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Year 3 - Surgery > MSK > Flashcards

MSK Flashcards

1
Q

NoF #

Classes and subclasses

A
  1. Intracapsular
    - Sub capital
    - Intra-cervical
    - Basi-cervical
  2. Intra trochanteric
  3. Sub trochanteric
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2
Q

Subacromial impingement

  • X-Ray signs
A

Subacromial impingement

  • Reduced AC joint space
  • Hooked acromion (osteophyte)
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3
Q

Subacromial impingement

  • Mx
A

Subacromial impingement Mx

  1. Analgesia + PT
  2. CST (I Art)
  3. Acromioplasty
    Decompression
    Cuff repair
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4
Q

ACJ Impingement

  • Tests
A

ACJ Impingement

  1. Neers Test
    - InterNal rotate
    - Passive flex pain
  2. HawKins test
    - FleX to 90°
    - I rotation pain
  3. Painful arc
    - 60-120°
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5
Q

Rotator cuff special tests

A
  1. Supra spin
    - Empty can test - resistance
  2. Sub scap
    - internal rotate
    Eg. Belly press
    Eg. Gerbers lift off test
  3. Infra spin/ teres min
    - External rotate (elbow 90°)
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6
Q

Pelvis XR

- Approach

A

Pelvis X Ray

A. Acetabulum

- eg. Perthes
- Joint space

B. Bones

- 3 Rings
- Single interruption always accompanied by another break
- Proximal femur

C. Coccyx
- Sacral foramina

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7
Q

Colles Fracture

  1. Location
  2. Mechanism
A

Colles

  1. Distal radius
  2. FOOSH
    • Osteoarthritis
    • Elderly Women
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8
Q

Bone Cysts

  1. Pathophysiology
  2. Complications
A

Bone Cysts

  1. Pathophysiology
    • Fluid filled
  2. Complications
    • Weakening of bone
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9
Q

Oxford Knee Score

- Indication
- Components
A

Oxford Knee Score

-	Indication
  1. Arthritis assessment
  2. QoL
  3. Pre- and post- Knee Replacement
    • Components
  4. Pain
    - Rest pain
  5. ADLs
  6. Gait
  7. Walking time
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10
Q

What focal neuropathy is a common presentation of MS?

A

Optic Neuritis

  1. Dull ache behind eye on movement
  2. Monocular loss/colour change/lights
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11
Q

Trigger Finger

  1. Presentation
  2. Epidemiology
A

Trigger finger

  1. S&S
    • Painful popping sensation with flexion and extension
    • Palpable node at MC head
  2. Epidemiology
    • Females 50-60
    • Dominant hand
    • DM
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12
Q

Trigger finger

- Mx

A

Trigger finger

  1. NSAIDs
  2. Flexor tendon sheath injection
    • methylprednisolone and lidocaine
  3. Surgery
    • Incise A1 Pulley
    • Synovectomy in RA
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13
Q

Cauda equina

- Examination red flags

A

Cauda equina

  1. Perineal numbness
  2. Inability to stop urinating mid-stream
  3. DRE: Cannot ‘bear down’
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14
Q

MSK History Taking

- Significant Allergies

A

MSK Allergies

  1. ABx
  2. NSAIDs
  3. Nickel
  4. Elastoplasts
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15
Q

Surgical history

  1. What is DDH
  2. What are the implications?
A

Developmental dysplasia of hip

  1. Shallow acetabulum, loose head of femur
  2. DDH Complications
    • Risk of avascular necrosis
    • Acetabular dysplasia
    • Pavlov harness disease (acetabular erosion)
    • Degenerative disease
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16
Q

MSK

- SHx

A

MSK Social history

  1. QoL
  2. Work
    • Occupation
    • Time off
    • Limb dominance
  3. Home
    • Acomm/adaptions
    • People
  4. ADLs
    • Wash, including toenails
    • Dress, including shoes
  5. Driving
  6. Hobbies and walking
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17
Q

Joint specific ADLs

A

ADLs

  1. Lower limb
    • Shoe laces
    • Socks
    • Toe nails
  2. Upper limb
    • High shelves
    • Brushing hair
    • Peg washing
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18
Q

MSK Ex

- Look (Toe to tip)

A

MSK - Look

  1. Gait
    • Toe off
    • Heel strike
  2. Varus legs
  3. Scoliosis
    • Hips
    • Shoulders
  4. Scars
  5. RA Hands
    • Swan Neck
    • Boutonierre
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19
Q

MSK - Move

  1. Active
  2. Active and passive
A

MSK - Move

  1. Active
    • Muscle
  2. Active and passive
    • Joint
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20
Q

Peripheral nerve assessment

A

Peripheral nerve assessment:

  1. Tone
  2. Power
  3. Reflexes
  4. Sensation
    • Light touch
    • Pin point
    • Vibration
    • Proprioception
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21
Q

Hoffman’s test

  1. Indication
  2. Steps
A

Hoffman’s test

  1. Cervical cortico-spinal tract dysfunction
  2. Test
    • Stabilise 3rd PIP joint
    • Flick 3rd distal phalanx
    • Thumb and finger adduct in positive sign
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22
Q

Three special tests for the hip?

A

Hip tests

  1. Trendelenberg
  2. Thomas
    • Hip flexion test
    • Supine patient
    • Hold unaffected knee to chest
    • Positive with loss of extension of other leg
  3. Apparent and true length
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23
Q

Knee

- Special tests

A

Special knee tests

  1. Bulge/tap/sweep tests
    • Effusion
  2. Varus and Valgus stress tests
  3. Drawer tests
  4. Lachmann’s test
  5. ?McMurray’s test
    • Meniscal tear
    • Flex knee and internally rotate
    • Positive if pain on extension
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24
Q

Shoulder

- Three special tests

A

Shoulder special tests

  1. Neers test
    • Depress scapula
    • Internally rotate arm
    • Positive for pain during passive full flexion
  2. Hawkin’s test
    • 90º flexion at shoulder and elbow
    • Positive for pain on passive internal rotation of shoulder
  3. Scarf test
    • 90º flexion at shoulder and elbow
    • Positive with pain on passive abduction of shoulder
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25
Q

MSK XRay

- Context for presenting

A

MSK XRay

  1. Name and age
  2. Source of referral
  3. Admission date
  4. Occupation and limb dominance
  5. Timing and mechanism of injury
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26
Q

MSK XRay

- Medical history of note

A

MSK XRay

  1. Smoker?
  2. Chronic disease?
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27
Q

MSK XRay

- A white line vs a dark line?

A

MSK XRay

  1. Dark line - is a gap
  2. White line - is an overlap
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28
Q

MSK Bone Lesions

- Three types

A

MSK Bone Lesions

  1. Lytic
  2. Sclerotic
  3. Mixed
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29
Q

Posterior humeral dislocation

  1. Sign
  2. Common presentation
A

Posterior humeral dislocation

  1. Lightbulb Sign
  2. Common after Status Epilepticus
    • Often missed during post-ictal
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30
Q

Scaphoid Fractures

  1. Complexity
  2. Followup
A

Scaphoid fractures

  1. Poor blood supply
    • Poor healing
  2. 8 week CT scan to check healing
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31
Q

Tendon rupture

- Ruling out neuropathy?

A

Tendon rupture

- Tenodesis (manipulating the tendon in clinic)
- No movement if rupture, movement in spite of any neuropathology
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32
Q

Correcting ulnar variance?

A

Ulnar variance correction

  1. Radial osteotomy
  2. Pelvic bone graft
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33
Q

Bennet’s fracture

  1. Location
  2. Mechanism
  3. Complications
A

Bennet’s fracture

  1. Location
    • Base of first metacarpal
  2. Mechanism
    • Commonly in sports
  3. Complications
    • Rolando fracture (segmented)
    • Malunion - uneven, arthritic
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34
Q

Vertebrae
- Anatomical features
(Body to process)

A

Vertebrae

  1. Body
  2. Posterior longitundinal ligament
  3. Pedicles
  4. Pars interarticularis
  5. Lamina
  6. Ligamentum flavum
  7. Spinous process
  8. Interspinous ligaments
  9. Supraspinous ligaments
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35
Q

Spine

- Five causes of instability

A

Spinal instability

  1. Degenerative
  2. Trauma
  3. Infection
  4. Tumour
  5. Developmental
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36
Q

Spinal bone damage

- Three degrees of lysis

A

Spinal bone

  1. Spondylosis
  2. Spondylolisthesis
  3. Spondyloptosis
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37
Q

Spondylolisthesis

- Causes

A

Spondylolisthesis

  1. Lytic
    • Isthmic movement
    • Subluxation
  2. Degenerative
  3. Iatrogenic
  4. Traumatic
  5. Congenital
  6. Malignant
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38
Q

Spondylolisthesis

- Most common site
- Most common presentation
A

Spondylolisthesis

  1. L5 nerve root
    • L5 - S1 foramen
  2. Axial back pain
    • Leg pain (L5 radiculopathy)
    • Neurogenic claudication
    • Dorsiflexion and EHL weakness (L5)
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39
Q

Disc prolapse

- Four stages

A

Disc prolapse

  1. Degeneration
  2. Prolapse
  3. Extrusion
    • Central/para-central/lateral
    • Cauda equina risk
  4. Sequestration
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40
Q

Spinal stenosis

- Common causes

A

Spinal stenosis causes

  1. OA of facet joint
  2. Ligamentum flavum thickening
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41
Q

Spinal stenosis

- Mx

A

Spinal stenosis

  1. Laminectomy
  2. Flavectomy and undercutting
  3. Discectomy and facetectomy
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42
Q

Cauda equina syndrome

- Most important action

A

Cauda equina syndrome

* Document everything

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43
Q

Cauda equina

- Red flags

A

Cauda equina S&S

  1. Back pain
  2. Saddle anaesthesia
  3. True incontinence
  4. Leg pain
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44
Q

Cauda equina

- Investigations

A

Cauda equina investigations

  1. Bedside DRE
    • Atony
    • Neuro-tip peri-anal numbness
  2. Bladder scan
    • 200ml+ post-void
  3. MRI
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45
Q

Level of the end of spinal cord

A

End of spinal cord

  1. Lower border of L1
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46
Q

Spinal cord compression

- Aetiologies

A

Cord compression

  1. Metastasis
  2. Trauma
  3. Epidural collection
  4. Disk prolapse (C1-T12)
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47
Q

Myelopathy

  1. Pathology
  2. S&S
A

Myelopathy

  1. Chronic cord compression
  2. S&S
    - Pain (neck, arm, lower back)
    - Paraesthesia or Myasthenia
    - UMN (Reflexes, incontinence)
    - Discoordination
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48
Q

Cord compression syndrome

- S&S

A

Cord compression syndrome S&S

  1. Ataxia
  2. Weakness
  3. Numbness
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49
Q

Spine Exam

- Look

A

Spine exam look

  1. Muscle
  2. Scoliosis
  3. Listing (acute scoliosis)
  4. Lordosis and kyphosis
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50
Q

Spine Exam

- Move

A

Spine Exam - Move

Cervical

  • Flex/extend
  • Rotate

Thoracic
- Rotate

Lumbar

  1. Flex
    • Modified Schober’s Test
  2. Extend
  3. Lateral flexion
    • Correction of scoliosis?
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51
Q

Spine exam

- Special Tests

A

Spine special test

  1. Modified schober
    - PSIS
    - 5 below, 10 above
  2. Straight leg raise
    • Disc or nerve root
    • Spine with pillow
    • Passive lift
    • Pain on other side
    • Repeat with ankle or neck
  3. Spurling
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52
Q

Ankle anatomy

- Joint between tibia and fibula?

A

Ankle joint

- Syndosmosis

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53
Q

Ankle anatomy

- Mortise components

A

Ankle joint

  1. Tibial ‘plafond’
  2. Talar ‘dome’
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54
Q

Ankle

- Sural supply?
- Saphenous supply?
A

Ankle

  1. SuraL supply
    • Lateral
  2. SapheNous supply?
    • Medial
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55
Q

Halux valgus

- Presentation

A

Halux valgus

  1. Middle-aged women
  2. Pain over medial eminence
56
Q

Hallux rigidus

- Presentation

A

Hallux rigidus

  1. MTJ 1 stiffness
  2. OA Changes
    • L oss of space
    • O steophytes
    • S ubchondral sclerosis
    • S ubchondral cysts
57
Q

Morton’s neuroma

  1. S&S
  2. Ex
A

Morton’s neuroma

  1. S&S
    • Localised pain
      III-IV toe base
    • Swollen sensory ganglion
  2. Ex
    • Feel for tenderness
    • “Click test”
      (Metatarsal squeeze)
58
Q

Plano-valgus foot

- Presentation

A

Plano-valgus foot Presentation

  1. Middle aged females
  2. Posterior tibial tendon
  3. Progressive deformity - can be traumatic
59
Q

Plano-valgus foot

- Classifications
- Management
A

Plano-valgus foot: Mx

  1. Conservative
    • Insoles
    • Physio
  2. If flexible
    • Reconstruction
  3. If stiff
    • Arthrodesis
    • Sub-talar or triple
60
Q

Ankle OA

- Presentation
- Management
A

Ankle OA Mx
- Pain over anterior

  1. Analgesia
  2. Immobilisation
  3. Surgery
    • Osteotomy realignment
    • Arthrodesis
    • Arthroplasty
61
Q

Foot exam - Look

- Three binaries

A

Foot exam - Look binaries

  1. Hind foot
    • Varus/valgus
  2. Mid-foot
    • Pes Planus/Pes cavus
  3. Toes
    • Deformity
62
Q

Foot exam

- Gaits

A

Foot exam - Gaits

  1. Foot drop
    • Tibialis anterior
  2. Antalgic
  3. Protective
    • Excessive lateral contact
63
Q

Foot exam

- Two special tests

A

Foot exam: Special tests

  1. Drawer test
    • One hand on leg
    • Draw and dorsiflex foot
  2. Thompson/Simmonds test
    • Prone patient, dangling foot/flexed knee
    • Calf squeeze
64
Q

Finkelstein’s Test

  1. Diagnosis
  2. Test
A

Finkelstein’s Test

  1. Diagnosis
    - De Quervains
  2. Test
  • Passive ulnar deviation of thumb
  • Passive longitudinal traction
  • EPB and APL pain over radial styloid
65
Q

Weber

- Three classifications

A

Ankle fractures

Weber A

- Below syndosmosis
- Generally stable

Weber B

- Level of syndosmosis
- Can suffer talar shift

Weber C
- Above the level of syndosmosis

66
Q

Lisfranc

- Common injury
- Anatomy
A

Lisfranc

  1. Ligament from medial cuniform to second metatarsal
  2. Common in fracture dislocation
67
Q

Jones Fracture

- Anatomy
- Mechanism
A

Jones fracture

  1. 5th metatarsal fracture
  2. Commonly injured on inversion (High Heels)
68
Q

March Fracture

  1. History
  2. Risk factors
  3. Management
A

March Fracture

  1. Stress fracture
    • Longer walk
    • Sudden pain
    • Bump noted after 1-2/52 (callous formation)
  2. RFs:
    • Osteoporosis
    • Vitamin D deficiency
  3. Reassure and observe
69
Q

Calcaneal injury

  1. Mechanism
  2. Investigations
A

Calcaneal injury

  1. Jump from height
  2. Investigate:
    • Spine
    • N of F
70
Q

Hip injury

-	History
A

Hip injury Hx

  1. Pain
    • Front and side
  2. Stiffness/RoM/LoF
71
Q

Hip pain

- DDx

A

Hip pain DDx

  1. NoF
  2. Greater trochanter
  3. Spine
72
Q

Hip injury

- 5 ADLs

A

Hip ADLs

  1. Walking aids (in/outside)
  2. Get out of car?
  3. Put on socks
  4. Stairs
  5. Sports
73
Q

Hip exam

- Three gaits

A

Hip Gaits

  1. Trendelenburg
  2. Antalgic
  3. Short leg
74
Q

Hip Exam

- Three leg measures

A

Measure leg length?

  1. True leg length
    • ASIS to Medial Malleolus
  2. Apparent leg length
    • Xiphisternum to medal malleolus
  3. Femur vs tibial shortening
    - Bend knee
75
Q

Hip Exam

- Three special tests

A

Hip Special tests

  1. Trendelenburg
  2. Leg length
  3. Thomas Test
76
Q

Hip exam

- Thomas test

A

Thomas test

  1. Hand under lumbar lordosis
  2. Single knee up to test
  3. Positive with other leg involvement (iliopsoas tension)
77
Q

Knee fractures

- Demographic

A

Knee fractures

  1. Female > Male (4:1)
  2. 86% are over 60.
78
Q

NoF

- Presentation

A

NoF Presentaiton

  1. Short and externally rotated
  2. Pain
    • Groin
    • Thigh
    • Referred to knee (elderly)
  3. Inability to weight-bear
79
Q

NoF

- Management

A

NoF Mx

  1. Analgesia and fluids
  2. Operation within 24 hours!
  3. Rapid mobilisation
80
Q

NoF

- Surgery

A

NoF Surgery

  1. ORIF
  2. DHS
  3. Hemi-arthroplasty
  4. THR
81
Q

NoF

- Classes of fracture

A

NoF

  1. Intra capsular
    • Sub-capital
    • Trans-cervical
    • Basi-cervical
  2. Inter-trochanteric
    - Pertrochanteric
  3. Sub-trachanteric
82
Q

NoF

- Garden Classification

A

NoF - Garden classification

Type I

- Non-displaced
- Incomplete

Type II

- Non-displaced
- Complete

Type III
- Displaced Partially

Type IV
- Displaced Fully

83
Q

NoF

- Subtrochanteric surgery

A

Sub-trochanteric NoF Surgery

-	Intra-medullary nail
84
Q

Sub-trochanteric fracture

- Three pathological causes

A

Sub-trochanteric fracture

  1. Metastasis
  2. Paget’s
  3. OP
85
Q

OA

- Management steps

A

OA

Conservative

  1. Weight-loss/walking aids
  2. Physio
  3. Splints/braces

Medical management

  1. Analgesia
  2. Steroids

Surgery

  1. Arthroplasty
  2. Arthrodesis
  3. Osteotomy
86
Q

Septic arthritis

  1. Risk factors
  2. Management
A

Septic arthritis

RFs

  1. Joint disease (OA/RA)
  2. Prosthesis
  3. 80+
  4. Immunosupression

Mx

  1. Urgent washout
  2. IV ABx
87
Q

Septic arthritis

- Investigations
A

Septic arthritis investigations

  1. Aspiration
    • WCC
    • Gram, MS&C
      - Polarising microscopy
  2. Bloods
    • Culture
    • WCC, ESR, CRP, U&E, LFT
  3. Imaging
    - USS (for hip aspiration)
    • XRay
88
Q

Supracondylar femur fracture

- Categories

A

Supra-condylar femur fractures

  1. Partial-condylar
  2. Uni-condylar
  3. Bi-condylar
89
Q

Patella fracture

- Classifications 
 	- Management
A

Patella fracture

Classifications

  1. Direct (commonly stellate)
  2. Indirect (commonly transverse)

Management

  1. Un-displaced
    • Splint and protect
  2. Displaced
    • Reduce and fix
90
Q

Patella dislocation

- Mechanism

A

Patella dislocation mechanisms

  1. Turning action
  2. Fall on bent knee
91
Q

Meniscal injury

  1. Mechanism
  2. Symptoms
A

Meniscal injury

  1. Mechanism
    • Twisting in high flexion
  2. Symptoms
    • Catching, jamming, locking
92
Q

Meniscal injury management

  1. Acute
  2. Chronic
A

Meniscal injury management

  1. Acute
    - Meniscectomy
    - Repair
  2. Chronic (eg. degenerative)
    - Conservative
    - Rehab
93
Q

Collateral ligament injury

  1. Mechanism
  2. Management
A

Collateral ligament injury

  1. Mechanism
    - Contact/direct force
  2. Management
    - Brace and rehab
    - Repair
94
Q

ACL Injury

  1. Presentation
  2. Management
A

ACL Injury

  1. Presentation
    - Loading force
    - Directional change

Sedentary mx

  1. PRICE
  2. NSAIDs
  3. Cautious physio
  • Moderate demands management
    1. PRICE
    2. Formal physio
    3. Customised bracing
  • Intense demands
    1. PRICE
    2. Cautious physio
    3. Surgical repair
  • Intra articular autograft
  • Hamstring graft
  • Cadaveric allograft
95
Q

PCL Injury

  1. Mechanism
  2. Management
A

PCL Injury

  1. Mechanism
    • Fall onto knee
    • Hyperextension
  2. Management
    • Brace
    • Rehabilitate
96
Q

Knee dislocation

- Mechanism

A

Knee dislocation mechanism
- 3/4 ligaments injured

  1. High energy trauma
  2. Low energy trauma in obesity
97
Q

Knee injury

- DDx and haemarthroma

A

Knee injury haemarthroma

  1. Large, fast - ACL
  2. Subtler - PCL
98
Q

Chronic knee pain

- Differentials

A

Knee pain DDx

  1. Referred pain
    - Back/hip
  2. Neoplastic pain
    - Osteochondroma
    - Bone/ST tumour
  3. Neuropathic
    - Sciatic
  4. Vascular
    - Claudication
99
Q

Knee effusion

- Two tests

A

Knee effusion tests

  1. Sweep test
  2. Patella tap (larger amount)
100
Q

Knee

- ROM

A

Knee RoM

-10º to 155º

101
Q

Knee

- Cruciate Special tests

A

Knee special tests

  1. ACL
    - Anterior draw (45°)
    - Lachman’s (20-30°)
    - Pivot shift (Passive flex +IR+Axial+Valgus)
  2. PCL
    - Posterior sag
    - Posterior draw test
102
Q

Knee

- Collateral tests

A

Colateral knee tests

  1. Varus and Valgus stress
  2. 0º of flexion
    30º of flexion
103
Q

Knee

- Meniscal tear Signs

A

Meniscal tear Signs

  1. McMurray test
    - Extension and flexion
    - IR and ER w/ Varus/valgus
  2. Apley test
    - Meniscal compression
    - Ligamental distraction
  3. ‘Duck Walk’ test
104
Q

Hand

- Intrinsic Innervationn

A

Intrinsic hand innervation

  1. Mostly Ulnar
  2. LOAF Median
105
Q

LOAF muscles

A

L ateral lumbricals
O pponens policis
A bductor policis brevis
F lexor policis brevis

106
Q

Hand injury

- Flexion significance

A

Hand injury flexion

  1. Flexed tendons will move after injury
  2. Extended tendons will remain after injury
107
Q

Hand Exam

- Special Tests

A

Hand Special Tests

  1. Bones
    - Anatomical snuffbox
    (Scaphoid)
    - Scaphoid palpation
    - Scaphoid balloting
  2. Neurovascular
    - Tinels
    - Phalens
    - Allen’s test
    - Cap refil
108
Q

Hand exam

- Look

A

Hand exam Look findings

  1. Elbow lump (RA)
  2. Lost cascade
    - Jersey injury
  3. Boutonniere’s
    - Central slip rupture
  4. Swan neck
    - Stress on plate or PIP
    - Trauma
    - RA, cerebral palsy
  5. Guttering
    (RA)
109
Q

Hand exam

- Functional assessment

A

Hand function tests

  1. Pinch grip
    - OK Sign
    - IO nerve
  2. Power grip
    - eg. Spanner
  3. Key grip
    - Froment’s Test
  4. Hook grip
    - eg. Climbing
110
Q

Hand exam

- Feel

A

Hand exam feel

  1. Warmth/perfusion
  2. Hydrosis
  3. MCPs
    - RA
  4. DIPs
    - OA
  5. Congruent?
  6. Dupuytren’s
111
Q

Dupuytren’s

- Mx at stages

A

Dupuytren’s Mx

  1. Observation
  2. Steroids

<30º

  1. Collagenase injection
  2. Needle aponeurotomy
  3. Percutaneous fasciotomy

> 30º

  1. Splinting
  2. Radiotherapy
112
Q

Hand exam

- Move

A

Hand exam movement

  1. Wrist flexion and deviation

2 Thumb movements

  • Thumb extend is radial
  • Thumb ABduct is palmar
113
Q

Hand exam

- 2 Tunnels and Specials

A

Hand exam specials

  1. Tinnel’s
    - Carpal
    - Cubital (lateral condyle)
  2. Finkelstein’s test
    - De Quervain’s
    - Grasp thumb with fingers
    - Ulnar deviation pain
114
Q

Radial fractures

- Dorsal displacement of distal portion

A

Colles

  1. Extra articular fracture
  2. Dorsal displacement
  3. Ulnar styloid injury
115
Q

Radial Fractures

- Volarly displaced distal portion

A

Volar radius fracture

  1. Smiths
    I - Extra-articular
    III - Juxta-articular (oblique)
  2. Type II (Barton’s)
    - Intra-articular
116
Q

Shoulder

- 3 Reaches

A

Shoulder functions

  1. Head
  2. Armpit
  3. Bottom
117
Q

Shoulder Injuries

- Three Demographics

A

Shoulder demographics

10-30

  1. Instability
    - CTD
    - Trauma

40-60

  1. Impingement
  2. Adhesive capsulitis
  3. Inflammatory

60-80

  1. Cuff tear/arthropathy
  2. OA
118
Q

Night joint pain

- Two differentials

A

Night pain

1. Inflammatory disease
Low cortisol
2. Cancer

119
Q

Shoulder

- Radiating pain

A

Shoulder radiating pain

C5/C6 Radiculopathy
- Paraesthesia in hand

120
Q

Shoulder

- Loss of ER 3 causes

A

Shoulder Ext. Rot. loss

  1. OA
  2. Frozen
  3. Post-dislocation
121
Q

Shoulder

- Three types of weakness

A

Shoulder weaknesses

  1. Muscle
    - Cuff tear
  2. Tendon pain
    - Eg. calcium tendonitis
  3. Nerve palsy
    - Axillary
    - Long thoracic
122
Q

Shoulder

- Two Swelling causes

A

Shoulder swelling

  1. Sub-deltoid bursitis
  2. ACJ dislocation
123
Q

Shoulder

- Four joints

A

Four shoulder joints

  1. GHJ
  2. SCJ
    - Sterno-clavicular
  3. ACJ
  4. STJ
    - Scapulo-thoracic
124
Q

Rotator cuff

- 4 Muscles

A

Rotator cuff

  1. Supra spin
  2. Sub scap

3&4 Infra spin
Teres minor

125
Q

Shoulder anatomy

- 3 Stabilisers

A

Shoulder stabilisers

  1. Labrum
  2. Ligaments
  3. Capsule
126
Q

Shoulder Exam

- Look (4 things)

A

Shoulder Exam Look

  1. Left/right
  2. Front/back
  3. Wasting
    - Cuff tear
  4. Popeye
    - Long head
    (Clavicle to radius)
127
Q

Shoulder exam

- Move (6 things)

A

Shoulder Exam Move

  1. Winging
    - Dynamic/static
  2. Compound
    - Hands behind head
  3. Painful arcs
    GH 45º-60º
    ACJ 170º-180º
  4. Cuff tests
    Jobe’s/Empty Can (Supra)
    Gerber’s/Lift off (sub)
    Hornblower’s/Ext Rot. (infra/TM)
  5. Impingement
    - Hawkins
    - Neers
    Scarf
  6. Instability
    - Apprehension
    (abduct, ext. rot)
128
Q

Shoulder instability

- Three injurous causes

A

Shoulder instability

  1. Hills Sachs
    - Humeral head
  2. Bankarts
    - Labrum (and bone)
  3. Cuff tear
129
Q

Compartment syndrome

- Pathophysiology

A

Compartment syndrome

  1. Inflammation
    - Bleeding
    - Oedema
  2. Reduced capillary flow
  3. Muscle ischaemia
    - Further inflammation
130
Q

Compartment syndrome

- Four sites

A

Compartment syndrome sites

  1. Proximal tibia Fx
  2. Elbow/forarm Fx
  3. Crush injury
  4. Circumferential burns
131
Q

Ischaemia

- Five Ps

A

Ischaemia

  1. Painful
  2. Pulseless
  3. Pale
  4. Paraesthesia
  5. Paralysed
132
Q

Compartment syndrome

- Investigation

A

Compartment Ix

  1. Intra-compartmental measurement
  2. Split catheter
133
Q

Compartment syndrome

- Mx

A

Compartment Mx

  1. Decompression
    - Casts and dressings
    - Nurse limb flat
  2. Fasciotomy
    - All compartments
  3. Monitor
    - Debride and close
134
Q

Hip fractures

- Garden Classification

A

Garden Classification
- Intracapsular

Type 1: Incomplete stable fracture
- impaction in valgus

Type 2: Complete non-displaced fracture
- Two groups of trabeculae in line

Type 3: Partially displaced

  • Varus
  • All three trabeculae disturbed

Type 4: Completely displaced
- No contact between fragments

135
Q

Fracture healing

-	Phases
A

Fracture healing phases

  1. Inflammatory phase
    • Hours to days
    • Haematoma, cytokines, GFs
    • Fibrovascular matrix and callus
  2. Reparative phase
    • Days to weeks
    • Radio-discernable D7-10
    • Hard callus formation
    • ‘Clinical Union’
  3. Remodeling phase
    • Months to years
    • External callus smoothed

Year 3 - Surgery (7 decks)

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