MSK Flashcards
Bony outgrowth with cartilagenous cap
Knee
Osteochondroma
Autosomal dominant
Most common
Excise
Intramedullary, metaphyseal tumour
Lucent/sclerotic
Long and small tublar bones
Enchondroma
failure of ossification at growth plate
Curretage to treat
Solitary unicystic growth
long bones
Fractures can occur
Curretage and bone graft
Possible stabilisation
Lucent
Multiloculated cyst in medulla
Pain and fractures
Aneurysmal bone cyst
Curretage and cement
Pain and fracture
lung mets
soap bubble appearance
Giant cell tumour
Translocation of 1 + 2
Excise and bone cement
Joint replacement
Widened bone thin cortices
Stress fractures
‘Shepherds crook deformity’
Fibrous dysplasia
Fault in g protein signalling leading to immature bone
treat with bisphosphonates, fixation and remove it
Pain worse at night and reieved by NSAIDs
X ray with sclerotic halo
Osteoid osteoma
leave alone/ablate/ en bloc excision
Lytic lesion
History of subacute osteomyelitis
Brodies abscess
Lytic lesions
history of hyperparathyroidism
Brown tumours
Most common primary bone tumour
Osteosarcoma
Treat with chemotherapy
Herringbone pattern
Abnormal bone pathology
Young
Fibrosarcoma
Fever raised ESR Swelling Onion skin pattern Small blue round cell tumours
Ewings sarcoma
11:22 translocation on Ch22
Give chemo and raddiotherapy
what test shows multiple myeloma
Bence Jones
Trat with chemo
Where do bone mets go?
Prostate (blastic) Breast (mixed) Kidney (lytic) Thryoid (lytic) Lungs (lytic)
Sagging rope sign
History of clotting
AVN
Precollapse: Drill to get blood flowing
Collapse: Replacement
Distinguish osteoporosis, osteomalacia and pagets
OP: >2.5 decrease in bone density and normal biochemistry
OM: <2.5 decrease, pseudofractures, low Ca2+ and PO
P: Raised ALP, thickened bone cortices
overcontracted muscle
Anti K+ antibodies
Neuromyotonia
Anticonvulsants
Muscle weakness due to Ca2+ antibodies
LE myasthenic syndrome
Anticholinesterases and K blockers
Progressive eye and muscle weakness
Anticholinesterases
Immunosuppressants
Joint pain
DIP and PIP
<1hr + worsens activity
LOSS on X ray
OA Lifestyle NSAIDS IA steroids Joint replacement
Joint pain PIP and MCP C1 C2 involvement stiffness >1hr and eases on activity Anti CCP and RF
RA Investigate with MRI 1. MTX + steroid 2. + SFZ/HCQ 3. + TNFi
Male
Reduced lordosis and increased kyphosis
Bamboo spine
Ank spond
Schober’s +ve
Nail changes
Psoriasis
‘pencil in cup’ X ray
Psoriatic arthritis
Arthritis and IBD features
Enteropathic
3 weeks after infection
Clear joint aspirate
Reactive arthritis
Butterfly rash Arthritis Systemic problems Anti-dsDNA Anti-sm C2/4 low
SLE
Dryness of mucosa
Ant-Ro/La
T cells on biopsy
Sjogrens
give pilocarpine for dryness
CREST syndrome
can be limited to distal skin or spread to trunk
Systemic sclerosis
Limited: centromere
Diffuse: anti-scl-70
Systemic symptoms
Anti-RNP
MCTD
Young stroke
Miscarriages
Prolonged APTT
Anticardiolpin
APLS
Anticoag
Muscle STIFFNESS
Shoulder and girdle
Spreads from one side to the other
Polymylagia rheumatica
Normal CK
Resposnds to low dose steroids
Steroids for GCA
40mg if no visual
60mg if yes
Muscle WEAKNESS 10x CK Anti-Jo SRP V shaped rash Gottrons papules Heliotrope rash
Myositis
Treatment:
40mg prednisilone
Immunosuppressants
> 50
polymyalgia rheumatica
GCA
<50s
Asian woman
Takayasu
‘String of beads’
Blood clots
Gi and renal inolvement
Pa
Neck stiffness that radiates to shoulders
Occurs over time
Cervical spondylosis
conservative
Dcompression if upper limb symptoms
Shooting dermatomal pain
Poor reflexes
Weakness
Cervical disc prolapse
do MRI
Conservative and surgery
Downs/RA patients
Abnormal neck movements
Upper MN signs
C spine instablity Flexion/extension Treatment: Collar if moderate Fusion if severe
RA, diabetes, CKD, colles fracture
altered sensation in thumb and radial fingers
Muscle wasting at thumb
worse at night
Carpal tunnel syndrome
Wrist splint
Steroids
Ulnar 2.5 fingers
Tinels test
Frontmants
Cubital tunnel
Decompress
Intervertebral discs are
2ndary catilagenous
Lumbar puncture is at
Post iliac crest L4, PSIS S2
Red flags for back pain
<20
>60 new onset
Constant severe pain
Systemic upset
Heavy lifting
Severe back pain on coughing
Neuropathic pain/weakness
Acute disc tear
Conservative
Surgery
Over 60
Claudicaton thats better on hill walking
Osteophytes on x ray
Spinal stenosis
Analgesia and physio
Back pain that worsens on activity
No neuro symptoms
Mechanical back pain
analgesia and physio
surgery if instable
Bruning pain in thigh and knee
Stretching knee recreates pain
crossover sign positive
Sciatica
Analgesia
Neuropathic meds
Surgery if severe
How is a crush fracture treated
Balloon vertebroplasty
Numb saddle area
Bilateral leg pain
Incontinence
Cauda equina syndrome
PR
MRI
Discectomy
frontal spinal fracture with ripped back
Chance
Distal radius fracture with volar displacement
Smiths
Bimalleolar fracture
Potts
Comprression fracture in osteoporosis
Wedge
Extreme trauma causing multiple fractures
Burst
Childhood fractures
Blue sclera
Hearing loss
Osteogenesis imperfecta
Stablise with IM
odd limbs
big forehead
bendy joints
Achondroplasia
Surgical correction
GH therapy
outline normal lower limb developement
varus at birth
valgus
reduced valgus
Internal rotation of humerus
Waiters tip
Erbs palsy (C5,6) Physio and surgery
horners syndome
internally rotated hand
Klumpkes palsy
c8 t1
Flat feet
Jacks test positive
Pathological flat feet
Breech birth, Downs girl
Skin creases
Shortened limb
+ve ortolani and bartlows
DDH
Observe
> 3months: pavlik/ reduce/dye manipulate
young boys with URTI
slow onset of hip pain
US shows effusion
TTSH
X ray to exclude perthes
Drain and NSAIDs
Pain in knee and groin
loss of interna roatation and abduction
flattened femoral head on x ray
Perthes (AVN of femoral head)
Osteotomy of acetabulum and femur
Young sporty overweight boys
loss of internal rotation and knee pain
inferior slipping of femoral head
SUFE
confirm with lateral X ray
Pin head to stop movement
Clubfoot is treated with
Ponsetti method
Incomplete fracture following compression
Buckle
3-4 weeks splintage
Distal radius
Broken on one side
Bent on other
Greenstick
Manipulate and cast
Forearm fracture
ulnar break
Radial dislocation
Montaggia
Reduce and screw/plate fixate
Forearm fracture
Radial break
Ulnar dislocation
Galeazzi
Reduce and screw/plate fixate
supracondylar fracture of elbow
mild: reduce and wire fixate
Severe: Open reduction
MEDIAN NERVE
BRACHIAL ARTERY
Fall onto flexed kee
Femoral shaft fracture
How to manage?
<2: gallows and hip spica
2-6: thomas splint + hip spica
6-12: flexible IM
12+: IM
Hanging rope sign on X ray
Patchy sclerosis
Groin pain
AVN
drill pre-collapse
THR if collapse
Resisted abduction causes pain
Trochanteric bursitis
Supportive and physio
Altered morphology of hip
grips hip with a C sign
hip impingement
Cam surgery
pincerc: osteotomy
Twisting on loaded knee
Effusion and joint line tendernes in knee
+ve steinmans
May lock
Meniscal tear
Suture if young and longituindal outer 3rd
Menisectomy if not
Lateral turn on planted foot
Pop and rapid effusion in knee
Instability
+ve anterior drawer test
ACL rupture
Primary repair or reconstruction
Direct blow to front of knee
Posterior drawer test
PCL rupture
varum blow that causes valgus pain when re-created
MCL tear
Hinged knee brace
Tightening/graft construction
valgus blow that causes varus pain when recreated
LCL injury
Repair/reconstruct
COMMON FIBULAR NERVE AT RISK
Rapid contraction leading to either high or low patella
Palpable gap in extensor mechanism
Extensor mechanism rupture
PTR: young
QTR: old
Tendon-tendon repair
Anterior knee pain
Worse downhill
grinds and clicks
PF disfunction
Physio
Release
Pain and effusion in knee follwoing shearing injury
Osteochondral injury
Fibrocartilage/drilling
Blow to knee causing lateral disloaction of patella
lipohaemarthrosis may be seen
Patellar instability
Straighten leg and manipulate
Solider/athelete experiencing pain in 2/3 metatarsal after training
X ray after 3 weeks shows callus
Stress fracture
6-12 weeks rigid soled boot
Medial arch loss and valgus heel
Tibialis posterior dysfunction
Splint with medial arch support
Decompression
Arthrodesis if severe
Poor alignment of big toe causing ulcers
Hallux valgus
Wide shoes and spacer
Surgery if symptomatic
OA of 1 MTP
Hallux rigidus
Stiff soles/arthrodesis
Burning in sole between 2/3 digital nerves
Clicking on mediolateral compression w US confirms
Morton’s neuroma
Conservative
Excise if not
Popping at ankle during sport
+ve simmonds test
Achlles tendon rupture
Suture/equinous cast
Pain on instep when walking
Plantar fasciitis
stretching exercises
Gel heel pad + steroids
PLANTAR NERVE INJURIES
Diabetic presents with Swelling Loss of sensation Joint deformity X ray shows fucked swollen foot
Charcot’s foot
Assess vasculature
infection
Amputate
What can be damaged in a pelvic fracture?
Internal iliac and venous plexus
Lumbosacral pleus nerves
Open book fractures are dangerous as?
Increased volume for bleeding
RTA with kness hitting dashboard
Damage to posterior wall o acetabulum
Acetabular fracture
Conservative
Reduce and fixate if young
THR i old
Fracture within capsule
Intracapsular
femoral head replacment/THR
Fracture outwidth capsule
Extracapsualr
internal fixation
Fracture below trochater after a fall
Subtrochanteric fracture
IM nail
High energy injury
Blood loss and fat embolus
Femoral shaft frature Resuscitate femoral nerve block Thomas splint IM nail/plate fixate
hyperextension/rotation leading to knee instability
Knee dislocation
Reduce revascularise
Fixate reconstruct
What nerves are at risk in a proximal tibia fracture
Fibular if valgus
Peroneal if varus
Proximal tibial fracture managemnt
reduce surface rigid fixation (plate and screw)
Tibial shaft fracutre managemnt
Conservative
Above knee cast
Internal fixation
Distal tibial fractures
pilon fracture
External fixation when swollen
Interal fixation if not
Ankle injury
ORIF
Talar fractures
closed reduction with screw fixation
Metatarsal fracture
Stout boot
K wires
Toe fracture
Stout boot
fixate
Shoulder pain that radiates to deltoid and upper arm
Pain on abduction and internal rotation
Impingement
Supportive
Steroid injection
Weak abduction of shoulder
Rotational movement causes pain
Rotator cuff tear
Physio, steroids and surgery
Pain for 6-9 months in shoulder followed by stiffness
Adhesive caspulitis
Physio, steroids, surgery
Shoulder pain
X ray shows calcific deposits
Acute calcific tendotinits
Steroids and anaesthetic
Feeling of shoulder going to dislocate
Sulcus signs
Instability of shoulder
Traumatic + anterior: Bankart repair
Deltoid labrum tears
MRI arthrogram
biceps tenotomy, resection or repair
Painful lateral epicondyle
Pain on extension of middle finger and wrist
Lateral epicondylitis
Rest, steroids, brace
Painful medial epicondyle
Medial epicondylitis
Dont inject steroids due to ulnar nerve
Ulnar finger tingling
Tinels and frontmans test +ve
Cubital tunnel syndrome
Release
Tinging in radial fingers
Worse at night
loss of thumb sensation
tinels and phalens test
Carpal tunnel syndrome
Splints + steroids
Decompress flexor retinaculum
Trigger finger
A1 pulley division
medial displacement of humeral neck due to fracture
sling if minimal
internally fixate if moderate
Replace shoulder if fucked
Loss of symmetry and internal rotation i humerus
May see hill sacks lesion
NUMB REG BADGE AREA
humeral fractures
Closed reduction and sling
Bankart repair if recurrent
Acromioclavicular injury
Sling and physio
Humeral shaft fracture
RADIAL NERVE INJURY
RADIAL NERVE INJURY MAY OCCUR BTW
Humeral brace and IM nail
Distal humerus fracture/olecranon fossa
Tension band wiring
ORIF
Lateral elbow pain and twisting of forearm
Full extension of arm not possible
Fat pad sign on X ray
Radial head and neck fracture
Sling and physio
ORIF if displaced
Posterior damage to elbow after FOOSH
Probable NV injury
closed reduciton
ORIF if complicated
Replacement if recurrent
Ulnar fracture
Nightstick fracture
Check radial head for monteggia
Both forearm fracture
Child: plaster cast
Adult: ORIF
Fracture to radial head and dislocation of ulna
Galeazzi
ORIF
Ulnar fracture and radial dislocation
Montaggia
ORIF
Dorsal displacement of radius with MEDIAN NERVE COMPRESSION
Colles
ORIF
Volar displacemetnt of distal radius
Smiths fracture
ORIF
Intrarticular fracture of distal radius
ORIF
Bartons
Tender anatomical snuffbox
RADIAL ARTERY AND NERVE DAMAGE
Scaphoid
cast if undisplaced
Displaced: Compression screw
penetrating hand injuries
Volar: Flexors digital nerve and arteries at risk
Dorsal: extensor
Surgical repair
Staving injury leads to DIPJ injury
Mallet flinger
Mallet splint
Flexor tendon injuries
Explore, smooth repair
Metacarpal injuries
Usually 5th broken with fight bite
Infection
Phalangeal injuries
Splint and k wiring if displaced