5 red flags for severe musculoskeletal problems
- weight loss
- severe night pain
- fever
- immunosuppresion
- persistant mono-arthritis
Yellow flags for musculoskeletal problems
- define
- examples
- increase pain + risk of developing serious muscular problem
- anxiety/depression + intensity of symptoms + duration of symptoms + localisation of pain
define enthesis
review - joint structure
- C.T between tendon + bone
- insertion of tendon into bone
what is tendosynovitis
inflammation of synovium surrounding tendon
4 soft tissue disorders affecting wrist + hand
- carpal tunnel syndrome
- de queverain
- dupuytren’s contracture
- trigger finger
CARPAL TUNNEL SYNDROME
- define
- tendon
- clinical features
- treatment
1.median nerve entrapment
2.flexor retinaculum ( transverse carpal lig)
3.weakness of 3 thenar muscles
thenar eminence atrophy
paresthesia of thumb + index + middle finger
4.decompression - cut flexor retinuaculum
steroid injection - reduce inflammation
What 3 conditions are co-morbitiies for carpal tunnel syndrome (in order of importance)
- pregnancy
- inflammatory disorders - RA
- HYPOthyroidism
DE QUERVAIN’S
- define
- tendon
- clinical features
- treatment
- gamer’s thumb - tenosynovitis of tendon controlling thumb
- 2 tendons controlling thumb movements (EPB +APL)
- CREPITUS + pain on resisted movement
- rest + corticosteroid injection
What is FINKLESTEIN’S TEST for
De Queverain’s
What is PHALEN’S TEST for
Carpal tunnel syndrom
What is TINDEL’S TEST for
carpal tunnel syndrome
In which musculoskeletal condition is CREPITUS a clinical feature
DE QUERVAIN
TRIGGER FINGER
- define
- tendon
- clinical features
- locking of the fingers
- flexors tendons of the hand
- NODULES - on hand - tendon cannot slide thorugh inflammed tendon sheath
DUPYUTREN’S CONTRACTURE
- define
- tendon
- clinical features
- fixed flexor contraction of the hand
- palmar fascia (thickens and shortens so that the tendons connected to the fingers cannot move freely)
- ring finger + little finger cannot be fully extended
Referred pain to the elbow 2 cases
- cervical vertebrae
- shoulder
3 causes of pain at the elbow
- referred pain
- periarticular pain - all ages - bursitis + epicondylitis
- articular pain -elderly -OA
TENNIS ELBOW
- affects what structure
- normal role of structure
- test
- treatmnet
- lateral epicondyle
- attachment for WRIST EXTENSORS
- tenderness/ pain on resisted WRIST EXTENSION
- rest/massage/steroids
4 causes of pain at the shoulder
- frozen shoulder
- rotator cuff entrapment
- rotator cuff tendinitis
- subacromial bursitiis
can also get OA at acromiclavicular joint = rare
FROZEN SHOULDER
- clinical name
- pathology
- clinical features
- treatment
- ADHESIVE CAPSULITIS
- GH joint inflammed + stiffens
- reduced range of movement + pain
- analgesia + steroids + hydrodilation (inject saline- stretch GH joint capsule)
normal range of movement at the shoulder
ABDUCTION -150
FLEXION-180
EXTENSION-45-60
SHOULDER IMPINGEMENT
- clinical name
- pathology
- 2 clinical features
- treatment
- rotator cuff tendinitis
- rotator cuff tendon-trapped - passing through SUBACROMIAL SPACE
- painful arc + pain on resisted ABduction
- physio + steroid injection (reduces inflammation)
3 types of pain at the hip
- referred -pelvis+ spine + special case
- periarticular - trochanteric/ischial bursitis
- articular - OA + RA +irritable hip (kids)
role of bursa
LUBRITCATION
-fluid filled sac - between muscles + bone AT A JOINT- allows tendons to glide freely on movemetn.
Special case of referred pain at the hip joint
MERALGIA PARESTHESIA
- lateral cutaneous nerve of thigh trapped
- paresthesia of outer thigh
