Musculoskeletal Medicine

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  Is this elbow fractured
Working in a rural practice we often get casualties walking through the door so I liked this paper because it helped to work out who should and who shouldn't be X-rayed.
  Rheumatoid arthritis - online only
The diagnostic criteria and management options of rheumatoid arthritis are changing. This clinical review in the BMJ is a timely reminder of our role in this disease.
  Ottawa ankle rules
This is an old paper but it is GREAT so I'm keeping it in! If you don't use the Ottawa ankle rules, this paper should change your practice!
  NICE on osteoarthritis
NICE guidance has recently been published on the management of osteoarthritis (OA) in adults. It is not rocket science!
  Hallux valgus
The BMJ recently published a nice 10-minute consultation of hallux valgus that goes some way in helping us with consultations such as this.
  Lateral hip pain/greater trochanter pain
Greater trochanteric pain syndrome is common – lifetime prevalence 20%.
  Club foot/talipes equinovarus

NB congenital club foot should not be confused with positional club foot, where you can move the foot into the normal position (and which usually needs physio input only). Congenital club foot is not correctable, although at rest the two look the same.
  Low back pain (including NICE guidance)
I don't need to tell you how common low back pain is! NICE have now produced some guidelines on management of persistent non-specific back pain. Before summarising the NICE guidance I will draw out the key points from a recent BMJ clinical review.
  Quinine and nocturnal cramp

Quinine sulphate 200mg (bisulphate 300mg) is licensed for the treatment of nocturnal cramp.

The MHRA has issued a drug safety update, warning GPs of potential side-effects including haematological disorders such as thrombocytopenia and also of its severe toxicity in overdose.
  Assessment of shoulder pain
Is it just me or does examining and diagnosing shoulder problems fill you with horror? Fear not… this great paper revolutionised my shoulder assessments …and it is so simple!
  Glucosamine
When the early trials on glucosamine came out I started to suggest patients with arthritis tried it. Later, when it became available on the NHS, I offered to prescribe it to those who felt it was making a difference to their symptoms. Then earlier this year the NICE Guidance on osteoarthritis suggested it should not be used and I started to be less encouraging about its use. So, does it work? Should we recommend it? Should we prescribe it? (If you live in Scotland, the Scottish Medicines Consortium does not recommend prescribing it either).
  Neck pain
Cervical radiculopathy from nerve entrapment/irritation results in shooting pain going down the arm and neurological symptoms (e.g. numbness, weakness, and parasthesia).
  Gout
Rare <25yrs of age, look for an enzyme deficiency 
Prevalence 1.4% 
Incidence 1–2/1000 in men.
First I'll summarise the latest research on gout, then the diagnosis and management.
  Steroid injections: how effective are they?
Many of us use soft-tissue corticosteroid injections in our treatment of rotator cuff injuries and other problems such as tennis elbow (lateral epicondylalgia). This review has looked at the evidence for soft-tissue steroid injections for tendinopathies.
  Giant cell arteritis (temporal arteritis)
GCA is commonly missed as this paper in the BMJ Easily Missed series points out!
 
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