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Medicine > MSK > Flashcards

MSK Flashcards

1
Q

4 Types of Bone Cells

A
  1. Osteoprogenitor: proliferate to form osteoblasts
  2. Osteoblasts: mineralization, bone remodelling, can become osteocytes
  3. Osteocytes: centrepiece of boney matrix
  4. Osteoclasts: bone breakdown
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2
Q

Muscle Hierarchy

A
  1. Myofilaments (myosin + actin)
  2. Sarcomere
  3. Myofibres
  4. Muscle fibres (covered by endomyseium)
  5. Muscle fasciculus (covered by perimyseium)
  6. Muscle (covered by epimyseium)
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3
Q

Tendon vs Ligament

A
  1. Tendon: muscle-bone, more collagen, limited perfusion, best for large uni-directional loads
  2. Ligament: bone-bone (“like”), less collagen, limited perfusion, better for multi-directional loads
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4
Q

3 Types of Joints

A
  1. Fibrous: little/ no mvmnt, skull
  2. Cartilaginous: some mvmnt, femur, bw vertebrae
  3. Synovial: ball + socket (hip), condyloid (MCP), saddle (CMC), hinge (elbow), pivot (atlanto-axial), plane (acromioclavicular)
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5
Q

3 Types of Cartilage

A
  1. Fibro: transitional cartilage, labrum, menisci
  2. Elastic: outer ear, epiglottis
  3. Hyaline/ Articular: thin, dense, translucent, no BVs/ lymphatic channels/ innervation
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6
Q

MSK Embryology

A
  • Somites: condensed cuboidal mesoderm tissue, form majority of MSK system, axial specification (same fncn even in a new spot).
  • Ossification (bone formation):
    1. Intramembranous: bone directly from mesoderm. (mesoderm → mesenchymal cell → osteoblasts → secrete collagen matrix → Ca pulled into the matrix → Ca lays down spicules of bone → connect to each other over time → bone)
    2. Endochondral: bone from hyaline cartilage model. (mesoderm → chondrocytes (committed cartilage cells) → compact nodules → proliferating chondrocytes → hypertrophic chondrocytes → atrophy → angiogenesis here → brings Ca → bone) (then secondary ossification of the epiphyseal plate after growth)
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7
Q

Congenital Defect - Achondroplasia

A
  • FGF 3 - auto dom defect
  • Affects cartilage production → affects endochondral formation (no cartilage model for elongation) → ↓ limb bone length BUT normal head size/ skull/ calvarium bc intramembranous formation unaffected.
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8
Q

Acute Injury - “SHARP”

A
  • SHARP: swelling, heat, altered fncn, red, pain
  • From 1 single event
  • Quick onset of sx
  • Usually worst during 48-72 hrs post-injury
  • Tx: RICE: rest, ice, compression, elevation
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9
Q

3 Degrees of a Sprain (Ligament)

A
  1. Minor: can weight bear, little swelling, no laxity/ solid end feel.
    - Tx: RICE + max 7-10 days non-wt bearing
  2. Moderate: muscle spasms, partial laxity, some swelling and dec ROM, point tenderness, usually can’t wt bear
    - Tx: RICE + 2-4 wks non-wt bearing. Expect full healing with immobilization with full healing expected.
  3. Severe: laxity/ empty end feel, big dec ROM, can not wt bear
    - Tx: RICE, 4-6 wks non-wt bearing, possibly surgical repair.
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10
Q

3 Degrees of a Strain (Muscle)

A
  1. Minor: DOMS, small dec ROM, can generate force + maintain contraction
  2. Moderate: muscle spasms, sub-optimal muscle contraction, big dec ROM, lots of pain + swelling
  3. Severe: visible deformity, can’t contract, no ROM.
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11
Q

3 Types of Fracture

A
  1. Sudden impact #: normal bone + abnormal force
  2. Stress #: normal bone + repetitive force
  3. Pathologic #: abnormal bone + normal force (underlying disease)
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12
Q

Tendonitis/ Tendinopathy

A
  • Itis = acute inflammation
  • Opathy = chronic, less of an inflammatory component
  • From chronic eccentric loading of musculotendinous region
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13
Q

Ectopic Calcification/ Myositis Ossificans

A
  • Bone formation in or around muscle

- From severe or repetitive contusions, or continuous use of injured muscle

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14
Q

Osteoarthritis

A
  • Progressive degeneration of a joints articular cartilage

- Location:

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15
Q

Rheumatoid Arthritis

A
  • Location:
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16
Q

Compartment Syndrome

A
  • Inc interstitial pressure in an enclosed myofascial compartment
  • Hallmark = pain with passive stretch
  • Can compromise muscle, nerve, and vascular function
  • S+S: pain out of proportion with injury, ↓ muscle fncn, ↓ neuro + vascular response distal to injury (ie diminished pulse or sensation).
17
Q

“Osteo-“ Diseases

A
  1. Osteoarthritis: separate card
  2. Osteoporosis: primary (age, post-menopause, ↓ estrogen/ Ca/ exercise) & secondary (Vit D def, corticosteroids)
  3. Osteopenia: bone mineral density (BMD) < peak BMD, but not yet osteoporosis
  4. Osteomalacia: ↓ Vit D, Ca, or PO4 - soft, weak bones. S+S: bowing of long bones, frontal bossing, etc. (Rickets in children)
  5. Osteomyelitis: inflamm/ infection, esp in metaphysis, mostly in kids, severe pain, tenderness with mvmnt, spread via hematogenous seeding
  6. Osteosarcoma: bone cancer, usually <20 yrs, S+S: painful enlarging mass, usually from mets (PB-KTL)
  7. Osteogenesis Imperfecta: aka brittle bone disease, • auto dom, ↓ collagen synthesis, S+S: blue sclera, hearing loss, many #s
18
Q

Carpal Tunnel Syndrome

A
  • (Carpal tunnel contains: flexor digitorum superficialis + profundus tendons, flexor pollicis longus tendon, and median nerve. Roof = flexor retinaculum)
  • Feel pain/ numbness/ tingling from the median nerve being compressed
  • Test: tap for 60 secs bw scaphoid tubercle + pisiform → numbness in median distribution
19
Q

Wrist # - Colles & Scaphoid

A

1) Colles #
- Distal radial #
- 60% will have associated ulnar styloid # → “dinner fork/ bayonet deformity” (wrist shifted dorsally like the curve of a fork)
- Tx: hematoma block (local anesthetic into the # site) → traction → closed reduction + appropriate pressure (volar + ulnar in this case) → splint → repeat

2) Scaphoid #:
- FOOSH → Xray can be normal at first, but TREAT anyways if radial snuffbox pain/ tenderness + limited ROM
- Immobilize with thumb spica splint & re-assess in 2 wks bc ↑↑ risk of non-union and of AVN (↓ blood supply)
- If # present → immobilize for 6-12wks (we care less about stiffness in this case)

20
Q

Epicondylopathy (tennis + golfer’s elbow)

A

1) Tennis elbow/ lateral epicondylitis
- Lateral epicondyle, extensor muscle tendons are overworked (think backhand in tennis) → micro tears → new unorganized collagen + vessels and nerves
- Test: resisted wrist extension

2) Golfers elbow/ medial epicondylitis
- Medial epicondyle, flexor muscle tendons are overworked.
- Less common but worse than tennis elbow, associated with ulnar n. issues
- Test: resisted wrist flexion

Tx:

  • 3 mos = steroid injections (controversial)
  • 6 mos-1 yr = surgery (~30%, debride the tendon)
  • Anti-inflammatories DON’T work bc not “itis”
21
Q

GH Dislocation

A
  • Glenoid + humerus separate (subluxation if partial), humeral head moves anteriorly 95% of the time
  • Usually when in external rotation + abduction.

Associated injuries:

  • Hill-Sachs: depression # on posterior humeral head from the head being compressed against the bony glenoid rim
  • Bankart lesion: labrum damage, in 95% of ppl from their first dislocation
  • SLAP injury: labrum damage.

Tx:

  • Closed reduction, sling, early ROM
  • Deciding on surgery:
  • -> AMBRI: atraumatic, multidirectional, bilateral, rehab focus, inferior capsular release. (These pts don’t do as well with surgery, so strengthen + correct mechanics)
  • -> TUBS: traumatic, unidirectional, bankart lesion, surgery.
22
Q

Salter-Harris # (pic in folder)

A
  • A # that involves the growth plate/ epiphyseal plate in the metaphysis (so, common in kids)
  • Type 1: S-straight, transverse #, don’t see on x-ray, heals rapidly, growth usually unaffected
  • Type 2: A-above, across plate + metaphysis (most common)
  • Type 3: L-low, across plate + epiphysis, chronic disability from the articular cartilage healing with fibrous cartilage (ie early OA), but no deformity, so ok prognosis, often surgical tx or reduction
  • Type 4: T-through all, across plate + epiphysis + metaphysis, chronic disability + deformity, more likely to produce growth arrest
  • Type 5: ER-cRush, crush/ compression # of growth plate (poor fncnal prognosis)
23
Q

MSK - Finger Abnormalities (pic in folder)

A

1) Mallet finger: hyperflexion of the extensor digitorum tendon to DIP
- Tx: dorsal splint the DIP joint in full extension – don’t ever let it come into flexion or you’re starting all over again, 4-6 wks for bone injury, 6-8 wks for tendon injury

2) PIP injury/ Boutonniere (“Button-hole” deformity):
- Sprained PIP –> PIP flexion + DIP hyperextension
- Tx: need to tx fast, splint finger in extension

3) Boxer’s #: 5th metacarpal neck #, with the metacarpal head displaced in the volar (palm) direction
- Assess rotatinal deformity, allow up to 30° of volar angulation (normal = 15°)
- Tx: >30° needs to have a closed reduction with hematoma block + 90/90 position (90° flexion at MCP + 90° flexion at PCP)
- Tx: “buddy tape” 5th digit to 4th digit via ulnar gutter splint or cast for 4-6 wks (in MCP flexion to keep the ligaments long)

24
Q

Ligaments of the Knee

A

1) MCL (medial collateral ligament): fan-shaped, not easily palpable.
- Fncn: resists valgus force
- Attached to medial meniscus so often injured together
- Test with valgus stress test, look for laxity

2) LCL (lateral collateral ligament): cord-like, easily palpated.
- Fncn: resists varus force.

3) ACL (ant cruciate ligament): ant portion of intercondylar eminence on tibia → runs posteriorly → attaches on medial aspect of lateral femoral condyle.
- Fncn: prevents tibia from sliding anteriorly on femur.
- Most commonly injured. MUCH more likely to get OA, and earlier.
- Test with ant drawer + Lachman’s maneuver
- Tx: surgery helps return to original fncn but doesn’t improve overall prognosis.

4) PCL (post cruciate ligament): post portion of intercondylar eminence on tibia → runs anteriorly → attaches on lateral aspect of medial femoral condyle.
- Fncn: prevents tibia from sliding posteriorly on femur.

5) Meniscus: medial (C-shape, attached to MCL) + lateral (O-shape, attached to popliteus muscle)
- Location of tear determines healing, only outer 1/3 has a blood supply
- Test with McMurray’s test
- Tx: arthroscopy surgery is the gold std

Unhappy triad: torn ACL + MCL + medial meniscus

25
Q

Hip Dislocation (DRRIFT) vs # (BREAKS)

A

DRRIFT

  • aDduction, Reduction, Rotate Internally, Flexion, Trauma
  • 90% posterior dislocations
  • ER, reduce ASAP, check neurovascular before + after
  • Osteonecrosis in 10%

BREAKS

  • aBduction, Rotate Externally, Avascular necrosis, Kills 10-30% in 1 yr, Surgery w/i 48 hrs.
  • Usually from lower energy impact
26
Q

Avascular Necrosis (AVN)

A
  • Most common places: hip, scaphoid, talus, femoral head
  • Hip causes: “ASEPTIC” - alcoholism, steroids, environ (temp injury), pancreatitis/ pregnancy, trauma, infection/ idiopathic, congenital
  • Best is MRI. Will see lucency (black) on x-ray
27
Q

Osgood Schlatter’s Disease

A
  • Avulsion injury of the patellar tendon from the apophysis of the tibial tuberosity from repeated eccentric quad activity
  • Esp seen in 12-15 yro M
  • Sx: swelling, tenderness, ↑ tibial tubercle prominence, unilateral or bilateral lower extremity pain, worse with exercise, esp running and jumping
  • NO restrictions of ROM, and knee + PFJ joints should be stable (more of a strength issue)
  • Imaging: bilateral = don’t image, unilateral = image (r/o more dangerous causes)
  • Tx: self-limiting, but may take mo-yrs to resolve (when the epiphyses closes during late adolescence the pain goes away), relative rest, RICE, brace
28
Q

Patellofemoral Joint Pain Syndrome

A
  • Most common knee complaint in active young people (25%)
  • Sx: diffuse aching pain in retro-patellar region of the knee, grinding + swelling in patellar region
  • Dx: Theatre sign (pain from sitting a long time without extending knee), Clarke’s sign (pt contracts quads, push down on patella)
29
Q

Achilles Tendon Rupture

A
  • Tendon rupture of soleus, plantaris, + gastrox, 5-7 cm proximal to the insertion onto calcaneus
  • Esp in middle aged men
  • Sx: sudden, severe pain, maybe a “pop”, v hard to walk after (plantar flexion affected).
  • Dx: a divot seen on posterior calf, swelling, Thompson test (squeeze calf from either side → should see slight plantar flexion of the foot, otherwise + test).
  • Tx: immobilize in plantar flexion, no wt bearing, may need surgery
30
Q

Ankle Sprain

A
  • 85% inversion (medial malleolus is shorter so doesn’t restrict inversion as much, and fewer/ weaker lateral ligaments)

Ligament sprained often dictated by position during injury:

  • *Plantarflexion + inversion → ATF Damage
  • Mid-stance + inversion → CF damage
  • Dorsi flexion + inversion → PTF damage
  • Plantar flexion → ATF + ant tib-fib + ant TT ligament damage
  • Eversion sprains usually from dorsiflexion + eversion → damage to deltoid ligament complex.

Degrees

  • 1st: more of a stretch (usually ATF), can wt bear, full ROM. Full recovery, back to activity in 2-3 days.
  • 2nd: some stretch + tear (usually ATF + CF), can’t wt bear, dec ROM. Recovery in 2-4 wks, rest, brace.
  • 3rd: tear several (ATF + CF + PTF +/- talo-crural joint dislocation)
  • 2nd & 3rd: + ant drawer or talar tilt test, always IMAGE to check for #s
31
Q

Ankle #

A
  • Stable #: only 1 side of the joint, determined by evaluating the medial clear space (>5mm suggests unstable)
  • Unstable #: both sides of the joint:
    • -> Bimalleolar #: both malleoli, usually from forced eversion + torsion of the foot
    • -> Trimalleolar #: both malleoli + talus forced posteriorly → breaks posterior lateral margin of tibia for the 3rd #
  • Potts #: fibular # above lateral malleolus + medial malleolus #
  • Avulsion #: ligament/ tendon pulls piece of bone away at attachment to foot or ankle, often seen with 3rd degree
32
Q

Shin Splints/ Tibial Stress Syndrome

A
  • Stress in lower leg isn’t absorbed properly/ legs can’t remodel fast enough → stress reaction in the fascia, bone or periosteum → overuse injury
    a) Anterior
    b) Posterior/ medial + distal 1/3 of the tibia
  • No night pain

Medicine (22 decks)

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