Disease Profiles 4 Flashcards
1
Q
Patellar Dislocation: Aetiologies (2)
A
Rapid turn or direct blow
Sudden quadriceps contraction with a flexing knee
2
Q
Patellar Dislocation: Most common group
A
Teenagers
3
Q
Patellar Dislocation: Sex Epidemiology
A
More common in females
4
Q
Patellar Dislocation: Always dislocates in what direction?
A
Lateral
5
Q
Patellar Dislocation: Risk Factors (5)
A
Ligamentous laxity or hypermobility
Increased Q angle
High riding patella
Hypoplastic lateral femoral condyle
Lateral quads insertion or weak vastus medialis
6
Q
Patellar Dislocation: Causes of an Increased Q angle (2)
A
Genu valgum
Femoral neck anteversion
7
Q
Patellar Dislocation: Clinical Presentation
A
History of patella dislocating laterally with often self-relocation
8
Q
Patellar Dislocation: Pain where? - why is this?
A
Medial pain due to torn medial patella retinaculum tendon
9
Q
Patellar Dislocation: Sign on examination
A
Patella apprehension test positive
10
Q
Patellar Dislocation: X-ray appearance is accompanied by what?
A
Lipo-haemarthosis
11
Q
Patellar Dislocation: What may suggest osteochondral fracture on X-ray?
A
Small opacification
12
Q
Patellar Dislocation: Management - May spontaneously reduce how?
A
Knee is straightened
13
Q
Patellar Dislocation: Management - When is aspiration required?
A
Intractable pain with swelling
14
Q
Patellar Dislocation: Risk of recurrent dislocation
A
10%
15
Q
Patellar Dislocation: What may occur as the patella dislocates? (2)
A
Medial patellofemoral ligament tears
Osteochondral fracture
16
Q
Patellar Dislocation: Why may medial patellofemoral ligament tears and osteochondral fractures occur?
A
Medial facet of the patella may strike the lateral femoral condyle
17
Q
Patellar Dislocation: Options for surgery if recurrent dislocation (2)
A
Lateral release
Medial patellofemoral ligament reconstruction
18
Q
Patellofemoral Pain Syndrome: Alternative name
A
Idiopathic Adolescent Anterior Knee Pain Chondromalacia Patellae
19
Q
Patellofemoral Pain Syndrome: Aetiologies (5)
A
Gluteal weakness
Tightness of lateral tissues
Bony malalignment due to valgus or internal rotation
Flat feet
Obvious patellar maltracking
20
Q
Patellofemoral Pain Syndrome: Often related to what other diagnoses? (3)
A
Chondromalacia patellae - softening of the hyaline cartilage
Adolescent anterior knee pain
Lateral patellar compression syndrome
21
Q
Patellofemoral Pain Syndrome: Clinical presentation
A
Anterior knee pain that is worse on walking downhill
22
Q
Patellofemoral Pain Syndrome: What sign may be observed after long periods of sitting?
A
Pseudolocking - grinding or clicking at the front of the knee with stiffness and stiffens in a flexed position
23
Q
Patellofemoral Pain Syndrome: Management
A
Physiotherapy aimed at rebalancing the quadriceps muscles - Vastus Medialis Oblique Muscles
24
Q
Extensor Mechanism Rupture: The extensor mechanism of the knee constitutes what 5 components?
A
Tibial tuberosity
Patellar tendon
Patella
Quadriceps tendon
Quadriceps muscles
25
Extensor Mechanism Rupture: More common in what population group?
Middle aged population that participate in running or jumping sports
26
Extensor Mechanism Rupture: Mechanism of injury
Falling onto a flexed knee with quadricep contraction
27
Extensor Mechanism Rupture: Patellar tendon ruptures tend to occur in what population groups?
Younger age groups - <40 years old
28
Extensor Mechanism Rupture: Quadriceps tendon ruptures tend to occur in what population groups?
Older age groups - >40 years old
29
Extensor Mechanism Rupture: Risk Factors (6)
Previous tendonitis
Steroid use or abuse
Chronic renal failure
Ciprofloxacin
Diabetes
Rheumatoid arthritis
30
Extensor Mechanism Rupture: How does Ciprofloxacin cause this?
Quinolone antibiotics can cause tendonitis
31
Extensor Mechanism Rupture: Clinical Presentation - Symptoms (2)
Knee pain
Weakness
32
Extensor Mechanism Rupture: Signs - Unable to perform what?
Straight leg raise
33
Extensor Mechanism Rupture: Signs - What can be palpated?
Palpable gap in the extensor mechanism
34
Extensor Mechanism Rupture: Diagnosis - X-rays may show what? (2)
Effusion or patella sitting in the wrong place
35
Extensor Mechanism Rupture: Diagnosis - Where does patella sit in Patellar tendon rupture?
High
36
Extensor Mechanism Rupture: Diagnosis - Where does the patella sit in Quadriceps tendon rupture?
Low
37
Extensor Mechanism Rupture: Management - Requires what urgent intervention?
Surgical repair
38
Extensor Mechanism Rupture: Management - Small partial tear
Immobilisation and Physiotherapy
39
Extensor Mechanism Rupture: What management should be avoided in Tendonitis of the extensor mechanism of the knee?
Steroid injections - high risk of tendon rupture
40
Osteochondritis Dissecans
An area of the surface of the knee loses its blood supply and cartilage +/- bone fragmentation
41
Osteochondritis Dissecans: Most common in what age groups?
Adolescents
42
Osteochondritis Dissecans: Clinical presentation (2)
Knee pain
Recurrent effusions of the knee
43
Osteochondritis Dissecans: Diagnostic tests
X-ray and MRI
44
Osteochondritis Dissecans: When is an MRI utilised?
If detachment is present and it can be localised
45
Osteochondritis Dissecans: Management - if detached
Can fix or remove
46
Osteochondritis Dissecans: Management for severe cases (2)
Cartilage regeneration or Osteochondral allograft
47
Loose Bodies
Detachment of a fragment of cartilage +/- bone causing a loose body within a joint
48
Loose Bodies: Aetiologies (3)
Trauma
Osteochondritis dissecans
Joint degeneration
49
Loose Bodies: How do they grow?
Nutrition from synovial fluid enables growth
50
Loose Bodies: What may they stick to become no longer loose?
Synovium or fat pad
51
Loose Bodies: Typical history
History of mobile lump or sharp occassional pain with locking or catching
52
Loose Bodies: Diagnosis - Presentation on X-ray
Opacification
53
Loose Bodies: Diagnosis - Fabella
Accessory ossicle in the lateral head of the gastrocnemius commonly misdiagnosed as a loose body
54
Loose Bodies: Diagnosis - What view is used to distinguish if it is loose?
Sagittal
55
Loose Bodies: Management
Arthroscopic removal
56
Baker's Cyst
Ganglion cyst found within the popliteal fossa due to inflammation and swelling of the semi-membranoosus bursa
57
Baker's Cyst: Pathophysiology
Joint fluid escapes through a communication to bursa under the medial gastrocnemius or semi-membranosus
58
Baker's Cyst: In adults this may occur due to what pathologies? (2)
Intra-articular - Osteoarthritis or Meniscal tear
59
Baker's Cyst: Clinical presentation (3)
Popliteal discomfort
Tightness
Acute calf pain and swelling
60
Shoulder Instability
Instability of the shoulder involving painful abnormal translational movement or subluxation or recurrent dislocation
61
Shoulder Instability: Most common age group
Teenagers to 30 year olds
62
Shoulder Instability: Two types
Traumatic instability
Atraumatic instability
63
Shoulder Instability: Traumatic instability
Instability following a traumatic anterior dislocation leading to recurrent dislocations and subluxations
64
Shoulder Instability: Atraumatic instability
Instability due to generalised ligamentous laxity with pain due to recurrent multi-directional subluxations or dislocations
65
Shoulder Instability: Examples of causes of generalised ligamentous laxity (2)
Ehlers-Danlos Syndrome
Marfan's Syndrome
66
Shoulder Instability: Symptoms
Atraumatic laxity or subluxations that are not painful
67
Shoulder Instability: Visual examination findings (3)
Abnormal shoulder contour
Muscle wasting
Scapular winging or Dyskinesia
68
Shoulder Instability: Management - Traumatic instability
Open or arthroscopic Bankart repair - reattaches the labrum and capsule to the anterior glenoid which was torn off in the first dislocation
69
Shoulder Dislocation: Why is this the most common joint dislocation?
The head of the humerus is substantially larger than the glenoid fossa
70
Shoulder Dislocation: Most common in what age group?
Teenagers to 30 years old
71
Shoulder Dislocation: Most common mechanisms of injury (2)
Fall
Traction injury
72
Shoulder Dislocation: Most common type
Anterior Shoulder Dislocation
73
Shoulder Dislocation: Anterior Dislocation description
Humeral head is anterior to the glenoid fossa
74
Shoulder Dislocation: Mechanism of injury for anterior dislocation
Fall with shoulder in external rotation
75
Shoulder Dislocation: Anterior dislocation can result in compromise of what?
The axillary artery
76
Shoulder Dislocation: Anterior Dislocation - Requires assessment of what?
Axillary nerve
77
Shoulder Dislocation: Causes of anterior dislocation (2)
Traumatic cause
Sports injury
78
Shoulder Dislocation: Posterior Dislocation - Aetiologies (2)
Epileptic fit
Electrocution
79
Shoulder Dislocation: Posterior Dislocation - Description
Humeral head posterior to the glenoid fossa
80
Shoulder Dislocation: Posterior Dislocation - Mechanism of injury
Fall with shoulder in the anterior location
81
Shoulder Dislocation: Inferior Dislocation - Description
Humeral head is inferior to the glenoid fossa
82
Shoulder Dislocation: Inferior Dislocation - Mechanism of injury
Shoulder is forced into hyperabduction
83
Shoulder Dislocation: Inferior Dislocation - Why is prompt neurovascular assessment required?
Due to the proximity of the brachial plexus
84
Shoulder Dislocation: Clinical presentation
Severe shoulder pain with an ability to move the shoulder
85
Shoulder Dislocation: Main difference in clinical presentation if chronic condition?
Not painful so requires no support
86
Shoulder Dislocation: Two possible investigations (2)
X-ray
MR Anthrogram
87
Shoulder Dislocation: X-Rays - What views are required?
AP shoulder
Garth view - Apical Oblique
88
Shoulder Dislocation: X-Rays - Posterior dislocation has what problem?
Lack of displacement makes it difficult to view
89
Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Emergency situations (2)
Analgesia or Sedation via IV
Oxygen
90
Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Reduction mechanisms (3)
Kocher Method
Hippocratic Method
Stimson Method
91
Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Kocher Method
Patient lies in supine position with the arm abducted and elbow flexed at 90 degrees, the practitioner then provides external rotation until a resistance and adduction is felt
92
Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Hippocratic Method
The practitioner holds the affected limb by the forearm and hand of the patient and the heel of the practitioner is put in the patients axilla whilst the arm is adducted
93
Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Stimson Method
The patient lies in a prone position with the arm hanging off the table and a downward traction is applied to the arm for 10-20 minutes to fatigue the shoulder musculature
94
Shoulder Dislocation: Management - Post-reduction treatment
2-3 weeks in a sling with early mobilisation and physiotherapy
95
Shoulder Dislocation: Management - TIme without driving
8-10 weeks
96
Shoulder Dislocation: Management - Time without heavy lifting
12 weeks
97
Shoulder Dislocation: Management - Return to sport period if no contact
12 weeks
98
Shoulder Dislocation: Management - Return to sport period if contact
6 weeks
99
Shoulder Dislocation: Complications - 4 examples
Bankart lesion
Hill Sachs
Bony Bankart Lesion
Rotator Cuff Tears
100
Shoulder Dislocation: Complications - Bankart Lesion definition and management
Lesion of the labrum
Arthroscopic or open stabilisation
101
Shoulder Dislocation: Complications - Hill Sachs definition
Fracture to the humeral head
102
Shoulder Dislocation: Complications - Bony Bankart Lesion definition
Fracture of the Glenoid
103
Mucous Cyst of the Hand
Outpouching of Synovial Fluid from the DIPJ
104
Mucous Cyst of the Hand: Management
Excision via advancement or a rotation flap
105
Shoulder Impingement: Most common in what age group
Patients under 25 years old
106
Shoulder Impingement: Can occur in the older population due to what?
Degenerative changes or acromioclavicular bony changes
107
Shoulder Impingement
Inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space
108
Shoulder Impingement: Clinical Presentation (3)
Pain
Weakness
Reduced range of motion within the shoulder
109
Shoulder Impingement: Intrinsic Mechanisms - 3 causes
Muscular weakness
Overuse of the shoulder
Degenerative tendinopathy
110
Shoulder Impingement: Intrinsic Mechanisms - Muscular weakness pathophysiology
Weakness of the rotator cuff muscles can lead to the humerus shifting proximally towards the body
111
Shoulder Impingement: Intrinsic Mechanisms - Overuse of the shoulder pathophysiology
Repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa
112
Shoulder Impingement: Intrinsic Mechanisms - Degenerative Tendinopathy pathophysiology
Degenerative changes of the acromion can lead to tearing of the rotator cuff allowing the proximal migration of the humeral head
113
Shoulder Impingement: Extrinsic Mechanisms - 3 pathophysiology mechanisms
Anatomical factors
Scapular musculature
Glenohumeral instability
114
Shoulder Impingement: Extrinsic Mechanisms - Scapular musculature pathophysiology
Reduction in function of the scapular muscles may result in a reduction in the size of the subacromial space
115
Shoulder Impingement: Extrinsic Mechanisms - Glenohumeral instability pathophysiology
Instability leads to superior subluxation of the humerus to cause an increased contact between the acromion and subacromial tissues
116
Shoulder Impingement: Rotator Cuff Tendonitis Pathophysiology
Repeated impingement results in inflammation or damage to the rotator cuff tendons
117
Shoulder Impingement: Subacromial Bursitis pathophysiology
Calcification of the tendon induces inflammation of the subacromial bursa
118
Shoulder Impingement: How does subacromial bursitis cause shoulder impingement to become worse?
Inflammed tendons rub against the acromium and clavicoacromial joints and ligaments
119
Shoulder Impingement: Neers Classification definition
Divides the proximal humerus into 4 segments - head, greater tuberosity, lesser tuberosity or shaft) to classify fractures
120
Shoulder Impingement: Neer's Classification - Type I
<25 years of age - has inflammation, oedema and haemorrhage
121
Shoulder Impingement: Neer's Classification - Type II
25-40 years - has fibrosis and tendonitis of the bursa or cuff
122
Shoulder Impingement: Neer's Classification - Type III
>40 years - has partial or full thickness tears with degeneration of the rotator cuff
123
Shoulder Impingement: Clinical Presentation - Symptoms (4)
Progressive pain in the anterior superior shoulder
Pain radiatesto the deltoid and upper arm
Difficulty sleeping on affected side, reaching overhead and lifting
Pain exacerbated by abduction and relieved by rest
124
Shoulder Impingement: Clinical Presentation - Sign on palpation
Tenderness below the lateral edge of the acromion
125
Shoulder Impingement: Clinical Presentation - Tests for this (3)
Hawkins-Kennedy Test
Jobes Test
Painful arc
126
Shoulder Impingement: Diagnostic Test
X-Ray - AP and Apical Oblique views
127
Shoulder Impingement: Diagnosis - May show what on X-Ray?
Bone spur
128
Shoulder Impingement: Management - Conservative options (4)
Rest
Analgesia
Physiotherapy
Corticosteroid Injections into Subacromial Space
129
Shoulder Impingement: Management - When is surgery considered?
After a minimum of 6 months non-operative management
130
Shoulder Impingement: Management - What surgery is available? (5)
Main option - Subacromial Decompression
Subacromial or Subdeltoid bursectomy
Release of coracoacromial ligaments
Release of calcific deposits
Excision of Intraclavicular spurs
131
Shoulder Impingement: What is it likely to be in <30 year olds?
Rotator cuff tendonitis or Subacromial bursitis
132
Shoulder Impingement: What is it likely to be in 30-40 year olds?
Calcific tendonitis
133
Shoulder Impingement: What is it likely to be in 40-50 year olds?
Tendinosis or a partial tear of the rotator cuff
134
Shoulder Impingement: What is it likely to be in 50-60 year olds?
Rotator Cuff Tear
135
Shoulder Impingement: What is it likely to be in >70 year olds?
Cuff Arthropathy
136
Watershed Areas
Areas of the body that receives dual blood supply from the most distal areas of two arteries
137
Hawkins Test
With the shoulder flexed forward and the elbow bent the arm is internally rotated
A positive test demonstrates pain
138
Jobes Test
With the shoulder abducted and slightly flexed forward, the patient is instructed to rotate the hand to point their thumb towards the floor and then try to maintain this whilst the physician pushes down - positive result shows muscle weakness.
139
Shoulder Impingement: If Jobes test causes pain but no weakness what is likely?
Supra-spinatus impingement
140
Ganglions
Outpouchings of the synovial lining of joints and filled with synovial fluid
141
Ganglions: More common over what joints?
Synovial
142
Ganglions: Management normal
Usually self-resolving
143
Ganglions: Management options if it does not resolve?
Aspiration or Excision
144
Ganglions: Why are they not a true cyst?
No epithelial lining
145
Ganglions: Histological appearance
Space with myxoid material
146
Ganglions: Visual presentation
Well-defined round swellings that are up to a few cm wide
147
Ganglions: They can readily ..
Transluminate
148
Trigger Finger
Swelling on the flexor tendon sheath leading to irritation causing the tendon to get caught on the edge of the A1 pulley
149
Trigger Finger: More common in what sex?
Females
150
Trigger Finger: Typically occurs in what age?
50+ years old
151
Trigger Finger: More common in what patient groups?
Diabetic
152
Trigger Finger: What do the tendons run within?
Flexor tendon sheath
153
Trigger Finger: Pathway Stages (4)
1. Stenosing tenosynovitis
2. Fibrocartilaginous metaplasia
3. Nodule of FDS Tendon
4. Nodule catches on the A1 pulley - this causes the trigger
154
Trigger Finger: Main 3 symptoms
Irritation
Swelling
Pain over the A1 pulley on the metacarpal head
155
Trigger Finger: Pain over the A1 pulley MC head causes what?
Sticking of the finger usually in a flexion position
156
Trigger Finger: Management - Conservative
Either resolves spontaneously or splint to prevent flexion
157
Trigger Finger: Management - What is the tendon sheath injection?
Steroid with local anaesthetic
158
Trigger Finger: Management - What surgery is available?
Divide the A1 pulley
Can have general or local anaesthetic
159
Carpal Tunnel Syndrome
Peripheral neuropathy causes by acute or chronic compression of the median nerve by the transverse carpal ligament
160
Carpal Tunnel Syndrome: Can occur secondary to what conditions? (3)
Rheumatoid Arthritis
Acromegaly
Conditions resulting in fluid retention
161
Carpal Tunnel Syndrome: Examples of conditions resulting in fluid retention (4)
Pregnancy
Diabetes mellitus
Chronic renal failure
Hypothyroidism
162
Carpal Tunnel Syndrome: Can be a consequence of ... to the wrist
Fractures
163
Carpal Tunnel Syndrome: More common in what sex?
Females
164
Carpal Tunnel Syndrome: What is the carpal tunnel of the wrist formed from? (2)
Carpal bones
Flexor retinaculum
165
Carpal Tunnel Syndrome: The median nerve passes through the carpal tunnel alongside what?
9 flexor tendons
4 x - Flexor Digitorum Profundus
4 x - Flexor Digitorum Superficialis
1 x - Flexor Pollicis Longus
166
Carpal Tunnel Syndrome: Medial nerve supplies motor innervation to what?
LOAF muscles
167
Carpal Tunnel Syndrome: Medial nerve supplies sensory innervation to what?
Palmar aspect of the hand, thumb, index, middle and radial half of the ring finger
168
Carpal Tunnel Syndrome: Any swelling within the carpal tunnel may result in what?
Median nerve compression
169
Carpal Tunnel Syndrome: Clinical Presentation - Parathesiae in what?
The median nerve innervated digits - thumb and radial 3 and 1/2 fingers
170
Carpal Tunnel Syndrome: Clinical Presentation - When is the pain worse?
Night
171
Carpal Tunnel Syndrome: Clinical Presentation - Impact on the thumb
Loss of sensation and weakness in the thumb
172
Carpal Tunnel Syndrome: Clinical Presentation - What sensation is often spared?
Palmar
173
Carpal Tunnel Syndrome: Clinical Presentation - Pain is relieved by what?
Shaking the hand
174
Carpal Tunnel Syndrome: Clinical Presentation - There can be observation of what?
Loss of sensation or muscle wasting of the thenar eminence
175
Carpal Tunnel Syndrome: What are the LOAF muscles?
Lumbricals I and II
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
176
Carpal Tunnel Syndrome: Late symptoms (2)
Numbness
Weakness
177
Carpal Tunnel Syndrome: Early symptoms (3)
Pins and Needles
Pain
Clumsiness
178
Carpal Tunnel Syndrome: What tests can be used on examination? (3)
Durkin's Test
Tinnel's Test
Phalen's Test
179
Carpal Tunnel Syndrome: Durkin's Test and Result
Press thumb over the carpal tunnel and hold pressure for 30 seconds
Result - Pain sensation or Parathesiae in median nerve distribution
180
Carpal Tunnel Syndrome: Tinnel's Test and Result
Tap the carpal tunnel
Result - tingling sensation is found over the innervation regions of the median nerve
181
Carpal Tunnel Syndrome: Phalen's Test and Result
Flex the wrist to 90 degrees for 1 minute
Result - Tingling sensation found over the innervation regions of the median nerve
182
Carpal Tunnel Syndrome: What investigations can be conducted? (4)
APB examination of the LOAF muscles
Nerve conduction studies with Electromyogram
Compressive neuropathy
Kamath and Stothard Carpal Tunnel Questionnaire
183
Carpal Tunnel Syndrome: Mild Or Moderate (3)
Splintage
Steroid Injection
Physiotherapy
184
Carpal Tunnel Syndrome: Severe Cases
Surgery Carpal Tunnel Decompression via division of the transverse carpal ligament
185
Dupuytren's Contracture
Superficial fibromatosis of the subdermal fascia leading to a fixed flexion deformity of the fingers
186
Dupuytren's Contracture: Common in what countries?
Northern Europe
187
Dupuytren's Contracture: More common in what sex?
Men
188
Dupuytren's Contracture: What pattern of inheritance is the genetic predisposition?
Autonomic dominant mutation
189
Dupuytren's Contracture: Environmental Risk Factors (3)
Alcohol
Smoking
Repetitive trauma or an acute injury to the hand
190
Dupuytren's Contracture: Conditions that are a risk factor (2)
Diabetes
Epilepsy - or the associated medication
191
Dupuytren's Contracture: Pathophysiology
Excessive myofibroblast proliferation and altered collagen matrix composition leads to a thickened and contracted palmar fascia
192
Dupuytren's Contracture: Bands predominantly consist of what?
Collagen Type II
193
Dupuytren's Contracture: Clinical presentation starts as what?
Palmar pit or nodule
194
Dupuytren's Contracture: What is required on exmaination?
Feeling of the cords
MCP and PIP Joint Angle measurements
195
Dupuytren's Contracture: What test can be conducted?
Table-Top Test
196
Dupuytren's Contracture: Management - Conservative (2)
Stretches
Activity modification
197
Dupuytren's Contracture: Management - Surgical options (3)
Needle Fasciectomy - for a single band
Limited Fasciectomy - for the removal of bands
Dermofasciectomy + Graft
198
Dupuytren's Contracture: Management - Dermofascietomy and Graft procedure
Removal of the band with the contracted skin and covered with a graft
199
Dupuytren's Contracture: Management - Newer Treatment Options (2)
Collagenase injection
Percutaneous needle fasciotomy
200
Dupuytren's Contracture: How would the progression be described?
Painless and Gradual
201
Dupuytren's Contracture: What fingers are most likely to be involved?
4th and 5th fingers
202
Dupuytren's Contracture: What does this causes to happen in the finger?
Flexion contracture of the affected fingers
203
Duputrens Diathesis
Severe form of Duputrens involving the ring and little fingers, Lederhosens and Peyronies
204
Lederhosens
Superficial fibromatosis of the foot
205
Peyronies
Supreficial fibromatosis of the penis
206
Dupuytren's Contracture: What is the table top test result?
Inability to flatten the palm against the surface of the table due to contractures in the metacarpophalangeal joints
207
Paronychia
Infection within the nail fold
208
Paronychia: What age group is most affected?
Children and Young adults
209
Paronychia: What is the main risk factor?
Nail biting
210
Paronychia: Clinical presentation
Inflammation and redness around the fingertip
May have pus collection
211
Paronychia: Management plan
Elevate
Antibiotics
Incise and drain pus collection
212
Flexor Tendon Sheath Infection
Infection within the sheath that tracks up the palm and arm
213
Flexor Tendon Sheath Infection: What is important about this disease?
It is a surgical emergency
214
Flexor Tendon Sheath Infection: Aetiologies (2)
Direct penetrating trauma e.g. knife wound
Haematogenous spread e.g. dental infection
215
Flexor Tendon Sheath Infection: Clinical presentation symptoms
Extremely painful
Limited passive and active extension due to pain
216
Flexor Tendon Sheath Infection: Kanavel's Cardinal Signs (4)
Affected finger held in fixed flexion
Fusiform swelling over the finger
Painful to percuss over the sheath
Painful on passive extension
217
Flexor Tendon Sheath Infection: Management
Elevation and high dose antibiotics
218
Flexor Tendon Sheath Infection: Emergency surgery
Washout the tendon sheath with opening up the A1 and A5 pulleys
219
Tendinopathy
Painful tendon
220
Tendonitis
Inflammation of the tendon
221
Tendonosis
Degeneration of the tendon
222
Tenosynovitis
Inflammation of a fluid-filled sheath
223
Enthesopathy
Pain at the enthesis that attaches tendons and ligaments onto the bone
224
Tendon Structure: Shape
Cylindrical
225
Tendon Structure: Predominant structure
Fibroblasts
226
Tendon Structure: Fibroblast function
Produces and maintains collagen to confer flexibility and tensile strength of the tendons
227
Tendon Structure: Fibroblasts mainly produce what type of collagen?
Type I
228
Tendon Structure: What are fibrils formed of?
Sub-fibrils
229
Tendon Structure: Sub-fibrils are made up of what?
Microfibrils
230
Tendon Structure: Fibrils are contained within what?
Fascicles
231
Tendon Structure: Fascicles are separated from what?
The endotendon
232
Tendon Structure: What is the endotendon covered in?
Epitenon
233
Tendon Structure: Blood supply from what 3 sources?
Perimyseum
Periosteal insertion of the tendon
Paratenon
234
Tendinopathies: Predisposing Disease
Rheumatoid arthritis
235
Tendinopathies: Anatomical risk factors (2)
Malalignment
Leg length discrepancy
236
Tendinopathies: Extrinsic Aetiologies (4)
Trauma
Repetitive injury
Drugs - steroids and antibiotics
Sport
237
Tendinopathies: Function of tendons
Links the muscle motor unit to the bone to enable joint function
238
Tendonosis
Histological degeneration of the collagen and ECM of the tendon
239
Tendonosis: Likely due to what structure?
Matrix Metalloproteinases
240
Tendonosis: Usually occurs at what areas?
Areas of poor blood supply
241
Tendon Disease: Injections must not be conducted on what diseases and why?
Achilles Tendon or Extensor Knee Mechanism due to risk of rupture
242
Tendon Disease: Surgical options for management? (4)
Debridement
Decompression
Synovectomy
Tendon Transfer
243
Tendon Disease: Debridement
Removal of diseased tissue
244
Tendon Disease: Decompression management is for what cases? (2)
Supraspinatus tendonitis
Sub-acromial tendon cases
245
Tendon Disease: Synovectomy is available for what structures? (2)
Extensor tendons of the wrist in Rheumatoid Arthritis
Tibialias posterior
246
Tendon Disease: Tendon Transfer is available for what structures? (2)
Tibialis posterior
Extensor Pollicis Longus
247
Tendon Disease: What is the risk of managements with steroids?
Toxic to tenocytes
248
Rotator Cuff Pathology: Common in what occupations? (2)
Athletes - that throw
Manual workers e.g. painters
249
Rotator Cuff Pathology: Intrinsic aetiologies (2)
Degeneration
Reduced tendon vascularity
250
Rotator Cuff Pathology: Extrinsic aetiologies (2)
Morphological changes in the acromion
Biomechanical factors - kinetics and performance
251
Rotator Cuff Pathology: Symptoms (3)
Dull achy pain down the arm that gradually increases
Difficulty sleeping on the affected side
Pain on reaching overhead or lifting
252
Rotator Cuff Pathology: Tenderness is present in what areas? (3)
Around the glenohumeral joint
Acromioclavicular joint
Over the shoulder
253
Rotator Cuff Pathology: Signs on examination (2)
Painful arc with weakness
Positive Impingement Tests
254
Rotator Cuff Pathology: Gold standard investigation
Ultrasound
255
Biceps Tendinopathy
Inflammation of the long head of the biceps tendon
256
Biceps Tendinopathy: Aetiologies (4)
Overuse
Instability
Impingement
Trauma
257
Biceps Tendinopathy: High risk group
Athletes - Javelin, Swimmers and Gymnasts
258
Biceps Tendinopathy: Clinical presentation (2)
Pain anterior to the shoulder radiating to the elbow
Clicking or snapping sensation with shoulder movement
259
Biceps Tendinopathy: Pain is aggravated by what?
Shoulder flexion
Forearm pronation
Elbow flexion
260
Biceps Tendinopathy: ... can cause snapping with shoulder movements
Subluxation
261
Biceps Tendinopathy: What part of the biceps is most commonly affected?
The bicipital groove anterior on the proximal humerus
262
Biceps Tendinopathy: What two signs are seen on examination?
Popeye sign
Extensive bruising
263
Biceps Tendinopathy: What investigation may be carried out?
Ultrasound
264
Biceps Tendinopathy: Management options
Conservative - rest, physiotherapy and corticosteroid injection
Surgery
265
Biceps Tendinopathy: Surgical repair has a high risk of what and where?
Neurovascular complications particularly at the distal end
266
Lateral Epicondylitis: Alternate name
Tennis elbow
267
Lateral Epicondylitis
Overuse injury of the hand which originate in the lateral humeral epicondyle
268
Lateral Epicondylitis: Most commonly effects what structures?
Finger extensor tendons
269
Lateral Epicondylitis: Most common aetiology
Repeated or excessive pronation or supination with extension of the wrist
270
Lateral Epicondylitis: Pathophysiology
Microtears within the common extensor origin
271
Lateral Epicondylitis: Characterised clinical presentation by what?
Pain and tenderness over the lateral epicondyle to the attachment of the forearm
272
Lateral Epicondylitis: Pain is worse when?
When stretching the muscles
273
Lateral Epicondylitis: Mill's Test and result
Flex elbow to 90 degrees in pronation and pain is produced on resisted middle finger and wrist extension
274
Lateral Epicondylitis: What clinical test can be used?
Mill's Test
275
Lateral Epicondylitis: What should be conducted if there are any nerve symptoms?
Nerve conduction studies
276
Lateral Epicondylitis: Conservative management (3)
Rest
Physiotherapy
Injection of local anaesthetic and steroids
277
Lateral Epicondylitis: Refractory case management
Surgical release - division and or excision of some of the fibres of the common extensor mechanism
278
Medial Epicondylitis: Alternate name
Golfer's Elbow
279
Medial Epicondylitis
Overuse injury of the hand which originates in the medial humeral epicondyle
280
Medial Epicondylitis: Aetiologies (2)
Repetitive strain
Degeneration of the common flexor origin
281
Medial Epicondylitis: Peak age of incidence
40-50 years of age
282
Medial Epicondylitis: Is this more or less common than lateral epicondylitis?
Less
283
Medial Epicondylitis: Main clinical presentation
Medial elbow pain with a tender point over the origin of the flexors at the medial epicondyle
284
Medial Epicondylitis: Pain is aggravated by what?
Wrist flexion, pronation and grasping
285
Medial Epicondylitis: May be associated with what complications? (2)
Ulnar neuropathy
Muscle weakness
286
Medial Epicondylitis: What clinical sign can be observed?
When the elbow is flexed to 90 degrees in supination, pain is produced when the wrist is flexed against resistance
287
Medial Epicondylitis: What investigations may be conducted?
US and MRI
288
Medial Epicondylitis: What should be conducted if there are any nerve symptoms?
Nerve conduction studies
289
Medial Epicondylitis: Conservative management
Rest
Physiotherapy
290
Medial Epicondylitis: Why should steroid injection be avoided?
Too close to the ulnar nerve
291
Medial Epicondylitis: Management for refractory cases
Surgical release
292
De Quervain's Tenosynovitis
Inflammation of the tendon sheaths within the first extensor compartment
293
De Quervain's Tenosynovitis: Impacts what structures? (2)
Abductor Pollicis Longus
Extensor Pollicis Brevis
294
De Quervain's Tenosynovitis: Epidemiology of sexes?
Women
295
De Quervain's Tenosynovitis: Most common in what age group?
30-50 years
296
De Quervain's Tenosynovitis: Associated with what two medical conditions?
Rheumatoid Arthritis
Pregnancy
297
De Quervain's Tenosynovitis: Typical Clinical Presentation
Repetitive strain injury with pain over the radial styloid process at the wrist
298
De Quervain's Tenosynovitis: Pain may radiate to where?
Proximally into the forearm
299
De Quervain's Tenosynovitis: What test can be used on examination?
Finklesteins
300
De Quervain's Tenosynovitis: What is the main differential diagnosis?
Osteoarthritis of Carpometacarpal Joint
301
De Quervain's Tenosynovitis: What tests can be used for differential diagnosis? (2)
US
X-ray
302
De Quervain's Tenosynovitis: What is Finklesteins Test
Patient makes a fist over the thumb and the hand is ulnar deviated to reproduce the pain
303
De Quervain's Tenosynovitis: Conservative Management (3)
Rest
Splint
Steroid Injections or NSAIDs
304
De Quervain's Tenosynovitis: Surgical options
Surgical decompression
305
Extensor Tendon Injuries: Examples (2)
Mallet finger
Extensor pollicus longus rupture
306
Mallet Finger
An avulsion of the extensor tendon from the distal phalynx resulting in the inability to extend the DIP joint
307
Mallet Finger: Causes a ... deformity
Flexion
308
Mallet Finger: Aetiology
Caused by an object hitting the tip of the finger or thumb - force tears the extensor tendon
309
Mallet Finger: Clinical presentation
Tenderness
Brusing
310
Mallet Finger: Clinical sign on examination
No resisted finger extension
311
Mallet Finger: Management if the joint is congruent
Mallet splint for 6 weeks 24/7
312
Mallet Finger: Management if the joint is not congruent (large displaced avulsion fracture)
Reduce the joint and fixate with K wires or screws
313
Mallet Finger: Non-congruent joints are predisposed to what?
Secondary osteoarthritis
314
Mallet Finger: Management for chronic cases
Dermatotenodesis
315
Extensor Pollicus Longus Rupture: Associated with what disease?
Rheumatoid Arthritis
316
Extensor Pollicus Longus Rupture: Pathophysiology
Autoimmune attack of the synovium causes tendon degeneration and rupture
317
Extensor Pollicus Longus Rupture: Can occur secondary to what condition?
Colles fracture
318
Extensor Pollicus Longus Rupture: Clinical presentation
Substantial loss of function meaning that the thumb cannot be extended at the MCP or IP joints
319
Extensor Pollicus Longus Rupture: Management if caught preceding synovitis from Rheumatoid Arthritis
Synovectomy - prevents rupture
320
Extensor Pollicus Longus Rupture: Management once rupture has occured?
Tendon transfer
321
Knee Extensor Mechanism Rupture: What does the extensor mechanism of the knee compromise? (5)
Tibial tuberosity
Patellar tendon
Patellar
Quadriceps tendon
Quadriceps muscle
322
Knee Extensor Mechanism Rupture: Most common in what patient group?
Middle aged population who play running or jumping sports
323
Knee Extensor Mechanism Rupture: Mechanism of injury
Patellar or Quadriceps Tendon ruptures due to rapid contractile force - heavy weight lifting or fall
324
Knee Extensor Mechanism Rupture: Mean age for patellar tendon rupture
<40 years old
325
Knee Extensor Mechanism Rupture: Mean age for quadriceps tendon rupture
>40 years old
326
Knee Extensor Mechanism Rupture: Risk Factors - Diseases (5)
Previous tendonitis
Chronic renal Failure
Diabetes
Rheumatoid arthritis
Steroid abuse
327
Knee Extensor Mechanism Rupture: What drug is a risk factor and why?
Ciprofloxin - quinolone antibiotics can cause tendonitis and risk tendon ruptures
328
Knee Extensor Mechanism Rupture: Clinical symptoms
Knee pain and weakness
329
Knee Extensor Mechanism Rupture: What may be observed in the extensor mechanism?
Palpable gap
330
Knee Extensor Mechanism Rupture: Examination will show people unable to do what?
Straight leg raise
331
Knee Extensor Mechanism Rupture: What may be observed on X-ray? (2)
High or low patellar
Effusion
332
Knee Extensor Mechanism Rupture: Patellar location in patellar tendon rupture?
High
333
Knee Extensor Mechanism Rupture: Patellar location in quadriceps tendon rupture?
Low
334
Knee Extensor Mechanism Rupture: What investigations may be required?
X-ray
US
MRI
335
Knee Extensor Mechanism Rupture: MRI or US may show what?
Partial or complete tear
336
Knee Extensor Mechanism Rupture: Management of small partial tears of the quadriceps
Immobilisation and Physiotherapy
337
Knee Extensor Mechanism Rupture: Requires what management?
Urgent surgical repair with physiotherapy
338
Knee Extensor Mechanism Rupture: Why should steroid injections be avoided?
High risk of tendon rupture
339
Traction Apophysitis
Insertion of the patellar tendon into the tibial tuberosity
340
Traction Apophysitis: Most common in what patient groups?
Adolescent active males
341
Traction Apophysitis: Clinical presentation - Can occur where? (2)
Patellar
Achilles
342
Traction Apophysitis: Clinical presentation - Osgood Schlatter's Disease
Presents at the tibial tubercle
343
Traction Apophysitis: Clinical presentation - Reamins as what?
Prominent bony lump
344
Tibialis Posterior Tendon anatomy
Tibialis posterior tendon inserts predominantly onto the medial navicular to support the medial arch of the foot
345
Tibialis Posterior Tendon Dysfunction: Most common cause of what?
Flat foot in adults
346
Tibialis Posterior Tendon Dysfunction: Pathophysiology stages (3)
Tenosynovitis
Progressive elongation
Rupture
347
Tibialis Posterior Tendon Dysfunction: Leads to what clinical presentation? (2)
Progressive flat foot
Valgus hindfoot
348
Tibialis Posterior Tendon Dysfunction: Risk Factors - Main patient group
Obese middle aged female
349
Tibialis Posterior Tendon Dysfunction: Risk is increased by what non-modifiable factor?
Age
350
Tibialis Posterior Tendon Dysfunction: Risk Factors - Diseases or Medications (5)
Hypertension
Diabetes Mellitus
Steroid injections
Seronegative arthropathies
Idiopathic tendonsosis
351
Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Very specific symptom
Pain and or swelling posterior to the medial malleolus
352
Tibialis Posterior Tendon Dysfunction: Clinical Presentation - More painful on what surfaces?
Uneven surfaces
353
Tibialis Posterior Tendon Dysfunction: Clinical Presentation - What foot deformity may develop?
Hallux valgus
354
Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type I (3)
Swelling
Tenderness
Slightly weaker muscle power
355
Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type II (5)
Planovalgus
Midfoot abduction
Passively correctable
Too many toes sign
Cannot single heel raise
356
Tibialis Posterior Tendon Dysfunction: Tendonitis should be treated how?
With a splint with medial arch support to avoid rupture
357
Tibialis Posterior Tendon Dysfunction: If the splint fails to settle the symptoms what should be considered?
Surgical decompression
Tenosynovectomy
358
Tibialis Posterior Tendon Dysfunction: What management should not be used?
Steroid injections
359
Tibialis Posterior Tendon Dysfunction: Surgical option if no secondary osteoarthritis is present?
Tendon transfer and Calcaneal osteotomy
360
Tibialis Posterior Tendon Dysfunction: Surgical option if osteoarthritis is present?
Arthrodesis
