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JL Musculoskeletal > Cortext Week 4 > Flashcards

Cortext Week 4 Flashcards

1
Q

What is the term for IV discs losing water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA?

A

Spondylosis

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2
Q

What can happen in the annulus fibrosis of an IV disc which classically happens after lifting a heavy object?

A

Acute tear - periphery of the disc is richly innervated and pain can be severe.

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3
Q

What type of back problem is characteristically worse on coughing and the symptoms usually resolve but can take 2-3 months to settle?

A

Acute disc tear - from heavy object lifting

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4
Q

What nerve roots can cause sciatica?

A

L4 - S1

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5
Q

In the lumbar spine, which nerve root is compressed?

A

Lower of the two vertebra

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6
Q

What nerve entrapment can cause pain down to the medial ankle, loss of quadriceps power and reduced knee jerk?

A

L4

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7
Q

What nerve entrapment can cause pain down dorsum of the foot, reduced power to extensor hallucis longus and tibialis anterior?

A

L5

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8
Q

What nerve entrapment can cause pain to sole of foot, reduced power plantarflexion and reduced ankle jerks?

A

S1

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9
Q

If neurological leg pain is severe - which drug could be given?

A

Gabapentin

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10
Q

What - affecting the facet joints - can result in impingement on exiting nerve roots, resulting in sciatica?

A

Osteophytes from OA

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11
Q

What can be done for osteophytes impinging on nerve roots?

A

Trimming

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12
Q

Name four differences between PVD claudication and spinal stenosis and claudication?

A
  1. Claudication distance is inconsistent in spinal
  2. Pain is burning in spinal and cramping in PVD
  3. Pain is less walking uphill in spinal - flexion creates more space
  4. Pedal pulses are preserved in spinal
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13
Q

What is cauda equina sndrome?

A

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

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14
Q

In cauda equina syndrome the nerve roots S4 and S5 are mainly affectd - what do these control?

A

Defaecation and urination

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15
Q

What does bilateral leg pain, paraesthesiae or numbness and saddle anaesthesia, urinary retention, faecal incontinence and constipation suggest?

A

Cauda equina syndrome

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16
Q

What MUST be performed if suspected cauda equina syndrome?

A

Rectal exam

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17
Q

What investigations and management is done for cauda equina syndrome?

A

Urgent MRI. Urgent discectomy

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18
Q

What are the four back pain red flag symptoms?

A
  1. Back pain in younger patients less than 20
  2. New back pain in older patients over 60
  3. Constant, severe pain worse at night
  4. Systemic upset
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19
Q

In severe osteoporosis whast can spontaneous crush fractures of the vertebral body lead to?

A

Acute pain and kyphosis

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20
Q

How are osteoporotic crush fractures treatd?

A

Conservatively

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21
Q

Name two conditions where cervical spine instability can occur?

A

Downs and rheumatoid arthritis

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22
Q

What rotator cuff muscle is anterior?

A

Subscapularis

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23
Q

Where do the infraspinatus, teres minor and supraspinatous attach?

A

Greater tuberosityq

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24
Q

What motion fo infraspinatus and teres minor do?

A

External rotators

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25
Q

Where does subscapularis attach and what motion does it do?

A

Lesser tuberosity and principal internal rotator

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26
Q

Name two problems associated with shoulder in middle aged?

A

Cuff tear nad froxen shoulder - grey hair, cuff tear

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27
Q

What do tendonitis sub acromial bursitis, AC OA with inferior osteophyte and a hooked acromion rotator cuff tear all cause?

A

Impingement syndrome - painful arc

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28
Q

How is impingement syndrome treated#;

A

NSAIDS, analgesia, physio and subacromial steroid injections

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29
Q

What is the differential in a patient with a histoy of a sudden jerk, over 40 and with subsequent pain and weakness of shoulder?

A

Rotator cuff tear

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30
Q

What is the most common rotator cuff to tear?

A

Supraspinatus

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31
Q

How are rotator cuff tears confirmed?

A

On ultrasound or MRI

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32
Q

What is the name of the disorder characterised by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after 18-24 months?

A

Adhesive capsulitis

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33
Q

What is the prinicipal clinical sign of adhesive capsulitis?

A

Loss of external rotation

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34
Q

Name three conditions that are associated with adhjesive capsulitis?

A
  1. Diabetes
    2, .Hypercholesterolemia
  2. Dupuytrens disease
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35
Q

What condition results in acute onset severe shoulder pain and is characterised by calcium deposition in supraspinatus tendon which is seen on xray just proximal to greater tuberostiy. Relief is achieved with subacromial steroid and local anaesthetic injections?

A

Acute calcific tendonitis - resolves on its own as calcium reabsorbsq

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36
Q

What is the redislocation of shoulder rates?

A

In under 20s its 80%

In over 30s its 20%

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37
Q

With recurrent shoulder dislocations - what can be done to stabilise the shoulder by attaching the labrum and capusle to anterior gelnoid?

A

Bankart repair

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38
Q

What can cause pain on biceps resisted contraction?

A

Biceps tendonitis - long head, attaches to glenoid labrum

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39
Q

What is popeye deformity associated with?

A

Biceps tendonitis

40
Q

What is a tear in glenoid labrum called?

A

SLAP lesions

41
Q

What forms the carpal tunnel?

A

Flexor retinaculum and carpal bones

42
Q

Name conditions associated with carpal tunnel syndrome?

A
  1. RA
  2. Pregnancy
  3. Diabetes
  4. Chronic renal failure
  5. Hypothyroidism
43
Q

Who are more commonly affected by carpal tunnel syndrome - men or women?

A

Women by 8 times more

44
Q

How can symptoms of carpal tunnel syndrome be reproduced?

A

Tinel’s test - percussing over median nerve

Phalen’s test - holding wrists hyperflexed

45
Q

What confirms carpal tunnel syndrome?

A

Nerve conduction studies

46
Q

How is carpal tunnel syndrome treated non-operatively?

A

With wrist splints at night to prevent flexion and injections of corticosteroids

47
Q

What is surgical treatment for carpal tunnel?

A

Decompression - involves division of the transverse carpal ligament

48
Q

What condition involves complaints of paraesthesiae in ulnar 1.5 fingers and tinels test positive over cubital tunnel?

A

Cubital tunnel syndrome

49
Q

In cubital tunnel syndrome - how can the 1st dorsal interosseous (abduction index finger) and adductor pollicis be tested?

A

Froments test

50
Q

What can compression be due to in cubital tunnel syndrome?

A

Osborne fascia forming on roof or tightness at intermuscular septum as nerve passes through between the two heads at the origin of flexor carpi ulnaris

51
Q

What is the radio-capitallar joint responsible for?

A

Supination and pronation

52
Q

Where does the triceps muscle insert and what does it power?

A

Olecranon process and powers elbow extension

53
Q

Where does brachialis insert?

A

Coronoid process

54
Q

Where does biceps insert?

A

Bicipital tuberosity of radius

55
Q

How does pronation of the forearm come about?

A

Contraction of the pronator teres proximally and pronator quadratus muscle distally

56
Q

What condition involves the production of abnormal collagen type 3 instead of type 1?

A

Dupuytrens contracture

57
Q

Who is more affected by dupuytrens contracture - men or women?

A

men 10 times more

58
Q

What associations does dupuytrens contracture have?

A

Familial - autosomal dominant, high prevelance in those of norhtern european/scandanavian descent, alcoholics and diabetics

59
Q

Where does ledderhose disease affect?

A

Feet

60
Q

What pully is most commonely affected by trigger finger?

A

A1

61
Q

How is trigger finger relieved?

A

Injection of steroid around tendon within the sheath

62
Q

What carpal joints are affected by primary OA?

A

STT joints - scaphoid, trapezium and trapezoid

63
Q

What is a swan neck deformity in RA?

A

Hyperextension at PIP with flexion at DIP

64
Q

What is a Boutonniere deformirt?

A

Flexion at PIP with hyperextension at DIP

65
Q

Other than boutonniere deformity and swans neck deformity - what are the three other clinical deformities in RA?

A
  1. Volar MCP subluxagtion
  2. Ulnar deviation
  3. Z-shpaed thumb
66
Q

What are common mucinous filled cysts found adjacent to a tendon or synovial joint?

A

Ganglion cyst - Bakers cyst if at knee

67
Q

What are second most common soft tissue swellings of the hand, usually found on palmar surface especially at PIP, can erode bone, contain multi nucleate giant cells and haemosiderin which makes them brown?

A

Ginat cell tumour of tendon sheath

68
Q

What nerve allows hip pain to radiate to knee?

A

Obturator nerve

69
Q

What can metal on metal hip replacement result in/

A

Inflammatory pseudotumour which causes necrosis of muscle and bone

70
Q

What can AVN of the hip be secondary to?

A

Alcohol, steroids, hyperlipidaemia or thrombophilia

71
Q

What does hanging rope sign on xray suggest

A

AVN of hip caused by lytic zone

72
Q

What condition presents with pain on resisted abduction of leg?

A

Trochanteric bursitis = gluteal medius

73
Q

What kind of injuries can twisting force on loaded knee cause?

A

Meniscal

74
Q

Is psuedolocking a sign of meniscal injury?

A

No

75
Q

What does the patient wusually develop after ACL rupture?

A

Haemarthrosis within an hour

76
Q

What ligament will a rugby tackle from the side usually tear?

A

MCL

77
Q

What ligament tears are more common and why - MCL or LCL?

A

Medial because it is more fixed and less flexible

78
Q

What will Steinmanns test show on degenerate meniscal tears?

A

Negative

79
Q

What is the principal complaint for ACL rupture?

A

Rotatory instability with giving way on turning

80
Q

Whast antibioitcs can cause tendonitis and risk tendon rupture?

A

Quinolones

81
Q

What treatment shouldbe avoided in tendonitis of the knee?

A

Steroid injection

82
Q

What knee condition presents with anterior knee pain, worse going downhill, grinding or clicking sensation at front of knee and stiffness after sitting - pseudolocking?

A

Patellogemoral dysfunction

83
Q

What does a lipo-haemarhtrosis on xray suggest?

A

Patella dislocation

84
Q

Is hallux valgus commoner in femlaes or males?

A

Females 4:1

85
Q

What is the term for OA of first MTP?

A

Hallux rigidus

86
Q

What is gold standard treatment surgically for hallux rigidus?

A

Arthrodesis - prevents women wearing heals

87
Q

Where is mortons nejuromea commonly found?

A

Between third and fourth metatarsals - more common in females 4:1

88
Q

How can mortons neuroma be tested?

A

Mulders click test - mediolateral compression of metatarsal heads exerted by squeezing with hand

89
Q

How can mortons neuroma be investigated and diagnosed?

A

Utrasound

90
Q

How can metatarsal stress fractures be diagnosed?

A

Bone scan, may not appear until 3 weeks

91
Q

What is Simmonds test and what is it used for?

A

Achilles tendonitis - no plantar flexion of the foot is seen when squeezing the calf

92
Q

What are three risk factors for plantar fascitis?

A

Diabetes, obesity and walking on hard floors with bad shoes

93
Q

What three things could aquired flat foot be due to?

A

Tibialis posterior tendon stretch, RA or diabetes with Chardcot foot

94
Q

What is the term for an abnormally high arch of foot?

A

Pes cavus

95
Q

What can hereditory senory, motor neuropathy, cerebral palsy, polio anbd spinal cord tethering all cause?

A

Pes cavus - claw toes often accompanies it

JL Musculoskeletal (35 decks)

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