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MSK Y2 > WK4 cortext - orthopaedics > Flashcards

WK4 cortext - orthopaedics Flashcards

1
Q

what is mechanical back pain

A

Implies that the pain is in the spine and/or supporting structures. This can be thought of as recurrent relapsing and remitting back pain with no neurological symptoms. The pain is worse on movement and relieved by rest.

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2
Q

what can cause mechanical back pain

A
  • obesity
  • poor posture
  • poor lifting technique
  • lack of physical activity
  • depression
  • degenerative disc prolapse
  • facet joint OA
  • spondylosis
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3
Q

what is spondylosis

A

when the invertebrate discs lose water content with age resulting in less cushioning and increased pressure on facet joints leading to secondary OA

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4
Q

what is treatment of mechanical back pain

A
  • analgesia
  • physiotherapy
  • urged to maintain normal function and return to work early
  • bed rest is not advised as will lead to stiffness and spasm
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5
Q

where can an acute tear of the lumbar spine occur

A

an acute tear can occur annulus fibrosis of an invertebrate disc which classically happens after lifting heavy objects. The periphery of the disc is richly innervated and pain can be severe

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6
Q

when is pain worse in acute disc tear of lumbar spine

A

on coughing (which increases disc pressure)

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7
Q

what is treatment for lumbar spine acute disc tear

A
  • analgesia

- physiotherapy

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8
Q

what can happen if a disc tears

A

the gelatinous nucleus pulpous can ‘herniate’ or ‘prolapse’ through the tear. Disc material can press on an exciting nerve root resulting in pain and altered sensation in dermatomal distribution as well as reduced power in myotomal distribution

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9
Q

what is sciatica

A

when the disc material presses on the L4,L5 and S1 nerve roots contributing to the sciatic nerve causing pain to radiate to the sensory distribution of the sciatic nerve

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10
Q

what is treatment for sciatica

A
  • analgesia
  • maintaining mobility
  • physiotherapy
  • occasionally drugs for neuropathic pain
  • very occasionally surgery (diseconomy) is indicated
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11
Q

what can osteoarthritis of the facet joints result in

A

results in osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica

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12
Q

how do you treat bony nerve root entrapment

A

surgical decompression with trimming pf the impinging osteophytes, may be performed in suitable candidates

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13
Q

what is spinal stenosis

A

With spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis, the cauda equina of the lumbar spine has less space and multiple nerve roots can be compressed/irritated

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14
Q

what are features of spinal stenosis and claudication

A
  • claudication
  • the claudication distance is inconsistent
  • the pain is burning
  • pain is less walking uphill (spine flexion creates more space for the cauda equina)
  • pedal pulses are preserved
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15
Q

what is the treatment for spinal stenosis

A

if symptoms fail to improve with conservative management (with physiotherapy and weight loss, if indicted) and there is MRI evidence of stenosis, surgery may be performed (decompression to increase space for the cauda equina) to help alleviate symptoms.

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16
Q

how is caudal equina syndrome caused

A

very large central disc prolapse can compress all the nerve roots of the caudal equina

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17
Q

why is caudal equina syndrome a medical emergency

A
  • affects the sacral nerve roots (S4 and S5) controlling defaecation and urination.
  • prolonged compression can potentially cause permanent nerve damage requiring colostomy and urinary diversion and urgent diseconomy way prevent this catastrophe
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18
Q

what are symptoms/signs of cauda equina syndrome

A
  • bilateral leg pain
  • paraesthesiae or numbness
  • “saddle anaesthesia”
  • altered urinary function
    faecal incontinance and constipation
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19
Q

what investigations are done for caudal equina syndrome

A
  • rectal examination
  • urgent MRI to determine level of prolapse
  • urgent diseconomy is required once the diagnosis is confirmed
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20
Q

what are red flags for spinal conditions

A
  1. back pain in the younger patient (<20 years)
  2. new back pain in the older patient (>60 years)
  3. nature of pain - constant, severe pain, worse at night
  4. systemic upset: fever, night sweats, weight loss, fatigue, malaise
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21
Q

what is treatment for osteoporotic crush fractures

A
  • usually conservative
  • ballon vertebroplasty (involves inserting a balloon into the vertebral body under fluoroscopic guidance, inflating a balloon to lift the cortices of the vertebral body)
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22
Q

how is cervical spondylosis caused

A

occurs when disc degeneration leads to increased loading and accelerated OA of the facet joints

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23
Q

what are features of cervical spondylosis

A
  • slow onset stiffness

- pain in neck which can radiate locally to shoulders and the occiput

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24
Q

what conditions can atraumatic cervical spine instability be seen

A

Down syndrome and rheumatoid arthritis

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25
Q

what is carpal tunnel syndrome

A

Carpal tunnel syndrome (CTS) is pressure on a nerve in your wrist. It causes tingling, numbness and pain in your hand and fingers. You can often treat it yourself, but it can take months to get better.

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26
Q

what causes carpal tunnel of the wrist

A
  • idiopathic
  • secondary to many conditions including rheumatoid arthritis and conditions resulting in fluid retention eg pregnancy, diabetes, chronic renal failure
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27
Q

what will patients present with with carpal tunnel syndrome

A
  • parathesiae in the median nerve innervated digits (thumb and radial 2 1/2 fingers) which is usually worse at night
  • loss of sensation and sometimes weakness of the thumb or clumsiness in the areas of the hand supplied by the median nerve
  • muscle wasting
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28
Q

how do you treat carpal tunnel syndrome

A

non operative - wrist splints at night to prevent flexion. Injection of corticosteroid can also be used

surgical treatment - carpal tunnel decompression involves division of the transverse carpal ligament under local anaesthetic

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29
Q

what causes cubital tunnel syndrome

A

involves compression of the ulnar nerve at the elbow behind the medial epicondyle (“funny bone” area)

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30
Q

what are signs and symptoms of cubital tunnel syndrome

A
  • paraesthesiae in the ulnar 1 1/2 fingers and Tinels test over the cubital tunnel is usually positive
  • weakness of ulnar nerve innervated muscles may be present including the 1st dorsal interosseous (abduction finger) and adductor pollicis
31
Q

what is osteogenesis imperfecta

A

“brittle bone disease”

defect of the maturation and organisation of type 1 collagen (which accounts for most of the organic composition of the bone)

32
Q

what are features of osteogenesis imperfecta

A
  • autosomal dominant
  • multiple fragility fractures of childhood
  • short stature with multiple deformities
  • blue sclera
  • loss of hearing
33
Q

what is seen on an X-ray of osteogenesis imperfecta

A
  • bone tends to be thin (gracile)
  • thin cortices
  • osteopenic
  • mild cases have relatively normal X-rays
34
Q

what is skeletal dysplasia

A

medical term for short stature

35
Q

what causes skeletal dysplasia

A

genetic error resulting in abnormal development of bone and connective tissue

36
Q

what is achondroplasia

A
  • most common type of skeletal dysplasia
  • results in disproportionality short limbs with a prominent forehead and widened nose
  • joints are lax
  • mental development is normal
37
Q

what is Marfans syndrome

A
  • autosomal dominant or sporadic mutation of the fibrillar gene
  • results in tall stature with disproportionately long limbs and ligamentous laxity
38
Q

what are features of Marfans syndrome

A
  • high arched palate
  • scoliosis
  • flattening of chest
  • eye problems (lens dislocations and retinal detachment)
  • aortic aneurysm
  • cardiac valve incompetence
39
Q

what is Ehlers-Danlos syndrome

A
  • heterogenous condition

- often autosomal dominantly inherited with abnormal elastin and collagen formation

40
Q

what are clinical features of Ehlers-Danlos syndrome

A
  • profound joint hypermobility
  • vascular fragility with ease of bruising
  • joint instability
  • scoliosis
41
Q

who do muscular dystophies affect

A

boys as its X-linked recessive

42
Q

what causes Duchenne muscular dystrophy

A

Defect in the dystrophin gene involved in calcium transport

43
Q

what is Gowers sign

A

Gowers’s sign is a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to “walk” up their own body from a squatting position due to lack of hip and thigh muscle strength.

44
Q

what are clinical features of Duchenne muscular dystrophy

A

progressive muscle weakness follows and by the age of 10 or so he can no longer walk and my age 20 progressive cardiac and respiratory failure develop with death typically by early 20’s

45
Q

how do you diagnose Duchenne muscular dystrophy

A
  • raised serum creatine phosphokinase and abnormalities on muscle biopsy
  • physiotherapy, splintage and deformity correction may prolong mobility
  • severe scoliosis may be corrected by spinal surgery
46
Q

what is cerebral palsy

A

a neuromuscular disorder with onset before 2-3 years due to an insult to the immature brain before, during or after birth

47
Q

what causes cerebral palsy

A
  • genetic problems
  • brain malformation
  • intrauterine infection in early pregnancy
  • prematurity
  • intra cranial haemorrhage
  • hypoxia during birth
  • meningitis
48
Q

what are clinical features of cerebral palsy

A

Possible signs in a child include:

delays in reaching development milestones – for example, not sitting by 8 months or not walking by 18 months
seeming too stiff or too floppy (hypotonia)
weak arms or legs
fidgety, jerky or clumsy movements
random, uncontrolled movements
muscle spasms
shaking hands (tremors)
walking on tiptoes
49
Q

what is Erbs palsy

A

injury to the upper 9C5/C60 nerve roots resulting in loss of motor innervation of the deltoid, suprapinatus, infraspinatus, bicep and Brachialis muscles.

50
Q

what are clinical features of Erbs palsy

A

internal rotation of the humerus (from unopposed subscapularis) and may lead to classic waiters tip posture.

51
Q

what is Klumpkes palsy

A

lower brachial plexus injury (C8 and T1 roots) caused by forceful adduction which results in paralysis of the intrinsic muscles +/- finger and wrist flexors and possible Horners syndrome. The fingers are typically flexed

52
Q

what is the progression in shape of knees/legs of a child from birth to age 9

A

birth = varus knees (bow legged)
14 months = neutrally aligned
age 3 = 10-15 degrees valgus (knock kneed)
age 7-9 = physiologic 6 degrees

53
Q

what is in-toeing

A

child who, when walking and standing will have feet that point towards the midline. Often exaggerated when running and children are felt by their parents to be clumsy and wear through shoes at an alarming rate

54
Q

what is femoral neck anteversion

A

as part of normal anatomy the femoral neck is slightly anteverted (pointing forwards). Excess femoral neck anteversion can give the appearance of in‐toeing (as well as knock knees). However the degree of apparent in‐toeing is not of a magnitude which would warrant surgical intervention.

55
Q

what are mobile/flexible feet

A

flattened medial arch from with dorsiflexion of the great toe. May be related to ligamentous laxity, may be familial or may be idiopathic

56
Q

what are rigid type flat footedness

A

the arch remains flat regardless of load or the great toe dorsiflexion. This implies there is an underlying bony abnormality which may require surgery

57
Q

what are curly toes

A

minor overlapping of the toes and curing of the tows is common with the fifth toe. Most will correct without intervention

58
Q

what is developmental dysplasia of the hip

A

involves dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint

59
Q

what is the epidemiology for developmental dysplasia of the hip

A
  • 5/1000 babies
  • girls>boys
  • left hip more common
60
Q

what are risk factors for DDH

A
  • first born
  • breech presentation
  • dawn syndrome
  • prescience of congenital disorders
61
Q

what are clinical features of DDH

A

shortening, asymmetric groin/thigh skin creases, click or clunk on the Ortolani or Barlow manoeuvre

62
Q

what is treatment for DDH

A

The Pavlik harness is used full‐time for around 6 weeks and part‐time for a further 6 weeks once the hip is confirmed to be stable. A Pavlik harness can be used up to around 4‐6 months of age and the success rate is 85‐95%.

63
Q

what is transient synovitis of the hip

A

elf‐limiting inflammation of the synovium of a joint, most commonly the hip

64
Q

when does transient synovitis of the hip occur after

A

shortly after an upper respiratory tract infection

65
Q

how do you treat transient synovitis

A

NSAIDs and rest

66
Q

what is Perthes disease

A

an idiopathic osteochondrosis of the femoral head which usually occurs between the ages of 4-9 and more common in active boys with short stature

67
Q

what happens in Perthes disease

A

the femoral head loses blood supply resulting in necrosis with subsequent abnormal growth. The femoral head may collapse of fracture. Subsequent remodeling occurs however the shape of the femoral head and congruence of the joint is determined by age of onset (with older children faring worse) and the amount of collapse. In incongruent joint will lead to early onset of arthritis and severe cases may require hip replacement in adolescence or early adulthood.

68
Q

what are clinical features of Perthes disease

A

Affected children present with pain and a limp. Most cases are unilateral and bilateral cases may represent an underlying skeletal dysplasia or a thrombophilia. Loss of internal rotation is usually the first clinical sign followed by loss of abduction and later on a positive Trendellenburg test from gluteal weakness.

69
Q

what is slipped upper femoral epiphysis

A

ondition mainly affecting overweight pre‐pubertal adolescent boys where the femoral head epiphysis slips inferiorly in relation to the femoral neck

70
Q

what are clinical features of SUFE

A

Cases can be acute (sudden onset), chronic or acute‐on‐chronic. Patients have pain and a limp. The pain may be felt in the groin (like other hip pathology) however the major pitfall is that patients can present purely with pain in the knee (due to the obturator nerve supplying both the hip and knee joint) and the diagnosis can be missed as an unwary clinician may fail to examine the hip, concentrating solely on the knee and treat as a benign knee condition. Loss of internal rotation of the hip is the predominant clinical sign. Xray changes may be subtle and a lateral view must be obtained to detect mild degrees of slip.

71
Q

what is the treatment of SUFE

A
  • urgent surgery to pin the femoral head to prevent further slippage
72
Q

what is talipes equinovarus (clubfoot)

A

congenital deformity of the foot affecting 1 in 800 births and is due to in utero abnormal alignment of the joints between the talus, calcaneus and navicular.

73
Q

what are clinical features of talipes equinovarus

A

The abnormal alignment of these joints results in contractures of the soft tissues (ligaments, capsule & tendons) resulting in a deformity consisting of ankle equinus (plantarflexion), supination of the forefoot and varus alignment of the forefoot which are not immediately correctable.

74
Q

who is likely to get clubfoot

A

Boys are twice as commonly affected than girls, there may be a genetic link with a positive family history and it is more common in breech presentation. Oligohydramnios (low amniotic fluid content) is another risk factor and it is occasionally part of another skeletal dysplasia.

MSK Y2 (3 decks)

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