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Med school CIDR/FoCP > MSK > Flashcards

MSK Flashcards

1
Q

Subacromial impingement - what?

A

Narrowing of subacromial space
Osteophytes under surface of acromion
Fraying rotator cuff muscles

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2
Q

Subacromial impingement - clinical features

A
  • Restriction of overhead activities
  • Low painful arc
  • Drop arm sign
  • Positive impingement tests
  • Weak abduction if cuff tear
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3
Q

Subacromial impingement - treatment

A

Rest
NSAIDs/analgesia
Anaesthetic injection
Surgical decompression

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4
Q

Rotator cuff tears

A

Acute - following injury - repair
Chronic - degenerative changes, with impingement - subacromial decompression, rotator cuff repair
Clinicallly: weakness abduction - supraspinatus

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5
Q

Osteoarthritis Gleno-humoral joint

A 
Primary
Secondary - trauma, RA
Pain - activity related and nocturnal
Post exertional stiffness
Restricted ROM
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6
Q

Osteoarthritis Gleno-humoral joint treatment

A 
Xray
Analgesia
Physio
Aneasthetic injection
Shoulder replacement
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7
Q

Osteoarthritis acromio-clavicular joint

A

Pain on movement, especially overhead
Cross body abduction

X ray

HCI
Resection lateral clavical

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8
Q

Frozen shoulder

A

Following trivial injury
1 - 1.5 years cycle: pain and stiffness → stiffness → movements return
Restricted movement - especially external rotation

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9
Q

Frozen shoulder treatment

A

Analgesia
Physio - aggressive
MUA (manipulation under anaesthesia)
Arthroscopy and division tight bands

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10
Q

Anterior dislocation of shoulder

A 
Hx of trauma
Pain
Restricted movements
Flat shoulder contour/visible acromian
Check circulation/nerves
Chronic - apprehension
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11
Q

Anterior dislocation of shoulder treatment

A

Acute - reduce under sedation, mobilise as pain allows

Chronic - Anterior stabilisation

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12
Q

Tennis elbow

A

Degenerative changes to the extensor carpi radialis brevis tendon
Repeated overuse injury
Pain lateral epicondyle
Exacerbated by activity, eased by rest

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13
Q

Tennis elbow treatment

A 
Rest
Analgesia
Clasp/brace
HCI
Surgical debridement
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14
Q

Osteoarthritis of the elbow

A

Risk factors: trauma, longterm overuse, RA
Clinical features: pain on movement, post-exertional stiffness, restricted movement
Management: Xray, analgesia, physio, debridement, RA - replacement

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15
Q

Ulnar nerve compression

A 
Fibrous tunnel behind medial epicondyle
Pain radiating down arm
Altered sensation ulnar fingers
Intrinsic muscle weakness
Differential diagnosis - compression at wrist
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16
Q

Ulnar nerve compression management

A 
Tenel's test
Nerve conduction studies
Analgesia
Avoid banging elbow
Surgical decompression
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17
Q

Scaphoid fracture

A

Clinical features: pain anatomical snuffbox, reduced ROM

Management: xray, repeat xray, bone scan, Colles cast, screw fixation

18
Q

Distal radial fracture

A

How - fall on outstretched hand
Clinical features - pain, swelling, ↓ ROM
Dinnerfork deformity = Colles fracture
Management - manipulation under anaesthetic, cast, internal fixation

19
Q

De Quervains

A

Tenosynovitis of extensor pollicis brevis and abductor pollicis longus
Overuse injury
Tender radial side of wrist
Finkelstein’s +ve

20
Q

De Quervain’s treatment

A

Rest
NSAID
HCI
Surgical release

21
Q

Osteoarthritis of the wrist

A

Pain, swelling, loss of function, loss of grip strength
Bouchard’s (PIP) and Heberden’s (DIP) nodes
Treatment: NSAIDs, analgesia, splints, fusion, excision arthroplasty, wrist replacement

22
Q

Carpal tunnel syndrome

A 
Hand pain radiating to arm
Nocturnal and holding books
Clumsiness
Numbness radial side of hand
Muscle wasting
Phalen's and tinnel's test
?neck pain
23
Q

Carpal tunnel syndrome management

A

Nerve conduction studies
Wrist splint
HCI
Carpal tunnel release

24
Q

Rheumatoid arthritis clinical features

A 
Produce hand and wrist deformities
Function can be well preserved - document
Synovitis
Tendon rupture
Radial/volar deviation wrist
Ulnar deviation fingers
Boutoniere/swan neck/Z deformities
25
Q

Rheumatoid arthritis treatment

A 
NSAID
analgesia
DMARDs
Physio
Splints
Aids to daily living
Synovectomy
Tendon repair
Joint replacement
Fusion
26
Q

DMARDs - disease process suppressing

A

Gold
Penicillamine
Sulfasalazine

27
Q

DMARDs - affecting the immune process

A 
Chloroquine and hydroxychloroquine
Methotrexate
Azathioprine
Ciclosporin
Leflunomide
28
Q

DMARDs - Anti-tumour necrosis factor or biological agents

A

The term biological agents encompasses tumour necrosis factor (TNF)-alpha-blockers (infliximab, etanercept, and adalimumab) and other agents, including abatacept, anakinra, and rituximab.

29
Q

Dupuytren’s contracture

A

Thickening of palmar fascia
Middle aged men
1-2 years tender nodules
Progressive contractures little/ring fingers
Palpable bands
Initially joints mobile - become stiffer later
Treatment: surgical release

30
Q

Hip: Viral synovitis

A 
History of URTI
Limp
Pain in groin, thigh or knee, sometimes tenderness in groin or over greater trochanter
Reluctance to weight bear
Systemically well or moderately unwell + pyrexia
Leg lies in external rotation
ROM limited
Investigations normal
Resolves over a few days
31
Q

Hip: Septic arthritis

A 
History of RTI
Pain in groin, thigh or knee, tender
Refuses to weight bear
Systemically unwell + pyrexia
Lies with hip flexed and in external rotation
ROM restricted
↑ WCC, CRP, ESR, +ve blood cultures
Immediate decompression and washout of the joint, culture fluid, high dose IV antibiotics
32
Q

Osteoarthritis - xray

A

Articular cartilage worn away → ↓ joint space
Underlying bone becomes dense → subchondral sclerosis
Subchondral cysts at pressure area
Osteophytes

33
Q

Osteoarthritis of the hip

A

Pain from groin to knee on weight bearing, often use a stick
Stiffness after rest, difficulty putting socks on and cutting toenails
Limp
Apparent shortening of the leg
Muscle wasting
Restricted ROM
Analgesia, NSAIDs, physio, heat, weight loss, modified activity, total hip replacement

34
Q

Bursitis - hip

A

Extra-articular joint pain
Trochanteric, ilio-psoas, ischial
Inflammation causes bursal synovial cells to thicken
Excess fluid accumulates inside and around affected bursae
Most common causes: mechanical overload and repetitive microtrauma
Ice, analgesia, NSAIDs, weightloss, HCI, physio, decreasing activity during recovery

35
Q

Nerve entrapment - hip

A

Lateral femoral cutaneous nerve: pain anterolateral thigh; nerve trapped at exit through ligament just inferior and medial to asis (meralgia paraesthesia)
Obturator nerve - pain in groin and down inner thigh

36
Q

Fractured neck of femur

A

Hip pain
Inability to weight bear
Leg shortened and externally rotated
Can lead to avascular necrosis of the femoral head

37
Q

Gardens classification (fractured NOF)

A

Grade 1: incomplete fracture of the femoral neck
Grade 2: complete fracture but undisplaced
Grade 3: complete fracture with partial displacement
Grade 4: complete fracture with total displacement

38
Q

OA of the knee

A

Pain - gradually progressive, exacerbations, activity related and nocturnal
Stiffness - post exertional and structural
Deformity - fixed flexion or box leg
Function - reduced distance of walking and poor sleep
Welling
Warmth/tenderness/painful ROM

39
Q

Anterior cruciate ligament injury

A

Typical injury pattern - football, skiing
Immediate swelling (sensitive indicator)
Tense swelling, anterior cruciate draw test

40
Q

Meniscal tear of the knee

A 
Previously normal joint
Twisting injury of semiflexed knee - football, skiing
Pain joint line
Locking
Giving way
Valgus thrust with foot in external rotation or varus thrust with foot in internal rotation
Gradual swelling (sensitive indicator)
Mild - moderate swelling
Fixed flexion
Spongy block to extension

Med school CIDR/FoCP (6 decks)

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