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Pance Re-Up > MSK Re-Up #7 (Foot, Hip, Spine) > Flashcards

MSK Re-Up #7 (Foot, Hip, Spine) Flashcards

1
Q

What is neuropathic (charcot) arthropathy?

What are some symptoms of chronic condition?

A

-Joint damage and destruction as a result of peripheral neuropathy from DM, PVD, or other diseases.

Joint or foot deformity, alteration of shape of the foot, ulcer or skin changes.

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2
Q

What is seen on radiographs for neuropathic arthropathy?

A

-Obliteration of the joint space, disorganization of the joint.

-Decreased sensation and repetitive micro trauma leads to bone resorption and weakening.

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3
Q

Treatment for neuropathic arthropathy

A

-Surgery is rarely performed
-Rest, non-weightbearing, accommodative footwear

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4
Q

Interdigital (Morton’s) Neuroma is compressive neuropathy of the interdigital nerve. What are some risk factors for this?

Where does this pain normally occur?

A

-Women 25-50 if they wear tight-fitting shoes, high heels, or have flat feet

-Lancinating or burning pain with weight bearing. MC in the third intermetatarsal space (between 3rd and 4th metatarsals).

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5
Q

Treatment for a Morton’s Neuroma

A

-Conservative: broad-toed shoes with firm soles
-Steroid injections
-Surgery if refractory or failed conservative

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6
Q

What is a Jones Fracture?

What is a common complication of this?

A

Transverse fracture through the diaphysis of the fifth metatarsal at the metaphyseal - diaphyseal junction

Risk of nonunion or malunion because it involves the vascular watershed area.

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7
Q

What is the treatment for a Jones Fracture?

A

-NWB in short leg cast x 6-8 weeks
-Frequently requires ORIF/pinning

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8
Q

On the other hand, what is a PseudoJones Fracture?

What is the treatment?

A

-Fracture through the base (tuberosity) or the fifth metatarsal
-Much more common and less serious than a Jones Fracture

-Walking cast x 2-3 weeks

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9
Q

What is the LisFranc joint?

A

Bases of the first three metatarsal heads and their respective cuneiforms

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10
Q

what is a LisFranc injury and how does it occur?

A

One or more of the metatarsal bones are displaced from the tarsus

Disruption between articulation of medial cuneiform and base of the second metatarsal, leading to ligamentous injury or fracture

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11
Q

What can be seen on radiographs for a LisFranc injury that is pathognomonic for this condition?

What is the treatment?

A

Fleck Sign: fracture at base of second metatarsal

ORIF followed by NWB cast for 12 weeks

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12
Q

Where does a herniated disc (nucleus pulposus) normally occur and why?

What are some symptoms of this condition?

A

L5-S1 because it is the junction between the mobile and non-mobile spine

Radicular back pain: unilateral, may radiate down the leg with paresthesias or numbness in a dermatomal pattern.
-Positive Straight Leg Raise, Crossover Test

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13
Q

If the herniated disc is at L4:
-Sensory
-Weakness
-Reflex Diminished

A

-Sensory: Anterior thigh pain, sensory loss to medial ankle
-Weakness: Ankle Dorsiflexion
-Reflex Diminished: Loss of Knee Jerk

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14
Q

If the herniated disc is at L5:
-Sensory
-Weakness
-Reflex

A

-Sensory: lateral thigh/leg, hip groin pain and dorsum of foot
-Weakness: Big Toe Extension (Dorsiflexion)
-Reflexes usually normal

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15
Q

If the herniated disc is at S1:
-Sensory
-Weakness
-Reflex

A

-Sensory: Posterior leg/calf pain, plantar surface of foot
-Weakness: Plantarflexion
-Reflex: Loss of ankle jerk

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16
Q

What is the DOC for a herniated disc?

Treatment?

A

MRI

Conservative initially: NSAIDs + continuation of ordinary activities as tolerated.
-Steroid injections if refractory to first line therapy
-Laminectomy if disabling pain > 6 weeks or not responsive to conservative care

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17
Q

Cauda Equina Syndrome is considered a neurosurgical emergency. What is the MC etiology for this?

Name the symptoms of this condition

A

-Lumbar disc herniation

-Back pain + 1 of the following
–Radiculopathy: bilateral leg radiation of pain
–Saddle Anesthesia, Erectile Dysfunction
–New onset urinary or bowel retention or incontinence
–Decreased anal sphincter tone

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18
Q

DOC of choice for cauda equine syndrome?

What is the treatment?

A

MRI

Emergent decompression

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19
Q

What are etiologies of a vertebral compression fracture (think about in kids or elderly)

Symptoms

A

-Children from jumping/falling from height
-Elderly from osteoporosis, malignancy, or systemic illness

Localized back pain with focal midline tenderness at level of fracture

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20
Q

What is seen on radiographs for a vertebral compression fracture?

A

Loss of vertebral height

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21
Q

Lumbar spinal stenosis is ….

What are some common etiologies of this condition?

A

-narrowing of the spinal canal with impingement of the nerve roots

-Degenerative arthritis or Spondylolysis MC especially if > 60 years old

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22
Q

Lumbar spinal stenosis is ….

What are some common etiologies of this condition?

A

-narrowing of the spinal canal with impingement of the nerve roots

-Degenerative arthritis or Spondylolysis MC especially if > 60 years old

23
Q

Symptoms of lumbar spinal stenosis

What is the diagnostic of choice?

A

-back pain, numbness, paresthesias that may radiate to the buttocks and thighs bilaterally
–Symptoms worsened with extension, walking, prolonged standing
–Relieved with flexion: leaning over shopping cart, walking uphill, cycling.

MRI**

24
Q

Treatment for lumbar spinal stenosis

A

-Conservative: pain control, PT, lumbar corticosteroid injections
-Surgery (decompression laminectomy) if refractory

25
Q

On the other hand, what is lumbosacral sprain or strain?

How does it occur?

What symptoms does it entail?

What is the treatment?

A

-Acute strain or tear of the paraspinal muscles especially after lifting or twisting injuries
-MCC of low back pain

-back pain and muscle spasms that is activity-related and does not radiate to the leg. No neuro symptoms.
-Paraspinal muscle tenderness, no neuro changes

-Analgesics (NSAIDs) resumption of normal activity
-Muscle relaxers may help in some cases

26
Q

What is the MCC of a spinal epidural abscess?

What are some risk factors?

A

Staph A

> 50 years old, IVDU, immunodeficiency (DM, HIV, corticosteroids), recent spinal procedure, epidural cath placement

27
Q

Symptoms of a spinal epidural abscess (there is a triad)

What is the test of choice (specific one) and what is seen on it***

A

-Fever + Spinal Pain + Neuro Deficits
–(focal and severe back pain)
–(radiculopathy)
–Myelopathy (neuro deficits): motor, sensory, bowel or bladder

MRI with gadolinium will reveal a ring-enhancing lesion**

28
Q

Treatment for a spinal epidural abscess

A

-Aspiration, drainage, and ABX
–Vanco PLUS either Cefotaxime or Ceftriaxone

29
Q

Symptoms of a spinal cord compression (external compression due to malignancy or infection)

A

-Sudden onset of focal neuro deficits (at sensory level), hyperreflexia below level of compression

30
Q

Scoliosis is ______ and may be associated with kyphosis ______ or lordosis _______.

How do you assess for this (what is the most sensitive physical finding)

A

-Lateral curvature of the spine
-Kyphosis: humpback
-Lordosis: sway back

Adams forward bend test: thoracic or lumbar prominence on one side seen with scoliosis.

31
Q

On Scoliometer, what is considered abnormal?

What is seen on radiographs to diagnose scoliosis?

A

-7-degree curve is abnormal

Cobb angle 10 or more degrees on AP and lateral films

32
Q

Treatment for scoliosis if:

  • Cobb angle < 25 degrees:
A

-Observation. Regular follow ups every 6-9 months. Bracing if Cobb angle increases 5 or more over a 3-6 month period.

33
Q

For scoliosis, bracing may be needed to stop progression if still skeletally immature. When should you use bracing as a treatment?

A

-If Cobb angle increases 5 or more over 3-6 month period or some patients with Cobb angle of 30-39 degrees

34
Q

When should surgery be pursued for scoliosis?

A

-If > 40 degrees Cobb angle or skeletally immature

35
Q

What is thoracic outlet syndrome?

what are some symptoms?

A

Idiopathic compression of the brachial plexus, subclavian vein, or subclavian artery as they exit the narrowed space between the shoulder girdle and first rib.

-Symptoms: ulnar neuropathy, pain or paresthesia to forearm and arm
–Swelling or discoloration of the arm with abduction

36
Q

What is a unique exam test you can do in the office for thoracic outlet syndrome?

What diagnostic can you do to confirm this?

A

-Adson Sign: loss of radial pulse with head rotated to affected side.

Confirm with MRI

37
Q

What is spondylolysis?

Where is it MC at?

A

-Pars interarticularis defect due to failure of fusion or stress fracture.

MC at L5-S1

38
Q

True or False: Spondylolysis is often the first step to ________ which is forward slipping of a vertebra onto another.

What are some symptoms of spondylolysis?

A

-Spondylolisthesis

-Low back pain with activity.

39
Q

What radiographs are obtained if you suspect spondylolysis and what is seen?

A

-Lateral view: radiolucent defect in pars
-Oblique view: resembles a scotty dog. Neck will have a break, looks like a collar around the neck.

40
Q

On the other hand, what is spondylolisthesis?

What are some symptoms?

A

-Forward slipping of vertebra on another
-Complication of spondylolysis

-Lower back pain MC symptom
-Nerve compression: sciatica, bowel or bladder dysfunction if severe

41
Q

Treatment for spondylolisthesis

A

-Mild: PT and activity restriction if symptomatic
-Severe: may need surgical intervention

42
Q

Risk factors for developmental dysplasia of the hip

What two maneuvers can assess for hip instability in a newborn? Explain them.

A

-Breech presentation, first born children, females, positive family history

–Barlow Maneuver: gentle adduction without downward pressure to feel for dislocation resulting in a click or jerk
–Ortolani Maneuver: abduction and elevation to feel for reducibility, results in a click or clunk

43
Q

What other diagnostics can be done for developmental dysplasia of the hip?

A

US: < 4 months
AP radiographs in older children

44
Q

Management for hip dysplasia if:
- < 6 months of age:
- 6 months - 2 years old:

A

< 6 months: Pavlik harness
6 months - 2 years old: closed reduction in the OR

45
Q

What are some symptoms of a pelvic fracture?

What can be done for this condition?

A

-Pain with ambulation, inability to ambulate
-perineal ecchymosis

-WB as tolerated
ORIF for more severe fractures

46
Q

MCC of a hip dislocation?

MC type?

How will the patient present?

A

Trauma (MVA, fall, etc.) Orthopedic emergency

Posterior MC type

Hip pain with leg shortened, internally rotated and adducted with the hip/knee slightly flexed

47
Q

How do you manage a hip dislocation?

What are two common complications?

A

-Closed reduction under conscious sedation VS open reduction.

Avascular necrosis and sciatic nerve injury

48
Q

How does a patient present with a hip fracture?

Management for a hip fracture

A

Hip, thigh, or groin pain with the affected leg shortened, abducted, and externally rotated

ORIF

49
Q

What is Slipped Capital Femoral Epiphysis (SCFE)?

Who does this occur in?

If seen in children before puberty, suspect what?

A

-Displacement of the femoral head from femoral neck through the growth plate

Children 8-16, obese, AA, males during adolescent growth spurts

Hormonal or systemic disorders (hypothyroidism, hypopituitarism)

50
Q

what is the treatment for SCFE?

What is seen on radiographs?

A

-NWB with crutches followed by internal fixation and pinning

-Posterior displacement of femoral epiphysis similar to ice cream slipping off of a cone

51
Q

What is Legg-Calve Perthes Disease?

Who is at risk for this condition?

A

-idiopathic avascular necrosis of the femoral head in children due to ischemia of capital femoral epiphysis.

Children 4-10 years old, males, obesity, coagulation abnormalities (Factor V Leiden, etc.)

52
Q

Symptoms of Legg-Calve Perthes?

What is seen on radiographs?

A

-painless limping worse with activity and at end of the day
-Antalgic gait
-Loss of abduction and internal rotation
-Atrophy of thigh muscles

Positive crescent sign: micro fractures with collapse of the bone

53
Q

What is the best treatment for Legg-Calve Perthes Disease?

A

-Observation: activity restriction, PT or brace/cas
-NSAIDs for pain management
-Surgical: pelvic osteotomy in children > 8 years old or more advanced disease

Pance Re-Up (76 decks)

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