MSK

Question 1

Ending Ix for MSK knee

Answer 1

Complete my assessment by
- taking full history
- conducting a thorough neurovascular examination of the lower limbs
- examining the hip and ankle joints
- review any previous radiographs

Question 2

Indications for (bilateral) knee replacement?

Question 3

Procedures for deformed toes?

Answer 3

Keller’s arthroplasty
* remove bone from MTP joint
* replaced with soft tissue
* Used for bunions, hallux rigidus

Question 4

Management of OA

Answer 4

MDT approach

Conservative
- weight loss
- exercise
- physiotherapy
- TENS

Medical
- analgesia: paracetamol +/- topical NSAIDs
- topical NSAIDs only if knee or hand
- short term codeine, oral NSAIDs with PPI cover

Invasive/surgical
- intra Articular steroids
- hyaluronic acid injections (NOT NICE approved)

Question 5

X R changes in OA

Answer 5

Loss of joint space
Osteopathies
Subchondral cysts
Subchondral sclerosis

Question 6

Compartments of the knee

Answer 6

Medial Compartment (inner side of knee)

1 - medial femoral condyle
2 - medial tibial plateau
3 - medial meniscus

Patellofemoral Compartment (front of knee)
4 - patella (kneecap)
- femoral trochlea (front of femur)

Lateral Compartment (outer side of knee)
5 - lateral femoral condyle
6 - lateral tibial plateau
7 - lateral meniscus

Question 7

Components of knee replacement

Answer 7

Femoral component

Plastic spacer

Tibial component

Question 8

Types of knee replacement

Answer 8

Total knee replacement

Partial knee replacement
- unicompartmental
- patellofemoral arthroplasty
- bicompartmental

Question 9

Compartments of the leg

Answer 9

Anterior compartment
- tibialis anterior
- extensor hallucis longus, digitorum longus
- anterior tibial artery, vein
- Deep fibular nerve

Lateral compartment

Superficial posterior compartment

Deep posterior
- tibial nerve
- flexor muscles, tibialis posterior

Question 10

XR views of knee XR

Answer 10

Lateral
AP
Skyline

Question 11

How many weeks are surgical staples left post TKR?

Answer 11

Skin staples - removed after 2 weeks

(Note: sutures dissolve after 6-8 weeks)

Question 12

Surgical management of leg length discrepancy

Answer 12

Epiphysiodesis
- for children not done growing
- surgeon fuses the growth plate, temporarily or permanently

Epiphyseal stapling
- staples surgically inserted on each side of the growth plate
- removed once legs are of equal length

Bone resection
- removing a section of bone in the longer leg.
- adolescents who have reached their adult height.

Question 13

Normal hip ROM

Answer 13

Extension up to 15
Flexion up to 120

Abduction up to 50
Adduction up to 30

External rot up to 60
Internal rot up to 40

Question 14

XR changes in psoriatic arthritis

Answer 14

Joint erosions
Joint space narrowing
Peri Articular and shaft periostitis

Late = Pencil in cup deformity

Question 15

Management of Hip/NOF fractures

Answer 15

Intracpasular
Undisplaced = internal fixation

Displaced
- THR if healthy
- Hemi if comorbid

Extracapsular
- Dynamic hip screw
- Shaft = Intramedullary nail

Question 16

Rheumatoid arthritis signs in the hands

Answer 16

Swan neck deformity

Boutonnière deformity

Z shaped thumb

Ulnar deviation at MCP
Radial deviation at wrist

Rheumatoid nodules (extensor surfaces)

Question 17

Ank Spond radiological findings

Answer 17

Syndesmophytes

Sacroiliac joints
sacroiliitis is usually the first manifestation 5 and is symmetrical and bilateral
the sacroiliac joints first widen before they narrow
subchondral erosions, sclerosis, and proliferation on the iliac side of the SI joints
at end-stage, the SI joint may be seen as a thin line or not visible
See: grading of sacroiliitis

Question 18

Causes of paediatric gout

Answer 18

Metabolic syndrome
Obesity

Congenital heart disease
Kidney disease

Genetic
-Down syndrome
-Lesch Nyhan syndrome