Musculoskeletal Disorders Flashcards
claw hand
ulnar nerve injury
ape hand
median nerve injury
wrist drop
radial nerve injury
scapular winging
long thoracic nerve injury
unable to wipe bottom
thoracodorsal nerve injury
loss of forearm pronation
median nerve injury
cannot abduct or adduct fingers
ulnar nerve injury
loss of arm abduction
axillary nerve injury
weak lateral rotation of arm
suprasacpular nerve or axillary nerve injury
loss of arm and forearm flexion
musculocutaneous nerve injury
loss of forearm extension
radial nerve injury
trouble iniating arm abduction
suprascapular nerve injury
unable to aduct arm beyond 10 degrees
axillary nerve injury
unable to raise arm above horizontal
long thoracic nerve and accessory nerve injury
what nerve is most at risk of injury with fracture of shaft of the humerus
radial nerve
what nerve is most at risk of injury with fracture of surgical neck of the humerus
axillary nerve
what nerve is most at risk of injury with fracture of supracondyle of the humerus
median nerve
what nerve is most at risk of injury with fracture of medial epicondyle
ulnar nerve
what nerve is most at risk of injury with fracture of anterior shoulder dislocation
axillary nerve
what nerve is most at risk of injury with injury to the carpal tunnel
median nerve
most commonly injured knee ligament
medial collateral ligament
positive lachman test
anterior cruciate ligament
positive mcmurray test aids in diagnosis
meniscal tear
common dashboard knee injury in an MVA
PCL tear
classic symptoms of carpal tunnel syndrome
weakness, tingling of thumb, index, and middle fingers, decreased 2-point discrimination, thenar atrophy, possible pain radiating to elbow
nerve injured in carpal tunnel syndrome
medial nerve
difference between monteggia’s fracture and galeazzi’s fracture
monteggia is dislocation of radial head with ulnar diaphyseal fracture and galeazzi is dislocation of distal radial ulnar joint with radial diaphyseal fracture
fall on outstretched arm with snuffbox tenderness
scaphoid fracture
anterior shoulder dislocation complication
axillary nerve/artery injury
fracture of fifth-metacarpal neck complication
irrigation and antibiotics (likely bite wound)
humerus fracture complication
radial nerve injury
hip fracture complication
DVT formation and avascular necrosis
femur fracture complication
fat embolism and excessive blood loss
tibial fracture complication
compartment syndrome
pelvic fracture complication
hemorrhagic shock
low back pain with pain increasing with passive straight leg raise
disc herniation
low back pain with pain lessening with flexion at the hips
spinal stenosis
low back pain with elderly, weight loss, pain constant but worse when supine
cancer
low back pain with acute urinary retention
cauda equina syndrome
low back pain made worse with walking and standing (AKA pseudoclaudication)
spinal stenosis
low back pain with loss of foot dorsiflexion and pain on crossed straight leg raise
disc herniation
low back pain with pain limited to the paraspinal region
muscle strain
nerve most at risk of injury with fracture of shaft of humerus
radial
nerve most at risk of injury with fracture of surgical neck of the humerus
axillary
nerve most at risk of injury with fracture of supracondyle of the humerus
median
nerve most at risk of injury with fracture of medial epicondyle
ulnar
nerve most at risk of injury with anterior shoulder dislocation
axillary
nerve most at risk of injury with injury to the carpal tunnel
median
scenarios favoring a posterior shoulder dislocation
seizures or electric shock
treatment for compartment syndrome
emergent fasciotomy
unhappy triad of the knee
ACL, MCL, and medial meniscal tears
PTH, alkaline phosphatase, serum calcium, and serum phosphate in paget’s disease
PTH: normal
alk phos: increased
calcium: normal
phosphate: normal
PTH, alkaline phosphatase, serum calcium, and serum phosphate in osteomalacia/rickets
PTH: increased
alk phos: normal or increased
calcium: decreased
phosphate: decreased (due to increased PTH)
PTH, alkaline phosphatase, serum calcium, and serum phosphate in chronic renal failure
PTH: increased
alk phos: normal or increased
calcium: decreased
phosphate: increased (kidneys cannot excrete phosphate)
PTH, alkaline phosphatase, serum calcium, and serum phosphate in osteoporosis
PTH: normal
alk phos: normal
calcium: normal
phosphate: normal
PTH, alkaline phosphatase, serum calcium, and serum phosphate in osteopetrosis
PTH: normal
alk phos: normal
calcium: normal
phosphate: normal
PTH, alkaline phosphatase, serum calcium, and serum phosphate in primary hyperparathyroidism
PTH: increased
alk phos: increased
calcium: increased
phosphate: decreased
PTH, alkaline phosphatase, serum calcium, and serum phosphate in hypoparathyroidism
PTH: decreased
alk phos: normal
calcium: decreased
phosphate: increased
PTH, alkaline phosphatase, serum calcium, and serum phosphate in pseudohypoparathyroidism
PTH: increased
alk phos: ?
calcium: decreased
phosphate: increased
what 3 studies can be used to make the diagnosis of osteomyelitis
MRI, bone scan, tagged WBC scan
what disease involves arthropathy of DIP and PIP
osteoarthritis
what disease involves arthropathy of PIP and MCP
rheumatoid arthritis
what disease involves arthropathy of isolated MCP (squared-off bone ends and hook-like osteophytes)
hemochromatosis
most common causes of bony metastasis
prostate, lung, breast
classic radiological appearance of osteosarcoma
sunburst pattern and codman’s triangle
treatment for lyme disease
doxycycline, amoxicillin, or cephalosporin
treatment for rocky mountain spotted fever
doxycycline or chloramphenicol
medications used in treatment of acute gout
NSAIDs (ketorlac), colchicine, steroids
medications used in treatment of pseudogout
NSAIDs, colchicine
treatment options available to patients with osteoporosis
exercise, calcium, vitamin D, bisphosphonate. pulsatile PTH
endocrine causes of osteoporosis
chronic steroid use, hyperthyroidism, hyperparathyroidism, hypogonadism
diagnosis: knee x-ray reveals calcification of the menisci
pseudogout
diagnosis: hats no longer fit, deafness
paget’s disease or osteopetrosis
diagnosis: needle-shaped, negatively birefringent crystals
gout
diagnosis: bone pain/tenderness with elevated WBC, CRP, and ESR
osteomyelitis
diagnosis: child with low-trauma fractures
osteogenesis imperfecta
diagnosis: narrowing of marrow cavity results in low H&H
osteopetrosis
diagnosis: 55 year-old female trips and sustains a distal radius fracture
osteoporosis
empiric treatment for septic arthritis
I&D + IV vancomycin
if suspect gonorrhea, no I&D, ceftriaxone + doxycycline
painful limp in child: x-ray reveals femoral head sclerosis
legg-calve-perthes avascular necrosis of the femoral head
painful limp in child: x-ray reveals ice-cream scoop (femoral head) falling off of cone (femur)
slipped capital femoral epiphysis
painful limp in child: obese, male adolescent with dull hip pain and an inability to bear weight
slipped capital femoral epiphysis
painful limp in child: acute onset of tibial pain, fever, malaise, elevated ESR, no joint pain
osteomyelitis
painful limp in child: acute onset of knee pain, fever, elevated ESR, and leukocytosis
septic arthritis
painful limp in child: 7-year-old with growth delay and inner thigh pain
legg-calve-perthes avascular necrosis of the femoral head
painful limp in child: 6-year-old with unilateral hip pain for 5 days, low-grade fever, spontaneous resolution
transient synovitis
painful limp in child: 13-year-old male with pain and swelling at the tibial tuberosity
osgood-schlatter
treatment of nursemaid’s elbow
manual reduction with supination on flexion and elbow pressure
treatment for slipped capital femoral epiphysis
no weight bearing and surgical pinning of leg and prophylactic pinning of contralateral leg
treatment for juvenile rheumatoid arthritis
NSAIDs, second-line NSAIDs, methotrexate for more severe cases
treatment for osgood-schlatter disease
rest, stretching, ice, NSAIDs
treatment for developmental dysplasia of the hip in children younger than 6 months
pavlik harness
treatment for developmental dysplasia of the hip in children 6 months - 2 years
closed or open reduction and spica casting
treatment for developmental dysplasia of the hip in children older than 2 years
open reduction
treatment for developmental dysplasia of the hip in children older than 8 years
correction may not be performed because of reduced benefit
characteristic findings of CREST scleroderma
calcinosis, reynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias
medications approved for treatment of fibromyalgia
pregabalin, duloxetine, milnacipran
rash of dermatomyositis
heliotrope rash around eyes, shawl sign around shoulders and upper back, discoloration of eyelids, scaly patches over hand joints “mechanic hands”
rheumatologic disease with proximal muscle weakness and facial rash
dermatomyositis
rheumatologic disease with pain and stiffness in the hips and shoulders
polymyalgia rheumatica
rheumatologic disease with muscle pain and tenderness in multiple distinct locations
fibromyalgia
rheumatologic disease with male in his 20s with low back pain that improves with exercise
ankylosing spondylitis
rheumatologic disease with jaw claudication and difficulty standing from a chair
polymyalgia rheumatica with temporal arteritis
rheumatologic disease with pencil in cup deformities of the DIP and PIP joints
psoriatic arthritis
rheumatologic disease with bamboo spine on x-ray
ankylosing spondylitis
rheumatologic disease with arthritis, oral ulcers, and proteinuria
SLE
rheumatologic disease with flexed DIP and hyperextended PIP
rheumatoid arthritis swan-neck deformity
anti-histone antibodies
drug-induced lupus
anti-dsDNA antibodies
renal disease in SLE
anti-centromere antibodies
CREST scleroderma
anti-RNP antibodies
mixed connective tissue disease
treatment after initial gout attack
alcohol cessation and weight loss
pharmacologic therapy is only initiated after repeated attacks, tophi (indicative of chronic disease), or renal insufficiency
pain between third and fourth toes reproducible with palpation, common in runners, often exhibits clicking sensation
motor neuroma
treatment: bilateral shoe inserts
burning pain in plantar area of foot, made worse with walking
planter fasciitis
sharp and localized pain over bony surface on foot that worsens with palpation
stress fracture
treatment for nondisplaced scaphoid fracture
wrist immobilization
treatment for displaced scaphoid fracture
open reduction and internal fixation
treatment for slipped capital femoral epiphysis
surgical pinning of slipped epiphysis
how to diagnose developmental dysplasia of the hips
< 4 months U/S
> 4 months X-ray (when bones have developed)
limitation of internal rotation and abduction of the hip
legg-calve-perthes
