ortho/ MSK

Question 1

What is De Quervain’s tenosynovitis?

Answer 1

Common - sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.

Features: typically females 30 - 50 yrs.

Features
Wrist pain over the radial styloid process.
abduction of the thumb is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction –> pain over radial part of wrist

Mx: analgesia, seroid injection, splint, sometimes surgery

Question 2

What are the ottawa rules?

Answer 2

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular AKA posterior tip tenderness)

bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia AKA posterior tip tenderness)

-inability to walk four weight-bearing steps immediately after the injury and in the emergency department

Question 3

How does adhesive capsulitis present?

Answer 3

Stiff shoulder
reduced active and passibe ROM in abduction, int and ext rotation - esp external
Difficulty sleeping on that side
painful freezing phase, an adhesive phase and a recovery phase

Question 4

Acromioclavicular degeneration presentation?

Answer 4

popping, swelling, clicking or grindings and a positive scarf test

Question 5

Subacromial impingement presentation?

Answer 5

pain on overhead activities and demonstrate a painful arc of abduction on examination - worse between 90 and 120 degrees. There may also be popping, snapping or grinding.

Question 6

Rotator cuff injury presentation? (think fo diferent muscles)

Answer 6

supraspinatus injury: jobes (empty can test) +ve; painful arc of movement (pain between 60-120 degrees

subscapularis: lift off test +ve

infraspinatus muscle and teres minor.: Pain on resisted external rotation

Question 7

calcific tendinopathy presentation

Answer 7

tenderness on palpation of the affected area and reluctance to move the arm.

Question 8

Golfers vs tennis elbow

Answer 8

Golfer’s elbow or medial epicondylitis produces tenderness over the medial epicondyle and medial wrist pain on resisted wrist pronation.

Tennis elbow or lateral epicondylitis produces tenderness over the lateral epicondyle and lateral elbow pain on resisted wrist extension.

Men play golf (golfer’s medial), lads play tennis (tennis is lateral)
golF - pain on wrist Flexion - in golf you flex the wrist
tEnnis - pain on wrist Extension - in tennis you extend the wrist

Question 9

What is the management of intra Vs extracapsular fractires?

Answer 9

A subcapital fracture is the commonest type of intracapsular fracture of the proximal femur.

The intertrochanteric line is the line connecting the greater and lesser trochanters. Any fracture proximal to that line is classed as intracapsular, while any fracture distal is classed as extracapsular.

Intracapsular hip fracture:
Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.

Displaced Fracture:
THR if able to walk independently/ not confused/ med fit otherwise hemiarth.

Extracapsular hip fracture:
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

Question 10

what is the thompson test?

Answer 10

Squeeze calf - if rupture to achilles tendon, injured foot wont move

Also should feel for tendon rupture, foot may appear dorsiflexed.

Question 11

Presentation of plantar fasciitis?

Answer 11

Heel pain, worse on walking on tiptoes

Question 12

Presentation of mortons neuroma/ what is it?

Answer 12

Morton’s neuroma is a thickening of the tissue around the nerve usually between the 3rd and 4th toes. Pain tends to be on the ball of the foot.

Question 13

Differentiate these knee injuries:
meniscal tear
ACL injury
LCL injury
PCL injury
patellar tendon rupture

Answer 13

meniscal tear: twisting injury. knee locks, catches and gives way. Swelling occurs hours after injury. mcmurrays test +ve.

ACL: twisting injury. Popping noise, rapid swelling, lateral knee tenderness O/E, positive anterior draw test

LCL: caused by blow to medial knee, tenderness over lateral knee, MCL is the opp.

PCL: hyperextension injury. posterior knee pain, mild swelling. posteior draw test +ve

Patellar tendon rupture: cannot extend knee, patellar has visible deformity O/E

Question 14

What is femoroacetabular impingement?

Answer 14

typically active young adults
worse on prolonged sitting
caused by anatomy variant –> contact with femur and acetabular rim

Question 15

What is snapping hip syndrome?

Answer 15

Snapping of tendons during flexion and extension, painless

Question 16

What can cause osteonecrosis of the femoral head?

Answer 16

steroids, alcohol, autoimmune associated

Question 17

What is iliotibial band syndrome?

Answer 17

Cause of lateral knee pain in keen runners

Question 18

What are the signs of a scaphoid fracture?

Answer 18

1. Point of maximal tenderness over the anatomical snuffbox
   This is a highly sensitive (around 90-95%), but poorly specific test (<40%) in isolation
2. Wrist joint effusion
   Hyperacute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
3. Pain elicited by telescoping of the thumb (pain on longitudinal compression)
4. Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
5. Pain on ulnar deviation of the wrist

Question 19

What is Meralgia paraesthetica

Answer 19

Caused by compression of lateral cutaneous nerve of thigh
Typically burning sensation over antero-lateral aspect of thigh

Question 20

What is Greater trochanteric pain syndrome?

Answer 20

AKA Trochanteric bursitis

Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years

Question 21

What is a boxers fracture?

Answer 21

Boxer fracture describes a minimally displaced fracture of the fifth metacarpal. This typically results following the patient punching a hard surface, for example a wall.

Question 22

Ruptured ACL vs PCL vs MCL vs meniscal tear?

Answer 22

ACL: high twist force injury, loud crack, pain and RAPID joint swelling (haemoarthrosis),
positive draw test

PCL: hyperextension injury,
Paradoxical anterior draw test

MCL: leg forced into valgus via force outside the leg
Knee unstable when put into valgus position

Meniscal tear: Rotational sporting injuries
Delayed knee swelling
Joint locking
reccurent episoes of pain and effusions

Question 23

prepatellar vs infrapatellar bursitis?

Answer 23

prepatellar =housemaids knee = upright kneeling

infrapatellar = clergymans knee = kneeling

Question 24

Features of a Colles fracture?

Answer 24

Fall onto extended outstretched hands
Described as a dinner fork type deformity
Classical Colles’ fractures have the following 3 features:
Features of the injury
1. Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation

Question 25

What is a Smiths fracture?

Answer 25

(reverse Colles’ fracture)
Volar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed