Ortho/MSK Flashcards
What age group is most commonly affected by Achilles tendon rupture?
30-50 year old recreational athletes
Achilles tendon rupture can occur at any age but is most prevalent in this age group.
What activities are commonly associated with Achilles tendon rupture?
Activities requiring a forceful push off or forced dorsiflexion of the foot
These actions create a sudden stretch on the tendon, increasing the risk of rupture.
List the risk factors for Achilles tendon rupture.
- Increasing age
- Chronic/recurrent tendonitis
- Systemic corticosteroids (prolonged or high doses)
- Previous steroid injections into the Achilles tendon
- Cushing’s syndrome
- Systemic conditions (e.g. gout, rheumatoid arthritis, SLE)
- Quinolone antibiotics (mainly if >60 and/or also taking steroids)
These factors can increase the likelihood of tendon rupture.
What is a common presentation of an Achilles tendon rupture?
Acute sudden sharp pain in the tendon, sometimes a ‘snap’ is heard
The pain often transitions into a dull ache and may be accompanied by swelling.
What sign on examination of gait may be seen with Achilles tendon rupture
Inability to stand on tiptoe
This symptom is common due to weakness or absence of active plantar flexion.
What examination findings are typical for a complete Achilles tendon rupture?
Localized swelling and a palpable defect in the tendon
Bruising may mask the tendon defect.
What test is used to assess for a complete Achilles tendon rupture?
Simmonds / Thompson test
A positive test indicates a complete tendon rupture.
What does a positive Simmonds Test indicate?
Complete Achilles tendon rupture
The test is performed with the patient lying prone and involves squeezing the calf muscle to assess plantar flexion.
What imaging techniques can be used for the diagnosis of Achilles tendon rupture?
Ultrasound or MRI
These imaging modalities help confirm the diagnosis.
What is the initial management approach for an Achilles tendon rupture?
Non-weight bearing
This is crucial to prevent further injury to the tendon.
What are the two main management options for Achilles tendon rupture?
- Conservative management with a splint
- Surgical repair
The choice between these options depends on the severity and specifics of the rupture.
What is a Maisonneuve fracture?
A spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane
What type of force is usually involved in a Maisonneuve fracture?
Pronation-external rotation force
What are the common associated injuries with a Maisonneuve fracture?
Fracture of the medial malleolus or rupture of the deep deltoid ligament
What must be examined in all ankle injuries to detect a Maisonneuve fracture?
The proximal fibula
True or False: A Maisonneuve fracture is easy to detect.
False
What should be performed if there is local tenderness in a suspected Maisonneuve fracture?
X-rays
What is a stress fracture of the metatarsals also known as?
March fracture
In which populations are stress fractures of the metatarsals commonly seen?
People undertaking repetitive walking or running, such as army recruits and runners
What is the most common site for a stress fracture of the metatarsals?
2nd MT shaft
What are the other potential sites for metatarsal stress fractures?
- 3rd MT
- Navicular
- Other MTs
What symptom do patients typically present with in a metatarsal stress fracture?
A tender lump on the dorsum of the foot
Where is the lump typically located during examination of a metatarsal stress fracture?
Just distal to the mid-shaft of a metatarsal bone
What might early radiology show in cases of metatarsal stress fractures?
Normal findings
What might later radiographs reveal in metatarsal stress fractures?
- Hairline fracture
- Development of callus in more severe cases
What are the symptomatic treatments for a metatarsal stress fracture?
- Analgesia
- Elevation
- Rest
- Modified daily activity
What type of footwear may be more comfortable for patients with a metatarsal stress fracture?
Firm shoes or boots
What is the expected recovery time for a stress fracture of the metatarsals?
6-8 weeks
What should be considered if a patient is unable to weight bear due to a metatarsal stress fracture?
A brief period in an ‘Aircast’ boot until symptoms improve
What is developmental dysplasia of the hip (DDH)?
A condition where the hip joint does not properly form in infants and young children.
True or False: DDH can occur in one or both hips.
True
Which population is most at risk for developing DDH?
Females, particularly those who are firstborn and breech presentation.
Fill in the blank: The __________ test is commonly used to assess hip stability in newborns.
Barlow
What is the primary treatment for mild cases of DDH?
Pavlik harness
Before 6 months what imaging is used to assess developmental dysplasia of the hip
USS
after 6 month Xray
What is a potential long-term consequence of untreated DDH?
Early onset osteoarthritis
True or False: DDH is generally asymptomatic in infants.
True
At what age is it recommended to start screening for DDH?
At birth and during well-child visits until 1 year of age.
What surgical procedure may be necessary for severe cases of DDH?
Open reduction and pelvic osteotomy
What is injury causes a medial calf tear?
An injury resulting from an acute, forceful push-off with the foot
Often seen in athletes, particularly ‘weekend warriors’
What symptoms might a patient experience during a medial calf tear?
An audible pop
This may be accompanied by a sensation of being struck in the calf
What are common complaints from a patient with a medial calf tear?
Pain in the calf area, radiating to the knee or ankle
Patients may describe the pain as sharp or sudden
What physical examination findings are noted in a medial calf tear?
Asymmetric calf swelling & discoloration
Swelling may spread to the ankle and foot
What might be visible if swelling has resolved in a medial calf tear?
A visible defect in the medial gastrocnemius muscle
Indicates the location of the tear
Where is tenderness most pronounced in a medial calf tear?
At the medial musculotendinous junction
Tenderness is also noted in the entire medial gastrocnemius muscle
What should palpation of the Achilles tendon reveal in a medial calf tear?
An intact tendon
What symptoms are associated with passive ankle dorsiflexion in a medial calf tear?
Moderate to severe pain
What is the patient’s response to active resistance to ankle plantar flexion in a medial calf tear?
Moderate to severe pain
Pain occurs due to the firing of the torn muscle fibers
What is recommended regarding weight bearing after a medial calf tear?
Early weight bearing, as tolerated
Helps in the recovery process
Define Colles Fracture
Dorsally displaced distal radius fracture
What is freibergs disease
Osteochondrosis affecting the toes
The articular surfaces of the 2nd or third metatarsal heads collapse
What is a typical presentat of freibergs disease
Girl age 12-15 pain on weight bearing
Which muscle flexes the thumb
Flexor pollicis longus
Which carpal bone is commonly fractured in a FOOSH
Scaphoid
- concurrent wrist fractures in 5-12
