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Muscoskeletal System > Lecture 1.2: Clinical Overview of the MSK > Flashcards

Lecture 1.2: Clinical Overview of the MSK Flashcards

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1
Q

How many adults consult their GP with musculoskeletal problems each year?

A

1 in 5

20%

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2
Q

What increases risk of MSK problems?

A
  • Trauma
  • Ageing
  • Underlying Pathology
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3
Q

Clinical Assessment in MSK

A

80% History
15% Clinical Examination
5% Investigations

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4
Q

History Taking

A

SQUITARS
Occupation
Dominant hand?

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5
Q

Possible symptoms with MSK presentation

A
  • Pain
  • Swelling
  • Bleeding
  • Stiffness
  • Loss of function
  • Weakness
  • Instability
  • Change in sensation
  • Weight bearing
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6
Q

What could suggest infection or malignancy as underlying cause for MSK presentation?

A
  • Fever
  • Unexplained weight loss
  • History of malignancy
  • Night sweats
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7
Q

Surgical Sieve: MIND IT

A 
M: metabolic
I: inflammation
N: neoplastic
D: degenerative
I: infection
T: trauma
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8
Q

Surgical Sieve: VINDICATE

A 
V: vascular
I: infection
N: neoplasm
D: degenerative or drugs
I: iatrogenic or intoxication
C: congenital
A: autoimmune
T: trauma
E: endocrine/metabolic
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9
Q

Family History in MSK presentation

A

Inflammatory Arthritis

Degenerative Diseases

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10
Q

Social History in MSK presentation

A
  • Mobility
  • Walking aids
  • Home situation
  • Carers
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11
Q

Principles of an Orthopaedic Examination (4)

A
  • Look
  • Feel
  • Move
  • Special Tests
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12
Q

Principles of an Orthopaedic Examination: Look (12)

A
  • Gait
  • Look around the bed!
  • Colour
  • Scars
  • Muscle wasting
  • Deformity
  • Swelling
  • Bruising
  • Puncture or skin wounds
  • Joint fluid
  • Asymmetry
  • Varus + Valgus
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13
Q

Principles of an Orthopaedic Examination: Feel (7)

A 
Look at the patient’s face!
• Pain
• Effusion
• Temperature
• Laxity
• Crepitus
• Pulses
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14
Q

Principles of an Orthopaedic Examination: Move (10)

A
  • Active and Passive
  • Flexion and Extension
  • Pronation and Supination
  • Abduction and Adduction
  • Eversion and Inversion
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15
Q

Principles of an Orthopaedic Examination: Special Tests for Hip

A
  • Trendelenburg
  • Thomas’ test
  • Hip impingement sign
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16
Q

Principles of an Orthopaedic Examination: Special Tests for Knee

A
  • Collateral ligaments
  • ACL/PCL
  • Mc Murray’s test (menisci)
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17
Q

Principles of an Orthopaedic Examination: Special Tests for Foot

A
  • Mulder Click (Morton’s neuroma)
  • Silverskoild test

…and many more

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18
Q

Varus vs Valgus

A

Varus is knees wider than they should be

Valgus is Knock Knees, knees point inwards

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19
Q

Key things to remember when examining the patient (5)

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A
  • Introduce yourself
  • Ask permission!
  • Expose the patient appropriately whilst maintaining patient dignity
  • Warm hands!
  • Don’t cause pain
20
Q

Rule of 2’s

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A
  • 2 joints
  • 2 limbs
  • 2 views (for X rays)

Examine joint above and below
Examine both limbs (for comparison)

21
Q

Investigations (5)

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A
  • Xrays
  • CT
  • MRI
  • Ultrasound
  • Bone Scan
22
Q

CT Pros vs Cons

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A

Pros:
• 3D imaging/ X-sectional imaging
• Can help with interventional procedures
• Excellent for BONE

Cons:
• Significant radiation dose
• Not as good as MRI for assessing soft tissues

23
Q

How does an MRI work?

Study These Flashcards
A
  • Magnetic field
  • Radiofrequency pulse
  • Hydrogen nuclei in water
24
Q

MRI Pros vs Cons

Study These Flashcards
A

Pros:
• Multi-planar imaging
• Non ionising radiation
• Good for picking up infection, tumours, soft tissue

Cons:
• Strict contraindications- Pacemaker, Metal/ FB
• Claustrophobia (1 in 3)
• Slow

25
How does an Ultrasound work?
High frequency sound waves (3-50MHz)
26
What is good about Ultrasounds and what can they be used for?
* Dynamic * Safe (no radiation) * Assessing tendons * Assessing masses * Joint effusions * Screening DDH
27
Osteoarthritis
* Condition that causes joints to become painful and stiff * Live long enough = OA * Big impact on ADL * Treat with Analgesia * Joint replacement
28
Rheumatoid Arthritis
Autoimmune condition that causes pain, swelling and stiffness in the joints
29
Infections
* Erythema (redness) * Swelling * Decreased ROM
30
Tumours
Primary: Lymphomas or Myelomas Secondary: Lung, Breast, Prostate...etc
31
Types of Joint Injury (6)
* Sprains * Fractures * Subluxations * Dislocations * Fracture dislocation/subluxation * Open/closed injury
32
Methods of Treatment (10)
* Conservative & support * Manipulation & cast * Manipulate & insert wires * Open Reduction Internal Fixation (ORIF) screws, plates, wires, combinations * External fixation * Arthroplasty (replace) * Excision (remove) * Osteotomy (re-align) * Amputation * Arthrodesis (restrict)
33
What is a sprain? Where do they commonly occur?
It is damage to a ligament Can be complete, partial or damaged fibres with continuity intact Commonly occur in ankle, knee, hand joints (thumb)
34
RICE for Sprains
R: rest I: ice C: compression E: elevation
35
What is a Dislocation?
A complete loss of continuity of the articulating surfaces of the joint
36
What is Subluxation?
A partial loss of continuity of the articulating surfaces of the joint
37
What is a Fracture?
A break in the continuity of the bone
38
Causes of Fractures? (4)
* Stress * Trauma * Deficiency (osteoporosis, osteomalacia) * Pathological (tumour, infection)
39
Classification of Fractures (4)
Displaced Non-displaced () Open () Closed ()
40
What happens in a Displaced Fracture?
The bone snaps into two or more parts and moves so that the two ends are not lined up straight
41
What is a Comminuted Fracture?
It is when the bone is in many pieces
42
What happens in a Non-Displaced Fracture?
The bone cracks either part or all of the way through, but does move and maintains its proper alignment
43
What happens in an Open Fracture?
The bone breaks through the skin It may then recede back into the wound and not be visible through the skin This is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection
44
What happens in a Closed Fracture?
When the bone breaks but there is no puncture or open wound in the skin
45
Treatment of Open Fractures
* Immediate cleaning * irrigation and reduction * IV antibiotics * Tetanus status * Subsequent surgical debridement/washout and fixation
46
Causes and Treatment of Neck of Femur Fractures
Typically caused either by low energy injuries (the most common type), such as a fall in frail older patient, High energy injuries, such as a road traffic collision or fall from height and are often associated with other significant injuries Cannulated Screw Fixation
47
Aims of Treatment of Fractures
• Pain relief (acute) • Prevent infection (open wounds) • Restoration of normal joint anatomy as far as possible (function and aesthetics) • Maintenance of position (function) • Rehabilitate- reduce risk loss of function • Reduce risk of chronic pain

Muscoskeletal System (15 decks)

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