Orthopaedics Flashcards
Examination - elbow
- Forearm flexor muscles origin
- Forearm extensor muscles origin
- Stigmata of systemic disease to look for (2)
- Golfer’s elbow =
- Tennis elbow =
- Functional problems - basic tests (3)
- Medial epicondyle
- Lateral epicondyle
- Psoriatic plaques, rheumatoid nodules
- Flexor tendonitis (medial epicondyle insertion)
- Extensor tendonitis (lateral epicondyle insertion)
- Both hands behind head, to mouth, behind bottom
Examination - foot
- Pes planus (flat foot) - can cause
- Pes cavus (high arch) - can cause
- Test for Achilles tendon integrity
- Foot pronation, valgus heel deformity
- Hind foot varus deformity
- Simmonds
Myotomes
- Hip flexion
- Hip extension
- Knee flexion
- Knee extension (+ reflex)
- Ankle dorsiflexion
- Ankle plantar flexion (+ reflex)
- Great toe extension
- L2/3
- L4/5
- L5, S1
- L3/4
- L4/5
- S1
- L5
Gait abnormalities - causes
- Trendelenburg - muscle and nerve involved
- High-stepping
- Loss of hip abductor function (superior gluteal nerve lesion)
- Peroneal or sciatic nerve palsy
Examination - shoulder
- Joints (4)
- Movements (6) + which muscles
- Jobes test - what, what for
- Lift off test - what, what for
- External rotation against resistance - muscles (2)
- Axilliary nerve (sensation) test where
- Usual direction of dislocation
- Sternoclavicular, acromiclavicular, glenohumeral, scapulothoracic
- Flex (biceps brachii (both heads), pectoralis major, anterior deltoid, coracobrachialis)
Extend (posterior deltoid, latissimus dorsi, teres major)
Abduct (supraspinatous for 15 degrees, middle fibres of deltoid to 90, trapezius + serratus anterior for >90)
Adduct (pectoralis major, latissimus dorsi, teres major)
Internal rotation (subscapularis, pectoralis major, latissimus dorsi, teres major, anterior deltoid)
External rotation (infraspinatus, teres minor) - Shoulder abduction against resistance, tests supraspinatus
- Medial rotation against resistance, tests subscapularis
- Teres minor, infraspinatous
- Regimental badge area
- Anterior
Examination - hand
- Median nerve - testing sensation/motor
- Ulnar nerve - testing sensation/motor
- Radial nerve - testing sensation/motor
- Function tests (3)
- Movements of hand
- Phalen test
- Tinnel test
- Lateral aspect of the index finger, thumb abduction
- Medial aspect of the little finger, little finger abduction
- Dorsal 1st IO space, wrist extension
- Pinch grip, power grip, fine motor control
- Pronation, supination, wrist/finger flexion/extension, finger abduction/adduction
- Wrist held in plantar flexion to reproduce CT symptoms
- Tap over the median nerve
Examination - hip
- True hip pain often felt where
- True leg length
- Apparent leg length
- Tibial discrepancy shown by
- Femoral discrepancy shown by
- Muscles - flexion (3)
- Extension (2)
- Abduction (3)
- Adduction (3)
- Lateral rotation (3)
- Medial rotation (4)
- Groin
- ASIS to MM
- Umbilicus to MM
- One knee higher than other
- One knee behind other
- Iliopsoas, rectus femoris, sartorius
- Gluteus maximus, hamstrings
- Gluteus medius + minimus, deep gluteals
- Adductor longus, brevis + magnus
- Biceps femoris, gluteus maximus, deep gluteals
- Semitendinosus, semimbranosus, Gluteus medius + minimus
Examination - back
- Schobers test - aim
- Femoral stretch test - which myotome, pain where
- Straight leg raise - which myotomes, pain where
- Quantify lumbar spine flexion
- L4, positive if pain in anterior thigh
- L5/S1, positive if pain in back of leg/buttock
Shoulder injuries
- Biceps tendonitis - position to test, pain where
- Adhesive capsulitis - presentaton
- First/most restricted movement
- Risk factors
- Acromioclavicular degeneration - presentation
- Subacromial impingement - presenation
- Rotator cuff tear - presentation
- Tendon which most commonly calcifies
- Frozen shoulder - which movement most reduced
- Shoulder in 60 degrees flexion, elbow in full extension, arm fully supinated - pain in bicipital groove
- Painful stiff shoulder with restriction of active and passive range of motion in abduction, internal and external rotation
- External rotation
- Female, DM, non-dominant hand
- Popping/swelling/clicking/grinding, positive scarf test
- Painful arc on abduction, worse at 90 - 120 degrees
- Specific trauma/chronic, weakness+ pain, maybe muscle wasting/tenderness, painful arc
- Supraspinatus
- External rotation
Childhood hip disorder
- Developmental dysplasia of hip - picked up when
- Risk factor
- Positive tests (2)
- Other signs
- Diagnostic imaging + treatment if < 6 months
- Transient synovitis of hip - commonest presentation
Management, time to improve - Perthe’s disease - definition
- Presentation
- X-ray changes
- Slipped upper femoral epiphysis (SUFE) - presentation
- Commoner in, management
- Reduced ROM where
- Juvenile idiopathic arthritis (JIA) - definition
- Pauciarticular JIA - features, associated symptoms
- Septic arthritis - presentation
- 6 week baby check (female)
- Breech delivery (do USS at 6 weeks if so)
- Ortoloni (reduce hip when abducted),
Barlow (dislocates with adduction) - Unequal skin folds/leg length
- USS, Pavlik harness (surgery if diagnosis > 6 months)
- 2-10 (5-6) yo, acute hip pain with viral infection (no fever) - commonest limp cause, diagnosis of exclusion
Improves by itself over weeks/months (analgesia) - Femoral head avascular necrosis
- Boys aged 4-8, progressive (over weeks) hip pain, limp, stiffness - leads to early hip OA. Treat supportively
- Wider joint space (early), small/flat femoral head (late)
- 10-50 yo, hip pain, limp, pain referred to the knee
- Boys, obese; surgical fixation
- Loss of leg internal rotation when flexed
- Arthritis <16, lasting >3 months
- <5 joints affected, limp, medium joint pain/swelling (e.g. knees, ankles, elbows), can ANA positive/link with anterior uveitis
- Acute, systemic (e.g. pyrexia), severe joint limitation
De Quervain’s Tendinosis
1. Test
- Finkelstein - place thumb against hand, make fist + close fingers over thumb, bend wrist toward little finger
Septic arthritis
- Risk factors
- Investigations
- CXR and CRP may be
- Kocher criteria
- 1st line ABX management
- If penicillin allergy/MRSA/prosthetic joint
- Commonest organism overall
- In infants
- Sexually active young adults
- Main cause of articular cartilage breakdown
- Commonest joints (2) + risk in 1
- Acutely hot swollen joint - other differentials
- Pre-existing joint disease (especially RA), DM, immunosuppression, recent joint surgery, prosthetic joint
- Urgent joint aspirate (stain, crystal microscopy, culture, ABX sensitivities), blood cultures, FBC, CRP/ESR
- Normal (or show pre-existing change e.g. in RA)
- Fever, raised CRP/ESR, raised WCC, won’t weight bear
- Flucloxacillin + rifampicin 3-6 weeks
- Vancomycin + rifampicin 3-6 weeks
- Staph. aureus
- H. influenzae
- N. Gonorrhoea
- Enzymes produced by leukocytes
- Knee, hip (avascular necrosis risk)
12. Gout (negatively birefringent urate crystals) Pseudogout (positive, Ca2+ pyrophosphate crystals) Reactive arthritis (urethritis/gastroenteritis trigger, associated with conjunctivitis
Osteomyelitis
- Commonest cause - overall
- Types (2), which commonest in children
- Bacteria settles where
- Risk factors - congenital (2)
- Acquired
- Presentation
- Examination - look for
- Cervical vertebral OM - presentation
- What type of abscess can form, consequence of this
- Best imaging (+ appearance at start)
- Appearance after 10 days
- In chronic OM
- Investigations - other
- ABX - 1st line (+ other management)
- Management - chronic (1st line)
- Staph. aureus
- Haematogenous (bacteraemia, acute commonest in children), contiguous (adjacent infection)
- Metaphysis of long bones
- Sickle cell disease, Haemophilia
- DM, renal failure, IVDU, malnutrition, penetrating injuries, surgical infection, immunosuppression,
- Reduced mobility, swelling (+ non-specific pain), low-grade fever, erythema, sinus/wound drainage
- Surgery scars, sinus, reduced ROM, deformity, pain
- Torticollis secondary to neck soft tissue infection
- Subperiosteal; bone death which harbours infection
- Plain X-ray; normal, may see osteopaenia
- New bone forming, periostal elevation, sclerotic lesion
- Sequestrum, with new bone around it
- Deep site swab culture, aspirate, blood culture
- Flucloxacillin 2-4 weeks, immobilise, analgesia
- Surgery to remove sequestrum
Open fractures
- Biggest risk
- First management
- Dressed with
- Prophylaxis (2)
- Management - theatre
- Bone infection leading to osteomyelitis
- Photographed then irrigated
- Saline soaked swabs
- ABX, tetanus
- Aggressive debridement, external/internal fixation
Fracture - definitions
- General
- Simple
- Comminuted
- Segmental
- Undisplaced
- Displaced
- Pathological fractures - causes (4)
- Loss of continuity of the cortex of the bone
- Bone fractured in two pieces
- Bone in 3 or more pieces
- Fracture at 2 levels of the same bone
- Anatomy entirely unchanged
- Bone components not in original anatomical position
- Tumours, infection, RA, metabolic bone disease
Trauma - imaging
- X-ray - planes (2)
- CT - used for
- AP, lateral
2. Complex fractures + to plan surgery
Compartment syndrome
- Definition
- Early signs
- Late signs (2)
- What happens to muscles
- Management if suspected
- Excessive pressure in a closed fasical muscle compartment
- Excessive pain, increased on passive stretching of muscles in that compartment
- Paraesthesia, pulselessness
- Necrosis
- Emergency fasciotomy
Fractured neck of femur (NOF)
- Examination
- X-rays (2)
- Classification (2)
- Management - extracapsular
- Intracapsular - elderly/frail
- Intracapsular - active, displaced
- Intracapcular - active, undisplaced
- Post-op management
- Can damage which nerve (+ presentation)
- Shortened, abducted, externally rotated, greater trochanter pain worse on rotation
- AP pelvis, lateral hip
- Intracapsular (higher risk of AN), extracapsular
- Dynamic hip screw (DHS)
- Hemiarthroplasty
- Total hip replacement
- DHS, cannulated screw
- Thromboprophylaxis, daily physio, review bone protection (Vit D, calcium, bisphosphonates)
- Femoral; weak knee extension, patella reflex lost, anteromedial thigh/lower leg numbness
MSK X-ray - presentation (ABCS)
- Alignment
- Bone
- Cartilage
- Soft tissue
Fracture description - SOD
- Site
- Obliquity
- Displacement (distal piece in relation to proximal)
- Joints and bones (dislocation, subluxation)
- Cortex, bone fragment, texture between cortex
- Joint space, contour disruption, signs of disease
- Disruption, swelling, foreign body, calcification
- Which bone, intra/extra articular, position (which third)
- Completeness, direction (transverse, oblique, spiral, greenstick), surrounding damage (simple/complex, open/closed), bone condition (comminuted, segmental, multiple, stable/unstable)
- Translation, angulation, rotation, length shortening
Carpal tunnel syndrome
- Nerve affected
- Presentation
- Examination
- Cause/associated disease
- Investigation
- Management
- Other muscles supplied by median
- Median
- Pain/pins and needles in thumb, index, middle finger, ascending proximally, shakes hand to improve at night
- Weak thumb abduction (abductor pollicis brevis), thenar wasting (not hypothenar), Tinel (tap)/Phalen (flex) signs
- Idiopathic, hypothyroid, DM, pregnancy, RA, acromegaly
- Electrophysiology: M+S prolonged action potential
- Steroid injections, night wrist splint, surgical decompression (flexor retinaculum division)
- 1st lumbricals, opponens pollicis, flexor pollicis brevis
Other nerve lesions
- Ulnar nerve compression - where
- Presentation
- Radial nerve - supply which muscles
- Compress against what
- Presentation
- Superficial peroneal nerve - motor
- Sensory
- Sciatic nerve - presentation
- Obturator nerve - presentation
- Damaged how
- Tibial nerve injury (rare) - due to
- Olecranon groove
- Claw deformity, loss of sensation in 4-5th fingers
- Triceps, brachoradialis, supinator, wrist/finger extensors
- Humerus
- Wrist drop, loss of finger extension, loss of sensation over anatomical snuffbox
- Ankle evertors
- Skin on the lateral side of the lower leg
- Weakness in knee flexion and foot movements, pain and numbness from gluts to ankle
- Numb over medial thigh, weak hip adduction
- Anterior hip dislocation (posterior more common - short, adducted, internally rotated)
- Popliteal laceration
Radiculopathy
- Definition
- Causes of compression (5)
- Red flags - infection (3)
- Fracture (3)
- Malignancy (2)
- Analgesia - 1st + 2nd line
- Muscle spasm
- Cervical myelopathy - gold-standard investigation
- Conduction block in axons of a spinal nerve or its roots
- Disc prolapse, spine degeneration, trauma, malignancy, infection (OM)
- Immunosuppression, IVDU, fever (unexplained)
- Steroid use, trauma, osteoporosis
- > 50, PMH of malignancy
- Amytriptyline, gabapentin
- Benzodiazepines e.g. diazepam
- Cervical MRI
Anatomy - general
- Femoral triangle - borders (3) + floor
- Contents - NAVEL (lateral to medial)
- Femoral canal - borders (4)
- Femoral nerve - sensory branches (2)
- Obturator nerve - supplies
- Sciatic nerve - motor supply
- Motor branches (2)
- Inguinal ligament (superior), Sartorius (lateral), Adductor longus (medial), fascia lata (floor)
- Femoral: nerve, artery, vein, empty space, lymph canal
- Lacunar ligement (medial), femoral vein (lateral), inguinal ligament (anterior), pectineus (posterior)
- Anterior cuteaneous (anteromedial thigh),
saphenous (medial leg + foot) - Adductor muscles, medial thigh sensation
- Posterior thigh and hamstring portion of adductor magnus
- Tibial (posterior leg muscles AP/lateral leg/sole of foot senation), common fibular (antero (deep) / lateral (superficial) leg muscles, lateral leg/dorsum of foot sensation)
Osteoporosis - general
- Definition
- Risk factors - most important
- Other
- Medication that may worsen
- Low bone density + abnormal bone structure - leads to compromised bone strength
- History of glucocorticoids, rheumatoid arthritis, active smoking, alcohol excess, low BMI, parent had #NOF
- Female, maternal FH of fragility, fractures, osteoporosis, older age, weight loss >10kg, post/premature menopause, endocrine/malabsorption conditions
- SSRI, AEDs, PPIs, glitazone
Osteoporosis - management
- When to start
- Threshold if steroid-induced OP
- 1st line (+ MOA)
- Side effects
- Counselling points
- Lifestyle advice
- Alternatives to 1st line medication (2) if GI upset (25%)
- DEXA T score of -2.5 (2.5 SD below mean BMD) (may not have to do this if F >75 and post-fragility fracture)
- 1.5 SD below mean (repeat in 1-3 years if -0.5-1.5) - even if <65 (same if going to be on steroids for 3+ months)
- Alendronate (bisphosphonate - decreases bone demineralisation) + supplements (Vit D + calcium if F)
- Oesophagitis/ulcers, diarrhoea/constipation, jaw ON, maybe acute phase response (fever, myalgia, arthralgia)
- 1/week, before breakfast/other meds, swallow whole with glass of water, upright for 30 minutes, tablets should be swallowed whole with a glass of water, regular dentist
- Exercise (weight bearing), stop smoking, less alcohol, balancing exercises, Ca2+/vit- D rich diet (milk)
- Risederonate, etidronate
Paget’s disease (bone)
- What is it
- Risk factors
- Bones most affected (3)
- Commonest presentation
- Examination findings if untreated
- Primary imaging + finding
- Blood test - abnormal result
- Management - main aim of treatment
- Treatment choices (2)
- Complications
- Chronic disorder - unbalanced bone turn over (focal reabsorption then excessive/chaotic bone deposition)
- Elderly, male, FH, northern latitude
- Femur, pelvis, skull
- Asymptomatic, sometimes long bone/face pain, or pathological fracture
- Skull bossing, bowed sabre tibia, bone enlargement
- Plain x-ray - abnormal sclerotic bone (skull: thickened vault, osteoporosis circumscripta, cotton wool pattern)
- ALP high (vitamin D, calcium, phosphate normal)
- Reduce osteoclast activity
- Bisphosphonates (PO risedronate / IV zoledronate), calcitonin
- Deafness (CN 8 entrapment), osteosarcoma, fractures, skull thickening, high-output cardiac failure
Osteomalacia
- Definition
- Name if in growing children
- Causes
- Presentation - osteomalacia (4)
- Presentation - rickets
- Bloods - abnormal results (2)
- X-ray - findings
- Biopsy
- Management - dietary insufficiency
- Malabsorption/hepatic disease
- Renal disease / vit D resistance
- Normal bony tissue but decreased mineral content (after fusion of epiphyses)
- Rickets
- Low vitamin D (malabsorption, lack of sunlight, diet), renal failure, liver cirrhosis, anti-epileptic medication
- Bone pain, fractures, tender muscle, proximal myopathy
- Knock-knee, bow leg, features of hypocalcaemia
- ALP / PTH high, vitamin D / calcium / phosphate low
- Cupped, ragged metaphyseal surface (children); adults: translucent bands (Looser’s zones / pseudo-fractures)
- Incomplete mineralisation
- Calcium with vitamin D tablets (calcium D3)
- Vitamin D2 (ergocalciferol) / monthly calcitriol
- Alfacalcidol/calcitriol daily (monitor weekly for high Ca2+)
Osteoporosis - investigation
- Tools for assessing risk
- When to assess
- When to recalculate
- When to go straight to DEXA
- FRAX - interpretation + management
- Bloosods (if osteoporosis/fragility fracture)
- QFracture or FRAX (10 year risk of fragility fracture)
- Women >65, men >75
- Change in risk factors, or borderline + >2 years since
- Starting sex hormone suppression, <40 + very high risk, post-fragility fracture
- Low risk (reassure, lifestyle advice), medium (DEXA), high (offer bone protection treatment)
- FBC, ESR/CRP, U+E, LFT, TFT, bone profile (Ca2+, albumin, phosphate, magnesium, ALP)
Ankle injuries
- Ottawa ankle rules
- Weber classification of fibula fracture
- Sprain - commonest ligament affected
- Commonest injury
- X-rays only necessary if pain in malleolar zone + 1 of:
no weight bear 4 steps/ distal tibia pain / distal fibula pain
2. Type A (below syndesmosis) Type B (start at level of tibial plafond, may extend proximally to involve syndesmosis) Type C (above the syndesmosis)
- Anterior talofibular
- Inversion injury
Knee pain in older adults - descriptions
- Osteoarthritis
- Bursitis (infrapatellar/prepatellar)
- ACL injury
- PCL injury
- Collateral ligament
- Meniscal tear
Younger
- Osgood–Schlatter disease
- Patellar tendonitis
- > 50yo, overweight, severe pain, intermittent swelling, crepitus + reduced ROM
- Associated with kneeling (upright = housemaid’s)
- Twisting of bent knee, ‘popping’ noise, rapid effusion (haemarthrosis), positive anterior draw/Lachman’s tests
- From anterior force applied to proximal tibia (e.g. knee hitting dashboard during RTA) or hyperextension, paradoxical anterior draw
- Tenderness over ligament, potential effusion. Medial (forced into valgus), lateral (forced into varus)
- From twisting, locks/gives way, tender joint line
- Prominent tibial tuberosity and knee pain (sporty)
- Athletic teenage boys; chronic anterior knee pain that worsens after running, sub-patellar tenderness
Hip pain in adults - descriptions
- Osteoarthritis
- Inflammatory arthritis
- Referred lumbar spine pain (femoral nerve compressed)
- Trochanteric bursitis
- Meralgia paraesthetica
- Avascular necrosis
- Pubic symphysis dysfunction
- Pain exacerbated by exercise and relieved by rest, reduced internal rotation, age, obese, other joint issues
- Pain/stiff in morning, systemic signs, inflammatory markers
- Positive femoral nerve stretch test
- F 50-70yo, from repeated movement of fibroelastic iliotibial band, lateral thigh pain/tenderness
- Anterolateral thigh burning sensation, lateral cutaneous nerve compression
- Gradual/sudden onset, high-dose steroids, previous hip fracture/dislocation
- Pregnancy, lax ligaments, pain over PS radiating to groin/medial thigh, waddling gait
Back pain - descriptions
- Red flags
Lower - causes
- Spinal stenosis
- Ankylosing spondylitis
- Peripheral arterial disease
- Prolapsed disc
- Spinal metastases
- Cervical spondylosis
- < 20 / > 50 yo, PMH malignancy, night pain, trauma history, systemically unwell (weight loss, fever), CES symptoms, thoracic pain
- Gradual onset, uni/bilateral leg pain (+/- back), numbness, weakness, worse on walking, relieved by sitting/crouching down or leaning forward. ‘Aching’, crawling’. Normal clinical exam, requires MRI
- Young man, pain/stiffness, worse in morning, better with activity, peripheral arthritis likelier if female
- Pain on walking, relieved by rest, weak foot pulse, smoking/PVD PMH, other signs of limb ischaemia
- Leg pain worse than back, worse on sitting (give analgesia, physio, MRI if symptoms persist)
- Unrelenting lumbar back pain, thoracic/cervical pain, worse when sneezing/coughing/straining, nocturnal
- Post-OA, neck pain, headache, radiculopathy, myelopathy
Spinal cord compression (SCC)
- Commonest cause for acute SCC
- Commonest primary malignancies (5)
- Traumatic causes (2)
- Infectious causes (2)
- Risk factors (things narrowing spinal canal) (3)
- Gold-standard imaging
- Metastatic
- Breast, prostate, thyroid, renal, lung
- Vertebral fracture, facet joint dislocation
- TB, fungal
5. Inflammatory conditions (RA, AS) Degenerative conditions (spinal cord stenosis)
- MRI of the whole spine - within a day if cord compressed, within 7 days if spinal mets suggested
Upper limb fractures
- Colles - following what, features
- Smith - following what, features
- If 1/2 with associated radiocarpal dislocation, name
- Bennett - following what, features, + on x-ray
- Commonest carpal fracture, post-FOOSH + signs
- Commonest radial fracture post-FOOSH + signs
- Galleazzi fracture - what it is
- Occur following
- Bruising/swelling/tenderness where
- X-ray findings
- Post-FOOSH, transverse distal radius, dorsal displacement + angulation (‘dinner fork deformity)
- Falling backwards onto outstretched hand / on flexed wrist. Palmar angulation of distal segment (‘garden spade deformity’)
- Barton’s fracture
- Intra-articular fracture of 1st CMC joint, caused by punching (flexed metacarpal), x-ray = triangular fragment at ulnar base of metacarpal
- Scaphoid fracture; swelling/tenderness in anatomical snuff box, pain on wrist movements/longitudinal thumb compression
- Radial head; local pain, low elbow ROM / rotation pain
- Radial shaft fracture, distal radioulnar joint dislocation
- Fall on hand with rotational force superimposed on it
- Lower end of forearm
- Displaced radius fracture + prominent ulnar head due to dislocation of the inferior radio-ulnar joint
Salter Harris classification
- Classifies what
- Types (1-5) - ‘SALTR’
- Commonest type (75%)
- Physis/growth plate/epiphyseal plate - made from
- Name when fused
Other paediatric fractures
- Greenstick
- Buckle (torus)
- Growth plate issue causing short height (heterozygous)
- Other features
- Fractures through growth plates/physis (paediatrics)
- Straight across (physis only)
- Above (physis + metaphysis/shaft)
- Lower (physis + epiphysis/end to include joint)
- Through (physis, metaphysis, epiphysis)
- Ruined (crush injury)
- Type 2
- Hyaline cartilage
- Epiphyseal line
- Unilateral cortical breach only
- Partial cortical disruption; periosteal haematoma only
- Achondroplasia (so short proximal limb, digits, height)
- Frontal bossing, otitis media, small foramen magnum (CC compression, hydrocephalus), scoliosis, bow legs
Back pain history
- Key questions - cauda equina
- Malignancy
- Previous medication
- Symptom indicating spinal stenosis
- Populations predisposed to osteomyelitis (2)
- Red flags
- Bedside tests (2)
- Blood tests
- Imaging - do plain x-ray if suspecting
- MRI if suspecting
- Mechanical back pain rare after what age
- Saddle anaesthesia, bladder / bowel incontinence (new onset), leg weakness / numbness / tingling
- B symptoms (weight loss, fever, night sweats), LOA
- Long-term steroids (OA)
- Bilateral limb claudication
- IVDUs, immunosuppressed
- Aged <20/>50, specific pain (at night, lying flat, thoracic), history of cancer, malignancy/CE symptoms, significant trauma, alcohol/drug use
- PR (cauda equina), urinalysis (pyelonephritis)
- FBC, CRP/ESR, U+Es, LFTs, calcium, phosphate, myeloma (bence jones, Ig), cultures (osteomyelitis)
- Osteoarthritis, minor disc narrowing
- Malignancy, soft tissue injury
- 60
Disc prolapse
- Definition
- Usual age of presentation
- Clinical presentation
- Management
- Nucleus pulposus herniates into annulus fibrosus
- 35-55
- Leg pain worse than back, worse on sitting
- Give analgesia, physio, MRI if symptoms persist