Year 4 MusSkel4: Musculoskeletal
- Prof Bruce Kidd
- b.l.kidd@qmul.ac.uk
Introduction
The modules aims to develop students understanding of the diagnosis and management of the common rheumatological and orthopaedic conditions including fractures.
The program consists of introductory lectures, small group tutorials in both rheumatology and orthopaedics, attendance in outpatient clinics and theatre sessions
Key learning outcomes
- Can apply to medical practice, the biomedical scientific principles, method and knowledge relevant to musculoskeletal disease (GMC TD 8)
- Can demonstrate knowledge of relevant drug actions: therapeutics and pharmacokinetic: drug side effects and interactions (GMC TD 8f)
- Can carry out a consultation with a patient with a musculoskeletal disease (GMC TD 13)
- Can diagnose and understand the basic management of a patient with a musculoskeletal disease (GMC TD 14)
- Can carry out, under supervision, specified practical procedures (GMC TD 18)
Sessions
Lecture: Rheumatoid Arthritis
- Can list a differential diagnosis for a patient presenting with acute polyarthritis
- Can list a differential diagnosis for a patient presenting with persistant polyarthritis.
- Knows the pathophysiology, and clinical and radiological features of rheumatoid arthritis
- Knows how to diagnose and treat a patient with rheumatoid arthritis
Lecture: Connective Tissue Disease & Vasculitis
- Discuss the clinical features, pathology and systemic manifestations of systemic lupus erythematosus
- Can describe the clinical features and treatment of the anti-phospholipid syndrome
- Describe clinical features and diseases associations of Sjogrens syndrome
- Can describe the clinical features and management of systemic sclerosis / scleroderma
- Understands the clinical features, diagnosis and overall management of polymyositis and dermatomysoitis
- Can list the clinical features and basic management of the major vasculitides
Lecture: Monarthritis & Myalgia
- Can list a differential diagnosis for a patient presenting with a hot swollen joint.
- Can list the causes and clinical features of gout
- Can differentiate between acute treatment and chronic prophylaxis of gout
- Can describe the clinical and radiological features, and treatment, of calcium pyrophosphate arthropathy (pseudogout)
- Can list a differential diagnosis for a patient presenting with myalgia
- Describe the clinical features, pathology, diagnosis and treatment of polymyalgia rheumatica
- Can describe how to diagnose and treat giant cell arteritis
- Can list a differential diagnosis for a patient with chronic widespread musculoskeletal pain
- Can diagnose and treat a patient with chronic widespread pain / fibromyalgia
Lecture: Osteoarthritis, Osteoporosis & Metabolic Bone Disease
- Can describe the pathology, clinical & radiological features and treatment of osteoarthritis
- Can discuss the pathogenesis, clinical features, treatment and complications of osteomalacia
- Can describe the pathogenesis, clinical features, treatment and complications of osteoporosis
- Understand the aetiology, clinical features, pathology and complications of Paget's disease of bone
Lecture: Regional Pain & Soft Tissue Disorders
- Can describe the clinical features and treatment of carpal tunnel syndrome, wrist ganglions, DeQuervain's tenosynovitis, Dupuytrens contracture, trigger finger
- Can describe the features and treatment of bunions, plantar fasciitis, achilles tendinitis and Mortons neuroma
- Can describe the features and treatment of frozen shoulder, rotator cuff tendinopathy, subacromial bursitis and biceps tendinopathy
- Can describe the clinical features and treatment of lateral and medial epicondylitis, olecranon bursitis and ulnar berve entrapment (cubital tunnel syndrome)
- Can describe the features and treatment of meniscal tears, anterior cruciate ligament tear, medial collateral ligament sprain, Osgood-Schlatters disease, iliotibial band syndrome, patellofemoral pain syndrome
- Can describe the features and treatment of trochanteric bursitis, transient synovitis of the hip, OA of the hip
Lecture: Back Pain & Spondyloarthropathy
- Can describe the common causes of back pain
- Understands the concept of red and yellow flags
- Can describe the clinical features and complications of the cauda equina syndrome
- Knows the clinical and radiological features of spondylosis, spondylolisthesis and spondylolysis
- Can describe the clinical and radiological features and treatment of ankylosing spondylitis
- Can describe the clinical features and treatment of reactive arthritis
- Can describe the main patterns of joint disease in psoriatic arthritis and their radiological features
Lecture: Orthopaedics, Infections and Malignancy
Lecture: Trauma & Fractures
- Can describe the clinical features and management of olecranon fracture, radial head fracture and dislocation
- Can describe the causes, clinical features and management of compartment syndrome (any site), neurovascular injury (any site), septic arthritis, open fractures and cauda equina
- Can identify the characteristic radiological abnormailities, complications and management of the common upper limb fractures, including: Clavicle, Humeral head/neck/shaft, Supracondylar, Olecranon, Radius and Ulnar, and Scaphoid.
Clin & SDL: History and Examination
- Can obtain a detailed musculoskeletal history from a patient presenting with either arthralgia, mylagia, back pain or chronic widespread disease
- Can identify, using the GALS (Gait, Arms, Legs Spine) screen, normality and regional abnormality of the musculoskeletal system
- To identify and characterize, through enquiry and regional examination, the symptoms and signs of arthropathy (joint inflammation and/or damage), common periarticular lesions (bursitis, tendonitis, tenosynovitis, enthesopathy) at the shoulder, elbow, wris
- Can perform a detailed examination of the peripheral joints and spine
Clin & SDL: General rheumatology topics
- Can describe the distribution of the major nerve roots and peripheral nerves
- Can describe the functional anatomy of synovial joints and the spine
- Can identify the characteristic radiological abnormailities of the common rheumatic diseases including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, pseudogout, psoriatic arthritis and disorders affecting the spine
- Can describe the diagnositic features of synovial fluid in the common rheumatological disorders (RA, OA, gout) as well infection
- Can describe the microscopic features of synovial fluid in gout
Clin & SDL: Rheumatoid Arthritis
Clin & SDL: CTD & Vasculitis
Clin & SDL: OA and Metabolic Bone Disease
- Understands the pharmacology and use of the following medications for Osteoporosis: Biphosphonates - Alendronate; Vitamin D; Calcium; Hormone Replacement Therapy - Oestrogen; Testosterone; Selective Oestrogen Receptor Modulators
- Is able to identify risk factors for Osteoporosis and give appropriate prophylaxis (non-pharmacological and pharmacological)
- Understands the causes of elevated and reduced serum calcium levels, the pathophysiology of vitamin D deficiency, and the effects of parathyroid disorders on the musculoskeletal system
Clin & SDL: Back pain & related topics
- Can describe the pathogenesis of an acute disc prolapse
- Can describe the features and predisposing causes of discitis
- Can describe the difference between referred and radicular symptoms
- Can describe six red flag features and understand their diagnostic value
- Understands the association between genetic (HLA B27) and environmental factors in spondyloarthropathy
Clin & SDL: General Orthopaedic topics
Clin & SDL: Orthopaedics: Trauma & Fractures
Clin & SDL: Orthopaedics: Paediatric orthopaedics
Clin & SDL: Orthopaedics: Meniscal and liagament injuries
- Can describe the features and treatment of recurrent shoulder dislocation, AC joint separation, clavicle fracture and biceps tendon rupture
- Can describe the features and management of meniscal tears, anterior cruciate ligament tear, medial collateral ligament sprain, patella fracture
- Can describe cfeatures and managment of ankle fractures, metatarsal stress fractures, Lisfranc injury and Achilles tendon rupture
Clin & SDL: Musculoskeletal Malignancies
Clin & SDL: Musculoskeletal Infections
Clin & SDL: Pain management
- Be able to distinguish between the following terms and conditions: Pain secondary to inflammation; Neuropathic pain; Pain secondary to malignancy; WHO analgesic ladder
- Know how to select the type, route, dose and frequency of analgesia to maximise efficacy and reduce harm
- Knows the indications for choosing, giving and monitoring the following medications: Aspirin; Non-steroidal anti-inflammatory drugs (NSAIDs) - Ibuprofen, Naproxen, Diclofenac; Cyclo-oxygenase 2 selective inhibitors (Coxibs) eg Celecoxib; Local Anaesthesi
