MSK Flashcards
Which wrist ligament stabilizes the ulna? How do you test if it is injured?
TFCC - triangular ligament that stabilizes ulnar
Test - Supination lift off table
PE for MSK Inury
Neuro - reflexes, sensation, 2 pt discrimination, strength compared to healthy wrist
Cardio - pulses, cap refill
Examine joints more proximal
I-PASS
- Idenitfy abnormalities
- Palpate - ea carpal, anatomic snuffbox, Lister’s tubercle, scaphoid-lunate joint
- Active ROM + passive ROM
- Sensation
- Special Tests
Finkelstein Test
reproducing pain w/ ulnar deviation of lateral fist means De Quervains tenosynovitis
Phalen v Tinnel
Carpal Tunnel
Phalen’s (flex wrists) & Tinnel’s (tap)
Common FOOSH Injuries (3)
scaphoid (avascular)
growth plate damage in kids (can stunt growth)
Collese in elderly women
Direct Palmar Injury
worry about hook of hamate (ulnar branch)
Trigger Finger
overuse inflammation –> nodule that prevents full extension of finger
Ganglion
aspiration drainage w/ needle or observation or surgical removal
Dupuytren’s Contracture
- skin thickening and fibrosis –> hand surgery (seen in Swedish population)
Mallet v Jersey Finger
Mallet Finger - forced flexion; splint 8 wks
Jersey Finger - forced extension
RA Dx Criteria
synovitis in 1+ joints
r/o other diagnoses
score 6/10+
pts for # joints, duration > 6 wks, +RF/anti-CCP, inc ESR or CRP
Gout Risk Factors
inc purines (red meat or seafood) & HCTZ/loops/chemo
Common Septic Joint Organisms
RA - staph aureus
HIV - pneumo, H flu, Salmonella
IV drug use - strep, staph, gram neg, Pseudomonas
Ankle Sprain Grades
1- stretch one ligament w/ minor swelling, no instability or sig loss of function
2- partial ligament tear w/ more severe swelling, pain and bruising; mild instability; some loss of ROM; pain when bearing wt
3- complete ligament tear so very unstable and cannot bear wt
Ottowa Ankle Rules
1- pain on palp of posterior or distal tip eithermalleolus
2- pt tenderness over mid foot / navicular or 5th metatarsal area
3- cannot bear wt immediately after or at appointment
** 2 perpendicular views if any 1 criteria (100% sensitive)
Ottowa Knee Rules
1- 55 yo + 2- isolated patella tenderness 3- tenderness at head of fibula 4- cannot flex knee to 90 degrees 5- cannot bear wt for 4 steps immediately after or at appointment
** 2 perpendicular views if any 1 criteria (100% sensitive)
Most Common Ankle Injury
Lateral more often injured b/c weaker ligaments - ATFL, PTFL, CFL
ATFL most commonly injured
inversion plantar injuries
3 Ankle Tests
Anterior Drawer - pull heal forward while lower leg steady; unstable ATL
Inversion stress test - invert ankle while holding lower leg steady; CFL
Squeeze test - squeeze mid calf; if pain at anterior ankle then high ankle syndesmotic injury
Ankle Sprain Tx
PRICE (protection, rest, ice, compression, elevation)
+ NSAIDs
+ early mobilization to dec stiffness
(ROM exercises in first 48-72 hrs)
5 Rotator Cuff Tests
Empty can - abducted and thumbs point down; supraspinatous
External rotation w/ elbow by side - infraspinatous/teres minor
Internal rotation w/ elbow by side - subscapularis
Hawkins Supacromial Impingement - pain when arm flexed, elbow bent and internal rotation
Drop arm - unable to lower arm slowly from raised position
4 Knee Injury Tests
Lachman - 20 degree flexion
Ant/Post Drawer - 90 degree flexion
Valgus - medial force to knee and lateral to ankle (for MCL)
Varus - lat force to knee and medial to ankle (for LCL)
Gout v Pseudo Gout Crystals
MSU - neg bifringe needles
CPPD - rhomboid, weak pos bifringe
Synovial Fluid in Septic v. Gout Joint
Septic - 100,000 WBCs
> 90% neutrophils in synovial fluid
Gout - 2-60,000 WBCs
< 90% neutrophils
**Still get cx even if see crystals
Acute v. Chronic Gout Tx
Acute - colchicine (inhibits microtubule polymerization of neutrophils) , steroid, NSAIDs for acute
Maint w/ probenacid (inc excretion) & allopurinol (dec prod)
RA Tx
Tx - sulfasalazine, methotrexate, NSAIDs, steroids, anti-cytokines (entarecept, infliximab)
Injuries Suspicious for Abuse
- Corner or “bucket handle” fractures of metaphysis of long bones
- Spiral fracture of femur or humerus (not tibia)
- Rib fracture (esp posterior or medial)
- Vert or spinal process fractures
- Digital fractures
- Sternal or scapular fractures
Toddler Fracture
spiral fracture of tibia from twisting on planted foot
Slipped Capital Femoral Epiphysis
- sep of growth plate b/n femoral head and shaft –> head medially and posteriorlly displaced –> dec internal rotation and obligatory external rotation w/ flexing
- Often in obese adolescent males
- Surgical pinning of femoral head
4 Factors that Determine if Septic Arthritis in Kid
- Fever > 38.5
- Not bearing wt
- WBC > 12,000
- ESR > 40
3 Tests for Cong Hip Problems
- Barlow - flex knee and hip and try to displace
- Ortolani - guided abduction
- Galeazzi - lay and flex knees so ankle near butt to Meas discrepancy in knee ht
Acute Low Back Pain Red Flags (14)
- Night pain or pain at rest
- Unexplained fever
- Neuro deficits
- > 6 wks duration
- Age > 70
- Loss of bowel or bladder control
- Suspect ankylosing spondylitis
- Trauma
- Hx or suspicion of cancer
- Osteoporosis
- Chronic steroid use
- Immunosuppression
- Alcohol abuse
- IV drug use
Diff for Acute Low Back Pain
- Cauda Equina - leg weakness, incontinence, numbness or pain in saddle distribution, pos straight leg and dec anal tone / dec ankle reflexes - get MRI
- Infectious - fevers, pt tenderness, recent infection, IV drug use
- Osteomyelitis, discitis, paraspinal or epidural abscess
- CBC, ESR, CSF tap, MRI, IV abx and drainage
- Herniated Disc /Sciatica - esp in L4-L5 and L5-S1 vert, better w/ laying and worse w/ Valsalva , pos straight leg test - conservative; MRI if symptoms persist > 1 mo
- Spinal stenosis - pseudoclaudication symptoms w/ activity but vascular supply good; worse w/ anything that dec canal space
- NSAIDs, musc relaxants, PT, epidural steroids
- Vert Compression Fracture - osteoporosis or steroid use; w/ little or no trauma; Xrays and treat osteoporosis
- Lumbosacral Strain -COMMON; conservative
- Cancer - mets from prostate, heme, breast, lung (wt loss and other signs)
