CORTEXT: Adult Orthopaedics Flashcards
another word for early OA?
spondylosis
what kind of back pain does this suggest: recurrent relapsing and remitting back pain with no other symptoms?
mechanical back pain
how does spondylosis cause secondary OA?
intervertebral discs lose water content with age = less cushioning and increased pressure on facet joints
treatment for mechanical back pain?
analgesia
physiotherapy
how do you diagnose instability using investigations?
MRI
an acute disc tear in which area usually occurs after lifting a heavy object?
outer annulus fibrosis
why is pain worse on coughing with an acute disc tear?
it increases disc pressure
how long will it take to recover from an acute disc tear?
2-3 months
complications of disc tears?
herniation of nucleus pulposis
impingement of disc on nerve root
what would disc impingement on a nerve root feel like and why?
pain
altered sensation in a dermatomal distribution
what effect does disc impingement have on muscles?
reduced power in a myotomal distribution
reflexes reduced
complications of OA of the facet joints?
osteophytes can impinge on exiting nerve roots, nerve root symptoms, sciatica
treatment for bad OA of facet joints?
surgical decompression with trimming of the impinging osteophytes
cause of the lack of space in spinal stenosis?
spondylosis bulging discs bulging ligamentum flavum osteophytes cauda equina
characteristic presentation of spinal stenosis?
claudication in legs on exertion that is burning, better uphill and with an inconsistent distance
main cause of cauda equina?
very large central disc prolapse compresses all nerve roots of cauda equina
main nerve roots affected by cauda equina syndrome?
S4 , S5
which symptoms constitute a cauda equina until proven otherwise?
bilateral leg pain
paraesthesiae
numbness
altered bladder/bowel function
what investigations should always be done when cauda equna is suspected?
PR exam
urgent MRI
treatment for cauda equina?
urgent discectomy
peak age for spondylolisthesis?
teens
which group are infections of the back most common in?
young children
symptoms of cervical spondylosis?
slow onset stiffness and pain in the neck that can radiate to the shoulders
when would you know nerve root compression was involved in a cervical disc prolapse?
patient complains of a shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes
in a C6/7 disc for example, which nerve root is more likely to be affected by a cervical disc prolapse?
C7 (the lower root)
what kind of dislocation in the cervical spine can occur from RA?
antlantoaxial subluxation
mild and severe treatment for antlantoaxial subluxation?
mild- collar
severe- surgical fusion
what comprises the shoulder girdle?
scapula clavicle proximal humerus rotator cuff deltoid
causes of painful arc/impingement?
tendonitis subacromial bursitis acromioclavicular OA hooked acromion rotator cuff tear
where does pain from impingement typically radiate to?
deltoid and upper arm
clinical context behind rotator cuff tears?
sudden jerk in a patient >40 with subsequent pain and weakness
which rotator cuff muscle is usually involved in a rotator cuff tear?
supraspinatus
when does frozen shoulder tend to resolve?
18-24 months
clinical presentation of acute calcific tendonitis?
acute onset of severe shoulder
which condition constitutes acute, severe shoulder pain with calcium deposits on x ray?
acute calcific tendonitis
which muscle is calcium deposited in acute calcific tendonitis?
supraspinatus
treatment for acute calcific tendonitis?
subacromial steroid
local anaesthetic injection
what non-MSK conditions can cause shoulder pain?
neck problems angina pectoris bilary colic hepatic abscess subphrenic abscess
why do upper limb compressive neuropathies not run in a dermatomal distrubution?
causes peripheral nerve compression so only affects its sensory and motor territories
secondary causes of carpal tunnel?
RA
pregnancy
diabetes
chronic renal failure
what is tinel’s test?
percussing over median nerve
what is phalen’s test?
wrist hyperflexion to decrease carpal tunnel space
clinical presentation of cubital tunnel?
paraesthesiae in ulnar 1 1/2 fingers and positive tinels test
weak muscles
what muscles are particularly weak in cubital tunnel?
1st dorsal interosseus muscle
adductor pollicis longus
muscles in charge of supination?
biceps brachii
supinator
which arthritis commonly affects the elbow?
RA
can you get a total elbow replacement?
yes
fingers most commonly affected by dupuytrens?
ring and little
what deformities are usually found as a result of RA?
volar MCPJ subluxation ulnar deviation swan neck deformity boutonniere deformity z shaped thumb
why does hip pain radiate to the knee?
both supplied by obturator nerve
referred pain
what is the cause of a positive trendelenburg test?
abductor weakness (eg in gluteus medius and minimus)
what conditions can be associated with limb shortening?
severe OA perthes SUFE AVN fracture
causes of groin pain other than hip pathology?
hernia (inguinal/femoral)
adductor tendonitis
pubic symphysis dysfunction
lumbar disc prolapse
how is a total hip arthroplasty different from THR?
THA includes hip resurfacing and other procedures
does the cup or stem of a THR last longer?
stem
what Hx questions should you ask to get an idea of the severity of a patients pain?
1-10
analgesia use
sleep
pain at rest
early medical complications of THR surgery?
MI chest infection UTI blood loss hypovolaemia DVT/PE
what isa revision HR?
re-done hip replacement
secondary causes of AVN?
alcohol abuse
steroids
hyperlipidaemia
thrombophilia
clinical presentation of AVN?
groin pain
most common sites for AVN?
ends of long bones eg femoral head (hip) humerus knee shoulder ankle jaw
radiographical appearance of late AVN?
patchy sclerosis of femoral head
hanging rope sign
what does the hanging rope sign on imaging mean?
lytic zone formed by granulation tissue from repair of AVN
treatment for AVN of hip?
pre collapse: drill holes in femoral neck to relieve pressure
post collapse: THR
which muscle is under particular strain in trochanteric bursitis?
abductor muscles especially gluteus medius
how does trochanteric bursitis happen?
insertion of abductor muscles gets inflamed (tendonitis) causing the trochanteric bursa to follow suit
what resisting movement on examination can be used to look for trochanteric bursitis?
resisted abduction
treatment for trochanteric bursitis?
analgesia
NSAIDs
physio
NOT SURGERY
what joints make up the knee joint?
medial compartment of tibiofemoral
lateral compartment of tibiofemoral
patellofemoral
role of ACL?
prevents abnormal internal rotation of tibia
role of PCL?
prevents hyperextension and anterior translation of femur
what does MCL do?
resists valgus force
what does LCL do?
resists varus force and abnormal external rotation of tibia
which knee injury will have an effusion develop by the next day?
meniscal injury
which knee injury will experience knee locking?
meniscal injury
why do patients feel their knee is going to give way in a meniscal tear?
a loose meniscal fragment from the tear is caught in the joint line
what actually is knee locking?
mechanical block to full knee extension
how could you differentiate pseudolocking from true locking?
if it is just on standing up from seated ->
which injury is typically caused by a high rotational force on the body with a planted foot?
ACL
a “pop” sound is heard in which knee injury?
ACL
which injury commonly presents with a haemathrosis?
ACL
how quickly will a haemarthrosis present with an injury
1 hr
how is a PCL injury commonly obtained?
direct blow to anterior tibia
what should you do for a patient with a clear knee injury but you cant examine?
MRI
name the unhappy triad of knee injuries?
medial collateral ligament
ACL rupture
meniscal tear
test for a meniscal tear?
steinmann’s
what kind of tear wold result in a bucket handle tear?
large longitudinal tear causing a meniscal fragment to diplace and cause knee locking
why does the meniscus have limited healing potential?
only has arterial blood supply on outer third
when would you consider meniscal repair?
young patient with fresh meniscal tear only affecting the outer third
what degenrate changes in the knee can you see on MRI?
hyaline cartilage loss
bone marrow oedema
ACL rupture clinical presentation?
rotatory instability with giving way on turning
examination findings for an ACL rupture?
haemarthrosis/effusion
positive anterior drawer test
positive lachmanns
best candidates for ACL reconstruction?
physio not working
athletes
which knee injury is the most likely to heal well?
MCL
what ligaments are injured in complete knee dislocation?
all of them
who gets quad tendon ruptures?
> 40s
who gets patellar tendon ruptures?
<40s
common causes of extensor mechanism rupture?
lifting heavy weight
fall
what does a straight leg raise test?
if extensor mechanism is in tact
predisposing factors for extensor mechanism rupture?
chronic steroid use steroid abuse diabetes RA chronic renal failure
what would be the cause of a high lying patella in an extensor mechanism rupture?
patellar tendon rupture
what would be the cause of a low lying patella in an extensor mechanism rupture
quads tendon rupture
clinical presentation of patellofemoral dysfunction?
anterior knee pain that is worse going downhill, grinding/clicking at front of knee and pseudolocking
treatment for patellofemoral dysfunction?
physio
what kind of effusion do you get in patellar dislocation?
lipohaemarthrosis
what other injuries to the knee can happen after the patella dislocates?
medial patellofemoral ligament tears
osteochondral fracture
which way does the toe invert in hallux valgus?
medially
what is hallux rigidus?
OA of first MTPJ
gold standard surgical treatment for hallux rigidus?
arthrodesis
what nerves are affected in mortons neuroma?
plantar interdigital nerves
clinical presentaton of mortons neuroma?
burning pain and tingling radiating to affected toes (mainly in women)
what is the most commomly involved nerve in mortons neuroma?
third interspace nerve
what is mulders click test and when would you use it?
squeezing forefoot to see if it causes symptoms or a click; mortons neuroma
can you use steroid injections for mortons neuroma?
yes
most common metatarsal to get a stress fracture?
2nd metatarsal
treatment for metatarsal stress fracture?
rest for 6-12 weeks in a rigid soled boot
predisposing factors for tendonitis?
quinolones
RA
inflammatory arthritis
gout
why shouldnt you inject the achilles tendon with steroids if it is inflamed?
can cause a rupture
examination findings of a ruptured achilles tendon?
negative simmonds test
clinical presentation of plantar fasciitis?
pain in instep of foot on walking with localised tenderness on palpation
predisposing factors for plantar fasciitis?
diabetes
obesity
frequent walking on hard floors
how long will plantar fasciitis take to heal?
2 yrs
where does the tibialis posterior tendon mainly insert?
medial navicular bone
treatment for tendonitis of tibialis posterior?
splint with medial arch support OR if bad -> arthrodesis
causes of pes cavus?
idiopathic
neuromuscular conditions eg cerebral palsy
how to treat pain from pes cavus?
soft tissue release
tendon transfer
why do you get claw/hammer toes?
imbalance between flexor and extensor tendons
which toe deformity has hyperextension at MTPJ and hyperflexion at DIPJ?
claw toes
which toe deformity has hyperextension of DIPJ?
hammer toe
treatment for claw/hammer toe?
tenotomy
tendon transfer
arthrodesis
