musculoskeletal Flashcards
MC fractured carpal bone
scaphoid
scaphoid fractures - presentation
pain at the radial wrist proximal to the base of the thumb
examination: tenderness in the shallow depression
- risk of osteonecrosis
scaphoid fractures - management
initial x-rays can be normal in nondisplaced fractures
if scaphoid fracture is suspected: CT or MRI to confirm or repeat x-ray in 7-10 d.
scaphoid fractures - treatment
Displaced fractures –> surgical intervention
nondisplaced –> wrist immobilization (but monitor with serial x-ray to rule out osteonecrosis)
ganglion cysts - age and area
age 15-40
arise in most cases due to repetitive stress or inflammation
all patients with clavicular fracture should have
a careful neurovascular examination to rule out injury to the underlying brachial plexus and subclavian artery
- if bruise is heard –> angiogram to rule out injury of vessel
MC clavicle fractures are at … (area) / how to treat every area
midline 3rd
fractures of the middle 3rd: nonoperatively with a brace, rest and ice
fractures of the lateral 3rd: open reduction and internal fixation
clavicular fractrues - presentation
pain + immobility of the affected arm
the contralateral hand is classically used to support the weight of the affected arm
- the affected shoudler is displaced inf + posteriorly
Meniscal tears - etiology
younger: rotational force on planted foot
older: degeneration of meniscal cartilage
meniscal tears - symptoms
- acute popping sensation
- catching, locking, reduced range of motion
- slow onset joint effusion
meniscal tears - examination
- joint line tenderness
2. pain or catching in provocative tests (Thessaly, McMurray
medical tears - diagnosis
MRI
arthroscopy
medical tears - management
mild symptoms, older: rest, activity modification
persistent symptoms, impaired activity: surgery
meniscus injury - effusion
not immediately because is not perfused very well
in several hours
Thessaly test
- patient stands on 1 leg with knee flexed 20 degrees
- then internally and externally rotates on flexed knee
succinylcholine - mechanism of action and severe SA
depolarizing neuromuscular blocker that can cause life-threatening hyperkalemia in patients with a condition leading to upregulation of postynaptic ACE receptors (eg. skeletal muscle trauma, atrophy, burn injury, stroke) or prior hyperkalemia (muscle trauma)
Nondepolrizing neuromuscular blocking agents should be used with these patients
situations that increase the risk for hyperkalemia in succinylochine use
upregulation of postsynaptic ACE receptors (skeletal muscle truama, atrophy, burn injury, stroke, denervation
hip fracture - how can we wait for the surgery
72 hours (if needed to undress unstable medical cormobitity)
supracondylar fracture of the humerus - mechanism
fall on an outstretched hand most common
supracondylar fracture of the humerus - complications (MC)
- Brachial artery injury (MC)
- median nerve injury (MC)
- cubitus varus deformity
- compartment syndrome (rare: less than 1%)
- volkman ischemic contracture (due to ischemia and infraction from compartment syndrome)
acute collateral ligament tear - acute effusion/hematthrosis?
uncommon unless there is concurrent inury to the anterior crciate ligament
medial collateral ligament - treatment
uncomplicated: nonoperatively with rest, ice, compression + elecation and analgesics
fat embolism syndrome - etiology
- fracture of marrow-contaning bone
- orthopedic surgery
- PANCREATITIS
fat embolism syndrome - clinical presentation
24-72 h following inciting event:
triad: resp distress, neurologic, petechial rash
Fat embolism syndrome - diagnosis
based on clinical presentation
Fat embolism syndrome - prevention + treatment
ealy immobilization of fracture
2. supportive care (eg. mechanical ventilation)
trochanteric bursitis
middle age adult, unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh (as when lying on the affected side in bed)
superficial pain
hip osteoarthritis - pain exacerbated by
internal rotation
deep pain
athrocentesis in recommended to
evaluate unexplained joint effusion
chronic exertional compartment syndrome
increased pressure within a muscle group during exercise –> young athletes (no point tenderness)
Popliteal (Baker) cysts - etiology
extrusion of fluid from knee joint space into seminmembranous/gastrocnemius bursa
popliteal (Baker) cyst - RF
- trauma (e. meniscal tear)
2. joint disease (RA or OA)
popliteal (Baker) cysts - clinical presentation
asymptomatic
posterior knee pain, swelling, stiffness
popliteal (Baker) cyst - complication
- venous compression
- dissection into calf (erythema, de,a, (+) Homan sign)
- Cyst rupture (acute calf pain, warmth, erythema, ecchymosis
causes of chronic low back pain
- mechanical
- radiculopathy
- spinal stenosis
- inflammatory
- metastatic
- infectious
when to referral to orthopedic surgeon for a stress fracture
at high risk for malunion (anterior tibial corte, 5th metatarsal)
meniscial tear - surgery or not
surgery in young
Common causes of shoulder pain - DDX
- rotator cuff impingement or tendinopathy
- rotator cuff tear
- Adhensive capsulitis (frozen shoulder)
- Biceps tendinopathy/rupture
- Glenohumeral osteoarthritis
rotator cuff impingement or tendinopathy
- pain with abduction, external rotation
- subacromial tenderness
- normal range of motion with positive impingement tests (eg. Neer, Hawkins)
rotator cuff tear
- similar to rotator cuff tendinopathy
- weakness with external rotation
- older than 40
adhensive capsulitis (frozen shoulder)
- decreased passive + active range motion
- more stiffness than pain
Biceps tendinopathy / rupture
- anterior shoulder pain
- pain with lifting, carrying, or overhead reaching
- weakness less common
Glenohumeral osteoarthritis
- uncommon + usually caused by trauma
- gradual onset of anterior or deep shoulder pain
- decreased active + passive abduction + external rotation
neer test
with the patient;s shoulder internally rotated and forearm pronated, the examiner stabilizes the scapula + flexes the humerus –> if pain is positive
non heeled strees fracture (non in malunion position) - next step
podiatric shoe
prepaterllar bursitis
anterior knee pain, tenderness, erythema, localized swelling, common in occupations requiring repetitive kneling
- it is often due to S. aureus
- active motion is often decreased and painful, passive is normal
- culture (-) –> NSAID + rest
- culutre (+) –> drainage + antibiotics
