MSK Flashcards
2 COMMON locations for compartment syndrome
Anterior compartment of lower leg
Volar compartment of forearm
Don’t forget that what can be a cause of compartment syndrome
Circumferential burn
What pressure is positive for compartment syndrome
Delta pressure over 30
Muscle breakdown causes what two things
Release of myoglobin leading to myoglobinuria
Kidney dysfunction = hyperkalemia // increased phosphate // LOW CALCIUM
MC complication of compartment syndrome
Rhabdomyolysis
BMI greater than what can cause osteoarthritis
25
5 things to remember about osteoarthritis
LOSS
Loss of joint space
Osteopphytes
Subchondral cysts
Sclerosis
And
Pip-E Bouchard Nodules with Heberden Nodules at the DIP Joint
4 management options for osteoarthritis
Oral or topical NSAIDS
Topical capsaicin
Duloxetine
CC Injections
With HLA B27 think ?
Ankloysing Spondylitis
Axial spine and Sacroiliac joints
Risk factors for AK
Male under age 45
Pain is what with AK
Worse in the morning and improves with activity
Just like osteoarthritis
1 extra articulate manifestation of AK
Anterior uveitis
1 st line for AK
NSAIDs and PT
Nerve distro effected by cauda equina
L2 - S1
Post void residual volume = + for urinary retention in cauda equina
Greater 100
Lateral upper arm
Lateral forearm and thumb
Posterior forearm and middle finger
Fifth finger
Nerve Roots.
C5
C6
C7
C8
Root associated with loss of
Brachioradialis reflex
Biceps reflex
Triceps reflex
C5
C6
C7
How does the leg get its innervation
S1 the butt
L5
L4
L3 wraps around the groin
What is a positive straight leg test
Hold the knee
Raise the leg
Pain shoots from back PAST the knee
Knee extension vs. Knee Flexion roots
Extension = L3/L4 —> KICK THE FLOOR
Flexion = L5/S1 —> RIDE ONE, FLEX.
In spinal stenosis sxs improve with
Flexion
What red flag is significant from seronegative splodylarthropathy
Morning stiffness in a greater than 30 yr old adult
When is a good time to X-rays for low back pain
Persists longer than 6 weeks despite conservative treatment or if ALARM sxs
Most shoulder dislocations are
Anterior
Mechanism for posterior shoulder dislocation
Seizure or electric shock
Special tests for shoulder instability
Apprehension and O’Brien Test
What movements aggravate each RTC muscle
Supraspinatus = abduction
Infraspinatus = ER
Tree Minor = ER
Subscapularis = IR
What are good tests for shoulder impingement?
Anterior = Hawkins Kennedy
Posterior = Neers Test
Shoulder lift off and belly press test what
Internal rotation of the shoulder
Shoulder impingement gets surgery for what
Full thickness tears
2 diseases associated with frozen shoulder
Diabetes
Hypothyroidism
Movement most effected in frozen shoulder
External rotation and abduction
Lateral epicondylitis is what?
Tennis Elbow
Lateral tendonidopathy of the Extensor carpi radilais brevis
Medial epicondylitis is?
Golfers elbow
Medial tendonopathy of the pronator teres
Lateral epicondylitis vs medial epicondylitis = PAIN WITH WHAT MOTIONS?
Lateral = activities where the arm and wrist are extended
Medial = activities that involve wrist Flexion and Pronation
Pain with resisted what in LATERAL VS. MEDIAL EPICOND
LATERAL = extension
MEDIAL = Flexion
Two tests if you suspect scaphoid tenderness
Ulnar wrist deviation PAIN
Exist compression of the thumb PAIN
When do you have surgery in scaphoid fracture
Displaced fractures
Type of splint for boxer fracture
Ulnar gutter splint
Colles vs. Smith fracture
Colles = volar displacement of wrist = R/o Schaphiod injury!
Smith = distal displacement
Colles vs. Smith Fracture
Colles = volar
Smith = distal
If you are gonna do surgery on Colles or smith what is the surgery / splint
ORIF = unstable or communited
Splint = sugar tong splint
Colles = Eat something sweeet with that FORK = Sugar Tong
Mallet finger is what?
Disruption of finger extensor tendon mechanism at the DIP.
Treatment mallet finger
Maintain the DIP joint in full extension for 6-8 weeks
Mallet finger can lead to what
Swan neck deformity
DIP in Flexion
PIP in hyperextension
Skiers game keeper thumb is a disruption of what ligament
Ulnar collateral ligament avulsion fracture by forced ABDUCTION
Posterior hip dislocation is described as
Leg shortened with hip flexed ; adducted ; internally rotated
FADIR
Anterior hip dislocation is defined as
Hip extended , abducted, and externally rotated
FABER
How does the femoral head appear in anterior vs. posterior hip dislocation
Anterior = larger and medial or inferior to the acetabulum
Posterior = smaller and superimposes on the roof of the acetabulum
Time frame for closed reduction in hip dislocation
6hours
Most common type of hip fx
Intertrochaneteric
What is the story for ACL tear
Pop sensation with effusion and instability
What would a plain film show in knee ligament injury
Segond fracture
What artery is injured in PCL tear
Popliteal artery injury
MCL vs LCL stress
MCL = Valgus
LCL = VARUS
What is the story for meniscal tear
Twisting motion of a flexed knee on a planted foot
Meniscus makes you think?
Mechanical symptoms
Ankle INVERSION injury is most common and effects what ligament
Anterior talofibular ligament
Ankle eversion is uncommon and effects what ligament
Deltoid
High ankle sprain effects what location
Distal tibiofibular syndesmosis
Brief explanation of Ottawa ankle rules
Pain in the malleolar region :
-Bone tenderness posterior edge of medial mall. or lateral mall. [6cm]
-Pain in the same area when walking [ 4 steps ]
Pain in the midfoot region :
-TTP at the Navicular
-Base of 5th metatarsal pain
-Pain in the same area when walking [ 4 steps ]
Maisoneueve fracture combination ? 2 things.
1st. Medial Malleolous fracture
2nd. Spiral fracture of proximal tibia
JONES VS. PSUEDOJONES definition
Jones = transverse fracture of the proximal diaphysis of the fifth metatarsal
PSUEDOJONES = avulsion fracture of the 5th metatarsal tuberosity
Jones vs. Pseudojones management
Jones = Non weight bearing 6-8 weeks
PSUEDOJONES = walking boot 2-3 weeks
What three ligaments are involved in the lesfranc fracture
Plantar
Lesfranc
Dorsal ligament
Lesfranc management
ORIF non weight bearing cast 6-12 weeks
Non weight bearing case and repeat X-ray every 2 weeks = no dislocation
Puncture wound from nail what pathogens
Staph A
Psuedomonas = shoe de Mona’s
Most sensitive study for osteomyelitis
MRI
Osteomyelitis treatment if
Psuedomonas
GBS
MSSA
Pseudomonas = Cefepime ; Ceftazidime
GBS = Vancomycin
MSSA = nafcilin oxacilin
If something looks like septic arthritis dont forget to think about
N. Gonnorhea
Antibiotics of choice for septic arthritis
Vancomycin + Ceftriaxone
What part of the bone is effected in Ewing sarcoma
Diaphysis of long bones
Biopsy of Ewing sarcoma looks like
Small round blue cells
Psuedorossetes
What age is effected by osteosarcoma
13-16 and greater than 65
Osteosarcoma think what
Sunburst
Osteosarcoma think what
Sunburst
5 PLATE, medications that can cause gout
Pyrazinamide
Loop diuretics
ASA
Thiazides
Ethambutol
“Too much seafood on your plate”
Gout arthrocentesis shows what
Negative birefringent crystals
Psuedomonas gout shows what
Positive birefrigent crystals
Mainstay treatment gout
Indomethacin
Colchicine for ATTACKS
MX = allupurinol
Allupurinol is what type of medication and what side effects
Probenacid
Xanthine oxidase inhibitor
probenacid = urate reputake inhibitor
Hematuria
Bleeding gums
Blue/pale skin
4 disease states assoc with pseudo gout
Hyper PTH
hypothyriodism
Hemochromatosis
Thiazides diuretics
X-RAY for pseudogout shows what
Chondrocalcinosis
Shape of crystals gout vs. psuedogout
Gout = sharp
Psuedogout = rhomboids
MC primary cause of osteoporosis
Post menopause loss of estrogen
Loss of zinc / ca2+