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Orthopaedics > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Risk factors for achilles tendon disorders:

A
  • quinolone use e.g. ciprofloxacin

- hypercholesterolaemia (predisposes to tendon xanthomata)

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2
Q

Features of achilles tendinopathy (tendinitis):

A
  • gradual onset of posterior heel pain worse following activity
  • morning pain and stiffness common
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3
Q

Management of achilles tendinopathy:

A
  • simple analgesia
  • reduction in activities
  • calf muscle eccentric exercises
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4
Q

Common presentation and investigations of achilles tendon rupture:

A
  • ‘pop’ in ankle with sudden onset significant pain in calf or ankle and inability to walk
  • Simmond’s triad
  • Ultrasound
  • acute referral to orthopaedic specialist
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5
Q

What is Simmond’s triad?

A
  • abnormal angle of declination
  • greater dorsiflexion of injured foot
  • gap in tendon and gently squeeze calf muscles - if rupture, foot will stay in neutral position
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6
Q

How are acromioclavicular joint injuries graded?

A

from I to VI depending on degree of separation

  • grades I and II: very common, manage conservatively, sling
  • grades IV, V and VI: rare, surgical intervention
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7
Q

What is adhesive capsulitis and in whom does it most commonly occur?

A
  • frozen shoulder
  • middle aged females
  • diabetes mellitus
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8
Q

Features of adhesive capsulitis:

A
  • develop over days
  • external rotation affected more than internal rotation or abduction
  • passive and active affected
  • painful freezing phase, adhesive phase, recovery phase
  • bilateral in 20%
  • episodes 6 months - 2 years
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9
Q

Management adhesive capsulitis:

A

NSAIDs, physio, oral corticosteroids, intra-articular corticosteroids

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10
Q

When is an ankle x-ray required for suspected fracture?

A

Ottawa rules:
if any pain in malleolar zone with any of the following:
-bony tenderness at lateral malleolar zone
-bony tenderness at medial malleolar zone
-inability to walk four weight bearing steps immediately after injury

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11
Q

Sensitivity of Ottawa rules:

A

100%

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12
Q

Ligamentous structures of ankle:

A
  • syndesmosis binds distal tibia and fibula: anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), interosseous ligament (IOL) and interosseous membrane
  • distal fibular to talus by anterior and posterior talofibular ligaments (ATFL and PTFL) and to calcaneus by calcanenofibular ligament (collectively lateral collateral ligaments)
  • distal tibia to talus by deltoid ligament
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13
Q

What is a sprain?

A

stretching, partial or complete tear of ligament

  • high ankle sprains involve syndesmosis
  • low ankle sprains involve lateral collateral ligaments
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14
Q

Presentation of low ankle sprains:

A
  • most common
  • injury to ATFL most common
  • inversion injury most common mechanism
  • pain, swelling, tenderness sometimes bruising
  • able to weight bear unless severe
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15
Q

Investigation low ankle sprain:

A
  • radiographs according to ottawa ankle rule

- MRI if persistent pain and useful for evaluating perineal tendons

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16
Q

Treatment low ankle sprain:

A
  • non operative: rest, ice, compression, elevation
  • removable orthosis, cast, crutches
  • surgery if symptoms fail to settle or significant joint instability
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17
Q

Presentation high ankle sprains:

A
  • injury to syndesmosis rare and severe
  • mechanism usually external rotation of foot causing talus to push fibula laterally
  • weight bearing painful
  • pain when tibia and fibula squeezed at mid-calf (Hopkin’s squeeze test)
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18
Q

Investigations high ankle sprain:

A
  • radiographs may show widening of tibiofibular joint or ankle mortise
  • MRI if high suspicion of syndesmotic injury but normal plain films
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19
Q

Treatment high ankle sprain:

A
  • if no diastasic, non-weight bearing orthosis or cast until pain subsides
  • if diastasic or failed non-operative management - operative fixation
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20
Q

What is avascular necrosis?

A
  • death of bone tissue secondary to loss of blood supply

- most commonly affects epiphysis of long bones e.g. femur

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21
Q

Causes of avascular necrosis:

A
  • long term steroid use
  • chemotherapy
  • alcohol excess
  • trauma
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22
Q

Features and investigations of avascular necrosis:

A
  • initially asymptomatic
  • pain in joint
  • plain X-ray: osteopenia and micro fractures early on, collapse of articular surface shows crescent sign
  • MRI: investigation of choice, more sensitive
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23
Q

Management avascular necrosis:

A

joint replacement

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24
Q

What are Baker’s cysts?

A
  • also popliteal cysts
  • not true cysts but distension of gastrocnemius-semimembranosus bursa
  • primary: no underlying pathology, typically children
  • secondary: underlying condition e.g. osteoarthritis, typically adults
25
Q

Features of ruptured Baker’s cyst:

A
  • similar symptoms to DVT
  • pain, redness, swelling
  • majority asymptomatic
26
Q

Management Baker’s cyst:

A
  • children typically resolve so no Tx

- adults: treat underlying cause where appropriate

27
Q

Tendons of biceps muscle:

A
  • long tendon attached to glenoid
  • short tendon attached to coracoid process
  • inserts distally via another tendon onto radial tuberosity
28
Q

What happens in biceps rupture?

A
  • one tendon separates from attachment site or torn across full width
  • most long tendon 90%
  • rarely distal tendon
29
Q

In whom are biceps ruptures more common?

A

men to women 3:1

30
Q

Risk factors biceps rupture:

A
  • heavy overhead activities
  • shoulder overuse or underlying shoulder injuries
  • smoking
  • corticosteroids
31
Q

Mechanism of injury of biceps rupture:

A
  • proximal long tendon: when biceps lengthened and contracted and load applied e.g. descent phase of pull up
  • distal tendon: flexed elbow suddenly and forcefully extended whilst biceps is contracted
32
Q

Presentation and features of biceps rupture:

A
  • sudden pop or tear at shoulder (long) or antecubital fossa (distal) with pain and swelling
  • proximal tendon - popeye deformity
  • distal rupture causes reverse Popeye
  • weakness in shoulder and elbow follows including difficulty with supination
  • some have chronic shoulder pain before
33
Q

Investigating for biceps rupture:

A
  • palpate long head and distal biceps tendon to assess neuromuscular function
  • biceps squeeze test - intact then squeeze will cause forearm supination
  • MSK US
  • consider MRI for long head
  • distal biceps rupture - urgent MRI (surgical intervention)
34
Q

Features of Paget’s:

A
  • focal bone resorption with excessive bone deposition
  • affects spine, skull, pelvis and femur
  • serum ALP raised
  • abnormal thickened, sclerotic bone on X-ray
  • risk of cardiac failure
  • small risk sarcomatous change
35
Q

Treatment Paget’s:

A

bisphosphonates

36
Q

Features of osteoporosis:

A
  • excessive bone resorption causing demineralised bone
  • common in older
  • increased risk of pathological fracture
  • otherwise asymptomatic
  • normal ALP, normal calcium
37
Q

Treatment osteoporosis:

A
  • bisphosphonates

- calcium and vit D

38
Q

Features secondary bone tumours:

A
  • bone destruction and tumour infiltration
  • mirel scoring used to predict risk of fracture
  • elevated serum calcium and ALP
39
Q

Treatment secondary bone tumours:

A
  • radiotherapy

- prophylactic fixation and analgesia

40
Q

What is a buckle fracture?

A
  • torus
  • incomplete fractures of shaft of long bone characterised by bulging of cortex
  • children 5-10 years
  • self limiting - no operative intervention
  • splinting and immobilisation
41
Q

What is carpal tunnel syndrome and what are the symptoms?

A
  • compression of median nerve
  • pain/pins and needles in thumb, index and middle finger
  • may ascend proximally
  • patient shakes hand to obtain relief
42
Q

Examination carpal tunnel syndrome:

A
  • weakness of thumb abduction (abductor pollicis brevis)
  • wasting of thenar eminence (not hypothenar)
  • Tinel’s sign: tapping causes paraesthesia
  • Phalen’s sign: flexion of wrist causes symptoms
43
Q

Causes of carpal tunnel syndrome:

A
  • idiopathic
  • pregnancy
  • oedema e.g. heart failure
  • lunate fracture
  • rheumatoid arthritis
44
Q

Electrophysiology carpal tunnel syndrome:

A

motor and sensory: prolongation of action potential

45
Q

Treatment carpal tunnel syndrome:

A
  • corticosteroid injection
  • wrist splints at night
  • surgical decompression (flexor retinaculum divison)
46
Q

What is cauda equina syndrome?

A
  • lumbosacral nerve roots bowl spinal cord compressed

- may lead to permanent nerve damage resulting in long term weakness and urinary/bowel incontinence

47
Q

Causes of cauda equina syndrome:

A
  • most common is central disc prolapse: L4/5 or L5/S1
  • tumours: primary or metastatic
  • infection: abscess, discitis
  • trauma
  • haematoma
48
Q

Features of cauda equina syndrome:

A
  • low back pain
  • bilateral sciatica
  • reduced sensation/pins and needles in perianal area
  • decreased anal tone
  • urinary dysfunction
49
Q

Investigation and management CES:

A
  • urgent MRI

- surgical decompression

50
Q

What is cervical spondylosis:

A
  • common condition resulting from osteoarthritis
  • most commonly presents as neck pain
  • referred pain e.g. headaches
  • complications: radiculopathy, myelopathy
51
Q

What is a charcot joint?

A
  • neuropathic joint
  • joint which has become badly disrupted and damaged secondary to los of senation
  • most commonly caused by neuropathy to syphilis (tabes dorsalis) but now diabetics
  • joint swollen, red and warm
52
Q

What is a colles’ fracture?

A
  • follows FOOSH
  • distal radius fracture with dorsal displacement of fragments
  • dinner fork type deformity
53
Q

3 classic features of colles’ fracture:

A
  • transverse fracture of radius
  • 1 inch proximal to radio-carpal joint
  • dorsal displacement and angulation
54
Q

What is compartment syndrome?

A
  • complication following fractures or ischaemia repercussion injury in vascular patients
  • raised pressure in anatomical space
  • leads to necrosis
  • two main fractures: supracondylar fractures and tibial shaft injuries
55
Q

Features of compartment syndrome:

A
  • pain, especially on movement (even passive)
  • excessive use of breakthrough analgesia
  • paraesthesia
  • pallor
  • arterial pulsation may still be felt
  • paralysis of muscle group may occur
  • presence of pulse does not rule out compartment syndrome
56
Q

Diagnosis of compartment syndrome:

A

-measurement of intracompartmental pressure - excess of 20mmHg abnormal
>40mmHg diagnostic
-no pathology on x-ray

57
Q

Treatment compartment syndrome:

A
  • prompt and extensive fasciotomies
  • myoglobinuria may occur following fasciotomy and result in renal failure so IV fluids
  • necrotic muscles derided and amputated
  • death of muscle occurs within 4-6 hours
58
Q

What is cubital tunnel syndrome?

A
  • compression of ulnar nerve
  • tingling and numbness of 4th and 5th finger
  • weakness and muscle wasting
  • pain worse on leaning on affected elbow
  • history of osteoarthritis or prior trauma to area
59
Q

Management of cubital tunnel syndrome:

A
  • avoid aggravating activity
  • physiotherapy
  • steroid injections
  • surgery in resistant cases

Orthopaedics (4 decks)

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