Musculoskeletal Flashcards
(75 cards)
1
Q
shoulder dislocation vs shoulder separation
A
dislocation - glenohumeral (humeral head in glenoid)
separation - acromioclavicular joint dislocation
2
Q
acromioclavicular joint dislocation / shoulder separation
A
- direct blow to adducted shoulder
- pain w/ lifting arm or unable to lift arm at shoulder
- class 1: normal CXR, ligament sprain
- class 2: slight widening (acromioclavicular ligament ruptured, coracoclavicular ligament sprain)
- class 3: significant widening, rupture of both AC and CC
- class 4: AC + CC rupture + displaced clavicle into trap
- class 5: class 4 plus disruption of clavicular attachments
3
Q
humeral head fracture - mechanism and what to r/o
A
- FOOSH, direct blow, metastatic breast cancer
- mc in elderly w/ osteoporosis
- check deltoid sensation to r/o brachial plexus or axillary nerve injuries
4
Q
humeral shaft fractures - what to r/o
A
-rule out radial nerve injury (wraps around shaft) - may devo wrist drop
5
Q
frozen shoulder
A
- shoulder stiffness due to inflamm (esp DM, hypothyroid)
- stiffness lasts 18-24 mo, dec ROM, worse at night
6
Q
thoracic outlet syndrome
A
-idiopathic compression of brachial plexus (95%), subclavian vein (5%) or subclavian artery (1%)
- nerve compression - pain/para arm, ulnar side of hand
- vascular compression - swell/discolor esp w/ abduction
- positive adson sign - loss of radial pulse w/ head rotated to affected side
7
Q
suppurative flexor tenosynovitis
A
- infx of flexor tendon synovial sheath
- staph aureus MC (skin flora) - often from penetrating trauma
- pain/tender on palmar side of finger
Kanavel’s Signs: FLEXor
- Finger held in flexion
- Length of tension sheath is tender
- Enlarged finger
- Xtension of finger causes pain
8
Q
radial head subluxation (nursemaids elbow)
A
stretched annular ligament
-children present w/ arm slightly flexed, refuse to use
9
Q
lateral epicondylitis / tennis elbow
A
- inflam of tendon insertion of extensor carpi radialis brevis muscle
- lateral elbow pain esp w/ gripping, forearm pronation and wrist extension against resitst
10
Q
medial epicondylitis / golfer’s elbow
A
- inflam of pronator teres-flexor carpi radialis due to repetitative stress @ tendo insertion
- tenderness on medial epi, worse w/ pulling, repro via wrist flex against resist w/ elbow extended
11
Q
elbow dislocation
A
- posterior MC (90%)
- presents w/ flexed elbow, marked olecranon prominance
- EMERGENT reduction
- complications: r/o brachial artery + median/ulnar/radial nerve injury
12
Q
cubital tunnel syndrome
A
-ulnar nerve compression at cubital tunnel along medial elbow
-paresthesias/pain along ulnar nerve distribution
+TINEL’S sign @ elbow
+FROMENT’S sign - pinching effect
13
Q
perilunate dislocation (wrist)
A
lunate doesn’t articulate w/ capitate
14
Q
lunate dislocation (wrist)
A
lunate doesn’t articulate w/ capitate or radius
15
Q
colles fracture
A
- FOOSH w/ wrist extension
- transverse distal radius fracture
- dorsal angulation of distal bone fragment
- complication: extensor pollicus longus tendon rupture mc
16
Q
smith fracture
A
- FOOSH w/ wrist flexion (less common than colles)
- transverse distal radius fracture
- ventral angulation of distal bone fragment
17
Q
barton fracture
A
intra-articular distal radius fracture w/ carpal displacement
18
Q
lunate fracture
A
- most serious carpal frx (lunate occupies 2/3 of radial articular surface)
- XR often negative
19
Q
complex regional pain syndrome (CRPS) aka reflex sympathetic dystrophy
A
-autonomic dysfx following bone or soft tissue injuries, MC upper extremities
Stage 1: pain out of proportion, ANS sx (swelling, color change, inc nail/hair growth)
Stage 2: waxy or pale skin, brittle nails, loss of hair
Stage 3: joint atrophy and contractures
-Vitamin C prophylaxis after frx may reduce incidence
20
Q
mallet (baseball finger)
A
- flexed at DIP joint, unable to extend
- mech: extensor tendon avulsion after blow
- uninterrupted extension x6 wks vs surgical pinning
21
Q
boutonniere deformity
A
- flexed at PIP joint, hyperextended at DIP jt
- disruption of extensor tendon at base of middle phalanx
- splint in extension 4-6 wks, hand sx FU
22
Q
swan neck deformity
A
-hyperextended at PIP and flexed DIP
23
Q
gamekeeper’s (skier’s) thumb
A
-sprain/tear of ulnar collateral ligament of thumb (forced hyper-abduction of thumb)
- skier’s thumb: acute (after fall)
- gamekeeper’s: chronic
24
Q
boxer’s fracture
A
-fracture at neck of 5th metacarpal (+/- 4th) from punching w/ clenched fist
+/- rotational deformity
+/- loss of knuckle on exam
25
bennett fracture (and rolando's)
- intraarticular fracture through base of 1st metacarpal bone (one side of base)
- rolando's frx: comminuted bennett's fracture (both sides of base)
26
Salter-Harris Classification of Frx
Type I: isolated growth plate fracture (may look normal)
Type II: growth plate fracture + fracture of metaphysis MC
Type III: growth plate fracture + fracture of epiphysis
Type IV: fracture extending across metaphysis, growth plate & epiphysis (needs reduction)
Type V: Growth plate compression injury (may arrest growth) - worst type
27
de quervain tenosynovitis
- stenosing tenosynovitis of abductor pollicus longus + extensor pollicus bravis
- excess thumb use w/ repetitive
28
carpal tunnel
- median nerve entrapment
- 1st, 2nd, 3rd and 1/2 4th digit
- thenar muscle wasting if advanced
-volar splint, steroid inj, sx if refractory
29
dupuytren contracture
- nodules over distal palmar crease or proximal phalanx (esp 4th/5th)
- fixed flexion deformity @ MCP jt
30
hip dislocation
- trauma mc
- posterior MC (90%) - leg shortened, internally rotated and adducted w/ hip/knee slightly flexed
- complication: avascular necrosis
31
hip fractures
- high incidence of avascular necrosis w/ femoral neck fracture
- leg shortened, externally rotated, abducted
- femoral head/neck frx are intrascapsular
- intertrochanteric/subtrochanteric frx are extrascapular
32
legg-calve-perthes disease
- idiopathic avascular osteo of femoral head in kids
- mc children 4-10y, 4x mc in boys
-painless limping x weeks (worse w/ activity)
33
slipped capital femoral epiphysis
- slips posterior and inferior at growth plate
- mc 7-16 yo, obese, AA males during growth spurt
- tx non-weight bearing crutches --> ORIF
34
ACL injuries
MC knee ligament injury
- noncontact pivoting injury
- pop + swelling, +/- knee buckling
- mc in women
35
PCL injuries
MC associated w/ dashboard injuries or fall on flexed knee
| -pivot shift test, posterior drawer test
36
meniscal tears
-degenerative; medial 3x mc (bc more bony attachments)
-locking, popping, giving away, effusion after activities
McMurray's sign
37
patellar and quad tendon ruptures
- forceful quad contraction (quads mc than patellar)
- mc males >40, hx of systemic dz (dm, gout, obesity, ckd)
- inability to extend knee
38
patellar dislocation
valgus stress after twisting injury
mc females, usually laterally
-closed reduction
39
knee (tib-femoral) dislocations
- LIMB THREATENING EMERGENCY
- high velocity trauma
- complications: popliteal artery injuty in 1/3 --> arteriography; +/- peroneal or tibial nerve injury
40
tibial plateau fractures
- axial loading/rotation/direct trauma
- mc in children in MVAs
- lateral plateau mc
- check for peroneal nerve injury (foot drop)
- complications: post degenerative arthritis
41
baker's cyst
synovial fluid effusion is displaced w/ cyst formation
- mass, effusion, clicking, buckling, locking, little pain
- ruptured --> pseudothrombophlebitis syndrome that mimics dvt
- US to rule out dvt and confirm cyst
42
patellofemoral syndrome (chondromalacia)
idiopathic softening/fissuring of patellar articular cartilage
-mc in runners
-anterior knee pain "behind" or around patella
+apprehension sign
43
IT band syndrome
inflammation of iliotibial band bursa
- mc cause of knee pain in runners
- lateral knee pain, esp during onset of running, worse downhill
- lateral condyle tenderness
44
ankle dislocation
- major trauma
| - posterior mc +/- peroneal nerve injury
45
ankle sprain
- 85% involve collateral ligaments (anterior talofibular mc - stabilizes in inversion)
- grade 1/2 (incomplete tears), grade 3 (complete tears)
46
ottawa ankle rules
ankle films:
pain along lateral malleolus, pain along medial malleolus
foot films:
navicular (midfoot) pain, 5th metatarsal pain
inability to walk >4 steps at injury + in ER
47
achilles tendon rupture
- 75% sports related, 30-50y common
- sudden heel pain after push off movement, pop, sudden sharp calf pain
- weak, absent plantar flexion when gastrocnemius squeezed
- splint in slight plantar flex, gradually move towards dorsiflexion to neutral - sx repair
48
maisonneuve fracture
spiral proximal fibular fracture due to rupture of distal talofibular syndesmosis and interosseus membrane as a result of distal medial malleolar fracture and/or deltoid ligament rupture
-distal medial malleolar fracture --> image to jcheck proximal fibula
49
pilon (tibial plafond) fracture
fracture of distal tibia from inpact w/ talus (frx extends into ankle joint)
ORIF
50
stress (march) fracture
3rd metatarsal MC
- localized pain, swelling, tenderness at end of activities; eventually tenderness throughout wt bearing activities
- dx- 50% of x-rays will be negative (+ w/ healing)
- tx- rest, splint or post-op shoe
51
plantar fasciitis
inflam of plantar fascia due to overuse, esp w/ flat feet or heel spur
- pain/tendeness of medial foot (inc w/ dorsiflexion of toes)
- pain usually worse after rest (in am)
- tx- rest, ice, NSAIDS, heel/arch support, stretching exercises, cortico w/ caution (may rupture fascia), sx last resort
52
tarsal tunnel syndrome
posterior tibial nerve compression from overuse, restrictive footwear, edema
- sx- pain/numbness at medial malleolus, heel, sole (like plantar fasciitis except pain increased throughout day)
- pain worse at night and w/ dorsiflexion +TINELS
- tx- rest, NSAIDs --> cortico --> sx
53
bunion (hallux valgus)
deformity of bursa over 1st metatarsal
- hx of poorly-fitting shoes MC, flat feet, RA
- tx- wide-toed shoes, sx if no response
54
hammer toe
deformity of PIP joint - flexion of PIP and hyperextension of MTP + DIP
-seen if 2nd, 3rd or 4th toe longer than 1st, people w/ tight-fitting shoes, OA, RA
55
charcot's joint (diabetic foot)
joint damage and destruction as a result of peripheral neuropathy from DM (or other PVD) --> microtrauma of foot w/out sensation and ANS dysfx leads to bone resorption and weakening
- MC in midfoot
- sx- pain, swelling, mis-shapen foot, ulcer, skin change
- dx- xray shows obliteration of joint space, scattered chunks of bone and fibrous tissue + inc ESR
- tx- rest, non-weight bearing, sx
56
morton's neuroma
degeneration/proliferation of plantar digital nerve --> painful mass near tarsal heads
- mc in women 25-50 esp if wear heels/tight shoes or flat feet
- 3rd metatarsal head mc
- sx- lancinating pain, esp with ambulation
- tx- wide shoes, glucocortico injection (sx if necessary, may cause permanent numbness)
57
jones fracture
transverse frx through diaphysis of 5th metatarsal
- tx- no weight bearing 6-8wks
* repeat xrays bc often NONUNION / MALUNION and may require ORIF/pins
58
pseudojones fracture
transverse avulsion fracture at base (tuberosity) of 5th metatarsal due to plantar flex w/ inversion (not as serious as true jones)
- tx- waling cast 2-3 wks, ORIF if displaced
* more proximal (less distal) fracture than true jones
59
lisfranc injury
disruption btw articulation of medial cuneiform (midfoot bone) + base of 2nd metatarsal
- dx- FLECK sign - frx at base of 2nd metatarsal pathognomonic for disruption of the ligaments
- tx- ORIF and non-weight bearing cast 12 weeks
60
herniated disc (nucleus pulposus)
MC L5-S1 bc jx btw mobile and non-mobile spine (also L4-L5)
sx- pain in dermatomal pattern (inc w/ cough, strain, bend, sit), sciatica
exam- pos straight leg raise +/- pos crossover test, maybe strength, reflex, sensation deficits
61
cauda equina syndrome
serious complication of herniated disc, compresses several nerve roots
- sx- new onset urinary or bowel retention/incontinence w/ saddle anesthesia, uni/bilateral leg radiation, decreased anal sphincter tone on rectal exam (no anal wink)
- tx- neuro ER - corticosteroids to reduce inflam
62
spinal stenosis (pseudoclaudication)
narrowing of spinal canal w/ impingement; >60yo
- sx- back pain w/ paresthesias in one or both extremities, worse w/ extension, prolonged walk/stand, relieved w/ flexion like sit or walk uphill (unlike claudication)
- lumbar flex = inc canal volume
- tx- epidural corticosteroids, laminectomy
63
lumbosacral sprain/strain
acute strain/tear of paraspinal muscles (esp twist/lift)
- sx- back muscle spasms, NO NEURO CHANGES
- tx- maybe brief bed rest (<2 days), NSAIDS/analgesic, +/- muscle relaxers
64
spinal compression frx
- children - "burst" from jumping from height
- elderly - lumbar compression (esp osteoporosis), tumor or systemic illness; pathologic frx in malignancy
- sx- point tenderness
- tx- ortho + neuro consult, analgesics
65
scoliosis
>10 degrees +/- assoc w/ kyphosis (humpback) or lordosis (sway back)
- mc begins 8-10yo, mc F, + family hx
- dx- ADAMS forward bending test, COBB'S ANGLE on A/P films
- tx- +/-brace if 20-40 deg, sx if >40
66
spondylolysis
pars interarticularis defect from either failure of fusion or stress fracture (often from repetitive hyperextension trauma i.e. football, gymnastics)
- often 1st step to spondylolisthesis
- MC back pain in children and adolescents
- MC at L5/S1
- tx- sx relief, activity restrict, PT, brace
67
spondylolisthesis
forward slipping of vertebrae on another
-MC adolescence 10-15yo
-sx- lower back pain +/- sciatica sx, may cause bowel/bladder dysfx
-tx- low grade: sx relief, activity restrict, PT, brace
high grade: sx
68
osteomyelitis
MC <20y (acute) and >50y (chronic)
RF: SS, DM, immunocomp, preexisting jt dz, URIs in kids
acute: hematogenous spread (mc route children, staph)
- hip mc in children
direct inoculation: infx close to bone s/p trauma, sx, prosthetic jt
-sx-
gradual onset days-weeks, signs of bactermia
local signs of inflam/infx, pain over involved bone, dec ROM in near joint, refusal to use joint, sinus tract drainage in chronic
-dx-
BONE ASPIRATION GOLD STD
labs: inc WBC, ESR (if ESR is normal, osteo is unlikely), blood cultures are positive 50%
MRI: mos sensitive in early dz
xray: early: soft tissue swelling and PERIOSTEAL RX (lucent areas of cortical destruction); advanced: sequestrum (segments of necrotic bone separated from living bone by granulation tissue)
-tx-
acute - abx 4-6 wks (2 wks IV) +/- debridement
chronic - sx, cultures, targeted abx
69
septic arthritis
medical ER (can rapidly destroy joint), most monoMO
- hematogenous spread, direct inoculation, contiguous spread
- RF: extremes of age, chronic dz, immunosuppressed, prosthetic jt/sx, chronic arthropathies
-sx- single, warm, swollen, painful joint, dec ROM, tender to palpation, KNEE MC (50%), hip > elbow > ankle/wrists
F/Ch, malaise, pain, diaphoresis
-dx- ARTHROCENTESIS - WBC > 50K, primarily PMNs
WBC > 1.1K in prosthetic joints
-tx- prompt abx guided by gram stain; ARTHROTOMY w/ joint drainage (2-4 wk course)
70
compartment syndrome
muscle/nerve ischemia (dec tissue perfusion)
- closed muscle compartment pressure > perfusion pressure
- MC after fracture of long bones (75%), crush injuries, tight casts or dressings
- sx- PAIN OUT OF PROPORTION, pain on passive stretching earliest sign, tense extremities (firm/wooden feeling), paresthesias; pulselessness and paresis are late findings
- dx- inc intracompartmental pressure >30-45 mmHg (change of pressure = diastolic BP - measured compartment pressure)
- tx- fasciotomy
71
osteosarcoma
mc bone malignancy, mc adolescents (80% <20y)
- produces immature bone (osteoid)
- 2nd peak 50-60yo (esp w/ hx of Paget dz or radiation)
- 90% occur in metaphysis of long bones (FEMUR, tibia, humerus)
- MC METS to LUNGS
-sx- bone pain/ joint swelling, palpable soft tissue mass
-dx- xray: "hair on end" or "sun ray / burst" appearance
codman's triangle - ossification of raised periosteum
-tx- limb-sparing resection (if not neovascular); radical amputation (if neovascular) + chemo
72
ewing sarcoma
giant cell tumor mc in children (mc males 5-25y)
-FEMUR MC and pelvis mc sites (bone also mc site of metastasis)
-sx- bone pain +/- palpable mass, may have joint swelling +/- fever
-dx- lytic lesion, layered periosteal rx "onion skin" on xray
+/- codman's triangle
-tx- chemo, sx, radiation options
73
chondrosarcoma
cancer of cartilage; MC adults 40-75yo
- dx- mineralized chondroid matrix w/ PUNCTATE OR RING + ARC APPEARANCE pattern of calcification
- tx- surgical resection +/- chemo
74
osteochondroma
MC benign bone tumor (esp age 10-20yo) MC males
-begins in childhood, grows until maturity; may precede chondrosarcomas
- dx- pedunculated, grows away from growth plate, involves medullary tissue
- tx- observation; resection if painful or located in pelvis (pelvis mc site for malignant transformation)
75
paget disease (osteitis deformans)
abnormal bone remodeling + disorganized osteoid formation
-mainly western european, 40% autosomal dom
- patho- disordered bone remodeling --> osteoclast bone resorption --> larger, weaker, less compact bones, more vascular and prone to fractures
- lytic phase (inc osteoclast) --> mixed phase --> sclerotic phase (inc osteoblast)
- sx- asymptomatic mc, found incidentally (HIGH ALK PHOS on labs), bone pain, pelvis mc, inc warmth
- skull involvement, deafness (seen in up to 50% due to compression of CN8)
- dx- "blade of grass/flame-shaped" lucency, coarsened trabeculae; skull = cotton wool appearance
- tx- BISPHOSPHONATES (inhib osteoclast activity - dec bone resorption and turnover) or calcitonin
