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MSK Injury Flashcards

1
Q

What are the red flags for cauda equina syndrome?

A

Back pain and lower limb weakness
Altered peri-anal or perineal sensation = saddle anaesthesia
Sphincter disturbance

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2
Q

What are the red flags for metastatic spinal cord compression?

A

Back pain - worse on coughing and lying flat
Leg weakness
Bowel/bladder dysfunction
Reflexes - increased below compression, absent at level of compression, normal above level

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3
Q

What are the red flags for ruptured AAA?

A

Central umbilical pain radiating to the back
Expansile and pulsatile central abdominal mass
Hypotensive/collapse/shock
Bruising
Acutely unwell

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4
Q

What must you include in your examination of someone presenting with acute back pain?

A 
Gait assessment
Spine examination
Peripheral nerve examination
Peripheral vascular examination
Abdominal examination
Rectal examination
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5
Q

How can you examine for nerve root pain?

A

Straight leg test for sciatica (L4, L5, S1)

Femoral stretch test for femoral nerve irritation (L2-L4)

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6
Q

What is the main cause of sciatica?

A

Lumbar disc prolapse

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7
Q

When is an X-Ray indicated for back pain?

A 
Over 55
Systemically unwell
History of trauma or malignancy
Infection
HIV suspected
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8
Q

What is the management for suspected cord compression?

A

16mg dexamethasone + PPI
Urgent MRI
Urgent neuro/oncology referral

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9
Q

What are the two joints in the ankle and what movements do they facilitate?

A

Subtalar joint

  • Calcaneus + talus
  • Facilitates eversion/inversion

True ankle joint

  • Tibia, fibula, talus
  • Facilitates dorsi/plantarflexion
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10
Q

What usually causes an ankle ligament strain?

A

Inversion injury (85%) - injury to the anterior talofibular part of the lateral ligament

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11
Q

What can help you decide if an X-Ray is needed to rule out a fracture in ankle injury?

A

Ottawa ankle rule:

  • Inability to weight bear immediately after injury and in ED
  • Pain in malleolar zone plus tenderness over posterior edge of lateral/medial malleolus
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12
Q

How can you manage a simple ankle sprain?

A

POLICE

Protection from further injury
Optimal Loading
Ice
Compression
Elevation

Full recovery can take 4 weeks
Advise to come back if not full weight-bearing by 4 days

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13
Q

Who are distal radial fractures most common in?

A

Osteoporotic post-menopausal women

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14
Q

What are the most common distal radial fractures? What most commonly causes them?

A

Colles’ - falling on outstretched hand

Smiths’ - falling on flexed wrist

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15
Q

How does Colles’ fracture present?

A

Dinner fork deformity

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16
Q

What would be seen on an X-Ray of a Colles’ fracture?

A

Extra-articular fracture of the distal radius with dorsal displacement of the distal radius

17
Q

If there is a grossly displaced fracture, how do you treat it?

A
  1. MUA (manipulation under anaesthetic) - Bier’s block with IV regional LA
  2. Apply POP backslab cast and sling
  3. XRay to check position
18
Q

When is MUA urgent in a distal radius fracture?

A

Compound fracture

Nerve compression

19
Q

How does a neck of femur fracture present?

A

Pain in hip radiating to knee
Inability to weight-bear
Affected leg is shorter and externally rotated
Adduction of affected leg

20
Q

What should you check for in an elderly patient with a hip fracture?

A

Signs of dehydration
Hypothermia

They may have been lying for hours

21
Q

What is a complication of intracapsular neck of femur fractures?

A

Disruption of blood supply to femoral head causing avascular necrosis

22
Q

What is the classification for intracapsular femoral neck fractures?

A

Garden classification

I - Incomplete undisplaced fracture with the inferior cortex intact
II - Complete undisplaced fracture through the neck
III - Complete neck fracture with partial displacement
IV - Fully displaced fracture

23
Q

What gives the best outcome in hip fractures if displacement is minimal?

A

Internal fixation in situ - the risk of displacement, risk of AVN and non-union are reduced

24
Q

What is the ED management for a hip fracture?

A

ABCDE

IV access

  • Bloods - FBC, U&Es, glucose, crossmatch to prepare for surgery
  • IV fluids if hypotension/dehydrated
  • IV morphine (titrate up) + antiemetic
  • Femoral nerve block

Lateral hip X-ray
Refer to orthopaedic surgery

25
Q

On a lateral hip X-ray, what indicated a fractured neck of femur?

A

Interrupted Shenton’s line (imaginary curved line drawn along inferior border of superior pubic ramus to inferomedial border of neck of femur)

26
Q

What is the most common type of shoulder dislocation?

A

Anterior dislocation (95%) - due to forced external rotation and abduction of the shoulder

27
Q

Who does anterior dislocation most commonly affect?

A

Young males playing contact sports

Elderly patients falling on outstretched hand

28
Q

What causes a posterior shoulder dislocation?

A

Trauma to anterior shoulder or fall onto internally rotated arm

29
Q

What is found on palpation of anterior shoulder dislocation?

A

Loss of shoulder contour - flattening of deltoid
Anterior bulge from head of humerus - can be palpated anteriorly and in axilla
Step-off deformity at acromion with palpable gap below acromion

30
Q

How can you test for injury to the axillary nerve?

A

Loss of sensation over lateral shoulder (badge area)

Lack of contraction of deltoid during attempted abduction

31
Q

What is posterior shoulder dislocation associated with?

A

Epileptic seizures
Electrical shocks
Direct blow during trauma

32
Q

What might occur at the same time as an anterior shoulder dislocation?

A

Fracture of the humeral head, neck or greater tuberosity

33
Q

How can you assess the radial nerve?

A

Weakness of wrist extension and thumb abduction
Reduced sensation on dorsum of hand
Abnormal triceps and brachioradialis reflexes

34
Q

What changes are seen on an X-Ray in anterior shoulder dislocation?

A

Humeral head lies inferior to coracoid process on AP view

Head of humerus anterior to glenoid on axillary view

35
Q

What sign is seen on X-Ray of posterior shoulder dislocation?

A

Lightbulb sign

36
Q

What is the most common method to manipulate an anterior shoulder dislocation?

A

External rotation method

  • Patient supine on bed
  • Affected arm is adducted and flexed to 90 degrees at elbow
  • Arm is then slowly externally rotated
  • The shoulder should be reduced before reaching the coronal plane

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