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MRCS part A- Principles of surgery in general > Pastest Orthopaedic For The MRCS Part A > Flashcards

Pastest Orthopaedic For The MRCS Part A Flashcards

1
Q

Define seronegative Spondyloarthritis?

A

A group of disorders,characterised by
(1) Seronegative inflammatory arthritis or spondylitis
(2) primarily affect the spine and the sacroiliac joints.

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2
Q

True or False: Spondyloarthritis can lead to fusion of the spine.

A

True

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3
Q

Name one common symptom of Spondyloarthritis.

A

Chronic lower back pain and stiffness (sacroiliitis)

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4
Q

Fill in the blank: Spondyloarthritis is often associated with the _____ gene.

A

HLA-B27

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5
Q

What are the main types of Seronegative Spondyloarthritis?

A

Mnemonic;RAPE
(1) Ankylosing spondylitis,
(2) psoriatic arthritis,
(3) reactive arthritis, and
(4) enteropathic arthritis.

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6
Q

Multiple choice: Which of the following is NOT a characteristic of Spondyloarthritis?
A) Enthesitis
B) Dactylitis
C) Osteoporosis
D) Hyperuricemia

A

D) Hyperuricemia

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7
Q

What is the typical age of onset for Spondyloarthritis?

A

15-40 yrs in most Seronegative spondyloartheritis

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8
Q

True or False: Spondyloarthritis primarily affects women more than men.

A

False (males are 3-5 times more than females,i.e.,3-5 times more common in males)

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9
Q

What is enthesitis?

A

Inflammation of the entheses, the sites where tendons or ligaments insert into the bone.

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10
Q

Fill in the blank: Patients with Spondyloarthritis may experience _____, which is swelling of fingers or toes.

A

Dactylitis

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11
Q

What imaging technique is commonly used to assess Spondyloarthritis?

A

1st/ XRs
-Indications: (1) Sacroiliitis
(2) Inflammatory spinal pain
(≥ 3 months)
(3) Limited spinal movements
(4) Limited chest expansion
- Changes: in the following successive order
(1) Blurred joint margins
(2) Subchondral erosion
(3) Sclerosis or fusion of the sacroiliac joint
(4) Loss of lumbar lordosis ( Loss of lumbar lordosis with
restriction of movements in a young pt are highly
suggestive of ankylosing spondylitis)
(5) Bamboo spine ( the latest sign)

2nd/MRI
- Indications: Early stages of Ankylosing spondylitis (as changes may take many years to become evident on XRs)

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12
Q

Which medication class is commonly used for treating Spondyloarthritis?

A

Non-steroidal anti-inflammatory drugs (NSAIDs)

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13
Q

True or False: Spondyloarthritis can affect organs outside the musculoskeletal system.

A

True

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14
Q

What is the role of TNF-alpha inhibitors in Spondyloarthritis treatment?

A

1) reduce inflammation and
2) improve symptoms.

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15
Q

Multiple choice: Which condition is commonly associated with Spondyloarthritis?
A) Ulcerative colitis
B) Diabetes
C) Asthma
D) Hypertension

A

A) Ulcerative colitis

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16
Q

What is the primary genetic marker associated with Spondyloarthritis?

A

HLA-B27 antigen

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17
Q

Fill in the blank: Spondyloarthritis is characterized by _____ involvement and may lead to spinal stiffness.

A

Axial

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18
Q

What is reactive arthritis?

A

A form of Spondyloarthritis that occurs following an infection in another part of the body.

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19
Q

True or False: Spondyloarthritis can lead to cardiovascular complications.

A

True (aortic and non aortic valve disease,congestive heart failure,arrhythmias)

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20
Q

What lifestyle modification can help manage Spondyloarthritis symptoms?

A

1) Regular exercise and
2) physical therapy.

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21
Q

What is the significance of the Schober test in Spondyloarthritis?

A

It assesses lumbar spine mobility.

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22
Q

Multiple choice: Which of the following is a key feature of Ankylosing Spondylitis?
A) Asymmetric joint involvement
B) Bamboo spine
C) Rheumatoid nodules
D) Morning stiffness

A

B) Bamboo spine

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23
Q

What is the term for inflammation of the eye associated with Spondyloarthritis?

A

Uveitis

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24
Q

Fill in the blank: The presence of _____ is a diagnostic criterion for Ankylosing Spondylitis.

A

Sacroiliitis

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25
Q

What is the typical course of Spondyloarthritis?

A

It is a chronic condition that can fluctuate in severity.

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26
Q

What a plain XRs shows in psoriatic arthritis?

A

Osteolysis around joints

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27
Q

Define Ankylosing spondylitis

A
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28
Q

What are the general features of Ankylosing spondylitis?

A

Mnemonic; SAC

(1) Systemic
(2) Autoimmune
(3) Chronic

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29
Q

What is the characteristic classical triad of Ankylosing spondylitis ?

A
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30
Q

Discuss the incidence of Ankylosing spondylitis ?

A
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31
Q

What is incidence of Ankylosing spondylitis in 1st degree relatives?

A
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32
Q

What is the incidence of Ankylosing spondylitis in identical twins?

A
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33
Q

What is the concordance rate of Ankylosing spondylitis in identical twins?

A
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34
Q

What does it mean that the concordance rate of Ankylosing spondylitis in identical twins is 50%?

A

Environmental factors may also contribute

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35
Q

What is the prevalence of Ankylosing spondylitis ?

A

0.1%

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36
Q

What is the aetiology of Seronegative spondyloartheritis?

A

Poorly understood,but it is thought to have a strong association (≈ 90%) with HLA-B27

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37
Q

Discuss pathogenesis of Ankylosing spondylitis?

A
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38
Q

What is the role of microorganisms in Ankylosing spondylitis?

A
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39
Q

Give 2 examples of how microorganisms get into the body in the pathogenesis of Ankylosing spondylitis

A

Barrier damage to the
(1) Skin in psoriasis
(2) Bowel in IBD

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40
Q

What is the role of the microtrauma in the pathogenesis of Ankylosing spondylitis?

A
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41
Q

What is the role of HLA-B27 in the pathogenesis of ankylosing spondylitis?

A
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42
Q

What is the percentage of HLA-B27 in pts from general population with ankylosing spondylitis?

A

90%

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43
Q

What is the percentage of HLA-B27 in 1st degree relatives with ankylosing spondylitis?

A

20%

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44
Q

What is the main genetic predisposition in white pts with ankylosing spondylitis?

A

HLA-B27

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45
Q

What is the main genetic predisposition in black pts with ankylosing spondylitis?

A

HLA-B7

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46
Q

What does the prevalence of HLA-B27 in white people and HLA-B7 in black people with ankylosing spondylitis indicate?

A

Supports a genetic predisposition

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47
Q

What are the C/P of ankylosing spondylitis?

A
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48
Q

What are the intrarticular clinical features of ankylosing spondylitis?

A
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49
Q

What is the site of the pain in ankylosing spondylitis?

A

Lower back pain [sacroiliitis]

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50
Q

What is the onset of the pain in ankylosing spondylitis?

A

Insidious

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51
Q

What is the character or feature of the pain in ankylosing spondylitis?

A

The main feature

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52
Q

What is the time of the pain in ankylosing spondylitis?

A

Early morning or nocturnal

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53
Q

What is associated with the pain in ankylosing spondylitis?

A

Mnemonic; SPEBSALR

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54
Q

What is the significance of the presence of loss of lumber lordosis and restriction of spinal movement in a young pt?

A

Highly suggestive of ankylosing spondylitis

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55
Q

What are the most common joints affected by peripheral arthritis in ankylosing spondylitis?

A

Affects larger joints:
1) Hip joint
2) Knee joint
3) Ankle joint

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56
Q

What is the incidence of peripheral artheritis in ankylosing spondylitis?

A

35%

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57
Q

What is the main feature of peripheral arthritis in ankylosing spondylitis?

A

Symmetrical

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58
Q

What aggravates the pain in ankylosing spondylitis?

A

Rest

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59
Q

What relieves the pain in ankylosing spondylitis?

A

Exercise or movement

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60
Q

Give examples of the extra-articular clinical features of ankylosing spondylitis

A

Mnemonic; UA/IP or PIA/U

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61
Q

What is the differential diagnosis of ankylosing spondylitis?

A
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62
Q

What are the investigations of ankylosing spondylitis?

A
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63
Q

What are the blood investigations of ankylosing spondylitis?

A
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64
Q

What is the significance of detecting HLA-B27 when investigating for ankylosing spondylitis ?

A
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65
Q

What is the significance of checking CBC when investigating for ankylosing spondylitis ?

A

Anaemia

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66
Q

What is the status of ALP when investigating for ankylosing spondylitis?

A

Increased

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67
Q

What are the radiological types of ankylosing spondylitis?

A
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68
Q

What is the characteristic feature of radiographic axial spondyloartheritis?

A

Characterised by SACROILIITIS on XRs

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69
Q

What is the characteristic feature of non radiographic axial spondyloartheritis?

A

Axial spondyloartheritis in the absence of XRs changes

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70
Q

What are the radiological diagnostic features of ankylosing spondylitis on the XRs?

A
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71
Q

What is the speciality for which we refer pts with ankylosing spondylitis?

A

Rheumatologist

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72
Q

Discuss treatment of ankylosing spondylitis

A
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73
Q

What is the non pharmacological treatment of ankylosing spondylitis?

A
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74
Q

What is the role of regular exercise in the treatment of ankylosing spondylitis?

A
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75
Q

What is the pharmacological treatment of ankylosing spondylitis?

A
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76
Q

What is the role of NSAIDs in the treatment of ankylosing spondylitis?

A

Symptomatic pain relief

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77
Q

What is the indication of DMARDs or steroids in the treatment of ankylosing spondylitis?

A

If the disease is refractory to NSAIDs

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78
Q

What is the drawback of using DMARDs or steroids in the treatment of ankylosing spondylitis?

A

Sulfasalazine or methotrexate may help peripheral arheritis but have no impact on spinal disease

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79
Q

Give 2 examples of the DMARDs used in the treatment of ankylosing spondylitis

A

1) Sulfasalzine
2) Methotrexate

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80
Q

What is the indication of anti-TNF-α in the treatment of ankylosing spondylitis?

A
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81
Q

What is the mechanism of action of anti-TNF-α in the treatment of ankylosing spondylitis?

A
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82
Q

Discuss surgical treatment of ankylosing spondylitis?

A
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83
Q

What is the indication of surgical treatment of ankylosing spondylitis?

A
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84
Q

What are the types of procedures of surgical treatment of ankylosing spondylitis?

A
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85
Q

Discuss prognosis of ankylosing spondylitis

A
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86
Q

What is the course of ankylosing spondylitis?

A
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87
Q

What affects quality of life in ankylosing spondylitis ?

A
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88
Q

What are the factors that affect prognosis of ankylosing spondylitis?

A
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89
Q

What are the complications of ankylosing spondylitis?

A
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90
Q

Give examples of ophthalmic complication of ankylosing spondylitis?

A

Anterior uveitis

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91
Q

Give examples of orthopaedic complications of ankylosing spondylitis?

A

1) Osteoporosis
2) Spinal fractures and spinal cord injury
3) Hip involvement

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92
Q

Give examples of cardiac complications of ankylosing spondylitis?

A

1) Valve disease (aortic and non aortic)
2) Congestive heart failure
3) Arrhythmias

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93
Q

What is the C/P of cauda equina syndrome?

A

1) Sudden onset of pain in the lower limbs
2) Loss of bladder and bowel control

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94
Q

What is the main cause of cauda equina?

A

Any condition that causes narrowing canal and compresses lower nerve roots

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95
Q

What is the treatment of cauda equina?

A

It is a surgical emergency and requires emergent decompression

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96
Q

What is the most common site for spinal disc herniation?

A

L4-L5 or L5-S1 discs

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97
Q

What is the C/P of spinal disc herniation?

A

Presentation may vary depending upon the level and severity of nerve root compression.
Loss of lumbar lordosis may occur due to spasm and contraction of paravertebral muscles

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98
Q

What is the diagnostic test for spinal disc herniation?

A

MRI

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99
Q

What is the treatment of spinal disc herniation?

A

Depending upon severity of the disease
1) Conservative
2) Surgical

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100
Q

Define spinal stenosis

A

Any narrowing of the spinal canal can lead to spinal stenosis

101
Q

What are the types of spinal stenosis?

A

1) Developmental
2) Degenerative- disease of the elderly

102
Q

What is the C/P of spinal stenosis?

A

1) Symptoms may mimic cauda equina
2) Restriction of spinal movement is not a feature

103
Q

Define spondylolisthesis

A

Abnormal forward slip or displacement of one vertebral body on another (I.e.,one vertebral body displacement relative to its immediate inferior vertebral body)

104
Q

What is the main vertebrae affected by spondylolisthesis?

A

1) L5
2) Sacral vertebrae

105
Q

What is the main investigation for spondylolisthesis and what is the finding?

A

XRs—
1) Prominent sacrum
2) scotty dog appearance ( in traumatic cases)

106
Q

What is the treatment of spondylisthesis?

A
  • Conservative for minor cases
    1) Exercise
    2) Steroid
  • Surgical fixation or correction (in the form of spinal decompression and stabilisation) for radicular manifestation
107
Q

What is the complication of spondylolisthesis?

A

Severe cases may cause Spinal stenosis leading to cauda equina

108
Q

What are the causes of spondylolisthesis?

A

1) Stress fractures
2) Spondylolysis

109
Q

Define osteoarthritis

A

Degenerative synovial joint disorder
+
Chronic arthropathy of an entire joint

110
Q

Discuss incidence of osteoarthritis

A

+ Generally
. Affects 70% of 70 years old
. Females (18%) > Males (10%) over 60 years
. The risk increases with age
. Affects 1% of the UK population

+Men
. Becomes symptomatic between 50-60 years
. Osteoarthritis in < 40 years is traumatic
. Nearly universal by the age of 80 years
Only 1/2 of those with the pathological changes
of osteoarthritis have symptoms

+Women
Become symptomatic between 40-70 years
after which both sexes are equal

111
Q

What is the general incidence of osteoarthritis?

A

. Affects 70% of 70 years old
. Females (18%) > Males (10%) over 60 years
. The risk increases with age
. Affects 1% of the UK population

112
Q

What is the sex incidence of osteoarthritis?

A

+ Generally
. Females (18%) > Males (10%) over 60 years

+Men (10%)
. Becomes symptomatic between 40-50 years
. Osteoarthritis in < 40 years is traumatic
. Nearly universal by the age of 80 years
Only 1/2 of those with the pathological changes
of osteoarthritis have symptoms

+Women (18%)
Become symptomatic between 40-70 years
after which both sexes are equal

113
Q

What is the incidence of osteoarthritis in different sexes?

A

+Men (10%)
. Becomes symptomatic between 50-60 years
. Osteoarthritis in < 40 years is traumatic
. Nearly universal by the age of 80 years
Only 1/2 of those with the pathological changes
of osteoarthritis have symptoms

+Women (18%)
Become symptomatic between 40-70 years
after which both sexes are equal

114
Q

Discuss the incidence of osteoarthritis in men?

A

+Men (10%)
. Becomes symptomatic between 50-60 years
. Osteoarthritis in < 40 years is traumatic
. Nearly universal by the age of 80 years
Only 1/2 of those with the pathological changes
of osteoarthritis have symptoms

115
Q

Discuss the incidence of osteoarthritis in women?

A

+Women (18%)
Become symptomatic between 40-70 years
after which both sexes are equal

116
Q

What is the incidence of osteoarthritis in the UK?

A

1%

117
Q

How many percentage of people aged 70 years are affected by osteoarthritis?

A

70%

118
Q

What is the relationship of incidence of osteoarthritis to the age?

A

The incidence of osteoarthritis increases with age

119
Q

What is the percentage of females affected by osteoarthritis?

A

18%

120
Q

What is the percentage of males affected by osteoarthritis?

A

10%

121
Q

At what age osteoarthritis becomes symptomatic in males?

A

40-50 years

122
Q

At what age osteoarthritis becomes symptomatic in females?

A

40-70 years

123
Q

What does it mean if osteoarthritis occurs in men less than 40 years?

A

Traumatic osteoarthritis

124
Q

At what age osteoarthritis becomes universal?

A

Nearly universal by the age of 80 years
Only 1/2 of those with the pathological changes of osteoarthritis have symptoms

125
Q

At what age osteoarthritis becomes equal in both sexes?

A

Above 70 years

126
Q

What are the risk factors of osteoarthritis ?

A

Wear and tear damage to weight bearing joints:
(1) Obesity
(2) Increased age related degeneration
(3) Female sex
(4) Genetics
(5) Joint injury- is a form of accelerated wear and joint laxity,i.e.,joint injury causing damage to bone and surrounding tissues leading to accelerated wear increasing risk of osteoarthritis,e.g., septic arthritis
(6) Occupational/exercise stress.

127
Q

Define 1ry osteoarthritis

A

Subluxation of
(1) Localised - one principal site ,e.g., hip
(2) Generalised - multiple sites,e.g., hands,knees,spine

128
Q

Discuss pathological features of 1ry osteoarthritis

A

(1) Injury or repeated excessive weight bearing or loading
and stress of a joint overtime
(2) Joint damage
(3) Starting of the repair process of the damage which damages
the joint overtime leading to typical features of:-
A- softening and degradation of articular cartilage
B- disruption and potential localised loss of joint cartilage at the site
that undergoes this stressful contact
C- 2ry changes in adjacent bone and other joint including
.remodelling of adjacent bone
.osteophyte formation leading to bone hypertrophy
.mild synovitis ( inflammation of Synovial membrane lining the joint capsule)
(4) Ongoing joint destruction
(5) Long term artheralgia
(6) Chronic arthropathy of an entire joint

129
Q

What is the effect of joint injury on osteoarthritis?

A

Joint injury is a form of accelerated wear and joint laxity,i.e.,joint injury causing damage to bone and surrounding tissues leading to accelerated wear increasing risk of osteoarthritis,e.g., septic arthritis

130
Q

What is the clinical picture of osteoarthritis ?

A
131
Q

What are the symptoms of osteoarthritis?

A
132
Q

What are the signs of osteoarthritis?

A
133
Q

Define 2ry osteoarthritis

A

Osteoarthritis involvement outside the usual joints

134
Q

What are the causes of 2ry osteoarthritis?

A

(1) Inherited dysplastic disorders
(2) Mechanical damage
(3) Metabolic conditions
(4) Previous inflammation,e.g.,gout,RA

135
Q

Discuss diagnosis of osteoarthritis

A
136
Q

What are the criteria of clinical diagnosis of osteoarthritis?

A
137
Q

What are the criteria of lab diagnosis of osteoarthritis?

A
138
Q

What are the criteria of radiological diagnosis of osteoarthritis?

A
139
Q

Hip osteoarthritis XRs

A
140
Q

What is the differential diagnosis of osteoarthritis becomes symptomatic?

A
141
Q

Discuss management of Osteoarthritis

A
142
Q

Discuss prognosis of osteoarthritis

A
143
Q

What is the other name of Talipes equinovarus?

A

Club foot

144
Q

Discuss incidence of talipes equinovarus

A
  • affected 1 in 1000 births
  • twice as common in males
  • congenital talipes equinovarus (CTEV) has a familial link (10% incidence if one 1st degree relative has the condition)
145
Q

What is the incidence of talipes equinovarus in new births?

A

Affects 1 in 1000 births

146
Q

What is the sex incidence of talipes equinovarus?

A

twice as common in males

147
Q

What is the incidence of congenital talipes equinovarus?

A

congenital talipes equinovarus (CTEV) has a familial link (10% incidence if one 1st degree relative has the condition)

148
Q

What are the causes of talipes equinovarus?

A

+ Most cases are thought to be idiopathic, however it is also associated with certain abnormalities eg: mnemonic;MNGD منجد
• myelomeningocele
• neuromuscular disorders
• generalised bone problems (arthrogryposis).
• down syndrome

+The condition is also thought to be related to mechanical pressure in utero

149
Q

What is the C/P of talipes equinovarus?

A

It is usually diagnosed clinically and is obvious from birth (may be detected during antenatal scanning).

• the right foot being more commonly affected, 50% of cases are bilateral.

• in clubfoot, both the hindfoot ,forefoot and midfoot are abnormal, so(Mnemonic;SEA/HPM)
(1) the forefoot is fixed in varus with subluxation of the talonavicular joint
(2) the hindfoot is fixed in varus and equinus (heel is not in line with lower leg),
(3) the midfoot is fixed varus and adduction
(4) high arch
(5) The foot (or feet) is fully plantarflexed and there is midtarsal adduction.

• severe cases are characterised by (mnemonic;RCDC)
(1) rigidity of the foot,
(2) constriction rings
(3) deep sole clefts,
(4) calf muscle wasting is also common.

150
Q

What is the main method to diagnose talipes equinovarus ?

A

It is usually diagnosed clinically and is obvious from birth (may be detected during antenatal scanning).

151
Q

Which foot is commonly affected by talipes equinovarus ?

A

the right foot

152
Q

What is the percentage of bilateral talipes equinovarus?

A

50%

153
Q

What is the position of the foot in talipes equinovarus?

A

in clubfoot, both the hindfoot ,forefoot and midfoot are abnormal, so
(1) the hindfoot is fixed in varus and equinus (heel is not in line with lower leg),
(2) the forefoot is fixed in varus with subluxation of the talonavicular joint
(3) the midfoot is fixed in varus and adduction
(4) high arch
(5) The foot (or feet) is fully plantarflexed and there is midtarsal adduction.

154
Q

What is the position of hindfoot in talipes equinovarus?

A

fixed in varus and equinus (heel is not in line with lower leg),

155
Q

What is the position of forefoot in talipes equinovarus?

A

Fixed in varus with subluxation of the talonavicular joint

156
Q

What is the position of the midfoot in talipes equinovarus?

A

fixed in varus and adduction

157
Q

What is the position of the foot in general in talipes equinovarus?

A

(1) high arch
(2) The foot (or feet) is fully plantarflexed and there is midtarsal adduction.

158
Q

What are the C/P of severe talipes equinovarus in?

A

severe cases are characterised by (mnemonic;RCDC)
(1) rigidity of the foot,
(2) constriction rings
(3) deep sole clefts,
(4) calf muscle wasting is also common.

159
Q

Enumerate key anatomical deformities of talipes equinovarus?

A
160
Q

What is the treatment of talipes equinovarus?

A
161
Q

What are the C/P of traumatic peripheral nerve injury?

A

1st/Symptoms
(1) Hypersensitivity
(2) Reduced two point discrimination
(3) Deranged vasomotor function
. Reduced sweat production
. Disturbance of sympathetic function
(Early sign of nerve damage)
2nd/Signs

162
Q

What are the symptoms of traumatic peripheral nerve injury?

A

(1) Hypersensitivity
(2) Reduced two point discrimination
(3) Deranged vasomotor function
. Reduced sweat production
. Disturbance of sympathetic function
(Early sign of nerve damage)

163
Q

What is the earliest symptom of traumatic peripheral nerve injury?

A

Disturbance of sympathetic function

164
Q

What are the signs of traumatic peripheral nerve injury?

A
165
Q

Which technique used to assess the traumatic peripheral nerve injury?

A
166
Q

What are the signs of traumatic peripheral nerve injury in the UL?

A
167
Q

What are the signs of traumatic peripheral nerve injury in the LL?

A
168
Q

What is the sensory distribution of axillary nerve?

A

Regimental badge area ( Lateral upper arm)

169
Q

What is the movement to assess axillary nerve function?

A

Shoulder abduction

170
Q

What is the sensory distribution of the musculocutaneous nerve?

A

Lateral area of forearm

171
Q

What is the movement to assess musculocutaneous nerve?

A

Lateral area of forearm

172
Q

What is the movement to assess musculocutaneous nerve?

A

Elbow flexion

173
Q

What is the sensory distribution of the median nerve?

A

Palmar aspect of index finger

174
Q

What is the movement to assess the median nerve?

A

Thumb abduction

175
Q

What is the sensory distribution of radial nerve?

A

Dorsal web space between thumb and index finger

176
Q

What the movement to assess radial nerve?

A

Wrist extension

177
Q

What is the sensory distribution of the ulnar nerve?

A

Little finger

178
Q

What is the movement to assess ulnar nerve function?

A

Index finger abduction

179
Q

What is the sensory distribution of the femoral nerve?

A

Anterior aspect of knee

180
Q

What is the movement to assess femoral nerve?

A

Knee extension

181
Q

What is the sensory distribution of the obturator nerve?

A

Medial aspect of thigh

182
Q

What is the movement to assess the obturator nerve function?

A

Hip adduction

183
Q

What is the sensory distribution of the superficial peroneal nerve?

A

Lateral aspect of foot dorsum

184
Q

What is the movement to assess the superficial peroneal nerve function?

A

Ankle eversion

185
Q

What is the sensory distribution of the deep peroneal nerve?

A

Dorsal aspect of the 1st web space

186
Q

What is the movement to assess the deep peroneal nerve function?

A

Ankle and toe dorsiflexion

187
Q

What is the purpose of performing Tinel’s sign?

A

To assess progression of peripheral nerve injury

188
Q

Discuss how we can perform Tinel’s sign?

A

This represents painful paraesthesia in the distribution of the nerve on percussion over the injured nerve

189
Q

What is the main method to manage traumatic peripheral nerve injury?

A

Surgical— primary repair (always favourable as the outcome is better)

190
Q

Define Bennett’s fracture

A

An intra-articular fracture of the base of the first metacarpal of thumb ,which extends into the carpometacarpal joint

191
Q

What is the main cause of Bennett’s fracture?

A

Impact on flexed metacarpal, caused by fist fights

192
Q

What is the DDx of Bennett’s fracture?

A

Ronaldo fracture

193
Q

Define Ronaldo fracture

A

comminuted intra articular fracture of first metacarpal bone

194
Q

What is the other name for Golfer’s elbow?

A

Medial epicondylitis

195
Q

Define Golfer’s elbow

A

Repetitive activities that cause micro-trauma to the insertion of the flexor-pronator mass

196
Q

Which muscle is affected by Golfer’s elbow and which part of that muscle is injured?

A

The insertion of the flexor-pronator mass

197
Q

What is the incidence of carpal tunnel syndrome?

A

Women aged 30-50 yrs

198
Q

What is the main cause of carpal tunnel syndrome?

A

Idiopathic

199
Q

What are the risk factors of carpal tunnel syndrome?

A

Mnemonic; DOHR HAAP

(1) D.M
(2) Obesity
(3) Hypothyroidism
(4) Rheumatoid arthritis or other types of wrist arthritis ( sometimes this is the presenting feature)
(5) Hand workers ( Activities or jobs that require repetitive flexion and extension of the
wrist can also be contributory factors.)
(6) Acromegaly
(7) Amyloidosis
(8) Pregnancy induced oedema

200
Q

Explain pathogenesis of carpal tunnel syndrome?

A

Tightening of flexor retinaculum causing pressure on median nerve

201
Q

Discuss C/P of carpal tunnel syndrome?

A
202
Q

Discuss symptoms of carpal tunnel syndrome?

A
203
Q

What is the site of carpal tunnel syndrome?

A

Hand and wrist

204
Q

What are the associated factors of carpal tunnel syndrome?

A

Tingling and numbness along the median nerve
+Palmar side of
-Thumb
-Index finger
-Middle finger
+Radial 1/2 of ring finger
+Whole hand

205
Q

What is the timing of the pain of carpal tunnel syndrome?

A

Nocturnal (at night)

206
Q

What is the character of the pain of carpal tunnel syndrome?

A

Burning or aching

207
Q

What is the relieving factors of the pain of carpal tunnel syndrome?

A

Hand shaking

208
Q

Discuss signs of carpal tunnel syndrome?

A
209
Q

Define Tinel’s sign

A
210
Q

Define Phalen’s sign

A

Reproduction of tingling with wrist flexion

211
Q

What is the investigation of choice for carpal tunnel syndrome?

A

Median nerve conduction study if
- severe case
- uncertain diagnosis

212
Q

What is the indication of median nerve conduction study in diagnosis of carpal tunnel syndrome?

A

(1) Severe case
(2) Uncertain diagnosis

213
Q

What is the treatment of carpal tunnel syndrome?

A
214
Q

What is the complication of carpal tunnel syndrome?

A

(1) Thenar atrophy
(2) Weakness of thumb opposition and abduction

215
Q

What is the other name for ulnar canal?

A

Guyon’s canal

216
Q

Define ulnar (Guyon’s) canal?

A

Fibro-osseous tunnel

217
Q

What is the structure of ulnar (Guyon’s) canal?

A

Fibro-osseous tunnel

218
Q

What is the location of the ulnar (Guyon’s) canal?

A

(1) At the level of the palm
(2) Medial to the carpal tunnel
(3) Extends from the proximal aspect of the pisiform bone to the origin of the hypothenar muscles at the hook of the hamate

219
Q

What is the length of the ulnar (Guyon’s) canal?

A

4cm

220
Q

What are the borders of ulnar (Guyon’s) canal?

A
221
Q

What is the medial ( ulnar) border of ulnar (Guyon’s) canal?

A

(1) Pisiform
(2) Flexor carpi ulnaris tendon
(3) Abductor digiti minimi muscle

222
Q

What is the lateral (radial) border of ulnar (Guyon’s) canal?

A

Hook of the hamate

223
Q

What is the roof of ulnar (Guyon’s) canal?

A

Palmar carpal ligament

224
Q

What is the medial border of ulnar (Guyon’s) canal?

A

(1) Flexor retinaculum
(2) Pisohamate ligament
(3) Hypothenar muscles (mnemonic;PAFO or POAF)
- Palmaris brevis
- Abductor digiti minimi
- Flexor digiti minimi
- Oppenens digiti minimi

225
Q

What are the contents of ulnar (Guyon’s) canal?

A
226
Q

What happens to the ulnar nerve within the ulnar (Guyon’s) canal?

A
227
Q

What the location the ulnar artery within the ulnar (Guyon’s) canal?

A
228
Q

What the relation of the ulnar artery to the ulnar nerve within the ulnar (Guyon’s) canal?

A
229
Q

What are the branches of the ulnar artery within the ulnar (Guyon’s) canal?

A

(1) Deep palmar branch
(2) Superficial palmar branch— continues laterally across the palm

230
Q

What is the course of the superficial palmar branch of the ulnar artery within the ulnar (Guyon’s) canal?

A

Continues laterally across the palm

231
Q

Define ulnar (Guyon’s) canal syndrome ?

A
232
Q

What is the cause of the ulnar (Guyon’s) canal syndrome

A

(1) Ganglion
(2) Lipoma
(3) Trauma

233
Q

What is the C/P of the ulnar (Guyon’s) canal syndrome?

A
234
Q

What is the sensory C/P of the ulnar (Guyon’s) canal syndrome?

A

Pain and parasthesia ulnar 1 1/2 fingers

235
Q

What is the motor C/P of the ulnar (Guyon’s) canal syndrome?

A
236
Q

What is the treatment of the ulnar (Guyon’s) canal syndrome?

A
237
Q

What is the initial treatment of the ulnar (Guyon’s) canal syndrome?

A

Conservative :-
(1) Analgesia
(2) Activity modification
(3) Splinting of the wrist

238
Q

What is the indication of surgical treatment of the ulnar (Guyon’s) canal syndrome?

A

On failure of conservative measures

239
Q

Define pes cavus

A

High arched foot that doesn’t flatten with weight bearing

240
Q

What is the aetiology of pes cavus?

A

1st/Identifiable
+ The aetiology of pes cavus can be identified approximately 80% of the time.
+ The causes include: Mnemonic;MBCS/RN
(1) malunion
(2) calcaneal or talar #
(3) burns
(4) sequelae resulting from compartment syndrome
(5) residual clubfoot
(6) neuromuscular disease

2nd/ Idiopathic
+ The remaining 20% of cases are idiopathic and non progressive.
+ Identifying the aetilogy is essential to determine if the deformity is progressive.
Which assists in operative planning

241
Q

Discuss identifiable causes of pes cavus

A

+ The aetiology of pes cavus can be identified approximately 80% of the time.
+ The causes include: Mnemonic;MBCS/RN
(1) malunion
(2) calcaneal or talar #
(3) burns
(4) sequelae resulting from compartment syndrome
(5) residual clubfoot
(6) neuromuscular disease

242
Q

What is the percentage of identifiable causes of pes cavus?

A

80%

243
Q

What are the causes of pes cavus?

A

Mnemonic;MBCS/RN
(1) malunion
(2) calcaneal or talar #
(3) burns
(4) sequelae resulting from compartment syndrome
(5) residual clubfoot
(6) neuromuscular disease

244
Q

What is the percentage of idiopathic causes of pes cavus?

A

20%

245
Q

What is the significance of identifying the cause of pes cavus?

A

Identifying the aetilogy is essential to determine if the deformity is progressive.
Which assists in operative planning

246
Q

What is the pathogenesis of pes cavus?

A
247
Q

What are the symptoms of pes cavus?

A

Significant pain due to metatarsal compression

248
Q

What is the main radiological investigation to diagnose pes cavus?

A

Weight bearing XRs

MRCS part A- Principles of surgery in general (6 decks)

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