Flashcards in Orthopaedic Examination Deck (20):
What is the technical name for Leriche's syndrome?
Aortoiliac occlusive disease
What is Leriche's syndrome?
A form of peripheral artery disease involving the blockage of the abdominal aorta as it transitions into the common iliac arteries.
What triad of symptoms in the lower half of the body do you get in Leriche's syndrome?
Claudication in the buttocks (and thighs)
Absent or decreased femoral pulses
In history and examination of MSK you can boil it down to 3 broad terms of what yours looking for.
What are they?
What are the three broad GALS screening questions?
Do you have any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?
In MSK history it is good to ask the patient to take you through a typical day.
Give some general examples of points that are good to touch on
Wake at normal time or woken by pain?
-How are they first thing
Dressing? Cut own toenails?
Get into and out of bath?
Walking distance on the flat
DOES OWN SHOPPING
Work hobbies -> does it get in the way
Give some read flag symptoms of pain that should never go uninvestigated.
Severe and worsening pain
Night pain during sleep
Apart from pain give some other red flag symptoms
(what gets you worried when you take a history?)
General malaise, febrile, rigors
Unexplained weight loss, anorexia, night sweats
Past history of malignant disease
Give some common allergens hospitals will be concerned with
-General anaesthetic (?morphine)
-Metal sensitivity (nickel, cobalt in ortho)
What medications should you be thinking about in a drug history in general?
(keep it basic)
Aspirin/ warfarin/ clopidogrel
If you have 2 legs and the patient is complaining about one, which leg do you examine first and why?
Normal leg first
-Can then compare the abnormal leg
How do you communicate the affected finger during a clinical handover?
(how do you describe the different fingers of the hand?)
How are the joint degrees taken?
(What is 0 degrees in termf of joints?)
Anatomical position = 0 degrees for all joints
i.e. en extended elbow = 0 degrees NOT 180
What do we mean by varus and valgus?
(explain the concept)
How do you remeber the differences?
The terms valgus and varus refer to angulation (or bowing) within the shaft of a bone or at a joint.
It is determined by the distal part being more medial or lateral than it should be. Whenever the distal part is more lateral, it is called valgus. Whenever the distal part is more medial, it is called varus. Therefore, when the apex of a joint points medially, the deformity, if any, would be called valgus, as the distal part points laterally.
It is important to bear in mind that the most proximal part of a bone or joint is the reference point and that varus and valgus angles are relative to the angle in a normal situation, which need not be zero.
L for lateral in vaLgus
What is another name for corneal arcus?
What is Trendelenburg's sign?
The Trendelenburg sign is said to be positive if, when standing on one leg, the pelvis drops on the side opposite to the stance leg to reduce the load by decreasing the lever arm.
By reducing the lever arm, this decreases the work load on the hip abductors. The muscle weakness is present on the side of the stance leg.
A Trendelenburg sign can occur when there is presence of a muscular dysfunction (weakness of the gluteus medius or minimus) or when someone is experiencing pain.
The body is not able to maintain the center of gravity on the side of the stance leg.
Normally, the body shifts the weight to the stance leg, allowing the shift of the center of gravity and consequently stabilizing or balancing the body. However, in this scenario, when the patient/person lifts the opposing leg, the shift is not created and the patient/person cannot maintain balance leading to instability.
How do you measure REAL limb length?
ASIS -> medial malleolus
use a measuring tape
How do you measure APPARENT limb length?
Midline marker like xiphisternum to the medial malleolus with a measuring tape
What is the Galleazzi test?
(what is the position for it? what does it show etc)
Hips flexed 45, knees 90
Leg length discrepancy above knee (short femur) vs below knee (short tibia)
Measure and record