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Musculoskeletal System > Disease Profiles 4 > Flashcards

Disease Profiles 4 Flashcards

1
Q

Patellar Dislocation: Aetiologies (2)

A

Rapid turn or direct blow
Sudden quadriceps contraction with a flexing knee

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2
Q

Patellar Dislocation: Most common group

A

Teenagers

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3
Q

Patellar Dislocation: Sex Epidemiology

A

More common in females

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4
Q

Patellar Dislocation: Always dislocates in what direction?

A

Lateral

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5
Q

Patellar Dislocation: Risk Factors (5)

A

Ligamentous laxity or hypermobility
Increased Q angle
High riding patella
Hypoplastic lateral femoral condyle
Lateral quads insertion or weak vastus medialis

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6
Q

Patellar Dislocation: Causes of an Increased Q angle (2)

A

Genu valgum
Femoral neck anteversion

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7
Q

Patellar Dislocation: Clinical Presentation

A

History of patella dislocating laterally with often self-relocation

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8
Q

Patellar Dislocation: Pain where? - why is this?

A

Medial pain due to torn medial patella retinaculum tendon

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9
Q

Patellar Dislocation: Sign on examination

A

Patella apprehension test positive

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10
Q

Patellar Dislocation: X-ray appearance is accompanied by what?

A

Lipo-haemarthosis

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11
Q

Patellar Dislocation: What may suggest osteochondral fracture on X-ray?

A

Small opacification

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12
Q

Patellar Dislocation: Management - May spontaneously reduce how?

A

Knee is straightened

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13
Q

Patellar Dislocation: Management - When is aspiration required?

A

Intractable pain with swelling

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14
Q

Patellar Dislocation: Risk of recurrent dislocation

A

10%

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15
Q

Patellar Dislocation: What may occur as the patella dislocates? (2)

A

Medial patellofemoral ligament tears
Osteochondral fracture

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16
Q

Patellar Dislocation: Why may medial patellofemoral ligament tears and osteochondral fractures occur?

A

Medial facet of the patella may strike the lateral femoral condyle

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17
Q

Patellar Dislocation: Options for surgery if recurrent dislocation (2)

A

Lateral release
Medial patellofemoral ligament reconstruction

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18
Q

Patellofemoral Pain Syndrome: Alternative name

A

Idiopathic Adolescent Anterior Knee Pain Chondromalacia Patellae

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19
Q

Patellofemoral Pain Syndrome: Aetiologies (5)

A

Gluteal weakness
Tightness of lateral tissues
Bony malalignment due to valgus or internal rotation
Flat feet
Obvious patellar maltracking

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20
Q

Patellofemoral Pain Syndrome: Often related to what other diagnoses? (3)

A

Chondromalacia patellae - softening of the hyaline cartilage
Adolescent anterior knee pain
Lateral patellar compression syndrome

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21
Q

Patellofemoral Pain Syndrome: Clinical presentation

A

Anterior knee pain that is worse on walking downhill

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22
Q

Patellofemoral Pain Syndrome: What sign may be observed after long periods of sitting?

A

Pseudolocking - grinding or clicking at the front of the knee with stiffness and stiffens in a flexed position

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23
Q

Patellofemoral Pain Syndrome: Management

A

Physiotherapy aimed at rebalancing the quadriceps muscles - Vastus Medialis Oblique Muscles

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24
Q

Extensor Mechanism Rupture: The extensor mechanism of the knee constitutes what 5 components?

A

Tibial tuberosity
Patellar tendon
Patella
Quadriceps tendon
Quadriceps muscles

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25
Q

Extensor Mechanism Rupture: More common in what population group?

A

Middle aged population that participate in running or jumping sports

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26
Q

Extensor Mechanism Rupture: Mechanism of injury

A

Falling onto a flexed knee with quadricep contraction

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27
Q

Extensor Mechanism Rupture: Patellar tendon ruptures tend to occur in what population groups?

A

Younger age groups - <40 years old

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28
Q

Extensor Mechanism Rupture: Quadriceps tendon ruptures tend to occur in what population groups?

A

Older age groups - >40 years old

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29
Q

Extensor Mechanism Rupture: Risk Factors (6)

A

Previous tendonitis
Steroid use or abuse
Chronic renal failure
Ciprofloxacin
Diabetes
Rheumatoid arthritis

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30
Q

Extensor Mechanism Rupture: How does Ciprofloxacin cause this?

A

Quinolone antibiotics can cause tendonitis

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31
Q

Extensor Mechanism Rupture: Clinical Presentation - Symptoms (2)

A

Knee pain
Weakness

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32
Q

Extensor Mechanism Rupture: Signs - Unable to perform what?

A

Straight leg raise

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33
Q

Extensor Mechanism Rupture: Signs - What can be palpated?

A

Palpable gap in the extensor mechanism

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34
Q

Extensor Mechanism Rupture: Diagnosis - X-rays may show what? (2)

A

Effusion or patella sitting in the wrong place

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35
Q

Extensor Mechanism Rupture: Diagnosis - Where does patella sit in Patellar tendon rupture?

A

High

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36
Q

Extensor Mechanism Rupture: Diagnosis - Where does the patella sit in Quadriceps tendon rupture?

A

Low

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37
Q

Extensor Mechanism Rupture: Management - Requires what urgent intervention?

A

Surgical repair

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38
Q

Extensor Mechanism Rupture: Management - Small partial tear

A

Immobilisation and Physiotherapy

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39
Q

Extensor Mechanism Rupture: What management should be avoided in Tendonitis of the extensor mechanism of the knee?

A

Steroid injections - high risk of tendon rupture

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40
Q

Osteochondritis Dissecans

A

An area of the surface of the knee loses its blood supply and cartilage +/- bone fragmentation

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41
Q

Osteochondritis Dissecans: Most common in what age groups?

A

Adolescents

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42
Q

Osteochondritis Dissecans: Clinical presentation (2)

A

Knee pain
Recurrent effusions of the knee

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43
Q

Osteochondritis Dissecans: Diagnostic tests

A

X-ray and MRI

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44
Q

Osteochondritis Dissecans: When is an MRI utilised?

A

If detachment is present and it can be localised

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45
Q

Osteochondritis Dissecans: Management - if detached

A

Can fix or remove

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46
Q

Osteochondritis Dissecans: Management for severe cases (2)

A

Cartilage regeneration or Osteochondral allograft

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47
Q

Loose Bodies

A

Detachment of a fragment of cartilage +/- bone causing a loose body within a joint

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48
Q

Loose Bodies: Aetiologies (3)

A

Trauma
Osteochondritis dissecans
Joint degeneration

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49
Q

Loose Bodies: How do they grow?

A

Nutrition from synovial fluid enables growth

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50
Q

Loose Bodies: What may they stick to become no longer loose?

A

Synovium or fat pad

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51
Q

Loose Bodies: Typical history

A

History of mobile lump or sharp occassional pain with locking or catching

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52
Q

Loose Bodies: Diagnosis - Presentation on X-ray

A

Opacification

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53
Q

Loose Bodies: Diagnosis - Fabella

A

Accessory ossicle in the lateral head of the gastrocnemius commonly misdiagnosed as a loose body

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54
Q

Loose Bodies: Diagnosis - What view is used to distinguish if it is loose?

A

Sagittal

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55
Q

Loose Bodies: Management

A

Arthroscopic removal

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56
Q

Baker’s Cyst

A

Ganglion cyst found within the popliteal fossa due to inflammation and swelling of the semi-membranoosus bursa

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57
Q

Baker’s Cyst: Pathophysiology

A

Joint fluid escapes through a communication to bursa under the medial gastrocnemius or semi-membranosus

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58
Q

Baker’s Cyst: In adults this may occur due to what pathologies? (2)

A

Intra-articular - Osteoarthritis or Meniscal tear

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59
Q

Baker’s Cyst: Clinical presentation (3)

A

Popliteal discomfort
Tightness
Acute calf pain and swelling

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60
Q

Shoulder Instability

A

Instability of the shoulder involving painful abnormal translational movement or subluxation or recurrent dislocation

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61
Q

Shoulder Instability: Most common age group

A

Teenagers to 30 year olds

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62
Q

Shoulder Instability: Two types

A

Traumatic instability
Atraumatic instability

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63
Q

Shoulder Instability: Traumatic instability

A

Instability following a traumatic anterior dislocation leading to recurrent dislocations and subluxations

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64
Q

Shoulder Instability: Atraumatic instability

A

Instability due to generalised ligamentous laxity with pain due to recurrent multi-directional subluxations or dislocations

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65
Q

Shoulder Instability: Examples of causes of generalised ligamentous laxity (2)

A

Ehlers-Danlos Syndrome
Marfan’s Syndrome

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66
Q

Shoulder Instability: Symptoms

A

Atraumatic laxity or subluxations that are not painful

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67
Q

Shoulder Instability: Visual examination findings (3)

A

Abnormal shoulder contour
Muscle wasting
Scapular winging or Dyskinesia

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68
Q

Shoulder Instability: Management - Traumatic instability

A

Open or arthroscopic Bankart repair - reattaches the labrum and capsule to the anterior glenoid which was torn off in the first dislocation

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69
Q

Shoulder Dislocation: Why is this the most common joint dislocation?

A

The head of the humerus is substantially larger than the glenoid fossa

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70
Q

Shoulder Dislocation: Most common in what age group?

A

Teenagers to 30 years old

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71
Q

Shoulder Dislocation: Most common mechanisms of injury (2)

A

Fall
Traction injury

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72
Q

Shoulder Dislocation: Most common type

A

Anterior Shoulder Dislocation

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73
Q

Shoulder Dislocation: Anterior Dislocation description

A

Humeral head is anterior to the glenoid fossa

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74
Q

Shoulder Dislocation: Mechanism of injury for anterior dislocation

A

Fall with shoulder in external rotation

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75
Q

Shoulder Dislocation: Anterior dislocation can result in compromise of what?

A

The axillary artery

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76
Q

Shoulder Dislocation: Anterior Dislocation - Requires assessment of what?

A

Axillary nerve

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77
Q

Shoulder Dislocation: Causes of anterior dislocation (2)

A

Traumatic cause
Sports injury

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78
Q

Shoulder Dislocation: Posterior Dislocation - Aetiologies (2)

A

Epileptic fit
Electrocution

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79
Q

Shoulder Dislocation: Posterior Dislocation - Description

A

Humeral head posterior to the glenoid fossa

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80
Q

Shoulder Dislocation: Posterior Dislocation - Mechanism of injury

A

Fall with shoulder in the anterior location

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81
Q

Shoulder Dislocation: Inferior Dislocation - Description

A

Humeral head is inferior to the glenoid fossa

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82
Q

Shoulder Dislocation: Inferior Dislocation - Mechanism of injury

A

Shoulder is forced into hyperabduction

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83
Q

Shoulder Dislocation: Inferior Dislocation - Why is prompt neurovascular assessment required?

A

Due to the proximity of the brachial plexus

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84
Q

Shoulder Dislocation: Clinical presentation

A

Severe shoulder pain with an ability to move the shoulder

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85
Q

Shoulder Dislocation: Main difference in clinical presentation if chronic condition?

A

Not painful so requires no support

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86
Q

Shoulder Dislocation: Two possible investigations (2)

A

X-ray
MR Anthrogram

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87
Q

Shoulder Dislocation: X-Rays - What views are required?

A

AP shoulder
Garth view - Apical Oblique

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88
Q

Shoulder Dislocation: X-Rays - Posterior dislocation has what problem?

A

Lack of displacement makes it difficult to view

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89
Q

Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Emergency situations (2)

A

Analgesia or Sedation via IV
Oxygen

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90
Q

Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Reduction mechanisms (3)

A

Kocher Method
Hippocratic Method
Stimson Method

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91
Q

Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Kocher Method

A

Patient lies in supine position with the arm abducted and elbow flexed at 90 degrees, the practitioner then provides external rotation until a resistance and adduction is felt

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92
Q

Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Hippocratic Method

A

The practitioner holds the affected limb by the forearm and hand of the patient and the heel of the practitioner is put in the patients axilla whilst the arm is adducted

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93
Q

Shoulder Dislocation: Management of Anterior Shoulder Dislocation - Stimson Method

A

The patient lies in a prone position with the arm hanging off the table and a downward traction is applied to the arm for 10-20 minutes to fatigue the shoulder musculature

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94
Q

Shoulder Dislocation: Management - Post-reduction treatment

A

2-3 weeks in a sling with early mobilisation and physiotherapy

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95
Q

Shoulder Dislocation: Management - TIme without driving

A

8-10 weeks

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96
Q

Shoulder Dislocation: Management - Time without heavy lifting

A

12 weeks

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97
Q

Shoulder Dislocation: Management - Return to sport period if no contact

A

12 weeks

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98
Q

Shoulder Dislocation: Management - Return to sport period if contact

A

6 weeks

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99
Q

Shoulder Dislocation: Complications - 4 examples

A

Bankart lesion
Hill Sachs
Bony Bankart Lesion
Rotator Cuff Tears

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100
Q

Shoulder Dislocation: Complications - Bankart Lesion definition and management

A

Lesion of the labrum
Arthroscopic or open stabilisation

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101
Q

Shoulder Dislocation: Complications - Hill Sachs definition

A

Fracture to the humeral head

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102
Q

Shoulder Dislocation: Complications - Bony Bankart Lesion definition

A

Fracture of the Glenoid

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103
Q

Mucous Cyst of the Hand

A

Outpouching of Synovial Fluid from the DIPJ

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104
Q

Mucous Cyst of the Hand: Management

A

Excision via advancement or a rotation flap

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105
Q

Shoulder Impingement: Most common in what age group

A

Patients under 25 years old

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106
Q

Shoulder Impingement: Can occur in the older population due to what?

A

Degenerative changes or acromioclavicular bony changes

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107
Q

Shoulder Impingement

A

Inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space

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108
Q

Shoulder Impingement: Clinical Presentation (3)

A

Pain
Weakness
Reduced range of motion within the shoulder

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109
Q

Shoulder Impingement: Intrinsic Mechanisms - 3 causes

A

Muscular weakness
Overuse of the shoulder
Degenerative tendinopathy

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110
Q

Shoulder Impingement: Intrinsic Mechanisms - Muscular weakness pathophysiology

A

Weakness of the rotator cuff muscles can lead to the humerus shifting proximally towards the body

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111
Q

Shoulder Impingement: Intrinsic Mechanisms - Overuse of the shoulder pathophysiology

A

Repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa

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112
Q

Shoulder Impingement: Intrinsic Mechanisms - Degenerative Tendinopathy pathophysiology

A

Degenerative changes of the acromion can lead to tearing of the rotator cuff allowing the proximal migration of the humeral head

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113
Q

Shoulder Impingement: Extrinsic Mechanisms - 3 pathophysiology mechanisms

A

Anatomical factors
Scapular musculature
Glenohumeral instability

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114
Q

Shoulder Impingement: Extrinsic Mechanisms - Scapular musculature pathophysiology

A

Reduction in function of the scapular muscles may result in a reduction in the size of the subacromial space

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115
Q

Shoulder Impingement: Extrinsic Mechanisms - Glenohumeral instability pathophysiology

A

Instability leads to superior subluxation of the humerus to cause an increased contact between the acromion and subacromial tissues

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116
Q

Shoulder Impingement: Rotator Cuff Tendonitis Pathophysiology

A

Repeated impingement results in inflammation or damage to the rotator cuff tendons

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117
Q

Shoulder Impingement: Subacromial Bursitis pathophysiology

A

Calcification of the tendon induces inflammation of the subacromial bursa

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118
Q

Shoulder Impingement: How does subacromial bursitis cause shoulder impingement to become worse?

A

Inflammed tendons rub against the acromium and clavicoacromial joints and ligaments

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119
Q

Shoulder Impingement: Neers Classification definition

A

Divides the proximal humerus into 4 segments - head, greater tuberosity, lesser tuberosity or shaft) to classify fractures

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120
Q

Shoulder Impingement: Neer’s Classification - Type I

A

<25 years of age - has inflammation, oedema and haemorrhage

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121
Q

Shoulder Impingement: Neer’s Classification - Type II

A

25-40 years - has fibrosis and tendonitis of the bursa or cuff

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122
Q

Shoulder Impingement: Neer’s Classification - Type III

A

> 40 years - has partial or full thickness tears with degeneration of the rotator cuff

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123
Q

Shoulder Impingement: Clinical Presentation - Symptoms (4)

A

Progressive pain in the anterior superior shoulder
Pain radiatesto the deltoid and upper arm
Difficulty sleeping on affected side, reaching overhead and lifting
Pain exacerbated by abduction and relieved by rest

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124
Q

Shoulder Impingement: Clinical Presentation - Sign on palpation

A

Tenderness below the lateral edge of the acromion

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125
Q

Shoulder Impingement: Clinical Presentation - Tests for this (3)

A

Hawkins-Kennedy Test
Jobes Test
Painful arc

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126
Q

Shoulder Impingement: Diagnostic Test

A

X-Ray - AP and Apical Oblique views

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127
Q

Shoulder Impingement: Diagnosis - May show what on X-Ray?

A

Bone spur

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128
Q

Shoulder Impingement: Management - Conservative options (4)

A

Rest
Analgesia
Physiotherapy
Corticosteroid Injections into Subacromial Space

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129
Q

Shoulder Impingement: Management - When is surgery considered?

A

After a minimum of 6 months non-operative management

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130
Q

Shoulder Impingement: Management - What surgery is available? (5)

A

Main option - Subacromial Decompression
Subacromial or Subdeltoid bursectomy
Release of coracoacromial ligaments
Release of calcific deposits
Excision of Intraclavicular spurs

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131
Q

Shoulder Impingement: What is it likely to be in <30 year olds?

A

Rotator cuff tendonitis or Subacromial bursitis

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132
Q

Shoulder Impingement: What is it likely to be in 30-40 year olds?

A

Calcific tendonitis

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133
Q

Shoulder Impingement: What is it likely to be in 40-50 year olds?

A

Tendinosis or a partial tear of the rotator cuff

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134
Q

Shoulder Impingement: What is it likely to be in 50-60 year olds?

A

Rotator Cuff Tear

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135
Q

Shoulder Impingement: What is it likely to be in >70 year olds?

A

Cuff Arthropathy

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136
Q

Watershed Areas

A

Areas of the body that receives dual blood supply from the most distal areas of two arteries

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137
Q

Hawkins Test

A

With the shoulder flexed forward and the elbow bent the arm is internally rotated
A positive test demonstrates pain

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138
Q

Jobes Test

A

With the shoulder abducted and slightly flexed forward, the patient is instructed to rotate the hand to point their thumb towards the floor and then try to maintain this whilst the physician pushes down - positive result shows muscle weakness.

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139
Q

Shoulder Impingement: If Jobes test causes pain but no weakness what is likely?

A

Supra-spinatus impingement

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140
Q

Ganglions

A

Outpouchings of the synovial lining of joints and filled with synovial fluid

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141
Q

Ganglions: More common over what joints?

A

Synovial

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142
Q

Ganglions: Management normal

A

Usually self-resolving

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143
Q

Ganglions: Management options if it does not resolve?

A

Aspiration or Excision

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144
Q

Ganglions: Why are they not a true cyst?

A

No epithelial lining

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145
Q

Ganglions: Histological appearance

A

Space with myxoid material

146
Q

Ganglions: Visual presentation

A

Well-defined round swellings that are up to a few cm wide

147
Q

Ganglions: They can readily ..

A

Transluminate

148
Q

Trigger Finger

A

Swelling on the flexor tendon sheath leading to irritation causing the tendon to get caught on the edge of the A1 pulley

149
Q

Trigger Finger: More common in what sex?

A

Females

150
Q

Trigger Finger: Typically occurs in what age?

A

50+ years old

151
Q

Trigger Finger: More common in what patient groups?

A

Diabetic

152
Q

Trigger Finger: What do the tendons run within?

A

Flexor tendon sheath

153
Q

Trigger Finger: Pathway Stages (4)

A
  1. Stenosing tenosynovitis
  2. Fibrocartilaginous metaplasia
  3. Nodule of FDS Tendon
  4. Nodule catches on the A1 pulley - this causes the trigger
154
Q

Trigger Finger: Main 3 symptoms

A

Irritation
Swelling
Pain over the A1 pulley on the metacarpal head

155
Q

Trigger Finger: Pain over the A1 pulley MC head causes what?

A

Sticking of the finger usually in a flexion position

156
Q

Trigger Finger: Management - Conservative

A

Either resolves spontaneously or splint to prevent flexion

157
Q

Trigger Finger: Management - What is the tendon sheath injection?

A

Steroid with local anaesthetic

158
Q

Trigger Finger: Management - What surgery is available?

A

Divide the A1 pulley
Can have general or local anaesthetic

159
Q

Carpal Tunnel Syndrome

A

Peripheral neuropathy causes by acute or chronic compression of the median nerve by the transverse carpal ligament

160
Q

Carpal Tunnel Syndrome: Can occur secondary to what conditions? (3)

A

Rheumatoid Arthritis
Acromegaly
Conditions resulting in fluid retention

161
Q

Carpal Tunnel Syndrome: Examples of conditions resulting in fluid retention (4)

A

Pregnancy
Diabetes mellitus
Chronic renal failure
Hypothyroidism

162
Q

Carpal Tunnel Syndrome: Can be a consequence of … to the wrist

A

Fractures

163
Q

Carpal Tunnel Syndrome: More common in what sex?

A

Females

164
Q

Carpal Tunnel Syndrome: What is the carpal tunnel of the wrist formed from? (2)

A

Carpal bones
Flexor retinaculum

165
Q

Carpal Tunnel Syndrome: The median nerve passes through the carpal tunnel alongside what?

A

9 flexor tendons
4 x - Flexor Digitorum Profundus
4 x - Flexor Digitorum Superficialis
1 x - Flexor Pollicis Longus

166
Q

Carpal Tunnel Syndrome: Medial nerve supplies motor innervation to what?

A

LOAF muscles

167
Q

Carpal Tunnel Syndrome: Medial nerve supplies sensory innervation to what?

A

Palmar aspect of the hand, thumb, index, middle and radial half of the ring finger

168
Q

Carpal Tunnel Syndrome: Any swelling within the carpal tunnel may result in what?

A

Median nerve compression

169
Q

Carpal Tunnel Syndrome: Clinical Presentation - Parathesiae in what?

A

The median nerve innervated digits - thumb and radial 3 and 1/2 fingers

170
Q

Carpal Tunnel Syndrome: Clinical Presentation - When is the pain worse?

A

Night

171
Q

Carpal Tunnel Syndrome: Clinical Presentation - Impact on the thumb

A

Loss of sensation and weakness in the thumb

172
Q

Carpal Tunnel Syndrome: Clinical Presentation - What sensation is often spared?

A

Palmar

173
Q

Carpal Tunnel Syndrome: Clinical Presentation - Pain is relieved by what?

A

Shaking the hand

174
Q

Carpal Tunnel Syndrome: Clinical Presentation - There can be observation of what?

A

Loss of sensation or muscle wasting of the thenar eminence

175
Q

Carpal Tunnel Syndrome: What are the LOAF muscles?

A

Lumbricals I and II
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

176
Q

Carpal Tunnel Syndrome: Late symptoms (2)

A

Numbness
Weakness

177
Q

Carpal Tunnel Syndrome: Early symptoms (3)

A

Pins and Needles
Pain
Clumsiness

178
Q

Carpal Tunnel Syndrome: What tests can be used on examination? (3)

A

Durkin’s Test
Tinnel’s Test
Phalen’s Test

179
Q

Carpal Tunnel Syndrome: Durkin’s Test and Result

A

Press thumb over the carpal tunnel and hold pressure for 30 seconds
Result - Pain sensation or Parathesiae in median nerve distribution

180
Q

Carpal Tunnel Syndrome: Tinnel’s Test and Result

A

Tap the carpal tunnel
Result - tingling sensation is found over the innervation regions of the median nerve

181
Q

Carpal Tunnel Syndrome: Phalen’s Test and Result

A

Flex the wrist to 90 degrees for 1 minute
Result - Tingling sensation found over the innervation regions of the median nerve

182
Q

Carpal Tunnel Syndrome: What investigations can be conducted? (4)

A

APB examination of the LOAF muscles
Nerve conduction studies with Electromyogram
Compressive neuropathy
Kamath and Stothard Carpal Tunnel Questionnaire

183
Q

Carpal Tunnel Syndrome: Mild Or Moderate (3)

A

Splintage
Steroid Injection
Physiotherapy

184
Q

Carpal Tunnel Syndrome: Severe Cases

A

Surgery Carpal Tunnel Decompression via division of the transverse carpal ligament

185
Q

Dupuytren’s Contracture

A

Superficial fibromatosis of the subdermal fascia leading to a fixed flexion deformity of the fingers

186
Q

Dupuytren’s Contracture: Common in what countries?

A

Northern Europe

187
Q

Dupuytren’s Contracture: More common in what sex?

A

Men

188
Q

Dupuytren’s Contracture: What pattern of inheritance is the genetic predisposition?

A

Autonomic dominant mutation

189
Q

Dupuytren’s Contracture: Environmental Risk Factors (3)

A

Alcohol
Smoking
Repetitive trauma or an acute injury to the hand

190
Q

Dupuytren’s Contracture: Conditions that are a risk factor (2)

A

Diabetes
Epilepsy - or the associated medication

191
Q

Dupuytren’s Contracture: Pathophysiology

A

Excessive myofibroblast proliferation and altered collagen matrix composition leads to a thickened and contracted palmar fascia

192
Q

Dupuytren’s Contracture: Bands predominantly consist of what?

A

Collagen Type II

193
Q

Dupuytren’s Contracture: Clinical presentation starts as what?

A

Palmar pit or nodule

194
Q

Dupuytren’s Contracture: What is required on exmaination?

A

Feeling of the cords
MCP and PIP Joint Angle measurements

195
Q

Dupuytren’s Contracture: What test can be conducted?

A

Table-Top Test

196
Q

Dupuytren’s Contracture: Management - Conservative (2)

A

Stretches
Activity modification

197
Q

Dupuytren’s Contracture: Management - Surgical options (3)

A

Needle Fasciectomy - for a single band
Limited Fasciectomy - for the removal of bands
Dermofasciectomy + Graft

198
Q

Dupuytren’s Contracture: Management - Dermofascietomy and Graft procedure

A

Removal of the band with the contracted skin and covered with a graft

199
Q

Dupuytren’s Contracture: Management - Newer Treatment Options (2)

A

Collagenase injection
Percutaneous needle fasciotomy

200
Q

Dupuytren’s Contracture: How would the progression be described?

A

Painless and Gradual

201
Q

Dupuytren’s Contracture: What fingers are most likely to be involved?

A

4th and 5th fingers

202
Q

Dupuytren’s Contracture: What does this causes to happen in the finger?

A

Flexion contracture of the affected fingers

203
Q

Duputrens Diathesis

A

Severe form of Duputrens involving the ring and little fingers, Lederhosens and Peyronies

204
Q

Lederhosens

A

Superficial fibromatosis of the foot

205
Q

Peyronies

A

Supreficial fibromatosis of the penis

206
Q

Dupuytren’s Contracture: What is the table top test result?

A

Inability to flatten the palm against the surface of the table due to contractures in the metacarpophalangeal joints

207
Q

Paronychia

A

Infection within the nail fold

208
Q

Paronychia: What age group is most affected?

A

Children and Young adults

209
Q

Paronychia: What is the main risk factor?

A

Nail biting

210
Q

Paronychia: Clinical presentation

A

Inflammation and redness around the fingertip
May have pus collection

211
Q

Paronychia: Management plan

A

Elevate
Antibiotics
Incise and drain pus collection

212
Q

Flexor Tendon Sheath Infection

A

Infection within the sheath that tracks up the palm and arm

213
Q

Flexor Tendon Sheath Infection: What is important about this disease?

A

It is a surgical emergency

214
Q

Flexor Tendon Sheath Infection: Aetiologies (2)

A

Direct penetrating trauma e.g. knife wound
Haematogenous spread e.g. dental infection

215
Q

Flexor Tendon Sheath Infection: Clinical presentation symptoms

A

Extremely painful
Limited passive and active extension due to pain

216
Q

Flexor Tendon Sheath Infection: Kanavel’s Cardinal Signs (4)

A

Affected finger held in fixed flexion
Fusiform swelling over the finger
Painful to percuss over the sheath
Painful on passive extension

217
Q

Flexor Tendon Sheath Infection: Management

A

Elevation and high dose antibiotics

218
Q

Flexor Tendon Sheath Infection: Emergency surgery

A

Washout the tendon sheath with opening up the A1 and A5 pulleys

219
Q

Tendinopathy

A

Painful tendon

220
Q

Tendonitis

A

Inflammation of the tendon

221
Q

Tendonosis

A

Degeneration of the tendon

222
Q

Tenosynovitis

A

Inflammation of a fluid-filled sheath

223
Q

Enthesopathy

A

Pain at the enthesis that attaches tendons and ligaments onto the bone

224
Q

Tendon Structure: Shape

A

Cylindrical

225
Q

Tendon Structure: Predominant structure

A

Fibroblasts

226
Q

Tendon Structure: Fibroblast function

A

Produces and maintains collagen to confer flexibility and tensile strength of the tendons

227
Q

Tendon Structure: Fibroblasts mainly produce what type of collagen?

A

Type I

228
Q

Tendon Structure: What are fibrils formed of?

A

Sub-fibrils

229
Q

Tendon Structure: Sub-fibrils are made up of what?

A

Microfibrils

230
Q

Tendon Structure: Fibrils are contained within what?

A

Fascicles

231
Q

Tendon Structure: Fascicles are separated from what?

A

The endotendon

232
Q

Tendon Structure: What is the endotendon covered in?

A

Epitenon

233
Q

Tendon Structure: Blood supply from what 3 sources?

A

Perimyseum
Periosteal insertion of the tendon
Paratenon

234
Q

Tendinopathies: Predisposing Disease

A

Rheumatoid arthritis

235
Q

Tendinopathies: Anatomical risk factors (2)

A

Malalignment
Leg length discrepancy

236
Q

Tendinopathies: Extrinsic Aetiologies (4)

A

Trauma
Repetitive injury
Drugs - steroids and antibiotics
Sport

237
Q

Tendinopathies: Function of tendons

A

Links the muscle motor unit to the bone to enable joint function

238
Q

Tendonosis

A

Histological degeneration of the collagen and ECM of the tendon

239
Q

Tendonosis: Likely due to what structure?

A

Matrix Metalloproteinases

240
Q

Tendonosis: Usually occurs at what areas?

A

Areas of poor blood supply

241
Q

Tendon Disease: Injections must not be conducted on what diseases and why?

A

Achilles Tendon or Extensor Knee Mechanism due to risk of rupture

242
Q

Tendon Disease: Surgical options for management? (4)

A

Debridement
Decompression
Synovectomy
Tendon Transfer

243
Q

Tendon Disease: Debridement

A

Removal of diseased tissue

244
Q

Tendon Disease: Decompression management is for what cases? (2)

A

Supraspinatus tendonitis
Sub-acromial tendon cases

245
Q

Tendon Disease: Synovectomy is available for what structures? (2)

A

Extensor tendons of the wrist in Rheumatoid Arthritis
Tibialias posterior

246
Q

Tendon Disease: Tendon Transfer is available for what structures? (2)

A

Tibialis posterior
Extensor Pollicis Longus

247
Q

Tendon Disease: What is the risk of managements with steroids?

A

Toxic to tenocytes

248
Q

Rotator Cuff Pathology: Common in what occupations? (2)

A

Athletes - that throw
Manual workers e.g. painters

249
Q

Rotator Cuff Pathology: Intrinsic aetiologies (2)

A

Degeneration
Reduced tendon vascularity

250
Q

Rotator Cuff Pathology: Extrinsic aetiologies (2)

A

Morphological changes in the acromion
Biomechanical factors - kinetics and performance

251
Q

Rotator Cuff Pathology: Symptoms (3)

A

Dull achy pain down the arm that gradually increases
Difficulty sleeping on the affected side
Pain on reaching overhead or lifting

252
Q

Rotator Cuff Pathology: Tenderness is present in what areas? (3)

A

Around the glenohumeral joint
Acromioclavicular joint
Over the shoulder

253
Q

Rotator Cuff Pathology: Signs on examination (2)

A

Painful arc with weakness
Positive Impingement Tests

254
Q

Rotator Cuff Pathology: Gold standard investigation

A

Ultrasound

255
Q

Biceps Tendinopathy

A

Inflammation of the long head of the biceps tendon

256
Q

Biceps Tendinopathy: Aetiologies (4)

A

Overuse
Instability
Impingement
Trauma

257
Q

Biceps Tendinopathy: High risk group

A

Athletes - Javelin, Swimmers and Gymnasts

258
Q

Biceps Tendinopathy: Clinical presentation (2)

A

Pain anterior to the shoulder radiating to the elbow
Clicking or snapping sensation with shoulder movement

259
Q

Biceps Tendinopathy: Pain is aggravated by what?

A

Shoulder flexion
Forearm pronation
Elbow flexion

260
Q

Biceps Tendinopathy: … can cause snapping with shoulder movements

A

Subluxation

261
Q

Biceps Tendinopathy: What part of the biceps is most commonly affected?

A

The bicipital groove anterior on the proximal humerus

262
Q

Biceps Tendinopathy: What two signs are seen on examination?

A

Popeye sign
Extensive bruising

263
Q

Biceps Tendinopathy: What investigation may be carried out?

A

Ultrasound

264
Q

Biceps Tendinopathy: Management options

A

Conservative - rest, physiotherapy and corticosteroid injection
Surgery

265
Q

Biceps Tendinopathy: Surgical repair has a high risk of what and where?

A

Neurovascular complications particularly at the distal end

266
Q

Lateral Epicondylitis: Alternate name

A

Tennis elbow

267
Q

Lateral Epicondylitis

A

Overuse injury of the hand which originate in the lateral humeral epicondyle

268
Q

Lateral Epicondylitis: Most commonly effects what structures?

A

Finger extensor tendons

269
Q

Lateral Epicondylitis: Most common aetiology

A

Repeated or excessive pronation or supination with extension of the wrist

270
Q

Lateral Epicondylitis: Pathophysiology

A

Microtears within the common extensor origin

271
Q

Lateral Epicondylitis: Characterised clinical presentation by what?

A

Pain and tenderness over the lateral epicondyle to the attachment of the forearm

272
Q

Lateral Epicondylitis: Pain is worse when?

A

When stretching the muscles

273
Q

Lateral Epicondylitis: Mill’s Test and result

A

Flex elbow to 90 degrees in pronation and pain is produced on resisted middle finger and wrist extension

274
Q

Lateral Epicondylitis: What clinical test can be used?

A

Mill’s Test

275
Q

Lateral Epicondylitis: What should be conducted if there are any nerve symptoms?

A

Nerve conduction studies

276
Q

Lateral Epicondylitis: Conservative management (3)

A

Rest
Physiotherapy
Injection of local anaesthetic and steroids

277
Q

Lateral Epicondylitis: Refractory case management

A

Surgical release - division and or excision of some of the fibres of the common extensor mechanism

278
Q

Medial Epicondylitis: Alternate name

A

Golfer’s Elbow

279
Q

Medial Epicondylitis

A

Overuse injury of the hand which originates in the medial humeral epicondyle

280
Q

Medial Epicondylitis: Aetiologies (2)

A

Repetitive strain
Degeneration of the common flexor origin

281
Q

Medial Epicondylitis: Peak age of incidence

A

40-50 years of age

282
Q

Medial Epicondylitis: Is this more or less common than lateral epicondylitis?

A

Less

283
Q

Medial Epicondylitis: Main clinical presentation

A

Medial elbow pain with a tender point over the origin of the flexors at the medial epicondyle

284
Q

Medial Epicondylitis: Pain is aggravated by what?

A

Wrist flexion, pronation and grasping

285
Q

Medial Epicondylitis: May be associated with what complications? (2)

A

Ulnar neuropathy
Muscle weakness

286
Q

Medial Epicondylitis: What clinical sign can be observed?

A

When the elbow is flexed to 90 degrees in supination, pain is produced when the wrist is flexed against resistance

287
Q

Medial Epicondylitis: What investigations may be conducted?

A

US and MRI

288
Q

Medial Epicondylitis: What should be conducted if there are any nerve symptoms?

A

Nerve conduction studies

289
Q

Medial Epicondylitis: Conservative management

A

Rest
Physiotherapy

290
Q

Medial Epicondylitis: Why should steroid injection be avoided?

A

Too close to the ulnar nerve

291
Q

Medial Epicondylitis: Management for refractory cases

A

Surgical release

292
Q

De Quervain’s Tenosynovitis

A

Inflammation of the tendon sheaths within the first extensor compartment

293
Q

De Quervain’s Tenosynovitis: Impacts what structures? (2)

A

Abductor Pollicis Longus
Extensor Pollicis Brevis

294
Q

De Quervain’s Tenosynovitis: Epidemiology of sexes?

A

Women

295
Q

De Quervain’s Tenosynovitis: Most common in what age group?

A

30-50 years

296
Q

De Quervain’s Tenosynovitis: Associated with what two medical conditions?

A

Rheumatoid Arthritis
Pregnancy

297
Q

De Quervain’s Tenosynovitis: Typical Clinical Presentation

A

Repetitive strain injury with pain over the radial styloid process at the wrist

298
Q

De Quervain’s Tenosynovitis: Pain may radiate to where?

A

Proximally into the forearm

299
Q

De Quervain’s Tenosynovitis: What test can be used on examination?

A

Finklesteins

300
Q

De Quervain’s Tenosynovitis: What is the main differential diagnosis?

A

Osteoarthritis of Carpometacarpal Joint

301
Q

De Quervain’s Tenosynovitis: What tests can be used for differential diagnosis? (2)

A

US
X-ray

302
Q

De Quervain’s Tenosynovitis: What is Finklesteins Test

A

Patient makes a fist over the thumb and the hand is ulnar deviated to reproduce the pain

303
Q

De Quervain’s Tenosynovitis: Conservative Management (3)

A

Rest
Splint
Steroid Injections or NSAIDs

304
Q

De Quervain’s Tenosynovitis: Surgical options

A

Surgical decompression

305
Q

Extensor Tendon Injuries: Examples (2)

A

Mallet finger
Extensor pollicus longus rupture

306
Q

Mallet Finger

A

An avulsion of the extensor tendon from the distal phalynx resulting in the inability to extend the DIP joint

307
Q

Mallet Finger: Causes a … deformity

A

Flexion

308
Q

Mallet Finger: Aetiology

A

Caused by an object hitting the tip of the finger or thumb - force tears the extensor tendon

309
Q

Mallet Finger: Clinical presentation

A

Tenderness
Brusing

310
Q

Mallet Finger: Clinical sign on examination

A

No resisted finger extension

311
Q

Mallet Finger: Management if the joint is congruent

A

Mallet splint for 6 weeks 24/7

312
Q

Mallet Finger: Management if the joint is not congruent (large displaced avulsion fracture)

A

Reduce the joint and fixate with K wires or screws

313
Q

Mallet Finger: Non-congruent joints are predisposed to what?

A

Secondary osteoarthritis

314
Q

Mallet Finger: Management for chronic cases

A

Dermatotenodesis

315
Q

Extensor Pollicus Longus Rupture: Associated with what disease?

A

Rheumatoid Arthritis

316
Q

Extensor Pollicus Longus Rupture: Pathophysiology

A

Autoimmune attack of the synovium causes tendon degeneration and rupture

317
Q

Extensor Pollicus Longus Rupture: Can occur secondary to what condition?

A

Colles fracture

318
Q

Extensor Pollicus Longus Rupture: Clinical presentation

A

Substantial loss of function meaning that the thumb cannot be extended at the MCP or IP joints

319
Q

Extensor Pollicus Longus Rupture: Management if caught preceding synovitis from Rheumatoid Arthritis

A

Synovectomy - prevents rupture

320
Q

Extensor Pollicus Longus Rupture: Management once rupture has occured?

A

Tendon transfer

321
Q

Knee Extensor Mechanism Rupture: What does the extensor mechanism of the knee compromise? (5)

A

Tibial tuberosity
Patellar tendon
Patellar
Quadriceps tendon
Quadriceps muscle

322
Q

Knee Extensor Mechanism Rupture: Most common in what patient group?

A

Middle aged population who play running or jumping sports

323
Q

Knee Extensor Mechanism Rupture: Mechanism of injury

A

Patellar or Quadriceps Tendon ruptures due to rapid contractile force - heavy weight lifting or fall

324
Q

Knee Extensor Mechanism Rupture: Mean age for patellar tendon rupture

A

<40 years old

325
Q

Knee Extensor Mechanism Rupture: Mean age for quadriceps tendon rupture

A

> 40 years old

326
Q

Knee Extensor Mechanism Rupture: Risk Factors - Diseases (5)

A

Previous tendonitis
Chronic renal Failure
Diabetes
Rheumatoid arthritis
Steroid abuse

327
Q

Knee Extensor Mechanism Rupture: What drug is a risk factor and why?

A

Ciprofloxin - quinolone antibiotics can cause tendonitis and risk tendon ruptures

328
Q

Knee Extensor Mechanism Rupture: Clinical symptoms

A

Knee pain and weakness

329
Q

Knee Extensor Mechanism Rupture: What may be observed in the extensor mechanism?

A

Palpable gap

330
Q

Knee Extensor Mechanism Rupture: Examination will show people unable to do what?

A

Straight leg raise

331
Q

Knee Extensor Mechanism Rupture: What may be observed on X-ray? (2)

A

High or low patellar
Effusion

332
Q

Knee Extensor Mechanism Rupture: Patellar location in patellar tendon rupture?

A

High

333
Q

Knee Extensor Mechanism Rupture: Patellar location in quadriceps tendon rupture?

A

Low

334
Q

Knee Extensor Mechanism Rupture: What investigations may be required?

A

X-ray
US
MRI

335
Q

Knee Extensor Mechanism Rupture: MRI or US may show what?

A

Partial or complete tear

336
Q

Knee Extensor Mechanism Rupture: Management of small partial tears of the quadriceps

A

Immobilisation and Physiotherapy

337
Q

Knee Extensor Mechanism Rupture: Requires what management?

A

Urgent surgical repair with physiotherapy

338
Q

Knee Extensor Mechanism Rupture: Why should steroid injections be avoided?

A

High risk of tendon rupture

339
Q

Traction Apophysitis

A

Insertion of the patellar tendon into the tibial tuberosity

340
Q

Traction Apophysitis: Most common in what patient groups?

A

Adolescent active males

341
Q

Traction Apophysitis: Clinical presentation - Can occur where? (2)

A

Patellar
Achilles

342
Q

Traction Apophysitis: Clinical presentation - Osgood Schlatter’s Disease

A

Presents at the tibial tubercle

343
Q

Traction Apophysitis: Clinical presentation - Reamins as what?

A

Prominent bony lump

344
Q

Tibialis Posterior Tendon anatomy

A

Tibialis posterior tendon inserts predominantly onto the medial navicular to support the medial arch of the foot

345
Q

Tibialis Posterior Tendon Dysfunction: Most common cause of what?

A

Flat foot in adults

346
Q

Tibialis Posterior Tendon Dysfunction: Pathophysiology stages (3)

A

Tenosynovitis
Progressive elongation
Rupture

347
Q

Tibialis Posterior Tendon Dysfunction: Leads to what clinical presentation? (2)

A

Progressive flat foot
Valgus hindfoot

348
Q

Tibialis Posterior Tendon Dysfunction: Risk Factors - Main patient group

A

Obese middle aged female

349
Q

Tibialis Posterior Tendon Dysfunction: Risk is increased by what non-modifiable factor?

A

Age

350
Q

Tibialis Posterior Tendon Dysfunction: Risk Factors - Diseases or Medications (5)

A

Hypertension
Diabetes Mellitus
Steroid injections
Seronegative arthropathies
Idiopathic tendonsosis

351
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Very specific symptom

A

Pain and or swelling posterior to the medial malleolus

352
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - More painful on what surfaces?

A

Uneven surfaces

353
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - What foot deformity may develop?

A

Hallux valgus

354
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type I (3)

A

Swelling
Tenderness
Slightly weaker muscle power

355
Q

Tibialis Posterior Tendon Dysfunction: Clinical Presentation - Type II (5)

A

Planovalgus
Midfoot abduction
Passively correctable
Too many toes sign
Cannot single heel raise

356
Q

Tibialis Posterior Tendon Dysfunction: Tendonitis should be treated how?

A

With a splint with medial arch support to avoid rupture

357
Q

Tibialis Posterior Tendon Dysfunction: If the splint fails to settle the symptoms what should be considered?

A

Surgical decompression
Tenosynovectomy

358
Q

Tibialis Posterior Tendon Dysfunction: What management should not be used?

A

Steroid injections

359
Q

Tibialis Posterior Tendon Dysfunction: Surgical option if no secondary osteoarthritis is present?

A

Tendon transfer and Calcaneal osteotomy

360
Q

Tibialis Posterior Tendon Dysfunction: Surgical option if osteoarthritis is present?

A

Arthrodesis

Musculoskeletal System (9 decks)

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