Orthopaedics

Question 1

Describe the myotomes of the arm

Answer 1

C5 (axillary) - shoulder abduction
C6 (msc.) - elbow flexion
C7 (radial) - elbow extension
C8 (median) - finger flexion
T1 (ulnar) -> finger adduction + abduction

Question 2

Describe the dermatomes of the cervical spine

Answer 2

C2 top of head
C3 back of head
C4 neck
C5 anterolateral arm
C6 latera larm and tumb
C7 posterior arm and 1st 2 fingers
C8 medial arm and little 2 dingers

Question 3

Describe the dermatomes of the thoracic spine

Answer 3

T1 armpit
T2 - L1 over tink top to bottom
T4 nipples
T10 umbilicus

Question 4

Describe the dermatomes of the lower limb

Answer 4

L1 inguinal area

Remember the ventral axial line of the leg

Th predominant dermatome is L5, it ends up intersecting S1 and S2

Big toe - L5
Little toe - S1

Question 5

How would you asses L3 and L4?

Answer 5

L3 - sesnation ant thigh
L4 - sensation ant knee

both will show weak quadriceps, with a reduced knee reflex and a positive femoral stretch test

Question 6

How would you test L5 and S1?

Answer 6

L5 - dorsum foot, big toe, intact reflexes
S1 - lateral foot, little toe, reduced ankle reflex

Question 7

Describe the main reflexes we test for

Answer 7

Ankle - S1-2, buckly my shoe
Knee - L3-4 , kick the door
Biceps - C5-6, pick up stick
Triceps - C7-8, open the gate

Question 8

Why do patients need close follow-up following surgery for cervical myelopathy?

Answer 8

Risk of recurrence at adjacent spinal levels

Question 9

How would you differentiate Tennis elbow and Golfer’s elbow?

Answer 9

Tennis elbow - lateral epicondylitis

Golfer’s elbow - medial epicondylitis

Question 10

How would you differentiate a posterior and anterior dislocated hip from a NOF?

Answer 10

post - internally rotate, short

ant - externally rotated, long

NOF - externall rotated, short

Question 11

Which nerve supplies the interossei of the hand?

Answer 11

Ulnar nerve

Question 12

What is a Hill-Sachs lesion?

Answer 12

Cartilage of the humerus is in contact with the glenoid rim

50% of glenohumeral dislocations are associated with this

Question 13

What part of long bones is sysceptible to osteomyelitis in children?

Answer 13

Metaphysis

Question 14

How might you prevent chest infections in those with rib fractures?

Answer 14

Chest physiotherapy and analgesia

Question 15

Which type of analgesia is associated with slow bone healing?

Answer 15

NSAIDs

Question 16

What is the most common site for a metartarsal stress fracture?

Answer 16

2nd metatarsal

Question 17

What is the investigation of choice for osteomyelitis?

Answer 17

MRI

Question 18

What are the causative agents for osteomyelitis?

Answer 18

staph aureus

Sickle cell salmonella

Question 19

What might you use to assess hypermobility in Ehler-Danlos syndrome?

Answer 19

Beighton score