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Msk > Session 4 Clinical > Flashcards

Session 4 Clinical Flashcards

1
Q

What’s the most commonly fractures tarsal bone

A

Calcaneus

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2
Q

Most calcaneal fractures occur from

A

Forceful landing on a heel, talus is driven down into calcaneus

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3
Q

What is compartment syndrome

A

Trauma (blunt or penetrating) to a fascial compartment may lead to haemorrhage and/or oedema and cause a rise in intra-compartmental pressure.

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4
Q

Clinical signs of compartment syndrome

A

Severe pain in the limb, which is excessive for the degree of injury, increasing and not relieved by analgesia. Pain is classically exacerbated by passive stretch of the muscles.

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5
Q

Short term consequences of compartment syndrome

A
  • Decreased perfusion of muscle
  • Ischaemic muscle releases mediators
  • These further increase capillary permeability and exacerbate the rise in intracompartmental pressure
  • Neurovascular signs develop late, loss of peripheral pulses and increased capillary refill time. Distal Parasthesia preceded loss of motor function
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6
Q

Long term consequences of compartment syndrome

A

Rhabdomyolysis (muscle necrosis) and acute kidney injury which may become chronic.

Necrotic muscle may also undergo fibrosis- causing Volkmann’s ischaemic contracture (permanent painful and disabling contracture)

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7
Q

Mechanism of injury for an ankle fracture

A

Inversion or eversion

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8
Q

Co-morbidities for delayed fracture healing

A

Diabetes, neuropathy, peripheral vascular disease, smoking

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9
Q

Open ankle-fractures key points

A

Urgent surgery with extensive irrigation and debridement to reduce the risk of osteomyelitis (infection of the bone)

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10
Q

What happens in Talar shift

A

Ankle mortise becomes unstable and widens so that the talus can shift medially or laterally within the ankle joint.

Happens when there is disruption of any two out of the syndesmosis, medial or lateral ligaments.

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11
Q

Treatment of stable ankle fracture

A

Non-operative such as air cast boot or fibreglass cast for comfort. Can weight-bear safely and low rate of complications

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12
Q

Treatment for unstable ankle fractures

A

Surgical stabilisation

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13
Q

Sprained ankle definition

A

Partial or complete tear of one or more ligaments of the ankle joint

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14
Q

Factors that contribute to increased risk of ankle sprains

A

Weak muscles/tendons, weak/lax ligaments (hereditary or due to repetitive ankle strains) , inadequate joint proprioception, slow neuromuscular response , running on uneven surfaces, shoes with inadequate heel support, high heeled shoes

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15
Q

Ankle sprains cause

A

Excessive external rotation, inversion or eversion of the foot due to an external force

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16
Q

most common mechanism of injury in ankle sprains

A

Inversion injury affecting a plantar-flexed and weight bearing foot (anterior talofibular ligament is most at risk of sprain)

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17
Q

What is an avulsion fracture

A

When a tendon or ligament is placed under tension and instead of it tearing, a fragment of bone is pulled off at insertion site

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18
Q

Why is avulsion fraction of 5th metatarsal tuberosity common in severe sprain of ankle

A

Fibularis brevis tendon is attached to a tubercle on the base of the 5th metatarsal

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19
Q

What can be confusingly mistaken for a 5th metatarsal tuberosity avulsion fracture

A

Unfused apophysis on 10-16 year old

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20
Q

Causes of Achilles’ tendon rupture

A
  • forceful push off with extended knee (jumping)
  • fall with foot outstretched and ankle dorsiflexed
  • falling from high, into hole, or off kerb
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21
Q

Why is Achilles’ tendon vascular watershed more susceptible to tear

A

Decreased vascularity and thickness of tendon

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22
Q

Symptoms and signs of Achilles’ tendon rupture

A
  • Sudden and severe pain at back of ankle or calf
  • Sound of pop or snap
  • palpable/visible gap in tendon
  • Swelling followed by bruising
  • Inability to stand on tip toe or push off whilst walking
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23
Q

How do you test for ruptured Achilles’ tendon

A

Thompson’s test/Simmond’s test (calf squeeze, foot should plantar flex)

24
Q

Why is surgical reconstruction of a tendon difficult

A

Two ends are frayed like a mop head

25
Q

Hallux valgus definition

A

Distal part of big toe deviated laterally

26
Q

What can hallux valgus lead to

A

Painful movement of 1st MTPJ and difficulty with footwear

27
Q

Hallux valgus can occur secondary to

A

Trauma, arthritis/metabolic conditions such as gout, rheumatoid arthritis and psoriatic arthritis and to connective tissue disorders causing ligament outs laxity such as Ehlers-Danilo’s syndrome

28
Q

What exacerbates hallux valgus

A

Line of pull on extrinsic tendons

29
Q

what is hallux rigidus

A

OA of 1st MTPJ- results in stiffness (joint usually under tremendous stress when walking)

30
Q

Symptoms of Hallux rigidus

A

Pain in MTPJ on walking and dorsiflexion of toe. In severe cases, pain present at rest, walk on outside of foot. Range of dorsiflexion can become severely restricted. Dorsal bunion may develop

31
Q

Arthroplasty meaning

A

Joint replacement

32
Q

Arthrodesis meaning

A

Joint fusion

33
Q

Excision arthoplasty meaning

A

Surgical removal of the joint with interposition of soft tissue

34
Q

Osteotomy menaing

A

Surgical cutting do bone to allow realignment

35
Q

Treatment of hallux rigidus

A

Activity modification, analgesia, orthotics, aids, intra-articular steroid injections.

Arthrodesis if severe or arthroplasty

36
Q

Nearly all cases of OA of the ankle are

A

Secondary arthritis (post-traumatic).

Some are from joint stress e.g. ballet dancers, footballers, obesity

37
Q

OA of ankle treatment

A

Arthrodesis or maybe arthroplasty

38
Q

What is claw toe

A
  • hyperextention at the MTPJ and flexion at the PIP joint
39
Q

Claw toe develops due to

A

Muscle imbalance causing ligaments and tendons to become unnaturally tight e.g. neurological damage (such as cerebral palsy, stroke, diabetes or alcohol dependence). Can also be from trauma, inflammation and RA.

40
Q

Hammer toe/Mallet toe meaning and cause

A

Hammer toe- flexed at PIPJ
Mallet toe- flexed at DIPJ

Ill-fitting pointed shoes, pressure on second toe from an adjacent hallux valgus

41
Q

Curly toes key points

A

Congenital, 3rd to 5th digits usually. Tendons of FDL or FDB are too tight. Surgery rarely needed- usually passive extension.

42
Q

What is Achilles tendinopathy

A

Degenerative not inflammatory process (degenerative change).

43
Q

Where can tendinopathy develop

A

Point of insertion into calcaneum or vascular watershed area within tendon

44
Q

What causes Achilles tendinopathy

A

Years of overuse e.g. long distance runners, sprinters.

Obesity, diabetes.

45
Q

Symptoms and signs of Achilles tendinopathy

A
  • Pain and stiffness along Achilles’ tendon in morning/worsens with activity
  • Severe pain 24 hrs after exercising
  • Thickening of tendon
  • Swelling that is present all the time but worsens during activity
  • Palpable bone spur
46
Q

Treatment for Achilles tendinopathy

A

Physiotherapy to improve vascularity and promote healing

47
Q

What is flat foot (pes planovalgus)

A

Medial arch of foot has collapsed- valgus angulation of hind foot caused

48
Q

When is flat foot normal

A

in young as large amount of subcutaneous adipose tissue in sole of foot (medial fat pad) and arches have not yet developed

49
Q

Flexible fat feet key points

A

No medial arch whilst standing normally, but one forms on tip toes

50
Q

Rigid flat foot key points

A

Always abnormal- develop usually as a result of tarsal coalition (failure of tarsal bones to separate during embryonic development)

Symptomatic- requires treatment

51
Q

Adult acquired flat foot key points

A
  • Dysfunction of tibialis posterior tendon
  • Obesity, hypertension and diabetes
  • Pregnancy due to increased laxity
  • Need orthotics or physio, rarely surgical reconstruction or Arthrodesis
52
Q

Foot disease in diabetes includes

A

Infection, ulceration or destruction of the tissues of the foot

53
Q

What can lead to foot ulcers, severe infections and other serious complications of diabetic foot

A
  • Loss of sensation due to peripheral neuropathy
  • Ischaemia due to peripheral arterial disease and micro vascular disease
  • Immunosupression due to poor Glycaemic control
  • Continual weight-bearing exacerbates problem
54
Q

Poorly controlled diabetes can lead to

A

Charcot arthropathy

55
Q

What’s Charcot arthropathy

A

Ankle and foot- combination of neuropathy, abnormal loading, repeated microtrauma and metabolic abnormalities

Lead to inflammation causing muscle spasticity, osteolysis, fractures, dislocation and deformity.

56
Q

Treatment if Charcot arthropathy

A

Optimisation of glycaemic control and reduction of load

Msk (38 decks)

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