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MSK Flashcards

1
Q

common cause for a posterior shoulder dislocation

A

seizure/electric shock

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2
Q

define bankhart and hill sachs lesions

A

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

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3
Q

what sign is seen on X ray in a posterior shoulder dislocation

A

lightbulb sign

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4
Q

what is the neer classification used for

A 
proximal humerus fractures
describes displacement of 4 segements
humeral head
greater tuberosity
lesser tuberosity
humeral shaft
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5
Q

what is a holstein-lewis fracture

A

spiral fracture of the distal 1/3 of the humeral shaft wioth associated radial nerve palsy

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6
Q

what is the terrible triad in elbow dislocations

A

lateral ulna collateral ligament tear + radial head fracture + coronoid tip fracture

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7
Q

how to assess an elbow dislocation

A

anterior humeral line
radiocapitellar line
posterior fat pads

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8
Q

what is a monteggia fracture

A

fracture of the proximal 1/3 of the ulna with anterior dislocation of the radial head

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9
Q

what is a galeazi fracture

A

fracture of the distal 1/3 of the radial shaft and associated with DRUJ injury

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10
Q

signs of DRUJ injury

A

ulna styloid fracture
widening of joint on AP x ray
dorsal or volar displacement on lateral x ray
radial shortening

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11
Q

what is bennets and boxers fracture

A 
boxers = # distal 5th metacarpal
bennets = # at base of the 1st metacarpal
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12
Q

describe the blood supple of the femoral head

A

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

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13
Q

management of intracapsular hip fractures

A

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)

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14
Q

management of extracapsular hip fracture

A

blood supply should be preserve = fixation

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15
Q

complications of hip fractures

A

AVN
non union
risk of dislocation following arthroplasty
DVT, chest infection, pressure sores

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16
Q

types of pelvic fractures

A

lateral compression
AP compression
vertical shear

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17
Q

complications of pelvic fractures

A

damage to surrounding organs (bowel, bladder, female genital organs, prostate/male urethra)
nerve and major vessel damage

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18
Q

management of pelvic fracture

A

high energy
pelvic binder to prevent blood loss
fixation with plates and bolts

low energy
mobilisation with analgesia

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19
Q

what is Weber classification used for

A

classification oflateral malleolarfractures, relating to the level of the fracture in relation to the distal tibiofibularsyndesmosis.
A = stable B = maybe C = unstable

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20
Q

management of ankle fractures

A

weber A = most likely conservative (boot/cast)
weber B = conservative/interanl fixation
weber C = internal fixation

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21
Q

what is lisfrac fracture

A

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

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22
Q

tests for subacromial inpingment

A

painful arc test
neer impingement test
hawkins test

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23
Q

tests for rotator cuff tears

A

supraspinatous - empty can test
infraspinatous - external rotation
teres minor - horn blower sign
subscapularis - lift off/belly press test

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24
Q

what is tennis elbow

A

lateral epicondylitis
overuse of the extensor carpi radialis brevis

pain with gripping and resister wrist extension

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25
Q

what is golfers elbow

A

medial epicondylitis
overuse of the flexor pronator origin

pain with gripping and resisted wrist flexion

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26
Q

presentation of olecranon bursitis

A

swelling, redness, pain

fever if infective

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27
Q

diagnosis of olecranon bursitis

A

gold standard = aseptic needle aspiration of bursa for gram stain and culture

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28
Q

management of tennis or golfers elbow

A

NSAIDs
physio
corticosteroid injection
surgical debridement and reattachment of ECRB origin/flexor pronator origin

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29
Q

management of olecranon bursitis

A

NSAIDs
if infective - Abx
bursectomy if recurrent

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30
Q

management of DDH

A

<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)

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31
Q

knee injury terrible triad

A

ACL tear
MCL tear
medial meniscus tear

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32
Q

structures found in the carpal tunnel

A

median nerve
flexor pollicis longus
4 x flexor digitorum superficialis
4 x flexor digitorum profundus

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33
Q

disease associated with carpal tunnel syndrome

A 
diabetes
RA
pregnancy
wrist fractures
hypothyroidism
acromegaly
34
Q

presentation of carpal tunnel syndrome

A

gradual onset
intermittent symptoms (worse at night)
numbness/tingling in median nerve distribution (alleviated by shaking)
hand weakness

35
Q

clinical findings in carpal tunnel syndrome

A 
altered sensation
ring finger splitting
LOAF weakness (test = thumb abduction)
thenar muscle wasting
\+tinnels
\+phalens
36
Q

LOAF muscles

A

lumbricals of digits 2 and 3
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

37
Q

management of carpal tunnel syndrome

A

wrist splint (especially for night symptoms)
steroid injections
decompression surgery

38
Q

what is trigger finger

A

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

39
Q

presentation trigger finger

A

finger sticks in flexion then clicks painfully as finger is extended
worse in the morning

40
Q

management of trigger finger

A

splitage
steroid injection
surgical release/widening of the A1 pulley

41
Q

presentation of extensor tendon subluxation

A

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

42
Q

management of extensor tendon subluxation

A

splint with MCPJ extended

surgical reconstruction

43
Q

risk factors for dupuytren’s disease

A

alcohol
family history
diabetes
epilepsy and anticonvulsant therapy

44
Q

presentation of dupuytren’s

A

lumps on palm progressing into contractures of the fingers
skin thickening, tethering, puckering, pitting
fixed flexion deformities at MCP and PIP

45
Q

what are some ectopic manifestations in dupuytren’s disease

A

plantar fasciitis of feet (ledderhouse disease)
knuckle pads on dorsal aspect of PIP (garrods disease)
dartos fascia of penis (peyronies disease_

46
Q

management of dupuytren’s disease

A

needle aponneurectomy
collagenase injections
fasciectomy
dermo fasciectomy

47
Q

management of mechanical back pain w/o red flags

A

patient education
simple analgesia
return to normal physical activity
self referral to physio

48
Q

what is c spine triple immobilisation

A

hard collar
tape
blocks

49
Q

blood loss in haemorrhagic shock classes

A

I < 15%
II 15-30%
III 30-40%
IV >40%

50
Q

signs of OA

A

crepitation
limited ROM
heberden’s (DIP) and bochard’s (PIP) nodes
muscle wasting

51
Q

X ray of OA

A

loss of articular cartilage/JS narrowing
subchondral cysts
subchondral sclerosis
osteophytes

52
Q

red flag symptoms for bone cancer

A

night pain
unremitting pain
non traumatic limb pain
wt loss

53
Q

investigations if suspicious og bone/soft tissue lesions

A

x ray
alkaline phosphatase
ct/MRI
biopsy

54
Q

common benign bone/soft tissue tumours

A

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

55
Q

malignant bone/soft tissue tumours

A

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

56
Q

cancers that commonly spread to the bone

A 
breast
prostate
lung
renal
thyroid
57
Q

osteoporotic fractures

A

vertebral crush
distal radius
humeral neck
hip

58
Q

risk factors for osteoporosis

A

oestrogen deficiency
malabsorption (IBD, coeliac, chronic pancreatitis)
endocrine (hyperparathyroidism, diabetes)
Low BMI
corticosteroid use

59
Q

investigations for osteoporosis

A

FRAX score
DEXA
Ca, phosphate, Vit D, PTH, TFTs, Testosterone

60
Q

management of osteoporosis

A 
exercise, smoking cessation
Vit D and Ca supplements
bisphosphonates - alendronic acid
salmon calcitonin
Denosumab (anti RANKL)
recombinant PTH
Raloxifine, HRT (menopause related)
61
Q

features of osteomalcia

A

bone and muscle pain
proximal weakness (waddling gait)
fractures
loss of pelvic volume (obstetrics issues)

62
Q

features of Rickets

A

bowing of long bones
varus/valgus deformity
Rachitic rosary
kyphosis

63
Q

investigations for osteomalacia

A 
low serum and urinary Ca
low phosphate
low Vit D (normal in phosphopenic osteomalacia)
high alkaline phosphate
x ray (osteopenic, looser's sones)
64
Q

management of osteomalacia

A

calcium and vit D supplements
calcitriol
phosphate

65
Q

define pagets disease

A

A chronic bone disorder that is characterised by focal areas of increased bone remodelling (osteoclast activity), resulting in overgrowth of poorly organised bone.

66
Q

presentation of Pagets

A

localised bone or joint pain
deformities (frontal bossinf, protruding jaw, bowing of long bones)
limited ROM
Pathological fractures

67
Q

complications of pagets

A 
hearing loss (compression of CN VIII, fixation of ossicles, loss of bone mineral density pf the cochlear capsule)
fracture, deformities
transformation into osteosarcoma
hyperparathyroidism
68
Q

investogations for Pagets

A

high ALP but normal Ca and phosphate
X ray
radio isotope bone scan

69
Q

management of pagets

A

zoledronic acid
calcitonin
analgesia

70
Q

define osteomalacia

A

incomplete mineralisation of the underlying organic matrix

71
Q

presentation of compartment syndrome

A

pain disproportional to injury
pain of passive stretching
acute limb ischaemia (6Ps)

72
Q

investigations for compartment syndrome

A

compartment pressure > 30
delta pressure (DBP - compartment pressure) < 30
serum creatine kinase and urine myoglobin (muslce lysis.necrosis)

73
Q

management of compartment syndrome

A 
release of external pressure
morphine
fluids
fasciectomy
amputation
chronic - limit exercise and NSAIDs
74
Q

what re the compartments of the lower limb

A

anterior
lateral
superficial posterior
deep posterior

75
Q

causes of septic arthritis

A

s. aureus
beta haemolytic strep
strep pneumoniae

neisseria gonorrhoea
haemophilus influezae in children

76
Q

risk factors for septic arthritis

A 
underlying joint disease
prosthetic joint
immunosuppressed
steroid injection use
IVDU
77
Q

investigations for septic arthritis

A 
joint aspirate
WWC, CRP, ESR
BC, urine NAAT
x ray
LFTs, U&Es (assess end organs for sepsis)
78
Q

management of septic arthritis

A

flucloxacillin (strep or stalph)
ceftriaxone (gonococcal)
aspirate joint can alleviate pain
wash out

if prosthetic joint
aspirate and wash out in theatre

79
Q

complications of septic arthritis

A

rapid destruction of joint
osteomyelitis
sepsis
death

80
Q

wHat is de quervain’s tensynovitis

A

inflammation of the extersor pollicis brevis and abductor pollicis longus tendons

81
Q

presentation of de quervain’s

A

pain on radial side of wrist
radial styloid tenderness
pain on resisted abduction of thumb
positive finkelstein’s test

82
Q

management of De quervain’s

A

NSAIDs
steroid injection
splintage of thumb
surgical repair

finals (13 decks)

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