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ACL
ACL
ACL
Injuries to the anterior cruciate ligament (ACL) are common in young athletes, especially women who participate in noncontact sports requiring rapid direction changes or pivots on the lower extremity (eg, soccer, basketball, tennis). ACL tears can also occur in high-conta
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Medicine
Medicine
Todos
- tolearn
- MKSAP todos
- heart murmurs
Organ Systems
- Allergy and Immunology
- Rheumatology
- Cardiology
- Dermatology
- Endocrine
- ENT
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- Hemeonc
- ID
- MSK
- Nephrology
- Urology
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- Pulmonology
- Podiatry
Subject Areas
- General
- Biostats
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- [[Geriatric
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Osgood Schlatter
Osgood Schlatter
Osgood Schlatter
- patient: adolescent male athletes. Early adolescence (typically ages 13-14 for affected males, and ages 10-11 for affected females)
- pathogenesis: This condition is caused by chronic/repetitive strain at the insertion of the patellar tendon on the tibial tubercle and is seen in pre-adolescent and adolescent patients undergoing rap
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Carpal Tunnel
Carpal Tunnel
- related: MSK
- tags: #msk
Symptoms of CTS are frequently worse at night and can be exacerbated by repetitive/sustained hand movements (eg, knitting). Preservation of sensation over the thenar eminence is highly indicative as the palmar sensory cutaneous branch of the median nerve goes over, not through, th
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Patellofemoral Pain
patellofemoral pain
- Patient population: common cause of knee pain in young athletes and predominantly affects women.
- Pathogenesis: chronic overuse or malalignment (eg, angular deformities, weakness of hip abductors) but can also be seen acutely following trauma.
- Sx:
- aching sensation and worsened by activities such as squatting or climbing stairs. Also
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Pes Anserine Bursitis
pes anserine bursitis
Pes Anserine Bursitis
- aka anserine pain
- patient:
- pathogenesis: PAPS can be caused by an abnormal gait, overuse, or trauma.
- Sx: pain and tenderness at the anterior medial knee distal to the joint line, often exacerbated by pressure from the opposite knee while lying on the side.
- Dx: Examination shows a well-defined area of tenderness ov
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Rhabdomyolysis
rhabdomyolysis
- related: MSK
- tags: #msk
This patient with a recent stroke, who was found confused and incontinent, has developed acute kidney injury (AKI); urinalysis shows 4+ blood in the absence of red blood cells (RBCs). This presentation suggests rhabdomyolysis likely due to seizure.
Rhabdomyolysis is characterized by the release of intracellular muscle contents into the circulati
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Septic Arthritis
septic arthritis
- related: MSK, ID, pediatric septic arthritis, osteomyelitis, prosthetic joint infection, notes, arthrocentesis
Causes
Septic arthritis is an infection of the synovial joint space.
Septic arthritis can occur through hematogenous spread, local extension, or direct inoculation (trauma).
- S. aureus: most common, more than 50% of cases
- chil
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Shoulder Pain Ddx
shoulder pain ddx
- folder: MSK
- related: shoulder pain tests, 02 Shoulder
aehesive capsulitis
This patient's clinical features – shoulder pain with decreased active and passive range of motion (ROM) – are most consistent with adhesive capsulitis (AC) (frozen shoulder syndrome). AC can be idiopathic or secondary to underlying
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Shoulder Pain Tests
shoulder pain tests
- related: MSK, shoulder pain ddx
Supraspinatus and infraspinatus
Supraspinatus examination (“empty can” test). The patient attempts to elevate the arms against resistance while the elbows are extended, the arms are abducted and the thumbs are pointing downward.
Infraspinatus/teres minor examinatio -
Tibial Stress Fracture
tibial stress fracture
- related: MSK
- pt: vigorous running regimen, runners, ballet dancers, military recruits, soccer/basketball players
- cause: increase in tension/compression without adequate rest
- sx:
- lower leg pain, tibial tenderness
- initial: medial tibial stress syndrome (shin splints), no tibial tenderness
- later: fracture, tenderness on palpation
- diagnosis:
- pain at area of stress, local swellin
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Olecranon Bursitis
olecranon bursitis
- related: MSK
- tags: #msk
Overview
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pt:
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cause:
- overproduction of bursa fluid
- mechanical: pressure, friction, overuse
- inflammatory: autoimmune (RA)
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sx:
- acute elbow pain with localized swelling
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dx:
- aspiration to differentiate septic from sterile
Septic olecranon bursitis is common, and can be due to direct bacterial seeding of the bursa or extension from a local cellulitis. Staphylococcus aureus is the m
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Osteomyelitis
osteomyelitis
- related: MSK
- tags:#note
Wong D, Holtom P, Spellberg B. Osteomyelitis Complicating Sacral Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy. Clin Infect Dis. 2019;68(2):338–342. Doi:10.1093/cid/ciy559
This patient with sickle cell disease (SCD) has fever, f
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Prosthetic Joint Infection
prosthetic joint infection
- related: septic arthritis, MSK, ID
Prosthetic Joint Infection
Prosthetic joint infection -
Back Pain 12 2020 Note
back pain 12 2020 note
- related: MSK
Approach to back pain
- Is it really back pain
- How worried spinal urgency/emergency
- How progressive is back pain
Red Flags
- fever
- incontinence
- night sx
- weakness, loss of sensation
- saddles anesthesia
- DIP, PIP, CMC
- worse with gripping
- As CMC joint enlarges, thumb pulls inward
 and 2 (skin tear):
- Mepilex and zinc
- Use xeroform or wet to dry if dry skin
- Stage 3: can see fat or muscle
- yellow/black tissue = dead tissue
- use Dakins BID: bleach that breaks down dead tissues
- red tissues = alive tissues
- if dry: use wet to dry or xeroform
- if wet/oozing/secretions: use aquacel AG or mepilex AG to soak up moisture. Can leave on 3 days at a time
- yellow/black tissue = dead tissue
- S
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Arthrocentesis
arthrocentesis
- related: MSK
- tags: #msk
Joint aspiration findings can help narrow the differential diagnosis of joint pain. A synovial fluid leukocyte count of less than 2,000 cells/mL is seen in patients with noninflammatory conditions such as osteoarthritis. Leukocyte counts between 2,000 and 75,000 cells/mL are seen in inflammatory conditions like rheumatoid arthritis and gout. Counts above 100,000 cells/mL suggest infectious arthritis.
This patient’s presentation is consistent with Morton's neuroma (interdigital nerve compression). This condition is common in women who wear high-heeled shoes, runners, and people with flat feet. Repetitive injury leads to painful enlargement of the plantar digital nerve between the metatarsal heads. Patients complai
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Metatarsal Stress Fracture
metatarsal stress fracture
- related: MSK
- tags: #msk
Cause
- Repetitive activities (eg, running, gymnastics, military recruits).
- Abrupt increase in physical activity. Inadequate calcium & vitamin D intake
- Decreased caloric intake.
- Female athlete triad: low caloric intake, hypomenorrhea/amenorrhea, low bone density
Symptoms
Insidious onset of localized pain. Point tenderness at fracture site.
Diagnosis
Examination shows focal poi
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Tarsal Tunnel Syndrome
tarsal tunnel syndrome
- related: MSK
- tags: #msk
This patient's clinical features suggest tarsal tunnel syndrome, which is due to posterior tibial nerve compression as it passes under the flexor retinaculum posterior to the medial malleolus. Tarsal tunnel syndrome is most common following an ankle fracture or dislocation involving the talus, calcaneus, or medial malleolus, in which scar tissue, bony spurs, or bone/cartilage fragments can compre
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Management of Vertebral Compression Fracture
management of vertebral compression fracture
- related: MSK
- tags: #msk
This patient has acute back pain and vertebral tenderness after a ground-level fall. X-ray confirms a vertebral compression fracture (VCF), likely due to postmenopausal osteoporosis. Initial management of pain following VCF may require simple analgesics (eg, acetaminophen, nonsteroidal anti-inflammatory drugs),
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Iliotibial Band Syndrome
iliotibial band syndrome
- related: MSK
- tags: #msk
This patient, with poorly localized lateral knee pain radiating to the thigh, shows typical features of iliotibial (IT) band syndrome. IT band syndrome is a common overuse injury seen most frequently in inexperienced runners, especially those starting a new or more strenuous training regimen. The exact pathophysiology is disputed, but it a
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Meralgia Paresthetica Is Lateral Thigh Pain in Obese Patients
meralgia paresthetica is lateral thigh pain in obese patients
- related: MSK
- tags: #msk
Meralgia paresthetica is a common cause of lateral thigh symptoms in obese patients. It is caused by compression of the lateral femoral cutaneous nerve at the waist and has been linked to tight-fitting clothing. Patients with mera
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