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END OF YEAR NEURO-ORTHO > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is the most common elbow complaint?

A

Lateral humeral epicondylitis

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2
Q

Lateral epicondylitis -
Prevalence in overall population

A

1-3% in overall population

  • 5-10% are from tennis, However 40-50% of all tennis players experience the condition at some time in their career
  • Highest in 30-55 year age group
  • It may occur with athletic activities in younger individuals and occupational activities in older patients (screwing, gripping)
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3
Q

What percentage of all cases of lateral humeral epicondylitis is contributed by tennis

A

5-10%

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4
Q

What percentage of all cases of lateral humeral epicondylitis are attributed to workplace activities?

A

35-64%

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5
Q

Aetiology(Cause) of lateral humeral epicondylitis?

A

Reptitive strain issue which leads to microtrauma (of common extensor tendon)

or

could be a blow to the lateral epicondyle that leads to tearing of the enthesis and can cause inflammatory response and pain

Poor circulation, slow healing an further trauma any lead to a chondric lesion with fibroblastic degeneration and ultimately rupture

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6
Q

Which muscle is the most frequently involved with lateral humeral epicondylitis?

A

Extensor carpi radialis brevis

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7
Q

In the modified cozens test or maudsleys test, what muscle is being tested?

A

Extensor digitorum

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8
Q

Lateral epicondylitis can be divided into 4 subcategories based on the location of the lesion- Which has a highest incidence rate?

A

Type II - Tendoperiosteal origin of the ECRB, palpation of the lateral and posterior aspect will be painful

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9
Q

What is the subcategory Type I for LHE?

A

Type I -
Just proximal to epicondyle i.e tendoperiosteal origin of the ECRL

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10
Q

What is the subcategory Type IV for LHE?

A

The upper part of the muscle bellies of the ERCB & ECRL

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11
Q

What is the subcategory Type II for LHE?

A

Type II - Tendoperiosteal origin of the ECRB
Palpation of the lateral and posterior aspect of the epicondyle may also be painful

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12
Q

Explain the numbers within the incidence rate of each type according to Cyriax

A

Type I - 1%
Type II - 90%
Type III - 1%
Type IV - 8%

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13
Q

Risk factors of Lateral humeral epicondylitis?

A

Males: Female ratio is Equal
Adults commonly between ages of 30-55 years
Occupation - At risk groups with workers using repititive gripping/pronation-supination actions (carpenters etc)
Athletics (racket and throwing sports)

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14
Q

Signs and Symptoms of Lateral humeral epicondylitis

A
  • Acute onset
  • Pain (variable degree) localised to lateral epicondyle and radiating distally variable distace into forearm, soemtimes into 3rd and 4th digits.
    Rarely radiates proximally
  • Tenderness on palpation and on the wrist extensor muscles
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15
Q

Aggrevating factors of Lateral humeral epicondylitis?

A
  • Gripping movements espiecally with elbow fully extended
  • Wrist extension
  • Elbow extension after periods of immobility in flexion

Reliving factors
- Rest in neutral position and wrist

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16
Q

Most common cause of medial elbow pain?

A

Medial epicondylitis
Less common (10x) than lateral epicondylitis

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17
Q

Prevelenace of Medial Epicondylitis?

A

30-50yo
Male-to-female 2:1

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18
Q

Describe the lesion of Medial humeral Epicondylitis

A

Identical to tennis elbow but affects the medial epicondyle at the site of origin of common FLEXOR muscles

Often referred to as golfer’s elbow, is a condition characterised by pain and inflammation on the inner side of the elbow where the tendons of the forearm muscles attach to the medial epicondyle of the humerus.

It typically results from repetitive wrist flexion and gripping activities, leading to micro-tears

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19
Q

What are the Classifications of Medial Humeral Epicondylitis?

A

Type I
Tendoperiosteal variety -
located at the anterior aspect of the medial epicondyle at the origin of the common flexor tendon

Type II -
Musculotendinous Variety -
Located 5mm below the edge of the epicondyle at the musculoteninous junction

In addition, an Ulnar neuropraxia caused by compression of the ulnar nerve in or around the medial epicondylar groove has been estimated to occur in up to 50% of cases

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20
Q

Signs and Symptoms of Medial humeral Epicondylitis?

A
  • Clinically pain is made worse by use of wrist flexor muscles
  • 50% of patients with Medial Epicondylitis complain of occasional or constant numbness and/or tingling sensation that radiates into their 4th an 5th fingers, suggests involvment of ulnar nerve
  • Range of motion of the elbow and wrist is uaully within normal limits
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21
Q

With bicep lesions such as strains and ruptures, where is the complain usually located?

A

90-97% of all bicep ruptures are exclusively involves the long head so pain would be localed on the anterior aspect on the shoulder

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22
Q

What is Bicipital tendinitis

A

Inflammation or irritation of the biceps tendon, usually due to repetitive use, overloading

It typically causes pain, tenderness, and swelling in the front of the shoulder, which worsens with movement or lifting

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23
Q

Signs and Symptoms of Biceps rupture?

A

Sudden pain in the anterior shoulder during activity. This acute pain, frequently described as sharp in nature, may be accompanied by an audible pop or a percieved snapping sensation

Others may report experiencing recurrent pain while performing overhead or reptitive activites

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24
Q

Discuss the major impairment within bicep ruptures

A

Limitations due to pain during the acute phase,

but impairment ultimately relates to a decrease in strength during shoulder flexion, elbow extension and forearm supination

Distal ruptures also initially result in pain followed by reduced strength in supination, elbow flexion and grip strength

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25
Q

Epidemiology of biceps rupture?

A

M/C in 40-60 yo with a history of shoulder problems, secondary to chronic wear of the tendon

Younger individuals may rupture the biceps tendon from a traumatic fall, during heavy weightlifting or during sporting activities

More common in men to suffer from bicep ruptures than women d/t occupational and recreational activities.

Dominant arm being primarily involved (overuse)

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26
Q

What is a biceps rupture caused by?

A

Generally caused by insidious inflammation from subacromial impingment and may be the result of chronic microtrauma. Repeated insults often lead to fraying of the tendon

Tendon rupture d/t chronic inflammation can occur in rheumatoid arthritis

Excessive loading and rapid stress upon the tendon, such as weightlifting, often causes an acute tendon ruptures

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27
Q

Explain Painful Arc Syndrome/Subacromial Impingment syndrome

A

Compromise of the space between the coracoacromial arch and the proximal humerus.

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28
Q

What percentage does SAPS account for within shoulder pain?

A

65-85%

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29
Q

Demographic within subacromial Impingement syndrome?

A

Not restricted to one population: athletes, repetitive activity & elderly

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30
Q

Recovery time from SAPS?

A
  • Natural history is often prolonged with no spontaneous recovery with 18 months
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31
Q

Causes of Impingement Syndrome

A

Most common causes: rotator cuff tendinitis/tendinosis/tendinopathy.
- Additional reasons: injury to the subacromial bursa, AC joint, or biceps tendon.

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32
Q

What is torticollis?

A

A contracted state of the cervical muscles producing twisting of the neck and an unnatural position of the head.

SCM - shortening, painless defomity due to soft tissue lesion

33
Q

What are the different types of Torticollis you can get?

A

Congenital - d/t SCM - muscle shortening
Neurogenic - d/t spinal accessory nerve lesion
Myogenic - Tranient, d/e muscular contraction from injury/cold

34
Q

Most Common Cause of Infant Torticollis

A

Congenital muscular torticollis associated with a contracture of the sternocleidomastoid muscle.Due to lesion of spinal accessory nerve

35
Q

Treatment for Congenital Muscular Torticollis

A

Manual cervical stretching regimen

36
Q

What is the common cause of torticollis in older children

A

Neck injury or inflammation in the oropharyngeal, known as atlantoaxial rotatory displacement

37
Q

What are some causes infectious of torticollis

A

Retropharyngeal abscesses and pryogenci cervical spondylitis

38
Q

Prevalence of Torticollis?

A

No age or sex preference

39
Q

What is the most common peripheral entrapment neuropathy of the upper extremity?

A

Carpal tunnel syndrome

40
Q

Prevalence of CTS?

A

45-60yo, Only 10% of pt are younger than 31yo
50% bilateral
More common in females than males

Prevalence is 70-160 cases per 1000 subjects in the UK

41
Q

Local causes of CTS?

A

Inflammatory e.g. tenosynovitis
Trauma e.g. Colles fracture
Tumours e.g. Cyst

42
Q

Regional causes of CTS?

A

Osteoarthritis
Rheumatoid Arthritis
Gout

43
Q

Systemic causes of CTS?

A

Diabetes -
(Prevalence 14%-30% with neuropathy)
Obesity
Hypothyroidism
Pregnancy

44
Q

Signs and Symptoms of CTS?

A

Numbness and tingling localised to the palmer aspect of the first to the fourth fingers and the distal palm (i.e. sensory distribution of the median nerve at the wrist)

Night time symptoms that wake the individual are more specific to CTS, espeically if the patient relieves symptoms by shaking the hand/wrist

Bilateral CTS is common, although the dominant hand is uaully affected first and more severely than the other hand

Loss of power in the hand, particularly for precision grips involving the thumb

45
Q

Sensory & Motor examination of CTS?

A

Sensory - 2 point discrimination may be more sensitive

Vibration, Soft and Sharp testing

Motor - Wasting and weakness of median-innervated hand muscles (LOAF muscles) may be detectable

46
Q

LOAF Muscles?

A

L - Lateral two lumbricals.
O - Opponens pollicus
A - Abductor pollicus brevis
F - Flexor pollicus brevis

47
Q

Special Tests for CTS?

A

Hoffman-Tinels sign - gently tap over the median nerve - elicit tingling in the nerve’s distribution.

Carpal compression test - apply firm pressure directly over the carpal tunnel, usually with thumbs for up to 30second to reproduce symptoms

Phalens sign - Tingling in the median nerve distribution is induced by full flexion of wrists for up to 60 seconds

48
Q

How do you intrepret the Ottawa Ankle Rules?

A

Set of clinical guidelines used to determine whether ankle injuries require X-ray imaging to rule out fractures

Posterior edge or tip of the lateral malleolus - 6cm up
Posterior edge or tip of the medial malleolus - 6cm up
Palpate for pain on Base of 5th metatarsal
Palpate for pain on Navicular
Can they bear weight for 3 steps forward

49
Q

What is Plantar Interdigital Neuroma?

A

Morton’s Neuroma
Trauma or repititive stress caused by tight fitting shoes or pronated foot putting abnormal pressure on the plantar digital nerves as they are compressed between the metatarsal heads and transverse intermetatarsal ligament

Most common 2/3 or 3/4 intermetatarsal spaces

Sometimes bilateral

50
Q

Signs and Symptoms of Plantar interdigital Neuroma?

A
  • Sensation of having a stone in the shoe that worsens with standing
  • Tingling or burning radiating to the toes along with intermittent sharp pain
  • Painful mass and pain on palpation between the metatarsal heads
51
Q

Examination of Plantar Interdigital Neuroma?

A

Pt supine, hold the pt’s foot around the MTT heads amd compress them, should produce a sharp electric pain accompanied by numbness which radiates to the toes

52
Q

Slipped Capital Femoral Epiphysis

A

A condition that occurs when the ball at the upper end of the femur slips off the hip joint.

53
Q

Slipped Capitial Femoral Epiphysis is more common in

A

Children who are above the 90th percentile for height or are obese
- M/C males than female
- Blacks more than whites
- Left hip
- Bilteral in 20/30% of cases with the 2nd slip usually within a year

54
Q

Cause of Slipped Captial Femoral Epiphysis?

A

Age related weakness
Trauma
Overweight
Coxa Vaga
Congenital abnormalities
An autoimmune process
Inflammation and hormonal imbalance

55
Q

Clinical presentation of Slipped Capital Femoral Epiphysis?

A

Vague symptoms of pain in the anterior and lateral groin, over a protracted period of weeks to months with the eventual appearance of a limp

Common to present soely with medial knee pain

Slip may be ‘silent’ with only a painless limp giving any clue to a hip pathology

Also, direct trauma giving an acute onset of pain and an unwillingness to bear weight on the involved side

56
Q

Physical findings of Slipped Femoral Captital Femoral Epiphysis?

A

Painful active and passive ROM in all directions with marked limitation of internal rotation and abduction - d/t position of the displaced femoral head in relation to the femoral neck

57
Q

What is Legg-Calve-Perthes

A

Condition where the blood supply to the femoral head is disrupted, leading to necrosis (death) of the bone tissue and deformity of the hip joint

58
Q

Legg-Calve-Perthes prevalence?

A

Reported incidence of approx 1 in 1500

6:1 - Male to Female ratio

Overall cases in children aged between 5 - 7 years

Bilateral in 20% of affected children

59
Q

Legg-Calve-Perthes Clinical Presentation?

A

Characterstic presentation involves limp which may or may not be associated with pain

If painful it is usually lateral hip, anterior thigh or sometimes in the suprapatellar space

60
Q

Legg-Calve-Perthes Physical findings

A

Decreased in active and passive ROM particularly on rotation and abduction, atrophy of thigh and occasionally gluteal muscles
Tenderness over the hip joint d/t synovitis

61
Q

What is Osteomyelitis

A

An infection of the bone, often caused by bacteria entering the bone tissue through the bloodstream or from nearby infected tissue. Usually occurs in children under 16 years old

62
Q

Symptoms of osteomyelitis?

A

localised pain, swelling, redness, warmth, and sometimes fever. In severe cases, there may be restricted movement of the affected limb

63
Q

Clinical presentation of osteomyelitis?

A

infants: Fever and signs of systemic toxicity are usually absent the most common clinical being irritability, poor feed, localised limb oedema (swelling) and pseudo-paralysis (muscle guarding and unwillingness to move the affected limb)

64
Q

What is Septic Arthritis?

A

Septic arthritis is a serious infection of a joint, typically caused by bacterial infection.

It leads to severe pain, swelling, warmth, and limited mobility in the affected joint and requires prompt medical treatment,

often with antibiotics and drainage of the infected fluid from the joint.

65
Q

Demographic for Septic Arthritis?

A

Septic arthritis can affect individuals of all ages, including children and adults. No significant gender predilection

66
Q

Risk factors for Septic Arthritis?

A
  • Compromised Immune System: Conditions such as diabetes, HIV, or immunosuppressive therapy.
  • Joint Disease: Pre-existing joint conditions such as osteoarthritis or rheumatoid arthritis.
  • Joint Surgery or Injections: Procedures that breach the joint space.
  • Skin Infections or Open Wounds: Providing a route for bacteria to enter the joint.
67
Q

Kocher criteria- for a child with a painful hip to decide if its septic arthritis

A

Non weight-bearing on affected side
erythrocyte sedimentation rate (ESR) greater than 40mm/hr
Fever >38.5 degrees (counts as positive)
WBC count >12,000

68
Q

How do we understand the Kocher criteria for septic arthritis?

A

4/4 criteria are met, 99% chance that child has septic arthritis
3/4 criteria are met, 93%
2/4 criteria are met, 40%
1/4 criteria are met, 3%

69
Q

What is Transient Synovitis -

A

Most common cause of limping in childhood

Acute, non-specific, inflammatory process affecting the joint synovium

Also known as toxic synovitis, is typically a self-limiting condition most commonly seen in children 3 - 10 years and more common in boys

70
Q

Aetiology of transient Synovitis?

A

A self limiting acute inflammatory reaction that commonly follows an upper respiratory infection. Has also been associated with history of minor trauma and overuse

71
Q

Clinical presentation of tranisent Synovitis?

A
  • Painful limp is the cardinal sign with referred pain into groin and thigh
  • Restriction in extension and internal rotation
  • Temperature seldom exceeds 38.3C (Temperature above think osteomyelitis)
72
Q

What is Horners Syndrome?

A

Horner’s syndrome is a neurological disorder that affects the nerves in the face and eyes, causing a range of symptoms.

73
Q

Signs and symptoms of Horners Syndrome?

A

Rapid and involuntary movement of the eyes, difficulty with balance and coordination, and vision problems.

Ptosis
Miosis
Anhdryosis

74
Q

What are the Ottawa knee rules?

A
  • Age > 55
  • Isolated tenderness of the patella (no other bony tenderness)
  • Tenderness at the fibular head
  • Unable to flex knee to 90°
  • Unable to bear weight both immediately and in ED
75
Q

What are the Ottawa ankle rules

A
  • Bony tenderness along distal 6 cm of the posterior edge of fibula or tip of Lateral & Medial malleolus
  • Bony tenderness at the base of the 5th metatarsal
  • Bony tenderness at the navicular
  • Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
76
Q

What is the Schobers test used for?

A

Schöber’s test is a simple clinical assessment used to measure lumbar spine flexion.

77
Q

How do you perform Schobers sign?

A

Pt stands upright with the examiner marking two points along the midline of the lumbar spine:
- one at the level of the dimples of Venus (lumbar prominence) and another 10 cm above while the pt bends forward as far as possible keeping their knees straight

78
Q

Interpretation of Schobers sign?

A

Normally, the distance between the two points increases by at least 5 cm during flexion. If it increases by less than 5 cm, it may indicate restricted lumbar flexion, possibly due to conditions like ankylosing spondylitis or other causes of spine stiffness.

79
Q

What is Tarsal tunnel syndrome?
Signs and symptoms?
Test for TTS?

A

Compression of the posterior tibial nerve or its branches under the fibrous flexor retinaculum in the foot.

S/S
- Pt complaining of pain at medial malleolus rading into the sole of and heel
- Paraesthesia
- Hyperthesia

Positive Tinels Test over the course of the nerve

END OF YEAR NEURO-ORTHO (5 decks)

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