Orthopaedics Flashcards
What are the 4 rotator cuff muscles and their functions?
Subscapularis - internal rotation of shoulder
Supraspinatus - first 20degrees of shoulder abduction
Infraspinatus - external rotation of shoulder
Teres minor - external rotation of shoulder
What are the 4 steps of fracture management (after initial A-E assessment)?
1) assess neurovascular status of limb, remove any gross contamination
2) cover fracture/wound in gauze, and put in a back slab
3) IV antibiotics given - to prevent infection
4) take to theatre for wound washout and reduction/stabilisation of fracture
What is a pathological fracture?
Fracture though diseased bone
The break in the bone is due to disease rather than an injury
What are the causes of a pathological fracture?
Osteoporosis
Osteomalacia
Osteopaenia
Tumours - primary or secondary
What is compartment syndrome?
Orthopaedic emergency
Due to increased pressure within the facial compartment
This causes ischaemia of the tissues within the compartment
Where does comparment syndrome typically occur?
In the leg
In the forearm
How does compartment syndrome typically present?
Disproportionate pain
Pain on passive stretch
Pallor
Weak pulse (this is a late sign and suggests blood flow is already compromised)
How is compartment syndrome managed?
Release any dressings/casts causing external compression
Elevate the limb to be level with position of the heart
Emergency fasciotomy surgery
Which nerve is commonly damaged in shoulder dislocation?
Axillary nerve
Which nerve is commonly damaged in a midshaft humerus fracture?
Radial nerve
Which nerve is commonly damaged in a supracondylar fracture?
Median nerve
Which nerve is commonly damaged in a hip dislocation?
Sciatic nerve
Which nerve is commonly damaged in a fibula neck fracture?
Common peroneal nerve
What are the different classifications of nerve injuries?
Neuropraxia - injury to axon sheath
Axonotmesis - disruption to myelin sheath and the axon
Neurotmesis - complete nerve division, disruption of endoneurium
What is a greenstick fracture?
Fracture commonly occurring in children
Childs bones are more flexible, so they are more bendy. A greenstick fracture is caused by a crack in the bone while bending
What are the different special tests for testing the rotator cuff muscles?
Supraspinatus - empty can test
Infraspinatus - external rotation against resistance
Teres minor - hornblowers test
Subscapularis- lift off test
What is impingement syndrome?
Where there is pain on abduction of the shoulder joint between 60 and 120 degrees
Due to rotator cuff tear - mainly involving supraspinatus and infraspinatous
How is a rotator cuff injury managed?
Conservative - pain management and physio
If pain not controlled - steroid injections into subacromial space
If still not controlled - can undergo Subacromial decompresssoin surgery
What is adhesive capsulitis?
Frozen shoulder
Where the shoulder is painful and stiff for a long period of time
What are the risk factors for frozen shoulder?
Previous shoulder injury or surgery to shoulder
Diabetes
Thyroid disease
What are the causes of sciatica?
Slipped disc (between L5/S1) - most common cause (more likely in patients <50)
Spinal stenosis - (more likely in patients >60)
Spondyloisthesis - vertebrae slips over the one below
What is laseague’s test?
Test for sciatica
Positive straight leg test
Pain in the leg or lower back whilst straight lifting the leg
What is Perthes disease and how does it commonly present?
Condition affected hip joint in children (aged 4-10)
Presents with limp, and difficulty with internal rotation
What is the pathophysiology of Perthes disease?
Loss of blood supply to the femoral head
Over time this can lead to necrosis of tissue causing avascular necrosis of femoral head
Femoral head loses mass and is more prone to fractures
Femur head becomes mis happen and can no longer rotate as well
How is Perthes disease investigated?
X-ray: will show misshapen femoral head
How is Perthes disease usually managed?
Conservatively - pain relief, physio, limit physical activity when disease is active
Will usually get better on its own in time
Can do surgery if the femur becomes extremely fractured due to disease
What is a slipped upper femoral epiphysis (SUFE)?
Who does it usually present in
Where the head of the femur slips off the neck in a backwards direction
Usually occurs in boy adolescents who are obese
How does slipped upper femoral epiphysis (SUFE) usually present?
Pain in hip (sometimes pain can come from knee) Limp Leg may appear shortened Leg may be externally rotated Limited movement
How is SUFE investigated?
X-ray
Will show head displacement posteriorly
How is SUFE managed?
Surgery - screw are used to stabilise the femoral head to prevent it from slipping
Sometime prophylactic fixing of the contralateral hip is also done
What is Ewing’s sarcoma?
Rare type of bone cancer
Effects children aged 10-20
More common males
What are the examination tests and signs for carpal tunnel syndrome?
Tinnel’s test - tapping on wrist under base of thumb elicits tingling
Phalen’s test - putting hands together back to back fingers pointing downwards elicits tingling
How is carpal tunnel syndrome managed?
Resting the hand
Using splint or wrist support
Steroid injection or surgery if problem continues
