Brainscape's Knowledge GenomeTM

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


See full index

2a > Ortho > Flashcards

Ortho Flashcards

1
Q

What is osteoporosis?

A

Reduced bone mineral density

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

What medications increase the risk of osteoporosis?

A
  • Corticosteriods
  • SSRIs
  • PPIs
  • Anti-epileptics
  • Anti-oestrogens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can bone mineral density be measured?

A

DEXA scan

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

How can bone density be represented? Which of these is key?

A
  • Z/T scores
  • Z scores represent the number of standard deviations that patients bone density falls bellow the mean for their age
  • T scores represent the number of standard deviations below the mean for a healthy young adult
  • T score at the hip is key for assessing someones level of osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What T scores would indicate normal bone mineral density, osteopenia and osteoporosis?

A

More than -1 = normal
- 1 to -2.5 = osteopenia
Less than -2.5 = osteoporosis

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

What is the first line treatment for osteoporosis? What are key side effects to remember?

A
  • Bisphophonates e.g. alendronate
  • Reflux - take on empty stomach 30 mins before food
  • Atypical fractures (femoral)
  • Osteonecrosis of the jaw
  • Osteonecrosis of the external auditory canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the follow up for started on bisphosphonates?

A
  • Repeat FRAX and DEXA 3-5 yrs after starting
  • If BMD improves consider withholding treatment for at least 18 months then repeat Ix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What investigations are important for ?septic arthritis?

A
  • Bloods - WCC, CRP
  • XR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are important to mention if referring to ortho for ? septic arthritis?

A
  • ROM - minimal ROM
  • Weight bearing - NWB
  • Systemic features - systemically unwell
  • WCC/CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are ddx for septic arthritis?

A
  • OA
  • Fracture
  • Gout
  • Cellulitis
  • Haemarthrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common causative organism of septic arthritis? What is an important cause to consider in sexually active individuals?

A
  • Staph aureus
  • Neisseria gonorrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When aspirating a joint for septic arthritis what should you send the sample for?

A
  • Gram staining
  • Crystal microscopy
  • Culture
  • Antibiotic sensitivities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is often first line treatment of septic arthritis?

A
  • Flucloxacillin plus rifampicin
  • Continued for 3-6 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give 3 types of fracture

A
  • Compound fracture
  • Stable fracture
  • Pathological fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a compound fracture?

A

When the skin is broken and the broken bone is exposed to air

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

What is a stable fracture?

A

When the sections of bone remain in alignment at the fracture

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

What is a pathological fracture?

A

When a bone breaks due to an abnormality within the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can you describe/present fractures?

A
  1. Describe the radiograph
  2. What type of fracture?
  3. Where is the fracture?
  4. Is it displaced?
  5. Is there anything else going on?
    - Joint involvement?
    - Another fracture?
    - Underlying bone lesion?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can you classify different types of fractures?

A
  1. Complete (all the way through bone)
    - Transverse
    - Oblique
    - Spiral
    - Comminuted
  2. Incomplete (whole cortex is not broken)
    - Bowing
    - Buckle
    - Greenstick
  3. Salter-Harris (growth plate fracture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the types of paediatric fractures?

A
  • Complete - both sides of cortex breached
  • Toddlers fracture - oblique tibial fracture in infants
  • Plastic deformity - stress on bone -> deformity without cortical disruption
  • Greenstick fracture - unilateral cortical breach only
  • Buckle (‘torus’) fracture - incomplete cortical disruption -> periostea haematoma only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In children, fractures may also involve the growth plate. How are these classified?Which require surgery?

A

Salter-Harris system

Remember SALTER:
- I (S) - straight through (physis only)
- II (A) - above (physis and metaphysis)
- III (L) - beLow (physis and epiphysis to include joint)
- IV (T) - through (fracture involving all 3)
- V (ER) - everything ruined (crush injury)

Type II is most common and is relatively stable

Types III, IV, V will usually require surgery

Type V is associated with disruption to growth

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

What do you need to mention when describing where a fracture is?

A
  • Bone involved
  • What part of the bone is affected:
    • Diaphysis
    • Metaphysis
    • Epiphysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you investigate fractures?

A
  • XR - two views are always required
  • CT - if XR is inconclusive or further information needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the principles of fracture management?

A
  1. Pain relief
  2. Mechanical alignment
    - Closed reduction (manipulation of the limb)
    - Open reduction (surgery)
  3. Provide relative stability for healing
    - External casts
    - K wires
    - Intramedullary wires
    - Intramedullary nails
    - Screws
    - Plate and screws
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are potential early complications of fractures?

A
  • Damage to local structures
  • Haemorrhage
  • Compartment syndrome
  • Fat embolism
  • VTE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are potential late complications of fractures?

A
  • Delayed union
  • Malunion
  • Non-union
  • Avascular necrosis
  • Osteomyelitis
  • Joint instability
  • Joint stiffness
  • Contractures
  • Arthritis
  • Chronic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What happens in fat embolism? When does in occur?

A
  • Fat globules are released into circulation following a fracture (of a long bone)
  • These may become lodged in blood vessels and cause obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can fat embolism lead to? What is used for diagnosis?

A
  • Fat embolisation can cause a systemic inflammatory response leading to fat embolism syndorme
  • Occurs 24-72 hrs after the fracture

Gurd’s criteria is used for diagnosis:
- Major criteria - resp distress, petechial rash, cerebral involvement
- There is a long list for the minor criteria

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

What is the management of fat embolism? How can it be avoided?

A
  • Management = supportive
  • Operating early to fix the fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are causes of pathological fractures?

A
  • Tumours (prostate, renal, thyroid, breast, lung)
  • Osteoporosis
  • Paget’s disease of the bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Where are common sites for pathological fractures?

A
  • Femur
  • Vertebral bodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a Colle’s fracture?

A

Transverse fracture of the distal radius

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

How can Colle’s fracture be described?

A
  • Dinner fork deformity
  • Distal radius is dorsally displaced (posterior when think of anatomical position)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are early complications of a Colle’s fracture?

A
  • Median nerve injury - acute carpal tunnel syndrome presenting with weakness/loss of thumb/index finger flexion
  • Compartment syndrome
  • Vascular compromise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a Smith’s fracture?

A

Volar displacement of the distal radius (opposite of Colle’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What typically causes a Smith’s fracture?

A

Falling backwards onto the palm of an outstretched hand or falling with wrists flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How can Smith’s fracture be described?

A

Garden spade deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is a FOOSH?

A

A fall onto an outstretched hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What fractures are commonly caused by a FOOSH?

A
  • Colle’s fracture
  • Scaphoid fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the scaphoid?

A

One of the carpal bones at the base of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is a key sign of scaphoid fractures?

A

Tenderness in the anatomical snuffbox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do scaphoid fractures present?

A
  • Pain along radial aspect of wrist and at base of thumb
  • Loss of grip/pinch strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is important to know about scaphoid fractures?

A
  • They have a retrograde blood supply
  • The blood vessels supply the bone from only one direction
  • This means a fracture can cut off the blood supply -> avascular necrosis and non-union
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How do you investigate a scaphoid fracture?

A
  • Plain film radiographs - AP and lateral view
  • MRI is definite investigation but is normally used second line where XR is inconclusive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the initial management of scaphoid fractures?

A
  • Immobilisation with a Futuro splint/below-elbow backslab
  • Referral to orthopaedics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which bones have vulnerable blood supplies in which a fracture could lead to avascular necrosis?

A
  • Scaphoid bone
  • Femoral head
  • Humeral head
  • Talus, navicular and fifth metatarsal in the foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What do ankle fractures involve?

A
  • The lateral malleolus - distal fibula
  • The medial malleolus - distal tibia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What can be used to classify fractures of the lateral malleolus?

A
  • Weber classification
  • Describes the fracture in relation to the distal syndesmosis
  • The tibiofibular syndesmosis is important for the stability/function of the ankle joint
  • If disrupted, surgery is more likely to me be required

Weber classification:
- Type A: below ankle joint (syndesmosis intact)
- Type B: at level of ankle joint (syndesmosis intact/partially torn)
- Type C: above ankle joint (syndesmosis disrupted)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the Ottawa rules for ankle injury?

A

Used to decide wether an ankle XR is required. Have a sensitivity approaching 100%

They state an XR is required ONLY if there is pain in the malleolar zone and any one of:
- Bony tenderness at the lateral malleolar zone
- Bony tenderness at the medial malleolar zone
- Inability to walk 4 weight bearing steps immediately after the injury and in the ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the rule with pelvic fractures?

A

The pelvis is a ring therefore if one part of the ring is fractured, another part will also fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are risk factors for hip fractures?

A
  • Increasing age
  • Osteoporosis
  • Female sex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How can hip fractures be categorised?

A
  • Intra-capsular fractures
  • Extra-capsular fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are key structures of the hip?

A
  • Head
  • Neck
  • Greater trochanter (lateral)
  • Lesser trochanter (medial)
  • Intertrochanteric line
  • Shaft (body)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Describe the blood supply of the head of the femur

A
  • The head of the femur has a retrograde blood supply
  • The medial and lateral circumflex femoral arteries join the femoral neck proximal to the intertrochanteric line
  • Braches run along the femoral neck to the head
  • They supply to only blood supply to the femoral head
  • A fracture of the intra-capsular neck of the femur can damage these vessel -> avascular necrosis of the femoral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What do intra-capsular fractures involve?

A
  • A break in the femoral neck
  • They affect the area proximal to the intertrochanteric line therefore can disrupt the blood supply to the femoral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is used to classify intra-capsular fractures?

A

Garden classification:
- Grade I - incomplete and non-displaced
- Grade II - complete and non-displaced
- Grade III - partial displacement
- Grade IV - full displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the management of grade I/II intra-capsular fractures?

A
  • Internal fixation (with screws) to hold the femoral head in place as the fracture heals
  • These fractures are non-displaced -> may have an intact blood supply -> able to heal without avascular necrosis occurring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the management of grade II/IV intra-capsular fractures?

A
  • Hemiarthroplasty/total hip replacement
  • These fractures are displaced -> blood supply to the femur is disrupted -> avascular necrosis of the femoral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

When is a total hip replacement vs a hemiarthroplasty offered?

A

Total is offered to pts who can walk independently and are fit for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Does the head of the femur need to be replaced in extra-capsular hip fractures?

A
  • No
  • They do not disrupt the blood supply to the head of the femur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the two types of extra-capsular hip fractures? Include management

A
  1. Intertrochanteric fractures
    - Rx - dynamic hip screw (aka sliding hip screw)
  2. Subtrochanteric fractures
    - Distal to the lesser trochanter (but within 5cm)
    - Rx - intramedullary nail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How do hip fractures present?

A
  • Pain in the groin/hip - can radiate to the knee
  • Not able to wt bear
  • Shortened, abducted and externally rotated leg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the initial investigation of choice for hip fractures? What sign indicates a fractured NOF?

A
  • XR - two views (AP and lateral)
  • Disruption of Shenton’s line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the principles of hip fracture management?

A
  • Appropriate analgesia
  • Ix to establish diagnosis (XR0
  • VTE risk assessment and prophylaxis (LMWH)
  • Pre-op assessment (bloods + ECG)
  • Surgery (within 48 hrs due to risk of mobility/mortality)
  • Post-operative physiotherapy (the operation should allow the pt to weight bear straight away)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is compartment syndrome?

A

Where the pressure within a fascial compartment is abnormally elevated, cutting off the blood flow to the contents in that compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is fascia? What do fascial compartments contain?

A
  • Strong fibrous connect tissue, not able to stretch of expand
  • Muscles, nerves and blood vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What type of compartment syndrome is an orthopaedic emergency? What is the risk?

A
  • Acute compartment synbdrome
  • Tissue necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What causes acute compartment syndrome?

A
  • Acute injuries associated with bleeding/tissue swelling which increases pressure within the fascial compartment
  • Examples - bone fractures, crush injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How does acute compartment syndrome present?

A

5 P’s
- Pain (disproportionate to injury)
- Paraesthesia
- Pale
- Pressure (high)
- Paralysis (late + worrying feature)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the management of acute compartment syndrome?

A
  • Needle manometry to measure compartment pressure
  • Escalate to orthopaedic reg/consultant
  • Elevate leg (if affected) to heart level
  • Maintain good BP (avoid hypotension)
  • Emergency fasciotomy is the definitive management (within 6 hrs) - wound is left open and covered with a dressing
  • Repeated trips to theatre to explore the compartment for necrotic tissue and to gradual close the compartment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Why do patients with acute compartment syndrome often require aggressive IV fluids?

A

Myoglobinuria may occur following fasciotomy -> renal failure

72
Q

What is another name for chronic compartment syndrome?

A

Chronic Exertional compartment syndrome

73
Q

What happens in chronic compartment syndrome?

A
  • During exertion the pressure within a fascial compartment rises and blood blood is restricted -> symptoms
  • During rest the pressure falls and the symptoms begin to resolve
  • It is not an emergency
74
Q

What are the symptoms of chronic compartment syndrome?

A
  • Pain
  • Numbness
  • Paraesthesia
75
Q

What is spinal stenosis?

A

Narrowing of part of the spinal canal -> compression of the spinal cord/nerve roots

76
Q

What is the most common type of spinal stenosis in terms of location?

A

Lumbar spinal stenosis

77
Q

What are the 3 types of spinal stenosis?

A
  • Central stenosis - narrowing of central spinal canal
  • Lateral stenosis - narrowing of the nerve root canals
  • Foramina stenosis - narrowing of the intervertebral foramina
78
Q

What is a key presenting feature of lumbar spinal stenosis with central stenosis?

A
  • Intermittent neurogenic claudication
  • Aka pseudoclaudication
  • Typical symptoms are lower back pain, buttock and leg pain, leg weakness
79
Q

How does lateral/foramina stenosis present?

A

Symptoms of sciatica

80
Q

What exacerbates/improves the symptoms of spinal stenosis?

A
  • The symptoms are absent at rest
  • Bending forward expands the spinal canal and improves symptoms
  • Standing straight extends the spine, narrowing the canal and worsening symptoms
81
Q

What can the symptoms of intermittent neurogenic claudication mimic?

A
  • Peripheral arterial disease
  • Normal peripheral pulses/the ankle-brachial pressure index (ABPI)
82
Q

What imaging is used to diagnose spinal stenosis?

A

MRI

83
Q

What is the management of spinal stenosis?

A
  • Wt loss
  • Analgesia
  • Physio
  • Decompression surgery where conservative tx fails - laminectomy
84
Q

What is another term for lower back pain?

A

Lumbago

85
Q

What is a way for grouping together the causes of lower back pain?

A
  1. Causes of mechanical lower back pain
    - muscle strain
    - herniated disc
    - scoliosis
    - degenerative changes
  2. Red flag causes of lower back pain
    - spinal fracture
    - caudal equina
    - spinal stenosis
    - ank spon.
    - spinal infection
  3. Other causes
    - ruptured AA
    - kidney stones
    - pancreatitis
    - prostatitis
86
Q

What spinal nerves for the sciatic nerve?

A

L4-S3

87
Q

What does the sciatic nerve divide into?

A

Divides are knee into:
- Tibial nerve
- Common peroneal nerve

88
Q

What are the main causes of sciatic?

A

Lumbosacral nerve root compression by:
- Herniated disc
- Spondylolisthesis
- Spinal stenosis

89
Q

What does the sciatic nerve supply sensation and motor function to?

A
  • Sensation - lateral lower leg and foot
  • Motor - posterior thigh, lower leg, foot
90
Q

What is the management of sciatica?

A
  • Physio
  • Analgesia:
    • NSAIDs (first line)
    • Codeine (as alternative)
    • Benzodiazepines >5 days (for muscle spasm)
    • Neuropathic med (amitriptyline/duloxetine only)
  • Specialist management:
    • Epidural corticosteroid injections
    • LA injections
    • Radiofrequency denervation
    • Spinal decompression
91
Q

What can be used to stratify the risk of a pt presenting with acute back pain, developing chronic back pain?

A

STarT Back screening tool

92
Q

What is the caudal equina?

A

A collection of nerve roots that travel through the spinal canal after the spinal cord terminates (around L2/L3)

93
Q

What do the nerves of the caudal equina supply?

A
  • Sensation to the lower limbs, perineum, bladder, rectum
  • Motor innervation to the lower limbs, anal and urethral sphincters
  • Parasympathetic innervation of the bladder and rectum
94
Q

What are potential causes of caudal equina syndrome?

A
  • Herniated disc
  • Tumours
  • Spondylolisthesis
  • Abscess
  • Trauma
95
Q

What are caudal equina red flags?

A
  • Saddle anaesthesia
  • Urinary incontinence/retention
  • Faecal incontinence
  • Loss of sensation in the bladder and rectum (not knowing when they are full)
  • Bilateral sciatica
  • Bilateral motor weakness in the legs
  • Reduced anal tone on PR examination
96
Q

What is the management of caudal equina?

A
  • Immediate admission
  • Emergency MRI scan
  • Neurosurgical input - lumbar decompression surgery
97
Q

How does metastatic spinal cord compression (MSCC) differ from caudal equina syndrome?

A
  • In MSCC the spinal cord is compressed so it presents with upper motor neurone signs e.g. increased tone, brisk reflexes, upping plantar response
  • In cauda equina the nerves compressed have exited the spinal cord -> they are lower motor neurones. It presents with LMM signs e.g. reduced tone and reflexes

A key feature of MSCC is back pain that is worse on coughing/straining

98
Q

What may the management of MSCC involve?

A
  • High dose dexamethasone (to reduce swelling and relieve compression)
  • Analgesia
  • Surgery
  • Chemo/radio
99
Q

What is trochanteric bursitis?

A

Inflammation of a bursa over the greater trochanter on the outer hip

100
Q

How does trochanteric bursitis present? What are typical examination findings?

A
  • Women aged 50-70
  • Gradual onset lateral hip pian
  • May radiate down outer thigh
  • Aching/burning pain
  • Worse with activity/sitting or sitting for long periods/trying to sit cross legged
  • Ex - tenderness over greater trochanter, resisted abduction of hip/external and internal rotation
101
Q

What is the management of trochanteric bursitis? How long can recover take?

A
  • Rest
  • Ice
  • Analgesia (NSAIDs)
  • Physio
  • Steroid injections

Can take 6-9 months to recover

102
Q

What is the function of the anterior cruciate ligament? Where does it originate from and attach too?

A
  • Stops the tibia sliding forward in relation to the femur
  • Originates from the lateral aspect of the intercondylar notch of the femur and attaches to the anterior intercondylar area of the tibia
103
Q

How does an ACL tear present?

A
  • A ‘pop’
  • Rapid onset swelling
  • Instability or giving way

Occurs following a twisting injury

104
Q

What are the special tests for ACL injury?

A

Anterior drawer of Lachman tests

105
Q

What are the first line and gold standard investigations for ACL injury?

A
  • First line - MRI
  • Gold standerd - arthroscopy
106
Q

What is the management of ACL injury?

A
  • RICE
  • NSAIDs
  • Crutches and knee braces
  • Physio
  • Arthroscopic surgery to reconstruct the ligament (use a graft of tendon from another location)
107
Q

What is the purpose of the medial and lateral meniscus of the knee?

A
  • Help the femur and tibia fit together and move smoothly across each other
  • Act as shock absorbers
  • Help stabilise the joint
108
Q

How does meniscal tear present?

A
  • A ‘pop’
  • Rapid onset swelling
  • Instability or giving way
  • Locking

Occur during twisting movements in the knee - sports in young people, standing from seated with an awkward twist in older people

109
Q

What are the special tests for meniscal tears?

A
  • McMurray’s test
  • Alley grind test

Not recommended in clinical practice as can worse tear

110
Q

What are the first line and gold standard investigations for meniscal tear?

A
  • First line - MRI
  • Gold standerd - arthroscopy
111
Q

What is the management of meniscal tear?

A
  • RICE
  • NSAIDs
  • Physio
  • Arthroscopic surgery to repair/resect the affected meniscus
112
Q

What happens in Achilles tendon rupture?

A

A sudden onset injury results in rupture of the Achilles and loss of connection between the calf muscles and the heel

113
Q

What are RF for Achilles tendon rupture?

A
  • Sports that stress the Achilles
  • Increasing age
  • Existing Achilles tendinopathy
  • FHx
  • Fluoroquinolone abx
  • Systemic steroids
114
Q

What antibiotic should you look out for in someone presenting with Achilles tendinopathy or rupture?

A
  • Fluoroquinolones (ciprofloxacin, levofloxacin)
  • Rupture can occur spontaneously within 48hrs of starting them
115
Q

What are examination signs of Achilles tendon rupture? What is the special test?

A
  • Tenderness to the area
  • Palpable gap in the Achilles tendon

Normally flexion of the calf pulls on the Achilles -> plantar flexion. This is lost meaning:
- When relaxed and dangling the ankle will rest in a dorsiflexed position
- Weakness of plantar flexion
- Unable to stand on tiptoes

Simmond’s calf squeeze test:
- Pt is prone with feet hanging freely off the bed
- When squeezing calf muscle of leg with intact Achilles there will be plantar flexion
- When ruptured there is no connection -> a lack of plantar flexion

116
Q

How do you diagnose Achilles tendon rupture?

A

USS

117
Q

What is the management of Achilles tendon rupture?

A
  • Same day ortho r/v
  • Rest and immobilsation
  • Ice
  • Elevation
  • Analgesia

Debate between non-surgical vs surgical management:
- Non-surgical management - specialist boot to immobile ankle, higher risk of re-rupture
- Surgical - surgical fixation

118
Q

What is the rotator cuff made up of? What are the actions of each muscle?

A

SITS
- Supraspinatus - abducts arm
- Infraspinatus - externally rotates arm
- Teres minor - externally rotates arm
- Subscapularis - internally rotates arm

119
Q

What can cause rotator cuff tear?

A
  • Acute injury e.g. FOOSH
  • Degenerative changes related to age/overhead activities (e.g. tennis, construction work)
120
Q

How do rotator cuff tears present?

A
  • Shoulder pain - difficulty getting comfortable at night
  • Weakness and pain with movements relating to site of tear
121
Q

What investigations can diagnose rotator cuff tear?

A

USS/MRI

122
Q

What is the management of rotator cuff tear?

A
  • Rest
  • Analgesia
  • Physio
  • Surgery
    • Where physio fails
    • Arthroscopic rotator cuff repair
123
Q

What is another name for frozen shoulder?

A

Adhesive capsulitis

124
Q

What are the two types of frozen shoulder?

A
  • Primary - occurring spontaneously without any trigger
  • Secondary - occurring in response to trauma, surgery, immobilisation
125
Q

What is the basic anatomy of the shoulder?

A
  • The glenohumeral joint is a ball and socket joint
  • It is surrounded by connective tissue which forms the joint capsule
126
Q

What happens in frozen shoulder?

A

Inflammation and fibrosis in the joint capsule -> adhesions -> capsule tightens around the joint -> restricts movement

127
Q

What are the 3 phases of frozen shoulder? How long do these typically last?

A
  1. Painful phase - shoulder pain, worse at night
  2. Stiff phase - affects active and passive movement (external rotation most), pain settles during this phase
  3. Thawing phase - gradual improvement and return to normal

The entire illness lasts 1-3 yrs - normally 6 months in each phase

128
Q

How do you diagnose frozen shoulder?

A
  • Clinical diagnosis - hx + ex, exclude other causes of shoulder pain and stiffness
  • Imaging is not normally required
  • USS/CT/MRI can show thickened joint capsule
129
Q

What is the management of frozen shoulder?

A
  • Continue to use arm but don’t exacerbate pain
  • Analgesia
  • Physio
  • Steroid joint injections
  • Hydrodilation
  • Surgery (particularly resistant/severe cases)
    • Manipulation under anaesthesia (forcefully stretching capsule)
    • Arthroscopy to cut adhesions
130
Q

What is the glenoid cavity?

A

Socket aspect of the shoulder joint

131
Q

What are the 2 types of shoulder dislocation? Which is more common?

A
  • Anterior dislocation (90% of shoulder dislocations)
  • Posterior dislocation (associated with electric shocks and seizures)
132
Q

What’s a key complication of shoulder dislocation? How does it present?

A
  • Axillary nerve damage
  • Loss of sensation in ‘regimental badge’ area over lateral deltoid
  • Motor weakness in the deltoid and teres minor muscles
133
Q

What is olecranon bursitis? What is it sometimes called?

A
  • Inflammation and swelling of the bursa over the elbow
  • Olecranon is part of the ulnar bone
  • ‘Students elbow’
134
Q

What are causes of olecranon bursitis?

A
  • Friction from repetitive movements
  • Trauma
  • Inflammatory conditions (e.g. RA/gout)
  • Infection (septic bursitis)
135
Q

How does olecranon bursitis present?

A

Young/middle aged man with an elbow that is:
- Swollen
- Warm
- Tender
- Fluctuant (fluid filled)

136
Q

When would you aspirate fluid in olecranon bursitis?

A
  • When an infection is suspected
  • To relieve pressure
  • Pus - infection
  • Straw-coloured - infection less likely
  • Milky - gout/pseudogout
137
Q

What is the management of olecranon bursitis?

A
  • Rest
  • Ice
  • Analgesia (paracetamol/NSAIDs)
  • Protect elbow from pressure/trauma
  • Manage infection with abx
  • Steriods in problematic cases where infection is excluded
138
Q

What is epicondylitis?

A

Inflammation at the point where to tendons of the forearm insert into the epicondyles of the humerus

139
Q

What are the 2 types of epicondylitis?

A
  • Medial epicondylitis
  • Lateral epicondylitis
140
Q

What is lateral epicondylitis aka?

A

Tennis elbow

141
Q

How do you test for lateral epicondylitis?

A
  • The muscles that insert into the lateral epicondyle act the extend the wrist
  • Mill’s test involves stretching these extensor muscles whilst palpating the lateral epicondyle

Mill’s test:
- The elbow is extended
- The forearm pronated
- The wrist is flexed
- Pressure on the lateral epicondyle -> pain

142
Q

What is medical epicondylitis aka?

A

Golfer’s elbow

143
Q

How do you test for medical epicondylitis?

A
  • The muscles that insert into the medial epicondyle act to flex the wrist
  • A golfer’s elbow test involves stretching these flexor muscles whilst palpating the medial epicondyle

Golfer’s elbow test:
- The elbow is extended
- The forearm is supinated
- Wrist and fingers are extended
- Pressure on medial epicondyle -> pain

144
Q

What’s the management of epicondylitis?

A
  • Self-limiting and resolves with time (can be years)
  • Rest
  • Analgesia
  • Physio
  • Orthotics (elbow braces/straps)
  • Steroid injections
145
Q

What is De Quervain’s tenosynovitis?

A
  • A condition where there is swelling and inflammation of the tendon sheaths in the wrist
  • Primarily affects 2 tendons; abductor pollicis longus, extensor pollicis brevis
146
Q

What is De Quervain’s tenosynovitis aka? Why?

A
  • ‘Mummy thumb’
  • Bilateral De Quervain’s tenosynovitis can because by new parents repetitively lifting babies in a way that stresses the tendons of the thumb
147
Q

How does De Quervain’s tenosynovitis present?

A

Pain on radial aspect of the wrist

148
Q

What is another name for trigger finger?

A

Stenosing tenosynovitis

149
Q

What happens in trigger finger?

A
  • The flexor tendons of the fingers pass through tunnels (sheaths) along the length of the fingers
  • In trigger finger there is thickening of the tendon or tightening of the sheath
  • This prevents the tendon moving smoothly through the sheath
  • Most commonly affects part of the sheath = A1 at the metacarpophalangeal joint
150
Q

What are RF for trigger finger?

A
  • 40/50s
  • F>M
  • DM (T1>T2)
151
Q

How does trigger finger present?

A
  • Tender around MCP joint
  • Does not move smoothly
  • Makes popping/clicking sound
  • Gets stuck in flexed position

Symptoms worse in morning

152
Q

What is the management of trigger finger?

A
  • Analgesia
  • Splinting
  • Steroid injections
  • Surgery to release A1
153
Q

What happens in Dupuytren’s contracture? What causes it?

A
  • Fascia of the hand becomes thickened and tight -> finger contractures
  • It’s unclear why this happens but is thought to be due to micro trauma
154
Q

How does Dupuytren’s contracture present? Which finger is most often affected?

A
  • Finger flexion
  • A thick nodular cord can be palpated from the palm into the affected finger
  • Ring finger
155
Q

How can you test for Dupuytren’s contracture?

A

Table top test:
- Get the pt to position their hands flat on a table
- If the hand cannot rest completely flat, the test is positive

156
Q

What is the management of Dupuytren’s contracture?

A
  • Conservative (do nothing)
  • Surgical - fasciotomy/fasciectomy
157
Q

What happens in carpal tunnel syndrome?

A

Compression of the median nerve as it passes through the carpal tunnel

158
Q

What is the carpal tunnel? What does it contain?

A
  • Passage way between the forearm and the hand
  • Formed by the flexor retinaculum
  • The median nerve and the flexor tendons of the forearm
159
Q

What causes carpal tunnel syndrome?

A
  • Idiopathic
  • Swelling of the contents (swelling of tendon sheaths due to repetitive strain)
  • Narrowing of the tunnel
160
Q

What are RF for carpal tunnel syndrome?

A
  • Repetitive strain
  • Obesity
  • RA
  • Diabetes
  • Acromegaly
  • Hypothyroidism

Exams may want you to pick up on features indicating underlying cause e.g. bilateral carpal tunnel and acromegaly

161
Q

How does carpal tunnel syndrome present?

A
  • Gradual onset symptoms
  • Symptoms worse at night (may wake from sleep)
  • Sensory symptoms in median nerve distribution:
    • Numbness
    • Paraesthesia
    • Burning
    • Pain
  • Motor symptoms:
    • Weakness of thumb movements
    • Weakness of grip strength
    • Thenar muscle atrophy
162
Q

What are special tests for carpal tunnel syndrome?

A
  • Phalen’s test
  • Tinel’s test

Both will induce sensory symptoms

163
Q

How do you investigate carpal tunnel syndrome?

A

Nerve conduction studies

164
Q

What is the management of carpal tunnel syndrome?

A
  • Rest
  • Wrist splints at night (minimum 4 wks)
  • Steroid injections
  • Surgery - flexor retinaculum is cut to release pressure on the median nerve
165
Q

What are ganglion cysts?

A

Sacs of synovial fluid that originate from tendon sheaths/joints

166
Q

Where do ganglion cysts commonly occur?

A
  • Wrist
  • Fingers
167
Q

How do ganglion cysts present?

A
  • Visible lump
  • Non tender
  • Firm
  • Transilluminates
  • Can appear rapidly (over days) or gradually
168
Q

What is the management of ganglion cysts?

A
  • Conservative - 40-50% will resolve spontaneously
  • Needle aspiration
  • Surgical excision
169
Q

What is osteomyelitis?

A

Inflammation in a bone and bone marrow - usually due to a bacterial infections

170
Q

What is haematogenous osteomyelitis?

A

When a pathogen is carried through the blood and seeded in the bone (most common mode of infection)

171
Q

What are sarcomas?

A

Cancers originating in the muscles, bones or other types of connective tissue

172
Q

What are the types of bone sarcoma?

A
  • Osteosarcoma
  • Chrondrosarcoma - originating from cartilage
  • Ewing sarcoma - bone and soft tissue cancer, most often affects children and young adults
173
Q

How does sarcoma present?

A
  • Soft tissue lump
  • Bone swelling
  • Persistent bone pain
174
Q

How do you investigate sarcoma?

A
  • XR - initial Ix for bony lumps/persistent pain
  • USS - initial Ix for soft tissue lumps
  • CT/MRI to visualise in more detail + for metastatic spread (CT thorax as commonly spreads to lungs)
  • Biopsy for histology of cancer
175
Q

What is the management of sarcomas?

A
  • Surgery - aim for complete resection
  • Radiation - often used in conjunction with surgery. Pre-op (neoadjuvant) to shrink the tumour or post-op (adjuvant) to minimise the risk of local reoccurrence
  • Chemo - typically used neo-adjuvant/adjuvant to minimise the risk of recurrence

2a (12 decks)

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