Orthopaedics

Question 1

What are the 4 rotator cuff muscles and their functions?

Answer 1

Subscapularis - internal rotation of shoulder
Supraspinatus - first 20degrees of shoulder abduction
Infraspinatus - external rotation of shoulder
Teres minor - external rotation of shoulder

Question 2

What are the 4 steps of fracture management (after initial A-E assessment)?

Answer 2

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

Question 3

What is a pathological fracture?

Answer 3

Fracture though diseased bone

The break in the bone is due to disease rather than an injury

Question 4

What are the causes of a pathological fracture?

Answer 4

Osteoporosis
Osteomalacia
Osteopaenia
Tumours - primary or secondary

Question 5

What is compartment syndrome?

Answer 5

Orthopaedic emergency
Due to increased pressure within the facial compartment
This causes ischaemia of the tissues within the compartment

Question 6

Where does comparment syndrome typically occur?

Answer 6

In the leg

In the forearm

Question 7

How does compartment syndrome typically present?

Answer 7

Disproportionate pain
Pain on passive stretch
Pallor
Weak pulse (this is a late sign and suggests blood flow is already compromised)

Question 8

How is compartment syndrome managed?

Answer 8

Release any dressings/casts causing external compression
Elevate the limb to be level with position of the heart
Emergency fasciotomy surgery

Question 9

Which nerve is commonly damaged in shoulder dislocation?

Answer 9

Axillary nerve

Question 10

Which nerve is commonly damaged in a midshaft humerus fracture?

Answer 10

Radial nerve

Question 11

Which nerve is commonly damaged in a supracondylar fracture?

Answer 11

Median nerve

Question 12

Which nerve is commonly damaged in a hip dislocation?

Answer 12

Sciatic nerve

Question 13

Which nerve is commonly damaged in a fibula neck fracture?

Answer 13

Common peroneal nerve

Question 14

What are the different classifications of nerve injuries?

Answer 14

Neuropraxia - injury to axon sheath
Axonotmesis - disruption to myelin sheath and the axon
Neurotmesis - complete nerve division, disruption of endoneurium

Question 15

What is a greenstick fracture?

Answer 15

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

Question 16

What are the different special tests for testing the rotator cuff muscles?

Answer 16

Supraspinatus - empty can test
Infraspinatus - external rotation against resistance
Teres minor - hornblowers test
Subscapularis- lift off test

Question 17

What is impingement syndrome?

Answer 17

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

Question 18

How is a rotator cuff injury managed?

Answer 18

Conservative - pain management and physio
If pain not controlled - steroid injections into subacromial space
If still not controlled - can undergo Subacromial decompresssoin surgery

Question 19

What is adhesive capsulitis?

Answer 19

Frozen shoulder

Where the shoulder is painful and stiff for a long period of time

Question 20

What are the risk factors for frozen shoulder?

Answer 20

Previous shoulder injury or surgery to shoulder
Diabetes
Thyroid disease

Question 21

What are the causes of sciatica?

Answer 21

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

Question 22

What is laseague’s test?

Answer 22

Test for sciatica
Positive straight leg test
Pain in the leg or lower back whilst straight lifting the leg

Question 23

What is Perthes disease and how does it commonly present?

Answer 23

Condition affected hip joint in children (aged 4-10)

Presents with limp, and difficulty with internal rotation

Question 24

What is the pathophysiology of Perthes disease?

Answer 24

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

Question 25

How is Perthes disease investigated?

Answer 25

X-ray: will show misshapen femoral head

Question 26

How is Perthes disease usually managed?

Answer 26

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

Question 27

What is a slipped upper femoral epiphysis (SUFE)?

Who does it usually present in

Answer 27

Where the head of the femur slips off the neck in a backwards direction

Usually occurs in boy adolescents who are obese

Question 28

How does slipped upper femoral epiphysis (SUFE) usually present?

Answer 28

Pain in hip (sometimes pain can come from knee)
Limp 
Leg may appear shortened 
Leg may be externally rotated
Limited movement

Question 29

How is SUFE investigated?

Answer 29

X-ray

Will show head displacement posteriorly

Question 30

How is SUFE managed?

Answer 30

Surgery - screw are used to stabilise the femoral head to prevent it from slipping

Sometime prophylactic fixing of the contralateral hip is also done

Question 31

What is Ewing’s sarcoma?

Answer 31

Rare type of bone cancer

Effects children aged 10-20
More common males

Question 32

What are the examination tests and signs for carpal tunnel syndrome?

Answer 32

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

Question 33

How is carpal tunnel syndrome managed?

Answer 33

Resting the hand
Using splint or wrist support
Steroid injection or surgery if problem continues