Orthopaedics Flashcards
What is adhesive capsulitis?
Thickening and contraction of the glenohumeral joint capsule and formation of adhesions.
What is the aetiology of adhesive capsulitis?
Idiopathic
Rotator cuff injury
Immobilisation
What is the main risk factor for adhesive capsulitis?
Diabetes
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
Restriction of ADLs occurs in adhesive capsulitis due to what?
Impaired external rotation
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
How is adhesive capsulitis diagnosed?
Inability to do passive external rotation
How is adhesive capsulitis managed?
Physio
Corticosteroid injection
Analgesia
Manipulation under anaesthesia
How does MUA aid management of adhesive capsulitis?
Inflamed ligaments are torn, which stretched the capsule.
Define Colles’ fracture.
Fracture through the distal metaphysis of the radius, within 2-3cm of the articular surface
How does Colles’ fracture usually occur?
Fall onto an outstretched hand
results in forced dorsiflexion of the wrist
What are the signs of Colles’ fracture?
Dinner fork deformity
Shortening, ulnar deviation, and dorsal deviation
How is a Colles’ fracture reduced?
The opposite of the deformity - movement forwards, downwards, and medially
After reduction, how is a Colles’ fracture managed?
Back slab and repeat X-Ray
Wrist immobilisation
Surgical reduction if intra-articular fractures
Give three complications of Colles’ fracture.
Median/ulnar damage: acute carpal tunnel syndrome
Compartment syndrome
Mal/non-union leading to deformity
Define a Smith’s fracture?
Fracture of the distal radius, with or without ulnar involvement, that has volar displacement of the distal fragments
How does a Smith’s fracture usually occur?
Falling backwards onto an outstretched hand with the arm above it pronating as the body falls
What is the deformity of a Smith’s fracture?
Garden spade
How is a Smith’s fracture reduced?
Backwards and medially
What does a hip fracture actually mean?
Fractured proximal femur; proximal to 5cm below the lesser trochanter.
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
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
What is a complication of an intracapsular fracture of the femoral neck?
Avascular necrosis of the femoral head
What does extracapsular fracture of the femur include?
Trochanteric and subtrochanteric
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
