MSK/Rheum #1 Flashcards
Etiology of acute compartment syndrome
- Trauma; fracture of the long bones
- Crush injuries, constriction (tight casts, splints, burns)
Pathophysiology of acute compartment syndrome
Muscle and nerve ischemia (decreased perfusion) when the closed muscle compartment pressure > perfusion pressure
- > 30-45 mmHg
Symptoms of acute compartment syndrome
- Pain with passive stretching (earliest finding and most sensitive)
- Tense compartment (firm or wood-like feeling)
- Pulselessness, pallor, paresis
- Capillary refill preserved
Diagnostics for acute compartment syndrome
- Increased intracompartmental pressure > 30 mmHg
- Increased creatinine kinase and myoglobin
Treatment of acute compartment syndrome
Emergent Fasciotomy (Decompression)
- Place limb at level of the heart
- Remove constrictive dressings, IVF, oxygen
Adhesive Capsulitis is shoulder stiffness due to inflammation (especially _____ and _____). It is most common in people aged 40-60
Diabetes and Hypothyroidism
Symptoms of Adhesive Capsulitis
- Shoulder pain/stiffness
- Decreased ROM (External rotation)
- Gradual return of ROM
- Resistance of passive range of motion
Treatment for adhesive capsulitis
- Rehab ROM therapy
- Anti-inflammatories, steroid injections, heat
What is the standard treatment for an amputated digit?
- Wrap in gauze and soak in sterilized isotonic saline to prevent from drying
- Placed in a plastic bag immersed in ice water
- NEVER PLACE DIRECTLY IN ICE WATER
What is the MC knee ligamental injury
Anterior cruciate ligament (ACL)
Mechanism of action for ACL injury
-Noncontact pivoting injury, deceleration, changing direction, hyperextension, internal rotation
Clinical manifestations of an ACL injury
- Associated with pop and swelling followed by hemarthrosis (intra-articular bleeding)
- Knee buckling, inability to bear weight
- Does not actively extend knee
What tests are performed for ACL tear?
- Lachman Test (Most sensitive)
- Pivot Shift Test
- Anterior Drawer Test
What are some diagnostics for an ACL tear?
- XR: done initially to rule out fracture
- MRI: best test
What is seen on a knee XR if the ACL is torn?
Segund Fracture (avulsion of lateral tibial condyle with varus stress of the knee)
What are the three parts of the Unhappy (O’Donoghue’s) Triad?
- ACL Tear
- MCL injury
- Medial Meniscus injury
What is a basilar skull fracture?
Linear fracture at the base of the skull, associated with dural tear
Other symptoms of a basilar skull fracture
- CSF Otorrhea
- Raccoon eyes
- Hemotympanum
- Bruising over mastoid (Battle Sign)
- Do a Glascow Coma Scale
What is a Boxer’s Fracture?
Fracture at the neck of the 5th metacarpal
-MOI: punching with a clenched fist
What should you check for and what is the treatment in a Boxer’s Fracture?
Check for bite wounds
-Treat with Augmentin
What should a Boxer Fracture go in?
Ulnar gutter splint
-ORIF if angulation > 40 degrees
What is the MC bone malignancy?
Osteosarcoma
MC site of osteosarcoma
Metaphysis of long bones (distal femur MC)
MC site of METS in bone cancer
-Lungs (MCC of death)
Symptoms of Osteosarcoma
- Localized bone pain worse at night
- Joint swelling without systemic symptoms
- Palpable soft tissue mass
What do radiographs for an osteosarcoma show?
-“Hair on End” or “Sunburst” appearance
What is the definitive diagnostic for osteosarcoma?
Biopsy
Treatment for Osteosarcoma
-Chemo + Surgical Removal with amputation or limb-sparing resection
What is a C1 fracture called and what is the mechanism of injury?
Atlas
- Jefferson (Burst) Fracture
- Vertical compression
What is a C2 fracture called and what is the mechanism of injury?
- Axis pedicle
- Hangman’s Fracture
- Hyperextension then flexion
What is a Colles Fracture?
Distal radius fracture with dorsal angulation
MOA for Colles Fracture and what is seen on Physical Exam?
- FOOSH
- Dinner fork deformity appearance to the wrist
Treatment for Colles Fracture
Closed reduction followed by sugar tong splint or cast
-ORIF if > 20 degrees angulation
What is the MC Complication of a Colles Fracture?
Extensor Pollicis Longus Tendon Rupture
-Others: Malunion, joint stiffness, median nerve compression, CRPS
What is the treatment for Congenital Talipes Equinovarus (Clubfoot)?
Ponseti method of serial manipulation and casting
When should you perform an xray of a finger with a subungal hematoma?
When hematoma is > 50% of nail to evaluate for phalanx fracture
Dermatomyositis is associated with _____ in 25% of cases
Cancer
Symptoms of Dermatomyositis
- Progressive symmetric proximal muscle weakness (shoulders, hips)
- Systemic symptoms: dysphagia, fever, fatigue, weight loss
- Decreased muscle strength
- Gottron’s Papules (scaly patches on PIP and MCP)
- Heliotrope Rash (blue discoloration of eyelids)
- Malar Rash: Shawl Sign (erythema of shoulder, chest, back)
Diagnostics for Dermatomyositis
- Increased muscle enzymes (CK and aldolase): best initial
- Anti-Jo 1 and Anti-Mi-2 (most specific)
- Muscle biopsy: definitive
Treatment for Dermatomyositis
-High-dose glucocorticoids first-line
+/- Methotrexate, Azathioprine, IVIG
Clinical Intervention for a distal radius fracture
Sugar Tong Splint
Risk Factors for Dupuytren Contracture
- Men > 40
- Northern Europeans
- ETOH
- DM
- Smoking
Symptoms of Dupuytren Contracture
- Visible or palpable nodules over the distal palmar crease along course of flexor tendons
- Fixed flexion deformity at MCP joint
- May have thickened skin or bands in the palmar fascia
Treatment for Dupuytren Contracture
- Intralesional injections
- Physical therapy
- Surgical correction (fasciotomy) for advanced stages
Symptoms of a knee effusion
- Bulge sign
- Ballottement
- Patellar Tap Tests
What is a Bennett’s Fracture
Intraarticular fracture through the base of the 1st metacarpal (MCP) bone
What is a Rolando Fracture?
Comminuted Bennett’s Fracture (Y sign)
Treatment for Bennett or Rolando Fracture
Thumb Spica Splint
- Bennett: Immobilization
- Rolando: ORIF, external fixation
What is a Galeazzi Fracture?
Mid-distal radial shaft fracture with dislocation of the distal radioulnar joint
(GRUesome)
Treatment for Galeazzi Fracture
- ORIF
- Long arm/sugar tong splint temporarily
Triggers for Gout
- Purine-Rich Foods (alcohol, liver, seafood)
- Thiazide & Loop Diuretics, ACEi, Pyrazinamide, Ethambutol, Aspirin
What is the ONLY ACEi that decreases uric acid levels?
Losartan
Symptoms of Gout
- First MTP joint of great toe (Podagra)
- Joint pain, erythema, warmth, swelling, tenderness, fever
What is the diagnostic of choice for gout?
Arthrocentesis: negatively birefringent, needle-shaped crystals
On X-rays, what is seen for gout?
Mouse or rat bite lesions (punched out erosions with sclerotic and overhanging margins)
Treatment for acute management of gout
- NSAIDs (NOT Aspirin)
- Colchicine (if cannot use NSAIDs)
Chronic Management for gout
- Lifestyle: decrease alcohol consumption, weight loss, decrease meats/seafood
- Allopurinol: Xanthine Oxidase Inhibitors (DO NOT START DURING ACUTE ATTACK)
True or False: Allopurinol is safe in renal insufficiency
True
Gout is a problem with metabolism of what type of molecule?
Purine
In gout, what compound precipitates into the synovial fluid?
Sodium Urate
Where is a herniated disc most common?
L5-S1
-Because it is the junction between the mobile and non-mobile spine)
Symptoms of a herniated disc
- Radicular back pain; unilateral in a dermatomal pattern
- Pain increases with coughing, straining, bending, sitting, Valsalva
With a herniated L4, what are the symptoms?
- Anterior Thigh Pain
- Sensory loss to medial ankle
- Weakness with ankle dorsiflexion
- Loss of knee jerk
With a herniated L5 disc, what are the symptoms?
- Lateral thigh/leg, hip, groin pain
- Weakness in big toe dorsiflexion/extension
- Reflexes usually normal
With a herniated S1 disc, what are the symptoms?
- Posterior leg/calf/gluteus pain
- Plantar surface of the foot sensory diminished
- Weakness in plantarflexion
- Loss of ankle jerk
What is the diagnostic of choice for a herniated disc
-MRI
Treatment for herniated lumbar disc
- NSAIDs, short period of rest
- Anti-inflammatories
- Warm, moist heat
- Resume activities as tolerated
- Injections, Transcutaneous electrical nerve stimulation
