Ortho + MSK Flashcards
Reflexes eponym
1,2 buckle my shoe, 3,4 kick the door, 5,6 pick up a stick, 7,8 open the gate
S1 & S2 = Ankle reflex
L3 & L4 = Patellar reflex
C5 & C6 = Biceps reflex
C7 & C8 = Triceps reflex
L3 Radiculopathy
Sensory loss to Anterior thigh
Quadricep weakness
Reduced Knee reflex
Test = +ve Femoral stretch test
Which nerve roots does the femoral nerve arise from
L2-L4
L4 radiculopathy
Sensory loss to anterior Knee
Quad weakness
Reduced knee reflex
+ve femoral stretch test
L5 radiculopathy
Anterolateral shin + dosrum of foot sensory loss
Weakness of dorsiflexion (foot drop)
Reflexes intact
+Ve sciatic stretch test
S1 radiculopathy
Sensory loss = posterolateral leg
Weakness = Plantarflexion
Reduced ankle reflex
+Ve sciatic stretch test
In which spinal roots does the sciatic nerve originate
L4-S3
Cauda equina
Surgical emergency where the nerve roots of the cauda equina (L2/L3) are compressed.
Causes = Disc prolapse / Tumor / Spondylethesis / Abscess / Trauma
Features;
* Saddle anaesthesia
* Loss of sensation in bladder + rectum = urinary/fecal incontinence + loss of sphincter tone
* Bilateral sciatica / Bilateral motor weakness in legs
* Sexual dysfunction.
Diagnosis;
* PR - for anal sphincter tone
* Emergency MRI scan
Management = Surgery ASAP
Sciatica
Cause = Any compression of the nerve roots of the sciatic nerve (L4-S3) e.g disc herniation / Spinal stenosis / RA / AS / Tumor / Piriformis syndrome / Wallet sciatica / Pregnancy
Sciatic nerve innervates the hamstrings & then splits into the Tibial + Common fibular nerve
Features;
* Sharp shooting pain down posterior leg + back pain
* Unilateral
* Worse on sitting / standing
O/E = +ve sciatic nerve stretch test.
Management = Analgesia + physio. Only MRI if there is signs of UMNL or cauda equina Red Flags.
90% resolve in 6 weeks.
Spondylethesis
Displaced vertebral body (typically L5)
Causes - Spondylosis / Degeneration / Malignancy / Trauma / Congenital
Common in younger or much older patients.
Poorly localised back pain which is worse on activity.
Stiffness + waddling gait + Palpable ‘step’ of the spine.
Diagnosis = Xray - shows collaged scotty dog deformity
Management = physio + analgesia + orthotics. May require fusion surgery or decompression.
Spinal stenosis
Typically pt >50yrs with sharp lower back pain + tingling down the legs which improves upon rest.
Pain eases when walking up hill and when leaning forward / sitting.
Diagnosis = MRI scan
Management = Physio + Analgesia + Epidural steroids
Weight loss will help
If neurological comprise then laminectomy can be done
How to differentiate between neurogenic claudication and vascular claudication
Neurogenic claudication = often alleviated by walking uphill and eased when sitting. pulses intact
Vascular claudication = Worse on walking uphill and pulses may be abnormal.
Schuermanns disease
A condition of hyperkyphosis of atleast 3 vertebrae - due to epiphysitis of vertebral joints (cartilage –> bone)
Features;
* Typically presents in adolescence with back pain + stiffnss + progressive kyphosis
Diagnosis = Xray shows epiphyseal plate disturbance + anterior wedging.
Cervical spondylotic myelopathy
= Posterior disc protrusion in the cervical spine. Often secondary to spondylosis
Features;
* Neck pain & stiffness
* Slow progression of motor weakness - difficulty walking, spastic paraparesis + reduced hand dexterity.
* May have radiculopathy too
* Autonomic dysfunction can occur e.g incompetence.
Examination findings; +ve hoffman + babinski’s
Invx = MRI
Management = decompression might be needed
Pott’s disease
This is TB induced spondylitis due to haematogenous spread.
High risk of disc collapse from caseous necrosis - may cause pott’s paraplegia
What is the most common causative organisms in Discitis
Staph aureus - most common
Pseudomonas - in IVDU
What other investigations should be done if Staph aureus discitis is found
Echocardiogram - to look for infective endocarditis due to haematogenous spread. (Septic emboli most common cause of discitis / psoas abscess in non IVDU)
Epidural abscess
Often forms secondary to discitis
Features;
* Severe localised back pain & tenderness on palpation
* Systemic infection - high fever etc
* Focal neurological deficit possible
Invx = Sepsis screen. MRI is best radiological invx
Consider echo + dental Xray
Management = Long term broad spec antibiotics (IV)
Osteomyelitis
Types;
1. Haematogenous - results from a bacteria, more common if immunosupressed / infective endocarditis
2. Non-haematogenous = local spread of infection e.g diabetic foot, PAD - often polymicrobial
Staph aureus most common cause
Salmonella in Sickle cell patients
Invx = MRI
Management = IV antibiotics
Osteopetrosis
Marble bone disease - autosomal recessive
Bone becomes harder and more dense
Typically presents in young adults /children
Radiology shows marble bone - lack of differentiation between cortex & medulla
Monteggias fracture
Ulnar shaft fracture + Dislocated proximal radioulnar joint
Complication = radial nerve palsy
Galeazzis fracture
Radial shaft fracture & Dislocation of the Distal radioulnar joint (DRUJ)
Colles Fracture
Distal radius
Dorsally ungulated
Dorsal displacement
Dinner fork deformity
Complications = Median nerve injury + compartment syndrome + EPL rupture + OA.
Mx = Dorsal plaster slab + slight ulnar deviation
Smiths fracture
Reverse colles fracture = Volar angulation of distal smiths fracture & garden spade deformity.
Mx = open reduction
Which drug is association with duputryens contracture
Phenytoin
NoF fractures
Intracapsular/Subcapital - Displaced fractures need athroplasty, undisplaced ones can have Internal fixation or Hemiarthroplasty
Extracapsular - Intertrochanteric can have dynamic hip screw. If displaced or subtrochanteric then intermedullary device is needed.
Salter-Harris Classification
I - Straight across growth plate (physis only - Xray may look normal)
II - Above (Physis + metaphysis)
III - Lower or below (physis + epiphysis and includes joint)
IV - Two or through (physis + metaphysis + epihysis)
V - Erasure of growth plate or crush injury (Xray may look normal)
