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MSK wk 2 Flashcards

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1
Q

What ar ethe major problems of the forefoot?

A 
Hallux valgus
Hallux rigidus
Lesser toe deformities
Morton's neuroma
Metatarsalgia
Rheumatoid forefoot
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2
Q

What is the presentation of hallux valgus?

A

“bunion”
Pressure symptoms from shoe
Pain from crossing does
Metatarsalgia

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3
Q

What causes hallux valgus?

A

Genetic
Foot wear
Female>male

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4
Q

What is the pathogenesis of hallux vagus?

A

Lateral angulation of great toe
Tendons pull relaigned to lateral angle - worsens defmority
Continues in a cycle
Less weight goes through great toe
Eventually abnormalities of the lesser toes occur

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5
Q

How do you diagnose hallux vagus?

A

Clinical

X-rays )to check for severity of underlying bone deformity)

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6
Q

How do you manage hallux vagus?

A

Non-operative - shoe wear modification
Activity modification
Orthotics to correct deformity
Analgesia

Operative - osteotomy
release soft tissues

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7
Q

What is hallux rigidus?

A

Stiff big toe - osteoarthritis of MTP of toe
AKA hallux limitus
Hallux nonextensus

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8
Q

What are the symptoms of hallux rigidus?

A

Many asymptomatic

Pain (extreme dorsiflexion)

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9
Q

How do you diagnose hallux rigidus?

A

Clinical

X-ray

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10
Q

What is teh non-operative management of hallux rigidus?

A

Activity modification
Shoe wear rigid soles
Analgesia

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11
Q

What are teh types of surgery available for hallux rigidus?

A

Cheilectomy (remove dorsal impingement)
Arthrodesis (imbolisation of joint)
Arthroplasty

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12
Q

What is the best surgery for hallux rigidus?

A

Arthrodesis (MTP fusion)

Permanent

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13
Q

When is a hemiarthroplasty indicated in hallux rigidus?

A

When need to maintian range of movement

Although high failure rate so best in low demand patients

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14
Q

What are the lesser toe deromities?

A 
Claw toes  (both proximal + distal)
Hammer toes (Distal)
Mallet toes (proximal)

Where interphalangeal joints are permanently flexed

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15
Q

What is the aeitiology of lesser toe deformtiies?

A 
Imbalance of flexor/extensors
Shoes
Neurological
Rheumatoid arthrits
Idiopathic
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16
Q

What are teh symptoms of lesser toe deformities?

A

Deformity
Pain from dorsum
Pain from plantar side

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17
Q

What are the treamtnet options for lesser toe deformities?

A

Non-oper
Activity/shoe modification
Orthotic insoles

Operative
Flexor to extensor transfer
Fusionof interphangeal joints
Release metatarsophalngeal joint
Shortening ostetomy of metatarsal
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18
Q

What is another name for interdigital neuralgia?

A

Morton’s neuroma

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19
Q

What casues morton’s neuroma?

A

Mechanically induced degenerative neuropathy
Females 40-60
Associated with high hell shoes

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20
Q

What are hte symtoms of morton’s neuroma?

A

2nd/3rd webspace
Neuralgic burning pain in toes
Intermittent
Altered sensation into toes

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21
Q

How do you diagnose morton’s neuroma?

A

Clinical
Mulder’s click
US best, MRI good

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22
Q

How do you manage morton’s neuroma?

A

Injection for small lesions

Surgery - excision of lesion including section of normal nerve

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23
Q

What are the complications with surgery for morton’s neuroma?

A

Numbness
Possible recurrance
Up to 30% still have pain 1yr post surgery

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24
Q

What is metatarsalgia?

A

A symptom - pain of metatarsals

Sometimes difficult to treat

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25
What can cause metatarsalitis?
``` Syovitis Bursitis Arthritis Neuralgia Neuromata Freibergs disease ```
26
How do you treat rheumatoid forefoot?
Shoewear/orthotics Operative - toe - MTP arthrodesis Smal toes - arthroplasty
27
What are the pain midfoot problems?
Ganglia Osteoarthrits Plantar fibromatosis
28
What causes dorsal foot ganglia?
Underlying arthritis Underlying tendon pathology -arises from joint or tendon sheath
29
What are the symptoms of sorsal foot ganglia?
Pain from shoe wear pressure | Pain from underlying problem
30
How do you treat dorsal foot ganglia?
Non-operative - aspiration Operative - excision However high rate of return
31
What types of midfoot arthritis are there?
Post-traumatic Osteoarthritis Rheumatoid arthritis
32
What are the treatmnets for midfoort arthritis?
Non-op Injections - x-ray guided Operative - fusion
33
What is plantar fibromatosis?
"ledderhose disease" Similar to druptyns but foot Progressive and usually asymptomatic
34
How do you treat plantar fibromatosis
Non-op - avoid pressure, shoewear Operative - excision Radiotherapy Combination (high risk complications but low risk of recurrance)
35
What are the main problems of the hindfoot?
``` Achilles tendonitis Plantar fasciitis Ankle osteoarthritis Tibialis posterior dysfunction Charcots foot Diabetic foot ulcerfoot ```
36
What is achilles tendonitis/tendinosis
Degenerative /overuse condition with little inflammation Tendinosis is histopathy Tendiopathy used to describe symptoms
37
What causes achilles tendiopathy>
``` Common in non-athletic people Obesity Steroids Diabetes Middle aged ```
38
What causes paratenonopathy?
Commonest in athletic populations 30-40 | More common in men
39
What are the symptoms of achilles tendinopathy?
Recurrent episodes of pain during or following exercise Difficulty fitting shoes Sometimes rupture
40
How do you diagnose achilles tendinopathy?
Tenderness + test for rupture - simmonds + test angle US/MRI
41
What is the simmonds rupture test?
``` Squeeze calf (soleus) If foot moves, tendon is not fully ruptures If failure to move full rupture ```
42
What is the treatment for achilles tendinopathy?
Weight loss Shoe wear/acitivty modification Immbolisation Operative - gastronemius recession Release and debridement of tendon
43
What is plantar fasciitis?
Chronic degeneration of fibroblast hypertophy Disorganised/dysfunctional blood vessesl/collagen Leads to unable to make extra cellular matrix required for matrix/repair and remodelling Note, fasciosis is a better term
44
What causes plantar fasciitis?
Unknown, but associated with: Obesity Lowerlimb rotational deformities Running with poorly padded shoes on hard surfaces Tight gastro-soleus complex High intensity/rapid increase in training
45
What are teh symptoms of plantar fasciitis?
Pain first thing in morning Pain on weight bearing after weight Pain located at origin of plantar fascia
46
What are the differentials for plantar fasciitis?
Nerve entrapment Arthritis Calcaneal pathology
47
How do you diagnose plantar fasciitis?
Mainly clinical | Ocasionally radiography
48
How do you treat plantar fasciitis?
``` Rest/ICE NSAIDs Stretching Physio Injections Night splinting ```
49
What newer treatments are there for plantar fasciitis?
``` Extracorporeal Shockwave therapy Topaz Plasma Coblation Nitric Oxide Platelet Rich Plasma Endoscopic / Open Surgery ```
50
How do you diagnose ankle arthritis?
Clinical Radiographs CT to exclude adjacent joint arthritis
51
How do you manage arthritis?
Weight loss Activity modification Analgesia Physio Sugery: Anterior symptoms only - arthroscopic anterior debridement Arthrodesis (gold standard) Joint replacement - difficult to revise
52
What is tibialis posterior tendon dysfnction?
Acquired flat foot planovalgus | Common but under recognised
53
What are the symptoms of tibialis posterior tendon dysfunction?
Medial or lateral pain | Double or single heel raise
54
How do you diagnose tibialis posterior tendon dysfunction?
Clinically
55
What is the heel raise test?
Raise heels Normally heel should swing inwards as it rises Swings outwards in positive
56
How do you manage tibialis posterior tendon dysfunction?
``` Orthotics Reconstruction of tendon Triple fusion (subtalar, talonavicular, calcaneocuboid) ```
57
What are the aims of surgical treatment of diabetic foot ulcer?
Improve vascular supply Debride ulcers + deep samples for microbiology Correct any deformity to offload area Sometimes amputation to mitigate damage
58
What is the prognosis of a diabetic foot ulcer?
25% go on to get amputation | 5 yr mortality
59
What causes charcot neurarthropathy?
Anything that causes neuropathy Diabetes most common Most common with syphillis historically
60
What is the pathophysiology of charcots foot?
Neurotraumatic - loss of proprioception and protective pain sensation Or neurovascular - abnormal autonomic nervous system results in increased vascular supply + bone reabsorption
61
How do you diagnose charcot's foot?
Consider in any diabetic with acutely swollen red foot Esp with neuropathy Frequntly not painful MRI/radiograph 3degree difference between limbs
62
How do you manage charcot's foot?
Immoblisation until acute fragmentation revolved Correct deformity (to prevent ulceration/infection/amputation)
63
What are common conditions of the hand - ellective?
``` Drupuytren's disease Trigger finger De quevain's tenovaginiits Nerve entrapments (carpal/cubital tunnel syndromes) ganglion OA ```
64
Who is likely to get dupuytren's?
``` Men more than women Almost exclusively white Associated with diabetes Alochol Tobacco HIV Epilepsy ```
65
What is the pathology of drupruten's?
Myofibroblast proliferation and collagen depositation leading to a progressive thickening of the palmar fascia Causes digital protraction of fingers
66
What are the functional problems in druputren's?
Loss of figner extension | Hard to do simple tasks - grip, wash face, hands in pocket
67
How do you treat drupuytren's?
Radiotherpahy (splints don't work) Partial/dermo fasciectomy Arthrodesis
68
Why is partial fasciectomy the gold standard for drupuytren's?
Good correction achieved Wound takes 2-3 weeks Druputytren's can't be cured
69
What is dermofasciectomy?
A more radial procedure, removing skin may reduce recurrance | Requires more inetnsive physio
70
What are the benefits to percutaneous needle fascitomy?
Quick + no wounds Return to activity in 2-3 days Can be repeated However risk of nerve injury and higher recurrance
71
What is the pathology behind trigger finger?
Swelling in tendon which catches on bone
72
Who gets trigger finger?
Women more than men - 40s-60s Ring finger most common, then thumb and middle Associated with RA, diabetes, gout
73
How do you diagnose trigger finger?
Patient history Clickingsensation on digit movement Lump in palm under pulley Clicking may become lcoked
74
What can cause trigger finger?
Repitive use of hand | Local trauma
75
How do you treat trigger finger?
Splint/steroids Or seurgically - percutaneous release or open surgery
76
What is the clinical history of de quervians syndrome?
Several weeks of pain localised to radial side of wrist Pain aggravated by thumb mvement Localised swelling - potentially Localised tenderness over tunnel
77
Who gets De quervains syndrome?
Women 50-60 most common Increased in post partum/lactating women Associated with regular ulnar deviation
78
What is the pathology of de quervains syndrome?
A fibroossous tunnel in 1st dorsal extensor compartment Leads to thickening of localised segment 30% have compartment divided by septum
79
How do you diagnose de quervains syndrome?
Examine thumb joints (consider OA at base of thumb) Finklesteins test Resisted thumb extension
80
How do you treat de quervains syndrom?
Splints/steroir Decompression surgery
81
What is a ganglion?
Myxoid degeneration from a joint synovia "lump"
82
Who is most likely to get gnaglia?
Women 2x, most common 20-40yrs | Associated with recurrent injury around wrist
83
What is the presentation of ganglia?
More common on dorsal side (3:1) 3x | 70% of all swellings on hand
84
How do you diagnose a ganglia
Firm, non-tender lump witha change in size Smooth, only occasionally lobulated Normally not fixed to underlying tissue - NEVER to skin
85
How do you treat ganglia?
Reassure + observe - aspiration | Operate - excise
86
What are the symptoms of OA at base od thumb?
``` Pain Stiffness Swelling Deformity Loss of function ```
87
Who gets OA at base of thumb?
1/3 of all women
88
What are the presenting features of base of thumb OA?
Pain on opening jars or pinching Dorsal subuxation Metacarpal adduction MCP hyperextension
89
Where should you test if OA is found in base of thumb?
Scapho-trapezio-trapezoinal OA at wrist
90
How do you treat osteoarthritis base of thumb?
Life style modifications NSAIDs Splint/steroid Opertive Replacement fusion Trapeziectomy - gold standard

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