Clinical Conditions Flashcards
What is the role of the coracoacromial arch in the event of a FOOSH?
Prevents displacement of clavicle and dislocation of shoulder
Which nerve is most at risk in dislocation of the humeral head from the glenoid cavity?
Axillary Nerve
How would one test for damage to the axillary nerve following humeral dislocation?
Test shoulder abduction as deltoid innervated by Ax.N.
Test sensation in regimental badge area
State two common causes of Posterior Dislocation of the humerus
Electric shock
Seizure
What is the pathophysiology of calcific tendonitis?
Calcium hydroxyapatite deposit associate with tendon
Name a common symptom of impingement
Low painful arc
or tender over tuberosity
Which test is often used to diagnose impingement of supraspinatus?
Hawkins Test
Will be positive with impingement
List 3 treatments for impingement
Physio
Steroids
Surgical decompression
What other condition can give signs of impingement?
Rotator cuff tear
Which 4 tests will show abnormalities in event of rotator cuff tear?
Supraspinatus test (weak)
Infraspinatus (weak)
Subscapularis lift-off (weak)
Belly press (weak)
What form of surgery is used to repair RC tears?
Open repair - augmentation with allograft
In which group is RC arthropathy most common?
The Elderly
What action is taken in the event of RC Arthropathy if athritis is present and the cuff is irreparable?
Reverse anatomy shoulder replacement
What symptoms might someone with AC Osteoarthritis experience?
Majority are asymptomatic but may have a high painful arc and joint tenderness
Which test will be positive in AC Osteoarthritis?
Scarf test
What pharmaceutical interventions are possible for AC Osteoarthritis?
NSAIDS and steroid injections
What surgical intervention can be indicated for AC Osteoarthritis?
Excision of lateral clavicle
What would a person with GH Osteoarthritis experience?
Progressive pain and stiffness over the years
Crepitus
List 3 treatments for GH Osteoarthritis
Analgaesia and exercises
Steroid injections
Joint replacement
What does an elbow dislocation usually follow?
FOOSH!
It’s a good acronym, say it again!
What is the initial management for elbow dislocation?
Sling (point to elbow, people, it's not that hard) Splintage Analgesia NVT Assessment X-Ray
What definitive management is carried out for elbow dislocations?
Closed reduction under sedation/anaesthesia
Reassess NVT and stability
Cast for 2 weeks
Re-X-Ray
What does a supracondylar fracture usually follow?
FOOSH!
List some NVT assessments you might perform following a supracondylar fracture of the distal humerus
Parasthaesia
OK Sign
Radial pulse
Capillary return
Which 2 surgical procedures may be performed following supracondylar #?
Manipulation Under Anaesthesia (MUA)
Open reduction
Which is the most common elbow fracture?
Radial head/neck
As an occult fracture, what sign might one look for when diagnosing radial head/neck fractures?
Fat pad sign
What can cause subluxation of the radial head/Pulled elbow/Nursemaid’s elbow?
Longitudinal traction along extended arm
What will parents notice if their larva has a pulled elbow?
It won’t use or move the arm very much
What 2 treatment methods can be used for pulled elbow?
Closed reduction
Sling - spontaneous resolution
What’s the more impressive term for tennis elbow?
Lateral Epicondylitis
What are the common causes of lateral elbow tendinopathy?
Manual work
Sports
–Repetitive activity
What is the suggested treatment for tennis elbow?
Activity modification, brace, physiotherapy, various injections, surgery
Of what should one be aware when diagnosing lateral epicondylitis?
Could be radiating pain from neck or shoulder
What is the less impressive term for golfer’s elbow?
Medial epicondylitis
What is medial epicondylitis?
Degenerative tendinopathy of the common flexor origin
Or etymologically, inflammation of the medial epicondyle, but that’s a semantic argument…
What is a common extra-articular manifestation of Rheumatoid Arthritis?
Rheumatoid nodules
What treatment is available for rheumatoid nodules?
DMARDs (Disease-Modifying Anti-Rheumatic Drugs) eg methotrexate
Biologics
What is olecranon bursitis?
Inflammation of olecranon bursa due to trauma or friction
What are the characteristics of olecranon bursitis?
Soft, cystic, transilluminatory swelling
How might one treat olecranon bursitis?
Aspiration
Surgery
What is gouty tophi?
Disorder of nucleic acid metabolism leading to hyperuicaemia and subsequent urate crystal deposits
What does gouty tophie affect?
Joints - recurrent attacks of arthritis
Soft tissues - ear, elbows, achilles tendon
What are the two types of # of the distal radius?
Colles’ - dorsal displacement and angulation, FOOSH
Smith’s - palmar displacement and anulation
What complication can occur following a scaphoid #?
Avascular necrosis of proximal segment
Where will a patient likely experience tenderness with scaphoid #?
Anatomical snuffbox
What is the problem with diagnosis scaphoid #s from X-rays?
Delayed presentation on X-ray
What treatments can be used for scaphoid #s?
Cast - 2-3 months
Surgery if unstable, displaced, or delayed/non-union
What is cubital tunnel syndrome?
Compression of ulnar nerve at elbow
What might a person with cubital tunnel syndrome experience?
Paraesthesia, numbness, and weakness as well as a hypersensitive ‘funny bone’
What is tenosynovitis of the 1st dorsal compartment?
Swelling of sheath surrounding tendon of abductor pollicis longus and extensor pollicis brevis
What diagnostic test can be performed to diagnose tenosynovitis?
Finkelstein’s test
What treatments are available for tenosynovitis?
Steroid injections
Splint
Surgery
What is Dupuytren’s disease?
Functional deficit caused by proximal interphalangeal joint contracture of >30 degrees (often genetic but can be due to diabetes, alcoholic liver disease, or epilepsy_
What treatments can be used for carpal tunnel syndrome?
Splint Steroids Surgery NSAIDs Physio
Which meniscus of the knee is most commonly torn?
Medial
What is the unhappy triad?
ACL, medial collateral ligament, and medial meniscus all torn
Commonly caused by twisting with a planted foot
Why might a ‘locked’ knee present with meniscal tears?
Femur ‘catches’ on tibia preventing smooth articulation
What is housemaid’s knee?
Prepatellar bursitis caused by prolonged periods of genuflection
What is Clergyman’s knee?
Infrapatellar bursitis cause by prolonged periods of genuflection
Why are shortening and external rotation found in a patient with an intertrochanteric fracture of the femur?
Gluteus medius and minimus, piriformis, obturator internus and externus, and gemelli muscles attach to greater trochanter which pull the femur upward and laterally.
What causes shortening and internal rotation of the leg in posterior hip dislocations?
Internal rotation from gluteus medius and minimus
Locked into shortened position by gluteus maximus and hamstrings
Why might hemiarthroplasty not be effective for intracapsular femoral fractures?
Avascular necrosis may cause head of femur to die and fixation would fail
