MSK Vivas Flashcards
What is seen here?
THR scar
What is seen here?
Total knee replacement
What is seen here?
Carpal tunnel decompression release
What is seen here? What condition is this seen in?
Heberdans nodes
OA
What is seen here? What condition is this seen in?
Bouchards nodes
OA
What is seen here? What condition is this seen in?
1st CMC squaring
OA
What is seen here? What condition is this seen in?
Boutonniere deformity
RhA
What is seen here? What condition is this seen in?
Swan neck deformity
RhA
What is seen here? What condition is this seen in?
Ulnar deviation
RhA
X-ray features of RhA
Loss of joint space
Juxta-articular osteoporosis
Soft-tissue swelling
Periarticular erosions
Subluxation
X-ray features of OA
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
Unilateral swollen joint differential diagnosis
Septic arthritis
Haemarthrosis
Crystal arthropathy: gout or pseudogout
Bursitis
Reactive arthritis
Diagnosis of OA
Clinical dx if:
>,45
+
have activity-related joint pain
+
have either no morning joint-related stiffness or morning stiffness that lasts < 30 mins.
Conservative management of OA
Therapeutic exercise
Weight loss
Walking aids/ grip aids
Medical management of OA
Topical NSAID for knee OA
NSAID PO if ineffective/ unsuitable + PPI
Consider IA CS injection when other Tx ineffective- only short term relief 2-10w
Imaging for OA
Do NOT routinely use imaging for f/u or to guide non-surgical Mx
When should a patient be referred for joint replacement in OA?
Joint Sx are substantially impacting QoL
AND
Non-surgical Mx is ineffective/ unsuitable
Rheumatoid typical presentation
Symmetrical synovitis of small joints of hands + feet, although any synovial joint may be affected
Pain: worse at rest
Swelling: AROUND joint ‘boggy’
Early morning stiffness >1h
What may distinguish RhA from other conditions?
Inability to make a fist or flex fingers
List 3 features additional to synovitis in RhA
Rheumatoid nodules: hard, firm swellings over extensors
Extra-articular: vasculitis, eye, lungs, heart
Systemic: fever, sweats, WL
Describe assessment of potential RhA
Refer those with persistent synovitis with unknown cause to rheumatologist
within 3w
Offer NSAIDs whilst awaiting +PPI
Ix for RhA
Clinical dx
Rheumatoid factor
Anti-CCP
Hand + feet XR
Mx for RhA
DMARD: Methotrexate
Bridging therapy/ flares: PO/ IM/ IA CS
When should patients with RhA be referred for surgical opinion?
If any of the following dont respond to non-surgical Mx:
Persistent pain due to joint damage
Worsening joint function
Progressive deformity
Persistent localised synovitis
Achilles tendinopathy S/S
Gradual onset posterior heel pain, worse following activity
Morning pain + stiffness
RFs for achilles tendinopathy
Quinolone use e.g. Ciprofloxacin
Hypercholesterolaemia (predisposes to tendon xanthomata)
Achilles tendinopathy Mx
Analgesia
Reduce precipitating activities
Calf muscle eccentric exercises
In which patients is adhesive capsulitis seen? What are the S/S?
Middle age, diabetics
Painful, stiff movement
Limited movement in all directions
Loss of external rotation + abduction
What is supraspinatus tendonitis?
Rotator cuff injury: subacromial impingement
Painful arc of abduction 60-120 degrees
Tender over anterior acromion
What is shoulder dislocation?
Humeral head dislodges from glenoid cavity of scapula
Anterior accounts for >95%
Septic arthritis S/S
Acute swollen joint
Warm, fluctuant joint
Fever
Septic arthritis most common cause
S aureus
(In young, sexually active: N gonorrhoea)
Septic arthritis Ix
Synovial fluid sampling prior to abx
Blood cultures
Joint imaging
Septic arthritis Mx
IV Abx: Flucloxacillin
Needle aspiration to decompress
+/- Arthroscopic lavage
Psoriatic arthritis nail changes
Pitting
Onycholysis
Subungual hyperkeratosis
Loss of nail
Psoriatic arthritis patterns
Symmetric poly arthritis (most common)
Asymmetrical oligoarthritis (hands + feet)
Sacroiliitis
DIP joint disease
Arthritis mutilans
What is seen here? What condition is this seen in?
Arthritis mutilans
Psoriatic arthropathy
What is seen here? What conditions is this seen in?
Dactylitis
Psoriatic arthritis
Reactive arthritis
Sickle cell
Describe the periarticular disease manifestations in psoriatic arthritis
Enthesitis: achilles tendonitis, plantar fasciitis
Tenosynovitis: flexor tendons of hands
Dactylitis
What is seen here? In what condition is this seen?
Pencil-in-cup appearance
Psoriatic arthritis
Psoriatic arthritis Ix
XR:
erosive changes
new bone formation
periostitis
pencil-in-cup appearance
Psoriatic arthritis Mx
Managed by rheumatologist
Mild: NSAID
Mod/ severe: Methotrexate
Biologics e.g. Ustekinumab
What is the most common cause of heel pain in adults?
Plantar fasciitis
Worse around medial calcanea tuberosity
Mx of plantar fasciitis
Rest feet where possible
Wear shoes with good arch support + cushioned heels
Insoles + heel pads
Scaphoid fracture S/S
FOOSH/ contact sports
Pain along radial aspect of wrist, at base of thumb
Loss of pinch/ grip strength
Max. tenderness over anatomical snuffbox
Wrist joint effusion
What is seen here?
Scaphoid fracture
Scaphoid fracture management
Immobilisation: futuro splint/ below-elbow backslab
Refer to orthodox: further imaging within 7-10 days
Undisplaced: cast 6-8w
Displaced/ proximal scaphoid pole: surgical fixation
Complications of scaphoid fracture
Non-union: pain + early OA
Avascular necrosis
Innervation of thenar muscles
Median nerve
Innervation of hypothenar muscles
Ulnar nerve
Tests for carpal tunnel syndrome
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes Sx
Carpal tunnel syndrome S/S
Pain/ pins + needles in thumb, index + middle finger
Patients shake hand to obtain relief
Weakness of thumb abduction
Wasting of thenar eminence
Carpal tunnel syndrome Mx
6w conservative: wrist splints at night + CS injection
If severe/ persistent: surgical decompression
What is surgical decompression for CTS?
Flexor retinaculum division
What is seen here?
Unicompartmental knee replacement
What is seen here?
Total knee replacement
Indication for unicompartmental knee replacement. Positives and negatives
OA limited to a single compartment
+ves: less invasive, quicker rehab
-ves: highly specialised, likely going to need to replace other compartment
Indication for total knee replacement. Positives and negatives
OA affecting all knee compartments
+ves: well established, no progression of OA, less specialised
-ves: more invasive, slower rehab
What are the clinical signs of a fracture?
Pain
Swelling
Crepitus
Deformity
Adjacent structural injury: nerves, vessels, ligaments, tendons
Describe management of a closed fracture
Reduction: manipulation/ traction
Hold: plaster/ traction
Rehabilitate
Describe management of an open fracture
Reduce: mini-incision/ full exposure
Hold: fixation (internal or external)
Rehabilitate
What does rehabilitation of a fracture involve?
Use: pain relief
Move
Strengthen
Weight bear
4 general complications of a fracture
Fat embolus
DVT
Infection
Prolonged immobility: UTI, chest infections, bed sores
5 specific complications of a fracture
Neuromuscular injury
Muscle/ tendon injury
Non union/ malunion
Local infection
Degenerative change (intra-articular)
3 causes of NOF fracture
Osteoporosis (older)
Trauma (younger)
Combination
5 Clinical findings of NOF fracture
Leg shortened, externally rotated + abducted
Palpation of hip painful
Unable to perform straight leg raise
Pain on gentle internal + external rotation of leg (log roll test)
Soft tissue Sx: bruising + swelling in + around the hip area
Imaging for NOF fracture
XR: AP + Lateral hip first line
MRI: gold standard to exclude hip fracture
Management of extra capsular hip fractures
Fix with plate + screws (dynamic hip screw)
Minimal risk to blood supply + AVN
Management of undisplayed intracapsular hip fractures
Fix with screws
Less risk to blood supply
Management of displaced intracapsular hip fractures
> 65 + fit: THR
65 + less fit: hemiarthroplasty
<55: reduce + fixation with screws
Initial management of NOF fracture
Analgesia: paracetamol, opioids + iliofascial/ femoral nerve blocks. NOT NSAIDs.
IV access: for fluid resus, blood transfusion + administration of medications.
Assess + manage complications to prevent delays in surgical Mx (e.g. correct anaemia, anticoagulation, volume depletion + infection).
What are the principles of surgical management o NOF fractures?
Urgent reduction + internal fixation (<36h)
Early mobilisation
