msk patholgoies

Question 1

mx of rotator cuff lesions

Answer 1

pain control
rest
heat and ice
steriod joint injections
physio

Question 2

what pathology is painful restrition of all passive and active movements and is slow to imrpove taking 12-42 months to recover

Answer 2

froxen shoulder- adhesive capuslitits

Question 3

mx of frozen shoulder

Answer 3

exclude other arthritis - ESR , rhuematodi facotr and shoulder XR
analgesia
info about duration and progression of condition
nsaid
physio

Question 4

Inflammation of the common extensor origin at the lateral epicondyle of the
humerus

Related to repeated flexion/extension or pronation/supination of the forearm

Pain exacerbated by e.g. pouring from a jug or shaking hands

Pain lateral epicondyle, no swelling

Pain on flexion of wrist with bent elbow

Answer 4

lateral epicondylitis

Question 5

management of tennis elbow

Answer 5

rest
epicondylitis brace and USS
Ice
analgesia
Nsaid
steriod injections if risk of atrophy
surgery if recurrent

Question 6

Olecranon bursa enlarges due to pressure or friction

Painful bursitis – due to infection, gout, or rheumatoid arthritis

Infection can be precipitated by steroid injection

Investigation – aspiration for crystals, gram stain & culture, FBC,
inflammatory markers, blood culture

Answer 6

olecranon bursitis

Question 7

olecranon bursitis investigations

Answer 7

aspiration for crystals, gram stain & culture, FBC,
inflammatory markers, blood culture

Question 8

tx of olecranon bursitis

Answer 8

Infection – antibiotics +/- drainage and lavage

Uncomplicated – conservative

Inflammatory / crystal – steroid injection

Question 9

Pain

insidious onset

progressive

worse with exertion

Stiffness – worse after rest

Functional impairment

No systemic symptoms
Joint swelling

Bony enlargement

Joint deformity

Crepitus

Decreased range of movement

Muscle wasting

Answer 9

OA

Question 10

Heberden’s nodes on what joint - got a D in it

Answer 10

Heberden’s nodes (DIP joints)

Bouchards nodes (PIP joints)

Question 11

radiographic features of OA

Answer 11

Joint space narrowing (cartilage loss)

Osteophytes

Subchondral sclerosis - increased trabecular thickness

Bone cysts (myxoid degeneration)

Osteochondral “loose” bodies - islands of chondral metaplasia that have ossified

Question 12

OA management

Answer 12

Joint protection- Weight loss, Appliances e.g. walking stick and Modifying daily activities (occupational therapist)

Maintain aerobic fitness & joint stability

Pain control & ↓stiffness - Analgesia, Joint injection, Physiotherapy

Decreasing disability - OT , Coping strategies

Surgery - Arthroscopy, Joint replacement, Arthrodesis

Question 13

RF for gout

Answer 13

Male

> 40 years

Obesity

Alcohol

Hypertension

Family history

↓Urate excretion

Renal failure

Drugs- diuretics, laxatives, alcohol

↑Urate production

Cell lysis

Tumour lysis syndrome

Myeloproliferative disorders

Trauma

Drugs

Alcohol

Warfarin

cytotoxics

Question 14

mx of gout

Answer 14

Aspiration –

MC&S (exclude septic arthritis)

Polarised light microscopy for crystals

Negatively birefringent, needle shaped

Serum urate – may be normal, monitor after attack

Acute attack

NSAID

Colchicine

Steroids – oral or IM (must exclude septic arthritis first)

Prevention

Allopurinol – do not start in acute attack, can exacerbate

Question 15

can you start allopurinol in an acute attack of gout

Answer 15

no as can exacerbate gout

Question 16

Many differing presenting patterns

Pain, stiffness, symmetrical swelling of joints

Fatigue, malaise, weight loss, myalgia, morning stiffness

Any synovial joint can become affected

Systemic features usually develop as the disease progresses

Answer 16

rh

Question 17

mx of rh

Answer 17

Bloods - FBC, ESR, CRP, U&E, LFT, Rheumatoid factor

Rheumatologists, Specialist nurses
Physiotherapists – exercises, joint mobilisation, muscle strengthening
Occupational Therapists – splits, appliances, joint protection
Podiatrists – foot care
Orthotics – orthoses, specialist footwear

NSAID, Corticosteroids, Disease Modifying Drugs - need to blood monitor E.g. methotrexate, sulphasalazine, gold,
hydroxychloroquine etc

Biological Therapies- Anti-TNF: Infliximab, Etanercept For complications:
Anaemia – iron, erythropoietin (epo)
Osteoporosis – bisphosphonates,
oestrogens

Question 18

hand in RA signs

Answer 18

PIP and MCP swelling
sublaxation
dorsal guttering - prominence of extensor tendons
swan neck deformity
ulnar deviation

Question 19

volar plate fracture mechanism

Answer 19

A volar plate injury is commonly called a jammed or sprained finger. It happens when the finger is bent back or to the side too far (hyperextended).

The middle joint in a finger has 3 ligaments that wrap around it to move and support it. Ligaments are tissues that connect 2 bones together. They let a finger bend, straighten, and stop from bending too far back or sideways

Volar plate – A thick ligament on the underside of the middle finger joint. It keeps the finger from hyperextending back.

get pain and swelling of the front side of the finger
can get bursiing
lack of mvoement
avulsion fracture to partner

exect losts of brusiing with fratcure