23/01/2025 – MSK and Ortho

Question Easy: A 24-year-old rugby player presents with shoulder pain after falling directly onto his shoulder during a match. On examination, there is tenderness over the acromioclavicular joint with some swelling, but the range of motion is relatively preserved. What is the most likely diagnosis? 🏉

A) Dislocated shoulder
B) Acromioclavicular joint sprain
C) Clavicle fracture
D) Rotator cuff tear
E) Biceps tendon rupture

Question Medium: A 45-year-old office worker comes to the GP with complaints of diffuse wrist pain and numbness in the thumb, index, and middle fingers, especially at night. The symptoms worsen after typing. What is the most appropriate initial management option? ⌨️

A) Wrist splinting
B) NSAIDs
C) Surgical decompression
D) Corticosteroid injection
E) Physiotherapy

Question Hard: A 65-year-old woman presents with increasing knee pain and stiffness for the past few years. She’s tried over-the-counter pain relievers without much relief. On examination, her right knee has bony swelling and crepitus, but no redness or warmth. X-rays show joint space narrowing and osteophyte formation. What is the most appropriate first-line pharmacological treatment according to NICE guidelines? 🦵

A) Ibuprofen
B) Paracetamol
C) Codeine
D) Glucosamine
E) Duloxetine

Explanations & Answers:

Question Easy Answer: B) Acromioclavicular joint sprain
Question Easy Explanation: This presentation is typical for an acromioclavicular joint sprain, especially after direct trauma to the shoulder. It is often seen in contact sports and the range of motion is usually less restricted compared to shoulder dislocation.

Question Medium Answer: A) Wrist splinting
Question Medium Explanation: The presentation is classic for carpal tunnel syndrome. According to NICE guidelines, wrist splinting at night is the recommended initial treatment to alleviate symptoms by reducing the pressure on the median nerve.

Question Hard Answer: B) Paracetamol
Question Hard Explanation: NICE guidelines recommend paracetamol as the first-line oral analgesic for the symptomatic relief of osteoarthritis before considering NSAIDs due to its safety profile.

Medical fact of the day: The UK sees about 10 million new cases of musculoskeletal conditions annually, making them a leading cause of disability and absenteeism from work, highlighting the significant impact on public health and the economy.

Quote of the day: “In the heart of healing lies the courage to care with compassion, even when the load is heavy.”