MSK tutorial Flashcards
what is synovitis and what does it indicate?
inflammation of a synovial membrane
> feature of arthritis (active inflammation)
common causes
- gout
- RA
- sometimes OA
what is early morning stiffness an indicator of?
feature of RA
inflammatory arthritis
generalised and lasts >30mins = RA
a reduction in PASSIVE ROM/ pain on passive movement indicates problem with?
problem with joint itself e.g. foreign body, bony deformity, inflammation, contracture (fixed tightening)
a reduction in ACTIVE ROM/ pain on active movement indicates problem with?
muscles/ tendons
WHO pain ladder
stepwise
1) simple analgesia e.g. paracetamol
2) NSAIDs
3) opiates (codeine/ morphine)
- don’t forget non pharm approach e.g. physiotherapy.
function of bursae?
small fluid filled sacs which reduce friction between moving tendons and provide cushioning for the joint.
what is a knee effusion?
due to excess synovial fluid in joint capsule itself.
- fluid can be moved across the knee (bulge test) or (patellar tap)
what is unique about bursitis?
swelling is localised to the bursa that is affected.
intrapatellar bursitis
prepatellar bursitis
which type of hip pain appears laterally?
trochanteric bursitis
which type of hip pain appears posterior/posterolateral?
lumbosacral spine/ gluteal muscles
what is true hip pain?
e.g. from osteoarthritis
anterior to the groin
typical presentation of plantar fascitis
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
typical presentation of metatarsalgia
pain at the mid foot. wide range of causes.
typical presentation of Morton’s neuroma
tenderness in the inter-digit space where the neuroma is located
> one cause of metatarsalgia
what is radicular back pain?
nature of pain?
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
common pattern of pain with sciatica
back pain which radiates to buttock and posterior leg.
> worse when sciatic nerve is stretched (straight leg raise test)
what is painful arc?
indicates?
pain worse when?
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.
causes of presentation with pain in shoulder(s)
- referred pain from neck
- cardiac problems (MI/angina)
- lung problems (pancoast tumour)
- diaphragmatic pain (right shoulder pain from liver enlargement)
- polymyalgia rheumatica (bilateral)
Typical appearance of OA in the hands
- Heberden’s nodes (on distal IP joints)
- Bouchard’s nodes (on proximal IP joints) > less common!!
Typical appearance of RA in the hands
(acute v chronic)
acute episodes: affected
- proximal IP
- metacarphalangeal
- wrist
chronic
- ulnar deviation of the fingers
- swan neck
- boutonniere deformities
difference between swan neck and boutonniere deformities?
swan neck
- PIP hyperextension
- DIP flexion
boutonniere
- PIP flexion
- DIP hyperextension
what is lateral epicondylitis?
tennis elbow
- pain in lateral elbow with tenderness over common extensor origin
what is medial epicondylitis?
golfers elbow
- pain in medial elbow with tenderness over common flexor origin
when to suspect olecranon bursitis?
if fluctuant (usually non painful) swelling over the olecranon process of elbow
