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Medicine Year 4 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Classification of open #?

A

Gustilo - Anderson Grading system

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2
Q

Greenstick #?

A

A childhood fracture of young, soft bone in which the bone bends and bMixereaks

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3
Q

McMurray test?

A

Used to evaluate tears in the menisci of the knee joint.

Test by flexing knee with a values stress on the knee and ext rotating the foot. Lateral meniscus

Likewise, then flex knee with varrus stress and int rotate the foot. Medial meniscus.

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4
Q

Other examination pointers:

A

Test for collaterals without full extension.

Don’t look at examiner for reassurance.

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5
Q

Which nerve runs next to fibula? What can a # here causes?

A

Common perennial nerve. Damage can lead to foot drop

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6
Q

Radial nerve function?

A

Sensory and Motor.

Sensation thumb and first finger (back of hand)
Motor - wrist, finder extenstion (WRIST DROP)

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7
Q

Median Nerve function?

A

Mixed

Sens - thumb, index, middle and 1/2 ring finger
Motor - thenar eminence (BENEDICTION SIGN, APE HAND DEFORMITY)

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8
Q

Where can back pain come from?

A 
Bones
Discs
Facet Joints
Muscles and Ligaments
Nerves
Extra-spinal areas (Kidneys, pancrease, aorta)
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9
Q

Pathological Processes?

A 
Degeneration 
Trauma
Infection
Malignancy
Inflammation
Metabolic
Congenital
Psychological
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10
Q

Cardinal Features of Acute/Chronic nerve root pain?

A

Leg pain worse than back pain
Pain to areas below knee
Paraesthesia, numbness, weakness (not always)
Nerve Root Tension Signs

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11
Q

Symptoms of acute lumbar nerve root pain

A

Severe predominant leg pain radiating below knee
Paraesthesia and numbness
Pain aggravated by coughing

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12
Q

Signs of acute lumbar nerve root pain

A

Loss of Lordosis (flat lower back)
Stiffness
Root tension signs
(Sometimes) abnormal neurology of single root - ir foot weakness, loss of ankle (S1) or knee (L3/4) reflex, numbness of single dermatome

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13
Q

What are the root tension signs?

A

Straight leg raise (SLR) - L5 and S1 compression results in pain (Secondary to disc protrusion at L4/5 or L4/S1 level)

Femoral stretch test - L3 and L4 compression gives pain (Secondary to L2/3 or L3/4 protrusion).

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14
Q

Differentials to consider in disc prolapse?

A

Peripheral Vascular Disease (therefore check pulses and circulation)
OA of hip/knees

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15
Q

Management of disc protrusion?

A 
First 6 weeks:
explanation/reasurance
analgesia
avoid lng bed rest
mobilisation
physio
After 6 weeks:
Recheck red flags
XRay/MRI
Physio
Patience
Specialist Referal
Epidural steroid and analgesia

After 2/3 months:
Discectomy (standard/micro)

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16
Q

Indications for a discectomy

A

Severe leg pain unresponsive to conservative measures (hx of sciatica, exam with nerve root tension, mri = disc prolapse)

Cauda Equina compression

Progressive neurological deficit

17
Q

What is Cauda Equina Syndrome?

A

Massive central disc prolapse compressing nerves to bladder and bowel (S2,3,4) as well as L5 ad S1 roots

18
Q

Symptoms and Signs of Cauda Equina Syndrome?

A

Acute bilateral leg pain
Bladder and bowel dysfunction
Saddle Anaesthesia
Weakness of foot, no ankle jerks

MRI shows massive L4/5 disc protrusion

19
Q

Management?

A

urgent decompression

however this will still usually leave incomplete recovery from bladder and bowel symptoms

20
Q

Which condition can cause neurological claudication?

A

Spinal Stenosis

21
Q

Red flags for sinister back pain?

A 
Extreme of age (under 20, over 55)
Acute onset
Nocturnal pain
Fever, night sweats, weight loss
Hx of malignancy
Abdomincal mass
Thoracic back pain
Morning stiffness
Bilateral or alternating pain
Neurological disturbance
Sphincter disturbance
Current of recurrent infection
Immunosuppresion
Neuological Claudication (spinal stenosis)
22
Q

Typical symptoms in spinal stenosis?

A

Over 50yrs
Previous hx of LBP
Bilateral leg pain on walking/standing with weakness and numbness
Improved with flexing (better walking uphill/rising a bike)

23
Q

Examination findings?

A

Flat spine/Simian stance (leaning forward with hip and knees flexed - like a ape)

No stiffness
No significant neurology
Normal Pulses
SLR decreased or normal

24
Q

Differentials in spinal stenosis?

A

PVD - intermitant claudicaiton

Peripheral neuropathy

25
Q

Serious, sinister pathology in back pain?

A

Primary malignancy incl. myeloma
Secondary Malignancy (breast, prostate, lung, kidney, thyroid)
Infection
Inflammatory Disease (Ank. Spond.)

These all have RED FLAG symptoms

26
Q

3 Joints of shoulder?

A

Gleno-humeral joint
Scapulo-thoracic joint
Acromio-clavicular joint

27
Q

Ligaments of shoulder?

A 
Coracoclavicular ligament (stabilizes A_C joint)
Coracoacromial Joint
28
Q

Muscles of Shoulder?

A

ROTATOR CUFF
Supraspinatus (abduction)
Infraspinatus and teres minor (ext. rotation)
Subscapularis (int. rotation)

29
Q

Blood and Nerve Supply?

A

Axillary artery and nerve

30
Q

Burse of shoulder?

A

Subacromial bursa, lies underneath acromium and above rotator cuff.
Can become inflammed after trauma and give rise to impingement pain.

31
Q

Symptoms and signs of impinged rotator cuff?

A

Painful shoulder, esp in overhead movements
Tender greater tuberosity
Painful arc - rotator cuff rubbing against acromium
Positive impingement test (e.g Hawkin’s Test)

A completely torn rotator cuff results in complete loss of active abduction (passive fine) BUT if arm is passively listed to 30 degrees then deltoid take over and full abduction occurs

32
Q

Hawkin’s test?

A

Hawkin’s Test assesses for possible rotator cuff impingement. Stabilize the scapula, passively abduct the shoulder to 90 degrees, flex the shoulder to 30 degrees, flex the elbow to 90 degrees, and internally rotate the shoulder. Pain is a positive test.

http://sitemaker.umich.edu/fm_musculoskeletal_shoulder/hawkin_s_test

33
Q

Investigation of impinged rotator cuff?

A 
X-ray
Ultrasound
Arthrogram
Arthroscopy
MRI
34
Q

Treatment of impinged rotator cuff?

A 
Explanation of symptoms
Analgesia 
Physiotherapy 
Subacromial steroid injection
Arthroscopic decompression subacromially
35
Q

Frozen shoulder - what is it?

A

Painful and stiff shoulder with restricted movement in all directions

Associated with normal x-ray

Secondary to fibrosis and contractures of the gleno-humeral capsule

36
Q

Clinical course?

A

Painful phase and beginning of stiff phase
Stiff phase, reducing pain
Recovery phase

Lasts for 2 years then improves, never to 100% however

Medicine Year 4 (15 decks)

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