15 Dec 2022

Winter 2022 Clinical masqueraders

This edition of InTouch focuses on common masqueraders seen in the musculoskeletal clinic and is packed full of relevant information designed to give that little extra depth of knowledge for those challenging cases. The range of articles offers a variety of clinical pearls that will guide and encourage you should you encounter that tough case that challenges thinking skills and leaves you unsure of what is the most effective action to take, and exactly how to vocalise that.

Upskilling to decrease delay to diagnosis in rheumatology

Inflammatory arthritis can have a significant impact on those living with it and early treatment has been shown to improve outcomes. The physiotherapist, working in a clinical setting where people with undiagnosed inflammatory arthritis might present, has a crucial role in early identification and onwards referral. Considerations of how inflammatory arthritis presents in its early stages and how the physiotherapist can pick up on characteristic signs and symptoms are discussed in this article. Well-informed, thorough and inquisitive clinicians can and will lead to reduction in diagnosis delay.

Will Gregory

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Recognition and management of hypermobility related disorders

Joint hypermobility (JHM) is common in the general population and may present in a single joint, a few joints or in multiple joints. While JHM is usually asymptomatic, it can predispose to instability, pain, fatigue, multi-systemic complaints and significant disability, and may also be a sign of an underlying hereditary disorder of connective tissue, the most common of which is the hypermobile form of Ehlers-Danlos syndrome. This article provides an overview of the recent evidence base relating to aetiology, epidemiology, clinical presentation and biopsychosocial personalised approach to hypermobility related disorders (HRDs), as well as highlighting that early recognition and treatment are key to effective management.

Jane Simmonds


Recognising deep vein thrombosis (DVT) in the musculoskeletal clinic

This article considers the clinical reasoning, assessment, diagnosis and management of suspected deep vein thrombosis (DVT) in a musculoskeletal (MSK) environment. The presented information is timely, in that it links to increasing evidence that COVID-19 has been shown to be an independent risk factor for DVT and pulmonary embolus. This suggests that physiotherapists working in a range of environments may be increasingly exposed to patients who may be affected by these conditions. It is well known that DVT will commonly mimic MSK conditions in the early stages, and that unravelling the patient story and presenting symptoms is essential for optimal management. An understanding of Virchow’s Triad is an essential part of the knowledge base and two cases are presented to assist with the learning process.

Alan Taylor


Do non-steroidal anti-inflammatory medicines affect the healing process of musculoskeletal injuries? A brief overview of the evidence

Non-steroidal anti-inflammatory drugs (NSAIDs) are the first choice of many clinicians for the management of musculoskeletal (MSK) pathologies and this approach has expanded to patient self-management owing to the plethora of options now available over the counter. There does, however, continue to be much debate over the efficacy and safety of NSAIDs in MSK medicine and recent clinical evidence suggests that the negative effects of NSAIDs are beginning to outweigh the positive ones. Similarly, there is good evidence that fracture healing can be impaired with NSAIDs, leading to potential non-union fractures and even re-fractures, and recent research is beginning to demonstrate a more negative effect of NSAIDs on soft tissue healing, including affecting muscle strength during rehabilitation.

Solomon Abrahams
Sarah Didier


Vocal skills and the physiotherapist

How often do we consider that how we speak to people can have a definite effect on their comprehension and performance? Our voice is the tool we use to present information and the vocal tone of a physiotherapist can make a difference to how the patient responds. This article highlights that how we sound as professionals is extremely important, and that understanding how to use our vocal skills can be instrumental in achieving good patient outcomes. It also discusses the importance of understanding the relationship between the voice and the response that it can generate in the person we are talking to.

Lesley Hendy