MSK Flashcards
What nerve is most likely to be damaged in a humeral shaft fracture?
Radial
An externally rotated hip is most suggestive of what pathology?
Fractured neck of femur
If a patient presents with a joint problem, what 4 things should you always ask about?
Pain, stiffness, weakness, loss of movement
What muscles are primarily responsible for flexion of the knee? What is the nerve supply?
Hamstrings - supplied by the sciatic nerve (L4-S3)
Steinmann’s test assesses for what injury?
Acute meniscal tear
Performing internal rotation against resistance assesses which rotator cuff muscle power?
Subscapularis
Arterial supply to the hip is largely via which arteries?
Medial and lateral circumflex arteries (branches of the profunda femoris artery)
What muscle is the chief flexor of the hip joint? What is its nerve supply?
Iliopsoas - anterior rami of L1-L3
Describe Phalen’s test used to assess for carpal tunnel syndrome?
Holding wrist in flexion for 30 seconds should recreate the pain
Where should you assess sensation of the median nerve?
Lateral aspect of index finger
Loss of which movement is most sensitive for indicating shoulder pathology, especially frozen shoulder?
External rotation
If a knee injury is thought to be significant, what is the best investigation to use?
MRI
Patients will not be able to straight leg raised if they have damage to which muscles or which nerve?
Quadriceps muscles or femoral nerve
During a femoral stretch test, back pain radiating down the anterior leg is suggestive of what pathology?
L4 nerve root compression
Pain in the anterior mid-groin is most suggestive of pathology where?
The hip joint itself
What spinal movements should be assessed within a GALS exam?
Lateral flexion of cervical spine and flexion of lumbar spine
Which movements of the lower limb should be assessed within a GALS exam?
Flexion and extension of the knee, internal rotation of the hip
A total hip replacement or posterior hip dislocation are most likely to cause damage to which nerve?
Sciatic (L4-S3)
What muscle is responsible for external rotation of the knee joint? What is its nerve supply?
Biceps femoris - supplied by the sciatic nerve (L4-S3)
Which nerve is most likely to be damaged in an anterior shoulder dislocation or humeral neck fracture?
Axillary
A fixed flexion deformity of the hip is most commonly caused by which pathology?
Osteoarthritis
What is the cause of a 1) True and 2) Apparent leg length discrepancy?
1) Bony/joint pathology 2) pelvic tilting (e.g. fixed flexion deformity, scoliosis)
Other than the iliopsoas, what other muscles are responsible for flexion at the hip joint? What is their nerve supply?
The anterior compartment of the thigh (quadriceps femoris, sartorius, pectineus) - supplied by the femoral nerve (L2-L4)
What muscles are responsible for external rotation of the hip? What is their nerve supply?
Lots of muscles, but specifically the external rotator group, innervated by the lumbosacral plexus (L4-S2)
AVN of the femoral head is most likely caused by damage to which artery?
Medial circumflex artery
If taking a history of knee pain, what are some useful symptoms to ask about?
Giving way, locking, clicking/catching
Where should you assess sensation of the axillary nerve?
Regimental badge patch area
A Thomas’ test for a fixed flexion deformity is positive if what happens?
The thigh lifts off the couch
If a patient presents with a joint problem that you suspect could be systemic, other than those already discussed in the systemic enquiry, what are some other important systems to ask about?
Skin changes and/or eye problems
Which nerve is most likely to be damaged in a posterior elbow dislocation?
Ulnar nerve
Hearing a ‘pop’ at the time of a knee injury and developing haemarthrosis within one hour is generally suggestive of what pathology?
ACL rupture
An acutely inflamed joint is what until proven otherwise?
Septic arthritis
Describe Tinel’s test used to assess for carpal tunnel syndrome?
Percussing the median nerve over the ventral aspect of the wrist should recreate the pain
What muscles are responsible for hip adduction? What is their nerve supply?
Medial compartment of the thigh (adductor magnus/brevis/longus, gracilis) - supplied by the obturator nerve (L2-L4)
Scapula winging is a sign caused by palsy of which nerve?
Long thoracic nerve
Anterior and posterior drawer tests assess the stability of what structure?
Anterior and posterior cruciate ligaments
True knee locking is a sign of what injury?
Bucket handle meniscal tear
A combination of what three knee injuries makes up the ‘unhappy triad’?
MCL rupture, medial meniscus tear, ACL rupture
What are the two main risk factors for AVN of the hip?
Steroid use and alcohol abuse
What special tests should you perform in a shoulder exam of an older person who you suspect may have a rotator cuff tear?
Perform rotator cuff movements against resistance
What muscles are responsible for extension of the hip? What is their nerve supply?
Posterior compartment of the thigh (hamstrings- biceps femoris, semimembranosus, semitendinosus) supplied by the sciatic nerve (L4-S3) and the gluteus maximus supplied by the interior gluteal nerve (L5-S2)
Which nerve is most likely to be damaged in a Colles fracture?
Median nerve
What nerve is damaged to cause a claw hand?
Ulnar nerve
The hip joint is primarily innervated by which nerves?
Sciatic, femoral and obturator
A hip joint which is shortened and internally rotated is most suggestive of what pathology?
Posterior dislocation
What movement of the hand assesses the function of the median nerve?
Thumb abduction
Where should you assess sensation of the ulnar nerve?
Medial aspect of the little finger
Which muscle is responsible for internal rotation of the shoulder? What is the nerve supply?
Subscapularis - supplied by the upper and lower subscapular nerves (C5/6)
What muscles are responsible for internal rotation of the hip? What is their nerve supply?
Gluteus medius and minimus - supplied by the superior gluteal nerve (L4-S1)
What are the steps of management for lower limb arthritis?
1) Weight loss (if necessary) 2) Analgesia 3) Physiotherapy 4) Walking aids 5) Surgical intervention
What muscle is responsible for flexion and extension of the shoulder?
Deltoid
During a straight leg raise, back pain radiating down the posterior leg beyond 90 degrees is suggestive of what pathology?
L5/S1 nerve root compression
What muscle is responsible for abduction beyond 15 degrees?
Deltoid
What special tests should you perform in a shoulder exam of a young person?
Look for sulcus sign and perform shoulder apprehension tests
If the medial collateral ligament is damaged, it is highly likely that what other structure in the knee is also damaged?
Medial meniscus
What muscle is responsible for the first 15 degrees of abduction? What is its nerve supply?
Supraspinatus - supplied by the suprascapular nerve (C5/6)
What muscles are responsible for hip abduction? What is their nerve supply?
Gluteus medius and minimus - supplied by the superior gluteal nerve (L4-S1)
What nerve is damaged to cause wrist drop?
Radial nerve
What is the pathology behind impingement syndrome?
Supraspinatus tendonitis
What are some particularly important questions to ask when taking a history about back pain?
Does it wake you at night? Any lower limb sensory/motor deficits? Any saddle anaesthesia? Any bladder/bowel changes?
Trochanteris bursitis typically presents with pain on what movement?
Resisted abduction
What muscle is responsible for adduction and internal rotation of the shoulder?
Teres major
What is the nerve supply to the deltoid muscle?
Axillary nerve (C5/6)
A Schober’s test is within normal range if the gap increases by more than what value on flexion?
5cm
What neurovascular structures are most likely to be damaged in a supracondylar fracture of the elbow?
Median nerve and brachial artery
You should only do a heel height test in a knee exam if you are suspecting what injury?
Bucket handle meniscal tear
How is trochanteric bursitis treated?
Self-limiting, provide analgesia (paracetamol, ibuprofen, steroid injections) and physiotherapy
A Trendelenberg gait or a positive Trendelenberg test is caused by unilateral weakness of which group of muscles? This can be secondary to damage to which nerve?
The hip abductors (gluteus medius/minimus) / Superior gluteal nerve (L4-S1)
A femoral shaft fracture is likely to result in damage to which neurovascular structures?
Femoral artery and sciatic nerve
The scarf test used in the shoulder exam may indicate what problem?
AC joint pathology
Jobe’s test assesses which rotator cuff muscle power?
Supraspinatus
What movement of the hand assesses the function of the radial nerve?
Wrist and finger extension
Which muscle is responsible for external rotation of the shoulder? What is the nerve supply?
Infraspinatus (suprascapular nerve) and teres minor (axillary nerve) - both C5/6
Performing external rotation against resistance assesses which rotator cuff muscle power?
Infraspinatus/teres minor
What muscles are primarily responsible for internal rotation of the knee joint? What is its nerve supply?
Semimembranosus and semitendinosus - supplied by the tibial nerve (L5-S2)
Pain in the medial groin is most suggestive of pathology where?
Pubic rami - ? fracture
A foot drop is caused by damage to what nerve?
Common fibular nerve (L4-S2)
Describe Froment’s test used to assess for ulnar nerve damage?
Ask patient to pinch paper between a straight thumb and index finger while pulling the paper away- flexion of the thumb at the DIP joint is a positive test
What is usually the first movement to be reduced in hip pathology such as OA?
Internal rotation
Where should you assess sensation of the radial nerve?
Dorsal first interosseous space
What special tests should you perform in a shoulder exam of a middle-aged person who you suspect may have instability?
Painful arc and Hawkins-Kennedy test
What movement of the hand assesses the function of the ulnar nerve?
Finger abduction
What three questions should you ask patients before starting a GALS exam?
Do you currently have any pain or stiffness in your joints or muscles? Do you have any difficulty getting dressed? Do you have any difficulty getting up and down stairs?
What muscle group is responsible for extension of the knee? What is its nerve supply?
Quadriceps femoris - supplied by the femoral nerve (L2-L4)
What is seen in this x-ray?
Left subcapital (intracapsular) hip fracture
What is seen in this x-ray?
Left subcapital (intracapsular) hip fracture
What is seen in this x-ray?
Left intertrochanteric (extracapsular) hip fracture
What is seen in this x-ray?
Left subtrochanteric (extracapsular) hip fracture
What is seen in this x-ray?
(Impacted) Left subcapital (intracapsular) hip fracture
What is seen in this x-ray?
Right subtrochanteric (extracapsular) hip fracture
What is seen in this x-ray?
Left intertrochanteric (extracapsular) hip fracture
How are intracapsular (subcapital) hip fractures treated?
Total hip replacement in high functioning patients
Hemiarthroplasty in those with poor mobility and/or cognitive impairment
How are intertrochanteric extracapsular hip fractures treated?
Dynamic hip screw (DHS)
How are subtrochanteric extracapsular hip fractures treated?
IM nail
What are some specific things to look at in an x-ray where a hip fracture is suspected?
Trace Shenton’s line
Look for asymmetry (particularly of the lesser trochanter)
What things should you do first when looking at an MSK x-ray?
Confirm patient name/DOB and assess the adequacy of the film
How do you assess the adequacy of an MSK x-ray?
Make sure there are AP and lateral views
Ensure the joint above and below are imaged
Make sure the film isn’t rotated and is adequately penetrated
What are the 4 steps to looking at an MSK x-ray?
Alignment and joint spaces
Bony texture
Cortices
Soft tissues
What should you comment on in the alignment and joint space section of an MSK x-ray?
Are the bones displaced or angulated in any way?
Is there any joint space narrowing, new bone formation or subchondral sclerosis?
How can you tell that bony texture is normal on an x-ray?
Trabeculae (fine white lines) are visible within the internal matrix of the bone, and there is a thick external covering
What sort of things are you looking for when assessing the soft tissues on an x-ray?
Swelling/effusions, foreign bodies
How should you describe a fracture?
Location (proximal/middle/distal third of bone x, intra or extracapsular)
Complete/incomplete and type
Open or closed
Any displacement or angulation
What are some examples of incomplete fracture types?
Buckle, bowing, greenstick
What are some examples of complete fracture types?
Oblique, transverse, comminuted, segmental, spiral
How is displacement of a fracture described?
% displacement (in reference to the width of the bone) of the distal fragment anteriorly/posteriorly/medially/laterally
How is angulation of a fracture described?
Degrees of angulation of the distal fragment anteriorly/posteriorly/medially/laterally
