Musculoskeletal station Flashcards
back pain red flags
Age < 20, Age >55, Sphincter disturbance, Infection, Malignancy, Stiffness morning, Neurological disturbance, FLAWS
rheumatoid arthritis signs
MCP swelling, swan neck deformity = flexed DIP, boutonniere = extended DIP, Z-thumb deformity, ulnar deviation, MCP subluxation, nodules on elbows, reduced function
rheumatoid additional signs
No nail changes. If nail changes = psoriatic
Scar = carpel tunnel syndrome
Cushingoid appearance = steroids
Features of RA
Improves with use
Bilateral
Systemic symptoms XRAY - LESS
rheumatoid extra–articular manifestations
Pulmonary = effusions, fibrosis, bronchiectasis
Eyes = sjogren’s, scleritis
Haem = anaemia, felty’s syndrome
Neurological = carpal tunnel, atlanto-axial subluxation
Other = amyloidosis, nephrotic syndrome, pericarditis
rheumatoid arthritis investigations
RF = 80% sensitive
Anti-CCP
management of rheumatoid arthritis
NSAIDs for symptoms
Steroids for flare ups
DMARDS = methotrexate, Sulfasalazine, hydroxychloroquine
Biologicals - Anti-TNFs = interferon gamma test + CXR first
rheumatoid arthritis xray changes
Loss of joint space Erosions periarticular Soft tissue swelling Subluxation + deformity
OA signs
Bony swelling, heberdon’s nodes, bouchard’s nodes (before = proximal), fixed flexion deformity in the knee following knee replacement, midline knee scar, unable to fully extend, weight bearing joints more likely affected
Features of OA
Pain following use
Improves with rest
Unilateral
OA management
Conservative = Weight loss and exercise
Medical = Analgesia = NSAID’s + PPI, Intra-articular steroids
Surgical = Total joint replacement
xray changes in OA
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
Psoriatic arthritis signs
Rash, arthritis, nail pitting, extensor plaques with scales, nail onycholysis, hyperkeratosis, psoriatic arthritis mutilans
Psoriatic arthritis diagnostic criteria
CASPAR criteria
= skin psoriasis, nail changes, dactylitis, negative rheumatoid factor, new bone formation on xray
Psoriatic arthritis nail signs
Pitting
Onycholysis
Subungual hyperkeratosis
Ridging
Psoriatic arthritis management
Conservative = stop precipitants e.g. smoking, beta blockers, stress, alcohol
Medical = calcipotriol + steroids + tar
Surgical = UV light
Gout investigations
Polarised light microscopy = negatively birefringent needle shaped crystals
Serum urate = can be normal
Monosodium urate crystals
Gout treatment
1st = Colchicine, NSAIDs
PO steroids if renal impairment
Chronic prevent = WL, EToh, allopurinol
pseudogout investifations
Polarised light microscopy = positive birefringent rhomboid shaped crystals
pseudogout treatment
Analgesia
NSAIDS
Steroids
Ankylosing spondylitis features
Back pain
Relieved by exercise
Costochondritis
SOB
Ankylosing spondylitis investigations
Schober’s test
<5cm increase = positive
Xray spine
Ankylosing spondylitis treatment
Conservative = Exercise/ physio
Medical = NSAID
Surgical = hip replacement
Reactive arthritis
Sterile arthritis after 1-4 weeks after urethritis or dysentery (Chlamydia
Campylobacter)
NSAID’s
PO steroids
Sulfasalazine
PMR signs and treatment
Pain/stiff
Shoulder neck and hips Raised ESR, CRP, ALP
15mg PO prednisolone
CXR presentation
This film is a PA/AP chest x-ray of X, born on the Y. This was taken on the Z date for W reason at S hospital.
The film is not rotated and there is adequate inspiration. There is also adequate penetration and exposure of the film.
The main abnormality in the film is…
The trachea is central and non-deviated.
Both lung fields are clear in all zones, there are no obvious well-defined lesions or areas of patchy/nodular consolidation. Lung markings are visible throughout the lung field.
The heart is normal size/cannot comment on it. There is no mediastinal enlargement or syins of lymphadenopathy.
The diaphragm is normal/flattened/raised. The costrodiaphagmantic and cardiodiaphragmatic angles are visible/blunted.
There are not obvious soft tissue abnormalities. The gastric bubble is present.
There are no obvious fractures, and there are midline sternotomy pins visible which may indicate a cardiac surgery.
There is a NG tube/ECG leads/monitoring attached to the patient.
In conclusion this was abnormal chest x-ray with main findings…
My top differential is…
shoulder movements
Ad/bduction: 180 degrees
Flexion: 180
Extension: 60
External rotation: 90
Internal rotation: 90
Painful arc
60-120 degrees = impingment or rotator
cuff tendonitis
140-180 = ACJ OA
Movements in Abduction
0-30: supraspinatus only
30-90: deltoid
90-180: scapulothoracic movement
knee movements
Flexion: up to 140
Extension: at 0 degrees, shouldn’t go more than -5
degrees
Fixed flexion deformity causes
OA and NOF fracture
Hip movements
Flexion: 120
Extension: 20
Abduction: 45
Adduction: 30
Internal rotation: 30
External rotation: 45
what is Schober’s test
a line is drawn 10 cm above and 5 cm below the back
dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm
when the patient bends as far forward as possible
4 major stabilising ligaments of the knee?
ACL, PCL, MCL & LCL
What intra-articular structure is commonly damaged
with an ACL tear?
The lateral meniscus
Are ACL injuries more common in men or women?
Women
2 grafts commonly used in ACL reconstruction
Quadriceps tendon, Hamstring tendons
give some complications of ACL reconstruction?
Graft failure, Septic arthritis, Fibrosis of the joint,
Saphenous nerve irritation, Complex Regional Pain
Syndrome
