MSK Flashcards
What are some hand signs O/E you may see for RA?
Tender, stiff and ‘boggy joints’: PIP, MCP, wrist and MTP (toe). Positive squeeze test. Swan neck deformity (DIP flexion, PIP hyperextension). Boutonniere’s deformity (DIP hyperextension, PIP flexion). Z-thumb (CMC flexion, MP hyperextension, IP flexion). Ulnar deviation of MCP joints. Rheumatoid nodules.
What are some hand signs you might see O/E for OA?
Heberden’s (DIP) and Bouchard’s (PIP) nodes. Squaring at the base of thumb. Reduced ROM. Weak grip. Crepitus on movement. Joint swelling/effusions.
What are some hand signs you might see O/E for psoriatic arthritis?
Psoriatic plaques on skin. Nail pitting: pin prick-like pits. Onycholysis: separation of nail from nail bed. Dactylitis: inflammation of entire finger or toe. Enthesitis (may look at elbow for this).
What are some signs and symptoms of a NOFF?
Acute pain in hip/groin – may radiate to knee. Unable to weight bear. Decreased or painful mobility of affected hip. Signs= shortened, externally rotated and abducted left leg. Palpation of the hip and log-roll test (gentle IR-ER) produces pain. Unable to straight leg raise. Bruising + swelling around area.
Before a lower limb fracture is surgically repaired in theatre, how is it investigated/managed?
A-E assessment. Analgesia: iliofascial nerve block. VTE prophylaxis (after hip op = LMWH for 28d. Knee= 14d). Imaging (AP + lateral). Immobilise. Treat underlying causes (anaemia, infection, diabetes). If it was a fall investigate why. If open fracture- early ABx prophylaxis + surgical debridement.
How would you interpret an AP pelvis X-ray for a suspected NOFF?
Identify Shenton’s line: continuous from medial border of femoral neck to inferior border of superior pubic ramus. Disruption = may be fractured NOF.
For each type of NOFF, how are they surgically repaired?
Intracapsular: Undisplaced – internal fixation (plates+screws) or hemiarthroplasty if unfit. Displaced – total hip arthroplasty or hemiarthroplasty if unfit. Extracapsular: Stable intertrochanteric – dynamic hip screw. Subtrochanteric or unstable – intramedullary device, i.e. nail.
How might a dislocated hip present + how is it investigated?
Sx= pain, popping sound, inability to weight bear, sensation changes to posterior leg/foot. Signs= internal rotation, adduction, shortening of limb, local haematoma, reduced deep tendon ankle reflex. Lateral + AP view of hip (X-ray) + CT scan to assess for acetabular fractures.
How would you manage a dislocated hip? What are some potential complications?
Closed reduction, ideally within 6h (i.e. Allis technique – traction applied in line with deformity), under sedation or GA. Open reduction, if closed reduction fails or there is an associated fracture. Complications= AVN of femoral head, post-traumatic arthritis or recurrent dislocations, sciatic nerve injury.
What is the Garden system classification for hip fractures?
Type I: incomplete fracture + non-displaced. Type II: complete fracture + non-displaced. Type III: complete fracture, incomplete displacement but still has boney contact (usually rotated + angulated). Type IV: complete fracture + complete displacement, i.e. bone disruption.
What is fat embolism syndrome? What is Gurd’s major and minor criteria?
Can occur after fracture of long bones, i.e. femur. Fat globules -> circulation, become lodged in BVs = BF obstruction. Leads to systemic inflammatory response (usually 24-72h after fracture). Major criteria = respiratory distress, petechial rash, cerebral involvement. Minor= jaundice, thrombocytopenia, fever, tachy.
What is compartment syndrome? What are the s+s, investigation + management?
Increased pressure in myofascial compartment= impairs perfusion = ischaemia and necrosis. 5 P’s: pain (disproportionate + excessive use of breakthrough analgesia), paraesthesia, pallor, pressure (high) and paralysis. Pulselessness= differentiates it from acute limb ischaemia. Key hint= recent trauma or procedure with disproportionate pain + pain exacerbated by passive stretch. M/c in supracondylar or tibial shaft fractures. Ix= clinical, raised CK. Mx= emergency fasciotomy (within 6h), irrigation + debridement.
What is the Weber classification for lateral malleolus ankle fractures? How are they managed?
Type A: below the ankle joint - will leave the syndesmosis intact (boot or cast). Type B: at the level of the ankle joint - syndesmosis will be intact or partially torn (OR + IF, cast after surgery). Type C: above the ankle joint - syndesmosis will be disrupted (OR + IF, cast after surgery).
What is a Colle’s fracture? How might it present?
Transverse fracture of the radius; dorsal displacement of distal radius (+ angulation). Usually results from FOOSH + common fragility fracture. Wrist pain and swelling. Dinner fork deformity of the wrist. Paraesthesia and weakness- can damage median nerve (=carpal tunnel).
How is a Colle’s fracture investigated + managed?
X-ray: AP and lateral views; can see transverse fracture of distal radius (2.5cm proximal to radio-carpal joint). If complex – CT or MRI. Usually: Closed reduction with immobilisation with a plaster cast for 4-6 weeks – then repeat the X-ray. If complex or unstable = ORIF or closed reduction and K-wiring.
What is a Smith’s fracture? How is it often caused + managed?
Volar angulation of distal radius fragment (= garden spade deformity). Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed. Management = ORIF with plates and screws (volar displacement= always unstable and requires surgical fixation).
What are the symptoms and 5 key signs of a scaphoid fracture? How is it usually caused?
FOOSH or contact sports. Sx= pain along radial aspect of wrist and loss of grip/pinch strength. 5 key signs: 1) Point of maximal tenderness is over the anatomical snuffbox. 2) Wrist joint effusion: unless hyperacute (<4h) or delayed (>4d old). 3) Pain elicited by telescoping the thumb (longitudinal compression). 4) Tenderness of scaphoid tubercle. 5) Pain on ulnar deviation of wrist.
How is a scaphoid fracture investigated? What are the potential complications of a scaphoid fracture?
A-E, analgesia, immobilise with Futuro splint. X-ray (AP+lateral). If X-ray inconclusive, immobilise + refer for MRI/CT 7-10 days later. Complications: AVN of scaphoid (m/c with proximal fractures- disrupt retrograde blood supply). Non-union -> early OA.
How is a scaphoid fracture surgically managed?
Undisplaced= cast for 6-8 weeks. Displaced= surgical fixation. Proximal scaphoid pole fracture = surgical fixation.
What is a Galeazzi and Monteggia’s fracture?
Galeazzi= radial shaft fracture with dislocation of distal radioulnar joint. Monteggia’s = ulnar shaft fracture with dislocation of proximal radioulnar joint.
What are the typical cancers that metastasise to bone?
Prostate, renal, thyroid, breast and lung.
Which bones are at greatest risk of avascular necrosis?
Scaphoid bone, femoral head, humeral head, talus, navicular, 5th metatarsal in the foot.
What are the expected lab values of calcium, phosphate, ALP and PTH for the following conditions: a. Osteoporosis b. Osteomalacia c. Primary hyperparathyroidism d. Secondary hyperparathyroidism (CKD) e. Paget’s disease
A) Normal for all. B) Decreased calcium + phosphate, increased ALP + PTH. C) Increased calcium, decreased phosphate, increased ALP + PTH. D) Decreased calcium, increased phosphate, ALP, PTH. E) Isolated rise in ALP (everything else normal).
Give the WHO criteria for osteoporosis and osteopenia. What is a Z-score and T-score?
T-score >-1 SD below mean = normal, -1 to -2.5 = osteopenia, <-2.5= osteoporosis [considered severe if this is present + fracture]. T-score= compares against healthy young adult aged 20-35 (same race+sex). Z-score= compares against someone same gender + age.
