MSK Flashcards
1
Q
Tennis elbow aka…
A
Lateral epicondylitis
2
Q
Features of lateral epicondylitis
A
- Pain and tenderness localised to lateral epicondyle
- Pain on resisted wrist extension
3
Q
Golfer’s elbow aka…
A
Medial epicondylitis
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
5
Q
Features of radial tunnel syndrome
A
- Pain 4-5cm distal to lateral epicondyle
- Symptoms worsening by extending elbow and pronating forearm
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
7
Q
Features of olecranon bursitis
A
- Swelling over posterior aspect of elbow
- Associated pain, warmth, and erythema
- Typically middle aged patients
8
Q
Where is intracapsular hip fracture
A
From edge of femoral head to insertion of capsule of hip joint
9
Q
Where is extracapsular hip fracture
A
Trochanteric or subtrochanteric
10
Q
Treatment of intracapsular hip fracture - undisplaced
A
Internal fixation, hemiarthroplasty if unfit
11
Q
Treatment of intracapsular hip fracture - displaced
A
Replacement arhtroplasty (total or hemi)
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
13
Q
Treatment of extracapsular hip fractures
A
If stable intertrochanetric, dynamic hip screw
If reverse oblique, transverse, or subtrochanetric - intramedullary device
14
Q
Features of osteoarthritis of knee
A
- Typically >50, often overweight
- May be severe pain
- Intermittent swelling
- Crepitus
- Limitation of movement
15
Q
Clergymans knee aka…
A
Infrapatellar bursitis
16
Q
Housemaids knee aka…
A
Prepatellar bursitis
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
18
Q
PCL injury features
A
May be caused by anterior force applied to proximal tibia, e.g. knee hitting dashboard during car accident
19
Q
Collateral ligament injury features
A
- Tenderness over affected ligament
- Knee effusion may be seen
20
Q
Meniscal lesion features
A
- May be caused by twisting of knee
- Locking and giving way common feature
- Tender joint line
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
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
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
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
25
Roots of musculocutaneous nerve
C5-7
26
Motor function of musculocutaneous nerve
Elbow flexion (biceps brachii) and supination
27
Sensory function of musculocutaneous nerve
Lateral part of forearm
28
Mechanism of injury musculocutaneous nerve
Isolated injury rare, usually injured as part of brachial plexus injury
29
Roots of axillary nerve
C5-6
30
Motor function of axillary nerve
Shoulder abduction (deltoid muscle)
31
Sensory function of axillary nerve
Inferior region of deltoid muscle
32
Mechanism of injury of axillary nerve
Humeral neck fracture/dislocation
33
Clinical presentation of injury to axillary nerve
Flattened deltoid
34
Roots of radial nerve
C5-8
35
Motor function of radial nerve
Extension of forearm, wrist, fingers, and thumb
36
Sensory function of radial nerve
Small area between dorsal aspect of 1st and 2nd metacarpals
37
Mechanism of injury of radial nerve
Humeral midshaft fracture
38
Clinical presentation of injury to radial nerve
Wrist drop
39
Roots of median nerve
C6, C8, T1
40
Motor function of median nerve
LOAF muscles
Lateral two lumbricals
Opponens pollis
Abductor pollis brevis
Flexor pollis brevis
41
Clinical features of median nerve lesion at wrist
Paralysis of thenar muscles, oppenens pollicis (carpal tunnel syndrome)
42
Clinical features of median nerve lesion at elbow
Loss of pronation of forearm and weak wrist flexionS
43
Sensory function of median nerve
Palmar aspect of lateral 3 1/2 fingers
44
Roots of ulnar nerve
C8, T1
45
Motor function of ulnar nerve
Intrinsic hand muscle except LOAF
Wrist flexion
46
Sensory function of ulnar nerve
Medial 1 1/2 fingers
47
Mechanism of injury of ulnar nerve
Medial epicondyle fracture
48
Clinical presentation of ulnar nerve lesion
Claw hand
49
Roots of long thoracic nerve
C5-7
50
Motor function of long thoracic nerve
Serratus anterior
51
Mechanism of injury of long serratus nerve
Often during sport, e.g. following blow to ribs
Complication of mastectomy
52
Clinical presentation of damage to long thoracic nerve
Winged scapula
53
Roots injured in Erb-Duchenne palsy
Damage to upper trunk of brachial plexus - C5-6
54
Cause of Erb-Duchenne palsy
Shoulder dystocia
55
Presentation of Erb-Duchenne palsy
Arm hands by side, internally rotation, elbow extended
56
Roots injured in Klumpke palsy
Lower trunk of brachial plexus C8, T1
57
Cause of Klumpke palsy
- Shoulder dystocia
- Sudden upward jerk of hand
58
X ray changes in osteoarthritis
- Loss of joint space
- Osteophytes forming at joint margins
- Subchondral sclerosis
- Subchondral cysts
59
Ankle reflex nerve roots
S1-2
60
Knee reflex nerve roots
L3-4
61
Biceps reflex nerve roots
C5-6
62
Triceps reflex nerve roots
C7-8T
63
Tinels sign
Tapping cause paraesthesia
64
Phalens sign
Flexion of wrist causes symptoms
65
Ottawa rules
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
Risk factors Achilles tendon disorders
Quinolone use, e.g. ciprofloxacin
Hypercholesterolaemia (tendon xanthomata)
67
Features of achilles tendinopathy
Gradal onset posterior heel pain, worse following activity
Morning pain and stiffness
68
Features achilles tendon rupture
- Audible pop in ankle
- Sudden onset significant pain in calf or ankle
- Inability to walk/continue sport
69
Examination features of achilles tendon rupture
- 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
Imaging modality suspected Achilles tendon rupture
Ultrasound
71
Features adhesive capsulitis
External rotation affected more than internal rotation or abduction
Both active and passive movement affected
72
What is Boxer fracture
Minimally displaced fracture of 5th metacarpal
73
What is Buckle fracture
Incomplete fractures of the shaft of the long bone, characterised by bulging of the cortex
74
Symptoms carpal tunnel syndrome
Pain/pins and needles in thumb, index, and middle finger
Shaking hand obtains relief, classically at night
75
Examination findings carpal tunnel syndrome
Weakness of thumb abduction
Wasting of thenar eminence (NOT hypothenar)
Tinels sign - tapping causing paresthesia
Phalens sign - flexion of wrist causes symptoms
76
Treatment carpal tunnel syndrome
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
What is De Quervain's tenosynovitis
Condition where sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
78
Features De Quervain's tenosynovitis
- Pain on radial side of wrist
- Tenderness over radial styloid process
- Abduction of the thumb against resistance is painful
- Positive Finkelstein's test
79
What is Finkelstein's test
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
Most common bacterial cause discitis
Staphylococcus aureus
81
Investigations discitis
- MRI
- CT guided biopsy for antimicrobial treatment
- Echo to r/o endocarditis (discitis usually due to haematogenous seeding)
82
Features of posterior hip dislocation
Affected leg shortened, adducted, and internally rotated
83
Features of anterior hip dislocation
Affected leg abducted and externally rotated, no leg shortening
84
Who is iliotibial band syndrome common in
Runners (1 in 10 people who run regularly)
85
Features of iliotibial band syndrome
Tenderness 2-3cm above the lateral joint line of knee
86
Mechanism of injury ruptured ACL
Sport injury - high twisting force applied to bent knee
87
Presentation ruptured ACL
- Loud crack
- Pain
- Rapid joint swelling (haemarthrosis)
88
Management ruptured ACL
Intense physiotherapy or surgery
89
Mechanism of injury ruptured PCL
Hyperextension injuries
90
Mechanism of injury ruptured MCL
Leg forced into valgus via force outside the leg
91
Examination findings ruptured MCL
Knee unstable when put into valgus position
92
Mechanism of injury menisceal tear
Rotational sporting injuries
93
Features menisceal tear
Delayed knee swelling
Joint locking
Recurrent episodes of pain and effusion following minor trauma
94
Demographic chondromalacia patellae
Teenage girls
95
Features chondromalacia patallae
Pain going downstairs or at rest
Quadriceps wasting
96
Mechanism of injury patella dislocation
Direct trauma or severe contraction of quadriceps with knee stretched in valgus and external rotation
97
Types of patella fracture
Direct blow to patella causing undisplaced fragments
Avulsion fracture
98
Features lumbar spinal stenosis
- Back pain
- Neuropathic pain
99
Lumbar spinal stenosis vs claudication
In lumbar spinal stenosis, sitting is better than standing, and easier walking uphill than downhill
100
What is meralgia paraesthetica
Syndrome of paraesthesia and anaesthesia in distribution of lateral femoral cutaneous nerve
101
Risk factors meralgia paraesthetica
Obesity
Pregnancy
Tense ascites
Trauma
Iatrogenic
Sports
Idiopathic
102
Iatrogenic causes of meralgia paraesthetica
- Pelvic osteotomy
- Spinal surgeries
- Laparoscopic hernia repair
- Bariatric surgery
- Abduction splints used in management of Perthes disease
103
Symptoms meralgia paraesthetica
Symptoms in upper lateral aspect of thigh:
- Burning, tingling, coldness, shooting pain
- Numbness
- Deep muscle ache
Aggravated by standing, relieved by sitting
104
Signs meralgia paraesthetica
- 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
Investigations meralgia paraesthetica
Pelvic compression test highly sensitive - diagnosed based on this alone
Injection of nerve with local anaesthetic abolish pain
106
Advice to minimise risk of dislocation after hip replacement
- Avoid flexing hip >90 degrees
- Avoid low chairs
- Do not cross legs
- Sleep on back for first 6 weeks
107
Types of osteomyelitis
Haematogenous - from bacteraemia
Non-haematogenous.- from contiguous spread of infection from adjacent soft tissues to bone, or direct injury/trauma to bone
108
Most common site of haematogenous osteomyelitis in adults
Vertebral
109
Risk factors haematogenous osteomyelitis
Sickle cell anaemia
IV drug user
Immunosuppression
Infective endocarditis
Most common form in children
110
Risk factors non-haematogenous osteomyelitis
Diabetic foot ulcers/pressure sores
Diabetes mellitus
Peripheral arterial disease
111
Most common organism osteomyelitis
Staph aureus
112
Most common organism osteomyelitis in sickle cell
Salmonella
113
Treatment osteomyelitis
Fluclox 6 weeks
Clindamycin if pen allergic
114
When should DEXA scan be offered without risk score
>50 with history of fragility fracture
<40 with major risk factors
115
Interpretation of QFracture score
If 10 year fracture risk ≥10%, arrange DEXA scan
116
Interpretation of FRAX score
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
Features rotator cuff injury
Shoulder pain worse on abduction
Painful arc of abduction
Tenderness over anterior acromion
118
Subacromial impingement painful arc degrees
60-120
119
Rotator cuff tears painful arc degrees
First 60
120
Blood supply scaphoid
Dorsal carpal branch (branch of radial artery) in retrograde manner
121
Associations with talipes
Most commonly idiopathic
Spina bifida
Cerebral palsy
Edward's syndrome
Oligohydraminos
Arthrogryposis
122
Features trigger finger
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
Treatment trigger finger
Steroid injection successful in majority of patients, finger splint may be applied afterwards
Surgery for patients non responsive to steroids
124
Mechanism of injury Colles fracture
FOSH
125
Features of Colles fractures
- Transverse fracture of radius
- 1 inch proximal to radio-carpal joint
- Dorsal displacement and angulation
126
Mechanism of injury Smith's fracture
Falling backwards onto palm of outstretched hand, or falling with wrists flexed
127
Features Smith's fracture
Volar angulation of distal radius fragment
128
Mechanism of injury Bennett's fracture
Impact on flexed metacarpal, e.g. fist fight
129
Features Bennett's fracture
Intra-articular fracture at base of thumb metacarpal
130
X-ray Bennett's fracture
Triangular fragment at base of metacarpal
131
Mechanism of injury Monteggia's fracture
FOSH with forced pronation
132
Features Monteggia's fracture
Dislocation of proximal radioulnar joint in association with ulna fracture
133
Features Barton's fracture
Distal radius fracture with associated radiocarpal dislocation
134
Mechanism of injury Barton's fracture
Fall onto extended and pronated wrist
135
Mechanism of injury radial head fracture
FOSH
136
Clinical features radial head fracture
- 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)
