Disease Profiles 5 Flashcards
1
Q
FAI
A
Femoroacetabular Impingement Syndrome
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
3
Q
FAI: What movements are impacted?
A
Flexion
Adduction
Internal rotation
4
Q
FAI: Aetiology
A
Hip bone misformation during the childhood growth years
5
Q
FAI: 3 types
A
CAM type impingement
Pincer type impingement
Mixed impingement
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
7
Q
FAI: CAM type Impingement - Present in what patient groups?
A
Young athletic males
8
Q
FAI: CAM type Impingement - Can be related to what disease?
A
Slipped upper femoral epiphysis
9
Q
FAI: Pincer type Impingement - Pathophysiology
A
Acetabular overhang
10
Q
FAI: Pincer type Impingement - More common in what sex?
A
Females
11
Q
FAI: Pincer type Impingement - Impact on the labrum
A
Can be crushed under the prominent rim of the acetabulum
12
Q
FAI: Consequences on the joint (3)
A
Damage to labrum and tears
Damage to cartilage
Osteoarthritis in later life
13
Q
FAI: Clinical Presentation - Pain is related to what?
A
Activity - flexion and rotation
14
Q
FAI: Clinical Presentation - Have difficulty doing what motion?
A
Sitting
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
16
Q
FAI: Investigation required (2)
A
X-Ray
MRI
17
Q
FAI: Management for CAM
A
Arthroscopic or open surgery
18
Q
FAI: Management for labral tears
A
Arthroscopic or open debridement
19
Q
FAI: Management for Pincer impingement
A
Peri-acetabular Osteotomy
20
Q
FAI: Management for older patients with secondary Osteoarthritis
A
Arthroplasty or Total Hip Replacement
21
Q
Idiopathic Transient Osteonecrosis of the Hip
A
Local hyperaemia and impaired venous return with marrow oedema and increased inter-medullary pressure
22
Q
Idiopathic Transient Osteonecrosis of the Hip: Epidemiology of sexes
A
More common in Females
23
Q
Idiopathic Transient Osteonecrosis of the Hip: 2 most common patient groups
A
Middle aged men
Pregnant women in the third trimester
24
Q
Idiopathic Transient Osteonecrosis of the Hip: Clinical Presentation (2)
A
Unilateral progressive groin pain
Difficulty weight bearing
25
Idiopathic Transient Osteonecrosis of the Hip: Gold standard investigation
MRI
26
Idiopathic Transient Osteonecrosis of the Hip: Results on bloods
Raised Erythrocyte Sedimentation Rate
27
Idiopathic Transient Osteonecrosis of the Hip: What is shown on X-ray? (3)
Osteopenia of the head and neck
Thinning of the cortices
Preserved joint space
28
Idiopathic Transient Osteonecrosis of the Hip: Management
Self-resolving - resolves in 6-9 months
29
Trochanteric Bursitis
Repetitive trauma caused by the iliotibial band tracking over the trochanteric bursa to cause inflammation of the bursa
30
Trochanteric Bursitis: Epidemiology of sexes
More common in females
31
Trochanteric Bursitis: In older patients this is linked to what?
Gluteal cuff syndrome
32
Trochanteric Bursitis: What may cause tendon tears?
Broad tendinous insertion of the abductor muscles is under strain and subject to tendonitis
33
Trochanteric Bursitis: Main cause
Repetitive trauma
34
Trochanteric Bursitis: Symptoms (2)
Pain on the lateral aspect of the hip
Pain on palpation of the greater trochanter
35
Trochanteric Bursitis: Pain is felt on what movement?
Restricted abduction
36
Trochanteric Bursitis: Management (3)
NSAIDs
Physiotherapy
Steroid injection
37
Disease of the Nail: Type I
Soft tissue injury only
38
Disease of the Nail: Type II
Soft tissue and nail injury
39
Disease of the Nail: Type III
Soft tissue, Nail and Bone injury
40
Disease of the Nail: Type IV
Proximal 1/3 of the Phalanx damaged
41
Disease of the Nail: Type V
Damage proximal to the DIP joint
42
Disease of the Nail: Management of Type I and II
Dressing
43
Disease of the Nail: Management of Type III
Repair the nail bed and stabilise the bone
44
Disease of the Nail: Management of Type IV
Repair nail bed and stabilise the bone unless <5mm of nail bed present - then ablate
45
Disease of the Nail: If the tip is not available what management is done?
Terminalise or V-Y Flap
46
Subungual Haematoma: Management if the pressure is causing pain
Trephine
47
Boxer's Fracture
Fracture of the 5th metacarpal neck
48
Boxer's Fracture: Aetiology
Caused by a clenched fist striking a hard object
49
Boxer's Fracture: Symptoms (2)
Dorsal hand pain
Swelling
50
Boxer's Fracture: Sign
Distal part of the fracture is displaced anteriorly to produce a shortened finger
51
Boxer's Fracture: Investigation
AP, Lateral and Oblique X-Ray
52
Boxer's Fracture: Management
Buddy strap with early mobilisation
53
Proximal Interphalangeal Joint Dislocation: Concerns with delayed presentation
Impossible to reduce - may require fusion
54
Proximal Interphalangeal Joint Dislocation: Fracture requires what management?
Fixation and stabilisation
55
Proximal Interphalangeal Joint Dislocation: Management
Pull to reduce and use a buddy strap
56
Bennett's Fracture
A fracture of the first metacarpal base
57
Bennett's Fracture: Mechanism of injury
Forced hyperabduction of the thumb
58
Bennett's Fracture: Aetiology
Axial force applied to the thumb in flexion
59
Bennett's Fracture: Fractures can extend into what?
First carpometacarpal joint
60
Bennett's Fracture: Fracture can lead to what in the joint? (2)
Subluxation
Instability
61
Bennett's Fracture: If missed, what are the pathological impacts?
Articular cartilage of the joint will degenerate to cause deformity, dysfunction and arthritis
62
Bennett's Fracture: Main symptom
Acute pain at the base of the thumb
63
Bennett's Fracture: Pain occurs when?
With movement
64
Bennett's Fracture: Tenderness felt where?
At the Carpometacarpal joint
65
Bennett's Fracture: What clinical signs are present? (2)
Swelling
Ecchymosis - small bruise due to blood leaking from blood vessels
66
Bennett's Fracture: Investigation of choice
AP and Lateral X-Rays
67
Bennett's Fracture: Following fracture what tends to be present?
Small bony fragment attached to the volar beak ligament
68
Bennett's Fracture: Management
Surgical reduction onto the bony fragment and fixed with K wires
69
Eschar
Thick leathery inelastic skin that can form after burns
70
Cellulitis
Inflammation and infection of soft tissues with generalised swelling
71
Cellulitis: Clinical Presentation (3)
Pain
Swelling
Erythema
72
Cellulitis: Causative organisms (2)
Beta Haemolytic Streptococcus
Staphylococci
73
Cellulitis: Management (4)
Rest and elevation
Analgesia
Splint
Antibiotics
74
Abscess
Discrete collection of pus
75
Abscess: Aetiologies (4)
Cellulitis
Bursitis
Penetrating wound
Infected sebaceous cyst
76
Abscess: Clinical Presentation (3)
Defined and fluctuant swelling
Erythema
Pain
77
Abscess: Management (3)
Rest and elevation
Surgical excision and drainage
Antibiotics
78
Ganglion Cysts
Outpouchings of the synovium lining of joints that are filled with the synovial fluid
79
Ganglion Cysts: Aetiologies (2)
Developmental cause
Underlying joint damage or arthritis with a build up of pressure
80
Ganglion Cysts: Examples of ganglion cysts? (4)
Juvenile Baker's Cyst
Adult Baker's Cyst
Mucous cyst of the DIP joint
Wrist ganglion
81
Ganglion Cysts: Why are these not a true cyst?
No epithelial lining
82
Ganglion Cysts: Histological appearance
Space with myxoid material
83
Ganglion Cysts: Occurs where? (2)
Around a synovial joint or synovial tendon sheath
84
Ganglion Cysts: Physical appearance
Well-defined round swellings from <10mm to several cm wide
85
Ganglion Cysts: Locations (3)
Wrist
Feet
Knees
86
Ganglion Cysts: What management should not be used?
Do not aspirate
87
Ganglion Cysts: Management options
Percutaneous rupture
Surgical excision
88
Baker's Cyst
Ganglion cyst found in the popliteal fossa
89
Baker's Cyst: Pathophysiology
Inflammation and swelling of the semimembranosus bursa
90
Baker's Cyst: Usually arises in conjunction with what disease?
Osteoarthritis of the knee
91
Baker's Cyst: Clinical presentation
General fullness of the popliteal fossa that is soft and tender
92
Bursitis
Inflammation of the synvoium lined sacs that protect the bony prominences and joints
93
Bursa
Small fluid filled sac lined by synovium around a joint to prevent friction between tendons, bones, muscle and skin
94
Bursitis: Aetiology
Repeated trauma or pressure
95
Bursitis: Examples
Pre-patellar bursitis
Olecranon bursitis
Bunions - over the medial 1st metatarsal head in the hallux valgus
96
Bursitis: When may this develop into an abscess?
Secondarily infection from a small wound on the limb
97
Bursitis: Management options (3)
NSAIDs
Antibiotics
Excision - in chronic cases
98
Bursitis: Management if there is a secondary infection?
Incision and drainage
99
Rheumatoid Nodules
Swellings present in the joints associated with rheumatoid patients associated with repetitive trauma
100
Rheumatoid Nodules: Histology shows what?
Intense inflammatory changes
101
Rheumatoid Nodules: Do not respond to what?
DMARDs
102
Rheumatoid Nodules: Management
Excision if problematic
103
Bouchard's Nodes
Bone swellings of the proximal interphalangeal joints
104
Bouchard's Nodes present in what disease?
Osteoarthritis
Rheumatoid Arthritis
105
Heberden's Nodes
Bone swellings of the distal interphalangeal joints
106
Heberden's Nodes: Present in what disease?
Osteoarthritis
107
Are Heberdens or Bouchard Nodes more common?
Heberdens
108
Giant Cell Tumour of The Tendon Sheath
Benign nodular tumour found on the tendon sheath of the hands and feet
109
Giant Cell Tumour of The Tendon Sheath: 2 types
Localised
Diffuse
110
Giant Cell Tumour of The Tendon Sheath: Which type is more common?
Localised
111
Giant Cell Tumour of The Tendon Sheath: Pathophysiology
Benign regenerative hyperplasia with inflammatory processes
112
Giant Cell Tumour of The Tendon Sheath: Diffuse type is associated with what condition?
Pigemented villonodular synovitis
113
Giant Cell Tumour of The Tendon Sheath: Clinical presentation
Firm discrete swelling on the volar aspect of digits or on toes
114
Giant Cell Tumour of The Tendon Sheath: Management
Left if no functional complications
115
Giant Cell Tumour of The Tendon Sheath: Management if there is functional complications
Surgical marginal excision
116
Giant Cell Tumour of The Tendon Sheath: Why is surgical excision not done as a complete excision?
As it is adherent to the tendon sheath
117
Sebaceous Cysts
Dematological condition originating at the hair follicles in which they are filled with caseous keratin
118
Sebaceous Cysts: Pathophysiology
Hair follicles are filled with caseous material
119
Sebaceous Cysts: Common locations (3)
Face
Trunk
Neck
120
Sebaceous Cysts: Growth pattern
Slow growth
121
Sebaceous Cysts: Are they painful?
No
122
Sebaceous Cysts: Clinical presentation
Mobile discrete swellings
123
Sebaceous Cysts: Management
Excision if required
124
Hip Fractures: Majority of patients are of what age?
Over 60 years
125
Hip Fractures: More common in what sex?
Women
126
Hip Fractures: Diseases that are risk factors for this? (2)
Osteoporosis
Neurological impairment
127
Hip Fractures: Environmental Risk Factors (4)
Smoking
Malnutrition
Excess alcohol intake
Low BMI
128
Hip Fractures: Risk doubles when?
Every 10 years after the age of 50
129
Hip Fractures: Typical Mechanism of injury in the elderly
Low impact fall
130
Hip Fractures: Mechanism of injury in the young
High energy trauma
131
Hip Fractures: Fractures are classified how?
Intracapsular or Extracapsular
132
Hip Fractures: Shaft of the femur blood supply
Intra-medullary artery
133
Hip Fractures: 3 blood supplies
Intramedullary artery
Medial and lateral circumflex branches of the profunda femoris
Artery of the ligamentum teres
134
Hip Fractures: Intracapsular Fractures - Occur where?
Proximal to the intertrochanteric line
135
Hip Fractures: Intracapsular Fractures - Involves what structures?
Femoral head and neck
136
Hip Fractures: Intracapsular Fractures - Subdivided into what types?
Subcapital fracture
Transcervical fracture
137
Hip Fractures: Intracapsular Fractures - Subcapital Fractures
Fracture line extends through the junction of the head and neck of the femur
138
Hip Fractures: Intracapsular Fractures - Transcervical Fracture
Fracture line occurs along the femoral neck
139
Hip Fractures: Intracapsular Fractures - Garden Fractures predicts what?
Predicts union and AVN
140
Hip Fractures: Intracapsular Fractures - Undisplaced fractures
Pieces of fracture are not moved out of alignment
141
Hip Fractures: Intracapsular Fractures - Displaced fractures
Pieces of fracture are moved out of alignment
142
Hip Fractures: Intracapsular Fractures - Complications (2)
Femoral head AVN
Non-union
143
Hip Fractures: Intracapsular Fractures - Can damage what structure?
Medial femoral circumflex artery
144
Hip Fractures: What type is more likely to heal?
Extra-capsular
145
Hip Fractures: Extracapsular Fractures - Occur where?
Distal to the interotrochanteric line
146
Hip Fractures: Extracapsular Fractures - 4 types
Basicervical
Intertrochanteric
Reverse oblique
Subtrochanteric fractures
147
Hip Fractures: Extracapsular Fractures - Why is AVN and non-union is rare?
Blood supply to the head of the femur is intact
148
Hip Fractures: Extracapsular Fractures - Basi-cervical
Right below the capsule
149
Hip Fractures: Extracapsular Fractures - Reverse Oblique requires what management?
Hip fracture nail
150
Hip Fractures: Extracapsular Fractures - Sub-trochanteric requires what management?
Hip fracture nail
151
Hip Fractures: What investigations are required?
X-Ray - Pelvic and Lateral Hip
MRI
152
Hip Fractures: Shenton's Line
Formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus
153
Hip Fractures: What is the sign of a fractured femur neck on the X-ray?
Loss of contour of the Shenton's Line
154
Hip Fractures: Symptoms (3)
Hip or groin pain
Swelling
Unable to weight bear
155
Hip Fractures: Signs - How may this affect the limb?
Shortening or external rotation on affected sign
156
Hip Fractures: Signs - What must be assessed? (4)
Neurology and vascular status
Cognitive impairment
Other injuries
Dehydration
157
Hip Fractures: Management - THR
Total Hip Replacement
158
Hip Fractures: Management - CHS
Compression Hip Screw
159
Hip Fractures: Management - DHS
Dynamic Hip Screw
160
Hip Fractures: Management - IMN
Intra-medullary Nail
161
Hip Fractures: Management - Intracapsular fracture with high function that is displaced
Total Hip Replacement
162
Hip Fractures: Management - Intracapsular fracture with high function that is undisplaced
Compression Hip Screw
163
Hip Fractures: Management - Intracapsular fracture with Low function
Hemi-arthroplasty
164
Hip Fractures: Management - Extracapsular fracture that is Intertrochanteric
Dynamic Hip Screw
165
Hip Fractures: Management - Extracapsular fracture that is Subtrochanteric
Intra-medullary Nail
166
Hip Fractures: Management - What analgesia should be used?
Local nerve blocks
167
Hip Fractures: Complications - Intra-capsular
Non-union
AVN
168
Hip Fractures: Complications - Extra-capsular
Malunion
Non-union
169
Compartment Syndrome
Increased pressure in the enclosed space of the limb compartments due to swelling of tissue or increase in fluid
170
Compartment Syndrome: What sex is this more common in?
Men
171
Compartment Syndrome: Risk Factors - Environmental
Intravenous drug administration
172
Compartment Syndrome: Risk Factors - Disease (4)
Tibial fractures
Open fractures
Forearm fractures
Burns
173
Compartment Syndrome: Risk Factors - Drugs
Anticoagulation
174
Compartment Syndrome: Main age range
10-35 years
175
Compartment Syndrome: Pathophysiology - Increased pressure in the muscle compartment causes a reduction in what?
Perfusion pressure
176
Compartment Syndrome: Pathophysiology - Reduction in perfusion pressure can lead to what? (4)
Ischaemia
Necrosis
Lactic Acidosis
Muscle, Nerve or Vessel death
177
Compartment Syndrome: Pathophysiology - Significant muscle damage occurs at what pressures?
>30-40 mmHg or diastolic pressure 10-30 mmHg
178
Compartment Syndrome: Pathophysiology - Occurs anywhere in skeletal muscle surrounded by what?
Fascia
179
Compartment Syndrome: Pathophysiology - Commonly occurs in what compartment?
Anterior and deep posterior compartments of the leg
Volar compartment of the forearm
180
Compartment Syndrome: Pathophysiology - Left untreated what will happen?
Ischaemic muscle will necrose to cause fibrotic contracture (Volkmann's Ischaemic Contracture)
181
Compartment Syndrome: Pathophysiology - 5 stages
1. Increased pressure
2. Reduced blood flow
3. Venous occlusion with arterial patency
4. Rapid increase in pressure
5. Arterial occlusion
182
Compartment Syndrome: Clinical Presentation - 4 Ps
Disproportionate pain
Paraethesia
Pallor
Pulselessness - late sign
183
Compartment Syndrome: Management
Immediate release of dressings and casts with a fasciotomy
184
Compartment Syndrome: Management - What should not be done?
Do not elevate
185
Compartment Syndrome: Management - What should be done after surgery?
Open wound is left open for a few days
186
Tibial Shaft Fracture: Mechanism of injury (2)
Low energy - due to indirect torsional injury
High energy - due to direct force
187
Tibial Shaft Fracture: 4 configurations
Spiral
Transverse
Oblique
Comminuted
188
Tibial Shaft Fracture: High risk of what happening?
Compartment Syndrome
189
Tibial Shaft Fracture: Clinical Presentation (3)
Pain
Inability to weight bear
Deformity present
190
Tibial Shaft Fracture: Investigation
X-ray - AP and Lateral
191
Tibial Shaft Fracture: Conservative Management
Above knee cast - may require closed reduction
192
Tibial Shaft Fracture: Operative Management (2)
Intramedullary nailing
Open Reduction and Internal Fixation
193
Tibial Plateau Fracture: Mechanism of Injury in young patients
High energy injuries
194
Tibial Plateau Fracture: Mechanism of injury in older patients
Osteoporotic bone
195
Tibial Plateau Fracture: 80% of cases affect what structure?
Lateral condyle
196
Tibial Plateau Fracture: How is lateral condyle impacted?
Valgus force with foot planted
197
Tibial Plateau Fracture: What classification system is used?
Schatzer Classification
198
Tibial Plateau Fracture: Clinical presentation (2)
Pain
Instability
199
Tibial Plateau Fracture: Investigations (2)
X-ray - AP and horizontal beam lateral
CT
200
Tibial Plateau Fracture: CT shows what?
Area of condylar involvement or depth of depression
201
Tibial Plateau Fracture: Horizontal beam lateral of intra-articular fracture will show what?
Lipohaemarthrosis - fat floating on the blood in the suprapatellar recess
202
Tibial Plateau Fracture: Small avulsed bone fragments indicates what?
Significant soft tissue injury
203
Tibial Plateau Fracture: Conservative management
Above knee cast
204
Tibial Plateau Fracture: Operative management options (3)
Open Reduction Internal Fixation
External fixation
Delayed Total Knee Replacement
205
Tibial Plateau Fracture: Complications - Blow to the lateral aspect of the knee can cause what?
Damage the common fibular nerve
206
Tibial Plateau Fracture: Complications (3)
Compartment syndrome
Soft tissue injury
Neurovascular injury of popliteal structures or common peroneal nerve
207
Femoral Shaft Fracture: Mechanism of Injury
High energy injuries
208
Femoral Shaft Fracture: Investigation
X-Ray
209
Femoral Shaft Fracture: Management - Initial management
Thomas splint for temporary stabilisation
210
Femoral Shaft Fracture: Management - Operative Management options (2)
Intramedullary nail
Plate fixation - Open Reduction with Internal Fixation OR Minimally invasive percutaneous plate osteosynthesis (MIMMO)
211
Femoral Shaft Fracture: Complications (2)
Significant blood loss
Fat embolus
212
Pelvic Fracture: Aetiology in Older patients
Osteoporotic bone
213
Pelvic Fracture: Aetiology in younger patients
High energy injury
214
Pelvic Fracture: Pathophysiology - Why are there normally multiple fractures?
Bony ring disruption
215
Pelvic Fracture: Pathophysiology - What classification system is used?
Young-Burgess Classification
216
Pelvic Fracture: Investigations - High energy - pelvis is only site of injury
X-ray first
217
Pelvic Fracture: Investigations - High energy polytrauma patients
CT first
218
Pelvic Fracture: Investigations - Low energy fractures are often ...
Undisplaced
219
Pelvic Fracture: Investigations - What is the most sensitive test?
MRI
220
Pelvic Fracture: Management - Initial Management
Pelvic binder - controls circulatory loss
221
Pelvic Fracture: Management - Conservative management (2)
Analgesia
Weight bearing as tolerated
222
Pelvic Fracture: Management - Operative management options (3)
Open reduction with internal fixation
External fixators
Internal fixators
223
Distal Radius Fracture: Mechanism of injury
Fall on out-stretched hand
224
Distal Radius Fracture: 3 pattern types
Colles
Smith
Barton's
225
Distal Radius Fracture: Colles fracture
Fracture of the distal radial metaphyseal region with posterior displacement of the distal fragment
There is no involvement of the articular surface
226
Distal Radius Fracture: Smith fracture
Fracture of distal radius with anterior displacement of the distal fragment
227
Distal Radius Fracture: Bartons Fracture
Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint
228
Distal Radius Fracture: Barton's Fracture is normally associated with what?
Sub-luxation or dislocation of the radiocarpal joint
229
Distal Radius Fracture: Symptoms (2)
Pain
Swelling
230
Distal Radius Fracture: Signs (2)
Ecchymosis
Diffuse tenderness
231
Distal Radius Fracture: Investigations (3)
X-ray - AP, Lateral and Oblique
CT - evaluate intra-articular involvement
MRI - indicated in soft tissue injury
232
Distal Radius Fracture: Conservative management
Cast or splint
233
Distal Radius Fracture: Operative management options (3)
Open reduction with internal fixation
Manipulation under anaesthesia with K-wires
External fixation
234
Distal Radius Fracture: Complications - Colles fracture
Median nerve compression due to stretch of nerve or bleed into the carpal tunnel
235
Distal Radius Fracture: Complications - Fracture of the distal radius that have malunion may result in what?
Impaired grip strength - due to loss of extension
236
Forearm Fractures: How are the radius and ulna connected?
Radioulnar joints - they form a ring
237
Forearm Fractures: 3 types of fracture patterns
Monteggia
Galeazzi
Nightstick fracture
238
Forearm Fractures: Monteggia
Fracture of the proximal third of the ulnar shaft with concomitant dislocation of the proximal radial head
239
Forearm Fractures: Galeazzi
Fracture of the distal third of the radius with dislocation of the distal radioulnar joint - the ulnar remains intact
240
Forearm Fractures: Night stick fracture
Isolated fracture of the ulnar shaft
241
Forearm Fractures: Typical location of a nightstick fracture
Transverse fracture at the mid-diaphysis
242
Forearm Fractures: Conservative management
Cast
243
Forearm Fractures: Operative management
Open Reduction with Internal Fixation
244
Forearm Fractures: Investigation
AP and Lateral X-ray
245
Olecranon Fracture: Olecranon function
Insertion site of the triceps tendon - enables extension of the elbow
246
Olecranon Fracture: Symptom
Pain well localised to the posterior elbow
247
Olecranon Fracture: Signs (2)
Palpable defect - if displaced fracture present
Inability to extend the elbow - indicates discontinuity of tricep mechanism
248
Olecranon Fracture: Investigations (2)
X-ray - AP and Lateral
CT
249
Olecranon Fracture: Conservative Management
Cast
250
Olecranon Fracture: Operative Management (3)
Tension band wiring
Open Reduction with Internal Fixation
Plate fixation
251
Humeral Shaft Fracture: Mechanism of injury - Transverse or comminuted fracture
Direct trauma to the arm
252
Humeral Shaft Fracture: Mechanism of injury - Oblique or spiral fractures
Rotational fall
253
Humeral Shaft Fracture: Signs - What exam is critical?
Preoperative or pre-reduction neurovascular exam
254
Humeral Shaft Fracture: Investigations
X-ray - AP and lateral
255
Humeral Shaft Fracture: Conservative management
Humeral brace and U slab cast
256
Humeral Shaft Fracture: Operative management (3)
Intramedullary nail
Open Reduction Internal Fixation
Plate Fixation
257
Humeral Shaft Fracture: Complications
Risk of injury to the radial nerve
258
Proximal Humerus Fracture: Aetiology
Low energy on osteoporotic bone
259
Proximal Humerus Fracture: Pathophysiology - usually occurs where?
Surgical neck
260
Proximal Humerus Fracture: Complications
Damage to the axillary nerve
261
Proximal Humerus Fracture: Sign (2)
Extensive ecchymosis of chest, arm and forearm
Axillary nerve injury
262
Proximal Humerus Fracture: Investigations (3)
X-Ray - AP and lateral
CT
MRI - if associated rotator cuff injury
263
Proximal Humerus Fracture: Conservative Management
Collar and cuff
264
Proximal Humerus Fracture: Operative Management
Open Reduction and Internal Fixation
265
Shoulder Dislocation: Common in what population group?
Young adults
266
Shoulder Dislocation: Aetiology (2)
Fall
Traction injury - limb being pulled away from the body
267
Shoulder Dislocation: Anterior Dislocation - Main mechanism of injury
Fall with shoulder
268
Shoulder Dislocation: Anterior Dislocation - Pathophysiology
Humeral head becomes anterior to the glenoid
269
Shoulder Dislocation: Posterior Dislocation - Mechanism of injury
Fall with shoulder in internal rotation or direct blow to the anterior shoulder
270
Shoulder Dislocation: Posterior Dislocation - Pathophysiology
Humeral head becomes posterior to the glenoid
271
Shoulder Dislocation: Inferior Dislocation - Mechanism of injury
Arm held in abduction
272
Shoulder Dislocation: Inferior Dislocation - Mechanism of injury
Humeral head is inferior to the glenoid
273
Shoulder Dislocation: Investigations - Requires assessment of what?
Axillary nerve
274
Shoulder Dislocation: Investigations
X-ray
275
Shoulder Dislocation: Investigations - Posterior Dislocation X-ray sign
Light bulb sign
276
Shoulder Dislocation: Most common type
Anterior Dislocation
277
Shoulder Dislocation: Anterior Dislocation - Can result in compromise to what?
Axillary artery
278
Shoulder Dislocation: Posterior shoulder dislocation is often associated with what situations?
Epileptic fits
Electrocution
279
Shoulder Dislocation: Inferior shoulder dislocation is due to the shoulder being forced into what?
Hyperabduction
280
Shoulder Dislocation: Needs urgent neurovascular assessment and reduction due to what?
Proximity of brachial plexus
281
Shoulder Dislocation: Clinical presentation (2)
Severe shoulder pain
Inability to move the shoulder
282
Shoulder Dislocation: Investigations (2)
X-ray - AP and Garth (Apical oblique views)
MRI Anthrogram
283
Shoulder Dislocation: Management - Anterior Shoulder Dislocation
Analgesia and sedation IV
Oxygen
Reduction by manipulation - closed or open
284
Shoulder Dislocation: Management - 3 mechanisms of reduction
Kocher method
Hippocratic method
Stimson method
285
Shoulder Dislocation: Management - Hippocratic method
Foot in the axilla with in line traction to move the glenoid medial so the humerus pops back in
286
Elbow Dislocation: Mechanism of injury
Fall onto an outstretched hand
287
Elbow Dislocation: What pathophysiology may occur in a child?
Pulled elbow may cause sole radial head dislocation rather than a full dislocation
288
Elbow Dislocation: Investigation
X-Ray - AP and Lateral View
289
Elbow Dislocation: Management (2)
Reduction - traction in extension +/- pressure over olecranon
2 weeks in sling and rehabilitation
290
Elbow Dislocation: Complications
Risk of radial head fractures and coronoid process fractures
291
Interphalangeal Joint Dislocation: Mechanism of injury (2)
Hyperextension injury
Direct axial blow
292
Interphalangeal Joint Dislocation: Most common
Posterior dislocation
293
Interphalangeal Joint Dislocation: Clinical presentation
Pain and deformity of the affected digit
294
Interphalangeal Joint Dislocation: Investigation
X-ray - AP and lateral view
295
Interphalangeal Joint Dislocation: Management - PIP
Closed reduction and buddy taping
296
Interphalangeal Joint Dislocation: Management - DIP
Closed reduction +/- splinting
297
Interphalangeal Joint Dislocation: Management - If extremely unstable
Volar slab in Edinburgh position
298
Interphalangeal Joint Dislocation: Management - Reduction method
In line traction with corrective pressure
299
Interphalangeal Joint Dislocation: Complications (2)
Head of the phalynx button holes through the volar plate causing volar plate entrapment to block reduction
Recurrent instability
300
Interphalangeal Joint Dislocation: Management. ifthere is volar plate entrapment
Open reduction
301
Patella Dislocation: More common in what patient group
Teenagers
302
Patella Dislocation: More common in what sex?
Females
303
Patella Dislocation: Always dislocates in what direction?
Laterally
304
Patella Dislocation: Aetiologies (2)
Direct blow
Sudden quadriceps contraction with a flexing knee
305
Patella Dislocation: Aetiology in children
Under-developed hypoplastic lateral femoral condyle
306
Patella Dislocation: Risk Factors (5)
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
Patella Dislocation: Pain located where and why?
Medial due to torn medial retinaculum
308
Patella Dislocation: Signs on examination (2)
Patella apprehension test is positive
Effusion - haemarthosis
309
Patella Dislocation: Investigations
X-ray
310
Patella Dislocation: Appearance on X-ray (2)
Lipo-haemarthosis
Small opacification - suggests osteochondral fracture
311
Patella Dislocation: Management (3)
May spontaneously reduce
Brace
Physiotherapy
312
Patella Dislocation: Management - If intractable pain and swollen
Aspiration
313
Patella Dislocation: Management - if repeat dislocations
Surgery of lateral release of medial reefing with patella tendon realignment
314
Patella Dislocation: Complications - When the patella dislocates what may occur?
Medial patellofemoral ligament tears and osteochrondral fracture may occur as the medial facet of the patella strikes the lateral femoral condyle
315
Knee Dislocation: Common in what patient group?
Teenagers
316
Knee Dislocation: More common in what sex?
Females
317
Knee Dislocation: Mechanism of injury
Serious high energy injury
Or twisting injury
318
Knee Dislocation: Pathophysiology - Spontaneous relocation
Lateral collateral ligament injury with perineal nerve injury results in dislocation
319
Knee Dislocation: Investigations - Clinical concern of vascular injury
Arteriography or MRI of the popliteal artery or veins
320
Knee Dislocation: Investigations - What nerve needs to be tested for injury?
Peroneal nerve
321
Knee Dislocation: Investigation of choice
X-ray
322
Knee Dislocation: Management - Definitive
Sequential ligamentous pair
323
Knee Dislocation: Management - Early surgical option
Vascular repair of 6 hour window or nerve repair
324
Knee Dislocation: Management - Immediate
Emergency reduction under sedation
325
Knee Dislocation: Management - Medial Femoral Condyle Buttoned through the capsule
Theatre reduction
326
Knee Dislocation: Complications (4)
Neurovascular injury - popliteal artery or common peroneal nerve
Ligamentous injury
Arthrofibrosis
Ligament laxity
327
Hip Dislocation: Mechanism of injury
Impact during RTA or contact sports during hip flexion
328
Hip Dislocation: Most common direction
Posterior
329
Hip Dislocation: Pathophysiology for posterior dislocations
Force is driven along the femur proximally so the femoral head to dislocate posteriorly with an acetabular rim fracture
330
Hip Dislocation: Associated fractures
Posterior acetabular wall
Femoral fracture
331
Hip Dislocation: Clinical presentation
Flexed, internally rotated and adducted knee
332
Hip Dislocation: Investigations (2)
X-ray
CT
333
Hip Dislocation: Investigations - Neurovascular assessment of what?
Sciatic Nerve
334
Hip Dislocation: Management - Immediated
Urgent reduction - stabilise in tractions if required
335
Hip Dislocation: Management - Definitive
Fixation of associated pelvic fractures and other injuries
336
Hip Dislocation: Complications (5)
Posterior acetabular wall fracture
Femoral fractures
Sciatic nerve palsy
AVN of the femoral head
Secondary osteoarthritis of the hip
337
Paediatric Fractures: Anatomical point of weakness in the bone
Point at which a metaphysic connects to a physis
338
Paediatric Fractures: What is stronger than bones in young patients?
Ligaments and tendons
339
Paediatric Fractures: ... is thick in children meaning it often stays intact during injury
Periosteum
340
Paediatric Fractures: Buckle Fracture
Fracture due to compressive force
341
Paediatric Fractures: Greenstick fracture
Fracture due to force on one side of the bone to cause a break in only one cortex
342
Paediatric Fractures: Advantage of children's fractures compared to adult
Shorter immobilisation times
343
Paediatric Fractures: Disadvantage of children's fractures compared to adult
Mal-aligned fragments become solid sooner
344
Paediatric Fractures: What should be anticipated if a child has >2 years of growth left?
Remodelling
345
Paediatric Fractures: Two types of remodelling and their management?
Mild angulation
Rotational
346
Paediatric Fractures: Nerve Assessment - OK sign
Anterior interosseous nerve
347
Paediatric Fractures: Nerve Assessment - Thumbs up sign
Posterior interosseous nerve
348
Paediatric Fractures: Nerve Assessment - Rock sign
Median nerve
349
Paediatric Fractures: Nerve Assessment - Paper nerve
Radial nerve
350
Paediatric Fractures: Nerve Assessment - Scissor action or crossing of fingers
Ulnar nerve
351
Paediatric Fractures: Physeal Injury - High grade fractures are more likelt to have what impact?
Cause growth disturbance
352
Paediatric Fractures: Physeal Injury - What classification system is used?
Salter Harris Classification
353
Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type I
Fracture passes transversely through the physis to separate the epiphysis from the metaphysis
354
Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type II
Transverse fracture through the physis but exits through the metaphysis to produce a triangular fragment
355
Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type III
Fracture that crosses the physis and exits through the physis at the joint space
356
Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type IV
Fracture extends upwards from the joint line through the physis and out of the metaphysis
357
Paediatric Fractures: Salter Harris Classification of Physeal Injuries - Type V
Crush injury to the growth plate
358
Paediatric Fractures: Elbow Fractures - Most are of what type?
Supracondylar
359
Paediatric Fractures: Elbow Fractures - What acronym is used for the sequence of ossification?
CRITOL
360
Paediatric Fractures: Elbow Fractures - Sequence of ossification
Capitellum
Radial head
Medial epicondyle
Trochlea
Olecranon
Lateral epicondyle
361
Paediatric Fractures: Elbow Fractures - Age of ossification of the capitellum
1 year
362
Paediatric Fractures: Elbow Fractures - Age of ossification of the radial head
3 years
363
Paediatric Fractures: Elbow Fractures - Age of ossification of the medial epicondyle
5 years
364
Paediatric Fractures: Elbow Fractures - Age of ossification of the trochlea
7 years
365
Paediatric Fractures: Elbow Fractures - Age of ossification of Olecranon
9 years
366
Paediatric Fractures: Elbow Fractures - Age of ossification of the lateral epicondyle
11 years
367
Paediatric Fractures: Elbow Fractures - On examination of a lateral X-ray what should be checked?
The anterior humeral line and the radiocapitellar line should both bisect the capitellum - if it is not it suggests a displaced fracture
368
Paediatric Fractures: Elbow Fractures - What fat pad sign is always abnormal?
Posterior fat pad sign
369
Paediatric Fractures: Elbow Fractures - Most supracondylar fracture are of what type?
Extension
370
Paediatric Fractures: Elbow Fractures - Where do supracondylar fractures occur?
Weakest part of the elbow joint where the humerus flattens and flares
371
Paediatric Fractures: Elbow Fractures - Classification system for extension type supracondylar fractures?
Gartland Classification
372
Paediatric Fractures: Supracondylar Elbow Fractures - Type I Gartland
Undisplaced fracture
373
Paediatric Fractures: Supracondylar Elbow Fractures - Type I Gartland treatment
Conservative due to undisplaced type
374
Paediatric Fractures: Supracondylar Elbow Fractures - Type IIa Gartland
Displaced posteriorly but intact posterior peri-steal hinge and anterior humeral line transects the capitellum
375
Paediatric Fractures: Supracondylar Elbow Fractures - Type IIa Gartland Management
Conservative treatment
376
Paediatric Fractures: Supracondylar Elbow Fractures - Type IIb Gartland
Displaced posteriorly but intact posterior hinge and the anterior humeral line does not transect the capitellum
377
Paediatric Fractures: Supracondylar Elbow Fractures - Type IIb Gartland Management
Manipulation under anaesthesia +/- wires
378
Paediatric Fractures: Supracondylar Elbow Fractures - Type III Gartland
Displaced posteriorly with no posterior peri-osteal hinge
379
Paediatric Fractures: Supracondylar Elbow Fractures - Type III Gartland Management
Manipulation under anaesthesia +/- wires
380
Paediatric Fractures: Supracondylar Elbow Fractures - Complications (2)
Radial artery compromise
Nerve compromise - AIN, Medial, Radial and Ulna
381
Paediatric Fractures: Common fractures in toddlers
Undisplaced spiral fracture of the tibia with no fibular fracture
382
Paediatric Fractures: Most common sites of fractures due to NAI (3)
Femur
Humerus
Tibia
383
Impingement Syndrome
Inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space resulting in pain, weakness and reduced ROM
384
Impingement Syndrome: Most likely cause in <30 year olds
Rotator cuff tendonitis or subacromial bursitis
385
Impingement Syndrome: Most likely cause in 30-40 year olds
Calcific tendonitis
386
Impingement Syndrome: Most likely cause in 40-50 year olds
Tendinosis or Partial tear of the rotator cuff
387
Impingement Syndrome: Most likely cause in 50-60 year olds
Rotator cuff tear
388
Impingement Syndrome: Most likely cause in >70 year olds
Cuff Arthropathy
389
Impingement Syndrome: Intrinsic Mechanisms (3)
Muscular weakness
Overuse of the shoulder
Degenerative tendinopathy
390
Impingement Syndrome: Intrinsic Mechanisms - Pathophysiology behind muscular weakness
Weakness in the rotator cuff muscles can lead to the humerus shifting proximally towards the body
391
Impingement Syndrome: Intrinsic Mechanisms -Pathophysiology behind overuse of the shoulder
Repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa
392
Impingement Syndrome: Intrinsic Mechanisms - Pathophysiology behind degenerative tendinopathy
Degenerative changes of the acromion can lead to tearing of the rotator cuff to allow proximal migration of the humeral head
393
Impingement Syndrome: Extrinsic Mechanisms (3)
Anatomical factors
Scapular musculature
Glenohumeral Instability
394
Impingement Syndrome: Extrinsic Mechanisms - Pathophysiology of anatomical factors
Anatomical variations in the shape and gradient of the acromion
395
Impingement Syndrome: Extrinsic Mechanisms - Pathophysiology of Scapular musculature
Reduction in the function of scapular muscles may result in a reduction in the size of the sub-acromial space
396
Impingement Syndrome: Extrinsic Mechanisms - Pathophysiology of Glenohumeral Instability
Can lead to superior subluxation of the humerus causing an increased contraction between the acromion and sub-acromial tissue
397
Impingement Syndrome: What classification system is used?
Neer's Classification
398
Impingement Syndrome: Stage I Neer's Classification
Inflammation, oedema and Haemorrhage in <25 year olds
399
Impingement Syndrome: Stage II Neer's Classification
Fibrosis or Tendonitis of the bursa or cuff in 25-40 year olds
400
Impingement Syndrome: Stage III Neer's Classification
Partial. orfull thickness tears and degeneration in >40 year olds
401
Impingement Syndrome: Examination on movement
ROM is limited with a painful arc and weakness in the rotator cuff
402
Impingement Syndrome: What clinical tests can be conducted? (2)
Hawkin's Test
Jobe's Test
403
Impingement Syndrome: Hawkin's Test
With the shoulder flexed forward and the elbow bent the arm is internally rotated - pain exacerbated if positive
404
Impingement Syndrome: Jobe's Test
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
Impingement Syndrome: Jobe's Test - pain but no weakness on the test indicates what?
Supra-spinatus impingement
406
Impingement Syndrome: Clinical Presentation - Tenderness felt where?
Below the lateral edge of the acromion
407
Impingement Syndrome: Investigations
X-ray - AP and Garth (apical oblique) views
US or MRI for shoulder mobilityir
408
Impingement Syndrome: What may appear on X-ray?
Bone spur
409
Impingement Syndrome: Conservative management options (3) and time period
Rest
Pain relief - corticosteroid injections into the subacromial space
Physiotherapy
Minimum of 6 months
410
Impingement Syndrome: Surgical management options (5)
Subacromial decompression
Subacromial or Subdeltoid Bursectomy
Release of coracoacromial ligaments
Release of calcific deposits
Excision of intraclavicular spur
411
Rotator Cuff Tear: Usually occurs in what age group?
>40 year olds
412
Rotator Cuff Tear: Aetiology (3)
Degenerate changes in the tendon
Acute tear - fall onto an outstretched arm or sudden jerk
Significant injury - e.g. shoulder dislocation
413
Rotator Cuff Tear: Types of tear (2)
Partial
Full thickness
414
Rotator Cuff Tear: Tears usually involve what structure?
Supraspinatus
415
Rotator Cuff Tear: Large tears can extend into what? (2)
Sub-scapularis
Infra-spinatus
416
Rotator Cuff Tear: Clinical presentation - Symptoms (2)
Pain in front of shoulder that radiates down the arm
Weakness
417
Rotator Cuff Tear: Clinical Presentation - Signs (2)
Wasting of supraspinatus
Tenderness in the sub-deltoid region
418
Rotator Cuff Tear: Investigations (3)
X-ray
MRI - if reduced ROM
US - if good ROM
419
Rotator Cuff Tear: Clinical Presentation - Sign on movement
ROM is less on active movement than passive - due to weakness of the Supraspinatus, Infraspinatus, Teres minor and Subscapularis
420
Rotator Cuff Tear: What examinations should be conducted? (3)
Supraspinatus test
Gerber's Lift Off
Horn Blowers test
421
Rotator Cuff Tear: Supraspinatus Test
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
Rotator Cuff Tear: Gerbers Lift Off Test
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
Rotator Cuff Tear: Horn Blowers Test
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
Rotator Cuff Tear: Management - Conservative management options (3)
Rest
Analgesia
Sling
425
Rotator Cuff Tear: Management - Chronic Cases (2)
Physiotherapy - Anterior Deltoid Strengthening
Steroid injections
426
Rotator Cuff Tear: Management - Acute Cases (2)
Early intervention - physiotherapy and reassessment
Surgical options are controversial - failure in 1/3 of patients
427
Rotator Cuff Tear: Management - Surgical option
Arthroscopic or open repair of the cuff
428
Rotator Cuff Tear: Complications (2)
Pulls the head of the humerus upwards
Abnormal forces on the glenoid leads to osteoarthritis
429
Adhesive Capsulitis: Alternate name
Frozen Shoulder
430
Adhesive Capsulitis
Inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint
431
Adhesive Capsulitis: Most common age
40-50 years old
432
Adhesive Capsulitis: More common in what sex?
Females
433
Adhesive Capsulitis: Associated with what diseases? (4)
Diabetes Mellitus
Hypercholesterolaemia
Endocrine Disease
Dupuytren's Contracture
434
Adhesive Capsulitis: Pathophysiology
Contracture and thickening of coracohumeral ligament, rotator interval and the ingerior glenohumeral ligament (axillary fold)
435
Adhesive Capsulitis: Pathophysiology - Can cause a decrease in what?
Joint volume
436
Adhesive Capsulitis: Pathophysiology - What is no t present?
Adhesion
437
Adhesive Capsulitis: Pathophysiology - First stage and description
Freezing or painful stage - minimal synovitis with pain to cause a reduced ROM
438
Adhesive Capsulitis: Pathophysiology - Second stage and description
Frozen or Transitional stage - pain decreases but proliferative synovitis with contraction of the capsule and adhesion of the axillary recess increases
439
Adhesive Capsulitis: Pathophysiology - Third stage and description
Thawing stage - inflammation decreases and movement slowly improves
440
Adhesive Capsulitis: Clinical Presentation - When is pain worse?
At rest and at night
441
Adhesive Capsulitis: Clinical Presentation - Where is the pain located?
Anterior
442
Adhesive Capsulitis: Clinical Presentation - When does pain reduce?
Around 2-9 months
443
Adhesive Capsulitis: Clinical Presentation - When does stiffness increase?
4-12 months
444
Adhesive Capsulitis: Clinical Presentation - Main restriction in ROM?
External rotation
445
Adhesive Capsulitis: Differential Diagnosis (2)
Locked posterior dislocation
Glenohumeral arthritis
446
Adhesive Capsulitis: Resolution time
18-24 months
447
Adhesive Capsulitis: Conservative Management (3)
Physiotherapy and analgesia
Intra-articular glenohumeral steroid injections
Fluoroscopic distension
448
Adhesive Capsulitis: Management - Surgery indicated when?
Patient cannot tolerate functional loss due to stiffness
449
Adhesive Capsulitis: Management - Surgical options (2)
Manipulation under anaesthesia
Arthroscopic capsular release
450
Glenohumeral Osteoarthritis: Age that is common
>60 years old
451
Glenohumeral Osteoarthritis: Onset of pain
Gradual onset of pain with intermittent exacerbations
452
Glenohumeral Osteoarthritis: Pain worse when?
At rest and night
453
Glenohumeral Osteoarthritis: Movement limited how?
On external rotation
454
Glenohumeral Osteoarthritis: Investigation
X-ray
455
Glenohumeral Osteoarthritis: Appearance on X-ray (4)
Joint space narrowing
Sub-chondral sclerosis
Sub-chondral cysts
Osteophyte formation
456
Glenohumeral Osteoarthritis: Conservative Management Options (3)
Analgesia
Physiotherapy
Glenohumeral Steroid Injection
457
Glenohumeral Osteoarthritis: Operative Management Options (3)
Shoulder Replacement
Total shoulder arthroplasty
Reverse polarity shoulder arthroplasty
458
Cubital Tunnel Syndrome
Compression of the ulnar nerve at the elbow behind the medial epicondyle
459
Cubital Tunnel Syndrome: Aetiologies (2)
Osborne's Fascia - tight band of fascia forming the roof of the tunnel
Tightness at the intermuscular septum as the nerve passes through
460
Cubital Tunnel Syndrome: Most common age
>30 years old
461
Cubital Tunnel Syndrome: More common in what sex?
Males
462
Cubital Tunnel Syndrome: Symptoms
Parathesiae in the ulnar 1 and 1/2 fingers
463
Cubital Tunnel Syndrome: How may this be caused at night?
Sleeping with arm in flexion
464
Cubital Tunnel Syndrome: What nerve is affected?
Ulnar nerve
465
Cubital Tunnel Syndrome: Where is the intramuscular septum?
Arcade of Struthers
466
Cubital Tunnel Syndrome: Cubital Tunnel Anatomy - Roof
Flexor carpi ulnaris fascia and Osborne's Ligament
467
Cubital Tunnel Syndrome: Cubital Tunnel Anatomy - Floor
Medial collateral ligament and joint capsule
468
Cubital Tunnel Syndrome: Cubital Tunnel Anatomy - Walls
Medial epicondyle and Olecranon
469
Cubital Tunnel Syndrome: Ulnar nerve innervates what? (5)
Ulnar two lumbricals
All hypothenar muscles
Deep head of the flexor pollicis brevis
Adductor pollicis
Forearm flexors
470
Cubital Tunnel Syndrome: Early Symptoms (3)
Ulnar pins and needles
Pain
Clumsiness
471
Cubital Tunnel Syndrome: Late symptoms (2)
Numbness
Weakness
472
Cubital Tunnel Syndrome: Signs - Atrophy of what muscles? (2)
Hypothenar muscles
Interosseous muscles
473
Cubital Tunnel Syndrome: Signs - Weakness in what muscles?
Abductor digiti minimi
474
Cubital Tunnel Syndrome: Signs - Weakness in what movement?
Grasp and pinch
475
Cubital Tunnel Syndrome: Signs - What 4 tests are used?
Tinnel's Test
Phalen's Test
Froment's Test
Wartenberg's Test
476
Cubital Tunnel Syndrome: Signs - Tinnel's Test and Positive Test
Tapping of the cubital fossa
Positive - causes a tingling sensation
477
Cubital Tunnel Syndrome: Signs - Phalen's Test and Positive Test
Flexion of the elbow at 90 degrees for 1 minute
Positive - Causes tingling in the regions innervated by the ulnar nerve
478
Cubital Tunnel Syndrome: Signs - Froment's Test and Positive Test
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
Cubital Tunnel Syndrome: Signs - Wartenberg's Sign and Positive Result
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
Cubital Tunnel Syndrome: Management - Mild or Moderate (3)
Elbow splintage
Physiotherapy
NSAIDs
481
Cubital Tunnel Syndrome: Management - Severe cases
Surgical ulnar nerve decompression - release the nerve from the Arcade of Struthers to the heads of the Flexor Carpi Ulnaris
482
Rickets Disease
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
Osteomalacia
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
Rickets and Osteomalacia: Primary causes
Insufficient calcium absorption or phosphate deficiency due to increased renal losses
485
Rickets and Osteomalacia: Other causes of disease (4)
Vitamin D deficiency
Hypophosphataemia
Long term anticonvulsant use
Chronic kidney disease
486
Rickets and Osteomalacia: Causes of Vitamin D deficiency (3)
Lack of sunlight exposure
Malnutrition
Malabsorption
487
Rickets and Osteomalacia: Causes of hypophosphataemia (4)
Re-feeding Syndrome
Alcohol abuse - impairs phosphate absorption
Malabsorption
Renal tubular acidosis
488
Rickets and Osteomalacia: Pathophysiology behind the impact of CKD
Reduced phosphate resorption and failure of activation of Vitamin D results in secondary hyperparathyroidism
489
Rickets and Osteomalacia: Pathophysiology - Vitamin D impact on calcium
Stimulates absorption of calcium from the GI tract, Kidney and bone
490
Rickets and Osteomalacia: Pathophysiology - Vitamin D impact on osteoblasts
Induces release of osteocalcin from osteoclasts
491
Rickets and Osteomalacia: Pathophysiology - Vitamin D deficiency has what impact on calcium and PTH?
Hypocalcaemia
Elevated PTH
492
Rickets and Osteomalacia: Pathophysiology - Why does Vitamin D deficiency result in Osteomalacia?
Release of calcium from bone causes impaired mineralisation of newly formed osteoid
493
Rickets and Osteomalacia: Clinical Presentation -Bone pain where?
Pelvis
Spine
Femur
494
Rickets and Osteomalacia: Clinical Presentation -Symptoms of hypocalcaemia (6)
Paraesthesiae
Muscle cramps
Irritability
Fatigue
Seizures
Brittle nails
495
Rickets and Osteomalacia: Clinical Presentation -Signs (3)
Deformities from soft bones
Proximal myopathy
Dental defects
496
Rickets and Osteomalacia: Investigations (2)
X-ray
Bloods
497
Rickets and Osteomalacia: Investigations - X-ray presentation
Pseudofractures - looser's zones
- These are in the pubic rami, proximal femur, ulna and ribs
Poor cortico-medullary differentiation
498
Rickets and Osteomalacia: Investigations - Blood results (3)
Decreased calcium
Decreased serum phosphate
Increased serum ALP
499
Rickets and Osteomalacia: Management
D3 tablets with Calcitriol and Alfacalcidol
500
Rickets and Osteomalacia: Management - D3 dose
400-800 IU per day after loading dose of 3200 IU per day for 12 weeks
501
Rickets and Osteomalacia: Management - Considerations for Chronic Renal Disease (3)
Check 1-25 OH Vitamin D as may have high Vitamin D
Titrate treatment to PTH levels
Phosphate binders
502
Osteogenesis Imperfecta
Group of genetic disorders mainly affecting the bone
503
Osteogenesis Imperfecta: Genetic inheritance pattern
Autosomal Dominant Disorder
504
Osteogenesis Imperfecta: Pathophysiology
Defect of the maturation and organisation of Type I collagen
505
Osteogenesis Imperfecta: Examples of Autosomal Dominant Mutations (2)
COL1A1
COL1A2
506
Osteogenesis Imperfecta: Clinical presentation - Autosomal dominant type (5)
Multiple fragility fractures of childhood
Short stature
Blue sclerae
Dentinogenesis imperfecta
Loss of hearing
507
Osteogenesis Imperfecta: Clinical presentation - Autosomal recessive
Fatal in the perinatal period or associated with spinal deformity
508
Osteogenesis Imperfecta: Investigation
X-ray
509
Osteogenesis Imperfecta: Investigations - Appearance on X-ray
Bones are thin with thin cortices and osteopenic
510
Osteogenesis Imperfecta: Management
