Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Tenosynovitis is inflammation of the protective sheath (the synovial membrane) that surrounds your tendons. It can be painful and make it hard to move your joints like you usually can.
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
Tendon ruptures of the biceps brachii, one of the dominant muscles of the arm, have been reported in the United States with increasing frequency. Ruptures of the proximal biceps tendon make up 90-97% of all biceps ruptures and almost exclusively involve the long head.
Avascular necrosis is a condition which appears when there is a loss of blood supply to the bone, resulting in bone death. Avascular necrosis is also known as aseptic necrosis, ischemic bone necrosis, or osteonecrosis
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Failed Back and Neck Surgery Syndromes happen when a surgery to correct pain completely fails to alleviate the pain and in some cases makes the pain worse.
There are many reasons why a surgery could fail to provide results, both related to the patient and the surgeon.
How is it that a patient could cause a surgery to fail. A great example of this would be that a patient has undergone a spinal fusion to correct spinal instability in the lower back. The surgeon has advised the patient that smoking cigarettes which could severely reduce the healing chances and effect the fusion process. The patient ignores the doctor and continues to smoke and the fusion doesn’t heal. This is an example of the patient being at fault.
In what ways could a surgeon be at fault? There are many times that there is fault before the surgery is even performed. If there is an inaccurate diagnoses the surgery will be performed in the wrong area, and possibly the wrong surgery will be done. It is important to seek a second opinion of a specialist before proceeding with surgery of any kind. If two heads can agree on what and where the problem is, it is likely that there will be an accurate diagnosis.
One of the most common reasons for Failed Back and Neck Surgery Syndrome is that the surgeon is just not experienced enough in the technique being performed and he/she doesn’t perform it properly. This is why it is important to ask the right questions to the surgeon before moving forward with the surgery. How long have you been performing back surgeries? How long have you been performing this specific surgical procedure? and how many times a year do you perform this surgery.
Back and neck surgeries are procedures meant to be a permanent fix for a specific problem and correcting failed back or neck surgery is difficult.
Human spine is a complex structure that provides both mobility (so to bend and twist) and stability (so to remain upright). The normal curvature of spine has an “s”- like curve when looked at from the side. This curvature allows even distribution of weight and with stand stress.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Tenosynovitis is inflammation of the protective sheath (the synovial membrane) that surrounds your tendons. It can be painful and make it hard to move your joints like you usually can.
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
Tendon ruptures of the biceps brachii, one of the dominant muscles of the arm, have been reported in the United States with increasing frequency. Ruptures of the proximal biceps tendon make up 90-97% of all biceps ruptures and almost exclusively involve the long head.
Avascular necrosis is a condition which appears when there is a loss of blood supply to the bone, resulting in bone death. Avascular necrosis is also known as aseptic necrosis, ischemic bone necrosis, or osteonecrosis
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Failed Back and Neck Surgery Syndromes happen when a surgery to correct pain completely fails to alleviate the pain and in some cases makes the pain worse.
There are many reasons why a surgery could fail to provide results, both related to the patient and the surgeon.
How is it that a patient could cause a surgery to fail. A great example of this would be that a patient has undergone a spinal fusion to correct spinal instability in the lower back. The surgeon has advised the patient that smoking cigarettes which could severely reduce the healing chances and effect the fusion process. The patient ignores the doctor and continues to smoke and the fusion doesn’t heal. This is an example of the patient being at fault.
In what ways could a surgeon be at fault? There are many times that there is fault before the surgery is even performed. If there is an inaccurate diagnoses the surgery will be performed in the wrong area, and possibly the wrong surgery will be done. It is important to seek a second opinion of a specialist before proceeding with surgery of any kind. If two heads can agree on what and where the problem is, it is likely that there will be an accurate diagnosis.
One of the most common reasons for Failed Back and Neck Surgery Syndrome is that the surgeon is just not experienced enough in the technique being performed and he/she doesn’t perform it properly. This is why it is important to ask the right questions to the surgeon before moving forward with the surgery. How long have you been performing back surgeries? How long have you been performing this specific surgical procedure? and how many times a year do you perform this surgery.
Back and neck surgeries are procedures meant to be a permanent fix for a specific problem and correcting failed back or neck surgery is difficult.
Human spine is a complex structure that provides both mobility (so to bend and twist) and stability (so to remain upright). The normal curvature of spine has an “s”- like curve when looked at from the side. This curvature allows even distribution of weight and with stand stress.
La hernie du sportif : diagnostic et traitement, technique mini-ainvasive -Dr...VitamineB
La hernie du sportif : diagnostic et traitement, technique mini-invasive
Par le Docteur Ulrike MUSCHAWECK
Lors de la 1ère Journée Européenne de la pubalgie
Clinique du Sport Bordeaux Mérignac
The arachnoid is essential for a gathering of layers that pad the mind and spinal rope nerves. While this padding is harmed, nerves may not work accurately. The nerves in the spinal rope are encircled by a few slim tissues, called meninges, which give padding and assurance. The arachnoid mater is the center tissue of the meninges.
Swelling and inflammation result from damage to the arachnoid mater. This swelling can make nerves in the spine remain together, modifying nerve work and setting off extraordinary pain. Arachnoiditis is almost always caused by an injury.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
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Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
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Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. Table of contents
2
Acute Musculoskeletal Pain
Low Back Pain
Neck Pain
Upper Extremity Disorders
Lower Extremity Disorders
3. Acute Musculoskeletal Pain
is caused by various soft tissue injuries,
strains (injury to a tendon or a muscle), and
sprains (injury to a ligament).
3
4. Acute Musculoskeletal Pain
4
are inaccurately
treated with
opioids
20%
Substantial potential harms
➔ Risk for longer-term use
➔ Addiction
➔ Overdose
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
acute pain
(<4 weeks duration)
Topical
NSAIDs
second line
improved pain and function
Oral
NSAIDs
not recommended
Opioids
6. Low Back Pain
6
Most common identifiable causes
➔ spinal stenosis
➔ disk herniation
➔ compression fractures
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Chronic Pain
(>12 weeks)
Subacute Pain
(4 - 12 weeks)
Acute Pain
(<4 weeks)
Less common identifiable causes
➔ vertebral metastases
➔ infection
Diagnosis and Evaluation
9. Low Back Pain
9
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
History and Physical Examination
fever and
neurological signs
strength, sensory and
reflex testing of the
legs
ipsilateral and
contralateral straight
raise leg test
10. Low Back Pain
10
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
History and Physical Examination
11. Low Back Pain
11
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Further Diagnostic Testing
Within the first 6 weeks of symptoms
➔ avoid performing images routinely
➔ imaging abnormalities are
common
➔ obtaining images is not associated
with improved outcomes
➔ their discovery may lead to
unhelpful and costly interventions
Imaging indications
➔ severe or progresive neurologic
compromise
➔ suspicion of a life/function
threatening cause
➔ MRI is the preferred test for most
suspicions
12. Low Back Pain
12
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Treatment
Nonpharmacologic treatment Pharmacologic treatment
Acute Low Back Pain
➔ Physical therapy
➔ Local heat
➔ Acupuncture
➔ Spinal manipulation therapy
Chronic Low Back Pain
➔ Exercise therapy
➔ Massage therapy
➔ Acupuncture
➔ Yoga
➔ Cognitive Behavioral therapy
Acute Low Back Pain
➔ NSAIDs
➔ Non-benzodiazepine muscle
relaxants
Chronic Low Back Pain
➔ NSAIDs
➔ Non-benzodiazepine muscle
relaxants
➔ SNRIs
14. Neck Pain
14
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
A priority in evaluating neck pain is differentiating musculoskeletal pain from
conditions that may cause serious complications.
The most common causes
are musculoskeletal
➔ cervical strains
➔ spondylosis
➔ cervical facet osteoarthritis
Pain and stiffness in the absence of
neurologic abnormalities
15. Neck Pain
15
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Radiculopathy and myelopathy are the most common causes of neurological neck pain.
Cervical radiculopathy
Paresthesia in a dermatomal
distribution
Radiating arm pain
Neck pain
Decreased deep tendon reflexes
Diminished strength
16. Neck Pain
16
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Compressive cervical myelopathy
➔ neck pain with leg weakness
➔ gait/coordination disturbances
➔ bladder and bowel dysfunction
On examination
➔ upper motor neuron signs in upper
extremities
➔ lower motor neuron signs near
compression level
17. Neck Pain
17
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Treatment
A multimodal approach that is tailored for each individual appears to work best
➔ range of motion exercise
➔ physical therapy
➔ ice / heat applications
➔ stretching / strengthening
exercises
Analgesic agents
➔ NSAIDs
➔ Non-benzodiazepine muscle
relaxants
➔ SNRIs
➔ Neuromodulators
19. Thoracic Outlet Syndrome
19
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Arterial
(1-3%)
➔ subclavian artery
compression
➔ w/wo thrombosis
➔ abnormal cervical rib
➔ arm or hand pain
➔ weakness
➔ paresthesia
➔ coolness
➔ pallor
Neurogenic
(>90%)
➔ compression of the
brachial plexus
➔ arm paresthesia
➔ pain
➔ weakness
Venous
(3-5%)
➔ axillary vein
compression
➔ thrombosis
➔ arm pain/fatigue
➔ swelling
➔ cyanosis
Thoracic Outlet Syndrome (TOS), refers to signs and symptoms due to compression of the
upper extremity neurovascular bundle.
Neurogenic TOS is a clinical diagnosis (electro-diagnostic testing may be
useful). Vascular causes require US. Arterial TOS may be identified using
chest x-ray imaging.
20. Thoracic Outlet Syndrome
20
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Treatment
Venous/Arterial TOS
➔ Catheter directed
thrombolysis
➔ Prompt surgical
decompression of the
thoracic outlet
Neurogenic TOS
➔ Improving posture
➔ Strengthening
shoulder girdle
muscles
➔ Surgical treatment if
disabling symptoms
are present
22. Shoulder Pain
22
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Shoulder examination should be performed with both shoulders fully exposed, including
inspection, palpation, range-of-motion assessment, and specialized maneuvers.
Anterolateral shoulder pain
➔ most common shoulder pain
➔ impingement syndrome
➔ rotator cuff tendinopathy
➔ adhesive capsulitis
➔ labral tear
➔ biceps tendinitis
Posterior shoulder pain
➔ rotator cuff tendinopathy
➔ referred back pain
➔ glenohumeral joint pathology
➔ acromioclavicular pathology
23. Shoulder Pain
23
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Rotator Cuff Disease
➔ most common cause of shoulder
pain
➔ encompases all rotator cuff
disorders
➔ pain is worsened with overhead
activities
Risk Factors
➔ increasing age
➔ activities that require repetitive
overhead arm use
Pharmacologic treatment
➔ Acetaminophen
➔ Oral or topical NSAIDs
➔ Glucocorticoid injections
Surgery
(if conservative therapy has failed)
24. Shoulder Pain
24
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Adhesive Capsulitis
➔ anterolateral pain associated
with stiffness
➔ worse at night and in cold
weathers
Associated with
➔ prolonged immobilization
➔ history of shoulder injury
➔ diabetes
➔ hypothyroidism
➔ autoimmune disorders
Pharmacologic treatment
➔ Oral or topical NSAIDs
➔ Physical therapy
➔ Glucocorticoid injections
Surgery
(if conservative therapy has failed)
25. Shoulder Pain
25
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Acromioclavicular Joint Degeneration
➔ poorly localized pain on the
superior shoulder
➔ pain usually elicited on palpation
of the acromioclavicular joint
➔ the crossed-arm adduction test
often reproduces the pain
Pharmacologic treatment
➔ Oral or topical NSAIDs
➔ Activity modifications
26. Shoulder Pain
26
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Labral Tears
➔ superior labrum anterior and posterior
(SLAP) tears are common in athletes
and laborers
➔ pain worsens with abduction and
external rotation
➔ catching sensation, crepitus and
instability of the joint
early referral to an orthopedic surgeon
with experience in treating shoulder
injuries is recommended
28. Elbow Problems
28
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Elbow problems may be caused by pathology within the elbow joint, surrounding tissues, or
nerves. Evaluation focuses on the patient history and physical examination.
Epicondylitis
➔ caused by repetitive strain of extensor
tendons
➔ pain and tenderness are located over the
lateral epicondyle and increase with
resisted wrist extension
Management
➔ avoidance of pain inducing activities
➔ physical therapy
➔ NSAIDs
Radial or Ulnar Nerve Entrapment
➔ the radial nerve is susceptible to
compression
➔ prolonged unconsciousness
➔ wrist drop
➔ sensory loss on the dorsum of the first 3
fingers
Management
➔ avoidance of elbow trauma
➔ nocturnal splinting
➔ NSAIDs
29. Elbow Problems
29
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Olecranon Bursitis and Synovitis
➔ most common cause of swelling of the
elbow
➔ secondary to trauma, crystal disease or
infection
➔ bursa or joint aspiration with culture and
fluid analysis (for severe pain), when there
is any suspicion of infection, or when crystal
disease is suspected.
Management
➔ joint rest
➔ elbow protection
➔ NSAIDs
30. Elbow Problems
30
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Wrist and Hand Pain
may be caused by trauma or overuse leading to musculoskeletal abnormalities and nerve
compression.
➔ acute pain associated with trauma
suggests fracture - requires imaging
➔ ulnar nerve entrapment
↪ wrist pain
↪ interosseous muscle weakness
↪ diminished sensation
➔ ganglion cysts
herniated synovial tissue around tendon
sheaths Finkelstein test for de Quervain stenosing
tenosynovitis
31. Elbow Problems
31
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Carpal Tunnel Syndrome
➔ median nerve compression
➔ wrist / hand pain
➔ paresthesia and weakness first 3
digits
➔ worse at night and with repetitive
wrist motion
Some findings include
➔ hipoalgesia
➔ thenar muscle atrophy
➔ weakened thumb abduction
Treatment
➔ activity modification
➔ wrist splinting
➔ short course of oral glucocorticoids
➔ surgery
33. Hip Pain
33
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
The location of the pain (anterior/groin, lateral, or posterior) is often helpful in focusing the
evaluation.
Anterior hip pain
➔ insidious pain that worsens standing
(suggests osteoarthritis) older patients
(labral tear) younger patients
(infectious) fever
➔ gradual onset
↪ avascular necrosis
↳ alcoholism
↳ glucocorticoid use
↳ sickle cell anemia
↳ SLE
34. Hip Pain
34
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
35. Hip Pain
35
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
Lateral Hip Pain
➔ commonly caused by greater
trochanteric pain syndrome (GTPS)
➔ pain that worsens with lying on the
affected side suggests GTPS
➔ distal anterolateral thigh paresthesia
associated with tight-fitting clothes or
obesity
Symptoms follow the distribution of the lateral
femoral cutaneous nerve
Posterior Hip Pain
➔ lumbar radiculopathy
➔ vascular claudication
➔ sacroiliac joint dysfunction
➔ gluteal tendinopathy
The presence of morning stiffness, fever, or
peripheral joint symptoms should prompt
consideration of sacroiliitis
36. Hip Pain
36
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
FABER (Flexion, ABduction, and External Rotation) Test
37. Hip Pain
37
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Treatment
Labral Tears
➔ muscle strengthening
➔ activity modification
➔ arthroscopic surgery if conservative
measures fail
➔ hip arthroplasty
(advanced avascular necrosis)
Greater Trochanteric Pain Syndrome
➔ activity modification
➔ NSAIDs
➔ glucocorticoid injection
Meralgia Paresthetica
➔ reassurance
➔ avoidance of tight-fitting clothes
➔ weight loss
39. Knee and Leg Pain
39
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Diagnosis and Evaluation
The history should focus on timing (acute, subacute, or chronic) and pain characteristics. History of
knee injury or surgery, osteoarthritis, and crystal arthropathies should also be elicited.
Knee examination
(with both full knees exposed)
➔ inspection
➔ palpation
➔ range of motion testing
➔ special maneuvers
Radiography
➔ suspicion of
↪ fracture
↪ bone pathology
↪ osteoarthritis
MRI
➔ internal derangements
➔ surgery considerations
Joint Aspiration
➔ palpable effusion
(exclude inflammatory
or infectious arthritis)
Ligament and Meniscal Tears
42. Knee and Leg Pain
42
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Patellofemoral Pain Syndrome
➔ caused by disordered patellar tracking
with knee movement
➔ poorly localized anterior knee pain
and/or stiffness with prolonged sitting,
climbing, or descending stairs, and with
running or squatting
➔ abrupt patellar deviation may be noted
during squatting and standing
Treatment
➔ NSAIDs
➔ ice
➔ physical therapy
➔ strengthening exercises
43. Knee and Leg Pain
43
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Other disorders
Disorder Manifestations Causes Treatment
Bursitis acute or chronic swelling anterior to
the patella, tenderness, warmth, and
erythema
infection, trauma and gout Septic bursitis
knee immobilization, systemic antibiotics, and
re-aspiration if needed
Gouty bursitis managed with appropriate gout
therapy
Traumatic bursitis managed with activity
modification (avoidance of kneeling) and NSAID
Tendinopathies
and Tears
knee pain with movement, such as
jumping, running, or squatting
tendon tear causes acute
knee pain with effusion after
low-impact trauma or
fluoroquinolone or
glucocorticoid use
strengthening and stretching exercises and
NSAIDs
Osteochondral
Injury
diffuse knee pain significant trauma to the
knee or as an overuse injury
surgical
44. Knee and Leg Pain
44
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Other disorders
Disorder Manifestations Causes Treatment
Medial Tibial Stress
Syndrome
pain in the mid to distal shins,
usually after activity
structural stress avoidance of high-impact activities
(e.g., running) and using shock-
absorbing insoles
Chronic Exertional
Compartment
Syndrome
swelling of a specific muscle bed,
throbbing pain during exercise
exercise modification of the exercise regimen
and occasionally surgical fasciotomy
Iliotibial Band
Syndrome
poorly localized lateral knee and
distal thigh pain
exercise abstaining from the inciting activity
and using ice, followed by a gradual
return to activity, stretching,
strengthening, and local massage
Popliteal Cysts posterior knee pain and swelling knee trauma, osteoarthritis, or
inflammatory arthritis
joint aspiration and intra-articular
glucocorticoid injection. Ruptured
cysts can be treated with rest,
elevation, and NSAIDs, surgical
excision
46. Ankle and Foot Pain
46
MKSAP 19. General Internal Medicine I. Common Musculoskeletal Problems
Disorder Manifestations Causes Treatment
Ankle Sprains ecchymosis and swelling with
tenderness of involved ankle
ligaments
excessive ankle inversion intermittent cryotherapy and a lace-up support or air
stirrup brace combined with elastic compression
wrapping, acetaminophen and NSAIDs can be used for
pain control
Stress
Fracture
bony tenderness, pain with
percussion, or pain with hopping
on a single leg
structural stress immobilization and serial imaging or surgical fixation;
specialist involvement should be considered
Hindfoot
Pain
activity-related posterior heel
pain and stiffness that improves
with rest, tenderness of the
Achilles tendon
strenuous activities, although it
may occur spontaneously in
the elderly or rarely with
fluoroquinolone useral stress
treatment includes activity modification, eccentric
exercises (muscle lengthening in response to external
resistance), and use of appropriate footwear. NSAIDs
can be used for pain control
Midfoot Pain posteromedial heel paresthesia
that radiates distally into the
plantar foot surface
posterior tibial nerve
compression as it passes
through the tarsal tunnel
First-line treatment consists of activity modification,
orthotics, NSAIDs, and neuromodulators
Forefoot Pain pain between the metatarsal
heads and the sensation of
walking on a pebble
Morton neuroma, Hammertoe
deformities and Hallux or
bunion deformity
Ffootwear modification and padding. Glucocorticoid
injections may provide temporary relief. Interdigital
nerve resection is reserved for those who do not
respond to conservative measures
