Orthopaedics Flashcards by Lucy Searle

What is adhesive capsulitis?

Thickening and contraction of the glenohumeral joint capsule and formation of adhesions.

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What is the aetiology of adhesive capsulitis?

Idiopathic
Rotator cuff injury
Immobilisation

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What is the main risk factor for adhesive capsulitis?

Diabetes

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How does adhesive capsulitis present?

Pain before stiffness
Gradual and severe
Inability to sleep on the affected side
Usually non-dominant shoulder but can be bilateral

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Restriction of ADLs occurs in adhesive capsulitis due to what?

Impaired external rotation

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What are the phases of adhesive capsulitis

Phase 1 (severe pain and stiffness) lasts up to 9 months
Phase 2 (stiffness) lasts 4-12 months
Phase 3 (ROM increases) lasts 1-3 years

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How is adhesive capsulitis diagnosed?

Inability to do passive external rotation

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How is adhesive capsulitis managed?

Physio
Corticosteroid injection
Analgesia
Manipulation under anaesthesia

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How does MUA aid management of adhesive capsulitis?

Inflamed ligaments are torn, which stretched the capsule.

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Define Colles’ fracture.

Fracture through the distal metaphysis of the radius, within 2-3cm of the articular surface

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How does Colles’ fracture usually occur?

Fall onto an outstretched hand

results in forced dorsiflexion of the wrist

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What are the signs of Colles’ fracture?

Dinner fork deformity

Shortening, ulnar deviation, and dorsal deviation

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How is a Colles’ fracture reduced?

The opposite of the deformity - movement forwards, downwards, and medially

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After reduction, how is a Colles’ fracture managed?

Back slab and repeat X-Ray
Wrist immobilisation
Surgical reduction if intra-articular fractures

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Give three complications of Colles’ fracture.

Median/ulnar damage: acute carpal tunnel syndrome
Compartment syndrome
Mal/non-union leading to deformity

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Define a Smith’s fracture?

Fracture of the distal radius, with or without ulnar involvement, that has volar displacement of the distal fragments

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How does a Smith’s fracture usually occur?

Falling backwards onto an outstretched hand with the arm above it pronating as the body falls

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What is the deformity of a Smith’s fracture?

Garden spade

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How is a Smith’s fracture reduced?

Backwards and medially

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What does a hip fracture actually mean?

Fractured proximal femur; proximal to 5cm below the lesser trochanter.

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What does the term fractured neck of femur include?

Femoral neck - elderly
Femoral shaft and supracondyle - violent trauma in young adults
Stress fractures of the femoral neck

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What does an intracapsular fracture of the femur involve?

Fracture of the femoral neck between the edge of the femoral head and insertion of the capsule of the hip joint

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What is a complication of an intracapsular fracture of the femoral neck?

Avascular necrosis of the femoral head

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What does extracapsular fracture of the femur include?

Trochanteric and subtrochanteric

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Where is a trochanteric fracture?

Distal to the insertion of the hip capsule | Involves or is between the trochanters

Where is a subtrochanteric fracture?

Fractures less than 5cm below the lesser trochanter i.e. involves the proximal femoral shaft

What is the main risk factor for fractured femoral neck?

Increasing age and osteoporosis --> falls

How does a fracture of the femoral neck present?

History of a fall Pain in outer upper thigh or groin, that may radiate to the knee Inability to bear weight Aggravated by flexion and rotation of the leg

What is the usual deformity in a fractured neck of femur?

Affected leg may be shortened, adducted, and externally rotated.

How is fracture of the femoral neck diagnosed?

Anteroposterior pelvic and lateral hip X-Rays: - Disruption of the trabeculae - Abnormality of pelvic contours - Shenton's line is broken

How are fractured femoral necks classified?

Garden 1, 2, 3, 4

How are fractured neck of femurs managed?

Intracapsular: hip arthroplasty Extracapsular: internal fixation If patients are less fit then a hemiarthroplasty is performed

How is a shoulder dislocation managed?

Reduction Immobilisation Rehabilitation

How is a dislocated shoulder reduced?

Closed or manipulation under anaesthesia

What are the 7As of open fracture management?

``` ATLS Assessment Anti-sepsis Alignment Anti-tetanus Antibiotics Analgesia ```

Which fractures may result in compartment syndrome?

Open or closed long bone fractures

How does compartment syndrome present?

Excruciating pain out of keeping with symptoms Leg very tight Tachycardia and hypotension

How is compartment syndrome managed?

Open fasciotomy

What is the most common cause of shoulder, usually subacromial pain?

Rotator cuff disorders

What are three common rotator cuff disorders?

Rotator cuff tears Subacromial impingement Calcific tendonitis

What is the aetiology of rotator cuff disorders?

Post-traumatic | Overuse in athletes/occupations

What are the four rotator cuff muscles?

Subscapularis Infraspinatus Supraspinatus Teres minor

What is the function of the rotator cuff?

Stabilises the shoulder joint | Internal and external rotation of the shoulder

What is the rotator cuff tendon and where does it attach/pass?

One large tendon made from the four tendons of the rotator cuff muscles. Attaches to head of humerus and passes through the subacromial space

What is subacromial impingement?

Rotator cuff tendon becomes inflamed as it passes through the subacromial space.

How is subacromial impingement diagnosed?

Painful arc | 60-120 degrees of active abduction

What is the drop arm test used to diagnose?

A massive rotator cuff tear Px will be able to lower the arm to 90 degrees as this uses the deltoid muscle, but below 90 degrees the arm will drop to the side)

What is the aetiology of rotator cuff tears?

Younger - trauma | Elderly - atraumatic

How do you test the function of the infraspinatus?

Patient is seated Actively abducts humerus to 90 and flexes elbow to 90 Pressure applied to internal rotation Patient resists and tries to externally rotate humerus

How do you test the function of the subscapularis?

Patient is seated Affected arm at side with elbow flexed to 90 Pressure applied into external rotation Patient resists and tries to internally rotate arm OR LIFT OFF TEST

How do you test the function of the supraspinatus?

Empty can test - push arm down

What is calcific tendonitis causing shoulder pain?

Crystalline calcium phosphate is deposited in the rotator cuff tendon

What are the functions of the following: 1) Supraspinatus 2) Infraspinatus and teres minor 3) Subscapularis

1) Abduction 2) External rotation 3) Internal rotation

Which nerves supply the rotator cuff muscles?

``` Suprascapular nerve (C6-5) Axillary nerve (C5-6) - teres minor only ```

Give five risk factors for Carpal Tunnel Syndrome.

``` Pregnancy Oedema Rheumatoid arthritis Hypothyroidism Lunate fracture ```

What is seen on examination in Carpal tunnel syndrome?

Weakness of thumb abduction (abductor pollicis brevis) Wasting of thenar eminence Tinel's signs Phalen's sign

If conservative treatment of Carpal tunnel syndrome (wrist splints, steroid injection) fails, what is tried?

Surgical decompression - flexor retinaculum division

Which is the most common rotator cuff tear, and why?

Supraspinatus | Degeneration

What is the most common type of shoulder dislocation?

Glenohumeral - a type of anterior

What results from a posterior hip dislocation?

Shortened and internally rotated leg

Which medications are first line for back pain?

Oral NSAIDs

What are the signs of fat embolism following long bone fracture?

Fever Breathlessness Confusion Retinal haemorrhages

What is Dupuytren's contracture?

Condition of the palmar fascia causing it to fibrose and become stiff, causing contraction of the affected fingers.

How does lumbar spinal stenosis present?

A combination of back pain, neuropathic pain, and symptoms mimicking claudication Easier to walk uphill

Name two risk factors for Bakers' cyst.

Gout | Arthritis

What are the characteristics of ACL rupture?

Caused by twisting of the knee, popping noise may be heard RAPID onset of knee effusion Positive anterior draw test

What are characteristics of meniscal tears?

May be caused by twisting of the knee | Locking and giving way are common

How do you differentiate a popliteal artery aneurysm from a Bakers' cyst?

Aneurysm would be pulsatile | Bakers cyst can occur in any age group

Which nerve is most commonly injured during anterior dislocation of the shoulder?

Axillary nerve

What nerve may be injured during posterior dislocation of the hip?

Sciatic nerve

What are the characteristics of Paget's disease of bone?

Bone pain and deformities Deafness (nerve compression) High output cardiac failure Can lead to osteosarcoma

How is Paget's disease diagnosed and treated?

Very high ALP, normal Ca and PO4 IV pamidronate/zoledronate