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PACES Management > MSK > Flashcards

MSK Flashcards

1
Q

How to describe a radiograph

A

PAID
pattern and pieces

Anatomical location

Inter/extra-articular inc. dislocation and subluxation

Deformity inc translation, angulation, rotation, impaction

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2
Q

Types of fracture lines

A 
TOGSAC
Transverse
oblique
greenstick
Spiral
Avulsion
Crush
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3
Q

fat embolism presentation

A

PE + neuro signs
confusion, agitation, retinal haemorrhages

red/brown petechial rash

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4
Q

painful arc between 60-120 degrees is what pathology?

A

glenohumeral (impingement, rotator cuff, calcific tendonitis)

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5
Q

painful arc between 170-180 degrees is what pathology

A

acromioclavicular: arthritis, SLAP tears, trauma

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6
Q

describe subacromial impingement syndrome

A

greater tuberosity of humerus and acromion hit each other causing pain in the rotator cuff tendon

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7
Q

management of impingement

A

steroids
NSAIDs
physio for RC

surgery: arthroscopic subacromial decompression

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8
Q

management of rotator cuff tear

A

Conservative: NSAIDs, steroid injections, physio

Surgical: rotator cuff repair +/- subacromial decompression

e.g. single or double row

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9
Q

management of frozen shoulder

A

steroid injections and intensive physio

manipulation under anaesthetic

surgery: capsule and rotator interval release

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10
Q

3 stages of frozen shoulder

A

freezing: painful, 0-6m
frozen: stiff, 6-24m
thawing: resolution, 24-36m

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11
Q

most common shoulder dislocation direction

A

antero-inferior, more obvious on X-ray

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12
Q

posterior shoulder dislocation sign

A

light bulb sign, can’t see tuberosity

need an axillary view to confirm

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13
Q

management of anteroinferior dislocation

A

Traction
Neuro status

1st: external rotation brace
recurrent: early mobilisation and surgery (keyhole stabilisation

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14
Q

causes of posterior shoulder dislocation

A

major trauma
seizures
electrocution

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15
Q

Growth plate injury classification

A

Salter-Harris

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16
Q

Describe Salter Harris Classification

A 
type can be thought of as S A L T ER
S = straight across
A = above
L = lower
T = through
ER = ERasure (crushed)
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17
Q

X rays for NOF and findings

A

AP and lateral

Shenton’s line disruption from medial femoral neck to inferior edge of pubic ramus

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18
Q

NOF presentation and classification

A

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
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19
Q

management of intracapsular NOF

A

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

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20
Q

two types of extracapsular NOF

A

intertrochanteric
subtrochanteric

must be within 5cm inferior of lesser trochanter or it’s femoral shaft

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21
Q

management of intertrochanteric NOF

A

DHS and plate system following closed reduction

if unstable ORIF with cancellous/cannulated screws

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22
Q

management of subtrochanteric NOF

A

IM nailing

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23
Q

osteoarthritis XR

A

Loss of joint space
Osteophytes (Heberden/Bouchard)
Subchondral cysts
Subchondral sclerosis

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24
Q

RhA XR

A

Loss of joint space
Erosion
Soft tissue swelling
Soft bones (osteopaenia)

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25
Q

RhA join signs

A 
ulnar deviation
swan necking/Boutonniere deformity
subluxation of ulnar styloid
muscle wasting
tendon rupture
rheumatoid nodules
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26
Q

RhA extraarticular signs

A 
Sjogren's
Scleritis
Nodules
Leg ulcers
pyoderma gangrenosum
lower lobe fibrosis
Cardio involvement
Vasculitis
Renal
Felty's syndrome
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27
Q

Management of RhA

A

NSAIDs
Steroids
DMARDs = MTX, HCQ, Sulfasalazine
Biologics = etanercept tocilizumab, rituximab

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28
Q

tibial fracture management

A

internal or external fixation

if children/young adults: manipulation and plaster immobilisation

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29
Q

Management of Achilles tendon rupture

A

equinus cast (plaster of paris cast), slowly reducing the plantar flexion over months

surgical repair

can use flexor hallucis longus tendon for repair

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30
Q

signs of ulnar nerve damage

A 
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
31
Q

ACL management

A

isolated: specialised quadriceps physiotherapy

Instability, concurrent injury, paediatric: grafting from the hamstring and patellar tendon (semitendinosus and gracilis)

32
Q

MCL/LCL management

A

hinged knee brace and physio

33
Q

Meniscal tear management

A

Arthroscopic debridement

Arthroscopic repair works better in lateral 1/3rd due to blood supply

34
Q

O’Donoghue unhappy triad

A

medial meniscal tear
ACL tear
MCL injury

35
Q

organism causing septic arthritis

A

Staph aureus

CoNS

36
Q

Anterior shoulder dislocation palsy

A

Axillary nerve damage: weak abduction and sargent’s patch

37
Q

Humeral shaft # palsy

A

Radial nerve: Waiter’s tip

38
Q

Elbow dislocation palsy

A

ulnar nerve: Claw hand

39
Q

Hip dislocation palsy

A

Sciatic nerve: Foot drop

40
Q

Fibula neck #/knee dislocation palsy

A

peroneal nerve: foot drop

41
Q

ottawa knee rule

A 
any of
55
Isolated patellar tenderness
Cannot flex to 90
Can't weight bear for 4 steps
42
Q

ottawa ankle rule

A

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
43
Q

Humeral head fracture management

A

2 part, minimally displaced: collar and cuff
3 part/displaced: ORIF plate and screws
Large displacement: arthroplasty
Unrepairable rotator cuff: reverse arthroplasty

44
Q

Supracondylar elbow # classification

A

Gartland for extension fractures (distal fragment displaces posteriorly)

45
Q

Supracondylar humeral # palsy

A

median nerve palsy: Hand of Benediction, weak OK

Brachial artery:

46
Q

management of compartment syndrome

A

elevate limb
remove bandages/splint
fasciotomy

47
Q

artery supplying head of femur

A

retinacular artery from medial circumflex femoral artery

48
Q

femoral shaft # management

A 
traction
IM nailing (anterograde from hip or retrograde from knee)

ORIF if IM nailing unsuitable

49
Q

supracondylar elbow # management

A

no displacement: collar/cuff for 3 weeks with fully flexed arm

Displacement: Manipulation under anaesthetic and K wire fixation + collar/cuff 3w

50
Q

Colle’s fracture deformity

A

Dinner fork

51
Q

Monteggia #

+ management

A

proximal 3rd of ulnar shaft + anterior dislocation of proximal radius

adult: ORIF
paeds: MUA + above-elbow POP

52
Q

Galeazzi #

+ management

A

distal 3rd of radial shaft + dislocation of radio-ulnar joint

adult: ORIF
paeds: MUA + above-elbow POP

53
Q

5 signs of scaphoid fracture

A

1) snuffbox pain
2) pain telescoping thumb
3) tenderness on scaphoid
4) pain on ulnar deviation
5) wrist joint effusion

54
Q

scaphoid x ray views

A

scaphoid, AP and lateral

55
Q

scaphoid management

A

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

56
Q

why scaphoid risk of AVN

A

retrograde blood supply from dorsal carpal branch of radial artery

57
Q

Pott’s fracture

A

ankle bimalleolar fracture

58
Q

Cotton’s fracture

A

ankle trimalleolar fracture

59
Q

Ankle fracture classification

A

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

60
Q

management of ankle fracture

A

Weber A/non-displaced B: Boot/below-knee POP

Weber B displaced/C: ORIF +/- syndesmosis repair

61
Q

Compartment syndrome investigations

A

clinical suspicion #1

manometer

62
Q

complications of compartment syndrome

A 
Volkmann contractures
Sensory loss
Weak dorsiflexors
Chronic pain
Claw toe
Amputation
63
Q

Shoulder dislocation lesions

A

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

64
Q

biceps tendon rupture pain

A

Long tendon proximally: shoulder

Long tendon distally: antecubital fossa

65
Q

Popeye’s deformity sign

A

proximal biceps tendon rupture

needs urgent MRI

66
Q

Elbow Epicondylitis types

A

lateral (tennis): worse on wrist extension

medial (golfer’s): worse on flexion, tingling in 4/5 fingers

67
Q

management of carpal tunnel syndrome

A

conservative: modify activity, splints at night, hand exercises

Surgery: Steroid injections, surgical decompression

68
Q

causes of knee locking

A

meniscus/cruciate tear, osteochondritis, osteophytes

69
Q

chondromalacia patellae usually tends to affect

Management

A

teenage girls after knee injury
pain going downstairs/prolonged sitting

Mx: vastus medialis strengthening

70
Q

PCL management

A

isolated: physio and bracing

instability, concurrent injury, paeds: reconstruction from hamstring/patellar tendon

71
Q

define meralgia paraesthetica

A

parasthesia in lateral femoral cutaneous nerve distribution (L2/3) NO MOTOR

due to it travelling around the ASIS and being subject to repetitive trauma

72
Q

define bipartate patella

A 
patella fails to fuse
3 types (inferior pole, lateral, superolateral)
73
Q

causes of true leg length discrepancy

A

Congenital: idiopathic, NF, spina bifida, CP, clubfoot
Developmental: growth plate injury, polio, DDH, perthe’s, cancer
Post-trauma: #femur, #tibia

74
Q

causes of apparent leg length discrepancy

A

arthritis: fixed flexion deformity of hip, fixed adduction deformity of hip
scoliosis
changes in muscle length/contracture

PACES Management (11 decks)

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