MSK Flashcards
common cause for a posterior shoulder dislocation
seizure/electric shock
define bankhart and hill sachs lesions
bankhart
injury to the anterior inferior glenoid labrum due to anterior shoulder dislocation
hills sach lesion
depression of the posterolateral head of the humerus due to anterior dislocation
what sign is seen on X ray in a posterior shoulder dislocation
lightbulb sign
what is the neer classification used for
proximal humerus fractures describes displacement of 4 segements humeral head greater tuberosity lesser tuberosity humeral shaft
what is a holstein-lewis fracture
spiral fracture of the distal 1/3 of the humeral shaft wioth associated radial nerve palsy
what is the terrible triad in elbow dislocations
lateral ulna collateral ligament tear + radial head fracture + coronoid tip fracture
how to assess an elbow dislocation
anterior humeral line
radiocapitellar line
posterior fat pads
what is a monteggia fracture
fracture of the proximal 1/3 of the ulna with anterior dislocation of the radial head
what is a galeazi fracture
fracture of the distal 1/3 of the radial shaft and associated with DRUJ injury
signs of DRUJ injury
ulna styloid fracture
widening of joint on AP x ray
dorsal or volar displacement on lateral x ray
radial shortening
what is bennets and boxers fracture
boxers = # distal 5th metacarpal bennets = # at base of the 1st metacarpal
describe the blood supple of the femoral head
comes from the femoral artery. It travels down the femur then loops back up in a retrograde fashion forming the femoral circumflex arteries which travels along the femoral neck
management of intracapsular hip fractures
if blood supple preserved (undisplaced) = fixation with screes and plate
if not preserved (displaced) = joint replacement (hemiarthroplasty in older/less active patients. total in younger/high functional demand)
management of extracapsular hip fracture
blood supply should be preserve = fixation
complications of hip fractures
AVN
non union
risk of dislocation following arthroplasty
DVT, chest infection, pressure sores
types of pelvic fractures
lateral compression
AP compression
vertical shear
complications of pelvic fractures
damage to surrounding organs (bowel, bladder, female genital organs, prostate/male urethra)
nerve and major vessel damage
management of pelvic fracture
high energy
pelvic binder to prevent blood loss
fixation with plates and bolts
low energy
mobilisation with analgesia
what is Weber classification used for
classification oflateral malleolarfractures, relating to the level of the fracture in relation to the distal tibiofibularsyndesmosis.
A = stable B = maybe C = unstable
management of ankle fractures
weber A = most likely conservative (boot/cast)
weber B = conservative/interanl fixation
weber C = internal fixation
what is lisfrac fracture
dislocation of the midfoot between tarsal bones and base of the metatarsals
presents with bruising on the sole, pain and swelling of midfoot, and inability to wt bear
tests for subacromial inpingment
painful arc test
neer impingement test
hawkins test
tests for rotator cuff tears
supraspinatous - empty can test
infraspinatous - external rotation
teres minor - horn blower sign
subscapularis - lift off/belly press test
what is tennis elbow
lateral epicondylitis
overuse of the extensor carpi radialis brevis
pain with gripping and resister wrist extension
what is golfers elbow
medial epicondylitis
overuse of the flexor pronator origin
pain with gripping and resisted wrist flexion
presentation of olecranon bursitis
swelling, redness, pain
fever if infective
diagnosis of olecranon bursitis
gold standard = aseptic needle aspiration of bursa for gram stain and culture
management of tennis or golfers elbow
NSAIDs
physio
corticosteroid injection
surgical debridement and reattachment of ECRB origin/flexor pronator origin
management of olecranon bursitis
NSAIDs
if infective - Abx
bursectomy if recurrent
management of DDH
<3months old = splintage of joints in abduction and flexion
3-18months = closed or open reduction + immobilisation in hip spica cast
walking child = above + osteotomy if significant dysplasia
later childhood/adolescence = femoral/acetabular osteotomy (consider THR)
knee injury terrible triad
ACL tear
MCL tear
medial meniscus tear
structures found in the carpal tunnel
median nerve
flexor pollicis longus
4 x flexor digitorum superficialis
4 x flexor digitorum profundus
disease associated with carpal tunnel syndrome
diabetes RA pregnancy wrist fractures hypothyroidism acromegaly
presentation of carpal tunnel syndrome
gradual onset
intermittent symptoms (worse at night)
numbness/tingling in median nerve distribution (alleviated by shaking)
hand weakness
clinical findings in carpal tunnel syndrome
altered sensation ring finger splitting LOAF weakness (test = thumb abduction) thenar muscle wasting \+tinnels \+phalens
LOAF muscles
lumbricals of digits 2 and 3
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis
management of carpal tunnel syndrome
wrist splint (especially for night symptoms)
steroid injections
decompression surgery
what is trigger finger
tendonitis of the digital flexor tendon at the A1 pulley leading to catching and locking.
Constriction and thickening of the A1 pulley forming a nodule on the tendon.
Associated with
Diabetes
RA
Pregnancy
presentation trigger finger
finger sticks in flexion then clicks painfully as finger is extended
worse in the morning
management of trigger finger
splitage
steroid injection
surgical release/widening of the A1 pulley
presentation of extensor tendon subluxation
weakness of the saggital bands that hold the extensor tendon over the MCJP
tendon subluxes on flexion leading to it flicking back in extension or needing to be straightened manually
management of extensor tendon subluxation
splint with MCPJ extended
surgical reconstruction
risk factors for dupuytren’s disease
alcohol
family history
diabetes
epilepsy and anticonvulsant therapy
presentation of dupuytren’s
lumps on palm progressing into contractures of the fingers
skin thickening, tethering, puckering, pitting
fixed flexion deformities at MCP and PIP
what are some ectopic manifestations in dupuytren’s disease
plantar fasciitis of feet (ledderhouse disease)
knuckle pads on dorsal aspect of PIP (garrods disease)
dartos fascia of penis (peyronies disease_
management of dupuytren’s disease
needle aponneurectomy
collagenase injections
fasciectomy
dermo fasciectomy
management of mechanical back pain w/o red flags
patient education
simple analgesia
return to normal physical activity
self referral to physio
what is c spine triple immobilisation
hard collar
tape
blocks
blood loss in haemorrhagic shock classes
I < 15%
II 15-30%
III 30-40%
IV >40%
signs of OA
crepitation
limited ROM
heberden’s (DIP) and bochard’s (PIP) nodes
muscle wasting
X ray of OA
loss of articular cartilage/JS narrowing
subchondral cysts
subchondral sclerosis
osteophytes
red flag symptoms for bone cancer
night pain
unremitting pain
non traumatic limb pain
wt loss
investigations if suspicious og bone/soft tissue lesions
x ray
alkaline phosphatase
ct/MRI
biopsy
common benign bone/soft tissue tumours
osteoid osteoma - osteoblasts - femur, tibia
osteochondroma - cartilage capped bony projections on the surface of bones
enchondroma - cartilage
simple bone cyst - cavity filled with yellow fluid
lipoma - fat tissue
malignant bone/soft tissue tumours
osteosarcoma - metaphysis of distal femur, proximal tibia, proximal humerus
chondrosarcoma - cartilage - femur, pelvis, scapula
ewing’s sarcoma - mesenchymal cells of medullary cavity - dyaphysis of long bones
cancers that commonly spread to the bone
breast prostate lung renal thyroid
osteoporotic fractures
vertebral crush
distal radius
humeral neck
hip
risk factors for osteoporosis
oestrogen deficiency
malabsorption (IBD, coeliac, chronic pancreatitis)
endocrine (hyperparathyroidism, diabetes)
Low BMI
corticosteroid use
investigations for osteoporosis
FRAX score
DEXA
Ca, phosphate, Vit D, PTH, TFTs, Testosterone
management of osteoporosis
exercise, smoking cessation Vit D and Ca supplements bisphosphonates - alendronic acid salmon calcitonin Denosumab (anti RANKL) recombinant PTH Raloxifine, HRT (menopause related)
features of osteomalcia
bone and muscle pain
proximal weakness (waddling gait)
fractures
loss of pelvic volume (obstetrics issues)
features of Rickets
bowing of long bones
varus/valgus deformity
Rachitic rosary
kyphosis
investigations for osteomalacia
low serum and urinary Ca low phosphate low Vit D (normal in phosphopenic osteomalacia) high alkaline phosphate x ray (osteopenic, looser's sones)
management of osteomalacia
calcium and vit D supplements
calcitriol
phosphate
define pagets disease
A chronic bone disorder that is characterised by focal areas of increased bone remodelling (osteoclast activity), resulting in overgrowth of poorly organised bone.
presentation of Pagets
localised bone or joint pain
deformities (frontal bossinf, protruding jaw, bowing of long bones)
limited ROM
Pathological fractures
complications of pagets
hearing loss (compression of CN VIII, fixation of ossicles, loss of bone mineral density pf the cochlear capsule) fracture, deformities transformation into osteosarcoma hyperparathyroidism
investogations for Pagets
high ALP but normal Ca and phosphate
X ray
radio isotope bone scan
management of pagets
zoledronic acid
calcitonin
analgesia
define osteomalacia
incomplete mineralisation of the underlying organic matrix
presentation of compartment syndrome
pain disproportional to injury
pain of passive stretching
acute limb ischaemia (6Ps)
investigations for compartment syndrome
compartment pressure > 30
delta pressure (DBP - compartment pressure) < 30
serum creatine kinase and urine myoglobin (muslce lysis.necrosis)
management of compartment syndrome
release of external pressure morphine fluids fasciectomy amputation chronic - limit exercise and NSAIDs
what re the compartments of the lower limb
anterior
lateral
superficial posterior
deep posterior
causes of septic arthritis
s. aureus
beta haemolytic strep
strep pneumoniae
neisseria gonorrhoea
haemophilus influezae in children
risk factors for septic arthritis
underlying joint disease prosthetic joint immunosuppressed steroid injection use IVDU
investigations for septic arthritis
joint aspirate WWC, CRP, ESR BC, urine NAAT x ray LFTs, U&Es (assess end organs for sepsis)
management of septic arthritis
flucloxacillin (strep or stalph)
ceftriaxone (gonococcal)
aspirate joint can alleviate pain
wash out
if prosthetic joint
aspirate and wash out in theatre
complications of septic arthritis
rapid destruction of joint
osteomyelitis
sepsis
death
wHat is de quervain’s tensynovitis
inflammation of the extersor pollicis brevis and abductor pollicis longus tendons
presentation of de quervain’s
pain on radial side of wrist
radial styloid tenderness
pain on resisted abduction of thumb
positive finkelstein’s test
management of De quervain’s
NSAIDs
steroid injection
splintage of thumb
surgical repair
