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Musculoskeletal System > Disease Profiles 3 > Flashcards

Disease Profiles 3 Flashcards

1
Q

Transient Synovitis

A

Self-limiting inflammation of the synovium of a joint

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2
Q

Transient Synovitis: Most common joint affected

A

Hip

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3
Q

Transient Synovitis: Most common aetiology

A

Following URTI - usually viral

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4
Q

Transient Synovitis: Peak age of incidence

A

2-10 years old

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5
Q

Transient Synovitis: Epidemiology of sexes

A

More common in boys

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6
Q

Transient Synovitis: Clinical presentation

A

Limp or reluctance to bear weight on the affected side with reduced range of motion
Pain at the end range of hip movements - reduced ROM

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7
Q

Transient Synovitis: What criteria is used for diagnosis?

A

Kochers Criteria - differentiated septic arthritis from transient synovitis in a child with an inflamed hip

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8
Q

Transient Synovitis: Test to exclude Perthes Disease

A

X-Ray

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9
Q

Transient Synovitis: Test to exclude septic arthritis

A

CRP

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10
Q

Transient Synovitis: Test to exclude osteomyelitis of the proximal femur

A

MRI

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11
Q

Transient Synovitis: Management

A

NSAIDs and Rest

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12
Q

Septic Arthritis of the Hip: Why is it a surgical emergency? (3)

A

High bacterial load
Destruction of the joint occurs due to proteolytic enzymes
Potential for osteonecrosis of the hip due to increased pressure

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13
Q

Septic Arthritis of the Hip: Aetiologies (4)

A

Direct inoculation due to trauma or surgery
Haematogenous seeding
Extension from adjacent bone osteomyelitis
Can develop from contiguous spread of osteomyelitis

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14
Q

Septic Arthritis of the Hip: Most common cause

A

Haematogenous seeding

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15
Q

Septic Arthritis of the Hip: What enables the spread?

A

Highly vascular metaphysis

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16
Q

Septic Arthritis of the Hip: Why is this common in neonates?

A

Transphyseal vessels allow spread into the joint

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17
Q

Septic Arthritis of the Hip: Causative organisms (4)

A

Staphylococcus aureus
Group B streptococcus
E. coli
Streptococcus pneumoniae

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18
Q

Septic Arthritis of the Hip: Most common causative organism in first 2 years of life

A

Streptococcus pneumoniae

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19
Q

Septic Arthritis of the Hip: Clinical Presentation (3)

A

Unable to weight bear
Severe hip or groin pain on passive movement
Pyrexial

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20
Q

Septic Arthritis of the Hip: Kocher Criteria (5 criteria)

A

Fever - >38.5
Refusal to weight bear
ESR - 40mm/hour
Serum EBC - >12,000 cells
CRP - >2

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21
Q

Septic Arthritis of the Hip: Management

A

Open surgical washout - takes an anterior approach
6 weeks of antibiotics via PICC line

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22
Q

Perthes Disease

A

Idiopathic osteochondritis of the femoral head

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23
Q

Perthes Disease: Peak age of incidence

A

4-9 years old

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24
Q

Perthes Disease: Epidemiology of sexes

A

More common in men - more commonly active boys of short stature

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25
Q

Perthes Disease: What ethnicities are at greater risk?

A

Asian
Inuit
Central european

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26
Q

Perthes Disease: Pathophysiology

A

The femoral head transiently loses its blood supply resulting in necrosis with subsequent abnormal growth

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27
Q

Perthes Disease: Remodelling causes the formation of an incongruent joint, what impact may this have?

A

Increased risk of early onset arthritis

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28
Q

Perthes Disease: Symptoms (2)

A

Child presents with unilateral pain and a limp

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29
Q

Perthes Disease: Bilateral pain may represent what?

A

Underlying skeletal dysplasia or a thrombophilia

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30
Q

Perthes Disease: Impact on movement

A

Loss of internal rotation
Loss of abduction
Positive Trendelenburg Test - detects gluteal weakness

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31
Q

Perthes Disease: Growth pattern of these patients

A

Delayed bone age - retarded growth soon after diagnosis but later catch up

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32
Q

Perthes Disease: Why do some patients become Trendelenburg Positive?

A

The femoral head becomes aspherical, flattened and widened therefore weakens the lever arm of the abductor muscles

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33
Q

Perthes Disease: When may osteotomy of the femur or acetabulum be required?

A

When the femoral head subluxes - partially dislocates

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34
Q

Hallux Valgus

A

Deformity of the great toes due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself

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35
Q

Hallux Valgus: Epidemiology of sexes

A

More common in females

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36
Q

Hallux Valgus: What would indicate a strong family history of this?

A

Presentation in late adolescence

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37
Q

Hallux Valgus: More common in those impacted by what?

A

Inflammatory Arthropathies - RA or Neuromuscular diseases e.g. MS or Cerebral palsy

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38
Q

Hallux Valgus: Extrinsic Risk Factors (2)

A

High heels
Narrow toe box shoes

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39
Q

Hallux Valgus: Pathophysiology

A

Valgus deviation of the phalanx promotes medial deviation of the metatarsal head

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40
Q

Hallux Valgus: Impact on the sesamoids

A

Lateral deviation

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41
Q

Hallux Valgus: Why are the sesamoids deviated laterally?

A

Due to attachment to the flexor hallucis brevis that attaches to the base of the proximal phalanx of the toe

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42
Q

Hallux Valgus: Is presentation normally unilateral or bilateral?

A

Bilateral

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43
Q

Hallux Valgus: Why may patients become unable to wear closed shoes? (2)

A

Bursa present
Nerve damage

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44
Q

Hallux Valgus: How could a bunion form?

A

A widened forefoot may cause rubbing of the foot with the shows causing an inflamed bursa over the medial 1st metatarsal head

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45
Q

Hallux Valgus: How could ulceration develop?

A

The great toe and the second toe rubbing on each other

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46
Q

Hallux Valgus: Joint pain indicates what?

A

Osteoarthritis

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47
Q

Hallux Valgus: What does defunctioned 1st ray indicate?

A

Transfer metatarsalgia
Poor balance

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48
Q

Hallux Valgus: Defunctioned 1st Ray

A

Segment of the foot composed of the first metatarsal and the first cuneiform bones

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49
Q

Hallux Valgus: Conservative management

A

Wear wider and deeper shoes to prevent bunion formation
Spacer used to prevent ulceration

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50
Q

Hallux Valgus: What surgical procedure can be performed?

A

Osteotomies

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51
Q

Hallux Valgus: Function of Osteotomies

A

Realign bones and soft tissue to tighten slack tissues and release tight tissues

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52
Q

Hallux Valgus: Indications for surgery (5)

A

Failure of conservative management
Lesser toe deformities
Liftstyle limitation
Overlapping
Functional limitation

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53
Q

Hallux Valgus: Complications of surgery (2)

A

Pain in the metatarsal heads
Risk of recurrence of deformity in adolescents

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54
Q

Hallux Valgus: Aim of surgical management

A

Realign the hallux and decrease the HV angle

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55
Q

Hallux Rigidus

A

Osteoarthritis of the first Metatarsophalangeal Joint

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56
Q

Hallux Rigidus: Predisposing factors (2)

A

Acute trauma
Microtrauma

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57
Q

Hallux Rigidus: Symptoms (3)

A

Painful 1st Metatarsophalangeal Joint
Stiffness
Pain increases with activity or shoes

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58
Q

Hallux Rigidus: Signs (2)

A

Dorsal Exostosis - this is a bone spur
Interphalangeal Joint hyperextension

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59
Q

Hallux Rigidus: Diagnostic Test

A

X-Ray - Anteroposterior, Lateral and Oblique

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60
Q

Hallux Rigidus: Conservative management (3)

A

Weight loss
Analgesia or NSAIDs
Intra-articular injection

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61
Q

Hallux Rigidus: Surgical Management - For early cases with dorsal osteophytes impinging during dorsiflexion

A

Cheilectomy - removal of osteophytes

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62
Q

Hallux Rigidus: Surgical Management - Gold standard surgical management

A

Arthrodesis - fusion of the bones to remove diseased cartilage

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63
Q

Rheumatoid Foot

A

Inflammatory autoimmune disorder characterised by joint pain, swelling and synovial destruction of the foot

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64
Q

Rheumatoid Foot: Impacts what % of RA patients?

A

90%

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65
Q

Pes Planus: Alternate name

A

Flat feet

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66
Q

Pes Planus: Prevalence

A

1 in 5 adults

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67
Q

Pes Planus: Most people are born with flat feet, how is this changed over time?

A

Most individuals develop a medial arch once walking as the tibialis posterior strengthens

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68
Q

Pes Planus: Suggested pathophysiology for this (2)

A

Generalised ligamentous laxity or tightness of the gastrocsoleus complex, causing stretching
Tarsal Coalition - Underlying bone connection

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69
Q

Pes Planus

A

Loss of the medial longitudinal arch of the foot where it contacts or nearly contacts the floor

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70
Q

Pes Planus: Acquired flat foot may occur due to what? (4)

A

Tibialis posterior tendon stretch
Tibialis posterior tendon rupture
Rheumatoid arthritis
Diabetes with Charcot Foot - neuropathic joint destruction

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71
Q

Pes Planus: Mobile Flat Feet

A

Feet where the flattened medial arch forms with dorsiflexion of the great toe and forms an arch when patient is on tip toes

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72
Q

Pes Planus: Mobile Flat Feet - Management

A

This is normal in children - medial arch orthoses are not required

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73
Q

Pes Planus: Mobile Flat Feet - Cause in adults

A

Tibialis posterior tendon dysfunction

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74
Q

Pes Planus: Rigid Flat Feet

A

The arch of the foot remains flat regardless of load or great toe dorsiflexion

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75
Q

Pes Planus: Rigid Flat Feet - Implies what is present? (3)

A

Underlying bony abnormality - tarsal coalition where the bones of the hindfoot have an abnormal or cartilaginous connection
Inflammatory disorder
Neurological disorder

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76
Q

Pes Planus: Diagnostic test

A

Calf Tightness Assessment

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77
Q

Pes Planus: Complications

A

Higher risk of tendonitis of the tibialis posterior tendon

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78
Q

Tibialis Posterior Tendon Dysfunction: The Tibialis Posterior Tendon inserts where?

A

Onto the medial navicular

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79
Q

Tibialis Posterior Tendon Dysfunction: Tibialis Posterior Tendon serves what function?

A

Support the medial arch of the foot

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80
Q

Tibialis Posterior Tendon Dysfunction: Most common cause of what?

A

Acquire flat foot (pes planus) in adults

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81
Q

Tibialis Posterior Tendon Dysfunction: Most at risk patient group

A

Obese middle aged females

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82
Q

Tibialis Posterior Tendon Dysfunction: Correlation between incidence and age

A

Risk increases with age

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83
Q

Tibialis Posterior Tendon Dysfunction: Risk Factors (4)

A

Hypertension
Diabetes
Steroid injections
Seronegative Arthropathies

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84
Q

Tibialis Posterior Tendon Dysfunction: Pathophysiology

A

Under repeated stress the tendon is degenerated to develop tendonitis, elongation and then rupture

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85
Q

Tibialis Posterior Tendon Dysfunction: What is the result of this pathophysiology?

A

Loss of the medial arch with resulting valgus of the heel and flattening of the medial arch of the foot

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86
Q

Tibialis Posterior Tendon Dysfunction: Anatomy - Posterior to what?

A

Medial malleolus

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87
Q

Tibialis Posterior Tendon Dysfunction: Anatomy - Attaches onto what?

A

Navicular tuberosity
Plantar aspect of the medial and middle cuneiforms

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88
Q

Tibialis Posterior Tendon Dysfunction: Anatomy - What elevates the arch?

A

Primary dynamic stabiliser of the medial longitudinal arch

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89
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Specific symptom

A

Pain and/or swelling posterior to the medial malleolus

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90
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type I

A

Normal Arch - with swelling and tenderness over the posterior tibia with weak muscular power

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91
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type II

A

Flat foot with midfoot abduction - the arch is collapsed

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92
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Management of Type II

A

Passively correctable

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93
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - What sign is present in Type II?

A

Too many toes sign - cannot single heel raise

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94
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type III

A

Flat foot with rigid forefoot with a collapses arch

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95
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - What pathologies are present in Type III?

A

Hindfoot deformities
Subtalar arthritis

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96
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type IV

A

Arch collapse with a talar tilt in ankle mortise

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97
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - What pathology is present in Type IV?

A

Subtalar arthritis

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98
Q

Tibialis Posterior Tendon Dysfunction: Tendonitis should be treated how?

A

Splint with a medial arch support to avoid rupture

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99
Q

Tibialis Posterior Tendon Dysfunction: Management - First line

A

Orthoses to accommodate foot shape and medial longitudinal arch

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100
Q

Tibialis Posterior Tendon Dysfunction: Management - Second line if orthoses fail

A

Surgical decompression and tenosynovectomy

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101
Q

Tibialis Posterior Tendon Dysfunction: Management - What must not be used?

A

Steroid injections

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102
Q

Tibialis Posterior Tendon Dysfunction: Management - Surgical options if no secondary osteoarthritis is present

A

A tendon transfer with a calcaneal osteotomy

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103
Q

Tibialis Posterior Tendon Dysfunction: Management - Surgical options if secondary osteoarthritis is present

A

Arthrodesis

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104
Q

Tibialis Posterior Tendon Dysfunction: Complications

A

Failure of static hind foot stabilisers, spring ligament, plantar fasciitis and plantar ligaments

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105
Q

Pes Cavus

A

Abnormally high arch of the foot

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106
Q

Pes Cavus: Often caused by what?

A

Neuromuscular conditions - Neuropathy, Cerebral palsy, Polio and Spinal cord tethering from the spina bifida occulta

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107
Q

Pes Cavus: Main symptom

A

Pain in the arch of the foot

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108
Q

Pes Cavus: What is an accompanying symptom of pes cavus?

A

Claw toes

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109
Q

Pes Cavus: Combined deformities (3)

A

Hindfoot varus
Forefoot adduction
Clawing of the toes

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110
Q

Pes Cavus: Investigation if tumour is suspected

A

MRI of the spine

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111
Q

Pes Cavus: Gold standard

A

X-ray of the foot

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112
Q

Pes Cavus: Management - If movement is easy

A

Soft tissue release and tendon transfer

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113
Q

Pes Cavus: Management - If rigid movement

A

Calcaneal osteotomy

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114
Q

Plantar Fasciitis

A

Degenerative condition of the plantar fascia that causes sharp pain on the bottom of the foot

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115
Q

Plantar Fasciitis: Aetiology

A

Repetitive stress or overload
Degenerative condition

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116
Q

Plantar Fasciitis: 5 Risk Factors

A

Physical overload - excessive exercise or weight
Diabetes
Increased age
Abnormal foot shape
Frequent walking on hard floors with poor cushioning in shoes

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117
Q

Plantar Fasciitis: Why does increased age increase risk?

A

The cushioning heel fat pad atrophies with age

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118
Q

Plantar Fasciitis: What abnormal foot shapes increase risk? (2)

A

Planovalgus
Cavovagus

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119
Q

Plantar Fasciitis: Clinical presentation

A

Pain after rest on the instep of the foot

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120
Q

Plantar Fasciitis: When is the pain worse?

A

After exercise

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121
Q

Plantar Fasciitis: Where is the pain mainly felt?

A

At the origin of the plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity

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122
Q

Plantar Fasciitis: Sign on the plantarmedial aspect of the heel

A

Fullness or swelling

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123
Q

Plantar Fasciitis: What test can be used and what result would it have?

A

Tinel’s Test - lightly tap over the nerve to elicit a tingling sensation
Positive for Baxter’s nerve

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124
Q

Plantar Fasciitis: Management - Risk of surgical release of the plantar fascia

A

Injury to the plantar nerves

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125
Q

Plantar Fasciitis: Management - General suggestion

A

Rest and NSAIDs

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126
Q

Plantar Fasciitis: Management - Suggested physiotherapy

A

Achilles and plantar fascia stretching exercises

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127
Q

Morton’s Neuroma

A

Benign fibrotic thickening of a plantar digital nerve near the bifurcation

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128
Q

Morton’s Neuroma: 2 Aetiologies

A

Repeated trauma of the plantar interdigital nerves from the medial and lateral plantar nerves overlying the intermetatarsal ligaments
Irritated nerves

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129
Q

Morton’s Neuroma: Most commonly involved

A

Third interspace of the foot

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130
Q

Morton’s Neuroma: Mean age

A

45-50 years old

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131
Q

Morton’s Neuroma: Main 2 Risk factors

A

Obesity
Females

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132
Q

Morton’s Neuroma: Epidemiology of sexes

A

More common in women - due to high heels

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133
Q

Morton’s Neuroma: Main symptom

A

Burning pain and tingling that radiates to the affected toes

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134
Q

Morton’s Neuroma: What is metatarsalgia?

A

Forefoot pain

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135
Q

Morton’s Neuroma: How is pain exacerbated?

A

Footwear

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136
Q

Morton’s Neuroma: How is pain relieved?

A

Removal of a shoe
Massaging the foot
Changing footwear

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137
Q

Morton’s Neuroma: Main Sign

A

Loss of sensation in the affected webspace

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138
Q

Morton’s Neuroma: What test can be used?

A

Mulder’s Click Test

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139
Q

Morton’s Neuroma: What is the Mulder’s Click Test?

A

Medio-lateral compression of the metatarsal heads by squeezing the forefoot in the hand may reproduce symptoms or a characteristic click

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140
Q

Morton’s Neuroma: Diagnostic test

A

Ultrasound

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141
Q

Morton’s Neuroma: What will an ultrasound show?

A

Swollen nerve

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142
Q

Morton’s Neuroma: Problem with Diagnostic US

A

Poor specificity if <6 mm in diameter

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143
Q

Morton’s Neuroma: Conservative management

A

RICE
Weight loss if appropriate
Activity modification

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144
Q

Morton’s Neuroma: Management to relieve symptoms

A

Steroid and local anaesthetic injections

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145
Q

Morton’s Neuroma: Indication for surgical intervention

A

Symptoms persisting after 2-3 months of footwear medication and metatarsal pads with an inadequate response to corticosteroid injection

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146
Q

Achilles Tendonitis

A

Inflammation of the achilles tendon

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147
Q

Achilles Tendonitis: What is the real name for the achilles tendon?

A

Calcaneal tendon

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148
Q

Achilles Tendonitis: Aetiology (2)

A

Repetitive microtrauma leads to peritendonitis
Degenerative processes

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149
Q

Achilles Tendonitis: What drugs are risk factors?

A

Quinolone antibiotics e.g. Ciprofloxacin

150
Q

Achilles Tendonitis: What conditions are a risk factor? (3)

A

Rheumatoid Arthritis
Gout
Inflammatory Arthritis

151
Q

Achilles Tendonitis: Pathophysiology - Can be due to failure of what?

A

Collagen repair - leads to loss of fibre alignments

152
Q

Achilles Tendonitis: Pathophysiology - What can occur to the vascuature of surrounding tissue?

A

Hypovascular region 2-6cm proximal to the insertion

153
Q

Achilles Tendonitis: Clinical Presentation (2)

A

Pain of the achilles tendon or at its insertion in the calcaneus
Morning stiffness

154
Q

Achilles Tendonitis: Pathophysiology - What makes the pain better?

A

Walking

155
Q

Achilles Tendonitis: Complication

A

Increased risk of tendon rupture

156
Q

Achilles Tendonitis: What can be administered to prevent tendon rupture?

A

Steroid injection around the Achilles Tendon

157
Q

Achilles Tendonitis: Management - Conservative

A

Activity modification
Analgesia
NSAIDs

158
Q

Achilles Tendonitis: Secondary management to lifestyle and pain killer

A

Heel raise in a splint or boot to offload the tendon

159
Q

Achilles Tendonitis: Management for resistant cases

A

Tendon decompression or resection of the paratendon

160
Q

Achilles Tendon Rupture: Peak age of incidence

A

> 40 years old

161
Q

Achilles Tendon Rupture: Why is risk increased in those over 40?

A

Tendon degeneration

162
Q

Achilles Tendon Rupture: What may cause tendon rupture? (3)

A

Single high energy event
Accumulation of recurrent minor tears
Following recent tendonitis

163
Q

Achilles Tendon Rupture: Risk Factors (4)

A

Diabetes
Rheumatoid Arthritis
Steroid use
Pre-existing Tendonitis

164
Q

Achilles Tendon Rupture: Common description of symptom

A

Like being kicked in the back of the leg

165
Q

Achilles Tendon Rupture: Example of initiating event

A

Sudden deceleration with resisted calf muscle contraction

166
Q

Achilles Tendon Rupture: What test can be done and what would it show?

A

Simmonds Test - No plantar flexion when the calf is squeezed

167
Q

Simmonds Test - what is a normal result?

A

Patient is asked to kneel on a chair and each calf is squeezed individually
Normal - the foot will planterflex due to contraction of the gastrocnemius

168
Q

Achilles Tendon Rupture: What will the patient be unable to do?

A

Stand on tip toes

169
Q

Achilles Tendon Rupture: Shows weakness in what?

A

Plantar flexion

170
Q

Achilles Tendon Rupture: What can be felt in these cases?

A

Palpable gap in the tendon

171
Q

Achilles Tendon Rupture: What diagnostic test is used to distinguish between complete and partial tears?

A

US or MRI

172
Q

Achilles Tendon Rupture: What are the two treatment options?

A

Suture repair of the tendon
Series of casts in the equinous position

173
Q

Achilles Tendon Rupture: Problem with surgical suture repair of the tendon

A

Problems with wound problems

174
Q

Achilles Tendon Rupture: How do serial casts work?

A

The ankle is plantarflexed with the toes pointing down to close the gap in the torn tendon over 8 weeks

175
Q

Ankle Sprains: Most common cause

A

Twisted ankle - inversion or twisted forces on a planted foot

176
Q

Ankle Sprains: Most common ankle sprains

A

Lateral ankle sprains

177
Q

Ankle Sprains: Lateral Ankle Sprains - Most common cause

A

Inversion of plantar flexed foot leading to excessive supination of the rearfoot about an externally rotated leg

178
Q

Ankle Sprains: Lateral Ankle Sprains - What is injured first?

A

Anterior Talo-fibular Ligament

179
Q

Ankle Sprains: Lateral Ankle Sprains - What is injured second?

A

Calcaneofibular ligament

180
Q

Ankle Sprains: Lateral Ankle Sprains - What ligament is least likely to be affected?

A

Posterior Talofibular Ligament

181
Q

Ankle Sprains: Lateral Ankle Sprains - Grade I

A

Microscopic tear

182
Q

Ankle Sprains: Lateral Ankle Sprains - Grade II

A

Partial tear

183
Q

Ankle Sprains: Lateral Ankle Sprains - Grade III

A

Complete rupture

184
Q

Ankle Sprains: Lateral Ankle Sprains - Chronic Sprain

A

Recurrent sprain or giving way that persists for more than 6 months

185
Q

Ankle Sprains: Lateral Ankle Sprains - Initial management

A

Protection with RICE

186
Q

Ankle Sprains: Lateral Ankle Sprains - Management for pain if physiotherapy does not work

A

Arthroscopy

187
Q

Ankle Sprains: Lateral Ankle Sprains - First line management if functional instability is present?

A

Physiotherapy

188
Q

Ankle Fractures: Main cause

A

Inversion injury with a rotational force applied. tothe planted foot

189
Q

Ankle Fractures: Can affect what structures? (3)

A

Lateral malleolus
Medial malleolus
Posterior malleolus

190
Q

Ankle Fractures: What type are often small avulsion fractures or undisplaced?

A

Solitary malleolar fractures

191
Q

Ankle Fractures: What type are often associated with a tendency to instability?

A

Trimalleolar fracture

192
Q

Ankle Fractures: What classification system is used?

A

Weber Classification System

193
Q

Ankle Fractures: Weber A Classification

A

Fracture of the fibular distal to the syndesmosis

194
Q

Ankle Fractures: Weber B Classification

A

Fracture of the fibular at the level of the syndesmosis

195
Q

Ankle Fractures: Weber C Classification

A

Fracture of the fibular proximal to the syndesmosis

196
Q

Ankle Fractures: What is the Lauge Hansen Analysis system?

A

Analyses the fracture based on. thefoot position and force applied

197
Q

Ankle Fractures: Stable ankle fracture description

A

Distal fibula fracture with no medial malleolus fracture or deltoid ligament rupture

198
Q

Ankle Fractures: Unstable ankle fracture description

A

Distal fibula fracture with medial malleolus fracture or deltoid ligament rupture

199
Q

Ankle Fractures: X-Ray - How to locate the site of fracture?

A

Check for soft tissue swelling

200
Q

Ankle Fractures: X-Ray - What does non-uniform ankle joint space indicate?

A

Instability often with ligamentous damage

201
Q

Ankle Fractures: CT - What is a pilon fracture?

A

High energy fracture at the bottom of the tibia and involves the ankle joint

202
Q

Ankle Fractures: Management - Conservative options (2)

A

Cast
Moon boot

203
Q

Ankle Fractures: Management - Surgical option

A

Open Reduction Internal Fixation

204
Q

5th Metatarsal Fracture: Main cause

A

Inversion injury

205
Q

5th Metatarsal Fracture: 3 different types

A

Avulsion by the peroneus brevis tendon
Jones fracture
Proximal shaft

206
Q

5th Metatarsal Fracture: Cause of jones fracture

A

Sudden force applied to the outside of the foot whilst the foot is twisted outwards

207
Q

5th Metatarsal Fracture: The proximal shaft is a common site for what?

A

Stress fracture

208
Q

5th Metatarsal Fracture: Concern with Jones fracture

A

Poor blood supply - risk of non-union

209
Q

5th Metatarsal Fracture: Clinical presentation

A

Pain over the lateral border of the forefoot - increased when weight bearing

210
Q

5th Metatarsal Fracture: Clinically resemble what other pathology

A

Lateral malleolar fracture

211
Q

5th Metatarsal Fracture: Fractures are in what direction?

A

Transverse

212
Q

5th Metatarsal Fracture: Fractures may be confused with what on X-ray due to transverse direction?

A

Normal longitudinal adolescent ossification centre

213
Q

5th Metatarsal Fracture: Management

A

Immobilisation and protected weight bearing
Surgery may be required

214
Q

Lis Franc Injury

A

Tarsometatarsal fracture dislocation characterised by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal

215
Q

Lis Franc Injury: Main cause

A

High energy injury

216
Q

Lis Franc Injury: Clinical presentation

A

Severe midfoot pain - inability to bear weight

217
Q

Lis Franc Injury: How to correctly assess the X-Ray

A

AP view - 1st and 2nd TMT joint congruity assessed
Oblique view - 3rd, 4th and 5th joint congruity assessed

218
Q

Lis Franc Injury: What X-rays need to be taken?

A

AP and Oblique view

219
Q

Lis Franc Injury: What clinical features is best shown on CT?

A

Multiple ligamentous avulsion fractures

220
Q

Lis Franc Injury: Management

A

Requires fixation - Open Reduction Internal Fixation

221
Q

Lis Franc Injury: Complications (2)

A

Can cause disability
Osteoarthritis

222
Q

Calcaneus Fracture: Main cause

A

Axial compression e.g. falling from a height onto the heel

223
Q

Calcaneus Fracture: Clinical presentation

A

Pain at the heel that. isunable to bear weight and has significant swelling

224
Q

Calcaneus Fracture: Diagnostic testing (2)

A

X-ray
CT

225
Q

Calcaneus Fracture: X-Ray presentation

A

Loss of central peak seen in a normal calcaneus
Increased bone density

226
Q

Calcaneus Fracture: How is the central peak measured on X-Ray?

A

Bohler’s angle

227
Q

Calcaneus Fracture: Conservative management

A

Non-weight bearing for 6-12 weeks

228
Q

Calcaneus Fracture: Why is surgery controversial?

A

High risk of infection and wound breakdown

229
Q

Calcaneus Fracture: Complication

A

Compartment Syndrome

230
Q

Talus Fracture: Main causes (2)

A

Forced dorsiflexion
Rapid deceleration

231
Q

Talus Fracture: What is there a risk of?

A

AVN

232
Q

Talus Fracture: Why is there a risk of AVN?

A

Reversed blood supply

233
Q

Talus Fracture: What two bones form a ring with the talus?

A

Tibia
Fibula

234
Q

Talus Fracture: Talar Dome Margin Fracutre is caused by what?

A

Excessive inversion or eversion

235
Q

Bone Tumours: Terminology - Osteo is cancer of what?

A

Bone

236
Q

Bone Tumours: Terminology - Chondro is cancer of what?

A

Cartilage

237
Q

Bone Tumours: Terminology - Sacro is cancer of what?

A

Soft tissue

238
Q

Bone Tumours: Examples of bone-forming tumours (4)

A

Osteoma
Osteoid Osteoma
Osteoblastoma
Osteosarcoma

239
Q

Bone Tumours: Examples of cartilage-forming tumours (3)

A

Enchondroma
Osteochondroma
Chondrosarcoma

240
Q

Bone Tumours: Can be secondary to what other cancers? (5)

A

Breast
Lung
Prostate
Kidney
Thyroid

241
Q

Bone Tumours: Predisposing condition risk factors (3)

A

Paget’s disease
Fibrous dysplasia
Multiple enchondromas

242
Q

Bone Tumours: Genetic causes (2)

A

Li Fraumeni - p53
Familial Retinoma - RBI

243
Q

Bone Tumours: Environmental risk factor

A

Previous radiotherapy

244
Q

Bone Tumours: Sites of metastatic cancer in the bone (5)

A

Vertebra
Pelvis
Ribs
Femur
Skull

245
Q

Bone Tumours: May not show on X-ray until what?

A

> 50% of bone is depleted

246
Q

Bone Tumours: Radiological features of Malignant Lesions (3)

A

Broad zone of transition
Periosteal reaction
Cortical destruction

247
Q

Bone Tumours: 3 options for management

A

Neoadjuvant - Chemotherapy, Radiotherapy or Hormonal Treatment
Surgery - Reconstruction or Amputation
Adjuvant therapy - Chemotherapy or Radiotherapy

248
Q

What is the most common primary sarcoma of the bone?

A

Osteosarcoma

249
Q

Osteosarcoma: Impacts what patient groups?

A

Children and young adults

250
Q

Osteosarcoma: 2nd peak occurs when and why?

A

Elderly due to Paget’s Disease

251
Q

Osteosarcoma: 2nd peak occurs when and why?

A

Elderly due to Paget’s Disease

252
Q

Osteosarcoma: Usually affects what bones?

A

Distal femur
Proximal tibia

253
Q

Osteosarcoma: Common site of metastasis

A

Lung

254
Q

Osteosarcoma: Management

A

Chemotherapy
Limb salvage

255
Q

Ewing’s Sarcoma: Found in what bones?

A

Diaphysis of long bones, distal femur or proximal tibia

256
Q

Ewing’s Sarcoma: Management

A

Chemotherapy with limb salavge +/- Adjuvant Radiation

257
Q

Chondrosarcoma

A

Malignancy of the chondrocytes

258
Q

Chondrosarcoma: Peak age

A

40-75 years

259
Q

Chondrosarcoma: May arise from what?

A

Benign lesions - Enchondroma and Osteochondroma

260
Q

Chondrosarcoma: Most common locations (3)

A

Pelvis
Proximal femur
Distal femur

261
Q

Chondrosarcoma: Histology

A

Lytic or blastic lesion with reactive cortical thickening

262
Q

Osteoid Osteoma

A

Painful benign bone-forming tumour of long bones

263
Q

Osteoid Osteoma: Peak age of incidence

A

5-25 years old

264
Q

Osteoid Osteoma: Common sites (3)

A

Proximal femur
Diaphysis of long bones
Vertebrae

265
Q

Osteoid Osteoma: Clinical presentation

A

Intense constant pain thayt worsens at night

266
Q

Osteoid Osteoma: Why does the pain worsen at night?

A

Intense inflammatory response

267
Q

Osteoid Osteoma: Appearance on CT

A

Central nodule of woven/immature bone with an osteoblastic rim that appears as an intense sclerotic halo

268
Q

Osteoid Osteoma: What would bone scan show?

A

Intense local uptake

269
Q

Osteoid Osteoma: Management - of pain

A

NSAIDs

270
Q

Osteoid Osteoma: Management of severe cases (2)

A

CT-guided radiofrequency ablation
En bloc excision

271
Q

Osteochondroma

A

A benign lesion derived from aberrant cartilage from the perichondral ring

272
Q

Osteochondroma: Peak age of incidence

A

10-20 years old

273
Q

Can have what cause?

A

Trauma

274
Q

Osteochondroma: Multiple osteochondromas can occur due to what?

A

Multiple Hereditary Exostosis - Autosomal dominant hereditary disorder

275
Q

Osteochondroma: Pathophysiology

A

A bony outgrowth on the external surface with a cartilaginous cap

276
Q

Osteochondroma: Common location (2)

A

Near the knee - Distal femur or proximal tibia

277
Q

Osteochondroma: Clinical presentation

A

Painless hard lump that may produce pain or numbness with activity

278
Q

Osteochondroma: Pain may generate from where?

A

Tendons

279
Q

Osteochondroma: Numbness may develop due to what?

A

Nerve compression

280
Q

Osteochondroma: Diagnostic test

A

X-Ray

281
Q

Osteochondroma: X-ray appearance

A

Carilage capped ossified pedicle

282
Q

Osteochondroma: When is excision required?

A

Growth of the lesion
Pain caused

283
Q

Osteochondroma: Complication

A

Progression to Chondrosarcoma as pelvic lesions

284
Q

Enchondroma

A

Intramedullary cartilaginous cancer caused by failure of normal enchondral ossification at the growth plate

285
Q

Enchondroma: Usually occurs where?

A

Metaphysis

286
Q

Enchondroma: Peak age of incidence

A

20-50 years old

287
Q

Enchondroma: Can occur in what bones? (5)

A

Femur
Humerus
Tibia
Small bones of the hands and feet

288
Q

Enchondroma: Increased risk of what developing?

A

Fracture - due to weakening of the bone

289
Q

Enchondroma: Appearance on X-ray

A

Lesion is typically lucent - can undergo mineralisation with a patchy sclerotic appearance

290
Q

Enchondroma: Management - If healed fracture or risk of impending fracture

A

Curettage and filled with bone graft

291
Q

Knee Ligament Injuries: Most common cause

A

Rotational movement of the knee joint

292
Q

Knee Ligament Injuries: Grade I

A

Sprain - some fibres are torn but macroscopic strctures are intact

293
Q

Knee Ligament Injuries: Grade II

A

Partial Tear with some fascicles disrupted

294
Q

Knee Ligament Injuries: Grade III

A

Complete tear

295
Q

Knee Ligament Injuries: MCL Rupture may lead to what?

A

Valgus instability

296
Q

Knee Ligament Injuries: ACL rupture may lead to what?

A

Rotatory instability

297
Q

Knee Ligament Injuries: PCL rupture can lead to what?

A

Recurrent hyperextension
Instability on descending stairs

298
Q

Knee Ligament Injuries: Posterolateral corner rupture leads to what? (2)

A

Varus
Rotatory instability

299
Q

Knee Ligament Injuries: Multiligament injuries can result in what?

A

Gross instability

300
Q

Knee Ligament Injuries: MCL Injury - Mechnism of Injury

A

Valgus stress with possible external rotation

301
Q

Knee Ligament Injuries: MCL Injury - Clinical presentation (3)

A

Knee swelling with pain, bruising, deformity and instability
Medial joint line tenderness over the origin or insertion of the MCL
Medial joint laxity and pain on valgus stress

302
Q

Knee Ligament Injuries: MCL Injury - Primary management

A

Brace with early motion and physiotherapy

303
Q

Knee Ligament Injuries: MCL Injury - Acute tear management

A

Hinged knee brace

304
Q

Knee Ligament Injuries: MCL Injury - Chronic instability management

A

MCL tightening or MCL reconstruction with a tendon graft

305
Q

Knee Ligament Injuries: ACL Injury - Mechanism of injury

A

High rotational force turning the upper body laterally on a planted foot

306
Q

Knee Ligament Injuries: ACL Injury - ACL function

A

Main stabiliser of the tibia

307
Q

Knee Ligament Injuries: ACL Injury - Epidemiology of sexes

A

Higher incidence in females

308
Q

Knee Ligament Injuries: ACL Injury - Clinical presentation

A

Audible pop followed by deep knee pain and swelling within 1 hour of injury

309
Q

Knee Ligament Injuries: ACL Injury - Impact on long term movement

A

Rotatory instability - gives way on turning on a planted foot due to excessive internal rotation of the tibia

310
Q

Knee Ligament Injuries: ACL Injury - What tests can be conducted?

A

Anterior Drawer Test
Lachman Test

311
Q

Anterior Drawer Test

A

Patient is positioned in supine with knee flexed to 90 degrees
The hands are wrapped around the proximal tibia with the fingers at the back of the knee joint
The forearm is rested down on the patients lower leg to fix position
Position the thumbs over the tibial tuberosity
Pull the tibia anteriorly whilst the hamstrings are relaxed and feel for any anterior movement of the tibia

312
Q

Lachman’s Test

A

Flex the patients knee to 30 degrees
Hold the lower leg with your dominant hand with your thumb on the tibial tuberosity and your fingers over the calf
With the non-dominant hand, hold the thing just above the patella
Use the dominant hand to pull the tibia forwards on the femur whilst the other hand stabilises the femur

313
Q

Knee Ligament Injuries: ACL Injury - Diagnostic Tests

A

Joint aspiration
MRI to confirm

314
Q

Knee Ligament Injuries: ACL Injury - Join aspiration will show what?

A

Haemarthrosis

315
Q

Knee Ligament Injuries: ACL Injury - Complications

A

Arthritis within 10 years

316
Q

Knee Ligament Injuries: ACL Injury - ACL reconstruction indicated when? (3)

A

Rotatory instability not responding to physiotherapy
Multi-ligament reconstruction
Professional athletes

317
Q

Knee Ligament Injuries: ACL Injury - Options for ACL reconstruction (3)

A

Autograft - from the patellar tendon or hamstrings tendon
Allograft from the achilles tendon
Synthetic graft

318
Q

Knee Ligament Injuries: ACL Rupture - Rule of Thirds

A

1/3 compensate and function well
1/3 avoid instability by avoiding certain activities
1/3 do not compensate and have frequent instability

319
Q

Knee Ligament Injuries: LCL Injury - Mechanism. of injury

A

Varus stress
Hyperextension

320
Q

Knee Ligament Injuries: LCL Injury - Clinical presentation

A

Knee swelling with the ecchymosis, pain, deformity and instability

321
Q

Knee Ligament Injuries: LCL Injury - Presentation on examination

A

Lateral joint line tenderness
Varus stress test shows lateral joint laxity

322
Q

Knee Ligament Injuries: LCL Injury - Can have what complication?

A

Common peroneal nerve palsy

323
Q

Knee Ligament Injuries: LCL Injury - Diagnosis

A

Clinical diagnosis - X-rays and MRI can rule out associated injuries

324
Q

Knee Ligament Injuries: LCL Injury - Management of LCL rupture with early (2-3 weeks) diagnosis

A

Urgent repair

325
Q

Knee Ligament Injuries: LCL Injury - Management of LCL rupture with late diagnosis

A

Reconstruction with tendon graft

326
Q

Knee Ligament Injuries: LCL Injury - Complications

A

Early osteoarthritis in the knee
Common fibular nerve palsy

327
Q

Knee Ligament Injuries: PCL Injury - Mechanism of injury (2)

A

Direct blow to the anterior tibia
Hyperextension injury

328
Q

Knee Ligament Injuries: PCL Injury - Clinical presentation

A

Popliteal knee pain and bruising

329
Q

Knee Ligament Injuries: PCL Injury - Presentation on examination

A

Positive posterior drawer test
Positive sag sign - gravity pulls the tibia downward greater than 10mm

330
Q

Knee Ligament Injuries: PCL Injury - Management if instability present

A

Consider reconstruction

331
Q

Knee Ligament Injuries: PCL Injury - Management if part of a multi-ligament injury

A

Reconstruction

332
Q

Meniscal Tears: Aetiology - Young patients (2)

A

Twisting force on a loaded knee
Getting up from a squat position

333
Q

Meniscal Tears: Aetiology - Older patients

A

Meniscus weakening with age can cause spontaneous tears

334
Q

Meniscal Tears: Probably represents the first stage of what in older patients?

A

Knee osteoarthritis

335
Q

Meniscal Tears: Aetiology - Pain in older patients causes what? (2)

A

Bone marrow oedema
Synovitis

336
Q

Meniscal Tears: What type is more common?

A

Medial meniscal tears

337
Q

Meniscal Extrusion

A

Meniscus is pushed slightly out of the knee joint due to root tear or degeneration

338
Q

Meniscal Tears: Clinical Presentation - Examination for medial meniscus tear

A

Medial joint line tenderness

339
Q

Meniscal Tears: Clinical Presentation - Examination for lateral meniscus tear

A

Lateral joint line tenderness

340
Q

Meniscal Tears: Clinical Presentation (3)

A

Pain and tenderness localised to the joint line
Knees feel like they will give way if a loose meniscal fragment is caught in the knee
Catching or locking sensation

341
Q

Meniscal Tears: Clinical Presentation - Signs present on examination

A

Positive meniscal provocation tests

342
Q

Meniscal Tears: Clinical Presentation - What does an acute locked knee signify?

A

Displaced bucket handle mechanism tear

343
Q

Meniscal Tears: Clinical Presentation - What is a Bucket Handle Meniscal Tear?

A

Large meniscal fragment is able to flip out of its normal position and displace anteriorly or into the intercondylar notch when the knee locks and is unable to fully extend due to mechanical obstruction from the trapped meniscal fragment

344
Q

Meniscal Tears: Bucket Handle Mechanism - Presentation on extension

A

15 degree springy block to extension

345
Q

Meniscal Tears: Bucket Handle Mechanism - What indicates a fixed flexion deformity?

A

Heel height asymmetry

346
Q

Meniscal Tears: Degenerative Meniscal Tear - Presentation

A

Pain due to bone marrow oedema and synovitis
Inflammation from initial outset

347
Q

Meniscal Tears: Diagnosis

A

MRI

348
Q

Meniscal Tears: Management - Why is there limited healing potential?

A

Only has arterial blood supply to the outer third

349
Q

Meniscal Tears: Management - What types of tear do not heal?

A

Radial tears

350
Q

Meniscal Tears: Management - Younger Patients with acute peripheral or bucket handle meniscal tears

A

Arthroscopic repair

351
Q

Meniscal Tears: Management - Acute traumatic peripheral meniscal tears in young patients

A

Arthroscopic repair

352
Q

Meniscal Tears: Management - If meniscal repair fails, what is required?

A

Arthroscopic menisectomy

353
Q

Menisectomy

A

Surgical removal of a torn meniscus

354
Q

Meniscal Tears: Management - Young patients with irreparable tears with recurrent pain, effusion or mechnical symptoms that fails to settle within 3 months

A

Arthroscopic meniscectomy

355
Q

Meniscal Tears: Management - Knees with degenerate changes on X-ray or MRI in young patients should avoid what treatment?

A

Arthroscopic menisectomy - as removal of meniscal tissue may increase stress on the changed surface of the joint

356
Q

Meniscal Tears: Management - Degenerative tear symptomatic control in the early period

A

Corticosteroid injection

357
Q

Meniscal Tears: Management - When is arthroscopic menisectomy appropriate for degenerative tears?

A

Only for unstable tears with mechanical symptoms

358
Q

Meniscal Tears: Management - Bucket Handle Tears when irreparable

A

Partial menisectomy to unlock knee and prevent further damage

359
Q

Meniscal Tears: Management - Bucket Handle Tears when knee remains locked

A

Develop permanent fixed flexion deformity

360
Q

Meniscal Extrusion Two Types

A

Traumatic
Degenerative

361
Q

Knee Dislocation: Aetiology

A

Serious high energy injury

362
Q

Knee Dislocation: Potential directions of dislocation

A

Posterior
Anterior
Medial
Lateral
Rotatory

363
Q

Knee Dislocation: Clinical Presentation

A

Pain and instability of the knee

364
Q

Knee Dislocation: Primary investigation

A

Check the neurovascular status

365
Q

Knee Dislocation: Investigation if concern on neurovascular status

A

CT angiogram

366
Q

Knee Dislocation: Investigation if no concern on the neurovascular status

A

MRI

367
Q

Knee Dislocation: Definitive Management

A

Sequential ligamentous repair

368
Q

Knee Dislocation: Immediate Management

A

Emergency reduction under sedation with reassessment of neurovascular status

369
Q

Knee Dislocation: When may a theatre reduction be required?

A

If the medial condyle has button-holed through the medial capsule

370
Q

Knee Dislocation: What may be required if there is neurovascular injury?

A

Vascular stenting or bypass

371
Q

Knee Dislocation: Reperfusion of the joint may result in what complication?

A

Compartment syndrome

Musculoskeletal System (9 decks)

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