Musculoskeletal injury Flashcards
Describe the difference amongst:
1) Ligament
2) Tendon
3) Bursae
4) Plantar fascia
Ligament - bone to bone connective tissue;
Tendon - bone to muscle connective tissue;
Bursae - fluid-filled sacs around joints;
Plantar Fascia - fibrous attachment which connects Heel bone to base of Toes.
Periarticular pain presents as:
Palpation, Movement, Direction
- Maximal tenderness at join line (on palpation);
- pain on Active movement > Passive movement;
- Certain lines of muscle pull: where maximal pain is experienced.
Conditions for Urgent Referral of soft tissue injuries are:
- Fracture
- Ligament rupture
- Infection-related causes
Specific to lower back pain:
- Malignancy / metastasis
- Relating to underlying visceral conditions (eg. Gynae, GI)
Conditions for (Non-urgent / Urgent) Referral of Heel / Sole pain are:
- Paresthesia / numbness
- Nocturnal smx: neuropathic pain / neoplasm
- Radiating pain from posterior aspect of leg to heel
- Trauma
- Inflammatory PMH
Urgent:
- Fever, constant pain
- Sudden onset pain (rupture?)
- Erythema nodosum (sarcoidosis?)
what is RICER HARM?
Rest
Ice - w cloth
Compression - stocking or bandage
Elevation - higher than heart level
Referral
No HARMs:
Heat
Alcohol
Re-injury
Massage
Which action of the ankle is most likely to be affected by sprain?
Plantarflexion and Inversion (rolling ankle)
Which ligament is most likely to be at risk from inversion (rolling ankle)?
Anterior talofibular ligament
when should a patient be referred to A&E for a Sprain?
Severe pain, swelling ->
Cannot bear weight or ambulate
- leading to significant instability
- loss of motion and function.
Describe the etiology of Tendonitis.
(!) Overuse
(!) Sports Injury
- Inflammatory rheumatic disease
- Calcium apatite deposition
- Drug-induced: FQ antibiotics and Statins
common sites where Tendonitis may occur are:
Shoulder- rotator cuff tendinopathy
Elbow - tennis / golfer’s elbow
Ankle - achilles (jumping, running)
Wrist
Hip
how does Bursitis occur? What are the causes?
Compression of bursa -> increase in intrabursal pressure -> inflammation of bursa
Acute (Key Sx: pain on active and passive flexing)
- Trauma
- Crystal-induced process
- Infection
Chronic (Key Sx: swelling and thickening)
- Overuse
- Prolonged pressure
- Inflammatory arthritis
describe the Etiology of Plantar Fasciitis.
- Prolonged standing / jumping / running on hard surfaces
- Flat feet / high arched feet
- Tight hamstring muscle
- Reduced ankle dorsiflexion
Differentials for Heel / sole pain are:
1) Neurologic causes -> paresthesia, numbness, nocturnal smx, diffuse pain, radiating pain)
2) Skeletal causes -> trauma, bone contusion
- Osteomyelitis: fever, constant pain
- Neoplasm: nocturnal smx
3) Soft Tissue causes
- Achilles, Bursitis: closer to back of heel
- Fat-pad atrophy
- No tenderness when palpating plantar fasciia
- Plantar Fasciia rupture: sudden onset, visible swelling, ecchymosis
4) Inflammation
- arthritis: PMH of inflammatory Dx
- Sarcoidosis
describe the Presentation of Frozen Shoulder.
- Unilateral - non-dominant hand (bilateral in the long-term)
- Limited overhead reach, to side, across chest, rotation.
describe the Stages of recovery for Frozen Shoulder.
- Initial 2-9 mo: severe disabling pain, diffuse, worse at night, increasingly stiff.
- Intermediate 4-12 mo: stiffness, severe loss of shoulder motion, gradually improving pain.
- Recovery 5-24 mo: gradual return of range of motion.
Conditions for (Non-urgent / Urgent) Referral of Shoulder Pain are:
Marked loss of motion
Urgent:
- Systemic Sx of infection
- Malignancy
- Associated chronic illness (RA, Gout, Septic arthritis)
Treatment for Frozen Shoulder are:
1) Analgesic (paracet / NSAIDs / weak opioids)
2) Range of motion exercises
3) IA glucocorticoid + physical therapy
Treatment for Bursitis are:
1) Analgesic (paracet / Top NSAIDs / Oral NSAIDs)
2) IA glucocorticoid (for deep regions)
Conditions for (Non-urgent / Urgent) Referral of Lower Back Pain are:
- Subacute (4-12 wk) or Chronic (>12 wk) pain
Urgent:
- neurologic Sx: motor weakness, fall, gait instability, numbness, loss of bowel/bladder function.
- Osteoporotic fractures: Glucocorticoid (chronic), age, trauma, had fragility / traumatic fracture before)
- Malignancy: unintended weight loss, PMH of malignancy
- Osteomyelitis: fever, constant pain
- Visceral issues: eg. severe abdo pain
Treatment for Acute / Subacute (<12 wks) Lower Back Pain are:
1) NSAIDs / SMR (orphenadrine)
2) Superficial heat
Low-quality evidence:
3) Massage
4) Acupuncture
5) Spinal manipulation
Treatment for Chronic (>=12 wks) Lower Back Pain are:
1) NSAIDs -> Tramadol / Duloxetine (2nd line)
2) Exercise
3) Multidisciplinary rehab
4) Acupuncture
5) Mindfulness-based stress reduction
Low-quality evidence:
6) Tai Chi
7) Yoga
8) Motor control exercise
9) Progressive relaxation
10) Electromyography biofeedback
11) Low-level laser therapy
12) Operant therapy
13) Cognitive behavioural therapy
14) Spinal manipulation
Counselling Points for patients w Lower Back Pain are:
- Impvt may be small.
- Acute/subacute pain are usually self-limiting.
- Avoid potentially harmful & Costly tests / Tx.
- Low-impact core strengthening exercises (eg. swimming, stationary bicycling, brisk walking). NOT jogging (high-impact).
- Correct lifting & moving techniques.
- Maintain correct sitting / standing posture.
- Maintain healthy weight.
- Quit smoking -> hardening of arteries cause low back pain & degenerative disc disorders.
Management for Myalgia is:
- RICE
- Topical NSAIDs
- Prevention: doing proper warm-up before exercise.
Conditions for (Non-urgent / Urgent) Referral of Myalgia are:
Urgent:
- Infection: diffuse myalgia, fever, chills, arthralgia, fatigue, back pain.
- Med toxicity: statin-induced rhabdomyolysis (muscle pain, weakness, red-brown “tea-coloured” urine)
