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Orthopaedics Flashcards

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1
Q

what is adhesive capsulitis

A

inflammation of the connective tissue around the glenohumeral joint

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2
Q

symptoms of adhesive capsulitis

A

pain - external rotation

restricted movement - both passive and active

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3
Q

what are the 3 phases of adhesive capsulitis?

A

painful freezing (6 weeks to 9 months - slow onset of pain and motion loss), adhesion (4 to 9 months were the pain improves but stiffness remains) and recovery (slowly returns to normal can take 5 to 26 months)

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4
Q

management of adhesive capsulitis?

A

NSAIDs
corticosteroid injections (contraindicated in diabetes)
phsyiotherapy

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5
Q

management of compartment syndrome?

A

fasciotomy + analgesia + fluids

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6
Q

what is supraspinatus tendonitis?

A

inflammation of the supraspinatus muscle

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7
Q

what are the muscles of the rotator cuff?

A

supraspinatus
infraspinatus
teres minor
subscapularis

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8
Q

role of supraspinatus?

A

abducts the arm at shoulder level

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9
Q

symptoms of supraspinatus tendinitis?

A

classic symptom is pain between 60- 120 degrees of rotation (when the inflamed muscle pushes against the acromium)

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10
Q

investigations for surpaspinatus tendinitis?

A

XRAY- calcification of the supraspinatus tendon

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11
Q

management of supraspinatus tendinitis?

A

physiotherapy
NSAIDs
rest
corticosteroid injection if persists

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12
Q

which muscles are responsible for should abduction and for how many degrees?

A

supraspinatus - initiates abduction first 15 degrees
deltoid - up to 90 degrees
trapezius and serratus anterior - beyond 90 degrees

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13
Q

which nerve innervates the deltoid?

A

deltoid - C5 and C6 (axillary)

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14
Q

Appearance of NOF fracture?

A

externally rotated and shortened

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15
Q

describe 2 types of NOF fracture?

A

intracapsular - within the intertrochanteric line

extracapsular- outside the intertrochanteric line

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16
Q

what are the two types of extracapsular NOF fracture?

A

intertrochanteric - within the surgical intertrochanteric line
subtrochanteric - outside the surgical line

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17
Q

how do you treat a subtrochanteric NOF fracture?

A

nail

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18
Q

how do you tx a intertrochanteric NOF fracture?

A

dynamic screw

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19
Q

how do you treat an intracapsular fracture?

A

if good baseline mobility + can tolerate surgery = total hip replacement
if poor baseline mobility = hemi hip arthoplasty

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20
Q

what classification is used for NOF fractures?

A

Gardners classification

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21
Q

what is gardners classification for NOF fracutres? (4)

A

Type 1- stable fracture
Type 2- complete fracture but undisplaced
type 3- complete fracture, displaced but with bony contact
type 4- complete fracture with loss of bony contact

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22
Q

which artery may be compromised in a NOF fracture and why?

A

the medical femoral circumflex artery - runs distal to proximal and if compromised causes avascular necrosis

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23
Q

which artery may be compromised in a scaphoid fracture?

A

the radial artery (volar and dorsal branches)

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24
Q

symptoms of osteomyelitis?

A

dull pain
worse with movement
may have swelling, warmth and tenderness due to associated septic arthritis

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25
common organisms in osteomyelitis?
staph aureus e.coli pseudomonas (IVDU)
26
investigations for osteomyelitis?
MRI
27
management of osteomyelitis?
surgical debridement and flucloxacillin for 6 weeks
28
what is de quervains tenosinovitis?
inflammation of the sheath containing the extensor pollicis brevis and pollicis abductor longus
29
symptoms of de quervains tenosinovitis?
pain on abduction and flexion of the thumb
30
in what position can de quervains tenosinovytis pain be recreated?
thumb flexed across hand, wrist flexion and ulnar deviation
31
management of de quervains tenosinovytis?
splint analgesia steroid injection
32
what is achilles tendonitis associated with?
quinolone use | hypercholesterolaemia
33
what rules are used to classify whether an ankle fracture needs an xray?
ottowa ankle rules
34
what are the ottowa ankle rules?
A) pain in the malleolar zone B) cannot weight bear for 4 steps C) tender over distal tibia/fibula
35
what Xrays should be taken for an ankle fracture?
3 different views
36
what classification is used to decide the treatment for ankle fractures?
Danis-Weber classification
37
what is the danis-weber classification?
Type A- fracture of the lateral malleolus distal to the syndesmosis - stable Type B- fracture of the fibula at the level of the syndesmosis - variable stability Type C- fracture of the fibula proximal to the syndesmosis - requires open reduction and internal fixation
38
which nerve is compressed in carpal tunnel?
median nerve
39
symptoms of carpal tunnel?
pins and needles pain worse at night often needs to shake hand to get rid of symptoms
40
treatment of carpal tunnel?
splint at night and pain relief corticosteroid injection surgical decompression
41
what causes 4th and 5th finger tingling symptoms?
cubital tunnel syndrome/ulnar nerve entrapment syndrome - compression of the ulnar nerve
42
symptoms of ulnar nerve entrapment syndrome?
wasting and paralysis of intrinsic hand muscles (except lateral 2 lumbricals) wasting of HYPOthenar muscles sensory loss or tingling in medial 1 and half fingers
43
sign of ulnar nerve damage?
claw hand - hyperextension of the metacarpophalangeal joints and flexion at the distal and proximal interphalangeal joints of the 4th and 5th digits
44
sign of radial nerve damage?
wrist drop | sensory loss between 1 and 2nd metacarpals
45
sign of axillary nerve damage?
wasting of deltoid muscle | paralysis of triceps
46
symptoms of lateral epicondylitis (tennis elbow)?
pain and tenderness localised to lateral epicondyle | pain worse on wrist extension with elbow extended or supination of the forearm with the elbow extended
47
symptoms of medial epicondylitis (golfers elbow)?
pain and tenderness localised to the medial epicondyle | pain is aggrevated in wrist flexion and pronation (when the elbow is extended)
48
what are the three types of wrist fracture?
colles - dorsal displacement (dinner fork) smiths- volar displacement (garden spade) bartons - colles or smiths PLUS dislocation
49
investigation for wrist fracture?
AP Xray 2 different views
50
management of a wrist fracture?
bier block manipulation under anaesthetic Xray before and after cast
51
describe the dermatomes of the upper limb?
``` C4- top of shoulder C5- outside of upper arm C6-outside of forearm and thumb C7- middle of hand C8- little finger and wrist T1- inner forearm and half of upper arm T3 -under arm pit T5 - nipple line T10- belly button ```
52
describe the dermatomes of the lower limb?
L2- anterior aspect of upper thigh L3- anterior aspect of lower thigh L4- anterior aspect of knee, inside of leg and big toe L5- outside of leg and middle of foot and toes S1- little toe and back of foot S2- back of thigh
53
what is the motor function of C5-C7 (musculocutaneous)?
elbow flexion
54
what is the motor function of C5-C6 (axillary)?
shoulder abduction
55
function of C5-C8 (radial)?
wrist extension | get wrist drop if damaged
56
function of C8 and T1? (ulnar)
wrist flexion | claw hand if damaged
57
nerves for knee reflex?
L3 and L4
58
which nerve innervates dorsiflexion of the foot?
L5
59
which nerve innervats plantar flexion of the foot?
L6
60
which nerve is responsible for foot drop?
common peroneal nerve
61
which nerve roots form the sciatic nerve?
L3-4
62
sciatic nerve symptoms?
Pain down back of legs weak quadriceps reduced knee reflex positive femoral stretch test
63
what is pagets disease of the bone?
increased but controlled bone turnover, due to excessive osteoclast reabsorption
64
risk factors for pagets bone disease?
male sex northern latitude family history age
65
clinical features of pagets?
older male with bone pain and isolated raised ALP ``` bone pain bossing of skull bowing of tibia raised ALP thickened vault on skull cray ```
66
complications of pagets?
deafness due to cranial nerve entrapment bone sarcoma high output cardiac failure
67
management of pagets?
bisphosphonates | calcitonin
68
risk factors for osteoporosis?
``` age female gender corticosteroid use smoking alcohol low BMI FHx ```
69
investigations of osteoporosis?
bloods- high ALP FRAX- screen to assess the 10 year risk of a patient developing a fragility fracture if FRAX +ve -> DEXA scan
70
what value of DEXA scan is indicative for treatment?
T score < -2.5
71
treatment of osteoporosis?
bisphosphonates - alendronate
72
what medications can cause osteoporosis?
``` corticosteroids aromatase inhibitors long term heparin therapy PPI antiepileptic SSRI ```
73
side effects of bisphosphonates?
oesophageal reactions osteonecrosis of the jaw increased risk of atypical stress fracture hypocalcaemia

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