anatomy and by region Flashcards
(203 cards)
1
Q
what muscles attach at the greater trochanter of the femur?
A
gluteus medius and minimus
piriformis, gemelli, obturator internus
2
Q
what muscles attach at the lesser trochanter of the femur?
A
psoas major and iliacus
together known as iliopsoas
3
Q
what muscle attaches to intertrochanteric chest of the femur?
A
quadratus femoris.
4
Q
what is the nerve supply of gluteus maximus, medius and minimus?
A
maximus - inferior gluteal nerve
medius and minimus - superior gluteal nerve
5
Q
what is the function of gluteus minimus, medius and maximus?
A
minimus and medius - hip extension, abduction, medial rotation
maximus: hip extension and lateral rotation
6
Q
name the muscles responsible for hip abduction?
A
gluteus minimus, medius, piriformis, obturator internus
7
Q
what muscles are responsible for hip flexion?
A
iliopsoas (iliacus and psoas major)
rectus femoris
8
Q
what muscles are responsible for knee extension?
A
vastus lateralis, medialis and intermedialis
rectus femoris
9
Q
the abductor magnus is innervated by 2 nerves what are these?
A
obturator
tibial portion of sciatic nerve
10
Q
describe the hip joint structure including ligaments
A
the head of the femur and acetabulum are covered in articular cartilage
there is a joint capsule
labrum - fibrocartilaginous structure around the acetabulum to deepen the socket
ligaments:
- intracapsular - ligament to head of femur (teres ligament) - carries the artery to head of femur
- extracapsular ligaments:
- ileofemoral - ileium to anterior side of femur
- pubofemoral - pubic rami to intertrochanteric line
- ischiofemoral - ischium to greater trochanter - mainly around the posterior side
11
Q
describe the arterial supply of the hip joint
A
deep femoral artery gives medial and lateral circumflex arteries. these give rise to retinacular arteries that supply the proximal femur proximally to distally. Mainly by the medial circumflex.
there is also some supply from the artery to head of femur (branch of obturator arterior) and inferior gluteal artery,
12
Q
what is the weakest ligament of the hip?
A
ischiofemoral - posterior - therefore posterior hip dislocation is more likely
13
Q
what factors help to stabilise the hip joint?
A
deep acetabulum
deepened further with the labrum
spiral orientation of the extracapsular hip ligaments
medial rotators of the hip keep the femur in place
joint capsule
14
Q
what is the overall function of the extra-capsular hip ligaments?
A
prevent hyperextension.
15
Q
what is femeroacetebular impingement? What are the different types and what are the symptoms?
A
there are bony spurs on either acetabulum/femur meaning there is friction and limited movement of the hip joint. with movement this results in damage and breakdown of labrum/cartilage thus pain. can result in deformity and later OA
pincer - bony spurs on acetabulum
cam - bony spurs on femur
combined - on both.
often asymptomatic until later. may present earlier in athletes. pain around the groin and hip. worse with activity. stiffness
16
Q
how can we test femeroacetebular impingement? what other investigation would confirm the diagnosis?
A
lie patient supine, flex hip and bring knee up to chest and then point knee to the opposite shoulder. pain suggests impingement
confirmed by bony spurs seen on Xray
17
Q
how can femeroacetebular impingement be treated?
A
NSAIDs, physio, reduce movements that make it worse especially running, jumping
surgically remove bony spurs (arthroplasty) to reduce impingment
18
Q
name 4 bursa of the hip and 2 that commonly become inflamed around the hip joint. which is more common? where do these bursa lie?
A
greater trochanteric - near greater trochanter - commonest region for bursitis
iliopsoas - near lesser trochanter - 2nd most common
ischiogluteal - under ischium
gluteal medius bursa -lesser tronchanter
19
Q
what are the symptoms of trochanteric bursitis?
A
pain on outer hip can be sharp or dull/throbbing.
particularly worse at night when lying on affected hip
worse with prolonged walking , squatting, climbing
20
Q
what are the symptoms of iliopsoas bursitis?
A
inner groin pain
worse with extension of hip
21
Q
what are the different types of snapping hip syndrome?
A
this is where a tendon ‘snaps’ over a bony prominence
iliotibial band snapping - side of hip - iliotibial band over greater trochanter
rectus femoris tendon snapping - in front of hip
hamstrings tendon snapping - back of hip over ischial tuberosity
22
Q
what are the risk factors for AVN of the hip?
A
trauma - intracapsular neck of femur facture
steroids alcohol transplant radiotherapy, chemotherapy sickle cell disease, lupus, HIV
23
Q
how can AVN of the hip be diagnosed?
A
Xray
24
Q
what are the 3 most common sites for pelvic fractures?
A
acetabulum
pubic ramus
sacroiliac joint
25
what are the complications of pelvic fractures?
can damage near by strcutures - bladder, urethra, sciatic nerve.
often result from high impact trauma and thus may be polytrauma or excessive bleeding (pelvis can hold a lot of blood)
26
how are pelvic fractures managed?
ATLS /ABCDE
check to see if there are any other major injuries/ vascular injury, nerve injuries.
pelvic binder/ internal rotation of hips = reduces pelvic capacity to reduces amount of blood loss.
surgery is required for those fractures invoving acetabulum or that are unstable. otherwise use binder and then eventually physio
27
what are the two types of hip dislocations and how does each occur? which is most common? how does each present?
posterior - most common because ischiofemoral ligament is weakest.
Anterior - rare
posterior occurs when hip is flexed, adducted and large anterior force (dashbored injury)
anterior - hip extended, abducted and lateral rotation
posterior: shortened leg and medially rotated
anterior: shortened leg, abducted and laterally rotated.
28
what are the complications of hip dislocation?
posterior - sciatic nerve damage
anterior - femoral head fracture
both: AVN, reoccurance, OA
29
what classification can be used for hip dislocations?
Thompson - Epstein classification:
I: no fracture of posterior wall or at most a small part
II: large fracture of posterior wall
III: comminuted fracture of posterior wall
IV: acetabular fracture
V: femoral head fracture.
30
how are acquired hip dislocations managed?
GA and reduction
immobilisation/rest
physio
surgery only for fracture dislocations
31
how do we manage femoral shaft fracture? what are the complications of these fractures?
ABCDE - analgesia, fluids
splinting, surgery (intramedullary nail, outer plate and screws, external fixation). intrameduallry nail is mostly preffered option.
complications:
- P.E, DVT, pneumonia, pressure sores, fat embolus, compartment syndrome, haemorrhage (femoral artery)
- malunion
32
what is a Vancouver fracture?
post op periprosthesis fracture - graded A to C depending on location of fracture.
A = trochanter fractured
B = at level of prosthesis, femoral shaft
C = femoral shaft but much further down.
33
what muscles attach to the greater tubercle of the humerus? lesser tubercle?
supraspinatus, infraspinatus, teres minor - greater tubercle
lesser tubercle - subscapularis
34
what structures lung along humeral shaft?
radial nerve and deep brachial artery (a.k.a. profunda brachii)
these run within the radial groove on posterior surface of the humerus
35
in relation to distal humerus where does the ulnar nerve run?
behind medial epicondyle
36
describe the articulations of the elbow joint
trochlea with the ulnar
| capitulum with the radius
37
name the intrinsic and extrinsic shoulder muscles
intrinsic: rotator cuffs, deltoid, teres major
extrinsic: trapezius, latissimus dorsi, rhomboid major/minor and levator scapula
38
what nerve innervates the teres major, subscapularis supraspinatus and infraspinatus?
subscapular nerve
39
what is the function of the different rotator cuff muscles?
supraspinatus: abduction (0-15 degrees) (lateral rotation)
infraspinatus - lateral rotation
teres minor - lateral rotation
subscapularis - internal rotation
40
what nerve innervates the trapezius?
accessory nerve
41
describe the glenohumeral joint (including ligaments)
the head of humerus sits within the glenoid fossa. The glenoid fossa is shallow and large compared to humerus - this allows greater movement but compromises its stability.
ball and socket joint. / synovial joint
each covered in articular cartilage (hyaline)
surrounded by a joint capsule
glenoid labrum - fibrocartilaginous structure helps to deepen glenoid socket.
ligments:
- glenohumeral ligament
- corocohumeral ligament - coracoid to greater tubercle
- transverse humeral ligament - spans two condyles to support the biceps brachii tendon
- corocoacromial ligament
42
what are the different bursae within the shoulder?
subacromial - below acromion/deltoid and above the suprapinatus tendon
subcoracoid - under coracoid process
subscapular bursa - between scapula and subscapularis tendon.
43
what is the corocoacromial arch?
coracoid process
acromion
corocoacromial ligament
prevents superior displacement of the humeral head.
44
what is the blood supply of the shoulder?
anterior and posterior circumflex humeral arteries
| suprascapular artery
45
what are the stabilising factors of the glenohumeral joint?
glenoid labrum,
joint capsule
ligaments
rotator cuff muscles
46
who does frozen shoulder mainly effect and what are the symptoms?
women >40yrs
symptoms include: pain which gradually gets worse. worse at night. this is followed by stiffness and reduced range of movement
47
what is subcoracoid impingment? how can it be tested?
the subscapularis tendon becomes impinged between coracoid process and lesser tuberosity
Gebers test - back of hand on buttocks and ask them to lift hand against resistence - pain indicates pain on internal rotation - subscapularis pain
Can also check for tenderness over anterior coracoid
48
what is biceps tendenopathy?
what causes this and how is it treated?
inflammation of biceps tendon often associated with rotator cuff pathology. leads to tenderness just infront of greater tuberosity. pain on shoulder flexion and medial rotation
caused by degeneration due to age and overuse
treat with NSAIDs, ICE, rest, physiotherapy
can sometimes give steroid injections but risk of rupture
can surgically remove areas of damaged tendon and reattach
49
what is thoracic outlet syndrome?
narrowing of the thoracic outlet (an area where a number of blood vessels and nerves run). IF these become compressed it leads to thoracic outlet syndrome:
- pressure on brachial plexus - vague aching in neck, shoulder arm
- pressure on vessels - redness and swelling of arm. reduced blood flow means arm is cold and becomes tired.
pain is increased when arms are above head
50
what is thoracic outlet syndrome caused by?
muscle hypertrophy
subclavian aneurysm
cervical ribs
fibrous muscle band
51
how can thoracic outlet syndrome be tested for?
ask patient to put their arms above their head for 3 mins and open and close fists. positive test elicits symptoms of thoracic outlet syndrome.
Xray - for cervical ribs
subclavian bruits/ angiography - subclavian aneurysm
52
how is thoracic outlet syndrome treated?
avoid movements causing pain
change posture/ muscle strengthening - physio
surgery to remove cervical rib/ release muscle band/ repair aneurysm
53
why is anterior shoulder dislocation more common than posterior?
the glenohumeral ligament is the weakest and this is an anterior ligament.
shoulder overall is unstable - shallow glenoid fossa and head of humerus is too big.
54
how does posterior shoulder dislocation present?
pain, reduced movement
cant externally rotate/ held in internation and adduction
posterior bulge
55
when should you not attempt to reduce a shoulder dislocation?
if it occurred >3/4 weeks ago because adhesions to axillary artery may have been made which will lead to rupture of axillary artery if manipulated.
instead requires open reduction and reconstruction surgery
56
how does a posterior shoulder dislocation occur?
large anterior force to adducted, internally rotated and flexed arm
seizures, electric shocks
57
what are the complications of clavicle fractures?
may damage suprascapular nerves by upwards movement of medial part --> this nerve usually intervates lateral rotators of shoulder and thus results in waiters tip
damage to brachial plexus - most likely median/ulnar nerve
malunion/non-union
pneumothorax
58
what is seen on examination of a clavicle fracture?
lateral section is pulled down by weight of arm and internal rotation by pec major
medial pulled up by SCM
visible protrusion along clavicular line
pain and tenderness.
59
how do we classify rotator cuff tears?
small <1cm
medium 1cm -2cm
large 2-5cm
massive >5cm
60
how are clavicular fractures managed?
ABCDE, check NV status
immobilisation followed by phsyio - ususally good healing potential
sometimes surgery is required if:
- open fracture
- very displaced
- NV damage
- floating shoulder - ipsilateral clavicle and humeral fracture
61
what are the complications of humeral surgical neck fracture?
```
axillary nerve damage
posterior circumflex artery damage --> AVN
secondary OA, stiffness
non-union
rotator cuff injury
```
62
what are the complications of mid shaft humeral fractures?
radial nerve damage - wrist drop, loss of sensation over dorsum of hand and lateral 3 1/2 finger tips
deep brachial artery - volkmans ischaemic contractures.
63
how are humeral shaft fractures normally managed? what are the exceptions?
usually just a cast because moderate malallignment is well tolerated (non weight bearing and mobile joints below and above)
however if open fracture, floating shoulder, need to use crutches or pathological fracture then ORIF is required
64
where are IM injections of the shoulder given?
into deltoid 4cm below acromion to avoid axillary nerve
65
describe the articulations of the elbow:
and the other structures of elbow joint
trochlea of humerus articulates with trochlea notch of ulna
capitulum of the humerus articulates with the radial head
this is covered in a joint capsule which is thickened laterally and medially to make collateral ligaments (ulnar collateral, radial collateral
other ligaments:
- annular ligament - holds radial head in place
66
where does the triceps tendon attach?
olecranon of ulna
67
name the bursa of the elbow
intratendinosus - within triceps tendon
olecranon bursa - between olecranon and sub cut tissue
subtendinosis - between olecranon and triceps tendon
68
name the nerve that innervates muscles of the anterior forearm
anterior interosseous nerve (branch of median nerve)
exception is flexor carpi ulnaris and part of flexor digitorum profundus ( medial 2 fingers) - supplied by ulnar nerve
69
what nerve innervates muscles of posterior compartment of forearm?
radial nerve
deep compartment is supplied by posterior interosseous nerve (branch of radial nerve)
70
what muscles are responsible for flexion of elbow?
biceps brachii
brachialis
brachioradialis
71
what is cubitus varus? how can it occur?
when elbow is extended the distal fragment deviates towards the midline
following supracondylar fracture
72
how is golfers elbow and tennis elbow tested for?
golfers elbow: pain on resisted wrist flexion with arm supinated
tennis elbow: pain on resisted wrist extension with arm pronated
73
when is surgery for distal humerus fracture considered to be an emergency?
compartment syndrome
open fracture
vascular occlusion
74
what is a monteggia fracture?
| what is a galeazzi fracture?
monteggia - fracture of ulna shaft and dislocation of radial head
Galeazzi - fracture of radius and dislocation of ulnar head (distal radioulnar joint)
75
what damage occurs with an elbow dislocation?
ulnar collateral torn
| ulnar nerve damage
76
what direction do elbow dislocations normally occur in?
posterior dislocation - ulna and radius have move posteriorly with respect to humerus
77
what is medial and lateral epicondylitis also known as?
medial epicondylitis - golfers elbow (flexors all attach to medial epicondyle)
lateral epicondylitis - tennis elbow (extensors attach to lateral)
78
name the thenar muscles
| what nerve innervates them?
opponens pollicis
abductor pollicis brevis
flexor pollicis
median nerve
79
which thumb muscle is not innervated by the median nerve?
adductor pollicis - ulnar nerve
80
describe the wrist joint
articulations between scaphoid, lunate, triquetrium with the radius and articular disc (fibrocartilage structure that separates wrist from ulna)
ligament:
- palmar radiocarpal
- dorsal radiocarpals
- ulnar collateral - prevents excess abduction
- radioal collateral - prevents excess adduction
81
what muscles are involved in flexion of the wrist ?
flexor carpi ulnaris and radialis
| flexor digitorum superficialis
82
what muscles are involved in extension of the wrist?
extensor carpi ulnaris and radialis
| extensor digitorum
83
what are the contents of the carpal tunnel?
4 tendons of flexor digitorum profundus
4 tendons of flexor digitorum superficialis
1 tendon flexor pollicis longus
median nerve
84
describe the pathway for the different branches of the median nerve?
within the arm the anterior interosseous nerve and palmar cutaneous nerve are given off. the palmar cutaneous nerve does not travel through carpal tunnel
after the carpal tunnel the median nerve divides into the recurrent branch and palmar digital branch
85
what muscles are involved in abduction and adduction of the wrist?
adduction - flexor and extensor carpi ulnaris
| abduction - flexor and extensor carpi radialis
86
what causes carpal tunnel syndrome?
with age thickening of flexor retinaculum and also tendon sheaths within the carpal tunnel.
87
what is a ganglion?
A fluid filled cyst - originates from a joint and most frequently develops on back of hand over wrist. (dorsal wrist ganglia)
mainly affects young people
often asymptomatic but can cause tingling and muscle weakness.
usually disappear without any treatment
88
what are the different types of ganglia?
Dorsal wrist ganglia - most common, sometimes pain on wrist extension
palmar wrist ganglia
flexor tendon sheath - on palm of hand, sometimes pain with gripping
digital mucous cyst - dorsal surface over IPJ. associated with arthritis (older women)
89
what is De Quervains tendinosis?
inflammation of the abductor pollicis longus and extensor pollicis brevis around the base of the thumb
due to overuse, RA, pregnancy
leads to pain over radial side of wrist especially when gripping/fist. also accompanied by swelling and tenderness.
90
what are differentials for De Quervains tendinosis?
scaphoid injury
| basal thumb arthritis
91
how is De Quervains tendinosis tested?
Finkelstein sign - make a fist with thumb tucked in and then adduct wrists - pain felt over thumb area/ lateral wrist
92
how is De Quervains tendinosis treated?
rest, NSAIDs, splinting thumb and steroid injection
| surgery - make more room for tendon
93
what is trigger finger also known as?
stenosing tenosynovitis
94
which finger does stenosing tenosynovitis normally affect?
ring and middle.
| most common in middle aged women
95
what is boutonnieres deformity?
associated with RA
extension of DIPJ and flexion of PIPJ
96
differentials for a lump in the hand?
ganglion
giant cell tumour of tendon sheath
hereditary multiple exostoses
97
what are volksmanns ischaemic contractures?
following vascular injury/compartment syndrome there is necrosis of muscle tissue resulting in fibrosis of muscles and fixed flexion deformity. particular of FDP and flexor pollicis longus.
98
who is guyon canal syndrome most common in?
cyclist that put pressure on handle bars
99
what movement makes pain worse with a scaphoid fracture?
pinching/ gripping
pain felt over anatomical snuffbox
100
how does a boxers fracture present?
the distal fragment moves posteriorly and thus shortened finger.
101
what are the complications of an anterior dislocation of the lunate?
occurs by falling onto back of dorsiflexed hand
can compress the carpal tunnel to give symptoms of carpal tunnel. also wrist pain, deformity and reduced movement
102
why is prompt reduction of a lunate dislocation required?
risk of AVN and later OA.
103
how are tendon injuries of the hand treated?
partial tear - splinting and physio. Partial tears present as weakness in bending fingers and pain
full tear - requires surgery and physio. inability to flex finger
104
what is a wrist sprain?
damage to ligament, mainly shapholunate ligament
can be partial or complete or just stretch.
swelling, pain, bruise
105
what is the terry Thomas sign?
increased distance between scaphoid and lunate on Xray - suggests dislocation and disruption of scapholunate interosseous ligament.
106
what is infective tenosynovitis?
how quickly is it treated?
how does it present?
infection of a tendon sheath
mainly caused by S.aureus
emergency because the longer it is left the more likely it will spread, result in more scarring and disability and risk of sepsis.
presents with pain especially on passive stretching
flexed fingers
swelling and tenderness
check for signs of sepsis - fever, HR , BP
107
how is infective tenosynovitis treated?
analgesia
IV Abx
urgent wash out
phsyio to reduce scarring and allow best recovery
108
what are the complications of infective tenosynovitis?
sepsis
horseshoe abscess - infection spreads to palmer space and other fingers
ulna bursa abscess - little finger
deep thenar abscess - index and thumb
109
what is the name of the regional block used for distal radial fractures?
biers block - tornicade used to prevent anaesthetic agent going systemically
110
how is a colles fracture reduced?
longitudinal traction throughout
hyperextension to disimpact
flexion, ulnar deviation and pronation - hold in this position in cast
press down on dorsum to get fragments in place.
usually under biers block
111
what are the complications of distal forearm fractures in children?
compartment syndrome
malunion - rare in children
radioulnar length discrepancy:
- may stimulate premature fusion of radial epiphysis
- can lead to subluxation of radio-ulnar joint
112
how is a greenstick and buckle fracture in children managed?
buckle - cast for 2 weeks
greenstick :
- <10yrs allow up to 30 degrees angulation
- >10yrs only 15 degrres
- immbolise with neutral wrist and elbow flex for 6 weeks.
113
what nerve runs close to the fibula?
common peroneal nerve
114
name 3 articulations the talus makes
subtalar joint - talus and calcaneus
talonavicular joint
ankle joint - talus + tibia and fibula
115
what is the common function and nerve supply of anterior compartment of the leg? and arterial supply?
ankle dorsiflexion
inversion of foot
deep peroneal nerve (branch of common peroneal)
anterior tibial artery
116
what is the common function of the lateral compartment of the leg? nerve supply?
eversion of foot
| superficial fibular nerve
117
what is the common function of the posterior compartment of the leg? nerve supply?
plantar flexion
| tibial nerve
118
which muscles are responsible for ankle inversion?
tibialis posterior and tibialis anterior
119
name the nerves innervating intrinsic foot muscles
medial plantar nerve
lateral plantar nerve
deep fibular nerve
120
what is the arterial supply of the knee?
genicular anatomoses form from genicular braches from femoral and popliteal arteries
121
describe the anatomy of the knee joint
tibia - medial and lateral condyls with medial and lateral condyls of femur.
patella articulates with distal femur
meniscus (fibrocartilage) - increase stability and shock absorbers
collateral ligaments
patellar ligament
anterior cruciate ligament and posterior:
- PAM APL
- posterior travels anterior and attaches medially to femur
- anterior travels posterior and attaches to lateral femur
bursae - prepatellar, suprapatella, infrapatella semimembranosus
122
what is the function of ACL and PCL?
ACL prevents anterior dislocation of tibia
| PCL prevents posterior dislocation of tibia
123
describe the ankle joint?
the tibia and fibula are bound together by strong tibiofibular ligament to create mortise for talus to articulate with.
ligaments:
- medial = deltoid (consists of 4 ligaments) - prevent excess eversion
- lateral - 3 ligament (anterior talofibular, posterior talofibular and calcaneofibular) - resist inversion
124
how can you test ACL?
anterior withdraw test.
hip and knee flexed.
sit on foot
put hand under knee and pull tibia anteriorly
others include lachman test and pivot shift test
125
if the medial collateral ligament of the knee is damaged, what else is important to check?
saphenous nerve
| also ACL and medial meniscus - unhappy triad
126
what are the symptoms of a meniscus knee injury?
pain, stiffness, swelling
| locking sensation and sensation of knee giving way
127
what is the McMurrays test?
flex hip and knee
then simultaneously extend and externally rotate knee (twist foot in)
feel over the knee for any clicking
clicking and pain = positive test
128
what is an extensor mechanism injury of the knee and how is it caused?
unable to extend knee
caused by patella fracture
patella ligament rupture
rupture of quadriceps tendon (more likely in elderly)
129
what is the most common direction for a patella dislocation?
lateral dislocation
130
how do we manage a patella dislocation?
check for NV damage and compartment syndrome
reduce and immobilise in cast
wait for swelling to reduce and perform ligament reconstruction at later date.
be aware of reperfusion injury and thus keep checking for compartment syndrome
131
what can cause a patella tendon tear?
trauma
tendinitis - esp if corticosteroid injection
CKD, SLE, RA and diabetes all weaken the tendon
previous knee injury
132
what structure is at risk in a knee dislocation?
popliteal - check via ABPI or pulses
also nerve damage
compartment syndrome
133
what are the branches of the common fibular nerve and what function does each have?
superficial fibular nerve - supplies fibularis longus and brevis (lateral leg) and then cutaneous branch to innervate dorsum of foot
deep fibular nerve - anterior leg muscles, intrinsic foot muscles and sensory between big toe and second toe
134
what is the sural nerve made of? what is its function?
braches of tibial and common fibular nerve
| sensation over posterolateral leg
135
what is the saphenous nerve?
cutaneous branch of femoral nerve
| supplies anteromedial lower leg
136
name for upper and lower brachial plexus injury?
upper - erbs plasy - C5,6
| lower - klumpkes palsy
137
what deformity is seen in erbs palsy and why?
adduction of arm - weakness of deltoid and supraspinatius
medial rotation - weak infra and supraspinatus
pronation and loss of supination - biceps brachi weakness
loss of sensation down lateral arm - axillary and musculocutaneous.
138
what nerves are affected in erbs palsy?
musculocutaneous
axillary
suprascapular
139
how do brachial plexus injuries occur?
both from traumatic child birth
both from trauma
lower brachial plexus injury also from pancost tumour and cervical rib
140
what nerves and muscles are affected in klumpkes palsy?
C8, T1
intrinsic hand muscles
clawed hand
loss of sensation over medial arm
141
what is more common erbs or klumpkes?
ERBS
142
what sensation does the radial nerve provide?
lower lateral cutaneous nerve of arm (below regimental badge)
posterior cutaneous nerve of arm and forearm
superficial branch - back of hand (except finger tips and medial 1 1/2)
143
where does the radial nerve terminate?
in forearm by giving posterior interosseous and superficial branch (sensation of hand)
144
what are the risk factors for guyon canal compression?
RA
OA
pregnancy
145
what can cause accessory nerve damage and what pathology does this cause?
cervical lymph node biopsy
cannulation of IJV
inability to shrug shoulder due to paralysis of trapezius
146
what is winged scapula caused by?
paralysis of serratus anterior
| caused by long thoracic nerve
147
how can the sciatic nerve be damaged and what pathology does this result in?
posterior hip dislocation, pelvic fracture, hip fracture
weakness in ankle/foot movements
loss of sensation majority of below knee (except saphenous nerve territory - medial leg)
148
how can the tibial nerve be damaged and what pathology will this cause?
medial malleolar fracture
tibial shaft fracture
compartment syndrome
reduced plantar flexion and inversion
loss of sensation over sole of foot
toe clawing/high arch
wasting of sole of foot - chronic
149
how can the common fibular nerve be damaged? how does it present?
fracture of fibula
weak dorsiflexion - foot drop and high stepping gait
reduced eversion
loss of sensation over lateral leg and dorsum of foot
150
how can foot drop be treated?
splint
| physiotherapy
151
what are the causes of foot drop?
traumatic injury to common peroneal nerve
polio virus
L5 nerve root compression
152
what are the roots of the sciatic nerve?
L4 to S1
153
what are the roots of the femoral nerve?
L2-L4
154
how is the saphenous nerve commonly damaged and how does this present?
stripping of varicose veins
| loss of sensation/paraesthesia over medial lower leg
155
how do tibial platau fractures normally occur?
high impact trauma - requires assessment for other injuries too.
156
what classification is used to grade tibial platau fractures?
schatzkers - low to high energy (grades I to 6)
157
how are tibial shaft fractures managed?
if displacement is minimal - closed reduction. place leg in long leg cast
otherwise external fixation until swelling reduced and then IM nailing OR percutaneous locking plate
158
what are the complications of tibial shaft fractures?
compartment syndrome
associated with fibula fractures
soft tissue injuries
malunion / non union and deformity e.g. shortening
NV damage - fibular nerve, tibial nerve, sural and saphenous nerve - check all these
check tibialis posterior and dorsalis pedis pulses
open fractures and infection
159
why is surgical treatment of femoral shaft fractures usually indicated?
non surgical requires long period of immobolisation - DVT pneumonia etc.
160
how is femoral shaft fracture surgically fixed?
internal fixation with intramedullary nail OR plates/scres
early mobilisation, analgesia,
no weight bearing until 3 months
161
what is chondromalacia patella?
compression forces from the femur at the patella femoral joint.
occurs due to overactivity using in young e.g. jumping and running
usually bilateral with one knee being worse
162
how can a stress fracture be diagnosed?
bone scan
163
what are the symptoms of chondromalacia patella?
pain in patella and around it caused by repetitive
stiffness
makes walking downstairs difficult
crepitus
164
how is chondromalacia patella treated?
NSIADS, ICE, rest
physio to strengthen and stretch quads
very worse case = steroids/knee replacement
165
list differentials for knee pain in adults and adolescence?
```
osteochondritis dissicans
chondromalacia patella
Osgood schlatters
hypermobility
bipartite patella
```
166
what bursa is bakers cyst?
inflammation and fluid accumulation in semimembranous bursa at back of knee - swelling and redness
167
what is associated with bakers cyst?
arthritis of knee
168
what are the different bursa of the knee that can be inflamed?
semimembranosus - bakers cyst
pre patella
infra patella
169
how is bursitis treated?
if infected - aspirate and Abx
| otherwise - rest, NSAIDs, avoid irritation, ICE, aspiration
170
what is the OTTOWA criteria?
criteria for whether an ankle XRAY is needed after injury
- if there is pain over the posterior tip of malleolus OR unable to weight bear
171
what cast is worn for ankle fractures? what management comes alongside this
```
short leg walking cast/boot
no weight bearing 6-8 weeks
no driving 9 weeks
encourage walking with crutches ASAP
physio
```
172
after ORIF of an ankle joint what needs to be removed 9 weeks later?
syndesmosis screw - cant weight bear with this
173
what are pilon fractures? what classification is used for these?
fractures involving tibial plafond (articular surface)
Ruedi classification - degree of displacement and articulation
174
describe the 3 levels of Reudi classification
1. intraarticular with little/no displacement
2. disruption of articular surface but no comminition
3. severe comminution of articular surface
175
what are the 2 other names for CRPS?
reflex sympathetic dystrophy
| algodystrophy
176
name 1 complication of a talus fracture?
fracture to neck can disrupt blood supply - AVN
177
why are lateral ankle ligaments at most risk of being damaged?
you can invert the foot at a greater angle
| they are weaker
178
which ankle ligament is most at risk of irreversible damage?
anterior talofibular
179
what tests can you do to check for achillis tendon rupture?
Simmonds/Thomas test - squeeze calf and look for plantar flexion of ankle (only positive test i.e. no plantar flexion if there is a full thickness tear)
can also feel for a tendon gap.
180
what are risk factors for rupturing achillis?
```
achillis tendonitis
gout
RA
steroids
previous rupture
```
181
what is used to treat an achillis tendon partial tear?
vacoped boot to keep ankle in plantar flexion
then slowly dorsiflex over few weeks
full tears require surgery
182
what is achilis tendonitis? what are the two types?
inflammation of achillis tendon - due to microtrauma and a poor blood supply. bony spurs form within the tendon
insertional: part near calcaneus (poorest blood supply here so prone to tendonitis) - older patients
non insertional : middle portion - in young and active
183
what is found on examination of achillis tendonitis?
bony spurs can be felt within the achillis
| reduced plantar flexion or weak
184
what are the complications of hallux valgus?
OA, MTPJ dislocation, exostosis (new bone formation)
185
what is plantar fasciitis?
inflammation of the plantar fascia at bottom of foot. can cause heal pain and pain over bottom of foot esp with dorsiflexion. worsens with activities
more likely in those with high arched feet, tight calf muscles, new repetitive activity
186
what is a mortoms neuroma?
benign tumour of nerves on base of the foot usually between 3th and 4th toe
more common in women
187
how can pes cavus and planus be conservatively managed?
foot insoles
| weight loss
188
what is the difference between claw toe, hammer toe and mallet tow?
what causes such deformities?
claw: flexion of all
mallet toe: extension of PIPJ but flexion of DIPJ
hammer: extension of DIPJ and flexion of PIPJ
inflammatory arthritis or charot joint
high heals and claw toe
189
what nerve is trapped in tarsal tunnel syndrome and what are the symptoms?
tibial nerve
| paraesthesia in ankle and sole of foot.
190
what is a Jefferson fracture?
fracture of C1 (Atlas)
- anterior and posterior arches often both fractured
does not compress spinal cord
191
what is a hangman fracture?
fracture of C2
| fracture fragments are likely to fracture spinal cord - lethal
192
which cervical vertebrae is most likely to dislocate?
C5/6
193
when is an MRI for back pain indicated?
back pain >1 month not responding to treatment
| red flag symptoms
194
how do we treat spinal stenosis?
analgesia
physiotherapy , weight loss
rest
corticosteroid/anaesthetic injections
surgical decompression to shave away osteophytes etc
195
what is foraminal stenosis?
stenosis of intervertebral foramen by degenerative changes (osteophytes etc)
196
how can you distinguish between back pain radiating and radiculopathy?
if it radiates below knees- radiculopathy
197
how does myelopathy present?
bilateral leg pain
back pain
UMN/LMN signs - depending if before or after the cord
overall wide spread symptoms
198
what nerve does a Monteggi fracture dislocation damage?
posterior interosseous
causes weak wrist extension
199
how can the common peroneal nerve be damaged?
fibular neck fracture
200
what is a nerve conduction study and when is it used?
measures the efficacy of a nerve by measuring conduction spread using electrodes.
carpal tunnel syndrome
peripheral neuropathy
disc herniation
201
what is the difference between radiculopathy and myelopathy ?
radiculopathy - one spinal nerve root compressed - symptoms in that dermatome/myotome
myelopathy neurogenic deficit related to the spinal cord - more wide spread symptoms
202
which deformity at the elbow is more likely to lead to ulnar nerve compression?
valgus
203
what are the causes of sciatic nerve compression?
piriformis syndrome
invertebral disc prolapse
tumour
