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Clinical Conditions > MSK > Flashcards

MSK Flashcards

1
Q

Winged scapula?

A

Damage to long thoracic nerve, which innervates serratus anterior
Usually holds scapula in place

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2
Q

Clavicle fractures?

A

Most common place - lateral 1/3rd
Sternocleidomastoid muscle elevates medial fragment, pec major pulls down lateral fragment
Shoulder drop (sagging limb)
Subclavian vessels most at damage risk
Suprascapular nerve at damage risk - results in unopposed medial rotation (waiter’s tip position)

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3
Q

Calcific Tendinitis?

A

Calcium hydroxyapatite deposit
Subacromial impingement if large
If bursts –> acute calcific tendinitis

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4
Q

Long head of biceps rupture?

A

Causes Popeye’s muscle

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5
Q

Impingement?

A

Impingement of tendons/bursa by bones in the shoulder
Common cause of shoulder pain
Low painful arc, tender over tuberosity

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6
Q

Rotator cuff tear?

A 
Full thickness, large tears
Impingement signs
Supraspinatus, infraspinatus weak
Progressive functional loss with size of tear
Glenohumeral arthiritis
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7
Q

Acromioclavicular osteoarthritis?

A

Usually asymptomatic
High painful arc
Tender joint

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8
Q

Glenohumeral osteoarthritis?

A

Progressive pain/stiffness over years in joint

Crepitus

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9
Q

Frozen shoulder/Adhesive capsulitis?

A

Severe progressive nocturnal jerk pain, stiffness

Resolves after 2-3 years

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10
Q

Shoulder dislocation?

A

Possible brachial plexus dislocation

Axillary nerve most likely damaged

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11
Q

Mid-shaft humeral fracture?

A

Radial nerve most likely to be injured - causes wrist drop

No big effect on elbow movement (trice innervation not effected)

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12
Q

Elbow dislocation?

A

FOOSH
Capsule and annular ligament somewhat damaged
Pain, deformity, loss of function
Prognosis: either simple or stiffness & recurrent instability

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13
Q

Supracondylar fracture?

A

Fracture of supracondylar region of distal humerus
FOOSH
Pain, swelling, bruising, loss of function
Median nerve possibly damaged (check for radial pulse, OK sign etc)

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14
Q

Radial head/neck fractures?

A

FOOSH
Commonest elbow fracture
Lateral pain, modest swelling, loss of range

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15
Q

Pulled/nursemaid’s elbow?

A

Subluxation of radial head from annular ligament
Longitudinal traction along extended arm
Reduced movement/lateral pain
More common in children

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16
Q

Elbow osteoarthritis?

A

Degenerative disease of articular cartilage - wear and tear
Can be primary or secondary (post traumatic)
Rare symptoms

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17
Q

Elbow rheumatoid arthritis?

A 
Commonest inflammatory arthropathy
Systemic autoimmune disease
Synovial pannus causes joint destruction cellular enroaches on joint surface
Morning stiffness
Rheumatoid nodules
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18
Q

Lateral elbow tendinopathy?

A

Tennis elbow
Degenerative tendinopathy - common extensor origin
Elbow pain, radiating pain from neck or shoulder

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19
Q

Medial elbow tendinopathy?

A

Golfer’s elbow
Degenerative tendinopathy - common flexor origin
10X less common than LET
Presentation similar to LET

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20
Q

Ulnar fractures?

A

Most common site is shaft - Ulna pulled proximal

Olecranon process can be fractured - FOFE, triceps displaces fragment proximally

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21
Q

Olecranon bursitis?

A

Student’s elbow
Inflammation of bursa due to trauma or friction
Soft, cystic, transilluminates
Can become infected

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22
Q

Gouty tophi?

A

Disorder of nucleic acid metabolism - hyperuricaemia (urate crystal deposition)
Urate crystal deposition
Recurrent attacks of arthritis
Also effects ear and Achilles tendon

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23
Q

Colles’ fracture?

A 
Dinner fork fracture
Most common fracture of radius
Dorsal displacement and angulation, radial shortening (inward)
FOOSH
Pain, swelling
Increased risk with Type 1 osteoporosis
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24
Q

Smith’s fracture?

A

Palmar displacement and angulation, shortening (inward)
FOOSH (back of hand)
Pain, swelling

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25
Q

Scaphoid fracture?

A

Most frequently fractured carpal bone
FOOSH
Tenderness in Snuff box, pain on lateral side
Hard to see on initial X-rays
Tenuous (weak) blood supply - poor healing, avascular necrosis
Delayed presentation

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26
Q

Herpes Zoster (shingles)?

A

Viral infection (affects the skin of a single dermatome)
Caused by reactivation of Varicella zoster virus (chickenpox)
Virus travels through cutaneous nerve and remains dormant in dorsal root ganglion
When host immune suppressed - reactivated, travels through peripheral nerve to skin of single dermatome

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27
Q

Tenosynovitis of hand tendons (APL/EPB)?

A

APL/EPB tendons swell up
Causes pain
Finkelstein’s test - Squeeze thumb into palm, ulnar deviate –> painful
Treatment: surgery, steroids, splint

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28
Q

Dupuytrens disease?

A

Build up of scar tissue in palm
Causing >30 degree contracture of interphalangeal joints of hand
More common - Caucasian
Due to: usually genetics, diabetes, epilepsy
No cure

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29
Q

Tendon avulsion (FDP)?

A

FDP tendon snaps at distal phalanx, pulls off chunk of bone with it

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30
Q

Carpal tunnel syndrome?

A

Compression of the median nerve at wrist due to increased pressure in carpal tunnel
Symptoms: tingling in radial 3 and a half fingers (worse at night), numbness, weakness/atrophy of thenar muscles
Positive Phalen’s and Tinel’s test to diagnose
Treatment: treat the cause, splints, steroid injections, surgery

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31
Q

Tinel’s test?

A

To diagnose CTS
Percuss firmly on anterior wrist
Positive: Tingling in thumb, index, middle fingers, radial side of ring finger

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32
Q

Phalen’s test?

A

To diagnose CTS
Force flexion of wrist for 60s
Positive: Tingling in thumb, index, middle fingers, radial side of ring finger

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33
Q

Low ulnar nerve injury?

A

Ulnar nerve damaged at wrist - distal ulnar claw
Flexed at IP joints - lost extension of lumbricals
Little and ring fingers hyperextended at MCP joint - FDP works in opposition to lumbricals

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34
Q

High ulnar nerve injury/ulnar paradox?

A

Ulnar nerve damage at elbow - proximal ulnar claw (less pronounced)
Paradox - paralysis of ulnar half of FDP and flexor carpi ulnaris. Only FDS working (not a strong clawer)
Hence no flexion at distal IPJ of ring and little finger
Looks less serious but is actually worse

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35
Q

Ulnar nerve neuropathy/Cubital tunnel syndrome?

A

Compression of ulnar nerve at elbow
Effects ulnar one and a half digits - numbness, parasthesiae, weakness
Hypersensitive “funny bone”

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36
Q

Radial nerve injury?

A

Radial nerve damaged
Wrist drop when attempted to extend
Due to inability to extend forearm –> reduced supination, reduced thumb abduction

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37
Q

Median nerve injury?

A

Median nerve damaged

Hand of Benediction - inability to flex 2nd & 3rd MCP joints/fingers on attempts to make a fist/flexion

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38
Q

Locked knee?

A

Leg stuck in one position, can’t bend or straighten

  • True locking: due to mechanical block (meniscus tear etc)
  • Pseudo locking: causes pain, muscle spasms
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39
Q

Osgood Schlatter’s disease?

A

Traction apophysitis (inflammation of apophysis-common tendon insertion site) of tibial tubercle M>F, common young sport’s injury

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40
Q

Pre-patellar bursitis?

A

Housemaid’s knee

Inflammation of pre-patellar bursa

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41
Q

Infra-patellar bursitis?

A

Clergyman’s knee

Inflammation of infra-patellar bursa

42
Q

Meniscal cyst?

A

Meniscal tear - fluid from joint goes between sections, causing cyst

43
Q

Tendonitis?

A

Inflammation of tendon, usually due to tendinosis - non inflammatory condition with degeneration of collagen in tendon due to repetitive overload (sudden increase in use or strain of tendon)
Cause poor flexibility, posture, control of joints

44
Q

Medial collateral ligament injury (knee)?

A

Rupture of MCL
Most common ligament injury
Heals well - 3 to 6 weeks
Part of unhappy triad

45
Q

Tibial spine fracture?

A

Tibial spine - place of attachment of ACL

So just like an ACL rupture

46
Q

Anterior cruciate ligament injury?

A 
Rupture of ACL
Common sports injury
Treatment: reconstruction (autograft better than synthetic)
Long recovery/healing time - 9 months
Part of unhappy triad
47
Q

Unhappy triad (knee)?

A

3 sports injuries that often occur together

  • ACL tear
  • MCL tear
  • Medial meniscus tear
48
Q

Septic arthritis?

A

Staph aureus - produces enzymes which rapidly damage articular cartilage
Travel through blood stream to joint
Rare, but devastating
Treatment: drain joint, antibiotics etc

49
Q

Crystal arthropathy?

A

Uric acid (gout) or calcium pyrophosphate (pseudogout) formed on knee joint
Causes swelling and high temp
Risk factors: obesity, renal failure, low phosphate, parathyroid hormone, high Ca

50
Q

Arthritis?

A

Painful inflammation and stiffness of joints
Risk factors: obesity, past joint injury, occupational, genetics
Predisposing factors: female, inactive, senile
Symptoms: joint pain/deformity/stiffness, crepitis, osteophytes
Tests: FBC, U&E, LFT, CRP, ESR
Imaging: subchondrial sclerosis, osteophytes, joint space narrowing, subchondrial cysts
Management: exercises, physio, paracetamol, NSAIDS, surgery
Treatment: hip etc replacement

51
Q

Osteoarthritis?

A

Chronic degenerative joint disease - articular cartilage affected (knees, hips etc)
Symptoms: Joint pain, functional limitation and reduced QOL, non inflammatory, slow onset, stiffness worse at end of day
Primary - known cause
Secondary - unknown cause; trauma, previous joint disorders, DDH, septic arthiritis etc

52
Q

Rheumatoid arthiritis?

A

AU disease causing inflammation of joints (small hand/feet joints)
Symptoms: painful inflammation, rapid onset, stiffness worse in morning, fatigue, fever, night sweats

53
Q

Coxarthrosis?

A

Osteoarthritis of the hip

Symptoms: antalgic limping, limitation of/painful first internal rotation, +ve Trendelenburg, leg length discrepancy

54
Q

Femoral acetabular impingement?

A

Mismatch b/w roundness of head and acetabulum
Assc. with congenial abnormality. Childhood hip injury
Causes hip labrum tear

55
Q

Superior gluteal nerve damage?

A

Supplies gluteus medium and minimus (stabilise pelvis during locomotion)
Produces Trendelenberg sign when damaged: if left nerve & muscles damaged, standing on left leg will produce right sided pelvic drop

56
Q

Gluteal injury?

A

Sciatic nerve in danger

Eg femoral head driven backwards into back wall of socket, fractures, capsule detaches - driven into sciatic nerve

57
Q

Displacement fracture of femoral neck?

A

Intra capsular
-within joint capsule
-compromise blood supply (necrosis) to femoral head, so compromised healing and recovery
-partial/full hire replacement replacement req.
Extra capsular
-distal to trochanteric line
-treat with nails

58
Q

Intertrochanteric fracture?

A

Find shortening and external rotation of limb

59
Q

Posterior dislocation of hip?

A

Find shortening and external rotation of limb

60
Q

Hallux valgus/bunion?

A

Deformity of big toe resulting in displacement away from midline. Prominence of medial eminence
Common in: middle aged females
Symptoms: pain over bump, difficulty with shoes

61
Q

Hallux rigidis?

A

Arthiritis of big toe
Presentation: pain in MTPJ, lump over joint
X-ray: loss of joint space, osteophytes, cysts, subchondral sclerosis (white)

62
Q

Achilles tendon rupture?

A

Common because hypovascular area prone to weakness
Test: Thompson’s positive
Investigations: MRI, ultrasound

63
Q

Thompson’s test?

A

To diagnose Achille’s tendon rupture
Kneel relaxed on chair, grab/squeeze calf
Positive:
-Foot doesn’t move (usually should) -> no continuity of tendon
-Can also see loss of definition

64
Q

Charcot arthropathy?

A

Loss of protective sensation of joints -> massive deformity and bone loss
Presentation: soft bone due to inflammation, lack of pain, cognitive problems, immunocompromised
In foot: due to diabetes - affects CNS/PNS causing loss of sensation -> destruction of joints

65
Q

Rocker bottom foot?

A

Foot collapsed completely

Lower bones bearing all the weight

66
Q

Ankle fracture?

A

Stable or unstable

Talar shift -> talus moves out from Mortis, shifts laterally

67
Q

Planovalgus/flatfoot?

A

Loss of medial longitudinal arch
Common in: middle aged females
Presentation: pain behind medial malleolus, tibialis posterior dysfunction

68
Q

Antalgic gait?

A

Due to painful leg
Presents as: short stance phase in affected leg, short swing phase in unaffected leg, Lack of body weight shift to affected leg
Req. walking stick in opp. hand

69
Q

Hemiplegic gait?

A

Due to hemi-brain injury (stroke, cerebral palsy, trauma)
Flexed upper limb, extended lower limb
Presents as: short step in unaffected leg, circumduction in affected leg -> swing leg around when walking
Stiff hip/knee

70
Q

Diplegic gait?

A

Due to neuromuscular disorders (cerebral palsy)
Tight muscle groups: psi as, abductors, HS, calf
Presents as: scissoring -> 1 knee bent in front of other, struggle to lift foot -> drag soles, ankle plantar flexed, forefoot initial contact (can’t heel strike)

71
Q

High steppage gait/foot drop?

A

Inability to dorsiflex foot (pull it up)
Due to: sciatica, common peroneal palsy, neuromuscular disorders
Excessive hip flexion on affected side
Presents as: toes hanging down, audible foot slap

72
Q

Parkinsonian gait?

A

Due to neurological diseases (Parkinson’s)

Presents as: shuffling/short step (falling into it), forward flexed, no arm swing

73
Q

Mechanical back pain?

A

Intermittent pain when spine is loaded
Could be due to problems in discs, facet joints, tendons, ligaments
Worse with exercise, better with rest
Predispositions: obese, unhealthy
Can effect both physical and mental health

74
Q

Intervertebral disc degeneration?

A

Age related change where discs lose height, pressure, ability to transfer forces evenly across disc space -> marginal osteophytosis
Increased stress on facet joints -> osteoarthritis
Decreased foramen size -> compression of spinal nerves

75
Q

Slipped disc/disc prolapse?

A 
Different appearances: 
-Degeneration -> bulge
-Prolapse -> NP protrusion
-Extrusion -> NP breaks through AF
-Sequestration 
Occurs in 30-50yo
Most commonly in L4/5 or L5/S1 (most compression here)
Usually herniates posterolaterally (potential stress area, point of weakness) 
Paracentral most common
Usually resolves in 3 months
76
Q

Sciatica?

A

Compression of nerve roots which contribute to sciatic nerve
Types:
-L4: pain in anterior thigh/knee, shin
-L5: pain in lateral thigh/calf, dorsal foot
-S1: pain in posterior thigh/calf, foot sole

77
Q

Cauda equina syndrome?

A

Compression of cauda equina (lumbar/sacral nerve roots post L1/2)
-big disc prolapse covering whole canal
Symptoms: bilateral sciatica, perianal numbness, painless urinary retention, faecal/urine incontinence
Surgical emergency. Needs to be treated in 48hrs for recovery

78
Q

Lumbar canal stenosis?

A

Narrowing of spina canal
Seen in elderly patients due to: disk bulge, facet joint osteoarthritis (osteophytes), ligamentum flavum hypertrophy
Causes claudication

79
Q

Neurogenic claudication?

A

Pain in legs when you walk
Due to lumbar canal stenosis -> narrowing of nerves -> low blood supply to them -> become ischaemic -> pain in sciatic distribution
Pain stops, blood flow restored when resting, pain starts again when you walk again

80
Q

Spondyolisthesis?

A

A slip forwards of one vertebra on the vertebra below
Types: dysplastic (ab. facet joint shape), isthmic (pars interaticularis defect), degenerative (arthiritis), iatrogenic (surgery), pathological (tumour)

81
Q

Isthmic spondylolisthesis?

A

A slip forwards of vertebra above on the vertebra below due to pars interarticularis defect
Develops abnormally - thinner-> fracture->pain
Present with back pain & L5 sciatica
No compression of nerve roots - because fracture of posterior arch
Most common in L5/S1

82
Q

Degenerative spondylolisthesis?

A

A slip forwards of vertebra above on the vertebra below due to arthiritis
Posterior arch intact - if vertebra moves forward, nerves get compressed
Present with claudication

83
Q

Boxer’s fracture?

A

Usually fracture of 5th metacarpal neck
Caused by clenched fist striking hard object
Distal part displaced posteriorly - shortening of finger

84
Q

Herniated/prolapsed intervertebral discs?

A

Nucleus pulposus ruptures, breaks through annulus fibrosus. Puts pressure on the spinal cord, causing neurological and muscular symptoms

85
Q

Kyphosis?

A

Excessive thoracic curvature -> hunchback deformity

86
Q

Lordosis?

A

Excessive lumbar curvature -> swayback deformity

87
Q

Scoliosis?

A

Lateral curvature of spine (unknown cause)

88
Q

Cervical spondylosis?

A

Changes in disk and facet joints as you age
Degenerative osteoarthritis of intervertebral joints in cervical spine
-Radiculopathy: pressure on nerve roots->dermatomal (parasthesia, pain) & myotomal (muscle weakness) symptoms
-Myelopathy (less common): weakness, gait dysfunction, loss balance/bladder control

89
Q

Hangman’s fracture?

A

Hyperextension fracture of the axis through the pars interarticularis - forward displacement of C2 on C3
Not many neurological problems

90
Q

Peg fracture?

A 
Hyperextension fracture of axis odontoid process
Due to blow to back of head 
More common in young/elderly patients
No neurological problems
Can cause avascular necrosis
91
Q

Jefferson’s fracture?

A

Fracture of anterior and posterior arches of atlas
Due to axial pressure on head -> Drives skull into C1 -> bone breaks in 2 places
No neurological problems large vertebral foramen)
Causes pain

92
Q

Whiplash injury?

A

Hyperextension and then hyperflexion of neck
No identifiable structures damaged
Usually due to low energy car accidents (neck has high mobility and low stability)
Symptoms: neck pain, dizziness, headaches

93
Q

Cervical myelopathy?

A

Compression of spinal cord due to osteoarthiritis of cervical spine, osteophytes, thickening ligametum flavum, spondylosis, congenital stenosis etc
Causes motor and sensory problems - clumsiness, loss of fine motor movements/gait/balance, dysdiadhokokinesis

94
Q

Thoracic cord compression?

A

Compression of thoracic spinal cord usually due to a tumour or fracture (bony fragments in canal)
All nerve roots below tumour/fracture affected - usually results in whole leg numbness/weakness/paralysis

95
Q

Neuroma?

A

Swelling or bundle where nerve was cut -> pain

  • Neurapaxia: conduction block (only myelin sheath damaged)
  • Axonotmesis: axons divided (still potential to regrow)
  • Neurotmesis: nerve divided (low potential of regrowth)
96
Q

Piriformis syndrome?

A

Overuse of piriformis leads to muscle spasms

Causes symptoms of sciatica

97
Q

Meralgia paraesthetica?

A

Compression of lateral cutaneous nerve of thigh as it passes through inguinal ligament or fascia lata
Due to: obesity, pregnancy, tight clothing/belt
Symptoms: burning/stinging over anterolateral thigh (worse on walking, better when lying down), tenderness, reduce sensation
Test: +ve Tinel’s sign

98
Q

Femoral nerve injury?

A

Causes weakness of quads (knee extension) and hip flexors

99
Q

Tibial nerve injury?

A

Causes weakness of posterior leg muscles (plantarflexion and inversion) and unopposed dorsiflexion/eversion -> calcaneovalgus foot
Loss of plantar sensation

100
Q

Common fibular nerve injury?

A

Superficial nerve injury: loss of lateral muscles (eversion weakness), sensory loss over dorsal foot. Due to fibula fracture or surgery
Deep nerve injury: loss of anterior muscles (dorsiflexion weakness) causes foot drop, sensory loss in 1st web space

101
Q

Saphenous nerve injury?

A

Due to tripping of long saphenous vein varicosities (they lie close together)
Causes loss of sensation over medial leg

102
Q

Sural nerve injury?

A

Due to injury in surgery
Loss of sensation to sole of foot
Usually a useful nerve graft

Clinical Conditions (6 decks)

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