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Conditions + definitions > MSK wk 2 > Flashcards

MSK wk 2 Flashcards

1
Q

What ar ethe major problems of the forefoot?

A 
Hallux valgus
Hallux rigidus
Lesser toe deformities
Morton's neuroma
Metatarsalgia
Rheumatoid forefoot
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2
Q

What is the presentation of hallux valgus?

A

“bunion”
Pressure symptoms from shoe
Pain from crossing does
Metatarsalgia

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3
Q

What causes hallux valgus?

A

Genetic
Foot wear
Female>male

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4
Q

What is the pathogenesis of hallux vagus?

A

Lateral angulation of great toe
Tendons pull relaigned to lateral angle - worsens defmority
Continues in a cycle
Less weight goes through great toe
Eventually abnormalities of the lesser toes occur

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5
Q

How do you diagnose hallux vagus?

A

Clinical

X-rays )to check for severity of underlying bone deformity)

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6
Q

How do you manage hallux vagus?

A

Non-operative - shoe wear modification
Activity modification
Orthotics to correct deformity
Analgesia

Operative - osteotomy
release soft tissues

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7
Q

What is hallux rigidus?

A

Stiff big toe - osteoarthritis of MTP of toe
AKA hallux limitus
Hallux nonextensus

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8
Q

What are the symptoms of hallux rigidus?

A

Many asymptomatic

Pain (extreme dorsiflexion)

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9
Q

How do you diagnose hallux rigidus?

A

Clinical

X-ray

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10
Q

What is teh non-operative management of hallux rigidus?

A

Activity modification
Shoe wear rigid soles
Analgesia

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11
Q

What are teh types of surgery available for hallux rigidus?

A

Cheilectomy (remove dorsal impingement)
Arthrodesis (imbolisation of joint)
Arthroplasty

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12
Q

What is the best surgery for hallux rigidus?

A

Arthrodesis (MTP fusion)

Permanent

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13
Q

When is a hemiarthroplasty indicated in hallux rigidus?

A

When need to maintian range of movement

Although high failure rate so best in low demand patients

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14
Q

What are the lesser toe deromities?

A 
Claw toes  (both proximal + distal)
Hammer toes (Distal)
Mallet toes (proximal)

Where interphalangeal joints are permanently flexed

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15
Q

What is the aeitiology of lesser toe deformtiies?

A 
Imbalance of flexor/extensors
Shoes
Neurological
Rheumatoid arthrits
Idiopathic
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16
Q

What are teh symptoms of lesser toe deformities?

A

Deformity
Pain from dorsum
Pain from plantar side

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17
Q

What are the treamtnet options for lesser toe deformities?

A

Non-oper
Activity/shoe modification
Orthotic insoles

Operative
Flexor to extensor transfer
Fusionof interphangeal joints
Release metatarsophalngeal joint
Shortening ostetomy of metatarsal
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18
Q

What is another name for interdigital neuralgia?

A

Morton’s neuroma

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19
Q

What casues morton’s neuroma?

A

Mechanically induced degenerative neuropathy
Females 40-60
Associated with high hell shoes

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20
Q

What are hte symtoms of morton’s neuroma?

A

2nd/3rd webspace
Neuralgic burning pain in toes
Intermittent
Altered sensation into toes

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21
Q

How do you diagnose morton’s neuroma?

A

Clinical
Mulder’s click
US best, MRI good

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22
Q

How do you manage morton’s neuroma?

A

Injection for small lesions

Surgery - excision of lesion including section of normal nerve

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23
Q

What are the complications with surgery for morton’s neuroma?

A

Numbness
Possible recurrance
Up to 30% still have pain 1yr post surgery

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24
Q

What is metatarsalgia?

A

A symptom - pain of metatarsals

Sometimes difficult to treat

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25
Q

What can cause metatarsalitis?

A 
Syovitis
Bursitis
Arthritis
Neuralgia
Neuromata
Freibergs disease
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26
Q

How do you treat rheumatoid forefoot?

A

Shoewear/orthotics
Operative - toe - MTP arthrodesis
Smal toes - arthroplasty

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27
Q

What are the pain midfoot problems?

A

Ganglia
Osteoarthrits
Plantar fibromatosis

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28
Q

What causes dorsal foot ganglia?

A

Underlying arthritis
Underlying tendon pathology

-arises from joint or tendon sheath

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29
Q

What are the symptoms of sorsal foot ganglia?

A

Pain from shoe wear pressure

Pain from underlying problem

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30
Q

How do you treat dorsal foot ganglia?

A

Non-operative - aspiration
Operative - excision
However high rate of return

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31
Q

What types of midfoot arthritis are there?

A

Post-traumatic
Osteoarthritis
Rheumatoid arthritis

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32
Q

What are the treatmnets for midfoort arthritis?

A

Non-op
Injections - x-ray guided
Operative - fusion

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33
Q

What is plantar fibromatosis?

A

“ledderhose disease”
Similar to druptyns but foot
Progressive and usually asymptomatic

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34
Q

How do you treat plantar fibromatosis

A

Non-op - avoid pressure, shoewear
Operative - excision
Radiotherapy
Combination (high risk complications but low risk of recurrance)

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35
Q

What are the main problems of the hindfoot?

A 
Achilles tendonitis
Plantar fasciitis
Ankle osteoarthritis
Tibialis posterior dysfunction
Charcots foot
Diabetic foot ulcerfoot
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36
Q

What is achilles tendonitis/tendinosis

A

Degenerative /overuse condition with little inflammation
Tendinosis is histopathy
Tendiopathy used to describe symptoms

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37
Q

What causes achilles tendiopathy>

A 
Common in non-athletic people
Obesity
Steroids
Diabetes
Middle aged
38
Q

What causes paratenonopathy?

A

Commonest in athletic populations 30-40

More common in men

39
Q

What are the symptoms of achilles tendinopathy?

A

Recurrent episodes of pain during or following exercise
Difficulty fitting shoes
Sometimes rupture

40
Q

How do you diagnose achilles tendinopathy?

A

Tenderness + test for rupture
- simmonds + test angle
US/MRI

41
Q

What is the simmonds rupture test?

A 
Squeeze calf (soleus)
If foot moves, tendon is not fully ruptures
If failure to move full rupture
42
Q

What is the treatment for achilles tendinopathy?

A

Weight loss
Shoe wear/acitivty modification
Immbolisation

Operative - gastronemius recession
Release and debridement of tendon

43
Q

What is plantar fasciitis?

A

Chronic degeneration of fibroblast hypertophy
Disorganised/dysfunctional blood vessesl/collagen
Leads to unable to make extra cellular matrix required for matrix/repair and remodelling

Note, fasciosis is a better term

44
Q

What causes plantar fasciitis?

A

Unknown, but associated with:
Obesity
Lowerlimb rotational deformities
Running with poorly padded shoes on hard surfaces
Tight gastro-soleus complex
High intensity/rapid increase in training

45
Q

What are teh symptoms of plantar fasciitis?

A

Pain first thing in morning
Pain on weight bearing after weight
Pain located at origin of plantar fascia

46
Q

What are the differentials for plantar fasciitis?

A

Nerve entrapment
Arthritis
Calcaneal pathology

47
Q

How do you diagnose plantar fasciitis?

A

Mainly clinical

Ocasionally radiography

48
Q

How do you treat plantar fasciitis?

A 
Rest/ICE
NSAIDs
Stretching
Physio
Injections
Night splinting
49
Q

What newer treatments are there for plantar fasciitis?

A 
Extracorporeal Shockwave therapy
Topaz Plasma Coblation
Nitric Oxide
Platelet Rich Plasma
Endoscopic / Open Surgery
50
Q

How do you diagnose ankle arthritis?

A

Clinical
Radiographs
CT to exclude adjacent joint arthritis

51
Q

How do you manage arthritis?

A

Weight loss
Activity modification
Analgesia
Physio

Sugery:
Anterior symptoms only - arthroscopic anterior debridement
Arthrodesis (gold standard)
Joint replacement - difficult to revise

52
Q

What is tibialis posterior tendon dysfnction?

A

Acquired flat foot planovalgus

Common but under recognised

53
Q

What are the symptoms of tibialis posterior tendon dysfunction?

A

Medial or lateral pain

Double or single heel raise

54
Q

How do you diagnose tibialis posterior tendon dysfunction?

A

Clinically

55
Q

What is the heel raise test?

A

Raise heels
Normally heel should swing inwards as it rises
Swings outwards in positive

56
Q

How do you manage tibialis posterior tendon dysfunction?

A 
Orthotics
Reconstruction of tendon
Triple fusion (subtalar, talonavicular, calcaneocuboid)
57
Q

What are the aims of surgical treatment of diabetic foot ulcer?

A

Improve vascular supply
Debride ulcers + deep samples for microbiology
Correct any deformity to offload area
Sometimes amputation to mitigate damage

58
Q

What is the prognosis of a diabetic foot ulcer?

A

25% go on to get amputation

5 yr mortality

59
Q

What causes charcot neurarthropathy?

A

Anything that causes neuropathy
Diabetes most common
Most common with syphillis historically

60
Q

What is the pathophysiology of charcots foot?

A

Neurotraumatic - loss of proprioception and protective pain sensation

Or neurovascular - abnormal autonomic nervous system results in increased vascular supply + bone reabsorption

61
Q

How do you diagnose charcot’s foot?

A

Consider in any diabetic with acutely swollen red foot
Esp with neuropathy
Frequntly not painful
MRI/radiograph

3degree difference between limbs

62
Q

How do you manage charcot’s foot?

A

Immoblisation until acute fragmentation revolved
Correct deformity
(to prevent ulceration/infection/amputation)

63
Q

What are common conditions of the hand - ellective?

A 
Drupuytren's disease
Trigger finger
De quevain's tenovaginiits
Nerve entrapments (carpal/cubital tunnel syndromes)
ganglion
OA
64
Q

Who is likely to get dupuytren’s?

A 
Men more than women
Almost exclusively white
Associated with diabetes
Alochol
Tobacco
HIV
Epilepsy
65
Q

What is the pathology of drupruten’s?

A

Myofibroblast proliferation and collagen depositation leading to a progressive thickening of the palmar fascia
Causes digital protraction of fingers

66
Q

What are the functional problems in druputren’s?

A

Loss of figner extension

Hard to do simple tasks - grip, wash face, hands in pocket

67
Q

How do you treat drupuytren’s?

A

Radiotherpahy (splints don’t work)
Partial/dermo fasciectomy
Arthrodesis

68
Q

Why is partial fasciectomy the gold standard for drupuytren’s?

A

Good correction achieved
Wound takes 2-3 weeks
Druputytren’s can’t be cured

69
Q

What is dermofasciectomy?

A

A more radial procedure, removing skin may reduce recurrance

Requires more inetnsive physio

70
Q

What are the benefits to percutaneous needle fascitomy?

A

Quick + no wounds
Return to activity in 2-3 days
Can be repeated
However risk of nerve injury and higher recurrance

71
Q

What is the pathology behind trigger finger?

A

Swelling in tendon which catches on bone

72
Q

Who gets trigger finger?

A

Women more than men - 40s-60s
Ring finger most common, then thumb and middle
Associated with RA, diabetes, gout

73
Q

How do you diagnose trigger finger?

A

Patient history
Clickingsensation on digit movement
Lump in palm under pulley
Clicking may become lcoked

74
Q

What can cause trigger finger?

A

Repitive use of hand

Local trauma

75
Q

How do you treat trigger finger?

A

Splint/steroids

Or seurgically - percutaneous release or open surgery

76
Q

What is the clinical history of de quervians syndrome?

A

Several weeks of pain localised to radial side of wrist
Pain aggravated by thumb mvement
Localised swelling - potentially
Localised tenderness over tunnel

77
Q

Who gets De quervains syndrome?

A

Women 50-60 most common
Increased in post partum/lactating women
Associated with regular ulnar deviation

78
Q

What is the pathology of de quervains syndrome?

A

A fibroossous tunnel in 1st dorsal extensor compartment
Leads to thickening of localised segment
30% have compartment divided by septum

79
Q

How do you diagnose de quervains syndrome?

A

Examine thumb joints (consider OA at base of thumb)
Finklesteins test
Resisted thumb extension

80
Q

How do you treat de quervains syndrom?

A

Splints/steroir

Decompression surgery

81
Q

What is a ganglion?

A

Myxoid degeneration from a joint synovia “lump”

82
Q

Who is most likely to get gnaglia?

A

Women 2x, most common 20-40yrs

Associated with recurrent injury around wrist

83
Q

What is the presentation of ganglia?

A

More common on dorsal side (3:1) 3x

70% of all swellings on hand

84
Q

How do you diagnose a ganglia

A

Firm, non-tender lump witha change in size
Smooth, only occasionally lobulated
Normally not fixed to underlying tissue - NEVER to skin

85
Q

How do you treat ganglia?

A

Reassure + observe - aspiration

Operate - excise

86
Q

What are the symptoms of OA at base od thumb?

A 
Pain
Stiffness
Swelling
Deformity
Loss of function
87
Q

Who gets OA at base of thumb?

A

1/3 of all women

88
Q

What are the presenting features of base of thumb OA?

A

Pain on opening jars or pinching
Dorsal subuxation
Metacarpal adduction
MCP hyperextension

89
Q

Where should you test if OA is found in base of thumb?

A

Scapho-trapezio-trapezoinal OA at wrist

90
Q

How do you treat osteoarthritis base of thumb?

A

Life style modifications
NSAIDs
Splint/steroid

Opertive
Replacement
fusion
Trapeziectomy - gold standard

Conditions + definitions (68 decks)

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