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YEAR 2 FCM Revision > MSK > Flashcards

MSK Flashcards

1
Q

What is the diagnostic test for fractures?

A

Xray

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2
Q

What imaging modality is best for soft tissue and liagments?

A

MRI

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3
Q

what can treatment of an open fracture involve?

A

ORIF = open reduction, internal fixation

surgical debridement
IV abx
tetanus vaccine

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4
Q

What can treatment of a closed fracture involve?

A

treated non-surgically with immobilisation

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5
Q

What is the most common fracture in children?

A

Greenstick

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6
Q

what is a subluxation? How does it present?

A

Partial dislocation

often after injury
often obvious deformity or typical posturing

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7
Q

Ix and Mx for a subluxation?

A

XR to confirm diagnosis and rule out any concurrent fractures

Mx - reduction & stabilisation
check neurovascular status before and after

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8
Q

What does presentation of compartment syndrome involve?

A 
Pain out of proprotion - excessive need for breakthrough pain relief 
pallor 
parathesia 
pulselessness 
polkilothermia 
paralysis
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9
Q

Investigations for compartment syndrome

A

intracompartmental pressure measurements
>20mmHg - abnormal
>40mmHg - diagnostic

XR usually normal

CK and urine myoglobulin elevated

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10
Q

What does management of Compartment syndrome involve?

A

Immediate fasciotomy

aggressive IV fluids -
fasciotomy often results in renal failure

if tissue necrotic - consider debridement and amputation

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11
Q

Patient presenting with a couple days history of pain moving shoulder
middle aged
diabetic

hx of shoulder injury/surgery

A

Adhesive capsulitis

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12
Q

what conditions is adhesive capsulitis associated with?

A

diabetes

thyroid disease

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13
Q

what clinical signs O/E are indicative of adhesive capsulitis?

A

external rotation more affected

Coracoid pain test positive

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14
Q

What investigations are done for adhesive capsulitis?

A

none - usually clinical

XR only done if symptoms persistent or is presentation atypical - r/o any fractures of posterior dislocation

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15
Q

How is adhesive capsulitis managed?

A

first line - NSAIDs and physio

second line - intra-articular steroids (can give PO)

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16
Q

Pain on abduction and positive empty can test

which muscle is affected?

A

Supraspinatus

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17
Q

Pain on external rotation

which tendon is affected?

A

Infraspinatus

adhesive cap is a ddx - with hx of DM

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18
Q

Pain on internal rotation

which tendon is affected?

A

Subscapularis

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19
Q

Painful abduction
recent over the head activity
painful arc 60-120°
anterior acromion tenderness

A

Subacromial impingement

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20
Q

Management approach for rotator cuff injuries?

A

NSAIDs
physio
IA steroids - if symptoms persistent or unresponsive to NSAIDs

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21
Q

FOOSH followed by externally rotated arm at side of body
greater fullness of the shoulder

may be visibly deformed

A

Anterior shoulder dislocation

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22
Q

Ix and management for Anterior shoulder dislocation?

A

XR

reduction and appropriate pain relief

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23
Q

Which nerve should be tested on shoulder dislocations? How is it tested?

A

axillary nerve

- check sensation in the deltoid

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24
Q

Causes of posterior shoulder dislocation?

A

seizures

electrocution

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25
Q

medially rotated arm - very locked in position
front of shoulder appears flat
prominent coracoid process

A

posterior dislocation

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26
Q

Ix and Mx of posterior dislocation

A

XR - axillary view

mx - posterior reduction (closed)
if missed/ no detected - open reduction up to 8/52 after injury

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27
Q

Lower back pain red flags

A 
aged under 20 or over 50 
hx of previous malignancy 
night pain/ pain wakes them up 
hx of trauma 
systemically unwell/constitutional symptoms 
saddle anaesthesia 
loss of anal sphincter tone 
loss of bowel/bladder continence
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28
Q

Diagnosis of lower back pain

A

clinical - no lab or imaging needed

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29
Q

Management of lower back pain

A

Patient education
Analgesia - NSAIDs/Paracetamol
muscle relaxants

! avoid bed rest !

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30
Q 
morning stiffness <15mins
worse with certain activities 
onset often post injury 
fluctuating symptoms 
overuse also RF
A

mechanical back pain

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31
Q 
morning stiffnedd >1hr
better with movement 
insidious onset 
progressive 
typically younger patients
A

Inflammatory back pain

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32
Q 
male in 20s 
lower back pain of insidious onset 
morning stiffness (longer duration)
improves on exercise 
pain at night - imporved on getting up 
sacroiliac pain
A

Ankylosing spondylitis

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33
Q

signs of ankylosing spondylitis on examination

A

reduced lateral flexion
reduced forward flexion
positive schobers test (>5cm)

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34
Q

Other features of Ankylosing spondylitis?

A 
6As 
apical fibrosis (lung disease)
anterior uveitis 
aortic regurg 
achilles tendonitis 
AV node block 
amyloidosis
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35
Q

Investigations for ankylosing spondylitis

A

raised inflammatory markers - ESR/CRP

XR - ‘bamboo spine’
sclerosis, subchondral erosions and syndesmophytes and squaring of lumbar vertebrae

if XR normal but clinical suspicion remains - MRI

genetic tests for HLA-B27
CXR - apical fibrosis
spirometry - restrictive picture

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36
Q

Management of ankylosing spondylitis

A

first line = NSAIDs
If peripheral joint involvement = DMARD (sulphasalazine)

Encourage regular exercise and physio

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37
Q

What nerves are compressed in cauda Equina?

A

L1-S5

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38
Q

What are the causes of Cauda Equina?

A

central disc prolapse - L4/5 or L5/S1

others include - trauma, haematoma, infection, tumours

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39
Q

Presentation of Cauda Equina?

A 
Lower back pain 
bilateral sciatica or progressive neuro deficit in limbs
Decreased anal tone 
bowel/bladder incontinence
saddle anathesia
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40
Q

Ix for Cauda Equina?

A

urgent MRI

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41
Q

Management for Cauda Equina?

A

surgical decompression

under neurosurgery

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42
Q

What are the complications of cauda equina?

A

bladder/bowel/sexual dysfunction

leg weakness
sensory impairment

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43
Q

What is herniated disc pulposus?

A

A condition characterised by lower limb pain resulting from spinal nerve compression

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44
Q

Causes of herniated disc pulposus?

A

herniated disc

vertebral body mets

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45
Q

back pain
unilateral leg pain - worse than back
worse on sitting, radiates to foot/toes
associated numbness and paresthesia

A

herniated disc pulposus

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46
Q

presentation of L1-L3 nerve roots affected in herniated disc pulposus involves…

A

pain from lower back radiating to hip or anterior thigh
reduced knee reflex
+ve femoral stretch - thigh pain

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47
Q

presentation of L4-S1 nerve roots affected in herniated disc pulposus involves….

A

pain radiates below the knee

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48
Q

Investigation for herniated disc pulposus

A

MRI diagnostic

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49
Q

Management for herniated disc pulposus?

A

analgesia - NSAIDs
physio
exercising

persistent symptoms - 4-6wks can refer for an MRI

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50
Q

What is spinal stenosis?

A

The narrowing of part of the spinal canal resulting in compression of the spinal cord and nerve roots

commonly lumbar spine affects, in 50-60s

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51
Q

Causes of spinal stenosis include?

A

congenital stenosis, degenerative changes, herniated discs, spinal fractures and tumours

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52
Q

insidious back pain,

paresthesia on ambulation and relieved when supine

Bilateral leg pain - often worse on standing and walking or leaning forward

normal pulse
lower extremity pain and numbness

A

spinal stenosis

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53
Q

spinal stenosis presenting with unilateral leg pain suggests?

A

unilateral foraminal stenosis

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54
Q

spinal stenosis presenting with bilateral leg pain suggests?

A

central or bilateral foraminal stenosis

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55
Q

Ix for spinal stenosis?

A

MRI

to r/o PAD - ABPI & angio

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56
Q

Management approach to spinal stenosis?

A

spinal specialist to recommend exercise, analgesia and physio

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57
Q

DDX for spinal stenosis

A

peripheral arterial disease

neuropathy

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58
Q

What is kyphosis?

A

‘hunchback’ - a curvature of the spine measuring 50 degrees or greater on an X-ray
often seen in those with osteoporosis and in the elderly

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59
Q

What is lordosis?

A

the inward curve of the lumbar spine

often seen in pregnancy

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60
Q

What is scoliosis?

A

a sideways curvature of the spine

treated dependent on the degree of scoliosis
<20° = exercise and monitor
21-45° = bracing
>45° = surgery

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61
Q

loss of cartilage under the patella

A

chondromalacia patella

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62
Q

chondromalacia patella presentation

A

pain in the knee - dull ache
aggravated by deep bending

hypermobile patella with significant crepitus = grinding sensation

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63
Q

Investigations

A

XR = bone to bone (patella and femur)

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64
Q

what is patellofemoral pain syndrome?

A

broad term for pain in and around the patella - chondromalacia patella is one of the causes

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65
Q

knee pain - worse on straightening the knee
associated swelling, stiffness
restricted ROM and locking
instability

hx of injury
Mechanism of injury = twisting leg

A

Meniscal tear/injury

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66
Q

What special tests can be done to test for meniscal injury?

A

Mc Murray’s
Apley grind tests

not in clinical practice due to causing pain and worsening the injury

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67
Q

What are Ottawa Knee rules?

A

used to determine if imaging warranted

  1. aged 55+
  2. isolated patella tenderness
  3. fibular head tenderness
  4. cannot flex knee to 90°
  5. cannot wait bear <4 steps

scoring any 1 of criterion warrants imaging

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68
Q

Ixs for meniscal injury

A

XR - if ottawa rules warrant
MRI scan - first line
arthroscopy - GOLD STANDARD (diagnosis and allows for therapeutic intervention)

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69
Q

management for meniscal injury?

A

Conservative - RICE protocol
NSAIDs - first line analgesia
Physio for rehab
Surgery - arthroscopy

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70
Q

loss of anterior/posterior stability
knee painful, swollen
Weight bearing can be difficult
‘pop’ heard during injury

+drawer tests

A

Cruciate ligament injury

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71
Q

What does mechanism of injury for ACT involve?

A

blow to the back of knee combined with rotation - often in sports

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72
Q

What does mechanism of injury for PCT involve?

A

anterior force - dashboard collision in RTA

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73
Q

How are cruciate ligament injuries investigated?

A

Conservative management - RICE
NSAIDs first line
physio - pre and post surgery

arthroscopic surgery

  • if reconstruction required
  • young, active patients
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74
Q

Pain, swelling and redness in knee - swelling prominent
difficult to kneel or walk
history of trauma
occupation or recreational activities involving repetitive or prolonged kneeling

A

pre-patellar bursitis

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75
Q

Causes of Pre-patella bursitis?

A

acute trauma
chronic trauma - repetitive pressure/overuse
gout or RA/SLE

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76
Q

Ix for pre-patellar bursitis?

A

bursal aspiration - rule out septic knee or crystal-induced bursitis

bloods - CRP, ESR, WCC, uric acid, blood glucose, ANA and RF

XR - if bony abnormality suspected

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77
Q

management of pre-patellar bursitis?

A

if confidently ruled out septic joint
- ICE, activity modification and simple analgesia

if not responsive to conservative measures - aspirate or steroid injection

Septic joint suspected = empirically treat with antibiotics (flucloxacillin 500mg QDS)

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78
Q

Single joint
hot painful erythematous swollen joint
restricted ROM
tender on palpation

may have hx of trauma, recent illness, IV drug user, STI

A

Septic joint

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79
Q

What are common organisms associated with septic joint

A

children - staph or strep

sexually active adults - Neisseria gonorrhoeae

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80
Q

Ix for septic joint

A

aspirate - gram stain and culture

contraindicated if prosthetic joint

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81
Q

Management of septic joint

A

IV Abx - vancomycin

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82
Q

what is acute osteomyelitis? what is the most common causative organism

A

infection of bone commonly caused by staph aureus

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83
Q

non-specific pain
fever
malaise
swelling around affected bone

A

acute osteomyelitis

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84
Q

Ix for acute osteomyelitis?

A

Bloods - raised WCC, CRP, ESR
XR = osteopenia and bone destrctiion
- MRI better
Blood culture and bone cultures

85
Q

Management of acute osteomyelitis?

A

High dose flucloxacillin (6/52)
- if pen allergy = offer clindamycin

some may need surgical debridement

86
Q

What is chronic osteomyelitis associated with?

A

Prosthetic joints

87
Q

Management of chronic osteomyelitis?

A

3/12 of antibiotics (perhaps longer)

some may require complete revision/replacement surgery of prosthetic limb

88
Q

osteoma info?

A

benign tumour - overgrowth of bone often in skull

association gardener’s syndrome (polyps/FAP)

89
Q

osteochrondroma info?

A

most common benign bone tumour
more common in males, under 20s

‘cartilage capped bony protrusion’

90
Q

giant cell tumour?

A

benign tumour
multinucleated giant cells
affects 20-40s

epiphyses of long bones predominantly affected
XR = double bubble or soap bubble - described as radiolucent lesion

91
Q

Osteosarcoma info

A

malignant bone tumour
mainly children and adolescents
metaphyseal region
may have pagets, Rb gene and radiotherapy hx

92
Q 
younger age (child-teenager)
Bone pain intially localised then persistent ache in the area - pain at night 
B symptoms
A

osteosarcoma

93
Q

Ix and management for osetosarcoma

A

XR - codman triangle or sunburst patten

mx - chemotherapy and radiation therapy

94
Q

Other malignancy bone tumours

A

erwing’s sarcoma - children/adolescents in the pelvic and long bones
- severe pain and Onion skin appearance on XR

Chondrosarcoma - affects axial skeleton and middle aged men

95
Q 
aged 10-17, mainly males
high BMI 
Limping 
pain in knee 
pain in hip (&groin)
affected leg externally rotated 
reduced ROM and loss of internal rotation
A

slipped capital femoral epiphysis (SCFE)

96
Q

How is SCFE investigated?

A

XR

  • bilateral hips
  • lateral views
  • frog shaped position
97
Q

Management of SCFE?

A

internal surgical fixation (1-2 screws)

often bilateral procedure as prophylactic measure

98
Q

What is Legg Calve Perthes disease?

A

self-limiting disease affecting children in the growing phase and is essentially AVN of femoral head

99
Q

RFs for Legg Calve Perthes?

A

boys
aged 4-8yrs
hypercoagulability

100
Q

painless limp + hip pain

  • worse on activity
  • gradual onset over a few weeks

shortening of limb
O/E: reduced ROM

A

Legg Calve Perthes

101
Q

Investigations for Legg Calve Perthes?

A

AP XR - lateral views in frog leg position
= widening joint space in earlier stages
= decreased/flattened femoral head size in later stages

if XR normal but pt symptomatic - MRI

102
Q

Management of Legg Calve Perthes?

A

earlier stage + younger age (<6yrs) = Conservative

  • immobilise, cast/braces
  • appropriate physio and monitoring with XR

if later stage, more sever case or older age (>6yrs) of presentation = surgical intervention

103
Q

What is developmental hip dysplasia?

A

A spectrum of conditions affecting the proximal femur and acetabulum

104
Q

RFs for developmental hip dysplasia?

A 
first born girls 
breech baby 
left hip usually affected more 
birth weight >5kg
oligohydramnios
105
Q

restricted abduction of hip in flexion
+ve barlow or ortalani tests
legs may be not symmetrical when flexed bilaterally

A

developmental hip dysplasia

106
Q

Outline the tests involved in developmental hip dysplasia

A

barlow = attempts to dislocate femoral head

ortolani = attempts to relocate the femoral head

107
Q

Ix for developmental hip dysplasia?

A

US - confirms diagnosis

if abover age of 4.5/12 - can do XR

108
Q

Management of developmental hip dysplasia

A

observe and consider splinting

  • 3-6weeks needed for hip to stabilise
  • Pavlik harness - <4-5/12

dislocated hip = reduce, splint

109
Q

Screening measures for developmental hip dysplasia?

A

routine US in infants

  • hip problem in first degree family member
  • breech presentation at 36weeks+
  • multiple pregnancy

Newborn checks - barlow and ortolani done in examination

110
Q

Localised point tenderness on the outside of hip

  • on lateral aspect on hip + thigh
  • can radiate down thigh

O/E = pain on flexion+ extension, abduction and rotation
+ve trendelenburg test

A

trochanteric bursitis

111
Q

Diagnosis and management of trochanteric bursitis?

A

clinical diagnosis - no Ix needed
mx - exercise, RICE and analgesia
= steroid injection into bursa

recovery time = 6-9 months, sometimes longer

112
Q

Pain in hip
uanble to mobilise + unable to bear weight
shortened and internally roatated
- may be flexed and adducted

A

Hip dislocation

113
Q

Ix for dislocated hip?

A

XR - confirm dx + rule out concurrent fractures also

114
Q

Management of dislocated hip?

A

ABCDE approach
analgesia
reduce hip under GA within 4hrs - reduce risk of AVN

long-term mx = physiotherapy

115
Q

which type of hip dislocation is the most common? mechanism of injury?

A

posterior

major/high imapct trauma
dashboard due to RTA

116
Q

complications from hip dislocation?

A

sciatic/femoral nerve injury
AVN
OA - more in older pts
recurrent dislocation - if there is damage to supporting ligaments

117
Q

RFs for AVN?

A

alcoholism
steroids use
chemotherapy/immunosupressant
sickle cell anaemia

118
Q

groin pain - radiates to leg
pain resistant to analgesia

presence of RFs - etoh, steroid use, chemo/immunosuppressed. SCA

A

AVN of hip

119
Q

Investigations for AVN of hip?

A

XR

  • initially normal, some signs of osteopenia/microfractures may be present
  • later = collapse of articular surface, crescent sign

> 6wks symptomatic + normalXR = consider MRI

120
Q

Management of AVN of hip?

A

ortho referral and MRI if not previously been done

early tx - total hip replacement = increase chances of hip survival

121
Q

pain in groin
unable to bear weight
leg shorterned, externall rotated and adducted

older pt, female, minor injury

A

NOF/hip fracture

122
Q

Ix and dx of NOF/hip#?

A

XR - AP and lateral view needed
- disrupted Shenton’s line seen on AP

MRI/CT done if XR normal but clinical suspicion remians

123
Q

classfication system of hip fractures? In which is blood supply affected?

A

Garden System - 4 types

Types 3&4 = disrupted blood supply

124
Q

Management of Hip fractures

A

Intracapsular - internal fixation or hemiarthroplasty (unfit pt)

Extracapsular - dynamic hip screw or intramedullary device if oblique, transverse or subtrochanteric

otho input & surgery needed on same day or within 48hrs

encourage weight bearing and mobilisation soon after surgery = faster recover

125
Q

if hip pain
leg abducted and externally rotated
normal length of affected leg

A

anterior dislocation

126
Q 
joint pain and stiffness 
little or no effusion 
no erythema 
reduced ROM 
joint crepitus

older pt
if in hands - heberden’s nodes or bouchard’s nodes

A

Osteoarthritis

127
Q

RFs for osteoarthritis?

A 
obesity 
increasing age 
occupation 
trauma 
female 
FHx
128
Q

Ix and classical findings in OA?

A

XR

  • loss of joint space
  • subchondral sclerosis
  • osteophytes
129
Q

Management of OA?

A

educate + advise weight loss if appropriate

exercises + improve muscle strength

pain control - analgesia, joint aspiration/injections

surgery - knee replacement

130
Q

What is metabolic bone disease?

A 
refers to conditions/problems in bones resulting from abnormalities in 
minerals - calcium & phosphate 
vitamins - vit D deficiency 
bone mass
bone structure
131
Q

what is osteoporosis?

A

Osteoporosis is the loss of bone mass

weakening of bone - poses risk of fractures

132
Q

RFs for osteoporosis?

A 
post-menopausal women 
increasing age 
smoker 
steroid use (long-term)
low BMI
133
Q

Presentation of osteoporosis?

A

often asymptomatic and diagnosed when a pt has a fracture

not associated with pain

134
Q

Ix & Dx of osteoporosis?

A

DEXA scan - look at T score
-2.5 to 0 = osteopenia (mild thinning/weakening of bone)
< -2.5 = osteoporosis

135
Q

Management of osteoporosis?

A
  1. bisposphonates
    - drug holiday every 3-5yrs
  2. calcium + vitD supplements
136
Q

Side effects of bisphosphonates?

A

oesophagitis - take while sitting up straight

osteonecrosis of jaw

137
Q

Screening tools for osteoporosis?

A

FRAX

QFracture

138
Q

what is Osteomalacia? What is the term for it in children?

A

softening of bones secondary to low vitD levels which in turn leads to decreased bone mineral density

referred to as rickets in children

139
Q

Causes of osteomalacia?

A

bone pain
bone and muscle tenderness
proximal myopathy (arms and legs)
- waddling gait (difficulty getting around)

common seen fracture - NOF

140
Q

Ixs in osteomalacia?

A

bloods - low vitD/calcium/phosphate and raised ALP

XR = translucent bands (looser zones and pseudofractures

141
Q

Management of Osteomalacia?

A

vitD supplementation

calcium supplementation is dietary intake inadequate

142
Q

What is Paget’s disease?

A

increased and uncontrolled turnover of bone

143
Q

which bones are affected in Paget’s disease?

A

skull, spine/pelvis, long bones of lower extremities

144
Q

RFs fro paget’s disease

A

male
increasing age
FHx
northern latitude

145
Q

usually asymtpomatic

bone pain + isolated raised ALP

bowing of tibia
bossing of skull

A

Paget’s disease

146
Q

Ix for Paget’s disease?

A

blood - raised ALP, normal calcium/phosphate

other markers - PINP, CTx,
urinary NTx and hydroxyproline

XR

  • early disease = osteolysis
  • later disease = mixed lytic/sclerotic lesions
  • skull = thickened vault & osteoporosis circumscripta

Bone scintigraphy - increased uptake = focally active bone lesions

147
Q

Management of Paget’s disease?

A

bisphosphonates - oral or IV

148
Q

Complication of paget’s disease?

A

deafness (CN involvement)
bone sarcoma
bone disorder (CKD-MBD)

149
Q

What is renal bone disease?

A

low vitD means that there is high serum phosphate
this in turn means high calcium
calcium stimulates osteoclast activity
dysregulating bone turnover

150
Q

3 main features of bone disease?

A

osteomalacia - increased bone turnover without adequate calcium

osteoporosis

osteosclerosis = compensatory increased osteoblastic activity without adequate calcium - cannot mineralise properly

151
Q

How is CKD-MBD investigated?

A

XR of spine

  • sclerosis at the ends of vertebrae
  • osteomalacia in the centre of vertebra
152
Q

Management of CKD-MBD?

A

active forms of vit D
low phosphate diet
osteoporosis tx with bisphosphonates

153
Q 
insidious onset of pain in the lateral aspect of elbow,
can radiate down forearm 
feels like a burning sensation 
pain on wrist extension
difficulty lifting/raising objects

localised point tenderness
+ve maudsley test
reduced ROM - passive & active

A

lateral Epicondylitis

aka ‘tennis elbow’

154
Q

Mx of lateral epicondylitis?

A

conservatively manage - rest, physio and NSAIDs

155
Q

point tenderness of the medial aspect of the elbow
insidious onset of pain
hx of repetitive movements - occupational or sports

A

Medial epicondylitis

156
Q

Which muscles are affected in medial epicondylitis?

A

flexors and pronators

157
Q

Management of epicondylitis?

A

conservatively manage

- rest, physio and NSAIDs

158
Q

mechanism of injury FOOSH
pain and tenderness
dinner forks - prominent back and depressed front

A

colle’s fracture

159
Q

what are key features of a colles?

A
  1. transverse fracture
  2. 1inch proximal to radio-carpal joint
  3. dorsal displacement and angulation
160
Q

Management of a colles fracture?

A

straighten deformity and immbolise for ~6wks

161
Q

distal fracture
displaced ventrally
mechanism of injury - falling on flexed wrists

A

Smith’s wrists

162
Q

Ix and Mx for smith’s fracture

A

XR & straighten/immbolise

163
Q

hard nodules turn into thicker, nodular cord
can be palpated on affected palm
ring/small fingers commonly affected
+ve table top test

A

Dupuytren’s contracture

164
Q

RFs for Dupuytren’s contracture

A

manual labour/trauma to hand
phenytoin treatment
alcoholic liver disease
DM

165
Q

Ix and Mx of Dupuytren’s contracture

A

clinical diagnosis - no Ix needed
early cases = monitor
step 2 = steroid injection

surgery
- removal of abnormal fascia

166
Q 
not using affected arm 
extended forearm in pronation
distressed only on moving elbow 
no swelling, bruising around the elbow or wrist 
tenderness absent in most 
supination of forearm - resistance+pain
A

Pulled elbow

167
Q

Ix for pulled elbow

A

XR - subluxation of radial head

168
Q

Management of pulled elbow?

A

reduction and immobilisation - flexed at 90°

analgesia for pain management

169
Q

FOOSH
Pain along radial aspect of wrist
loss of grip/pinch strength
wrist effusion

anatomical snuffbox tenderness
pain on telescoping thumb and ulnar deviation

A

Scaphoid fracture

170
Q

Investigations for a scaphoid fracture?

A

XR wrist - AP and lateral views
CT = XR normal but clinical suspicion

MRI - definitive when other imaging has been inconclusive

171
Q

Management of scaphoid fractures?

A

immobilise with futuro splint/backslab
refer to orthopaedics

if imaging inconclusive - see ortho within 7-10days

6-8wks cast = undisplaced #

surgical fixation = displaced #
or proximal scaphoid pole #

172
Q

complications of scaphoid #?

A

AVN

non-union = pain and early onset arthritis

173
Q

aching tingling and paresthesia in the hand
hand feels swollen, numb and can have burning sensations
lateral aspect of palm , thumb, index, middle and half ring finger
symptoms nocturnal - temporary relief on shaking/hanging on bedside
worsened by strenuous movement

+ve phalen’s and tinel’s test

A

Carpel tunnel syndrome

174
Q

which nerve is affected in carpal tunnel?

A

median nerve

175
Q

Ix for Carpel Tunnel syndrome?

A

nerve conduction studies/electrophysiological studies

176
Q

Management of carpel tunnel syndrome?

A

conservative = NSAIDs & nocturnal splints and steroid injections for 6wks

if severe/very symptomatic = surgical decompression

177
Q

pain on radial aspect of wrist
tender on radial styloid process

abduction of the thumb against resistance painful

+ve finkelstein’s test = ulnar deviation and longitudinal traction

A

De Quervain’s tenosynovitis

178
Q

management of De Quervain’s tenosynovitis ?

A

analgesia, steroid injection, splinting of thumb

surgical tx sometimes required

179
Q

Boxer’s fracture

A

punching resulting in fracture of the 5th metatarsal

180
Q

Management of boxer’s fracture?

A

immobilise with splint

analgesia

181
Q

hx of recent trauma
ankle pain and swelling
unable to weight bear
medial/lateral malleolus tenderness and swelling

A

Ankle fracture

182
Q

What are the Ottawa ankle rules?

A

bony tenderness on either

  • lateral malleolar zone
  • medial malleolar zone

bony/point tenderness on 5th metatarsal or navicular pain

inability to weight bear (<4steps)

183
Q

Ixs for ankle fracture?

A

XR

184
Q

Management for ankle fracture?

A

open fracture = surgical fixation

closed fracture = reduce and splint

185
Q

mechanism of action = inversion of foot

pain. , swelling, tenderness over the affected ligaments
- sometimes bruising

reduced ability to weight bear

A

ankle sprain

186
Q

Which ligament is commonly sprained in the ankle

A

anterior-inferior tibio-fibula ligament

187
Q

Ix for ankle sprain?

A

if Ottowa ankle criterion met = XR

MRI if persistent pain (evaluate perineal tendons)

188
Q

Management of ankle sprain?

A

non operative - RICE protocol

occasionally given cast/splint for short-term relief

persistent symptoms or significant joint instability = consider MRI & surgery

189
Q

high ankle sprains mechanism of injury and key feature?

A

usually occurs following external rotation of foot - talus and fibular pushed laterally

more severe pain on weight bearing

hopkin’s squeeze test elicits pain

190
Q

What is achilles tendinopathy?

A

involves damage, swelling, inflammation and reduced function of achilles tendon

191
Q

RFs for achilles tendinopathy?

A

sports, inflammatory conditions, diabetes, raised cholesterol and flouroquinolone use

192
Q

gradual onset pain on arching achilles tend or heel with activity
stiffness
tenderness & swelling
nodularity on palpation of tendon

A

achilles tendonopathy

193
Q

management for achilles tendinopathy?

A

rest, altered activities and analgesia
using insoles

extracorporeal shock-wave therapy, or surgery

194
Q 
sudden onset pain in the achilles or calf 
snapping sensation or sound 
palpable gap, tender around achilles 
more dorsiflexed foot
weak plantar flexion
unable to stand on tiptoes  
\+ve simmonds/thompsons test
A

Achilles tendon rupture

195
Q

Investigation and diagnosis of achilles rupture?

A

US

196
Q

management of achilles rupture?

A

admit to hospital - ortho referral

immediate mx = rest, immobilise, RICE

non-surgical = boot in full plantar flexion for 6-12weeks + long period of rehab

surgical = reattachment of tendon, immobilise in boot and slowly adjust to neutral position + long period of rehab

197
Q

development of bony lump over the MTP of base of big toe
develops over time
first metatarsal becomes angulated medially
pain particularly on walking or wearing tight socks

A

bunion/hallux valgus

198
Q

Ix for bunion/hallux valgus ?

A

weight bearing XR

- assess extent of deformity

199
Q

management of bunion/hallux valgus ?

A

conservatively manage through advising using wide, comfortable socks
analgesia

definitive tx = surgery - realign bone and correct deformity

200
Q

toes middle joint is bent

deformity often of 2nd, 3rd and fourth middle toe

A

hammer toes

201
Q

how are hammer toes managed?

A

definitive = surgical fixation

202
Q

gradual onset pain on plantar aspect of heel

  • worse with pressure, standing or walking for prolonged periods
  • pain described as stabbing
  • most painful are first few steps
  • relieved on rest

plantar aspect of heel is tender to palpate

A

plantar fasciitis

203
Q

plantar fasciitis diagnosis and management?

A

clinical diagnosis - no Ix needed

management - rest and advise insole use
exercise and physio
NSAIDs

204
Q

RFs of plantar fasciitis?

A

aged 40-60
runners
obesity

205
Q

pain between the 3rd, 4th toes - marble sensation
- pain can be described as a burning, numbness or parasthesia

pain eliciited on deep palpation
+ve metatarsal squeeze test
mulder’s sign +ve

A

morton’s neuroma

206
Q

How to investigate morton’;s neuroma?

A

US or MRI - confirms diagnosis

207
Q

Management of morton’s neuroma?

A

Adapting activities, better footwear/insoles
analgesia
if appropriate advise weight loss

steroid injections, radiofrequency ablation and surgery

208
Q

commonly in diabetics with peripheral neuropathy
swelling, pain and redness
altered shape of foot

hx of injury/fractures of bones in foot

A

charcot’s joint

YEAR 2 FCM Revision (8 decks)

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