Syllabus points

Question 1

Torticollis. Definition. Epidemiology. Types. Tx

Answer 1

Torticollis (from the Latin torti (twisted) and collis (neck)) refers to presentation of the neck in a twisted or bent position. It arises as a result of involuntary contractions of the neck muscles, leading to abnormal postures and movements of the head.

Torticollis commonly occurs in the 15–30yr age group but may present soon after birth.

Cong Muscular T(CMT) is most common. SCM muscle problem. Seen in breech deliveries.
Spasmodic = dystonic. affects muscles of the neck, thus involuntary contractions.

Tx: non-operative = try exercises which stretch the neck muscles. local injection of botulinum toxin to relax the muscles. Operative= release the SCM

Question 2

Scoliosis. Definition. Types. Tx

Answer 2

Scoliosis is an abnormal curvature of the spine >10 degree in coronal plane.
1. Idiopathic 2. Congenital 3. Neuromuscular
Scoliosis is more often seen in women.
Ix: find out Cobbs angle, bone densitometry

Question 3

Cerebral palsy

Answer 3

Cerebral palsy is a motor disorder which is non-progressive and caused by abnormalities in the brain.
Aetiology is divided into 3: prenatal, perinatal and postnatal causes of brain injury.
CP is categorised by type and the location.
TYPES: 1) spastic(pyramidal) 2)athetoid(EPS) 3)ataxis (cerebellum/brain stem) 4) Rigid
Pathogenesis: since the skeletal muscles requires normal stretching/ relaxing under load to develop, issues such as spastic CP causes the s.m to develop incorrectly. Leading to:
1. Dynamic contractures 2. Muscles contractures 3. Secondary bone changes

Question 4

Syndactyly. Aplasia, hypoplasia, Amniotic disease.

Answer 4

A condition in which 2 or more digits are fused together. Higher preponderance in males. Most common congenital limb abnormality.
Divided into: 1. simple 2. simple complete 3. Complex 4. Complicated
Amniotic disease is when the amniotic sac entangles around the digits.

Question 5

Manus vara, manus valga. Synostosis.

Answer 5

Manus vara= excessive inward angulation of the distal segment of a bone
Manus valga=opposite of vara.
Synostosis= fusion of 2 bones. Normal in puberty e.g. fusion of epiphyseal plates.

Question 6

Dupuytren contracture

Answer 6

A proliferative thickening and subsequent contracture of the palmar fascia of the hand. It is highly prevalent in the Scandinavian population.

Question 7

The bands of Dupuytren’s are called

Answer 7

Cords.

1. Pretendinous cords run longitudinally from proximal palm to base of the digit
2. The spiral cords are made up of the diseased pretendinous band, spiral band, lateral band and Grayson’s ligament. They pull the neurovascular bundle towards the midline, proximally and superficially

Question 8

Development dysplasia of hip

Answer 8

definition is a hip joint which in unstable, subluxated, or dislocated which manifests at birth or subsequently. Ix:Ultrasound

Question 9

Risk factors for DDH

Answer 9

risk factors:
• Positive family history
• Female gender (but too broad for use in screening)
• Breech position 
  High birth weight
• Oligohydramnios
• Congenital anomalies.

Question 10

Tx for DDH

Answer 10

0-3 months= Pavlik harness
Surgery can be either open or closed. In open surgery large cuts are made and spica cast is needed to make sure the femur head stays in acetabulum and joint becomes stable.

Question 11

Pes Equinovarus congenitus

Answer 11

clubfoot is the inward+downward rotation of the foot

Question 12

Name of tx method for club foot

Answer 12

Ponseti method (Cavus, Adduction, Varus and Equinus) remember CAVE

Question 13

Bunions is also called

Answer 13

hallux valgus

Question 14

Hallux valgus is a deviation at which joint

Answer 14

lateral deviation at metatarsophalangeal joint

Question 15

Aseptic bone necrosis caused by? diagnosis and tx

Answer 15

Aseptic bone necrosis is due to loss of blood supply to the bone. Ix: MRI and x-ray (crescent sign) tx: bisphosphonates in early to stop osteoclastic reabsorption. Arthroplasty might be considered if bone is severely affected. Core decompression/graft is an option if joint surface is intact.

Question 16

On MRI double density usually indicates

Answer 16

avascular necrosis

Question 17

4 zones of AVN

Answer 17

Articular cartilage, zone of ischaemia, reparative zone, normal bone

Question 18

Lateral epicondylitis is also called

Answer 18

Tennis elbow

Question 19

The examinations for tennis elbow

Answer 19

cozen’s and mills

Question 20

2 types of tenosynovitis

Answer 20

De Quervain’s and Stenosing

Question 21

De Quervain’s is

Answer 21

myxoid degeneration of the tendon which are found along the side of the hand from the base of the thumb. Common in new mothers due to high strain picking up the baby. (extensor+ abductor pollicis)

Question 22

Finkelstein test is used for

Answer 22

De Querven’s

Question 23

Osteoarthritis: pathophy ,diagnosis and tx

Answer 23

mainly affects synovial joints. progressive loss of articular cartilage which causes friction, inflammation, pain.

Question 24

Hip replacement. Indication. Tx option. Complications.

Answer 24

Hip replacement is indicated in pts with osteoarthritis mainly. Other conditions include AVN of the femoral head, congenital hip dislocation.
Tx options:
1. THR where both the articular surfaces of the femur head and acetabulum is replaced
2. Hip resurfacing
3. Hemiarthroplasty. Only the femoral head articular surface is replaced.
Be hesitant to do a hip replacement on <60yrs because of the need for revision later on.
Complications: VTE, dislocation, limb length discrepancy.

Question 25

Knee replacement. Tx options.

Answer 25

``` knee articular surface is resected and resurfaced with metal and polyethylene. Types: 1. unicondylar 2. bicondylar (total) 3. patellofemoral ```

Question 26

Radiological features of osteoarthritis (4)

Answer 26

``` LOSS loss of joint space osteophytes subarticular sclerosis subchondral cysts ```

Question 27

Clavicle fx. most common spot.

Answer 27

clavicle is s shaped bone. articulates with the manubrium medially and the acromion laterally. most common spot is at the point where the clavicle changes shape, middle. Happens when you fall onto outstretched arm.

Question 28

classification of clavicle fx

Answer 28

Robinsons Edinburgh. Based upon: location (medial, middle, lateral), A/B (undisplaced, displaced), 1,2( 1= extra-articular, simple undisplaced).

Question 29

what is tenting in clavicle fx

Answer 29

this is where the clavicle is displaced upwards causing skin to go up, looks like a tent.

Question 30

Scapula fx are usually due to

Answer 30

high energy traumatic

Question 31

Scapula fx classification

Answer 31

Ideberg. 6 types

Question 32

Scapula fx tx.

Answer 32

Surgical management is indicated for intra-articular fractures, displaced scapular neck fractures, open fractures, and those associated with glenohumeral instability. Most are using sling.

Question 33

Shoulder dislocation. Types

Answer 33

Anterior or posterior dislocation

Question 34

Anterior dislocation clinical picture

Answer 34

squared off shoulder, regimental badge area

Question 35

Lesion of shoulder dislocation

Answer 35

Bankart lesion= the anteriorinferior glenoid labrum is damaged Hill-Sachs= Cortical depression in the posterolateral part of the humeral head following impaction against the glenoid rim during anterior dislocation.

Question 36

Management of shoulder dislocation

Answer 36

1. assess neurovascular deficit (axillary n. over the chevron area). x-ray to look for fx 2. reduction methods w/sedation (Hippocrates. Kochers) 3. x-ray 4. physio and rest

Question 37

Femoral neck fx classification

Answer 37

1. Garden (based on displacement and used in geriatric/ insufficiency fx) 2. Pauwels (angle of fx across the femoral neck)