MSK guidelines Flashcards
carpa tunnel syndrome Ix
nerve conduction studies show prolongation of APs both motor and sensory
carpal tunnel syndrome Mx
splinting, steroid injection, surgery
trigger finger 1st line and last line
steroids and surgery
dupuytrens indication for surgery
cannot place hand flat on table
de Quervains tenosynovitis test and 1st and 2nd line Mx
finklesteins
1st = immobilisation in spica splint +/- steroid
2nd = splitting tendon sheath surgically
mallet finger 1st and last line
6 weeks of splinting followed by surgery
Scaphoid fracture Ix and mx
AP and lateral xrays
If fracture, refer to ortho and POP
If no fracture, rexray in 2w with POP in meantime
olecranon bursitis 1st and 2nd line
RICE and NSAIDs
steroid injection
epicondylitis 1st and 2nd line
RICE
surgery to release extensor or flexor origins
ACJ injury Mx
grade 1-2 = conservative with sling
Grade 3 = unsure
grade 4-6 = surgery
Hip fractures
- Ix and definitive Ix
Xray, if negative and suspicious do MRI
Hip fractures
- admission and surgery target
admit to ortho in 4 hours, surgery in 36 hours
Hip fractures
- analgesia
iliofascial nerve block
Hip fractures
- garden 1 or 2
weight bearing = ORIF screw
non-weight bearing = hemi
Hip fractures
- garden 3 or 4
total if all good
hemi if dementia, comorbid, more than one stick
screw if young and roll the dice
Hip fractures
- intertrochanteric
DHS
Hip fractures
- subtrochanteric
IM nail
meniscal tear - 3 tests
McMurays, Apley, Thessaly
Meniscal tear/cruciate ligament definitive test
MRI
Simmonds triad for achiles tendon
1) Simmonds tets positive
2) palpable gap in tendon
3) angle of the dangle
best test for achiles rupture
USS
Mx of achiles tear
always refer to ortho
old/comorbid = splint in equinus
young/normal = surgery
ottowa ankle rule
do an xray if pain over malleolus + 1 of:
- non weight bear for 4 steps
- pain in distal fibula or tibia (6cm)
ottowa foot rule
do an xray if pain in the midfoot + 1 of:
- non weight bear for 4 steps
- pain base 5th metatarsal
- pain navicular
weber a b c Mx
a = boot or cast below knee b = pop to midfott and below knee c = ORIF
DDH Ix and Mx
<4.5 month = USS and Pavlik
>4.5 month = xray and surgery
1st line Ix for perthes. definitive?
Xray and MRI (but remember MRI is first for adult AVN)
caterall staging
for perthes 1 = symptmos only 2 = crescent sign only 3 = femoral head destruction 4 = also acetabulum destruction
Mx of Perthes
<6 = conservative 6+ = surgery
clubfoot Mx
ponsetti method
85% need achiles tenotomy
night braces till 4yo
kocher criteria
38.5
ESR
WCC
non weight bearing
definitive Ix for septic arthritis
aspirate (NOT IF PROSTHETIC)
usualy abx for septic arthritis
2w IV fluiclox and 4w oral fluclox
SUFE Ix and Mx
frog leg and lateral xray
need surgery
nursemaid elbow ix and mx
USS for annular ligament
manual reduction
open fracture staging and Mx
gustillo Anderson 1 = <1cm 2 = >1cm 3 = >1cm and severe soft tissue damamg 3c = vascularly impaired
need tetanus stuff, IV abx, debridement, ex-fix
compartment syndrome Ix
intracompartmebtal pressure >40 is diagnostic >20 is abnormal
Xray is nothing
discitis Ix and Mx
MRI and 6-8w IV Abx
Iliopsoas abscess Ix and Mx
MRI and drainage+abx
simple back pain Ix and Mx
No Ix. only do MRI if suspect other stuff
Mx = oral naproxen
meralgia paraesthetica Ix and Mx
Ix = push on ASIS, inject LA into nerve Mx = neuropathic pain meds and conservative
osteomyelitis Ix and Mx
MRI and IV abx fluclox
Osteoporosis
- who do you screen
women >65
men >75
anyone else with a big RF (alchol >14U, BMI<18.5, steroid, smoking, history of falls or fractures)
Osteoporosis
- who do you do straight dexa for and what result means you treat straight away
if about to start a med that will affect bones
if
Osteoporosis
- DEXA results
-1 to -2.5 is osteopaenia
Mx based on FRAX
low = lifestyle medium = do DEXA high = bone protection which is always alendronate PO OD
