ORTHO bro Flashcards
Ac joint degenerative disease
a very common occurance, by 3rd decade of life usually.
pain particularly on overhead or cross body activities.
occurs due to large axial loads on a small surface area.
Ix: imaging with x-rays, or palpation
Rx: activity modification, nsaids.
steroid injection
surgery- remove only 8-10 mm as any more risks loosing ligamentous stability.
AC joint seperation
quite common, 9% of all shoulder injuries.- a fall onto adducted arm.
Rf: male, athletes.
S+S: pain, noticable seperation, history consistent, pain on adduction
Ix: imaging- x-ray Ap B/L.
+ axuillary lateral view + zanca view.
Classification:
1- no instability- reducable Rx with sling
2- AC torn, CC sprained, horizonal instability-inc CC distance <25% of contralateral– RX with sling.
3- AC + CC torn. inc CC dist 25-100% contralateral. - controversial management.
3A has only vertical instability
3B has both horiz and vert.
4- AC + CC Torn- skin tenting, posterior fullness. - lateral clav dinsplaced into trap posteriorly on axillary XR. – surgery.
5- Ac +CC torn- shoulder droop, not imp with shrug. CC dist > 100% contralat. – surg
6- inferior dislocation- surg
achilles tendon rupture
sudden dorsiflexion of a plantarflexed foot- I.e stepping backwards
clinical diagnosis- dangle angle, thompsons test, weakness.
MRI can confirm + plan surgical management.
Rf: male, 30-40, weekend warrior, steroid injections, fluroquinolones.
S+S: pop, weakness, difficulty walking.
Rx: mix of casting + bracing or surgery to re-approximate the ends.- similar outcomes.
if ends done approximate- hen ? surgical management.
role of nsaids and corticosteroids in achilles tendinopathy
nsaids in acute phase only, not for long term use
no corticosteroids
ACL tear
half of all knee injuries
Rf: female, previous concussion, landing in risky position.
non contact pivoting injury, assoc with lateral meniscus tears (54% of time) medial in chroinc cases.
2 bundles- AM- ightest in flexion,
PL- tightest in extension
S+S: pop, immediate swelling,
Ix: lachmans most sensitive, pivot shift,
confirm with MRI scan
Rx: can be conservative
or
reconstruction-
repair - in younger/ avulsion patients.
adhesive capsulitis
painful, restrictive shoulder condition. fibrosing pathology. usually lasts 18-24 months.
Rf: women, 40-70. recent trauma to shoulder. DM, Thyroid
S+S: pain, worse in bed and disturbs sleep.
stiffness- capsular pattern
Ix: diagnosis of exclusion- X-rays +/- ultrasound may help.
Rx:
heat pack, physio, analgesia.
2’ -steroid early if no progress with physio.
3’ - MUA, Hydrodilatation, arthroscopic release.
pain and stiffness for 3 months–> refferal.
ankle fracture
generally following trauma.
most commonly lat mal.
but can be medial +/- posterior also.
inability to wt bear/ ottowa ankle rules helpful
Ix: plain x-ray.
Rx: non-displaced, anatomically reduced- conservative- cast 6/52
if open- debride wound, saline irrigation
internal fixation once wound clean.
if talar shift, irreducable, webber C, - ORIF.
distal biceps tendon rupture
excessive eccentric contraction- avulses bicep off its radial tuberosity.
occurs in dominant hand in men in their 40s.
Rf: steds (both types) smoking,
S+S: acute, pop sound, weakness + pain in supination. reverse popeye sign,
Ix: Hook test, MRI- will help beetween partial/ full.
Rx: low demand + willing to ccept functional loss- non-op
op otherwise- done within a few weeks of injury.
biceps tendinopathy
painful, swollen, and structurally weaker tendon that is at risk of rupture
Rf: young, active,
S+S: pain worse on stressing tendon, tenderness on palp,
Ix: speeds test
clinical diagnosis- aided by uss.
Rx: analgesia, physio
uss guided injections
3’- arthroscopic tenodesis, tenectomy.
clavicle fracture
fall onto lateral shoulder +/- adducted arm.
most common fracture of childhood- 10% of all fractures.
middle 1/3 # in 70% of cases, lateral in 28%, v rare medial.
Rf: male, sports, young, cycling, older + falling.
S+S: pain, trauma, setp, tenderness on palp,
Ix: perform a complete neurovasc exam.
X-rays- AP + 45 deg cephalic tilt.
Rx
- non displaced- sling with less than 90 deg motion
displaced- fix-
absolut indications for surg- neurvasc compromise, open, tenting, angulation/ displacement.
shortening of 1.5cm or more, or 15% of contralateral side. floating shoulder, poly trauma, seziure disorder.
compartment syndrome
where the ossiofascial compartment of the leg reaches pressure that causes occlusion of the vessels. – causing hypoaemia and damage
S+S: severe foot ankle and leg pain, worsens with time and movement of the foot.
- pain out of proportion with current sitch
common following trauma/ crush injuries.
common in the young.
Ix: compartment pressure measurement- within 5cm of #.
Rx: generally emergency fasciotomy of all 4 compartments. - anterior lateral and posteriomedial incisions- 15-18 in length.
distal radius fracture
most common orthopaedic injury- nearly 20% of all fractures.
FOOSH
50% intra-articular
RF: osteoperosis- DEXA reccomended for all women with one.
S+S: swelling, pain, deformity.
Ix: X-rays, AP, lateral, oblique.
Rx: non-op if- less than 5mm radial shortening
dorsal angulation of less than 5’
ORIF- if intra articular step >2mm.
dupuytrens contracture
benign proliferative disorder
painless nodule progressing to diseased cords.
2:1 male- female ratio. 5-7th decades of life.
northern europeans most at risk.
autosomal dominant with variable penetrance.
ring > small> middle > index.
cytokine-mediated transformation of normal fibroblasts into abnormal myofibroblasts, turning normal fascial bands into pathological cords
generally painless, restricts ROM.
Ix: clinical diagnosis
Rx: watch + wait
hand therapy + injection
needle aponeurotomy
partial/ full palmary fasciectomy if severe
elbow dislocation
most often posteriorlateral dislocations.
10-20 year old active people.
axial load, supination force + valgus posteriolateral.
progression of lig injury lateral to medial.
simple- if no assoc #.
complex- if # e.g terrible triad (coronoid + radial head)
Ix: x-ray.
Rx: simple- closed reduction and immobilisation splint at least 90’ for 10 days.
complex- ORIF- LCL repair, fix #s.
flexor tendon injury zones
1- fdp
2fdp and fds
3- palm
4 - carpal tunnel
5- after wrist
extensor tendon injury zones
odd is on a joint
1- dip or later
2- middle phalanx
3- pip
4- prox phalanx
5- mcp
6- back of hand
7- wrist.