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MSK Flashcards

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1
Q

How to describe a radiograph

A

PAID
pattern and pieces

Anatomical location

Inter/extra-articular inc. dislocation and subluxation

Deformity inc translation, angulation, rotation, impaction

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2
Q

Types of fracture lines

A 
TOGSAC
Transverse
oblique
greenstick
Spiral
Avulsion
Crush
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3
Q

fat embolism presentation

A

PE + neuro signs
confusion, agitation, retinal haemorrhages

red/brown petechial rash

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4
Q

painful arc between 60-120 degrees is what pathology?

A

glenohumeral (impingement, rotator cuff, calcific tendonitis)

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5
Q

painful arc between 170-180 degrees is what pathology

A

acromioclavicular: arthritis, SLAP tears, trauma

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6
Q

describe subacromial impingement syndrome

A

greater tuberosity of humerus and acromion hit each other causing pain in the rotator cuff tendon

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7
Q

management of impingement

A

steroids
NSAIDs
physio for RC

surgery: arthroscopic subacromial decompression

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8
Q

management of rotator cuff tear

A

Conservative: NSAIDs, steroid injections, physio

Surgical: rotator cuff repair +/- subacromial decompression

e.g. single or double row

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9
Q

management of frozen shoulder

A

steroid injections and intensive physio

manipulation under anaesthetic

surgery: capsule and rotator interval release

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10
Q

3 stages of frozen shoulder

A

freezing: painful, 0-6m
frozen: stiff, 6-24m
thawing: resolution, 24-36m

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11
Q

most common shoulder dislocation direction

A

antero-inferior, more obvious on X-ray

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12
Q

posterior shoulder dislocation sign

A

light bulb sign, can’t see tuberosity

need an axillary view to confirm

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13
Q

management of anteroinferior dislocation

A

Traction
Neuro status

1st: external rotation brace
recurrent: early mobilisation and surgery (keyhole stabilisation

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14
Q

causes of posterior shoulder dislocation

A

major trauma
seizures
electrocution

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15
Q

Growth plate injury classification

A

Salter-Harris

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16
Q

Describe Salter Harris Classification

A 
type can be thought of as S A L T ER
S = straight across
A = above
L = lower
T = through
ER = ERasure (crushed)
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17
Q

X rays for NOF and findings

A

AP and lateral

Shenton’s line disruption from medial femoral neck to inferior edge of pubic ramus

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18
Q

NOF presentation and classification

A

pain in groin with referral to thigh
external rotation and shortened limb length
Can be intracapsular or extracapsular
extracapsular: intertrochanteric or subtrochanteric

Garden classification for intracapsular
1 = incomplete and undisplaced
2 = complete but undisplaced
3 = complete and partial displaced
4 = complete and fully displaced
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19
Q

management of intracapsular NOF

A

iliofascial block

<55and Garden I/II: ORIF with 3/4 parallel cancellous screws

Displaced:
<55 ORIF and cannulated screws
55-75: Total Hip Rreplacement
>75: Hemiarthroplasty

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20
Q

two types of extracapsular NOF

A

intertrochanteric
subtrochanteric

must be within 5cm inferior of lesser trochanter or it’s femoral shaft

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21
Q

management of intertrochanteric NOF

A

DHS and plate system following closed reduction

if unstable ORIF with cancellous/cannulated screws

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22
Q

management of subtrochanteric NOF

A

IM nailing

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23
Q

osteoarthritis XR

A

Loss of joint space
Osteophytes (Heberden/Bouchard)
Subchondral cysts
Subchondral sclerosis

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24
Q

RhA XR

A

Loss of joint space
Erosion
Soft tissue swelling
Soft bones (osteopaenia)

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25
RhA join signs
``` ulnar deviation swan necking/Boutonniere deformity subluxation of ulnar styloid muscle wasting tendon rupture rheumatoid nodules ```
26
RhA extraarticular signs
``` Sjogren's Scleritis Nodules Leg ulcers pyoderma gangrenosum lower lobe fibrosis Cardio involvement Vasculitis Renal Felty's syndrome ```
27
Management of RhA
NSAIDs Steroids DMARDs = MTX, HCQ, Sulfasalazine Biologics = etanercept tocilizumab, rituximab
28
tibial fracture management
internal or external fixation | if children/young adults: manipulation and plaster immobilisation
29
Management of Achilles tendon rupture
equinus cast (plaster of paris cast), slowly reducing the plantar flexion over months surgical repair can use flexor hallucis longus tendon for repair
30
signs of ulnar nerve damage
``` claw hand deformity positive froment's: holding paper between thumb and index shows flexion of terminal phalanx of thumb failure of finger abduction hypothenar wasting no sensation on medial 2.5 fingers ```
31
ACL management
isolated: specialised quadriceps physiotherapy Instability, concurrent injury, paediatric: grafting from the hamstring and patellar tendon (semitendinosus and gracilis)
32
MCL/LCL management
hinged knee brace and physio
33
Meniscal tear management
Arthroscopic debridement | Arthroscopic repair works better in lateral 1/3rd due to blood supply
34
O'Donoghue unhappy triad
medial meniscal tear ACL tear MCL injury
35
organism causing septic arthritis
Staph aureus | CoNS
36
Anterior shoulder dislocation palsy
Axillary nerve damage: weak abduction and sargent's patch
37
Humeral shaft # palsy
Radial nerve: Waiter's tip
38
Elbow dislocation palsy
ulnar nerve: Claw hand
39
Hip dislocation palsy
Sciatic nerve: Foot drop
40
Fibula neck #/knee dislocation palsy
peroneal nerve: foot drop
41
ottawa knee rule
``` any of 55 Isolated patellar tenderness Cannot flex to 90 Can't weight bear for 4 steps ```
42
ottawa ankle rule
pain in malleolar zone AND: - bone tenderness at posterior edge/tip of lateral malleolus - bone tenderness at posterior edge/tip of medial malleolus - inability to bear weight for 4 steps OR pain in mid-foot and - bone tenderness at base of 5th metatarsal - bone tenderness at navicular - inability to weight bear for 4 steps
43
Humeral head fracture management
2 part, minimally displaced: collar and cuff 3 part/displaced: ORIF plate and screws Large displacement: arthroplasty Unrepairable rotator cuff: reverse arthroplasty
44
Supracondylar elbow # classification
Gartland for extension fractures (distal fragment displaces posteriorly)
45
Supracondylar humeral # palsy
median nerve palsy: Hand of Benediction, weak OK Brachial artery:
46
management of compartment syndrome
elevate limb remove bandages/splint fasciotomy
47
artery supplying head of femur
retinacular artery from medial circumflex femoral artery
48
femoral shaft # management
``` traction IM nailing (anterograde from hip or retrograde from knee) ``` ORIF if IM nailing unsuitable
49
supracondylar elbow # management
no displacement: collar/cuff for 3 weeks with fully flexed arm Displacement: Manipulation under anaesthetic and K wire fixation + collar/cuff 3w
50
Colle's fracture deformity
Dinner fork
51
Monteggia # | + management
proximal 3rd of ulnar shaft + anterior dislocation of proximal radius adult: ORIF paeds: MUA + above-elbow POP
52
Galeazzi # | + management
distal 3rd of radial shaft + dislocation of radio-ulnar joint adult: ORIF paeds: MUA + above-elbow POP
53
5 signs of scaphoid fracture
1) snuffbox pain 2) pain telescoping thumb 3) tenderness on scaphoid 4) pain on ulnar deviation 5) wrist joint effusion
54
scaphoid x ray views
scaphoid, AP and lateral
55
scaphoid management
Futuro splint pre x-ray if X-ray negative, return in 10 days to repeat if positive: undisplaced at scaphoid waist - cast for 6-8w displaced at scaphoid waist OR any fracture at proximal pole - ORIF NB: Scaphoid waist = middle
56
why scaphoid risk of AVN
retrograde blood supply from dorsal carpal branch of radial artery
57
Pott's fracture
ankle bimalleolar fracture
58
Cotton's fracture
ankle trimalleolar fracture
59
Ankle fracture classification
Weber = lateral malleolus fracture A: below syndesmosis B: at syndesmosis C: above syndesmosis 1: isolated 2: with medial malleolus 3: with medial malleolus and posterolateral tibia
60
management of ankle fracture
Weber A/non-displaced B: Boot/below-knee POP Weber B displaced/C: ORIF +/- syndesmosis repair
61
Compartment syndrome investigations
clinical suspicion #1 | manometer
62
complications of compartment syndrome
``` Volkmann contractures Sensory loss Weak dorsiflexors Chronic pain Claw toe Amputation ```
63
Shoulder dislocation lesions
Hill-Sachs: Bony dents on humeral head Bankart: damage to cartilage (labrum/glenoid) Bony Bankart: fracture of glenoid floating around Axillary nerve palsy Rotator cuff tears
64
biceps tendon rupture pain
Long tendon proximally: shoulder | Long tendon distally: antecubital fossa
65
Popeye's deformity sign
proximal biceps tendon rupture needs urgent MRI
66
Elbow Epicondylitis types
lateral (tennis): worse on wrist extension medial (golfer's): worse on flexion, tingling in 4/5 fingers
67
management of carpal tunnel syndrome
conservative: modify activity, splints at night, hand exercises Surgery: Steroid injections, surgical decompression
68
causes of knee locking
meniscus/cruciate tear, osteochondritis, osteophytes
69
chondromalacia patellae usually tends to affect | Management
teenage girls after knee injury pain going downstairs/prolonged sitting Mx: vastus medialis strengthening
70
PCL management
isolated: physio and bracing | instability, concurrent injury, paeds: reconstruction from hamstring/patellar tendon
71
define meralgia paraesthetica
parasthesia in lateral femoral cutaneous nerve distribution (L2/3) NO MOTOR due to it travelling around the ASIS and being subject to repetitive trauma
72
define bipartate patella
``` patella fails to fuse 3 types (inferior pole, lateral, superolateral) ```
73
causes of true leg length discrepancy
Congenital: idiopathic, NF, spina bifida, CP, clubfoot Developmental: growth plate injury, polio, DDH, perthe's, cancer Post-trauma: #femur, #tibia
74
causes of apparent leg length discrepancy
arthritis: fixed flexion deformity of hip, fixed adduction deformity of hip scoliosis changes in muscle length/contracture

PACES Management (11 decks)

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