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MSK Flashcards

1
Q

most common cause of osteomyelitis

in normal
in px w sickle cell

A

normal - staph aureus

sickle cell - salmonella

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2
Q

imaging for osteomyelitis

A

MRI best for dx

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3
Q

mx osteomyelitis

A

surgical debridement of infected bone + tissues

acute =
flucloxacillin 6 wks

clindamycin if penicillin allergic
Vancomycin or teicoplanin when treating MRSA

chronic =
3 months+ abx

if assoc w prosthetics = complete revision surgery to replace

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4
Q

sx + s of ACL injury

A

Damaged during a twisting injury to knee

Sudden painful ‘popping’ sensation with rapid swelling

Inability to return to activity

Lateral knee and joint line tenderness

Lachman test often positive
Anterior drawer test may be positive

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5
Q

osteoporosis RFs

A

SHATTERED FAMILY
Steroid use >5mg/day prednisolone
Hyperthyroidism; hyperparathyroidism, hypercalciuria
Alcohol and tobacco use
Thin (BMI <22)
Testosterone low (e.g. anti androgen in cancer of prostate)
Early menopause (oestrogen is protective against it)
Renal or liver failure
Erosive/inflammatory bone disease (e.g. RA or myeloma)
Dietary Ca low/malabsorption or DMT1
Fhx

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6
Q

+ve simmonds sign

A

archilles tendon rupture

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7
Q

what maneuver is used for reduction of dislocated shoulders

A

Stimson

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8
Q

mx of diff grades of Acromioclavicular joint injury (shoulder hit in collision sports or FOOSH)

A

(rockwood classification used)

Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling.

Grade IV, V and VI are rare and require surgical intervention.

III = either

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9
Q

when to do ankle x ray

A

if there is pain in the malleolar zone and:
1. Inability to weight bear for 4 steps
2. Tenderness over the distal tibia
3. Bone tenderness over the distal fibula

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10
Q

weber classification of ankle fractures

A

Related to the level of the fibular fracture.

Type A = below the syndesmosis - leaves it in tact

Type B = at the level of the ankle joint – the syndesmosis will be intact or partially torn

Type C = above the ankle joint – the syndesmosis will be disrupted

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11
Q

mx of ankle fractures

A

All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis

Weber A&B: cast/boot and weight bear as tolerated

Weber C (unstable): open reduction internal fixation

Follow-up in 6-8 weeks

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12
Q

what is a buckle fracture

A

incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex

head parts flattened out a bit due to pressure

typically occur in children aged 5-10 years

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13
Q

what is a greenstick fracture

A

occurs when a bone bends and cracks, instead of breaking completely into separate pieces. Most common in children under 10.

usually has a wedge + bit still hanging on

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14
Q

what is a salter harris fracture

A

A fracture that involves the epiphyseal plate or growth plate of a bone. Childhood fracture most common in the long bones.

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15
Q

what is spinal stenosis

A

refers to the narrowing of part of the spinal canal, resulting in compression of the spinal cord or nerve roots.
by tumour, disk prolapse or other similar degenerative changes.

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16
Q

presentation of spinal stenosis

A

gradual onset

Intermittent neurogenic claudication is a key presenting feature of lumbar spinal stenosis with central stenosis. It is sometimes referred to as pseudoclaudication. Typical symptoms are:
Lower back pain
Buttock and leg pain
Leg weakness

The symptoms are absent at rest and when seated but occur with standing and walking.

Bending forward (flexing the spine) expands the spinal canal and improves symptoms.

Standing straight (extending the spine) narrows the canal and worsens the symptoms.

Lateral stenosis and foramina stenosis in the lumbar spine tends to cause symptoms of sciatica.

always need MRI to confirm

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17
Q

how to mx suspected scaphoid fractures (maximal tenderness over anatomical snuff box)

A

immobilisation using a below-elbow back slab and repeat radiographs in 7-10 days/Futuro splint

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18
Q

subacromial impringement - where is the pain

A

a rotator cuff injury
= painful arc of abduction between 60 + 120 deg

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19
Q

where is the pain in rotator cuff tears

A

in the first 60 deg in arc of abduction

will also be weakness compared to opp arm, muscle wasting + tenderness

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20
Q

what is compartment syndrome

A

complication that may occur following fractures (or following ischaemia reperfusion injury in vascular patients)

  • raised pressure within a closed anatomical space -> compromised tissue perfusion -> necrosis
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21
Q

most common fractures to result in compartment syndrome

A

supracondylar fractures and tibial shaft injuries.

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22
Q

features of compartment syndrome

A

Bone fracture or crush injury

Pain, especially on movement (even passive), disproportionate
- excessive use of breakthrough analgesia should raise suspicion for compartment syndrome

Parasthesiae

Pallor

Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise

Paralysis - worrying

limb swelling

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23
Q

dx compartment syndrome

A

usually clinical

measurement of intracompartmental pressure measurements using needle manometry
>20mmHg is abnormal and >40mmHg is diagnostic

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24
Q

tx compartment syndrome

A

essentially prompt and extensive fasciotomies

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25
Q

tx displaced intracapsular hip fracture

A

hemiarthroplasty (if not healthy/dementia) or total hip replacement (if healthy)

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26
Q

tx undisplaced intracapsular hip fracture

A

internal fixation (healthy)

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27
Q

tx extrascapular hip fracture

A

stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or subtrochanteric fractures: intramedullary nail

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28
Q

features of hip fracture

A

pain
the classic signs are a shortened and externally rotated leg
patients with non-displaced or incomplete neck of femur fractures may be able to weight bear

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29
Q

red flags for lower back pain

A

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
thoracic/middle
sudden onset + progression

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30
Q

spinal stenosis back pain

A

gradual onset
unilateral/bilateral leg pain, numbness, weakness worse on walking
relieved by sitting down
, leaning forward + crouching down
clinical exam often normal

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31
Q

ank spon back pain

A

Typically a young man who presents with lower back pain and stiffness
Stiffness is usually worse in morning and improves with activity
Peripheral arthritis (25%, more common if female)

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32
Q

PAD back pain

A

Pain on walking, relieved by rest
Absent or weak foot pulses and other signs of limb ischaemia
Past history may include smoking and other vascular diseases

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33
Q

main cancers with mets to bones

A

PORTABLE

Po – Prostate
R – Renal
Ta – Thyroid
B – Breast
Le – Lung

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34
Q

what is polymyalgia rheumatica

A

inflam condition that causes pain + stiffness in shoulders, pelvic girdle + neck
strong assoc w GCA
older white px

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35
Q

presentation polymyalgia rheumatica

A

onset of sx over days to weeks, sx present for 2 wks b4 dx

pain + stiffness of: shoulders, pelvic girdle, neck
this is:
worse in morning
interferes w sleep
takes 45 mins to ease in the morn
improves w activity

NO TRUE WEAKNESS

assoc features:
systemic sx
muscle tenderness
carpel tunnel
peripheral oedema

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36
Q

dx polymyalgia rheumatica

A

Based on clinical presentation, response to steroids and excluding differentials.
Inflammatory markers usually raised

Ix b4 steroids:
FBC
U&Es
LFTs
Ca (abnormal in hyperparathyroidism, cancer + osteomalacia)
Serum protein electrophoresis for myeloma
TFTs
Creatine kinase for myositis
RF for RA
Urine dipstick

Consider:
Anti-nuclear antibodies (ANA) for SLE
Anti-cyclic citrullinated peptide (anti-CCP) for rheumatoid arthritis
Urine Bence Jones protein for myeloma
CXR for lung + mediastinal abnormalities (e.g., lung cancer or lymphoma)

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37
Q

tx polymyalgia rheumatica

A

15mg prednisolone daily then follow up after 1 week
If they have it there will be dramatic improvement in sx
Then follow reducing regime

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38
Q

additional mx for px on long term steroids

A

Don’t STOP
Don’t – steroid dependence occurs after 3 weeks of treatment, and abruptly stopping risks adrenal crisis
S – Sick day rules (steroid doses may need to be increased if the patient becomes unwell - double)
T – Treatment card – patients should carry a steroid treatment card to alert others that they are steroid-dependent
O – Osteoporosis prevention may be required (e.g., bisphosphonates and calcium and vitamin D)
P – Proton pump inhibitors are considered for gastro-protection (e.g., omeprazole)

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39
Q

what is Greater trochanteric pain syndrome (Trochanteric bursitis)

A

Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years

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40
Q

what is a t score and z score (+ what are they based on)

A

T score of -1.0 means bone mass of one standard deviation below that of young reference population

T score: based on bone mass of young reference population
Z score is adjusted for age, gender and ethnic factors

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41
Q

t score ranges

A

> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis
< -2.5 + a fracture = severe osteoporosis

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42
Q

what is a compound fracture

A

when the skin is broken and the broken bone is exposed to the air. The broken bone can puncture through the skin.

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43
Q

what is a stable fracture

A

when the sections of bone remain in alignment at the fracture

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44
Q

what is a pathological fracture

A

when a bone breaks due to an abnormality within the bone

may occur with minor trauma or even spontaneously
Common sites are the femur and the vertebral bodies

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45
Q

what fractures typically occur in children

+ only occur in children

A

Greenstick and buckle fractures

Salter-Harris fractures only occur in children (adults do not have growth plates)

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46
Q

what is a colle’s fracture

A

a transverse fracture of the distal radius near the wrist, causing the distal portion to displace posteriorly (upwards), causing a “dinner fork deformity”.

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47
Q

what is a colle’s fracture the result of

A

fall on outstretched hand (FOOSH)

can also get scaphoid fracture

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48
Q

key sign of scaphoid fracture

A

tenderness in the anatomical snuffbox

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49
Q

problem w scaphoid fractures

A

scaphoid has a retrograde blood supply, with blood vessels supplying the bone from only one direction. This means a fracture can cut off the blood supply, resulting in avascular necrosis and non-union.

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50
Q

which bones have vulnerable BS

A

the scaphoid bone, the femoral head, the humeral head and the talus (bone at top of foot), navicular and fifth metatarsal in the foot

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51
Q

what bones do ankle fractures involve

A

lateral malleolus (distal fibula) or the medial malleolus (distal tibia)

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52
Q

what is the distal syndesmosis

A

fibrous join between the tibia and fibula

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53
Q

what happens in pelvic ring fractures

A

when one part fractures another part will also fracture
often lead to signif intra-abdominal bleeding, either due to vascular injury or from the cancellous bone of the pelvis -> shock and death -> emergency resuscitation + trauma management.

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54
Q

what is a fragility fracture

A

occur due to weakness in the bone, usually due to osteoporosis. They often occur without the appropriate trauma that is typically required to break a bone

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55
Q

FRAX tool

A

A patient’s risk of a fragility fracture over the next 10 years

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56
Q

DEXA scan

A

to measure bone mineral density

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57
Q

first-line mx to reduce risk of fragility fractures

A

Calcium and vitamin D
Bisphosphonates (e.g., alendronic acid) (start if >75 w/o waiting for a dexa scan)

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58
Q

how do bisphosphonates work

A

reduce osteoclast activity preventing resorption of bone

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59
Q

SEs of bisphosphonates

A

reflux + oesophageal erosions
atypical fractures
osteonecrosis of jaw
osteonecrosis of external auditory canal

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60
Q

how to take oral bisphosphonates

A

on an empty stomach sitting upright for 30 minutes before moving or eating

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61
Q

alt when bisphosphonates CI

A

Denosumab - a monoclonal antibody that works by blocking the activity of osteoclasts

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62
Q

what is a fat embolism

A

Can occur following the fracture of long bones (24-72 hrs after). Fat globules are released into the circulation following a fracture (poss from the bone marrow), they may become lodged in BVs and cause blood flow obstruction.
Can cause a systemic inflam response -> fat embolism syndrome

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63
Q

criteria for dx of a fat embolism

A

Gurd’s major criteria
- resp distress
- petechial rash
- cerebral involvement

Gurd’s minor criteria inc:
- Jaundice
- Thrombocytopenia
- Fever
- Tachycardia

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64
Q

what is osteomyelitis

A

inflammation in a bone and bone marrow, usually caused by bacterial infection
can be acute or chronic

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65
Q

ways infection can occur in osteomyelitis

A

Haematogenous osteomyelitis - when a pathogen is carried through the blood and seeded in the bone, most common

Can occur due to direct contamination of the bone from adjacent tissues / structures e.g. during op

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66
Q

osteomyelitis RFs

A

Open fractures
Orthopaedic operations, particularly with prosthetic joints
Diabetes, particularly with diabetic FOOT ULCERS
Peripheral arterial disease
IV drug use
Immunosuppression

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67
Q

osteomyelitis presentation

A

Fever
Pain and tenderness
Erythema
Swelling
Purulent discharge

quite non spec

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68
Q

initial signs of osteomyelitis on XR (not gd for dx)

A

Periosteal reaction (changes to the surface of the bone)
Localised osteopenia (thinning of the bone)
Destruction of areas of the bone

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69
Q

what is trochanteric bursitis

A

inflammation of a bursa over the greater trochanter on the outer hip
produces pain localised at the outer hip (greater trochanteric pain syndrome)

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70
Q

what are bursae

A

sacs created by synovial membrane filled with a small amount of synovial fluid.
-found at bony prominences (e.g., at the greater trochanter, knee, shoulder and elbow)
- reduce friction between the bones and soft tissues during movement.

71
Q

what is bursitis

A

inflammation of a bursa -> thickening of the synovial membrane and increased fluid production -> causing swelling.

72
Q

causes of bursitis

A

Friction from repetitive movements
Trauma
Inflammatory conditions (e.g., rheumatoid arthritis)
Infection – referred to as septic bursitis

73
Q

trochanteric bursitis presentation

A

middle-aged patient with gradual-onset lateral hip pain (over the greater trochanter) that may radiate down the outer thigh
-pain is aching or burning
-worse with activity, standing after sitting for a prolonged period and trying to sit cross-legged
-may disrupt sleep, can’t get comfy

74
Q

examination in trochanteric bursitis

A

tenderness over the greater trochanter (no swelling unlike bursitis in other areas)

special tests:
- Trendelenburg test
- Resisted abduction of the hip
- Resisted internal rotation of the hip
- Resisted external rotation of the hip

75
Q

mx trochanteric bursitis

A

Rest
Ice
Analgesia (e.g., ibuprofen or naproxen)
Physiotherapy
Steroid injections

6-9 mths to recover fully

It can rarely be caused by infection but if so - abx

76
Q

what does the ACL do

A

stops the tibia from sliding forward in relation to the femur

77
Q

how is the ACL attached

A

The ACL attaches at the anterior intercondylar area on the tibia + originates from the lateral aspect of the intercondylar notch in the femur

78
Q

first-line ix for dx ACL injury

A

MRI scan

79
Q

gold standard for dx ACL injury

A

Arthroscopy

80
Q

mx ACL injury

A

urgent referral in patients with an acute onset of knee pain associated with symptoms suggestive of an acute ACL tear

Conservative management RICE:
R – Rest
I – Ice
C – Compression
E – Elevation

NSAIDs for analgesia
Crutches and knee braces
Physiotherapy
Arthroscopic surgery

81
Q

what is a baker’s cyst

A

a fluid-filled sac in the popliteal fossa (diamond in back of knee), causing a lump

82
Q

causes of baker’s cysts

A

usually 2ndary to DEGENERATIVE changes in the knee joint. They can be associated with:
Meniscal tears (an important underlying cause)
Osteoarthritis
Knee injuries
Inflammatory arthritis

83
Q

presentation baker’s cyst

A

Pain or discomfort
Fullness
Pressure
A palpable lump or swelling
Restricted range of motion in the knee (with larger cysts)

84
Q

baker’s cyst examination

A

Most apparent when the patient stands with their knees fully extended. The lump will get smaller or disappear when the knee is flexed to 45 degrees (Foucher’s sign).

Oedema may occur if the cyst compresses the venous drainage of the leg.

85
Q

presentation of ruptured baker’s cyst

A

causes inflammation in the surrounding tissues and calf muscle, presenting with:

Pain
Swelling
Erythema

DDx is DVT

86
Q

first line ix bakers cyst

A

USS

87
Q

mx baker’s cyst

A

none for asx

sx:
Modified activity to avoid exacerbating symptoms
Analgesia (e.g., NSAIDs)
Physiotherapy
Ultrasound-guided aspiration
Steroid injections

surgical mx if other knee path - arthroscopic procedures

88
Q

what is subluxation

A

partial dislocation of shoulder

89
Q

are most shoulder dislocations anterior or posterior

A

> 90% are anterior (head of humerus moves forward in relation to glenoid cavity)

occurs when arm is forced backwards whilst abducted + extended at the shoulder

90
Q

what are posterior shoulder dislocations assoc w

A

electric shocks + seizures

91
Q

key comp of shoulder dislocations

A

axillary nerve damage

92
Q

where does the axillary nerve come from

A

C5 and C6 nerve roots (direct continuation of the posterior cord from the brachial plexus)

93
Q

damage to axillary nerve

A

causes a loss of sensation in the “regimental badge” area over the lateral deltoid.
It also leads to motor weakness in the deltoid and teres minor muscles.

94
Q

presentation shoulder dislocation

A

present after acute injury, px will know
muscles go into spasm + tighten around joint
arm held against side of body
deltoid flattened, head of humerus causing bulge + is palpable

95
Q

what to assess px w shoulder dislocation for

A

Fractures
Vascular damage (e.g., absent pulses, prolonged capillary refill time and pallor)
Nerve damage (e.g., loss of sensation in the “regimental patch” area)

96
Q

what is the apprehension test

A

assess for shoulder instability, specifically in the anterior direction
90 deg, external rotation - apprehension

97
Q

what muscles make up the rotator cuff

A

S – Supraspinatus – abducts the arm (first 20 deg, deltoid does the rest)
I – Infraspinatus – externally rotates the arm
T – Teres minor – externally rotates the arm
S – Subscapularis – internally rotates the arm

98
Q

ix to dx rotator cuff tear

A

Ultrasound or MRI scans

99
Q

RFs frozen shoulder (/adhesive capsulitis)

A

diabetes

most commonly affects ppl of middle age

100
Q

what happens in frozen shoulder (/adhesive capsulitis)

A

inflammation and fibrosis in the joint capsule (glenohumeral joint) -> adhesions -> bind capsule so it tightens around joint + restrict movement

101
Q

what to do if little response to steroid tx for polymyalgia rheumatica

A

consider alt dx as sld have dramatic improv - refer to specialist

102
Q

what is osteochondritis dissecans

A

pathological process affecting the subchondral bone causing knee pain after exercise, locking and ‘clunking’
usually children + young adults

103
Q

ix osteochondritis dissecans

A

X-ray (AP, lateral, tunnel views) - subchondral crescent sign or loose bodies
MRI - used to evaluate cartilage, visualise loose bodies, stage and assess the stability of the lesion

104
Q

what level does the spinal cord terminate

A

L2/L3

105
Q

causes of cauda equina compression

A

Herniated disc (the most common cause)
Tumours, particularly metastasis
Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
Abscess (infection)
Trauma

106
Q

red flags for cauda equina

A

Saddle anaesthesia (loss of sensation in the perineum – around the genitals and anus)
Loss of sensation in the bladder and rectum (not knowing when they are full)
Urinary retention or incontinence
Faecal incontinence
Bilateral sciatica
Bilateral or severe motor weakness in the legs
Reduced anal tone on PR examination

107
Q

mx cauda equina

A

neurosurg emergency
- Immediate hospital admission
- Emergency MRI scan to confirm or exclude cauda equina syndrome
- Neurosurgical input to consider lumbar decompression surgery

108
Q

features of metastatic spinal cord compression

A

Back pain - worse on coughing or straining

Motor and sensory signs and symptoms. (more UMN signs (if above L1) than cauda equina as nerves have not yet left the spinal cord)

109
Q

tx metastatic spinal cord compression

A

High dose dexamethasone (to reduce swelling in the tumour and relieve compression)
Analgesia
Surgery
Radiotherapy
Chemotherapy

110
Q

what does the achilles tendon do

A

connects the calf muscles (gastrocnemius and soleus) to the heel (the calcaneus bone)
flexion of the calf muscles pulls on the Achilles and causes plantar flexion of the ankle

111
Q

RFs Achilles Tendinopathy

A

Sports that stress the Achilles (e.g., basketball, tennis and track athletics)
Inflammatory conditions (e.g., rheumatoid arthritis and ankylosing spondylitis)
Diabetes
Raised cholesterol
Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin)

112
Q

presentation Achilles Tendinopathy

A

gradual onset of:

Pain or aching in the Achilles tendon or heel, with activity
Stiffness
Tenderness
Swelling
Nodularity on palpation of the tendon

113
Q

how to exclude achilles tendon rupture

A

Simmonds’ calf squeeze test
USS for dx of it

114
Q

RFs achilles tendon rupture

A

Sports that stress the Achilles (e.g., basketball, tennis and track athletics)
Increasing age
Existing Achilles tendinopathy
Family history
Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin) - can occur spontan within 48 hrs of tx
Systemic steroids

115
Q

achilles tendon rupture presentation

A

Sudden onset of pain in the Achilles or calf
A snapping sound and sensation
Feeling as though something has hit them in the back of the leg

greater dorsifelxion (lie supine w feet hanging off bed)

116
Q

examination signs for achilles tendon rupture

A

When relaxed in a dangled position, the affected ankle will rest in a more dorsiflexed position
Tenderness to the area
A palpable gap in the Achilles tendon (although swelling might hide this)
Weakness of plantar flexion of the ankle (dorsiflexion is unaffected)
Unable to stand on tiptoes on the affected leg alone
Positive Simmonds’ calf squeeze test (will not move the foot)

117
Q

what is osteoporosis

A

signif reduction in bone density - weakening bones + making them more prone to fractures

118
Q

when to assess someone for osteoporosis

A

Anyone on long-term oral corticosteroids or with a previous fragility fracture
Anyone >50 with RFs/fragility fracture (calc using FRAX + then NOGG guideline chart)
All women >65
All men >75

Treatment may be started without a DEXA in patients with a vertebral fracture

119
Q

mx osteoporosis

A

Address reversible RFs
Address insuff intake of Ca + VD
Bisphosphonates
e.g. Alendronate 70 mg once weekly (oral)
Reassess bisphon tx after 3-5 yrs w repeat DEXA scan - stop if T-score>-2.5 apart from if high risk

120
Q

what is osteomalacia

A

condition where defective bone mineralisation causes “soft” bones
due to insuff VD
rickets in adults

121
Q

osteomalacia pres

A

asx
Fatigue
Bone pain
Muscle weakness
Muscle aches
Pathological or abnormal fractures

122
Q

what are looser zones

A

fragility fractures that go partially through the bone

123
Q

osteomalacia RFs

A

darker skin, low exposure to sunlight, living in colder climates and spending most of their time indoors

124
Q

lab ix VD

A

Serum 25-hydroxyvitamin D
Less than 25 nmol/L – vitamin D deficiency
25 to 50 nmol/L – vitamin D insufficiency

125
Q

other lab ix osteomalacia

A

Low serum calcium
Low serum phosphate
High serum alkaline phosphatase
High parathyroid hormone (secondary hyperparathyroidism)

126
Q

imaging osteomalacia

A

X-rays may show osteopenia (more radiolucent bones)
DEXA scan shows low bone mineral density

127
Q

tx osteomalacia

A

colecalciferol (vitamin D₃)
Loading dose then maintenance
check serum Ca within month of loading regime

128
Q

presentation septic arthritis

A

single joint - often knee
rapid onset:
hot, red, swollen, painful joint
stiffness + reduced ROM
systemic sx = fever, lethargy

129
Q

mx septic arthritis

A

local acute hot joint policy - to guide what team admits px (ortho, rheum, ID)
joint aspiration b4 abx
empirical IV abx
- Flucloxacillin (often first-line)
- Clindamycin (penicillin allergy)
- Vancomycin (if MRSA is suspected)
- Ceftriaxone (typically used for treating Neisseria gonorrhoea)

ctu 4-6 wks (IV then oral)

130
Q

causes dupuytren’s contracture

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

131
Q

what is dupuytren’s contracture

A

thickening of the connective tissue in the palm. This results in the fingers taking on a ‘curled’ appearance, with an inability to extend the fingers.

132
Q

what happens with a ruptured medial meniscus

A

Catching or locking of the knee with an inability to extend fully or bend the joint

133
Q

what action might result in ruptured PCL

A

when a person jumps and lands on a bent knee or during impact with another person

134
Q

RFs trigger finger (stenosing tenosynovitis)

A
  • 40s/50s
  • F>M
  • DM
  • RA
135
Q

presentation trigger finger

A

-more common in the thumb, middle, or ring finger
- initially stiffness and snapping (‘trigger’) when extending a flexed digit
- a nodule may be felt at the base of the affected finger

worse in morn + improves through day

136
Q

which spinal nerves form the sciatic nerve

A

L4-S3

137
Q

route of sciatic nerve

A

exits the posterior part of the pelvis through the greater sciatic foramen, in the buttock area on either side.

It travels down the back of the leg.

At the knee, it divides into the tibial nerve and the common peroneal nerve.

138
Q

what does the sciatic nerve do

A

supplies sensation to the lateral lower leg and the foot

supplies motor function to the posterior thigh, lower leg and foot.

139
Q

sciatica presentation

A

unilateral pain from the buttock radiating down the back of the thigh to below the knee or feet. It might be described as an “electric” or “shooting” pain. Other symptoms are paraesthesia (pins and needles), numbness and motor weakness. Reflexes may be affected depending on the affected nerve root.

140
Q

main causes of sciatica

A

lumbosacral nerve root compression by:

Herniated disc
Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
Spinal stenosis

141
Q

why is bilateral sciatica a worry

A

a red flag for cauda equina syndrome

142
Q

choices of neuropathic meds for sciatica

A

Amitriptyline
Duloxetine

143
Q

what might indicate an epidural abscess

A

Signs of systemic sepsis with changing lower limb neurology

144
Q

what is discitis

A

an infection in the intervertebral disc space

can lead to serious complications such as sepsis or an epidural abscess.

145
Q

features of discitis

A

Back pain
General features
- pyrexia
- rigors
- sepsis
Neurological features
e.g. changing lower limb neurology
if an epidural abscess develops

146
Q

causes of discitis

A

Bacterial - Staphylococcus aureus is the most common cause
Viral
TB
Aseptic

147
Q

thumbs in OA

A

squaring
- Deformity of the carpometacarpal joint of the thumb resulting in fixed adduction of the thumb

Lateral subluxation of the base of the 1st metacarpal

148
Q

painless nodes on the hand in OA

A

Heberden’s nodes at the DIP joints
Bouchard’s Nodes at the PIP joints
these nodes are the result of osteophyte formation.

149
Q

presentation of carpal tunnel syndrome

A

pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night

150
Q

examination signs w carpal tunnel

A

weakness of thumb abduction (abductor pollicis brevis)
wasting of thenar eminence (NOT hypothenar)
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms

151
Q

causes of carpal tunnel

A

mainly idiopathic
There are a number of key risk factors:
Repetitive strain
Obesity
Hypothyroidism

MEDIAN TRAP
Myxoedma
Edema pre-menopause
Diabetes
Idiopathic
Acromegaly (bilateral carpal tunnel)
Neoplasm

Trauma
RA
Amyloidosis
Pregnancy

152
Q

ix carpal tunnel

A

nerve conduction studies: motor + sensory: prolongation of the action potential

153
Q

tx carpal tunnel

A

6-week trial of conservative treatments if the symptoms are mild-moderate
- corticosteroid injection
- wrist splints at night: particularly useful if transient factors present e.g. pregnancy

if there are severe symptoms or symptoms persist with conservative management:
- surgical decompression (flexor retinaculum division)

154
Q

main neurovascular structure that is compromised in a scaphoid fracture

A

The dorsal carpal branch of the radial artery

155
Q

what is flail chest

A

serious comp of multiple rib fractures following trauma
- caused by 2/+ fractures along 3/+ consecutive ribs (usually anterior)
-> chest wall becomes unstable: the flail segment moves paradoxically (opp way to normal) during respiration and impairs ventilation of the lung on the side of injury

156
Q

best dx scan for rib fractures

A

CT chest

157
Q

mx rib fractures

A

the majority of cases are managed conservatively with good analgesia to ensure breathing is not affected by pain
- inadequate ventilation may predispose to chest infections
- if the pain is not controlled by normal analgesia then nerve blocks can be considered

surgical fixation can be considered to manage pain if this is still an issue and the fractures have failed to heal following 12 weeks of conservative management

158
Q

what is iliotibial band syndrome

A

a common cause of lateral knee pain in runners

  • tenderness 2-3cm above the lateral joint line
159
Q

hand deformities in RA

A

swan-neck deformity - hyperextension of the PIP joint and flexion of the DIP joint

Boutonniere deformity - flexion at the PIP joint and hyperextension at the DIP joint due to damage to central slip extensor tendon overlying PIP joint

160
Q

Causes of avascular necrosis of the hip

A

long-term steroid use
chemotherapy
alcohol excess
trauma

161
Q

where is the pain in avascular necrosis of the hip

A

anterior groin

162
Q

where in long bones is the infection likely to occur in osteomyelitis
adults
children

A

Adults = E lders = E piphysis

Children = M inors = M etaphysis

163
Q

most common site of metatarsal stress fractures

A

2nd metatarsal shaft

164
Q

most commonly fractured metatarsal + how

A

proximal 5th metatarsal

Usually associated with a lateral ankle sprain and often follow inversion injuries of the ankle.

165
Q

management for subluxation of the radial head (usually get from pulling injury)

A

Analgesia + Passive supination of the elbow joint whilst flexed to 90 degrees

166
Q

how do meniscal tears typically result

A

twisting injuries

167
Q

test used to assess for possible meniscal tears in the knee joint

A

McMurry’s

168
Q

what is Cubital tunnel syndrome + presentation

A

compression of the ulnar nerve

presents w tingling/numbness in 4th/5th finger
Pain worse on leaning on the affected elbow

169
Q

what is a charcot joint

A

neuropathic joint
a joint which has become badly disrupted and damaged secondary to a loss of sensation

a lot less painful than would be expected
swollen, red and warm

170
Q

presentation of posterior hip dislocation

A

internally rotated and shortened limb

commonly get sciatic nerve injury

171
Q

what is chronic compartment syndrome

A

During periods of exertion, pressure within the restricted compartment will rise and blood flow is restricted. This will cause the symptoms to begin. During rest, the pressure falls, and symptoms begin to resolve. It differs to acute compartment syndrome and is not a medical emergency.

differences:
Bilateral involvement
Happens on exertion
No neurovascular compromise
Relapsing and remitting pain

172
Q

what is an avulsion fracture

A

where a small piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone
usually in sports - changing direction

173
Q

what is osgood-schlatter disease

A

type of osteochondrosis characterised by inflammation at the tibial tuberosity

174
Q

indications for knee XR

A

ottowa knee rules
- age >/= 55
- isolated patella tenderness
- tenderness at the head of the fibula
- inability to flex the knee to 90deg
- inability to weight bare >4 steps immediately after injury and in the emergency department

finals (27 decks)

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