Orthopaedics Flashcards
First line analgesia for lower back pain
ORAL NSAIDS
What medication will worsen compartment syndrome?
Anticoagulation
When is an ankle xray needed?
Pain in malleolar zone +
- bony tenderness at lateral/medial malleolar zone
- inability to walk 4 steps after injury and in ED
Assessing patients fracture risk
FRAX tool
Presentation of trochanteric bursitis
Isolated lateral hip/thigh pain with tenderness over the greater trochanter
Short Hx of pain with radiological signs affecting second metatarsal
Stress fracture
Carpal tunnel action potentials
Prolongation in sensory and motor axons
Pain over radial styloid on forced abduction/flexion of the thumb
Tenosynovitis
4-8 y/o boy
weeks Hx of hip/groin pain
xray widening of right hip joint space with flattening of femoral head
Perthes
4 year old with limp and pain which gets better during the day
Juvenile idiopathic arthritis
Cubital tunnel syndrome
compression of ulnar nerve
+ve tinnels
Intracapsular NOF fracture in active and mobile woman
Internal fixation
Weakness of hip abduction and foot drop with no specific reflex lost
L5 radiculopathy
Salter Harris:
Through the metaphysis and epiphysis
4
Poor prognosis
Risk factor for adhesive capsulitis
T2DM
Common cause of knee pain in runners
Iliotibial band syndrome
Injury with ‘pop’ and locking of the knee
Meniscal tear
Overweight adolescent boy with knee/hip problems
Slipped upper femoral epiphysis
What diagnosis increases the risk of carpal tunnel syndrome
Rheumatoid Arthritis
How to assess for achilles tendon rupture?
Simmonds triad
- palpate tendon
- angle of declination at rest
- calf squeeze test
Management of grade 1-2 acromioclavicular joint injury
Conservative: rest and sling
Bone remodelling on xray with swollen red warm join in pt with T2DM
Charcot joint
Fever + Back pain worse on hip extension
Iliopsoas abscess
Impaired external rotation
Adhesive capsulitis
management for subluxation of the radial head
Passive supination of the elbow joint whilst flexed to 90 degrees
Spinal stenosis
Presents with claudication
Pain improves when sitting forward
McMurray Test
Meniscal tear
External rotation and abduction of the upper limb
Bulge under the clavicle
Axillary nerve loss
Anterior shoulder dislocation
Achilles Tendon rupture
- test and diagnosis
Thompson test (calf squeeze) Ultrasound first line
Knee pain after exercise, locking and clunking
Osteochondritis dissecans
Pain localised over tibia
Stress fracture - x ray
Heel pain
- diagnosis and management
Plantar fasciitis
Rest, stretching and weight loss
Open fracture initial management
Immediate wound debridement and application of external fixation
Delay surgery until soft tissues have recovered
Leriche syndrome
- claudication of the buttocks and thighs
- Atrophy of leg muscles
- Impotence (paralysis of L1 nerve)
Pudendal nerve damage
Paraesthesia in pelvic area
Increased sensitivity to pain
Feeling of a golf ball in perineum
Young adult, FOOSH, tenderness over radial head, pain on lateral elbow with pronation and supination
Fracture of the radial head
FOOSH with rotational force, bruising over lower forearm, displaced fracture of radius and disrupted joint
Galeazzi fracture
Investigation in child with unexplained bone pain
xray in 48 hours
What movements are impaired in adhesive capsulitis?
External rotation
IV drug users with infective endocarditis can present with discitis
What organism causes osteomyelitis?
Staph aureus
What structure is divided in surgical management of carpal tunnel?
Flexor retinaculum
Anterior shoulder dislocation
Arm is abducted and externally rotated
Humeral head in a subcoracoid position in AP view
95%
Position of a posterior hip dislocation
Shortened and internally rotated
Position of a NOF fracture
Shortened and externally rotated
Where is the cubital tunnel?
Elbow
What does a Monteggia fracture involve?
Dislocation of the proximal radioulnar joint in association with an ulnar fracture
Diagnose meniscal tears
MRI
How long after hip replacement is weight bearing?
Immediately post op
Anterolateral leg sensation
Lateral cutaneous nerve of thigh
Management of scaphoid fracture in emergency department
In the emergency department, suspected scaphoid fractures should be managed with immobilisation using a Futuro splint or standard below-elbow backslab before specialist review
Scaphoid fracture management
Internal fixation if displaced
Conservative management if no xray abnormality
Where is the anatomical snuffbox
Between the extensor pollicis longus and brevis tendons
Management for intertrochanteric (extracapsular) proximal femoral fracture
Dynamic hip screw
Trochanteric pain syndrome
Trochanteric bursitis
Avascular necrosis on xray
Crescent sign
Biggest risk factor for avascular necrosis
Chemotherapy
Fracture of the distal radius with posterior displacement and no articular involvement
Colle’s
Hill Sachs Lesion
Glenohumeral dislocation
Shoulder pain to 90 degrees abduction
Supraspinatus tear
Diabetic with reduced sensation in feet and temperature and investigation
Osteomyelitis
MRI
Sepsis with changing lower lib neurology
Epidural abscess
Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test
Nerve root
S1
Hit to knee, swollen, with no fractures
Dislocated patella
15 year old gradual onset knee pain worse with activity, tenderness over tibial tuberosity
Osgood Schlatter
Mortons neuroma
Sharp pain and numbness in foot
Ultrasound
Clubfoot management
Manipulation and progressive casting soon after birth
Triceps tendon nerve root and nerve
Radial nerve C7
Foot drop
Peroneal nerve
Investigation and management for psoas abscess
CT abdomen
IV ABx and percutaneous drainage
Management of simple rib fracture
Conservative management with adequate analgesia
Imaging for cauda equina
MRI spine
Nerve damaged:
numb thigh, weak knee extension, patella reflex not elicited
Femoral nerve
Displaced hip fracture management
Hemiarthroplasty
Tender swelling on posterior elbow
Olecranon bursitis
Neurovascular structure damaged with a scaphoid fracture
Dorsal carpal arch of the radial artery
Imaging for achilles tendon rupture
Ultrasound ankle
Undisplaced scaphoid fracture
Cast for 6-8 weeks
What is radiculopathy
Follows a dermatomal distribution unlike a named nerve pathology
ICU avoiding chest infection
Physiotherapy
Pain over the lateral cutaneous nerve of the thigh
Meralgia parasthetica
L5 lesion
Loss of foot dorsiflexion and sensory loss dorsum of foot
What nerve is injured during a knee arthroplsaty?
Common peroneal nerve
Common cause of bilateral carpal tunnel syndrome
RA
cause of 5th metatarsal fractures
Inversion of the foot and ankle
Squaring of the thumb - OA or RA
OA
Shoulder pain and weakness following glandular fever
Parsonage-Turner Syndrome
Medial epicondylitis
Golfers elbow
Lateral epicondylitis
Tennis elbow
What are heberdens nodes?
bony outgrowths in the DIP associated with OA that skew the fingertip sideways
Investigation for osteoporotic vertebral fracture
X ray spine
Lachman Test
ACL
Osteomyelitis in sickle cell - organism
Salmonella enterididis
Nerve injured in posterior hip displacement
Sciatic
Clubfoot examination findings
Inverted and plantar flexed foot which is not passively correctable
What medication increases the risk of dupytrens?
Seizure
Management of undisplaced patella fractures
Conservative management
What is the most common reason that total hip replacements need to be revised?
Aseptic loosening of the implant
Analgesia in patients with a NOF fracture
Iliofascial nerve block
Pain on shoulder abduction 90-120 degreees
Subacromial impingement
What do oslers nodes look like and what conditions are they found in?
tender purple/red raised lesions with a pale centre
endocarditis, SLE, haemolytic anaemia, gonorrhoea
Minimally displaced stable fracture management
May weight bear in CAM boot
What 2 fractures is compartment syndrome most commonly associated with?
Supracondylar fracture
Tibial shaft fracture
