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Year 2 Revision > MSK Investigations and Management > Flashcards

MSK Investigations and Management Flashcards

1
Q

Disc prolapse causing sciatica management

A 
Conservative treatment (NSAID)
Consider surgery if not resolving after 3 months
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2
Q

When would you operate on a flat foot?

A

If rigid and painful with tarsal coalition (bony connection)

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3
Q

When would you do an MRI for back pain?

A

Only if red flags or considering surgery (non-resolving sciatica, spinal stenosis)

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4
Q

Tibialis posterior dysfunction management

A 
Physiotherapy
Insole
NOT steroid injections
Bespoke footwear
Last line is surgery
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5
Q

Plantar fasciitis management

A 
NSAIDs
Night splints
Taping
Heel cups or medial arch supports
Physio
Steroid injection
Can do surgery (but not usually)
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6
Q

Hallux valgus management

A

Shoe modifications, padding

Operative (only if pain, lesser toe deformities, functional limitation or other complications)

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7
Q

Management of mortons neuroma

A 
Non operative (insoles, injections)
Operative (excise)
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8
Q

Management of achilles tendonitis

A 
Activity modification/analgesia
NSAIDs
Shockwave therapy
Orthotics
Physio
Surgery
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9
Q

Management of achilles tendon rupture

A

Operative repair
Non-operative (casting)

Similar efficacy

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10
Q

Claw, hammer and mallet toe management

A

Surgery (tenotomies, tendon transfer, fusions or amputation)

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11
Q

Ankle fracture management

A

Stable - cast/moon boot

Unstable - ORIF

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12
Q

Lisfranc fracture management

A

ORIF

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13
Q

Femeroacetabular impingement syndrome (FAI) investigations

A

Radiographs
CT
MRI (labrum damage and bony oedema)

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14
Q

FAI CAM deformity management

A

Observation if asymptomatic

Arthroscopic/open surgery to remove CAM/debride labral tears

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15
Q

FAI pincer impingement management

A

Peri-acetabular osteotomy/debride labral tears in pincer impingement

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16
Q

FAI in older patients with secondary OA management

A

Arthroplasty

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17
Q

AVN investigations

A

Radiographs (normal in early disease)
MRI

Shows hanging rope sign (slcerotic line through femoral head/neck)

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18
Q

Management of AVN with no permanent changes to geography of femoral head

A

Bisphosphonates
Core decompression/bone grafting
Curretage and bone grafting
Vascularised fibular bone graft

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19
Q

Management of AVN with permanent changes to geography of femoral head

A 
Rotational osteotomy (only good for small bits of bone)
Total hip replacement
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20
Q

Investigations for idiopathic transient osteonecrosis of the hip (ITOH)

A

Raised ESR
X-ray (osteopaenia of head and neck, thinning of cortices, preserved joint space)
MRI (gold standard)
Bone scan

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21
Q

ITOH management

A 
Self limiting (6-9 months)
Analgesia
Protected weight bearing to avoid stress fracture
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22
Q

Investigation for trochanteric bursitis

A

None, clinical diagnosis

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23
Q

Management of trochanteric bursitis

A

Analgesia
NSAIDs
Physio
Steroid injection

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24
Q

What hip replacement is used in younger patients?

A

Hybrid THA (uncemented cup, cemented stem)

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25
Q

What hip replacement is used in older patients?

A

Cemented THA (cemented cup and stem)

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26
Q

Should you x-ray in hip OA?

A

Only if it will affect management

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27
Q

DDH investigations

A

Clinical exam
US
Radiographs later on

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28
Q

Early picked up DDH management

A 
Pavlik harness (23 hours a day for up to 12 weeks until US normal)
Night time splinting for a few more weeks
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29
Q

Late picked up DDH management

A 
Closed reduction (maybe tenotomies) with spica (hip plaster cast)
Open reduction and osteotomies (pelvic or femoral) with spica

Both involve hip arthrograms to assess.

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30
Q

Reactive synovitis diagnosis and investigation

A

Kochers criteria

Ultrasound with maybe aspiration

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31
Q

Septic arthritis investigations

A

Blood tests/cultures
Kochers criteria
Radiographs to rule out other pathologies
Ultrasound and aspiration

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32
Q

Septic arthritis management

A

Open surgical washout

6 week antibiotics

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33
Q

Perthes disease investigations

A

Radiographs

MRI

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34
Q

Perthes disease management

A

Restrict weight bearing
Maintain ROM with physio

Surgery in young patients with severe disease and deformity (femoral and pelvic osteotomies)

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35
Q

SUFE investigations

A

Radiographs

MRI

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36
Q

SUFE management

A

Percutaneous pinning of the hip (with maybe pinning on the other side)
Open reduction if a very severe slip

37
Q

Extensor mechanism rupture management

A

Surgical repair

38
Q

Meniscal tear investigation

A

MRI

39
Q

Meniscal tear management

A

Consider arthroscopic repair in acute peripheral years in younger patient
Arthroscopic menisectomy for mechanical symptoms or failed repair

URGENT surgery if acute locked knee to prevent fixed flexion deformity

40
Q

Management of degenerative mensical tear

A

Injection may help

Menisectomy ONLY if mechanical symptoms, not pain

41
Q

MCL rupture management

A

Brace, early motion physio

Rarely surgery

42
Q

ACL rupture management

A

Around 40% require ACL reconstruction (not repair)

The rest get on

43
Q

LCL rupture management

A

Complete rupture repair if within 2-3 weeks, reconstruction otherwise

44
Q

Isolated PCL rupture management

A

Don’t require reconstruction (rare)

45
Q

PCL tear as part of multiligament knee injury management

A

Needs reconstruction

46
Q

Knee dislocation management

A 
Check NV status
Emergency reduction
Recheck NV status
May need external fixation for temporary stabilisation
Multi ligament reconstruction

Any concerns with vascular status contact vascular surgery

47
Q

Management of clubfoot

A

Ponseti method (serial casting with maybe achilles tenotomy)

48
Q

Cerebral palsy management

A

Benzodiazepines
Baclofen
Botulinum toxin injections
Selective dorsal rhizotomy (surgery)

49
Q

Duchenne muscular dystrophy investigation

A

CK

Muscle biopsy

50
Q

Mucous cyst management

A

Leave alone

Excision

51
Q

Trigger finger management

A

Conservative - often resolves spontaneously, splint to prevent flexion
Tendon sheath injection (steroid and LA, often curative, may be repeated 3 times)
Surgery (divide A1 pulley)

52
Q

De quervains tenosynovitis clinical sign

A

Finklesteins test positive (thing where you try and dislocate your thumb)

53
Q

De quervains tenosynovitis management

A 
NSAIDs
Splint
Rest
Steroid injection
Surgical decompression
54
Q

Dupuytrens management

A

Conservative - stretches, activity modification
Surgery - fasciectomy, amputation
Newer treatments - collagenase injection, percutaneous needle fasciotomy

55
Q

Paronychia management

A

Elevate
Antibiotics
Incise and drain collection

56
Q

Flexor tendon sheath infection management

A

Surgical emergency

Wash out tendon sheath

57
Q

Nail/nailbed injury management

A

Keep nail if possible

Repair nail bed

58
Q

Mallet finger management

A

Mallet splint for 6 weeks

59
Q

PIPJ dislocation management

A

Vital to be treated acutely

Pull to reduce, buddy strap

60
Q

PIPJ dislocation late presentation management

A

Impossible to reduce

May require fusion

61
Q

PIPJ dislocation with fracture management

A

Needs fixation/stabilisation

62
Q

Bennett’s fracture (fracture of 1st MC and CMC joint) management

A

Fixation

63
Q

Hand burns management

A

Excise damaged skin and perform split skin grafts early
Aggressive mobilisation to prevent finger stiffness
Escharotomy

64
Q

Rheumatoid nodule management

A

Excision if problematic

Recurrence high

65
Q

Management of giant cell tumour of the tendon sheath

A

Leave if no functional issue

Marginal excision, incidence of recurrence

66
Q

System used to grade the shape of the acromion

A

Bigliani acromial grading

67
Q

Supraspinatus tendinopathy management

A

Active shoulder movement with physiotherapy
Steroid and local anaesthetic injection
If refractory try arthroscopic sub-acromial decompression

68
Q

Management of calcifying teninopathy

A

Physiotherapy
NSAIDs
Steroid injection
Rarely excision of calcium

69
Q

Management of ACJ OA

A

Rest
NSAID
Steroid injection
Refractory then removal of ACJ

70
Q

Frozen shoulder management

A

Early physio and NSAIDs
Steroid injection
Surgical release with either manipulation under anaesthetic or arthroscopic arthrolysis

71
Q

Management of tennis elbow

A

Steroid injections

Surgical release and debridement of ERCB origin (only for refractory cases)

72
Q

Management of golfers elbow

A

Avoid injecting due to proximity to the ulnar nerve

Surgical debridement last resort

73
Q

RA extensor tendon rupture management

A

Tendon transfer

Synovectomy can prevent

74
Q

EPL rupture management

A

May require tendon transfer is affecting quality of life

75
Q

Radiocapitellar OA management

A

Excise and maybe replace radial head

76
Q

Management of tendon deformities in RA

A 
Splintage
Surgery (tendon reposition)
77
Q

Management of shoulder dislocation

A

Closed reduction under sedation (first line)
Open reduction
Stabilisation and rehab

78
Q

Management of elbow dislocation

A

Closed reduction under sedation
Open reduction rarely required
2 weeks in sling and rehab

79
Q

Management of IPJ fracture

A

Closed reduction under digital or metacarpal block
Open reduction rarely required
2 weeks in neighbour strapping
If very unstable then volar slab in edinburgh position

80
Q

Patellar dislocation management

A 
Reduces with knee extension
Radiographs
Aspiration
Brace
Physio
81
Q

Repeat patellar dislocation management

A

Lateral release/medial reefing

Patella tendon realignment

82
Q

Knee urgent management

A

Reduction under sedation
May require theatre reduction
Splint/external fixation
Vascular and nerve repair

83
Q

Knee dislocation imaging

A

X-ray (associated fractures)

MRI

84
Q

Knee dislocation definitive management

A

Sequential ligamentous repair

85
Q

Hip dislocation early management

A 
Neurovascular assessment (esp sciatic)
X-rays
Urgent reduction
Stabilise in tractions if required
CT
86
Q

Hip dislocation definitive management

A

Fixation of associated pelvic fractures

87
Q

Management of undisplaced intracapsular femoral fracture

A

Hemi-arthroplasty

THR for young fit people

88
Q

Management of extracapsular femoral fracture

A

Dynamic hip screw

89
Q

Management of sub-trochanteric femoral fracture

A

Intramedullary device (also has screw portion that goes into femoral head)

Year 2 Revision (45 decks)

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