MSK 🦵🏼 Flashcards
Identify the hip injury. Shortened and internally rotated leg
Posterior hip dislocation
Identify the hip injury. Lengthened and externally rotated leg
Anterior hip dislocation
Identify the hip injury.
Shortened and externally rotated leg
Hip fracture
Treatment for clavicle fracture
A sling if uncomplicated. Surgery required if open fracture, displaced with skin tenting, or neurovascular compromise
Nerve injury at risk in anterior shoulder dislocation
Axillary
Presenting differences between anterior and posterior shoulder dislocation
Anterior patient has abducted and externally rotated arm. Posterior patient has adopted an internally rotated arm
Treatment for shoulder dislocation
Sling and swath. Reduction would’ve been done first
Initial and confirmatory test to diagnose rotator cuff tears
Clinical diagnosis. But confirmed with MRI
Treatment for rotator cuff tears. Went to do surgery
Rest and NSAID. Surgery only if lost active range of motion with preserved passive range of motion
 Nerve affected if humeral fracture is proximal, mid shift, distal
Proximal would be axillary, mid shift would be radial, distal would be median
Humeral fracture treatment
coaptation splint un complicated. Surgery if open or displaced
Monteggia fracture
Proximal owner fracture and radial dislocation (may be called diaphyseal fracture of proximal owner with subluxed radial head)
Night stick fracture
Owner shaft fracture from direct trauma (often in self defence)
Galeazzi fracture 
Diaphyseal fracture of the radius with dislocation of distal ulnar.
Treatment of nightstick fracture
Conservative therapy if an complicated. Surgery if open or displaced
Monteggia fracture treatment
Open reduction and internal fixation of fracture And closed reduction of dislocated Radial head
Galeazzi fracture treatment
Open reduction internal fixation of radius and casting of fractured forum in supination to reduce the distal radio ulnar joint
Management of Colles fracture
Close reduction followed by short arm cast. Open reduction if fracture is open or displaced or intra-articular
Treatment of boxers fracture
Closed reduction and splint. Surgery if excessively angulated or unstable or if more than one metacarpal is fractured
Treatment of de quervain Tenosynovitis. And what to do if refractory
NSAIDs, ice, thumb splint. Steroid injection if refractory
Is a scaphoid fracture seen on an x-ray immediately. What’s the impact this has on the diagnosis
No, usually takes two weeks to show. So can assume a diagnosis if snuffboxes tender
Treatment for scaphoid fracture
Some cast (thumb spica splint), cereal x-ray monitoring, if displacement or non-union president must do ORIF (only really if more than 1 mm displacement,)
What nerves are impacted in posterior and anterior hip dislocation
Anterior is the obturator nerve. Posterior is the sciatic
Treatment for hip dislocation
Emergent closed reduction (unless there’s a pathology requiring open reduction). Do CT scan after reduction
Treatment for femoral fracture
0RIF. Irrigate and debride open fractures
If you suspect hip fracture, however x-ray is negative, what do you do
CT or MRI, because x-rays can be negative
Treatment for hip fracture. Consider DVT risk. And consider if heavily displaced
0RIF. Arthroplasty needed if there’s a high chance of displacement. Anticoagulation for DVT risk
Diagnostic test of choice for all knee ligament injuries
MRI
ACL tear when to Tx
Young symptomatic patients
Meniscus tear Tx
Younger patients, (repair or remove). Older patients (conservative remove)
Tibial stress fracture presentation
Point tenderness worsening with activity. Seen in misalignment, foot arch issues, female athlete triad
Non operative and operative Tx for tibial stress fracture
Active modification and casting. Or intramedullary nailing or ORIF
Thompson test is positive in what
Achilles’ tendon rupture
Who gets surgery for Achilles’ tendon rupture
Elite athletes. Everyone else should have conservative
What is Crescent sign in baker cyst rupture
And Ekhymosis at the medial malleolus
How to manage a patient with bakers cyst
NSAIDs and activity modification, surgery if symptomatic. Ultrasound to rule out DVT
What is used to determine if an x-ray is necessary for an ankle fracture suspicion
Ottawa ankle rules
Treatment for ankle fracture
ORIF if open displaced or unstable
Treatment for calcaneal stress fracture
Conservat
Treatment of metatarsal stress fracture
Usually Conservative. Fifth metatarsal involvement means we need treatment due to non-union risk (0RIF)
What is the Ottawa ankle rule
To know if somebody should get an x-ray for ankle pain. Do x-ray if patient cannot walk four steps four pain with palpation at the malleolus zone or specifically malleolus
Salter-Harris paediatric fracture classification type one
Fracture line is within growth plate (physis) straight across. But no compression
Salter-Harris paediatric fracture classification type 2
Fracture extends through both metaphysis and physis (most common)
Salter-Harris paediatric fracture classification type 3
Fracture extends through both physis and epithesis
Salter-Harris paediatric fracture classification type 4
Fracture extends through all three (metaphysis, physis, epithesis)
Salter-Harris paediatric fracture classification type 5
Physis is compressed or crushed (like one with compression). Worst Px
Pneumonic for Salter-Harris classification
Type one straight across, type two above growth plate, type three lower, type four through, type five erased growth plate
Long thoracic nerve findings
Cannot abduct the above 90°. Potential history of chest tube placement or stab wound to axilla. Winging seen on exam
Radial nerve palsy findings
Wrist drop and sensory deficit of proximal. Finger drop without sensory deficit if distal. Potential history of mid shaft humeral fracture, compression of humerus (Saturday night palsy), Radiohead subluxation
Median nerve palsy findings
Flat thinner eminence, weak wrist flexion, cannot oppose the thumb, weak finger flexion, potential history of supracondylar fracture or carpal tunnel syndrome. Recall median claw and Benediction sign
Ulnar nerve palsy findings
Ulnar claw (Recall distal proximal findings). Cannot abduct fingers. Potential history of guyon canal syndrome, Hi mate book fracture, medial epicondyle fracture
Musculocutaneous nerve palsy findings
Absent biceps reflex, weak elbow and shoulder flexion. Cannot supinate forearm. Potential history of shoulder dislocation or trauma to anterior bicep
Axillary nerve palsy findings
Cannot abduct arm above 15°. Deltoid is flat. Decrease sensation of a deltoid. Potential history of anterior shoulder dislocation, fracture of surgical neck of humorous
Common perineal nerve palsy findings
Foot drop, cannot dorsiflex or avert foot. Recall sensory deficit. Potential history of needles location prolonged mobilisation or trauma to fibula
Superior gluteal nerve palsy findings
Dropping of contra lateral pelvis due to horizontal walking (Trendelenburg). I.e. cannot hip abduct
Tibial nerve palsy findings
Cannot foot invert or plantarflex. Can be tarsal tunnel syndrome if distal. Since we lost soul of the foot. Look out for patient with trauma to the back of the knee or baker cyst
Obturator nerve palsy
Wide base gate, are you cannot see a doctor. Sensory loss to distal medial side. Look out for patient with pelvic lymph-node dissection or tumour
Femoral nerve palsy signs
Abnormal knee reflex, are you cannot flex and extend. Sensory loss to anterior medial side and medial side of lower leg (saphenous branch). Look out for patient with prolonged pressure on nerve or direct trauma
Lateral femoral cutaneous nerve palsy
Abnormal thigh sensation (lateral). Get meralgia Parasthetica. Causes include obesity or tight fitting clothes, or even surgeries and IVC filter
What is complex regional pain syndrome
Loss of function and autonomic dysfunction occurring after trauma (not a true nerve injury). Three phases development of pain (out of proportion) from trauma, soft tissue and oedema, atrophy and limitation of movement
Treatment of complex regional pain syndrome
Trial of NSAIDs for initial phase. Oral corticosteroids, low dose TCA, gabapentin, all for adjuvant mads. Refer to chronic pain specialist if complicated
Where does osteosarcoma occur in the bone
Metaphyseal region
Enchondroma usually found where
Hands or feet
Enchondroma, treatment
Serial x-rays
X-ray findings of giant cell tumours
Soap bubble Appearance
Medication for Giants of tumour of the bone
Denosumab
Location for osteoblastoma
In the back (blasted in the back)
Osteochondroma management
Monitor with cereal x-rays
Management for osteoid osteoma
Conservative, but can respect if patient cannot tolerate NSAIDs for pain
Management for osteosarcoma or ewing sarcoma or chondrosarcoma
Reception and chemotherapy. Chondro and ewing can use radiation to
Which bone tumour has a moth-eaten appearance on x-ray
Chondrosarcoma
Best initial test for osteosarcoma
X-ray (Sunburst and Codman triangle findings)
Onion skinning finding seen on x-ray for tumour
EWing sarcoma
Most accurate test for osteosarcoma
Bone biopsy
Intense pain with brief joint movement is pathognomic of which joint disease
Septic arthritis
In which joint disease is the synovial fluid viscosity low
Inflammatory arthritis is
Treatment for staphylococcus septic arthritis
Vancomycin
Treatment for neisseria Septic arthritis
Third gen Ceohalosporin
Treatment for salmonella and hemophilus septic arthritis
Third gen cephalosporin
General treatment of septic arthritis
Broad spec (ceph, vanco) until culture result comes back. Joint drain and debride
How does an osteoid osteoma present and what is the treatment
Adolescent, pain in upper thigh, x-ray showing small Lucent nidus. Pain relief with NSAID is needed surgery may be needed
I what pathogen do you think is responsible for these osteomyelitis patients:
No risk factor
IVDU
Sickle-cell disease
Hip replacement
Foot puncture
Diabetes
Staph aureus
Aureus or pseudomonas
Salmonella
Epidermidis
Pseudomonas
Polymicrobial

Osteomyelitis in a diabetic, antibiotics should be targeting what
Polymicrobial and gram-positive bacteria
Imaging test of choice for osteomyelitis
MRI
Treatment for osteomyelitis
Surgical department of necrosis, IV antibiotics for a month.
Consider antibiotics used for osteomyelitis:
If gram-negative, if MRSA, if methicillin sensitive,
If gram-negative do floxacin or Cephtriaxone. For methicillin sensitive stuff give floxacin or ampicillin or oxacillin, for MRSA give Vanco
Most accurate test to diagnose osteomyelitis
Bone Aspiration with culture and stain. But not always needed
What kind of cancer can come from osteomyelitis
Squeamish cell carcinoma can occur. This would be a marjolin ulcer 
Role of opioids in osteoarthritis
Only in severe refractory pain cases, and the patient is not able to take a surgical approach
Main imaging/diagnosis for osteoarthritis
X-ray
Best initial treatment for OA
Physical therapy, weight reduction and NSAIDs. CS injection for temporary relief
The most definitive treatment for osteoarthritis
Surgery (i.e. joint replacement)
Diagnostic criteria for rheumatoid arthritis
Six or more of the following points:
Rheumatoid factor or anti-CCP
High ESR or CRP
Duration more than six weeks
Exclusion of other differentials
Three or more joints involved (up to 5 points)
First line and second line medications for rheumatoid arthritis
DMARDS like methotrexate. Second lines are TNF inhibitor’s and rituximab all leflunomide
How to bridge rheumatoid arthritis treatment in flares
NSAIDs or glucocorticoids
Keratoderma blennorrhagica and circulate balanitis are both scene in which arthropathy
Reactive arthritis
Best initial test for ankylosing spondylitis
X-ray of sacroiliac joint and lumber
Best initial therapy for ankylosing spondylitis
NSAID for pain
The two best initial lab tests for dermatomyositis or Polymyositis
Creatine kinase and anti-Joe antibodies
Most accurate test for dermato and polymyositis
Muscle biopsy
Treatment for dermatomyositis and polymyositis
High-dose corticosteroids with taper after 4 to 6 weeks. Azathioprine or MTX for resistant cases
Treatment for TMJ disorders. Consider what pharmacology also could be given
Patient education and South Ken measures to avoid triggers. Incense and steroid injections can be given. Dental splints can be given for bruxism
What is myofascial pain syndrome
Similar to fibromyalgia, but has indurated regions which when palpated cause pain in another location. Trigger points are palpated, pain is in the target zone
Some ideas for treatment for myofascial pain syndrome
Sleep hygiene, low impact exercise, therapy, antidepressant, gabapentin, muscle relaxant
Which antibody in scleroderma is a risk factor for a Renal crisis
Anti RNA polymerase 3
Summarise the treatment for systemic sclerosis
Steroids for acute flares, methotrexate for limited type. CCB for Raynolds. ACEi for a Renal crisis
For SLE diagnostic criteria we have the pneumonic DOPAMINE RASH. What does that stand for and how many of these do we need
We need four or more. Discoid rash, oral ulcers, photo sensitivity, arthritis, Mallow rush, immune criteria, neuro symptoms, elevated ESR, renal disease, ANA, serositis, haematologic abnormalities
Discuss the treatment for SLE
NSAIDs for mild joint symptoms. Steroids for acute exacerbations. Hydroxychloroquine is good for progressive and refractory cases (also good for isolated skin and joint problems). Cyclo phosphide mid or mycophenolate is for severe cases especially lupus nephritis
What is Jaccoud arthropathy 
A pattern of arthritis in SLE. Similar to rheumatoid arthritis but is nondeforming
Serum sickness like reaction
Just a self-limited fever, at carrier, arthralgia, lymph nodes, proteinuria weeks after beta lactams or sulphurs
Best initial test and most accurate test for GCA
ESR. Then biopsy of the artery (don’t wait for results before giving steroids)
Which exact artery is affected in AION in GCA
Posterior ciliary artery
Discuss diagnostic approach to Takayasu
Clinical presentation and imaging. Imaging is usually MRA Or CTA
Treatment for Takayasu
High-dose steroids
Discuss treatment regime for Behcet syndrome
Topical steroids for ulcers, ophthalmic steroids for ocular involvement, colchicine for prevention
Myofascial pain syndrome versus fibromyalgia
Fibromyalgia does not have trigger points and target zones, and fibromyalgia has multiple painful areas
Diagnostic criteria for fibromyalgia
Multiple painful areas in autobody quadrants and axle skeleton for more than three
Treatment regime for fibromyalgia
Start nonpharmacologically. Good sleep, low impact exercise, psychotherapy, education. Then pharma including TCA, gabapentin, pre-Gabalin
Treatment for polymyalgia rheumatica
Low-dose steroid
When do you do imaging for lower back pain
If there are red flags present
What are the red flags for lower back pain that warrants further imaging
Constitutional symptoms (like fever), sensory or motor deficit, suspicion for infection, risk factors for fracture (glucocorticoids, old age), history of drug abuse, malignancy
If lower back pain is mechanical should we do Bedrest
No it is contra indicated
Imaging of choice for herniated disc
MRI. 100% necessary if you suspect cauda equina or rapidly progressive symptoms. But could also do x-ray if you suspect trauma, infections or compression fracture
Best initial treatment for herniated disc
NSAIDs, physical therapy, local heat. Not bedrest
If a patient doesn’t respond to the Conservative therapy for herniated disc pain, what can be given next
Epidural steroid injection or nerve block
What is the definitive treatment for herniated disc
Surgery. Indicated if focal neuro, cauda equina, six weeks of pain or more
Diagnose this:
Back pain radiating to the buttocks and legs bilaterally. Some leg weakness numbness. Worse when standing and walking, relieved when flexing the hip
Spinal stenosis
Main imaging for spinal stenosis
MRI
Mild to moderate spinal stenosis treatment
NSAIDs, weight loss and abdominal muscle strengthening
Advanced spinal stenosis treatment
Epidural corticosteroid injection
Treatment for refractory spinal stenosis
Surgical laminectomy
Main treatment and management of spondylosis/spondylolisthesis
Can prescribe two weeks of bedrest and symptom control. Due close follow-up. If there’s any neurological injury or of the bedrest doesn’t work do imaging. Spine surgery can be obtained
Diagnose the nerve root
Patient has absent plantar flexion and weak hip extension. Achilles reflex is negative. Lateral aspect of the foot in little toe have no sensation
S1
Diagnosed nerve root
Big toe cannot dorsiflex. Foot cannot advert. Patella an Achilles reflex are okay. Dorsum of the foot and lateral aspect of the lower leg has no sensation
L
Diagnose the nerve root
Week hip flexion and weak foot dorsi flexion. Absent patella Reflects. Anterior thigh and medial aspect of the lower leg has poor sensation
L2 - L4
Diagnose the nerve root lesion
Incontinence and impotence. Anocutaneous reflex absent. Posterior medial thigh and perianal Anastasia
S2 – S4
What is osteochondritis dissecans
An adolescent condition with subchondral bone detaches from underlying bone. Seen in heavily active voice. Presents with dough joint pain worsening with activity, stiffness, crepitus, swelling. Antalgic gate, catching unlocking sensation
Discuss the diagnosis of osteochondritis dissecans
X-ray, can see subchondral bone fragment. If radiograph as normal but still suspect do MRI
Treatment for osteochondritis dissecans
 Rest, physical therapy and surgery in severe cases
Thank Treatment for bursitis. Consider if septic or nonseptic
Nonseptic just do activity modification and NSAIDs. If septic then systemic antibiotics and surgical debridment maybe needed
What is pes anserinus pain syndrome
A bursitis. Located at the anterior medial tibia at the insertion of the Pes anserinus. Pain develops over weeks, worse at night, worse when in use, Valgus stress test doesn’t aggravate pain
Treatment for pes anserinus pain syndrome 
NSAIDs and strengthen the quadricep
Patient presents with boxers fracture and abrasions over the skin. How we manage
If skin is broken in boxers fracture have to do surgical debride meant and give IV antibiotics to cover Eikenella
Best initial treatment for patellofemoral syndrome. First line regime? And what is CI in septic bursitis
Rest, heat and ice, elevation and NSAIDs. Physical therapy to strengthen quadriceps. Intrabursal steroid injection potentially considered (contraindicated in septic bursitis)
What is Morton neuroma, what’s the Tx
Degeneration of the nerves between the toes due to compression of the metatarsals (walking on hard surfaces or high heels). Often have a clicking sensation palpating joint space, and get numbness and pain and paraesthesia. Treat with padded inserts in the shoes
Diagnostic procedure to confirm gout
Join aspiration an analysis of crystals
What can you see on x-ray for gout
Rat bite erosions. Which is punched out erosions with an overhanging cortical bone
Discuss treatment for a cute gout attack
Hide those incidents like indomethacin of first line. Steroids are used if NSAIDs are contraindicated or ineffective. Inject if one or two joints, systemic if multiple joints. Colchicine can also be used as well
When is maintenance therapy needed for gout patience
If you have two or more attacks annually, your presence of tophi or you have structural joint damage
 Probenecid is contraindicated in which cases 
Patience with tophi, nephrolithiasis or chronic kidney disease
What is adhesive capsulitis, how’s it diagnose how is it managed
Glenohumeral joint pathology, where it loses normal range of movement. Can be due to lots of things (such as fracture, rotator cuff injury, surgery, hypothyroidism, stroke, etc.) Presents with nagging shoulder pain and decrease range of movement. Clinically diagnosed, imaging only needed to rule out other pathology. Treatment includes exercises and therapy. NSAIDs and surgery needed if refractory
What are the Neer and Hawkins signs, and what are they related to
They are both signs of rotator cuff impingement (not tear). Hawkins is pain when internally rotating arm that is 90° and flexed. Neer Is pain when passively raising an internally rotated arm.
What sign is usually indicative that the rotator cuff has torn and not just been impinged
Drop arm test. Positive if patient drops arm while lowering yet from 90° of abduction
Diagnosis for rotator cuff impingement and then rotator cuff tear
Impingement do x-ray. If you suspect her MRI is best
Volkmann contracture
Contracture of the wrist and fingers due to compartment syndrome following a supracondylar humeral fracture. Affecting the brachial artery and radial nerve
Early signs and late signs of compartment syndrome
Early: pain out of proportion and paresthesia
Late: pallor and poikilothermia, then paralysis and pulselessness
What is the delta pressure in compartment syndrome
Diastolic pressure minus compartment pressure. If pressure less than or equal to 30 then compartment syndrome is diagnosed
Treatment for compartment syndrome
Fasciotomy
Treatment of rhabdomyolysis
IV fluid resource and correct electrolytes. Three any aetiology
What is the magic number of hours compartment syndrome can last before major complications occur
Six hours must do fasciotomy
Best initial treatment for carpal tunnel
Splint of the wrist at night and day if possible
Medical therapy that can be given in carpal tunnel
Steroid injection and NSAIDs
Definitive treatment for carpal tunnel
Surgical decompression
Discuss treatment regime for hand infections/bite wounds. Mention different sources of bite, if there is necrosis, if the septic arthritis
Broad spec antibiotics until culture is confirmed. If cat and dog cover Pasteurella and staphylococcus and streptococcus. If human cover eikenalla, and strep. Any necrosis requires surgical debride meant. Any septic arthritis requires joint aspiration and surgical debride to
Other than clinical what other investigations can you do in hand infections/bite wounds
Usual lab studies, culture of the wound, X-ray is first line Imaging (to see if there is emphysema, foreign body, osteomyelitis et cetera
Treatment of dupytrens contracture
Fasciotomy or fasciectomy. Percutaneous needle aponeurotomy is less invasive but less effective
Diagnosis of avascular necrosis
X-ray first. MRI is good standard for negative x-ray and high suspicion. Recalled that scaffold fractures and AVN is associated with a negative x-ray for 2 to 6 weeks
Treatment for femoral head AVN
Total hip replacement
Scaphoid AVN treatment
Wrist splints after full and surgical referral if displaced or vascular compromise
Patient 6mo after femoral neck fracture, presents with groin pain and inability to place weight on that side. What is the likely diagnosis
Avascular necrosis
Femoroacetabular impingement syndrome…
Femoral head compresses the acetabular rim. Gradual onset of pain excaverbated by sitting/flexing the hip
Patient has pain on lateral hip, especially when walking upstairs or generally flexing the hip. Palpating elicits pain on lateral hip. Dx?
Greater trochanteric PAin syndrome
IVDU, 20-30 year old. With back pain, and tender spinous processes with light touch. No fever or high WBC. What’s the diagnosis
Vertebral osteomyelitis
Main treatment for Meralgia paresthica
Conservative. Lose weight, loose clothes etc.
Nerve block or gabapentin if persitient
Hook-like osteophytes is seen in which disease?
Hemochromatosis induced arthritis
The Rat bite lesion seen on x ray is part of what disease
Gout. Where there is bone erosion and overhanging cortisone bone
Dx this;
5 year old boy, with limp for few months. Initial X-rays were normal. BMI normal. No muscle pain, and hip pain is fairly stable. Cannot place weight on on leg. Limited abduction and internal rotation of hip.
Legg Calvé Perthens disease
Contrast septic and overuse bursitis
Overuse: swollen and painful. History of overuse. Do RICE Mx
Septic: red and warm and painful. Aspirate to confirm. Abx given and even drain if persistent
If some random person has posting antiphospholipid antibodies… what may this mean
A few people have transient positive APL Abs, so repeat the bloods a few months later
Overview of Mx for Acute uncomplicated lower back pain
Heat pad and other non med stuff. NSAID is first line med. can add non benzo muscle relaxant
What indicates that Genu Varum is physiological. How to Mx
No leg length discrepancy.
Symmetrical
Around 2 years old
Slightly short
Good ROM
Observe and reassure
Giant cell tumour tx
Surgery (1st). Denosunab can shrink the tumour
Moth eaten, onion skinning, codmans triangle.. seen in what Dx on X-RAY
Ewing Sarcoma
Patient has signs of OA. very clear. Do we need to do further imaging?
No more invx needed. X-RAY NOT RECQUIRED
Dx this:
5 year old boy. 3 mo Hx of on and off Thigh pains at night, and a little shin pain. Worse on active days. Whole exam and labs normal.
Growing pain. Aka idiopathic nocturnal pains of childhood
Diagnose this;
Older patient, sudden back pain when doing light excersize.
Ain is midline, and point tender. Remains at night, worse when cough.
How to invx
Compression fracture, do X-ray and DEXA.
What is complex regional,pain syndrome, and how is it Mx’d
Unknown pathophys, but occurs after trauma. Usually over weeks. Pain is burning or stinging, and not dermatomal. Can be red, warm, edematous, low ROM. But bloods will be normal and X-ray will show patchy osteopenia. Tx by educating P, and excersize. Can also do NSAID, gabapentin, TCA etc.
Clavicle fracture risk to vessels? How to invx?
Yes can pierce the subclavian vessels. Give fluids (patient likely unstable). If they improve, do CT chest to check to issues. If they remain unstable do exploratory thoractomy.
Dx this:
Patient with acheing hip. Externally rotated and flexed hip. Recently had a episode of diahrrea. No tenderness or gross issues.wbc normal, esr normal.
Transient synovitis (likely secondary to viral illness)
Greater trochanteric pain syndrome
Overuse of glutes, that run over the greater trochanter, causing pain. Point tenderness over the lateral hip (burning feeling). Worse when active. Tx by excersize, NSAID, and injected CS if refractory
What is adhesive capsulitis? How is it Tx
Glenohumeral joint capsule contracture, begins with pain, then more stiffness. No local tenderness, and no X-ray findings. Has Decreased ROM in multiple planes. Main RFs are TIIDM and hypothyroidism. Usual Tx, of NSAID, excersizes, and even injected GCs
Myofascial pain syndrome versus fibromyalgia clinically
Myofascial pain syndrome has trigger points, that when palpated cause pain in the target zones. Fibromyalgia just has pain where you have paint
Transient synovitis
Usually in younger children, following minor infx. Bloods roughly normal, X-ray normal, abducted and externally rotated, but can bear weight on leg. Give NSAID and rest
Compare and contrast different causes of horn in lower back pain. Ie, infx, ca, mechanical, inflammatory etc.
FOOSH FRACTURES
Shoulder dislocation, reduced ok. Then paintient has pain and unable to abduct arm. No sensation issue
Rotator cuff tear.
Difference in hammer and claw toe deformity…. At the joint level
Deformities in the foot of diabetics
Claw toe and hammer toe deformities reflect an imbalance in strength and flexibility between the flexor and extensor muscle groups. In a patient with longstanding diabetes, these deformities may suggest underlying diabetic peripheral neuropathy. Other complications of diabetic neuropathy include callusing, ulceration, joint subluxation, and Charcot arthropathy.
Fractures suggesting child abuse
Bruises/fractures at various stages of healing
• Femur fracture in nonambulatory infant
• Posterior rib fractures
• Metaphyseal corner fractures
• Retinal & subdural hemorrhages
Colles fracture can compress which nerve
Median nerve
Gout tophi appearance on X-ray
Bone erosion and overhanging edges of cortical bone
Chronic bursitis vs tophi on palpating
Chronic bursitis (also caused by gout) is round and fluctaunt
What is trigger thumb
Stenosing tenosynovitis (“trigger thumb”) results in pain over the palmar aspect of the first
metacarpophalangeal joint; the pain is associated with a catching sensation during movement or locking of the thumb in flexion.
Tibial Stress fracture vs medial tibial stress syndrome (shin splints)
Tibial stress fracture often seen in our athletic female triad etc. and shows insidious point tenderness. shin splints usually seen on overweight casual runners, but not always, and had diffuse tenderness, not point .
Tibial stress fracture details
High in athletic female triad, and in extreme exercises. Increase vit D. Insidious onset of point tender pain. And X-rays are negative until weeks after
Discuss the clinical approach to transient synovitis patients. When to US, when to sus septic arthritis.
Acute, traumatic hip pain in children is typically caused by transient synovitis, which presents in well-
appearing children who are often febrile and able to ambulate. However, patients with features
concerning for septic arthritis (eg, inability to ambulate, leukocytosis) require bilateral hip ultrasound, with or without arthrocentesis, to distinguish between the conditions. If the ultrasound shows unilateral fluid, do arthrocentesis
Causes and Mx of Charcot joint
DM, tabes d, syringomyelia, b12 def, SC injury. Do mechanical offloading and consider cast
X-ray findings of Charcot joint
Bone loss, osteophytes and even bone fragments
Chronic osteomyelitis findings on X-ray
Calcaneal apophysitis vs plantar fasc
Former is what I had!! Literally carbon copy of me. It’s sort of the lagoon schaltter in the heal. Plantar fasciitis is unilateral usually and gets better throughout the day
Extraadticular manifestations of RA
Lung fibrosis and nodules, effusions, pulmonary HTN, atheroscle, osteoP, anemia, fever, weight loss, fatigue, depression, scleritis and episcleritis, neuropathy
High risk areas for stress fracture
Metatarsal, tibia
Repetitive running, point tender bone, insidious onset
Stress fracture
Pain in between third and fourth toes, with clicking and squeezing them together
Morton neuroma
Pain at lateral epicondyle on passive flex and active extension on wrist. Tender at lateral distil humerus
Tennis elbow (lateral epicondylitis). Vice versa or golfers eblow
What is radial tunnel syndrome
Radial tunnel syndrome is caused by compression of the radial nerve where it passes under
the supinator. Although it may cause lateral elbow pain resembling lateral epicondylitis, the tenderness is
typically greatest at the margin of the supinator several centimeters distal to the elbow, rather than at the
lateral epicondyle (eg, lateral distal humerus) as in this patient.
Mixed connective tissues disorder mix of which three disorders. Which antibody seen
SLE, SysScl, Polymyositis
What is the definition of chronic non specific lower back pain
Pain for more than 3 months with no specific etiollogy. All the scary stuff ruled out
How to manage non specific lower back pain (consider if acute or chronic)
Acute, can do intermittent NSAIDs and moderate activity. If chronic do Normal activity, stretching and strengthening excersizes, heat and even CBT. Intermittent NSAIDs, SSRIs can also be tried in chronic when needed
Hemochromatosis osteoarthropathy affects where the most
2nd and 3rd MCP. AND WRIST. like an OA but not in the DIP PIP, and in younger patients. Has chondrocalcinosis and hook like osteophytes
Young Patient with diabetes, OA in the hands (MCP), and high LFTS
Hereditary hemochromatosis
Mx of HH osteoarthopathy
NSAID, paracetamol. Or phlebotomy if severe
Being vegetarian a risk factor for osteoporosis.?
No. Being vegan kinda is… but only really in the case of a low BMI vegan
How can salter Harris III and IV fractures cause growth long term leg length discrep
The distal tibial growth plate typically closes around age 14 in boys (age 12 in girls), and fractures involving the maturing, partially fused, physis (eg, Salter-Harris type Ill and IV fractures) carry an increased risk for long-term complications. In particular, injury to the growth plate can cause growth arrest and lead to persistent limb-length discrepancy.
Three main fractures to cause avasc necrosis
Post-fracture vascular necrosis is most common in areas of bone with limited blood supply
such as the scaphoid, femoral head, or metadiaphyseal junction of the fifth metatarsal
Foot drop is a complication of which fracture
Traumatic foot drop is typically caused by injury to the common peroneal nerve where it wraps
around the lateral neck of the proximal fibula.
Characteristics of physiologic gen varum include:
• Symmetric bowing
• Normal stature
• No leg length discrepancy
• No lateral thrust when walking
What is lateral thrust in genu varum
Patient stands in one leg, and the bowing worsens
How to treat radial head subluxation
While pressure is applied at the radial head, forearm hyperpronation or supination plus flexion usually reduces the annular ligament with an audible click. Either maneuver should restore full, normal use of the extremity. The response to reduction is diagnostic of this condition.
Recap on Sever disease
Calcaneal apophysitis is a common cause of heel pain in children who play running or jumping sports.
Tenderness at the base of the heel and with calcaneal compression are diagnostic findings. Treatment is supportive.
Last resort Tx for meralgia P
Patients with persistent symptoms may respond to anticonvulsants (eg, gabapentin) or local nerve block.
Main two causes of myosotis ossificance. And the general Tx of it
Traumatic: muscle injury, fracture, orthopedic surgery (eg, arthroplasty)
Neurogenic: stroke, traumatic brain injury, spinal cord injury
Give NSAID, and do ROM excersizes, can do Sx removal
When is pain worse in osteosarcoma? Or bone cancer generally
Neoplastic bone disorders (eg: osteosarcoma) classically present with deep pain that is worse
at night.
Generally indications to do X-RAY or MRI in chronic lower back pain
X-RAY
Osteoporosis/compression fracture
• Suspected malignancy
Ankylosing spondylitis (eg, insidious onset, nocturnal pain, better
with movement)
MRI
• Sensory/motor deficits
• Cauda equina syndrome (eg, urine retention, saddle anesthesia)
Suspected epidural abscess/infection (eg, fever, intravenous
drug abuse, concurrent infection, hemodialysis)
Causes of trendelenberg in younger patients, not nerve related. If groin pain present
conditions causing a Trendelenburg sign (eg, developmental
dysplasia of hip, avascular necrosis of femoral head, SCFE) also warrant bilateral hip x-rays.
SCFE presentation
SCFE classically presents in adolescence with chronic, progressive pain of the hip, groin, or knee. Examination shows decreased abduction and internal rotation of the hip, as seen by this patient’s externally rotated foot. Opposite of Leg Calve perthers?
Chronic osteomyelitis in setting of fracture. Signs, Dx and mx
Wound and sinus drainage, and lil pain. History of fracture in area. Non union. Do X-ray and bone biopsy. Sx debride and abx
Radial subluxation vs fracture…,key signs
Fracture will have more pain, point tender, swell. Subluxation patient will hold arm in pronation
Patient with potential radial subluxation… and is above 5 years old. Why do we need X-ray now?
Because subluxation is rare above 5… so could be a fracture
Mx of Achilles tendinopathy
Acute: activity modification, ice, NSAIDs
Chronic: eccentric resistance exercises
Contrast sever disease and Achilles tendinopathy and enthesitis
Sever is in adol who do jumping and extreme excersize. And is within 2cm on calcareous. Achilles tendinopathy is in excersizes, GCs, quinolones, and not so much in adol. It is more than 3 cm from calcaneous. Enthesitis is almost Always seen in HLA b27 arthrop
Which knee ligament, when torn, causes significant effusion
ACL
Rotator cuff impingement vs tear
Impinge
Pain with abduction, external rotation
Subacromial tenderness
Rotator cuff impingement or
tendinopathy
Normal range of motion with positive impingement tests
(eg, Neer, Hawkins)
Rotator cuff tear
• Similar to rotator cuff tendinopathy
• Weakness with abduction & external rotation
• Age >40
In occult supracondylar fractures, what can be seen in xray
Fat pads
Neer test
Thumb to ground (pronated arm) then raise arm in front on patient. Sign of rotator cuff tendinopathy
Common causes of transient tenovosynovits
Post viral, extreme excersize and trauma
Compare differences between SLE and DILE
Compared with systemic lupus erythematosus, drug-induced lupus erythematosus produces more abrupt symptom onset, is less likely to involve the skin, and affects men and women of any age.
Causes of DILE
Most common: procainamide, hydralazine, penicillamine
• Others: minocycline, TNF-a inhibitors (eg, etanercept, infliximab), isoniazid
How to diagnose sacroilititis. If this test is negative?
x-rays of the pelvis showing sacroiliitis can confirm the diagnosis of AS. However, ×-rays may be negative in early stages; MRI can confirm sacroiliitis in such cases.
Diagnosis and Mx of fat emboli syndrome
FES is a
clinical diagnosis, and management is supportive.
Asymmetrical thigh creases in child….
Dev dysplasia sign
When does pseudogout usually occur in patients with chronic chondrocalcinosis
Attacks of pseudogout often occur in the setting of trauma/overuse, surgery, or medical
illness.
Red flags and supportive findings for dev dysplasia of hip. Generally what should you do if there is a red flag, or supportive findings
Red flags
- Positive Ortolani test
• Dislocated hip
• Limited hip abduction
=refer to otho for sx
Supportive findings
• Limb length discrepancy
• Asymmetric gluteal/inguinal/thigh creases
= do US (less than 4mo) or X-ray (more than 4mo)
Treatment for scleroderma renal crisis… how does it help?
ACEi. Since in renal crisis we see renal damage, increasing RAAS, which increases BP, then kidney damaged more
Is hypothyroidism risk factor for SCFE
Yes, since there will be less ossification
Shoulder pain how to differentiate
Rotator cuff tendinopathy
• Pain with abduction (overhead activities) or external rotation
- Strength preserved
Rotator cuff tear
- Similar to rotator cuff tendinopathy
• Weakness
Adhesive capsulitis
• Decreased passive & active range of shoulder motion
(frozen shoulder)
AC joint sprain
• Pain over AC joint
• Passive shoulder adduction provokes pain
Biceps tendinopathy
• Pain over bicipital groove
We all know about drain till dry for septic arthritis. But how do we manage it if it’s deep and cannot aspirate
Surgical/arthroscopic irrigation
Lyme disease clinical features early local, early dissem and late signs
Early localized
(days to 1 month)
• Erythema migrans
Fatique, headache
Myalgias, arthralgias
Multiple erythema migrans
Unilateral/bilateral CN palsy (eg, CN VIl)
Early disseminated
(weeks to months)
• Meningitis
• Carditis (eg, AV block)
Migratory arthralgias
• Arthritis
Late
(months to years)
• Encephalitis
• Peripheral neuropathy
Features of mild Osteogenisis Imperfecta
Frequent fractures
• Blue sclera
• Conductive hearing loss
• Short to normal stature
• Dentinogenesis imperfecta
• Joint hypermobility
Achondroplasia gene mutation
Achondroplasia is caused by a fibroblast growth factor receptor
Urine hydroxyproline. What is it used to measure
Urine hydroxyproline is derived almost exclusively from the breakdown of collagen, so it’s high when there is resorp of bone
Gout preventative measures (non pharma)
•Weight loss to achieve BMI <25 kg/m?
• Low-fat diet
• Decreased seafood & red meat intake
• Protein intake preferably from vegetable & low-fat dairy products
Avoidance of organ-rich foods (eg, liver & sweetbreads)
• Avoidance of beer & distilled spirits
• Avoidance of diuretics when possible
Meds causing increase gout attacks
thiazide and loop diuretics, aspirin, and beta blockers, can increase the risk of gouty attacks.
Dx
Pain at plantar aspect of heel & hindfoot
Worse with weight bearing (especially after prolonged rest). Worse in the morning and after long walks.
Pain with dorsiflexion of toes
Plantar fasciitis
X-ray in plantar fasciitis may show calcifications in the proximal fascia (heel
spurs), is this sens, spec?
but this is neither sensitive nor specific.
Compartment syndrome common and uncommon signs
Pain out of proportion to injury
• Pain 1 on passive stretch
• Rapidly increasing & tense swelling
• Paresthesia (early)
Uncommon
• Low Sensation
• Motor weakness (within hours)
• Paralysis (late)
• | Distal pulses (uncommon)
Toe stress fracture Mx. If middle toes, or 5th toes
Middle toes just do rest and analgesia (since surrounding toes keep it in place)
5th toe needs casting or internal fixation
Describe post amputation disorders. Acute stump pain, is medic pain, post traumatic neuroma, phantom limb pain
Acute stump pain
Tissue & nerve injury
• Severe pain lasting 1-3 weeks
Ischemic pain
• Swelling, skin discoloration
• Wound breakdown
• | Transcutaneous oxygen tension
Post-traumatic neuroma
• Weeks to months after amputation
• Focal tenderness, altered local sensation
• | Pain with anesthetic injection
Phantom limb pain
• Onset usually within 1 week
• Increased risk in patients with severe acute pain
• Intermittent cramping, burning felt in distal limb
Minor criteria for rheum fever.? (recall need 2 major, or 1 minor and 2 major to Dx)
Fever
Minor
• Arthralgias
• Elevated ESR/CRP
• Prolonged PR interval
Two main differences between acute rheum fever and JIA
Systemic juvenile idiopathic arthritis is diagnosed when arthritis is present for >6 weeks. And the arthritis is not migratory
Triad of one type of disseminated gonoccocal infx. How to Dx
triad of pustular rash, migrating arthralgia, and tenosynovitis. Do urogen NAAT
Other type is just septic monoarthtiris
Tx for acute non specific LBP. Consider two non pharma, first line pharma, and second line pharma
Spinal issues in DMD
Scoliosis
Aside from calcinosis, Pseudogout is also associated with ?
and ?.
Hemohromatosis and hypothyroidism
Neck pain differential:
History of neck injury, and pain/stiffness with neck movement
Most likely a strain
Neck pain differential:
Old patient, pain and stiffness in the neck which is worse with movement, I’m relieved by rest.
Likely facet osteoarthritis
Neck pain:
Neck pain that radiates to the shoulder/arm, with a dermatomal sensory motor and reflex finding. Spurling test positive
Radiculopathy
Neck pain differential:
Lhermitte sign, lower extremity weakness bilaterally, some bladder and bowel dysfunction, a bit of gait,
Cervical myelopathy
Neck pain differential:
Pain is constant, and especially worse at night. Pain does not change when moving position.
Tender spinous processes
Spinal metastasis
Neck pain differential:
Focal tenderness, fever and night sweats, IVDU, recent infection, immuno compromised
Vertebral osteomyelitis
Name as many causes of carpal tunnel as you can
Idiopathic/overuse, hypothyroidism, diabetes, rheumatoid arthritis, pregnancy, renal disease, acromegaly, gout
anterior shoulder pain radiating to the upper arm. partial weakness of shoulder flexion, abduction is not affected. noticeable bulge in the anterior arm. Dx?
Biceps tendinopathy
Suprascaupular nerve injury signs and causes
Back packs, weights, baseball etc. compresses the nerve. Causing triad of shoulder pain, weak abd and external rotation of shoulder. May also increase pain when addict arm across body
FetaL US: Foot in same plain as fibula and tibia
Means what?
Clubfoot (talipes equinovarus)
Positional clubfoot vs proper clubfoot main different
Positional talipes foot can be easily moved and corrected. Proper clubfoot is fixed
General Mx for humeral fracture . Not in Mx sheet
most cases treated nonsurgically (eg, closed reduction followed by arm immobilization with a coaptation or sugar-tong splint), open reduction and surgical exploration are indicated with open fractures, significant displacement (g, arm shortening, as in this patient), neurovascular compromise (eg, asymmetric radial pulses, as in this patient), polytrauma, and pathologic fractures.
Patient has hip fracture and another potential issue (HF, Pneumonia etc.). What is thing to do? How long can we delay for
Delay up 72 hr and find cause and stabilise P.
Intracapsular vs extracapsular hip fracture…. General Mx rules. Not details
Intracapsular higher risk of AVN…. Whereas extracapsular has higher need for nails and rods
Spinal stenosis worse with spinal flexion or extension
Extension (shopping cart sign)
Lumbar muscular pain signs
Lumbar muscle strain is the most common cause of low back pain; however, muscle strains
are usually worsened with activity, alleviated by rest, and associated with paraspinal tenderness (not focal vertebral tenderness).
Why might plantarflexion be kept in Achilles’ tendon rupture
Because there are other muscles that do this movement. That’s why Thompson test is vital
Imaging of choice for osteomyelitis
MRI
Management overview for osteomyelitis. Mention if staph, MRSA, gram-negative
Once diagnosed, do surgical department and IV antibiotics for one month. If staff give either Cipro, ampicillin, nafcillin. If MRSA give vanco. If gram negative give foxy
 Spinal stenosis management. Consider if mild, advanced, refractory
Mild to moderate you can just give NSAIDs and decrease weight. If advanced or more acute can do epidural corticosteroid injection. If refractory do laminectomy (above 75% stenosis)
When do you normally do Sx for spondylosis or spondylolisthesis
If neuro injury. Otherwise do bed rest, symptom control, close follow up
JIA has a risk to the eyes?
Risk of uveitis
JIA and ankylosing spondylitis, first line therapy is what for both
NSAID
Management of SLE. Consider main medication is prevalent joint, Reno, problems. Main medication for flare. Cornerstone medication for long-term
For joints give NSAIDs. For renal disorder consider cyclo phosphide or mycophenolate. For flare give steroids. For long-term management hydroxychloroquine is best
For Behcets We know corticosteroids can be given topically. What can be given for recurrence prevention
Colchicine
For polyarteritis nodosa, what’s the main imaging we do. What’s the gold standard diagnostic tool (not always needed
CT Angio is the best imaging. Biopsy is gold standard
Clavicle fracture. The so-called soft and hard signs. How to manage in the presence of either one
Soft signs: decrease pulses, decrease blood pressure, minor haematoma. Do CTA
Hard signs: no pulse, bruit, large and expanding haematoma. Do surgery immediately
Management of Colles’ fracture. Then what happens if it’s open? Or intra-articular or displaced?
Most of the time you do close reduction and put in a cast. If open fracture, intra-articular, displaced do open reduction
When would you do ORIF in scaphoid fracture
If there is non-union or there is more than 1 mm displacement
General rule with Salter-Harris fractures, regarding treatment
One two and three can do close reduction. Four usually needs open reduction. Five varies based on severity
Meralgia paresthica doesn’t cause weakness, why?
Lat fem cut nerve doesn’t have motor element
Dermatomal of the groin and upper leg revise
Three-year-old child with right knee swelling and pain. Presentation is inflammatory (Wasim morning veteran day). Can bear weight, skin as normal, not that tender
Likely JIa oligo arthritis type
If giving patient Vanco for septic arthritis, and it’s not getting better. What antibiotic do I add
Foxy
Close toe and hammertoe can both be seen in what complication of diabetes
Neuropathy
Hi suspicion of abuse (MSK question) what kind of investigation should we do
Skeletal survey, philosophy, head CT. Then of course the other stuff
Three main side effects of methotrexate
Stomatitis, hepatotoxicity, cytopenia
When does the anterior fontanelle close
1yr
Which nerve is susceptible in Colles’ fracture
Median
What is the onion skinning in ewing sarcoma
Cortical layering
In charcot joint, What might we see
Bone loss, osteophytes, bone fragments
Is plantar fasciitis usually unilateral or bilateral. Is calcaneal apophysitis usually unilateral or bilateral
Unilateral, bilateral respectively
Just because you had a mind blip: morning stiffness of less than 30 minutes indicates what
Mechanical.
If transient synovitis is a clear clinical picture, and as mild pain. And no red flags (yes as normal, white blood cell count is normal) how we manage next
Ibuprofen and follow up
If a transient synovitis case has some alarm signs, (very bad pain, refuse to walk, high ESR, high WBC) and if the diagnosis is in 100% set. How do we manage next
US. If it is unilateral, we have to do an athro centesis
If C osteoarthritis like signs in a younger patient. LFTs are elevated or patient has diabetes what are you thinking
Hereditary haemochromatosis
What is the triad of diseases in mixed connective tissue
Lupus, scleroderma, polymyositis
Other than viral infections, what is the other cause of transient Tenosynovitis
Trauma/exercise
Haitian on hydralazine, suddenly get pleurisy or pericarditis
Considered DILE
In calcaneal apophysitis, what manoeuvre will hurt
Dorsey flexion
Myositis ossificans, name a couple of significant clinical findings. How do you manage
Mobile solid mass in an area that had trauma a few weeks ago. Often has pain when the muscle is stretched. NSAIDs are given, consider surgical excision
Calcaneal apophysitis is within how many centimetres of the calcaneous (in terms of pain
2! If more than to consider Achilles tendinopathy
Acute Achilles tendinopathy can just be treated with ice and NSAIDs. How can we tackle chronic tendinopathy
Resistance training
We know patellofemoral is often seen in patience to do a lot of exercise. What deformity can be responsible
Angular deformities. So just check for this
What is the compression test and is it positive in patellofemoral
Extend the knee and Press and the patella. It will be painful. And yes it is
If in fracture, or dislocation. Arm or leg is swollen and pale, and it’s failing to have pain management with opioids. What’s the likely diagnosis
Compartment syndrome
Management of fat Emboli syndrome
It is a clinical diagnosis and supportive management
Sickle crisis before six months. Is it likely
No
Call the Management for dev Dysplasia
Do you have any of the red flags (Ortolani for example) then Refer straight to ortho. If only support of findings to ultrasound of less than four months old, do x-ray if more than four months old
Which disorder is hypothyroidism a risk for
SCFE
Alcohol is a risk factor for which hip disorder
Avascular necrosis
Nonlocalised knee pain, in a younger woman. Pain when contract quad muscle
Patellofemoral
Recall our pes anserine bursitis management
Rest, NSAID, quad/hamstring management
If have secondary Reynolds, what is a good lad to do first
ANA. Since many connective tissue disorder is actually have railroads, it’s good to do ANA first.
Nephritic syndrome, low 3 and C4, palpable purpura on the legs.
Mixed cryoglobulinaemia. Wagners would not have low compliment. Polyarteritis nodosa would not cause low compliment or an nephritic
How to confirm the presence of a painful traumatic neuroma
Can inject a local anaesthetic, if it helps, it’s probably the diagnosis
As divine said. Tender paraspinal lumber acute onset is usually a sign of what
Muscle sprain. So given non-benzo muscle relaxant if NSAIDs didn’t work
If a shoulder or arm pain is relieved when a patient puts their hand on the head what is this
Cervical radiculopathy
Vertebral compression fracture versus sprain
Sprain will be relieved with rest, and will have tender or spasms of the paraspinal muscle. Fracture will have point tenderness usually at the spinous process. And will not be relieved with rest
Once remission is induced by steroids in polymyositis, what do we go onto
Methotrexate or Azathioprine 
Patient has pain on the lateral hip Describe does burning. Worse when active and tender on deep palpation.
Not meralgia paraesthetica. Greater trochanteric pain syndrome
Some tests I have to do before putting a patient on methotrexate
Hepatitis and pregnancy for example
Name two metabolic disorders that are risks for adhesive capsulitis
Hypothyroidism and diabetes
The buzz term tender passive extension or flexion especially in the setting of swollen or tense compartment.
Compartment syndrome
Do I need to do an x-ray in a clear clinical osteo arthritis
You world says no
Lateral thigh pins and needles and numbness and pain. Works on Valsalva. Obese patient. No tenderness to the femoral epicondyle
Meralgia paraesthetica
Radiotracer uptake in multiple myeloma versus Padgett
Myeloma it’s gonna have decrease uptake. Padgett is going to have increase
Foot pain near here, worse when stands after sitting for a while.
Especially worth of patient runs barefoot.
Plantar fasciitis
Dermato myositis patient…. Sudden weakness or stiffness of extension of arm
Maybe rotator cuff tear
Risk factors for AVN in scaphoid fracture
Proximal, comminuted, displaced, fracture, smoker
More than 1mm displacement of a scaphoid fracture
Consider ORIF
Anterior hip dislocation… nerve damage
Obruator
What medication to give in patient with hip fracture
Anticoag
If high risk of displacement of femoral neck fracture… consider ??
Arthroplasty
Injuries causing ACL injury
Hyper extension or landing on extended leg
Casual excersize and overweight person. More shin splints or stress fracture
Shin splints. Tibial stress, is more female athletic triad, and foot misalignment
Crescent sign 🌙
Bakers cyst rupture
Other than unhappy triad… what year is most commonly seen with acute ACL
Lateral meniscus…. Even though triad is medial
SCFE is what slater Harris
i
Radial head subluxation can cause which nerve palsy
Radial nerve
Crutches or Saturday night palsy
Radial nerve
Distil radial nerve issue… patient loses motor or sensory
Motor (finger drop, not wrist drop)
Just go through the whole distil or proximal claws (ulnar and median)
Causes of long thoracic nerve palsy
Axillary lymphadenectomy. Chest tube placement or stab wound
Hook of hamate fracture causes what nerve
Ulnar!! And guyons, recall
Musculocutaneous nerve palsy. Which movement other than elbow flexion
No forearm supination. Pronation is our median nerve
Baker cyst can cause which nerve palsy
Tibial
Prolonged lithotomy position cause which nerve palsy
Femoral
Other than anterior thigh, which lower leg area loses sense in femoral nerve palsy
Medial
Wide based gait in which nerve palsy
Obruator
Pelvic LN dissec causes which nerve damage
Obruator
Ok sign test… for which nerve
Median
Thumb extension against resistance which nerve
Radial nerve
Most common bone tumour
Osteochrondroma
