MSK-SLA2 Flashcards
What are the key differences between Osteoarthritis and RA?
OA:
-in the morning stiffness less than 30 min
-usually larger joints- knees, hips, shoulders
-usually asymmetrical
RA:
-Younger
- Morning stiffness>30min
-smaller joints- DIPJ and PIPJ
What is the management for RA?
1.Monotherapy- with Methotrexate- with preds for flares
2.If not improving increase the dose of DMARDS
3. If still not improving give with another DMARD- like hydroxychloroquine
4. symptom control with NSAIDs
NON-PHARMOCOLOGICAL:
-Orthotics
-Exercise
-podiatrist assessment
Treatment for osteoarthirtis?
- NSAIDs Topical for pain control
- consider injections only when NSAIDS arent cutting it
NON-PHARM:
-Exercise- muscle strengthening
-weight management
-walking aid
What is the difference between mechanical and inflammatory back pain?
INFLAMMATORY BACK PAIN:
- insidious onset
-persistent
-<40 y/o
-improves with exercise
-worse with rest
-morning stiffness
-more common in men
MECHANICAL BACK PAIN:
-This is acute onset
-Usually the patient is older
-equally likely in men and women
Treatment of mechanical back pain?
NON-pharmacological:
-Exercise
-Manual loading
-weight loss
PHARMACOLOGICAL:
-oral NSAIDs with/without PPI cover
-Weak Opioids
What is the WHO Pain ladder?
Step 1- this is with basic analgesics- like Paracetamol/NSAIDs
Step 2- weak opioids- HYDROCODONE, CODEINE
Step 3- stronger opioids - MORPHINE, BUPRENORPHINE
Why is using the WHO PAIN ladder not entirely reliable in MSK conditions?
-Because it does focus the treatment solely on drugs- this reduces the focus on non-pharmacological treatment
-also with long term use this can result in addictions and dependencies
What is the difference between Knee bursitis and Knee effusions?
Bursitis is when there is fluid in the bursa- it does not move.
knee effusion is fluid in the synovium this does move with the patellar tap test
What are three main places on the hips that patients experience pain in and why?
-Anterior to groin- true hip pain- OA
-Laterally- this is trochanteric bursitis
-Lumbosacral/ gluteal muscles
What is trochanteric bursitis?
This is when there is inflammation of the bursa between the greater trochanter and muscles- as a result of trauma or overuse.
What is plantar fasciitis?
This is when there’s thickening of plantar fascia- usually occurs in patients who are on their feet a lot- this tends to be worse at the beginning of the day - the first few steps and then towards the end of the day
What is Metatarsalgia?
This is when the balls of the feet become painful- usually due to exercise or overuse
What is mortons neuroma?
This is a thickening of skin in the interdigital space where the digital nerve travels.
CAUSE- entrapment
symptoms- swelling between digits, pain between toes when walking
What is radicular pain?
This is pain that radiates from the hip to the leg through the spine- as a result of spinal nerve root compression
MYELOPATHIC PAIN V RADICULAR PAIN
Myelopathic is spinal cord compression
Symptoms of sciatica?
-This is shooting pain from the back to the leg
-tingling sensation
-MADE WORSE ON STRAIGHT LEG RAISE- where the sciatic nerve is stretched
-shooting/numb pain
What is painful arc syndrome?
pain on abduction of the shoulder- usually active, between 45-120degrees
GOLFERS V TENNIS ELBOW?
Golfers elbow - medial epichondyle inflammation-common flexor origin
Tennis elbow- Lateral epicondyle- common extensor origin
What is metastatic spinal cord compression?
This is when there is a tumour in the spinal cord which compresses on the nerve
What is the treatment/ management options for MSCC?
-Pain relief
-Bisphosphonates for prostate cancer mets
-Denosumab for breast cancer mets
-radiotherapy
What is the treatment for septic arthritis?
Flucloaxicillin - for 4-6 weeks
What are the red flag signs for MSCC?
Referred back pain
Escalating back pain
Different character to usual symptoms
Funny feeling
Lying flat increases the back pain
Agonising pain
Gait disturbances
Sleep disturbances because of pain
What is multiple myeloma?
this is a type of cancer that builds up in white blood cells- which in turn build up in the bone marrow.
What are the symptoms of Multiple myeloma?
Calcium elevation
Renal dysfunction
Anaemia
Back ache
What is the treatment for multiple myeloma?
-High dose chemotherapy and stem cell transplantation
-bortezomib if chemo isn’t suitable
What is POTTS spine?
This is also known as spinal TB- when there is haematogenous spread of TB from a central focus.
Symptoms of spinal TB?
-back pain
-spinal tenderness
-weight loss
-systemic symptoms
-night sweats
-loss of apetite
Treatment of Spinal TB?
-Isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months
and then isoniazid and rifampicin for 10 more months
What is vertebral osteomyelitis?
This is also known as spondylodiskitis and is when there is spread of an infection to the spine
What is the management for Cauda Equina syndrome?
-Spinal decompression within 48 hours- otherwise faecal and urinary incontinence can become permanent.
