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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
If pain is a persistent problem in flat feet what intervention is required?
Fusion of the subtalar joint (no to be undertaken lightly as profoundly disturbs function)
26
What are bunions?
Fluid filled bursae found around bony prominences
27
Where are bunions usually found?
Distal part of first metatarsal and occasionally ove rthe fifth
28
What do bunions indicate?
Form as a natural response to pressure and indicate an underlying abnormality which should be treated
29
What are corns?
Painful excessive corny skin formed in response to pressure
30
What is Hallux valgus?
Turning away of the phalanges of the big toe from the midline (usually because of a deformity at the joint line)
31
What is Hallux rigidus?
Osteoarthritis of the first MTP
32
What is the likely cause of Hallux rigidus in adolescents?
Osteochondral fracture (not always easy to prove)
33
What are the treatment options for adolescent with Hallux rigidus alone?
``` Metatarsal bar (so toe doesn't bend when walking) Surgery if bar not cosmetically accepted ```
34
In the elderly is Hallux rigidus more likely to occur with or without Hallux valgus?
With Hallux valgus
35
What does the surgical management of minor Hallux rigidus involve?
Surgical removal of the osteophytes with an osteotomy of the proximal phalanx
36
What is the most reliable treatment of Hallux rigidus?
Surgical fusion in a neutral position
37
What is the cause of Hallux valgus?
Unknown (but gives more problem in women and many sufferers have a short first metatarsal often in varus)
38
What management of Hallux valgus is suitable at almost 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
39
When is it appropriate the use Keller's procedure when treating Hallux valgus?
To be avoided in the young | Probably unnecessary if the joint is not painful
40
When is Hallux valgus with rigidus seen?
In older people where joint degeneration is usually secondary to the valgus deformity
41
What is "claw foot"?
Condition of the foot where wasted muscles make the bones and the toe nails appear more prominent (like a dog's foot)
42
What us the cause of claw foot?
Muscle weakness of deficiency
43
What is claw foot often associated with?
Minor spinal abnormalities such as spina bifida occulta
44
What are hammer toes secondary to?
Disruption of the MTP joints
45
How might patients with hammer toe present?
Generally sore forefeet (metatarsalgia)
46
What is the management of hammer toes?
Fusion of the interphalangeal joints in a straight position (so they don't rub) Good pair of soft comfortable shoes
47
What gives rise to a neuroma?
Cutaneous nerves to the toes become trapped or irritated between the metatarsal heads
48
What is the characteristic presentation of a neuroma?
Dull throbbing pain with sharp exacerbations | Tingling of the toes
49
How can the symptoms of a neuroma be confirmed?
Sideways compression of the foot produces a palpable click, reprodcing the symptoms
50
What are the outcomes of neuromas?
Excision may leave sensory disturbance to affected toes | Recurrence is common
51
What are the risks of an ingrown toenail?
Infection (becomes self-perpetuating and long term) | Secondary blood borne infections
52
What are the treatment options for ingrown toenails?
Careful nail care Removal of nail Wedge resection (Comestic may be necessary after)
53
What is the plantar fascia?
Tough layer of fibrous tissue which runs from the os calcis to each toe base
54
What are the symptoms of plantar fascitis?
``` 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
What is the course of plantar fascitis?
Most cases are self limiting and settle spontaneously
56
What are the management options for plantar fascitis?
Insoles (hollowed out under tender area) Soft shoes Local injection of steroids Surgical stripping of fascia (unpredictable)
57
What is the most common cause of neuropathy in the western world?
Diabetes
58
Which 2 groups of people are likely to suffer from achilles tendinitis and rupture?
Young athletes | Middle aged men
59
How is achilles tendinitis in young athletes treated?
Rest is usually adequate | Surgical decompression of tissue surrounding the tendon will often relieve symptoms
60
What should be avoided when treating achilles tendon problems?
Steroid injection (penetration of the tendon may lead to rupture)
61
How might achilles tendinitis present in middle aged men?
phase of discomfort may precede rupture indicating degeneration within the tendon tissue
62
What is a potential cause of achilles problems in middle aged men?
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
How is an achilles tendon rupture treated?
Equinis plaster for min 8 weeks | Can be sutured by open or closed technique
64
What is the prognosis of a tendo achilles rupture?
Significant risk of re-rupture but decreases with time (wearing felt raise in heel will help)
65
What structures are commonly involved in pathological conditions causing shoulder discomfort?
``` Subacromial bursa Supraspinatus tendon AC joint Biceps tendon Rotator cuff ```
66
What is a painful arc suggestive of?
Supraspinatus tendon inflammation or a subacromial bursitis
67
What is an effective management for supraspinatus tendon inflammation or subacromial bursitis?
Steroid injection into the bursa or around the tendon (should not be done repetitively)
68
What would be seen on radiograph if a patient is suffering severe pain alongside painful arc?
Calcified material within the supraspinatus tendon
69
After temporary response to injection what will be seen on investigation?
Degenerative changes and osteophytes in the AC joint
70
Persistent supraspinatus tendon inflammation will lead to...
Rupture of the supraspinatus muscle
71
What is frozen shoulder?
Condition in which there is little or no glenohumeral movement
72
What causes frozen shoulder?
Trauma (epileptic fit or electric shock) | Often cause is obscure
73
What is the management of frozen shoulder?
Usually recover in 18-24 months Psychological support Manipulation under anaesthetic (maybe)

AY BMSc Orthopaedics (5 decks)

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