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MBChB Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Imbalance of cartilage wear down and insufficient chondrocyte activtiy describes what condition?

A

Osteoarthritis

‘wear and tear’ of the synovial joints

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2
Q

70 year old patient presents with joint pain. The pain is present in the base of their thumbs and gets worse throughout the day. They enjoy gardening so hope that something can be done about it.

What investigations do you perform and what do you find?

A

Clinical diagnosis: Patient over 45 with no morning stiffness

If atypical presentation: XR of affected joint would show

Loss of joint space

Osteophytes (bone spurs)

Subarticular sclerosis (increased density of bone along joint line)

Subchondral cysts (fluid-filled holes)

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3
Q

What 4 lifestyle changes should be given following diagnosis of osteoarthritis?

A

Weight loss to reduce load on joints

Physio to maintain/improve function

Occupational therapy to modify ADLs

Orthotics

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4
Q

What is the analgesic ladder for osteoathritis?

A
  1. Oral paracetamol + topical NSAIDs
    • Oral NSAIDs (+ PPI)
  3. Consider opiates eg codeine
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5
Q

Outside lifestyle and analgesia, what 3 further options can help manage osteoarthritis?

A

Topical capsaicin

IA steroid injection

Joint replacement for severe cases

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6
Q

Aside from osteoarthritis, what other conditions may require joint replacement?

A

Fractures

Arthritis: Septic or rheumatoid

Osteonecrosis

Bone tumours

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7
Q

What are the 3 types of joint replacement?

A

Partial joint resurfacing: replacing part of the joint

Hemiarthroplasty: Replacing half the joint surface

Total joint replacement: Replacing both joint surfaces

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8
Q

Explain what an:

a) total knee replacement
b) total shoulder replacement

entails

A

a) synthetic replacement of joint surfaces + spacer
b) Head replaced by synthetic ball, socket replaced with metal

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9
Q

Regarding VTE prophylaxis in joint replacement surgery…

a) What agent is typically given?
b) How long is it given for in
i) Knee replacement
ii) Hip replacement
c) What alternative methods of prophylaxis can be given?

A

a) LMWH

b)

i) 14 days knee
ii) 28 days hip
c) DOACs, aspirin, anti-embolis stockings

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10
Q

Regarding prosthetic joint infections

a) What is the most common pathogen?
b) What are the 3 predisposing factors?

A

a) S.aureus
b) Prolonged operative time

Obesity

Diabetes

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11
Q

What is meaning of:

a) compound fracture
b) Stable fracture
c) Pathological fracture

A

a) Broken bone breaks through skin, exposed to air
b) bone sections remain aligned at the fracture
c) break due to underlying bone abnormality

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12
Q

Patient reports to A+ E following a FOOSH. The arm shows dorsal displacement of the distal radius. X ray of the arm is shown below. What is the likely diagnosis?

A

Colle’s fracture

Dorsally Displaceed Distal radius / Dinner fork Deformity

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13
Q

Patient presents to A+E with a broken arm. On examination, the affected arm shows palmar (volar) deviation of the distal radius. They state that they fell backwards after slipping and their hands got caught under them. What is the likely diagnosis?

A

Smith’s fracture

Volar displacement of distal radius

‘garden spade’ deformity

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14
Q

Patient presents with a sore wrist. They state that the got into a fight last night and despite remembering “knocking the f***** out” they can’t remember hurting their wrist. An X-ray of the wrist is provided below. What is the likely diagnosis?

A

Bennett’s fracture: Intra-articular fracture of 1st MC joint

Typically caused by fist fights

Triangular fragment at metacarpal base

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15
Q

A patient presents to A+E with a sore wrist. Since the injury, they state that they are unable to grab things and the pain is greatest over the base of the thumb.

a) What 3 signs can aid diagnosis?
b) What is the diagnosis with positive signs?
c) What imaging should be done
i) first line
ii) definitively

A

a) i) telescoping of thumb elicits pain, ii) point of maxminal tenderness over snuffbox and iii) Tenderness over back of wrist
b) Scaphoid fracture

c)

i) AP and Lateral X rays
ii) MRI scan

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16
Q

For scaphoid fractures, what is the

a) initial management
b) Further ortho management with
i) undisplaced
ii) displaced
iii) proximal scaphoid pole fracture?

A

A) Futuro splint/below elbow backslab + 7-10 day review (if imaging inconclusive)

B)

i) Cast for 6-8 weeks, surgical if athlete

ii and iii) Surgical fixation

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17
Q

Why do you worry about a scaphoid fracture?

A

Has a one way (retrograde) blood supply from the dorsal carpal branch of the radial artery

Severance risks avascular necrosis

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18
Q

Which 6 bones/areas are particularly prone to AVN?

A

Wrist: Scaphoid

Arm: Humeral head

Leg: Femoral head

Foot: Talus, navicular, fifth metatarsal

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19
Q

Who gets an ankle X-ray?

A

Those who fufill the Ottawa rules:

Malleolar pain AND

  1. No weight bearing for 4 steps
  2. Tenderness over the distal tibia
  3. Bone tenderness over the distal fibula
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20
Q

How does the Weber system classify ankle fractures

A

Fracture level to the joint

A) Below with intact syndesmosis

B) At joint +/- extend above with partial tear

C) Above joint with disruption

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21
Q

What are the main sites bone cancer metastasises to?

A

PRTBL/Lead Kettle

Prostate

Breast

Kidney

Thyroid

Lung

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22
Q

With regard to bone fragility…

a) How can fragility risk be estimated?
b) How can bone density be assessed and graded?

A

a) FRAX for 10 year risk
b) DEXA for density

WHO crteria for T score at hip:

-1 to -2.5: Osteopenia

>-2.5: Osteoporosis

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23
Q

Although bisphosphonates can help with reduced bone density, what are the 3 side effects it can cause?

A

Reflux and oesophageal erosions

Osteonecrosis of jaw and external auditory canal

Atypical femoral fractures

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24
Q

What are the two main principles of fracture management?

A

1) Mechanical aligment: Closed (limb manipulation) vs open (surgery)
2) Relative stability

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25
Q

Patient presents with new onset confusion, rash and tachypnoea. You also note a high temperature and fever. Their notes state recent tibial frature after being found following a climbing fall.

1) What is the likely issue?
2) What criteria helps rule the diagnosis?
3) Whats the treatment?

A

Fat embolism

Guards major criteria: Resp distress, petechial rash and cerebral involvement

Guards minor criteria: Jaundice, thrombocytopaenia, fever, tachycardia

Typically in those with delayed surgery

Avoided with early surgery

Management is supportive

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26
Q

A patient presents following a fall down the stairs. They state they have pain in the groin that stops them walking. On examination, the affected leg is positioned and twisted outwards and looks shorter than the other leg.

1) What is the likely diagnosis?
2) What is the initial and follow on investigations to confirm?
3) What timeframe should treatment commence?

A

1) Hip fracture: Fall history producing abduction, external rotation and shortening of leg
2) X ray is initial choice (AP and lateral)

MRI to confirm, CT if unavailable

3) Within 48 hours of presentation

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27
Q

Why does the phrase ‘hip fracture’ cause ortho bois to sweat?

A

Joining of lateral and medial femoral arteries

Means retrograde blood supply to femoral head

so potential AVN

:(

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28
Q

What are the 4 Garden grades of intracapsular hip fracture?

A

Grade I: Incomplete and non-displaced

Grade II: Complete fracture, non-displaced

Grade III: Partial displacement (angled trabeculae)

Grade IV: Full displacement (parallel trabeculae)

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29
Q

Why does determining a hip fracture as intracapsular vs extracapsular matter?

A

Determines if femoral head is likely needing replaced

Intracapsular + displaced (G3-4): Replace head due to disruption of blood supply

Extracapsular: No replacement needed

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30
Q

What are the surgical options for the following hip fractures:

a) Intracapsular
b) Extracapsular

A

a) THR if fit, hemiarthroplasty if less so
b) Depends on trochanteric involvement

Intertrochanteric: Dynamic screw

Subtrochanteric (within 5cm distal to lesser trochanter): IM nail

31
Q

Patient presents with sore leg. The complain of pain that was worse when their friend tried to straighten it. The state that on the way to A+E they felt ‘pins and needles’. On examination the leg looks pale. They state that the leg was injured when they fell off their bike and the friend ran over their leg.

1) What is your suspected diagnosis?
2) What clinical features help whittle down the differentials?
3) How do you confirm the diagnosis?
4) How do you treat the condition?

A

1) Compartment syndrome: Pain, Paraesthesia, Pale, Pressure, Paralysis if late (NOT PULSELESS
2) Disproportionate pain even after meds, not pulseless (excludes acute limb ischaemia)
3) Don’t need to as its clinical. Can do manometry to confirm pressure

4)

Intial: Escalate, Expose, Elevate, Equilibrate (keep BP up)

Fasciotomy: Open fascia to relieve pressure then close

32
Q

How can acute and chronic compartment syndrome be distinguised?

A

Chronic induced and relieved by exertion not related to trauma

33
Q

Patient presents acutely unwell post-operatively. They are feverish and feel achy. On examination, their leg appears red, swollen and tender. They came in following an open tibial fracture. They are diabetic and have a history of IV drug use.

1) suspected diagnosis?
2) What investigations do you request?
3) How is it managed?

A

1) Osteomyelitis: Bacteria triggered inflammation of bone and marrow. Typically S. aureus through direct or haematogenous spread. Bone exposure, Immunocompromise (inc diabetes), PAD and IV drug use are risk factors.
2) For bone status: MRI +/- XR

For pathogen: Blood cultures +/- bone culture

3) Surgical debridement

Flucloxcillin 6 weeks +/- rifampicin and fusidic acid for 1st 2 weeks

34
Q

What alternative antibiotics can be given for osteomyelitis?

A

Normal: Flucloxicillin + rifampicin + fusidic acid

If penicillin allergic: Clindamycin

If MRSA: Vanc/teicoplanin

35
Q

Patient presents with a lump on their thigh. They have had it for 3 months and in the last 2 weeks there has been persistent deep pain in the leg. The

1) What is your initial suspicion?
2) What investigations would guide your suspicion?
3) How do you manage?
4) How is your thinking affected if this was:
i) A child
ii) An HIV positive person

A

1) Sarcoma: Connective tissue cancers that present with bone pain, swelling and associated lump.
2) Investigations:

Initial: X ray for bone, US for soft tissue

Confirmatory: CT/MRI for location, biospy for diagnosis

3) Referral to specialist sarcoma centre
4) i) Ewing’s sarcoma most common
ii) Kaposi’s sarcoma in late HIV

36
Q

What are the red flags for lower back pain?

A

THE RED FLAGS

Trauma

History of Cancer

Extended duration (>4 weeks)

Rest/night pain

Equina

Disability

Fever

Losing weight

Age <20/>50

Generally unwell

Steroids/immunosuppressed

37
Q

What are the 4 key things to examine for with back pain?

A

LNDN

Localised tenderness to spine (Fracture/cancer)

Neurological deficts bilaterally (cauda equina)

Distention of bladder (cauda equina)

No or reduced anal tone (cauda equina)

38
Q

A patient presents to her GP with back pain. She is worried that it is sciatica, as both her friend and mum have it. How can you determine during the consultation if this is likely?

A

Stretch test

Lift single extended leg to maximal hip flexion

flex patients ankle up causes pain

flexing knee relieves

39
Q

What are the red flag causes of back pain and their key features?

A

Spinal fracture: Major trauma history

Cauda equina: Saddle anaesthesia, urinary retention, incontinence, bilateral neuro signs

Spinal stenosis: Intermittent neurogenic claudication

Ankylosing spondylitis: Under 40s, Gradual onset, morning stiffness, night pains

Spinal infection: Fever, IVDU use

40
Q

What investigations should be done for suspected

a) mechanical back pain
b) Spinal fractures
c) Cauda equina
d) Ankylosing spondylitis

A

a) None, its clinical
b) X-ray, CT

C) Emergency MRI

d) Inflammatory markers + X-ray + MRI

41
Q

What screening tool can aid risk assessment for chronic back pain? Outline the quotas for low, medium and high risk

A

STaRT Back: Total of 9, psychological subscale of 4

Low risk: <3 on either

Medium: >3 total, >=3 sub

High: >3 on either

42
Q

How does chronic back pain risk affect holistic care for the patient?

A

Low: Reassure and educate

Medium or high: Physio, CBT

43
Q

What is the analgesic ladder for back pain? What drugs are avoided?

A

NSAIDs –> Codeine –> Benzodiazepines: 5 days (for muscle spasm)

DONT GIVE OPIOIDS, Antidepressants or atypical pain meds

44
Q

Aside from the acute low back pain ladder, what drugs can be given for neuropathic pain in sciatica?

A

Amitripyline or duloxetine

45
Q

Patient presents to GP following a 2 day history of altered bowel habit. They state that they “can’t hold their stool in” which they put down to a dodgy takeaway on the first night but today they state having “pins and needles” in “that area”. They deny pain on coughing or straining

1) What differential are you worried about?
2) How could you explore this differential
i) in the practice
ii) in secondary care
3) What are the management options?

A

1) Cauda equina syndrome

2)

i) PR exam shows loss of anal tone
ii) Admit first then emergency MRI + neurosurg input
3) Surgical decompression

46
Q

How can you differentiate between cauda equina and metastatic spinal cord compression? How does initial management change?

A

MSCC is worse on coughing or straining

High dose dexamethasone is given to reduce swelling

47
Q

What is the most common reason for cauda equina?

A

Herniated disc at L4/5 or S1/2

48
Q

Patient presents with a sore leg. They state that they get pain in their bum and right leg as well as feeling weaker. This was first noticed 2 months ago, coming on during their daily walk with an over 60s group. They state that resting helps. They also state they’ve started to get back pain but put that down to “getting older”.

1) What is the likely diagnosis?
2) How can you improve your certainty
i) on examination
ii) with imaging
3) How is the suspected condition managed?

A

Spinal stenosis: Narrowed spinal canal due to damage, degeneration or displacement

Claudicant symptoms of leg pain and weakness

2)

i) Flexion at hips by bending over relieves pain
ii) MRI first line

May consider CT along with ABPI to exclude PAD

3) Exercise and weight loss

Analgesia

?Decompression surgery where conservative management fails

49
Q

Patient presents to GP with “funny sensation in leg”. They state that for 2 weeks the outside of their right thigh has felt “pins and needles” and no other symptoms. They notice the feeling more when walking. They also state that while shaving yesterday, they noticed their thigh had a bald patch on the same area. On examination, motor function appears normal

1) What is the suspected diagnosis?
2) What investigations would you do?
3) How would you manage if confirmed?

A

1) Meralgia Paraesthetica: Pressure or deformity of the the lateral femoral cutaneous nerve leading to SENSORY LOSS of the upper lateral thigh that worsens on extension
2) Diagnosis is clinical via pevlic compression

but image if compressive/red flag picture

3)

Conservative: Ease pressure via weight loss, physio and looser clothing

Medical: Paracetamol, NSAIDs, neuropathic analgesia

Surgical: Decompression/transection/resection

50
Q

A patient presents with hip pain. They state that they’ve had aching feeling for 2 months that has slowly become worse, noticing it most when they get up after watching their soaps and when trying to sleep. They are 60 years old.

1) What is the suspected diagnosis?
2) What tests would aid diagnosis?
3) How is this managed?

A

Trochanteric bursitis: Gradual onset lateral hip pain. Due to mechanical, inflammatory or infective irritation of the trochanteric bursa.

2) Trendelenburg: Stand on affected side and contralateral hip will dip

Resisted movements: Abduction, internal and external rotation causes pain

3) Conservative management +/-steroid injections if severe

51
Q

Patient presents to A+E with knee pain. It started after someone dummied past them in a basketball game. Since then, they can’t limp on the knee or move it. On examination the knee is swollen and tender along joint line. They are 24 years old

1) What injury is most likely at this stage?
2) What examination tests do you want to perform
3) What imaging would you do?
4) How do you manage?

A

1) Meniscal tear: Tender, swollen knee with restricted motion, typically following a twisting injury.
2) McMurray test and Apley grind test
3) MRI as patient can’t weight bear or flex to 90 degrees

Confirm with arthroscopy if necessary

4) Rest, Ice, Compression, Elevation

NSAIDs for analgesia

Arthroscopic repair or resection if severe

52
Q

What is the

a) McMurray Test
b) Apley grind test

A

McMurray: With patient supine…

Internal rotation of leg, press out from knee and gently extend

Then do reverse: External rotation, press in, extend

Apley: With patient prone

Flex knee 90 degree, apply downward pressure then internally and externally twist.

Pain localises to affected side

53
Q

What is the difference in origins and functions of the…

Anterior cruciate ligament

Posterior cruciate ligament

A

ACL: Attaches to anterior intercodylar area, stops tibia sliding forward

PCL: Attaches to posterior intercondylar area, stops knee sliding backward

54
Q

Patient presents to A+E with a sore knee. They state it came on after getting tackled in a rugby game, hearing a loud ‘pop’ at the time. Since then the patient claims that the knee has significantly swollen, worse than other milder injuries they have had. They cannot weight bear and feel their knee would ‘come out from under them’

1) What is the likely diagnosis?
2) What tests can confirm the diagnosis?
3) How is this managed?

A

1) Anterior cruciate ligament tear: Knee pain and swelling associated with a ‘pop’, typically following twisting or longitudinal force on bent knee.
2) Flex knee at either 45 (Anterior drawer) or 20 degrees (Lachman) then move proximal tibia anterior and posteriorly.

Excessive anterior movement without definite end point will be seen as ACL not there to restrcit tibial movement.

3) RICE + NSAIDs + Physio

If young and fit: Arthroscopic surgery involving grafting the tendon from the hamstring/quadriceps/bone-patellar tendon

55
Q

a teenage male presents with a month long history of a sore knee. The pain is at the front of the knee and is most noticeable after running in PE. On examination of the knee, there is a little bump at the top of the tibia

1) Diagnosis
2) Investigations
3) Management

A

1) Osgood-Schattler’s Disease: Anterior knee pain exacerbated by extension and flexion of knee. Due to irritation of tibial insert of patellar tendon.
2) None, clinicial diagnosis
3) RIPE + NSAIDs, knee rehab to improve

If avulsion fracture occurs, surgery is required

56
Q

Patient presents to GP with a painful lump. The lump sits behind the knee and the pain is worse when standing up. The patient states that aside from the pain, the lump is starting to make it harder to move their knee. On examination, there is a soft lump that decreases in size as you flex the knee. The patient is 65 years old and had a meniscal tear 8 months ago

1) Likely diagnosis
2) Investigations
3) Management

A

1) Baker’s Cyst: Painful lump behind the knee, worse on extension. Due to synovial fluid accumulation typically from degenerative change to the knee.
2) Clinical diagnosis

Ultrasound to exclude ruptured cyst

MRI to look for meniscal tear

3) RIPE + NSAIDS

Surgery for underlying pathology where appropriate

57
Q

Patient presents to GP with sore ankle. The have noticed a gradual pain over the back of their ankle that’s worse during their evening runs. They are diabetic and have rheumatoid arthritis in their hands. They are 50 years old.

1) Likely diagnosis
2) Investigations
3) Management

A

1) Achilles tendinopathy: Pain, stiffness and swelling from irritation of the achilles tendon. More likely if sporty, inflammatory, diabetic and fluoroquinilone use.
2) Clinical diagnosis but

Exclude rupture with Simmonds Calf squeeze test

US if suspicion of rupture

3) RIPE + Orthotics

AVOID STEROID INJECTIONS AS THEY CAUSE RUPTURE

58
Q

A patient presents with a sore ankle. They felt like theyd been shot in the ankle due to the pain and a loud pop was heard. They had been admitted last night with a chest infection. From the notes you see that they are 55 years old, asthmatic and penicillin allergic.

1) Diagnosis
2) Investigations
3) Management

A

1) Achilles tendon rupture: Acute onset of ankle pain associated with loud bang. More likely with age, systemic steroids (asthma) and fluoroquinolones (pen allergic chest infection)
2) Squeezing calf does not cause plantarflexion

US to confirm diagnosis

3) RICE

Surgical reattachment: Lesser re-rupture but surgical risks

Plantarflexion boot: More rereupture but less surgical risks

59
Q

Heel pain can be caused by both plantar fascitis and fat pad atrophy but how does their management differ?

A

Both require rest and adaptation

Steroids can be given in plantar fasciitis but this is a cause of fat pad atrophy

60
Q

Patient presents with a painful foot. They state that its worse at the top of the foot and often feels like there is a stone in their shoe.

1) Diagnosis
2) What exam tests can raise suspicion
3) What imaging confirms
4) How is it managed?

A

Morton’s neuroma: Abnormal intermetatasal nerve, typically 3-4 metatarsal. Burning, lump in shoe and pins and needles are features

2) Direct pressure/metatarsal squeezse causes pain; squeezing sides of feet causes clicking
3) US/MRI to confirm
4) Typical foot lifestyle malarkey

Can ablate or excise neuroma too

61
Q

How is hallux valgus confirmed and managed?

A

Weight bearing X-rays to determine extent

Wider shoes +/- surgery

62
Q

Patient presents with a sore foot. The base of their toe is red, hot and swollen. They state that they had a similar bout of this but in their thumb. They have no past medical history but confess that they do drink a bottle of wine a night

1) Whats the likely diagnosis?
2) How do you confirm the diagnosis
3) How do you treat the condition?

A

1) Gout but septic arthritis very similar so dont be swayed
2) Joint aspiration
- No baceria
- Negatively birefringent polarised light

Needle shaped crystals

Monosodium urate crystals

3)

Acute: 1. NSAIDs, 2. Colchine, 3. Steroids

Prophylactic: Allopurinol POST-ATTACK (makes it worse)

63
Q

Patient presents to their GP with shoulder pain and stiffness. They report the pain has been present for around 3 months but they found ibuprofen helped. The stiffness has been present for a week and is bothering them as they are finding it more difficult to stack shelves at work. They are a type II diabetic and are 47 years old

1) Likely diagnosis?
2) How to confirm?
3) Management?

A

1) Frozen shoulder/adhesive caspulitis: Pain followed by stiffness in the shoulder. More common in diabetics and middle age. Due to inflammation and fibrosis of joint capsule.Can be primary or secondary to injury
2) Clinical diagnosis involving exclusion of other pathologies…

Jobe test (arms out and thumbs down): supraspinatus tendinopathy

Tender AC joint palpation/positive scarf test: AC joint arthritis

Inflammatory and malignant causes need ruled out too

3) Conservative +/- IA steroids/fluids

Surgery if resistant

64
Q

Patient presents with a sore shoulder. It started suddenly while reaching overhead for a ball in a game of volleyball. They also report the arm feeling weaker when moving it

1) likely diagnosis
2) How do you localise the site of the injury?
3) How do you manage?

A

1) Rotator cuff tear: Acute injury of the shoulder following episode of strain or secondary to degeneration.
2) Supraspinatus: Abducts

Infraspinatus, Teres minor: externally rotates the arm

Subscapularis

3) US/MRI to confrm

Conservative management

Arthroscopic rotator cuff repair

65
Q

If you were at William Hill and someone dislocated their shoulder, would you put £20 on it being an anterior or posterior dislocation?

A

Anterior

Accounts for 80-90%

Posterior only really in seizure or electric shock

66
Q

In shoulder dislocation, which lesion…

a) Occurs with repeated dislocations
b) leaves the patient at greater risk of repeated dislocations

A

a) Bankart: Anterior labrum tear
b) Hill-Sachs: Postero-lateral humeral head damaged from hitting the anterior glenoid cavity rim

67
Q

Patient has a shoulder dislocation, what…

a) Nerve (with its roots) are you worried about
b) How can you tell if its involved?

A

a) Axillary nerve (C5,6)
b) Sensory: Regimental badge patch numbness over deltoid

Motor: shoulder abduction weak

68
Q

What fractures should you look for in a shoulder dislocation?

A

Humeral: head, greater tuberosity

Scapula: Acromion

Clavicle

69
Q

Patient presents after falling onto their arm. They complain of a sore shoulder. On examination, the deltoid looks deflated and there is an anterior bulge.

1) Likely diagnosis and what you need to assess for?
2) What imaging
3) What is the management
i) Initially
ii) Following on

A

1) Shoulder dislocation: Pain and deformity of shoulder due to displacement of the humeral head out of the glenoid
2) Do after reduction but…

X-rays: If particularly concerned about fractures

MRI to assess soft tissue damage

3) Acute

Closed reduction of dislocation with analgesia and entonox

Ongoing

Perform anticipation test (external rotation leads to fear of dislocation)

Physio +/- surgery to improve stability

70
Q

Regarding olecranon bursitis…

1) What are the symptoms
2) How do you differentiate from infection
3) What investigation helps you determine the cause
4) If infected, what antibiotics should be used?

A

1) Olecranon bursitis: Trauma/infection/inflammation of bursa leading to painful swelling
2) Will appear hot and red. Septic arthritis will reduce range of motion
3) Joint aspiration

Pus: infection

Straw: less likely infection

Blood-stained: trauma/inflammation

Milky: Gout/pseudogout

4) Flucloxicillin or clarithromycin

71
Q

A middle age patient presents with a sore, non swollen elbow. How do you

a) differentiate between lateral and medial epicondylitis
b) Manage either case

A

a)

Lateral

Pain on applying pressure over joint while arm supine (Mill’s) or if prone while resisting extension of radially deviated wrist (Cozen’s)

Medial

Pain on pressing medial epicondyle on extended, supine arm (Golfer’s elbow test)

Management

Typical conservative joint rigamarole

72
Q

Patient presents with sore wrist. The pain affects the lateral half of their hand and is described as burning. They tried to ignore it at first but its affecting their sleep and now find themselves struggling with their grip. They find shaking the hand about aids symptoms temporarily

1) Likely diagnosis
2) Examination tests
3) How is it confirmed and managed?
4) Who is at increased risk of the condition?

A

1) Carpal tunnel syndrome: Burning pain +/- motor loss from thumb –> lateral ring finger. Due to compression of carpal tunnel damaging the sensory and motor innervation of the median nerve
2) Phalens: place back of hands together, pointing down at their feet, triggers symptoms

Tinel’s test: Tap middle of where wrist meets joint triggers symptoms

3) NCS confirms

Rest +/- splints

Day case surgery to release pressure

73
Q

Ganglion cysts are non-painful, palpable lumps of the wrist and elbow joint. How do you treat them?

A

Conservative as half self resolve

Can needle aspirate or excise if not

74
Q

Given the fact that both trigger finger and dupytren’s contracture are more common in diabetics, how can you tell them apart?

A

Trigger // Dupytren’s

Index // Usually ring finger

Pain // No pain

40-50s // Increases with age

Females // Males

Dupytrens also: Smoking, alcohol, autosomal dominant, Hard nodules, vibraitng tool work

MBChB Finals (31 decks)

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