Musculoskeletal Flashcards
Lower back pain red flags
unexplained weight loss
previous or suspected malignancy
drug abuse, hiv, immunocompetent
ESR >50
fevers
thoracic or night pain
trauma
<20 or >55yo (worsening or new onset)
disturbed gait
unwell patient
urinary/ faecal incontinence
severe morning stiffness
Lower back pain Ix
<20 yo
- HLA B27- ?ank spon
> 55 yo
- ESR, electrophoresis (myeloma)
- urine dip - renal stones
- PSA - prostate
- CA 125 - ovarian
Knee pain DDx
Osteoarthritis
Gout
Inflammatory - rheumatoid/ psoriatic arthritis
septic arthritis
malignancy
injury/ trauma
Osteoporosis risk factors
high risk
>7.5mg Pred daily >3 months
prev major osteoporotic fracture
multiple fragility fractures
med risk
corticosteroids
prev osteoporotic fracture
premature menopause
Screening Osteoporosis
Female > 65 yo or < 65 with risk factors
Male >75yo or <75 with risk factors
Osteoporosis Ix
1st - FRAX score
Bloods for reversable causes - TFT, PTH, Ca, FSH
low risk = lifestyle
med risk = DXA and recalculate BMD
high risk = start treatment
Osteoporosis Mx
Vit D/ Ca
- Vit D only if adequate Ca intake
- Both if not
Lifestyle - diet, weight bearing exercise, stop smoking
Bloods
Repeat DEXA 3 years
Bisphosphonates - offer to all confirmed osteoporosis - need counselling
- alendronic acid (most common = take sitting up, with large glass of water, 30 mins before food, same time each week
- SE oesophageal irritation, osteonecrosis of jaw
T -1.0 and -2.5 = osteopenia
T <-2.5 = osteoporosis
Gout Mx
1st- NSAIDs + PPI
2nd - Colchicine
3rd - Prednisolone
Prevention
- 4-6 weeks after acute episodes.
- confirm with uric acid levels
- allopurinol
- lifestyle - weight, diet, exercise, low alcohol/ smoking
Frozen shoulder prognosis
Painful freezing phase - up to 9 month
Frozen/ adhesive - up to 1 year
Thawing/ recovery - 1-3 years
Mx - physio, steroid injection in first 8 weeks
