Mark Brooke Samar Shefta 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!

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

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

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

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

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

Ultrasound guidance is needed for trochanteric bursitis injections 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?

The lifetime prevalence of acute low back pain is 58% 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 C B A

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