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Muscoskeletal System > Lecture 1.2: Clinical Overview of the MSK > Flashcards

Lecture 1.2: Clinical Overview of the MSK Flashcards

1
Q

How many adults consult their GP with musculoskeletal problems each year?

A

1 in 5

20%

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2
Q

What increases risk of MSK problems?

A
  • Trauma
  • Ageing
  • Underlying Pathology
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3
Q

Clinical Assessment in MSK

A

80% History
15% Clinical Examination
5% Investigations

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4
Q

History Taking

A

SQUITARS
Occupation
Dominant hand?

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5
Q

Possible symptoms with MSK presentation

A
  • Pain
  • Swelling
  • Bleeding
  • Stiffness
  • Loss of function
  • Weakness
  • Instability
  • Change in sensation
  • Weight bearing
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6
Q

What could suggest infection or malignancy as underlying cause for MSK presentation?

A
  • Fever
  • Unexplained weight loss
  • History of malignancy
  • Night sweats
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7
Q

Surgical Sieve: MIND IT

A 
M: metabolic
I: inflammation
N: neoplastic
D: degenerative
I: infection
T: trauma
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8
Q

Surgical Sieve: VINDICATE

A 
V: vascular
I: infection
N: neoplasm
D: degenerative or drugs
I: iatrogenic or intoxication
C: congenital
A: autoimmune
T: trauma
E: endocrine/metabolic
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9
Q

Family History in MSK presentation

A

Inflammatory Arthritis

Degenerative Diseases

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10
Q

Social History in MSK presentation

A
  • Mobility
  • Walking aids
  • Home situation
  • Carers
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11
Q

Principles of an Orthopaedic Examination (4)

A
  • Look
  • Feel
  • Move
  • Special Tests
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12
Q

Principles of an Orthopaedic Examination: Look (12)

A
  • Gait
  • Look around the bed!
  • Colour
  • Scars
  • Muscle wasting
  • Deformity
  • Swelling
  • Bruising
  • Puncture or skin wounds
  • Joint fluid
  • Asymmetry
  • Varus + Valgus
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13
Q

Principles of an Orthopaedic Examination: Feel (7)

A 
Look at the patient’s face!
• Pain
• Effusion
• Temperature
• Laxity
• Crepitus
• Pulses
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14
Q

Principles of an Orthopaedic Examination: Move (10)

A
  • Active and Passive
  • Flexion and Extension
  • Pronation and Supination
  • Abduction and Adduction
  • Eversion and Inversion
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15
Q

Principles of an Orthopaedic Examination: Special Tests for Hip

A
  • Trendelenburg
  • Thomas’ test
  • Hip impingement sign
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16
Q

Principles of an Orthopaedic Examination: Special Tests for Knee

A
  • Collateral ligaments
  • ACL/PCL
  • Mc Murray’s test (menisci)
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17
Q

Principles of an Orthopaedic Examination: Special Tests for Foot

A
  • Mulder Click (Morton’s neuroma)
  • Silverskoild test

…and many more

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18
Q

Varus vs Valgus

A

Varus is knees wider than they should be

Valgus is Knock Knees, knees point inwards

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19
Q

Key things to remember when examining the patient (5)

A
  • Introduce yourself
  • Ask permission!
  • Expose the patient appropriately whilst maintaining patient dignity
  • Warm hands!
  • Don’t cause pain
20
Q

Rule of 2’s

A
  • 2 joints
  • 2 limbs
  • 2 views (for X rays)

Examine joint above and below
Examine both limbs (for comparison)

21
Q

Investigations (5)

A
  • Xrays
  • CT
  • MRI
  • Ultrasound
  • Bone Scan
22
Q

CT Pros vs Cons

A

Pros:
• 3D imaging/ X-sectional imaging
• Can help with interventional procedures
• Excellent for BONE

Cons:
• Significant radiation dose
• Not as good as MRI for assessing soft tissues

23
Q

How does an MRI work?

A
  • Magnetic field
  • Radiofrequency pulse
  • Hydrogen nuclei in water
24
Q

MRI Pros vs Cons

A

Pros:
• Multi-planar imaging
• Non ionising radiation
• Good for picking up infection, tumours, soft tissue

Cons:
• Strict contraindications- Pacemaker, Metal/ FB
• Claustrophobia (1 in 3)
• Slow

25
Q

How does an Ultrasound work?

A

High frequency sound waves (3-50MHz)

26
Q

What is good about Ultrasounds and what can they be used for?

A
  • Dynamic
  • Safe (no radiation)
  • Assessing tendons
  • Assessing masses
  • Joint effusions
  • Screening DDH
27
Q

Osteoarthritis

A
  • Condition that causes joints to become painful and stiff
  • Live long enough = OA
  • Big impact on ADL
  • Treat with Analgesia
  • Joint replacement
28
Q

Rheumatoid Arthritis

A

Autoimmune condition that causes pain, swelling and stiffness in the joints

29
Q

Infections

A
  • Erythema (redness)
  • Swelling
  • Decreased ROM
30
Q

Tumours

A

Primary: Lymphomas or Myelomas
Secondary: Lung, Breast, Prostate…etc

31
Q

Types of Joint Injury (6)

A
  • Sprains
  • Fractures
  • Subluxations
  • Dislocations
  • Fracture dislocation/subluxation
  • Open/closed injury
32
Q

Methods of Treatment (10)

A
  • Conservative & support
  • Manipulation & cast
  • Manipulate & insert wires
  • Open Reduction Internal Fixation (ORIF) screws, plates, wires, combinations
  • External fixation
  • Arthroplasty (replace)
  • Excision (remove)
  • Osteotomy (re-align)
  • Amputation
  • Arthrodesis (restrict)
33
Q

What is a sprain? Where do they commonly occur?

A

It is damage to a ligament
Can be complete, partial or damaged fibres with continuity intact
Commonly occur in ankle, knee, hand joints (thumb)

34
Q

RICE for Sprains

A

R: rest
I: ice
C: compression
E: elevation

35
Q

What is a Dislocation?

A

A complete loss of continuity of the articulating surfaces of the joint

36
Q

What is Subluxation?

A

A partial loss of continuity of the articulating surfaces of the joint

37
Q

What is a Fracture?

A

A break in the continuity of the bone

38
Q

Causes of Fractures? (4)

A
  • Stress
  • Trauma
  • Deficiency (osteoporosis, osteomalacia)
  • Pathological (tumour, infection)
39
Q

Classification of Fractures (4)

A

Displaced
Non-displaced ()
Open ()
Closed ()

40
Q

What happens in a Displaced Fracture?

A

The bone snaps into two or more parts and moves so that the two ends are not lined up straight

41
Q

What is a Comminuted Fracture?

A

It is when the bone is in many pieces

42
Q

What happens in a Non-Displaced Fracture?

A

The bone cracks either part or all of the way through, but does move and maintains its proper alignment

43
Q

What happens in an Open Fracture?

A

The bone breaks through the skin

It may then recede back into the wound and not be visible through the skin

This is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection

44
Q

What happens in a Closed Fracture?

A

When the bone breaks but there is no puncture or open wound in the skin

45
Q

Treatment of Open Fractures

A
  • Immediate cleaning
  • irrigation and reduction
  • IV antibiotics
  • Tetanus status
  • Subsequent surgical debridement/washout and fixation
46
Q

Causes and Treatment of Neck of Femur Fractures

A

Typically caused either by low energy injuries (the most common type), such as a fall in frail older patient,

High energy injuries, such as a road traffic collision or fall from height and are often associated with other significant injuries

Cannulated Screw Fixation

47
Q

Aims of Treatment of Fractures

A

• Pain relief (acute)
• Prevent infection (open wounds)
• Restoration of normal joint anatomy as far as possible (function and
aesthetics)
• Maintenance of position (function)
• Rehabilitate- reduce risk loss of function
• Reduce risk of chronic pain

Muscoskeletal System (15 decks)

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