MSK/Rheum #1 Flashcards by Tyler Cichowski

Etiology of acute compartment syndrome

Trauma; fracture of the long bones

- Crush injuries, constriction (tight casts, splints, burns)

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Pathophysiology of acute compartment syndrome

Muscle and nerve ischemia (decreased perfusion) when the closed muscle compartment pressure > perfusion pressure
- > 30-45 mmHg

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Symptoms of acute compartment syndrome

Pain with passive stretching (earliest finding and most sensitive)
Tense compartment (firm or wood-like feeling)
Pulselessness, pallor, paresis
Capillary refill preserved

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Diagnostics for acute compartment syndrome

Increased intracompartmental pressure > 30 mmHg

- Increased creatinine kinase and myoglobin

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Treatment of acute compartment syndrome

Emergent Fasciotomy (Decompression)

Place limb at level of the heart
Remove constrictive dressings, IVF, oxygen

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Adhesive Capsulitis is shoulder stiffness due to inflammation (especially _____ and _____). It is most common in people aged 40-60

Diabetes and Hypothyroidism

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Symptoms of Adhesive Capsulitis

Shoulder pain/stiffness
Decreased ROM (External rotation)
Gradual return of ROM
Resistance of passive range of motion

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Treatment for adhesive capsulitis

Rehab ROM therapy

- Anti-inflammatories, steroid injections, heat

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What is the standard treatment for an amputated digit?

Wrap in gauze and soak in sterilized isotonic saline to prevent from drying
Placed in a plastic bag immersed in ice water
NEVER PLACE DIRECTLY IN ICE WATER

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What is the MC knee ligamental injury

Anterior cruciate ligament (ACL)

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Mechanism of action for ACL injury

-Noncontact pivoting injury, deceleration, changing direction, hyperextension, internal rotation

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Clinical manifestations of an ACL injury

Associated with pop and swelling followed by hemarthrosis (intra-articular bleeding)
Knee buckling, inability to bear weight
Does not actively extend knee

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What tests are performed for ACL tear?

Lachman Test (Most sensitive)
Pivot Shift Test
Anterior Drawer Test

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What are some diagnostics for an ACL tear?

XR: done initially to rule out fracture

- MRI: best test

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What is seen on a knee XR if the ACL is torn?

Segund Fracture (avulsion of lateral tibial condyle with varus stress of the knee)

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What are the three parts of the Unhappy (O’Donoghue’s) Triad?

ACL Tear
MCL injury
Medial Meniscus injury

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What is a basilar skull fracture?

Linear fracture at the base of the skull, associated with dural tear

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Other symptoms of a basilar skull fracture

CSF Otorrhea
Raccoon eyes
Hemotympanum
Bruising over mastoid (Battle Sign)
Do a Glascow Coma Scale

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What is a Boxer’s Fracture?

Fracture at the neck of the 5th metacarpal

-MOI: punching with a clenched fist

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What should you check for and what is the treatment in a Boxer’s Fracture?

Check for bite wounds

-Treat with Augmentin

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What should a Boxer Fracture go in?

Ulnar gutter splint

-ORIF if angulation > 40 degrees

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What is the MC bone malignancy?

Osteosarcoma

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MC site of osteosarcoma

Metaphysis of long bones (distal femur MC)

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MC site of METS in bone cancer

-Lungs (MCC of death)

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Symptoms of Osteosarcoma

- Localized bone pain worse at night - Joint swelling without systemic symptoms - Palpable soft tissue mass

What do radiographs for an osteosarcoma show?

-"Hair on End" or "Sunburst" appearance

What is the definitive diagnostic for osteosarcoma?

Biopsy

Treatment for Osteosarcoma

-Chemo + Surgical Removal with amputation or limb-sparing resection

What is a C1 fracture called and what is the mechanism of injury?

Atlas - Jefferson (Burst) Fracture - Vertical compression

What is a C2 fracture called and what is the mechanism of injury?

- Axis pedicle - Hangman's Fracture - Hyperextension then flexion

What is a Colles Fracture?

Distal radius fracture with dorsal angulation

MOA for Colles Fracture and what is seen on Physical Exam?

- FOOSH | - Dinner fork deformity appearance to the wrist

Treatment for Colles Fracture

Closed reduction followed by sugar tong splint or cast | -ORIF if > 20 degrees angulation

What is the MC Complication of a Colles Fracture?

Extensor Pollicis Longus Tendon Rupture -Others: Malunion, joint stiffness, median nerve compression, CRPS

What is the treatment for Congenital Talipes Equinovarus (Clubfoot)?

Ponseti method of serial manipulation and casting

When should you perform an xray of a finger with a subungal hematoma?

When hematoma is > 50% of nail to evaluate for phalanx fracture

Dermatomyositis is associated with _____ in 25% of cases

Cancer

Symptoms of Dermatomyositis

- Progressive symmetric proximal muscle weakness (shoulders, hips) - Systemic symptoms: dysphagia, fever, fatigue, weight loss - Decreased muscle strength - Gottron's Papules (scaly patches on PIP and MCP) - Heliotrope Rash (blue discoloration of eyelids) - Malar Rash: Shawl Sign (erythema of shoulder, chest, back)

Diagnostics for Dermatomyositis

- Increased muscle enzymes (CK and aldolase): best initial - Anti-Jo 1 and Anti-Mi-2 (most specific) - Muscle biopsy: definitive

Treatment for Dermatomyositis

-High-dose glucocorticoids first-line | +/- Methotrexate, Azathioprine, IVIG

Clinical Intervention for a distal radius fracture

Sugar Tong Splint

Risk Factors for Dupuytren Contracture

- Men > 40 - Northern Europeans - ETOH - DM - Smoking

Symptoms of Dupuytren Contracture

- Visible or palpable nodules over the distal palmar crease along course of flexor tendons - Fixed flexion deformity at MCP joint - May have thickened skin or bands in the palmar fascia

Treatment for Dupuytren Contracture

- Intralesional injections - Physical therapy - Surgical correction (fasciotomy) for advanced stages

Symptoms of a knee effusion

- Bulge sign - Ballottement - Patellar Tap Tests

What is a Bennett's Fracture

Intraarticular fracture through the base of the 1st metacarpal (MCP) bone

What is a Rolando Fracture?

Comminuted Bennett's Fracture (Y sign)

Treatment for Bennett or Rolando Fracture

Thumb Spica Splint - Bennett: Immobilization - Rolando: ORIF, external fixation

What is a Galeazzi Fracture?

Mid-distal radial shaft fracture with dislocation of the distal radioulnar joint (GRUesome)

Treatment for Galeazzi Fracture

- ORIF | - Long arm/sugar tong splint temporarily

Triggers for Gout

- Purine-Rich Foods (alcohol, liver, seafood) | - Thiazide & Loop Diuretics, ACEi, Pyrazinamide, Ethambutol, Aspirin

What is the ONLY ACEi that decreases uric acid levels?

Losartan

Symptoms of Gout

- First MTP joint of great toe (Podagra) | - Joint pain, erythema, warmth, swelling, tenderness, fever

What is the diagnostic of choice for gout?

Arthrocentesis: negatively birefringent, needle-shaped crystals

On X-rays, what is seen for gout?

Mouse or rat bite lesions (punched out erosions with sclerotic and overhanging margins)

Treatment for acute management of gout

- NSAIDs (NOT Aspirin) | - Colchicine (if cannot use NSAIDs)

Chronic Management for gout

- Lifestyle: decrease alcohol consumption, weight loss, decrease meats/seafood - Allopurinol: Xanthine Oxidase Inhibitors (DO NOT START DURING ACUTE ATTACK)

True or False: Allopurinol is safe in renal insufficiency

True

Gout is a problem with metabolism of what type of molecule?

Purine

In gout, what compound precipitates into the synovial fluid?

Sodium Urate

Where is a herniated disc most common?

L5-S1 | -Because it is the junction between the mobile and non-mobile spine)

Symptoms of a herniated disc

- Radicular back pain; unilateral in a dermatomal pattern | - Pain increases with coughing, straining, bending, sitting, Valsalva

With a herniated L4, what are the symptoms?

- Anterior Thigh Pain - Sensory loss to medial ankle - Weakness with ankle dorsiflexion - Loss of knee jerk

With a herniated L5 disc, what are the symptoms?

- Lateral thigh/leg, hip, groin pain - Weakness in big toe dorsiflexion/extension - Reflexes usually normal

With a herniated S1 disc, what are the symptoms?

- Posterior leg/calf/gluteus pain - Plantar surface of the foot sensory diminished - Weakness in plantarflexion - Loss of ankle jerk

What is the diagnostic of choice for a herniated disc

-MRI

Treatment for herniated lumbar disc

- NSAIDs, short period of rest - Anti-inflammatories - Warm, moist heat - Resume activities as tolerated - Injections, Transcutaneous electrical nerve stimulation

MSK/Rheum #1 Flashcards

(67 cards)