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