Musculoskeletal Flashcards
Where is pain and stiffness felt in PMR?
- Neck
- Shoulders
- Pelvic girdle
What cdtn is PMR associated with?
GCA (aka temporal arteritis)
Epidemiology of PMR
> 50 yrs
White
Female
Describe the features of PMR:
1. How long is it present for?
2. Where is the pain?
3. Pain exacerbated?
4. When and how long is stiffness present?
5. Systemic features?
- Pain present for >2 wks
- Bilateral shoulder pain - can radiate to elbow, bilateral pelvic girdle pain
- Pain worse with movement and can interfere with sleep
- Stiff AM and lasts 45 min
- low grade fever, wgt loss, fatigue, low mood
DDx of PMR
OA
RA
SLE
Fibromyalgia
Hypothyroidism
Myositis
Ix for PMR
FBC
U&E
Infl Markers -> CRP and ESR (inc) - since PMR is an inflammatory cdtn!
Calcium
Serum protein electrophoresis
Can do other Ix to rule out ddx
Tx of PMR
STEROIDS!!!
Improvement should be seen within 1 wk of steroid use if it’s PMR
What is fibromyalgia?
Chronic cdtn characterised by widespread pain and hypersensitivity to pressure
Fibro = fibrous tissue
Mya = Muscle tissue
Algia = Pain
Fibromyalgia symptoms?
- Chronic widespread pain
- Hypersensitivity to pressure
- Fatigue and sleep disturbance
- Cognitive impairment
- Paresthesia (pins and needles)
- Muscle spasms
How to diagnose fibromyalgia?
- 9 pairs of tender points
- Duration of > 3 mths
Tx for fibromyalgia
No cure
Exercise
CBT
What are the commonly Affected Joints in osteoarthritis?
Hips
Knees
Distal interphalangeal (DIP) joints in the hands
Carpometacarpal (CMC) joint at the base of the thumb
Lumbar spine
Cervical spine (cervical spondylosis)
X-ray changes in osteoarthritis
L – Loss of joint space
O – Osteophytes (bone spurs)
S – Subarticular sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone)
Sx of osteoarthritis
Joint pain and stiffness - worsen with activity and at the end of the day.
Bulky, bony enlargement of the joint
Restricted range of motion
Crepitus on movement
Effusions (fluid) around the joint
Signs in the Hands of osteoarthritis px?
Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb (CMC joint)
Weak grip
Dx of osteoarthritis?
if px is over 45, has typical pain associated with activity and has no morning stiffness = osteoarthritis
Tx of osteoarthritis
Topical NSAIDs first-line for knee osteoarthritis
Oral NSAIDs where required and suitable (co-prescribed with a proton pump inhibitor for gastroprotection)
Weak opiates and paracetamol are only recommended for short-term, infrequent use - strong opiates not recommended for osteoarthritis
What is bursitis?
Acute or chronic inflammation of a bursa.
A bursa is a sac containing a small amount of synovial fluid that lies between a tendon and either skin or bone to act as a friction buffer and facilitate movement of adjacent structures.
Sx of bursitis
pain at site of bursa
tenderness to palpation
decreased active ROM
+
If septic bursitis:
low-grade temperature
erythema/swelling
warmth of overlying skin
RF of bursitis
Occupational
RA
Gout or pseudogout
Ix for bursitis
Clinical diagnosis
Gram stain and fluid aspirate - sus septic bursitis
Tx for bursitis (non-septic and septic)
Non-septic:
1st line - analgesia + conservative
2nd line - corticosteroid injection
3rd line - surgery
Septic:
1st line - abx (dicloxacillin) + bursa aspiration
2nd line - surgery to drain bursa
RF for gout (4)
Male
Family history
Obesity
High purine diet (e.g., meat and seafood)
Alcohol
Diuretics
Cardiovascular disease
Kidney disease
Typical joints affected by gout?
The base of the big toe – the metatarsophalangeal joint (MTP joint)
The base of the thumb – the carpometacarpal joint (CMC joint)
Wrist
Larger joints (e.g., knee and ankle)
