MSK

Prevalence in children (10%) and adults (25%) during visits.
Use "OLDCHART" for obtaining comprehensive history:
- Onset (when symptoms began)
- Location (where pain/symptoms are)
- Duration (how long symptoms last)
- Character (description of pain or symptoms, e.g., sharp, dull, aching)
- Aggravating factors (what makes it worse)
- Relieving factors (what makes it better)
- Timing (when it occurs, e.g., morning, night, with activity)
Common symptoms include pain, stiffness, swelling, functional limitations, and reduced range of motion.

Consider the type of force involved (e.g., direct impact, twisting, hyperextension), height of fall, patient's size, and age.
Analyze occupation and sports/repetitive activity history.
Important to assess neurovascular status (pulses, sensation, motor function) distal to the injury.

Most common form; involves degenerative joint disease, affecting $25\%$ of adults.
Characterized by articular cartilage loss, osteophyte formation, & subchondral sclerosis.
It is a non-inflammatory condition primarily due to wear and tear, often exacerbated by age, obesity, and previous joint trauma.

Chronic inflammatory autoimmune disease affecting synovial joints symmetrically.
Higher prevalence in females ( $2-3:1$ ); family history significant.
Can also involve systemic symptoms like fatigue, low-grade fever, weight loss, and generalized stiffness.

Rheumatoid: Affects metacarpophalangeal & proximal interphalangeal joints. Soft, warm, tender with morning stiffness often lasting longer than $30$ minutes. Laboratory findings include positive RF & anti-CCP. May present with swan neck or boutonnière deformities.
Osteoarthritis: Affects distal interphalangeal and carpometacarpal joints. Hard, bony characteristics with stiffness after effort, typically lasting less than $30$ minutes. May present with Heberden's (DIP) and Bouchard's (PIP) nodes.

Non-pharmacologic: Physical therapy (strength and flexibility), weight loss, patient education, manual therapy, assistive devices.
Pharmacologic: Acetaminophen, NSAIDs, corticosteroid injections, viscosupplementation.
Surgical options include arthroscopy and total joint replacement for severe cases.

Early, aggressive treatment with DMARDs (e.g., Methotrexate as first choice, hydroxychloroquine, sulfasalazine).
Consider biologic DMARDs for inadequate response to conventional DMARDs.
Physical therapy, exercise, and regular monitoring of disease activity score (DAS-28).
Corticosteroids can be used for acute flare-ups.

Characterized by inflammatory arthritis due to monosodium urate crystals; often presents as sudden, excruciatingly painful attacks predominantly at the first MTP joint (podagra).
Caused by hyperuricemia ( > 6.8\ mg/dL), which can be related to diet (high purine foods, alcohol), certain medications (e.g., diuretics), or impaired renal excretion.
Acute Management: NSAIDs, colchicine, and corticosteroids.
Long-term Management: Lifestyle modifications (low-purine diet, hydration), urate-lowering therapy (e.g., allopurinol, febuxostat) to prevent recurrent attacks and tophi formation.

Inflammation of bursal sacs, which are fluid-filled sacs that cushion joints. Common sites are olecranon (elbow) and trochanteric (hip) bursae.
Causes often include overuse, repetitive trauma, prolonged pressure, or infection.
Symptoms include localized pain, swelling, tenderness, and restricted movement.
Treatment includes RICE (Rest, Ice, Compression, Elevation) and NSAIDs.

Prevalent in up to $90\%$ of individuals at some point.
Commonly caused by mechanical or musculoskeletal issues such as muscle strains, ligament sprains, or disc herniation, without major red flags.
Red flags indicating a potentially serious underlying condition include fever, unexplained weight loss, bowel/bladder incontinence, saddle anesthesia, severe or progressive neurologic deficits (e.g., leg weakness, foot drop), or a history of trauma/cancer, implying the need for imaging and further assessment.

Common injuries: ACL ruptures, meniscus tears, collateral ligament sprains (MCL, LCL), and patellofemoral pain syndrome.
Tests include Lachman, anterior drawer, posterior drawer (PCL), valgus stress (MCL), varus stress (LCL), and McMurray tests (meniscus).
Management may involve physical therapy for rehabilitation, bracing, or surgical intervention (e.g., arthroscopy, ligament reconstruction) depending on severity and instability.