Orthropaedics part 2 Flashcards
What is a tendon?
Dense, highly structured
What is Tendonitis & Tendinopathy?
inflammation of the tendons, it happens when a person overuses or injure a tendon during a physical activity.
What are the red flags for tendonitis ?
- Sudden Pain
- Severe with ‘ popping’ or ‘snapping’ sound
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What is Tendinopathy
a broad term for any tendon condition that causes pain
It is a degeneration not inflammation where patients will get pain, decline in function and they won’t be able to exercise aswell
Treatment for tendinopathy?
- Rest
- ice pack, anti-inflammatory pain killers such as ibuprofen
- Physiotherapy
What is Lateral Epicondylitis ?
**Tennis Elbow **
cause damage to tendons around the elbow (overuse injury) by ecentric (muscle lengthening)
This causes tendinosis and inflammation of the extensor carpi radialis brevis ( ECRB)
What is the prevelance of Lateral Epicondilitis ?
- common in dominant arm
- 1-3 % of adults are affected annually
- 50% of tennis players develop this condition
- age - 30-50 years
- 5% assoc with radial nerve injury
What are the symtpoms of tennis elbow -lateral epicondilitis ?
pain with resisted wrist extension
pain with gripping activities and decreased grip strength
What are the history questions or things to look for ?
- Joint swelling
- history of trauma
- Ask about the severity, onset, duration & exabberating factors
- Pain ( +/- burning sensation ) lateral epicondyle with radiation down extensor aspect of forearm
- grip weakness
What would you expect in examination?
- Point tenderness at lateral epicondyle
- Decreased grip strength
What test & examination would you do for Lateral Epicondylitis ?
- Resisted wrist extension
- Check for **Tinel’s sign **at the elbow to r/o Cubital Tunnel Syndrome
- Assess neck and Shoulder (reffered pain) - always asses joint above & below for this reason
- In msk, when youe examine a joint, make sure to examinae both above and below of the joint and whenever the pt comes in with knee pain always examine the hip.
What is cubital tunnel syndrome ?
occur when the ulnar nerve which runs through the elbow’s cubital tunnel become compressed or irritated.
What is the Management of Lateral Epicodylitis ?
- Aim - to relief the pain & restore functionally
- Apply heat/ice to relieve the pain
- Activity modification for 6 weeks- also avoid tasks that involeve hand gripping
- Elbow brace
- Analgesia ( paracetamol as first line/ topical NSAIDS such as ibuprofen gel)
- 2nd line PO NSAID
However if the pain does not settle after 6 weeks reassess and refer to physiotherapy
Again, if there is no response to initial treatment after 6 weeks then refer to ortho Surgeon
What is the surgery for Lateral Epicondylitis ?
- (Open / orthoscopic debridement and or release)
What is the prognosis after the surgery ?
The average duration if between 6 months to 2 years but 89% of people will be recoevered within one year however 5-10% do not resolve and require surgery.
What is Medial Epicondylitis?
also called as Golfer’s Elbow
Overuse syndrome caused by damage to the muscles & tendons that control your wrist & fingers.
age 30-40 yrs are mostly common
What are the risk factors of Medial epicondylitis ?
Sports that require repeated wrist flextion/forearm pronation during ball release.
Repetitive activities cause microtrauma at the muscle tendon junction at its origin at the medial epicondyle.
What is the presentation of medial epicondyle ?
- Pain
- Tendorness over the medial epicondyle radiate into the forearm
- The pain exacerbated by wrist flexion & pronation and the pain is aggravated by using affected muscles - grasping objects
What is the test you carry out for Golfer’s elbow ?
active wrist flextion against resistence
What is the management of Golfer’s elbow ?
- Activity modification
- rehabilation exercise
- physiotherapy
- Surgical management
What is the prognosis for golf elbow
self limiting
similar to lateral epicondylitis
Que 56, was out dancing, doing the twist on the dance floor, immediately felt left leg give away and felt a pulling sensation.
- Left knee swelling days after
- Pain localised to medial patella
- knee felt like it was catching when walking
what is the differential?
Meniscal injuries
Medial & Lateral menisci = fibrocartilage structures on the knee
What is the function of Meniscal injury ?
- Deepen the articular surface of the tibia
- Acts as a shock absorber
- ’ C shaped ‘
- Medial tears are more common than lateral tears
what are the symptoms of meniscal injuries
- MOI - typically twisting
- Pain localising to medial or lateral side
- Mechanical symptoms including locking and clicking
- Delayed or intermittent swelling
- McMurray’s test
How do you diagnose meniscal injuries ?
MRI Scan
What are the management of Meniscal injury ?
Refferal to orthopaedic Surgeon
What is the first line of Meniscal injury ?
- Rest
- NSAIDs and rehabiliation
- Physiotherapy
What is the surgery for Meniscal injury ?
Arthoscopy
treat through a meniscal repair or partial meniscectomy
