MSK deformities profoma Flashcards
What is scoliosis? Presentation? Investigation? Management?
Curvature of spine in S shape.
- may lead to back pain
Presentation:
1. postural asymmetry
- shoulder
- waist-line
- thoracic wall or breast
2. 6 to 12 months post puberty
Investigation:
- Clinical exam (observation) -
- Standing PA and lateral x-rays of cervical, thoracic and lumbar spine & pelvis.
- MRI of cervical, thoracic and lumbar spine and pelvis
Management:
- NSAIDs
- Physiotherapy
- Steroid injections & local anaesthetic injections
- Back braces for pain relief
- Surgery - lumbar decompression, disectomy, spinal fusion
What is lordosis? Cause? Presnetation? Investigations? Management?
Exaggerated lumbar curve
Cause:
- congenital
- muscular dystrophy
- osteoporsis
- obesity
Can present w/ back pain, stiffness, tenderness & tiredness
Investigations:
- check flexibility
- neurological assessment if experiencing paraesthesia, spasms or weakness or changes in bowel or bladder control
- x-ray of lumbar spine & hips
- muscle bipsy- if cause is musclar dystrophy
Management:
- Analgesia
- Physio
- Braces
- Weight loss
What is kyphosis? Causes? Presentation? Investigation? Management?
Curvature of spine causing the top of the back to appear more rounded than normal.
Causes: poor posture, abnormally shaped vertebrae, ageing, spinal injury or congenital kyphosis
Presentation:
-Can present w/ back pain, stiffness, tenderness
- Tiredness
Investigation- x-ray
Management:
- Analgesia
- Back braces
- surgery- spinal fusion
Causes of varus hip or knee? Presentation? Investigation?
Management?
Caused by rickets, cancer, osteoarthritis.
Presentation- bow legged
Investigation:
- Blood tests: look for low calcium or vitamin D
- X-rays: look for osteoarthritis or cancer
Management
- High tibial osteotomy
Causes of values hip or knee? Presentation? Investigation? Management?
Caused by injury or infection, lack of vitamin D or calcium, obesity, arthritis.
Presentation- knees locked inwards
Investigation
- Blood tests: look for low vitamin D or calcium
- X-ray: osteoarthritis
Management:
- Arthroscopy or arthrodesis
What are the causes of club foot? Presentation? Investigation? Differential diagnosis? Management?
Causes:
- idiopathic
- when achilles tenon is too short
- conditions e.g. spina bifida, amniotic band syndrome
Presentation:
- painless
- deformed feet
- can affect both or 1 feet
- feet locked inwards
Investigations:
- Clinical examination
- Can be spotted during routine ultrasound at 18-21 weeks
Management:
- Feet usually correct themselves after 3 months
- Treatment starts 1-2 weeks from birth
- Ponseti method - manipulating & stretching the babies foot & then putting it into a cast.
- After the cast comes off = surgery
- Local anaesthetic - loosening of the Achilles tendon to release foot into a more natural position
Presentation of flat feet?
All children have flat feet, the arch develops after weight-bearing.
Presentation:
- Congenital
- Obesity, hypertension, diabetes
- Inflammatory arthritis; e.g. RA
- Tibialis posterior tendon rupture/dysfunction
- Not painful unless associated w/ secondary degenerative changes
Investigations
- Standing AP and lateral views
- Plantar flexion lateral
- Oblique : coalition
Management:
- Children with painless flat feet are best left untreated. Splints or special shoes do not influence the outcome
- Muscle exercises & arch supports may improve the comfort of older patients
- The only clear indications for treatment are severe shoe wear problems or severe foot or calf pain
- Where hindfoot valgus is a feature, calcaneal opening wedge osteotomy may correct the deformity
Cause of pectus axcavatum/ pectus carinatum? Presentation? Investigation? Management?
Caused by Marfan’s
Presentation:
- pectus axcavatum- breastbone is sunken into chest.
- pectus carinatum- breast bone grows outwards
Investigation:
- Chest X-ray
- CT - to determine whether heart or lungs are being compressed.
- Electrocardiogram - looks at the hearts electrical activity and conduction.
- Echocardiogram - scan to look at the heart and the nearby vessels. It is a type of ultrasound.
- Lung function tests
Management- Pectus excavatum
- silicone insertion
- nuss procedure- curved metal bar threaded under depressed breastbone- raises it into more normal position
- Ravitch techniqu- removes deformed cartilage attaching ribs to lower breastbone & then fixes breastbone into normal position w/ surgical hardware
Management- Pectus carinatum
- Nonoperative therapy e.g. dynamic compression
- Surgical reconstruction
Cause of pectus axcavatum/ pectus carinatum? Presentation? Investigation? Management?
Caused by Marfan’s
Presentation:
- pectus axcavatum- breastbone is sunken into chest.
- pectus carinatum- breast bone grows outwards
Investigation:
- Chest X-ray
- CT - to determine whether heart or lungs are being compressed.
- Electrocardiogram - looks at the hearts electrical activity and conduction.
- Echocardiogram - scan to look at the heart and the nearby vessels. It is a type of ultrasound.
- Lung function tests
Management- Pectus excavatum
- silicone insertion
- nuss procedure- curved metal bar threaded under depressed breastbone- raises it into more normal position
- Ravitch techniqu- removes deformed cartilage attaching ribs to lower breastbone & then fixes breastbone into normal position w/ surgical hardware
Management- Pectus carinatum
- Nonoperative therapy e.g. dynamic compression
- Surgical reconstruction
What is hallux valgus?
bunion is hallux (big toe) causes toe to point inwards
NOTE: view image on notes
What is ulnar deviation?
Fingers point outwards due not MCP becoming swollen
Seen in RA
What is mallet finger?
DIP in flexion
Seen in RA
What is z-thumb deformity?
Seen in RA
IP Flexed
MP hyperextended
CMC flexed
What is boutonniere deformity?
Seen in RA
PIP in flexion
DIP in hyperextension
NOTRE: view image on note
What is swan-neck deformity?
Seen in RA
PIP in hyperextenion
DIP in flexion
What is bourchard’s nodes?
Seen in OA
Swelling in DIP joint
What are herbeden’s node?
Seen in OA
Swelling in PIP joints
What is trigger finger?
Inflammation of A1 pulley & synovium sheath (of tendon) leads to swelling- causes sheath to bunch up into nodule
Extension of finger weaker than flexion, so unable to pull nodule (flexor tendon) across pulley- leading to trigger finger
finger can be straightened w/ help from other hand
any finger can be affected
NOTE: view image on notes
What is duputrens contracture?
Unable to extend finger
Due to fascia thickening & drawing in, causing affected finger to bend towards palm.
- tight bands & nodules form in skin holding the tight
Power & sensation normal
Usually ring & small finger
What is hand of benediction?
Medial fingers (ring & pinky) flexed
Lateral fingers extended
Due to damage to median nerve!
NOTE: view image
What is ulnar paradox?
Also called ULNAR claw hand
PIP & DIP joints flexed towards palm
Hyperextension of MCP joint
NOTE: view image
What is mallet toe, hammer toe and claw toe?
Hammer toe- toe bends down towards the floor at the middle toe joint (proximal phalani)
- causes middle toe joint to rise up
- usually affects second toe
- often occur w/ bunions.
Claw toe- toes bend up at the joint where the toes & foot meet (metaphalangial joint)- bend down at the middle joints & at joints nearest tip of toes.
-causes the toes to curl down toward the floor.
- affects 4smaller toes at the same time
Mallet toe- toe bends down at joint closest to the tip of the toe (distal phalanx)
- often affects the second toe
NOTE: view image on notes
What is hamate hammer syndrome?
Ulnar nerve compression at wrist
Only intrinsic muscles of hand will be affected
More severe clawing
Clawing occurs when lumbricals are damaged- leads to imbalance of flexion/extension w/in affected digits.
- If the ulnar nerve is damaged atelbow, then flexor digitorum profundus stops working & clawing is less severe.
- If the nerve is damaged at wrist, then both digital flexors are still working, resulting in more pronounced clawing.
