MSK 2 Flashcards by Aisha Mujahid

AVN is what
commonest place
XR

ischemic necrosis of bone predom in adults

hip joint commonest place . groin pain

hanging rope on XR

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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

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MCI symp

laxity on valgus stress and pain
tenderness over origin or insertion of MCL

heals well

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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

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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

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PCL symp

popliteal knee pain and swelling
instability - recurrent hyperextension or feeling unstable going down stairs

isolated - doesn’t need reconstruction

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bone joint infection organisms

SA, strep group A, coliforms, pseudomonas aergnosa

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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

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osteomyelitis treatment

what is it

infection of bone and medullary cavity

high dose flucoxicillin 4-8 weeks

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septic arthritis is what

infection of joint space
SA - high dose fluc IV
<5 add ceftrixone for king ella and HI cover
2-4 weeks of AB

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cellulitis organisms

treatment

beta haemolytic strep. SA

rest, analgesia, splint

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abscess when

history or trauma

surgical incision and drain

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gas gangrene spores
organism
treatment

clostridium perfringes - gram neg strictly anaerobic rods
spores germinate - gas bubbles crepitus

urgent debirdement
penicillin +/- metho

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tetanus organism

what causes the paralysis

clostridium tetani
gram neg strictly anaerobic rods
neurotoxin causes spastic paralysis - lock jaw

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cervical spondolysis
what is it
symp

disc degeneration

slow onset stiffness and pain in the neck - can radiate to neck and occiput

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cervical disc prolapse symp

treatment

neck pain and potential nerve compression

conservative treatment or discectomy

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cervical instability

downs

RA - atlanto axial subluxation

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mechanical back pain

worse with activity relieved by rest

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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

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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

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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