Ortho Flashcards
Adhesive Capsulitis - clinical findings
Associations
diabetes mellitus: up to 20% of diabetics may have an episode of frozen shoulder
Features typically develop over days
- external rotation is affected more than internal rotation or abduction
- both active and passive movement is affected
- patients typically have a painful freezing phase, an adhesive phase and a recovery phase
- bilateral in up to 20% of patients
the episode typically lasts between 6 months and 2 years
Ankle Ottawa Rules
The Ottawa Rules for ankle x-rays have a sensitivity approaching 100%
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
- bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
- bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
Inability to walk four weight-bearing steps immediately after the injury and in the emergency department
There are also Ottawa rules available for both foot and knee injuries
Nerve Compression features: L3-S1
L3:
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4:
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L5:
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1:
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Meniscal tear
Typically result from twisting injuries.
Features
- pain worse on straightening the knee
- knee may ‘give way’
- displaced meniscal tears may cause knee locking
- tenderness along the joint line
- Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee
Elective hip replacement - post procedure VTE prophylaxis?
LMWH for 10 days followed by aspirin (75 or 150 mg) for a further 28 days
or
LMWH for 28 days combined with anti-embolism stockings until discharge
or
Rivaroxaban
Elective knee replacement - post procedure VTE prophylaxis?
Aspirin (75 or 150 mg) for 14 days
or
LMWH for 14 days combined with anti-embolism stockings until discharge
or
Rivaroxaban
Fragility fractures of the pelvis, hip and proximal femur - post procedure VTE prophylaxis?
Offer VTE prophylaxis for a month to people with fragility fractures of the pelvis, hip or proximal
femur if the risk of VTE outweighs the risk of bleeding. Choose either:
LMWH , starting 6-12 hours after surgery or fondaparinux sodium, starting 6 hours after surgery, providing there is low risk of bleeding.
