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MSK > MSK 1.2 MSK overview > Flashcards

MSK 1.2 MSK overview Flashcards

fractures, joint injuries, investigations, special tests for joints, orthopaedic examination

1
Q

What is excision of fracture fragments ?

A

Removal of fracture fragments

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2
Q

What is athroplasty ?

A

Surgical repair or replacement of a joint

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3
Q

What is open reduction internal fixation (ORIF)

A
  • surgical repair of a fracture by making an incision into the skin and muscle at the site of the fracture
  • Manually moving the bones into alignment and fixing the bones in place with surgical wires, screws, pins, rods or plates
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4
Q

Aims of treatment with fractures

A
  • pain relief (acute)
  • Prevent infection (open wounds)
  • Restoration of normal joint anatomy as far as possible (function and aesthetics)
  • Maintenance of position (function)
  • Rehabilitate - reduce risk loss of function
  • Reduce risk of chronic pain
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5
Q

What’s external fixation ?

A

Fracture treatment in which pins are placed through the soft tissues and bone so that an external applicance can be used to hold the pieces of bone firmly in place during healing

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6
Q

What’s internal fixation ?

A

fracture treatment in which a plate of pins are placed directly into the bone to hold the broken pieces in place

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7
Q

What’s a closed fracture ?

A

Broken bone with no open wound

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8
Q

In the case of an open fracture, what must immediately be conducted to prevent infection ?

A
  • immediate cleaning
  • Irrigation and reduction
  • IV antibiotics
  • Tetanus status
  • Subsequent surgical debridement (removal of dead tissue) / washout and fixation
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9
Q

What’s an open fracture ?

A
  • Compound fracture ; broken bone with an open wound
  • risk of infection
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10
Q

Fracture where bone breaks incompletely, common in children (as bones are softer)

A

Greenstick

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11
Q

Fracture where broken bone ends are forced into each other, commonly occurs when person jumps from height

A

Impacted

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12
Q

Fracture where it’s separation of a bone fragment at its attachment of a ligament or tendon ?

A

avulsion

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13
Q

Fracture where bone breaks into multiple pieces ?

A

Comminuated

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14
Q

What’s spiral bone fracture due to ?

A

Twisting forces

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15
Q

8 types of fracture ?

A
  • transverse
  • Oblique
  • Spiral
  • Comminuated
  • Avulsion
  • Impacted
  • Fissure
  • Greenstick
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16
Q

Causes of fracture ?

A
  • stress
  • Trauma
  • Deficiency (osteoporosis, osteomalacia)
  • Pathological (tumour, infection)
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17
Q

What’s a stress fracture ?

A

Small crack in the bone that often develops from chronic , excessive impact (repetitive force, often from overuse )

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18
Q

What’s a pathological fracture ?

A

A break in a bone weakened by some other disease, such as bone cancer or osteoporosis

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19
Q

what is a pathological fracture usually caused by ?

A

a stress that would not normally fracture a bone

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20
Q

How are bone fractures classified ?

A
  • displaces / non-displaced = position of bone ends after fracture
  • Open/closed fracture
  • Number of fragments = comminuted
  • Orientation of the break to the long axis of the bone
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21
Q

What is a fracture ?

A

Break in the continuity of the bone

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22
Q

What is subluxation ?

A

Partial loss of continuity of the articulating surfaces of the joint

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23
Q

What is Dislocation ?

A

A complete loss of continuity of the articulating surfaces of the joint

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24
Q

treatment for joint sprain

A

RICE
1. Rest
2. Compression
3. Ice
4. Elevation

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25
Q

Definition of sprains & commonly affects where ?

A
  • Damage to ligament: complete , partial, damaged fibres with continuity intact
  • Ankle, knee, hand joints (thumb)
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26
Q

Methods of treatments for joint injuries

A
  • conservative & support
  • Manipulation & cast
  • Manipulate & insert wires
  • Open reduction internal fixation (ORIF): screws, plates, wires, combinations
  • External fixation
  • Arthroplasty (replace)
  • Excision (remove)
  • Osteotomy (re-align)
  • Amputation
  • Arthrodesis (restrict )
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27
Q

What are the 6 type of joint injuries ?

A
  • sprains
  • Fractures
  • Subluxations
  • Dislocations
  • Fracture dislocation/ subluxation
  • Open / closed injury
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28
Q

Cancer found in the bone is commonly secondary / metastatic. What primary cancers have a predilection for spreading to the bone ?

A
  • lung
  • breast
  • prostate
  • kidney
  • thyroid
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29
Q

Primary bone cancer is very rare. Usually cancer found in the bone is … or …

A

Secondary , metastatic

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30
Q

Signs of infected bone (osteomyelitis)

A
  • erythema (redness)
  • Swelling
  • Decreased range of movement (ROM)
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31
Q

A common specific symptom of rheumatoid arthritis

A

Early morning stiffness

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32
Q

Treatment of osteoarthritis

A
  • analgesics
  • Joint replacement
  • Weight loss
  • Physiotherapy
  • Graduated exercise
33
Q

Risk factor of osteoarthritis

A
  • age
  • Obesity
  • Smoking
34
Q

MRI = …..field, …. pulse, in water ….. found

A
  • magnetic
  • Radio frequency
  • Hydrogen nuclei
35
Q

Pros and Cons of CT ?

A

Pros
* 3D imaging / X-sectional imaging
* Can help with interventional procedures
* Excellent for bone

Cons
* Significant radiation dose
* Not as good as MRI for assessing soft tissues

36
Q

What investigations involved with joints ?

A
  • x-rays
  • CT
  • MRI
  • U/S
  • Bone scan
37
Q

Ultrasound pros

A
  • dynamic
  • safe
  • uses high frequency sound waves (no radiation)
  • cheap
  • fast
38
Q

ultrasound cons

A
  • artefacts common
  • requires trained person to carry out
39
Q

MRI pros

A
  • Magnetic field (non-ionising radiaiton)
  • Multi-planar imaging
  • Good detail
40
Q

MRI cons

A
  • Strict contraindications (pacemaker, metal)
  • Claustrophobia
  • Slow
  • Expensive
41
Q

CT pros

A
  • 3D imaging
  • Can help with interventional procedures
42
Q

CT cons

A
  • Significant radiation dose
  • Not as good as MRI for assessing soft tissue
43
Q

X-ray pros

A

cheap, fast, easy

44
Q

x-ray cons

A
  • Radiation exposure
  • Lack of detail
  • Single, flat image (not multiple images with different angles)
45
Q

Which investigation is Good for looking at infection, tumours , soft tissue ?

A

MRI

46
Q

Which investigation is Excellent for looking at bone ?

A

CT

47
Q

Which investigation is good for looking at the long bones ?

A

x-ray

48
Q

Which investigation is good for screening for developmental dysplasia of the hip (DDH) in babies ?

A

Ultrasound

49
Q

which investigation is good for assessing tendons, masses, joint effusions ?

A

Ultrasound

50
Q

Valgus deformity ?

A
  • knock-kneed
  • Pressure is laterally
  • Osteoarthritis most likely to develop laterally
51
Q

Varus deformity ?

A
  • bow legged
  • Pressure is medially
  • Osteoarthritis most likely to develop medially
52
Q

When looking at patient during MSK clinical examination, what are some examples of what you should be looking out for ?

A
  • gait
  • Walking aids
  • Signs = deformity, swelling, bruising, open wounds
  • Asymmetry = varus or vagus deformity
53
Q

Special tests for the foot ?

A
  • mulder click
  • silverskoild test
54
Q

what is mulder click test for foot ?

A

(squeeze 2 sides of your foot together, same time put pressure on space between the toes , if there’s a click, or shooting nerve pain indicates suffering from morton’s neuroma)

55
Q

what is silverskoild test as a special test for the foot ?

A

(special test for soleus) (to assess the tightness of the gastrocnemius and soleus muscles , commonly used to evaluate the ankle joint and lower leg injuries)

56
Q

special tests for the knee ?

A
  • collateral ligaments
  • ACL/PCL
  • Mc Murray’s test
57
Q

What is collateral ligaments test as a special test for the knee ?

A

vagus and varus stress tests are a series of movements that will be used to diagnose ligament injuries to the collateral ligaments in the knee or elbow

58
Q

What is ACL/PCL test as a special test for the knee ?

A

lachman test for anterior cruciate ligament & posterior cruciate ligament

59
Q

What is Mc Murray’s test as a special test for the knee ?

A

(menisci) (positive when there is a click or catch and pain in the extension of the knee)

60
Q

Special tests for the hip ?

A
  • trendelenburg test
  • thomas’ test
  • hip impingement test
61
Q

What is trendelenburg test as a special test for the hip?

A

(hands on iliac crests on either side of pelvis observing to see if it stays level during single-leg stance)

62
Q

What is hip impingement test as a special test for the hip?

A

(hip and knee flexed at 90 degrees, hip is progressively rotated from external rotation to internal rotaiton while moving from abduction to adduction, positive result = sudden, sharp pain in the hip)

63
Q

In orthopaedic examination , what is felt for ?

A

PT CELP

**Pulses **(assessing blood flow to the extremities such as arms and legs)

Temperature

Crepitus (crackling or grating sound occurs when moving joint)

**Effusion **(abnormal accumulation of fluid within a joint, leading to swelling)

Laxity (degree of looseness or instability in a joint)

Pain

64
Q

In a orthopaedic examination, what is looked for ?

A
  • around the bed , colours, scars, muscle wasting
  • Deformity
  • Swelling
  • Bruising
  • Puncture or skin wounds
  • Joint fluid
  • Asymmetry
  • Varus (like bowed legs in rickets)
  • Valgus (locked knees)
65
Q

What is included in the stance phase and swing phase of gait ?

A

stance phase:
* heat strike (double support)
* loading response (single support)
* mid-stance (single support)
* terminal stance (single support)
* pre-swing (double support)

swing phase
* toe-off (single support)
* mid-swing (single support)
* terminal-swing (single support)

66
Q

What is the rule of 2’s ? where do you examine ?

A
  • 2 joints, 2 limbs, 2 views (for x-rays)
  • Examine joint above and below
  • Examine both limbs (for comparison)
67
Q

Red flags for infection or malignancy in orthopaedic examination

A

Systemic symptoms…

  • Fever
  • Unexplained weight loss
  • History of malignancy
  • Night sweats
68
Q

General rules of the orthopaedic examination ?

A
  1. Ask for consent
  2. Warm hands
  3. Do not cause pain
  4. Rule of 2’s = always examine both sides of the patient
69
Q

Principles of an orthopaedic examination ? try to include examples of each

A
  • look = e.g. swelling, bruising, obvious deformity (asymmetry, vagus, valgus [knocked knees]), puncture or skin wounds, joint fluid
  • Feel = e.g. painful anatomical sites, heat, laxity, crepitus, pulses, neurlogical function
  • Move = range of movement - active, passive and against resistance
  • Special tests
70
Q

5% of the clinical assessment of MSK is taken from..

A

Investigations e.g. X-rays, CT, MRI, ultrasound

71
Q

Clinical examination of MSK (moving) includes…

A

Active and passive movements

72
Q

During clinical examination of MSK (when feeling) - should you be looking at the patient’s site of pain e.g. , their leg ?

A

No, you should be looking at the patient’s face to detect facial expression that could indicate pain / discomfort (e.g. grimacing)

73
Q

15% of the clinical assessment of MSK is taken from…

A

15% of the clinical assessment of MSK is taken from…

74
Q

a majority (80%) of the clinical assessment of MSK is taken from…

A

History-taking

75
Q

if referring to a chronic disease , particularly with pain, how many months ?

A

3

76
Q

What does VINDICATE stand for with surgical sieve ?

A

V = vascular
I = infection
N = neoplasm
D = degenerative or drugs
I = iatrogenic or intoxication
C = congenital
A = autoimmune
T = trauma
E = endocrine / metabolic

77
Q

What does MIDNIT stand for with surgical sieve ?

A

M = metabolic
I = inflammation
D = degenerative
N = neoplastic
I = infection
T = trauma

78
Q

History taking with MSK in clinical situations includes what ?

A
  • open initial question
  • SQITARS / SOCRATIES
  • Mechanism of injury
79
Q

1 in …. patients , adults consult their GP with musculoskeletal problems each year. With increasing age there is …. prevalence due to …., ….. , …..

A
  • 1 in 5
  • increased
  • trauma, ageing , underlying pathology

MSK (25 decks)

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