MSK Flashcards
What are red flags and likely diagnoses in back pain?
Spinal infection, cancer, fracture, cauda equina, aneurysm/haemorrhage. Likely: musculoligamentous strain/sprain, facet joint OA = spondylosis.
How is non-specific low back pain and lumbar herniation managed?
Oral analgesia, education, consider massage, activity modification, physio/pilates. Most improves in 4-6 weeks, image if not. Steroids have limited effect.
Ankylosing spondylitis - symptoms, imaging bloods.
< 40yo, 3mo of pain, improves w exercise, stiffness >45min in morning. Schobers test - lumbar flexion < 5cm. Xray can be normal early, MRI better early but may miss. HLA-B27 common, not specific. ESR/CRP may be elevated.
What are scheuermann’s disease and spondylolisthesis? How are they managed?
Sc: hyperkyphosis in thorax in young male - hunchback, seen on xray. Physio, brace or surgery. Sp: slippage of vertebrae, lateral xray. Sx vary - pain w walk/stand, better leaning forward. Flexion exercise + core strengthen, avoid hyperextension.
What are the symptomatic and radiological features of OA?
< 30mins stiff, asymmetric joints, DIP (heberdens) and 1st CMC, pain w activity. Joint space narrowing, osteophyte formation, subchondral scelrosis and cysts, joint space irregularity.
What are the non-pharm aspects of OA management? Flares, general and adjuncts.
F: RICE, physio, brace. Function oriented goals, weight loss if overweight, land based exercise, GLA:D for hip/knee 6 weeks educ/exercise. Adj: aquatic exercise, heat pad, massage, walking devices, CBT for coping, TENS.
What medications can help in OA? What treatments are not recommended?
Panadol, NSAID (COX2 still high CVD, naproxen higher GI risk), topical NSAID or capsaicin, steroid inject 3mo, duloxetine, fish oil 2.7g omega 3 EPA +DHA. Cod liver, glucosamine, hyaluronan/PRP/Stem cel injections have limited evidence.
Paget’s disease of the bone - cause, symptoms, radiological features.
Excessive abnormal bone remodelling. Bone pain, deformity, fractures, deafness, neuropathy, hypercalcaemia, cardiac hypertrophy. Lytic lesions - candle flame, later cortical thickening and curved.
Paget’s disease of the bone - tests, differentials, treatment.
ALP + bone specific ALP, ca/phos often normal. DDx: OA (can overlap), hyperparathyroid, metastatic disease. Tx: only if symptomatic, IV zoledronic acid.
Symptoms/signs of TMJ dysfunction. Differential.
Restricted opening after 24mm joint moves, tender joint, clicking/crepitus - can feel in ear. DDx: myofascial pain w tenderness of masticatory muscles, fatigue on chewing.
Management of TMJ dysfunction - 8 features.
Education and jaw rest, avoid extreme movements, massage/heat/cold, physio for stretch/strengthening, consider splint, alt panadol/NSAID w 1st episode. If worse -CBT, behaviour modification (sleep hygiene, stress reduction), pain specialist.
What are some tests of peripheral upper limb nerve function?
Radial: extend at wrist and fingers. Median: fist/finger flexion. Anterior interosseous: oppose thumb and index. Ulnar: finger abduction.
How are humerus neck + shaft fractures managed? In Kids?
Surgical neck: sling (C&C or triangle) for 6 weeks w early mobilisation. If N/V compromise or anatomical neck - ortho. Shaft: C&C, elbow flexed to 110 w some angulation okay. Kids - rarely operate, immobilise sling then review 1 week.
How are AC joint injuries assessed? How can they be managed?
Test by adduction. RICE, sling usually. Grade 1: tender, no bumb 3weeks. 2: AC rupture clavicle up w bump 4-6 weeks. 3: complete dislocation - consider surgery.
How are clavicle fractures and olecranon fractures managed?
C: broad arm sling 2-6 weeks. Ortho if tenting, N/V damage or ends displaced. Aim for clinical not true union (no pain, full ROM). O: surgery as triceps leads to displacement.
How are patellar fractures caused, assessed and managed?
Trauma or sudden force (jump/sprint). Check knee extension and displaced - surgery. If all intact, immobiliser - zimmer or walking cylinder 4-6 weeks. Start rehab after 2-3 days. No driving if affected leg.
What are the ottawa ankle and foot rules?
X-ray if pain + any of unable to WB immediately and in ED 4 steps; tender at posterior edge or tip of malleoli; tender at base of 5th metatarsal or navicular.
How are ankle fractures classified? Management. What other injury should be considered?
Weber A below syndesmosis, WBAT in cast/boot. Weber B - distal end at syndemosis, may need ORIF. C if above, needs ORIF. Consider maisonneuve - shifted ankle w proximal fibula fracture.
How are shin splints and stress fractures different? Cause and management
SS: lower third medial tibia from stress to fascial insertion, diffuse tenderness. NSAID, reduce distance running. #: tib or fib, often medial tibia and manage w rest. Can do CT or MRI if unclear.
How do calcaneal fractures and fat pad atrophy present?
Post fall from height, CT if worried often need surgery review. Fat pad from atrophy - overuse, pain worse w use .
How are foot stress fractures diagnosed and managed? Which sites are common?
Subacute history, x-ray difficult in 1st 2 weeks. MRI gold standard if concern - eg. base of 2nd metatarsal, proximal 4th/5th MT, big toe sesamoids. Rest from stenuous activity 4-8 weeks. Partial/NWB for 2 weeks if painful to walk.
Morton’s neuroma - cause, symptoms, tests, management.
Fibrous enlargement of interdigital nerve, from overuse/footwear. Often < 50, women, can be bilateral. Burning pain + click when pushing metatarsal heads 3/4 together. U/S or MRI can confirm. Change shoes, orthotics - sponge MT pad, consider steroid injection, rarely surgery.
What are 3 fractures of the 5th metatarsal? How are they managed?
Avulsion at base = dancers/pseudojones, CAM/firm shoe 2-3 weeks. Jones = proximal shaft, risk separation, consider ORIF at 2 week review, CAM for 8 weeks. Shaft - 4-6 weeks CAM, refer if angulated.
What is a lisfranc fracture? How, where and risks, management.
Injury to tarsometatarsal joint complex, displacement of MTs often bw 1st and 2nd. From fall or foot in stirrup. Bruising to arch of foot. Risk OA, disability. Ortho review.
How do achilles, tibialis posterior, flexor hallucis tendinopathies present and manage? Sx/mx of tarsal tunnel syndrome.
A: rest, physio, PRN NSAID. TP: rupture causes flat foot, too many toes, diff heel raise. FHL worse in bending toe.TTS: burning/tingling sole of foot/toes, use orthotics, steroid, surgery.
How are forearm greenstick fractures managed in kids?
Closed reduction - above elbow cast for 6 weeks, review in 1 week. Accept 10-15 degrees angulation (more in young).
How are buckle radial fractures managed in kids?
Heal well, below elbow backslab or removable splint 3 weeks. No sport for 6 weeks. If ulna or cortex of bone involved, dw ortho.
What is a pulled elbow? How is it managed?
Toddler with partial subluxation of radial head. Rotation hurts. Apply pressure to radial head, fully pronate arm then flex elbow. Resolve in 10min.
What 2 lines are drawn in relation to the capitellum? What are they used for?
Anterior humeral line on lateral xray - normal thru middle of capitellum. If anterior or missing, supracondylar fracture displaced posteriorly. Radiocapitellar line - radial shaft + centre of cap, for radial head displacement w ulna fracture (Monteggia fracture dislocation), risk delay + radial nerve injury.
What is a Galeazzi fracture dislocation?
Distal 3rd of radius fracture with dislocated distal radioulnar joint.
Osgood-schlatter - cause, management, prognosis.
Traction apophysitis from overuse, worse w running/jumping. Self limiting, relative rest w flexible load management, strengthen and stretch quads + hamstrings, PRN cold packs/knee brace/NSAIDs. Can last 2 years.
SUFE - risk factors, signs, types, investigations and management, risks.
Age 8-17 M>F, 20% bilateral. RF: obesity, hypothyroid, radiation/chemo. Can be acute or chronic - 3 weeks (80%). Obligatory external rotation of hip when flexed, klein line goes above femoral head. Avoid frog leg xray acute. Urgent ED and NWB, risk OA, necrosis, FAI.
Legg-Calve-Perthes disease: age, cause, investigation, management.
Male, age 5-8, can be bilateral. Idiopathic AVN of hip. X-ray may be normal early, can do bone scan or MRI. NWB, early ortho for splint or surgery. 1/3 get arthritis later.
How are genu valgum and genu varum assessed? When do you refer?
Knocked knees, normal age 3-5 + falling over. Concern if >8yo, >8cm intermalleolar distance, assymetric/progressive or painful. Bow legs - normal age 2-3, possible rickets. Concern if >6cm intercondylar distance, assymetric or not resolved by 3yo.
Growing pains - presentation, management.
Generalised leg pains, burning/aching, often at night. May disrupt sleep, worse after activity. No systemic symptoms. Massage, heat pack, stretching may help.
What is sever’s disease? How is it managed?
Calcaneal apophysitis, active kids 10yo. Elevate heels w gel heel pads and restrict strenuous sport for 3mo, calf exercises, PRN ice and NSAIDs. May take 6-12mo.
What is a toddler’s fracture? How is it managed?
1-3yo, minimally displaced spiral fracture of tibia w intact periosteum. Femur - abuse. From stress of walking/twisting. Supportive treatment, can backslab or walking cast, # review in 2 weeks.
What are salter-harris fractures? Classification and management.
Fracture near growth plate. SALTR: slip, above II, lower III, through IV, rammed/compression. Type II (above - in shaft) common. If in epiphysis or through, needs surgery.
How is cervical radiculopathy and whiplash managed?
Similar to lumbar - check weakness, red flags. Trial 6-8 weeks, analgesia physio, rest, steroid. W: image according to c-spine rules. Do postural modification, early mobilisation, consider physio and CBT if >3 weeks.
What are the nexus criteria for c-spine imaging? What high risk factors for canadian rules need imaging?
Midline tenderness, altered mental state, focal neuro deficit, intoxication, distracting injury. CCR: age >65, dangerous mechanism, limb paraesthesia.
What are 2 elbow tendinopathies? How are they managed?
Lateral epidoncylar = tennis, extensor overload. Medial epicondylar = golfer, flexors. Self limit in 1 year, analgesia modified activity, exercise.
What are causes for olecranon bursitis? How is it managed?
Prolonged pressure, overuse, gout/pseudogout, RA, infection, bleed, trauma. NSAID, compression, avoid use. Consider apiration or steroid injection.
Plantar fasciitis - differentials, feature, mx.
Calcaneal stress fracture, fat pad syndrome. Pain 1st morning or end of day. Avoid flat shoes (orthotic, heel cup), strength and stretch calf w physio/podiatry, massage/ice after use, short term NSAID, rest, steroid inject after 3-4 weeks.
Osteoid osteoma - features, symptoms, mx.
Benign radiolucent nidus, in teens. Often femur. Can cause pain at night. Responds to NSAIDs, can resolve or be removed.
How is a monkey muscle tear and chronic compartment syndrome present and managed?
Plantaris - acute pain, RICE and firm bandage to compress then movement. CCS: pain/firm/warm and even weak w exercise, normal at rest. Consider fasciotomy.
What are the features of patellofemoral pain syndrome - triggers, risk factors, cause.
Pain behind kneecap, worse upstairs or downslope or prolonged sitting. Obesity risk, weak quads or tight hamstring. Chondromalacia patellae - ragged cartilage behind knee cap.
What are Lachman’s and McMurray’s tests?
L: hold knee 15-30 degree flex, pull tibia forward - for ACL. M: Hold knee joint lines and heel, passively flex and extend knee with tibia internally and externally rotated. For Meniscal injury.
What is greater trochanteric pain syndrome?
From glute med/minimus tendons, lateral hip pain. Female, obese OA. Pain to greater trochanter and lying on hip. Improve strength, avoid leg crossing, steroid inject.
What are MSK causes of shoulder pain?
7
Rotator cuff tear/tendinopathy; adhesive capsulitis; subacromial bursitis; biceps tendinopathy/rupture; AC injury/OA; glenoid labrum tear. Glenohumeral OA - rare.
What tests are used for biceps tendon, supraspinatus, subscapularis and impingement?
Full can, empty can, lift off (gerbers), hawkins kennedy.
Features and treatment of glenoid labrum tears and adhesive capsulitis.
Eg. SLAP - throwing/jerking injury, clicking, apprehension test positive. Need MRI + ortho. AC: self limit in 2-3 years, painful then stiff. Analgesia, steroids, hydrodilatation can help.
What conditions are associated with carpal tunnel syndrome?
Idiopathic, acromegaly, diabetes, hypothyroid, pregnancy, RA, gout, repetitive work. C6 radiculopathy can mimic.
How is a mallet finger managed? What is a jersey finger?
Splint DIP in extension 6 weeks fully, then 6 weeks night. Surgery if subluxed phalanx or avulsion >30% surface. Jersey finger is from sudden hyperextension, affects flexor tendon. Surgery if torn.
What should be checked if pseudogout is diagnosed? How is it managed?
CMP, ALP, PTH, iron studies (assoc HH and hyperparathyroid). Steroid injection, NSAIDs, colchicine.
What are the causes of an inflammatory and non-inflammatory joint effusion?
WCC >2000. Septic, gout, pseudogout, RA, SLE. Non-inflam: OA, trauma, charcot, haemachromatosis.
