4. MSK Flashcards
Flail Chest
Cause/PE/Tx/MC site
- Cause: Blunt trauma (3 or more adjacent ribs broken)
- PE
- inspiration - flail segment contract
- expiration - flail segment expands
- Tx: Supportive care (NO CHEST WRAPPING)
- 2 or more possible internal damage, should admission
- MC rib fx - 4-9
- Rib 1-2 - serious
- Rib 9-12 - liver, spleen damage
Compartment syndrome
Cause/Sx/PE/Tx
- Cause: tibial fx
- Sx: out of proportion pain
- PE
- 6 p’s
- Pallor
- Pain
- Pulselessness
- Paralysis (muscle function is gone)
- paresthesia (abnormal dermal sensation)
- poikilothermia (unable to control body temp)
- 6 p’s
- Dx: intracompartmental pressure >30-45 (normal 0-10), Delta pressure 30>, Lab: CK/Myoglobin
- Tx: Emergent fasciotomy
Osteoarthritis
Cause/Sx/PE/Dx/Tx
- Cause: Age related
- Sx: Joint pain with activity
- PE: PIP (Bouchard), DIP (heberden)
- Dx: X-ray (joint narrowing)
- Tx: NSAID, corticosteriod
Osteomyelitis
Cause/Sx/Dx/Tx
- Cause: infection
- General - Staph A
- Sickle cell - salmonella
- cat/dog - pasteurella multocida
- Puncture wound - pseudoma
- Sx: pain over bone, fever
- Dx: X-ray (initial), MRI (best), Bone aspiration (Gold)
- Tx: Abx (2-6 week) - IV for 2 weeks
- Staph A - Nafcillin
- MRSA - Vanco
- Puncture - cipro
- Sickle cell - cipro
- Cat/dog - ampicillin, augmentin
- Spread
- hematogenous - children
Septic arthritis
Cause/Sx/Dx/Tx
- Cause: Staph A infection
- Sx: Fever, joint pain, swelling
- Dx: Arthrocentesis (WBC 50,000 PMN)
- Tx: Gram + - nafcillin, Gram - (Gonorrhea) - Ceftx
Rhabdomyolysis
Cause/Sx/Dx/Tx
- Cause: injury muscle releave CK or myoglobin to blood stream -> kidney
- Sx: edema
- Dx: CK level(initial) , Urine Dark (myoglobin but NO RBC)
- hypocalcemia, Hyperkalemia - ECG check
- Tx: IVF, bicarbonate
- Complications: DIC, ARF, compartment syndrome
Avascular necrosis
Cause/Common site/Dx
- Cause: Corticosteriod use
- Femoral head is common site
- Dx: MRI
Develomental dysplasia of the hip
Cause/PE/Dx/Tx
- Cause: decreased pressure of the femoral head against acetabulum
- PE
- Galeazzi - flex hip both knee not even (postivie)
- Barlow - dislocation occur when adduction
- Ortolani - dislocation occur when abduction
- Dx: US
- Tx: Pavlik harness
Hip dislocation
Cause/MC site/PE/Tx
- Cause: MC MVA trauma
- MC site: Posterior
- PE: leg shorten internal rotated - sciatic nerve injury
- Tx: Emergent reduction
Hip Fx
MC common site/PE/Dx/Tx
- MC common site: Femoral neck
- PE: leg shorten external rotated
- Dx: MRI
- Tx: ORIF
Prepatella bursitis
Cause/PE/Dx/Tx
- Cause: chronic kneeling (house maids knee)
- PE: Dome shape swelling
- Dx: Aspiration to rule out septic, inflammation
- Tx: NSAID, steriod injection
Patella dislocation
Cause/PE/Tx
- Cause: twisting injury
- MC common: lateral dislocation
- PE: patella displaced, apprehension sign (push laterally patient contract qudriceps
- Tx: Closed reduction and knee immobilizaer
Patella fx
Cause/Dx/Tx/Special comment
- Cause: Direct Trauma
- Dx: Sunrise view x-ray
- Tx
- Nondisplaced - knee immobilize x 6 weeks
- Displaced - surgery
- Special comment: bipartitie patella - if both broken part is not sharp and smooth the means not related to trauma
Knee dislocation
Cause/Dx/Tx
- Cause
- MC anterior - hyperextension
- Posterior - knee flexed and anterior tibia blow
- Dx: X-ray
- Nerve - common peroneal
- Artery - Popliteal artery
- Tx: Emergent reduction
Meniscus injury
Cause/Sx/PE/Dx/Tx
- Cause: Twisting
- Sx: Knee locking, effusion after activity
- PE: McMurray (tibia externally or internally rotate pop or click)
- Dx: MRI
- Tx: NSAID, PT
MCL vs LCL
PE/Tx
- PE
- MCL - vaLgus
- LCL - vaRus
- Tx: NSAID, complete tear - surgical
ACL vs PCL
Cause/Sx/PE/Tx
ACL
- Cause: Sports related Pivoting injury (MC knee ligament injury)
- Sx: audiable pop, swelling
- PE: Lachman
- Tx: Surgical
PCL
- Cause: Dashboard injury (hit proximal anterior tibial when knee flexed)
- Sx: dull aching pain and swelling
- PE: Posterior drawer test
- Tx: surgical
Ankle sparin
Cause/MC site/Sx/Dx/Tx
Ankle dislocation
MC type/Tx
- Cause: foot inversion
- MC site: ATFL (ankle talofibular ligament)
- Sx: Swelling and tenderness
- Dx: Ottawa ankle rule (x-ray)
- Tenderness Posterior tip of lateral or medial malleoulus
- Tenderness on navicular, fifth metasal (mid foot)
- Inability to bear weight 4 step
- Tx: PRICE (Protect, rest, ice, compress,elevation)
- MC type: Posterior
- Tx: close reduction
Type of fracture
SALTR
- Type of fx
- open - bone expose to outside
- Closed - fx inside
- SALTR
- Slipped
- Above
- Low
- Through
- Rammed
Lisfranc injuries vs Jones and Psedo jones fx
PE/Tx
Lisfranc
- PE: Pain tenderness at base of 2nd metatarsal (Malunion possible)
- Tx: Surgical
Jones and Pseudo jones fx
- PE: Fifth metatarsal diaphysis fx (Jone), Avulsion (pseudo jone)
- Tx: Cast 6-8weeks (Jone), 2-3weeks (pseudo jone)
Morton’s neuroma
Cause/Sx/Dx/Tx
- Cause: Painfull mass at 3rd metatarsal head
- Sx: Pain with walking
- Dx: MRI
- Tx: Wide shoes, Glucocorticoid injection -> Surgical remove if failed 1st tx
Bunion vs Hammer
Joint involve/Tx
- Bunioin
- Location: 1st metatarsal deviation
- Tx: Wide shoes, surgical if failed 1st tx
- Hammer toe
- Location: 2-4th metatarsal PIP flex DIP extend
- Tx: Wide shoes, surgical if failed 1st tx
Tarsal tunnel syndrome
Cause/Sx/Tx
- Cause: posterior tibial nerve compressed
- Sx: Numbness at medial malleolus heel and sole
- PE: Tinel sign
- Tx: NSAID, corticosteriod inject
Plantar fasciitis
Cause/Sx/PE/Tx
Children with heal pain?
- Cause: inflammation of plantar fascia
- Sx: heel pain, tenderness worse at night
- Dx: X-ray normal, flat foot
- Tx: Rest, Ice, NSAID
Sever disease, 8-12yo, self limied
Foot Stress fx
Cause/Location/Dx/Tx
- Cause: overuse foot (athletes & military)
- Location: 3rd metatarsal
- Dx: X-ray normal
- Tx: Rest
Baker’s cyst
Cause/Sx/Tx
- Cause: fluid effision is displaced with cyst formation
- Sx: Painless cyst at knee
- Tx: ICE, rest, NSAID
Osgood-Schlatter disease
Cause/Sx/PE/Tx
- Cause: Rapid growth at tibial tuberosity 10-15 yo
- Sx: Knee Pain when runs
- PE: Tenderness over tibial tuberosity
- Tx: ICE, Rest, NSAID
Patellofemoral syndrome
Sx/Dx/Tx
- Sx: knee pain behind or around the patella (usually runner)
- Dx: Apprehension sign
- Tx: NSAID, rest
ITB syndrome
Sx/Dx/Tx
- Sx: lateral knee pain (runner)
- Dx: Ober test
- Tx: NSAID, rest
Achilles tendon rupture
Sx/Risk/PE/Tx
- Sx: sudden pop sound, sharp calf pain
- Risk: hx of using FQ
- PE: Thompson test (squeez calf to see plantar flextion)
- Tx: Plantar flexed Splint (1st) -> surgical repair
Legg-Calve-Perthes disease
Cause/Sx/Dx/Tx
- Cause: Avascular necrosis of femoral head in children (4-10)
- Sx: painless limping
- Dx: X-ray
- Tx: observation (usually revacularization at 2 yo)
- Limit activity
Slipped capital femoral epiphysis
Cause/Sx/Tx
- Cause: femoral head epiphysis slips
- MC patient: obese male 12-16 yo
- Sx: hip, thigh or knee pain with limp
- Dx: X-ray
- Tx: non-weight bearing clutch
Common peroneal neuropathy
Cause/PE/Tx
- Cause: Fx of proximal fibula
- PE: foot drop w/ numbness
- Tx: ankle splint
Benign Tumor
Name/Patient/Dx/Tx
- Osteocondroma
- Patient: 10-20y M
- Dx: X-ray grows away from growth plate
- Tx: Observation
Maliganant tumor
3 type name/Patient/MC site/Dx/Tx
- Osteosarcoma
- Patient: adolescent (20yo>) or 50<
- MC site: femur
- Dx: X-ray sun burst appearance or hair on end
- Tx: surgical, chemo
- Special comment: MC bone malignancy (MET to lung)
- Ewing sarcoma
- Patient: children (5-25yo)
- MC site: femur
- Dx: X-ray onion skin
- Tx: surgical, chemo
- Chondrosarcoma
- Patient: Adult (40-75yo)
- Dx: X-ray punctate or ring & arc appearance
- Tx: Surgical
Fibromyalgia
Sx/Dx/Tx
- Sx: wide spread muscle pain
- Dx: diffuse pain 9 out of 18 site
- All lab Normal
- Tx: exercise (swimming), pregabalin (FDA approved)
Gout vs pseudogout
Crystal type/Synovial Fluid/PE/Tx/Chroinc Tx/Special comment
Gout
- Crystal type: Monosodium urate
- Synovial Fluid: Negative needle shape
- PE: First MTP (podogra)
- Tx: NSAID (1st), colchicine, Corticosteroid
- Chronic Tx(prevention): Allopurinol (Never use when gout attack occur)
- Special comment: HCTZ,, Niacin makes worse
Pseudogout
- Calcium pyrophosphate
- Positive rhomboid shape
- PE: Knee swelling
- Tx: NSAID(1st), colchicine
Juvenile idiopathic arthritis
3 type/Age/Sx/Tx
- 3 type/Sx
- Pauci articular - less than 5 joint but major joint
- Systemic - Salmon colored rash
- Polyarthicular - more than 5 joint but small joint
- Age: less than 16 yo
- Tx: NSAID, MTX
Osteoporosis
Cause/Risk/Dx/Tx
- Cause: decline in bone mass
- Risk: Steriod use
- Dx: Dexa scan -2.5 (osteoporosis) 2.5-1.0 (osteopenia)
- Tx: Bisphosphonates
- Complication: Osteonecrosis of the jaw, pillesophagitis
Polyarteritis Nodosa
Cause/Age/Related/PE/Dx/Tx
- Cause: Inflammation of vasculitis
- Age: 40-50 yo
- Related Dz: Hep B
- PE
- Tender lumps under the skin thigh and lower legs
- Derm: Livedo reticularis (startburst livedo)
- Dx: Bx (necrotizing arteritis) - definitive
- Lab - ESR high
- Tx: Steriods
Polymyalgia Rheumatica
Cause/Sx/Hx/Dx/Tx
- Cause: inflammation
- Sx: stiffness hip shoulder neck in the morning
- Hx: Giant cell artery
- Dx: ESR high
- Tx: Corticosteriod
Dermatomyositis/Polymyositis
Cause/Sx/PE/Dx/Tx
- Cause: inflammation
- PE: purple rash on eyelid (heliotrope), progressive weakness of three month
- Dx: CK, Aldolase high, Anti Jo
- Tx: Steroid
Reactive arthritis
Sx/Dx/Tx/Related dz
- Sx: uveitis, arthritis, urethritis
- Dx: HLA B27
- Tx: NSAID
- Related dz: chlamydia
Rheumatoid arthritis vs Ostoarthritis (Main difference Only)
Sx/Dx/Tx
- Main difference sx
- RA - DIP spare, morning stiffness, Osteopenia, constitutional sx (fever, weakness, muscle pain)
- PE: Boutonniere deformity, Mallet
- OA - DIP involove, evening stiffness, Osteophytes
- PE: heberden, bouchard
- RA - DIP spare, morning stiffness, Osteopenia, constitutional sx (fever, weakness, muscle pain)
- Dx: RF, Anti-CCP
- Tx: DMARDs
- monitor CBC
Sjogren syndrome
Sx/Dx/Tx
- Sx: Dry mouth, dry eye
- Dx: Anti Ro, Anti La test Positive
- Schirmer test (tear production low)
- Tx: Pilocarpine, artificial tear
SLE (systemic lupus erythematosus)
Sx/PE/Dx/Tx
- Sx: Fever, Joint pain
- PE: Malar rash
- Dx: ANA (initial), Anti dsDNA(specific), Anti smith
- Tx: NSAID, hydroxychloroquine, sun protection
Scleroderma
Sx/Dx/Tx
- Sx: Thicken skin, CREST (calinosis, raynaud, esophageal modility, Sclerodactyly, tenlangiectasia)
- Dx: Anti-Centrome, Anti-Scl 70
- Tx: DMARDs
Ankylosing Spondylitis
Cause/Sx/Dx/Tx
- Cause: HLA B27 positive
- Sx: Worse in the morning, better with activity
- Dx: ESR high, X-ray bamboo spine (spine fusion)
- Tx: NSAID, PT
Cauda equina syndrome
Cause/Sx/Dx/Tx
- Cause: herniated disc
- Sx: acute lower back pain with numbness
- PE: saddle anesthesia, decreased rector tone
- Dx: MRI
- Tx: Emergency operative decompression
Hernidated disk
Sx/Location/PE/Dx/Tx
- Sx: back pain radiate to the thigh
- Location - L4 (thigh), L5 (lateral thigh) S1 (calf, posterior of leg)
- PE: Straight leg test positive
- Dx: MRI
- Tx: PT, surgical intervention
Scoliosis
Type/Dx/Tx
- Type
- Scoliosis - left or right curve
- Kyphosis - humpback
- lordosis - sway back
- Dx: Cobb angle on x-ray
- Tx: Observe (if 0-10), brace (20-40), surgical (40<)
Spinal stenosis
Cause/Sx/Dx/Tx
- Cause: compression on spinal cord
- Sx: leaning forward relieves pain with old age
- Dx: MRI
- Tx: Lumbar epidural injection of corticosteriod
Back sprain/Strain
Cause/Hx/Sx/Tx
- Cause: paraspinal muscle injury
- Hx: lifting object
- Sx: pain with activity but NO neurologic problem
- Tx: NSAID, bad rest
- Red flag of back pain for image test
- Night pain and weight loss
- fever, chill and sweats
- Actue bony tenderness
- Morning stiffness
Toticollis
Cause/PE/Tx
- Cause: Shorten neck muscle
- PE: Contract sternocleidomastoid muscle
- head tiltedtoward affected muscle and chin is away from affect muscle.
- Tx: Daily stretch and PT
Spinal Trauma
Sx/PE
- Brown-sequard syndrome
- Cause: Panetrating trauma damage spinal hemisection
- PE
- Ipsilateral - motor, position loss
- Contralateral - Pain, temperature
- Anterior cord syndrome
- Cause: Flexion injury
- PE: motor, pain, temp loss
- propriception and vibratory intact
Neck Fx
MOA/Dx/Tx
C1 Jefferson fx
- MOA: Axial load (Football, diver)
- Dx: Xray (odontoid)
- Tx: halo collar
C2 hangman fx
- MOA: MVA (hyperextension)
- Dx: CT
- Tx: Collar if 3mm less, operative more than 5mm
C6 or C7 fx (clay shoveler)
- MOA: abrupt flexion
- Dx: X-ray (avulsion fx)
- Tx: immobilization
Anterior vs posterior dislocation
Sx/Tx
Anterior
- Sx: Externally abduct MC dislocation
- Dx: X-ray Y view, (hill sachs lesion - humerous head, bankart lesion - glenoid inferior)
- Tx: immobilization (axillary nerve check - pinprick sensation over the deltoid)
Posterior
- Sx: Internally adduct
- Dx: X-ray AP
- Tx: immobilization
AC joint seperation
Cause/Dx/Tx
- Cause: Football direct blow
- Dx: X-ray
- Tx: sling immobilization
- Grade
- 1 - No rupture
- 2 - AC rupture
- 3 - AC, CC rupture
Adhesive capsule
Sx/Tx
- Sx: Progressive stiffness for 18-24 month
- Tx: PT
Rotator cuff injuries
Type/Muscle involve/Sx/PE/Tx
- Type
- Tendonitis - young <40
- Tear - old 40<
- Muslce involve: SITS
- Supraspinatus MC
- infraspinatus
- Teres minor
- Subscapularis
- Sx: Can’t raise arm up
- PE: Neer and hawk test
- Tx: Wall climing exercise, Rest, ICE, NSAID
Humeral fx
Other injuries/Tx
Clavical fx
Patient/Tx
Elbow fx (radial head or supracondyler)
PE/Dx
Humeral
- Other injuries: Radial nerve
- Tx: Sugar tong
Clavical
- MC Children
- Tx: mid 1/3 - sling, proximal 1/3 orthopedic surgery
Elbow
- PE: can’t fully extend
- Dx: X-ray Fat pad sign, Sail sign
- Children - supracondyler
- Adult - radial head
- Tx: Sling or splint
Flexor tenosynovitis
Pathogen/Cause/Sx/Dx/Tx
- Pathogen: Staph A
- Cause: infection
- Sx
- swelling finger (sausage like)
- pain with extension
- finger flexed
- tenderness near tendon sheath
- Dx: aspiration or Bx (definitive)
- Tx: I&D + Abx
Olecranon bursitis vs fx
Sx/Complication/Tx
Olecranon Fx
- Sx: Swelling at elbow can’t full extend
- Complication: Ulnar nerve
- Tx: Reduction
Olecranon bursitis
- Sx: Abrupt gooes egg (boggy, red elbow)
- Complication: Septic bursitis
- Tx: Rest, NSAID
Scaphoid fx
Sx/Complication/Dx/Tx
- Cause: FOOSH
- PE: Anatomic snuff box tenderness
- Complication: avascular necrosis
- Tx: always Thumb spica splint
Colles vs smith fx
Cause/Dx/Complication/Tx
- Colles
- Cause: fall w/ Wrist extension
- Dx: dinner fork X-ray
- Complication: EPL rupture
- Tx: sugar tong splint
- Smith
- Cause: fall w/ wrist flexed
- Dx: garden spade X-ray
- Complication: medial nerve
- Tx: sugar tong splint
CRPS (Complex regional pain syndrome)
Hx/Sx/Tx
- Hx: hx of fx or soft tissue injured and healed
- Sx: Pain started after healed
- Tx: NSAIDs (1st), Vitamin C prophylaxis
Mallet vs boutonniere vs swan neck
PE/Tx
- Mallet
- DIP flexed
- Boutonnier
- PIP Flexed
- Swan neck
- PIP hyperextend
- DIP flexed
- Tx: Splint anormal part
Game vs skier thumb
Ligament involve/Sx/Tx
- Ligament - ulnar collateral
- Sx
- Game - chronic
- Skier - acute
- Tx: Thumb spica
Boxer fx
Cause/Tx
- Cause: fist fighting 4,5th finger broken
- Tx: Ulnar gutter splint
- Always check for bit wound
- if bitten - augmentin
- Always check for bit wound
Carpal tunnel syndrome
Sx/Dx/Tx/Other similar dz
- Cause: median nerve compressed
- Sx: night pain, 1-3 1/2 finger, thenar muscle wasting
- Dx: Phalen test (best), tinel
- Tx: Volar splint
- Other similar dz: pronator dz (medial nerve compressed but NO night pain)
Dypuytren contracture
Sx/Tx
- Sx: Crease, nodule proximal phalanx
- Tx: Corticosteriod injection
de Quervain tenosynovitis
Cause/Sx/Dx/Tx
- Cause: APL + EBP
- Sx: Radial side pain
- Dx: Finkelstein test (pain with ular deviation)
- Tx: Thumbspica
- night of heavy drinking and wrist drop?
- MUGR fx?
- Lateral vs medial epicondylitis
- Nursemaid elbow
- Spill teacup x-ray
- Most serious carpal fx (complication)
- Saturaday night palse
- Radial nerve compress C6-8
- Tx: PT, pain management
- MUGR
- MU - monteggia - ulnar fx
- GR - Galeazzi - Radial fx
- Tx: ORIF
- Lateral epicondylitis
- lateral - extension resist - ECRB
- Medial - flexsion resist
- Tx: RICE
- Nursemaid
- Sx: Pulling with one hand, 5yo>
- Tx: Manual reduction (supinate and flex)
- Lunate dislocation
- Lunate fx (avascular lunate - keinbock dz)