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Focused 2 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is Lachman’s test?

A

tests ACL integrity - leg external rotated, knee flexed to 30 degrees; lower leg pulled forward whilst stabilising thigh, finger should be on tibial tuberosity. positive sign - moves forward >2mm compared with other side, soft endpoint

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2
Q

What is McMurray’s test?

A

tests for Meniscal tear - maximally flex hip + knee; then extend -if click/catch, is positive

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3
Q

Which patient group is typically affected by Perthes disease?

A

Boys (M:F 5:1) age 4-8 years

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4
Q

What are the typical X-ray findings in Perthes disease?

A

=avascular necrosis of femoral head - early changes include widening of joint space, later changes include decreased femoral head size/flattening

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5
Q

Which age group is affected by SUFE?

A

10-15 years (males, obese)

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6
Q

What happens in SUFE?

A

Displacement of femoral head epiphysis posterior-inferiorly

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7
Q

What is pauciarticular JIA?

A

Arthritis affecting 4 or fewer joints, usually medium size - knees, ankles, elbows. Joint pain and swelling, limp

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8
Q

What is another name for lateral epicondylitis?

A

tennis elbow

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9
Q

What is lateral epicondylitis / tennis elbow?

A

pain over lateral epicondyle of humerus - worse with wrist extension against resistance when elbow is extended OR supination of forearm with elbow extended

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10
Q

What activities may cause lateral epicondylitis?

A

tennis (tennis elbow); house painting

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11
Q

What is the classic examination finding in lateral epicondylitis (tennis elbow)?

A

pain on resisted wrist extension when elbow is extended

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12
Q

How long do episodes of lateral epicondylitis typically last?

A

6 months - 2 years (acute pain for 6-12 weeks)

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13
Q

What are 4 treatment options for tennis elbow (lateral epicondylitis)?

A
  • avoid excessive loading
  • simple analgesia
  • intraarticular steroids
  • physiotherapy
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14
Q

What is Simmonds triad?

A

For Achilles tendon rupture -
- when patient prone on examination couch with feet over edge, injured foot more dorsiflexed
- feel for gap in Achilles tendon
- when calf gently squeezed there is no plantarflexion

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15
Q

What is the imaging modality of choice for Achilles tendon rupture?

A

Ultrasound

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16
Q

What is the management of Achilles tendon rupture?

A

Urgent referral orthopaedics

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17
Q

What is the clinical presentation of iliotibial band syndrome?

A

Keen runners - knee pain after exercise; sharp pain to palpation over lateral epicondyle of femur (2-3 cm above lateral join margin)

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18
Q

What is the management of SUFE?

A

stop weight bearing, surgical fixation ASAP (in situ internal screw fixation) +- prophylactic for contralateral side

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19
Q

What predisposes patients to SUFE?

A

weakness in proximal femoral growth plate (physis) - allows displacement of capital femoral epiphysis

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20
Q

Which ethnicity is SUFE commoner in?

A

African Caribbean

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21
Q

What proportion of SUFE cases are bilateral?

A

20%

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22
Q

What are 3 risk factors for SUFE?

A
  1. excessive weight or obesity
  2. family history
  3. endocrine disorder - e.g. hypothyroidism, hypopituitarism, hyperparathyroidism, renal osteodystrophy (outside typical age range)
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23
Q

What type of growth plate injury is SUFE?

A

Type I Salter-Harris growth plate injury (due to repeated trauma on BG mechanical / hormonal predisposing factors)

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24
Q

What is a key examination finding in SUFE?

A

obligatory external rotation on hip flexion

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25
Q

What is the key imaging finding on pelvic radiographs in SUFE?

A

Klein lines - drawn along superior cortex of femoral neck - if normal should intesect the epiphysis, if abnormal doesn’t intersect

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26
Q

When is CT used in SUFE?

A

should not be used unless absolutely necessary due to radiation - allows multi-plane reconstruction to assess femoral head with relation to metaphysis

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27
Q

When is MRI used in SUFE?

A

examine contralateral hip (high incidence of bilateral slip)

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28
Q

Why is prophylactic pinning of the unaffected side in SUFE recommended by some?

A

sometimes stabilisation of affected side can precipitate slip on contralateral side

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29
Q

What are 5 complications of SUFE?

A
  1. long term degenerative OA
  2. avascular necrosis of femoral head
  3. chondrolysis or acute cartilage necrosis
  4. deformity + limb length discrepency
  5. femoroacetabular impingement
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30
Q

What is de Quervain’s tenosynovitis?

A

sheath containing extensor pollicis brevis and abductor pollicis longus tendons becomes thickened and inflamed

more common in women 30-50y

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31
Q

What is the classical presentation of de Quervain’s tenosynovitis?

A
  • unaccustomed or excessive activity e.g. rose pruning
  • pain on radial side of wrist
  • swelling + tender along thumb tendons / thickened tendon sheath
  • tender over tip of radial styloid
  • finkelstein’s test positive
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32
Q

What are the treatment options for de Quervain’s tenosynovitis?

A
  • coricosteroid injection if diagnosed early
  • splint at wrist
  • chronic: operation - slitting thickened lateral wall of tendon sheath
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33
Q

What is a Colles’ fracture?

A

dorsally displaced distal radius fracture (mechanism = FOOSH) causes dinner fork deformity

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34
Q

What imaging is needed in Colles fracture?

A

posteroanterior and lateral radiographs (+- oblique radiographs of injured forearm to reveal intra-articular involvement not apparent on other views)

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35
Q

What is the management of a Colles fracture?

A
  1. immobilisation without fracture manipulation if non-displaced
  2. displaced: closed reduction + immobilisation in plaster splint
  3. surgical treatment for unstable fractures
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36
Q

In which patients do supracondylar fractures classially occur?

A

children falling onto outstretched hand - present with painful swollen elbow, hesitant to move it

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37
Q

What is the presentation of a supracondylar fracture?

A
  • painful swollen elbow
  • may appear angulated and upper extremity shortened (open wounds in 30% of patients)
  • neuropraxias common - generally resolve with restoration of normal alignment
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38
Q

How long may it take for neuropraxias to recover after a supracondylar fracture has been restored to normal alignment?

A

up to 18 months

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39
Q

What investigations should be performed to diagnose a supracondylar fracture?

A
  • AP and lateral films
  • if complicated - CT
  • if vascular compromise - arteriograms
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40
Q

What is the management of a supracondylar fracture with arterial disruption present?

A

vascular surgery consultant + immediate ORIF for skeletal stability + support of vascular reconstruction

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41
Q

What is the most frequently gractures caarpal bone?

A

scaphoid (71%)

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42
Q

What is the primary mechanism of injury for scaphoid fracture?

A

FOOSH

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43
Q

What are 5 clinical features of scaphoid fracture?

A
  1. snuff box tenderness
  2. tenderness of palmar and dorsal aspect of scaphoid
  3. pain on compressing thumb longitudinally
  4. pain on gentle flexion + ulnar deviation of wrist
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44
Q

What is done if scaphoid fracture is suspected but is not apparent on xray?

A

cast for 7-10 days, then second set of xrays taken (hairline fracture healing may be apparent)
CT or MRI can provide more information

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45
Q

What is the management of scaphoid fractures?

A

6-12 weeks of casting

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46
Q

What is a common complication of scaphoid fractures?

A

avascular necrosis

if missed scaphoid fracture suspected - urgent ortho assessment in ED

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47
Q

What are 3 investigations indicated in transient synovitis?

A
  1. WBC + inflammatory markers - mildly elevated
  2. Plain films - exclude fractures, tumours and Perthes disease
  3. US - demonstrates fluid in joint capsule (not always present), helps distinguish from septic arthritis

if need to r/o septic arthritis - US guided needle aspiration of fluid

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48
Q

What is the most common cause of acute hip pain in children aged 3-10 years?

A

transient synovitis

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49
Q

What is the management of transient synovitis?

A
  • rest + appropriate analgesia
  • keep leg flexed + some external rotation
  • aspiration of effusion if present

surgical washout not necessary

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50
Q

What is the commonest form of shoulder dislocation?

A

anterior - 95%

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51
Q

What are 3 types of shoulder dislocation in addition to anterior?

A
  1. inferior
  2. superior
  3. intrathoracic
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52
Q

What is the usual mechanism causing anterior shoulder dislocation?

A

traumatic - abduction, extension & posteriorly directed force on the arm; & fall on outstretched hand common in elderly

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53
Q

What happens anatomically in anterior shoulder dislocation?

A

humeral head forced anteriorly out of glenohumeral joint, tearing shoulder capsule & detaching labrum from glenoid

note #humeral head / neck / greater tuberosity can also occur

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54
Q

What is the presentation of anterior shoulder dislocation?

A
  • h/o trauma, inability to move shoulder
  • arm held at side of body in external rotation
  • shoulder loses usual roundness, anterior bulge may be seen
  • humeral head palpable anteriorly
  • abduction and internal rotation resisted
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55
Q

Where should sensation and vascular damage be assessed in anterior shoulder dislocation?

A
  • regimental badge - axillary nerve
  • radial pulse
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56
Q

What investigations should be performed for suspected anterior shoulder dislocation?

A
  • AP XR - humeral head under coracoid process
  • Axillary or transcapular ‘Y’ view
  • in axillary - head of humerus anterior to glenoid
  • Y view: humeral head anterior to Y (glenoid at centre of Y)
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57
Q

What is the management of anterior shoulder dislocation?

A
  • without fracture - closed reduction
  • fracture dislocation - surgery
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58
Q

What is the most common muscle involved in a rotator cuff tear?

A

supraspinatus

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59
Q

What typically leads to rotator cuff tear?

A

chronic rotator cuff disease in patients <40 years old. may follow trauma e.g. fall with hyperabduction or hyperextension of shoulder

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60
Q

What is the presentation of rotator cuff tear?

A
  • reduced range of motion
  • weakness
  • crepitus and tenderness over cuff insertions and subacromial area
  • supraspinatus strength usually reduced (test by resistance to abduction)
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61
Q

What may xray show in rotator cuff tear?

A

bony avulsions

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62
Q

What is the management of a rotator cuff tear?

A

analgesia, broad arm sling, physio at 2 weeks
younger patients with complete tear: may require surgical repair

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63
Q

What is the commonest mechanism of clavicle fracture?

A
  • violent upward and backward force
  • e.g. landing on outstretched hand after being thrown from a horse / over handlebards of a bicycle
  • less common: blows or falls on the point of the shoulder or by direct violence
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64
Q

What are the commonest locations for the clavicle to fracture?

A

middle 1/3: most common at junction of middle third and outer third

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65
Q

What is the management of a clavicle fracture?

A
  • accurate closed reduction
  • sling for 10 days (pain relief)
  • operative reduction if severely displaced outer one-third (untreated caused marked deformity + shoulder weakness)
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66
Q

How long does it usually take a for a clavicle fracture to heal?

A

heal quickly - 6 weeks in adult, return of function in 3 weeks; 3 weeks in child

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67
Q

What are 5 specific causes of Dupuytren’s contracture?

A
  1. manual labour
  2. phenytoin treatment
  3. alcoholic liver disease
  4. diabetes mellitus
  5. trauma to the hand

60-70% have a positive family history

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68
Q

When is surgical treatment considered for dupuytren’s contracture?

A

metacarpophalangeal joints can’t be straightened and thus hand can’t be placed flat on the table

69
Q

What is the next best action if a suspected missed scaphoid fracture is diagnosed?

A

urgent ortho assessment in ED/urgent ortho clinic due to risk of avascular necrosis

70
Q

Why is the scaphoid bone susceptible to avascular necrosis?

A

the tubercule receives part of the flexor retinaculum; the only part of the scaphoid available for entry of blood vessels.

71
Q

How are fractured NOFs divided anatomically?

A
  • intracapsular
  • extracapsular - divided into trochanteric and subtrochanteric
72
Q

What is an eponymous classification system for fractured NOF?

A

Garden system

73
Q

What divides intertrochanteric from subtrochanteric extracapsular fractures?

A

Lesser trochanter is the dividing line

74
Q

What are the 4 types of fractured NOFs based on the Garden system?

A
  1. Stable fracture with impaction in valgus
  2. Complete fracture but undisplaced
  3. Displaced fracture, usually rotated and angulated, but still has bony contact
  4. Complete bony disruption
75
Q

Which type of fractured NOFs is blood supply disruption most common with?

A

Garden type III and IV

76
Q

What is the management of an undisplaced intracapsular hip fracture?

A

Internal fixation; hemiarthroplasty if unfit

77
Q

What is the management of a displaced intracapsular hip fracture?

A

Replacement arthroplasty (THR or hemiarthroplasty)

78
Q

What are 3 factors that favour THR over hemiarthroplasty?

A
  1. able to walk independently outdoors with no more than stick
  2. No CI
  3. Medically fit for anaesthesia
79
Q

What is the management of stable intertrochanteric (extracapsular) fractures?

A

Dynamic hip screw

80
Q

What is the management of reverse oblique, transverse or subtrochanteric extracapsular hip fractures?

A

Intramedullary device

81
Q

What is the gold standard for diagnosis of degenerative cervical myelopathy?

A

MRI (disc degeneration, ligamentous hypertrophy and cord signal change)

82
Q

In the GP setting what is the next step in management if DCM is suspected?

A

Urgent referral for specialist spinal services (orthopaedics or neurosurgery) - early treatment important

83
Q

How soon should treatment of DCM be?

A

Within 6 months of diagnosis

84
Q

What is the only effective treatment for DCM?

A

Decompressive surgery

85
Q

What are the Ottawa rules ot determine if ankle x-ray is required after ankle injury?

A

Any pain in the malleolar zone AND one of the following:
* bony tenderness at lateral malleolar zone (from tip of lateral malleolus to include lower 6cm of posterior border of fibula)
* bony tenderness at medial malleolar zone (top of medial malleolus to lower 6cm of posterior border of tibia)
* inability ot walk 4 weight-bearing steps immediately after injury and in the ED

86
Q

What is the most common joint affected by septic arthritis in adults?

A

knee

87
Q

What is the commonest organism involved in septic arthritis overall?

A

Staphylococcus aureus

Neisseria gonorrhoeae in young adults

88
Q

What investigations are warranted in septic arthritis?

A
  • synovial fluid sampling (prior to abx if possible)
  • blood cultures
  • joint imaging
89
Q

What is the commonest cause of septic arthritis?

A

haematogenous spread

90
Q

Which abx are indicated for septic arthritis and for how long?

A

flucloxacillin (clindamycin if pen allergic) - 4-6 weeks (switch to oral after 2)

91
Q

What are 3 aspects of management of septic arthritis?

A
  1. IVABx
  2. needle aspiration to decompress joint
  3. arthroscopic lavage may be required
92
Q

What is the value of radiographs in diagnosing DCM?

A

No value - MRI required for diagnosis

93
Q

What are the features of posterior vs anterior hip dislocation?

A
  • posterior dislocation: affected leg shortened, adducted, internally rotated
  • anterior dislocation: affected leg abducted and externally rotated. no leg shortening
94
Q

What are 3 types of hip dislocation and which is most common?

A

posterior (90%), anterior, central

95
Q

What is the management of hip dislocation?

A

reduction under GA in <4h to reduce risk of avascular necrosis
long term - physio

96
Q

What are 4 complications of hip dislocation?

A
  1. sciatic or femoral nerve injury
  2. avascular necrosis
  3. OA - in older patients
  4. recurrent dislocation (damage of supporting ligaments)
97
Q

How long does it take the hip to heal after traumatic dislocation?

A

2-3 months

98
Q

What gives the best prognosis following hip dislocation?

A

when hip reduced <12h post injury, and when there is less damage to the joint

99
Q

When do NICE guidelines suggest a presumptive diagnosis of transient synovitis can be made and managed in primary care?

A

if child is 3-9 years, well, afebrile, mobile but limping, symptoms <72h

100
Q

What is the stepwise management for osteoarthritis?

A
  • topical NSAIDs - first line
  • oral NSAIDs - second line (+PPI)
  • non-pharmacological: walking aids for knee + hip OA
  • intra-articular steroid if standard treatment ineffective
  • if conservative methods fail: refer for consideration of joint replacement
101
Q

What drugs are NOT recommended for pain relief in OA?

A
  • paracetamol
  • weak opioids
    (unless used only infrequently in short-term or other options contraindication)
  • glucosamine
  • strong opioids
102
Q

How long is benefit derived from intra-articular steroid injections in OA?

A

2-10 weeks - short-term relief only

103
Q

What is often the first sign on examination in hip OA?

A

reduction in internal rotation

104
Q

What sign may be positive in referred lumbar spine pain to the hip joint, leading to femoral nerve compression?

A

femoral nerve stretch test - patient lies prone, hip joint extended with straight leg, then knee bent - +Ve if pain

105
Q

What causes trochanteric bursitis (greater trochanteric pain syndrome)?

A

repeated movement of the fibroelastic ilitibial band

106
Q

Which patient group is trochanteric bursitis most common in?

A

women 50-70y

107
Q

What causes pubic symphysis dysfunction?

A

common in pregnancy - ligament laxity increases in response to hormonal changes of pregnancy

108
Q

What is the presentation of pubic symphysis dysfunction?

A

pain over pubic symphysis with radiation to the groins and medial aspects of thighs, waddling gait

109
Q

What patient group is transient idiopathic osteoporosis seen in?

A

uncommonly seen in third trimester of pregnancy

110
Q

What is the presentation of transient idiopathic osteoporosis?

A

groin pain associated with limited range of movement of hip, unable to weight bear, raised ESR

111
Q

In which patient group does femoroacetabular impingement present?

A

young, active adults

112
Q

What is the presentation of femoroacetabular impingement?

A
  • hip/groin pain with prolonged sitting
  • snapping, clicking or locking of the hip
  • associated with prior hip pathology e.g. Perthes
113
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve as it passes through the cubital tunnel causing tingling and numbness of 4th and 5th fingers

114
Q

What is the typical presentation of cubital tunnel syndrome?

A
  • tingling and numbness 4th and 5th digits
  • starts intermittent then becomes constant
  • weakness and muscle wasting over time
  • pain worse leaning on affected elbow
  • history of OA or trauma
115
Q

Which 2 things may be in the history of someone with cubital tunnel syndrome?

A
  • OA
  • previous trauma
116
Q

How is a diagnosis of cubital tunnel syndrome made?

A

Clinical diagnosis - NCS in selected cases

117
Q

What are 4 aspects of the management of cubital tunnel syndrome?

A
  • avoid aggravating activity
  • physiotherapy
  • steroid injections
  • surgery in resistant cases
118
Q

What are the 2 classes that osteomyelitis can be grouped into?

A
  1. haematogenous
  2. non-haematogenous
119
Q

What is the most common form of haematogenous osteomyelitis in adults?

A

vertebral osteomyelitis

120
Q

What are 4 risk factors for haematogenous osteomyelitis?

A
  1. sickle cell anaemia
  2. IVDU
  3. immunosuppression due to medication or HIV
  4. infective endocarditis
121
Q

Which type of osteomyelitis is most common in adults?

A

non-haematogenous (haematogenous in children)

122
Q

What organism is the commonest cause in non-sickle cell related osteomyelitis?

A

Staph. aureus

123
Q

What organism is the commonest cause in sickle cell related osteomyelitis?

A

salmonella species

124
Q

What is the imaging modality of choice for osteomyelitis?

A

MRI

125
Q

What is the management of ostemyelitis?

A

flucloxacillin for 6 weeks (clinda if pen allergy)

126
Q

What is the commonest reason for revision operation of total hip replacement?

A

aseptic loosening of the implant

127
Q

What score can be used to work out severity in hip OA?

A

Oxford Hip Score

128
Q

What are 4 perioperative complications of total hip replacement?

A
  1. venous thromboembolism
  2. intraoperative fracture
  3. nerve injury
  4. surgical site infection
129
Q

What are 4 complications of total hip replacement?

A
  1. leg length discrepency
  2. posterior dislocation
  3. aseptic loosening
  4. prosthetic joint infection
130
Q

What are the features of prosthetic hip (THR) posterior dislocation?

A
  • may occur during extremes of hip flexion
  • typically presents acutely with ‘clunk’, pain and inability ot weight bear
  • internal rotation + shortening of affected leg
131
Q

What can exacerbate the symptoms of cubital tunnel syndrome?

A

leaning on the affected elbow

132
Q

What are 5 types of paediatric fractures?

A
  1. complete fracture - both sides of cortex breached
  2. Toddlers fracture - oblique tibial fracture in infants
  3. plastic deformity - stress on bone resulting in deformity without cortical disruption
  4. Greenstick fracture - unilateral cortical breach only
  5. Buckle (torus) fracture - incompete cortical disruption resulting in periosteal haematoma only
133
Q

What classification system is used for paediatric growth plate fractures?

A

Salter-Harris system

134
Q

What are the 5 grades of the Salter-Harris grading system?

A
  1. fracture through physis only (xray may be normal)
  2. fracture through physis and metaphysis
  3. fracture through physis and epiphysis to include joint
  4. fracture involving physis, metaphysis and epiphysis
  5. crush injury involving physis (xray may resemble type 1 / appear normal)
135
Q

Which types of Salter-Harris growth plate fractures usually require surgery?

A

III, IV, V

136
Q

Which type of Salter-Harris growth plate injury is often associated with disruption to growth?

A

type V

137
Q

What are 2 genetic conditions that may predispose to pathological fractures in children?

A
  1. osteogenesis imperfecta
  2. osteopetrosis
138
Q

What is osteogenesis imperfecta?

A
  • Defective osteoid formation due to congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine
  • Failure of maturation of collagen in all the connective tissues.
139
Q

What are the 4 subtypes of osteogenesis imperfecta?

A
  • Type I - The collagen is normal quality but insufficient quantity.
  • Type II - Poor collagen quantity and quality.
  • Type III - Collagen poorly formed. Normal quantity.
  • Type IV - Sufficient collagen quantity but poor quality
140
Q

What is the inheritance pattern of osteopetrosis?

A

autosomal recessive

141
Q

What is osteopetrosis?

A

common in young adults - bones become harder and more dense

142
Q

What is seen on x-rays in osteogenesis imperfecta?

A
  • translucent bones
  • multiple fractures, particularly of the long bones
  • wormian bones (irregular patches of ossification)
  • trefoil pelvis
143
Q

What does radiology show in osteopetrosis?

A

lack of differentiation between the cortex and the medulla described as marble bone

144
Q

What is thought to be the effect of obesity on joint replacement?

A

only slight increase in short-term complications, no difference in long-term joint replacement survival

145
Q

What is the commonest surgical procedure for hip OA?

A

cemented hip replacement - metal femoral component cemented into femoral shaft, accompanied by cemented acetabular polyethylene cup

146
Q

What are 2 alternative procedures for hip OA to cemented hip replacement?

A
  1. uncemented replacements - expensive, popular in young acite patients
  2. hip resurfacing - metal cap over femoral head, younger patients, preserves femoral neck
147
Q

What are 3 key aspects of the post-operative recovery following hip replacement?

A
  1. physiotherapy
  2. home-exercises
  3. walking sticks or crutches used up to 6 weeks after hip / knee replacement surgery
148
Q

What are 4 key pieces of advice to give to patients who have had a hip replacement to avoid dislocation?

A
  1. avoid flexing hip >90 degrees
  2. avoid low chairs
  3. do not cross legs
  4. sleep on back for first 6 weeks
149
Q

What is done to reduce the risk of VTE after hip replacement?

A

LMWH for 4 weeks

150
Q

Is Perthe’s disease painful? What are the clinical features?

A

no - usually painless limp and restricted range of movement

151
Q

What patients are classically affected by adhesive capsulitis?

A

middle-aged females, associated with diabetes mellitus

152
Q

What features are characteristic of adhesive capsulitis on examination?

A
  • limited external rotation - affected more than internal rotation or abduction
  • active and passive movement affected
153
Q

What are the 3 typical phases of adhesive capsulitis?

A
  1. freezing phase - painful
  2. adhesive phase
  3. recovery phase
154
Q

How long does an episode of adhesive capsulitis typically last for?

A

6 months - 2 years

155
Q

What are 3 options for the management of adhesive capsulitis?

A
  1. NSAIDs
  2. physiotherapy
  3. oral corticosteroids / intra articular steroids
156
Q

What is patellofemoral pain syndrome?

A

aka chondromalacia patellae - softening of cartilage of patella

157
Q

What is the classic presentation fo patellofeoramol pain syndrome?

A

teenage girls - anterior knee pain on walking up and down stairs, rising from prolonged sitting

158
Q

What is the management of patellofemoral pain syndrome?

A

physiotherapy

159
Q

What are 4 diseases on the spectrum of rotator cuff injury?

A
  1. subacromial impingement
  2. calcific tendonitis
  3. rotator cuff tears
  4. rotator cuff arthropathy
160
Q

What are the classic examination findings in subacromial impingement?

A

painful arc 60 -120 degrees

161
Q

Where is the painful arc in rotator cuff tears?

A

first 60 degrees

162
Q

What is Osgood-Schlatter disease?

A

small avulsion fractures within tibial tuberosity are caused by traction of the patellar tendon on the immature tibial tuberosity during forceful contractions of the quadriceps muscle

163
Q

Which patients get Osgood-Schlatter disease?

A

children who do sports -overuse syndrome associated with physical exertion before skeletal maturity - strength of quadripceps may exceed ability of tibial tuberosity to resist that force

164
Q

How may Osgood-Schlatter disease present?

A

tibial tubercle may enlarge - pain and swelling below knee relieved by reset, worst on activity

165
Q

What is the management of Osgood-Schlatter disease?

A

conservative - rest from painful activities

166
Q

What is a Maisonneuve fracture?

A

spiral fracture of upper third of fibula + tear of distal tibiofibular syndesmosis and the interosseous membrane, with associated fracture of medial malleolus, or rupture of deep deltoid ligament

167
Q

Who is affected by stress fracture of the metatarsals (March fracture)?

A

individuals who undertake repetitie walking or running e.g. army recruits, runners

168
Q

What is the presentation of a stress fracture of the metatarsals?

A

usually 2nd metatarsal shaft - tender lump on dorsum of foot, palpable just medial to mid-sharf of a metatarsal bone

169
Q

What is the management of metatarsal stress fracture / march fracture?

A

analgesia, elevation, rest, modified daily activity

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