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MSRA - passmed textbook > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Adhesive capsulitis associations?

A
  1. DM = 20% may have an episode
  2. Middle aged females
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2
Q

Adhesive capsulitis features?

A
  1. External rotation largely affected
  2. Both active and passive movement affected
  3. Typically have a painful freezing phase, an adhesive phase, and a recovery phase
  4. Bilateral in 20%
  5. Episode lasts b/w 6m and 2y
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3
Q

Adhesive capsulitis Rx?

A

NSAIDs, physiotherapy, oral corticosteroids, intra-articular corticosteroids

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4
Q

Prolapsed lumbar disc mushkies?

A
  1. Produces clear dermatomal leg pain associated with neurological deficits
  2. Leg pain usually worse than back
  3. Pain often worse when sitting
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5
Q

L3 nerve root compression?

A
  1. Sensory loss over anterior thigh
  2. Weak quadriceps
  3. Reduced knee reflex
  4. Positive femoral nerve stretch test
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6
Q

L4 nerve root compression?

A
  1. Sensory loss anterior aspect of knee
  2. Weak quadriceps
  3. Reduced knee reflex
  4. Positive femoral stretch test
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7
Q

L5 nerve root compression?

A
  1. Sensory loss dorsum of foot
  2. Weakness in foot and big toe dorsiflexion
  3. Reflexes intact
  4. Positive sciatic nerve stretch test
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8
Q

S1 nerve root compression?

A
  1. Sensory loss posterolateral aspect of leg and lateral aspect of foot
  2. Weakness in foot plantar flexion
  3. Reduced ankle reflex
  4. Positive sciatic nerve stretch test
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9
Q

Prolapsed disc Rx?

A
  1. Analgesia, physiotherapy, exercises
  2. If symptoms persist e.g. 4-6 weeks then referral for consideration of MRI
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10
Q

Lower back pain red flags?

A
  1. Age < 20 y/o or > 50 y/o
  2. Hx of previous malignancy
  3. Night pain
  4. Hx of trauma
  5. Systemically unwell
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11
Q

Facet joint lower back pain mushkies?

A
  1. May be acute or chronic
  2. Pain worse in morning and on standing
  3. Pain over facets, pain is worse on extension of the back
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12
Q

Spinal stenosis mushkies?

A
  1. Usually gradual onset
  2. 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
  3. Relieved by sitting down, leaning forwards and crouching down
  4. Examination often normal, requires MRI to confirm diagnosis
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13
Q

Specific causes of lower back pain?

A
  1. Facet joint
  2. Spinal stenosis
  3. Ankylosing spondylitis
  4. Peripheral arterial disease
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14
Q

What % of sciatica settles within 3m with conservative management?

A

90%

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15
Q

Lateral epicondylitis features?

A
  1. Pain and tenderness on lateral epicondyle
  2. Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
  3. Episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks
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16
Q

Medial epicondylitis features?

A
  1. Pain and tenderness on medial epicondyle
  2. Pain aggravated by wrist flexion and pronation
  3. Symptoms may be accompanied by numbness/tingling in the 4th and 5th finger due to ulnar nerve involvement
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17
Q

Radial tunnel syndrome?

A
  1. Most commonly due to compression of the posterior interosseous branch of the radial nerve. It is thought to be a result of overuse
  2. 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
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18
Q

Cubital tunnel syndrome?

A
  1. Due to compression of the ulnar nerve
  2. Initially intermittent tingling in the 4th and 5th finger
  3. May be worse when the elbow is resting on a firm surface or flexed for extended periods
  4. Later numbness in the 4th and 5th finger with associated weakness
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19
Q

Olecranon bursitis mushkies?

A
  1. Swelling over the posterior aspect of the elbow
  2. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.
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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.

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21
Q

Trigger finger associations?

A
  1. Women
  2. RhA
  3. DM
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22
Q

Trigger finger features?

A
  1. More common in thumb, middle, ring finger
  2. Initially stiffness and snapping ‘trigger’ when extending a flexed digit
  3. A nodule may be felt at the base of the affected finger
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23
Q

Trigger finger Rx?

A
  1. Steroid injection is successful in the majority of patients. A finger splint may be applied afterwards
  2. Surgery for those not responded to steroid injections
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24
Q

Who should be assessed for risk of fragility fractures?

A
  1. Women > 65
  2. Men > 75
  3. Younger with risk factors
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25
Q

2 tools to assess patients 10 year risk of developing a fracture?

A

FRAX or QFracture

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26
Q

FRAX mushkies?

A
  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
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27
Q

QFracture mushkies?

A
  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
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28
Q

When do you do DEXA rather than using prediction tool?

A
  1. Before starting treatment that may have rapid adverse effect
  2. <40 y/o who have a major risk factor
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29
Q

FRAX without BMD interpretation?

A
  1. Low risk = reassure and lifestyle advice
  2. Intermediate risk = BMD test
  3. High risk = Bone protection
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30
Q

FRAX with BMD interpretation?

A
  1. Reassure
  2. Consider treatment
  3. Strongly recommend treatment
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31
Q

When to repeat FRAX/QFracture?

A
  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
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32
Q

Most common cause of posterior heel pain?

A

Achilles tendon disorders

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33
Q

Risk factors for achilles tendon disorders?

A
  1. Quinolone use e.g. ciprofloxacin
  2. Hypercholesterolaemia (predisposes to tendon xanthomata)
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34
Q

Achilles tendinitis features?

A
  1. Gradual onset of posterior heel pain worse with activity
  2. Morning pain and stiffness common
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35
Q

Achilles tendinopathy Rx?

A
  1. Simple analgesia
  2. Reduction in precipitating activities
  3. Calf muscle eccentric exercises (self-directed/physio guided)
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36
Q

Achilles tendon rupture clinical examination?

A

Simmond’s triad
1. Altered angle of declination
2. Palpable gap in tendon
3. Calf squeeze

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37
Q

Achilles tendon rupture Ix?

A

US

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38
Q

Achilles tendon rupture Rx?

A

Refer to orthopaedics

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39
Q

Discitis definition?

A

Infection in the intervertebral space

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40
Q

Discitis features?

A
  1. Back pain
  2. Pyrexia, rigors, sepsis
  3. Neuro = changing lower limb neurology if epidural abscess develops
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41
Q

Discitis features?

A
  1. Back pain
  2. Pyrexia, rigors, sepsis
  3. Neuro = changing lower limb neurology if epidural abscess develops
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42
Q

Discitis causes?

A
  1. Bacterial = S. aureus most common
  2. Viral
  3. TB
  4. Aseptic
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43
Q

Discitis Dx?

A
  1. MRI has highest sensitivity
  2. CT guided biopsy may be required to guide antimicrobial Rx
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44
Q

Discitis Rx?

A
  1. 6-8wks IV Abx
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45
Q

Discitis complications?

A
  1. Sepsis
  2. Epidural abscess
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46
Q

Discitis further Ix?

A
  1. TTE/TOE for endocarditis
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47
Q

Positive scarf test?

A

Acromioclavicular degeneration

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48
Q

Positive scarf test?

A

Acromioclavicular degeneration

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49
Q

Chondromalacia patellae AKA?

A

Patellofemoral pain syndrome

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50
Q

Patellofemoral pain syndrome mushkies?

A
  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
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51
Q

Infrapatellar bursitis?

A

Clergyman’s knee, associating with kneeling

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52
Q

Prepatellar bursitis?

A

Housemaid’s knee, associated with more upright kneeling

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53
Q

ACL injury mushkies?

A
  1. Twisting of knee - popping noise may be noted
  2. Rapid onset of knee effusion
  3. Positive draw test
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54
Q

PCL injury mushkies?

A
  1. May be caused by anterior force applied to the proximal tibia (e.g. knee hitting dashboard during car accident)
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55
Q

Collateral ligament injury?

A
  1. Tenderness over the affected ligament
  2. Knee effusion may be seen
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56
Q

Meniscal lesion?

A
  1. May be caused by twisting of knee
  2. Locking and giving-way are common features
  3. Tender joint lines
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57
Q

FOOSH anatomical snuffbox pain?

A

Scaphoid fracture

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58
Q

Morning stiffness > 2 hours?

A

May be inflammatory arthritis

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59
Q

Hip OA RFs?

A
  1. Increasing age
  2. Female
  3. Obesity
  4. DDH
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60
Q

Hip OA mushkies?

A
  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
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61
Q

Hip OA Ix?

A
  1. If features typical, clinical Dx is ok
  2. Otherwise, plain XRs
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62
Q

Hip OA Rx?

A
  1. Oral analgesia
  2. Intra-articular injections: short term benefit
  3. THR definitive Rx
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63
Q

THR complications?

A
  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
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64
Q

Myxoid/mucoid cyst?

A

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.

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65
Q

Ottawa ankle rules?

A

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

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66
Q

Cubital tunnel syndrome features?

A

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

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67
Q

Cubital tunnel syndrome Ix?

A

Dx usually clinical, however in selected cases nerve conduction studies may be used

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68
Q

Cubital tunnel syndrome Rx?

A
  1. Avoid aggravating activity
  2. Physiotherapy
  3. Steroid injections
  4. Surgery in resistant cases
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69
Q

Osteomyelitis classification?

A
  1. Haematogenous
  2. Non-haematogenous
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70
Q

Haematogenous osteomyelitis mushkies?

A
  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
Q

Non-haematogenous osteomyelitis mushkies?

A
  1. Contiguous spread/direct injury
  2. Often polymicrobial
  3. Most common form in adults
  4. RFs = diabetic foot ulcers/pressure sores, DM, PAD
72
Q

Osteomyelitis most common cause in SCA?

A

Salmonella

73
Q

Osteomyelitis Ix?

A

MRI, sensitivity 90-100%

74
Q

Osteomyelitis Rx?

A
  1. 6w Flucloxacillin
  2. Clindamycin if penicillin-allergic
75
Q

Carpal tunnel syndrome definition?

A

Compression of median nerve in the carpal tunnel

76
Q

Carpal tunnel syndrome Hx?

A
  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
Q

Carpal tunnel syndrome Ex?

A
  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
Q

Carpal tunnel syndrome causes?

A
  1. Idiopathic
  2. Pregnancy
  3. Oedema e.g. HF
  4. Lunate fracture
  5. RhA
79
Q

Carpal tunnel syndrome electrophysiology?

A

Motor + Sensory prolongation of action potential

80
Q

Carpal tunnel syndrome Rx?

A
  1. 6w conservative if mild-moderate –> corticosteroid injection, wrist splints at night
  2. Severe/persistent symptoms –> surgical division (flexor retinaculum division)
81
Q

Rotator cuff injury spectrum?

A
  1. Subacromial impingement (aka impingement syndrome, painful arc syndrome)
  2. Calcific tendonitis
  3. Rotator cuff tears
  4. Rotator cuff arthropathy
82
Q

Rotator cuff injury symptoms?

A

Shoulder pain worse on abduction

83
Q

Rotator cuff injury sign?

A
  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
Q

Types of hip dislocation?

A
  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
Q

Management of hip dislocation?

A
  1. ABCDE
  2. Analgesia
  3. Reduction under GA within 4h to reduce risk fo avascular necrosis
  4. Long-term = physio to strengthen the surrounding muscles
86
Q

Hip dislocation complications?

A
  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
Q

Hip dislocation prognosis?

A
  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
Q

Musculocutaneous nerve roots?

89
Q

Musculocutaneous nerve mushkies?

A
  1. Motor = elbow flexion and supination
  2. Sensory = Lateral part of forearm
90
Q

Axillary nerve roots?

91
Q

Axillary nerve mushkies?

A
  1. Motor = Shoulder abduction (deltoid muscle)
  2. Sensory = inferior region of deltoid muscle
  3. Injury = humeral neck fracture/dislocation, results in flattened deltoid
92
Q

Radial nerve roots?

93
Q

Radial nerve mushkies?

A
  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
Q

Median nerve roots?

A

C6, C8, T1

95
Q

Median nerve mushkies?

A
  1. Motor = LOAF muscles
  2. Sensory = Palmar aspect of the lateral 3.5 fingers
  3. Wrist lesion = carpal tunnel syndrome
96
Q

Ulnar nerve roots?

97
Q

Ulnar nerve mushkies?

A
  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
Q

Long thoracic neve roots?

99
Q

Long thoracic nerve mushkies?

A
  1. Motor = serratus anterior
  2. Injury = blow to the ribs/complication of mastectomy –> winged scapula
100
Q

LOAF muscles?

A
  1. Lateral 2 lumbricals
  2. Opponens pollicis
  3. Abductor pollicis brevis
  4. Flexor pollicis brevis
101
Q

Erb-Duchenne palsy?

A

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
Q

Klumpke injury?

A
  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
Q

Olecranon bursitis definition?

A

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
Q

Olecranon bursitis epidemiology?

A
  1. Men
  2. 30-60 y/o
105
Q

Olecranon bursitis AKA?

A

Student’s elbow

106
Q

Olecranon bursitis causes?

A
  1. Repetitive trauma = writers, students, plumbers, miners
  2. Trauma
  3. Infection
  4. Gout
  5. RhA
  6. Idiopathic
107
Q

Septic olecranon bursitis mushkies?

A

Due to infection, 50% occur in immunosuppressed (alcohol, DM, steroids, CKD, malignancy). 90% due to S. aureus.

108
Q

Olecranon bursitis signs?

A
  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
Q

Olecranon bursitis Ix?

A

If septic bursitis considered then aspiration of bursal fluid for MC&S is essential

110
Q

Housemaid’s knee?

A

Prepatellar bursitis

111
Q

De Quervain’s tenosynovitis definition?

A

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
Q

De Quervain’s tenosynovitis features?

A
  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
Q

De Quervain’s tenosynovitis Rx?

A
  1. Analgesia
  2. Steroid injection
  3. Thumb splint immobilisation may be effective
  4. Surgical Rx sometimes required
114
Q

Tapes equinovarus definition?

A

Talipes equinovarus, or club foot, describes an inverted (inward turning) and plantar flexed foot.

115
Q

Tapes equinovarus epidemiology?

A
  1. 2M:1F
  2. 1/1000
  3. 50% bilateral
116
Q

Tapes equinovarus associations?

A
  1. Spina bifida
  2. Cerebral palsy
  3. Edward’s syndrome (Trisomy 18)
  4. Oligohydramnios
  5. Arthrogryposis
117
Q

Tapes equinovarus Dx?

A

Clinically (deformity not passively correctable) and imaging is not normally needed

118
Q

Tapes equinovarus Rx?

A
  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
Q

Lumbar spinal stenosis definition?

A

A condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.

120
Q

Lumbar spinal stenosis presentation?

A
  1. Back pain, neuropathic pain, symptoms mimicking claudication
  2. Sitting better than standing, easier to walk uphill
121
Q

Lumbar spinal stenosis most common cause?

A

Degenerative disease

122
Q

Lumbar spinal stenosis Dx?

123
Q

Lumbar spinal stenosis Rx?

A

Laminectomy

124
Q

Colles’ fracture?

A
  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
Q

Smith’s fracture?

A
  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
Q

Bennett’s fracture?

A
  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
Q

Monteggia’s fracture?

A
  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
Q

Galeazzi fracture?

A
  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
Q

Barton’s fracture?

A
  1. Distal radius (Colles/Smith) fracture with associated radiocarpal dislocation
  2. Fall onto extended and pronated wrist
130
Q

Scaphoid fracture mushkies?

A
  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
Q

Radial head fracture mushkies?

A
  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
Q

Dupuytren’s contracture definition?

A

Thickening of the palmar fascia

133
Q

Dupuytren’s contracture epidemiology?

A
  1. 5% prevalence
  2. Older males
  3. 60-70% FHx
134
Q

Dupuytren’s specific causes?

A
  1. Manual labour
  2. Phenytoin
  3. ALD
  4. DM
  5. Trauma to hand
135
Q

Dupuytren’s contracture features?

A

Ring finger and little fingers most affected

136
Q

Dupuytren’s contracture Rx?

A

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
Q

Osgood-Schlatter AKA?

A

Tibial apophysitis

138
Q

Iliotibial band syndrome presentation?

A
  1. Lateral knee pain in runner, 1/10 who run regularly
  2. Tenderness 2-3 cm above the lateral joint line
139
Q

Iliotibial band syndrome Rx?

A
  1. Activity modification and iliotibial band stretches
  2. If not improving then physiotherapy referral
140
Q

Commonest cause of hip pain in children?

A

Transient synovitis

141
Q

Perthes disease definition?

A

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
Q

Perthes disease more common in?

143
Q

Perthes disease features?

A
  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
Q

SUFE mushkies?

A
  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
Q

JIA mushkies?

A
  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
Q

Boxer’s fracture?

A

Minimally displaced fracture of the 5th metacarpal, usually after punching a hard surface e.g. a wall

147
Q

Hip fracture classification?

A
  1. Location
  2. Garden System
148
Q

Hip fracture location classification?

A
  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
Q

Garden system classification?

A
  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
Q

Blood supply disruption common in which Garden types?

A

III and IV

151
Q

Intracapsular hip fracture management?

A
  1. Undisplaced fracture = internal fixation, or hemiarthroplasty if unfit
  2. Displaced fracture = THR or hemiarthroplasty
152
Q

When is THR preferred to hemiarthroplasty?

A
  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
Q

Extracapsular hip fracture Rx?

A
  1. Stable intertrochanteric = DHS
  2. If reverse oblique, transverse or subtrochanteric = IM device
154
Q

Clergyman’s knee?

A

Infrapateller bursitis

155
Q

Meralgia paraesthetica nerve?

A

Lateral femoral cutaneous nerve

156
Q

Meralgia paraesthetica epidemiology?

A
  1. 30 - 40 y/o
  2. Sometimes both legs
  3. Men > Women
  4. More commonly in diabetes
157
Q

Meralgia paraesthetica RFs?

A
  1. Obesity, pregnancy, ascites
  2. Trauma, iatrogenic, sports, idiopathic
158
Q

Meralgia paraesthetica symptoms?

A
  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
Q

Meralgia paraesthetica signs?

A
  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
Q

Meralgia paraesthetica Ix?

A
  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
Q

Post hip replacement advice?

A
  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
Q

Compartment syndrome main fracture causes?

A

Supracondylar fractures and tibial shaft injuries

163
Q

Compartment syndrome features?

A
  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
Q

Does presence of a pulse rule out compartment syndrome?

165
Q

Compartment syndrome Dx?

A
  1. Intracompartmental pressure measurement = >20mmHg abnormal, >40mmHg diagnostic
  2. Wont show any pathology on XR
166
Q

Compartment syndrome Rx?

A
  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
Q

McMurrays test is for?

A

Meniscal tear

168
Q

Sprained ankle and tenderness over anterior aspect of the fibula?

A

ATFL sprain

169
Q

Most common reason THR needs to be revised?

A

Aseptic loosening

170
Q

Meralgia paraesthetica Ix?

A
  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
Q

Meralgia paraesthetica Ix?

A
  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
Q

JIA mushkies?

A
  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
Q

Infrapatellar bursitis?

A

Clergyman’s knee, associating with kneeling

174
Q

Discitis features?

A
  1. Back pain
  2. Pyrexia, rigors, sepsis
  3. Neuro = changing lower limb neurology if epidural abscess develops

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