MSK pathology (UL 2)

Question 1

What is articular vs peri-articular pain?

Answer 1

articular pathology presents with more global symptoms affecting all movements and may be inflammatory or degenerative (worse after repeated use)

Question 2

What is a sign of inflammation in a joint?

Answer 2

morning stiffness easing with movement

Question 3

What is acute rotator cuff tendonitis?

Answer 3

deposition of apatite (basic calcium phosphate) in the supraspinatous tendon, leads to an inflammatory reaction and swelling

Question 4

How does acute rotator cuff tendonitis present?

Answer 4

• young patients, complaining of aching pain following over-use
• pain increases to an intense climax, before resolving in a few days
• arm is held immobile
• joint will be tender to palpate

Question 5

What will be seen on X-ray in acute rotator cuff tendonitis?

Answer 5

XR will show calcification just above the greater tuberosity

Question 6

What is the management of acute rotator cuff tendonitis?

Answer 6

rest the arm in a sling and prescribe NSAIDS
severe pain may require intra-capsular corticosteroid/lignocaine injection
resolves in 1-3 weeks

Question 7

What is chronic rotator cuff tendonitis?

Answer 7

Over-use or minor tears of the rotator cuff initiate a subacute/chronic vascular response leading to pain and stiffness

Question 8

How does chronic rotator cuff tendonitis present?

Answer 8

pain in the shoulder, worse at night and when abducting/elevating the arm
there is tenderness just beneath the anterior edge of the acromion
painful arc present (60-120 degrees), with less pain when passively abducted
power is normal despite the pain (seperates it from a tear)
MRI/USS are diagnostic

Question 9

What is the management of chronic rotator cuff tendonitis?

Answer 9

NSAID analgesia
corticosteroid injection and physiotherapy if severe
Surgical Mx - arthroscopic decompression of rotator cuff

Question 10

What causes a rotator cuff tear?

Answer 10

complete tears are caused by trauma in the younger patient or happens spontaneously in the older patient
partial tears occur with and may precipitate chronic tendonitis (can repair naturally)

Question 11

How do rotator cuff tears present?

Answer 11

• patient will describe a ‘sprain’ in the shoulder with limited abduction after the event
• tenderness over the anterior acromion
• sudden arm drop when lowering arm (auction paradox)

Question 12

How can full and partial tears be differentiated?

Answer 12

intra-articular anaesthetic injection can distinguish between full and partial tears, as partial tears regain the abduction movement when the pain is abolished

diagnosis confirmed with USS, MRI or arthroscopy

Question 13

How are rotator cuff tears managed in the acute phase?

Answer 13

heat
exercises
local anaesthetic injection

Question 14

How are rotator cuff managed longer term?

Answer 14

extent of rupture fully assessed after 3 weeks
complete tear is surgically repaired in younger patients
partial tears are conservatively treated to allow natural healing

Question 15

What is subacromial bursisitis?

Answer 15

often due to repetitive overhead lifting, pulling or trauma

causes burning pain, worse when lifting above the head and stiffness when passively abducting the arm

Question 16

How is the diagnosis of subacromial bursitis confirmed?

Answer 16

USS/MRI to separate from cuff pathology

Question 17

How is subacromial bursitis treated?

Answer 17

non surgical approach

primarily NSAIDS and avoiding exacerbating movements

Question 18

What are the potential complications of rotator cuff pathology?

Answer 18

subluxation of the humeral head - loss of cuff stabilising effect
cuff arthopathy - rotator cuff pathology leads to a less stable humeral head in the GHJ and secondary arthritis

Question 19

What is painful arc/impingement syndrome?

Answer 19

the shoulder pathologies lead to swelling and oedema and decrease the space between the humeral head and acromion which leads to painful arc (from 80-120 degrees)

Question 20

How can articular and peri-articular pathology be differentiated using the painful arc/impingement syndrome?

Answer 20

impingement due to articular pathology will be painful on both active and passive movements
impingement due to peri-articular pathology will be less painful on passive movements (as inflamed muscle is not contracting)

Question 21

How does ACJ osteoarthritis present?

Answer 21

painful high arc

alongside crepitus and global pain/stiffness