MSK Flashcards
Which nerve damaged in shoulder dislocation can cause loss of sensation in “reg badge” area?
Axillary (supplying deltoid)
Which nerve root do axillary nerve, musculocutaneous nerve and suprascapular nerve originate from?
C5/6
What is Klumpke’s paralysis?
Claw-like hand in baby from damage to spinal roots C8 and T1
What is a Bennett fracture?
Fracture of base of first metacarapal
Which medication can increase risk of hip fracture?
Carbamazepine
Clin pres of osteochondritis dissecans
Young adult
Joint stiffness
Worse on activity
Due to overuse and repetitive microtrauma
Risk factors for wedge fracture
Steroid use, female, old age, low BMI
History of low-impact trauma
First line management of CRPS
Amitryptyline
What can be seen on exam of DeQuervain’s tenosynovitis?
Tenderness elicited over the radial styloid upon ulnar flexion of the wrist with thumb clasp in the palm
Describe Lisfranc injury
Dislocation of base of second metatarsal and medial cuneiform in midfoot
Usually due to joint rotation of forced plantar flexion
Investigation used in polymyalgia rheumatica
DEXA scan
- to determine low bone density
Medication to manage RA with little response to DMARDs
Biologics e.g. adalimumab
Erb’s palsy is characterised by which deformities of wrist and elbow
Impaired wrist extension
Impaired elbow flexion
Nerve supplying sensation over medial aspect of leg an foot which may be injured in placing of IM nails post-hip fracture
Saphenous nerve
Fracture in kids involving only one cortex of bone involving bending at fracture site?
Greenstick fracture
LFT abnormality assoc with Paget’s disease
High ALP
How can you distinguish between trigger finger and Dupuytren’s contracture?
Trigger finger - passively corrected and no skin changes
Dupuytren’s contracture - fixed flexion w fibrotic thickening, assoc with excessive alcohol use
Risk factor for frozen shoulder
Diabetes
Tenderness elicited over the radial styloid upon ulnar flexion of the wrist with thumb clasp in the palm suggests
DeQuervain’s tenosynovitis
- positive Finkelstein’s test
Tennis player with weakness in 4th/5th fingers, decreased grip strength and no history of trauma
Hamate fracture
Gradual onset midfoot pain in ballet dancer with amennorhoea
Second metatarsal base stress fracture
Describe a Lisfranc fracture
Dislocation of the base of the second metatarsal and the medial cuneiform in the midfoot.
Usually due to direct trauma
Management of SCFE
Surgical fixation of femoral head
Nerve responsible for elbow and wrist flexion
Radial nerve
Medication used in the management of Raynaud’s
Calcium channel blockers
What anticoag is used in pregnancy with anti-phospholipid?
LMWH
Low levels of complement in SLE indicate what?
Active disease
Nail changes assoc with psoriatic arthritis
Onycholysis (lifting of the nail from its nailbed)
Pitting
Is allopurinol used for prevention or management of acute attacks of gout?
Prevention
- NSAIDs/steroids/colchicine for management
What is Wolff’s law?
The idea that extra bone is laid down at areas of stress
e.g. extra bone growth at fracture site
Gradually worsening instep foot pain (worse on walking) with tenderness over calcaneal tuberosity over post/medial arch?
Plantar fasciitis
Common side effects of bisphOsphOnates
Osteonecrosis of jaw
Oesophageal ulcers
First line investigation for suspected Sjogren’s
Schrimer’s test
Common side effect of colchicine
Diarrhoea
Management of delayed presentation of scaphoid fracture
Urgent ortho review
Patient with difficulty picking up objects but no reduced sensation after a radial head fracture?
Low radial nerve injury
Describe osteochondritis dissecans
Necrosis and displacement of a fragment of bone and cartilage in the joint due to overuse and repetitive microtrauma of the joint
Commonly affects young adults and is worsened by physical activity
Patients may experience joint locking and stiffness.
Which Weber classification requires definitive surgical management?
Type C
Fracture above the level of the ankle joint with disruption of the tibiofibular syndesmosis
What movements are involved in the pronation and supination of the arm?
Rotation of radius on ulna
When would you not choose internal fixation?
Open fractures = dirty wounds
Hep B infection with CNIII and ulnar nerve palsy and ulcers with systemic upset suggests?
Polyarteritis nodosa
Antibody assoc with systemic sclerosis
Anti-centromere
Is lateral epicondylitis assoc with resisted extension or flexion of wrist and digits?
Resisted extension
What is a lipohaemarthrosis?
Fat and blood floating mass above patella esp after fracture
Signs of Perthes on X-ray
Femoral head collapse and fragmentation suggestive of osteonecrosis
Most common arteries damaged in hip fracture and dislocation
Fracture - AVN of medial femoral circumflex artery
Dislocation - Artery of ligamentum teres
Which muscle is responsible for flexion of DIP joints?
Flexor digitorum profundus
Anatomical snuffbox is innervated by?
Radial nerve
Damage to which nerve would cause reduced flexion and adduction of the wrist?
Ulnar
Abdominal presentation of cauda equina?
Suprapubic mass
Ligament injury most assoc with type 4 tibial plateau fracture
ACL tear
Which cancers spread to bone?
Prostate Loves To Kill Bone
- prostate, lung, thyroid, kidney, breast
What lesion can occur after repeated shoulder disloctions/subluxations?
Bankart lesion
- seen on MRA
Osteoarthritis of the knee can cause what kind of swelling and how would you investigate it?
Baker’s cyst
- US
Management of Achilles tendon rupture
Same-day ref to ortho
Urgent ultrasound
Venous thromboembolism prophylaxis
Plantarflexed cast/Achilles tendon reattachment
Which test can rule out Achilles rupture?
Simon’s calf squeeze test
Sudden pain during walking recently post-op total hip replacement?
Posterior hip displacement
Which muscle can cause a fibular head avulsion fracture?
Biceps femoris
- sudden contraction of the biceps femoris is a common cause of an avulsion fracture of the fibular head
Nerve injury most commonly assoc with fibular fracture
Common peroneal
- loss of the ability to dorsiflex and evert the foot causing a foot drop
- Sensory functions of this nerve cover the skin on the anterolateral aspect of the leg and the dorsum of the foot
Management in septic arthritis of prosthetic joint where broad-spectrum antibiotics have not provided any relief
Surgical washout
Back pain which wakes from sleep assoc with raised ESR?
Inflammatory pain e.g. AS
- lumbar x-ray
Back pain which radiates to buttocks and thigh and improves on sitting down/leaning forward
Lumbar spine stenosis
Intrinsic hand muscle wasting suggests a lesion at what site?
T1 nerve root
Which test has highest specificity for RA?
Anti-CCP
Back pain with leg weakness and minor trauma and PMHx of cancer
Spinal cord compression
C8/T1 radiculopathy would cause what type of symptoms in what location?
Sensation synptoms proximal to wrist
e.g. paraesthesia or numbness
55y/o make with acute back pain, cervical stiffness, foot pain and difficulty breathing?
Ankylosing spondylitis
X-ray showing a well healed fracture with a backed out DHS assoc with pain over greater trochanter?
Trochanteric bursitis from prominent metalwork
Bilateral parotid swelling assoc with Sjogren’s, gradual and assoc lymphadenopathy
MALT lymphoma
Diagnostic test for disc herniation
Straight leg raise
Swan-neck deformity?
MCP flexion
Prox hyperetension
Distal hyperflexion
Symptoms of S1 nerve root lesion
Foot eversion is weak
Ankle jerk is affected
Characteristics of IgG4 disease
Recurrent AI pancreatitis
Haemodynamic stability, mildly deranged LFTS, and a normal CRP are also characteristic
Sausage pancreas = diffuse thickening
What investigations should be undertaken before starting methotrexate?
Baseline liver function test, renal function, full blood count, CXR
What is first line for lupus?
Hydroxychloroquine
Then azathioprine
Acyclophosphamide if acute e.g. lupus nephritis
Pain on medial heel, worse in the morning, no injury history, runner?
Plantar fasciitis
Is paralysis a late or early comp of compartment syndrome?
Late
Innervation of thumb adduction
Ulnar
Immediate swelling of knee joint after injury would suggest damage to which ligaments?
Cruciate
- meniscal is usually 12-24h after
In what incidence would you give a septic arthritis patient antibiotics before aspiration?
If there is an unavoidable delay in performing a knee aspiration or the patient is septic
How doe pain from talus fracture present?
Ankle pain rather than foot pain
Swellings in osteochondritis dissecans and osgood-schlatter’s
Tibial tuberosity - osgood
Femoral condyle - osteochondritis
Most unstable type of ankle fracture
Ones involving tibiofibular syndesmosis
- manage ORIF
Which head of biceps more commonly ruptures?
Long head
What is the female athletic triad and what hip fracture can it cause?
Osteoporosis, eating disorders and amenorrhoea
- stress fracture of femoral head due to osteoporosis
Achilles tendon rupture inv
US ankle and calf
