MSK Flashcards
What is the presentation of a navicular fracture?
- wrist pain on palpation of the anatomical snuffbox
- pain on axial loading of the thumb
- history of a FOOSH
Initial x-ray of a suspected navicular or scaphoid fracture may be ____ in the event that it is what is advised?
normal; repeat in 2 weeks
What is the management of a navicular fracture
- thumb spica splint
- refer
What is the risk with a navicular fracture
-high risk for avascular necrosis
What is a colles fracture
-fracture of the distal radius +/- ulnar fracture of the forearm with dorsal displacement
What is the presentation of a colles fracture
- history of FOOSH
- also known as the dinner fork fracture
What is the most common type of risk fracture
Colles
What is the presentation of osteomyelitis
- localized bone pain
- swelling
- redness
- tenderness of the affected area
- fever
- if weight bearing joint, may refuse to walk or bear weight
What is osteomyelitis
-infection of the bone that causes inflammation and destruction
What are the causes of osteomyelitis
- contagious spread from a nearby infected wound to the bone
- hematogenous spread from a bloodstream infection
- direct trauma
The most common bacteria that causes osteomyelitis is
Staphylococcus aureus
What are labs indicated in suspected osteomyelitits
- CBC
- ESR
- CRP
- blood cultures
What is the presentation of hip fracture
- sudden onset 1 sided hip pain
- unable to walk or bear weight weight on affected hip
- may have pain with external rotation
- leg shortening (if dispalced)
- Usually a history of a fall
What is the presentation of pelvic fracture
- history of significant trauma or high impact injury
- sx depend on the degree of injury to the pelvic bones and structures
- ecchymosis
- lower abdominal, hip, groin or scrotal swelling
- bladder or fecal incontinence
- vaginal or rectal bleeding
- hematuria
- numbness
What is the presentation of cauda equina
- acute onset of saddle anesthesia
- bladder incontinence
- fecal incontinence
- bilateral leg numbness and weakness
Acute onset of “tearing” severe low back pain/abdominal pain with presence of abdominal bruit or pulsation
Dissecting AAA
Bone metastases presents like
- achy, sharp well localizied or neuropathic pain
- can be severe at night
- pain with weight bearing
- can be associated with night sweats, fatigue, fever, malaise, weight loss
- can be constant or intermittent and get exacerbated by movement of the joint/bone
Genu valgum
Genu varum
valgum: knock knee
varum: bow leged
If a patient experiences an exercise injury, what is the management in the 1st 48 hours
RICE
- Rest: avoid use
- Ice: 20 minutes on 10 off for 24-48 hrs
- Compression: Elastic bandage over joints ot decrease swelling and support the joint (usually ankles and knees)
- Elevation:
Drawer sign tests for
knee stability
+ Anterior drawer is indicative of _____ while + posterior drawer is indicative of _____
ACL tear
PCL tear
What does the a + finkelstein’s test suggest
De Quervain’s (which is inflammation of the tendon sheath located at the base of the thumb)
+ Lachman’s suggests
ACL damage
+ McMurrays suggests
meniscus, (+ if knee pain and click)
Valgus stress test of the knee tests
MCL
Varus stress test of the knee tests
LCL
What are complications of steroid joint injections
- tendon rupture
- nerve damage
- infection
- bleeding
- HPA suppression
What is gold standard imaging for dx injuries of cartilage, menisci, tendons, ligaments or any joint
MRI
What is medial tibia stress syndrome
-lower extremity injury caused by overuse, resulting in microtears and inflammation fo the muscles, tendons and bone tissue of the tibia
What are risk factors for medial tibia stress syndrome
- runners
- flat feet
- females
- female athlete triad
What is the presentation of medial tibia stress syndrome
- Pain on inner edge of the tibia
- pain may be sharp, stabbing or dull and throbbing
- aggravated during and after exercise
- focal area tenderness
What is the management of medial tibia stress syndrome
- RICE
- NSAIDs PRN
- When pain is gone wait ~2 weeks before resuming exercise, avoid hills and hard surfaces
What is the imaging of choice in a suspected stress fracture
-MRI or bone scan
What is the presentation of plantar fasciitis
- pain on the bottom of the feet
- aggravated by walking and weight bearing
- complains that foot pain is worse during first few steps in the am and worsens with prolonged walking
What are risk factors for plantar fasciitis
- obesity
- DM
- Aerobic exercise
- flat feet
- prolonged standing
What is a morton’s neuroma
-inflammation of the digital nerve of the foot between the 3rd and 4th metatarsals
What are risk factors for morton’s neuroma
- high heels
- dancers
- obesity
- runners
This test is done by grasping the 1st and 5th metatarsals and squeezing the forefoot. A + test is hearing a click along with patient reporting pain during compression.
Mulder test for Morton’s Neuroma
What are risk factors for DJD or OA
- older age
- overuse of joints
- family hx
What is the presentation of DJD or OA
- Gradual onset
- Early morning stiffness with inactivity
- Shorter duration of joint stiffness (<15 minutes) when compared with RA
- Pain aggravated by overuse of the join
- Can be unilateral
- No systemic sx
- HeberDen’s Nodes: DIP
- Bouchards: PIP
What is the non-pharmacological mgmt of DJD or OA
- Exercise 3x/wk
- weight loss
- smoking cessation
- isometric exercises
- weight bearing exercises
- avoid aggravating activities
What is the first line medication for DJD or OA
Acetaminophen 325 to 650mg q4-6 hours to a max of 4g/daily
What NSAIDs have the highest risk of GI bleed
-toradol and piroxicam
What NSAIDs have the lowest risk of gi bleed
-Ibuprofen and celebrex
What NSAIDs have the highest risk for CV events
Diclofenac and celebrex
What NSAIDs have lowest risk of CV events
Naproxen
Toradol should be limited to ___ days of use and the 1st dose is give
5 days; IM/IV
Heberden’s node appear ____ and are associated with
DIP; OA
Bouchards nodes appear ____ and are associated with
PIP; OA or RA
What are types of pharmacology treatments in DJD or OA
-Acetaminophen, NSAIDs (oral/topical), steriod injections, surgery
What organs are affected by lupus
-skin, kidney, heart, blood vessels
What is the classic presentation of lupus
- maculopapular butterfly rash on middle of face (malar rash), nonpruritic thick scaly red rashes on sun exposed areas (discoid rash)
- proteinuria on UA
What education should you provide to pts with lupus
- avoid sun between 10-4
- sun protection
- use nonflourescent lights
What is the presentation of RA
- gradual onset of
- daily fatigue
- low grade fever
- generalized body aches
- myalgia
- generalized joint pain
- early morning stiffness
- pain, warmth, tender joints
- joint involvement is symmetrical
- Swan neck or boutonniers present
What is swan neck deformity
-flexion of the DIP with hyperextension of the PIP
Boutonniere deformity
-hyperextension of the DIP with flexion of the PIP
What labs are indicated in RA
- ESR
- CRP
- CBC
- RF
- Radiographs
- Serology/antibodies: Anti-CCP
What joints are most commonly affected in RA
-fingers, hands, wrist, shoulders, elbows, ankles and feet
What medications are indicated in RA management
- NSAIDs
- Steroids
- DMARDs
- Biologics
RA increases the risk of:
-uveitis, scleritis, vasculitis, pericarditis, certain malignancies (lymphoma)
Before starting plaquenil what do all patients need
an eye exam
Plaquenil is an
antimalarial
Methotrexate is an example of a _____ it is contraindicated during ____ and so what precautions should be taken
DMARD
Pregnancy
Contraception is in place
NSAIDs injure GI tract by blocking ____ resulting in
COX-1 and 2 resulting in lower levels of systemic prostaglandins
Aspiring affects platelets and clotting ______. It resolves when the therapy is stopped and platelet dies which is ____ days
Permanent
10 days
What is gout
deposit of uric acid crystals inside joints and tendons r/t genetic excess production or low excretion of purine crystals (a by-product of protein metabolism)
What is the gold standard for dx gout
-joint aspiration of the synovial fluid
The most common way to dx gout is
recurrent flares with elevated serum uric acid level >6.8mg/dL
The joints most commonly affected by gout are
- MTP
- Ankles
- Hands
- Wrists
What is the classic presentation of gout
- painful, hot red and swollen MTP joint
- often precipitated by ingestion of ETOH, meats or seafoot
What are lab finding sin gout
- Uric acid level: elevated >6.8mg/dL *Note uric acid doesn’t rise until after the acute phase
- CBC: WBC level elevated
- ESR elevated
- CRP: Elevated
Medications for gout flares
NSAIDS, steroids, colchicine
In a patient taking urate lowering therapies with a gout flare do you D/C the med?
No
What are common side effects of colchicine
- diarrhea
- abdo pain
- cramps
- nausea
- vomiting
What are drug interactions of colchicine
- Macrodlides
- Azoles
- Anti virals
- CCBs
- Cyclosporines
- Tacrolimus
What is the presentation of ankylosing spondylitis
- chronic back pain starting at neck and progressing down
- impaired spinal mobility
- joint pain at night
- generalized sx such as low grade fever, fatigue
- costochondritis
- stiffness improves with activity
- marked loss of ROM of the spin
- uveitis
- +HLA-B27
What are classic lab/imaging findings of Ankylosing spondylitis
- ESR/CRP: Elevated
- Spinal X-ray: Classic bamboo spine
What are complications of ankylosing spondlyitis
- anterior uveitis
- aortitis
- fusing of the spine with significant loss of ROM
- spinal stenosis, hyperkyphosis
What is the management of ankylosing spondylitis
-refer to rheum
-smoking cessation
-PT
-Exercise therapy and hydrotherapy
-First line pharm is NSAIDs
for sever cases same as RA
Red flags back pain
- significant trauma
- cancer
- suspected infection
- suspected spinal/vertebral fracture
- age >50 new onset back pain or waking pt from sleep
- radiculopathy
- fever, night sweats, weight loss
What is the presentation of piriformis syndrome
- sciatic symptoms
- pain, numbness of the buttocks with radiation
- pain worse with prolonged sitting
- episodic
What ist he cast for wrist fractures
thumb spica cast
What are signs of cauda equina
- incontinence
- saddle anesthesia
- bilateral sciatic sx
Microtears on a tendon causing inflammation and pain
Tendinitis
Rotator cuff pathology presentation
- repetitive overhead activity
- complains of shoulder pain with over head movements
- local point tenderness over the anterior shoulder
Jobes test or empty can tests teh
supraspinatus
-+ without weakness (tendiopathy)
+ with weakness suggests a tear
Painful arc test is positive when
shoulder pain occurs between 60-120 degrees
Lateral epicondylitis
- tennis elbow
- gradual onset of pain on the outside of elbow with radiation to forearm
- pain is worse with twisting and grasping movements
- pain on palpation of lateral epicondyle
Medial epicondylitis
- golfers elbow
- aching pain on the medial area of elbow
- localized tenderness
a complication of epicondylitis is
ulnar nerver neuropathy
What are the best imaging methods for hamstring injuries
- US
- MRI
What is the presentation of a a hamstring injury
- acute, popping noise
- sudden onset of posterior thigh pain while performing activities
- swelling, bruising, tenderness on posterior thigh
What is the most common mechanism of injury for a lateral ankle sprain
-inversion with plantar flexed foot
What is the most common mechanism of injury for a medial ankle sprain
-eversion of the ankle
Grade II sprain
- moderate swelling
- pain
- joint tenderness
- ambulation and weight bearing are painful
Classic presentation of a meniscus tear includes
- clicking, locking. buckling of the kees
- unable to extend the knee
- knee pain
- joint line tenderness
- decreased ROM
- swelling
What does McMurrays test for
meniscal tears + is pain, clicking or knee locks
Apleys test for
Meniscal tears
+ if pain occurs with compression of the knee
What is the presentation of a ruptured bakers cyst
- ball like mass behind knee that is soft and smooth
- mass softens when knee is at 45 degrees (fouchers sign)
- may be asymptomatic or have pressure, pain or stiffness in posterior knee
Ankle series is required if
- inability to bear weight immediately after injury
- inability to ambulate 4 steps
- bone tenderness over the posterior tip of medial malleolus
- bone tenderness over posterior tip of lateral malleolus
