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MSK > Trauma ortho 3 > Flashcards

Trauma ortho 3 Flashcards

1
Q

What shoulder problem is commonly seen in patients in their teens/20s?

A

Fractures and instability

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2
Q

What shoulder problem is commonly seen in patients in their 30s and 40s?

A

Rotator Cuff problems and capsulitis

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3
Q

What shoulder problem is commonly seen in patients in their 50s and 60s?

A

Impingement

AC joint problems

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4
Q

What shoulder problem is commonly seen in patients in their 70s?

A

Degenerative rotator cuff problems and degenerative joints

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5
Q

Subacromial impingement definition (3)

A

Pain and dysfunction resulting from

  • pathology which decreases volume of subacromial space
  • pathology which increases size of subacromial content
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6
Q

Subacromial impingement treatment - 3 modalities

A

Subacromial steroid injection
Physiotherapy
Arthroscopic subacromial decompression

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7
Q

4 modalities of treatment in traumatic shoulder injury

MIPS

A

Manipulation
Immobilisation
Physiotherapy
Surgery

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8
Q

Rotator cuff injury - the 4 diseases in the spectrum

Rotator cuff tears can be acute or chronic - what’s the difference?

A
  1. Subacromial impingement aka impingement syndrome or painful arc syndrome
  2. Calcific tendonitis
  3. Rotator cuff tears
  4. Rotator cuff arthropathy

Acute tears happen when there is violent injury e.g. FOOSH

Chronic tears happen as we grow older (inability to heal fully) and in chronic overuse (baseball pitchers)

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9
Q

Rotator cuff tear vs impingement

A

Patients will normally describe weakness as well as pain in tears
Impingement - no weakness

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10
Q

Types of shoulder dislocation [3] - which is most common?

A

*Glenohumeral dislocation
Acromioclavicular dislocation
Sternoclavicular dislocato

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11
Q

Types of glenohumeral dislocation [4]

A

Anterior shoulder dislocation
Inferior shoulder dislocation
Posterior shoulder dislocation
Superior shoulder dislocation

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12
Q

Anterior shoulder dislocation
Mechanism of injury [2]
Clinical features [3]

A

External rotation and abduction, greater tuberosity #
35-40% recurrent
Bankart lesion, Hill-Sachs defect

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13
Q

Inferior shoulder dislocation is also known as

A

Luxatio erecta

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14
Q

Posterior shoulder dislocation. What are the 3 signs?

A

Rim’s sign, light bulb sign.

Associated with Trough sign

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15
Q

Adhesive capsulitis
Presentation of pain
SOCRATES

A

The pain is usually located over the outer shoulder area and sometimes the upper arm.
Dull or aching
It is typically worse early in the course of the disease and when you move your arm.

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16
Q

What are the 3 stages of adhesive capsulitis

A

Freezing - pain
Frozen - less pain but stiff
Thawing - recovery

17
Q

Adhesive capsulitis
Early presentation - treatment?
Late stages - treatment?

A

Early presentation - inject steroids

Late stages - surgery

18
Q

Rotator cuff tears can be traumatic or degenerative.
Acute rotator cuff tears = treatment?
Chronic degenerative tears = treatment?

A

Acute rotator cuff tears warrants early surgical treatment

Chronic degenerative tears should only be treated surgically if symptomatic

19
Q 
Elbow injuries
State the diseases that are most commonly found in these age groups:
Young
Middle age
Elderly
CTS
A

Young - fractures, dislocations
Middle age - tendinopathies
Elderly - degenerative diseases
CTS - any age

20
Q

Elbow pain differentials [4]

A 
Lateral epicondylitis (tennis)
Medial epicondylitis (golfers)
Radial tunnel syndrome
Cubital tunnel syndrome
Olecranon bursitis
21
Q

Lateral vs medial epicondylitis

A

Lateral:

  • pain worse on resisted wrist extension with elbow extended
  • pain worse on supination of forearm with elbow extended

Medial:
- opposite of this

22
Q

Medial epicondylitis features [3]

A
  1. pain and tenderness localised to the medial epicondyle
  2. pain is aggravated by wrist flexion and pronation
  3. symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
23
Q

Duration of symptoms for lateral epicondylitis
Etiology
Ep
Mx [4]

A 
6m - 2 years
Acute pain 6-12w
Ax: typically follows unaccustomed activity such as house painting or playing tennis 
Ep: 45-55 yo
Mx:
advice on avoiding muscle overload
simple analgesia
steroid injection
physiotherapy
24
Q

Radial tunnel syndrome
Ax [2]
Characteristics of pain [2]

A

Most commonly due to compression of the posterior interosseous branch of the radial nerve. It is thought to be a result of overuse.
Pain:
- pain tends to be around 4-5 cm distal to the lateral epicondyle
- symptoms may be worsened by extending the elbow and pronating the forearm

25
Q

Cubital tunnel syndrome can cause elbow pain
Ax
Symptoms [2]

A

Ax: Due to the compression of the ulnar nerve.
Symptoms:
- initially intermittent tingling in the 4th and 5th finger
may be worse when the elbow is resting on a firm surface or flexed for extended periods
- later numbness in the 4th and 5th finger with associated weakness

26
Q

Olecranon bursitis
Symptoms [2]
Ep

A

Swelling over the posterior aspect of the elbow.
There may be associated pain, warmth and erythema.

It typically affects middle-aged male patients.

27
Q 
Psoas abscess
Define
Complications [2]
Causative organism [2]
RF [4]
A 
Collection of pus within psoas muscle
Cx: septicemia, multiple organ failure
Causative organism: Staph or Strep
RF:
- HIV, cancer, DM
- TB
- previous surgery
- IVDU
28
Q

Psoas abscess presentation [5]

A

Presentation:

  • no ppt trauma/injury with pain that increases over several days
  • pain on hip movement
  • +/- fever
  • Comfortable lying on back with slightly flexed knees
  • inability to WB
29
Q

Psoas abscess
Ix [2]
Mx [2]

A

Investigation:

  • septic screen
  • MRI gold standard

Management:
- ab therapy
+/- drainage

30
Q

Iliopsoas abscess
Define
Causes: primary and secondary [6]
Increased mortality rate in secondary abscesses

A

An iliopsoas abscess describes a collection of pus in iliopsoas compartment (psoas and iliacus).

Primary

  • Haematogenous spread of bacteria
  • Staphylococcus aureus: most common

Secondary

  • Crohn’s (commonest cause in this category)
  • Diverticulitis, colorectal cancer
  • UTI, GU cancers
  • Vertebral osteomyelitis
  • Femoral catheter, lithotripsy
  • Endocarditis
31
Q

Iliopsoas abscess
Symptoms [4]
Position
Specific tests [2]

A

Symptoms

  • Fever
  • Back/flank pain
  • Limp
  • Weight loss

Position: supine with the knee flexed and the hip mildly externally rotated
Specific tests:
1. Place hand proximal to the patient’s ipsilateral knee and ask patient to lift thigh against your hand. This will cause pain due to contraction of the psoas muscle.
2. Lie the patient on the normal side and hyperextend the affected hip. This should elicit pain as the psoas muscle is stretched.

32
Q

Iliopsoas abscess
Ix
Mx [5]

A

Investigation
CT is the gold standard

Management
> Antibiotics
> Percutaneous drainage (successful 90%)
> Surgery indicated:
- failure of perc. drainage
- presence of other intra-abdominal pathology requiring surgery
33
Q

Discitis
Define
Complications [2]
Features [3]

A

Discitis is an infection in the intervertebral disc space.
Cx: sepsis or an epidural abscess
Features:
- Back pain
- General: pyrexia, rigors, sepsis
- Neuro:
e.g. changing lower limb neurology, if epidural abscess develops

34
Q

Discitis causative organism [4]

Dx [2]

A

Bacterial: Staph aureus is the most common cause of discitis
Viral
TB
Aseptic

Imaging:

  • MRI has the highest sensitivity
  • CT guided biopsy may be required to guide antimicrobial treatment
35
Q

Discitis mx

A

The standard therapy requires six to eight weeks of intravenous antibiotic therapy
Choice of antibiotic is dependent on a variety of factors. The most important factor is to identify the organism with a positive culture (e.g. blood culture, or CT guided biopsy)

MSK (28 decks)

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