MSK Quiz 2: Part 2 Flashcards
1
Q
What does diarthroses mean?
A
freely movable
2
Q
Where is the synovial fluid secreted from?
A
synoviocytes
3
Q
what’s the job of the synovial fluid?
A
nourishes the articular cartilage, shock absorber
4
Q
What’s the most common of all joint diseases?
A
osteoarthritis
5
Q
What is osteoarthritis?
A
progressive, irreversible loss of joint cartilage
6
Q
Most commonly affected joints by osteoarthritis?
A
cervical and lumbosacral spine, hip, knee, 1st MTP joint, hands (DIP, PIP, 1st CMC joint)
7
Q
Risk factors for osteoarthritis
A
joint vulnerability (systemic factors, intrinsic joint factors) and joint loading
8
Q
Systemic risk factors for OA
A
increased age, female gender, racial/ethnic factors, genetics, nutrition
9
Q
Intrinsic joint risk factors for OA
A
previous damage, muscle weakness, increasing bone density, malalignment, proprioceptive deficiencies
10
Q
Does OA impact extra-articular organs?
A
No
11
Q
Does OA impact men or women more?
A
women
12
Q
Presentation of OA
A
pain (bone pain, aching to severe, localized to radiating, affects sleeping), stiffness lasting <30 minutes (worse with inactivity), swelling, joint instability, decreased ROM, locking and grinding
13
Q
PE OA
A
TTP, joint effusion, possible deformity, crepitus, antalgic gait, decreased ROM, muscle atrophy
14
Q
What are OA deformities you can see in the knees?
A
genu varum, genu valgum
15
Q
what are OA deformities you can see in teh hands?
A
Heberden nodes (DIP) and Bouchard nodes (PIP)
16
Q
Films for OA
A
Plain films (joint space narrowing, osteophytes, subchondral bone sclerosis/cysts), MRI (r/o if needed), US (not routinely used)
17
Q
What labs are used for OA?
A
nothing specific, just r/o other causes
18
Q
Treatment for OA?
A
RICE, unloader brace, injections, NSAIDS/tramadol/glcuosamine and chondroitin sulfate, physical therapy/aquatic therapy, patient education, CAM
19
Q
Surgical options for OA?
A
arthroscopy is NOT indicated for OA, joint replacement
20
Q
What’s the most common form of autoimmune arthritis?
A
Rheumatoid arthritis
21
Q
What types of joints does RA typically impact?
A
synovial joints
22
Q
What’s the cause of RA?
A
unknown triggers for immune response in synovial tissue
23
Q
Which genetic marker determines both risk and severity of RA?
A
HLA-DR4
24
Q
What are possible triggers of RA?
A
bacterial antigens (mycobacteria, strep, mycoplasma, e. coli, h. pylori), viral agents (EBV, rubella, parvovirus), smoking, hormonal changes
25
Risk factors for RA?
female sex, positive family history, older age, smoking, coffee consumption (>3 cups daily)
26
Who is impacted by RA more, men or women?
women
27
When does RA occur?
Any age; men <45 is uncommon, women it increases with age until 60 yo
28
Presentation of RA
insidious to sudden onset pain (affecting distal joints first), stiffness, swelling, possible systemic symptoms (Fatigue, low-grade fever, weight loss); symmetric polyarthritis, morning stiffness (gel phenomenon, lasting more than 1 hour, decreases with physical activity), swelling and tenderness, nodules
29
PE findings of OA
painful/loss of ROM, possible muscle pain, swelling, deformity, rheumatoid nodules
30
Affected joints for RA
MCP, PIP (flexor tendon tenosynovitis), MTP, wrist, knees, elbows, ankles, hips, shoulder, C1-C2 articulation, TMJ
31
When is the DIP joint involved in RA?
almost never
32
Hand/feet symptoms of RA?
MCP ulnar deviation, swan-neck deformity, boutonniere deformity, nodules, hammer toes
33
Exta-articular manifestations of RA
rheumatoid nodulosis, pulmonary nodules and fibrosis, vasculitis, pericarditis, musculoskeletal nodules, tenosynovitis, k. sicca, scleritis
34
Skin symptoms you may see in RA
subcutaenous nodules
35
Pulmonary symptoms you may see in RA
pleurisy, effusion
36
cardiovascular symptoms you may see in RA
digital infarcts, ischemic mononeuropathy
37
Musculoskeletal symptoms you may see in RA
carpal tunnel syndrome, tarsal tunne syndrome, trigger finger
38
Ocular symptoms you may see in RA
dry eyes, corneal ulcer, scleral injection
39
Felty's syndrome is a combination of?
RA, splenomegaly, and neutropenia
40
Associated complication of Felty's syndrome
hepatomegaly, thrombocytopenia, lymphandenopathy, fever
41
Diagnostic tests for RA
RF, ANA, CBC with diff (anemia, thrombocytosis, neutropenia), CRP, ESR, Anti-CCP
42
Imaging for RA
x-rays (joint erosions)
43
4 categories for RA criteria
joint involvement, serology, duration of synovitis, acute phase reactants
44
How many points do you need for criteria for RA?
6/10
45
Joint Involvement criteria (RA)
1 med/large joint (0), 2-10 med/large joints (1), 1-3 small joints (2), 4-10 small joints (3), >10 joints with at least one small (5)
46
Serology criteria (RA)
neither RF nor ACPA positive (0), at least one test low positive titre (2), at least one test high positive titre (3)
47
Duration of synovitis criteria (RA)
<6 weeks (0); >6 weeks (1)
48
Acute phase reactants criteria RA
neither CRP nor ESR abnormal (O), abnormal CRP or abnormal ESR (1)
49
Treatment of RA?
lifelong disease without cure; patient education, referral to rheumatologst, braces, splints, orthoses, medications
50
What's the goal of RA treatment?
remission
51
Drug treatment options for RA?
NSAIDS or low-dose prednisolone, intra-articular steroid injection, disease modifying antirheumatic drugs (DMARDs), anti-TNF drugs
52
What do antirheumatic drugs (DMARDs) do?
target cytokines or receptors in inflammatory cascade, decrease monocolonal antibodies
53
Examples of antirheumatic drugs?
sulfasalazine, hydroxychloroquine, methotrexate, leflunomide, cyclophosphamide
54
Anti-TNF drug examples?
infliximab, etanercept, adalimumab, golimumab
55
RA surgical options?
joint replacement
56
Describe three components of RA?
inflamed joint capsule and synovial membrane; loss of space in synovial cavity; cartilage destruction
57
Describe three components of OA?
loose cartilage particles; bone spur; severe cartilage destruction
58
Fracture presentation
history of an injury with pain and edema, worse over first 1-3 days, TTP
59
4 phses of fracture healing
1) cellular callus--mesenchymoid cell proliferation, 2) mineralized callus--collagen to cartilage 3) bony callus-lamellar bone replaces mineralized callus 4) remodeling
60
Fracture complication
ARDS (fat embolism syndrome), atelectasis (early post-op fevers and hypoxemia), DVT, PE, compartment syndrome, nerve or blood vessel injury, failure of normal healing
61
Five Ps of compartment syndrome
pain out of proportion, paresthesia, pallor, paralysis, pulselessness
62
Malunion:
incomplete or faulty healing
63
Delayed union:
slower than normal healing
64
Non-union:
lack of bony reconstruction
65
How do you describe position on bone?
proximal, mid, distal
66
Closed fracture:
no break in the skin
67
Open fracture:
part of bone protrudes through skin
68
Complete fracture:
all cortical surfaces are disrupted
69
What are two types of incomplete fractures?
greenstick, buckle
70
What's a greenstick fracture?
one side of bone breaks, the other side is still intact
71
What's a buckle fracture?
crunches on one side of the bone
72
Simple fracture:
single fracture line in 2 bone fragments
73
Comminuted fracture:
2 or more fracture fragments
74
Butterfly fracture:
esults from two oblique fracture lines meeting to create a large triangular or wedge-shaped fragment located between the proximal and distal fracture fragments, and resembles a butterfly.
75
Give examples of fracture line direction
transverse, spiral, oblique
76
Term for a fracture that disrupts the joint?
intra-articular
77
Distraction:
a fracture resulting in increased overall bone length (bone fragments are pulled apart)
78
Impaction:
If there is shortening of bone without loss of alignment, the fracture is impacted. "over riding"
79
How to describe displacement?
anterior, posterior, lateral, medial (need 2-3 views!)
80
Angulation:
direction apex is pointing; location of distal fragment
81
Change in anatomic position in a circular motion is called?
rotation
82
Partial disruption/displacement of joint:
subluxation
83
Clavicle fracture MOI
direct blow, fall on outstretched arm
84
Presentation of clavicle fracture
pain, deformity, grinding at fracture site, sagging shoulder
85
Treatment of clavicle fracture
based on displacement; conservative (immobilize in sling figure-8 brace for 4-6 weeks) vs. surgery (open reduction internal fixation or intramedullary nail)
86
Proximal humerus MOI
high energy injury (Fall, MVA)
87
What classification system do you use for proximal humerus fracture?
Neer Classification
88
Treatment for proximal humerus fractures?
sling up to 6 weeks, passive ROM after 3 weeks vs. surgery (ORIF vs hemiarthroplasty)
89
With proximal humerus fractures, which nerve do we worry about?
Axillary
90
Humeral shaft fracture MOI
trauma, fall
91
What's a common negative outcome with humeral shaft fractures?
mal-union
92
What nerve do we worry about with humeral shaft fracture?
Radial (wrist drop)
93
Elbow x-ray analysis
joint effusion, ossification centers, alignment, subtle fractures
94
Fat pad sign
When there is a joint effusion, the anterior fat pad becomes elevated, likely intraarticular fracture.
95
What's the most common elbow fracture in kids?
supracondylar fractures
96
supracondylar fractures MOI
fall with elbow extended
97
Treatment of supracondylar fracture
typically surgery
98
Complications of supracondylar fractures
brachial artery injury
99
Epicondyle/condylar fracture MOI
FOOSH, valgus or varus force
100
treatment of epicondyle/condylar fracture MOI
conservative (rest, splint, delayed ROM) vs surgical (percutaenous pinning vs ORIF)
101
What's the most common elbow fracture in adults?
radial head/neck fractures
102
radial head/neck fracture MOI
fall with elbow extended
103
treatment of radial head/neck fracture
long arm splint for 2-3 weeks (must go beyond wrist); rarely surgery; do not immobilize too long (need early PT)
104
Olecranon fracture MOI
fall on posterior elbow or active triceps avulsion
105
treatment of olecranon fracture
displacement and triceps guide treatment
106
Describe the Monteggia fracture
ulnar fracture (proximal 1/3), radial head dislocation
107
Describe the Galeazzi fracture
radial fracture, distal radioulnar joint dislocation
108
Monteggia fracture MOI
FOOSH
109
Monteggia fracture demographics
peds patients ages 4-10
110
Monteggia fracture treatmetn
usually surgery
111
Galeazzi fracture MOI
fall on outstretched hand with elbow flexed
112
Galeazzi fracture demographics
adult males
113
Galeazzi treatment
surgical fixation
114
Radial shaft fracture usually occurs with?
ulnar shaft fractures or dislocation
115
radial shaft fracture MOI
high energy injury (MVA)
116
treatment of radial shaft fracture
often surgery
117
ulnar shaft fracture AKA
nighstick
118
ulnar shaft fracture MOI
usually a direct blow
119
presentation of ulnar shaft fracture
medial forearm pain
120
treatment of ulnar shaft fracture
splint, rarely needs surgery
121
What's the most common fracture of upper extremity?
distal radius fracture
122
who commonly experiences distal radial fractures?
elderly (low energy FOOSH), younger patients (higher energy falls)
123
presentation of distal radial fractures
deformity, swelling, ecchymosis, tenderness over fracture site
124
Colles fracture MOI
FOOSH
125
colles fracture (3 components)
dorsal angulation (apex volar), dorsal displacement, impaction/shortening
126
Smith fracture AKA
reverse colles
127
Which is more common colles or smith?
colles
128
Smith fracture MOI
falling onto flexed wrist
129
What's the common anecdote for the smith fracture?
"i drank too much and fell down"
130
Treatment of distal radius fracture (buckle or minimal displacement)
immobilize
131
Treatment of distal radius fracture (other than buckle or minimal displacement)
colles, smith, or any angulation/displacment require referral
132
treatment for adults with distal radius fracture (immobilization)
6 weeks immobilization (2 in splint, 4 in cast)
133
treatment for adolescents with distal radius fracture (immobilization)
6 weeks immobilization
134
Wrist reduction and splint procedure
analgesia to area or patient, hang in traps with counter-weight typically ten pounds, wait ten minutes, reduce and sugartong splint
135
Chauffer fracture
radial styloid fracture
136
chauffeur fracture MOI
direct blow to back of wrist, forced ulnar deviation and supination
137
treatment of chauffeur fracture
surgery
138
Most common carpal fracture?
scaphoid fracture
139
presentation of scaphoid fracture
snuff box pain
140
scaphoid fracture MOI
FOOSH
141
scaphoid fractures are commonly diagnosed as?
sprains
142
Scaphoid fractures have a % nonunion rate?
8-10
143
Scaphoid fractures can result in?
AVN
144
Treatment for scaphoid fracture
splint, cast for total of 12 weeks vs. surgery
145
Are metacarpal fractures more common in men or women?
men
146
Metacarpal fractures MOI
hitting an object with closed fist
147
common metacarpal fracture locations
5th metacarpal (especially neck AKA boxer's fracture)
148
PE metacarpal fracture
pain, swelling, deformity, rotational deformity, depression knuckle; look for open wounds
149
What do you need to assess with metacarpal fracture?
assess for rotational deformity
150
What's the most common metacarpal fracture?
boxers fracture
151
Bennet fracture
intra-articular avulsion fracture at CMC joint
152
Bennet fracture MOI
sublux/dislocation
153
Rolando Fracture
Y or T shaped comminuted, intra articular fracture
154
Rolando Fracture MOI
sublx/dislocation
155
Metacarpal fracture treatment
treated by fracture type: angulation (10-20-30-40 rule) and rotational deformity (not accepted); conservative (ulnar gutter splint/cast--recheck in 1 week, 4-6 weeks immobilization); referral for unstable or rotational deformity fractures
156
What's the 10-20-30-40 rule
It's how much angulation is acceptable in index through little metacarpal
157
Complications of metacarpal fractures?
loss of grip strength, residual dorsal deformity, loss of knuckle prominence
158
What's the most common skeletal system injuries?
phalange fracures
159
Which fragment phalange is most often fractured?
distal > middle and proximal
160
PE for phalange fractures
pain, swelling, deformity, look for open wounds, nail bed injuries
161
Phalange fractures treatment
buddy taping (except mallet finger...need extension splint); surgical if angulation or displacement or open
162
complications of phalange fractures
loss of motion, malunion, nonunion
163
Low energy pelvic fractures are common iN?
elderly after a fall
164
PE for low energy pevlic fracture
pain in groin, lateral hip or buttock with ambulation
165
tx of low energy pelvic fracture
conservative, PT/OT, possible rehab or SNF (skilled nursing facility)
166
High energy pelvic fracture MOI
MVA--side impact and motorcycle account for most
167
For high energy pelvic fracture you need to assess...
GU injuries (check bladder and prostate)
168
treatment of high energy pelvic fracture
stabilize, most need surgical repair
169
Hip fracture presentation
fall, unable to bear weight, leg is shortened and externally rotated
170
Considerations with treatment of femoral neck fractures
displacement, patient activity level, patient/family wishes
171
Treatment of femoral neck fracture with no/minimal displacement:
femoral neck with no/minimal displacement: hip pinning = cannulated screw fixation
172
Treatment of femoral neck fracture with displacement
hip arthroplasty
173
Intertrochanteric fracture surgical treatment
intramedullary nail gamma nail, dynamic hip screw
174
Femur fractures (shaft) MOI
high energy, typically MVA; in elderly patients it could be fall with poor bone quality
175
Femur fracture (shaft) treatment
non-displaced and patients with multiple co-morbidities = non-surgical; surgical if displaced/unstable
176
Supracondylar fracture MOI
load to flexed knee (younger patients MVA), older patients (low energy fall)
177
Associated injuries of supracondylar fracture
popliteal artery, ACL
178
What else do you need to order with supracondylar fracture
arteriogram
179
presentation of supracondylar fractures
pain, swelling, inability to flex/extend knee, posible deformity
180
Supracondylar fracture tx
conservative vs. surgical
181
Tibial plateau fracture MOI
extreme load or fall
182
Where are tibial plateau fractures commonly located?
60% are lateral, often accompanying cartilage/ ligament injury
183
Treatment of tibial plateau fracture
depends on displacement. Non-operative must be NWB with close follow-up; surgical is cannulated screen fixation or plate/screw with NWB
184
Patella fracture MOI
direct trauma or forceful quadriceps contraction
185
patella fracture presentation
deformity, swelling, can't SLR
186
treatment for patella fracture
surgery if displacement is >3 mm; non-operative is NWB for 6 weeks, gradually increase PROM
187
What's the most common long bone fractures?
tibial shaft fractures
188
tibial shaft fractures MOI
high energy--associated with open fractures; twisting mechanism--spiral/oblique
189
tibial fracture presentation
pain, deformity, wounds, fracture blisters, compartmetn syndrome
190
tibia shaft fracture
conservative (LLC with progressive weight bearing) vs surgical for unstable, open fracture (IM nail)
191
Fibula fracture MOI
direct blow, inversion or eversion injury
192
Fibular fracture presentation
limping or unable to bear weight (due to pain), edema, ecchymosis
193
Treatment of fibular fracture
dependent on severity of fracture and location
194
Maisonneuve Fracture
Eversion injury; mortise widening and proximal 1/3 fibula fracture
195
What do you worry about with a maisonneuve fracture?
superficial peroneal nerve palsy
196
Treatment of maisonneuve fracture
surgery
197
What's the most common bone and join injury?
ankle fractures
198
contributing factors to ankle fracture?
smoking and body habitus
199
MOI of ankle fractures
twisting--inversion/eversion; MVA
200
presentation of ankle fractures
pain, swelling, deformity, inability to ambulate
201
Conservative treatment of ankle fractures
avulsion is treated like a severe ankle sprain, minimally or non-displaced fractures get posterior splint x 1 week; recheck (walking cast vs. walking boot for 4-5 weeks)
202
Surgical treatment of ankle fractures if?
any mortise widening/suspicion of syndesmotic injury
203
Medial malleolus fracture MOI
usually high-impact
204
Considrations of medial malleolus fracture
displacement (<2 mm in joint is acceptable), joint involvement (<25% joint surface involvement), tenderness elsewhere
205
Medial malleolus fracture treatmetn
surgery if ankle mortise widening and displacement; non-operative = NWB short leg splint x 1 week (recheck in 1 week); NWB vs. WBAT short leg cast x 6-7 weeks (recechk every 1-2 weeks)
206
Bi-malleolar fracture tx
need referral, sx (ORIF)
207
Tri-malleolar fracture tx
referral for surgery
208
3 main types of fifth metatarsal fracture
stress, jones, avulsion
209
Fifth metatarsal fracture: stress tx
NWB cast for 6-8 weeks
210
Fifth metatarsal fracture: jones tx
surgery vs. short-leg walking cast vs. NWB cast for 6-8 weeks
211
Fifth metatarsal fracture: avulsion tx
most common, short-leg walking cast/boot for 4-6 weeks
212
What's a common MOI for firth metatarsal fracture?
inversion ankle sprain
213
What causes a stress fracture?
result of bone being exposed to repeated tensile or compressive stresses
214
Where is the most likely place for stress fractures?
spine (pars interarticularis in lumbar spine), hip (femoral neck), lower leg (tibia), ankle and foot (talus and metacarpals)
215
Stress fracture presentation
onset of insidious pain that progressively gets worse
216
imaging for stress fracture
plain films, bone scan, MRI SCAN (looking for fluid/inflammatory response), Ct scan
217
Treatment of stress fracture
Initial: eliminated stress; NWB 6-12 weeks; possible immobilization; activity modification; PT; pain control
218
Risk factors for stress fractures
prior stress fracture, low fitness, sudden increase in exercise, female gender/menstrual irregularity, lower BMI, eating disorders, poor diet, poor bone health, poor biomechanics, workout environment
219
What's the assessment of physeal fractures called?
Salter-Harris classification
220
SALTER:
straight across; above; lower and below; two or through; erasure of growth plate or crush
221
Type I: S
fracture of the cartilage of the physis
222
Type II: A
the fracture lies above the physis
223
Type III: L
the fracture is below the physis in the epiphysis
224
Type IV: T
through the metaphysis, physis, and epiphysis
225
Type V: R
physis has been crushed
