Orthopaedics Flashcards
1
Q
How many people will be affected by back pain in their life time?
A
-Almost everyone at some point in their life
2
Q
What is the most common cause of back pain?
A
-Mechanical back pain (usually in the lumbar region)
3
Q
What is the most common cause of back pain in the elderly?
A
-Spinal cord stenosis
4
Q
What is the most common cause of back pain in the younger patient?
A
-Disc prolapse
5
Q
What are risk factors for mechanical back pain?
A
- Highly demanding jobs
- Prolonged standing
- Awkward lifting
- Obesity
- Psychosocial
- Work-related stress
- Family history
6
Q
What are the causes of back pain?
A
-Mechanical
-Degenerative and age related change ie OA, osteoporosis - vertebral fractures
-Inflammatory
>RA, Psoriatic arthritis, Reactive arthritis, Gout, Ank. Spond, Sacroiliitis
-Bone disorders
>Paget’s disease, Osteoporosis, Spinal stenosis
-Immunodeficiency
>Steroids, chemotherapy, infection (HIV, TB), IVDU
-Malignancy
-Trauma
-Somatic
-NAI
7
Q
Where are secondary metastases commonly from?
A
- The 5 Bs
- Bronchus
- Breast
- (B)Thyroid
- (B)Prostate
- (B)Kidney
8
Q
What are some causes of back pain originating from outside the spinal column?
A
- Dissecting aortic aneurysm
- Posterior duodenal ulcer
- Nephrolithiasis
- Pyelonephritis
- PMS
9
Q
What are the red flags of back pain?
A
- Age related: <18 or >60 with new onset back pain
- Neurological symptoms: Bowel and bladder dysfunction, Parasthesia of the legs
- Weight loss
- Clinical features of infection: Night sweats, fever
- Thoracic back pain: aortic aneurysm, trauma, poor posture, thoracic disc herniation
- Immunosuppression: Steroids, chemotherapy, HIV, IVDU
10
Q
What is yellow flag back pain?
A
-Back pain that is exaggerated by life stressors
11
Q
What are some examples of life events that may cause yellow flag back pain?
A
- Belief that pain and activity are harmful
- Sickness behaviour ie extended rest
- Social withdrawal
- Mood problem
- Problems at work
- Problems with compensation or time off work
- Over protective family or lack of support
- Inappropriate expectations of treatment including low expectations of active participation in treatment
12
Q
What are the imaging investigations for back pain?
A
-Xray: >suspected fracture >myeloma >vertebral fracture (osteoporotic) >metastatic carcinoma >Paget's disease of the bone -CT: Fractures, spondyloisthesis -MRI: Soft and hard tissue. >disc lesions, nerve root compression, discitis, suspected neoplastic disease
13
Q
What are the other investigations needed for back pain apart from imaging?
A
- Bloods: FBC, U&E, LFTs, CRP
- Urine: Bence jones protein, hydroxyproline
14
Q
What will LFTs show in Paget’s disease?
A
-Increase in alkaline phosphatase
15
Q
What is the management for mechanical back pain?
A
-Lifestyle advice >Exercise >Desk/chair alterations -NSAIDs -Physiotherapy
16
Q
What is the management for yellow back pain?
A
- Reassurance
- Referral to physio/chiropracters
- Relieve life stress
17
Q
What is the management for red flag back pain?
A
-Urgent referral to neurosurgeon or specialist orthopaedic surgeon
>Urgent MRI
18
Q
What is carpal tunnel syndrome?
A
-Compression of the median nerve in the carpal tunnel causing numbness and tingling
19
Q
What is the carpal tunnel formed by?
A
- Carpal bones
- Flexor retinaculum
20
Q
What is the epidemiology of carpal tunnel?
A
- Incidence peaks in late 50s
- Female > male
- Obesity is a risk factor
21
Q
What are genetic risk factors for carpal tunnel syndrome?
A
- Square shaped wrist
- Short stature
- Family history
- Hereditary neuropathy
22
Q
What are some secondary causes of carpal tunnel syndrome?
A
- Post-colles fracture
- Flexion/extension injuries of the wrist
- Space occupying lesion within the carpal tunnel
- Diabetes
- Thyroid disorders
- Menopause
- Inflammatory arthridities of the wrist
- Renal dialysis
23
Q
What are some space occupying lesions that can result in carpal tunnel syndrome within the carpal tunnel space?
A
- Aneurysm
- Neurofibroma
- Haemangioma
- Lipoma
- Ganglions
24
Q
What are some other risk factors for carpal tunnel syndrome? (excluding genetics and secondary causes)
A
- Pregnancy
- Lactation
- Use of walking aids
- Lack of aerobic exercise
25
How does carpal tunnel syndrome present?
- Numbness, pain and tingling in the distribution of the median nerve
- Often worse at night
- Weakness
- +ve Phalen's and Tinnel's test
26
Investigations for carpal tunnel syndrome?
- Clinical diagnosis
- Electroneurography
- Ultrasound
27
What is the management for carpal tunnel syndrome?
- NSAIDs
- Night splint
- Corticosteroid injections
- Surgical decompression
- Physiotherapy (increase blood flow and therefore healing)
28
What is osteoarthritis?
-Clinical syndrome of joint pain accompanied by varying degrees of functional limitations and reduced quality of life
29
What is the most common form of arthritis?
-Osteoarthritis
30
Where does OA commonly affect?
- Hips
- Knees
- Small joints of hands and fingers
31
What is the pathology behind OA?
-Repeated trauma causes:
>localised loss of cartilage
>remodelling of adjacent bone
>has associated inflammation
32
Who is affected by OA?
-Older people
33
What are some risk factors of OA?
- Heretability (genes unknown)
- Age
- Sex
- Obesity
- High or low bone density
- Joint injury
- Occupational or recreational stresses on the joint
- Reduced muscle strength
- Joint laxity
- Joint malalignment
34
How does OA present?
- Joint pain that is exacerbated by movement and relieved by rest
- Advanced disease: pain at night and rest
- Joint stiffness for <30 mins in the morning
- Reduced function
- Joint swelling
- Crepitus
- Absence of systemic symptoms
- Bony swellings ie Heberdens and Bouchards
35
Where does OA in the knee cause pain?
-In and around the knee
36
Where does OA in the hip cause pain?
- Pain in the groin, anterior or lateral thigh
| - Can cause referred pain in the knee or testicle of the affected side in males
37
Where do OA nodules commonly form and what are they called?
- Heberden's nodes: DIPJ
| - Bouchard's nodes: PIPJ
38
What is needed for a clinical diagnosis of OA?
>45 years
>Activity related joint pain
>Less than 30 mins morning stiffness
39
What are the investigations for OA?
- Clinical examination
- X ray
- MRI
- Blood tests: Normal in OA
- Joint aspiration: Exclusion of septic arthritis and gout
40
What are the X ray signs of OA?
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts
41
What is the non-pharmacological management for OA?
```
-Hollistic approach
>function, QOL, occupation, mood, relationships, leisure activities
-Weight loss
-Walking aids and physio assessment
-Increase exercise
```
42
What are some drug treatments for OA?
- Topical NSAIDs
- Oral NSAIDs + PPI
- Intra-articular injections
- Surgery
43
What is the prevention for OA?
- Weight control
- Increasing physical activity
- Avoiding injury
- Education about OA
44
What is a scissor gait?
-Seen in lesions of the upper motor neurones ie CP
-Extensor muscles are stronger than the flexor muscles
>Tight adductors
>Plantar flexion of the ankles
>Flexion at the knee
45
What is a shuffling gait?
- Seen in parkinsons
| - Rigidity and bradykinesia
46
What is a trendelenberg gait?
- Weakness in abductor muscles and gluteus medias
| - The hip moves outwards and the shoulder dips to compensate
47
What is a high stepping gait?
-Lesion of the common peroneal nerve
>Caused by: Compression, trauma, vasculitis, syphilis
-Diabetes
-Disc herniation
48
What is an ataxic gait?
-Like the patient is drunk
-Wide base
Other ataxic signs: Nystagmus, hypotonia, Dysdiadokinesia, intention tremor
49
What is an antalgic gait?
-Decreased standing stage on the affected leg
50
What is tiptoeing gait?
-Children with DDH, leg length discrepency
51
What is achilles tendinopathy?
-Chronic overuse of the achilles tendon
52
Who most commonly suffers from achilles tendinopathy?
-Active people who participate in sports that involve running or jumping
53
What forms the achilles tendon and where does it insert?
-Gastrocnemius and soleus forms around the mid calf and inserts onto the posterior calcaneus
54
What are risk factors for achilles tendinopathy??
```
-Activities such as:
>running
>jumping
>dancing
-Change in footwear or training surface
-Poor running technique
-Family history
-DM
-HTN
-Quinolone abx
```
55
How does achilles tendinopathy present?
-Gradual onset of pain and stiffness over the tendon
>May improve with heat or gentle walking
>Worsens with strenuous activity
-Tenderness of the tendon on palpation
-Pain on active movement of the ankle joint
56
What investigations would you do is achilles tendinopathy was suspected? Why?
- USS
- MRI
- To differentiate between tendinopathy and partial thickness tears
57
What is the management for achilles tendinopathy?
- RICE
- NSAIDs
- Heel lifts
- Alteration of activities in the short term
- Stretches
58
What is the epidemiology of an achilles tendon rupture?
- Recreational athletes between 30s-50s
| - Commonly seen in football, basketball, running, tennis
59
What are risk factors for achilles tendon rupture?
- Increasing age
- Chronic or recurrent achilles tendinopathy
- Systemic or injected steroids (around the achilles tendon)
- Systemic conditions ie RA, SLE
- Quinolone abx
60
How does an achilles tendon rupture present?
- Acute onset pain (sharp and sudden), feels like being hit in the back of the leg
- Snap may be heard
- Inability to stand on tiptoe
- Altered gait
- Localised swelling
- Simmonds test +ve
61
What is simmonds test?
- Test for achilles tendon rupture
| - Squeezing of the calf muscle doesn't cause the foot to move
62
What are some differential diagnosis of achilles tendon rupture?
- Achilles tendinopathy
- Retrocalcaneal bursitis
- Plantaris muscle injury
- Other ankle injury
- Ankle OA
- Rupture baker's cyst
63
What investigations would you do for achilles rupture?
-USS or MRI
64
What is the conservative management for an achilles tendon rupture?
- Rest
- Pain control
- Walking boot for 2 weeks
- Weight bearing as tolerated from 4-6 weeks
- Orthosis
65
What is the surgical management reserved for?
- Younger more active patients
| - Reduces the chances of re-rupture
66
What is the medical name for bunions?
-Hallux valgus
67
What are bunions?
-Lateral deviation of the great toe causing a valgus deformity deformity of the first metatarsoplangeal joint.
68
What some potential consequences of bunions
- Subluxation of the first MTP joint
| - Great toe may overlap the second toe
69
What is the epidemiology of bunions?
- Female >Male
- Significant family history
- Bilateral
70
What are risk factors for bunions?
- Footwear: tight fitting, high heels
- Genetic predisposition
- Female
- Abnormalities of the foot (pes planus, hypermobility, achilles tendon contracture)
- Positional change due to neuro conditions ie stroke, CP
- Systemic conditions causing ligament laxity ie Marfan's, RA
71
How does a patient with bunions present?
-Pain
>usually progressive, deep sharp pain in the hallux MTP on walking. Limits daily activities
-Cosmetic
>Overlapping of the second toe
-History of trauma or arthritis is common
72
What needs to be included in the medical history when a patient presents with bunions?
-Check if patient is immunosuppressed as that can increase the risk of complications and increase healing time
73
What investigations do you do for bunions?
-Clinical diagnosis
-X ray
>Shows degree of deformity and presence of subluxation
74
What are some differentials for bunions?
- Hallux rigidus
- Sesamoiditis
- Fracture
- Gout
- RA
- Neuropathic pain
- Infection
75
What is the Conservative management for bunions?
```
-Appropriate footwear
>low heeled, soft soled, loose fitting
>Laces or adjustable straps
-Analgesia
-Bunion pads
-Ice packs
-Podiatry referral
```
76
When should surgery for bunions be considered?
- When the pain caused is not responding to conservative measures
- Affected second toe
- Inhibition of activity or lifestyle
77
What are some complications of bunions?
- Difficulty finding good fitting footwear
- OA of the MTP joint
- Loss of mobility
- Increased risk of falling in the elderly
- Nerve entrapment
- Hammer toes
- Sesamoiditis
- Ulcers
- Inflammatory conditions
78
What are the 4 ligaments of the knee and what is the mnemonic to remember their relation to the menisci?
- AMPL(E)
- ACL-medially insterts to the tibia and associated with the medial meniscus
- PCL-laterally inserts to the tibia and associated with the lateral meniscus
- Lateral collateral meniscus
- Medial collateral meniscus
79
What do the ligaments in the knee do?
- ACL: prevents forward movement of the tibia in relation to the femur. Contols rotational movement
- PCL: prevents forward sliding of the femur in relation to the tibia
- MCL: prevents lateral movement of the tibia when there is valgus stress on the knee
- LCL: prevents medial movement of the tibia when there is varus stress on the knee
80
How are knee ligament injuries graded?
Grade I: Few fibres damaged or torn (sprain)
Grade II: more fibres torn but ligament still intact (severe sprain)
Grade III: Complete rupture of ligament. Unstable knee joint and surgery may be indicated
81
After an acute injury, what are the differentials of a large tense effusion over 0-2 hours?
- Ligamentous injury, especially ACL
- Fracture
- Dislocation
82
When is an injury to the MCL most likely to occur?
- Injury involves a direct blow to the lateral aspect of the knee
- Twisting injury
83
What test is used to identify an injury to the MCL?
-Valgus stress test
84
What investigation is required to identify ligamentous injuries?
-MRI
85
What is the general management for a MCL injury?
```
-PRICER
>Protect, Rest, Ice, Compression, Elevation, Rehabilitation
-Braces
-Non-weight bearing
-Surgery
```
86
How is an injury to the LCL most likely to happen?
- Medial blow to the knee
- Varus stress in running
- Yoga
87
What is the test for LCL injury?
-Varus stress test
88
What is the general management for LCL injuries?
- PRICER
- Knee brace locked in full extension and weight bearing as tolderated
- Surgery
89
How are younger patients most likely to rupture their ACL?
-High impact twisting injuries ie football, basketball
90
How are older patients most likely to rupture their ACL?
-Skiing
91
What is the mechanism of an ACL injury?
-Non-contact deceleration or change in direction with a fixed foot that produces a valgus twisting injury
92
What are ACLs commonly associated with?
-Meniscal injuries
93
What is the management for an ACL injury?
-Conservative
>Physio to strengthen hamstrings and quads
>Exercises in one plane of movement
-Surgery
94
What is the immediate Mx for an acute ACL injury?
-PRICER
95
What causes PCL injuries?
-Hyperextension typically from a direct blow to the proximal tibia with the knee in flexion
96
What will the patient not like to do if they've ruptured their PCL?
-Won't like walking down stairs
97
What is the management for a PCL injury?
- PRICER
- Axillary crutches and leg brace
- Weight bear as tolerated
- Rehab
- Surgery
98
What is pes planus?
Loss of the medial longitudinal arch of the foot (flat feet)
99
What are the purposes of the arches of the feet?
- Adds elasticity and flexibility to the foot
- Absorbs shock
- Produces strength to push off and adjust to balance and walk
- Distributes weight evenly around the foot
100
Who is affected by flat feet?
- Children
| - Flexible hypermobile people
101
What might cause flat feet in children?
- Part of normal development
- Obesity
- Neurological problems ie CP, polio
- Bony abnormalities ie fusion of tarsal bones
- Ligamentous laxity ie Ehlers-Danlos
102
What might cause flat feet in adults?
```
-Reduced arch strength
>dysfunction of the tibilais posterior tendon
>Tear of ligament
>Tibialis anterior rupture
>Neuropathic foot
>Age related degenerative cahnges to foot and ankle joint ie OA, RA
-Factors increasing load
>High heels
>Obesity
>Pregnancy
>Tight achiles tendon or calf muscle
```
103
How might someone with pes planus present?
- Pain in foot, ankles, knees, hips or spine
| - Altered gait
104
What investigations are needed for pes planus?
-X ray (standing)
| >AP, lateral
105
What is the management for pes planus in children?
- Foot orthoses
| - Surgery
106
What is the management for pes planus in adults?
- Activity modification
- Footwear and orthoses
- Exercise
- NSAIDs
- Surgery
107
What are the different types of potential femoral fractures?
- Fractures of the femoral neck (common in the elderly)
- Fractures of the femoral shaft ad supracondylar fractures (caused by violent trauma in younger people)
- Femoral stress fracture (chronic overuse injuries)
108
What is the definition of a hip fracture?
-Fracture of the proximal femur (proximal to 5cm below the lesser trochanter)
109
What is an intracapsular hip fracture?
-The femoral neck between the edge of the femoral head and insertion of the capsule of the hip joint are involved.
110
Why are intracapsular hip fractures important to identify?
-Can cause avascular necrosis of the femoral head
111
What are the causes of hip fractures in elderly and in younger people?
- Elderly: osteoporosis causing fragility fractures
| - Younger patients: high energy trauma. More likely to result in serious injuries
112
What are risk factors for hip fractures?
-Increasing age
-Osteoporosis
-Osteomalacia
-Increased risk of falls
>Instability
>Lack of core strength
>Gait disturbance
>Sensory impairment
113
How do patients with hip fractures present?
-Pain in the upper thigh or in the groin
>May radiate to the knee
>Inability to weight bear
>Pain aggrevated by flexion and rotation of the leg
-May be no history of trauma (esp. in elderly patients)
-Leg may be shortened, abducted and externally rotated
114
How are hip fractures diagnosed?
-X ray: AP and lateral
>disruption of trabeculae, inferior and superior cortices and abnormality of pelvic contours
-MRI
>if fracture is suspected but x ray does not identify it
115
What is Garden's classification of intracapsular neck of femur fractures?
Garden I: trabeculae angulated, inferior cortex intact. No significant displacement
Grade II: trabeculae in line but a fracture line is visible from superior to inferior cortex. No sig. displacement
Grade III: obvious complete fracture line with slight displacement and/or rotation of femoral head
Garden IV: gross, often complete displacement of the femoral head
116
What investigations are used in an assessment of a patient with a NOF fracture?
```
-Bloods
>FBC, U&E, G&S, crossmatch
>Blood glucose
>ECG
>CXR
>Iv access
-Cognitive impairment assessment
-Treatment of treatable comorbidities
```
117
How are NOF fractures managed?
-Surgery
>internal fixation with screws
>hip replacement (hip arthroplasty)
118
What are some complications of NOF fracture?
```
-High mortality
>Infection
>Haemorrhage
>Avascular necrosis
>Pneumonia
>MI
>Stroke
>DVT, PE
```
119
How are femoral shaft fractures sustained?
- High energy injury ie RTA
| - Pathological fracture ie osteoporosis, metastatic disease
120
What are the different forms of fractures?
- Transverse
- Oblique
- Spiral
- Comminuted
- Open
- Closed
121
What is required for a diagnosis of a femoral shaft fracture?
- Severe pain with supporting history of injury
- Tense, swollen, tender thigh
- Inability to weight bear
- Deformity and shortening of the affected side
122
What investigations are needed for a femoral shaft fracture?
-X ray
>AP and lateral
>Ipsilateral knee
123
What is the management for femoral shaft fracture?
- Bloods: FBC, Cross match, G+S
- Iv access and fluid replacement
- Analgesia
- Surgery
124
What are some early complications of a femoral fracture?
- Neurovascular damage from sharp bone ends
- Bleeding
- Acute compartment syndrome
- Infection
- Delayed healing
125
What are some late complications of a femoral fracture?
- Fat embolism
- DVT
- PE
- Infection
- Shortening, angulation and malalignment
126
What are supracondylar fractures and how are they caused?
- Fractures of the distal third of the femur
| - Direct trauma
127
What are supracondylar fractures associated with?
- Damage to the knee joint
| - May cause damage to the popliteal artery
128
What is frozen shoulder?
- Adhesive capsulitis
| - A glenohumeral disorder causing intrinsic pain and loss of movement
129
How does frozen shoulder occur?
-Thickening and contraction of the glenohumeral joint capsule and formation of adhesions causes pain and loss of mobility
130
Who is affected by frozen shoulder?
- Commonly affects 40-65 year olds
- Female>Male
- Increased risk for patients with DM or thyroid disorders
131
How does frozen shoulder present?
```
-Pain occurs before stiffness
>Gradual onset
-Non-dominant shoulder usually affected
-Inability to sleep on affected side
-Restriction of ADL due to impaired external rotation ie driving, dressing
```
132
What is phase 1 of frozen shoulder?
- Severe generalised pain with associated stiffness
- Daily activities are limited
- Can last up to 9 months
133
What is phase 2 of frozen shoulder?
-Pain gradually subsides but residual stiffness
-Movement can become more limited
>External rotation is commonly affected
-Lasts between 4-12 months
134
What is phase 3 or frozen shoulder?
- Shoulder becomes less stiff
- Increase in range of movement
- Usually lasts within 1-3 years
135
What investigations are needed for suspected frozen shoulder?
-Clinical diagnosis
>Tender on palpation
>Inability to externally rotate
-X rays are generally normal
136
How should frozen shoulder be managed?
- Simple analgesia
- Encourage physical activity
- Physiotherapy
- Steroid injections in early stage disease
137
What are the 3 joints forming the shoulder?
- Glenohumeral joint
- Acromioclavicular joint
- Sternoclavicular joint
138
What are the muscles of the rotator cuff?
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
139
What does the supraspinatus muscle do?
| What's the innervation?
- Abducts 0-15 and then assists deltoid from 15-90
| - Suprascapular nerve
140
What does the infraspinatus muscle do? What's the innervation?
- Externally rotates the arm
| - Suprascapular nerve
141
What does the teres minor muscle do? What's the innervation?
- Externally rotated the arm
| - Axillary nerve
142
What does subscapularis muscle do? What's the innervation?
- internal rotation of the arm
| - Upper and lower subscapular nerves
143
What are some of the other muscles that make up the shoulder?
- Deltoid
- Teres major
- Trapezius
- Latissmus dorsi
- Levator scapulae
- Rhomboid major and minor
144
What are some risk factors for shoulder pain?
-Occupations, sports, hobbies that include repetitive movements
-Psychosocial factors
>Stress, job pressure, social support
-Athletes lifitng above their heads, high impact sports
145
What occupations are more prone to expreience shoulder pain?
- Cashiers
- Bricklayers
- Construction workers
- Painter/decorators
- Welders
- Hair dressers
- Plasterers
146
What are some causes of intrinsic shoulder pain?
- Rotator cuff disorders
- Glenohumeral disroders
- Acromioclavicular disorders
- Infection
- Shoulder instability
147
What are rotator cuff tears?
- Tearing of the tendon of the rotator cuff.
| - Causes subacromial pain and impingement as there is no muscle protecting the humerus and acromion = pain
148
What are examples of glenohumeral disorders?
- Adhesive capsulitis
| - Arthritis
149
What are some causes of extrinsic shoulder pain?
-Referred pain
>Neck pain, MI
-PMR
-Malignancy
150
What are rotator cuff disorders also called?
- Subacromial impingement
- Rotator cuff syndrome
- Subacromial pain
- Supraspinatus tendonitis
- Rotator cuff tendinopathy
- Painful arc cyndrome
151
What age range does rotator cuff disorders affect?
-30-75 years old
152
What can subacromial impingement lead to?
- Rotator cuff tear
| - The conditions are a spectrum and if the impingement is not treated and rested, the tendons can tear as a result.
153
How does subacromial impingement occur?
-Repetitive movements and heavy lifting above shoulder level causes impingement of tendons
154
What is likely to be seen O/E of subacromial impingement?
- Muscle wasting, painful movements, restricted active movements
- Painful arc between 70-120
155
How are rotator cuff tears likely to be sustained in younger patients and the elderly?
- Young: trauma
| - Elderly: atraumatic
156
What are the common causes of acromioclavicular disorders?
- Trauma
| - OA
157
How do acromioclavicular disorders present?
-Pain and tenderness localised to the AC joint
| >Restriction of passive, horizontal movement of the arm across the body
158
What are the red flag symptoms of shoulder pain?
- History or presentation of malignancy
- Overlying skin erythema
- Presentation of systemic illness ie PMR
- Fever
- History of trauma
- Recurrent convulsions
- Neurological symptoms
159
What are some investigations that can be done for shoulder pain?
- USS
- X rays
- MRI
160
What is the management for rotator cuff disorders?
- Advise modification of activities
- Analgesia
- Physiotherapy
- Corticosteroid injections
- Rest
161
What management may be required to repair rotator cuff tears?
- Physio and steroids for minor tears
| - Surgery for major tears
162
What management may be needed for degeneration of the humeral head?
- Physio
- Pain releif
- Topical/oral NSAIDs
- Steroids
- Shoulder arthroplasty
163
What is epicondyitis?
- Overloading tendon injuries
- Can occur after unrecognised or minor trauma
- Can be caused by repetitive stress at the insertion site
164
What is a slang name for lateral epicondylitis?
-Tennis elbow
165
How is lateral epicondylitis caused and what symptoms will a patient have?
- Trauma to the proximal insertion of the extensor tendon
| - Causes lateral elbow pain and upper forearm pain and tenderness
166
Which age group is most commonly affected by lateral epicondylitis?
- 40-50
| - Occurs in people who have a job, sport or hobby which involves repetitive strain
167
What is the aetiology of lateral epicondylitis?
- Jobs involving repetitive heavy lifting or use of heavy tools
- Jobs involving movements that require an awkward posture
- New and unaccustomed strains ie DIY, moving house, lifting a new baby
168
How does lateral epicondylitis present?
-Gradual onset pain usually affecting the dominant arm.
>pain and tenderness over the lateral epicondyle of the humerus
>exacerbated by active and resisted movements of the extensor muscles of the forearm
169
What are 2 special tests that can be done to help diagnose lateral epicondylitis?
-Mill's test
>painful pronation
-Cozen's test
>painful resisted extension of the wrist
170
What is the slang name for medial epicondylitis?
-Golfer's elbow
171
What is the pathology behind medial epicondylitis?
- Reactive tendon pathology of the flexor forearm muscles causing medial elbow pain
- Caused by repetitive stress at the muscle-tendon junction at the medial epicondyle
172
Is tennis elbow or golfer's elbow more common?
-Tennis elbow
173
What is the usual aetiology of medial epicondylitis?
- Golf and other sports involving gripping or throwing
- Jobs and hobbies using other repetitive elbow movements
- Use of vibrating tools
174
How does medial epicondylitis present?
- Pain and tenderness over the medial epicondyle which radiates into the forearm
- Pain is aggrevated by wrist flexion and pronation
- May have associated ulnar neuropathy
175
What are the investigations for lateral and medial epicondylitis?
-Clinical diagnosis
-X ray of elbow, bloods, MRI
>if uncertain about diagnosis
176
What is the management for medial and lateral epicondylitis?
-Modify activities using or exacerbating symptoms
-Activity restriction
>Avoid lifting, gripping, pronation, supination
-Rehab exercises
-Corticosteroid injections
-Physiotherapy
177
What are the 5 stages of fracture healing?
- Haematoma formation
- Inflammation
- Callus formation
- Granulation tissue
- Remodelling
