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Conditions + definitions > MSK wk 3 > Flashcards

MSK wk 3 Flashcards

1
Q

What are the consequences of childrens’ ligaments being stronger than the growth plates?

A

Easy to produce epihyseal separation

Difficult to dislocate or sprain

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2
Q

What are the consequences of young bones being more porous?

A

Tolerates for deformation
Fails in compression as well as tension
(Buckle + green stick fractures)

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3
Q

What are presenting parental concerns in children development?

A 
In or Out-toeing
Bow legs
Kock knees
Flat/curved feet
Curly toes
Tiptoe walking
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4
Q

What is the david jones system?

A 
Symetrical
Symtomatic
Systemic illness
Skeletal dysplasia
Stiffness
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5
Q

What is a slipped upper/capital femoral epiphysis?

A

Posterior medial displacement of proximal femoral epiphysis in relation to neck
Normally in the widened zone of hypertophy in physis

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6
Q

Who is likely to get a slipped upper/capital femoral epiphysis?

A

Range 9-16 yrs
Boys more than girls
Girls often earlier peack age

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7
Q

What can cause a slipped upper/capital femoral epiphysis?

A 
Idiopathic (adolescence, increased weight, delayed bone age)
Secodnary to underlying disorder
Ie hypothyroidism
Hypogonadism
Renal osteodystophy
Growth hormone therapy
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8
Q

What is the presenting history of a slipped upper/capital femoral epiphysis?

A

Pain in groin/knee/thigh
Lip
Trauma
ER deformity

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9
Q

What is seen in the physical exam of a slipped upper/capital femoral epiphysis?

A

Look at body habitus (general physique)
Externally rotated extermity
Obligatory external rotation in flexion
ROM limited by pain

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10
Q

What is the radiological investigation into a slipped upper/capital femoral epiphysis?

A

X-ray in frog lateral position

If positive urgent review

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11
Q

What infections can cause limping in children?

A

Septic arthtis
Osteomyelitis
Transient synovitis
Muscle abscess

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12
Q

What is the history of an infection causing limp?

A 
Pain 
(Limp)
General maliase
Increased temp
Trauma?
Psuedoparalysis
Recent URTI
Listen to parent - normally right
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13
Q

What is the examination process if infection is suscpeted in limping child?

A

Do they look sick
Is there a refusal to weight bear?
What movements hurt most on hip movement?
Upper limb dissuse?

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14
Q

What are the initial investigations into a limping child with suspected infection?

A

Temperature
X-ray?
Bloods - WCC, CRP, ESR, CK + cultures

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15
Q

What is the presentation of septic arthritis?

A 
Limping
Pseudoparalysis
Swollen, red joint
Refusal to move said joint
Pain + temperature
Most common in hip + knee
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16
Q

How should you investigate septic arthrtis?

A

FBC, ESR, CRP
blood cultures (usually staph A)
US!
Synovial fluid asporation - gramstain + culture

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17
Q

How do you treat septic arthrits?

A

Aspiration
Athroscopy
Arthrotomy
Antiobiotics IV

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18
Q

What are the risk factors for osteomyelitis?

A

blunt trauma

Recent infection

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19
Q

What is teh pathogenesis of acute haemotgenous osteomyelitis?

A

Vascular loops with terminal braches
Inhibited phagocytosis (due to low pO2)
Trauma

Rare in adults

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20
Q

What are the indicatins for surgery in osteomyelitis?

A 
When any of the following need to be carried out
Aspiration for culture
Drainage of subperiosteal abscess
Drainage of joint sepsis
Debridement of dead tissue
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21
Q

What are the symptoms of transient synovitis?

A 
Limping, often touch weight bearing
Slightly unwell
History of viral infection (URTI/ear)
Apyrexial
Allows joint to be examined
Low CRP, normal WCC
May have joint infusion
Not that unwell
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22
Q

What are the most common shoulder or elbow injuries in teens/20s?

A

Fractures + instability

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23
Q

What are the most common injuries to shoulder and elbow in people in 30s-40s?

A

Rotator uff muscle injury

Capsulitis

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24
Q

What are teh most common injuries t the shoulder/elbow in the 50s/60s age group?

A

Impingement of AC joint

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25
Q

What is the most common injury of shoulder and elbow of 70s+?

A

Degnerative rotator cuff and joint

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26
Q

What is the epideimiology of UL fractures int eh varying age groups?

A

Young - high energy fracture

Elderly - osteoporotic

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27
Q

What is the likelyhood of an anterior shoulder dislocation?

A

90%

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28
Q

What is subacromial impingement?

A

Pain/dysfunction from any pathology which
Decreases volume of subacromial space
Increases size of contents

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29
Q

How do you treat subacromial impingenment?

A

Subacromial steroid injection
Physio
Arthroscopic subacromial decompression

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30
Q

How do you diagnose frozen shoulder (adhesive capsulitis)?

A

Clinical

X-ray

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31
Q

How do you treat a frozen shoulder?

A

If early - steroid injection

Iflater - surgery

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32
Q

What are the symtpoms of frozen shoulder?

A

First 0-9 months pain
Stiffness from about 4-5 months
And then thawing
Can last up to 18-24 months

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33
Q

What are the types of rotator cuff tears?

A

Traumatic

Degenerative

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34
Q

How do you treat rotator cuff tears?

A

Acute - early surgery
Chronic degnerative - surgery if symptomatic
Depends on size, time and age

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35
Q

What are the types of shoulder arthritis?

A

Osteoarthritis
Inflmammatory arthritis
Post traumatic arthritis

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36
Q

What are the common elbow pathologies?

A

Fractures/dislocations in young
Tendinopathies middle age
Degenerative disease in elderly

Cubital tunnel syndrome any age

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37
Q

What are the main nerves that get effected by ner palsies?

A

Ner roots
Brachial plexus
Sacral + lumbar plexus
Peripheral nerves

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38
Q

What is hilton’s law?

A

Nerves crossing a joint supply both the joint and the musles acting on it

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39
Q

What are the types of palsies that can affect the brachial plexus?

A

Erb’s palsy
Klumpke’s palsy
Total brachial plexus palsy

40
Q

What are the roots of the main myotomes? (UL)

A 
C5 - elbow flexors
C6 - wrist extensors
C7 - Elbow extensors
C8 - Finger extensors
T1 - Intrinsic hand muscles
41
Q

What are the roots of the main myotomes of the LL?

A 
L2 - hip flexors
L3 - knee extensors
L4 - Ankle dorsiflexors
L5 - Long toes extensors
S1 - Ankle plantar flexors
42
Q

What can cause an axillary nerve palsy?

A

Shoulder dislocation

Fracture surgical neck of humerus

43
Q

What are the symptoms of radial nerve palsy?

A 
Dependant on site of lesion
Wrist - loss of sensation
Forearm - loss of finger extension
arm - loss of wrist extension
Axilla - kiss if elbow extension
44
Q

What can cause carpal tunnel syndrome?

A

Trauma (distal radius fracture)
Swellings (ganglion, fibroma, lipoma)
Inflammatory (rhuem, gout, TB, amyloid)
Metabolic - pregnancy, hypothyroidism, mucopolysaccharidoses

45
Q

What are the symptoms of carpal tunnel syndrome?

A

Nocturnal pain + parasethesia in median nerve

Wasting of thenar muscles

46
Q

What is cubital tunnel syndrome?

A

Nerve entrapment (second most common)
Cubital tunnel between medial epicondyle and olecranon
Numbness on ulnar side of hand + difficulty with fine tasks

47
Q

What are the symptoms of ulnar nerve palsy?

A

Wasting of muscles - 1st webspace
Guttering
Hypothenar wasting

Claw hand - Yperextenstion at MCP and flexion at ICJ

48
Q

What is the ulnar paradox?

A

Distal lesion has a worse clawing than proximal lesion

Due to intact long flexors with distal lesion

49
Q

What is forment’s test?

A

Get patient to hold sheet
If ulnar not working then thumb is bent
If negative thumb flat against 2ns digit

50
Q

What is meralgia parasthetica?

A

Altered sensation + pain in lateral thigh

Compression of lateral femoral cutaneous nerve as travels under lateral border of inguinal ligament

51
Q

What is the sign of common peroneal nerve palsy?

A

Foot drop

Slapping gait

52
Q

What type of joint is the intervertebral disc?

A

Secondary cartiliginous

53
Q

What makes up the intervertebral discs?

A 
Annulus fibrous (outer layer - very tough)
Nucleus pulpous - gelatinous core
54
Q

When do discs fail?

A

Twisting movement

55
Q

What direction do discs normally fil?

A

Posteriolateral

56
Q

What are the degenerative pathological processes of the spine?

A 
Tearing annulus fibrosis + protrusion of nucleus
Nerve root compression by osteophytes
Central spinal stenosis
Abnormal movement
(spondylosis + spondylodesis)
57
Q

What are the presenting features of nerve root pain?

A 
Limb pain worse than back pain
Pain in a radicular distribution (like nerve root)
Root tension signs
Root compression signs
Affected dermatomes/myotomes
58
Q

How do you manage nerve root pain?

A

Physio
Strong analgesia
Most settle within 3 months
Refer for MRI after 12 weeks

59
Q

What are the types of prolapse possible?

A

Bulge (common and mostly asymptomatic)
Protrusion (annulus intact but weakened
Extrusion (through annulus but intact
Sequestration (dessicated material inside spinal canal)

60
Q

What is the most common cervical disc prolapse?

A

C5/6

61
Q

What are the most common thoracic disc prolapse - how common are tehey overall?

A

Less than 1% of all prolapses
Most at T11-12
75% from T8-12

62
Q

What are the most common lumbar prolapses (and direction)?

A

Normally L4/5 (45%)
L5/S1 - 40%
L3/4 - 10%
Most posteriolateral as posterior longitudinal ligamnet weakest

63
Q

What is the loss at L5/S1 prolapse?

A

Little toe + sole of foot sensory loss
Motor weakness in plantar flexion foot
Ankle jerk reflex change

64
Q

What is the loss at L4/L5 prolapse?

A

Great toe + 1st web space sensory loss
Extensor hallucis longus weakness
No reflex changes

65
Q

What is the loss at L3/L4 prolapse?

A

Medial aspect of lower leg sensory loss
Quadriceps weakness
Knee jerk reflex change

66
Q

What are the symptoms of cauda equina syndrome?

A

Bowel/bladder dysfunction
Saddle anaesthesia, loss of anal tone/reflex
Urinary retention
Leg weakness

67
Q

What is spondylosis?

A

A coomon disease; effectively osteoarthritis
Degenerative changes at facet joints, discs + ligaments
Can sometimes cause myelopathy if severe

68
Q

What are the ligaments of the spine?

A 
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Interspinous and supraspinous ligaments
Intertransverse ligament
69
Q

Where do the longitudinal ligaments of the spine run?

A

Anterior - front of vertebral bodies (broad and strong)

Posterior - along back of vertebral bodies (narrower)

70
Q

Where does the ligamentum flavum run?

A

Between laminae

71
Q

Where do the inter/supraspinous ligaments run?

A

Between the spinous processes

72
Q

Where do the intertransverse ligaments run?

A

Between transverse processes

73
Q

How is spinal cluadication distinguished from vascular claudication?

A

Spinal claudication:

Usually bilateral
Sensory dysaethesaie
Poss weaknss (foot drop)
Several minutes to ease after walking
Worse walking down hills because spinal canal becomes smaller in extension
Beter riding uphill/riding bicyles
74
Q

What are the types of spinal stenosis?

A

Lateral recess stenosis
Central stenosis
Foraminal stenosis

75
Q

How do you treat lateral recess stenosis/foraminal?

A

Non-operative measures
Nerve root injection
Epidural injection
Surgery

76
Q

How do you treat central stenosis?

A

Non-op meausres
Epidural steroid injection
Surgery (80% improve)

77
Q

What is an injury?

A

Physical damage or harm caused by accident or by an attack

Damage due to application of mechanical force

78
Q

How are injuries classified?

A

By appearance/causation
Abraison, contusion, laceration, incised wounds
Gunshot wounds, burns etc

Manner of causation - suicidal, accidental etc
Nature - blunt force, sharp force explosive etc

79
Q

What are blunt force injuries?

A 
Caused by impact with blunt objects
Can be:
Contusions (bruises) - 
Abraisons (graze/scratch) 
Lacerations (cut/tear)
80
Q

What affects the prominence of bruises?

A 
Skin pigmentition
Depth + location (mostly over loose skin)
Fat - more subcut fat more bruses
Age - children + elderly
Coagulative areas
81
Q

What are the resilient areas to brusing?

A

Buttocks

Abdomen

82
Q

What is a sharp force injury + types?

A

Injury iwth any sharp cutting edge
Incision
Stab wound

83
Q

What are passive defensive injuries?

A

Victum raises arms/legs for protection

Sliced, shelved often with skin flaps of hands and forearms (sharp weapon)

84
Q

What are active defensive type injuries?

A

Victum trying to grab weapon or attackers hand

Sliced shelved incised wounds on palmar aspect of hand + web spaces

85
Q

What is the pattern to self inflicted injuries?

A

Commonly sharp force
Site tends to be wrist/forearms, chest and abdomen
Often parallel with multiple and tentative incisions

86
Q

What do the consequences of injury depend on?

A

Type of mechanical insult
Nature of targeted tissue
Forces involved
Number of impacts

87
Q

What are the symptoms fo blood loss from brain?

A

35ml - symptomatic
40-50ml - clinical deterioation, life threatening
80-100ml - commonly fatal due to herniation and raised ICP
150ml - fatal

88
Q

What causes a traumatic subarachnoid haemorrhange?

A

Rapid rotational movement of head - usually result of single punch to jaw/upper part of neck/side of head
Sudden unexpected twisting movement
Traumatic rupture of vessels at base of brain
Immediately unconious and in cardiac arest

89
Q

What are the types of diffuse brain injury?

A

Diffuse axonal (clinical term) - immediate and prolonged coma with no mass lesion/metabolic abnormality
TIA
Traumatic axonal injury (pathological term) - damage due to trauma

90
Q

What is a contusion?

A

Bruises

burst vessels in skin

91
Q

What are teh types of skull fractures?

A

Linear (little force i.e falling)
Depressed (against protrusion i.e weapons hammer etc)
Ring fractures - higher force (high storey land on feet)

92
Q

What is an abrasion?

A

Abraisons (graze/scratch) - scraping of skin surface

93
Q

What is a laceration?

A

Lacerations (cut/tear) - tear/split due to CRUSHING

94
Q

What is an incised wound (inscision)?

A

Incised - superficial, slashing - longer than deep

95
Q

What is a stab wound?

A

Stab wound - penetrating from thrusting motion

Depth greater than length

96
Q

What causes an extradural haemorrhage?

A

Rupture of meningeal artery

Bleeding in space outside dura

97
Q

What causes a subdural haemorrhage?

A

Breaking of bridging veins

Lucid injuries - slow progression

Conditions + definitions (68 decks)

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