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Med Student Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Osteoarthritis

Aetiology (6)

A 
Abnormal anatomy 
Intra-articular fracture 
Ligament rupture 
Meniscal injury 
Persistent heavy physical activity 
Obesity
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2
Q

Osteoarthritis

Signs + symptoms of generalised disease (5)

A 
Heberden's nodes (DIP) 
Bouchard's nodes (PIP) 
Joint tenderness 
Decreased ROM 
Mild synovitis
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3
Q

Osteoarthritis

Signs + symptoms of localised disease (5)

A 
Usually knee/hip 
Pain on movement 
Crepitus 
Worse at end of day and after rest 
Joint instability
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4
Q

Osteoarthritis

X-ray findings (4)

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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5
Q 
Osteoarthritis 
Differential Diagnoses (4)
A

Gout
Other inflammatory arthritides
Septic arthritis
Malignancy

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6
Q

Osteoarthritis

Treatment (6)

A

Exercise (improve muscle strength)
Weight loss
Analgesia: paracetamol + NSAIDs (topical) –> codeine/oral NSAID + PPI
Intra-articular steroids or hyaluronic acid
Physiotherapy + occupational therapy
Surgery: joint replacement

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7
Q

Osteomyelitis

Aetiology (8)

A 
Haematogenous spread 
Secondary to contiguous local infection (+/- vascular disease) 
Direct from trauma/surgery (open fractures, surgical prostheses) 
Boils 
Abscesses 
Pneumonia 
Diabetes 
Pressure sores
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8
Q

Osteomyelitis

Organisms (5)

A 
Staph. aureus 
Pseudomonas 
E.coli 
Streptococci 
Fungi (especially in HIV/AIDS)
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9
Q

Osteomyelitis

Infection sites in adults + children (2)

A

Cancellous bone typical in adults- vertebrae (IVDU), feet (diabetics)
Vascular bone in children (long bone metaphyses)

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10
Q

Osteomyelitis

Pathology (4)

A

Infection ledas to cortex erosion
Exudation of pus lifts up periosteum, interrupting blood supply to underlying bone
Necrotic fragments of bone may form (sequestrum)
New bone formation created by elevated periosteum

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11
Q

Osteomyelitis

Signs + symptoms (7)

A 
More marked in children 
Pain of gradual onset 
Unwillingness to move 
Tenderness 
Warmth 
Erythema 
Signs of systemic infection (fever, tachycardia, malaise)
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12
Q

Osteomyelitis

Investigations (4)

A

Bloods: elevated ESR, elevated CRP, elevated WCC, blood culture
Bone biopsy and culture
X-ray: changes not apparent for 10-14 days, haziness, loss of density
MRI

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13
Q 
Osteomyelitis
Differential diagnoses (6)
A 
Septic arthritis 
Acute inflammatory arthritis 
Trauma 
Transient synovitis 
Cellulitis 
Necrotising fasciitis
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14
Q

Osteomyelitis

Treatment (2)

A

Antibiotics: vancomycin and cefotaxime
Surgery: drain abscesses and remove sequestrae

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15
Q

Osteomyelitis

Complications (5)

A 
Septic arthritis 
Pathological fractures 
Chronic osteomyelitis 
Septicaemia and death 
Deformity/altered growth
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16
Q

Chronic Osteomyelitis

Aetiology (2)

A

Poor treatment of acute osteomyelitis

Always suspect in non-healing ulceration in vascular insufficiency

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17
Q 
Chronic Osteomyelitis 
Risk factors (3)
A

Diabetes
Immunosuppressed
Elderly

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18
Q

Chronic Osteomyelitis

Investigations (1)

A

X-ray: thick irregular bone

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19
Q

Chronic Osteomyelitis

Treatment (1)

A

Radical excision of sequestra and antibiotics (vancomycin and cefotaxime)

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20
Q

Chronic Osteomyelitis

Complications (1)

A

Squamous carcinoma development in sinus track

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21
Q

Osteochondroma

Definition (2)

A

Commonest benign bone tumour

Usually occurring about knee/proximal femure/humerus

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22
Q

Osteochondroma

Signs + symptoms (2)

A

Painful mass

Associated with trauma

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23
Q

Osteochondroma

Investigations (1)

A

X-ray: bony spur arising from the cortex

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24
Q

Osteochondroma

Treatment (2)

A

Surgery if causing symptoms eg. pressure on adjacent structures
Any osteochondroma continuing to grow after skeletal maturity must be removed due to risk of malignancy

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25
Q

Osteoid Osteoma

Definition (2)

A

Painful benign bone lesion

Occurs most commonly in long bones of males aged 10-25

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26
Q

Osteoid Osteoma

Investigations (2)

A

X-ray: local cortical sclerosis

CT

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27
Q

Osteoid Osteoma

Treatment (1)

A

CT-guided biopsy and radiofrequency ablation

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28
Q

Chondroma

Definition (1)

A

Benign cartilaginous tumours

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29
Q

Chondroma

Signs + symptoms (2)

A

Local swelling

Fracture

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30
Q

Sarcoma

Definition (1)

A

Any malignant neoplasm arising from mesenchymal cells (which give rise to connective and non-epithelial tissue)

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31
Q

Sarcoma

Categories (3)

A

Soft tissue cancers
Primary bone cancers
Gastrointestinal stromal tumours

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32
Q

Osteosarcoma

Aetiology (2)

A

Primary osteosarcoma: affects adolescents and arises in the metaphyses of long bones
Secondary osteosarcoma: may arise in bone affected by Paget’s disease or after irradiation, presents age 10-20

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33
Q

Osteosarcoma

Signs + symptoms (4)

A

Non-mechanical bone/joint pain
Bone pain at night
Bony swellings
Pathological fractures

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34
Q

Osteosarcoma

Investigations (3)

A

X-ray: bone destruction, new bone formation, marked periosteal elevation
Staging MRI: assess intramedullary spread
HRCT: assess for pulmonary metastases

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35
Q

Osteosarcoma

Treatment (2)

A

Neoadjuvant chemotherapy

Amputation

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36
Q

Ewing’s Sarcoma

Definition (2)

A

Malignant round-cell tumour of long bones and limb girdles

Typically presents in adolescents

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37
Q

Ewing’s Sarcoma

Investigations (2)

A

X-ray: bone destruction, new bone formation, soft tissue swelling, periosteal elevation
MRI

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38
Q

Ewing’s Sarcoma

Treatment (1)

A

Chemotherapy + Surgery + Radiotherapy

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39
Q

Chondrosarcoma

Aetiology (2)

A

Idiopathic

From malignant transformation of chondromas

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40
Q

Chondrosarcoma

Signs + symptoms (3)

A

Pain
Lump
Presents in axial skeleton of middle-aged

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41
Q

Chondrosarcoma

Investigations (2)

A

X-ray: calcification

MRI/CT: to define tumour extent

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42
Q

Chondrosarcoma

Treatment (2)

A

Unresponsive to chemotherapy + radiotherapy

Excision

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43
Q

Fractures

Describing an X-ray (8)

A

Site: bones involved and part (eg. proximal/shaft/distal)
Intra-articular involvement
Epiphyseal involvement
Obliquity: transverse/spiral
Displacement: rotation/angulation/shortening/translation
Impaction: causes shortening
Fracture pattern: simple (spiral/oblique/transverse), buckle, greenstick, comminuted (splintered), segmental (multiple breaks), avulsion (tendon/ligament pulls bone fragment away)
Soft tissues

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44
Q

Fractures

Healing (8)

A

Haematoma –> Vascular granulation tissue –> Osteoblast stimulation –> Bone matrix –> Endochondral ossification –> Callus (woven bone) –> Lamellar bone –> Fracture union

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45
Q

Fractures

Risk factors for poor healing (7)

A 
Age
Recent trauma 
Osteoporosis 
NSAIDs
Comorbidities 
Smoker 
Corticosteroids
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46
Q

Fractures

Gustilo Classification of Open Fractures (3)

A

Type I: low energy, <1cm
Type II: low energy, >1cm, moderate soft tissue damage
Type III: high energy, irrespective of wound size

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47
Q

Fractures

Salter Harris Classification of Epiphysal Injury (5)

A

Type I: transverse fracture through growth plate, babies/pathological
Type II: fracture line above growth plate, most common, spares epiphysis
Type III: fracture through growth plate + epiphysis, spares metaphysis
Type IV: fracture through growth plate, metaphysis + epiphysis, interferes with growth
Type V: compression of growth plate, causes deformity and stunting

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48
Q

Fractures

Principles of fracture management (4)

A

Realignment
Stabilisation to allow normal activity
Maintaining neurovasculr supply
Encouraging early rehabilitation

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49
Q

Fractures

Management of fractures (4)

A

Traction (mostly children)
Conservative (splints/casts/traction)
ORIF: for intra-articular, failed conservative management, multiple fractures, open fractures (plates provide strength and stabilisation, screws, intramedullary nails, IC-wires for closed reduction and fixation)
External fixation: burns/loss of skin or if open fracture, causes less disruption to fracture site + associated sot tissue

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50
Q

Fractures

Complications (8)

A

Fat embolism: released from disrupted bone marrow, usually day 2-3, altered mental state, pyrexia, SOB, tachycardia
Neurovascular injury
Infection
Delayed union: poor blood supply, systemic disease
Non-union: no healing after 6 months
Malunion: fragments not healed in anatomical positions causing loss of function
Thromboembolic events
Compartment syndrome (can lead to rhabdomyolysis then renal failure)
Complex regional pain syndromes

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51
Q

Hip Fractures

Presentation (2)

A

Elderly and minor fall

Visible shortening of leg, abduction, external rotation

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52
Q

Hip Fractures

Investigations (6)

A

X-ray: AP + lateral + full length femur if querying pathological fracture
Bedside investigations to ensure haemodynamically stable, ECG + urine dip to ensure no delirium or infection
FBC: rule out anaemia
U&E: ensure pre-op optimisation
LFTs: admission baseline
Group + save: so transfusion prepared

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53
Q

Hip Fractures

X-ray description (3)

A

Disruption to Shenton’s line (should be smooth arch)
Extra or intra-capsular
Any displacement

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54
Q

Hip Fractures

Treatment (6)

A

Analgesia + fluid resuscitation
DVT prophylaxis (LMWH)
Conservative management rare unless unfit
Surgical: depends if intracapsular (replace) or extracapsular (fix)
Intracapsular surgery: blood supply is disrupted so at risk of avascular necrosis– hemiarthroplast/total hip replacement
Extracapsular surgery: if between the trochanters then dynamic hip screw, if subtrochanteric then intramedullary nail

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55
Q

Wrist Fractures

Examination (2)

A

Vascular status: palpate radial and ulnar pulses, distal limb perfusion (temp., colour, cap refill)
Neurological status: sensation + motor function in nerve regions

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56
Q

Wrist Fractures

X-ray description (5)

A

Postero-anterior for distal radius and lateral centred on wrist
State bones fractured
Intra or extra-articular
Evidence of radial shortening
Describe displacement and angulation of the distal fragment

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57
Q

Wrist Fractures

Colle’s Fracture (2)

A

Extra-articular transverse fracture of distal radius

Dinner fork deformity: distal fragment displaced dorsally

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58
Q

Wrist Fractures

Smith’s Fracture (1)

A

Reverse Colle’s fracture: displacement of distal fragment is volar (palmar)

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59
Q

Wrist Fractures

Barton’s Fracture (2)

A

Intra-articular

Either dorsal or volar depending on which cortex the fracture extends into

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60
Q

Wrist Fractures

Chauffeur’s Fracture (3)

A

Isolated fracture of radial styloid process
Displacement of fragment uncommon
Associated with injury to the scapholunate ligament

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61
Q

Wrist Fractures

Treatment (2)

A

Based on fracture pattern and stability (extension into radiocarpal joint, loss of radial height, amount of dorsal comminution and loss of volar tilt)
Non-operative: closed reduction and casting
Operative: ORIF (with volar/dorsal plate) or external fixation

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62
Q

Ankle Fractures

Anatomy of the Ankle (6)

A

Ankle joint: tibia + fibula + talus
Syndesmosis joint: tibia + fibula
Movements: dorsi/plantarflexion at the tibiotalar joint, eversion and inversion at the subtalar joint, rotation
Medial soft tissue structures: delotid ligament joins medial malleolus to talus, calcaneus and navicular bones
Lateral soft tissue structures: anterior talo-fibular ligament, calcaneo-fibular ligament and posterior talo-fibular ligament
Anterior and posterior soft tissue structures: tibio-fibular ligaments

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63
Q

Ankle Fractures

Assessment (3)

A

Displaced fractures should be reduced under sedation/anaesthesis
Vascular: temp., perfusion, cap refill, dorsalis pedis and posterior tib. pulses
Neurological: sensation, motor and sensory function of: superficial peroneal, deep peroneal, saphenous and sural nerves

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64
Q 
Ankle Fractures 
Ottawa Rules (2)
A

Differentiates between likely sprain or fracture
Ankle X-rays indicated if: >55, unable to weight bear for 4 steps, bony tenderness at post. edge or inf. tip of lateral malleolus, bony tenderness at posterior edge/inferior tip of medial malleolus

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65
Q 
Ankle Fractures 
Simple Classification (3)
A

Medial/lateral malleolar
Bimalleolar (both involved)
Trimalleolar (medial + lateral + posterior part of the tibia

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66
Q

Ankle Fractures

Weber-AO System (4)

A

Refers to level of lateral malleolus or distal fibular fracture
Weber A: transverse fractures below syndesmosis, generally stable
Weber B: at level of syndesmosis, extending proximally (spiral or short oblique pattern), may be stable or unstable
Weber C: above tibial plafond, likely syndesmotic injury, unstable

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67
Q

Ankle Fracture

Treatment (2)

A

Conservative: for stable, undisplaced fractures with minimal disruption to articular surface, displaced fractures can be manipulated and put in cast
Surgical: for unstable fractures with talar shift, displacement and fragmentation of articular surface, ORIF with plate and screws to reduce and fix fracture

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68
Q

Clavicle Fractures

Aetiology (2)

A

Fall on outstretched hand

Direct blow to clavicle

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69
Q

Clavicle Fractures

Location (1)

A

Middle 1/3rd where proximal fragment is pulled superiorly by sternocleidomastoid is most common

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70
Q

Clavicle Fractures

Treatment (3)

A

Broad arm sling with follow up X-rays at 6 weeks to ensure union
ORIF if fracture significantly displaced
Possibility of neurovascular injury (brachial plexus, subclavian vessels) and pneumothorax as complications

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71
Q

Compartment Syndrome

Definition (1)

A

Raised pressure within a closed compartment resulting in tissue ischaemia, and if untreated, necrosis followed by fibrosis and muscle contracture

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72
Q

Compartment Syndrome

Epidemiology (3)

A

<35
M>F
Most often seen in the leg, followed by the forearm

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73
Q

Compartment Syndrome

Aetiology (2)

A

Decreases in compartment size (tight casts/bandages, lying on limb, burns)
Increase in compartment content (haemorrhage, post-op swelling)

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74
Q

Compartment Syndrome

Pathology (4)

A

Increased compartment pressure –> Reduced capillary pressure gradient –> Reduced tissue perfusion and hypoxic injury –> Fluid diffusion into compartment

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75
Q

Compartment Syndrome

Signs + Symptoms (6)

A 
Pain (out of proportion to injury, not improving wit analgesia) 
Pallor 
Pressure 
Paraesthesia 
Paralysis 
Pulseless
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76
Q

Compartment Syndrome

Investigations (2)

A

Clinical diagnosis: severe pain on passive stretching of involved limbs’ digits (fingers/toes)
Pressure monitor inserted into compartment (DELTA pressure when there is 30mmHg difference from diastolic)

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77
Q

Compartment Syndrome

Treatment (4)

A

V. quick (by 8 hours- permanent damage)
Remove dressing
Hold limb at level of heart to promote arterial inflow
Fasciotomy

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78
Q

Compartment Syndrome

Complications (2)

A

If untreated, necrosis of muscles leading to ischaemic contracture
Loss of limb

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79
Q 
Knee Injuries 
Patellar dislocation (5)
A

Typically lateral
Result of twisting lower leg and contraction of the quadriceps
Reduction by firm medial pressure whilst extending the knee
Post reduction: check extensor mechanism of knee and X-ray to ensure no fracture
Treatment: period of immobilisation in cast/split/brace

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80
Q

Knee Injuries

Recurrent Patellar Subluxation (5)

A

Subluxation: partial dislocation, not fully out of joint
A tight lateral retinaculum causes patella to sublux laterally, giving medial pain
Commoner in girls and in those with valgus knees
Signs: increased lateral patellar movement and pain and contraction of quadriceps
May warrant surgery to strengthen medial expansion

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81
Q

Knee Injuries

Collateral Ligament Injury (5)

A

Common in sport
Mechanism in medial ligament: blow to lateral aspect of knee whilst foot is fixed
Mechanism in lateral ligament: blow to medial aspect of knee whilst foot is fixed
Feel of ‘crack’
Signs: effusion +/- tenderness over affected ligament

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82
Q 
Knee Injuries 
ACL tear (3)
A

Follows twisting injury of knee with foot fixed to ground
‘Pop’
Signs: rapid effusion, haemarthrosis, +ve draw sign (anterior)

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83
Q 
Knee Injuries 
PCL tear (2)
A

Less frequently damaged than aCL

+ve posterior draw test

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84
Q 
Knee Injuries 
Meniscal tears (5)
A

Medial meniscus: twist to flexed knee
Lateral meniscus: adduction + internal rotation
Extension is limited (knee locking) as displaced segments lodged between condyles
Slow swelling
Painful ‘squelch’

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85
Q

Olecranon Bursitis (5)

A

Student’s elbow
Traumatic bursitis following pressure on the elbows
Pain and swelling behind olecranon
If overlying skin cellulitis then consider antibiotics
Complications: abscess formation, septic bursitis

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5
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86
Q

Prepatellar Bursitis (5)

A

Causes anterior knee pain
Following trauma or overuse (kneeling for a prolonged time- housemaid knee)
Swelling anteriorly
Treatment: aspiration +/- corticosteroid to prevent recurrence
Always consider septic arthritis of joint

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87
Q 
Club Foot (Talipes Equinovarus) 
Deformity (4)
A

Inversion
Adduction of forefoot relative to hindfoot (which is in varus)
Equinus (plantarflexion) deformity
Foot cannot be passively everted and dorsiflexed through the normal range

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88
Q 
Club Foot (Talipes Equinovarus) 
Treatment (1)
A

Ponseti method: foot manipulated and placed in a long leg plaster cast on repeated occasions (important that correction is gradual)

89
Q

Developmental Dysplasia of the Hip

Aetiology (9)

A 
M:F 1:6
L:R 4:1 
Breech birth 
Other malformations 
Sibling with DDH 
Increased birth weight 
Older mother or principarous 
Postmaturity 
Oligohydramnios
90
Q

Developmental Dysplasia of the Hip

Signs (5)

A

Widened perineum and buttock flattening on affected side
Unequal leg length
Asymmetrical groin creases
Limited abduction of hip
In older children: delay in walking and waddling gait (affected leg is shorter)

91
Q

Developmental Dysplasia of the Hip

Investigations (3)

A

Clinical diagnosis: all babies have hips examined in 1st days of life and at 6 weeks
Ultrasound (up to 4.5 months old)
Pelvic X-rays in older children

92
Q

Developmental Dysplasia of the Hip

Treatment (4)

A

Treatment delayed 2-8 weeks to allow spontaneous resolution
Unstable hips at 6 weeks: long term splinting in flexion- abduction harness
From 6-18 months: period of immobilisation in bandage
After 18 months or failure of closed techniques: open reduction

93
Q

Slipped Upper Femoral Epiphysis (SUFE)

Aetiology (3)

A

10-16
M:F 3:1
Obesity

94
Q

Slipped Upper Femoral Epiphysis (SUFE)

Pathology (2)

A

Displacement through the growth plate

Epiphysis slips down and back

95
Q

Slipped Upper Femoral Epiphysis (SUFE)

Signs + Symptoms (5)

A

Usually presents after minor injury
Limping
Pain in groin, anterior thigh, knee
90% are able to weight bear (stable), 10% cannot (unstable)
Flexion, abduction and medial rotation are limited (eg. lying with foot externally rotated)

96
Q

Slipped Upper Femoral Epiphysis (SUFE)

Investigations (1)

A

AP + frog-leg lateral X-rays

97
Q

Slipped Upper Femoral Epiphysis (SUFE)

Treatment (1)

A

Early internal fixation to stabilise any slippage and encourage physeal closure

98
Q

Perthes’ Disease

Aetiology (3)

A

Idiopathic
3-11
M:F 4:1

99
Q

Perthes’ Disease

Pathology (3)

A

Avascular necrosis of femoral head
Ischaemia self heals
Subsequent bone remodelling distorts the epiphysis and generates abnormal ossification

100
Q

Perthes’ Disease

Signs + Symptoms (2)

A

Pain in hip/knee causing a limp

All movements at the hip are limited, especially internal rotation and abduction

101
Q 
Perthes' Disease
Radiological Findings (3)
A

Early on: joint space widening
Then: decrease in size of femoral head with patchy density
Finally: collapse and deformity of femoral head with new bone formation

102
Q

Perthes’ Disease

Outcome (2)

A

Severe deformity of the femoral head risks early arthritis and likely need for joint replacement
Younger patients have better ability to remodel and greater prognosis

103
Q

Perthes’ Disease

Treatment (2)

A 
Less severe disease (<1/2 femoral head affected and joint space depth well preserved): bed rest + NSAIDs
Severe disease (>1/2 femoral head affected and joint space narrowing): surgery
104
Q 
Cervical Spondylosis 
Define spondylosis (2)
A

Degenerative changes in the spine such as bone spurs and degenerating intervertebral discs between the vertebrae
Often referred to as back osteoarthritis

105
Q

Cervical Spondylosis

Signs + Symptoms (4)

A

Neck stiffness
Crepitus on moving neck
Stabbing/dull arm pain
Root compression (radiculopathy): pain/tingling in arms/fingers at level of compression and LMN signs in muscles innervated by affected root, may be UMN signs below level suggesting cord compression

106
Q

Cervical Spondylosis

Investigations (1)

A

MRI: localise lesion

107
Q 
Cervical Spondylosis 
Differential diagnoses (3)
A

MS
Nerve root neurofibroma
Compression by bone/cord tumours

108
Q

Cervical Spondylosis

Treatmnet (3)

A

Neck collar to restrict movement and relieve pain
Surgical root decompression (laminectomy/laminoplatsy)
Transforaminal steroid injection to reduce pain

109
Q

Spondylolisthesis

Definition (1)

A

Displacement (usually forward of one lumbar vertebra upon the on below- usually L5 on S1, sometimes palpable)

110
Q

Spondylolisthesis

Aetiology (4)

A

Spondylosis (age-related degeneration resulting from joint deformity and associated with osteophyte formation)
Spondylolysis (results from a defect in pars interarticularis- could be a stress defect)
Congenital malformation of articular processes
Osteoarthritis of posterior facet joints

111
Q

Spondylolisthesis

Signs + Symptoms (2)

A

Pain +/- sciatica

May have hamstring tightness causing a waddling gait

112
Q

Spondylolisthesis

Investigations (2)

A

X-ray

MRI

113
Q

Spondylolisthesis

Treatment (2)

A

Temporary relief with conservative bracing and physio

Curative treatment is spinal fusion

114
Q

Prolapsed Disc

Signs + Symptoms (3)

A

Typically acute onset of pain on coughing/sneezing/twisting a few days after back strain
Pain may radiate to buttock/leg (sciatica) if the herniated nucleus pulposus compresses a nerve root
Forward flexion and extension limited

115
Q

Prolapsed Disc

Signs of L4/5 Prolpase (L5 Root Compression) (2)

A

Weak hallus extension

Decreased sensation on outer dorsum of foot

116
Q

Prolapsed Disc

Signs of L5/S1 Prolapse (S1 Root Compression) (4)

A

Calf pain
Weak foor plantar flexion
Reduced sensation over sole of foot and back of calf
Reduced ankle jerk

117
Q

Prolapsed Disc

Investigations (2)

A

MRI

Make sure no cauda equina compression

118
Q

Prolapsed Disc

Treatment (3)

A

Brief rest and early mobilisation
Analgesia +/- physiotherapy is enough for most
Discectomy if cauda equina/progressive muscular weakness/continuing pain

119
Q

Rotator Cuff Tears

Aetiology (2)

A

Degeneration in elderly

Trauma in young

120
Q

Rotator Cuff Tears

Signs + Symptoms (1)

A

Shoulder weakness + pain

121
Q

Rotator Cuff Tears

Investigations (2)

A

Ultrasound: tear or no tear
MRI: quantify muscle wasting

122
Q

Rotator Cuff Tears

Treatment (2)

A

Incomplete: surgery if symptoms persist
Complete: prompt referral for open arthroscopic repair

123
Q

Impingement Syndrome

Aetiology (3)

A

Supraspinatus tendinopathy or partial rupture of supraspinatus tendon
Calcifying tendinopathy
Acromioclavicular joint osteoarthritis

124
Q

Impingement Syndrome

Pathology (1)

A

As the tendon catches under the acromion during abduction

125
Q

Impingement Syndrome

Signs + symptoms (1)

A

On abducting 45-160 you get pain

126
Q

Impingement Syndrome

Treatment (3)

A

Supraspinatus tendinopathy: active shoulder movement with physio and pain relief, subacromial bursa injection of corticosteroid and local anaesthetic, surgery (subacromial decompression) if >6 months
Calcifying tendinopathy: physio, NSAIDs, steroid injection
Osteoarthritis: rest, NSAIDs, steroids

127
Q

Frozen Shoulder

Phases of symptoms (3)

A

1: painful phase (up to 1 year), active and passive movement range reduced, reduced abduction +/- external rotation
2: frozen phase, pain usually settles but shoulder remains stiff (6-12 months)
3: thawing phase (1-3 years), shoulder slowly regains range of movement

128
Q

Frozen Shoulder

Aetiology (3)

A

Cervical spondylosis
Diabetes
Thyroid disease

129
Q

Frozen Shoulder

Treatment (3)

A

Early physio + NSAIDs
Corticosteroid injections
Surgery: manipulation under anaesthesia or arthroscopic arthrolysis

130
Q 
Lateral Epicondylitis (Tennis Elbow)
Definition (1)
A

Inflammation where the common extensor tendon arises form the lateral epicondyle of the humerus

131
Q 
Lateral Epicondylitis (Tennis Elbow)
Signs + Symptoms (3)
A

Clear history of repetitive strain
Pain at front of lateral condyle
Exacerbated when tendon is most stretched (wrist + finger flexion with hand pronated)

132
Q 
Lateral Epicondylitis (Tennis Elbow)
Treatment (3)
A

Most resolve through restriction of activities which overload the tendons
Physio
Surgery: tendon release (severe cases)

133
Q 
Medial Epicondylitis (Golfer's Elbow) 
Definition (1)
A

Inflammation of the forearm flexor muscles at their origin on the medial epicondyle

134
Q 
Medial Epicondylitis (Golfer's Elbow) 
Signs + Symptoms (2)
A

Pain exacerbated by pronation and forearm flexion

Occasionally associated with ulnar neuropathy as the ulnar nerve runs behind the epicondyle

135
Q 
Medial Epicondylitis (Golfer's Elbow) 
Treatment (3)
A

Rest + restrict movement
Physio
Surgery if severe

136
Q

Dupuytren’s Contracture

Definition (1)

A

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

137
Q

Dupuytren’s Contracture

Aetiology (4)

A

Genetic
Smoking
Diabetes
Antiepileptics

138
Q

Dupuytren’s Contracture

Signs + Symptoms (2)

A

Ring + little fingers chiefly affected, often bilateral

As the thickening worsens, there may be MCP joint flexion

139
Q

Dupuytren’s Contracture

Treatment (2)

A

Early disease: clostridium histolyticum or percutaneous needle fasciotomy
Surgery: fasciectomy to remove palmar fascia and release contractures (refer if cannot lay palm flat on table)

140
Q

Ganglia

Definition (1)

A

Smooth multilocular swellings are cysts containing jelly-like fluid in communication with joint capsules or tendon sheaths

141
Q

Ganglia

Treatment (4)

A

Not needed unless they cause pain or pressure (eg. on the median/ulnar nerve)
May disappear spontaneously
Local pressure (eg. Bible)
Aspiration or surgical dissection

142
Q

Carpal Tunnel Syndrome

Definition (2)

A

Commonest mononeuropathy and cause of hand pain at night

Compression of the median nerve as it passes under the flexor retinaculum

143
Q

Carpal Tunnel Syndrome

Signs + Symptoms (4)

A

Tingling and pain in thumb, index and middle fingers
Relieved by dangling and shaking hand
Wasted thenar eminence
Weakness of abductor pollicis brevis

144
Q

Carpal Tunnel Syndrome

Median Nerve Anatomy (4)

A

Arises from C5-T1 from lateral and medial cords of brachial plexus
Jut distal to elbow, gives off anterior interosseous branch (motor to FPL, FDP, index finger and pronator quadratus)
Just proximal to wrist gives off palmar cutaneous branch (sensory to thenar skin), over lies flexor retinaculum
Recurrent motor branch to the thenar muscles arises at distal end of carpal tunnel

145
Q

Carpal Tunnel Syndrome

Carpal Tunnel Function (2)

A

Motor: pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, and LOAF (Lateral 2 lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis)
Sensation: radial 3.5 digits

146
Q

Carpal Tunnel Syndrome

Investigations (4)

A

Nerve conduction studies to confirm lesion site and severity
Phalen’s: maximal wrist flexion for 1 minute
Tinel’s: tapping over nerve at wrist –> tingling
Ultrasound/MRI: identifies lesions

147
Q

Carpal Tunnel Syndrome

Associations (4)

A

Hypothyroidism
Pregnancy
Diabetes and obesity
RA

148
Q

Carpal Tunnel Syndrome

Treatment (4)

A

Treat associations
Rest, reduce weight and wrist splints 1st line
Corticosteroids for pain relief
Surgery: carpal tunnel decompression

149
Q

De Quervain’s Disease

Definition (1)

A

Stenosing tenosynovitis (thickening and tightening) of the 1st extensor compartment, abductor pollicis longus and extensor pollicis brevis tendons (at anterior border of anatomical snuffbox) as they cross the distal radial styloid

150
Q

De Quervain’s Disease

Signs + Symptoms (2)

A

Pain is worst when tendons are stretched (eg. lifting a teapot)
Finkelstein’s sign: pain elicited by gripping the thumb into the palm of the same hand with passive ulnar deviation

151
Q

De Quervain’s Disease

Treatment (3)

A

Rest (thumb splint), ice + NSAIDs
Corticosteroid injection
Surgery: decompression of the tendons by splitting the tendon sheaths

152
Q

Trigger Finger

Pathology (4)

A

Caused by a swelling of the flexor tendon or tightening of the sheath
Ring + middle fingers most commonly affected
Swelling of tendon sheath, tendon nodule formation, AI pulley prevents tendon gliding smoothly and instead ‘catches’ causing the finger to lock in flexion
As extension occurs, nodule moves with the flexor tendon and becomes jammed and has to be flicked straight, producing triggering

153
Q

Trigger Finger

Treatment (3)

A

Rest + splintage
If severe, steroid injection into nodule region
Surgery may be needed in recurrence (which is high)

154
Q

Kyphosis

Definition (1)

A

Excessive curvature of the spine in the sagittal plane, typically the thoracocervical spine

155
Q

Kyphosis

Aetiology (5)

A 
Congenital 
Osteoporosis 
Spina bifida
Paget's disease 
Ankylosing spondylitis
156
Q

Kyphosis

Complications (1)

A

Dislocations of the spinal column into cord can cause cord compression and paraplegia

157
Q

Scoliosis

Definition (1)

A

Lateral spinal curvature with secondary vertebral rotation

158
Q

Scoliosis

Classification (4)

A

Idiopathic (most common adolescent)
Neuromuscular (neuropathic or myopathic)
Syndromic (eg. Marfan’s)
Other (eg. tumour, osteoporosis)

159
Q

Scoliosis

Signs + Symptoms (3)

A

Complications (pain, cosmesis, impaired lung function) occurs as they grow
Double curves progress more than single curves
Scoliosis in girls more likely to progress

160
Q

Scoliosis

Investigations (2)

A

X-ray

Cobb angles to measure deformity

161
Q

Scoliosis

Treatment (3)

A

Cobb angle 1/6 requires treatment
Braces to prevent progression
Surgery: deformity correction with spinal fusion and stabilisation

162
Q

Spinal Stenosis

Definition (1)

A

Generalised narrowing of the spinal canal or its lateral recesses causes nerve ischaemia

163
Q

Spinal Stenosis

Aetiology (2)

A

Facet joint OA (only synovial joints in back)

Osteophytes

164
Q

Spinal Stenosis

Signs + Symptoms (4)

A

Pain worse on walking with aching and heaviness in one/both legs causing the person to stop walking (spinal claudication)
Pain on extension
Negative straight leg raising test
Few CNS signs

165
Q

Spinal Stenosis

Investigations (2)

A 
MRI 
Myelography (injection of contrast into subarachnoid space) if MRI contraindicated
166
Q

Spinal Stenosis

Treatment (4)

A

Decompressive laminectomy
NSAIDs
Epidural steroid injection
Corsets (prevent exaggerating the lumbar lordosis)

167
Q

Spinal Tumours

Origin (2)

A

May be of spinal cord, meninges, nerves or bone

Primary or secondary (metastases tend to affect cancellous bone)

168
Q

Spinal Tumours

Signs + Symptoms (7)

A

Cord compression: pain, LMN signs at level, UMN signs + sensory loss below, or bladder and bowel dysfunction
Peripheral nerve impairment: pain along course of nerve, weakness, hyporeflexia and reduced sensation
Cauda equina involvement
If tumour in spinal canal with no bone involvement, there may just be long tract signs
When bones involved, progressive pain and local bone destruction
Muscle spasm + tenderness to percussion
Bone collapse: deformity, cord/nerve compression

169
Q

Spinal Tumours

Investigations (8)

A 
Bloods: FBC, ESR, LFT
Bone profile 
Myeloma screen if age >50 
Plain X-rays
CT
MRI 
Isotope bone scans 
Bone biopsy
170
Q

Cauda Equina Syndrome

Anatomy (3)

A

Cord tapers to its end (conus medullaris) at L1 in adults
Lumbar and sacral nerve roots arising from the conus medullaris form the cauda equina
These spinal nerve roots separate in pairs, exiting laterally through the nerve root foramina, providing motor and sensory to the legs and pelvic organs

171
Q

Cauda Equina Syndrome

Aetiology (5)

A 
Compression is most frequently from large prolapses or herniation of lumbar discs 
Extrinsic tumours 
Primary cord tumours 
Spondylosis 
Spinal stenosis
172
Q

Cauda Equina Syndrome

Signs + Symptoms (6)

A 
LMN lesion 
Poor anal tone 
Severe back pain 
Saddle-area (perianal) reduced sensation 
Incontinence/retention of faeces/urine 
Paralysis +/- sensory loss
173
Q

Transient Synovitis

Definition (1)

A

Inflammation in the hip joint (chief cause of hip pain in children aged 4-10)

174
Q

Transient Synovitis

Aetiology (2)

A

Viral illness preceded by recent viral URTI

Autoimmune

175
Q

Transient Synovitis

Signs + Symptoms (4)

A

Most are self limiting
Pain (particularly at extremities of movement)
Refusal to weight bear
Investigations all come back normal but consider JIA if other joints are involved)

176
Q

Hallux Valgus

Definition (1)

A

The big toe deviates laterally at the metatarsophalangeal joint

177
Q

Hallux Valgus

Signs + Symptoms (3)

A

Typically present bilaterally
Pressure of MTP against shoe leads to bunion formation
Secondary OA of the joint

178
Q 
Hallux Valgus
Risk Factors (6)
A 
Female 
Age
Type of footwear 
\+ve family history 
Conditions causing joint hypermobility 
Neuromuscular disease
179
Q

Hallux Valgus

Treatment (4)

A

Education on appropriate footwear (wide and low heeled)
Foot exercises to strengthen musculature around big toe
Bunion pads and plastic wedges may relieve pain
Painful bunions affecting lifestyle considered for surgery

180
Q

Hallux Valgus

Complications (3)

A

Chronic pain
Recurrence
Joint stiffness

181
Q 
Lesser Toe Deformities 
Hammer Toes (3)
A

Definition: extended at the MTP joint, hyperflexed at the PIP joint and extended at the DIP joint (toes look curled)
Associated with contracture of flexor digitorum longus tendon
2nd toes most commonly affected

182
Q 
Lesser Toe Deformities 
Claw Toes (2)
A

Definition: extended at the MTP joint but flexed at PIP and DIP joints giving a clawed appearance where the toe digs into the sole of the foot
Treatment: same for hammer toes, metatarsal shortening (flexible deformity) or PIP joint arthrodesis (fixed deformity)

183
Q 
Lesser Toe Deformities 
Mallet Toes (2)
A

Definition: flexion deformity of DIP joint in isolation
Treatment: flexor tenotomy (flexible deformity) or DIP joint arthrodesis (fixed deformity)

184
Q

Morton’s Neuroma

Definition (1)

A

Common cause of metatarsalgia (forefoot pain) in women

185
Q

Morton’s Neuroma

Pathology (1)

A

Degenerative and inflammatory changes tot he interdigital nerve resulting in entrapment neuropathy

186
Q 
Morton's Neuroma
Risk Factors (5)
A 
High BMI 
High heels 
Toe deformities 
High impact sports 
Inflammatory arthritis
187
Q

Morton’s Neuroma

Signs + Symptoms (2)

A

Pain is from pressure from an interdigital neuroma between the metatarsals (eg. from tight shoes)
Pain usually radiates tot he lateral side of one toe, and the medial side of its neighbour

188
Q

Morton’s Neuroma

Investigations (1)

A

MRI/ultrasound

189
Q

Morton’s Neuroma

Treatment (1)

A

Neuroma excision

190
Q

Plantar Fasciitis

Pathology (3)

A

The plantar fascia supports the arch of the foot
Most common cause of plantar heel pain
Arises from degenerative changes from microtrauma

191
Q 
Plantar Fasciitis
Risk Factors (3)
A

Obesity
Inactivity
Excessive walking

192
Q

Plantar Fasciitis

Treatment (3)

A

Stretching achilles tendon
Orthotics
Shockwave therapy

193
Q

Osteogenesis Imperfecta

Definition (2)

A

An inherited disorder of type 1 collagen

Results in joint laxity and fragile, low-density bones which recurrently fracture

194
Q

Osteogenesis Imperfecta

Types (4)

A

1- mildest and most common, autosomal dominant, blue sclera and hearing loss, normal life expectancy, pre-puberty fractures
2- lethal perinatal form with many fractures, blue sclera and dwarfism, autosomal recessive
3- severe form, autosomal recessive, fractures at birth with progressive spinal and limb deformity with resultant short stature, decreased life expectancy
4- moderate form, autosomal dominant, fragile bones

195
Q

Osteogenesis Imperfecta

Signs + Symptoms (6)

A 
Growth deficiency 
Defective tooth formation 
Hearing loss 
Blue sclerae 
Scoliosis 
Easy bruising
196
Q

Osteogenesis Imperfecta

Investigations (2)

A

X-ray: many fractures, osteoporotic bones, bowing deformity of long bones
Histology: immature unorganised bone with abnormal cortex

197
Q

Osteogenesis Imperfecta

Treatment (4)

A

Prevent injury
Physio, rehab, OT
Osteotomies may correct deformity
Bisphosphonates to increase cortical thickness

198
Q

Joint Replacement

Types (3)

A

Total hip replacement: both articular surfaces of femur and acetabulum are replaced
Hip hemiarthroplasty: only articular surface of femoral head is replaced
Knee replacement: resection of articular surfaces of knee, then resurfacing with metal and polyethylene components

199
Q 
Joint Replacement 
Early complications (7)
A

VTE
Dislocation (increased risk if revision surgery due to existing weakness surrounding)
Deep infection (if caught early- debridement and antibiotics, if late- removal)
Fracture
Nerve palsy
Limb-length discrepancy
Death

200
Q 
Joint Replacement 
Joint Survival (2)
A

Knee: 90% last 15 years
Hip: by 9-10 years 11% of implants have been revised

201
Q

Mallet Finger

Aetiology (1)

A

Sudden blow to an extended finger which leads to rupture of the extensor tendon at the distal phalanx

202
Q

Mallet Finger

Treatment (3)

A

Splint for 6 weeks (in slight hyperextension)
If untreated, may develop swan-neck deformity
Surgery if splint fails or there is a large evulsion fracture

203
Q

Achilles Tendon Rupture

Signs + Symptoms (5)

A

Sudden pain at back of ankle running/jumping
Walk with limp
Some plantar flexion but impossible to raise heel from floor when stood on affected side
Gap may be palpated in tendon course
Squeeze test: kneel on chair and squeeze both calve, if Achilles ruptured there’s less plantar flexion on affected side

204
Q

Achilles Tendon Rupture

Treatment (2)

A

Tendon repair for young and athletic
Conservative (casting in equinus position, brought to neutral over 6-8 weeks with no weight bearing) for smokers/diabetics/>50s

205
Q

Brachial Plexus Injuries

Anatomy (3)

A

C5-T1
Roots leave vertebral column between scalenus anterior and medius
Divisions occur under the clavicle

206
Q

Brachial Plexus Injuries

Aetiology (2)

A

Direct: eg. shoulder girdle fracture, penetrating/iatrogenic injury
Indirect: eg. avulsion/traction injuries

207
Q

Brachial Plexus Injuries

Erb’s Palsy- C5/6 (3)

A

Abductors and external rotators paralysed
Waiters tip position
Loss of sensation in C5/6 dermatomes

208
Q

Brachial Plexus Injuries

Klumpke’s Paralysis- C8/T1 (3)

A

Paralysis of small hand muscles
Claw hand
Loss of sensation in C8/T1 dermatomes

209
Q

Brachial Plexus Injuries

Radial Nerve Injury (3)

A 
C5-T1 
Low lesions (fracture around elbow/forearm): loss of extension of CMC joints causing finger drop 
High lesions (fracture at humerus shaft where nerve is in radial groove): wrist drop, loss of sensation over snuff box
210
Q

Brachial Plexus Injuries

Ulnar Nerve Injury (5)

A

C8-T1
Intrinsic hand muscle paralysis –> claw hand
Weakness of finger ad/abduction (interossei)
Sensory loss over little finger
Test: can’t cross fingers for luck

211
Q

Brachial Plexus Injuries

Median Nerve Injury (3)

A

C5-T1
Carpal tunnel syndrome
Can cause loss of sensation in median distribution

212
Q

Soft Tissue Tumours

Pathology (1)

A

Arise in any mesenchymal tissue, origination from fat, muscle etc.

213
Q 
Soft Tissue Tumours 
Risk Factors (2)
A

Neurofibromatosis type 1

Previous radiotherapy

214
Q

Soft Tissue Tumours

Signs + Symptoms (1)

A

Painless enlarging mass

215
Q

Soft Tissue Tumours

Red Flag Symptoms (4)

A

> 5cm
Increased size
Deep to the deep fascia
Painful

216
Q

Soft Tissue Tumours

Investigations (2)

A

MRI

Needle Biopsy

217
Q

Soft Tissue Tumours

Treatment (2)

A

Excision with wide margins followed by radiotherapy

Adjuvant chemotherapy may be appropriate

218
Q

Paget’s Bone Disease
Aetiology (2)
Pathology (3)

A

Aetiology:
- >40
- genetics
Pathology:
- localised disorder of bone turnover
- increased bone resorption and formation
- bone becomes bigger, more vascular and more susceptible to deformity and fracture

219
Q

Paget’s Bone Disease
Signs + symptoms (5)
Treatment (1)

A

Signs + symptoms:
- bone pain
- excessive heat over bone
- neurological complications such as nerve deafness
- elevation of serum alkaline phosphatase bone deformity/fracture
Treatment:
- IV bisphosphonate therapy

Med Student Finals (23 decks)

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