MSK SURG Flashcards

Question

What is carpal tunnel syndrome? how does it present? Examination Management

Answer 1

idiopathic median neuropathy at the carpal tunnel altered sensation on lateral 3 fingers Wasting of muscles in the thenar eminence TInels test Formal diagnosis electrophysiological studies -motor + sensory: prolongation of the action potential Treatment- splinting and surgical review and corticosteroids for 6 weeks if that doesnt work surgical decompression (flexor retinaculum division)

Answer 2

lateral knee pain in runners tenderness 2-3cm above laterasl joint line Iliotibial band stretches and physiotherpay referral

Answer 3

DDH- NIPE, barlow and ortolani test positive unequal skin folds and leg length Transient synovitis- hip pain associated with viral infection Perthes disease- degenerative condition affecting kids, avascular necrosis of the femoral head, Perthes disease is 5 times more common in boys. Around 10% of cases are bilateral xray- widening of the joint space SUFE- fat kid Displacement of the femoral head epiphysis postero-inferiorly Bilateral slip in 20% of cases JIA- arthritis occurring in someone who is less than 16 years old that lasts for more than three months, can be associated with ana and anterior uveitis, pauciarticular- less than 4 joints affected septic arthiritis- Acute hip pain associated with systemic upset e.g. pyrexia. Inability/severe limitation of affected joint

Answer 4

Fever/back pain with pain on extension of the hip → iliopsoas abscess collection of pus in iliopsoas compartment S aureaus crohns diverticulitis and ivdu Fever back/flank pain/limp CT abdomen abx draininage surgery if above fail

Answer 5

Lachmans test- ACL injuries Anterior draw test- acl Empty can test- supraspinatus injury Mcmurrays test- meniscal tear Posterior draw test- PCL injury Sweep test - effusion

Answer 6

ACL- port injury Mechanism: high twisting force applied to a bent knee Typically presents with: loud crack, pain and RAPID joint swelling (haemoarthrosis) Poor healing Management: intense physiotherapy or surge PCL Mechanism: hyperextension injuries Tibia lies back on the femur Paradoxical anterior draw test MCL INJURY Mechanism: leg forced into valgus via force outside the leg Knee unstable when put into valgus position Meniscal tear-Rotational sporting injuries Delayed knee swelling Joint locking (Patient may develop skills to 'unlock' the knee Recurrent episodes of pain and effusions are common, often following minor trauma- Thessaly's test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee Patellar-Undisplaced fractures, particularly vertical fractures with an intact extensor mechanism can be managed non-operatively in a hinged knee brace for 6 weeks and patients allowed to fully weight bear. Displaced fractures and those with loss of extensor mechanisms should be considered for operative management with either tension band wire, inter-fragmentary screws or cerclage wires. Again, patients are placed in a hinged knee brace for 4 to 6 weeks and allowed to fully weight bear.

Answer 7

Repetitive activity and loading of normal bone may result in small hairline fractures. Xray severity depends on immobilisation

Answer 8

thoracic pain age < 20 years or > 50 years history of previous malignancy night pain history of trauma systemically unwell e.g. weight loss, fever

Answer 9

Pain may be described as 'aching', 'crawling'. Relieved by sitting down, leaning forwards and crouching down Clinical examination is often normal Requires MRI to confirm diagnosis laminectomy

Answer 10

Pain may be described as 'aching', 'crawling'. Relieved by sitting down, leaning forwards and crouching down Clinical examination is often normal Requires MRI to confirm diagnosis laminectomy

Answer 11

Meralgia paraesthetica refers to localised sensory symptoms of the outer thigh caused by compression of the lateral femoral cutaneous nerve. It is a mononeuropathy, meaning it only affects a single nerve. Outer thigh- burning, numbness, pins and needles and cold sensation loss of hair dx The pelvic compression test is highly sensitive, and often, meralgia paraesthetica can be diagnosed based on this test alone Injection of the nerve with local anaesthetic will abolish the pain. Using ultrasound is effective both for diagnosis and guiding injection therapy in meralgia paraesthetica Nerve conduction studies may be useful. management Conservative management involves: Rest Looser clothing (tight clothes such as belts may add pressure to the nerve) Weight loss (if appropriate) Physiotherapy Medical management is based around analgesia if pain is a feature, such as: Paracetamol NSAIDs Neuropathic analgesia (e.g., amitriptyline, gabapentin, pregabalin or duloxetine) Local injections of steroids or local anaesthetics Surgical management may involve: Decompression – removing pressure on the nerve Transection – cutting the nerve Resection – removing the nerve

Answer 12

FOOSH compression of the scaphoid damage to the dorsal carpal branch of the radial artery leading to avascular necrosis of scaphoid pain in aantomical snuff boxc teslescoping thumb causes pain loss of grip strength xray- anterior posterior land lateral mri - gold management- futuro splint ALWAYS REFER TO ORTHOPAEDICS if the fracture undisplaced- cast 6-8 weeks displaced- surgical fixation proximal pole- surgical fixation

Answer 13

abnormal flexion of the diits, tendons become stuck thumb, middle and ring finger steroid injection finger splint

Answer 14

Buckle, or torus, fractures are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years.

Answer 15

Baker’s cysts are also called popliteal cysts. A Baker’s cyst is a fluid-filled sac in the popliteal fossa, causing a lump. GASTROCNEMEUIUS-SEMIMEMBRANOUS BURSA The popliteal fossa is the diamond-shaped hollow area formed by the: Ultrasound is usually the first-line investigation to confirm the diagnosis. It is also used to rule out a DVT. MRI can evaluate the cyst further if required, for example, before surgery. They can also demonstrate underlying knee pathology, such as meniscal tears. No treatment is required for asymptomatic Baker’s cysts. Non-surgical management for symptomatic Baker’s cysts include: Modified activity to avoid exacerbating symptoms Analgesia (e.g., NSAIDs) Physiotherapy Ultrasound-guided aspiration Steroid injections

Answer 16

Plantar fasciitis is the most common cause of heel pain seen in adults. The pain is usually worse around the medial calcaneal tuberosity. Management rest the feet where possible wear shoes with good arch support and cushioned heels insoles and heel pads may be helpful

Answer 17

disruption of the bony cortex associated with a breach in the overlying skin Gustilo and Anderson Administration of intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film

Answer 18

Achilles tendon disorders Quinolone use- ciprofloxacin and hypercholestrolaemia gradual onset posterior heel pain worse on activity, morning pain and stiffness, do execrise and analgesia whilst playing a sport or running; an audible 'pop' in the ankle, sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport. US scan and acute referral to orthopaedics POSITIVE SIMMONDS SIGN Use Simmonds triad (palpation, examining the angle of declination at rest and the calf squeeze test) to assess for evidence of Achilles tendon rupture

Answer 19

SITS supraspinatus, infraspinatus,teres minor, subscapularis, 1. Subacromial impingement (also known as impingement syndrome, painful arc syndrome) 2. Calcific tendonitis 3. Rotator cuff tears 4. Rotator cuff arthropathy Symptoms shoulder pain worse on abduction Signs -painful arc of abduction. With subacromial impingement, this is typically between 60 and 120 degrees. With rotator cuff tears the pain may be in the first 60 degrees. tenderness over anterior acromion

Answer 20

these decide whether someone should have an XRAY Xray only required if pain in the medial malleolar zone and - bony tenderness at lateral malleolar zone - bony tenderness at medial malleolar zone -inability to walk 4 weight bearing steps

Answer 21

promptly reduce pressure Young- surgical plate Old- conservative management

Answer 22

death of bone tissue secondary to loss of blood supply Long term steroid use chemotherapy Alcohol excess Trauma Osteopaenia MRI investigation of choice Usually requires joint replacement

Answer 23

an incomplete fracture of the shaft of a long bone, characterised by bulge in the cortex

Answer 24

a person with osteoarthiritis has neck pain and headaches

Answer 25

a neuropathic joint of the foot, it has been so badly disrupted leads to loss of sensation, redness swelling and warm ASSOCIATED WITH DM AND SYPHILIS

Answer 26

infection and inflammation of the intervertebral disc can lead to sepsis or an abscess back pain and sepsis like features s aureus most common cause MRI highest sensiitivity 6-8 weeks of abx

Answer 27

damage to the: anterior cruciate ligament medial collateral ligament meniscus (classically the medial meniscus but recent evidence shows that the lateral meniscus is more commonly injured)

Answer 28

Anterior cruciate ligament Damage may result from twisting injuries Anterior drawer test and Lachman test may be positive if damaged Posterior cruciate ligament Damage may occur following dashboard injuries Medial collateral ligament Damage may commonly result from skiing and following valgus stress Damage typically causes abnormal passive abduction of the knee Lateral collateral ligament Isolated injury is uncommon Menisci Damage may result from twisting injuries

Answer 29

proximal 5th metatarsal usually because of lateral ankle sprain but Metatarsal stress fractures Occurs in otherwise healthy athletes, e.g. runners The most common site of metatarsal stress fractures is the 2nd metatarsal shaft

Answer 30

Infection of the bone S aureus most common but in sickle cell patients it is salmonella species MRI imaging choice FLucoxacillin 6 weeks and clindamycuin if penicillin allergic

MSK SURG Flashcards

(56 cards)