Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Orthopaedics > MSK Cortex Regional Adult Orthopaedics - Spine & Upper Limb > Flashcards

MSK Cortex Regional Adult Orthopaedics - Spine & Upper Limb Flashcards

1
Q

What is the treatment for “mechanical” back pain?

A

Analgesia and physiotherapy. Bed rest is not advised as this will lead to stiffness and spasm of the back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

And acute disc tear can occur where?

A

In the outer annulus fibrosis of an intervertebral disc (which classically happens after lifting a heavy object)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is pain characteristically worse in an acute disc tear?

A

On coughing (this increases disc pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment for an acute disc tear?

A

Analgesia and physiotherapy are the mainstay of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the commonest site of of a disc prolapse where a nerve root is impinged?

A

Lower lumbar spine with L4, L5 and S1 nerve roots causing sciatica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In the lumbar spine, when there is a disc prolapse and a nerve is impinged which of the higher or lower of the two vertebra in the effected segment is usually compressed?

A

Lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe a L3/4 prolapse?

A

L4 root entrapment > pain down to medial ankle (L4), loss of quadriceps power, reduced knee jerk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe a L4/5 prolapse?

A

L5 root entrapment > pain down dorsum of foot, reduced power Extensor Hallucis Longus and tibialis anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe a L5/S1 prolapse?

A

S1 root entrapment > pain to sole of foot, reduced power planarflexion, reduced ankle jerks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the 1st line treatment for a nerve root compression?

A

Analgesia, maintaining mobility and physiotherapy (occasionally drugs for neuropathic pain can be used - gabapentin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a bony nerve root entrapment?

A

OA of the facet joints resulting in osteophytes impinging on exit nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for bony nerve root entrapment in suitable candidates?

A

Surgical decompression, with trimming of the impinging osteophytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do the signs and symptoms of spinal stenosis differ from vascular claudication?

A
  1. Claudication distance is inconsistent
  2. Pain is boring (rather than cramping)
  3. Pain is less walking uphill (spine flexion creates more space for the caudal equina)
  4. Pedal pulses are preserved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What surgery may be performed for spinal stenosis if symptoms fail to improve with conservative management?

A

Decompression surgery to increase space for the caudal equina to help alleviate symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is cauda equina syndrome?

A

A very large central disc prolapse compressing all the nerve roots of the cauda equina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prolonged cauda equina syndrome can cause what?

A

Permanent nerve damage requiring colostomy and urinary diversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the symptoms of cauda equina syndrome?

A
  1. Bilateral leg pain, parasthesiae or numbness in a saddle pattern (saddle anaesthesia)
  2. Altered urinary function
  3. Altered bowel function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the management of caudal equina syndrome?

A

Urgent MRI to determine the level of prolapse and urgent discesctomy once the diagnosis is confirmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the “red flags” in back pain?

A
  1. Back pain in the younger patient (<20 years)
  2. New back pain in the older patient (>60 years)
  3. Nature of pain - constant, severe, worse at night
  4. Systemic upset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is an osteoporotic crush fracture?

A

In severe osteoporosis, spontaneous crush fractures of the vertebral body can occur leading to acute pain and kyphosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment for osteoporotic crush fractures?

A

Usually conservative, however, some clinicians have tried balloon vertebroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is cervical spondylosis?

A

Disc degeneration leading to increased loading and accelerated OA of the facet joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the symptoms of cervical spondylosis?

A

Slow onset stiffness and pain in the neck which can radiate locally to shoulders and the occiput

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Children with Down syndrome are at risk of developing an instability where in the vertebrae?

A

Atlanto-axial (C1/C2) with subluxation potentially causing spinal cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What makes up the shoulder girdle?

A

Scapula
Clavicle
Proximal humerous
Supporting muscles including the deltoid and rotator cuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which muscles make up the rotator cuff?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Where do the supraspinatus, infraspinatus and teres minor attach?

A

Greater tuberosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Where does the subscapularis attach?

A

Lesser tuberosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does the supraspinatus do?

A

Responsible for initiating abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does the infrapinatus and teres minor do?

A

External rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does the subscapularis do?

A

Is the principle internal rotator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Impingement syndrome causes a painful arc between which angles of abduction?

A

60 - 120 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are some causes of impingement syndrome?

A
  1. Tendonitis subacromical bursitis
  2. Acromioclavicular OA with inferior osteophyte
  3. A hooked acromion rotator cuff tear
34
Q

What is the treatment of impingement syndrome?

A

Conservative in the first instance with NSAIDs, analgesics, physiology and subacromial injection of steroid (up to 3 may be required). Subacromial decompression surgery may be performed if conservative treatment isn’t successful

35
Q

A rotator cuff tear usually affects which tendon?

A

Supraspinatus

36
Q

What is adhesive capsulitis (frozen shoulder)?

A

Progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18‐24 months

37
Q

What is the principle clinical sign in frozen shoulder?

A

Loss of external rotation?

38
Q

How does acute calcific tendonitis present and what causes it?

A

Acute onset of severe shoulder pain and is characterised by calcium deposition in the supraspinatus tendon

39
Q

What is the treatment for acute calcific tendonitis?

A

Subacromial steroid and local anaesthetic injection. It is self-limiting with pain easing as the calcification reabsorbs

40
Q

What treatment can be given to patients with recurrent dislocations?

A

Bankart repair - stabilises the shoulder by reattaching the labrum and capsule to the anterior glenoid which was torn off in the first dislocation

41
Q

Carpal tunnel syndrome is due to the compression of which nerve?

A

Median

42
Q

What are the causes of carpal tunnel syndrome?

A
  1. Idiopathic (most cases)
  2. Rheumatoid arthritis
  3. Fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroidism
  4. Fractures around the wrist (esp. collet fracture)
43
Q

Does carpal tunnel syndrome mostly affect men or women?

A

Women (8:1 ratio)

44
Q

Chronic carpal tunnel syndrome may have what on examination?

A

Muscle wasting of the thenar eminence

45
Q

What tests can be done to reproduce the symptoms in carpal tunnel syndrome?

A

Tinel’s test (percussing over the median nerve OR Phalen’s test (holding the wrists hyper-flexed which decreases space in the carpal tunnel)

46
Q

What investigation can be performed to confirm carpal tunnel syndrome?

A

Nerve conduction studies - slowing of conduction across the wrist

47
Q

Carpal tunnel decompression involves doing what?

A

Division of the transfer carpal ligament

48
Q

Cubital tunnel syndrome is due to the compression of which nerve?

A

Ulnar

49
Q

Ulnar compression can be due to what?

A
  1. Tight band of fascia forming the roof of the tunnel (Osborne’s fascia)
  2. Tightness at the intermuscular septum
  3. Compression between two heads at the origin of flexor carpi ulnaris
50
Q

Which joints make up the elbow and what are the responsible for?

A

Humero-ulnar joint - flexion/extension

Radio-capitallar joint - supination/pronation

51
Q

Where does the triceps muscle insert?

A

Coronoid process

52
Q

Where does the biceps muscle insert?

A

Bicipital tuberosity of the radius

53
Q

Forearm supination is performed using which muscles?

A

Biceps and supinator muscles

54
Q

Forearm pronation is performed using which muscles?

A

Pronator teres muscle proximally and the pronator quadrates distally

55
Q

The common extensor origin of the wrist arises from where?

A

Lateral epicondyle

56
Q

The common flexor origin of the wrist arises from where?

A

Medial epicondyle

57
Q

What is the proper name for Tennis elbow?

A

Lateral epicondylitis

58
Q

What causes tennis elbow?

A

Repetitive strain injury in those who regularly perform resisted extension at the wrist OR due to degenerative enthesopathy

59
Q

What is the proper name for Golfer’s elbow?

A

Medial epicondylitis

60
Q

Why is a steroid injection less commonly used for Golfer’s elbow than Tennis elbow?

A

Risk of injury to ulnar nerve

61
Q

An elbow severely affected by RA or OA at the humero‐ulnar joint which isn’t satisfactorily treated with conservative management can be treated surgically with which operation?

A

Total elbow replacement

62
Q

Describe dupuytren’s contracture?

A

Hyperplasia of palmar fascia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints

63
Q

What is the pathology involved in dupuytren’s contracture?

A

Proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1)

64
Q

Duputren’s contracture can be a feature of what disease?

A

Alcoholic cirrhosis (also more common in diabetics)

65
Q

What is the name for the connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis?

A

Peyronie’s disease

66
Q

What is the name of the fibromatosis which causes thickening of the feet’s fascia?

A

Ledderhose disease (plantar fibromatosis)

67
Q

What degree of contracture at the MCP joint may be tolerated in duputren’s contracture?

A

30 degrees

68
Q

What degree of contracture at the PIP joint may be tolerated in duputren’s contracture?

A

None (PIPJ readily stiffens and any contracture here is usually an indication for surgery)

69
Q

What is trigger finger?

A

Nodular enlargement of the affected tendon, usually distal to a fascial pulley over the metacarpal neck (the A1 pulley). The finger may lock in a flexed position as the nodule passes under the pulley

70
Q

Which fingers does trigger finger most commonly affect?

A

Middle and ring finger

71
Q

What is the first line treatment for trigger finger?

A

Steroid injection around the tendon sheath

72
Q

What are Heberden’s nodes?

A

Stiffness and bony thickening of the DIP joints - sign of OA

73
Q

What is the name for tiffness and bony thickening of the PIP joints?

A

Bouchard’s nodes

74
Q

In severe OA what surgery on the index finger may be performed to preserve pinch-grip?

A

Arthrodesis (fusion)

75
Q

Does RA tend to spare the PIP or DIP joints?

A

DIP

76
Q

What are the 3 stages of RA in the hands?

A
  1. Synovitis and tenosynovitis
  2. Erosions of the joints
  3. Joint instability and tendon rupture
77
Q

What type of drugs are mainly used for RA?

A

Disease modifying anti-rheumatic drugs (DMARDs)

78
Q

What hand deformities may be present in patients with RA?

A
  1. Volar MCPJ subluxation
  2. Ulnar deviation
  3. Swan neck deformity (hyperextension at PIPJ with flesion DIPJ)
  4. Boutonniere deformity (flexion at PIPJ with hyperextension at DIPJ)
  5. Z-shaped thumb
79
Q

What is a ganglion cyst?

A

A common mutinous filled cyst found adjacent to a tendon or synovial joint

80
Q

What is a ganglion cyst on the posterior knee called?

A

Baker’s cyst

Orthopaedics (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions