Unit 4: Minor Adult Disorders Flashcards
Describe the sites of the two common enthesopathies
Elbow - common flexor and extensor origins are the sites of the two common enthesopathies
Define the term enthesopathy
Enthesopathy refers to an inflammation of a muscle origin
Describe the management of a bunion
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
What is a bunion?
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
How would you manage an adolescent patient with hallux rigidus alone?
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
Give two possible aetiologies of frozen shoulder
Unaccustomed activity or a recent minor pull are both aetiologies of frozen shoulder
Describe the management of flat feet associated with pain
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
What is a neuroma?
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
Hallux valgus alone typically occurs in which age group?
Can occur at any age
Describe the management of an ingrown toenail
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)
What is the plantar fascia?
The plantar fascia is a tough layer of fibrous tissue which runs from the os calcis to each toe base
Describe the management of a neuroma
Excision
How would you manage the rupture of an Achilles tendon?
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
Describe the management of pain-free flat feet
Symptom-free flat feet are a normal variation and are benign, so should be ignored
Define the term neuropraxia
Neuropraxia is the term given to compression and stretching of a nerve
Describe the management of claw foot
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
Define plantar fascitis
Plantar fascitis includes a number of vague, but nevertheless incapacitating painful disorders of the foot
What characterises a self-limiting disorder?
A self-limiting disorder gets better spontaneously
Define the term ‘hammer toe’
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
Hallux valgus with rigidus typically occurs in which age group?
This is seen in older people where joint degeneration is usually secondary to the valgus deformity
Name the two groups of patients in which Achilles tendinitis is seen
Young athletes (overuse) and middle-aged men (degenerative)
Define metartarsalgia
Metatarsalgia is the term given to a patient presenting with generally sore forefeet
Name five structures often involved in shoulder disorders
The subacromial bursa, supraspinatus tendon, acromioclavicular joint, biceps tendon, the and rotator cuff as a whole are five structures often involved in shoulder disorders
What is the relationship between a corn and a bunion?
Both corns and bunions are formed as a reaction to higher than normal applied pressure
How would you manage hallux valgus with rigidus?
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
What is an enthesis?
An enthesis is the ligamentous origin of a muscle
How would you manage an adult patient with hallux rigidus alone?
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
What is the most common cause of extrinsic nerve entrapment?
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
Describe the management of plantar fascitis
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
Describe the management of hammer toe
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
Give two examples of an enthesopathy in the upper limb
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
How would you manage Achilles tendonitis in a young athelete?
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
Name 4 common sites of intrinsic nerve entrapment
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
Define sensory neuropathy
A sensory neuropathy is a loss of sensation caused by disease or injury to sensory peripheral nerves
How should people with sensory neuropathy look after their feet?
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
What does the term ‘painful arc’ mean?
A positive test for subacromial impingement is indicated if the patient reports shoulder pain in 60-120 degrees of abduction
Define the term tenosynovitis
Tenosynovitis is the term given to inflammation of tendons and their associated synovial sheaths and its cause is unknown
Define the term ‘claw foot’
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
List three common sites of nerve entrapment
The median nerve at the wrist, the ulnar nerve at the wrist or elbow and the posterior tibial nerve at the ankle
Define hallux rigidus
Hallus rigidus refers to osteoarthritis of the metatarsophalangeal joint
How would you manage halux valgus alone?
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
Define hallux valgus
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
What is a corn?
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
Hallux rigidus alone typically occurs in which age group?
Adolescents and adults
Describe the management of a corn
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
Define the term bursitis
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
