Orthopaedics Flashcards
What is golfers elbow?
Over use injury causing pain over the medial epicondyle
What is tennis elbow?
Over use injury causing pain over the lateral epicondyle
What is Radial nerve palsy?
Compression of the radial nerve
What can be the cause of radial nerve palsy?
Mid shaft humeral fracture
Common symptoms of radial nerve palsy?
Loss of sensation in dermatomes and loss of function to muscles in wrist, hand and fingers
What is gout?
Hyperuricemia due to deposits of monosodium urate crystals in the joint space
How does gout present?
Sudden severe attack of pain (normally found in the 1st metatarsal joint) , hot, tender, red and swollen
What in the history makes gout more likely?
Previous gout and high alcohol intake
What is pseudo-gout?
Calcium pyrophosphate crystals in and around the joint
What is the first line treatment for acute gout? (2 drugs dependent on patient)
NSAIDs (not aspirin) - and give a PPI alongside for gastric protection. Or oral colchicine.
Common osteoarthritis presentation?
Worsening pain on activity and over the course of the day. Stiffness after inactivity that is quickly relieved. Joint instability and loss of function.
What is the first line treatment for preventing/chronic gout?
Allopurinol
What is osteopetrosis?
Marble bone disease - due to defect of the osteoclasts. Increased bone density. Rare inherited disease.
What is a positive anterior drawer sign of the knee indicative of?
Anterior cruciate ligament rupture
What are the 4 changes which may be seen on a X-ray of a osteoarthritic joint?
Joint space narrowing (must be weight bearing), subchondral sclerosis, subchondral cysts, osteophytes.
What are the treatment options for osteoarthritis?
Offload joint Analgesia - WHO ladder, steroid injections, nerve block physio orthotics anti-depressants osteotomy - young patients to readjust the joint so it is on the healthy part Joint replacement - knee and hip only. Debridement Fusion
What is the pathology of osteoarthritis?
Focal destruction of articular cartilage without inflammation.
Increased chondrocytes - excess cartilage - oedema - erosions - chondrocyte apoptosis - fistula and fibrilles - microfractures and cysts. Tries to repair itself = osteophytes and possible excess bone growth.
What is avascular necrosis?
Death of bone tissue due to reduced blood supply
What are the risks of avascular necrosis?
TISH-SI Trauma Irradiation Sickle cell Haematological disease Dysbaric disease Alcoholism Steroids Hypercoagulable SLE Idiopathic
What can be the cause of groin pain (+thigh and butt) with a limited range of movement?
Osteonecrosis of the femoral head
What are the treatment options for osteonecrosis?
Early - bisphosphonates
Early surgery = joint preserving core decompression
Late surgery = replacement joint
What is the gold standard investigation for avascular necrosis?
MRI
What is Neuropraxia?
Reversible conduction block with no wallerian degeneration
What is axonotmesis?
Reversible conduction block with wallerian degeneration. Axon and myelin sheath are disrupted but endoneurium is intact.
What is neurotmesis?
Complete nerve division. Irreversible unless surgically repaired.
What injury is related with the ulnar nerve?
Cubital tunnel syndrome
What injury is related with the median nerve? What are the symptoms, investigations and treatment?
Carpal tunnel syndrome - numb/tingling first 3.5 fingers Thenar muscle wasting Pain - worse at night, gradual and intermittent Loss of grip and sensation Decreased strength Dry skin Phalen's test, Tinels test, Durkans test EMG or nerve conduction Splint - analgesia - steroid injection Open or endoscopic decompression
In what fracture is radial nerve damage likely?
Humeral shaft fracture.
Who is at risk of developing osteoporosis? (ACCESS)
Alcohol Corticosteroids Calcium low Estrogen Smoking Sedentary
What is the pathology behind osteoporosis?
Increased osteoclast resorption without increased osteoblast action. Increased porosity of bones = weaker.
What are advanced signs of osteoporosis?
Kyphosis, Short stature, back pain
What investigations would be completed to confirm osteoporosis?
Bloods - calcium, phosphate, PTH, ALP = normal. vitamin D may be low. DEXA scan (gold standard) of femoral neck and spine- T score is SD compared with a normal 30 yr old.
When would you treat osteoporosis?
Vertebral or hip fracture with low impact trauma
Other fracture with a T score of 1.5
T score of >2.5
What are the 3 possible treatments for osteoporosis?
HRT - very effective but comes with lots of SE’s and not to be used long term.
Bisphosphonates - alendronic acid. Decrease osteoclast activity. S/E = osteonecrosis of the jaw or oesophagitis (sit up 2hrs after having)
Denosumab - RANKL monoclonal antibody. Check calcium and phosphate before starting. S/E =osteonecrosis of the jaw
A child comes in limping what are the possible diagnosis?
Septic arthritis Transient synovitis CHILD ABUSE (under 5s) SUFE (slipped capital femoral epiphysis) LCPD
What makes a child more likely to get developmental dysplasia of the hip?
1-5
female
Family history
breech presentation
What is Legg-calvé-Perthes Disease?
Avascular necrosis of the femoral epiphysis
What increases the risk of developing SUFE (slipped capital femoral epiphysis)
10-15 yr olds
Male increased risk
Obesity
Overweight white girls or athletic black girls also.
What is the difference between pes planus and pes cavus?
Pes planus = flat feet. Don’t have arches until 5 yrs old.
Pes cavus = high arch - normally due to neuromuscular cause
