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Clin Med 1 - MSK/ HEENT exam 2 > MSK Intro/terms > Flashcards

MSK Intro/terms Flashcards

1
Q

Initial imaging study of choice following skeletal trauma

A

X-ray

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2
Q

When ordering an X-ray how many view should you Order? What are the names of these views?

A

AT LEAST 2 views

AP/Lateral usually suffice

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3
Q

Pt presents with extremity pain but shows and initial negative x-ray for fx.

How do we treat?

A

If patient symptomatic and high clinical suspicion for fracture:

  • Treat as fracture and splint
  • Have patient follow up with ortho in 7-10 days
  • Repeat x-rays may show cortical changes suggesting a fracture

ALWAYS treat as a fx !!!

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4
Q

CT scans are used in trauma to identify and characterize injury _____/_____.

A

pattern/severity

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5
Q

What scenarios are CT better than x-ray?

There are 3**

A
  • Identifying subtle fractures
  • Visualizing articular extension of fracture
  • Assessing for the presence of articular step-off/gap
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6
Q

What are the uses of MRI?

A
  • Primarily for soft tissue evaluating - Mass/lesion
  • Diagnosing occult fractures (i.e. femoral neck fx)
  • Concern for associated ligament or articular cartilage injury
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7
Q

MRI is the modality of choice for diagnosing what type of condition?

A

disc herniation

Assess “internal derangement” of joints; ex. ACL tear

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8
Q

Ultrasound is used in trauma to assess ____?

A

soft tissue injury

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9
Q

Pt presents with what you believe is an achilles tendon rupture.

What imaging do you order to confirm your dx?

A

Ultrasound

also used for quad tendon rupture

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10
Q

What do bone scans most commonly detect?

A
  • Metastases
  • Stress fractures
  • Insufficiency fractures
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11
Q

What presents as an optical illusion, usually appearing at sites of cortex overlap between two bones, or skin fold overlap of the cortex?

A

Mach Bands

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12
Q

Most fracture lines appear as?

A

Lucent fracture lines - radiolucent line

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13
Q

Name the abnormality.

What pt population is this seen in?

A

Corticol Buckling

children - children buckle adults break

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14
Q

What are 2 contributing conditions to tendon rupture?

A
  • Injection of steroids into tendon
  • Use of fluoroquinolone ABX
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15
Q

Identify.

A

Intra-articular Extension

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16
Q

Name the type of fx that involves articular cartilage only?

Both the bone and articular cartilage?

A

chondral fracture

osteochondral fracture

both types of Intra-articular Extension

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17
Q

Name the fracture line caused by compression fractures and may appear as a bright white line.

A

Sclerotic fx line

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18
Q

Name the most common locations to find a Sclerotic fracture line?

there are 2**

A

vertebral bodies

distal radium

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19
Q

Identify the type of fx line?

A

Mach Bands

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20
Q

Identify the type of fx line?

A

Sclerotic Fx Line

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21
Q

Identify the type of fx line?

A

Lucent Fracture Lines

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22
Q

Name the most common locations to find Mach Bands?

A

Ankle radiographs (tibia overlaps fibula)

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23
Q

Name 3 aspects of Displacement?

A

Translation

Angulation (in degrees)

Rotation

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24
Q

Describe how you would look at Translation on an x-ray and how it is measured.

A

line drawn down center of bone not continuous at the fracture site

Graded in terms of shaft width in quartiles (25%, 50%)

Described in terms of position of distal fragment compared to proximal

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25
Q

How would you describe the angulation of a fracture?

How is it measured?

A

Line drawn down center of bone angled at the fracture

Direction of angulation of distal fracture component as compared to proximal

DEGREES (estimate)

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26
Q

Where anatomically should you look on an x-ray to identify if the fx is rotated? (2 places)

A

looking at orientation of joints above and below fracture

•Can be seen on orthogonal views

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27
Q

Define rotation when talking about displacement of a fx?

A

Turning of the distal fracture fragment in relation to proximal portion

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28
Q

What are we measuring?

A

Translation

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29
Q

What are we measuring?

A

angulation

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30
Q

Common with transverse fractures that result from a tension force that pulls or stretches two objects apart.

A

Distraction

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31
Q

Injury seen on x-ray that is NOT a fx and is often missed by inexperienced readers?

A

Joint alignment

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32
Q

Name type of injury?

A

Distraction

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33
Q

_____ joint alignment is an important check area when assessing hand and wrist x-rays.

A

CMC (carpometacarpal joints)

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34
Q

In normal anatomical alignment what bone of the wrist should the 5th metacapral attach to?

A

Hamate

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35
Q

T/F

There’s too much swelling to identify a fracture

A

FALSE

→It’s possible to not be able to identify a fracture initially; splint/protect and repeat x-rays in 3-5 days

→Soft tissue swelling at some sites of injury can help identify an underlying fracture

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36
Q

T/F

Soft tissue swelling at some sites of injury can help identify an underlying fracture

A

TRUE

When bone breaks there is bleeding which causes swelling. This finding can be helpful in a patient who is noncommunicative (young child, elderly patient with dementia)

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37
Q

Identify the type of injury and the makeup of the fluid we would find here?

A

Soft tissue injury

•Blood (hemarthrosis) -> Result of an intra-articular injury, Soft tissues or adjacent bone

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38
Q

Define impaction fx?

Is it stable?

A

Fx edges wedged into one another

Yes- stable

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39
Q

What is the name of the Fx that is caused by abnormal tensile stress on ligaments or tendons?

A

Avulsion

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40
Q

name the 3 most common locations we would see an avulsion fx?

A

hands

feet

pelvis

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41
Q

where would an avulsion fx occur in the hands?

A

dorsal distal phalanx with extensor tendon avulsion

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42
Q

where would an avulsion fx occur in the Feet?

A

base of fifth metatarsal with peroneus brevis avulsion

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43
Q

where would an avulsion fx occur in the pelvis?

A

ischial tuberosity with hamstring tendon avulsion

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44
Q

Name that fx?

A

avulsion

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45
Q

Name that fx?

What type of force usually causes this?

A

Transverse fx

direct (also can be tension)

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46
Q

you are clinically suspicous of a quad tendon tendon rupture.

what diagnostic imaging should you order? (pick BEST option)

A

ultrasound

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47
Q

What type of fx is commonly caused by Indirect Force, usually both compression and angulation forces?

A

Oblique fx

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48
Q

Name type of Fx?

Stable or unstable?

A

oblique

unstable - repaired in OR w/ plates and screws

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49
Q

Name the fx that results from rotation/shear forces that cause twisting movement through the long bone axis?

A

Spiral fx

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50
Q

Name that fx?

stable or unstable?

A

Spiral

Unstable

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51
Q

define comminuted fx:

A

•Contains >2 fracture fragments

Inherently unstable fracture

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52
Q

How do we repair a comminuted fx what is the goal?

A

Goal is function!!!

Hemiarthroplasty/ arthroplasty

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53
Q

Identify the fx:

A

butterfly fragment

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54
Q

Name incomplete fx that usually occurs in forearm of young child that results from a bending force applied perpendicular to the shaft?

A

Greenstick Fx

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55
Q

Name the fx that typically occurs in children at the metaphyseal diaphsyeal junction after FOOSH.

A

Buckle or Torus Fx

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56
Q

Name that fx?

A

Greenstick

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57
Q

Name that fx?

A

Greenstick

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58
Q

Name that fx?

Most common injury that results in this fx?

A

Buckle (Torus fx)

FOOSH

59
Q

Name that Fx?

Stable or unstable?

A

Buckle Fragment -Torus Fx

stable

60
Q

When describing angulation what are the 4 ways of describing the position of the fx?

A

dorsal

volar

varus

valgus

61
Q

Varus/Valgus??

excessive inward angulation (medial angulation, that is, towards the body’s midline) of the distal segment of a bone or joint.

A

Varus (knock-kneed)

62
Q

Varus/Valgus?

excessive outward angulation (lateral angulation, that is, away from the body’s midline) of the distal segment of a bone or joint.

A

Valgus (bow-legs)

63
Q

Varus/Valgus?

A

Varus - distal portion TWOARD midline

64
Q

Valgus/Varus?

A

valgus

65
Q

3 most common musculoskeletal conditions reported each year:

A

Trauma

Back pain

Arthritis

66
Q

What does the axial skeleton consist of?

Name the 6 parts.

A

•Bones of head and trunk

Six parts

  • skull bones
  • ossicles of middle ear
  • hyoid bone
  • rib cage
  • sternum and vertebral column
67
Q

Name the regions of appendicular skeleton:

A
  • Pectoral girdles
  • Clavicles and scapulae

bones of the:

shoulder girdle

the upper limbs

the pelvic girdle

the lower limbs.

68
Q

Name the 2 types of bone:

A

Cortical (hard outer surface)

Cancellous (spongy/trabecular bone)

69
Q

Type of bone that provides skeletal support and is site of attachment for tendons and ligaments?

A

Cortical

70
Q

where is cancellous bone found?

A

found at ends of long bones, pelvis, ribs, skull, and vertebrae

71
Q

Name 2 types of Bone marrow and their functions.

A

Red - precursor for RBCs

Yellow- Contains fat and undergoes continuous change due to biochemical and mechanical forces

72
Q

Define osteoclast vs osteoblast.

A
  • Osteoblast: build bone
  • Osteoclast: break down bone
73
Q

Define bone resportion.

is this done by osetoclasts or blasts?

A

Begins when osteoclasts remove a portion of the bone that will be replaced later with the action of osteoblasts

74
Q

Define Bone formation:

A

osteoblasts lay down collagen and mineral deposits over the area previously remodeled by osteoclasts

75
Q

Are osteoclasts or blasts vital for maintaining bone mineral density and strength?

A

blasts

76
Q

Explain approximate locations of PROXIMAL:

Epiphysis

Metaphysis

Diaphysis

A
77
Q

Define tendons and ligaments.

A

Tendons: Fibrous cords of tissue that attach muscles to bone

Ligaments: Fibrous cords of tissue that attach bone to another bone

78
Q

What is the timeframe when differentiating b/w an acute vs chronic injury?

A
  • Acute: < 6 weeks –> Typically injury related
  • Chronic: > 6 weeks
79
Q

Name the causes of acute MSK injury:

A

Fractures

Dislocations

Ligament sprains

Septic joints

80
Q

Name causes of chronic MSK injury:

A

Overuse syndromes

Tendonitis

Osteoarthritis

Stress Fractures

81
Q

Define a provocative tests

A

•recreate mechanism of injury to reproduce patient’s pain

82
Q

What is the name of the test:

apply load to test ligament stability.

A

Stress

83
Q

What test is useful to assess injury severity and ADLs

A

Functional Test

84
Q

Name the 3 tests to assess joints

A

Provocative

Stress

Functional

85
Q

Contrast closed vs open fx

A

closed: Skin envelope is in tact - watch for soft tissue injury
open: Break in skin envelope and underlying soft tissue, Surgical treatment within 6 hours recommended

86
Q

Name fx classification system used when looking at Epiphyseal plate(growth plate)fractures.

A

Salter-Harris System

87
Q

Explain Salter-Harris System Type I-V fx:

A
88
Q

Name 4 classification systems for fx:

A
  • Salter-Harris System (Peds)
  • AO System
  • Garden System (hip fx)
  • Gustilo system (open fx)
89
Q

Fx care method used to stabilize/immobilize fractures until the patient can be evaluated by ortho?

A

Splinting

90
Q

When applying a splint that wraps an extremity, wrap from _____ to _____.

A

distal to proximal

91
Q

Evaluate distal ______, ____ _____, and _______ before and after splinting

A

circulation, motorfunction and sensation

92
Q

Purposes of splinting

A
  • Stabilize fractures
  • Decrease pain
  • Prevent further soft tissue, vascular, or neurologic injury
  • May provide definitive treatment for some injuries
  • Used to stabilize/immobilize fractures until the patient can be evaluated by ortho (usually within 2-3 days)
93
Q

Name 2 types of splints

A

orthoglass

plaster

94
Q

Name the purpose of casting

A
  • Maintain position to provide for bone healing
  • Prevent displacement of fracture
  • Protect from further injury
  • Usu. on for 4-6 weeks
95
Q

•Some fractures (i.e. ______ ______) not amenable to casting

A

proximal humerus

96
Q

treatment of choice for most nonoperative fractures

A

casting

97
Q

Name 3 types of casts we use on Upper extremities

A

short arm

long arm

Thumb spica

98
Q

Name type of cast we use on a wrist fx

A

short arm

99
Q

Name the type of cast we use on an unstable wrist fx:

A

Long arm

100
Q

Name the type of cast we use on a scaphoid fx:

A

Thumb Spica

101
Q

Name type of cast we use on a radial styloid fx:

A

Thumb Spica

102
Q

Why do we use Long Arm casts on forearm fx?

Prevents ____/_____

A

supination/pronation

103
Q

What pt population would we almost always cast a lower extremity?

A

Used more with children to protect from themselves

104
Q

Name 2 types of Lower extremity casts

A

Short leg

Long leg

105
Q

What are the indications for a short leg cast?

A

Foot

Ankle

Achilles tear

106
Q

what are the indications for a long leg cast?

A

Tib/fib fx

Quad tendon repair

107
Q

•Successful casting requires three things:

A
  • proper materials
  • proper positioning
  • selection and application of the appropriate type of cast
108
Q

What type of reduction was done here:

“Recreate the fracture” to align

A

•Closed Reduction Percutaneous Pinning (CRPP)

109
Q

What reduction is approproate when a pt presents with an unstable closed fx where casting alone would be ‘not enough’?

A

•Closed Reduction Percutaneous Pinning (CRPP)

110
Q

•Closed Reduction Percutaneous Pinning (CRPP) how long until the pins are out?

A

3 wks

111
Q

Pt presents w/ an unstable fx, what method was used to repair?

A

ORIF plates and screws

112
Q

WHat is the name of the open reduction performed here:

A

ORIF Intramedullary Nail/Rod

113
Q

When performing an ORIF w/ plates and screws we need how many cortices above and below the fx?

A

Needs 6 cortices above and 6 below the fracture

114
Q

What type of injury would require an Ex-Fix?

A
  • Trauma indication
  • When major non-lifesaving procedures must be avoided
115
Q

What open reduction is referred to as an “Internal splint’

A

ORIF

116
Q

What reduction is used as bridge to definitive internal fixation

A

External Fixator

117
Q

What are the 3 stages of fx healing

A
  1. Inflammatory phase (hematoma and granulation tissue)
  2. Reparative phase (callus formation)
  3. Bone remodeling
118
Q

What phase of bone healing includes the formation of a hematoma and granulation tissue.

how long does this phase last?

A

Inflammatory phase

2 wks

119
Q

What phase of fx healing consists of:

Compact bone replaces spongy bone around fracture periphery

A
  1. Bone remodeleing
120
Q

What phase of fx healing includes Fibrocartilaginous Callus Formation?

how long does this phase last?

A

Reparative phase

3-4 mo.

121
Q

Explain the inflammatory phase of fx healing:

A
  • Hematoma and granulation tissue form
  • Blood vessels across fracture are disrupted and leak blood
  • Blood clot forms at fx. site within 8 hours
  • Phagocytes (neutrophils and macrophages) and osteoclasts remove necrotic tissue at fx. Site

last 2 wks

122
Q

Explain the reparative phase of fx healing:

A
  • Fibrocartilaginous Callus Formation
  • Fibrovascular tissue invades hematoma
  • Fibroblasts develop into chondroblasts and produce fibrocartilage
  • Results in fibrocartilaginous “callus”
  • callus lasts 3-4 months
123
Q

Explain the final phase of fx healing

A

Compact bone replaces spongy bone around fracture periphery

Remaining dead fracture portions reabsorbed osteoclasts

124
Q

Define a strain and the most common mechanism of injury:

A
  • Injury to muscle or muscle and tendon from overuse
  • Muscle fibers tear
  • Often caused by overextension or over stretching
125
Q

Most common area that is sprained and the mechanism of injury:

A
  • Ankle most common
  • Inversion with plantar flexion most common type
126
Q

Most common area of muscle strain

A

calf

Medial head of the gastrocenmius muscle

127
Q

•Strain Typical symptoms:

A
  • Pain –> Worse with use
  • Muscle spasm/weakness
  • Swelling
  • Cramping
128
Q

Tx for sprains and strains

A

RICE

Splint/Brace

Protect, comfort

NSAIDs

Early ROM

Physical Therapy referral

129
Q

Define RICE

A

Rest

Avoidance of pain

? crutches

Ice

20-30 min, protect skin

Multiple times/day x as needed

Compression (wrap)

Reduces swelling

Give muscles proprioceptive support

Elevation

Above heart level

Manage swelling

130
Q

Pt presents to clinic after an injury to his shoulder.

You note asymmetry with deformity and swelling, along with the inability to move his shouder.

His x-rays are below:

what type of injury is this?

A

Dislocation

131
Q

Tx for dislocations:

A

reductions

  • Evaluate neuro-vasc status before AND after reduction
  • Analgesia
  • Reduction maneuver
  • Splint/sling for pain relief
  • Appropriate referral for further eval
132
Q

Define a sprain and the mechanism of injury:

A

Stretching/tearing of ligaments

MOI: twist

133
Q

Pt presents w/ pain and tenderness directly on the tendon of elbow.

Dx?

what are the common sites where we encounter this? (4)

A

Tendinitis

shoulders

elbows

wrists

knees

134
Q

Can we inject a steroid into a tendon?

A

NO!!

135
Q

Pt presents to clinic with pain in his achilles. He is a runner who had a big race he could not miss so one week prior he saw the doc who injected a steroid into the area to help with the pain and get him through the race.

Dx?

what could also contribute to this condition?

A

tendon rupture

Contributing Conditions:

  • Injection of steroids into tendon
  • Use of fluoroquinolone ABX
136
Q

4 most common tendons ruptured

A
  • Achilles
  • Biceps (proximal>distal)
  • Rotator Cuff
  • Quad
137
Q

Common sports injury that results from a valgus stress or direct fall onto joint

A

Ligament Rupture

  • Example: ACL, MCL
  • Athletic young women 3x > athletic young men
138
Q

Tendon/Ligament Rupture Tx

A
  • Splint/protect
  • Ice
  • NSAIDs
  • ? Repair/reconstruction
  • Early ROM
  • Physical Therapy
  • Goal is to return to previous level
139
Q

Step-wise approach to pain management

A
  • Splint/cast, brace
  • Ice/Cryocuff
  • NSAIDs
  • Acetaminophen
  • ? Narcotics
  • Steroids
  • Topicals
140
Q

Name 2 topical analgesics used to tx pain

A

Topical diclofenac (Voltaren Gel)

Aspercreme- Trolamine salicylate

141
Q

What pharmacological pain management must we use caution when reccommending to pts w/ liver disease or ETOH abuse?

What is the proper dosing regimen?

Max daily doses?

A

acetaminophen (Tylenol)

Max dose 4g/day

max dose 2g/day if chronic ETOH or liver disease

(325 to 650 mg q 4-6 hrs. on a scheduled basis)

142
Q

When prescribing NSAIDs to pts what should we always explain to them regarding the length of time it takes to see anti-inflammatory benefits?

A

•Analgesic effects begin within 1 to 2 hours, whereas anti-inflammatory benefits may require 2 weeks of continuous therapy

143
Q

Dosing of NSAIDs - naproxen (alieve)

A
  • Naproxen 220 mg PO bid (OTC Aleve)
  • Naproxen 220 mg, Take 2 tabs PO bid

Clin Med 1 - MSK/ HEENT exam 2 (4 decks)

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