Ortho Flashcards
Red flags for back pain
Investigations they should receive
Thoracic pain Age <20 or >55 years Non-mechanical pain Pain worse when supine Night pain Weight loss Pain associated with systemic illness Presence of neurological signs Past medical history of cancer or HIV Immunosuppression or steroid use IV drug use Structural deformity
should have blood tests for FBC, ESR, Calcium, Phosphate, Alkaline phosphatase and PSA if appropriate. X-ray imaging should also be arranged.
clinical signs of a fracture
pain swelling deformity crepitus adjacent structural injury
complications of fractures
immediate - internal and external haemorrhage - electrolyte imbalance (monitor lactate and correct electrolytes) - nerve injury (including PND) general - Fat embolus
medium/early - post op infection - pressure sores and ulcers - DVT and PE - Compartment syndromes - poor wound healing General: DVt/ PE/ Shock/ Infection
late
- non-union/malunion
- degenerative change
- reflex sympathetic dystrophy
- avascular necrosis
general: prolonged immobility (stiffness, pressure sores)
what is a bursae
pathology that occurs in them
important ones in shoulder
synovial lined fluid filled enclosed cushions that protect tendons and ligament from injury related to friction movement over adjacent bony projections or other rough surfaces
can become infected, fill with fluid and become painful
Subacromial
- reduced friction beneath the deltoid, promoting free movement of the rotator cuff tendons
Subscapular
- beneath subscapularis tendon and scapula
stabilizers of the shoulder joint
What type of the joint is shoulder?
muscles of the shoulder
stabilizers of the shoulder joint
- labrum
- ligaments
- biceps tendon
- rotator cuff muscles
What type of the joint is shoulder?
multiaxial ball and socket - inherently unstable
muscles of the shoulder
- Extrinsic: originate from torso and attach to bones of the shoulder
- Intrinsic: Originates from the scapula and/or clavicle and attach to the humerus : 4 rotator cuff muscles, deltoid, teres major
function of teres major
rotator cuff muscles function and innervation
teres major
- adducts the shoulder and medically rotates the arm
supraspinatus - abducts the arm for 0-15 degrees - innervated by suprascapular nerve infraspinatus - laterally rotates the arm - innervation - suprascapular nerve teres minor - laterally rotates the arm - innervation - axillary nerve Subscapularis - medically rotates the arm - innervation - upper and lower subscapular nerve
nb all attach to greater tubercle of humerus except subscapularis which attaches to lesser tubercle
What Is de Quervain’s tenosynovitis?
Features
e Quervain’s tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.
Features
Pain on the radial side of the wrist
Tenderness over the radial styloid process
Abduction of the thumb against resistance is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
Management Analgesia Steroid injection Immobilisation with a thumb splint (spica) may be effective surgical treatment is sometimes required
What is a buckle fracture
Incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years.
As they are typically self-limiting they do not usually require operative intervention and can sometimes be managed with splinting and immobilisation rather than a cast
Ulnar nerve injury location
At wrist
- Clawing of 4th/5th finger as FDP not affected
At elbow
- Less clawing of 4th/5th finger as FDP affected
- Gets worse before getting better
ULNAR PARADOX
Hip dislocation
Most common type
Features
Complications
Posterior dislocation: Accounts for 90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated.
Complications
- Sciatic nerve injury
- Avascular necrosis
- OA
- Recurrent dislocations
Fat embolus features
Respiratory
- Early persistent tachycardia
- Tachypnoea, dyspnoea, hypoxia usually 72 hours following injury
- Pyrexia
Dermatological
- Red/ brown impalpable petechial rash (usually only in 25-50%)
- Subconjunctival and oral haemorrhage/ petechiae
CNS
- Confusion and agitation
- Retinal haemorrhages and intra-arterial fat globules on fundoscopy
Classification of ankle fractures
Management
Weber
Related to the level of the fibular fracture.
Type A is below the syndesmosis
Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
Type C is above the syndesmosis which may itself be damaged
Management
Type C: Surgical repair
Type A+B: Below knee cast
