MSK + Rheum Flashcards
Knee extension, thigh flexion
Ant + medial aspect of thigh + lower leg sensory.
Usually affected in hip + pelvic fractures and stab/gunshot wounds.
which nerve
femoral nerve
Knee extension, thigh flexion
Ant + medial aspect of thigh + lower leg sensory.
Usually affected in hip + pelvic fractures and stab/gunshot wounds.
which nerve
femoral nerve
Thigh adduction, medial thigh sensation. Damaged in anterior hip dislocation
which nerve
Obturator nerve
Compression of nerve near ASIS usually - meralgia paraesthetica
which nerve
lateral cutaneous nerve of thigh
Foot plantarflexion + inversion
Sole of foot sensory
Not commonly injured
which nerve
tibial nerve
Foot dorsiflexion + eversion + EHL motor, dorsum foot and lower lat part sensory
Injury often at neck fibular
Tightly applied lower limb plaster cast etc and injury cause foot drop
which nerve
common peroneal nerve
Hip adduction
Dmaaged by misplaced iM injection, hip surgery, pelvic fracture, post hip dislocation.
Positive trendelenburg sign
which nerve
superior gluteal nerve
Hip extension + lateral rotation
Generally injured in ass with sciatic nerve - difficulty rising from seated (cant jump, cant climbs tairs)
which nerve
inferior gluteal nerve
Worse on resisted wrist extension
Typically acute pain 6-12 weeks
What’s this called
Lateral epicondylitis
Tennis elbow
Pain aggravated by wrist flexion + pronation
Can have tingling 4/5th finger (ulnar nerve entrapment)
What is this called
Golfers
medial epicondylitis
Pins and needles, shakes hand at night.
What condition and mx
Carpal tunnel
Median nerve
6 week trial splint/CS injection and if severe surgery
Compression ulnar nerve symptoms
Compression of ulnar nerve
Tingling/numbness 4/5th finger, muscle wasting etc
If ulnar nerve palsy do sign (pull piece paper between thumb and index)
which nerve:
Damaged by humeral neck fracture/dislocation
Flattened deltoid
axillary nerve
which nerve:
Dagae usually by humeral midshaft fracture - wrist drop
radial nerve
which nerve
Usually damaged by medial epicondyle fracture - claw hand
Hypothenar wasting
Cant abduct thumb
ulnar nerve
hand benediction
Wasting of thenar muscles
which nerve
median
Often in sports, damaged
Winged scapula
which nerve
long thoracic nerve C5-7
Mx Talipes equinovarus (club foot)
Ponseti method 6-10 weeks.
Night time braces until child 4
Post vs anterior hip dislocation + mx
Posterior (affected leg shortened, adducted, internally rotated), anterior (abducted, Ext rotated, no leg shortening) or central. Reduction under GA within 4hrs due to avascular necrosis risk.
Barlows/Ortolani positive, unequal skin folds/leg length, often picked up newborn exam.
DDH
Pavlik harness
4-8 (7) males, hip pain progressive with limp, stiffness, ROM,
DX, XR CHANGES
Perthes
XR (widened joint space -> decreased fem head/flattening)
10-15 (12), more in obese children/boys. Loss of internal rotation of leg in flexion
SUFE
knee injury
Twisting.
Anterior drawer test + Lachman positive.
Poor healing
ACL
Knee injury
Dashboard injuries hyperextension injuries
PCL
knee injury
From skiing/valgus stress
Abnormal passive abduction of knee
MCL
Knee injury….
From twisting. Locking + giving way common
Thessalys test
menisci
Teen girls after injury to knee. Pain on going downstairs or at rest. Tenderness, quadriceps watsing
Teen girls after injury to knee. Pain on going downstairs or at rest. Tenderness, quadriceps watsing
Chrondromalacia patellae
Pathological process affecting subchondral bone with secondary effects on joint cartilage etc. Children/young adults and can become degenerative. Knee pain + swelling typically after exercising, locking, clunking. XR might show subchondral crescent sign or loose bodies, MRI can evaluate cartilage.
Osteochondritis dissecans
Most common organism disci tis
staph aureus
Ix and Abx of choice for osteomyelitis
MRI Best
Flucloxicillin 6 weeks
young man, stiffness worse in morning + improves with activity
dx and mx
ankylosing spondylitis
NSAIDs (+ pPI)
Hemisection spinal cord, ipsiateral paralysis, ipsilateral loss proprioception and fine discrimination, contralateral loss pain and temp
brown squared syndrome
Bloods tests - ca/po4/alp/pth for Osteoporosis and tx
N Ca, N PO4, N ALP, N PTH
Fragility fractures = need DEXA and FRAX if <75, if >75 start Mx without Ix
Vit d + calcium supplementation before bisphosphonates- Alendronate 1st line
Bloods tests - ca/po4/alp/pth for osteomalacia
↓Ca/PO4, ↑ALP/PTH
Bloods tests - ca/po4/alp/pth for primary hyperparathyroidism
↑Ca/ALP/PTH, ↓Po4
Bloods tests - ca/po4/alp/pth - for CKD (2 hyperparathyroidism
↓Ca, ↑PO4/ALP/PTH
Bloods tests - ca/po4/alp/pth - pages disease
N Ca/PO4/PTH, ↑ALP
Disorder collagen metabolism. Autosomal dominant. Presents childhood with fractures after minor trauma, blue scleria, deafness, dental imperfections
osteogenesis imperfecta
Ab ass with
Proximal muscle weakness and ksin lesions
Can be ass with malignancy
Photosensitive macular rash, Gottron’s papules (extensory surfaces fingers), mechanics hand, nail fold capillary dilation
Dermatomyositis
Anti-Jo-1 Ab
Most ANA positive and might have anti-synthetase Abs
Polymyositis
Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1
High dose corticosteroids
Polymyositis
Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1
High dose corticosteroids
Polymyositis
Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1
High dose corticosteroids
XR changes OA
Loss Joint space, Osteophytes at joint margins, subchondral sclerosis, subchondral cysts
1st line analgesia in OA
1st line Mx is paracetamol + topical NSAIDs (if knee/hand(
RA XR changes
loss joint space, juxta-articular osteoporosis, periarticular erosions, subluxation.
Mx RA
DMARD monotherapy +/- short course prednisolone for flares. If inadequate response to at least 2 DMARDs (inc M) then TNF-inhibitor (etanercept, infliximab- reactive TB, adalimumab)
Psoriatic arthropathy symptoms
Nail changes, arthritis mutilans (telescoping fingers- pencil in cup on XR). DIP jint disease in some, sacroiliitis, hands and feet
Urethritis, conjunctivitis, arthritis after dysenteric illness typ <4wks (STI).
diagnosis and mx
Reactive arthritis
NSAIDs, steroids, analgesia etc. Sulfasalazine/methotrexate for persistent disease and symp rarely >12m
Gout, ix, tx
Mostly 1st MTP- neg befringement, uric acid usually high.
Acute (NSAIDs/colchicine), Urate lowering therapy (allopurinol or febuxostat 2nd line). In acute, if already taking allopurinol continue
Pseudogout - ix
Deposition ca pyrophosphate dihydrate crystals in syonovium. Positive befringement rhomboid shaped crystals. CHondrocalcinosis
Male 20-30, stiffness worse morning and improves with exercise. Reduced Shobers. Other systemic features eg, amyloidosis, anterior uveitis, aortic regurg
dx, xray, mx
Ankylosing spondylitis
HLA-27.
Dx = Best supported by sacro-ilitis on pelvic XR
Subchondral erosions, sclerosis and Squaring lumbar vertebrae, sarcoilitis, bamboo spine, syndesmophytes. Apical fibrosis on CXR. NSAIDs first line
Muscle stiffness + raised inflammation markers
Abrupt onset bilateral early morning stiffness in over 60s
>60, rapid onset, aching et
diagnosis, mx
polymyalgia rheumatica
Need prednisolone (if unresponsive re think diagnosis)
Chronic fatigue time frame for diagnosis
> 3m
Mx raynauds
CCBs (nifedipine)
Tall stature, high arched palate, pectus excavatum, mitral prolapse, dilation aortic sinuses, dural ectasia…
marfans
pain/stiffness/myoglobinuria, low lactate levels in exercise
diagnosis
McArdlle’s disease
Autosomal recessive T5 glycogen storage disease -> muscle glycogenolysis – pain/stiffness/myoglobinuria, low lactate levels in exercise
Mx temporal arteritis
high dose glucocorticosteroids immediately and if visual loss IV methylprednisolone.
Raynauds may be 1st sign, scleroderma, ass with anti-centromere Abs. Subtype is CREST (calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia)
diagnosis
Limited systemic sclerosis (ANA)
Anti scl-70 Abs, most common cause of death resp involvement, cx is renal disease.
Scleroderma – tightening of fibrosis of skin.
dx
Diffuse systemic sclerosis
Ab in systemic sclerosis
ANA
Key S/E hydroxychloroquine
S/E bulls eye retinopathy (visual loss).
