MSK/Rheum #5 Flashcards
A Morton’s Neuroma is
Compressive neuropathy of the interdigital nerve (MC involves the second or third interdigital nerve between the metatarsal heads)
Risk factors for a Morton’s Neuroma
- Women 25-50 years old
- Tight-fitting shoes
- High feels
- Flat feet
What is a Jones Fracture?
-Transverse fracture through the diaphysis of the fifth metatarsal at the metaphysical-diaphyseal junction
Treatment for Jones Fracture
-Non weight bearing in short leg cast for 6-8 weeks
Frequently requires ORIF/pinning
What is a LisFranc Injury?
One or more of the metatarsal bones are displaced from the tarsus
What is the treatment for a LisFranc injury?
ORIF
On a radiograph for a LisFranc fracture, a Fleck Sign may be seen. What is this?
Fracture at the base of the second metatarsal
A Ewing Sarcoma is the 2nd MC primary bone malignancy in children and young adults (after Osteosarcoma). Which location is the MC for this type of bone cancer?
Femur (diaphysis of long bones)
-Then pelvis
Symptoms of a Ewing Sarcoma
- Localized bone pain and swelling with systemic symptoms (fever, malaise, weight loss)
- Palpable mass, local tenderness, or joint swelling
A Ewing Sarcoma occurs due to a translocation between chromosomes ___ and ___
11 and 22
On radiographs for a Ewing Sarcoma, what is seen?
Layered periosteal reaction (Onion Skin Appearance), “Moth-eaten appearance.”
Treatment for Ewing Sarcoma
- Chemotherapy followed by limb-sparing resection when possible
- Radiation when you cannot excise
Treatment for Fibromyalgia
- Conservative measures: low impact aerobic exercise, swimming, water aerobics
- TCA (Amitriptyline) is the first line
- Pregabalin is approved by the FDA for treatment though
What is Polyarteritis Nodosa (PAN)
- Systemic vasculitis of medium-sized vessels
- Pulmonary vessels (lung) not involved
PAN has an increased association with
Chronic Hepatitis B and C
Symptoms of PAN
-Hypertension, Abdominal pain worse with eating, Livedo Reticularis, Raynaud’s, Myalgias, Fever, Peroneal foot drop
Diagnostics for PAN
- Classic PAN is ANCA negative
- Renal or Mesenteric Angiography: micro aneurysms or beading of small arteries
Treatment for PAN
Glucocorticoids
Risk factors for ALS
- Young males 15-30 years old
- HLA-B27 positivity
Symptoms of ALS
- Back pain, stiffness and decreased ROM worse in morning
- Pain decreases with exercise and activity
- Sacroilitis
- Uveitis
What do radiographs of ALS show?
Sacroilitis (narrowing of the joint)
-Bamboo spine = straightening of the spine + squaring and fusion of the vertebrae
Treatment for ALS
NSAIDs are first line
Anti-TNF drugs if no response to NSAIDs
Symptoms of Cauda Equina Syndrome
- Bilateral leg radiation of pain
- Saddle anesthesia (S2-S4 nerve roots)
- Urinary or bowel retention or incontinence
- Decreased anal sphincter tone
Study of choice for Cauda Equina Syndrome
MRI
Medial Epicondylitis (Golfer’s Elbow) is inflammation of which muscles due to repetitive overuse?
Pronator Teres & Flexor Carpi Radialis
Exam findings of a patient with medial epicondylitis
- Pain with wrist flexion against resistance with elbow fully extended
- Tenderness over medial epicondyle
Cubital Tunnel Syndrome is compression of which nerve?
Ulnar Nerve
Symptoms of a patient with Osteogenesis Imperfecta
- Blue-tinted sclera
- Brown teeth
- Severe premature osteoporosis
- Presenile deafness
A Boxer’s Fracture is put in a
Ulnar Gutter Splint
-Always check for bite wounds
A Gamekeeper’s Thumb is put in a
Thumb Spica Splint and referred to hand surgeon
What can be given after fractures as prophylaxis to reduce incidence of CRPS
Vitamin C
When a patient has pain along the radial aspect of the wrist and base of thumb radiating to the forearm, what is the diagnosis?
DeQuervain Tenosynovitis
What is the treatment for DeQuervain’s?
Thumb spica splint, NSAIDs, PT
Risk factors for DeQuervain’s?
Clerical workers
- Women PostPartum (from lifting newborn)
- diabetics
- Posttraumatic
What tendons are entrapped in DeQuervain’s?
APL and EBP
- Abductor pollicis longus
- Extensor Pollicis Brevis
What nerve is entrapped and compressed in carpal tunnel syndrome?
Median nerve
What area(s) does the median nerve cover?
First 3 and radial half of the fourth digits
What two tests are positive in Carpal Tunnel Syndrome?
Tinel and Phalen
What is the difference between carpal tunnel syndrome and Pronator Teres Syndrome?
Pronator Teres Syndrome does not have pain at night, whereas carpal tunnel has severe pain at night
