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Ortho and Rheum > Ortho > Flashcards

Ortho Flashcards

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1
Q

What is ankylosis?

A

Stiffening of a joint with fibrous or bony Union across it

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2
Q

What is arthroplasty?

A

Creation of an artificial joint

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3
Q

What is a closed fracture?

A

One contained totally inside the body

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4
Q

What is a comminuted fracture?

A

A fracture having more than 2 parts

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5
Q

What is a multi fragmentary fracture?

A

A fracture having several discernible and countable parts

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6
Q

What is an open fracture?

A

One having any communication with the outside world

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7
Q

What is osteotomy?

A

Surgical cutting, wedging and then realignment in a bone

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8
Q

What is reaming?

A

Surgical widening of the medullary cavity of a bone

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9
Q

What is spondylolysis?

A

A defect in the pars interarticularis of a vertebra

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10
Q

What is spondylosis?

A

Term used for a generalised degenerative disease of the spine

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11
Q

What is subluxation of a joint?

A

Partial dislocation of a joint - as opposed to full dislocation

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12
Q

What does valgus mean?

A

Deformity of part of a limb laterally from the normal axis

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13
Q

What does varus mean?

A

Deformity of a part of a limb medially from the normal axis

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14
Q

What is cervical spondylosis? Examples

A

Degenerative changes of the cervical spine - changes can include degeneration of the annulus fibrosus and bony spurs narrowing the spinal canal and the IV foramina

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15
Q

Incidence of cervical spondylosis

A

Very common

90% of men >60 and women >50

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16
Q

Symptoms of cervical spondylosis x4

A

Usually asymptomatic
Can cause neck and arm pain with paraesthesiae
Sometime myelopathy (spastic weakness and later incontinence)

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17
Q

What is cervical spondylolisthesis?

A

Displacement of one vertebra upon the one below

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18
Q

Causes of cervical spondylolesthesis? X3

A

1) Congenital failure of fusion of odontoid process with axis or fracture of axis (skull, atlas and o-process slip forward on axis)
2) inflammation eg. RA or complicating throat infection - cause lax transverse ligament leading atlas to skip forward on axis
3) instability after injuries

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19
Q

What is cervical rib?

A

Congenital development of the costal process of c7 vertebra - is a spectrum so can just have prominent transverse processes
Can just be fibrous band - won’t show on x Ray

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20
Q

Symptoms of cervical rib

A

Can cause thoracic outlet compression - normally of lower brachial plexus therefore pain and numbness in hand/forearm, usually ulnar side
May be hand weakness and muscle wasting
Weak radial pulse +/- forearm cyanosis

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21
Q

What can cause infant torticollis?

A

Can result from birth damage to sternocleidomastoid muscle

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22
Q

Typical age and presentation of infant torticollis x3 symptoms

A

Age 1-36months with head tilting towards affected side
Can also get retarded facial growth in affected side
Tumour like muscle thickening - benign fibrous lesion

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23
Q

What are the rotator cuff muscles?

A

Supraspinatous, infraspinatous, teres minor and subscapularis

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24
Q

What do you suspect if all shoulder movements make shoulder pain worse?

A

Arthritis or capsulitis

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25
What do you suspect if only some movements make shoulder pain worse?
Impingement
26
Best way to test shoulder external rotation
Hold elbows flexed with hands on waist and move hands outwards
27
Best way to test shoulder internal rotation
Ask to do up bra
28
Who is most commonly affected by atraumatic recurrent shoulder dislocation?
Teenagers with no history of trauma but general joint laxity
29
What does AMBRI mean for recurrent shoulder dislocations?
``` Atraumatic Multidirectional Bilateral Rehabilitation for treatment Inferior capsule shift surgery if rehab fails ```
30
What are most traumatic shoulder dislocations
Anterior Sometimes inferior Rarely posterior
31
What does TUBS mean for recurrent shoulder dislocations?
Traumatic Unilateral Bankart lesion (capsule attached to scapula but pulled off from glenoid labrum) Surgical treatment
32
What movement causes anterior dislocations?
Abduction and external rotation of arm eg.putting coat on
33
What is Hill-Sachs lesion?
Posterolateral 'dent' in humeral head which occurs with anterior dislocations
34
What happens in rare posterior shoulder dislocations?
Capsule torn from back of scapula Humeral dent is superomedial Caused by abduction and medial rotation - eg.seizure
35
What is Neer's test?
Passive flexion of shoulder with pronated arm whilst stabilising scapula - painful arc between 60-120• is impingement
36
What is jobe test?
Patient internally rotates arm whilst held in 90• abduction and 30• forward flexion with extended elbow Further abducting against resistance cause pain = supraspinatus weakness and injury
37
What is speeds test?
Patient has arm flexed at 60•, forearm in supination and attempt to flex shoulder against resistance Pain on palpation of long head of biceps tendon = biceps tendonitis
38
What is apprehension test?
Elbow flexed at 90•, forearm supine, abduct and externally rotate arm to 90• Apprehension = anterior joint instability
39
What is scarf test?
Forced adduction of arm across the neck. If causes pain then AC joint disease
40
What is painful arc syndrome?
Pain on abducting 45-160•
41
Causes of painful arc syndrome x3
Supraspinatus tendinopathy Calcifying tendinopathy AC joint osteoarthritis
42
What is cubitus valgus and what is it associated with?
Increased carrying angle at elbow Associated with turners syndrome Can lead to ulnar neuritis and OA
43
What is Huestons table top test?
If someone with dupuytrens contracture can't place palm flat on surface the refer for surgery (fasciotomy)
44
What is arthrodesis?
Surgical fusion of a joint
45
What is Volkmann's ischaemic contracture?
Muscle necrosis following compartment syndrome or interruption of the brachial artery near the elbow - results in contraction and fibrosis mainly of flexor pollicis longus and flexor digitorum profundus
46
Symptoms of Volkmann's ischaemic contracture
Forearm pronation, wrist flexion, thumb flexion and adduction, digital MCP joint extension and IPJ joint flexion (causing curved hand)
47
What does straight leg raising test?
Looking for underlying herniated disc Lie flat, knee extended, lift leg off couch and note angle which can be reached before eliciting pain 30-70• Lasegues sign positive
48
Mechanism of straight leg test
Stretches sciatic nerve and causes root pain
49
What else can you do with straight leg test
If lifting unaffected leg causes pain in affected side it is said to be positive and sign of herniated disc
50
What is Paget's disease of the bone
Disorder characterised by excessive bone breakdown and formation with disordered bone remodelling which results in pain and misshapen weak bones
51
What is the natural spinal curvature?
Thoracic kyphosis, Lumbar lordosis and sacral kyphosis
52
What is kyphosis?
Spinal thoracocervical flexion = hump back
53
Why is congenital kyphosis important?
Cord compression and paraplegia can sometimes develop rapidly
54
What is scoliosis?
Lateral curvature of the spine
55
Causes of scoliosis? Most common
Idiopathic most commonly Congenital due to failure of formation of segments Neuromuscular Syndromic eg. marfans or neurofibromatosis
56
What is Cobb angle
Angle of lateral curvature of the spine
57
Details of idiopathic scoliosis
Cobb angle >10• Most common and worse in girls - convexity more often to the right Curvature increases with growth Can cause impaired lung function
58
Management of idiopathic scoliosis
Bracing - with Boston or Milwaukee brace- not very comfortable - doesn't stop it just slows progression Can do surgical correction with spinal fusion and stabilisation
59
What is lumbar microdiscectomy?
Surgery for lumbar disc prolapse | Microscopic resection of the protruding disc from a posterior approach
60
What is endoscopic discectomy?
Same procedure as lumbar microdiscectomy but less invasive
61
What is laser discectomy?
Radiographically assisted placement of a delivery device into the disc - through which a laser can be introduced to remove material
62
What is lumbar disc arthoplasty
Becoming more common - replacing the disc with an artificial disc
63
What is chemonucleolysis?
Used to more common, injection of chymopapain (comes from papayas) into nucleus pulposus - lots of controversy - risk of anaphylaxis but less invasive
64
How do spinal tumours present?
Lower motor neurone signs at level of lesion and pain and UMN signs along with sensory loss below the lesion Can get pain along course of the nerve Can get bowel or bladder dysfunction Cauda equina syndrome If no bone involved can just get signs without pain
65
What is presentation of spinal tumour with involvement of bones of the back?
Progressive, constant pain and local destruction of bone | Bone collapse can result in deformity or cause cord/nerve compression
66
Presentation of pyogenic spine infection?
Difficult to diagnosis because all signs of infection may be absent - but may be secondary to other septic foci Pain and movement is restricted by spasm
67
Risk factors for pyogenic spine infection?
DM, immunosuppresion, urinary surgery or catheterisation
68
Where does pyogenic spine infection usually occur?
Usually occurs in the disc space - discitis
69
Infective organism in pyogenic spine infection?
50% are staphylococcal | Can also be streptococcal, proteus, E.coli, salmonella typhi and TB
70
Treatment for pyogenic spine infection
Drain and antibiotics | Bed rest with brace
71
Radiograph in pyogenic spine infection
Rarefaction (decreased density) or erosion Joint space narrowing Subligamentous new bone formation
72
Who does spinal TB tend to affect?
Rare in west | Tends to affect young adults
73
Presentation of spinal TB
Pain and stiffness on all back movements with raised ESR
74
What is Pott's paraplegia
Spinal cord compression due to spinal TB abscesses
75
Radiograph in spinal TB
Narrow disc spaces and local osteoporosis Bone destruction leading to wedging of vertebrae May see paraspinal abscesses
76
Treatment of spinal TB
Anti-TB medication and drain abscess
77
What is apparent leg length disparity?
Leg length from ASIS and medial malleolus with pelvis held square - is equal therefore either apparent shortening due to pelvic tilt or fixed adduction or apparent lengthening due to fixed hip abduction
78
What is Thomas test?
Test for fixed flexion deformity - patient supine on examination couch, flex good hip up to chest until lumbar lordosis is obliterated (back flat on couch) if there is fixed flexion then the thigh on affected side will lift off couch as ll is obliterated
79
Causes of a positive trendelenburg test
(pelvis falls off to side when standing on one leg) Abductor muscle paralysis Upward displacement of greater trochanter (severe coxa vara or dislocation) Absence of stable fulcum eg. neck of femur fractures
80
What is antalgic gait?
Shortening of stance phase on painful leg with quick and short steps
81
What is Short-leg gait?
Discrepancy in length compensated by adduction of long leg at hip and abduction of short leg creating pelvic drop
82
What is coxa vara?
A hip in which the angle between the neck and shaft of femur is less than normal 125degrees
83
Consequences of coxa vara?
True shortening of limb - trendelenburg dip on walking makes the affected person limp

Ortho and Rheum (13 decks)

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