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cortext > regional adult orthopaedics > Flashcards

regional adult orthopaedics Flashcards

1
Q

the majority of cases of lumbar spine pain are….

A

mechanical back pain

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2
Q

non-pathological causes of back pain include

A

obesity

lack of physical activity

awkward twisting/poor lifting technique

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3
Q

what is spondylosis?

A

intervertebral discs lose their water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA

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4
Q
A
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5
Q

why is bed rest not advised in mechanical back pain

A

it will lead to stiffness and spasm of the back which may exacerbate disabilty

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6
Q

what are some examples of secondary gain or behavioural issues to consider when offering treatment for mechanical back pain

A

disability allowance appeal

compensation claim

psychological dysfunction

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7
Q

who would be suitable for spinal stabilisation for mechanical back pain

A

if a single level is affected

instability

AND hasnt improved with conservative management

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8
Q

what is an acute disc tear

A

the outer annulus fibrosis tears

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9
Q

what is the cahracteristic pain presenation in an acute disc tear

A

the pain is worse on coughing

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10
Q

how long do symptoms from an acute disc tear take to settle

A

2-3 months

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11
Q

acute disc tear treatment

A

analgesia and physio

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12
Q

pathophysiology of radiculopathy

A

the gelatinous nucleus pulposis cna herniate through a disc tear

the disc material can impinge an exiting root nerve reu;ting in pain and altered sensation in a dermatomal distribution and reduced power in a myotomal distribution

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13
Q
A
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14
Q

nerve roots involved in sciatica?

A

L4, L5 and S1

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15
Q

how is radicular pain described?

A

neuralgic burning or severe tingling, often like severe tootchache radiating down the back of the thigh to the below the knee

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16
Q

how can OA cause nerve root symptoms?

A

osteophytes can impinge on exiting nerve roots

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17
Q

what is spinal stenosis

A

narrowing of the sapces within the spine, which can impinge nerve roots

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18
Q

what can cause spinal stenosis

A

spondylosis

bluging discs

bulging ligamentum flavum

osteophytes

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19
Q

what is a common symptom of spinal stenosis

A

claudication

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20
Q

how does claudication in spinal stenosis vary from claudication in PAD

A

the distance is inconsistent

the pain is buring, rather than cramping

pain is less when walking uphill (spine flexion creates more space for the cauda equina)

pedal pulses are preserved

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21
Q

management of spinal stenosis

A

intial - physio and weight loss

if conservative fails, decompression surgery

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22
Q

what is cauda equina syndrome

A

compression of all the nerve roots of the cauda equina

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23
Q

why is cauda equina syndrome a surgical emergency?

A

the sacral nerve roots (mainly S4 and S5) control defaecation and urination

prolonged compression can cause permanent nerve damage requiring colostomy and urinary diversion

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24
Q

signs of cauda equina syndrome

A

bilateral leg pain

paraesthesiae

numbness

saddle anasthesia (numbness arounf the sitting area and perineum)

altered urinary function (retention/incontence)

faecal incontinence/constipation

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25
Q

a patient presents with bilateral leg pain and altered bladder/bowel function

whats up?

A

cauda equina syndrome

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26
Q

which examination is mandaotory in cauda equina syndrome

A

PR exam

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27
Q

cauda equina syndrome investigations

A

urgent MRI to determin the level of prolapse

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28
Q

cauda equina syndrome treatment

A

urgent discectomy

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29
Q

what are the ‘red flags’ for back pain

A

back pain in the youger patient <20

new back pain in the older adult <60

constant, severe pain thats worse at night

systemic upset

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30
Q

why is back pain the young patients a red flag

A

high risk of infection (OM, discitis)

peak of of spondylolisthesis is adolescence

higher risk of benign and malignant primary bone tumours

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31
Q

why is new back pain in the older patient a red flag

A

higher risk of metastatic disease and myeloma

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32
Q

why is constant, severe, worse at night back pain a red flag

A

suggests tumour or infection

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33
Q

why is systemic upset a red flag for back pain

A

may suggest tumour or infection

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34
Q

signs of spontaneous crush fracture in osteoporosis

A

acute pain

kyphosis

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35
Q

cervical spondylosis presentation

A

slow onset stiffness

pain (can radiate to shoulders and the occiput)

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36
Q

cervical spondylosis treatment

A

physio and analgesics

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37
Q

cervical nerve root compression presentation

A

shooting neuralgic pain down a dermatomal distribution woth weakness and loss of reflexes depending on the nerve root affected

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38
Q

2 conditions that can result in cervical spine instability

A

RA

down syndrome

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39
Q

what does RA cause atlanto-axial instability

A

destruction of the synovial joint between the atlas and the dens and rupture of the transverse ligament

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40
Q

complications of cervical spine instability

A

subluxation of the atlanto-axial joint leading to cord compression and death

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41
Q

cervical spine instability in RA treatment

A

less severe - collar to prevent flexion

more severe - surgical fusion

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42
Q

the shoulder girdle is made up of

A

scapula

clavicle

proximal humerus

supporting muscles (eg deltoid, SITS)

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43
Q

what are the rotator cuff muscles

A

supraspinatus

infraspinatus

teres minor

subscapularis

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44
Q

where do supraspinatus, infraspinatus and teres minor attach on the humerus?

A

greater tuberosity

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45
Q

action of supraspinatus

A

initiation of abduction

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46
Q

action of infraspinatus

A

external rotator

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47
Q

aaction of teres minor

A

external rotator

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48
Q

subscapularis attachment to the humerus

A

lesser tuberosity

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49
Q

action of subscapularis

A

internal rotation

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50
Q

collective action of the rotator cuff muscles

A

pull the humeral head into the glenoid to provide a stable fulcrom for the deltoid to abduct the arm

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51
Q

shoulder problem in a young adult?

A

instability

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52
Q

shoulder pain in a middle aged patient?

A

cuff tear

‘grey hair, cuff tear’

frozen shoulder

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53
Q

shoulder pain in the elderly?

A

OA

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54
Q

why does impingement syndrome (painful arc) cause pain

A

tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight subacromial space during movement producing pain

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55
Q

impingement syndrome presentation

A

painful arc between 60-120 degrees

pain radiates to deltoid and upper arm

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56
Q

causes of impingement (painful arc)

A

tendonitis

subacromial bursitis

acromioclavicular OA with inferior osteophyte

a hooked acromion

rotator cuff tear

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57
Q
A
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58
Q

which clinical test can help diagnose impingement

A

hawkins kennedy test

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59
Q

conservative treatment of impingement syndrome

A

NSAIDs, analgesics, physio and subacromial injection of steroid

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60
Q

how many subacromial injections can be administered in painful arc/impingement

A

up to 3 injections

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61
Q

surgical treatment of impingement syndrome

A

subacromial decompression surgery (open or arthroscopic)

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62
Q

a sudden jerk in a patient >40, with subsequent pain and weakness is a typcial history of

A

rotator cuff tear

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63
Q

which rotator cuff tendon is most commonly involved in rotator cuff tears

A

supraspinatus

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64
Q

signs of rotator cuff tear

A

weakness of initiation of abduction (supraspinatus)

weakness of internal rotation (subscapularis)

weakness of external rotation (infraspinatus)

wasting of supraspinatus

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65
Q

rotator cuff tear investigation

A

USS or MRI

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66
Q

surgical treatment of rotator cuff tear

A

rotator cuff repair with subacromial decompression

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67
Q

difficulties with rotator cuff repair surgery

A

the tendon is usually diseases and failure of repair occurs in 30% of cases

large tears may be irrepairable

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68
Q

non-operative management of rotator cuff tear

A

physiotherapy to strengthen remaining muscles

subacromial injections

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69
Q

what is adhesive caspulitis also known as

A

frozen shoulder

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70
Q

frozen shoulder presentatio

A

pain, which will subside (after 2-9/12) as stiffness increases (4-12/12)

stiffness eventually thaws over time

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71
Q

a disorder characterised by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18-24 months

A

frozen shoulder

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72
Q

the principal clinical sign of frozen shoulder is

A

loss of external rotation

(alonf with restriction of other movements)

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73
Q

frozen shoulder is linked to diabetes

true/false

A

true

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74
Q

frozen shoulder treatment

A

pain relief and prevention of further stiffening while the condition naturally resolves

physio and analgesics

IA injections may help relieve pain

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75
Q

surgical options for frozen shoulder

A

manipulation uner anaesthetic (tears capsule)

sirgical capsular release (arthroscopic)

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76
Q

calcium depostion in the supraspinatus tendon, see on xray just proximal to the greater tuberosity

A

actue calcific tendonitis

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77
Q

acture calcific tendonitis presentation

A

acute onset severe shoulder pain

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78
Q

acute calcific tendonitis treatment

A

subacromial steroid and local anaesthetic injection

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79
Q

what are the two sub-type of shoulder instability

A

traumatic and atraumatic

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80
Q

what is shoulder instability

A

painful abnormal translation movement

subluxation

recurrent dislocation

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81
Q

what is a bankart repair

A

stabilises the shoulder by reattaching the labrum and capsule to the anterior glenoid

(was unattached due to trauma from initial dislocation)

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82
Q

which conditions cause generalised ligamentous laxity

A

marfan’s, ehlers-danlos

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83
Q

referred pain in the shoulder

A

neck problems

angina pectoris

diaphragmatic irritation (biliary colic, hepatic or subphrenic abscess)

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84
Q

what is the carpal tunnel formed by

A

the carpal bones and the flexor retinaculum

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85
Q

what passes through the carpal tunnel

A

the median nerve and 9 flexor tendons

(FDS and FDP to 4 digits + FPL)

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86
Q

what causes carpal tunnel syndrome

A

any swelling within the carpal tunnel can result in median nerve compression

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87
Q

causes of carpal tunnel syndrome

A

idiopathic

RA (synovitis)

fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroid)

wrist fractures

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88
Q

carpal tunnel syndrome presentation

A

paraesthesiae in the thumb and radial 2 1/2 fingers

usually worse at night

loss of sensation

weakness of thumb or clumsiness in areas supplied by median nerve

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89
Q

signs of carpal tunnel syndrome

A

loss of sensation/wasting of thenar eminence

replication of symptoms on tinel’s or phalen’s test

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90
Q

what is tinel’s test

A

percussing over median nerve (or ulnar nerve in cubital tunnel syndrome)

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91
Q

what is phalen’s test

A

holding the wrists hyperflexed to decrease the space in the carpal tunnel

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92
Q

non-operative treatment of carpal tunnel

A

wrist splints at night to prevent flexion

injection of corticosteroid

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93
Q

surgical treatment of carpal tunnel syndrome

A

division of the transverse carpal ligament under local anaesthetic

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94
Q

what is cubital tunnel syndrome

A

compression of the ulnar nerve at the elbow behind the medial epicondyle (funny bone area)

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95
Q

weakness of the ulnar nerve may be apparent in which muscles

A

1st dorsal interosseous (abduction of the index finger)

adductor pollicis

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96
Q

cubital tunnel syndrome presentation

A

paraesthesiae of the ulnar 1 1/2 fingers

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97
Q

what is froment’s test

A

ulnar nerve damage leads to adductor pollicis brevis paralysis, leading to excess thumb flexion when pinching

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98
Q

causes of cubital tunnel syndrome

A

osborne’s fascia (tight band of fascia forming the roof of the tunnel)

tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flaxor carpi ulnaris

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99
Q

which two joints make up the elbow

A

humero-ulnar

radio-capitallar

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100
Q

which muscle extends the elbow

A

triceps

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101
Q

which muscles flex the elbow

A

brachialis and biceps

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102
Q

what is the common extensor origin for the elbow

A

lateral epicondyle

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103
Q

elbow common flexor origin

A

medial epicondyle

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104
Q

supination is performed by

A

biceps and supinator muscles

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105
Q

pronation is performed by

A

pronator teres (proximally)

pronator quadratus (distally)

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106
Q

what is tennis elbow also known as

A

lateral epicondylitis

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107
Q

clinical features of lateral epicondylitis

A

painful and tender lateral epicondyle

pain on resisted middle finger and wrist flexion

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108
Q

treatment of lateral epicondylitis

A

period of rest from activites that exacerbate pain

physiotherapy

NSAIDs

steroid injections

use of a brace

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109
Q

what is golfer’s elbow also known as

A

medial epicondylitis

110
Q

what is the risk of injections in the treatment of medial epicondylitis

A

risk of injury to the ulnar nerve

111
Q
A
112
Q

which types of arthritis most commonly affect the elbow

A

RA

secondary OA

not primary OA

113
Q

arthritic change at the radio-capitallar joint which has failed non-operative management can be treated with

A

surgical excision of the radial head

114
Q

what is dupuytren’s contracture

A

proliferative connective tissue disorder where the specialised palmar fascia under goes hyperplasia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints

115
Q

which joints does dupuytren’s contracture affect

A

MCP and PIP

116
Q

dupuytren’s contracture pathology

A

prolifection of myofibroblast cells and the production of abnormal collagen (type III rather than type I)

117
Q

skin changes in dupuytren’s contractures

A

skin may be adherent to the diseased fascia

puckering of the skin

palpable nodules

118
Q

which fingers are most commonly affected by dupuytren’s contracture

A

ring and little finger

119
Q

dupuytren’s contracture risk factors

A

male sex

family history

northern european/scandinavian descent

alcholic cirrhosis

diabetes

120
Q

indications for surgery in dupuytren’s contracture

A

disease affecting the PIPJ

>30 degree contracture of the MCPJ

121
Q

surgical treatment of dupuytren’s contracture

A

fasciectomy

division of cords (fasciotomy)

if very severe may require amputation

122
Q

what is trigger finger

A

nodular enlargement of a tendon, distal to a fascial pulley, resulting in a clicking sensation when extending the finger

123
Q

signs of trigger finger

A

clicking sensation when moving finger

locking of finger in a flexed position

pain

124
Q

which fingers are most commonly affected by trigger finger

A

middle and ring finger

125
Q

treatment of trigger finger

A

injection of steroid around the tendon within the sheath

division of A1 pulley if doesnt respond to steroids

126
Q
A
127
Q

what are heberden’s nodes

A

bony thickening of DIPJs

128
Q

what are bouchard’s nodes

A

bony swelling of the PIPJ

129
Q

treatment of MCP OA

A

MCP joint replacment

steroid injection in 1st MCPJ for flare ups

130
Q

hand deformities of RA

A

volar MCPJ subluxation

ulnar deviation

swan neck deformity

bouteonniere deformity

z-shaped thumb

131
Q

what is a swan neck deformity

A

hyperextension at PIPJ with flexion of DIPJ

132
Q

what is boutonniere deformity

A

flexion at PIPJ with hyperextension at DIPJ

133
Q

surgical management of RA in hands

A

tenosynvectomy (excision of synovial tendon sheath) to prevent tendon rupture

tendon transfer or joint fusion if tendon has already ruptured

134
Q

what are ganglion cysts

A

mucinous filled cysts found adjacent to a tendon or synovial joint

135
Q

ganglion cyst in the knee?

A

baker’s cyst

136
Q

on examination, ganglion cysts are

A

firm, smooth, rubbery

should transilluminate

137
Q

pain from hip pathology is typcially felt where

A

in the groin area

138
Q

hip pain may radiate to

A

the knee

139
Q

why does hip pain radiate to the knee

A

because the obturator nerve supplies both joints

140
Q

the first sogn of hip pathology is usually

A

loss of internal rotation

141
Q

hip abductor (gluteus medius and minimus) weakness may manifest as

A

a positive trendellenburg sign or trendellenburg gait

142
Q

shortening of the lower limb may be due to which hip pathologies

A

severe OA, perthes, SUFE, AVN, fracture

143
Q

what is the difference between total hip arthroplasty and total hip replacement

A

total hip arthroplasty also includes hip resurfacing

144
Q

why do all THRs fail eventually

A

loosening of one or both of the prosthetic components

145
Q

what causes the components of a THR to loosen

A

wear particles from the bearing surface causing an inflammatory response at the implant-bone interface

146
Q

local reaction to a metal-on-metal hip replacement may result in

A

an inflammatory psuedotumour whcih can cause necrosis of muscle and bone

147
Q

conservative measures to treat hip OA

A

analgesics

physio

use of a stick (reduces joint force)

weight reduction

modification of activities

148
Q

how to guage a patient’s level of pain in hip OA

A

analgesic use

rest pain

sleep disturbance

149
Q

how to measure diability caused by hip OA

A

walking distance

activites of daily living

impact on hobbies

150
Q

early local complications of THR

A

infection

dislocation

nerve injury (sciatic nerve)

leg length discrepancy

151
Q

early general complications of THR

A

medical surgical complications (MI, chest infection, UTI, blood loss and hypovolaemia)

DVT and PE

152
Q

late local complications of THR

A

early loosening

late infection (haematogenus spread from distant site)

late dislocation

153
Q

revision hip replacements are as successful as primary hip replacements

true/false

A

false

the surgery is more complex, with higher risk of blood loss, double the complication rates and poorer functional outcome

154
Q

why should THR be delayed as long as possible in younger patients

A

they will put more demand on their hip and have a longer life expectancy so will be more likely to require a revision replacement

155
Q
A
156
Q

causes of AVN

A

idiopathic

alcohol abuse

steroids

hyperlipidaemia

thrombophilia

157
Q

xray signs of AVN

A

patchy sclerosis of the weight bearing areas of the femoral head with a lytic zone underneath formed by granulation tissue from attempted repair

158
Q

the ‘hanging rope sign’ on xray is a sign of

A

AVN

159
Q

trochanteric bursitis presentation

A

pain and tenderness in the region of the greater trochanter with paon on resisted abduction

160
Q

trochanteric bursitis treatment

A

analgesic

anti-inflammatories

physiotherapy

steroid injection

161
Q

the knee joint consists of two joints

what are they

A

medial and lateral compartments of the tibiofemoral joint

patellofemoral joint

162
Q

where is the thickest hyaline cartilage in the body found

A

retropatellar surface

163
Q

what is the purpose of the menisci

A

shock absorbers

164
Q

the four main ligaments of the knee are

A

ACL and PCL

MCL and LCL

165
Q

the role of the ACL is to

A

prevent abnormal internal rotation of the tibia

166
Q

the PCL prevents

A

hyperextension and anterior translation of the femur

167
Q

how to test the ACL

A

anterior translation of the tibia

168
Q

how to test the PCL

A

posterior translation of the tibia

169
Q

the role of the MCL

A

resist valgus force

170
Q

the role of the LCL

A

resist varus force and abnormal external rotation of the tibia

171
Q

risk factors for early OA of the knee

A

previous meniscal tear

ligament injuries (especially ACL)

malalignment (genu varum/genu valgus)

172
Q

knee replacement can be considered in a patient with

A

substantial pain and disability where conservative management is no longer effective

173
Q

meniscal injuries classically occur

A

with a twisting force on a loaded knee

174
Q

symptoms of meniscal injury

A

pain localised to medial or lateral joint line

effusion by the following day

catching sensation or locking on attempt to extend knee

175
Q

true knee locking is defined as

A

a mechanical block to full extension

176
Q

what causes knee locking in a meniscal injury

A

a significantly torn meniscus flipping over and becoming stuck in the joint line

177
Q

ACL ruptures usually occur with what type of injury

A

a higher rotational force, turning the upper body laterally on a planted foot

178
Q

what develops within an hour of an ACL rupture

A

haemarthrosis due to vascular supply within the ACL

179
Q

valgus stress injuries may cause (knee)

A

tear MCL

potentially damage to the ACL

lateral tibial plateau fracture

180
Q

a direct blow to the tibia with the knee flexed may cause

A

PCL rupture

181
Q

a varus stress injury injury may rupture

A

the LCL (with or without damage to the PCL)

182
Q

clincial examination of a meniscal tear

A

effusion

joint line tenderness

pain on tibial rotation (steinmann’s test)

183
Q

lateral meniscal tears are more common

true/false

A

false

medial meniscal tears are 10 times more likely

184
Q

degenerate meniscal tears are steinmann’s positive

true/false

A

false

unlike acute tears, degenerative tears are steinmann’s negative

185
Q

why does the meniscus have limited healing potential

A

it only has a blood supply in its outer third

186
Q

meniscal tear treatment

A

generally meniscal tears arent suitable for repair

if symptoms don’t settle within 3 months, arthroscopic menisectomy may alleviate symptoms

187
Q

the principal complaint of ACL deficiency is

A

rotatory instability with giving way on turning

188
Q

ACL rupture clinical signs

A

knee swelling (haemarthrosis or effusion)

excessive anterior translation of the tibia on anterior drawer test

189
Q

ACL rupture treatment

A

primary repair (not very effective)

ACL reconstruction

190
Q

ACL reconsturction involves

A

tendon graft (patellar or semitendinosus and gracilis autograft) being passed through tibial and femoral tunnels at the usual location of the ACL in th knee and secured to the bone

191
Q

MCL injuries generally heal well

true/false

A

true

192
Q

clinical signs of MCL tear

A

laxity and pain on valgus stress

tenderness over the origin or insertion of the MCL

193
Q

MCL treatment

A

acute - hinged knee brace

chronic - MCL tightening (advancement) or reconstruction (tendon graft)

194
Q

which nerve is often injured in LCL injuries

A

common peroneal nerve

195
Q

complete knee dislocations result in rupture of

A

all four knee ligaments

196
Q

why is vascular monitoring of the leg/foot necassary after a complete knee dislocation

A

intimal tears can occur which later thrombose

197
Q

what is a risk of reperfusion after complete knee dislocation

A

compartment syndrome

198
Q

what are the components of the knee extensor mechanism

A

tibil tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscles

199
Q

patellar tendon ruptures occur in young/old patients

quadriceps tendon ruptures occur in young/old patients

A

patellar tendon ruptures occur in young patients

quadriceps tendon ruptures occur in old patients

200
Q

quinolone antibiotics are a risk factor for tendonitis

true/false

A

true

201
Q

why should steroid injections be avoided in tendonitis of the extensor mechanism

A

high risk of tendon rupture

202
Q

why should knee examination include a straight leg raise

A

to test the extensor mechanism

203
Q

extensor mechanism rupture treatment

A

tendon to tendon repair

reattachment of the tendon to the patella

204
Q

what is patellofemoral dysfunction

A

disorders of the patellofemoral articulation resulting in anterior knee pain

205
Q

examples of patellofemoral dysfunction

A

chondromalacia patellae (softening of the hyaline cartilage)

adolescent anterior knee pain

lateral patellar compression syndrome

206
Q

what causes lateral patellar compression syndrome

A

the pull of the quadriceps tends to pull the patella slightly laterally

excessive lateral force produces anterior knee pain and the lateral facet of the patella is compressed against the lateral wall of the distal femoral trochlea

207
Q

risk factors for patellofemoral dysfunction

A

female sex

adolescence (greater degree of ligamentous laxity)

hypermobility

genu valgum

femoral neck anteversion

208
Q

patellofemoral dysfunction presentation

A

anterior knee pain, worse going downhill

grinding or clicking sensation at the front of the knee

stiffness after prolonged sitting (psuedolocking)

209
Q
A
210
Q

causes of patellar instability

A

direct blow

sudden twist of the knne

211
Q

the patella normally dislocates laterally/medially

A

laterally

212
Q

what is hallux valgus

A

a deformity of the great toe due to medial deviation of the 1st metatarsal head and lateral deviation of the toe itself

213
Q

risk factors for hallux valgus

A

female sex

family history

RA

inflammatory arthropathies

214
Q

presentation of hallux valgus

A

painful joint incongruence

bunions (inflamed burse over medial 1st metatarsal head due to rubbing on shoes)

ulceration and skin breakdown between great toe and 2nd toe

215
Q

coservative treatment of hallux valgus

A

wearing wider and deeper accomodating shoes

a spacer between the first and second toe to prevent rubbing

216
Q

surgical management of hallux valgus

A

osteotomy to realign the bones

soft tissue prcedures to tighten slack tissues and release tight tissues

217
Q
A
218
Q

what is hallux rigidus

A

OA of the 1st MTPJ

219
Q

conservative treatment of hallux rigidus

A

a stiff soled shoe to limit motion at the MTPJ

220
Q

gold standard surgical treatment for hallux rigidus

A

arthrodesis

221
Q

what is morton’s neuroma

A

thickening of the nerve around the tissue between the bases of the toes

222
Q

where is morton’s neuroma normally found

A

the third interspace nerve (between third and fourth toes)

223
Q

what causes morton’s neuroma

A

irritation of the nerves causes them to become inflamed and swollen

high heels are thought to be a cause in women

224
Q

clinical features of morton’s neuroma

A

loss of sensation in the affectd web space

medio-lateral compression of the metatarsal heads may reproduce symptoms or produce a characteristic click (mulder’s test)

225
Q

what is mulder’s test

A

squeeze the forefoot

to test for morton’s neuroma

226
Q

diagnosis of morton’s neuroma

A

USS

227
Q

conservative management of morton’s neuroma

A

use of a metatarsal pad or offloading insole

steroid and local anaestheric injections may relieve symptoms and aid diagnosis

228
Q

surgical management of morton’s neuroma

A

excision of neuroma

229
Q

most common site of metatarsal stress fracture

A

2nd metatarsal head

followed by the 3rd

230
Q

management of metatarsal stress fracture

A

rest for 6-12 weeks in a rigid soled boot

231
Q

risk factors for achilles tendonitis

A

repetitive strain (from sports)

degenerative processes

quinolone antibiotics

RA/inflammatory arthropathies

gout

232
Q

treatment of achilles tendonitis

A

rest

physio conditioning

use of a heel raise to offload tendon

splint/boot

233
Q

should steroid injections be used in achilles tendonitis

A

no

risk of rupture

234
Q

which age groups do achilles tendon ruptures occur in

A

middle aged or older

235
Q

mechanism of achilles tendon tear

A

sudden decelrationwith resisted calf muscle contraction (eg lunging at squash) leads to sudden pain and difficulty weight bearing

236
Q

clinical signs of achilles tendon rupture

A

difficults weight bearing

weakness of plantar flexion

palpable gap in the tendon

no plantar flexion is seen when squeezing the calf (simmonds test)

237
Q

what is simmond’s test

A

squeezing the calf to check for plantar flexion

achilles tendon rupture

238
Q

what sort of cast should be used in achilles tendon rupture

A

equinous position

239
Q

presentation of plantar fasciitis

A

pain with walking felt on the instep of the foot

localised tenderness on palpation at this site

240
Q

risk factors for plantar fasciitis

A

diabetes

obesity

frequent walking on hard floors with poor cushioning in shoes

241
Q

treatment of plantar fasciitis

A

rest

achilles and plantar fascia stretching exercises

gel filled heel pad

steroid injection

242
Q

pes planus AKA

A

flat foot

243
Q

causes of acquired flat foot

A

tibialis posterior tendon stretch/rupture

RA

diavetes with Charcot foot (neuropathic joint destruction)

244
Q

where does the tibialis posterior insert

A

medial navicular

245
Q

treatment of tibialis posterior tendonitis

A

splint with a medial arch support to avoid rupture

246
Q

elongation or rupture of the tibialis posterior tendon results in

A

loss of the medial arch with resulting valgus of the heel

247
Q

pes cavus AKA

A

abnormally high arched foot

248
Q

pes cavus risk factors

A

cerebral palsy

polio

spinal cord thethering from spina bifida occulta

249
Q

pes cavus is often accompanied by

A

claw toes

250
Q

treatment of pain from pes cavus

A

soft tissue release and tendon transfer if supple

calcaneal osteotomy if more rigid

arthrodesis if very severe

251
Q
A
252
Q

why do claw toes and hammer toes occur

A

acquired imbalance between the flexor and extensor tendons

253
Q

claw toes have hyperextension/hyperflexion at the MTPJ with hyperextension/hyperflexion at the PIPJ and DIP

hammer toes have hyperextension/hyperflexion at the MTPJ with hyperextension/hyperflexion at the PIPJ and hyperextension/hyperflexion at the DIPJ

A

claw toes have hyperextension at the MTPJ with hyperflexion at the PIPJ and DIP

hammer toes have hyperextension at the MTPJ with hyperflexion at the PIPJ and hyperextension at the DIPJ

254
Q

non-surgical treatment of claw toes

A

toe ‘sleeves’ to prevent rubbing

corn plasters

255
Q

surgical treatment of claw toes

A

tenotomy

tendon transfer

arthrodesis of PIPJ

toe amputation

256
Q

what type of collagen is produced in dupuytren’s contracture

A

type III

257
Q

the risk of recurrent shoulder dislocation following a traumatuc shoulder dislocation increased with age of patient at first-time dislocation

true/false

A

false

258
Q

carpal tunnel syndrome is due to impingement of

A

the median nerve

259
Q

cubital tunnel syndrome is due to impingement of

A

the ulnar nerve

260
Q

shoulder impingement is due to impingement of

A

rotator cuff tendon

261
Q

hip impingement is due to impingement of

A

the acetabular rim

262
Q

risk factors for carpal tunnel syndrome

hypothyroidism

gout

female gender

chronic renal failure

pregnancy

OA

A

hypothyroidism

female gender

chronic renal failure

pregnancy

263
Q

alignment of the knee in which the distal end of the tidia is angled away form the axis of the femur/midline

there is an increased gap between the ankles compared to the knees

A

genu valgum

264
Q

alignment of the knees in which the distal end of the tibia is angled towards the axis of the femur/midline

there is an increased gap between the knees compared to the ankles

A

genus varum

265
Q

weakness of which muscle will give rise to a positive froment’s test

A

adductor pollicis

266
Q

a quadricep tendon rupture is a relatively common injury in the patient over 40 and rarely requires surgical intervention

true/false

A

false

these cases are almost always surgically managed

267
Q

what degree of fixed flexion deformity is require at the MCPJs for a patient to fail th eHuestion Table Top Test

A

>30 degrees

268
Q

it may be appropriate to omit the PR exam while examining someone for cauda equina syndrome

A

false

269
Q

the principle clinical sign on examnation of restriction of shoulder movement is in which direction

frozen shoulder

A

external rotation

270
Q

bed rest is good for mechanical back pain

true/false

A

false

271
Q

a varus alignment of the knee will predispose to OA in which knee compartment

A

medial

272
Q
A

cortext (6 decks)

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