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Musculosckeletal - FCM > Back and Lower Extremity > Flashcards

Back and Lower Extremity Flashcards

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1
Q

How does a fracture present?

A

After injury
Pain and swelling
Decreased range of motion
Deformity

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2
Q

What is the diagnostic test for fracture?

A

X ray

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3
Q

When is MRI vs x ray in musculoskeletal problems

A

MRI for ligaments and soft tissue
X ray for bones

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4
Q

Open fracture treatment

A

ORIF - open reduction internal fixation (with plates and pins)
Surgical debridement
Prophylactic IV antibiotics - cephalosporins such as cefazolin or cefuroxime
Tetanus vaccine

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5
Q

Closed fracture treatment

A

Non surgically with immobilisation (casts)

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6
Q

What is a green stick fracture and when does it happen ?

A

Common in children and infancy - soft bone bends without breaking fully

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7
Q

What is subluxation

A

Partial dislocation

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8
Q

How does pt present with subluxation

A

After injury with deformed joint and typical posturing

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9
Q

Investigations for dislocation / subluxation

A

X ray - confirm no concurrent fractures

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10
Q

Treatment for dislocation

A

Reduction and stabilisations
CHECK NEUROVASCULAR (pulses and sensation) STATUS BEFORE AND AFTER to see if symptoms are due to treatment or injury

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11
Q

What is a femoral neck fracture

A

Hip fracture

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12
Q

Typical presentation of femoral neck fracture

A

In elderly women with osteoporosis
Minimal injury
Pain in groin
Unable to bear weight
Shortened leg
Externally rotated and abducted

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13
Q

Investigation and treatment for femoral neck fracture

A

Ix - X ray
Tx - total hip replacement

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14
Q

Hip dislocation typical presentation

A

Usually posterior (dashboard injury)
MAJOR injury - high impact or trauma
Any age
Pain
Inability to bear weight
Deformity
Shorter leg

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15
Q

Ix and Tx for hip dislocation

A

Ix - x ray
Tx - reduction and stabilisation

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16
Q

Define bursitis

A

Acute of chronic inflammation of bursa (sac containing synovial fluid)

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17
Q

How does bursitis present

A

Localised tenderness in bursa
Decreased range of motion of joint due to swelling
SIGNIFICANT SWELLING

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18
Q

Diagnosis and treatment for bursitis

A

Diagnosis - clinical
Treatment - conservative management and analgesia is 1st line
Intra articulate steroid injection (only if 1st line doesn’t work

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19
Q

How do you determine if presentation is bursitis and not cellulitis or elbow fracture

A

Elbow fracture - history of injury
Cellulitis - infection of skin so should look red hot and inflamed
Bursitis is just swelling - no skin changes or injury

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20
Q

Typical presentation of osteoarthritis

A

Decreased ROM and function
joint crepitus (joint cracking on movement)
effusion
muscle weakness and wasting around joint due to less usage

JOINT PAIN WITHOUT STIFFNESS - pain increases with activity and stops with rest
No swelling or redness

Affects one or more weight bearing joints (hip, knee, wrist, spine)

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21
Q

Common osteoarthritis findings

A

NON inflammatory condition for ESR and CRP normal
Heberden’s nodes (DIP) - osteophytes on distal interphalangeal joints)
Bouchard’s nodes (PIP) - osteophytes on proximal interphalangeal joints

Diagnosed via X - Ray
- loss of joint space (due to cartilage loss)
- subchondral sclerosis (bright white showing bone damage)
- osteophytes (new bony formation)

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22
Q

Osteoarthritis management and treatment plan

A

Weight reduction (joints are weight bearing)
Low impact exercise and improve muscle strength
Analgesia - NSAIDs and PPI for gastric protection (long term omeprazole increases osteoporosis risk not osteoarthritis - bones not cartilage)
Tramadol if NSAIDs contraindication
Physiotherapist

Steroid (cortisone) joint injection in extreme cases

Orthopaedic surgery for joint replacement - last resort

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23
Q

List serious red flags for back pain

A

Significant trauma related to age or condition (e.g heavy lifting with osteoporosis)
Major or progressive motor/sensory deficit
Bowel or bladder incontinence
Urinary retention
Loss of anal sphincter tone
Saddle anaesthesia
History of cancer metastatic to bone
Suspected spinal infection (fever + any of above symptoms)

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24
Q

Treatment for mechanical back pain

A

Eliminate red flags
Pt education, NSAIDs, paracetamol, muscle relaxant
Avoid bed rest

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25
How can you tell back pain is mechanical
Morning stiffness lasts less than 15 mins Pain worsens with activities Onset - injury Fluctuating symptoms Overuse is risk factor
26
How can you tell back pain is inflammatory
Morning stiffness lasts longer than an hour Pain gets better with movement - throughout day Onset - insidious lasting years Progressive - symptoms don’t fluctuate Usually young pts
27
What is ankylosing spondylitis
Chronic INFLAMMATORY joint disease of spine (causes vertebrae to fuse over time)
28
Who is ankylosing spondylitis more common in
Male Caucasians in mid twenties onwards
29
How does ankylosing spondylitis classically present + findings
Mid twenties Caucasian man Insidious onset of back pain Morning stiffness - inflammatory so over an hour Family history (there is a genetic component) Pain relieved by exercise On X ray - bamboo spine Cartilaginous joints so spine and sacroilium Disease of synovial fluid similar to RA
30
Ankylosing spondylitis treatment
NSAIDs first line Steroid injections If other joint problems as well - DMARDs (disease modifying anti rheumatic drugs) - immunosuppressant - e.g. methotrexate
31
What is Cauda equina
Compression of spinal nerves L1 - S5
32
How does Cauda equina present
Saddle anaesthesia or paraesthesia Recent onset of bladder dysfunction (retention) Recent onset of faecal incontinence - laxity of anal sphincter Severe or progressive neurological deficit in lower extremity
33
Cauda equina management
MRI and immediate decompression
34
What is herniated nucleus pulposus
Pain in leg due to compression of nerves in spine e.g. herniated disc
35
How does herniated nucleus pulposus present
Unilateral leg pain worse than low back pain - WORSENS WHEN SITTING DOWN Pain radiation Numbness and paraesthesia Motor, sensory or reflex change Limited to one nerve root Symptoms vary depending on which disc is herniated (L1-L3 back pain radiates to hip or anterior thigh, L4-S1 pain radiates to below the knee to foot/toes)
36
What is spinal stenosis
Narrowing of spinal canal or neural foramina which can lead to root compression or ischaemia of spinal cord
37
How does spinal stenosis present
Insidious back pain 50-60 years old Paraesthesia with ambulation but relieves when lying supine Lower extremity numbness and pain Leg pain - worse than back pain - RELIEVED BY LEANING FORWARDS AND WORSENS WITH STANDING OR WALKING Pain will be unilateral is foraminal stenosis, bilateral is central or bilateral foraminal stenosis) Normal pulse
38
Differential diagnoses for spinal stenosis prevention
Peripheral vascular disease Neuropathy
39
What is the treatment for scoliosis
Depends on degree of scoliosis (lateral curvature) <20 degrees - exercise and monitoring 21-45 - bracing >45 - surgery
40
What is a vascular necrosis of hip (AVN)
Loss of blood supply to the femoral head causes death of bone (osteonecrosis)
41
Symptoms for AVN - avascular necrosis of hip
Groin pain with radiation into leg Pain despite analgesia
42
Management and treatment for AVN - avascular necrosis of hips
MRI scan of hip then refer to orthopaedics is pain lasts longer than 6 weeks with normal radiographs Total hip replacement
43
Risk factors of AVN - avascular necrosis
Alcoholism, use of steroids, chemotherapy and immunosuppressant medication, sickle cell anaemia
44
How to differentiate between SCFE (slipped capital femoral epiphysis) and LCP (legg calve perthes)
SCFE adolescents (10-17) Overweight children Displacement of femoral neck Operative treatment LCP Aged 4-8 Shorter children Deformity of femoral head Conservative treatment
45
What is SCFE - slipped capital femoral epiphysis
Hip disorder when upper femoral epiphysis is displaced - slipped through growth plate (epiphysis if between head and neck of bone) so the femoral epiphysis stays in hip socket whereas metal shy sis (end of femur) moves in anterior direction
46
Symptoms and presentation of SCFE - slipped capital femoral epiphysis
Adolescent boys (10-17) that are obese (may also have hypogonadism) presents with limp with leg externally rotated, knee pain, groin pain and ROM on exam 20-60% cases bilateral
47
How is SCFE - slipped capital femoral epiphysis diagnosed and treated
AP X-rays of bilateral hips and frog leg lateral Treatment - surgical fixation with screws - bilateral side may be done prophylactically
48
What is legg calve perthes
Self limiting disease of femoral head comprising of necrosis, collapse, repairs and re-modelling
49
Why does LCP happen in young boys?
Disease affects bones in growing phase so only affects children
50
What is the typical presentation of legg calve perthes
Boys aged 4-8 Hypercoagulability PAINLESS LIMP (gluteal medius lurch) - worsens with activity Hip pain after activity Pain relieved with rest ROM
51
What is developmental hip dysplasia
Spectrum of conditions affecting proximal femur and acetabulum e.g acetabular immaturity, hip subluxation and frank hip dislocation
52
How is developmental hip dysplasia diagnosed and who is at higher risk
DIAGNOSED IN BABIES - usually first born girls, breech babies, oligohydramnios (reduced amniotic fluid), family history Ortolani and Barlow tests before 6 months age or ultrasound Older than 6 months - X-ray
53
What is the treatment for developmental hip dysplasia and what happens if not diagnosed and treated
Treatment - observe and consider splinting , if hip dislocates then reduce and splint If not diagnosed children may have delayed walking or crawling or can toe walk unilaterally
54
What is trochanteric bursitis
Localised pinpoint tenderness on outside of hip - not much in groin
55
What are the examination findings, how to diagnose and what is the treatment for trochanteric bursitis
Pain on flexion extension, rotation and abduction Pain down thigh No classical swelling like other bursitis Localised pin point tenderness on outside of hip - not in groin No investigations needed - clinical diagnosis Treatment - exercises or steroid injection into bursa
56
What is chondromalacia patella
Runners knee - loss of cartilage under patella
57
What is patellofemoral pain syndrome
Broad term to describe pain in and around patella - can be caused by chondromalacia patella
58
How does chondromalacia patella present and investigation findings
Deep bending aggravates pain in knee Hyper mobile patella with significant crepitus X-rays of skyline view show bone on bone patella and femur
59
What is meniscus in knee
Medial and lateral menisci - cushions between femur and tibia on inside and outside of knee
60
How does meniscus tear present
Usually starts due to twisting injury whilst weight bearing Torn fragment can trap in joint and cause TRANSIENT LOCKING AND CATCHING causing SEVERE knee pain Above will cause effusion
61
What are the tests for meniscus injuries
MRI (views tissues better) Special tests - McMurray (painful so less common) and Apley (also not used clinically as symptoms can be aggravated)
62
How does a cruciate tear present
Loss of anterior and posterior stability Swollen knee (blood stained effusion within 30 mins of injury) Painful Weight bearing difficulty Knee may give way Usually on injury - may feel pop up during injury Knee feels unstable
63
What are the special tests for cruciate ligament injuries
Positive anterior drawer test Positive Lachman tests Positive posterior draw
64
How do you differentiate between anterior and posterior cruciate tear
Anterior cruciate tear usually after blow to back of knee combined with rotation with foot fixed to ground Use anterior drawer test when testing for ACL injury Posterior cruciate tear follows anterior force such as dashboard of car after car accident Use posterior drawer test when testing for PCL injury
65
Diagnosis and treatment for ACL/PCL injury
MRI Treatment - conservative unless pt active e.g. athlete Conservative management - PRICEM, bracing, physio PRICEM - protect, rest, ice, compression, elevation, movement
66
What is osgood schlatter
One disease under umbrella term of osteochondritis Tibial tuberosity apophysitis Result of excessive muscle pull on growing bone
67
How does osgood schlatter present
Growing teenager especially 10-14 yrs Active children e.g.footballer Pain and swelling directly over tibial tuberculosis Point tenderness on examination Pain aggravated by loaded knee extension - increased symptoms with walking or using stairs
68
Osgood schlatter treatment
Modify exercises, physio and NSAIDs Sx should resolve but may recur until skeletal maturity
69
Ankle fracture presentation, diagnosis and treatment
Presentation - Recent trauma with ankle pain and swelling Can’t weight bear Diagnosis - Ottawa ankle rules (no details needed) , x-ray Treatment - if open - surgical fixation, if closed - reduce and splint
70
How does ankle sprain/strain present and how do you diagnose
Swelling and bruising Pain after injury Diagnosing - no fracture on X ray and Ottawa rules don’t apply, do MRI or US to see soft tissues
71
What is the difference between sprain and strain
Sprain - injury to ligament Strain - injury to tendon
72
Achilles tendon injury presentation
Injury - a gap may be seen near to injury time Feels like been struck above heel Cannot tiptoe Pt may be able to walk Partial rupture more painful than complete
73
What is the Achilles tendon test
Simmons test aka Thomson’s test Squeeze call - if ruptured, foot doesn’t move, if not, foot will flex
74
Typical presentation of plantar fasciitis
40-60 yrs Runners Obese Heel pain and stabbing pain on bottom of foot especially first few steps in the morning, pain relieved by rest and worse when walking barefoot
75
Diagnosis and treatment of plantar fasciitis
Clinical diagnosis Treatment - heel padding, insoles, exercises, physio therapy and NSAIDs
76
How does motor’s neuroma present
Pain between 3rd and 4th toe - feels like walking on a marble More common in woman
77
Diagnosing Morton’s neuroma
Pain when squeezing toes from sides Palpate web space - mulder sign - mulder click positive
78
What is charcot’s joint
Change in foot shape due to weakening / fracturing of the bones in the foot due to severe neuropathy (diabetes or peripheral vascular disease)
79
How does Charcot’s joint present
Rocker foot deformity Swelling, pain, redness and altered shape

Musculosckeletal - FCM (5 decks)

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