating immune complexes containing meningococcal antigens

85
Q

Treatment of meningococcal arthritis

A

PENICILLIN

86
Q

Clinical presentation of epicondylitis

A
  1. Cozen’s test (extending wrist against will - pain in lateral epicondyle)
  2. Weakness in grip
  3. Pain in lateral or medial epicondyle
87
Q

What is repetitive strain disorder mistaken for

A
  1. Tenosynovitis and epicondylitis
88
Q

Clinical presentation of rotator cuff problems

A

Hawkins sign

Pain

89
Q

What is Hawkin’s sign

A

Inward movement of the arm while the rotator cuff is kept still

Year 2 (155 decks)

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