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Clinical > MSK/Orthopaedics > Flashcards

MSK/Orthopaedics Flashcards

1
Q

A patient presents with a swollen, red, painful elbow with reduced range of motion after a fall. XR shows joint effusion, what is this likely to be?

A

Radial head fracture

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2
Q

A distal fracture of the radius with dorsal displacement and angulation of the the distal segment (dinner fork deformity) is what fracture? Management? Which nerve might become damaged?

A

Colles
Mx: closed reduction and immobilisation with cast.
Cx: median nerve damage causing weakness in finger flexion.

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3
Q

A distal radial fracture with volar displacement of the distal segment is what fracture?

A

Smiths

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4
Q

A fracture of the distal 3rd of the radius with dislocation of the distal radioulnar joint is what type of classification?

A

Galeazzi fracture

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5
Q

Fracture of the proximal ulna with dislocation of the radial head at the capitulum is called what?

A

Monteggia fracture

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6
Q

What is a greenstick fracture?

A

Incomplete fracture of soft bones in children as they easily bend and break.

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7
Q

What is a bennett fracture?

A

fracture at the base of the 1st metacarpal caused by an axial force which has caused abduction and extension, such as punching a a wall.
Causes pain at the base of the thumb.

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8
Q

What is a Boxer’s fracture?

A

fracture at the base of the 4th or 5th metacarpals.
Caused by an axial force such as punching a wall.

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9
Q

A pt presenting with pain in the anatomical snuffbox following a FOOSH is likely what? How do we treat it?

A

Scaphoid fracture,
Mx: plaster for 10 days - even if can’t visualise on XR.

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10
Q

What causes Dupuytrytren’s contracture?

A

Tendon’s leading to the 4th/5th digits become thick and develop nodules causing the digits to be held in flexion due to ‘tightness’ of the tissues.

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11
Q

What is Finkelstein’s test?

A

1) Bend the thumb across the palm of the hand and bending fingers over
2) Bend wrist laterally toward the little finger
If this causes pain at the base of the thumb this pt may be positive for DeQuervain’s tenosynovitis.

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12
Q

What is DeQuervain’s tenosynovitis?

A

Inflammation at the base of the thumb where extensor pollicis brevis inserts into the radial styloid process.
Often caused by RSI such as from knitting.
The pt often has a ‘sticky’ thumb’

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13
Q

Tennis elbow is caused by what? How can you test for it?

A

Inflammation of lateral epicondyle where extensor tendons insert causing pain.
Test with Conzen’s test (resisted extension of fingers and wrist causes pain)

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14
Q

Golfer’s elbow is pain where? How can you elicit this pain?

A

Pain at the medial epicondyle due to inflammation where flexor tendons attach.
Pain can be elicited by flexing the wrist against resistance whilst the forearm is supinated.

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15
Q

How can you test hand movements of the ulna, medial, and radial nerves?

A

Ulna: touch thumb to finger
Median: obstetricians fingers
Radial: flexing wrist into stop sign

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16
Q

A mid-humeral shaft fracture is associated with what nerve injury?

A

High radial nerve palsy affecting the function of brachioradialis (flexion at the elbow), and causes wrist/finger drop.

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17
Q

A very high radial nerve palsy e.g., axilla impingement will have what effect?

A

tricep weakness and wrist/finger drop

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18
Q

A low radial nerve palsy will have what effect?

A

finger drop

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19
Q

What is saturday night palsy?

A

wrist drop - radial nerve palsy

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20
Q

Cubital tunnel syndrome causes what sx?

A

weakness and sensory changes in medial 1 and a half digits.

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21
Q

What is frozen shoulder? What is a common RF?

A

Adhesive capsulitis - progressive shoulder pain and stiffness causing limited range of movement (most commonly affecting external rotation).
T2DM is a common RF.

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22
Q

How do you manage frozen shoulder?

A

1) Conservative: NSAIDs, physio
2) Steroid injections
3) Arthroscopic capsular release surgery (only if the others were unsuccessful)

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23
Q

Where are extra-capsular hip fractures? How are these managed?

A

Inter or sub-trochanteric fractures - intramedullary screw

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24
Q

Where are intracapsular fractures located?

A

Within the femoral neck (between the trochanter and head)

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25
Q

How is an intracapsular hip fracture further classified?

A

Garden classification:
1) incomplete, minimally displaced
2) complete, non-displaced
3) Complete, <50% displaced
4) complete, >50% displaced

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26
Q

How do you manage an intracapsular NOF?

A

If it is displaced consider hemi or total arthroplasty.
Fixation with DHS (dynamic hip screws) if non-displaced.

27
Q

What is lipohemarthrosis?

A

Fracture of long bones with articular involvement (tibial plateau), causes fat-fluid level on XR.

28
Q

What is a maisonneuve fracture?

A

Proximal fibular fracture and ligamentous injury in the ankle causing a widening syndesmosis and pain at the medial malleolus.

29
Q

What action causes posterior hip dislocation? How does it present?

A

flexion, abduction, and internal rotation (crossing legs).
Presents with a flexed, adducted, shortened, and internally rotated leg.

30
Q

What mechanism causes an anterior hip dislocation? How does it present?

A

Hyper-abduction with extension.
Presents with extended and externally rotated leg.

31
Q

Why might someone have a central hip dislocation?

A

Caused by high energy trauma alongside an acetabular fracture - femoral head is forced medially toward the acetabulum floor.

32
Q

What movement is advised against post hip replacement to avoid dislocation?

A

Crossing legs

33
Q

A pt presenting with pain in their knee following a popping sensation that caused rapid swelling is likely what? How can you test for it?

A

ACL injury.
Lachman and anterior drawer tests.

34
Q

Posterior knee pain in a pt due to a direct blow to the proximal tibia with a flexed knee is likely what? How can you test for it?

A

PCL injury.
Posterior drawer test and observation for sag sign.

35
Q

What lower leg fracture is associated with ACL injury?

A

Tibial plateau fracture.

36
Q

A pt presenting with knee pain, swelling, and a ‘locking/buckling’ sensation following twisting of the leg is likely an injury where?

A

Meniscal tear.

37
Q

Ciprofloxacin can affect what tendon?

A

Achilles tendonitis is associated with ciprofloxacin

38
Q

Common peroneal nerve injury is associated with what fracture?

A

Neck of fibular

39
Q

What is L5 radiculopathy? How does it present.

A

Damage to the nerve root where it leaves the cord.
Unilateral foot drop, weakness in foot dorsiflexion, inversion, eversion, and big toe dorsiflexion.
May also have weakness in hip abduction and internal rotation.
Sensory loss of the lateral thigh and lower leg.

40
Q

What is osteochondritis dissecans? Who is it seen in?

A

Necrosis and displacement of bone/cartilage (most commonly in the knee) due to interruption of blood supply after microtrauma and repetitive use of joint. Can cause stiffness and locking.
Young adults who are active.

41
Q

What is Perthes disease? Who is at risk?

A

Avascular necrosis of the femoral head, followed by collapse, repair, and remodelling in a continuous cycle.
Often in young males (4-8 y/o).

42
Q

How might Perthes disease present? How is it investigated?

A

Pain and limited range of motion (abduction and internal rotation most affected), and potentially a limp.
Frog leap XR - increased density of femoral head at the beginning of the disease and then irregular edges as it progresses.

43
Q

What are Perkin and Hilgenreiner lines? What happens in DDH?

A

Perkin lines should intersect the H line at perpendicular angles at the lateral most aspect of the acetabular roof.
The upper femoral epiphysis should be seen in the inferomedial quadrant (medial to the perkin line and underneath the H line).
In DDH there is lateral displacement relative to the perkin lines so it sits outside the inferomedial quadrant.

44
Q

A child presenting with a progressively growing lump on the thigh causing pain and tenderness associated with weight loss and fever is likely what?
How do you investigate this? What are you looking for?

A

Ewing’s sarcoma
XR - lytic lesion with ‘onion skin’ appearance

45
Q

How do you manage a SUFE? Why?

A

Surgical fixation - to prevent avascular necrosis

46
Q

What is a cervical myelopathy?

A

Wear and tear due to age causing degeneration of nerve roots, resulting in sx such as pain, pins and needles, etc.

47
Q

What score on DEXA scan is indicative of osteoporosis? Mx?

A

-2.5 = osteoporosis
mx - calcium and vitamin D supplements, bisphosphonates (if CI then PTH injections).
Denosumab can be used in post menopausal women who cannot tolerate bisphosphonates.

48
Q

What are the most common osteoporotic fractures? What are the common RFs?

A

Colle’s, vertebral wedge, and NOF.
RFs: long-term steroid use, low BMI, frailty, female sex.

49
Q

What is the role of raloxifene in managing osteoporotic fractures?

A

Help to reduce future risk in post-menopausal women by increasing bone density in a similar way to oestrogen.

50
Q

What are the XR signs of OA?

A
  • Loss of joint space
  • Osteophytes (bone spurs)
  • Subchondral sclerosis
  • Subcortical cysts
51
Q

What is Paget’s disease of the bone? How does it present? What do you get on biochemistry results?

A

Cycle of increased osteoblastic activity followed by increased osteoclastic activity resulting in disorganised bone breakdown.
Bone weakness, arthritis, fractures, and can cause hearing loss due to cochlear damage.
Bloods show an isolated rise in ALP.

52
Q

How do you differentiate multiple myeloma from Paget’s?

A

Paget’s has raised ALP, MM does not.

53
Q

What are the biochemistry results for osteomalacia? How does it present?

A

Low calcium, phosphate, and B12.
Lower back, hip, and pelvic pain, may also present with pseudo fractures (layer of decreased density).

54
Q

What do you see on XR for osteomyelitis?

A

Periosteal retraction, focal cortical loss, regional osteopenia.

55
Q

What are the most common organisms causing osteomyelitis? How is it managed?

A
  • staph aureus and strep pyogenes
  • 4-6 weeks abx, start with IV flucloxacillin (clindamycin in penicillin allergic, vancomycin if MRSA suspected) and switch to oral once stable.
    If it is a prosthetic joint you should get an MRI.
56
Q

When should an ankle XR be ordered?

A

Ottawa ankle rules:
Pain the the malleolar zone and any of…
- Boney tenderness and the tip or edge of lateral/medial malleolus
- Inability to weight bear immediately and for four steps in ED

57
Q

A patient presenting with a swollen, bruised, and painful heel after jumping from a height has most likely fractured which bone?

A

Calcaneal

58
Q

How does a pt present with rupture of a proximal bicep tendon?

A

Sudden, painless popeye sign (lump over the bicep) with normal function/movement.

59
Q

How does a pt present with rupture of the distal bicep tendon?

A

Sudden, painful, limited movement (flexion and supination at elbow).

60
Q

What are then criteria for a clinical diagnosis of OA?

A

Age >45, joint pain worsens during activity, no morning stiffness.

61
Q

At what age does Duchenne Muscular Dystrophy present? What features are seen?

A

Usually between 3-5 years.
- Gower sign
- Muscle wasting (calves)
- Cramps
- Difficulty mobilising

62
Q

What is the difference between Duchenne and Becker’s muscular dystrophy?

A

Becker’s maintains some of the function of the dystrophin gene meaning it results in less severe features and a later onset.

63
Q
A

Clinical (27 decks)

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