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Phase 3B > Orthopaedics > Flashcards

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

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2
Q

What is the most common cause of back pain?

A

-Mechanical back pain (usually in the lumbar region)

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3
Q

What is the most common cause of back pain in the elderly?

A

-Spinal cord stenosis

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4
Q

What is the most common cause of back pain in the younger patient?

A

-Disc prolapse

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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
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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

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7
Q

Where are secondary metastases commonly from?

A
  • The 5 Bs
  • Bronchus
  • Breast
  • (B)Thyroid
  • (B)Prostate
  • (B)Kidney
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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
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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
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10
Q

What is yellow flag back pain?

A

-Back pain that is exaggerated by life stressors

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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
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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
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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

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14
Q

What will LFTs show in Paget’s disease?

A

-Increase in alkaline phosphatase

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15
Q

What is the management for mechanical back pain?

A 
-Lifestyle advice
>Exercise
>Desk/chair alterations
-NSAIDs
-Physiotherapy
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16
Q

What is the management for yellow back pain?

A
  • Reassurance
  • Referral to physio/chiropracters
  • Relieve life stress
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17
Q

What is the management for red flag back pain?

A

-Urgent referral to neurosurgeon or specialist orthopaedic surgeon
>Urgent MRI

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18
Q

What is carpal tunnel syndrome?

A

-Compression of the median nerve in the carpal tunnel causing numbness and tingling

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19
Q

What is the carpal tunnel formed by?

A
  • Carpal bones

- Flexor retinaculum

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20
Q

What is the epidemiology of carpal tunnel?

A
  • Incidence peaks in late 50s
  • Female > male
  • Obesity is a risk factor
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21
Q

What are genetic risk factors for carpal tunnel syndrome?

A
  • Square shaped wrist
  • Short stature
  • Family history
  • Hereditary neuropathy
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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
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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
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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
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25
Q

How does carpal tunnel syndrome present?

A
  • Numbness, pain and tingling in the distribution of the median nerve
  • Often worse at night
  • Weakness
  • +ve Phalen’s and Tinnel’s test
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26
Q

Investigations for carpal tunnel syndrome?

A
  • Clinical diagnosis
  • Electroneurography
  • Ultrasound
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27
Q

What is the management for carpal tunnel syndrome?

A
  • NSAIDs
  • Night splint
  • Corticosteroid injections
  • Surgical decompression
  • Physiotherapy (increase blood flow and therefore healing)
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28
Q

What is osteoarthritis?

A

-Clinical syndrome of joint pain accompanied by varying degrees of functional limitations and reduced quality of life

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29
Q

What is the most common form of arthritis?

A

-Osteoarthritis

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30
Q

Where does OA commonly affect?

A
  • Hips
  • Knees
  • Small joints of hands and fingers
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31
Q

What is the pathology behind OA?

A

-Repeated trauma causes:
>localised loss of cartilage
>remodelling of adjacent bone
>has associated inflammation

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32
Q

Who is affected by OA?

A

-Older people

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33
Q

What are some risk factors of OA?

A
  • 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
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34
Q

How does OA present?

A
  • 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
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35
Q

Where does OA in the knee cause pain?

A

-In and around the knee

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36
Q

Where does OA in the hip cause pain?

A
  • Pain in the groin, anterior or lateral thigh

- Can cause referred pain in the knee or testicle of the affected side in males

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37
Q

Where do OA nodules commonly form and what are they called?

A
  • Heberden’s nodes: DIPJ

- Bouchard’s nodes: PIPJ

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38
Q

What is needed for a clinical diagnosis of OA?

A

> 45 years
Activity related joint pain
Less than 30 mins morning stiffness

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39
Q

What are the investigations for OA?

A
  • Clinical examination
  • X ray
  • MRI
  • Blood tests: Normal in OA
  • Joint aspiration: Exclusion of septic arthritis and gout
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40
Q

What are the X ray signs of OA?

A
  • Loss of joint space
  • Osteophytes
  • Subchondral sclerosis
  • Subchondral cysts
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41
Q

What is the non-pharmacological management for OA?

A 
-Hollistic approach
>function, QOL, occupation, mood, relationships, leisure activities
-Weight loss
-Walking aids and physio assessment
-Increase exercise
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42
Q

What are some drug treatments for OA?

A
  • Topical NSAIDs
  • Oral NSAIDs + PPI
  • Intra-articular injections
  • Surgery
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43
Q

What is the prevention for OA?

A
  • Weight control
  • Increasing physical activity
  • Avoiding injury
  • Education about OA
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44
Q

What is a scissor gait?

A

-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

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45
Q

What is a shuffling gait?

A
  • Seen in parkinsons

- Rigidity and bradykinesia

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46
Q

What is a trendelenberg gait?

A
  • Weakness in abductor muscles and gluteus medias

- The hip moves outwards and the shoulder dips to compensate

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47
Q

What is a high stepping gait?

A

-Lesion of the common peroneal nerve
>Caused by: Compression, trauma, vasculitis, syphilis
-Diabetes
-Disc herniation

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48
Q

What is an ataxic gait?

A

-Like the patient is drunk
-Wide base
Other ataxic signs: Nystagmus, hypotonia, Dysdiadokinesia, intention tremor

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49
Q

What is an antalgic gait?

A

-Decreased standing stage on the affected leg

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50
Q

What is tiptoeing gait?

A

-Children with DDH, leg length discrepency

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51
Q

What is achilles tendinopathy?

A

-Chronic overuse of the achilles tendon

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52
Q

Who most commonly suffers from achilles tendinopathy?

A

-Active people who participate in sports that involve running or jumping

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53
Q

What forms the achilles tendon and where does it insert?

A

-Gastrocnemius and soleus forms around the mid calf and inserts onto the posterior calcaneus

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54
Q

What are risk factors for achilles tendinopathy??

A 
-Activities such as:
>running
>jumping
>dancing
-Change in footwear or training surface
-Poor running technique
-Family history
-DM
-HTN
-Quinolone abx
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55
Q

How does achilles tendinopathy present?

A

-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

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56
Q

What investigations would you do is achilles tendinopathy was suspected? Why?

A
  • USS
  • MRI
  • To differentiate between tendinopathy and partial thickness tears
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57
Q

What is the management for achilles tendinopathy?

A
  • RICE
  • NSAIDs
  • Heel lifts
  • Alteration of activities in the short term
  • Stretches
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58
Q

What is the epidemiology of an achilles tendon rupture?

A
  • Recreational athletes between 30s-50s

- Commonly seen in football, basketball, running, tennis

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59
Q

What are risk factors for achilles tendon rupture?

A
  • Increasing age
  • Chronic or recurrent achilles tendinopathy
  • Systemic or injected steroids (around the achilles tendon)
  • Systemic conditions ie RA, SLE
  • Quinolone abx
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60
Q

How does an achilles tendon rupture present?

A
  • 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
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61
Q

What is simmonds test?

A
  • Test for achilles tendon rupture

- Squeezing of the calf muscle doesn’t cause the foot to move

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62
Q

What are some differential diagnosis of achilles tendon rupture?

A
  • Achilles tendinopathy
  • Retrocalcaneal bursitis
  • Plantaris muscle injury
  • Other ankle injury
  • Ankle OA
  • Rupture baker’s cyst
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63
Q

What investigations would you do for achilles rupture?

A

-USS or MRI

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64
Q

What is the conservative management for an achilles tendon rupture?

A
  • Rest
  • Pain control
  • Walking boot for 2 weeks
  • Weight bearing as tolerated from 4-6 weeks
  • Orthosis
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65
Q

What is the surgical management reserved for?

A
  • Younger more active patients

- Reduces the chances of re-rupture

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66
Q

What is the medical name for bunions?

A

-Hallux valgus

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67
Q

What are bunions?

A

-Lateral deviation of the great toe causing a valgus deformity deformity of the first metatarsoplangeal joint.

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68
Q

What some potential consequences of bunions

A
  • Subluxation of the first MTP joint

- Great toe may overlap the second toe

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69
Q

What is the epidemiology of bunions?

A
  • Female >Male
  • Significant family history
  • Bilateral
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70
Q

What are risk factors for bunions?

A
  • 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
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71
Q

How does a patient with bunions present?

A

-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
Q

What needs to be included in the medical history when a patient presents with bunions?

A

-Check if patient is immunosuppressed as that can increase the risk of complications and increase healing time

73
Q

What investigations do you do for bunions?

A

-Clinical diagnosis
-X ray
>Shows degree of deformity and presence of subluxation

74
Q

What are some differentials for bunions?

A
  • Hallux rigidus
  • Sesamoiditis
  • Fracture
  • Gout
  • RA
  • Neuropathic pain
  • Infection
75
Q

What is the Conservative management for bunions?

A 
-Appropriate footwear
>low heeled, soft soled, loose fitting
>Laces or adjustable straps
-Analgesia
-Bunion pads
-Ice packs
-Podiatry referral
76
Q

When should surgery for bunions be considered?

A
  • When the pain caused is not responding to conservative measures
  • Affected second toe
  • Inhibition of activity or lifestyle
77
Q

What are some complications of bunions?

A
  • 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
Q

What are the 4 ligaments of the knee and what is the mnemonic to remember their relation to the menisci?

A
  • 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
Q

What do the ligaments in the knee do?

A
  • 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
Q

How are knee ligament injuries graded?

A

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
Q

After an acute injury, what are the differentials of a large tense effusion over 0-2 hours?

A
  • Ligamentous injury, especially ACL
  • Fracture
  • Dislocation
82
Q

When is an injury to the MCL most likely to occur?

A
  • Injury involves a direct blow to the lateral aspect of the knee
  • Twisting injury
83
Q

What test is used to identify an injury to the MCL?

A

-Valgus stress test

84
Q

What investigation is required to identify ligamentous injuries?

85
Q

What is the general management for a MCL injury?

A 
-PRICER
>Protect, Rest, Ice, Compression, Elevation, Rehabilitation
-Braces
-Non-weight bearing
-Surgery
86
Q

How is an injury to the LCL most likely to happen?

A
  • Medial blow to the knee
  • Varus stress in running
  • Yoga
87
Q

What is the test for LCL injury?

A

-Varus stress test

88
Q

What is the general management for LCL injuries?

A
  • PRICER
  • Knee brace locked in full extension and weight bearing as tolderated
  • Surgery
89
Q

How are younger patients most likely to rupture their ACL?

A

-High impact twisting injuries ie football, basketball

90
Q

How are older patients most likely to rupture their ACL?

91
Q

What is the mechanism of an ACL injury?

A

-Non-contact deceleration or change in direction with a fixed foot that produces a valgus twisting injury

92
Q

What are ACLs commonly associated with?

A

-Meniscal injuries

93
Q

What is the management for an ACL injury?

A

-Conservative
>Physio to strengthen hamstrings and quads
>Exercises in one plane of movement
-Surgery

94
Q

What is the immediate Mx for an acute ACL injury?

95
Q

What causes PCL injuries?

A

-Hyperextension typically from a direct blow to the proximal tibia with the knee in flexion

96
Q

What will the patient not like to do if they’ve ruptured their PCL?

A

-Won’t like walking down stairs

97
Q

What is the management for a PCL injury?

A
  • PRICER
  • Axillary crutches and leg brace
  • Weight bear as tolerated
  • Rehab
  • Surgery
98
Q

What is pes planus?

A

Loss of the medial longitudinal arch of the foot (flat feet)

99
Q

What are the purposes of the arches of the feet?

A
  • 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
Q

Who is affected by flat feet?

A
  • Children

- Flexible hypermobile people

101
Q

What might cause flat feet in children?

A
  • Part of normal development
  • Obesity
  • Neurological problems ie CP, polio
  • Bony abnormalities ie fusion of tarsal bones
  • Ligamentous laxity ie Ehlers-Danlos
102
Q

What might cause flat feet in adults?

A 
-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
Q

How might someone with pes planus present?

A
  • Pain in foot, ankles, knees, hips or spine

- Altered gait

104
Q

What investigations are needed for pes planus?

A

-X ray (standing)

>AP, lateral

105
Q

What is the management for pes planus in children?

A
  • Foot orthoses

- Surgery

106
Q

What is the management for pes planus in adults?

A
  • Activity modification
  • Footwear and orthoses
  • Exercise
  • NSAIDs
  • Surgery
107
Q

What are the different types of potential femoral fractures?

A
  • 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
Q

What is the definition of a hip fracture?

A

-Fracture of the proximal femur (proximal to 5cm below the lesser trochanter)

109
Q

What is an intracapsular hip fracture?

A

-The femoral neck between the edge of the femoral head and insertion of the capsule of the hip joint are involved.

110
Q

Why are intracapsular hip fractures important to identify?

A

-Can cause avascular necrosis of the femoral head

111
Q

What are the causes of hip fractures in elderly and in younger people?

A
  • Elderly: osteoporosis causing fragility fractures

- Younger patients: high energy trauma. More likely to result in serious injuries

112
Q

What are risk factors for hip fractures?

A

-Increasing age
-Osteoporosis
-Osteomalacia
-Increased risk of falls
>Instability
>Lack of core strength
>Gait disturbance
>Sensory impairment

113
Q

How do patients with hip fractures present?

A

-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
Q

How are hip fractures diagnosed?

A

-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
Q

What is Garden’s classification of intracapsular neck of femur fractures?

A

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
Q

What investigations are used in an assessment of a patient with a NOF fracture?

A 
-Bloods
>FBC, U&amp;E, G&amp;S, crossmatch
>Blood glucose
>ECG
>CXR
>Iv access
-Cognitive impairment assessment
-Treatment of treatable comorbidities
117
Q

How are NOF fractures managed?

A

-Surgery
>internal fixation with screws
>hip replacement (hip arthroplasty)

118
Q

What are some complications of NOF fracture?

A 
-High mortality
>Infection
>Haemorrhage
>Avascular necrosis
>Pneumonia
>MI
>Stroke
>DVT, PE
119
Q

How are femoral shaft fractures sustained?

A
  • High energy injury ie RTA

- Pathological fracture ie osteoporosis, metastatic disease

120
Q

What are the different forms of fractures?

A
  • Transverse
  • Oblique
  • Spiral
  • Comminuted
  • Open
  • Closed
121
Q

What is required for a diagnosis of a femoral shaft fracture?

A
  • Severe pain with supporting history of injury
  • Tense, swollen, tender thigh
  • Inability to weight bear
  • Deformity and shortening of the affected side
122
Q

What investigations are needed for a femoral shaft fracture?

A

-X ray
>AP and lateral
>Ipsilateral knee

123
Q

What is the management for femoral shaft fracture?

A
  • Bloods: FBC, Cross match, G+S
  • Iv access and fluid replacement
  • Analgesia
  • Surgery
124
Q

What are some early complications of a femoral fracture?

A
  • Neurovascular damage from sharp bone ends
  • Bleeding
  • Acute compartment syndrome
  • Infection
  • Delayed healing
125
Q

What are some late complications of a femoral fracture?

A
  • Fat embolism
  • DVT
  • PE
  • Infection
  • Shortening, angulation and malalignment
126
Q

What are supracondylar fractures and how are they caused?

A
  • Fractures of the distal third of the femur

- Direct trauma

127
Q

What are supracondylar fractures associated with?

A
  • Damage to the knee joint

- May cause damage to the popliteal artery

128
Q

What is frozen shoulder?

A
  • Adhesive capsulitis

- A glenohumeral disorder causing intrinsic pain and loss of movement

129
Q

How does frozen shoulder occur?

A

-Thickening and contraction of the glenohumeral joint capsule and formation of adhesions causes pain and loss of mobility

130
Q

Who is affected by frozen shoulder?

A
  • Commonly affects 40-65 year olds
  • Female>Male
  • Increased risk for patients with DM or thyroid disorders
131
Q

How does frozen shoulder present?

A 
-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
Q

What is phase 1 of frozen shoulder?

A
  • Severe generalised pain with associated stiffness
  • Daily activities are limited
  • Can last up to 9 months
133
Q

What is phase 2 of frozen shoulder?

A

-Pain gradually subsides but residual stiffness
-Movement can become more limited
>External rotation is commonly affected
-Lasts between 4-12 months

134
Q

What is phase 3 or frozen shoulder?

A
  • Shoulder becomes less stiff
  • Increase in range of movement
  • Usually lasts within 1-3 years
135
Q

What investigations are needed for suspected frozen shoulder?

A

-Clinical diagnosis
>Tender on palpation
>Inability to externally rotate
-X rays are generally normal

136
Q

How should frozen shoulder be managed?

A
  • Simple analgesia
  • Encourage physical activity
  • Physiotherapy
  • Steroid injections in early stage disease
137
Q

What are the 3 joints forming the shoulder?

A
  • Glenohumeral joint
  • Acromioclavicular joint
  • Sternoclavicular joint
138
Q

What are the muscles of the rotator cuff?

A
  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis
139
Q

What does the supraspinatus muscle do?

What’s the innervation?

A
  • Abducts 0-15 and then assists deltoid from 15-90

- Suprascapular nerve

140
Q

What does the infraspinatus muscle do? What’s the innervation?

A
  • Externally rotates the arm

- Suprascapular nerve

141
Q

What does the teres minor muscle do? What’s the innervation?

A
  • Externally rotated the arm

- Axillary nerve

142
Q

What does subscapularis muscle do? What’s the innervation?

A
  • internal rotation of the arm

- Upper and lower subscapular nerves

143
Q

What are some of the other muscles that make up the shoulder?

A
  • Deltoid
  • Teres major
  • Trapezius
  • Latissmus dorsi
  • Levator scapulae
  • Rhomboid major and minor
144
Q

What are some risk factors for shoulder pain?

A

-Occupations, sports, hobbies that include repetitive movements
-Psychosocial factors
>Stress, job pressure, social support
-Athletes lifitng above their heads, high impact sports

145
Q

What occupations are more prone to expreience shoulder pain?

A
  • Cashiers
  • Bricklayers
  • Construction workers
  • Painter/decorators
  • Welders
  • Hair dressers
  • Plasterers
146
Q

What are some causes of intrinsic shoulder pain?

A
  • Rotator cuff disorders
  • Glenohumeral disroders
  • Acromioclavicular disorders
  • Infection
  • Shoulder instability
147
Q

What are rotator cuff tears?

A
  • 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
Q

What are examples of glenohumeral disorders?

A
  • Adhesive capsulitis

- Arthritis

149
Q

What are some causes of extrinsic shoulder pain?

A

-Referred pain
>Neck pain, MI
-PMR
-Malignancy

150
Q

What are rotator cuff disorders also called?

A
  • Subacromial impingement
  • Rotator cuff syndrome
  • Subacromial pain
  • Supraspinatus tendonitis
  • Rotator cuff tendinopathy
  • Painful arc cyndrome
151
Q

What age range does rotator cuff disorders affect?

A

-30-75 years old

152
Q

What can subacromial impingement lead to?

A
  • 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
Q

How does subacromial impingement occur?

A

-Repetitive movements and heavy lifting above shoulder level causes impingement of tendons

154
Q

What is likely to be seen O/E of subacromial impingement?

A
  • Muscle wasting, painful movements, restricted active movements
  • Painful arc between 70-120
155
Q

How are rotator cuff tears likely to be sustained in younger patients and the elderly?

A
  • Young: trauma

- Elderly: atraumatic

156
Q

What are the common causes of acromioclavicular disorders?

A
  • Trauma

- OA

157
Q

How do acromioclavicular disorders present?

A

-Pain and tenderness localised to the AC joint

>Restriction of passive, horizontal movement of the arm across the body

158
Q

What are the red flag symptoms of shoulder pain?

A
  • History or presentation of malignancy
  • Overlying skin erythema
  • Presentation of systemic illness ie PMR
  • Fever
  • History of trauma
  • Recurrent convulsions
  • Neurological symptoms
159
Q

What are some investigations that can be done for shoulder pain?

A
  • USS
  • X rays
  • MRI
160
Q

What is the management for rotator cuff disorders?

A
  • Advise modification of activities
  • Analgesia
  • Physiotherapy
  • Corticosteroid injections
  • Rest
161
Q

What management may be required to repair rotator cuff tears?

A
  • Physio and steroids for minor tears

- Surgery for major tears

162
Q

What management may be needed for degeneration of the humeral head?

A
  • Physio
  • Pain releif
  • Topical/oral NSAIDs
  • Steroids
  • Shoulder arthroplasty
163
Q

What is epicondyitis?

A
  • Overloading tendon injuries
  • Can occur after unrecognised or minor trauma
  • Can be caused by repetitive stress at the insertion site
164
Q

What is a slang name for lateral epicondylitis?

A

-Tennis elbow

165
Q

How is lateral epicondylitis caused and what symptoms will a patient have?

A
  • Trauma to the proximal insertion of the extensor tendon

- Causes lateral elbow pain and upper forearm pain and tenderness

166
Q

Which age group is most commonly affected by lateral epicondylitis?

A
  • 40-50

- Occurs in people who have a job, sport or hobby which involves repetitive strain

167
Q

What is the aetiology of lateral epicondylitis?

A
  • 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
Q

How does lateral epicondylitis present?

A

-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
Q

What are 2 special tests that can be done to help diagnose lateral epicondylitis?

A

-Mill’s test
>painful pronation
-Cozen’s test
>painful resisted extension of the wrist

170
Q

What is the slang name for medial epicondylitis?

A

-Golfer’s elbow

171
Q

What is the pathology behind medial epicondylitis?

A
  • 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
Q

Is tennis elbow or golfer’s elbow more common?

A

-Tennis elbow

173
Q

What is the usual aetiology of medial epicondylitis?

A
  • Golf and other sports involving gripping or throwing
  • Jobs and hobbies using other repetitive elbow movements
  • Use of vibrating tools
174
Q

How does medial epicondylitis present?

A
  • 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
Q

What are the investigations for lateral and medial epicondylitis?

A

-Clinical diagnosis
-X ray of elbow, bloods, MRI
>if uncertain about diagnosis

176
Q

What is the management for medial and lateral epicondylitis?

A

-Modify activities using or exacerbating symptoms
-Activity restriction
>Avoid lifting, gripping, pronation, supination
-Rehab exercises
-Corticosteroid injections
-Physiotherapy

177
Q

What are the 5 stages of fracture healing?

A
  • Haematoma formation
  • Inflammation
  • Callus formation
  • Granulation tissue
  • Remodelling

Phase 3B (14 decks)

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