Orthopaedics Flashcards
(239 cards)
1
Q
what is Paget’s disease of the bone?
A
it’s a condition characteristed by disorganised bone resorption and formation
2
Q
how can Paget’s disease present?
A
often asymptomatic bone pain heat over affected area patient >40yo raised ALP hearing loss
3
Q
what is the treatment for Paget’s disease?
A
normally no treatment. if severe, one off IV bisphosphonate injection (zolendronic acid)
4
Q
what is the difference between rickets and osteomalacia?
A
rickets is Vit D deficiency in growing child, osteomalacia is Vit D deficiency in adults
5
Q
why does vitamin D deficiency cause rickets and osteomalacia?
A
because it impairs the absorption of calcium, therefore preventing proper bone mineralisation
6
Q
how does rickets present?
A
bone deformities
growth impairment
muscle weakness and pain
7
Q
how does osteomalacia present?
A
bone pain
fractures
muscle weakness and pain
8
Q
what is osteogenesis imperfecta?
A
a genetic condition that affects Type 1 collagen
9
Q
name some symptoms of osteogenesis imperfecta
A
frequent fractures short stature growth impairment blue sclera dentigenesis imperfecta hyperlaxity scoliosis hearing loss
10
Q
how is osteogenesis imperfecta managed?
A
- bisphosphonates to prevent fractures
- surgery for fractures
- social adaptations
- genetic counselling
11
Q
what is the definition of osteoporosis?
A
thin bones with increased risk of low trauma fractures
12
Q
what is the purpose of a DXA scan?
A
it measures bone density in the desired area
13
Q
given the pathogenesis of Paget’s disease, what can be a complication of the condition?
A
the disordered osteoblast/osteoclast activity could give rise to osteosarcoma
14
Q
what is the difference between osteopenia and osteoporosis?
A
osteoporosis is a more severe stage of bone loss than osteopenia
15
Q
what is the first line treatment for osteoporosis?
A
bisphosphonates
16
Q
name a few side effects of bisphosphonates
A
oesophagitis
uveitis
17
Q
which patient groups are most likely to develop osteoporosis?
A
men over 50
women post menopause
patients on long-term steroids
18
Q
name a few treatment options for patients with osteoporosis
A
bisphosphonates
HRT (women)
denosumab (anti-RANKL)
teriparatide
19
Q
name a few side effects of HRT for osteoporosis
A
increased risk of breast ca if prolonged use
increased risk of blood clots/MI/stroke
20
Q
what causes gout?
A
build up of uric acid in joint spaces
21
Q
what is the management of an acute attack of gout?
A
NSAIDS
colchicine
steroids
lifestyle advice
22
Q
should asymptomatic hyperuricaemia be treated?
A
no
23
Q
should you attempt to treat hyperuricaemia before, during or after an acute attack of gout
A
wait until after the acute attack has settled
24
Q
what medications can be used to treat hyperuricaemia?
A
allopurinol
febuxostat
probenecit
canakinumab
25
name a few causes of uric acid underexcretion
```
renal impairment
hypertension
hypothyroidism
certain drugs (eg alcohol, diuretics)
dehydration
```
26
name a few causes of uric acid overproduction
```
malignancy
severe psoriasis
drugs (eg alcohol)
metabolic diseases
HGPRT deficiency
```
27
what is pseudogout?
a type of arthritis, similar to gout, but which normally presents in knee joints in elderly women and is caused by a build up of different crystals to gout
28
what is polymyalgia rheumatica?
sudden severe stiffness of shoulder and/or pelvic girdle
29
what is the treatment for pseudogout?
NSAIDS
| steroids
30
what investigation can be done to confirm gout when diagnosis is not clear?
synovial fluid analysis for crystals
31
what condition is polymyalgia rheumatica often associated with?
giant cell arteritis
32
name a few signs/symptoms of polymyalgia rheumatica
high ESR
old age (>70)
anaemia
malaise
33
what is the treatment for polymyalgia rheumatica?
prednisolone
34
what are the four stages of bone fracture healing?
1. inflammation
2. soft callus
3. hard callus
4. bone remodelling
35
how does inflammation promote the start of bone healing after a fracture?
inflammation encourages blood supply to increase to the fractured area
36
how does muscle attempt to stabilise the bone after a fracture?
it contracts to try keeping the bone together
37
what does formation of a soft callus depend on in bone fracture repair?
formation of a soft callus depends on the blood and oxygen supply to fractured area
38
why is it better to use someone's own bone when using a bone graft to repair a fracture, rather than using bone from the bone bank?
own bone is made of collagen reinforced with crystals, which is stronger than hydroxy-apatite crystals alone which make up bone bank bone
39
how does a soft callus become a hard callus during bone fracture repair?
fibroblasts that make up the soft callus turn into osteocytes in response to mechanical strain
40
which ossification centres are responsible for 1. circumferential bone growth; 2. longitudinal bone growth?
1. primary (endochondral) ossification centre
| 2. secondary (epiphyseal) ossification centre
41
what process occurs during the formation of hard callus in bone fracture repair?
cartilage is replaced by woven bone
42
what process occurs during bone remodelling in bone fracture repair?
woven bone is replaced by lamellar bone
43
what external stimulus is crucial for bone fracture repair?
mechanical strain
44
name a few factors which can cause delayed union in bone fracture repair
```
high energy injury
infection
instability
distraction
smoking
drugs (steroids, warfarin, NSAIDS, immunosuppressants, ciprofloxacin)
```
45
what is the pathology behind acute osteomyelitis?
infection reaches bone through blood supply at metaphysis.
inflammation results in increased pressure.
pus is released into medulla/periosteum.
pus in joint causes bone destruction and reformation.
outcome is resolution or chronic osteomyelitis
46
what is the most common organism to cause acute osteomyelitis?
staph aureus
47
if osteomyelitis occurs as a result of standing on a nail, what is the most likely organism?
pseudomonas
48
how does acute osteomyelitis present in infants?
- irritability
- failure to thrive
- may be fine or very unwell
- swollen tender joint
49
where does acute osteomyelitis commonly present in infants?
knee joint
50
how does acute osteomyelitis present in children/adolescents?
- severe pain
- no weight-bearing
- painful tender joint
- reduced range of movement
- swinging fever
51
why does osteomyelitis cause a swinging fever?
due to the presence of pus
52
what investigations can be done to confirm a diagnosis of acute osteomyelitis?
```
blood cultures (x3)
FBC (esp neutrophil count)
ESR
CRP
U&E
joint aspiration
X-ray
bone scan
ultrasound (especially in children)
MRI
```
53
how is acute osteomyelitis treated?
fluid and pain management
rest/splintage
antibiotics
surgery
54
what is the term for the bone destruction/necrosis process in osteomyelitis?
sequestrum
55
what is the term for new bone formation in osteomyelitis?
involucrum
56
name a few examples of when surgery may be indicated in acute osteomyelitis
aspiration of pus for diagnostic purposes
abscess drainage/lavage
debridement of dead tissue from infected area
infected joint replacement
57
name a few complications that can occur as a result of acute osteomyelitis
```
abnormal bone growth
chronic osteomyelitis
metastatic infection
pathological fractures
septic arthritis
```
58
in which part of a long bone is acute osteomyelitis likely to start, and why?
commonly originates in the metaphysis, because it's the most vascular area of the bone
59
name a few ways an infection can spread to cause osteomyelitis
```
hematogenous spread (eg from skin abrasions, tonsilitis)
local spread (eg fracture, prosthetic)
```
60
which bones are more likely to develop osteoarthritis?
long bones
| bones with intra-articular metaphysis (eg hip, radius)
61
what is the pathology behind chronic osteomyelitis?
chronic inflammation, possibly caused by retention of dead tissue inside the involucrum of new bone
62
how is chronic osteomyelitis managed?
long-term antibiotics
| surgery for debridement/reconstruction
63
name a few likely organisms to be involved in chronic osteomyelitis
- staph aureus
- strep pyogenes
- e. coli
64
which bones are more likely to be affected by osteomyelitis in children and adults respectively?
children - limbs
| adults - spine, hips
65
what is the pathology of septic arthritis?
an infection of the joint space
66
what is the commonest cause of septic arthritis in adults?
infection of joint replacement
67
name a few likely organisms to cause septic arthritis
- staph aureus
- strep pyogenes
- e. coli
- haemophilus influenzae
68
what investigations are done to diagnose septic arthritis?
```
FBC (WBC)
ESR/CRP
blood cultures
joint aspirate testing
ultrasound
x-ray/MRI
```
69
how is septic arthritis treated?
pain/fluid management
long term antibiotics
joint lavage/drainage
joint replacement/reconstruction
70
what is the classification of bone/joint involvement in tuberculosis?
vertebral (most common)
intra-articular
extra-articular
71
what is the pathology of tuberculosis in the bone?
- initial site of infection (lung, GIT)
| - secondary spread of infection
72
what investigations are done to diagnose bone tuberculosis?
```
Mantoux test
sputum/urine swab
FBC
CRP/ESR
x-ray
MRI
```
73
what is the management of bone tuberculosis?
Rest/splintage
| Anti-TB medication (isoniazin, ethambutol, pirazynamide, rifampicin)
74
What is the most common site of bone tuberculosis?
Spine
75
How can bone tuberculosis present?
Back pain
Kyphosis
Osteopaenia around infection site
76
how can bone tuberculosis present?
back pain
Kyphosis
osteopaenia around infection site
systemic symptoms of TB
77
in the knee, which meniscus is more likely to tear and why?
medial is more likely to tear as it is more fixed and less flexible
78
what is the treatment of a meniscal tear?
rest
NSAIDS
physiotherapy
79
how does a meniscal tear present?
swelling
locking
clicking
pain
80
what investigations are done to diagnose a meniscal tear?
x-ray
| MRI
81
how does an ACL tear normally occur?
due to a twist in the knee on landing
82
why do meniscal tears not tend to heal?
because they have very limited blood supply
83
what is the unhappy triad of the knee?
ACL rupture
medial meniscus rupture
MCL rupture
84
name a few immediate symptoms of an ACL tear
```
pop/crack sound
deep pain
haemarthrosis
swelling
instability
```
85
which ligament in the knee only really tends to rupture as a result of an ACL tear?
anterolateral ligament
86
what are treatment options for ACL tears?
non-surgical: quadriceps muscle strenghtening
| surgical: ACL reconstruction
87
what is the most common ligament to tear in the knee?
medial collateral ligament
88
how does an MCL tear normally occur?
contact causing severe valgus stress on the knee
89
how does an MCL normally present?
pop/crack sound
swelling
severe pain
bruising on medial side of knee
90
how is MCL normally managed?
conservatively with rest, NSAIDS, physiotherapy and sometimes a brace
91
what is osteochondrosis dissecans?
a condition which causes parts of articular cartilage/subchondral bone to fragment resulting in inflammation in the joint
92
which insertion of the ligament is normally ruptured during a MCL tear?
the femoral insertion of the MCL
93
what is osteochondrosis dissecans?
a condition which causes parts of articular cartilage and/or subchondral bone to fragment and cause inflammation in the joint
94
how is osteochondrosis dissecans normally managed?
arthroscopy to fixate loose fragment
95
what are common causes of osteochondrosis dissecans in children and adults?
children/adolescents - activity related
| adults - secondary to avascular necrosis
96
name a few things that can cause trochanteric bursitis
overuse
trauma
abnormal use
97
how can trochanteric bursitis be treated?
NSAIDS
rest/activity change
physiotherapy
steroid injection
98
why is bursitis not normally treated surgically?
due to high risk of complications and leaking sinuses
99
how can avascular necrosis be treated?
```
rest
NSAIDS
anticoagulants
surgical restoration of blood supply
hip replacement
```
100
name a few risk factors for avascular necrosis of the hip
```
trauma
radiation
hypercoagulability
idiopathic
iatrogenic
alcoholism
steroid use
dislocation
```
101
how does avascular necrosis of the hip present?
insidious pain in groin
trouble walking uphill/upstairs
limp
102
what are the two types of femoroacetabular impingement?
CAM and pincer
103
what is a CAM lesion in FAI?
the neck of femur is too wide and restricts movement in acetabulum
104
what is a pincer lesion in FAI?
the acetabulum is too deep and restricts movement of the femur
105
name a few ways FAI can present
pain in groin
locking
reduced range of movement
pain with certain movements
106
how is femoroacetabular impingement treated?
rest
physiotherapy
NSAIDS
surgery - arthroscopy to shave off extra bone
107
who is most likely to get a pincer lesion FAI?
athletic females
108
what test is positive during a FAI examination?
FADIR test:
- flexion
- adduction
- internal rotation
109
what test is positive during an examination for a labral tear in the hip joint?
FABER test:
- flexion
- abduction
- external rotation
110
what is the treatment for labral tears in the hip joint?
NSAIDS
rest
steroid injection
surgery - arthroscopy to repair tear
111
name a few causes of labral tears in the hip joint
osteoarthritis
FAI
trauma
112
what is the difference between an incise wound and a stab wound?
incise wound is longer than it is deep - ie a slash
| stab wound is deeper than it is long
113
what is a contusion?
a bruise caused by force on the skin
114
what are tramline bruises normally caused by?
rod or cylinder shaped objects pushing blood to either side of the impacted area
115
name a few factors that can differentiate a laceration from an incise wound
lacerations have irregular edges, more bruising around the wound and some abrasion
116
what kinds of injuries can blunt force trauma cause?
contusions
abrasions
lacerations
117
what kinds of injuries can sharp force trauma cause?
incise wounds
| stab wounds
118
damage to which part of the brachial plexus causes Erb's palsy? which nerve roots are involved?
damage to upper trunk
| C5-C6 roots involved
119
damage to which part of the brachial plexus causes Klumpke's palsy? which nerve roots are involved?
damage to lower trunk
| C8-T1 roots involved
120
what is compression of the median nerve called?
carpal tunnel syndrome
121
what is compression of the ulnar nerve called?
cubital tunnel syndrome
122
what are the features of Erb's palsy?
Waiter's tip position:
- shoulder: internally rotated and adducted
- elbow: extended and pronated
- wrist: flexed
123
what is the main feature of Klumpke's palsy?
claw hand
124
what are the myotomes of the brachial plexus roots?
```
C5 - elbow flexors
C6 - wrist extensors
C7 - elbow extensors
C8 - finger extensors
T1 - intrinsic muscle of the hand
```
125
what are common causes of axillary nerve palsy?
fracture of humerus
| shoulder dislocation
126
what is the main sign of radial palsy?
wrist drop
127
what is radial nerve palsy also called?
saturday night palsy
128
which flexor muscle is not found in the carpal tunnel sheath?
flexor carpi radialis
129
name a few important signs of carpal tunnel syndrome
nocturnal pain and paresthesia/tingling
| wasting of thenar muscles of the hand
130
name a few causes of carpal tunnel syndrome
inflammatory (RA, gout, amyloid)
swellings (lipoma, ganglion)
metabolic (pregnancy, hypothyroidism)
trauma (radius fracture)
131
during examination of the hand, which tests are done to diagnose carpal tunnel syndrome?
tinnel's test (tap on median nerve)
| phalen's test (hold wrist down)
132
which nerve arising in the brachial plexus does not have any branches in the arm?
ulnar nerve
133
which two bony prominences does the cubital tunnel form between?
olecranon
| medial epicondyle
134
patients with ulnar nerve damage have issues with which tasks?
fine hand tasks
135
what sign is commonly seen in patients with cubital tunnel syndrome?
wasting of first webspace (first dorsal interosseus)
136
what is a unique feature of ulnar nerve damage?
the more distal the lesion, the more severe the symptoms
137
how does ulnar claw hand present?
flexion of the ring finger and little finger, with extension at their MCP joint
138
what does Froment's test assess?
it looks for patient's ability to use adductor pollicis over the flexor pollicis longus to keep hold of a piece of paper
139
what is the main sign resulting from common peroneal nerve palsy?
foot drop
140
what does damage to the lateral cutaneous femoral nerve cause?
meralgia paresthetica
141
what is the pathology behind Dupuytren's disease?
increase of myofibroblasts producing collagen
| first nodules in fascia, as disease progresses these form a thick band of fascia which pulls on the affected finger
142
if disease severe enough to be treated, what is the mainstay treatment for Dupuytren's disease?
partial fasciectomy
| dermofasciectomy
143
what is the genetic inheritance of Dupuytren's disease?
autosomal dominant (with various penetrance)
144
what is the usual management of Dupuytren's disease?
watch and wait, can't cure it and often patients aren't affected by it
145
why can Dupuytren's disease not be cured, despite surgical treatment options?
because there is a 50% chance of recurrence within 5 years
146
what are the management options for trigger finger?
splints
steroid injections
tendon release
147
what conditions are associated with trigger finger?
rheumatoid arthritis
diabetes
gout
148
what is the management of ganglia in the hand?
no treatment, it will go away eventually
149
what is the management of De Quervain's tenosynovitis?
splints
steroid injections
decompression
150
how does trigger finger present?
affected finger clicking back into original place after the rest of the hand, or locking and having to be unlocked with the other hand
151
how does De Quervain's Syndrome present?
pain on radial side of wrist
| pain aggravated by thumb abduction
152
what is the pathology behind De Quervain's syndrome?
inflammation of tendons of Extensor pollicis longus and extensor pollicis brevis
153
what is Finklestein's test and what disease does it help to diagnose?
abducting wrist with thumb inside fist
| used to diagnose De Quervain's syndrome
154
what are the non-operative ways to manage osteoarthritis in the thumb?
lifestyle advice
NSAIDS
splinting
steroid injections
155
what are the operative ways to manage osteoarthritis in the thumb?
trapeziectomy
fusion
replacement
156
what is the management of hallux valgus?
```
analgesia
shoewear modification
activity modification
orthotics
surgery (osteotomy)
```
157
what is the management of hallux rigidus?
analgesia
shoewear/activity modification
surgery (remove osteophyte, bone fusion)
158
what is the pathology of hallux rigidus?
osteoarthritis of first metatarsal-phalangeal joint
159
what is the main symptom of hallux rigidus?
loss of big toe dorsiflexion
160
what are the features of claw toes, hammer toes and mallet toes?
claw toes: MTP extended, PIP and DIP flexed
hammer toes: PIP flexed
mallet toes: DIP flexed
161
what is the management of lesser toe deformities (eg claw, hammer, mallet)?
activity modification
orthotics
surgery
162
in which webspace is Morton's neuroma most likely to occur?
third webspace
| sometimes second webspace
163
what are the symptoms of Morton's neuroma?
neuralgia in toes
altered sensation
mulder's click
164
what lifestyle habit is associated with Morton's neuroma?
wearing high heels
165
what investigation is done to diagnose Morton's neuroma?
ultrasound
| sometimes MRI
166
how can Morton's neuroma be managed?
steroid injections
orthotics
excision of lesion/part of nerve
167
what is the management of rheumatoid arthritis in the foot?
orthotics/footwear/analgesia
steroid injections
arthroplasty/arthrodesis
168
what is plantar fibromatosis, and what is its equivalent in the hand?
build up of fibrous nodules on sole of foot, can cause pain
| similar to Dupuytren's disease in the hand
169
what is the epidemiology of Achille's tendinopathy vs paratendinopathy?
paratendinopathy: healthy athletic people
tendinopathy: non-active people, obese, diabetes, steroid use
170
name the test to assess for Achille's tendon rupture, and how it is carried out
Simmond's test
| squeeze calf - if foot moves, no/partial rupture. if foot doesn't move, full rupture
171
how is Achille's tendinopathy diagnosed?
clinically: tenderness, Simmond's test
imaging: ultrasound, MRI
172
how is Achille's tendinopathy managed?
```
analgesia
shoewear (slight heel)
weight loss
activity modification
physiotherapy
surgery
```
173
how is plantar fasciitis managed?
```
NSAIDS
rest/ice
activity/training modification
shoewear modification
weight loss
stretching/physiotherapy
```
174
what is the management of ankle arthritis?
non-operative: NSAIDs, weight loss, physiotherapy, activity modification, steroid injections
operative: arthrodesis, arthroplasty, replacement
175
what happens as a result of tibialis posterior tendon dysfunction?
acquired flat feet
176
how is tibialis posterior tendon dysfunction assessed?
heel raise - foot should swing from valgus to varus. if it doesn't, there is dysfunction of the posterial tibial tendon
177
how is tibialis posterial tendon dysfunction managed?
orthotics to support arch of foot
| surgery
178
what are the two major problems with the foot that can occur in diabetic neuropathy?
ulcers - can lead to infections and amputations
| charcot foot - severe deformities, can lead to ulcers/amputations
179
what are the three stages in Charcot neuroarthropathy that cause bone destruction in the foot?
fragmentation
coalescence
remodelling
180
what is the management of Charcot neuroarthropathy?
avoid weightbearing until fragmentation is stopped
| correct deformities to avoid ulcers/infections
181
what is the grading system for open fractures called?
Gustilo grading
182
what are the general principles of open fracture management?
```
advanced trauma life support (ATLS) assessment
tetanus and antibiotic cover
x-rays of joint above and below
remove contamination
cover wound with saline swabs
refer to orthopaedic/plastic surgery
```
183
what circumstances causing an open fracture would indicate the need for urgent intervention?
```
farmland/marine environment accidents
polytraumatised patient
gross wound contamination
compartment syndrome
neurovascular damage
```
184
what time limit should not be exceeded in terms of fixing an open fracture after initial stabilisation?
72 hours
185
what is the difference between a subluxation and dislocation of a joint?
dislocation - complete disruption of joint (out of socket)
| subluxation - partial disruption of joint (not fully out of joint)
186
what are posterior shoulder dislocations most likely to be caused by?
epilepsy
| electric shock
187
how are joint dislocations diagnosed?
clinical examination
| x-ray
188
which direction do the majority of shoulder dislocations occur?
anteriorly
189
what's the management of shoulder dislocations?
manipulation back into socket
mobilisation (sling)
physiotherapy
surgery
190
what is the pathology of frozen shoulder?
inflamed and fibrosed shoulder capsule restricting ROM
191
what is a typical feature in the history of a frozen shoulder?
onset and subsiding of pain, followed by progressive reduction of ROM
192
what can cause frozen shoulder?
any damage to the capsule that can cause it to become inflamed
193
what is the management of frozen shoulder?
manipulation under anaesthesia
physiotherapy
hydrodilatation
capsule release
194
what is another term for frozen shoulder?
adhesive capsulitis
195
what is rotator cuff arthropathy?
damage to rotator cuff as a result of trauma or degenerative change
196
what can occur to the shoulder joint as a result of rotator cuff arthropathy?
weakness in rotator cuff muscles allows deltoid to pull humeral head up, causing superior migration (subluxation) of the shoulder joint
197
what is the management of rotator cuff arthropathy?
physiotherapy
occupational therapy
surgery (tendon transfer, reverse shoulder replacement)
198
how is osteoarthritis is the shoulder joint managed?
pain relief/physio/lifestyle advice
steroid injections
arthroplasty (hemi/total)
199
what treatment is sometimes used in patients with golfer's elbow or tennis elbow?
platelet-rich plasma (PRP) injections
200
which tendons are affected in golfer's and tennis elbow?
golfer's elbow - tendons of common flexor origin
| tennis elbow - tendons of common extensor origin
201
what does a hip fracture look like clinically?
shortened leg, hip/foot rotated outwards
202
why is the hip shortened during a hip fracture?
iliopsoas contracts in response to trauma, pulling hip up
203
how are intracapsular vs extracapsular hip fractures managed?
intracapsular: hemi/total hip replacement
extracapsular: intramedullary nail
204
what are the main features of osteomyelitis on an x-ray?
involucrum
| sequestrum
205
what are the commonest causes of chronic joint pain?
- osteoarthritis
- gout/pseudogout
- rheumatoid arthritis
- malignancy (especially night pain)
206
what are the commonest causes of acute joint pain?
- trauma (bone or soft tissue)
- septic arthritis
- gout flareup
- osteoarthritis flareup
- rheumatoid arthritis flareup
207
what is subacromial impingement?
irritation of rotator cuff tendons in subacromial space either due to reduction of subacromial space or increased size of contents due to inflammation
208
what is the management of subacromial impingement?
physiotherapy
steroid injection
surgical decompression
209
what investigation should be done if a patient presents with joint pain but xray reveals no fracture?
CT scan
210
which ligament in the ankle is most likely to rupture?
anterior talofibular ligament
211
what is the healing process of a ligament?
similar to bone
- inflammatory phase: haematoma/blood clot to increase vascularity
- proliferative phase: formation of disorganised fibrous scar tissue
- remodelling phase: matrix remodelled into organised connective tissue
212
in general terms, what are the management options for ligament ruptures?
conservative management
| surgical management
213
what structural property allows ligaments to increase their stretching ability?
crimping
214
what are the roles of articular ligaments?
aid movement
joint stability
proprioception
215
what are the three types of traumatic peripheral nerve damage, and what defines each type?
neurapraxia - nerve stretched but structures intact
axonotmesis - axon and myelin sheath ruptured but surrounding structures (endoneurium, perineurium, epineurium) still intact
neurotmesis - entire neuron ruptured
216
what is Wallerian degeneration of the nerve?
death of nerve distal to the site of injury
217
which type of peripheral nerve damage has the worst prognosis?
neurotmesis
218
what is the main management of a nerve injury with no nerve tissue loss?
direct repair/suturing
219
what is the management of a nerve injury following nerve tissue loss?
nerve graft
220
explain the formation of neuromas as a result of peripheral nerve damage
it's thickening of both cut ends of a damaged nerve, as a result of axons growing disordinately in an attempt to reform connections
221
what are the two most common mechanisms of injury in peripheral nerves?
compression
| trauma
222
what is the purpose of the tendon sheath?
it protects the tendon and separates it from the surrounding fascia
223
when is a tendon rupture treated conservatively?
if in an area with no articulation (little movement)
| if ends can be opposed to promote healing
224
when is a tendon rupture treated surgically?
if ends can't be opposed
if high activity area (articulation)
if high risk of re-rupture
225
what is the mainstay treatment of tendon lacerations?
surgical repair as early as possible, as once damaged the tendon starts to retract and becomes harder to repair
226
name a few examples of tendon injuries
```
degenerative
inflammation
avulsion fracture
tear/rupture
laceration
enthesitis (eg golfer's/tennis elbow)
de quervain's tenosynovitis
osgood-shlatter disease
```
227
what is the definition of sarcoma?
malignant tumour arising from connective tissue
228
what are the common symptoms of bone tumours?
pain (at rest, at night, increasing despite physio/analgesia)
swelling/effusion
loss of function
neurovascular damage
deformity
pathological bone fractures
systemic symptoms (weight loss, fatigue, anaemia)
229
what are the common investigations done to help diagnose bone tumours?
- bloods
- x-ray
- CT (chest, abdomen, pelvis)
- MRI scan
- bone biopsy (core tissue biopsy)
230
what is the main difference between osteosarcoma and ewing's sarcoma?
osteosarcoma does not respond to radiotherapy
| ewing's sarcoma responds to radiotherapy
231
what is the most common type of bone tumour in young people?
osteosarcoma
232
what are the management options for bone tumours?
surgery - resection
radiotherapy (ewing's sarcoma)
chemotherapy
233
what are the commonest tumours that metastasize to the bone?
- breast
- lung
- prostate
- kidney
- thyroid
- GI
- melanoma
234
what is the purpose of the Mirel scoring system in the context of bone metastases?
it helps decide if a patient with bone metastases should undergo preventative fixation to prevent pathological fractures
235
name some features of soft tissue tumours
- deep (deep to deep fascia)
- may be painless
- hard, craggy and fixed
- rapidly growing
- larger than 5cm
236
what are the commonest signs of septic arthritis?
knee
| hip
237
what are the possible routes of infection that can result in septic arthritis?
- through blood spread
- from osteomyelitis
- through procedure (ie needle aspiration)
- through adjacent soft tissue infection
- through direct trauma
238
in which type of joint inflammation is WCC and CRP low/normal?
transient synovitis
239
does a child who presents with transient synovitis have systemic symptoms?
no
