Orthopaedics Flashcards
motor to knee extension and hip extension
sensory to anterior/medial thigh and lower leg
Femoral nerve
cause of femoral nerve lesions
hip/pelvic fractures
stab/gun wounds
loss of patella reflex
femoral nerve
motor to hip adduction
sensory to medial thigh
obturator nerve
cause of obturator nerve lesion
anterior hip doslocation
sensory to lateral and posterior thigh
lateral cutaneous nerve of the thigh
burning pain in the lateral thigh due to compression of the lateral cutaneous nerve at the ASIS
meralgia paraesthesia
motor to foot inversion and plantarflexion
sensory to sole of foot
tibial nerve
cause of tibial nerve lesion
posterior knee dislocation / popliteal laceration
motor to foot eversion and dorsiflexion and to extensor hallucis longus
sensory to foot dorsum and lower lateral leg
common peroneal nerve
cause of common peroneal nerve lesion
neck of fibula injury
tight plaster cast
nerve lesion which causes foot drop
common peroneal nerve
motor to hip abduction
superior gluteal nerve
causes of superior gluteal nerve lesion
posterior hip dislocation
pelvic fracture
hip surgery
misplaced IM injection
nerve lesion which would show a positive trendelenbergs
superior gluteal nerve
motor to hip extension and lateral rotation
inferior gluteal nerve
presentation of inferior gluteal nerve lesion
can’t move from seated / jump / climb stairs
alongside sciatica
weakness in ankle dorsiflexion and numbness in calf and foot
injury to lumbosacral trunk
nerve root injury:
sensory loss over anterior thigh
weak quadriceps
reduced knee reflex
positive femoral stretch
L3
nerve root injury:
sensory loss over anterior knee
weak quadriceps
reduced knee reflex
positive femoral stretch
L4
nerve root injury:
sensory loss over foot dorsum
weak dorsiflexion of foot and big toe
intact reflexes
positive sciatic stretch
foot drop
L5
nerve root injury:
sensory loss over posterolateral leg and lateral foot
weak foot plantarflexion
reduced ankle reflex
positive sciatic stretch
S1
weak knee flexion and foot movements
numbness from gluteal region to ankle
sciatic nerve lesion
what dislocation causes a sciatic nerve lesion
posterior hip dislocation or total hip replacement
signs of posterior hip dislocation
leg internally rotated and short
management of sciatica
trial of analgesia and physio
refer after 6w
isolated lateral hip/thigh pain
tenderness over greater trochanter
trochanteric bursitis
cause of knee pain in runners
iliotibial band syndrome
knee pain after exercise
locking and clunking
osteochondritis dissecans
NOF fracture leg signs
LEG SHORTENED AND EXTERNALLY ROTATED
analgesia in NOF fracture
iliofascial nerve block
management of intracapsular (intratrochanteric) NOF fracture
undisplaced: internal fixation if fit, hemiarthroplasty if unfit
displaced: arthroplasty/hemiarthroplasty
management of extracapsular (intertrochanteric) NOF fracture
stable: dynamic hip screw
other: intramedullary device
twisting force to a bent knee whilst playing sports
loud crack and rapid swelling
Ruptured anterior cruciate ligament
management of ruptured ACL
physio/surgery
hyperextension and a paradoxial anterior draw test
Ruptured posterior cruciate ligament
knee unstable in valgus position
ruptured medial collateral ligament
rotational/twisting sports injury with delayed swelling and joint locking
can be associated with chronic effusion after minor trauma
Menisceal tear
test for menisceal tear
mcmurray
management of menisceal tears
MRI and NSAIDs
teenage girl presents with pain walking down the stairs and at rest after a knee injury
quadriceps wasting
chondromalacia patellae
traumatic injury causing severe contraction of the quadriceps
knee stretched in valgus and externally rotated
associated with osteochondral fracture
patella dislocation
xray for patella dislocation
skyline views
2 types of patella fracture
avulsion fracture
undisplaced fragments
management of a patella fracture if the extensor system is intact
non-operative
knee forced into valgus/varus but the bone fractures before the ligaments rupture
tibial plateau fracture
- varus is medial plateau
- valgus is lateral plateau
demographic of tibial plateau fracture
elderly or significant trauma in the young
classification of tibial plateau fracture
schatzer classification
most common reason for total hip replacement revision surgery
aseptic loosening of the joint
risk of long term steroid use
avascular necrosis
osteonecrosis on pelvix xray
crescent sign
hip/groin pain with a snapping sensation
acetabular labral tear
bimalleolar fracture from forced foot eversion
Potts fracture
most common site for a metatarsal stress fracture
2nd metatarsal
cause of a 5th metatarsal fracture
forced inversion of the foot and ankle
pop in ankle followed by pain in the calf
achilles tendon rupture
what is simmonds triad
for achilles tendon rupture
1. palpation
2. examine ankle of delination
3. thompson test (calf squeeze)
imaging for achilles tendon rupture
USS
RF for achilles tendon rupture
ciprofloxacin
inverted and plantarflexed foot which is not passively correctable
clubfoot
imaging for ligament injuries
MRI
signs of acromioclavicular joint injury
prominent clavicle and a step deformity
management of a grade 1-2 acromioclavicular joint injury
rest and sling
sign of a glenohumeral joint dislocation
Hill sachs lesion
motor to elbow flexion and supination (biceps)
sensory to lateral forearm
musculocutaneous nerve
nerve root for musculocutaneous nerve
C5-C7
motor to shoulder abduction (deltoid)
sensory to inferior deltoid
axillary nerve
nerve root for axillary nerve
C5 C6
humeral neck fracture/dislocation damaged which nerve
axillary
motor to forearm, wrist, finger and thumb extension
sensory to dorsal webspage of thumb and index
radial nerve
nerve root for radial nerve
C5-C8
humeral midshaft fracture damages which nerve
radial
wrist drop is a sign of which nerve lesion
radial
motor to the LOAF muscles and sensory to palmar lateral 3 1/2 fingers
median
nerve root for median nerve
C6 C8 T1
what are the LOAF muscles
Lateral 2 Lumbricles
Opponens pollices
Abductor pollicies brevis
Flexor pollices brevis
paralysis of thenar muscles and opponens pollices with carpal tunnel
wrist lesion affecting the median nerve
loss of forearm pronation and wrist flexion
elbow lesion affecting the median nerve
motor to the serratus anterior
long thoracic nerve
nerve root for long thoracic nerve
C5-C7
winged scapula after rib injury or mastectomy from injury of which nerve
long thoracic nerve
arm hanging and internally rotated with the elbow extended
erbs palsy
nerve root damaged in erbs palsy
C5-C6
cause of erbs or klumpke palsy
shoulder dystocia
sudden upward jerk of the arm causing horners and weakness of the intrinsic hand muscles
klumpke palsy
nerve root damaged in klumpke palsy
C8 and T1
which nerve is affected in carpal tunnel
median
management of carpal tunnel
wrist split and steroids
what happens to sensory and motor action potentials in carpal tunnel
prolonged
painful and stiff active and passive movement
loss of external rotation and abduction
adhesive capsulitis (frozen shoulder)
2 RF for adhesive capsulitis
middle aged and diabetics
rotator cuff injury causing a painful arc at 60-90 degrees
supraspinatus tendonitis (subacromial impingement)
pain to 90 degrees abduction
supraspinatus tear
pain on radial styloid/wrist
dequarveins tenosynovitis
what is kanevel’s sign used for
flexor tendon sheath infection
(fixed flexion, pain on extension, swelling)
RF for dupytrens
phenytoin
fall on extended outstretched hand causing a dinner fork deformity
colle’s fracture
3 findings in colles
- transverse radial fracture
- proximal to radio-carpal joint
- dorsal displacement and anulation
fall backwards onto outstretched hand with the wrists flexed and a garden spade deformity
smiths fracture (reverse colles)
impact on flexed metacarpal causing an intraarticular fracture of the thumb base
bennetts fracture
FOOSH with forced pronation and dislocation of the proximal radioulnar joint
monteggias fracture
fall on hand with rotation causing fracture of the radial shaft with distal radio-ulnar joint dislocation and bruising over lower forearm
galeazzi fracture
xray of galaezzi fracture
displaced radius and prominent ulnar head
distal radius fracture (colle/smith) with radiocarpal dislocation from fall on extended and pronated wrist
bartons fracture
FOOSH in young adults with tenderness over radial head, reduced elbow movement and sharp pain on extreme of pronation and supination
radial head fracture
carpal fracture due to FOOSH/blow to palm with swelling and tenderness in the anatomical snuffbox or on longitudinal compression of the thumb
Scaphoid fracture
which artery is at risk in scaphoid fractures
dorsal carpal branch of radioulnar artery
xray of scaphoid
ulnar deviation in AP film
management of scaphoid fractures in ED
immbolise with splint and backslab –> review
management of uncomplicated scaphoid fractures
cast for 6-8w
when do you need surgery for a scaphoid fracture
when the fracture is to the proximal pole
mechanism of injury in subluxation of the radial head
a child who has been pulled
management of subluxation of the radial head
passive supination of the elbow whilst flexed to 90 degrees
both sides of the cortex breeched
complete fracture
oblique tibial fracture in infants
toddlers fracture
unilateral cortical breech
greenstick fracture
stress on bone causing deformity with no cortical disruption
plastic deformity
incomplete cortical disruption causing periosteal haematoma
Buckle ‘forus’ fracture
management of open fractures
delay surgery until the soft tissue has recovered
what are the 5 salter harris fractures
see image
acute hip pain post viral infection in 2-10 years
transient synovitis
management of transient synovitis
rest and analgesia
barlow and ortalani positive, unequal leg length and skin folds
DDH
weeks of hip pain with a limp, stiffness and reduced range of movement in 4-8y male
perthes
pathophys of perthes
avascular necrosis of the femoral head
xray findings in perthes
increased joint space and flat femoral head
knee/thigh pain and reduced internal rotation in 10-15y obese male following trauma or chronic
SUFE
pathophys of SUFE
displaced femoral head
xray views for SUFE
AP and frog leg
2 - in juvenile idiopathic arthritis
under 16 years
more than 3m
most common type of JIA
pauciarticular
joints affected in paucarticular arthritis
knee ankle and elbow
swelling and limp
which antibody is positive in JIA
ANA (associated with anterior uveitis)
acute hip pain and systemically unwell
septic arthritis
management of xray suggesting sarcoma
immediate 48hr referral
pain at rest with high calcium and ALP
metastatic bone tumour
asymptomatic fluctuant swelling behind knee
bakers cyst
what is parsonage turner syndrome
peripheral neuropathy after a virus
presentation of iliopsoas abscess
fever and back pain
imaging for iliopsoas abscess
CT abdo
common demographic for osteomyelitis
IVDU
imaging for osteomyelitis
MRI
sepsis and changing lower limb neurology
epidural abscess
first line medication for back pain
NSAID
red flag back pain
thoracic
back pain and haemodynamic compromise
AAA
management of discitis due to staph aureus
ECHO for endocarditis
bilateral sciatica found in what
cauda equina
imaging for cauda equina
MRI spine in 6 hours
pain worse when walking down hill
spinal stenosis
imaging for spinal stenosis
MRI
association with spinal stenosis
mets
presentation of syringomyelia
spinothalamic
reduced pain and temperature
sudden onset back pain after bending with normal straight leg raise test
facet joint pain
sudden onset back pain after bending with abnormal straight leg raise test
disc prolapse
patient needing excessive breakthrough analgesia then suspect
compartment syndrome
what medication worsens compartment syndrome
anticoagulants
2 hand findings in osteoarthritis
squaring of the thumbs
swelling of DIPs (heberdens nodes)
3 factors in Leriche syndrome
- claudication of thigh and buttocks
- leg muscle atrophy
- impotence (L1 paralysis)
(males)
