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Summary of Stuff > MSK Lectures > Flashcards

MSK Lectures Flashcards

1
Q

What are proteoglycans?

A
  • Highly hydrophilic

- Act like balloons/sponge to soak up water to give compressive strength

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2
Q

What is the role of collagen fibres?

A

Give tensile strength

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3
Q

What are the atraumatic causes of articular cartilage defects?

A
  • Osteochondritis Dissecans
  • OA
  • Inflammatory arthritis
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4
Q

What is fibroblast and why is it used?

A
  • Used in cartilage regeneration

- Has higher friction and is less wear resistant

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5
Q

What is Osteochondritis Dissecans and who does it affect?

A
  • An area of the surface of the knee loses its blood supply and cartilage and bone can fragment off
  • Most common in adolescence
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6
Q

What is the treatment of Osteochondritis Dissecans?

A
  • Can heal or resolve spontaneously
  • If detecting on MRI can pin in place
  • If detached can fit or remove
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7
Q

What is the most commonly used cartilage regeneration technique?

A
  • Microfracture
  • Involves drilling holes into the cartilage
  • Simplest and cheapest
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8
Q

What are the cartilage regeneration techniques available?

A
  • Microfracture (drilling holes)
  • Mosaicplasty (lots of little plugs for larger defects)
  • Osteochondral allograft (large defects or bone loss)
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9
Q

What are the outcomes in cartilage regeneration techniques?

A
  • Better for smaller defects
  • About 60-70% improvement in symptoms
  • Some patients worse
  • Unsuccessful in patellofemoral joint
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10
Q

What can cartilage regeneration techniques NOT be used in?

A
  • Radiograph change of OA
  • Inflammatory arthritis
  • Joint Arthritis
  • Joint instability
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11
Q

What might the imbalance of cartilage breakdown and repair be predisposed by?

A
  • Injury
  • Malalignment
  • Degenerate meniscal tears
  • Infection
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12
Q

When can osteotomy be used in OA?

A
  • In varus knee with isolated early medial compartment OA

- Results for valgus knee less well established

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13
Q

Success rates of total knee replacement?

A
  • Partial poorer than total

- TKR 80% successful and lasts 15-20years

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14
Q

Is night time pain associated with impingement syndrome?

A

No

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15
Q

What is the BIGLIANI ACROMIAL grading used in?

A

Shape of the acromion

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16
Q

Dislocation:

TUBS

A

Traumatic
Unilateral
Bankart
Surgery

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17
Q

Dislocation:

AMBRI

A 
Atraumatic
Multidirectional
Bilateral
Rehabilitation 
Inferior capsular shift
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18
Q

What are the two complications of recurrent anterior shoulder dislocations?

A
  • Hills-sach lesion

- Bankart lesion

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19
Q

What is a Hills-sach lesion?

A
  • 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
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20
Q

What is a Bankart lesion?

A
  • 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
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21
Q

Sulcus sign

A

Ehlers Danlos

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22
Q

Causes of upper limb arthritis

A
  • Degenerative OA
  • Inflammatory (RA, psoriasis, gout)
  • Post traumatic
  • Septic
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23
Q

Upper limb arthritis associated with impingement

A

ACjt

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24
Q

Causes of glenohumeral OA

A
  • Cuff tear
  • Instability
  • Previous surgery
  • Idiopathic
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25
Q

Clinical sign of glenohumeral OA

A

Loss of external rotation

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26
Q

What happens during rotator cuff arthropathy?

A
  • Rotator cuff torn
  • Deltoid pulls upwards
  • Abnormal forces on glenoid
  • Reverse geometry shoulder replacement to prevent upwards migration
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27
Q

Radiocapitellar OA

A

Radial head is a secondary stabiliser so not vital, excise and replace

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28
Q

Terry Thomas sign on x-ray

A

Scaphlunate advanced collapse

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29
Q

Places of small joint OA

A
  • DIP most common
  • Base of thumb OA
  • Thumb MCPjt
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30
Q

What are the tendons involved in De Quervains?

A
  • Extensor pollucis brevis

- Abductor pollucis longus

31
Q

What is De Quervains Tenosynovitis?

A

-Tendons around the base of the thumb are irritated or constricted

32
Q

Causes of De Quervains Tenosynovitis?

A
  • May be caused by overuse
  • Associated with pregnancy and RA
  • Middle aged women
33
Q

Investigations and treatment of De Quervains Tenosynovitis?

A
  • Fickelstein’s test (place thumb in palm and tilt forwards)

- NSAIDs, splint, rest

34
Q

What is paronychia?

A
  • Infection within nail fold
  • Children
  • Nail biting
  • May result in pus formation
35
Q

How many times can a steroid injection be given in trigger finger?

A

3 times

36
Q

What is a mucous cyst?

A
  • Out pouching of synovial fluid from DIPjt OA

- May be painful/fluctuate/discharge

37
Q

Why is it vital to treat a PIPjt acutely?

A
  • Delayed presentation is impossible to reduce

- Pull to reduce, buddy strap

38
Q

What is a Bennett’s fracture?

A
  • Intra-articular fracture of the base of the 1st metacarpal bone
  • Fracture extends into the CMCjt
39
Q

What is Eschar?

A

Thick, leathery, inelastic skin which can form after burns and may require surgical release to allow movement

40
Q

What are the two types of mallet finger injury?

A
  • Soft tissue

- Avulsion fracture

41
Q

In Arthroplasty, what can metal particles cause?

A

An inflammatory granuloma- pseudotumour

42
Q

In Arthroplasty, what can polythene particles cause?

A

An inflammatory response in bone with subsequent resorption- osteolysis

43
Q

Keller’s procedure

A

Removal of joint in Hallux valgus

44
Q

What OA can osteotomy be used in?

A

Early arthritis in knee and hip

45
Q

How does Osteomyelitis impair blood flow?

A

Once infected, enzymes from leukocytes cause local osteolysis and pus forms which impairs blood flow making it difficult to eradicate

46
Q

Dead bone in osteomyelitis

A

Sequestrum

47
Q

New bone in osteomyelitis

A

Involucrum

48
Q

Children, subacute osteomyelitis, insidious onset, thin rim of sclerotic bone

A

Brodies abscess

49
Q

Organisms in osteomyelitis:

a) All ages
b) Children
c) Adults
d) Sickel cell anaemia

A

a) Staph aureus
b) H.influenza
c) Enterobacter
d) Salmonella

50
Q

Treatment for acute and chronic osteomyelitis

A

Acute: best guess IV Abx
Chronic: Surgery: deep bone tissue cultures, remove sequestrum and non viable bone, external fixation

51
Q

Those affected by osteomyelitis of the spine?

A
  • IVDU
  • Immunocompromised
  • Affects lumbar
  • Look for endocarditis
  • IV Abx
52
Q

What is the most common presentation of the humeral neck?

A

Surgical neck fracture with medial displacement of the humeral shaft due to the pull of the pectoralis major

53
Q

Patient presents with arm held in adducted position, supported by other arm

A

Anterior dislocation

54
Q

Mechanism of ACjt injury?

A

-Sports: fall onto the point of the shoulder

55
Q

Mechanism of Olecranon injury?

A

Due to a fall onto the point of the elbow with contraction of triceps muscle

56
Q

What investigation is mandatory with an isolated radial shaft fracture?

A

Lateral x-ray of the wrist

57
Q

Grip strength and wrist extension are greatly reduced in this fracture

A

Smith’s

58
Q

What x-ray views in a scaphoid and carpus fractures?

A

AP, lateral, 2 oblique

59
Q

What is the management of a suspected scaphoid fracture which is not visible on initial x-rays

A
  • Splint wrist
  • X-ray is arranged for 2 weeks after the injury
  • “Clinical scaphoid fracture”
60
Q

Is a perilunate fracture an emergency?

A

Yes

61
Q

“Spilt cup sign” on x-ray

A
  • Lunate dislocation, tilted volarly

- Emergency reduction and pinning

62
Q

Management of penetrating hand injuries

A
  • Low threshold for surgical exploration

- Digital nerve injuries proximal to DIDpt warrant repair

63
Q

Forced flexion of the extended DIPjt

A

Mallet finger

64
Q

Morbidity from hip fractures at:

  • one month
  • 4 months
  • 1 year
A
  • 10% at one month
  • 20% at 4 months
  • 30% at 1 year
65
Q

Management of extra-articular proximal hip fractures

A

Dynamic hip screw

66
Q

Mechanism of subtrochanteric femoral fractures

A

Fall onto the side

67
Q

Definitive treatment for femoral shaft fracture?

A

IM nail

68
Q

Varus stress injury

A
  • LCL rupture

- Injury to common peroneal nerve

69
Q

Treatment for tibial shaft fracture in up to 50% displacement and 5 degrees angulation?

A

Above knee cast

70
Q

Surgical stabilisation in tibial shaft fracture?

A

IM nail is inserted behind the patellar tendon

71
Q

Ottowa criteria

A

Suspected ankle fractures

72
Q

Treatment in stable ankle fracture

A

6 weeks in splint

73
Q

Mechanism of talar fracture?

A

Forced dorsiflexion from rapid deceleration

Summary of Stuff (14 decks)

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