Orthopaedics Flashcards
1
Q
L3 nerve root compression
A
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
2
Q
L4 nerve root compression
A
Sensory loss knee
Weak quadriceps
Reduced knee reflex
3
Q
L5 nerve root compression
A
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
4
Q
S1 nerve compression
A
Sensory loss lateral leg and lateral foot
Weakness in plantar flexion of foot
Reduced ankle reflex
5
Q
Types of hip replacement
A
Cemented hip replacement most common
Uncemented hip replacements in active patients
6
Q
Advice for patients with hip replacements to avoid dislocation
A
Avoid flexing hip >90 degrees
Avoid low chairs
Do not cross legs
Sleep on back for first 6 weeks
7
Q
Complications of joint replacement
A
Infection
Thromboembolism
Dislocation
8
Q
How long do patients receive LMWH for after hip replacement?
A
4 weeks
9
Q
Scoring systems to assess risk of fracture
A
FRAX
QFracture
10
Q
What does the FRAX scoring system estimate?
A
10 year risk of fragility fracture
11
Q
Who is FRAX valid for?
A
Patients age 40-90 years
12
Q
Factors included in FRAX
A
age sex weight height previous fracture parental fracture smoking steroids RA secondary osteoporisis alcohol
13
Q
What does QFracture estimate?
A
10 year risk of fragiity fracture
14
Q
Who is QFracture valid for?
A
Age 30-99 years
15
Q
Who should get a DEXA?
A
If FRAX is ‘intermediate”
If starting treatment with rapid effect on bone density
If <40 years and major risk factors
16
Q
Who should be assessed for risk of fragility fracture?
A
Women over 65
Men over 75
Younger patients with risk factors
17
Q
First line treatment for lower back pain
A
NSAIDs
+PPI if over 45
18
Q
Who should get an MRI for their back pain?
A
Only if result will change management or red flags for malignancy, fracture, infection, ank spond or cauda equina
19
Q
Features of acetabular labral tear
A
Hip/groin pain
Snapping sensation around hip
Occasional locking sensation
20
Q
Associations with trigger finger
A
RA
Diabetes
21
Q
Management of trigger finger
A
Steroid injection
Finger split
Surgery if no response to steroids
22
Q
Investigations of Baker’s cysts
A
In children - ultrasound
23
Q
What are myxoid cysts?
A
Benign ganglion cysts usually found on distal, dorsal aspect of the finger
24
Q
What is associated with myxoid cysts?
A
Osteoarthritis
25
Causes of Dupuytren's contracture
```
Manual labour
Phenytoin
Alcoholic liver disease
Diabetes
Trauma to hand
```
26
Ottawa rules for ankle injury
Pain in the malleolar zone AND
- bony tenderness at lateral malleolar
- bony tenderness at medial malleolar
- unable to walk 4 steps after injury and in the ED
27
What is a charcot joint?
Joint which has become badly disrupted and damaged secondary to a loss of sensation
28
Main cause of charcot joint
uncontrolled diabetes
29
Features of charcot joint
Joint pain
| Joint is swollen, red and warm
30
Online risk stratification tool for lower back pain
StarT BACK
31
Test used for meniscal tear
Thessaly's test
32
What is Thessaly's test used for?
Meniscal tear
33
Features of meniscal tear
Pain worse on straining the knee
Knee may 'give way'
Displaced meniscal tears may cause knee locking
Tenderness along joint line
34
Features of greater trochanteric pain syndrome
Pain over lateral side of hip/thigh
| Tenderness on palpation of greater trochanter
35
Which nerve is compressed in carpal tunnel syndrome?
Median nerve
36
Causes of carpal tunnel syndrome
```
Idiopathic
Pregnancy
Oedema e.g. heart failure
Lunate fracture
Rheumatoid arthritis
```
37
History in carpal tunnel syndrome
Pain/paraesthesia in thumb, index, middle finger
| Shakes hand at night to relieve pain
38
Examination findings in carpal tunnel syndrome
Weakness of thumb abduction
Wasting of thenar eminance
Tinel's sign
Phalen's sign
39
Describe Tinel's sign
Tapping over wrist causes paraesthesia
| Test for carpal tunnel syndrome
40
Describe Phalen's sign
Flexion of wrist causes symptoms
| Test for carpal tunnel syndrome
41
Management of carpal tunnel syndrome
Corticosteroid injection
Wrist splint at night
Surgery - flexor retinaculum division
42
Findings in talipes equinovarus
Inverted and plantar flexed foot
43
What percentage of talipes equinovarus are bilateral?
50%
44
Associations with talipes equinovarus
```
Spina bifida
Cerebral palsy
Edward's syndrome
Oligohydramnios
Arthrogryposis
```
45
Management of talipes equinovarus
Ponseti method
```
Manipulation and progressive casting from birth
Corrected by 6-10 weeks
May need achilles tenotomy
Braces at night till age 4
15% relapse rate
```
46
Which nerve is compressed in cubital tunnel syndrome?
Ulnar nerve
47
Features of cubital tunnel syndrome
Paraesthesia of 4th and 5th finger
Weakness and muscle wasting
Pain worse on leaning on affected elbow
48
Risk factors for osteoporotic fractures
```
Advancing age
Previous fragility fracture
Steroid use
Falls
Family history of hip fracture
Low BMI
Smoking
Alcohol history
```
49
Signs of osteoporotic vertebral fractures
Loss of height
Kyphosis
Localised tenderness
50
Investigations for osteoporotic vertebral fractures
Xray spine 1st line
CT spine
MRI to check for other causes e.g. tumour
DEXA scan
51
What percentage of frozen shoulder is bilateral?
20%
52
How long does frozen shoulder last?
6 months to 2 years
53
Features of frozen shoulder
Active and passive movement restricted
| External rotation most affected
54
Features of intersection syndrome
Pain in distal forearm, 5-10cm proximal of wrist
| Swelling and erythema
55
Who is affected by intersection syndrome?
Skiers
Tennis players
Weight lifters
Canoeists
56
What is intersection syndrome?
A tenosynivitis
Symptoms in forearm above wrist
Seen in sporty folk
57
Features of de Quervain's tenosynovitis
Pain over radial side of wrist
Tenderness over radial styloid process
Abduction of thumb against resistance is painful
Finkelstein's test
58
What is the test for de Quervain's tenosynovitis
Finkelstein's test
59
What does Finkelstein's test test for?
De Quervain's tenosynovitis
60
Malignant fibrous histiocytoma
May arise from soft tissue and bone
| Most common sarcoma in adults
61
What is the most common cause of anterior heel pain?
Achilles tendon disorders
62
Risk factors for achilles tendon disorders
Quinolones (e.g. ciprofloxacin)
| Hypercholesterolaemia causing tendon xanthomata
63
Features of achilles tendinopathy
Gradual onset posterior heel pain
Worse after activity
Morning pain and stiffness
64
Management of achilles tendinopathy
Simple analgesia
Reduce activities that trigger pain
Calf muscle eccentric exercises
65
History given in achilles tendon rupture
Sudden onset pain whilst playing sport
Audible pop
Can't walk or continue exercise
66
Examination findings in achilles tendon rupture
Palpable gap
| Simmonds triad
67
Investigations for achilles tendon rupture
Ultrasound
68
In a patient with possible hip OA, which red flags should make you reconsider?
Rest pain
Night pain
Morning stiffness >2 hours
69
Risk factors for hip OA
Increasing age
Female
Obesity
Developmental dysplasia of the hip
70
Reasons for total hip replacement revision
Aseptic loosening (most common)
Pain
Dislocation
Fracture
71
What is lumbar spinal stenosis?
Central canal narrowed by tumour, disc prolapse or other degenerative changes
72
Features of lumbar spinal stenosis
```
Back pain
Neuropathic pain, sciatica
Sitting relieves pain, sitting forward relieves pain
Walking uphill easier than downhill
Paraesthesia in leg
Foot drop
Sexual dysfunction
```
73
Investigations for lumbar spinal stenosis
MRI
74
Management of lumbar spinal stenosis
Laminectomy
75
Features of lateral epicondylitis
Pain and tenderness at lateral epicondyle
Pain worse on resisted wrist extension with elbow extended
Pain worse on supination of forearm with elbow extended
76
What is lateral epicondylitis also called?
Tennis elbow
77
Formal name for tennis elbow
Lateral epicondylitis
78
Features of medial epicondylitis
Pain and tenderness at medial epicondyle
Pain worse by wrist flexion and pronation
Paraesthesia of 4/5th finger due to ulnar nerve compression
79
What is medial epicondylitis also called?
Golfers elbow
80
Formal name for golfers elbow
Medial epicondylitis
81
Features of olecranon bursitis
Swelling over posterior aspect of elbow
| Pain, warmth, erythema
82
Who usually gets olecranon bursitis?
Middle aged men
83
Radial tunnel syndrome features
Pain 4-5cm distal to lateral epicondyle
| Worse on extending forearm and pronating forearm
84
Lower back pain - red flags
```
Age <20 or >50
history of malignancy
night pain
history of trauma
systemically unwell (fever, weight loss)
```
85
When to refer a patient with sciatica?
consider MRI if persistent symptoms at 4-6 weeks
86
Management of lower back pain
Stay active
| NSAIDS (+PPI if over 45)
87
Morton's neuroma - features
Forefoot pain - shooting/burning, worse on walking
Mulder's click
Loss of sensation distally in toes
88
What is Morton's neuroma?
Benign neuroma affecting the intermetatarsal plantar nerve
89
Most common location of Morton's neuroma
3rd inter-metatarsophalangeal space
90
Morton's neuroma - diagnosis
Clinical
| Ultrasound may be helpful
91
Morton's neuroma - management in primary care
Avoid high heels
Metatarsal pad
Refer if symptoms >3 months despite these
92
Morton's neuroma - management in secondary care
Metarsal dome orthotic
Corticosteroid injection
Neurectomy
93
Injury of which nerve causes foot drop?
Common peroneal nerve
94
Which area gets sensation from lateral cutaneous nerve of the thigh?
Lateral and posterior thigh
95
Origin of axillary nerve
C5, C6
96
Origin of median nerve
C6, C8, T1
97
Sensory supply of median nerve
Palmar aspect of lateral 3 1/2 fingers
98
Wrist lesion of median nerve presentation
Paralysis of thenar muscles and opponens pllicis
| Carpal tunnel
99
Elbow lesion of median nerve presentation
Loss of pronation of forearm
| Weak wrist flexion
100
Origin of ulnar nerve
C8, T1
101
Motor supply of ulnar nerve
Intrinsic hand muscles
102
Sensory supply of ulnar nerve
Medial 1 1/2 fingers
103
What nerve is injured in claw hand?
Ulnar nerve
104
How is the ulnar nerve commonly injured?
Medial epicondyl fracture
105
Origin of long thoracic nerve
C5-C7
106
Which muscle is innovated by the long thoracic nerve?
Serratus anterior
107
Causes of long thoracic nerve injury
Sports injury e.g. chest wall collision
| Complication of mastectomy
108
What does damage to the long thoracic nerve result in?
Winged scapula
109
Origin of radial nerve
C5-C8
110
Motor function of radial nerve
Extension
111
Sensory supply of radial nerve
Dorsal aspect between 1st and 2nd metacarpals
112
Causes of injury to radial nerve
Humeral midshaft fracture
113
What does radial nerve injury result in?
Wrist drop
114
Origin of musculocutaneous nerve
C5-C7
115
Motor function of musculocutaneous nerve
Elbow flexion and supination
116
Sensory supply of musculocutaneous nerve
Lateral part of forearm
117
What is osteochondritis dissecans?
A small part of bone separates due to lack of blood supply
Causes fragmentation of articular surface and intraarticular loose bodies
118
Types of osteochondritis dissecans
Adult
| Juvenile - when growth plate still open
119
Features of osteochondritis dissecans
```
Subacute onset
Knee pain and swelling after exercise
Knee catching and giving way
"Clunk" when flexing/extending
Joint effusion
```
120
Investigations of osteochondritis dissecans
Xray = subchondral crescent sign, loose bodies
MRI
121
Management of osteochondritis dissecans
Conservative = analgesia, immobilise, PT
Surgery
122
Osteoarthritis of the hand - xray findings
Osteophytes
| Joint space narrowing
123
Osteoarthritis of the hand - features
```
Bilateral
Carpometacarpal joints, DIP joints, PIP joint
Heberden's nodes
Bouchard's nodes
Squaring of the thumb
Episodic pain provoked by movement
Stiffness after rest lasts minutes
```
124
What does Heberden's nodes mean?
OA
125
What does Buchard's nodes mean?
OA
126
Where are Heberden's nodes found?
DIP
in OA
127
Where are Buchard's nodes found?
PIP
in OA
128
What is meralgia paraesthetica?
Paraesthesia in distribution of lateral femoral cutaneous nerve
129
Meralgia paraesthetica - causes
Entrapment of nerve under inguinal ligament
Iatrogenic - after surgery
Idiopathic
Trauma
Neuroma
130
Meralgia paraesthetica - risk factors
```
Obesity
Pregnancy
Tense ascites
Trauma
Diabetes
Sports = gymnastics, football, body building
```
131
Meralgia paraesthetica - features
Symptoms in upper lateral aspect of thigh
Burning, tinging, shooting pain, numbness
Deep muscle ache
Worse on standing better sitting
Reproduce symptoms by deep palpation below ASIS
132
Meralgia paraesthetica - investigations
Clinical diagnosis with pelvic compression test
Ultrasound
Injecting nerve with LA abolishes pain
133
Meralgia paraesthetica - management
```
Lose weight
NSAIDS
TENS
Pregabalin
Severe - decompressive surgery
```
