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CP3 MDD > Peri-articular pain > Flashcards

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
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2
Q

Enthesopathy

A

Attachment of ligament/tendon on bone

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3
Q

Cause De Quervain’s tenosynovitis

A

Unknown

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4
Q

What is affected in De Quervain’s tenosynovitis?

A

APL
APB tendons
In anatomical snuff box

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5
Q

How does De Quervain’s tenosynovitis present? (2)

A

Acute pain

Swelling/tenderness

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6
Q

O/E De Quervain’s tenosynovitis (LFM)

A

Look - norm/swollen
Feel - norm/tender
Move - active thumb abduction/opp + ulnar deviation

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7
Q

Test for De Quervain’s tenosynovitis

A

Finklesteins +ve

Push thumb down across palm

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8
Q

What must you differentiate De Quervain’s tenosynovitis from?

A

Base of thumb OA

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9
Q

Mx De Quervain’s tenosynovitis - conservative

A

Rest
Analgesia
Splintage - thumb isolation 3 w

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10
Q

Mx De Quervain’s tenosynovitis - surgical

A

Longitudinal compartment release

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11
Q

PS base of thumb OA

A

Pain on gripping/pinching

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12
Q

O/E Base of thumb OA (LFM)

A

Look - shoulder signs. Swelling/deformity @ CMCJ
Feel - pain + warmth
Move - global pain/stiffness

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13
Q

Mx Base of thumb OA

A

Conservative

Surgical (denervation)

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14
Q

Which nerve is compressed in carpal tunnel syndrome?

A

Median nn

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15
Q

Causes carpal tunnel syndrome (3)

A

Idiopathic
Pregnancy
DM

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16
Q

Hx Carpal tunnel syndrome

A

Pain in thumb. index + middle finger
Worse in AM
Shakes hand to relieve pain

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17
Q

O/E Carpal tunnel (LFM)

A

Look - thenar wasting (advanced)
Feel - decr bulk/sensation
Move - active thumb abduction + opposition

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18
Q

Tests for Carpal Tunnel (3)

A

Tinel’s
Phalen’s
Durkan’s

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19
Q

Which tendon is not in the carpal tunnel?

A

FCR

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20
Q

How many structures are there in the carpal tunnel?

A

10

9 tendons, med nn

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21
Q

Mx carpal tunnel - conservative

A

Rest
Activity mod
Night time splinting
NSAID/Steroid injections

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22
Q

Mx carpal tunnel - surgical

A

Division flexor retinaculum

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23
Q

what nn is compressed in Cubital tunnel

A

Ulnar

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24
Q

PS Cubital tunnel

A

Tingling/ numbness 4/5 funger
Weakness + mm wasting
Hx OA/Trauma

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25
Q

Ix Cubital tunnel

A

XRAY/nn conduction study

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26
Q

Mx cubital tunnel - conservative

A

Night time splint
NSAIDs
Activity mod

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27
Q

Mx cubital tunnel - surgery

A

Cubital tunnel compression

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28
Q

What is a ganglion?

A

Cyst arising from joint sheath

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29
Q

O/E - ganglion?

A

Swellings, not fixed to skin

Transilluminate

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30
Q

Mx Ganglion

A

NSAIDs

Reassurance

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31
Q

What is trigger finger?

A

Abnormal flexion of digits

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32
Q

What 4 things is trigger finger associated with?

A

Idiopathic
Women
RA
DM

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33
Q

Features trigger finger

A

Initial stiffness

Nodules may be felt

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34
Q

Mx trigger finger - conservative

A

AM
NSAIDS
Injection

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35
Q

Mx trigger finger - surgical

A

Release A1 pulley

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36
Q

What is Dupuytren’s contracture?

A

Painless thickening of palmar fascia –> flexion deformities

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37
Q

What movements do you lose in Dupuytren’s contacture?

A

Active/passive movement

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38
Q

Mx Dupuytren’s contracture

A

Surgery IF loss of movement

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39
Q

Another name for Golfers elbow

A

Medial epicondylitis

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40
Q

Cause golfer’s elbow

A

Recurrent trauma medial epicondyle

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41
Q

Sx golfers elbow

A

Subacute pain
Incr by use
Radiates up/down arm

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42
Q

O/E golfers elbow (3)

A

Tenderness medial epicondyle
Pain on resisted flexion
NORMAL ROM

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43
Q

Mx golfers elbow - conservative

A 
Rest
NSAIDS
physio
Epicondylar clasp/splint
Steroid injection
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44
Q

Mx golfers elbow - surgical

A

Golfers elbow release

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45
Q

Another name for tennis elbow

A

Lateral epicondylitis

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46
Q

Peak age Tennis elbow

A

40-60

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47
Q

What is tennis elbow assoc w/ (apart from tennis) (3)

A

Smoking
Obesity
Carpal tunnel

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48
Q

O/E tennis elbow

A

Point tenderness

Pain on extension of wrist

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49
Q

Mx tennis elbow - surgery

A

Tennis elbow release

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50
Q

Is olecranon bursitis painful?

A

No

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51
Q

Main difference articular vs peri-articular lesion?

A

Articular leads to global Sx - affecting all movements

52
Q

What is the most common cause of weak and painful shoulder?

A

Rotator cuff mm injury

53
Q

Role of supraspinatus

A

Abducts the arm past 60’

54
Q

Role of Infraspinatus

A

Externally rotates the humerus

55
Q

Role of teres minor

A

Externally rotates humerus in abduction

56
Q

Role of subscapularis

A

Internally rotates humerus

57
Q

Pathophysiology acute RC tendonitis

A

Deposition of CaPO4 in supraspinatus tendon

58
Q

‘Clinical picture’ acute RC tendonitis

A 
Young pts 
Aching following overuse
Pain climaxes, then resolves over days
Arm immobile
Can't palpate
59
Q

XR appearance acute RC tendonitis

A

Calcification just above greater tuberosity

60
Q

Mx acute RC tendonitis

A

Sling

NSAIDs

61
Q

PS chronic RC tendonitis

A

Pain in shoulder
Worse @ night
Painful arc/catching pain
Normal power

62
Q

Mx chronic RC tenodintis

A

NSAIDs
Injection
Physio if severe

63
Q

Mx of chronic RC tendonitis if conservative doesn’t work

A

Surgical arthroscopic decompression

64
Q

What % of >80s have RC tear?

A

40%

65
Q

Can a complete RC tear heal naturally?

A

No

66
Q

PS RC tear (2)

A

Limited abduction

Tender acromion

67
Q

What % rotator cuff tears are asymptomatic?

A

2/3

68
Q

How to differentiate between partial and complete tears?

A

Intra-artic anaesthesia
partial - movement regained
Complete - still can’t move

69
Q

Diagnosis RC tear (2)

A

USS/MRI

Arthroscopy

70
Q

Mx RC tear

A

Acute - heat/exercise + LA injection
If complete - will req surgery
If partial - conservative

71
Q

What is another name for adhesive capsulitis

A

Frozen shoulder

72
Q

What age group get adhesive capsulitis

A

35-65 y/o

73
Q

PS frozen shoulder

A 
Progressive deep pain - can't sleep on one side 
Stiffness worsens as pain subsides
Global reduction in ROM 
Normal cuff strength
Normal XR
74
Q

How long does frozen shoulder normally take to resolve?

A

2-4y

75
Q

Mx frozen shoulder (3)

A

Reassurance
NSAIDS
Physio

76
Q

What is subacromial bursitis due to?

A

Repetitive overhead lifting, pulling or trauma

77
Q

Sx subacromial bursitis

A

Burning pain

Pain is worse when lifting overhead

78
Q

Diagnosis subacromial bursitis

A

USS

or MRI

79
Q

Mx subacromial bursitis

A

NSAIDs

Avoid exacerbating movements

80
Q

Pathology of trochaniteric bursitis

A

Inflamm of bursa betw greater trochanter and fascia lata

B/c repetitive trauma

81
Q

Who is trochanteric bursitis more common in? (2)

A

Females

Active patients

82
Q

Sx trochanteric bursitis

A

Hip pain that radiates down leg
Worse on movement/ @ night
Point tenderness over GT

83
Q

Mx trochanteric bursitis

A

Injection
then physio
Then surgery - release + excision bursa

84
Q

Cause of meniscal tear

A

twisting on flexed/W bearing knee

85
Q

Which meniscus is commonly injured

A

Medial meniscus

86
Q

PS meniscal tear

A

Initial pain
Swelling hrs later
Locking of knee
Giving way

87
Q

O/E meniscal tear

A

Effusion

Medial/lateral tenderness

88
Q

Ix meniscal tear

A

XR

MRI

89
Q

Mx meniscal tear - vascular zone

A

amenable to repair

arthroscopic in young/active pt

90
Q

Mx meniscal tear - avascular zone

A

Meniscoectomy

91
Q

Why should a total meniscetomy be avoided?

A

Risk of OA

92
Q

What are ligaments composed of? (4)

A

Elastin
Ground substance
Surrounding CT
Nutrition/blood supply

93
Q

What are the most common type of ligament injury?

A

ACL injury

94
Q

Factors affecting ligament function (3)

A

Age
Endocrine effects
Anabolic steroids/CCS

95
Q

Ix ligament injury (3)

A

XR
MRI
Diagnostic arthroscopy

96
Q

Conservative Mx - ligament injury

A

Physio/splinting

Acting movement

97
Q

Surgical Mx ACL injury

A

Hamstring graft

98
Q

What is pre-patellar bursitis due to

A

Unaccustomed kneeling (i.e. housemaids knee)

99
Q

What is infra-patellar bursitis due to?

A

Unaccustomed kneeling - Clergymans knee

100
Q

PS infra/pre-patellar bursitis

A

Anterior knee pain

Fluctuant swelling

101
Q

Mx infra/pre-paterllar bursitis

A

Avoid kneeling

Injections if troublesome

102
Q

PS anserine bursitis

A

Pain + bursitis @ insertion MCL to tibia
Worsen on standing
Medial

103
Q

Who gets anserine bursitis? (2)

A

Obese women

Breast stroke swimmings

104
Q

Mx anserine bursitis

A

Physio

Injection

105
Q

What is a popliteal cyst?

A

Bulging of posterior capsule knee –> synovial herniation –> swelling in fossa

106
Q

Causes popliteal cyst? (2)

A

OA

RA

107
Q

What condition can a popliteal cyst mimic

A

DVT (if ruptures)

108
Q

Mx unruptured popliteal cyst

A

Aspiration

Hydrocortisone injection

109
Q

What is plantar fascitis

A

Enthesitis @ insertion of plantar fascia into tendn on calcaneus

110
Q

Sx plantar fascitis

A

Pain on walking/standing

+ midline tenderness

111
Q

What can plantar fascitis occur alongside?

A

Sero -ve spondyloarhtropathies

112
Q

Mx plantar fascitis

A

Heel pads
Splinting foot in dorsiflexino
Decr walking

113
Q

What is subcalcaeneal bursitis?

A

Pressure-induced bursa under heel

114
Q

What is subcalcaneal bursitis usually due to?

A

due to tight shoes

115
Q

Sx subcalcaneal bursitis

A

Pain on walking/standing

Pain on sides

116
Q

Mx subcalcaneal bursitis

A

Heel pads

Decr walking

117
Q

What is achilles tendonitis

A

Enthesitis at insertion of achilles tendon

118
Q

What can achilles tendonitis be due to? (2)

A

Trauma

Sero -ve spondyloarthropaties

119
Q

PS achilles tendonitis

A

Pain behind heel/leg

120
Q

Mx achilles tendonitis

A

Raise shoe heel

Low P injection

121
Q

PS tibialis posterior rupture

A

Sudden pain + valgus deformity

Tender around medial malleolus

122
Q

Key Sx complex regional pain syndrome (4)

A

Allodynia
Persistent pain
Stiffness/swelling
Abnorm hair/nail changes

123
Q

What would a bone scan show in complex regional pain syndrome?

A

Increased activity in affected limb

124
Q

Mx complex regional pain syndrome

A

Specialist pain team

Physio

125
Q

What is complex regional pain syndrome

A

Abnormal neuroinflammatory response to trauma

126
Q

What must be ruled out in complex regional pain syndrome (7)

A 
Polyarthritis 
Polymyalgia rheumatica 
RA
AS
Fibromyalgia 
Virus 
CT disease

CP3 MDD (13 decks)

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