Orthopaedics Flashcards

Question

avn of femoral head

Answer 1

If retinacular vessels damaged there is risk of | AVN of the femoral head → pain, stiffness and OA

Answer 2

Intracapsular: subcapital, transcervical, basicervical | • Extracapsular: Intertrochanteric, subtrochanteric

Answer 3

``` Garden Classification of Intracapsular Fractures • Incomplete #, undisplaced • Complete #, undisplaced • Complete #, partially displaced • Complete #, completely displaced ```

Answer 4

``` Intracapsular • 1,2: ORIF ¯c cancellous screws • 3,4: § <55: ORIF ¯c screws. - f/up in OPD and do arthroplasty if AVN develops (in 30%) § 55-75: total hip replacement § >75: hemiarthroplasty - Mobilises: cemented Thompson’s - Non-mobiliser: uncemented Austin Moore Extracapsular • ORIF ¯c DHS ```

Answer 5

Specific Complications • AVN of fem head in displaced #s (30%) • Non / mal-union (10-30%) • Infection • Osteoarthritis Prognosis • 30% mortality @ 1yr • 50% never regain pre-morbid functioning • >10% unable to return to premorbid residence • Majority will have some residual pain or disability

Answer 6

``` Clinical Features • Fall onto an outstretched hand • Most common in elderly females ¯c osteoporosis • Dinner fork deformity Radiographic Features • Extra-articular # of dist. radius (w/i 1.5” of joint) • Dorsal displacement of distal fragment • Dorsal angulation of distal fragment § Normally 11 degrees volar tilt • ↓ radial height (norm =11mm) • ↓ radial inclination (norm =22O) • ± avulsion of ulna styloid • ± impaction ```

Answer 7

``` Examine for neurovascular injuries as median nerve and radial artery lie close. • If much displacement → reduction § Under haematoma block, IV regional anaesthesia (Bier’s block) or GA. § Disimpact and correct angulation. § Position: ulnar deviation + some wrist flexion § Apply dorsal backslab: provide 3-point pressure • Re X-Ray – satisfactory position? § No: ortho review and consider MUA ± K wires § Yes: home ¯c # clinic f/up w/i 48hrs for completion of POP • 6 wks in POP + physio • If comminuted, intra-articular or re-displaces: § Surgical fixation ```

Answer 8

``` Median N. injury • Frozen shoulder / adhesive capsulitis • Tendon rupture: esp. EPL • Carpal tunnel syn. • Mal- /non-union • Sudek’s atrophy / CRPS ```

Answer 9

Clinical Features • FOOSH • Pain in anatomical snuffbox • Pain on telescoping the thumb

Answer 10

Request scaphoid x-ray view • If clinical hx and exam suggest a scaphoid #, it should initially be treated even if the x-ray is normal. § # may become apparent after 10 days due to localised decalcification. • Place wrist in scaphoid plaster (beer glass position) • If initial x-ray is negative, pt. returns to # clinic after 10 days for re-xray. § # visible → plaster for 6 wks § No visible # but clinically tender → plaster for 2 wks § # not visible and not clinically tender → no plaster Specific Complications • Main risk is AVN of the scaphoid as blood supply runs distal to proximal. § → stiffness and pain at the wrist

Answer 11

Classification • Monteggia § # of proximal 3rd of ulna shaft § Anterior dislocation of radial head at capitellum § May → palsy of deep branch of radial nerve → weak finger extension but no sensory loss • Galleazzi § # of radial shaft between mid and distal 3rds § Dislocation of distal radio-ulna joint

Answer 12

``` • Unstable fractures § Adults: ORIF § Children: MUA + above elbow plaster • Fractures of forearm should be plastered in most stable position: § Proximal #: supination § Distal #: pronation § Mid-shaft #: neutral ```

Answer 13

``` Classification • Anterior § 95% of shoulder dislocations. § Direct trauma or falling on hand § Humeral head dislocates antero-inferiorly • Posterior § Caused by direct trauma or muscle contraction (seen in epileptics). ```

Answer 14

``` Presentation • Shoulder contour lost: appears square • Bulge in infraclavicular fossa: humeral head • Arm supported in opposite hand • Severe pain ```

Answer 15

Specific Management • Assess for neurovascular deficit: esp. axillary N. § Sensation over “chevron” area before and after reduction. § Occurs in 5% • X-ray: AP and transcapular view • Reduction under sedation (e.g. propafol) § Hippocratic: Longitudinal traction ¯c arm in 30O abduction and counter traction @ the axilla § Kocher’s: external rotation of adducted arm, anterior movement, internal rotation • Rest arm in a sling for 3-4wks • Physio

Answer 16

Recurrent dislocation § 90% of pts. <20yrs with traumatic dislocation • Axillary N. injury

Answer 17

Pathology • Entrapment of supraspinatus tendon and subacromial bursa between acromion and grater tuberosity of humerus. • → subacromial bursitis and/or supraspinatous tendonitis Presentation • Painful arc: 60-120O • Weakness and ↓ ROM • +ve Hawkin’s test

Answer 18

``` Ix • Plain radiographs: may see bony spurs • US • MRI arthrogram Rx • Conservative § Rest § Physiotherapy • Medical § NSAIDs § Subacromial bursa steroid ± LA injection • Surgical § Arthroscopic acromioplasty ```

Answer 19

Impingement • Supraspinatous tear or partial tear • AC joint OA

Answer 20

``` Frozen Shoulder: Adhesive Capsulitis Presentation • Progressive ↓ active and passive ROM § ↓ ext. rotation <30O § ↓ abduction <90O • Shoulder pain, esp. @ night (can’t lie on affected side) Cause • Unknown, may follow trauma in elderly • Commonly assoc. ¯c DM ```

Answer 21

``` Rx • Conservative: rest, physio • Medical § NSAIDs § Subacromial bursa steroid ± LA injection ```

Answer 22

• 2O to degeneration or a sudden jolt or fall • Partial tears → painful arc • Complete tear § Shoulder tip pain § Full range of passive movement § Inability to abduct the arm § Active abduction possible following passive abduction to 90O § Lowering the arm beneath this → sudden drop - “drop arm” sign Rx: open or arthroscopic repair

Answer 23

Presentation • Common in children after FOOSH • Elbow very swollen and held semi-flexed. • Sharp edge of proximal humerus may injure brachial artery which lies anterior to it. risk of neurovasc probs, compartment syndrome, gunstock deformity

Answer 24

``` Specific Management • Resus and Mx life-threatening injuries first. • X-Match § Tibial #: 2 units § Femoral #: 4 units • Assess neurovascular status: esp. distal pulses • If open § Abx and ATT § Take to theatre urgently for debridement, washout and stabilisation • Fixation methods § Intramedullary nail § Ex-fix § Plates and screws § MUA ¯c fixed traction for 3-4mo ```

Answer 25

``` Specific Complications • Hypovolaemic shock • Neurovascular § SFA: swelling and check pulses § Sciatic nerve • Compartment syndrome • Respiratory complications § Fat embolism § ARDS § Pneumonia ```

Answer 26

Ligament Strains • Typically twisting inversion injury § Strains anterior talofibular part of lateral collateral ligament • Medial deltoid ligament strains are rare. • May be assoc. ¯c malleolar avulsion #s

Answer 27

``` Ankle Fracture Ottowa Ankle Rules • X-ray ankle if pain in malleolar zone + in any of: § Tenderness along distal 6cm of posterior tib / fib including posterior tip of the malleoli. § Inability to bear weight both immediately and in ED Weber Classification • Relation of fibula # to joint line • A: below joint line • B: at joint line • C: above joint line • Weber’s B and C represent possible injury to the syndesmotic ligaments between tib and fib → instability Mx • Weber A § Boot or below-knee POP • Non-displaced Weber B/C § Below-knee POP • Displaced Weber B/C § Closed reduction and POP if anatomical reduction achieved § ORIF if closed reduction fails ```

Answer 28

History • Mechanism • Swelling § Immediate = haemarthrosis = # or torn cruciates § Overnight = effusion = meniscus or other lgt • Pain / tenderness § Joint line = meniscal § Med/lateral margins = collateral lgts. • Locking: meniscal tear → mechanical obstruction • Giving way: instability following lgt. injury

Answer 29

``` Knee Haemarthrosis • 1O: spontaneous bleeding § Coagulopathy: warfarin, haemophilia • 2O: trauma § ACL injury: 80% § Patella dislocation: 10% § Meniscal injury: 10% - Outer third where its vascularised § Osteophyte # ```

Answer 30

Mx of acutely injured knee • Full examination of acutely swollen knee after injury is difficult. • Take x-ray to ensure no #s § Fluid level indicates a lipohaemarthrosis and indicates either a # or torn cruciate. • If no # → RICE + later re-examination for pathology • If meniscal or cruciate injury suspected → MRI

Answer 31

Mx of Ruptured ACL Conservative • Rest • Physio to strengthen quads and hamstrings • Not enough stability for many sports Surgical • Gold-standard is autograft repair • Usually semitendinosus ± gracilis (can use patella tendon) • Tendon threaded through heads of tibia and femur and held using screws.

Answer 32

Degenerative joint disorder in which there is progressive loss of hyaline cartilage and new bone formation at the joint surface and its margin.

Answer 33

Aetiology / Risk Factors • Age (80% > 75yrs) • Obesity • Joint abnormality Classification • Primary: no underlying cause • Secondary: obesity, joint abnormality Symptoms • Affects: knees, hips, DIPs, PIPs, thumb CMC • Pain: worse ¯c movement, background rest/night pain, worse @ end of day. • Stiffness: especially after rest, lasts ~30min (e.g. AM) • Deformity • ↓ ROM

Answer 34

Bouchards and Heberdens nodes § ‘Pouchards’ (prox), ‘Heberdips’ (dist.) • Thumb CMC squaring • Fixed flexion deformity

Answer 35

``` History • Pain severity, night pain • Walking distance • Analgesic requirements • ADLs and social circumstances • Co-morbidities • Underlying causes: trauma, infection, congenital ```

Answer 36

``` X-ray Changes • Loss of joint space • Osteophytes • Subchondral cysts • Subchondral sclerosis • Deformity ```

Answer 37

``` MDT: GP, physio, OT, dietician, orthopod Conservative • Lifestyle: ↓ wt., ↑ exercise • Physio: muscle strengthening • OT: walking aids, supportive footwear, home mods Medical • Analgesia § Paracetamol § NSAIDs: e.g. arthrotec (diclofenac + misoprostol) § Tramadol • Joint injection: local anaesthetic and steroids Surgical • Arthroscopic Washout § Mainly knees § Trim cartilage § Remove loose bodies. • Realignment Osteotomy § Small area of bone cut out § Useful in younger (<50yrs) pts. ¯c medial knee OA § High tibial valgus osteotomy redistributes wt. to lateral part of joint. • Arthroplasty: replacement (or excision) ```

Answer 38

Mx • Conservative § Max 2d bed rest § Education: keep active, how to lift / stoop § Physiotherapy § Psychosocial issues re. chronic pain and disability § Warmth: e.g. swimming in a warm pool • Medical § Analgesia: paracetamol ± NSAIDs ± codeine § Muscle relaxant: low-dose diazepam (short-term)

Answer 39

Disc Prolapse • Herniation of nucleus pulposus through annulus fibrosus Presentation • L5 and S1 roots most commonly compressed by prolapse of L4/5 and L5/S1 discs. • May present as severe pain on sneezing, coughing or twisting a few days after low back strain • Lumbago: low back pain • Sciatica: shooting radicular pain down buttock and thigh

Answer 40

Limited spinal flexion and extension • Free lateral flexion • Pain on straight-leg raise: Lesague’s Sign • Lateral herniation → radiculopathy • Central herniation → corda equina syndrome

Answer 41

L4/5 → L5 Root Compression • Weak hallux extension ± foot drop § In foot drop due to L5 radiculopathy, weak inversion (tib. post.) helps distinguish from peroneal N. palsy. • ↓ sensation on inner dorsum of foot

Answer 42

``` L5/S1 → S1 Root Compression • Weak foot plantarflexion and eversion • Loss of ankle-jerk • Calf pain • ↓ sensation over sole of foot and back of calf ```

Answer 43

Ix: MRI (emergency if cauda equina) Rx • Brief rest, analgesia and mobilisation effective in ≥90% • Conservative: brief rest, mobilisation/physio • Medical: analgesia, transforaminal steroid injection • Surgical: discectomy or laminectomy may be needed in cauda-equina syndrome, continuing pain or muscle weakness.

Answer 44

``` Spondylolisthesis • Displacement of one lumbar vertebra on another § Usually forward § Usually L5 on S1 • May be palpable Causes • Congenital malformation • Spondylosis • Osteoarthriti ```

Answer 45

``` Presentation • Onset of pain usually in adolescence or early adulthood § Worse on standing • ± sciatica, hamstring tightness, abnormal gait Dx: Plain radiography Rx • Corset • Nerve release • Spinal fusion ```

Answer 46

``` Spinal Stenosis • Developmental predisposition ± facet joint osteoarthritis → generalized narrowing of lumbar spinal canal. Presentation • Spinal claudication § Aching or heavy buttock and lower limb pain on walking § Rapid onset § May c/o paraesthesiae/numbness § Pain eased by leaning forward (e.g. on bike) • Pain on spine extension Ix: MRI Rx • Corsets • NSAIDs • Epidural steroid injection • Canal decompression surgery ```

Answer 47

``` Acute Cord Compression • Bilateral pain: back and radicular • LMN signs at compression level • UMN signs and sensory level below compression • Sphincter disturbance ```

Answer 48

``` Acute Cauda Equina Compression • Alternating or bilateral radicular pain in the legs • Saddle anaesthesia • Loss of anal tone • Bladder ± bowel incontinence ```

Answer 49

Rx • Large prolapse: laminectomy / discectomy • Tumours: radiotherapy and steroids • Abscesses: decompression emergency!!!

Answer 50

Osteochondritis • Idiopathic condition in which bony centres of children/adolescents become temporarily softened due to osteonecrosis. • Pressure → deformation • Bone hardens in new, deformed position Radiography • Initially: ↑ density / sclerosis

Answer 51

Osgood-Shlatter’s • Tibial tuberosity apophysitis + patellar tendonitis • Children 10-14yrs, M>F=3:1 • Assoc. ¯c physical activity • Symptoms: pain below knee, esp ¯c quads contraction • X-ray: tuberosity enlargement ± fragmentation • Rx: rest, consider POP

Answer 52

``` Causes • # or dislocation • SCD, thalassaemia • SLE • Drugs: steroids, NSAIDs ```

Answer 53

``` DDH • Transient synovitis • Septic arthritis • Perthes’ • Slipped Capital Femoral Epiphyses • JIA / Still’s Disease ```

Answer 54

``` DDH • Congenital hip joint deformity in which the femoral head is or can be completely / partially displaced. Epidemiology • Incidence: 1/1000 • Sex: F>M Predisposing Factors • FH • Breech presentation • Oligohydramnios Presentation • Screening • Asymmetric skin folds • Limp / abnormal gait Ix • US is v. specific Mx: maintain abduction • Double nappies • Pavlik harness • Plaster hip spica • Open reduction: derotation varus osteotomy ```

Answer 55

``` Transient Synovitis: Irritable Hip • Commonest cause of acute hip pain in children Presentation • 2-12yrs • Sudden onset hip pain / limp • Often following or with viral infection • Not systemically unwell Ix • PMN and ESR/CRP are normal • -ve blood cultures • May need joint aspiration and culture Mx • Rest and analgesia • Settles over 2-3d ```

Answer 56

``` Perthes’ Disease • Osteochondritis of the femoral head 2O to AVN. Epidemiology • 4-10yrs • M>F=5:1 Presentation • Insidious onset • Hip pain initially, then painless • 10-20% bilateral Ix • X-rays normal initially • ↑ density of femoral head § Becomes fragmented and irregular § Flattening and sclerosis • Bone scan is useful Mx • Detected early and < half femoral head affected § Bed rest and traction • More severe § Maintain hip in abduction ¯c plas ```

Answer 57

``` Slipped Capital Femoral Epiphysis • Postero-inferior displacement of femoral head epiphysis • 10-15yrs • Two main groups § Fat and sexually underdeveloped § Tall and thin Presentation • Slip may be acute, chronic or acute-on-chronic • Acute § Groin pain § Shortened, externally rotated leg § All movements painful • 20% bilateral Ix • Confirm Dx by x-ray Mx • Acute: reduce and pin epiphysis • Chronic: in situ pinning § Epiphyseal reduction risks AVN Complications • Chondrolysis: breakdown of articular cartilage § ↑ risk ¯c surgery ```

Answer 58

``` Pathophysiology • Source: local or haematogenous. • Organisms § Staph § Strep § E. coli § Pseudomonas § Salmonella (in SCD) • RFs § Vascular disease § Trauma § SCD § Immunosuppression (e.g. DM) § Children - Rich blood supply to growth plate - \ usually affects metaphysis ```

Answer 59

``` Symptoms and Signs • Pain, tenderness, erythema, warmth, ↓ROM • Effusion in neighbouring joints • Signs of systemic infection Investigations • ↑ESR/CRP, ↑WCC • +ve blood cultures in 60% • X-ray: § Changes take 10-14d § Haziness + ↓ bone density § Sub-periosteal reaction § Sequestrum and involucrum • MRI is sensitive and specific Management • IV Abx: Vanc + cefotaxime until MCS known • Drain abscess and remove sequestra • Analgesia ```

Answer 60

``` Pathophysiology • Source: local or haematogenous. • Organisms § Staph: 60% § Streps § Gonococcus § Gm-ve bacilli • RFs § Joint disease (e.g. RA) § CRF § Immunosuppression (e.g. DM) § Prosthetic joints Symptoms • Acutely inflamed tender, swollen joint. • ↓ROM • Systemically unwell ```

Answer 61

``` nvestigations • Joint aspiration for MCS § ↑↑ WCC (e.g. >50,000/mm3 ) : mostly PMN • ↑ESR/CRP, ↑WCC, Blood cultures • X-ray Management • IV Abx: vanc + cefotaxime • Consider joint washout under GA • Splint joint • Physiotherapy after infection resolved Complications • Osteomyelitis • Arthritis • Ankylosis: fusion Differential • Crystal arthropathy • Reactive arthritis ```

Answer 62

Commonest bone tumours • Bronchus, thyroid, breast, kidney and prostate • Usually radiolucent (except prostate which is sclerotic) • Usually axial skeleton (contains red marrow) • Present with pain or pathological # § Path # → internal fixation § Pain → radiotherapy

Answer 63

“Ground Glass” lytic lesion Shepherds crook deformity of prox. femur

Answer 64

``` 10-20 M>F = 3:1 Commonest benign bone tumour May be related to previous trauma Knee Cartilage-capped bony outgrowth ```

Answer 65

``` O sign - Oval lucencies ¯c radiodense rim Endosteal scalloping 10-40 M=F ```

Answer 66

knee epiphysis 10-20 yrs old

Answer 67

``` >40 Pain + lump Arise de novo or from chondromas 70% 5ys Pelvis Axial skeleton Lytic lesion Fluffy “popcorn calcification” ``` malignant cartilagenous

Answer 68

``` M>F = 2:1 Teens and 20s Severe nocturnal pain relieved by aspirin Hot on bone scan Lower limb Diaphyseal cortex Lytic lesion ¯c central nidus and sclerotic rim ```

Answer 69

Osteoblastoma Pain unresponsive to aspirin Spine

Answer 70

``` Giant Cell Tumour / Osteoclastoma 20-40 (After fusion of growth plate) F>M Knee Abut joint surface Soap bubble appearance Solitary, expansile, lytic lesion ```

Answer 71

``` Adolescents M>F = 2:1 Commonest 1O bone tumour Pain, warm, bruit May arise 2o to Paget’s or irradiation Knee Metaphysis Periosteal Elevation: - Sunburst appearance - Codman’s triangle ``` malignant bone cancer

Answer 72

``` malignant bone ca Ewing’s Sarcoma <20 Painful, warm, enlarging mass Systemic: fever, ↑ESR, anaemia, ↑WCC Long bone diaphysis Lytic tumour Onion-skin periosteal reactio ```

Answer 73

Anatomy • C5-T1 • Roots leave vertebral column between scalenus anterior and medius. • Divisions occur under the clavicle, medial to coracoid process. • Plexus has intimate relationship ¯c subclavian and brachial arteries. Median N. is formed anterior to brachial artery

Answer 74

High (C5/6): Erb’s Palsy • Abductors and external rotators paralysed • Waiter’s tip position • Loss of sensation in C5/6 dermatomes

Answer 75

Low (C8/T1): Klumpke’s Paralysis • Paralysis of small hand muscles • Claw hand • Loss of sensation in C8/T1 dermatomes

Answer 76

Radial Nerve (C5-T1) Low Lesions: posterior interosseous nerve • Site: # around elbow or forearm § E.g. # head of radius • Loss of extension of CMC joints (finger drop) • No sensory loss High Lesions • Site: # shaft of humerus where N. is in radial groove. • Wrist drop • Loss of sensation to dorsum of thumb root (snuff box) • Triceps functions normally Very High Lesions • Site: axilla – e.g. crutches or Sat night palsy • Paralysis of triceps and wrist drop

Answer 77

Ulnar Nerve (C8-T1) Site • Elbow: cubital tunnel • Wrist: in Guyon’s Canal Effects • Intrinsic hand muscle paralysis → claw hand • Ulnar paradox: lesion at elbow has less clawing as FDP is paralysed, decreasing flexion of 4th/5th digits. • Weakness of finger ad/abduction (interossei) • Sensory loss over little finger Tests • Can’t cross fingers for luck • Froment’s Sign: flexion of thumb IPJ when trying to hold onto paper held between thumb and finger. § Indicates weak adductor policis.

Answer 78

Median Nerve (C5-T1) Injury Above the Antecubital Fossa • Can’t flex index finger IPJs (e.g. on clasping hands) • Can’t flex terminal thumb phalanx (FPL) • Loss of sensation in median distribution Injury at the Wrist • Typically affects abductor pollicis brevis Carpal Tunnel Syndrome

Answer 79

Anatomy • Carpal tunnel formed by flexor retinaculum and carpal bones. • Contains § 4 tendons of FDS § 4 tendons of FDP § 1 tendon of FPL § Median N. • Median N. supplies LLOAF (aBductor pollicis brevis) • Palmer cutaneous branch travels superficial to flexor retinaculum → spares sensation over thenar area.

Answer 80

``` Causes • F>M • Primary / idiopathic • Secondary • Water: pregnancy, hypothyroidism • Radial # • Inflammation: RA, gout • Soft tissue swelling: lipomas, acromegaly, amyloidosis • Toxic: DM, EtOH Symptoms • Tingling / pain in thumb, index and middle fingers • Pain worse @ night or after repetitive actions • Relieved by shaking / flicking • Clumsiness ``` ``` Signs • ↓ sensation over lateral 3½ fingers • ↓ 2-point touch discrimination § Early sign of irreversible damage • Wasting of thenar eminence § Late sign of irreversible damage • Phalen’s flexing and Tinel’s tapping ```

Answer 81

``` Ix • Not usually performed • Nerve conduction studies • US Non-surgical Mx • Mx of underlying cause • Wrist splints § Neutral position § Esp. @ night • Local steroid injections Surgical Mx • Carpal tunnel decompression by division of the flexor retinaculum Complications • Scar formation: high risk for hypertrophic or keloid • Scar tenderness: up to 40% • Nerve injury § Palmar cutaneous branch of the median nerve § Motor branch to the thenar muscles • Failure to relieve symptoms ```

Answer 82

``` Dupuytren’s Contracture • Progressive, painless fibrotic thickening of palmar fascia. The Patient • M>F • Middle age / elderly • Skin puckering and tethering • Fixed flexion contracture of ring and little fingers • Often bilateral and symmetrical • MCP and IP joint flexion Associations: BAD FIBERS • Bent penis: Peyronies (3%) • AIDS • DM • FH: AD • Idiopathic: commonest • Booze: ALD • Epilepsy and epilepsy meds (phenytoin) • Reidel’s thyroiditis and other fibromatoses § Ledderhose disease - Fibrosis of plantar aponeurosis - 5% ¯c dupuytren’s § Retroperitoneal fibrosis • Smoking Management • Conservative: e.g. physio / exercises • Fasciectomy § e.g. when hand can’t be placed flat on the table. § Z-shaped scars: prevent contracture § Can damage ulnar nerve § Usually recurs Differential • Skin contracture: old laceration or burn • Tendon fibrosis, trigger finger • Ulnar N. palsy ```

Answer 83

Trigger Finger • Tendon nodule which catches on proximal side of tendon sheath → triggering on forced extension. • → Fixed flexion deformity • Usually ring and middle fingers • Assoc. ¯c RA • Rx: steroid injection (high recurrence) or surgery

Answer 84

``` Ganglion • Smooth, multilocular cystic swellings • Mucoid degeneration of joint capsule or tendon sheath • May be in communication ¯c joint capsules / tendons Presentation • 90% located on dorsum of wrist. • Subdermal, fixed to deeper structures. § Limits planes of movement • May cause pain or nerve pressure symptoms Management • 50% disappear spontaneously • Aspiration ± steroid and hyaluronidase injection • Surgical excision Differential • Lipoma • Fibroma • Sebaceous cyst ```

Answer 85

• Entrapment of lat. cutaneous nerve of thigh § Between ASIS and inguinal ligament • Pain ± paraesthesia on the lateral thigh • No motor deficit • ↑ risk ¯c obesity: compression by belts, underwear § Relieved by sitting down • Can occasionally be damaged in lap hernia repair

Answer 86

• Predominantly young women • Patellar aching after prolonged sitting or climbing stairs • Pain on patellofemoral compression: Clarke’s test • Ix: no abnormality on X-ray • Rx: vastus medialis strengthening

Answer 87

``` Baker’s Cyst • Popliteal swelling arising between the medial head of gastrocnemius and semimembranosus muscle • Herniation from joint synovium • Usually 2O to OA • Rupture: acute calf pain and swelling § DVT differentia ```

Answer 88

``` Hallux Valgus • Great toe deviates laterally @ MTP joint • Pressure of MTP against shoe → bunion • ↑ wt. bearing @ 2nd metatarsal head § → pain: “Transfer metatarsalgia” § → hammer toe Aetiology • Pointed shoes • Wearing high heels Mx • Conservative: bunion pads, plastic wedge between great and second toes. • Surgical: metatarsal osteotomy ```

Answer 89

check know what they look like

Orthopaedics Flashcards

(113 cards)