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1 - MSRA > MSK > Flashcards

MSK Flashcards

1
Q

Tennis elbow aka…

A

Lateral epicondylitis

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2
Q

Features of lateral epicondylitis

A
  • Pain and tenderness localised to lateral epicondyle
  • Pain on resisted wrist extension
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3
Q

Golfer’s elbow aka…

A

Medial epicondylitis

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4
Q

Features of medial epicondylitis

A
  • Pain and tenderness localised to medial epicondyle
  • Pain aggravated by wrist flexion and pronation
  • Symptoms may be accompanied by numbness/tingling in 4th and 5th finger due to ulnar nerve involvement
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5
Q

Features of radial tunnel syndrome

A
  • Pain 4-5cm distal to lateral epicondyle
  • Symptoms worsening by extending elbow and pronating forearm
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6
Q

Features of cubital tunnel syndrome

A
  • Initially intermittent tingling in 4th and 5th finger
  • May be worse when elbow resting on firm surface of flexed for extended periods
  • Later numbness in 4th and 5th fingers with associated weakness
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7
Q

Features of olecranon bursitis

A
  • Swelling over posterior aspect of elbow
  • Associated pain, warmth, and erythema
  • Typically middle aged patients
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8
Q

Where is intracapsular hip fracture

A

From edge of femoral head to insertion of capsule of hip joint

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9
Q

Where is extracapsular hip fracture

A

Trochanteric or subtrochanteric

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10
Q

Treatment of intracapsular hip fracture - undisplaced

A

Internal fixation, hemiarthroplasty if unfit

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11
Q

Treatment of intracapsular hip fracture - displaced

A

Replacement arhtroplasty (total or hemi)

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12
Q

Criteria for total hip replacement in displaced intracapsular fracture

A
  • Able to walk independently outdoors with no more than use of stick
  • Not cognitively impairment
  • Medically fit for anaesthetic and procedureT
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13
Q

Treatment of extracapsular hip fractures

A

If stable intertrochanetric, dynamic hip screw
If reverse oblique, transverse, or subtrochanetric - intramedullary device

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14
Q

Features of osteoarthritis of knee

A
  • Typically >50, often overweight
  • May be severe pain
  • Intermittent swelling
  • Crepitus
  • Limitation of movement
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15
Q

Clergymans knee aka…

A

Infrapatellar bursitis

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16
Q

Housemaids knee aka…

A

Prepatellar bursitis

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17
Q

ACL injury features

A
  • May be caused by twisting of knee, popping noise may be noted
  • Rapid onset of knee effusion
  • Positive draw test
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18
Q

PCL injury features

A

May be caused by anterior force applied to proximal tibia, e.g. knee hitting dashboard during car accident

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19
Q

Collateral ligament injury features

A
  • Tenderness over affected ligament
  • Knee effusion may be seen
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20
Q

Meniscal lesion features

A
  • May be caused by twisting of knee
  • Locking and giving way common feature
  • Tender joint line
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21
Q

L3 nerve root compression

A
  • Sensory loss over anterior thigh
  • Weak hip flexion, knee extension, and hip adduction
  • Reduced knee reflex
  • Positive femoral stretch test
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22
Q

L4 nerve root compression

A
  • Sensory loss anterior aspect of knee and medial malleolus
  • Weak knee extension and hip adduction
  • Reduced knee reflex
  • Positive femoral stretch test
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23
Q

L5 nerve root compression

A
  • Sensory loss dorsum of foot
  • Weakness in foot and big toe dorsiflexion
  • Reflexes in tact
  • Positive sciatic nerve stretch test
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24
Q

S1 nerve root compression

A
  • Sensory loss posterolateral aspect leg and lateral aspect of foot
  • Weakness in plantarflexion of foot
  • Reduced ankle reflex
  • Positive sciatic nerve stretch test
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25
Q

Roots of musculocutaneous nerve

A

C5-7

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26
Q

Motor function of musculocutaneous nerve

A

Elbow flexion (biceps brachii) and supination

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27
Q

Sensory function of musculocutaneous nerve

A

Lateral part of forearm

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28
Q

Mechanism of injury musculocutaneous nerve

A

Isolated injury rare, usually injured as part of brachial plexus injury

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29
Q

Roots of axillary nerve

A

C5-6

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30
Q

Motor function of axillary nerve

A

Shoulder abduction (deltoid muscle)

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31
Q

Sensory function of axillary nerve

A

Inferior region of deltoid muscle

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32
Q

Mechanism of injury of axillary nerve

A

Humeral neck fracture/dislocation

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33
Q

Clinical presentation of injury to axillary nerve

A

Flattened deltoid

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34
Q

Roots of radial nerve

A

C5-8

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35
Q

Motor function of radial nerve

A

Extension of forearm, wrist, fingers, and thumb

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36
Q

Sensory function of radial nerve

A

Small area between dorsal aspect of 1st and 2nd metacarpals

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37
Q

Mechanism of injury of radial nerve

A

Humeral midshaft fracture

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38
Q

Clinical presentation of injury to radial nerve

A

Wrist drop

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39
Q

Roots of median nerve

A

C6, C8, T1

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40
Q

Motor function of median nerve

A

LOAF muscles

Lateral two lumbricals
Opponens pollis
Abductor pollis brevis
Flexor pollis brevis

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41
Q

Clinical features of median nerve lesion at wrist

A

Paralysis of thenar muscles, oppenens pollicis (carpal tunnel syndrome)

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42
Q

Clinical features of median nerve lesion at elbow

A

Loss of pronation of forearm and weak wrist flexionS

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43
Q

Sensory function of median nerve

A

Palmar aspect of lateral 3 1/2 fingers

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44
Q

Roots of ulnar nerve

A

C8, T1

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45
Q

Motor function of ulnar nerve

A

Intrinsic hand muscle except LOAF
Wrist flexion

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46
Q

Sensory function of ulnar nerve

A

Medial 1 1/2 fingers

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47
Q

Mechanism of injury of ulnar nerve

A

Medial epicondyle fracture

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48
Q

Clinical presentation of ulnar nerve lesion

A

Claw hand

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49
Q

Roots of long thoracic nerve

A

C5-7

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50
Q

Motor function of long thoracic nerve

A

Serratus anterior

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51
Q

Mechanism of injury of long serratus nerve

A

Often during sport, e.g. following blow to ribs
Complication of mastectomy

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52
Q

Clinical presentation of damage to long thoracic nerve

A

Winged scapula

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53
Q

Roots injured in Erb-Duchenne palsy

A

Damage to upper trunk of brachial plexus - C5-6

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54
Q

Cause of Erb-Duchenne palsy

A

Shoulder dystocia

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55
Q

Presentation of Erb-Duchenne palsy

A

Arm hands by side, internally rotation, elbow extended

56
Q

Roots injured in Klumpke palsy

A

Lower trunk of brachial plexus C8, T1

57
Q

Cause of Klumpke palsy

A
  • Shoulder dystocia
  • Sudden upward jerk of hand
58
Q

X ray changes in osteoarthritis

A
  • Loss of joint space
  • Osteophytes forming at joint margins
  • Subchondral sclerosis
  • Subchondral cysts
59
Q

Ankle reflex nerve roots

A

S1-2

60
Q

Knee reflex nerve roots

A

L3-4

61
Q

Biceps reflex nerve roots

A

C5-6

62
Q

Triceps reflex nerve roots

A

C7-8T

63
Q

Tinels sign

A

Tapping cause paraesthesia

64
Q

Phalens sign

A

Flexion of wrist causes symptoms

65
Q

Ottawa rules

A

Ankle x-ray only required if pain in malleolar zone and any of following:
- Bony tenderness at lateral or medial malleolar zone
- Inability to walk 4 weight-bearing steps immediately after the injury and in the emergency department

66
Q

Risk factors Achilles tendon disorders

A

Quinolone use, e.g. ciprofloxacin
Hypercholesterolaemia (tendon xanthomata)

67
Q

Features of achilles tendinopathy

A

Gradal onset posterior heel pain, worse following activity
Morning pain and stiffness

68
Q

Features achilles tendon rupture

A
  • Audible pop in ankle
  • Sudden onset significant pain in calf or ankle
  • Inability to walk/continue sport
69
Q

Examination features of achilles tendon rupture

A
  • Greater dorsiflexion of injured foot compared to uninjured limb when patient lies prone with feet over edge of bed
  • Gap in Achilles tendon
  • When calf muscle squeezed, injured foot stays in neutral position
70
Q

Imaging modality suspected Achilles tendon rupture

A

Ultrasound

71
Q

Features adhesive capsulitis

A

External rotation affected more than internal rotation or abduction
Both active and passive movement affected

72
Q

What is Boxer fracture

A

Minimally displaced fracture of 5th metacarpal

73
Q

What is Buckle fracture

A

Incomplete fractures of the shaft of the long bone, characterised by bulging of the cortex

74
Q

Symptoms carpal tunnel syndrome

A

Pain/pins and needles in thumb, index, and middle finger
Shaking hand obtains relief, classically at night

75
Q

Examination findings carpal tunnel syndrome

A

Weakness of thumb abduction
Wasting of thenar eminence (NOT hypothenar)
Tinels sign - tapping causing paresthesia
Phalens sign - flexion of wrist causes symptoms

76
Q

Treatment carpal tunnel syndrome

A

6 week trial of conservative treatment if symptoms are mild-moderate:
- Corticosteroid injection
- Wrist splints at night

If severe or persistent symptoms, surgical decompression (flexor retinaculum division)

77
Q

What is De Quervain’s tenosynovitis

A

Condition where sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed

78
Q

Features De Quervain’s tenosynovitis

A
  • Pain on radial side of wrist
  • Tenderness over radial styloid process
  • Abduction of the thumb against resistance is painful
  • Positive Finkelstein’s test
79
Q

What is Finkelstein’s test

A

Examiner pulls thumb of the patient in ulnar deviation and longitudinal traction - if positive, this causes pain over radial styloid process and along the length of extensor pollicis brevis and abductor pollicis longus

80
Q

Most common bacterial cause discitis

A

Staphylococcus aureus

81
Q

Investigations discitis

A
  • MRI
  • CT guided biopsy for antimicrobial treatment
  • Echo to r/o endocarditis (discitis usually due to haematogenous seeding)
82
Q

Features of posterior hip dislocation

A

Affected leg shortened, adducted, and internally rotated

83
Q

Features of anterior hip dislocation

A

Affected leg abducted and externally rotated, no leg shortening

84
Q

Who is iliotibial band syndrome common in

A

Runners (1 in 10 people who run regularly)

85
Q

Features of iliotibial band syndrome

A

Tenderness 2-3cm above the lateral joint line of knee

86
Q

Mechanism of injury ruptured ACL

A

Sport injury - high twisting force applied to bent knee

87
Q

Presentation ruptured ACL

A
  • Loud crack
  • Pain
  • Rapid joint swelling (haemarthrosis)
88
Q

Management ruptured ACL

A

Intense physiotherapy or surgery

89
Q

Mechanism of injury ruptured PCL

A

Hyperextension injuries

90
Q

Mechanism of injury ruptured MCL

A

Leg forced into valgus via force outside the leg

91
Q

Examination findings ruptured MCL

A

Knee unstable when put into valgus position

92
Q

Mechanism of injury menisceal tear

A

Rotational sporting injuries

93
Q

Features menisceal tear

A

Delayed knee swelling
Joint locking
Recurrent episodes of pain and effusion following minor trauma

94
Q

Demographic chondromalacia patellae

A

Teenage girls

95
Q

Features chondromalacia patallae

A

Pain going downstairs or at rest
Quadriceps wasting

96
Q

Mechanism of injury patella dislocation

A

Direct trauma or severe contraction of quadriceps with knee stretched in valgus and external rotation

97
Q

Types of patella fracture

A

Direct blow to patella causing undisplaced fragments
Avulsion fracture

98
Q

Features lumbar spinal stenosis

A
  • Back pain
  • Neuropathic pain
99
Q

Lumbar spinal stenosis vs claudication

A

In lumbar spinal stenosis, sitting is better than standing, and easier walking uphill than downhill

100
Q

What is meralgia paraesthetica

A

Syndrome of paraesthesia and anaesthesia in distribution of lateral femoral cutaneous nerve

101
Q

Risk factors meralgia paraesthetica

A

Obesity
Pregnancy
Tense ascites
Trauma
Iatrogenic
Sports
Idiopathic

102
Q

Iatrogenic causes of meralgia paraesthetica

A
  • Pelvic osteotomy
  • Spinal surgeries
  • Laparoscopic hernia repair
  • Bariatric surgery
  • Abduction splints used in management of Perthes disease
103
Q

Symptoms meralgia paraesthetica

A

Symptoms in upper lateral aspect of thigh:
- Burning, tingling, coldness, shooting pain
- Numbness
- Deep muscle ache

Aggravated by standing, relieved by sitting

104
Q

Signs meralgia paraesthetica

A
  • Symptoms may be reproduced by deep palpation just below ASIS and extension of hip
  • Altered sensation over the upper lateral aspect of thigh
  • Motor weakness
105
Q

Investigations meralgia paraesthetica

A

Pelvic compression test highly sensitive - diagnosed based on this alone
Injection of nerve with local anaesthetic abolish pain

106
Q

Advice to minimise risk of dislocation after hip replacement

A
  • Avoid flexing hip >90 degrees
  • Avoid low chairs
  • Do not cross legs
  • Sleep on back for first 6 weeks
107
Q

Types of osteomyelitis

A

Haematogenous - from bacteraemia
Non-haematogenous.- from contiguous spread of infection from adjacent soft tissues to bone, or direct injury/trauma to bone

108
Q

Most common site of haematogenous osteomyelitis in adults

A

Vertebral

109
Q

Risk factors haematogenous osteomyelitis

A

Sickle cell anaemia
IV drug user
Immunosuppression
Infective endocarditis

Most common form in children

110
Q

Risk factors non-haematogenous osteomyelitis

A

Diabetic foot ulcers/pressure sores
Diabetes mellitus
Peripheral arterial disease

111
Q

Most common organism osteomyelitis

A

Staph aureus

112
Q

Most common organism osteomyelitis in sickle cell

A

Salmonella

113
Q

Treatment osteomyelitis

A

Fluclox 6 weeks

Clindamycin if pen allergic

114
Q

When should DEXA scan be offered without risk score

A

> 50 with history of fragility fracture
<40 with major risk factors

115
Q

Interpretation of QFracture score

A

If 10 year fracture risk ≥10%, arrange DEXA scan

116
Q

Interpretation of FRAX score

A

Colour risk given
Patients in orange zone should have DEXA scan to further refine 10 year risk
Patients in red zone should have DEXA scan to act as baseline and guide drug treatment

117
Q

Features rotator cuff injury

A

Shoulder pain worse on abduction
Painful arc of abduction
Tenderness over anterior acromion

118
Q

Subacromial impingement painful arc degrees

A

60-120

119
Q

Rotator cuff tears painful arc degrees

A

First 60

120
Q

Blood supply scaphoid

A

Dorsal carpal branch (branch of radial artery) in retrograde manner

121
Q

Associations with talipes

A

Most commonly idiopathic

Spina bifida
Cerebral palsy
Edward’s syndrome
Oligohydraminos
Arthrogryposis

122
Q

Features trigger finger

A

More common thumb, middle, or ring finger
Initially stiffness and snapping when extending a flexed digit
Nodule may be felt at base of affected finger

123
Q

Treatment trigger finger

A

Steroid injection successful in majority of patients, finger splint may be applied afterwards
Surgery for patients non responsive to steroids

124
Q

Mechanism of injury Colles fracture

A

FOSH

125
Q

Features of Colles fractures

A
  • Transverse fracture of radius
  • 1 inch proximal to radio-carpal joint
  • Dorsal displacement and angulation
126
Q

Mechanism of injury Smith’s fracture

A

Falling backwards onto palm of outstretched hand, or falling with wrists flexed

127
Q

Features Smith’s fracture

A

Volar angulation of distal radius fragment

128
Q

Mechanism of injury Bennett’s fracture

A

Impact on flexed metacarpal, e.g. fist fight

129
Q

Features Bennett’s fracture

A

Intra-articular fracture at base of thumb metacarpal

130
Q

X-ray Bennett’s fracture

A

Triangular fragment at base of metacarpal

131
Q

Mechanism of injury Monteggia’s fracture

A

FOSH with forced pronation

132
Q

Features Monteggia’s fracture

A

Dislocation of proximal radioulnar joint in association with ulna fracture

133
Q

Features Barton’s fracture

A

Distal radius fracture with associated radiocarpal dislocation

134
Q

Mechanism of injury Barton’s fracture

A

Fall onto extended and pronated wrist

135
Q

Mechanism of injury radial head fracture

A

FOSH

136
Q

Clinical features radial head fracture

A
  • Marked local tenderness over head of radius
  • Impaired movements at elbow
  • Sharp pain on lateral side of elbow at extremes of rotation (pronation and supination)

1 - MSRA (17 decks)

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