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MSK > Summary - MSK > Flashcards

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
Q

What is the most important risk factor for gout?

A

Hyperuricaemia

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26
Q

What are the symptoms of gout?

A

Rapid onset of pain with redness and swelling in one or more joints
Tophi - accumulation of uric acid

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27
Q

What is the investigation for gout?

A

Aspiration is gold standard
Also serum urate level measured

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28
Q

What is the management and treatment for gout?

A

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

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29
Q

Describe pseudogout

A

Condition caused by deposition of calcium pyrophosphates on tissues and cartilage around joints
Most commonly affects the knee in elderly

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30
Q

What is the investigations for pseudogout?

A

X-rays - chondrocalcinosis
Aspiration to show crystals

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31
Q

What is the treatment for psuedogout?

A

NSAIDs, intra-articular steroids and no prophylatic treatments

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32
Q

Describe polymyalgia rheumatica

A

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

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33
Q

What are the symptoms of polymyalgia rheumatica?

A

Sudden onset of shoulder and possible pelvic gridle stiffness
Anaemia, malaise, weight loss, fever and depression
Arthralgia and synovitis occasionally

34
Q

What is the treatment for PMR?

A

Prednisolone 15mg per day initially
18-24 month course
Bone prophylaxis - calcium and vitamin D

35
Q

Describe troahanteric bursitis

A

Inflammation of fluid filled sac sandwiched between hip adductors and iliotibial band

36
Q

What is the presentation of trochanteric bursitis?

A

Pain and point tenderness with on lateral hip
Tenderness of greater tuberosity and worst pain in active abduction of hip joint

37
Q

What is the treatment for trochanteric bursitis?

A

NSAIDs, relative rest, physio, injection of corticosteroids, and surgery
Bursectomy - rare

38
Q

Describe avascular necrosis

A

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
Q

What are the symptoms of avascular necrosis of the hip?

A

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
Q

What is the treatment for avascular necrosis of the hip?

A

Reduce weight bearing, NSAIDs, bisphosphonates, anticoagulants and physio
Surgery - decompression and vascularised graft
Rotational osteotomy or total hip replacement

41
Q

Describe femoral acetabular impingement

A

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
Q

What is the presentation of femoral acetabular impingement?

A

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
Q

What is the treatment for femoral acetabular impingment?

A

Activity modification, NSAIDs and physio
Operative - arthroscopy
Also, open surgery - resection, osteotomy, and hip arthroplasty

44
Q

Describe labral tears

A

Tear of acetabular larum of the hip
Most commonly anterosuperior tear
Commonly affects females - FAI, OA, trauma and collagen disease
Positive FABER test

45
Q

What is the symptoms of labral tears?

A

Activity modification, NSAIDs and physio
Arthroscopy which is repair and resection

46
Q

Describe Dupuytren’s disease

A

Benign, progressive fibroproliferative condition of fascia of hands and fingers leading to disabling contractures
Thickening of connective tissue
Loss of finger extension

47
Q

What is dupuytren’s associated with?

A

Diabetes, alcohol, tobacco, HIV and epilepsy

48
Q

What is the management and treatment for Dupuytren’s disease?

A

Observe, splints and RT
Partial fasciectomy, dermo-fasciectomy, arthrodesis and amputation
Also, percutaneous needle fasciotomy and collagenase

49
Q

Describe trigger finger

A

Condition where it is hard to bend or straighten affected finger due to inflammation of tendon or tendon sheath
Swelling catches on pulley

50
Q

What is the presentation of trigger finger?

A

Clicking sensation when movement of digit, limp under pulley and clicking can progress to locking
Tenderness at swelling
Fell triggering around A1 pulley

51
Q

What is the treatment for trigger finger?

A

Slintage and steroids
Percutaneous release and open surgery

52
Q

Describe De Quervain’s tenovaginitis

A

Painful condition which affects the tendons where they run through tunnel on radial side
Inflamed tendon and sheath as runs through extensor retinaculum

53
Q

What is the presentation of De Quervain’s tenovaginitis?

A

Several weeks of pain localised to radial side of wrist, aggravated by movement of thumb, localised tenderness and swelling

54
Q

What is the treatment for De Quervain’s tenovaginitis?

A

Splints and steroid injection
Decompression

55
Q

Describe carpal tunnel syndrome

A

Entrapment neurological condition where median nerve is compressed in carpal tunnel of wrist

56
Q

What are the symptoms of carpal tunnel syndrome?

A

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
Q

What is the management and treatment for carpal tunnel syndrome?

A

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
Q

Describe a ganglion of the hand

A

Swelling of hand or wrist at intra-articular ganglion
Arises from joint capsule, tendon, sheath or ligament
More dorsal than volar

59
Q

What does ganglion of hand present with?

A

Presents with lump, form, non-tender, change in size, smooth and occasionally lobulated
Normally fixed to underlying tissues and never to skin

60
Q

What is the treatment for ganglion of hand?

A

Reassure, observe and aspirate
Excision - including root
‘hit with bible’

61
Q

What is the management and treatment for OA of base of thumb?

A

Lifestyle modification, NSAIDs, splints and steroid injections
Trapeziectomy is gold standard
Operative - fusion and replacement

62
Q

Describe hallux valgus

A

‘Bunions’
Lateral angulation of big toe and tendons pull realigned to lateral which creates worsening of deformity
Sesamoid bones sublux medially

63
Q

What is the treatment for hallux valgus?

A

Show wear modification, orthotics, activity modification and analgesia
Operative - release of lateral soft tissues, osteotomy 1st metatarsal and proximal phalanx

64
Q

Describe hallux rigidus

A

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
Q

What is the treatment for hallux rigidus?

A

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
Q

Describe claw toes

A

Proximal and distal IPJs affected

67
Q

Describe hammer toes

A

Flexion at proximal IPJ causing dorsiflexion at MTP joint

68
Q

Describe mallet toes

A

Flexion at distal IPJ

69
Q

What is the treatment for lesser toes deformities?

A

Activity modification, shoe wear and orthotic insoles
Operative - flexor to extensor transfer, fusion of IPJ, release of MTPJ and shortening osteotomy of metatarsal

70
Q

Describe Morton’s neuroma

A

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
Q

What is the treatment of Morton’s neuroma?

A

Injection of small lesions with steroids and surgery
Surgery - excision of lesion including a section of normal nerve

72
Q

Describe plantar fibromatosis

A

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
Q

What is the treatment of Plantar fibromatosis?

A

Avoid pressure by correct shoe wear and orthotics
Operative - excision but high chance of recurrence
RT
Combination therapy has lowest risk of recurrence

74
Q

Describe Achilles tendonitis/ tendinosis

A

Degenerative/ overuse condition with little inflammation
Can be insertional (within 2cm of insertion), non-insertional and bursitis

75
Q

What are the symptoms of Achilles tendonitis/ tendinosis

A

Pain during exercise, pain following exercise, recurrent episodes, and difficulty fitting shoes - insertional
Tenderness and test for rupture - Simmond’s rupture test

76
Q

What is the treatment for Achilles tendinosis?

A

Activity modification, weight loss, show wear modification, physio and extra-corporeal shockwave treatment
Gastrocnemius recession + release and debridement of tendon

77
Q

Describe plantar fasciitis

A

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
Q

What symptoms are included in plantar fasciitis?

A

Pain first thing in morning, pain on weight bearing after rest, pain located at origin of plantar fascia and frequently long lasting

79
Q

What is the treatment for plantar fasciitis?

A

Rest, change, training, stretching, ice, NSAIDs, orthoses, physio, weight loss, corticosteroid injections and night splints

80
Q

Describe posterior tibial tendon dysfunction

A

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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