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
What is the GALS assessment?
Gait
Arms
Legs
Spine
What is the role of TXA?
Stabilisation of clot, rather than stopping the bleeding
When would you consider Infection in back pain?
CONSIDER INFECTION -discitis (infection in invertebra disk space) & osteomyelitis (infection of bone marrow) in pt with new onset or worsening constant non-traumatic neck or back pain, particularly if pain is worse at night.
What are the RED FLAG Symptoms in neck pain -
- Hx of major trauma (or minor in elderly)
- Extremes of age (<20 or >55)
- Systemic symptoms (weight loss/fevers/chills)
- Hx of malignancy
- Night pain
- IV drug use
- Immunocompromised
- Chronic steroid use
- Rheumatoid arthritis
- Significant/progressive neurological signs
- Bladder or bowel dysfunction
Neck injuries…
Acute sprain injury
- whiplash
- pain + stiffness often delayed
- often associated with back/shoulder pain, headache + pins and needles in arms
Non-trauma torticollis
- caused by slipped cervical disc
- normally presenting with head over to affected side
Osteoarthritis & disc prolapse
- Neck pain & stiffness due to degenerative disease of cervical spine
