Ortho Flashcards
Name the rotator cuff muscles
(SITS) Supraspinatus Infraspinatus Teres minor Subscapularis
What conditions make up rotator cuff disorders?
Subacromial (shoulder) impingement
Rotator cuff tear
Calcific tendonitis
Which imaging technique is first line for adhesive capsulitis and other shoulder joint problems?
USS
What does a positive scarf test indicate?
Acromioclavicular disorder
What does supraspinatus do?
ABducts 0-15 degrees and assists deltoid 15-90
Which muscles abduct the arm beyond 90 degrees?
Trapezius and serratus anterior
What is the ‘lift off test’ (resisted internal rotation) used for?
Subscapularis pathology
What is resisted external rotation a test for?
Infraspinatus
Teres minor
Name a test for shoulder impingement
Neers test
Hawkins-kennedy test
Which condition is adhesive capsulitis associated with?
DM
What examination findings are suggestive of frozen shoulder?
Unable to do passive external rotation
What is the most common cause of acromioclavicular joint problems?
Trauma (e.g. fracture of clavicle in young males)
Which nerve can be damaged in shoulder dislocation?
Axillary
Are most shoulder dislocations anterior or posterior?
Anterior
Define compartment syndrome
Critical pressure increase within compartmental tissue causing decline in perfusion to tissue within that compartment
Causes of compartment syndrome
Fracture
Crush
Burns
Penetrating wounds
How does compartment syndrome present?
PAIN disproportionate to injury
Tx compartment syndrome
Fasciotomy
Which organism most common cause osteomyelitis
S.aureus
What should you suspect if a young person found to have spinal fracture following low impact trauma?
Tumour
Which pt group are at very high risk of spinal fracture and always need CT rather than XR to exclude?
Anky spond
Which primary ca most commonly metastasise to bone?
Breast Bronchus Thyroid Kidney Prostate
What components form FRAX score?
3 person - age sex BMI
3 # - previous #, parent hip #, low femoral neck BMD
3 in - alcohol, smoking, steroids
2 conditions - RA, secondary causes (e.g. prem menopause)
Describe the appearance of a colles # on XR
Distal radius # with dorsal displacement of fragments
Describe the appearance of a smiths # on XR
Distal radius # with volar displacement of fragments
What physical abnormality is seen in Colles #?
Dinner fork deformity
Which nerve is most commonly damaged in a colles #
Median
How is colles # mx?
Reduction under anaesthesia
What deformity is seen in smith #?
Garden spade deformity
Which nerve is damaged in a smith #?
Median
How must you treat suspected scaphoid #?
All must be treated with cast immobilisation and followed by repeat XR/examination
Sign of scaphoid #
Snuffbox tenderness
What would a leg with a NOF# look like on exam?
Shortened, adducted and externally rotated
What classification can be used to grade intracapsular fractures?
Garden classification
How do you determine when to XR an ankle injury?
Ottowa ankle rules
How do you classify ankle #?
Weber classification
How do you manage a type C ankle #?
Internal fixation
What are the 4 stages of # healing?
Haematoma formation
Soft callus formation
Bony callus formation
Bone remodelling
What T score indicates osteopenia
Between -1 and -2.5
What are the risk factors for osteoporosis?
SHATTERED Steroids Hyperthyroid/hyperparathyroid Alcohol and smoking Thin Testosterone decreased Early menopause Renal/liver dysfunction Erosive disease (RA) Dietary Ca low
How is osteoporosis tx?
Ca and vit D supplements
Bisphosphonates
Side effects of bisphosphonates
Oesophagitis
Osteonecrosis of jaw
What are the causes of osteomalacia?
Vit D deficiency
CKD (renal osteodystrophy)
Drug-induced (e.g. anti-convulsants)
Liver cirrhosis
What biochemistry findings are suggestive of osteomalacia?
Low 25(OH) vit D
Raised ALP
Low Ca and P (30%)
Secondary hyperparathyroidism
What XR sign is suggestive of osteomalacia?
Looser’s zone
pseudofractures
What are the roles of vit D?
Increase osteoclast function
Increase Ca and P absorption
Decreases PTH secretion
What is the role of PTH?
Increases osteoclast function
At kidney - increases Ca reabsorption but increases phosphate excretion
What biochemical findings suggest primary hyperparathyroidism?
Increased Ca, ALP and PTH
Decreased P
What’s the most likely diagnosis of an elderly women px with increased thirst. Blood tests reveal raised calcium and low phosphate.
Primary hyperparathyroidism
What biochemistry is suggestive of Pagets disease?
Isolated raised ALP
Signs of Rickets
Leg bowing
Knock knees
Rachitic rosary
delayed walking
What causes hypocalcaemia with raised PO4?
CKD
Hypoparathyroidism
What causes hypocalcaemia with low/normal P?
Vit D deficiency/ osteomalacia
Acute pancreatitis
CKD?
Px of hypocalcaemia
SPASMODIC
Spasms
Perioral paraesthesia
Anxious/irritable
Seizures Muscle tone increased Orientation impaired/confusion Dermatitis Cardomyopathy (long QT on ECG)
XR findings in OA
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
RA XR findings
Loss of joint space
Erosions
Softening of bones (osteopenia)
Soft tissue swelling
Which cells secrete PTH?
Chief cells
You biopsy a bone in leg and discover a malignant primary tumour, what is your first management step?
Immobilise the limb to prevent pathological fracture leading to dissemination
What is the main organism that causes septic arthritis?
S aureus
Which STI can cause SA?
N.gonorrhoea
Which nerve can be damaged in elbow dislocation?
Ulnar
What are the treatment options for intracapsular fracture?
Fit = total hip replacement Immobile = hemiarthroplasty
How do you treat a intertrochanteric #?
Dynamic hip screw
How tx subtrochanteric #?
nail
How can you classify intracapsular #?
Garden classification
How do you determine whether ankle injury needs XR?
Ottowa ankle rules
How to manage weber A #?
Put in cast and ask to return in one week
How to manage weber B?
Do weight bearing XR to decide whether needs surgery
How to manage weber C #?
open reduction and internal fixation
