Trauma and Orthopaedics Flashcards
name all the different vertebral bodies in the spine - how many of each are there? how many cervical roots are there ?
C7, T12, L5, S5
but there are 8 Cervical roots
what is the highest and the Lowest score for the UK MRX strength scale ? which is best ?
- 0 (mo muscle contraction)
- 5 (normal power)
what is a radiculopathy ?
compression of nerve roots as they exit spinal cord
what is frozen shoulder ? and what is another name for it ?
adhesive capsulitis
- inflammation + fibrosis of joint capsule => adhesions (scar tissue) => tighten joint + restrict motion
frozen shoulder RF ? (1)
DM
usually affects those in middle age
describe the different phases to frozen shoulder ? how many phases ? how long does each phase last ?
- painful phase (shoulder pain worse at night)
- stiff phase
- thawing phase
(each phase is 6-12 months)
frozen shoulder Mx ? (2)
- clinical Dx (don’t usually need scans)
- early physio + NSAIDs
would could shoulder pain preceded by trauma indicate ? (3)
- shoulder dislocation
- fractures
- rotator cuff tear
what does the empty can test test for ?
tests for supra spinatus tendinopathy
what is a rotator cuff tear ?
refers to injury (partially or fully torn) to tendons of the rotator cuff muscles
what are the muscles in the rotator cuff ? (4)
SITS
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
rotator cuff tear px ?
typically acute (after injury)
- shoulder pain + specific weakness
what imaging would you do for rotator cuff tear ?
- US (cheaper and quicker)
- MRI (more info)
no point doing XR as don’t show soft tissue injury
rotator cuff tear Mx ? when surgical Mx ?
- NSAIDs + physio
- if fails, then surgery (if young and complete tear)
what is another name for students elbow ? what is it ?
olecranon bursitis (bony lump at elbow - ulnar)
- traumatic bursitis following pressure on elbows => pain + swelling behind the olecranon, fluctuant (fluid filled)
what are bursae ? bursitis ?
sacs created by synovial membrane filled with small about of synovial fluid
- bursitis is inflame of a bursa
what do you do if infection suspected in bursitis px ?
aspirate
aspirate shows pus, what could this indicate ?
infection
aspirate shows straw-coloured fluid, what could this indicate ?
infection less likely
aspirate shows blood stained fluid , what could this indicate ?
- trauma
- infection
- inflammation
aspirate shows milky fluid, what could this indicate ?
- crystal arthopathy
students elbow mx ?
- rest
- ice
- compression
- NSAIDs
what is epicondylitis ?
inflammation at the point where tendons of forearm insert into epicondyles (as a result of repeitic strain - RSI)
what examination tests can be used to assess for lateral epicondylitis (tennis elbow) (2)
- mills + cozens test (pain indicates +ve)
epicondylitis mx ? (3)
- self limiting + will resolve with time, but can take urs to resolve
- rest, physio, NSAIDs
what is dupuytren’s contracture ?
progressive, painless fibrotic thickening of the palmar fascia with skin puckering + tethering (often bilateral + symmetrical)
dupuytren’s contracture inheritance pattern ?
autosomal dominant pattern
dupuytren’s contracture mx ? what examination test ?
if patient can’t place palm flat on flat surface (Hestons table top test) => refer for surgery
what is the most frequent cause of hand pain at night ?
carpal tunnel syndrome
(also most common nerve compression syndrome)
what is carpal tunnel syndrome ? what nerve involved ?
caused by compression of median nerve as travels through carpal tunnel => pain + numbness in median distribution
(usually due to RSI => swelling of contents of carpal tunnel)
what is bilateral carpal tunnel syndrome linked to ?
acromegaly
(strange huh)
carpal tunnel syndrome px ?
gradual onset, intermittent, worse at night
- sensory sx: numbess, parestesia, burning, pain
- motor: sx affect that muscles
what is median distribution of hand ?
palmar aspects + full fingertips of thumb, inside and lateral half of ring finer
carpal tunnel syndrome mx ? (4)
- rest
- splints
- steroid infection
- surgery
what conditions could red flags for sinister back pain indicate ? (5)
- spinal fracture
- cauda equina
- spinal stenosis
- ankylosing spondylitis
- spinal infection
what imagine does red flag for sinister back pain require ?
refer at once to
- needs MRI < 4 hrs
what is spondylolisthesis ? cause of it ?
anterior displacement of vertebra out online with one below
- causes: spondylosis (age related degeneration)
what is spinal stenosis ?
narrowing of part of spinal canal => compression of spinal cord or nerve roots => can cause nerve ischaemia
spinal stenosis px ?
- gradual onset lower back pain, buttock + leg pain
- leg weakness
spinal stenosis Ix ?
- MRI
- Ix to exclude PAD (ABPI) when sx of intermittent claudication
spinal stenosis mx ? (4)
- exercise and weight loss
- analgesia
- physio
- decompression surgery
what nerve roots form the sciatic nerve ?
L4 - S3
where does the sciatic nerve supply ? sensation ? motor ?
- sensation to lateral lower leg + foot
- motor to posterior thigh, lower leg + foot
sciatica px ?
unilateral pain from buttock radiating down thigh to below knee or feet
- parasthesia, numbness motor weakness
sciatica aetiology - what can lead to it ? (3)
- herniated disc
- spondylolithesis
- spinal stenosis
what is the overall mx to chronic back pain ? what risk tool ?
- online star back tool to stratify risk of chronic pack pain
- physio
- CBT
- NSAID
- amitriptyline
what is spinal cord compression ? usually due to what ?
oncological emergency
- usually due to vertebral mets
what cancers usually metastasise to bone ?
PoRTaBLE
- Porstate
- Renal
- Thyroid
- Breast
- Lung
spinal cord compression px ? what makes it worse (2)
back pain (most common) worse online down and coughing
- lower limb weakness
- sensory changes
(can be first px of met cancer)
spinal cord compression ix ?
Urgery contrast MRI (whole MRI spine within 24 hrs)
spinal cord compression mx ? (2)
high dose oral dex
urgent oncological assessment
What is the most common swelling of popliteal fossa ?
bakers cyst (popliteal cyst)
bakers cyst pathophys ?
secondary to degernative changes => synovial fluid squeezed out of knee + collects in the popliteal fossa
bakers cyst ix ? rule out what ?
US usual first line (+ rule out DVT)
bakers cyst mx ?
no treatment if asymptomatic
- non-surgical: physio, analgesia, US guided aspiration
- surgical
what is the most common primary malignant bone tumour ?
multiple myeloma
most common form of bone cancer ?
osteosarcoma
what is Ewing sarcoma ?
a bone + soft tissue cancer most often affecting children + young adults
XR features of Ewing sarcoma ?
- Bone destruction
- new bone formation (onion ring sign)
(eWING, onion WING)
what is a compound fracture ?
skin is broken + broken bone exposed to air
which fractures typically occur in children ? (3)
- greenstick
- buckle
- Salter Harris (only in kids as involve growth plate)
what are pathological fractures ?
fractures secondary to underlying disease of the bone
give some examples of causes of pathological fractures (4)
- tumour (metastatic or primary)
- pagets
- oseoporosis
- osteogenesis imperfecta
what is fat embolism ? when does it typically occur ?
occurs following fracture of long bone
- globules of fat from bone marrow enter circulation => become lodged in blood vessels (pulm arteries) + systemic inflammation response
what is done to reduce risk of fat embolism ?
operating early to reduce fracture which reduces risk of this
fat embolism mx ?
supportive while condition improvoes
- mortality 10%
what is a colles fracture ?
distal radius fracture with dorsal displacement
what is dinner fork deformity associated with ?
colles fracture
what nerve injury may coleus fracture result in ? how does this present
median nerve injury
- weakness or loss of thumb/index finger flexion
what is a smiths fracture ?
reverse colles
- distal radius fracture with volar displacement
farden spade deformity associated with what ?
smiths fracture
what is monteggia fracture ?
Manchester United
- ulnar fracture
+ dislocation of proximal radioulnar joint
what is galeazzi fracture ?
Galaxy Rangers
- Distal radius fracture
+ dislocation of distal radioulnar joint
Explain the blood supply to the hip - name the arteries ? where do they run along ?
the medial + lateral circumflex femoral arteries run along intertrochanteric line + provide only blood supply to femoral head
what hip fracture has AVN risk ?
intracapsular fracture
what classification categorises NOF fractures ? explain the levels ?
garden classification (I - IV)
- I/II: non-displaced: may have intact blood supply
- III/IV: disrupt blood supply to head of femur
Mx of non-displaced NOF fracture ?
garden I/II
- internal fixation (screws): hold fewer head in place while heals
Mx of displaced NOF fracture ?
garden III/IV
- hemi or total hip replacement
(total offer if pt is fit)
intertrochanteric NOF fracture mx ?
dynamic hip screw
NOF fracture O/E ?
shortened
abducted
externally rooted
NOF fracture Ix ?
XR two views (AP, lateral)
What is compartment syndrome ?
pressure within fascial compartment is abnormally elevated => cuts of blood supply
(can be acute or chronic. acute is med emergency)
compartment syndrome px ? (5) what is a worry sign ?
(usually after bone fracture or crush injury)
5Ps
- pain (disproportionate)
- parasthesia
- pale
- pressure
- paralysis (late + worry sign)
compartment syndrome mx ?
medical emergency
- escalate to ortho reg
- remove external dressings/bandages
- elevate limb to heart
- definitive: emergency fasciotomy
