MSK cortext Flashcards
what is a lipoma
neoplastic proliferation of fast which usually occurs in subcutaneous tissue but can grow in fat
GCT of tendon sheet what do they look like histologically and microscopically?
what are they called when in a joint
pigmented and contain multinucleate giant cells and haemosiderin
pigmented villonodular synovitis (PVN)
what are some rare causes of AVN
sea diving
decompression sickness
what are the two types of osteoporosis
type 1 - post menopausal increase in osteoclastic bone resorption with loss of protective effects of oestrogen
type 2 - osteoporosis of old age
what do bisphosphonates do and give some examples
reduce osteoclast production
alendronate, risedronate, etidronates
what type of drug is zoledronic and how often is it given
IV bisphosphonate
once yearly
what kind of drug is desunomab and what does it do
monoclonal AB
decreases osteoclast activity
what does strontium do
increases osteoblast production and decreases absorption
what is osteomalacia
abnormal softening of the bone due to deficient mineralisation of osteoid secondary to inadequate amounts of calcium and phosphate
what is the presentation of osteomalacia
bone pain, deformity, pathological fracture, symptoms of hypocalcaemia, pseudo fractures (loosers zones)
what is brittle bone disease and what causes it
osteogenesis imperfecta
defect in type 1 collagen
is osteogensis imperfect autosomal dom or recessive
what are the symptoms/signs
what do the bones look like
dominant
fragility fractures, blue sclera, loss of hearing
thin (gracile) with thin cortices and osteopenic
why does skeletal dysplasia occur
genetic error - abnormal development of bone and connective tissue
what type of skeletal dysplasia is the commonest - give the occurrence/cause, what does it present like, what are the joints like and does it have an effect on mental development
achondroplasia
autosomal dom but 80% are sporadic
disproportionally short limbs with prominent forehead and widened nose
joints are lax and mental development is normal
how does marfans syndrome occur
what does it look like
other signs
autosomal dominant or sporadic mutation of fibrillin gene
tall stature with disproportionally long limbs and ligamentous laxity
high arched palate, scoliosis, flattening of chest, eye problems, aortic aneurysm, cardiac valve incompetence
what is ehlers-danlos syndrome
how does it occur
wha are the signs
abnormal collagen and elastin formation
autosomal dom
joint hyper mobility, joint instability, scoliosis
commonest type of CP
spastic 80% - injury to motor cortex
Ataxic CP what does it affect and what are the signs
cerebellum
decreased co ordination and balance
what does athetoid CP affect and what are the signs
extra pyramidal motor system, pyramidal triangle, basal ganglia
uncontrolled writhing motion, sudden changes in tone and difficulty controlling speech
monoplegic
hemiplegic
diplegia
total body involvement
one limb
one ipsilateral upper and lower limb
both legs
all 4 limbs
treatment of CP
physio
orthotics
baclofen - injection intrathecally in the subarachnoid space to reduce spasticity
what is spina bifida
congenital disorder where the two halves of the posterior vertebral arch fail to fuse
spina bifida occult is what kind of form
what can some patients develop
when do neurological symptoms occur
what are some characteristics of this condition
mildest form
tethering of spinal cord and roots which leads to claw toes and pes cavus
neurological symptoms can occur at any age
tell tale sign of tuft of hair in skin overlying defect
spina bifida cystica is what form
what happens
severe form
contents of vertebral canal herniate through defect with either herniation of meninges alone (meningocele) or with the spinal cord or caudal equina
is meningocele associated with neurological effects
but
no
but myelomeningocele has neurological defects below lesion
what is spina bifida cystia associated with
hydrocephalus (excess CSF around increase intracranial pressure)
how is spina bifida cystia treated
defect usually closed within 48 hours of birth
what is polio and what does it affect
viral infection
affects motor anterior horn cells in the spinal cord or brain stem resulting in lower motor neurone deficit
how does the virus in polio enter and what does it lead to
vie GIT with a flu like illness leading to a variable degree of paralysis usually affecting a group of muscles within 2-3 days
what is the treatment of residual paralysis of polio
splint age
shortening of leg can be treated with a shoe raise
what is syndactyly
2 digits fused together due to failure of separation of skin/soft tissues or pahalnges of adjacent digits
what is polydactyl
extra digit formed
what is fibular hemimelia
partial or complete loss of fibula leading to a shortened limb
what does an absence or hypoplasia of radium lead to
absence of thumb
radial clubhand
how does tarsal coalition occur and what is it
congenital fusion
painful flat feet in later childhood
what is Erbs palsy and what does it lead to
what are the signs
treatment
inquiry to C6 and C7 motor neurones
loss of motor innervation to deltoid, supra, infra, biceps, brachialis
internal rotation of humerus, classic waters tip posture
physio
what is klumpke’s palsy
cause
leads to what
sign
c8 and T1 roots damage
forceful adduction
paralysis of intrinsic hand muscles and finger and wrist flexors
fingers are flexed
when do bow legs (virus knees) become normal aligned and what does this then progress to
14 months knock knees (valgus)
what are valgus knees
knock knees 10-15 degrees at the age of 3 and progresses to 6 degrees by 6-9
test for mobile flat feet
jacks test - medial arch is formed with dorsiflexion of great toe
what happens when jacks test for flat feel is negative
and what are the causes of this
rigid flat feet
underlying bone abnormality (tarsal coalition), underlying inflam disorder or neurological disorder
what is developmental dysplasia of the hip (DDH)
dislocation or subluxation of the femoral head in the perinatal period which affects development of the hip joint
who does DDH occur
where
and both sides or just one?
females more than men
left hip commoner
only 20% bilateral
what are the risk factors for DDH?
FH
first born
Downs
other congenital disorders
what are the signs of DDH
limb shortening, assym groin/thick skin creases
click/clunk on ortolani or barlow manoeuvre
describe ortolani and barlow manœuvres
O - reducing dislocated hip with abduction and anterior displacement
B - dislocatable hip with flexion and posterior displacement
what are the investigations for DDH and the limitation
XR but can’t be used until after 6 months as femoral head hasn’t ossified
what is the treatment for DDH depending on the stages
mild
dislocated or persistently unstable
over 18 months
closely observed US done
reduced and help with parlik harness (used full time for 6 weeks then part time for 6 weeks - used in ages 4-6 months)
over 18 months - open reduction
when does transient synovitis occur
who does it occur in
what is the treatment
after a URTI
2-10 year old. boys
short course of steroids and rest
what is the commonest cause of hip pain in childhood
transient synovitis
what is perthes disease
idiopathic osteochonditis of the femoral head
femoral head loses blood supply becomes necrotic and leads to abnormal growth
who does perthes disease occur in and how do they present
what are the signs
4-9 yr olds
active boys with short stature
pain and limp
loss of internal rotation followed by loss of abduction and tredenlburgs sign is positive
what might bilateral perthes disease mean
underlying skeletal dysplasia or thrombophilia
what is the treatment of perthes disease
XR observation and avoid physical activity
who does a SUFE occur
obese pre pubertal boys
what is a SUFE
femoral head slips inferiorly in relation to femoral neck
when does a SUFE occur in girls
hypothyroidism or renal disease predisposes them to a SUFE
presentation of a SUFE
limp
pain - may only be pain in knee
loss of internal rotation
investigation and treatment of SUFE
lateral view XR
pin femoral head
if chronic then osteotomy
what is apophysitis and where can it occur
inflammation of growing tubercle where tendon attaches
either side of the patella tendon
what is Osgood shatters
inflammation of tibial tubercle apophysitis
what can osteochondiritis discens result in which predisposes to OA
loose bodies - pot holes on surface
meniscal problems in children are caused why
treatment
some children have abnormally shaped discoid meniscus which is circular and can cause pain and popping
arthroscopic partial meniscectomy
what is clubfoot and what is the treatment
ankle equinus (plantar flexion) supination of forefoot and various alignment of foot donsets technique
what is tarsal coalition
abnormal bridge between calcaneus and navicular or between talus and calcaneus
what is spondolythesis where does it usually occur who does it usually occur in symptoms/signs treatment
slippage of one vertebrae over the other
L4/L5 or L5/S1
adolescents
low back pain, flat back, waddling gait
physio. if severe stabilisation and reduction
what can metal particles in joint replacement lead to
what can polyethylene particles in joint replacement lead to
inflam granuloma (pseudotumour) osteolysis
in osteomyelitis if there is dead bone what can happen
might break off (sequestrum)
and new bone (involucrum) will form around the area of necrosis
what is a brodies abscess
in osteomyelitis in children the area is just cut off - abscess formed with thin rim of sclerotic bone
how can chronic OM present
what can cause it
can lie dormant for years
localised pain, inflammation
systemic upset
TB esp spinal OM
how does spinal OM present
insidious back pain which is constant and unremitting
paraspinal muscle spasm
tenderness in spine
fever
list the nerves that can be damaged in the following fractures/dislocations: colles fracture anterior shoulder dislocation humeral shaft fracture supracondylar fracture posterior dislocation of the hip bumper injury to lateral knee
median nerve axillary nerve radial nerve intertossous branch of median nerve sciatic nerve common perineal nerve
what does degloving mean and what are the symptoms
avulsion of skin from underlying blood vessels
skin will not bleach on pressure and loss of sensation
treatment of soft tissue injuries
RICE rest ice compression elevation
commonest cause of septic arthritis in adults, second most commonest cause
commonest cause in children
young adults
E Coli occurs in who
SA, streptococci
H influence - not since vaccination
Neisseria gonorrhoea (rare)
elderly, IVDU, very ill
