⚕️FREE MSRA PODCAST –Posterior Cruciate Ligament (PCL) Tear

🎧 Your high-yield revision audio for mastering PCLtears — for the MSRA, exams, or on the go.

🧠Key Learning Points

📌Definition

• Posterior cruciate ligament (PCL) tear = injuryto the main ligament that stabilises the back of the knee, preventing the tibiafrom moving backwards relative to the femur

• PCL provides up to95% of posterior knee stability

📌Causes & RiskFactors

• Direct blow to the front of the knee (e.g.“dashboard injury” in car crashes)

• Hyperextension injuries

• Falling hard onto a bent knee

• High-impact/contact sports (football, rugby)

• Previous PCLinjury increases re-injury risk

Mnemonic: DHFSA — Dashboard, Hyperextension,Fall (bent knee), Sports, Accidents

📌Pathophysiology

• Force exceedsPCL’s tensile strength → partial or complete tear

• Posterior tibialdisplacement = loss of knee stability

• Hamstrings/gravitypull tibia backwards in absence of PCL

📌Symptoms &Clinical Features

• Knee pain, often with swelling and a sensation of instability(“knee might buckle”)

• Difficulty bearingweight

• Instability especially with walkingdownhill/stairs

• May be lessdramatic than ACL tears (often less “pop”)

📌DifferentialDiagnosis

• ACL tear

• Medial/Lateralcollateral ligament tears (MCL/LCL)

• Meniscal tear

• Patellardislocation

• General kneeinstability

• Osteoarthritis (inchronic cases)

📌Diagnosis

• Physical exam:

 – Posterior drawer test (most sensitive)

 – Posterior sag test (Godfrey’s test)

• MRI: gold standard for assessingligament/tissue injuries and grading severity

• X-ray: rules out fractures (especially tibialplateau avulsion)

📌Management

• Conservative for most isolated, mild/moderatetears:

 – PRICE/PRICER: Pain relief, Rest, Ice,Compression, Elevation, early Rehabilitation

 – Physiotherapy: emphasise quadriceps strengthening (quads = key fordynamic stability)

 – Bracing orcrutches for some injuries

• Surgical:

 – Reserved forsevere/complete tears, multi-ligament injuries, avulsion fractures, orpersistent instability

 – Procedure = PCLreconstruction (using tendon grafts)

Mnemonic: "Quadsfor PCL" — quad strength is vital in rehab!

📌Prognosis &Complications

• Good prognosis with early, focused rehab — manyregain full function

• Untreated/unstableknees risk chronic pain, instability, and earlyosteoarthritis

• Complications: Patellofemoral/medial arthrosis,chronic knee pain

• Commitment torehab is crucial for long-term outcome

📎MSRA Resources forPosterior Cruciate Ligament Tear

📝 Revision Notes: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-revision-notes/

💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-accordion-qa-notes/

🧠 Flashcards: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-flashcards/

🚀 Rapid Quiz: https://www.passthemsra.com/topic/posterior-cruciate-ligament-tear-rapid-quiz/

🎓 Full Quiz: https://www.passthemsra.com/quizzes/posterior-cruciate-ligament-tear/

#MSRA #PCLTear#PosteriorCruciateLigament #MSRARevisionNotes #MSRAQuiz #MSRAFlashcards#MSRAQandANotes #MSRAAccordions #MSK #KneeInjury #Orthopaedics#MSRAOnlineRevision

🎙️Deep Dive:Prepatellar Bursitis (Housemaid’s Knee)– MSRA Essentials

Knee pain right overthe front of the patella? Swelling like a little water balloon? In thisepisode, we break down Prepatellar Bursitis,a deceptively simple but clinically important condition — especially for MSRA revision. Whether it’s from kneeling,trauma, or infection, we walk you through whatmatters and why.

🧠Key Concepts Covered

• 📍 Definition: Inflammation of the prepatellar bursa,a fluid-filled sac sitting just in front of the kneecap

• 💥 Causes: Repetitive kneeling (👷‍♂️ carpet layers, cleaners), direct trauma,infection, or associated inflammatory conditions (RA, gout)

• ⚠️Septic vs Non-septic: ~30% are infected – often Staph aureus

• 👩‍⚕️ Risk Factors: Manual occupations, contact sports,immunosuppression, skin breaks

• 🔍 Pathophysiology: Inflammation or bacterial colonisation of the bursa→ swelling, fluid accumulation, tenderness

🔄DifferentialDiagnosis

📌Don't assume it’sbursitis — rule out:

• Septic arthritis – red flag: systemic symptoms,joint pain with all movement

• Patellar tendonitis – pain below the patella

• Meniscal tear – twisting injury,locking/clicking

• Patellofemoral pain syndrome – ache behindkneecap, worse on stairs

• Cellulitis, infrapatellarbursitis, gout/pseudogout

🔬Diagnosis – What YouNeed to Know

✅Aspiration is key – gold standard to rule out infection or crystals

 • Send fluid for:

  – WCC, Gram stain& culture

  – Crystal analysis:

   • ⬆️MSU = gout

   • Rhomboid CPP =pseudogout

✅ Imaging:

 • Not routinely needed unless complicationssuspected

 • 🩻 X-ray: rule out trauma

 • 🧲 MRI/ultrasound: only if persistent or uncertain

💊Treatment Pathways

Type

First-line Management

Second-line

Non-septic

PRICE: rest, ice, NSAIDs, knee pads 🧊

Aspiration ± steroid (if no sepsis)

Septic

Empirical IV antibiotics 🚨

Repeated aspiration or surgical drainage

➡️ Consider bursectomy forchronic/recurrent cases

➡️ Patient education on knee protection is crucialfor prevention 🔁

📈Epidemiology &Prognosis

• 🧍‍♂️ More common in men aged 40–60

• 💼 Linked to manual jobs (e.g. cleaners, roofers, gardeners)

• ~1 in 10,000incidence/year in UK

• 🤒 ~30% are septic – more likely in children or immunocompromised

• 🩹 Non-septic cases usually resolve with conservative care

• 🔁 Recurrence possible if aggravating factors not addressed

📝Rapid MSRA Recap

• Swelling directly over kneecap = think prepatellar bursitis

• Always ask:occupation, trauma, systemic signs

• Aspiration rules in/out: sepsis, gout,inflammation

• Treatment:conservative for non-septic, antibiotics &drainage for septic

• Preventrecurrence: avoid kneeling, use knee pads

📚MSRA Resources forPrepatellar Bursitis

• 🧾 Revision Notes:

https://www.passthemsra.com/topic/prepatellar-bursitis-revision-notes/

• 🃏 Flashcards:

https://www.passthemsra.com/topic/prepatellar-bursitis-flashcards/

• ❓Accordion Q&A Notes:

https://www.passthemsra.com/topic/prepatellar-bursitis-accordion-qa-notes/

• ⏱️Rapid Quiz:

https://www.passthemsra.com/topic/prepatellar-bursitis-rapid-quiz/

• 🔍 Full Quiz:

https://www.passthemsra.com/quizzes/prepatellar-bursitis/

📎For More RevisionSupport

🎓 Full course: https://www.passthemsra.com

🆓 Free resources: https://www.freemsra.com

💡Final Thought

Prepatellar bursitismight seem simple, but missing a septic casecan be serious. Know how to spot it, aspirate safely, and treat it effectively— it's a small joint space, but a big examfavourite.

🔖 #MSRA #PrepatellarBursitis #HousemaidsKnee#MSRARevision #MSRAQuestionBank #MSKRevision #KneePain #MSRAMusculoskeletal#MSRAFlashcards #FreeMSRA #PassTheMSRA #Bursitis

🎧Deep Dive:Infrapatellar Bursitis (Clergyman’s Knee)

Welcome back to The Deep Dive, your go-to MSRA revisioncompanion. In this high-yield episode, we unpack InfrapatellarBursitis, sometimes known as Clergyman’sKnee, helping you master the key facts for your MSK section prep —without the fluff.

Whether you’retackling SBA questions or consolidating core knowledge, this episode willsharpen your understanding of what sets infrapatellarbursitis apart from other knee pathologies.

🦴What Is InfrapatellarBursitis?

• Inflammation of the infrapatellar bursa, located below the kneecap
• Acts as a cushion to reduce friction in the anterior knee
• Key symptom: pain and swelling just below the patella

💥Causes & RiskFactors

🔁Repetitive kneeling (e.g. gardeners, plumbers, carpet layers)

⚽️Direct trauma to the front of the knee

🦠Septic bursitis from bacterial infection

🧬Underlyinginflammatory conditions like gout or RA

🛠️ Immunocompromised individuals are at increasedrisk of septic bursitis

📍Mnemonic for Causes:

“Knocks, Kneels & Nasties”

• Knocks = trauma

• Kneels =repetitive pressure

• Nasties =infection/inflammation

📋Symptoms and ClinicalFeatures

• Localised anterior knee pain, worse withkneeling, stairs, or bending

• Swelling and tenderness below the patella

• Pain on palpationover the bursa

• May feel boggy or fluctuant swelling

• In septic cases: redness, warmth, systemic features like fever

🔎DifferentialDiagnoses

• Prepatellar bursitis (above the patella)

• Patellar tendonitis

• Patellofemoral pain syndrome

• Knee osteoarthritis

📍Location is key: Infra = below the kneecap

🧪Investigations

✅ Often a clinical diagnosis

🖼️X-ray or MRI may be used to exclude fracture or tendonpathology

💉Aspiration of thebursa if septic bursitis is suspected (for culture and microscopy)

🧊Management (UKApproach)

💡Mnemonic: B-RICE +NSAIDs

• Bursitis-specific care

• Rest

• Ice

• Compression (if needed)

• Elevation

• NSAIDs for inflammation and pain

💊Antibiotics for septic bursitis

🩺Aspiration ±corticosteroid injection in resistantcases

🔪Surgery = rare, only for chronic/recurrent or severeinfections

📈Prognosis

✅ Most cases resolve within a few weeks

⚠️ Chronic pain or limited mobility if not treatedearly

🚨 Septic bursitis = serious → needs urgentantibiotics to prevent joint damage

🧠Top Tip for MSRA

Always distinguish infrapatellar vs prepatellarbursitis — it’s a common SBA trap!

And if there’s systemic illness, redness, or rapid swelling,think septic bursitis and act fast.

🧪Quick Summary

• Definition: Inflammation of the bursa below the kneecap

• Causes: Kneeling, trauma, infection, orsystemic inflammation

• Symptoms: Pain + swelling just under thepatella

• Diagnosis: Clinical ± aspiration for infection

• Treatment: Rest, NSAIDs, ice, physio —antibiotics if septic

• Complications: Chronic bursitis, infection,mobility loss

📚MSRA Resources

📝 Revision Notes:

https://www.passthemsra.com/topic/infrapatellar-bursitis-revision-notes/

🃏 Flashcards:

https://www.passthemsra.com/topic/infrapatellar-bursitis-flashcards/

📚 Accordion Q&A Notes:

https://www.passthemsra.com/topic/infrapatellar-bursitis-accordion-qa-notes/

🎯 Rapid Quiz:

https://www.passthemsra.com/topic/infrapatellar-bursitis-rapid-quiz/

💡 Quiz Portal:

https://www.passthemsra.com/quizzes/infrapatellar-bursitis/

🌐More Free MSRA Help

• https://www.passthemsra.com

• https://www.freemsra.com

#MSRA#InfrapatellarBursitis #KneePain #MSRAQuiz #Orthopaedics #MSK #SepticBursitis#MSRAFlashcards #MSRARevisionNotes #PassTheMSRA #FreeMSRA #ClergymansKnee

🎧FREE MSRA PODCAST –Meniscal Tears: Catching Knee Pain & Shock Absorbers Gone Wrong

In this episode, wedissect meniscal tears – a common cause of knee pain in both athletes andolder adults. Learn the differences between traumaticvs degenerative tears, when to suspect aroot tear, and how to manage it from conservativetreatment to surgery. Whetheryou’re revising for the MSRA or brushing up your MSK knowledge, this one’s amust-listen.

🧠Key Learning Points –Meniscal Tear for the MSRA

📌Definition

• Meniscal tears are rips in the C-shaped cartilage pads (menisci) between thefemur and tibia.

• Two menisci: medial and lateral– they act as shock absorbers, assist inload distribution, joint stability, and lubrication.

📌Causes & RiskFactors

• Traumatic tears: Sudden twisting/pivoting(sports injuries)

• Degenerative tears: Gradual wear (often inolder adults with osteoarthritis)

• Risk ↑ with:

 – Age

 – Previous kneeinjury

 – Sports (football,basketball)

 – Osteoarthritis

🧠Memory hook:"Twist + Time = Tear"

📌Pathophysiology

• Traumatic: Suddenoverload of force → tear

• Degenerative:Cartilage thins + weakens → minor stress can tear

• Meniscal root tears mimic total meniscus loss →↑ joint pressure → ↑ OA risk

📌Symptoms (ClinicalFeatures)

• Knee pain, swelling(gradual onset), stiffness

• Catching, locking,or popping sensation

• Joint line tenderness (inner or outer knee)

• Giving way or feeling of instability

• Swelling often delayed (2–36 hrs post-injury)

📌DifferentialDiagnoses

• ACL/PCL injuries

• Patellofemoralpain syndrome

• Osteoarthritis

• Bursitis ortendinopathies

• Referred pain orincidental meniscal findings on MRI

📋Diagnosis &Investigations

• History + Physical Exam → joint linetenderness, positive McMurray’s or Apley’s test

• 🧲 MRI = gold standard (shows tear type, size, and location)

• 🩻 X-ray: to rule out fracture using Ottawa Knee Rules

• DGEMRIC:specialist MRI for cartilage assessment (not routine)

🩹Management (Mnemonic:PRICER)

P = Protect

R = Rest

I = Ice

C = Compression

E = Elevation

R = Rehabilitation (Physio is key!)

🔹Conservative:

• NSAIDs, exercisetherapy, strengthening quads/hamstrings

• Activitymodification

🔹Surgical:

• Arthroscopy:

 – Repair (preserve meniscus)

 – Partial meniscectomy (trim the damaged part)

• Post-op physiotherapy is essential

• Rare: meniscaltransplant or scaffold procedures

🔴 Urgent ortho referral if true locking present

📉Prognosis &Complications

✅ Many improve with appropriate treatment

❌ Risks:

 – Re-tear

 – Infection

 – Persistent pain

 – Early knee osteoarthritis, esp. if meniscus removed

 – ↓ Shockabsorption = ↑ wear over time

🧠 Prevention: Strengthen muscles + avoid twistingstress

📎More MSRA Resources –Meniscal Tear

📝 Revision Notes:

https://www.passthemsra.com/topic/knee-pain-meniscal-tear-revision-notes/

🧠 Flashcards:

https://www.passthemsra.com/topic/knee-pain-meniscal-tear-flashcards/

📖 Accordion Q&A Notes:

https://www.passthemsra.com/topic/knee-pain-meniscal-tear-accordion-qa-notes/

🎯 Rapid Quiz:

https://www.passthemsra.com/topic/knee-pain-meniscal-tear-rapid-quiz/

🧪 Quiz Bank:

https://www.passthemsra.com/quizzes/knee-pain-meniscal-tear/

🌐 For more learning resources:

✅PassTheMSRA.com – 1000+ flashcards, revision notes & mockexams

🔓FreeMSRA.com – 100% free podcasts, crib sheets & questionwalkthroughs

Hashtags

#MSRA #MeniscalTear#KneePain #MSKMSRA #MSRARevisionNotes #MSRAQuiz #MSRAFlashcards #MSRAAccordions#MSRATextbook #MSRAOnlineRevision #PassTheMSRA

⚕️FREE MSRA PODCAST –Iliotibial Band Syndrome (ITBS)

🎧 The rapid, practical guide to mastering ITBS –perfect for MSRA revision, clinic, or on the move.

🧠Key Learning Points

📌Definition

• Iliotibial band syndrome (ITBS) is a common overuse injury of the lateral (outer)knee, caused by repetitive friction of the iliotibial band over the lateralfemoral epicondyle.

• Particularlycommon in runners and cyclists.

📌Causes & RiskFactors

• Repetitive flexion/extension of the knee(running, cycling) causes friction/compression of the IT band at the knee

• Biomechanical issues:

 – Excessive footpronation

 – Leg lengthdiscrepancy

 – Hip abductorweakness

• Training errors:

 – Sudden increasein distance or intensity

 – Poor technique

 – Inadequatestretching or warm-up

• Key risk group: Endurance athletes, especiallythose increasing activity too quickly

Mnemonic: “Runner’sfriction at the knee = ITBS”

📌Pathophysiology

• Friction between the IT band and the lateralfemoral condyle leads to inflammation andmicrotrauma

• Chronic casescause thickening of the IT band and persistent pain

📌Symptoms &Clinical Features

• Lateral knee pain (sharp, burning, or stinging)

• Worse withrepetitive knee movements – especially runningdownhill or cycling

• Sometimes swellingor “snapping” sensation at the knee

• No mechanicallocking or instability

Classic clue: Pain at lateral knee, worse withactivity, especially in athletes

📌DifferentialDiagnosis

• Patellofemoralpain syndrome (“runner’s knee”)

• Lateral meniscustear

• Bursitis

• Stress fracture

• Referred pain (hipor lumbar spine)

📌Diagnosis

• Primarily clinical: History of activity-relatedlateral knee pain, exam shows tenderness at the lateral femoral condyle

• Special tests: Ober’s test (tightness), Noble’s compression test (reproduce pain)

• Imaging(ultrasound, MRI) only if diagnosis is unclear or to rule out differentials

📌Management

• Conservative first:

 – Rest and activity modification (stop or reduceoffending activity)

 – Physiotherapy: IT band stretching,strengthening hip abductors (gluteus medius), core stability

 – Correctbiomechanical issues (footwear, orthotics if needed)

• Simple analgesia: NSAIDs for short-termpain/inflammation

• Persistent cases: Corticosteroid injection atthe IT band insertion (rarely needed)

• Surgery: Only for resistant chronic cases

Mnemonic: “R.I.C.E.S.– Rest, Ice, Correction, Exercises, Stretch”

📌Prognosis &Complications

• Excellent prognosis with early conservativemanagement

• Untreated, canbecome chronic, causing persistent painand limiting activity

• Important toaddress underlying biomechanical issues to prevent recurrence

📎MSRA Resources forIliotibial Band Syndrome

📝 Revision Notes: https://www.passthemsra.com/topic/iliotibial-band-syndrome-revision-notes/

💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/iliotibial-band-syndrome-accordion-qa-notes/

🧠 Flashcards: https://www.passthemsra.com/topic/iliotibial-band-syndrome-flashcards/

🚀 Rapid Quiz: https://www.passthemsra.com/topic/iliotibial-band-syndrome-rapid-quiz/

🎓 Full Quiz: https://www.passthemsra.com/quizzes/iliotibial-band-syndrome/

#MSRA#IliotibialBandSyndrome #MSRARevisionNotes #MSRAQuiz #MSRAFlashcards#MSRAQandANotes #MSRAAccordions #MSK #RunnerKnee #Orthopaedics#MSRAOnlineRevision

🎙️ Deep Dive: Juvenile Idiopathic Arthritis (JIA) – MSRA Essentials
In this focused episode, we break down Juvenile Idiopathic Arthritis (JIA) — a challenging yet high-yield topic for the MSRA exam. Whether you're revising for the MSRA, encountering paediatric rheumatology in clinic, or just want to reinforce your knowledge, we cover all the key facts in a memorable and exam-friendly format. ✅

🧠 What You'll Learn About JIA
• 📌 Definition: Chronic joint inflammation starting before age 16, lasting ≥6 weeks
• 🧬 Cause: Idiopathic – but involves immune dysfunction triggered by genetic & environmental factors
• 🩺 Subtypes:
 • Oligoarticular – ≤4 joints, ANA+ → ↑ uveitis risk
 • Polyarticular RF− / RF+ – ≥5 joints; RF+ = poorer prognosis
 • Systemic JIA – Fevers, rash, hepatosplenomegaly, serositis
 • Psoriatic arthritis – Arthritis + psoriasis or nail/digit signs
 • Enthesitis-related – Inflammation at tendon insertions, HLA-B27+
 • Undifferentiated – Doesn’t fit others neatly

🧪 Investigations
• Inflammatory markers: CRP, ESR
• ANA – for uveitis risk (esp. in oligoarticular)
• RF – to distinguish polyarticular subtypes
• HLA-B27 – for enthesitis-related JIA
• Ultrasound/MRI – better than X-ray early on
• Rule out differentials: Septic arthritis, malignancy, trauma, reactive arthritis

💊 Management – NICE-Aligned

Treatment TypeExamples & NotesNSAIDsIbuprofen, naproxen – symptom reliefDMARDsMethotrexate (1st-line), sulfasalazineBiologicsTNF-inhibitors: etanercept, adalimumabSteroidsIntra-articular or short-course oral useNon-drugPhysio, OT, hydrotherapy, eye screening