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2 MSK > CORTEXT: Adult Orthopaedics > Flashcards

CORTEXT: Adult Orthopaedics Flashcards

1
Q

another word for early OA?

A

spondylosis

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2
Q

what kind of back pain does this suggest: recurrent relapsing and remitting back pain with no other symptoms?

A

mechanical back pain

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3
Q

how does spondylosis cause secondary OA?

A

intervertebral discs lose water content with age = less cushioning and increased pressure on facet joints

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4
Q

treatment for mechanical back pain?

A

analgesia

physiotherapy

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5
Q

how do you diagnose instability using investigations?

A

MRI

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6
Q

an acute disc tear in which area usually occurs after lifting a heavy object?

A

outer annulus fibrosis

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7
Q

why is pain worse on coughing with an acute disc tear?

A

it increases disc pressure

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8
Q

how long will it take to recover from an acute disc tear?

A

2-3 months

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9
Q

complications of disc tears?

A

herniation of nucleus pulposis

impingement of disc on nerve root

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10
Q

what would disc impingement on a nerve root feel like and why?

A

pain

altered sensation in a dermatomal distribution

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11
Q

what effect does disc impingement have on muscles?

A

reduced power in a myotomal distribution

reflexes reduced

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12
Q

complications of OA of the facet joints?

A

osteophytes can impinge on exiting nerve roots, nerve root symptoms, sciatica

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13
Q

treatment for bad OA of facet joints?

A

surgical decompression with trimming of the impinging osteophytes

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14
Q

cause of the lack of space in spinal stenosis?

A 
spondylosis
bulging discs
bulging ligamentum flavum
osteophytes
cauda equina
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15
Q

characteristic presentation of spinal stenosis?

A

claudication in legs on exertion that is burning, better uphill and with an inconsistent distance

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16
Q

main cause of cauda equina?

A

very large central disc prolapse compresses all nerve roots of cauda equina

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17
Q

main nerve roots affected by cauda equina syndrome?

A

S4 , S5

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18
Q

which symptoms constitute a cauda equina until proven otherwise?

A

bilateral leg pain
paraesthesiae
numbness
altered bladder/bowel function

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19
Q

what investigations should always be done when cauda equna is suspected?

A

PR exam

urgent MRI

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20
Q

treatment for cauda equina?

A

urgent discectomy

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21
Q

peak age for spondylolisthesis?

A

teens

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22
Q

which group are infections of the back most common in?

A

young children

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23
Q

symptoms of cervical spondylosis?

A

slow onset stiffness and pain in the neck that can radiate to the shoulders

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24
Q

when would you know nerve root compression was involved in a cervical disc prolapse?

A

patient complains of a shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes

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25
Q

in a C6/7 disc for example, which nerve root is more likely to be affected by a cervical disc prolapse?

A

C7 (the lower root)

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26
Q

what kind of dislocation in the cervical spine can occur from RA?

A

antlantoaxial subluxation

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27
Q

mild and severe treatment for antlantoaxial subluxation?

A

mild- collar

severe- surgical fusion

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28
Q

what comprises the shoulder girdle?

A 
scapula
clavicle
proximal humerus
rotator cuff
deltoid
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29
Q

causes of painful arc/impingement?

A 
tendonitis
subacromial bursitis
acromioclavicular OA
hooked acromion
rotator cuff tear
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30
Q

where does pain from impingement typically radiate to?

A

deltoid and upper arm

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31
Q

clinical context behind rotator cuff tears?

A

sudden jerk in a patient >40 with subsequent pain and weakness

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32
Q

which rotator cuff muscle is usually involved in a rotator cuff tear?

A

supraspinatus

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33
Q

when does frozen shoulder tend to resolve?

A

18-24 months

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34
Q

clinical presentation of acute calcific tendonitis?

A

acute onset of severe shoulder

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35
Q

which condition constitutes acute, severe shoulder pain with calcium deposits on x ray?

A

acute calcific tendonitis

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36
Q

which muscle is calcium deposited in acute calcific tendonitis?

A

supraspinatus

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37
Q

treatment for acute calcific tendonitis?

A

subacromial steroid

local anaesthetic injection

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38
Q

what non-MSK conditions can cause shoulder pain?

A 
neck problems
angina pectoris
bilary colic
hepatic abscess
subphrenic abscess
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39
Q

why do upper limb compressive neuropathies not run in a dermatomal distrubution?

A

causes peripheral nerve compression so only affects its sensory and motor territories

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40
Q

secondary causes of carpal tunnel?

A

RA
pregnancy
diabetes
chronic renal failure

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41
Q

what is tinel’s test?

A

percussing over median nerve

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42
Q

what is phalen’s test?

A

wrist hyperflexion to decrease carpal tunnel space

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43
Q

clinical presentation of cubital tunnel?

A

paraesthesiae in ulnar 1 1/2 fingers and positive tinels test
weak muscles

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44
Q

what muscles are particularly weak in cubital tunnel?

A

1st dorsal interosseus muscle

adductor pollicis longus

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45
Q

muscles in charge of supination?

A

biceps brachii

supinator

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46
Q

which arthritis commonly affects the elbow?

A

RA

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47
Q

can you get a total elbow replacement?

A

yes

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48
Q

fingers most commonly affected by dupuytrens?

A

ring and little

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49
Q

what deformities are usually found as a result of RA?

A 
volar MCPJ subluxation
ulnar deviation
swan neck deformity
boutonniere deformity
z shaped thumb
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50
Q

why does hip pain radiate to the knee?

A

both supplied by obturator nerve

referred pain

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51
Q

what is the cause of a positive trendelenburg test?

A

abductor weakness (eg in gluteus medius and minimus)

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52
Q

what conditions can be associated with limb shortening?

A 
severe OA
perthes
SUFE
AVN
fracture
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53
Q

causes of groin pain other than hip pathology?

A

hernia (inguinal/femoral)
adductor tendonitis
pubic symphysis dysfunction
lumbar disc prolapse

54
Q

how is a total hip arthroplasty different from THR?

A

THA includes hip resurfacing and other procedures

55
Q

does the cup or stem of a THR last longer?

A

stem

56
Q

what Hx questions should you ask to get an idea of the severity of a patients pain?

A

1-10
analgesia use
sleep
pain at rest

57
Q

early medical complications of THR surgery?

A 
MI
chest infection
UTI
blood loss
hypovolaemia
DVT/PE
58
Q

what isa revision HR?

A

re-done hip replacement

59
Q

secondary causes of AVN?

A

alcohol abuse
steroids
hyperlipidaemia
thrombophilia

60
Q

clinical presentation of AVN?

A

groin pain

61
Q

most common sites for AVN?

A 
ends of long bones eg femoral head (hip)
humerus
knee
shoulder
ankle
jaw
62
Q

radiographical appearance of late AVN?

A

patchy sclerosis of femoral head

hanging rope sign

63
Q

what does the hanging rope sign on imaging mean?

A

lytic zone formed by granulation tissue from repair of AVN

64
Q

treatment for AVN of hip?

A

pre collapse: drill holes in femoral neck to relieve pressure

post collapse: THR

65
Q

which muscle is under particular strain in trochanteric bursitis?

A

abductor muscles especially gluteus medius

66
Q

how does trochanteric bursitis happen?

A

insertion of abductor muscles gets inflamed (tendonitis) causing the trochanteric bursa to follow suit

67
Q

what resisting movement on examination can be used to look for trochanteric bursitis?

A

resisted abduction

68
Q

treatment for trochanteric bursitis?

A

analgesia
NSAIDs
physio
NOT SURGERY

69
Q

what joints make up the knee joint?

A

medial compartment of tibiofemoral
lateral compartment of tibiofemoral
patellofemoral

70
Q

role of ACL?

A

prevents abnormal internal rotation of tibia

71
Q

role of PCL?

A

prevents hyperextension and anterior translation of femur

72
Q

what does MCL do?

A

resists valgus force

73
Q

what does LCL do?

A

resists varus force and abnormal external rotation of tibia

74
Q

which knee injury will have an effusion develop by the next day?

A

meniscal injury

75
Q

which knee injury will experience knee locking?

A

meniscal injury

76
Q

why do patients feel their knee is going to give way in a meniscal tear?

A

a loose meniscal fragment from the tear is caught in the joint line

77
Q

what actually is knee locking?

A

mechanical block to full knee extension

78
Q

how could you differentiate pseudolocking from true locking?

A

if it is just on standing up from seated ->

79
Q

which injury is typically caused by a high rotational force on the body with a planted foot?

A

ACL

80
Q

a “pop” sound is heard in which knee injury?

A

ACL

81
Q

which injury commonly presents with a haemathrosis?

A

ACL

82
Q

how quickly will a haemarthrosis present with an injury

A

1 hr

83
Q

how is a PCL injury commonly obtained?

A

direct blow to anterior tibia

84
Q

what should you do for a patient with a clear knee injury but you cant examine?

A

MRI

85
Q

name the unhappy triad of knee injuries?

A

medial collateral ligament
ACL rupture
meniscal tear

86
Q

test for a meniscal tear?

A

steinmann’s

87
Q

what kind of tear wold result in a bucket handle tear?

A

large longitudinal tear causing a meniscal fragment to diplace and cause knee locking

88
Q

why does the meniscus have limited healing potential?

A

only has arterial blood supply on outer third

89
Q

when would you consider meniscal repair?

A

young patient with fresh meniscal tear only affecting the outer third

90
Q

what degenrate changes in the knee can you see on MRI?

A

hyaline cartilage loss

bone marrow oedema

91
Q

ACL rupture clinical presentation?

A

rotatory instability with giving way on turning

92
Q

examination findings for an ACL rupture?

A

haemarthrosis/effusion
positive anterior drawer test
positive lachmanns

93
Q

best candidates for ACL reconstruction?

A

physio not working

athletes

94
Q

which knee injury is the most likely to heal well?

A

MCL

95
Q

what ligaments are injured in complete knee dislocation?

A

all of them

96
Q

who gets quad tendon ruptures?

A

> 40s

97
Q

who gets patellar tendon ruptures?

A

<40s

98
Q

common causes of extensor mechanism rupture?

A

lifting heavy weight

fall

99
Q

what does a straight leg raise test?

A

if extensor mechanism is in tact

100
Q

predisposing factors for extensor mechanism rupture?

A 
chronic steroid use
steroid abuse
diabetes
RA
chronic renal failure
101
Q

what would be the cause of a high lying patella in an extensor mechanism rupture?

A

patellar tendon rupture

102
Q

what would be the cause of a low lying patella in an extensor mechanism rupture

A

quads tendon rupture

103
Q

clinical presentation of patellofemoral dysfunction?

A

anterior knee pain that is worse going downhill, grinding/clicking at front of knee and pseudolocking

104
Q

treatment for patellofemoral dysfunction?

A

physio

105
Q

what kind of effusion do you get in patellar dislocation?

A

lipohaemarthrosis

106
Q

what other injuries to the knee can happen after the patella dislocates?

A

medial patellofemoral ligament tears

osteochondral fracture

107
Q

which way does the toe invert in hallux valgus?

A

medially

108
Q

what is hallux rigidus?

A

OA of first MTPJ

109
Q

gold standard surgical treatment for hallux rigidus?

A

arthrodesis

110
Q

what nerves are affected in mortons neuroma?

A

plantar interdigital nerves

111
Q

clinical presentaton of mortons neuroma?

A

burning pain and tingling radiating to affected toes (mainly in women)

112
Q

what is the most commomly involved nerve in mortons neuroma?

A

third interspace nerve

113
Q

what is mulders click test and when would you use it?

A

squeezing forefoot to see if it causes symptoms or a click; mortons neuroma

114
Q

can you use steroid injections for mortons neuroma?

A

yes

115
Q

most common metatarsal to get a stress fracture?

A

2nd metatarsal

116
Q

treatment for metatarsal stress fracture?

A

rest for 6-12 weeks in a rigid soled boot

117
Q

predisposing factors for tendonitis?

A

quinolones
RA
inflammatory arthritis
gout

118
Q

why shouldnt you inject the achilles tendon with steroids if it is inflamed?

A

can cause a rupture

119
Q

examination findings of a ruptured achilles tendon?

A

negative simmonds test

120
Q

clinical presentation of plantar fasciitis?

A

pain in instep of foot on walking with localised tenderness on palpation

121
Q

predisposing factors for plantar fasciitis?

A

diabetes
obesity
frequent walking on hard floors

122
Q

how long will plantar fasciitis take to heal?

A

2 yrs

123
Q

where does the tibialis posterior tendon mainly insert?

A

medial navicular bone

124
Q

treatment for tendonitis of tibialis posterior?

A

splint with medial arch support OR if bad -> arthrodesis

125
Q

causes of pes cavus?

A

idiopathic

neuromuscular conditions eg cerebral palsy

126
Q

how to treat pain from pes cavus?

A

soft tissue release

tendon transfer

127
Q

why do you get claw/hammer toes?

A

imbalance between flexor and extensor tendons

128
Q

which toe deformity has hyperextension at MTPJ and hyperflexion at DIPJ?

A

claw toes

129
Q

which toe deformity has hyperextension of DIPJ?

A

hammer toe

130
Q

treatment for claw/hammer toe?

A

tenotomy
tendon transfer
arthrodesis

2 MSK (61 decks)

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