Principles of orthopaedic medicine Flashcards
What are the two main categories of pain?
Nociceptive and Non-nociceptive
What types of pain are in nociceptive and non-nociceptive?
Nociceptive:
1- Somatic: skin pain, tissue pain, muscle pain
2- Visceral: internal organs
Non-nociceptive:
1- Neurogenic: caused by damage or disease
2- Psychogenic
What are the four different sources of pain?
1- Local: inert or contractile tissue
2- Referred: from where?
3- Systemic: what disease?
4- Psychosocial: combined with somatic causes?
How to test contractile tissue?
1- Isometric contraction in mid-range
2- Passive stretching
What does an isometric contraction test?
The muscle belly, musculo-tendinous junction, body of the tendon, teno-osseous junction
How to test inert tissues?
Passive stretching or by squeezing
What are the inert tissues?
Bone, cartilage, capsule, ligament, bursa, fascia, neural and vascular tissue
What are the four rules of referred pain from unilateral structures?
1- It does not cross midline
2- It refers distally (except at a distal site of injury)
3- It refers segmentally (according to the nerve supply of the structure)
4- It occupies part or all of its dermatome
Capsular pattern of the elbow joint?
Flexion > extension
Capsular pattern of the proximal radioulnar joint?
Supination > Pronation
Capsular pattern of the distal radioulnar joint?
Pain at the extremes of rotation
Capsular pattern of the wrist joint?
Flexion = Extension
Capsular pattern of the trapeziofirst-metacarpal joint?
Abduction > Extension
Capsular pattern of the MCP and IP joints?
Flexion > Extension
What is a capsular pattern?
When a joint capsule is irritated by irritation/degeneration/disease/trauma
The inflamed capsule contracts, producing a loss of range in a set pattern
What are normal and pathological end feels?
Normal:
1- Elastic: capsular/ligamentous tightening
2- Hard: bone to bone or tough ligamentous tension
3- Soft: tissue approximation
Pathological:
1- Empty: Pain limits movement, no end point
2- Springy: intra-articular block, loose body
3- Spasm: hard twang of protective muscle spasm
During Clinical Exam what are the three observations?
1- Face: ill, tired, anxious, angry, excessively bright
2- Posture: slumped, exaggerated, tense, consistent with Hx
3- Gait: exaggerated, consistent with Hx
What are the nine categories in taking a History?
“ASOS DOBS”
1- Age 2- Occupation 3- Site 4- Spread 5- Duration 6- Onset 7- Behaviour 8- Symptoms 9 - PMH
During the clinical examination what are the four things to inspect?
1- Deformity
2- Wasting
3- Colour
4- Swelling
What is the capsular pattern of the hip?
Medial rotation > Flexion + Abduction > Extension
What is the capsular pattern of the knee?
Flexion > Extension
What is the capsular pattern of the tibiofibular joint?
Pain when joint is stressed
What is the capsular pattern of the talocrural joint?
Plantar flexion > Dorsi flexion
What is the capsular pattern of the subtalar joint?
Increasing limitation of supination, eventual fixation of the joint in pronation
