Orthopaedics

Question 1

What is a frozen shoulder?

Answer 1

Adhesive capsulitis
Chronic fibrosing condition characterised by insidious & progressive severe restriction of active & passive RoM of the shoulder

Question 2

What are the Sx of a frozen shoulder?

Answer 2

Insidious shoulder pain

Stiffness lasting 6m-2yr then resolves

Question 3

What are the phases of a frozen shoulder?

Answer 3

Painful phase: Pain worse at night & moving, ↓RoM
Frozen phase: Pain resolves, shoulder still stiff
Thawing phase: Slowly regains RoM

Question 4

How is a frozen shoulder managed?

Answer 4

Physio

1) NSAIDs:
2) IA Steroid injection

Question 5

What is a rotator cuff tear?

Answer 5

Acute injury or chronic degeneration leading to rotator cuff damage in subacromial space
Leads to tendon tear

Question 6

The tendon of which muscle usually tears in rotator cuff injury?

Answer 6

Supraspinatus

Question 7

What muscles make up the rotator cuff?

Answer 7

SITS:
S: Supraspinatus
I: Infraspinatus
T: Teres minor
S: Subscapularis
Tendons pass through subacromial space to attach to humeral head

Question 8

What are the Sx of a rotator cuff tear?

Answer 8

ACUTE shoulder pain & weakness
Worse on moving
PAINFUL ARC
↓RoM: Abduction limited to 40-50degrees = COMPLETE TEAR
Clicking/catching during moving

Question 9

How is a rotator cuff tear investigated?

Answer 9

USS:
Xray: Exclude other causes
MRI: If muscle wasting

Question 10

How is a rotator cuff tear treated?

Answer 10

Analgesia: NSAIDs + Paracetamol
ICE
Physio
Steroid injection
Complete = surgery

Question 11

What is epicondylitis?

Answer 11

Inflammation at common extensor tendon arising from lateral epicondyle
OR
Forearm flexor muscle origin at medial epicondyle of humerus

Question 12

What are the RF for epicondylitis?

Answer 12

Repetitive strain
Heavy lifting
Sports

Question 13

Which is more common lateral or medial epicondylitis?

Answer 13

Lateral x5 more common than medial

Question 14

How does lateral epicondylitis present?

Answer 14

Pain & tenderness
Radiates to forearm 
EXACERBATED: Resisted wrist extension
Mill's test
Cozen’s test

Question 15

How does medial epicondylitis present?

Answer 15

Pain & tenderness
Dull ache
Worse w/grasping movement
EXACERBATED: Pronation & forearm flexion

Question 16

How is epicondylitis treated?

Answer 16

Avoid activities that overload tendon- physio

NSAIDs

Question 17

What tumours commonly metastasise to bone?

Answer 17

Prostate
Thyroid
Lung
Breast
Kidney

Question 18

What type of cancers present as a primary in bone?

Answer 18

Myeloma: Back pain, pathological #, hyperCa
Osteosarcoma: Bone pain, mass, pathological #
Ewing’s: Malignant round cell tumour of diaphysis of long bones & limb girdle
Chondrosarcoma: Popcorn calcification on xray, malignant transformation of chondromas, pain/lump in axial skeleton

Question 19

What are the usual fragility fractures?

Answer 19

Osteoporosis of vertebral body
Distal radius
NOF
Pubic ramus
Neck of humerus

Question 20

What is a fragility fracture?

Answer 20

Low impact fracture from standing height that would not otherwise be expected to cause a fracture

Question 21

What are the causes of a fragility fracture?

Answer 21

Osteoporosis
Advanced age
Osteogenesis imperfecta

Question 22

What are the red flags of back pain?

Answer 22

Saddle anaesthesia
Recent bladder dysfunction
Recent faecal incontinence
Perianal/perineal sensory loss
Laxity of anal sphincter
Severe/progressive neuro deficit
Pain at night
Point tenderness
>50yo or <20yo
Hx of cancer

Question 23

What is the difference between a sprain & strain?

Answer 23

Sprain = Injury to ligament
Strain = Injury to muscle/tendinous junction

Question 24

How do ankle sprains occur?

Answer 24

Majority Inversion injury
Causes damage to structures of lateral malleolus
Most commonly ATFL injury

Question 25

What are the Sx of an ankle sprain?

Answer 25

``` Tender Swollen Bruising Functional loss (pain weight bearing) EXTENSIVE swelling & bruising = lig tear or # ```

Question 26

How are ankle sprains investigated?

Answer 26

Exam | Ankle Xray: If Ottawa rules apply

Question 27

What are the Ottawa rules?

Answer 27

- Pain in malleolar region AND 1 of: - Tenderness at POST edge of LATERAL malleolus - Tenderness at POST edge of MEDIAL malleolus - Inability to weight bear immediately AND in A&E

Question 28

How are sprains treated?

Answer 28

``` RICE R: Rest I: Ice C: Compression E: Elevation Cannot weight bear: Crutches, physio follow-up ```

Question 29

What are the complications of an ankle sprain?

Answer 29

Weakness & instability | Peroneal tendon subluxation

Question 30

What survey is carried out after in a multi-system trauma?

Answer 30

``` Primary Survey: (C) ABCDE C: Catastrophic haemorrhage control A: Airway & C-Spine control B: Breathing & ventilation C: Circulation D: Disability & neuro deficit E: Extremity/exposure/environment ```