Ortho Flashcards
Presentation of iliotibial band syndrome?
Lateral knee pain in runners
tenderness 2-3cm above the joint line
Management of iliotibial band syndrome?
activity modification and iliotibial band stretches
if not improving then physiotherapy referral
Management of ?missed scaphoid fracture?
urgent ortho review - risk of avascular necrosis
presentation of spinal stenosis?
Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down.
Clinical examination is often normal.
Requires MRI to confirm diagnosis.
Cauda equina presentation?
lower back pain
Problems with bowel and bladder function (usually inability to pass urine).
Numbness in the saddle area around the back passage (anus).
Weakness in one or both legs.
Disc prolapse presentation?
Sudden onset lower back pain, eased by lying still.
Nerve pain - usually sciatica (I.e. straight leg raise.)
Disc prolapse management?
Manage pain - NSAIDS first (could consider opioids ?tramadol for breakthrough)
rest and exercise
If severe and not better in 6 weeks - refer for surgery
Signs of systemic sepsis with changing lower limb neurology?
?epidural abscess
Advice to give pts following hip surgery?
avoiding flexing the hip > 90 degrees
avoid low chairs
do not cross your legs
sleep on your back for the first 6 weeks
Features of cubital tunnel syndrome? What nerve is affected?
Ulnar nerve
- Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.
- Over time patients may also develop weakness and muscle wasting
- Pain worse on leaning on the affected elbow
- Often a history of osteoarthritis or prior trauma to the area.
Nerve root compression in lower limbs (L3-S1) root compressed and symptoms?
L3 nerve root compression
- Sensory loss over anterior thigh
- Weak quadriceps
- Reduced knee reflex
- Positive femoral stretch test
L4 nerve root compression
- Sensory loss anterior aspect of knee
- Weak quadriceps
- Reduced knee reflex
- Positive femoral stretch test
L5 nerve root compression
- Sensory loss dorsum of foot
- Weakness in foot and big toe dorsiflexion
- Reflexes intact
- Positive sciatic nerve stretch test
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
Common pathogens linked to osteomyelitis?
Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
tests for de-quervian tenosynovitis?
abduction of the thumb against resistance is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process.
Management of tenosynovitis?
analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective
surgical treatment is sometimes required
Most common ligament damanged in sprained ankle?
The anterior tibulofibular ligament (90%)
Causes of dupuytrens contracture?
manual labour phenytoin treatment alcoholic liver disease diabetes mellitus trauma to the hand
When would you treat dupuytrens contractor?
consider surgical treatment of Dupuytren’s contracture when the metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table
What is chondromalacia patellae or patellofemoral pain syndrome? Presentating features? What can cause it?
Softening of the patellar cartilage
pain anterior and medial.
Pain on walking up stairs
Can happen due to athletics/running
Common in teenage girls
What condition is adhesive capsulitis associated with?
diabetes (20% may develop).
Management of NOFs according to type of fracture?
Depends on whether they are intra or extracapsular and whether they are displaced or not.
Intracapsular (subcapital):
Extracapsular: trochanteric or subtrochanteric
If intracapsular and non-displaced: internal fixation, or hemiarthroplasty if unfit.
If intracapsular and displaced: Hemi or THR.
THR if:
- pts were able to walk independently out of doors with no more than the use of a stick and
- are not cognitively impaired and
- are medically fit for anaesthesia and the procedure.
If extracapsular:
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
What area of hand has a boxer fracture broken?
5th Metatarsal
When to assess people for fragility fracture risk?
Women over 65 and men over 75.
Younger if they have RF such as, Smoking, alcohol, family history, falls, fragility fractures and steroid use
Talipes (clubfoot) presentation?
an inverted (inward turning) and plantar flexed foot - is passively correctable
What knee disorder is associated with kneeling?
Infrapataller bursitis
RF for athletic females for stress fracture?
Inadequate calories, menstrual irregularities, increased or new exercise
Simmons triad test is for what?
Achilles tendon rupture.
In discitis caused by staph aureus what investigation do you need to do for source
Echo - ?IE
presentation of trigger finger?
Finger becomes ‘stuck’
Management of trigger finger?
Steroid injections
reasons for THR revision?
Reasons for revision of total hip replacement aseptic loosening (most common reason) pain dislocation infection
Presentation of perthes?
Perthes disease is a degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head
Perthes disease is 5 times more common in boys. Around 10% of cases are bilateral
Features
- hip pain: develops progressively over a few weeks
limp
- stiffness and reduced range of hip movement
- x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
Presentation of slipped upper femoral epiphysis?
Typical age group = 10-15 years
More common in obese children and boys
Displacement of the femoral head epiphysis postero-inferiorly
Bilateral slip in 20% of cases
May present acutely following trauma or more commonly with chronic, persistent symptoms
Features
knee or distal thigh pain is common
loss of internal rotation of the leg in flexion
presentation of Juvenile idiopathic arthritis?
<16 yrs
- Joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows
- Limp
- ANA may be positive in JIA - associated with anterior uveitis
Presentation of transient synovitis?
Typical age group = 2-10 years
Acute hip pain associated with viral infection
Commonest cause of hip pain in children
Features of meniscal tear?
Knee pain
Positive McMurrays test
May be caused by twisting of the knee
Locking and giving-way are common feature
Tender joint line
Subacromial impingement presentation?
Painful arc (midway through abduction 60-120degrees) Acromial tenderness
It is a type of rotator cuff injury
Most common organism causing discitis?
Staph Aureus
Red flags for lower back pain?
- age < 20 years or > 50 years
- history of previous malignancy
- night pain
- history of trauma
- systemically unwell e.g. weight loss, fever
Difference in tinnels and phalens?
Tines (T) = Tapping
Phalens - holding in flexion
Ottawa rukes for ankle XRAY?
- Point tenderness over the distal 6 cm of the lateral malleolus
- Point tenderness over the distal 6 cm of the medial malleolus
- Inability to weight bear by at least four steps immediately post trauma and in the emergency department
Features of lateral and medial epicondylitis?
Lateral epicondylitis (tennis elbow)
- pain and tenderness localised to the lateral epicondyle
- pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
- episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks
Medial epicondylitis (golfer’s elbow)
- pain and tenderness localised to the medial epicondyle
- pain is aggravated by wrist flexion and pronation
- symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
Nerve that supplies the cutaneous anterolateral skin of the thigh?
Lateral cutaneous.
Management of RA? Monitoring response?
Initial therapy
- DMARD monotherapy +/- a short-course of bridging prednisolone.
Monitoring response to treatment
NICE recommends using a combination of CRP and disease activity (using a composite score such as DAS28) to assess response to treatment
Flares
flares of RA are often managed with corticosteroids - oral or intramuscular
DMARDs methotrexate is the most widely used DMARD. Monitoring of FBC & LFTs is essential due to the risk of myelosuppression and liver cirrhosis. Other important side-effects include pneumonitis - sulfasalazine - leflunomide - hydroxychloroquine
TNF-inhibitors
- tried at least two DMARDs including methotrexate
- etanercept or infliximab or adalimumab:
Rituximab
- two infusions given 2 weeks apart.
Features of dermatomyositis?
Skin features
- photosensitive
- macular rash over back and shoulder
- heliotrope rash in the periorbital region
- Gottron’s papules - roughened red papules over extensor surfaces of fingers
- ‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
- nail fold capillary dilatation
Other features
- proximal muscle weakness +/- tenderness
- Raynaud’s
- respiratory muscle weakness
- interstitial lung disease: e.g. Fibrosing alveolitis or organising pneumonia
- dysphagia, dysphonia
