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MSK - Cortex > Week 4 > Flashcards

Week 4 Flashcards

1
Q

what is cause of bony nerve root entrapment

A

OA of the facet joints can result in osteophytes impinging on exiting nerves

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2
Q

Tx of bony nerve root entrapment

A

surgical decompression

trimming of the impinging osteophytes

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3
Q

what causes cauda equina syndrome

A

large central disc prolapse can compress all the nerve roots of the cauda equina

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4
Q

why is cauda equine syndrome a surgical emergency

A

affected nerve roots include the sacral nerve roots (mainly S4 & S5) controlling defaecation and urination

prolonged compression can potentially cause permanent nerve damage

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5
Q

what can be the outcome if cauda equine is not managed

A

colostomy and urinary diversion

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6
Q

Symptons/Signs of C.E syndrome

A 
bilateral leg pain
paraesthesia
numbness
saddle anaesthesia - numbness around sitting area and perineum
urinary/faecal incontinence
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7
Q

what is mandatory is suspected C.E. syndrome

A

rectal examination (PR)

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8
Q

IX for C.E. syndrome

A

MRI

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9
Q

red flags of back pain

A

back pain 60 y/o
nature of pain - constant, severe, worse at night
systemic upset - fever, night sweats, weight loss, fatigue

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10
Q

what causes spontaneous crush fractures of the spine

A

severe osteoporosis

causes acute pain and kyphosis

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11
Q

what are the symptoms of cervical spondylosis

A

slow onset stiffness + pain in the neck

can radiate to shoulders and the occiput

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12
Q

Mx of cervical spondylosis

A

physio

analgesics

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13
Q

complications of cervical spondylosis

A

osteophytes impinge on exiting nerve roots resulting in radiculopathy involving upper limb dermatones and myotomes

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14
Q

what does acute/degenerative disc prolapse cause in the cervical spine and how does it present

A

nerve root compression
shooting pain down dermatomal distribution
loss of reflexes depending on the nerve root affected

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15
Q

Ix for cervical disc prolapse

A

MRI

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16
Q

why should you be wary of disc prolapses found on MRI

A

with age, there is a number of symptomatic disc prolapse
results in ‘false positives’
the disc prolapse is not responsible for the symptoms
needs to be considered in adjunction with clinical findings

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17
Q

who can get atraumatic cervical spine instability and why

A

RA
atlanto-axial subluxation
can compress the spinal cord and be fatal

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18
Q

Tx of cervical spine instability

A

less severe - with a collar to prevent flexion

severe - surgical fusion

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19
Q

what can be upper motor neurone signs of cord compression

A

wide based gait
weakness
increased tone
upgoing plantar response

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20
Q

role of the rotator cuff muscles

A

pulling the humeral head into the glenoid to provide a stable fulcrum for the powerful deltoid muscle to abduct the arm

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21
Q

roughly, what are the causes of pain in the shoulder by age group

A

young adult - instability
middle age - rotator cuff tear/frozen shoulder
elderly - glenohumeral OA

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22
Q

what is impingement syndrome

A

tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight sub-acromial space during movement producing pain

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23
Q

causes of impingement syndrome

A

Tendonitis Subacromial bursitis
Acromioclavicular OA with inferior osteophyte
A hooked acromion Rotator cuff tear

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24
Q

what does a painful arc show

A

Supraspinatus tendon is inflamed

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25
Q

Sx of impingement syndrome

A

pain - can radiate to deltoid and upper arm
tenderness - below lateral edge of acromion
+ve Hawkins Kennedy

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26
Q

Tx for impingement syndrome

A

NSAIDS/Analgesic/Physio
up to 3x steroid injections in subacromial
subacromial decompression surgery

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27
Q

classic Hx in rotator cuff tear

A

sudden jerk (eg holding a rail on a bus which suddenly stops) in a patient >40 years of age, with subsequent pain and weakness

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28
Q

features of rotator cuff tear

A

can be partial or full thickness and usually involve suprapinatus

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29
Q

Sx of rotator cuff tear

A
  • Weakness of initiation of abduction (supraspinatus)
  • internal rotation (subscapularis) - external rotation (infraspinatus)
  • wasting of supraspinatus
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30
Q

Ix for rotator cuff tear

A

USS - 1st line

MRI - 2nd line

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31
Q

classic history of Adhesive capsulitis/frozen shoulder

A

disorder characterized by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18‐24 months

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32
Q

what is the principle clinical sign of frozen shoulder

A

loss of external rotation

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33
Q

timeline of frozen shoulder

A

initially pain which will subside in 2-9 months
stiffness increases from 4-12 months
stiffness gradually ‘thaws’

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34
Q

what is frozen shoulder associate with

A

diabetes
hypercholesterolaemia
Dupuytren’s disease

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35
Q

Tx of frozen shoulder

A

physio, analgesics

intra-articular injections in gleno-humeral

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36
Q

Hx of acute calcific tendonitis

A

acute severe shoulder pain

calcium deposition in the supraspinatus tendon

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37
Q

Ix for acute calcific tendonitis

A

x-ray

38
Q

Tx for acute calcific tendonitis

A

subacromial steroid
local anaesthetic injection
self-limiting

39
Q

surgical Tx for traumatic anterior dislocation

A

Bankart repair

40
Q

who has atraumatic instability

A

Idiopathic ligamentous laxity
Ehlers-Danlos
Marfan’s

41
Q

what are secondary causes of carpal tunnel syndrome

A 
RA
Pregnancy
Diabetes
Chronic renal failure
Hypothyroidism
Wrist Fractures e.g. Colles
42
Q

presentation of carpal tunnel syndrome

A

parathesiae in the median nerve innervated digits (thumb and radial 2½ fingers)
usually worse at night,
loss of sensation
weakness of the thumb or clumsiness

43
Q

Ex of carpal tunnel syndrome

A

loss of sensation

muscle wasting of the thenar exminence

44
Q

Tests for carpal tunnel syndrome

A

Tinel’s test

Phalen’s test

45
Q

Ix for carpal tunnel syndrome

A

NCS

46
Q

Sx of CUBITAL tunnel syndrome

A

paraesthesiae in the ulnar 1½ fingers

weakness in ulnar nerve innervated muscle - 1st dorsal interosseous and adductor pollicis

47
Q

causes of cubital tunnel syndrome

A

Osbourne’s fascia - tight band of fascia forming the roof of the tunnel
Tightness at the inter muscular septum

48
Q

Ix of cubital tunnel syndrome

A

NCS

49
Q

clinical feature of tennis elbow

A

painful and tender lateral epicondyle

pain on resisted middle finger + wrist extension

50
Q

what type of elbow arthritis is more common

A

RA

51
Q

Surgical Tx of elbow arthritis

A

Arthritic change at the radio‐capitellar joint - surgical excision of the radial head

Elbow severely affected - Total Elbow replacement

52
Q

what is Dupuytren’s contracture associated with

A

Peyronie’s disease - affects the penis

Ledderhose disease - affects the feet

53
Q

what degree of Dupuytren’s contracture can be tolerated by MCP joint

A

up to 30 degrees

54
Q

pathogenesis of trigger finger

A
  • tendonitis of flexor tendon can result in nodular enlargement
  • movement of finger produces a clicking sensation as nodule catches on pulley
  • can be painful, finger appears locked in flexed position
  • have to forcible manipulate finger to regain extension (painful)
55
Q

what fingers are commonly affected with trigger finger

A

middle + ring finger

56
Q

Tx for trigger finger

A

steroid injection

57
Q

division of what pulley does not affect function

A

A1 pulley

58
Q

features of OA in the hand

A

DIP affected
Herberden’s nodes - stiffness and bony thickening
Mucous cyst - dorsal ganglion

PIP can also be affected
Bouchards nodes

59
Q

Surgical Tx of OA in the hands

A

mild to moderate - removal of osteophytes and excision of mucous cyst
severe - arthrodesis (esp if in index finger to preserve pinch grip)

can also do replacement arthroplasty

1st CMCjt - arthroplasty or fusion

60
Q

what are the deformities of RA that affect the hand

A 
volar MCPJ subluxation
Ulnar deviation
Swan neck deformity
Boutonniere deformity
Z-shaped thumb
61
Q

what is swan neck deformity

A

hyperextension at PIPJ with flexion DIPJ

62
Q

what is boutonniere deformity

A

flexion at PIPJ with hyperextension at DIPJ

63
Q

what surgery can prevent tendon rupture

A

Tenosynovectomy

64
Q

why do we not aspirate ganglion cyst

A

recurrence rate is high

65
Q

causes of AVN

A 
idiopathic
alcohol abuse
steroids
hyperlipidaemia
thrombophilia
66
Q

Ix of AVN

A

MRI - 1st line

X-ray - see classic ‘hanging rope sign’

67
Q

Tx of AVN

A

if caught early - drill holes up femoral neck to relieve pressure/decompression

collapsed - THR

68
Q

signs of Trochanteric bursitis / gluteal cuff syndrome

A

pain and tenderness in the region of the greater trochanter with pain on resisted abduction.

69
Q

what is ‘pseudo-locking’

A

knee becomes stuck with temporary difficulty straightening the leg

not the same as ‘locking’ in bucket handle tear

70
Q

what do people with ACL ruptures complain of

A

rotatory instability with their knee giving way when turning on a planted foot

71
Q

if unable to examine knee, what is the Ix of choice

A

MRI

72
Q

what type of meniscal tears should be considered for repair

A

fresh longitudinal tears involving the outer 1/3 of the meniscus in a younger patient

73
Q

rupture of which knee ligament has the best chance of healing

A

medial collateral ligament

74
Q

what can cause anterior knee pain, worse going down hill, grinding sensation and stiffness siting long time

A

patellofemoral dysfunction

Tx- physio

75
Q

patellar instability

A

occurs with a direct blow/sudden twist of the knee
almost always dislocates laterally
may reduce when knee is straightened

76
Q

what happens when the patella dislocates

A

medial patellofemoral ligament tears
osteochondral fracture may occur
lipohaemarthosis

77
Q

what can be seen on x-ray when the patella dislocated

A

lipo‐haemarthrosis

78
Q

what is hallux valgus

A

deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself

79
Q

who gets hallux valgus

A

RA
Inflammatory arthropathies
MS
Cerebral palsy

80
Q

what is a bunion

A

inflamed bursa over the medial 1st metatarsal head

81
Q

surgical Tx of hallux valgus

A

osteotomies - to realign bone

soft tissue procedures - to tighten slack tissues and release tight tissues

82
Q

what is OA of 1st MTPJ called

A

Hallux rigidus

83
Q

gold standard Tx of hallux rigidus

A

arthrodesis

84
Q

what is presenting complaint of morton’s neuroma

A

burning pain and tingling radiating into the affected toes

85
Q

Ix for morton’s neuroma

A

Mulder’s click test

US - first line imaging

86
Q

what is most commonly affected by metatarsal stress fracture

A

2nd metatarsal followed by 3rd

87
Q

Ix for metatarsal stress fracture

A

Bone scan

X-ray - may not showing anything till 3 weeks after

88
Q

what antibiotics can cause achilles tendonitis/rupture

A

Quinolone antibiotics (ciprofloxacin etc)

89
Q

Tx of achilles tendonitis

A

rest
physio
heel raise
splint/boot

self-limiting

90
Q

what is simmonds test

A

No plantarflexion of the foot is seen when squeezing the calf

91
Q

what are signs of plantar fasciitis

A

Pain with walking is felt on the instep of the foot with localized tenderness on palpation of this site.

92
Q

role of tibialis posterior tendon

A

support the medial arch of the foot

MSK - Cortex (5 decks)

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