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Surgery > Trauma and Orthopedics > Flashcards

Trauma and Orthopedics Flashcards

1
Q

What are the steps to a joint examination?

A 
Introduce
Ask
Look
Feel
Move
Special Tests
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2
Q

When assessing the neurological functions of the limbs and trunk, what else do we need to assess?

A

Power
Co-ordination
Reflexes
Sensation

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3
Q

What is the difference between primary and secondary bone healing?

A

Primary does not produce a callus, and is due to fracture fragments being reduced anatomically - there is no movement between the fracture surfaces.

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4
Q

What are the 2 distinct but similtaneous processes occuring in secondary bone healing?

A

Intramembranous and endochondral ossification

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5
Q

What are the 2 stages of secondary bone healing?

A
  1. Haematoma and inflammation

2. Callus formation - soft and hard

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6
Q

What are Perkins rules?

A

Rules describing the length of time it takes for different fractures to unite

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7
Q

How long, according to Perkins rules, do cancellous/metaphyseal bone fractures take to unite?

A

6 weeks

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8
Q

How long, according to Perkins rules, do cortical/diaphyseal bone fractures take to unite?

A

12 weeks

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9
Q

How long, according to Perkins rules, do tibial fractures take to unite?

A

24 weeks

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10
Q

How long, according to Perkins rules, do fractures in children take to unite?

A

(Age of child + 1) weeks

Although should apply common sense in older children

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11
Q

What is delayed union of a fracture?

A

A failure of union to occur in 1.5 times the normal time for fracture union

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12
Q

What is non-union of a fracture?

A

A failure of union to occur in twice the normal time for fracture union

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13
Q

What are the 2 types of non-union?

A

Hypertrophic and Atrophic

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14
Q

Hypertrophic vs Atrophic non-union

A

H - non union due to excess mobility or strain at fracture site. Blood supply is good.

A - Due to poor blood supply (due to initial injury or surgical intervention)

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15
Q

What is a fracture?

A

A soft tissue injury with an associated broken bone

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16
Q

Considering the definition of a fracture, what principle should be used when treating a pt with one?

A

Treat the soft tissues with care and the broken bone will heal well

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17
Q

What are the 4 principles of modern fracture reduction and treatment?

A
  1. Reduce and fix fractures to restore anatomical relationships
  2. Stabilise with fixation or splinting as required
  3. Presvere the blood supply with the above gentle techniques
  4. Early and safe mobilization of the part and pt
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18
Q

What is the cheapest and easiest way to reduce a fracture?

A

Casting

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19
Q

What can we do to immobilise a fracture prior to definitive management?

A

Half casts, or back-slabbing

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20
Q

What are the complications of casting?

A 
Cast problems (loosening, pressure areas)
Thromboembolic events
Coverage of wounds
Skin breakdown
Compartment syndorme
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21
Q

What injuries of the phalanges and metacarpals can occur?

A

Extra-articular - shaft fractures and base fractures
Dislocations - thumb MCPJ, PIP
Neck fracture (metacarpal)

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22
Q

How do thumb injuries usually occur?

A

Direct blow, or forced opposition

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23
Q

How do metacarpal injuries usually occur?

A

“punch” injury - Friday night, or boxers fracture

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24
Q

How do distal phalanx injuries usually occur?

A

Crush injury

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25
Q

How do proximal and middle phalanx injuries usually occur?

A

Direct blow, or twisting

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26
Q

PIP dislocation - What is the Edinburgh position, and why is it good?

A

MC joint immobilised in 90 degree flexion, and PIPJ in extension, and wrist at 30 degrees.

Ligaments are stretched to the max while immobile so the pt doesnt end up with a flexion deformity.

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27
Q

What is the mechanism of a scaphoid fracture?

A

Fall onto outstretched hand (forced dorsiflexion)

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28
Q

What is the sign of effusion in a scaphoid fracture?

A

Anatomical snuffbox feels full

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29
Q

Where is tender in a scaphoid fracture? 2 sites

A
  • Anatomical snuffbox (dorsal)

- Tubercle of scaphoid (volar)

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30
Q

How do we investigate a ?scaphoid facture?

A

Scaphoid series radiograph films

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31
Q

How do we treat a scaphoid fracture?

A

Below elbow cast in neutral position for 8-12 weeks

If displaced >1mm or angulated -> Open reduction with internal fixation (ORIF)

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32
Q

What are the complications of scaphoid fracture?

A
  • Non union
  • Avascular necrosis (esp. with proximal or displaced fractures)
  • Degenerative change
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33
Q

After scaphoid, what is the next most commonly fractured carpal bone?

A

Hamate fracture

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34
Q

How are distal radius and ulna fractures usually obtained?

A

Fall on an outstretched hand

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35
Q

How common are distal radius or ulna fractures?

A

Very - makes up 1 in 6 of all fractures

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36
Q

When I say that distal radius/ulna #s are bimodal in incidence, what do I mean?

A

There are 2 peaks of incidence, one in childhood (6-10) and one in early old age (60-70)

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37
Q

What can accompany #distal radius/ulna?

A

Scaphoid and ligamentous wrist injuries

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38
Q

What is a Colles fracture?

A

The most common radial fracture - the wrist and hand (i.e. all structures distal to the #) are displaced posteriorly

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39
Q

What is seen on examination of a colles fracture?

A

Dinner fork deformity - on lateral view of affected wrist, the posterior displacement of distal structures causes a curve like a fork to be seen on the palmar surface

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40
Q

What is a Smith’s fracture?

A

of radius that is the opposite of a Colles. The wrist and hand (i.e. all structures distal to the #) are displaced anteriorly

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41
Q

Having made you learn what Colles, Barton’s and Smiths #s are, what is the safest way to describe a #?

A

By radiological/anatomical features

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42
Q

What is a Barton’s fracture?

A

Intra-articular distal radius # with associated dislocation of radio-carpal joint. Can be volar or dorsal.

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43
Q

What are the characteristics that we can describe in a #?

A 
Site - which bone, where in that bone?
Pattern
Displacement
Angulation
Dislocated/In joint
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44
Q

What is important to remember when looking at a radiograph of a #?

A

Theres should be 2 views!! AP and lateral

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45
Q

What # patterns can there be?

A 
Transverse
Oblique
Spiral
Comminuted
Multi-fragmented
Segmental
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46
Q

How can radial/ulnar shaft fractures be caused?

A

Fall on outstretched hand

Direct blow to forearm

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47
Q

What often happens if the ulna or radius is fractured on its own?

A

The other bone is dislocated

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48
Q

What do we call a proximal ulnar fracture with proximal radial head dislocation?

A

Monteggia fracture

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49
Q

What do we call a distal radial fracture with distal radio-ulna joint dislocation?

A

Galaezzi fracture

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50
Q

How are the vast majority of R/U shaft fractures managed in adults?

A

Above elbow cast if undisplaced.
If displaced - open reduction and compression plate fixation

Closed reduction is impossible/insufficient.

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51
Q

Where can the humerous fracture in adults?

A

Shaft
Condyles
Olecranon
Radial head

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52
Q

How do humeral shaft #s usually occur?

A

Fall with torsion or direct blow

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53
Q

What would we suspect if a humeral shaft # occured after a low energy blow?

A

Osteoporosis

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54
Q

What nerve is at risk from a humeral shaft fracture? Why?

A

Radial nerve - it runs down the radial groove on the posteroir aspect of the humerus

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55
Q

What else should we get x-rays of with a humeral shaft #? Why?

A

Joint above and below i.e. shoulder and elbow

In case of intra-articular extension/floating elbow/shoulder

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56
Q

If the radial nerve is involved in a humeral shaft #, what signs do we get?

A

Wrist drop
Sensory loss to dorsal aspect of lateral 3.5 digits
(depending on site) ?weakened extension of arm

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57
Q

How are humeral shaft #s usually managed?

A

Conservatively

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58
Q

When would surgical intervention be indicated for a humeral shaft #?

A

Open fracture
Vascular injury
Floating shoulder/elbow
Intra-articular extension

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59
Q

What can a pt do if they fall onto their elbow?

A

Humeral condylar #

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60
Q

What is the mechanism for humeral condylar #s?

A

Olecranon driven into the humerus -> condyle splits into “T” or “Y” shape

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61
Q

What is the most common type of humeral condylar #?

A

Intercondylar - fracture line goes from articular surface to supracondylar region (T or Y shape)

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62
Q

There are 3 other types of humeral condylar #. What are they?

A
  • Supracondylar
  • Isolated medial or lateral condyle fracture
  • Isolated capitellum #
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63
Q

What is the Colton classification?

A

Classification of olecranon fractures according to whether it is displaced.

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64
Q

What is a type one and a type two colton fracture?

A

1 - undisplaced

2 - displaced

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65
Q

How can a radial head # occur?

A

FOOSH with the forearm in pronation

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66
Q

Which system do we use for radial head # classification?

A

Mason classification

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67
Q

What complications can occur as a result of elbow fractures?

A

Joint stiffness
Osteoarthritis
Heterotopic ossification
Neurovascular injury

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68
Q

What is the terrible triad of the elbow?

A

Posterior elbow dislocation w/ radial head fracture + coronoid process fracture + lateral collateral ligament tear

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69
Q

By what mechanism does the clavicle #?

A

Fall, or direct blow to lateral shoulder

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70
Q

What % of all #s do clavicle #s make up?

A

5-10%

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71
Q

Where do the majority of clavicle #s occur?

A

Middle 3rd (i.e. 2/3rds from sternum)

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72
Q

WRT displacement, how are clavicle #s assessed?

A

WRT the sternoclavicular joint

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73
Q

How are the majority of clavicle fracture treated?

A

Conservatively

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74
Q

How do most scapula #s occur?

A

Direct trauma, usually a RTA

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75
Q

What other injuries should be considered/ruled out when a scapula # is present?

A
  • Rib #
  • Pulmonary contusion
  • Pneumo/haemothorax
  • Ipsilateral clavicle #s
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76
Q

In the shoulder region, what can dislocate?

A 
Sternoclavicular joint
Acromioclavicular joint
Glenohumeral joint (anterior or posterior)
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77
Q

Which shoulder dislocation is the most common?

A

Anteroir dislocation of glenohumeral joint - 95% of dislocations

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78
Q

Are sternoclavicular joint dislocations common?

A

Noop

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79
Q

Who is at risk of reoccuring shoulder dislocations?

A

Pts whos shoulder dislocates first at a young age

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80
Q

Why do shoulder dislocations reoccur?

A

Bankart lesions or capsular redundancy

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81
Q

When do single rib #s typically occur?

A

Direct injury such as a fall

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82
Q

Apart from trauma, when can lower ribs #?

A

With coughing

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83
Q

When do sternal #s typically occur?

A

Traaaaauma

84
Q

What can happen with a high velocity RTA/crush injury to ribs and sternum?

A

“Stove-in” chest with flail segments (multiple rib #s)

85
Q

How are rib #s treated?

A
  • Single ribs - analgesia/symptomatic treatment

- Multiple (>3) - admit to observe overnight + analgesia

86
Q

How is a sternal # treated?

A

Symptomatic treatment + observe for associated injuries

87
Q

How are flail chest or extensive rib #s treated? Why?

A

High flow O2 and analgesia. CPAP or IPPV may be necessary. Adequate ventilation may be prevented, pt may present with severe respiratory distress

88
Q

What are the serious complications that can occur fter rib or sternal #s?

A
  • Cardiac tamponade

- Pneumothorax

89
Q

How do fractures of the pelvis typically occur in pts >60?

A

Low energy - fall from standing height

90
Q

How do fractures of the pelvis typically occur in pts <60?

A

High energy - RTA, falls at work, sport

91
Q

Considering the force required to # a young pts pelvis, what are the outcomes like for these pts?

A

Morbidity and mortality can be as high as 20%.

Main cause of death in multiple trauma pts.

92
Q

What system is used to classify pelvic #s?

A

Young and Burgess

93
Q

What is true of an isolated pelvic #?

A

It is generally stable - the ring will not break

94
Q

What is true of pelvic #s with 2 breaks in a ring?

A

Unstable as it is able to displace or open

95
Q

What are the Young and Burgess classifications?

A
  • AP compression
  • Lateral compression
  • Vertical shear
  • Combined mechanical
96
Q

How can we image the pelvis to assess the structures there?

A

AP x-ray pelvis

CT to assess posteroir structures

97
Q

How do we treat a stable single ring #?

A
  • Check for sacroiliac ligament injury (indicates if unstable)
  • CT scan to confirm stability before mobilisation
  • Bed rest, analgesia, early mobilisation
98
Q

How do we treat an unstable multiple ring #s?

A
  • Establish haemodynamic control as liable to massive haemorrhage + ABCDE
  • CT to define the #
  • External fixation to stabilise
  • May require screw/plate fixation depending on location
99
Q

Name some major complications of unstable pelvic #s.

A
  • Haemorrhage
  • Urogenital injury
  • Thromboembolism
  • Neuro injury
  • Paralytic ileus
  • OA
  • Malunion -> difficult pregnancy
100
Q

Apart from ring #s in the pelvis, what other #s can occur?

A

Acetabular #s

Sacral #s

101
Q

What is the most common # in the elderly?

A

Neck of femur #s

102
Q

What are the risk factors for NoF#s?

A
  • Increasing age
  • Decreasing bone mass/osteoporosis
  • Increased risk of falls
  • Lower body weight
103
Q

How should NoF #s be described?

A

Anatomically - intra- or extra- capsular, subtrochanteric, displaced or undisplaced, relationship to the blood supply

104
Q

What is an intracapsular NoF#?

A

occuring within the joint capsule, above the intertochanteric line

105
Q

What is an extracapsular NoF#?

A

occuring outside the joint capsule, along or below the intertochanteric line

106
Q

What kind of NoF#s are at risk of avascular necrosis?

A

Intracapsular displaced #s

107
Q

Tell me about subtrochanteric #s

A

Occur below the level of the lesser trochanter.

Often occur through an area of pathological bone (metastatic) in older pts.

108
Q

What medical problems must be considered in pts with NoF #s?

A

Stroke, MI, hypotension, alcoholism, infection, electrolyte imbalance, etc etc - causes of a fall that arent purely mechanical

109
Q

What is the common appearance of a hip fracture? Why?

A

Leg shortened and externally rotated if the fracture is displaced

110
Q

What will be found O/E of a hip #?

A

Straight leg raise and hip movements globally painful

Leg short and externally rotated

111
Q

WRT SHx, what is important to know with a hip #?

A
  • Pre-injury mobility baseline

- Home circumstances

112
Q

What must we assess with a NoF #?

A

Neurovascular state

113
Q

How should we image a NoF #?

A

AP and lateral plain radiograph - good for displaced #s.

If unable to visualise # on xray, Gold standard = MRI

114
Q

Generally speaking, what is the treatement for hip #s?

A

Surgical stabilisation

115
Q

How are intracapsular NoF undisplaced impacted #s in the elderly treated?

A

Mobilise early w/ analgesia

Operate only if displaces later

116
Q

How are intracapsular NoF undisplaced #s treated?

A

Internal fixation - dynamic hip screw (DHS) or cannulated screws

117
Q

How are intracapsular NoF displaced #s treated?

A

Hemiarthroplasty

118
Q

When are total hip replacements used?

A

If symptomatic pre-existing arthritis or those with few co-morbidities

119
Q

How are extracapsular NoF #s treated?

A

DHS

Intramedullary hip screw if 4-part #

120
Q

How are subtrochanteric #s treated?

A

Intramedullary nail or fixed angle plating

121
Q

After NoF #s, what is the 90 day mortality rate in the elderly?

A

20%

122
Q

Aside from mortality, what are the possible complications of NoF #s/surgery?

A
  • AVN of femoral head
  • Dislocation of arthroplasty
  • Loss of fixation
  • Non-union
  • Lower limb thromboembolic disease
123
Q

How are femoral shaft #s described?

A

Anatomically e.g. oblique mid-shaft femoral #

124
Q

When the femoral shaft is #ed, what else should we look for?

A

Associated injuries - polytrauma is common (head, chest, abdo, ipsilateral NoF)

125
Q

When a pt comes into A&E with a femoral shaft #, what should ya do?

A

ABCDE assessment haemorrhage assessment and compensation**

126
Q

Why do an A to E with a femoral shaft #?

A

Large blood loss is common (up to 1.5 L/ 4U), but can be hidden by haemodynamic compensation in young pts

127
Q

How do we compensate for potential blood loss in a femoral shaft #?

A

Give 2000ml of crystalloid via 1 of 2 large bore cannula

128
Q

Before imaging a femoral shaft #, what should we do in A&E?

A

Splint it! Helps control pain and haemorrhage

129
Q

What are the potential complications of femoral shaft #s/surgery? It’s a big ol’ list.

A
  • Compartment syndrome
  • Fat embolus
  • Infection
  • Non-union
  • Thromboembolic disease
  • Neuro injury
  • Malunion
  • Pressure sores/bronchpneumonia/UTI if treated conservatively
130
Q

What is an “open” fracture?

A

When there is direct communication between the # and the external environment

131
Q

What are the most common places for open #s to occur?

A 
Tibial
Phalangeal
Forearm
Ankle
Metacarpal
132
Q

What should all pt with open fractures get?

A

Abx cover and an up to date tetanus vaccination

133
Q

With an open #, which teams should potentially be involved?

A

T&O
Plastics
Vascular surgeons

134
Q

Define OA.

A

Condition characterised by progressive loss of articular cartilage and remodelling of underlying bone

135
Q

What is responsible for remodelling and cartilage degradation in OA?

A

Chondrocytes and inflammatory cells in the surrounding tissues

136
Q

Which joints are most commonly affected in OA?

A

Small joints of hands/feet
Hips
Knees

137
Q

What is the pattern of pain and stiffness with OA?

A

Worse with use, relieved by rest

138
Q

If you suspect OA in the hands, what else should you rule out?

A

De Quervain’s tenosynovitis
RA
Gout

139
Q

If you suspect OA in the hip, what else should you rule out?

A

Trochantic bursitis
Radiculopathy
Spinal stenosis
Iliotibial band syndrome

140
Q

If you suspect OA in the knee, what else should you rule out?

A

Referred hip pain
Meniscal tear
Ligament tear
Chondromalacia patellae

141
Q

What radiological features can you see on an xray of a pt with OA?

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

142
Q

What conservative management can we give for OA?

A

Pt education
Physiotherapy - strengthen and exercise
Ice/heat packs
Joint supports

143
Q

What medical management can we give for OA?

A

Simple analgesia and topical NSAIDs

144
Q

Depending on the site affected and the failure of conservative and medical management, what surgical intervention can we offer for OA?

A

Arthroplasty, athroscopy, or osteotomy

145
Q

What is septic arthritis?

A

Infection of a joint

146
Q

What organisms commonly cause septic arthritis? Who are they most common in?

A

Staph aureus (adults)
Strep spp.
N. gonorrhoea (young, sexually active)
Salmonella (sickle cell disease)

147
Q

If not treated in a timely fashion, what can septic arthritis lead to?

A

Articular cartilage damage -> OA

148
Q

What are the main risk factors for septic arthritis?

A 
Age over 80
Pre-existing joint disease
DM/immunosuppression
Chronic renal failure
Hip/knee prosthesis
IV drug use
149
Q

What is the most common presentation for septic arthritis?

A

Single swollen joint, causing severe pain

60% will be pyrexic

150
Q

What will you find O/E of a septic arthritic joint?

A

Red, swollen, warm, pain on movement (active and passive), unabe to weight bear.

151
Q

How should we investigate ?septic arthritis?

A
  • Routine bloods, including FBC, CRP, ESR, urate, and blood cultures.
  • Joint aspiration
152
Q

How is joint fluid analysed in ?septic arthritis?

A

Gram stain
Leucocyte count
Polarising microscopy
Fluid culture

153
Q

Do we use imaging for septic arthritis?

A

Yes - plain radiograph

Further imaging isn’t used regularly

154
Q

How do we manage septic arthritis?

A

Manage as per results of investigations.

Fluid resus, empirical abx asap initially IV, continue for ~4-6 weeks.
Surgical irrigation and drainage (“washout”)

155
Q

Aside from OA, what can be another complication of septic arthritis?

A

Osteomyelitis

156
Q

What is compartment syndrome?

A

Critical pressure increase within a confined compartmental space

157
Q

What does compartment syndrome cause in the affected limb?

A

Decline in perfusion pressure -> ischaemia and necrosis if not treated quickly.
If untreated -> limb loss, multi-organ failure, and death.

158
Q

When does compartment syndrome usually occur?

A

Post #, trauma, iatrogenic vascular injury, tight cast/splint, DVT, or post-reperfusion syndrome swelling

159
Q

In the first stage of compartment syndrome, how does it make itself worse?

A

Fluid in the compartment increases the pressure, causing venous congestion, which further increases the pressure

160
Q

What are the Heberdens nodes?

A

Hard or bony swellings that can develop in the distal interphalangeal joints due to OA

161
Q

What are the clinical features of compartment syndrome?

A
  • Pain disproportionate to the injury
  • Worsening pain with passive movement
  • Parasthesia
  • Generalised muscular tenderness
162
Q

How do we manage compartment syndrome?

A
  • Keep limb at neutral level
  • High flow oxygen
  • IV crystalloids
  • Remove constricting dressings
  • Analgesia and anti-emetics

Definitive treatment with emergency open fasciotomy

163
Q

What, apart from death and limb loss, can be complications of compartment syndrome?

A

Rhabdomyolysis

Reperfusion syndrome

164
Q

What is adhesive capsulitis? What is it also known as?

A

Glenohumeral joint capsule becomes contracted and adherent to the humeral head.

Frozen shoulder

165
Q

What clinical features occur in adhesive capsulitis?

A

Shoulder pain - deep and constant, often disturbs sleep.
Reduced range of movement.
Generalised tenderness.

External rotation and flexion mostly affected.

166
Q

What causes adhesive capsulitis?

A

Primary is idiopathic

Secondary due to shoulder pathology and co-morbidities

167
Q

What shoulder conditions can cause adhesive capsulitis?

A

Rotator cuff tendinopathy
Subacromial impingement
Biceps tendinopathy
Prev. surgery/trauma

168
Q

What co-morbidities can cause adhesive capsulitis?

A

Diabetes mellitus

Inflammatory conditions

169
Q

What are the 3 stages of adhesive capsulitis?

A

Initial painful stage
Freezing stage
Thawing stage

170
Q

Can imaging help us with diagnosis of adhesive capsulitis?

A

Noop.

Generally not as a rule. MRI can show joint capsule thickening, but can also rule out other pathology.

171
Q

How do we manage adhesive capsulitis?

A

It is usually self limiting, but has high incidence of recurrence.

Educate and reassure
Physiotherapy
Analgesia - start with paracetamol/NSAIDS. Injection/oral corticosteroids if no improvement.

172
Q

Can we operate on adhesive capsulitis?

A

Yeah, why else would it be in this deck of flashcards? It’s rarely done though.

173
Q

Why would we use surgery to help with adhesive capsulitis?

A

No improvement with conservative management over 3 months/ significant affect on QoL

174
Q

How can we use surgery to help with adhesive capsulitis?

A

Joint manipulation under GA to remove adhesions, or release joint capsule

175
Q

What is subacromial impingement syndrome?

A

Inflammation and irritation of rotator cuff tendons as they pass through the subacromial space

176
Q

What does subacromial impingement syndrome cause?

A

Pain, weakness, and reduced range of movement

177
Q

What conditions can cause SAIS?

A

Rotator cuff tendonitis
Subacromial bursitis
Calcific tendonitis

178
Q

Who is SAIS most common in?

A

Pts under 25, active individuals, and manual workers

179
Q

What is the most common symptom of SAIS?

A

Progressive pain in anterior superior shoulder

180
Q

What is Hawkin’s test?

A

Test for SAIS in the shoulder - flex shoulder to 90 degrees, and elbow also. Examiner stabilises the humerus and passively internally rotates arm.

181
Q

What is the sign of a positive Hawkins test?

A

Pain in the anterolateral aspect of shoulder

182
Q

How is imaging useful in SAIS?

A

Confirming a clinical diagnosis by MRI

183
Q

How is SAIS managed mainly?

A

Conservatively

184
Q

What is the conservative management for SAID?

A

Analgesia (usually NSAIDS)
Physio

Trialed corticosteroid injections if required

185
Q

When do we consider surgery for SAIS?

A

6 months with no response to conservative management

186
Q

What complications can SAIS cause?

A

Rotator cuff degeneration/tear
Adhesive capsulitis
Complex regional pain syndrome

187
Q

What is the resolution rate for SAIS?

A

60-90% with early diagnosis and management

188
Q

How will OA present typically?

A

Dull ache around hip, that can extend or refer to the knee.

Worse with activity, better with rest.

189
Q

O/E of a pt with hip OA, what do we see on inspection?

A 
Muscle wasting (quads and gluts).
Leg length discrepancy or fixed flexion deformity.
Antalgic/Trendelenberg gait
190
Q

O/E of a pt with hip OA, what do we see on movement?

A

Crepitus on passive movement

Reduced range of movement

191
Q

What are the symptoms of carpal tunnel syndrome?

A

Pain, numbness, and parasthesia in lateral 3.5 digits

192
Q

Who usually gets carpal tunnel syndrome?

A

Women

People aged 45-60

193
Q

Main risk factors for carpal tunnel syndrome?

A 
Female
Increasing age
Pregnancy
Obesity
Previous wrist injury
194
Q

MEDIAN TRAP?

A 
Myoxoedma
(O)Edema
Diabetes
Idiopathic
Acromegaly
Neoplasm

Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy

195
Q

In carpal tunnel syndrome, why can the palm be spared from symptoms?

A

Te palmar cutaneous branch of median nerve branches off proximal to flexor retinaculum, so does not pass through the carpal tunnel.

196
Q

What story might a carpal tunnel pt tell about the pain?

A

Worse at night but the symptoms go away if they hang their arm over the edge of the bed, or by shaking the arm

197
Q

How do we test for carpal tunnel syndrome?

A

Tinel’s test

Phalen’s test

198
Q

What is Tinel’s test?

A

Percuss over median nerve to try and reproduce symptoms

199
Q

What is Phalen’s test?

A

Hold wrist in full flexion for one minute.

200
Q

Differentials for carpal tunnel syndrome?

A

Cervical radiculopathy involving C6
Pronator teres syndrome
Flexor carpi radialis tenosynovitis

201
Q

How do we manage carpal tunnel syndrome?

A

Wrist splint at night
Trial injected corticosteroids
Release surgery in severely limiting cases

202
Q

What is De Quervain’s tenosynovitis?

A

Inflammation of the tendons within the first extensor compartment of the wrist, resulting in wrist pain and swelling.

203
Q

Which tendons are involved in De Quervain’s tenosynovitis?

A

Extensor policis brevis

Abductor pollicis longus

204
Q

Risk facors for De Quervain’s tenosynovitis?

A

Age 30-50
Female
Pregnancy
Hobbies/occupations involving repetative wrist movement

205
Q

Which antiobiotic can predispose a person to achilles tendonitis?

A

Ciprofloxacin

Surgery (11 decks)

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