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MSK > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What shape does the menisci appear from above?

A
  • C shaped
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2
Q

Meniscal tears tend to be a result from a ____ injury

A
  • sporting injury
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3
Q

What percentage of ACL ruptures also have a meniscal tear?

A
  • 50%
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4
Q

What are the symptoms of a meniscal tear?

A
  • pain and tenderness localised to the joint
  • sudden pain when getting up from squatting
  • Effusion
  • Pain on tibial rotation
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5
Q

What investigation should be done for a suspected meniscal tear?

A
  • MRI

- Effusion

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6
Q

Meniscal tears have a poor healing potential

TRUE / FALSE

A

TRUE

- only the peripheral 1/3 has blood supply

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7
Q

Acute locked knee is what type of meniscal tear?

A
  • Bucket handle meniscal tear
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8
Q

What may occur is a bucket handle meniscal tear isn’t repaired?

A
  • FFD

- Fixed flexion deformity

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9
Q

What is the treatment of a bucket handle meniscal tear?

A
  • Urgent surgery
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10
Q

MCL resists ___ stress

A
  • resists valgus stress
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11
Q

LCL resists ____ stress

A
  • resists varus stress
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12
Q

ACL resists ____

A
  • anterior subluxation of the tibia

- internal rotation of the tibia in extension

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13
Q

PCL resists ____

A
  • posterior subluxation of the femur
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14
Q

MCL rupture may lead to ____ instability

A

Valgus instability

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15
Q

What is the symptom of an MCL rupture?

A
  • Pain and laxity of valgus stress
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16
Q

Playing football, tackled and pop heard in knee. What ligament?

A
  • ACL
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17
Q

What investigations for an ACL rupture?

A
  • anterior drawer test

- Lachmans

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18
Q

Motorbike accident. What ligament?

A
  • PCL
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19
Q

What are serious risks of a knee dislocation?

A
  • risk of popliteal artery injury
  • nerve injury
  • compartment syndrome
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20
Q

Patellar dislocations are always ___medially/laterally___

A
  • lateral
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21
Q

Extensor mechanism rupture may occur when?

A
  • fall onto flexed knee

- rupture quads or patellar tendon

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22
Q

Explain osteochondritis dissecans?

A
  • during growth area of knee loses blood supply
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23
Q

Explain osteoarthritis?

A
  • imbalance between wear and repair of articular (hyaline) cartilage
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24
Q

What is hyaline cartilage?

A
  • covers surfaces of bone in synovial joints
  • decreases friction
  • avascular, nutrients received from synovial fluid
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25
Q

What are the conservative management of osteoarthritis of the knee?

A
  • analgesics
  • NSAIDs
  • weight loss
  • physio
  • steroid injection for flare up
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26
Q

How many steroid injections can be given per year for a flare up of osteoarthritis?

A
  • 3 per year
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27
Q

What is the ideal candidate for a TKR (total knee replacement)?

A
  • over 60 years
  • no underlying conditions
  • not obese
  • no chronic pain
  • severe - end stage arthritis
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28
Q

Explain unicompartmental knee replacement?

A
  • only worn part of knee is replaced
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29
Q

Explain knee osteotomy

A
  • surgical realignment of the knee joint

- redistribute forces

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30
Q

When might a knee osteotomy be preferred over a TKR?

A
  • active patient
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31
Q

Another term for flat foot?

A
  • Pes Planus
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32
Q

Explain flexible flat feet?

A
  • Arch forms when patient tip-toes
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33
Q

What is the most common cause of acquired flatfoot deformity in adults?

A
  • Tibialis posterior dysfunction
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34
Q

Who gets tibialis posterior dysfunction (typically)?

A 
o	Obese middle aged female
o	Increases with age
o	Hypertension
o	Diabetes
o	Seronegative arthropathies
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35
Q

Symptoms of tibialis posterior dysfunction?

A
  • pain and swelling posterior to the medial malleolus
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36
Q

Explain pes cavus?

A
  • high arch

- clawing of toes

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37
Q

Explain plantar fasciitis?

A
  • Inflammation of the plantar fascia on heel of foot
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38
Q

What are the symptoms of plantar fasciitis?

A
  • pain worse after exercise
  • swelling plantar medial aspect
  • tenderness
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39
Q

What investigations are done of plantar fasciitis?

A
  • Tinel’s test positive for Baxter’s nerve
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40
Q

Treatment of plantar fasciitis?

A
  • NSAIDS
  • night splints
  • taping
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41
Q

Explain hallux valgus?

A
  • bunion
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42
Q

Explain Morton’s neuroma?

A
  • degenerative fibrosis of digital nerve near its bifurcation
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43
Q

What is a possible cause of Morton’s neuroma?

A
  • high heels
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44
Q

Symptoms of Morton’s neuroma?

A
  • forefoot pain

- burning and tingling in toes

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45
Q

Investigations for Morton’s neuroma?

A
  • Mulders test

- characteristic click when squeezing forefoot

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46
Q

Investigations of tendo-achilles tendinitis?

A
  • USS

- Clinical

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47
Q

What test is performed for tendo-achilles tendinitis?

A
  • Simmond’s test

- no plantarflexion of foot is seen when squeezing calf

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48
Q

What ligament is typically affected in an ankle sprain?

A
  • lateral ligaments
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49
Q

What criteria is done for ankle sprains?

A

-o Ottowa criteria
♣ X-ray or not?
♣ Severe localised tenderness
♣ Inability to weight bear for 4 steps

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50
Q

Treatment of a calcaneal fracture?

A
  • ORIF

- Open reduction, internal fixation

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51
Q

Explain femoracetabular impingement syndrome

A
  • altered morphology of femoral neck and/or acetabular
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52
Q

Explain a CAM type FAI?

A
  • Femoral deformity

- athletic males

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53
Q

Explain a PINCER type FAI

A
  • Acetabular deformity

- usually seen in females

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54
Q

Which type of femoracetabular impingement syndrome (FAI) is most common in females?

A
  • PINCER

- Acetabular deformity

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55
Q

What are the longer term consequences of femoracetabular impingement syndrome

A

o Damage to labrum and tears
o Damage to cartilage
o Osteoarthritis in later life

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56
Q

What are symptoms of femoracetabular impingement syndrome

A

o Activity related pain in the groin
o Difficulty sitting
o C sign positive
o FADIR provocation test positive

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57
Q

Diagnosis of femoracetabular impingement syndrome

A
  • Radiograph
  • CT
  • MRI
58
Q

Management of femoralacetabular impingement syndrome?

A
  • observation in asymptomatic patients

- arthroscopic or open surgery to remove CAM

59
Q

Explain avascular necrosis of femoral head

A
  • Failure of the blood supply to the femoral head
60
Q

What are the risk factors for avascular necrosis?

A
  • idiopathic
  • trauma
  • haematological disease
  • long term steroid usage
61
Q

What are the symptoms of avascular necrosis?

A
  • insidious onset of groin pain over months
62
Q

Management of avascular necrosis of femoral head?

A
  • based on stage of disease may be reversible (bishosphonates, core decompression)
  • total hip replacement
63
Q

Explain idiopathic transient osteonecrosis of the hip (ITOH)

A
  • Transient local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure
64
Q

Symptoms of idiopathic transient osteonecrosis of the hip?

A
  • progressive groin pain over several weeks

- usually unilateral

65
Q

Diagnosis of idiopathic transient osteonecrosis of the hip?

A
  • diagnosis of exclusion
  • elevated ESR
  • MRI
66
Q

Treatment of idiopathic transient osteonecrosis of the hip?

A
  • self limiting
  • analgesia
  • protected weight bearing to avoid stress fracture
67
Q

Explain trochanteric bursitis?

A
  • repetitive trauma caused by iliotibial band tracking over trochanteric bursa
  • inflammation to bursa
68
Q

Symptoms of trochanteric bursitis?

A
  • pain on lateral aspect of hip

- pain on palpation of greater trochanter

69
Q

Treatment of trochanteric bursitis?

A
  • self-limiting
  • analgesia
  • NSAIDs
70
Q

What are some extrinsic causes of tendinopathies?

A
  • trauma
  • repetitive injury
  • drugs (steroids/antibiotics)
71
Q

General management of tendinitis?

A
  • rest
  • physiotherapy
  • analgesics
  • injections
  • splinting
72
Q

When conditions should steroid injections be avoided in?

A
  • achilles tendon
  • extensor knee mechanism
    Can lead to tendon rupture
73
Q

What is the most commonly affected muscle in rotator cuff disease?

A
  • supraspinatus
74
Q

What are the 4 muscles of the rotator cuff?

A
  • supraspinatus
  • infraspinatus
  • subscapularis
  • teres minor
75
Q

What are the symptoms of rotator cuff disease

A
  • achy pain down arm
  • difficulty sleeping on affected side
  • tenderness over glenohumeral joint and AC joint
76
Q

What surgical managements may be considered if conservative management fails in rotator cuff?

A
  • subacromial decompression
77
Q

What may cause biceps tendiopathy

A
  • overuse
  • instability
  • impingement
  • trauma
78
Q

What head of the biceps is most commonly affected in biceps tendiopathy?

A
  • long head
79
Q

Symptoms of biceps tendinopathy

A
  • pain anterior shoulder radiating to elbow

- aggravated by shoulder flexion

80
Q

Distal or proximal biceps tendinopathy is most likely to require surgery?

A
  • Distal
81
Q

Popeye sign and extensive bruising may be what?

A
  • biceps tendon rupture
82
Q

Lateral epicondylitis is also known as?

A
  • tennis elbow
83
Q

What are the symptoms of tennis elbow?

A
  • pain and tenderness over lateral epicondyle

- pain worse when stretching the muscle

84
Q

What investigations can be performed for lateral epicondylitis (tennis elbow)

A
  • Mills test

- pain in wrist extension with palm pronation)

85
Q

Treatment of tennis elbow?

A
  • rest
  • physio
  • injection
86
Q

Golfers elbow is also known as?

A
  • medial epicondylitis
87
Q

Symptoms of golfers elbow

A
  • medial elbow pain

- worse upon grasping

88
Q

What are the symptoms of de quervains tenosynovitis?

A
  • pain over radial styloid process
89
Q

Investigations for de quervains tenosynovitis?

A
  • Finklesteins test

- USS

90
Q

What pulley is involved in trigger finger?

A
  • A1 pulley
91
Q

Traction apophysitis at tibial tubercle is also known as?

A
  • Osgood-Schlatter’s disease
92
Q

What population is Osgood-schlatter’s disease often seen in?

A
  • adolescent active boys
93
Q

What are the 2 main causes of an EPL (Extensor pollicis longus) rupture?

A
  • Rheumatoid arthritis

- Colles fracture

94
Q

What is the treatment of an EPL rupture?

A
  • Tendon transfer
95
Q

What 2 tendons are involved in de quervains tenosynovitis?

A
  • APL (Abducter pollicis longus)

- EPB (Extensor pollicis brevis)

96
Q

Unable to straight leg rise??

A
  • Quads or patellar tendon injury
97
Q

What is most common? An anterior or a posterior shoulder dislocation?

A
  • Anterior
98
Q

What are some reduction by manipulation techniques?

A
  • kocher method
  • hippocratic method
  • Stimson method
99
Q

Neer’s classification can be used for what?

A
  • Cuff disease (impingement)

- Humeral head fractures

100
Q

What age group is a cuff tear most likely seen in?

A
  • ages 50-60
101
Q

What are some risk factors and associations for a frozen shoulder?

A
  • diabetes
  • lipid and endocrine disease
  • duputrytren
102
Q

Explain duputytren’s contracture?

A
  • progressive thickening of the fascia on the palm

- eventually creating a thick cord that can pull one or more fingers into a bent position.

103
Q

Clawing of the ring finger and little finger may be a sign of what?

A
  • cubital tunel syndrome
104
Q

Describe the appearance of a mucous cyst?

A
  • outpouching of synovial fluid
  • raised swelling
  • may be painful
105
Q

Symptoms of trigger finger?

A
  • finger tight going into flexion
106
Q

What are the LOAF muscles (carpal tunnel)

A

Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

107
Q

What is an example of a carpal tunnel syndrome questionnaire?

A
  • Kamath and stothard
108
Q

What causes dupuytren’s contracture?

A
  • genetics + environment (alcohol, diabetes)
109
Q

Differences between dupuytrens and de quervians

A
  • dupuytrens = not sore, table top test

- de quervains = sore, finklesteins test

110
Q

What is the name given to infection of the nail bed?

A
  • Paronychia
111
Q

Treatment of flexor tendon sheath infection

A
  • surgical emergency

- washout tendon sheath (a1 and a5 pulley)

112
Q

Symptoms of flexor tendon sheath infection

A
  • limited extension
  • painful to percuss
  • affected finger held in fixed flexion
113
Q

Explain the potential treatment option for a painful subungual haematoma?

A
  • trephine

- releases pressure

114
Q

What is the treatment of a boxer’s fracture?

A
  • buddy strap
115
Q

Treatment of a PIPJ dislocation?

A
  • pull to reduce

- buddy strap

116
Q

Explain a Bennett’s fracture?

A
  • fracture to base of thumb
117
Q

How do you examine the FDP tendon?

A
  • hold finger in middle phalanx and see if patient can flex at the DIP joints.
118
Q

How do you examine the FDS tendon?

A

-hold all fingers straight, except the one examining. Ask patient to flex the finger examining

119
Q

Why can it be difficult to examine the FDS tendon?

A
  • FDP tendon has mass involvement over the 4 fingers

- Must immobilise the other fingers to ensure it is just the FDS you are examining

120
Q

What are the principles in treatment of a mutilating injury?

A
  • Preserve amputated parts on ice
  • Early debridement
  • Establish bony support
  • Establish vascularity
  • Establish skin cover
  • Prevent/treat infection
121
Q

What is eschar?

A
  • Post burn injury
  • Thick, leathery, inelastic skin which can form after burns
  • May require surgical release to allow movement
122
Q

What is the commonest bacteria involved in cellulitis?

A
  • s.aureus
123
Q

What is an abscess?

A
  • collection of pus
124
Q

How will an abscess present?

A
  • well defined
  • erythema
  • pain
125
Q

Treatment of an abscess?

A
  • surgical incision and drainage

- antibiotics

126
Q

What is septic arthritis?

A
  • bacterial infection of the joint
127
Q

What are the causes of septic arthritis?

A
  • trauma

- haematogenous spread

128
Q

What is the affect on cartilage by septic arthritis?

A
  • irreversible damage
129
Q

Management of septic arthritis?

A
  • urgent joint aspiration
  • culture
  • arthroscopic or open washout
130
Q

Management of a ganglia?

A
  • based upon symptoms

- don’t advise aspiration

131
Q

What is a baker’s cyst?

A
  • ganglia in the popliteal fossa
132
Q

What is a baker’s cyst associated with?

A
  • Osteoarthritis
133
Q

Explain bursitis?

A
  • fluid filled cushion

- can become inflammed or infected

134
Q

What would aspiration of grotty crystals appear as?

A
  • negative birefringent monosodium urate crystals
135
Q

Chronic treatment of gout?

A
  • allopurinol
136
Q

Where might rheumatoid nodules appear?

A
  • extensor regions of forearm/elbow
137
Q

Management of dyputren’s disease?

A
  • needle fasciotomy

- collagenase injection

138
Q

Where is a giant cell tumour of tendon sheath found?

A
  • volar aspects of digits
139
Q

Lipoma is __benign/malignant__

A
  • benign
140
Q

Ewing’s sarcoma is a malignant primary bone tumour that affects people aged ______

A
  • 10-20 years
141
Q

Explain myositis ossificans?

A
  • post trauma
  • haematoma in muscle
  • haematoma calcifies
  • noted on x-ray or MRI

MSK (16 decks)

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