15/08/2024 – MSK and Ortho

Question Easy:
A 55-year-old woman presents with chronic lateral elbow pain, worsened by gripping objects and extending her wrist. What is the most likely diagnosis? 🏋️

A) Medial epicondylitis
B) Lateral epicondylitis
C) Olecranon bursitis
D) Rheumatoid arthritis
E) Radial tunnel syndrome

Question Easy Answer:
B) Lateral epicondylitis

Question Easy Explanation:
Lateral epicondylitis, also known as tennis elbow, presents with pain and tenderness over the lateral epicondyle, particularly aggravated by activities involving wrist extension and gripping. This condition is common among individuals aged 40-60 and is managed with conservative measures such as physiotherapy and NSAIDs according to NICE guidelines.

Question Medium:
A 32-year-old male runner presents with anterior knee pain, particularly when climbing stairs and after prolonged sitting. There is no history of trauma. What is the most likely diagnosis? 🏃‍♂️

A) Meniscal tear
B) Patellofemoral pain syndrome
C) Anterior cruciate ligament injury
D) Osgood-Schlatter disease
E) Quadriceps tendonitis

Question Medium Answer:
B) Patellofemoral pain syndrome

Question Medium Explanation:
Patellofemoral pain syndrome is commonly seen in athletes and presents with anterior knee pain, particularly aggravated by activities like stair climbing or prolonged sitting, known as “theater sign”. Treatment typically includes physiotherapy focusing on strengthening the quadriceps and improving patellar tracking, as outlined by NICE guidelines.

Question Hard:
A 45-year-old male presents with acute, severe back pain radiating to the right leg. He experiences urinary incontinence and numbness in the perianal region. What is the most appropriate next step in management? ⚕️

A) Oral NSAIDs and rest
B) Urgent MRI of the lumbar spine
C) Referral to physiotherapy
D) Oral corticosteroids
E) Electromyography (EMG)

Question Hard Answer:
B) Urgent MRI of the lumbar spine

Question Hard Explanation:
The presentation of severe back pain with radiculopathy, urinary incontinence, and perianal numbness is concerning for cauda equina syndrome. This is a surgical emergency, and an urgent MRI of the lumbar spine is warranted to confirm the diagnosis and expedite surgical decompression, in line with NHS guidelines.

Medical Fact of the Day:
Did you know that patellar tendinopathy, also known as jumper’s knee, is common among athletes, particularly those involved in sports that require frequent jumping like basketball and volleyball? It’s crucial to evaluate the biomechanics and training load in these patients to effectively manage the condition.

Quote of the Day:
“In the midst of movement and chaos, keep stillness inside of you. A calm mind brings inner strength and self-confidence.” – Anonymous