Musculoskeletal / Orthopedic Flashcards
valgus stress test (knee)
abnormality in what condition?
outward pressure on medial leg with a fixed femur
if MCL is injured, pt will show excessive knee joint widening on valgus stress
(MCL protects against valgus stress + excess external tibial rotation)
serratus anterior
functions (origin, insertion)
facilitates arm elevation by pulling lower end of scapula forward
helps with respiration by lifting ribs when shoulder girdle is fixed
(ribs 1-8 to medial scapular border)
Conditions associated with Carpal Tunnel Syndrome (5)
Pregnancy - fluid accumulation
RA - tendon inflammation
Hypothyroidism - GAG buildup
Diabetes Mellitus - CT thickening
Long-Term Dialysis - dialysis-associated amyloidosis > buildup of beta2-microglobulin
Signs + sx in carpal tunnel
1 symptom group, 3 signs
Median nerve distribution pain/paresthesia/sensory impairment (lateral 3.5 digits palmar surface)
motor weakness of thumb abduction/opposition with THENAR ATROPHY
Tinel sign - tapping flexor surface of wrist invokes sx
Phalen sign - flexion of wrist invokes sx
Ankylosing Spondylitis
S/S
(msk issues plus 3 extraskeletal issues)
Low back pain - onset slow + <40 yrs; improves with exercise; worse at night; also HIP + BUTT pain
Enthesitis - where tendon meets bone
Systemic - fever, chills, fatigue, weight loss
- Limited chest wall expansion - causes hypoventilation; must monitor!
- Acute anterior uveitis - unilateral pain, photophobia and blurry vision
- Ascending aortitis - dilation with aortic insufficiency
Friederich Ataxia
inheritance + gene? Musculoskeletal issues? Other issues (3)?
AR mutation of frataxin (FXN) - increased GAA repeats > decreased expression of mitochondrial protein for iron-sulfur enzyme assembly > decreased energy production + increased oxidative stress
Spinocerebellar and lateral corticospinal degeneration - gait ataxia + spastic weakness
Kyphoscoliosis + high plantar arches (pes cavus)
Dorsal column/DRG degeneration - position/vibration loss
Heart - HCM and CHF
Diabetes Mellitus - in 10%
Charcot-Marie-Tooth disease
inheritance? pathogenesis? s/s?
differential?
AD - demyelination of peripheral nerves via a mutated myelin protein gene
distal leg weakness/atrophy + sensory deficits
kyphoscoliosis + high plantar arch (pes cavus)
specific foot dorsiflexion weakness via COMMON PERONEAL NERVE involvement
differential for Friedreich ataxia - C-M-T disease does NOT have heart involvement
Rhabdomyolysis
causes? pain? labs?
trauma, sepsis, drugs (statin, alcohol, cocaine) and overexertion
myalgia in proximal mm., lower back + calves
high CK, AKI and electrolyte issues (HYPERkalemia/-phosphatemia, HYPOcalcemia, metabolic acidosis)
heme from myoglobin causes ATN with GRANULAR BROWN CASTS
false-positive dipstick for blood, no RBCs in urine
Scaphoid fracture
location? cause? s/s?
complication?
Scaphoid - proximal row, radial-most carpal
Cause - fall onto outstretched hand; direct axial compression or wrist hyperextension
S/s - wrist pain in ANATOMICAL SNUFFBOX (EPL + APL/EPB tendons)
Complication - AVASCULAR NECROSIS with NONUNION
(fracture creates 2 fragments > dorsal scaphoid branch of radial a. enters distal fragment + runs retrograde to proximal fragment, which may necrotize when connection is disrupted)
Osteonecrosis of femoral head
How? What artery?
femoral neck fracture can injure the MEDIAL CIRCUMFLEX ARTERY (from deep femoral a.) which gives most of the head its blood supply
What is Trendelenburg gait?
What is an iatrogenic cause of it?
When abductors (glut med/min) are weak on one side, there will be contralateral hip drop when the contralateral foot is lifted while walking.
IM injection in the buttock can paralyze the SUPERIOR GLUTEAL NERVE (L4-S1, suprapiriform hiatus) if done into the SUPEROMEDIAL quadrant of the buttock
How should IM injections to the butt be done?
To avoid what?
In the ANTEROLATERAL gluteal area (von Hochstetter triangle)
Put PALM ON GREATER TROCHANTER and INDEX FINGER ON ASIS … spread middle finger out and triangle is btwn index and middle finger
to avoid nerve damage to gluteal or sciatic nerves (SUPERIOR GLUTEAL N. –> trendelenburg gait)
Osteoarthritis vs. RA
age? joints? morning sx? systemic sx? examination
age:
OA = >40
RA = 40-60, but often younger
joints:
OA = Knees, Hips, DIP, 1st CMC
RA = MCP, PIP, wrist
morning stiffness:
OA = none or <30 min
RA = prolonged
systemic sx:
OA = none
RA = fever, fatigue, weight loss
examination:
OA = hard, bony joint enlargement
RA = soft, spongy, warm joints
Heberden and Bouchard nodes in OA
what are they?
DIP enlargement - Heberden
PIP enlargement - Bouchard
via osteophytes
Osgood-Schlatter disease
what is it? cause?
overuse injury of the SECONDARY OSSIFICATION CENTER of the TIBIA
REPETITIVE QUAD CONTRACTION and CHRONIC AVULSION cause patellar ligament to separate from the tibial tuberosity > forms a CALLOUS that elevates the tuberosity
Osgood Schlatter disease
epidem? s/s?
YOUNG ATHLETES after a RECENT GROWTH SPURT
pain + swelling at TIBIAL TUBERCLE
relieved by rest
reproduced by SEATED KNEE EXTENSION
Pes anserinus bursitis
what? in whom?
ANTEROMEDIAL KNEE PAIN in a RUNNER
Muscles inserting at the pes anserinus (3)
semitendinosus
gracilis
sartorius
calcium / PTH / phosphorus levels in osteoporosis?
how are they usually, how might they be in certain situations?
usually NORMAL unless osteoporosis is SECONDARY
torticollis cause (2 cats, w/ examples)
uterine malposition - fetal macrosomia or oligohydramnios
birth trauma - breech delivery
what is foot “eversion”?
same as pronation
mediated by peroneus longus muscle (superficial peroneal n.) … fibular head fractures can injure this nerve
what is foot “inversion”?
same as supination
mediated by TIBIALIS POSTERIOR innervated by TIBIAL NERVE
fibular neck fracture
complications?
common peroneal nerve injury
impaired eversion (pronation) and dorsiflexion loss of dorsal foot sensation
saphenous nerve injury
sx?
loss of medial leg sensation
tibial nerve
innervates what?
injury causes what?
skin - posterior calf, lateral foot + sole, knee joint, plantar flexion/inversion muscles (gastroc, soleus, tib post)
weak plantar flexion / inversion
numb sole
Rotator Cuff Syndrome
main injured tendon + sx
SUPRASPINATUS tendon (repeated impingement trauma btwn humeral head + acromion; as in GOLF or other repeated abduction movements)
painful abduction (especially against resistance)
Orthopedic test to isolate the supraspinatus when testing rotator cuff function
“empty can” test
abduct arms 90 degrees to side, flex them 30 degrees forward and point thumbs to floor
apply downward force to arm while patient presses up; may elicit pain in supraspinatus tendon impingement
Sudden upward jerking of the arm at the shoulder
can cause what?
injury to the “lower trunk” of the brachial plexus (C8 to T1) giving the MEDIAN and ULNAR nerves
“Klumpke’s palsy” - paralysis of all INTRINSIC hand muscles with “total claw hand deformity” due to relative sparing of extrinsic flexors + extensors
Besides the intrinsic hand muscle paralysis and “total claw hand deformity” of Klumpke’s palsy (lower trunk brachial plexus injury)…
what other symptoms / syndromes (2) can present?
- Sensory loss - over MEDIAL HAND/FOREARM (ulnar nerve)
2. Ipsilateral HORNER SYNDROME - if T1 nerve root is involved
