Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Describe the pathophysiology of osteoarthritis

A

Synovial joints
Combination of genetics and overuse and injury
Imbalance between cartilage wearing down and chondrocytes repairing it, leading to strucural issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some risk factors of osteoarthritis

A 
Age
Obesity
Occupation
Trauma
Female
FH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the joints commonly affected by osteoarthritis

A 
Hips
Knees
Sacroiliac joints
DIPs 
CMC of the thumb
Wrist
Cervical spine - spondylosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the 4 key X-ray changes of osteoarthritis

A

Loss of joint space
Osteophyte formation
Subchondral cysts
Subchondral sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does osteoarthritis present

A

Joint pain
Stiffness - worsens with activity
Deformity - bulky, bony enlargement of the joint
Crepitus on movement
Effusions around the joint
Instability
Reduced function/range of movement of the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the signs of osteoarthritis in the hands

A 
Heberden's nodes - DIP
Bouchards nodes - PIP 
Squaring at the base of thumb - CMC 
Weak grip 
Reduced ROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When can OA be diagnosed

A

Patient >45
Typical symptoms with activity
No morning stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is osteoarthritis managed

A

Patient education
Lifestyle change - weight loss, physiotherapy, OT, orthotics
Analgesia - oral paracetamol and topical NSAIDs, oral NSAIDs (PPI), opiates (codeine), topical capsaicin, intra-articular injection, joint replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a hemiarthroplasty

A

Replacing one half of the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a total joint replacement

A

Replacing both articular surfaces of the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which organism is most common in prosthetic joint infections

A

Staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List some risk factors for prosthetic joint infection

A

Prolonged op time
Obesity
Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some symptoms of prosthetic joint infection

A 
Fever
Pain
Swelling
Erythema 
Warm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is a prosthetic joint infection diagnosed

A

Clinical finding
X-ray
Blood tests - Inflammatory markers and cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is prosthetic joint infection managed

A

Antibiotics and surgery - Joint irrigation, debridement complete replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a compound fracture

A

Skin is broken and broken bone is exposed to air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a stable fracture

A

Sections of bone remain in alignment at the fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a pathological fracture

A

Bone breaks due to an abnormality within the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a salter-harris fracture

A

Growth plate fracture - occurs only in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a Comminuted fracture

A

Breaking into multiple fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a compression fracture

A

Affects the vertebrae in the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe a Colle’s fracture

A

Transverse fracture of the distal radius
Causes the distal portion to displace posteriorly (upwards)
Causes a dinner fork deformity
Commonly a result of a fall onto outstretched hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe a scaphoid fracture

A

Fall onto outstretched hand
Scaphoid is a carpal bone at the base of the thumb
Key sign - tenderness in the anatomical snuffbox (groove between tendons when you extend thumb)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why is it important to spot scaphoid fractures

A

Scaphoid bone has retrograde blood supply with blood vessels supplying the bone from only one direction

Avascular necrosis and non-union if blood supply cut off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
List some bones which if fractured may result in avascular necrosis, impaired healing and non union due to vulnerable blood supplies
``` Scaphoid Femoral head Humeral head Talus Navicular and 5th metatarsal in foot ```
26
What is the name of the fibrous join between the tibia and fibula
Tibiofibular syndesmosis
27
What is the function of the tibiofibular syndesmosis
Stability and function of the ankle joint
28
What is the Weber classification
Used to describe fractures of the lateral malleolus - fracture is described in relation to the distal syndesmosis Type A - below the ankle joint - syndesmosis in tact Type B - at the level of the ankle joint - syndesmosis intact or partially torn Type C - above the ankle joint - syndesmosis disrupted
29
Why is the weber classification of lateral malleolus fractures important
Decide management - surgery more likely if syndesmosis disrupted
30
What must you look for with pelvic ring fracture
Another fracture in the pelvic ring | Bleeding - shock
31
List some causes of pathological fractures
Pagets disease of bone Osteoporosis Cancer mets
32
List the cancers which commonly metastasise to bone
``` Prostate Renal Thyroid Breast Lung ```
33
What are fragility fractures
Fractures occuring due to weakness of the bone - usually due to osteoporosis
34
What tool is used to calculate a patients risk of fragility fracture over the next 10yrs
FRAX tool
35
What scan is done to measure bone mineral density
DEXA scan
36
Give the WHO criteria for osteoporosis and osteopenia
T score at hip >-1 - normal -1 to -2.5 osteopenia
37
What is the first line treatment for reducing the risk of fragility fractures
Calcium Vit D Bisphosphonates /denosumab
38
How do bisphosphonates work?
Interfere with osteoclasts, reducing their activity and preventing the reabsorption of bone
39
List some important side effects and patient info for bisphosphonates
Reflux and oesophageal erosison - taken on empty stomach, stand up for 30 mins after Osteonecrosis of jaw an external auditory canal Atypical fractures - femoral
40
Describe the action of denosumab
Monoclonal antibody that works by blocking the activity of osteoclasts
41
What is the investigation of choice for fractures
X-ray - 2 views - AP and lateral | CT if X-ray inconclusive and more info required
42
What are the principles of fracture management
Mechanical alignment | Relative stability
43
How is mechanical alignment achieved
Closed reduction via manipulation of the limb | Open reduction via surgery
44
How is relative stability of a fracture achieved
``` External casts K wires IM nails IM wires Screws Plates and screws ```
45
Describe the management of fractures
Pain management Closed reduction and plaster cast with FU in fracture clinic Refer to on call trauma and ortho team, admit, NBM, trauma meeting
46
List some early complications of a fracture
``` Damage to local structures Haemorrhage - shock and death Compartment syndrome Fat embolism DVT ```
47
List some longer term complications fo fractures
``` Delayed union - slow Malunion - misaligned Non-union - failure to heal Avascular necrosis Infection - osteomyelitis Joint instability Joint stiffness Contractures Arthritis Chronic pain Complex regional pain syndrome ```
48
What is a fat embolism
Fat globule from long bone fracture travels through systemic circulation and causes blood flow obstruction Causes systemic inflammatory response Presents 24-72hrs after fracture
49
Which criteria is used for Fat embolism syndrome
``` Gurd's criteria Major criteria - Resp distress - Petechial rash - Cerebral involvement Minor criteria - Jaundice - Thrombocytopenia - Fever - Tachycardia ```
50
How is fat embolism syndrome treated
Supportive | Operate early to prevent this occurring
51
Give some risk factors for hip fractures
Osteoporosis Female Age
52
What are the two classes of hip fracture
Intracapsular | Extracapsular
53
What is the capsule of the hip joint
Strong fibrous structure Attaches to the rim of the acetabulum on the pelvis and the intertrochanteric line on the femur Surrounds the head and neck of the femur
54
Describe the blood supply of the femoral head
Retrograde supply Medial and lateral circumflex femoral arteries join the femoral neck just proximal to the intertrochanteric line and branches run up toward the femoral head
55
What is the intertrochanteric line
Line between greater and lesser trochanter of femur
56
Which classification is used for intra-capsular neck of femur fractures
``` Garden classification Grade 1-4 1 - partial # and no displacement 2 - complete # and no displacement 3 - partial displacement 4 - full displacement ```
57
How are non-displaced intracapsular femur fractures managed
Blood supply still intact - Internal fixation (screws)
58
How are displaced intracapsular femur fractures managed
Risk of avascular necrosis Head of femur needs to be replaced Hemiarthroplasty - co-morbidity or limited mobility Total hip replacement for those mobile and fit for surgery
59
What are the two types of extra-capsular hip fractures
Intertrochanteric - occurs between greater and lesser trochanters Sub trochanteric - distal to lesser trochanter
60
How are extra-capsular fractures treated
Intertrochanteric - Dynamic hip screw Sub trochanteric - IM nail (through greater trochanter)
61
Describe the presentation of a hip fracture
Pain in groin or hip Not being able to weight bear Shortened, abducted and externally rotated leg Cause of fall - anaemia, electrolytes, arrhythmia, HF, MI, Stroke, infection
62
What is shentons line and how is it used
Shentons line seen on AP hip X-ray One continuous line formed by medial border of femoral neck to inferior border of superior pubic ramus Disruption to shentons lone indicates fractured neck of femur
63
When should hip fracture surgery be carried out
<48hrs of # occurring
64
When should patients weight bear after surgery
Right away
65
How does trochanteric bursitis present
Lateral hip/thigh pain with tenderness over the greater trochanter
66
Describe compartment syndrome
Abnormally elevated pressure in a fascial compartment cuts off blood flow to the contents of that compartment
67
What is fascia
Strong fibrous connective tissue | Not able to stretch or expand
68
What do fascial compartments contain
Muscle Nerve Blood vessels
69
What causes acute compartment syndrome
Injury - oedema and bleeding Bone fracture Crush injuries
70
How does compartment syndrome present
``` 5Ps Pain disproportionate to underlying injury - worsened by passive stretching of muscle Paraesthesia Pale Pressure - high Paralysis is a late sign ```
71
How is compartment syndrome managed
Needle manometry - measure the compartment pressure Escalate to ortho reg or consultant Remove bandages and dressings Elevate leg to heart level Maintain good BP Definitive treatment - emergency fasciotomy - operation to cut through fascia down entire length of compartment to release pressure then debride necrotic tissue - wound left open and covered with dressing. May require skin graft later
72
Describe chronic compartment syndrome
Increased pressure with exertion Pain, numbness and paraesthesia stops with rest Needle manometry for diagnosis Fasciotomy for treatment
73
What is osteomyelitis and how is it caused
Inflammation of bone/bone marrow Usually caused by bacterial infection Acute/chronic Haematogenous osteomyelitis - pathogen carried through blood and seeded in bone or direct contamination
74
Which bacteria commonly causes osteomyelitis
Staphylococcus aureus
75
List some risk factors for osteomyelitis
``` Open # Ortho op DM PAD IVDU Immunosuppression ```
76
How does osteomyelitis present
``` Fever Pain and tenderness Erythema Swelling Non-specific - fatigue, nausea, fever, muscle ache ```
77
How is osteomyelitis investigated
X-ray - not too helpful but some changes are periosteal reaction, localised osteopenia and destruction MRI is best imaging modality Bloods - WCC, Inflammatory marker, blood cultures
78
How is osteomyelitis managed
Surgical debridement Antibiotics therapy - prolonged course, 6 weeks flucloxacillin with rifampicin or fusidic acid in first 2 weeks or clindamycin in pen allergic or vancomycin/teicoplanin in MRSA Chronic osteomyelitis - 3 months antibioitcs If due to prosthesis - complete revision surgery
79
What is a charcot joint
One which has become disrupted and damaged secondary to a loss of sensation - seen in diabetes
80
What are sarcomas
Cancers of muscle, bone and other connective tissue
81
How do sarcomas present
Soft tissue lump - growing, painful or large Bone swelling Persistent bone pain
82
How should you investigate sarcomas
Xray - bone lump/persistent pain Ultrasound - soft tissue lump CT/MRI - lesion in more detail and look for metastatic spread Biopsy for histology
83
Where does sarcoma commonly spread to
Lungs
84
What causes Kaposi's sarcoma (red/purple skin lesions)
HSV8 | HIV
85
How does Osteomalacia present
Bone pain Tenderness Proximal myopathy Waddling gait
86
What is osteomalacia
Lack of bone mineralisation | Vit D deficiency
87
What is the prognosis for acute low back pain
Should improve within 2 weeks | May become chronic
88
What is the prognosis for sciatica
Most recover by 4-6weeks
89
List some causes of mechanical back pain
``` Muscle or ligament sprain Facet joint dysfunction Sacroiliac joint dysfunction Herniated disc Spondylolisthesis Scoliosis Degenerative changes ```
90
Give some causes of neck pain
Muscle or ligament strain Torticollis Whiplash Cervical spondylosis
91
List some red flag causes of back pain
Spinal fracture - major trauma Cauda equina - saddle anaesthesia, urinary retention, incontinence, bilateral neurological symptoms Spinal stenosis - intermittent neurogenic claudication Ankylosing spondylitis - <40yo, gradual onset, morning stiffness or night time pain Cancer - previous or current, weight loss, night pain, age >50 Infection - fever, IVDU
92
What are sine abdominal/thoracic causes of back pain
``` Pneumonia Ruptured AAA Kidney stones Pyelonephritis Pancreatitis Prostatitis PID Endometriosis ```
93
Which spinal nerves form the sciatic nerve
L4-S3
94
Describe the path the sciatic nerve takes
Sciatic nerve through the greater sciatic foramen, in the buttock area on either side. It travels down the back of the leg. At the knee, it divides into the tibial nerve and common peroneal nerve
95
What is the function of the sciatic nerve
Provide sensation to the lateral lower leg and foot | Motor function to posterior thigh, lower leg and foot
96
What symptoms does sciatica cause
``` Unilateral pain from the buttock down the back of the thigh to below the knee or foot Electric or shooting Paraesthesia Numbness Motor weakness Reflexes may be affected ```
97
What are the main causes of sciatica
Herniated disc Spondylolisthesis Spinal stenosis Cauda equina if bilateral
98
What is a test which can help diagnose sciatica
Sciatic stretch test Patient lies on back with leg straight Examiner lifts one leg from the ankle with the knee extended until the limit of hip flexion is reached Dorsiflex foot and this recreates sciatic pain in the buttock/posterior thigh - sciatic nerve root irritation. Symptoms then improve on flexing the knee
99
Describe the STarT back screening tool
Stratify the risk of a patient with acute back pain developing chronic back pain Helps guide initial management /9
100
How are patients at low risk of developing chronic back pain managed
Self management Education Reassurance Analgesia - NSAIDs, codeine, benzodiazepines Staying active and continuing to mobilise as usual Safety net
101
How are patients at medium/high risk of developing chronic back pain managed
``` As for low risk with: Physiotherapy CBT Group exercise Radiofrequency denervation Safety net ```
102
How is sciatica managed
Amitryptiline Duloxetine fi symptoms persisting or worsening Chronic management - epidural corticosteroid injections, LA injections, radiofrequency denervation, spinal compression
103
What is the cauda equina
Collection of nerve roots that travel through the spinal canal after the spinal cord terminates around L2/3
104
What do the nerves of the cauda equina do
Sensation to perineum, bladder and rectum Motor to lower limbs, anal and urethral sphincters Parasympathetic to bladder and rectum
105
List some causes of cauda equina
``` Herniated disc Tumours - mets Spondylolisthesis Abscess Trauma ```
106
What are some red flag symptoms of cauda equina
``` Saddle anaesthesia Loss of sensation in bladder/rectum Urinary retention or incontinence Faecal incontinence Bilateral sciatica Bilateral or severe motor weakness Reduced anal tone ```
107
Describe the management of cauda equina
Immediate hospital admission Emergency MRI Neurosurgical review - lumbar decompression surgery
108
Describe the presentation of metastatic spinal cord compression
Back pain worse on coughing or straining | Motor and sensory symptoms
109
Describe the treatment of Metastatic spinal cord compression
``` High dose dexamethasone Analgesia Surgery Radiotherapy Chemotherapy ```
110
What may a patient with intermittent claudication but normal ABPI have
Spinal stenosis - pseudo claudication
111
Describe the symptoms of a lumber spinal stenosis
Psuedoclaudication | Symptoms better when lean forward and at rest
112
Define radiculopathy
Compression of the nerve roots as they exit the cord and column leading to motor and sensory symptoms
113
How is spinal stenosis diagnosed
MRI | Exclude PAD - ABPI and CT angiogram
114
How is spinal stenosis managed
``` Exercise Weight loss Analgesia Physiotherapy Decompression surgery Laminectomy ```
115
What is meralgia paraesthetica
Mononeuropathy Compression of the lateral femoral cutaneous nerve (L1,2,3 - carries only sensory signals) Burning, pins and needles, cold sensation, numbness over the upper outer thigh Symptoms aggravated by walking or standing and extending the hip
116
Describe the management of meralgia Paraesthetica
Rest Loose clothing Weight loss Physiotherapy Medical - paracetamol, NSAIDs, neuropathic (amitriptyline, duloxetine, gabapentin and pregabalin), local injections of steroids or anaesthetic Surgical - decompression, transection, resection
117
What is trochanteric bursitis
Inflammation of the bursa at the greater trochanter | Tickening of the synovial membrane and increased fluid production - swelling
118
What are bursa
Synovial membrane filled sacs with synovial fluid found at bony prominences to reduce friction between bone and soft tissue during movement
119
What causes trochanteric bursitis
Friction from repetitive movement Trauma Inflammatory condition - RA Infection - septic bursitis
120
Describe the presentation of trochanteric bursitis
Lateral hip pain - aching or burning May worsen after activity, standing after sitting prolonged time or trying to sit cross legged, disrupts sleep Gradual onset May radiate down thigh
121
What may be found on examination in trochanteric bursitis
Trendelenburg test - ask patient to stand one legged on affected leg. Normally the other side of pelvis remains level or goes up slightly. Positive Trendelenburg is when other side drops down suggesting weakness in that hip Resisted abduction, internal and external rotation of hip
122
Describe the treatment of trochanteric bursitis
``` Rest NSAIDs ICE Steroid injections Physiotherapy ``` If caused by infection give antibiotics
123
Describe the anatomy of the knee
2 menisci (medial and lateral) between condyles of femur and tibia Patella - patella tendon inserts into tibial tuberosity Quadriceps tendon - when contracts causes knee extension Between condyles of the femur is an intercondylar notch Between the condyles of the tibia is an intercondylar area Anterior and posterior cruciate ligaments - both originate from the intercondylar notch (ACL- lateral aspect and PCL - medial aspect) of the femur, ACL attaches anterior intercondylar area of tibia and PCL attaches to the posterior intercondylar area of the tibia Medial and lateral collateral ligaments
124
How do meniscal tears occur
Twisting of the knee
125
What symptoms may a person with meniscal tear have
``` Pain - may be referred to hip Swelling Stiffness Restricted ROM Locking of the knee Instability or the knee giving way ```
126
What may be found on examination in a person with a meniscal tear
Localised tenderness on the joint line Swelling Restricted ROM
127
List some Ottawa knee rules
A patient requires a knee X-ray after acute knee injury if any of the following present - >55yo - Patella tenderness - Fibular head tenderness - Cannot flex the knee to 90 degrees - Cannot weight bear
128
What investigations do you do for diagnosing meniscal tear
MRI - 1st line | Arthroscopy
129
Describe the management of meniscal tears
``` Refer to A&E/# clinic RICE NSAIDS Physio Surgery - arthroscopy - repair or resection (results in OA) ```
130
What is the function of the ACL
Prevents the tibia sliding forward in relation to the femur
131
What is the function of the PCL
Prevents the tibia sliding backwards in relation to the femur
132
How is the ACL typically damaged
Twisting injury to the knee
133
Describe the presentation of an ACL injury
Pain Swelling Pop sound or sensation Instability of the knee joint - tibia can move anteriorly below the femur - knee can buckle
134
List some test on examination which can help assess for ACL damaged
Anterior drawer test - patient is supine with hip flexed to 45 degrees and knee flexed to 90 degrees with foot flat on the couch. Examiner sits on patients toes to stabilise the foot. Examiner holds the leg just below the knee and pulls the proximal tibia anteriorly, sliding it forward from the femur - no clear end point and tibia moves excessive distance anteriorly Lachman test - knee is tested while flexed at 20-30 degrees
135
How is ACL damage investigated
MRI | Arthroscopy
136
How is ACL damage treated
Refer to A&E or # clinic if symptoms suggest RICE Crutches and knee braces Physiotherapy Arthroscopic surgery - new ligament formed using a graft of tendon from another location (hamstrings, quadriceps, bone-patellar tendon bone)
137
Describe Osgood-Schlatter disease
Inflammation at the tibial tuberosity where the patella ligament inserts Lump in this location - tender at first due to active inflammation Avulsion fractures at the tibial tuberosity Unilateral Males aged 10-15
138
Describe the borders of the popliteal fossa
Semimembranosus and semitendinosus tendons - superior and medial Biceps femoris tendon - superior and lateral Medial head of gastrocnemius - inferior and medial Lateral head of gastrocnemius - inferior and lateral
139
What are Baker's cysts
Fluid filled sacs in the popliteal fossa Synovial fluid squeezed out of the knee joint and collects in the popliteal fossa. A connection between the synovial fluid in the joint and the cyst can remain so the cyst will continue to enlarge. They do not have their own epithelial lining so difficult to remove as contained in soft tissue
140
What causes a Bakers cyst
Secondary to degenerative changes in the knee joint | Can occur with other knee pathology - meniscal tears, OA, Knee injuries, inflammatory arthritis
141
Describe the presentation of a Baker's cyst
Symptoms in back of knee Pain or discomfort Fullness or pressure Palpable lump/swelling Restricted range of movement - large cysts Oedema if cyst compresses venous drainage of the leg
142
What is a sign of a bakers cyst
Foucher's sign - lump gets smaller when knee is flexed to 45 degrees
143
When sis a bakers cyst most apparent?
When the patient stands and the knees are fully extended
144
Describe a ruptured Baker's cyst
Pain Swelling Erythema
145
What are some differentials of a Baker's cyst
``` DVT Popliteal artery aneurysm Abscess Ganglion cyst Lipoma Varicose veins Tumour ```
146
Describe the investigations for a Baker's cyst
USS | MRI - assess for other pathology such as meniscal tears
147
How are Baker's cysts managed
Modified activity - avoid exacerbating symptoms Analgesia - NSIADs Physio Ultrasound guided aspiration Steroid injection Surgery - arthroscopic procedures to treat underlying knee pathology - resection is difficult and is likely to recur
148
Which nerve injury causes a foot drop
Peronal nerve
149
Which drugs can precipitate an Achilles tendinopathy and rupture
Fluoroquinolone antibiotics (ciprofloxacin)
150
Describe Simmonds calf squeeze test
Normally when calf is squeezed, this results in plantar flexion of the foot. No plantar flexion occurs if the Achilles tendon is ruptured
151
What is the plantar fascia
Thick connective tissue that attaches the calcaneus at the heel and travels along the sole of the foot and branches out to connect to the flexor tendons of the toes
152
Describe plantar fascitis
Inflammation of the plantar fascia Gradual onset pain on the plantar aspect of the heel Worse with pressure, particularly when walking or standing for long periods of time. Tenderness to palpation of this area
153
Describe the management of plantar fascitis
``` Rest Ice Analgesia Physiotherapy Steroid injections Extracorporeal shockwave therapy Surgery ```
154
Describe the pathophysiology of frozen shoulder (adhesive capsulitis)
Inflammation and fibrosis in the joint capsule causes adhesions which bind the capsule and cause it to tighten around the joint and restrict movement
155
Describe the typical course of symptoms in adhesive capsulitis
Painful phase - shoulder pain, worse at night Stiff phase - shoulder stiffness develops and affects both active and passive movement (external rotation) Thawing phase - gradual improvement in stiffness and return to normal
156
Describe the test for supraspinatus tendinopathy
``` Jobe test (empty can test) Patient abducts their shoulder to 90 degrees and fully internally rotates the arm as if they are emptying a can of water. The examiner pushes down on the arm as the patient resists. The test is positive if there is pain or if the arm gives way ```
157
What are the signs on examination of acromioclavicular joint arthritis
Tenderness to palpation Pain is worse at the extremes of shoulder abduction, from 170 degrees onwards when arm is overhead Positive scarf test - pain caused by wrapping the arm over the chest and opposite shoulder
158
How is adhesive capsulitis diagnosed
History and examination - exclude other causes of shoulder pain and stiffness CT/MRI may show thickened joint capsule but not required for diagnosis
159
Describe the management of adhesive capsulitis
``` Continue to use the arm but do not exacerbate the pain Analgesia - NSAIDs Physiotherapy Intra-articular steroid injections Hydro dilation ``` Surgery - resistant and severe cases - manipulation under anaesthesia (forcefully stretching the capsule to improve ROM) and arthroscopy (cut the adhesions and rerelease the shoulder)
160
Which disease is adhesive capsulitis associated with?
Diabetes
161
Which range of movement is most affected in adhesive capsulitis
External rotation
162
List the muscles of the rotator cuff and their actions
Supraspinatus - abducts the arm Infraspinatus - externally rotates the arm Teres minor - externally rotates the arm Subscapularis - internally rotates arm
163
Which activities are more likely to cause rotator cuff injury
Acute injury - fall onto outstretched hand Overhead activities Degenerative change with age
164
How do rotator cuff injuries present
Shoulder pain Weakness and pain with specific movements relating to the site of the tear Pain in first 60 degrees of abduction
165
How are rotator cuff tears diagnosed
CT/MRI | X-ray - exclude bony pathology
166
How are rotator cuff tears managed
Degenerative - conservative management - rest, adapted activity, analgesia, physiotherapy Surgery - arthroscopic rotator cuff repair
167
How does subacromial impingement present
Painful arc of abduction 60-120 degrees
168
Describe shoulder subluxation
Partial shoulder dislocation - head pops back in
169
Name and describe the two types of shoulder dislocation
Anterior dislocation - >90% cases, head of Humerus moves forward in relation to glenoid cavity, Occurs when the arm is forced backward whilst abducted and extended at the shoulder Posterior dislocation - associated with electric shock and seizure
170
List some associated damage with shoulder dislocation
Axillary nerve damage - C5 and C6 nerve roots, damage causes loss of sensation in regimental badge area over lateral deltoid and motor weakness in teres minor and deltoid muscles Fractures Hil-sachs lesions - compression fractures on the posterolateral part of head of humerus Bankart lesion - tear in anterior portion of the glenoid labrum
171
Describe the apprehension test in shoulder dislocation
Patient lies on back Shoulder abducted and elbow flexed Shoulder externally rotated As arm approaches 90 degrees of external rotation patient will be worried and anxious and want you to stop - previous dislocation or subluxation
172
What investigations are done in shoulder dislocations
Xray - before and after reduction MRI - shoulder damage and plan for surgery Arthroscopy
173
Describe the acute management in shoulder dislocation
Analgesia, muscle relaxants and sedation Gas and air (entonox) - 50% nitrous oxide and 50% O2 Broad arm sling Close reduction of shoulder Dislocation associated with fracture requires surgery Post reduction Xray Immobilise shoulder
174
Describe the ongoing management of shoulder dislocation
High risk of recurrence Physiotherapy Shoulder stabilisation surgery
175
How do patients with shoulder dislocation present
Arm held to their side Buldge and palpable at front of shoulder Assess for fracture, nerve and vascular samage
176
What is epicondylitis
Type of repetitive sprain injury Inflammation at the point where the tendons of the forearm insert into the epicondyles on the distal end of the humerus
177
What is the function of the tendons inserting into the medial epicondyle?
Flex the wrist
178
What is the function of the tendons inserting into the lateral epicondyle
Extend the wrist
179
Describe lateral epicondylitis
Tennis elbow Pain and tenderness at the lateral epicondyle Pain radiates down the forearm Weak grip strength
180
Describe Mills test
Stretching the extensor muscles of the forearm while palpating the lateral epicondyle Elbow is extended., forearm supinated and the wrist and fingers are extended. Examiner holds the patients elbow with pressure on the lateral epicondyle - if this causes pain then is positive indicating lateral epicondylitis
181
Describe Cozen's test
Elbow extended, forearm pronated, wrist deviated in the direction of the radius and a hand in a fist. Examiner holds the patients elbow with pressure on lateral epicondyle. The examiner applies resistance to the back of the hand while the patient extends the wrist. If it causes pain, it is positive indicating lateral epicondylitis
182
Describe medial epicondylitis
Golfers elbow Pain and tenderness on the medial epicondyle Pain may radiate down the arm and there may be weak grip strength
183
How do you test for medial epicondylitis
Golfers elbow test Elbow extended, forearm supinated, wrist and fingers extended Examiner puts pressure on the medial epicondyle and is positive if pain
184
Describe the management of epicondylitis
``` Rest Adapting activity Analgesia Physiotherapy Orthotics - elbow straps/braces Steroid injections Platelet rich plasma injections Extracorporeal shockwave therapy ```
185
What is De Quervain’s tenosynovitis
Type of repetitive strain injury | Inflammation and swelling of the tendon sheaths in the wrist under the extensor retinaculum
186
Which two tendons are most affected in De Quervain’s tenosynovitis
Abductor pollicis longus | Extensor pollicis brevis
187
How does De Quervain’s tenosynovitis present
``` Radial side of hand Pain radiating to forearm Ache Burn Weakness Numbness Tenderness ```
188
Describe Finkelsteins test for De Quervain’s tenosynovitis
Make a fist with thumb inside Adduct the wrist (ulnar deviation) Movement causes pain on radial aspect as strain on APL and EPB - positive for De Quervain’s tenosynovitis
189
How is De Quervain’s tenosynovitis managed
``` Rest Adapting activity Splints Analgesia - NSAIDs Physiotherapy Steroid injections Surgery - rare - cut the extensor retinaculum releasing the pressure and creating more space for tendons ```
190
Describe Dupuytren's contracture
Palmar fascia becomes thickened and tight leading to finger contractures (fingers pulled into flexion and restricting ability to extend)
191
List some risk factors for Dupuytren's contracture
``` Age FH - autosomal dominant Male Manual labour - vibrating tools DM Epilepsy Smoking and alcohol ```
192
Describe a test for Dupuytren's contracture
Table top test - patient can not position hands completely flat on a table
193
Which finger is most affected by Dupuytren's contracture
Ring finger
194
How is Dupuytren's contracture managed
Conservative or surgical Needle fasciotomy - insert needle through skin to divide and loosen the cord causing the contracture Limited fasciotomy - removal of abnormal fascia and cord to release contracture Dermofasciectomy - remove abnormal cord, fascia and skin, replace removed skin with skin graft
195
Describe carpal tunnel syndrome
Compression of the median nerve as it travels through the carpal tunnel in the wrist, causing pain and numbness in the median nerve distribution of the hand
196
Describe the carpal tunnel
Between the carpal bones and the flexor retinaculum (fibrous band that wraps across the palmar side of the wrist) The median nerve and flexor tendons of the forearm travel through the carpal tunnel
197
What does the palmar cutaenous branch of the median nerve supply and is it affected in carpal tunnel syndrome
Palm sensation | Not affected in carpal tunnel syndrome - does not pass through carpal tunnel
198
List some risk factors for carpal tunnel
``` Repetitive strain Obesity Perimenopause RA DM Acromegaly - bilateral Hypothyroidism ```
199
What does the median nerve supply
Motor - abductor pollicis brevis, opponens pollicis, flexor pollicis brevis Sensory - thumb, up to lateral half of ring finger
200
List some symptoms of carpal tunnel syndrome
Sensory symptoms of thumb to lateral aspect of ring finger - pain, burning, numbness and pins and needles Motor symptoms of thenar muscles - weak thumb movement, weak grip strength, difficulty with fine thumb movements, thenar atrophy
201
Name and describe two special tests for carpal tunnel syndrome
Tinnel's - tapping on wrist at location median nerve passes through tunnel (middle at point where wrist meets the hand), test is positive when sensory symptoms are triggered Phalen's test - fully flexing the wrist and holding it in this position, often done by asking the patient to put backs of hand together and bend wrists at 90 degrees. Positive when symptoms of carpal tunnel resent
202
Describe the Kamath and Slothard carpal tunnel questionaire
High score replaces need for nerve conduction studies Predicts likelihood of CTS based on questionaire - Do the symptoms wake you at night? - Do you have trick movements to make the symptoms go? - Is your little finger affected?
203
How is carpal tunnel syndrome diagnosed
Nerve conduction studies - how well the signals pass through the carpal tunnel along the median nerve
204
Describe the management of carpal tunnel
Rest and altered activity Wrist splints that maintain a neutral position of the wrist worn at night - minimum 4 weeks Steroid injections Surgery - flexor retinaculum transverse carpal ligament is cut to release pressure on median nerve
205
What is a ganglion cyst and how does it present
Sac of synovial fluid originating from tendon sheath or joint capsule Synovial membrane herniates forming a pouch Appear suddenly/gradually Non-tender - although may compress nerves to give sensory and motor symptoms Well circumscribe Transilluminates Hard
206
Describe the management of ganglion cysts
Conservative - 50% resolve spontaneously Needle aspiration - may recur Surgery - remove affected part of tendon sheath/ joint capsule - infection and scarring
207
List the carpal bones
``` Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate ```
208
How is Achille's tendon rupture managed
Equinus cast - foot held in plantar flexion
209
What is Froments sign
Inability to pinch normally between the first and second digits Ulnar nerve pathology
210
Which nerve roots form the ulnar nerve
C8-T1
211
Which nerve roots form the radial nerce
C5-T1

Finals (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions