MSK/Rheum #2 Flashcards
Clinical intervention for ankle dislocation
Closed reduction + posterior splint +/- ORIF in severe cases
Posterior shoulder dislocations are MC from what events?
-Seizures, electric shock, trauma
Adducted and internally rotated
In a shoulder dislocation, what must you do first?
Rule out an axillae nerve injury by doing pin prick test over deltoid.
What radiographs are ordered for posterior shoulder dislocation?
Scapular “Y” and axillary lateral views best to distinguish anterior from posterior.
(Ice cream cone or light bulb sign)
An anterior shoulder dislocation is MC from
A blow to an abducted, externally rotated arm that is extended.
Complication to which nerve is the MC in a shoulder dislocation
Axillary nerve
Treatment for anterior shoulder dislocation
- Reduction and immobilization
- Neurovascular compromise is uncommon
Describe the typical mechanism and history of a patient with a meniscus injury
Rotational force of femur on tibia
-Now joint pain with locking and giving way
Symptoms of a Meniscal Tear
- Positive McMurray Sign: pop or click the knee is flexed and externally rotated and extended
- Apley Test
- Joint Line Tenderness
- Joint effusion
- Swelling
What type of meniscal tear is most common?
Medial is 3x more likely than lateral
Lateral Epicondylitis, also known as (Tennis Elbow), is inflammation of the tendon insertion of which tendon due to repetitive pronation of forearm and excessive wrist extension.
Extensor Carpi Radialis Brevis Muscle
What motions cause pain in lateral epicondylitis?
Gripping, forearm pronation and wrist extension against resistance
Treatment for lateral epicondylitis
-Activity modification, RICE, NSAIDs, physiotherapy, steroid injections
Idiopathic avascular necrosis of the femoral head
Legg-Calve Perthes Disease
Demographics for Legg-Calve Perthes Disease
- Children 4-10 years old
- Males
- Obesity
- Coagulation Abnormalities (Factor V Leiden)
-DECREASED INCIDENCE IN AA
Symptoms of Legg-Calve Perthes Disease
- Painless limping (worse with activity and at end of the day)
- Loss of abduction and internal rotation
On a radiograph of Legg-Calve Perthes Disease, what is seen?
-Deformity, positive crescent sign (micro fractures with collapse of the bone)
Treatment for Legg-Calve Perthes Disease
- Activity restriction (non-weightbearing initially)
- Physical therapy or brace/cast
- Surgical: Pelvic osteotomy if > 8 years old or severe disease
With lumbar spondylosis, what diagnostic is initially used?
DEXA scan
Symptoms of Marfan Syndrome
- MVP
- Aortic Root Dilation (Aortic Regurgitation, Aortic Dissection, and Aortic Aneurysms)
- Tall stature, long lanky fingers, arms and legs
- Pectus Carinatum (Pigeon Chest)
- Joint Laxity
- Ectopia Lentis (Malposition of lens of eyes)
- Myopia (nearsightedness)
Mechanism of injury for MCL injury
Direct blow to outside of knee
- Femoral attachment is to medial epicondyle
- Tibial attachments are semimembranosus and posteromedial tibia
With an MCL injury, what stress will cause pain?
Valgus
With an LCL injury, what stress will cause pain?
Varus stress
What is Meralgia Paresthetica?
Compression of the lateral femoral cutaneous nerve (outer thigh starting from inguinal ligament and extending down toward the knee)
Meralgia Paresthetica is also known as
Bernhardt-Roth syndrome
Treatment for Meralgia Paresthetica
- Weight loss
- Loose clothing
- Focal nerve block at inguinal ligament with combination of lidocaine and corticosteroids
- Surgical decompression
What is a Monteggia Fracture?
Fracture to proximal 1/3 of the ulnar shaft + radial head dislocation
(MURder)
What can occur in a Monteggia Fracture?
Radial nerve injury (70% of the time)
May develop a wrist drop
Management of a Monteggia Fracture
ORIF
Treatment for Myositis
-High dose corticosteroids
Symptoms of Osteoarthritis
- Evening joint stiffness (worsens throughout the day)
- If morning stiffness present, short lived
- Hard, bony joint, decreased ROM, crepitus
- Heberden node (DIP enlargement)
- Bouchard node (PIP enlargement)
What is shown on a radiograph for osteoarthritis?
Asymmetric joint narrowing, marginal osteophytes, subchondral bone sclerosis, bone cysts
For labs for OA, what is unusual?
Lack of inflammatory markers
-Normal ESR, CRP, ANA, RF
Treatment for OA
- Lifestyle modification: weight loss, exercise, assistive devices
- Acetaminophen preferred in elderly
- NSAIDs are more effective, but higher risk in elderly
- Intraarticular steroid injections, Sodium Hyaluronate, Glucosamine, Chondroitin
