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.
