Orthopedics ENG Flashcards
(43 cards)
Septic (acute suppurative) arthritis
Tuberculosis of the bone and joint
Idiopathic femoral head necrosis
Reflex sympathetic dystrophy (Sudeck’s atrophy)
Recurrent dislocation of the patella
Chondromalacia of the patella
The knee joint is made up of the patella, tibia and femur.v The patella is wrapped up inside a tendon: the tendon connects the quadriceps muscle of the tigh to the tibia below the knee joint.v The patella sits in the trochlear groove at the junction of the femor and tibia.v Medial patellofemoral ligament: connects inner side of patella. Damage to it→ dislocation. v The patella is important functionally because it increases the leverage of the knee joint.v From a mechanical perspective, the patella allows for an increase of about 30% in strength of extension (kicking) of the leg at the knee joint.v The most common symptom of patellar irritation is pain associated with prolonged sitting and descendingstairs.
Adolescent kyphosis (Scheuermann’s disease)
Calvé’s disease
Ankylosing spondylitis
Chronic instability of the shoulder
Dislocation, subluxation of the shoulder
Idiopathic scoliosis
Sciatica
Spinal stenosis
Disc prolapse
Sciaticav Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itselfv Pain radiating downward from the buttock over the posterior or lateral side of the lower limb.v In addition to pain, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg.v Typically, the symptoms are only felt on one side of the body.v Causes:• Compression of lumbar nerves L4 or L5 or sacral nerves S1, S2 or S3, or less commonly, by compression of the sciatic nerve itself.• Spondylolisthesis: displacement of one vertebrae on the other• Entrapment of sciatic or posterior femoral cutaneousnerves.• Slipped or herniated disk.• Spinal stenosis: spinal canal narrows and compresses the spinal cord• Piriformis syndrome- In 15% of the population, the sciatic nerve runs through the piriformis muscle rather than beneath it.o When the muscle shortens/spasms due to trauma it can compress the nerve.• Sacroiliac joint dysfunction- unhealthy postural habits, such as excessive time sitting• Pregnancy- resulting from the uterus pressing on the sciatic nervev Pseudo-sciatica: same symptoms similar to spinal nerve root compression but it is caused by compression of peripheral sections of the nerve, usually from tension or musclesv Symptoms:• Extreme pain in the low back radiating into one buttock and down the leg.• Pain often increases on exertion or bending forward.• Alternatively, there may only be a mild sensation in the leg or buttock.• Numbness in the area, weakness in the leg• Diminishing of the reflexes• An area of extreme irritability that when compressed is very tender and can give rise to referred pain and tenderness.v Diagnosis• Patients will be asked to adopt numerous positions and actions such as, walking on toes, bending forward and backward, rotating the spine, sitting, lying on back, and raising one leg at a time. Increased pain will occur during some of these activities• MR neurography has been shown to diagnose 95% of severe sciatica patientsv Treatment• Anti-inflammatory medications (i.e. NSAIDs or oral steroids)• Pain medications, LIMITED bed rest.• Epidural steroid injections• Acupuncture/ Physical Therapy/ Chiropractic manipulation• Surgery:o Diskectomy: the surgeon removes anything pressing on the nerve like herniated disc, bone spur, etc. o Laminectomy: the surgeon removes the lamina pressing on the nerve.
The irritable hip
Normal and abnormal body posture
Types of scoliosis
Congenital dislocation of the hip (aetiology, pathogenesis, clinical features, imaging)
Screening
Congenital dislocation of the hip (conservative and surgical management)
Perthes’ disease
Slipped epiphysis of the femoral head
Tennis elbow (lateral epicondylitis) Golfer’s elbow (medial epicondylitis)
Infantile cerebral palsy
Osteochondritis (Osteochondrosis)
Osteoarthritis of the hip (aetiology, pathogenesis, clinical features, biomechanics)
Spondylolysis, spondylolisthesis
Treatment of osteoarthritis of the hip
Osteoarthritis of the knee (aetiology, pathogenesis, clinical features biomechanics)
Treatment of osteoarthritis of the knee
Primary malignant bone tumors
Multiple myelomav This is a fatal tumor of bone marrow occurring in adults.v Pathology:• It arises from the plasma cells of the red bone marrow.• It is disseminated to many parts of the skeleton through the blood stream.• The osteolytic lesions that are mostly small; there is no reaction in the surrounding bone.• Pathological fracture is common, particularly in the spine.v Clinical features:• There is general malaise, with local constant pain at one or more of the tumorsites.• It affects adults past middle age• Associated anemia due to suppression of red marrow function.• There may be no obvious swelling over the affected bones• The patient is prone to develop infections due to suppression of immunity• Usual cause of death: renal failure• CRAB mnemonic: Ca elevated, Renal disease, Anemia, Bone lesion • Affects axial skeleton and long bones. v Imaging:• Radiographs show multiple small areas of low density, especially in bones containing red marrow, such as ribs, vertebral bodies, pelvic bones, and skull.• Radioisotope bone scanning shows increased uptake of the isotope.• Biopsy will confirm the diagnosis.v Tests:• Urine analysis- show Bence jones proteins• Marrow aspiration- histology, biopsy• Immunohistochemistry- typically CD56, CD38, CD138 positive and CD19 and CD45 negativev Treatment:• Radiotherapy Chemotherapy may also bring remission for some years• Internal fixation for limb fractures• Autologous hematopoietic stem cell transplantation
