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3B General Care > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Cervical Spondylosis

A

Degenerative changes of the cervical spin (e.g. annulus fibrosis and bony spurs)
narrow the spinal canal and intervertebral foramina
- usually asymptomatic but can cause neck and arm pain with parasthesiae
5-10% symptomatic patients develop cevical myelopathy

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2
Q

Cervical spondylolisthesis

A

Displacement of one vertebra onto the one below

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3
Q

Causes of cervical spondylolisthesis

A
  1. congenital failure of fusion of the odontiod process in the axis or fracture of the odontoid process (skull, atlas and odontoid slip forward on the axis)
  2. inflammation softens the transverse ligament of the atlas e.g. RA or complicating throat infection
  3. Instability after injury
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4
Q

Treatment of cervical spondylolisthesis

A

traction
immobilisation in plaster jacket
spinal fusion

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5
Q

Prolapsed cervical disc

A

Central protrusions give symptoms of spinal cord compression
posterolateral protrusions may cause a stiff neck, pain radiating to the arm, weakness of muscles affected by the nerve root and depressed reflexes

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6
Q

Investigating prolapsed discs

A

MRI

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7
Q

Treating prolapsed disc

A

NSAIDs
Collar (if cervical)
Physio to restore mobility
surgery if indicated by MRI findings

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8
Q

Rotator cuff tears

A

tears in supraspinatus, subscapularis and infraspinatus
- insidious & degeneration in the elderly, after trauma in the young
- night pain
-USS and MRI are helpful
Surgery

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9
Q

Shoulder impingement syndrome

causes

A
  1. Supraspinatus tendinopathy
  2. Calcifying tendinopathy - acute calcific arthropathy. Physio, NSAIDs, steroid injection
  3. Acromioclavicular joint osteoarthritis- common in young weight lifters. Rest, NSAIDs, steroids.
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10
Q

Rupture of long head of biceps

A

discomfort- something has gone wehn lifting or pulling

ball appears in the muscle on elbow flexion (popeye)

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11
Q

Long head of biceps tendinopathy

A

pain in anterior shoulder
characteristically on forced contraction of biceps
Pain relief, corticosteroid injection

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12
Q

Lateral epicondylitis

tennis elbow

A

inflammation where common extensor tendon arises from lateral epicondyle of humerus

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13
Q

Lateral epicondylitis

presentation

A

clear history of repetitive strain

pain felt at the from of lateral condyle exacerbated when tendon is stretched

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14
Q

Treatment

lateral epicondyitis

A

rest
6-24 months
physio

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15
Q

Medical epicondylitis

golfers elbow

A

inflammation of the forearm flexor muscles at their origin on the medial epicondyle
pain exacerbated by pronation and forearm flexion

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16
Q

Olecranon bursitis

students elbow

A

traumatic bursitis from pressure on elbows
pain and swelling behind the olecranon
may develop into septic bursitis if overlying cellulitis

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17
Q

ulnar neuritis

cubital tunnel syndrome

A

osteoarthritis or rheumatoid narrowing of the ulnar groove and constriction of the ulnar nerve as it passes behind the medial epicondyle
- decreased sensation over little finger and medial half of ring finger
Surgical decompression

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18
Q

Dupuytren’s contracture

A

progressive, painless fibrotic thickening of palmar fascia with skin puckering and tethering

  • ring and little fingers- bilateral and symmetrical
  • may have MCP join flexion
  • if interphalangeal joints are affected hand may be quite disabled
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19
Q

Treatment of Dupuytren’s contracture

A

Early - injection of clostridium histolyticum or percutaneous needle fasciotomy
Later- fasciectomy

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20
Q

Ganglia

A

smooth, multiocular swellings with cysts containing jelly like fluid
communicate with joint capsules or tendon sheaths
treatment not needed unless causing pain or pressure

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21
Q

Trigger finger

tendon nodules

A

caused by swelling of flexor tendon or tightening of the sheath
ring and middle fingers most commonly affected

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22
Q

Kyphosis

A

excessive curvature of the spine in the sagittal planne

  • typically thoracocervical spine
  • less common than scoloiosis but potentially more dangerous with dislocations–> cord compression
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23
Q

Scoliosis

A

lateral spinal curvature
secondary spinal vertebral rotation
- idiopathic (infantile, juvenile, adolescent or adult onset)
- neuromuscular (neuropathic or myopathic)
- syndromic (e.g. Marfan’s, neurofibromatosis)
- other- tumour, osteoporosis, infection

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24
Q

lumbar disc prolapse

A

severe pain brought on by coughing, sneezing or twisting a few days after back sprain
signs- forward flexion and extension limited ± lateral flexion
- calf pain, weak foot plantar flexion, reduced pinprick sensation = S1

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25
Treatment of disc prolapse
brief rest and early mobilisation + pain relief ± physiotherapy Discectomy is needed in cauda equina syndrome, progressive muscular weakness or continuing pain
26
Degenerative disc disease
multifactorial may lead to herniation surgical options include prosthetic disc replacement
27
Spondylolisthesis
Displacement (usually forward) of one lumbar vertebra on one below (usually L5/S1) causes- spondylosis, spondyloloysis, congenital malformation of the articular process, OA of posterior fact joints - onset of pain ± sciatica in adolescence ± hamstring tightness causing qaddling gait curative treatmetn- spinal fusion
28
Lumbar spinal stenois
generalised narrowing of lumbar spinal canal or lateral recesses --> nerve ischaemia typically caused by facet joint OA and osteophytes - pain worse on walking, aching and heaviness in one or both legs = spinal claudication - pain on extension - negative straight leg raise - prefers to walk up hill, lean over trollies or cycling Treatment = decompressive laminectomy, NSAIDs, epidural steroids and corsets
29
Pott's disease spinal TB
Frequent form of extra-pulmonary TB, especially with HIV co-infection Systemic symptoms, gradual onset localised back pain and stiffness of all back movements
30
Cauda Equina Syndrome
compresssion to cauda equina - poor anal tone, severe back pain, saddle anaethesia, incontinence or retention of faeces/urine, paralysis ± sensory loss
31
Transient synovitis of the hip irribitable hip
chief cause of hip pain in children- diagnosis of exclusion - acute onset and self limiting with rest ± analgesia - viral illness preceeded by viral URTI or autoimmune
32
Perthe's disease
Avascular necrosis of the femoral head occurs (ischaemia is self healing), bone remodelling distorts the epiphysis and generates abnormal ossification - presents with pain in hip or knee - causes a limp - all hip movements are limited esp. internal rotation
33
Slipped upper femoral epiphysis SUFE
10-16yrs combination of hormonal and biomechanical factors (50% obese) displacement through the growth plate- epiphysis slips down and back - usually presents after a minor injury with limping and pain in groin, anterior thigh or knee
34
Osteomalacia
problem with bone modelling or formation due to a lack of Vit D--> reduced intake of GI calcium and phosphate --> reduced mineralisation of bone - bony pain, muscle weakness, pathological fractures, waddling gait (proximal myopathy) - low serum Ca2+, PO43-, raised ALP
35
Paget's disease of the bone
increased bone turnover associated with increased numbers of osteoblasts and osteoclasts with resultant remodelling, bone enlargement, deformity and weakness
36
Clinical features of Paget's disease of the bone
asymptomatic deep, boring pain and bony deformity and enlargement - typically pelvis, lumbar spine, skull, femur and tibia
37
Complications of Pagets
``` pathological fractures osteoarthritis raised calcium nerve compression due to bone overgrowth e.g. deagess, root compression) high output CCF osteosarcoma ```
38
Treatment of Pagets
analgesia | alendronate may be tried to reduce bone pain and reduce deformity
39
Osteoporosis
reduced bone mass primary - age related or secondary to condition/drugs - trabecular bone affected = crush fractures of vertebrae - cortical bone affected = long bone fractures
40
risk factors for osteoporosis
parental history alcohol >4 units a day rheumatoid arthritis BMI<22 ``` S- steroid use H- hyperthyroidism, hyperparathyroidism, hypercalcuria A- alcohol/tabacco use T- thin T- testosterone low E- early menopause R - renal/ liver failure E- erosive/ inflammatory bone disease D- dietary Ca2+ low, malabsorption, T1DM ```
41
Investigations of osteoporosis
x-ray DEXA scan Bloods- Ca2+, phosphate and alk phos normal
42
Management of osteoporosis Lifestyle
- quit smoking, reduce alcohol - weight bearing exercise - balance exercises such as tai chi to reduce falls - calcium and vit d rich diet - home based falls prevention programme
43
Management of osteoprosis Pharmacological
- bisphosphonates - calcium and vit D supplements - strontium ranelate reduces fractures in those intolerant to bisphosphonates - HRT - raloxifene - selective oestrogen receptor modulator similar to HRT but with lower breast ca risk - recombinant PTH - calcitonin may reduce pain after vertebral fracture - testosterone in hypogonadal men denosumab decreases reabsorption
44
Osteogenesis imperfecta
inherited disorder for type 1 collagen that results in joint laxity and fragile, low density bine -immature unorganised bone with abnormal cortex
45
Achondroplasia
most common cause of disproportionate short stature - reduced growth of cartilaginous bone - short proximal long bones and wide epiphyses
46
Osgood-Schlatter disease
tibial tuberosity apophysitis children 10-15 - repeated traction causes inflammation and chronic avulsion of the secondary ossification centre --> inflammation - associated with physical overuse - pain below the knee is worse on strenuous activity and quadriceps contraction Treatment- limitation of activity, ice, oral anti-inflammatories, knee padding and physio
47
Steps of fracture healing
haematoma - -> vascular granulation tissue - ->subperiosteal osteoblast stimulation - ->bone matrix - ->endochonral ossification - ->deformable woven bone (callus) - ->lamellar bone - ->facture union
48
risk factors for poor fracture healing
``` older age co-morbidities (esp. DM) recent trauma smoker osteoporosis corticosteroids NSAIDs local complications to fractures ```
49
management of fractures | 4 steps
1. Anatomic reduction - realignment of fracture fragments 2. Stabilisation of fragments to enable normal activity 3. maintaining neurovascular supply 4. encouraging early rehabilitation
50
Methods of traction
- skin traction - adhesive strapping to attach load to skin - skeletal traction - pin through bone - --> fixed traction e.g. Thomas' spin, - -> balanced traction - weight of limb balanced against load - -> Gallows traction
51
Managemet of severe open lower limb fractures
1. IV Abx - coamoxiclav 2. continuous assessment of neurovascular status 3. Immediate surgery - vascular impairment/ compartment syndrome 4. Debridement 5. Cover wound- saline soaked gauze to prevent desiccation 6. Splint the limb 7. Vacuum foam dressing/ abx bead pouch until definitive surgery 8. definitive skeletal stabilisation and wound cover
52
Indications for ORIF
``` failed conservative treatment 2 fractures in 1 limb bilateral identical fractures intra-articular fractures open fractures displaced unstable fractures ```
53
Plates in ORIF
provide strength and stabilse fractures including articular surfaces specifically designed types exist to counteract various doces in different joints may heal slower as have to remove periosteum to attach
54
Screws in ORIF
combined with other devices
55
Intermedullary nails in ORIF
placed in the medullary cavity of long bones | typically used in femoral and tibial shaft fixation
56
Kirschner wires (K-wires) in ORIF
often used for closed reduction and percutaneous or internal fixation of fractures less rigid than plates or screws easily removed after use
57
ORIF
open reduction, internal fixation - fractures involving joint articulations - stable internal fixation in oder to facilitate healing and reduce serious complications
58
External fixation
useful in burns/ loss of skin or bone/ open fractures - less disruption of fracture site and associated soft tissue - stability of fixation depends on number and site of pins, larger pins, moving rods closer to bone, different planes of pins
59
Complications of fractures | immediate
``` internal bleeding external bleeding organ injury nerve or skin injury vessel injury ```
60
complications of fractures local later
skin necrosis/ gangrene pressure sores infection non or delayed union
61
complications of fractures | later general
venous/ fat embolism pulmonary embolism pneumonia arthritis
62
Compartment syndrome
occurs when swelling of tissues in an anatomical compartment occludes the vascular supply --> hypoxia and necrosis rhabdomyolysis can cause renal failure - correct hypovolaemia - monitor urine output and plasma potassium swelling, redness, mottling and pain on passive muscle stretching pain is disproportionate to injury

3B General Care (8 decks)

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