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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 = 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