MSK Passmed Flashcards
What is the main blood supply to scaphoid ?
Dorsal carpal branch of the radial artery
can be compromised when scaphoid is FRACTURED = AVN
How is scaphoid bone fractured ?
Wrist fracture due to fall onto outstretched hand (FOOSH).
Presentation of scaphoid fracture ?
Pain along the radial aspect of the wrist, at the base of the thumb.
Loss of grip / pinch.
Tenderness over the anatomical snuffbox.
May or may NOT present with joint effusion.
Management of scaphoid fracture ?
Futuro splint or standard below-elbow backslab
What is osteomyelitis ?
Is inflammation of the bone / bone marrow due to infection.
Can be either contagious / Hematogenous
Examples of contagious OM ?
From adjacent soft tissues to the bone or from direct injury/trauma to bone.
Common in
Young: injury
Elderly: pressure sore, vascular insuff
DM: soft tissue infection
Risk factors for Contagious include:
Diabetic foot ulcers / pressure sores, diabetes mellitus, peripheral arterial disease.
Examples of Hematogenous OM ?
Due to dental procedures, IV drugs, haemodialysis
Common in
In children: long bones
Adults: vertebrae osteomyelitis
Risk factors for Hematogenous include:
Sickle cell anaemia, intravenous drug user, immunosuppression due to either medication or HIV, infective endocarditis
OM: s. aureus ?
common in children / adults prosthetic IV drug vertebral lesions
OM: s. epidermis ?
Common in
Diabetics
Prosthetics
OM: strep ?
Diabetics
Neonates + infants
OM: salmonella ?
sickle cell anemia
OM: klebsiella ?
UTI
What to test for to rule out SLE ?
Over 99% of patients with SLE are ANA +VE Complement level (C3 – 4) are LOW.
ANCA most likely assoc. with vasculitis
what is Raynaoud’s phenomenon ?
Exaggerated vasocontraction response to cold / stress.
Reduces the blood supply to the finger’s, causing the white colour change.
Common in young women.
What is Osteopetrosis :
Aka MARBLE BONE disease.
Rare disorder of defective osteoclasts function resulting in failure of normal bone resorption.
What is Carpal tunnel syndrome ?
Can cause weakness to the areas above the wrist due to the compression of the median nerve.
Presentation of Carpal tunnel syndrome ?
pain/pins + needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night
wWhat is Tinel’s sign ?
Tapping causes paraesthesia
What is Phalen’s sign ?
Flexion of wrist causes symptoms
Treatment of CTS ?
Corticosteroid injection Wrist splints at night surgical Decompression (flexor retinaculum division)
What is Fibromyalgia ?
Pain all over the body.
Causes tiredness + sleep disturbance + tenderness in some area.
PMR = present with wt loss + fever.
What are the assoc. with GOUT ?
Lesch-Nyhan syndrome - Inherited enzyme deficiency also known as juvenile gout.
What assoc. with Pseudogout ?
Hyperparathyroidism -
deposition of calcium pyrophosphate dihydrate crystals in the synovium
Aspiration: weakly-positively birefringent rhomboid-shaped crystals.
Who is more likely to get HIP fractures ?
Very common in elderly people = esp. osteoporotic females
Signs of HIP Fractures ?
the classic signs are a shortened + externally rotated leg.
Patients with non-displaced / incomplete neck of femur fractures may be able to weight bear.
SE of Denosumab ?
RANKL antagonist and inhibits the formation, function and survival of osteoclasts.
SE of Bisphosphonate ?
Associated with osteonecrosis of the jaw
system used to classify growth plate injury in children ?
Salter - harris system
What is complete fracture ?
both sides of cortex are breached
Toddlers fracture ?
Oblique tibial fracture in infants
Plastic deformity ?
Stress on bone resulting in deformity without cortical disruption
Greenstick fracture ?
Unilateral cortical breach only
Buckle fracture ?
Incomplete cortical disruption resulting in periosteal haematoma only
Boxer fracture is associated with which fracture ?
5th metacarpal fracture = common after punching a hard surface
Chondromalacia Patellae
Softening of cartilage of patella.
Common in teens
Anterior knee pain on waling up + down.
Osgood-schlatter Disease (tibial apophysitis)
Seen in sporty teens
pain, tenderness + swelling over the tibial tubercle
Osteochondritis Dissecans
Pain after exercise
Intermittent swelling + locking
Patellar Subluxation
Medial knee pain = lateral subluxation of patella
Patellar Tendonitis
More common n athletic teenage boys.
Chronic anterior knee pain worsens after running.
Tender below patella.
