Passmed Orthopaedics Mushkies Flashcards
1
Q
What is the usual mechanism by which an AC joint injury typically occurs?
A
FOOSH
2
Q
How are AC joint injuries graded?
A
from I to VI depending on the degree of separation
3
Q
How are AC joint injuries managed?
A
- I and II = conservative rx with sling and immobilisation
- III = depends on individual circumstances
- IV, V and VI are rare and require surgical intervention
4
Q
What is the initial imaging modality of choice for Achilles tendon rupture?
A
US
5
Q
What are risk factors for achilles tendon disorders?
A
- Quinolone (e.g. ciprofloxacin) use
2. Hypercholesterolaemia (predisposes to tendon xanthoma)
6
Q
What are the features of achilles tendinopathy?
A
- Gradual onset of posterior heel pain that is worse following activity
2, Morning pain and stiffness common
7
Q
How does one examine for achilles tendon rupture?
A
Simmond’s triad
- Abnormal angle of declination, with possible greater dorsiflexion of injured foot (Matles test)
- Gap in the tendon
- Foot will stay in neutral position when calf is squeezed (Thompson test)
8
Q
What are features of lateral epicondylitis?
A
- Pain and tenderness localised to the lateral epicondyle
- Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
- Episodes last between 6 months and 2 years, with pts tending to have acute pain for 6-12 weeks
9
Q
What are features of medial epicondylitis?
A
- Pain and tenderness localised to the medial epicondyle
- Pain is aggravated by wrist flexion and pronation
- Numbness/tingling in the 4th and 5th finger due to ulnar nerve involvement
10
Q
What are features of radial tunnel syndrome?
A
- Symptoms similar to lateral epicondylitis, making it difficult to diagnose
- However, pain tends to be 4-5cm distal to the lateral epicondyle
- Symptoms worsened by extending the elbow and pronating the forearm
11
Q
What is the most common cause of radial tunnel syndrome?
A
Most commonly due to compression of the posterior interosseous branch of the radial nerve
12
Q
What is cubital tunnel syndrome?
A
Compression of the ulnar nerve as it passes through the cubital tunnel
13
Q
What are features of cubital tunnel syndrome?
A
- Initially intermittent tingling in the 4th and 5th finger
- May be worse when the elbow is resting on a firm surface or flexed for extended periods
- Later numbness in the 4th and 5th finger associated with weakness
14
Q
What are features of olecranon bursitis?
A
- Swelling over the posterior aspect of the elbow
- May be associated pain, warmth and erythema
- Typically affects middle-aged male patients
15
Q
What demographic of pts does Perthes disease typically affect?
A
4-8 y/o, 5M:1F
16
Q
What are some X-ray features of Perthes disease?
A
Widening of joint space and flattening of the femoral head
17
Q
What are 5 red flags for lower back pain?
A
- Age = <20 y/o or >50 y/o
- Hx of malignancy
- Hx of trauma
- Night pain
- Systematically unwell (FLAWS)
18
Q
What is the most likely cause of an asymptomatic, fluctuant swelling behind the knee in a child?
A
Baker’s cyst
19
Q
What are Baker’s cysts?
A
They are not true cysts, but are in fact a distension of the gastrocnemius-semimembrnaosus bursa
20
Q
How can you classify Baker’s cysts?
A
- Primary = no underlying pathology, typically seen in children
- Secondary = underlying condition such as osteoarthritis, typically seen in adults
21
Q
How does one manage a Baker’s cyst?
A
- In children they typically resolve and do not require rx
2. In adults, the underlying cause should be rx where appropriate
22
Q
What causes Osgood-Schlatter disease?
A
Multiple small avulsion fractures within the ossification centre of the tibial tuberosity at the inferior attachment of the patellar ligament
23
Q
What is the structure that is divided in the surgical management of carpal tunnel syndrome?
A
The flexor retinaculum
24
Q
What are the typical findings in a Hx of a pt with carpal tunnel syndrome?
A
- Pain/pins and needles in the thumb, index and middle finger
- Pt shakes their hand to obtain relief, typically at night
- Unusually, the symptoms may ‘ascend’ proximally
25
What may you find on examination of a pt with carpal tunnel syndrome?
1. Weakness of thumb abduction (ABP)
2. Wasting of thenar eminence (NOT hypothenar)
3. Tinnel's sign = tapping causes paraesthesia
4. Phalen's test = flexion of wrist causes pain
26
What are some causes of Carpal tunnel syndrome?
1. Idiopathic
2. Pregnancy
3. Oedema e.g. HF
4. Lunate fracture
5. RhA
27
What do you find upon performing EP in carpal tunnel syndrome?
Motor and sensory prolongation of the action potential
28
What is the management for carpal tunnel syndrome?
1 .Corticosteroid injections
2. Wrist splints at night
3. Surgical decompression
29
What is compartment syndrome?
Raised pressure within a closed anatomical space, with the raised pressure eventually compromising tissue perfusion, resulting in tissue necrosis
30
What are the 2 main fractures carrying a risk of compartment syndrome?
1. Supracondylar fractures
| 2. Tibial shaft injuries
31
How does one diagnose compartment syndrome?
By measurement of intracompartmental pressures = pressures >20mmHg are abnormal and >40mmHg are diagnostic
32
What is the management for compartment syndrome?
Prompt and extensive fasciotomies
33
What may have to be considered if muscle groups are frankly necrotic at fasciotomy?
Debridement and amputation
34
In what time frame does death of a muscle group start to occur?
4-6 hours
35
Why do pts with compartment syndrome require aggressive IV fluids?
Myoglobinuria may occur following fasciotomy and result in AKI
36
What is the management for an undisplaced, intracapsular hip fracture?
1. No comorbidities = internal fixation (esp. if young)
| 2. Major comorbidities = hemiarthroplasties
37
What is the management for a displaced, intracapsular fracture in a pt with no co-morbidities?
1. Age < 70 = internal fixation if possible
| 2. Age > 70 = total hip arthroplasty
38
What is the management for a displaced, intracapsular fracture in a pt with major comorbidities?
Hemiarthroplasty
39
What is the management for an extracapsular fracture (non-special type)?
Dynamic hip screw
40
What is the management for an extracapsular fracture (reverse oblique, transverse or sub-trochanteric)?
Intramedullary device
41
What is the more formal term for a Charcot joint?
Neuropathic arthropathy
42
What causes a Charcot joint?
Progressive degeneration of a weight-bearing joint due to loss of sensation
43
What is the most likely cause of a non-tender, swollen, erythematous, hot foot?
An acute Charcot joint
44
What are 3 causes of Charcot's joints?
1. DM
2. Alcohol
3. Syphilis (Tabes dorsalis)
45
What is the likely cause of knee pain in a 19 year old girl which is worse when walking down the stairs and when sitting still?
Chondromalacia patallae
46
What is the mainstay of management for chondromalacia patellae?
Physiotherapy
47
Knee pain after being hit with a hockey stick with a normal X ray?
Patellar dislocation - may spontaneously reduce when the leg is straightened`
48
What is the most common cause of heel pain in adults?
Plantar fasciitis
49
What is a Morton's neuroma?
Thickening of the tissue around the nerve, usually between the 3rd and 4th toes
50
Where is pain most typically worst in plantar fasciitis?
Around the medial calcaneal tuberosity
51
What is the management of plantar fasciitis?
1. Rest the feet where possible
2. Wear shoes with good arch support and cushioned heels
3. Insoles and heel pads may be helpful
52
Twisting sporting injury followed by delayed onset of knee swelling and locking are suggestive of a?
Menisceal tear
53
What is the usual management for a menisceal tear?
Arthroscopic meniscectomy
54
How does a ruptured ACL typically present?
1. Mechanism = high twisting force applied to a bent knee
| 2. Typically presents with loud crack, pain, and rapid joint swelling (haemarthrosis)
55
How does a ruptured PCL typically present?
1. Mechanism = hyperextension injuries
| 2. Tibia lies back on the femur with a paradoxical anterior draw test
56
How does a ruptured MCL present?
1. Mechanism = leg forced into valgus via force outside the leg
2. Knee unstable when put into valgus position
57
What are the 2 types of patellar dislocation?
1. Direct blow to patella causing undisplaced fragments
| 2. Avulsion fracture
58
What are some features of a Tibial plateau fracture?
1. Occur in the elderly (or young following significant trauma)
2. Mechanism = knee forced into valgus/varus, but the knee fractures before the ligaments fracture
3. Varus injury affects medial plateau and valgus injury affects lateral plateau
59
What classification system is used for tibial plateau fractures?
The Schatzker classification system
60
What are 5 types of paediatric fracture?
1. Complete = both sides of cortex breached
2. Toddlers = oblique tibial fracture in infants
3. Plastic deformity = deformity without cortical disruption
4. Greenstick = unilateral cortical breach only
5. Buckle = incomplete cortical disruption resulting in periosteal haematoma only
61
What are the 5 Salter-Harris types?
1. Through physis only
2. Through physis and metaphysis
3. Through physis and epiphysis
4. Through metaphysis, physis and epiphysis
5. Crush injury only involving physis
62
What are 2 conditions that can cause pathological fractures in young people?
1. Osteogenesis imperfecta
| 2. Osteopetrosis
63
What is De Quervain's tenosynovitis?
Inflammation of the tendons on the lateral aspect of the wrist and thumb, in the first dorsal compartment i.e. abductor pollicis longus and extensor pollicis brevis tendons
64
What test can be done to diagnose De Quervain's tenosynovitis?
Finkelstein's test = grab the thumb and ulnar deviate the hand sharply, leading to pain along the distal radius
65
How doe De Quervain's tenosynovitis present?
1. Pain on the radial side of the wrist
2. Tenderness over the radial styloid process
3. Abduction of the thumb against resistance is painful
66
What is the management of De Quervain's tenosynovitis?
1. Analgesia
2. Steroid injection
3. Immobilisation with thumb splint (spica) may be effective
4. Surgical Tx is sometimes required
67
Where is the distal fragment displaced in a Colles fracture?
Dorsally
68
Where is the distal fragment displaced in a Smith's fracture?
Anteriorly
69
What is a galeazzi fracture?
Fracture of the wrist with dislocation of the distal radioulnar joint
70
What are the 3 features of a classic Colles' fracture?
1 .Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation
71
Foot drop after a low anterior resection, what nerve is damaged?
Peroneal nerve
72
Groin pain after inguinal hernia repair, what nerve is damaged?
Ilioinguinal nerve
73
Foot drop after a total hip replacement via a posterior approach, what nerve is damaged?
Sciatic nerve
74
What are the muscular components of the lower limb?
1. Anterior compartment
2. Peroneal compartment
3. Superficial posterior compartment
4. Deep posterior compartment
75
What are the muscles of the anterior compartment of the lower limb?
1. Tibialis anterior
2. Peroneus tertius
3. Extensor hallucis longus
4. Extensor digitorum longus
76
What nerve supplies the anterior compartment of the lower limb?
Deep peroneal nerve
77
What is the function of tibialis anterior?
Dorsiflexes ankle, inverts foot
78
What is the function of peroneus tertius?
Dorsiflexes ankle, everts foot
79
What is the function of extensor hallucis longus?
Dorsiflexes ankle, extends big toe
80
What is the function of extensor digitorum longus?
Dorsiflexes ankle, extends lateral 4 toes
81
What are the muscles of the peroneal compartment of the lower limb?
Peroneus longus and peroneus brevis
82
What nerve supplies the peroneal compartment of the lower limb?
Superficial peroneal nerve
83
What is the function of peroneus longus?
Everts foot, assists in ankle plantar flexion
84
What is the function of peroneus brevis?
Plantar flexes ankle
85
What are the muscles of the superficial posterior compartment of the lower limb?
Gastrocnemius and soleus
86
What nerve supplies the superficial posterior compartment of the lower limb?
Tibial nerve
87
What is the function of gastrocnemius?
Plantar flexes foot, may also flex knee
88
What is the function of soleus?
Plantar flexes foot
89
What are the muscles of the deep posterior compartment of the lower limb?
1. Tibialis posterior
2. Flexor hallucis longus
3. Flexor digitorum longus
90
What nerve supplies the deep posterior compartment of the lower limb?
Tibial nerve
91
What is the function of flexor digitorum longus?
Flexes lateral 4 toes
92
What is the function of flexor hallucis longus?
Flexes the big boi
93
What is the function of tibialis posterior?
Plantar flexes foot, inverts foot
94
What are the bony components of the ankle joint?
Distal tibia and fibula and superior aspect of the talus
95
What is the only mortise and tenon joint in the body?
The talocrural joint (ankle joint)
96
What ligaments support the syndesmosis between the tibia and fibula?
1. Anterior inferior tibiofibular ligament (AITFL)
2. Posterior inferior tibiofibular ligament (PITFL)
3. Interosseous ligament (IOL)
97
What ligament joints the distal fibula to the talus?
Anterior and posterior talofibular ligaments (ATFL and PTFL)
98
What ligament joins the calcaneus to the fibula?
Calcaneofibular ligament
99
What are the lateral collateral ligaments?
The ATFL, PTFL and calcaneofibular ligament
100
What ligament joins the distal tibia to the talus?
The deltoid ligament
101
What is a sprain?
A stretching, partial or complete tear of a ligament
102
How can you classify ankle sprains?
High ankle sprains and low ankle sprains
103
What is a high ankle sprain?
Sprain involving the syndesmosis
104
What is a low ankle sprain?
Involving the lateral collateral ligaments
105
Which kind of ankle sprain is more common
Low ankle sprain (90%)
106
Which ligament is most commonly injured in a low ankle sprain?
ATFL
107
What percentage of ankle sprains are associated with a fracture?
15%
108
What is the management for a low ankle sprain?
1. RICE protocol
2. Removable orthosis/cast/crutches for short term symptoms relief
3. MRI +/- surgical intervention
109
What is the common mechanism by which low ankle sprains occur?
Inversion injury
110
What is the common mechanism by which a high ankle sprain occurs?
External rotation of the foot, causing the talus to push into the fibula laterally
111
Which kind of ankle sprain is more associated with painful weight-bearing?
High ankle sprains
112
What is Hopkin's squeeze test?
A test for high ankle sprain
| 1. Pain when the tibia and fibula are squeezed together at the level of the mid-calf
113
What may you see on plain radiograph of a high ankle sprain?
Widening of the tibiofibular joint or ankle mortise
114
What is the management of a high ankle fracture?
1. Widening of the tibiofibular joint --> operative fixation is usually warranted
2. No widening of the tibiofibular joint --> non-weight-bearing orthosis or cast until pain subsides
115
Which nerve is Froment's sign testing?
Ulnar nerve palsy
116
What muscle function is being tested with Froment's sign?
Adductor pollicis
117
What is Froment's sign?
Hold a piece of paper between their thumb and index finger. The object is then pulled away. If ulnar nerve palsy, unable to hold the paper and will flex the flexor pollicis longus to compensate (flexion of thumb at interphalangeal joint)
118
Which is more sensitive - Phalens or Tinels sign?
Phalen's
119
What nerve is most likely to be injured during a knee arthroplasty?
Common peroneal nerve
120
What is an eponymous test used to assess a meniscal teat?
Thessaly's test
121
What is Thessaly's test?
The patient is supported by doctor and is asked to stand on the affected leg, flexed to 20 degree. The test is positive if there is pain on twisting knee
122
What is the most common cause of lumbar canal stenosis?
Degenerative disease
123
What is the pathology of degenerative disease in the spine that causes lumbar spinal stenosis?
Degeneration is believed to begin in the intervertebral disk where biochemical changes such as cell death and loss of proteoglycan and water content lead to progressive disk bulging and collapse. This process leads to an increased stress transfer to the posterior facet joints, which accelerates cartilaginous degeneration, hypertrophy, and osteophyte formation; this is associated with thickening and distortion of the ligamentum flavum. The combination of the ventral disk bulging, osteophyte formation at the dorsal facet, and ligamentum flavum hyptertrophy combine to circumferentially narrow the spinal canal and the space available for the neural elements. The compression of the nerve roots of the cauda equina leads to the characteristic clinical signs and symptoms of lumbar spinal stenosis.
124
What is the management of degenerative spinal canal stenosis?
Laminectomy
125
What is a Bennett's fracture?
1. Intra-articular fracture of the first carpometacarpal joint
2. Often due to impact on flexed metacarpal, caused by fist fights
126
What is a Pott's fracture?
Bimalleolar ankle fracture, usually caused by forced foot eversion
127
What is morning stiffness >2 hours indicative of?
Inflammatory arthritis
128
What score is used to assess severity of OA of the hip?
The Oxford Hip Score
129
What are 4 reasons for revision of a THR?
1. Aseptic loosening (most common)
2. Pain
3. Dislocation
4. Loosening
130
How does frozen shoulder present?
Through an initial painful stage followed by a period of joint stiffness (painful freezing phase --> adhesive phase --> recovery phase)
131
What are two causes of rotator cuff tears in the elderly??
1. Minor trauma
| 2. Longstanding impingement
132
What is parsonage-turner syndrome?
An acute brachial neuropathy, the cause of which is unknown, but tends to result in autoimmune inflammation of the brachial plexus
133
How does parsonage-turner syndrome typically present?
Severe shoulder or arm pain followed by weakness and numbness, often associated with winging of the scapula
134
How is an impacted fracture of the surgical neck of the humerus usually managed?
Collar and cuff for 3w followed by physiotherapy
135
What are 3 different anatomical types of shoulder dislocation?
1. Glenohumeral (most common)
2. Acromioclavicular
3. Sternoclavicular (least common)
136
What is the most sensitive test for detesting meniscal tears?
MRI
137
What movement causes the worst pain with a meniscal tear?
Straightening the knee
138
What may a displaced meniscal tear cause?
Knee locking
139
How can you further subclassify extracapsular fractures of the hip?
Trochanteric or subtrochanteric
140
What is the management for a child/teenager with unexplained bone swelling/pain?
Very urgent X-ray to assess for osteosarcoma
141
What are sarcomas?
Malignant tumours of mesenchymal origin
142
What are 3 types of bone sarcoma?
1. Osteosarcoma
2. Ewing's sarcoma
3. Chondrosarcoma
143
What is a 'ganglion' in ortho?
A 'cyst' arising from a joint or tendon sheath, most commonly seen around the back of the wrist and are 3 times more common in women. They often disappear spontaneously after several months.
144
What is a Dupuytren's contracture?
Fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended, due to fibrosis of the palmar fascia
145
Which finger's are most affected in Dupuytren's?
Ring and little finger
146
What are some causes of Dupuytren's contracture?
LIAM PT
1. Idiopathic
2. Liver cirrhosis
3. Alcoholism
4. Manual labour
5. Phenytoin
6. Trauma
147
What is the first line medication for back pain?
NSAID e.g. naproxen (PPIs co-prescribed if >45 y/o)
148
What is the initial management of an open fracture?
1. IV ABx
2. Photographs
3. Sterile soaked gauze and impermeable film
4. Debridement
5. Wound irrigation with 6L saline
6. Stabilise fracture, an external fixator is often used in the first instance
149
What classification system is used for open fractures?
Gustilo-Anderson Fractures
150
What are the Grades of the Gustilo Anderson Classification of open fractures?
1. Low energy wound <1cm
2. >1cm wound w/ moderate soft tissue damage
3. >1cm with extensive soft tissue damage
3a. Adequate soft tissue coverage
3b. Inadequate soft tissue coverage
3c. Associated arterial injury
151
What scoring system can be used to predict the need for primary amputation in Type IIIC GA open fractures?
MESS
| Mangled extremity scoring system
152
When should surgical treatment of Dupuytren's contractures be considered?
When the MCP joints cannot be straightened and thus the hand cannot be placed flat on the table
153
What is the triad of presentation of fat embolism syndrome?
1. Respiratory distress
2. Cerebral signs
3. Petechial rash
154
What is are 2 important differentials for back pain in an IVDU?
1. Psoas abscess
| 2. Vertebral osteomyelitis
155
What is the management of a psoas abscess?
Antiobiotic therapy +/- drainage
156
What is the most common cause of osteomyelitis?
S. aureus
157
What are some predisposing conditions for osteomyelitis?
1. DM
2. Sickle cell
3. IVDU
4. Immunosuppression (medication/HIV)
5. Alcohol excess
158
In a pt with PMR, what could cause avascular necrosis of the femoral head?
Long term steroid usage
159
What are 4 causes of avascular necrosis of the femoral head?
1. Long term steroid use
2. Chemotherapy
3. Alcohol excess
4. Trauma
160
What presents with a shortened and internally rotated leg?
Posterior hip dislocation
161
What are the different types of hip dislocation?
1. Posterior dislocation
2. Anterior dislocation
3. Central dislocation
162
What kind of hip dislocation is most common?
Posterior dislocation (90%)
163
How would an anterior hip dislocation present?
Abducted and externally rotated leg without shortening
164
What are some complications of hip dislocation?
1. Sciatic/femoral nerve injury
2. Avascular necrosis
3. Osteoarthritis
4. Recurrent dislocation due to damage of supporting ligaments
165
What kind of splint is used for a scaphoid fracture?
Futuro splint
166
What is an oblique fracture?
One where the fracture lies obliquely to the long axis of the bone
167
What is a communited fracture?
>2 fragments
168
What is a segmental fracture?
More than one fracture along a bone
169
What is a transverse fracture?
Perpendicular to the long axis of the bone
170
What is a spiral fracture?
Severe oblique fracture with rotation along the long axis of the bone
171
What are 5 causes of Oslers nodes?
1. Infective endocarditis
2. SLE
3. Gonorrhoea
4. Typhoid
5. Haemolytic Anaemia
172
What eponymous test is used for a meniscal tear?
McMurray's Test
173
What is the most common demographic of adhesive capsulitis?
Middle aged females
174
What condition is frozen shoulder associated with?
DM
175
Which movement of the shoulder is most affected by frozen shoulder?
External rotation
176
What is the management of adhesive capsulitis?
1. NSAIDs
2. Physio
3. Oral steroids
4. Intra-articular steroids
177
When and what kind of weight bearing should be sought after a hip fracture surgery?
Full weight bearing immediately post-operatively
178
What is a Morton's neuroma?
A benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space. The female to male ratio is around 4:1.
179
What are some features of Morton's neuroma?
1. Forefoot pain most commonly in 3rd inter-metatarsophalangeal space
2. Worse on walking - 'pebble in shoe'
3. Loss of sensation distally in toes
4. Mulder's click = : one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads
180
What is Foucher's sign?
Increase in tension of the Baker's cyst on extension of the knee
181
What causes an Erb-Duchenne palsy?
1. Damage of the upper trunk of the brachial plexus (C5,C6)
2. May be secondary to shoulder dystocia during birth
3. Arm hangs by the side and is internally rotated, elbow extended
182
What causes a Klumpke injury?
1. Due to damage of the lower trunk of the brachial plexus (C8, T1)
2. May be due to secondary dystocia or sudden upw
183
What are some respiratory signs of a fat embolism?
1. Tachycardia
2. Tachypnoea
3. Dyspnoea
4. Hypoxia
184
What are some derm signs of a fat embolism?
1. Red/brown impalpable petechial rash (25-50%)
| 2. Subconjunctival and oral haemorrhage/petechiae
185
What are some CNS signs of fat embolism?
1. Confusion and agitation
| 2. Retinal haemorrhages and intra-arterial fat globules on fundoscopy
186
What is a Monteggia fracture?
Dislocation of the proximal radioulnar joint associated with an ulnar fracture
187
Wwhat is a Galeazzi fracture?
Dislocation of the distal radioulnar joint associated with a radial shaft fracture
188
What is the management for a subtrochanteric fracture?
Intramedullary nail
189
What is the management for a trochanteric fracture?
Sliding hip screw
190
What is the management for a displaced intracapsular fracture in a mobile pt?
THR
191
What is the management for a displaced intracapsular fracture in a not-independently mobile pt?
Hemiarthroplasty, cemented implants preferred
192
What is the main neurovascular structure that is compromised in a scaphoid fracture?
Dorsal carpal branch of the radial artery
193
What is the average age at which a scaphoid fracture occurs, and gender predominance?
22 years old, 7M:1F
194
What are 5 signs of a scaphoid fracture?
1. Point of maximal tenderness over the anatomical snuffbox.
2. Wrist joint effusion1: Hyper acute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
3. Pain elicited by telescoping of the thumb (pain on longitudinal compression)
4. Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
5. Pain on ulnar deviation of the wrist
195
How do you remember that Monteggia affects the Ulna?
Manchester United
196
How do you remember that Galeazzi affects the radius?
Galaxy rangers
197
What is Mallet thumb?
An injury to the end of the thumb which causes it to bend towards the palm
198
What is the first line imaging tool in occult hip fractures?
MRI
199
What is an iliopsoas abscess?
A collection of pus in the iliopsoas compartment (iliopsoas and iliacus)
200
How can you classify the causes of an iliopsoas abscess?
Primary and Secondary
201
What is the primary cause of iliopsoas abscesses?
Haematogenous spread of bacteria
202
What are some secondary causes of iliopsoas abscesses?
1. Crohns
2. Diveriticulitis
3. Colorectal Ca
4. UTI, GU Ca
5. Vertebral osteomyelitis
6. Endocarditis
7. Lithotripsy
203
What is the gold standard tool for diagnosis of an iliopsoas abscess?
CT
204
What is the Weber classification used for?
Ankle fractures around the syndesmosis
1. Type A = below syndesmosis
2. Type B = at level of syndesmosis
3. Type C = above the syndesmosis
205
What is the Gartland classification used for?
Supracondylar fractures in children
206
What should be done before definitive management of open fractures?
The soft tissues should have recovered = immediate wound debridement and application of spanning external fixation device
207
How can symptoms of meralgia paraesthetica be reproduced?
Pelvic compression test = symptoms reproduced by deep palpation just below the ASIS
208
What is the greek word for thigh?
Meros
209
What is the greek word for pain?
Algos
210
What is meralgia paraesthetics?
An entrapment mononeuropathy of the LCFN
211
What is the most common site where osteomyelitis occurs along a long bone in children?
Metaphysis
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What are the Ottawa ankle rules?
X-rays are only necessary if there is pain in the malleolar zone and:
1. Inability to weight bear for 4 steps
2. Tenderness over the distal tibia
3. Bone tenderness over the distal fibula
213
What should you do with failed conservative management of plantar fasciitis?
Referral to orthopaedics
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What is syringomyelia?
A disorder in which a cystic cavity forms within the spinal cord
215
What is the commonest variant of a syringomyelia?
Arnold-Chiari malformation, in which the cavity connects with a congenital malformation affecting the cerebellum
216
Classically, what neurological deficit do you see with syringomyelia?
Only the spinothalamic tract affected, with loss of pain and temperature sensation
217
What presents with a painful arc of abduction?
Subacromial impingement
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What degree of abduction is classically referred to as the 'painful arc'?
90 to 120 degrees
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How does Leriche syndrome present?
The triad of:
1. Claudication of the buttocks and thighs
2. Atrophy of the musculature of the legs
3. Impotence (due to paralysis of the L1 nerve)
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What causes Leriche syndrome?
An atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries
221
What is the ulnar paradox?
Proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions
222
What nerve supplies the palmar and dorsal interossei muscles and therefore finger abduction and adduction?
Ulnar nerve
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How can one explain the ulnar paradox?
1. When the ulnar nerve is damaged at the wrist, the medial two lumbrical muscles are affected (the lateral two being supplied by the median nerve). Denervation of the lumbricals, which flex the metacarpal phalangeal joints (MCPJ) and extend the interphalangeal joints (IPJ), causes unopposed extension of the MCPJ by extensor digitorum longus and flexion of the IPJ by flexor digitorum profundus and superficialis. This gives the hand a claw like appearance.
2. When the ulnar nerve is damaged at the elbow, the ulnar half of flexor digitorum profundus is also affected resulting in a less marked clawing due to reduced unopposed flexion at the IPJ
224
What is the the most common upper limb injury in children under the age of 6?
Subluxation of the radial head
225
What is the management of subluxation of the radial head?
Analgesia and passively supination of the elbow joint whilst the elbow is flexed to 90 degrees
226
What could cause back pain in a pt with infective endocarditis?
Discitis
227
What is discitis?
An infection of the intervertebral disc space
228
How can you classify the causes of discitis?
1. Bacterial (Staph A)
2. Viral
3. TB
4. Aseptic
229
What are Kanavel's signs of flexor tendon sheath infection?
1. Fixed flexion
2. Fusiform swelling
3. Tenderness
4. Pain on passive extension
230
Insect bite and finger held in strict flexion, finger is also painful - what is the diagnosis?
Infective flexor tenosynovitis
231
What FRAX score warrants a DEXA scan.
FRAX score >10%
232
What is the most common complication of a posterior hip dislocation?
Sciatic nerve injury (10-20%)
233
What is trigger finger?
A common condition associated with abnormal flexion of the digits, thought to be caused by a disparity between the size of the tendon and pulleys through which they pass
234
What are 3 associations with trigger finger?
1. Women
2. RhA
3. DM
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What is the management for trigger finger?
1. Steroid injection successful in majority
2. Finger splint
3. Surgery if not responsive to steroid injections
236
What imaging can be used to diagnose a Morton's neuroma?
US
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What is a complication of discitis?
Epidural abscess
238
What is the sensitivity of Ottawa rules for ankle X-rays?
Approaching 100%
239
What are signs of a radial head fracture?
1. Local tenderness over head of the radius
2. Impaired movements at the elbow
3. Sharp pain at the lateral side of the elbow and during pronation and supination
240
What percentage of anterior glenohumeral dislocations are associated with a Hill-Sachs lesion?
50%
241
What is a Hill-Sachs lesions?
A cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly
242
What tear is the most common of the rotator cuff tears?
A supraspinatus tear
243
What is the correct term for clubfoot?
Talipes equinovarus
244
What is the management for talipes equinovarus?
Manipulation and progressive casting starting soon after birth
245
What is Medial tibial stress syndrome?
A repetitive-stress injury of the shin area, a.k.a. shin splints
246
What is an important differential for tibial stress syndrome?
Stress fracture of the tibia
247
What is gradual swelling of the knee suggestive of?
Meniscal injury
248
What is a commonly used method of analgesia for pts with a NOF?
Iliofascial nerve block
