1
Q
what are the signs adn symptoms of achilles tendinopathy?
A
- pain aggravated by acitvity or pressure to area
- stiffness in the tendon after rest
- crepitus, thickening, nodularity
- pain worsens with passive dorsiflexion
2
Q
what is the difference between mid portion and insertion tendinopathy?
A
- gradual onset pain 2-6cm prximal to achilles tendon insertion - mid portion
- pain and swelling in insertion to posterior calcaneus - insertional tendinopathy
3
Q
how do you investigate fro achilles tendinopathy?
A
US or MRI - by referral
4
Q
what are teh risk factors for achilles tendinopathy?
A
- diabetes mellitus
- dyslipidaemia
- fluoroquinolone use
5
Q
when woudl you suspect an achilles rupture?
A
- sudden pain in back of leg asociated with audible snap (1/3 dont experience pain)
- aching of calf, swelling, mild burising and weakness when pushing off affected foot
- difficulty weight bearing
6
Q
what is the improtant test used to test fro achilles tendon rupture?
A
- Simmonds triad (angle of declination, palpation and calf squeeze test)
pt. lies prone with feet hanging off edge of bed
7
Q
how do you manage an achilles tendon rupture in primary care?
A
admission or same day referral to ortho
8
Q
how do you manage achilles tendinopathy in primary care?
A
- manage underlying causes (fluoroquinolone use, hypercholesterolaemia, diabetes)
- ice packs apples to ease symptoms
- paracetamol for pain relief
- rest / reduce amount of exercise
- weight bear as tolerated
- if sympotms dontimrpvoe within 7-10 days refer to physio
9
Q
what is a sprain?
A
stretch or teat of a ligament
10
Q
what is a strain?
A
stretch and or tear of a muscle fibre or tendon
11
Q
what are teh symptoms of a sprain?
A
pain, tenderness ,swelling, bruising, pain on weight bearing, decreased function, joint instability
12
Q
what are the symptoms of a strain?
A
muscle pain, cramping, spasm, muscle weakness, inflammation, bruising
13
Q
how do you manage a sprain or strain in primary care?
A
- pain relief
- PRICE
- advice on safe return to sport
- review after 5-7 days to see if improved
- if ongoing symptoms: physio referral
if worsenign/worrying symptoms: ortho referrral
14
Q
what are the signs and symptoms of tennis elbow?
A
- insidious onset that may follow injury or increased levels of activity
- pain in lateral epicondyle of dominant arm with radiation down extensor aspect of forearm
- grip weakness
- localised point tenderness on palpation
15
Q
what is the managment of tennis elbow?
A
- apply hear or ice to help relieve pain
- rest arm, avoid tasks that invovle high force
- pain relief
- if no improvment after 6 wks consider alternative diagnosis or consider referring to physio
16
Q
what are the clinical features of raynauds?
A
demarcated pallor of the digits, followed by another colours (erythema or cyanosis)
sympotms precipitated by cold
may have parasthesia on rewarming
other extremities may be affected
17
Q
waht is secondary raynauds?
A
occurs in association with an underlying condition (often connective tissue disorder that reduces blood flow to extremities)
= digital ulcers, gangrene, severe ischaemia, episodes are intense + painful, abnormal nail fold capillaries
18
Q
what investigatiosn woudl you arrange if you suspected a pt. had raynauds?
A
FBC, ESR, ANA
other tests is suspect underlying cuase
19
Q
how do you manage a pt. with raynauds in primary care?
A
- refer to rheum if <12yo or suspected secondary raynauds
- keep whole body warm
- stop smoking
- reduce stress
- exercise regularly
- trial of nifedipine as prophylaxis if no else works
20
Q
what are the clinical features of plantar fasciitis?
A
- insidious onset heel pain
- intesne heel pain after period of rest
- pain reduces w moderate acitivty, but worsens after long periods of standing/walking
- tenderness on palpation of plantar heel area
- limited dorsiflexion range
- tightness of achilles tendon
- antalagic gait
21
Q
what is the management of plantar fasciitis?
A
- most ppl make a complete recovery within a year
- rest foot
- wear shoes with good arch support
- cosnider purchasing insoles and heel pads
- lose weight
- analgesics
- icepack
- self -physio stretches
- if v serious: consider corticosteroid injeciton into plantar fascia
- after few monhts of self care and self physio then refer to podiatrist or physio
22
Q
what are the clinical features of RA
A
- symmetrical synovitis of small joints of hands and feet, most commonly
- pain (worse at rest)
- swelling
- heat
- stiffness (worse in mornings fro ~1 hour)
- rhuematoid nodules, swan neck deformity, extra-articualr features, systemic features, FHx
- positive metocarpophalangeal squeeze test
- DIPJS SPARED !
23
Q
what investigatios are done when RA is suspected?
A
clinical diagnosis! in primary care
can offer blood test for rheumatoid factor, anti-CCP
ESR, CRP
x -ray to determine disease severity or possibly MRI
24
Q
management of suspected RA in primary care?
A
- refer urgently (wihtin 3 working days) if any of the following:
- small joints of hands and feet affects
- more than one joint affected
- > 3 months of symptoms
- consider offering low dose NSAID - ibuprofen/naproxen
25
what treatment is given in secondary care to patients with RA?
- 1. DMARDs -methotrexate, sulfasalazine
- 2. hydroxychloroquine
- 3. glucocorticoids (short term bridging treatment until DMARD takes effect)
- 4. biological DMARDs (infliximab, rituximab)
26
how shoudl RA flares be managed in primary care
- intraarticular glucocorticoid injection for localised flare
- IM glucocorticoid injection
- oral glucocorticoid (14 days)
- consider NSAID fro short time
27
what is olecranon bursitis?
olecranon bursa is a sac overlying the olecranon process of elbow
the bursa can become irritated and infalmed = bursitis ( septic or non septic )
28
what are the clinical features of olecranon bursitis
- swelling over olecranon process
- tender or warm
- fluctuant (movable and compressible)
- when elbow is in full felxion swollen bursa = compressed = pain
septic bursitis = systemic symptoms
29
when would you aspirate bursal fluid from a bursa?
septic bursitis or to rule out infection in persistent cases of aseptic bursitis
- sample for microscopy and gram staining
30
how shoudl you manage bursitis?
response to conservative treatment:
- rest, ice, reduec activity
- avoid trauma/direct pressure
- compressive bandaging
- analgesia for pain relief
- consider aspiration if effusion is large
- if no response to conservative or aspiration then corticosteroid injection
31
how shoudl you manage septic bursitis?
aspirate bursal fluid
| fluclox 7 days 500mg QID
32
what are the signs and symptoms of pre patellar bursitis?
- pain, swelling (warm, tender, fluctuant) and redness of knee
- difficulty kneeling or walking
- fever
- history of trauma or repettive prolonged kneeling
33
what is a bakers cyst?
distension of teh gastrocnemius - semimembranosus bursa behind the knee
34
what can cause bakers cysts?
- trauma, local irritation (chidlren)
| - OA, inflammatory arthropathies, meniscal teas, ACL damage (adults )
35
what are teh clinical features of a bakers cyst?
- asymptomatic swelling behind knee
- pain
- aggravated by walking
- tightness behind knee
- lump is round, smooth and fluctuant, tender
- cyst may feel tense in full extension and soften/disappear in flexion
- ROM may be restricted
36
what investigations need to be arranged when bakers cysts are suspected?
- US scan to confirm
| - MRI is suspect meniscal tear as well
37
in children, how is a bakers cyst managed?
- admit to peads or A+E fro urgnet assessment
| - if not underlyign disease and confirmed on US then reassure that will resolve without treatment
38
in adults, how is a bakers cysts managed?
identify and manage underlying condition if one
if asymptomatic: no treatment
if symptomatic: analgesia, refer to rehumatologist or ortho surgeon (aspirate or corticosteroid injection or athroscopy)
39
what are the clinical features of gout?
- arthritis: swelling, redness, warmth, pain
| - tophi (firm, white nodules) - develop over 10 years after first attack
40
what are some risk factors of gout?
- alcohol intake,
- dietary intakes (red meat,seafood, fructose)
- drugs
- FHx
- associated co morbidity e.g. obesity, HTN, hyperlipideami, diabetes
41
what ivnestigatiosn are doen when gout is suspected?
diagnosis doesnt usualy need investigations but if in doubt:
joint fluid microscopy and culture - see urate crystals
serum uric acid measures after acute attack
joint xray - normal
42
when woudl you suspect septic arthritis over gotu -
if patient is systemically unwell e.g. fever then suspect septic
43
what is the managemnt of acute gout?
1. selfcare: rest, ice, elevate, avoid trauma
2. pharm: NSAID (+PPI) or oral colchicine
possible joint aspirationa dn intra articular croticosteroids
^^ if noen of above possibel then consider oral or IM corticosteroids
+paracetamol
44
what follow up is recommended ater an acute attack of gout?
- after 4-6 wks:
check serum uric acid elvel
measure BP, HbA1c, renal function and lipid profile
manage any underlying conditions
provide adivce on smoking, alcohol, obesity, exercise, diet
discuss use of ULT
45
what treatment is recommended to prevent gout attacks?
- ULT: allopurinol or febuxostat as 2nd line
- consider prescribing colchicine (or NSAID) when initating or increasing the dose oF A ULT as prophylaxis (as initially can increase amout of gout attacks)
must check SUA and renal function regularly + CVS risk factors review annually
46
what are teh symptoms of leg cramps?
- sudden intense calf or foot pain most often at night
- visible or palpable knotting or tightening of muscle
- seconds - 10 mins
- single muscle invovlenbt
- good response to strecthing
47
name some differential diagnoses for leg cramps?
- dystonia
- myoclonus
- exercise associated muscle cramping
- peripheral neuropathy
- claudication
- myalgia and myositis
- restless legs syndrome
- DVT
- bakers cysts
- periodic limb movement disorder
48
what self care advice shoudl you give someone with leg cramps?
- adivse strecthing and massaging to alleviate attack
- stretch often and stop pointing toes downwards when sleeping
- online info nhs
- consider analgesia if muscle tender
49
what medication could possibly be given for leg cramps?
- quinine, although not generally used for idiopathic leg cramps
trial can be done if not underlying cuases and leg crmaps are severe
prescribe 200-300mg for 4 weeks
50
what are teh signs and symptoms of carpal tunnel syndrome?
- intermittent parasthesia
- burnign or pain in median nerve distribution
- symptoms worse at nigth
- may radiate up wrist. arm
- loss of grip strenght, reduced manual dexterity,
- wasting of thenar eminence
- weakness of muscles supplied by median nerve
51
how do you diagnose carpel tunnel syndrome?
- correct clinical features
- positive tinels and phalens test
- examination of upper limb: median sensory loss and muscle weakness in hand
52
how do you manage a patient with carpal tunnel syndrome?
lifestyle: avoid repetitive hand/wrist movements
6 week of any:
1. wrist splint at night
2. singel corticosteroid injection
3. hand exercises and median nerve mobilisation techniques
if dont work: refer to rheum, ortho surgeon, hand surgeon = carpal tunnel surgery
53
what clinical features would lead you to suspect temperomandibular disorder?
- pain around TMJ and/or muslces of mastication, may radiate (pain provoked by palpation or jaw movement)
- joint noise of TMK - clicking, popping, crepitus
- headache of temporal region
- otalgia and/or tinnitus
54
what are the different types of temporomandibular disorders?
- myalgia/myofascial pain
- TMJ disc displacemnt with reduction
- TMJ disc displacement wihtout reduction (closed lock)
- degenerative joint disease
- sublaxation
- arthralgia
- headache attribuable to TMD
55
name some red flags for TMJ pain?
- previous malignnayc or unexplained fever/weight loss
- persistent or unexplained neck lump or cervical lymphadenopathy
- persistent/worsening pain
- concurrent infection
- Hx of recent head or neck trauma
- facial asymmetry/swelling/mass
- neuro symptoms
- GCS symptoms (unilater headahce, scalp enderness, jaw claudication and malaise)
-
56
how do you manage a person with suspected TMD?
- soft diet, rest jaw
- avoid anythign that woudl exacerbate e.g. chewing gum
- ice/heat pad
- paracetamol or ibuprofen
- consider short course low dose benzo e/g/ diazepam 2mg OR amitriptyline/gabapentin
- consider physio or dentist referral
57
when would you refer a patient to oral medicien or maxillofacial?
- persisent or worsening symptoms for 3 months
- severe pain and dysfunction
- Hx trauma to TMJ
- closed lock jaw
- recurrent dislocation of TMJ
58
what are teh secondary care managment options
- botulinum toxin injection into masseter and temporalis
- intraarticular injection by sodium hyaluronate or corticosteroid preparations
- surgeries: athrocentesis or arthroscopy, athroplasty for severe, eminectomy/eminoplasty fro recurrent dislocation
- total prosthetic TMJ replacemnt for end stage degenrative disease
59
what is cervical radiculopathy?
pain and weakness/numbness in one of both upper extremities which corresponds to the dermatome of theinvolved cervical nerve root
60
what are the most common cuases of cervical radiculopathy?
degenerative changes
cervical disc herniation
spondylosis
trauma
61
what are teh symptoms of cervical radiculopathy?
- pain in neck, shoulder or arm that approximates to dermatome
- usually unilateral
- absent/altered sensation
- motor weakness
- gradual onset
*most common nerve root affected - C7 followed by C6
62
what are the signs of cervical radiculopathy
- postural asymmetry (head tilted to one side or flexed)
- neck movemnts = restricted or sharp pain
- dural irritation - assess with spurlings test
- neurological problems
63
what is the management for cervical radiculopathy?
if present for less than 4-6 weeks and no neuro signs:
- reassurance as can improve without surgery long term
- encourage activity
- advice firm pillow at night
- analgesics (paracetamol, ibuprofen, codeine)
- consider prescriving muscle relaxants
- consider prescribing amitriptyline
64
if cervical radiculopathy is present for more than 4-6 weeks, what is the management?
- confirm diagnosis with MRI
- indications for surgery: signs and symptoms of cervical radiculopathy, unremitting radicular pain despite 6-12 wks of conservative treatments , or progressive motor weakness, + MRI that shows nerve root compression
65
what are the clinical features that would point you towards and diagnosis with OA?
age > 45 yo
- acitvity related joint pain (gradual development)
- bony swelling and joint deformity
- joint effusions
- joint warmth or tenderness
- muscle wasting and weakness
- restricted ROM, crepitus, joint instability
* herberden and bouchards nodules in hands
* trendelenburg gait in hip
66
what is the main diagnostic test for OA?
X-ray (usually onyl needed to 100% confirm - mostly can tell from clinical features)
67
how do you initially manage a patient with OA?
- weight loss, local muscle strenghening exercises, appropriate footwear, ice packs,
- analgesia for symptom relief (paracetamol, ibuprofen, codeine)
68
when would you refer a patietn with OA to a physio?
- fro advice on local muscle strengthening exercises
- fro additional manipulation and stretching
- for provision of joint supports, splints, braces
- intra articular corticosteroid injections
69
when would you refer a patient with OA to a ortho surgeon?
- symptoms of joint pain, stiffness and functions impairmnet
- significant impact of QOL
- uncertianty abotu diagnosis or atypical symptoms
- sudden worsenign of symptoms
70
what are the signs and symptoms of sciatica?
- unialteral leg pain radiating below the knee to foot or toes
- low back pain
- numbness, tingling in dermatomal distribution
- weakness or reflex changes in myotomal distribution
- positive result in striaghth leg raise test (pain at 60 degrees)
71
what investgiations may you do to rule out other cuases of back pain? (if a patient is suected on sciatica)
- FBC
- ESR
- CRP
- blood vultures
- urinalysis
72
what are the sciatica red flag symtpoms and signs?
- bowel/bladder dysfunction
- progressive neuro wekaness
- saddel anaesthesia
- bialteral radiculopathy
- incapacitiating pain
- unrelenting night pain
- use of steroids or IV drugs
*any signs of cauda equina, spinal fracture, cancer or infection
73
how do you manage a patient with sciatica?
- self management: carry on normal activity, local heat
- offer analgesia
- DO NOT offer opiods, gabapentinoids, antiepileptics, oral corticoseorids, benzos
74
when woudl you refer a patient who has sciatica with no red flags ?
- sevre radicualr pain at 2-6 wks
- acute and severe sciatica
- non tolerable radicular pain at 6 weeks
- sciatica when non surgical treatment has not improved pain or function
75
what is ankylosing spondylitis?
ankylosing spondylitis is axial spondyloarthritis characterised by sacroilitis on x-ray
it is an inflammator rhuematological condition
76
what are the clinical features of ankylosing spondylitis?
age < 45 yo
- chronic or recurrent low back pain present for >3 months
- fatigue
- stiffness
- pain and stiffness worse in mornings + imrpoving w movement
- symptoms wake them at nigth
- buttock, thoracic or cervical spine pain
- arthritis
- anterior uveitis
- psoriasis or IBD
- symptoms respond to NSAIDs
77
what investigatiosn/referrals do you do in primary care for a patient who may have ankylosing spondylitis?
- ESR, CRP
- X-ray
- MRI - infalmmation of sacroiliiac joint detected
- HLA - B27
- refer to rheumatologist
78
what treatment do you start on a pt. with suspected ankylosing spondylitis while waiting fro referral?
- NSAID - lowest effective dose
79
when shoudl you refer a person with suspected ankylosing spondylitis to rheumatologist?
4 or more of following:
- low back pain starting before 35yo
- back pain lasting > 3 months
- symptoms waking them up at nigth
- buttock pain
- improvement when moving
- improvemnt within 48 hrs of taking NSAIDs
- spondyloarthritis in first degreee relative
- current or past arthritis
- current or past enthesitis
- current or past psoriasis
if 3 present + positive HLA-B27 = refer
80
what are teh drug treatment options for ankylosing spondylitis?
- NSAIDs
- DMARDs
- biologic therapies - anti TNF therapies
- steroid (injections)
81
what is greater trochanteric pain syndrome?
regional pain syndrome in which chronic intermittent pain is felt around greater trochanter
- caused by inflammation or physical trauma in muscles, tendons, fascia or bursae
- common in women > men and age 40-60
- frequently seen together with low back pain, OA of knee, RA and fibromyalgia
82
what are the signs and symptoms of greater trochanteric pain syndrome?
- chronic lateral hip/thigh/buttock pain (intermittent or persistent)
- gradual onset that may progressively worsen
- pain can radiate down lateral aspect of thigh
- pain aggravated by physical activity + pressure
83
what is the management of greater trochanteric pain syndrome
- usually self limiting
- rest
- apply ice every few hours for 10 mins
- paracetamol/ibuprofen
- info on weight loss
- smokign cessation advice
- assess needs to walking aids or physio/OT referral
- consider if all fail: peritrochnateric corticosteroid injection and referral to physio
84
name some risk factors for osteoporosis?
- female sex
- increasign age
- menopause
- oral corticosteroids
- smoking
- alcohol
- previous fragility fracture
- rheum conditions
- parental history of hip fracture
- BMI<18.5
85
how do you assess person for fragility fractue risk?
- dual energy x ray absorptiometry (DXA) scan to measure bone mineral density
- if have risk factors, calculate fragility frature risk, using online calculator, before ordering DXA scan
- asses for vit D deficiency and inadequate calcium intake
86
what drug treatments are recommened for people at high risk of osteoporotic fracture
(if T score is -2.5 or lower)
- bisphosphonate (alendronate 10mg once daily in men or risedronate 5mg once daily in postmenopausal women)
- calcium (need 1000mg daily) plus 10 micrograms prescribed daily (or 20 micrograms if elderly + housebound)
- consider HRT to younger postmenopausal women
87
what lfiestyle advice shoudl be given to ppl with osteoporosis?
- regualr exercise to improve msucel strength
- eat balanced diet
- stop smoking
- lower alcohol intake
- provide with online sources + support
88
when shoudl you test/suspect vit D deficiency in an adult?
- MSK symptoms: muscle pain or weakness, and joint pain or bone pain, most often affecting the shoulders, pelvis, ribs, and spine
- suspected bone disease(osteoamalacia or osteoporosis)
- known bone disease, where correction of vit D is needed prior to specific treatment
89
when diagnosed vit D deficiency with blood testing, which other investigatiosn may be useful to arrange?
- bone profile (calcium, phosphate, alkaline phosphatase)
- PTH level
- FBC
- TFTs
- renal and liver function test s
- coeliac serology
90
treatment of vit D deficiency in adults?
(seek specialist if have co morbidities that would be affected by increased calcium)
- oral vit D3
- if rapid vit D correction needed (e.g. if have symptoms), start with fixed loading dose (300,000 IU) then maintenance (800-2000 IU daily)
- if patient has low calcium intake then calcium supplements
91
what lfiestyle advice should be given to adults with vit D deficiency?
- adequate sunlight exposure
- adequate calcium and vit d intake in diet
- give sources online for support with diet
92
when would you suspect polymyalgia rhuematica in a patient?
- over 50 yrs old
- bilateral shoudler and/or pelvic girdle pain - worsened with movement, + may radiate to elbows + knees respectively
- stiffness lasting for at least 45 mins after waking
- low grade fever, fatigue, weight loss, depression, capral tunnel syndrome, peripheral arteritis
93
how is polymyalgia rheumatica diagnosed? which criteria
- identifying core features of condition
- excluding conditions that mimic PMR
- positive response to oral corticosteroids (trial 15mg prednisolone daily for 1 week)
(- ESR or CRP - supportive)
94
what differentials are important to exclude when suspecting a diagnosis of polymyalgia rheumatica?
- giant cell arteritis
- active infection or cancer
- arthritis
- thryoid disease
- statin induced myalgia or myositis
- bilateral adhesive capsulitis
- cervical and lumbar spondylosis
95
how do you manage a person for whom a diagnosis of polymyalgia rheumatica has been made?
- reduce the dose of prednisolone slowly when symptoms are fully controlled
- ensure person is provided with blue steroid card
- arrange routine reviews every 3 months for first yr follwoing diagnosis
- provide written info
96
what differentials need to be ruled out when a patient complains of low back pain?
- cauda equina
- sciatica
- ankylosing spondylitis
- osteoporosis
- cancer of spine
- spinal fracture / spinal infection
- gastrointestinal e.g. peptic ulcer
- genitourinary e.g. kidney stones,
- shingles
97
what are the red flags for lower back pain?
- infection: fever, TB, diabetes, IV drug user, use of immunosupressants
- cancer: weight loss, gradual onset, PMHx of cancer, aching night pain, no improvemnt with conservative treatment
- spinal fracture: sudden onset, trauma, structural deformity, point tenderness over vertebral body
- cauda equina: perianal or perineal sensory loss, recent onset faecal incontinence or urinary retention, bilateral neuro deficit of legs - motor
98
how do you manage a patient with lower back pain?
- analgesia: ibuprofen or naproxen first line, codeine second line
- seek follow up if no improvment in 3-4 weeks or worsening
- consider referral to physio, group exercise programme or CBT
- keep exercising
- local heat
99
what are the signs and symptoms of non specific neck pain?
- pain aggravated by particular movements, posture + activities
- pain radiates in a non segemntal distribution down arm/shoulder/head
- pain associated with parasthesia but no loss of sensation or muscle strenght
- positional asymmetry, limite ROM
- tenderness in intervertebral joints and/or hypertonic muscles
100
name some red flags signs and symptoms of neck pain?
- fever, night sweats, weight loss, n+V, severe headache, photophobia
- sensory changes/loss, altered muscle tone, gait disturbance, babinski sign, hoffmans sign, bowel/bladder dysfunction
- altered cognitive state
- osteroporosis risk factors
- Hx of TB, inflammatory artheritis, immunosupression, drug abuse, trauma
101
what is the managemnt for non specific neck pain?
- oral analgesics - ibuprofen, paracetamol, codeine
- consider topical NSAID
- encourage exercise
- consider muscles relaxants e.g. diazepam
- consider referral to physio, psychological therapy, occupational health
- if neck pain for >12 wks then consider referral to pain clinic if failed to respond to conservative treatment
102
name some differentials for shoulder pain
- rotator cuff disorders
- frozen shoulder
- instability disorders
- acromioclavicular joint disorders
- glenohumeral joint OA
- inflammatory arthritis
- septic arthritis
- referred pain
- polymyalgia rheumatica
103
name some red flags for shoulder pain.
- trauma
- pain and weakness
- shoulder mass or swelling
- red skin
- fever
- abnormal shape
- new symptoms of inflammation in several joints
104
how do you manage a person with frozen shoulder?
- frozen shoudler is usually self limiting: symptoms are pain and stiffness
- maintain movement but avoids movemnts that cause pain
- take analgesia (paracetomaol then ibuprofen or codeine)
- hot packs
- support arm wiht pillow in bed
- physio referral
- intraarticular corticosteroid injection
105
how do you manage a patient with a rotator cuff disorder
- rest in acute phase
- exercise/physio
- analgesia
- subacromial corticosteroid injection
- referral to secondary care
106
how shoudl you manage a person with a an acromioclavicular joint disorder?
- activity modification + avoid heavy lifting
- offer analgesia
- consider physio referral
- consider corticosteroid injection
- arrange x-ray and ortho referral if no improvement from ^^
107
how do you manage a person with glenohumeral joint OA?
- strenghthenign exercised and consider physio referral
- weight loss if overweight
- assisted devices if needed
- analgesia
- corticosteroid injection
- if ^^ dont work the refer to secondary care
108
what is teh step wise strategy for managing mild-moderate pain in >16 yrs?
step 1 - paracetamol
step 2 - paracetom subbed with ibuprofen or weak opioid (codeine)
step 3 - paracetamol added to ibuprofen or weak opioid
step 4 - paracetamol continues and ibuprofen replaced with alternative NSAID (e.g. naproxen)
step 5 - weak opioid started in addition to paracetamol and/or NSAID
109
what are the canadian c spine rules?
- > or = 65 yo
- dangerous mechanism
- parasthesia in extremities
Y3 GP
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