Orthopaedics 2 Flashcards by H JP

Red flags back pain (5)

<20yo >50yo
Hx of malignancy
Night pain
History of trauma
Systemically unwell

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Stiffness usually worse in the morning and improves with activity. Young man with lower back pain =

Ank spond

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Spinal stenosis
Sx (3)

Gradual onset
Unilateral or bilateral leg pain
Numbness and weakness

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Spinal stenosis
Worse when?
Relieved by?

Worse on walking/downhill
Relieved by sitting/ leaning forwards/ crouching/ walking uphill

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Spinal stenosis examination
Ix
Rx

NAD
MRI
Rx laminectomy

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PAD sx

Pain on walking, relieved by rest
Absent or weak pulses

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Lower back pain (non specific)
Ix (2)

Lumbar spine XR
MR

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Lower back pain
When should an MR be offered?

If it will change management OR if malignancy/ infection/ fracture/ cauda equina or ank spond is suspected

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Lower back pain Mx
1st line mx

NSAIDs with PPI if >45yo

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Lower back pain
Should paracetamol be offered?

Paracetamol should not be offered as monotherapy

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Features of prolapsed disc (2)

Leg pain worse than back pain
Clear dermatomal leg pain

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L3 nerve root compression features (4)
Sensory
Motor
Reflexes
Stretch test

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

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L4 nerve root compression
Sensory loss ?
Weak ?
Reflexes
Stretch test

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

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L5 nerve root compression
Sensory
Motor
Reflexes
Stretch test

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

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S1 nerve root compression
Sensory
Motor
Reflexes
Stretch test

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

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Mx prolapsed disc (2)

Analgesia, physio

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Prolapsed disc - when to refer for MR?

If symptoms persist after 4-6 weeks

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Femoral nerve
Motor
Sensor
Mechanism of injury

M knee extension, hip flexion
S Anterior and medial aspect of thigh and lower leg
Hip and pelvic fractures/ stab and gun shot wounds

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Obturator nerve
Motor
Sensory
Mechanism of injury

Thigh adduction
Medial thigh
Anterior hip doslocation

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Lateral cutaneous nerve of the thigh
Motor
Sensory
Mechanism of injury

M - none
S Lateral and posterior thigh
Compression of the nerve can lead to meralgia paraesthetica

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Tibial nerve
Motor
Sensory
Mechanism of injury

Plantarflexion and inversion
Sole of the foot
Not commonly injured, popliteal lacerations and posterior knee dislocations

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Common peroneal nerve
Motor
Sensory
Mechanism of injury

Dorsiflexion and eversion + Extensor hallucis longus
Dorsum of the foot and lower lateral part of the leg
Neck of fibula injury
Tight lower limb cast
Foot drop

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Superior gluteal nerve
Motor
Sensory
Mechanism of injury

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M Hip abduction
S None
Misplaced IM injection/ hip surgery, pelvic fracture, posterior hip dislocation
Positive Trendelenburg

Inferior gluteal nerve
Motor
Sensory
Mechanism of injury

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M hip extension and lateral rotation
S None
Injury to sciatic nerve
Difficult in rising from seated position.
Cannot jump or climb stairs.

Lumbar spinal stenosis can be caused by? (3)

Degenerative changes Prolapsed disc Tumour

pain and tenderness localised to the medial epicondyle pain is aggravated by wrist flexion and pronation symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement

Golfers elbow/ Medial epicondylitis

Meralgia paraesthetica originated from which L segment Age range Gender Unilat versis bilat More common in those with which condition?

L2/L3 30-40 M>F Can be bilat DM

Meralgia paraesthetica RF (7)

DM Obesity Pregnancy Tense ascites Trauma Surgery Sports

Meralgia paraesthetica aggravated by/ relieved by

Aggravated Standing, extension of the hip Relieved Sitting

Ix meralgia paraesthatica Rx

Pelvic compression test Rx local anaesthetic

What is Morton's neuroma?

Neuroma most commonly in the third inter-metatasophalangeal space

Morton's neuroma Gender Sx (4)

F>M Sx Forefoot shooting or Burning pain Worse on walking Pebble in the shoe feeling Loss of sensation in the toes

Morton's neuroma Ix Mx (2) When to refer?

US Mx - avoid high heels, metatarsal pads If symptoms persist for >3 months

RF OA hand (3)

Previous trauma Obesity Hypermobility

How does stiffness in OA hand differ from RA

OA hand - stiffness after periods of inactivity, which resolves after a few minutes unlike RA

Heberden's and Bouchard's locations?

DIP, PIP (osteophyte formation)

XR findings OA (2)

Osteophytes Joint space narrowing

Red flags for hip pain

Rest pain Night pain Morning stiffness >2 hours

Hip pain Ix Mx (3)

Clinical if typical features Otherwise XR Mx analgesia, injections, THR

Posterior dislocation rotation

Internal rotation and shortening

Most common type of hip replacement? How long will sticks/ crutches be used after op?

Cemented hip replacement 6 weeks

Advice to give post hip replacement (4)

Avoiding flexing the hip > 90 degrees Avoid low chairs Do not cross your legs Sleep on your back for the first 6 weeks

Osteochondritis dissecans impact what age group?

Children and young adults

Knee pain and swelling after exercise Catching and locking/ giving away Clunk on flexing or extending knee (involvement of lateral femoral condyle) Joint effusion Tenderness on palpation of the articular cartilage medial femoral condyle when knee is flexed

osteochondritis dissecans

Osteochondritis dissecans Ix (2) + finding on each Mx (1)

XR subchondral crescent sign or loose bodies MR cartilage evaluation, loose bodies Mx ortho referral

Who should be assessed for osteoporosis? F age M age Then how often after that?

F >=65yo M >=75yo Then 2 yearly after this

Which younger people should be assessed for fragility fractures? (7)

Younger if - previous fragility fracture - steroid use - hx of falls - FH hip fracture - low BMI - smoking - ETOH >14units

Risk assessment for osteoporosis tool When to do a DEXA? (2)

FRAX or QFracture Before starting treatments which have an effect on bone density e.g hormone deprivation >40yo with a major risk fracture

Interpretation of FRAX without a BMD (DEXA)

Low risk: lifestyle advice and reassure Intermediate risk: offer BMD High risk: bone protection treatment

Ewing's sarcoma Gender Age of onset Commonest site Mets Rx (2)

M>F 10-20yo Femoral diaphysis Blood Rx chemo and surgery

Osteosarcoma Gender Age Rx (2)

20% of all primary bone tumours M >F Age 15-30 Limb preserving surgery + chemo

Liposarcoma Age Location Growth speed

>40yo Retroperitoneum Slow growing

Most common sarcoma in adults

Malignant Fibrous Histiocytoma

What is talipes equinovarus?

Club foot - inverted and plantar flexed foot

Talipes equinovarus Gender When is it diagnosed?

M>F Newborn examination

Talipes equinovarus Mx Resolves by: What is normally required under local?

Ponseti method - soon after birth, normally corrected by week 6-10 + night time braces until aged 4yo Achilles tenotomy

Orthopaedics 2 Flashcards

(56 cards)