Unit 4: Minor Adult Disorders

Question 1

Describe the sites of the two common enthesopathies

Answer 1

Elbow - common flexor and extensor origins are the sites of the two common enthesopathies

Question 2

Define the term enthesopathy

Answer 2

Enthesopathy refers to an inflammation of a muscle origin

Question 3

Describe the management of a bunion

Answer 3

Bunions form as a natural response to pressure and indicate an underlying abnormality that should be treated rather than the bunion. Occasionally they become infected and need drainage, followed a few weeks later by treatment of the cause or a review of the footwear

Question 4

What is a bunion?

Answer 4

Bunions are a fluid-filled bursae which are found around bony prominences, commonly over the distal part of the first metatarsal and occasionally over the fifth

Question 5

How would you manage an adolescent patient with hallux rigidus alone?

Answer 5

Hallux rigidus in adolescents is said to be the result of an osteochondral fracture. Conservative treatment includes the use of a metatarsal bar. Surgical treatment (same as in adults) may be required

Question 6

Give two possible aetiologies of frozen shoulder

Answer 6

Unaccustomed activity or a recent minor pull are both aetiologies of frozen shoulder

Question 7

Describe the management of flat feet associated with pain

Answer 7

If associated with pain, a medial heel lift will correct the deformity of the hind part of the foot. If pain is a persistent problem, fusion of the subtalar joint will help

Question 8

What is a neuroma?

Answer 8

The cutaneous nerves to the toes may become trapped or irritated between the metatarsal heads giving rise to a neuroma. The cause is uncertain except that it is almost certainly secondary to repetitive trauma

Question 9

Hallux valgus alone typically occurs in which age group?

Answer 9

Can occur at any age

Question 10

Describe the management of an ingrown toenail

Answer 10

Careful nail care and straight cutting usually controls the condition. If chronic infection occurs, the nail may need to be removed (wedge resection or removal of the nail bed)

Question 11

What is the plantar fascia?

Answer 11

The plantar fascia is a tough layer of fibrous tissue which runs from the os calcis to each toe base

Question 12

Describe the management of a neuroma

Answer 12

Excision

Question 13

How would you manage the rupture of an Achilles tendon?

Answer 13

If the tendon ruptures it will heal if the ankle is kept in an equinus plaster for a minimum of eight weeks. The tendon can be sutured by open or closed suture

Question 14

Describe the management of pain-free flat feet

Answer 14

Symptom-free flat feet are a normal variation and are benign, so should be ignored

Question 15

Define the term neuropraxia

Answer 15

Neuropraxia is the term given to compression and stretching of a nerve

Question 16

Describe the management of claw foot

Answer 16

Clawing implies muscle weakness or deficiency, and is often associated with minor spinal abnormalities such as spina bifida occulta. This means claw toes should be approached with caution as far as surgery is concerned

Question 17

Define plantar fascitis

Answer 17

Plantar fascitis includes a number of vague, but nevertheless incapacitating painful disorders of the foot

Question 18

What characterises a self-limiting disorder?

Answer 18

A self-limiting disorder gets better spontaneously

Question 19

Define the term ‘hammer toe’

Answer 19

The term hammer toe is a description of the toe which looks like the end of a hammer. Hammer toes are secondary to disruption of the metatarsophalangeal joints

Question 20

Hallux valgus with rigidus typically occurs in which age group?

Answer 20

This is seen in older people where joint degeneration is usually secondary to the valgus deformity

Question 21

Name the two groups of patients in which Achilles tendinitis is seen

Answer 21

Young athletes (overuse) and middle-aged men (degenerative)

Question 22

Define metartarsalgia

Answer 22

Metatarsalgia is the term given to a patient presenting with generally sore forefeet

Question 23

Name five structures often involved in shoulder disorders

Answer 23

The subacromial bursa, supraspinatus tendon, acromioclavicular joint, biceps tendon, the and rotator cuff as a whole are five structures often involved in shoulder disorders

Question 24

What is the relationship between a corn and a bunion?

Answer 24

Both corns and bunions are formed as a reaction to higher than normal applied pressure

Question 25

How would you manage hallux valgus with rigidus?

Answer 25

These patients may be well satisfied by having their pain relieved by well-fitting, extra-depth shoes. If this fails, Keller’s arthroplasty may be suitable

Question 26

What is an enthesis?

Answer 26

An enthesis is the ligamentous origin of a muscle

Question 27

How would you manage an adult patient with hallux rigidus alone?

Answer 27

Conservative measures are rarely sufficient, and surgery is normally required. Surgical options include removal of the osteophytes with an osteotomy of the proximal phalanx, , surgical fusion in a neutral position, and inter-position arthroplasty with a silicone plastic spacer

Question 28

What is the most common cause of extrinsic nerve entrapment?

Answer 28

Patients in bed or in plaster casts are at risk from pressure on nerves, the most common site at risk is the common peroneal nerve as it winds around the head of the fibula

Question 29

Describe the management of plantar fascitis

Answer 29

Most cases are self-limiting. Soft shoes and insoles can relieve symptoms. If there is a marked tender point, a local injection of steroids and long-acting local anaesthetic can be very effective. Surgical options include stripping of the fascia from the os calcis, but this has unpredictable results

Question 30

Describe the management of hammer toe

Answer 30

Surgery to hammer toes includes fusion of the IPJs in a straight position, so that they do not rub on the toes. Often a good pair of soft and comfortable shoes is all that is required

Question 31

Give two examples of an enthesopathy in the upper limb

Answer 31

Golfer’s elbow - inflammation of the common origin of the flexor muscles in the forearm

Tennis elbow - inflammation of the common origin of the extensor muscles in the forearm

Question 32

How would you manage Achilles tendonitis in a young athelete?

Answer 32

Rest is usually adequate to recover, but if it is recurrent, a surgical decompression of the tissue surrounding the tendon will often eradicate the symptoms

Question 33

Name 4 common sites of intrinsic nerve entrapment

Answer 33

The median nerve at the wrist, the ulnar nerve at the elbow, the ulnar nerve at the wrist, and the posterior tibial nerve at the ankle

Question 34

Define sensory neuropathy

Answer 34

A sensory neuropathy is a loss of sensation caused by disease or injury to sensory peripheral nerves

Question 35

How should people with sensory neuropathy look after their feet?

Answer 35

They should regularly inspect their feet and make sure the nails are tidy. Footwear must be chosen with care and if necessary extra-depth shoes may be prescribed

Question 36

What does the term ‘painful arc’ mean?

Answer 36

A positive test for subacromial impingement is indicated if the patient reports shoulder pain in 60-120 degrees of abduction

Question 37

Define the term tenosynovitis

Answer 37

Tenosynovitis is the term given to inflammation of tendons and their associated synovial sheaths and its cause is unknown

Question 38

Define the term ‘claw foot’

Answer 38

The terms claw foot and claw toes describe a condition of the foot where wasted muscles make the bones and the toe nails appear more prominent

Question 39

List three common sites of nerve entrapment

Answer 39

The median nerve at the wrist, the ulnar nerve at the wrist or elbow and the posterior tibial nerve at the ankle

Question 40

Define hallux rigidus

Answer 40

Hallus rigidus refers to osteoarthritis of the metatarsophalangeal joint

Question 41

How would you manage halux valgus alone?

Answer 41

Management depends on age. Realignment of the first metatarsal to a more lateral position and excision of any bony prominence over the first metatarsal head gives satisfactory results at almost any age. Excision of the MTP joint (the Keller’s procedure) is to be avoided in the young and is probably unnecessary if the joint is not painful

Question 42

Define hallux valgus

Answer 42

Hallux valgus refers to the turning away of the phalanges of the big toe from the midline, usually because of a deformity at the joint line

Question 43

What is a corn?

Answer 43

A corn is a thick, hardened layers of skin that develops on the feet when the skin tries to protect itself against friction or pressure

Question 44

Hallux rigidus alone typically occurs in which age group?

Answer 44

Adolescents and adults

Question 45

Describe the management of a corn

Answer 45

The painful excessive corny skin may be superficially removed but in the long-term it will recur unless the underlying cause of the high pressure is removed

Question 46

Define the term bursitis

Answer 46

Inflammation of a bursa, a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body