MSK disorders

Question 1

Besides overuse, what condistions predispose pts to carpal tunnel syndrome?

Answer 1

pregnancy, RA, DM, acromegaly, hypothyroidism, obesity

Question 2

What is the goal of carpal tunnel surgery?

Answer 2

release the transverse carpal ligaments

Question 3

What kinds of should dislocations are most common and what are the predisposing risks/ mechanism of injury for shoulder dislocation?

Answer 3

Anterior dislocations most common, usually due to a posteriorly directed force (complicated and counterintuitive- see pg 204 for fuller explanation)
Posterior dislocations are uncommon but may result from seizure or electric shock

Question 4

What nerve might be injured in shoulder dislocations and how would that manifest? What artery could be injured?

Answer 4

Axillary nerve- may be deltoid weakness or numbness over the shoulder. Axillary artery could also be injured.

Question 5

What kinds of hip dislocations are most common and what are the typical mechanisms of injury?

Answer 5

Posterior hip dislocations are most common due to a posteriorly directed force on an internally rotated, flexed, and adducted hip (ie you are sitting in your car)

Question 6

What is the treatment for hip dislocation?

Answer 6

closed reduction, bracing, abduction pillow?

Question 7

What is the management for an open fracture?

Answer 7

thorough irrigation ain the OR and abx to reduce the risk of infection

Question 8

What body parts are injured in a sprain?

Answer 8

injuries to ligaments (connect bone to bone) and surrounding soft tissues in a joint

Question 9

What are the manifestations of a ligamenous tear?

Answer 9

pain and swelling that worsens with joint stress; decreased joint ROM, instability on joint testing

Question 10

What is the tx for a ligamentous tear?

Answer 10

initially RICE (rest, ice, compression to reduce swelling, elevation), but may require surgical management

Question 11

What is the “unhappy triad” for the knee, and what is its significance?

Answer 11

-lateral meniscual tear, medial collateral ligament tear, and ACL, due to a medially directed blow to the lateral side of the knee.

Question 12

What causes meniscal tears?

Answer 12

repetitive microtrauma and degeneration, or forceful twisting of a planted knee

Question 13

What other injuries are often associated with meniscal tears?

Answer 13

ACL injury

Question 14

What are complications of meniscal tears?

Answer 14

meniscal debridement predisposes the patient to osteoarthritis at an older age

Question 15

What are the most common sites of compartment syndrome?

Answer 15

-usually lower leg due to tibial fracture; also seen in forearm

Question 16

What are the indications for fasciotomy in compartment syndrome?

Answer 16

-pressures > 30 mmHg or for pressures within 20 mmHg of diastolic BP