Orthopaedics Flashcards
1
Q
Adhesive capsulitis associations?
A
- DM = 20% may have an episode
- Middle aged females
2
Q
Adhesive capsulitis features?
A
- External rotation largely affected
- Both active and passive movement affected
- Typically have a painful freezing phase, an adhesive phase, and a recovery phase
- Bilateral in 20%
- Episode lasts b/w 6m and 2y
3
Q
Adhesive capsulitis Rx?
A
NSAIDs, physiotherapy, oral corticosteroids, intra-articular corticosteroids
4
Q
Prolapsed lumbar disc mushkies?
A
- Produces clear dermatomal leg pain associated with neurological deficits
- Leg pain usually worse than back
- Pain often worse when sitting
5
Q
L3 nerve root compression?
A
- Sensory loss over anterior thigh
- Weak quadriceps
- Reduced knee reflex
- Positive femoral nerve stretch test
6
Q
L4 nerve root compression?
A
- Sensory loss anterior aspect of knee
- Weak quadriceps
- Reduced knee reflex
- Positive femoral stretch test
7
Q
L5 nerve root compression?
A
- Sensory loss dorsum of foot
- Weakness in foot and big toe dorsiflexion
- Reflexes intact
- Positive sciatic nerve stretch test
8
Q
S1 nerve root compression?
A
- Sensory loss posterolateral aspect of leg and lateral aspect of foot
- Weakness in foot plantar flexion
- Reduced ankle reflex
- Positive sciatic nerve stretch test
9
Q
Prolapsed disc Rx?
A
- Analgesia, physiotherapy, exercises
- If symptoms persist e.g. 4-6 weeks then referral for consideration of MRI
10
Q
Lower back pain red flags?
A
- Age < 20 y/o or > 50 y/o
- Hx of previous malignancy
- Night pain
- Hx of trauma
- Systemically unwell
11
Q
Facet joint lower back pain mushkies?
A
- May be acute or chronic
- Pain worse in morning and on standing
- Pain over facets, pain is worse on extension of the back
12
Q
Spinal stenosis mushkies?
A
- Usually gradual onset
- Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling
- Relieved by sitting down, leaning forwards and crouching down
- Examination often normal, requires MRI to confirm diagnosis
13
Q
Specific causes of lower back pain?
A
- Facet joint
- Spinal stenosis
- Ankylosing spondylitis
- Peripheral arterial disease
14
Q
What % of sciatica settles within 3m with conservative management?
A
90%
15
Q
Lateral epicondylitis features?
A
- Pain and tenderness on lateral epicondyle
- Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
- Episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks
16
Q
Medial epicondylitis features?
A
- Pain and tenderness on medial epicondyle
- Pain aggravated by wrist flexion and pronation
- Symptoms may be accompanied by numbness/tingling in the 4th and 5th finger due to ulnar nerve involvement
17
Q
Radial tunnel syndrome?
A
- Most commonly due to compression of the posterior interosseous branch of the radial nerve. It is thought to be a result of overuse
- Symptoms similar to lateral epicondylitis but pain 4-5cm distal to lateral epicondyle, symptoms may be worsened by extending the elbow and pronating the forearm
18
Q
Cubital tunnel syndrome?
A
- Due to compression of the ulnar nerve
- Initially intermittent tingling in the 4th and 5th finger
- May be worse when the elbow is resting on a firm surface or flexed for extended periods
- Later numbness in the 4th and 5th finger with associated weakness
19
Q
Olecranon bursitis mushkies?
A
- Swelling over the posterior aspect of the elbow
- There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.
20
Q
Trigger finger definition?
A
Common condition associated with abnormal flexion of the digits. It is thought to be caused by a disparity between the size of the tendon and pulleys through which they pass. In simple terms the tendon becomes ‘stuck’ and cannot pass smoothly through the pulley.
21
Q
Trigger finger associations?
A
- Women
- RhA
- DM
22
Q
Trigger finger features?
A
- More common in thumb, middle, ring finger
- Initially stiffness and snapping ‘trigger’ when extending a flexed digit
- A nodule may be felt at the base of the affected finger
23
Q
Trigger finger Rx?
A
- Steroid injection is successful in the majority of patients. A finger splint may be applied afterwards
- Surgery for those not responded to steroid injections
24
Q
Who should be assessed for risk of fragility fractures?
A
- Women > 65
- Men > 75
- Younger with risk factors
25
2 tools to assess patients 10 year risk of developing a fracture?
FRAX or QFracture
26
FRAX mushkies?
1. Estimates 10 year risk of fragility fracture
2. 40-90 y/o
3. International data
4. Factors = age, sex, weight, height, previous fracture, parental fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol intake
5. Bone mineral density (BMD) is optional, but clearly improves the accuracy of the results. NICE recommend arranging a DEXA scan if FRAX (without BMD) shows an intermediate result
27
QFracture mushkies?
1. Estimates 10 year risk of fragility fracture
2. 30-99 y/o
3. Includes larger group of RFs = Cardiovascular disease, history of falls, chronic liver disease, rheumatoid arthritis, type 2 diabetes and tricyclic antidepressants
28
When do you do DEXA rather than using prediction tool?
1. Before starting treatment that may have rapid adverse effect
2. <40 y/o who have a major risk factor
29
FRAX without BMD interpretation?
1. Low risk = reassure and lifestyle advice
2. Intermediate risk = BMD test
3. High risk = Bone protection
30
FRAX with BMD interpretation?
1. Reassure
2. Consider treatment
3. Strongly recommend treatment
31
When to repeat FRAX/QFracture?
1. If the original calculated risk was in the region of the intervention threshold for a proposed treatment and only after a minimum of 2 years
2. When there has been a change in the person's risk factors
32
Most common cause of posterior heel pain?
Achilles tendon disorders
33
Risk factors for achilles tendon disorders?
1. Quinolone use e.g. ciprofloxacin
2. Hypercholesterolaemia (predisposes to tendon xanthomata)
34
Achilles tendinitis features?
1. Gradual onset of posterior heel pain worse with activity
2. Morning pain and stiffness common
35
Achilles tendinopathy Rx?
1. Simple analgesia
2. Reduction in precipitating activities
3. Calf muscle eccentric exercises (self-directed/physio guided)
36
Achilles tendon rupture clinical examination?
Simmond's triad
1. Altered angle of declination
2. Palpable gap in tendon
3. Calf squeeze
37
Achilles tendon rupture Ix?
US
38
Achilles tendon rupture Rx?
Refer to orthopaedics
39
Discitis definition?
Infection in the intervertebral space
40
Discitis features?
1. Back pain
2. Pyrexia, rigors, sepsis
3. Neuro = changing lower limb neurology if epidural abscess develops
41
Discitis features?
1. Back pain
2. Pyrexia, rigors, sepsis
3. Neuro = changing lower limb neurology if epidural abscess develops
42
Discitis causes?
1. Bacterial = S. aureus most common
2. Viral
3. TB
4. Aseptic
43
Discitis Dx?
1. MRI has highest sensitivity
2. CT guided biopsy may be required to guide antimicrobial Rx
44
Discitis Rx?
1. 6-8wks IV Abx
45
Discitis complications?
1. Sepsis
2. Epidural abscess
46
Discitis further Ix?
1. TTE/TOE for endocarditis
47
Positive scarf test?
Acromioclavicular degeneration
48
Positive scarf test?
Acromioclavicular degeneration
49
Chondromalacia patellae AKA?
Patellofemoral pain syndrome
50
Patellofemoral pain syndrome mushkies?
1. Softening of the cartilage of the patella
2. Common in teenage girls
3. Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
4. Usually responds to physiotherapy
51
Infrapatellar bursitis?
Clergyman's knee, associating with kneeling
52
Prepatellar bursitis?
Housemaid's knee, associated with more upright kneeling
53
ACL injury mushkies?
1. Twisting of knee - popping noise may be noted
2. Rapid onset of knee effusion
3. Positive draw test
54
PCL injury mushkies?
1. May be caused by anterior force applied to the proximal tibia (e.g. knee hitting dashboard during car accident)
55
Collateral ligament injury?
1. Tenderness over the affected ligament
2. Knee effusion may be seen
56
Meniscal lesion?
1. May be caused by twisting of knee
2. Locking and giving-way are common features
3. Tender joint lines
57
FOOSH anatomical snuffbox pain?
Scaphoid fracture
58
Morning stiffness > 2 hours?
May be inflammatory arthritis
59
Hip OA RFs?
1. Increasing age
2. Female
3. Obesity
4. DDH
60
Hip OA mushkies?
1. Chronic groin ache following exercise and relieved by rest
2. Oxford Hip score to assess severity
3. Red flags suggesting alternative cause = rest pain, night pain, morning stiffness
61
Hip OA Ix?
1. If features typical, clinical Dx is ok
2. Otherwise, plain XRs
62
Hip OA Rx?
1. Oral analgesia
2. Intra-articular injections: short term benefit
3. THR definitive Rx
63
THR complications?
1. Perioperative = VTE, fracture, nerve injury, infection
2. Leg length discrepancy
3. Posterior dislocation = during extremes of hip flexion, presents with clunk + pain + inability to weight bear, internal rotation and shortening of leg
4. Aseptic loosening (most common reason for revision)
5. Prosthetic joint infection
64
Myxoid/mucoid cyst?
Benign ganglion cysts usually found on the distal, dorsal aspect of the finger. There is usually osteoarthritis in the surrounding joint. They are more common in middle-aged women.
65
Ottawa ankle rules?
Ankle XR required only if there is pain in the malleolar zone and any 1 of the following:
1. Bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibula)
2. Bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
3. Inability to walk four weight bearing steps immediately after the injury and in the emergency department
66
Cubital tunnel syndrome features?
Cubital tunnel syndrome occurs due to compression of the ulnar nerve as it passes through the cubital tunnel.
1. Tingling and numbness of 4th and 5th finger which starts off intermittent then becomes constant
2. Over time pts may also develop weakness and muscle wasting
3. Pain worse on leaning on affected elbow
4. Often a Hx of osteoarthritis or prior trauma to the area
67
Cubital tunnel syndrome Ix?
Dx usually clinical, however in selected cases nerve conduction studies may be used
68
Cubital tunnel syndrome Rx?
1. Avoid aggravating activity
2. Physiotherapy
3. Steroid injections
4. Surgery in resistant cases
69
Osteomyelitis classification?
1. Haematogenous
2. Non-haematogenous
70
Haematogenous osteomyelitis mushkies?
1. Results from bacteraemia, usually monomicrobial
2. Most common form in children
3. Vertebral osteomyelitis is the most common form in adults
4. RFs = SCA, IVDU, IE, immunosuppression
71
Non-haematogenous osteomyelitis mushkies?
1. Contiguous spread/direct injury
2. Often polymicrobial
3. Most common form in adults
4. RFs = diabetic foot ulcers/pressure sores, DM, PAD
72
Osteomyelitis most common cause in SCA?
Salmonella
73
Osteomyelitis Ix?
MRI, sensitivity 90-100%
74
Osteomyelitis Rx?
1. 6w Flucloxacillin
2. Clindamycin if penicillin-allergic
75
Carpal tunnel syndrome definition?
Compression of median nerve in the carpal tunnel
76
Carpal tunnel syndrome Hx?
1. Pain/pins and needles in thumb, index and middle finger
2. Unusually the symptoms may ascend proximally
3. Shakes hand to obtain relief, classically at night
77
Carpal tunnel syndrome Ex?
1. Weakness of thumb abduction (APB)
2. Wasting of thenar eminence
3. Tinel's sign = tapping causing paraesthesia
4. Phalen's sign = flexion of wrist causes symptoms
78
Carpal tunnel syndrome causes?
1. Idiopathic
2. Pregnancy
3. Oedema e.g. HF
4. Lunate fracture
5. RhA
79
Carpal tunnel syndrome electrophysiology?
Motor + Sensory prolongation of action potential
80
Carpal tunnel syndrome Rx?
1. 6w conservative if mild-moderate --> corticosteroid injection, wrist splints at night
2. Severe/persistent symptoms --> surgical division (flexor retinaculum division)
81
Rotator cuff injury spectrum?
1. Subacromial impingement (aka impingement syndrome, painful arc syndrome)
2. Calcific tendonitis
3. Rotator cuff tears
4. Rotator cuff arthropathy
82
Rotator cuff injury symptoms?
Shoulder pain worse on abduction
83
Rotator cuff injury sign?
1. Painful arc of abduction = With subacromial impingement, this is typically between 60 and 120 degrees. With rotator cuff tears the pain may be in the first 60 degrees.
2. Tenderness over anterior acromion
84
Types of hip dislocation?
1. Posterior = 90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated
2. Anterior = Affected leg is usually abducted and externally rotated. No leg shortening.
3. Central dislocation
85
Management of hip dislocation?
1. ABCDE
2. Analgesia
3. Reduction under GA within 4h to reduce risk fo avascular necrosis
3. Long-term = physio to strengthen the surrounding muscles
86
Hip dislocation complications?
1. Sciatic or femoral nerve injury
2. Avascular necrosis
3. OA = more common in older pts
4. Recurrent dislocation = due to damage of supporting ligaments
87
Hip dislocation prognosis?
1. 2-3 months for hip to heal after traumatic dislocation
2. Prognosis best when hip is reduced less than 12 hours post-injury and when there is less damage to the joint
88
Musculocutaneous nerve roots?
C5-C7
89
Musculocutaneous nerve mushkies?
1. Motor = elbow flexion and supination
2. Sensory = Lateral part of forearm
90
Axillary nerve roots?
C5-C6
91
Axillary nerve mushkies?
1. Motor = Shoulder abduction (deltoid muscle)
2. Sensory = inferior region of deltoid muscle
3. Injury = humeral neck fracture/dislocation, results in flattened deltoid
92
Radial nerve roots?
C5-C8
93
Radial nerve mushkies?
1. Motor = extension
2. Sensory = small area between the dorsal aspect of the 1st and 2nd metacarpals
3. Injury = humeral midshaft fracture, palsy results in wrist drop
94
Median nerve roots?
C6, C8, T1
95
Median nerve mushkies?
1. Motor = LOAF muscles
2. Sensory = Palmar aspect of the lateral 3.5 fingers
3. Wrist lesion = carpal tunnel syndrome
96
Ulnar nerve roots?
C8, T1
97
Ulnar nerve mushkies?
1. Motor = intrinsic hand muscles except LOAF, wrist flexion
2. Medial 1.5 fingers
3. Injury = medial epicondyle fracture, damage may result in claw hand
98
Long thoracic neve roots?
C5-C7
99
Long thoracic nerve mushkies?
1. Motor = serratus anterior
2. Injury = blow to the ribs/complication of mastectomy --> winged scapula
100
LOAF muscles?
1. Lateral 2 lumbricals
2. Opponens pollicis
3. Abductor pollicis brevis
4. Flexor pollicis brevis
101
Erb-Duchenne palsy?
AKA Waiter's tip
1. Due to damage of the upper trunk of the brachial plexus = C5,C6
2. May be secondary to shoulder dystocia during birth
3. Arm hangs by the side and is internally rotated, elbow extended
102
Klumpke injury?
1. Due to damage of the lower trunk of the brachial plexus = C8,T1
2. May be secondary to shoulder dystocia during birth or sudden upward jerk of the hand
3. Associated with Horner's syndrome
103
Olecranon bursitis definition?
Inflammation of the olecranon bursa, the fluid-filled sac overlying the olecranon process at the proximal end of the ulna. This bursa exists to reduce friction between the posterior aspect of the elbow joint and the overlying soft tissues.
104
Olecranon bursitis epidemiology?
1. Men
2. 30-60 y/o
105
Olecranon bursitis AKA?
Student's elbow
106
Olecranon bursitis causes?
1. Repetitive trauma = writers, students, plumbers, miners
2. Trauma
3. Infection
4. Gout
5. RhA
6. Idiopathic
107
Septic olecranon bursitis mushkies?
Due to infection, 50% occur in immunosuppressed (alcohol, DM, steroids, CKD, malignancy). 90% due to S. aureus.
108
Olecranon bursitis signs?
1. Swelling over the posterior aspect of the elbow, usually fluctuant and well-circumscribed, appearing over hours to days
2. Tenderness, redness, warmth
3. Fever
4. Skin abrasion overlying the bursa
5. Effusions in other joints if associated with RhA
6. Tophi if associated with gout
109
Olecranon bursitis Ix?
If septic bursitis considered then aspiration of bursal fluid for MC&S is essential
110
Housemaid's knee?
Prepatellar bursitis
111
De Quervain's tenosynovitis definition?
Common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.
112
De Quervain's tenosynovitis features?
1. Pain on radial side of wrist
2. Tenderness over radial styloid process
3. Abduction of the thumb against resistance is painful
4. Finkelstein's test =examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
113
De Quervain's tenosynovitis Rx?
1. Analgesia
2. Steroid injection
3. Thumb splint immobilisation may be effective
4. Surgical Rx sometimes required
114
Tapes equinovarus definition?
Talipes equinovarus, or club foot, describes an inverted (inward turning) and plantar flexed foot.
115
Tapes equinovarus epidemiology?
1. 2M:1F
2. 1/1000
3. 50% bilateral
116
Tapes equinovarus associations?
1. Spina bifida
2. Cerebral palsy
3. Edward's syndrome (Trisomy 18)
4. Oligohydramnios
5. Arthrogryposis
117
Tapes equinovarus Dx?
Clinically (deformity not passively correctable) and imaging is not normally needed
118
Tapes equinovarus Rx?
1. Ponseti method = manipulation and progressive casting which starts soon after birth. The deformity is usually corrected after 6-10 weeks. An Achilles tenotomy is required in around 85% of cases but this can usually be done under local anaesthetic
2. Night-time braces should be applied until the child is aged 4 years. The relapse rate is 15%
119
Lumbar spinal stenosis definition?
A condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.
120
Lumbar spinal stenosis presentation?
1. Back pain, neuropathic pain, symptoms mimicking claudication
2. Sitting better than standing, easier to walk uphill
121
Lumbar spinal stenosis most common cause?
Degenerative disease
122
Lumbar spinal stenosis Dx?
MRI
123
Lumbar spinal stenosis Rx?
Laminectomy
124
Colles' fracture?
1. FOOSH
2. Dinner fork type deformity
3. Classical Colles' have these 3 features:
a. Transverse fracture of the radius
b. 1 inch proximal to the radio-carpal joint
c. Dorsal displacement and angulation
125
Smith's fracture?
1. AKA Reverse Colles' fracture
2. Volar angulation of distal radius fragment (Garden spade deformity)
3. Falling backwards onto the palm of an outstretched hand or falling with wrists flexed
126
Bennett's fracture?
1. Intra-articular fracture at the base of the thumb metacarpal
2. Impact on flexed metacarpal, caused by fist fights
3. X-ray = triangular fragment at base of metacarpal
127
Monteggia's fracture?
1. Dislocation of the proximal radioulnar joint in association with an ulna fracture
2. FOOSH with forced pronation
3. Needs prompt diagnosis to avoid disability
128
Galeazzi fracture?
1. Radial shaft fracture with associated dislocation of the distal radioulnar joint
2. FOOSH with rotational force superimposed on it
3. Bruising, swelling and tenderness over lower end of the forearm
4. XR = displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint
129
Barton's fracture?
1. Distal radius (Colles/Smith) fracture with associated radiocarpal dislocation
2. Fall onto extended and pronated wrist
130
Scaphoid fracture mushkies?
1. Most common carpal fracture
2. Forms floor of anatomical snuffbox
3. Fall onto outstretched hand (tubercle, waist, or proximal 1/3)
4. Swelling and tenderness in the anatomical snuffbox, pain on wrist movements and/or longitudinal compression of the thumb
5. Ulnar deviation AP needed for visualization of scaphoid
6. Immobilization of scaphoid fractures difficult
131
Radial head fracture mushkies?
1. Young adults, FOOSH
2. On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination)
132
Dupuytren's contracture definition?
Thickening of the palmar fascia
133
Dupuytren's contracture epidemiology?
1. 5% prevalence
2. Older males
3. 60-70% FHx
134
Dupuytren's specific causes?
1. Manual labour
2. Phenytoin
3. ALD
4. DM
5. Trauma to hand
135
Dupuytren's contracture features?
Ring finger and little fingers most affected
136
Dupuytren's contracture Rx?
Consider surgical treatment of Dupuytren's contracture when the metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table
137
Osgood-Schlatter AKA?
Tibial apophysitis
138
Iliotibial band syndrome presentation?
1. Lateral knee pain in runner, 1/10 who run regularly
2. Tenderness 2-3 cm above the lateral joint line
139
Iliotibial band syndrome Rx?
1. Activity modification and iliotibial band stretches
2. If not improving then physiotherapy referral
140
Commonest cause of hip pain in children?
Transient synovitis
141
Perthes disease definition?
A degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head
142
Perthes disease more common in?
Boys
143
Perthes disease features?
1. Hip pain = develops progressively over a few weeks
2. Limp
3. Stiffness and reduced range of hip movement
4. Xray = early changes include widening of joint space, later changes include decreased femoral head size/flattening
144
SUFE mushkies?
1. 10-15 y/o, obese children and boys
2. Displacement of femoral head epiphysis postero-inferiorly
3. Bilateral slip in 20%
4. May present acutely following trauma or more commonly with chronic, persistent symptoms
5. Knee or distal thigh pain is common, loss of internal rotation of the leg in flexion
145
JIA mushkies?
1. < 16 y/o, >3 months
2. Pauciarticular JIA = 4 or less joints are affected, accounts for 60% cases
3. Pauciarticular features = joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows, lump, ANA may be positive (associated with anterior uveitis)
146
Boxer's fracture?
Minimally displaced fracture of the 5th metacarpal, usually after punching a hard surface e.g. a wall
147
Hip fracture classification?
1. Location
2. Garden System
148
Hip fracture location classification?
1. Intracapsular (subcapital) = from the edge of the femoral head to the insertion of the capsule of the hip joint
2. Extracapsular = these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)
149
Garden system classification?
1. Type I = Stable with impaction in valgus
2. Type II = Complete fracture but undisplaced
3. Type III = Displaced fracture, usually rotated and angulated, but still has bony contact
4. Type IV = Complete bony disruption
150
Blood supply disruption common in which Garden types?
III and IV
151
Intracapsular hip fracture management?
1. Undisplaced fracture = internal fixation, or hemiarthroplasty if unfit
2. Displaced fracture = THR or hemiarthroplasty
152
When is THR preferred to hemiarthroplasty?
1. Were able to walk independently out of doors with no more than the use of a stick and
2. Are not cognitively impaired and
3. Are medically fit for anaesthesia and the procedure
153
Extracapsular hip fracture Rx?
1. Stable intertrochanteric = DHS
2. If reverse oblique, transverse or subtrochanteric = IM device
154
Clergyman's knee?
Infrapateller bursitis
155
Meralgia paraesthetica nerve?
Lateral femoral cutaneous nerve
156
Meralgia paraesthetica epidemiology?
1. 30 - 40 y/o
2. Sometimes both legs
3. Men > Women
4. More commonly in diabetes
157
Meralgia paraesthetica RFs?
1. Obesity, pregnancy, ascites
2. Trauma, iatrogenic, sports, idiopathic
158
Meralgia paraesthetica symptoms?
1. Burning, tingling, coldness or shooting pain
2. Numbness, deep muscle ache
3. Symptoms usually aggravated by standing, relieved by sitting
4. Can be mild and resolve spontaneously or may severely restrict the patient for many years
159
Meralgia paraesthetica signs?
1. Symptoms reproduced by palpation just below ASIS and by extension of the hip
2. Altered sensation over upper lateral aspect of the thigh
3. No motor weakness
160
Meralgia paraesthetica Ix?
1. Often Dx on pelvic compression test alone
2. Injection of nerve with LA will abolish pain (US helpful)
3. Nerve conduction studies may be useful
161
Post hip replacement advice?
1. Avoid flexing hip > 90 degrees
2. Avoid low chairs
3. Do not cross your legs
4. Sleep on back for first 6 weeks
162
Compartment syndrome main fracture causes?
Supracondylar fractures and tibial shaft injuries
163
Compartment syndrome features?
1. Pain especially on omvement (even passive) --> excessive use of breakthrough analgesia should raise suspicion for compartment syndrome
2. Paraesthesia
3. Pallor
4. Paralysis of muscle group
5. Pulsation of artery may still be felt as the necrosis occurs due to microvascular compromise
164
Does presence of a pulse rule out compartment syndrome?
No
165
Compartment syndrome Dx?
1. Intracompartmental pressure measurement = >20mmHg abnormal, >40mmHg diagnostic
2. Wont show any pathology on XR
166
Compartment syndrome Rx?
1. Prompt and extensive fasciotomies
2. Myoglobinuria may occur and result in renal failure --> aggressive IV fluids
3. If muscle groups frankly necrotic at fasciotomy, they should be debrided and amputation considered
4. Death of muscle groups may occur within 4-6 hours
167
McMurrays test is for?
Meniscal tear
168
Sprained ankle and tenderness over anterior aspect of the fibula?
ATFL sprain
169
Most common reason THR needs to be revised?
Aseptic loosening
170
Meralgia paraesthetica Ix?
1. Often Dx on pelvic compression test alone
2. Injection of nerve with LA will abolish pain (US helpful)
3. Nerve conduction studies may be useful
171
Meralgia paraesthetica Ix?
1. Often Dx on pelvic compression test alone
2. Injection of nerve with LA will abolish pain (US helpful)
3. Nerve conduction studies may be useful
172
JIA mushkies?
1. < 16 y/o, >3 months
2. Pauciarticular JIA = 4 or less joints are affected, accounts for 60% cases
3. Pauciarticular features = joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows, lump, ANA may be positive (associated with anterior uveitis)
173
Infrapatellar bursitis?
Clergyman's knee, associating with kneeling
174
Discitis features?
1. Back pain
2. Pyrexia, rigors, sepsis
3. Neuro = changing lower limb neurology if epidural abscess develops
