Orthopaedics Flashcards
What shape does the menisci appear from above?
- C shaped
Meniscal tears tend to be a result from a ____ injury
- sporting injury
What percentage of ACL ruptures also have a meniscal tear?
- 50%
What are the symptoms of a meniscal tear?
- pain and tenderness localised to the joint
- sudden pain when getting up from squatting
- Effusion
- Pain on tibial rotation
What investigation should be done for a suspected meniscal tear?
- MRI
- Effusion
Meniscal tears have a poor healing potential
TRUE / FALSE
TRUE
- only the peripheral 1/3 has blood supply
Acute locked knee is what type of meniscal tear?
- Bucket handle meniscal tear
What may occur is a bucket handle meniscal tear isn’t repaired?
- FFD
- Fixed flexion deformity
What is the treatment of a bucket handle meniscal tear?
- Urgent surgery
MCL resists ___ stress
- resists valgus stress
LCL resists ____ stress
- resists varus stress
ACL resists ____
- anterior subluxation of the tibia
- internal rotation of the tibia in extension
PCL resists ____
- posterior subluxation of the femur
MCL rupture may lead to ____ instability
Valgus instability
What is the symptom of an MCL rupture?
- Pain and laxity of valgus stress
Playing football, tackled and pop heard in knee. What ligament?
- ACL
What investigations for an ACL rupture?
- anterior drawer test
- Lachmans
Motorbike accident. What ligament?
- PCL
What are serious risks of a knee dislocation?
- risk of popliteal artery injury
- nerve injury
- compartment syndrome
Patellar dislocations are always ___medially/laterally___
- lateral
Extensor mechanism rupture may occur when?
- fall onto flexed knee
- rupture quads or patellar tendon
Explain osteochondritis dissecans?
- during growth area of knee loses blood supply
Explain osteoarthritis?
- imbalance between wear and repair of articular (hyaline) cartilage
What is hyaline cartilage?
- covers surfaces of bone in synovial joints
- decreases friction
- avascular, nutrients received from synovial fluid
What are the conservative management of osteoarthritis of the knee?
- analgesics
- NSAIDs
- weight loss
- physio
- steroid injection for flare up
How many steroid injections can be given per year for a flare up of osteoarthritis?
- 3 per year
What is the ideal candidate for a TKR (total knee replacement)?
- over 60 years
- no underlying conditions
- not obese
- no chronic pain
- severe - end stage arthritis
Explain unicompartmental knee replacement?
- only worn part of knee is replaced
Explain knee osteotomy
- surgical realignment of the knee joint
- redistribute forces
When might a knee osteotomy be preferred over a TKR?
- active patient
Another term for flat foot?
- Pes Planus
Explain flexible flat feet?
- Arch forms when patient tip-toes
What is the most common cause of acquired flatfoot deformity in adults?
- Tibialis posterior dysfunction
Who gets tibialis posterior dysfunction (typically)?
o Obese middle aged female o Increases with age o Hypertension o Diabetes o Seronegative arthropathies
Symptoms of tibialis posterior dysfunction?
- pain and swelling posterior to the medial malleolus
Explain pes cavus?
- high arch
- clawing of toes
Explain plantar fasciitis?
- Inflammation of the plantar fascia on heel of foot
What are the symptoms of plantar fasciitis?
- pain worse after exercise
- swelling plantar medial aspect
- tenderness
What investigations are done of plantar fasciitis?
- Tinel’s test positive for Baxter’s nerve
Treatment of plantar fasciitis?
- NSAIDS
- night splints
- taping
Explain hallux valgus?
- bunion
Explain Morton’s neuroma?
- degenerative fibrosis of digital nerve near its bifurcation
What is a possible cause of Morton’s neuroma?
- high heels
Symptoms of Morton’s neuroma?
- forefoot pain
- burning and tingling in toes
Investigations for Morton’s neuroma?
- Mulders test
- characteristic click when squeezing forefoot
Investigations of tendo-achilles tendinitis?
- USS
- Clinical
What test is performed for tendo-achilles tendinitis?
- Simmond’s test
- no plantarflexion of foot is seen when squeezing calf
What ligament is typically affected in an ankle sprain?
- lateral ligaments
What criteria is done for ankle sprains?
-o Ottowa criteria
♣ X-ray or not?
♣ Severe localised tenderness
♣ Inability to weight bear for 4 steps
Treatment of a calcaneal fracture?
- ORIF
- Open reduction, internal fixation
Explain femoracetabular impingement syndrome
- altered morphology of femoral neck and/or acetabular
Explain a CAM type FAI?
- Femoral deformity
- athletic males
Explain a PINCER type FAI
- Acetabular deformity
- usually seen in females
Which type of femoracetabular impingement syndrome (FAI) is most common in females?
- PINCER
- Acetabular deformity
What are the longer term consequences of femoracetabular impingement syndrome
o Damage to labrum and tears
o Damage to cartilage
o Osteoarthritis in later life
What are symptoms of femoracetabular impingement syndrome
o Activity related pain in the groin
o Difficulty sitting
o C sign positive
o FADIR provocation test positive
Diagnosis of femoracetabular impingement syndrome
- Radiograph
- CT
- MRI
Management of femoralacetabular impingement syndrome?
- observation in asymptomatic patients
- arthroscopic or open surgery to remove CAM
Explain avascular necrosis of femoral head
- Failure of the blood supply to the femoral head
What are the risk factors for avascular necrosis?
- idiopathic
- trauma
- haematological disease
- long term steroid usage
What are the symptoms of avascular necrosis?
- insidious onset of groin pain over months
Management of avascular necrosis of femoral head?
- based on stage of disease may be reversible (bishosphonates, core decompression)
- total hip replacement
Explain idiopathic transient osteonecrosis of the hip (ITOH)
- Transient local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure
Symptoms of idiopathic transient osteonecrosis of the hip?
- progressive groin pain over several weeks
- usually unilateral
Diagnosis of idiopathic transient osteonecrosis of the hip?
- diagnosis of exclusion
- elevated ESR
- MRI
Treatment of idiopathic transient osteonecrosis of the hip?
- self limiting
- analgesia
- protected weight bearing to avoid stress fracture
Explain trochanteric bursitis?
- repetitive trauma caused by iliotibial band tracking over trochanteric bursa
- inflammation to bursa
Symptoms of trochanteric bursitis?
- pain on lateral aspect of hip
- pain on palpation of greater trochanter
Treatment of trochanteric bursitis?
- self-limiting
- analgesia
- NSAIDs
What are some extrinsic causes of tendinopathies?
- trauma
- repetitive injury
- drugs (steroids/antibiotics)
General management of tendinitis?
- rest
- physiotherapy
- analgesics
- injections
- splinting
When conditions should steroid injections be avoided in?
- achilles tendon
- extensor knee mechanism
Can lead to tendon rupture
What is the most commonly affected muscle in rotator cuff disease?
- supraspinatus
What are the 4 muscles of the rotator cuff?
- supraspinatus
- infraspinatus
- subscapularis
- teres minor
What are the symptoms of rotator cuff disease
- achy pain down arm
- difficulty sleeping on affected side
- tenderness over glenohumeral joint and AC joint
What surgical managements may be considered if conservative management fails in rotator cuff?
- subacromial decompression
What may cause biceps tendiopathy
- overuse
- instability
- impingement
- trauma
What head of the biceps is most commonly affected in biceps tendiopathy?
- long head
Symptoms of biceps tendinopathy
- pain anterior shoulder radiating to elbow
- aggravated by shoulder flexion
Distal or proximal biceps tendinopathy is most likely to require surgery?
- Distal
Popeye sign and extensive bruising may be what?
- biceps tendon rupture
Lateral epicondylitis is also known as?
- tennis elbow
What are the symptoms of tennis elbow?
- pain and tenderness over lateral epicondyle
- pain worse when stretching the muscle
What investigations can be performed for lateral epicondylitis (tennis elbow)
- Mills test
- pain in wrist extension with palm pronation)
Treatment of tennis elbow?
- rest
- physio
- injection
Golfers elbow is also known as?
- medial epicondylitis
Symptoms of golfers elbow
- medial elbow pain
- worse upon grasping
What are the symptoms of de quervains tenosynovitis?
- pain over radial styloid process
Investigations for de quervains tenosynovitis?
- Finklesteins test
- USS
What pulley is involved in trigger finger?
- A1 pulley
Traction apophysitis at tibial tubercle is also known as?
- Osgood-Schlatter’s disease
What population is Osgood-schlatter’s disease often seen in?
- adolescent active boys
What are the 2 main causes of an EPL (Extensor pollicis longus) rupture?
- Rheumatoid arthritis
- Colles fracture
What is the treatment of an EPL rupture?
- Tendon transfer
What 2 tendons are involved in de quervains tenosynovitis?
- APL (Abducter pollicis longus)
- EPB (Extensor pollicis brevis)
Unable to straight leg rise??
- Quads or patellar tendon injury
What is most common? An anterior or a posterior shoulder dislocation?
- Anterior
What are some reduction by manipulation techniques?
- kocher method
- hippocratic method
- Stimson method
Neer’s classification can be used for what?
- Cuff disease (impingement)
- Humeral head fractures
What age group is a cuff tear most likely seen in?
- ages 50-60
What are some risk factors and associations for a frozen shoulder?
- diabetes
- lipid and endocrine disease
- duputrytren
Explain duputytren’s contracture?
- progressive thickening of the fascia on the palm
- eventually creating a thick cord that can pull one or more fingers into a bent position.
Clawing of the ring finger and little finger may be a sign of what?
- cubital tunel syndrome
Describe the appearance of a mucous cyst?
- outpouching of synovial fluid
- raised swelling
- may be painful
Symptoms of trigger finger?
- finger tight going into flexion
What are the LOAF muscles (carpal tunnel)
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
What is an example of a carpal tunnel syndrome questionnaire?
- Kamath and stothard
What causes dupuytren’s contracture?
- genetics + environment (alcohol, diabetes)
Differences between dupuytrens and de quervians
- dupuytrens = not sore, table top test
- de quervains = sore, finklesteins test
What is the name given to infection of the nail bed?
- Paronychia
Treatment of flexor tendon sheath infection
- surgical emergency
- washout tendon sheath (a1 and a5 pulley)
Symptoms of flexor tendon sheath infection
- limited extension
- painful to percuss
- affected finger held in fixed flexion
Explain the potential treatment option for a painful subungual haematoma?
- trephine
- releases pressure
What is the treatment of a boxer’s fracture?
- buddy strap
Treatment of a PIPJ dislocation?
- pull to reduce
- buddy strap
Explain a Bennett’s fracture?
- fracture to base of thumb
How do you examine the FDP tendon?
- hold finger in middle phalanx and see if patient can flex at the DIP joints.
How do you examine the FDS tendon?
-hold all fingers straight, except the one examining. Ask patient to flex the finger examining
Why can it be difficult to examine the FDS tendon?
- FDP tendon has mass involvement over the 4 fingers
- Must immobilise the other fingers to ensure it is just the FDS you are examining
What are the principles in treatment of a mutilating injury?
- Preserve amputated parts on ice
- Early debridement
- Establish bony support
- Establish vascularity
- Establish skin cover
- Prevent/treat infection
What is eschar?
- Post burn injury
- Thick, leathery, inelastic skin which can form after burns
- May require surgical release to allow movement
What is the commonest bacteria involved in cellulitis?
- s.aureus
What is an abscess?
- collection of pus
How will an abscess present?
- well defined
- erythema
- pain
Treatment of an abscess?
- surgical incision and drainage
- antibiotics
What is septic arthritis?
- bacterial infection of the joint
What are the causes of septic arthritis?
- trauma
- haematogenous spread
What is the affect on cartilage by septic arthritis?
- irreversible damage
Management of septic arthritis?
- urgent joint aspiration
- culture
- arthroscopic or open washout
Management of a ganglia?
- based upon symptoms
- don’t advise aspiration
What is a baker’s cyst?
- ganglia in the popliteal fossa
What is a baker’s cyst associated with?
- Osteoarthritis
Explain bursitis?
- fluid filled cushion
- can become inflammed or infected
What would aspiration of grotty crystals appear as?
- negative birefringent monosodium urate crystals
Chronic treatment of gout?
- allopurinol
Where might rheumatoid nodules appear?
- extensor regions of forearm/elbow
Management of dyputren’s disease?
- needle fasciotomy
- collagenase injection
Where is a giant cell tumour of tendon sheath found?
- volar aspects of digits
Lipoma is __benign/malignant__
- benign
Ewing’s sarcoma is a malignant primary bone tumour that affects people aged ______
- 10-20 years
Explain myositis ossificans?
- post trauma
- haematoma in muscle
- haematoma calcifies
- noted on x-ray or MRI
