Musculoskeletal Flashcards
What are the causes of low back pain?
Degenerative:
- Facet joint osteoarthritis
- Disc degeneration
- Disc herniation (central: canal stenosis or posterolateral: radicular impingement)
RED FLAGS:
- Inflammatory back pain: ankylosing spondylitis, psoriatic arthritis, reactive arthritis/Reiter’s syndrome
- Fractures: osteoporosis, malignancy, trauma
- Malignancy: breast, lung, prostate
- Infection: discitis, osteomyelitis, epidural abscess
- Intra-abdominal pathology: AAA, renal, pelvic
What is ankylosing spondylitis?
Ankylosing Ankylosing spondylitis (AS) is a chronic progressive inflammatory arthropathy predominantly affecting the spine and sacroiliac joints.
What are the causes of spinal canal stenosis?
Usually caused by a combination of:
- facet joint OA
- ligamentum flavum hypertrophy
- disc herniation
What is lumbar claudication?
Lumbar claudication is a clinical syndrome caused by camal stenosis.
It present as lumbar, buttock or thigh pain, usually unilateraly but may be bilateral. It is NOT present at rest but comes on with exercise.
What are the risk factors for osteoarthritis?
- age >50 years
- female gender
- family history of OA
- physical/manual occupation
What joints are commonly affected in osteoarthritis?
- knee
- hip
- hands: DIP and PIP (not MCP)
- lumbar and cervical spine
What is the clinical presentation of osteoarthritis? (history and examination)
History:
- pain in affected joints related to activity
- relieved by rest (pain at night only in advanced OA)
Examination:
- knee, hip, hand, or spine involvement
- limited range of motion (passive and active) - associated with pain
- bony deformities (Bouchard’s nodes, Heberden’s nodes, squaring at base of thumb)
- malalignment (genu varum or valgum)
- tenderness on palpation
- crepitus (palpable or audible)
What investigations should be ordered for presentation of joint pain?
Bloods:
- ESR and CRP for inflammation (not raised in OA)
- Rheumatoid Factor and anti-CCP for RA
Imaging:
- X-ray of affected joints
What is the appearace of osteoarthritis joints in an X-ray?
- Joint space narrowing
- New bone formation (osteophytes)
- Subchondral sclerosis
- Subchondral cysts
What are the differential diagnoses for joint pain?
Mechanical:
- osteoarthritis
Inflammatory:
- rheumatoid arthritis
- psoriatic arthritis
- ankylosing spondylitis
- viral, post-infectious
- Systemic Lupus Erythematosus
Crystal-induced:
- Gout
- Pseudo-gout
Haemarthrosis (due to trauma, haemophilia, anticoags)
What are the clinical features of rheumatoid arthritis?
Commonly:
- active symmetrical arthritis lasting >6 weeks
- joint pain in MCP, PIP and MTP joints
- joint swelling
- morning stiffness, relieved by movement
Uncommonly:
- swan neck deformity (DIP hyperflexion and PIP hyperextension)
- Boutonniere’s deformity (PIP flexion and DIP hyperextension)
- ulnar deviation
- rheumatoid nodules
- vasculitic lesions
- slceritis or uveitis
What are the clinical features of gout?
(note: gout cannot be clinically differentiated from septic arthritis)
History:
- rapid onset
- severe pain
- morning stiffness (due to inflammation)
- foot joint distribution
- usually monoarticular or oligoarticular
Examination:
- swelling and joint effusion
- tenderness
- tophi (elbows, knees, Achilles tendons)
- erythema and warmth
What are the risk factors for gout?
older age;
male gender;
use of drugs including aspirin, ciclosporin (cyclosporine), tacrolimus, or pyrazinamide;
consumption of meat, seafood, or alcohol;
genetic susceptibility;
conditions with a high cell turnover rate
What are the risk factors for osteoporosis?
- prior fragility fracture
- female sex
- white ancestry
- older age (>50 women; >65 men)
- post-menopause
- low BMI
- smoking
- excessive alcohol use
- low calcium intake
- vtamin D deficiency
- corticosteroid use
- glucocorticoid excess
What are the common clinical presentations of osteoporosis?
Osteoporosis is largely an asymptomatic disease that culminates in a bone fracture (some of which are also asymptomatic, e.g. sacral and lumbar vertebrae)
Presentation:
- back pain (vertebral fracture)
- kyphosis (vertebral fracture)
- impaired vision, gait, imbalance, lower-extremity weakness (increased risk of fall/fracture)
