week 1 MSK Flashcards
Rheumatoid arthritis:
what is it?
risk factors?
presentation?
investigations?
treatment?
Chronic inflammatory autoimmune disease effecting the synovium symmetrical small joints
3:1 female, 30-50
small joints of hand and feet symmetrically, multiple joints effected, 3+ month history of pain, morning stiffness and swelling, swan neck and boutinaires defomity, carpal tunnel syndrome and malasie
Rheumatoid factor bloods, anti CCP blood, FBC, CRP, US, Xray
LESSS (loss of space, erosion, see through bones, subluxation, swelling)
NSAID (PPI cover)
DMARD - methotrexate or sulfasalazine
Steroids (acutely)= PO/IM or intra-articular for flares
Steroid long term in established RA
biologics
Non-drug- OT/PT, podiatry, psychological
osteoarthritis:
what is it?
risk factors?
presentation?
investigations?
treatment?
disease of synovial weight bearing joints asymmetrically - repeated excessive loading and stress of a joint over time, or by injury
previous injury to joint , obesity, age, women
45 year old +, with months to years of activity related joint pain commonly in knees, hips, and small joints of the hand
on examination the joints may be deformed, warm, tender, unstable, reduced ROM, crepitus, muscle wasting, heberdens nodes (DIPJ), Bouchards node (PIPJ)
history, examination, Xray - LOSS (loss of space, osteophyte, subchondral sclerosis, subchondral cysts)
Non-drug - Strengthening and range of movement exercises, Weight loss to reduce joint loading, insoles/ walking stick
Drug- Paracetamol regularly, NSAIDs short-term, Topical NSAIDs
Intraarticular corticosteroids
Surgery (joint replacement) - If pharmacological and physical modalities of treatment don’t work
Younger patients have higher chance of revision surgery int eh future
osteoporosis?
what is it?
risk factors?
presentation?
investigations?
treatment?
a structural degeneration of bone leading to bone fragility
female sex, menopause, age, oral corticosteroids, smoking, inflammatory joint disease, low BMI >18.5
an elderly person or person with said risk factors presenting with a fragility fracture (fracture following a fall from standing height or less) vertebrae may crack spontaneously
DXA scan of T-score is -2.5 or lower
bisphosphonate (alendronate)
VItamin D and calcium
2nd line denosumab
bursitis:
what is it?
risk factors?
presentation?
investigations?
treatment?
Inflammation of a bursa
overuse, infection, injury
swelling, pain, redness, reduced movement, fluctuant and moveable swelling
examination, US, MRI, aspiration
NSAIDS, Ice and rest - if continue bursa aspiration/ corticosteroid injection
if septic bursitis = aspiration + flucloxacillin or clarithromycin (allergy) or erythromycin in preg/breast feed
gout:
what is it?
risk factors?
presentation?
investigations?
treatment?
Inflammatory arthritis related to a hyperuricemia- causes deposition of monosodium urate crystal which accumulate in joints and soft tissue
purine/meat, alcohol, urate raising drugs (diuretics), obesity, HTN, smoking
severe pain often in big toe, hot tender, swollen, skiny, red
serum urate of 360 micromol/L, Joint aspiration (MSU crystals) - negatively birefringent through polarised light (microscope), imaging - Xray, US, CT
NSAID, colchicine, oral corticosteroids (first line), intrarticular if continues
if its chronic use ULT (urate lowering therapy) e.g. allopurinol
psoriatic arthritis
what is it?
risk factors?
presentation?
investigations?
treatment?
it is inflammatory joint disease related to arthritis
having psoriasis, fam hx
pitted nails, nail separation (onycholysis), joint pain/stiffness, swollen fingers (dactylitis)
inflammatory blood tests and X ray
NSAID, oral or intra articular steroids
SLE:
what is it?
risk factors?
presentation?
investigations?
treatment?
Autoimmune disease where body attacks own health tissue over a number of systems
women, aged 15-44,
ANA antibody
NSAID, hydroxychloroquine, steroids, ritixumab
ankylosing spondylitis
what is it?
risk factors?
presentation?
investigations?
treatment?
inflammatory joint disease effecting sacroiliac joints and the spine
45 years or below ! men, family history
3+month back pain, under 45, uveitis, enthesitis, psoriasis, IBD, stiffness relived by exercise, nor relived by laying supine
use modified new york criteria to diagnose,
X ray and history/examination, MRI, HLA-B27, CRP, ESR
sciatica
what is it?
risk factors?
presentation?
investigations?
treatment?
symptoms and pain associated with compression of the sciatic nerve - L4-S1
can be causes by s a slipped disc, cancer, infection, Spondylolisthesis (vertebrae slips forward)
- Smoking.
- Obesity.
- Occupational factors — for example, whole body vibration, strenuous physical activity.
- General health
- age
pain in lower back spreading to below knee or foot, tingling paraesthesia and weakness in dermatome, loss of reflexes, positive straight leg test, extensor plantar response
rule out cauda equina red flags, infection red flags and cancer red flags
use STarT back tool to asses, MSK and neurological exam, femoral stretch test for upper lumbar disc herniation
pain killer - NSAID, come back if worsens or not resloved in 2 weeks
can refer to physio and psycho support
heat pads, do not rest too much, OPH
cauda equina
what is it?
causes?
presentation?
investigations?
treatment?
when the cauda equina becomes severly compressed
haemorrhage, infection, malignancy, herniated disc
- Severe or progressive bilateral neurological deficit of the legs.
- Recent-onset urinary retention (caused by bladder distension because the sensation of fullness is lost) and/or urinary incontinence (caused by loss of sensation when passing urine).
- Recent-onset faecal incontinence (due to loss of sensation of rectal fullness).
- Perianal or perineal sensory loss (saddle anaesthesia or paraesthesia).
- Unexpected laxity of the anal sphincter
MRI
emergency referral and decompression surgery within 24-48 hours
tendinitis
what is it?
risk factors?
presentation?
investigations?
treatment?
the swelling of a tendon due to injury or repetitive straining movement
sports, occupation, age
pain, tenderness swelling
physical examination and forms of imaging e.g. US or MRI
rest for 6 weeks, ice, physical therapy, orthosis/support and analgesia , possibly corticosterid injections
back pain
shingles, when to suspect ?
(herpes zoster) if the person has unilateral pain and rash in the distribution of a dermatome.
causes of back pain that may not originate from the back
- Gastrointestinal – such as peptic ulcer or pancreatitis
- Genitourinary – such as kidney stones, pyelonephritis, prostatitis, or pelvic infection
score on a DXA scan
osteopenia
osteoporosis
- 1 to -2.5
- 2.5 or less
osteomalacia
what is it
risk factors
presentation
treatment
a bone condition where they are unable to mineralise or harden
due to lack of vit D or sunlight, digestive problems or kidney issues
bone pain all over body especially in lower back and hips
physical examination , blood tests and imaging/biopsy
supplements for lack of vit D
correct kidney failure with drugs to balance mineral and hormones
WHO pain ladder
hand of benediction?
wrist drop?
claw hand?
