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Musculoskeletal HDR

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

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Musculoskeletal HDR

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  1. Musculoskeletal HDR Mark Brooke Samar Shefta

  2. 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!

  3. Question 1 The only treatment for bunions is surgery True or False?

  4. Question 2 Plantar fasciitis is best treated by steroid injection True or False?

  5. Question 3 Mortons neuroma is more common with a Mortons foot True or False?

  6. Question 4 A sprained ankle should be better by two weeks True or False?

  7. Question 5 Suspected Osgood-Schlatters disease should be x-rayed for confirmation True or False?

  8. Question 6 Arthroscopy and washout is a good treatment for osteoarthritis of the knee True or False?

  9. Question 7 McMurrays test is the best way to diagnose meniscal tears True or False?

  10. Question 8 Ultrasound guidance is needed for trochanteric bursitis injections True or False?

  11. Question 9 60% of patients presenting with whiplash injuries suffer long lasting symptoms True or False?

  12. Question 10 The lifetime prevalence of acute low back pain is 58% True or False?

  13. 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

  14. 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!

  15. 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

  16. 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!

  17. Ankle Sprain C B A

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. ‘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

  24. 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

  25. <20 yrs >55 yrs Non-mechanical pain Thoracic pain PMH of carcinoma HIV Steroid use Unwell Weight loss Widespread neurology Structural deformity Back Pain ‘Red Flag’ Signs

  26. Questions? Total points: 24

  27. 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

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