MSK tutorial - solo learning Flashcards
1
Q
What three questions are asked in GALS?
A
- Do you have any pain or stiffness in any of your joints, muscles or back?
- Are you able to dress yourself without any difficulty?
- Can you walk up and down the stairs without any difficulty?
2
Q
What is involved in gait?
A
Smoothness, symmetry and ability to turn quickly
3
Q
What else to assess when patient stood up?
A
- Muscle bulk - trapezius, shoulder girdle
- Spine straight?
- Iliac crests level?
- Gluteal muscle bulk and size?
- Popliteal fossa swelling?
- Hindfoot deformities
4
Q
What to assess in spine?
A
- From side of patient
- Normal cervical lordosis?
- Normal thoracic kyphosis?
- Normal lumbar lordosis?
- Bend forward and touch toes, assess lumbar spine movement with fingers, fingers should come together when pt comes up
5
Q
What to check in arms?
A
- Normal anatomical position - normal elbow exension
- Symmetry
- Muscle bulk - pectoralis and shoulder
- Jaw side to side - TMJ related to RA
- Elbows back and behind head - glenohumoural, elbow flexion, function assessment
- Hands out infront - pronate
- Inspect hands - swelling, skin changes, deformity
- Palms - muscle bulk, tendon thickening
- Fist -
- Touch each finger together
- Grip strength
- Squeeze MCPJ
6
Q
What is involved in leg assessment?
A
- Knee flexion
- Hip flexion
- Internal rotation hip - push leg outwards
- Both sides
- Patella tap - fluid?
- Sweep test?
- Inspect feet - callous? squeeze MTPJ and look for pain
7
Q
If no problem with gals…
A
Record GALS NAD
8
Q
What does GALS stand for?
A
- Gait
- Arm
- Legs
- Spine
9
Q
Function of GALS
A
- Screening for function of joints
- Used to identify problems which require more focused assessment
10
Q
OA of the knee exam findings
A
- Complain of - pain on walking, grinding sensation
- Muscle wasting
- Inability to fully extend knee
- Normal temp joint
- Normal patella tap
- Positive sweep test?
- Limited knee flexion
- Crepitus felt on full ROM
- Tenderness when flexed knee palpated
- Normal anterior drawer test
- Normal collateral ligament tests - maybe uncomfy
- Varus deformity on standing?
- Stick to mobilise?
- Slow walk - antalgic?
11
Q
Inflammatory arthiritis of feet findings
A
- Antalgic gait
- Symmetrical deformities feet
- Clawing toes
- Normal temp and foot pulses
- Squeeze MTPJ - some tenderness
- Palpate painful joints - tender
- Normal midfoot, ankle and subtalar palpation
- Normal dorsi/plantar flexion, inversion and eversion
- Stiffness on individual IPJ
- Loss ROM ankle joint and toes
- Flat foot walk - inability to stand on toes
12
Q
Rheumatoid arthirits findings - hands
A
- Bilateral, symmetrical
- Polyartropathy
- Ulnar deviation
- Subluxation
- Z deformity thumb
- Boutonierre deformity
- Good power and pincer grip
- If no pain/tenderness - disease may be inactive currrently
13
Q
What is synovitis?
A
- Inflammation (swelling, pain and warmth) of synvoial membrane
- Feature of arthirits when there ois active inflammation
- Causes inc RA and gout
- Can occur in OA if degen process causes inflammation
14
Q
What is stiffness and early morning stiffness?
A
- Difficulty moving one or more joints
- Early morning = stiffness on getting out of bed/staying in one position
- Indicates inflammatory arthritis
- Usually lasts more than 30 mins on waking to be RA
15
Q
Likely causes of limited or painful active movement but with full, pain free passive movement
A
- Passive movement does not require pt to use own nerves, muscles and tendons to produce movement
- Reduction in passive range/pain on passive indicates joint problem (foreign body, deformity, inflam)
- Problem with muscles, tendons etc would cause pain on active movement but not passive
16
Q
What is WHO pain ladder?
A
- Developed for acute pain
- Stepwise
- Simple analgesia (eg paracetamol)
- NSAIDs
- Stronger analgesics eg opioids
- Also used for cancer pain
17
Q
When can pain ladder be problematic?
A
- Chronic pain - risk of side effects and habituation with prolonged regular use of analgesics
- Addiction to opiates can occur
- Risk of neglecting non-pharmacological options eg physio/psychological pain management
18
Q
Mechanical symptoms of knee
A
- Locking/catching of the knee
- Suggest loose body/meniscal tear
- But they are quite common in knee disease even without obvious obstruction
19
Q
What is bursitis? How to differentiate from effusion of knee?
A
- Bursa reduce friction between tendons and cushion joint, surround joint
- Knee effusion is swelling due to excess synovial fluid within joint capsule
- Knee effusion fluid can be moved across knee - bulge test and patella tap causes fluid to move
- In bursitis, swelling is localised to bursa
20
Q
What causes of hip pain would produce pain in anterior, lateral and posterior hip area?
A
- True hip pain from OA - anterior to the groin
- Trochanteric bursitis - laterally to hip
- Posterior/posterolateral - lumbosacral spine/gluteal muscles
21
Q
Clinical features of plantar fasciitis
A
- Pain at insertion of plantar fascia into the calcaneum
- Occurs in people who spend a lot of time on their feet
- Pain is marked with first few steps on getting out of bed, worsens again to the end of the day
22
Q
In metatarsalgia, what would make you suspect Mortons neuroma?
A
- Pain in midfoot = metatarsalgia
- Mortons neuroma = inter-digital space tenderness where neuroma is located
23
Q
Clinical features of gout
A
- Quite rapid onset
- Severe pain
- Marked swelling and evidence of inflammation of joint
- Recurrent
24
Q
Which joints most affected by gout?
A
- Great toe - first MTPJ
25
Preventative measures for gout
* Allopurinol - lowers uric acid levels
26
Acute treatment of episode of gout
* NSAIDs eg naproxen
* Colchicine
* Consider oral steroids eg prednisolone or intra-articular injection of steroid if NSAIDs and colchicine not worked/not tolerated
27
What features in history and exam identify radicular back pain?
* Radicular = impingement/irritation of nerve root
* Felt in dermatomal area
* Shooting/numb and can have other neurological signs eg weakness, ankle hyporeflexia
28
Sciatica radicular pain
* Pain radiates from buttock and posterior leg
* Worse when nerve is stretched - eg straight leg raise test
29
What is painful arc in shoulder?
* Pain in mid range of abduction of shoulder - 45 to 120 degress
* Eases at greater range of abduction
* Pain more pronounced on active than passive movement
30
What does painful arc indicate?
Indicates impingement of shoulder - catching of rotator cuff tendons or shoulder bursae in subacromial space with movement
31
Besides shoulder pathology, what other problems may present with pain in one/both shoulders?
* Referred pain from neck - cervical spine radiculopathy
* Cardiac problems - MI, angina
* Lung problems - pancoast tumour
* Diaphragm pain - right shoulder from liver enlargement
* Polymyalgia rheuemtica - bilateral
32
Appearance of OA vs RA hands
* OA - Herberdens nodes - on distal IP joints, Bouchards less common (on proximal)
* RA - proximal IPJ, MCPJ and wrist are commonly affected, may see ulnar deviation, swan neck and boutonierre
33
Tennis elbow, golfers elbow and olecranon bursitis
* **Tennis elbow** - lateral epicondylitis, suspect if pain in lateral elbow with tenderness over common extensor origin
* **Golfers elbow** - medial epicondylitis - pain in medial elbow, tenderness over common flexor origin
* **Olecranon bursitis** - fluctuant, non painful swelling over olecranon process of elbow
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