MSK 2 Flashcards
AVN is what
commonest place
XR
ischemic necrosis of bone predom in adults
hip joint commonest place . groin pain
hanging rope on XR
extensor mechanism rupture how
RF
what should be avoided that can lead to this
ix
fall onto flexed knee with quads contracted
prev tendonitis, steroids, CRF, cipro, RA
steroid injection on prev tendonitis
unable to straight leg raise. palpable gap in some
MCI symp
rx
laxity on valgus stress and pain
tenderness over origin or insertion of MCL
heals well
LCL symp
cx
rx
marked instability on rotation movement
perineal nerve injury
complete rupture - urgent repair if early
late - reconstruction with hamstring or other tendon
ACL symp
ix
rx
pop heard or felt. haemarthrosis within 1 hour. pain in knee. knee gives way when turning on planted foot . knee swelling
ant translation
ACL reconstruction with allograft, autograft or synthetic graft
PCL symp
rx
popliteal knee pain and swelling
instability - recurrent hyperextension or feeling unstable going down stairs
isolated - doesn’t need reconstruction
bone joint infection organisms
SA, strep group A, coliforms, pseudomonas aergnosa
PJI prophylaxis
first dose within 60 mins of start of surgery
should not continue 24 hours after surgery
screen for MRSA pre op
co amox 1.2g peri op and 2 doses post op
PA co tramoxazole
osteomyelitis treatment
what is it
infection of bone and medullary cavity
high dose flucoxicillin 4-8 weeks
septic arthritis is what
rx
infection of joint space
SA - high dose fluc IV
<5 add ceftrixone for king ella and HI cover
2-4 weeks of AB
cellulitis organisms
treatment
beta haemolytic strep. SA
rest, analgesia, splint
abscess when
rx
history or trauma
surgical incision and drain
gas gangrene spores
organism
treatment
clostridium perfringes - gram neg strictly anaerobic rods
spores germinate - gas bubbles crepitus
urgent debirdement
penicillin +/- metho
tetanus organism
what causes the paralysis
clostridium tetani
gram neg strictly anaerobic rods
neurotoxin causes spastic paralysis - lock jaw
cervical spondolysis
what is it
symp
disc degeneration
slow onset stiffness and pain in the neck - can radiate to neck and occiput
cervical disc prolapse symp
treatment
neck pain and potential nerve compression
conservative treatment or discectomy
cervical instability
downs
RA - atlanto axial subluxation
mechanical back pain
worse with activity relieved by rest
acute disc tear what is it
symp
treatment
acute disc tear in annulus fibrous of disc lifting a heavy object worse on coughing analgesia and physio can take 2-3 months to resolve
sciatica is what
symp
if disc tears gelatinous nucleus pulporis can herniate or prolapse throughout the tear - press on exiting on nerve root - impinge
paina nd altered sensation, decreased power, decreased reflexes
bony nerve entrapment how
symp
treatment
OA of facet joints - osteophytes impinge on nerve root
nerve root pain and radiation
surgical decompression with trimming of osteophytes
osteoporotic crush fracture
severe osteoarthritis leads to spontaneous crush fracture
acute pain and kyphosis
conservative treatment
cauda equina symp
ix
rx
bilateral leg pain. paraesthesia. numbness. saddle anaesthesia. urinary retention, incontinecne. fiscal retention incontincance
PR exam. urgent MRI
surgery
spinal stenosis and claudication what is it age symptoms treatment
spine has less pace due to spondolysis and bulging discs -> spinal stenosis. multiple nerve roots can be compressed/irritated
> 60s
distance inconsistent
pain burning (not cramping)
pain less walking uphill
peripheral pulses present
conservative. decompression surgery
GCT of tendon sheath is what
firm discrete swelling on volar aspects of digits
may be tender
ganglion cyst is what
treatment
mucous cyst adjacent to a tendon on a synovial joint
surgical excision if localised discomfort
OA of hands and wrists
DIP OA common in menopause women
bouchards DIP and herbends PIP
squaring of thumb
RA hands
volar MCP joint subluxation ulnar deviation swab neck E, F boutonné deformity F, E bouchards Z shaped thumb
trigger finger
what is it
where is it commonest
treatment
tendonitis of flexor tendon leading to nodular enlargement of tendon
A1 commonest
steroid injections around tendon in sheath
dupytrens contracture is what
collagen change form 1 to 3
carpal tunnel syndrome is what
investigations
treatment
median nerve compression
tinnels test, phalans test
steroid injection, splint
cubital tunnel syndrome is what
tests
treatment
ulnar nerve compression
tinnels. froments - weak grip - adductor pollicis
surgical release of any tight structures
polymyositis cells
Dermato cells
muscle inflammation of CD8 and CD4 T cells
B and T cells
DMD genetics
what is it
X linked recessive
progressive proximal muscle weakness
BMD
later onset
slower progression
myotonic dystrophy
muscle weakness
cataracts
frontal balding
low intelligence
myasthenia gravis
AI disease affecting NM transmission. females. 20-40s
25% have thyoma others have thyme hyperplasia
weakness more at end of the day
proptosis. fatigue. dysphagia
flat foot commonest cause in elderly women
tibialis posterior tendon dysfunction
no steroid injection!
tendoachilles tendonitis causes
symptoms
treatment
over training. cipro. RA. gout. CTD
pain in main bit of tension or at insertion into calcaneus
morning stiffness. eases with heat/walking
self limiting
tendoachilles rupture
tendonitis predisposes to rupture
sudden pain and difficulty weight bearing
weakness of plantar flexion and palpable gap in tendon
simmonds test - calf squeeze
plantar fasciitis
pain with walking felt on instep or foot with localised tenderness on palpation
worse after exercising
tinnels test for baxter nerve positive
self limiting 18-24 months
mortons neuroma
what is it
symptoms
treatment
degenerative fibrosis of the digital nerve near its bifurcation
burning pain and tingling radiating into affected toes
murders click test
excise or insoles
impingement syndrome what is it
signs
investigations
treatment
tendons of rotator cuff are contraindicated in the tight acromial space - pain
painful arc 60-120, pain radiates -> deltoid and upper arm and tender below lateral edge of acromium
hawkins positive
conservative. subacromial steroid injection
acute calcific tendonitis
acute onset of severe shoulder pain
calcium depositis in supra tendon
subacromial steroid injection and local anaesthetic injection
rotator cuff tear how
sudden jerk in >40s with pain and tenderness
20% of >60s - asymp cuff tears due to degeneration
weakness of initiation of abduction, internal rotation and external rotation
MRI
adhesive capusilitis (frozen shoulder) risk factors symptoms loss of what treatment
DM. high cholesterol. dyptrens
progressive pain and stiffness. 40-60s. resolves after 10-24months
pain subsides over 2-9 months. stiffness increases for 4-12 months then that resolves
loss of external rotation
physio. analgesia. intra articular glenohumeral injections
lateral epicondylitis/ tennis elbow
micro tears in extensor origin
self limiting
rest, NSAIDs, physio, steroid injection, brace
medial epicondylitis/ golfers elbow
less common
steroid injections carries risk of injury to ulnar nerve
volkmans contracture is what
causes
claw like - permanent flexion
result of un diagnosed compartment syndrome
complex regional syndrome
exaggerated pain after injury
burning neuralgic pain, swelling , skin changes
