Ortho - spot diagnosis Flashcards
Inability to passively or actively rotate affected arm externally following a seizure.
- sign on XR
- What is the other main cause of this pathology?
Posterior shoulder dislocation
- Lightbulb sign on XR
Only 2-5% of all shoulder dislocations. Seen mainly in epilepsy and electric shocks
55 year old woman complains of her right ring finger locking in flexion. It is difficult to then straighten, but she pulls it open with her other hand and often a click is heard as it goes back into place.
a) Most likely diagnosis
b) How does this differ from Dupuytren’s?
c) How does it differ to tetany?
d) What is the management?
a) Trigger finger
b) Dupuytren’s cannot be extended back into place with the other hand
c) Tetany usually has flexion of the wrist and may be associated with tingling around the mouth (e.g. in hypocalcaemia)
d) Some improve spontaneously, some require steroid injection, some require tendon release
23 year old man tackled playing rugby and falls on outstretched hand. Examination reveals loss of contour around the left shoulder.
a) What is the most likely diagnosis?
b) What sensory loss may be evident? Why?
c) What muscle weakness may be evident? Why?
a) Anterior shoulder dislocation
b) Regimental badge area (C5/C6), due to axillary nerve damage
c) Abduction due to deltoid paresis (secondary to axillary nerve damage)
31 year old factory worker presents with painful swelling in radial aspect of hand/wrist.
- given occupation, most likely diagnosis?
de Quervain’s tenosynovitis (repetitive strain)
82 year old woman slips on the ice and falls onto outstretched hand. She presents with pain in her wrist, which is dorsally displaced.
a) What is the name of the deformity shown?
b) What is the diagnosis?
c) What is the name for the fracture of the distal radius leading to volar displacement? What is the usual mechanism of injury?
a) Colles fracture - fall on extended wrist
b) a dinner fork deformity
c) Smiths fracture - fall on flexed wrist
22 year old falls on dry ski slope and outstretched thumb catches in the mat. She is unable to make a pincer grip and there is a palpable mass on ulnar aspect of 1st MCPJ.
a) Likely diagnosis
b) Management
a) Torn ulnar collatéral ligament in thumb. (AKA skiers thumb)
b) Partial tear: splint and PT
Full tear: surgical repair
40 year old woman presents with pain in the right hip that is worse at night when sleeping on the affected side. Also worse after activity
a) Likely diagnosis
b) Give 2 feature o/e to support this
c) Management
a) Greater trochanteric pain syndrome (AKA trochanteric bursitis)
b) Positive Trendelenburg sign, point tenderness around the greater trochanter (note: the bursa itself is very rarely palpable)
c) Conservative: rest, avoidance of activity that makes it worse, ice packs, analgesia, physiotherapy
- If these fail, consider CS injection
- If all fails, consider referral to orthopaedics
A 68 year old man has a swollen tender knee for 3 days and cannot weight bear. He has had previous episodes of big toe swelling. He has a history of chronic kidney disease stage 4.
a) likely diagnosis
b) investigations
c) management and rationale
a) Acute gout (must rule out septic arthritis!)
b) - Bedside - urine dip
- Bloods - FBC, CRP, U+Es, Uric acid, blood cultures
- Imaging - XR knee
- Aspirate knee - polarised light and MC+S
c) Oral prednisone (not NSAIDs due to CKD stage 4)
34 year old man has pain in his right shoulder and upper arm for 6 weeks that worsens when elevating his arm above his head. He does not recall any injury.
There is no deformity, tenderness or reduced range of movement. There is pain on abduction of the right shoulder that is worse with the arm in internal rotation and when abduction is resisted. He is treated with ibuprofen.
a) likely diagnosis
b) most appropriate management
a) Rotator Cuff Tendinopathy (most likely supraspinatus - confirm with empty can test)
b) - Physio
(Only refer to orthopaedics if Acute tear, failure of conservative management for ~ 3 months or severe pain/ functional limitation)
