Musculoskeletal issues

Question 1

painful arc is a sign of

Answer 1

rotator cuff injury

Question 2

drop arm test positive indicates

Answer 2

large rotator cuff tear including supraspinatus

Question 3

positive cross arm test

Answer 3

AC joint pathology

Question 4

positive empty can test

Answer 4

supraspinatus pathology

Question 5

positive Hawkins test

Answer 5

impingement - subacromial bursitis

Question 6

positive lift off test

Answer 6

subscapularis pathology

Question 7

subacromial bursitis

Answer 7

subacute/chronic pain
consider if positive impingement test
may last months

Question 8

subacute rotator cuff issues

Answer 8

• subacromial bursitis
• specific tears

Question 9

adhesive capsulitis

Answer 9

‘frozen shoulder’
consider if passive ROM is lost
lasts 12-18 months

Question 10

glenohumeral osteoarthritis

Answer 10

consider if passive ROM lost and x-ray supportive

Question 11

AC joint osteoarthritis

Answer 11

consider if AC joint tenderness/cross arm test positive

Question 12

shoulder investigations

Answer 12

maybe none - often clinical diagnosis is sifficient
x-ray - relevant to possible fractures and arthritis
US - relevant to rotator cuff tears and bursal impingement

Question 13

rotator cuff disorders management

Answer 13

physical therapy - specifically exercise therapies
subacromial steroid injections 0 slight benefit but not clearly better than NSAID
surgery not usually first line

Question 14

adhesive capsulitis management

Answer 14

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

Question 15

osteoarthritis of the shoulder

Answer 15

physiotherapy ?
surgery ?

Question 16

special tests for hip examination

Answer 16

modified trendelenberg
Faber - Patrick test
Fadir - impingement test

Question 17

> 50yo, gradual onset, mechanical pain, limited ROM of the hip

Answer 17

osteoarthritis

Question 18

osteoarthritis of the hip history

Answer 18

> 50yo, gradual onset, mechanical pain, limited ROM

Question 19

femoroacetabular impingement

Answer 19

young adult, physically active
impingement test often positive

Question 20

labral tear

Answer 20

due to trauma or dysplasia or impingement or degeneration
can lead to degeneration

Question 21

meralgia paraesthetica

Answer 21

anterolateral thigh, neuropathic features (mononeuropathy)
Rx: weight loess, time, steroid injection, analgesia +/- neuropathic pain meds

Question 22

trochanteric bursitis/greater trochanteric pain syndrome

Answer 22

tender laterally, pain on active abduction and passive adduction

Question 23

other causes of hip pain

Answer 23

hip fracture +/- avascular necrosis
septic arthritis
osteomyelitis

Question 24

hip pain in children

Answer 24

septic arthritis
irritable hip - transiet synovitis
Perthe’s disease - avascular necrosis
slipped capital femoral epiphysis - stop weight bearing; urgent referral

Question 25

investigations for hip pain

Answer 25

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

Question 26

non-pharmacological management of hip pain

Answer 26

weight
land and water based exercise
other physical therapies

Question 27

pharmacological management of hip pain

Answer 27

paracetamol
topical NSAIDs or capsaicin
oral NSAIDS (but beware side effects)
opioids if severe symptoms

Question 28

greater trochanteric pain syndrome management

Answer 28

usually self resolves
physiotherapy approach of load management plus exercise has best outcomes

Question 29

refractory trochanteric pain syndrome

Answer 29

surgery if refractory

Question 30

meralgia paraesthetica

Answer 30

spontaneous improvement with time
steroid injection
analgesia +/- neuropathic pain meds
surgery

Question 31

knee locking

Answer 31

consider loose body

Question 32

knee instability

Answer 32

consider ligament rupture

Question 33

red flags for the knee

Answer 33

fever - suggests infection
bony swelling - consider tumour
haemarthrosis - sudden swelling, bruising - significant internal derangement such as ACL tear or fracture

Question 34

knee fracture after acute injury signs

Answer 34

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

Question 35

knee fracture management

Answer 35

immobilise, oath involevment

Question 36

ACL tear management

Answer 36

immobilise, oath review +/- surgery

Question 37

collateral ligament tear

Answer 37

immobilisation/crutches
bracing/isometric exercises via orthopaedics

Question 38

meniscal injury management

Answer 38

usually conservative initially, refer if persistent

Question 39

acute non specific low back pain

Answer 39

analgesia - NSAIDs or opioids
exercise interventions - better for prevention
muscle relaxants - adverse side effects
spinal manipulation - uncertain evidence

Question 40

sciatica management

Answer 40

such the same as ANSLBP
- corticosteroid injection
- surgery
consider neurosurgery referral immediately if neurological compromise eg. loss of power

Question 41

red flags in back pain

Answer 41

symptoms and signs of infection
immunosuppression, penetrating wound
history of trauma
history of malignancy
pain at multiple sites or at rest
age > 50 years

Question 42

imaging for back pain

Answer 42

not recommended in absense of red flags

Question 43

prognosis for sciatica and ANSLBP

Answer 43

expect recovery within 3 motnhs
recurrences common