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Orthopaedics Flashcards

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1
Q

Risk factors for achilles tendon disorders:

A
  • quinolone use e.g. ciprofloxacin

- hypercholesterolaemia (predisposes to tendon xanthomata)

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2
Q

Features of achilles tendinopathy (tendinitis):

A
  • gradual onset of posterior heel pain worse following activity
  • morning pain and stiffness common
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3
Q

Management of achilles tendinopathy:

A
  • simple analgesia
  • reduction in activities
  • calf muscle eccentric exercises
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4
Q

Common presentation and investigations of achilles tendon rupture:

A
  • ‘pop’ in ankle with sudden onset significant pain in calf or ankle and inability to walk
  • Simmond’s triad
  • Ultrasound
  • acute referral to orthopaedic specialist
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5
Q

What is Simmond’s triad?

A
  • abnormal angle of declination
  • greater dorsiflexion of injured foot
  • gap in tendon and gently squeeze calf muscles - if rupture, foot will stay in neutral position
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6
Q

How are acromioclavicular joint injuries graded?

A

from I to VI depending on degree of separation

  • grades I and II: very common, manage conservatively, sling
  • grades IV, V and VI: rare, surgical intervention
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7
Q

What is adhesive capsulitis and in whom does it most commonly occur?

A
  • frozen shoulder
  • middle aged females
  • diabetes mellitus
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8
Q

Features of adhesive capsulitis:

A
  • develop over days
  • external rotation affected more than internal rotation or abduction
  • passive and active affected
  • painful freezing phase, adhesive phase, recovery phase
  • bilateral in 20%
  • episodes 6 months - 2 years
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9
Q

Management adhesive capsulitis:

A

NSAIDs, physio, oral corticosteroids, intra-articular corticosteroids

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10
Q

When is an ankle x-ray required for suspected fracture?

A

Ottawa rules:
if any pain in malleolar zone with any of the following:
-bony tenderness at lateral malleolar zone
-bony tenderness at medial malleolar zone
-inability to walk four weight bearing steps immediately after injury

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11
Q

Sensitivity of Ottawa rules:

A

100%

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12
Q

Ligamentous structures of ankle:

A
  • syndesmosis binds distal tibia and fibula: anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), interosseous ligament (IOL) and interosseous membrane
  • distal fibular to talus by anterior and posterior talofibular ligaments (ATFL and PTFL) and to calcaneus by calcanenofibular ligament (collectively lateral collateral ligaments)
  • distal tibia to talus by deltoid ligament
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13
Q

What is a sprain?

A

stretching, partial or complete tear of ligament

  • high ankle sprains involve syndesmosis
  • low ankle sprains involve lateral collateral ligaments
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14
Q

Presentation of low ankle sprains:

A
  • most common
  • injury to ATFL most common
  • inversion injury most common mechanism
  • pain, swelling, tenderness sometimes bruising
  • able to weight bear unless severe
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15
Q

Investigation low ankle sprain:

A
  • radiographs according to ottawa ankle rule

- MRI if persistent pain and useful for evaluating perineal tendons

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16
Q

Treatment low ankle sprain:

A
  • non operative: rest, ice, compression, elevation
  • removable orthosis, cast, crutches
  • surgery if symptoms fail to settle or significant joint instability
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17
Q

Presentation high ankle sprains:

A
  • injury to syndesmosis rare and severe
  • mechanism usually external rotation of foot causing talus to push fibula laterally
  • weight bearing painful
  • pain when tibia and fibula squeezed at mid-calf (Hopkin’s squeeze test)
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18
Q

Investigations high ankle sprain:

A
  • radiographs may show widening of tibiofibular joint or ankle mortise
  • MRI if high suspicion of syndesmotic injury but normal plain films
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19
Q

Treatment high ankle sprain:

A
  • if no diastasic, non-weight bearing orthosis or cast until pain subsides
  • if diastasic or failed non-operative management - operative fixation
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20
Q

What is avascular necrosis?

A
  • death of bone tissue secondary to loss of blood supply

- most commonly affects epiphysis of long bones e.g. femur

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21
Q

Causes of avascular necrosis:

A
  • long term steroid use
  • chemotherapy
  • alcohol excess
  • trauma
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22
Q

Features and investigations of avascular necrosis:

A
  • initially asymptomatic
  • pain in joint
  • plain X-ray: osteopenia and micro fractures early on, collapse of articular surface shows crescent sign
  • MRI: investigation of choice, more sensitive
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23
Q

Management avascular necrosis:

A

joint replacement

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24
Q

What are Baker’s cysts?

Study These Flashcards
A
  • also popliteal cysts
  • not true cysts but distension of gastrocnemius-semimembranosus bursa
  • primary: no underlying pathology, typically children
  • secondary: underlying condition e.g. osteoarthritis, typically adults
25
Features of ruptured Baker's cyst:
- similar symptoms to DVT - pain, redness, swelling - majority asymptomatic
26
Management Baker's cyst:
- children typically resolve so no Tx | - adults: treat underlying cause where appropriate
27
Tendons of biceps muscle:
- long tendon attached to glenoid - short tendon attached to coracoid process - inserts distally via another tendon onto radial tuberosity
28
What happens in biceps rupture?
- one tendon separates from attachment site or torn across full width - most long tendon 90% - rarely distal tendon
29
In whom are biceps ruptures more common?
men to women 3:1
30
Risk factors biceps rupture:
- heavy overhead activities - shoulder overuse or underlying shoulder injuries - smoking - corticosteroids
31
Mechanism of injury of biceps rupture:
- proximal long tendon: when biceps lengthened and contracted and load applied e.g. descent phase of pull up - distal tendon: flexed elbow suddenly and forcefully extended whilst biceps is contracted
32
Presentation and features of biceps rupture:
- sudden pop or tear at shoulder (long) or antecubital fossa (distal) with pain and swelling - proximal tendon - popeye deformity - distal rupture causes reverse Popeye - weakness in shoulder and elbow follows including difficulty with supination - some have chronic shoulder pain before
33
Investigating for biceps rupture:
- palpate long head and distal biceps tendon to assess neuromuscular function - biceps squeeze test - intact then squeeze will cause forearm supination - MSK US - consider MRI for long head - distal biceps rupture - urgent MRI (surgical intervention)
34
Features of Paget's:
- focal bone resorption with excessive bone deposition - affects spine, skull, pelvis and femur - serum ALP raised - abnormal thickened, sclerotic bone on X-ray - risk of cardiac failure - small risk sarcomatous change
35
Treatment Paget's:
bisphosphonates
36
Features of osteoporosis:
- excessive bone resorption causing demineralised bone - common in older - increased risk of pathological fracture - otherwise asymptomatic - normal ALP, normal calcium
37
Treatment osteoporosis:
- bisphosphonates | - calcium and vit D
38
Features secondary bone tumours:
- bone destruction and tumour infiltration - mirel scoring used to predict risk of fracture - elevated serum calcium and ALP
39
Treatment secondary bone tumours:
- radiotherapy | - prophylactic fixation and analgesia
40
What is a buckle fracture?
- torus - incomplete fractures of shaft of long bone characterised by bulging of cortex - children 5-10 years - self limiting - no operative intervention - splinting and immobilisation
41
What is carpal tunnel syndrome and what are the symptoms?
- compression of median nerve - pain/pins and needles in thumb, index and middle finger - may ascend proximally - patient shakes hand to obtain relief
42
Examination carpal tunnel syndrome:
- weakness of thumb abduction (abductor pollicis brevis) - wasting of thenar eminence (not hypothenar) - Tinel's sign: tapping causes paraesthesia - Phalen's sign: flexion of wrist causes symptoms
43
Causes of carpal tunnel syndrome:
- idiopathic - pregnancy - oedema e.g. heart failure - lunate fracture - rheumatoid arthritis
44
Electrophysiology carpal tunnel syndrome:
motor and sensory: prolongation of action potential
45
Treatment carpal tunnel syndrome:
- corticosteroid injection - wrist splints at night - surgical decompression (flexor retinaculum divison)
46
What is cauda equina syndrome?
- lumbosacral nerve roots bowl spinal cord compressed | - may lead to permanent nerve damage resulting in long term weakness and urinary/bowel incontinence
47
Causes of cauda equina syndrome:
- most common is central disc prolapse: L4/5 or L5/S1 - tumours: primary or metastatic - infection: abscess, discitis - trauma - haematoma
48
Features of cauda equina syndrome:
- low back pain - bilateral sciatica - reduced sensation/pins and needles in perianal area - decreased anal tone - urinary dysfunction
49
Investigation and management CES:
- urgent MRI | - surgical decompression
50
What is cervical spondylosis:
- common condition resulting from osteoarthritis - most commonly presents as neck pain - referred pain e.g. headaches - complications: radiculopathy, myelopathy
51
What is a charcot joint?
- neuropathic joint - joint which has become badly disrupted and damaged secondary to los of senation - most commonly caused by neuropathy to syphilis (tabes dorsalis) but now diabetics - joint swollen, red and warm
52
What is a colles' fracture?
- follows FOOSH - distal radius fracture with dorsal displacement of fragments - dinner fork type deformity
53
3 classic features of colles' fracture:
- transverse fracture of radius - 1 inch proximal to radio-carpal joint - dorsal displacement and angulation
54
What is compartment syndrome?
- complication following fractures or ischaemia repercussion injury in vascular patients - raised pressure in anatomical space - leads to necrosis - two main fractures: supracondylar fractures and tibial shaft injuries
55
Features of compartment syndrome:
- pain, especially on movement (even passive) - excessive use of breakthrough analgesia - paraesthesia - pallor - arterial pulsation may still be felt - paralysis of muscle group may occur - presence of pulse does not rule out compartment syndrome
56
Diagnosis of compartment syndrome:
-measurement of intracompartmental pressure - excess of 20mmHg abnormal >40mmHg diagnostic -no pathology on x-ray
57
Treatment compartment syndrome:
- prompt and extensive fasciotomies - myoglobinuria may occur following fasciotomy and result in renal failure so IV fluids - necrotic muscles derided and amputated - death of muscle occurs within 4-6 hours
58
What is cubital tunnel syndrome?
- compression of ulnar nerve - tingling and numbness of 4th and 5th finger - weakness and muscle wasting - pain worse on leaning on affected elbow - history of osteoarthritis or prior trauma to area
59
Management of cubital tunnel syndrome:
- avoid aggravating activity - physiotherapy - steroid injections - surgery in resistant cases

Orthopaedics (4 decks)

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