Musculoskeletal Flashcards
What is carpel tunnel syndrome?
- the medial nerve is compressed at the wrist
- commonly affects women
- can be caused by forceful and repetitive work
What tests can you use for diagnosis of carpel tunnel?
- Tinel’s
- Phalen’s
- both will give a positive result
What is tenosynovitis?
- Caused by inflammation of APL and EPB tendon-sheath
- Diagnosis via Finkelstein’s test
What is the treatment for tenosynovitis?
- NSAIDS
- Steroid injection
- Rest
How do you diagnose an inflamed joint?
- Blood culture
- then aspirate the joint
- if infected, it is cloudy and thicker than water
How would you manage an inflamed joint?
- DMARD and anti-TNF injections
- IV flucloxacillin
- Prednisolone
- Analgesia
What is septic arthritis?
- painful infection in the joint
- Common organisms include staph aureus, streptococci, gonorrhoea, gram -ve bacilli
What is gonococcal arthritis?
- Septic joint, in those with gonorrhea
- Disseminated gonococcal infection
What are the symptoms of gonococcal arthritis?
- fever
- tenosynovitis
- pustular rash (common in palms and soles). Painful before visible
What are risk factors for a septic joint?
- Any cause for bacteraemia
- Direct trauma
- Skin breaks/ulcers
- Damaged joints
- RA/ diabetes / elderly / immunosuppressed
What is the clinical presentation of a septic joint?
- Painful, red, swollen, hot
- fever
- 90% monoarthritis (asymmetrical)
What is the management for a septic joint?
- Aspiration
- Antibiotics
- Joint washout
What are the inflammatory markers used?
- Single CRP (>10) and ESR (>30) = if raised, 50% chance of infection
- Multiple CRP and ESR = if raised, 80% chance of infection
What is osteomyelitis?
- Bone marrow inflammation, where the infection is localised to the bone
- Severe, which needs to be recognised as early as possible
What are host factors for risk of osteomyelitis?
- Behavioural e.g. risk of trauma
- Vascular supply = DM or sickle-cell
- Pre-existing bone/joint problem
- Immune deficiency
What bacteria is mainly in osteomyelitis?
- Staph aureus
- C -ve staph
- aerobic gram-ve bacilli
What are the signs and symptoms of osteomyelitis?
- onset = several days
- dull pain at site
- systemic infection
- Acute OM = tenderness and swelling
- Chronic = draining sinus tract and large ulcers failing to heal
What can osteomyelitis of the joint also present as?
- Septic arthritis
- when infection breaks through cortex resulting in discharge of pus into the joint (knee, hip, and shoulder).
What investigations can you do for osteomyelitis?
- Lab tests = high WCC in acute OM. Raised inflammatory markers
- Imaging - Xray or MRI
What is the differential diagnosis of osteomyelitis?
- Soft tissue infection
- Avascular necrosis
- Gout
What is the treatment for osteomyelitis?
- Surgical (debridement or removal)
- Antimicrobial therapy
What are the red flag signs for soft bone tumours?
- Pain at rest and in the night
- Lump present - tender and deep to fascia
- Loss of function
- Unwell / weight loss
What are the investigations for bone tumours?
- Blood tests
- X-ray
- CT scan = bone quality
- MRI scan = changes in soft tissue
What is osteosarcoma?
- Cell neoplasms that produce osteoid
- Secondary includes Paget’s
- Most common type
- location: knee, proximal humerus or femur
