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MSRA ORTHOPEDICS > ORTHOPEDICS > Flashcards

ORTHOPEDICS Flashcards

1
Q

What is the most common cause of posterior heel pain?

A

Achilles tendon disorders

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2
Q

What are the presentations of achilles tendon disorders?

A
  1. tendinopathy - tendonitis
  2. partial tear
  3. complete rupture achilles tendon
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3
Q

What are the risk factors to achieve;;es tendon disorders?

A

quinolone use - e.g. ciprofloxacin

hypecholestrerolaemia - tendon xanthomata

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4
Q

What is the onset like for achilles tendinopathy/ tendonitis?

A

gradual

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5
Q

Where is the pain in achilles tendinopathy?

A

posterior heel pain

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6
Q

When is the heel pain worse in achilles tendinopathy?

A

worse following activity

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7
Q

At what time of the day is the pain worse in achilles tendinopathy?

A

morning - stiffness

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8
Q

What is the management of achilles tendinopathy?

A

SUPPORTIVE

  1. simple analgesia
  2. reduction in precipitating activities
    3.calf muscle eccentric exercises - physio
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9
Q

When should a achilles tendon rupture be suspected?

A

audible pop in the ankle

sudden onset significant pain in the calf or ankle

inability to walk

all whilst doing sport or running

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10
Q

What is the Simmond’s triad?

A

an examination used to exclude achilles tendon rupture.

lie prone with feet over bed

look for abnormal ankle of declination

squeeze calf and ankle will stay in neutral position

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11
Q

What is the imaging of choice for achilles tendon rupture?

A

US

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12
Q

When should a referral be made to oath regarding achilles tendon rupture?

A

Acutely

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13
Q

What is adhesive capsulitis?

A

frozen shoulder

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14
Q

Who does adhesive capsulitis most commonly affect?

A

middle aged females

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15
Q

What is the aetiology of adhesive capsulitis?

A

not understood

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16
Q

What is adhesive capsulitis associated with?

A

diabetes

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17
Q

What rotation is affected in adhesive capsulitis?

A

external rotation

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18
Q

What movement is affected in adhesive capsulitis? (active or passive)

A

both active and passive

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19
Q

What phases do patient’s have in adhesive capsulitis?

A
  1. painful freezing phases
  2. Adhesive phase
  3. recovery phase
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20
Q

What percentage of people have bilateral adhesive capsulitis?

A

20%

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21
Q

How long does an episode of adhesive capsulitis last?

A

6 months and 2 years

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22
Q

How is a diagnosis of adhesive capsulitis made?

A

clinical

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23
Q

What is the management of adhesive capsulitis?

A

NSAIDs
Physio
Oral corticosteroids
Intra-articular corticosteroids

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24
Q

What is the Ottawa ankle rule?

A

criteria for ankle injuries and X-ray

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25
Q

When is an ankle X-ray require according to Ottawa ankle rule?

A

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:

bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)

bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)

inability to walk four weight bearing steps immediately after the injury and in the emergency department

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26
Q

What is a sprain?

A

stretching, martial or complete tear of a ligament

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27
Q

What does a high ankle sprain involve?

A

syndesmosis

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28
Q

What does a low ankle sprain involve?

A

lateral collateral ligaments

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29
Q

What is the presentation of a low ankle sprain?

A

most common (>90%) with injury to the ATFL
the most common offender

inversion injury most common mechanism

pain, swelling, tenderness over affected ligaments and sometimes bruising

patients usually able to weight bear unless severe

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30
Q

What is a grade I low ankle sprain?

A

mild ankle sprain

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31
Q

How is the ligament disrupted in a grade I ankle sprain?

A

stretch or micro tear

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32
Q

In a grade I ankle sprain what degree of bruising and swelling is there?

A

minimal

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33
Q

In a grade I ankle sprain is there any pain on weight bearing?

A

none

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34
Q

What isa grade II ankle sprain?

A

a moderate low ankle sprain

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35
Q

How is the ligament disrupted in grade II ankle sprain?

A

Partial tear

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36
Q

What degree of bruising and swelling is there is a grade II low ankle sprain?

A

moderate

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37
Q

Is there any pain on weight bearing in a grade II ankle sprain?

A

minimal

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38
Q

What is a grade III ankle sprain?

A

severe low ankle sprain

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39
Q

How is the the ligament disrupted in a grade III ankle sprain?

A

complete tear

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40
Q

What is the degree of bruising like in a grade III ankle sprain?

A

severe

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41
Q

Is there any pain on weight bearing in a grade III ankle sprain?

A

severe

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42
Q

Investigations of low ankle sprains

A

radiographs - 15% associated with fractures

MRI if resistant pain - useful for evaluating perineal tendons

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43
Q

What is the management for a low ankle sprain?

A

RICE

removable orthosis, cast +/- crutches shrt term

surgical and MRI intervention is rare - only if persistent

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44
Q

What are high ankle sprains and how common are they?

A

injuries to the syndesmosis

rare

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45
Q

What is the mechanism of injury in high ankle sprains?

A

external rotation - causes the talus t pus the fibula laterally

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46
Q

How do patients find weight bearing in high ankle sprains?

A

painful

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47
Q

What is the Hopkins Squeeze Test?

A

in relation to high ankle sprains

pain when the tibia and fibula are squeezed together at the level of the mid calf

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48
Q

What re the investigations of high ankle sprains?

A

Radioraphs - show widening of the tibiofibular joint (diastatsis) or ankle mortise

MRI - if high suspicion of syndesmotic injury but normal plain films

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49
Q

What is the management for high ankle sprains?

A

if no diastasis - non- WB orthosis or cast until pain subsides

if diastasis or failed non-operative management then operative fixation

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50
Q

When should one look out for Maisonneuve fracture of the proximal fibula in high ankle sprains?

A

deltoid ligament isolated injuries - which are rare

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51
Q

When can treatment of a high ankle sprain be as per low ankle sprain?

A

provided the ankle mortise is anatomically reduced

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52
Q

What is a boxer fracture?

A

a minimally displaced fifth metacarpal

after punching

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53
Q

What is found on examination in carpal tunnel syndrome?

A

weakness of thumb abduction - abductor policies brevis

wasting of theanar eminences - not hypothenar

tinels sign

phalens sign - flexion of wrists

54
Q

What re the accuses of carpal tunnel?

A

idiopathic
pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis

55
Q

What is the electrophysiology behind carpal tunnel’s syndrome?

A

motor + sensory: prolongation of the action potential

56
Q

What is the treatment of carpal tunnel’s syndrome

A

a 6-week trial of conservative treatments if the symptoms are mild-moderate:

corticosteroid injection
wrist splints at night

if there are severe symptoms or symptoms persist with conservative management:

surgical decompression (flexor retinaculum division)

57
Q

What is cubital tunnel syndrome?

A

Cubital tunnel syndrome occurs due to compression of the ulnar nerve as it passes through the cubital tunnel.

58
Q

What are the features of cubital tunnel syndrome?

A

Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.

Over time patients may also develop weakness and muscle wasting

Pain worse on leaning on the affected elbow

Often a history of osteoarthritis or prior trauma to the area.

59
Q

What are the investigations of cubital tunnel syndrome?

A

clinical

however, in selected cases nerve conduction studies may be used

60
Q

What is the management of cubital tunnel syndrome?

A

Avoid aggravating activity

Physiotherapy

Steroid injections

Surgery in resistant cases

61
Q

What is de quervain tenosynovitis?

A

the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.

62
Q

Who does de quervain’s tenosynovitis typically affect?

A

females aged 30 - 50 years old.

63
Q

De Quervain’s tenosynovitis - where is the pain and tenderness ?

A

Radial side of the wrist

tenderness over the radial styloid process

64
Q

What movement of the thumb is painful in de quervains?

A

abduction of the radial styloid process

65
Q

What is Finkelstein test in de quervains tenosynovitis?

A

the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction.

In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

66
Q

What is the management of de quervain’s tenosynovitis?

A

analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective
surgical treatment is sometimes required

67
Q

What is discitis?

A

Discitis is an infection in the intervertebral disc space. It can lead to serious complications such as sepsis or an epidural abscess.

68
Q

What are the features of discitis?

A

Back pain

General features
-pyrexia,
-rigors
-sepsis

Neurological features
e.g. changing lower limb neurology
if epidural abscess develops

69
Q

What are the causes of disci tis?

A

Bacterial
-Staphylococcus aureus is the most common
cause of discitis

Viral

TB

Aseptic

70
Q

How is discitis diagnosed?

A

Imaging: MRI has the highest sensitivity

CT guided biopsy may be required to guide antimicrobial treatment

71
Q

What is the management of discitis?

A

The standard therapy requires six to eight weeks of intravenous antibiotic therapy

Choice of antibiotic is dependent on a variety of factors.

The most important factor is to identify the organism with a positive culture (e.g. blood culture, or CT guided biopsy)

72
Q

What are the complications of discitis?

A

sepsis

epidural abscess

73
Q

What are the further investigations of discitis?

A

Assess the patient for endocarditis e.g. with transthoracic echo or transesophageal echo.

74
Q

Who is a dupuytren’s contracture most common in?

A

older males

60-70% have posiive family history

75
Q

Causes of duputytrens contracture

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

76
Q

Which fingers are commonly affected in dupuytren’s contracture?

A

the ring finger and little finger

77
Q

What is the management of dupuytren’s contracture?

A

surgery

78
Q

What is lateral epicondylitis?

A

tennis elbow

79
Q

Weher is the pain and tenderness in lateral epicondylitis?

A

localised to the lateral epicondyle

80
Q

When is the pain worse in lateral epidondylitis?

A

resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended

81
Q

How long does lateral epicondylitis last for?

A

between 6 months and 2 years

82
Q

How long do people with lateral epicondylitis have acute pain for?

A

6-12 weeks

83
Q

What is medial epicondylitis?

A

golfer’s elbow

84
Q

Where is the pain in medial epicondylitis?

A

medical epicondyle

85
Q

How is the pain aggravated in medial epicondylitis?

A

wrist flexion and pronation

86
Q

what are the symptoms of medial epicondylitis?

A

numbness and tingling in the 4 th and 5tth finger due to ulnar nerve involvement

87
Q

What is radial tunnel syndrome?

A

compression of the posterior interosseous branch of the radial nerve

as a results of overuse

88
Q

What are the symptoms of radial tunnel syndrome similar to?

A

lateral epicondylitis

89
Q

where is the pain in the radial tunnel syndrome?

A

around 4-5cm distal to the lateral epicondyle

90
Q

how are the symptoms worsened in radial tunnel syndrome?

A

extending elbow and pronating forearm

91
Q

What is olecranon bursitis?

A

swelling over the posterior aspect of the elbow

associated with pain, warmth and erythema

92
Q

who does olecranon bursitis typically affect?

A

middle aged male patients

93
Q

What types of hip dislocation are there?

A

posterior dislocation - most common, leg shortened, adducted and internally rotated

94
Q

What is the management of hip dislocation?

A

ABCDE approach.

Analgesia

A reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.

Long-term management: Physiotherapy to strengthen the surrounding muscles.

95
Q

What are the complications of hip dislocation?

A

Sciatic or femoral nerve injury

Avascular necrosis

Osteoarthritis: more common in older patients.

Recurrent dislocation: due to damage of supporting ligaments

96
Q

What are the complications of hip dislocation?

A

Sciatic or femoral nerve injury

Avascular necrosis

Osteoarthritis: more common in older patients.

Recurrent dislocation: due to damage of supporting ligaments

97
Q

What is the prognosis of hip dislocation?

A

It takes about 2 to 3 months for the hip to heal after a traumatic dislocation

the prognosis is best when the hip is reduced less than 12 hours post-injury and when there is less damage to the joint.

98
Q

What is a intracapsular or sub capital fracture of the hip?

A

from the edge of the femoral head to the insertion of the capsule of the hip joint

99
Q

What is an extra capsular fracture?

A

these can either be trochanteric or subtrochanteric

(the lesser trochanter is the dividing line)

100
Q

What is the garden system and how is it classified?

A

Type I: Stable fracture with impaction in valgus

Type II: Complete fracture but undisplaced

Type III: Displaced fracture, usually rotated and angulated, but still has boney contact

Type IV: Complete boney disruption

101
Q

In the garden system which type is blood supply disruption most common in regards to a hip fracture?

A

types III and IV

102
Q

What is the management for an undisplaced intracapsular fracture?

A

internal fixation, or hemiarthroplasty if unfit.

103
Q

what is the management of an intracapsular displaced hip fracture?

A

arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture

total hip replacement is favoured to hemiarthroplasty if patients:

were able to walk independently out of doors with no more than the use of a stick and

are not cognitively impaired and

are medically fit for anaesthesia and the procedure.

104
Q

What is the management of an extra capsular hip fracture?

A

stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or
subtrochanteric fractures: intramedullary device

105
Q

How is development dysplasia of the hip picked up?

A

barrows test

ortolani’s

106
Q

What is transient synovitis (irritable hip)?

A

acute hip pain with oral infection

COMMONEST cause of hip pain in kids

107
Q

What is the typical age group affected by transient synovitis?

A

2-10 years

108
Q

What is transient synovitis also known as?

A

irritable hip

109
Q

What is perthes disease?

A

a degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head

110
Q

Is perthes disease more common in boys or females?

A

males

111
Q

is perthes disease of the hip bilateral or unilateral?

A

unilateral

112
Q

Over what period of time does perthes disease develop?

A

hip pain: develops progressively over a few weeks

113
Q

what are the symptoms of perthes disease?

A

limp
stiffness and reduced range of hip movement

114
Q

what are the xray changes seen in perthes disease?

A

early changes include:

widening of joint space,

later changes include decreased femoral head size/flattening

115
Q

what age range is typically affected by perthes disease?

A

4-8 years

116
Q

what age range is a slipped upper emoral epiphysis

A

10-15 years

117
Q

in whom is a slipped upper femoral epiphysis most common in?

A

obese children and boys

118
Q

what direction is the displacement of the femoral head epiphysis in slipped upper femoral epiphysis?

A

postero-inferiorly

119
Q

is a slipped upper femoral epiphysis usually bilateral or unilateral?

A

unilateral

bilateral in 20%

120
Q

what are the features of a slipped upper femoral epiphysis? (pain and movement affected)

A

knee or distal thigh pain

loss of internal rotation of the leg in flexion

121
Q

what is juvenile idiopathic arthritis?

A

describes arthritis occurring in someone who is less than 16 years old that lasts for more than three months.

122
Q

What does pauciartciular Jia refer to and how many joints are affected and how may cases does it account for?

A

where 4 or less joints are affected. It accounts for around 60% of cases of JIA

123
Q

what are the signs and symptoms of JIA?

A

joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows
limp

124
Q

Are you ANA positive with JIA and what other condition is it associated with ?

A

maybe - associated with anterior uveitis

125
Q

What is iliotibial band syndrome?

A

common cause of lateral knee pain in runners

126
Q

What is the main sign/symptom of iliotibial band syndrome?

A

tenderness 2-3cm above the lateral joint line

127
Q

What is the management of iliotibial band syndrome?

A

activity modification

iliotibial band stretches

if not improving physio

128
Q

What causes a meniscal tear?

A

twisting injuries

129
Q

When is the pain worse with a meniscal tear?

A

when straightening the knee

130
Q

What are the signs and symptoms of meniscal tear?

A

knee locking

knee giving way

tender alone joint line

131
Q

What is Thessaly’s test?

A

investigate meniscal tear

weight bearing at 20 degrees knee flexion

patient supported by doctor

positive pain on twisting knee

MSRA ORTHOPEDICS (17 decks)

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