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BMSc SB > Orthopaedics Unit 4 > Flashcards

Orthopaedics Unit 4 Flashcards

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1
Q

what is an enthesopathy

A

inflammation of a muscle origin

possible to have multiple inflammations at one point causing many aches and pains

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2
Q

what is golfer’s elbow

A

inflammation of origin of the flexor muscles of the forearm at the medial epicondyle

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3
Q

what is tennis elbow

A

inflammation of origin of the extensor muscles of the forearm at the lateral epicondyle

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4
Q

what are features of enthesopathies

A

may arise spontaneously but mostly commonly associated with repetitive movements or overuse

most recover spontaneously with rest

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5
Q

Tx for an enthesopathy that becomes chronic or severe

A

NSAID

local steroid injections [have to ensure steroid is injected into the enthesis with no leaked into subcut fat or skin, as this would exacerbate pain]

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6
Q

what is the surgery for enthesopathies in severe cases

A

scraping the origin of the muscle from the bone and permitting it to slide distally thus “decompressing” the area

[although patients should be encourage to wait as, spontaneous recovery is likely]

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7
Q

what is neuropraxia

A

continued pressure that has lead to atrophy of the nerve

takes a long time to recover and can be permanent

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8
Q

what are the 2 types of nerve entrapments

A

1) extrinsic
- i.e. LOC and patient presses on a nerve or patients in bed or plaster casts
- most common site is common peroneal nerve as it winds around the head of the fibula

2) intrinsic
- causes by structural local anatomical variations or inflammatory swelling

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9
Q

where are common sites of intrinsic nerve entrapments

A

median nerve at the wrist

ulnar nerve at the elbow

ulnar nerve at the wrist

posterior tibial nerve at the ankle

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10
Q

Sx for nerve entrapments

A

numbness
tingling
weakness
sensory loss

Ix = nerve conduction study

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11
Q

Mx for nerve entrapments

A

need to reduce pressure

surgical relief of pressure may be required
- cutting skin and fascia

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12
Q

what is tenosynovitis and what is it associated with

A

Inflammation of tendons and their associated synovial sheaths

associated with RA

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13
Q

when does tenosynovitis occur spontaneously

A

usually it is precipitated by unusual levels of activity, or overuse

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14
Q

what is a bursa

A

small sac of fibrous tissue lined with synovial membrane and filled with fluid

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15
Q

what is the function of a bursa

A

natural form of “bearing” aimed at improving muscle and joint function

reduces friction, usually where tendons and ligaments pass over bones

new ones can form in response to pressure

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16
Q

what causes inflammation of a bursa

A

repetitive movement or strain, or from being subject to abnormal loads

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17
Q

where are the most common sites of bursitis

A

knee
elbow
shoulder
greater trochanter at the hip

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18
Q

Sx of bursitis

A

chronic discomfort over the bursa, associated with causative elements such as movement or pressure

swelling of the bursa

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19
Q

what is housemaid’s knee

A

swelling of pre-patellar bursa

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20
Q

what are Sx of an infection of the bursa

A

tense swelling associated with infection of the skin (cellulitis) and general ill health (malaise).

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21
Q

Tx for chronic bursae

A

need no Tx unless patient demands so

if tender, may be excised

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22
Q

Tx for infected bursae

A

incised and drained

- leads to spontaneous recovery through scarring and fibrosis

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23
Q

features of a painful spasmodic flat foot

A

associated with infection or chronic inflammatory disease

can occur acutely in middle age

  • o/e painful and tender swelling over tibialis posterior insertion
  • may indicate acute or impending degenerative rupture
  • warrants early intervention
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24
Q

if a flat foot in an adult is associated with pain, what is a possible Tx

A

a medial heel lift

- will correct the deformity of the hind part of the foot and stabilise the medial arch.

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25
if a flat foot in an adult is associated with PERSISTENT pain, what is a possible Tx
fusion of subtalar joint | - will disturb foot and ankle profoundly
26
what are bunions
fluid filled bursae found around bone prominences commonly over the distal part of the 1st metatarsal and occasionally over the 5th
27
Tx of bunions
form as a natural response to pressure from underling abnormality - Tx this if bunion becomes infected - drainage
28
what are corns and what is the Tx
painful corny skin formed in response to high pressure Tx - can be removed - need to Tx underling cause and remove cause of high pressure
29
what is hallux valgus
turning away of the phalanges of the big toe from the mid-line
30
what is hallux rigidus
OA of the metatarsophalangeal joint
31
what is the relationship between hallux valgus and hallux rigidus
can occur separately or together
32
who gets hallux rigidus alone
can occur in adolescents and adults
33
who gets hallux valgus alone
may occur at any age.
34
in cases of hallux rigidus in adolescents, what is the cause thought to be
osteochondral fracture [not easy to prove]
35
Tx of hallux rigidus in adolescents
conservative Tx - use of a metatarsal bar to provide a rocker at the front of the foot so that the toe need not bend in normal walking surgical Tx - same as adults
36
why does conservative Tx of hallux rigidus in adolescents normally fail
do not accept the cosmetic consequences on their shoes
37
Tx of hallux rigidus in adults
in minor cases - surgical removal of the osteophytes with an osteotomy of the proximal phalanx - surgical fusion in a neutral position alternative option - Inter- position arthroplasty with a silicone plastic (silastic) spacer [mixed results]
38
in cases of hallux valgus alone, what are the features of the condition
F > M Many, but not all, sufferers have a short first metatarsal, often in varus.
39
Mx of hallux valgus
can depend on age any age - Realignment of the first metatarsal to a more lateral position and excision of any bony prominence (an exostosis) over the first metatarsal head elderly - Keller's procedure = Excision of the metatarsophalangeal joint - avoid in the young - unnecessary if joint is not painful
40
who gets Hallux valgus with also Hallux rigidus
older people where joint degeneration is usually secondary to the valgus deformity
41
Mx of Hallux valgus with also Hallux rigidus
in older patients - may be satisfied by having their pain relieved by well fitting shoes if this fails - Keller’s arthroplasty = excision of metatarsophalangeal joint then put in an artificial joint
42
why should you try to avoid Keller’s arthroplasty
severely disrupts normal foot mechanics should be reserved for the older, less active patient.
43
what is claw foot
wasted muscles of the foot make the bones and the toe nails appear more prominent implies muscle weakness or deficiency
44
what is claw foot associated with
weak or denervated small muscles of the feet minor spinal abnormalities such as spina bifida occulta
45
what is hammer toe
top of the toe looks like the end of a hammer secondary to the disruption of the metatarsophalangeal joints
46
Sx of hammer toe
metatarsalgia | - generally sore forefoot
47
Tx of hammer toes
good pair of soft, comfortable shoes Surgery - fusion of the interphalangeal joints in a straight position, so that they do not rub on the shoes
48
what is a neuroma
when the cutaneous nerves to the toes become trapped or irritated between the metatarsal heads there is a benign growth of nervous tissue a.k.a Morton's neuroma when in the foot secondary to repetitive trauma
49
Sx of neuroma
dull and throbbing pain sharp exacerbations accompanied by tingling of the toes difficult to localise
50
what is the classic clinical sign of Morton's neuroma
sideways compression of the foot produces a palpable click, reproducing the symptoms.
51
Tx of Morton's neuroma
excision - s.e. = sensory disturbance to affect toes recurrence is common
52
what causes ingrowing toenails
curved nail grows into the nail fold and digs in trauma to skin can lead to secondary skin infection can lead on to secondary blood bourne infections [big issue it patient has prosthetic joints or heart values]
53
Tx of ingrowing toenails
remove the nail to clear up chronic infection Wedge resection of the nail bed may retain the toe nail and remove the problem. if keeps recurring - remove the nail bed using phenol after removing the nail
54
what is plantar fascia
a tough later of fibrous tissue which runs from the os calcis to each toe base
55
Sx of plantar fascia
soreness of the instep, often worse first thing on rising, or after sitting for a few hours minimally relieve by walking, but then persist as a debilitating ache exacerbated by change of direction, or walking on rough ground o/e - tenderness at the origin of the plantar fascia medially
56
Tx for plantar fascia
self-limiting - but may last few months to years Sx relief - Soft shoes and insoles, particularly modern sports trainers if marked tender spot - local injection of steroids and long acting local anaesthetic surgery - stripping of the fascia from the os calcis - results unpredictable
57
what are neuropathic feet
feet without sensation (sensory neuropathy) most common cause is diabetes [in western world] and leprosy [in developing world]
58
what are the issues that can develop because of sensory neuropathy
developing sores - due to inability to perceive minor trauma ulcers and secondary infection - can lead to amputation
59
who gets achilles tendinitis
2 groups 1) Young athletes - from over use - area may be tender or swollen 2) Middle aged men - phase of discomfort may precede rupture of the tendon achilles - due to degeneration within the tendon tissue
60
Tx for achilles tendinitis in young athletes
rest if recurrent however, - surgical decompression of the tissue surrounding the tendon
61
why is steroid injections avoided in achilles tendinitis
injection into the tendon will lead it to rupture
62
why is it thought that the achilles tendon tissue degenerates
has a poor blood supply
63
Tx for tendon rupture
1) ankle is kept in an equinus plaster for a minimum of eight weeks OR 2) tendon can be sutured either by a closed technique or by open suture - has high risk complication both methods have a significant risk of re-rupture, although this decreases with time
64
what does arcomioclavicular joint consist of
joint between the acromion process of the scapula and the clavicle
65
what are Sx of shoulder pathology
pain, particularly on movement limited ROM Sx associated with recent incident
66
what are the structures involved in shoulder discomfort
``` the subacromial bursa, 􏰀 the supraspinatus tendon, 􏰀 the acromioclavicular joint, 􏰀 the biceps tendon, and 􏰀 the rotator cuff as a whole. ```
67
Mx of shoulder discomfort
1st line | - rest, gentle exercise, anti-inflammatory drugs
68
what does tenderness under active movement of the shoulder suggest
painful arc | = supraspinatus tendon inflammation or a subacromial bursitis
69
Tx of supraspinatus tendon inflammation or a subacromial bursitis
steroid injection into the bursa or around the tendon
70
what happens in Calcific tendinitis of the shoulder
get calcified material within the SUPRASPINATUS tendon that can be seen on imaging causes very severe pain Tx = removal of material
71
what is frozen shoulder
condition in which there is little or no glenohumeral movement cause often obscure can be caused by specific trauma incident, such as a fit
72
Mx of frozen shoulder
people eventually recover | - 18months to 2 years
73
Tx of supraspinatous tendon inflammation
steroid injection into the bursa
74
who gets frozen shoulder and what is the Sx [what is the principal sign]
characterised by progressive pain and stiffness of shoulder in patients aged 40-60 y/o over 18-24 months [loss of external rotation]
75
what age group gets what pathology of shoulder discomfort
young - instability, dislocation middle age - rotator cuff tear, frozen shoulder elderly - glenohumeral OA

BMSc SB (18 decks)

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