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MSK Y2 > WK3-spine and paediatric orthopaedics > Flashcards

WK3-spine and paediatric orthopaedics Flashcards

1
Q

what are features of simple backache

A
  • age 20-55
  • lumbosacral region, buttocks and thighs
  • pain mechanical in nature - varies with time and activity
  • prognosis good as 90% better in 6 weeks
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2
Q

what is caudal equine syndrome

A

rare and serious spinal stenosis where all the nerves in the lower back suddenly become severely compromised

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3
Q

what are symptoms of cauda equina syndrome

A
  • sciatica on both sides
  • weakness or numbness in both legs that is severe or getting worse
  • numbness around or under your genitals, or around your anus
  • finding it hard to start peeing, can’t pee or can’t control when you pee – and this isn’t normal for you
  • you don’t notice when you need to poo or can’t control when you poo – and this isn’t normal for you
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4
Q

what are clinical features of inflammatory disorders

A
  • gradual onset
  • marked morning stiffness
  • persisting limitation of spinal movement in all directions
  • peripheral joint involvement
  • irits, skin rashes, colitis, urethral discharge
  • family history
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5
Q

what is a ganglion cyst

A

Lump near a joint capsule or tendon sheath commonly arising around the wrist. Its caused by a degenerative change within connective tissues

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6
Q

what is nodular fasciitis

A

Nodular fasciitis is a fast-growing lump in your soft tissue. Cellular proliferation of fibroblastic and myofibroblastic cells

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7
Q

what is myositis ossificans

A

Associated with insertions of large muscles of arms and legs. Its cellular proliferation but with evidence of bone formation and critically zonation. Similar to nodular fasciitis

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8
Q

what its superficial fibromatoses

A

Superficial fibromatosis is a non-cancerous tumour made up of a specialized type of connective tissue called fibrous tissue

  • M>F
  • average age 60
  • idiopathic
  • recognised associations = alcohol, DM and anticonvulsants
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9
Q

what is Dupuytrens

A

Dupuytren’s contracture (also called Dupuytren’s disease) is an abnormal thickening of the skin in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm.

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10
Q

what is tenosynovitis

A

Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Giant cell tumour of tendon sheath

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11
Q

what are the 3 features in grading of sarcomas

A
  • degree of differentiation
  • degree of proliferation: mitotic count
  • presence of coagulative necrosis
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12
Q

what are the regions of the vertebral column

A 
cervical 
thoracic 
lumbar 
sacral 
coccyx
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13
Q

how many vertebrae are in each section of vertebral column

A 
cervical 7
thoracic 12
lumbar 5
sacral 
coccyx 4
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14
Q

what is thoracic kyphosis

A

Kyphosis is an exaggerated, forward rounding of the upper spine

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15
Q

what is lumbar lordosis

A

Lumbar lordosis is the inward curve of the lumbar, or lower, spine in the lower back

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16
Q

what are the superficial (extrinsic) muscle layers of the back

A

muscles of the pectoral girdle and upper limb

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17
Q

what are the deep (intrinsic) muscles of the back

A
  • splenius
  • erector spinae
  • transversospinalis
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18
Q

what is the orientation of the cervical articular facets

A

superior - face posterosuperior

inferior - face anteroinferior

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19
Q

what is the orientation of the thoracic articular facets

A

superior - face posterolateral

inferior - face anteromedial

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20
Q

what is the orientation of the lumbar articular facets

A

superior - face medially

inferior - face laterally

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21
Q

what are features of referred leg pain

A
  • dull/knawing
  • buttock/thigh
  • rarely below the knee
  • ill defined sensory symptoms
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22
Q

what are features of root leg pain

A
  • sharp/shooting/electric
  • invariably below the knee to foot and ankle
  • anatomical sensory/motor symptoms
  • sciatica
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23
Q

higher the gross motor function the higher the …

A

risk of dislocation

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24
Q

what are the features of walking

A
  • muscles and or ground reactive forces provide the required force for motion
  • the skeleton provides the rigid lever-arm for the forces
  • the joints provide the action point at which movement occurs
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25
Q

what does normal motion depend on

A

an appropriate and adequate force acting via a rigid lever of appropriate length on a stable joint

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26
Q

what causes primary, secondary and tertiary cerebral palsy

A

primary - from injury to CNS
secondary - from growth
tertiary - “coping responses”

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27
Q

what is Congenital talipes equinovarus (CTEV)

A

Known as ‘club-foot’, is a common but little studied developmental disorder of the lower limb. It is defined as fixation of the foot in adduction, in supination and in varus, i.e. inclined inwards, axially rotated outwards and pointing downwards

28
Q

what is rocker bottom feet

A

Congenital vertical talus, sometimes called “rocker-bottom foot,” is a rare birth defect of the foot in which the talus bone has formed in the wrong position and other foot bones have shifted on top of it.

29
Q

what are red flags of leg pain

A
  • asymmetry
  • good localisation
  • short history
  • persisting limp
  • not thriving
  • pain worsening
30
Q

what is hereditary motor and sensory neuropathies

A

Hereditary motor and sensory neuropathies (HMSN) is a name sometimes given to a group of different neuropathies which are all characterized by their impact upon both afferent and efferent neural communication. HMSN are characterised by atypical neural development and degradation of neural tissue.

31
Q

how do longitudinal bones grow

A

longitudinal from the growth plate (physis) by enchondral ossification

32
Q

how do circumferential bones grow

A

circumferential from the periosteum by appositional growth

33
Q

what is normal development of a child

A 
6-9 months - sits alone and crawls 
8-12 months - stands 
14-17 months - walks 
24 months - jumps 
3 years - manages stairs alone
34
Q

what does varum mean

A

bow legged

35
Q

what does valgum mean

A

knock kneed

36
Q

what is blounts disease

A

Growth arrest of medial tibial physis of unknown aetiology. Blount’s disease is a condition found in children that affects the growth plates around the knee. The disease causes the growth plate near the inside of the knee to either slow down or stop making new bone. Meanwhile, the growth plate near the outside of the knee continues to grow normally.

37
Q

what is intoeing

A

child walks with toes pointing in AKA pigeon-toes

38
Q

what is the epidemiology of developmental dysplasia

A
  • females 8:1

- L>R hip

39
Q

what is the diagnosis of developmental dysplasia

A
  • early Dx essential
  • neonatal baby checks
  • selective US screening Scotland
    6-8 week GP check
40
Q

what is a baby hip examination

A
  • warm, relaxed, fed baby
  • inspection
    A. Asymmetry (leg lie)
    B. loss of knee height
    C. create asymmetry
    D. less abduction in flexion
  • moulded baby?
  • specific tests eg Barlows, Ortolani
41
Q

what is the Barlow test

A

The Barlow Maneuver is done by guiding the hips into mild adduction and applying a slight forward pressure with the thumb. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, again producing a palpable sensation of subluxation or dislocation.

42
Q

what is the Ortolani test

A

The examiner’s hands are placed over the child’s knees with his/her thumbs on the medial thigh and the fingers placing a gentle upward stress on the lateral thigh and greater trochanter area. With slow abduction, a dislocated and reducible hip will reduce with a described palpable “clunk.”

43
Q

what is early treatment of DDH

A

Pavlik harness

  • 23-24 hours a day for up to 12 weeks until USS is normal
  • night time splinting for a few more weeks
  • hips are abducted and flexed
44
Q

what is developmental dysplasia of the hip

A

Developmental dysplasia of the hip (DDH) is a condition where the “ball and socket” joint of the hip does not properly form in babies and young children.

45
Q

what is slipped upper femoral epiphysis

A

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing. For reasons that are not well understood, the ball at the head of the femur (thighbone) slips off the neck of the bone in a backward direction. This causes pain, stiffness, and instability in the affected hip. The condition usually develops gradually over time.

46
Q

what is the epidemiology of slipped upper femur ephisis

A
  • 1 in 10000
  • age 8-18
  • pubertal growth
  • weight
47
Q

what is the diagnosis of SCFE

A
  • hip/groin/thigh or knee pain
  • limp
  • Dx delayed or missed
  • Lifelong hip problems
  • £250K payout
48
Q

what is seen in the examination of SCFE

A
  • antalgic gait
  • lower limb
    short
    externally rotated
    loss of internal rotation
    loss of deep flexion
  • pain at extreme hip ROM
49
Q

what is transients synovitis

A

inflammation of the synovial, often secondary to a viral infection

50
Q

what is the patient presentation of transient synovitis

A
  • often Hx of viral illness
  • limp and hip/groin pain
  • may present with referred pain to knee
  • hip lying flexed/externally rotated
  • pain at end range of hip movements
  • usually symmetrically well, apyrexial
51
Q

how do you diagnose transient synovitis

A
  • Kochers criteria

- ultrasound +/- aspiration

52
Q

what is Perthes disease

A

avascular necrosis of the hip

53
Q

epidemiology of Perthes disease

A
  • 1/10000 children
  • 5x more common in males
  • most common in 4-8 yr olds
  • commoner in lower socioeconomic class
  • bilateral in 12% cases but never at the same time
54
Q

what is a typical patient of Perthes disease

A
  • delayed bone age
  • retarded growth soon after diagnoses later catch up growth
  • undersized at Dx
  • small hands and feet
  • 30% have attention disorder
55
Q

what is treatment of Perthes disease

A
  • containment
  • movement
  • seeing through fragmentation
  • restrictions
  • crutches/wheel chairs
  • healing
  • minimise degenerative changes
56
Q

what does sciatica mean

A

nerve pain in the leg that is caused by irritation and/or compression of the sciatic nerve. Sciatica originates in the lower back, radiates deep into the buttock, and travels down the leg.

57
Q

when would you give an MRI to a patient with back pain

A

only if red flags or is considering surgery (non resolving sciatica, spinal stenosis)

58
Q

what causes back pain

A
  • mechanical/non specific >90%
  • tumour/metastases - 0.7%
  • ankolysing spondolysis - 0.3%
  • infection - 0.01%
59
Q

what are red flags of back pain

A
  • age <20 or >50
  • thoracic pain
  • previous carcinoma (breast, bronchus, prostate)
  • immunocompromise (steroids, HIV)
  • feeling unwell
  • weight loss
  • widespread neurological symptoms
  • structural spinal deformity
60
Q

what features are in association with infection

A
  • rubor
  • calor
  • tumor
  • functio laesa - loss of capacity to function
61
Q

what are basic principles in diagnosis of infection

A
  • don’t start antibiotics until you know what you’re treating
  • get a specimen for culture and sensitivity
  • do not over rely on lab tests
  • choose your imaging correctly
  • speak to the right colleagues
62
Q

what is acute osteomyelitis

A

clinical term for a new infection in bone. This infection occurs predominantly in children and is often seeded hematogenously. In adults, osteomyelitis is usually a subacute or chronic infection that develops secondary to an open injury to bone and surrounding soft tissue

63
Q

what is chronic osteomyelitis

A

a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation

64
Q

what is septic arthritis

A

Septic arthritis is a serious type of joint infection. It should be treated as soon as possible.

65
Q

what is cellulitis

A

Cellulitis is an infection caused by bacteria getting into the deeper layers of your skin.

66
Q

what is necrotising fasciitis

A

Necrotising fasciitis is a rare but serious bacterial infection that affects the tissue beneath the skin and surrounding muscles and organs (fascia).

MSK Y2 (3 decks)

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