ORTHO Flashcards
What is jumpers knee?
Patellar tendonitis
What occurs in Patellar tendinitis ?
microtears at tendon insertion at distal pole
Where does patella tendon insert?
Inserts into the tibial tuberosity
What are clinical signs of patella tendinitis?
pain in anterior knee
thickening and swelling
tender to palpation on tibial tuberosity
treatment options for patella tendinitis?
RICE, NSAIDS, Strapping, Brace
what is Osgood Schlaters injury?
Inflammation of the patella tendon (ligament) at the insertion point on the tibial tuberosity
What age and gender is osgood schlaters injury most common in ?
more common in boys aged 10-15 years of age
What is mechanism for osgood chlaters injury?
repeated tensil stress on the tendon leads to minor avulsion and inflammation at the tibial tuberosity head.
What is clinical presentation and clinical examiniation sign for osgood schlaters injury ?
pain on anterior knee.
exacerbated by kneeling or by jumping.
Examination will show:
- tender lump over the tibial tuberosity
- pain on resisted knee extension
What is treatment options for osgood schlaters injury?
treatment is symptomatic reflief as:
Benign, self limited condition
When will osgood schlaters injury most likely resolve?
resolves at growth hiatus
Anterior Knee Pain Causes
Patellofemoral Syndrome (young females) OSgood Schlatters (young males) Chrondromalacia Patellae Lateral Patellar Compression Syndrome ITB syndrome Patellar Instability (dislocation/sublaxation) Patellar tenditnitis Pre-oatellar bursitis Plica
Knee Dislocation: What is this associated with in terms of injury?
EMERGENCY: rare but serious: indicates severe injurysuch as high speed MVA with associated tears of multiple ligaments
What is seen physical examination?
Knee large effusion, swelling, pain and instability and ischaemic limb (due to popliteal artery injury) and potentially peroneal nerve injury
What is treatment of knee dislocation?
- Non operative URGENT closed reduction
- Operative ( vascular repair and ligament repair/reconstruction)
- Additional 6 weeks immobilisation
What are the acute complications of knee dislocation?
Common peroneal nerve injury
Popliteal artery occlusion
Compartment syndrome
What are 3 long term complications of a knee dislocation ?
Chronic stiffness (#1)
Chronic knee instability
post-traumatic arthritis
What is important about knee dislocation and the popliteal artery?
Popliteal artery occlusion can occur within the first 12 hours = important to check regularly on patients
What is used to diagnose knee dislocation ?
XRAY: AP/Lateral
CT Angiogram: Evaulate for arterial injury
Ankle Brachial Index: <0.9 indicates abnormalities
MRI: ligament injury, meniscus
MCL injuries: Mechanism they occur
Valgus force to knee ( outside to in) common in football
Haemarthrosis: WHy might it not be present in severe injuries?
Due to capsule disruption
MCL injuries: What is seen on examination
Tenderness at medial epicondyle and along tendon (inserts at around 4-6cm below tibial plateua, deep to pes aneurius)
Laxity/pain in valgus
What is MCL associated with injury wise?
ACL and medial meniscus (unhappy triad)
IN the case of multi-ligamntary injuried knee: treatment involves?
surgery
Treatment MCL:
Mostly conservative: ROM and strengthening and hinge knee brace.
Surgery is uncommon
Slipped capital femoral epiphysis:
What is this ?
what type salter harris
femoral head stays in acetabulum but slips inferiorly and the metaphysis slips nateirorlya nd superiorly = causes hip pain and a limp
Type 1 Salter Harris
Slipped capital femoral epiphysis: Is this bilateral or unilateral usually?
50% cases bilateral
Slipped capital femoral epiphysis: what occurs to the femur and metaphysis ?
Femur head remains in the acetabulum whilst the metaphysis slipps out anteriorly and superiorly
Slipped capital femoral epiphysis: what is this most common?
MOST common adolescent hip disorder
commonly occurs in puberty growth spurt
Slipped capital femoral epiphysis: when is peak incidence
pubertal growth spurt
Slipped capital femoral epiphysis: risk factors
obesity (main)
Male
hypothyroidism (risk for bilateral as lack of thyroid hormone influences bone age and growth hormone)
What is clinical presentation for SCFE?
What movements restricted?
Where tender?
Dull hip pain/referred knee pain with painful limp
restricted internal rotation and abduction (pts tend to hold in passive external rotation)
tenderness of joint capsule
SCFE: inability to ambulate/weight bear is classified as ?
unstable SCFE
What are 2 diagnostic methods for SCFE ?
XRAY - AP and and frog leg lateral
TSH to rule out hypothyroid
What will XRAY demonstrated for SCFE?
posterior and inferior displacement of the femoral head.
What is treatment for SCFE and why is fast treatment inmportant ?
Immediate surgical screw fixation (reduces risk of AVN)
No weight bearing allowed
What are three copmlications of SCFE ?
AVN
chondrolysis (resulting in loss of articular cartilage, narrowing of joint space)
premature hip osteoarthritis
osteomyelitis pathophysiology
Most commonly due to S aureus via inoculation, haematogenous spread or contiguous spread from adjacent tissue
osteomyelitis where is it found child vs adults
child = long bones
adult: vertebrae
osteomyelitis risk factors
IV drug uses
Immunocompromised
Diabetes
Trauma
Signs and symptoms osteomyelitis
signs: pain fever
signs: redness, oedema, abscess + draining sinus traact
osteomyelitis diagnosis:
Imaging:
Definitive test
Bloods
Imaging: MRI gold standrad, X-ray shows periosteal elevation
Definitive: Bone Biopsy/aspirate culture
Labs: WBCS, CRP, CBC and blood culture
Treatment osteomyelitis
Flucoxaccilin + vancomycin
Surgical: Irrigation and Debridement
+ hardware removal if present
Septic Arthritis: Pathophysiology:
adults
hardware
newborn
adults: S aureus
CONS: hardware
N gonorrhoea newborn or sexuallya ctive
clincal presenation Septic arthritis
localised joint pain
(erythem,a warmth, swelling)
may be systemic
inabability to wirght bear
SA Joint aspirate: will show?
yellow cloudy fluid increased WBC increased protein decreased glucose positive gram stain
SA treatment:
empiric flucox + vancomycin then guided by resutlts
non operative: theraputic joint aspirate
operative: arthoscopic/open irrigation and drainage
outcomes of SA
10 - 15% mortality
rapid joint destruction
Compartments syndrome clinical presentation
6 p’s
Pain (out of proportion with injury) Pain on passive stretch (sensitive tests) Pulseness Parasethesia Pallor Paralysis
treatment: Compartments
urgent fasciotomy +/- necrotic tissue debridement
complicaitons compartments
Volkman’s contracture (ischaemia causing necrosis then secondary fibrosis and calcification)
Rhabdomylosis: muscle breakdown - myoglobinuria
myotome vs dermatome
dermatome: single nerve skin supply
myotome: group of muscles supplied by single spinal nerve
UPPER LIMB MYOTOMES:
Elbow
C5-C6 = elbow flexion C7-C8= elbow extension
Shoulder
c5 shoulder abduction
c678 adduction
Wrist
c6 extension
c7 flexion
finger
c7 finger extension
c8 flexion
t1 abduction/adduction
finger
c7 finger extension
c8 flexion (little finger)
t1 abduction/adduction
Ulnar nerve roots
C8-T1
Median Nerve roots
C6-T1
Radial Nerve roots
C5-T1
fat embolism cause
piece of fat that can become lodged in vessels:
caused by long bone or pelvic fractures
Presentation fat embolism
respiratory distress (ARDS due to inflammatory damage to lungs)
neurological dec LOC
anaemia and thrombocytopenia
Subacromial impingement
compression (between head of humurs and underside of acromiom) of rotator cuff tendons (esp. supraspinatus) and subacromial bursa
subacromial impingement Causes spectrum of:
bursititis
tendonitis
tearing of Rotator cuff
subacromial impingement : clinical presentaiton
insidious onset pain wekaness and on active movement (painful arc of 60-120 degrees)
subacromial impingement non operative treatment
physio, NSAIDS and steroid injections
subacromial impingement operative
arthroscopy or open surgical repair either acromioplasty (shaving off acromiom) or repairing tendons (rotator cuff repair)
supraspinatus movement
abduction
suprascapular nerve
infra spinatus movement
external rotation
subscaprular nerve
Teres minor movement
external rotation
axillary nerve
subscapularis movement
internal rotation and adduction
subscapular nerve
