Clincal Conditions Flashcards
What is syndactyly?
Two or more digits fused together
What is polydactyly?
Having extra digits
What is Amelia?
Lacking 1+ limbs or having 1+ shrunken/deformed limbs
What is meromelia?
Lacking part of 1+ limbs but still have the presence of hand/foot
Have a shrunken/ deformed extremity
What are the two types of hip fractures?
Intracapsular and extracapsular
What are the main difference in the types of hip fractures? (2)
- Intracapsular affects more elderly and female people, whilst extra-capsular affects more young/middle aged people
- Intracapsular leads to avascular necrosis because there is damage to the medial circumflex artery, whilst there isn’t any in an extra-capsular fracture
What artery is at risk following an intracapsular hip fracture?
Medial circumflex artery
What happens to the lower limb following a hip fracture? Why?
Shorter and toes pointing out
Because the distal fragment of the fracture is pulled up and rotated laterally
What are the 3 types of humeral fractures that can occur?
- Surgical neck
- Midshaft
- Distal
How might you get a surgical neck humeral fracture?
FOOSH or direct blow
What are the structures at risk after a surgical neck fracture? (2)
Axillary nerve
Posterior circumflex artery
What might be the consequences of axillary nerve damage following a surgical neck fracture of the humerus?
- Paralysis of deltoid and teres minor therefore difficulty abducting
- Sensation loss/impairment in regimental badge region (distal fibres of delt)
What structures are most at risk during a mid-shaft humeral fracture? Why? (2)
- Radial nerve
- Profunda brachii artery
As they are both tightly bound in the radial groove
What occurs after radial nerve damage during a mid-shaft humeral fracture? Why?
Wrist drop
Extensors (supplied by nerve) are paralysed, meaning there is unopposed flexion of the wrist.
What are the effects on sensory function of the radial nerve during a mid-shaft humeral fracture?
There is some loss over the dorsal surface of the hand and the proximal ends of the lateral 3 and a half fingers dorsally
What are the 2 common types of distal humeral fractures?
- Supracondylar fractures
2. Medial epicondyle fractures
What is a supraepicondylar fracture and how might it occur?
A transverse fracture. Spanning between the two epicondyles
Occurs by falling on a flexed elbow
What structure is at risk from a distal humeral fracture?
Brachial artery
What is the effect of direct damage/post fracture swelling on the brachial artery in the cubital fossa?
Ischaemia cuasing Volkmans ishaemic contracture
Damage to median, ulnar or radial nerves
What is volkmans ischaemic contracture?
Uncontrolled flexion of the hand as flexor muscles become fibrotic and short.
What nerve can a medial epicondyle fracture cause damage to? What will this result in?
Ulnar
Ulnar claw, loss of sensation over the medial 1 and a half fingers on the hand, on both the dorsal and palmar surfaces too
What can someone with ulnar claw not do with their hand?
Extend all fingers (medial 2)
What is congenital hip dislocation also called?
Developmental dysplasia of the hip (DDH)
Why does DDH occur?
Because the hip joint does not develop properly in utero
What are the common clinical features of congenital hip dislocation? (3)
- Limited abduction at the hip joint
- Limb length discrepancy (affected limb is shorter)
- Asymmetrical gluteal or thigh skin folds
How is DDH (developmental dysplasia of the hip) treated?
With a Pavlik harness- holds femoral head in place and promotes normal development of joint
Surgery may be needed for those who don’t respond to harness treatment
How are dislocations of the shoulder described?
By where the humeral head lies in relation to the infraglenoid tubercle
What type of shoulder dislocation is more common?
Anterior
What stops superior movement of the humeral head?
The coraco-acromial arch
What is the movement that causes an anterior dislocation? Why?
Excessive extension and lateral rotation of the humerus, the head of the humerus is forced anteriorly and inferiorly into the weakest part of the joint capsule
**tearing the joint capsule is associated with an increased risk of future dislocations
What structure(s) is at risk during shoulder dislocation?
Axillary nerve (it runs in close proximity to the shoulder joint)
Radial nerve can be stretched as it is tightly bound in the radial groove
What is the effect of injuring the axillary nerve at the shoulder?
Paralysis of the deltoid and teres minor and loss of sensation over regimental badge area
What is calcific supraspinatus tendonitis?
The calcification (by hydroxyapatite deposits) of the supraspinatus tendon causing pain and inflammation
What are the consequences of calcific supraspinatus tendonitis?
Pain upon abduction over 90 degrees or by lying on the shoulder
How would you treat calcific supraspinatus tendonitis?
Rest
Analgesia (pain relief)
Physiotherapy
Steroid injections and surgery (if severe)
How are clavicle fractures commonly caused?
Fall onto shoulder or FOOSH
What is the most commonly point of fracture along the clavicle?
Medial 2/3 and lateral 1/3
After a clavicle fracture, what happens to the lateral and medial fragments? Why?
Lateral: displaced inferiorly and medially- due to weight of arm and pectoralis major.
Medial: displaced superiorly- by sternocleidomastoid muscle
What nerves are in danger of being damaged during the upward movement of the medial fragment of a clavicular fracture? What muscles do these nerves innervate?
Suprascapular nerves:medial lateral and intermedial)
Innervate the lateral rotators of the upper limb at the shoulder
What does damage to the suprascapular nerves by the medial fragment of a clavicular break lead to? Why?
Waiters tip position
The damage results in unopposed medial rotation of the upper limb
How are elbow dislocations named?
According to the position of the ulna and radius (not the humerus)
What is the most common kind of elbow dislocation?
Posterior
Why is a posterior elbow fracture most common?
Becuase the humerus is driven through the weakest part of the joint capsule (anterior side)
Which ligament is usually torn during a elbow dislocation?
Ulnar Collateral ligament
What is the most common mechanism of elbow dislocations?
A young child falling on a hand with the elbow flexed
What are the other names for olecranon bursitis?
Student’s elbow
Popeye elbow
What causes olecranon bursitis?
Repeated friction and pressure on the bursa
Infection (it is relatively superficial)
What is olecranon bursitis?
Inflammation of the subcutaneous bursa
What is pulled/nursemaid’s elbow?
Subluxation of the radial head
Dislocation of the radial head form where it usually sits by a sudden pull on the extended pronated foramen
In what age groups is pulled elbow most commonly seen?
2-5 yrs
What are the symptoms of pulled elbow? (3)
- Reduced movement (no supination)
- Arm tends to be held in flexed pronated position
- Pain in proximal forearm
What is a colles’ fracture?
Transverse fracture of the distal radius
What causes an Colles’ fracture?
FOOSH
What to you get with a colles’ fracture?
Dinner fork deformity
Why does a coles’ fracture of the radius result in a dinner fork deformity?
Because the structures distal to the break are posteriorly displaced
How do you end up with a Smiths fracture?
Falling onto the back of the hand (opposite of a colles’ fracture)
In what direction is the distal fragment of a smiths’ fracture displaced?
Anteriorly
What is a Smiths fracture?
Transverse fracture to the distal radius
Which carpal bone takes most of the force in the event of a blow to the wrist (ie FOOSH)?
Scaphoid
What is the main clinical sign of a scaphoid fracture?
Tenderness in the anatomical snuffbox
Why must a scaphoid fracture be treated immediately?
Because it has a distal to proximal blood supply and in the event of a fracture the proximal part may not be receiving blood. This can cause avascular necrosis and can cause arthritis later in life
At what stage would you X-ray a scaphoid fracture? Does this effect treatment?
Few weeks later,
Treatment must be started straight away to prevent avascular necrosis and further issues (even if scaphoid fracture is only suspected)
What can cause a spinal cord lesion to arise?
Traumatic injury to spinal cord
How would you assess deficits caused by spinal nerve lesions?
Motor function: use knowledge of myotomes
Sensory function: use knowledge of dermatomes (cotton wool/pin- testing senses)
What is the Allen’s test?
Examination of the arterial blood flow to the hands
Why is the Allen’s test used?
So you can assess which artery of the forearm to cannulate
How do you perform the Allen’s test? (4)
- Hand elevated, patient clenches fist for ~30 secs
- Pressure is applied to radial and ulnar arteries (to occlude them)
- Still elevated, the hand is opened: should appear blanched/with some pallor of finger nails
- Ulnar pressure is released while the radial pressure is maintained, colour should return within 5-15 seconds
How do you interpret the results of an Allen’s test?
If colour returns as described, test is normal. If colour fails to return the test is abnormal and it suggests that the ulnar artery supply to the hand is not sufficient. Therefore it would not be advisory to cannulate and the radial artery will need to be used.
Name the typical causes of arthritis (4)
Osteoarthritis: heavy use of articular joint (wear and tear of articular cartilage)
Infection (of the joint)
Autoinflammatory disease (rheumatoid arthritis)
Reactive arthritis (due to infection but not of the joint itself)
What is a boxer fracture?
Break in the neck of either the 4th/5th metacarpals
What can cause a boxer’s fracture and what is presentation of it?
Punching an object or person
Causes tenderness over fracture site
What is De quervain’s tenosynovitis?
Inflammation of tendons on the side of the wrist at the base of the thumb
Tendons: abductor pollicis longus and extensor pollicis brevis
What movements are painful when you have De Quervain’s synovitis?
Wrist movement
Making a fist
Grasping anything
What causes carpal tunnel syndrome?
Compression of the median nerve
-usually idiopathic but can be due to thickened ligaments and tendon sheaths
What can carpal tunnel syndrome lead to?
Weakness and atrophy of thenar muscles (which are supplied by the recurrent branch of the median nerve)
What are the clinical features of carpal tunnel syndrome?
Numbness
Tingling
Pain (radiating to forearm) where the median nerve is
Worse in the morning
How can you examine someone for carpal tunnel syndrome?
- Tinel’s sign: tapping nerve in carpal tunnel to elicit pain in its distribution
- Phalen’s manoeuvre: hold wrist in flexion for 60 secs, there should be pain and numbness in median nerve distribution
How would you treat carpal tunnel syndrome?
Splint
Corticosteroids
Surgical decompression
