Emergency medicine: MSK

Question 1

What is the most common type of shoulder dislocation?

Answer 1

Anterior

- occurs due to excessive external rotation and abduction of the shoulder

Question 2

What is the presentation of anterior shoulder dislocation?

Answer 2

Pain 
Decreased sensation over badge area
Step-off deformity - gap can be felt below acromion
Glenoid can be felt anterior 
Distal pulses are palpable

Question 3

What is the management of suspected anterior shoulder dislocation?

Answer 3

1. X-Ray
   - identify dislocation
   - exclude complicated (fracture) before reduction
2. Analgesia
3. Manipulation under sedation or anaesthetic
   - External rotation of shoulder or
   - Kocher technique or
   - Modified Milch technique

Question 4

What are the findings of posterior shoulder dislocation?

Answer 4

1. Clinical presentation
   - Pain
   - Shoulder lies posterior
2. X-Ray
   - Light bulb sign

Question 5

How is posterior shoulder dislocation managed?

Answer 5

1. X-Ray
   - identify dislocation
   - exclude complicated (fracture) before reduction
2. Analgesia
3. Manipulation under sedation or anaesthetic
   - Traction and External rotation of shoulder or

Question 6

What is the difference between a Smith’s and a Colle’s fracture?

Answer 6

Colle’s - fall onto extended wrist causes dorsal angulation of radial fragment

• Pain
• Tender and swollen
• Dinner fork deformity

Smith’s - fall onto flexed wrist causes impaction of radial fragment and anterior angulation

• Pain
• tender and swollen

Question 7

How are wrist fractures treated?

Answer 7

1. X-Ray
2. Analgesia
3. Immobilise and Backslab
4. Manipulation under anaesthetic (MUA) §

Question 8

What is the most common type of hip fracture?

Answer 8

Intra-capsular hip fracture

- hip fracture typically in elderly patients with osteoporosis who fall onto bum or hip

Question 9

how does a intracapsular fracture present?

Answer 9

Pain
tender and swollen
I/L Hip appears externally rotated and leg shorter

Question 10

What is the X-Ray findings and classification for intracapsular fractures?

Answer 10

X-Ray
- Shenton lines

Garden classification

Question 11

What are the two types of extra capsular fractures?

Answer 11

Trochanteric - involves fracture on or between the two trochanters

Sub-trochanteric - involves femur < 5cm below lesser trochanter

Question 12

What are the worrying red flag differentials for lower back pain?

Answer 12

Ruptured or enlarged AAA
Cauda Equina syndrome
MSSC

Question 13

What is the similarity and difference in presentation between MSSC and caudal equina syndrome?

Answer 13

Cauda equina

• Back pain
• Lower limb weakness or sensory change
• Perineal or peri-anal sensory change
• Sphincter disturbance

MSSC

• Back pain - localised, radicular, U/L or B/L
• Leg weakness ± sensory changes
• Bowel or urinary incontinence
• Reflexes - Increased below, absent at level, normal above

Question 14

How does a foot fracture come about and how does it present?

Answer 14

Force onto Internal rotation and plantar flexion foot

• Pain
• Tenderness, swelling and bruising
• Peroneal nerve loss - reduced sensation over dorm of foot and proprioception at ankle joint

Question 15

What must you do before deciding to have an ankle/foot x-ray?

Answer 15

Ottawa ankle rule assessment