MSK Flashcards
Scaphoid Fracture
Aetiology
Signs + Symptoms
Pathology
Investigations
A- Any age, common in adolescents and young adults- FOOSH,
S+S- pain at anatomical snuff box, pain by moving wrist, passive range of motion reduced, swelling around radial and posterior aspects of wrist is common
P- commonly affect waist of scaphoid (70%), proximal pole (30%) or distal pole/scaphoid tubercle (10%)
I- PA and lateral X-ray
follow up in 10 days if fracture not visible
Colles’ fracture
Aetiology & Epidemiology Signs + Symptoms Pathology Investigations Treatment Complications
A- most common type of distal radial fracture, patients with osteoporosis, post-menopausal women, high impact traumas. FOOSH
S+S- painful, deformed, swollen wrist
P- extra-articular fracture of distal radial metaphysis with dorsal angulation and impaction. 50% cases have associated ulnar styloid fracture
I- Plain X-ray- fracture line, dorsal angulation and impaction are clearly visible esp lateral view.
T- reduction and immobilisation in cast
C- malunion= ‘dinner-fork’ deformity
median nerve palsy and post-traumatic carpal tunnel syndrome
secondary osteoarthritis (more common with intra-articular fractures)
tear of the extensor pollicis longus tendon (through attrition of the
tendon over a sharp fragment of bone)
Smith Fracture
Aetiology & Epidemiology Signs + Symptoms Pathology Investigations Treatment Complications
A- <3% of all fractures of radius and ulna, young males most common, elderly females. fall on flexed hand.
S+S- tenderness in anatomical snuffbox
P- fractures of distal radius with volar (palmar) angulation of the distal fracture fragment. 85% extra-articular.
I- X-ray may be normal if undisplaced. Repeat XR in 10 days
T- undisplaced= cast immobilisation for 6 weeks
displaced- reduction needed before immoblisation either surgical or non-surgical
C- malunion with residual volar displacement of the distal radius = garden space deformity. this narrows and distorts the carpal tunnel can result in carpal tunnel syndrome
Rheumatoid arthritis of the metacarpophalangeal joints (MCPJ) and interphalangeal joints (IPJs).
Aetiology & Epidemiology Signs + Symptoms Pathology Investigations Deformities
A- autoimmune disorder- IgG forms against cartilage, and rheumatoid factor (RF- an IgM antibody)-forms against IgG leading to synovitis. This eventualy leads to inflammed synovial cells proliferate to form a pannus pannus (deposits in the synovial membrane) and joint destruction.
M:F is 1:2. onset usually in young adults, increased risk in smokers, stress, infection
S+S- pain and swelling of the PIPJs and MCPJs of the fingers
erythema overlying the joints (indicating inflammation)
stiffness, that is worst in the morning or after periods of inactivity
carpal tunnel syndrome (compression of the median nerve in the carpal tunnel, in this case due to synovial swelling)
fatigue and flu-like symptoms (due to the systemic nature of
rheumatoid disease)
P- particularly affects MCPJ and PIPJ or hands and feet & cervical spine.
onset of symmetrical polyarthritis over weeks to months
I- X ray= joint space narrowing, periarticular osteopenia, juxta-articular bony erosions, subluxation (partial dislocation) and gross deformity
D- swan neck- PIPJ
hyperextends and the MCPJ and DIPJ are flexed
Boutonniere- MCPJ and DIPJ are hyperextended and the PIPJ is flexed.
Psoriatic arthropathy
Aetiology & Epidemiology
Signs + Symptoms
Pathology
A- affects minority of psoriasis pts. asymmetrical oligoarthritis (it develops in one joint at a time, progressing in an asymmetrical manner e.g. left big toe then right index finger)
S+S- dactylitis: fusiform (sausage-shaped) swelling of digits
arthrisits mutilans= joint deformity and destruction
P- commonly affects DIPJs. red, flaky patches of skin
covered with silvery scales.
80% of pts have nail lesions e.g pitting and onycholysis (distal nail detachment preceded by yellow/brown discolouration)
