MSK Pathologies (Remember Imaging - X-ray/CT/MRI) Flashcards
Baker’s cyst (definition, causes, symptoms, management)
Definition: swelling and inflammation at the back of the knee (extension of the synovium between the medial head of gastrocnemius and semi-membranous)
Causes: sports injury, blow to the knee, RA, OA, and gout
Symptoms: asymptomatic, joint locking and crepitus, pain
Management: IMPORTANT to rule out DVT (D-dimer blood test and duplex ultrasound) NSAID (eg. ibuprofen) and ice to decrease swelling, rest and elevation
Erb’s palsy (definition, symptoms and signs, causes, treatment)
Definition: damage to the upper roots of the brachial plexus (C5-6)
Symptoms and signs: dermatome sensory loss, weakness, partial/whole paralysis, waiter’s tip sign (shoulder adduction, elbow extension, forearm pronation, and wrist flexion)
Causes: injury during delivery
Treatment: physiotherapy to maintain the muscles
Klumpke’s palsy (definition, symptoms and signs, and treatment)
Definition: damage to the lower roots of the brachial plexus (C8-T1)
Symptoms: dermatomal sensory loss and weakness of intrinsic muscles, T1 involvement can cause Horner’s syndrome, ulnar claw sign
Treatment: physiotherapy
Carpal tunnel syndrome (definition, symptoms, causes, treatment)
Definition: median nerve entrapment in the carpal tunnel
Symptoms: tingling/pain in first 3 digits, worse at night and relieved by shaking/hanging out hand, weakness in thumb, numbness
Causes: diabetes, pregnancy, hypothyroidism, acromegaly, radial fracture, RA
Treatment: splints, steroid injections, treatment of underlying condition
Cauda equina syndrome (definition, symptoms, causes and treatment)
Definition: compression of the cauda equina
Symptoms: lower back pain, saddle anaesthesia, bowel and bladder disturbance, sexual dysfunction
Causes: usually herniation of L4/5 or L5/S1 disc, neoplasms, iatrogenic
Treatment: EMERGENCY whole spine MRI and decompression surgery
Colles’ fracture (definition and treatment)
Definition: a fall on an outstretched hand causing a distal radial fracture with dorsal displacement of the distal fragment
Treatment: alignment then open reduction and internal fixation
Compartment syndrome (definition, symptoms and signs, treatment)
Definition: usually after limb trauma where swelling and inflammation increase pressure within the muscular compartment reducing blood flow to the area (MEDICAL EMERGENCY)
Symptoms and signs: severe pain, pallor, paralysis of the limb, pulselessness, paraesthesia
Osteoarthritis (Definition, symptoms, risk factors, examination signs, x-ray signs, management)
Definition: natural ‘wear-and-tear’ of joints over time
Symptoms: joint pain and stiffness over the course of months/years, commonly large weight bearing joints, pain worse with movement and towards the end of the day
Risk factors: obesity, repetitive trauma to joints (occupational/sports)
On examination: reduced range of movement, possible fixed deformity, swollen but not hot and tender, maybe crepitus
On X-ray (LOSS): loss of joint space, osteophytes (bony lumps), subchondral cysts, subarticular sclerosis (thickening of bone)
Management: weight loss and anaerobic exercise (AVOID weight-bearing exercise), analgesia (NSAIDs are appropriate - follow pain ladder), if severe intra-articular steroid injection, joint replacement if severe
Osteogenesis imperfecta (definition and signs)
Definition: genetic disorder caused by inadequate collagen formation in bones (fragile bones)
Signs: bone, eye, teeth and ear abnormalities. Discolouration of sclera (blue/gray), hearing loss, discolouration of teeth
Osteomyelitis (definition, causes, risk factors, signs, tests and management)
Definition: bacterial/fungal infection of the bone. Can be acute (single organsim)/chronic (polymicrobial)
Causes: seeding from haematogenous infection spread from adjacent tissues/joints, direct inoculation into wound contamination in trauma/surgery
Risk factors: diabetes, peripheral vascular disease, malnutrition, immunosuppression, malignancy, very young/old, local factors
ACUTE signs: fever, swelling, erythema at site
CHRONIC signs: history of pain, persistent wound/soft tissue damage
Tests: bone biopsy, blood CRP, ESR and cultures, MRI
Management: antibiotics (flucloxicillin and fusidic acid/rifampicin), clindamycin (if penicillin allergy), surgical debridement
Osteoporosis (definition, risk factors, tests, treatment)
Definition: fragility fractures
Risk factors (SHATTERED FAMILY): steroid use, hyperthyroidism/hyperparathyroidism, alcohol and smoking, thin, testosterone deficiency, early menopause, renal/liver failure, erosive/inflammatory bone disease, diabetes, family history
Tests: DEXA scan (bone density), X-rays (investigate fractures)
Treatment: lifestyle changes (to decrease risk factors), diet (adequate calcium, vit D, protein - supplements may be needed), weight bearing exercise, biphosphonates (increases apoptosis of osteoclasts)
Scaphoid fractures (definition, treatment and complication)
Definition: pain on palpation of the anatomical snuffbox after a fall on an outstretched hand
Treatment: x-ray, then cast hand in ‘beer glass position’
Complication: avascular necrosis, presents with pain and stiffness of wrist
Septic arthritis (definition, risk factors, signs, tests, management)
Definition: joint infection which spreads to fluid surrounding the joint
Risk factors: joint disease, immunosuppression, prosthetic joints
Signs: acutely tender and swollen joint, decreased range of movement, systemically unwell
Tests: joint aspiration for culture, FBC, CRP and ESR, blood cultures, X-ray
Management: IV antibiotics, maybe joint washout, physiotherapy
Reactive arthritis (Definition, risk factors and treatment)
Definition: triad of urethritis, arthritis and conjunctivitis
Risk factors: male, HLA B27 positive, preceding STI/GI infection
Treatment: NSAIDs and corticosteroid injections, possibility of recurrence
Rheumatoid arthritis (definition, symptoms, tests, and treatment)
Definition: chronic inflammatory autoimmune disease
Symptoms: pain and stiffness in joints that develops over days/weeks, pain improved with movement, swollen red and tender joints
Tests: FBC (anaemia common), CRP and ESR (usually raised), rheumatoid factor and anti-CCP antibodies (positive)
Treatment: regular paracetamol and NSAIDs (symptomatic relief), steroids in flare ups, physiotherapy
- in severe cases, DMARDs eg. methotrexate, sulfasalazine, and hydroxychloroquine (slows progression of disease)
- in severe cases where DMARDs are not effective alone, + biologics eg. infliximab (anti-TNF)
