MSK Lectures Flashcards
What are proteoglycans?
- Highly hydrophilic
- Act like balloons/sponge to soak up water to give compressive strength
What is the role of collagen fibres?
Give tensile strength
What are the atraumatic causes of articular cartilage defects?
- Osteochondritis Dissecans
- OA
- Inflammatory arthritis
What is fibroblast and why is it used?
- Used in cartilage regeneration
- Has higher friction and is less wear resistant
What is Osteochondritis Dissecans and who does it affect?
- An area of the surface of the knee loses its blood supply and cartilage and bone can fragment off
- Most common in adolescence
What is the treatment of Osteochondritis Dissecans?
- Can heal or resolve spontaneously
- If detecting on MRI can pin in place
- If detached can fit or remove
What is the most commonly used cartilage regeneration technique?
- Microfracture
- Involves drilling holes into the cartilage
- Simplest and cheapest
What are the cartilage regeneration techniques available?
- Microfracture (drilling holes)
- Mosaicplasty (lots of little plugs for larger defects)
- Osteochondral allograft (large defects or bone loss)
What are the outcomes in cartilage regeneration techniques?
- Better for smaller defects
- About 60-70% improvement in symptoms
- Some patients worse
- Unsuccessful in patellofemoral joint
What can cartilage regeneration techniques NOT be used in?
- Radiograph change of OA
- Inflammatory arthritis
- Joint Arthritis
- Joint instability
What might the imbalance of cartilage breakdown and repair be predisposed by?
- Injury
- Malalignment
- Degenerate meniscal tears
- Infection
When can osteotomy be used in OA?
- In varus knee with isolated early medial compartment OA
- Results for valgus knee less well established
Success rates of total knee replacement?
- Partial poorer than total
- TKR 80% successful and lasts 15-20years
Is night time pain associated with impingement syndrome?
No
What is the BIGLIANI ACROMIAL grading used in?
Shape of the acromion
Dislocation:
TUBS
Traumatic
Unilateral
Bankart
Surgery
Dislocation:
AMBRI
Atraumatic Multidirectional Bilateral Rehabilitation Inferior capsular shift
What are the two complications of recurrent anterior shoulder dislocations?
- Hills-sach lesion
- Bankart lesion
What is a Hills-sach lesion?
- Posterolateral compression fracture secondary to recurrent anterior shoulder dislocations
- As the humeral head comes to rest against the anteroinferior part of the glenoid
- Often associated with Bankart lesions
What is a Bankart lesion?
- Common complication of anterior shoulder dislocation
- Frequently associated with Hills-sach lesion
- Result from detachment of the anterior inferior labrum from the underlying glenoid as a result of the anteriorly dislocated head compressing against the labrum
Sulcus sign
Ehlers Danlos
Causes of upper limb arthritis
- Degenerative OA
- Inflammatory (RA, psoriasis, gout)
- Post traumatic
- Septic
Upper limb arthritis associated with impingement
ACjt
Causes of glenohumeral OA
- Cuff tear
- Instability
- Previous surgery
- Idiopathic
Clinical sign of glenohumeral OA
Loss of external rotation
What happens during rotator cuff arthropathy?
- Rotator cuff torn
- Deltoid pulls upwards
- Abnormal forces on glenoid
- Reverse geometry shoulder replacement to prevent upwards migration
Radiocapitellar OA
Radial head is a secondary stabiliser so not vital, excise and replace
Terry Thomas sign on x-ray
Scaphlunate advanced collapse
Places of small joint OA
- DIP most common
- Base of thumb OA
- Thumb MCPjt
What are the tendons involved in De Quervains?
- Extensor pollucis brevis
- Abductor pollucis longus
What is De Quervains Tenosynovitis?
-Tendons around the base of the thumb are irritated or constricted
Causes of De Quervains Tenosynovitis?
- May be caused by overuse
- Associated with pregnancy and RA
- Middle aged women
Investigations and treatment of De Quervains Tenosynovitis?
- Fickelstein’s test (place thumb in palm and tilt forwards)
- NSAIDs, splint, rest
What is paronychia?
- Infection within nail fold
- Children
- Nail biting
- May result in pus formation
How many times can a steroid injection be given in trigger finger?
3 times
What is a mucous cyst?
- Out pouching of synovial fluid from DIPjt OA
- May be painful/fluctuate/discharge
Why is it vital to treat a PIPjt acutely?
- Delayed presentation is impossible to reduce
- Pull to reduce, buddy strap
What is a Bennett’s fracture?
- Intra-articular fracture of the base of the 1st metacarpal bone
- Fracture extends into the CMCjt
What is Eschar?
Thick, leathery, inelastic skin which can form after burns and may require surgical release to allow movement
What are the two types of mallet finger injury?
- Soft tissue
- Avulsion fracture
In Arthroplasty, what can metal particles cause?
An inflammatory granuloma- pseudotumour
In Arthroplasty, what can polythene particles cause?
An inflammatory response in bone with subsequent resorption- osteolysis
Keller’s procedure
Removal of joint in Hallux valgus
What OA can osteotomy be used in?
Early arthritis in knee and hip
How does Osteomyelitis impair blood flow?
Once infected, enzymes from leukocytes cause local osteolysis and pus forms which impairs blood flow making it difficult to eradicate
Dead bone in osteomyelitis
Sequestrum
New bone in osteomyelitis
Involucrum
Children, subacute osteomyelitis, insidious onset, thin rim of sclerotic bone
Brodies abscess
Organisms in osteomyelitis:
a) All ages
b) Children
c) Adults
d) Sickel cell anaemia
a) Staph aureus
b) H.influenza
c) Enterobacter
d) Salmonella
Treatment for acute and chronic osteomyelitis
Acute: best guess IV Abx
Chronic: Surgery: deep bone tissue cultures, remove sequestrum and non viable bone, external fixation
Those affected by osteomyelitis of the spine?
- IVDU
- Immunocompromised
- Affects lumbar
- Look for endocarditis
- IV Abx
What is the most common presentation of the humeral neck?
Surgical neck fracture with medial displacement of the humeral shaft due to the pull of the pectoralis major
Patient presents with arm held in adducted position, supported by other arm
Anterior dislocation
Mechanism of ACjt injury?
-Sports: fall onto the point of the shoulder
Mechanism of Olecranon injury?
Due to a fall onto the point of the elbow with contraction of triceps muscle
What investigation is mandatory with an isolated radial shaft fracture?
Lateral x-ray of the wrist
Grip strength and wrist extension are greatly reduced in this fracture
Smith’s
What x-ray views in a scaphoid and carpus fractures?
AP, lateral, 2 oblique
What is the management of a suspected scaphoid fracture which is not visible on initial x-rays
- Splint wrist
- X-ray is arranged for 2 weeks after the injury
- “Clinical scaphoid fracture”
Is a perilunate fracture an emergency?
Yes
“Spilt cup sign” on x-ray
- Lunate dislocation, tilted volarly
- Emergency reduction and pinning
Management of penetrating hand injuries
- Low threshold for surgical exploration
- Digital nerve injuries proximal to DIDpt warrant repair
Forced flexion of the extended DIPjt
Mallet finger
Morbidity from hip fractures at:
- one month
- 4 months
- 1 year
- 10% at one month
- 20% at 4 months
- 30% at 1 year
Management of extra-articular proximal hip fractures
Dynamic hip screw
Mechanism of subtrochanteric femoral fractures
Fall onto the side
Definitive treatment for femoral shaft fracture?
IM nail
Varus stress injury
- LCL rupture
- Injury to common peroneal nerve
Treatment for tibial shaft fracture in up to 50% displacement and 5 degrees angulation?
Above knee cast
Surgical stabilisation in tibial shaft fracture?
IM nail is inserted behind the patellar tendon
Ottowa criteria
Suspected ankle fractures
Treatment in stable ankle fracture
6 weeks in splint
Mechanism of talar fracture?
Forced dorsiflexion from rapid deceleration
