MSK core Flashcards
ant shoulder disloc
abducted and externally rotated (inverse = P)
biceps rupture
Popeye
high arc pain abduction
AC joint pathology
middle arc pain
rotator cuff pathology
pain on passive joint movement
more joint than muscle issue
testing serratus anterior
scapular winging
testing supraspinatous
resisted empty can
testing infraspinatous/teres minor
resisted external rotation
testing subscapulais
lumbar handpushback
impingement syndrome
supraspinatous tendonitis (painful empty can/Hawkin’s test) -> physio, steroid inj, arthroscope
rotator cuff tears
SS wasting, weak abduction -> cons or surgical repair
adhesive capsulitis
– frozen shoulder – severe pain then persistent stiffness, lost active+passive ROM in all directions -> pain relief /steroid then long physio
persistent instability disloc
Persistently unstable shoulder disloc – MRI arthrogram and surgical repair
OA shoulder
- painful movement restriction all directions, steroids + analgesia
olecranon bursitis
– localised boggy swelling over elbow, ROM intact
lateral epicondylitis
– tennis elbow – repetitive strain – pain on resisted wrist extension, rest the arm
medial epicondylitis
golfers – pain on resisted wrist flexion
cubital tunnel syndrome
– from elbow leaning – ulnar nerve entrapped
varus / valgus force
apply valgus force, press on Lateral side. Medial for varus F.
Heb/Bouch node
Heberden’s nodes DIP, Bouchard nodes PIP
OA
Rheum vs others keys dif
no distal hand joints
DIPs NO!
RA
low of guttering, swan neck deformity, boutonniere, Z thumb, ulnar deviation, palmar MCP subluxation
psoriatic hand changes
more distal arthritis, less symm?
notice NAILS
onycholysis
pitting
trigger finger
MCP bump with triggering on palpation
catches on extensoin
tender radial styloid
De Quervain’s tenosynovitis (do Finkelstein’s)
dactylitis
sausage finger = seronegative spondyloarthropathy
squaring at base of thumb
OA
RA full summary
chronic autoimmune disorder leading to a SYMMETRICAL DEFORMING POLYARTHROPATHY. synovitis, bony deformities as you know, palmar erythema, muscle wasting, loss of ROM, sublux.
DIP joints spared
NSAIDs, steroids, DMARDs, surgery
OA hand summary
mechanical joint degradation with degen of art cart.
joint crepitus, lower ROM, bony defromities
analgesia, steroid injections, physio/splints, surgery
carpal tunnel syndrome summary
median nerve entrapment neuropathy due to compression
intermittent pins and needles, pain/burning and numbness of thumb, worse at night
loss ofpower, wasting of thenar eminence, sensory loss median zone
splints, steroid inject, CT decomp surgry
trigger finger summary
thickening of flexor tendon sheath causing entrapment at the pulley near the MCP
discomfort or bump at base of digit causing catching or cliking during extension
splints, NSAIDs, steroids, rsrugical release
spine percussion tenderness
serious pathology e.g. cancers, osteomyelitis, compressoin fracture
lost lumbar lordosis
= in pain or spondylolistehesis
special spine tests
– Schober’s, chest circumference expansion, femoral nerve stretch test, straight leg raise, sacroiliac stress test
OA spine
OA of spine stiff for <30 mins in morning, no neuro signs
ank spond
spond stiff >30 mins, reduced ROM all directions
sciatica
nerve root impinged, pain radiates down leg on SLR
cauda equina summary
compression of c e nerves - lower back pain, urinary retention, perianal numbness, reduced anal tone
MRI emergency and surgical decompression
Trendelenberg +ve
Trendelenberg +ve if the hip off the ground dips rather than raises
NOF o/e
shortened,externally rotated leg NOF#
unequal leg lenght
unequal leg length spinal or pelvic deformity
freacture
torch bursitis
trochanteric bursitis tenderness on trochanter palpation, can’t lie on that side
OA hip
OA hip lose internal rotation early, pain and reduced ROM, T+T tests +ve
Thomas test +ve
Thomas test +ve contralateral thigh forced off the bed with passive flexion of other hip without lumbar lordosis reduction
valgus knees
valgus knees feet splayed out
varus knees
bow legged
Rickets = vaRus
ACL teaer
ACL tear twisting injury with pop + imm swelling, can’t examine too painful, increased laxity on anterior drawer test – do physio or surgery
PCL tear
PCL tear high energy trauma, often assoc injuries, posterior sag – physio/surg
meniscal tear
Meniscal tear torn in twisting, hours later selling, sharp localised pain worse on hyperflexion / twisting, locking or giving way of knee, good ROM, +ve McMurr, MRI or athroscopy investigation then arthroscopic surgery
collateral lig tear
Collateral lig tears varus laxity or valgus laxity (medial lig), effusion, tender, rest physio and brace
knee OA
knee OA pain and stiffness, reduced ROM, crepitus
prepatellar bursitis
prepatellar bursitis local patellar swelling, kneeling a lot, normal ROM, steroid/rest/NSAID
househusband’s knee ;’(
recall knee special tests
Knee special tests posterior sag, anterior drawer, collateral stress tests, McMurr
pes planus
Pes planus – flat foot – loss of medial arch, flexible flat foot normal toddlers. Rigid in adults = tarsal coalition or tib posterior tendon rupture SEs
hallux valugs
hallux valgus – lateral angulation of big toe, older women, medial MTP pain and bunions – osteotomy, fusion, footwear
gout
gout – monoarthropathy – ms urate crystals, hyperuric. V painful hot red joint. MTP common. NSAID, colchicine. Prevent – allopurinol, less rich diet, stop thiazide/loop diuretics
Achilles rupture
achilles rupture – kicked in back of leg while running e.g can’t plantar flex, Simmond’s +ve
charcot foot
charcot foot pain free joint destruction from minor trauma – diabetic feet – gross deformity – educate, treat cause, podiatry + cast/boot
morton neuroma
Morton neuroma – benign, between metatarsals, ‘walking on a marble’
lateral ligament sprain ankle
ateral lig sprain inversion injury – ant talofib lig injury, physio and splin
syndesmosis injury
syndesmosis (high ankle sprain) external rotation and usually fractured too, surgical fixation
toe deformities
flexed PIP joints (hammer), flexed DIP (mallet), flexed PIP+DIP (claw toes)
osteoarthritis RFs and summary
osteoarthritis RFs age, obesity, FH, female, sports (primary), joint damage / inflamm disorder, metabolic disease (2nd ) inv – exclude other causes with CXR, FBC/ESR/CRP. Cons – exercise, physio, lose wt, footwear, pain ladder analgesia, steroid inject, replace the joint
osteoarthritis x ray findings
loss of joint space
osteophytes
subchondral sclerosis
subhondral cysts
gout RFs, treatment summary
and assoc probs
gout RF = CKD, male, diet, diuretics, obese. 2 weeks of monoarthritis. Can get tophi + kidney stones. Uric acid levels, aspirate -ve brief needles (pseudo = +ve rhomboids), XR. Allopurinol caution – first 3 months do NSAID/colchicine, then start allopurinol as can trigger an episode otherwise. Febuxostat if can’t have allopurinol
rheum arth summary and extra articular manifestations
treatment pathway
rheumatoid arthritis symmetrical deforming polyarthropathy. Extra articular features – ACD, dry eyes, LNs, osteoporosis, pleurisy+fibrosis+effusions, nodules, pericardial effusion, Felty’s, Raynaud’s, vasculitis. DAS28 severity score. 1. Pred for remission 2. DMARDs maintain 3. NSAIDs symptom relief. Physio/OT. Infliximab instead can.
classic rheum arth x ray
loss of joint space
soft tissue swellin
periarticular osteopenia
marginal erossions
ank spond o/e
question mark posture
sacroiliac joint tender
Schober’s failed
night pain relieved by exercise radiates to hips
morning stiffness
fever, wt loss, fatigue
ank spond extra articular
bamboo signs
MRI better for dx thanX RAY
exercise/physio
then NSAIDs
then TNF a blocker e.g. etancercept
