Ortho/MSK Flashcards
(54 cards)
What age group is most commonly affected by Achilles tendon rupture?
30-50 year old recreational athletes
Achilles tendon rupture can occur at any age but is most prevalent in this age group.
What activities are commonly associated with Achilles tendon rupture?
Activities requiring a forceful push off or forced dorsiflexion of the foot
These actions create a sudden stretch on the tendon, increasing the risk of rupture.
List the risk factors for Achilles tendon rupture.
- Increasing age
- Chronic/recurrent tendonitis
- Systemic corticosteroids (prolonged or high doses)
- Previous steroid injections into the Achilles tendon
- Cushing’s syndrome
- Systemic conditions (e.g. gout, rheumatoid arthritis, SLE)
- Quinolone antibiotics (mainly if >60 and/or also taking steroids)
These factors can increase the likelihood of tendon rupture.
What is a common presentation of an Achilles tendon rupture?
Acute sudden sharp pain in the tendon, sometimes a ‘snap’ is heard
The pain often transitions into a dull ache and may be accompanied by swelling.
What sign on examination of gait may be seen with Achilles tendon rupture
Inability to stand on tiptoe
This symptom is common due to weakness or absence of active plantar flexion.
What examination findings are typical for a complete Achilles tendon rupture?
Localized swelling and a palpable defect in the tendon
Bruising may mask the tendon defect.
What test is used to assess for a complete Achilles tendon rupture?
Simmonds / Thompson test
A positive test indicates a complete tendon rupture.
What does a positive Simmonds Test indicate?
Complete Achilles tendon rupture
The test is performed with the patient lying prone and involves squeezing the calf muscle to assess plantar flexion.
What imaging techniques can be used for the diagnosis of Achilles tendon rupture?
Ultrasound or MRI
These imaging modalities help confirm the diagnosis.
What is the initial management approach for an Achilles tendon rupture?
Non-weight bearing
This is crucial to prevent further injury to the tendon.
What are the two main management options for Achilles tendon rupture?
- Conservative management with a splint
- Surgical repair
The choice between these options depends on the severity and specifics of the rupture.
What is a Maisonneuve fracture?
A spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane
What type of force is usually involved in a Maisonneuve fracture?
Pronation-external rotation force
What are the common associated injuries with a Maisonneuve fracture?
Fracture of the medial malleolus or rupture of the deep deltoid ligament
What must be examined in all ankle injuries to detect a Maisonneuve fracture?
The proximal fibula
True or False: A Maisonneuve fracture is easy to detect.
False
What should be performed if there is local tenderness in a suspected Maisonneuve fracture?
X-rays
What is a stress fracture of the metatarsals also known as?
March fracture
In which populations are stress fractures of the metatarsals commonly seen?
People undertaking repetitive walking or running, such as army recruits and runners
What is the most common site for a stress fracture of the metatarsals?
2nd MT shaft
What are the other potential sites for metatarsal stress fractures?
- 3rd MT
- Navicular
- Other MTs
What symptom do patients typically present with in a metatarsal stress fracture?
A tender lump on the dorsum of the foot
Where is the lump typically located during examination of a metatarsal stress fracture?
Just distal to the mid-shaft of a metatarsal bone
What might early radiology show in cases of metatarsal stress fractures?
Normal findings
