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MSK - Cortex > Week 4 > Flashcards

Week 4 Flashcards

1
Q

what is cause of bony nerve root entrapment

A

OA of the facet joints can result in osteophytes impinging on exiting nerves

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2
Q

Tx of bony nerve root entrapment

A

surgical decompression

trimming of the impinging osteophytes

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3
Q

what causes cauda equina syndrome

A

large central disc prolapse can compress all the nerve roots of the cauda equina

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4
Q

why is cauda equine syndrome a surgical emergency

A

affected nerve roots include the sacral nerve roots (mainly S4 & S5) controlling defaecation and urination

prolonged compression can potentially cause permanent nerve damage

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5
Q

what can be the outcome if cauda equine is not managed

A

colostomy and urinary diversion

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6
Q

Symptons/Signs of C.E syndrome

A 
bilateral leg pain
paraesthesia
numbness
saddle anaesthesia - numbness around sitting area and perineum
urinary/faecal incontinence
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7
Q

what is mandatory is suspected C.E. syndrome

A

rectal examination (PR)

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8
Q

IX for C.E. syndrome

A

MRI

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9
Q

red flags of back pain

A

back pain 60 y/o
nature of pain - constant, severe, worse at night
systemic upset - fever, night sweats, weight loss, fatigue

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10
Q

what causes spontaneous crush fractures of the spine

A

severe osteoporosis

causes acute pain and kyphosis

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11
Q

what are the symptoms of cervical spondylosis

A

slow onset stiffness + pain in the neck

can radiate to shoulders and the occiput

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12
Q

Mx of cervical spondylosis

A

physio

analgesics

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13
Q

complications of cervical spondylosis

A

osteophytes impinge on exiting nerve roots resulting in radiculopathy involving upper limb dermatones and myotomes

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14
Q

what does acute/degenerative disc prolapse cause in the cervical spine and how does it present

A

nerve root compression
shooting pain down dermatomal distribution
loss of reflexes depending on the nerve root affected

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15
Q

Ix for cervical disc prolapse

A

MRI

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16
Q

why should you be wary of disc prolapses found on MRI

A

with age, there is a number of symptomatic disc prolapse
results in ‘false positives’
the disc prolapse is not responsible for the symptoms
needs to be considered in adjunction with clinical findings

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17
Q

who can get atraumatic cervical spine instability and why

A

RA
atlanto-axial subluxation
can compress the spinal cord and be fatal

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18
Q

Tx of cervical spine instability

A

less severe - with a collar to prevent flexion

severe - surgical fusion

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19
Q

what can be upper motor neurone signs of cord compression

A

wide based gait
weakness
increased tone
upgoing plantar response

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20
Q

role of the rotator cuff muscles

A

pulling the humeral head into the glenoid to provide a stable fulcrum for the powerful deltoid muscle to abduct the arm

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21
Q

roughly, what are the causes of pain in the shoulder by age group

A

young adult - instability
middle age - rotator cuff tear/frozen shoulder
elderly - glenohumeral OA

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22
Q

what is impingement syndrome

A

tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight sub-acromial space during movement producing pain

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23
Q

causes of impingement syndrome

A

Tendonitis Subacromial bursitis
Acromioclavicular OA with inferior osteophyte
A hooked acromion Rotator cuff tear

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24
Q

what does a painful arc show

A

Supraspinatus tendon is inflamed

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25
Sx of impingement syndrome
pain - can radiate to deltoid and upper arm tenderness - below lateral edge of acromion +ve Hawkins Kennedy
26
Tx for impingement syndrome
NSAIDS/Analgesic/Physio up to 3x steroid injections in subacromial subacromial decompression surgery
27
classic Hx in rotator cuff tear
sudden jerk (eg holding a rail on a bus which suddenly stops) in a patient >40 years of age, with subsequent pain and weakness
28
features of rotator cuff tear
can be partial or full thickness and usually involve suprapinatus
29
Sx of rotator cuff tear
- Weakness of initiation of abduction (supraspinatus) - internal rotation (subscapularis) - external rotation (infraspinatus) - wasting of supraspinatus
30
Ix for rotator cuff tear
USS - 1st line | MRI - 2nd line
31
classic history of Adhesive capsulitis/frozen shoulder
disorder characterized by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18‐24 months
32
what is the principle clinical sign of frozen shoulder
loss of external rotation
33
timeline of frozen shoulder
initially pain which will subside in 2-9 months stiffness increases from 4-12 months stiffness gradually 'thaws'
34
what is frozen shoulder associate with
diabetes hypercholesterolaemia Dupuytren's disease
35
Tx of frozen shoulder
physio, analgesics | intra-articular injections in gleno-humeral
36
Hx of acute calcific tendonitis
acute severe shoulder pain | calcium deposition in the supraspinatus tendon
37
Ix for acute calcific tendonitis
x-ray
38
Tx for acute calcific tendonitis
subacromial steroid local anaesthetic injection self-limiting
39
surgical Tx for traumatic anterior dislocation
Bankart repair
40
who has atraumatic instability
Idiopathic ligamentous laxity Ehlers-Danlos Marfan's
41
what are secondary causes of carpal tunnel syndrome
``` RA Pregnancy Diabetes Chronic renal failure Hypothyroidism Wrist Fractures e.g. Colles ```
42
presentation of carpal tunnel syndrome
parathesiae in the median nerve innervated digits (thumb and radial 2½ fingers) usually worse at night, loss of sensation weakness of the thumb or clumsiness
43
Ex of carpal tunnel syndrome
loss of sensation | muscle wasting of the thenar exminence
44
Tests for carpal tunnel syndrome
Tinel's test | Phalen's test
45
Ix for carpal tunnel syndrome
NCS
46
Sx of CUBITAL tunnel syndrome
paraesthesiae in the ulnar 1½ fingers | weakness in ulnar nerve innervated muscle - 1st dorsal interosseous and adductor pollicis
47
causes of cubital tunnel syndrome
Osbourne's fascia - tight band of fascia forming the roof of the tunnel Tightness at the inter muscular septum
48
Ix of cubital tunnel syndrome
NCS
49
clinical feature of tennis elbow
painful and tender lateral epicondyle | pain on resisted middle finger + wrist extension
50
what type of elbow arthritis is more common
RA
51
Surgical Tx of elbow arthritis
Arthritic change at the radio‐capitellar joint - surgical excision of the radial head Elbow severely affected - Total Elbow replacement
52
what is Dupuytren's contracture associated with
Peyronie’s disease - affects the penis | Ledderhose disease - affects the feet
53
what degree of Dupuytren's contracture can be tolerated by MCP joint
up to 30 degrees
54
pathogenesis of trigger finger
- tendonitis of flexor tendon can result in nodular enlargement - movement of finger produces a clicking sensation as nodule catches on pulley - can be painful, finger appears locked in flexed position - have to forcible manipulate finger to regain extension (painful)
55
what fingers are commonly affected with trigger finger
middle + ring finger
56
Tx for trigger finger
steroid injection
57
division of what pulley does not affect function
A1 pulley
58
features of OA in the hand
DIP affected Herberden's nodes - stiffness and bony thickening Mucous cyst - dorsal ganglion PIP can also be affected Bouchards nodes
59
Surgical Tx of OA in the hands
mild to moderate - removal of osteophytes and excision of mucous cyst severe - arthrodesis (esp if in index finger to preserve pinch grip) can also do replacement arthroplasty 1st CMCjt - arthroplasty or fusion
60
what are the deformities of RA that affect the hand
``` volar MCPJ subluxation Ulnar deviation Swan neck deformity Boutonniere deformity Z-shaped thumb ```
61
what is swan neck deformity
hyperextension at PIPJ with flexion DIPJ
62
what is boutonniere deformity
flexion at PIPJ with hyperextension at DIPJ
63
what surgery can prevent tendon rupture
Tenosynovectomy
64
why do we not aspirate ganglion cyst
recurrence rate is high
65
causes of AVN
``` idiopathic alcohol abuse steroids hyperlipidaemia thrombophilia ```
66
Ix of AVN
MRI - 1st line | X-ray - see classic 'hanging rope sign'
67
Tx of AVN
if caught early - drill holes up femoral neck to relieve pressure/decompression collapsed - THR
68
signs of Trochanteric bursitis / gluteal cuff syndrome
pain and tenderness in the region of the greater trochanter with pain on resisted abduction.
69
what is 'pseudo-locking'
knee becomes stuck with temporary difficulty straightening the leg not the same as 'locking' in bucket handle tear
70
what do people with ACL ruptures complain of
rotatory instability with their knee giving way when turning on a planted foot
71
if unable to examine knee, what is the Ix of choice
MRI
72
what type of meniscal tears should be considered for repair
fresh longitudinal tears involving the outer 1/3 of the meniscus in a younger patient
73
rupture of which knee ligament has the best chance of healing
medial collateral ligament
74
what can cause anterior knee pain, worse going down hill, grinding sensation and stiffness siting long time
patellofemoral dysfunction Tx- physio
75
patellar instability
occurs with a direct blow/sudden twist of the knee almost always dislocates laterally may reduce when knee is straightened
76
what happens when the patella dislocates
medial patellofemoral ligament tears osteochondral fracture may occur lipohaemarthosis
77
what can be seen on x-ray when the patella dislocated
lipo‐haemarthrosis
78
what is hallux valgus
deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself
79
who gets hallux valgus
RA Inflammatory arthropathies MS Cerebral palsy
80
what is a bunion
inflamed bursa over the medial 1st metatarsal head
81
surgical Tx of hallux valgus
osteotomies - to realign bone | soft tissue procedures - to tighten slack tissues and release tight tissues
82
what is OA of 1st MTPJ called
Hallux rigidus
83
gold standard Tx of hallux rigidus
arthrodesis
84
what is presenting complaint of morton's neuroma
burning pain and tingling radiating into the affected toes
85
Ix for morton's neuroma
Mulder's click test US - first line imaging
86
what is most commonly affected by metatarsal stress fracture
2nd metatarsal followed by 3rd
87
Ix for metatarsal stress fracture
Bone scan | X-ray - may not showing anything till 3 weeks after
88
what antibiotics can cause achilles tendonitis/rupture
Quinolone antibiotics (ciprofloxacin etc)
89
Tx of achilles tendonitis
rest physio heel raise splint/boot self-limiting
90
what is simmonds test
No plantarflexion of the foot is seen when squeezing the calf
91
what are signs of plantar fasciitis
Pain with walking is felt on the instep of the foot with localized tenderness on palpation of this site.
92
role of tibialis posterior tendon
support the medial arch of the foot

MSK - Cortex (5 decks)

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