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ORTHO Flashcards

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1
Q

What is jumpers knee?

A

Patellar tendonitis

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2
Q

What occurs in Patellar tendinitis ?

A

microtears at tendon insertion at distal pole

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3
Q

Where does patella tendon insert?

A

Inserts into the tibial tuberosity

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4
Q

What are clinical signs of patella tendinitis?

A

pain in anterior knee
thickening and swelling
tender to palpation on tibial tuberosity

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5
Q

treatment options for patella tendinitis?

A

RICE, NSAIDS, Strapping, Brace

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6
Q

what is Osgood Schlaters injury?

A

Inflammation of the patella tendon (ligament) at the insertion point on the tibial tuberosity

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7
Q

What age and gender is osgood schlaters injury most common in ?

A

more common in boys aged 10-15 years of age

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8
Q

What is mechanism for osgood chlaters injury?

A

repeated tensil stress on the tendon leads to minor avulsion and inflammation at the tibial tuberosity head.

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9
Q

What is clinical presentation and clinical examiniation sign for osgood schlaters injury ?

A

pain on anterior knee.
exacerbated by kneeling or by jumping.

Examination will show:

  1. tender lump over the tibial tuberosity
  2. pain on resisted knee extension
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10
Q

What is treatment options for osgood schlaters injury?

A

treatment is symptomatic reflief as:

Benign, self limited condition

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11
Q

When will osgood schlaters injury most likely resolve?

A

resolves at growth hiatus

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12
Q

Anterior Knee Pain Causes

A 
Patellofemoral Syndrome (young females) 
OSgood Schlatters (young males) 
Chrondromalacia Patellae
Lateral Patellar Compression Syndrome 
ITB syndrome 
Patellar Instability (dislocation/sublaxation) 
Patellar tenditnitis 
Pre-oatellar bursitis 
Plica
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13
Q

Knee Dislocation: What is this associated with in terms of injury?

A

EMERGENCY: rare but serious: indicates severe injurysuch as high speed MVA with associated tears of multiple ligaments

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14
Q

What is seen physical examination?

A

Knee large effusion, swelling, pain and instability and ischaemic limb (due to popliteal artery injury) and potentially peroneal nerve injury

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15
Q

What is treatment of knee dislocation?

A
  1. Non operative URGENT closed reduction
  2. Operative ( vascular repair and ligament repair/reconstruction)
  3. Additional 6 weeks immobilisation
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16
Q

What are the acute complications of knee dislocation?

A

Common peroneal nerve injury
Popliteal artery occlusion
Compartment syndrome

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17
Q

What are 3 long term complications of a knee dislocation ?

A

Chronic stiffness (#1)
Chronic knee instability
post-traumatic arthritis

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18
Q

What is important about knee dislocation and the popliteal artery?

A

Popliteal artery occlusion can occur within the first 12 hours = important to check regularly on patients

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19
Q

What is used to diagnose knee dislocation ?

A

XRAY: AP/Lateral
CT Angiogram: Evaulate for arterial injury
Ankle Brachial Index: <0.9 indicates abnormalities
MRI: ligament injury, meniscus

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20
Q

MCL injuries: Mechanism they occur

A

Valgus force to knee ( outside to in) common in football

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21
Q

Haemarthrosis: WHy might it not be present in severe injuries?

A

Due to capsule disruption

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22
Q

MCL injuries: What is seen on examination

A

Tenderness at medial epicondyle and along tendon (inserts at around 4-6cm below tibial plateua, deep to pes aneurius)
Laxity/pain in valgus

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23
Q

What is MCL associated with injury wise?

A

ACL and medial meniscus (unhappy triad)

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24
Q

IN the case of multi-ligamntary injuried knee: treatment involves?

A

surgery

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25
Treatment MCL:
Mostly conservative: ROM and strengthening and hinge knee brace. Surgery is uncommon
26
Slipped capital femoral epiphysis: What is this ? what type salter harris
femoral head stays in acetabulum but slips inferiorly and the metaphysis slips nateirorlya nd superiorly = causes hip pain and a limp Type 1 Salter Harris
27
Slipped capital femoral epiphysis: Is this bilateral or unilateral usually?
50% cases bilateral
28
Slipped capital femoral epiphysis: what occurs to the femur and metaphysis ?
Femur head remains in the acetabulum whilst the metaphysis slipps out anteriorly and superiorly
29
Slipped capital femoral epiphysis: what is this most common?
MOST common adolescent hip disorder | commonly occurs in puberty growth spurt
30
Slipped capital femoral epiphysis: when is peak incidence
pubertal growth spurt
31
Slipped capital femoral epiphysis: risk factors
obesity (main) Male hypothyroidism (risk for bilateral as lack of thyroid hormone influences bone age and growth hormone)
32
What is clinical presentation for SCFE? What movements restricted? Where tender?
Dull hip pain/referred knee pain with painful limp restricted internal rotation and abduction (pts tend to hold in passive external rotation) tenderness of joint capsule
33
SCFE: inability to ambulate/weight bear is classified as ?
unstable SCFE
34
What are 2 diagnostic methods for SCFE ?
XRAY - AP and and frog leg lateral | TSH to rule out hypothyroid
35
What will XRAY demonstrated for SCFE?
posterior and inferior displacement of the femoral head.
36
What is treatment for SCFE and why is fast treatment inmportant ?
Immediate surgical screw fixation (reduces risk of AVN) | No weight bearing allowed
37
What are three copmlications of SCFE ?
AVN chondrolysis (resulting in loss of articular cartilage, narrowing of joint space) premature hip osteoarthritis
38
osteomyelitis pathophysiology
Most commonly due to S aureus via inoculation, haematogenous spread or contiguous spread from adjacent tissue
39
osteomyelitis where is it found child vs adults
child = long bones | adult: vertebrae
40
osteomyelitis risk factors
IV drug uses Immunocompromised Diabetes Trauma
41
Signs and symptoms osteomyelitis
signs: pain fever signs: redness, oedema, abscess + draining sinus traact
42
osteomyelitis diagnosis: Imaging: Definitive test Bloods
Imaging: MRI gold standrad, X-ray shows periosteal elevation Definitive: Bone Biopsy/aspirate culture Labs: WBCS, CRP, CBC and blood culture
43
Treatment osteomyelitis
Flucoxaccilin + vancomycin Surgical: Irrigation and Debridement + hardware removal if present
44
Septic Arthritis: Pathophysiology: adults hardware newborn
adults: S aureus CONS: hardware N gonorrhoea newborn or sexuallya ctive
45
clincal presenation Septic arthritis
localised joint pain (erythem,a warmth, swelling) may be systemic inabability to wirght bear
46
SA Joint aspirate: will show?
``` yellow cloudy fluid increased WBC increased protein decreased glucose positive gram stain ```
47
SA treatment:
empiric flucox + vancomycin then guided by resutlts non operative: theraputic joint aspirate operative: arthoscopic/open irrigation and drainage
48
outcomes of SA
10 - 15% mortality | rapid joint destruction
49
Compartments syndrome clinical presentation
6 p's ``` Pain (out of proportion with injury) Pain on passive stretch (sensitive tests) Pulseness Parasethesia Pallor Paralysis ```
50
treatment: Compartments
urgent fasciotomy +/- necrotic tissue debridement
51
complicaitons compartments
Volkman's contracture (ischaemia causing necrosis then secondary fibrosis and calcification) Rhabdomylosis: muscle breakdown - myoglobinuria
52
myotome vs dermatome
dermatome: single nerve skin supply myotome: group of muscles supplied by single spinal nerve
53
UPPER LIMB MYOTOMES: Elbow
``` C5-C6 = elbow flexion C7-C8= elbow extension ```
54
Shoulder
c5 shoulder abduction | c678 adduction
55
Wrist
c6 extension | c7 flexion
56
finger
c7 finger extension c8 flexion t1 abduction/adduction
57
finger
c7 finger extension c8 flexion (little finger) t1 abduction/adduction
58
Ulnar nerve roots
C8-T1
59
Median Nerve roots
C6-T1
60
Radial Nerve roots
C5-T1
61
fat embolism cause
piece of fat that can become lodged in vessels: | caused by long bone or pelvic fractures
62
Presentation fat embolism
respiratory distress (ARDS due to inflammatory damage to lungs) neurological dec LOC anaemia and thrombocytopenia
63
Subacromial impingement
compression (between head of humurs and underside of acromiom) of rotator cuff tendons (esp. supraspinatus) and subacromial bursa
64
subacromial impingement Causes spectrum of:
bursititis tendonitis tearing of Rotator cuff
65
subacromial impingement : clinical presentaiton
insidious onset pain wekaness and on active movement (painful arc of 60-120 degrees)
66
subacromial impingement non operative treatment
physio, NSAIDS and steroid injections
67
subacromial impingement operative
arthroscopy or open surgical repair either acromioplasty (shaving off acromiom) or repairing tendons (rotator cuff repair)
68
supraspinatus movement
abduction | suprascapular nerve
69
infra spinatus movement
external rotation | subscaprular nerve
70
Teres minor movement
external rotation | axillary nerve
71
subscapularis movement
internal rotation and adduction | subscapular nerve

ALM5 (12 decks)

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