Musculoskeletal System

Flashcards covering key orthopedic conditions, anatomy, movements, diagnostic tests, and treatments from the lecture notes.

What are the common patient complaints and signs of Acute Osteomyelitis?

Localized bone pain, swelling, redness, tenderness, and fever. May refuse to walk or bear weight if on leg/hip.

What is the primary cause of most cases of Acute Osteomyelitis?

Contiguous spread from a nearby infected wound to the bone (nonhematogenous spread).

What is hematogenous spread in osteomyelitis?

Seeding of the bone from an infection in the bloodstream (bacteremia).

Which bacteria is among the most common causes of osteomyelitis?

Staphylococcus aureus (including MRSA).

Which imaging test is most sensitive for showing early changes in bone and bone marrow for osteomyelitis?

MRI.

What lab results are often elevated in Acute Osteomyelitis?

White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

What are the common characteristics of bone pain from bone metastases?

Achy, sharp, well-localized, or neuropathic (burning shooting) pain; severe, often with night pain and/or pain with weight bearing.

What systemic symptoms may accompany bone pain from metastases?

Night sweats, malaise, fever, and weight loss.

What routine lab findings may indicate bone metastases?

Elevated alkaline phosphatase and/or serum calcium (hypercalcemia).

Which cancers most commonly cause bone metastases?

Prostate, breast, lung, thyroid, and kidney cancers.

What is Cauda Equina Syndrome?

Acute onset of low back pain with radiating pain down one or both legs, saddle anesthesia, bladder incontinence (or retention), fecal incontinence, and bilateral lower extremity numbness and weakness.

What causes Cauda Equina Syndrome?

Dysfunction or damage to the lumbar and sacral nerve roots of the cauda equina (e.g., disc herniation, epidural abscess, or tumor).

Why is Cauda Equina Syndrome considered a surgical emergency?

It requires spinal decompression to prevent permanent nerve damage.

What is a Colles Fracture?

A fracture of the distal radius (with or without ulnar fracture) of the forearm along with dorsal displacement of the wrist.

What is the common history leading to a Colles fracture?

Falling onto an outstretched hand (FOOSH).

What is another name for a Colles fracture due to its physical appearance?

Dinner fork fracture.

What is the classic presentation of a Hip Fracture?

History of slipping or falling, sudden onset of one-sided hip pain, and inability to walk or bear weight on the affected hip (if displaced fracture, severe pain with external rotation and leg shortening).

What is the one-year mortality rate for older adults with hip fractures and why?

Approximately 21% due to complications of immobility like pneumonia and deep vein thrombophlebitis.

What kind of trauma often causes a Pelvic Fracture?

Significant or high-energy trauma such as a motor vehicle or motorcycle accident.

What are severe potential complications of a pelvic fracture?

Internal hemorrhage, which can be life-threatening. Always assess ABCs first.

What are the key signs of a Scaphoid (Navicular) Fracture?

Wrist pain on palpation of the anatomic snuffbox and pain on axial loading of the thumb.

What is the typical mechanism of injury for a scaphoid fracture?

Falling forward with an outstretched hand (hyperextension of the wrist).

Why might an initial X-ray be normal in a scaphoid fracture, and what is the recommendation?

Initial X-ray is often normal; a repeat X-ray in 2 weeks will show the fracture. Place in a thumb spica splint and refer to orthopedist, even if initial X-rays are negative.

What are the risks associated with a scaphoid fracture?

High risk of avascular necrosis and nonunion.

What is the function of synovial fluid in a joint?

Provides lubrication for the joint.

What does cloudy synovial fluid indicate?

Infection.

What is articular cartilage?

The cartilage lining the open surfaces of bones in a joint.

What are menisci, and what is their role?

Crescent-shaped cartilages in each knee (two per knee) that aid in dissipating loading forces, stabilization during rotation, and lubricating the joint.

What connects muscle to bone?

Tendon.

What connects bone to bone?

Ligament.

What is the medical term for a partial or complete tear of a tendon or muscle?

Strain.

What is the medical term for a partial or complete tear of a ligament?

Sprain.

What are bursae, and what is their function?

Saclike structures near joints that act as padding and are filled with synovial fluid when inflamed (bursitis).

Define abduction in terms of body movement.

Movement going away from the body.

Define adduction in terms of body movement.

Movement going toward the body.

Define flexion in terms of body movement.

Decreases the angle between two bones; bending.

Define extension in terms of body movement.

Increases the angle and straightens the joint.

What are metacarpals?

Bones of the hands.

What are carpals?

Bones of the wrist (total of eight).

What are phalanges?

Fingers and toes.

What are metatarsals?

Bones of the feet.

What is the talus?

Ankle bone.

What is the calcaneus?

Heel bone.

What does 'proximal' mean in anatomy?

Body part located closer to the body.

What does 'distal' mean in anatomy?

Body part farther away from the center of the body.

What is genu recurvatum?

Hyperextension or backward curvature of the knees.

What is genu valgum?

Knock-knees (think 'gum stuck between the knees').

What is genu varum?

Bowlegs.

What are the general recommendations for the first 48 hours after a musculoskeletal injury?

Avoid vigorous exercise; engage in gentle range-of-motion (ROM) exercises.

What does the RICE mnemonic stand for?

Rest, Ice, Compression, Elevation.

How long should ice be applied after an injury?

20 minutes on, 20 minutes off, for the first 24 to 48 hours.

What is recommended for muscle strengthening exercise for adults weekly?

At least 2 days a week.

What are non-weight-bearing exercises, and what is an example?

Exercises performed in a fixed state where the muscle is flexed against a stationary object, such as isometric exercises (e.g., pushing one fist against the palm of the other hand). Biking and swimming are also examples.

Why are weight-bearing exercises recommended for osteopenia and osteoporosis?

They force bones/muscles against gravity, helping to strengthen bone durability.

What is Finkelstein's Test used for?

Screening for De Quervain's tenosynovitis (inflammation of the tendon sheath at the base of the thumb).

How is a positive Finkelstein's Test indicated?

Pain and tenderness on the wrist on the thumb side when the patient makes a fist with the thumb inside and ulnarly deviates the wrist.

What do the Anterior and Posterior Drawer Signs test for?

Knee stability and torn ligaments.

What does a positive Anterior Drawer Sign indicate?

A damaged or torn anterior cruciate ligament (ACL).

What does a positive Posterior Drawer Sign indicate?

A damaged or torn posterior cruciate ligament (PCL).

What does Lachman's Sign test for?

A tear to the ACL.

What do the Valgus and Varus stress tests of the knee identify?

Valgus stress tests the medial collateral ligament (MCL); Varus stress tests the lateral collateral ligament (LCL).

What are the common complications of intra-articular/periarticular joint injections with steroids?

Tendon rupture, nerve damage, infection, bleeding, hypothalamic–pituitary–adrenal (HPA) suppression.

What do plain x-ray films (radiographs) primarily show?

Bone fractures, osteoarthritis (joint space narrowing, osteophyte formation), damaged bone (osteomyelitis, metastases), metal and other dense objects.

What imaging is the gold standard for injuries of cartilage, menisci, tendons, ligaments, or joints?

MRI.

What is a contraindication for MRI imaging?

Metal implants, certain cardiovascular implantable devices, cardiac valves, aneurysm clips, drug infusion pumps, cochlear implants, neurostimulators, bullets, shrapnel, and other metal fragments.

What are the treatment recommendations for acute musculoskeletal injuries immediately after onset?

RICE (Rest, Ice, Compression, Elevation) and NSAIDs for pain and swelling.

What is Ankylosing Spondylitis?

A chronic inflammatory disorder (seronegative arthritis) primarily affecting the spine (axial skeleton) and sacroiliac joints.

What is the classic presentation of Ankylosing Spondylitis?

Young adult male with chronic back pain (>3 months) that started at the neck and progressed down the spine. Pain worsens at night but improves with activity, not relieved by rest.

What decreased physical finding is associated with Ankylosing Spondylitis?

Decreased respiratory excursion (<2.5 cm).

What ocular condition is common in Ankylosing Spondylitis patients?

Uveitis (eye irritation, photosensitivity, pain, scleral injection, blurred vision).

What classic finding on a spinal radiograph is pathognomonic for late Ankylosing Spondylitis?

Bamboo spine.

What is the first-line initial treatment for Ankylosing Spondylitis?

NSAIDs such as naproxen or ibuprofen at maximum doses.

What serious complications can arise from Ankylosing Spondylitis?

Anterior uveitis, osteopenia, fractures, spinal cord injury, atlantoaxial subluxation, cauda equina syndrome, renal and pulmonary disease, cardiovascular disease.

What is Lateral Epicondylitis (Tennis Elbow)?

Chronic tendinosis at the origin of the wrist extensors, causing gradual onset pain on the outside of the elbow, worse with twisting or grasping movements.

What is Medial Epicondylitis (Golfer’s Elbow)?

Chronic tendinosis at the origin of the wrist flexors, causing gradual onset aching pain on the medial area of the elbow.

What severe complication can arise from Medial Epicondylitis affecting the ulnar nerve?

Ulnar nerve neuropathy/palsy, with numbness/tingling in the little finger and lateral side of the ring finger, hand weakness, and potentially 'claw hand' deformity.

What is Gout caused by?

Deposits of uric acid crystals (monosodium urate) inside joints and tendons due to genetic excess production or low excretion of purine crystals.

What is the gold standard for diagnosing gout?

Joint aspiration of synovial fluid and microscopy exam using polarized light to identify uric acid crystals.

What is the classic presentation of an acute gout flare?

Middle-aged man with painful, hot, red, and swollen MTP joint of the great toe (podagra), often at night, precipitated by alcohol, meats, or seafood.

What is the target serum uric acid level for gout treatment?

When is the most accurate time to assess serum urate levels relative to a gout flare?

2 weeks or more after a gout flare subsides.

During an acute gout flare, should daily urate-lowering therapy (ULT) be discontinued?

No, it should be continued alongside gout flare medications.

What are the first-line medications for treating an acute gout flare?

Oral steroids, NSAIDs, or colchicine.

What is the typical dosing for colchicine during an acute gout flare?

Two tablets (1.2 mg) at onset, then one tablet (0.6 mg) in 1 hour; total dose on day 1 not to exceed 1.8 mg.

What are common side effects of colchicine?

Diarrhea, abdominal pain, cramps, nausea, and vomiting.

What are serious and life-threatening effects of colchicine?

Blood cytopenias, rhabdomyolysis, liver failure, neuropathy.

What medications are XOI (xanthine oxidase inhibitors) used for gout maintenance?

Allopurinol (Zyloprim), febuxostat (Uloric).

What is the boxed warning for febuxostat?

Gout patients with heart disease treated with febuxostat have a higher rate of CV death compared with those treated with allopurinol.

What lifestyle modifications are recommended for gout management?

Avoid/minimize alcohol, fructose- or corn syrup-sweetened beverages, stay well hydrated, follow DASH or Mediterranean diet, moderate purine intake, and consider cherries, vitamin C, fish, and omega-3 fatty acids.

What are potential complications of chronic gout?

Joint destruction, joint deformity, and tophi.

What is the classic presentation of a Hamstring Muscle Injury?

Sudden onset of posterior thigh pain and a popping noise during activities like sprinting, often with swelling, bruising, warmth, and tenderness.

What imaging methods are best for assessing hamstring injuries?

Musculoskeletal ultrasonography and MRI.

What types of low back pain are defined by duration?

Acute (

What are red flag symptoms that indicate a need for further evaluation in low back pain?

History of significant trauma, suspected cancer metastases or infection, suspected spinal/vertebral fracture, new onset pain >50 years old, pain waking patient from sleep, suspected cauda equina, radiculopathy, ankylosing spondylitis, fevers, night sweats, weight loss, or worsening symptoms despite treatment.

Which imaging method is best for diagnosing a herniated disc?

MRI.

What is the recommended treatment for uncomplicated low back pain?

NSAIDs, warm packs for muscle spasms, and muscle relaxants (if spasms present). Abdominal and core-strengthening exercises after acute phase.

What is Medial Tibia Stress Syndrome (Shin Splits)?

Recent onset of pain on the inner edge of the tibia, aggravated during and after exercise, with diffuse tenderness on the inside of the lower leg.

What is the treatment plan for shin splints and suspected stress fractures?

RICE mnemonic, NSAIDs, compression bandage, cushioned shoes. If stress fracture suspected, recommend lower-impact exercises and refer to orthopedist as MRI is highly sensitive and specific.

What are the classic symptoms of a Meniscus Tear in the knee?

Clicking, locking, or buckling of the knee, inability to fully extend the knee, knee pain, difficulty walking and bending the knee, and joint line pain.

What physical examination tests are used for meniscus tears?

Steinman's test (pain over posterior joint line with flexion) and Apley's test (pain with compression and twisting of the foot while knee is flexed).