Peri-articular pain Flashcards
1
Q
PS Over-use injury (5)
A
Exact time/mechanism = ID'd Pain non-progressive Pain prod 1/few movements O/E - local tenderness Pain on resisted active movement
2
Q
Enthesopathy
A
Attachment of ligament/tendon on bone
3
Q
Cause De Quervain’s tenosynovitis
A
Unknown
4
Q
What is affected in De Quervain’s tenosynovitis?
A
APL
APB tendons
In anatomical snuff box
5
Q
How does De Quervain’s tenosynovitis present? (2)
A
Acute pain
Swelling/tenderness
6
Q
O/E De Quervain’s tenosynovitis (LFM)
A
Look - norm/swollen
Feel - norm/tender
Move - active thumb abduction/opp + ulnar deviation
7
Q
Test for De Quervain’s tenosynovitis
A
Finklesteins +ve
Push thumb down across palm
8
Q
What must you differentiate De Quervain’s tenosynovitis from?
A
Base of thumb OA
9
Q
Mx De Quervain’s tenosynovitis - conservative
A
Rest
Analgesia
Splintage - thumb isolation 3 w
10
Q
Mx De Quervain’s tenosynovitis - surgical
A
Longitudinal compartment release
11
Q
PS base of thumb OA
A
Pain on gripping/pinching
12
Q
O/E Base of thumb OA (LFM)
A
Look - shoulder signs. Swelling/deformity @ CMCJ
Feel - pain + warmth
Move - global pain/stiffness
13
Q
Mx Base of thumb OA
A
Conservative
Surgical (denervation)
14
Q
Which nerve is compressed in carpal tunnel syndrome?
A
Median nn
15
Q
Causes carpal tunnel syndrome (3)
A
Idiopathic
Pregnancy
DM
16
Q
Hx Carpal tunnel syndrome
A
Pain in thumb. index + middle finger
Worse in AM
Shakes hand to relieve pain
17
Q
O/E Carpal tunnel (LFM)
A
Look - thenar wasting (advanced)
Feel - decr bulk/sensation
Move - active thumb abduction + opposition
18
Q
Tests for Carpal Tunnel (3)
A
Tinel’s
Phalen’s
Durkan’s
19
Q
Which tendon is not in the carpal tunnel?
A
FCR
20
Q
How many structures are there in the carpal tunnel?
A
10
9 tendons, med nn
21
Q
Mx carpal tunnel - conservative
A
Rest
Activity mod
Night time splinting
NSAID/Steroid injections
22
Q
Mx carpal tunnel - surgical
A
Division flexor retinaculum
23
Q
what nn is compressed in Cubital tunnel
A
Ulnar
24
Q
PS Cubital tunnel
A
Tingling/ numbness 4/5 funger
Weakness + mm wasting
Hx OA/Trauma
25
Ix Cubital tunnel
XRAY/nn conduction study
26
Mx cubital tunnel - conservative
Night time splint
NSAIDs
Activity mod
27
Mx cubital tunnel - surgery
Cubital tunnel compression
28
What is a ganglion?
Cyst arising from joint sheath
29
O/E - ganglion?
Swellings, not fixed to skin
| Transilluminate
30
Mx Ganglion
NSAIDs
| Reassurance
31
What is trigger finger?
Abnormal flexion of digits
32
What 4 things is trigger finger associated with?
Idiopathic
Women
RA
DM
33
Features trigger finger
Initial stiffness
| Nodules may be felt
34
Mx trigger finger - conservative
AM
NSAIDS
Injection
35
Mx trigger finger - surgical
Release A1 pulley
36
What is Dupuytren's contracture?
Painless thickening of palmar fascia --> flexion deformities
37
What movements do you lose in Dupuytren's contacture?
Active/passive movement
38
Mx Dupuytren's contracture
Surgery IF loss of movement
39
Another name for Golfers elbow
Medial epicondylitis
40
Cause golfer's elbow
Recurrent trauma medial epicondyle
41
Sx golfers elbow
Subacute pain
Incr by use
Radiates up/down arm
42
O/E golfers elbow (3)
Tenderness medial epicondyle
Pain on resisted flexion
NORMAL ROM
43
Mx golfers elbow - conservative
```
Rest
NSAIDS
physio
Epicondylar clasp/splint
Steroid injection
```
44
Mx golfers elbow - surgical
Golfers elbow release
45
Another name for tennis elbow
Lateral epicondylitis
46
Peak age Tennis elbow
40-60
47
What is tennis elbow assoc w/ (apart from tennis) (3)
Smoking
Obesity
Carpal tunnel
48
O/E tennis elbow
Point tenderness
| Pain on extension of wrist
49
Mx tennis elbow - surgery
Tennis elbow release
50
Is olecranon bursitis painful?
No
51
Main difference articular vs peri-articular lesion?
Articular leads to global Sx - affecting all movements
52
What is the most common cause of weak and painful shoulder?
Rotator cuff mm injury
53
Role of supraspinatus
Abducts the arm past 60'
54
Role of Infraspinatus
Externally rotates the humerus
55
Role of teres minor
Externally rotates humerus in abduction
56
Role of subscapularis
Internally rotates humerus
57
Pathophysiology acute RC tendonitis
Deposition of CaPO4 in supraspinatus tendon
58
'Clinical picture' acute RC tendonitis
```
Young pts
Aching following overuse
Pain climaxes, then resolves over days
Arm immobile
Can't palpate
```
59
XR appearance acute RC tendonitis
Calcification just above greater tuberosity
60
Mx acute RC tendonitis
Sling
| NSAIDs
61
PS chronic RC tendonitis
Pain in shoulder
Worse @ night
Painful arc/catching pain
Normal power
62
Mx chronic RC tenodintis
NSAIDs
Injection
Physio if severe
63
Mx of chronic RC tendonitis if conservative doesn't work
Surgical arthroscopic decompression
64
What % of >80s have RC tear?
40%
65
Can a complete RC tear heal naturally?
No
66
PS RC tear (2)
Limited abduction
| Tender acromion
67
What % rotator cuff tears are asymptomatic?
2/3
68
How to differentiate between partial and complete tears?
Intra-artic anaesthesia
partial - movement regained
Complete - still can't move
69
Diagnosis RC tear (2)
USS/MRI
| Arthroscopy
70
Mx RC tear
Acute - heat/exercise + LA injection
If complete - will req surgery
If partial - conservative
71
What is another name for adhesive capsulitis
Frozen shoulder
72
What age group get adhesive capsulitis
35-65 y/o
73
PS frozen shoulder
```
Progressive deep pain - can't sleep on one side
Stiffness worsens as pain subsides
Global reduction in ROM
Normal cuff strength
Normal XR
```
74
How long does frozen shoulder normally take to resolve?
2-4y
75
Mx frozen shoulder (3)
Reassurance
NSAIDS
Physio
76
What is subacromial bursitis due to?
Repetitive overhead lifting, pulling or trauma
77
Sx subacromial bursitis
Burning pain
| Pain is worse when lifting overhead
78
Diagnosis subacromial bursitis
USS
| or MRI
79
Mx subacromial bursitis
NSAIDs
| Avoid exacerbating movements
80
Pathology of trochaniteric bursitis
Inflamm of bursa betw greater trochanter and fascia lata
| B/c repetitive trauma
81
Who is trochanteric bursitis more common in? (2)
Females
| Active patients
82
Sx trochanteric bursitis
Hip pain that radiates down leg
Worse on movement/ @ night
Point tenderness over GT
83
Mx trochanteric bursitis
Injection
then physio
Then surgery - release + excision bursa
84
Cause of meniscal tear
twisting on flexed/W bearing knee
85
Which meniscus is commonly injured
Medial meniscus
86
PS meniscal tear
Initial pain
Swelling hrs later
Locking of knee
Giving way
87
O/E meniscal tear
Effusion
| Medial/lateral tenderness
88
Ix meniscal tear
XR
| MRI
89
Mx meniscal tear - vascular zone
amenable to repair
| arthroscopic in young/active pt
90
Mx meniscal tear - avascular zone
Meniscoectomy
91
Why should a total meniscetomy be avoided?
Risk of OA
92
What are ligaments composed of? (4)
Elastin
Ground substance
Surrounding CT
Nutrition/blood supply
93
What are the most common type of ligament injury?
ACL injury
94
Factors affecting ligament function (3)
Age
Endocrine effects
Anabolic steroids/CCS
95
Ix ligament injury (3)
XR
MRI
Diagnostic arthroscopy
96
Conservative Mx - ligament injury
Physio/splinting
| Acting movement
97
Surgical Mx ACL injury
Hamstring graft
98
What is pre-patellar bursitis due to
Unaccustomed kneeling (i.e. housemaids knee)
99
What is infra-patellar bursitis due to?
Unaccustomed kneeling - Clergymans knee
100
PS infra/pre-patellar bursitis
Anterior knee pain
| Fluctuant swelling
101
Mx infra/pre-paterllar bursitis
Avoid kneeling
| Injections if troublesome
102
PS anserine bursitis
Pain + bursitis @ insertion MCL to tibia
Worsen on standing
Medial
103
Who gets anserine bursitis? (2)
Obese women
| Breast stroke swimmings
104
Mx anserine bursitis
Physio
| Injection
105
What is a popliteal cyst?
Bulging of posterior capsule knee --> synovial herniation --> swelling in fossa
106
Causes popliteal cyst? (2)
OA
| RA
107
What condition can a popliteal cyst mimic
DVT (if ruptures)
108
Mx unruptured popliteal cyst
Aspiration
| Hydrocortisone injection
109
What is plantar fascitis
Enthesitis @ insertion of plantar fascia into tendn on calcaneus
110
Sx plantar fascitis
Pain on walking/standing
| + midline tenderness
111
What can plantar fascitis occur alongside?
Sero -ve spondyloarhtropathies
112
Mx plantar fascitis
Heel pads
Splinting foot in dorsiflexino
Decr walking
113
What is subcalcaeneal bursitis?
Pressure-induced bursa under heel
114
What is subcalcaneal bursitis usually due to?
due to tight shoes
115
Sx subcalcaneal bursitis
Pain on walking/standing
| Pain on sides
116
Mx subcalcaneal bursitis
Heel pads
| Decr walking
117
What is achilles tendonitis
Enthesitis at insertion of achilles tendon
118
What can achilles tendonitis be due to? (2)
Trauma
| Sero -ve spondyloarthropaties
119
PS achilles tendonitis
Pain behind heel/leg
120
Mx achilles tendonitis
Raise shoe heel
| Low P injection
121
PS tibialis posterior rupture
Sudden pain + valgus deformity
| Tender around medial malleolus
122
Key Sx complex regional pain syndrome (4)
Allodynia
Persistent pain
Stiffness/swelling
Abnorm hair/nail changes
123
What would a bone scan show in complex regional pain syndrome?
Increased activity in affected limb
124
Mx complex regional pain syndrome
Specialist pain team
| Physio
125
What is complex regional pain syndrome
Abnormal neuroinflammatory response to trauma
126
What must be ruled out in complex regional pain syndrome (7)
```
Polyarthritis
Polymyalgia rheumatica
RA
AS
Fibromyalgia
Virus
CT disease
```
