MSK Step up

OA and Degenerative Joint Disease

-Labs

-Radiology

-Tx

OA vs RA

Carpal tunnel syndrome

-def

-RF

-SXS

-EMG

-Tx

Next Step: Suspect _____ in cases of deltoid malfunction or shoulder numbness s/p dislocation

Axillary nerve injury

Next step: Open fracture requires

Shoulder dislocation

-most commonly

-posterior dislocations most frequently occur following

-tx

-complications

Hip dislocations

-most commonly

Knee dislocations

-most commonly

-posterior dislocations often involve an injury to

-Complications

Hip mostly posterior

Knees mostly anterior

posterior with popliteal artery injury

C: common peroneal nerve injury, popliteal artery injury, compartment syndrome

Patella dislocation

-most commonly

-what should be obtained and when

-Tx

What is most useful in dx in bone pathology vs soft tissue injuries

Sprains

-def

-SXS

-Tx

Ligament Tears

-occur from

-SXS

-Radiology

-Tx

unhappy triad

Meniscus tears (knee)

-Complication

Young athletes may get an ____ during atheletic activity with mild elevation of _______ that resolves following ______

Sits muscles

AC joint seperation Shoulder

-results from

-SXS

AC joint separation shoulder

-tx

Compartment syndrome

-symptoms

-best initial screening test

-tx

6 P’s: 

-pain 

-pallor

-poikilothermia

-pulselessness

-parasthesia

-paralysis 

Best initial screening test: pain with passive stretching 

Tx: emergency fasciotomy for pressures >30 or pressures within 20 of DBP 

A painful leg that has a pulse NEVER rules out

compartment syndrome

Plantar fasciitis

-presents as

-pathophys

-usually from

-diagnosis

-exam shows

-tx

Presents as heel/plantar pain that is worse in the morning and gets better throughout the day 

Inflammation of plantar aponeurosis 

Usually form overuse 

Clinical diagnosis and improves within 1 year 

Exam shows TTP of plantar surface that worsens with dorsiflexion of toes. Medial calcaneus tenderness 

tx: conservative, heel/arch support, stretching exercises. Steroid shots if refractory. 

Morton neuroma

due to

sxs

exam shows

confirm clinical diagnosis with

tx

Due to mechanical injury. Running or high heels 

Causes burning pain and numbness of foot 

Exam shows pain and clicking sound (Mulder sign) when pressing 3rd and 4th metatarsal joints +/- small palpable mass 

Confirm clinical diagnosis with US or MRI 

Tx: hard-sole footwear, injection/surgery for refractory 

Stress fracture

-where affected

-caused by

-exam shows

-imaging

-treatment

Mid foot pain, 2nd metatarsal most affected but also 5th metatarsal 

From repetitive tension, associated with dramatic increase in physical activity 

Exam shows tenderness over mid foot and pain with use of flexion/extension, subsides with rest 

Imaging: XRAY is normal initially. Positive after 2-3 weeks, frequently missed. MRI and CT more sensitive in early stages 

Treatment: conservative, hard-sole footwear, walking bottoms if 5th toe involvement 

Jones fracture

-fracture desciption

-happens with

-exam findings

-dx

-tx

-complications

Fracture between metaphysic and diaphysis of 5th toe 

Happens with ankle sprains in dancers 

TTP lateral base of 5th metatarsal, pain with use 

XRAY diagnostic 

Tx: if nondispaced- cast and non weight bearing. If dispalcement- sx 

Complication of nonunion and avascular necrosis (watershed zone) 

Back pain pathway

incomplete sadly

DDD

-Radiology

-Tx

Spinal Stenosis

-secondary to ____ causing

-pain better with

-pain worse with

-Diagnosis

-Tx

Secondary to arthritic changes, causing nerve compression 

Common in middle age and older adults 

Pain better with leaning forward 

Worse with standing and walking 

CT/XRAY to confirm. MRI can help r/o herniation 

Tx: conservative, NSAIDS 

tx cauda equina syndrome with

immediate surgical decompression because it can quickly result in permanent neurologic injury

Cauda Equina Syndrome

-def

-trauma can damage

-SXS

-Tx

Compression for specific nerve roots

Brachial Plexus

Brachial Plexus

-site of injury

• Erb-duschenne palsy

• Claw hand

• Wrist drop

• Deltoid paralysis

• Klumpke palsy

Erb-Duchenne palsy: Superior trunk 

Claw hand: Ulnar nerve 

Wrist drop: posterior cord/ radial nerve 

Deltoid paralysis: Axillary nerve 

Klumpske: posterior or medial cords (horanghae)

OP

-presentation

-prevention

-Tx

OP asymptomatic until fracture (eg. Colles, femoral, neck, and veterbral) and neuromuscular impingement occur 

Prevention: 

-Exercise

-Calcium 

-Vitamin D 

Tx: 

-Bisphosphonates 

-SERM Raloxifene 

-pulsatile teriparatide (recombinant human PTH) for 2 years 

OP is less likely to occur in

Hormone and electrolyte levels will be ____ for age in OP unless _____

XRAYs will only show changes in OP bone _____

hormone replacement therapy is no longer considered acceptable for OP prevention because

Osteopetrosis

-Pathophys

-sxs

-Labs

-Tx

Increased bone density d/t impaired osteoclast activity 

Fx, blindness, deafness, neuro sxs, impaired fracture healing 

Labs: decreased H/H, increased acid phosphatase, increased CK 

Tx: marrow transfusion, activity restriction 

Paget Dz of bone

-pathophysiology

-Symptoms

-Labs

-Radiology
-Tx

Overactive osteoclasts AND osteoblasts= excessive bone turnover and disorganized bony architecture 

asxs, bone pain, fractures, tibial bowing, increased head size, deafness, kyphosis 

Labs:

• increased alkaline phosphatase,

• increased urine hydroxyproline,

• normal calcium and phosphorus 

Radiology: osteolytic lesions and hyperdense bone with hot spots of active disease 

tx: bisphosponates, calcitonin 

Next step: “my hat no longer fits”

workup for paget disease of Osteopetrosis

Osteogensis imperfecta

-Tx

-activity restriction 

-surgical correction of bony misalignment 

-bisphosphonates decrease fx risk 

Next step: allopurinol should NOT be administered in _____

Gout

Joint aspiration shows:

Treatment:

Joint aspiration shows: 

-needle shaped

-negatively birefringent crystals 

-several white blood cells 

Tx: 

-NSAIDS, colchicine, corticosteroids

-Decrease ETOH and diuretic use 

-avoid foods high in purines (red meats, fish) 

-Allopurinol or probenecid if chronic to prevent flare-ups 

Podagra rules out _______ and suggests a diagnosis of ______

Pseudogout

-def

-famillial condition assoicated with

-SXS

-Labs

-Radiology

-Tx

Septic Joint and Septic arthritis

-most commonly occurs through

-most commonly caused by

-Consider gram ____ in patients with DM, cancer, or other underlying disease

-Pre-existing arthritis increases

-SXS

-Labs

-Tx

the bodys inflammatory response to bacteria in the joint is the cause of _____ in joint sepsis

Because the inflammatory response to ______ is not as severe as the other bacteria ______

Although S. aureus is the ______ cause of ______ in general Salmonella is the ______ cause of patients with ______

Pseudomonas osteomylitis is more common in

Osteomyelitis

-def

-bacteria

-SXS

-Labs

-Joint aspiration findings in OA/Trauma, Inflammatory arthropathies, septic joint

-radiology

-tx

-complications

Lyme disease

-cause

-SXS

-Labs

-Tx

RA

-def

-patho

-most commonly seen in

-joints affected

-SXS

Labs

RA

-Radiology

-Tx

Next step: check ____ to screen for latent TB before starting ____

SLE

-def

-AB mediated cellular attack occurs with

-RF

-Drugs to discontinue

-SXS

-Labs

-Tx

-Complications

Weakness is a sxs of ____ but not ______

Polymyositis and Dermatomyositis

-def

-RF

-SXS

-Labs

-EMG

-Tx

-Complications

Pts with PMR will frequently experience

PMR

-def

-SXS
-Labs

-Radiology

-Tx

Next Step: Once PMR has been diagnosed, the patient should

Scleroderma

-Def

-SXS

-Labs

-CREST

-Tx

-Complications

MTCD

-Tx

MCTD tx: 

-NSAIDS

-Corticosteroids

-ACE-I

-Supportive measures 

Sjogren

-def

-can be seen in assoication in

-SXS

-Labs

-Tx

____ syndrome is sjogren syndrome WITHOUT ____

Next step: any pt with a new bone tumor should

Tumors that mets to bone pneumonic

Bone mets

-most common

-can result from

-SXS
-Labs

-Radiology

-Tx

Osteosarcoma

-def

-most frequently invovle

-RF

-SXS

-Labs

-Radiology

-Tx

-Complications

Ewing Sarcoma

-def

-SXS

-Labs

-Radiology

-Tx

-Complications

What is concerning for malignant bone lesion

Osteocondroma

-most common

-typically occurs in

-SXS

-Radiology

-TX

-Complications