MSK

Question 0

Cancers that metastasize to bone

Answer 0

breast lung prostate

Question 1

Tenosynovitis: Kanavel’s 4 signs

Answer 1

For diagnosing infectious tenosynovitis:

1. Pain on passive extension of digit:
   - this is absent in local involvement
   - pain will be noted along the course of tendon with extension
   - earliest and most important sign
   - in case of a local furuncle, in contrast, the finger can be held straight without much pain
2. Finger is held in flexion for comfort
3. Sausage digit: uniform swelling involving entire finger in contrast to localized swelling in local inflammation
4. Percussion tenderness along the course of the tendon sheath - tenderness is marked along the course of inflammed sheath in contrast to its absence in a localized inflammation

Diff Dx:

• Beware that a mid palmar space abscess may elicit pain w/ attempted passive motion of the ring and long fingers;
• Localized bleeding into the tendon sheath may occur in patients on coumadin, and this will give the exact appearance of infectious tenosynovitis

medical emergency because the tendon sheath is a closed space and too much swelling can lead to compartment syndrome and necrosis

Tx:
IV Antibiotics: vancomycin + ciprofloxacin (or ceftriaxone)
Tendon sheath drainage & surgical debridement

Question 2

myositis

Answer 2

muscle pain or weakness
weakness of the proximal musculature and hip and shoulder girdles is prominent
patients classically describe difficulty getting up out of a chair
muscles are often tender to palpation
reflexes and sensation are normal

some pts have an associated rash (dermatomyositis) that classically resents as erythema and swelling over the extensor surfaces and around the eyes

the cpk is elevated although rhahbdomyalisis is uncommon

mgmt - steroids and supportive care

Question 3

what is the goal for UOP in rhabdomyolysis with acute renal injury

Answer 3

3 ml/kg/hr or about 200 cc/hour

the rate of volume repletion with NS is 400 cc/hr

Question 4

Compartment syndrome

Answer 4

Fasciotomy indicated for pressures >30 mmHg

Question 5

Radial head fx

Answer 5

Splinting or sling with early ROM