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MSK Flashcards

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1
Q

What radiographic findings are typical of osteoarthritis?

A

Joint space narrowing, osteophyte formation, subchondral sclerosis, and bone cysts.

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2
Q

How do you differentiate osteoarthritis from rheumatoid arthritis?

A

Osteoarthritis is non-inflammatory, asymmetrical, and worsens with activity, while rheumatoid arthritis is inflammatory, symmetrical, and improves with movement.

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3
Q

What factors determine the need for surgical intervention in osteoarthritis?

A

Persistent pain despite conservative treatment, severe functional impairment, and radiographic evidence of advanced disease.

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4
Q

What laboratory findings are consistent with rhabdomyolysis?

A

Elevated creatine kinase (CK), myoglobinuria, hyperkalemia, and acute kidney injury.

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5
Q

How does rhabdomyolysis lead to acute kidney injury?

A

Myoglobin release causes renal tubular obstruction and oxidative stress, leading to nephrotoxicity.

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6
Q

What are the principles of fluid management in rhabdomyolysis?

A

Aggressive IV fluid resuscitation with isotonic saline to prevent renal failure, and possible alkalization of urine to prevent myoglobin precipitation.

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7
Q

What are the six Ps of compartment syndrome?

A

Pain (out of proportion), Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia.

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8
Q

How do you confirm the diagnosis of compartment syndrome?

A

Measurement of compartment pressures (>30 mmHg or within 30 mmHg of diastolic pressure) or clinical findings.

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9
Q

What are the long-term complications if compartment syndrome is not treated promptly?

A

Muscle necrosis, Volkmann’s contracture, permanent nerve damage, and limb loss.

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10
Q

What is the most common lumbar level affected in disc herniation?

A

L4-L5 and L5-S1.

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11
Q

How do you differentiate lumbar disc herniation from cauda equina syndrome?

A

Cauda equina syndrome includes bowel/bladder dysfunction, saddle anesthesia, and bilateral lower extremity weakness.

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12
Q

What non-surgical treatments are recommended for lumbar disc herniation?

A

NSAIDs, physical therapy, activity modification, and epidural steroid injections.

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13
Q

What are the clinical signs of carpal tunnel syndrome?

A

Numbness, tingling in the first three digits, positive Tinel’s and Phalen’s tests, and thenar muscle weakness in severe cases.

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14
Q

How do you differentiate carpal tunnel syndrome from cervical radiculopathy?

A

Cervical radiculopathy involves dermatomal pain distribution, neck pain, and weakness in arm muscles, while carpal tunnel syndrome is limited to the hand.

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15
Q

When should surgical intervention be considered in carpal tunnel syndrome?

A

Persistent symptoms despite splinting and steroid injections, or evidence of nerve damage on electromyography (EMG).

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16
Q

What special tests help diagnose an ACL tear?

A

Lachman test, anterior drawer test, and pivot shift test.

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17
Q

What factors influence the decision between conservative vs. surgical management of ACL injuries?

A

Activity level, degree of instability, age, and patient preference.

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18
Q

What are the key rehabilitation goals after ACL reconstruction?

A

Restore range of motion, strengthen quadriceps and hamstrings, and gradual return to activity.

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19
Q

What are the hallmark clinical symptoms of plantar fasciitis?

A

Heel pain that is worse in the morning or after periods of rest, tenderness at the plantar fascia insertion.

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20
Q

What non-surgical treatments are recommended for the management of plantar fasciitis?

A

Stretching exercises, orthotics, NSAIDs, and corticosteroid injections if severe.

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21
Q

How would you modify a patient’s training regimen to prevent recurrence of plantar fasciitis?

A

Gradual increase in activity, proper footwear, and avoiding excessive impact exercises.

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22
Q

What is the pathophysiology of a muscle strain?

A

Overstretching or tearing of muscle fibers due to excessive force or sudden contraction.

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23
Q

How do you differentiate between a mild, moderate, and severe muscle strain?

A

Mild involves minimal fiber damage and pain; moderate has partial tearing and weakness; severe involves complete rupture with loss of function.

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24
Q

What is the recommended treatment and rehabilitation protocol for a hamstring strain?

A

RICE (Rest, Ice, Compression, Elevation), followed by progressive stretching and strengthening to prevent recurrence.

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25
What are common red flag symptoms in low back pain?
Unexplained weight loss, night pain, history of cancer, fever, progressive neurological deficits, bowel/bladder dysfunction.
26
How do you differentiate mechanical low back pain from radicular pain?
Mechanical pain is localized and worsens with movement, whereas radicular pain follows a nerve root distribution and is associated with numbness/weakness.
27
When is imaging indicated for low back pain?
If red flag symptoms are present or if pain persists beyond 6 weeks despite conservative treatment.
28
What are the most common causes of chronic neck pain?
Cervical spondylosis, myofascial pain, degenerative disc disease, and herniated discs.
29
How do you differentiate cervical radiculopathy from myelopathy?
Radiculopathy affects a specific nerve root (unilateral arm symptoms), whereas myelopathy involves spinal cord compression (bilateral weakness, gait instability).
30
When should a patient with chronic neck pain be referred for surgical evaluation?
If there are progressive neurological deficits, severe myelopathy, or persistent pain despite conservative management.
31
What are the hallmark symptoms of cauda equina syndrome?
Saddle anesthesia, bowel/bladder dysfunction, bilateral leg weakness, and loss of reflexes.
32
Why is early surgical intervention critical in cauda equina syndrome?
Delay in decompression can lead to permanent neurological deficits, including incontinence and paralysis.
33
What is the first-line imaging study for suspected cauda equina syndrome?
MRI of the lumbar spine.
34
What is the mechanism of injury for an AC joint separation?
Direct blow to the acromion, often from a fall onto an outstretched arm or shoulder.
35
How do you classify AC joint separations?
Grades I-III are mild to moderate (treated conservatively), while Grades IV-VI involve significant displacement and require surgery.
36
When is surgical intervention indicated in AC joint separation?
Severe displacement (Grade III+), persistent instability, or high physical demand (e.g., athletes, military personnel).
37
What structures are impinged in shoulder impingement syndrome?
Supraspinatus tendon, subacromial bursa, and sometimes the long head of the biceps.
38
How is shoulder impingement diagnosed clinically?
Positive Neer’s test, Hawkins-Kennedy test, and painful arc test.
39
What are the treatment options for shoulder impingement?
NSAIDs, physical therapy focusing on rotator cuff strengthening, corticosteroid injections, and subacromial decompression for refractory cases.
40
What is the most common type of shoulder dislocation?
Anterior dislocation (95% of cases).
41
What are the key signs of an anterior shoulder dislocation?
Arm held in abduction and external rotation, squared-off shoulder appearance, positive apprehension test.
42
What is the long-term management for recurrent shoulder dislocations?
Strengthening of rotator cuff and scapular stabilizers, possible surgical stabilization if recurrent.
43
What are the three stages of adhesive capsulitis?
Freezing (painful), Frozen (stiffness), and Thawing (gradual recovery of motion).
44
What are the risk factors for adhesive capsulitis?
Diabetes, prolonged immobilization, thyroid disorders, and prior shoulder surgery/injury.
45
When should manipulation under anesthesia be considered in the management of adhesive capsulitis?
If there is no improvement after 6 months of conservative treatment.
46
What is the mechanism of injury for a brachial plexus “stinger”?
Sudden traction or compression of the brachial plexus during sports or trauma.
47
How does a transient stinger differ from a severe brachial plexus injury?
Stingers resolve within minutes; severe injuries cause persistent weakness, sensory loss, and functional impairment.
48
When should an MRI be ordered for a brachial plexus injury?
If symptoms persist beyond 24 hours, there is significant weakness, or if bilateral symptoms are present.
49
What are the clinical signs of a biceps tendon rupture?
Sudden pain, audible pop, and the “Popeye deformity” in the upper arm.
50
How do you differentiate between a proximal and distal biceps tendon rupture?
Proximal ruptures involve the long head and usually don’t require surgery, while distal ruptures require surgical repair for full function.
51
What is the rehabilitation protocol following surgical repair of a distal biceps tendon rupture?
Immobilization for 4-6 weeks, followed by gradual strengthening and range-of-motion exercises over 3-6 months.
52
What is the pathophysiology of lateral epicondylitis?
Overuse injury causing microtears in the common extensor tendon at the lateral epicondyle.
53
How do you differentiate lateral from medial epicondylitis?
Lateral (tennis elbow) affects wrist extensors, while medial (golfer’s elbow) affects wrist flexors.
54
What are the most effective treatment strategies for chronic epicondylitis?
Eccentric strengthening exercises, activity modification, bracing, and corticosteroid injections if needed.
55
What causes prepatellar bursitis?
Repetitive kneeling or direct trauma (“housemaid’s knee”).
56
How do you differentiate infectious from non-infectious bursitis?
Infectious bursitis presents with warmth, erythema, and fever, requiring aspiration and possible antibiotics.
57
What are the treatment options for chronic bursitis?
Avoidance of aggravating activities, NSAIDs, aspiration, and corticosteroid injections if symptoms persist.
58
What is the hallmark physical exam finding in a scaphoid fracture?
Snuffbox tenderness.
59
Why are scaphoid fractures prone to avascular necrosis?
The scaphoid has retrograde blood supply, making the proximal pole susceptible to ischemia.
60
What is the appropriate management for a suspected scaphoid fracture with a negative initial X-ray?
Thumb spica splint and repeat imaging (Xray) in 10-14 days.
61
What is the most common mechanism of Achilles tendon rupture?
Sudden dorsiflexion while the foot is plantarflexed, often during sports.
62
How do you test for an Achilles tendon rupture?
Positive Thompson test (lack of plantarflexion when squeezing the calf).
63
What are the pros and cons of surgical versus conservative management of Achilles tendon injuries?
Surgery has lower re-rupture rates but higher complications, while conservative treatment has a longer recovery time.
64
What is the most common cause of patellofemoral pain syndrome?
Overuse and malalignment of the patella, leading to anterior knee pain, particularly with activities like squatting and stairs.
65
How is patellofemoral pain syndrome differentiated from patellar tendinitis?
Patellofemoral pain syndrome worsens with prolonged sitting or stairs, while patellar tendinitis causes localized pain at the inferior patellar pole.
66
What rehabilitation exercises are most effective for patellofemoral pain syndrome?
Quadriceps strengthening, especially the vastus medialis oblique (VMO), hip abductor strengthening, and patellar taping.
67
What tendons are involved in De Quervain’s tenosynovitis?
The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.
68
How is De Quervain’s tenosynovitis diagnosed clinically?
Positive Finkelstein’s test (pain with ulnar deviation while thumb is flexed).
69
What are the treatment options for severe, persistent De Quervain’s tenosynovitis?
Splinting, corticosteroid injections, NSAIDs, and surgical release in refractory cases.
70
What is the mechanism of injury in Jersey Finger?
Forced hyperextension of the flexed distal phalanx, causing a rupture of the flexor digitorum profundus tendon.
71
How is Jersey Finger differentiated from Mallet Finger?
Jersey Finger affects flexion and requires surgical repair, whereas Mallet Finger affects extension and can often be treated conservatively.
72
What is the definitive treatment for a complete Jersey Finger tendon rupture?
Surgical repair followed by extensive hand therapy.
73
What is the classic presentation of Mallet Finger?
Inability to actively extend the distal interphalangeal (DIP) joint after trauma.
74
Why does Mallet Finger require splinting in extension?
To allow the extensor tendon to heal properly and prevent a chronic extensor lag.
75
When is surgical intervention required for Mallet Finger?
If there is a large bony avulsion fragment or joint subluxation.
76
What is a ganglion cyst?
A benign, fluid-filled cyst arising from a joint or tendon sheath, commonly found on the wrist.
77
How is a ganglion cyst diagnosed?
Transillumination (cyst glows with light) and clinical examination.
78
What are the treatment options for symptomatic ganglion cysts?
Observation, aspiration, or surgical excision if recurrent or causing significant pain.
79
What are the typical symptoms of costochondritis?
Localized chest wall pain, tenderness at the costosternal junction, and pain worsened by movement or palpation.
80
How is costochondritis differentiated from a myocardial infarction?
Costochondritis has reproducible chest pain with palpation, whereas cardiac causes are not typically tender to touch.
81
What treatment options are available for chronic costochondritis?
NSAIDs, physical therapy, and reassurance as it is self-limiting.

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