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General practice > Ortho > Flashcards

Ortho Flashcards

1
Q

What do rotator cuff tears refer to

A

Injury to tendons of the rotator cuff muscles

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2
Q

Muscles of the rotator cuff

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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3
Q

Action of supraspinatus

A

Abducts the arm

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4
Q

Action of infraspinatus

A

Externally rotates the arm

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5
Q

Action of teres minor

A

Externally rotates the arm

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6
Q

Action of subscapularis

A

Internally rotates the arm

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7
Q

Typical presentation of rotator cuff tears

A

Shoulder pain
Weakness and pain with specific movements relating to the site of the tear
Patients may find it difficult to get comfortable at night due to pain the shoulder, disrupting sleep

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8
Q

IX for rotator cuff tears

A

X-rays will not show soft tissue injuries such as rotator cuff tears. They may be helpful for excluding bony pathology, such as osteoarthritis.

Ultrasound or MRI scans can diagnose a rotator cuff tear.

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9
Q

Management of rotator cuff tears

A

Surgery

Non-surgical options include physiotherapy, rest, adapted activities and analgesia(NSAIDs)

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10
Q

Main surgical option for rotator cuff tear

A

Arthroscopic rotator cuff repair, where the tendon is reattached to the bone during an arthroscopy(keyhole surgery)

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11
Q

What is frozen shoulder

A

Inflammation and fibrosis in the glenohumeral joint leads to adhesions(scar tissue)

The adhesions bind the capsule and cause it to tighten around the joint, restrict movement in the joint

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12
Q

Key risk factor for adhesive capsulitis

A

Diabetes

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13
Q

What are the three phases of frozen shoulder

A

Painful phase
Stiff phase
Thawing phase

Entire illness lasts 1-3 years before resolving but patients can have persistent symptoms

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14
Q

What is the painful phase of adhesive capsulitis

A

Shoulder pain is often the first symptom and may be worse at night

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15
Q

What is the stiff phase of adhesive capsulitis

A

Shoulder stiffness develops and affects both active and passive movement (external rotation is the most affected) – the pain settles during this phase

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16
Q

What is the thawing phase of adhesive capsulitis

A

There is a gradual improvement in stiffness and a return to normal

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17
Q

What is primary adhesive capsulitis

A

Occurs spontaneously without any trigger

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18
Q

What is secondary adhesive capsulitis

A

Occurs in response to trauma, surgery or immobilisation

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19
Q

What is supraspinatus tendinopathy

A

Involves inflammation and irritation of the supraspinatus tendon, particularly due to impingement at the point where it passes between the humeral head and the acromion.

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20
Q

Which test can be used to assess for supraspinatus tendinopathy

A

Jobe test

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21
Q

How can acromioclavicular joint arthritis be demonstrated clinically

A

Tenderness to palpation of the AC joint

Pain is worse at the extremes of the shoulder abduction, from around 170 degrees onwards when the arm is overhead

Positive scarf test – pain caused by wrapping the arm across the chest and opposite shoulder

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22
Q

Non-surgical options for management of frozen shoulder

A

Continue using the arm but don’t exacerbate the pain
Analgesia (e.g., NSAIDs)
Physiotherapy
Intra-articular steroid injections
Hydrodilation (injecting fluid into the joint to stretch the capsule)

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23
Q

Surgical options for management of frozen shoulder

A

Manipulation under anaesthesia – forcefully stretching the capsule to improve the range of motion

Arthroscopy – keyhole surgery on the shoulder to cut the adhesions and release the shoulder

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24
Q

What is subluxation

A

Partial dislocation of the joint

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25
Q

What type of dislocations occur in most shoulder dislocation cases

A

Anterior dislocations(head of the humerus moves anteriorly in relation to the glenoid cavity)

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26
Q

What are posterior shoulder dislocations associated with

A

Electric shocks and seizures

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27
Q

Potential nerve damage complication associated with anterior shoulder dislocation

A

Axillary nerve damage

28
Q

What does axillary nerve damage result in

A

Loss of sensation in the “regimental badge” area over the lateral deltoid. It also leads to motor weakness in the deltoid and teres minor muscles.

29
Q

What is the apprehension test

A

Supine position
Shoulder abducted to 90 degrees and the elbow is flexed to 90 degrees
Shoulder is then slowly externally rotated
As arm approaches 90 degrees of external rotation, patients with shoulder instability will become anxious and apprehensive

30
Q

IX for shoulder dislocations

A

X-rays
MRI
Arthroscopy

31
Q

Acute management of shoulder dislocation

A

Analgesia, muscle relaxants and sedation as appropriate
Gas and air (e.g., Entonox) may be used, which contains a mixture of 50% nitrous oxide and 50% oxygen

A broad arm sling can be applied to support the arm
Closed reduction of the shoulder (after excluding fractures)

Dislocations associated with a fracture may require surgery

Post-reduction x-rays

Immobilisation for a period after relocation of the shoulder

32
Q

Ongoing management of shoulder dislocations

A

Physiotherapy

Shoulder stabilisation surgery

33
Q

What does epicondylitis refer to

A

Inflammation at the point where the tendons of the forearm insert into the epicondyles at the elbow(type of repetitive strain injury)

34
Q

Function of tendons that insert into the medial epicondyle

A

Act to flex the wrist

35
Q

Function of tendons that insert into the lateral epicondyle

A

Act to extend the wrist

36
Q

What is lateral epicondylitis often called

A

Tennis elbow

37
Q

Presentation of tennis elbow

A

Causes pain and tenderness at the lateral epicondyle(outer elbow)

The pain often radiates down the forearm and can lead to weakness in grip strength

38
Q

What does Mill’s test involve

A

Involves stretching the extensor muscles of the forearm while palpating the lateral epicondyle

Elbow is extended, the forearm supinated, and the wrist and fingers are extended. The examiner holds the patient’s elbow with pressure on the lateral epicondyle. If this causes pain, the test is positive, indicating lateral epicondylitis.

39
Q

What is the cozen’s test

A

Starts with the elbow extended, forearm pronated, wrist deviated in the direction of the radius and hand in a fist.

The examiner holds the patient’s elbow with pressure on the lateral epicondyle.

The examiner applies resistance to the back of the hand while the patient extends the wrist. If this causes pain, the test is positive, indicating lateral epicondylitis.

40
Q

What is medial epicondylitis often called

A

Golfer’s elbow

41
Q

Presentation of golfer’s elbow

A

Medial epicondylitis causes pain and tenderness at the medial epicondyle (inner elbow). The pain often radiates down the forearm. It can lead to weakness in grip strength.

42
Q

What does a golfer’s elbow test involve

A

Involves stretching the flexor muscles of the forearm while palpating the medial epicondyle.

The elbow is extended, forearm supinated and wrist and fingers are extended.

The examiner holds the patient’s elbow with pressure on the medial epicondyle. If this causes pain, the test is positive, indicating medial epicondylitis.

43
Q

Management of epicondylitis

A

Often self-limiting

Rest
Adapting activities
Analgesia (e.g., NSAIDs)
Physiotherapy
Orthotics, such as elbow braces or straps
Steroid injections
Platelet-rich plasma (PRP) injections
Extracorporeal shockwave therapy
44
Q

What is DeQuervain’s tenosynovitis

A

Swelling and inflammation of the tendon sheaths in the wrist

Type of repetitive strain injury and results in pain on the radial side of the wrist

45
Q

what are the two tendons primarily affected by DeQuervain’s tenosynovitis

A

Abductor pollicis longus(APL)

Extensor pollicis brevis(EPB) tendon

46
Q

Action of abductor policis longis

A

Acts to abduct the thumb and abduct the wrist

The tendon inserts into the base of the first metacarpal bone(at the base of the thumb)

47
Q

Action of extensor policis brevis

A

The extensor pollicis brevis also acts to abduct the thumb and abduct the wrist. The tendon inserts into the base of the proximal phalanx of the thumb.

48
Q

What is the extensor retinaculum

A

Is a fibrous band that wraps across the back (dorsal side) of the wrist.

The APL and EPB pass underneath the extensor retinaculum. Repetitive movement of the APL and EPB under the extensor retinaculum result in inflammation and swelling of the tendon sheaths.

49
Q

Presentation of DeQuervain’s tenosynovitis

A 
Pain, often radiating to the forearm
Aching
Burning
Weakness
Numbness
Tenderness
50
Q

Special tests for DeQuervain’s tenosynovitis

A

Finkelstein’s test

Eichoff’s test

51
Q

What is the finkelstein’s test/eichoff’s test

A

Involves the patient making a fist with their thumb inside their fingers. Then, the wrist is adducted (ulnar deviation), causing strain on the APL and EPB tendons. If this movement causes pain at the radial aspect of the wrist, the test is positive, indicating De Quervain’s tenosynovitis.

52
Q

Management of DeQuervain’s tenosynovitis

A 
Rest and adapting activities
Using splints to restrict movements
Analgesia (e.g., NSAIDs)
Physiotherapy
Steroid injections

Rarely, surgery may be required to release (cut) the extensor retinaculum, releasing the pressure and creating more space for the tendons.

53
Q

What can bursitis be caused by

A

Friction from repetitive movements or leaning on the elbow
Trauma
Inflammatory conditions(eg. rheumatoid arthritis or gout)
Infection(septic bursitis)

54
Q

Presentation of olecranon bursitis

A

Swollen
Warm
Tender
Fluctuant (fluid-filled)

55
Q

Features of septic bursitis

A

Hot to touch
More tender
Erythema spreading to the surrounding skin
Fever
Features of sepsis (e.g., tachycardia, hypotension and confusion)

56
Q

When should septic arthritis be considered instead of olecranon bursitis

A

Swelling in the joint (rather than the bursa)

Painful and reduced range of motion in the elbow

57
Q

Management of septic bursitis

A

Aspiration(before antibiotics)
Antibiotics(fluclox first line, clarithromycin as an alternative)
Hospital admission if systemically unwell

58
Q

General management of olecranon bursitis

A

Rest
Ice
Compression
Analgesia (e.g., paracetamol or NSAIDs)
Protecting the elbow from pressure or trauma
Aspiration of fluid may be used to relieve pressure
Steroid injections may be used in problematic cases where infection has been excluded

59
Q

IX for adhesive capsulitis

A

MRI gold standard - thickening of joint

HbA1c - more common in diabetics

60
Q

When should conservative mx be advised for rotator cuff tear

A

If presenting within 2 wks

61
Q

Main complication of rotator cuff tear

A

Adhesive capsulitis

62
Q

Bony injuries associated with shoulder dislocations

A

Bankart lesion

Hill Sachs lesion

63
Q

Which sign on an X-ray is associated with posterior shoulder dislocation

A

Lightbulb sign

64
Q

Which type of radial fracture always requires surgery

A

Essex-lopresti fracture

65
Q

Which nerve is typically injured in supracondylar fractures

A

median nerve

anterior interosseous branch

66
Q

Test for anterior interosseous branch

A

OK sign

General practice (26 decks)

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