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