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MSK Systems > Misc > Flashcards

Misc Flashcards

Shoulder problems Elbow problems Spinal problems Back pain problems

1
Q

What shoulder problem is commonly seen in patients in their teens/20s?

A

Fractures and instability

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2
Q

What shoulder problem is commonly seen in patients in their 30s and 40s?

A

Rotator Cuff problems and capsulitis

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3
Q

What shoulder problem is commonly seen in patients in their 50s and 60s?

A

Impingement

AC joint problems

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4
Q

What shoulder problem is commonly seen in patients in their 70s?

A

Degenerative rotator cuff problems and degenerative joints

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5
Q

Whats the most common injury in traumatic shoulder injuries?

Anterior, posterior or inferior

A

Anterior

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6
Q

4 modalities of treatment in traumatic shoulder injury

MIPS

A

Manipulation
Immobilisation
Physiotherapy
Surgery

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7
Q

Subacromial impingement definition (3)

A

Pain and dysfunction resulting from

  • pathology which decreases volume of subacromial space
  • pathology which increases size of subacromial content
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8
Q

Subacromial impingement treatment - 3 modalities

A

Subacromial steroid injection
Physiotherapy
Arthroscopic subacromial decompression

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9
Q

Adhesive capsulitis
Presentation of pain
SOCRATES

A

The pain is usually located over the outer shoulder area and sometimes the upper arm.
Dull or aching
It is typically worse early in the course of the disease and when you move your arm.

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10
Q

What are the 3 stages of adhesive capsulitis

A

Freezing - pain
Frozen - less pain but stiff
Thawing - recovery

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11
Q

Adhesive capsulitis
Early presentation - treatment?
Late stages - treatment?

A

Early presentation - inject steroids

Late stages - surgery

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12
Q

Rotator cuff tears can be traumatic or degenerative.
Acute rotator cuff tears = treatment?
Chronic degenerative tears = treatment?

A

Acute rotator cuff tears warrants early surgical treatment

Chronic degenerative tears should only be treated surgically if symptomatic

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13
Q 
Elbow injuries
State the diseases that are most commonly found in these age groups:
Young
Middle age
Elderly
CTS
A

Young - fractures, dislocations
Middle age - tendinopathies
Elderly - degenerative diseases
CTS - any age

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14
Q

Name 5 categories of LBP causes

A
  1. Spondylogenic - originating in the spine
  2. Neurogenic
  3. Viscerogenic
  4. Vascular
  5. Psychogenic
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15
Q

Mechanical back pain is managed in ______

A

Mechanical back pain is managed in primary health care

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16
Q

Mechanical back pain: first-line treatment approach (3)

A
  1. Reassurance, explanation
  2. Simple analgesia
  3. Avoid bed rest, keep active, early return to work
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17
Q

Mechanical back pain: second-line treatment approach

A

If fails to settle, physiotherapy

Alternative therapies e.g. facet joint injections, acupuncture

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18
Q

Persistent mechanical back pain: third line treatment approach

A

Rehabilitation programmes

Pain clinics

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19
Q

Prolapsed intervertebral disc
What can happen to the…
Annulus
Nucleus pulposus

A

Annulus can tear
Nucleus can prolapse
Resulting in cord/nerve root compression

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20
Q

Prolapsed intervertebral disc

Which ligaments are involved

A

Anterior longitudinal ligament

Posterior long ligament

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21
Q

Prolapsed intervertebral disc
Disc changes in normal aging - name 4
Physiological and on imaging

A
  1. Decreased water content of discs
  2. Disc space narrowing
  3. Degenerative x-ray changes
  4. Degenerative changes in facet joints
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22
Q

Prolapsed intervertebral disc

What social factor can aggravate this?

A

Normal degenerative disc changes can be aggravated by smoking

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23
Q

Prolapsed intervertebral disc

Pathological disc changes 6

A

Tearing of annulus fibrosis, prolapse of nucleus
Osteophytes causing nerve root compression
Central spinal stenosis
Abnormal movement - trauma
Spondylosis
Spondylolisthesis

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24
Q

Nerve root pain

  • distribution of pain
  • progression/prognosis
  • 2 modalities of treatment
  • when to refer
A 
Distribution of pain - radicular, along nerve root
Prognosis: usually settles in 3 months
2 modalities of treatment:
- Physiotherapy
- Strong analgesia
Refer after 12 weeks and do MRI
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25
Q

4 types of disc problems
Which one is the most common, asymptomatic?
Which one involves desiccated disc material free in canal?
Which one is caused by weakened but intact annulus?

A

Bulge - common, asymptomatic
Protrusion - weakened annulus but intact
Herniation - through annulus but still in continuity
Sequestration - desiccated disc material free in canal

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26
Q

Cervical disc prolapse

Which nerve roots

A

C5-6

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27
Q

Thoracic disc prolapse

Which nerve roots

A

T11-12

28
Q

Lumbar disc prolapse

Most common nerve root involvement

A

L4/5

29
Q

Lumbar disc prolapse

Which ligament weakening causes posterolateral lumbar disc prolapse?

A

PLL

30
Q

3 types of thoracic disc prolapse and herniations

A

Central
Posterolateral
Lateral

31
Q

Cauda Equina Syndrome (CES)
Name 6 causes
Which is the most common cause

A
  1. Central lumbar herniated disc
  2. Tumours
  3. Trauma
  4. Spinal stenosis
  5. Epidural abscess
  6. Iatrogenic
32
Q

Name 3 iatrogenic causes of CES

A

Spinal manipulation
Spinal epidural
Spinal surgery

33
Q

Name 4 clinical features of Cauda Equina Syndrome (CES)

Investigation of choice
If this is contraindicated, what investigative modalities are used? (2)

A
  1. Injury or precipitating event
  2. Location of symptoms
    - Bilateral buttock and leg pain, varying dyasthesia and weakness
  3. Bowel and bladder dysfunction
    - urinary retention, incontinence
  4. Saddle anaesthesia - loss of anal tone, loss of anal reflex

Investigation of choice - MRI
If contraindicated, use CT or pyelogram

34
Q

Cauda Equina Syndrome (CES)
Treatment
Prognosis after surgery

A

Treatment - surgery outcome good if surgery within 48 hours

Prognosis after surgery - third will not regain function of bladder/sensory/motor deficit

35
Q

Degenerative cervical spondylosis

Why might a patient lose consciousness in this situation

A

Vertebral artery passing through foramina transversarium may get occluded in cervical spondylosis

36
Q

Degenerative cervical spondylosis
Name 5 clinical features excluding referred pain
What are the 3 areas of referred pain?

A 
Cervical pain worsened by movement
Retro-orbital or temporal pain
Numbness, paresthesia of upper limbs
Limited ROM of cervical spine
Poorly localized tenderness
Referred pain
- occiput
- between shoulder blades
- upper limb
37
Q

Degenerative cervical spondylosis
Investigation largely dependent on clinical or imaging
What can imaging show to confirm dx (2)

A

Largely clinical diagnosis but x-ray can show osteophytes and narrowing disc space with
encroachment of intervertebral foramina

38
Q

What will be an indication of MRI at early stage of investigation (4)

A

Neurological symptoms:
Progressive myelopathy
Radiculopathy
Intractable pain

39
Q

What is Lhermitte’s sign

A

Neck flexion causing electric shock like sensation radiating down spine

40
Q 
Degenerative cervical spondylosis
Treatment approaches (3)
A

Wait and see
Avoid bed rest, keep active
Physiotherapy - after 4-12 weeks of not resolving pain

41
Q

Spinal stenosis/claudication

Presentation (4)

A

Bilateral - usually
Sensory dyasthesiae
Weakness - foot drop
Takes several minutes to ease after stopping walking

42
Q

Spinal stenosis/claudication

Which factors improve/worsen symptoms

A

Worse walking down hills - extension

Better walking uphill, riding bicycle - flexion

43
Q

Spinal stenosis/claudication - Lateral recess stenosis

Tx (4)

A

Non-operative measures
Nerve root injection
Epidural steroid injection
Surgery

44
Q

Spinal stenosis/claudication - Central stenosis

Tx (3)

A

Non-operative measures
Epidural steroid injection
Surgery

45
Q

Spinal stenosis/claudication - foramina stenosis

Tx (4)

A

Non-operative measures
Nerve root injection
Epidural injection
Surgery

46
Q

Spondylosis definition (1)

A

defect of pars interarticularis

47
Q

Spondylolisthesis definition (1)

A

anterior displacement of vertebral body

48
Q

Spondylosis

2 symptoms

A
  1. LBP

2. Radicular symptoms occasionally

49
Q

Spondylosis
Investigations - 4
Treatment - 3 modalities

A 
X-rays
CT
MRI
Bone scan
Treatment
- Non-operative measures
- Injection therapy
- Surgery
50
Q

Spondylolisthesis

Wiltse Classification 5 categories

A 
Congenital
Isthmic
Degenerative
Traumatic
Pathologic
51
Q 
Spondylolisthesis
Surgical indications (2)
A

Indicated in persistent pain and/or nerve root entrapment

52
Q

According to ASIA classification of SCI, which grade has completely no chance of recovery

A

ASIA Grade A

53
Q

What fracture causes tetraplegia or quadriplegia

A

Cervical fracture

54
Q

In tetraplegia/quadriplegia, respiratory failure is due to loss of innervation of what? What nerve is this and state nerve roots

A

In tetraplegia/quadriplegia, respiratory failure is due to loss of innervation of diaphragm
Phrenic nerve C3-5

55
Q

Paraplegia definition (1)

A

Partial or total loss of use of the lower limbs

56
Q

What is spared in paraplegia

A

Arm function spared

57
Q

What are 2 partial cord syndromes

A

Central cord syndrome

Anterior cord syndrome

58
Q

Which patients and which type of injuries are typically affected in central cord syndrome

A

Elderly patients with arthritic neck with hyperextension injury (low velocity)

59
Q

What injury can cause central cord syndrome

A

Hyperexentension injury

60
Q

Clinical features of central cord syndrome

What is typically preserved? (2)

A

Weakness of arms > legs
Dyasthesias
Perianal sensation and lower extremity power preserved

61
Q 
Anterior cord syndrome
Presentation
What type of injury causes this (2)
Damage to what causes this?
What is preserved
A

Profound weakness
Type of injury causing this - hyperextension injury, anterior compression fracture
Damage to anterior spinal artery
Fine touch and proprioception preservaed

62
Q

Management of SCI

A

Prevent secondary insult/further damage

ABCD management

63
Q

What is ABCD management

A

Airway and c-spine
Breathing
Circulation
Disability - PR, peri-anal sensation

64
Q 
Spinal shock definition
Clinical features (2)
A

Transient depression of cord function below level of injury lasting several hours-days after injury
Clinical features
Flaccid paralysis
Areflexia

65
Q

Neurogenic shock
Cause (2)
3 clinical signs

A 
2 causes of neurogenic shock:
- Injuries above T6
- Secondary to disruption of sympathetic outflow leading to loss of sympathetic tone
3 Clinical signs
- Hypotension
- Bradycardia
- Hypothermia

MSK Systems (7 decks)

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