Pathologies for MSK July Practical Exam

Question 1

Hip OA

Answer 1

Degeneration of the acetabulum and femoral head cartilage.
Thinning of cartilage and osteophyte formation.
Narrowing of joint space and bones rubbing together.
Very common for degenerative changes, more common in women
Can’t resolve it - natural

Question 2

Knee OA

Answer 2

Degeneration of cartilage, bone remodelling at femoral condyles.
Osteophyte formation and decreased joint space.
Most common OA -83%
Can’t resolve it - natural, noticed early can adjust lifestyle and slow down

Question 3

Knee Ligament Injury

Answer 3

Stretch, partial tear or complete tear to ACL, PCL, MCL, LCL.
Trauma to the ligaments.
Direct external impact, abrupt stopping or changing direction, ACL = pivoting, MCL = valgus force, PCL = over extension, LCL = varus force
Some long term knee instability, recovery can take several months

Question 4

Patellofemoral Joint Pain

Answer 4

Pain around patella, umbrella term for absence of a pathology.
Due to malalignment, over use, over load of bone, imbalances in vastus med and lat causes tissue damage beyond capability of function - force distributed unevenly.
1 in 4 active population get it, worse with loaded flexed knee
4-6 weeks conservative treatment = 95% recovery, 90% still get reoccuring symptoms

Question 5

Knee Meniscal Injury

Answer 5

Damage to either lateral or medial meniscus.
Partial or full tears.
Medial meniscus most commonly injured, twisting or rotating on a flexed loaded knee, rapid extension or external rotation strains cartilage
80% success 2yr post injury, good healing
Can lead to OA rapid progression

Question 6

Sprained Ankle

Answer 6

Stretch, partial tear or complete rupture of ATFL (65%), CFL, PTFL.
uneven surface, plantar flexion and inversion
50% population get sprained ankle
mild = couple weeks to heal, 3 months grade2, longer grade 3.

Question 7

Frozen Shoudler

Answer 7

Affects anterosuperior joint capsule.
Causes tight joint capsule with some synovitis.
Fixes itself typically 20 weeks to 2.5 years, some stiffness and pain may remain
3 stages - painful freezing, adhesive 4-12 months, low pain high stiffness, resolution = spontaneous

Question 8

Shoulder Impingement Syndrome

Answer 8

A cluster of conditions where subacromial space is decreased causing entrapment or pinching of the soft tissue in that area.
Rotator cuff tendonitis, subacromial bursitis.
Most common cause of shoulder pain, over head shoulder activity, rounded posture.
60% good results in 2 years
60-90% pt improve
3-6 months to resolve

Question 9

Cervical OA

Answer 9

Cartilage on facet joints wears away so the bones rub against each other.
Osteophyte formation causes inflammation.
Secondary is disc degeneration.
Prolonged static positions, women
75% symptom improvement with treatment

Question 10

Cervical Radiculopathy

Answer 10

Nerve root compression causing pain radiating down the arm due to OA, scalene entrapment, disc herniation.
Limited or blocked nerve conduction in C6/C7.
Repetitive neck motions, vibrations
88% improve in 4 weeks
fully recovered 4-6 month after initial symptoms
May have some residual pain

Question 11

Whiplash Associated Disorder

Answer 11

Acceleration-deceleration mechanism of injury and energy transfer to the neck.
Bony or soft tissue injury including sprains, strains, disc, nerve, ligament, capsular injury.
Self-limiting, lasts 4-6weeks

Question 12

Tennis Elbow

Answer 12

Lateral epicondylitis.
Tendinopathy caused by repetitive movements causing damage to collagen fibres to ECRB, ECRL ECU - microtears
Repetitive overload on the extensor tendons.
Common 35-50 yr old, 2nd common UL complaint
Self-limiting will improve naturally 1-2 years (80%)

Question 13

Lumbar OA

Answer 13

Facet joint cartilage wears away, bones rub together and osteophytes grow.
Intervertebral disc degeneration puts load on FJ, as is secondary and closely linked to OA
Facet Joint degeneration, disc space narrowing.
Most common cause of LBP in 50+
Can slow progression with lifestyle changes

Question 14

SIJ Pain

Answer 14

Pain around SIJ, pain worse on flexion.
From over use, pregnancy, leg length discrepancies, inflammation, change in joint mechanics.
Common in mothers - third trimester relaxants, lordosis increases, weight gain
6 month recovery

Question 15

Non-specific LBP

Answer 15

Symptom rather than a disease.
Due to over sensitive pain system that triggers pain response when there is no remaining tissue damage.
Most common form of LBP
Acute flare ups 4-6 weeks - resolve itself

Question 16

LBP with Sciatica

Answer 16

Sciatic nerve root irritation or compression due to L4,L5,S1 disc prolapse causing pain radiating down the leg.
13-40% life time incidence
Improves 6 weeks, can last several months, most see an improvement