MSK Flashcards
what are the differentials of osteomyelitis
soft tissue infection/cellulitis charcot joint avascular necrosis gout fracture bursitis malignancy
define acute osteomyelitis
associated with inflammatory bone changes caused by pathogenic bacteria
present within 2 weeks
define chronic osteomyelitis
involves BONE NECROSIS
symptoms not until 6 weeks after onset infection
describe haemotagenous OM in the long bone
metaphysis = common site of infection
blood vessels penetrate midshaft then go to either end = metaphysis
at metaphysis blood flow is slower and no BM present and no phagocytes lining the capillaries so bacteria moves easily from blood to bone
why does OM occur in long bones of children
metaphysis very metabolically active due to growth
= large flow of blood to this area = higher chance of infection
why does OM occur in vertabrae of elderly
with age vertebrae = more vascular = more blood flow and higher chance of infection
what microbial factors help cause OM
different bacteria have different virulence factors
some bacteria e.g. S.aureus bind more easily to fibronectin, fibrinogen and collagen = easier cause OM
describe the hostological changes in acute OM
- bacteria reach bone and proliferate
- dendritic cell/macrophage activation
- immune system breaks down and destroys bacteria
- osteoblast/clast repair damaged bone
- resolution
describe the histological changes in chronic OM
- necrotic bone
- formation of sequestrum
- osteoblast form new bone around sequestrum = involucrum
- periosteum loosely attached to compact bone
- abscess formation
- tracking to nearby joints/muscles/skin/blood vessels
describe mycobacterium osteomyelitis
= extrapulmonary TB
slower onset and symptoms
biopsy essential for diagnosis
longer treatment = 12 months
what is gonococcal arthritis
joint infection caused by neisseria gonorrhoea
affects multiple joints
causes fever, arthritis, tenosynovitis and maculopapular pustular rash
what primary tumours are most likely to metastasis to bone
kidney = lytic prostate = sclerotic thyroid = lytic breast = lytic
what does lytic mean
bone destructive
what does sclerotic mean
bone forming
name the 5 most common primary bone tumours
- multiple myeloma = lytic
- hodgkin lymphoma = sclerotic
- ewing’s sarcoma = lytic
- osteosarcoma = lytic
- chondrosarcoma = lytic, sclerotic at higher grades
what are the red flags for bone malignancy
night pain weight loss rapid deterioration gross loss of movement infection non-mechanical
how does Paget’s present on XR
moth eaten bones
median nerve examination of hand
ask patient to make OK sign
check sensation of radial 3 digits on palm
median nerve palsies = loss of flexion in the two index fingers
radial nerve examination of hand
check patient can point with index finger
check sensation on back of hand of radial 3 and half digits
radial nerve palsies typically present with wrist drop
ulnar nerve examination of hand
ask patients to cross fingers
check sensation on ulnar side of hand
ulnar nerve palsies = claw hand as individuals unable to extend fingers
name 3 types of hip fracture
- sub-trochanteric
- intertrochanteric = always fixable
- intracapsular = likely chance of avascular necrosis if femur head displaced
what are the key principles of fracture management
reduction
stabilisation
rehabilitation
what is the number 1 cause of death for ages 1-46
trauma
define a fracture
soft tissue injury with loss of continuity of bone
what are the 5 Ps of compartment syndrome
pain pallor pulselessness paralysis perishingly cold
what shoulder dislocation is more common
anterior dislocation
name 6 metabolic diseases associated with pseudogout
haemochromatosis hyperparathyroidism hypophosphatasia hypomagnesaemia hypothyroidism acromegaly
what joints does RA commonly affect
hands = MCP and wrist neck and shoulder elbow knee ankle foot = MTP
how does RA present on XR
Loss of joint space
Erosions
Soft tissue swelling
Soft bones = osteopenia
+ juxta-articular bony lesions
what is fibromyalgia
chronic condition that causes muscular and musculoskeletal pain and stiffness
no known cause but believed to have genetic link
can be triggered by physical or emotional event
what is vertebral disk degeneration
anatomical changes and LOF of one or more intervertebral disk of the spine which causes symptoms
how does vertebral disk degeneration present
lower pack or upper neck pain = does not collate with level of deterioration
pain radiating to hips, buttocks, thigh or legs
pain worse on bending, lifting or twisting
arthritis, scoliosis, hypokyphosis or hyperlordosis may occur
how is vertebral disk degeneration diagnosed
radiography shows degenerative changes
how is vertebral disk degeneration treated
physical therapy
NSAIDs
epidural steroid injections
surgery
describe the Enneking system of grading malignant tumours
G1 = histologically benign, low mitotic count G2 = low grade malignant, few mitoses, low risk of mets G3 = high grade malignant, frequent mitoses, high risk of mets
describe the Enneking classification of benign tumours
grade 1 = latent, well defined and may heal spontaneously
grade 2 = active, progressive growth, may expand, negligible recurrence after resection
grade 3 = aggressive, mets present in 5%, high recurrence after resection
what does the prefix osteo mean
originates from bone
what does the prefix chondro mean
originates from cartilage
what does the prefix rhabdomyo mean
originates from skeletal muscle
what does the suffix -oma mean
benign tumour
what does sarcoma mean
malignant connective tissue tumour
what does carcinoma mean
malignant epithelial/endothelial tumour
what does blastoma mean
malignant tumour of embryonic cells
what is Paget’s disease
condition that causes dysregulated cellular remodelling of bone which results in structural changes and deformity
where does Pagets most commonly affect
femur
pelvis
lumbar vertbra
skull
how does Pagets disease present
deformity first noticed in the skull headaches hearing loss bone pain bone weakness (pathological fracture) pain arthritis vision loss (rare)
name 6 disease that can be caused by Pagets disease
osteoarthritis heart failure kidney stones nervous system issues chronic dental issues/jaw infection ulceration of female reproductive organs
how is paget’s disease diagnosed
elevated alkaline phosphatase
normal Ca, Phosphate, aminotransferase
characteristic XR = moth eaten
how do you treat Paget’s disease
Bisphosphonates = alendronic acid
calcitonin
surgery = fix fractures/ degenerative arthritis/bone deformity fixation
what is Feltys syndrome
neutropenia
splenomegaly
RA
what is caplans syndrome
combination of RA and pneumoconiosis that manifests as intrapulmonary nodules
appear homogenous and well defined on XR
what is pneumoconiosis
disease of lungs due to inhalation of dust
inflammation, coughing, fibrosis
what activities increase the risk of MSK issues
heavy manual handling = over 2kg lifting above shoulders repetitive tasks lifting from below knee height incorrect manual handling/poor posture or grip fast repetitive work
what is epicondylitis
inflammation of epicondyles can be medial or lateral
associated with forceful pronation/supination = lateral
medial = forceful flexion/extension
how is epicondylitis treated
NSAIDS
rest
surgery
what is tenosynovitis
inflammation of a tendon/tendon sheath (sometimes)
associated with repetitive forceful work and hyperextension
how is de quervains tenosynovitis diagnosed
finklestein’s test = ask patient put thumb on the inside of hand and then ulnar deviate = pain is positive diagnosis
how is tenosynovitis treated
NSAIDs
rest
steroid injections
surgery
what is repetitive strain disorder
repetitive use of hand muscles causing cramp and fatigue
causes non-specific hand pain
associated with computer usage
treated with ergonomic working areas/reduced work load
what is hand arm vibration syndrome
due to excessive vibration of the hands
can cause secondary Raynauds
causes numbness/tingling/loss of dexterity
what is carpal tunnel
compression of median nerve due to swelling of carpal tunnel
can cause numbness, thenar wasting and tingling
what is carpal tunnel syndrome associated with
repeated flexion/extension of wrist hand transmitted vibrations obesity pregnancy RA hypothyroidism acromegaly
how is Carpal Tunnel syndrome diagnosed
positive Tinel’s test = tap on wrist with tendon hammer = pain
positive Phalen’s test = hold wrist flexed for few minutes = pain = indicate carpal tunnel
describe rotator cuff issues
usually affects supraspinitus = tears/damage
associated with shoulder impingement, OA, heavy manual handling, lifting above shoulder, throwing
painful arc between 70-120 degrees of lifting
what is thoracic outlet syndrome
compression of trunks of brachial plexus or subclavian artery
associated with poor posture and shoulder loading
causes pain or tingling down arm/blanching of fingers
describe mechanical back pain
pain associated with abnormal stress or strain on vertebral column
associated with heavy manual lifting, stooping, twisting while lifting, whole body vibration
what are common causes of mechanical back pain
sprain/strain
disk herniation
vertebral column fracture
lumbar spinal stenosis
spondylolisthesis
how is mechanical back pain treated
NSAIDs/other analgesics
spinal exercises
encouragement of normal activity
what is dupytren’s contracture
thickening of palmar tendons
associated with vibrating tool use
what is game keepers thumb
dislocation of thumb
associated with hyperextension
what is writers cramps
focal dystonia where hand is stuck in pen holding way
what are the most common causes of septic arthritis and osteomyelitis
OM = s. aureus
Septic arthritis = s.aureus EXCEPT in sexually active young people = N. gonorrhoea
most common cause of reactive arthritis
chlamydia
what is antiphospholipid syndrome
acquired disorder
1. predisposition to venous/arterial clots
2. recurrent fetal loss
3. thrombocytopenia
30% have +ve antiphospholipid antibody
what condition can antiphospholipid syndrome occur secondary to
SLE
what are the features of antiphospholipid syndrome
venous/arterial thrombosis
recurrent miscarriages
pre-eclampsia
pulmonary HTN
what investigation findings in antiphospholipid syndrome
+ve antibodies
anticardiolipin antibodies
thrombocytopenia
prolonged APTT
how is antiphospholipid syndrome managed
primary:
low dose aspirin
secondary:
initial event = lifelong warfarin 2-3
second event = add aspirin + target 3-4
what is olecranon bursitis, how do you diagnose it, what is first line tx and what is an important ddx
inflamm + swelling over bursa of elbow
caused by leaning/infection/inflamm
diagnose with aspiration of synovial fluid + gram stain
treat with flucloxacillin (clarithromycin in pen allergic)
key ddx is gout/pseudogout
hiker/runner with gradual onset heel pain
what is it? how do you treat? what are the complications of treatment?
plantar fasciitis
give steroid injections
can cause rupture of plantar fascia
can cause fat pad atrophy
what is the landmark of a fractured NOF on XR
disruption of shentons line
how to manage an intracapsular NOF?
how to manage an intratrochanteric NOF?
how to manage a subtrochanteric NOF?
intrascapular = hemiarthroplasty / total hip replacement
intratrochanteric = dynamic hip screw
subtrochanteric = intramedullary nail
what can cause achilles tendon rupture and what movement is weak?
what is the clinical test?
clindamycin
ankle plantarflexion
simmonds calf squeeze
knee joint that goes pop after twisting, swelling, pain, restricted RoM + locks and gives way?
what special tests?
what test is gold standard?
meniscal tear
mcmurrays
apley grind test
MRI
arthroscopy = gold
what is first line carpal tunnel management
wrist splints at night
what condition is trigger finger associated with
diabetes
what is mortons neuroma?
what special test?
what special sign?
how to treat?
dysfunction of nerve in intermetatarsal space
= lump on foot, painful
Metatarsal squeeze test
mulders sign = painful click when manipulating metatarsal head
tx with steroid injections
what chemical is raised in gout
uric acid
crystals in gout vs pseudo gout
gout = negatively befringement needle monosodium urate crystals
pseudogout = positively befringement rhomboid calcium phosphate crystals
what is the medical term for bunion
hallux valgus
what are some causes of bakers cysts and what is the clinical sign
osteoarthritis
meniscal tear
RA
fouchers sign = soft swelling when knee flexed
guidelines for deciding whether to treat osteoporosis
NOGG
what would you see on XR and blood tests for osteomalacia
XR = looser zones
raised ALP
raised PTH
low Ca
low Phosphate
