MSK Flashcards
What do we use the McMurray test for?
The McMurray test, also known as the McMurray circumduction test is used to evaluate individuals for tears in the meniscus of the knee.
How does JIA present?
For a diagnosis to be made the child must have had objective arthritis in the joint for at least 6 weeks. There may be stiffness on waking or after periods of inactivity. In certain sub-types the child may have a spiking fever, a salmon-coloured rash over the trunk and proximal extremities, uveitis, and rheumatoid nodules on extensor surfaces of tendons.
What is Felty syndrome?
Felty syndrome is a rare autoimmune disease that occurs in less than 1% of people with rheumatoid arthritis (RA).
How does Felty syndrome present?
Rheumatoid arthritis: An autoimmune condition that causes painful, swollen, and stiff joints
Splenomegaly: An enlarged spleen
Neutropenia: A low white blood cell count (and thrombocytopenia)
What is the flexor pollicis longus?
Muscle in the forearm and the hand which flexes the thumb
How does dislocation of the patella present?
Dislocation of the patella is most common in adolescents girls.
The patella usually dislocates laterally and there may be an associated osteochondral fracture.
Presents with knee pain and the knee is held in flexion with lateral displacement of the patella.
How does ACL injury present?
An audible pop often accompanies ACL injury.
* Within a few hours, a large haemarthrosis develops.
* In the absence of bony trauma, an immediate effusion is believed to have a 70% correlation with an ACL injury of some degree.
* The classic “terrible triad”
What does the ACL do?
Attaches the femur to the tibia
Which test do we use to dx ACL injury?
The Lachman test
How does patellar fracture present?
Pain
Overlying abrasions, ecchymosis over the anterior aspect of the knee, or both may be present.
There may be an associated haemarthrosis.
Displaced, transverse fractures result in an inability to straight leg raise (also a feature of rupture of quadriceps tendon or patellar tendon).
What is the Boutonniere deformity?
The Boutonniere deformity describes a fixed flexion deformity at the proximal interphalangeal (PIP) joint along with
hyperextension of the distal interphalangeal (DIP) joint of the finger.
What is the Z deformity?
Seen in RA
It is seen at the thumb and consists of hyperextension of the interphalangeal joint, & fixed flexion and subluxation of the metacarpophalangeal joint.
How does the back pain in ankylosing spondylitis present?
Improves with exercise - inflammatory
In which condition do you see the dinner fork deformity?
Colles’ fracture - dorsally displaced distal radius fracture
Seen in older patients who have fallen onto their outstretched hands
In which patients would you most likely see a supracondylar fracture
Children falling onto an outstretched hand
How does spinal stenosis present?
The classic presentation is radiating leg pain associated with walking that is relieved by rest (neurogenic claudication).
What is first-line for treating RA?
DMARD e.g. methotrexate
What is a Maisonneuve fracture?
The Maisonneuve fracture is a spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular sundesmosis and the interosseous membrane usually involvina a pronation-external rotation force. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament.
What is a March fracture?
Stress fracture of the metatarsals
Seen with excessive walking/running
What are the indications for a DEXA scan?
Patient <75y.o with a history of a low trauma fracture
Incidental x-ray finding of osteopenia or vertebral collapse or in the investigation of thoracic kyphosis or loss of height.
Postmenopausal women with a family history of a hip fracture.
Low BMI <19kg/m?
Long term steroid treatment
Oestrogen deficiency (e.g. premature menopause <45y.o. or primary hypogonadism)
How does tarsal tunnel syndrome present?
Tarsal tunnel syndrome (compression of the posterior tibial nerve as it passes underneath the flexor retinaculum behind the medial malleolus can produce the lower limb equivalent of carpal tunnel syndrome) and causes mid-foot pain.
How do scaphoid fractures present?
Clinically patients present with snuff box tenderness.
* In addition, look for tenderness over the palmar & dorsal aspect of the scaphoid, pain on compressing the thumb longitudinally and pain on gentle flexion & ulnar deviation of the wrist.
What is the function of the mental nerve?
The mental nerve is a sensory nerve which comes off the inferior alveolar nerve at about the level of the mandibular 2nd premolars, which then exits the mandible via the mental foramen supplying sensation to the chin & lower lip.
How does complex regional pain syndrome present?
It is typically characterised by segmental limb pain after a (usually) relatively minor injury to a limb but is more
severe and lasts much longer than would normally be expected given the injury.
What are the Ottawa knee rules
A knee x-ray series is only required for knee injury patients with any of these findings:
1. Age 55 years or older or
2. Isolated tenderness of patella* or
3. Tenderness at head of fibula
4. Inability to flex to 90 degrees or
5. Inability to bear weight both immediately and in the emergency department (4 steps)*
How does rotator cuff tear present?
On examination there may be a reduced range of motion, weakness or crepitus and tenderness over the cuff insertions & subacromial area.
* Supraspinatus strength is usually reduced (test by resistance to abduction).
* X ray may show bony avulsions.
When do we avoid giving colchicine?
- Blood disorders
- eGFR <10 (as colchicine is excreted by the kidneys)
- Severe hepatic impairment
- Pregnant or breastfeeding
- Taking P-glycoprotein inhibitors (1 colchicine levels) e.g. clarithromycin, erythromycin, verapamil; itraconazole, ketoconazole, anti-virals
Naproxen instead
How can we r/o septic arthritis OE?
The almost full range of motion in this patient would exclude a septic arthritis (& gout) which is associated with marked limitation of
both active and passive ranges of motion due to extreme pain.
How do we manage ? whiplash?
For all patients presenting with acute whiplash injury - exclude spinal cord compression &/or fracture/subluxation of the cervical vertebrae which if suspected, refer immediately to A&E.
Otherwise, reassurance
Which joints are most commonly affected in RA?
RA usually causes a symmetrical small joint polyarthritis in the hands, particularly affecting the metacarpophalangeal joints and sparing the distal interphalangeal joints.
How do calcaneal fractures present?
Patients with a fracture of the calcaneus may present with pain, oedema, ecchymosis, deformity of the heel or plantar arch, & an inability to bear weight on the injured foot.
- Pain when the heel of the patient’s foot is held in the palm of the hand and gently squeezed suggests calcaneal fracture.
What is the Mondor sign?
- Bruising that tracks distally to the sole of the foot is known as the Mondor sign and is pathognomonic for calcaneal fracture
How does Brown-Sequard syndrome present?
Ipsilateral loss of proprioception & motor function with contralateral loss of pain & temperature sensation often in the
cervical cord region.
How do we treat SUFE?
Surgery
What is a Pavlik harness used for?
Children with DDH
What is Morton’s neuroma?
Morton’s neuroma occurs as a result of irritation of an interdigital nerve by compression between metatarsal heads often in
tightly fitting footwear.
Where do you see anti-nuclear antibodies?
SLE
What is the most common cause of septic arthritis?
S aureus
What is spondylolisthesis?
The word spondylolisthesis is derived from the Greek words spondylo, meaning spine, and listhesis, meaning to slip or slide.
* Spondylolisthesis is a descriptive term referring to slippage (usually forward - see arrow) of a vertebra and the spine above
it relative to the vertebra below.
What is a Colles’ fracture?
dorsally displaced distal radius fracture.
What is Freiberg’s disease?
Freiberg’s disease is an osteochondrosis affecting the toes - the articular surfaces of the second or third metatarsal heads collapse.
How does Freiberg’s disease present?
It is commonest in girls aged 12-15 years.
* It causes pain on weight bearing & restricts physical activity.
* Rest & use of a metatarsal pad are usually sufficient treatment, but surgery is sometimes necessary.
What is the most common cause of sciatica?
Herniated intervertebral disc (‘slipped disc’) - 90% of cases. Most commonly L4/L5 & L5/S1.
What is the piriformis?
The piriformis is the small muscle that crosses the greater sciatic foramen, bisecting it into two spaces as the muscle passes from the edge of the sacrum to the greater trochanter.
* The sciatic nerve comes out of the greater sciatic foramen below the piriformis, & is liable to compression by the muscle.
How does piriformis muscle syndrome present?
Persistent and radiating low back pain, (chronic) buttock pain, numbness, paresthesia, difficulty with walking, and other functional activities.
Bicycle riding & running may also set off symptoms, which may take the form of chronic nagging ache, pain, tingling, or numbness.
Which antibodies are associated with limited cutaneous systemic sclerosis?
Limited cutaneous systemic sclerosis (CREST syndrome) presents with Calcinosis; Raynaud’s; Oesophageal dysmotility;
Sclerodactyly and Telangiectasia. It is associated with anti-nuclear and anti-centromere antibodies.
A 78-year-old woman slipped on some ice and fell on to her left outstretched hand. On examination, she has numbness over the inferior part of the deltoid muscle. An x-ray shows an anteriorly dislocated shoulder. Which nerve has most likely been affected?
Axiliary nerve
What are Smith’s fractures?
Smith fractures are uncommon fractures of the distal radius (<3% of all fractures of the radius & ulna).
Can be thought of as a “reverse Colles fracture”
What are Boxer’s fractures?
Boxers’ fractures are minimally comminuted, transverse fractures of the 5th metacarpal neck, and are the most common type of metacarpal fracture.
* Almost always a consequence of a direct blow with a clenched fist against a solid surface which causes axial loading of the 5th metacarpal.
