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MSK Flashcards

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1
Q

common cause for a posterior shoulder dislocation

A

seizure/electric shock

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2
Q

define bankhart and hill sachs lesions

A

bankhart
injury to the anterior inferior glenoid labrum due to anterior shoulder dislocation

hills sach lesion
depression of the posterolateral head of the humerus due to anterior dislocation

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3
Q

what sign is seen on X ray in a posterior shoulder dislocation

A

lightbulb sign

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4
Q

what is the neer classification used for

A 
proximal humerus fractures
describes displacement of 4 segements
humeral head
greater tuberosity
lesser tuberosity
humeral shaft
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5
Q

what is a holstein-lewis fracture

A

spiral fracture of the distal 1/3 of the humeral shaft wioth associated radial nerve palsy

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6
Q

what is the terrible triad in elbow dislocations

A

lateral ulna collateral ligament tear + radial head fracture + coronoid tip fracture

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7
Q

how to assess an elbow dislocation

A

anterior humeral line
radiocapitellar line
posterior fat pads

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8
Q

what is a monteggia fracture

A

fracture of the proximal 1/3 of the ulna with anterior dislocation of the radial head

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9
Q

what is a galeazi fracture

A

fracture of the distal 1/3 of the radial shaft and associated with DRUJ injury

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10
Q

signs of DRUJ injury

A

ulna styloid fracture
widening of joint on AP x ray
dorsal or volar displacement on lateral x ray
radial shortening

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11
Q

what is bennets and boxers fracture

A 
boxers = # distal 5th metacarpal
bennets = # at base of the 1st metacarpal
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12
Q

describe the blood supple of the femoral head

A

comes from the femoral artery. It travels down the femur then loops back up in a retrograde fashion forming the femoral circumflex arteries which travels along the femoral neck

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13
Q

management of intracapsular hip fractures

A

if blood supple preserved (undisplaced) = fixation with screes and plate
if not preserved (displaced) = joint replacement (hemiarthroplasty in older/less active patients. total in younger/high functional demand)

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14
Q

management of extracapsular hip fracture

A

blood supply should be preserve = fixation

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15
Q

complications of hip fractures

A

AVN
non union
risk of dislocation following arthroplasty
DVT, chest infection, pressure sores

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16
Q

types of pelvic fractures

A

lateral compression
AP compression
vertical shear

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17
Q

complications of pelvic fractures

A

damage to surrounding organs (bowel, bladder, female genital organs, prostate/male urethra)
nerve and major vessel damage

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18
Q

management of pelvic fracture

A

high energy
pelvic binder to prevent blood loss
fixation with plates and bolts

low energy
mobilisation with analgesia

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19
Q

what is Weber classification used for

A

classification oflateral malleolarfractures, relating to the level of the fracture in relation to the distal tibiofibularsyndesmosis.
A = stable B = maybe C = unstable

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20
Q

management of ankle fractures

A

weber A = most likely conservative (boot/cast)
weber B = conservative/interanl fixation
weber C = internal fixation

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21
Q

what is lisfrac fracture

A

dislocation of the midfoot between tarsal bones and base of the metatarsals
presents with bruising on the sole, pain and swelling of midfoot, and inability to wt bear

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22
Q

tests for subacromial inpingment

A

painful arc test
neer impingement test
hawkins test

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23
Q

tests for rotator cuff tears

A

supraspinatous - empty can test
infraspinatous - external rotation
teres minor - horn blower sign
subscapularis - lift off/belly press test

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24
Q

what is tennis elbow

A

lateral epicondylitis
overuse of the extensor carpi radialis brevis

pain with gripping and resister wrist extension

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25
what is golfers elbow
medial epicondylitis overuse of the flexor pronator origin pain with gripping and resisted wrist flexion
26
presentation of olecranon bursitis
swelling, redness, pain | fever if infective
27
diagnosis of olecranon bursitis
gold standard = aseptic needle aspiration of bursa for gram stain and culture
28
management of tennis or golfers elbow
NSAIDs physio corticosteroid injection surgical debridement and reattachment of ECRB origin/flexor pronator origin
29
management of olecranon bursitis
NSAIDs if infective - Abx bursectomy if recurrent
30
management of DDH
<3months old = splintage of joints in abduction and flexion 3-18months = closed or open reduction + immobilisation in hip spica cast walking child = above + osteotomy if significant dysplasia later childhood/adolescence = femoral/acetabular osteotomy (consider THR)
31
knee injury terrible triad
ACL tear MCL tear medial meniscus tear
32
structures found in the carpal tunnel
median nerve flexor pollicis longus 4 x flexor digitorum superficialis 4 x flexor digitorum profundus
33
disease associated with carpal tunnel syndrome
``` diabetes RA pregnancy wrist fractures hypothyroidism acromegaly ```
34
presentation of carpal tunnel syndrome
gradual onset intermittent symptoms (worse at night) numbness/tingling in median nerve distribution (alleviated by shaking) hand weakness
35
clinical findings in carpal tunnel syndrome
``` altered sensation ring finger splitting LOAF weakness (test = thumb abduction) thenar muscle wasting +tinnels +phalens ```
36
LOAF muscles
lumbricals of digits 2 and 3 opponens pollicis abductor pollicis brevis flexor pollicis brevis
37
management of carpal tunnel syndrome
wrist splint (especially for night symptoms) steroid injections decompression surgery
38
what is trigger finger
tendonitis of the digital flexor tendon at the A1 pulley leading to catching and locking. Constriction and thickening of the A1 pulley forming a nodule on the tendon. Associated with Diabetes RA Pregnancy
39
presentation trigger finger
finger sticks in flexion then clicks painfully as finger is extended worse in the morning
40
management of trigger finger
splitage steroid injection surgical release/widening of the A1 pulley
41
presentation of extensor tendon subluxation
weakness of the saggital bands that hold the extensor tendon over the MCJP tendon subluxes on flexion leading to it flicking back in extension or needing to be straightened manually
42
management of extensor tendon subluxation
splint with MCPJ extended | surgical reconstruction
43
risk factors for dupuytren's disease
alcohol family history diabetes epilepsy and anticonvulsant therapy
44
presentation of dupuytren's
lumps on palm progressing into contractures of the fingers skin thickening, tethering, puckering, pitting fixed flexion deformities at MCP and PIP
45
what are some ectopic manifestations in dupuytren's disease
plantar fasciitis of feet (ledderhouse disease) knuckle pads on dorsal aspect of PIP (garrods disease) dartos fascia of penis (peyronies disease_
46
management of dupuytren's disease
needle aponneurectomy collagenase injections fasciectomy dermo fasciectomy
47
management of mechanical back pain w/o red flags
patient education simple analgesia return to normal physical activity self referral to physio
48
what is c spine triple immobilisation
hard collar tape blocks
49
blood loss in haemorrhagic shock classes
I < 15% II 15-30% III 30-40% IV >40%
50
signs of OA
crepitation limited ROM heberden's (DIP) and bochard's (PIP) nodes muscle wasting
51
X ray of OA
loss of articular cartilage/JS narrowing subchondral cysts subchondral sclerosis osteophytes
52
red flag symptoms for bone cancer
night pain unremitting pain non traumatic limb pain wt loss
53
investigations if suspicious og bone/soft tissue lesions
x ray alkaline phosphatase ct/MRI biopsy
54
common benign bone/soft tissue tumours
osteoid osteoma - osteoblasts - femur, tibia osteochondroma - cartilage capped bony projections on the surface of bones enchondroma - cartilage simple bone cyst - cavity filled with yellow fluid lipoma - fat tissue
55
malignant bone/soft tissue tumours
osteosarcoma - metaphysis of distal femur, proximal tibia, proximal humerus chondrosarcoma - cartilage - femur, pelvis, scapula ewing's sarcoma - mesenchymal cells of medullary cavity - dyaphysis of long bones
56
cancers that commonly spread to the bone
``` breast prostate lung renal thyroid ```
57
osteoporotic fractures
vertebral crush distal radius humeral neck hip
58
risk factors for osteoporosis
oestrogen deficiency malabsorption (IBD, coeliac, chronic pancreatitis) endocrine (hyperparathyroidism, diabetes) Low BMI corticosteroid use
59
investigations for osteoporosis
FRAX score DEXA Ca, phosphate, Vit D, PTH, TFTs, Testosterone
60
management of osteoporosis
``` exercise, smoking cessation Vit D and Ca supplements bisphosphonates - alendronic acid salmon calcitonin Denosumab (anti RANKL) recombinant PTH Raloxifine, HRT (menopause related) ```
61
features of osteomalcia
bone and muscle pain proximal weakness (waddling gait) fractures loss of pelvic volume (obstetrics issues)
62
features of Rickets
bowing of long bones varus/valgus deformity Rachitic rosary kyphosis
63
investigations for osteomalacia
``` low serum and urinary Ca low phosphate low Vit D (normal in phosphopenic osteomalacia) high alkaline phosphate x ray (osteopenic, looser's sones) ```
64
management of osteomalacia
calcium and vit D supplements calcitriol phosphate
65
define pagets disease
A chronic bone disorder that is characterised by focal areas of increased bone remodelling (osteoclast activity), resulting in overgrowth of poorly organised bone.
66
presentation of Pagets
localised bone or joint pain deformities (frontal bossinf, protruding jaw, bowing of long bones) limited ROM Pathological fractures
67
complications of pagets
``` hearing loss (compression of CN VIII, fixation of ossicles, loss of bone mineral density pf the cochlear capsule) fracture, deformities transformation into osteosarcoma hyperparathyroidism ```
68
investogations for Pagets
high ALP but normal Ca and phosphate X ray radio isotope bone scan
69
management of pagets
zoledronic acid calcitonin analgesia
70
define osteomalacia
incomplete mineralisation of the underlying organic matrix
71
presentation of compartment syndrome
pain disproportional to injury pain of passive stretching acute limb ischaemia (6Ps)
72
investigations for compartment syndrome
compartment pressure > 30 delta pressure (DBP - compartment pressure) < 30 serum creatine kinase and urine myoglobin (muslce lysis.necrosis)
73
management of compartment syndrome
``` release of external pressure morphine fluids fasciectomy amputation chronic - limit exercise and NSAIDs ```
74
what re the compartments of the lower limb
anterior lateral superficial posterior deep posterior
75
causes of septic arthritis
s. aureus beta haemolytic strep strep pneumoniae neisseria gonorrhoea haemophilus influezae in children
76
risk factors for septic arthritis
``` underlying joint disease prosthetic joint immunosuppressed steroid injection use IVDU ```
77
investigations for septic arthritis
``` joint aspirate WWC, CRP, ESR BC, urine NAAT x ray LFTs, U&Es (assess end organs for sepsis) ```
78
management of septic arthritis
flucloxacillin (strep or stalph) ceftriaxone (gonococcal) aspirate joint can alleviate pain wash out if prosthetic joint aspirate and wash out in theatre
79
complications of septic arthritis
rapid destruction of joint osteomyelitis sepsis death
80
wHat is de quervain's tensynovitis
inflammation of the extersor pollicis brevis and abductor pollicis longus tendons
81
presentation of de quervain's
pain on radial side of wrist radial styloid tenderness pain on resisted abduction of thumb positive finkelstein's test
82
management of De quervain's
NSAIDs steroid injection splintage of thumb surgical repair

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