Musculoskeletal issues Flashcards
painful arc is a sign of
rotator cuff injury
drop arm test positive indicates
large rotator cuff tear including supraspinatus
positive cross arm test
AC joint pathology
positive empty can test
supraspinatus pathology
positive Hawkins test
impingement - subacromial bursitis
positive lift off test
subscapularis pathology
rotator cuff syndrome/subacromial pain syndrome
often not important to further differentite the cause, but may be due to
subacromial bursitis
tendinitis
specific tears
subacromial bursitis
subacute/chronic pain
consider if positive impingement test
may last months
adhesive capsulitis
‘frozen shoulder’
consider if passive ROM is lost
lasts 12-18 months
glenohumeral osteoarthritis
consider if passive ROM lost and x-ray supportive
AC joint osteoarthritis
consider if AC joint tenderness/cross arm test positive
shoulder investigations
maybe none - often clinical diagnosis is sifficient
x-ray - relevant to possible fractures and arthritis
US - relevant to rotator cuff tears and bursal impingement
rotator cuff disorders management
physical therapy - specifically exercise therapies
subacromial steroid injections: slight benefit but not clearly better than NSAID
surgery not usually first line
adhesive capsulitis management
manual therapy/exercise - mixed evidence
steroid injection - possible benefit, limited evidence
oral steroids - shirt term benefit
arthrographic distension with saline and steroid - short term benefit but unclear if superior to other options
osteoarthritis of the shoulder
physiotherapy ?
surgery ?
special tests for hip examination
modified trendelenberg
Faber - Patrick test
Fadir - impingement test
> 50yo, gradual onset, mechanical pain, limited ROM of the hip
osteoarthritis
osteoarthritis of the hip history
> 50yo, gradual onset, mechanical pain, limited ROM
femoroacetabular impingement
young adult, physically active
impingement test often positive
labral tear
due to trauma or dysplasia or impingement or degeneration
can lead to degeneration
meralgia paraesthetica
anterolateral thigh, neuropathic features (mononeuropathy)
Rx: weight loess, time, steroid injection, analgesia +/- neuropathic pain meds
trochanteric bursitis/greater trochanteric pain syndrome
tender laterally, pain on active abduction and passive adduction
other causes of hip pain
hip fracture +/- avascular necrosis
septic arthritis
osteomyelitis
hip pain in children
septic arthritis
irritable hip - transiet synovitis
Perthe’s disease - avascular necrosis
slipped capital femoral epiphysis - stop weight bearing; urgent referral
investigations for hip pain
x-ray - relevant to possible fractures/arthritis/perthe’s/SCFE
US - may be relevant to busitis if not clear clinically
MR or CT - special situations only
non-pharmacological management of hip pain
weight
land and water based exercise
other physical therapies
pharmacological management of hip pain
paracetamol
topical NSAIDs or capsaicin
oral NSAIDS (but beware side effects)
opioids if severe symptoms
greater trochanteric pain syndrome management
usually self resolves
physiotherapy approach of load management plus exercise has best outcomes
refractory trochanteric pain syndrome
surgery if refractory
meralgia paraesthetica
spontaneous improvement with time
steroid injection
analgesia +/- neuropathic pain meds
surgery
knee locking
consider loose body
knee instability
consider ligament rupture
red flags for the knee
fever - suggests infection
bony swelling - consider tumour
haemarthrosis - sudden swelling, bruising - significant internal derangement such as ACL tear or fracture
knee fracture after acute injury signs
ottawa knee rule: x ray if any one of the following
age >55
tender head of fibula
isolated patellar tenderness
inability to flex to 90°
inability to weight near
knee fracture management
immobilise, oath involevment
ACL tear management
immobilise, oath review +/- surgery
collateral ligament tear
immobilisation/crutches
bracing/isometric exercises via orthopaedics
meniscal injury management
usually conservative initially, refer if persistent
acute non specific low back pain
analgesia - NSAIDs or opioids
exercise interventions - better for prevention
muscle relaxants - adverse side effects
spinal manipulation - uncertain evidence
sciatica management
such the same as ANSLBP
- corticosteroid injection
- surgery
consider neurosurgery referral immediately if neurological compromise eg. loss of power
red flags in back pain
symptoms and signs of infection
immunosuppression, penetrating wound
history of trauma
history of malignancy
pain at multiple sites or at rest
age > 50 years
imaging for back pain
not recommended in absense of red flags
prognosis for sciatica and ANSLBP
expect recovery within 3 motnhs
recurrences common
