MSK tutorial

Question 1

what is synovitis and what does it indicate?

Answer 1

inflammation of a synovial membrane

> feature of arthritis (active inflammation)

common causes
- gout
- RA
- sometimes OA

Question 2

what is early morning stiffness an indicator of?

feature of RA

Answer 2

inflammatory arthritis

generalised and lasts >30mins = RA

Question 3

a reduction in PASSIVE ROM/ pain on passive movement indicates problem with?

Answer 3

problem with joint itself e.g. foreign body, bony deformity, inflammation, contracture (fixed tightening)

Question 4

a reduction in ACTIVE ROM/ pain on active movement indicates problem with?

Answer 4

muscles/ tendons

Question 5

WHO pain ladder

Answer 5

stepwise
1) simple analgesia e.g. paracetamol
2) NSAIDs
3) opiates (codeine/ morphine)

• don’t forget non pharm approach e.g. physiotherapy.

Question 6

function of bursae?

Answer 6

small fluid filled sacs which reduce friction between moving tendons and provide cushioning for the joint.

Question 7

what is a knee effusion?

Answer 7

due to excess synovial fluid in joint capsule itself.

• fluid can be moved across the knee (bulge test) or (patellar tap)

Question 8

what is unique about bursitis?

Answer 8

swelling is localised to the bursa that is affected.

intrapatellar bursitis
prepatellar bursitis

Question 9

which type of hip pain appears laterally?

Answer 9

trochanteric bursitis

Question 10

which type of hip pain appears posterior/posterolateral?

Answer 10

lumbosacral spine/ gluteal muscles

Question 11

what is true hip pain?

Answer 11

e.g. from osteoarthritis

anterior to the groin

Question 12

typical presentation of plantar fascitis

Answer 12

pain at the insertion of plantar fascia into the calcaneum (bone forming heel)

• occur in those who spend a lot of time on feet.
• worse on first few steps of day
• worse at end of day

Question 13

typical presentation of metatarsalgia

Answer 13

pain at the mid foot. wide range of causes.

Question 14

typical presentation of Morton’s neuroma

Answer 14

tenderness in the inter-digit space where the neuroma is located

> one cause of metatarsalgia

Question 15

what is radicular back pain?

nature of pain?

Answer 15

caused by irritation or impingement of a nerve root.
> felt in dermatomal area supplied by the root.

• shooting/ numb
• other neurological symptoms e.g. weakness/ ankle Hyporeflexia

Question 16

common pattern of pain with sciatica

Answer 16

back pain which radiates to buttock and posterior leg.
> worse when sciatic nerve is stretched (straight leg raise test)

Question 17

what is painful arc?

indicates?
pain worse when?

Answer 17

pain in the mid range (45-120 degrees) of abduction of the shoulder, eases with greater range of abduction.

> indicates impingement of shoulder (catching of rotator cuff tendons or shoulder bursae) in the sub acromial space.

> more pronounced on active than passive movement.

Question 18

causes of presentation with pain in shoulder(s)

Answer 18

• referred pain from neck
• cardiac problems (MI/angina)
• lung problems (pancoast tumour)
• diaphragmatic pain (right shoulder pain from liver enlargement)
• polymyalgia rheumatica (bilateral)

Question 19

Typical appearance of OA in the hands

Answer 19

• Heberden’s nodes (on distal IP joints)
• Bouchard’s nodes (on proximal IP joints) > less common!!

Question 20

Typical appearance of RA in the hands
(acute v chronic)

Answer 20

acute episodes: affected
- proximal IP
- metacarphalangeal
- wrist

chronic
- ulnar deviation of the fingers
- swan neck
- boutonniere deformities

Question 21

difference between swan neck and boutonniere deformities?

Answer 21

swan neck
- PIP hyperextension
- DIP flexion

boutonniere
- PIP flexion
- DIP hyperextension

Question 22

what is lateral epicondylitis?

Answer 22

tennis elbow
- pain in lateral elbow with tenderness over common extensor origin

Question 23

what is medial epicondylitis?

Answer 23

golfers elbow
- pain in medial elbow with tenderness over common flexor origin

Question 24

when to suspect olecranon bursitis?

Answer 24

if fluctuant (usually non painful) swelling over the olecranon process of elbow