MSK Rx Flashcards
Acute Osteomyelitis
Supportive care
Rest + splintage
Abx - flucloxacillin + benzylpenicillin
Surgical drainage / lavage
Chronic Osteomyelitis
Long-term Abx - gentamicin
Surgically eradicate infection
? Amputation
Tuberculosis in bone and joint
8w - rifampicin, isoniazid, pyrazinamide, ethambutol
6m - rifampicin, isoniazid
Rest + splint age
Operative drainage
Acute Septic Arthritis
General supportive measures Abx 3-4w Surgical drainage Open / arthroscopic lavage Infected joint replacements
Adhesive Capsulitis
frozen shoulder
Hydrodilatation (early presentation)
Surgery (later presentation)
Subacromial Impingement Syndrome
Subacromial steroid injection
Physiotherapy
Arthroscopic subacromial decompression
Rotator Cuff Tear
Early surgery
Superior capsular reconstruction (in massive irreparable tear - cadaveric skin graft used to reconstruct capsule)
Shoulder Dislocation
Manipulation
Immobilisation
Physiotherapy
Surgery
Lateral Epicondylitis
tennis elbow
Rest + massage
Analgesia (NSAIDs)
Local corticosteroid injection
Surgery
Medial Epicondylitis
golfers elbow
Rest + massage
Analgesia (NSAIDs)
Local corticosteroid injection
Surgery
Olecranon Bursitis
Aspiration
Avoidance of activities causing pressure to elbow
Analgesia (NSAIDs)
Dupuytren’s Disease
Non-operative
- observe
- radiotherapy
Operative
- partial fasciectomy
- dermo-fasciecotmy
- arthrodesis (fusion of joint)
- amputation
Percutaneous needle fasciotomy
Collagenase
Trigger Finger
Non-operative
- splintage
- steroids
Operative
- percutaneous release
- open surgery
De Quervain’s Tenovaginitis
Non-operative
- splintage
- steroid injection
Operative
- decompression
Basal Thumb Osteoarthritis
Non-operative
- lifestyle modifications
- NSAIDs
- splint
- steroid injections
Operative
- trapeziectomy
- fusion
Carpal Tunnel Syndrome
Bracing or splinting
NSAIDs
Steroid inejctions
Open / endoscopic carpal tunnel release
Cubital Tunnel Syndrome
Avoidance of actions which cause Sx
Hand therapist
Surgery
Osgood Schlatter’s Disease
Rest
Stretching exercises
NSAIDs
Rheumatoid Arthritis
DMARDs
- methotrexate
- hydroxychloroquine
Biologics
- rituximab
- infliximab
Corticosteroids (for pain relief)
- prednisolone
- prednisone
JAK inhibitors
Pain relief
- paracetamol
- NSAIDs
Osteoporosis
Hormone replacement therapy Selective oestrogen receptor modulator (SERM) Bisphosphonates Denosumab Teriparatide
Osteomalacia
Vitamin D supplements
Calcium supplements
Phosphorus supplements
Rickets
Vitamin D supplements
Spend time in the sun
Paget’s Disease
Don’t treat asymptomatic
IV bisphosphonate therapy
Gout
Acute attack
- NSAIDs
- colchicine
- steroids
Xanthine oxidase inhibitors - allopurinol
Pseudogout
NSAIDs
Intra-articular steroids
Polymyalgia Rheumatica
Prednisolone
Bone prophylaxis
Ankylosing Spondylitis
Physiotherapy NSAIDs DMARDs - sulfasalazine Anti-TNF - infliximab Anti-IL-17 Joint replacements / spinal surgery
Psoriatic Arthritis
DMARDs - sulfasalazine / methotrexate Cyclosporine Anti-TNF - infliximab Anti-IL-17 and IL-23 Steroids - prednisolone Physiotherapy Occupational therapy
Reactive Arthritis
Reiter’s Syndrome
Acute
- NSAIDs
- joint injection
- Abx in chlamydia infection
Chronic
- NSAIDs
- DMARD - sulfasalazine / methotrexate
Systemic Lupus Erythematosus
Mild
- topical NSAIDs
- lifestyle changes - less time in the sun
- hydroxychloroquine
Moderate
- methotrexate
- steroid injections for flare ups
Severe
- cyclophosphamide
- rituximab
Sjogren’s Syndrome
Mild - hydroxychloroquine
Moderate - methotrexate
Severe - cyclophosphamide
Polymyositis
Mild - hydroxychloroquine
Moderate - methotrexate
Severe - cyclophosphamide
IV immunoglobulin
Dermatomyositis
Mild - hydroxychloroquine
Moderate - methotrexate
Severe - cyclophosphamide
Giant Cell Arteritis
Prednisolone
IV methylprednisolone if visual loss
Juvenile Idiopathic Arthritis
1st line
- simple pain kilers
- NSAIDs
2nd line
- methotrexate
- Anti-TNF
Developmental Dysplasia of the Hip
Pavlik harness if <6 months
Open / closed reduction surgery if >6 months
Perthes’ Disease
Maintain hip motion Analgesia - NSAIDs Crutches Restrict painful activities Consider osteotomy
Slipper Upper / Capital Femoral Epiphysis
- in situ screw fixation
- open reduction + internal fixation with surgical hip disloacation
- bone graft epiphysiodesis
- prophylactic fixation of contralateral hip
Benign / Malignant Bone Tumour
Chemotherapy
Surgical removal
Radiotherapy
Osteoarthritis
Non-pharma
- thermotherapy
- electrotherapy
- aids and devices
- manual therapy
Pharma
- oral analgesia - paracetamol / NSAIDs
- topical treatments - NSAIDs / capsaicin
- intra-articular injections - steroids / hyaluronic acid
Joint replacement surgery
Arthrodesis (joint immobilisation)
Achilles Tendinosis
Non-operative
- activity modification
- weight loss
- shoe wear modification
- physiotherapy
- extra-corporeal shockwave therapy
- immobilisation
Operative
- gastrocnemius recession
- release and debridement of tendon
Plantar Fasciosis / Fasciitis
Rest, ice, change training Stretching NSAIDs Orthoses - heel pads Physiotherapy Weight loss Injections - corticosteroid Night splinting
Charcot’s Neuroarthropathy
Prevention - good diabetic control
Acute fragmentation:
- immobilisation / non-weight bearing
Correct deformity
Trochanteric Bursitis
NSAIDs Relative rest / activity modification Physiotherapy Corticosteroid injection Surgery
Avascular Necrosis
Non-operative
- reduce weight-bearing
- NSAIDs
- bisphosphonates
- anticoagulants
- physiotherapy
Operative
- restore blood supply w/ cord decompression ± vascularised graft
- rotational osteotomy
- total hip replacement
Femoroacetabular Impingement
Non-operative
- activity modification
- NSAIDs
- physiotherapy
Operative
- arthroscopy
- open surgery - resection / osteotomy / hip arthroplasty
Labral Tear of the Hip
Non-operative
- activity modification
- NSAIDs
- physiotherapy
- steroid injections
Operative
- arthroscopy
Meniscal Tear of the Knee
Non-operative
- rest
- NSAIDs
- physiotherapy
Operative
- arthroscopy
Anterior Cruciate Ligament Rupture
Non-operative
- quadriceps focussed training programme
Operative - ACL reconstruction ± partial meniscectomy ± ligament repair or augmentation - hamstring graft
Medial Collateral Ligament Rupture
Non-operative
- rest and NSAIDs
- physiotherapy
- knee brace for comfort
Operative
- repair + reconstruction
Osteochondritis dissecans
Non-operative
- restricted weight-bearing
- ROM brace
Operative
- arthroscopy
- open fixation
Sciatica
Analgesia - paracetamol / NSAIDs Exercise Heat / cold compression packs / ice Physiotherapy Surgery - lumbar laminectomy / discectomy
Osteogenica imperfecta
Bisphosphonates
Pre-emptive surgical pinning
