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MSK Flashcards

1
Q

Which nerve can be damaged in axillary node clearance and what affect may this have?

A

Long thoracic nerve

Winged scapula

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2
Q

What muscle group is supplied by the musculocutaneous nerve.

A

All muscles in anterior arm -

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3
Q

Musculocutaneous nerve damage - causes, effects

A

Rare because deep structure. Stab wound to the axilla.

Weakened flexion of the elbow, loss of sensation on lateral forearm

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4
Q

Radial nerve damage

Causes, results

A

In the axilla - shoulder dislocation or proximal humeral fracture. Unable to extend forearm, wrist, fingers. Unopposed flexion of wrist causes wrist drop. Sensory loss over the lateral and posterior arm, posterior forearm and dorsal surface of lateral 3.5 fingers.
In the radial groove- humeral shaft fractures. Unable to extend at wrist and hand. Wrist drop. Sensory loss only to dorsal aspect of lateral 3.5 fingers.
Superficial branch damage in forearm - stabbing or laceration of forearm - sensory loss of dorsal aspect of 3.5 lateral fingers
Deep branch in forearm - radial head fracture, posterior radial dislocation. Weakened extension of wrist without wrist drop because carpi radialis longus is unaffected

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5
Q

Surgical neck of humerus fracture - causes and consequences

A

direct blow to the area or fall on an outstretched hand. Axillary nerve damage, deltoid paralysis therefore unable to abduct the affected limb. sensory impairment to regimental patch. Posterior circumflex artery.

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6
Q

Mid-shaft humeral fracture - causes and consequences

A

Trauma, radial artery damage.

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7
Q

Distal humeral fractures - causes and consequences.

A

supraepicondylar - falling on a flexed elbow. Brachial artery damage can result in volkmann’s ischaemic contracture (uncontrolled flexion of the hand). Median, ulnar or radial nerve damage.
Medial epicondyle fractures can damage the ulnar nerve resulting in ulnar claw and loss of sensation over the medial 1.5 fingers

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8
Q

What causes winging of the scapula?

A

Nerve damage to the long thoracic nerve resulting in serratus anterior paralysis

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9
Q

What muscle is most commonly affected in rotator cuff tendonitis?

A

supraspinatus

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10
Q

What causes rotator cuff tendonitis?

A

repetitive use of the shoulder joint above the horizontal e.g. playing racquet sports

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11
Q

Subacromial bursitis
what is it also known as?
What causes it?
How does it present?

A

Painful arc syndrome
Subscapularis tendon Impingement under the AC joint leading to inflammation
pain during abduction of the arm

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12
Q

Anterior glenohumeral joint dislocation - how?

A

Joint is weak inferiorly, especially when abducted. When dislocated powerful adductors pull it anteriorly so anterior dislocations are more common.

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13
Q

Posterior glenohumeral joint dislocation

A

uncommon, usually due to high energy trauma

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14
Q

What is Monteggia’s fracture and how can it occur?

A

proximal ulna fracture with the head of the radius dislocated at the elbow. force from behind the ulna.

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15
Q

What is Galeazzi’s fracture and how can it occur?

A

a fracture of the distal radius, with dislocation of the ulna head at the distal radio-ulna joint.

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16
Q

What is Colles’ fracture and how can it occur?

A

The most common type of radial fracture - typically caused by a fall onto an outstretched hand resulting in distal radial fracture. results in ‘dinner fork’ deformity due to posterior dislocation of the wrist and hand.

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17
Q

What causes fractures of the radial head?

A

Fall on an outstretched hand. Radial head is forced back into the capitulum of the humerus causing it to fracture

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18
Q

What is Smith’s fracture and how can it occur?

A

Falling onto the back of the hand. Opposite of a Colles’ fracture, distal radial fragment results in anterior dislocation of the wrist and hand.

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19
Q

What causes scaphoid fractures? Clinical presentation? complication?

A

Fall on an outstretched hand, most commonly in men aged 20-30 yrs. Requires specific x-ray views to image. Pain in anatomical snuffbox. Requires rapid reduction to prevent avascular necrosis. which may result in later necrosis

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20
Q

What causes lunate fractures? associated injury?

A

Trauma when there is hyperextension of the wrist. . associated with median nerve damage.

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21
Q

Describe the salter harris classification.

A

Classification of growth plate fractures.
I - fracture through the physis
II - fracture through the physis and metaphysis
III- fracture through the physis and epiphysis to include the joint.
IV- fracture involving the physis, metaphysis and epiphysis
V- crush injury involving the physis

X-ray often appears normal despite underlying fracture. Injuries of type III, IV and V require surgery.

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22
Q

red flags for back pain x12

A

1) Thoracic pain
2) Younger than 50 or older than 50
3) non-mechanical pain
4) night pain
5) pain worse when supine
6) neurological signs
7) history of malignancy or HIV
8) immunosuppression or steroid use
9) IVDU
10) Structural deformity
11) history of trauma
12) systemically unwell i.e. fever, weight loss

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23
Q

presentation of facet joint pain

A

acute or chronic
pain worst in the morning on standing
pain over the facets
pain worse on spinal extension

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24
Q

presentation of spinal stenosis

A

gradual onset
unilateral or bilateral leg pain, parasthesia, weakness which is worse on walking
relieved by sitting down, leaning forward, crouching
Clinical exam normal, MRI to investigate

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25
Q

presentation of Ankylosing spondylitis

A

young men
lower back pain and stiffness
worse in morning and improves with activity

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26
Q

presentation of peripheral arterial disease

A

pain in the buttocks brought on by exercise, relived by rest.reduced peripheral pulses
history of CVS risk factors

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27
Q

AC joint injury
mechanism
management based on grading

A

FOOSH
I and II - sling and rest
III - debatable
IV, V and VI - require surgery

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28
Q

De Quervain’s tenosynovitis
presentation
test
management

A

pain on radial side of wrist and radial styloid process.
Finkelstein’s test - flex thumb inside fist then pull hand towards ulnar.
analgesia, splint, steroid injection, surgery.

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29
Q

management of hip factures

A

intracapsular and displaced- if independently mobile (max aid 1 stick) THR, otherwise hemiarthroplasty
Trochanteric fracture - sliding hip screw
sub trochanteric fracture - intramedullary nail

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30
Q

clinical findings in club foot

A

inverted, plantar flexed foot which is not passively correctable

31
Q

management of club foot

A

ponseti method - manipulation and progressive casting from birth, taking 6-10 weeks. many need Achilles tenotomy in addition.
Night time braces until the child is 4.
surgery rarely required.

32
Q

Open Fracture Classification

A

Gustilo and Anderson
1 - low energy <1cm
2 - >1cm wound, moderate soft tissue injury
3 - High energy wound >1 cm with extensive soft tissue damage +all farm yard injuries
3a - adequate soft tissue coverage
3b - inadequate soft tissue coverage
3c - associated arterial injury

33
Q

management of open fractures

A

Immobilise the fracture
monitor neurovascular status carefully
tetanus prophylaxia + IV Abx
debride and lavage in 12 hours if high energy, 24 for low energy
delay definitive surgical management until soft tissue coverage (within 72 hours). External fixation may be used in the interim.

34
Q

What are Osler’s nodes

A

painful, red, raised lesions found in the hands and feet as a result of deposition of immune complexes

35
Q

What are bouchard’s nodes?

A

hard, boney outgrowths from the PIPS. Sign of OA

36
Q

What are Heberden’s nodes?

A

permanent bony outgrowth which occur in the DIPs which may deviate distal portion..

37
Q

What is a ganglion?

A

Fluid filled swelling associated with a tendon sheath near a joint. Usually asymptomatic.

38
Q

What imaging for osteomyeltits?

A

MRI

39
Q

Posterior hip dislocation - mechanism and presentation

A

RTA, especially if driver was braking. Shortened and internally rotated leg.

40
Q

Presentation of anterior hip dislocations

A

abducted and, externally rotated, palpable bulge, associated with hip prostheses

41
Q

presentation of femoral shaft fracture

A

swelling, deformity and shortening of the leg. high impact mechanism.

42
Q

neck of femur fracture - presentation

A

low energy, elderly, shortened and externally rotated

43
Q

radial head subluxation - mechanism and presentation

A

pulling injuries in young children. reduced ability to supinate or extend the elbow joint.

44
Q

management of radial head subluxation

A

Analgesia, reduction by passive supination of the elbow at 90 degrees of flexion

45
Q

presentation of fat embolism in trauma patients

A

CVS - early, persistent tachycardia, later tachypnoea, dyspnoea, hypoxia, pyrexia
Derm - 25 - 50% have a non blanching petechial rash
CNS - confusion and agitation, retinal haemorrhages and intra-arterial fat globules on fundoscopy.

46
Q

Features of Nerve Root compression by level (L3,4,5&S1)

A

L3 - sensory loss over anterior thigh, weak quadriceps, reduced knee reflex
L4 - sensory loss over anterior knee, weak quadriceps, reduced knee reflex
L5 - sensory loss on dorsum of foot, weakness in foot and big toe dorsiflexion, reflexes normal
S1 - sensory loss on posterolateral leg and lateral foot. Weakness in plantar flexion of foot, reduced ankle reflex.

47
Q

Management of prolapsed disc

A

analgesia, physio, exercises. If red flags or persistent symptoms MRI

48
Q

Motor supply of Ulnar Nerve

A 
medial two lumbricals
aDductor pollicis
interossei
hypothenar muscles: abductor digiti minimi, flexor digiti minimi
flexor carpi ulnaris
49
Q

Sensory supplied by ulnar nerve

A

medial 1 1/2 fingers (palmar and dorsal aspects)

50
Q

Trochanteric bursitits- features, most commonly affected group

A

unilateral lateral hip pain - tender to palpation 50 to 70

women aged

51
Q

Pathology of and Clinical Presentation of Osteochondritis Dessicans

A

Subchondral bone damage, which causes swelling and pain in the affected joint, most commonly the knee.
Commonly affects young males with open growth plates.
Presents with pain and swelling after exercise,
painful clunking,
knee catching, locking or giving way

52
Q

Initial Management of Osteochondritis Dessicans

A

Low threshold for imaging (radiograph initially) or getting an orthopaedic opinion

53
Q

Which structure is divided in carpal tunnel release surgery?

A

flexor retinaculum

54
Q

Most common site of metatarsal stress fractures?

A

2nd Metatarsal shaft

55
Q

First-line management for lower back pain?

A

NSAIDs

56
Q

Risk factors for congenital hip dislocation (5)

A 
Female gender
Breech presentation
Family history
Firstborn
Oligohydramnios
57
Q

Presentation of a Meniscal Tear?

A

Pain worse on straightening the knee
Knee may ‘give way’
Displaced meniscal tears may cause knee locking - patient may have a way to ‘unlock’
Tenderness along the joint line

58
Q

Special test for meniscal tears?

A

Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee

59
Q

What iliotibial band syndrome?

Who gets it?

A

Pain on the lateral aspect of the knee, 2-3 cm above the joint line.
Regular runners - common in this group

60
Q

Management of iliotibial band syndrome

A

activity modification and iliotibial band stretches

if not helping - physiotherapy referral

61
Q

Mx of compartment syndrome

A
  • prompt and extensive fasciotomies
  • Myoglobinuria may occur so patients require aggressive
    IV fluids
  • frankly necrotic muscle should be debrided and
    amputation may have to be considered
62
Q

burning thigh pain? most likely cause?

A

meralgia paraesthetica - lateral cutaneous nerve of thigh compression

63
Q

features of ruptured anterior cruciate ligament and management

A

Sport injury
high twisting force applied to a bent knee
Loud crack, pain and RAPID joint swelling (haemoarthrosis)
Poor healing
Management: intense physiotherapy or surgery

64
Q

features of ruptured posterior cruciate ligament and special test

A

hyperextension of the knee injuries

paradoxical anterior draw test

65
Q

What is a Hill-Sachs lesion and when does it occur?

A

Cartilage surface of the humerus is in contact with the rim of the glenoid
anterior dislocation

66
Q

Occult hip fracture imaging modality

A

MRI

67
Q

Presentation of Chondromalacia Palattea

A

Teenage girls, following an injury to knee e.g. Dislocation patella
Typical history of pain on going downstairs or at rest
Tenderness, quadriceps wasting

68
Q

Presentation of dislocation of the patella

Imaging required

A

Most commonly occurs as a traumatic primary event, either through direct trauma or through severe contraction of quadriceps with knee stretched in valgus and external rotation
Skyline x-ray views of patella are required, although displaced patella may be clinically obvious

69
Q

Risk factors for patella dislocation

A

Genu valgum, tibial torsion and high riding patella

70
Q

What is Oscood-Schlatter disease? Who gets it? Mx?

A

inflammation at the tibial tuberosity caused by repeated avulsion of the apophysis into which the patellar tendon is inserted
Athletic teenagers

Management is supportive

71
Q

Causes of Drupytrens contracture (6)

A 
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
family Hx
72
Q

two fractures associated with compartment syndrome

A

supracondylar and tibial shaft fractures

73
Q

causative organism of osteomyelitis in sickle cell anaemia

A

Salmonella

Finals (34 decks)

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