Clin Med Final- High Yield MSK / Autoimmune Disorders / Seronegative Spondylopathies

DIPs and PIPs mostly progressive and irreversible loss of articular cartilage

osteoarthritis

MC places of osteoarthritis

knees hips lumbar spine hands

sx of osteoarthritis

stiffness first thing in the morning that gets better in < 15 mins and gets worse with movement

Heberden's nodules are found at the

DIP (Herbert likes the dip)

Bouchard nodules are found at the

PIP

osteoarthrits of the foot is found at

1st MTP joint

medial loss of knee cartilage making the knee point out

genu varum

(think var=far so they point out)

lateral loss of knee cartilarge making the knees point in

genu valgus

fluid filled cavity of the posterior knee

bakers cyst

what imaging findings are seen with osteoarthritis

joint space narrowing

sclerosis

osteophytes (bone spurs)

tx of osteoarthritis

topical NSAIDS (voltaren gel)

loss of bone density (think older lady presenting with vertebral fx)

osteoporosis

in osteoporosis rate of bone _____ is normal while rate of bone ____is increased

formation normal

reabsorption increased

(blasts cant keep up with clasts)

what population carries the disease burden of osteoporosis

postmenopausal women

osteoporosis is typically asymptomatic until ___

fracture

long term use of ____can lead to osteroporosis

corticosteroids

all postmenopausal women over 65 and men over 70 and post meno women with RF <65 should recive what scan

DEXA

__ score measures how much above or below you are compared to a healthy 30 y/o person

T score

>/= -1 is

normal

-1 to -2.4 is

osteopenia

<-2.5 is

osteoporosis (severe if with fx)

tx of osteoporosis

adequate vitamin D and Ca intake

smoking cessation

a vertebral fx is a dx of osteoporosis and is an indication for pharm treatment with ___

bisphosphates

people should only use bisphosphonates for how long

5 yearrs

what patient education would you give to someone starting on bisphosphonates

take on empty stomach with 8 oz h20 and sit upright for 30-60 mins before eating

which bisphosphonate only prevents vertebral fx

Ibandronate

what could help decrease the risk of developing osteoporosis in females

estrogen

patients treated with _____ for osteoporsis should be treated indefinitely or transition to another med before d/c

denosumab

tx for achillies tendonitis

RICE

PT

tx for achillies tendond rupture

surgical if younger

immobilize and rehab if older

deltoid ligaments of the ankle are ____

medial

tibia is

medial (tibia towards)

fibula is

lateral (fibula far)

salter harris classification is for

growth plate fractures

salter harris type 1

physis only

salter harris type 2

physis and metaphysis

salter harris type 3

physis and epiphysis

salter harris type 4

all three

salter harris type 5

crush injury

jones fracture is a fx of the

5th metatarsal

lisfranc injury is

axial load on plantar flexed foot think dancer tumbles

what is known as the weekend warrior injury

Achillies tendonitis (chronic overuse)

MC ankle sprain

Lateral sprain from inversion injury

PIP flexion deformity of the foot

hammer toe

DIP flexion deformity of the foot

mallet toe

bone breakdown of the foot often caused by diabetic neruoupathy

Charcot foot

nerve irritation between 3rd and 4th MT heads feels like walking on a marble common in women wearing tight shoes

mortons neruoma

pelvic fx most commonly happen at the

pelvic ring and acetabulum

proximal femur fracture of the ________ is bad bc it disrupts blood flow and has higher incidence on nonunion and osteonecrosis

femoral neck (intracapsular)

a displaced femoral fracture will be

externally rotated

ABducted

and shortened

tx of a femur fracture

ORIF (open reduction internal fixation)

femoral shaft fractures are often due to

high energy trauma

tx of a femoral shaft fx

intramedullary nail(surgery)

which type of hip dislocations are most common

posterior (femoral head displaces from the acetabulum)

posterior hip dislocation results in the limb being

Shortened

Flexed

ADDucted

Internal rotation

treatment for hip dislocations

reduce ASAP

plain films first to r/o other fx

what is most important complication of hip dislocation

osteonecrosis of femoral head

what is the most common cause of lateral hip pain

greater trochanteric pain syndrome (trochanteric bursitis)

lateral hip pain near the greater trochanter that is worse with ambulation, prolonged standing, direct pressure., see tenderness on palpation of the greater trochanter,

trochantieric brusits

treatment of trochanteric bursitis

NSAIDS

PT

Steroid injectuoin

progressive displacement of the upper portion of the femur that occurs in relation to the capital femoral epiphysis (think adolescent kiddo with a limp)

slipped capital femoral epiphysis

SCFE is associated with

hypothyroidism,

pain in SCFE is localized to the

groin and anterior thigh

patient with SCFE is often

obese

and has loss of internal hip rotation

commonly presents with chronic limp that has gradually developed over several weeks

imaiging of choice for SCFE

AP and frog leg lateral plain films

treatment for SCFE

stabalize physis

single screw stabalzition

avascualr necorsis of the femoral head is a complication of

trauma

heavy etoh use

glucocorticoids

boys age 4-8 with unilateral pain and limping for 3-6 weeks worse with activity and restricted range of motion with ABduction and internal rotation

Legg calve perthes disease (refer them)

legg calve perthes disease shows what on imaging

crescent sign

developmental dysplasia of the hip is usually seen in PE findings when

right after birth

kiddos with developmental dysplasia of the hip often have

gait disturbance or limp

attempt to posteriorly displace the hip (positive if clunk heard as femoral head displaces) is what maneuver

Barlow Maneuver

attempted to relocate after displaced (positive if clunk as it slides back into acetabulum)

Ortolani maneuver

(think "O" for original position--> putting it back where it belongs)

maneuver better for older kids with pt positioned with knees in are and feet planted behind butt

affected knee will be lower due to displacement

Galeazzi

treatment for developmental dysplasia of the hip

ABduction device until 6 mo

closed reduction and spica test if brace fails

"funnel chest" (sternal depression) associated with marfans, ehlers danlos

pectus excavatum

pigeon chest (protrusion deformity) typically worsens with adolescence

pectus carinatum

what muscles make up the rotator cuff muscles

SITS

supraspinatus (posterior)

Infrapinatus (posterior)

Teres minor (posterior)

Subscapularis (anterior)

inflammation of the sub acromil bursa and underlying rotator cuff tendons from repetative overhead movements

impingement syndrome

sx of impingement syndrome

dull achey pain worse with overhead movements difficulty sleeping

what special test is positive in impingement syndrome

painful arch test

what special test is negative in imingement syndrome

drop arm test

if the drop arm test is positive what are we concerned for

a tear

what is the treatment for impingement syndrome

NSAIDS

subacromial joint injection

standard imaging series of the shoulder

AP

Scapular Y

Axillary views

what muscle is MC torn in a rotator cuff tear

supraspinatus

what special tests are positive in a rotator cuff tear

drop arm

external lag

painful arc

what imaging confrims the dx of a rotator cuff tear

MRI w/o contrast

treatment for a rotator cuff tear

surgery if large

direct impact to the superior and or lateral aspect of the shoulder while it is in ADduction

AC separation

in grade 3 AC separations and higher what deformity is noted

step off deformities

sx of an AC seperation

ABduction hurts

pain at the AC joint

tx for grades 1-3

sling

tx for grades >3

ortho refer for surgery

what type of shoulder dislocation is the most common

Anterior

in an anterior shoulder dislocation what position would the arm be in

ABduction

External rotation

("anterior ABE)

in a posterior shoulder dislocation what position would the arm be in

ADduction

Internal rotation

in an inferior shoulder dislocation what position would the arm be in

above head

what Xray views should be obtained for a shoulder dislocation

axillary and scapular y

what is the treatment for a shoulder dislocation

closed reduction and sling for 5-10 days