Orthopaedics 1 Flashcards
What is an acetabular labral tear?
Secondary to ? in young people and older people
Features (3)
Following trauma in young people
Degenerative changes in older people
Snapping sensation
Locking
Hip/groin pain
What drug can cause Achilles tendonopathy?
High ? can cause Achilles tendonopathy?
Ciprofloxacin (quinolones)
High cholesterol
Gradual onset heel pain
Worse following activity
Morning pain and stiffness
Achilles tendinopathy
What is the Simmon’s triad?
Patient lies prone, feet over edge
1. Look for abnormal angle i.e greater dorisflexion
2. Feel for a gap in the tendon
3. Gently squeeze calf - if it is injured it won’t move
Suspected rupture Ix and Mx (Achilles rupture) (1)
USS
Ortho referral - acute
Which age group is frozen shoulder/ adhesive capsulitis most common in?
What chronic disease is it associated with?
Middle aged females
T2DM
Frozen shoulder which is worse external or internal rotation?
Rx (4)
Length of time till it heals
External
NSAIDs, physio, PO steroids, intra-articular steroids
6 months to 2 years
When do you refer to secondary care for frozen shoulder?
3 months of stiffness with no benefit of conservative measures
Ottawa rules - ankle (3)
Ankle XR is only needed if:
- Bony tenderness at lateral malleolar zone
- Bony tenderness at medial malleolar zone
- Inability to walk four weight bearing steps immediately after the injury and in ED
Causes of carpal tunnel (4)
RA
Pregnancy
Lunate fracture
Oedema
Mx carpal tunnel
Mild-moderate (3)
Severe (1)
6 week trial of conservative management
- corticosteroid injections
- wrist splints
- physio
Severe surgical decompression
De Quervain’s tenosynovitis
Which age group and gender?
Females 30-50
What is Finkelstein’s test?
Used to check for which condition?
Ulnar deviation of the wrist
Pain on radial styloid process
De Quervain’s tenosynovitis
Mx De Quervain’s tenosynovitis (4)
- Analgesia
- Steroids
- Immobilisation with a thumb splint
- Surgery
Dupuytren’s contracture
Age group gender
Older male
+ve FH
Causes of Dupuytren’s (5)
- Trauma
- Manual labour
- Phenytoin
- Alcoholic liver disease
- DM
Dupuytren’s contracture
When do you consider surgical treatment?
Consider surgical treatment when the joins cannot be straightened/ hand cannot be placed flat on a table
What is tennis elbow?
Which movements make the pain worse? (2)
Lateral epicondylitis
Wrist extension or supination with elbow extended
Tennis elbow - how long does it last? How long is the acute pain?
6months-2year
6-12weeks
What is golfer’s elbow?
Which movements make the pain worse? (2)
Other features (1)
Medial epicondylitis
Wrist flexion and pronation
Numbness and tingling in 4th-5th finger
What is radial tunnel syndrome most commonly caused by?
Where is the pain?
Worse on which movements? (1)
Overuse
4-5cm distal to the lateral epicondyle
Pronation with extended elbow
Cubital tunnel syndrome is compression of which nerve?
Ulnar nerve
Features of cubital tunnel syndrome?
Worse when?
Tingling, numbness and weakness in 4th and 5th finger
Worse when resting on a firm surface
What is olecranon bursitis?
Swelling over posterior aspect of elbow - pain, warmth and erythema
Olecranon bursitis age group and gender
Middle aged men
Describe a ganglion
Where is it found
Which gender is it more common
Mx
When would you consider surgery?
Well circumscribed mass
Transilluminates
Dorsal aspect of wrist
F > M
Mx disappear sponatenously after several months
Severe symptoms or neurovascular sx
Pain over lateral side of hip thigh =
What is caused by?
Common in which age group
Greater trochanteric pain syndrome
Due to repeated movement of iliotibial band and most common in aged 50-70
Development dysplasia of the hip
Age group
Test
Signs (2)
Picked up at newborn examination
Ortolani and Barlow’s test
Unequal skin folds/ leg length
Transient synovitis
Age group
Associated with what?
2-10yo
Acute hip pain with viral infection
Commonest cause of hip pain
Perthes disease
Age group
What is it
Gender
Male
Aged 4-8yo
Avascular necrosis of femoral head
Perthe’s disease
Features (4) - pain over what time period, unilat or bilat?
Hip pain develops over a few weeks
Limp
Stiffness and reduced ROM
Can be bilateral 10%
Perthe’s disease XR findings (2)
widening of the joint space
decreased femoral head size/ flattening
Slipped upper femoral epiphysis
Age group
Gender
10-15yo
Obese children
Male > female
Knee or distal thigh pain
Loss of internal rotation when leg if flexed
Bilateral in 20%
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis
Age
Length of symptoms
Number of joints
<16yo
>3 months of symptoms
<4 joints
Juvenile idiopathic arthritis
Type of joints
Associated with
Antibody
Medium joints eg knees, ankles, elbows
ANA +Ve
Associated with ant uveitis
Commonest cause of lateral knee pain in runners
Mx (2)
Iliotibial band syndrome
Mx
Activity modification and stretches
Physio if not improving
What is intersection syndrome/ where is the pain?
Pain in the distal dorsoradial forearm
5-10cm proximal of the wrist joint
Intersection syndrome is commonly seen in which four sports?
Skiers, tennis players, weight lifters, canoeists
Intersection syndrome
Mx (3)
NSAIDs
Steroid injection
Physio
What is Thessaly’s test?
What is it used to test?
weight bearing at 20 degrees of knee flexion, patient supported by doctor, positive if pain on twisting knee
Meniscal tears
Meniscal tear
Results from which motion?
Pain worse when?
Twisting injury
Straightening the knee
Meniscal tear Features (3)
Locking
Give way
Tenderness along joint line
Associated with kneeling
Infrapatellar bursitis (clergyman’s knee)
Associated with upright kneeling
Prepatellar bursitis
Housemaid’s knee
caused by twisting of the knee - ‘popping’ noise may have been noted
Rapid onset of knee effusion
Positive draw test
Anterior cruciate ligament
May be caused by anterior force applied to the proximal tibia (e.g. knee hitting dashboard during car accident)
Posterior cruciate ligament
Tenderness over the affected ligament
Knee effusion may be seen
Collateral ligament
May be caused by twisting of the knee
Locking and giving-way are common feature
Tender joint line
Meniscal lesion
LOAF muscles
Lumbricals
Opponens pollis
Abductor pollis brevis
Flexor pollis brevis
What is Klumpke injury?
Caused by?
Associated with?
Which nerve roots affected?
Can be secondary to shoulder dystocia
Horner’s
C8,T1 lower trunk of brachial plexus
Erb Duchenne palsy
Nerve roots affected?
Secondary to?
Sx
Upper trunk palsy, C5,C6
Shoulder dystocia
Arm hangs by the side and is internally rotated, elbow extended
Musculocutaneous nerve
Nerve
Motor
Sensory
Typical mechanism of injury
C5-C7
Elbow flexion + supination (biceps)
Lateral part of forearm
Rare injury
Axillary
Nerve
Motor
Sensory
Typical mechanism of injury
C5,C6
Shoulder abduction (deltoid)
Inferior region of deltoid
Humeral neck fracture
Radial
Nerve
Motor
Sensory
Typical mechanism of injury
C5-C8
Extension forearm
Dorsal aspect of 1st and 2nd metacarpals
Humeral midshaft fracture
Wrist drop
Median nerve
Nerve
Motor
Sensory
Typical mechanism of injury
C6,8 T1
LOAF muscles
Palmar aspect of 3.5 fingers
Carpal tunnel
Ulnar nerve (6)
Nerve
Motor
Sensory
Typical mechanism of injury
C8,T1
Intrinsic hand muscles except LOAF, wrist flexion
Medial 1.5 fingers
Medial epicondyle fracture, claw hand
Long thoracic (4)
Nerve
Motor
Sensory
Typical mechanism of injury
Serratus anterior
C5-C7
Blow to the ribs or mastectomy
Winged scapula
Trigger finger is more common in? (3)
Mx
Women
RA
DM
Steroid injection +/- finger splint
