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