Musculoskeletal Flashcards
Mortons neuroma clinical sign
Mulder’s sign
Pagets investigations
ALP
P1NP (bone specific ALP)
Xray
Treatment of Paget’s
Bisphosphonates:
Zoledronic acid the best
Clinical features of Paget’s
Skull enlargement: Headache, hat size increase, facial appearance change
Fractures
Risk factors for osteoporosis (in >60 men or >50 for women)
- Smoking
- etOH >4std /day
- family hx fracture
- Vit D deficiency
- BMI <20
- recurrent falls
- immobility
Causes of secondary osteoporosis
- Corticosteroid use (7.5mg for 3 months)
- Endocrine conditions: hypogonadism, cushings, hyperparathyroidism, hyperthyroidism)
- premature menopause
- AN with amenorrhoea >12 months
- RA
- CKD, CLD
- Coeliac
- DM (1 or 2)
- MM or MGUS
- HIV
- Medications: anti-epileptics, anti-rejection therapy, aromatase inhibitors, anti-androgens, excessive thyroxine
Saturday night palsy approach
- Nerve conduction studies
- Physiotherapy
Mean recover 3-4 months
Radial nerve clinical exam
Wrist and finger extension
THUMBS UP
Sensation:
Webspace - 1st dorsal
Median nerve clinical exam
Pincer function
“A OK sign “
Senation: index finger volar tip
Ulnar nerve clinical exam
Finger adduction and abduction
Sensation: Little finger volar tip
Restless leg syndrome history questions
Restless legs character ‘URGE’
- Urge to move
- Rest induces symptoms
- Gets better with activity
- Evening worse
Rule out other causes
- Cramps
- Restlessness during the day (akathisia)
- Pain on exertion (PVD)
- Numbness
Medications that worsen restless legs
- Sedating antihistamines
- Metaclopramide (dopamine agonist)
- Mirtazepine
Tests for restless legs
EUC
B12 - peripheral neuropathy
Iron - associated with RLS
Hba1c
FBC - anaemia may contribute
Treatment for restless leg syndrome (non pharmacological)
Distracting activities (crosswords)
Regular exercise (30mins/day)
Stretching
Keep legs cooler than rest of body
No caffeine
No etOH
Rest less legs treatment (pharmacological)
MILD
Levodopa & Benserzide (100mg /25mg) nocte
SEVERE
Pregabalin 75mg nocte
or
Gabapentin 100mg
or
Pramipexole 0.125mg (not in risk of gambling, addicts)
Special tests for ankle injury
Positive anterior drawer test: ruptured ATFL
Lateral talar tilt test: ruptured ATFL and CFL
Name these fractures (hint: first one fine)
Jone’s fracture: where and management
- 5th metatarsal (proximal diaphyseal region)
- Surgical due to risk of malunion
Plantar fasciitis management
- Rest
- Simple analgesia
- Ice after activity
- Stretches: soleus, gastroc & achilles
- Podiatry referral
–> then cortisone injection
Differentials for plantar fasciitis/heel pain
- Calcaneal (specify which side) stress fracture
- Calcaneal fat pad syndrome/atrophy
Posterior heel pain differentials
- Achilles tendinitis
- Retrocalcaneal bursitis
Age for perthes
3-12 yrs old
Type of imaging for suspected spinal epidural abscess
MRI with gadolinium contrast
Paediatric proximal humeral fracture indications for ORIF
<12 yrs old:
60 deg angulation
50% displacement
> 12
30 deg angulation
30 % displacement
Wrist extension and finger: which nerve
Radial
Risk factors for SUFE
- Afrocarribean
- Obestity
- Radiation or chemo
- Hypothryoidism
- Hypoputitarism
- Hyperparathryoidism
Sign on xray for SUFE
Trethowan sign
SALTER HARRIS types of fractures
Red flag fractures for NAI
Metaphyseal fractures
Rib (esp posterior)
Scapular
Sternal
Lisfranc injury definition
Injury to tarsometatarsal joint complex
Tarsometatarsal fracture dislocation - disruption between articulation of medial cuneiform & base of the 2nd MT
Fibromyalgia pharmacotherapy
First line TCA:
Amitryptiliine 10-25mg nocte
If concurrent depression or if wanting SNRI
Then Duloxetine 30mg
If not tolerating TCA
Then gabapentin 100-300mg or pregabalin 25-75mg
Examination for De Querviain’s
- Finkelstein test positive
Medial ankle tendinopathy
- Tibialis posterior tendinopathy
- Flexor hallicus longus tendinopathy
Clinical features of Tibialis posterior tendinopathy
-
- Pain on eversion !!!!
- Pain medial ankle
- Weakness in medial ankle and foot
- Standing on toes painful
- Common in dancers and those with flat feet
Clinical features of Tibialis posterior tendon rupture:
- Too many toes sign
- Flat foot (abnormal)
Flexor hallicus longus tendinitis clinical features
Pain with great toe flexion on exam
Tarsal Tunnel syndrome clinical features
- Burning toe and sole of the foot
Young people (7-15yrs old) with posteroinferior heel pain most likely ddx
Sever’s disease (Calcaneal apophysitis)
Young people (7-15yrs old) with posteroinferior heel pain most likely ddx
Sever’s disease (Calcaneal apophysitis)
Bruise in the arch of the foot- diagnosis
Lisfranc injury
What am I
Osteoid Osteoma
What is a monkey muscle tear?
Rupture of medial head of Gastrocnemius
(ddx achilles tendon rupture)
Jumper’s knee (patella tendinopathy) key features
Pain below the knee
Jumping exercises
Iliotibial band syndrome key features
- Pain with heel strike
- Think in runners
- pain on lateral edge of knee
Mechanisms for development of bursitis
- Prolonged pressure (eg elbow on desk)
- Overuse or strenuous activity
- Crystal- induced arthropathy
- Inflammatory arthritis
Olecranon bursitis management
- Compression bandage
- Corticosteroid injection
- Drainage (if painful) controversial
- NSAID
Causes for Carpal Tunnel Syndrome
- Pregnancy
- Idiopathic
- Hypothyroidism
- Diabetes mellitus
- Occupational: repetitive work with flexed wrists
- Tophaceous gout
Pain and tenderness of 2nd and 3rd MTPJs diagnosis not to miss
Hereditary Haemochromatosis
Reynauds pharmacological management
Amlodipine 5mg -10mg
or
Nifedipine 30mg-120mg
Investigations for pseudogout (CPPD)
Weakly positively birefringent crystals
CMP
ALP
PTH
IRON STUDIES
DVT dose of anticoagulant (apixaban)
10mg BD for 7 days then5mg BD
What type of fracture are you thinking of?
Orbital blowout fracture
or
Orbito-zygomatic fracture
Knocked knees when to refer
- Persistent beyond 8yrs old
- Intermalleloar space >8cm
- Asymmetrical
- Progressive
- Other issue in addition eg: height <5th centile
** also do xray
Osteoporosis non-pharmacological
- Weight bearing impact loading exercise guided by AEP
- Smoking cessation
- etOH reduction
- Dietary calcium 1300mg
- 5-10mins sun exposure most days for vit D
- OT assessment for falls risk reduction
Empty can test for…
Supraspinatus tear
Osteopenia/porosis, amenorrhea, disordered eating.
WHAT AM I?
Female athlete triad syndrome
Relative energy deficient syndrome
C7 Radiculopathy signs
SENSATION
Palm, index middle finger (almost median)
POWER
- Elbow & wrist extension
- Forearm pronation
- Wrist Flexion
REFLEX
- Triceps
What is this called?
What other imaging would you do?
Consider Maisonneuve fracture
Needs proximal fibula to be imaged
What is this called?
What other imaging would you do?
Consider Maisonneuve fracture
Needs proximal fibula to be imaged
Monteggia fracture what is it?
What to do?
ULNAR fracture
Radial head dislocation
EMERGENCY urgent intervention
Physical exam findings of anterior shoulder dislocation ?
- Arm in slight abduction and external rotation
- Humeral head palpable anterior to glenohumeral fossa
- Reduced global ROM
- Loss of normal deltoid contour
Complications/risks of corticosteroid injection ?
- Joint infection
- Fat pad atrophy
- Tendon rupture
- Allergic reaction
- Vagal response
- Haemarthroses of specific joint
What to do with this fracture? What is it?
ED for urgent reduction
Monteggia
What type of 5th metatarsal fracture needs referral ?
- JONES (Proximal diaphysis)
- Angulated midshaft
Mallet finger indications for surgical management
- > 30% articular surface
- volar subluxation
L5 dermatome
L5 myotome
Dorsum of foot
Dorsiflexion big toe and ankle
L3/4 dermatome
L3/4 myotome
Anterolateral thigh
Knee extension
S1 dermatome
S1 myotome
Sole of foot
Ankle plantar flexion
