Musculoskeletal HDR

Mark Brooke

Samar Shefta

Why Is MSK So Important?

1 in 5 patients consulting their GP is for a MSK condition

MSK conditions are often one of the main reasons for repeat consultations

FRUSTRATION!

Question 1

The only treatment for bunions is surgery

True or False?

Question 2

Plantar fasciitis is best treated by

steroid injection

True or False?

Question 3

Mortons neuroma is more common

with a Mortons foot

True or False?

Question 4

A sprained ankle should be better

by two weeks

True or False?

Question 5

Suspected Osgood-Schlatters disease should be x-rayed for confirmation

True or False?

Question 6

Arthroscopy and washout is a good treatment for osteoarthritis of the knee

True or False?

Question 7

McMurrays test is the best way to

diagnose meniscal tears

True or False?

Question 8

Ultrasound guidance is needed for trochanteric bursitis injections

True or False?

Question 9

60% of patients presenting with whiplash injuries suffer long lasting symptoms

True or False?

Question 10

The lifetime prevalence of acute low back pain is 58%

True or False?

Hallux Valgus

The only treatment for bunions is surgery FALSE

~150 different operations Corrective action in some cases

Eg: flat feet, hyperpronation, small shoes(!) Physiotherapy Injections

Plantar Fasciitis

Plantar fasciitis is best treated by steroid injection FALSE

Inflammatory condition Heel pain worst in morning / after rest Examination = tender spot on stretching Xray NOT needed Address the risk factors!

Mortons Neuroma

Mortons neuroma is more common with a Mortons foot FALSE

Interdigital neuroma between metatarsals Shooting pain + numbness in affected toe Foot squeeze “Mulders click” <5mm steroid injection >5mm surgery

Ankle Sprain

A sprained ankle should be better by 2 weeks FALSE

Not worth investigating until >6wks Complications often missed

Talar dome # Peroneal tendon dislocation

Always examine on standing!

Ankle Sprain

A

B

C

Ankle Sprain

A = Calcaneus, B = Lateral malleolus, C = Fibula

Ottawa rules: Bony tenderness at posterior tip of lateral

malleolus Bony tenderness at posterior tip of medial

malleolus Unable to weight bear at the time of injury and

when examined

Osgood-Schlatters Disease

Suspected Osgood-Schlatters disease should be xrayed for confirmation FALSE

Osteochondritis of antr tibial tubercle More common in active children Diagnosis is clinical! Treat with activity modification

Knee Osteoarthritis

Arthroscopy and washout is a good treatment for OA of the knee FALSE

Unless a loose body is present Many conservative treatments

ARC website, NICE guidelines

Meniscal Tears

McMurrays test is the best way to diagnose meniscal tears FALSE

History! (NB: degenerative tears) Weight-bearing rotational injury

swelling ?ongoing locking Joint line tenderness

Trochanteric Bursitis

US guidance is needed for trochanteric bursitis injections FALSE

Inflammation / degenerative changes over greater trochanter

Pain on lateral hip after exertion Weakness in hip abduction Physiotherapy! Ice + injections

‘Whiplash’

60% of patients presenting with whiplash injuries suffer long lasting symptoms FALSE

Stretching / tearing of cervical muscles + ligaments due to sudden extension Pain and decreased neck mobility

Analgesia + early mobilisation 40% suffer long lasting symptoms

Back Pain

The lifetime prevalence of acute low back pain is 58% TRUE

Acute low back pain = <6wk duration Chronic low back pain = >3months Prevention! ‘Red flag’ signs

Back Pain ‘Red Flag’ Signs

<20 yrs >55 yrs Non-mechanical

pain Thoracic pain PMH of carcinoma HIV

Steroid use Unwell Weight loss Widespread

neurology Structural

deformity

Questions?

Total points: 24

References

www.getwelluk.com www.wayodd.com www.foot-ankle.co.uk www.eorthopod.com www.runnersweb.com www.e-radiography.net Biomed.brown.edu www.healthallrefer.com www.orthogate.org