Limb Flashcards
Raynard phenomenon. Rx
Treatment is with calcium antagonist
Diff b/w embolus and atheromatic occlusions
Sudden onset of symptoms; pain, pallor, paresis, pulselessness, paraesthesia
claudication, ulceration and gangrene
Upper limb venous thrombosisarise as a result of
arise as a result of repetitive use of the limb in a task such as painting a ceiling
Adsons test
Test for Cer vical rib
Lateral flexion of the neck away from symptomatic side and traction of the symptomatic arm- leads to obliteration of radial pulse)
Cervical rib. fibrous band arises from
fibrous band that often originates from C7
Simmons Thompson test
Used to chk Achilles tendon rupture
Positive when lack of plantar flexion on squeezing the calf
Achilles Tendon rupture at
4-6 cm above Calcaneal insertion in the watershed hypovascular area
What rule is usedto get xray in order of foot or anKle injury
Ottawa ankle rule
What occurs with Tibialis post tendon rupture
valgus deformity due to unopposed eversion
Fibular flap
Useful source of long segment of vascularised bone and is used for mandibular reconstruction
Not used in just skin injuries
Anterior interosseous nerve syndrome
Anterior interosseous nerve syndrome This is a loss of motor function in FPL,FDP index and pronatorquadratus without sensory loss.
Perthes disease
Idiopathic avascular necrosis of the femoral epiphysis of the femoral head
Conservative management of perthes disease age
<6 years of age
Caterral staging is for what disease
Perthes
Articular surface in caterral staging
Stage 2 preservation of articular disease
Stage 3 femoral head affected
Stage 4 loss of acetabular integrity
Management of perthes disease
keeping the femoral head in the acetabulum by braces, casts or surgery.
Sites from where cancer metastasize to bone/
Secondary Malignant Tumor of bone
renal, thyroid, lung, prostate, and breast
Most common siteof bone metastasis
Spine
Genetic association of osteosarcoma
RB1(familial retinoblastoma)
p53 (Li Fraumeni Syndrome
Genetic association of chordomas during childhood
Mutations to TSC1 andTSC2 mutation (tuberous sclerosis)
Paget’s disease is associated with What kind of cancer
Osteosarcoma
which benign bone condition can lead to osteosarcoma
Paget’s disease and fibrous dysplasia
Feature of pain in bone cancer
Not associated with movement
Worse at night
Codman’s triangle” or as a “sunburst pattern in which brain tumor
Osteosarcoma
Osteosarcoma Features
More in males
Bimodal age of onset, either at 10-14 years or in those >65yrs
Epiphysis of long bones (most commonly the distal femur, proximal tibia, and distal radius).
Rhabdomyosarcoma vs Leiomyosarcoma
Rhabdomyosarcoma-striated muscle
Leiomyosarcoma-smooth muscle
Most frequently site of charcot
Knee or hip joints in Tabes dorsalis
Shoulder or elbow joint In syringomyelia
Labs in Paget vs 2ndry bone Ca
Paget: only raised ALP
2ndry Tumors: raised ALP, Ca and phosphate
Appearance of secondary bone tumors
Sclerotic if from prostate
Lytic if from breast
Osteoclastoma has a characteristic appearance on x-ray
with multiple lytic and lucent areas (Soap bubble) appearances.
Which site secondary tumor of bone are most prone to spontaneous fracture
peritrochanteric region
Tumour Features
Osteoid osteoma
Males more
Younger 10 to 25
Worse at night and relieved by NSAIDS
Long bones
Histology of
Osteoid osteoma
Lesion affects cortex and radiologically consists of a lucent centre surrounded by reactive sclerosis
multiple lytic and lucent areas (Soap bubble) appearances
Osteoclastoma/ Giant cell tumor
Two syndromes are associated with chondromas both of which are characterised by the formation of multiple enchondromas
, Ollier’s disease and Maffucci syndrome,
Endochondroma vs Ecchondroma
En: centre of bone
Ec: surface of bone
Ollier’s disease has which type of chondromatosis
Multiple Enchondromatosis
Pedunculated bone cancer
Osteochondroma
Features of bone cysts
In adolescence
proximal femur and humerus
ovoid radiolucent area with surrounding cortical thinning
ovoid radiolucent area with surrounding cortical thinning
Bone cysts
ES R raised in which bone tumor
Ewing
This is asigns ofbad prognosis
Treatment of osteosarcoma versus Ewing sarcoma
Osteo: Excision
Ewing: excisional surgery and chemotherapy.
Which bone tumor occurs in long bones, pelvis and ribs
Chondrosarcoma
Mirel scoring system is used
to stratify the risk of spontaneous fracture for bone metastasis of varying types.
Paget Disease of Bone
- Skull vault expansion and sensorineural hearing loss.
- Areas of sclerosis and radiolucency in skull.
- Normal Calcium and PTH levels with elevated ALP.
Paget disease is actually a problem of
Osteoclast which is followed by osteblast
Predisposing factors of paget
increasing age
male sex
northern latitude
family history
Bones affected in paget disease
Skull vertebra long bones and pelvis
skull x-ray of paget
thickened vault, osteoporosis circumscripta
Indications for treatment of paget
bone pain, skull or long bone deformity, fracture, periarticular Paget’s
Which bone tumor is related to paget disease
Osteogenic sarcoma
Complications of paget disease of bone
Pathological fractures
High cardiac output failure
Osterogenic sarcoma
Paraplegia
Compressive symptoms due to skull and enlargement for example
deafness, blindness
Boxer vs Bennet #
Boxer’s fracture – A fracture of the 5th metacarpal neck usually caused by a clenched fist striking a hard object.
Bennett’s fracture – A fracture of the 1st metacarpal base, caused by forced hyperabduction of the thumb.
Which carpal bones form wrist joint
Scaphoid and lunate
Most common ankle ligament injury
Ant talofibukar and calcaneofibular
When will callus form
3 weeks
Bu fibroblast and chondrblasts
Chondromalcia pataeelae key point
A teenage girl with knee pain on walking down the stairs is characteristic for chondromalacia patellae (anterior knee pain). Most cases are managed with physiotherapy.
Osgood schlatter disease points
Pain at tibial tuberosity in young athletes but with no hx of injury
Rx of patellar fracture
K wiring
