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)
reactive arthritis test
+ HLAB27
reactive arthritis tx
self limiting 3-12mo
supportive: NSAIDS
granulomatosis w/ polyangiitis
URI sx, saddle nose deformity, lower respiratory tract sx
glomerulonephritis
+ CANCA
tx w/ CS
RA sx
improves during day, morning stiffness >30m
swan neck deformity
boutonniere deformity
bow string sign
felty syndrome
triad: RA + splenomegaly + dec WBCr/repeat infx
Caplan syndrome
pneumoconiosis + RA
RA labs
+ RF, anti-CCP (most specific)
RA tx
DMARDS: MTX, hydroxychloroquine in pregnancy
NSAIDs first line for acute pain
supplement w/ MTX
folic acid
sjogrens syndrome tests
+ ANA, + RF, + schemer test
rose bengal test: devitalized epithelium of conjunctiva
anti SS-A (ro), anti SSB (La)
bx: increased infiltration of lymphoblasmacytic
sjrogens syndrome tx
pilocarpine
clevimeline
SLE can be induced by which meds
methyldopa
INH
procainamide
hydralazine
quinidine
SLE sx
triad: joint pain, fever, butterfly rash
discoid rash: annular dry patches on face and scalp
glomerulonephritis, retinitis, oral ulcers, alopecia
SLE test
BIT: +ANA
+anti dsDNA, anti smith
+RF, antihistone ab
antiphhospholipid ab syndrome
+ anti cardiolipin
SLE tx
hydroxychloroquine
decrease time in sun
hydroxychloroquine monitor
do eye exam
scleroderma limited
MC: CREST (calcinosis cutis, Raynaud, esophageal dysmotility, sclerodactyly, telangiectasia)
CREST
Calcinosis cutis: ca deposits on elbow, knee, finger
Raynaud
esophageal dysmotility (GERD/dysphasia)
sclerodacytyly: red/blue edema, fibrosis
telangiectasia
diffuse scleroderma
widespread trunk
pigmentation
more aggressive
cardiac, lung, kidney dz present
generalized sx scleroderma
skin thickening/tightning, appears smooth/shiny
digital pitting, depigmentation
scleroderma dx
> 3/5 crest sx
+ anti scl 70
+ANA
limited scleroderma tests
anti SCL70
anticentromere antibodies
ANA
scleroderma tx
supportive
MTX
nifedipine CCB for raynauds
hence schlonlien purpura
IgA
hematuria, palpable purpura, abd pain, synovial
normal coags
supportive tx
ankylosing spondylitis tx
NSAIDs, PT
if doesn’t work, TNF inh (infliximab)
psoriatic arthritis
asymmetric arthritis, dactyliitis
sausage fingers
xray: pencil in cup
HLAB27, inc ESR
NSAID 1st line
cauda equina MCC
herniated disk
cauda equina sx
acute onset, low back pain, numbness
urinary retention, saddle anesthesia
dec rectal tone/ fecal incontinence
dec DTR
cauda equina dx
MRI study of choice
CT pyelogram if unable to do MRI
cauda equina tx
emergent surgery decompression
MC locations of herniated disk
L5/S1
L4/L5
herniated disk test
MRI best method
herniated disk L4 sx
anterior thigh pain
sensory loss to medial ankle
ankle dorsiflexion weakness
loss of knee jerk
weak knee extension- quads
herniated disk L5 sx
lateral thigh/leg, hip groin paresthesias and pain
dorsum of foot, esp between 1st and 2nd toes
big toe extension/dorsiflexion weakness
walking on heels harder than on toes
reflexes usually normal
herniated disk S1 sx
posterior leg/calf gluteus
plantar surface of foot
plantar flexion weakness
walk on toes harder than heels
loss of ankle jerk reflex
kyphosis sx
hunchback
scheuermanns juvenile kyphosis
genetic
shmorls nodes on xray
kyphosis test
later xray of spine
Cobb angle >40 degrees
anterior wedging of >3 vertebral bodies
kyphosis tx
PT
NSAIDs
>75: surgery
>60: brace/cast
cafe au lait spots
skin tags
axillary freckles
scoliosis
neurofibromatosis type I
scoliosis MC pattern
right thoracic curve
scoliosis test
Adams forward bending test
confirm: xray
Cobb method
scoliosis tx
brace if 20-40 degrees
observation if <25 degrees, repeat imaging
surgery if >40
scoliosis left sided curve
higher incidence of intraspinal pathology (syrinx or tumor)
spinal stenosis sx
load dependent low back pain, worse w/ extension, standing, walking
shopping cart test
spinal stenosis due to
osteoarthritis (DJD) of lumbar spine or large disk herniation
spinal stenosis test
initial: XR
confirm: MRI
spinal stenosis tx
conservative: NSAIDs, PT, CS inj
laminectomy
thoracic outlet syndrome compression of
brachial plexus
vascular compression w/ abduction of arm
thoracic outlet syndrome sx
neck pain, paresthesias to fingers, hand atrophy
dec BP in affected arm
thoracic outlet syndrome compression of
brachial plexus
subclavian artery
subclavian vein
thoracic outlet syndrome test
arterial TOS = MRA
venous TOS = duplex us
neurogenic TOS = EMG study
+ adson: dec radial pulse if head toward affected side
thoracic outlet syndrome tx
mild: PT, NSAIDs, thrombolytics if venous
acute: surgical decompression
torticollis which muscle
sternocleidomastoid
torticollis tx
congenital: PT, surgery at 12mo if not corrected
wry neck: self limiting
brown sequard syndrome
ipsilateral hemiplegia, increased muscle tone.
ipsilateral loss of motor, vibratory, and proprioception
contralateral loss of pain and temp sensation
brown sequard syndrome tx
supportive, rehab
CS
anterior cord syndrome sx
complete loss of motor, pain, and temp below injury
retains proprioception and vibratory
MC shoulder dislocation
anterior
anterior arm dislocation sx
abducted and externally rotated arm
axillary nerve damage: dec sensation in shoulder badge description
bankart lesion
detaching of anterior inferior labrum from glenoid rim
hills Sachs lesion
defect of postiolateral humeral head d/t abrasions of anterior rum of glenoid
posterior shoulder dislocation causes
electric shock
seizures
posterior shoulder dislocation sx
arm adduction and internal rotation
posterior shoulder dislocation tx
closed reduction
posterior shoulder dislocation complications
labral injuries
tears to SITS
+neer and + Hawkins
clavicle fx MC location
middle 1/3
clavicle fx test
CT angio dx TOC
clavicle fx complication
middle 3rd of clavicle has brachial plexus and subclavian artery/vein
clavicle fx tx
figure 8 sling
neonatal: reassurance
prox 1/3: ortho
colles fx
fx distal radius w/ dorsal and radial displacement
tx w/ sugar tong splint
from FOOSH
smiths fx
distal radius
garden spade deformity
volar angulation
torus fx
Peds, buckle fx
humeral head fx MOA
FOOSH
humeral head fx neuro eval
watch for axillary nerve and brachial plexus
humeral head fx tx
immobilization in sling
MC complication humeral head fx
frozen shoulder
humeral shaft fx tx
r/o radial nerve injury (wrist drop)
tx sugar tong splint
radial head fx xray
fat pad sail sign
radial head fx sx
FOOSH
cannot fully extend elbow
radial head fx tx
sling
displaced ORIF
fat pad sail sign in child
supracondylar fx
boxers fx
5th metacarpal neck
ulnar gutter cast
galeazze fx dislocation
FOOSH
distal radius rx, radioulnar joint (DRUJ) dislocation
monteggia fx
proximal/mid ulna fx
radial head dislocation
conteggia fx complication
radial nerve injury (wrist drop)
dupuytrens contracture association
diabetes
dupuytrens contracture (trigger finger) tx
injection
surgery
orbital blowout fx sx
inferior rectus entrapment CN3
upward gaze
infraorbital anesthesia
MC area mandibular fx
body
condyle
legg calve perthes sx
child 4-8yo
painless limp
legg calve perthes tx
self limiting
pain reduction
unhappy triad
ACL
MCL
medial meniscus
tenosynovitis sx
Finger in flexion
Length of tendon sheath tender
Enlarged finger
Xtension of finger causes pain
meds that can cause gout
pyrazinamide
loop diuretics
low dose aspirin
thiazides
ethambutol
colchicine AE
diarrhea
NSAID gout caution/CI
renal insufficiency
active duodenal/gastric ulcer
cardiovascular dz
allopurinol AE
SJS
meds that can cause SJS
allopurinol
phenytoin
phenobarbital
lamotrigine
ethosuximinde
penicillins
carbamazepines
sulfonamides
MC joint involved in pseudo gout
knee
pseudo gout tx
intraairticular injection (1-2 joints) first line
NSAIDS, steroids, colchicine
juvenile idiopathic arthritis criteria
<16yo
arthritis for at least 6 weeks
juvenile idiopathic arthritis sx
Fever at least 2 wks (quotidian pattern: F spikes and disappears daily)
arthritis at least 6 weeks
salmon colored rash
uveitis
juvenile idiopathic arthritis tx
NSAIDS
MC type of fx in osteoporosis
vertebral compression fx
bisphosphonates AE
pill induced esophagitis
jaw osteonecrosis
atypical femur fx
polyarteritis nodosa sx
hx of hepatitis
renal dz (HTN)
dermatologic
mononeuropathy multiplex
tends to spare the lungs
polyarteritis nodosa dx and tx
- ANCA
glucocorticoids
polymyalgia rheumatica sx
stiffness and pain in shoulders, hip girdle, and neck, worse in AM
Female > 50yo
giant cell arteritis
polymyalgia rheumatica test
inc ESR/CRP
polymyositis and dermatomyositis sx
muscle weakness (proximal, progressive, symmetric)
dermatomyositis: gottron papules, shawl sign/ v sign (photo distributed koikiloderma), heliotrope rash,
polymyositis and dermatomyositis test
elevated CK, aldolase
anti-jo-1, anti-mi-2 (dermtomyositis)
causes of reactive arthritis
chlamydia
preceding GI/GU infx
sjogrens test
anti ro SSA
anti la SSB
schirmer test
limited scleroderma test
anti centromere ab
diffuse scleroderma test
anti scl 70
lupus tests
anti smith ab
anti dsDNA ab
antiphospholipid ab `
lupus tx
hydroxychloroquine
MC type of dislocation
anterior glenohumeral dislocation
anterior glenohumeral dislocation presentation
abducted externally rotated arm
axillary nerve injury
common in pts with glenohumeral dislocation
lose feeling around shoulder badge distribution
associated injuries w/ anterior shoulder dislocation
hill-sachs lesion
bankart lesion
axillary nerve injury
posterior shoulder dislocation xray
light bulb sign
adhesive capsulitis RF
diabetes
hypothyroidism
supracondylar humerus fx presentation
2-7yo
FOOSH w/ elbow hyperextendedn
supracondylar humerus fx test
xray: fat pads
supracondylar humerus fx complications
volkmann ischemic contracture
cubital tunnel syndrome test
tinel sign
scaphoid fx tx
thumb spicca splint
colles fx xray
dorsal displacement of the distal radius fragment
smith fx xray
volar/ palmar displacement of the distal radius fragment
lunate fx xray
spilled tea cup sign
lunate fx complications
avascular necrosis (kienbocks disease)
de quervain tenosynovitis tendons
abductor pollicis longus
extensor pollicis brevis
type of femur fx associated w/ avascular necrosis
femoral neck fx
hip fx presentation
externally rotated, shortened leg
hip dislocation presentation
internally rotated, shortened leg
MC Hip dislocation
posterior
SCFE presentation
12-13yo obese
painful limp
SCFE gold standard tx
surgical pinning
legg calve perthes presentation
painless limp
5-8yo
legg calve perthes presentation
painless limp
5-8yo
ACL test
lachman most sensitive
PCL test
posterior drawer test
meniscal injury test
Mcmurray
joint line tenderness
meniscal injury sx
pop
lock
knee gives out (drop)
tibiofemoral dislocation complication
popliteal artery injury: can lose limb
peroneal nerve injury
patellofemoral syndrome sx
anterior knee pain
patellofemoral syndrome RF
runners
women
IT band syndrome sx
lateral knee pain
achilles tendon rupture RF
FQ
achilles tendon rupture test
thompson test
