MSK Flashcards
tietze syndrome
costochondritis + local edema
costochondritis tx
self limiting
responds well to NSAIDS
flail chest sx
3+ ribs w/ segmental fx
paradoxical respiration (area of injury sinks in w/ inspiration)
crepitus
flail chest tx
nonoperative (no respiratory compromise): pain control, positive pressure ventilation
operative (displaced fx, open fx): ORIF
MCC rib fx
blunt trauma
rib fx test
CXR AP lat view
compartment syndrome MC fx
long bone fx
compartment syndrome sx
6 Ps: pulselessness, pallor, paresthesia, paralysis, pain out of proportion, poikilothermia
tight wood like muscles
compartment syndrome tests
pressure >30
elevated CK d/t muscle injury
compartment syndrome tx
emergent fasciotomy of >30
compartment syndrome complication
volkmann contracture: permanent nerve/muscle damage “claw like deformity”
osteoarthritis sx
evening joint stiffness, worse throughout the day
heberdens nodes: DIP
Bouchard nodes: PIP
osteoarthritis test
Xray: joint space narrowing, joint mice, osteophytes, subchondral sclerosis
osteoarthritis tx
acetaminophen 1st line for elderly w/ bleed risk and mild/mod
NSAIDS
intraairticular glucocorticoid injections
surgery: end-prosthesis (joint replacement)
MCC osteomyelitis
S. aureus
salmonella: sickle cell
osteomyelitis sx
point tenderness, pain to site, sinus connecting to abscess
F
children: long bones
osteomyelitis homogenous vs exogenous
homogenous: indirect, children
exogenous: direct inoculation, adults
osteomyelitis test
inc WBC
CT: codmans triangle = agressive
MRI: edema, cortical loss
inc ESR and CRP
gold: bone aspiration
osteomyelitis tx
long term IV abx: ampicillin sulbactam
surgical removal of dead bone
amputation
acute osteomyelitis <4mo etiology and tx
GBS
nafcillin or oxacillin + 3rd gen cef
acute osteomyelitis >4mo etiology and tx
MSSA: nafcillin or oxacillin or cefazolin (clinda or vanco if penicillin allergic)
MRSA: vancomycin or linezolid
acute osteomyelitis sickle cell etiology and tx
salmonella
3rd gen Cef or FQ (cipro or levo)
acute osteomyelitis puncture wound etiology or tx
pseudomonas
ciprofloxacin or levofloxacin
septic arthritis etiology
MCC: S aureus
sexually active: S. gonorrheaeoe
septic arthritis sx
MC joint knee, unilateral
dec ROM, edema, warm to touch
F
septic arthritis dx
leukocytosis
XR
arthrocentesis: >50k WBC, neutrophils, low glucose
septic arthritis tx
arthrotomy w/ joint drainage
IV Vanco + 3rd gen ceph
avascular necrosis sx
hx of steroid use
pain w/ internal/external rotation of hip
avascular necrosis test
hip xray AP and frog: joint space narrowing, subchondral sclerosis
avascular necrosis tx
protective weight bearing until dx established
hip arthroplasty if + for femoral head collapse
developmental dysplasia sx
ortolani +: clunk hip in
Barlow +: hip adduction out of place
galeazzi +: knee level asymmetric
trendelenburg +: stand of affected leg, dip in pelvis opposite side
waddling gait
developmental dysplasia test
US reliable if <4mo
xray not useful, better if >6wks
developmental dysplasia tx
reversible w/in 1st, can spontaneously correct by 2-6wk
pavlik harness
forced abduction or reduction is CI d/t avascular necrosis
if >2yo: surgery
femoral neck fx sx
acutely shortened
externally rotated
due to posts and iliacus
femoral neck fx tx
surgery
patella fx sx
acute swelling w/ effusion
inability to extend knee against gravity
quads can’t contract
patellar vs biparte fx
biparte fx has rounded edges
patellar fx has sharp edges
jones fx sx
transverse fx 5th metatarsal at metadiaphyseal junction
pain in lateral mid foot
tenderness at base of 5th metatarsal
jones fx MOA
twisting foot wearing heels
1st metatarsal fx
dancers fx
ortho referral
jones fx tx
non weight bearing
posterior splint then immobilization in short leg cast
surgery
Osgood schlatter dz sx
osteochondritis at tibial tuberosity from overuse
tenderness to anterior tibial tubercle
MCC chronic knee pain in young active adolescents
Osgood schlatter dz
Osgood schlatter test
xray: irregular ossification of tibial tubercle
Osgood schlatter tx
spontaneously resolves at skeletal maturity
conservative: ice, NSAIDs, PT
surgery if refractory
SCFE sx
adolescent obese boys
limited internal rotation of hip
pain and limp
pain referred to thigh or medial knee
SCFE tx
crutches, referral
pes anserinus pain syndrome muscles
gracilis
sartorius
semitendinous
pes anserinus pain syndrome sx
pain medial knee below joint line
pain over medial tibial condyle, exacerbated by pressure from opposite knee while lying on side
swelling, erythema, and induration typically absent
pes anserinus pain syndrome tx
quad strengthening exercise
NSAIDs
medial ankle injury sx
tibiofibular ligament
+ external rotation stress test
medial ankle injury test
MRI best test
medial ankle injury tx
conservative: cast/boot and crutches
PT
refer if tibiotalar joint space is widened/asymmetrical
gold: screw fixation
lateral ankle injury sx
inward inversion of foot, anterior taolfibular ligament
anterior drawer test
lateral ankle injury test
Ottawa ankle rules
plain radiograph
lateral ankle injury tx
uncomplicated: conservative or ortho if bony fx is present
ortho if open fx and neuromuscular impairment
osteochondroma
10-20yo
pedunculate grows away from growth plate
observe, resect
chondrosarcoma
cartilage based tumor
malignant
punctate ring and arc appearance
35-50yo
tx w/ surgery
pages dz of bone
elderly, inc ALP
blade of grass, flame shaped
skull: cotton wool appearance
bisphosphonates TOC
calcitonin
osteosarcoma sx
adolescent and <30yo
MC mets to lungs
metaphysics of long bones
MC bone malignancy that produces immature or osteoid bone
osteosarcoma
osteosarcoma test
xray: hair on end, starry or sunburnt appearance
Rodman’s triangle (also seen in Ewings sarcoma)
osteosarcoma tx
limb sparing resection if not neovascular
amputation if neovascular
chemo adjunct
high dose IV drugs: MTX, doxirubicon, cisplatin
Ewing sarcoma sx
children, femur/pelvis
long bone diaphysis and axial skeleton
palpable mass
fever
Ewing sarcoma x ray
lytic lesion
onion peel
moth eaten appearance
periosteal elevation: codman’s triangle
fibromyalgia associations
MDD
GAD
IBS
fibromyalgia ACR criteria
11/18 symmetrical characteristic trigger points
sx >3mo
fibromyalgia bx
moth eaten appearance
fibromyalgia tx
low dose TCA (amitryptiline)
SNRI (duloxetine)
anticonvulsants (pregabalin)
gout gold standard test
arthrocentesis of synovial fluid
biferingent negative needle shaped
gout tx
NSAIDS acute first line (indomethacin, naproxen, ibuprofen)
colchicine 2nd line and glucocorticoids
gout prophylaxis
low dose colchicine or NSAIDS or low dose steroid
gout 1st line chronic tx
allopurinol
CI in acute gout
avoid ASA
gout NSAID CI
CKD
PUD
pseudo gout test
gold: arthrocentesis: rhomboid positive birefringent
XR: chonedrocalcinosis (linear radiodensities)
pseudo gout tx
initial: NSAIDs (naproxen)
alt: colchicine and steroids
juvenile RA
1+ joints involved >6wks <16yo
inc CRP/ESR, +ANA
juvenile RA tx
opthalmologic exam
NSAIDS
DMARDS
steroid injection to inflamed joint
first line tx osteoporosis
bisphosphonates (alendronate)
behcets dz
autoimmune recurrent painful oral/genital ulcers
tx w/ CS
osteogenesis imperfecta sx
blue tinted sclera
presentile deafness
polyarteritis nodosa association
hep B
polyarteritis nodes sx
necrotizing vasculitis of medium sized muscular arteries
skin ulcers, subq nodules on lower legs
starburst lived (lived reticularis)
nononeuritis multiplex
HTN, fever
polyarteritis nodes test
inc ESR/CRP
definitive: deep wedge bx of nodules
anca -
polyarteritis nodosa tx
systemic steroids (prednisone) + cyclophosphamide
polyarteritis nodosa complications
cardiac
bowel infarction or perforation
renal failure
polymyalgia rheumatica assoc w/
giant cell arteritis
polymyalgia rheumatica sx
pain/morning stiffness of shoulder/hip/neck
better thru the day, worse in morning
F
polymyalgia rheumatica test
high ESR >50
inc CRP
neg CK, RF, and autoab
polymyalgia rheumatica tx
low dose prednisone w/ taper
eosinophilic granulomatosis w/ polyangitis triad
asthma
hypereosinophilia
chronic rhino sinusitis
eosinophilic granulomatosis w/ polyangitis labs
eosinophilia hallmark
+ PANCA, + RF
inc ESR/CRP, inc BUN/Cr
inc IgE
eosinophilic granulomatosis w/ polyangitis tx
CS
polymyositis sx
painless progressive weakness
pain of proximal muscles
polymyositis test
anti-jo-1
inc aldolase
polymyositis tx
high dose prednisone
dermatomyositis sx
heliotrope: blue purple upper eyelid discoloration
gottrons papules: raised violicious scaly eruptions on knuckles
shawl or V sign: photosensitive poikiloderma
dermatomyositis dx
anti MI 2 ab
reactive arthritis MC pathogens
hx of recent GI or chlamydia infx
chlamydia, salmonella, campy, shigella
reactive arthritis sx
arthritis, urethritis, conjunctivitis (can’t see, can’t pee, can’t climb a tree)
brown red hyperkeratotic macules on palms and soles (keratoderma blemmoragium)