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AY BMSc Orthopaedics > Orthopaedics (Unit 4: Minor Adult Disorders) > Flashcards

Orthopaedics (Unit 4: Minor Adult Disorders) Flashcards

1
Q

What is an enthesis?

A

Short fibrous origin of a muscle

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2
Q

What is Golfer’s elbow?

A

Inflammation of the common origin of the flexor muscles of the forearm

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3
Q

What is tennis elbow?

A

Inflammation of the common origin of the extensor muscles of the forearm

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4
Q

How can recovery from common enthesopathies be sped up?

A

Course of anti-inflammatory agents

Steroid injections

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5
Q

What is the surgical management of enthesopathies if required?

A

Scraping the origin of the muscle from the bone and permitting it to slide distally (“decompressing”)

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6
Q

What is neuropraxia?

A

Stretching and compression of nerves

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7
Q

Why is early diagnosis essential in nerve entrapments?

A

Continued pressure will lead to atrophy of the nerve which at best takes a very long time to recover and is usually permanent

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8
Q

What are common sites of intrinsic nerve entrapment?

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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9
Q

What are extrinsic causes of nerve entrapments?

A

Accidents with loss of consciousness

Patients in bed or plaster casts

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10
Q

Which nerve is the most common site at risk of extrinsic pressure?

A

Common peroneal nerve as it winds around the head of the fibula

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11
Q

How is nerve entrapment diagnosed?

A

Numbness or tingling in the area should be taken seriously
Weakness and real sensory loss ar diagnostic
(If in doubt do nerve conduction studies)

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12
Q

How is nerve entrapment managed?

A

Remove cause if obvious

If symptoms persist surgical relief of pressure

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13
Q

What is tenosynovitis?

A

Inflammation of tendons and their associated synovial sheaths

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14
Q

What is tenosynovitis often associated with?

A

Rheumatoid Arthritis

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15
Q

What normally precipitates tenosynovitis?

A

Unusual levels of activity or overuse

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16
Q

What is a bursa?

A

Small sac of fibrous tissue lined with synovial membrane anf filled with fluid

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17
Q

What is the purpose of bursae?

A

“Bearing” aimed at improving muscle and joint function by reducing friction (usually where tendons and ligamens pass over bones)
However may also form in response to pressure

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18
Q

What are the most common sites of bursitis?

A

Shoulder
Knee
Elbow
Greater trochanter at the hip

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19
Q

What is pre-patellar bursitis also called?

A

Housemaid’s knee

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20
Q

What would make you suspicious that there was an infection of the bursa?

A

Tense swelling associated with cellulitis and general ill health

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21
Q

What is the treatment of chronic bursae?

A

If tender may be excised although patient should be encouraged to remove the underlying cause

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22
Q

What is the treatment for infected bursae?

A

Incised and drained (leads to spontaneous recovery through scarring and fibrosis)

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23
Q

When might a painful spasmodic flat foot warrant early intervention and what would be found on examination?

A

Occurs acutely in middle age
Painful tender swelling over insertion of tibialis posterior
Indicates acute or impending degenerative rupture

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24
Q

If a flat foot is associated with pain what conservative intervention may help and why?

A

Medial heel lift will correct the deformity of the hind part of the foot and stabilize the medial arch

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25
Q

If pain is a persistent problem in flat feet what intervention is required?

A

Fusion of the subtalar joint (no to be undertaken lightly as profoundly disturbs function)

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26
Q

What are bunions?

A

Fluid filled bursae found around bony prominences

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27
Q

Where are bunions usually found?

A

Distal part of first metatarsal and occasionally ove rthe fifth

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28
Q

What do bunions indicate?

A

Form as a natural response to pressure and indicate an underlying abnormality which should be treated

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29
Q

What are corns?

A

Painful excessive corny skin formed in response to pressure

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30
Q

What is Hallux valgus?

A

Turning away of the phalanges of the big toe from the midline (usually because of a deformity at the joint line)

31
Q

What is Hallux rigidus?

A

Osteoarthritis of the first MTP

32
Q

What is the likely cause of Hallux rigidus in adolescents?

A

Osteochondral fracture (not always easy to prove)

33
Q

What are the treatment options for adolescent with Hallux rigidus alone?

A 
Metatarsal bar (so toe doesn't bend when walking) 
Surgery if bar not cosmetically accepted
34
Q

In the elderly is Hallux rigidus more likely to occur with or without Hallux valgus?

A

With Hallux valgus

35
Q

What does the surgical management of minor Hallux rigidus involve?

A

Surgical removal of the osteophytes with an osteotomy of the proximal phalanx

36
Q

What is the most reliable treatment of Hallux rigidus?

A

Surgical fusion in a neutral position

37
Q

What is the cause of Hallux valgus?

A

Unknown (but gives more problem in women and many sufferers have a short first metatarsal often in varus)

38
Q

What management of Hallux valgus is suitable at almost any age?

A

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

39
Q

When is it appropriate the use Keller’s procedure when treating Hallux valgus?

A

To be avoided in the young

Probably unnecessary if the joint is not painful

40
Q

When is Hallux valgus with rigidus seen?

A

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

41
Q

What is “claw foot”?

A

Condition of the foot where wasted muscles make the bones and the toe nails appear more prominent (like a dog’s foot)

42
Q

What us the cause of claw foot?

A

Muscle weakness of deficiency

43
Q

What is claw foot often associated with?

A

Minor spinal abnormalities such as spina bifida occulta

44
Q

What are hammer toes secondary to?

A

Disruption of the MTP joints

45
Q

How might patients with hammer toe present?

A

Generally sore forefeet (metatarsalgia)

46
Q

What is the management of hammer toes?

A

Fusion of the interphalangeal joints in a straight position (so they don’t rub)
Good pair of soft comfortable shoes

47
Q

What gives rise to a neuroma?

A

Cutaneous nerves to the toes become trapped or irritated between the metatarsal heads

48
Q

What is the characteristic presentation of a neuroma?

A

Dull throbbing pain with sharp exacerbations

Tingling of the toes

49
Q

How can the symptoms of a neuroma be confirmed?

A

Sideways compression of the foot produces a palpable click, reprodcing the symptoms

50
Q

What are the outcomes of neuromas?

A

Excision may leave sensory disturbance to affected toes

Recurrence is common

51
Q

What are the risks of an ingrown toenail?

A

Infection (becomes self-perpetuating and long term)

Secondary blood borne infections

52
Q

What are the treatment options for ingrown toenails?

A

Careful nail care
Removal of nail
Wedge resection
(Comestic may be necessary after)

53
Q

What is the plantar fascia?

A

Tough layer of fibrous tissue which runs from the os calcis to each toe base

54
Q

What are the symptoms of plantar fascitis?

A 
Sore instep (often wore first thing or after long sitting) 
Minimally relieved by walking 
Then a persistent ache exacerbated by change of direction or walking on rough ground
55
Q

What is the course of plantar fascitis?

A

Most cases are self limiting and settle spontaneously

56
Q

What are the management options for plantar fascitis?

A

Insoles (hollowed out under tender area)
Soft shoes
Local injection of steroids
Surgical stripping of fascia (unpredictable)

57
Q

What is the most common cause of neuropathy in the western world?

A

Diabetes

58
Q

Which 2 groups of people are likely to suffer from achilles tendinitis and rupture?

A

Young athletes

Middle aged men

59
Q

How is achilles tendinitis in young athletes treated?

A

Rest is usually adequate

Surgical decompression of tissue surrounding the tendon will often relieve symptoms

60
Q

What should be avoided when treating achilles tendon problems?

A

Steroid injection (penetration of the tendon may lead to rupture)

61
Q

How might achilles tendinitis present in middle aged men?

A

phase of discomfort may precede rupture indicating degeneration within the tendon tissue

62
Q

What is a potential cause of achilles problems in middle aged men?

A

Lower a=part of tendo achilles has a poor blood supply and is a point of weakness in some people who keep particularly active into middle age

63
Q

How is an achilles tendon rupture treated?

A

Equinis plaster for min 8 weeks

Can be sutured by open or closed technique

64
Q

What is the prognosis of a tendo achilles rupture?

A

Significant risk of re-rupture but decreases with time (wearing felt raise in heel will help)

65
Q

What structures are commonly involved in pathological conditions causing shoulder discomfort?

A 
Subacromial bursa 
Supraspinatus tendon 
AC joint 
Biceps tendon 
Rotator cuff
66
Q

What is a painful arc suggestive of?

A

Supraspinatus tendon inflammation or a subacromial bursitis

67
Q

What is an effective management for supraspinatus tendon inflammation or subacromial bursitis?

A

Steroid injection into the bursa or around the tendon (should not be done repetitively)

68
Q

What would be seen on radiograph if a patient is suffering severe pain alongside painful arc?

A

Calcified material within the supraspinatus tendon

69
Q

After temporary response to injection what will be seen on investigation?

A

Degenerative changes and osteophytes in the AC joint

70
Q

Persistent supraspinatus tendon inflammation will lead to…

A

Rupture of the supraspinatus muscle

71
Q

What is frozen shoulder?

A

Condition in which there is little or no glenohumeral movement

72
Q

What causes frozen shoulder?

A

Trauma (epileptic fit or electric shock)

Often cause is obscure

73
Q

What is the management of frozen shoulder?

A

Usually recover in 18-24 months
Psychological support
Manipulation under anaesthetic (maybe)

AY BMSc Orthopaedics (5 decks)

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