MSK Flashcards
How to describe a radiograph
PAID
pattern and pieces
Anatomical location
Inter/extra-articular inc. dislocation and subluxation
Deformity inc translation, angulation, rotation, impaction
Types of fracture lines
TOGSAC Transverse oblique greenstick Spiral Avulsion Crush
fat embolism presentation
PE + neuro signs
confusion, agitation, retinal haemorrhages
red/brown petechial rash
painful arc between 60-120 degrees is what pathology?
glenohumeral (impingement, rotator cuff, calcific tendonitis)
painful arc between 170-180 degrees is what pathology
acromioclavicular: arthritis, SLAP tears, trauma
describe subacromial impingement syndrome
greater tuberosity of humerus and acromion hit each other causing pain in the rotator cuff tendon
management of impingement
steroids
NSAIDs
physio for RC
surgery: arthroscopic subacromial decompression
management of rotator cuff tear
Conservative: NSAIDs, steroid injections, physio
Surgical: rotator cuff repair +/- subacromial decompression
e.g. single or double row
management of frozen shoulder
steroid injections and intensive physio
manipulation under anaesthetic
surgery: capsule and rotator interval release
3 stages of frozen shoulder
freezing: painful, 0-6m
frozen: stiff, 6-24m
thawing: resolution, 24-36m
most common shoulder dislocation direction
antero-inferior, more obvious on X-ray
posterior shoulder dislocation sign
light bulb sign, can’t see tuberosity
need an axillary view to confirm
management of anteroinferior dislocation
Traction
Neuro status
1st: external rotation brace
recurrent: early mobilisation and surgery (keyhole stabilisation
causes of posterior shoulder dislocation
major trauma
seizures
electrocution
Growth plate injury classification
Salter-Harris
Describe Salter Harris Classification
type can be thought of as S A L T ER S = straight across A = above L = lower T = through ER = ERasure (crushed)
X rays for NOF and findings
AP and lateral
Shenton’s line disruption from medial femoral neck to inferior edge of pubic ramus
NOF presentation and classification
pain in groin with referral to thigh
external rotation and shortened limb length
Can be intracapsular or extracapsular
extracapsular: intertrochanteric or subtrochanteric
Garden classification for intracapsular 1 = incomplete and undisplaced 2 = complete but undisplaced 3 = complete and partial displaced 4 = complete and fully displaced
management of intracapsular NOF
iliofascial block
<55and Garden I/II: ORIF with 3/4 parallel cancellous screws
Displaced:
<55 ORIF and cannulated screws
55-75: Total Hip Rreplacement
>75: Hemiarthroplasty
two types of extracapsular NOF
intertrochanteric
subtrochanteric
must be within 5cm inferior of lesser trochanter or it’s femoral shaft
management of intertrochanteric NOF
DHS and plate system following closed reduction
if unstable ORIF with cancellous/cannulated screws
management of subtrochanteric NOF
IM nailing
osteoarthritis XR
Loss of joint space
Osteophytes (Heberden/Bouchard)
Subchondral cysts
Subchondral sclerosis
RhA XR
Loss of joint space
Erosion
Soft tissue swelling
Soft bones (osteopaenia)
RhA join signs
ulnar deviation swan necking/Boutonniere deformity subluxation of ulnar styloid muscle wasting tendon rupture rheumatoid nodules
RhA extraarticular signs
Sjogren's Scleritis Nodules Leg ulcers pyoderma gangrenosum lower lobe fibrosis Cardio involvement Vasculitis Renal Felty's syndrome
Management of RhA
NSAIDs
Steroids
DMARDs = MTX, HCQ, Sulfasalazine
Biologics = etanercept tocilizumab, rituximab
tibial fracture management
internal or external fixation
if children/young adults: manipulation and plaster immobilisation
Management of Achilles tendon rupture
equinus cast (plaster of paris cast), slowly reducing the plantar flexion over months
surgical repair
can use flexor hallucis longus tendon for repair
signs of ulnar nerve damage
claw hand deformity positive froment's: holding paper between thumb and index shows flexion of terminal phalanx of thumb failure of finger abduction hypothenar wasting no sensation on medial 2.5 fingers
ACL management
isolated: specialised quadriceps physiotherapy
Instability, concurrent injury, paediatric: grafting from the hamstring and patellar tendon (semitendinosus and gracilis)
MCL/LCL management
hinged knee brace and physio
Meniscal tear management
Arthroscopic debridement
Arthroscopic repair works better in lateral 1/3rd due to blood supply
O’Donoghue unhappy triad
medial meniscal tear
ACL tear
MCL injury
organism causing septic arthritis
Staph aureus
CoNS
Anterior shoulder dislocation palsy
Axillary nerve damage: weak abduction and sargent’s patch
Humeral shaft # palsy
Radial nerve: Waiter’s tip
Elbow dislocation palsy
ulnar nerve: Claw hand
Hip dislocation palsy
Sciatic nerve: Foot drop
Fibula neck #/knee dislocation palsy
peroneal nerve: foot drop
ottawa knee rule
any of 55 Isolated patellar tenderness Cannot flex to 90 Can't weight bear for 4 steps
ottawa ankle rule
pain in malleolar zone AND:
- bone tenderness at posterior edge/tip of lateral malleolus
- bone tenderness at posterior edge/tip of medial malleolus
- inability to bear weight for 4 steps
OR
pain in mid-foot and
- bone tenderness at base of 5th metatarsal
- bone tenderness at navicular
- inability to weight bear for 4 steps
Humeral head fracture management
2 part, minimally displaced: collar and cuff
3 part/displaced: ORIF plate and screws
Large displacement: arthroplasty
Unrepairable rotator cuff: reverse arthroplasty
Supracondylar elbow # classification
Gartland for extension fractures (distal fragment displaces posteriorly)
Supracondylar humeral # palsy
median nerve palsy: Hand of Benediction, weak OK
Brachial artery:
management of compartment syndrome
elevate limb
remove bandages/splint
fasciotomy
artery supplying head of femur
retinacular artery from medial circumflex femoral artery
femoral shaft # management
traction IM nailing (anterograde from hip or retrograde from knee)
ORIF if IM nailing unsuitable
supracondylar elbow # management
no displacement: collar/cuff for 3 weeks with fully flexed arm
Displacement: Manipulation under anaesthetic and K wire fixation + collar/cuff 3w
Colle’s fracture deformity
Dinner fork
Monteggia #
+ management
proximal 3rd of ulnar shaft + anterior dislocation of proximal radius
adult: ORIF
paeds: MUA + above-elbow POP
Galeazzi #
+ management
distal 3rd of radial shaft + dislocation of radio-ulnar joint
adult: ORIF
paeds: MUA + above-elbow POP
5 signs of scaphoid fracture
1) snuffbox pain
2) pain telescoping thumb
3) tenderness on scaphoid
4) pain on ulnar deviation
5) wrist joint effusion
scaphoid x ray views
scaphoid, AP and lateral
scaphoid management
Futuro splint pre x-ray
if X-ray negative, return in 10 days to repeat
if positive:
undisplaced at scaphoid waist - cast for 6-8w
displaced at scaphoid waist OR any fracture at proximal pole - ORIF
NB: Scaphoid waist = middle
why scaphoid risk of AVN
retrograde blood supply from dorsal carpal branch of radial artery
Pott’s fracture
ankle bimalleolar fracture
Cotton’s fracture
ankle trimalleolar fracture
Ankle fracture classification
Weber = lateral malleolus fracture
A: below syndesmosis
B: at syndesmosis
C: above syndesmosis
1: isolated
2: with medial malleolus
3: with medial malleolus and posterolateral tibia
management of ankle fracture
Weber A/non-displaced B: Boot/below-knee POP
Weber B displaced/C: ORIF +/- syndesmosis repair
Compartment syndrome investigations
clinical suspicion #1
manometer
complications of compartment syndrome
Volkmann contractures Sensory loss Weak dorsiflexors Chronic pain Claw toe Amputation
Shoulder dislocation lesions
Hill-Sachs: Bony dents on humeral head
Bankart: damage to cartilage (labrum/glenoid)
Bony Bankart: fracture of glenoid floating around
Axillary nerve palsy
Rotator cuff tears
biceps tendon rupture pain
Long tendon proximally: shoulder
Long tendon distally: antecubital fossa
Popeye’s deformity sign
proximal biceps tendon rupture
needs urgent MRI
Elbow Epicondylitis types
lateral (tennis): worse on wrist extension
medial (golfer’s): worse on flexion, tingling in 4/5 fingers
management of carpal tunnel syndrome
conservative: modify activity, splints at night, hand exercises
Surgery: Steroid injections, surgical decompression
causes of knee locking
meniscus/cruciate tear, osteochondritis, osteophytes
chondromalacia patellae usually tends to affect
Management
teenage girls after knee injury
pain going downstairs/prolonged sitting
Mx: vastus medialis strengthening
PCL management
isolated: physio and bracing
instability, concurrent injury, paeds: reconstruction from hamstring/patellar tendon
define meralgia paraesthetica
parasthesia in lateral femoral cutaneous nerve distribution (L2/3) NO MOTOR
due to it travelling around the ASIS and being subject to repetitive trauma
define bipartate patella
patella fails to fuse 3 types (inferior pole, lateral, superolateral)
causes of true leg length discrepancy
Congenital: idiopathic, NF, spina bifida, CP, clubfoot
Developmental: growth plate injury, polio, DDH, perthe’s, cancer
Post-trauma: #femur, #tibia
causes of apparent leg length discrepancy
arthritis: fixed flexion deformity of hip, fixed adduction deformity of hip
scoliosis
changes in muscle length/contracture
