ortho passmed (2) Flashcards
Common cause of bilateral carpal tunnel syndrome
Rheumatoid arthritis
5 signs found in carpal tunnel syndrome:
- Compression of median nerve
- wasting of THENAR eminence
- flexion of wrist: reproduces symptoms
- weakness of thumb abduction
- Tinel’s sign
Treatment of carpal tunnel syndrome?
6 week trial of conservative treatments: if symptoms are mild-moderate
- wrist splint at night +/- steroid injection (main treatment=wrist split)
if severe symptoms still persist: surgical decompression; (flexor retinaculum division)
Avascular necrosis of femoral head?
- crescent sign
- MRI is inv. of choice
- risk factors: chemo, alcohol excess, trauma
- on scan: looks flat and decreased volume of femoral head
- initially asymptomatic then pain.
- mx: maybe joint replacement may be needed
1st line mx. for lower back pain?
NSAIDS - naproxen
- not use paracetamol, if nsaids aren’t enough, consider co-codamol
Ganglion presentation?
Firm and well-circumscribed mass that does trans illuminates on the dorsal aspect of the wrist.
Mx: usually disappears spontaneously after several months, for severe symptoms: can do surgical excision of the cysts.
Ddx: Lipoma: does NOT transilluminate
IVDU users with infective endocarditis + presenting with: lower back pain, constant and sharp radiating down leg?
Discitis: most common cause: Staph Aureus
- Infective Endocarditis can present with ortho symptoms.
Inv: MRI= has highest sensitivity
Mx: 6-8 wks of abx: identify which abx to use: by CT guided biopsy or blood culture
Complications: sepsis, epidural abscess
Ddx: Osteomyelitis: affects 1 specific joint/bone and pain localised to that area
If scaphoid fracture is suspected, but imaging is inconclusive?
Need to do: further imaging + clinical review(referral to orthopaedics) should occur at 7-10 days
falling on outstretched hand (FOOSH); which fracture?
Scaphoid Fracture
- usually presents with tenderness over anatomical snuffbox.
Mx: undisplaced fracture: cast for 6-8 weeks, displaced fracture: needs surgical fixation
Complications: avascular necrosis, non-union (pain and early osteoarthritis)
Ottowa ankle rules: for when to get an ankle Xray?
Either:
- Bony tenderness over the malleoli zones OR an inability to walk four weight-bearing step
These rules include: pain in the malleolar or midfoot zone, bone tenderness at the posterior edge or tip of either malleolus, inability to bear weight both immediately and in the emergency department (4 steps). Swelling, although commonly associated with ankle sprains and fractures, is not included within these criteria as it does not specifically indicate a fracture.
- therefore if doesn’t meet Ottowa criteria: safety net and analgesia
Psoas/iliopsoas abscess presenting features:
Fever/back pain with pain on extension of the hip
- most common cause: staph aureus + haematogenous spread of bacteria
- Secondary cause: could also be IVDU
Trochanteric bursitis (greater trochanteric pain syndrome) presentation?
presents with isolated lateral hip/thigh pain with tenderness over the greater trochanter
- is most common in women aged: 50-70 years.
Dupuytren’s contracture can be caused as a side effect of which treatment?
Phenytoin
Buckle fracture?
- in children (5-10 yrs)
- is an incomplete fracture of the shaft of a long bone: bulging of cortex
- typically self-limiting, sometimes can be managed with splinting and immobilisation rather than cast.
Types of hand fractures and how they present?
- FOOSH (fall onto hand): Colle’s: fracture of distal radius along metaphysis + no articular involvement: DDD (Dorsally Displaced Distal radius): Dinner fork Deformity
- Galeazzi fracture: common in children, distal radius fracture + dislocation of radioulnar joint. Rotational force associated with it.
- Smith fracture: ‘reverse colle’s fracture’: fall onto POSTERIOR aspect of hand
- Bennet fracture: break of thumb base: due to forced abduction of the first metacarpal.
Pain: is exacerbated by walking on tip toes
-is most common cause of heel pain in adults
plantar fasciitis
Achilles tendonitis pain:
calcaneal insertion of the tendon or further up the tendon depending on the area affected.
Achilles tendon rupture: imaging of choice?
Ultrasound (of calf/affected part). Inv. to Confirm (gold-standard): MRI
Presents: Patients with Achilles tendon rupture are unable to plantarflex the ankle. A positive Thompson’s test is pathognomonic for Achilles tendon rupture;
A referral for sciatica(shooting pains down leg is appropriate after?
4-6 weeks of conservative treatment (analgesia and physiotherapy) has failed
1st line: NSAIDS +/- PPI
De Quervain’s tenosynovitis/ also called Tenosynovitis:
Finkelstein test positive ie. she has pain over her radial styloid on forced abduction/flexion of the thumb.
Mx: analgesia, steroid injection, immobilisation with a thumb splint (spica), maybe sometimes surgical treatment might be required.
If sensory loss cannot be explained by single nerve: think dermatomal distribution being affected?
Radiculopathy follows a dermatomal distribution, unlike named nerve pathology
Management of ortho LEG fractures:
1) Intertrochanteric (Extracapsular) femoral fracture: Dynamic Hip Screw (DHS)
2) Intracapsular: Hemiarthroplasty or Total Hip replacement: if displaced, if undisplaced= internal fixation.
3) Subtrochanteric/transverse/oblique: Intramedullary nail
Weber A fractures: Management?
Patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot.
Osteoarthritis of the hand: joints involved?
Carpometacarpal and distal interphalangeal (DIP) joint involvement is characteristic
compartment syndrome?
Keep limb level with the body
pain control
IV fluids
Fasciotomy: surgical decompression of the involved compartments.
shoulder dislocations:?
Anterior shoulder dislocation is associated with FOOSH;
Posterior shoulder dislocation is more likely associated with seizures and electric shock; unilateral shoulder deformity
Management of rib fractures?
- Conservative management: with adequate analgesia: majority of rib fractures are managed conservatively.
NB: rib belts are contraindicated.
compartment syndrome: main diagnostic presentation?
Compartment syndrome produces pain on passive stretch
NB: + Simmonds test: is for Achilles Tendon rupture
Complication of Discitis? - that results in ongoing spiking of fever and worsening pain.
- Epidural Abscess
- sepsis
