MSK Flashcards
What are the red flags in back pain?
Significant trauma related to age (significant fall/MVA in young patient, or
minor fall / heavy lifting in a patient with osteoporosis)
* Major or progressive motor or sensory deficit
* Bowel or bladder incontinence or urinary retention
* Loss of anal sphincter tone
* Saddle anesthesia
* History of cancer metastatic to bone
* Suspected spinal infection.
Name some differences with mechanical pain and inflammatory pain
Mechanical
Morning stiffness <15 minutes
Worse with certain activities
Onset – injury
Fluctuating symptoms
Overuse is a risk factor
Inflammatory
Morning stiffness >1hour
Better with movement
Onset – insidious
Progressive
Typically, younger patients
What is ankalosing spondalyitis?
Ankylosing spondylitis (AS) is a type of arthritis that causes inflammation in certain parts of the spine. Ankylosing means stiff or rigid. Spondyl means spine. Itis refers to inflammation. The disease causes inflammation of the spine and large joints, resulting in stiffness and pain.
Ankylosing spondylitis, also known as axial spondyloarthritis, is an inflammatory disease that, over time, can cause some of the bones in the spine, called vertebrae, to fuse. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply
What is the difference between SCFE and LCP?
SCFE
Occurs between 10-15
Children tend to be overweight
Displacement of femoral neck
Treatment primarily operative
LCP
Occurs between 4-8
Children tend to be shorter
Deformity of femoral head
Treatment primarily conservative
What are some risk factors for childern on babies with DDH?
First born girls,
breech baby, oligohydramnios,
Family history
What special tests are done in a meniscal injury
Apleys test
Mcmuray test
What special tests are done if you suspect cruciate injury?
Anterior draw test
Posterior draw test
what is the difference between a strain and a sprain?
Sprain – injury to ligament. Strain – injury to tendon
what is the most common strain or sprain?
inversion ankle sprain, where excessive plantar
flexion and supination cause the anterior talofibular
ligament (ATF) to be affected.
Describe a colles fracture
Fracture of the distal radius with dorsal displacement of wrist
The fracture is classically caused by a fall onto an outstretched hand
(FOOSH injury). The elderly and the osteoporotic are especially at risk
Describe Smiths fracture
A Smith’s fracture, also sometimes known as a reverse Colles’ fracture is a
fracture of the distal radius caused by falling onto flexed wrists, as
opposed to a Colles’ fracture which occurs as a result of falling onto wrists
in extension.
What is carpal tunnel syndrome and what are possible causes of it?
Median nerve runs through the carpal tunnel, so when the tunnel is
swollen/inflamed, the median nerve is affected. Symptoms come
from compression of the median nerve.
Causes: fluid retention – this can affect women during pregnancy or
can be related to menses, hypothyroidism, diabetes, overuse
What is the treatment for carpal tunnel syndrome?
NSAID’s
Splints
(Steroid injection)
Surgical decompression
What is fibromylagia?
Fibromyalgia is a condition that causes widespread pain and extreme tiredness.
What is the treatment for septic arthritis?
you will aspirate the native join before starting antibiotics. Then they will normally be started on antibiotics usually vancomycin
What are some odf the symptoms of osteomyelitis?
Non specific pain
fever
Malasie
Inflammation
Swelling
What investigation are needed to be carried out for suspected osteomyelitis?
WBC (inc), CRP&ESR (inc), xray
What is compartment syndrome?
Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.
What is the management for back pain?
Patient education, NSAIDs, paracetamol, muscle relaxants
* Bed rest should be avoided if possible
What relieve pain in ankolosing spondilytis?
Exercise
What is the treatment for ankolosing spondilytis
1) Treated with NSAIDs (1st line),
2) steroid injections.
3)Disease Modifying Anti-rheumatic drugs (DMARDs) – methotrexate
– only if they have other joint symptoms. Not proven for back pain
alone.
A patient comes in with unilateral leg pain and also has back pain, but the leg pain is worse. The pain radiate to the toes, foot and also complains about numbness in those areas. There has be changes to his motor and sensory movement and changes to his reflexes.
Disc herniation- compression of the spinal nerves caused by the the herniated disc
What is the treatment of scoloisis?
IT is the depend on the severity
<20deg exercise and
monitoring
21-45 bracing
>45 surgery
What is AVN and how is it treated?
AVN is avascular necrosis and this is the loss of blood supply to the fermoral head. It presents with pain in the groin and leg that is not relived by anagelsia. The treatment is total hip replacement. If the patient has been complaining about pain in the groin for 6 weeks and the scans are normal refer to othor and get an MRI (hip)
What are the risk factors for development hip dysplasia?
First born girls
Breech babies
oligohydramnios
FMHx
What tests are done to test for development hip dysplasia?
Ortolani and Barlow tests are done prior to 6 months (they are best when done
<3months old).
Describe Trochanteric bursitis
Localised pinpoint tenderness on outside of the hip. Not as much pain in
the groin.
Pain – flexion extension, rotation and abduction
Pain down the thigh
No classical swelling that you see in other bursitis (olecranon,
prepatellar)
What are the special tests used to test foe meniscal injury?
McMurrray and Apley
What are the Ottawa rules?
Bony tenderness along distal 6 cm of the posterior edge of fibula or tip of lateral malleolus
Bony tenderness along distal 6 cm of the posterior edge of tibia/tip of medial malleolus
Bony tenderness at the base of the 5th metatarsal
Bony tenderness at the navicular
Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
What test is used to test for achilles tendon injury?
Thomptons test/simmions test
What are RFs for Dupetyren contrature?
Men
40-60 yrs
Diabetes
Smokers
What is the treatment of trigger finger?
Symptoms less than 3 months: inject
Steroid injection within tendon sheath
Hand therapy for tendon gliding
repeat once in 2-4 wks
*3 months + of symptoms:
Injection versus surgical referral for release
What is trigger finger?
Trigger finger is caused by swelling affecting one of the tendons in your fingers or thumb.In this condition, a finger gets stuck in a bent position and may straighten suddenly with a snap.
What nerve runs through the carpal tunnel?
Median nerve
What adhesive capsulitis?
It is also known as a frozen shoulder,it is a slow progressive loss of active and passive ROM because of chronic fibrosis
What is the treatment for a frozen shoulder?
Physio & NSAID
IA steriod injection
What are the risk factors for adhesive capsulitis?
women
40-70
DM
thyroid disease
prior to shoulder surgery
shoulder injury
What nerve can be affected in an anterior dislocation?
axillary nerve
