msk Flashcards
1
Q
twisting knee injury knee swollen and painful to palpate - worse on straightening knee McMurray’s test positive (painful click) diagnosis
A
possible meniscal tear
2
Q
falling hard onto bent knee positive posterior drawer test diagnosis?
A
injury to posterior cruciate ligament
3
Q
direct trauma to knee positive patellar apprehension test diagnosis?
A
patella dislocation
4
Q
hyperextension of knee positive anterior drawer test diagnosis
A
anterior cruciate ligament rupture
5
Q
repeated jumping and landing on hard surfaces anterior knee pain over 2-4wks which comes on with exercise and worsens with jumping diagnosis
A
patella tendinopathy (or ‘jumpers knee)
6
Q
causes of carpal tunnel syndrome
A
idiopathic pregnancy oedema (heart failure) lunate fracture rheumatoid arthritis
7
Q
isolated lateral hip/thigh pain with tenderness over greater trochanter able to weight bear no trauma hx systemically well discomfort worse at night when lying on that side diagnosis
A
greater trochanteric pain syndrome (trochanteric. bursitis) due to repeated movement of fibroelastic iliotibial band - most common in women 50-70
8
Q
rugby player painful knee popping sensation in right knee during match swollen unable to fully extend knee most appropriate imaging?
A
meniscal tear: MRI
9
Q
36yr 6wk hx painful wrist pain over radial aspect of wrist elicited by forced adduction and flexion of thumb test name? most likely diagnosis?
A
Finkelstein’s test De Quervain’s tenosynovitis
10
Q
diagnosis?
A
collar on scotty dog appearance = Spondylolysis
Spondylolysis = fracture of pars interarticularis (sticking out bit of vertebra)
Spondylolisthesis: fracture + slipping of one vertebral body on another
11
Q
diagnosis
sporting injury - forced abduction and external rotation
loss of deltoid mass
A
anterior dislocation of humeral head
- humerus inconguinent with glenoid (inferior to glenoid and overlaps)
- most common type of shoulder dislocation
- forced abduction and external rotation
- loss of deltoid mass
posterior dislocation: is usually in line so harder to spot on AP
12
Q
fall on outstretched hand
diagnosis?
A
posterior humeral dislocation
light bulb sign - fixed in internal rotation so humeral head looks more round (like light bulb)
13
Q
reducing mechanisms for anterior humeral dislocation
A
- hanging arm (stimson maneuvre) - hanging arm with weight
- Kocher: traction with external rotation, adduction, then internal rotation
- Hippocrates: foot in armput and pull on arm
14
Q
neers classification
A
for humerus head fracture
15
Q
what movement do you lose first in frozen shoulder
A
lose external rotation first
16
Q
management for frozen shoulder
A
also called adhesive capsulitis - inflammation of capsule
Mx:
- first line conservative
- if not better after 3 months:
- manipulation under anaesthesia
- arthroscopy/ open capsular release
17
Q
features of supracondylar fracture of distal humerus
A
usually child falling on outstretched hand
reduction in extension
stiffness in elbow joint
18
Q
Volkmann’s ischaemic contracture
A
permanent flexion contracture of forearm following a period of ischaemia that can follow a supracondylar fracture
19
Q
Mx for supracondylar fracture of distal humerus
A
surgical - bicortical wire fixation
20
Q
intra-articular fractures Mx
A
intra-articular: within the joint
open reduction, internal rigid fixation
- to promote primary bone healing
21
Q
olecranon fracture Mx
A
undisplaced: immobilization and cast
displaced: surgery - tension band wiring or plate
22
Q
fall on outstretched hand
diagnosis?
management?
A
posterior dislocation of ulner
Mx:
uncomplicated: reduce with traction
collar and cuff flexed at 90 degrees
23
Q
what is tennis elbow
Mx
A
lateral epicondylosis (in extensor tendons)
Mx:
- XR
- anti-inflammatory
- corticosteroid + LA injection
24
Q
what is golfer’s elbow
A
pain over medial epicondyle
flexor tendons
25
colles vs smith fracture
Mx
colles:
- fall on outstretched hand
- dorsal (upward) displacement
smiths:
- fall on back of hand
- palmar displacement
Mx: closed reduction, back slab and repeat XR
26
scaphoid palpable in anatomical snuffbox when thumb hyperextended
diagnosis?
Mx:
scaphoid palpable: scaphoid fracture
Mx: POP cast
27
saturday night palsy
Mx
radial nerve palsy
fall asleep drunk on chair with arm over back of chair --\> compression of radial nerve in axilla
wrist drop + sensory loss
Mx: wrist splints
28
nerve compression
Ix
Mx
Ix: nerve conduction studies
Mx: splint
if needed surgical decompression
29
what test is used to determine the arterial blood supply of the hand
allens test
30
diagnosis?
ganglion cyst
fixed to deep tissue but not to overlying skin
transilluminates
31
test for de quervains tenosynovitis
Finkelsteins
32
causes of carpal tunnel syndrome
ICRAMPS
Idiopathic
Colles, Cushings
Rheumatoid
Acromegaly/Amyloid
Myxoedema, mass, (diabetes) Mellitus
Pregnancy
Sarcoid, SLE
33
shortened and externally rotated leg
neck of femur fracture
34
what to worry about with intracapsular fracture of femur
**avascular necrosis**
due to disruption of **lateral femoral circumflex artery**
35
garden classification
for neck of femur fractures
36
diagnosis
posterior hip dislocation
flexxed, internally rotated and adducted
usually due to fall from height
Mx: relocation in A&E or in theatre under GA
37
band of pain going down lower back
sacroiliac joint disfunction
38
recent URTI
mild fever
acute groin/thigh pain
in children
refuse to weight bare
in flexion abduction and external rotation
diagnosis?
Mx
Transient Synovitis of the Hip (paeds)
- must rule out septic arthritis
- XR normal
- do USS if suspicious of septic arthritis
Mx: treat conservatively (NSAIDs)
39
hot painful swollen joint
fever
systemically unwell
knee most commonly
septic arthritis
40
most common bacteria causing septic arthritis
staph.aureus
41
risk factors for septic arthritis
- Common in patients \>80yo with history of:
- crystal arthropathy,
- IVDU,
- endocarditis
- recent bacteraemia
42
Mx of septic arthritis
A-E
bloods: WCC and CRP
aspiration and sent for C&S
- IV abx STAT and joint wash out in theatre
43
swollen painful knee with varus or valgus deformity
diagnosis
Ix
Mx
tibial plateau fracture
Ix: CT
Mx:
- undisplaced: hinge brace
- displaced: ORIF
44
ACL and PCL role
ACL: prevents anterior movement of tibia
connects from back of femur to front of tibia
PCL: restricts posterior movement of tibia
45
ACL/ PCL classical presentation
Mx
on side stepping sports
snap/ pop sound
immediate swelling of knee
feeling of instability with knee
Mx:
- conservatively with drainage of haemarthrosis with PT
- PCLs recover well under conservative
- surgical reconstruction: tendon transfer from hamstring or patella
46
medial/ collateral ligament injury
valgus or varus of each?
Valgus (MCL injury)
Varus (LCL injury)
47
does meniscal injury in the knee cause slow or quick swelling
slow swelling
48
anterior vx posterior knee dislocation
Mx
anterior: tibia forward, femur back
posterior: tibia back, femur forward
Mx: urgent reduction under anaesthesia
49
signs of osteoarthritis on XR
LOSS
L: loss of joint space
O: osteophytes
S: subchondral sclerosis
S: subchondral cyst
50
management of knee osteoarthritis
usually conserative
as it progresses surgery:
knee arthroplasty
total knee replacement
51
diagnosis
dislocation of patella
52
presentation of Osgood Schlatter's disease
inflammation where tendon from kneecap (patella tendon) attaches to tibia
pain and lump after exercise over tibial tuberosity
pain worse when going up stairs
Mx: rest and restriction of activity
53
what type of bursitis is housemaids knee
prepatella bursitis
- lying over the patella
- working on knees frequently
54
what type of bursitis is clergymans knee
infrapatella bursitis
- below patella over patella tendon
- also occurs in people who work on knees
55
managment of prepatella and infrapatella busitis
firm bandaging
avoiding kneeling without protective padding
bursa may require aspiration
56
what classification is used for ankle fractures
Webers classification: a,b,c
57
mangement of ankle fractures according to weber classification
A & B: cast/boot and weight bear as tolerated
C (unstable - above level of syndesmosis): ORIF
58
unilateral foot in dorsiflexed position
been running up hill
simmonds test positive
diagnosis
achilles tendon rupture
- simmonds test: squeezing calf produces no plantar flexion in affected foot
59
slow onset over time
diagnosis?
Mx
bunion (hallux valgus)
metatarsopharyngeal joint
Mx:
wear wider shoes
surgery
60
management of plantar fasciitis
common cause of heel pain
conservative
surgery after 9months if conservative not helping --\> plantar fasciotomy
61
the 5P's of compartment syndrome
**Pain** (with passive stretch)
**Paraesthesia**
Perishingly cold, Pallor
Paralysis
Pulselessness
**severe pain disproportionate to injury**
presents within hrs
pain may be absent with nerve damage
62
diagnosis of compartment syndrome
mostly clinical
if uncertain: **intra-compartmental pressure monitor \>30**
creatinine kinase may be elevated
63
management of compartment syndrome
**early recognition**
immediate surgical treatment: **urgent fasciotomies**
**skin incisions are left open** and a re-look is planned for 24-48hrs (for debridement of dead tissue)
**monitor renal function**
also:
- keep leg in neutral position (not elevated or lowered)
- high flow O2
- help BP with bolus of IV crystalloid fluids
- **Remove all dressings / splints / casts**
64
developmental dysplasia of hip Ix and Mx
all infants screened after birth
\<4months: USS
4-6months after ossification begins : XR
\<6months: Pavlick harness (abduction bracing)
6-18 months: closed reduction and spica casting
\>18months: open reduction with spica casting
\>2yrs: osteotomy
65
screening tests for developmental dysplasia of hip
Barlow test: (Barlow bad)
- push down with legs together
- hip started reduced - test will dislocate hip
Ortolani test:
- push leg apart and round
- hip started dislocated - test will reduce hip
66
cancers that commonly spread to bone
breast
bronchus
thyroid
renal
prostate
67
most common primary bone cancer
multiple myeloma (bone marrow)
lytic lesions
68
most likely type of cancer
osteosarcoma
- presents most commonly in knee, femor or tibia
69
bone cancer most likely to affect children
Ewing's sarcoma
-presents children 5-30
in upper and lower leg, pelvis, upper arm and ribs
70
chondrosarcoma
cancer of cartilage
71
differentials for hip pain in children
72
normal serum calcium
normal serum phosphate
normal ALP
normal PTH
diagnosis?
osteoporosis
in elderly and more common in women
73
decreased calcium
decreased phosphate
increased ALP
increased PTH
diagnosis
osteomalacia
(rickets in children)
have low vit D
Mx: calcium + vit D
74
normal calcium
normal phosphate
increased ALP
normal PTH
Pagets disease
75
claw hand following medial epicondyle fracture
ulner nerve damage
76
rheumatoid arthritis features
autoimmune
more common in females
adults of all ages
MCP (2nd and 3rd) and PIP joints
morning stiffness - improves with use
bilateral symptoms
systemic upset
77
rheumatoid arthritis X-ray findings
loss of joint space
juxta-articular osteoporosis
periarticular erosions
subluxation
78
features of osteoarthritis
79
bone pain
deaf
isolated raised ALP
pagets disease of bone
80
middle aged woman
raynauds phenomenon
dysphagia
multiple telangiectasia
systemic sclerosis
part of CREST symptoms: limited systemic sclerosis
81
polyarteritis nodosa
more common in middle aged men
associated with hep B infection
features:
- fever
- malaise
- arthralgia (joint stiffness)
- livedo reticularis
- neuropathy
82
FRAX for osteoporosis:
FRAX:
history of glucocorticoid use
rheumatoid arthritis
alcohol excess
history of parental hip fracture
low body mass index
current smoking
83
foot drop following a fibular neck fracture
which nerve
common peroneal nerve
84
what condition do you get this in
chondrocalcinosis (calcium deposits in articular cartilage)
gout
pseudogout
high calcium
high PTH
85
common symptoms of meniscal injury
locking and giving way
86
unhappy triad following a lateral blow to knee
damage to what?
medial collateral ligament
anterior cruciate ligament
meniscus
87
which nerve damage results in winged scapula
long thoracic nerve
often injured during sport
complication of mastectomy (breast removal)
88
wrist drop
which nerve and where most likely injured
radial nerve
due to humeral midshaft fracture
89
flattened deltoid muscle
which nerve and where injured
axillary nerve
injured at humeral neck fracture/ dislocation
90
Erb-Duchenne palsy (waiter's tip) vs Klumpke injury
Erb-Duchenne palsy (waiter's tip):
- damage to upper trunk of brachial plexus (C5,C6)
- can be 2ndry to shoulder dystocia
Klumpke injury:
- damage of lower trunk of brachial plexus
- due to sudden upward jerk of hand
- may be 2ndry to shoulder dystocia
91
which nerve supplies pincer grip
median nerve
92
calcium
phosphate
ALP
PTH
levels in MSK conditions
93
adhesive capsulitis of shoulder
features
external rotation impaired
painful stiff shoulder
94
most common bacteria for osteomyelitis
staph. aureus
95
marfans syndrome
deficiency of what
deficiency of fibrillin --\> disorder of connective tissue
mutation on chromosome 15
96
contraindication for bisphosphonates
if eGFR \<35
can give strontium ranelate or raloxifene (if T-score \<-3.5)
strictest criteria for denosumab
97
type of fracture
buckle fracture
bulging of the cortex
typically 5-10yrs
usually self limiting or splinting and immobilisation
98
what type of fractures are at increased risk on bisphosphonates
atypical stress fractures at increased risk on bisphosphonates
99
imaging for osteomyelitis
MRI (looking for bone marrow oedema)
100
most common site of metatarsal stress fractures
2nd metatarsal shaft
need MRI to visualise fracture
101
Behcets syndrome
autoimmune inflammation of arteries and veins
triad:
- oral ulcers
- genital ulcers
- anterior uveitis
102
fat embolism presentation
after recent injury
early persistent tachycardia
tachypnoea, dyspnoea, hypoxia usually 72hrs following injury
pyrexia
red/brown impalpable petechial rash
confusion and agitation
103
man suspected of giant cell arteritis (temporal arteritis)
given prednisolone
biopsy normal
what next
can have skip lesions in giant cell arteritis
may therefore show normal biopsy
continue prednisolone regardless of biopsy result
104
nerves in legs and injury sites
105
which nerve at risk during total hip replacement
sciatic nerve
106
common peroneal nerve
causes dorsiflexion of foot
injury results in foot drop
nerve runs around neck of fibula
107
what should patients be given when taking long-term steroids
bone protection started immediately = alendronate + calcium and vit D replete
108
knee pain after exercise
locking and 'clunking'
osteochondritis dissecans
overuse of joints due to sporting activity - big risk factor
most commonly btwn 12-19yrs
109
SUFE ix and mx
teenage obese
loss of internal rotation of leg in flexion
emergency due to risk of avascular necrosis
Ix: AP and lateral (frog leg) Xray
Mx: internal fixation across growth plate
110
fever
back/flank pain
pain on extension of hip
iliopsoas abscess
most common cause: staph aureus
most common secondary cause: chrons
raise thigh against hand will elicit pain (contraction of psoas muscle)
lie patient on normal side and hyperextend affected hip - pain as psoas stretched
CT is investigation of choice
Mx: abx + percutaneous drainage
111
most likely neurovascular structure compromised in scaphoid fracture
dorsal carpal arch of the radial artery
leading to avascular necrosis
112
long term steroid use
progressive pain in right hip joint
painful in all directions
no shortening or external rotation
xray: osteopenia and microfractures
avascular necrosis of the femoral head
risk factors:
- long term steroid use
- chemo
- alcohol excess
- trauma
pain in affected joint
Xray: early on shows osteopenia and microfractures
collapse of articular surface may show crescent sign
MRI is ix of choice
joint replacment may be needed
113
test to show median nerve injury
make a 6 with thumb and forefinger
114
examining for ulner nerve injury
spread fingers apart
115
repeating units of muscle
sarcomere
repeating units of actin and myosis
