5. MSK Flashcards
What is kyphosis?
Abnormal posterior convexity of thoracic spine, causing a hunch back and back pain/stiffness.
How can kyphosis be corrected?
With a brace if young.
What is lordosis?
Abnormal posterior concavity of lumbar or cervical spine, causes a saddle back and back pain/stiffness.
How can lordosis be corrected?
With a brace if young.
What is scoliosis?
Abnormal three-dimesnional abnormality of the spine, with some lateral deviation, and potentially a degree of twisting.
What can scoliosis lead to?
Issues with posture, and very rarely back pain.
How can scoliosis be treated?
With bracing.
What is a slipped disc?
Nucleus polposus herniates, and as a result leaks out from the centre of the intervertebral disk in either a postero-lateral or psoterior direction.
What are the consequence of a slipped disc?
If in postero-lateral direction, pain. If posterior direction, paralysis from spinal cord compression in worst-case scenario.
Which age is slipped disc more common in?
More likely as age increases as discs degenerate.
What are the most likely levels for slipped discs?
L4-L5, or L5-S1.
What causes whiplash?
Sudden jerking movement of the head.
What is whiplash?
Sudden jerking of the head damages ligaments and muscles and can dislocate vertebrae.
How does whiplash affect C5 and C6?
It causes them to adopt a sigmoid shape and causes C5 and C6 to hyperextend, moving them outside their range of movement and leaving them vulnerable to a dislocation.
What are the results of whiplash?
Pain, and some partial paralysis if the spinal cord is damaged.
Who are intracapsular fractures of the femur common in?
Older patients and women.
What is the result of intracapsular fracture of the femur?
Medial femoral circumflex artery damaged so avascular necrosis of the femoral head.
How does intracapsular fracture of the femur present?
Shortened and laterally rotated leg.
How are intracapsular fractures dealt with?
Hip replacement.
Who are extracapsular fractures of the femur common in?
Younger patients.
How does an extracapsular fracture of the femur present?
Shortened and laterally rotated leg.
What causes avulsion of the greater trochanter?
Huge force, like a car accident.
What is the consequence of avulsion of the greater trochanter?
Attachment of gluteus medius and minimum means they can’t perform their function so positive Trendelenberg’s test.
What causes mid shaft femur fracture?
Lots of force, car accident of crushing.
What are the consequences of mid shaft femur fracture?
Leg shortening from overriding of spiral fracture fragments, easily comminuted so takes a year to heal, risk of femoral artery damage.
What causes proximal fracture of the tibia?
Bumper car break in road traffic accident.
What is a complication of proximal tibia fracture?
Knee joint issues as cruciate and tibial collateral ligament attachment site damaged.
What causes stress fracture of the tibia?
Repetitive force on the tibia when the bone isn’t strong enough.
What is the consequence of stress fracture of the tibia?
Tibia shortening from overlying of bone fragments.
What causes distal fracture of the tibia?
Overeversion of the ankle, forces talus against medial malleolus and fractures it.
What is a bimalleolar fracture?
Fracture of medial malleolus accompanied by lateral malleolus fracture.
What causes proximal fibula fracture?
Bumper break.
What is the risk of proximal fibula fracture?
Damage to common fibula nerve.
What causes distal fibula fracture?
Overinversion causing transverse fracture or excessive external rotation causing spiral fracture.
What causes talar neck fracture?
Excessiver dorsiflexion causes neck to snag on tibia and snap off, e.g. foot on break in road traffic accident.
What is a complication of talar neck fracture?
Disrupted blood supply to talus so avascular necrosis.
Why is there minimal displacement of fragments in talar fractures?
Malleoli hold everything together.
What causes talar body fracture?
Jumping from a height, the force is transmitted through calcaneus into talus.
What causes calcaneal fractures?
Falling from a particularly high heigh.
What are the consequences of calcaneal fractures?
Subtalar joint disrupted, joint becomes arthritic so inversion and eversion is difficult.
What can cause metatarsal fractures?
Dropping a heavy object on bones, stress fracture, excessive inversion.
What causes a femoral-radial pulse delay?
Aortic coarctation.
What signals ischaemic foot/leg?
Absent pulses of distal lower limb and popliteal.
What is deep vein thrombosis from?
Formation of a clot in a deep vein of the lower limb from hypercoagulability or stasis of blood.
What are the symptoms of DVT?
Pain, swelling, and tenderness distal to blockage.
What are the risks of DVT?
Clot embolising to the lungs.
How is pulmonary embolism from DVT prevented?
High risk patients are given heparin short term or warfarin long term.
What causes varicose veins?
Incompetence of the valves in the superficial leg veins. Backflow of blood causes vein distension and tortuous path.
What is the consequence of chronic valve disease in the superficial leg veins?
Increased venous pressure leading to bruising, brown pigmentation, and ulceration.
How is chronic valve disease in the superficial leg veins treated?
Repairing and reconstructing the valves, cut the veins or strip them.
What is a risk of stripping superficial leg veins?
Damage to the saphenous nerve.
Where is the femoral pulse felt?
The mid point between the ASIS and the pubic symphysis.
Why is the femoral artery being superficial clinically relevant?
It can be accessed for coronary angiograms and stents.
What is a femoral hernia?
Part of the bowel protrudes into the area.
What is a Baker’s cyst?
Inflammation of the semimembranous bursa secondary to arthritis of the knee joint.
What is a popliteal aneurysm?
Dilation of the popliteal artery that compresses other structures in the popliteal fossa.
What can cause plexopathy of the lumbar and sacral plexuses?
Tumours/ space occupying lesions, diabetic amyotrophy, idiopathic plexopathy.
How is lumbosacral plexopathy treated?
Underlying factors are eliminated and steroids can help.
What is the presentation of femoral nerve damage at the hip?
Difficulty extending leg and flexing hip. Visible atrophy of quadirecps and desensitisation over cutaneous nerve distribution.
What is the presentation of saphenous nerve damage?
Pain and paraesthesia over posterior, anterior and medial leg, and medial edge of foot.
What is the presentation of obturator nerve damage at pelvis?
Weakened adduction, leading to posture and gait issues. Paraesthesia of medial anterior thigh.
What is the presentation of sciatic nerve damage in the gluteal region?
Loss of knee flexion, difficulty moving ankle and foot. Pain below knee except saphenous nerve innervation.
What is the presentation of tibial nerve damage in the posterior leg?
Loss of plantar flexion, flexion of toes, and weakened inversion of foot. Pain over cutaneous distribution.
What is the presentation of common fibular nerve damage at the neck of the fibula?
Loss of dorsiflexion so permanently planterflexed - foot drop. Gait issues and paraesthesia over posterolateral leg, dorsum of foot and skin between 1st and 2nd toes.
What is the presentation of entrapment of the superficial fibular nerve?
Pain and paraesthesia over cutaneous distribution.
What is the presentation of direct damage to the superficial fibular nerve?
Loss of eversion and paraesthesia over cutaneous distributions.
What is the presentation of deep fibular nerve damage in the anterior compartment?
Foot drop so abnormal gait. Pain over skin between 1st and 2nd digits.
What is the presentation of deep fibular nerve damage at the ankle?
Pain over skin between 1st and 2nd toes.
What causes the hip joint injury - slipped upper femoral epiphysis?
Minor trauma to the hip joint in a teenager, the epiphysis within the femoral neck slips.