MSK Flashcards
1
Q
Winged scapula?
A
Damage to long thoracic nerve, which innervates serratus anterior
Usually holds scapula in place
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)
3
Q
Calcific Tendinitis?
A
Calcium hydroxyapatite deposit
Subacromial impingement if large
If bursts –> acute calcific tendinitis
4
Q
Long head of biceps rupture?
A
Causes Popeye’s muscle
5
Q
Impingement?
A
Impingement of tendons/bursa by bones in the shoulder
Common cause of shoulder pain
Low painful arc, tender over tuberosity
6
Q
Rotator cuff tear?
A
Full thickness, large tears Impingement signs Supraspinatus, infraspinatus weak Progressive functional loss with size of tear Glenohumeral arthiritis
7
Q
Acromioclavicular osteoarthritis?
A
Usually asymptomatic
High painful arc
Tender joint
8
Q
Glenohumeral osteoarthritis?
A
Progressive pain/stiffness over years in joint
Crepitus
9
Q
Frozen shoulder/Adhesive capsulitis?
A
Severe progressive nocturnal jerk pain, stiffness
Resolves after 2-3 years
10
Q
Shoulder dislocation?
A
Possible brachial plexus dislocation
Axillary nerve most likely damaged
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)
12
Q
Elbow dislocation?
A
FOOSH
Capsule and annular ligament somewhat damaged
Pain, deformity, loss of function
Prognosis: either simple or stiffness & recurrent instability
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)
14
Q
Radial head/neck fractures?
A
FOOSH
Commonest elbow fracture
Lateral pain, modest swelling, loss of range
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
16
Q
Elbow osteoarthritis?
A
Degenerative disease of articular cartilage - wear and tear
Can be primary or secondary (post traumatic)
Rare symptoms
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
18
Q
Lateral elbow tendinopathy?
A
Tennis elbow
Degenerative tendinopathy - common extensor origin
Elbow pain, radiating pain from neck or shoulder
19
Q
Medial elbow tendinopathy?
A
Golfer’s elbow
Degenerative tendinopathy - common flexor origin
10X less common than LET
Presentation similar to LET
20
Q
Ulnar fractures?
A
Most common site is shaft - Ulna pulled proximal
Olecranon process can be fractured - FOFE, triceps displaces fragment proximally
21
Q
Olecranon bursitis?
A
Student’s elbow
Inflammation of bursa due to trauma or friction
Soft, cystic, transilluminates
Can become infected
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
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
24
Q
Smith’s fracture?
A
Palmar displacement and angulation, shortening (inward)
FOOSH (back of hand)
Pain, swelling
25
Scaphoid fracture?
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
26
Herpes Zoster (shingles)?
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
27
Tenosynovitis of hand tendons (APL/EPB)?
APL/EPB tendons swell up
Causes pain
Finkelstein's test - Squeeze thumb into palm, ulnar deviate --> painful
Treatment: surgery, steroids, splint
28
Dupuytrens disease?
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
29
Tendon avulsion (FDP)?
FDP tendon snaps at distal phalanx, pulls off chunk of bone with it
30
Carpal tunnel syndrome?
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
31
Tinel's test?
To diagnose CTS
Percuss firmly on anterior wrist
Positive: Tingling in thumb, index, middle fingers, radial side of ring finger
32
Phalen's test?
To diagnose CTS
Force flexion of wrist for 60s
Positive: Tingling in thumb, index, middle fingers, radial side of ring finger
33
Low ulnar nerve injury?
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
34
High ulnar nerve injury/ulnar paradox?
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
35
Ulnar nerve neuropathy/Cubital tunnel syndrome?
Compression of ulnar nerve at elbow
Effects ulnar one and a half digits - numbness, parasthesiae, weakness
Hypersensitive "funny bone"
36
Radial nerve injury?
Radial nerve damaged
Wrist drop when attempted to extend
Due to inability to extend forearm --> reduced supination, reduced thumb abduction
37
Median nerve injury?
Median nerve damaged
| Hand of Benediction - inability to flex 2nd & 3rd MCP joints/fingers on attempts to make a fist/flexion
38
Locked knee?
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
39
Osgood Schlatter's disease?
Traction apophysitis (inflammation of apophysis-common tendon insertion site) of tibial tubercle M>F, common young sport's injury
40
Pre-patellar bursitis?
Housemaid's knee
| Inflammation of pre-patellar bursa
41
Infra-patellar bursitis?
Clergyman's knee
| Inflammation of infra-patellar bursa
42
Meniscal cyst?
Meniscal tear - fluid from joint goes between sections, causing cyst
43
Tendonitis?
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
Medial collateral ligament injury (knee)?
Rupture of MCL
Most common ligament injury
Heals well - 3 to 6 weeks
Part of unhappy triad
45
Tibial spine fracture?
Tibial spine - place of attachment of ACL
| So just like an ACL rupture
46
Anterior cruciate ligament injury?
```
Rupture of ACL
Common sports injury
Treatment: reconstruction (autograft better than synthetic)
Long recovery/healing time - 9 months
Part of unhappy triad
```
47
Unhappy triad (knee)?
3 sports injuries that often occur together
- ACL tear
- MCL tear
- Medial meniscus tear
48
Septic arthritis?
Staph aureus - produces enzymes which rapidly damage articular cartilage
Travel through blood stream to joint
Rare, but devastating
Treatment: drain joint, antibiotics etc
49
Crystal arthropathy?
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
Arthritis?
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
Osteoarthritis?
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
Rheumatoid arthiritis?
AU disease causing inflammation of joints (small hand/feet joints)
Symptoms: painful inflammation, rapid onset, stiffness worse in morning, fatigue, fever, night sweats
53
Coxarthrosis?
Osteoarthritis of the hip
| Symptoms: antalgic limping, limitation of/painful first internal rotation, +ve Trendelenburg, leg length discrepancy
54
Femoral acetabular impingement?
Mismatch b/w roundness of head and acetabulum
Assc. with congenial abnormality. Childhood hip injury
Causes hip labrum tear
55
Superior gluteal nerve damage?
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
Gluteal injury?
Sciatic nerve in danger
| Eg femoral head driven backwards into back wall of socket, fractures, capsule detaches - driven into sciatic nerve
57
Displacement fracture of femoral neck?
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
Intertrochanteric fracture?
Find shortening and external rotation of limb
59
Posterior dislocation of hip?
Find shortening and external rotation of limb
60
Hallux valgus/bunion?
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
Hallux rigidis?
Arthiritis of big toe
Presentation: pain in MTPJ, lump over joint
X-ray: loss of joint space, osteophytes, cysts, subchondral sclerosis (white)
62
Achilles tendon rupture?
Common because hypovascular area prone to weakness
Test: Thompson's positive
Investigations: MRI, ultrasound
63
Thompson's test?
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
Charcot arthropathy?
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
Rocker bottom foot?
Foot collapsed completely
| Lower bones bearing all the weight
66
Ankle fracture?
Stable or unstable
| Talar shift -> talus moves out from Mortis, shifts laterally
67
Planovalgus/flatfoot?
Loss of medial longitudinal arch
Common in: middle aged females
Presentation: pain behind medial malleolus, tibialis posterior dysfunction
68
Antalgic gait?
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
Hemiplegic gait?
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
Diplegic gait?
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
High steppage gait/foot drop?
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
Parkinsonian gait?
Due to neurological diseases (Parkinson's)
| Presents as: shuffling/short step (falling into it), forward flexed, no arm swing
73
Mechanical back pain?
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
Intervertebral disc degeneration?
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
Slipped disc/disc prolapse?
```
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
Sciatica?
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
Cauda equina syndrome?
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
Lumbar canal stenosis?
Narrowing of spina canal
Seen in elderly patients due to: disk bulge, facet joint osteoarthritis (osteophytes), ligamentum flavum hypertrophy
Causes claudication
79
Neurogenic claudication?
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
Spondyolisthesis?
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
Isthmic spondylolisthesis?
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
Degenerative spondylolisthesis?
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
Boxer's fracture?
Usually fracture of 5th metacarpal neck
Caused by clenched fist striking hard object
Distal part displaced posteriorly - shortening of finger
84
Herniated/prolapsed intervertebral discs?
Nucleus pulposus ruptures, breaks through annulus fibrosus. Puts pressure on the spinal cord, causing neurological and muscular symptoms
85
Kyphosis?
Excessive thoracic curvature -> hunchback deformity
86
Lordosis?
Excessive lumbar curvature -> swayback deformity
87
Scoliosis?
Lateral curvature of spine (unknown cause)
88
Cervical spondylosis?
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
Hangman's fracture?
Hyperextension fracture of the axis through the pars interarticularis - forward displacement of C2 on C3
Not many neurological problems
90
Peg fracture?
```
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
Jefferson's fracture?
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
Whiplash injury?
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
Cervical myelopathy?
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
Thoracic cord compression?
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
Neuroma?
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
Piriformis syndrome?
Overuse of piriformis leads to muscle spasms
| Causes symptoms of sciatica
97
Meralgia paraesthetica?
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
Femoral nerve injury?
Causes weakness of quads (knee extension) and hip flexors
99
Tibial nerve injury?
Causes weakness of posterior leg muscles (plantarflexion and inversion) and unopposed dorsiflexion/eversion -> calcaneovalgus foot
Loss of plantar sensation
100
Common fibular nerve injury?
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
Saphenous nerve injury?
Due to tripping of long saphenous vein varicosities (they lie close together)
Causes loss of sensation over medial leg
102
Sural nerve injury?
Due to injury in surgery
Loss of sensation to sole of foot
Usually a useful nerve graft
