Orthopaedics Flashcards
Describe the causes of Achilles tendon rupture
?
- Middle aged man;
- Infrequent sports goer;
- Repetitive jumping motion.
Describe the Simmond’s triad for the diagnosis of Achilles tendon rupture
?
Patient in prone position:
- Affected leg rests in a dorsiflexed position;
- Palbable gap at the heel;
- No plantar flexion when calf is squeezed.
What is the management of Achilles tendon rupture
?
Same day referral to orthopaedics.
What medications can contribute to Achilles tendon rupture
?
Fluoroquinolones
- Increases the risk of tendinitis and tendon rupture.
Ex: ciproflocxacin.
Describe the Thompson test for Achilles tendon rupture
?
Calf is squezeed ➝ reduced/absent plantar flexion.
Indication of tendon discontinuity.
What are the muscles group affected in Achilles tendon rupture
?
HIGH YIELD
- Gastrocnemius
- Soleus
Describe the presentation
of Baker’s cyst / popliteal cyst.
- Popliteal mass;
- Occasional pain;
- Cyst rupture ➝ calf sweeling and pain.
How is the diagnosis
of Baker’s cyst / popliteal cyst done?
Ultrasound.
What are the symptoms of frozen shoulder / adhesive capsulitis?
- Pain;
- Stiffness of the shoulder;
- Restriction of active and passive shoulder movements;
- Inability of doing passive external rotation.
What is the cause of frozen shoulder / adhesive capsulitis?
- Thickened and contraction of the glenohumeral joint capsule;
- Formation of adhesions.
What is the Rx of frozen shoulder / adhesive capsulitis?
- Paracetamol and NSAIDs
- Physiotherapy
- Steroid injection
What is the commonest cause of shoulder pain?
Rotator cuff disorders.
Name the 4 rotator cuff muscles.
- Supraspinatus;
- Infraspinatus;
- Teres minor;
- Subscapularis.
What is the cause
of Rotator cuff disorders?
- Rotator cuff tears;
- Calcific tendonitis;
- Subacromial impingement.
What is the Rx
of rotator cuff disorders?
- Pain relief;
- Physiotherapy;
- Steroid injections (max 2);
- Surgery.
What are the symptoms
of shoulder impingement syndrome?
- Pain on shoulder movement ;
- Weakness on shoulder movement;
- Restriction of activity;
What is the cause
of shoulder impingement syndrome?
- History of repetitive overhead activity or of carrying heavy objects;
- It will cause narrowing of the subacromial space leading to supraspinatus tendinitis.
DDx between:
- Supraspinatus tendinitis
- Adhesive capsulitis
Supraspinatus tendinitis
- Difficulty lifting arm above shoulder;
- Painful arc test positive;
- Associated with injury of heavy lifting;
Adhesive capsulitis (stiff shoulder)
- Reduced active movements;
- Reduced passive glenohumeral joint movements;
- Difficulty to put on a jacket (external rotation impaired);
- Associated with DM.
What is the presentation / symptoms of Colles fracture
?
- Radial fracture (with or w/out ulnar fracture);
- Dinner-fork deformity:
Distal fragment of radius deviated backwards and laterally
.
➔ Elderly patient who has fallen on an outstretched hand.
What is the management & Rx of Colles fracture
?
- X-ray;
- Analgesia: haematoma block with lidocaine;
- Closed reduction and immobilisation with a cast;
- X-ray post reduction.
Describe the presentation
of Smith’s fracture.
- Reverse colles fracture;
-
Garden spade deformity
; - Anterior displacement of the distal fragment.
Garden spade = pá de jardinagem/machamba.
Describe the presentation
of scaphoid fracture.
➜ Most common carpal bone fracture.
- Fall on an outstreched hand;
- Tenderness on the anatomical snuffbox.
Describe the complications
of scaphoid fracture.
High risk of avascular necrosis.
What are the investigations
done in scaphoid fracture?
X-ray
- One immediately
- One in 10-14 days if the first one doesn’t show the fracture line.
What is the Rx
done in scaphoid fracture?
Fracture visible on x-ray
- Scaphoid cast for 6 weeks;
Fracture not visible:
- Cast of the wrist for 2 weeks, review with x-ray.
DDx between:
- Galeazzi fracture;
- Monteggia fracture.
Galeazz
i fracture
- Z is distal
➝ fracture of distal 1/3 of radius shaft;
- Distal radioulnar joint dislocation;
Monteggia
fracture
- A is proximal
➝ fracture of proximal 1/3 of ulna.
- Radial nerve damage
;
- Dislocation of the head of radius.
What are the complications of fracture
?
➔ Fat embolism syndrome
- Fracture of long bones;
- Petechial rash;
- Chest pain & dyspnoea;
- Oliguria & haematuria;
➔ Compartment syndrome
➔ Gunstock deformity
- Cubitus varus following supracondylar fracture of the humerus;
➔ Myositis ossificans
- Formation of new bone in muscle after the fracture.
What are the symptoms
of osteosarcoma?
- Knee pain worse at night;
- Fracture even with minor trauma;
- Swelling
➔ Distal femur & proximal tibia commonly affected.
➔ Adolescents & old adults.
What are the investigations
done in osteosarcoma?
◉ X-ray:
- Sunburst appearance;
- Codman’s triangle.
◉ CT scan
◉ Bone biopsy
What is the Rx
of osteosarcoma?
Radical resection of the tumour.
DDx between:
- Osteosarcoma
- Ewing sarcoma
Osteosarcoma
- Teenage boy with knee pain
Ewing sarcomaTeenage boy with:
- Bone pain;
- Tiredness;
- Fever;
- Weight loss.
What are the symptoms
of osteoid osteoma?
- Unilateral leg pain;
- Worse at night;
- Relieved by NSAID.
What are the symptoms
of transient synovitis?
- Acute onset hip pain;
- Limp;
- Fever (mild).
DDx of elbow fracture.
◆ Child
⟶ radial neck.◆ Adult
⟶ radial head.
What is the most common type of ELBOW fracture in children
?
Supracondylar fracture of humerus.
What are the structures damaged
in elbow fracture?
Most likely:
- Brachial artery
Others:
- Median nerve
- Ulnar nerve
- Radial nerve
What is the most commom origin of a bone metastasis
?
◆ Male
⟶ Prostate > lung.◆ Female
⟶ Breast > lung.
What is the most common type of childhood fracture
?
- Torus fracture / buckling fracture;
- Distal radius.
What are the symptoms
of Ewing sarcoma?
- Bone pain;
- Fever;
- Weight loss;
- Fractures;
➔ Common in the 2nd decade
of life;
➔ Location:
diaphysis of femur, pelvis, tibia.
What is the Rx
of Ewing sarcoma?
Highly metatastic
- Chemo
&
- Surgery
or
- Radiotherapy
& - Surgery
What are the symptoms
of sciatica?
- Shooting pain from buttocks down the leg;
- Pain ↓ on lying down and ↑ on sitting or walking;
- Numbness;
- Paraesthesia;
- Weakness;
- +/- loss of tendon reflexes.
What is the cause
of sciatica?
➜ Disk prolapse:
- L4
- L5
- S1
➜ Large herniation can cause cauda equina syndrome
What is the management
of sciatica?
- NSAIDs
- Amitriptyline
➜ Avoid gabapentinoids.
Describe the unhappy triad of knee injuries
.
Injury to:
- Anterior cruciate ligament;
- Medial collateral ligament;
- Medial meniscus.
What is investigation
done in unhappy triad of knee injuries
?
Gold standard: MRI.
What is management / treatment
done in unhappy triad of knee injuries
?
- Protect
- Rest
- Ice
- Compression
- Elevation
- Rehabilitation
➔ Complete ligament tear: Arthroplasty.
Describe the mechanism of knee injury in medial collateral ligament
.
- Direct blow / twisting injury to lateral side of knee.
- Associated to meniscal tears.
Describe the mechanism of knee injury in lateral collateral ligament
.
- Direct blow / twisting injury to medial side of knee with the foot planted.
Describe the mechanism of knee injury in anterior cruciate ligament
.
- Foot is fixed + rotational force + POP sound.
- Deceleration movement.