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w215 Hip fracture > bone pathology MSK questions > Flashcards

bone pathology MSK questions Flashcards

1
Q

What is Osgood schlater disease?

A
  • Pain, tenderness and swelling over the tibial tubercle
  • OSD is a very common cause of knee pain in children aged 8-15 years. It is rarely a cause of permanent impairment or disability.
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2
Q

What is Chondromalacia patellae?

A
  • Softening of the cartilage of the patella
  • Common in teenage girls
  • Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
  • Usually responds to physiotherapy
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3
Q

What is Osteochondritis dissecans?

A
  • Pain after exercise

* Intermittent swelling and locking

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4
Q

What is a Patellar subluxation?

A
  • Medial knee pain due to lateral subluxation of the patella

* Knee may give way

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5
Q

What is Patellar tendonitis

A
  • Tendonitis of the patella
  • More common in athletic teenage boys
  • Chronic anterior knee pain that worsens after running
  • Tender below the patella on examination
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6
Q

What is the definition of a Talipes equinovarus (club foot)?

A
  • An inverted (inward turning) and plantar flexed foot that is not passively correctable.
  • It is usually diagnosed on the newborn exam.
  • treatment is with the Ponseti method.manipulation and progressive casting which starts soon after birth. The deformity is usually corrected after 6-10 weeks. An Achilles tenotomy is required in around 85% of cases but this can usually be done under local anaesthetic
  • Assoc. with spina bifida
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7
Q

What is adhesive capsulitis?

A
  • Affects the shoulder
  • Also known as frozen shoulder, adhesive capsulitis is a painful and disabling disorder of unclear cause in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.
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8
Q

What is a bakers cyst?

A
  • The most common mass in the popliteal fossa, Baker cyst, also termed popliteal cyst, results from fluid distention of the gastrocnemio-semimembranosus bursa.
  • They are more likely to develop in patients with arthritis or gout and following a minor trauma to the knee.
  • Foucher’s sign describes the increase in tension of the Baker’s cyst on extension of the knee.
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9
Q

Describe an anterior shoulder dislocation?

A
  • Anterior dislocation is the most common
  • External rotation and abduction
  • 35-40% recurrent (it is the commonest disorder)
  • Associated with greater tuberosity fracture, Bankart lesion, Hill-Sachs defect
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10
Q

Describe an inferior shoulder dislocation?

A

Also called Luxatio erecta it is an uncommon form of shoulder dislocation

  • Arm held over head in fixed position with elbow flexed caused by severe hyperabduction resulting in impingement of humeral head against acromion.
  • Can cause rotator cuff tear, fracture of acromion and neurovascular injury
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11
Q

Describe a posterior shoulder dislocation?

A
  • Usually due to axial loading of an adducted and internally rotated arm
  • > 50% unrecognized initially and subsequently misdiagnosed as frozen shoulder
  • Look for Rim’s sign, light bulb sign.
  • Associated with Trough sign
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12
Q

Describe a Superior shoulder dislocation?

A

Normally as a result of extreme trauma.

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13
Q

What is Medial epicondylitis?

A
  • Also called golfer’s elbow.
  • pain and tenderness localised to the medial epicondyle
  • pain is aggravated by wrist flexion and pronation
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14
Q

What is lateral epicondylitis?

A
  • Also called tennis elbow.
  • pain and tenderness localised to the lateral epicondyle
  • pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
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15
Q

What is radial tunnel syndrome?

A
  • Due to compression of the posterior interosseous branch of the radial nerve.
  • It is thought to be a result of overuse.
  • symptoms are similar to lateral epicondylitis making it difficult to diagnose: pain tends to be around 4-5 cm distal to the lateral epicondyle
  • symptoms may be worsened by extending the elbow and pronating the forearm
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16
Q

What is Cubital tunnel syndrome?

A
  • Due to the compression of the ulnar nerve.
  • initially intermittent tingling in the 4th and 5th finger
  • may be worse when the elbow is resting on a firm surface or flexed for extended periods
  • later numbness in the 4th and 5th finger with associated weakness
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17
Q

What is Olecranon bursitis?

A
  • Swelling over the posterior aspect of the elbow.
  • There may be associated pain, warmth and erythema.
  • It typically affects middle-aged male patients
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18
Q

What is De Quervain’s tenosynovitis?

A
  • De Quervain’s tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
  • It typically affects females aged 30 - 50 years old
  • pain on the radial side of the wrist
  • tenderness over the radial styloid process
  • abduction of the thumb against resistance is painful
  • Finkelstein’s test
  • treat with analgesia and steroids
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19
Q

Describe Osteoarthritis?

A
  • Pain exacerbated by exercise and relieved by rest
  • Reduction in internal rotation is often the first sign
  • Age, obesity and previous joint problems are risk factors
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20
Q

Describe Inflammatory arthritis?

A

Includes: rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis

  • Pain in the morning
  • Systemic features
  • Raised inflammatory markers
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21
Q

Describe referred lumbar spine pain?

A
  • Femoral nerve compression may cause referred pain in the hip
  • Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped
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22
Q

What is Greater trochanteric pain syndrome

A

• Also called Trochanteric bursitis, It is due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh

• Most common in women aged 50-70 years

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23
Q

What is Meralgia paraesthetica?

A
  • Caused by compression of lateral cutaneous nerve of thigh → tight jeans
  • Typically burning sensation over antero-lateral aspect of thigh
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24
Q

What is avascular necrosis of the femoral head?

A
  • Symptoms may be of gradual or sudden onset

* May follow high dose steroid therapy or previous hip fracture of dislocation

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25
Q

What is pubic symphysis dysfunction?

A
  • Common in pregnancy
  • Ligament laxity increases in response to hormonal changes of pregnancy
  • Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs.
  • A waddling gait may be seen
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26
Q

What is transient idiopathic osteoporosis?

A
  • An uncommon condition sometimes seen in the third trimester of pregnancy
  • Groin pain associated with a limited range of movement in the hip
  • Patients may be unable to weight bear
  • ESR may be elevated
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27
Q

What disease are heberdens nodes associated with?

A

Osteoarthritis → Distal inter phalangeal joint

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28
Q

What disease are Bouchards nodes nodes associated with?

A

Rheumatoid arthritis → proximal inter phalangeal joint

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29
Q

Describe meniscal injuries to the knee?

A
  • Rotational sporting injuries
  • Delayed knee swelling
  • Joint locking (Patient may develop skills to “unlock” the knee
  • Recurrent episodes of pain and effusions are common, often following minor trauma
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30
Q

Describe as tibial plateau fracture?

A
  • Occur in the elderly (or following significant trauma in young)
  • Mechanism: knee forced into valgus or varus, but the knee fractures before the ligaments rupture
  • Varus injury affects medial plateau and if valgus injury, lateral plateau depressed fracture occurs
  • Classified using the Schatzker system
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31
Q

Describe an ACL injury?

A
  • Sport injury
  • Mechanism: high twisting force applied to a bent knee
  • Typically presents with: loud crack, pain and RAPID joint swelling (haemoarthrosis)
  • Poor healing
  • Management: intense physiotherapy or surgery
32
Q

Describe a PCL injury?

A
  • Mechanism: hyperextension injuries (car accident, knee on the dashboard)
  • Tibia lies back on the femur
  • Paradoxical anterior draw test
33
Q

Describe an MCL injury?

A
  • Mechanism: leg forced into valgus via force outside the leg
  • Knee unstable when put into valgus position
34
Q

What is compartment syndrome?

A

• Acute compartment syndrome occurs when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure and results in muscle and nerve ischemia and resulting in necrosis.

• It typically occurs subsequent to a traumatic event,
most commonly a fracture.

• The two main fractures implicated

→supracondylar fractures

→ tibial shaft injuries.

35
Q

What are the 2 main fractures implicated in compartment syndrome?

A
  • supracondylar fractures

* tibial shaft injuries.

36
Q

What are the symptoms of compartment syndrome?

A
  • Pain, especially on movement (even passive)
  • Parasthesiae
  • Pallor may be present
  • Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
  • Paralysis of the muscle group may occur
37
Q

How do you diagnose compartment syndrome?

A
  • Diagnosis is made by measurement of intracompartmental pressure measurements.
  • Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic.
38
Q

What is the treatment for compartment syndrome?

A
  • Extensive fasciotomy.

* Muscle death occurs between 4-6 hrs.

39
Q

What is a sub capital hip fracture?

A
  • A subcapital fracture is the commonest type of intracapsular fracture of the proximal femur.
  • The intertrochanteric line is the line connecting the greater and lesser trochanters. Any fracture proximal to that line is classed as intracapsular, while any fracture distal is classed as extracapsular.
40
Q

What is the general rule in association with intracapsular hip fractures and their treatment?

A

Because the blood supply is threatened in intracapsular fractures, as a general rule:

  • Intracapsular femoral fracture - hemiarthroplasty
  • extracapsular femoral fracture - dynamic hip screw
41
Q

When looking at a hip xray, what line should be used as a diagnostic tool?

A

Shenton’s line

42
Q

What are the 3 types of intracapsular NOF break?

A
  • subcapital (below the femoral head)
  • transcervical (across the mid-femoral neck)
  • basicervical (across the base of the femoral neck)
43
Q

What are the 2 types of extracapsular hip break?

A
  • Intertrochanteric

* Subtrochanteric

44
Q

What system of classification is used to grade the severity of intracapsular break?

A

The Garden system of classification:

  • Type I: Stable fracture with impaction in valgus
  • Type II: Complete fracture but undisplaced
  • Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
  • Type IV: Complete boney disruption
45
Q

When is it most common to have a hip dislocation?

A

Post operatively for a total hip replacement

46
Q

Which way do hips normally dislocate?

A

Dislocation is usually in a posterior direction which clinically leads to leg shortening, with flexion and internal rotation at the hip

47
Q

What is a pathological fracture?

A

A pathologic fracture is a bone fracture caused by disease that led to weakness of the bone structure. This process is most commonly due to osteoporosis, but may also be due to other pathologies such as: cancer, infection, inherited bone disorders, or a bone cyst.

48
Q

Following which types of garden classification fracture are blood supply disruption more common?

A

Blood supply disruption is most common following Types III and IV.

49
Q

What is the treatment for an undisplaced intracapsular fracture?

A

• Internal fixation, or hemiarthroplasty if unfit.

50
Q

What is the treatment for a displaced intracapsular fracture?

A
  • young and fit i.e. <70 years- Reduction and internal fixation (if possible).
  • older and reduced mobility- Hemiarthroplasty or total hip replacement.
51
Q

What is the treatment for an extracapsular hip fracture?

A
  • dynamic hip screw

* if reverse oblique, transverse or subtrochanteric: intramedullary device

52
Q

What is the most characteristic feature of a common peroneal nerve lesion?

A

Foot drop.

Other features include:

  • Weakness of foot dorsiflexion
  • Weakness of foot eversion
  • Weakness of extensor hallucis longus
  • Sensory loss over the dorsum of the foot and the lower lateral part of the leg
  • Wasting of the anterior tibial and peroneal muscles
53
Q

What is dupuytrens?

A

Dupuytren’s contracture has a prevalence of about 5%. It is more common in older male patients and around 60-70% have a positive family history

Specific causes include:

  • manual labour
  • phenytoin treatment
  • alcoholic liver disease
  • trauma to the hand
54
Q

What is plantar fasciitis?

A

Plantar fasciitis is the most common cause of heel pain seen in adults. The pain is usually worse around the medial calcaneal tuberosity.

Management

  • rest the feet where possible
  • wear shoes with good arch support and cushioned heels
  • insoles and heel pads may be helpful
55
Q

In a paediatric fracture, what is a Complete fracture?

A

Both sides of cortex are breached

56
Q

In a paediatric fracture, what is a Toddlers fracture?

A

Oblique tibial fracture in infants

57
Q

In a paediatric fracture, what is a plastic deformity?

A

Stress on bone resulting in deformity without cortical disruption

58
Q

In a paediatric fracture, what is a Greenstick fracture?

A

Unilateral cortical breach only

59
Q

In a paediatric fracture, what is a Buckle fracture?

A

Incomplete cortical disruption resulting in periosteal haematoma only

60
Q

What is ankylosing spondylitis?

A
  • Chronic inflammatory disease of the spine and sacro-illiac joints.
  • Uknown aetiology
61
Q

What are the typical presenting features of Ankylosing spondylitis?

A
  • It typically presents in males (sex ratio 3:1) aged 20-30 years old.
  • Typically a young man who presents with lower back pain and stiffness of insidious onset
  • Stiffness is usually worse in the morning and improves with exercise
  • The patient may experience pain at night which improves on getting up
62
Q

What are the clinical examinations for Ankylosing spondylitis?

A
  • Reduced lateral flexion
  • Reduced forward flexion - Schober’s test - a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible
  • Reduced chest expansion
63
Q

What are the tests for Ankylosing spondylitis?

A
  • Clinical diagnosis supported by MRI.

* “Bamboo sign”

64
Q

What is the treatment for Ankylosing spondylitis?

A

EXERCISE → intensive regime supported by NSAIDs and physiotherapy.

Prognosis is worse if ESR>30 +/- onset < 16 yrs

65
Q

What does a positive lachman test indicate?

A

Torn ACL (anterior drawer test)

66
Q

What would you expect in L3 nerve root compression?

A
  • Sensory loss over anterior thigh
  • Weak quadriceps
  • Reduced knee reflex
  • Positive femoral stretch test
67
Q

What would you expect in L4 nerve root compression?

A
  • Sensory loss anterior aspect of knee
  • Weak quadriceps
  • Reduced knee reflex
  • Positive femoral stretch test
68
Q

What would you expect in L5 nerve root compression?

A
  • Sensory loss dorsum of foot
  • Weakness in foot and big toe dorsiflexion
  • Reflexes intact
  • Positive sciatic nerve stretch test
69
Q

What would you expect in S1 nerve root compression?

A
  • Sensory loss posterolateral aspect of leg and lateral aspect of foot
  • Weakness in plantar flexion of foot
  • Reduced ankle reflex
  • Positive sciatic nerve stretch test
70
Q

From what kind of fracture is the radial nerve most at risk?

A

Fracture of the shaft of the humerus

71
Q

What is the treatment for a displaced intracapsular fracture if the patient is independently mobile (does not use more than a stick) ?

A

Total hip replacement

72
Q

What is the treatment for a displaced intracapsular fracture if the patient is not independently mobile?

A

Hemiarthroplasty, cemented implants preferred

73
Q

What is the treatment for a Trochanteric fracture?

A

Sliding hip screw

74
Q

What is the treatment for a subtrochanteric fracture?

A

Intramedullary nail

75
Q

What is a pathological ganglion?

A
  • A ganglion presents as a ‘cyst’ arising from a joint or tendon sheath. They are most commonly seen around the back of the wrist and are 3 times more common in women
  • Ganglions often disappear spontaneously after several months
76
Q

What is Mortons neuroma?

A
  • Morton’s neuroma is a benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space.
  • The female to male ratio is around 4:1.
77
Q

How would you test damage to the radial nerve?

A

Wrist extension

w215 Hip fracture (2 decks)

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