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02F > MSK SURG > Flashcards

MSK SURG Flashcards

1
Q

Features of back pain associated with prolapsed disc?

A

leg pain usually worse than back
pain often worse when sitting

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2
Q

L3 Nerve Compression

A

Sensory loss over anterior knee
Weak Quadriceps
Reduced Knee reflex
Positive femoral stretch test

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3
Q

L4 Nerve compression

A

sensory loss of anterior thigh
Weak Quadriceps
Reduced Knee reflex
Positive femoral stretch test

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4
Q

L5 compression

A

Sensory loss over dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive Sciatic nerve stretch test

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5
Q

S1 nerve root compression

A

Sensory loss over posterolateral aspect of leg and lateral aspect of foot
Weakness sin plantar flexion of foot
reduced ankle reflex
Positive sciatic nerve stretch test

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6
Q

Management of disc prolapse

A

analgesia physiotherapy
If symptoms persist after 6-9 weeks then MRI

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7
Q

What is an acromoclavicular joint injury

A

Injury to acromo-clavicular joint usually in collision sports or FOOSH
Graded 1-4
1 and 2 simple rest and sling
3-4 surgical intervention

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8
Q

UPPER LIMB ANATOMY LEARN A WEEK BEFORE EXAM

A

PASSMED- UPPER LIMB ANATOMY

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9
Q

Which shoulder dislocation most common?

A

when the humeral head dislodges from gleinoid cavity of scapula- 2 types anterior and posterior

Anterior dislocation
External rotation and abduction
if acute onset- reduction may be tried without analgesia/sedation, some will require relaxation of rotator cuff muscles

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10
Q

Posterior shoulder dislocation

A

Not much reading about this just learn:

a shoulder locked in an internally rotated position is highly suggestive of a posterior dislocation.

Rim’s sign, light bulb sign.
Associated with Trough sign

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11
Q

What is adhesive capsulitis?
Main risk Factor?
Presentation
Treatment

A

Frozen shoulder
Diabetes mellitus
Pain MAINLY EXTERNAL ROTATION AFFECTED
affects passive and active movements
Management
Nsaids, physiotherapy, cortiosteroids

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12
Q

RIb fracture
Cause
Features
Flail chest?
Investigation
Management

A

C- blunt trauma + Coughing and sneezing
Pathological tumours
Features- severe chest wall pain, especially on breathing, tenderness, crackles on auscultation, reduction in ventilation and can predispose to pneumothorax
Flail chest- multiple rib fractures impairing the movement of chest
DX- CT
management- conservatively most cases
Surgical fixation if failure to heal after 12w
More than one fracture- surgical
Ensure good ventilation or chest infections arise.

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13
Q

HIP FRACTURE
Why is it important to manage?
Features
Classification
Management

A

FemoraL head runs very close to the neck so displaced fracture can cause avascular necrosis

Pain, shortened and externally rotated leg

intracapsular (subcapital): from the edge of the femoral head to the insertion of the capsule of the hip joint
extracapsular: these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)

Intracapsular- if undisplaced- internal fixation of hemiarthoplasty (if frail)
If displaced- Total hip replacement or hemiarthoplasty

Extracapsular- dynamic hip screw

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14
Q

Hip dislocation
what causes it?
Posterior dislocation?
Anterior dislocation?
Management
COmplication

A

Direct trauma, RTA, falls from a certain height
Posterior= more common, affected leg shortened, adduceted and internally rotated
anterior- affected leg abducted and externally rotated no leg shortening

ABCDE approach.
Analgesia
A reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.
Long-term management: Physiotherapy to strengthen the surrounding muscles.

complications
sciatic/femoral nerve injury
avascular necrosis

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15
Q

What is a Colles fracture?

A

falling on an outstretched hand with a dorsiflexed wrist

Transverse fracture of the radius
1 inch proximal to radio- carpal joint
dorsal displacement and angulation

following a foosh you get Displaced dorsally distal radius leading to a dinner fork deformity

Basically a kid falls and the long bone has a straight fracture

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16
Q

smith fracture
Bennet fracture
Monteggia fracture
Galeazzi fracture
Potts fracture
Bartons fracture

A

passmed

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17
Q

What is compartment syndrome?
What common fractures cause?
\features
Test
management

A

After a fracture, there may be a raised pressure within that anatomical space, causes a compromise in tissue perfusion leading to necrosis.

2 main fractures that cause- supracondylar fractures and tibial shaft injuries.

Pain- despite breakthrough analgesia
Paraethesia
Pallor
Pulsation
DX- intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic

Treatment fasciotomies
IV fluids
Debridements

NOTE FASCIOTOMIES RESULT IN MYOGLOBINURIA WHICH CAN CAUSE RENAL FAILURE

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18
Q

What is cubital syndrome?
Features
Management

A

Compression of the ulnar nerve as it passes through the cubittal tunnel

TIngling in the 4th and 5th finger
Weakness and muscle wasting
Pain worse whe nleaning on the elbow

Clinical diagnosis
Nerve conduction studies

Avoid physical activity
physiotherapy
steroids

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19
Q

What is dequervarains tenonsynivitis?
Features?
Special test?
Management

A

sheath containing extensor pollicis brevis and abductor pollicis longus is inflamed

Pain on the radial side of the wrist
abduction of the thumb is painful
FInklesteins test

Management-
analgesia
steroids
Immobilisation with a splint
surgicla treatment

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20
Q

What is duputrens contracture
Causes
Management

A

condition in the hand in which the little and middle finger is bent
Labour
Phenytonin treatment
ALD
DM
trauma

only surgical if cannot straighten the hand

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21
Q

What is fat embolism?

A

Fat embolism occurs when fragments of fat enter the systemic circulation and lode in the small vessels of the lungs or other tissues. It most often occurs as a result of a fracture, particularly long bone fractures. Symptoms depend on the site of embolism

After surgery
casues tachycardia, tachypnoea, hypoxia
red petachial rash
Confusion agitation retinal haemorrhages

Prompt fixation of long bone fractures
Some debate regarding benefit Vs. risk of medullary reaming in femoral shaft/ tibial fractures in terms of increasing risk (probably does not).
DVT prophylaxis

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22
Q

What is tennis elbow?
What is golfers elbow?
What is radial tunnel syndrome?
What is olecranon bursitis?

A

Tennis elbow- lateral epicondylitis
pain worse on rested wrist extension or supination of the forearm

Golfers elbow- Medial epicondylitis - wrist flexion and pronation
tingling in 4th and 5th finger due to ulnar involvement

Radial tunnel syndrome- very similar to lateral epicondylitis due to compression of radial nerve

Olecranon bursitis- swelling on the posterior aspect of elbow, middle aged patients, pain warmth and erythema

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23
Q

What is a ganglion?
Features?
Management?

A

Cyst arising from a joint or tendon sheath, most commonly sene in dorsal wirst and more common in women

a firm well circumscribed lump that transilluminates

Disappear spontaenously
surgical excision may be required

24
Q

What is greater trochanteric pain syndrome?

A

Aka trochanteric bursitis, movement of the fibroelastic illiotibial band
Pain over lateral thigh
tenderness on palpitation of greater trochanter

25
Q

What is carpal tunnel syndrome?
how does it present?
Examination
Management

A

idiopathic median neuropathy at the carpal tunnel
altered sensation on lateral 3 fingers
Wasting of muscles in the thenar eminence
TInels test
Formal diagnosis electrophysiological studies -motor + sensory: prolongation of the action potential
Treatment- splinting and surgical review and corticosteroids for 6 weeks
if that doesnt work surgical decompression (flexor retinaculum division)

26
Q

what is iliotibial band syndrome?
Who is it common in?
Where is it found
Management

A

lateral knee pain in runners
tenderness 2-3cm above laterasl joint line
Iliotibial band stretches and physiotherpay referral

27
Q

Hip problems in children
DDH
Transient synovitis
Perthes disease
SUFE
JIA
Septic arthritis

A

DDH- NIPE, barlow and ortolani test positive
unequal skin folds and leg length

Transient synovitis- hip pain associated with viral infection

Perthes disease- degenerative condition affecting kids, avascular necrosis of the femoral head, Perthes disease is 5 times more common in boys. Around 10% of cases are bilateral
xray- widening of the joint space

SUFE- fat kid Displacement of the femoral head epiphysis postero-inferiorly
Bilateral slip in 20% of cases

JIA- arthritis occurring in someone who is less than 16 years old that lasts for more than three months, can be associated with ana and anterior uveitis, pauciarticular- less than 4 joints affected

septic arthiritis- Acute hip pain associated with systemic upset e.g. pyrexia. Inability/severe limitation of affected joint

28
Q

What is an iliopsoas abscess?
WHat causes it?
Features
Examination and investigation
Management

A

Fever/back pain with pain on extension of the hip → iliopsoas abscess

collection of pus in iliopsoas compartment
S aureaus
crohns diverticulitis and ivdu
Fever back/flank pain/limp

CT abdomen
abx
draininage
surgery if above fail

29
Q

Lachmans test is for
Anterior draw test?
Empty can test?
Mcmurrays test?
posterior draw test?
Sweep test?

A

Lachmans test- ACL injuries
Anterior draw test- acl
Empty can test- supraspinatus injury
Mcmurrays test- meniscal tear
Posterior draw test- PCL injury
Sweep test - effusion

30
Q

ACL injury
PCL INJURY
MCL
and meniscal
Patellar fracture

A

ACL- port injury
Mechanism: high twisting force applied to a bent knee
Typically presents with: loud crack, pain and RAPID joint swelling (haemoarthrosis)
Poor healing
Management: intense physiotherapy or surge

PCL
Mechanism: hyperextension injuries
Tibia lies back on the femur
Paradoxical anterior draw test

MCL INJURY
Mechanism: leg forced into valgus via force outside the leg
Knee unstable when put into valgus position

Meniscal tear-Rotational sporting injuries
Delayed knee swelling
Joint locking (Patient may develop skills to ‘unlock’ the knee
Recurrent episodes of pain and effusions are common, often following minor trauma- Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee

Patellar-Undisplaced fractures, particularly vertical fractures with an intact extensor mechanism can be managed non-operatively in a hinged knee brace for 6 weeks and patients allowed to fully weight bear.

Displaced fractures and those with loss of extensor mechanisms should be considered for operative management with either tension band wire, inter-fragmentary screws or cerclage wires. Again, patients are placed in a hinged knee brace for 4 to 6 weeks and allowed to fully weight bear.

31
Q

what is a stress fracture
how is it diagnosed?

A

Repetitive activity and loading of normal bone may result in small hairline fractures.
Xray
severity depends on immobilisation

32
Q

Lower back pain red flgas

A

thoracic pain
age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever

33
Q

SPinal stenosis

A

Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnosis
laminectomy

34
Q

SPinal stenosis

A

Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnosis
laminectomy

35
Q

What is meralgia paraethetics
presentation

A

Meralgia paraesthetica refers to localised sensory symptoms of the outer thigh caused by compression of the lateral femoral cutaneous nerve. It is a mononeuropathy, meaning it only affects a single nerve.

Outer thigh- burning, numbness, pins and needles and cold sensation loss of hair

dx
The pelvic compression test is highly sensitive, and often, meralgia paraesthetica can be diagnosed based on this test alone
Injection of the nerve with local anaesthetic will abolish the pain. Using ultrasound is effective both for diagnosis and guiding injection therapy in meralgia paraesthetica
Nerve conduction studies may be useful.

management
Conservative management involves:

Rest
Looser clothing (tight clothes such as belts may add pressure to the nerve)
Weight loss (if appropriate)
Physiotherapy

Medical management is based around analgesia if pain is a feature, such as:

Paracetamol
NSAIDs
Neuropathic analgesia (e.g., amitriptyline, gabapentin, pregabalin or duloxetine)
Local injections of steroids or local anaesthetics

Surgical management may involve:

Decompression – removing pressure on the nerve
Transection – cutting the nerve
Resection – removing the nerve

36
Q

Scaphoid fracture

A

FOOSH
compression of the scaphoid
damage to the dorsal carpal branch of the radial artery leading to avascular necrosis of scaphoid

pain in aantomical snuff boxc
teslescoping thumb causes pain
loss of grip strength

xray- anterior posterior land lateral
mri - gold

management- futuro splint ALWAYS REFER TO ORTHOPAEDICS

if the fracture undisplaced- cast 6-8 weeks
displaced- surgical fixation
proximal pole- surgical fixation

37
Q

What is trigger finger

A

abnormal flexion of the diits, tendons become stuck
thumb, middle and ring finger
steroid injection
finger splint

38
Q

what is a buckle fracture

A

Buckle, or torus, fractures are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years.

39
Q

bakers cyst?

A

Baker’s cysts are also called popliteal cysts. A Baker’s cyst is a fluid-filled sac in the popliteal fossa, causing a lump.

GASTROCNEMEUIUS-SEMIMEMBRANOUS BURSA

The popliteal fossa is the diamond-shaped hollow area formed by the:

Ultrasound is usually the first-line investigation to confirm the diagnosis. It is also used to rule out a DVT.

MRI can evaluate the cyst further if required, for example, before surgery. They can also demonstrate underlying knee pathology, such as meniscal tears.

No treatment is required for asymptomatic Baker’s cysts.

Non-surgical management for symptomatic Baker’s cysts include:

Modified activity to avoid exacerbating symptoms
Analgesia (e.g., NSAIDs)
Physiotherapy
Ultrasound-guided aspiration
Steroid injections

40
Q

plantar fascilitis

A

Plantar fasciitis is the most common cause of heel pain seen in adults. The pain is usually worse around the medial calcaneal tuberosity.

Management
rest the feet where possible
wear shoes with good arch support and cushioned heels
insoles and heel pads may be helpful

41
Q

what is an open fracture
what system used to assess

A

disruption of the bony cortex associated with a breach in the overlying skin
Gustilo and Anderson
Administration of intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film

42
Q

Most common cause of posterior heel pain
risk factors for their disorder
What is achiles tendonapothy
when can we suspect an achiles tendon rupture?
Imaging choice and management for achiles tendon rupture

A

Achilles tendon disorders
Quinolone use- ciprofloxacin and hypercholestrolaemia
gradual onset posterior heel pain worse on activity, morning pain and stiffness, do execrise and analgesia
whilst playing a sport or running; an audible ‘pop’ in the ankle, sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport.
US scan and acute referral to orthopaedics POSITIVE SIMMONDS SIGN

Use Simmonds triad (palpation, examining the angle of declination at rest and the calf squeeze test) to assess for evidence of Achilles tendon rupture

43
Q

Muscles of the rotator cuff
Common rotator cuff injuries

A

SITS supraspinatus, infraspinatus,teres minor, subscapularis,
1. Subacromial impingement (also known as impingement syndrome, painful arc syndrome)
2. Calcific tendonitis
3. Rotator cuff tears
4. Rotator cuff arthropathy

Symptoms
shoulder pain worse on abduction

Signs
-painful arc of abduction. With subacromial impingement, this is typically between 60 and 120 degrees. With rotator cuff tears the pain may be in the first 60 degrees.
tenderness over anterior acromion

44
Q

What are the ankle ottawa rules

A

these decide whether someone should have an XRAY

Xray only required if pain in the medial malleolar zone and
- bony tenderness at lateral malleolar zone
- bony tenderness at medial malleolar zone
-inability to walk 4 weight bearing steps

45
Q

ankle fractures management

A

promptly reduce pressure

Young- surgical plate
Old- conservative management

46
Q

what is avascular necrosis of the hip?

Causes of avascular necrosis of the hip?

IX
Management

A

death of bone tissue secondary to loss of blood supply

Long term steroid use
chemotherapy
Alcohol excess
Trauma

Osteopaenia
MRI investigation of choice

Usually requires joint replacement

47
Q

What is a buckle fracture

A

an incomplete fracture of the shaft of a long bone, characterised by bulge in the cortex

48
Q

what is cervical spondylosis

A

a person with osteoarthiritis has neck pain and headaches

49
Q

what is a charcot joint

A

a neuropathic joint of the foot, it has been so badly disrupted leads to loss of sensation, redness swelling and warm ASSOCIATED WITH DM AND SYPHILIS

50
Q

what is discitis

A

infection and inflammation of the intervertebral disc
can lead to sepsis or an abscess
back pain and sepsis like features
s aureus most common cause

MRI highest sensiitivity

6-8 weeks of abx

51
Q

EPONYMOUS FRACTURE LEARN FOR EXAM

A
52
Q

what is the unhappy triad

A

damage to the:
anterior cruciate ligament
medial collateral ligament
meniscus (classically the medial meniscus but recent evidence shows that the lateral meniscus is more commonly injured)

53
Q

what injuriers cause what structure damage

A

Anterior cruciate ligament Damage may result from twisting injuries
Anterior drawer test and Lachman test may be positive if damaged

Posterior cruciate ligament Damage may occur following dashboard injuries

Medial collateral ligament Damage may commonly result from skiing and following valgus stress
Damage typically causes abnormal passive abduction of the knee

Lateral collateral ligament Isolated injury is uncommon

Menisci Damage may result from twisting injuries

54
Q

which metatarsal most likely injured

A

proximal 5th metatarsal usually because of lateral ankle sprain

but
Metatarsal stress fractures
Occurs in otherwise healthy athletes, e.g. runners
The most common site of metatarsal stress fractures is the 2nd metatarsal shaft

55
Q

Osteomyelitis
causes
ix
management

A

Infection of the bone
S aureus most common but in sickle cell patients it is salmonella species

MRI imaging choice

FLucoxacillin 6 weeks and clindamycuin if penicillin allergic

56
Q

BITEMED MSK

A

02F (18 decks)

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