Soft tissue conditions

Question 1

ERON stage 1 + 2 presentation

Answer 1

1 = no signs of systemic toxicity, no uncontrolled comorbidities
2 = systemically unwell or has comorbidity

Question 2

ERON stage 3 + 4 presentation

Answer 2

3 = significant systemic upset
4 = sepsis/ life threatening infection

Question 3

Investigations for ?cellulitis

Answer 3

Examine

ERON classification

Question 4

ERON 1 + 2 management for cellulitis

Answer 4

1 = phenoxymethylpenicillin or flucloxacillin oral
2 = flucloxacillin IV but can be in community

Question 5

ERON 3 + 4 management for ?cellulitis

Answer 5

Admit for IV abx

Flucloxacillin +- benzylpenicillin, cipro + clindamycin if severe

Question 6

Tendons in rotator cuff

Answer 6

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Question 7

S+S of rotator cuff injury

Answer 7

Arc of pain (pain while lowering arm)
Night pain
Weakness, instability, restricted ROM
Numbness

Question 8

Diagnosis of rotator cuff tear

Answer 8

X ray:
AP view: sclerosis, cyst formation, smaller gap between acromion + humerus 
Lat view:  state of acromion 
Axillary view: humeral head position 
MRI / US

Question 9

Management of rotator cuff tear

Answer 9

NSAIDs
Surgery
Physio

Question 10

Which tests show impaired movement in subscapularis tear?

Answer 10

Gerber’s lift off
Supine napoleon

Impaired internal rotation

Question 11

Which tests show impaired movement in supraspinatus tear?

Answer 11

Active painful arc test
Drop arm test
Jobe’s test

Impaired abduction

Question 12

Which test show impaired movement in infraspinatus + teres minor tears?

Answer 12

External rotation test

Question 13

What is a nursemaids elbow?

Answer 13

Dislocation of radial head in elbow joint

Question 14

Causes of nursemaids elbow?

Answer 14

Pulling extended arm males annular ligament slip above radial head
Due to lifting/ swinging child

Question 15

S+S of nursemaids elbow

Answer 15

Child can’t bend/ use affected arm

Inability to supinate

Question 16

RF for achilles tendon rupture

Answer 16

30-40
Males
Obesity
Systemic corticosteroid use

Question 17

S+S of achilles tendon rupture

Answer 17

Sudden, painful pop

Inability to walk

Question 18

What tests elicit signs in achilles tendon rupture?

Answer 18

Calf squeeze (Simmonds/ Thompson)
Palpable gap test
Knee flexion test (Matles test)

Question 19

What is the typical mechanism of injury for an ACL tear?

Answer 19

Twisting knee after planting foot

Question 20

RF for ACL tear

Answer 20

Females

Valgus knees

Question 21

What is the main complication of an ACL tear?

Answer 21

Segond fracture = avulsion fracture of lateral aspect of tibial plateau

Question 22

S+S of ACL tear

Answer 22

Immediate pain + knee swelling

Knee may ‘give out’ when standing

Question 23

Investigations for ?ACL tear

Answer 23

MRI

Question 24

What tests elicit signs in an ACL tear?

Answer 24

Pivot sign, seen at heel strike phase of walking
Anterior drawer test
Lachman test

Question 25

Describe the surgery for an ACL tear

Answer 25

Reconstruction with neighbouring patellar ligament/ semitendinosus tendon

Question 26

What is the pathology + cause of iliotibial band syndrome?

Answer 26

Overuse injury - common in runners | ITB used in knee flexion + extension

Question 27

RF for iliotibial band syndrome

Answer 27

``` Weak hip abductors/ flexors Leg length discrepance Sudden distance/ intensity increase Foot eversion when running Running in cold weather ```

Question 28

S+S of iliotibial band syndrome

Answer 28

Knee pain worse at 30 flexion | Pain along lateral femoral epicondyle

Question 29

What tests elicit signs in iliotibial band syndrome?

Answer 29

Noble compression test | Ober test

Question 30

Pathology of meniscal tears

Answer 30

Injury to fibrocartilage knee pads | Medial > lateral

Question 31

What is the typical mechanism of injury of meniscal tears?

Answer 31

Forceful, sudden decelerating movement while changing direction

Question 32

Complications of meniscal tears

Answer 32

Osteoarthritis

Question 33

S+S of meniscal tears

Answer 33

Pain + swelling Clicking/ crepitus Inability to full extend knee (posterior tear)

Question 34

What diagnostic imaging is used for knee injuries?

Answer 34

MRI

Question 35

What tests elicit signs in meniscal tears?

Answer 35

McMurray test Apley grinding test Thessaly test Childress duck-waddle test

Question 36

Typical mechanism of injury for patellar tendon rupture

Answer 36

Landing from high jump Making sudden changes in direction at high speed Foot/leg stuck as person falls backwards

Question 37

Complications of patellar tendon rupture

Answer 37

Tibial tuberosity avulsion fracture | Patellar fracture/ avulsion

Question 38

What is the unhappy triad?

Answer 38

ACL, MCL + lateral meniscus tears

Question 39

Mechanism of injury for unhappy triad

Answer 39

Forecful blow to posterolateral aspect of knee with planted foot