hi everyone today we'll be doing a high yield msk review like the previous videos I'll be mentioning a vignette take a few seconds to pause try to guess the answer and let's get started so first we'll be doing some muscle injuries so the first one is the most common rotator cuff injury there's going to be trouble abducting the arm the first 15° and there's an abnormal empty and full can test so this is a supraspinatus muscle injury and remember the nerve that innervates this muscle is the suprascapular nerve next the patient's going to have trouble abducting 15 to 90 degrees so this is a deltoid muscle injury and remember that axillary nerve innervates this muscle next the patient's going to have trouble abducting over 90 Dees and asymmetry of the shoulder blades after a chest tube placement or a breast surgery so this is a serratus anterior muscle injury and we call this winged scapula and remember the nerve here that innervates the muscle is the long thoracic nerve and and remember the roots are C5 6 and 7 next we're going to be talking about nerve injuries so this one is affected in a fracture of the humorous neck and it causes loss of sensation to over the deltoid region and the lateral arm so this is an axillary nerve injury and remember the artery that runs with it is the posterior circum Flex next a patient's going to fracture the humorous mid shaft and they develop a wrist drop so this is a radial nerve injury and it's associated with the Deep brachial artery next we're going to have a fracture of the distal humoris at the suond region and there's a loss of sensation over the thear Eminence and the lateral three and a half fingers so this is a medial nerve injury and remember this one is going to run with the brachial artery next a baby's going to have an arm that's abducted medially rotated extended and pronated and it's due to a C5 C6 injury so this is called herbs py next someone's going to develop a claw hand after upward first during childbirth or an adult grabbing a tree branch during a fall and this is due to a C8 to T1 injury and this is called clumpies py and this is associated with a lower trunk injury versus herbs py is an upper trunk injury next we're going to have atrophy of the hand muscles an extra cervical rib often seen on Imaging and compression of the scaling muscles so this is thoracic outlet syndrome next a patient's going to fall on outstretched hand they're going to have pain by the thumb and it can cause avascular necrosis and this is a scaffo fracture so this is the most common fracture um of the U bones in the hand and remember the thumb side of the hand is called the thear side and another important thing is that the pain in this region by the thumb is called the anatomic snuffbox and we often have pain in this area when the scaffo is fractured next we have somebody who injures their hand after a fall and then develops carpal tunnel syndrome so this is a lunate dislocation and remember harpal tunnel syndrome is explained by pain and numbness to the first three digits and then you can also have um issues with abduction and opposition of the thumb next the patient is unable to extend the medial two fingers and this is due to an ner claw caused by a distal oler nerve nerve injury now we have a patient that can't close their lateral fingers when trying to make a fist so this is Hand of benediction due to a proximal median nerve injury next we have a patient that can extend their lateral fingers so this is median claw due to a distal median nerve injury and then we have a patient that can't close the medial fingers when trying to make a fist so this is the okay gesture caused by a proximal olar nerve injury now remember in distal nerve injuries were're trying to get the patient to extend their digits and issues here cause claw hands versus in proximal injuries you're trying to get the patient to flex and make make a fist okay and remember issues with the lateral fingers are going to be due to median nerve injuries and issues with the medial fingers are due to nner nerve injuries next we have a nerve that's affected where you get burning tingling in the suprapubic region after abdominal surgery so this is the iloh hypogastric nerve being affected next we have a nerve injury that leads to decreased sensation to the medial and anterior thigh and an absent cremasteric reflex so this is the genital femoral nerve next we have a female with high BMI that has decreased sensation to the anterior and lateral thigh so this is the lateral femoral cutanous nerve and remember here often people who are more obese wear tight clothing um it can compress this nerve and lead to um decrease sensation in the anterior and lateral parts of the thigh next we have a patient who's unable to extend the leg after a car accident which causes anterior hip dislocation the patient's going to have decreased patellar reflex and the leg is externally rotated so this is the femoral nerve being affected next we have a patient with lower back pain radiating down one leg after a posterior hip dislocation and the leg appears shorter and internally rotated so this is the sciatic nerve next we have trauma to the lateral leg and now the patient is unable to pick up the foot while walking or feel the top of the foot so this is the common fibular peronal nerve that's affected and remember this nerve runs through the lateral leg um where the fibular neck is and so injuries to this region can lead to the issues with iversion dorsy flexion and sensation to the dorsum of the foot next we have a patient with injury to the knee or to the angle and now they're unable to stand on the tiptoes or feel the solar of the foot so this is a tibial nerve injury so remember things like knee trauma Baker cyst and then also if the tarsel tunnel is affected uh lower down um these can all affect the tibial nerve and you get issues with inversion planter flexion of the foot and sensation is going to be lost at the sole of the foot which is the bottom part of the foot okay and the tip fial nerve and the last one we talked about the common fibular peronal nerve are branches of the sciatic nerve next we have a patient given an injection to the superior medial Glu region and standing on one leg leads to the pelvis dropping to the opposite side so this is a superior gluteal nerve injury and remember this finding of standing on one leg um is called the Trendelenburg sign okay and so the pelvis drops to the opposite side uh of the nerve injury and so uh to prevent damage to this nerve remember that you want to inject in the lateral quadrants of the glutes to prevent the nerve from getting damaged next we have a patient with a posterior hip dislocation that develops difficulty climbing the stairs so this is an inferior Glu nerve injury next we have a patient with decreased sensation to the genital area after childbirth and a nerve block uh that we do we use an isial spine for the landmark for the injection so this is the pendal nerve um and so remember that the pendal nerve block is used during childbirth um and the isal spine is used as a landmark okay and injury to this area leads to loss of sensation in the perenium and the genital area and it can also cause feal and urinary incontinence if the external sphincters are damaged um next we have a patient with knee pain during soccer and the increased gliding of the tibia when the leg is pulled forward so this is a ACL injury next we have a patient who has injury to the knee and increased gliding of the tibia when the leg is pushed backwards so this is a PCL injury okay so for ACL injury we use the anterior drawer sign and for PC injury this is the posterior drawer sign next we patient with knee injury and medial space widening of the tibia when you apply lateral Force so this is an MCL injury next we have a patient who also has a knee injury but this time they have lateral space widening of the tibia with medial Force applied this is an LCL injury next we have a patient who has pain and popping on internal rotation and Varys Force so this is a lateral meniscal tear next we have a patient who has pain and popping on external rotation and valgus force so this is a medial meniscus tear next is the most common ligament affected in an ankle sprain this is the anterior ior taof fibular ligament next we have someone who comes in with pain on the inner part of their elbow that's worse with repetitive wrist flexion like pling golf so this is medial epicondilitis and this is also known as golfer's elbow next we have a patient who has pain on the outer part of their elbow that's worse with repetitive wrist extension like playing tennis or B adinton so this is lateral epicondilitis also known as tennis elbow next there's a child who has shoulder drop after a fall so this is a clavicle fracture now remember in clavicle fractures the proximal part is pulled up by the sternomastoid and trapezius muscles and the distal part is depressed due to the deltoid muscle next we have a patient who has wrist pain after a long bike ride and there's damage to the hook of hamate so this is guong Canal syndrome which is an aler nerve compression next we have a patient with numbness and pain in the first three digits loss of thumb abduction and opposition I fenar atrophy and percussion of wrist or flexion of the wrist causes tingling which are known as positive tinel and Fallon tests so this is carpal tunnel syndrome and remember this is where the median nerve is entract and it causes the nerve compression leading to these symptoms and you can see this in pregnancy rheumatoid arthritis hypothyroidism so a lot of different conditions um even such as repetitive use um of the hands can cause carpal tennel syndrome as well next we have hand pain after punching someone in the face so this is a fifth metacarpal neck fracture also called boxers fracture so this is where you have a direct blow with a closed Fist and you injure the fifth metacarpal neck next you have somebody with sudden knee pain and swelling after injury in a soccer game and three things happen here there's an ACL injury medial meniscus injury and an MCL injury this is an unhappy triad next we have a painter or a maid who gets swelling in pain in front of the kneecap so this is callede prepatellar btis and it's due to repetitive trauma or pressure from excessive kneeling which is why painters and Maids often get these uh symptoms next we have swelling behind the knee in a patient with osteoarthritis or rheumatoid arthritis and it can lead to tibial nerve injury so this is a popal or Baker cyst and just to connect to the last condition that we saw with a tibial nerve injury you have issues with inversion and planter flexion next a new mother gets thumb pain worse with movement and physical exam reveals radial styloid tenderness so this is decrane tenosinovitis and people that use their thumbs a lot like new mothers lifting their babies thumb textur sports players can all get this r medal styloid tenderness next we have a patient with swelling on the wrist or ankle that trans illuminates and it arises from degeneration of the periarticular tissue so this is a gangan cyst okay and often this condition just resolves spontaneously and the key thing here is that it trans illuminates next we have a runner Who develops lateral knee pain so this is ilot tibial band syndrome next we have a patient who has severe pain after a bone fracture and you can't feel the pulses the skin is pale and there's numbness so this is called limb compartment syndrome and it's due to increased pressure in the fascial compartment okay and so this can block blood flow and lead to these Sy symptoms and we call it the five PS usually which stand for pain poar paresthesia pulselessness and paralysis next we have a patient with heel pain worse with First Steps in the morning or after sitting for a long time so this is plantar fasciitis and it's inflammation of the plantar aerosis that causes these symptoms next we have Facial Pain and a headache that worsens when opening the mouth so this is a TMJ disorder so the temporo mandibular joint often uh is inflamed or injured and sometimes you hear a clicking when the person's chewing and it can lead to symptoms such as facial pain and headaches next we have a child that starts crying after the parent picks them up and they're holding their arm close to the body in a flexed and pronated position so this is the radial head subluxation also called nursemaid's elbow and when you suddenly pull on the arm of a child the annular ligament slips over the head of the radius um and it causes a lot of pain to the child and they have these symptoms next we have an athletic child that has knee pain and there's tenderness over the tibial tubercle and it's often due to quadriceps overuse so this is called osid Schlatter disease and the key word here is the tibial tubercle tenderness next we have a young female athlete who presents for anterior knee pain so this is called patellofemoral syndrome next we have a newborn baby that has a clunk on hip physical exam and the diagnosis is confirmed with ultrasound so this is called developmental dysplasia of the hip and it's due to abnormal acetabulum development in newborns and so the hip has this instability and dislocation and you can hear this clunking sound on physical exam next we have a child with hip pain and a limp and it's chronic and the initial x-ray can be normal so this is leg calv prse and it's due to idiopathic avascular necrosis of the femoral head next we have an obese child with hip or knee pain and the X-ray shows the epiphysis displaced relative to the femoral neck it looks like an ice cream slipping off the cone so this is called slipped capital femoral epithesis so usually the mention a chubby kid who has some sort of pain and you want to think about this condition next we have a patient with short arms and legs a normal siiz head it's an fgfr3 activation mutation and multiple family members are affected so this is acondroplasia okay remember the fgfr3 gain of function causes um inhibition of the condres which then prevent our extremities from growing so um you know it's an autosomal dominant mutation and the patients present as these dwarfs okay next we have an old frail lady with severe pain after a mild fall with normal calcium and phosphate levels so this is osteoporosis next we have a patient that has thick dent bones that are prone to fractures due to defective osteal classs so this is osteopetrosis okay the osteoclasts aren't working and so there's abnormal bone resorption that lead to these really thick bones um and here a bone marrow transplant is potentially Curative because the osteoclast are derived from the monocytes in the bone Mar nrow next we have an adult with weak bones and fractures and Labs show low calcium and high pth levels so this is osteomalacia also known as vitamin D deficiency okay and it leads to lack of mineralization of the bones which lead to these really weak bones next we have a child with bod legs prominent rib points a soft skull and the labs show low calcium and a high pth so this is called rickets okay so if a child has vitamin d deficiency we call it rickets if an adult has vitamin d deficiency we call it osteomalacia next we have a male with trouble hearing his hat doesn't fit anymore he has a high Alp and it increases his risk of high output heart failure and osteosarcoma so this is Petes or ositis deformans next you have a patient that has sickle cell disease or a patient on steroids or an alcoholic who presents with hip pain and there's medial femoral circumflex artery insufficiency so this is avascular necrosis of the femoral head next we have a patient who's a young male with bony projection of the metathesis and it's covered by a cartil enous cap so this is osteochondroma next we have a male with bone pain that's worse at night and it's relieved with Neds so this is osteoid osteoma next we have a young male with bone pain that's not responsive to nids so this is osteoblastoma and they always like to compare osteoid osteoma and osteoblastoma because it's very similar but look out for the response to nids and also osteoblastomas tend to be larger than 2 cmers in size versus Osteo osteomas are smaller next we have a benign tumor of cartilage in the hands and feet so this is a chroma next we have a patient who has knee pain and imaging shows a soap bubble appearance so this is a giant cell tumor next we have a child with retinol blastoma seen by a loss of the red reflex in the eye now they develop bone pain or we could have an elder male with pet Who develops bone pain it's often due to RBP 53 mutation and imaging is going to show a Codman triangle or a Sunburst pattern so this is osteoar coma next we have a tumor at the diaphysis X-ray shows onion skinning pattern there's a transcation of 11:22 and hystology is going to show small blue cells so this is Ewing saroma next we have a middle-aged female with over an hour of morning stiffness symetric joint pain allar deviation of the hand lumps on the hand or arm and imaging shows erosion of the bone so this is rheumatoid arthritis this is an autoimmune condition and the antibodies here are rheumatoid factor and anti-ccp next we have an elder female with joint pain worse with activity bone deformity of the dip and pip hand joints and imaging is going to show joint space narrowing subchondral sclerosis and osteop FY so this is osteoarthritis and the bone deformities of the dip and pip we call those buard and heans nodes okay and this is due to overuse so we often see it in Elder patients and it gets worse with more activity next we have a patient with sudden pain and swelling in the big toe we see needle-shaped negative biof fringing crystals and first we treat the pain with nids and then we give alopurinol which is a zanthin oxidase inhibitor for long-term treatment so this is Gilt then next we have a patient with hemocromatosis who develop sudden pain and swelling of the knee and we see rhomboid shaped positive borrent needles so this is CP PPD calcium pyrro phosphate deposition disease also caused pseudo Gilt and it tends to sometimes affect patients with liver issues and here they like to compare Gilt and pseudo gelt so remember the shape of the needles here those are very important next we have a patient with middleaged complaining of increased need for eye drops and new dental cavities and it increases the risk of lymp so this is shogren syndrome and remember this is a autoimmune condition and they have antibodies against SSA and SSB also called row and la and they get dry eyes dry mouth and on histology you see a lot of lymphocytes because it's an autoimmune condition and over time this inflammation can cause lymphomas next we have a patient with a red hot swollen knee a fever and increased white blood cell count so this is septic arthritis next we have a patient with joint pain silver scaly plaques on the elbows and knees as well as nail pitting so this is psoriatic arthritis next we have a patient who has joint pain after recent sore throat and fever and they have trouble seeing and urinating so this is reactive arthritis um and this condition tends to happen after some sort of infection and then you can't see you can't pee and you can't climb a tree known as the conjunctivitis urethritis and the arthritis next we have a 22-year-old patient with low back pain that resolves with movement an x-ray of the sacral spine shows fuse vertebra so this is anoing spondilitis okay and the Imaging findings are also known as bamboo spine and something really important here is that you want to monitor chest expansion to assess the disease severity next we have a 33y old female with joint pain and a facial rash and Labs show low hemoglobin and high binning creatinin so this is systemic lupus orthosis and very high yield it's going to be these females that tend to get uh joint pain the malow rash it can also have a lot of other symptoms as well because it's very widespread um you can get renal issues photosensitivity ulcers a carditis so if you see like a bunch of random symptoms um usually in like a female uh tend tend to think of Lupus for this okay and remember you get antibodies against double stranded DNA um Smith antibody antiphospholipid antibody Ana antibody can be positive so look out for those features next you have a patient with recurrent pregnancy loss and they develop a new um DVT in the leg and they have a high PTT so this is called antiphospholipid syndrome next you have a patient with stiffness in the shoulders and hips High ESR and CRP and it quickly resolves with steroids so this is polymyalgia rheumatica and remember here it can also be associated with giant cell temporal arteritis next we have a 45-year-old female with chronic pain in the neck Shoulders Knees and feet and they've had a hard time sleeping so this is Fibromyalgia it's really common in females who are like aged 20 to 50 and it's like a very chronic widespread msk pain sometimes they'll mention the patients have tender Point stiffness in these areas so just look for very chronic widespread pain next we have a patient who has trouble walking up the stairs and getting up from a seated position and there's endom mesial inflammation so this is polymyositis next we have a patient who has trouble walking upstairs and getting up from a seated position and they also have a skin rash now and there's perial inflammation so this is dermatomyositis and remember these two conditions have a high CK level okay the differen is here is that polymyositis just affects the uh proximal muscles versus dermatomyositis affects the proximal muscles as well as um the skin as well and in polymyositis you have inflammation with cd8 te Cells versus dermatomyositis you have inflammation with the CD4 te cells okay so look out for those key features that differentiate them and remember proximal muscle weakness is typically in your shoulders and your hip so you know combing your hair could be a symptom getting up from a seated position could be a symptom so look out for those features in the vignette next we have a patient that develops a painful lump in the muscle after getting injured in a soccer game so this is myositis oans and here you get an injury and then bone develops in the muscle and it develops this painful soft tissue Mass next we have muscle weakness wors with repetitive activity and at the end of the day there's double vision and drooping of the eyelid so this is myasthenia gravis okay remember antibodies form against the post synaptic acetylcholine receptor and it can also be associated with a thymoma next we have an elder male smoker with weight loss and a chronic cough who now develops muscle weakness that improves with activity so this is Lambert Ean syndrome and here we have antibodies against the preoptic calcium channels okay and this is associated with small cell lung cancer next we have a patient who's 45 years old they develop heartburn after eating and their fingers turn blue in the [Music] cold so this is Scleroderma and remember the difference between Crest syndrome versus uh Scleroderma is that Crest syndrome just has the calcinosis the rain noes phenomenon the esophageal this motility the sclerodactyly and the telangiectasias versus if you have other symptoms that are you know affect different parts of your body we call that diffuse scleroderma and in Crest syndrome we have um an antibody against anti-centromere versus in diffus Scleroderma you have antibodies against Scleroderma 70 also known as topoisomerase antibody okay so look out for those features and when the fingers turn blue we call that rodde phenomenon thank you so much for for watching I hope you found this helpful like always like comment share and subscribe reach out if you have any questions and I will be posting the Dermatology uh presentations very soon thank you so much we'll see you again good luck studying everyone