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Orthopaedics > MSK Cortex Regional Adult Orthopaedics - Spine & Upper Limb > Flashcards

MSK Cortex Regional Adult Orthopaedics - Spine & Upper Limb Flashcards

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1
Q

What is the treatment for “mechanical” back pain?

A

Analgesia and physiotherapy. Bed rest is not advised as this will lead to stiffness and spasm of the back

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2
Q

And acute disc tear can occur where?

A

In the outer annulus fibrosis of an intervertebral disc (which classically happens after lifting a heavy object)

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3
Q

When is pain characteristically worse in an acute disc tear?

A

On coughing (this increases disc pressure)

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4
Q

What is the treatment for an acute disc tear?

A

Analgesia and physiotherapy are the mainstay of treatment

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5
Q

Where is the commonest site of of a disc prolapse where a nerve root is impinged?

A

Lower lumbar spine with L4, L5 and S1 nerve roots causing sciatica

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6
Q

In the lumbar spine, when there is a disc prolapse and a nerve is impinged which of the higher or lower of the two vertebra in the effected segment is usually compressed?

A

Lower

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7
Q

Describe a L3/4 prolapse?

A

L4 root entrapment > pain down to medial ankle (L4), loss of quadriceps power, reduced knee jerk

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8
Q

Describe a L4/5 prolapse?

A

L5 root entrapment > pain down dorsum of foot, reduced power Extensor Hallucis Longus and tibialis anterior

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9
Q

Describe a L5/S1 prolapse?

A

S1 root entrapment > pain to sole of foot, reduced power planarflexion, reduced ankle jerks

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10
Q

What is the 1st line treatment for a nerve root compression?

A

Analgesia, maintaining mobility and physiotherapy (occasionally drugs for neuropathic pain can be used - gabapentin)

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11
Q

What is a bony nerve root entrapment?

A

OA of the facet joints resulting in osteophytes impinging on exit nerve roots

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12
Q

What is the treatment for bony nerve root entrapment in suitable candidates?

A

Surgical decompression, with trimming of the impinging osteophytes

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13
Q

How do the signs and symptoms of spinal stenosis differ from vascular claudication?

A
  1. Claudication distance is inconsistent
  2. Pain is boring (rather than cramping)
  3. Pain is less walking uphill (spine flexion creates more space for the caudal equina)
  4. Pedal pulses are preserved
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14
Q

What surgery may be performed for spinal stenosis if symptoms fail to improve with conservative management?

A

Decompression surgery to increase space for the caudal equina to help alleviate symptoms

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15
Q

What is cauda equina syndrome?

A

A very large central disc prolapse compressing all the nerve roots of the cauda equina

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16
Q

Prolonged cauda equina syndrome can cause what?

A

Permanent nerve damage requiring colostomy and urinary diversion

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17
Q

What are the symptoms of cauda equina syndrome?

A
  1. Bilateral leg pain, parasthesiae or numbness in a saddle pattern (saddle anaesthesia)
  2. Altered urinary function
  3. Altered bowel function
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18
Q

What is the management of caudal equina syndrome?

A

Urgent MRI to determine the level of prolapse and urgent discesctomy once the diagnosis is confirmed

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19
Q

What are the “red flags” in back pain?

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, worse at night
  4. Systemic upset
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20
Q

What is an osteoporotic crush fracture?

A

In severe osteoporosis, spontaneous crush fractures of the vertebral body can occur leading to acute pain and kyphosis

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21
Q

What is the treatment for osteoporotic crush fractures?

A

Usually conservative, however, some clinicians have tried balloon vertebroplasty

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22
Q

What is cervical spondylosis?

A

Disc degeneration leading to increased loading and accelerated OA of the facet joints

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23
Q

What are the symptoms of cervical spondylosis?

A

Slow onset stiffness and pain in the neck which can radiate locally to shoulders and the occiput

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24
Q

Children with Down syndrome are at risk of developing an instability where in the vertebrae?

A

Atlanto-axial (C1/C2) with subluxation potentially causing spinal cord compression

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25
What makes up the shoulder girdle?
Scapula Clavicle Proximal humerous Supporting muscles including the deltoid and rotator cuff
26
Which muscles make up the rotator cuff?
Supraspinatus Infraspinatus Teres minor Subscapularis
27
Where do the supraspinatus, infraspinatus and teres minor attach?
Greater tuberosity
28
Where does the subscapularis attach?
Lesser tuberosity
29
What does the supraspinatus do?
Responsible for initiating abduction
30
What does the infrapinatus and teres minor do?
External rotation
31
What does the subscapularis do?
Is the principle internal rotator
32
Impingement syndrome causes a painful arc between which angles of abduction?
60 - 120 degrees
33
What are some causes of impingement syndrome?
1. Tendonitis subacromical bursitis 2. Acromioclavicular OA with inferior osteophyte 3. A hooked acromion rotator cuff tear
34
What is the treatment of impingement syndrome?
Conservative in the first instance with NSAIDs, analgesics, physiology and subacromial injection of steroid (up to 3 may be required). Subacromial decompression surgery may be performed if conservative treatment isn't successful
35
A rotator cuff tear usually affects which tendon?
Supraspinatus
36
What is adhesive capsulitis (frozen shoulder)?
Progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18‐24 months
37
What is the principle clinical sign in frozen shoulder?
Loss of external rotation?
38
How does acute calcific tendonitis present and what causes it?
Acute onset of severe shoulder pain and is characterised by calcium deposition in the supraspinatus tendon
39
What is the treatment for acute calcific tendonitis?
Subacromial steroid and local anaesthetic injection. It is self-limiting with pain easing as the calcification reabsorbs
40
What treatment can be given to patients with recurrent dislocations?
Bankart repair - stabilises the shoulder by reattaching the labrum and capsule to the anterior glenoid which was torn off in the first dislocation
41
Carpal tunnel syndrome is due to the compression of which nerve?
Median
42
What are the causes of carpal tunnel syndrome?
1. Idiopathic (most cases) 2. Rheumatoid arthritis 3. Fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroidism 4. Fractures around the wrist (esp. collet fracture)
43
Does carpal tunnel syndrome mostly affect men or women?
Women (8:1 ratio)
44
Chronic carpal tunnel syndrome may have what on examination?
Muscle wasting of the thenar eminence
45
What tests can be done to reproduce the symptoms in carpal tunnel syndrome?
Tinel's test (percussing over the median nerve OR Phalen's test (holding the wrists hyper-flexed which decreases space in the carpal tunnel)
46
What investigation can be performed to confirm carpal tunnel syndrome?
Nerve conduction studies - slowing of conduction across the wrist
47
Carpal tunnel decompression involves doing what?
Division of the transfer carpal ligament
48
Cubital tunnel syndrome is due to the compression of which nerve?
Ulnar
49
Ulnar compression can be due to what?
1. Tight band of fascia forming the roof of the tunnel (Osborne's fascia) 2. Tightness at the intermuscular septum 3. Compression between two heads at the origin of flexor carpi ulnaris
50
Which joints make up the elbow and what are the responsible for?
Humero-ulnar joint - flexion/extension | Radio-capitallar joint - supination/pronation
51
Where does the triceps muscle insert?
Coronoid process
52
Where does the biceps muscle insert?
Bicipital tuberosity of the radius
53
Forearm supination is performed using which muscles?
Biceps and supinator muscles
54
Forearm pronation is performed using which muscles?
Pronator teres muscle proximally and the pronator quadrates distally
55
The common extensor origin of the wrist arises from where?
Lateral epicondyle
56
The common flexor origin of the wrist arises from where?
Medial epicondyle
57
What is the proper name for Tennis elbow?
Lateral epicondylitis
58
What causes tennis elbow?
Repetitive strain injury in those who regularly perform resisted extension at the wrist OR due to degenerative enthesopathy
59
What is the proper name for Golfer's elbow?
Medial epicondylitis
60
Why is a steroid injection less commonly used for Golfer's elbow than Tennis elbow?
Risk of injury to ulnar nerve
61
An elbow severely affected by RA or OA at the humero‐ulnar joint which isn't satisfactorily treated with conservative management can be treated surgically with which operation?
Total elbow replacement
62
Describe dupuytren's contracture?
Hyperplasia of palmar fascia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints
63
What is the pathology involved in dupuytren's contracture?
Proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1)
64
Duputren's contracture can be a feature of what disease?
Alcoholic cirrhosis (also more common in diabetics)
65
What is the name for the connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis?
Peyronie's disease
66
What is the name of the fibromatosis which causes thickening of the feet's fascia?
Ledderhose disease (plantar fibromatosis)
67
What degree of contracture at the MCP joint may be tolerated in duputren's contracture?
30 degrees
68
What degree of contracture at the PIP joint may be tolerated in duputren's contracture?
None (PIPJ readily stiffens and any contracture here is usually an indication for surgery)
69
What is trigger finger?
Nodular enlargement of the affected tendon, usually distal to a fascial pulley over the metacarpal neck (the A1 pulley). The finger may lock in a flexed position as the nodule passes under the pulley
70
Which fingers does trigger finger most commonly affect?
Middle and ring finger
71
What is the first line treatment for trigger finger?
Steroid injection around the tendon sheath
72
What are Heberden's nodes?
Stiffness and bony thickening of the DIP joints - sign of OA
73
What is the name for tiffness and bony thickening of the PIP joints?
Bouchard's nodes
74
In severe OA what surgery on the index finger may be performed to preserve pinch-grip?
Arthrodesis (fusion)
75
Does RA tend to spare the PIP or DIP joints?
DIP
76
What are the 3 stages of RA in the hands?
1. Synovitis and tenosynovitis 2. Erosions of the joints 3. Joint instability and tendon rupture
77
What type of drugs are mainly used for RA?
Disease modifying anti-rheumatic drugs (DMARDs)
78
What hand deformities may be present in patients with RA?
1. Volar MCPJ subluxation 2. Ulnar deviation 3. Swan neck deformity (hyperextension at PIPJ with flesion DIPJ) 4. Boutonniere deformity (flexion at PIPJ with hyperextension at DIPJ) 5. Z-shaped thumb
79
What is a ganglion cyst?
A common mutinous filled cyst found adjacent to a tendon or synovial joint
80
What is a ganglion cyst on the posterior knee called?
Baker's cyst

Orthopaedics (6 decks)

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