Cortext Week 4 Flashcards
What is the term for IV discs losing water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA?
Spondylosis
What can happen in the annulus fibrosis of an IV disc which classically happens after lifting a heavy object?
Acute tear - periphery of the disc is richly innervated and pain can be severe.
What type of back problem is characteristically worse on coughing and the symptoms usually resolve but can take 2-3 months to settle?
Acute disc tear - from heavy object lifting
What nerve roots can cause sciatica?
L4 - S1
In the lumbar spine, which nerve root is compressed?
Lower of the two vertebra
What nerve entrapment can cause pain down to the medial ankle, loss of quadriceps power and reduced knee jerk?
L4
What nerve entrapment can cause pain down dorsum of the foot, reduced power to extensor hallucis longus and tibialis anterior?
L5
What nerve entrapment can cause pain to sole of foot, reduced power plantarflexion and reduced ankle jerks?
S1
If neurological leg pain is severe - which drug could be given?
Gabapentin
What - affecting the facet joints - can result in impingement on exiting nerve roots, resulting in sciatica?
Osteophytes from OA
What can be done for osteophytes impinging on nerve roots?
Trimming
Name four differences between PVD claudication and spinal stenosis and claudication?
- Claudication distance is inconsistent in spinal
- Pain is burning in spinal and cramping in PVD
- Pain is less walking uphill in spinal - flexion creates more space
- Pedal pulses are preserved in spinal
What is cauda equina sndrome?
When a very large central disc prolapse can compress all the nerve roots of the cauda equina
In cauda equina syndrome the nerve roots S4 and S5 are mainly affectd - what do these control?
Defaecation and urination
What does bilateral leg pain, paraesthesiae or numbness and saddle anaesthesia, urinary retention, faecal incontinence and constipation suggest?
Cauda equina syndrome
What MUST be performed if suspected cauda equina syndrome?
Rectal exam
What investigations and management is done for cauda equina syndrome?
Urgent MRI. Urgent discectomy
What are the four back pain red flag symptoms?
- Back pain in younger patients less than 20
- New back pain in older patients over 60
- Constant, severe pain worse at night
- Systemic upset
In severe osteoporosis whast can spontaneous crush fractures of the vertebral body lead to?
Acute pain and kyphosis
How are osteoporotic crush fractures treatd?
Conservatively
Name two conditions where cervical spine instability can occur?
Downs and rheumatoid arthritis
What rotator cuff muscle is anterior?
Subscapularis
Where do the infraspinatus, teres minor and supraspinatous attach?
Greater tuberosityq
What motion fo infraspinatus and teres minor do?
External rotators
Where does subscapularis attach and what motion does it do?
Lesser tuberosity and principal internal rotator
Name two problems associated with shoulder in middle aged?
Cuff tear nad froxen shoulder - grey hair, cuff tear
What do tendonitis sub acromial bursitis, AC OA with inferior osteophyte and a hooked acromion rotator cuff tear all cause?
Impingement syndrome - painful arc
How is impingement syndrome treated#;
NSAIDS, analgesia, physio and subacromial steroid injections
What is the differential in a patient with a histoy of a sudden jerk, over 40 and with subsequent pain and weakness of shoulder?
Rotator cuff tear
What is the most common rotator cuff to tear?
Supraspinatus
How are rotator cuff tears confirmed?
On ultrasound or MRI
What is the name of the disorder characterised by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after 18-24 months?
Adhesive capsulitis
What is the prinicipal clinical sign of adhesive capsulitis?
Loss of external rotation
Name three conditions that are associated with adhjesive capsulitis?
- Diabetes
2, .Hypercholesterolemia - Dupuytrens disease
What condition results in acute onset severe shoulder pain and is characterised by calcium deposition in supraspinatus tendon which is seen on xray just proximal to greater tuberostiy. Relief is achieved with subacromial steroid and local anaesthetic injections?
Acute calcific tendonitis - resolves on its own as calcium reabsorbsq
What is the redislocation of shoulder rates?
In under 20s its 80%
In over 30s its 20%
With recurrent shoulder dislocations - what can be done to stabilise the shoulder by attaching the labrum and capusle to anterior gelnoid?
Bankart repair
What can cause pain on biceps resisted contraction?
Biceps tendonitis - long head, attaches to glenoid labrum
What is popeye deformity associated with?
Biceps tendonitis
What is a tear in glenoid labrum called?
SLAP lesions
What forms the carpal tunnel?
Flexor retinaculum and carpal bones
Name conditions associated with carpal tunnel syndrome?
- RA
- Pregnancy
- Diabetes
- Chronic renal failure
- Hypothyroidism
Who are more commonly affected by carpal tunnel syndrome - men or women?
Women by 8 times more
How can symptoms of carpal tunnel syndrome be reproduced?
Tinel’s test - percussing over median nerve
Phalen’s test - holding wrists hyperflexed
What confirms carpal tunnel syndrome?
Nerve conduction studies
How is carpal tunnel syndrome treated non-operatively?
With wrist splints at night to prevent flexion and injections of corticosteroids
What is surgical treatment for carpal tunnel?
Decompression - involves division of the transverse carpal ligament
What condition involves complaints of paraesthesiae in ulnar 1.5 fingers and tinels test positive over cubital tunnel?
Cubital tunnel syndrome
In cubital tunnel syndrome - how can the 1st dorsal interosseous (abduction index finger) and adductor pollicis be tested?
Froments test
What can compression be due to in cubital tunnel syndrome?
Osborne fascia forming on roof or tightness at intermuscular septum as nerve passes through between the two heads at the origin of flexor carpi ulnaris
What is the radio-capitallar joint responsible for?
Supination and pronation
Where does the triceps muscle insert and what does it power?
Olecranon process and powers elbow extension
Where does brachialis insert?
Coronoid process
Where does biceps insert?
Bicipital tuberosity of radius
How does pronation of the forearm come about?
Contraction of the pronator teres proximally and pronator quadratus muscle distally
What condition involves the production of abnormal collagen type 3 instead of type 1?
Dupuytrens contracture
Who is more affected by dupuytrens contracture - men or women?
men 10 times more
What associations does dupuytrens contracture have?
Familial - autosomal dominant, high prevelance in those of norhtern european/scandanavian descent, alcoholics and diabetics
Where does ledderhose disease affect?
Feet
What pully is most commonely affected by trigger finger?
A1
How is trigger finger relieved?
Injection of steroid around tendon within the sheath
What carpal joints are affected by primary OA?
STT joints - scaphoid, trapezium and trapezoid
What is a swan neck deformity in RA?
Hyperextension at PIP with flexion at DIP
What is a Boutonniere deformirt?
Flexion at PIP with hyperextension at DIP
Other than boutonniere deformity and swans neck deformity - what are the three other clinical deformities in RA?
- Volar MCP subluxagtion
- Ulnar deviation
- Z-shpaed thumb
What are common mucinous filled cysts found adjacent to a tendon or synovial joint?
Ganglion cyst - Bakers cyst if at knee
What are second most common soft tissue swellings of the hand, usually found on palmar surface especially at PIP, can erode bone, contain multi nucleate giant cells and haemosiderin which makes them brown?
Ginat cell tumour of tendon sheath
What nerve allows hip pain to radiate to knee?
Obturator nerve
What can metal on metal hip replacement result in/
Inflammatory pseudotumour which causes necrosis of muscle and bone
What can AVN of the hip be secondary to?
Alcohol, steroids, hyperlipidaemia or thrombophilia
What does hanging rope sign on xray suggest
AVN of hip caused by lytic zone
What condition presents with pain on resisted abduction of leg?
Trochanteric bursitis = gluteal medius
What kind of injuries can twisting force on loaded knee cause?
Meniscal
Is psuedolocking a sign of meniscal injury?
No
What does the patient wusually develop after ACL rupture?
Haemarthrosis within an hour
What ligament will a rugby tackle from the side usually tear?
MCL
What ligament tears are more common and why - MCL or LCL?
Medial because it is more fixed and less flexible
What will Steinmanns test show on degenerate meniscal tears?
Negative
What is the principal complaint for ACL rupture?
Rotatory instability with giving way on turning
Whast antibioitcs can cause tendonitis and risk tendon rupture?
Quinolones
What treatment shouldbe avoided in tendonitis of the knee?
Steroid injection
What knee condition presents with anterior knee pain, worse going downhill, grinding or clicking sensation at front of knee and stiffness after sitting - pseudolocking?
Patellogemoral dysfunction
What does a lipo-haemarhtrosis on xray suggest?
Patella dislocation
Is hallux valgus commoner in femlaes or males?
Females 4:1
What is the term for OA of first MTP?
Hallux rigidus
What is gold standard treatment surgically for hallux rigidus?
Arthrodesis - prevents women wearing heals
Where is mortons nejuromea commonly found?
Between third and fourth metatarsals - more common in females 4:1
How can mortons neuroma be tested?
Mulders click test - mediolateral compression of metatarsal heads exerted by squeezing with hand
How can mortons neuroma be investigated and diagnosed?
Utrasound
How can metatarsal stress fractures be diagnosed?
Bone scan, may not appear until 3 weeks
What is Simmonds test and what is it used for?
Achilles tendonitis - no plantar flexion of the foot is seen when squeezing the calf
What are three risk factors for plantar fascitis?
Diabetes, obesity and walking on hard floors with bad shoes
What three things could aquired flat foot be due to?
Tibialis posterior tendon stretch, RA or diabetes with Chardcot foot
What is the term for an abnormally high arch of foot?
Pes cavus
What can hereditory senory, motor neuropathy, cerebral palsy, polio anbd spinal cord tethering all cause?
Pes cavus - claw toes often accompanies it
