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Rheum/MSK > Ortho 2 > Flashcards

Ortho 2 Flashcards

1
Q

What are the rotator cuff muscles?

A

Subscapularis
Teres Minor
Infraspinatus
Supraspinatus

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2
Q

What are the different types of shoulder dislocation?

A

Anterior shoulder dislocation - loss of shoulder contour, anterior bulge from head of the humerus

Posterior shoulder dislocation - limitation of external rotation, ‘light-bulb’ appearance of the humeral head

Inferior shoulder dislocation - neurovascular dislocation - neurovascular injur, tuberosity avulsion, rotator cuff tear (luxation erecta)

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3
Q

What are the X-ray findings for shoulder dislocation?

A

Posterior - Light bulb sign

Rim sign

Trough line sign

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4
Q

What are the complications of shoulder dislocation?

A

Axillary Nerve damage - deltoid paralysis

Brachial Plexus - damage

Fracture

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5
Q

How would you manage shoulder dislocation?

A

Assess neurovascular status of upper limb before and after reduction

Reduction ASAP - give analgesia/anesthetic
closed, MUA

Immobilization - Broad sling - 2-6 weeks

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6
Q

What is a Hill Sachs Lesion? Bankart Lesion?

A

Posterolateral Humeral Compression Fractire - defect on head or edge of glenoid process after dislocation - sugery

Bankart - avulsion of gleoid labrum and anterior margin

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7
Q

Causes of recurrent shoulder dislocation?

A

Atraumatic (5%) - AMBRI
Atraumatic, Multidirectional, Bilateral, treat by Rehab, Inferior capsular shift surgery if rehab fails

Traumatic - TUBS
Traumatic
Unilateral
Bankart lesion
Surgical treatment
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8
Q

What are special tests for shoulder?

A

Neer’s test – passive flexion of shoulder with a pronated arm. Painful arc between 90-120 degrees = IMPINGEMENT
Drop arm sign – Patient lowers arm slowly from 160 abduction – if can’t control descent = rotator cuff tear
Jobe test – internally rotate arm whilst in 90 degrees abduction and 30 degree forward flexion with an extended elbow. Attempt to further abduct against resistance which result in pain = supraspinatus weakness or injury
Speed’s test – arm flexed forward 60 degrees, elbow extended and forearm in supination, attempts to flex shoulder forward against resistance
Apprehension test – elbox flexed 90 degrees, the forearm supine, abduct and externally rotate arm to 90 degrees. Apprehension = anterior joint instability
Scarf test – forced adduction of arm across the neck. Pain = AC joint disease

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9
Q

How does rotator cuff tear present?

A

Partial tear - painful arc syndrome (pain on abduction)

Complete tear - limits shoulder abduction

Pain level depending on severity of tear

weakness

Weakness

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10
Q

What are the actions of the supraspinatus? How can you test for supraspinatus tendinopathy?

A

Abducts humerus - empty beer can test

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11
Q

What are the actions of the infraspinatus? How can you test it?

A

Externally rotates humerus - resisted external rotation

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12
Q

What are the actions of the teres minor?

A

Externally rotates humerus

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13
Q

What are the actions of the subscapularis? How can you test it?

A

Internally rotates humerus

Lift-off test

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14
Q

How can you treat acromioclavicular joint osteoarthritis?

A

Steroid injection or excision of lateral end of the clavicle

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15
Q

How could you investigate rotator cuff tears?

A

USS (tendon imaging)
MRI (labral tears)
MRI arthrography

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16
Q

What pathology is indicated for which part of shoulder abduction movement?

A

First 15 degree - supraspinatus

15-90 deltoid

trapezius and serratus anterior >90 degrees

High arc pain 120-180 = ACJ pathology - OA/Trauma

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17
Q

What is a frozen shoulder?

A

Adhesive capsulitis

Glenohumeral disorder and can occur in both shoulders

Commonly affect 40-65

More common in women and DM

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18
Q

What is are risk factors for a frozen shoulder?

A 
Women
DM
Past surgery
Increasing age
RA
Past trauma
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19
Q

How does adhesive capsulitis present?

A
  • severe pain in shoulder
  • active and passive ROM is reduced (ER affected more than IR or abduction)
  • Assoc. with cervical spondylosis
  • difficulty sleeping on affected side
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20
Q

How would you investigate and manage adhesive capsulitis?

A

thorough physical exam
USS
MRI

investigate systemic symptoms - infection/inflammation

SLEEPER STRETCH - improves internal rotation, other PHYSIO
MAITLAND technique

NSAID or oral corticosteroid

Intra-articular corticosteroid

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21
Q

What makes the elbow joint? What movements occur at the elbow joint?

A

Distal humerus with the proximal radius and ulna

Flexion/extension at the ulno-humeral joint (0-150 degrees)

Supination of 90 degrees should be possible

22
Q

What is tennis elbow?

A

Lateral Epicondylitis
- inflammation where the common extensor tendon arises from the lateral epicondyle of the humerus +/- rupture of aponeurosis fibres

75% dominant arm

23
Q

How can you investigate Tennis elbow?

A

Clinical

Mill’s and Cozen’s

24
Q

How would you treat tennis elbow?

A

rest + ice + NSAID + brace/strap

physio + local anaesthetic injection

surgery - open surgical debridement of the extensor carpi radialis brevis

extracorporeal shock wave therapy

25
Q

What is golfer’s elbow?

A

Medial Epicondylitis

flexor muscles and medial epicondyle

exarcebrated by wrist flexion and pronation

26
Q

How would you manage golfer’s elbow?

A

rest + ice + NSAID + brace/strap

physio + local anaesthetic injection

surgery

injection with non-anaesthetic agents - autologous blood, platelet rich plasma, hyaluronic acid, botox

27
Q

What is cubital tunnel syndrome?

A

osteoarthritic or rheumatoid narrowing of the ulnar grrove and constriction of the ulnar nerve as it passes behind the medial epicondyle

28
Q

How does cubital tunnel syndrome present?

A

Sensory symptoms - decreased sensation over the little finger and medial half of ring finger

Clumsiness and weakness of small muscle of hand (adductor pollicis, interossei, abductor digiti minimi and opponens digiti minimi

29
Q

What is Dupuytren’s?

A

Progressive disorder affecting the palmar fascia, causing fibrous tissue to shorten and thicken

cause unknwon

30
Q

Which part of hand does Dupuytren’s contracture affect?

A

Ring finger, little then middle

Often bilateral

Thickening, cord formation and contraction of cord = flexion of MCP and PIP

31
Q

How would you treat Dupuytren’s?

A

If cannot place palm flat on flat surface - refer for surgery (Hueston’s table top test)

Corticosteroid injections

Collagenase injection

Percutaneous fasciotomy

> 30 degrees
- open partial fasciectomy

post surgery splinting

32
Q

What is De Quervain’s disease?

A

Stenosing tenosynovitis (thickening and tightening) of the ABDUCTOR POLLICIS LONGUS and EXTENSOR POLLICIS BREVIS tendons

33
Q

How would De Quervain’s present? Management?

A

Pain on radial side of wrist
Abduction of thumb against resistance is painful
Finkelstein’s sign - sharply pulling on the relaxed thumb to cause ulnar deviation

Analgesia, steroid injection, immobilisation and surgery

34
Q

What is trigger finger? How does it present?

A

Swelling of tendon or tighthening of flexor tendon sheath

Ring and middle fingers most commonly affected

Fingers lock in flexion

Trapped flexor tendon - A1 pulley

Digit locked in flexion must be passively released

35
Q

Risk factors for trigger finger?

A

RA
DM
Women

36
Q

What is Lasegue’s sign positive?

A

Straight knee raising test for herniated disc

Knee extended - lift patient’s leg off the couch and note the angle to which leg can be raised before eliciting pain

30-70 degrees = positive

37
Q

What are some differentials for back pain in a 15-30 year old?

A 
Prolapsed disc
Trauma
Fractures
Ankylosing spondylitis
Spondylolosthesis
Pregnancy
38
Q

What are some differentials for back pain in a >30 year old?

A

Prolapsed disc

Cancer (breast, lung, prostate, thyroid, kidney)

39
Q

What are some differentials for back pain in a >50 year old?

A 
Degenerative
Osteoporosis
Paget's disease
Malignancy
Myeloma
Lumbar artery atheroma
40
Q

Where is a lowe back disc prolapse most likely to occur?

A

L4/5, L5/S1

L5/S1 - calf pain, weak foot plantar flexion, decreased pinprick over sole of foot and back of calf, decreased ankle jerk

L4/5 - hallux extension is weak and sensation is decreased on outer dorsum of foot

41
Q

What are sigs of cauda equina? What should management be?

A

Saddle-area decreased sensation

Incontinence/retention of faeces or urine

Poor anal tone (PR)

Paralysis +/- sensory loss

= MRI within 4 hrs

42
Q

What are some examples of lumbar disc prolapse surgery?

A

Lumbar microdisectomy - most common

Endoscopic discectomy - less invasive

Laser discectomy - radiographically assisted placement

Lumbar disc arthroplasty

Interspinous spacers

Chemonucleolysis

43
Q

What is Kyphosis?

A

Anterior curvature of the spine

44
Q

What are some causes/risk factors of Kyphosis?

A 
PONDS
Postural
Osteoporotic
Neuromuscular
Degenerative
Scheuermann's disease
Osteoporosis
Spina Bifida
Malignancy
Infection
Paget's disease
Ankylosing spondylitis
45
Q

What is scoliosis?

A

lateral curvature of the THORACIC spine

46
Q

How does scoliosis present?

A

Girls
Causes pain, comesis and impaired lung function

Rib deformity causes characteristic hump on the convex side of the curve - manifests when patient bends FORWARDS

Curvature increases with time

Earlier onset - worse the deformity

47
Q

What are causes/RFs for scoliosis?

A

Idiopathic - cobb angle >10 degrees

Congenital

Neuromuscular
Syndromic (marfan’s, neurofibromatosis)

Other (tumour, infection, trauma)

48
Q

What are the types of scoliosis?

A

Thoracolumbar - usually curves to the right

Lumbar - usually curves to left

Infantile thoracic - usually curves to the left

Adolescent thoracic - usually curves to the right

Double major - two curves in each direction

49
Q

What is treatment for scoliosis?

A

Physio, exercise, swimming

Analgesia

Boston/Milwaukee brace, >20 hrs a day

Surgery

50
Q

What should be excluded in young scolisis patient with night pain?

A

Osteoid Osteoma
Osteoblastoma
Spondylolisthesis
Spinal Tumours

Rheum/MSK (5 decks)

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