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Musculoskeletal System > Disease Profiles 5 > Flashcards

Disease Profiles 5 Flashcards

1
Q

FAI

A

Femoroacetabular Impingement Syndrome

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2
Q

Femoroacetabular Impingement Syndrome

A

Altered morphology of the femoral neck and/or acetabular causes abutment of the femoral neck on the edge of the acetabulum during movement

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3
Q

FAI: What movements are impacted?

A

Flexion
Adduction
Internal rotation

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4
Q

FAI: Aetiology

A

Hip bone misformation during the childhood growth years

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5
Q

FAI: 3 types

A

CAM type impingement
Pincer type impingement
Mixed impingement

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6
Q

FAI: CAM type Impingement - Pathophysiology

A

Assymetrical femoral head with reduced head to neck ratio causes limited smooth rotation
A bump forms on the edge of the femoral head to grind against the cartilage

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7
Q

FAI: CAM type Impingement - Present in what patient groups?

A

Young athletic males

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8
Q

FAI: CAM type Impingement - Can be related to what disease?

A

Slipped upper femoral epiphysis

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9
Q

FAI: Pincer type Impingement - Pathophysiology

A

Acetabular overhang

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10
Q

FAI: Pincer type Impingement - More common in what sex?

A

Females

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11
Q

FAI: Pincer type Impingement - Impact on the labrum

A

Can be crushed under the prominent rim of the acetabulum

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12
Q

FAI: Consequences on the joint (3)

A

Damage to labrum and tears
Damage to cartilage
Osteoarthritis in later life

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13
Q

FAI: Clinical Presentation - Pain is related to what?

A

Activity - flexion and rotation

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14
Q

FAI: Clinical Presentation - Have difficulty doing what motion?

A

Sitting

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15
Q

FAI: Clinical Presentation - What is observed on examination?

A

C-sign positive - hand is cupped over the greater trochanter with the thumb posterior and the fingers gripping deep into the anterior groin

FADIR Provocation Test positive - Anterior groin or anterolateral hip pain during flexion, adduction and on internal rotation

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16
Q

FAI: Investigation required (2)

A

X-Ray
MRI

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17
Q

FAI: Management for CAM

A

Arthroscopic or open surgery

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18
Q

FAI: Management for labral tears

A

Arthroscopic or open debridement

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19
Q

FAI: Management for Pincer impingement

A

Peri-acetabular Osteotomy

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20
Q

FAI: Management for older patients with secondary Osteoarthritis

A

Arthroplasty or Total Hip Replacement

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21
Q

Idiopathic Transient Osteonecrosis of the Hip

A

Local hyperaemia and impaired venous return with marrow oedema and increased inter-medullary pressure

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22
Q

Idiopathic Transient Osteonecrosis of the Hip: Epidemiology of sexes

A

More common in Females

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23
Q

Idiopathic Transient Osteonecrosis of the Hip: 2 most common patient groups

A

Middle aged men
Pregnant women in the third trimester

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24
Q

Idiopathic Transient Osteonecrosis of the Hip: Clinical Presentation (2)

A

Unilateral progressive groin pain
Difficulty weight bearing

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25
Q

Idiopathic Transient Osteonecrosis of the Hip: Gold standard investigation

A

MRI

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26
Q

Idiopathic Transient Osteonecrosis of the Hip: Results on bloods

A

Raised Erythrocyte Sedimentation Rate

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27
Q

Idiopathic Transient Osteonecrosis of the Hip: What is shown on X-ray? (3)

A

Osteopenia of the head and neck
Thinning of the cortices
Preserved joint space

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28
Q

Idiopathic Transient Osteonecrosis of the Hip: Management

A

Self-resolving - resolves in 6-9 months

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29
Q

Trochanteric Bursitis

A

Repetitive trauma caused by the iliotibial band tracking over the trochanteric bursa to cause inflammation of the bursa

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30
Q

Trochanteric Bursitis: Epidemiology of sexes

A

More common in females

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31
Q

Trochanteric Bursitis: In older patients this is linked to what?

A

Gluteal cuff syndrome

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32
Q

Trochanteric Bursitis: What may cause tendon tears?

A

Broad tendinous insertion of the abductor muscles is under strain and subject to tendonitis

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33
Q

Trochanteric Bursitis: Main cause

A

Repetitive trauma

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34
Q

Trochanteric Bursitis: Symptoms (2)

A

Pain on the lateral aspect of the hip
Pain on palpation of the greater trochanter

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35
Q

Trochanteric Bursitis: Pain is felt on what movement?

A

Restricted abduction

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36
Q

Trochanteric Bursitis: Management (3)

A

NSAIDs
Physiotherapy
Steroid injection

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37
Q

Disease of the Nail: Type I

A

Soft tissue injury only

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38
Q

Disease of the Nail: Type II

A

Soft tissue and nail injury

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39
Q

Disease of the Nail: Type III

A

Soft tissue, Nail and Bone injury

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40
Q

Disease of the Nail: Type IV

A

Proximal 1/3 of the Phalanx damaged

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41
Q

Disease of the Nail: Type V

A

Damage proximal to the DIP joint

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42
Q

Disease of the Nail: Management of Type I and II

A

Dressing

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43
Q

Disease of the Nail: Management of Type III

A

Repair the nail bed and stabilise the bone

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44
Q

Disease of the Nail: Management of Type IV

A

Repair nail bed and stabilise the bone unless <5mm of nail bed present - then ablate

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45
Q

Disease of the Nail: If the tip is not available what management is done?

A

Terminalise or V-Y Flap

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46
Q

Subungual Haematoma: Management if the pressure is causing pain

A

Trephine

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47
Q

Boxer’s Fracture

A

Fracture of the 5th metacarpal neck

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48
Q

Boxer’s Fracture: Aetiology

A

Caused by a clenched fist striking a hard object

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49
Q

Boxer’s Fracture: Symptoms (2)

A

Dorsal hand pain
Swelling

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50
Q

Boxer’s Fracture: Sign

A

Distal part of the fracture is displaced anteriorly to produce a shortened finger

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51
Q

Boxer’s Fracture: Investigation

A

AP, Lateral and Oblique X-Ray

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52
Q

Boxer’s Fracture: Management

A

Buddy strap with early mobilisation

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53
Q

Proximal Interphalangeal Joint Dislocation: Concerns with delayed presentation

A

Impossible to reduce - may require fusion

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54
Q

Proximal Interphalangeal Joint Dislocation: Fracture requires what management?

A

Fixation and stabilisation

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55
Q

Proximal Interphalangeal Joint Dislocation: Management

A

Pull to reduce and use a buddy strap

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56
Q

Bennett’s Fracture

A

A fracture of the first metacarpal base

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57
Q

Bennett’s Fracture: Mechanism of injury

A

Forced hyperabduction of the thumb

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58
Q

Bennett’s Fracture: Aetiology

A

Axial force applied to the thumb in flexion

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59
Q

Bennett’s Fracture: Fractures can extend into what?

A

First carpometacarpal joint

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60
Q

Bennett’s Fracture: Fracture can lead to what in the joint? (2)

A

Subluxation
Instability

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61
Q

Bennett’s Fracture: If missed, what are the pathological impacts?

A

Articular cartilage of the joint will degenerate to cause deformity, dysfunction and arthritis

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62
Q

Bennett’s Fracture: Main symptom

A

Acute pain at the base of the thumb

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63
Q

Bennett’s Fracture: Pain occurs when?

A

With movement

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64
Q

Bennett’s Fracture: Tenderness felt where?

A

At the Carpometacarpal joint

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65
Q

Bennett’s Fracture: What clinical signs are present? (2)

A

Swelling
Ecchymosis - small bruise due to blood leaking from blood vessels

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66
Q

Bennett’s Fracture: Investigation of choice

A

AP and Lateral X-Rays

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67
Q

Bennett’s Fracture: Following fracture what tends to be present?

A

Small bony fragment attached to the volar beak ligament

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68
Q

Bennett’s Fracture: Management

A

Surgical reduction onto the bony fragment and fixed with K wires

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69
Q

Eschar

A

Thick leathery inelastic skin that can form after burns

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70
Q

Cellulitis

A

Inflammation and infection of soft tissues with generalised swelling

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71
Q

Cellulitis: Clinical Presentation (3)

A

Pain
Swelling
Erythema

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72
Q

Cellulitis: Causative organisms (2)

A

Beta Haemolytic Streptococcus
Staphylococci

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73
Q

Cellulitis: Management (4)

A

Rest and elevation
Analgesia
Splint
Antibiotics

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74
Q

Abscess

A

Discrete collection of pus

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75
Q

Abscess: Aetiologies (4)

A

Cellulitis
Bursitis
Penetrating wound
Infected sebaceous cyst

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76
Q

Abscess: Clinical Presentation (3)

A

Defined and fluctuant swelling
Erythema
Pain

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77
Q

Abscess: Management (3)

A

Rest and elevation
Surgical excision and drainage
Antibiotics

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78
Q

Ganglion Cysts

A

Outpouchings of the synovium lining of joints that are filled with the synovial fluid

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79
Q

Ganglion Cysts: Aetiologies (2)

A

Developmental cause
Underlying joint damage or arthritis with a build up of pressure

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80
Q

Ganglion Cysts: Examples of ganglion cysts? (4)

A

Juvenile Baker’s Cyst
Adult Baker’s Cyst
Mucous cyst of the DIP joint
Wrist ganglion

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81
Q

Ganglion Cysts: Why are these not a true cyst?

A

No epithelial lining

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82
Q

Ganglion Cysts: Histological appearance

A

Space with myxoid material

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83
Q

Ganglion Cysts: Occurs where? (2)

A

Around a synovial joint or synovial tendon sheath

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84
Q

Ganglion Cysts: Physical appearance

A

Well-defined round swellings from <10mm to several cm wide

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85
Q

Ganglion Cysts: Locations (3)

A

Wrist
Feet
Knees

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86
Q

Ganglion Cysts: What management should not be used?

A

Do not aspirate

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87
Q

Ganglion Cysts: Management options

A

Percutaneous rupture
Surgical excision

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88
Q

Baker’s Cyst

A

Ganglion cyst found in the popliteal fossa

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89
Q

Baker’s Cyst: Pathophysiology

A

Inflammation and swelling of the semimembranosus bursa

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90
Q

Baker’s Cyst: Usually arises in conjunction with what disease?

A

Osteoarthritis of the knee

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91
Q

Baker’s Cyst: Clinical presentation

A

General fullness of the popliteal fossa that is soft and tender

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92
Q

Bursitis

A

Inflammation of the synvoium lined sacs that protect the bony prominences and joints

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93
Q

Bursa

A

Small fluid filled sac lined by synovium around a joint to prevent friction between tendons, bones, muscle and skin

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94
Q

Bursitis: Aetiology

A

Repeated trauma or pressure

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95
Q

Bursitis: Examples

A

Pre-patellar bursitis
Olecranon bursitis
Bunions - over the medial 1st metatarsal head in the hallux valgus

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96
Q

Bursitis: When may this develop into an abscess?

A

Secondarily infection from a small wound on the limb

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97
Q

Bursitis: Management options (3)

A

NSAIDs
Antibiotics
Excision - in chronic cases

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98
Q

Bursitis: Management if there is a secondary infection?

A

Incision and drainage

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99
Q

Rheumatoid Nodules

A

Swellings present in the joints associated with rheumatoid patients associated with repetitive trauma

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100
Q

Rheumatoid Nodules: Histology shows what?

A

Intense inflammatory changes

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101
Q

Rheumatoid Nodules: Do not respond to what?

A

DMARDs

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102
Q

Rheumatoid Nodules: Management

A

Excision if problematic

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103
Q

Bouchard’s Nodes

A

Bone swellings of the proximal interphalangeal joints

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104
Q

Bouchard’s Nodes present in what disease?

A

Osteoarthritis
Rheumatoid Arthritis

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105
Q

Heberden’s Nodes

A

Bone swellings of the distal interphalangeal joints

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106
Q

Heberden’s Nodes: Present in what disease?

A

Osteoarthritis

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107
Q

Are Heberdens or Bouchard Nodes more common?

A

Heberdens

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108
Q

Giant Cell Tumour of The Tendon Sheath

A

Benign nodular tumour found on the tendon sheath of the hands and feet

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109
Q

Giant Cell Tumour of The Tendon Sheath: 2 types

A

Localised
Diffuse

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110
Q

Giant Cell Tumour of The Tendon Sheath: Which type is more common?

A

Localised

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111
Q

Giant Cell Tumour of The Tendon Sheath: Pathophysiology

A

Benign regenerative hyperplasia with inflammatory processes

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112
Q

Giant Cell Tumour of The Tendon Sheath: Diffuse type is associated with what condition?

A

Pigemented villonodular synovitis

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113
Q

Giant Cell Tumour of The Tendon Sheath: Clinical presentation

A

Firm discrete swelling on the volar aspect of digits or on toes

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114
Q

Giant Cell Tumour of The Tendon Sheath: Management

A

Left if no functional complications

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115
Q

Giant Cell Tumour of The Tendon Sheath: Management if there is functional complications

A

Surgical marginal excision

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116
Q

Giant Cell Tumour of The Tendon Sheath: Why is surgical excision not done as a complete excision?

A

As it is adherent to the tendon sheath

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117
Q

Sebaceous Cysts

A

Dematological condition originating at the hair follicles in which they are filled with caseous keratin

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118
Q

Sebaceous Cysts: Pathophysiology

A

Hair follicles are filled with caseous material

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119
Q

Sebaceous Cysts: Common locations (3)

A

Face
Trunk
Neck

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120
Q

Sebaceous Cysts: Growth pattern

A

Slow growth

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121
Q

Sebaceous Cysts: Are they painful?

A

No

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122
Q

Sebaceous Cysts: Clinical presentation

A

Mobile discrete swellings

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123
Q

Sebaceous Cysts: Management

A

Excision if required

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124
Q

Hip Fractures: Majority of patients are of what age?

A

Over 60 years

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125
Q

Hip Fractures: More common in what sex?

A

Women

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126
Q

Hip Fractures: Diseases that are risk factors for this? (2)

A

Osteoporosis
Neurological impairment

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127
Q

Hip Fractures: Environmental Risk Factors (4)

A

Smoking
Malnutrition
Excess alcohol intake
Low BMI

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128
Q

Hip Fractures: Risk doubles when?

A

Every 10 years after the age of 50

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129
Q

Hip Fractures: Typical Mechanism of injury in the elderly

A

Low impact fall

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130
Q

Hip Fractures: Mechanism of injury in the young

A

High energy trauma

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131
Q

Hip Fractures: Fractures are classified how?

A

Intracapsular or Extracapsular

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132
Q

Hip Fractures: Shaft of the femur blood supply

A

Intra-medullary artery

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133
Q

Hip Fractures: 3 blood supplies

A

Intramedullary artery
Medial and lateral circumflex branches of the profunda femoris
Artery of the ligamentum teres

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134
Q

Hip Fractures: Intracapsular Fractures - Occur where?

A

Proximal to the intertrochanteric line

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135
Q

Hip Fractures: Intracapsular Fractures - Involves what structures?

A

Femoral head and neck

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136
Q

Hip Fractures: Intracapsular Fractures - Subdivided into what types?

A

Subcapital fracture
Transcervical fracture

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137
Q

Hip Fractures: Intracapsular Fractures - Subcapital Fractures

A

Fracture line extends through the junction of the head and neck of the femur

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138
Q

Hip Fractures: Intracapsular Fractures - Transcervical Fracture

A

Fracture line occurs along the femoral neck

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139
Q

Hip Fractures: Intracapsular Fractures - Garden Fractures predicts what?

A

Predicts union and AVN

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140
Q

Hip Fractures: Intracapsular Fractures - Undisplaced fractures

A

Pieces of fracture are not moved out of alignment

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141
Q

Hip Fractures: Intracapsular Fractures - Displaced fractures

A

Pieces of fracture are moved out of alignment

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142
Q

Hip Fractures: Intracapsular Fractures - Complications (2)

A

Femoral head AVN
Non-union

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143
Q

Hip Fractures: Intracapsular Fractures - Can damage what structure?

A

Medial femoral circumflex artery

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144
Q

Hip Fractures: What type is more likely to heal?

A

Extra-capsular

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145
Q

Hip Fractures: Extracapsular Fractures - Occur where?

A

Distal to the interotrochanteric line

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146
Q

Hip Fractures: Extracapsular Fractures - 4 types

A

Basicervical
Intertrochanteric
Reverse oblique
Subtrochanteric fractures

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147
Q

Hip Fractures: Extracapsular Fractures - Why is AVN and non-union is rare?

A

Blood supply to the head of the femur is intact

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148
Q

Hip Fractures: Extracapsular Fractures - Basi-cervical

A

Right below the capsule

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149
Q

Hip Fractures: Extracapsular Fractures - Reverse Oblique requires what management?

A

Hip fracture nail

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150
Q

Hip Fractures: Extracapsular Fractures - Sub-trochanteric requires what management?

A

Hip fracture nail

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151
Q

Hip Fractures: What investigations are required?

A

X-Ray - Pelvic and Lateral Hip
MRI

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152
Q

Hip Fractures: Shenton’s Line

A

Formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus

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153
Q

Hip Fractures: What is the sign of a fractured femur neck on the X-ray?

A

Loss of contour of the Shenton’s Line

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154
Q

Hip Fractures: Symptoms (3)

A

Hip or groin pain
Swelling
Unable to weight bear

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155
Q

Hip Fractures: Signs - How may this affect the limb?

A

Shortening or external rotation on affected sign

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156
Q

Hip Fractures: Signs - What must be assessed? (4)

A

Neurology and vascular status
Cognitive impairment
Other injuries
Dehydration

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157
Q

Hip Fractures: Management - THR

A

Total Hip Replacement

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158
Q

Hip Fractures: Management - CHS

A

Compression Hip Screw

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159
Q

Hip Fractures: Management - DHS

A

Dynamic Hip Screw

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160
Q

Hip Fractures: Management - IMN

A

Intra-medullary Nail

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161
Q

Hip Fractures: Management - Intracapsular fracture with high function that is displaced

A

Total Hip Replacement

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162
Q

Hip Fractures: Management - Intracapsular fracture with high function that is undisplaced

A

Compression Hip Screw

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163
Q

Hip Fractures: Management - Intracapsular fracture with Low function

A

Hemi-arthroplasty

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164
Q

Hip Fractures: Management - Extracapsular fracture that is Intertrochanteric

A

Dynamic Hip Screw

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165
Q

Hip Fractures: Management - Extracapsular fracture that is Subtrochanteric

A

Intra-medullary Nail

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166
Q

Hip Fractures: Management - What analgesia should be used?

A

Local nerve blocks

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167
Q

Hip Fractures: Complications - Intra-capsular

A

Non-union
AVN

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168
Q

Hip Fractures: Complications - Extra-capsular

A

Malunion
Non-union

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169
Q

Compartment Syndrome

A

Increased pressure in the enclosed space of the limb compartments due to swelling of tissue or increase in fluid

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170
Q

Compartment Syndrome: What sex is this more common in?

A

Men

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171
Q

Compartment Syndrome: Risk Factors - Environmental

A

Intravenous drug administration

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172
Q

Compartment Syndrome: Risk Factors - Disease (4)

A

Tibial fractures
Open fractures
Forearm fractures
Burns

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173
Q

Compartment Syndrome: Risk Factors - Drugs

A

Anticoagulation

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174
Q

Compartment Syndrome: Main age range

A

10-35 years

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175
Q

Compartment Syndrome: Pathophysiology - Increased pressure in the muscle compartment causes a reduction in what?

A

Perfusion pressure

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176
Q

Compartment Syndrome: Pathophysiology - Reduction in perfusion pressure can lead to what? (4)

A

Ischaemia
Necrosis
Lactic Acidosis
Muscle, Nerve or Vessel death

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177
Q

Compartment Syndrome: Pathophysiology - Significant muscle damage occurs at what pressures?

A

> 30-40 mmHg or diastolic pressure 10-30 mmHg

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178
Q

Compartment Syndrome: Pathophysiology - Occurs anywhere in skeletal muscle surrounded by what?

A

Fascia

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179
Q

Compartment Syndrome: Pathophysiology - Commonly occurs in what compartment?

A

Anterior and deep posterior compartments of the leg
Volar compartment of the forearm

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180
Q

Compartment Syndrome: Pathophysiology - Left untreated what will happen?

A

Ischaemic muscle will necrose to cause fibrotic contracture (Volkmann’s Ischaemic Contracture)

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181
Q

Compartment Syndrome: Pathophysiology - 5 stages

A
  1. Increased pressure
  2. Reduced blood flow
  3. Venous occlusion with arterial patency
  4. Rapid increase in pressure
  5. Arterial occlusion
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182
Q

Compartment Syndrome: Clinical Presentation - 4 Ps

A

Disproportionate pain
Paraethesia
Pallor
Pulselessness - late sign

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183
Q

Compartment Syndrome: Management

A

Immediate release of dressings and casts with a fasciotomy

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184
Q

Compartment Syndrome: Management - What should not be done?

A

Do not elevate

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185
Q

Compartment Syndrome: Management - What should be done after surgery?

A

Open wound is left open for a few days

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186
Q

Tibial Shaft Fracture: Mechanism of injury (2)

A

Low energy - due to indirect torsional injury
High energy - due to direct force

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187
Q

Tibial Shaft Fracture: 4 configurations

A

Spiral
Transverse
Oblique
Comminuted

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188
Q

Tibial Shaft Fracture: High risk of what happening?

A

Compartment Syndrome

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189
Q

Tibial Shaft Fracture: Clinical Presentation (3)

A

Pain
Inability to weight bear
Deformity present

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190
Q

Tibial Shaft Fracture: Investigation

A

X-ray - AP and Lateral

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191
Q

Tibial Shaft Fracture: Conservative Management

A

Above knee cast - may require closed reduction

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192
Q

Tibial Shaft Fracture: Operative Management (2)

A

Intramedullary nailing
Open Reduction and Internal Fixation

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193
Q

Tibial Plateau Fracture: Mechanism of Injury in young patients

A

High energy injuries

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194
Q

Tibial Plateau Fracture: Mechanism of injury in older patients

A

Osteoporotic bone

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195
Q

Tibial Plateau Fracture: 80% of cases affect what structure?

A

Lateral condyle

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196
Q

Tibial Plateau Fracture: How is lateral condyle impacted?

A

Valgus force with foot planted

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197
Q

Tibial Plateau Fracture: What classification system is used?

A

Schatzer Classification

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198
Q

Tibial Plateau Fracture: Clinical presentation (2)

A

Pain
Instability

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199
Q

Tibial Plateau Fracture: Investigations (2)

A

X-ray - AP and horizontal beam lateral
CT

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200
Q

Tibial Plateau Fracture: CT shows what?

A

Area of condylar involvement or depth of depression

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201
Q

Tibial Plateau Fracture: Horizontal beam lateral of intra-articular fracture will show what?

A

Lipohaemarthrosis - fat floating on the blood in the suprapatellar recess

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202
Q

Tibial Plateau Fracture: Small avulsed bone fragments indicates what?

A

Significant soft tissue injury

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203
Q

Tibial Plateau Fracture: Conservative management

A

Above knee cast

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204
Q

Tibial Plateau Fracture: Operative management options (3)

A

Open Reduction Internal Fixation
External fixation
Delayed Total Knee Replacement

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205
Q

Tibial Plateau Fracture: Complications - Blow to the lateral aspect of the knee can cause what?

A

Damage the common fibular nerve

206
Q

Tibial Plateau Fracture: Complications (3)

A

Compartment syndrome
Soft tissue injury
Neurovascular injury of popliteal structures or common peroneal nerve

207
Q

Femoral Shaft Fracture: Mechanism of Injury

A

High energy injuries

208
Q

Femoral Shaft Fracture: Investigation

A

X-Ray

209
Q

Femoral Shaft Fracture: Management - Initial management

A

Thomas splint for temporary stabilisation

210
Q

Femoral Shaft Fracture: Management - Operative Management options (2)

A

Intramedullary nail
Plate fixation - Open Reduction with Internal Fixation OR Minimally invasive percutaneous plate osteosynthesis (MIMMO)

211
Q

Femoral Shaft Fracture: Complications (2)

A

Significant blood loss
Fat embolus

212
Q

Pelvic Fracture: Aetiology in Older patients

A

Osteoporotic bone

213
Q

Pelvic Fracture: Aetiology in younger patients

A

High energy injury

214
Q

Pelvic Fracture: Pathophysiology - Why are there normally multiple fractures?

A

Bony ring disruption

215
Q

Pelvic Fracture: Pathophysiology - What classification system is used?

A

Young-Burgess Classification

216
Q

Pelvic Fracture: Investigations - High energy - pelvis is only site of injury

A

X-ray first

217
Q

Pelvic Fracture: Investigations - High energy polytrauma patients

A

CT first

218
Q

Pelvic Fracture: Investigations - Low energy fractures are often …

A

Undisplaced

219
Q

Pelvic Fracture: Investigations - What is the most sensitive test?

A

MRI

220
Q

Pelvic Fracture: Management - Initial Management

A

Pelvic binder - controls circulatory loss

221
Q

Pelvic Fracture: Management - Conservative management (2)

A

Analgesia
Weight bearing as tolerated

222
Q

Pelvic Fracture: Management - Operative management options (3)

A

Open reduction with internal fixation
External fixators
Internal fixators

223
Q

Distal Radius Fracture: Mechanism of injury

A

Fall on out-stretched hand

224
Q

Distal Radius Fracture: 3 pattern types

A

Colles
Smith
Barton’s

225
Q

Distal Radius Fracture: Colles fracture

A

Fracture of the distal radial metaphyseal region with posterior displacement of the distal fragment
There is no involvement of the articular surface

226
Q

Distal Radius Fracture: Smith fracture

A

Fracture of distal radius with anterior displacement of the distal fragment

227
Q

Distal Radius Fracture: Bartons Fracture

A

Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint

228
Q

Distal Radius Fracture: Barton’s Fracture is normally associated with what?

A

Sub-luxation or dislocation of the radiocarpal joint

229
Q

Distal Radius Fracture: Symptoms (2)

A

Pain
Swelling

230
Q

Distal Radius Fracture: Signs (2)

A

Ecchymosis
Diffuse tenderness

231
Q

Distal Radius Fracture: Investigations (3)

A

X-ray - AP, Lateral and Oblique
CT - evaluate intra-articular involvement
MRI - indicated in soft tissue injury

232
Q

Distal Radius Fracture: Conservative management

A

Cast or splint

233
Q

Distal Radius Fracture: Operative management options (3)

A

Open reduction with internal fixation
Manipulation under anaesthesia with K-wires
External fixation

234
Q

Distal Radius Fracture: Complications - Colles fracture

A

Median nerve compression due to stretch of nerve or bleed into the carpal tunnel

235
Q

Distal Radius Fracture: Complications - Fracture of the distal radius that have malunion may result in what?

A

Impaired grip strength - due to loss of extension

236
Q

Forearm Fractures: How are the radius and ulna connected?

A

Radioulnar joints - they form a ring

237
Q

Forearm Fractures: 3 types of fracture patterns

A

Monteggia
Galeazzi
Nightstick fracture

238
Q

Forearm Fractures: Monteggia

A

Fracture of the proximal third of the ulnar shaft with concomitant dislocation of the proximal radial head

239
Q

Forearm Fractures: Galeazzi

A

Fracture of the distal third of the radius with dislocation of the distal radioulnar joint - the ulnar remains intact

240
Q

Forearm Fractures: Night stick fracture

A

Isolated fracture of the ulnar shaft

241
Q

Forearm Fractures: Typical location of a nightstick fracture

A

Transverse fracture at the mid-diaphysis

242
Q

Forearm Fractures: Conservative management

A

Cast

243
Q

Forearm Fractures: Operative management

A

Open Reduction with Internal Fixation

244
Q

Forearm Fractures: Investigation

A

AP and Lateral X-ray

245
Q

Olecranon Fracture: Olecranon function

A

Insertion site of the triceps tendon - enables extension of the elbow

246
Q

Olecranon Fracture: Symptom

A

Pain well localised to the posterior elbow

247
Q

Olecranon Fracture: Signs (2)

A

Palpable defect - if displaced fracture present
Inability to extend the elbow - indicates discontinuity of tricep mechanism

248
Q

Olecranon Fracture: Investigations (2)

A

X-ray - AP and Lateral
CT

249
Q

Olecranon Fracture: Conservative Management

A

Cast

250
Q

Olecranon Fracture: Operative Management (3)

A

Tension band wiring
Open Reduction with Internal Fixation
Plate fixation

251
Q

Humeral Shaft Fracture: Mechanism of injury - Transverse or comminuted fracture

A

Direct trauma to the arm

252
Q

Humeral Shaft Fracture: Mechanism of injury - Oblique or spiral fractures

A

Rotational fall

253
Q

Humeral Shaft Fracture: Signs - What exam is critical?

A

Preoperative or pre-reduction neurovascular exam

254
Q

Humeral Shaft Fracture: Investigations

A

X-ray - AP and lateral

255
Q

Humeral Shaft Fracture: Conservative management

A

Humeral brace and U slab cast

256
Q

Humeral Shaft Fracture: Operative management (3)

A

Intramedullary nail
Open Reduction Internal Fixation
Plate Fixation

257
Q

Humeral Shaft Fracture: Complications

A

Risk of injury to the radial nerve

258
Q

Proximal Humerus Fracture: Aetiology

A

Low energy on osteoporotic bone

259
Q

Proximal Humerus Fracture: Pathophysiology - usually occurs where?

A

Surgical neck

260
Q

Proximal Humerus Fracture: Complications

A

Damage to the axillary nerve

261
Q

Proximal Humerus Fracture: Sign (2)

A

Extensive ecchymosis of chest, arm and forearm
Axillary nerve injury

262
Q

Proximal Humerus Fracture: Investigations (3)

A

X-Ray - AP and lateral
CT
MRI - if associated rotator cuff injury

263
Q

Proximal Humerus Fracture: Conservative Management

A

Collar and cuff

264
Q

Proximal Humerus Fracture: Operative Management

A

Open Reduction and Internal Fixation

265
Q

Shoulder Dislocation: Common in what population group?

A

Young adults

266
Q

Shoulder Dislocation: Aetiology (2)

A

Fall
Traction injury - limb being pulled away from the body

267
Q

Shoulder Dislocation: Anterior Dislocation - Main mechanism of injury

A

Fall with shoulder

268
Q

Shoulder Dislocation: Anterior Dislocation - Pathophysiology

A

Humeral head becomes anterior to the glenoid

269
Q

Shoulder Dislocation: Posterior Dislocation - Mechanism of injury

A

Fall with shoulder in internal rotation or direct blow to the anterior shoulder

270
Q

Shoulder Dislocation: Posterior Dislocation - Pathophysiology

A

Humeral head becomes posterior to the glenoid

271
Q

Shoulder Dislocation: Inferior Dislocation - Mechanism of injury

A

Arm held in abduction

272
Q

Shoulder Dislocation: Inferior Dislocation - Mechanism of injury

A

Humeral head is inferior to the glenoid

273
Q

Shoulder Dislocation: Investigations - Requires assessment of what?

A

Axillary nerve

274
Q

Shoulder Dislocation: Investigations

A

X-ray

275
Q

Shoulder Dislocation: Investigations - Posterior Dislocation X-ray sign

A

Light bulb sign

276
Q

Shoulder Dislocation: Most common type

A

Anterior Dislocation

277
Q

Shoulder Dislocation: Anterior Dislocation - Can result in compromise to what?

A

Axillary artery

278
Q

Shoulder Dislocation: Posterior shoulder dislocation is often associated with what situations?

A

Epileptic fits
Electrocution

279
Q

Shoulder Dislocation: Inferior shoulder dislocation is due to the shoulder being forced into what?

A

Hyperabduction

280
Q

Shoulder Dislocation: Needs urgent neurovascular assessment and reduction due to what?

A

Proximity of brachial plexus

281
Q

Shoulder Dislocation: Clinical presentation (2)

A

Severe shoulder pain
Inability to move the shoulder

282
Q

Shoulder Dislocation: Investigations (2)

A

X-ray - AP and Garth (Apical oblique views)
MRI Anthrogram

283
Q

Shoulder Dislocation: Management - Anterior Shoulder Dislocation

A

Analgesia and sedation IV
Oxygen
Reduction by manipulation - closed or open

284
Q

Shoulder Dislocation: Management - 3 mechanisms of reduction

A

Kocher method
Hippocratic method
Stimson method

285
Q

Shoulder Dislocation: Management - Hippocratic method

A

Foot in the axilla with in line traction to move the glenoid medial so the humerus pops back in

286
Q

Elbow Dislocation: Mechanism of injury

A

Fall onto an outstretched hand

287
Q

Elbow Dislocation: What pathophysiology may occur in a child?

A

Pulled elbow may cause sole radial head dislocation rather than a full dislocation

288
Q

Elbow Dislocation: Investigation

A

X-Ray - AP and Lateral View

289
Q

Elbow Dislocation: Management (2)

A

Reduction - traction in extension +/- pressure over olecranon
2 weeks in sling and rehabilitation

290
Q

Elbow Dislocation: Complications

A

Risk of radial head fractures and coronoid process fractures

291
Q

Interphalangeal Joint Dislocation: Mechanism of injury (2)

A

Hyperextension injury
Direct axial blow

292
Q

Interphalangeal Joint Dislocation: Most common

A

Posterior dislocation

293
Q

Interphalangeal Joint Dislocation: Clinical presentation

A

Pain and deformity of the affected digit

294
Q

Interphalangeal Joint Dislocation: Investigation

A

X-ray - AP and lateral view

295
Q

Interphalangeal Joint Dislocation: Management - PIP

A

Closed reduction and buddy taping

296
Q

Interphalangeal Joint Dislocation: Management - DIP

A

Closed reduction +/- splinting

297
Q

Interphalangeal Joint Dislocation: Management - If extremely unstable

A

Volar slab in Edinburgh position

298
Q

Interphalangeal Joint Dislocation: Management - Reduction method

A

In line traction with corrective pressure

299
Q

Interphalangeal Joint Dislocation: Complications (2)

A

Head of the phalynx button holes through the volar plate causing volar plate entrapment to block reduction
Recurrent instability

300
Q

Interphalangeal Joint Dislocation: Management. ifthere is volar plate entrapment

A

Open reduction

301
Q

Patella Dislocation: More common in what patient group

A

Teenagers

302
Q

Patella Dislocation: More common in what sex?

A

Females

303
Q

Patella Dislocation: Always dislocates in what direction?

A

Laterally

304
Q

Patella Dislocation: Aetiologies (2)

A

Direct blow
Sudden quadriceps contraction with a flexing knee

305
Q

Patella Dislocation: Aetiology in children

A

Under-developed hypoplastic lateral femoral condyle

306
Q

Patella Dislocation: Risk Factors (5)

A

Increased Q angle - Genu Valgus or Increased femoral neck anteversion
Ligamentous laxity or hypermobility
High riding patella
Hypoplastic lateral femoral condyle
Lateral quad insertions or weak vastus medialis

307
Q

Patella Dislocation: Pain located where and why?

A

Medial due to torn medial retinaculum

308
Q

Patella Dislocation: Signs on examination (2)

A

Patella apprehension test is positive
Effusion - haemarthosis

309
Q

Patella Dislocation: Investigations

A

X-ray

310
Q

Patella Dislocation: Appearance on X-ray (2)

A

Lipo-haemarthosis
Small opacification - suggests osteochondral fracture

311
Q

Patella Dislocation: Management (3)

A

May spontaneously reduce
Brace
Physiotherapy

312
Q

Patella Dislocation: Management - If intractable pain and swollen

A

Aspiration

313
Q

Patella Dislocation: Management - if repeat dislocations

A

Surgery of lateral release of medial reefing with patella tendon realignment

314
Q

Patella Dislocation: Complications - When the patella dislocates what may occur?

A

Medial patellofemoral ligament tears and osteochrondral fracture may occur as the medial facet of the patella strikes the lateral femoral condyle

315
Q

Knee Dislocation: Common in what patient group?

A

Teenagers

316
Q

Knee Dislocation: More common in what sex?

A

Females

317
Q

Knee Dislocation: Mechanism of injury

A

Serious high energy injury
Or twisting injury

318
Q

Knee Dislocation: Pathophysiology - Spontaneous relocation

A

Lateral collateral ligament injury with perineal nerve injury results in dislocation

319
Q

Knee Dislocation: Investigations - Clinical concern of vascular injury

A

Arteriography or MRI of the popliteal artery or veins

320
Q

Knee Dislocation: Investigations - What nerve needs to be tested for injury?

A

Peroneal nerve

321
Q

Knee Dislocation: Investigation of choice

A

X-ray

322
Q

Knee Dislocation: Management - Definitive

A

Sequential ligamentous pair

323
Q

Knee Dislocation: Management - Early surgical option

A

Vascular repair of 6 hour window or nerve repair

324
Q

Knee Dislocation: Management - Immediate

A

Emergency reduction under sedation

325
Q

Knee Dislocation: Management - Medial Femoral Condyle Buttoned through the capsule

A

Theatre reduction

326
Q

Knee Dislocation: Complications (4)

A

Neurovascular injury - popliteal artery or common peroneal nerve
Ligamentous injury
Arthrofibrosis
Ligament laxity

327
Q

Hip Dislocation: Mechanism of injury

A

Impact during RTA or contact sports during hip flexion

328
Q

Hip Dislocation: Most common direction

A

Posterior

329
Q

Hip Dislocation: Pathophysiology for posterior dislocations

A

Force is driven along the femur proximally so the femoral head to dislocate posteriorly with an acetabular rim fracture

330
Q

Hip Dislocation: Associated fractures

A

Posterior acetabular wall
Femoral fracture

331
Q

Hip Dislocation: Clinical presentation

A

Flexed, internally rotated and adducted knee

332
Q

Hip Dislocation: Investigations (2)

A

X-ray
CT

333
Q

Hip Dislocation: Investigations - Neurovascular assessment of what?

A

Sciatic Nerve

334
Q

Hip Dislocation: Management - Immediated

A

Urgent reduction - stabilise in tractions if required

335
Q

Hip Dislocation: Management - Definitive

A

Fixation of associated pelvic fractures and other injuries

336
Q

Hip Dislocation: Complications (5)

A

Posterior acetabular wall fracture
Femoral fractures
Sciatic nerve palsy
AVN of the femoral head
Secondary osteoarthritis of the hip

337
Q

Paediatric Fractures: Anatomical point of weakness in the bone

A

Point at which a metaphysic connects to a physis

338
Q

Paediatric Fractures: What is stronger than bones in young patients?

A

Ligaments and tendons

339
Q

Paediatric Fractures: … is thick in children meaning it often stays intact during injury

A

Periosteum

340
Q

Paediatric Fractures: Buckle Fracture

A

Fracture due to compressive force

341
Q

Paediatric Fractures: Greenstick fracture

A

Fracture due to force on one side of the bone to cause a break in only one cortex

342
Q

Paediatric Fractures: Advantage of children’s fractures compared to adult

A

Shorter immobilisation times

343
Q

Paediatric Fractures: Disadvantage of children’s fractures compared to adult

A

Mal-aligned fragments become solid sooner

344
Q

Paediatric Fractures: What should be anticipated if a child has >2 years of growth left?

A

Remodelling

345
Q

Paediatric Fractures: Two types of remodelling and their management?

A

Mild angulation
Rotational

346
Q

Paediatric Fractures: Nerve Assessment - OK sign

A

Anterior interosseous nerve

347
Q

Paediatric Fractures: Nerve Assessment - Thumbs up sign

A

Posterior interosseous nerve

348
Q

Paediatric Fractures: Nerve Assessment - Rock sign

A

Median nerve

349
Q

Paediatric Fractures: Nerve Assessment - Paper nerve

A

Radial nerve

350
Q

Paediatric Fractures: Nerve Assessment - Scissor action or crossing of fingers

A

Ulnar nerve

351
Q

Paediatric Fractures: Physeal Injury - High grade fractures are more likelt to have what impact?

A

Cause growth disturbance

352
Q

Paediatric Fractures: Physeal Injury - What classification system is used?

A

Salter Harris Classification

353
Q

Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type I

A

Fracture passes transversely through the physis to separate the epiphysis from the metaphysis

354
Q

Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type II

A

Transverse fracture through the physis but exits through the metaphysis to produce a triangular fragment

355
Q

Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type III

A

Fracture that crosses the physis and exits through the physis at the joint space

356
Q

Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type IV

A

Fracture extends upwards from the joint line through the physis and out of the metaphysis

357
Q

Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type V

A

Crush injury to the growth plate

358
Q

Paediatric Fractures: Elbow Fractures - Most are of what type?

A

Supracondylar

359
Q

Paediatric Fractures: Elbow Fractures - What acronym is used for the sequence of ossification?

A

CRITOL

360
Q

Paediatric Fractures: Elbow Fractures - Sequence of ossification

A

Capitellum
Radial head
Medial epicondyle
Trochlea
Olecranon
Lateral epicondyle

361
Q

Paediatric Fractures: Elbow Fractures - Age of ossification of the capitellum

A

1 year

362
Q

Paediatric Fractures: Elbow Fractures - Age of ossification of the radial head

A

3 years

363
Q

Paediatric Fractures: Elbow Fractures - Age of ossification of the medial epicondyle

A

5 years

364
Q

Paediatric Fractures: Elbow Fractures - Age of ossification of the trochlea

A

7 years

365
Q

Paediatric Fractures: Elbow Fractures - Age of ossification of Olecranon

A

9 years

366
Q

Paediatric Fractures: Elbow Fractures - Age of ossification of the lateral epicondyle

A

11 years

367
Q

Paediatric Fractures: Elbow Fractures - On examination of a lateral X-ray what should be checked?

A

The anterior humeral line and the radiocapitellar line should both bisect the capitellum - if it is not it suggests a displaced fracture

368
Q

Paediatric Fractures: Elbow Fractures - What fat pad sign is always abnormal?

A

Posterior fat pad sign

369
Q

Paediatric Fractures: Elbow Fractures - Most supracondylar fracture are of what type?

A

Extension

370
Q

Paediatric Fractures: Elbow Fractures - Where do supracondylar fractures occur?

A

Weakest part of the elbow joint where the humerus flattens and flares

371
Q

Paediatric Fractures: Elbow Fractures - Classification system for extension type supracondylar fractures?

A

Gartland Classification

372
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type I Gartland

A

Undisplaced fracture

373
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type I Gartland treatment

A

Conservative due to undisplaced type

374
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type IIa Gartland

A

Displaced posteriorly but intact posterior peri-steal hinge and anterior humeral line transects the capitellum

375
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type IIa Gartland Management

A

Conservative treatment

376
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type IIb Gartland

A

Displaced posteriorly but intact posterior hinge and the anterior humeral line does not transect the capitellum

377
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type IIb Gartland Management

A

Manipulation under anaesthesia +/- wires

378
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type III Gartland

A

Displaced posteriorly with no posterior peri-osteal hinge

379
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Type III Gartland Management

A

Manipulation under anaesthesia +/- wires

380
Q

Paediatric Fractures: Supracondylar Elbow Fractures - Complications (2)

A

Radial artery compromise
Nerve compromise - AIN, Medial, Radial and Ulna

381
Q

Paediatric Fractures: Common fractures in toddlers

A

Undisplaced spiral fracture of the tibia with no fibular fracture

382
Q

Paediatric Fractures: Most common sites of fractures due to NAI (3)

A

Femur
Humerus
Tibia

383
Q

Impingement Syndrome

A

Inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space resulting in pain, weakness and reduced ROM

384
Q

Impingement Syndrome: Most likely cause in <30 year olds

A

Rotator cuff tendonitis or subacromial bursitis

385
Q

Impingement Syndrome: Most likely cause in 30-40 year olds

A

Calcific tendonitis

386
Q

Impingement Syndrome: Most likely cause in 40-50 year olds

A

Tendinosis or Partial tear of the rotator cuff

387
Q

Impingement Syndrome: Most likely cause in 50-60 year olds

A

Rotator cuff tear

388
Q

Impingement Syndrome: Most likely cause in >70 year olds

A

Cuff Arthropathy

389
Q

Impingement Syndrome: Intrinsic Mechanisms (3)

A

Muscular weakness
Overuse of the shoulder
Degenerative tendinopathy

390
Q

Impingement Syndrome: Intrinsic Mechanisms - Pathophysiology behind muscular weakness

A

Weakness in the rotator cuff muscles can lead to the humerus shifting proximally towards the body

391
Q

Impingement Syndrome: Intrinsic Mechanisms -Pathophysiology behind overuse of the shoulder

A

Repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa

392
Q

Impingement Syndrome: Intrinsic Mechanisms - Pathophysiology behind degenerative tendinopathy

A

Degenerative changes of the acromion can lead to tearing of the rotator cuff to allow proximal migration of the humeral head

393
Q

Impingement Syndrome: Extrinsic Mechanisms (3)

A

Anatomical factors
Scapular musculature
Glenohumeral Instability

394
Q

Impingement Syndrome: Extrinsic Mechanisms - Pathophysiology of anatomical factors

A

Anatomical variations in the shape and gradient of the acromion

395
Q

Impingement Syndrome: Extrinsic Mechanisms - Pathophysiology of Scapular musculature

A

Reduction in the function of scapular muscles may result in a reduction in the size of the sub-acromial space

396
Q

Impingement Syndrome: Extrinsic Mechanisms - Pathophysiology of Glenohumeral Instability

A

Can lead to superior subluxation of the humerus causing an increased contraction between the acromion and sub-acromial tissue

397
Q

Impingement Syndrome: What classification system is used?

A

Neer’s Classification

398
Q

Impingement Syndrome: Stage I Neer’s Classification

A

Inflammation, oedema and Haemorrhage in <25 year olds

399
Q

Impingement Syndrome: Stage II Neer’s Classification

A

Fibrosis or Tendonitis of the bursa or cuff in 25-40 year olds

400
Q

Impingement Syndrome: Stage III Neer’s Classification

A

Partial. orfull thickness tears and degeneration in >40 year olds

401
Q

Impingement Syndrome: Examination on movement

A

ROM is limited with a painful arc and weakness in the rotator cuff

402
Q

Impingement Syndrome: What clinical tests can be conducted? (2)

A

Hawkin’s Test
Jobe’s Test

403
Q

Impingement Syndrome: Hawkin’s Test

A

With the shoulder flexed forward and the elbow bent the arm is internally rotated - pain exacerbated if positive

404
Q

Impingement Syndrome: Jobe’s Test

A

With the shoulder abducted and slightly flexed forward, instruct the patient rotate hand the hand to point their thumb towards the floor. Ask the patient to try to maintain this position while you push down on their forearms - muscle weakness is positive result

405
Q

Impingement Syndrome: Jobe’s Test - pain but no weakness on the test indicates what?

A

Supra-spinatus impingement

406
Q

Impingement Syndrome: Clinical Presentation - Tenderness felt where?

A

Below the lateral edge of the acromion

407
Q

Impingement Syndrome: Investigations

A

X-ray - AP and Garth (apical oblique) views
US or MRI for shoulder mobilityir

408
Q

Impingement Syndrome: What may appear on X-ray?

A

Bone spur

409
Q

Impingement Syndrome: Conservative management options (3) and time period

A

Rest
Pain relief - corticosteroid injections into the subacromial space
Physiotherapy
Minimum of 6 months

410
Q

Impingement Syndrome: Surgical management options (5)

A

Subacromial decompression
Subacromial or Subdeltoid Bursectomy
Release of coracoacromial ligaments
Release of calcific deposits
Excision of intraclavicular spur

411
Q

Rotator Cuff Tear: Usually occurs in what age group?

A

> 40 year olds

412
Q

Rotator Cuff Tear: Aetiology (3)

A

Degenerate changes in the tendon
Acute tear - fall onto an outstretched arm or sudden jerk
Significant injury - e.g. shoulder dislocation

413
Q

Rotator Cuff Tear: Types of tear (2)

A

Partial
Full thickness

414
Q

Rotator Cuff Tear: Tears usually involve what structure?

A

Supraspinatus

415
Q

Rotator Cuff Tear: Large tears can extend into what? (2)

A

Sub-scapularis
Infra-spinatus

416
Q

Rotator Cuff Tear: Clinical presentation - Symptoms (2)

A

Pain in front of shoulder that radiates down the arm
Weakness

417
Q

Rotator Cuff Tear: Clinical Presentation - Signs (2)

A

Wasting of supraspinatus
Tenderness in the sub-deltoid region

418
Q

Rotator Cuff Tear: Investigations (3)

A

X-ray
MRI - if reduced ROM
US - if good ROM

419
Q

Rotator Cuff Tear: Clinical Presentation - Sign on movement

A

ROM is less on active movement than passive - due to weakness of the Supraspinatus, Infraspinatus, Teres minor and Subscapularis

420
Q

Rotator Cuff Tear: What examinations should be conducted? (3)

A

Supraspinatus test
Gerber’s Lift Off
Horn Blowers test

421
Q

Rotator Cuff Tear: Supraspinatus Test

A

Arm is moved into the plane of the scapula at 90 degrees of abduction, the practitioner holds the patients wrist and hand and the other hand is used to apply a posterior force to externally rotate the humerus
Positive test - weakness represents a tear in the supraspinatus tendon or impingement

422
Q

Rotator Cuff Tear: Gerbers Lift Off Test

A

The patient has the dorsum of the hand against the mid lumbar spine and ask them to push their hand against yours away from the back

Positive Test - cannot push away to indicate scapular instability or determines subscapularis tendon rupture

423
Q

Rotator Cuff Tear: Horn Blowers Test

A

Arm is placed at a 90 degree angle in the scapular plane and flexes the elbow to 90 degrees. The patient is asked to externally rotate against resistance

Positive test - patient is unable to externally rotate

424
Q

Rotator Cuff Tear: Management - Conservative management options (3)

A

Rest
Analgesia
Sling

425
Q

Rotator Cuff Tear: Management - Chronic Cases (2)

A

Physiotherapy - Anterior Deltoid Strengthening
Steroid injections

426
Q

Rotator Cuff Tear: Management - Acute Cases (2)

A

Early intervention - physiotherapy and reassessment
Surgical options are controversial - failure in 1/3 of patients

427
Q

Rotator Cuff Tear: Management - Surgical option

A

Arthroscopic or open repair of the cuff

428
Q

Rotator Cuff Tear: Complications (2)

A

Pulls the head of the humerus upwards
Abnormal forces on the glenoid leads to osteoarthritis

429
Q

Adhesive Capsulitis: Alternate name

A

Frozen Shoulder

430
Q

Adhesive Capsulitis

A

Inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint

431
Q

Adhesive Capsulitis: Most common age

A

40-50 years old

432
Q

Adhesive Capsulitis: More common in what sex?

A

Females

433
Q

Adhesive Capsulitis: Associated with what diseases? (4)

A

Diabetes Mellitus
Hypercholesterolaemia
Endocrine Disease
Dupuytren’s Contracture

434
Q

Adhesive Capsulitis: Pathophysiology

A

Contracture and thickening of coracohumeral ligament, rotator interval and the ingerior glenohumeral ligament (axillary fold)

435
Q

Adhesive Capsulitis: Pathophysiology - Can cause a decrease in what?

A

Joint volume

436
Q

Adhesive Capsulitis: Pathophysiology - What is no t present?

A

Adhesion

437
Q

Adhesive Capsulitis: Pathophysiology - First stage and description

A

Freezing or painful stage - minimal synovitis with pain to cause a reduced ROM

438
Q

Adhesive Capsulitis: Pathophysiology - Second stage and description

A

Frozen or Transitional stage - pain decreases but proliferative synovitis with contraction of the capsule and adhesion of the axillary recess increases

439
Q

Adhesive Capsulitis: Pathophysiology - Third stage and description

A

Thawing stage - inflammation decreases and movement slowly improves

440
Q

Adhesive Capsulitis: Clinical Presentation - When is pain worse?

A

At rest and at night

441
Q

Adhesive Capsulitis: Clinical Presentation - Where is the pain located?

A

Anterior

442
Q

Adhesive Capsulitis: Clinical Presentation - When does pain reduce?

A

Around 2-9 months

443
Q

Adhesive Capsulitis: Clinical Presentation - When does stiffness increase?

A

4-12 months

444
Q

Adhesive Capsulitis: Clinical Presentation - Main restriction in ROM?

A

External rotation

445
Q

Adhesive Capsulitis: Differential Diagnosis (2)

A

Locked posterior dislocation
Glenohumeral arthritis

446
Q

Adhesive Capsulitis: Resolution time

A

18-24 months

447
Q

Adhesive Capsulitis: Conservative Management (3)

A

Physiotherapy and analgesia
Intra-articular glenohumeral steroid injections
Fluoroscopic distension

448
Q

Adhesive Capsulitis: Management - Surgery indicated when?

A

Patient cannot tolerate functional loss due to stiffness

449
Q

Adhesive Capsulitis: Management - Surgical options (2)

A

Manipulation under anaesthesia
Arthroscopic capsular release

450
Q

Glenohumeral Osteoarthritis: Age that is common

A

> 60 years old

451
Q

Glenohumeral Osteoarthritis: Onset of pain

A

Gradual onset of pain with intermittent exacerbations

452
Q

Glenohumeral Osteoarthritis: Pain worse when?

A

At rest and night

453
Q

Glenohumeral Osteoarthritis: Movement limited how?

A

On external rotation

454
Q

Glenohumeral Osteoarthritis: Investigation

A

X-ray

455
Q

Glenohumeral Osteoarthritis: Appearance on X-ray (4)

A

Joint space narrowing
Sub-chondral sclerosis
Sub-chondral cysts
Osteophyte formation

456
Q

Glenohumeral Osteoarthritis: Conservative Management Options (3)

A

Analgesia
Physiotherapy
Glenohumeral Steroid Injection

457
Q

Glenohumeral Osteoarthritis: Operative Management Options (3)

A

Shoulder Replacement
Total shoulder arthroplasty
Reverse polarity shoulder arthroplasty

458
Q

Cubital Tunnel Syndrome

A

Compression of the ulnar nerve at the elbow behind the medial epicondyle

459
Q

Cubital Tunnel Syndrome: Aetiologies (2)

A

Osborne’s Fascia - tight band of fascia forming the roof of the tunnel
Tightness at the intermuscular septum as the nerve passes through

460
Q

Cubital Tunnel Syndrome: Most common age

A

> 30 years old

461
Q

Cubital Tunnel Syndrome: More common in what sex?

A

Males

462
Q

Cubital Tunnel Syndrome: Symptoms

A

Parathesiae in the ulnar 1 and 1/2 fingers

463
Q

Cubital Tunnel Syndrome: How may this be caused at night?

A

Sleeping with arm in flexion

464
Q

Cubital Tunnel Syndrome: What nerve is affected?

A

Ulnar nerve

465
Q

Cubital Tunnel Syndrome: Where is the intramuscular septum?

A

Arcade of Struthers

466
Q

Cubital Tunnel Syndrome: Cubital Tunnel Anatomy - Roof

A

Flexor carpi ulnaris fascia and Osborne’s Ligament

467
Q

Cubital Tunnel Syndrome: Cubital Tunnel Anatomy - Floor

A

Medial collateral ligament and joint capsule

468
Q

Cubital Tunnel Syndrome: Cubital Tunnel Anatomy - Walls

A

Medial epicondyle and Olecranon

469
Q

Cubital Tunnel Syndrome: Ulnar nerve innervates what? (5)

A

Ulnar two lumbricals
All hypothenar muscles
Deep head of the flexor pollicis brevis
Adductor pollicis
Forearm flexors

470
Q

Cubital Tunnel Syndrome: Early Symptoms (3)

A

Ulnar pins and needles
Pain
Clumsiness

471
Q

Cubital Tunnel Syndrome: Late symptoms (2)

A

Numbness
Weakness

472
Q

Cubital Tunnel Syndrome: Signs - Atrophy of what muscles? (2)

A

Hypothenar muscles
Interosseous muscles

473
Q

Cubital Tunnel Syndrome: Signs - Weakness in what muscles?

A

Abductor digiti minimi

474
Q

Cubital Tunnel Syndrome: Signs - Weakness in what movement?

A

Grasp and pinch

475
Q

Cubital Tunnel Syndrome: Signs - What 4 tests are used?

A

Tinnel’s Test
Phalen’s Test
Froment’s Test
Wartenberg’s Test

476
Q

Cubital Tunnel Syndrome: Signs - Tinnel’s Test and Positive Test

A

Tapping of the cubital fossa

Positive - causes a tingling sensation

477
Q

Cubital Tunnel Syndrome: Signs - Phalen’s Test and Positive Test

A

Flexion of the elbow at 90 degrees for 1 minute

Positive - Causes tingling in the regions innervated by the ulnar nerve

478
Q

Cubital Tunnel Syndrome: Signs - Froment’s Test and Positive Test

A

The patient holds a piece of paper in between her thumb and index finger and attempt to pull the paper away from the patient

Positive - paper can be pulled away due to weakness or loss of function in the adductor pollicis muscle

479
Q

Cubital Tunnel Syndrome: Signs - Wartenberg’s Sign and Positive Result

A

Abduction of the small finger

Positive Result - Increased abduction of the fifth finger due to weakness or paralysis of the adducting palmar interosseous muscle and unopposed action of the digiti minimi and digitorum communis

480
Q

Cubital Tunnel Syndrome: Management - Mild or Moderate (3)

A

Elbow splintage
Physiotherapy
NSAIDs

481
Q

Cubital Tunnel Syndrome: Management - Severe cases

A

Surgical ulnar nerve decompression - release the nerve from the Arcade of Struthers to the heads of the Flexor Carpi Ulnaris

482
Q

Rickets Disease

A

Qualitative defect of bone with abnormal softening of the bone due to deficient mineralisation of osteoid secondary to calcium, vitamin D and phosphorus deficiency in children

483
Q

Osteomalacia

A

Qualitative defect of bone with abnormal softening of the bone due to deficient mineralisation of osteoid secondary to calcium, vitamin D and phosphorus deficiency in adults

484
Q

Rickets and Osteomalacia: Primary causes

A

Insufficient calcium absorption or phosphate deficiency due to increased renal losses

485
Q

Rickets and Osteomalacia: Other causes of disease (4)

A

Vitamin D deficiency
Hypophosphataemia
Long term anticonvulsant use
Chronic kidney disease

486
Q

Rickets and Osteomalacia: Causes of Vitamin D deficiency (3)

A

Lack of sunlight exposure
Malnutrition
Malabsorption

487
Q

Rickets and Osteomalacia: Causes of hypophosphataemia (4)

A

Re-feeding Syndrome
Alcohol abuse - impairs phosphate absorption
Malabsorption
Renal tubular acidosis

488
Q

Rickets and Osteomalacia: Pathophysiology behind the impact of CKD

A

Reduced phosphate resorption and failure of activation of Vitamin D results in secondary hyperparathyroidism

489
Q

Rickets and Osteomalacia: Pathophysiology - Vitamin D impact on calcium

A

Stimulates absorption of calcium from the GI tract, Kidney and bone

490
Q

Rickets and Osteomalacia: Pathophysiology - Vitamin D impact on osteoblasts

A

Induces release of osteocalcin from osteoclasts

491
Q

Rickets and Osteomalacia: Pathophysiology - Vitamin D deficiency has what impact on calcium and PTH?

A

Hypocalcaemia
Elevated PTH

492
Q

Rickets and Osteomalacia: Pathophysiology - Why does Vitamin D deficiency result in Osteomalacia?

A

Release of calcium from bone causes impaired mineralisation of newly formed osteoid

493
Q

Rickets and Osteomalacia: Clinical Presentation -Bone pain where?

A

Pelvis
Spine
Femur

494
Q

Rickets and Osteomalacia: Clinical Presentation -Symptoms of hypocalcaemia (6)

A

Paraesthesiae
Muscle cramps
Irritability
Fatigue
Seizures
Brittle nails

495
Q

Rickets and Osteomalacia: Clinical Presentation -Signs (3)

A

Deformities from soft bones
Proximal myopathy
Dental defects

496
Q

Rickets and Osteomalacia: Investigations (2)

A

X-ray
Bloods

497
Q

Rickets and Osteomalacia: Investigations - X-ray presentation

A

Pseudofractures - looser’s zones
- These are in the pubic rami, proximal femur, ulna and ribs

Poor cortico-medullary differentiation

498
Q

Rickets and Osteomalacia: Investigations - Blood results (3)

A

Decreased calcium
Decreased serum phosphate
Increased serum ALP

499
Q

Rickets and Osteomalacia: Management

A

D3 tablets with Calcitriol and Alfacalcidol

500
Q

Rickets and Osteomalacia: Management - D3 dose

A

400-800 IU per day after loading dose of 3200 IU per day for 12 weeks

501
Q

Rickets and Osteomalacia: Management - Considerations for Chronic Renal Disease (3)

A

Check 1-25 OH Vitamin D as may have high Vitamin D
Titrate treatment to PTH levels
Phosphate binders

502
Q

Osteogenesis Imperfecta

A

Group of genetic disorders mainly affecting the bone

503
Q

Osteogenesis Imperfecta: Genetic inheritance pattern

A

Autosomal Dominant Disorder

504
Q

Osteogenesis Imperfecta: Pathophysiology

A

Defect of the maturation and organisation of Type I collagen

505
Q

Osteogenesis Imperfecta: Examples of Autosomal Dominant Mutations (2)

A

COL1A1
COL1A2

506
Q

Osteogenesis Imperfecta: Clinical presentation - Autosomal dominant type (5)

A

Multiple fragility fractures of childhood
Short stature
Blue sclerae
Dentinogenesis imperfecta
Loss of hearing

507
Q

Osteogenesis Imperfecta: Clinical presentation - Autosomal recessive

A

Fatal in the perinatal period or associated with spinal deformity

508
Q

Osteogenesis Imperfecta: Investigation

A

X-ray

509
Q

Osteogenesis Imperfecta: Investigations - Appearance on X-ray

A

Bones are thin with thin cortices and osteopenic

510
Q

Osteogenesis Imperfecta: Management

A

Musculoskeletal System (9 decks)

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