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Surgery > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are the main principles of fracture management

A

Reduce

Hold

Rehabilitate

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2
Q

What is involved in reduction in fracture management

A

Restore anatomical alignment of fracture/deformity

Tamponades bleeding

Reduces swelling in surrounding tissue

Reduces risk of nerve damage

Reduces pressure in blood vessels

Clinical requirements: analgesia, consider conscious sedation

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3
Q

What is osteoarthritis

A

Progressive loss of articular cartilage and remodelling of underlying bone

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4
Q

What is the pathophysiology of osteoarthritis

A

Degeneration of cartilage and remodelling of bone

Get release of enzymes that break down collagen and proteoglycans

Underlying subchondral bone becomes exposed

Get: sclerosis, remodelling (formation of osteophytes and subchondral cysts), joint space narrowing

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5
Q

What are the risk factors for osteoarthritis

A

Obesity

Increasing age

Female

Tissue disease

Trauma

Infiltrative disease

Connective tissue disease

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6
Q

How might osteoarthritis present

A

Joint pain and stiffness

Worse on activity

Relieved by rest

Pain worsens throughout day

Stiffness improves throughout day

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7
Q

What are Bouchard’s nodes

A

Swelling of PIPJs

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8
Q

What are Heberden’s nodes

A

Swelling of DIPJs

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9
Q

What are the X-ray features of osteoarthritis

A

Loss of joint space

Osteophytes

Subchondral cysts

Subchondral sclerosis

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10
Q

What is the management for osteoarthritis

A

Education

Weight loss

Physio

Analgesia (topical/oral/intra-articular)

Osteotomy

Joint fusion

Arthroplasty

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11
Q

What are the different classes of open fractures

A

Gustilo-Anderson classification

Type 1: < 1cm, clean

Type 2: 1-10cm, clean

Type 3A: > 10cm, high energy, adequate soft tissue coverage

Type 3B: > 10cm, high energy, inadequate soft tissue coverage

Type 3C: all injuries with vascular injury

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12
Q

What investigations are needed for open fractures

A

Clotting screen

Group and save

X-ray

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13
Q

What is the management for open fractures

A

Realignment and splinting

Broad spectrum antibiotics

Tetanus vaccination status check/administration

Photograph wound

Remove gross debris (re-dress with saline-soaked gauze)

If have vascular compromise, immediate surgical exploration by vascular

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14
Q

What is compartment syndrome

A

Critical pressure increase within a confined compartmental space

Any fascial compartment can be affected

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15
Q

What are the causes of compartment syndrome

A

High-energy trauma

Crush injuries

Fractures causing vascular compromise

Iatrogenic vascular injury

Tight cast/splint

DVT

Post-reperfusion swelling

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16
Q

What are the sequence of events that lead to compartment syndrome

A

Intra-compartmental pressure increase

Veins compressed

Increased hydrostatic pressure (fluid moves out of veins)

Further intra-compartmental pressure increase

Traversing nerves compressed

Get paraesthesia

Intra-compartmental pressure reaches diastolic pressure

Arterial flow compromised

Ischaemia

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17
Q

How might compartment syndrome present

A

Within 48 hours of injury

Severe pain: disproportionate to injury, not improved with analgesia/removing splint, made worse by passive stretching

Paraesthesia

Tenseness in affected compartment

Not swollen (fascial layer not able to distend)

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18
Q

What are the 5 signs of arterial insufficiency

A

Pain

Pallor

Persistently cold

Paralysis

Pulselessness

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19
Q

What investigations are needed for compartment syndrome

A

Usually clinical diagnosis

Intra-compartmental pressure monitoring

Creatine kinase levels

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20
Q

What is the management for compartment syndrome

A

Early recognition

Immediate management: limb in neutral position, high flow oxygen, improve blood pressure, remove all dressings/casts, analgesia

Surgical fasciotomy

Post-fasciotomy: incision left open, re-look in 24-48 hrs (assess for dead tissue), can close wound but leave fascia open

Monitor renal function (can get rhabdomyolysis or reperfusion injury)

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21
Q

What are the main causative organisms of septic arthritis

A

S aureus

Streptococcus

Gonorrhoea

Salmonella

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22
Q

What are the risk factors for septic arthritis

A

> 80

Pre-existing joint disease

Diabetes

Immunosuppression

Chronic renal failure

Hip/knee prosthesis

IV drug use

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23
Q

How might septic arthritis present

A

Single swollen joint

Severe pain

Pyrexia

Unable to weight bear

Joint red, swollen, warm

Pain on active and passive movement

May have an effusion

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24
Q

What investigations are needed for septic arthritis

A

Routine bloods

Blood cultures

Joint aspiration

Joint fluid analysis

X-ray

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25
Q

What are the X-ray signs of septic arthritis

A

Usually normal appearance

In severe disease: in capsule and soft tissue swelling, fat pad shift, joint space widening

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26
Q

What is the management for septic arthritis

A

Early resuscitation and investigation

Empirical antibiotics (2 weeks IV, further 2-4 weeks oral)

Native joint: irrigation and debridement

Prostatic joint: washout, may need revision

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27
Q

What is osteomyelitis

A

Infection of bone

Acute - bacterial

Chronic - fungal

Adults - vertebrae

Children - long bones

Due to: haematological spread, direct inoculation, direct spread from nearby infection

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28
Q

What are the common causative organisms for osteomyelitis

A

S aureus

Streptococci

Enterobacter spp

H influenzae

P aeruginosa

Salmonella

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29
Q

What is the pathophysiology of osteomyelitis

A

Bacteria enter bone, express adhesins to bind host cells, produce polysaccharide extracellular matrix, pathogens: propagate, spread, seed

Get devascularisation of affected bone, necrosis

Resorption of surrounding bone (‘floating’ pieces of dead bone - reservoir for infection)

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30
Q

What are the risk factors for osteomyelitis

A

Diabetes (suspect in all diabetics with deep/chronic joint infection)

Immunosuppression

Alcohol

IV drug use

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31
Q

How might osteomyelitis present

A

Severe, constant pain

Worse at night

Low grade pyrexia

Tender at site

Swelling

Erythema

May not be able to weight bear

Look for source of infection: pock marks in IVDU, cellulitic areas, penetrating wounds

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32
Q

Give an overview of Pott’s disease

A

Infection of vertebral body and vertebral disc

By mycobacterium tuberculosis

Presentation: back pain, neurological features, low grade fever, non-specific infective symptoms

MRI

Management: prolonged course of anti-TB meds, abscess drainage

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33
Q

What investigations are needed for osteomyelitis

A

Routine bloods

Blood cultures

X-ray

MRI (definitive diagnosis)

Bone biopsy at debridement (gold standard)

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34
Q

What are the X-ray signs of osteomyelitis

A

Osteopenia

Periosteal thickening

Endosteal scalloping

Focal cortical bone loss

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35
Q

What is the management for osteomyelitis

A

Clinically well: > 4 weeks IV antibiotics

Deteriorating: surgery (curettage of affected area, prevent chronic osteomyelitis developing)

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36
Q

What can osteomyelitis lead to in children

A

Growth disturbances (premature physeal closure)

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37
Q

What are some benign bone tumours

A

Osteoma

Osteoid osteoma

Osteoblastoma

Chondroma

Osteochondroma

Chondroblastoma

Fibroma

Fibromatosis

Benign osteoclastoma

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38
Q

What are some malignant bone tumours

A

Osteosarcoma

Chondrosarcoma

Fibrosarcoma

Malignant osteoclastoma

Ewing’s tumour

Myeloma

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39
Q

What are the risk factors for bone tumours

A

Genetics (RB1, p53, TSC1, TSC2)

Previous exposure to radiation

Previous alkylating agent chemotherapy

Benign bone conditions

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40
Q

How might bone tumours present

A

Pain

At rest

Worse at night

Fracture without trauma

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41
Q

What staging system is used for orthopaedic tumours

A

Enneking

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42
Q

How are clavicle fractures classified

A

Allman classification

Type 1: middle 3rd (weakest segment), most common, generally stable, significant deformity seen

Type 2: lateral 3rd, unstable when displaced

Type 3: proximal 3rd, seen in multi-system polytrauma, associated with neurovascular compromise/pneumothorax/haemothorax

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43
Q

Which ways are fragments displaced in clavicle fractures

A

Medial fragment displaced superiorly (pull of SCM)

Lateral fragment displaced inferiorly (weight of arm)

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44
Q

What are the differentials for clavicle fractures

A

Sternoclavicular dislocation

Acromioclavicular joint separation

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45
Q

What investigations are needed for clavicle fractures

A

X-ray (anteroposterior, modified-axial)

CT (only for medial injuries)

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46
Q

What is the management for clavicle fractures

A

Slings

Early movement (prevent frozen shoulder)

Surgery for: open fractures, very comminuted (2+ fragments), very shortened arm, bilateral

May need ORIF if don’t unite in 2-3 months

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47
Q

What is the prognosis for clavicle fractures

A

Non-union associated with distal 3rd fractures

Usually heal in 4-6 weeks

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48
Q

How are rotator cuff tears classified

A

Acute - < 3 months

Chronic - > 3 months

Partial thickness

Full thickness (small - < 1 cm, medium - 1-3 cm, massive - > 5 cm)

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49
Q

What are the muscles in the rotator cuff

A

Supraspinatus (abduction)

Infraspinatus (external rotation)

Teres minor (external rotation)

Subscapularis (internal rotation)

All muscles stabilise humeral head in glenoid fossa

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50
Q

What is the pathophysiology of rotator cuff tears

A

Minimal force - pre-existing degeneration

Large force - in young

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51
Q

What are the risk factors for rotator cuff tears

A

Increasing age

Trauma

Overuse

Repetitive overhead shoulder motion

BMI > 25

Smoking

Diabetes

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52
Q

How might rotator cuff tears present

A

Pain over lateral shoulder

Inability to abduct arm > 90 degrees

Mostly in dominant arm

Tenderness of greater tuberosity

Tenderness of subacromial bursa

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53
Q

What are the special tests for rotator cuff tears

A

Jobe’s test (empty can test): tests supraspinatus

Gerber’s lift-off test: dorsum of hand on lower back, lift off against resistance, tests subscapularis

Posterior cuff test: elbow flexed at 90 degrees, externally rotate against resistance, tests infraspinatus and teres minor

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54
Q

What are the differentials for rotator cuff tear

A

Fracture

Persistent glenohumeral subluxation

Brachial plexus injury

Radiculopathy

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55
Q

What investigations are needed for rotator cuff tears

A

X-ray (exclude fracture)

Ultrasound (size of tear)

MRI (size, characteristics, location)

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56
Q

What are the X-ray signs of chronic rotator cuff tears

A

Reduced acromiohumeral distance

Sclerosis

Cyst formation

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57
Q

What is the management for rotator cuff tears

A

Analgesia

Physio

Activity modification

Trial corticosteroid injections

Surgery: arthroscopy or open (for > 2 weeks since injury, symptomatic despite conservative strategies, large and massive)

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58
Q

Which factors lead to poor outcomes for rotator cuff tears

A

Large/massive tears

> 65

Poor compliance with rehabilitation

Smoking

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59
Q

How might shoulder dislocation present

A

Recent trauma

Painful shoulder

Acutely reduced mobility

Feels unstable

Reluctant to move limb

Asymmetry

Loss of shoulder contours

Anterior bulge from head of humerus

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60
Q

What associated injuries can shoulder dislocation lead to

A

Neurovascular (axillary nerve and suprascapular nerve very prone to injury)

Bony Bankart lesion (fracture of anterior inferior glenoid bone, common in recurrent dislocations)

Hill-Sachs defect: fracture of greater tuberosity/surgical neck of humerus

Rotator cuff injuries

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61
Q

What investigations are needed for shoulder dislocations

A

X-ray (trauma shoulder series): light bulb sign in posterior dislocations

MRI (if labral/rotator cuff injury suspected)

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62
Q

What is the management for shoulder dislocation

A

A to E

Analgesia

Reduce, immobilise, rehabilitate

Closed reduction

Broad-arm sling (2 weeks)

Physio

Surgery for: ongoing pain, joint instability, large Hill-Sach’s lesion, large Bankart lesion

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63
Q

Which part of the humerus is normally fractures

A

Middle 3rd

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64
Q

What is Holstein-Lewis fracture

A

Fracture of distal 3rd of humerus

Entrapment of radial nerve

Loss of sensation in radial distribution

Wrist drop

Needs surgical management

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65
Q

What investigations are needed for humeral shaft fractures

A

X-ray (andteroposterior and lateral views)

CT (in severe cases, for pre-op planning)

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66
Q

What is the management for humeral shaft fractures

A

Re-align limb

Functional humeral brace or U slab

Usually have full union in 8-12 weeks

Surgery: ORIF (with plate), intramedullary nailing (pathological fractures, polytrauma, osteoporosis)

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67
Q

What is biceps tendinopathy

A

Range of pathologies

Usually due to overuse

Swollen, painful, weak tendon

Risk of rupturing

Young: tennis/cricket players

Old: degenerative tendinopathy

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68
Q

How might biceps tendinopathy present

A

Pain, weakness, stiffness

Worse on stressing tendon

Alleviated by rest and ice

Tenderness over tendon

Reduced muscle bulk

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69
Q

What are the special tests for biceps tendinopathy

A

Speed test (proximal biceps tendon)

Yargason’s test (distal biceps tendon)

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70
Q

What are the differentials for biceps tendinopathy

A

Inflammatory arthropathy

Radiculopathy

Osteoarthritis

Rotator cuff disease

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71
Q

What investigations are needed for biceps tendinopathy

A

Clinical diagnosis

Routine bloods

X-ray (exclude differentials)

Ultrasound/MRI (thickened tendon)

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72
Q

What is the management for biceps tendinopathy

A

Analgesia

Ice therapy

Physio

Steroid injections

Arthroscopic tenodesis (tendon severed and reattached)

Tenotomy (division of tendon)

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73
Q

What are the risk factors for biceps tendon rupture

A

Previous episode of biceps tendinopathy

Steroid use

Smoking

CKD

Fluoroquinolone antibiotics

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74
Q

How might biceps tendon rupture present

A

Sudden onset pain and weakness

‘Pop’ during incident

Swelling and bruising of antecubital fossa

Can get bulge in arm (reverse popeye sign, as proximal muscle belly retracts)

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75
Q

What is the special test for biceps tendon rupture

A

Hook test

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76
Q

What investigations are needed for biceps tendon rupture

A

Clinical diagnosis

Confirm via ultrasound

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77
Q

What is the management for biceps tendon rupture

A

Analgesia

Physio

Surgery

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78
Q

Which nerves can be damaged during surgery for biceps tendon rupture

A

Lateral antebrachial cutaneous nerve

Posterior interosseous nerve

Radial nerve

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79
Q

What is adhesive capsulitis

A

Frozen shoulder

Glenohumeral joint capsule contracts and adheres to humeral head

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80
Q

What are the causes of adhesive capsulitis

A

Idiopathic

Rotator cuff tendinopathy

Subacromial impingement syndrome

Biceps tendinopathy

Previous surgery/trauma

Joint arthropathy

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81
Q

What are the stages of adhesive capsulitis

A

Initial painful stage

Freezing stage

Thawing stage

(Pain and limited movement throughout)

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82
Q

How might adhesive capsulitis present

A

Deep, constant pain

Radiates to bicep

Disturbs sleep

Joint stiffness

Reduced function

Reduced range of motion (external rotation and flexion)

Loss of arm swing

Atrophy of deltoid

Tender on palpation

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83
Q

What investigations are needed for adhesive capsulitis

A

Clinical diagnosis

X-ray (rule out differentials)

MRI (thickening of glenohumeral joint capsule)

HbA1c (more common in diabetes)

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84
Q

What is the management for adhesive capsulitis

A

Usually self-limiting (over months to years)

Education and reassurance

Physio

Analgesia

Glenohumeral joint corticosteroid injections

Surgery (no improvement): manipulation under GA (remove capsular adhesion), arthrographic distension, surgical release of glenohumeral joint capsule

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85
Q

What is subacromial impingement syndrome

A

Inflammation and irritation of rotator cuff tendons as they pass through subacromial space

Get pain, weakness, reduced range of motion

Mostly in < 25, active people

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86
Q

What are the intrinsic mechanisms of subacromial impingement syndrome

A

Pathologies of rotator cuff tendon due to tension: muscular weakness, overuse of shoulder, degenerative tendinopathy

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87
Q

What are the extrinsic mechanisms of subacromial impingement syndrome

A

Pathologies of rotator cuff due to external compression: anatomical abnormalities, scapular musculature, glenohumeral instability

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88
Q

How might subacromial impingement syndrome present

A

Progressive pain in anterior superior shoulder

Exacerbated by abduction, relieved by rest

Some weakness and stiffness due to pain

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89
Q

What are the special tests for subacromial impingement syndrome

A

Neers test

Hawkins test

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90
Q

What investigations are needed for subacromial impingement syndrome

A

Clinical diagnosis

MRI

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91
Q

What are the MRI signs of subacromial impingement syndrome

A

Subacromial osteophytes

Subacromial sclerosis

Subacromial bursitis

Humeral cystic changes

Narrowing of subacromial space

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92
Q

What is the management for subacromial impingement syndrome

A

Analgesia

Physio

Corticosteroid injections into subacromial space

Education

Surgery (if > 6 months with no response): surgical repair of muscle tear, surgical removal of subacromial bursa, surgical removal of sections of acromion

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93
Q

What are the complications of subacromial impingement syndrome

A

Rotator cuff degeneration

Rotator cuff tear

Adhesive capsulitis

Complex regional pain syndrome

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94
Q

What is a supracondylar fracture

A

Common paediatric elbow injury

Usually 5 - 7s

After FOOSH with elbow extended

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95
Q

How might supracondylar fracture present

A

Recent trauma

Sudden onset severe pain

Reluctance to move arm

Gross deformity

Swelling

Limited range of elbow movement

Ecchymosis of antecubital fossa

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96
Q

Which nerves need to be examined in supracondylar fracture

A

Median

Radial

Ulnar

Anterior interosseous (deep motor branch of median)

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97
Q

What are the differentials for supracondylar fracture

A

Distal humeral fracture

Olecranon fracture

Soft tissue injury

Subluxation of radial head

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98
Q

What investigations are needed for supracondylar fracture

A

X-ray: posterior fat pad sign - lucency on lateral view, displacement of anterior humeral line

CT: for comminuted fracture and when intra-articular extension suspected

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99
Q

What are the classes of supracondylar fracture

A

Gartland classification

Type 1: undisplaced

Type 2: displaced, with intact posterior cortex

Type 3: displaced in 2-3 planes

Type 4: displaced, with complete periosteal disruption

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100
Q

What is the management for supracondylar fracture

A

Immediate closed reduction: need K-wire fixation in children, remove in 3-4 weeks

Above elbow cast

Open reduction with percutaneous pinning (open fractures)

May need vascular exploration if have ongoing vascular compromise

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101
Q

What are the complications of supracondylar fracture

A

Nerve palsies (common)

Malunion (gunstock deformity, extended forearm deviates towards midline)

Volkmann’s contracture (ischaemia and necrosis of flexor muscles in forearm, wrist and hand in permanent flexion, claw-like deformity)

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102
Q

Where is the olecranon

A

Part of proximal ulna

Articulates with trochlea and distal humerus

Site of insertion of triceps

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103
Q

How might olecranon fracture present

A

History of FOOSH

Elbow pain

Swelling

Lack of mobility

Tenderness over posterior elbow

Inability to extend elbow against gravity (disruption of triceps mechanism)

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104
Q

What investigations are needed for olecranon fracture

A

Routine bloods (+ clotting + group and save)

X-ray: often displaces (pull of triceps)

CT: for complex fractures, can work out degree of comminution

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105
Q

What is the management for olecranon fracture

A

Analgesia

< 2 mm displacement: cast

> 2 mm displacement: tension band wiring, olecranon plating

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106
Q

What is the most common fracture of the elbow

A

Radial head fracture

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107
Q

What is the classification for radial head fracture

A

Mason classification

Type 1: non-displaced, minimally displaced (< 2 mm)

Type 2: partial articular fracture with > 2 mm displacement or angulation

Type 3: Comminuted fracture and displacement

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108
Q

How might radial head fracture present

A

History of FOOSH

Elbow pain

Swelling, bruising

Tender on palpation of lateral elbow and radial head

Pain and crepitations on pronation and supination

Elbow effusion

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109
Q

What investigations are needed for radial head fracture

A

Routine bloods (+ clotting + group and save)

X-ray: sail sign (elbow effusion causing elevation of anterior fat pad on lateral view)

CT: complex injuries

MRI: suspected ligament injuries

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110
Q

What is the management for radial head fracture

A

Analgesia

Mason 1: sling, early mobilisation

Mason 2: sling, or ORIF

Mason 3: ORIF, radial head excision, radial head replacement

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111
Q

What are the types of elbow dislocations

A

Simple

Complex (associated with a fracture)

Anterior

Posterior (90%)

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112
Q

How might elbow dislocation present

A

High energy fall

Painful

Deformed joint

Swelling

Decreased function

Usually have neurovascular abnormalities in ulnar nerve region

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113
Q

What investigations are needed for elbow dislocation

A

X-ray: loss of radiocapitellar and ulnotrochlear congruences

CT: if other fractures

114
Q

What is the management for elbow dislocation

A

Closed reduction

Analgesia

Above-elbow backslab (1-2 weeks)

Early rehabilitation

ORIF

115
Q

In which positions is the arm more stable based on the ligaments damaged in elbow dislocation

A

Damaged lateral collateral ligament: more stable in pronation

Damaged medial collateral ligament: more stable in supination

116
Q

What are the complications of elbow dislocation

A

Early stiffness

Loss of terminal extension

Ulnar nerve most commonly stretched

Injury to brachial artery/median nerve (rare)

Recurrent instability

117
Q

What is the terrible triad for elbow dislocation

A

Elbow dislocation with: lateral collateral ligament injury, radial head fracture, coronoid fracture

Causes a very unstable elbow

Often seeds surgical fixation

118
Q

Why is the olecranon bursa prone to inflammation

A

Superficial position

Vulnerable to pressure and trauma

119
Q

What are the causes of olecranon bursitis

A

Repetitive flexion-extension movements

Gout

Rheumatoid arthritis

Infection through abrasion

120
Q

How might olecranon bursitis present

A

Pain and swelling over olecranon

Small swelling over time, but recent increase in size/discomfort

Full range of movement (joint capsule not affected)

Minimal discomfort

Systemic symptoms if infected

121
Q

What are the differentials for olecranon bursitis

A

Inflammatory arthropathies

Gout

Cellulitis

Septic arthritis

122
Q

What investigations are needed for olecranon bursitis

A

Routine bloods

X-ray: rule out bony injury

Aspiration of fluid: microscopy and culture for definitive diagnosis

123
Q

What is the management for olecranon bursitis

A

Analgesia

Rest

Consider splinting

IV antibiotics

Washout

Surgical drainage

Bursectomy (long term, don’t respond)

124
Q

What is lateral epicondylitis

A

Chronic symptomatic inflammation of forearm tendons at elbow

Due to overuse

Lateral epicondylitis: tennis elbow

Medial epicondylitis: golfer’s elbow

125
Q

How might lateral epicondylitis present

A

Pain radiates down forearm

Worsens over weeks-months

Local tenderness on palpation

Reduced grip strength

126
Q

What are the special tests for lateral epicondylitis

A

Cozen’s test: elbow flexed at 90 degrees, pain on extending wrist against resistance

Mill’s test: pain on palpation of lateral epicondyle whilst pronating arm/flexing wrist/extending elbow

127
Q

What are the differentials for lateral epicondylitis

A

Cervical radiculopathy

Elbow osteoarthritis

Radial carpal tunnel syndrome

128
Q

What investigations are needed for lateral epicondylitis

A

Clinical diagnosis

Ultrasound/MRI to confirm

129
Q

What is the management for lateral epicondylitis

A

Modification of activities

Analgesia

Corticosteroid injections

Physio

Brace

Tendon release/repair

Open/arthroscopic debridement

130
Q

What is carpal tunnel syndrome

A

Compression of median nerve within carpal tunnel

131
Q

What are the risk factors for carpal tunnel syndrome

A

F>M

45 - 60

Pregnancy

Obesity

Previous injury

Comorbidity: diabetes, rheumatoid arthritis, hypothyroidism

Repetitive hand movements

132
Q

How might carpal tunnel syndrome present

A

Pain, numbness, paresthesia in lateral 3.5 fingers

Palm spared (palmar cutaneous branch of median nerve passes over carpal tunnel)

Worse at night

Weakness of thumb abduction

Wasting of thenar eminence

133
Q

What are the special tests for carpal tunnel syndrome

A

Tinel’s: percussion over median nerve

Phalen’s: hold wrist in full flexion for one minute

134
Q

What are the differentials for carpal tunnel syndrome

A

Cervical radiculopathy

Pronator teres syndrome

Flexor carpi radialis tenosynovitis

135
Q

What investigations are needed for carpal tunnel syndrome

A

Clinical diagnosis

Can use nerve conduction studies to confirm

136
Q

What is the management for carpal tunnel syndrome

A

Wrist splint

Physio

Corticosteroid injections

Carpal tunnel release

137
Q

What is De Quervain’s tenosynovitis

A

Inflammation of tendons within first extensor compartment of wrist

Wrist pain and swelling

F>M

30 - 50

138
Q

Which tendons are involved in De Quervain’s tenosynovitis

A

Tendons of extensor pollicis brevis and abductor pollicis longus

139
Q

How might De Quervain’s tenosynovitis present

A

Pain near base of thumb

Swelling (thickening of tendon sheath)

Pain on grasping/pinching

140
Q

What is the special test for De Quervain’s tenosynovitis

A

Finkelstein’s test

141
Q

What are the differentials for De Quervain’s tenosynovitis

A

Arthritis of carpometacarpal joint

Intersection syndrome (tendons of first and second compartment cross)

Wartenberg’s syndrome (neuritis of superficial radial nerve)

142
Q

What is the management for De Quervain’s tenosynovitis

A

Avoid repetitive movements

Splint

Steroid injections

Decompression of extensor compartment

Transverse/longitudinal incision in tendon sheath at centre

143
Q

What is distal radial fracture

A

Fracture through distal metaphysis of radius

Mostly due to FOOSH

Risk increases with age

144
Q

What are the types of distal radial fracture

A

Colle’s

Smith’s

Barton’s

145
Q

What is a Colle’s fracture

A

A type of distal radial fracture

A fragility fracture

Wrist forced into supination

Extra-articular fracture of distal radius with dorsal angulation and dorsal displacement within 2cm of articular line

146
Q

What is a Smith’s fracture

A

A type of distal radial fracture

Volar angulation of distal fragment of extra-articular fracture

Due to forced pronation of wrist

147
Q

What is Barton’s fracture

A

A type of distal radial fracture

Intra-articular fracture, with associated dislocation of radio-carpal joint

Can be volar or dorsal

148
Q

How might distal radial fracture present

A

Following trauma

Pain

Deformity

Swelling

149
Q

What are the risk factors for distal radial fracture

A

Osteoporosis

Increasing age

F>M

Early menopause

Smoking

Alcohol

Prolonged steroids

150
Q

What investigations are needed for distal radial fracture

A

X-ray

CT/MRI

151
Q

What is the management for distal radial fracture

A

Closed reduction

Backslab

Physio

ORIF with plating
K-wire fixation

152
Q

What is Dupuytren’s contracture

A

Starts as painless nodule, fibrous cords and flexion contractures at MCP and interphalangeal joints

Can progress to severely limit finger movement

M>F

40 - 60

Mostly in ring and little finger

Due to contraction of longitudinal palmar fascia

153
Q

What is the pathophysiology of Dupuytren’s contracture

A

Fibroplastic hyperplasia and altered collagen matrix of palmar fascia

Pitting and thickening of palmar skin and underlying tissue

Formation of firm, painless nodule

Tendon-like cord develops

Contraction of cord pulls on MCP and PIP joints

154
Q

What are the risk factors for Dupuytren’s contracture

A

Smoking

Alcoholic liver cirrhosis

Occupational exposure (vibrating tools, heavy manual work)

Genetics

155
Q

How might Dupuytren’s contracture present

A

Reduced range of movement of affected finger

Nodular deformity

Usually affects right hand

Skin blanching on active extension

156
Q

What is the special test for Dupuytren’s contracture

A

Hueston’s test

Positive if patient can’t lay their hand flat on a table

157
Q

What are the differentials for Dupuytren’s contracture

A

Stenosing tenosynovitis

Ulnar nerve palsy

Trigger finger

158
Q

What investigations are needed for Dupuytren’s contracture

A

Clinical diagnosis

Routine bloods

159
Q

What is the management for Dupuytren’s contracture

A

Hand therapy

Injectable collagenase clostridium histolyticum (CCM)

Excision of diseased fascia (regional fasciotomy, segment fasciotomy, dermofasciectomy)

Finger amputation (severe cases)

160
Q

What is ganglionic cyst

A

Non-cancerous soft tissue lump

Can occur in any joint or tendon

Due to degeneration within joint capsule/tendon sheath

161
Q

What are the risk factors for ganglionic cyst

A

F>M

20 - 40

Osteoarthritis

Previous joint/tendon injury

162
Q

How might ganglionic cyst present

A

Smooth, spherical, painless lump adjacent to affected joint

Transilluminates

May affect range of movement

163
Q

What are the differentials for ganglionic cyst

A

Tenosynovitis

Giant cell tumour of tendon sheath

Lipoma

Osteoarthritis

Sarcoma

164
Q

What investigations are needed for ganglionic cyst

A

Clinical diagnosis

X-ray

Ultrasound/MRI

Aspiration

165
Q

What is the management for ganglionic cyst

A

Monitor

Aspiration

Steroid injections

Remove cyst capsule (and portion of associated tendon sheath)

166
Q

What are the contents of the anatomical snuffbox

A

Radial artery

Superficial radial nerve

Cephalic vein

167
Q

What is the pathophysiology of scaphoid fracture

A

Fracture can compromise blood supply, can get avascular necrosis

Can get degenerative wrist disease

Blood supply via radial artery (80% dorsal branch, 20% volar branch)

The more proximal the fracture, the higher the chances of avascular necrosis

168
Q

How might scaphoid fracture present

A

Following high-energy trauma

Sudden onset wrist pain

Bruising

Tender in floor of anatomical snuffbox

Pain on palpating scaphoid tubercle

Pain on telescoping thumb

169
Q

What are the differentials for scaphoid fracture

A

Distal radial fracture

Alternative carpal bone fracture

Fracture at base of 1st metacarpal

Ulnar collateral ligament injury

Wrist sprain

De Quervain’s tenosynovitis

170
Q

What investigations are needed for scaphoid fracture

A

X-ray (scaphoid series)

MRI (repeat negative X-rays, but suspect)

171
Q

What is the management for scaphoid fracture

A

Undisplaced: strict immobilisation, surgery if high risk of avascular necrosis

Displaced: operative fixation (percutaneous variable-pitched screw)

172
Q

What are the complications of scaphoid fracture

A

Avascular necrosis

Non-union

173
Q

What is trigger finger

A

Stenosing flexor tenosynovitis

Finger/thumb clicks/locks when flexing

Nodal formation in tendon at metacarpal joint, distal to A1 pulley

174
Q

What are the risk factors for trigger finger

A

Occupations/hobbies involving prolonged gripping/use of hand

F>M

Increasing age

Rheumatoid arthritis

Diabetes

175
Q

How might trigger finger present

A

Painless clicking/snapping/catching when extending finger

Becomes painful over time

176
Q

What are the differentials for trigger finger

A

Dupuytren’s contracture

Infection within tendon sheath

Ganglion

Acromegaly (swelling o flexor synovium within tendon sheath)

177
Q

What is the management for trigger finger

A

Advice about specific movements

Splint (hold in extension overnight)

Steroid injections

Percutaneous trigger finger release

Surgical decompression of tendon tunnel

178
Q

What is radiculopathy

A

Conduction block in axon of spinal nerve or spinal nerve root

Can impact motor and sensory axons

179
Q

What is radiculopathy caused by

A

Nerve compression due to:

Intervertebral disc prolapse

Degenerative disease of spine

Fracture

Malignancy

Infection

180
Q

How might radiculopathy present

A

Sensory and motor features

Burning, deep pain

181
Q

What are the differentials for radiculopathy

A

Referred pain

Myofascial pain

Thoracic outlet syndrome

Greater trochanter bursitis

Meralgia paraesthetica

Piriformis syndrome

182
Q

What is the management for radiculopathy

A

Analgesia (amitriptyline first line)

Physio

Benzodiazepines for muscle spasms

Emergency surgery for cauda equina syndrome

183
Q

What is degenerative disc disease

A

Natural deterioration of intervertebral disc structure

Related to ageing

Factors leading to damage of intervertebral discs: progressive dehydration of nucleus pulposus, daily activities causing tear in annulus fibrosus, injury/pathology causing instability

184
Q

What are the 3 stages of degenerative disc disease

A

Dysfunction: outer annular tears, separation of endplate, cartilage dysfunction, facet synovial reaction

Instability: disc resorption, loss of disc space height, facet capsular laxity, can get subluxation and spondylolisthesis

Restabilisation: degenerative changes lead to osteophyte formation and canal stenosis

185
Q

How might degenerative disc disease present

A

Localised spine tenderness

Contracted paraspinal muscles

Hypermobility

Painful extension of back/neck

Instability

Paraesthesia

Stiffness

Reduced mobility

Scoliosis

186
Q

What is the special test for degenerative disc disease

A

Lasegue test

Pain on straight leg raise is positive

187
Q

What investigations are needed for degenerative disc disease

A

MRI (gold standard)

Only image if: red flags, > 6 weeks, evidence of spinal cord compression

188
Q

What is the management for degenerative disc disease

A

Analgesia

Encourage mobility

Physio

Emergency surgery for cauda equina

189
Q

Where can neck of femur fractures be located

A

Anywhere between subcapital region of femoral head and 5cm distal to greater trochanter

Intracapsular: from subcapital region of head to basocervical region of neck

Extracapsular: outside capsule. Intertrochanteric (between greater to lesser trochanter) or subtrochanteric (lesser trochanter to 5cm below)

190
Q

Explain the bloodflow to the head of the femur

A

Retrograde blood flow

Goes distal to proximal (neck to head)

Through medial circumflex femoral artery

Displaced intracapsular fractures disrupt blood to femoral head (get avascular necrosis) - need joint replacement (rather than fixation)

191
Q

What is the classification system for neck of femur fracture

A

Garden classification

Type 1: incomplete fracture, non-displaced

Type 2: complete fracture, non-displaced

Type 3: complete fracture, partially displaced

Type 4: complete fracture, fully displaced

192
Q

How might neck of femur fracture present

A

History of trauma

Pain in groin/thigh/knee

Shortened and externally rotated leg (pull of short extensors)

Pain on pin-rolling leg and axial loading

193
Q

What investigations are needed for neck of femur fracture

A

X-ray (AP and lateral of hip, other hip, full length femur)

Routine bloods (+ clotting + group and save)

Urine dip and CXR in elderly

194
Q

What is the management for neck of femur fracture

A

A to E

Analgesia

Early rehabilitation

Displaced subcapital - hip hemiarthroplasty

Intertrochenteric and basocervical - dynamic hip screw

Non-displaced intracapsular - cannulating hip screw

Subtrochanteric - intramedullary femoral nail

195
Q

What are the long term complications of neck of femur fracture

A

Joint dislocation

Aseptic loosening

Peri-prosthetic fracture

Deep infection/prosthetic joint infection

196
Q

What are the causes of femoral shaft fracture

A

High energy trauma

Fragility fracture

Pathological fracture

Bisphosphonate-related fracture

197
Q

Describe the blood supply of the femoral shaft

A

Highly vascularised

Supplied by penetrating branches of profunda femoris artery

198
Q

How might femoral shaft fracture present

A

Pain (thigh/hip/knee)

Inability to weight bear

Obvious deformity

Proximal section pulled into flexion and external rotation

199
Q

What are the classifications for femoral shaft fracture

A

Winquist and Hansen classification. Assesses degree of comminution

Type 0 - no comminution

Type 1 - insignificant amount of comminution

Type 2 - > 50% cortical contact

Type 3 - < 50% cortical contact

Type 4 - segmental fracture, no contact between proximal and distal fragments

200
Q

What investigations are needed for femoral shaft fracture

A

Routine bloods (+ clotting + group and save)

X-ray (AP and lateral views of whole femur)

CT (if suspect polytrauma)

201
Q

What is the management for femoral shaft fracture

A

A to E

Analgesia

If open: antibiotics, prophylaxis, tetanus shot

Immediate reduction and immobilisation

Traction splinting: for mid-shaft fractures (hold against action of thigh muscle mass)

Long-leg cast: undisplaced fractures with significant comorbidities

Surgical fixation: within 24-48 hrs

Antegrade intramedullary nail

External fixation

202
Q

What is distal femoral fracture

A

Can extend from distal metaphyseal-diaphyseal junction of femur to articular surface of femoral condyles

Can be related to knee replacements

203
Q

What are the classifications of distal femoral fracture

A

Type A - extraarticular

Type B - partially articular

Type C - completely articular

204
Q

How might distal femoral fracture present

A

History of trauma

Severe pain in distal thigh

Inability to weight bear

Obvious deformity

Swelling

Ecchymosis of distal thigh

205
Q

What investigations are needed for distal femoral fracture

A

Normal bloods (+ clotting + group and save)

X-ray (AP and lateral)

CT (if have intraarticular extension)

206
Q

What is the management for distal femoral fracture

A

Realign

Analgesia

Immobilise (skin traction)

Retrograde nailing (proximal extraarticular, simple intraarticular)

ORIF with distal plate (distal, complex intraarticular)

207
Q

What are the different classification systems for pelvic fracture

A

Young and Burgess classification (based on disrupting force and degree of displacement)

Tile classification (based on stability of pelvic ring)

Denis classification (describes line of fracture in relation to sacral foramina)

208
Q

What investigations are needed for pelvic fracture

A

X-ray (AP, inlet and outlet views)

CT

209
Q

What is the management for pelvic fracture

A

A to E

Pelvic bindle (gives skeletal stabilisation)

Surgery for: life threatening haemorrhage, unstable fractures, open fractures, associated urological injury

210
Q

What is the classification system for acetabular fracture

A

Judet and Letournel classification

Elementary: posterior wall, posterior column, anterior wall, anterior column, transverse

Associated: combination of regions

211
Q

What investigations are needed for acetabular fracture

A

X-ray (AP, Judet, obturator and iliac oblique views)

CT (gold standard)

212
Q

What is the management for acetabular fracture

A

A to E

Reduce any associated hip dislocation (minimise further damage to acetabulum)

Conservative

Fixation

213
Q

What is the classification system for knee osteoarthritis

A

Kellgren and Lawrence system

Grade 0: no radiological features of OA

Grade 1: unclear joint space narrowing and possible osteophytic lipping

Grade 2: definitive osteophytes and possible joint space narrowing on AP weight-bearing view

Grade 3: multiple osteophytes, definite joint space narrowing, evidence of sclerosis, possible bony deformity

Grade 4: large osteophytes, marked joint space narrowing, severe sclerosis, definite bony deformity

214
Q

Give an overview of patellofemoral osteoarthritis

A

OA affecting articular cartilage along trochlear groove and underside of patella

Risk factors: patella dysplasia, previous patella fracture

Anterior knee pain (worse on climbing stairs), stiffness, swelling

Skyline view X-ray

Conservative management, then patellofemoral replacement

215
Q

What does the ACL do

A

Stabilises knee joint

Stops tibia slipping forward (relative to femur)

Provides rotational stability

216
Q

How might ACL tear present

A

Twist knee whilst weight bearing (sudden change of direction on flexed knee)

Unable to weight bear

Rapid joint swelling

Significant pain

Leg gives way

217
Q

What are the special tests for ACL tear

A

Lachman test (stabilise femur with one hand, pull tibia forward with other hand)

Anterior draw test (flex to 90 degrees, pull lower leg forward)

218
Q

What investigations are needed for ACL tear

A

X-ray: AP and lateral views (exclude bony injury)

MRI: gold standard

219
Q

What is the management for ACL tear

A

RICE

Physio

ACL reconstruction (use tendon/artificial graft)

Acute surgical repair of ACL (re-suture ends of ligament together)

220
Q

What is the PCL

A

Less commonly tears than ACL

Prevents posterior movement of tibia

Prevents hyperflexion of knee

221
Q

How might PCL tear present

A

Following high-energy trauma (or low energy where there is hyperflexion of knee on plantar-flexed foot)

Immediate posterior knee pain

Instability

Positive draw test

222
Q

What imaging is needed for PCL tear

A

MRI

223
Q

What is the management for PCL tear

A

Knee brace

Physio

Graft insertion (for recurrent instability)

224
Q

How might MCL tear present

A

Trauma to lateral knee

Hear ‘pop’

Immediate medial joint line pain

Swelling within hours

Increased laxity on valgus stress test

May be able to weight bear

225
Q

What are the different grades for MCL tear

A

Grade 1: mild injury, minimally torn fibres, no loss of MCL integrity

Grade 2: moderate injury, incomplete tear, increased laxity of MCL

Grade 3: severe injury, complete tear, gross laxity of MCL

226
Q

What investigations are needed for MCL tear

A

X-ray (exclude fracture)

MRI (gold standard)

227
Q

What is the management for MCL tears

A

RICE

Analgesia

Physio

Knee brace

Surgery only for grade 3 where there is associated distal avulsion

228
Q

Which nerve can be damaged as a complication of MCL tear

A

Saphenous nerve

229
Q

How can you differentiate between the medial and lateral menisci of the knee

A

Medial: more circular, attached to MCL

Lateral: less circular, not attached to MCL

230
Q

How might meniscal tears present

A

Twist knee whilst flexed and weight bearing

Longitudinal tears most common

Tearing sensation

Sudden intense pain

Slow swelling (over 6-12 hrs)

May be locked in flexion

Joint tenderness

Significant joint effusion

231
Q

What are the special tests for meniscal tears

A

McMurray’s test

Apley’s grind test

232
Q

What investigations are needed for meniscal tears

A

X-ray (exclude fractures)

MRI

233
Q

What is the management for meniscal tears

A

RICE

Small heal spontaneously over a few days

Arthroscopic surgery

234
Q

Which structures may be damaged as a complication of knee arthroscopy

A

Saphenous nerve

Saphenous vein

Peroneal nerve

Popliteal vessels

235
Q

What are tibial shaft fractures at great risk of

A

Open fracture

Compartment syndrome

236
Q

How might tibial shaft fractures present

A

Severe pain

Inability to weight bear

Swelling

Bruising

237
Q

What investigations are needed for tibial shaft fractures

A

Urgent bloods (+ clotting + group and save)

X-ray: AP and lateral views, including knee and ankle

CT

238
Q

What is the management for tibial shaft fractures

A

Realignment under analgesia

Above knee backslab

Elevate limb immediately

Post-manipulation X-ray needed

Intramedullary nailing

ORIF with locking plates

239
Q

What classification is used for tibial plateau fracture

A

Schatzker classification

Type 1: lateral split fracture

Type 2: lateral split-depressed fracture

Type 3: lateral pure depression fracture (rare)

Type 4: medial plateau fracture

Type 5: bicondylar fracture

Type 6: metaphyseal-diaphyseal dislocation

240
Q

What is the management for tibial plateau fracture

A

Hinge knee brace

Physio

Analgesia

ORIF

External fixation

241
Q

What is the iliotibial band

A

Branch of longitudinal fibres that form the shared aponeurosis of tensor fascia latae and gluteus maximus

242
Q

What is iliotibial band syndrome

A

Inflammation of iliotibial band

Most common cause of lateral knee pain in athletes

Due to repetitive flexion and extension of knee

243
Q

How might iliotibial band syndrome present

A

Lateral knee pain

Exacerbated by exercise

Worse on running downhill

244
Q

What are the special tests for iliotibial band syndrome

A

Nobles test

Renne test

245
Q

What are the investigations for iliotibial band syndrome

A

Clinical diagnosis

Imaging (to rule out differentials)

246
Q

What is the management for iliotibial band syndrome

A

Modify activities

Analgesia

Local steroid injections

Physio

Surgical release of iliotibial band from attachment to patella (only if symptomatic for > 6 months and treatment resistant)

247
Q

What is ankle fracture

A

Fracture of lateral/medial/posterior malleolus

With/without disruption of syndesmosis

248
Q

What is the syndesmosis

A

Where tibia and fibula are connected

Very strong fibrous structure

Anterior inferior tibiofibular ligament

Posterior inferior tibiofibular ligament

Intra-osseous membrane

249
Q

What classification is used for lateral malleolus ankle fracture

A

Weber classification

Type A: below syndesmosis

Type B: at level of syndesmosis

Type C: above level of syndesmosis

The more proximal the injury, the higher the chances of ongoing instability

250
Q

What investigations are needed for ankle fracture

A

X-ray (AP and lateral views)

CT (complex cases)

251
Q

What is the management for ankle fracture

A

Immediate fracture reduction

Below knee backslab

ORIF

252
Q

Give an overview of ankle sprain

A

Ligamentous injury

High (above syndesmosis) or low

Presentation: inversion injury on plantarflexed foot, significant swelling and pain, may not be able to weight bear, tender over affected ligament

X-ray (rule out fracture)

Management: analgesia, ice, elevation, early mobilisation

253
Q

What is the most commonly fractured tarsal bone

A

Calcaneus

254
Q

How might calcaneal fracture present

A

Recent trauma

Pain and tenderness over calcaneus

Inability to weight bear

Swelling and bruising

Shortened and widened heel

May have varus deformity

255
Q

How are calcaneal fractures classified

A

Intra-articular: 75%, Sanders classification (type 1 - nondisplaced posterior facet, regardless of number of fracture lines, type 2 - one fracture line in posterior facet, 2 fragments, type 3 - two fracture lines in posterior facet, 3 fragments, type 4 - comminuted, >3 fracture lines in posterior facet, 4+ fragments)

Extra-articular: 25%, avulsion fracture

256
Q

What are the X-ray signs of calcaneal fracture

A

Calcaneal shortening

Varus tuberosity deformity

Decreased Bohler’s angle

257
Q

What is the management for calcaneal fracture

A

Cast immobilisation

Analgesia

Physio

Closed reduction with percutaneous pinning

ORIF

258
Q

What is Achilles tendonitis

A

Inflammation of Achilles tendon

Common in high intensity activities that chronically overload tendon

Can lead to Achilles tendon rupture

259
Q

What are the risk factors for Achilles tendonitis

A

Unfit people who have a sudden increase in exercise levels

Poor footwear

M>F

Obesity

Fluoroquinolone use

260
Q

How might Achilles tendonitis present

A

Gradual onset pain

Worse on movement

Improves with exercise and heat

Stiffness in posterior ankle

Putting pressure over tendon reproduces pain

261
Q

How might Achilles tendon rupture present

A

Sudden onset severe pain

Audible popping sound

Loss of power of ankle plantarflexion

262
Q

What are the special tests for Achilles tendon rupture

A

Simmond’s test (squeeze calf)

Palpable step in tendon

263
Q

What investigations are needed for Achilles tendon tears

A

Clinical diagnosis

Ultrasound (differentiate between complete and partial tears)

264
Q

What is the management for Achilles tendonitis

A

Encourage stopping certain exercises

Ice

NSAIDs

Rehab

Physio

265
Q

What is the management for Achilles tendon rupture

A

Analgesia

Immobilisation (cast)

Surgical end-to-end repair

266
Q

What is talar fracture

A

Due to high energy trauma where ankle is forced into dorsiflexion

Most fractures through talar neck

Talus reliant on extraosseous blood supply (very susceptible to disruption, high risk of avascular necrosis)

267
Q

What classification is used for talar fracture

A

Hawkin’s classification

Type 1: undisplaced, low chance of avascular necrosis

Type 2: subtalar dislocation, medium chance of avascular necrosis

Type 3: subtalar and tibiotalar dislocation, 90-100% chance of avascular necrosis

Type 4: subtalar, tibiotalar and talonavicular dislocation, 100% chance of avascular necrosis

268
Q

What is the management for talar fracture

A

Plaster

Crutches

Closed reduction

Surgery for displaced fractures

269
Q

What is tibial pilon fracture

A

Severe injury of distal tibia

Due to high energy axial load

Characteristics: articular impaction, severe comminution, considerable soft tissue injury

270
Q

Which nerves may be damaged in tibial pilon fracture

A

Superficial peroneal

Seep peroneal

Tibial

271
Q

What is the classification for tibial pilon fracture

A

Ruedi and Allgower

Type 1 - undisplaced intraarticular

Type 2 - diaplaced intraarticular

Type 3 - comminuted or impacted

272
Q

What is the management for tibial pilon fracture

A

Below-knee backslab

Elevate limb

Analgesia

Surgery

273
Q

What is hallux valgus

A

Bunion

Deformity of first metatarsophalangeal joint

Characteristics: medial deviation of first metatarsal, lateral deviation of hallux, joint subluxation

274
Q

What are the risk factors for hallux valgus

A

F>M

Connective tissue disorders

Hypermobility syndrome

Anatomical variant

High heels

275
Q

How might hallux valgus present

A

Painful medial prominence

Aggravated by walking or standing

Lateral deviation of hallux

276
Q

What investigations are needed for hallux valgus

A

X-ray (measure angle between first metatarsal and first proximal phalanx)

277
Q

What is the management for hallux valgus

A

Analgesia

Proper footwear

Physio

Chevron/scarf/lapidus/keller surgical procedure

278
Q

What is plantar fasciitis

A

Inflammation of plantar fascia of foot

Unilateral or bilateral

40 - 60

279
Q

What are the risk factors for plantar fasciitis

A

Anatomical factors (excessive pronation, high arches)

Weak plantar flexors

Prolonged standing

Excessive running

Leg length discrepancy

Obesity

Unsupportibe footwear

280
Q

How might plantar fasciitis present

A

Sharp pain across plantar aspect of foot

Most severe in heel, radiates towards arch

Worse on first few steps of the day

Tenderness on palpating medial calcaneal tubercle

281
Q

What investigations are needed for plantar fasciitis

A

Clinical diagnosis

X-ray (plantar heel spur)

MRI (for ongoing uncertainty)

282
Q

What is the management for plantar fasciitis

A

Activity modification

NSAIDs

Adjust footwear

Physio

Steroid injections

Plantar fasciotomy

Surgery (7 decks)

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