Orthopaedics Flashcards
Features of De Quervain’s tenosynovitis?
De Quervain’s tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.
- Pain on the radial side of the wrist
- Tenderness over the radial styloid process
- Abduction of the thumb against resistance is painful
- Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus.
Dx in burning sensation over the antero-lateral aspect of thigh?
Meralgia paraesthetica is a condition characterised by numbness, tingling and burning pain in the outer part of the thigh. It’s caused by compression of the lateral cutaneous nerve of the thigh (also called the lateral femoral cutaneous nerve) which supplies sensation to the skin’s surface on the upper thigh.
- Symptoms may be reproduced by deep palpation just below the ASIS (pelvic compression) and also by extension of the hip.
- There is altered sensation over the upper lateral aspect of the thigh.
- There is no motor weakness.
McMurray’s test is used for?
Meniscal tears.
- Pain worse on straightening the knee
- Knee may ‘give way’
- Displaced meniscal tears may cause knee locking
Features of Carpal Tunnel Syndrome?
- Pain/pins and needles in thumb, index, middle finger
- Patient shakes his hand to obtain relief, classically at night.
- Weakness of thumb abduction (abductor pollicis brevis).
- Wasting of thenar eminence (NOT hypothenar)
- Tinel’s sign: tapping causes paraesthesia
- Phalen’s sign: flexion of wrist causes symptoms
Which finger commonly affected in Dupuytren’s contracture?
It is more common in older male patients and around 60-70% have a positive family history.
Specific causes include:
- manual labour
- Phenytoin treatment
- alcoholic liver disease
- diabetes mellitus
- trauma to the hand
- The ring finger and little finger are the fingers most commonly affected.
Which nerve root for which reflex?
Buckle the shoe (ankle) (S1, S2)
Kick the door (Knee) (L3, L4)
Pick up sticks (Biceps) (C5, C6)
Lie them straight (triceps) (C7, C8)
Features in Cubital Tunnel Syndrome?
Due to the compression of the ulnar nerve as it passes the cubital tunnel at the elbow.
- Initially intermittent tingling in the 4th and 5th finger
- May be worse when the elbow is resting on a firm surface or flexed for extended periods
- Later numbness in the 4th and 5th finger with associated weakness
Features of lateral epicondylitis (tennis elbow)?
- Pain and tenderness localised to the lateral epicondyle.
- Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended.
- Episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks.
Features of medial epicondylitis? (golfer’s elbow)
- Pain and tenderness localised to the medial epicondyle.
- Pain is aggravated by wrist flexion and pronation.
- Symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
Features of spinal stenosis?
Usually gradual onset.
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnosis.
Lumbar spinal stenosis is a condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.
Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication. One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill.
Ankle injury Ottawa Rules?
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
- Bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular).
- Bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia).
- Inability to walk four weight-bearing steps immediately after the injury and in the emergency department.
common cause of lateral knee pain in runners?
Iliotibial band syndrome.
Its an inflamed tendon running from your hip to the outside of your knee (laterally).
- Pain usually most severe where the tendon runs over lateral epicondyle of femur (any protrusion gives more friction and rub on the band).
Non tender lump in popliteal fossa?
Baker’s cyst. They are more likely to develop in patients with arthritis or gout and following a minor trauma to the knee. Foucher’s sign describes the increase in tension of the Baker’s cyst on extension of the knee.
Trigger finger most commonly affects which fingers?
- More common in the thumb, middle, or ring finger
- Initially stiffness and snapping (‘trigger’) when extending a flexed digit
- A nodule may be felt at the base of the affected finger
Painful arc of abduction is seen in which condition?
Subacromial impingement often presents with a painful arc of abduction (classically causing pain between 60 to 120 degrees of abduction).
With rotator cuff tears the pain may be in the first 60 degrees!
