regional adult orthopaedics Flashcards
(272 cards)
1
Q
the majority of cases of lumbar spine pain are….
A
mechanical back pain
2
Q
non-pathological causes of back pain include
A
obesity
lack of physical activity
awkward twisting/poor lifting technique
3
Q
what is spondylosis?
A
intervertebral discs lose their water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA
4
Q
A
5
Q
why is bed rest not advised in mechanical back pain
A
it will lead to stiffness and spasm of the back which may exacerbate disabilty
6
Q
what are some examples of secondary gain or behavioural issues to consider when offering treatment for mechanical back pain
A
disability allowance appeal
compensation claim
psychological dysfunction
7
Q
who would be suitable for spinal stabilisation for mechanical back pain
A
if a single level is affected
instability
AND hasnt improved with conservative management
8
Q
what is an acute disc tear
A
the outer annulus fibrosis tears
9
Q
what is the cahracteristic pain presenation in an acute disc tear
A
the pain is worse on coughing
10
Q
how long do symptoms from an acute disc tear take to settle
A
2-3 months
11
Q
acute disc tear treatment
A
analgesia and physio
12
Q
pathophysiology of radiculopathy
A
the gelatinous nucleus pulposis cna herniate through a disc tear
the disc material can impinge an exiting root nerve reu;ting in pain and altered sensation in a dermatomal distribution and reduced power in a myotomal distribution
13
Q
A
14
Q
nerve roots involved in sciatica?
A
L4, L5 and S1
15
Q
how is radicular pain described?
A
neuralgic burning or severe tingling, often like severe tootchache radiating down the back of the thigh to the below the knee
16
Q
how can OA cause nerve root symptoms?
A
osteophytes can impinge on exiting nerve roots
17
Q
what is spinal stenosis
A
narrowing of the sapces within the spine, which can impinge nerve roots
18
Q
what can cause spinal stenosis
A
spondylosis
bluging discs
bulging ligamentum flavum
osteophytes
19
Q
what is a common symptom of spinal stenosis
A
claudication
20
Q
how does claudication in spinal stenosis vary from claudication in PAD
A
the distance is inconsistent
the pain is buring, rather than cramping
pain is less when walking uphill (spine flexion creates more space for the cauda equina)
pedal pulses are preserved
21
Q
management of spinal stenosis
A
intial - physio and weight loss
if conservative fails, decompression surgery
22
Q
what is cauda equina syndrome
A
compression of all the nerve roots of the cauda equina
23
Q
why is cauda equina syndrome a surgical emergency?
A
the sacral nerve roots (mainly S4 and S5) control defaecation and urination
prolonged compression can cause permanent nerve damage requiring colostomy and urinary diversion
24
Q
signs of cauda equina syndrome
A
bilateral leg pain
paraesthesiae
numbness
saddle anasthesia (numbness arounf the sitting area and perineum)
altered urinary function (retention/incontence)
faecal incontinence/constipation
25
a patient presents with bilateral leg pain and altered bladder/bowel function
whats up?
cauda equina syndrome
26
which examination is mandaotory in cauda equina syndrome
PR exam
27
cauda equina syndrome investigations
urgent MRI to determin the level of prolapse
28
cauda equina syndrome treatment
urgent discectomy
29
what are the 'red flags' for back pain
back pain in the youger patient \<20
new back pain in the older adult \<60
constant, severe pain thats worse at night
systemic upset
30
why is back pain the young patients a red flag
high risk of infection (OM, discitis)
peak of of spondylolisthesis is adolescence
higher risk of benign and malignant primary bone tumours
31
why is new back pain in the older patient a red flag
higher risk of metastatic disease and myeloma
32
why is constant, severe, worse at night back pain a red flag
suggests tumour or infection
33
why is systemic upset a red flag for back pain
may suggest tumour or infection
34
signs of spontaneous crush fracture in osteoporosis
acute pain
kyphosis
35
cervical spondylosis presentation
slow onset stiffness
pain (can radiate to shoulders and the occiput)
36
cervical spondylosis treatment
physio and analgesics
37
cervical nerve root compression presentation
shooting neuralgic pain down a dermatomal distribution woth weakness and loss of reflexes depending on the nerve root affected
38
2 conditions that can result in cervical spine instability
RA
down syndrome
39
what does RA cause atlanto-axial instability
destruction of the synovial joint between the atlas and the dens and rupture of the transverse ligament
40
complications of cervical spine instability
subluxation of the atlanto-axial joint leading to cord compression and death
41
cervical spine instability in RA treatment
less severe - collar to prevent flexion
more severe - surgical fusion
42
the shoulder girdle is made up of
scapula
clavicle
proximal humerus
supporting muscles (eg deltoid, SITS)
43
what are the rotator cuff muscles
supraspinatus
infraspinatus
teres minor
subscapularis
44
where do supraspinatus, infraspinatus and teres minor attach on the humerus?
greater tuberosity
45
action of supraspinatus
initiation of abduction
46
action of infraspinatus
external rotator
47
aaction of teres minor
external rotator
48
subscapularis attachment to the humerus
lesser tuberosity
49
action of subscapularis
internal rotation
50
collective action of the rotator cuff muscles
pull the humeral head into the glenoid to provide a stable fulcrom for the deltoid to abduct the arm
51
shoulder problem in a young adult?
instability
52
shoulder pain in a middle aged patient?
cuff tear
'grey hair, cuff tear'
frozen shoulder
53
shoulder pain in the elderly?
OA
54
why does impingement syndrome (painful arc) cause pain
tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight subacromial space during movement producing pain
55
impingement syndrome presentation
painful arc between 60-120 degrees
pain radiates to deltoid and upper arm
56
causes of impingement (painful arc)
tendonitis
subacromial bursitis
acromioclavicular OA with inferior osteophyte
a hooked acromion
rotator cuff tear
57
58
which clinical test can help diagnose impingement
hawkins kennedy test
59
conservative treatment of impingement syndrome
NSAIDs, analgesics, physio and subacromial injection of steroid
60
how many subacromial injections can be administered in painful arc/impingement
up to 3 injections
61
surgical treatment of impingement syndrome
subacromial decompression surgery (open or arthroscopic)
62
a sudden jerk in a patient \>40, with subsequent pain and weakness is a typcial history of
rotator cuff tear
63
which rotator cuff tendon is most commonly involved in rotator cuff tears
supraspinatus
64
signs of rotator cuff tear
weakness of initiation of abduction (supraspinatus)
weakness of internal rotation (subscapularis)
weakness of external rotation (infraspinatus)
wasting of supraspinatus
65
rotator cuff tear investigation
USS or MRI
66
surgical treatment of rotator cuff tear
rotator cuff repair with subacromial decompression
67
difficulties with rotator cuff repair surgery
the tendon is usually diseases and failure of repair occurs in 30% of cases
large tears may be irrepairable
68
non-operative management of rotator cuff tear
physiotherapy to strengthen remaining muscles
subacromial injections
69
what is adhesive caspulitis also known as
frozen shoulder
70
frozen shoulder presentatio
pain, which will subside (after 2-9/12) as stiffness increases (4-12/12)
stiffness eventually thaws over time
71
a disorder characterised by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18-24 months
frozen shoulder
72
the principal clinical sign of frozen shoulder is
loss of external rotation
(alonf with restriction of other movements)
73
frozen shoulder is linked to diabetes
true/false
true
74
frozen shoulder treatment
pain relief and prevention of further stiffening while the condition naturally resolves
physio and analgesics
IA injections may help relieve pain
75
surgical options for frozen shoulder
manipulation uner anaesthetic (tears capsule)
sirgical capsular release (arthroscopic)
76
calcium depostion in the supraspinatus tendon, see on xray just proximal to the greater tuberosity
actue calcific tendonitis
77
acture calcific tendonitis presentation
acute onset severe shoulder pain
78
acute calcific tendonitis treatment
subacromial steroid and local anaesthetic injection
79
what are the two sub-type of shoulder instability
traumatic and atraumatic
80
what is shoulder instability
painful abnormal translation movement
subluxation
recurrent dislocation
81
what is a bankart repair
stabilises the shoulder by reattaching the labrum and capsule to the anterior glenoid
(was unattached due to trauma from initial dislocation)
82
which conditions cause generalised ligamentous laxity
marfan's, ehlers-danlos
83
referred pain in the shoulder
neck problems
angina pectoris
diaphragmatic irritation (biliary colic, hepatic or subphrenic abscess)
84
what is the carpal tunnel formed by
the carpal bones and the flexor retinaculum
85
what passes through the carpal tunnel
the median nerve and 9 flexor tendons
| (FDS and FDP to 4 digits + FPL)
86
what causes carpal tunnel syndrome
any swelling within the carpal tunnel can result in median nerve compression
87
causes of carpal tunnel syndrome
idiopathic
RA (synovitis)
fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroid)
wrist fractures
88
carpal tunnel syndrome presentation
paraesthesiae in the thumb and radial 2 1/2 fingers
usually worse at night
loss of sensation
weakness of thumb or clumsiness in areas supplied by median nerve
89
signs of carpal tunnel syndrome
loss of sensation/wasting of thenar eminence
replication of symptoms on tinel's or phalen's test
90
what is tinel's test
percussing over median nerve (or ulnar nerve in cubital tunnel syndrome)
91
what is phalen's test
holding the wrists hyperflexed to decrease the space in the carpal tunnel
92
non-operative treatment of carpal tunnel
wrist splints at night to prevent flexion
injection of corticosteroid
93
surgical treatment of carpal tunnel syndrome
division of the transverse carpal ligament under local anaesthetic
94
what is cubital tunnel syndrome
compression of the ulnar nerve at the elbow behind the medial epicondyle (funny bone area)
95
weakness of the ulnar nerve may be apparent in which muscles
1st dorsal interosseous (abduction of the index finger)
adductor pollicis
96
cubital tunnel syndrome presentation
paraesthesiae of the ulnar 1 1/2 fingers
97
what is froment's test
ulnar nerve damage leads to adductor pollicis brevis paralysis, leading to excess thumb flexion when pinching
98
causes of cubital tunnel syndrome
osborne's fascia (tight band of fascia forming the roof of the tunnel)
tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flaxor carpi ulnaris
99
which two joints make up the elbow
humero-ulnar
radio-capitallar
100
which muscle extends the elbow
triceps
101
which muscles flex the elbow
brachialis and biceps
102
what is the common extensor origin for the elbow
lateral epicondyle
103
elbow common flexor origin
medial epicondyle
104
supination is performed by
biceps and supinator muscles
105
pronation is performed by
pronator teres (proximally)
pronator quadratus (distally)
106
what is tennis elbow also known as
lateral epicondylitis
107
clinical features of lateral epicondylitis
painful and tender lateral epicondyle
pain on resisted middle finger and wrist flexion
108
treatment of lateral epicondylitis
period of rest from activites that exacerbate pain
physiotherapy
NSAIDs
steroid injections
use of a brace
109
what is golfer's elbow also known as
medial epicondylitis
110
what is the risk of injections in the treatment of medial epicondylitis
risk of injury to the ulnar nerve
111
112
which types of arthritis most commonly affect the elbow
RA
secondary OA
not primary OA
113
arthritic change at the radio-capitallar joint which has failed non-operative management can be treated with
surgical excision of the radial head
114
what is dupuytren's contracture
proliferative connective tissue disorder where the specialised palmar fascia under goes hyperplasia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints
115
which joints does dupuytren's contracture affect
MCP and PIP
116
dupuytren's contracture pathology
prolifection of myofibroblast cells and the production of abnormal collagen (type III rather than type I)
117
skin changes in dupuytren's contractures
skin may be adherent to the diseased fascia
puckering of the skin
palpable nodules
118
which fingers are most commonly affected by dupuytren's contracture
ring and little finger
119
dupuytren's contracture risk factors
male sex
family history
northern european/scandinavian descent
alcholic cirrhosis
diabetes
120
indications for surgery in dupuytren's contracture
disease affecting the PIPJ
\>30 degree contracture of the MCPJ
121
surgical treatment of dupuytren's contracture
fasciectomy
division of cords (fasciotomy)
if very severe may require amputation
122
what is trigger finger
nodular enlargement of a tendon, distal to a fascial pulley, resulting in a clicking sensation when extending the finger
123
signs of trigger finger
clicking sensation when moving finger
locking of finger in a flexed position
pain
124
which fingers are most commonly affected by trigger finger
middle and ring finger
125
treatment of trigger finger
injection of steroid around the tendon within the sheath
division of A1 pulley if doesnt respond to steroids
126
127
what are heberden's nodes
bony thickening of DIPJs
128
what are bouchard's nodes
bony swelling of the PIPJ
129
treatment of MCP OA
MCP joint replacment
steroid injection in 1st MCPJ for flare ups
130
hand deformities of RA
volar MCPJ subluxation
ulnar deviation
swan neck deformity
bouteonniere deformity
z-shaped thumb
131
what is a swan neck deformity
hyperextension at PIPJ with flexion of DIPJ
132
what is boutonniere deformity
flexion at PIPJ with hyperextension at DIPJ
133
surgical management of RA in hands
tenosynvectomy (excision of synovial tendon sheath) to prevent tendon rupture
tendon transfer or joint fusion if tendon has already ruptured
134
what are ganglion cysts
mucinous filled cysts found adjacent to a tendon or synovial joint
135
ganglion cyst in the knee?
baker's cyst
136
on examination, ganglion cysts are
firm, smooth, rubbery
should transilluminate
137
pain from hip pathology is typcially felt where
in the groin area
138
hip pain may radiate to
the knee
139
why does hip pain radiate to the knee
because the obturator nerve supplies both joints
140
the first sogn of hip pathology is usually
loss of internal rotation
141
hip abductor (gluteus medius and minimus) weakness may manifest as
a positive trendellenburg sign or trendellenburg gait
142
shortening of the lower limb may be due to which hip pathologies
severe OA, perthes, SUFE, AVN, fracture
143
what is the difference between total hip arthroplasty and total hip replacement
total hip arthroplasty also includes hip resurfacing
144
why do all THRs fail eventually
loosening of one or both of the prosthetic components
145
what causes the components of a THR to loosen
wear particles from the bearing surface causing an inflammatory response at the implant-bone interface
146
local reaction to a metal-on-metal hip replacement may result in
an inflammatory psuedotumour whcih can cause necrosis of muscle and bone
147
conservative measures to treat hip OA
analgesics
physio
use of a stick (reduces joint force)
weight reduction
modification of activities
148
how to guage a patient's level of pain in hip OA
analgesic use
rest pain
sleep disturbance
149
how to measure diability caused by hip OA
walking distance
activites of daily living
impact on hobbies
150
early local complications of THR
infection
dislocation
nerve injury (sciatic nerve)
leg length discrepancy
151
early general complications of THR
medical surgical complications (MI, chest infection, UTI, blood loss and hypovolaemia)
DVT and PE
152
late local complications of THR
early loosening
late infection (haematogenus spread from distant site)
late dislocation
153
revision hip replacements are as successful as primary hip replacements
true/false
false
the surgery is more complex, with higher risk of blood loss, double the complication rates and poorer functional outcome
154
why should THR be delayed as long as possible in younger patients
they will put more demand on their hip and have a longer life expectancy so will be more likely to require a revision replacement
155
156
causes of AVN
idiopathic
alcohol abuse
steroids
hyperlipidaemia
thrombophilia
157
xray signs of AVN
patchy sclerosis of the weight bearing areas of the femoral head with a lytic zone underneath formed by granulation tissue from attempted repair
158
the 'hanging rope sign' on xray is a sign of
AVN
159
trochanteric bursitis presentation
pain and tenderness in the region of the greater trochanter with paon on resisted abduction
160
trochanteric bursitis treatment
analgesic
anti-inflammatories
physiotherapy
steroid injection
161
the knee joint consists of two joints
what are they
medial and lateral compartments of the tibiofemoral joint
patellofemoral joint
162
where is the thickest hyaline cartilage in the body found
retropatellar surface
163
what is the purpose of the menisci
shock absorbers
164
the four main ligaments of the knee are
ACL and PCL
MCL and LCL
165
the role of the ACL is to
prevent abnormal internal rotation of the tibia
166
the PCL prevents
hyperextension and anterior translation of the femur
167
how to test the ACL
anterior translation of the tibia
168
how to test the PCL
posterior translation of the tibia
169
the role of the MCL
resist valgus force
170
the role of the LCL
resist varus force and abnormal external rotation of the tibia
171
risk factors for early OA of the knee
previous meniscal tear
ligament injuries (especially ACL)
malalignment (genu varum/genu valgus)
172
knee replacement can be considered in a patient with
substantial pain and disability where conservative management is no longer effective
173
meniscal injuries classically occur
with a twisting force on a loaded knee
174
symptoms of meniscal injury
pain localised to medial or lateral joint line
effusion by the following day
catching sensation or locking on attempt to extend knee
175
true knee locking is defined as
a mechanical block to full extension
176
what causes knee locking in a meniscal injury
a significantly torn meniscus flipping over and becoming stuck in the joint line
177
ACL ruptures usually occur with what type of injury
a higher rotational force, turning the upper body laterally on a planted foot
178
what develops within an hour of an ACL rupture
haemarthrosis due to vascular supply within the ACL
179
valgus stress injuries may cause (knee)
tear MCL
potentially damage to the ACL
lateral tibial plateau fracture
180
a direct blow to the tibia with the knee flexed may cause
PCL rupture
181
a varus stress injury injury may rupture
the LCL (with or without damage to the PCL)
182
clincial examination of a meniscal tear
effusion
joint line tenderness
pain on tibial rotation (steinmann's test)
183
lateral meniscal tears are more common
true/false
false
medial meniscal tears are 10 times more likely
184
degenerate meniscal tears are steinmann's positive
true/false
false
unlike acute tears, degenerative tears are steinmann's negative
185
why does the meniscus have limited healing potential
it only has a blood supply in its outer third
186
meniscal tear treatment
generally meniscal tears arent suitable for repair
if symptoms don't settle within 3 months, arthroscopic menisectomy may alleviate symptoms
187
the principal complaint of ACL deficiency is
rotatory instability with giving way on turning
188
ACL rupture clinical signs
knee swelling (haemarthrosis or effusion)
excessive anterior translation of the tibia on anterior drawer test
189
ACL rupture treatment
primary repair (not very effective)
ACL reconstruction
190
ACL reconsturction involves
tendon graft (patellar or semitendinosus and gracilis autograft) being passed through tibial and femoral tunnels at the usual location of the ACL in th knee and secured to the bone
191
MCL injuries generally heal well
true/false
true
192
clinical signs of MCL tear
laxity and pain on valgus stress
tenderness over the origin or insertion of the MCL
193
MCL treatment
acute - hinged knee brace
chronic - MCL tightening (advancement) or reconstruction (tendon graft)
194
which nerve is often injured in LCL injuries
common peroneal nerve
195
complete knee dislocations result in rupture of
all four knee ligaments
196
why is vascular monitoring of the leg/foot necassary after a complete knee dislocation
intimal tears can occur which later thrombose
197
what is a risk of reperfusion after complete knee dislocation
compartment syndrome
198
what are the components of the knee extensor mechanism
tibil tuberosity, patellar tendon, patella, quadriceps tendon, quadriceps muscles
199
patellar tendon ruptures occur in young/old patients
quadriceps tendon ruptures occur in young/old patients
patellar tendon ruptures occur in young patients
quadriceps tendon ruptures occur in old patients
200
quinolone antibiotics are a risk factor for tendonitis
true/false
true
201
why should steroid injections be avoided in tendonitis of the extensor mechanism
high risk of tendon rupture
202
why should knee examination include a straight leg raise
to test the extensor mechanism
203
extensor mechanism rupture treatment
tendon to tendon repair
reattachment of the tendon to the patella
204
what is patellofemoral dysfunction
disorders of the patellofemoral articulation resulting in anterior knee pain
205
examples of patellofemoral dysfunction
chondromalacia patellae (softening of the hyaline cartilage)
adolescent anterior knee pain
lateral patellar compression syndrome
206
what causes lateral patellar compression syndrome
the pull of the quadriceps tends to pull the patella slightly laterally
excessive lateral force produces anterior knee pain and the lateral facet of the patella is compressed against the lateral wall of the distal femoral trochlea
207
risk factors for patellofemoral dysfunction
female sex
adolescence (greater degree of ligamentous laxity)
hypermobility
genu valgum
femoral neck anteversion
208
patellofemoral dysfunction presentation
anterior knee pain, worse going downhill
grinding or clicking sensation at the front of the knee
stiffness after prolonged sitting (psuedolocking)
209
210
causes of patellar instability
direct blow
sudden twist of the knne
211
the patella normally dislocates laterally/medially
laterally
212
what is hallux valgus
a deformity of the great toe due to medial deviation of the 1st metatarsal head and lateral deviation of the toe itself
213
risk factors for hallux valgus
female sex
family history
RA
inflammatory arthropathies
214
presentation of hallux valgus
painful joint incongruence
bunions (inflamed burse over medial 1st metatarsal head due to rubbing on shoes)
ulceration and skin breakdown between great toe and 2nd toe
215
coservative treatment of hallux valgus
wearing wider and deeper accomodating shoes
a spacer between the first and second toe to prevent rubbing
216
surgical management of hallux valgus
osteotomy to realign the bones
soft tissue prcedures to tighten slack tissues and release tight tissues
217
218
what is hallux rigidus
OA of the 1st MTPJ
219
conservative treatment of hallux rigidus
a stiff soled shoe to limit motion at the MTPJ
220
gold standard surgical treatment for hallux rigidus
arthrodesis
221
what is morton's neuroma
thickening of the nerve around the tissue between the bases of the toes
222
where is morton's neuroma normally found
the third interspace nerve (between third and fourth toes)
223
what causes morton's neuroma
irritation of the nerves causes them to become inflamed and swollen
high heels are thought to be a cause in women
224
clinical features of morton's neuroma
loss of sensation in the affectd web space
medio-lateral compression of the metatarsal heads may reproduce symptoms or produce a characteristic click (mulder's test)
225
what is mulder's test
squeeze the forefoot
to test for morton's neuroma
226
diagnosis of morton's neuroma
USS
227
conservative management of morton's neuroma
use of a metatarsal pad or offloading insole
steroid and local anaestheric injections may relieve symptoms and aid diagnosis
228
surgical management of morton's neuroma
excision of neuroma
229
most common site of metatarsal stress fracture
2nd metatarsal head
followed by the 3rd
230
management of metatarsal stress fracture
rest for 6-12 weeks in a rigid soled boot
231
risk factors for achilles tendonitis
repetitive strain (from sports)
degenerative processes
quinolone antibiotics
RA/inflammatory arthropathies
gout
232
treatment of achilles tendonitis
rest
physio conditioning
use of a heel raise to offload tendon
splint/boot
233
should steroid injections be used in achilles tendonitis
no
risk of rupture
234
which age groups do achilles tendon ruptures occur in
middle aged or older
235
mechanism of achilles tendon tear
sudden decelrationwith resisted calf muscle contraction (eg lunging at squash) leads to sudden pain and difficulty weight bearing
236
clinical signs of achilles tendon rupture
difficults weight bearing
weakness of plantar flexion
palpable gap in the tendon
no plantar flexion is seen when squeezing the calf (simmonds test)
237
what is simmond's test
squeezing the calf to check for plantar flexion
achilles tendon rupture
238
what sort of cast should be used in achilles tendon rupture
equinous position
239
presentation of plantar fasciitis
pain with walking felt on the instep of the foot
localised tenderness on palpation at this site
240
risk factors for plantar fasciitis
diabetes
obesity
frequent walking on hard floors with poor cushioning in shoes
241
treatment of plantar fasciitis
rest
achilles and plantar fascia stretching exercises
gel filled heel pad
steroid injection
242
pes planus AKA
flat foot
243
causes of acquired flat foot
tibialis posterior tendon stretch/rupture
RA
diavetes with Charcot foot (neuropathic joint destruction)
244
where does the tibialis posterior insert
medial navicular
245
treatment of tibialis posterior tendonitis
splint with a medial arch support to avoid rupture
246
elongation or rupture of the tibialis posterior tendon results in
loss of the medial arch with resulting valgus of the heel
247
pes cavus AKA
abnormally high arched foot
248
pes cavus risk factors
cerebral palsy
polio
spinal cord thethering from spina bifida occulta
249
pes cavus is often accompanied by
claw toes
250
treatment of pain from pes cavus
soft tissue release and tendon transfer if supple
calcaneal osteotomy if more rigid
arthrodesis if very severe
251
252
why do claw toes and hammer toes occur
acquired imbalance between the flexor and extensor tendons
253
claw toes have hyperextension/hyperflexion at the MTPJ with hyperextension/hyperflexion at the PIPJ and DIP
hammer toes have hyperextension/hyperflexion at the MTPJ with hyperextension/hyperflexion at the PIPJ and hyperextension/hyperflexion at the DIPJ
claw toes have hyperextension at the MTPJ with hyperflexion at the PIPJ and DIP
hammer toes have hyperextension at the MTPJ with hyperflexion at the PIPJ and hyperextension at the DIPJ
254
non-surgical treatment of claw toes
toe 'sleeves' to prevent rubbing
corn plasters
255
surgical treatment of claw toes
tenotomy
tendon transfer
arthrodesis of PIPJ
toe amputation
256
what type of collagen is produced in dupuytren's contracture
type III
257
the risk of recurrent shoulder dislocation following a traumatuc shoulder dislocation increased with age of patient at first-time dislocation
true/false
false
258
carpal tunnel syndrome is due to impingement of
the median nerve
259
cubital tunnel syndrome is due to impingement of
the ulnar nerve
260
shoulder impingement is due to impingement of
rotator cuff tendon
261
hip impingement is due to impingement of
the acetabular rim
262
risk factors for carpal tunnel syndrome
hypothyroidism
gout
female gender
chronic renal failure
pregnancy
OA
hypothyroidism
female gender
chronic renal failure
pregnancy
263
alignment of the knee in which the distal end of the tidia is angled away form the axis of the femur/midline
there is an increased gap between the ankles compared to the knees
genu valgum
264
alignment of the knees in which the distal end of the tibia is angled towards the axis of the femur/midline
there is an increased gap between the knees compared to the ankles
genus varum
265
weakness of which muscle will give rise to a positive froment's test
adductor pollicis
266
a quadricep tendon rupture is a relatively common injury in the patient over 40 and rarely requires surgical intervention
true/false
false
these cases are almost always surgically managed
267
what degree of fixed flexion deformity is require at the MCPJs for a patient to fail th eHuestion Table Top Test
\>30 degrees
268
it may be appropriate to omit the PR exam while examining someone for cauda equina syndrome
false
269
the principle clinical sign on examnation of restriction of shoulder movement is in which direction
frozen shoulder
external rotation
270
bed rest is good for mechanical back pain
true/false
false
271
a varus alignment of the knee will predispose to OA in which knee compartment
medial
272
