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Year 2 Revision > MSK Investigations and Management > Flashcards

MSK Investigations and Management Flashcards

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1
Q

Disc prolapse causing sciatica management

A 
Conservative treatment (NSAID)
Consider surgery if not resolving after 3 months
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2
Q

When would you operate on a flat foot?

A

If rigid and painful with tarsal coalition (bony connection)

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3
Q

When would you do an MRI for back pain?

A

Only if red flags or considering surgery (non-resolving sciatica, spinal stenosis)

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4
Q

Tibialis posterior dysfunction management

A 
Physiotherapy
Insole
NOT steroid injections
Bespoke footwear
Last line is surgery
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5
Q

Plantar fasciitis management

A 
NSAIDs
Night splints
Taping
Heel cups or medial arch supports
Physio
Steroid injection
Can do surgery (but not usually)
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6
Q

Hallux valgus management

A

Shoe modifications, padding

Operative (only if pain, lesser toe deformities, functional limitation or other complications)

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7
Q

Management of mortons neuroma

A 
Non operative (insoles, injections)
Operative (excise)
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8
Q

Management of achilles tendonitis

A 
Activity modification/analgesia
NSAIDs
Shockwave therapy
Orthotics
Physio
Surgery
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9
Q

Management of achilles tendon rupture

A

Operative repair
Non-operative (casting)

Similar efficacy

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10
Q

Claw, hammer and mallet toe management

A

Surgery (tenotomies, tendon transfer, fusions or amputation)

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11
Q

Ankle fracture management

A

Stable - cast/moon boot

Unstable - ORIF

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12
Q

Lisfranc fracture management

A

ORIF

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13
Q

Femeroacetabular impingement syndrome (FAI) investigations

A

Radiographs
CT
MRI (labrum damage and bony oedema)

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14
Q

FAI CAM deformity management

A

Observation if asymptomatic

Arthroscopic/open surgery to remove CAM/debride labral tears

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15
Q

FAI pincer impingement management

A

Peri-acetabular osteotomy/debride labral tears in pincer impingement

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16
Q

FAI in older patients with secondary OA management

A

Arthroplasty

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17
Q

AVN investigations

A

Radiographs (normal in early disease)
MRI

Shows hanging rope sign (slcerotic line through femoral head/neck)

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18
Q

Management of AVN with no permanent changes to geography of femoral head

A

Bisphosphonates
Core decompression/bone grafting
Curretage and bone grafting
Vascularised fibular bone graft

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19
Q

Management of AVN with permanent changes to geography of femoral head

A 
Rotational osteotomy (only good for small bits of bone)
Total hip replacement
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20
Q

Investigations for idiopathic transient osteonecrosis of the hip (ITOH)

A

Raised ESR
X-ray (osteopaenia of head and neck, thinning of cortices, preserved joint space)
MRI (gold standard)
Bone scan

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21
Q

ITOH management

A 
Self limiting (6-9 months)
Analgesia
Protected weight bearing to avoid stress fracture
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22
Q

Investigation for trochanteric bursitis

A

None, clinical diagnosis

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23
Q

Management of trochanteric bursitis

A

Analgesia
NSAIDs
Physio
Steroid injection

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24
Q

What hip replacement is used in younger patients?

A

Hybrid THA (uncemented cup, cemented stem)

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25
What hip replacement is used in older patients?
Cemented THA (cemented cup and stem)
26
Should you x-ray in hip OA?
Only if it will affect management
27
DDH investigations
Clinical exam US Radiographs later on
28
Early picked up DDH management
``` Pavlik harness (23 hours a day for up to 12 weeks until US normal) Night time splinting for a few more weeks ```
29
Late picked up DDH management
``` Closed reduction (maybe tenotomies) with spica (hip plaster cast) Open reduction and osteotomies (pelvic or femoral) with spica ``` Both involve hip arthrograms to assess.
30
Reactive synovitis diagnosis and investigation
Kochers criteria | Ultrasound with maybe aspiration
31
Septic arthritis investigations
Blood tests/cultures Kochers criteria Radiographs to rule out other pathologies Ultrasound and aspiration
32
Septic arthritis management
Open surgical washout | 6 week antibiotics
33
Perthes disease investigations
Radiographs | MRI
34
Perthes disease management
Restrict weight bearing Maintain ROM with physio Surgery in young patients with severe disease and deformity (femoral and pelvic osteotomies)
35
SUFE investigations
Radiographs | MRI
36
SUFE management
Percutaneous pinning of the hip (with maybe pinning on the other side) Open reduction if a very severe slip
37
Extensor mechanism rupture management
Surgical repair
38
Meniscal tear investigation
MRI
39
Meniscal tear management
Consider arthroscopic repair in acute peripheral years in younger patient Arthroscopic menisectomy for mechanical symptoms or failed repair URGENT surgery if acute locked knee to prevent fixed flexion deformity
40
Management of degenerative mensical tear
Injection may help | Menisectomy ONLY if mechanical symptoms, not pain
41
MCL rupture management
Brace, early motion physio | Rarely surgery
42
ACL rupture management
Around 40% require ACL reconstruction (not repair) | The rest get on
43
LCL rupture management
Complete rupture repair if within 2-3 weeks, reconstruction otherwise
44
Isolated PCL rupture management
Don't require reconstruction (rare)
45
PCL tear as part of multiligament knee injury management
Needs reconstruction
46
Knee dislocation management
``` Check NV status Emergency reduction Recheck NV status May need external fixation for temporary stabilisation Multi ligament reconstruction ``` Any concerns with vascular status contact vascular surgery
47
Management of clubfoot
Ponseti method (serial casting with maybe achilles tenotomy)
48
Cerebral palsy management
Benzodiazepines Baclofen Botulinum toxin injections Selective dorsal rhizotomy (surgery)
49
Duchenne muscular dystrophy investigation
CK | Muscle biopsy
50
Mucous cyst management
Leave alone | Excision
51
Trigger finger management
Conservative - often resolves spontaneously, splint to prevent flexion Tendon sheath injection (steroid and LA, often curative, may be repeated 3 times) Surgery (divide A1 pulley)
52
De quervains tenosynovitis clinical sign
Finklesteins test positive (thing where you try and dislocate your thumb)
53
De quervains tenosynovitis management
``` NSAIDs Splint Rest Steroid injection Surgical decompression ```
54
Dupuytrens management
Conservative - stretches, activity modification Surgery - fasciectomy, amputation Newer treatments - collagenase injection, percutaneous needle fasciotomy
55
Paronychia management
Elevate Antibiotics Incise and drain collection
56
Flexor tendon sheath infection management
Surgical emergency | Wash out tendon sheath
57
Nail/nailbed injury management
Keep nail if possible | Repair nail bed
58
Mallet finger management
Mallet splint for 6 weeks
59
PIPJ dislocation management
Vital to be treated acutely | Pull to reduce, buddy strap
60
PIPJ dislocation late presentation management
Impossible to reduce | May require fusion
61
PIPJ dislocation with fracture management
Needs fixation/stabilisation
62
Bennett's fracture (fracture of 1st MC and CMC joint) management
Fixation
63
Hand burns management
Excise damaged skin and perform split skin grafts early Aggressive mobilisation to prevent finger stiffness Escharotomy
64
Rheumatoid nodule management
Excision if problematic | Recurrence high
65
Management of giant cell tumour of the tendon sheath
Leave if no functional issue | Marginal excision, incidence of recurrence
66
System used to grade the shape of the acromion
Bigliani acromial grading
67
Supraspinatus tendinopathy management
Active shoulder movement with physiotherapy Steroid and local anaesthetic injection If refractory try arthroscopic sub-acromial decompression
68
Management of calcifying teninopathy
Physiotherapy NSAIDs Steroid injection Rarely excision of calcium
69
Management of ACJ OA
Rest NSAID Steroid injection Refractory then removal of ACJ
70
Frozen shoulder management
Early physio and NSAIDs Steroid injection Surgical release with either manipulation under anaesthetic or arthroscopic arthrolysis
71
Management of tennis elbow
Steroid injections | Surgical release and debridement of ERCB origin (only for refractory cases)
72
Management of golfers elbow
Avoid injecting due to proximity to the ulnar nerve | Surgical debridement last resort
73
RA extensor tendon rupture management
Tendon transfer | Synovectomy can prevent
74
EPL rupture management
May require tendon transfer is affecting quality of life
75
Radiocapitellar OA management
Excise and maybe replace radial head
76
Management of tendon deformities in RA
``` Splintage Surgery (tendon reposition) ```
77
Management of shoulder dislocation
Closed reduction under sedation (first line) Open reduction Stabilisation and rehab
78
Management of elbow dislocation
Closed reduction under sedation Open reduction rarely required 2 weeks in sling and rehab
79
Management of IPJ fracture
Closed reduction under digital or metacarpal block Open reduction rarely required 2 weeks in neighbour strapping If very unstable then volar slab in edinburgh position
80
Patellar dislocation management
``` Reduces with knee extension Radiographs Aspiration Brace Physio ```
81
Repeat patellar dislocation management
Lateral release/medial reefing | Patella tendon realignment
82
Knee urgent management
Reduction under sedation May require theatre reduction Splint/external fixation Vascular and nerve repair
83
Knee dislocation imaging
X-ray (associated fractures) | MRI
84
Knee dislocation definitive management
Sequential ligamentous repair
85
Hip dislocation early management
``` Neurovascular assessment (esp sciatic) X-rays Urgent reduction Stabilise in tractions if required CT ```
86
Hip dislocation definitive management
Fixation of associated pelvic fractures
87
Management of undisplaced intracapsular femoral fracture
Hemi-arthroplasty | THR for young fit people
88
Management of extracapsular femoral fracture
Dynamic hip screw
89
Management of sub-trochanteric femoral fracture
Intramedullary device (also has screw portion that goes into femoral head)

Year 2 Revision (45 decks)

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