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BMSc SB > Orthopaedics Unit 4 > Flashcards

Orthopaedics Unit 4 Flashcards

1
Q

what is an enthesopathy

A

inflammation of a muscle origin

possible to have multiple inflammations at one point causing many aches and pains

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2
Q

what is golfer’s elbow

A

inflammation of origin of the flexor muscles of the forearm at the medial epicondyle

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3
Q

what is tennis elbow

A

inflammation of origin of the extensor muscles of the forearm at the lateral epicondyle

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4
Q

what are features of enthesopathies

A

may arise spontaneously but mostly commonly associated with repetitive movements or overuse

most recover spontaneously with rest

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5
Q

Tx for an enthesopathy that becomes chronic or severe

A

NSAID

local steroid injections [have to ensure steroid is injected into the enthesis with no leaked into subcut fat or skin, as this would exacerbate pain]

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6
Q

what is the surgery for enthesopathies in severe cases

A

scraping the origin of the muscle from the bone and permitting it to slide distally thus “decompressing” the area

[although patients should be encourage to wait as, spontaneous recovery is likely]

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7
Q

what is neuropraxia

A

continued pressure that has lead to atrophy of the nerve

takes a long time to recover and can be permanent

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8
Q

what are the 2 types of nerve entrapments

A

1) extrinsic
- i.e. LOC and patient presses on a nerve or patients in bed or plaster casts
- most common site is common peroneal nerve as it winds around the head of the fibula

2) intrinsic
- causes by structural local anatomical variations or inflammatory swelling

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9
Q

where are common sites of intrinsic nerve entrapments

A

median nerve at the wrist

ulnar nerve at the elbow

ulnar nerve at the wrist

posterior tibial nerve at the ankle

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10
Q

Sx for nerve entrapments

A

numbness
tingling
weakness
sensory loss

Ix = nerve conduction study

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11
Q

Mx for nerve entrapments

A

need to reduce pressure

surgical relief of pressure may be required
- cutting skin and fascia

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12
Q

what is tenosynovitis and what is it associated with

A

Inflammation of tendons and their associated synovial sheaths

associated with RA

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13
Q

when does tenosynovitis occur spontaneously

A

usually it is precipitated by unusual levels of activity, or overuse

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14
Q

what is a bursa

A

small sac of fibrous tissue lined with synovial membrane and filled with fluid

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15
Q

what is the function of a bursa

A

natural form of “bearing” aimed at improving muscle and joint function

reduces friction, usually where tendons and ligaments pass over bones

new ones can form in response to pressure

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16
Q

what causes inflammation of a bursa

A

repetitive movement or strain, or from being subject to abnormal loads

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17
Q

where are the most common sites of bursitis

A

knee
elbow
shoulder
greater trochanter at the hip

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18
Q

Sx of bursitis

A

chronic discomfort over the bursa, associated with causative elements such as movement or pressure

swelling of the bursa

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19
Q

what is housemaid’s knee

A

swelling of pre-patellar bursa

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20
Q

what are Sx of an infection of the bursa

A

tense swelling associated with infection of the skin (cellulitis) and general ill health (malaise).

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21
Q

Tx for chronic bursae

A

need no Tx unless patient demands so

if tender, may be excised

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22
Q

Tx for infected bursae

A

incised and drained

- leads to spontaneous recovery through scarring and fibrosis

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23
Q

features of a painful spasmodic flat foot

A

associated with infection or chronic inflammatory disease

can occur acutely in middle age

  • o/e painful and tender swelling over tibialis posterior insertion
  • may indicate acute or impending degenerative rupture
  • warrants early intervention
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24
Q

if a flat foot in an adult is associated with pain, what is a possible Tx

A

a medial heel lift

- will correct the deformity of the hind part of the foot and stabilise the medial arch.

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25
Q

if a flat foot in an adult is associated with PERSISTENT pain, what is a possible Tx

A

fusion of subtalar joint

- will disturb foot and ankle profoundly

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26
Q

what are bunions

A

fluid filled bursae found around bone prominences

commonly over the distal part of the 1st metatarsal and occasionally over the 5th

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27
Q

Tx of bunions

A

form as a natural response to pressure from underling abnormality
- Tx this

if bunion becomes infected
- drainage

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28
Q

what are corns and what is the Tx

A

painful corny skin formed in response to high pressure

Tx

  • can be removed
  • need to Tx underling cause and remove cause of high pressure
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29
Q

what is hallux valgus

A

turning away of the phalanges of the big toe from the mid-line

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30
Q

what is hallux rigidus

A

OA of the metatarsophalangeal joint

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31
Q

what is the relationship between hallux valgus and hallux rigidus

A

can occur separately or together

32
Q

who gets hallux rigidus alone

A

can occur in adolescents and adults

33
Q

who gets hallux valgus alone

A

may occur at any age.

34
Q

in cases of hallux rigidus in adolescents, what is the cause thought to be

A

osteochondral fracture [not easy to prove]

35
Q

Tx of hallux rigidus in adolescents

A

conservative Tx
- use of a metatarsal bar to provide a rocker at the front of the foot so that the toe need not bend in normal walking

surgical Tx
- same as adults

36
Q

why does conservative Tx of hallux rigidus in adolescents normally fail

A

do not accept the cosmetic consequences on their shoes

37
Q

Tx of hallux rigidus in adults

A

in minor cases

  • surgical removal of the osteophytes with an osteotomy of the proximal phalanx
  • surgical fusion in a neutral position

alternative option
- Inter- position arthroplasty with a silicone plastic (silastic) spacer [mixed results]

38
Q

in cases of hallux valgus alone, what are the features of the condition

A

F > M

Many, but not all, sufferers have a short first metatarsal, often in varus.

39
Q

Mx of hallux valgus

A

can depend on age

any age
- Realignment of the first metatarsal to a more lateral position and excision of any bony prominence (an exostosis) over the first metatarsal head

elderly

  • Keller’s procedure = Excision of the metatarsophalangeal joint
  • avoid in the young
  • unnecessary if joint is not painful
40
Q

who gets Hallux valgus with also Hallux rigidus

A

older people where joint degeneration is usually secondary to the valgus deformity

41
Q

Mx of Hallux valgus with also Hallux rigidus

A

in older patients
- may be satisfied by having their pain relieved by well fitting shoes

if this fails
- Keller’s arthroplasty = excision of metatarsophalangeal joint then put in an artificial joint

42
Q

why should you try to avoid Keller’s arthroplasty

A

severely disrupts normal foot mechanics

should be reserved for the older, less active patient.

43
Q

what is claw foot

A

wasted muscles of the foot make the bones and the toe nails appear more prominent

implies muscle weakness or deficiency

44
Q

what is claw foot associated with

A

weak or denervated small muscles of the feet

minor spinal abnormalities such as spina bifida occulta

45
Q

what is hammer toe

A

top of the toe looks like the end of a hammer

secondary to the disruption of the metatarsophalangeal joints

46
Q

Sx of hammer toe

A

metatarsalgia

- generally sore forefoot

47
Q

Tx of hammer toes

A

good pair of soft, comfortable shoes

Surgery
- fusion of the interphalangeal joints in a straight position, so that they do not rub on the shoes

48
Q

what is a neuroma

A

when the cutaneous nerves to the toes become trapped or irritated between the metatarsal heads there is a benign growth of nervous tissue

a.k.a Morton’s neuroma when in the foot

secondary to repetitive trauma

49
Q

Sx of neuroma

A

dull and throbbing pain
sharp exacerbations

accompanied by tingling of the toes

difficult to localise

50
Q

what is the classic clinical sign of Morton’s neuroma

A

sideways compression of the foot produces a palpable click, reproducing the symptoms.

51
Q

Tx of Morton’s neuroma

A

excision
- s.e. = sensory disturbance to affect toes

recurrence is common

52
Q

what causes ingrowing toenails

A

curved nail grows into the nail fold and digs in

trauma to skin can lead to secondary skin infection

can lead on to secondary blood bourne infections
[big issue it patient has prosthetic joints or heart values]

53
Q

Tx of ingrowing toenails

A

remove the nail to clear up chronic infection

Wedge resection of the nail bed may retain the toe nail and remove the problem.

if keeps recurring
- remove the nail bed using phenol after removing the nail

54
Q

what is plantar fascia

A

a tough later of fibrous tissue which runs from the os calcis to each toe base

55
Q

Sx of plantar fascia

A

soreness of the instep, often worse first thing on rising, or after sitting for a few hours

minimally relieve by walking, but then persist as a debilitating ache

exacerbated by change of direction, or walking on rough ground

o/e
- tenderness at the origin of the plantar fascia medially

56
Q

Tx for plantar fascia

A

self-limiting
- but may last few months to years

Sx relief
- Soft shoes and insoles, particularly modern sports trainers

if marked tender spot
- local injection of steroids and long acting local anaesthetic

surgery

  • stripping of the fascia from the os calcis
  • results unpredictable
57
Q

what are neuropathic feet

A

feet without sensation (sensory neuropathy)

most common cause is diabetes [in western world] and leprosy [in developing world]

58
Q

what are the issues that can develop because of sensory neuropathy

A

developing sores
- due to inability to perceive minor trauma

ulcers and secondary infection
- can lead to amputation

59
Q

who gets achilles tendinitis

A

2 groups

1) Young athletes
- from over use
- area may be tender or swollen

2) Middle aged men
- phase of discomfort may precede rupture of the tendon achilles
- due to degeneration within the tendon tissue

60
Q

Tx for achilles tendinitis in young athletes

A

rest

if recurrent however,
- surgical decompression of the tissue surrounding the tendon

61
Q

why is steroid injections avoided in achilles tendinitis

A

injection into the tendon will lead it to rupture

62
Q

why is it thought that the achilles tendon tissue degenerates

A

has a poor blood supply

63
Q

Tx for tendon rupture

A

1) ankle is kept in an equinus plaster for a minimum of eight weeks

OR

2) tendon can be sutured either by a closed technique or by open suture
- has high risk complication

both methods have a significant risk of re-rupture, although this decreases with time

64
Q

what does arcomioclavicular joint consist of

A

joint between the acromion process of the scapula and the clavicle

65
Q

what are Sx of shoulder pathology

A

pain, particularly on movement

limited ROM

Sx associated with recent incident

66
Q

what are the structures involved in shoulder discomfort

A 
the subacromial bursa,
􏰀 the supraspinatus tendon,
􏰀 the acromioclavicular joint,
􏰀 the biceps tendon, and
􏰀 the rotator cuff as a whole.
67
Q

Mx of shoulder discomfort

A

1st line

- rest, gentle exercise, anti-inflammatory drugs

68
Q

what does tenderness under active movement of the shoulder suggest

A

painful arc

= supraspinatus tendon inflammation or a subacromial bursitis

69
Q

Tx of supraspinatus tendon inflammation or a subacromial bursitis

A

steroid injection into the bursa or around the tendon

70
Q

what happens in Calcific tendinitis of the shoulder

A

get calcified material within the SUPRASPINATUS tendon that can be seen on imaging

causes very severe pain

Tx = removal of material

71
Q

what is frozen shoulder

A

condition in which there is little or no glenohumeral movement

cause often obscure

can be caused by specific trauma incident, such as a fit

72
Q

Mx of frozen shoulder

A

people eventually recover

- 18months to 2 years

73
Q

Tx of supraspinatous tendon inflammation

A

steroid injection into the bursa

74
Q

who gets frozen shoulder and what is the Sx

[what is the principal sign]

A

characterised by progressive pain and stiffness of shoulder in patients aged 40-60 y/o over 18-24 months

[loss of external rotation]

75
Q

what age group gets what pathology of shoulder discomfort

A

young - instability, dislocation

middle age - rotator cuff tear, frozen shoulder

elderly - glenohumeral OA

BMSc SB (18 decks)

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