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Final Year > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is osteoarthritis?

A

Wear and tear in synovial joints
Imbalance between cartilage damage and chondrocyte response

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2
Q

What are the risk factors for osteoarthritis?

A

Obesity
Age
Occupation
Trauma
Female
FHx

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3
Q

Which joints are commonly affected in OA?

A

Hips
Knees
DIP hands
CMC thumb
Lumbar spine
Cervical spondylosis

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4
Q

What xray changes are seen in OA?

A

L- Loss of joint space
O- Osteophytes
S- Subarticular sclerosis (increased density bone along joint line)
S- Subchondral cysts (fluid filled holes in bone)

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5
Q

Outline presentation of OA

A

Joint pain and stiffness- Worse with activity and at end of day
Bulky, bony enlargement of joint
Restricted ROM
Crepitus on movement
Effusions (fluid) around joint

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6
Q

What are the hand signs in OA?

A

Heberden’s nodes (DIP)
Bouchard’s nodes (PIP)
Squaring at base of thumb
Weak grip
Reduced ROM

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7
Q

Outline diagnosis of OA

A

Clinical diagnosis if >45y, has typical pain associated with activity and no morning stiffness

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8
Q

Outline management of OA

A

Therapeutic exercise, weight loss, OT
1st line- Topical NSAIDs
Oral NSAIDs as required (with PPI)
Intra-articular steroid injections- Improve symptoms for up to 10wks
Joint replacement

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9
Q

What are the SEs of NSAIDs

A

GI- Gastritis and peptic ulcers
Renal- AKI and CKD
CV- HTN, HF, MI, stroke
Exacerbating asthma

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10
Q

What are the indications for joint replacement?

A

OA (most common)
Fractures
Septic arthritis
Osteonecrosis
Bone tumours
RA

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11
Q

What are the options for joint replacement?

A

Total- Replace both articular surfaces of joint
Hemiarthroplasty- Replace half joint
Partial joint resurfacing- Replace part of joint surface

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12
Q

Outline what occurs during joint replacement surgery in terms of anaesthetics and drugs

A

General anaesthetic
Prophylactic ABs
TXA

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13
Q

What guidance regarding VTE prophylaxis is given after joint replacement surgery?

A

LMWH:
28d hip
14d knee

Can also use aspirin, DOAC or anti-embolism stocking

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14
Q

What are the risk factors for prosthetic joint infection?

A

Prolonged operative time
Obesity
Diabetes

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15
Q

What are the symptoms of a prosthetic joint infection?

A

Fever
Pain
Swelling
Erythema
Increased warmth

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16
Q

Outline prosthetic joint infections

A

More likely to occur in revision surgery
Most common- Staph aureus

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17
Q

Outline diagnosis of prosthetic joint infection

A

Clinical findings
Xrays
Raised inflammatory markers
Cultures (blood or synovial fluid

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18
Q

Outline management of prosthetic joint infection

A

Repeat surgery- Joint irrigation/debridement/complete replacement
Prolonged ABs

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19
Q

What is a compound fracture?

A

Skin broken, broken bone exposed to air

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20
Q

What is a stable fracture?

A

Sections of bone remain in alignment

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21
Q

What is a pathological fracture?

A

Bone breaks due to abnormality within bone

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22
Q

What is a comminuted fracture?

A

Breaks into multiple fragments

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23
Q

What is a Salter-Harries fracture?

A

Growth plate fracture
Only occurs in children

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24
Q

What is a greenstick fracture?

A

Bone cracks on one side- Not all way through bone
More common in children

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25
Q

What is a buckle fracture?

A

Most common fracture in young children
Bone soft and flexible- Bends- Bulge in bone rather than break

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26
Q

What is a Colle’s fracture?

A

Transverse fracture of distal radius
Distal portion displaced posteriorly- Dinner fork deformity
FOOSH

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27
Q

Outline scaphoid fracture

A

Caused by FOOSH
Located at base of thumb
Tenderness in anatomical snuffbox
Has retrograde blood supply- Avascular necrosis and non-union

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28
Q

Outline Weber classification

A

Fractures of lateral malleolus
Type A- Below ankle joint- Leaves syndesmosis intact
Type B- Level of ankle joint- Syndesmosis intact/partially torn
Type C- Above ankle joint- Syndesmosis disrupted

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29
Q

What are the main cancers that metastasise to bones?

A

Po- Prostate
R- Renal
Ta- Thyroid
B- Breast
Le- Lung

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30
Q

What are fragility fractures?

A

Occur due to weakness in bone
Usually due to osteoporosis
Risk defined by FRAX score

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31
Q

Outline FRAX score

A

Risk of fragility fracture over next 10y
Uses bone mineral density- DEXA
Uses T score at hip

T >-1, BMD normal
T -1 to -2.5, BMD osteopenia
T <-2.5, BMD osteoporosis
T <-2.5 and fracture, BMD severe osteoporosis

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32
Q

How is the risk of fragility fracture reduced?

A

1st line:
Calcium and Vit D
Bisphosphonates (eg: Alendronic acid)

Denosumab- Blocks osteoclast activity

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33
Q

What is the MoA of bisphosphonates?

A

Interfere with osteoclasts and reduce their activity, preventing reabsorption of bone

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34
Q

What are the SEs of bisphosphonates?

A

Reflux and oesophageal erosions- Take on empty stomach, sit upright 30mins before eating
Atypical fractures
Osteonecrosis of jaw
Osteonecrosis external auditory canal

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35
Q

What imaging is used in fractures?

A

Xrays- 2 views required
CT scan- If xray inconclusive/further info required

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36
Q

How is mechanical alignment of a fracture achieved?

A

Closed reduction- Manipulation of limb
Open reduction- Surgery

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37
Q

List the possible early complications of fractures

A

Damage to local structures
Haemorrhage
Compartment syndrome
Fat embolism
VTE (due to immobility)

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38
Q

List possible long term complications of fractures

A

Delayed union
Malunion
Non-union
Avascular necrosis
Infection
Joint stability
Joint stiffness
Contractures
Arthritis
Chronic pain
Complex regional pain syndrome

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39
Q

What is a fat embolism?

A

Can occur following fracture of long bones
Fat globules released into circulation following fracture- Become lodged in blood vessels (eg: Pulmonary arteries)
Can cause systemic inflammatory response- Fat embolism syndrome

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40
Q

Outline presentation of fat embolism

A

24-72h after fracture

Gurd’s criteria

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41
Q

List Gurd’s major criteria for fat embolism

A

Respiratory distress
Petechial rash
Cerebral involvement

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42
Q

List Gurd’s minor criteria for fat embolism

A

Jaundice
Thrombocytopenia
Fever
Tachycardia

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43
Q

What is the prognosis of fat embolism?

A

Can lead to multiple organ failure
Supportive management and operate early to fix fracture
Mortality rate- Approx. 10%

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44
Q

List risk factors for hip fractures

A

Increasing age
Osteoporosis
Female

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45
Q

What is the timing for starting to operate on a hip fracture?

A

Within 48h

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46
Q

Where is the intertrochanteric line?

A

Between the greater and lesser trochanter

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47
Q

What is an intra-capsular hip fracture?

A

Break in femoral neck within capsule of hip joint
Affects area proximal to intertrochanteric line

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48
Q

Outline Garden classification

A

Used for intracapsular NOF fractures

Grade I- Incomplete fracture and non-displaced
Grade II- Complete fracture and non-displaced
Grade III- Partial displacement (trabeculae at angle)
Grade IV- Full displacement (trabeculae parallel)

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49
Q

Outline non-displaced intra-capsular fracture

A

Internal fixation (screws)
Intact blood supply

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50
Q

Outline displaced intra-capsular fractures

A

Replace head of femur
Disrupted blood supply

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51
Q

When is a total hip replacement offered?

A

Patients who can walk independently and fit for surgery

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51
Q

What is hemiarthroplasty and when is it offered?

A

Replace head of femur but leave acetabulum in place
Offered to patients with hip fractures who have limited mobility or sig. co-morbidities

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52
Q

What is an extra-capsular fracture?

A

Blood supply to head of femur intact- Head of femur doesn’t need replacing
Intertrochanteric and subtrochanteric fractures

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53
Q

Outline intertrochanteric fractures

A

Between lesser and greater trochanter
Dynamic hip screw

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54
Q

Outline subtrochanteric fractures

A

Distal to lesser trochanter, occurs to proximal shaft of femur
Intramedullary nail

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55
Q

Outline presentation of hip fracture

A

Pain in groin/hip, may radiate to knee
Unable to weight bear
Shortened, abducted and externally rotated

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56
Q

Outline imaging of hip fractures

A

1st line- Xray (2 views)
Disruption of Shenton’s line- NOF fracture
MRI/CT if xray negative but fracture still suspected

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57
Q

Outline management of hip fractures

A

Analgesia
Investigations
VTE prophylaxis (LMWH)
Pre-operative assessment- Bloods and ECG
Admit and surgery within 48h
Should be able to bear weight straight after surgery

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58
Q

What is compartment syndrome?

A

Abnormally increased pressure within fascial compartment- Cuts off blood flow
Can be acute/chronic

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59
Q

What is acute compartment syndrome?

A

Associated with acute injury- Bleeding/tissue swelling increases pressure

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60
Q

Outline presentation of compartment syndrome

A

Presents after acute injury

P- Pain disproportionate to injury
P- Paraesthesia
P- Pale
P- Pressure high
P- Paralysis (late and worrying feature)

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61
Q

Outline management of compartment syndrome

A

Clinical diagnosis based on signs and symptoms
Needle manometry- Measure compartment pressure
Elevate leg to heart level
Remove external dressings/bandages
Avoid hypotension
Emergency fasciotomy- Explore and debride

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62
Q

Outline chronic compartment syndrome

A

Usually associated with exertion
Pain, numbness or paraesthesia
NOT AN EMERGENCY
Diagnosis- Needle manometry
Treat- Fasciotomy

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63
Q

What is osteomyelitis?

A

Inflammation in bone and bone marrow
Usually caused by bacterial infection
Most common cause- Staph aureus

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64
Q

List the risk factors for osteomyelitis

A

Open fractures
Ortho operations
Diabetes (foot ulcers)
Peripheral artery disease
IV drug use
Immunosuppression

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65
Q

Outline presentation of osteomyelitis

A

Fever
Pain and tenderness
Erythema
Swelling
Lethargy, nausea and muscle aches

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66
Q

Outline investigations of osteomyelitis

A

Xray
MRI- Best for establishing diagnosis
Raised inflammatory markers
Blood cultures
Bone cultures

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67
Q

Outline xray findings of osteomyelitis

A

Periosteal reaction (changes to surface of bone)
Localised osteopenia (thinning of bone)
Destruction of areas of bone

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68
Q

Outline management of osteomyelitis

A

Surgical debridement
Antibiotic- 6wks flucloxacillin (can add rifampicin or fusidic acid for 1st 2wks)- Clindamycin in penicillin allergy

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69
Q

Which antibiotics are used to treat MRSA?

A

Vancomycin
Teicoplanin

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70
Q

List different types of bone sarcoma

A

Osteosarcoma- Most common
Chondrosarcoma- From cartilage
Ewing sarcoma- Bone and soft tissue cancer affecting children

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71
Q

List types of soft tissue sarcoma

A

Rhabdomyosarcoma- From skeletal muscle
Leiomyosarcoma- From smooth muscle
Liposarcoma- From adipose tissue
Synovial sarcoma- From soft tissue around joints
Angiosarcoma- From blood and lymph vessels
Kaposi’s sarcoma- Caused by HHV8- End-stage HIV- Red/purple raised skin lesions

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72
Q

Outline presentation of sarcoma

A

Soft tissue lump
Bone swelling
Persistent bone pain

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73
Q

Outline investigations of sarcoma

A

1st line for bony lumps/persistent pain)- Xray
1st line for soft tissue lumps- US
CT or MRI
Biopsy

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74
Q

Where is the most common site for sarcoma to metastasise to?

A

Lungs

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75
Q

Outline management of sarcoma

A

Surgery
Radio/chemotherapy
Palliative care

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76
Q

What are ganglion cysts?

A

Sacs of synovial fluid from tendon sheaths/joints

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77
Q

Outline presentation of ganglion cysts

A

Can appear rapidly (days) or gradually
Visible, palpable lump
Not painful
Firm and non-tender
Well-circumscribed
Transilluminates

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78
Q

Outline diagnosis of ganglion cysts

A

Clinical
US can help confirm

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79
Q

Outline management of ganglion cyst

A

Conservative
Needle aspiration
Surgical excision

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80
Q

Outline management of carpal tunnel syndrome

A

Rest and altered activities
Wrist splints to maintain normal position wrist at night (min 4wks)
Steroid injections
Surgery- Local anaesthetic- Cut flexor retinaculum

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81
Q

Outline nerve conduction studies used to diagnose carpal tunnel syndrome

A

Small electrical current applied by electrode to median nerve
Demonstrates how well signals passed through carpal tunnel along median nerve

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82
Q

Which special tests are used to test for carpal tunnel syndrome?

A

Tinel’s- Tap wrist- Numbness and paraesthesia
Phalen’s- Fully flex wrist- Numbness and paraesthesia

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83
Q

Outline presentation of carpal tunnel syndrome

A

Sensory symptoms in distribution of palmar digital cutaneous branch of median nerve affecting palmar aspects and full fingertips of:
Thumb
Index and middle finger
Lateral half of ring finger

Also motor symptoms

Symptoms worse at night- Can wake patient

84
Q

List sensory symptoms of carpal tunnel syndrome

A

Numbness
Paraesthesia
Burning sensation
Pain

85
Q

List motor symptoms of carpal tunnel syndrome

A

Affect thenar muscles:
Weakness of thumb movement
Weakness of grip strength
Difficulty fine movements involving thumb
Wasting of thenar muscle

86
Q

Which condition is bilateral carpal tunnel syndrome associated with?

A

Acromegaly

87
Q

List risk factors for carpal tunnel syndrome

A

Repetitive strain
Obesity
Perimenopause
RA
Diabetes
Acromegaly
Hypothyroidism

88
Q

What is carpal tunnel syndrome?

A

Compression of median nerve as travels through carpal tunnel in wrist

89
Q

What is Dupuytren’s contracture?

A

Fascia of hand thickens and tightens leading to finger contractures
Finger tightened into flexed position and cannot fully extend

90
Q

List risk factors for Dupuytren’s contracture

A

Age
FHx- Autosomal dominant
Male
Manual labour (vibrating tools)
Diabetes
Epilepsy
Smoking and alcohol

91
Q

Outline presentation of Dupuytren’s contracture

A

Hard nodules on palm
Skin thickening and pitting
Finger flexed, impossible to extend finger fully
Ring finger most commonly affected

92
Q

Outline diagnosis of Dupuytren’s contracture

A

Table-top test- Place hand flat

93
Q

Outline management of Dupuytren’s contracture

A

Conservative
Surgery- Needle fasciotomy/limited fasciectomy/dermofasciectomy

94
Q

Outline management of trigger finger

A

Rest and analgesia
Splinting
Steroid injections
Surgery to release A1 pulley

95
Q

Outline presentation of trigger finger

A

Painful and tender
Doesn’t move smoothly
Makes popping/clicking sound
Gets stuck in flexed position
Worse during morning and improves

96
Q

List RFs for trigger finger

A

40-60y
Women
Diabetes

96
Q

Outline management of De Quervain’s Tenosynovitis

A

Rest and adapting activities
Use splints to restrict movement
NSAIDs
Physio
Steroid injections
Rare- Surgery to cute extensor retinaculum

97
Q

What is De Quervain’s tenosynovitis?

A

Swelling and inflammation of tendon sheaths in wrist

Affects:
APL tendon
EPB tendon

Type of repetitive strain injury
Pain on radial side of wrist
Mummy thumb- Pain from lifting babies in a way that stresses thumb tendons

98
Q

Outline presentation of De Quervain’s tenosynovitis

A

Radial aspect of wrist near base of thumb
Pain, often radiating to forearm
Aching
Burning
Weakness
Numbness
Tenderness

99
Q

What is Finkelstein’s test?

A

Used to diagnose De Quervain’s tenosynovitis
Make fist with thumb inside fingers- Pain radial aspect of wrist

100
Q

What is torticollis?

A

Waking up with unilaterally stiff and painful neck due to muscle spasm

101
Q

What are the red flags indicating cauda equina?

A

Saddle anaesthesia
Urinary retention
Incontinence
Bilateral neuro signs

102
Q

What are the red flag indications of spinal stenosis?

A

Intermittent neuro claudication

103
Q

What are the red flag symptoms of ankylosing spondylitis?

A

<40y
Gradual onset
Morning stiffness
Night time pain

104
Q

What are the red flags for spinal infection?

A

Fever
History of IV drug use

105
Q

What is the pathway of the sciatic nerve?

A

L4-S3 form sciatic nerve- Exits posterior pelvis through greater sciatic foramen- Down back of leg- Splits into tibial and common peroneal nerve

106
Q

What is the role of the sciatic nerve?

A

Sensation to lateral lower leg and foot
Motor function to posterior thigh/lower leg/foot

107
Q

Outline sciatica

A

Unilateral pain from buttock radiating down back of thigh to below knee/feet
Electric/shooting pain
Paraesthesia (pins and needles), numbness and motor weakness

108
Q

What are the main causes of sciatica?

A

Lumbosacral nerve root compression:
Herniated disc
Spondylolisthesis
Spinal stenosis

109
Q

What is bilateral sciatica a red flag for?

A

Cauda equina syndrome

110
Q

What does localised tenderness to spine suggest?

A

Spinal fracture
Cancer

111
Q

Outline sciatic stretch test

A

Diagnosis of sciatica
Lie on back with legs straight
Passive lift one leg from ankle with knee extended until limit of hip flexion reached- Dorsiflex ankle
Sciatica-type pain in buttocks/post. thigh
Symptoms improve flexing knee

112
Q

Outline potential investigations of back pain

A

Xrays or CT scans- Fractures
Emergency MRI- Cauda equina

Ankylosing spondylitis:
CRP and ESR
Xray spine and sacrum- Bamboo
MRI spine- Bone marrow oedema

113
Q

How is acute lower back pain managed?

A

Cauda equina- Same day referral
Ank spond- Inflammatory markers and urgent rheum
Trauma- Immobilisation, trauma unit, xrays/CT scans

114
Q

Outline pain management advice for back pain

A

1st line- NSAIDs (ibuprofen/naproxen)
Codeine
Benzos (diazepam)- For muscle spasms (only use up to 5d)

115
Q

Outline management of sciatica

A

Amitriptyline
Duloxetine

(NO gabapentin/pregabalin/diazepam/oral corticosteroids)

Epidural corticosteroid injections
Local anaesthetic injections
Radiofrequency denervation
Spinal decompression

116
Q

What level does the spinal cord terminate?

A

L2/L3
Tapers into conus medullaris

117
Q

What do the nerves of the cauda equina supply?

A

Sensation to lower limbs, perineum, bladder, rectum
Motor innervation lower limbs, anal and urethral sphincters
Parasympathetic innervation of bladder and rectum

118
Q

Outline management of cauda equina syndrome

A

Immediate hospital admission
Emergency MRI
Lumbar decompression surgery

119
Q

Outline metastatic spinal cord compression

A

Compresses any part of spinal cord (not just isolated to cauda equina)
Presents similarly to cauda equina syndrome

120
Q

How can you tell the difference between cauda equina syndrome and metastatic spinal cord compression clinically?

A

CE- LMN- Reduced tone and reflexes
MSCC- UMN- Increased tone, brisk reflexes, upping plantar responses

121
Q

What is spinal stenosis?

A

Narrowing of part of spinal canal, resulting in compression of spinal cord or nerve roots

122
Q

Outline presentation of spinal stenosis

A

Intermittent claudication- Central spinal stenosis
Gradual onset
Lower back pain
Buttock and leg pain
Leg weakness
Symptoms absent at rest and seated, worsen with standing and walking

123
Q

Outline investigations of spinal stenosis

A

MRI
Exclude peripheral artery disease (ankle-brachial pressure index and CT angiogram)

124
Q

Outline management of spinal stenosis

A

Exercise and weight loss
Analgesia
Physio
Decompression surgery- Laminectomy

125
Q

What is meralgia paraesthetica?

A

Local sensory symptoms of outer thigh caused by compression of lateral femoral cutaneous nerve

126
Q

Outline function of lateral femoral cutaneous nerve

A

Carries only sensory signals
Innervation to upper outer thigh

127
Q

Outline presentation of meralgia paraesthetica

A

Abnormal/loss of sensation in lateral femoral cutaneous nerve distribution
Skin of upper-outer thigh affected
Burning
Numbness
Pins and needles
Cold sensation
Hair loss
Symptoms often worse with extension of hip and improved by sitting down

128
Q

Outline management of meralgia paraesthetica

A

Conservative:
Rest
Looser clothing
Weight loss
Physio

Medical:
Paracetamol
NSAIDs
Neuropathic analgesia (amitriptyline, gabapentin, pregabalin, duloxetine)

Surgical:
Decompression
Transection
Resection

129
Q

What is trochanteric bursitis?

A

Inflammation of bursa over greater trochanter

130
Q

Outline presentation of trochanteric bursitis

A

Pain localised to outer hip
Gradual onset
Worse with activity, may disrupt sleep
Pain on resisted movement
Trendelenburg- Positive

131
Q

Outline management of trochanteric bursitis

A

Rest and ice
NSAIDs- Ibuprofen or naproxen
Physio
Steroid injections

132
Q

Outline presentation of meniscal tears

A

Often occur during twisting movements in knee
Pop sound/sensation
Pain
Swelling
Stiffness
Restricted ROM
Locking of knee
Instability/knee giving way

133
Q

Outline McMurray’s test

A

Used to diagnose meniscal tears
Lie supine- Passive flex knee- Internally rotate tibia and apply varus pressure- Carefully extend knee- Pain/restriction = Lateral meniscus
External rotation and valgus pressure = Medial meniscus

134
Q

Outline Apley Grind test

A

Used to diagnose meniscal tears
Prone- Flex knee 90 degrees- Downward pressure through leg into knee- Internally/externally rotate- Pain localised to area of damage

135
Q

Outline the Ottawa knee rules

A

Determines whether patient requires xray of knee after acute injury

> 55y
Patella tenderness
Fibular head tenderness
Cannot flex knee 90 degrees
Cannot weight bear

136
Q

Outline investigations of meniscal tears

A

1st line- MRI
Arthroscopy

137
Q

Outline management of meniscal tears

A

RICE
NSAIDs
Arthroscopy

138
Q

What is the role of the ACL?

A

Stops tibia sliding forwards in relation to femur

139
Q

What is the role of the PCL?

A

Stops tibia sliding backwards in relation to femur

140
Q

Outline presentation of ACL injury

A

Twisting injury to knee
Pain
Swelling
Pop sound/sensation
Instability of knee joint- Tibia can move anteriorly

141
Q

Outline diagnosis of ACL tear

A

Anterior drawer test
1st line- MRI
Arthroscopy

142
Q

Outline management of ACL tear

A

RICE
1st line- NSAIDs
Arthroscopic surgery- New ligament formed with tendon graft

143
Q

What is Osgood-Schlatter disease?

A

Inflammation at tibial tuberosity where patella ligament inserts
10-15y old males
Lots of minor avulsion fractures and healing causing anterior knee pain

144
Q

Outline presentation of Osgood-Schlatter disease

A

Visible/palpable hard and tender lump at tibial tuberosity
Pain in anterior aspect of knee
Pain exacerbated by physical activity/kneeling/extension of knee

145
Q

Outline management of Osgood-Schlatter disease

A

Reduce physical activity
Ice
NSAIDs

146
Q

What is a rare complication of Osgood-Schlatter disease?

A

Complete avulsion fracture- Tibial tuberosity separated from rest of tibia- Requires surgery

147
Q

What are the 4 boundaries of popliteal fossa?

A

Semimembranosus and semitendinosus
Biceps femoris
Medial head of gastrocnemius
Lateral head of gastrocnemius

148
Q

Outline presentation of Baker’s cyst

A

Symptoms localised in popliteal fossa
Pain/discomfort
Fullness
Pressure
Palpable lump/swelling
Restricted ROM in knee

149
Q

What sign is associated with BAker’s cyst?

A

Foucher’s sign- Lump gets smaller/disappears when knee flexed 45 degrees

150
Q

Outline presentation of ruptured Baker’s cyst

A

Pain
Swelling
Erythema

151
Q

Outline investigations of Baker’s cyst

A

1st line- US to rule out DVT
MRI if surgery required or to find underlying cause (eg: Meniscal tear)

152
Q

Outline management of Baker’s cyst

A

No treatment if asymptomatic
Modified activity
NSAIDs
Physio
US-guided aspiration
Steroid injections

153
Q

What is Achilles tendinopathy?

A

Damage, swelling, inflammation and reduced function in Achilles tendon

154
Q

What are the RFs for Achilles tendinopathy?

A

Sports that stress Achilles
Inflammatory conditions (RA and ank spond)
Diabetes
Raised cholesterol
Fluoroquinolone ABs (ciprofloxacin)

155
Q

Outline presentation of Achilles tendinitis

A

Gradual onset
Pain/aching in Achilles tendon on heel with activity
Stiffness
Tenderness
Swelling
Nodularity on palpation of tendon

156
Q

Outline management of Achilles tendinopathy

A

Calf squeeze test- Tests for Achilles tendon rupture
Rest, ice and analgesia
Orthotics
Extracorporeal shock-wave therapy
Surgery to remove nodules and adhesions

AVOID steroid injections- Increase risk of rupture

157
Q

Outline Achilles Tendon rupture

A

Sudden onset injury
Loss of connection between calf muscles and heel

158
Q

List risk factors for Achilles Tendon Rupture

A

Sports increasing stress to Achilles (eg: Basketball, tennis, track athletes)
Increasing age
Existing Achilles tendinopathy
FHx
Fluoroquinolone ABs (Ciprofloxacin)
Systemic steroids

159
Q

Outline presentation of Achilles tendon rupture

A

Sudden onset pain in Achilles/calf
Snapping sound/sensation
Feeling as though something has hit them in the back of the leg
In relaxed dangled position- Affected ankle dorsiflexed
Weakness of plantar flexion
Unable to stand on tiptoes on affected leg
+ve Simmonds’ calf test

160
Q

Outline diagnosis of Achilles tendon rupture

A

US

161
Q

Outline management of Achilles tendon rupture

A

Rest, immobilisation, ice, elevation, analgesia
VTE prophylaxis whilst leg immobilised
Non-surgical- Boot 6-12wks
Surgical- Reattach tendon, immobilise plantarflexed, slowly adjust to neutral

162
Q

Outline plantar fasciitis

A

Inflammation of plantar fascia (attaches at calcaneus and travels along sole of foot)

163
Q

Outline presentation of plantar fasciitis

A

Gradual onset of pain on plantar aspect of heel
Worse with pressure, walking/standing
Tenderness to palpation

164
Q

Outline management of plantar fasciits

A

Rest, ice, NSAIDs
Steroid injections- Can be painful

165
Q

Outline fat pad atrophy

A

Affects heel
Atrophy of fat pad can occur with age or inflammation from repetitive impacts
Local steroid injections can cause fat pad atrophy

166
Q

Outline presentation of fat pad atrophy

A

Pain and tenderness on plantar aspect of heel
Worse with activity and walking barefoot on hard surfaces

167
Q

Outline management of fat pad atrophy

A

Diagnosis- US thickness of fat pad
Comfortable shoes, custom insoles
Adapt activity
Weight loss if appropriate

168
Q

Outline Morton’s Neuroma

A

Dysfunction of nerve in intermetatarsal space towards top of foot

169
Q

Outline presentation of Morton’s neuroma

A

Exacerbated by high heels or narrow shoes
Pain at front of foot at location of lesion
Sensation of lump in shoe
Burning, numbness or ‘pins and needles’ felt in distal toes

170
Q

How can you test for Morton’s neuroma?

A

Deep pressure causes pain
Metatarsal squeeze test causes pain
Mulder’s sign- Painful click felt when using 2 hands on either side of foot to manipulate metatarsal heads to rub neuroma
US or MRI

171
Q

Outline management of Morton’s neuroma

A

Adapting activities
NSAIDs
Insoles
Weight loss if appropriate
Steroid injections
Radiofrequency ablation
Surgery- Excision of neuroma

172
Q

Outline Halux valgus

A

Bunions
Bony lump created by deformity at MTP
1st metatarsal angles mdially, big toe angled laterally
MTP joint becomes inflamed and enlarged

173
Q

Outline management of bunions

A

Diagnosis- Weight bearing xrays
Wide, comfortable shoes and analgesia
Surgery definitive

174
Q

Outline frozen shoulder

A

Adhesive capsulitis
Middle aged diabetics
Inflammation and fibrosis in joint capsule leading to adhesions- Bind to capsule cause it to tighten and restrict movement

175
Q

Outline presentation of frozen shoulder

A

Painful phase- Shoulder pain, worse at night
Stiff phase- Shoulder stiffness affecting active and passive movement- External rotation most affected
Thawing phase- Gradual improvement in stiffness abd return to normal

176
Q

Outline supraspinatus tendinopathy

A

Inflammation and irritation of supraspinatus tendon
Impingement at point it passes between humeral head and acromion
Test- Empty can test

177
Q

Outline acromioclavicular joint arthritis

A

Tenderness to palpation of AC joint
Pain worse at extremes of shoulder abduction- 170 degrees onwards when arm overhead
Positive scarf test

178
Q

Outline management of frozen shoulder

A

NSAIDs
Intra-articular steroid injections
Hydrodilation (injecting fluid to stretch capsule)
Manipulation under anaesthesia
Arthroscopy

179
Q

Outline rotator cuff tears

A

Occur due to acute injury (eg: FOOSH) or degenerative changes with age

180
Q

What is the function of the supraspinatus?

A

Abducts arm

181
Q

What is the function of the infraspinatus?

A

Externally rotates arm

182
Q

What is the function of the teres minor?

A

Externally rotates arm

183
Q

What is the function of the subscapularis?

A

Internally rotates arm

184
Q

Outline presentation of rotator cuff tears

A

Shoulder pain
Weakness and pain with specific movements relating to site of tear
Difficult to get comfortable at night

185
Q

Outline investigations of rotator cuff tears

A

Xrays- Rule out other pathologies
US or MRI scans

186
Q

Outline management of rotator cuff tears

A

Degenerative- Conservative management
Non-surgical- Res and adapted activities, NSAIDs, physio
Surgical- Arthroscopic rotator cuff repair

187
Q

What is subluxation?

A

Partial dislocation

188
Q

What is the most common type of shoulder dislocation and how does this occur?

A

Anterior dislocation
Arm forced backwards whilst abducted and extended
Eg: Reaching up and trying to catch a heavy rockOutl

189
Q

Outline posterior shoulder dislocations

A

Associated with electric shocks and seizures

190
Q

Outline damage associated with shoulder dislocations

A

Glenoid labrum tear
Bankart lesions- Tear of anterior portion of labrum, occur with repeate dislocations
Hill-Sachs lesions- Compression fractures of posterolateral part of head of humerus- Increased risk future dislocations
Axillary nerve damage- Loss sensation of regimental patch and motor weakness deltoid and teres minor
Fractures
Rotator cuff tears

191
Q

What is the apprehension test?

A

Assesses shoulder instability specifically in anterior direction
Positive after anterior dislocation or subluxation
Externally rotate arm- Dislocation- Patient becomes apprehensive that will dislocate

192
Q

Outline investigations of shoulder dislocation

A

Xray- Not always required before reduction- Performed after to confirm placement and assess for fractures
MRI with contrast
Arthroscopy

193
Q

What is olecranon bursitis?

A

Inflammation and swelling of bursa over elbow (ulna)
Student’s elbow

194
Q

Outline presentation of olecranon bursitis

A

Young/middle aged men
Swollen, warm, tender, fluctuant

195
Q

What are the features of an infected olecranon bursa?

A

Hot to touch
More tender
Erythema spreading to surrounding skin
Fever
Features of sepsis (tachycardia, hypotension, confusion

196
Q

Outline aspiration of bursa

A

Pus- Infection
Straw-coloured- Infection less likely
Blood stained- Trauma/infection/inflammatory causes
Milky- Gout/pseudogout

197
Q

Outline management of olecranon bursitis

A

Rest, ice, compression, paracetamol/NSAIDs
Protect elbow from pressure/trauma
Aspiration of fluid to relieve pressure

If infected:
Aspiration for MC&S
ABs- Flucloxacillin 1st line, clarithromycin (penicillin allergy)

Systemically unwell:
Septic 6

198
Q

Outline repetitive strain injury

A

Umbrella term for soft tissue irritation, microtrauma, strain from repeated activities

199
Q

Outline presentation of repetitive strain injuries

A

History of repetitive activities
Pain, exacerbated by using associated joints/muscles/tendons
Aching
Weakness
Cramping
Numbness

200
Q

Outline management of repetitive strain injuries

A

RICE
NSAIDs
Steroid injections (in specific scenarios)

201
Q

What is epicondylitis?

A

Inflammation at point where tendons of forearm insert into epicondyles at elbow
Repetitive strain injury

202
Q

What is the function of the tendons that insert into the medial epicondyle?

A

Flex wrist

203
Q

What is the function of tendons that insert into lateral epicondyle?

A

Extend wrist

204
Q

Outline lateral epicondylitis

A

Tennis elbow
Pain and tenderness at lateral epicondyle
Weakness in grip strength

205
Q

Outline medial epicondylitis

A

Golfer’s elbow
Pain and tenderness at medial epicondyle

206
Q

Outline management of epicondylitis

A

Clinical diagnosis
Rest
NSAIDs
Orthotics
Steroid injections
Platelet-rich plasma (PRP) injections
Extracorporeal shockwave therapy

207
Q
A

Final Year (14 decks)

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