MSK Flashcards
What are the features of adhesive capsulitis?
symptoms develop over a few days. frozen shoulder. external rotation worse, both active and passive movement, painful phase, freezing phase, recovery phase, usually lasts between 6 months and 2 years
What are the features of trochanteric bursitis?
Pain over the lateral side of the hip
Tenderness on palpation on the greater trochanter
When should you reassess fracture risk in patients on alendronate?
After 5 years of treatment
If someone has a high FRAX score, what is the next step?
DEXA scan
What is the definition of reactive arthritis?
Arthritis that develops following an infection where no organism can be recovered from the joint
What is the management of reactive athritis?
symptomatic: NSAIDS, intra-articular steroids
sulfasalazine and methotrexate if persistant
usually lasts less than 12 months
What is the classical triad of reactive athritis?
Cant see, cant pee, cant climb a tree
What is found in the synovial fluid of someone with reactive athritis?
sterile synovial fluid with a high white cell count
Which type of arthritis has bouchards and heberdens nodes?
Osteoarthritis
Are bouchards and heberdens nodes painful?
No
What are the features of spinal stenosis?
gradual onset, unilateral/bilateral leg and back pain, numbness and weakness, worse on walking, resolves on sitting/crouching
What are the features of ankylosing spondylitis?
lower back pain and stiffness, worse in the morning and improved by exercise, peripheral arthritis
What are the features of facet joint pain?
pain worse in the morning and on standing, pain over facets. usually worse on extension of the back.
What is a positive straight leg raise?
Pain on raising leg from lying - sciatic nerve pain
What are the features of venous ulcers?
brown pigmentation, lipodermatosclerosis (champagne bottle legs), eczema, painless, usually above the ankle
What are the features of arterial ulcers?
occur on toes and heel, deep, punched-out appearance, painful, cold, low pulses
What are the features of neuropathic ulcers?
over plantar surface of metatarsal head and plantar surface of hallux, due to pressure, usually in diabetics
What is the management of an extracapsular hip fracture?
Intertrochanteric - dynamic hip screw
other extracapsular - intramedullary device
What is the management of an undisplaced intracapsular hip fracture?
internal fixation or hemiarthroplasty if unfit
What is the management of a displaced intracapsular hip fracture?
arthroplasty (hemiarthroplasty if unfit)
After how many years of bisphosphonates should you re-assess FRAX and DEXA?
Five years for oral bisphosphonates
three years for IV
What can cause avascular necrosis of the hip?
long-term steroids, chemo, alcohol, trauma
What are the features of trochanteric bursitis?
Lateral hip/thigh pain over greater trochanter, usually worse when lying on side, older women
What are the features of compartment syndrome?
Pain on movement even passive, parasthesia, pallor, arterial pulsation
commonly supracondylar and tibial shaft fractures
What is the most commonly affected joint in septic arthritis?
knee
What organism most commonly causes septic arthritis?
staphylococcus aureus (or gonorrhoeae in young adults)
What is the management of septic arthritis?
flucloxacillin or clindamycin if pen allergic (IV 2 weeks then oral 2 weeks)
needle aspiration to decompress joint
What is chondrocalcinosis and when is this seen?
linear calcifications of the meniscus and articular cartilage - seen in pseudogout
What are the features of De Quervain’s tenosynovitis?
inflammation of sheath of extensor pollicis brevis and abductor pollicis longus tendon
- causes radial wrist pain, usually middle-aged women
Finkelstein’s test (adduct and flex thumb, radial wrist hurts)
How do you manage an open fracture?
- debridement
- external fixation after soft tissue healing
- IV broad spectrum Abx
What are the features of osteomalacia?
bone pain, tenderness and proximal myopathy (waddling gait)
low Calcium, low phosphate, raised ALP, raised PTH
Which muscles do which parts of arm abduction?
Supraspinatus (0-15)
Deltoid (15-90)
Trapezius (the rest)
What is the painful arc?
60-120 degrees - due to supraspinatus impingement
What must you do when starting allopurinol?
Give colchicine cover for up to 6 months
What is the difference in presentation between an anterior and posterior hip dislocation?
posterior - leg shortened, adducted, and internally rotated
anterior - abducted and externally rotated
How do you diagnose a DVT?
- Wells score <= 1 - D dimer, if +ve then doppler US
- Wells score >2 Doppler US
What condition causes an isolated raise in ALP?
Paget’s disease
What is paget’s disease and it’s management?
Increased but uncontrolled bone turnover
Mx: bisphosphonates
What are the features of iliotibial band syndrome?
Tenderness on the lateral knee, usually in runners
What is the management of a proximal scaphoid fracture?
surgical fixation
What are the features of subclavian steal syndrome?
Dizziness and vertigo during exertion of arm - due to stenosis of subclavian artery, causing flow reversal from vertebral artery
What are the ottowa rules for doing an ankle X-Ray?
- inability to walk 4 steps
- bony tenderness around either of the malleoli
Which compartments of the leg are innervated by which nerves?
Anterior: deep peroneal nerve
Lateral: superficial peroneal nerve
posterior: tibial nerve
What diagnosis causes a positive Simmond’s sign?
Achilles tendon rupture
What are the features of Paget’s disease of the bone?
A disease of increased but uncontrolled bone turnover. Effects long bones and axial bones. Isolated raised ALP. Treat with bisphosphonates if symptomatic
What is the first line management of ankylosing spondylitis?
Physiotherapy and NSAIDs
Which foot bone is the most common site of stress fractures?
The second metatarsal
What is the management of osteomyelitis?
Flucloxacillin for 6 weeks
What are the clinical features of a fat embolism?
Recent injury
Resp: early tachycardia, pyrexia, hypoxia
derm: petechial rash
CNS: confusion and agitation
What is the first line investigation for suspected osteomyelitis?
MRI
What is meralgia parasthetica?
Thigh pain - paraesthesia or anaesthesia in distribution of the lateral femoral cutaneous nerve due to entrapment. pain on palpation
RF: obesity, pregnancy, trauma, sports
What are the features of osteochondritis dissecans?
Usually in young adults, knee pain and swelling after exercise, knee locking or giving way, pain on femoral condyles, joint effusion
How do you diagnose osteochondritis dissecans?
X-Ray subchondral crescent sign or loose bodies
MRI
How do you differentiate a neck of femur fracture from a hip dislocation?
NOF - shortened and externally rotated
Posterior dislocation - shortened and internally rotated
Anterior dislocation - abducted and externally rotated
What investigation can you use to diagnose ankylosing spondylitis?
Pelvic X-Ray to identify sacro-iliitis
What is angulation in a fracture?
the amount of deviation from the normal angle of the distal and proximal fragments
What is displacement in a fracture?
misalignment of the fragments, represents the distance the distal fracture fragment is from the proximal fragment
Why does a hip fracture cause an external rotation and shortening?
Psoas muscle attaches to the lesser trochanter, and pulls it in and externally rotates.
What is worse an intra or extracapsular fracture?
intra - due to the blood supply - more likely to get avascular necrosis
What is a Colles fracture?
distal radius fracture with dorsal displacement
What is a Smith’s fracture?
distal radius fracture with volar displacement
What are Galeazzi and Monteggia fractures?
GRUsome MURder
Galeazzi - radial fracture, ulnar dislocation
Monteggia - ulnar fracture, radial dislocation
What is a Bennet’s fracture?
Base of metacarpal fracture
What is the first line antibiotic for septic arthritis?
flucloxacillin
(clindamycin if penicillin allergic) - give for 4-6 weeks
What are the features of osteoarthritis?
Usually one joint affected at a time, DIPs and CMC, stiffness after inactivity, shorter morning stiffness, Heberden’s and bouchard’s nodes, squaring of thumb
How long should fatigue be present to diagnose CFS?
3 months
What are the features of L3 nerve root compression?
sensory loss over anterior thigh, Weak hip flexion, knee extension and hip adduction,
Reduced knee reflex,
Positive femoral stretch test
What are the features of L4 nerve root compression?
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
What are the features of L5 nerve root compression?
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
What are the features of S1 nerve compression?
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
What is paget’s disease?
Abnormal bone turnover, increased osteoclast and blast activity, raised ALP
What is the management of Paget’s disease?
Bisphosphonates
What do the salter-harris fracture types for growth plate fractures mean?
1-5
1 is best prognosis
1 is through physis, 2 metaphysis too, 3 epi and physis, 4 all three, 5 is crush fracture of growth plate
5 is worst
What are the features of osteogenesis imperfecta?
lack of collagen in bones or poor quality, translucent bones, multiple fractures
Which antibodies are commonly found in those with rheumatoid arthritis?
Anti-CCP
RF
Which biologics inhibit B cells and which T cells?
B cells - rituximaB
T cells - abatercepT
Which biologics inhibit TNF alpha?
etanercept
infliximab
What is the first line management of RA?
NSAIDS/steroids in acute flare.
methotrexate (not if pregnant - give hydroxychloroquinine or sulfasalazine)
What are the features of rheumatoid arthritis?
symmetrical progressive destruction of more than three joints, over more than 6 weeks. Morning stiffness > 30 mins.
What is the Simmonds’ triad?
examinations to assess achilles tendon rupture. squeeze calf test, observation of angle of declination, palpation of the tendon
Which imaging modality should be used to assess achilles tendon rupture?
Ultrasound
In a patient with discitis, what should be investigated?
Echo - to look for infective endocarditis
How do you diagnose discitis?
MRI, can do CT guided biopsy to determine anti-microbials
What is the first and second line management of OA?
1st - topical NSAIDS
2nd - oral NSAIDS
When do you measure uric acid levels in gout?
If gout is suspected, and if it is normal, repeat 2 weeks after symptoms resolve
Which is tennis elbow and which is golfers?
Tennis - lateral epicondylitis
Golfers - medial
What is the management of reactive athritis?
NSAIDs, if not recovering give methotrexate
Treat underlying cause
What type of analgesia is commonly used for people with severe pain with a NOF fracture?
iliofascial nerve block
What investigation should be done for osteomyelitis?
MRI
What is the difference between hip fractures and hip dislocations on examination?
Hip fracture: leg shortened, externally rotated
Posterior dislocation: Leg shortened, internally rotated
Anterior dislocation: leg lengthened, externally rotated
When do you refer for sciatica?
After 4-6 weeks of NSAIDs and physiotherapy do not help
What is the difference between an L5 and S1 nerve root compression?
Big Toe; Largest of 5 = L5, Little Toe; Smallest 1 = S1.
S1 loss of ankle jerk reflex
No loss of reflex on L5
Which scoring system is used to assess disease activity in rheumatoid arthritis?
DAS28
Should you move joints in osteoarthritis?
Yes, and in rheumatoid
