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Surgery > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

whats compartment syndrome

A

pressure within a fascial compartment is abnormally rasied cutting off blood supply to the contents of the compartment

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2
Q

whats in a fascial compartment

A

msucles
nerves
blood vesles
surrounded by fascia- un able to stretch expand

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3
Q

casues of acute compartment syndrome

A

usally due to an acute injury
get bleeding/ swelling (oedema) associated with the injury casuing increase in pressure
eg.
crush injury
bone fractures

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4
Q

presentation of acute compartment syndrome

A

most commonly in one of the compartments in legs but can be feet, thighs, buttcls , forearm

pain- disproportionate to the injury- pain meds dont help. main worse on passively stretching hte muscle
paraestheisa - pins and needles
pale
presure- high
paralysis- later and worrying feature

normally can feel the pulses - if not then probs more liekly acute limb ischemia

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5
Q

differnetial for acute compartment syndrome if cant feel pulse

A

acute limb ischemia

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6
Q

investigation of acute compartment syndrome

A

needle manometry - measure resitance of saline injected into compartment

usually dx is clinical

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7
Q

inital managemtn of acute compartment syndrome

A

escalate to reg/consultant orthopedic
remove external bandages/ dressings
elevate to level with heart if leg
maiantain good bp- avoid hypotension

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8
Q

definitive managemnt of acute compartment syndrome

A

emergency fasciotomy
- within 6hrs ideally

need to open up the compartment all the way and explore and debride any necrotic tisssue. leave wound open and then re op a few days a;ater can have many to keep debriding necrotic tissue and then eventually can cover the wound opnce swelling reduced. may need skin graf to close eventually

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9
Q

whats chronic compartment syndrome

A

also called chronic exertional compartment syndrome
not an emergency unlike acute

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10
Q

casues of chronic comparmtent syndrome

A

usually asscoaited with exertion
during exertion pressure in compartment increases and blood flow becomes restircted so symtooms start
when rest the pressure relives and so symtpoms start to resolve

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11
Q

symtpoms of chronic compartment syndrome

A

isolated to specific location at the affected compartment
pain
worse on exertion
relives by rest quickly
numbness/ paraestheisa

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12
Q

investigation and management for chronic compartment syndrome

A

needle manometry
measure p before during and after exertion

treat- fasciotomy - but not emergency

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13
Q

whats osteomyelitits

A

inflammation of bone and bone marrow usually casued by bacterial infection

can be acute or chronic
can have recurrent/ chronic infections after rx for acute

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14
Q

casues of osteomyelitits

A

usually bacterial- staphylcoccus aureus most common

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15
Q

modes of infection for osteomyeleitis

A

haematogenous osteomyleitits- spread through blood and seeds in bone = most common mode of infection

direct contamination of bone- fracture site/ ortho op

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16
Q

risk factors for osteomyeltitis

A

orthopedic surgery- esp prosthetic and esp revision surgery of prostehtic joints (hence give perioperative prophylactic abx for joint replacemnt)
diabetes - esp with diabetic foot ulcers
peripheral arterial disease
iv drug use
immunosupression
open fractures

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17
Q

presentation of osteomyeliti

A

fever
tender/bone pain
swelling
erythenma
generalsied infection:
nasuea and vomiting, lethargy, muscle aches

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18
Q

investigations for osteomyelitits

A

mri best for dx

xray can be donw but may not show changes- if no changesshown doesnt mean dont have it- cant use xray to exclude osteomyelitits
bloods- rasied crp, wbc, esr
blood culture may be psotive
bone cultures to find casue and anx senstivities

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19
Q

what may you see on xray in osteomyeltitis

A

periosteal rxn= changes to bone surface
locaslied osteopenia- thinning of bone
destruction of bone area

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20
Q

managemnt of osteomyltits

A

surgical debridment and abx

acute= 6 weeks abx of flucloxacillin and maybe rifampacin or fursolic acid for first 2 weeks

if allergic to penacillin use clindamycin
if mrsa then vancomycin/ teicoplanin

chronic= abx for 3 months or more

if associated wth prosthetis then may need compelete revision surgery to replace entire joint

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21
Q

what abx use for osteomyeltitis

A

flucloxacillin 6 weeks and maybe rifampacin/fusolic acid for the first 2 weeks

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22
Q

what abx use for osteomyletitis if allergic to penicllin

A

clindamycin instead of flucloxacillin
and maybe rifampacin/fusolic acid for first 2 weeks
6 week course

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23
Q

what abz use if mrsa cause osteomyleittis

A

vancomycin/teicoplanin

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24
Q

whats sarcoma

A

cancer originating from bone/ soft tissue/ other connective tissue

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25
Q

types of bone sarcoma and most common type of bone sarcoma

A

osteosarcoma= most common
chondrosarcoma - orginate from cartilage
ewing sarcoma= bone and soft tissue affecting children and young adults

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26
Q

rhabdomyosarcoma

A

cancer orignate from skeletal muslce

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27
Q

leiomyosarcoma

A

cancer originate from smooth muscle

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28
Q

liposarcoma

A

cacner originate from adipose tissue

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29
Q

synovial sarcoma

A

cancer orignate from soft tissue around joint

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30
Q

angiosarcoma

A

cancer orignate from lymph and bv

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31
Q

kaposis sarcoma

A

cancer casued by human herpes simplex virus 8 = most often seen in endsatge hiv

see typical purple/red srasied skin lesion and may have other body parts afected

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32
Q

what ccasues kaposis sarcoma

A

human herpes virus 8

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33
Q

presnetation of sarcoma

A

depnds location and cancer form
can be soft tissue lump eso if growing and painful/large
bone swelling
persistant bone pain

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34
Q

inital investigations for sarcoma
bone
soft tissue

A

xray best for bony lumps / peristant pain

us best for soft tissue lumps

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35
Q

definitive investigations for sarcoma -bone and soft tissue

A

ct/mri = can visualise in more detail and look for metasitc spread

ct thorax as sarcomas often spread to lungs

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36
Q

where do sarcomas commonly metastases to

A

lungs

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37
Q

managment of sarcomas

A

surgery- prefered option
radiotherpay
chemo
palliative

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38
Q

indications for elective joint replacement

A

osteoarthitis- main indication- if severe and not manageble by conservative rx
rheumatoid arthritits
fractures
septic arthritis
bone tumours
osteonecrosis

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39
Q

options for elective joint replacement

A

total joint replacement - replace both articualr surfaces
hemiarthroplasty= replace half joint
partial joint resurficing- replace part of the joint surgace eg. just medial surface

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40
Q

how does total hip replacment be donw

A

lateral incsion on outer aspect of hip
disolacte hip=expose both surfaces
remove head of femur and replace with ceramic or metal head on a metal stem
cement or push stem into shaft of femur
acetabulm hollowed out and metal socket put in place and spacer inbetween

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41
Q

total knee replacment done

A

vertical anterior icision
patella move out way
articular surfaces of femur and tibia removed (cartilage and some bone)
new metal surfaces that are cemented or screed in
spacer inbetween

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42
Q

total shoulder repalcment done

A

anterior incision down front shoulder - along deltoid
shoulder disolacted
head of humerus removed and replaced with ceramic/metal ball and attacthed to humerus either on a stem or screws
glenoid hollowed out and metal socket put in

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43
Q

reverse total shoulder replacment done

A

glenoid put a sphere on and humerus put a cup on head and then spacer inbetween
same function

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44
Q

whats need done before surgery for elective joint replacement

A

x ray
ct/mri
group and save and cross match
pre op assesment
consent
marker correct limb and side
med changes- temp stop anticoag
vte assesment
nbm before

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45
Q

whats done during surgeryfor elective joint replacment

A

ga/spinal
prophylactic abx to reduce risk infection
tranexamic acid = decreased blood loss

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46
Q

done after surgery for elective joint replacment

A

vte prophylaxis- LMWH or can use alternatively doac,aspirin, antiembolism stockings
physio
analgesia
post op xray
post op bloods- anemia
montior for complciatios- vte/ osteomyeltitis

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47
Q

how long LMWH for after hip replacment

A

28 days

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48
Q

how log LMWH for after knee repalcmeent

A

14 days

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49
Q

risks of elective joint replacemnt

A

bleeding
infection
pain
anestheitc risks
damage to nearby structures
not better
joint dislocation
sitff/restricted movement
looseing
fracutre during procedure
vte- pe and dvt

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50
Q

whats a big complication of joint replacement

A

prosthetic joint infection - osteomyelitis

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51
Q

whats done to prevent psteomyltiyis/prsthetic joint infection

A

perioperative prophylaxiss abx
increased chance happening in revision surgeries
most common its staphylcoccus aureus

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52
Q

risk facotrs of post op prostetic joint infection

A

diabetes
prolinged op tme
obestiy

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53
Q

investifations for osteomyltits/ prosthetic joing infection

A

clinical
can do xrya
bloods- increased crp
culutures- blood/ synovial fluid

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54
Q

treatment of osteomyltits in prostheitc joint surgery

A

repeat srugery - joint irrigation/ debridement/ complete repalcement
and
prlonged abx

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55
Q

whats meralgia parasthetica

A

localsied sensory symtoms of the outer thigh casued by compression of the lateral femoral cutaneous nerve
= mononeuropathy- only involes one nerve

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56
Q

what nerve roots supply the lateral femoral cutaneous nerve

A

L1,2,3

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57
Q

whats the route the lateral cutaneous femoral nerve takes

A

behind psoas muscle, aroud the surface of the iliacus muscle, under the iguinal ligament, ont the thigh medial and infeiort ASIS

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58
Q

what innervation does the lateral femoral cutaenous nerve supply

A

sensory only
to outer upper thigh

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59
Q

what casues meralgia parasthetica

A

pressure, deformity, trauma to nerve of lateral femoral cutaenous enrve
can ccur lots places
esp at where nerve goes under iguinal ligament

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60
Q

presentatin of meralgia parasthetica

A

abnormal sensation and loss of sessation of the lateral femoral cutaenous nerve districution- upper outer thigh
= dysaesthesia and anasthesia

skin of upper outer thigh affected
burning
numbness
pins and needles
cold sensation
localised hair loss
worse on walking/standing long time
better sat down
worsened by extention of hip on affected side= can do this in examination to test

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61
Q

diangosis of meraligia parasthetica

A

clincial
can do other investigations to exlcude other patholgy such as nerve root compression of spine
pelvic tumour compressin the nerve

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62
Q

managment of meralgia parasthetica

A

depends on severity
conservative:
rest
weight loss
loose clothing- no belts as this can casue compression of nerve
physio

medical:- analgesisa
nsaids
paracetamol
steoid injections/ local anesthitics
neuropathic pain meds= gabapenti, pregabalin, amitryptilin, duloxetine

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63
Q

what fractures are mainly for children

A

greenstick
buckle

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64
Q

salter harris fracture

A

only occur in children
growth plate fracture

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65
Q

whats a comminuted fracture

A

fracture in lots of pieces

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66
Q

colles fracture

A

transverse fracture of distal radius causing distal portion to displace posteriorly

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67
Q

fractures common from fall on outstretched hand

A

colles fracture
scaphoid fracture

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68
Q

tenderness in anatomical snuffbox

A

scaphoid fracture

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69
Q

whats worry about about scaphoid fracture

A

it has retrograde blood supply - fracture can cut off blood supply and casue avascular necrosis and non union

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70
Q

what bones have a vulnerable blood supply if they are fractured

A

scaphoid
head of femur
humeral head
talus
navicular
5th metatarsal in foot

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71
Q

whats important in ankle fracturs

A

the tibiofibular syndesmosis

  • v important for joint stability and function
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72
Q

type of lateral malleous ankle fracturs

A

type a= below ankle joint - syndesmosis intact

typpe b= a level of joint- sysndesmosis intact or partially torn

type c= fractur above ankle joint= syndesmosis disrupted

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73
Q

casues of pahtological fractures

A

osteoporosis
tumour
pagets disease of bone
disease of bone
common in femur and vertebral bodies

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74
Q

common metastases to bone

A

portable
prostate
renal
thyroid
breast
lungs

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75
Q

pelvic ring fracturs are dangerous why

A

break in two places like a polo mint
can often lead to intrababdominal bleed-
due to vascualr injury or from cancellous bone

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76
Q

imaging inital for fractur

A

xray

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77
Q

imaging for more detail fracture

A

ct

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78
Q

early complications of fracture

A

dvt/pe
damage to nearby structures
haemorrhage
compartment syndrome
fat embolism

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79
Q

long term complications of fractures

A

stiffness
arthritits
chronic pain
malunion
non union
delayed union
avascualr necrosis
osteomyleitits
joint instability
complex regional pain syndrome

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80
Q

managemnt of fracitr

A

abcde
mechanical alighnment- open or closed
stability - cast, k wires, intrameduallry wires, intramedullary nails, screw/plate
pain management

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81
Q

whats fat embolsim syndrome

A

fat embolsim can occur after fracture of long bone
fat globules relased into circulation and can become lodged and pbstruct bv eg. pulmoary a

can also casue systemic inflammatory repsonse which casues fat embolsim syndrome
incresaed vessel permeability leads to problems

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82
Q

presentaiton of fat embolsim syndrome

A

presents typically 24-72 hrs after fracture
jaundice
fever
confusion
worsening sob
tachycardia
tachypnoeic
hyoxic
drowsiness
organ dysfunction on late stages

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83
Q

diangoosis of fat embolsim syndrome

A

GURDS criteria
2 major or 1 major and 4 minors

majors:
petechial rash
resp distres- t1 resp failure
cerebral involvement- confusion / drowsy

minors:
jaundice
fever
anemia
tachycardia
tachypnoea
retinal changes
rasied ESR
thrombocytopenia
fat macroglobulinamiea

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84
Q

investigfations for fat embolsim syndrome

A

abg - t1 resp distress
fbc, crp, u and e, lft, clotting
blood film = fat globules
cxr= diffuse bilateral pulmonary infiltration
ctpa= ground glass

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85
Q

differntials for fat embolsim

A

pe
menigiococcal septicaemia- petechial rash and fever ad confusion

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86
Q

treament fat embolsim

A

supportive esp ventialtion

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87
Q

prevention of fat embolsim

A

early surgery for fixing fracture

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88
Q

rf for fat embolsim syndrome

A

young
long bone fracutre
close fracturs/multiple fractures
conservative managment of fracture

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89
Q

acute back pain resolve in

A

1-2 weeks

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90
Q

sciatica resove in

A

4-6 weeks - unless chronic obvc

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91
Q

aims of back pain

A

see if serious underlying patholgy
speedy recovery
decrease risk of chroni cback pain
manage symtoms of chronic back pain

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92
Q

casues of mechanical back pain

A

muscle/ligament spasm
facet joint dysfunction
sacroiliac joint dysfunction
herniated disc
spondylolisthesis= anterior displacement of vertebrae to one below it
scoliosis
degeneration changes- arthritits- f discs and facet joints

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93
Q

casues of neck pain

A

muscle/ligament spasm- poor posture/ repeitivtive activities
torticollis - wake up and unilateral stiff and painful neck= muscle spasm
whiplash - cervical spondylsis

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94
Q

red flag casues of back pain

A

cauda equina -> saddle anesthesia, urinary retention, incontinece of bladder and feacal
spinal fracture- major trauma
spinal stenosis- intermittent neurogenic claudication
ankylosing spondylitits - under 40, gradual morning stiff/night pain
spinal infection- fever/ iv drug use

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95
Q

other casues of back pain (not back)

A

pneumonia
ruptured aortic aneurysm
pancreatitis
kidney stones
pyeloneprhtitis
prostitis
PID
endometriosis

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96
Q

what nerve roots of sciatic nerve

A

L4-S3

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97
Q

what does sciatic nerve split into

A

common peroneal nerve
tibial nerve

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98
Q

what innervation does the sciatic nerve do

A

sensation to lateral lower leg and foot
motor to posterior thigh, lower leg and foot

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99
Q

s and s sciatica

A

UNILATERAL pain from buttock radiating down bakc of thicgh to below knee/foot (if bilateral then consider cauda equina)
parasthesia
bumbness
motor weakness
rfexles depedning on nerve root affected

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100
Q

osgood schaltter disease

A

caused by inflammation at tibial tuberosity and avulsion fractures occur

inflamamtion at the tibial tuberosity where the patella ligament/tendo, insert.
have multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of bone.
so you get growth at tibial tuberisity and so get lump and tender duet o inflammation

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101
Q

anterior knee pain adolescent
male
tneder bony lump anteior on tibial tuberosity

A

osgood schlatter disease

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102
Q

presentation osgood schaltter disease

A

10-15yrs common
more common in males
anterior knee pain
usually unilateral- can be bilateral
gradual onset
visible/palpable hard and tender lump on tibial tuberosity
pain worsened by physical activity, kneeling, extension of knee

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103
Q

managment of osgood schlatter disease

A

reduce ohysical activity
ice
nsaids
= inital

once symptoms setlled can have ohysio and stretching to strenghen the joint

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104
Q

prognosis of osgood schaltter disease

A

resolve over time
have hard bony lump on tibial tuberosity
can have rare complcation where have complete avuslion fracture and the tibial tuberosity is pulled away from the rest of the tibia= surgical intervention needed

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105
Q

bakers cyst

A

fluid filled sac in popliteal fossa
casuing lump/swelling in back of knee

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106
Q

popliteal fossa boundaries

A

back of knee
biceps femoris tendon- lateral and superior
semimembranous and semitendanous tendons- superior and medial
lateral head of gastrocnemius- inferior and lateral
medial head of gastrocnemius- inferior and medial

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107
Q

causes of bakers cyst

A

in adutls usually secondary to degernative changes in knee:
meniscal tear- imp to see if this cause
OA
inflammatory arthtrits- RA
injury to knee

synovial fliuid is squeezed out joint and into surrounding soft tissue - popliteal fossa

connection to cyst and synovial fluid can remain and so ccyst can increase in size

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108
Q

presentation of bakers cysts

A

localised to popliteal fossa
pain/discomfort- can be asymtomatic
reduced rang of mition if large
fullnesss
pressure
palpaple swelling/lump
most apparent stood with knee fully extended
smaller/disaperas when knee flexed at 45 degrees = focuhers sign

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109
Q

fouchers sign

A

bakers cyst
disapperas/smaller when knee flexed at 45 degrees

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110
Q

investigation bakers cyst

A

us - first line for dx
can check if dvt too
mri if need evaluate further - can show underlying casue eg. meniscal tear

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111
Q

differentials for lump in popliteal fossa

A

bakers cyst
varicose veins
tumour
dvt!
popliteal artery anuerysm
ganglion cyst
lipoma
abscess

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112
Q

managment of bakers cysts

A

nothing in asymptomatic
analgesia- nsaids
modify activity to not exaserbate it
physio
us guided aspiration
steroid injections
surgical- arthroscopy to rx underlying cause- resection hard and likely to recur esp other underlying pathology

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113
Q

pain in calf and swelling

A

dvt
bakers cyst rupture

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114
Q

bakers cyst rupture

A

cyst can rupture if pressure large enough
inflammation to surrounding tissue and claf:
pain
swelling
erythema

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115
Q

crucial differnetial to bakers cyst rupture

A

dvt

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116
Q

bakers cyst rupture can rarely casue what

A

compartment syndrome

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117
Q

causes of sciatica

A

lumbosacral nerve root compression by:
herniated disc
spondylolisthesis- anterior displaement f vertbrae
spinal stenosis

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118
Q

major ttrauma and back pain think

A

spinal fracture

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119
Q

stiffness in morning / rest back pain think

A

anklyoising spondlyitits

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120
Q

under 40 and back pain think

A

anklyosing spondylitits

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121
Q

gradual onset progressive back pain htink

A

ankylosingscpondylitits/ cancer

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122
Q

night pain back pain think

A

cancer/ ankylysing spondylyitits

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123
Q

over 50 and back pain think

A

cancer

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124
Q

weight loss and back pain think

A

cancer

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125
Q

bilateral motor.sensory and back pain think

A

cauda equina

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126
Q

saddle anesethisa and back pain think

A

cauda equina

127
Q

urinary retnetions/incontienceand back pain think

A

cauda equina

128
Q

faceal incontinece and back pain think

A

cauda equina

129
Q

history of cancerand back pain think

A

cauda equina/ spinal mets

130
Q

fever and back pain think

A

spianl infection

131
Q

bladder distention and back pain think

A

urinary retention- cauda equina

132
Q

deceased anal tone and back pain think

A

cauda equinea

133
Q

sciatic stretch test

A

sciatica

134
Q

cacners that commonly metastes to bone

A

portable
prostate
renal
thyroid
breast
lung

135
Q

how to asses to developing chronic back pain

A

STarT

136
Q

managemnt of acute lower back pain

A

self treatment
education
analgeisa
acitve and conitue mobilise
reassurance
saftey netting

NSAIDS- forst line
or cdoeine as alternative

benzodiasapines for 5 day max use for m spasm

137
Q

what meds not to use in low back pain analgesai

A

dont use opiods, anti d, amitryptoline, gabapenitn, pregablin

138
Q

in medium- high reisk developing chroni cback pain treamtnet of acute back pain

A

physio
group exercise
cbt

139
Q

treatment sciatica acute

A

same as acute low abck pain
dont use gabapentin, pregablin, diazaepa, oral corticosteroids.
neuropathic meds if symtoms persit/worsen= not pregablin/gabapentin :
use:
duloextine
amitriptiline

140
Q

meds not use chronic sciatica

A

dont use opiods in chrinic sciatica

141
Q

rx meds use in chronin=c sciatica

A

epidural corticosteroid injections
local anaesthesia injection
radiofrequency denervation
spinal decompression

142
Q

treatment chronic lower back pain if from facet joints

A

radiofrequency denervation
targets and damages the medial branch nerves that supply sensation to facet joints assocated with back pain
done under local

143
Q

investigations back pain

A

xray /ct= ssuspect spianl fracute
bladder scan suspect cauda equinea
mri susepct cuada equina

144
Q

cauda equina syndrome

A

surgical emergency
nerve roots of cauda equine compressed

145
Q

whats cauda equia and what supply

A

L3-S5 and co nerve roots ar epart of cauda equina
lower motor neruons as already left the spinal cord

sensations to perineum, bladder, rectum

PNS supply to bladder and rectum
motor-lower limb, anal and urethral sphincters

146
Q

causes of cauda equina syndrome

A

herniated disc- most common
tumours- esp metasatises
spondylolithiasis- anteior displacement of vertbrae to one below
abscess- infection
trauma

147
Q

red flags of cauda equina syndrome

A

saddle anaesthesia- does it feel norma when you wipe yourself after opneng bowels
loss of sensation of bladder and rectum
faceal incontinece
urinary incntirence/retentoin
bilateral sciatica
bilateral/sevre motor weakness in legs
decreased anal tone on PR

148
Q

managemnt for cauda equia syndrome

A

immediate hosp
surgical emergency
bladder scan- if susepct retention
emergecny mri
neuro
surgical decompression - but symptoms may not resolve

149
Q

metastatic spinal cord compression

A

metastatic lesion that compresses on spinal cord - before the end of the sc and start of cauda equina
oncological emergecny

150
Q

presentation of MSCC

A

similar to cauda equina
back pain- worse on coughin / straining
sensory s
morotr s
progressive lumba pain
pain throacic/cervical spine
localsied spine tenderness
any limb weakness/ diff walking
bladder dysfunction
bowel dysfunction
signs ofspinal cord/ cauda equina compression

151
Q

treatment MSCC

A

high dose dexamethasone= 16mg = reduce swelling in tumour and relive compression
analgesia
surgery
radio/chemo

152
Q

diff between cauda equina and MSCC

A

cauda equina= lmn= reduced reflexes and reduced tone

MSCC= umn= increase tone, brisk reflexes, up going plantar reflex

153
Q

spinal stenosis

A

narrowing of part of the spinal canal resulting in compression of the spinal cord or nerve roots

154
Q

which stenosis is more common

A

lumbar more than cervical

155
Q

types of spinal stenosis

A

central stenosis - narrowing of central spimal canal
foramina stneosis- narrowing of intervertebral foramina
lateral stenosis - narroinwing of nerve root cancal

156
Q

casues of spinal stenosis

A

congenital
degenrative- facet changes, disc disease, bone spurs
herniated discs
thickening of ligametum flava/ posterior longituidanl l
spinal fractures
spondylolithiasis
tumours

157
Q

presentation of spinal stenosis

A

intermittendt neurological claudication!!- lower back pain, leg weakness, buttcok/leg pain
over 60 more common cus degernative
gradual onset - as opossed to causda equina and MSCC
severity depneds on narrowing and compression
can present similar symtpoms to cauda equina- urinary incontineces, bowel incontinecen, sex dysfucntion
, saddle anaesthesia
sciatica- esp eith lateral stenosis and foramina stenosis in lumbar spine

158
Q

whats intermittent neruological claudication

A

key feature of spinal stenosis
lower back pain
buttock/leg pain
leg weakness
absent wehn seated/rest
worse/ occurs on standing/walking
bending forward improves symtpoms cu opens cana
standing straight worsens cus closes cancal

159
Q

whats radiculopathy

A

compression of nerve roots as they exit sc/coloum =? sensory and motor symptoms

160
Q

differential to intermitent neurological claudication

A

peripheral arterial disease
pad has no back pain though.

intermittendt neruologicl claudications has back pain and normal ABPI/ peripheral pulses

161
Q

back pain
worse on walking
leg pain
normal pulses and normal ABPI

A

spinal stneosis
- have intermittent neurological claudication

162
Q

investigations spinal stenosis

A

mri
exlcude PAD with ct angiogram/ABPI if have symtpoms of intermittent claudication

163
Q

managemnt of spinal stneosis

A

weight loss
exericse
analgesia
physio
decompression surgery
lamiectomy

164
Q

trochanteric bursitits

A

inflammation of the bursa over the greater trocheter on the outer hip

165
Q

bursae are what

A

synovial membrane with synovial fluid in to redcue fribction between bone and soft tissue - at bony prominences

bursitts have thickening of synovial mebrane and increased fluid producition-> swelling

166
Q

casues of trochanteric bursitits

A

friction from repetitive actions
infection= septic bursitits
inflam conditions- RA
trauma

167
Q

presentaion of trochanteric bursitits

A

gradaual onset
lateral hip pain- can radiate down outer thigh
pain feels aching/burning
worse with activity/ standnng after stting for a long time, truying to cross legs
may disrupt sleep
tenderness over greater torchanter
usually no swelling

167
Q

presentaion of trochanteric bursitits

A

gradaual onset
lateral hip pain- can radiate down outer thigh
pain feels aching/burning
worse with activity/ standnng after stting for a long time, truying to cross legs
may disrupt sleep
tenderness over greater torchanter
usually no swelling

168
Q

speical test to test for trochanteric bursitis

A

resisted abduction at hip
resisted internal rotation at hip
resisted external rotation at hip
treneleburg test- stand on one leg affected side and the other side will drops down= postive test= weakenss of affected hip side
resited movement causing pain supports bursitits

169
Q

manamgent trochanteric bursitis

A

rest
ice
nsaids- ibruprofen/naproxen
6-9months recover
physio
steoridinjections
abx if septic bursitits

170
Q

septic bursitits s and s

A

inflammation- red
swelling
wrmth
fever
pain over area of greater trochanter

171
Q

whats mesicsu

A

cartilage in knee
fucntion- shock absr=orber, redistribute weight throughout joint
stabalise joint

172
Q

presentation of meniscal tear

A

often due to twisting motion
hear/feel pop sound/sensation
knee give way/ instability
pain- can be refered to hip/ lower back
swelling- rapid normally
stiffness
restricted range of motion
locking of knee
localised tnederness to joint line

173
Q

investigations meniscal tear

A

mc murrays test
apley grind test
ottawa knee rules
MRI- frisrt line fr dx
athroscopy- gold stander for dx

174
Q

ottawa knee rules

A

say if need xray after acute knee injury if any presetn:
55 and over
patella tenderness and no where else
fibular tenderness
cant felx knee to 90 degress
cant weight bear- cant do 4 steps- limping counts

175
Q

managment for mensical tear

A

urgernt referal if acute onset knee pain
a and e
fracture clinic
varies
conservative- rice
nsaids= frisrt line analgesia
physio
surgery- arthroscopy- repair/ resection affected part often reusts in OA

176
Q

what casues instability to knee

A

injury to acl
pcl
meniscus

177
Q

which acl or pcl injury more common

A

ACL

178
Q

acl attaches where and fucntion

A

acl attach from lateral aspect intercondylar notch to anterior intercondylar area on tibia
stops tibia moving forward inrelation to femur

179
Q

pcl attaches where and function

A

pcl medial aspect intercondylar nothc to posterior interocndylar area of tibia
stops tibia sliding backwards in relation to femur

180
Q

presentation acl injury

A

typically twisting motion
pain
swelling
pop sound/sensation
insability
tibia moves anteriorly
knee can buckle- lack of confience wlaking- msucles weaknes- more injury likely to occur

181
Q

tests for acl injury

A

anterior draw test- psotiove if feel no clear end point to tibia moving forward

lachman test- same anteiro draw but knee at 20-30 degrees

182
Q

investigations acl injury

A

mri forst ine dx
arthrocopy- gold stander dx

183
Q

managment acl injury

A

urgent referla if sudeden onset knee pain with any symptoms suggesting acl injury- pop, rapidonset swelling, instaiblity/give wat
rice
anaglesia- nsaids
brace/cruchtes- help protect knoee
physio
arthroscopic surgery- reconstruct ligament- graft from hamstring tendon, quad tendon, bone-patella-tendon-bone(use some bone the tendon inserts into_

184
Q

pop sensation in knee
rapid swelling
insbility/knee give way

A

urgent referal
could be mensicus tear
ACL injury

185
Q

investifations for mesnicus tear/acl injury

A

mri forst lin for dx
arthroscopy- gold standerd for dx

186
Q

whats most common shoulder dislocation and cause

A

anterior dislocation
as if catching a big rock with arm abducted and extended and then forced backward
humerus head moves anteriorly

187
Q

casues of posterior shoulder dislocation

A

seizures
electric shock

188
Q

associated damage with shoulder dislocation anterior

A

bankart lesions = tears to the anterior portion of the labrum
occur with repead subluxation/dislocation

hill sachs lesion= compression fracture on posterolateral head of humerus
as the humerus head dislocates forward the head impacts with the anterior rim of the glenoid cavity
=> makes the shoulder les stable and risk further dislocations

axiallry nerve damage- c5 and c6
= loss sensation on regimental patch of deltoid and weakness of deltoid and teres minor

fractures:
clavicle, humerus head, greater tuberosirty of humerus, acromion of scapula

rotator cuff tears
- esp in older peopl

189
Q

presentation of anterior dislocation of shoulder

A

acute pai
occur after acute injury
muscles go into spasm and tighten shortly after
deltoid appears flatter and buldge of humerus head anterioly

asses for:
fractures
vascualr damage- absent pulses, prolonged cap refil time, pallor
nerve damage- loss sensation deltoidon regimental patch

190
Q

what test can do to see if patient has shoulder instability

A

apprehension test

supine
abduct arm 90
flex at elbow 90
then slwly externally rotate and pt will become worrued it will dislocate- no pain just apprehension

191
Q

investigations shoulder dislocation

A

xray= confrim dx and asses for fractures
not always needed do before relocation but do after to cehck in right place and no fractres
magnetic resonance arthrogrpahy= mri with cintrast injected into shoulder to asses for shoulder damage-> bankart lesions/ hill-sachs lesion

192
Q

acute managment of shouder dislocaition

A

analgesia, m relxants, sedation - if appropriate
gas and air- entonox
braod arm sling
closed reduction- after excluding fractures
post reduction xray
immobilisation for bit after relocation

193
Q

ongoing managment for shoulder dislocation

A

have increased risk of recurrent dislocation esp if younger
physio- inc movement and reduce risk recur
shoulder stabalisation surgery-
correct underlying strucutral issues:
repair bankart lesions
tighten capsule
bone graft - caracoid process to correct injury rto glenoid= laatarjet procedure
correct hills-sachs lesion= remplissace procedure

long recovery- 3 months

194
Q

frozen shoulder

A

common cause of shoulder pain and stiffness
also called adhesive capsulitis
loss of range of motion and function in shoulder joint

inflammation and fibrosis in joint capsule leads to adhesions=> bind to the capsule and cause it to tighten aorund the joint

195
Q

types of frozen shoulder

A

primary= occur spontaneously
seondary= occurs in response to trauma/ surgery/ immobilisation

196
Q

presentation frozen shoulder

A

3 phases
painful phase: shoulder pain first sy,tpkms - can be worse at night

stiff phase: shoulder becomes stiff, affected in passive and active movement
external rotation most affected
pain settles during this phase

thawing phase- gets less stiff

can last 1-3 years but some never resolves

197
Q

what movement is most affected in frozen shoulder

A

external rotation

198
Q

differentials for shoulder pain with no truama before

A

suraspinatous tendinopathy= inflamm and irritation of tendon- empty can test postive = pain

acrominoclavicular joint arthritits= tenderness when palpate AC joint and pain worse at extreme abduction of shoulder - over 170 degress when above head
glenohumeral joint arthritis
psotive scarf test

frozen shoulder

rare but important:
septic arthritis
inflammatory artheitits
malignacny- osteosarcoma/mets

199
Q

differentials for shoulder pain preceded buy truama

A

shoulder dislocation
fracturea- clavicle, proximal humerus
rotator cuff tear

200
Q

managment for frozen shoulder

A

keep moveing but dont exasrbeate pain
analgesia- nsaids
physio
intraarticular steorid inkectios
hydrodilation= inkject fluid intp capsule to strecth capsule

surgery if persitant:
arthroscopy- cut adhesions
manipulation under anaesthesia- frocefully stretch capsule

201
Q

risk factor for frozen shoulder

A

middle age
DIABETES

202
Q

muecles of rotator cuf

A

SITS
supraspinatus= abduction arm
infraspinatus= external rotation arm
teres minor= external rotation arm
subscapularis= internal rotation arm

203
Q

caues of rotator cuff tear

A

acute injury= foosh
degernerative chagnes with age
overhead activities- tennis, overhead construction work

204
Q

presentatin of rotator cuff tear

A

acute onset if after acute injury
gradual onset can be if degenerative
shoulder pain - disrupt sleep
weakenss and pain on specific movement eg. if supraspinatus tendon torn then pain and weakness on abduction of arm

205
Q

investigations rotator cuff tear

A

xray can be done to exclude bony patholpogy eg. OA

MRI/US for dx

206
Q

management of rotator cuff tear

A

if degernatiove cause:
conservative
esp if complcaition indicated for surgery
rest and adpat movement
analgesia-nsaids
physio

if acitive/young/ acute injury/ complete tear = surgery
arthroscopic rotator cuff repiar- tendon reattatched

207
Q

presentation of plantar fascitits

A

pain on plantar aspect of heel
gradualt onset
worse on standing/walking
tnederness on palpation

= inflamamtion of plantar facia

208
Q

managemnt of plantar fascitits

A

rest
ice
analgesia-nsaids
physio
steorid inkections- although v painful and can casue achilles rupture / fat pad atrophy
rarely can do suegery/ESWT

209
Q

risk of steroid injections in plantar fascia

A

fat pad atrophy
achilles rupture

210
Q

casues of fat pad atrophy

A

age
inflammation from reptitive impact- jumping, walking, obestiyy, running
steroid injections local

211
Q

presentation of fat pad atrophy

A

pain on heel
similar to platnar fascitits
worse standin/ wlaking and worse barefoot on hard surgace

212
Q

investigations fat pad atrophy

A

us can measure fat

213
Q

treamtent fat pad atrophy

A

comdortbale shoes
insoles
adapt activiteis- no high heels
wight loss

214
Q

pain on heel difffernetial

A

plantar fasciaitis
fat pad atrophy

215
Q

mortons neuroma

A

dysfunction of nerve in the intermetatasral spalce at top foot- usually between 3 and 4th metatarsal

216
Q

causes of mortons neuroma

A

irrirtated nerve duet o biomechanics of foot
snesation of lump in shoe
burning, numbness, pins and needles in distal toes

217
Q

tests for mortons neuroma

A

deep pressure - on afected area = pain
metatarsal squeeze test- concave foot and with other hand press on plantar side and pain
mulders sign= painful clikc when metatarsal heads rub

us/mri confrim

218
Q

management of mortons neuroma

A

adapt activities- no heels
anaglesai- nsaids
insoles
wight loss
steroid injkection
radiofrequency ablation
excision of neurome

219
Q

hallux valgus

A

bunions
bony lump created by deformity at the metatarsalphalangeal joint at base big toes
mtp become sinlfammed and enlarge
over time stress can cause oa in it

220
Q

presentation hallux valgus

A

develop slwoly
painful
esp walking and tight shoes hurts
bony lumo

221
Q

investigations bunion/hallux valgus

A

weight bearing xray

222
Q

treatment for hallux valgus

A

conservative:
wide shoes
anaglesia
bunion pads

definitve is surgery

223
Q

gout in foot wehre

A

common casue of pain and swellng in MTP joint at base big toe
= acutely hot, swollen and painful

224
Q

investigations gout in mtp big toe

A

clincial dx
exclude septic arthritis- joint fluid aspiration
:
no bacterial growth
needles shaped crystals
negative birefringent of polarised light
monosodium urate crystals

225
Q

managent acute flare of gout

A

nsaids - first line
colchine= second line
steorids- 3rd line

dont start allopurinol until acute settled as can casue/make it worse

226
Q

managment for prophylaxis of gout

A

allopurinol
dont start until acute flare gone down
once started it and then have acute flare can keep using it
decrease alchol and ourine diet- low seafood and red meat, keep hydrated

227
Q

risk factors achilles tendon rupture

A

sports that stress achilles- basetball, tennis, track
increasing age
existing achilles tendiopathy
flouroquinolones- ciprofloxacin, levofloxacin
fam hist
system steroids

228
Q

flouroquinolones can casues what within 48hrs starting

A

can cause spontaenous achilles rupture - need warn pts starting flouroquinolones about it

229
Q

presentation of achilles tendon rupture

A

sudden onset injury
sudden onset pain in calf/achilles
snapping sound/sensation
feel something hit them in back of leg
swelling
no prior warnings

o/e
with ankle relaxed more in dorsiflexion
palpable gap- but may be hidden by swelling
weakness on plantar flexion on affected side
cant walk/stand on tip toes on affected side
postive simmonds test on side= kneeling and squeeze calf and the foot doesnt plantar flex

230
Q

managment of achilles tendon rupture

A

orthorpedics same day
immediate:
rest
ice
analgesia
evelation
VTE prophylaxis- immobile

fix:
surgical/ non srugical
- similar recvoery times
surgical- reatch tendon but surgery risks
non surgical- more risk of re rupture but nmo srugical risks

both need be in a boot thats full plantar flexion of ankle and then slowly over time go more to neutral postion
- 6-12 weeks

231
Q

investigations for achilles tendon rupture

A

US

232
Q

fluouroquinolones are associated with what

A

achiles tendon rupture
achellies tendiopathy

233
Q

achilles tendinopathy

A

damage, swellint, inflammation and redcued function in tendon

234
Q

action of achilles tendon

A

connects gastrocnemius and soleus to calcaneus
flecion os calf uscles pulls on achiles and casues plantar flexion

235
Q

achilles tendiopathy 1cm from caclcaeus is what

A

insertion tendiopathy= within 2cm of insertion point on calcaenus

236
Q

achilles tendiopathy 3 cm from calcaenus is what

A

mid-portion tendipathy
2-6cm above insertion point

237
Q

risk factors achilles tendiopahy

A

sports that stress the achilles- basketball, tennis, track
inflam condition- ra, ankloysing spondylitits
diabetes
raised cholesterol
fluoroquinolones- ciprofloxacin, levofloxacin

238
Q

presentation achilles tendonopathy

A

gradual onset
pain/achingin achilles tendon/ heel with acitivty
stiffness
tenderness
nodualrity on palpation

239
Q

gradual onset of pain/ aching in heel
tneder to touch achilles
nodules on achilles tenon
stiff ankle

A

ahcilles tendonopathy

240
Q

differentials for achilles tendonopathy

A

achilles tendon rupture- investigate with US and simmons calf test to exclude

241
Q

managemnt of achilles tendonopathy

A

clicnial dx
exclude achilles rupture
rest and altered activity
ice
analgesi
physio
orthotics
extracorporeal shockwave therpay- ESWT
surgery- remove nodules and adhesion/ alter tnedon if other rx fails

242
Q

whats a ganglion cyst

A

sac of synrovialfluid that orginate from tendon sheath / joint

synovial membrane of tendon sheth/joint herniates forming a ouch and then fluid goes into the ouch

243
Q

most common places of ganglion cysts

A

wrist and finger

244
Q

presentation of ganglion cyst

A

palpable and visible lump
usally not painful although can compress nerve rarely causing sensory and motor symptoms then
transilluminate
gradual/rapid onset
ranges in size 0.5cm-5cm or more
firm non tender
well circumbised

245
Q

diangosis for ganglion cycst investigation

A

usally clinical
x ray normal
us can be sue to exlcude other casues and help confrim dx

246
Q

managemnt of ganglion cyst

A

conservative- some go but can take yeasr
aspiration with neede- but 50% recur
surgical excision- v low recur

247
Q

carpal tunnel syndrome

A

asued by compression of the median nerve as it goes through the carpal tunnel
casues pain and numbness of the median n distribution

flexor retinaculum = fibrous band over wrist

palmar digital cutanoues branch of median nerve goes through carpal tunnel = supplys innervation of sensory to palmar aspects of full finger tips of thumb, index, middle and lateral half of ring finger

palmar cutanoues bracnh of median nerve supplies palm sensory bu this goes over the flexor retinaculum so palm not affected

median nerve supplies: thenar muscle of hand:
abductor pollicis brevis, oppnens pollicis, flexor pollicis brevis

adductor pollicis is innervated by ulnar nerve

compression of the contents of the carpal tunnel which results in the syndrome is either due to swelliung of contetnseg. tendon due to repptivie strain or narrowing of the sheat

248
Q

risk factors for carpal tunnel syndrome

A

diabetes
acromegaly
hypothyroidism
rheumatoid arthritis
fam hist
repetivie strain
obesity
perimenopause

most cases are idiopathic but if they have ct syndrome esp bilateral then look for other features of these risk factors

249
Q

acromegaly is a risk facotr for what

A

carpa tunnel syndrome

250
Q

presentation of carpal tunnel syndrome

A

gradual onset - initally intermittent symptoms
worse at night - may shake hand to try make symtpoms go
sensory:
thumb, index and mid finger and also lateral half of ring finger and palmar aspects affected:
numbness
pain
paraestheisa
burning

motor:
thenar muscles
weakness of grip strenth
weakenss of thumb movements (adduction spared as this ulnar nerve)
muscle wasting of thenar
difficult to do fine movements with thrumb

251
Q

tests for carpal tunnel syndrome

A

tinnels test- tap on middle of wrist - get symptoms sensory postigve
phalens test- flex wrists together and get snesory symtpoms postive

carpal tunnel questionarie- if high risk of having ct then may not need do nerve conudciton

primary investigation is nerve conduction studies- see how well signals pass through median nerve

252
Q

managment of carpal tunnel syndrome

A

rest and adapt activities
split to hold in neutral position at night for min 4 weeks
steroid injectuins
surgery- la and can be open or laparoscopuc - cut flexor retinaculum to relive pressure on median nerve

253
Q

dupuytrens contracture

A

fascia of the palm becomes thickend and tight leading to finger contrcture

contracture= shortening of soft tissue

finger gets tighthend into a flexed postion and cant fully exend it

the palmar fascia is strong ct
this becomes thick and tigher and develops noduels and the cords of dnese ct can extend into the finger which pulls the finger into flexed

254
Q

presentation of dupuytrens contracture

A

frisst present with hard nodules on palm
skin thickening and pitting
fascia becomes thickened and gradually the finger is pulled int flexion
eventually impossible to fully extend the finger

can feel a thick nodular cord on the palm to the finger affected
usually no pain
affects fucntion of hand

255
Q

figner most affected in dupuytrens contracture

A

ring finger mosy
index finger least afected

256
Q

test for dupuytrens contracture

A

table top test

if they cant flatten their hands fully onto the table then suggest got it

257
Q

managment of dupuytrens contracture

A

conservative- do nothging
surgical:
needle fasciotomy - needle in and seperate the cords and loosen them

limited fasciectomy- remove the fascia affected and cord

dermofasciaectomy- remove skin assciated and the abnormal fasci anf then need a skin graft

258
Q

risk facotrs for dupuytrens contracture

A

smoking and alcohol
epilepsy
diabetes esp T1
age
fam hist- autosomal dominant pattern
male
manual labour- esp vibrating tools

259
Q

man who has epilepsy and uses vibrating tools cant extend his left ring finger.

A

could be trigger finger but more liekly dupuytrens contracture as rf for it and cant at all extend it

260
Q

trigger finger

A

stenosing tenosynovitis
pain and difficulty moving the affected finger

261
Q

casue and pathophysiology of trigger finger

A

flexor tendons pass through ltos of tendon sheaths along the finger

have thickening of the tendon/narrowing of the sheath (tighetning)
then this prevents the flexor tendons from running smoothly through the fliger when flexed and extended

msot common sheath affectedis ths the first annular pulley A1 at the MCP joint

can have a nodule in the tendon stopping it going through sheath

flexed the nodule is outside the A1 pulley but then as you extend the figner the nodule cant go thrugh and gets stuck at the entracne to the A1pulley and so the finger locks and gets stuck in the bent postion

262
Q

presnetation trigger finger

A

pain and tender on mcp joint on palmar side usually there
stiffness
locking / finger stuck in flexed psotion
suddenly realses with painful clicl/pop
deosnt move smoothly on flexion and extention
worse in morning and improve thoughout day

263
Q

risk factors trigger finger

A

40s and 50s
female more
diabetes esp T1

264
Q

diangosis investigations of trigger finger

A

clinical

265
Q

maagment of trigger finger

A

rest and analgesua - some resolve spontaenously
splintinh
steroid injection
surgery to release A1 pulley

266
Q

most common place to have pain and stiffness and tender on trigger finger

A

A1 pulley @ MCP joint on palmar side hurt

267
Q

de quervains tenosynovitits

A

type of repetitive strain injury
swelling and inflammation of the tendon sheaths in the wirst
primarily affects the extensor pollicis brevis tendon and the abudctor pollicis longus tendon

268
Q

pathology o dequaervains tenosynovitits

A

APL (abductor pollicis longus) - abduct the thumb and wrist
EPB (extenosr pollciis brevis) - abduct the tumb and wrist

tendon sheath srruounds the tendons - synovial membrane to lubricate and protect tendons

epb and apl got under extensor retinaculum

repetivie movement of the apl and epb casues inflammation and swlling of the tendon sheaths

269
Q

presentation of de quervains tenosynovitis

A

pain and tenderness on radia aspect of wrist near base of thumb
can radiate to forearm
burning
numbness
weaknnes
tenderness
aching

270
Q

special test for de quervains tenosynovitits

A

finkelsteins test
eichhoffs test

get pain in radial aspect of wirst then postive

271
Q

mangagment of de quervains tenosynovitits

A

repetivie strain injury:
rest and adapt activities
splint to restirct movement
nsaids
physio
steroid injections
surgery to cut extensor retinaculum= reelasing pressure and more space for tendons= done rarely

272
Q

casue of de quaervains tenosynovitis

A

repetitive movemnt using abductpr pollics longus and extensor pollicis brevis
- new parent picking up new brn in certain way that stresses the tendons

273
Q

new parent is lifing baby and they have pain in their forarm and numbness and some aching pain and tenderness in their wrist

A

dequervains tenosynoviits
pain on radial aspect of wrist where the apl and epb are used repetively
lifing baby up lots in that way abducting the wrist

274
Q

epicondylitits

A

inflammation at the point where the tendons of the forearm insert into the epicondyles of the humerus

specific type of repetitive strain injury

275
Q

what action msucles do insert on medial epicondyle and lateral epicondyle of humerus

A

medial epicondye= flex wrist
lateral epicondyle= extend wrist

276
Q

presentation of epicondylitits (lateral and medail)

A

pain often radiaoting to forearm - pain over affected epicondyle
tender
weakness of grip strength
could have numbness
gradually worsens
oftenmiddle age

277
Q

presentation and cause of lateral epicondylitis

A

pain and tendeness on lateral epicondyle
from extending wrist a lot- tennis elbow

278
Q

tests fir lateral epicondyltitis

A

mills test- pain postive
cozens test- pain psotive

279
Q

presentation and casue of medial epicondyltits

A

pain and tenderness over medial epicondyle can radiate to forearm
flexing wrist a lot- golfers elbow

280
Q

tests for medial epicondylitis

A

golfers elbow test- pain is postivie

281
Q

diangosis for epicondylitits

A

clinical

282
Q

management for epicondyltits

A

repetivie strain injury :
rest and adaptive activites
anaglesai- nsaids
orthotics- wlbow brace / straps
physio
steroid injections
platelet rich plasma injection
extracoreporeal shockwave therpay
srugery rare- debride and release and repair tendons

283
Q

person has pain in elbow and forearm from playing tennis

A

tennis elbow- extending elbow- lateral epicondyle

284
Q

repetitive strain injury

A

soft tissue irritation, microtrauma, strain
from repetitive action
affect muslce, tendon, nerves

285
Q

casues of repetitive strain injury

A

anything dine repetitive for long time
often occupational !!!
factory
computer and keyoard-wrist and arm
poor posture for long time- reading, patining, computer
texting and scrolling0- thumb base

characteristics that increase risk of it:
awkward position
small movements- scrolling
vibration- power tool

286
Q

presentation of repetitive strain injury

A

pain - exaserbated by using asscoaited joints, tendons, muscle
tenderness
hx of repetive activites
located in area related to activity
aching
burning
weakenss
numbness
cramping
tender on palpation
mild swelling can occur
recreate pain nby resting the affected tissue

287
Q

diagnsois of repetitive strain injury

A

clinical
may need exclude other casues
us- synovitis, ra, rotator cuff tear
bloods- inflamm markers, rf
can do xray to exclude eg. OA

288
Q

management of repetivie strain injury

A

rest and adaptive activities
may need speak occupational healthy
ice
compresion
elevation
analgesia- nsaids
physio
steroid inections in certain cases
can use orhtotics etg. braces, splints, strps to help

289
Q

what specifc repetitive strain injuries are there

A

de quervains tenosynovitits- abducting wrist lots - pain on radial side of wrist
lateral epicondyltits- tennis elbow- extending wrist lots
medial epicondyltitis- golfers elbow- flexing wrist lots

290
Q

olecranon bursitits

A

inflammationvand swelling of the bursa over the olecranon (part of ulnar bone)

291
Q

casues of olecranon bursitis

A

inflammation leads to thickening of synovial membrane and increase fluid production casuing swelling

friction from reeptitive movements / leaning on elbow- eg. student elbow, plumbers, drivers
trauma
inflammatory conditions- RA, gout
infection- septic bursitits

292
Q

presentation of olecranon bursitits

A

pain / tender- goes as becomes more chronic
tender more when presssure on it- lean on table
swollen- loike a goose egg can be
warm
fluctuant - fluid filled

if infected:
hot to touch
erythmea spreading to surrounidng skin
more tender
fever
features of sepsis- hypotension, tachycardia, confusion

293
Q

when to consider septic arthritis in olecranon bursitits

A

swelling in the joint not the bursa
painful and got decreased rang of motion of joint

294
Q

differnetials of olecranon bursitits

A

fracuture of olecranon
RA
septic arthritits
gout
psuedogout
cellulitits is got skin issues

295
Q

investigaitons for olecranon bursitits

A

aspiration if susepct infection

296
Q

apsirate olecranon bursists and its pus. suggest

A

infection

297
Q

aspirate olecranon bursittis and its milky-

A

gout/pseudogout

298
Q

aspirate olecranon bursitits and its bloody

A

trauma, infection, inflam casue

299
Q

aspirate olecranon bursitits and straw colored

A

infection less likely

300
Q

management of olecranon bursitits

A

rest
ice compresion
anaglesia- nsaids
protect elbow from pressure/ trauma
aspiration can relive presssure
steroid injection once excluded infection

301
Q

managemnt of olecranon bursitits is suspect infection cause or cant exclude it

A

abx- flucloxacillin, if cant then clarithromycin
aspiration for microscopy and culture

302
Q

if systemiccaly unwell and got olecranon bursitis

A

hosp
iv abx
iv fluids
bloods- lactate
blood culture

303
Q

what blood supplly has the ehad of femur

A

retrograde blood supply from medial and lateral circumflex arteries from femoral arterites. they join at the femoral neck proximal to the intertrochanteric lone

304
Q

what important about where the fracture occurs of the femur

A

if intracapsualr fracture then blood supply may be affected by damage of bv if the bone is displaced especially. this can then lead to avascualr necrosis

extracapsular fractures of the femur arnt an issue this way as blood supply remains intact

305
Q

whats an intracapsualar fractur of femur

A

fracture inside the capsule- proximal to the intertrochanteric line

garden classification:
grade 1= incomplete fracture and non displaced
grade 2= complete fracture and non displaced
grade 3= partially displaced- trabeculae at angle
grade 4= fully displaced - trabeculae parralele

306
Q

intracapsular fracture which grades may only need internal fixation of head
and which may need remobal and replacement of femoral head

A

grade 1 and 2 the blood supply may not be affected as not displaced so may have intact blood supply. if this the case then internal fixation may only be needed

grade 3 and 4 where displacemnt has occured will need remvoal and replacement of femoral head as the blood supply will be damaged and so avascualr necrosis of the femoral head will have occured

307
Q

treatment for intracaspualr fractures of femur

A

if non displaced grade 1 and 2 then may only need internal fixation eg. with screws if the bv arnt damaged

grade 3 and 4 where they are displaced will need removal of femoral head and replacemnt :
hemiarthroplasty= only remove and replace head
or
total hip replacement = head and acetabulum (do if fit and mobile before surgery before fracutre obvs)

308
Q

qhats an extracapsular fracture of hip and types

A

fracture occur distal to intertrochanteric line = bood supply of head not affected = head doesnt need replacing

intertrochanteric fractures:
between greater and lesser trochanter
treat with dynamic hi[p screw- adds some cntrolled compression across fracture so improve healing (bones need weight bearing stuff to make them grow eetc)

subtrochanteric fracture:
distal to lesser trochanter- no more than 5cm below
[roximal to shaft of femur fracture
treat:
intrameduallry nail

309
Q

presentation of hip fracutre

A

pain- groin, buttocks can radiate to knee
esp older pt fallen
SHORTENED ABDUCTED AND EXTERNALLY ROTATED LEG
look for any underlying illness that cuased it:
anemia
mi
arrythmia
stroke
electroylte imbalance
heart failure
urinary / chest infections

310
Q

investigations for hip fracture

A

xray inital - ap and lateral :
shentons line if distrupted then sign of neck of femur fracture
mri/ct if xray neg but suspect fracture still

311
Q

risk facotrs hip fracutre

A

female
osteoporosis
increasing age

312
Q

management of hip fractures

A

anaglesia
vte asssesment _> enoxaparin
pre op asess- bloods and ecg
orthogeriatrics
surgery same day or day after-> have surgery within 48 hrs of admitted as high mortality
want to weight bear straight away after op and have physio and anaglesia so can mobilise

Surgery (7 decks)

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