Orthopaedics 1 Flashcards
24 y/o male
- 2 month hx localised spine pain
- worse on movement
- IVDU
- no hx of TB
- excruciating pain at rest
- not improving with analgesia
- 39 degrees temp
possible diagnosis?
osteomylelitis
differential diagnoses:
- Osteosarcoma
- Traumatic stress fracture
- Inflammatory arthritis
- Gout
likely organism causing osteomylelitis
staph aureus
most commonly affected region in osteomyelitis
cervical spine
TB tends to affect thoracic spine
22 y/o male
- shot in lumbar region of back
- increased tone and hyperreflexia in right leg
- cannot feel left leg
diagnosis?
Brown-sequard syndrome
- caused by hemisection of the spinal cord
- ipsilateral paralysis (pyrimidal tract)
- loss of proprioception and fine discrimination (dorsal columns)
- pain and temp sensation lost on contra-lateral side
spinal disorders:
loss of pain, sensation and temperature
spinothalamic tract lesion
spinal disorders:
flaccid paralysis of the upper limbs
central cord lesion
spinal disorders:
- normally progressive
- staph aureus in IVDU
- normally cervical region affected
- fungal infections in immunocompromised
- thoracic region affected in TB
Osteomyelitis
spinal disorders:
- dorsal column signs
- loss of proprioception
- loss of fine discrimination
infarction spinal cord
spinal disorders:
- UMN signs
- malignancy
- haematoma
- fracture
cord compression
spinal disorders:
- hemisection of spinal cord
- ipsilateral paralysis
- ipsilateral loss of proprioception
- ipsilateral loss of fine discrimination
- contralateral loss of pain and temperature
brown-sequard syndrome
dermatome:
elbow flexors/ bicep
C5
dermatome:
wrist extensor
C6
dermatome:
elbow extensor / triceps
C7
dermatome :
long finger flexors
C8
dermatome:
small finger abductors
T1
dermatome:
hip flexors (psoas)
L1 and L2
dermatome:
knee extensors (quadriceps)
L3
dermatome:
ankle dorsiflexors (tibialis anterior)
L4 and L5
dermatome:
toe extensors (hallucis longus)
L5
dermatome:
ankle plantar flexors (gastrocnemius)
S1
management for subluxation of the radial head
passive supination of the elbow joint
whilst flexed to 90 degrees
analgesia
why is subluxation of the radial head (pulled elbow) the most common upper limb injury in children under 6
- in this age group
- distal attachment of the annular ligament covering radial head is weaker in children in this group
A FRAX score of 10% or greater is considered to indicate
high risk of suffering fragility fracture in the next 10 years
value is threshold for arranging a DEXA scan
where are stress fractures most common
- 2nd metatarsal
- this is the longest metatarsal bone
- thin and vulnerable to stress fractures
pain over radial styloid on forced abduction/flexion of thumb is
finkelstein test positive
patient most likely has de quervains tenosynovitis
common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
De Quervain’s tenosynovitis
management of De Quervain’s tenosynovitis
- analgesia
- steroid injection
- immobilisation wit a thumb splint
- surgical treatment?
the following clinical features show damage to which nerve:
Weakness in knee extension, loss of the patella reflex, numbness of the thigh
femoral nerve
the following clinical features show damage to which nerve:
Weakness in ankle dorsiflexion, numbness of the calf and foot
lumbosacral trunk
the following clinical features show damage to which nerve:
Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle
sciatic nerve
the following clinical features show damage to which nerve:
Weakness in hip adduction, numbness over the medial thigh
obturator nerve
most nerve injuries recover within how many weeks
6 - 8 weeks
occasionally nerve damage can be permanent
a patient with a sub trochanteric fracture fixed with an intramedullary nail should weight bear how soon post op?
immediately as long as tolerated.
reduced risk associated with prolonged immobilisation
- venous thromboembolism
Reshma is a 68-year-old with a history of type 2 diabetes who has presented with intermittent tingling of her left 4th and 5th fingers.
cubital tunnel syndrome
- caused by compression of ulnar nerve
- can present with tingling and numbness of the 4th and 5th finger
Carpal tunnel syndrome is caused by…
- median nerve entrapment in the wrist
- affects the 1st, 2nd, 3rd fingers plus lateral side of 4th finger
A teenage girl with knee pain on walking down the stairs is characteristic for
chondromalacia patellae
- anterior knee pain
managed with physio
15 y/o boy
- 3 week hx knee pain
- worse with activity
- settles with rest
OE
- tenderness over tibial tuberosity
- associated swelling at this site
Indicative of:
Osgood Schlatters disease
OSD is a traction phenomenon resulting from repetitive quadriceps contraction through the patellar tendon at its insertion upon the skeletally immature tibial tubercle
what is the most appropriate imaging modality to diagnose meniscal tears?
magnetic resonance imaging
32 y/o rugby player presents with a painful knee.
- pain worse on straightening the knee
- knee might give way
- displaced meniscal tears may cause knee locking tenderness along the joint line
indicative of:
meniscal tear
what is the most common cause of osteomyelitis?
staphylococcus aureus
weakness of hip abduction and foot drop, no specific reflex los
indicative of compression of which nerve root:
L5 radiculopathy
which nerve root compression would present with sensory loss over the anterior aspect of the knee, weakened quadriceps, and a reduced knee reflex:
L4 nerve root compression
which nerve root compression would present with sensory loss over the anterior thigh,
weakened quadriceps, and a reduced knee reflex:
L3 nerve root compression
which nerve root compression would present with back, groin, and anterior thigh pain.
There may be weakness of hip flexion but lower limb reflexes tend to be normal:
L2 nerve root compression
which nerve root compression typically presents with sensory loss of the posterolateral aspect of the leg
and lateral aspect of the foot.
There may be weakness of foot plantar flexion
and a reduced ankle reflex:
S1 nerve root compression
82 y/o woman admitted with fall
- diagnosed with displaced intracapsular fracture of the hip
- she has hypertension, mild cognitive impairment, and osteoarthritis.
- she appears frail, normally walks with aid of Zimmer frame
what is the correct surgical management?
patient not suitable for a total hip replacement due to
- decreased mobility
- cognitive impairment
- general frailty
correct treatment: cement hemiarthroplasty
give some examples of red flags for lower back pain:
- age < 20 years
- history of previous malignancy
- night pain
- history of trauma
- weight loss, fever, systemically unwell
patient presents with:
- pain on walking, relieved by rest
- absent of weak foot pulses and other signs of limb ishcaemia
- past history may include smoking and other vascular diseases
indicative of:
peripheral arterial disease
what is important to do in the presence of a displaced ankle fracture:
- reduce the ankle fracture asap
- due to risk of damage to the skin
a fracture resulting in a shortened, externally rotated leg:
neck of femur fracture
Garden classification system
a shortened, internally rotated leg suggests:
posterior dislocation
The affected leg is shortened, adducted, and internally rotated…
type of hip dislocation:
posterior dislocation
The affected leg is usually abducted and externally rotated. No leg shortening.
type of hip dislocation:
anterior dislocation
squaring of the thumb is characteristic of…
osteoarthritis
- bony outgrowths at the basilar joint of the thumb
condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed…
De Quervain’s tenosynovitis
typically affects 30 - 50 years old
indicative of:
pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
De Quervain’s tenosynovitis
