regional adult orthopaedics Flashcards
the majority of cases of lumbar spine pain are….
mechanical back pain
non-pathological causes of back pain include
obesity
lack of physical activity
awkward twisting/poor lifting technique
what is spondylosis?
intervertebral discs lose their water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA
why is bed rest not advised in mechanical back pain
it will lead to stiffness and spasm of the back which may exacerbate disabilty
what are some examples of secondary gain or behavioural issues to consider when offering treatment for mechanical back pain
disability allowance appeal
compensation claim
psychological dysfunction
who would be suitable for spinal stabilisation for mechanical back pain
if a single level is affected
instability
AND hasnt improved with conservative management
what is an acute disc tear
the outer annulus fibrosis tears
what is the cahracteristic pain presenation in an acute disc tear
the pain is worse on coughing
how long do symptoms from an acute disc tear take to settle
2-3 months
acute disc tear treatment
analgesia and physio
pathophysiology of radiculopathy
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
nerve roots involved in sciatica?
L4, L5 and S1
how is radicular pain described?
neuralgic burning or severe tingling, often like severe tootchache radiating down the back of the thigh to the below the knee
how can OA cause nerve root symptoms?
osteophytes can impinge on exiting nerve roots
what is spinal stenosis
narrowing of the sapces within the spine, which can impinge nerve roots
what can cause spinal stenosis
spondylosis
bluging discs
bulging ligamentum flavum
osteophytes
what is a common symptom of spinal stenosis
claudication
how does claudication in spinal stenosis vary from claudication in PAD
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
management of spinal stenosis
intial - physio and weight loss
if conservative fails, decompression surgery
what is cauda equina syndrome
compression of all the nerve roots of the cauda equina
why is cauda equina syndrome a surgical emergency?
the sacral nerve roots (mainly S4 and S5) control defaecation and urination
prolonged compression can cause permanent nerve damage requiring colostomy and urinary diversion
signs of cauda equina syndrome
bilateral leg pain
paraesthesiae
numbness
saddle anasthesia (numbness arounf the sitting area and perineum)
altered urinary function (retention/incontence)
faecal incontinence/constipation
a patient presents with bilateral leg pain and altered bladder/bowel function
whats up?
cauda equina syndrome
which examination is mandaotory in cauda equina syndrome
PR exam
cauda equina syndrome investigations
urgent MRI to determin the level of prolapse
cauda equina syndrome treatment
urgent discectomy
what are the ‘red flags’ for back pain
back pain in the youger patient <20
new back pain in the older adult <60
constant, severe pain thats worse at night
systemic upset
why is back pain the young patients a red flag
high risk of infection (OM, discitis)
peak of of spondylolisthesis is adolescence
higher risk of benign and malignant primary bone tumours
why is new back pain in the older patient a red flag
higher risk of metastatic disease and myeloma
why is constant, severe, worse at night back pain a red flag
suggests tumour or infection
why is systemic upset a red flag for back pain
may suggest tumour or infection
signs of spontaneous crush fracture in osteoporosis
acute pain
kyphosis
cervical spondylosis presentation
slow onset stiffness
pain (can radiate to shoulders and the occiput)
cervical spondylosis treatment
physio and analgesics
cervical nerve root compression presentation
shooting neuralgic pain down a dermatomal distribution woth weakness and loss of reflexes depending on the nerve root affected
2 conditions that can result in cervical spine instability
RA
down syndrome
what does RA cause atlanto-axial instability
destruction of the synovial joint between the atlas and the dens and rupture of the transverse ligament
complications of cervical spine instability
subluxation of the atlanto-axial joint leading to cord compression and death
cervical spine instability in RA treatment
less severe - collar to prevent flexion
more severe - surgical fusion
the shoulder girdle is made up of
scapula
clavicle
proximal humerus
supporting muscles (eg deltoid, SITS)
what are the rotator cuff muscles
supraspinatus
infraspinatus
teres minor
subscapularis
where do supraspinatus, infraspinatus and teres minor attach on the humerus?
greater tuberosity
action of supraspinatus
initiation of abduction
action of infraspinatus
external rotator
aaction of teres minor
external rotator
subscapularis attachment to the humerus
lesser tuberosity
action of subscapularis
internal rotation
collective action of the rotator cuff muscles
pull the humeral head into the glenoid to provide a stable fulcrom for the deltoid to abduct the arm
shoulder problem in a young adult?
instability
shoulder pain in a middle aged patient?
cuff tear
‘grey hair, cuff tear’
frozen shoulder
shoulder pain in the elderly?
OA
why does impingement syndrome (painful arc) cause pain
tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight subacromial space during movement producing pain
impingement syndrome presentation
painful arc between 60-120 degrees
pain radiates to deltoid and upper arm
causes of impingement (painful arc)
tendonitis
subacromial bursitis
acromioclavicular OA with inferior osteophyte
a hooked acromion
rotator cuff tear
which clinical test can help diagnose impingement
hawkins kennedy test
conservative treatment of impingement syndrome
NSAIDs, analgesics, physio and subacromial injection of steroid
how many subacromial injections can be administered in painful arc/impingement
up to 3 injections
surgical treatment of impingement syndrome
subacromial decompression surgery (open or arthroscopic)
a sudden jerk in a patient >40, with subsequent pain and weakness is a typcial history of
rotator cuff tear
which rotator cuff tendon is most commonly involved in rotator cuff tears
supraspinatus
signs of rotator cuff tear
weakness of initiation of abduction (supraspinatus)
weakness of internal rotation (subscapularis)
weakness of external rotation (infraspinatus)
wasting of supraspinatus
rotator cuff tear investigation
USS or MRI
surgical treatment of rotator cuff tear
rotator cuff repair with subacromial decompression
difficulties with rotator cuff repair surgery
the tendon is usually diseases and failure of repair occurs in 30% of cases
large tears may be irrepairable
non-operative management of rotator cuff tear
physiotherapy to strengthen remaining muscles
subacromial injections
what is adhesive caspulitis also known as
frozen shoulder
frozen shoulder presentatio
pain, which will subside (after 2-9/12) as stiffness increases (4-12/12)
stiffness eventually thaws over time
a disorder characterised by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18-24 months
frozen shoulder
the principal clinical sign of frozen shoulder is
loss of external rotation
(alonf with restriction of other movements)
frozen shoulder is linked to diabetes
true/false
true
frozen shoulder treatment
pain relief and prevention of further stiffening while the condition naturally resolves
physio and analgesics
IA injections may help relieve pain
surgical options for frozen shoulder
manipulation uner anaesthetic (tears capsule)
sirgical capsular release (arthroscopic)
calcium depostion in the supraspinatus tendon, see on xray just proximal to the greater tuberosity
actue calcific tendonitis
acture calcific tendonitis presentation
acute onset severe shoulder pain
acute calcific tendonitis treatment
subacromial steroid and local anaesthetic injection
what are the two sub-type of shoulder instability
traumatic and atraumatic
what is shoulder instability
painful abnormal translation movement
subluxation
recurrent dislocation
what is a bankart repair
stabilises the shoulder by reattaching the labrum and capsule to the anterior glenoid
(was unattached due to trauma from initial dislocation)
which conditions cause generalised ligamentous laxity
marfan’s, ehlers-danlos
referred pain in the shoulder
neck problems
angina pectoris
diaphragmatic irritation (biliary colic, hepatic or subphrenic abscess)
what is the carpal tunnel formed by
the carpal bones and the flexor retinaculum
what passes through the carpal tunnel
the median nerve and 9 flexor tendons
(FDS and FDP to 4 digits + FPL)
what causes carpal tunnel syndrome
any swelling within the carpal tunnel can result in median nerve compression
causes of carpal tunnel syndrome
idiopathic
RA (synovitis)
fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroid)
wrist fractures
carpal tunnel syndrome presentation
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
signs of carpal tunnel syndrome
loss of sensation/wasting of thenar eminence
replication of symptoms on tinel’s or phalen’s test
what is tinel’s test
percussing over median nerve (or ulnar nerve in cubital tunnel syndrome)
what is phalen’s test
holding the wrists hyperflexed to decrease the space in the carpal tunnel
non-operative treatment of carpal tunnel
wrist splints at night to prevent flexion
injection of corticosteroid
surgical treatment of carpal tunnel syndrome
division of the transverse carpal ligament under local anaesthetic
what is cubital tunnel syndrome
compression of the ulnar nerve at the elbow behind the medial epicondyle (funny bone area)
weakness of the ulnar nerve may be apparent in which muscles
1st dorsal interosseous (abduction of the index finger)
adductor pollicis
cubital tunnel syndrome presentation
paraesthesiae of the ulnar 1 1/2 fingers
what is froment’s test
ulnar nerve damage leads to adductor pollicis brevis paralysis, leading to excess thumb flexion when pinching
causes of cubital tunnel syndrome
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
which two joints make up the elbow
humero-ulnar
radio-capitallar
which muscle extends the elbow
triceps
which muscles flex the elbow
brachialis and biceps
what is the common extensor origin for the elbow
lateral epicondyle
elbow common flexor origin
medial epicondyle
supination is performed by
biceps and supinator muscles
pronation is performed by
pronator teres (proximally)
pronator quadratus (distally)
what is tennis elbow also known as
lateral epicondylitis
clinical features of lateral epicondylitis
painful and tender lateral epicondyle
pain on resisted middle finger and wrist flexion
treatment of lateral epicondylitis
period of rest from activites that exacerbate pain
physiotherapy
NSAIDs
steroid injections
use of a brace
what is golfer’s elbow also known as
medial epicondylitis
what is the risk of injections in the treatment of medial epicondylitis
risk of injury to the ulnar nerve
which types of arthritis most commonly affect the elbow
RA
secondary OA
not primary OA
arthritic change at the radio-capitallar joint which has failed non-operative management can be treated with
surgical excision of the radial head
what is dupuytren’s contracture
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
which joints does dupuytren’s contracture affect
MCP and PIP
dupuytren’s contracture pathology
prolifection of myofibroblast cells and the production of abnormal collagen (type III rather than type I)
skin changes in dupuytren’s contractures
skin may be adherent to the diseased fascia
puckering of the skin
palpable nodules
which fingers are most commonly affected by dupuytren’s contracture
ring and little finger
dupuytren’s contracture risk factors
male sex
family history
northern european/scandinavian descent
alcholic cirrhosis
diabetes
indications for surgery in dupuytren’s contracture
disease affecting the PIPJ
>30 degree contracture of the MCPJ
surgical treatment of dupuytren’s contracture
fasciectomy
division of cords (fasciotomy)
if very severe may require amputation
what is trigger finger
nodular enlargement of a tendon, distal to a fascial pulley, resulting in a clicking sensation when extending the finger
signs of trigger finger
clicking sensation when moving finger
locking of finger in a flexed position
pain
which fingers are most commonly affected by trigger finger
middle and ring finger
treatment of trigger finger
injection of steroid around the tendon within the sheath
division of A1 pulley if doesnt respond to steroids
what are heberden’s nodes
bony thickening of DIPJs
what are bouchard’s nodes
bony swelling of the PIPJ
treatment of MCP OA
MCP joint replacment
steroid injection in 1st MCPJ for flare ups
hand deformities of RA
volar MCPJ subluxation
ulnar deviation
swan neck deformity
bouteonniere deformity
z-shaped thumb
what is a swan neck deformity
hyperextension at PIPJ with flexion of DIPJ
what is boutonniere deformity
flexion at PIPJ with hyperextension at DIPJ
surgical management of RA in hands
tenosynvectomy (excision of synovial tendon sheath) to prevent tendon rupture
tendon transfer or joint fusion if tendon has already ruptured
what are ganglion cysts
mucinous filled cysts found adjacent to a tendon or synovial joint
ganglion cyst in the knee?
baker’s cyst
on examination, ganglion cysts are
firm, smooth, rubbery
should transilluminate
pain from hip pathology is typcially felt where
in the groin area
hip pain may radiate to
the knee
why does hip pain radiate to the knee
because the obturator nerve supplies both joints
the first sogn of hip pathology is usually
loss of internal rotation
hip abductor (gluteus medius and minimus) weakness may manifest as
a positive trendellenburg sign or trendellenburg gait
shortening of the lower limb may be due to which hip pathologies
severe OA, perthes, SUFE, AVN, fracture
what is the difference between total hip arthroplasty and total hip replacement
total hip arthroplasty also includes hip resurfacing
why do all THRs fail eventually
loosening of one or both of the prosthetic components
what causes the components of a THR to loosen
wear particles from the bearing surface causing an inflammatory response at the implant-bone interface
local reaction to a metal-on-metal hip replacement may result in
an inflammatory psuedotumour whcih can cause necrosis of muscle and bone
conservative measures to treat hip OA
analgesics
physio
use of a stick (reduces joint force)
weight reduction
modification of activities
how to guage a patient’s level of pain in hip OA
analgesic use
rest pain
sleep disturbance
how to measure diability caused by hip OA
walking distance
activites of daily living
impact on hobbies
early local complications of THR
infection
dislocation
nerve injury (sciatic nerve)
leg length discrepancy
early general complications of THR
medical surgical complications (MI, chest infection, UTI, blood loss and hypovolaemia)
DVT and PE
late local complications of THR
early loosening
late infection (haematogenus spread from distant site)
late dislocation
revision hip replacements are as successful as primary hip replacements
true/false
false
the surgery is more complex, with higher risk of blood loss, double the complication rates and poorer functional outcome
why should THR be delayed as long as possible in younger patients
they will put more demand on their hip and have a longer life expectancy so will be more likely to require a revision replacement
causes of AVN
idiopathic
alcohol abuse
steroids
hyperlipidaemia
thrombophilia
xray signs of AVN
patchy sclerosis of the weight bearing areas of the femoral head with a lytic zone underneath formed by granulation tissue from attempted repair
the ‘hanging rope sign’ on xray is a sign of
AVN
trochanteric bursitis presentation
pain and tenderness in the region of the greater trochanter with paon on resisted abduction
trochanteric bursitis treatment
analgesic
anti-inflammatories
physiotherapy
steroid injection
the knee joint consists of two joints
what are they
medial and lateral compartments of the tibiofemoral joint
patellofemoral joint
where is the thickest hyaline cartilage in the body found
retropatellar surface
what is the purpose of the menisci
shock absorbers
the four main ligaments of the knee are
ACL and PCL
MCL and LCL
the role of the ACL is to
prevent abnormal internal rotation of the tibia
the PCL prevents
hyperextension and anterior translation of the femur
how to test the ACL
anterior translation of the tibia
how to test the PCL
posterior translation of the tibia
the role of the MCL
resist valgus force
the role of the LCL
resist varus force and abnormal external rotation of the tibia
risk factors for early OA of the knee
previous meniscal tear
ligament injuries (especially ACL)
malalignment (genu varum/genu valgus)
knee replacement can be considered in a patient with
substantial pain and disability where conservative management is no longer effective
meniscal injuries classically occur
with a twisting force on a loaded knee
symptoms of meniscal injury
pain localised to medial or lateral joint line
effusion by the following day
catching sensation or locking on attempt to extend knee
true knee locking is defined as
a mechanical block to full extension
what causes knee locking in a meniscal injury
a significantly torn meniscus flipping over and becoming stuck in the joint line
ACL ruptures usually occur with what type of injury
a higher rotational force, turning the upper body laterally on a planted foot
what develops within an hour of an ACL rupture
haemarthrosis due to vascular supply within the ACL
valgus stress injuries may cause (knee)
tear MCL
potentially damage to the ACL
lateral tibial plateau fracture
a direct blow to the tibia with the knee flexed may cause
PCL rupture
a varus stress injury injury may rupture
the LCL (with or without damage to the PCL)
clincial examination of a meniscal tear
effusion
joint line tenderness
pain on tibial rotation (steinmann’s test)
lateral meniscal tears are more common
true/false
false
medial meniscal tears are 10 times more likely
degenerate meniscal tears are steinmann’s positive
true/false
false
unlike acute tears, degenerative tears are steinmann’s negative
why does the meniscus have limited healing potential
it only has a blood supply in its outer third
meniscal tear treatment
generally meniscal tears arent suitable for repair
if symptoms don’t settle within 3 months, arthroscopic menisectomy may alleviate symptoms
the principal complaint of ACL deficiency is
rotatory instability with giving way on turning
ACL rupture clinical signs
knee swelling (haemarthrosis or effusion)
excessive anterior translation of the tibia on anterior drawer test
ACL rupture treatment
primary repair (not very effective)
ACL reconstruction
ACL reconsturction involves
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
MCL injuries generally heal well
true/false
true
clinical signs of MCL tear
laxity and pain on valgus stress
tenderness over the origin or insertion of the MCL
MCL treatment
acute - hinged knee brace
chronic - MCL tightening (advancement) or reconstruction (tendon graft)
which nerve is often injured in LCL injuries
common peroneal nerve
complete knee dislocations result in rupture of
all four knee ligaments
why is vascular monitoring of the leg/foot necassary after a complete knee dislocation
intimal tears can occur which later thrombose
what is a risk of reperfusion after complete knee dislocation
compartment syndrome
what are the components of the knee extensor mechanism
tibil tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscles
patellar tendon ruptures occur in young/old patients
quadriceps tendon ruptures occur in young/old patients
patellar tendon ruptures occur in young patients
quadriceps tendon ruptures occur in old patients
quinolone antibiotics are a risk factor for tendonitis
true/false
true
why should steroid injections be avoided in tendonitis of the extensor mechanism
high risk of tendon rupture
why should knee examination include a straight leg raise
to test the extensor mechanism
extensor mechanism rupture treatment
tendon to tendon repair
reattachment of the tendon to the patella
what is patellofemoral dysfunction
disorders of the patellofemoral articulation resulting in anterior knee pain
examples of patellofemoral dysfunction
chondromalacia patellae (softening of the hyaline cartilage)
adolescent anterior knee pain
lateral patellar compression syndrome
what causes lateral patellar compression syndrome
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
risk factors for patellofemoral dysfunction
female sex
adolescence (greater degree of ligamentous laxity)
hypermobility
genu valgum
femoral neck anteversion
patellofemoral dysfunction presentation
anterior knee pain, worse going downhill
grinding or clicking sensation at the front of the knee
stiffness after prolonged sitting (psuedolocking)
causes of patellar instability
direct blow
sudden twist of the knne
the patella normally dislocates laterally/medially
laterally
what is hallux valgus
a deformity of the great toe due to medial deviation of the 1st metatarsal head and lateral deviation of the toe itself
risk factors for hallux valgus
female sex
family history
RA
inflammatory arthropathies
presentation of hallux valgus
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
coservative treatment of hallux valgus
wearing wider and deeper accomodating shoes
a spacer between the first and second toe to prevent rubbing
surgical management of hallux valgus
osteotomy to realign the bones
soft tissue prcedures to tighten slack tissues and release tight tissues
what is hallux rigidus
OA of the 1st MTPJ
conservative treatment of hallux rigidus
a stiff soled shoe to limit motion at the MTPJ
gold standard surgical treatment for hallux rigidus
arthrodesis
what is morton’s neuroma
thickening of the nerve around the tissue between the bases of the toes
where is morton’s neuroma normally found
the third interspace nerve (between third and fourth toes)
what causes morton’s neuroma
irritation of the nerves causes them to become inflamed and swollen
high heels are thought to be a cause in women
clinical features of morton’s neuroma
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)
what is mulder’s test
squeeze the forefoot
to test for morton’s neuroma
diagnosis of morton’s neuroma
USS
conservative management of morton’s neuroma
use of a metatarsal pad or offloading insole
steroid and local anaestheric injections may relieve symptoms and aid diagnosis
surgical management of morton’s neuroma
excision of neuroma
most common site of metatarsal stress fracture
2nd metatarsal head
followed by the 3rd
management of metatarsal stress fracture
rest for 6-12 weeks in a rigid soled boot
risk factors for achilles tendonitis
repetitive strain (from sports)
degenerative processes
quinolone antibiotics
RA/inflammatory arthropathies
gout
treatment of achilles tendonitis
rest
physio conditioning
use of a heel raise to offload tendon
splint/boot
should steroid injections be used in achilles tendonitis
no
risk of rupture
which age groups do achilles tendon ruptures occur in
middle aged or older
mechanism of achilles tendon tear
sudden decelrationwith resisted calf muscle contraction (eg lunging at squash) leads to sudden pain and difficulty weight bearing
clinical signs of achilles tendon rupture
difficults weight bearing
weakness of plantar flexion
palpable gap in the tendon
no plantar flexion is seen when squeezing the calf (simmonds test)
what is simmond’s test
squeezing the calf to check for plantar flexion
achilles tendon rupture
what sort of cast should be used in achilles tendon rupture
equinous position
presentation of plantar fasciitis
pain with walking felt on the instep of the foot
localised tenderness on palpation at this site
risk factors for plantar fasciitis
diabetes
obesity
frequent walking on hard floors with poor cushioning in shoes
treatment of plantar fasciitis
rest
achilles and plantar fascia stretching exercises
gel filled heel pad
steroid injection
pes planus AKA
flat foot
causes of acquired flat foot
tibialis posterior tendon stretch/rupture
RA
diavetes with Charcot foot (neuropathic joint destruction)
where does the tibialis posterior insert
medial navicular
treatment of tibialis posterior tendonitis
splint with a medial arch support to avoid rupture
elongation or rupture of the tibialis posterior tendon results in
loss of the medial arch with resulting valgus of the heel
pes cavus AKA
abnormally high arched foot
pes cavus risk factors
cerebral palsy
polio
spinal cord thethering from spina bifida occulta
pes cavus is often accompanied by
claw toes
treatment of pain from pes cavus
soft tissue release and tendon transfer if supple
calcaneal osteotomy if more rigid
arthrodesis if very severe
why do claw toes and hammer toes occur
acquired imbalance between the flexor and extensor tendons
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
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
non-surgical treatment of claw toes
toe ‘sleeves’ to prevent rubbing
corn plasters
surgical treatment of claw toes
tenotomy
tendon transfer
arthrodesis of PIPJ
toe amputation
what type of collagen is produced in dupuytren’s contracture
type III
the risk of recurrent shoulder dislocation following a traumatuc shoulder dislocation increased with age of patient at first-time dislocation
true/false
false
carpal tunnel syndrome is due to impingement of
the median nerve
cubital tunnel syndrome is due to impingement of
the ulnar nerve
shoulder impingement is due to impingement of
rotator cuff tendon
hip impingement is due to impingement of
the acetabular rim
risk factors for carpal tunnel syndrome
hypothyroidism
gout
female gender
chronic renal failure
pregnancy
OA
hypothyroidism
female gender
chronic renal failure
pregnancy
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
genu valgum
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
genus varum
weakness of which muscle will give rise to a positive froment’s test
adductor pollicis
a quadricep tendon rupture is a relatively common injury in the patient over 40 and rarely requires surgical intervention
true/false
false
these cases are almost always surgically managed
what degree of fixed flexion deformity is require at the MCPJs for a patient to fail th eHuestion Table Top Test
>30 degrees
it may be appropriate to omit the PR exam while examining someone for cauda equina syndrome
false
the principle clinical sign on examnation of restriction of shoulder movement is in which direction
frozen shoulder
external rotation
bed rest is good for mechanical back pain
true/false
false
a varus alignment of the knee will predispose to OA in which knee compartment
medial
