Orthopaedics unit 4 Minor adult disorders - deck 3

Question 1

Define what is meant by a sensory neuropathy

Answer 1

A sensory neuropathy is a loss of sensation caused by disease or injury to sensory peripheral nerves.

Question 2

What is meant by the term neuropathic feet?

Answer 2

Feet without sensation (sensory neuropathy)

Question 3

What are neuropathic feet prone to developing and why ?

Answer 3

Sores caused by the inability to perceive minor trauma from rubbing or treading on objects.

Question 4

Where are neuropathic feet most common ?

Answer 4

in areas where leprosy is normally seen

Question 5

In the western world what is the commonest cause of neuropathy ?

Answer 5

Diabetes

Question 6

What extra care must be taken in diabetics to help prevent the development of sores/ulcers ?

Answer 6

• They should regularly inspect their feet and be sure the nails are tidy
• Footwear must be chosen with care and if necessary extradepth shoes, which are very soft on the uppers, may be prescribed.

Question 7

What may the development of ulcers/sores in a diabetic lead to ?

Answer 7

Infection which could in turn lead to amputation

Question 8

Define what achilies tendonitis is

Answer 8

This is irritation/inflammation of the achilies tendon resulting in Pain around the tendo achilles where it inserts into the os calcis +/- swelling in the area

Question 9

What two groups of people is achilies tendonitis seen in ?

Answer 9

1. Young athletes
2. Middle aged men

Question 10

When achilies tendonitis presents in young athletes what does this signify?

Answer 10

Over-use

Question 11

What is the treatment of achilies tendonitis presenting in young athletes?

Answer 11

• 1st line = Rest
• 2nd line = If recurrent surgical decompression of the tissue surrounding the tendon will often eradicate the symptoms

Question 12

Why is it important that steroid injections must not be used in people with achilies tendonitis ?

Answer 12

Penetration of the tendon with a steroid injection may lead to rupture.

Question 13

What may achilies tendonitis in middle aged men preceed ?

Answer 13

It may preceed achilies tendon rupture

Question 14

What is the potential reason why achilies tendon rupture occurs in middle aged men ?

Answer 14

The cause is little understood, although we know that the lower part of the tendo achilles has a poor blood supply and is often a point of weakness in some people who keep particularly active into middle age

Question 15

What is the treatment of achilies tendon rupture ?

Answer 15

1st line = Ankle is kept in an equinus plaster for a minimum of eight weeks

2nd line = The tendon can be sutured either by a closed technique or by open suture.

Question 16

What is surgery for the treatment of achilies tendon rupture the less preferred choice ?

Answer 16

Because it has a high rate of complication

Question 17

Regardless of which technique is chosen to treat achilies tendon rupture what is there a high risk of ?

Answer 17

Re-rupture

Question 18

What can be done to help decrease the risk of re-rupture of the achilies tendon?

Answer 18

Wearing a felt raise inside the heel of the shoe

Question 19

What are the main articulations which the shoulder joint consists of ?

Answer 19

The articulation between the scapula and the chest wall and between the scapula and the humerus

Question 20

What is the main other joint to consider in shoulder discomfort other than the shoulder joint itself

Answer 20

The acromioclavicular joint

Question 21

What is the main articulation which comprise the acromioclavicular joint?

Answer 21

The joint between the acromion process of the scapula and the clavicle

Question 22

What are the main structures which good shoulder function relies on ?

Answer 22

The bones and joints of the shoulder and the associated ligaments, muscles and tendons.

Question 23

Who are most at risk of shoulder injuries ?

Answer 23

People involved in heavy, repetitive work and/or contact sports.

Question 24

What is the main symptom of shoulder discomfort in general ?

Answer 24

Pain, particularly on movement - it may be limited to a particular range of movement

Question 25

What sort of incidents frequently result in shoulder pain?

Answer 25

Incident such as a pull, or a period of unusual activity such as DIY.

Question 26

List the common shoulder structures which are commonly involved in pathological conditions resulting in shoulder discomfort

Answer 26

1. The subacromial bursa
2. The supraspinatus tendon
3. The acromioclavicular joint
4. The biceps tendon
5. The rotator cuff as a whole.

Think SSABR (tooth tiger)

Question 27

What is the problem with shoulder discomfort ?

Answer 27

• It may difficult or impossible to localise which structures gives rise to the symptoms
• To resolve the differential diagnosis may require specialist examination including arthrography or arthroscopy.

Question 28

What is the first line treatment for shoulder discomfort ?

Answer 28

Rest, gentle exercise and anti-inflammatory drugs

Question 29

What forms the rotator cuff ?

Answer 29

It is formed by the tendons of four muscles: an elevator (supraspinatus), an internal rotator(subscapularis) and two external rotators (infraspinatus and teres minor).

S SIT

(Stewart SIT down)

Question 30

What is shoulder tenderness under active movement within a painful arc suggestive ?

Answer 30

A supraspinatus tendon inflammation or a subacromial bursitis

Question 31

What technique can be done for supraspinatus tendon inflammation or a subacromial bursitis to help alleviate symptoms ?

Answer 31

A steroid injection into the bursa or around the tendon, but not into it, can be very effective

Question 32

Occasionally the sufferer of supraspinatus tendon inflammationmay have very severe pain and a radiograph will show calcified material within the supraspinatus tendon, what treatment is justified in this situation ?

Answer 32

Steroid injection or even surgery to remove the calcified material in this case is well justified for the pain relief achieved.

Question 33

What is the problem with steroid injections in treating a supraspinatus tendon inflammation or a subacromial bursitis and what does further investigation often show?

Answer 33

many people only respond temporarily to the injection

Further investigation often shows degenerative change, and osteophytes in the acromioclavicular joint.

Question 34

What can degenerative change, and osteophytes in the acromioclavicular joint lead to ?

Answer 34

This may lead to rupture of the supraspinatus muscle which is part of the rotator cuff.

Question 35

Rotator cuff tears (mainly talking about rupture of the supraspinatus tendon here) can cause significant discomfort and pain what is done to treat these tears and what should be avoided?

Answer 35

Surgery to relieve the cause and repair the rotator cuff, will bring effective pain relief and some return of function.

Repetitive steroid injections in such patients can result in further degeneration of the rotator cuff and should not be practised.

Question 36

Define what a frozen shoulder is

Answer 36

A condition in which there is little or no glenohumeral movement

Question 37

What are frozen shoulders usually due to ?

Answer 37

pathological conditions causing shoulder discomfort from one of the following structures

1. the subacromial bursa
2. the supraspinatus tendon
3. the acromioclavicular joint
4. the biceps tendon
5. the rotator cuff as a whole.

Question 38

What are some of the potential causes of frozen shoulder ?

Answer 38

It occurs rarely, in those who have had a specific trauma incident, such as an epileptic fit or an electric shock. Often the cause is obscure.

Question 39

How long may a frozen shoulder take up to recover ?

Answer 39

18 months to 2years.

Question 40

What support do people with frozen shoulders need ?

Answer 40

• They require a lot of psychological support and physiotherapy.
• The condition may be helped by manipulation under anaesthetic.