Orthopaedics Flashcards
Which nerve is compressed in Carpal Tunnel Syndrome?
= median nerve
Risk factors to consider in patient’s who present with bilateral carpal tunnel syndrome? (4)
- rheumatoid arthritis
- DM
- acromegaly
- hypothyroidism
Sensory symptoms associated with Carpal Tunnel Syndrome?
= numbness, parasthesia, burning sensation OR, pain in the following distributions
palmar aspects and full fingertips of the thumb, index, middle finger, and lateral half of ring finger
What the Phalen’s test? and what is it used for?
= involves fully flexing wrists and holding it in this position – backs of their hands together
This position triggers numbness and paraesthesia in the median nerve distribution if patient has Carpal Tunnel
What the Tinel’s test? and what is it used for?
= involves tapping wrist at location where median nerve travels through carpal tunnel
Triggers numbness + paraesthesia in the medial nerve distribution associated with Carpal Tunnel Syndrome
Primary investigation for establishing a diagnosis of Carpal Tunnel Syndrome?
= nerve conduction studies
Lateral epicondylitis is also known as…
- ‘tennis elbow’
- ‘golfer’s elbow’
- ‘tennis elbow’
Medial epicondylitis is also known as…
- ‘tennis elbow’
- ‘golfer’s elbow’
- ‘golfer’s elbow’
Stenosing tenosynovitis is also known as?
= trigger finger
Is trigger finger more coming in women or men?
= women
Management options for trigger finger? (4)
- rest + analgesia
- splinting
- steroid injections
- surgery to release A1 pulley
What is De Quervain’s Tenosynovitis?
= condition where there is swelling + inflammation of the tendon sheaths in the wrist. It is a type of repetitive strain injury and results in pain on the radial side of the wrist
De Quervain’s Tenosynovitis: Describe the Finkelstein’s test
= patient making a fist with their thumb inside their fingers. Then, wrist is adducted (ulnar deviation), causing a strain on the APL and EPB tendons
If this movement causes pain at the radial aspect of the wrist > test is +ve, indicating De Quervain’s tenosynovitis
What is Trochanteric Bursitis?
= refers to the inflammation of a bursa over the greater trochanter on the outer hip
Which special tests can be performed to help establish a diagnosis of trochanteric bursitis? (2)
- Trendelenburg test
- Resisted movements (abduction, internal and external rotation of the hip)
Describe the Trendelenburg Test?
= ask patient to stand one-legged on the affected leg
Normally, the other side of the pelvis should remain level or tilt upwards slightly
Positive test is when the other side of the pelvis drops down, suggesting weakness in affected hip
2 types of Achilles tendinopathy
- insertion tendinopathy (within 2 cm of the insertion point on the calcaneus)
- mid-portion tendinopathy (2-6cm above the insertion point)
Which type of antibiotics are risk factors for tendinopathies?
= fluoroquinolone antibiotics (e.g., Ciprofloxacin and Levofloxacin)
What is important to exclude in patient with suspected Achilles tendinopathy?
= Achilles tendon rupture
What imaging is used to diagnose Achilles tendon rupture?
= USS
Why are steroid injections avoided in Achilles tendons?
= risk of tendon rupture
Which nerve is most likely to be damaged in a humerus fracture?
= radial nerve
‘RATS’ mnemonic for describing an orthopaedic x-ray
R - rotation
A - angulation
T - translation
S - shortening
4 R’s in management of a fracture
Resuscitate
Reduce (closed or open)
Retain (operative or non-operative)
Rehabilitate
Most common nerve to be damaged in an extension type supracondylar fracture?
= terminal branch of the median nerve (anterior interosseous nerve)
Most common nerve to be injured in a head of radius fracture?
= terminal branch of the radial nerve (posterior interosseous)
Most common nerve to be injured in an anterior shoulder dislocation?
= axillary nerve
What is the function of Tranexamic acid in an elective joint replacement?
= minimise blood loss during procedure
What is a compound fracture?
= skin is broken, and broken bone is exposed to air
What is a stable fracture?
= sections of the bone remain in alignment in the fracture
What is a pathological fracture?
= bone break due to an abnormality within the bone
What is a Colle’s fracture?
= transverse fracture of the distal radius, near the wrist
What kind of fracture can cause a ‘dinner fork deformity’?
= Colle’s fracture
What are scaphoid fractures at a higher risk of avascular necrosis?
= scaphoid bone has retrograde blood supply
What is Weber classification used for?
= classifying lateral malleolar fractures
Main cancers that metastasise to the bone
HINT: PoRTaBLe
P - prostate
R - renal
T - thyroid
B - breast
L - lung
What is fat embolism?
= complication of fractures. Fat globules are released into the circulation following a fracture, these can become lodged in blood vessels and cause blood flow obstruction
What is compartment syndrome?
= orthopaedic emergency
Pressure within a fascial compartment is abnormally elevated, cutting off the blood flow to contents of that compartment
5P’s of how acute compartment syndrome presents
P - pain disproportionate to underlying injury
P - parasthesia
P - pale
P - pressure (high)
P - paralysis - late and worrying sign
Specific test to check for compartment syndrome if you suspect this?
= pain worsened by passive stretching of the muscles in that compartment
What can be used to measure compartment pressure (in suspected compartment syndrome)?
= needle manometry
Definitive treatment in acute compartment syndrome?
= emergency fasciotomy
What is a fasciotomy?
= involves surgical operation to cut through the fascia, down the entire length of the compartment, and release the pressure
What is chronic compartment syndrome pain made worse by?
= increased activity, it is exertional
What is Cauda Equina Syndrome?
= surgical emergency where the nerve roots of the cauda equina at the bottom of the spine are compressed
Most common cause of Cauda Equina Syndrome?
= herniated disc