Orthopaedics Flashcards
vitamin D normal serum value
75-250 nanomole/L
Normal BMD T-score
> -1
osteopenic BMD T-score
-1 to -2.5
Osteoporotic BMD T-score
< -2.5
NEXUS Criteria
Finkelstein’s test is used to determine
De Quervain tenosynovitis
Tinel sign is used to determine
Carpal tunnel syndrome
Fromenr’s sign is used to determine
Ulnar nerve injury
Thompsons test is used to determine
Achilles tendon lesion/rupture
Lachmans test is used to determine
ACL
Drawers test is used to determine
anterior: ACL
posterior: PCL
Bulb sign is used to determine
Posterior dislocation of shoulder
most useful test for evaluation of osteoporosis
- DEXA
- 25-hydroxy vitamin D
corticosteroid use in osteoporosis
at least 3 months
Back pain without neurological symptoms
pulled muscle/muscle spasm
- analgesia + normal activity
Back pain classification
1- Acute low back pain lasts less than 6 weeks.
2- Sub-acute low back pain lasts between 6 and 12 weeks.
3- Chronic low back pain persists for more than 12 weeks.
Back pain diagnosis
chronic back pain persisting longer than 3 months, have to exclude:
- central canal stenosis
- nerve root compression
Signs of cauda equina compression
- loss of bladder
- loss of bowel control
- paraparesis/paraplegia
bilateral leg pain + worse on erect posture + responds to exercise
Spinal stenosis
Back pain around the anus, scrotum or vagina
saddle anaesthesia
- investigate by MRI
Acute herniation of an intervertebral disk that will require emergency surgery
crushed cauda equina
shooting radiating pain through the posterior thigh and posterior leg to little toe + anterior + posterior motor symptoms
Sciatica
pain radiating to the hip + anterior thigh + medial aspect of knee + calf + diminished knee jerk
L4 radiculopathy
posterolateral buttock + posterior thigh + lateral leg +
L5 radiculopathy
posterolateral buttock + posterior thigh + lateral leg posterior calf + lateral foot + diminished Ankle jerk
L5-S1 radiculopathy
pain radiates through posterior buttock + posterior calf +
lateral foot + diminished Ankle jerk
S1 radiculopathy
weakness of eversion and dorsiflexion + sensory loss of dorsum of foot + hc of colon cancer surgery
Common peroneal nerve damage
weakness of foot plantar flexion + inversion
Tibial nerve
Hip pain management
- walking stick on the contralateral hand
hip joint degeneration affected movement
Internal rotation
osteoporosis most common site fracture
Vertebrae
Osteoporosis risk factors
– Menopause
– Age over 70
– Corticosteroid use longer than three months
– Rheumatoid arthritis
– Alcoholism
– Smoking
– Anorexia nervosa.
– Inflammatory Bowel Disease
pain in the distal interphalangeal joints + carpometacarpal joints + hard/bony swelling + evening stiffness
Osteoarthritis (OA)
Osteoarthritis treatment
symptomatic pain treatment
Osteoarthritis not responding to pain
Severe
- orthopaedic consult for knee replacement
Osteoporosis treatment
- Alendronate, risedronate and zoledronic acid: first-line therapy in **postmenopausal osteoporosis **
and prevent vertebral, Non-vertebral and hip fractures. - bisphosphonates: primary prevention of fractures in px who never had minimal trauma fracture, secondary prevention of fractures
- Strontium ranelate: primary prevention of osteoporosis in women
- bisphosphonates and raloxifene: secondary prevention of fractures in women who have had minimal trauma fractures
Osteoporosis treatment not going to plan, what to do
- BMD T-score of =<-3
- > 1 symptomatic new
fracture after at least 12-months of
continuous therapy - > 2 minimal trauma fractures despite being on sufficient doses of bisphosphonates.
switch to teriparatide for 18 months
Most common pelvic bone tumour in young adult
Metastatic tumor
non-healing diabetic foot ulcer concern
osteomyelitis
- Do MRI
child + fever + limp + raised ESR
Acute osteomyelitis
osteomyelitis in children
- S aureus
- secondary to deep cellulitis
-MRI investigation
pain in the proximal interphalangeal joints + carpometacarpal joints + soft/tender swelling + morning stiffness > 30 minutes
Rheumatoid arthritis (RA)
Diagnosis of rheumatoid arthritis (RA)
-Persistent joint pain and swelling affecting at least three joint areas
2-Symmetrical involvement of the MCP or MTP joints
3-Morning stiffness lasting more than 30 minutes.
(if there’s a rash: Psoriatic arthritis)
Rheumatic arthritis treatment
NSAIDs + DMARDS
asymmetrical large joint monoarthritis/oligoarthritis + rash + uveitis + enthesitis
Reactive arthritis
Distal interphalangeal joints are most commonly seen in
Psoriatic arthritis
septic arthritis
septic arthritis management
- IV antibiotics (flucloxacillin) for 2 weeks
- Oral antibiotics after 6 weeks
positive rhomboid-shaped birefringent crystals
Pseudogout
Negative needle shaped birefringent crystals
Gout
Gout causes
- Alcohol (increase urate)