MSK + Rheum Flashcards
DDx for 6wks localised right heel pain, no obvious trauma (5)
- Right plantar fascitis
- Right achilles tendinopathy
- Right tender heel pad
- Right retrocalcaneal bursitis
- Right tibialis posterior tendinopathy
Dislocated shoulder from posterior force. ?exam findings (4)
- Arm held in slight abduction + external rotation
- Humeral head can be felt anterior to glenohumeral fossa
- Reduced global range of motion
- Loss of normal contour of deltoid
Recent traveller with arthritis, also complaining of conjuctivitis and dysuria.
?Condition and common causes (3)
Reactive arthritis
- Urethritis + conjuctivitis+-iritis + arthritis
Urogenital infection - chalmydia trachomatis
GI infections - Shigella + Salmonella
Patient noticed one foot feels more flat than the other
?Dx
Posterior tibialis tendon rupture
- often middle aged women
- uncommon for obvious discomfort at moment of rupture -> just note suddenly foot feels flat
- “too many toes” test when standing 3m behind patient
Calcaneal apophysitis (SEVER DISEASE)
- increased density of the calacneal apophysis
- typical between 7-14yrs
- loss of fat/soft tissue planes in the region of the retrocalcaneal bursa
Lisfranc injury
- plantar echymoses
- displacement of the metatarsals from the tarsus
-> particualry 2nd tarso-metatarsal joint
10-20yo, pain in thigh at night
Relief post NSAIDs
Osteoid Osteoma
- benign tumour
Features of general OA management (6)
- Individualised goals (function + QoL)
- Education (including reassurance)
- Optimise other co-morbidities
- Weight reduction (if relevant)
- Exercise (programs with physio)
- Medications
Dx?
Gout
- discrete punched out lesions
- slightly different to erosions seen in RA
-> also not preserved joint otherwise
Mx?
Humerus fracture
- most shaft AND SNOH fractures in GP can be managed with sling OR collar+cuff
Child with ulna fracture. What must you check + what is it called when present?
Need to check radial location
Ulna # + dislocated radial head = MONTEGGIA fracture
Child with clavicle fracture. Mx?
Broad arm sling for 2-3wks (or until comfortable)
- for mid 1/3 fractures
Acute referral for:
- Off ended
- Open
- Lateral third
KFP: Muscle tear or tendinitis management (non acute) - (6)
- Muscle stretching with specific example
- Muscle strengthening with specific example
- Avoid aggravating activity with example
- Graded return to activity over 4-8wks
- Refer to physio
- Apply warmth
AVOID RICE unless in first 48hrs
Mx of distal radius buckle fracture in kid (3)
Plaster back slab (or removable wrist splint) for 3wks
No follow-up required
**If both radius + ulna - likely need ortho advice
Kid with sore wrist ?Managment
This is distal radius fracture (NOT BUCKLE)
therefore:
- full below elbow cast for 6wks
- Fracture clinic with XR within 1wk
KFP DDx for paediatric hip pain (7)
- Transient synovitis
- Truama
- NAI
- Septic arthritis or OM
- <4yo - Toddlers fracture
- 4-10 - Perthes disease
- > 10 SUFE
2yo has bowed out legs, with intercondylar measurement of 3cm
Management? (3)
Genu Varum
- reassure that most physiological
- advise usually bow legged until 3, most resolve by 3
- Refer if >6cm at 4yrs, asymmetrical or not improving
5yo boy has bilateral knocked knees
You’ve measured something important at 5cm
?Management (2), when to Ix+ refer (4)
Genu Valgum
- physiological, often seen 3-5yo, most resolve by 8yo
- Measure intermalleolar distance standing with knees together
Investigate + refer if:
- Unilateral
- IM distance >8cm
- progressing
- lack of spontaneous resolution by 8
KFP: Anklylosing spondylitis, worsening symptoms affecting function. What non pharma management options? (3)
- Refer to rheumatologist for escalation of treatment
- Refer to physio for tailored exercise program
- Refer to physio for guided hydrotherapy
Child with hip + knee pain. External rotation of lef during passive flexion at hip ?
SUFE
- Drehmans sign
Non pharma Mx of fibromyalgia (3)
- Refer to PT for graded aerobic exercise
- Refer to psychologist for CBT
- Refer to Fibromyalgia support group
Pharmacological Mx of fibromyalgia (3)
- Amitriptyline nocte
- Gabapentanoid (gabapentin nocte)
- SNRI (duloxetine)
Radial nerve assessment - sensation + motor (1+3)
Backward fingerless glove for 3.5
Extension, supination + thumbs Up
Ulna nerve assessment - sensation + motor
Sensation: last 1.5
Motor: finger add/abduct
Median nerve assessment - sensation + motor
Sensation: palmar 3.5
Motor: pincer OK, pronation
45M eversion injury, sore ankle. XR - next step?
Possible Maisonneuve fracture
- combination of proximal fibula fracture PLUS unstable ankle injury (WIDENING of the ankle mortise on XR)
2 common knee pains associated with activity
- Patella tendinopathy - “Jumpers knee”
- gradual onset, localised below knee - Patellofemoral syndrome - “runners or joggers knee”
- aggravated during activity - stairs, squatting
- frozen after sitting
