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Concepts / Lists > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

shoulder dislocation vs shoulder separation

A

dislocation - glenohumeral (humeral head in glenoid)

separation - acromioclavicular joint dislocation

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2
Q

acromioclavicular joint dislocation / shoulder separation

A
  • direct blow to adducted shoulder
  • pain w/ lifting arm or unable to lift arm at shoulder
  • class 1: normal CXR, ligament sprain
  • class 2: slight widening (acromioclavicular ligament ruptured, coracoclavicular ligament sprain)
  • class 3: significant widening, rupture of both AC and CC
  • class 4: AC + CC rupture + displaced clavicle into trap
  • class 5: class 4 plus disruption of clavicular attachments
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3
Q

humeral head fracture - mechanism and what to r/o

A
  • FOOSH, direct blow, metastatic breast cancer
  • mc in elderly w/ osteoporosis
  • check deltoid sensation to r/o brachial plexus or axillary nerve injuries
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4
Q

humeral shaft fractures - what to r/o

A

-rule out radial nerve injury (wraps around shaft) - may devo wrist drop

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5
Q

frozen shoulder

A
  • shoulder stiffness due to inflamm (esp DM, hypothyroid)

- stiffness lasts 18-24 mo, dec ROM, worse at night

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6
Q

thoracic outlet syndrome

A

-idiopathic compression of brachial plexus (95%), subclavian vein (5%) or subclavian artery (1%)

  • nerve compression - pain/para arm, ulnar side of hand
  • vascular compression - swell/discolor esp w/ abduction
  • positive adson sign - loss of radial pulse w/ head rotated to affected side
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7
Q

suppurative flexor tenosynovitis

A
  • infx of flexor tendon synovial sheath
  • staph aureus MC (skin flora) - often from penetrating trauma
  • pain/tender on palmar side of finger

Kanavel’s Signs: FLEXor

  • Finger held in flexion
  • Length of tension sheath is tender
  • Enlarged finger
  • Xtension of finger causes pain
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8
Q

radial head subluxation (nursemaids elbow)

A

stretched annular ligament

-children present w/ arm slightly flexed, refuse to use

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9
Q

lateral epicondylitis / tennis elbow

A
  • inflam of tendon insertion of extensor carpi radialis brevis muscle
  • lateral elbow pain esp w/ gripping, forearm pronation and wrist extension against resitst
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10
Q

medial epicondylitis / golfer’s elbow

A
  • inflam of pronator teres-flexor carpi radialis due to repetitative stress @ tendo insertion
  • tenderness on medial epi, worse w/ pulling, repro via wrist flex against resist w/ elbow extended
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11
Q

elbow dislocation

A
  • posterior MC (90%)
  • presents w/ flexed elbow, marked olecranon prominance
  • EMERGENT reduction
  • complications: r/o brachial artery + median/ulnar/radial nerve injury
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12
Q

cubital tunnel syndrome

A

-ulnar nerve compression at cubital tunnel along medial elbow
-paresthesias/pain along ulnar nerve distribution
+TINEL’S sign @ elbow
+FROMENT’S sign - pinching effect

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13
Q

perilunate dislocation (wrist)

A

lunate doesn’t articulate w/ capitate

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14
Q

lunate dislocation (wrist)

A

lunate doesn’t articulate w/ capitate or radius

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15
Q

colles fracture

A
  • FOOSH w/ wrist extension
  • transverse distal radius fracture
  • dorsal angulation of distal bone fragment
  • complication: extensor pollicus longus tendon rupture mc
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16
Q

smith fracture

A
  • FOOSH w/ wrist flexion (less common than colles)
  • transverse distal radius fracture
  • ventral angulation of distal bone fragment
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17
Q

barton fracture

A

intra-articular distal radius fracture w/ carpal displacement

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18
Q

lunate fracture

A
  • most serious carpal frx (lunate occupies 2/3 of radial articular surface)
  • XR often negative
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19
Q

complex regional pain syndrome (CRPS) aka reflex sympathetic dystrophy

A

-autonomic dysfx following bone or soft tissue injuries, MC upper extremities

Stage 1: pain out of proportion, ANS sx (swelling, color change, inc nail/hair growth)
Stage 2: waxy or pale skin, brittle nails, loss of hair
Stage 3: joint atrophy and contractures

-Vitamin C prophylaxis after frx may reduce incidence

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20
Q

mallet (baseball finger)

A
  • flexed at DIP joint, unable to extend
  • mech: extensor tendon avulsion after blow
  • uninterrupted extension x6 wks vs surgical pinning
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21
Q

boutonniere deformity

A
  • flexed at PIP joint, hyperextended at DIP jt
  • disruption of extensor tendon at base of middle phalanx
  • splint in extension 4-6 wks, hand sx FU
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22
Q

swan neck deformity

A

-hyperextended at PIP and flexed DIP

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23
Q

gamekeeper’s (skier’s) thumb

A

-sprain/tear of ulnar collateral ligament of thumb (forced hyper-abduction of thumb)

  • skier’s thumb: acute (after fall)
  • gamekeeper’s: chronic
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24
Q

boxer’s fracture

A

-fracture at neck of 5th metacarpal (+/- 4th) from punching w/ clenched fist
+/- rotational deformity
+/- loss of knuckle on exam

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25
Q

bennett fracture (and rolando’s)

A
  • intraarticular fracture through base of 1st metacarpal bone (one side of base)
  • rolando’s frx: comminuted bennett’s fracture (both sides of base)
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26
Q

Salter-Harris Classification of Frx

A

Type I: isolated growth plate fracture (may look normal)
Type II: growth plate fracture + fracture of metaphysis MC
Type III: growth plate fracture + fracture of epiphysis
Type IV: fracture extending across metaphysis, growth plate & epiphysis (needs reduction)
Type V: Growth plate compression injury (may arrest growth) - worst type

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27
Q

de quervain tenosynovitis

A
  • stenosing tenosynovitis of abductor pollicus longus + extensor pollicus bravis
  • excess thumb use w/ repetitive
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28
Q

carpal tunnel

A
  • median nerve entrapment
  • 1st, 2nd, 3rd and 1/2 4th digit
  • thenar muscle wasting if advanced

-volar splint, steroid inj, sx if refractory

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29
Q

dupuytren contracture

A
  • nodules over distal palmar crease or proximal phalanx (esp 4th/5th)
  • fixed flexion deformity @ MCP jt
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30
Q

hip dislocation

A
  • trauma mc
  • posterior MC (90%) - leg shortened, internally rotated and adducted w/ hip/knee slightly flexed
  • complication: avascular necrosis
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31
Q

hip fractures

A
  • high incidence of avascular necrosis w/ femoral neck fracture
  • leg shortened, externally rotated, abducted
  • femoral head/neck frx are intrascapsular
  • intertrochanteric/subtrochanteric frx are extrascapular
32
Q

legg-calve-perthes disease

A
  • idiopathic avascular osteo of femoral head in kids
  • mc children 4-10y, 4x mc in boys

-painless limping x weeks (worse w/ activity)

33
Q

slipped capital femoral epiphysis

A
  • slips posterior and inferior at growth plate
  • mc 7-16 yo, obese, AA males during growth spurt
  • tx non-weight bearing crutches –> ORIF
34
Q

ACL injuries

A

MC knee ligament injury

  • noncontact pivoting injury
  • pop + swelling, +/- knee buckling
  • mc in women
35
Q

PCL injuries

A

MC associated w/ dashboard injuries or fall on flexed knee

-pivot shift test, posterior drawer test

36
Q

meniscal tears

A

-degenerative; medial 3x mc (bc more bony attachments)
-locking, popping, giving away, effusion after activities
McMurray’s sign

37
Q

patellar and quad tendon ruptures

A
  • forceful quad contraction (quads mc than patellar)
  • mc males >40, hx of systemic dz (dm, gout, obesity, ckd)
  • inability to extend knee
38
Q

patellar dislocation

A

valgus stress after twisting injury
mc females, usually laterally
-closed reduction

39
Q

knee (tib-femoral) dislocations

A
  • LIMB THREATENING EMERGENCY
  • high velocity trauma
  • complications: popliteal artery injuty in 1/3 –> arteriography; +/- peroneal or tibial nerve injury
40
Q

tibial plateau fractures

A
  • axial loading/rotation/direct trauma
  • mc in children in MVAs
  • lateral plateau mc
  • check for peroneal nerve injury (foot drop)
  • complications: post degenerative arthritis
41
Q

baker’s cyst

A

synovial fluid effusion is displaced w/ cyst formation

  • mass, effusion, clicking, buckling, locking, little pain
  • ruptured –> pseudothrombophlebitis syndrome that mimics dvt
  • US to rule out dvt and confirm cyst
42
Q

patellofemoral syndrome (chondromalacia)

A

idiopathic softening/fissuring of patellar articular cartilage
-mc in runners
-anterior knee pain “behind” or around patella
+apprehension sign

43
Q

IT band syndrome

A

inflammation of iliotibial band bursa

  • mc cause of knee pain in runners
  • lateral knee pain, esp during onset of running, worse downhill
  • lateral condyle tenderness
44
Q

ankle dislocation

A
  • major trauma

- posterior mc +/- peroneal nerve injury

45
Q

ankle sprain

A
  • 85% involve collateral ligaments (anterior talofibular mc - stabilizes in inversion)
  • grade 1/2 (incomplete tears), grade 3 (complete tears)
46
Q

ottawa ankle rules

A

ankle films:
pain along lateral malleolus, pain along medial malleolus
foot films:
navicular (midfoot) pain, 5th metatarsal pain

inability to walk >4 steps at injury + in ER

47
Q

achilles tendon rupture

A
  • 75% sports related, 30-50y common
  • sudden heel pain after push off movement, pop, sudden sharp calf pain
  • weak, absent plantar flexion when gastrocnemius squeezed
  • splint in slight plantar flex, gradually move towards dorsiflexion to neutral - sx repair
48
Q

maisonneuve fracture

A

spiral proximal fibular fracture due to rupture of distal talofibular syndesmosis and interosseus membrane as a result of distal medial malleolar fracture and/or deltoid ligament rupture
-distal medial malleolar fracture –> image to jcheck proximal fibula

49
Q

pilon (tibial plafond) fracture

A

fracture of distal tibia from inpact w/ talus (frx extends into ankle joint)
ORIF

50
Q

stress (march) fracture

A

3rd metatarsal MC

  • localized pain, swelling, tenderness at end of activities; eventually tenderness throughout wt bearing activities
  • dx- 50% of x-rays will be negative (+ w/ healing)
  • tx- rest, splint or post-op shoe
51
Q

plantar fasciitis

A

inflam of plantar fascia due to overuse, esp w/ flat feet or heel spur

  • pain/tendeness of medial foot (inc w/ dorsiflexion of toes)
  • pain usually worse after rest (in am)
  • tx- rest, ice, NSAIDS, heel/arch support, stretching exercises, cortico w/ caution (may rupture fascia), sx last resort
52
Q

tarsal tunnel syndrome

A

posterior tibial nerve compression from overuse, restrictive footwear, edema

  • sx- pain/numbness at medial malleolus, heel, sole (like plantar fasciitis except pain increased throughout day)
  • pain worse at night and w/ dorsiflexion +TINELS
  • tx- rest, NSAIDs –> cortico –> sx
53
Q

bunion (hallux valgus)

A

deformity of bursa over 1st metatarsal

  • hx of poorly-fitting shoes MC, flat feet, RA
  • tx- wide-toed shoes, sx if no response
54
Q

hammer toe

A

deformity of PIP joint - flexion of PIP and hyperextension of MTP + DIP
-seen if 2nd, 3rd or 4th toe longer than 1st, people w/ tight-fitting shoes, OA, RA

55
Q

charcot’s joint (diabetic foot)

A

joint damage and destruction as a result of peripheral neuropathy from DM (or other PVD) –> microtrauma of foot w/out sensation and ANS dysfx leads to bone resorption and weakening

  • MC in midfoot
  • sx- pain, swelling, mis-shapen foot, ulcer, skin change
  • dx- xray shows obliteration of joint space, scattered chunks of bone and fibrous tissue + inc ESR
  • tx- rest, non-weight bearing, sx
56
Q

morton’s neuroma

A

degeneration/proliferation of plantar digital nerve –> painful mass near tarsal heads

  • mc in women 25-50 esp if wear heels/tight shoes or flat feet
  • 3rd metatarsal head mc
  • sx- lancinating pain, esp with ambulation
  • tx- wide shoes, glucocortico injection (sx if necessary, may cause permanent numbness)
57
Q

jones fracture

A

transverse frx through diaphysis of 5th metatarsal

  • tx- no weight bearing 6-8wks
  • repeat xrays bc often NONUNION / MALUNION and may require ORIF/pins
58
Q

pseudojones fracture

A

transverse avulsion fracture at base (tuberosity) of 5th metatarsal due to plantar flex w/ inversion (not as serious as true jones)

  • tx- waling cast 2-3 wks, ORIF if displaced
  • more proximal (less distal) fracture than true jones
59
Q

lisfranc injury

A

disruption btw articulation of medial cuneiform (midfoot bone) + base of 2nd metatarsal

  • dx- FLECK sign - frx at base of 2nd metatarsal pathognomonic for disruption of the ligaments
  • tx- ORIF and non-weight bearing cast 12 weeks
60
Q

herniated disc (nucleus pulposus)

A

MC L5-S1 bc jx btw mobile and non-mobile spine (also L4-L5)
sx- pain in dermatomal pattern (inc w/ cough, strain, bend, sit), sciatica
exam- pos straight leg raise +/- pos crossover test, maybe strength, reflex, sensation deficits

61
Q

cauda equina syndrome

A

serious complication of herniated disc, compresses several nerve roots

  • sx- new onset urinary or bowel retention/incontinence w/ saddle anesthesia, uni/bilateral leg radiation, decreased anal sphincter tone on rectal exam (no anal wink)
  • tx- neuro ER - corticosteroids to reduce inflam
62
Q

spinal stenosis (pseudoclaudication)

A

narrowing of spinal canal w/ impingement; >60yo

  • sx- back pain w/ paresthesias in one or both extremities, worse w/ extension, prolonged walk/stand, relieved w/ flexion like sit or walk uphill (unlike claudication)
  • lumbar flex = inc canal volume
  • tx- epidural corticosteroids, laminectomy
63
Q

lumbosacral sprain/strain

A

acute strain/tear of paraspinal muscles (esp twist/lift)

  • sx- back muscle spasms, NO NEURO CHANGES
  • tx- maybe brief bed rest (<2 days), NSAIDS/analgesic, +/- muscle relaxers
64
Q

spinal compression frx

A
  • children - “burst” from jumping from height
  • elderly - lumbar compression (esp osteoporosis), tumor or systemic illness; pathologic frx in malignancy
  • sx- point tenderness
  • tx- ortho + neuro consult, analgesics
65
Q

scoliosis

A

> 10 degrees +/- assoc w/ kyphosis (humpback) or lordosis (sway back)

  • mc begins 8-10yo, mc F, + family hx
  • dx- ADAMS forward bending test, COBB’S ANGLE on A/P films
  • tx- +/-brace if 20-40 deg, sx if >40
66
Q

spondylolysis

A

pars interarticularis defect from either failure of fusion or stress fracture (often from repetitive hyperextension trauma i.e. football, gymnastics)

  • often 1st step to spondylolisthesis
  • MC back pain in children and adolescents
  • MC at L5/S1
  • tx- sx relief, activity restrict, PT, brace
67
Q

spondylolisthesis

A

forward slipping of vertebrae on another
-MC adolescence 10-15yo
-sx- lower back pain +/- sciatica sx, may cause bowel/bladder dysfx
-tx- low grade: sx relief, activity restrict, PT, brace
high grade: sx

68
Q

osteomyelitis

A

MC <20y (acute) and >50y (chronic)
RF: SS, DM, immunocomp, preexisting jt dz, URIs in kids

acute: hematogenous spread (mc route children, staph)
- hip mc in children

direct inoculation: infx close to bone s/p trauma, sx, prosthetic jt

-sx-
gradual onset days-weeks, signs of bactermia
local signs of inflam/infx, pain over involved bone, dec ROM in near joint, refusal to use joint, sinus tract drainage in chronic

-dx-
BONE ASPIRATION GOLD STD
labs: inc WBC, ESR (if ESR is normal, osteo is unlikely), blood cultures are positive 50%
MRI: mos sensitive in early dz
xray: early: soft tissue swelling and PERIOSTEAL RX (lucent areas of cortical destruction); advanced: sequestrum (segments of necrotic bone separated from living bone by granulation tissue)

-tx-
acute - abx 4-6 wks (2 wks IV) +/- debridement
chronic - sx, cultures, targeted abx

69
Q

septic arthritis

A

medical ER (can rapidly destroy joint), most monoMO

  • hematogenous spread, direct inoculation, contiguous spread
  • RF: extremes of age, chronic dz, immunosuppressed, prosthetic jt/sx, chronic arthropathies

-sx- single, warm, swollen, painful joint, dec ROM, tender to palpation, KNEE MC (50%), hip > elbow > ankle/wrists
F/Ch, malaise, pain, diaphoresis

-dx- ARTHROCENTESIS - WBC > 50K, primarily PMNs
WBC > 1.1K in prosthetic joints

-tx- prompt abx guided by gram stain; ARTHROTOMY w/ joint drainage (2-4 wk course)

70
Q

compartment syndrome

A

muscle/nerve ischemia (dec tissue perfusion)

  • closed muscle compartment pressure > perfusion pressure
  • MC after fracture of long bones (75%), crush injuries, tight casts or dressings
  • sx- PAIN OUT OF PROPORTION, pain on passive stretching earliest sign, tense extremities (firm/wooden feeling), paresthesias; pulselessness and paresis are late findings
  • dx- inc intracompartmental pressure >30-45 mmHg (change of pressure = diastolic BP - measured compartment pressure)
  • tx- fasciotomy
71
Q

osteosarcoma

A

mc bone malignancy, mc adolescents (80% <20y)

  • produces immature bone (osteoid)
  • 2nd peak 50-60yo (esp w/ hx of Paget dz or radiation)
  • 90% occur in metaphysis of long bones (FEMUR, tibia, humerus)
  • MC METS to LUNGS

-sx- bone pain/ joint swelling, palpable soft tissue mass

-dx- xray: “hair on end” or “sun ray / burst” appearance
codman’s triangle - ossification of raised periosteum

-tx- limb-sparing resection (if not neovascular); radical amputation (if neovascular) + chemo

72
Q

ewing sarcoma

A

giant cell tumor mc in children (mc males 5-25y)
-FEMUR MC and pelvis mc sites (bone also mc site of metastasis)

-sx- bone pain +/- palpable mass, may have joint swelling +/- fever

-dx- lytic lesion, layered periosteal rx “onion skin” on xray
+/- codman’s triangle

-tx- chemo, sx, radiation options

73
Q

chondrosarcoma

A

cancer of cartilage; MC adults 40-75yo

  • dx- mineralized chondroid matrix w/ PUNCTATE OR RING + ARC APPEARANCE pattern of calcification
  • tx- surgical resection +/- chemo
74
Q

osteochondroma

A

MC benign bone tumor (esp age 10-20yo) MC males
-begins in childhood, grows until maturity; may precede chondrosarcomas

  • dx- pedunculated, grows away from growth plate, involves medullary tissue
  • tx- observation; resection if painful or located in pelvis (pelvis mc site for malignant transformation)
75
Q

paget disease (osteitis deformans)

A

abnormal bone remodeling + disorganized osteoid formation
-mainly western european, 40% autosomal dom

  • patho- disordered bone remodeling –> osteoclast bone resorption –> larger, weaker, less compact bones, more vascular and prone to fractures
  • lytic phase (inc osteoclast) –> mixed phase –> sclerotic phase (inc osteoblast)
  • sx- asymptomatic mc, found incidentally (HIGH ALK PHOS on labs), bone pain, pelvis mc, inc warmth
  • skull involvement, deafness (seen in up to 50% due to compression of CN8)
  • dx- “blade of grass/flame-shaped” lucency, coarsened trabeculae; skull = cotton wool appearance
  • tx- BISPHOSPHONATES (inhib osteoclast activity - dec bone resorption and turnover) or calcitonin

Concepts / Lists (16 decks)

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