MSK problems

Question 1

What is synovitis and what clinical condition does it suggest?

Answer 1

Inflam of synovial membrane indicating arthritis, mainly RA and gout, sometimes OA

Question 2

What does stiffness indicate?

Answer 2

Stiffness - reduced ROM, can cause pain to move.

Early morning stiffness indicative of RA.

Question 3

What are the causes of limited, painful active movement but full, pain free passive movement?

Answer 3

Problem with muscles and tendons would cause reduced ROM on active movement but no change on passive movement.

Question 4

What is the WHO pain ladder?

Answer 4

Gradually work your way up in strength of pain killers when treating pain.

• Paracetemol/NSAIDs = simple analgesia
• Codeine
• Opiates

Question 5

What are mechanical symptoms of the knee?

Answer 5

Locking or catching of the knee on movement, don’t just indicate a mechanical problem but common in any knee disease

Question 6

Bursitis of the knee vs knee effusion

Answer 6

Bursitis = inflam of the bursa, closed fluid filled sac

Knee effusion = excessive synovial fluid in joint capsule

Question 7

How can u differentiate between bursitis and knee effusion o/e?

Answer 7

Knee effusion - can move fluid across knee, special test - patellar tap and bulge test. In bursitis the swelling is localised.

Question 8

What causes of hip pain would produce pain in ant, lat and post hip area?

Answer 8

• Hip OA = ant
• Trochanteric bursitis = lat
• Gluteal muscle pain = post

Question 9

What are the clinical features of plantar fasciitis?

Answer 9

• Pain on sole of foot, heel and arch
• First steps out of bed are worst and then bad at end of day
• In people who spend lots of time on feet

Question 10

What is metatarsalgia? What is Morton’s neuroma?

Answer 10

Metatarsalgia = pain in the ball of the foot, usually due to lots of running and jumping.
Morton’s neuroma = tenderness in inter digital space, due to nerve to a toe being thickened

Question 11

What are the CF of gout? Which joints?

Answer 11

Most commonly the big toe. Severe pain due to uric acid deposition in joint.

Question 12

What is the management of acute gout and how can it be prevented?

Answer 12

Acute attack - colchicine or NSAID.
Long term - NSAIDs w PPI
Urate lowering therapy - allopurinol, febuxostat, start after an acute attack settled

Question 13

What are the CF of radicular back pain?

Answer 13

Pain caused by compression of a spinal root.

• Tingling/numbness/shooting pain
• Regions of pain = dermatomal

Question 14

What is a painful arc in the shoulder and what does this suggest?

Answer 14

Suggests impingement of rotator cuff muscle or bursae. Painful arc is 45-120 degrees of abduction

Question 15

What non shoulder pathology problems present w pain in one or both shoulders?

Answer 15

• Brachial plexus compression from Pancoast’s tumour
• Diaphragm pain eg. from hepatomegaly
• Heart attack
• Polymyalgia rheumatica
• Referred pain from neck eg. cervical spine radiculopathy

Question 16

OA vs RA presentation in hands

Answer 16

OA - asymmetrical, Heberden’s or Bouchard’s nodes

RA - symmetrical, swan neck or boutonniere deformities, morning stiffness

Question 17

What is tennis elbow?

Answer 17

Lateral epicondylitis, suspect in lat elbow pain w tenderness

Question 18

What is Golfer’s elbow?

Answer 18

Medial epicondylitis, suspect if pain is medial w tenderness

Question 19

What is olecranon bursitis?

Answer 19

Suspect if fluctuant non painful swelling over olecranon process of elbow

Question 20

What are the symptoms of pre patellar bursitis?

Answer 20

• Pain, swelling and redness of knees
• Difficulty kneeling or walking
• Fever = indicates septic bursitis

Question 21

How should bursitis be managed in primary care?

Answer 21

• Arrange bursal aspiration to rule out septic bursitis
• XR if suspect joint disease/trauma
• Bloods - CRP, ESR, uric acid, BM, ANA and RF
• RICE, activity mods and simple analgesics
• Corticosteroid injection if not responding to conservative measures
• Abx if suspect septic bursitis