Orthopaedics Flashcards
what are red flags for lower back pain?
1) age <20 or >50
2) hx previous malignancy
3) night pain
4) hx trauma
5) systemically unwell (fever, weight loss)
what are some causes of lower back pain?
1) MSK- sprains, strains, trauma
2) degenerative changes- OA, spinal stenosis
3) herniated disc/sciatica, kidney stones, peripheral arterial disease
which nerve is most likely to be damaged during knee arthroplasty?
common peroneal nerve (one of the terminal branches of sciatic nerve)
how is sciatica managed?
1) conservative
- analgesia (NSAID + PPI) and physio
2) if symptoms persist 4-6 weeks then consider MRI
what are the different types of hip fracture?
1) intracapsular (femoral head or neck)
2) extracapsular (intertrochanteric, subtrochanteric)
which system is used to classify hip fractures?
Garden Classification
types 1-4
I- stable
II- complete but undisplaced
III- displaced but still has bony contact
IV- complete bony disruption
how is an intracapsular hip fracture treated?
1) undisplaced- internal fixation or hemiarthroplasty
2) displaced- total hip replacement or hemiarthroplasty (total is preferred if patient has good baseline function i.e. could walk independently, no cognitive impairment, med fit for procedure)
how is an extracapsular hip fracture treated?
1) stable intertrochanteric- dynamic hip screw
2) subtrochanteric, oblique, transverse- intermedullary device
what are risk factors for osteoporosis?
- systemic steroids
- low BMI
- smoking
- previous fragility fracture or falls
- malabsorption (IBD, coeliac, chronic pancreatitis)
- RA and other inflammatory arthropathies
- higher alcohol intake
- endocrine conditions- diabetes, Cushing’s, hyperthyroidism
- older age
when assessing somebody for osteoporosis, it is always important to have certain causes on your radar, including …
myeloma
Paget’s disease
bony metastases
postitive McMurray’s test indicates what?
meniscal tear
what are the Ottowa rules (ankle) used for?
criteria to determine if a patient with an ankle injury should have an XR
what are the criteria for the ankle Ottowa rules?
Pain in malleolar zone PLUS:
- bony tenderness at lateral malleolar zone
or
- bony tenderness at medial malleolar zone
(from tip of malleolus to include lower 6cm of posterior fibula)
or
inability to walk more than 4 steps
what examinations can you do to test for carpal tunnel syndrome?
1) thenar wasting
2) weak thumb abduction
1) tinel’s (tapping nerve causes paraesthesia)
2) phalen’s (flexion of wrists replicates symptoms)
what are some causes of carpal tunnel syndrome?
idiopathic
oedema
pregnancy
repetitive strain
trauma
acromegaly
diabetes
hypothryoidism
how is carpal tunnel syndrome treated?
1) analgesia, wrist splint at night trial 6 weeks
2) corticosteroid injection
3) surgical decompression (divide flexor retinaculum)
what does positive Foucher’s sign indicate?
Baker’s cyst
(cyst becomes firm on leg extension)
note for Baker’s cyst, should always ensure you rule out DVT (low threshold for USS as they can co-exist)
posterior heel pain with morning pain and stiffness are characteristic of what?
Achilles tendinitis
what is the treatment for frozen shoulder?
1) analgesia
2) physio
3) steroid injections
(stepwise)
what is cubital tunnel syndrome?
compression of the ulnar nerve as it passes through the cubital tunnel
gives rise to tingling of fourth and fifth finger
often hx of OA or trauma to the area
what are potential complications of hip replacement?
1) perioperative
- VTE
- infection
- fracture
- nerve injury
2) post-op
- leg length discrepancy
- dislocation
- aseptic loosening
- prosthetic joint infection
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
Which nerve root is affected?
L3
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
Which nerve root is affected?
L4
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
Which nerve root is affected?
L5
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Which nerve root is affectected?
S1
