Orthopaedics 6 Flashcards
Adhesive capsulitis
What clinical features are seen?
shoulder pain followed by stiffness
often middle-age and diabetes RF
What clinical features are seen in supraspinatus tendonitis?
- rotator cuff injury
- painful arc of abduction between 60 and 120 degrees
- tenderness over anterior acromion
What clinical features will be seen in
- Dorsal column lesion
- Spinothalamic tract lesion
- loss of vibration / fine discrimination and proprioception
- > can be caused by tabes dorsalis (late stage syphilis) or subacute degeneration of the cord (vit B12 deficiency or cystic fibrosis) - loss of temperature, sensation and pain
Brown-Sequard Syndrome
- What is it?
- What clinical features are seen?
- hemisection of the spinal cord
- ipsilateral: paralysis and loss of proprioception and vibration
- contralateral: loss of temperature and pain
NOTE: this must mean spinothalamic tract must cross over when it enters the CNS
What clinical features will be seen in infarction of the spinal cord?
dorsal column signs: loss of vibration and proprioception
State the function of the following myotomes:
- C5
- C6
- C7
- C8
- T1
- biceps
- wrist extensors
- triceps
- long finger flexion
- small finger abductors
State the function of the following myotomes:
- L1 and 2
- L3
- L4 and 5
- L5 only
- S1
- S2-4
- hip flexors (psoas)
- quadriceps
- ankle dorsiflexion
- big toe dorsiflexion
- plantar flexion
- anal sphincter
Subluxation of the radial head
- Who is it most common in?
- What clinical features are seen?
- How is it managed?
- children <6
- elbow pain
- limited supination and extension of the elbow
- analgesia
- passively supinate the elbow joint with it flexed at 90 degrees
Talipes equinovarus
- What is it?
NOTE: associated with spina bifida, Edwards (trisomy 18) and cerebral palsy
- How is it managed?
- clubfoot: inverted + plantar flexed foot (50% are bilateral)
- Ponseti method: progressive casting
+/- achilles tenotomy
Trigger finger
- What is it?
- What clinical features are seen?
- Where is it most common?
- How is it managed?
- disparity between tendon and pulley through which it passes
- stiffness following by snapping (trigger) of extending a flexed finger
+/- palpable nodule
- stiffness following by snapping (trigger) of extending a flexed finger
- thumb, middle + ring fingers
- steroid injection
surgery if this fails
Radial head fracture
- Who is it seen in?
- What clinical features are seen?
- young adults with FOOSH
- tenderness of radial head
- sharp pain on lateral elbow at extremes of rotation (pronation and supination)
Upper limb anatomy
Describe the motor and sensory function of the following nerves
- musculocutaneous nerve (C5-7)
- axillary nerve (C5,6)
- radial nerve (C5-8)
- median nerve (C6, C8, T1)
- ulnar nerve (C8,T1)
- long thoracic nerve
- motor: biceps - elbow flexion and supination
sensory: lateral arm - motor: deltoid - shoulder abduction
sensory: inferior region of deltoid (regimental badge area) - motor: extension (forearm, wrist, fingers, thumb)
sensory: dorsal lateral 3 1/2 fingers - motor:
- pronation + weak wrist flexion
- LOAF muscles: lateral two lumbricals, opponens pollis, abductor pollis, flexor pollis brevis
sensory: palmar lateral 3 1/2 fingers - motor: hand muscles except LOAF, weak wrist flexion
sensory: lateral 1 1/2 figners - Motor: serratus anterior
What is the typical mechanism of injury and appearance in injury to the following nerves:
- musculocutaneous nerve (C5-7)
- axillary nerve (C5,6)
- radial nerve (C5-8)
- median nerve (C6, C8, T1)
- ulnar nerve (C8,T1)
- long thoracic nerve (C5-7)
- brachial plexus injury
- humeral head fracture
- humeral shaft fracture - wrist drop
- wrist lesion
- medial epicondyle fracture - “claw hand”
- blow to the ribs / mastectomy complication - winged scapula
How should you manage back pain with a suspected spinal metastasis?
urgent transfer to hospital for assessment: indicated spinal stenosis which is oncological emergency
How should open fractures be managed?
- urgent debridement (<6 hours)
- IV ABx
- reduction + external fixation until soft tissues recover an then internal fixation
