cortext notes Flashcards
why might pain produced in groin/hip radiate to the knee?
both supplied by obbturator nerve –> referred pain
secondary causes of AVN
alcohol abuse
steroids
hyperlipidaemia
thrombophilia
imaging of AVN
early changes may only show on MRI
xray - lytic zone gives rise to hanging rope sign
management of AVN
(pre-collapse)
->drill holls into femoral neck of abnormal area to relieve pressure
(collapse) = total hip replacement
what ages do patellar tendon ruptures typically occur?
under 40s
what age do quadriceps tendon ruptures typically occur?
over 40s
what should be avoided in the management of extensor mechanism tendonitis?
steroid injections
which antibiotics can predispose tendonitis?
quinolones - ciprofloxacin etc
also rheumatoid arthritis, gout
lumbar spine red flgs
back pain in <20yrs
NEW back pain in >60
constant, severe, worse at night
systemic upset
saddle anaesthesia, bilateral symptoms, altered bowel habits, initial investigation?
PR !! then MRI
cauda equina
ortho probs in downs
recurrent patella dislocation
atlanto-axial dislocation
inheritance of duchennes
x-linked RECESSIVE
which has a worse prognosis duchennes or beckets muscle dystrophy
duchennes
beckers live longer
spastic cerebral palsy
commonest 70%
upper motor neurons
scissor gate
hypertonia, tight/stiff muscles
dyskinetic cerebral palsy
(athenoid)
basal ganglia
random, involuntary movement
chorea - dance like movements
ataxic cerebral palsy
cerebellum
shaky, uncoordinated
problems with precise movement
Mx of cerebral palsy
baclofen - injected into subarachnoid space
botox injections
hemiplegia
arm + leg on same side
diplegia
just legs
arms a lil
what babies are at risk of obsteric brachial plexus palsy
big babies, diabetes, twins
erbs palsy in babies
waiters tip hand
upper C5+C6 damage
prognosis - return of biceps at 6 months, 80-90% go away
Klumpke’s
obsteric brachial pleuxus palsy
C8 + T1
worse prognosis than erbs, 50% recover
wrist extended but like dropped also ?
flexible vs rigid flat feet
flexible = arch on dorsiflexion
rigid = remains flat - underlying -> tarsal coalition
ponseti method
talipes
–>after corrected, boots+bar till 3/4yrs so doesnt reoccur
in a myelomeningocele, what does the herniation contain?
cerebrospinal fluid
meninges
spinal cord/cauda equina
polio
virus enters GI, flu-like illness, motor neurons affected, typically manifesting as weakness of group muscle withi a single limb, sesation preserved
motor anterior horn cells affected
residual paralysis, shortening of limbs
ligament ruptured in patellar dislocation
medial patello-femoral ligament
lateral disloaction, medial ligament tear
commonest cause of paediatric hip pain
transient synovitis
mildest form of spina bifida
spina bifida occulta
high arched foot, clawing toes, neurological symtpoms
varus/valgus derformities throughout growth
birth - varus
neutrally aligned by 14months
progressing to 10/15 degrees valgus by age 3
regress to physiological 6 degrees valgus by 7-9
back pain worse on coughing
acute disc tear
-> outer annulus fibrosis of disc, periphery is richly innervated (super sore)
who are at greater risk of atraumatic cervical spine instbility
rheumatoid arthritis + downs
atlanto-axial (C1/C2)
subluxation
acute angular defority seen in sagittal plane
(from side)
Gibbus
peripheral arterial disease VS spinal stenosis
pad = calf pain is worse on walking uphill
spinal stenosis = worse DOWNHILL
which nerve would be impinged in a lateral L4/L5 prolapse
exiting L4 nerve
which nerve would be impinged in a paracentral L4/L5 disc prolapse
L5 nerve (travesing)
