Ortho Flashcards
what is OA
wear and tear in joints
imbalance of cartilage damage and chondrocyte reponse
where does OA occur
synovial joints
RF for OA
- obesity
- age
- FH
- occupation
- trauma
- female
commonly affected joints in OA
- Hips
- Knees
- Distal interphalangeal (DIP) joints in the hands
- Carpometacarpal (CMC) joint at the base of the thumb
- Lumbar spine
- Cervical spine (cervical spondylosis)
x-ray changes in OA
LOSS
- Loss of joint space
- Osteophytes (bone spurs)
- subchondral cysts
- subarticular sclerosis
presentation of OA
- joint pain and stiffness
- worsens with activity at end of day
- crepitus
- effusions around the joint
signs in hands of OA
- Heberden’s nodes (DIP)
- Bouchard’s node (PIP)
- squaring of base of thumb
- weak grip
- reduced range of motion
how to diagnose OA
clinical if >45
no morning stiffness
Mx of OA
- exercises, weight loss, OT
- topical NSAIDs
- oral NSAIDs
- joint injection
- weak opiates/paracetmaol
- joint replacement
When not to use systemic NSAIDs in OA
- renal failure
- peptic ulcer disease
- asthma
- be cautious in hypertension, can raise BP
most common joint replacement
hip, knee, shoulder
indication for joint replacement
- OA (MC)
- fracture
- septic arthritis
- osteonecrosis
- bone tumour
- RA
types of joint replacement available
- 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)
describe total hip replacement
lateral incision to hip
head of femur removed (metal/ceramic replacement)
acetabulum hollowed out and replaced by metal socket
describe total knee replacement
vertical knee incision
articular surfaces of femur and tibia removed- metal put in
spacer added between new articular surfaces
describe total shoulder replacement
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
most common organiss in prosthetic joint infection
staph aureus
RF for prosthetic joint infection
- prolonged oepration
- obesity
- diabetes
sx of prosthetic joint infection
fever
Pain
Swelling
Erythema
Increased warmth
mx of of prosthetic joint infection
prolonged abx
joint irrigation, debridement and replacement
types of fracture
- compound: skin and bone broken
- stable: bones are aligned
- pathological: bone break due to abnormality in the bone
how to describe a fracture
- transverse
- oblique
- comminuted
- spiral
- segmental
- greenstick
- compression
- buckle (torus) (child)
- salter harris (growth plate) (child)
colle’s wrist fracture
- fracture distal radius causing distal portion to displace posteriorly (up).
- Dinner fork deformity = Dorsally Displaced Distal radius
- falling on outstretched hand
smith wrist fracture
- 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
Describe a Galeazzi fracture
Dislocation of the distal radioulnar joint in association with a displaced radial shaft fracture
Galeazzi radius (Galaxy rangers)
Describe a Monteggia’s fracture
Dislocation of the proximal radioulnar joint in association with a displaced ulnar fracture
Monteggia ulna (Manchester United)
type of fracture caused by a Fall onto outstretched hand
scaphoid
what is the blood supply in scaphoid
retrograde (only one direction) - same in femur
so fracture can cut off blood supply –> avascular necrosis + non-union
presentation of scaphoid fracture
- Pain along the radial aspect of the wrist, at the base of the thumb
- Loss of grip / pinch strength
mx of scaphoid fracture
dependent on the type of fracture
- undisplaced fractures of the scaphoid waist = cast for 6-8 weeks
- displaced scaphoid waist fractures
requires surgical fixation
- proximal scaphoid pole fractures
require surgical fixation
describe ankle fractures
involve the lateral malleolus (distal fibula) or the medial malleolus (distal tibia)
classification used to describe fractures of the lateral malleolus
Weber classification
fracture described in relation to distal syndesmosis between tibia and fibula
types of ankle fracture
- 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)
mx of ankle fractures
- A= minimally displaced, stable fractures may weight bear as tolerated in a CAM boot
- young often need surgery using a compression plate.
- elderly= conservative
describe pelvis ring fracture
pelvis is a ring
when one part breaks another will too = significant intra-abdo bleeding –>emergency resus
diseases that can cause pathological fracture
tumour
osteoporosis
Paget’s disease of the bone
common sites of pathological fracture
femur
vertebral bodies
cancers that metastasise to the bone
PoRTaBLe
Po- prostate
R- renal
Ta- thyroid
B- breast
Le- lung
what is FRAX score
risk of a fragility fracture over the next 10 years
WHO criteria for osteoporosis using DEXA
> -1 normal
-1 to -2.5 osteopenia
< -2.5 osteoporosis
< -2.5 + fracture = severe OP
mx for reducing risk of fragility fractures
- vit D and calcium
- bisphosphonates (reduce osteoclast activity)
- denosumab if can’t have bisphosphonates
side effects of bisposphonates
- 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
mx of a fracture
mechanical alignment
- closed reduction manipulation
- surgical open reduction
stability = fixation with:
- casts, K-wires, nails, screws, plates
what is a fat embolism
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
signs of fat embolism
gurd’s criteria
major criteria:
- Respiratory distress
- Petechial rash
- Cerebral involvement
minor criteria
- jaundice
- fever, tachycardia
- thrombocytopenia
complication of fat embolism
multiple organ failure
10% mortality
RF for hip fracture
- age
- osteoporosis
- female
categories of hip fracture
- intra-capsular: can have avascular necrosis so need hemi/total hip replacement
- extra-capsular
describe intra-capsular fracture
break in the femoral neck, within the capsule of the hip, affects intertrochanteric line
classification used for intra-capsular fractures
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)
difference between non-displaced and displaced intra-capsular hip fracture
- 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
describe extra-capsular hip fractures
blood supply intact
intertrochanteric fracture- dynamic hip screw
subtrochanteric fracture- intramedullary nail
presentation of hip fracture
- Pain in the groin or hip, which may radiate to the knee
- Not able to weight bear
- Shortened, abducted and externally rotated leg
ix for hip fractures
- XR: AP and lateral. Disruption of Shenton’s line key sign
Mx of hip fracture
- analgesia
- surgery within 48hrs
what is compartment syndrome
pressure within a fascial compartment is abnormally elevated, cutting off the blood flow to the contents of that compartment
most common cause of compartment syndrome
tibia fracture
consequence of compartment syndrome
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,
priority of acute compartment syndrome
EMERGENCY
surgery ASAP otherwise tissue necrosis
cause of presentation of acute compartment syndrome
usually affects one of the fascial compartments in the leg, but can be forearm, feet, thigh and butt
- bone fracture
- crush injury
presentation of acute compartment syndrome
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)
Mx of acute compartment syndrome
- needle manometry to measure pressure
- escalate, remove dressings
- elevate limb
- emergency fasciotomy
what is chronic compartment syndrome
associated with exertion
pressure rises and restricts blood flow
what is osteomyelitis
inflammation in bone and bone marrow usually due to bacteria
most common site where osteomyelitis occurs in children
in a long bone is the metaphysis
what is Haematogenous osteomyelitis
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
MC organism for osteomyelitis
staph aureus
RF for osteomyelitis
- Open fractures
- Orthopaedic operations, particularly with prosthetic joints
- Diabetes, particularly with diabetic foot ulcers
- Peripheral arterial disease
- IV drug use
- Immunosuppression
Presentation of osteomyelitis
- fever
- pain and tenderness
- swelling
- erythema
Ix for osteomyelitis
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
Mx of osteomyelitis
- 6 weeks flucloxacillin +/- rifampicin/fusidic in first 2 weeks
- surgical debridgement
alternatives to fluclox = clindamycin or vancomycin
mx of chronic osteomyelitis
3+ months of abx
what is sarcoma
cancer originating in the muscles, bones or other types of connective tissue
types of bone sarcoma
- osteosarcoma (MC)
- chondrosarcoma (cartilage)
- Ewing sarcoma (children)
describe ewing sarcoma
<20y/o
highly malignant
onion skinning of periosteum
long bones/pelvis
describe chondrosarcoma
> 40y/o
Lytic lesion with fluffy calcification
axial skeleton/femur/tibia/pelvis
describe osteosarcoma
children
very rare
knee (60%)
Xray= Elevated periosteum (Codman’s
triangle). Sunburst appearance
types of soft tissue sarcoma
- 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
presentation of sarcoma
- A soft tissue lump, particularly if growing, painful or large
- Bone swelling
- Persistent bone pain
Ix for sarcoma
- xray
- USS for soft tissue
- CT/MRI
- biopsy
staging of sarcoma
TNM
common metastasis to lung
Mx of sarcoma
- Surgery (surgical resection is the preferred treatment)
- Radiotherapy
- Chemotherapy
- Palliative care
causes of mechanical back pain
- 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
causes of neck pain
- Muscle or ligament strain
- Torticollis
- Whiplash
- Cervical spondylosis
red flag causes of back pain
- 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)
nerve roots that form sciatic nerve
L4-S3
SN exits through greater sciatic foramn
divisions of sciatic nerve
divides into tibial nerve and common peroneal nerve
function of sciatic nerve
- sensation to the lateral lower leg and the foot
- motor function to the posterior thigh, lower leg and foot
presentation of sciatica
- unilateral pain from butt, down back of thigh to below knee or feet
- electic/shooting pain
- paraesthesia, numbness
causes of sciatica
- herniated disc
- spondylolisthesis
- spinal stenosis
sx of bilateral sciatica
RED FLAG for cauda equina
how to diagnose sciatica
sciatic stretch test (positive straight leg raise)
Mx for low risk chronic back
- self mx
- analgesia NSAIDs
- mobilise
mx for medium-high risk chronic back pain
- physio
- group exercise
- CBT
what is cauda equina syndrome
surgical emergency
nerve roots at base of spine compressed
collection of nerve roots travelling through canal after L2/3
cauda equina syndrome red flags
- 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
Mx of cauda equina syndrome
- Immediate hospital admission
- Emergency MRI scan
- Consider lumbar decompression surgery
mx of metastatic spinal cord compression
emergency
high dose dexamethasone
surgery
analgesia
what is spinal stenosis
refers to the narrowing of part of the spinal canal, resulting in compression of the spinal cord or nerve roots.
cervical or lumbar
types of spinal stenosis
- Central stenosis: narrowing of the central spinal canal
- Lateral stenosis: narrowing of the nerve root canals
- Foramina stenosis: narrowing of the intervertebral foramina
causes of spinal stenosis
- Congenital spinal stenosis
- Degenerative changes
- Herniated discs
- Thickening of the ligamenta flava or posterior longitudinal ligament
- Spinal fractures
- Spondylolisthesis
- Tumours
Presentation of spinal stenosis
- gradual onset
- severe= CES
- intermittent neurological claudication on exertion
how to diagnose spinal stenosis
MRI
Mx of spinal stenosis
- exercise
- analgesia
- physiotherapy
- decompression surgery
- laminectomy
what is meralgia paraesthetica?
localised sensory symptoms of the outer thigh caused by compression of the lateral femoral cutaneous nerve
mononeuropathy
where does lateral femoral cutaneous nerve originate
L1,2 and 3
presentation of meralgia paraesthetica
- abnormal sensations (dysaesthesia)
- loss of sensation in lateral femoral cutaneous nerve distribution.
- burning, numbness, pins and needles, cold sensation
Mx of meralgia paraethetica
mild- self limiting
Medical: NSAIDs, paracetamol, neuropathic meds
Surgical: decompression, transection of nerve, resection of nerve
what is trochanteric bursitis
inflammation of a bursa over the greater trochanter on the outer hip.
bursae: sacs with synovial fluid on bony prominences
presentation of trochanteric bursitis
- pain on outer hip: greater trochanteric pain syndrome
- middle age
- gradual onset
- aching/burning pain
- worse with activity
- tenderness on GT
causes of trochanteric bursitis
- Friction from repetitive movements
- Trauma
- Inflammatory conditions (e.g., rheumatoid arthritis)
- Infection
Mx of trochanteric bursitis
- rest, ice, analgesia
- physio
- steroid injection
4 ligaments in the knee
- Anterior cruciate ligament
- Posterior cruciate ligament
- Lateral collateral ligament
- Medial collateral ligament
presentation of meniscal tear
due to twisting movement e.g. sport
- pain
- swelling
- stiffness
- restricted ROM
- locking of knee
- knee giving way
test for meniscal tear
McMurray’s test
Mx of meniscal tear
MRI
RICE
Physio
Arthroscopy and repair/resection
Mx of ACL injury
RICE
NSAIDs
crutches and brace
physio
arthroscopy
what is osgood schlatter disease
- inflammation at the tibial tuberosity where the patella ligament inserts
- 10-15y/o
- M>F
- usually unilateral
presentation of osgood schlatter disease
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
Mx of osgood schlatter disease
- RICE
- NSAIDs
- knee pad
- physio
what is baker’s cyst
popliteal cyst usually secondary to degenerative changes
can be assoc with meniscal tears, OA, RA.
Presentation of baker’s cyst
- Pain or discomfort
- Fullness
- Pressure
- A palpable lump or swelling
- Restricted ROM in the knee (with larger cysts)
presentation of ruptured baker’s cyst
- pain
- swelling
- erythema
Ix for baker’s cyst
USS
MRI
Mx of baker’s cyst
Nil if asymptomatic
physio, analgesia, injection
arthoscopy
types of achilles tendinopathy
- Insertion tendinopathy (within 2cm of the insertion point on the calcaneus)
- Mid-portion tendinopathy (2-6 cm above the insertion point)
RFs for achilles tendinopathy
- 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)
Presentation of achilles tendinopathy
- Pain or aching in the Achilles tendon or heel, with activity
- Stiffness
- Tenderness
- Swelling
- Nodularity on palpation of the tendon
Mx of achilles tendinopathy
- exclude rupture by Simmond’s calf squeeze test
- RICE
- physio
- orthotics
- ESWT
- surgery if all else fails
- avoid steroid injections due to rupture risk
what is achilles tendon rupture
loss of the connection between the calf muscles (gastrocnemius and soleus) to the heel (the calcaneus bone).
RFs for achilles tendon rupture
- Sports that stress the Achilles
- Increasing age
- Existing Achilles tendinopathy
- Family history
- Fluoroquinolone antibiotics
- Systemic steroids
Presentation of achilles tendon rupture
- 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
diagnosing achilles tendon rupture
positive simmond’s triad (palpation, examining the angle of declination at rest and the calf squeeze test)
USS
Mx of achilles tendon ruptur
- RICE
- non surgical: boot 6-12wks
- surgical
both have same outcomes
what is plantar fasciitis
inflammation of the plantar fascia (attaches calcaneus at heel to toe flexor tendons)
Presentation of plantar fasciitis
- gradual onset of pain on the plantar aspect of the heel
- tender to palpate
- worse on walking
Mx of plantar fasciitis
RICE
analgesia
physio
steroid injection
surgery or ESWT- rare
Mx of fat pad atrophy
comfortable shoes, insoles
what is Morton’s neuroma
Dysfunction of a nerve in the intermetatarsal space (between the toes) towards the top of the foot
Usually between 3rd and 4th metatarsal
presentation of Morton’s neuroma
- pain at front of foot
- sensation of lump in shoe
- burning, numbness
- high heels can exacerbate
Mx of morton’s neuroma
- avoid heels
- analgesia
- insoles
- steroid injections
- radiofrequency ablation
- surgery
what is a bunion
bony lump created by a deformity at MTP joint of big toe
mx of a bunion
wide shoes
surgery
aspirate of fluid in gout signs
needle shaped crystals
negative bifringence
monosodium urate crystals
Mx of gout
NSAIDs
colchicine
steroidss
allopurinol- prophylaxis
what is adhesive capsulitis
frozen shoulder
middle age
RF diabetes
primary- no trigger
secondary- trauma, surgery
inflammation and fibrosis in the joint capsule lead to adhesions
presentation of adhesive capsulitis
- pain usually external rotation
- stiffness
- gradually improves 1-3 years
Mx of adhesive capsulitis
analgesia
physio
steroid injections
hydrodilation
manipulation under anaesthesia
arthroscopy to cut adhesions
muscles of the rotator cuff
SITS
1. supraspinatus- abduct
2. Infraspinatus- externally rotates
3. Teres minor- externally rotates
4. subscapularis- internally rotates
presentation of rotator cuff tear
- shoulder pain mostly on abduction
- weakness associated with movement
Mx of rotator cuff tear
degenerative cause= conservative (analgesia, physio)
young= surgery
what is subluxation
partial dislocation of the shoulder then pops back in
most common type of shoulder dislocation
90% anterior (force)
posterior (seizure or electric shock)
associated damage with shoulder dislocation
- glenoid labrum tear
- bankart lesion
- Hill-Sachs lesion
- axillary nerve damage (C5-6, regimental badge)
Mx of shoulder dislocation
relocate
physio
shoulder stabilisation surgery
Mx of olecranon bursitis
- RICE
- Analgesia
- Protect the elbow from pressure or trauma
- Aspiration of fluid
- Steroid injections
Example of repetitive strain injury
- lateral epicondylitis (tennis elbow)
causes of repetitive strain injury
any repetitive movement often work related
presentation of repetitive strain injury
- Pain, exacerbated by using the associated joints, muscles and tendons
- Aching
- Weakness
- Cramping
- Numbness
Mx of repetitive strain injury
RICE
analgesia
physio
steroid injection
what is epicondylitis
inflammation at the point where the tendons of the forearm insert into the epicondyles at the elbow
epicondyles of the distal humerus
- medial: flex wrist
- lateral: extend wrist
what is lateral epicondylitis
- tennis elbow
- pain and tenderness at the lateral epicondyle
- pain often radiates down the forearm
- weakness in grip strength
what is medial epicondylitis
- golfer’s elbow
- pain and tenderness at the medial epicondyle
- radiates down the forearm
- weakness in grip strength
- aggravated by wrist flexion and pronation
Mx of epicondylitis
self-limiting
rest
analgesia
physio
steroid injection
rarely surgery
What is De Quervain’s tenosynovitis
swelling and inflammation of the tendon sheaths in the wrist
primarily affects:
- Abductor pollicis longus (APL) tendon
- Extensor pollicis brevis (EPB) tendon
Presentation of de quervain’s tenosynovitis
sx at radial aspect of wrist near base of thumb
- Pain, often radiating to the forearm
- Aching, Burning
- Weakness, Numbness
- Tenderness
Mx of de quervain’s tenosynovitis
rest
analgesia
splints
physio
steroid injection
rarely surgery
what is trigger finger
pain and difficulty moving a finger. It is also known as stenosing tenosynovitis.
thickening of tendon or tightening of sheath
RFs for trigger finger
- 40s or 50s
- F>M
- Diabetes (more with type 1, but also type 2)
presentation of trigger finger
finger that is:
- painful and tender at MCP
- doesn’t move smoothly
- popping/clicking sound
- gets stuck flexed
- worse in morning
Mx of trigger finger
rest
analgesia
splint
steroid sinjection
surgery
what is Dupuytren’s contracture
fascia of the hand becomes thickened and tight, leading to finger contractures.
RF for dupuytren’s contracture
- age
- FH (autosomal dominant)
- Male
- Manual labour, particularly with vibrating tools
- Diabetes (more with type 1, but also type 2)
- Epilepsy
- Smoking and alcohol
Mx of Dupuytren’s contracture
nothing or surgical
needle fasciotomy, limited fasciectomy or dermofasciectomy
what is carpal tunnel syndrome
compression of the median nerve as it travels through the carpal tunnel in the wrist
presentation of carpal tunnel syndrome
- pain and numbness in the median nerve
RFs for carpal tunnel syndrome
- idiopathyic
- repetitive strain
- obesity
- perimenopause
- RA
- diabetes
- acromegaly
- hypothyroidism
Mx of carpal tunnel syndrome
- rest
- splint
- steroid injection
- surgery
what is ganglion cyst
sacs of synovial fluid that originate from the tendon sheaths or joints
presentation of ganglion cysts
- non painful palpable and visible lump
Mx of ganglion cyst
no intervention in most cases will resolve
- needle aspiration
- surgical excision
what is discitis
infection in the intervertebral disc space
It can lead to serious complications such as sepsis or an epidural abscess.
RF infective endocarditis
most common cause of discitis
staph aureus
mx of discitis
6-8 weeks IV abx
salter harris classification for gowth plate injury
- 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)
when to do a DEXA without calculating FRAX csore
- > 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)
Mx of Paget’s
bisphosphonates
what is a positive Lachman test suggestive of
ACL injury
sign of damage to femoral nerve
Weakness in knee extension, loss of the patella reflex, numbness of the thigh
L3
sign of damage to lumbosacral nerve
Weakness in ankle dorsiflexion, numbness of the calf and foot
sign of damage to sciatic nerve
Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle
sign of damage to obturator nerve
Weakness in hip adduction, numbness over the medial thigh
how to identify dislocation and fracture from exam
dislocation= internal rotation
fracture= external rotation
what is leriche syndrome
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)
what is spondylolithiasis
- one vertebra slips out of line with the one above it, most commonly in the lumbar spine.
- Presentation can b exaggerated lumbar lordosis and palpable depression above slipped vertebra
presentation of Supraspinatus tendonitis
- pain worsened by movement
- difficulty sleeping
- Rotator cuff injury
- Painful arc of abduction between 60 and 120 degrees
- Tenderness over anterior acromion
most common mechanism of ankle sprain
inversion of the foot
