Common musculoskeletal conditions Flashcards
Clavicle fracture: most common in who?
Children and as birth trauma
Clavicle fracture: cause?
Fall on outstretched hand or direct trauma to shoulder
Clavicle: weakest points?
At the junction of middle and lateral thirds
Clavicle: most common fractured segment?
Middle third
Clavicle fracture: presentation?
Shoulder drop, shortened clavicle
Why is the lateral fragment of a fractured clavicle depressed?
Arm weight
By what is the lateral fragment of a fractured clavicle medially rotated?
Arm adductor, e.g. pectoralis major, deltoid
What causes Guyon canal syndrome?
Compression of ulnar nerve at wrist
Fractured hook of Hamate
In who is Guyon canal syndrome classically seen?
Cyclist due to pressure on handlebars
Which syndrom is caused by compression of the ulnar nerve at the wrist?
Guyon canal syndrome
What causes carpal tunnel syndrome?
Compression of median nerve in carpal tunnel (between transverse carpal ligament and carpal bones)
What are the symptoms of CTS?
Paresthesia, pain, numbness in distribution of median nerve
Thenar eminance athropy
Sensation spared
Why is sensation spared in CTS?
Palmar cutaneous branch enters hand external to carpal tunnel
What syndrome is caused by entrapment of median nerve between transverse carpal ligament and carpal bones?
CTS
What is the Tinel sign?
Percussion of wrist causes tingling -> CTS
What is the Phalen maneuver?
90 degrees flexion of wrist 1>min causes tingling -> CTS
How to test for CTS?
Tinel and Phalen
What is CTS associated with?
Pregnancy (due to edema)
RA
Hypothyriodism
Diabetes
Acromegaly
Dialysis-related amyloidosis
Repetitive use
Metacarpal neck fracture (boxer’s fracture): cause?
Direct blow with a close fist (e.g. punching a wall)
Metacarpal neck fracture: in which metacarpal most common?
5th
What is most commonly caused by a direct blow with a close fist?
Metacarpal neck fracture or ‘boxer’s fracture’
Iliopsoas abscess: what is it?
Collection of pus in iliopsoas compartment
Iliopsoas abscess: cause?
Hematogenous spread or adjacent structures
From which adjacent structures can an iliopsoas abscess be caused?
Vertebral osteomyelitis
Tuberculous spondylitis (Pott’s disease)
Pyelonefritis
Iliopsoas abscess: associations?
Crohn, diabetes, immunocrompromised states
Iliopsoas abscess: which bacteria most commonly isolated?
S. Aureus, but also 2nd to TB
Iliopsoas abscess: findings?
Flank pain, fever, flank bulge, inguinal mass, positive psoas sign
Flank pain, fever, flank bulge, inguinal mass, positive psoas sign -> suggestive of what?
Iliopsoas abscess
What is a positive psoas sign?
Hip extension exacerbates lower abdominal pain
Iliopsoas abscess: lab findings?
Leukocytosis
Iliopsoas abscess: CT/MRI findings?
Focal hypodens (dark) lesion within the muscle plane
Iliopsoas abcess: treatment?
AB based on culture, CT-guided percutaneous drainage (PCD), or surgical drainage
What is and unhappy triad of the knee?
Damage to ACL, MCL, and medial meniscus (attached to MCL)
How is unhappy triad of knee commonly caused?
Lateral force impacting the knee when foot is planted on the ground (e.g. during contact sports)
Unhappy triad: presentation?
Acute pain and signs of joint instability
Prepatellar bursitis: what is it?
Inflammation of prepatellar bursa in front of the knee cap
Prepatellar bursitis: cause?
Repetitive trauma or pressure from excessive kneeling (housemaid’s knee)
Politeal cyst (Baker cyst): what is it?
Popliteal fluid collection, commonly communicating with synovial joint
Popliteal cyst: in which bursa?
Gastrocnemius - semimembranosus
Popliteal cyst: related to which diseases?
Chronic joint disease; e.g. osteoarthritis and RA
Swelling in back of knee: what is this suggestive of?
Popliteal cyst/Bakers cyst
Costochondritis: what is it?
Inflammation of costochondral of costosternal junctions (may be due to minor trauma)
Costochondritis: presentation?
Pleuritic chest pain and focal tenderness to palpation
What is pleuritic chest pain?
Sharp chest pain that worsens during breathing
Costochondritis: in who is it more common?
Young females
Costochondritis: treatment?
analgesics, stretching therapy
What may costochondritis mimic?
MCI, pleuritis, PE
Pleuritic chest pain and focal tenderness of costochondral and costosternal junctions to palpation: what can it be?
Costochondritis
DD MCI, PE, pleuritis
De Quervain tenosynovitis: what is it?
Non-inflammatory thickening of abductor pollicis longus and extensor pollicis brevis tendons
De Quervain tenosynovitis: which test?
Finkelstein (pain at radial styloid with active/passive stretch of thumbs tendons)
What is the Finkelstein test?
Active/passive stretch of thumbs tendons
Positive if pain at radial styloid
Who is at increased risk of De Quervain tenosynovitis?
New mothers (lifting of baby)
Golfers
Racquet sport players
Thumb texters
Positive Finkelstein test is suggestive of what?
De Quervain tenosynovitis
What is non-inflammatory thickening of thumb tendons?
De Quervain tenosynovitis
Pain at radial styloid is suggestive of what?
De Quervain tenosynovitis
Dupuytren contracture: what is it?
Fibroblastic proliferation and thickening of superficial palmar fascia
Fibroblastic proliferation and thickening of superficial palmar fascia: what is this?
Dupuytren contracture
Which fascia are typically involved in Dupuytren contracture?
At the base of ring and little fingers
Dupuytren contracture: in who most often seen?
Males >50 y/o from Northern European descendent
Ganglion cyst: what is this?
Fluid-filled swelling overlying joint or tendon
Fluid filled swelling overlying joint or tendon: what is this?
Ganglion cyst
Where is ganglion cyst most commonly seen?
Dorsal side of wrist
How does a ganglion cyst arise?
From herniation of dense connective tissue
What is the natural course of a ganglion cyst?
Resolves spontaneously
Iliotibial band syndrome: what is this?
Overuse injury of lateral knee, due to friction of iliotibial band against lateral femoral epicondyl
Iliotibial band syndrome: in who occurs this mostly?
Runners
Lateral knee pain in runners: what can it be?
Iliotibial band syndrome
Limb compartment syndrome: pathofysiology?
Increased pressure in fascial compartment of a limb -> venous outflow obstruction and arteriolar collapse -> anoxia, necrosis and rhabdomyolisis -> acute tubular necrosis
What is caused by increased pressure in a fascial compartment of a limb?
Limb compartment syndrome
What can cause limb compartment syndrome?
Long bone fractures (e.g. tibia)
Reperfusion injury
Animal venom
Limb compartment syndrome: presentation?
Severe pain and tense, swollen compartments with passive stretch
5 Ps of Limb compartment syndrome?
Pulselessness, pain, palor, paresthesia, paralysis
Limb compartment syndrome: late findings of irreversible muscle and nerve damage?
Increased serum creatine kinase, motor deficits
Medial tibial stress syndrome (shin splints): pathophysiology?
Bone resorption that outpaces bone formation in tibial cortex
Medial tibial stress syndrome (shin splints): presentation?
Shin pain and diffuse tenderness
Another name of medial tibial stress syndrome?
Shin splints
Another name for shin splints?
Medial tibial stress syndrome
Medial tibial stress syndrome: in who?
Runners and military recuits
Shin pain and diffuse tenderness: suggestive of?
Medial tibial stress syndrome or shin splints
Plantar fasciitis: what is it?
Inflammation of plantar aponeurosis characterized by heel pain and tenderness
Plantar fasciitis: when is the heel pain worse?
After long periods of inactivity (first steps in the morning)
Plantar fasciitis: associated with?
Obesity, prolonged standing or jumping (e.g. dancers, runners), and flat feet
Plantar fasciitis: what does often co-exist?
Heel spurs
Heel pain and tenderness, worse in the morning. What is this suggestive of?
Plantar fasciitis
Temporomandibular disorders: what is it?
Group of disorder affecting the temporomandibular joint (TMJ) and muscles of mastification
Temporomandibular disorders: associated with?
TMJ trauma
Poor head and neck posture
Abnormal trigeminal nerve processing
Psychological factors
Temporomandibular disorders: presentation?
Dull, constant, unilateral facial pain
Temporomandibular disorders: pain worsens with what?
Jaw movement, otalgia, headache, TMJ dysfunction (e.g. limited movement)
