Musculoskeletal Disorders Flashcards
What is a complication of plantar fasciitis?
Plantar fascial rupture, which occurs during push-off phase of gait
Best type of I&D for felon infection
Single lateral incision along ulnar aspect of digits 2-4 and radial aspect of digits 1 and 5
Complications of felon infections
- Ischemic necrosis
- Osteomyelitis
- Flexor tenosynovitis
- Septic arthritis
Most commonly injured ligament of the knee?
ACL
Most likely cause of disk herniation symptoms?
Repetitive flexion
Difference between herniated vs. bulging disk?
Herniated disk - rupture of nucleus pulposus beyond annulus fibrosus of the vertebral body
Symptoms suggesting meniscal tear
- Joint line pain
- Joint effusion
- Locking
- Giving way of knee
Most common injury associated with traumatic hemarthrosis of knee joint?
ACL rupture
Maneuvers to test for meniscal tear
- McMurray test
- Thessaly test
- Apley test
McMurray Test
lateral meniscus: knee fully flexed, rotate tibia medially and bring knee into extension
medial meniscus: knee fully flexed rotate tibia laterally and bring knee into extension
Positive = clicking, locking, pain
Apley test
Patient in prone position
Bring knee into 90 degree
Lateral and medial rotation of tibia
Excessive rotation or discomfort as compared with other side - ligamentous
Repeat procedure while pressing down on heel - decreased rotation or discomfort - meniscal damage
Thessaly Test
Most accurate for meniscal tests
Patient stand on injured leg flexed at 20 degrees
Rotate over tibia 3x on each side
Positive if patient complains of pain in joint line
Most serious complication associated with juvenile idiopathic arthritis, particularly during initiation of treatment
Macrophage activation syndrome
Presentation of juvenile idiopathic arthritis
- High fevers for minimum of 2 weeks
- Polyarticular arthritis
- Erythematous, macular rash involving trunk, palms, and soles
- May develop hepatosplenomegaly, lymphadenopathy, pleuritis, or pericarditis
Complications of juvenile idiopathic arthritis
- Interstitial lung disease
- Pulmonary hypertension
- Lipoid pneumonia
- Macrophage activation syndrome
What is macrophage activation syndrome
- Massive T-cell up-regulation
- Increased macrophage function
- Release of proinflammatory cytokines
- Hemophagocytosis
Clinical picture of macrophage activation syndrome
- High fever
- Hepatosplenomegaly
- Lymphadenopathy
- Pancytopenia
- Liver dysfunction
- DIC
- Low ESR
Tx of macrophage activation syndrome
High-dose glucocorticoids
What treatments besides disease-modifying antirheumatic drugs have helped decrease incidence of growth retardation and osteoporosis in patients with juvenile idiopathic arthritis?
Recombinant growth hormone and vitamin supplementation, particularly with calcium
Which imaging modality may be an effective tool in the diagnosis of tendinopathy?
Ultrasound
The shoulder is most vulnerable to an anterior glenohumeral dislocation in which of the following positions?
Abduction and external rotation
What is the most common type of major joint dislocation?
Glenohumeral joint
What is most sensitive for the diagnosis of cauda equina?
Urinary retention (90%)
What is the tx for cauda equina syndrome 2/2 malignancy?
Emergent radiation therapy
What organism makes up majority of septic bursitis cases?
Staph aureus (80%)
Mechanism of infection in septic bursitis
Percutaneous inoculation of skin organisms from trauma, prolonged pressure on the elbow such as from leaning on a hard surface, or from an overlying cellulitis
What is a Pott puffy tumor?
Subperiosteal abscess or osteomyelitis of the frontal bone that results from contiguous spread of frontal sinusitis
- tender, boggy protuberance overlying the frontal bone and frontal sinus
- rare, most often presents in children and adolescents
Presentation of a Pott puffy tumor
- Fever
- Headache
- Photophobia
- Vomiting
- AMS/lethargy
- Periorbital or forehead swelling
- Purulent rhinorrhea
- Meningismus
- Cranial nerve deficits
Complications of a Pott puffy tumor
- Cerebral abscess
- Meningitis
- Cavernous sinus or dural venous thrombosis
- Epidural abscess
What organisms are most responsible for a Pott puffy tumor?
Staphylococcus, Streptococcus, and anaerobes
Physical exam maneuvers that aid in diagnosing rotator cuff injury
- Painful arc test: patient abducts arm and if pain beyond 90 degrees = positive
- Empty can test: downward pressure on arm while patient abducts to 90 degrees and internally rotates arm pointing thumbs down
- Drop arm test: patient slowly lowers arm to side after abducting 90 degrees
- Weakness with external rotation
Rotator cuff muscles and their movements
Supraspinatus (abduction) Infraspinatus (external rotation) Teres minor (external rotation) Subscapularis (internal rotation)
What is Hawkins test?
Pain in shoulder with forced internal rotation with the arm parallel to the floor and elbow flexed at 90 degrees
-> shoulder impingement syndrome (sort of rotator cuff)
What is Neer’s test
Pain with passive elevation of arm above the head
-> shoulder impingement syndrome (sort of rotator cuff too)
Most common organism of felon
Staph aureus
Pressures indicative of compartment syndrome
Compartment pressure >30-40mm Hg
Delta pressure = diastolic blood pressure - direct pressure <30 (more reliable than direct pressures)
Compartments of forearm and legs
Look this up***
Drugs that can increase urate levels
Low-dose Aspirin
Diuretic
Cyclosporine
Tacrolimus
Upper Extremity Dermatomes
Q571252
What is a Segond fracture?
Avulsion injury of lateral tibial plateau
What ligamentous injury is highly associated with Segond fracture?
ACL
Most common ligamentous injury of the knee?
ACL
Most sensitive test for ACL tear
Lachman’s
What is a gamekeeper’s/skier’s thumb injury?
Acute forced abduction of the thumb at the MCP joint causing Ulnar collateral ligament injury
Weak pincer grasp
Tx for gamekeeper’s/skier’s thumb?
Thumb spica splint; could require operative repair
What is more common, injury to ulnar or radial collateral ligament?
Ulnar is 10x more common
Radiculopathies
Q138263
What is the most common bony tumor in children?
Osteosarcoma
Most common sites of involvement with osteosarcoma
- Distal femur
- Proximal tibia
- Proximal humerus
- Middle and proximal femur
Radiographical finding of osteosarcoma
Sunburst pattern (periosteal reaction) Codman triangle
Radiographical and path finding of Ewing Sarcoma
Onion skinning periosteal reaction
Blue cell tumor
Which tends to have systemic symptoms, osteosarcoma or ewing sarcoma?
Ewing sarcoma
Kanavel Criteria for Flexor Tenosynovitis
- Tenderness along course of flexor tendon
- Fusiform or symmetrical swelling of the finger
- Pain with passive extension (often first finding)
- Finger held in flexed posture
Causes of rhabdomyolysis
- Trauma
- Infection
- Drugs
- Medications
- Heat
- Exercise
- NMS
Electrolyte abnormalities in rhabdomyolysis
Early: hypocalcemia (results from deposition of calcium salts in necrotic muscle, binding with phosphorus, and sequestration by the sarcoplasmic reticulum)
Others: hyperkalemia, hyperphosphatemia
Most common extra-articular manifestation of ankylosing spondylitis?
Uveitis
What is first-line pharmacologic tx of ankylosing spondylitis?
NSAIDs
Ottawa ankle rules
Pain in malleolar region with any of the following:
- Bone tenderness at posterior edge of distal 6cm or the tip of lateral malleolus
- Bone tenderness at posterior edge of the distal 6cm or the tip of medial malleolus
- Inability to bear weight for at least 4 steps both immediately after injury and at time of evaluation
When to add a foot x-ray when evaluating ankle injury
Pain in midfoot region and one of the following:
- Bone tenderness at navicular bone
- Bone tenderness at base of fifth metatarsal
- Inability to bear weight for at least 4 steps both immediately after injury and at time of evaluation
What fracture of proximal fibula is associated with a medial ankle disruption
Maisonneuve fracture
