Clinical MSK Flashcards
GALS screening questions for musculoskeletal history
Do you have any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?
A sensory nerve supplying a JOINT also supplies the MUSCLES
moving the joint and the SKIN overlying the insertions of these muscles
Hilton’s Law
e.g. musculocutaneous nerve gives sensory supply to anterior capsule of elbow
The “rule of 3” in surgery for traumatic peripheral nerve injury
Clean + sharp injuries: immediate surgery within 3 days
Blunt/ contusion injuries: early surgery within 3 weeks
Closed injuries: delayed surgery within 3 months
4 signs of osteoarthritis shown on X-ray
- Reduced joint space
- Subchondral sclerosis (whitening of bone)
- Development of osteophytes
- Subchondral cyst formation
Definition of an injury
Damage to any part of the body due to the application of mechanical force
Calculating the kinetic energy of a weapon causing an injury
Kinetic energy = 1/2mass x velocity
3 types of blunt force injuries
Contusions (bruises) = burst blood vessels in intact skin
Abrasions (graze, scratch) = epidermis scraped off
Lacerations (cut/tear) = tear/split of skin due to crushing
Factors affecting the prominence of a contusion (bruise)
Skin pigmentation Depth and location Amount of s/c fat Age Coagulative disorders
Identifying a laceration (as not an incised wound)
Lacerations…
- are usually over bony prominences
- have tissue bridges btw the sides of the wound when pulled apart
- have rough edges
Types of sharp force injuries (and the difference btw them)
Incised wound
- superficial
- caused by slashing motion
- longer than it is deep
Stab wounds
- penetrating
- caused by thrusting motion
- deeper than it is long
Identifying defensive type injuries
Passive (victim raises arms for protection)
- incised wounds over backs of hands and forearms
Active (victim tries to grab weapon)
- incised wounds on palms and web spaces btw fingers
Commonest cause of extradural haemorrhage
Skull fracture damaging arteries
Commonest cause of subdural haemorrhage
acceleration-deceleration injury causing veins to tear
often a lucid interval as blood accumulates slowly
Most common cause of subarachnoid haemorrhage
Berry aneurysm
Cause of traumatic subarachnoid haemorrhage
+ cause of death
Rapid rotational movement of the head, usually due to a blow to the jaw
Causes rupture of vertebral arteries at base of skull causing haemorrhage around the brainstem.
Patient often dies IMMEDIATELY - so cause of death is likely from rotational tearing of axons in brainstem at the same time.
Common leg development
Bow legs common <2 years
Knock-knees common from 2-7 years
Most legs are straight by the teens
Number of steps per minute =
cadence
normal = 100-115 steps/min
Average comfortable walking speed (CWS) =
80m/min (5km/h, 3mph)
Gait pattern in which the stance phase on the affected side is shortened
Antalgic gait
common causes: splinter in foot!, OA, tendinitis
Causes of an increased walking base (normal = 5-10cm)
Deformities (abducted hip, valgus knee)
Instability
Indications for treatment of paediatric orthopaedic conditions
Symptoms - night pain/NWB pain Symmetry - lack of it Stiffness/ paralysis Syndromes - associated features Systemic illness - e.g. pyrexia
Knee pain may be a sign of…
HIP PATHOLOGY!
Members of the trauma team
Emergency department (ED) doctor
Anaesthetics
Radiology
Surgical
Important information in paramedic handover to trauma team
Time of injury Mechanism of injury (photos) Suspected serious injuries Vital signs interventions carried out
