orthopedics Flashcards
A 34year-patient who presented to the A&E with marked ring and finger clawing after injury his upper limb , with sensory loss of little finger and medial aspect of ring finger,
what is the most likely lesion :
A-Ulnar nerve injury at elbow B-Ulnar nerve injury at wrist C-Radial nerve injury D-Lower brachial plexues roots E-Upper brachial plexus roots
Answer is B
Ulnar Paradox
More Proximal - Injury at Elbow >
Less Clawing
More Distal - Injury At Wrist >
Marked clawing
Recall January 2020 - Patient presented to the A&E with loss of medial arm sensation and loss of sensation over hypothenar muscles with loss of finger adduction and wasting of thenar eminence
A-Ulnar nerve injury B-Radial nerve injury C-Upper trunk injury D-Lower trunk injury E-Middle trunk injury
D
Twisting knee injury
Then trying to standing on it next day twisting again with inability to do knee extension
Twisting sporting injuries followed by delayed onset of knee swelling and locking are strongly suggestive of a menisceal tear. Arthroscopic menisectomy is the usual treatment.
An 18-month-old girl has been referred to the orthopaedic outpatient clinic. Her mother has noticed that she is walking with an increasing limp on the left side. The girl denies any pain. A pelvic X-ray shows a vertically orientated acetabular roof and poorly developed femoral head.
What is the most likely diagnosis
A. Developmental dysplasia of the hip B. Genu valgum C. Genu varum D. Perthes’ disease E. Slipped upper femoral epiphysis
A
Developmental dysplasia of the hip
(DDH; previously known as congenital dislocation of the hip) encompasses a range of disorders ranging from a mildly dysplastic hip to an overtly dislocated one.
The primary abnormality is thought to be a shallow and anteverted acetabulum, with anteversion of the femoral head and neck. The overall prevalence of DDH is 3/1000 (higher at birth).
It most commonly affects the left hip of girls. Risk factors include being the first born, breech presentation, oligohydramnios and neuromuscular disorders, e.g. cerebral palsy, spina bifida. It is common in cultures where children are swaddled around their mothers.
A 74-year lady who has presented with fracture neck of the femur, underwent THR
Examination of the head will show
Common pathology condition ,
Regarding
Mineralization, density, architecture
Osteoporosis means normal mineralization
Low density low mass
Abnormal architecture
Weber classification
Weber A fractures
describe a fracture that is distal to the syndesmosis.
Weber B fractures
occur at the level of the syndesmosis and often extend proximally, laterally, and posteriorly.
These typically result from external rotation. Fifty percent of Weber B fractures are
associated with tearing of the anterior tibiofibular ligament and are unstable in such
instances.
Weber C fractures
occur above the level of the syndesmosis and often occur with the foot in pronation at the time of injury; they are almost always associ-
ated with a medial ankle injury, whether ligamentous or bony.
A 78 years old man complains of a long hisstory of shoulder pain and more reecently weakness. on examination, active attempts at abduction are impaired. passive movement are normal.
what is the most likely diagnosis?
A. rotator cuff tear B. osteoarthiritis C. Metastatic malignancy D. adhesive capsulitis E. calcific tendonitis
Answer is Tear
Tear is “unable” actively
But the doctor will help him do it passively without pain
Tendonitis “ Tenderness”
Patient can do it actively & passively but with severe tenderness
Scenario 1
A 47-year-old lady presents with a 3-month history of painful shoulder. The pain is worse during the mid-phase of
abduction and when bringing the hand down. There is no pain during the two extremes of movement.
G - Painful arc syndrome« CORRECT ANSWER
G – Painful arc syndrome:
In painful arc syndrome (chronic supraspinatus tendonitis; impingement syndrome), there is pain on
abduction 60–120° (middle 1/3 of the arc), but the extremes of movements are painless. The underlying
pathology is the swelling of the tendon, and the pain is produced when it impinges on the undersurface of
the acromial process during the mid-phase of abduction. Repeating the movement with the arm in full
external rotation throughout may be much easier and relatively painless; this is virtually pathognomonic
of painful arc syndrome.
Scenario 2
A 60-year-old presents with a painful right shoulder after he fell off a tree 2 days ago. He has suffered from
chronic shoulder pain in the past. On examination, there is tenderness at the tip of his shoulder and underneath
the acromial process. He is unable to lift his arm and there is hunching of the shoulder.
H - Rotator cuff tear« CORRECT ANSWER.
H – Rotator cuff tear:
Rotator cuff is a sheet of conjoint tendons (subscapularis, supraspinatus, infraspinatus and teres minor)
closely applied to the shoulder capsule and inserting into the greater and lesser tubercle of the humerus.
The differing clinical pictures stem from three basic pathological processes – degeneration, trauma and
vascular lesion. The supraspinatus tendon is liable to injury when it contracts against firm resistance;
this may occur when lifting a weight, or when the patient uses his or her arm to save themselves from
falling. This is much more likely if the cuff is already degenerate. The clinical presentation reflects the
loss of tendon function with weakness, a drop arm sign (characteristic hunching of the affected shoulder)
and even inability to lift the arm. There is often relentless night pain. On local palpation, pain is felt at the
shoulder-tip and upper arm and there is tenderness under the acromion
Scenario 3
A 68-year-old woman presents to her GP with an acutely painful left shoulder. There is no history of trauma. On
examination, the shoulder joint is tender anterolaterally and there is restriction of all movements except external
rotation. X-ray reveals radio-opaque deposits within the supraspinatus tendon.
Calcified tendinitis
any further minor or major injury = tear
Scenario 4
A 23-year-old rugby player presents with sudden shoulder pain after being involved in a tackle during the game.
On examination, there is loss of shoulder contour and a bulge is felt in the deltopectoral groove
D – Dislocated shoulder:
Shoulder dislocation is common after trauma.
Anterior dislocation is the commonest type (in contrast to
posterior dislocation in the hip joint). Shoulder dislocation may be associated with injury to the axillary
nerve which causes loss of sensation over the upper outer aspect of the deltoid region (‘badge’ area).
The round contour of the shoulder is lost because of the absence of the head of the humerus within the
glenoid fossa – the head of humerus may be felt in the deltopectoral groove (in anterior dislocation).
Even in clinically obvious dislocations, an X-ray should be performed to rule out an associated fracture.
A 24-year-old man sustains a twisting injury to his knee, with his body turning outwards (the tibia rotates inwards) as he falls while climbing a mountain. His binding fails to release and he feels a crack in his knee. Nothing seems to be out of place, but it swells immediately and he has to be brought down off the mountain on a stretcher. He has a positive Lachman’s test.
1 Anterior cruciate ligament injury
2 Chondromalacia patellae
3 Hoffa’s syndrome
4 Lateral collateral ligament injury
1
A 17-year-old long jumper injures her knee by landing with it hyperextended. She now has chronic knee pain, especially when she tries to straighten it. On examination she has tenderness to palpation over the anterior fat pad.
1 Anterior cruciate ligament injury
2 Chondromalacia patellae
3 Hoffa’s syndrome
4 Lateral collateral ligament injury
- Hoffa syndrome
a hyperextension injury of the knee crushes the fat pad in the front of knee. the fat pad becomes swollen and painful. usually settles spontaneously but may require arthroscopic resection of the fat pad.
examination = fat pad tenderness
A 16-year-old rugby player is tackled and feels severe pain in the knee. He notices something
out of place in this knee. However, as he rolls over to try to stand up, whatever it was clicks
back into place
1 Anterior cruciate ligament injury 2 Chondromalacia patellae 3 Hoffa’s syndrome 4 Patellar dislocation 5 Lateral collateral ligament injury
4
patella dislocation is one of the more common acute intrinsic injury to the knee.
it is most frequent in the second and third decades.
risk factor
- trochlear dysplasia
- ligamentous laxity
- patella alta
knee will be painful and swollen initially and so will be difficulty to examine but once the initial inflammation settled patient will be left with a patella apprehension sign. any attempt to push the patella laterally as you passively flex the knee will be resisted by the patient who have a sense of discomfort and apprehension.
radiograph is important to rule out any bony injuries
TX
- conservative treatment unless there is an acute bony pathology or recurrent problem with instability
An 18-year-old driver is involved in a high-energy motor vehicle accident. He sustains facial injuries from the windscreen and a fractured sternum from the steering wheel, and his right knee is painful and swollen. Radiographs are unremarkable.
1 Anterior cruciate ligament injury 2 Lateral collateral ligament injury 3 Meniscal injury 4 Patella dislocation 5 Posterior cruciate ligament injury
5
Dashboard injury
