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Finals > Ortho > Flashcards

Ortho Flashcards

1
Q

what is OA

A

wear and tear in joints
imbalance of cartilage damage and chondrocyte reponse

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2
Q

where does OA occur

A

synovial joints

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3
Q

RF for OA

A
  • obesity
  • age
  • FH
  • occupation
  • trauma
  • female
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4
Q

commonly affected joints in OA

A
  • Hips
  • Knees
  • Distal interphalangeal (DIP) joints in the hands
  • Carpometacarpal (CMC) joint at the base of the thumb
  • Lumbar spine
  • Cervical spine (cervical spondylosis)
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5
Q

x-ray changes in OA

A

LOSS
- Loss of joint space
- Osteophytes (bone spurs)
- subchondral cysts
- subarticular sclerosis

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6
Q

presentation of OA

A
  • joint pain and stiffness
  • worsens with activity at end of day
  • crepitus
  • effusions around the joint
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7
Q

signs in hands of OA

A
  • Heberden’s nodes (DIP)
  • Bouchard’s node (PIP)
  • squaring of base of thumb
  • weak grip
  • reduced range of motion
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8
Q

how to diagnose OA

A

clinical if >45
no morning stiffness

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9
Q

Mx of OA

A
  • exercises, weight loss, OT
  • topical NSAIDs
  • oral NSAIDs
  • joint injection
  • weak opiates/paracetmaol
  • joint replacement
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10
Q

When not to use systemic NSAIDs in OA

A
  • renal failure
  • peptic ulcer disease
  • asthma
  • be cautious in hypertension, can raise BP
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11
Q

most common joint replacement

A

hip, knee, shoulder

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12
Q

indication for joint replacement

A
  • OA (MC)
  • fracture
  • septic arthritis
  • osteonecrosis
  • bone tumour
  • RA
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13
Q

types of joint replacement available

A
  • Total joint replacement: replacing both articular surfaces of the joint
  • Hemiarthroplasty – replacing half of the joint (e.g., the head of the femur in the hip joint)
  • Partial joint resurfacing – replacing part of the joint surfaces (e.g., only the medial joint surfaces of the knee)
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14
Q

describe total hip replacement

A

lateral incision to hip
head of femur removed (metal/ceramic replacement)
acetabulum hollowed out and replaced by metal socket

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15
Q

describe total knee replacement

A

vertical knee incision
articular surfaces of femur and tibia removed- metal put in
spacer added between new articular surfaces

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16
Q

describe total shoulder replacement

A

head of the humerus is removed and replaced with a metal or ceramic ball.
glenoid (socket) is hollowed out and replaced by a metal socket

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17
Q

most common organiss in prosthetic joint infection

A

staph aureus

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18
Q

RF for prosthetic joint infection

A
  • prolonged oepration
  • obesity
  • diabetes
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19
Q

sx of prosthetic joint infection

A

fever
Pain
Swelling
Erythema
Increased warmth

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20
Q

mx of of prosthetic joint infection

A

prolonged abx
joint irrigation, debridement and replacement

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21
Q

types of fracture

A
  • compound: skin and bone broken
  • stable: bones are aligned
  • pathological: bone break due to abnormality in the bone
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22
Q

how to describe a fracture

A
  • transverse
  • oblique
  • comminuted
  • spiral
  • segmental
  • greenstick
  • compression
  • buckle (torus) (child)
  • salter harris (growth plate) (child)
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23
Q

colle’s wrist fracture

A
  • fracture distal radius causing distal portion to displace posteriorly (up).
  • Dinner fork deformity = Dorsally Displaced Distal radius
  • falling on outstretched hand
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24
Q

smith wrist fracture

A
  • fractures distal part of the radius bone points toward the palm side of the wrist.
  • When pt falls with their wrist bent forward or direct blow to the back of hand.
  • Volarly displaced distal radius fracture
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25
Q

Describe a Galeazzi fracture

A

Dislocation of the distal radioulnar joint in association with a displaced radial shaft fracture
Galeazzi radius (Galaxy rangers)

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26
Q

Describe a Monteggia’s fracture

A

Dislocation of the proximal radioulnar joint in association with a displaced ulnar fracture
Monteggia ulna (Manchester United)

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27
Q

type of fracture caused by a FOOSH

A

scaphoid

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28
Q

what is the blood supply in scaphoid

A

retrograde (only one direction) - same in femur
so fracture can cut off blood supply –> avascular necrosis + non-union

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29
Q

describe ankle fractures

A

involve the lateral malleolus (distal fibula) or the medial malleolus (distal tibia)

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30
Q

classification used to describe fractures of the lateral malleolus

A

Weber classification
fracture described in relation to distal syndesmosis between tibia and fibula

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31
Q

types of ankle fracture

A
  • type A: below ankle joint: syndesmosis intact
  • type B: at level of ankle joint: syndesmosis intact or partially torn
  • type C: above ankle joint: syndesmosis disrupted (surgery likely)
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32
Q

mx of ankle fractures

A
  • A= minimally displaced, stable fractures may weight bear as tolerated in a CAM boot
  • young often need surgery using a compression plate.
  • elderly= conservative
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33
Q

describe pelvis ring fracture

A

pelvis is a ring
when one part breaks another will too = significant intra-abdo bleeding –>emergency resus

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34
Q

diseases that can cause pathological fracture

A

tumour
osteoporosis
Paget’s disease of the bone

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35
Q

common sites of pathological fracture

A

femur
vertebral bodies

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36
Q

cancers that metastasise to the bone

A

PoRTaBLe
Po- prostate
R- renal
Ta- thyroid
B- breast
Le- lung

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37
Q

what is FRAX score

A

risk of a fragility fracture over the next 10 years

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38
Q

WHO criteria for osteoporosis using DEXA

A

> -1 normal
-1 to -2.5 osteopenia
< -2.5 osteoporosis
< -2.5 + fracture = severe OP

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39
Q

mx for reducing risk of fragility fractures

A
  • vit D and calcium
  • bisphosphonates (reduce osteoclast activity)
  • denosumab if can’t have bisphosphonates
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40
Q

side effects of bisposphonates

A
  • reflux and oesophageal erosions (take on empty stomach and don’t move for 30 mins)
  • osteonecrosis of the jaw
  • atypical fractures
  • osteonecrosis of external auditory canal
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41
Q

mx of a fracture

A

mechanical alignment
- closed reduction manipulation
- surgical open reduction

stability = fixation with:
- casts, K-wires, nails, screws, plates

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42
Q

what is a fat embolism

A

Can occur following the fracture of long bones
Fat globules are released into the circulation following a fracture - can become lodged in a vessel
results in fat embolism syndrome
presents 24-72hrs post fracture

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43
Q

signs of fat embolism

A

gurd’s criteria
major criteria:
- Respiratory distress
- Petechial rash
- Cerebral involvement

minor criteria
- jaundice
- fever, tachycardia
- thrombocytopenia

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44
Q

complication of fat embolism

A

multiple organ failure
10% mortality

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45
Q

RF for hip fracture

A
  • age
  • osteoporosis
  • female
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46
Q

categories of hip fracture

A
  • intra-capsular: can have avascular necrosis so need hemi/total hip replacement
  • extra-capsular
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47
Q

describe intra-capsular fracture

A

break in the femoral neck, within the capsule of the hip, affects intertrochanteric line

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48
Q

classification used for intra-capsular fractures

A

Garden classification
- Grade I: incomplete fracture and non-displaced
- Grade II: complete fracture and non-displaced
- Grade III: partial displacement (trabeculae are at an angle)
- Grade IV: full displacement (trabeculae are parallel)

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49
Q

difference between non-displaced and displaced intra-capsular hip fracture

A
  • non-displaced: intact blood supply –> internal fixation
  • displaced: disrupt blood supply –> head of femur needs to be replaced

hemiarthroplasty: leave acetabulum. for limited mobility/co-morbidities
total replacement: independent + fit

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50
Q

describe extra-capsular hip fractures

A

blood supply intact
intertrochanteric fracture- dynamic hip screw
subtrochanteric fracture- intramedullary nail

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51
Q

presentation of hip fracture

A
  • Pain in the groin or hip, which may radiate to the knee
  • Not able to weight bear
  • Shortened, abducted and externally rotated leg
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52
Q

ix for hip fractures

A
  • XR: AP and lateral. Disruption of Shenton’s line key sign
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53
Q

Mx of hip fracture

A
  • analgesia
  • surgery within 48hrs
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54
Q

what is compartment syndrome

A

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

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55
Q

most common cause of compartment syndrome

A

tibia fracture

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55
Q

consequence of compartment syndrome

A

Iincreased pressure in the fascial compartment –> muscle breakdown and myoglobin released into the bloodstream (rhabdomyolysis) –>Deposition of myoglobin the renal tubules –> results in acute kidney injury,

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56
Q

priority of acute compartment syndrome

A

EMERGENCY
surgery ASAP otherwise tissue necrosis

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57
Q

cause of presentation of acute compartment syndrome

A

usually affects one of the fascial compartments in the leg, but can be forearm, feet, thigh and butt

  • bone fracture
  • crush injury
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58
Q

presentation of acute compartment syndrome

A

5P’s
- Pain “disproportionate” to the underlying injury, worsened by passive stretching of the muscles
- Paresthesia
– Pale
– Pressure (high)
– Paralysis (a late and worrying feature)

Pulseless not a feature (acute limb ischaemia)

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59
Q

Mx of acute compartment syndrome

A
  • needle manometry to measure pressure
  • escalate, remove dressings
  • elevate limb
  • emergency fasciotomy
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60
Q

what is chronic compartment syndrome

A

associated with exertion
pressure rises and restricts blood flow

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61
Q

what is osteomyelitis

A

inflammation in bone and bone marrow usually due to bacteria

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62
Q

most common site where osteomyelitis occurs in children

A

in a long bone is the metaphysis

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63
Q

what is Haematogenous osteomyelitis

A

when a pathogen is carried through the blood and seeded in the bone (MC)

other form of osteomyelitis is through direct contact e.g. fracture

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64
Q

MC organism for osteomyelitis

A

staph aureus

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65
Q

RF for osteomyelitis

A
  • Open fractures
  • Orthopaedic operations, particularly with prosthetic joints
  • Diabetes, particularly with diabetic foot ulcers
  • Peripheral arterial disease
  • IV drug use
  • Immunosuppression
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66
Q

Presentation of osteomyelitis

A
  • fever
  • pain and tenderness
  • swelling
  • erythema
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67
Q

Ix for osteomyelitis

A

XRAY- often no changes
- Periosteal reaction (changes to the surface of the bone)
- Localised osteopenia (thinning of the bone)
- Destruction of areas of the bone

MRI = BEST
blood and bone cultures

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68
Q

Mx of osteomyelitis

A
  • 6 weeks flucloxacillin +/- rifampicin/fusidic in first 2 weeks
  • surgical debridgement

alternatives to fluclox = clindamycin or vancomycin

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69
Q

mx of chronic osteomyelitis

A

3+ months of abx

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70
Q

what is sarcoma

A

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

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71
Q

types of bone sarcoma

A
  • osteosarcoma (MC)
  • chondrosarcoma (cartilage)
  • Ewing sarcoma (children)
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72
Q

describe ewing sarcoma

A

<20y/o
highly malignant
onion skinning of periosteum
long bones/pelvis

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73
Q

describe chondrosarcoma

A

> 40y/o
Lytic lesion with fluffy calcification
axial skeleton/femur/tibia/pelvis

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74
Q

describe osteosarcoma

A

children
very rare
knee (60%)
Xray= Elevated periosteum (Codman’s
triangle). Sunburst appearance

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75
Q

types of soft tissue sarcoma

A
  • Rhabdomyosarcoma: skeletal muscle
  • Leiomyosarcoma: smooth muscle cancer
  • Liposarcoma: adipose (fat)
  • Synovial sarcoma: soft tissues around the joints
  • Angiosarcoma: blood and lymph vessels
  • Kaposi’s sarcoma: caused by human herpesvirus 8, most often in end-stage HIV, causing typical red/purple raised skin lesions but also affecting other parts of the body
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76
Q

presentation of sarcoma

A
  • A soft tissue lump, particularly if growing, painful or large
  • Bone swelling
  • Persistent bone pain
77
Q

Ix for sarcoma

A
  • xray
  • USS for soft tissue
  • CT/MRI
  • biopsy
78
Q

staging of sarcoma

A

TNM
common metastasis to lung

79
Q

Mx of sarcoma

A
  • Surgery (surgical resection is the preferred treatment)
  • Radiotherapy
  • Chemotherapy
  • Palliative care
80
Q

causes of mechanical back pain

A
  • Muscle or ligament sprain
  • Facet joint dysfunction
  • Sacroiliac joint dysfunction
  • Herniated disc
  • Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
  • Scoliosis
  • Degenerative changes
81
Q

causes of neck pain

A
  • Muscle or ligament strain
  • Torticollis
  • Whiplash
  • Cervical spondylosis
82
Q

red flag causes of back pain

A
  • Spinal fracture
  • Cauda equina (e.g., saddle anaesthesia, urinary retention, incontinence or bilateral neurological signs)
  • Spinal stenosis (e.g., intermittent neurogenic claudication)
  • Ankylosing spondylitis (e.g., age under 40, gradual onset, morning stiffness or night-time pain)
  • Spinal infection (e.g., fever or a history of IV drug use)
83
Q

nerve roots that form sciatic nerve

A

L4-S3
SN exits through greater sciatic foramn

84
Q

divisions of sciatic nerve

A

divides into tibial nerve and common peroneal nerve

85
Q

function of sciatic nerve

A
  • sensation to the lateral lower leg and the foot
  • motor function to the posterior thigh, lower leg and foot
86
Q

presentation of sciatica

A
  • unilateral pain from butt, down back of thigh to below knee or feet
  • electic/shooting pain
  • paraesthesia, numbness
87
Q

causes of sciatica

A
  • herniated disc
  • spondylolisthesis
  • spinal stenosis
88
Q

sx of bilateral sciatica

A

RED FLAG for cauda equina

89
Q

how to diagnose sciatica

A

sciatic stretch test (positive straight leg raise)

90
Q

Mx for low risk chronic back

A
  • self mx
  • analgesia NSAIDs
  • mobilise
91
Q

mx for medium-high risk chronic back pain

A
  • physio
  • group exercise
  • CBT
92
Q

what is cauda equina syndrome

A

surgical emergency
nerve roots at base of spine compressed
collection of nerve roots travelling through canal after L2/3

93
Q

cauda equina syndrome red flags

A
  • Saddle anaesthesia
  • Loss of sensation in the bladder and rectum
  • Urinary retention or incontinence
  • Faecal incontinence
  • Bilateral sciatica
  • Bilateral or severe motor weakness in the legs
  • Reduced anal tone
94
Q

Mx of cauda equina syndrome

A
  • Immediate hospital admission
  • Emergency MRI scan
  • Consider lumbar decompression surgery
95
Q

mx of metastatic spinal cord compression

A

emergency
high dose dexamethasone
surgery
analgesia

96
Q

what is spinal stenosis

A

refers to the narrowing of part of the spinal canal, resulting in compression of the spinal cord or nerve roots.
cervical or lumbar

97
Q

types of spinal stenosis

A
  • Central stenosis: narrowing of the central spinal canal
  • Lateral stenosis: narrowing of the nerve root canals
  • Foramina stenosis: narrowing of the intervertebral foramina
98
Q

causes of spinal stenosis

A
  • Congenital spinal stenosis
  • Degenerative changes
  • Herniated discs
  • Thickening of the ligamenta flava or posterior longitudinal ligament
  • Spinal fractures
  • Spondylolisthesis
  • Tumours
99
Q

Presentation of spinal stenosis

A
  • gradual onset
  • severe= CES
  • intermittent neurological claudication on exertion
100
Q

how to diagnose spinal stenosis

A

MRI

101
Q

Mx of spinal stenosis

A
  • exercise
  • analgesia
  • physiotherapy
  • decompression surgery
  • laminectomy
102
Q

what is meralgia paraesthetica?

A

localised sensory symptoms of the outer thigh caused by compression of the lateral femoral cutaneous nerve
mononeuropathy

103
Q

where does lateral femoral cutaneous nerve originate

A

L1,2 and 3

104
Q

presentation of meralgia paraesthetica

A
  • abnormal sensations (dysaesthesia)
  • loss of sensation in lateral femoral cutaneous nerve distribution.
  • burning, numbness, pins and needles, cold sensation
105
Q

Mx of meralgia paraethetica

A

mild- self limiting
Medical: NSAIDs, paracetamol, neuropathic meds
Surgical: decompression, transection of nerve, resection of nerve

106
Q

what is trochanteric bursitis

A

inflammation of a bursa over the greater trochanter on the outer hip.
bursae: sacs with synovial fluid on bony prominences

107
Q

presentation of trochanteric bursitis

A
  • pain on outer hip: greater trochanteric pain syndrome
  • middle age
  • gradual onset
  • aching/burning pain
  • worse with activity
  • tenderness on GT
108
Q

causes of trochanteric bursitis

A
  • Friction from repetitive movements
  • Trauma
  • Inflammatory conditions (e.g., rheumatoid arthritis)
  • Infection
109
Q

Mx of trochanteric bursitis

A
  • rest, ice, analgesia
  • physio
  • steroid injection
110
Q

4 ligaments in the knee

A
  1. Anterior cruciate ligament
  2. Posterior cruciate ligament
  3. Lateral collateral ligament
  4. Medial collateral ligament
111
Q

presentation of mensical tear

A

due to twisting movement e.g. sport
- pain
- swelling
- stiffness
- restricted ROM
- locking of knee
- knee giving way

112
Q

Mx of mensical tear

A

MRI
RICE
Physio
Arthroscopy and repair/resection

113
Q

Mx of ACL injury

A

RICE
NSAIDs
crutches and brace
physio
arthroscopy

114
Q

what is osgood schlatter disease

A
  • inflammation at the tibial tuberosity where the patella ligament inserts
  • 10-15y/o
  • M>F
  • usually unilateral
115
Q

presentation of osgood schlatter disease

A

gradual onset
- Visible or palpable hard and tender lump at the tibial tuberosity
- Pain in the anterior aspect of the knee
- Pain exacerbated by activity, kneeling and on extension of knee

116
Q

Mx of osgood schlatter disease

A
  • RICE
  • NSAIDs
  • knee pad
  • physio
117
Q

what is baker’s cyst

A

popliteal cyst usually secondary to degenerative changes
can be assoc with meniscal tears, OA, RA.

118
Q

Presentation of baker’s cyst

A
  • Pain or discomfort
  • Fullness
  • Pressure
  • A palpable lump or swelling
  • Restricted ROM in the knee (with larger cysts)
119
Q

presentation of ruptured baker’s cyst

A
  • pain
  • swelling
  • erythema
120
Q

Ix for baker’s cyst

A

USS
MRI

121
Q

Mx of baker’s cyst

A

Nil if asymptomatic
physio, analgesia, injection
arthoscopy

122
Q

types of achilles tendinopathy

A
  • Insertion tendinopathy (within 2cm of the insertion point on the calcaneus)
  • Mid-portion tendinopathy (2-6 cm above the insertion point)
123
Q

RFs for achilles tendinopathy

A
  • Sports that stress the Achilles (e.g., basketball, tennis and track athletics)
  • Inflammatory conditions (e.g., rheumatoid arthritis and ankylosing spondylitis)
  • Diabetes
  • Raised cholesterol
  • Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin)
124
Q

Presentation of achilles tendinopathy

A
  • Pain or aching in the Achilles tendon or heel, with activity
  • Stiffness
  • Tenderness
  • Swelling
  • Nodularity on palpation of the tendon
125
Q

Mx of achilles tendinopathy

A
  • exclude rupture by Simmond’s calf squeeze test
  • RICE
  • physio
  • orthotics
  • ESWT
  • surgery if all else fails
  • avoid steroid injections due to rupture risk
126
Q

what is achilles tendon rupture

A

loss of the connection between the calf muscles (gastrocnemius and soleus) to the heel (the calcaneus bone).

127
Q

RFs for achilles tendon rupture

A
  • Sports that stress the Achilles
  • Increasing age
  • Existing Achilles tendinopathy
  • Family history
  • Fluoroquinolone antibiotics
  • Systemic steroids
128
Q

Presentation of achilles tendon rupture

A
  • Sudden onset of pain in the Achilles or calf
  • A snapping sound and sensation
  • Feeling as though something has hit them in the back of the leg
129
Q

diagnosing achilles tendon rupture

A

positive simmond’s triad (palpation, examining the angle of declination at rest and the calf squeeze test)
USS

130
Q

Mx of achilles tendon ruptur

A
  • RICE
  • non surgical: boot 6-12wks
  • surgical
    both have same outcomes
131
Q

what is plantar fasciitis

A

inflammation of the plantar fascia (attaches calcaneus at heel to toe flexor tendons)

132
Q

Presentation of plantar fasciitis

A
  • gradual onset of pain on the plantar aspect of the heel
  • tender to palpate
  • worse on walking
133
Q

Mx of plantar fasciitis

A

RICE
analgesia
physio
steroid injection
surgery or ESWT- rare

134
Q

Mx of fat pad atrophy

A

comfortable shoes, insoles

135
Q

what is Morton’s neuroma

A

Dysfunction of a nerve in the intermetatarsal space (between the toes) towards the top of the foot
Usually between 3rd and 4th metatarsal

136
Q

presentation of Morton’s neuroma

A
  • pain at front of foot
  • sensation of lump in shoe
  • burning, numbness
  • high heels can exacerbate
137
Q

Mx of morton’s neuroma

A
  • avoid heels
  • analgesia
  • insoles
  • steroid injections
  • radiofrequency ablation
  • surgery
138
Q

what is a bunion

A

bony lump created by a deformity at MTP joint of big toe

139
Q

mx of a bunion

A

wide shoes
surgery

140
Q

aspirate of fluid in gout signs

A

needle shaped crystals
negative bifringence
monosodium urate crystals

141
Q

Mx of gout

A

NSAIDs
colchicine
steroidss
allopurinol- prophylaxis

142
Q

what is adhesive capsulitis

A

frozen shoulder
middle age
RF diabetes
primary- no trigger
secondary- trauma, surgery
inflammation and fibrosis in the joint capsule lead to adhesions

143
Q

presentation of adhesive capsulitis

A
  • pain usually external rotation
  • stiffness
  • gradually improves 1-3 years
144
Q

Mx of adhesive capsulitis

A

analgesia
physio
steroid injections
hydrodilation
manipulation under anaesthesia
arthroscopy to cut adhesions

145
Q

muscles of the rotator cuff

A

SITS
1. supraspinatus- abduct
2. Infraspinatus- externally rotates
3. Teres minor- externally rotates
4. subscapularis- internally rotates

146
Q

presentation of rotator cuff tear

A
  • shoulder pain mostly on abduction
  • weakness associated with movement
147
Q

Mx of rotator cuff tear

A

degenerative cause= conservative (analgesia, physio)
young= surgery

148
Q

what is subluxation

A

partial dislocation of the shoulder then pops back in

149
Q

most common type of shoulder dislocation

A

90% anterior (force)
posterior (seizure or electric shock)

150
Q

associated damage with shoulder dislocation

A
  • glenoid labrum tear
  • bankart lesion
  • Hill-Sachs lesion
  • axillary nerve damage (C5-6, regimental badge)
151
Q

Mx of shoulder dislocation

A

relocate
physio
shoulder stabilisation surgery

152
Q

Mx of olecranon bursitis

A
  • RICE
  • Analgesia
  • Protect the elbow from pressure or trauma
  • Aspiration of fluid
  • Steroid injections
153
Q

Example of repetitive strain injury

A
  • lateral epicondylitis (tennis elbow)
154
Q

causes of repetitive strain injury

A

any repetitive movement often work related

155
Q

presentation of repetitive strain injury

A
  • Pain, exacerbated by using the associated joints, muscles and tendons
  • Aching
  • Weakness
  • Cramping
  • Numbness
156
Q

Mx of repetitive strain injury

A

RICE
analgesia
physio
steroid injection

157
Q

what is epicondylitis

A

inflammation at the point where the tendons of the forearm insert into the epicondyles at the elbow

158
Q

epicondyles of the distal humerus

A
  • medial: flex wrist
  • lateral: extend wrist
159
Q

what is lateral epicondylitis

A
  • tennis elbow
  • pain and tenderness at the lateral epicondyle
  • pain often radiates down the forearm
  • weakness in grip strength
160
Q

what is medial epicondylitis

A
  • golfer’s elbow
  • pain and tenderness at the medial epicondyle
  • radiates down the forearm
  • weakness in grip strength
  • aggravated by wrist flexion and pronation
161
Q

Mx of epicondylitis

A

self-limiting
rest
analgesia
physio
steroid injection
rarely surgery

162
Q

What is De Quervain’s tenosynovitis

A

swelling and inflammation of the tendon sheaths in the wrist
primarily affects:
- Abductor pollicis longus (APL) tendon
- Extensor pollicis brevis (EPB) tendon

163
Q

Presentation of de quervain’s tenosynovitis

A

sx at radial aspect of wrist near base of thumb
- Pain, often radiating to the forearm
- Aching, Burning
- Weakness, Numbness
- Tenderness

164
Q

Mx of de quervain’s tenosynovitis

A

rest
analgesia
splints
physio
steroid injection
rarely surgery

165
Q

what is trigger finger

A

pain and difficulty moving a finger. It is also known as stenosing tenosynovitis.
thickening of tendon or tightening of sheath

166
Q

RFs for trigger finger

A
  • 40s or 50s
  • F>M
  • Diabetes (more with type 1, but also type 2)
167
Q

presentation of trigger finger

A

finger that is:
- painful and tender at MCP
- doesn’t move smoothly
- popping/clicking sound
- gets stuck flexed
- worse in morning

168
Q

Mx of trigger finger

A

rest
analgesia
splint
steroid sinjection
surgery

169
Q

what is Dupuytren’s contracture

A

fascia of the hand becomes thickened and tight, leading to finger contractures.

170
Q

RF for dupuytren’s contracture

A
  • age
  • FH (autosomal dominant)
  • Male
  • Manual labour, particularly with vibrating tools
  • Diabetes (more with type 1, but also type 2)
  • Epilepsy
  • Smoking and alcohol
171
Q

Mx of Dupuytren’s contracture

A

nothing or surgical
needle fasciotomy, limited fasciectomy or dermofasciectomy

172
Q

what is carpal tunnel syndrome

A

compression of the median nerve as it travels through the carpal tunnel in the wrist

173
Q

presentation of carpal tunnel syndrome

A
  • pain and numbness in the median nerve
174
Q

RFs for carpal tunnel syndrome

A
  • idiopathyic
  • repetitive strain
  • obesity
  • perimenopause
  • RA
  • diabetes
  • acromegaly
  • hypothyroidism
175
Q

Mx of carpal tunnel syndrome

A
  • rest
  • splint
  • steroid injection
  • surgery
176
Q

what is ganglion cyst

A

sacs of synovial fluid that originate from the tendon sheaths or joints

177
Q

presentation of ganglion cysts

A
  • non painful palpable and visible lump
178
Q

Mx of ganglion cyst

A

no intervention in most cases will resolve
- needle aspiration
- surgical excision

179
Q

what is discitis

A

infection in the intervertebral disc space
It can lead to serious complications such as sepsis or an epidural abscess.
RF infective endocarditis

180
Q

most common cause of discitis

A

staph aureus

181
Q

mx of discitis

A

6-8 weeks IV abx

182
Q

salter harris classification for gowth plate injury

A
  • I: Fracture through the physis only (x-ray often normal)
  • II: Fracture through the physis and metaphysis (MC)
  • III: Fracture through the physis and epiphysis to include the joint
  • IV: Fracture involving the physis, metaphysis and epiphysis
  • V: Crush injury involving the physis (x-ray may resemble type I, and appear normal)
183
Q

when to do a DEXA without calculating FRAX csore

A
  • > 50 y/o + history of fragility fracture
  • < 40 y/o + major fragility fracture RF
  • before starting treatments that may have a rapid adverse effect on bone density (for example, sex hormone deprivation for treatment for breast or prostate cancer)
184
Q

Mx of Paget’s

A

bisphosphonates

185
Q

what is a positive Lachman test suggestive of

A

ACL injury

186
Q

sign of damage to femoral nerve

A

Weakness in knee extension, loss of the patella reflex, numbness of the thigh
L3

187
Q

sign of damage to lumbosacral nerve

A

Weakness in ankle dorsiflexion, numbness of the calf and foot

188
Q

sign of damage to sciatic nerve

A

Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle

189
Q

sign of damage to obturator nerve

A

Weakness in hip adduction, numbness over the medial thigh

190
Q

how to identify dislocation and fracture from exam

A

dislocation= internal rotation
fracture= external rotation

191
Q

what is leriche syndrome

A

in males, triad:
1. Claudication of the buttocks and thighs
2. Atrophy of the musculature of the legs
3. Impotence (due to paralysis of the L1 nerve)

Finals (12 decks)

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