MSK Flashcards
UPPER LIMB
SHOULDER
What medical problems can cause shoulder pain?
- Ischemic chest pain
- Diaphragmatic irritation from pneumonia
- Blood within peritoneum e.g. from eptopic pregnancy
Injuries to the shoulder….
FOOSH
- Fracture of clavicle
- Anterior shoulder dislocation (affects auxillary nerve)
- Fracture of neck of humerus (affects auxillary nerve)
Direct trauma
- Fracture of clavicle
- Disruption of acromioclavicular joint
- Fracture of shaft of humerus (affects radial nerve)
Posterior shoulder dislocation
- Suspect if painful shoulder following electrocution or seizure = causes contraction of the strong latissimus doors muscles
Ruptured biceps + tendinitis
- caused by repeated stess on bicep tendon in subacromial space from repetitive movements of arm above head
Frozen shoulder
- can occur after repeated trauma or painful condition that causes restrictive movement
- more common in diabetes
Injuries to the elbow….
FOOSH
- radial head fractures
Olecranon fractures
Dislocated elbow
- hyper extension of elbow
- affects brachial artery + median nerve
Pulled elbow
- no obvious pain on palpation
Epicondylitis
- medial epicondylitis fractures (affects ulna nerve)
Olecranon bursitis
- caused by direct blow, or repetitive minor injury due to leaning/rubbing against table
Referred pain
- pain from humerus, shoulder, neck can present with elbow symptoms, wrist + radial joint
Distal biceps tendon rupture
- sudden pain over front of elbow after lifting heavy object against a flexed elbow
Injuries to the wrist….
Scaphoid fracture
- tenderness in anatomical snuff box
Carpal tunnel syndrome
- compression of median nerve
- pain, numbness
Pseudogout
- painfull, swollen red wrist
Colles fracture
- FOOSH
- Dinner fork deformity
Fractures of shaft of radium +
ulna
- nightstick fractures
- usually defence injury
Injuries to the hand….
Metacarpal fractures
- often caused by punch
Paronychia
- infection of nail fold
Thenar eminence Sprain
- forced abduction of thumb
Amputations
- successful preimplantation of digits severed distal to DIPJ is unlikely as nerves, arteries and veins are to small
Arthritis
- osteoarthritis (pain common at bottom of thumb)
- gout + pseudo gout (painful joint in hands, treated with elevation + splintage
Injuries to the hips….
Stress fracture
- combination of minor injuries e.g. runners
Septic arthritis
- non-traumatic hip pain, systemic upset esp if immunocompromised or pt has prosthetic joint
Pain from acute crush fractures of the lumbar spine, degenerative disc disease & nerve root compression can all be experienced in the hip & buttocks rather than the back.
Fasial block - common analgesia in ED
OTTAWA KNEE RULES
- X-ray guidelines
- 55 y/o +
- Isolated tenderness of patella
- Tenderness at head of fibula
- Inability to flex to 90 o
- inability to weight both immediately + in ED (4 steps)
Injuries to the knee….
Anterior cruciate ligament rupture
- twinning with change in direction
Posterior cruicite ligament rupture
- direct force on anterior tibia e.g. dashboard injury
Head of fibula #
- e.g direct blow
Dislocated knee / patella
Gout + pseudogout
Referred pain
- pain from hip can be referred to knee
Septic arthritis
Injuries to the calf + shin….
Thrombophlebitis
- tenderness + thread like lumpiness overlying superficial vein
- superficial thrombophlebitis in absence of varicose veins - DVT risk factor
DVT
- Aching, tenderness & swelling developing over a number of days/weeks
- Oedema of affected leg
- Redness & warmth over thrombosis
- Factors promotion;
- Prolonged immobility
- Major surgery
- Thrombophilias
Compartment syndrome
- Results from swelling of a muscle within fascia compartments e.g. forearm, leg or foot
- If left untreated the muscle dies, resulting in untreatable Ischemic contracture
- Severe & unremitting pain - usually result of severe crush injuries, but may occur after minor injuries e.g. soft tissue bruising
- Disproportionate pain, tense & swollen compartment, inability to walk & pain on passive stretch of the muscles.
- Numbness & cold digits
Ruptured bakers cyst
- Bakers cyst is out-pouching of synovium of the knee joint - occurs in people with inflammatory or degenerative arthritis & gives rise to a fullness in the popliteal fossa
- When fluid leaks out of the synovium into the calf muscle it excites an inflammatory response = sudden onset pain & swelling
Injuries to the ankle + foot….
Sprains
- damage to lateral ligament complex
Achilles tendon rupture
- e.g. when jumping
Fractured calcaneum
- e.g. fall from height
5th metatarsal fracture
- twisting or sudden inversion of foot
Crush injuries
Stress #
- common in metatarsals
Talar #
- fall on an inverted foot
Toe #
- big toe needs x-ray
- no need to treat # of other toes unless wound over toes
Plantar fasciitis
- pain in heal, no trauma
Gout
- swelling in 1st metatarsal joint
Ischemia
OTTAWA ANKLE RULES
Ankle radiograph should be performed if there is pain in the malleolar region with any of the following…
- bone tenderness at posterior edge of distal 6cm or the tip of lateral malleolus
- one tenderness at posterior edge of distal 6cm or the tip of medial malleolus
- Inability to weight bare for at least 4 steps both immediately after injury + at time of evaluation
Ankle radiograph should be performed if there is pain in the mid foot region with any of the following…
- bone tenderness at the navicular bone
- bone tenderness at the base of 5th metatarsal
- inability to weight bare for at least 4 steps both immediately after injury + at time of evaluation
What is the surgical sieve
- INVITED MD stand for?
Infection / iatrogenic Neuoplasia Vascular Inflammatory Trauma Endocrine Degenerative
Metabolic
Drugs
Causes of back pain…
- Infection/iatrogenic e.g. kidney
- Neoplasia (new growth = cancer) e.g. breast cancer
- Radiation from chest e.g. PE, Pneumonia, MI
- Vascular / radiation from abdomen e.g. leaking AAA, Pancreatitis (central abdo & radiates to back - usually N&V), Renal colic (causes unilateral back pain that radiates to groin, pain comes & goes in waves& can be associated with N&V)
- Inflammatory/autoimmune e.g. MS
- Trauma e.g. C-spine fractures
- Degenerative (and congenital) e.g. Osteoporosis
- Drugs e.g NSAIDS, alcohol (can affect pancreatitis)
Back conditions..
Sciatica
- caused by pressure on the nerve roots that make up the sciatic nerve (L4-S2). Pain typically goes below knee
Cauda Equina
- occurs when pressure on the nerve roots in the lower part of the spinal canal causes neurological dysfunction (entrapment of nerve)
• Causes; metastatic/primary tumours, large central disc prolapse, bony fragments in trauma.
• Usually presents acutely, but onset can be gradual
• Symptoms; bilateral leg/back pain, weakness in both legs, altered perianal sensation, sphincter disturbance, saddle sensation (urinary/faecal incontenance & retension) & sudden sexual dysfunction)
What are the RED FLAG Symptoms in back pain - TUNA FISH
T = Trauma U = Unexplained weight loss N = Neurological symptoms e.g. altered sensation, parathesia, loss of bowels A = Age > 50 F = Fever I = IVDU / Immunocompromised / Immunosuppressed e.g. HIV, on chemo S = Steroid use H = History of cancer / symptoms suggesting cancer e.g. fatigue, night sweats
