More disorders Flashcards
1
Q
Compartment syndrome
A
When the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. It usually occurs in the legs, feet, arms or hands, but can occur wherever there’s an enclosed compartment inside the body.
2
Q
What areas does compartment syndrome usually affect?
A
Calf and forearm
3
Q
Causes of Compartment syndrome
A
Trauma (complication of fracture)
Continued pressure on a limb (eg. Lying for hours in the same position on the same limb. Often seen in drug and alcohol abuse)
4
Q
Clinical features of Compartment syndrome
A
Often co-exists with fractures
Suspicious if Pain out of proportion, Pain increases over time (despite analgesia)
Often increased pain on passive flexion and extension of the fingers and toes of the affected limb
5
Q
Compartment syndrome investigations
A
Measure compartment pressure
> <30mmHg is normal
> >40mmHg is high
Compare diastolic arterial and compartmental pressures – the difference needs to be >30mmHg for adequate perfusion
6
Q
Compartment syndrome Management
A
Fasciotomy - Needs to be done as soon as possible to minimise risk of irreversible ischaemia
7
Q
Osteomyelitis
A
Infection of the bone and/or bone marrow - can affect all ages
8
Q
Common organisms involved in osteomyelitis
A
o Staph aureus
o Pseudomonas
o E. coli
o Strep
9
Q
Features of osteomyelitis
A
o Acute illness with extreme pain over the affected bone o Symptoms may vary o Fever o Erythema and swelling o Unwillingness to move limb
10
Q
What groups of patients are most likely to get osteomyelitis?
A
>
Neonates Drug users HIV
11
Q
What part of bones are usually affected in osteomyelitis?
A
- Long bones usually
* Most commonly in the metaphysis
12
Q
Investigations in osteomyelitis
A
Positive blood cultures
Increased WBC, ESR
Xrays - Will be normal early on, After 2 weeks will show loss of density and new bone outlining the raised periosteum
13
Q
Treatment for osteomyelitis
A
o Rest
o IV antibiotics (flucloxacillin and gentamicin)
o Drainage of any abscesses and removal of sequestra (pieces of dead bone)
14
Q
What IV antibiotics are used in osteomyelitis?
A
IV flucloxacillin and gentamicin
15
Q
Complications of osteomyelitis
A
- Septicaemia
- Acute pyogenic arthritis
- Growth retardation
- Chronic osteomyelitis
16
Q
What are the complications of fractures?
A
- Avascular necrosis
- Mal-union
- Non-union
- Delayed union
17
Q
Avascular necrosis
A
A disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone collapses. Early complication (within 48 hours of surgery)
18
Q
What bone is usually affected by Avascular necrosis?
A
Usually hip (treated with total hip replacement) - Can occur at the end of any long bone
19
Q
How quickly does avascular necrosis (a complication of fractures) occur
A
Early complication (within 48 hours of surgery)
20
Q
Clinical features of avascular necrosis
A
- Cold
- Pulseless
- Ischaemia
- Paralysis
- Paraesthesia of the limb
21
Q
Investigations in avascular necrosis
A
- Xray – normal in the early stages
2. Angiography – confirms diagnosis
22
Q
Management in avascular necrosis
A
Surgery to revascularise the limb
23
Q
What is mal-union?
A
Complication of fractures - the separate areas of bone heal, but with incorrect alignment
Proper placement and reduction of the fracture at the time of injury can prevent it - Significant mal-union can be corrected by osteotomy
24
Q
What is Non-union?
A
Complication of fractures - Non-union (the separated areas of bone do not fuse) - If union has not occurred by 6 months, then it is unlikely to do so without intervention
25
Investigations for non-union
1. Ongoing pain
2. Ongoing oedema
3. Movement at the fracture site
26
Delayed union of bones
Difficult to distinguish between delayed and non-union
X-ray at 6 months is definitive
In both instances the join is likely to be painful throughout
27
How to tell difference between non-union and delayed union
X-ray at 6 months - if still no union over 6 months, it is unlikely to ever unite therefore its a non-union
28
Tenosynovitis
The inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Tenosynovitis can be either infectious or noninfectious.
29
Causes of Tenosynovitis
De quervain’s tenosynovitis
30
De Quervain's tenosynovitis
A painful condition affecting the tendons on the thumb side of your wrist. If you have this, it will probably hurt when you turn your wrist, grasp anything or make a fist.
31
Clinical features of Tenosynovitis
* Pain on the radial side of the wrist - tenderness is most acute over the tip of the radial styloid
* Abduction of the thumb against resistance is painful
* Tendon sheath may be thickened
32
What muscles (within the tendon sheath) are affected in Tenosynovitis?
1. Extensor pollicis brevis
| 2. Abductor pollicis longus
33
What are the predisposing factors for Tenosynovitis?
> Diabetes
> IV drug abuse
> Immunocompromised
34
Tennis elbow a.k.a lateral epicondylitis
Is an overuse injury - Exacerbated by forced palmar flexion of the wrist
Painful & tender lateral epicondyle and pain on resisted middle finger and wrist extension
35
Golfer’s elbow (medial epicondylitis)
Is an overuse injury - Exacerbated by forced dorsiflexion of the wrist
36
Treatment for overuse injuries (medial and lateral epicondylitis)
```
o Avoid cause
o Painkillers
o NSAIDs
o Steroid
o physio
o Use of brace
o They are self-limiting
```
37
Developmental dysplasia of the hip (DDH)
Dislocation or subluxation of femoral head during the perinatal period which affects subsequent development of the hip joint - If left untreated, acetabulum is very shallow. In severe cases, a false acetabulum occurs proximal to original with shorter limp.
38
Risk factors for Developmental dysplasia of the hip (DDH)
> Breech position in the 2nd/3rd trimester
> Family history
> Other MSK abnormalities
> Girl
39
Clinical features of Developmental dysplasia of the hip (DDH)
1. Presents in babies
2. Older child - lump ever since they started walking
3. Limb shortening, asymmetrical groin/thigh skin
4. Clicky hip
5. Ortolani manoeuvre and the barlow manoeuvre – dislocatable hip
40
Diagnosis of Developmental dysplasia of the hip (DDH)
1. USS as femoral head not ossified yet
| 2. X-ray after 4-6 months
41
Treatment for Developmental dysplasia of the hip (DDH)
1. Palvik harness – up to age 4-6 months
2. Over 18 months – open reduction
3. Splint
42
Transient synovitis
Commonly called irritable hip, is the most common cause of limping in children. It is due to inflammation (swelling) of the lining of the hip joint. In most cases of irritable hip, your child will have recently recovered from a viral infection.
o 2-10 years
o More common in boys
o Insidious onset
43
Most common cause of hip pain in childhood
Transient synovitis
44
Clinical features of Transient synovitis
1. Low grade pyrexia
2. Generally well
3. Limp - Resistance to internal rotation
4. Pain on thigh/groin, knee
5. Restricted range of motion
45
Investigation for Transient synovitis
> Throat swab (to check for recent infection)
> Osteomyelitis possible diagnosis – MRI to exclude
> Aspiration of him or open surgical drainage to limit cartilage damage
46
Treatment for Transient synovitis
NSAID + rest. Pain resolves in weeks
47
Perthes AKA Legg-Calve-Perthes disease
Idiopathic osteochondritis of the femoral head - Afects 4 – 9 years, usually boys - Transient
A rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur is temporarily disrupted. Without an adequate blood supply can lead to avascular necrosis.
48
Clinical features of Perthes disease
> Reduced range of movement
> Pain at the groin, knee, thigh, buttocks
> Limp
> Unilateral
> Loss of internal rotation
> Loss of abduction – positive Trendelenburg test
49
Investigations for Perthes disease
1. Bloods
| 2. Xray (can show femoral head collapse)
50
Treatment for Perthes disease
> Bed rest
> Recurrent attacks increase the risk of necrosis
> Avoidance of physical activity
51
Trendelenburg test
A useful procedure for detecting hip-joint dysfunction.
A positive Trendelenburg sign is identified when the patient is unable to maintain the pelvis horizontal to the floor while standing first on one foot and then on the other foot
52
Slipped Upper Femoral Epiphysis (SUFE)
Fat teenage boys - Femoral head slips inferiorly in relation to the femoral neck - 10-16 years
Higher incidence in black people
53
Causes of Slipped Upper Femoral Epiphysis (SUFE)
1. Local trauma
2. Mechanical factors
3. Genetics
4. Hypothroidism or renal disease may predispose to SUFE
NOT actaully known what causes SUFE could be weight and horomes
54
Why is there knee pain in Slipped Upper Femoral Epiphysis (SUFE)
Might present with knee pain due to obturator nerve supplying both hip and knee joint
55
Examination findings in Slipped Upper Femoral Epiphysis (SUFE)
> Pain on hip
> Loss of internal rotation***
> Trethowans’ sign
> X-ray shows subtle changes. Lateral view must be taken
56
Treatment for Slipped Upper Femoral Epiphysis (SUFE)
1. Pin the femoral head to prevent further slippage
| 2. Risk of avascular necrosis
57
What conditions are associated with Carpal tunnel syndrome?
Hypothyroidism and acromegaly; RA; conditions with increased fluid retention; fracture (colles)
58
What nerve is affected in Carpal tunnel syndrome?
Median nerve
59
Carpal tunnel syndrome
Is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm.
60
Clinical features of Carpal tunnel syndrome
> Numbness
> Tingling, Pain
> Pins and needles
> Affects thumb, index, middle and half of ring finger
> Wasting of the thenar eminence (late sign)
61
Investigations for Carpal tunnel syndrome
1. Phalen’s test (upside-down prayer sign to elicit symptoms)
2. Tinel’s test (tapping over the medial aspect of the wrist to elicit symptoms)
62
Diagnosis of Carpal tunnel syndrome
> Often made clinically
| > If in doubt – nerve conduction studies
63
Phalen’s test
Upside-down prayer sign to elicit symptoms
64
Tinel’s test
Tapping over the medial aspect of the wrist to elicit symptoms
65
Treatment for Carpal tunnel syndrome
1. Splint
2. Steroid injections
3. Surgical decompression
66
Cubital tunnel syndrome
Involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand.
67
Causes of Cubital tunnel syndrome
Compression and stretching
Acute/delayed trauma
OA
RA
68
Clinical features of Cubital tunnel syndrome
1. Pain
2. Paraesthesia
3. Numbness (over ring and little finger)
4. Weak pinch
5. Claw hand deformity
69
Claw hand
Clawing of the 4th and little finger - in cubital tunnel syndrome
70
Investigations for Cubital tunnel syndrome
Froment’s sign (patient holds paper with fingers and needs to exert considerably more force than expected to hold it)
71
Froment’s sign
Patient holds paper with fingers and needs to exert considerably more force than expected to hold it
72
Treatment for Cubital tunnel syndrome
> Split
| > Anterior transposition
73
Radial nerve palsy
o Axillary compression
| o Trauma at the neck of the humerus
74
Radial nerve palsy clinical features
1. Pain
2. Paraesthesia
3. Numbness
4. Wrist drop/finger drop
75
Treatment for Radial nerve palsy
> Supportive
> Steroid injection
> Splint
76
Trigger finger
Permanently flexed finger due to tendonitis of a flexor tendon to a digit resulting in a nodular enlargement of the affected tendon.
77
Trigger finger epidemiology
* Males
* Caucasian
* Late adulthood
* Associated with diabetes and alcohol
78
Clinical features for Trigger finger
```
o Catching
o Snapping
o Locking
o Dysfunction
o Pain
```
79
Causes for Trigger finger
1. Idiopathic
2. Inflammation (tenosynovitis)
3. Autosomal dominant inheritance
80
What conditions are associated with trigger finger?
Associated with diabetes and alcohol
81
Treatment for trigger finger
Steroid injection
| Surgery
82
Dupuytren’s contracture
An abnormal thickening of the skin in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm.
83
What fingers are usually affected in Dupuytren’s contracture
Ring or little finger
84
Pathophysiology of Dupuytren’s contracture
Palmar fascia undergoes hyperplasia. Result of contracture and fibrosis of the palmar aponeurosis. Production of abnormal collagen (type 3 instead of type 1)
85
Epidemiology of Dupuytren’s contracture
* Tends to be men
* Scandanavian/northern European people
* Associated with diabetes, liver disease, epilepsy
* Associated with a history of alcohol excess
* Other fibromatoses like peyronie and ledderhose disease
86
What conditions are associated with Dupuytren’s contracture?
Associated with diabetes, liver disease, epilepsy
Associated with a history of alcohol excess
Other fibromatoses like peyronie and ledderhose disease
87
Clinical features of Dupuytren’s contracture
o Tender palpable nodule on palm
o Progressive deformity
o Pain subsides as it progresses
o Contracture of the MCP and PIP joints
88
Management of Dupuytren’s contracture
1. Steroid injections
| 2. Surgery (Removal of diseased tissue – faciectomy or division of cord – fascioctomy)
89
Posterior hip dislocation
1. Shortening and internal rotation
| 2. Happens in RTA (where knees hit the dashboard)
90
Anterior hip dislocation
Less common
1. Causes pain in the hip and inability to walk or adduct the leg
2. Externally rotated – abducted and extended at the hip
91
Shoulder impingement
Shoulder impingement is when a tendon in your shoulder rubs or catches on a nearby bone - is a syndrome not a diagnosis
Chronic thickening of the rotator cuff from repeated wear and tear
92
Another name for Shoulder impingement
Supraspinatus tendonitis
93
Clinical features of shoulder impingement
- Reaching upwards with the arm exacerbates the pain
- Painful arc between 50 and 120 degrees - On either side of the arc, it is painless
- Still full range of movement unlike frozen shoulder
94
Treatment for shoulder impingement
1. NSAIDs
2. Analgesics
3. Steroid injections
4. Physiotherapy
5. Surgery can be used to make more space
95
Frozen shoulder
Shoulder is painful and stiff
96
Frozen shoulder clinical features
o Unilateral shoulder pain
o Restriction of movement
o Tenderness of examination
o Over several months, the pain subsides but movement becomes restricted
97
Frozen shoulder management
1. Analgesics
| 2. Mobilising exercises
98
Difference in shoulder impingement and frozen shoulder
Difference in range of movement; in frozen shoulder range of movement is restricted at 50-120 degrees, shoulder impingement has no restirction
99
Rotator cuff tear features
o Night pain
o Muscle wasting
o Classically a sudden jerk with subsequent pain and weakness
o Usually involve supraspinatus
100
What 4 muscles make up the rotator cuff?
1. Supraspinatus
2. Infraspinatus
3. Teres minor
4. Subscapularis
101
Difference between full thickness and partial thickness rotator cuff tear
Full thickness (active shoulder movement is impossible) or partial thickness (movement is possible but there is pain)
102
Acute calcific tendonitis
o Acute onset of severe shoulder pain
o Calcium deposition in supraspinatus
o Self-limiting
o Pain can be eased by needling the lesion
103
Plantar fasciitis
Pain at the attachment of the plantar fascia to the medial tubercle of the calcaneus - type of enthesitis/enthesopathy
104
Plantar fasciitis clinical features
o Worse in the morning
o Aggravated by standing
o Worse after activity
o Occurs in runners
105
Treatment of Plantar fasciitis
1. Rest
2. Modified footwear
3. Pain relief
106
Oblique fractures
Oblique = compression
> Diagonal
> Follows impact
107
Transverse fractures
Transverse = bending tension on one side, compression on the other side
> Right angle to bone
> Follows impact
108
Spiral fractures
Spiral = twisting
109
Commuted fractures
Rubbish bone quality, low energy fracture
110
Segmental fractures
Same bone broken twice
> Very unstable
> Needs surgery
111
Crush fractures
In the middle, you’ll get a white bit of bone
| This is because the bones are overlying each other
112
Varus fracture
Bends medial - inwards angulation
113
Valgus fracture
Bends laterally
114
Management of open fractures
1. Cover wound with dressing
2. Broad spectrum antibiotics (IV)
3. Ensure tetanus immunisation
4. Early debridement in theatre
115
Mechanical back pain
Recurrent back pain with no neurological symptoms
• Worse with movement relieve by rest.
• No red flag symptoms
116
Causes of mechanical back pain
Obesity; posture; poor lifting technique; lack of physical activity; depression; degenerative disc prolapse; facet joint OA; spondylosis.
117
Management of mechanical back pain
* Analgesia & physiotherapy.
| * Maintain normal function as much as possible
118
Acute disc tear
Acute tear of outer annulus fibrosus after lifting a heavy object
Pain worse on coughing. Symptoms resolve in months
Treatment – analegesia & physiotherapy
(nucleus pulposis is inner portion if disc)
119
Lumbar Radiculopathy
Often secondary to compression and inflammation of a spinal nerve - if it travels down the back of the legs to the calf - its called scaitica
120
Sciatica
Describes nerve pain in the leg that is caused by irritation and/or compression of the sciatic nerve. Sciatica originates in the lower back, radiates deep into the buttock, and travels down the posterior leg.
121
Features of Lumbar Radiculopathy
Pain & altered sensation in a dermatomal distribution
| Reduced power in a myotomal distribution
122
L4 root entrapment
(L3/4 prolapse). Loss of quad power, reduced knee jerk
123
L5 root entrapment
(L4/5 prolapse). Pain to dorsum of foot. Reduced extensor hallucis longus & tibialis anterior
124
S1 root entrapment
(L5/S1 prolapse). Pain to sole of foot. Reduced plantar flexion, reduced ankle jerk
125
Spinal stenosis & claudication
Narrowing of spinal canal - Reduced space for the cauda equina as a result of spondylosis or bulging disc, bulging ligamentum flavum & osteophytes.
Multiple nerve roots compressed & irritated
126
Spinal stenosis clinical features
Over 60s, pain in legs on walking (claudication)
Symptoms similar to vascular claudication.
pain less on walking up hill (spin flexion creates more space for cauda equina)
pedal pulses preserved
127
Treatment of Spinal stenosis & claudication
* Conservative – physio + weight loss
| * MRI evidence of stenosis then decompression
128
Difference in peripheral vascular disease and spinal stenosis
Differences include: inconsistent claudication distance; burning rather than cramping pain; pain less on walking up hill (spin flexion creates more space for cauda equina); pedal pulses preserved
129
Cauda Equina syndrome
Large central disc prolapse compressing all nerve roots of cauda equina. Surgical emergency as prolongment can cause permanent nerve damage
130
Cauda Equina syndrome features
Bilateral leg pain, paraesthesiae or numbness and saddle anaesthesia
Altered urinary & bowel function.
131
Investigations and management of Cauda Equina syndrome
* PR exam is mandatory
* Urgent MRI & discectomy
Patients have residual nerve injury with permanent bladder & bowel dysfunction
132
Back pain causes in young patient (<20)
Osteomyelitis, discitis, spondylolisthese, osteoid osteoma, osteosarcoma
133
New back pain in older patient (>60)
Arthritic change, crush fracture; higher risk or neoplasia (metastatic disease & multiple myeloma)
134
Constant, severe pain worse at night
Pain from tumour or infection tends to be constant & unremitting
135
Cervical spondylosis
Commonly called arthritis of the neck, is the age-related, wear-and-tear changes that occur over time. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones osteophytes.
Osteophytes can also impinge on exiting nerve roots resulting in radiculopathy involving upper limb.
136
Features of Cervical spondylosis
Slow onset stiffness & pain in neck radiating to shoulders and occiput - commonly called arthritis of the neck, is the medical term for the wear-and-tear changes that occur in the cervical spine
137
Sacroilitis
Sacroiliitis is an inflammation of one or both of your sacroiliac joints
138
Saddle anesthesia
Refers to reduced sensation in the area that would be in contact with a saddle if sitting on one. This includes the perineum, buttocks, anus, groin and upper thighs.
Saddle anaesthesia will make these areas feel numb and abnormal
139
Atlantoaxial instability
Characterised by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or ligamentous abnormality.
Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved.
140
Xerotrachea
Dryness of the tracheobronchial mucosa which can manifest as a dry cough.
141
Xerostomia
Dry mouth
142
keratoconjunctivitis sicca
Dry eyes
143
Wilson’s disease
A rare inherited disorder that causes copper to accumulate in your liver, brain and other vital organs
144
Renal Osteodystrophy
A form of metabolic bone disease seen in patients with chronic renal insufficiency characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities.
Patients present with osteomalacia, osteonecrosis and pathologic fractures
145
Haemochromatosis
An inherited condition where iron levels in the body slowly build up over many years
146
Spondylolisthesis
Where one of the bones in your spine, known as a vertebra, slips out of position. It's most common in the lower back, but it can also happen in the mid to upper back
147
Spondylolisthesis verus slipped disc
Spondylolisthesis - slipped vertebrae
| Slipped disc - slipped intravertebral dosc BETWEEN vertebrae
148
Trendelenburg gait
An abnormal gait resulting from a defective hip abductor mechanism. The muscles involved are the gluteus medius and gluteus minimus. The weakness of these muscles causes drooping of the pelvis to the contralateral side while walking.
149
How to take Biphosphonates
Take at least 30 mins before breakfast with water and sit uprightfor 30 mins following.
150
Oftawa ankle rules
States Xrays are only necessary for suspected ankle fracture if
1) inability to weight bear for 4 steps
2) Tenderness over distal tibia
3) Tenderness over distal fibula
151
Maisonneuve fracture
A spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.
152
Most common causive organism for Psoas abscess
Staph aureus
153
iliopsoas abscess
An iliopsoas abscess describes a collection of pus in iliopsoas compartment (iliopsoas and iliacus).
154
Causes of primary illiopsoas abscess
Haematogenous spread of bacteria
| Staphylococcus aureus: most common
155
Causes of secondary illiopsoas abscess
```
Crohn's (commonest cause in this category)
Diverticulitis, colorectal cancer
UTI, GU cancers
Vertebral osteomyelitis
Femoral catheter, lithotripsy
Endocarditis
intravenous drug use
```
156
Clinical features of Psoas abscess
```
Patient in the supine position with the knee flexed and the hip mildly externally rotated
Fever
Back pain
Limp
Weight loss
```
157
Iliopsoas abscess investigation
CT abdomen
158
Management of iliopsoas abscess
```
Antibiotics
Percutaneous drainage
Surgery is indicated if:
1. Failure of percutaneous drainage
2. Presence of an another intra-abdominal pathology which requires surgery
```
159
Medications that worsen osteoporosis
```
SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole
```
160
Iliotibial band syndrome
Iliotibial band syndrome is a common cause of lateral knee pain in runners. Athletes commonly present with a sharp or burning pain around the lateral knee joint line.
161
Characteristic feature of hand osteoarthritis
Squaring of the thumb
162
Avascular necrosis causes
long-term steroid use
chemotherapy
alcohol excess
trauma
163
Management for renal complications of systemic sclerosis
ACE inhibitors - e.g. rampiril
164
Behcet's syndrome.
A complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins.
165
Behcet’s syndrome Features
1) oral ulcers 2) genital ulcers 3) anterior uveitis
thrombophlebitis and deep vein thrombosis
arthritis
neurological involvement (e.g. aseptic meningitis)
GI: abdo pain, diarrhoea, colitis
erythema nodosum
166
The new preferred name for trochantric bursitis
Greater trochantric pain syndrome
167
First line treatment for Raynaud’s
first-line: calcium channel blockers e.g. nifedipine
168
Anti-histone antibodies
Drug induced Lupus
169
Drug induced Lupus causes
```
procainamide
hydralazine
isoniazid
minocycline
phenytoin
```
170
Associations of Frozen shoulder
Diabetes
171
Specific feature of frozen shoulder
external rotation is affected more than internal rotation or abduction
172
Hand/knee osteoarthritis management
Paracetmol + Topical NSAIDs are indicated only for OA of the knee or hand
173
Investigations of anklyosing spondylitis
Diagnosis of ankylosing spondylitis can be best supported by sacro-ilitis on a pelvic X-ray
174
Facet joint pain
May be acute or chronic
Pain worse in the morning and when standing - may have pain over the facets
Pain is typically worse on extension of the back
175
Supraspinatus
Abducts arm before Deltoid - most commonly injured
176
Infraspinatus
Rotates arm laterally
177
Teres minor
Rotates and adducts arm laterally
178
Subscapularis
Adducts and rotates arm medially
179
Cuada equana syndrome management
Urgent surgical decompression
180
L3 nerve root compression
Sensory loss over anterior thigh
weak quadriceps
reduced knee jerk reflex
positive femoral stretch test
181
L4 nerve root compression
Sensory loss over anterior aspect of knee
weak quadriceps
reduced knee jerk reflex
positive femoral stretch test
182
L5 nerve root compression
Sensory loss over dorusm of foot
Weakness in big toe and foot dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
183
S1 nerve root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
184
Femoral nerve lesions
Weakness in knee extension,
Loss of patella reflex
Numbness of thigh
185
Lumbosacral trunk lesions
Weakness in ankle dorsiflexion
| Numbness of calf and foot
186
Sciatic nerve lesions
Weakness in knee flexion and foot movements
| Pain and numbness from gluteal region to ankle
187
Obturator nerve
Weakness in hip adduction
| Numbness over medial thigh
188
Long thoracic nerve (C5-C7)
Supplies MOTOR supply to serratus anterior
189
Musculocutaneous nerve (C5-C7)
MOTOR: Elbow extension & supination (biceps brachii)
SENSORY: Lateral part of forearm
190
Axillary nerve (C5-C6)
MOTOR: Shoulder abduction (deltoid)
SENSORY: Inferior region of deltoid also known as the regimental badge area
191
Radial nerve (C5-C8)
MOTOR: Extension of forearm, wrist, fingers & thumb
SENSORY: Small area between the dorsal aspect of the 1st and 2nd metacarpals
192
Median nerve (C6, C8, T1)
MOTOR: LOAF muscles
Features depend on sight of lesion
1) Wrist - Paralysis of thenar
2) Elbow - Loss of pronation of forearm and wrist flexion
193
Ulnar nerve (C8, T1)
MOTOR: Intrinsic hand muscles except LOAF - wrist flexion
