RTS - Musculoskeletal Conditions

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  • Created by: LBCW0502
  • Created on: 18-01-19 19:43
Outline the RTS consultation framework
Scene setting, information gathering and problem identification, actions and solutions, closing, consultation behaviours, staff training
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What are the key questions to ask when it comes for musculoskeletal conditions?
Age, duration (acute/chronic), symptoms (pain, swelling, site, fracture) and type of condition e.g. sprain, strain, muscular or bruising. Impact on lifestyle (patient may wait days before seeing HCP)
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Which symptoms would require a patient to be referred to the GP?
Head injury, bursitis (tender, swollen, painful joints), fibromyalgia (pain all over the body), frozen shoulder, painful joints, gout, back pain, RSI and whiplash
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What medical questions should be asked?
Medical conditions. Medication (prescribed, self-medication, doses, topical/systemic, adherence). What is the patient seeking? (e.g. treatment options, products, general advice, alternative treatment)
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Which patient types are more likely than others to be affected?
Children and elderly
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What type of training is required by all HCPs?
First Aid. Recognise the differences between serious and less serious conditions. Treatment and variety of options
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What is the economic impact of musculoskeletal conditions?
More working days lost to musculoskeletal problems (back/neck pain)
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Describe features of acute pain
Cause generally known. Duration of pain is short and well-characterised. Treatment approach - underlying disease
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Describe features of chronic pain
Cause often known. Duration of pain (persists after healing, >3 months). Treatment approach - underlying disease and pain disorder
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Describe the effects of chronic pain on the patient (1)
Physical functioning (ability to perform daily activities). Psychological morbidity (depression, anxiety, anger, loss of self-esteem). Social consequences (relationships with family/friends, intimacy/sexual activity, social isolation)
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Describe the effects of chronic pain on the patient (2)
Societal consequences (healthcare costs, disability, lost workdays)
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What are the symptoms of a sprain?
Pain around the affected joint. Being unable to use the joint properly. Bruising. Tenderness. Swelling. Inflammation
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What are the symptoms of a strain?
Pain in the affected muscle e.g. hamstring, calf, thigh, lower back. Being unable to use the muscle properly. Bruising. Muscle spasms. Swelling
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Which part of the body is the most commonly affected by musculoskeletal problems?
Lower back pain
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What are the risk factors for back pain?
Being overweight, smoking, pregnant, long-term use of some medications (e.g. glucocorticoid, osteoporotic fractures), mental health problems e.g. stress, depression, anxiety
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What are the key questions to ask about back pain?
When did you back pain start? Where are you feeling pain? Have you had back problems in the past? Can you describe the pain? What makes the pain better or worse?
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What is the cause of back pain?
Nerve root irritation. Degenerated discs (shock absorbers wear down and rupture) bulge out which puts pressure on the nerve and causes neuropathic pain
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What are the specific causes of back pain?
Cancer, infection, injury, fractures, inflammatory diseases (e.g. ankylosing spondylitis), osteoporosis, spinal stenosis, cauda equina (emergency), kidney problems
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What are the non-specific causes of back pain?
Lifting improperly, making a sudden movement, falling down, carrying excess body weight or a heavy handbag, poor posture, prolonged sitting/slouching in chairs, driving, sports or repetitive movement (RSI)
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Why does back ache in late pregnancy?
Ligaments become softer and stretch, which puts a strain on the lower back and pelvis (prostaglandins – change pelvic area, pregnancy – lower back pain)
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Which symptoms in pregnancy require a GP referral?
Prolonged pain, bleeding, increasing contractions, cramps, sciatica, pins and needles, loss of bladder function etc.
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What are the treatments for back pain in pregnancy? (1)
Aqua-natal exercises, pregnancy yoga, breathing techniques, avoid heavy lifting, correct posture when lifting objects (young children), wear flat shoes, rest, warm bath, maternity pillow, firm/supportive mattress
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What are the treatments for back pain in pregnancy? (2)
OTC analgesics (paracetamol only, check PIL). Avoid aspirin/NSAIDs (IUGR, haemorrhage, delayed onset of labour etc), opioids (respiratory depression/withdrawal, only used on advice of Dr), caffeine (not recommended during pregnancy)
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What are the causes of back pain in post-natal and breast feeding?
Labour, poor posture whilst breast feeding/changing nappies, epidural (tenderness at site of injection, not pain)
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What is the general advice to treat back pain in post-natal and breast feeding?
Post-natal check up (6 weeks), gentle exercise (care - caesarian section), swimming, posture, pelvic tilts/yoga, pelvic floor and stomach exercises, correct posture and support pillow during breast-feeding
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Describe which analgesics can and cannot be used to treat back pain in post-natal and breast feeding
Paracetamol (little passed through milk - amount too small to be harmful). Avoid aspirin (Reye's syndrome), NSAID (including topicals - see PIL), caffeine, opioids - always check SPC/PIL
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What are the risk factors of knee pain?
Overweight, overuse of knee, age
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What are the conditions for knee pain?
Ligament damage (football) and runner's knee
28 of 50
What are the non-specific causes of shoulder and neck pain?
Poor posture, neck strain, sport or work activities
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What are the specific causes of shoulder and neck pain?
Heavy lifting, prolonged elevation, frozen shoulder, rotator cuff disorder, whiplash, fracture (collar bone, shoulder blade), MI
30 of 50
State conditions for elbow pain
Tennis, golfer's, student's elbow - RSI
31 of 50
State features of ankle and thigh pain
Ankle sprains, achilles tendon injury, plantar fasciitis. Thigh strains, quadriceps, hamstring
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Describe features of arthritis
All ages, including children (JIA). OA and RA. Other types of arthritis and related conditions - ankylosing, cervical spondylosis, fibromyalgia, lupus, gout, psoriatic arthritis, enteropathic arthritis (e.g. ulcerative colitis, Crohn's), reactive/2nd
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What is osteoarthritis?
Joint pain and stiffness. Narrowing of joint space. Subchondral cysts, osteophytes, subchrondral sclerosis
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What is osteoporosis?
A condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a minor fall or sudden impact causes a bone fracture
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What is the advice for OTC prevention/lifestyle for osteoporosis?
Healthy eating advice, preventing falls, weight management, resistance and weight baring exercises, quit smoking, alcohol intake
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What is the OTC supportive treatment for osteoporosis?
Medication adherence, pain relief, heat (e.g. warm baths or hot packs), cold (e.g. cold packs), transcutaneous electrical nerve stimulation (TENS), simple relaxation techniques, massage
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What are the danger symptoms which require referral to the GP? (1)
Unexplained deformity, dislocation, children under 12, elderly, inability to bear weight and bone tenderness - fracture, severe pain, chest pain, unexplained weight loss, loss of bladder/bowel control, limited or excessive limb movement
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What are the danger symptoms which require referral to the GP? (2)
Acute injuries showing immediate swelling, weakness not due to pain, fever, chills, malaise accompanying the injury, unusual or excess bruising for no apparent reason, bruising - ADR e.g. steroids, carbimazole, anticoagulants, unresponsive to OTCs
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What is the PRICE treatment?
Protect, Rest, Ice, Compress, Elevate
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What is HARM?
Heat, Alcohol, Running, Massage
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What are the OTC, oral and analgesic treatments? (1)
First line - NSAIDs (ibuprofen, naproxen). Diclofenac re-classification (POM), analgesic/anti-inflammatory effects, OTC (short term), check medicines adherence (CI, asthma, hypertension, peptic ulcer/haemorrhage, GI bleed, perforation, heart failure)
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What are the OTC, oral and analgesic treatments? (2)
(CI - renal, hepatic failure, pregnancy etc.). Paracetamol (if NSAIDs not tolerated, max strength) - combination with codeine (constipation)
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What are the topical analgesics?
NSAIDs (ibuprofen, ketoprofen, diclofenac, felbinac, piroxicam). Formulations (gel, creams, sprays, patches). Adjuncts in knee or hand OA. Apply between 2-4 times a day for 7 days (see individual packs)
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What are the cautions of topical analgesics?
Gentle massage. Don't apply to eyes/mucous membranes, inflamed/broken skin. Apply to cool skin. Rash/discontinue. No occlusive dressings, wash hands, hypersensitivity/asthma, diabetes, aspirin (pregnant/breast feeding, <12). Photosensitive/ketoprofen
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What are the other treatments e.g. counter irritants, rubefacients, heat therapy?
Diethylamine salicylate, methyl nicotinate, methanol (e.g. deep freeze cold spray), camphor, capsaicin/capsicum, heat therapy (pads, patches, wraps), TENS, PEMF technology
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Give examples of everyday impacts on musculoskeletal system
Lifter's back, couch neck, computer neck/back, forward flexed neck position, driving tension, telephone neck
47 of 50
Outline the pain cycle (need to educate patients on how to break cardiac cycle)
Persistent pain, less active, loss of fitness/weak muscles/joint tissues, lack of energy/tiredness, stress/anxiety/fear/anger/frustration, negative thoughts/fears about pain/future, depression/mood swings, off work/money worries/relationship concerns
48 of 50
State features of self-care (1)
PRICE, posture, positioning (ergonomic), carrying loads correctly, exercise (pilates/yoga, pregnancy yoga/swimming, warm up/cool down/stretch, muscle strengthening). Heat, TENS, massage, support pillow, mattress, weight management, acupuncture
49 of 50
State features of self-care (2)
Glucosamine, physiotherapy, osteopathy, chiropractor, OT. Non-drug advice (e.g. shock absorbers, thermacare etc.). Independent living aids (e.g. bottle openers)
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Other cards in this set

Card 2

Front

What are the key questions to ask when it comes for musculoskeletal conditions?

Back

Age, duration (acute/chronic), symptoms (pain, swelling, site, fracture) and type of condition e.g. sprain, strain, muscular or bruising. Impact on lifestyle (patient may wait days before seeing HCP)

Card 3

Front

Which symptoms would require a patient to be referred to the GP?

Back

Preview of the front of card 3

Card 4

Front

What medical questions should be asked?

Back

Preview of the front of card 4

Card 5

Front

Which patient types are more likely than others to be affected?

Back

Preview of the front of card 5
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