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Musculoskeletal System > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

what is Paget’s disease of the bone?

A

it’s a condition characteristed by disorganised bone resorption and formation

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2
Q

how can Paget’s disease present?

A 
often asymptomatic
bone pain
heat over affected area
patient >40yo
raised ALP
hearing loss
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3
Q

what is the treatment for Paget’s disease?

A

normally no treatment. if severe, one off IV bisphosphonate injection (zolendronic acid)

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4
Q

what is the difference between rickets and osteomalacia?

A

rickets is Vit D deficiency in growing child, osteomalacia is Vit D deficiency in adults

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5
Q

why does vitamin D deficiency cause rickets and osteomalacia?

A

because it impairs the absorption of calcium, therefore preventing proper bone mineralisation

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6
Q

how does rickets present?

A

bone deformities
growth impairment
muscle weakness and pain

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7
Q

how does osteomalacia present?

A

bone pain
fractures
muscle weakness and pain

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8
Q

what is osteogenesis imperfecta?

A

a genetic condition that affects Type 1 collagen

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9
Q

name some symptoms of osteogenesis imperfecta

A 
frequent fractures
short stature
growth impairment
blue sclera
dentigenesis imperfecta
hyperlaxity
scoliosis
hearing loss
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10
Q

how is osteogenesis imperfecta managed?

A
  • bisphosphonates to prevent fractures
  • surgery for fractures
  • social adaptations
  • genetic counselling
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11
Q

what is the definition of osteoporosis?

A

thin bones with increased risk of low trauma fractures

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12
Q

what is the purpose of a DXA scan?

A

it measures bone density in the desired area

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13
Q

given the pathogenesis of Paget’s disease, what can be a complication of the condition?

A

the disordered osteoblast/osteoclast activity could give rise to osteosarcoma

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14
Q

what is the difference between osteopenia and osteoporosis?

A

osteoporosis is a more severe stage of bone loss than osteopenia

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15
Q

what is the first line treatment for osteoporosis?

A

bisphosphonates

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16
Q

name a few side effects of bisphosphonates

A

oesophagitis

uveitis

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17
Q

which patient groups are most likely to develop osteoporosis?

A

men over 50
women post menopause
patients on long-term steroids

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18
Q

name a few treatment options for patients with osteoporosis

A

bisphosphonates
HRT (women)
denosumab (anti-RANKL)
teriparatide

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19
Q

name a few side effects of HRT for osteoporosis

A

increased risk of breast ca if prolonged use

increased risk of blood clots/MI/stroke

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20
Q

what causes gout?

A

build up of uric acid in joint spaces

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21
Q

what is the management of an acute attack of gout?

A

NSAIDS
colchicine
steroids
lifestyle advice

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22
Q

should asymptomatic hyperuricaemia be treated?

A

no

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23
Q

should you attempt to treat hyperuricaemia before, during or after an acute attack of gout

A

wait until after the acute attack has settled

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24
Q

what medications can be used to treat hyperuricaemia?

A

allopurinol
febuxostat
probenecit
canakinumab

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25
Q

name a few causes of uric acid underexcretion

A 
renal impairment
hypertension
hypothyroidism
certain drugs (eg alcohol, diuretics)
dehydration
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26
Q

name a few causes of uric acid overproduction

A 
malignancy
severe psoriasis
drugs (eg alcohol)
metabolic diseases
HGPRT deficiency
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27
Q

what is pseudogout?

A

a type of arthritis, similar to gout, but which normally presents in knee joints in elderly women and is caused by a build up of different crystals to gout

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28
Q

what is polymyalgia rheumatica?

A

sudden severe stiffness of shoulder and/or pelvic girdle

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29
Q

what is the treatment for pseudogout?

A

NSAIDS

steroids

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30
Q

what investigation can be done to confirm gout when diagnosis is not clear?

A

synovial fluid analysis for crystals

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31
Q

what condition is polymyalgia rheumatica often associated with?

A

giant cell arteritis

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32
Q

name a few signs/symptoms of polymyalgia rheumatica

A

high ESR
old age (>70)
anaemia
malaise

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33
Q

what is the treatment for polymyalgia rheumatica?

A

prednisolone

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34
Q

what are the four stages of bone fracture healing?

A
  1. inflammation
  2. soft callus
  3. hard callus
  4. bone remodelling
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35
Q

how does inflammation promote the start of bone healing after a fracture?

A

inflammation encourages blood supply to increase to the fractured area

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36
Q

how does muscle attempt to stabilise the bone after a fracture?

A

it contracts to try keeping the bone together

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37
Q

what does formation of a soft callus depend on in bone fracture repair?

A

formation of a soft callus depends on the blood and oxygen supply to fractured area

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38
Q

why is it better to use someone’s own bone when using a bone graft to repair a fracture, rather than using bone from the bone bank?

A

own bone is made of collagen reinforced with crystals, which is stronger than hydroxy-apatite crystals alone which make up bone bank bone

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39
Q

how does a soft callus become a hard callus during bone fracture repair?

A

fibroblasts that make up the soft callus turn into osteocytes in response to mechanical strain

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40
Q

which ossification centres are responsible for 1. circumferential bone growth; 2. longitudinal bone growth?

A
  1. primary (endochondral) ossification centre

2. secondary (epiphyseal) ossification centre

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41
Q

what process occurs during the formation of hard callus in bone fracture repair?

A

cartilage is replaced by woven bone

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42
Q

what process occurs during bone remodelling in bone fracture repair?

A

woven bone is replaced by lamellar bone

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43
Q

what external stimulus is crucial for bone fracture repair?

A

mechanical strain

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44
Q

name a few factors which can cause delayed union in bone fracture repair

A 
high energy injury
infection
instability
distraction
smoking
drugs (steroids, warfarin, NSAIDS, immunosuppressants, ciprofloxacin)
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45
Q

what is the pathology behind acute osteomyelitis?

A

infection reaches bone through blood supply at metaphysis.
inflammation results in increased pressure.
pus is released into medulla/periosteum.
pus in joint causes bone destruction and reformation.
outcome is resolution or chronic osteomyelitis

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46
Q

what is the most common organism to cause acute osteomyelitis?

A

staph aureus

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47
Q

if osteomyelitis occurs as a result of standing on a nail, what is the most likely organism?

A

pseudomonas

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48
Q

how does acute osteomyelitis present in infants?

A
  • irritability
  • failure to thrive
  • may be fine or very unwell
  • swollen tender joint
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49
Q

where does acute osteomyelitis commonly present in infants?

A

knee joint

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50
Q

how does acute osteomyelitis present in children/adolescents?

A
  • severe pain
  • no weight-bearing
  • painful tender joint
  • reduced range of movement
  • swinging fever
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51
Q

why does osteomyelitis cause a swinging fever?

A

due to the presence of pus

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52
Q

what investigations can be done to confirm a diagnosis of acute osteomyelitis?

A 
blood cultures (x3)
FBC (esp neutrophil count)
ESR
CRP
U&E
joint aspiration
X-ray
bone scan
ultrasound (especially in children)
MRI
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53
Q

how is acute osteomyelitis treated?

A

fluid and pain management
rest/splintage
antibiotics
surgery

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54
Q

what is the term for the bone destruction/necrosis process in osteomyelitis?

A

sequestrum

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55
Q

what is the term for new bone formation in osteomyelitis?

A

involucrum

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56
Q

name a few examples of when surgery may be indicated in acute osteomyelitis

A

aspiration of pus for diagnostic purposes
abscess drainage/lavage
debridement of dead tissue from infected area
infected joint replacement

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57
Q

name a few complications that can occur as a result of acute osteomyelitis

A 
abnormal bone growth 
chronic osteomyelitis
metastatic infection
pathological fractures
septic arthritis
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58
Q

in which part of a long bone is acute osteomyelitis likely to start, and why?

A

commonly originates in the metaphysis, because it’s the most vascular area of the bone

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59
Q

name a few ways an infection can spread to cause osteomyelitis

A 
hematogenous spread (eg from skin abrasions, tonsilitis)
local spread (eg fracture, prosthetic)
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60
Q

which bones are more likely to develop osteoarthritis?

A

long bones

bones with intra-articular metaphysis (eg hip, radius)

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61
Q

what is the pathology behind chronic osteomyelitis?

A

chronic inflammation, possibly caused by retention of dead tissue inside the involucrum of new bone

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62
Q

how is chronic osteomyelitis managed?

A

long-term antibiotics

surgery for debridement/reconstruction

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63
Q

name a few likely organisms to be involved in chronic osteomyelitis

A
  • staph aureus
  • strep pyogenes
  • e. coli
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64
Q

which bones are more likely to be affected by osteomyelitis in children and adults respectively?

A

children - limbs

adults - spine, hips

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65
Q

what is the pathology of septic arthritis?

A

an infection of the joint space

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66
Q

what is the commonest cause of septic arthritis in adults?

A

infection of joint replacement

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67
Q

name a few likely organisms to cause septic arthritis

A
  • staph aureus
  • strep pyogenes
  • e. coli
  • haemophilus influenzae
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68
Q

what investigations are done to diagnose septic arthritis?

A 
FBC (WBC)
ESR/CRP
blood cultures
joint aspirate testing
ultrasound
x-ray/MRI
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69
Q

how is septic arthritis treated?

A

pain/fluid management
long term antibiotics
joint lavage/drainage
joint replacement/reconstruction

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70
Q

what is the classification of bone/joint involvement in tuberculosis?

A

vertebral (most common)
intra-articular
extra-articular

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71
Q

what is the pathology of tuberculosis in the bone?

A
  • initial site of infection (lung, GIT)

- secondary spread of infection

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72
Q

what investigations are done to diagnose bone tuberculosis?

A 
Mantoux test
sputum/urine swab
FBC
CRP/ESR
x-ray
MRI
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73
Q

what is the management of bone tuberculosis?

A

Rest/splintage

Anti-TB medication (isoniazin, ethambutol, pirazynamide, rifampicin)

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74
Q

What is the most common site of bone tuberculosis?

A

Spine

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75
Q

How can bone tuberculosis present?

A

Back pain
Kyphosis
Osteopaenia around infection site

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76
Q

how can bone tuberculosis present?

A

back pain
Kyphosis
osteopaenia around infection site
systemic symptoms of TB

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77
Q

in the knee, which meniscus is more likely to tear and why?

A

medial is more likely to tear as it is more fixed and less flexible

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78
Q

what is the treatment of a meniscal tear?

A

rest
NSAIDS
physiotherapy

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79
Q

how does a meniscal tear present?

A

swelling
locking
clicking
pain

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80
Q

what investigations are done to diagnose a meniscal tear?

A

x-ray

MRI

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81
Q

how does an ACL tear normally occur?

A

due to a twist in the knee on landing

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82
Q

why do meniscal tears not tend to heal?

A

because they have very limited blood supply

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83
Q

what is the unhappy triad of the knee?

A

ACL rupture
medial meniscus rupture
MCL rupture

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84
Q

name a few immediate symptoms of an ACL tear

A 
pop/crack sound
deep pain
haemarthrosis
swelling
instability
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85
Q

which ligament in the knee only really tends to rupture as a result of an ACL tear?

A

anterolateral ligament

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86
Q

what are treatment options for ACL tears?

A

non-surgical: quadriceps muscle strenghtening

surgical: ACL reconstruction

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87
Q

what is the most common ligament to tear in the knee?

A

medial collateral ligament

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88
Q

how does an MCL tear normally occur?

A

contact causing severe valgus stress on the knee

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89
Q

how does an MCL normally present?

A

pop/crack sound
swelling
severe pain
bruising on medial side of knee

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90
Q

how is MCL normally managed?

A

conservatively with rest, NSAIDS, physiotherapy and sometimes a brace

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91
Q

what is osteochondrosis dissecans?

A

a condition which causes parts of articular cartilage/subchondral bone to fragment resulting in inflammation in the joint

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92
Q

which insertion of the ligament is normally ruptured during a MCL tear?

A

the femoral insertion of the MCL

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93
Q

what is osteochondrosis dissecans?

A

a condition which causes parts of articular cartilage and/or subchondral bone to fragment and cause inflammation in the joint

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94
Q

how is osteochondrosis dissecans normally managed?

A

arthroscopy to fixate loose fragment

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95
Q

what are common causes of osteochondrosis dissecans in children and adults?

A

children/adolescents - activity related

adults - secondary to avascular necrosis

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96
Q

name a few things that can cause trochanteric bursitis

A

overuse
trauma
abnormal use

97
Q

how can trochanteric bursitis be treated?

A

NSAIDS
rest/activity change
physiotherapy
steroid injection

98
Q

why is bursitis not normally treated surgically?

A

due to high risk of complications and leaking sinuses

99
Q

how can avascular necrosis be treated?

A 
rest
NSAIDS
anticoagulants
surgical restoration of blood supply
hip replacement
100
Q

name a few risk factors for avascular necrosis of the hip

A 
trauma
radiation
hypercoagulability
idiopathic
iatrogenic
alcoholism
steroid use
dislocation
101
Q

how does avascular necrosis of the hip present?

A

insidious pain in groin
trouble walking uphill/upstairs
limp

102
Q

what are the two types of femoroacetabular impingement?

A

CAM and pincer

103
Q

what is a CAM lesion in FAI?

A

the neck of femur is too wide and restricts movement in acetabulum

104
Q

what is a pincer lesion in FAI?

A

the acetabulum is too deep and restricts movement of the femur

105
Q

name a few ways FAI can present

A

pain in groin
locking
reduced range of movement
pain with certain movements

106
Q

how is femoroacetabular impingement treated?

A

rest
physiotherapy
NSAIDS
surgery - arthroscopy to shave off extra bone

107
Q

who is most likely to get a pincer lesion FAI?

A

athletic females

108
Q

what test is positive during a FAI examination?

A

FADIR test:

  • flexion
  • adduction
  • internal rotation
109
Q

what test is positive during an examination for a labral tear in the hip joint?

A

FABER test:

  • flexion
  • abduction
  • external rotation
110
Q

what is the treatment for labral tears in the hip joint?

A

NSAIDS
rest
steroid injection
surgery - arthroscopy to repair tear

111
Q

name a few causes of labral tears in the hip joint

A

osteoarthritis
FAI
trauma

112
Q

what is the difference between an incise wound and a stab wound?

A

incise wound is longer than it is deep - ie a slash

stab wound is deeper than it is long

113
Q

what is a contusion?

A

a bruise caused by force on the skin

114
Q

what are tramline bruises normally caused by?

A

rod or cylinder shaped objects pushing blood to either side of the impacted area

115
Q

name a few factors that can differentiate a laceration from an incise wound

A

lacerations have irregular edges, more bruising around the wound and some abrasion

116
Q

what kinds of injuries can blunt force trauma cause?

A

contusions
abrasions
lacerations

117
Q

what kinds of injuries can sharp force trauma cause?

A

incise wounds

stab wounds

118
Q

damage to which part of the brachial plexus causes Erb’s palsy? which nerve roots are involved?

A

damage to upper trunk

C5-C6 roots involved

119
Q

damage to which part of the brachial plexus causes Klumpke’s palsy? which nerve roots are involved?

A

damage to lower trunk

C8-T1 roots involved

120
Q

what is compression of the median nerve called?

A

carpal tunnel syndrome

121
Q

what is compression of the ulnar nerve called?

A

cubital tunnel syndrome

122
Q

what are the features of Erb’s palsy?

A

Waiter’s tip position:

  • shoulder: internally rotated and adducted
  • elbow: extended and pronated
  • wrist: flexed
123
Q

what is the main feature of Klumpke’s palsy?

124
Q

what are the myotomes of the brachial plexus roots?

A 
C5 - elbow flexors
C6 - wrist extensors
C7 - elbow extensors
C8 - finger extensors
T1 - intrinsic muscle of the hand
125
Q

what are common causes of axillary nerve palsy?

A

fracture of humerus

shoulder dislocation

126
Q

what is the main sign of radial palsy?

A

wrist drop

127
Q

what is radial nerve palsy also called?

A

saturday night palsy

128
Q

which flexor muscle is not found in the carpal tunnel sheath?

A

flexor carpi radialis

129
Q

name a few important signs of carpal tunnel syndrome

A

nocturnal pain and paresthesia/tingling

wasting of thenar muscles of the hand

130
Q

name a few causes of carpal tunnel syndrome

A

inflammatory (RA, gout, amyloid)
swellings (lipoma, ganglion)
metabolic (pregnancy, hypothyroidism)
trauma (radius fracture)

131
Q

during examination of the hand, which tests are done to diagnose carpal tunnel syndrome?

A

tinnel’s test (tap on median nerve)

phalen’s test (hold wrist down)

132
Q

which nerve arising in the brachial plexus does not have any branches in the arm?

A

ulnar nerve

133
Q

which two bony prominences does the cubital tunnel form between?

A

olecranon

medial epicondyle

134
Q

patients with ulnar nerve damage have issues with which tasks?

A

fine hand tasks

135
Q

what sign is commonly seen in patients with cubital tunnel syndrome?

A

wasting of first webspace (first dorsal interosseus)

136
Q

what is a unique feature of ulnar nerve damage?

A

the more distal the lesion, the more severe the symptoms

137
Q

how does ulnar claw hand present?

A

flexion of the ring finger and little finger, with extension at their MCP joint

138
Q

what does Froment’s test assess?

A

it looks for patient’s ability to use adductor pollicis over the flexor pollicis longus to keep hold of a piece of paper

139
Q

what is the main sign resulting from common peroneal nerve palsy?

140
Q

what does damage to the lateral cutaneous femoral nerve cause?

A

meralgia paresthetica

141
Q

what is the pathology behind Dupuytren’s disease?

A

increase of myofibroblasts producing collagen

first nodules in fascia, as disease progresses these form a thick band of fascia which pulls on the affected finger

142
Q

if disease severe enough to be treated, what is the mainstay treatment for Dupuytren’s disease?

A

partial fasciectomy

dermofasciectomy

143
Q

what is the genetic inheritance of Dupuytren’s disease?

A

autosomal dominant (with various penetrance)

144
Q

what is the usual management of Dupuytren’s disease?

A

watch and wait, can’t cure it and often patients aren’t affected by it

145
Q

why can Dupuytren’s disease not be cured, despite surgical treatment options?

A

because there is a 50% chance of recurrence within 5 years

146
Q

what are the management options for trigger finger?

A

splints
steroid injections
tendon release

147
Q

what conditions are associated with trigger finger?

A

rheumatoid arthritis
diabetes
gout

148
Q

what is the management of ganglia in the hand?

A

no treatment, it will go away eventually

149
Q

what is the management of De Quervain’s tenosynovitis?

A

splints
steroid injections
decompression

150
Q

how does trigger finger present?

A

affected finger clicking back into original place after the rest of the hand, or locking and having to be unlocked with the other hand

151
Q

how does De Quervain’s Syndrome present?

A

pain on radial side of wrist

pain aggravated by thumb abduction

152
Q

what is the pathology behind De Quervain’s syndrome?

A

inflammation of tendons of Extensor pollicis longus and extensor pollicis brevis

153
Q

what is Finklestein’s test and what disease does it help to diagnose?

A

abducting wrist with thumb inside fist

used to diagnose De Quervain’s syndrome

154
Q

what are the non-operative ways to manage osteoarthritis in the thumb?

A

lifestyle advice
NSAIDS
splinting
steroid injections

155
Q

what are the operative ways to manage osteoarthritis in the thumb?

A

trapeziectomy
fusion
replacement

156
Q

what is the management of hallux valgus?

A 
analgesia
shoewear modification
activity modification
orthotics
surgery (osteotomy)
157
Q

what is the management of hallux rigidus?

A

analgesia
shoewear/activity modification
surgery (remove osteophyte, bone fusion)

158
Q

what is the pathology of hallux rigidus?

A

osteoarthritis of first metatarsal-phalangeal joint

159
Q

what is the main symptom of hallux rigidus?

A

loss of big toe dorsiflexion

160
Q

what are the features of claw toes, hammer toes and mallet toes?

A

claw toes: MTP extended, PIP and DIP flexed
hammer toes: PIP flexed
mallet toes: DIP flexed

161
Q

what is the management of lesser toe deformities (eg claw, hammer, mallet)?

A

activity modification
orthotics
surgery

162
Q

in which webspace is Morton’s neuroma most likely to occur?

A

third webspace

sometimes second webspace

163
Q

what are the symptoms of Morton’s neuroma?

A

neuralgia in toes
altered sensation
mulder’s click

164
Q

what lifestyle habit is associated with Morton’s neuroma?

A

wearing high heels

165
Q

what investigation is done to diagnose Morton’s neuroma?

A

ultrasound

sometimes MRI

166
Q

how can Morton’s neuroma be managed?

A

steroid injections
orthotics
excision of lesion/part of nerve

167
Q

what is the management of rheumatoid arthritis in the foot?

A

orthotics/footwear/analgesia
steroid injections
arthroplasty/arthrodesis

168
Q

what is plantar fibromatosis, and what is its equivalent in the hand?

A

build up of fibrous nodules on sole of foot, can cause pain

similar to Dupuytren’s disease in the hand

169
Q

what is the epidemiology of Achille’s tendinopathy vs paratendinopathy?

A

paratendinopathy: healthy athletic people
tendinopathy: non-active people, obese, diabetes, steroid use

170
Q

name the test to assess for Achille’s tendon rupture, and how it is carried out

A

Simmond’s test

squeeze calf - if foot moves, no/partial rupture. if foot doesn’t move, full rupture

171
Q

how is Achille’s tendinopathy diagnosed?

A

clinically: tenderness, Simmond’s test
imaging: ultrasound, MRI

172
Q

how is Achille’s tendinopathy managed?

A 
analgesia
shoewear (slight heel)
weight loss
activity modification
physiotherapy
surgery
173
Q

how is plantar fasciitis managed?

A 
NSAIDS
rest/ice
activity/training modification
shoewear modification
weight loss
stretching/physiotherapy
174
Q

what is the management of ankle arthritis?

A

non-operative: NSAIDs, weight loss, physiotherapy, activity modification, steroid injections
operative: arthrodesis, arthroplasty, replacement

175
Q

what happens as a result of tibialis posterior tendon dysfunction?

A

acquired flat feet

176
Q

how is tibialis posterior tendon dysfunction assessed?

A

heel raise - foot should swing from valgus to varus. if it doesn’t, there is dysfunction of the posterial tibial tendon

177
Q

how is tibialis posterial tendon dysfunction managed?

A

orthotics to support arch of foot

surgery

178
Q

what are the two major problems with the foot that can occur in diabetic neuropathy?

A

ulcers - can lead to infections and amputations

charcot foot - severe deformities, can lead to ulcers/amputations

179
Q

what are the three stages in Charcot neuroarthropathy that cause bone destruction in the foot?

A

fragmentation
coalescence
remodelling

180
Q

what is the management of Charcot neuroarthropathy?

A

avoid weightbearing until fragmentation is stopped

correct deformities to avoid ulcers/infections

181
Q

what is the grading system for open fractures called?

A

Gustilo grading

182
Q

what are the general principles of open fracture management?

A 
advanced trauma life support (ATLS) assessment
tetanus and antibiotic cover
x-rays of joint above and below
remove contamination
cover wound with saline swabs
refer to orthopaedic/plastic surgery
183
Q

what circumstances causing an open fracture would indicate the need for urgent intervention?

A 
farmland/marine environment accidents
polytraumatised patient
gross wound contamination
compartment syndrome
neurovascular damage
184
Q

what time limit should not be exceeded in terms of fixing an open fracture after initial stabilisation?

185
Q

what is the difference between a subluxation and dislocation of a joint?

A

dislocation - complete disruption of joint (out of socket)

subluxation - partial disruption of joint (not fully out of joint)

186
Q

what are posterior shoulder dislocations most likely to be caused by?

A

epilepsy

electric shock

187
Q

how are joint dislocations diagnosed?

A

clinical examination

x-ray

188
Q

which direction do the majority of shoulder dislocations occur?

A

anteriorly

189
Q

what’s the management of shoulder dislocations?

A

manipulation back into socket
mobilisation (sling)
physiotherapy
surgery

190
Q

what is the pathology of frozen shoulder?

A

inflamed and fibrosed shoulder capsule restricting ROM

191
Q

what is a typical feature in the history of a frozen shoulder?

A

onset and subsiding of pain, followed by progressive reduction of ROM

192
Q

what can cause frozen shoulder?

A

any damage to the capsule that can cause it to become inflamed

193
Q

what is the management of frozen shoulder?

A

manipulation under anaesthesia
physiotherapy
hydrodilatation
capsule release

194
Q

what is another term for frozen shoulder?

A

adhesive capsulitis

195
Q

what is rotator cuff arthropathy?

A

damage to rotator cuff as a result of trauma or degenerative change

196
Q

what can occur to the shoulder joint as a result of rotator cuff arthropathy?

A

weakness in rotator cuff muscles allows deltoid to pull humeral head up, causing superior migration (subluxation) of the shoulder joint

197
Q

what is the management of rotator cuff arthropathy?

A

physiotherapy
occupational therapy
surgery (tendon transfer, reverse shoulder replacement)

198
Q

how is osteoarthritis is the shoulder joint managed?

A

pain relief/physio/lifestyle advice
steroid injections
arthroplasty (hemi/total)

199
Q

what treatment is sometimes used in patients with golfer’s elbow or tennis elbow?

A

platelet-rich plasma (PRP) injections

200
Q

which tendons are affected in golfer’s and tennis elbow?

A

golfer’s elbow - tendons of common flexor origin

tennis elbow - tendons of common extensor origin

201
Q

what does a hip fracture look like clinically?

A

shortened leg, hip/foot rotated outwards

202
Q

why is the hip shortened during a hip fracture?

A

iliopsoas contracts in response to trauma, pulling hip up

203
Q

how are intracapsular vs extracapsular hip fractures managed?

A

intracapsular: hemi/total hip replacement
extracapsular: intramedullary nail

204
Q

what are the main features of osteomyelitis on an x-ray?

A

involucrum

sequestrum

205
Q

what are the commonest causes of chronic joint pain?

A
  • osteoarthritis
  • gout/pseudogout
  • rheumatoid arthritis
  • malignancy (especially night pain)
206
Q

what are the commonest causes of acute joint pain?

A
  • trauma (bone or soft tissue)
  • septic arthritis
  • gout flareup
  • osteoarthritis flareup
  • rheumatoid arthritis flareup
207
Q

what is subacromial impingement?

A

irritation of rotator cuff tendons in subacromial space either due to reduction of subacromial space or increased size of contents due to inflammation

208
Q

what is the management of subacromial impingement?

A

physiotherapy
steroid injection
surgical decompression

209
Q

what investigation should be done if a patient presents with joint pain but xray reveals no fracture?

210
Q

which ligament in the ankle is most likely to rupture?

A

anterior talofibular ligament

211
Q

what is the healing process of a ligament?

A

similar to bone

  • inflammatory phase: haematoma/blood clot to increase vascularity
  • proliferative phase: formation of disorganised fibrous scar tissue
  • remodelling phase: matrix remodelled into organised connective tissue
212
Q

in general terms, what are the management options for ligament ruptures?

A

conservative management

surgical management

213
Q

what structural property allows ligaments to increase their stretching ability?

214
Q

what are the roles of articular ligaments?

A

aid movement
joint stability
proprioception

215
Q

what are the three types of traumatic peripheral nerve damage, and what defines each type?

A

neurapraxia - nerve stretched but structures intact
axonotmesis - axon and myelin sheath ruptured but surrounding structures (endoneurium, perineurium, epineurium) still intact
neurotmesis - entire neuron ruptured

216
Q

what is Wallerian degeneration of the nerve?

A

death of nerve distal to the site of injury

217
Q

which type of peripheral nerve damage has the worst prognosis?

A

neurotmesis

218
Q

what is the main management of a nerve injury with no nerve tissue loss?

A

direct repair/suturing

219
Q

what is the management of a nerve injury following nerve tissue loss?

A

nerve graft

220
Q

explain the formation of neuromas as a result of peripheral nerve damage

A

it’s thickening of both cut ends of a damaged nerve, as a result of axons growing disordinately in an attempt to reform connections

221
Q

what are the two most common mechanisms of injury in peripheral nerves?

A

compression

trauma

222
Q

what is the purpose of the tendon sheath?

A

it protects the tendon and separates it from the surrounding fascia

223
Q

when is a tendon rupture treated conservatively?

A

if in an area with no articulation (little movement)

if ends can be opposed to promote healing

224
Q

when is a tendon rupture treated surgically?

A

if ends can’t be opposed
if high activity area (articulation)
if high risk of re-rupture

225
Q

what is the mainstay treatment of tendon lacerations?

A

surgical repair as early as possible, as once damaged the tendon starts to retract and becomes harder to repair

226
Q

name a few examples of tendon injuries

A 
degenerative
inflammation
avulsion fracture
tear/rupture
laceration
enthesitis (eg golfer's/tennis elbow)
de quervain's tenosynovitis
osgood-shlatter disease
227
Q

what is the definition of sarcoma?

A

malignant tumour arising from connective tissue

228
Q

what are the common symptoms of bone tumours?

A

pain (at rest, at night, increasing despite physio/analgesia)
swelling/effusion
loss of function
neurovascular damage
deformity
pathological bone fractures
systemic symptoms (weight loss, fatigue, anaemia)

229
Q

what are the common investigations done to help diagnose bone tumours?

A
  • bloods
  • x-ray
  • CT (chest, abdomen, pelvis)
  • MRI scan
  • bone biopsy (core tissue biopsy)
230
Q

what is the main difference between osteosarcoma and ewing’s sarcoma?

A

osteosarcoma does not respond to radiotherapy

ewing’s sarcoma responds to radiotherapy

231
Q

what is the most common type of bone tumour in young people?

A

osteosarcoma

232
Q

what are the management options for bone tumours?

A

surgery - resection
radiotherapy (ewing’s sarcoma)
chemotherapy

233
Q

what are the commonest tumours that metastasize to the bone?

A
  • breast
  • lung
  • prostate
  • kidney
  • thyroid
  • GI
  • melanoma
234
Q

what is the purpose of the Mirel scoring system in the context of bone metastases?

A

it helps decide if a patient with bone metastases should undergo preventative fixation to prevent pathological fractures

235
Q

name some features of soft tissue tumours

A
  • deep (deep to deep fascia)
  • may be painless
  • hard, craggy and fixed
  • rapidly growing
  • larger than 5cm
236
Q

what are the commonest signs of septic arthritis?

237
Q

what are the possible routes of infection that can result in septic arthritis?

A
  • through blood spread
  • from osteomyelitis
  • through procedure (ie needle aspiration)
  • through adjacent soft tissue infection
  • through direct trauma
238
Q

in which type of joint inflammation is WCC and CRP low/normal?

A

transient synovitis

239
Q

does a child who presents with transient synovitis have systemic symptoms?

Musculoskeletal System (4 decks)

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