orthopeadics Flashcards
(196 cards)
1
Q
what type of joints are intervertebral discs
A
secondary cartilaginous
2
Q
what surrounds the nucleus pulposus
A
anulus fibrosus
3
Q
why do people get shorter with old age
A
loss of water content
4
Q
what suggests facet joint pain
A
pain worse on extension
5
Q
what levels is degeneration and acute disc prolapse most common in
A
L4/5 L5/S1
6
Q
where does the cauda equina lend
A
l1
7
Q
what does nerve root compression cause
A
radiculopathy
8
Q
what is radiculopathy
A
pain down the dermatome
9
Q
pathology of spinal stenosis
A
compressed by osteophytes and hypertrophied ligaments in oa
10
Q
pathology of spinal stenosis
A
compressed by osteophytes and hypertrophied ligaments in oa
11
Q
easier to walk up hill is a sign of what and why
A
spinal stenosis as theyre opening up the spine
12
Q
signs of cauda equina syndrome
A
usually prolapsed disc, bladder and bowel dysfunction, saddle anaesthesia, loss of anal tone
13
Q
where to perform a lumbar puncture
A
posterior iliac crest - L4, PSIS S2
14
Q
what is genu varum also known as
A
bow legs
15
Q
what is typical of genu varum
A
the legs curve outward at the knees while feet and ankles touch
16
Q
when is genu varum normal
A
3-4 year olds
17
Q
examples of pathologies causing genu verum
A
skeletal dysplasia, rickets, tumour, blounts disease and trauma
18
Q
what is genu valgum also known as
A
knock knees
19
Q
presentation of ganu valgum
A
when the child stands straight and the knees touch but the ankles are apart
20
Q
what is intoeing
A
when the child walks with toes pointing inwards
21
Q
when is intoeing accentuated
A
in running
22
Q
what is femoral neck anteversion
A
femoral neck usually points anteriorly, can be at 30-40 degrees at birth
23
Q
what can femroal neck anteversion predispose
A
patellofemoral problems
24
Q
what is internal tibial torsion
A
on knees foot is rotated too far medially
25
what is metatarussu adductus
metatarsals go too medially
26
what can fixed flat feet indicated
calf tightness, tarsal coalition
27
who is curly toes common in
younger children
28
when is curly toes resolved by
6
29
who gets anterior knee pain
females more than men
30
how to resolve anterior knee pain
physio
31
red flags for prolapsed intervertebral disc
non mechanical pain, systemic upset, major and new and neurological deficet, saddle anaethesia, bladder and bowel upset
32
what is a myotome
a group of muscles innervated by a single nerve root
33
myotome L1/2
hip flexion
34
myotome L3/4
knee extension
35
myotome L5
foot dorsiflexion and EHL
36
myotome S1/2
ankle plantarflexion
37
prolapsed intervertebral disc investigations
MRI 1st main line
38
what is sciatica
buttock and/or leg pain in a specific dermatomal distribution accomanied by neurological disturbance
39
how can a disc prolaose present
may be asymptoamitc, leg pain, neurological disturbance, episodic back pain
40
management of disc prolapse
70% will settle in 3 months - not an emergency unless cauda equina
41
what is the management of backache
short bed rest, anti inflammatory, mobilise thereafter, physicaly therapy, return to normal activity, physio and reassurance
42
red flags of back pain
history of cancer, < 20 and > 60 1st back pain, non mechanical and saddle paraesthesia
43
what are back pain emergencies
cauda equina, fracture with deteriorating neurology
44
assessment of back pain
immobilise, X rau and neuro motor and sensory
45
what is a common theme of congenital scoliosis
imbalance in the number of growth plates
46
causes of secondary scoliosis
nueromuscular, tumours, spina bifida
47
management of scoliosis
corrective casts, bracing, exercises and electrical stimulation
48
what is kyphsis
an exagerated forward rounding of the back
49
what is spondyloysis
defect in the pars interarticularis of the vertebra
50
what is spondyloisthesis
forward slippage on one vertebra on anaother
51
investigations of lower back pain
typically none, ESR/visosity/calciumalkphos, rarely X ray, MRI
52
causes of lower back pain
90% mechanical/non specific, 0.7% tumour/mets, 0.3% ankylosing spondylitis, 0.01% infection
53
presentation of facet arthropathy
stiff in morning, loosen up routine, resless, difficulty sittig, driving and standing, worse with extension, better with activity, often radiates to buttocks and legs
54
how does acute osteomyelitis mainly occur
post traumatic / open - inoculation
55
how does osteomyelitis occur in children or immunosuppressed
haematogenous
56
investigations of chronic osteomyelitis
X rays and MRI
57
what do bone abscesses do
chronically cause inflammation of the joint
58
what does septic arthritis effect
child development of a joint
59
how can septic arthritis occur
from inoculation, metaphyseal spread and direct haemotogenous
60
principles of treatment of cellulitis
know the bug, operate if dead tissue or forguen body, target antibiotics, right team
61
what shoudl infected arthroplasty affect
ni more than 1% of primary joints
62
tests for infected arthroplasty
CRP, joint aspiration, bone scan, Xrau
63
management of infected arthroplasty
let pus outm prophylaxis
64
marfans syndrome caused by
mutaton of the fibrillin gene
65
what is ehlers danlos
abnormal elastin and collagen formation
66
what does ehlers danlos present with
hypermobility, vascular fragility, easy bruising, joint instability and scoliosis
67
what is duchene muscular dystrophy caused by
a defect in dystrophin gene involved in calcium transport
68
DMD presenation
progressive mmuscle weakness till can no longer walk by age 20 - carfiac and resp failure common in early 20s, gowers dign
69
what is gowers sign
usung hands to ush on legs to stand
70
what is the diagnosis of DCD
raised CK, abnormalities on muscle biopsy
71
management of muscular dystrphy
physiotherapy and splintage to prolong mobility
72
what is spinal bifida
congenital disorder where the two halves of the posterior vertebral arch fail to fuse
73
presentation of bifida occulta
spina tethering of spinal cord -> high arched foot and toe clawing
74
what is bifida cystica assocaited with
hydrocephalus
75
what is hydrocephalus
excess CSF at brain increasing intracranial pressure
76
mingocele has neuro deficit true or false
false
77
what occurs below the lesion in myelomengocele
motor/sensory deficit
78
management of spina bifida
usually closed at birth
79
what is syndactyly
two digits fused together
80
what is polydactyl
extra digit formed
81
what is fibular hemimelia
partial or complete absence of the fibula
82
what does fibular hemimelia lead to
shortened lib, bowing of the tibia and ankle deformity
83
management of mild fibular hemimelia
limb lengthening with circular frame
84
management of severe fibular hemimelia
ankle amputation
85
risk factors of brachial plexus palsy
large babies, twin deliveries, shoulder dystocia
86
risk factors of brachial plexus palsy
large babies, twin deliveries, shoulder dystocia
87
what is erbs palsy
injury t upper C5 and C6 nerve roots
88
what does erbs palsy lead to
loss of motor innervation of the deltoid, supraspinatus, infraspinatus biceps and brachalis
89
management of erbs palsy
physiotherapy to prevent contractures, retirn of biceps function by 6 months
90
what is klumpkes palsy
lower brachial plexus injury (C8 & T1)
91
what does klumpkes palsy cause
paralysis of intrinsic hand muscles due to forceful adduction
92
recovery of klumpke
less than 50%
93
knees at birth
varus knees
94
knees at 14 months
neutrally aligned
95
knees at 3 years
knock knees
96
knees at 7-9 years
6 degree valgus
97
normal range of knees
6 degree
98
varum
bow legged
99
valgum
lateral
100
what is genu varum due to
medial proximal tibial physis (blounts), growth plate restriction at medial side in adolescence, skeletal dysplasia, tumour, rickets, trauma
101
what is genu valgum due to
rickets, tumours, trauma and neurofibromatosis
102
management of genu vasum and valgus
osteotoy or growth plate manipulation surgery, olate at side of knee cap growing abnormally
103
what is intoeing
feet pointing toards the midline when walking and standing
104
causes of in toeing
femoral neck anteversion, internal tibial torsion, forefoot adduction
105
when does internal tibial torsion resolve
6 years
106
when does forefoot adduction resolev
8 years
107
when is flat feet normal
at bruth
108
flexible flat feet
flattened medial arch forms with dorsiflexion of the great toe
109
what is flexible flat foot due to
ligamentous laxity, familial or idiopathic, in adlts tibialis posterior tendon dysfunction
110
fixed fflat foot
flattened medial arch regardless of load or great toe dorsifelxion
111
cause of fixed flat foot
underlying bony abnormality
112
what may fixed foot require
surgey
113
when do curly toes resolve
by 6 years
114
how to treat persistant cases of curly toes
flexor tenotomy
115
what is developmental dysplasia of the hip
the dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip
116
who gets developmental displasia of the hip
usually females
117
what hip does developmental dysplasia tend to effect
left hip
118
what is a risk factor of developmental dysplasia of the hip
breech birth
119
signs of developmental dysplasia of the hip
asymmetric, decreased leg length, ortolanu test, barlow test
120
what is the ortolani test
reducing a dislocated hip with abducion and anterior displacement
121
what is barlow test
dislocatable hip with flecuon and posterior displacement
122
investigations of developmental dysplasia of the hip
US, X rays after 4-6 months
123
management of developmental dysplasia of the hip
panlik harness for over 18 months,, -> surgery
124
if left untreated what can developmental displasia of the hip lead to
arthritis,mobility affected, shallow acetabulum
125
what is transient synovitis of the hip
self limiting inflammation of the synovium of the hip
126
when does transient synovitis of the hip occur
after URTI
127
who gets transient synocitis of the hip
men more than females - 2-10 years
128
what is the most common cause of childhood hip pain
transient synovitis of the hip
129
presentation of transient synovitis of the hip
reluctance to weight bear on affected side, restriction motion, maybe low grade fever, less pain than septic arthritis
130
investigations of transient synovitis of the hip
US, normal CRP,
131
management of transient synovitis of the hip
NSAIDs and rest
132
what is perthes disease
idiopathic osteochondritis of the femoral head leading to loss of blood supply and avascular necrosis of femoral head
133
who gets perthes disease
males more than females - 4-9 years olf
134
stage 1 of perthes disease
necrosis/sclerosis
135
stage 2 of perthes disease
fragmentation
136
stage 3 of perthes disease
re ossification
137
stage 4 of perthes disease
remodelling
138
presentation of perthes disease
pain and limp, loss of internal rotation,loss of abduction, positive of trendelenburg test
139
what are the investigations of perthes disease
hip radiographs, regular x ray observation
140
management of perthes disease
containment, keep hip in socket and rest
141
who does SUFE effect
overweight pre pubertal adolenscent boys
142
why does SUFE oocur
the growth plate is not strong enough to support body weight and slips due to strain
143
who gets SUFE
males more than females
144
predisposing factors to SUFE
hypothyroidism and renal disease
145
presentation of SUFE
pain in hip, pain in knee, loss of unternal roatation of the hip
146
investigation of SUFE
hip radiographs
147
management of SUFE
urgent surgery to pin femoral head to prevent further slipping - if severe hip replacement and osteomoty
148
what is epophysitis
inflammation of growing tibercle where a tendon attaches due to repetitive strain
149
management of paellar tendonitis
rest +/- physiotherapy
150
what can anterior knee pain be due to
muscle imbalance, ligamentous laxity or subtle skeletal predisposition
151
what is patellar instability caused by
trauma witha tear in the medial patellofemoral ligament
152
what can dislocation of the patella cause
osteochondral fractures and torn MPFL
153
management of dislocation of patella
reduction on extension
154
management of patellar instability
stabilizes as growing older, physiotherapy
155
what is osteochondritis dissecans
ostiochondritis where a fragment of hyaline cartilage and bone fragments break the surface of a joint
156
where is osteochondritis dissecans most common
medial femoral condyle
157
what can osteochondritis dissecans result in
loose bodies that predispose to osteoathritis
158
presentation of osteochondritis dissecans
poorly localised pain, effusion, locking
159
investigations of osteochondritis dissecans
MRI
160
what is tilpes equinovarus also known as
club foot
161
what is club foot due to
a congenital defomrity due to in utero alignment of the joints between talus, calcaneus and navicular
162
who gets club foot
men more than women
163
development of club foot
abnormal alignment -> contractures of sort tissues ->deformity
164
risk factores of club foot
breech birth and oligohydramnios (low amniotic fluid content)
165
presentation of club foot
ankle equinus, supination of the forefoot, varus alignment of the forefoot
166
management of club foot
early splintage (ponseti technique and tenotomy of the achilles tendon, bracing until 3 years olf as prevention, late deformity - extensive surgery
167
what is tarsal coalition
abnormal bridge betwen the calcaneus and navicular or the talus ond calcaneus
168
what does tarsal coalition lead to
pain ful fixed flat foot
169
management of tarsal coalition
splintage if resistant pain -> surgery
170
young person with spine probelms
red flag
171
differentials of young person with spine problems
infection (discitis), tumours (osteoid osteoma)
172
what is kyphosis
abnormal rounding of the upper back - cenyre of gravity is amyerior to spine
173
management of kyphosis
bracing for kids
174
what is scoliosis
lateral curvature of the spine
175
what can scoliosis be caused by
congenital, idiopathic, secondary to mueromuscular disease
176
congenital scoliosis
defect of formation / segmentation
177
idiopathic scoliosis occurs when
growth spurrt before puberty
178
neuromuscular disease leading to scoliosis
tumour, skeletal dysplasia or infection
179
investigations of scoliosis
painful scoliosis -> urgen MRI
180
managemant of mild and non progressive scoliosis
no surgery
181
management of severe scoliosis with breathing difficulties
maybe surgery
182
what is spondylotehsis
slippage of one vertebra over another
183
where does spondylolisthesis usually occur
L4/5, L5/S1
184
what is spondylolisthesis due to
a developmental ldefect or posterior stress fractire which fails to heal
185
presentation of spondyloisthesis
adolenscence with low back pain, possible radiculopathy if severe slippage, paradoxial flat back due to muscle spasm, waddling gait
186
grading system for spondylolisthesis
meyerding
187
management of mild spondylolisthesis
rest and physio
188
management of severe spondylolisthesis
stabilistaion and possibly reduction
189
what spondylosis
defect in the pars interarticularis of vertebrae
190
when are distal radial fractures common
during metaphyseal growth spurt with FOOSH
191
radial fractires tend to occur in who
12-14 year old men
192
radial fractures tend to occur when in females
10-12 years
193
management of stable distal radial fractures
cast
194
managment of unstable distal radial fractures
fixation and cast
195
proximal ulna fracture and raidal head dislocation
manteggia fracture
196
distal 1/3 rd radius fracture and radioulnar joint injury
galeazzi fracture
