Summary 2 - MSK

Question 1

Describe acute compartment syndrome

Answer 1

Condition in which the circulation to, and functions of tissues in, closed space are compromised by increased pressure within space
Most common causes are haemorrhages into space by fractures

Question 2

What are the symptoms and signs of acute compartment syndrome?

Answer 2

Pain which is out of proportion to injury, pain on passive stretch, altered sensation, weakness and swelling
Paraesthesia, pale, pulseless, paralysis and cold
Elevated compartment pressure within 30mmHg of diastolic

Question 3

What is the treatment for acute compartment syndrome?

Answer 3

Open constriction dressings to skin, treat with emergency fasciotomy of all affected compartments

Question 4

Describe osteosarcoma

Answer 4

Type of primary bone cancer which mostly diagnosed in teenagers and young adults
MRI is the investigation of choice

Question 5

What are the symptoms of osteosarcoma?

Answer 5

Pain, loss of function, swelling, pathological fractures, joint effusion, deformity and neurovascular effects
Pain is a deep boring ache which is worse at night
Deep seated mass

Question 6

What is the treatment for osteosarcoma?

Answer 6

Chemo, surgery and RT
Surgery - lib is salvageable in most cases

Question 7

Describe metastatic bone disease

Answer 7

Secondary bone tumour which is 25x more common than primary
Bone is most common site for metastasis
Site is vertebrae> proximal femur> pelvis> ribs> sternum> skull

Question 8

What are the 7 most common primary cancers which metastasis to bone?

Answer 8

Lung, breast, prostate, kidney, thyroid, GI tract and melanoma

Question 9

What is the treatment and management for metastatic bone cancer?

Answer 9

Prevention of pathological fracture - embolization and conservatively if non-weight bearing part
Prophylactic fixation
RT, chemo and surgery

Question 10

Describe developmental dysplasia of the hip (DDH)

Answer 10

Hip joint is misaligned due to ball + socket of hip joint not being fully developed correctly leading to instability
More girls affected and left hip is more common

Question 11

What are the symptoms and signs of developmental dysplasia of the hip?

Answer 11

Ortolani’s sign, Barlow’s sign, hamstring sign and piston motion sign
Can lead to pain, OA of hip and back, and limp

Question 12

What is the management and treatment for DDH?

Answer 12

Under 3 months - Pavlik harness
Closed reduction and spica cast
Over 1 - open reduction and capsule reefing
Over 18 months - open reduction and femoral shortening

Question 13

Describe Perthes disease

Answer 13

Rare childhood condition where part of the femur dies due to lack of blood supply - collapse of bone
Pathological AVN of hip
More males and primary school age

Question 14

What is the symptoms and signs of Perthes disease?

Answer 14

First symptoms is a limp or change in walk
Knee pain on activity, stiff knee joint, systemically well, inflammation of hip and no injury associated to pain
Small sclerotic epiphysis seen on X-ray

Question 15

What is the management and treatment for Perthes disease?

Answer 15

Maintain hip motion, analgesia and restrict painful activities
Supervised neglect in most cases
Consider osteotomy if over 7 years

Question 16

Describe Slipped under femoral epiphysis (SUFE)

Answer 16

Affects the physis of proximal femur in adolescents
Classified on magnitude of slip - stable or unstable (can’t weight bear)
More teenage boys affected - many overweight

Question 17

What are the symptoms and signs of SUFE?

Answer 17

Left groin pain for around3 months, short, externally rotated and possibly painful to weight bear
Externally rotated posture and gait. Reduced internal rotation esp. in flexion

Question 18

What is the treatment for SUFE?

Answer 18

Stable slips are usually pinned in situ and severe unstable slips are considered for open reduction but high AVN risk

Question 19

Describe Paget’s disease of bone

Answer 19

Localised disorder of bone turnover which has increased bone resorption followed by increased bone formation - disorganised bone
Strong genetic component

Question 20

What are the symptoms and signs of SUFE?

Answer 20

Bone pain, bone deformity, excessive heat over Paget’s joint and neurological complications like nerve deafness
Isolated elevation of serum alkaline phosphatase

Question 21

What is the management and treatment for Paget’s disease?

Answer 21

No need to treat asymptomatic unless includes skull or needs surgical intervention
IV bisphosphonate therapy
Ca and Vitamin D supplements
Physio, OT and aids

Question 22

Describe Rickets and osteomalacia

Answer 22

Rickets - affects bone development in children
Osteomalacia - similar condition but in adults where epiphyseal plates are closed
Muscle function also impaired from low Vit D
Low Ca, low vitamin D, raised PTH and raised alkaline phosphatase

Question 23

What are the signs and symptoms of rickets?

Answer 23

Stunted growth, large forehead, odd curve to spine, wide joints, odd shaped legs, large abdomen and sore bones causing waddling
Bones more prone to breaking

Question 24

What are the signs and symptoms of osteomalacia?

Answer 24

Bone pain, muscle weakness and fragile bones which are more prone to fractures

Question 25

What is the treatment for rickets and osteomalacia?

Answer 25

Increasing intake of vitamin D and calcium - diet and supplements

Question 26

Describe osteogenesis imperfecta

Answer 26

Genetic disorder of connective tissue characterised by fragile bones from trauma and acts of daily life
Defects in collagen
Broad clinical diagnosis

Question 27

What are the symptoms and signs of osteogenesis imperfecta?

Answer 27

Type 1 - muscle weakness and bone fractures
Type 2 - babies can’t breathe
Type 3 - broken bones at birth
Type 4 - bone fractures and mild deformity
Growth deficiency, blue sclera, scoliosis, defective tooth formation and easy bruising

Question 28

What is the management and treatment for osteogenesis imperfecta?

Answer 28

Surgical to treat fractures
Medical to prevent fractures - IV bisphosphonates
Genetic counselling and educational adaptions

Question 29

Describe osteoporosis

Answer 29

Metabolic bone disease characterised by low bone mass and micro-architectural deuteriation of bone tissue
Leads to bone fragility and increase in fractures - most common is wrist, hip and vertebrae

Question 30

What are the investigations for osteoporosis?

Answer 30

Result on DXA bone scanning less than 2.5 SDs below the young adult mean in post-menopausal women or thin bones have increased risk of fracture
Q fracture - risk assessment tool

Question 31

What is the management and treatment for osteoporosis?

Answer 31

Ensure good calcium and vitamin D status
DXA scanning - if 15% 10 year risk then make treatment threshold
Medications - antiresorptive therapies (HRT, SERMs, bisphosphates and Denosumab) and anabolic therapies (teriparatide)

Question 32

Describe cerebral palsy

Answer 32

Permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 years of life
Can be spastic, athetoid, ataxia, and mixed
GMFCS - motor function classification

Question 33

What are the signs and symptoms of cerebral palsy?

Answer 33

Spasticity, lack of voluntary control, weakness, poor co-ordination and impaired senses
Can have dynamic or fixed contractures and dislocations
Hip displacement is common

Question 34

What is the non-surgical treatment for cerebral palsy?

Answer 34

Physio
Spasticity management - Baclofen oral, diazepam, botulinum toxin and intra-thecal pump of Baclofen

Question 35

Describe congenital talipes eqinovarus

Answer 35

Club feet
Deformity of foot presenting in infants
CAVE - cavus, adductus, varus hindfoot, and equinus hindfoot
95% treated successfully and are left pain free and mobile feet

Question 36

What is the treatment for congenital talpies equinovarous (CTEV)?

Answer 36

Strapping for positional talipes only
Serial casting and surgery
Correct equinus - percutaneous tenotomy of Achilles tendon