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Summary - MSK Flashcards

1
Q

Describe osteoarthritis

A

Long term condition of synovial joints where there is damage causing repair leading to structural changes
Loss of cartilage, bone and mild synovitis
Knees, hips, small joints of hand most affected

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2
Q

What are the signs and symptoms of OA?

A

Pain, stiffness, and loss of function
Possible bony swelling, joint deformity, painful/ restricted movement, crepitus, and joint instability
Heberden’s and Bouchard’s (proximal) nodes

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3
Q

What is the clinical history of OA?

A

Activity related joint pain plus has morning related joint stiffness or morning stiffness lasting more than 30 mins

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4
Q

What is the management and treatment for OA?

A

Exercise and weight loss
Thermotherapy, electrotherapy, and aids
Paracetamol and NSAIDs
Topical treatments - NSAIDs and capsaicin
Intra-articular injections
Surgical

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5
Q

Describe septic arthritis

A

Acute synovitis with purulent joint effusion
Articular cartilage is attacked by bacterial toxin and cellular enzymes
Common organism - staph aureus and strep. pyogenes.

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6
Q

What are some causes of Septic arthritis?

A

Infected joint replacement, age and immunosuppression

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7
Q

What are the symptoms and signs of septic arthritis?

A

Presents with hot, swollen, acutely painful joint with restricted movement
Fever, increased tenderness, increased pulse, and not erythema

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8
Q

What is the gold standard investigation for septic arthritis?

A

Joint aspiration

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9
Q

What is the treatment for septic arthritis?

A

General supportive measures
Antibiotics for 3-4 weeks
Surgical drainage and lavage in emergency

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10
Q

Describe osteomyelitis

A

Inflammatory condition of bone caused by infecting organism - commonly staph. aureus
Mainly in long bones and secondary OM is more common in adults

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11
Q

What are the symptoms of OM in infants and children?

A

Infants - failure to thrive, ill, irritable, swelling, and decreased ROM
Child - severe pain, fever, tachycardia, malaise and toxaemia

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12
Q

What are the signs and symptoms for OM in adults?

A

Backache as commonly thoracolumbar spine, history of UTI, and risk factors present

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13
Q

What is the treatment for osteomyelitis?

A

General care, analgesia and splints
Antibiotics - IV/ oral switch for 4-6 weeks
Surgery if aspiration of pus, abscess drainage, debridement of infected tissue and refractory to non-surgical treatment

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14
Q

Describe rheumatoid arthritis

A

Chronic autoimmune systemic inflammatory condition which is characterised by symmetrical polyarthritis
Commonly small joints of hand, wrist and feet

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15
Q

What is the symptoms and signs of RA?

A

Pain, morning stiffness for more than 30 mins, immobility, poor function and systemic symptoms
Swelling, tenderness, warmth, redness and limited ROM
Swan neck deformity and synovitis

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16
Q

What are the investigations for RA?

A

Bloods - FBC, Kidney function, LFTs, CRP, ESR, RF and anti-CCP antibodies
X-ray and US
DAS (disease severity score)

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17
Q

What is the management and treatment for RA?

A

NSAIDs and glucocorticoids - prednisolone/ hydrocortisone and dexamethasone
DMARDs - methotrexate, leflunomide and sulfasalazine
Biologics

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18
Q

Describe fibromyalgia

A

Centralised pain disorder characterised by severe pain and other features
Widespread pain, fatigue and difficulty concentrating
More women than men affected

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19
Q

What are the signs and symptoms of fibromyalgia?

A

Widespread pain in multiple regions of body for more than 3 months
Intrusive fatigue - emotional and physical
Increased sensitivity to light, sound and temp.

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20
Q

What is the management and treatment for fibromyalgia?

A

Pain related anxiety/ depression - CBT and SSRIs
Sleep disturbance - low dose amitriptyline and pregabalin
Severe pain - amitriptyline, gabapentin, pregabalin, duloxetine and tramadol
Physio

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21
Q

Describe hypermobility spectrum disorder (HSD)/ hypermobile Ehlers-Danlos syndrome (hEDS)

A

Connective tissue disorder which causes injury, pain, joint hypermobility and instability
Spectrum of hypermobility
Strongly genetically determined
Beighton diagnostic criteria

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22
Q

What are the signs and symptoms of HSD or hEDS?

A

Joint pain, myalgia, joint effusions, and soft tissue problems - bursitis, epicondylitis, and tendinopathies
Linked to CV and GI symptoms
Soft skin, easy bruising, papery scars, peizogenic papules and striae

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23
Q

What is the management for HDS or hEDS?

A

Appropriate physical therapy - strengthening and stretching
Core stability
Correct foot deformity and OT input

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24
Q

Describe gout

A

Type of arthritis caused by monosodium urate crystals forming inside and around joints
Sudden flares of heat, pain and swelling
Most commonly distal joints of toes

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25
What is the most important risk factor for gout?
Hyperuricaemia
26
What are the symptoms of gout?
Rapid onset of pain with redness and swelling in one or more joints Tophi - accumulation of uric acid
27
What is the investigation for gout?
Aspiration is gold standard Also serum urate level measured
28
What is the management and treatment for gout?
Acute flares - NSAID,s colchicine and steroids Long term - urate lowering therapy First line is allopurinol and UTL is measured 2nd line is febuxostat Lifestyle - weight, hydration, diet and limit alcohol
29
Describe pseudogout
Condition caused by deposition of calcium pyrophosphates on tissues and cartilage around joints Most commonly affects the knee in elderly
30
What is the investigations for pseudogout?
X-rays - chondrocalcinosis Aspiration to show crystals
31
What is the treatment for psuedogout?
NSAIDs, intra-articular steroids and no prophylatic treatments
32
Describe polymyalgia rheumatica
Chronic, systemic, rheumatoid disease characterised by pain and morning stiffness in neck, shoulder and pelvic gridle Is associated with giant cell arthritis and high ESR anaemia
33
What are the symptoms of polymyalgia rheumatica?
Sudden onset of shoulder and possible pelvic gridle stiffness Anaemia, malaise, weight loss, fever and depression Arthralgia and synovitis occasionally
34
What is the treatment for PMR?
Prednisolone 15mg per day initially 18-24 month course Bone prophylaxis - calcium and vitamin D
35
Describe troahanteric bursitis
Inflammation of fluid filled sac sandwiched between hip adductors and iliotibial band
36
What is the presentation of trochanteric bursitis?
Pain and point tenderness with on lateral hip Tenderness of greater tuberosity and worst pain in active abduction of hip joint
37
What is the treatment for trochanteric bursitis?
NSAIDs, relative rest, physio, injection of corticosteroids, and surgery Bursectomy - rare
38
Describe avascular necrosis
Death of bone due to loss of blood supply 80% are bilateral Can be due to injury of femoral head blood supply and also, intravascular coagulation MRI - crescent sign (lytic area)
39
What are the symptoms of avascular necrosis of the hip?
Insidious onset of groin pain, limp, pain with stairs, walking uphill, and impact activities Can have signs of early arthritis - reduced ROM and stiff joint
40
What is the treatment for avascular necrosis of the hip?
Reduce weight bearing, NSAIDs, bisphosphonates, anticoagulants and physio Surgery - decompression and vascularised graft Rotational osteotomy or total hip replacement
41
Describe femoral acetabular impingement
Can have cam lesion or pincer lesion - resulting in impingement of femoral head against anterior edge of acetabulum Cam lesion more common in males and pincer in females
42
What is the presentation of femoral acetabular impingement?
Groin pain which is worse on flexion, block to movement and pain with certain movements like getting out of chair and squatting Reduced flexion and internal rotation
43
What is the treatment for femoral acetabular impingment?
Activity modification, NSAIDs and physio Operative - arthroscopy Also, open surgery - resection, osteotomy, and hip arthroplasty
44
Describe labral tears
Tear of acetabular larum of the hip Most commonly anterosuperior tear Commonly affects females - FAI, OA, trauma and collagen disease Positive FABER test
45
What is the symptoms of labral tears?
Activity modification, NSAIDs and physio Arthroscopy which is repair and resection
46
Describe Dupuytren's disease
Benign, progressive fibroproliferative condition of fascia of hands and fingers leading to disabling contractures Thickening of connective tissue Loss of finger extension
47
What is dupuytren's associated with?
Diabetes, alcohol, tobacco, HIV and epilepsy
48
What is the management and treatment for Dupuytren's disease?
Observe, splints and RT Partial fasciectomy, dermo-fasciectomy, arthrodesis and amputation Also, percutaneous needle fasciotomy and collagenase
49
Describe trigger finger
Condition where it is hard to bend or straighten affected finger due to inflammation of tendon or tendon sheath Swelling catches on pulley
50
What is the presentation of trigger finger?
Clicking sensation when movement of digit, limp under pulley and clicking can progress to locking Tenderness at swelling Fell triggering around A1 pulley
51
What is the treatment for trigger finger?
Slintage and steroids Percutaneous release and open surgery
52
Describe De Quervain's tenovaginitis
Painful condition which affects the tendons where they run through tunnel on radial side Inflamed tendon and sheath as runs through extensor retinaculum
53
What is the presentation of De Quervain's tenovaginitis?
Several weeks of pain localised to radial side of wrist, aggravated by movement of thumb, localised tenderness and swelling
54
What is the treatment for De Quervain's tenovaginitis?
Splints and steroid injection Decompression
55
Describe carpal tunnel syndrome
Entrapment neurological condition where median nerve is compressed in carpal tunnel of wrist
56
What are the symptoms of carpal tunnel syndrome?
Nocturnal pain and paraesthesia in part or all median nerve distribution Wasting of thenar muscles can be seen Tinnel's and Phalen's test
57
What is the management and treatment for carpal tunnel syndrome?
Work, limit fine hand movement and driving 6 week course of conservative treatment - splints, corticosteroid injections and hand exercises Carpal tunnel surgery - carpal tunnel release
58
Describe a ganglion of the hand
Swelling of hand or wrist at intra-articular ganglion Arises from joint capsule, tendon, sheath or ligament More dorsal than volar
59
What does ganglion of hand present with?
Presents with lump, form, non-tender, change in size, smooth and occasionally lobulated Normally fixed to underlying tissues and never to skin
60
What is the treatment for ganglion of hand?
Reassure, observe and aspirate Excision - including root 'hit with bible'
61
What is the management and treatment for OA of base of thumb?
Lifestyle modification, NSAIDs, splints and steroid injections Trapeziectomy is gold standard Operative - fusion and replacement
62
Describe hallux valgus
'Bunions' Lateral angulation of big toe and tendons pull realigned to lateral which creates worsening of deformity Sesamoid bones sublux medially
63
What is the treatment for hallux valgus?
Show wear modification, orthotics, activity modification and analgesia Operative - release of lateral soft tissues, osteotomy 1st metatarsal and proximal phalanx
64
Describe hallux rigidus
Stiff bog toe where there is OA of 1st metatarsal phalangeal joint Many asymptomatic and pain worse on dorsiflexion of big toe and limited ROM
65
What is the treatment for hallux rigidus?
Activity modification, shoe wear with rigid sole and analgesia Cheilectomy, arthrodesis and arthroplasty 1st MTPJ fusion is gold standard as permanent treatment 1st MTPJ hemiarthroplasty for retaining ROM
66
Describe claw toes
Proximal and distal IPJs affected
67
Describe hammer toes
Flexion at proximal IPJ causing dorsiflexion at MTP joint
68
Describe mallet toes
Flexion at distal IPJ
69
What is the treatment for lesser toes deformities?
Activity modification, shoe wear and orthotic insoles Operative - flexor to extensor transfer, fusion of IPJ, release of MTPJ and shortening osteotomy of metatarsal
70
Describe Morton's neuroma
Inflammation causing severe pain and numbness Thickening of tissue surrounding the nerve and commonly affects plantar digital nerve of the foot Associated with wearing high heels Mulder's click
71
What is the treatment of Morton's neuroma?
Injection of small lesions with steroids and surgery Surgery - excision of lesion including a section of normal nerve
72
Describe plantar fibromatosis
Ledderhose disease - Dupuytren's of the foot Is progressive, benign proliferation on plantar fascia Lumpy areas on sole of foot - pain and discomfort on pressure
73
What is the treatment of Plantar fibromatosis?
Avoid pressure by correct shoe wear and orthotics Operative - excision but high chance of recurrence RT Combination therapy has lowest risk of recurrence
74
Describe Achilles tendonitis/ tendinosis
Degenerative/ overuse condition with little inflammation Can be insertional (within 2cm of insertion), non-insertional and bursitis
75
What are the symptoms of Achilles tendonitis/ tendinosis
Pain during exercise, pain following exercise, recurrent episodes, and difficulty fitting shoes - insertional Tenderness and test for rupture - Simmond's rupture test
76
What is the treatment for Achilles tendinosis?
Activity modification, weight loss, show wear modification, physio and extra-corporeal shockwave treatment Gastrocnemius recession + release and debridement of tendon
77
Describe plantar fasciitis
Chronic, degenerative change with fibroblast hypertrophy, absence inflammatory cells, disorganised and dysfunctional blood vessels + collagen Can't make extracellular matrix required for repair and remodelling
78
What symptoms are included in plantar fasciitis?
Pain first thing in morning, pain on weight bearing after rest, pain located at origin of plantar fascia and frequently long lasting
79
What is the treatment for plantar fasciitis?
Rest, change, training, stretching, ice, NSAIDs, orthoses, physio, weight loss, corticosteroid injections and night splints
80
Describe posterior tibial tendon dysfunction
Acquired adult flat foot planovalgus Relatively common and under-diagnosed Flat foot seen and heels more valgus Medial arch collapse Orthoses, reconstruction of tendon and triple fusion

MSK (39 decks)

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