ortho/ MSK Flashcards
What is De Quervain’s tenosynovitis?
Common - sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
Features: typically females 30 - 50 yrs.
Features
Wrist pain over the radial styloid process.
abduction of the thumb is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction –> pain over radial part of wrist
Mx: analgesia, seroid injection, splint, sometimes surgery
(ankle ones)
What are the ottawa rules?
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular AKA posterior tip tenderness)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia AKA posterior tip tenderness)
-inability to walk four weight-bearing steps immediately after the injury and in the emergency department
How does adhesive capsulitis present?
Stiff shoulder
reduced active and passibe ROM in abduction, int and ext rotation - esp external eg brushing hair
Difficulty sleeping on that side
painful freezing phase, an adhesive phase and a recovery phase
more common in women and diabetics
Acromioclavicular degeneration presentation?
popping, swelling, clicking or grindings and a positive scarf test
Subacromial impingement presentation?
pain on overhead activities and demonstrate a painful arc of abduction on examination - worse between 90 and 120 degrees. There may also be popping, snapping or grinding.
usually no weakness
Rotator cuff injury presentation? (think fo diferent muscles)
usually weakness present
supraspinatus injury: jobes (empty can test) +ve; painful arc of movement (pain between 60-120 degrees
subscapularis: lift off test +ve
infraspinatus muscle and teres minor.: Pain on resisted external rotation
calcific tendinopathy presentation
+++ tenderness on palpation of the affected area and reluctance to move the arm.
Golfers vs tennis elbow
Golfer’s elbow or medial epicondylitis produces tenderness over the medial epicondyle and medial wrist pain on resisted wrist pronation.
Tennis elbow or lateral epicondylitis produces tenderness over the lateral epicondyle and lateral elbow pain on resisted wrist extension.
Men play golf (golfer’s medial), lads play tennis (tennis is lateral)
golF - pain on wrist Flexion - in golf you flex the wrist
tEnnis - pain on wrist Extension - in tennis you extend the wrist
What is the management of intra Vs extracapsular fractires?
A subcapital fracture is the commonest type of intracapsular fracture of the proximal femur.
The intertrochanteric line is the line connecting the greater and lesser trochanters. Any fracture proximal to that line is classed as intracapsular, while any fracture distal is classed as extracapsular.
Intracapsular hip fracture:
Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.
Displaced Fracture:
THR if able to walk independently/ not confused/ med fit otherwise hemiarth.
Extracapsular hip fracture:
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
what is the thompson test?
Squeeze calf - if rupture to achilles tendon, injured foot wont move
Also should feel for tendon rupture, foot may appear dorsiflexed.
Presentation of plantar fasciitis?
Heel pain, worse on walking on tiptoes
Presentation of mortons neuroma/ what is it?
Morton’s neuroma is a thickening of the tissue around the nerve usually between the 3rd and 4th toes. Pain tends to be on the ball of the foot.
Differentiate these knee injuries:
meniscal tear
ACL injury
LCL injury
PCL injury
patellar tendon rupture
meniscal tear: twisting injury. knee locks, catches and gives way. Swelling occurs hours after injury. mcmurrays test +ve.
ACL: twisting injury. Popping noise, quickly swell with blood, lateral knee tenderness, O/E, positive anterior draw test, +ve lachmans
LCL: caused by blow to medial knee, tenderness over lateral knee, MCL is the opp.
PCL: hyperextension injury. posterior knee pain, mild swelling. posteior draw test +ve
Patellar tendon rupture: cannot extend knee, patellar has visible deformity O/E
What is femoroacetabular impingement?
typically active young adults
worse on prolonged sitting
caused by anatomy variant –> contact with femur and acetabular rim
What is snapping hip syndrome?
Snapping of tendons during flexion and extension, painless
What can cause osteonecrosis of the femoral head?
steroids, alcohol, autoimmune associated
What is iliotibial band syndrome?
Cause of lateral knee pain in keen runners
What are the signs of a scaphoid fracture?
- Point of maximal tenderness over the anatomical snuffbox
This is a highly sensitive (around 90-95%), but poorly specific test (<40%) in isolation - Wrist joint effusion
Hyperacute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions. - Pain elicited by telescoping of the thumb (pain on longitudinal compression)
- Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
- Pain on ulnar deviation of the wrist
What is Meralgia paraesthetica
Caused by compression of lateral cutaneous nerve of thigh
Typically burning sensation over antero-lateral aspect of thigh
What is Greater trochanteric pain syndrome?
AKA Trochanteric bursitis
Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years
What is a boxers fracture?
Boxer fracture describes a minimally displaced fracture of the fifth metacarpal. This typically results following the patient punching a hard surface, for example a wall.
Ruptured ACL vs PCL vs MCL vs meniscal tear?
ACL: high twist force injury, loud crack, pain and RAPID joint swelling (haemoarthrosis),
positive draw test
PCL: hyperextension injury,
Paradoxical anterior draw test
MCL: leg forced into valgus via force outside the leg
Knee unstable when put into valgus position
Meniscal tear: Rotational sporting injuries
Delayed knee swelling
Joint locking
reccurent episoes of pain and effusions
prepatellar vs infrapatellar bursitis?
prepatellar =housemaids knee = upright kneeling
infrapatellar = clergymans knee = kneeling
Features of a Colles fracture?
FOOSH
common with OP, causes dorsal angulation radius “dinner fork deformity”
What is a Smiths fracture?
(reverse Colles’ fracture)
Volar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
Which dieuretics trigger gout?
thiazide ONLY (indapamide, bendrofluthiazide)
Ottawa knee rules?
x-ray if 1 of - >55, isolated bony tenderness to patella, tenderness at head of fibula, inability to flex to 90 degrees, inability to weight bear after injury and in ED <4 steps
52 diabetic female, shoulder pain for 2 months, no trauma, now limited movement in all directions ? cause
adhesive capsulitis
