1. Mark Brooke Samar Shefta
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. The only treatment for bunions is surgery
Question 1
The only treatment for bunions is surgery
True or False?

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

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

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

7. 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?

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. Ultrasound guidance is needed for trochanteric bursitis injections
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. 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?

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. 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

26. Questions?
Total points: 24

27. References www.getwelluk.com www.wayodd.com www.foot-ankle.co.uk
Biomed.brown.edu