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Ortho and Rheum > Ortho > Flashcards

Ortho Flashcards

1
Q

What is ankylosis?

A

Stiffening of a joint with fibrous or bony Union across it

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2
Q

What is arthroplasty?

A

Creation of an artificial joint

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3
Q

What is a closed fracture?

A

One contained totally inside the body

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4
Q

What is a comminuted fracture?

A

A fracture having more than 2 parts

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5
Q

What is a multi fragmentary fracture?

A

A fracture having several discernible and countable parts

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6
Q

What is an open fracture?

A

One having any communication with the outside world

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7
Q

What is osteotomy?

A

Surgical cutting, wedging and then realignment in a bone

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8
Q

What is reaming?

A

Surgical widening of the medullary cavity of a bone

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9
Q

What is spondylolysis?

A

A defect in the pars interarticularis of a vertebra

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10
Q

What is spondylosis?

A

Term used for a generalised degenerative disease of the spine

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11
Q

What is subluxation of a joint?

A

Partial dislocation of a joint - as opposed to full dislocation

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12
Q

What does valgus mean?

A

Deformity of part of a limb laterally from the normal axis

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13
Q

What does varus mean?

A

Deformity of a part of a limb medially from the normal axis

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14
Q

What is cervical spondylosis? Examples

A

Degenerative changes of the cervical spine - changes can include degeneration of the annulus fibrosus and bony spurs narrowing the spinal canal and the IV foramina

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15
Q

Incidence of cervical spondylosis

A

Very common

90% of men >60 and women >50

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16
Q

Symptoms of cervical spondylosis x4

A

Usually asymptomatic
Can cause neck and arm pain with paraesthesiae
Sometime myelopathy (spastic weakness and later incontinence)

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17
Q

What is cervical spondylolisthesis?

A

Displacement of one vertebra upon the one below

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18
Q

Causes of cervical spondylolesthesis? X3

A

1) Congenital failure of fusion of odontoid process with axis or fracture of axis (skull, atlas and o-process slip forward on axis)
2) inflammation eg. RA or complicating throat infection - cause lax transverse ligament leading atlas to skip forward on axis
3) instability after injuries

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19
Q

What is cervical rib?

A

Congenital development of the costal process of c7 vertebra - is a spectrum so can just have prominent transverse processes
Can just be fibrous band - won’t show on x Ray

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20
Q

Symptoms of cervical rib

A

Can cause thoracic outlet compression - normally of lower brachial plexus therefore pain and numbness in hand/forearm, usually ulnar side
May be hand weakness and muscle wasting
Weak radial pulse +/- forearm cyanosis

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21
Q

What can cause infant torticollis?

A

Can result from birth damage to sternocleidomastoid muscle

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22
Q

Typical age and presentation of infant torticollis x3 symptoms

A

Age 1-36months with head tilting towards affected side
Can also get retarded facial growth in affected side
Tumour like muscle thickening - benign fibrous lesion

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23
Q

What are the rotator cuff muscles?

A

Supraspinatous, infraspinatous, teres minor and subscapularis

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24
Q

What do you suspect if all shoulder movements make shoulder pain worse?

A

Arthritis or capsulitis

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25
Q

What do you suspect if only some movements make shoulder pain worse?

A

Impingement

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26
Q

Best way to test shoulder external rotation

A

Hold elbows flexed with hands on waist and move hands outwards

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27
Q

Best way to test shoulder internal rotation

A

Ask to do up bra

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28
Q

Who is most commonly affected by atraumatic recurrent shoulder dislocation?

A

Teenagers with no history of trauma but general joint laxity

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29
Q

What does AMBRI mean for recurrent shoulder dislocations?

A 
Atraumatic 
Multidirectional
Bilateral
Rehabilitation for treatment 
Inferior capsule shift surgery if rehab fails
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30
Q

What are most traumatic shoulder dislocations

A

Anterior
Sometimes inferior
Rarely posterior

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31
Q

What does TUBS mean for recurrent shoulder dislocations?

A

Traumatic
Unilateral
Bankart lesion (capsule attached to scapula but pulled off from glenoid labrum)
Surgical treatment

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32
Q

What movement causes anterior dislocations?

A

Abduction and external rotation of arm eg.putting coat on

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33
Q

What is Hill-Sachs lesion?

A

Posterolateral ‘dent’ in humeral head which occurs with anterior dislocations

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34
Q

What happens in rare posterior shoulder dislocations?

A

Capsule torn from back of scapula
Humeral dent is superomedial
Caused by abduction and medial rotation - eg.seizure

35
Q

What is Neer’s test?

A

Passive flexion of shoulder with pronated arm whilst stabilising scapula - painful arc between 60-120• is impingement

36
Q

What is jobe test?

A

Patient internally rotates arm whilst held in 90• abduction and 30• forward flexion with extended elbow
Further abducting against resistance cause pain = supraspinatus weakness and injury

37
Q

What is speeds test?

A

Patient has arm flexed at 60•, forearm in supination and attempt to flex shoulder against resistance
Pain on palpation of long head of biceps tendon = biceps tendonitis

38
Q

What is apprehension test?

A

Elbow flexed at 90•, forearm supine, abduct and externally rotate arm to 90•
Apprehension = anterior joint instability

39
Q

What is scarf test?

A

Forced adduction of arm across the neck. If causes pain then AC joint disease

40
Q

What is painful arc syndrome?

A

Pain on abducting 45-160•

41
Q

Causes of painful arc syndrome x3

A

Supraspinatus tendinopathy
Calcifying tendinopathy
AC joint osteoarthritis

42
Q

What is cubitus valgus and what is it associated with?

A

Increased carrying angle at elbow
Associated with turners syndrome
Can lead to ulnar neuritis and OA

43
Q

What is Huestons table top test?

A

If someone with dupuytrens contracture can’t place palm flat on surface the refer for surgery (fasciotomy)

44
Q

What is arthrodesis?

A

Surgical fusion of a joint

45
Q

What is Volkmann’s ischaemic contracture?

A

Muscle necrosis following compartment syndrome or interruption of the brachial artery near the elbow - results in contraction and fibrosis mainly of flexor pollicis longus and flexor digitorum profundus

46
Q

Symptoms of Volkmann’s ischaemic contracture

A

Forearm pronation, wrist flexion, thumb flexion and adduction, digital MCP joint extension and IPJ joint flexion (causing curved hand)

47
Q

What does straight leg raising test?

A

Looking for underlying herniated disc
Lie flat, knee extended, lift leg off couch and note angle which can be reached before eliciting pain
30-70• Lasegues sign positive

48
Q

Mechanism of straight leg test

A

Stretches sciatic nerve and causes root pain

49
Q

What else can you do with straight leg test

A

If lifting unaffected leg causes pain in affected side it is said to be positive and sign of herniated disc

50
Q

What is Paget’s disease of the bone

A

Disorder characterised by excessive bone breakdown and formation with disordered bone remodelling which results in pain and misshapen weak bones

51
Q

What is the natural spinal curvature?

A

Thoracic kyphosis, Lumbar lordosis and sacral kyphosis

52
Q

What is kyphosis?

A

Spinal thoracocervical flexion = hump back

53
Q

Why is congenital kyphosis important?

A

Cord compression and paraplegia can sometimes develop rapidly

54
Q

What is scoliosis?

A

Lateral curvature of the spine

55
Q

Causes of scoliosis? Most common

A

Idiopathic most commonly
Congenital due to failure of formation of segments
Neuromuscular
Syndromic eg. marfans or neurofibromatosis

56
Q

What is Cobb angle

A

Angle of lateral curvature of the spine

57
Q

Details of idiopathic scoliosis

A

Cobb angle >10•
Most common and worse in girls - convexity more often to the right
Curvature increases with growth
Can cause impaired lung function

58
Q

Management of idiopathic scoliosis

A

Bracing - with Boston or Milwaukee brace- not very comfortable - doesn’t stop it just slows progression
Can do surgical correction with spinal fusion and stabilisation

59
Q

What is lumbar microdiscectomy?

A

Surgery for lumbar disc prolapse

Microscopic resection of the protruding disc from a posterior approach

60
Q

What is endoscopic discectomy?

A

Same procedure as lumbar microdiscectomy but less invasive

61
Q

What is laser discectomy?

A

Radiographically assisted placement of a delivery device into the disc - through which a laser can be introduced to remove material

62
Q

What is lumbar disc arthoplasty

A

Becoming more common - replacing the disc with an artificial disc

63
Q

What is chemonucleolysis?

A

Used to more common, injection of chymopapain (comes from papayas) into nucleus pulposus - lots of controversy - risk of anaphylaxis but less invasive

64
Q

How do spinal tumours present?

A

Lower motor neurone signs at level of lesion and pain and UMN signs along with sensory loss below the lesion
Can get pain along course of the nerve
Can get bowel or bladder dysfunction
Cauda equina syndrome
If no bone involved can just get signs without pain

65
Q

What is presentation of spinal tumour with involvement of bones of the back?

A

Progressive, constant pain and local destruction of bone

Bone collapse can result in deformity or cause cord/nerve compression

66
Q

Presentation of pyogenic spine infection?

A

Difficult to diagnosis because all signs of infection may be absent - but may be secondary to other septic foci
Pain and movement is restricted by spasm

67
Q

Risk factors for pyogenic spine infection?

A

DM, immunosuppresion, urinary surgery or catheterisation

68
Q

Where does pyogenic spine infection usually occur?

A

Usually occurs in the disc space - discitis

69
Q

Infective organism in pyogenic spine infection?

A

50% are staphylococcal

Can also be streptococcal, proteus, E.coli, salmonella typhi and TB

70
Q

Treatment for pyogenic spine infection

A

Drain and antibiotics

Bed rest with brace

71
Q

Radiograph in pyogenic spine infection

A

Rarefaction (decreased density) or erosion
Joint space narrowing
Subligamentous new bone formation

72
Q

Who does spinal TB tend to affect?

A

Rare in west

Tends to affect young adults

73
Q

Presentation of spinal TB

A

Pain and stiffness on all back movements with raised ESR

74
Q

What is Pott’s paraplegia

A

Spinal cord compression due to spinal TB abscesses

75
Q

Radiograph in spinal TB

A

Narrow disc spaces and local osteoporosis
Bone destruction leading to wedging of vertebrae
May see paraspinal abscesses

76
Q

Treatment of spinal TB

A

Anti-TB medication and drain abscess

77
Q

What is apparent leg length disparity?

A

Leg length from ASIS and medial malleolus with pelvis held square - is equal
therefore either apparent shortening due to pelvic tilt or fixed adduction or apparent lengthening due to fixed hip abduction

78
Q

What is Thomas test?

A

Test for fixed flexion deformity - patient supine on examination couch, flex good hip up to chest until lumbar lordosis is obliterated (back flat on couch) if there is fixed flexion then the thigh on affected side will lift off couch as ll is obliterated

79
Q

Causes of a positive trendelenburg test

A

(pelvis falls off to side when standing on one leg)
Abductor muscle paralysis
Upward displacement of greater trochanter (severe coxa vara or dislocation)
Absence of stable fulcum eg. neck of femur fractures

80
Q

What is antalgic gait?

A

Shortening of stance phase on painful leg with quick and short steps

81
Q

What is Short-leg gait?

A

Discrepancy in length compensated by adduction of long leg at hip and abduction of short leg creating pelvic drop

82
Q

What is coxa vara?

A

A hip in which the angle between the neck and shaft of femur is less than normal 125degrees

83
Q

Consequences of coxa vara?

A

True shortening of limb - trendelenburg dip on walking makes the affected person limp

Ortho and Rheum (13 decks)

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