MSK guidelines

Question 1

carpa tunnel syndrome Ix

Answer 1

nerve conduction studies show prolongation of APs both motor and sensory

Question 2

carpal tunnel syndrome Mx

Answer 2

splinting, steroid injection, surgery

Question 3

trigger finger 1st line and last line

Answer 3

steroids and surgery

Question 4

dupuytrens indication for surgery

Answer 4

cannot place hand flat on table

Question 5

de Quervains tenosynovitis test and 1st and 2nd line Mx

Answer 5

finklesteins
1st = immobilisation in spica splint +/- steroid
2nd = splitting tendon sheath surgically

Question 6

mallet finger 1st and last line

Answer 6

6 weeks of splinting followed by surgery

Question 7

Scaphoid fracture Ix and mx

Answer 7

AP and lateral xrays
If fracture, refer to ortho and POP
If no fracture, rexray in 2w with POP in meantime

Question 8

olecranon bursitis 1st and 2nd line

Answer 8

RICE and NSAIDs

steroid injection

Question 9

epicondylitis 1st and 2nd line

Answer 9

RICE

surgery to release extensor or flexor origins

Question 10

ACJ injury Mx

Answer 10

grade 1-2 = conservative with sling
Grade 3 = unsure
grade 4-6 = surgery

Question 11

Hip fractures

- Ix and definitive Ix

Answer 11

Xray, if negative and suspicious do MRI

Question 12

Hip fractures

- admission and surgery target

Answer 12

admit to ortho in 4 hours, surgery in 36 hours

Question 13

Hip fractures

- analgesia

Answer 13

iliofascial nerve block

Question 14

Hip fractures

- garden 1 or 2

Answer 14

weight bearing = ORIF screw

non-weight bearing = hemi

Question 15

Hip fractures

- garden 3 or 4

Answer 15

total if all good
hemi if dementia, comorbid, more than one stick
screw if young and roll the dice

Question 16

Hip fractures

- intertrochanteric

Answer 16

DHS

Question 17

Hip fractures

- subtrochanteric

Answer 17

IM nail

Question 18

meniscal tear - 3 tests

Answer 18

McMurays, Apley, Thessaly

Question 19

Meniscal tear/cruciate ligament definitive test

Answer 19

MRI

Question 20

Simmonds triad for achiles tendon

Answer 20

1) Simmonds tets positive
2) palpable gap in tendon
3) angle of the dangle

Question 21

best test for achiles rupture

Answer 21

USS

Question 22

Mx of achiles tear

Answer 22

always refer to ortho
old/comorbid = splint in equinus
young/normal = surgery

Question 23

ottowa ankle rule

Answer 23

do an xray if pain over malleolus + 1 of:

• non weight bear for 4 steps
• pain in distal fibula or tibia (6cm)

Question 24

ottowa foot rule

Answer 24

do an xray if pain in the midfoot + 1 of:

• non weight bear for 4 steps
• pain base 5th metatarsal
• pain navicular

Question 25

weber a b c Mx

Answer 25

``` a = boot or cast below knee b = pop to midfott and below knee c = ORIF ```

Question 26

DDH Ix and Mx

Answer 26

<4.5 month = USS and Pavlik | >4.5 month = xray and surgery

Question 27

1st line Ix for perthes. definitive?

Answer 27

Xray and MRI (but remember MRI is first for adult AVN)

Question 28

caterall staging

Answer 28

``` for perthes 1 = symptmos only 2 = crescent sign only 3 = femoral head destruction 4 = also acetabulum destruction ```

Question 29

Mx of Perthes

Answer 29

``` <6 = conservative 6+ = surgery ```

Question 30

clubfoot Mx

Answer 30

ponsetti method 85% need achiles tenotomy night braces till 4yo

Question 31

kocher criteria

Answer 31

38.5 ESR WCC non weight bearing

Question 32

definitive Ix for septic arthritis

Answer 32

aspirate (NOT IF PROSTHETIC)

Question 33

usualy abx for septic arthritis

Answer 33

2w IV fluiclox and 4w oral fluclox

Question 34

SUFE Ix and Mx

Answer 34

frog leg and lateral xray | need surgery

Question 35

nursemaid elbow ix and mx

Answer 35

USS for annular ligament | manual reduction

Question 36

open fracture staging and Mx

Answer 36

``` gustillo Anderson 1 = <1cm 2 = >1cm 3 = >1cm and severe soft tissue damamg 3c = vascularly impaired ``` need tetanus stuff, IV abx, debridement, ex-fix

Question 37

compartment syndrome Ix

Answer 37

intracompartmebtal pressure >40 is diagnostic >20 is abnormal Xray is nothing

Question 38

discitis Ix and Mx

Answer 38

MRI and 6-8w IV Abx

Question 39

Iliopsoas abscess Ix and Mx

Answer 39

MRI and drainage+abx

Question 40

simple back pain Ix and Mx

Answer 40

No Ix. only do MRI if suspect other stuff | Mx = oral naproxen

Question 41

meralgia paraesthetica Ix and Mx

Answer 41

``` Ix = push on ASIS, inject LA into nerve Mx = neuropathic pain meds and conservative ```

Question 42

osteomyelitis Ix and Mx

Answer 42

MRI and IV abx fluclox

Question 43

Osteoporosis | - who do you screen

Answer 43

women >65 men >75 anyone else with a big RF (alchol >14U, BMI<18.5, steroid, smoking, history of falls or fractures)

Question 44

Osteoporosis | - who do you do straight dexa for and what result means you treat straight away

Answer 44

if about to start a med that will affect bones | if

Question 45

Osteoporosis | - DEXA results

Answer 45

-1 to -2.5 is osteopaenia

Question 46

Mx based on FRAX

Answer 46

``` low = lifestyle medium = do DEXA high = bone protection which is always alendronate PO OD ```