MSK Flashcards
Age of presentation SUFE ve Perthe’s disease
SUFE: 10-16 yrs
Perthe’s disease: 3-11 yrs
Presentation of Perthe’s disease + pathophys
Path: avascular necrosis of the femoral head
Pain in hip or knee + limp
What nerve roots are in Erb’s palsy?
C5-C6
Note: Klumpks is C8-T1
Damage to what nerve causes foot drop?
Common peroneal nerve (L5, S1)
Obligate external rotation is characteristic of what?
SUFE
Note: this means when the hip is flexed, external rotation of the limb occurs
Mgmt of SCFE
Urgent fixation w/pinning (epiphysiodesis)
How often is SCFE bilateral?
20-25%
In the management of an open fracture it is important to probe it in the ER T/F
F - it should not be probed as this may dislodge debris further into the wound and introduce infection
Note: should check neuromuscular status and then immobilise, check tetanus status, ref to ortho and start IV antibiotics
In a pt with suspected Duchenne MD what is the 1st appropriate investigation?
Serum CK
Inguinal hernia in children are usually direct or indirect ?
Indirect
Direct hernias are very rare in the absence of a connective tissues disorder
Inguinal hernia in premature males have a high recurrence rate T/F
T - about 5% recur post op
When would it be expected for achondroplasia and hypochondroplasia to present?
Achondroplasia: usually in the neonatal period, growth in utero is normal until 22 weeks hence unless patient was getting a late scan for some reason.
Hypochondroplasia: presents later with short stature
How does achondroplasia usually present clinically?
Proximal (rhizomelic) limb shortening, esp in the upper limbs and normal head circumference
Telephone handle femurs on X-ray what pathology?
Thanatophoric dwarfism
Which ligament is injured in nursemaid elbow?
Annular
Teenage athlete presents with pain, swelling and locking of knee after sports, arthroscopy showing 3 loose bodies in synovial cavity. What pathology
Oestochondritis dissescans
Due to underlying necrosis of articular cartilage and its underlying bone. Cause of this is unknown
Note: if only one body was seen another differential would be a chip (avulsion) fracture
> 50 loose bodies in a joint cavity on arthroscopy, what disease?
Synovial chondromatosis
Metaphyseal fracture (AKA corner or bucket handle fracture) of lower limb is specifically associated with NAT T/F
T
Trethowan’s sign is indicative of what pathology
SUFE
Note: in this sign line of Klein passes above the femoral head.
What is the treatment of a toddlers fracture?
Long leg cast
Note: healing is rapid, 4-5 weeks
What is the most common elbow fracture?
Supracondylar fracture of the distal humerus
Complications of supracondylar fracture of the distal humerus?
- radial or median nerve damage
- brachial artery damage
- compartment syndrome
- Volkmann contracture
- improper reduction can lead to cubits varus
What is Blount disease? What is mgmt?
Developmental deformity resulting from abnormal endochondral ossification of the medial aspect of the proximal tibial physis leading to varus deformity and internal rotation of tibia
Mgmt: if diagnosis before three knee brace. If >3 at diagnosis or failure of knee brace ortho referral for surgery
Hyperkyphosis and X-ray showing wedging of > 5 degrees in at least 3 consecutive vertebrae bodies. What pathology and mgmt?
Scheuermann disease (AKA juvenile kyphosis)
Mgmt: bracing if < 70 degrees. > 70 degrees requires surgery
Note: usually minimal pain and normal neuro exam
Traumatic myositis ossificans is a bony mass, always slightly separated from the bone
T
More common in adolescent athletes. Painless
On xray round mass with mature peripheral ossification and a more radiolucent centre of mature osteoid. This tends to be a reverse of tumour appearance
Most common cause of intoeing in less than 2 yrs old and its management?
Internal tibial torsion
Mgmt: reassurance, usually resolves without intervention. Refer to surgeon if persists > 8 yrs of age, interferes with activity or has poor cosmetic appearance
At what age is genu vagum normal?
2-4 yrs (knock knee)
Note: birth - 2 yrs varus (bowing) is normal
Intermittent knee pain that worsens with activity. Sometimes knee “locks up/gives way”. Full extension of knee limited. Most likely pathology?
Osteochondritis dissecans
Note: most commonly affected is the medial condyl of femur; sometimes a boney fragment will be seen in joint space
When does polydactyly occur in utero? What race is it more common?
6 - 7 weeks
African American
A positive McMurrary test is characteristic of what injury?
Meniscal
Peripheral oedema, hyperglycaemia, HTN and arthralgia are side effects of what performance enhancing drug?
Growth hormone
Note: can also cause cardiomegaly
Tennis elbow vs golfers elbow locations?
Tennis: lateral epicondylitis
Golfer: medial epicondylitis
Note: little league elbow is also medial pain
SUFE is associated with hypothyroidism and T1 DM T/F
F - not associated with DM but is associated with hypothyroidism
Also associated with growth hormone therapy, renal osteodystrophy and obese males with hypogonadal conditions
Forward slippage of upper vertebra in relation to the vertebra below, spondylolesthesis or spondylolysis?
Spondylolesthesis
Note: 85% of spondylolesthesis is due to spondylolysis (bone defect in pars interarticularis of the vertebra)
Mgmt of spondylolesthesis vs spondylolysis
Spondylolysis: NSAIDs and can return to sport once pain free. Surg referral only if not improvement in pain
Spondylolesthesis: ortho referral. Surgical treatment is usually needed for high slip (> 50%). No contact sports if the slippage is more than 50% of the vertebral width
Mechanism of action associated with ACL or PCL tear?
ACL - sudden declaration and pivoting of knee
PCL - direct blow to anterior knee with knee flexed (often knee hits dashboard)
Mechanism of action of medial meniscus tear?
Twisting motion of planted leg
Mgmt of scoliosis
Mild < 20 degrees: no activity restrictions
Mod (25-45) : considering bracing
Severe (> 45): spinal fusion/Harrington rod
