MSK Flashcards
What is the most common type of shoulder dislocation?
Anterior
Initial management of shoulder dislocation
Analgesia and support in temporary sling
Give the names of 3 shoulder relocation methods
External rotation, kocher, milch
What should be done if shoulder has been dislocated for >24 hours?
Reduce under GA
What investigations/ management are needed after shoulder reduction?
Recheck pulses and sensation
Xray
Immobilise in collar and cuff
Analgesia and follow-up
Which nerve can be damaged in shoulder dislocation?
How may this present?
Axillary nerve
Reduced sesation in ‘regimental badge’ area
What can cause posterior shoulder dislocation?
Anterior blow
Fall onto internally rotated arm
Seizure
Electric shock
Difference in presentation between anterior and posterior shoulder dislocation
Anterior: arm is externally rotated and abducted
Posterior: arm is internally rotated
What is the most common mechanism of ankle sprain?
Inversion injury
Which ligament is most commonly damaged in ankle sprain?
Anterior talofibular
In suspected ankle sprain, where do you feel for tenderness over? (6)
Proximal fibular Lat and med malleoli Navicular Calcaneum Achilles Base of 5th MT
Ottawa criteria: what question does this help answer?
Is an xray required for this ankle?
Describe the Ottawa criteria
BONY TENDERNESS over 6cm above malleolus/ base of 5th MT
UNABLE TO WEIGHT-BEAR for 4 steps at the time of injury and examination
What advice would you give to someone with a sprained ankle?
RICE!
Initial rest: ankle above hip level, intermittent ice for 10 mins
Begin to weight bear asap!!
Gentle exercise
Someone with a sprained ankle wants to use an elastic support, what do you need to tell them?
Do not wear it in bed
How long should it take for a minor sprain to recover?
Around 4 weeks
Give 2 complications of ankle sprain (re peroneal)
Peroneal tendon subluxation: sensation of clicking/ snapping - may require surgery
Peroneal nerve injury
In peroneal nerve injury, where is sensation reduced?
Reduced sensation over the dorsum
Why is there an increased risk of hip fracture in the elderly?
Osteoporosis
Osteomalacia
Inc falls risk
How may the leg appear in #NOF
Leg looks shorter and is EXTERNALLY rotated
An elderly patient with dementia presents with sudden inability to WB - should you suspect #NOF?
YES!!! they may not remember the fall itself
Where may pain in #NOF radiate?
Considering this, when should you suspect #NOF?
May radiate to the knee
Suspect #NOF if unable to WB and pain in the knee
What is the name of the lines you look for in a hip xray?
Shenton’s lines - compare the shape on both sides
How many classes of hip # are there?
4 (garden 1234)
Describe grades 1 and 4 of #NOF
1: trabecular angulated, no significant displacement
Grade 4: gross, complete displacement of the femoral head
What are the principles of #NOF management?
IV access Fluids if dehydrated/ shock Analgesia and anti-emetic Try to determine the cause: CXR, ECG etc Admit to orthopaedics
Colle’s fracture
- location
- mechanism
- appearance
Within 2.5cm of the wrist
FOOSH
‘dinner fork appearance’
In Colle’s #, how may the radius appear on xray
Posterior and radial displacement of the distal fragment of the radius
What is the management of a simple colle’s #?
Analgesia
Immobilise in backslab POP
Elevate with sling
Follow-up with # clinic
When is manipulation under anaesthesia required in distal radius #?
Grossly displaced #
Loss of normal forward radial articular surface tilt on xray
What is a Smith’s fracture?
Usually caused by falling onto flexed wrists (RARE)
Distal radius displaced anteriorly
