Musculoskeletal 2 Flashcards
(103 cards)
1
Q
Bowing of tibia, bossing of skull =
A
Paget’s disease
2
Q
What foods should you avoid in gout?
A
Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
3
Q
How long should the symptoms be present for before a diagnosis of chronic fatigue can be made?
A
4 months
4
Q
Name two RF for tendinopathies
A
- Quinolone use
2. High cholesterol
5
Q
Name two features for achilles tendonitis
A
- Posterior heel pain
2. Morning pain and stiffness
6
Q
Achilles tendonitis Diagnostic Ix (1) Mx (3)
A
USS
- Simple analgesia
- Reduction in activities that trigger pain
- Calf muscle eccentric exercises
7
Q
Pop in the ankle, sudden onset severe pain, unable to walk/ continue with activity =
A
achilles tendon rupture
8
Q
Simmond’s triad checks for (1)
What are the three tests?
A
Achilles tendon rupture
- Calf squeeze
- Greater dorsiflexion when feet over bed in prone position
- Feel for gap in tendon
9
Q
What is the most commonly sprained ankle ligament?
Invert or evert?
Mx
A
Anterior talofibular ligament
(Lower)
Invert
Mx
- RICE
- Can use removable orthosis/ splint/ crutches if needed
- If pain not resolving consider MRI
10
Q
What are the grades of a lower ankle sprain
A
I micro tear, mild pain + swelling, nil pain on weight bearing
II partial tear, mod pain + swelling, minimal pain on weight bearing
III complete tear, severe pain + swelling, severe pain on weight bearing
11
Q
High ankle sprain = injury to?
Low ankle sprain = injury to?
A
- Syndesmosis
2. Lateral collateral ligaments
12
Q
Mechanism of injury to syndesmosis
A
External rotation of the foot
13
Q
What is the Hopkin’s squeeze test?
What injury do you see it in?
A
Pain on squeezing tibia and fibula together
High ankle sprains
14
Q
What might you see on high ankle sprains xray?
Mx (2)
A
Diastasis - widening of tibiofibular joint
Mx
- If nil diastasis - non-weight-bearing orthosis or cast until pain subsides
- If diastasis or failed non operative management then for operative fixation
15
Q
What is a Boxer’s fracture
A
A minimally displaced fracture of the fifth metacarpal
16
Q
A minimally displaced fracture of the fifth metacarpal is also known as
A
Boxer’s fracture
17
Q
What nerve is compressed in cubital tunnel syndrome?
A
Ulnar nerve
18
Q
Name four features of cubital tunnel syndrome
A
- Tingling/ pins and needles in 5th and 4th finger, intermittent then constant
- Pain worse on leaning on elbow
- Hx of OA or trauma to area
- Weakness and muscle wasting
19
Q
Mx cubital tunnel syndrome (4)
A
Avoid aggravating activity
Physiotherapy
Steroid injections
Surgery in resistant cases
20
Q
De Quervain’s tenosynovitis
Inflammation of what two muscles?
F/M
Age
A
Extensor pollicis brevis and longus
F>M
30-50yo
21
Q
Explain Finkelsteins test
What is it used for?
A
Pull thumb towards ulnar with wrist - pain at radial styloid process
De Quervain’s tenosynovitis
22
Q
Name three features of De Quervain’s tenosynovitis
A
- Tenderness at radial styloid process
- Pain at radial side of wrist
- Abduction of the thumb against resistance is painful
23
Q
Management of De Quervain’s tenosynovitis (4)
A
- Simple analgesia
- Steroid injection
- Immobilisation with a thumb splint (spica)
- Surgical mx
24
Q
Most common cause of bacterial discitis?
A
Staph Aureus
25
Name two investigations to diagnose discitis
1. MRI
| 2. CT guided biopsy to assess which abx is needed
26
List five causes of Duputren's contracture
(DAMPt)
Mx
1. DM
2. Alcoholic liver disease
3. Manual labour
4. Phenytoin
5. Trauma
DAMPT
Mx - if loss of function then for surgery
27
What is golfer's elbow?
| What movements elicit pain?
Medial epicondylitis
| Wrist flexion and pronation
28
What is radial turn syndrome?
| Which movements elicit pain?
Pain tends to be around 4-5 cm distal to the lateral epicondyle
Extension of elbow and pronation of the forearm
29
What is greater trochanteric pain syndrome/ trochanteric bursitis caused by?
Features (2)
F/M
Age
Repeated movement of the fibroelastic iliotibial band
```
Features
1. Greater trochanter tenderness
2. Pain along iliotibial band/ lateral side of hip/ thigh
F>M
50-70yo
```
30
What is Barlow's and Ortalani's test for?
Name a feature (1)
Age group
Development dysplasia of the hip
Skin folds unequal
Newborn
31
What is transient synovitis?
| Common age group
Acute hip pain associated with viral infection
Commonest cause of hip pain in children
2-10yo
32
What is Perthe's disease?
| Common age group?
Avascular necrosis of the femoral head
| 4-8yo
33
What are the common features in slipped upper femoral epiphysis? (3)
Age group
1. Obesity
2. Knee or distal thigh pain
3. Loss of internal rotation in leg flexion
10-15yo
34
How many joints are affected in juvenile idiopathic arthritis (JIA)?
Which joints are usually affected?
Age
1. <= 4 joints only
2. Middle sized joints e.g knee, ankle, elbow
<16yo
35
Lateral knee pain in runners =
| Mx
Iliotibial band pain
Mx
1. Activity modification and stretches
2. Physio
36
What movement will give you a meniscal tear?
| Name four features
Twisting injury
1. Tenderness along joint line
2. Pain on knee extension
3. Knee locking
4. Knee may give way
37
Weight bearing at 20 degrees of knee flexion, patient supported by doctor, positive if pain on twisting knee is what test?
Thelassy's test
| Used to assess for meniscal tears
38
What is infrapatellar bursitis associated with?
Kneeling
| Clergyman's knee
39
What is clergyman's knee?
Infrapatellar bursitis
40
What is housemaids knee?
Prepatellar bursitis
41
What is prepatellar bursitis associated with?
Upright kneeling
| Housemaids knee
42
ACL tear features (3)
1. Positive anterior draw test
2. Twisting of knee, may hear pop
3. Sudden knee effusion
43
PCL tear features (2)
1. Positive posterior draw test
| 2. Caused by anterior force applied to tibia
44
Collateral ligament
1. Tenderness over the affected ligament
| 2. Knee effusion may be seen
45
1. Positive anterior draw test
2. Twisting of knee, may hear pop
3. Sudden knee effusion
ACL tear
46
1. Tenderness over the affected ligament
| 2. Knee effusion may be seen
Collateral ligament tear
47
1. Positive posterior draw test
| 2. Caused by anterior force applied to tibia
PCL tear
48
Name five red flags for lower back pain
1. <20yo or >50yo
2. Hx of malignancy
3. Pain at night
4. Hx of trauma
5. Systemic symptoms
49
```
Name four features of spinal stenosis
Hint:
Type of pain
Acute/ gradual onset
Worse by
Eased by
```
1. Gradual onset
2. Bilateral/ unilateral leg pain/ weakness or numbness
3. Worse when walking
4. Eased when sitting, leaning forward, crouching
50
How do you diagnose spinal stenosis?
MRI
51
1st line management for back pain
1. NSAIDs
52
When should you prescribe a PPI with an NSAID for lower back pain?
>45yo
53
Clear dermatomal leg pain associated with neurological deficits may indicate which condition?
Prolapsed disc
54
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L3
55
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L4
56
How may someone with a prolapsed disc present?
Clear dermatomal leg pain with neurological deficits
57
S1 nerve root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
58
L3 nerve root compression
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
59
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
L5 nerve root compression
60
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
S1 nerve root compression
61
Mx prolapsed disc
1. NSAIDs
2. Physio + exercises
3. If persistent after 4-6 weeks - MRI
62
Mx spinal stenosis
1. Laminectomy
63
What is a myxoid cyst?
Where is it found?
Gender and age with what condition?
Benign ganglion cysts usually found on the distal, dorsal aspect of the finger
Middle aged women with OA
64
Caused of olecranon bursitis
| Movement of elbow should be painless/painful?
1. Trauma
2. Infection
3. RA
4. Gout
Painless
65
Name five signs of olecranon bursitis
If you see effusions in other joints which disease is this associated with?
If there is tophi, what disease is this associated with?
1. Swelling over posterior elbow
2. Erythema + tenderness
3. Fluctuant, well circumscribed
4. Appears over hours to days
5. Skin abrasion
If RA - will have effusions in other joints
If has tophi - gout
66
Hx of groin ache following exercise and relieved by rest =
OA of hip
67
Red flags for hip pain (3)
1. Pain at rest
2. Pain at night
3. Morning stiffness >2 hours
68
Name four reasons for revision of total hip replacement
1. Aseptic loosening
2. Infection
3. Dislocation
4. Pain
69
Name four complications post hip replacement
1. Intra-op fracture
2. Nerve injury
3. VTE (4 weeks of LMWH)
4. Infection
70
Types of total hip replacements (3)
1. Cemented
2. Uncemented (for younger more active patients)
3. Hip resurfacing - metal cap over the head, used in younger patients with neck intact
71
Advise regarding movements post THR
1. Do not sit cross legged
2. Avoid low chairs
3. Don't flex hip >90 degrees
4. Sleep on back for first 6 weeks
72
What does FRAX assessment do?
Assesses risk of fracture within 10 years
73
Name eight RF for fragility fracture
1. Low BMI
2. Prev fracture
3. FH of fracture
4. Use of steroids
5. Smoking
6. ETOH
7. Hx of falls
8. Secondary osteoporosis
74
Results of FRAX
| Reassess how often?
low risk: reassure and give lifestyle advice
intermediate risk: offer BMD test
high risk: offer bone protection treatment
Every 2 years
75
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Common in teenage girls
Patellafemoral syndrome
76
Patellafemoral syndrome is also known as
Chondromalacia patellae
77
Patellafemoral syndrome - what is it?
Who is it common in?
Mx
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Common in teenage girls
Mx physio
78
What is adhesive capsulitis also known as?
Frozen shoulder
79
Frozen shoulder/ adhesive capsulitis
Which movements are difficult?
Associated with which condition?
1. Associated with DM
| 2. External rotation difficulty more than internal rotation or ABduction
80
Frozen shoulder rx (4)
1. NSAIDs
2. Physio
3. PO steroids
4. Intra-articular steroids
81
What is impingement syndrome? (3)
Subacromial impingement
Pain from 60-120 degrees, painful arc
Tenderness over anterior acromion
82
Club foot is also known as
What is the positioning of the foot?
F/M
Talipes equinovarus
Inverted, plantarflexed
M>F
83
Name five causes of talipes equinovarus
1. Edwards syndrome
2. Oligohydramnios
3. Congenital contractures - arthrogryposis
4. Cerebral palsy
5. Spina bifida
84
Congenital contractures =
Arthrogryposis
85
Mx of talipes equinovarus (3)
1. Manipulation and progressive casting which starts soon after birth - 6-10 weeks total
2. Achilles tenotomy required (85% of cases)
3. Night time brace until 4yo
86
Trigger finger is associated with which conditions (2)
| What may you find on examination? (1)
1. DM
2. RA
Nodule may be felt at the base of the affected finger
87
Mx trigger finger (3)
1. Steroid injection
2. Splint
3. Surgery
88
What is Barton's fracture?
| Type of fall
Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
89
Anatomical snuffbox pain =
Scaphoid fracture
90
Radial head fracture features (1)
| Common in which age group
Common in young adults
| Pain at the lateral side of the elbow at the extremes of rotation (pronation and supination)
91
Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
=
Barton's fracture
92
Scaphoid fracture symptom (1)
anatomical snuff box pain
93
Common in young adults
| Pain at the lateral side of the elbow at the extremes of rotation (pronation and supination) =
radial head fracture
94
Deltoid ligament damage in what injury
Eversion
95
```
Osteoporosis management (3)
When would HRT be used?
```
```
If >= 75yo with fracture, or <75 with DEXA <2.5 with fracture. Vit D and calcium for all women.
1. Alendronate - can have GI S/E
2nd line
2. Risedronate or etidronate
Third line
3. Strontium ranelate and raloxifene
```
HRT - if went through menopause <45yo and to take until 50yo
96
Transient idiopathic osteoporosis
Which patient group?
Features (2)
Seen in third trimester of pregnancy
Groin pain associated with a limited range of movement in the hip
May be unable to weight bear
ESR elevated
97
Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years
Greater trochanteric bursitis
98
Greater trochanteric bursitis
Features (2)
M/F
Age group
Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years
99
Femoroacetabular impingement
anterior hip pain
100
Triad RF for stress fractures
1. Menstrual irregularities
2. Low BMI/ reduced caloric intake
3. Increased exercise intensity
101
What is Foucher's sign?
increase in tension of a Baker's cyst on extension of the knee
102
What is Felty's syndrome
| Triad
Complication of RA
1. Splenomegaly
2. RA
3. Neutropenia
103
What is the Modified New York criteria?
Used to diagnose ank spond
x3 clinical criteria + radiological finding
1. Lower back pain >3 months, eased by exercise
2. Reduced lumbar region motion in saggital and frontal planes
3. Limited chest expansion
xray or MRI of sacroilitis
Definite 1 clinical + radiological finding
Probable no clinical criteria with radiological finding or all three criteria with no radiological findings
