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Week 5 Flashcards

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1
Q

Definc comminuted fracture

A

Fracture with 3 or more shards

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2
Q

Displacement of bone?

A

Bone ends no longer in contact

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3
Q

What does fat look like on x-ray?

A

Darker than surrounding soft tissue

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4
Q

What is a buckle fracture?

A

Bend involving metaphysis
Most common in kids

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5
Q

4 easily missed upper limb injury?

A

Post shoulder dislocation
Supracondylar fracture
Scaphoid fracture
Bennett’s fracture

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6
Q

Result of lower limb immobility due to injury?

A

dehydration and starvation
DVT or pulmonary embolus
pneumonia

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7
Q

Typical sites of impacted fractures

A

femoral neck
tibial plateau
calcaneus

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8
Q

When is pelvic ring fracture most common?

A

Young people - RTA, fall from height
Elderly - osteoporosis, fall

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9
Q

What fracture commonly occurs with post hip dislocation?

A

Acetabular rim fracture

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10
Q

Intra vs extra capsular fracture corresponding with AVN?

A

Intra - affect blood supply to fem head, AVN more common, treat w hemiarthroplasty
Extra - doesn’t affect, treat w internal fixation

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11
Q

Key sign of meniscal injury?

A

Locking knee

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12
Q

What does damage to hyaline cart predispose to?

A

Osteoarthritis

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13
Q

What can be confused for fracture in lower limb?

A

Accessory ossification centres and sesamoid bones

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14
Q

Where can back pain refer to?

A

Buttock/thigh (ill-defined dull pain)

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15
Q

Describe nerve root pain in the back

A

SHARP / SHOOTING / ELECTRIC
BELOW THE KNEE (TO FOOT AND ANKLE)
e.g. Sciatica

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16
Q

How can nerve root/neuro issue present in terms of bowel/bladder?

A

LOSS OF MOTOR OR SENSORY FUNCTION

NOT CONSTIPATION

NOT URINARY FREQUENCY

e.g. cauda equina syndrome

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17
Q

What are some other causes of referred back pain?

A

PEPTIC ULCER DISEASE
GALL BLADDER
PANCREATIC
RENAL
UTERINE / OVARIAN
COLONIC
AAA

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18
Q

Risk factors for spinal fracture

A

Osteoporosis
Elderly
Long-term steroid use

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19
Q

Define cauda equina syndrome

A

Dysfunction of multiple lumbar & sacral nerve roots, caused by CE compresed from disc prolapse/tumour/etc
Clin pres:
urinary retention, urinary or faecal incontinence, saddle anaesthesia.

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20
Q

Cause of acute foot drop

A

Compression of nerves innervating anterior and lateral muscles of leg that cause dorsiflexion of foot

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21
Q

Typical patient with acute cord compression

A

Previous cancer patient, severe back pain, numbness/weakness of extremities

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22
Q

Key features of spinal infection (osteomyelitis/epidural abscess)

A

Focal back pain and low-grade fevers
(may be absent if immunosuppressed)

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23
Q

Describe hyper-kyphosis

A

Excessive convex curvature of the spine (esp thoracic)
Causes: Scheuermann’s, OP w wedge fractures
Conservative management

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24
Q

Describe spondylolisthesis (vertebral slip)

A

Anterior subluxation of one vertebra on another (commonly L5-S1)
5 types/causes
Meyerding’s grading

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25
5 causes of spondylolisthesis
Type 1: dysplastic – congenital, SB Type 2: isthmic – defect in pars, seen at L5-S1 Type 3: degenerative, seen at L4-L5 Type 4: traumatic – injuries other than pars fracture Type 5: pathologic – bone disease
26
How does age correspond to shoulder pathology?
20-30s – Instability 30-40s – Impingement 40-50s – Frozen Shoulder 50-60s – Cuff tear >60 - Arthritis
27
Causes of posterior/anterior shoulder dislocation
Post: Epileptic fit Electrocution Ant: Sport Trauma
28
Exam results with instability/dislocation
Look – abnormal shoulder contour, muscle wasting Feel – tenderness, muscle spasm Move – good ROM, scapular winging/dyskinesia Tests – RC strength, apprehension, relocation, general laxity
29
What injuries are assoc with shulder instability?
Labral lesion (Bankart) Fracture humeral head (Hill Sachs) Fracture of glenoid (Bony Bankart) Rotator cuff tear (>40y/o)
30
Define impingement/cuff disease
Pain originating from the sub-acromial space (intrinsic and extrinsic causes)
31
How does impingement syndrome correspond with age?
RC Tendonitis/ subacromial bursitis – <30s Calcific Tendonitis - 30-40s Tendinosis/ partial tears RC - 40-50s Cuff tear – 50-60s Cuff arthropathy – 70s
32
Exam results of impingement syndrome
Look - Contour, wasting, scapula position Feel - Tenderness bursa, ACJ Move - ROM active/passive, Painful arc, RC strength Tests - Positive Hawkins and Jobe’s
33
Pharmacological treatment of impingement syndrome in older patients?
Steroid injections in subacromial space (2)
34
Surgery for impingement?
Arthroscopic/Open Subacromial Decompression
35
Exam results of rotator cuff tear
Look - Contour, wasting Feel - Tenderness subdeltoid region Move - ROM active<
36
What should physio for cuff tear target?
Anterior deltoid strengthening
37
What is the pathology of frozen shoulder?
Contracture and thickening of coraco-humeral ligament, rotator interval, axillary fold Decr in joint volume (NOT ADHESION)
38
Diseases assoc w frozen shoulder
Diabetes, lipid & endocrine disease and Dupuytren’s contracture
39
Presentation of frozen shoulder
Pain at rest/night Anterior pain Stiffness Global ROM restruction Half external rotation
40
WHat are the differentials for shoulders with lack of external rotation?
Locked Posterior Dislocation Glenohumeral Arthritis Frozen Shoulder
41
Function of fluoroscopic distension in frozen shoulder
Inject dye and blow up balloon until capsule bursts
42
Operative management for shoulder arthritis (GH)
Shoulder Replacement (arthroplasty) Resurfacing Total Shoulder Arthroplasty Reverse polarity Shoulder Arthroplasty (ball and socket reversed)
43
Describe carpal tunnel
Compression of medial nerve, caused by reduction in blood suppply
44
Acronym for muscles innervated by median nerve
LOAF Lumbricals IF and MF Opponens Abd Pollicis Brevis Flexor Pollicis Brevis
45
Symptoms of CTS
Early - Pins & Needles, Pain, Clumsiness Late - Numbness, Weakness e.g. trouble driving, using phone
46
Clin signs of CTS
Thenar atrophy Altered sensation weakness APB Durkin’s Test - compression Tinnel’s Test - tapping Phalen’s Test - volar flexion
47
Management of CTS
Mild/moderate - Splintage - Physiotherapy - Steroid injection Severe - Carpal Tunnel Decompression
48
Describe cubital tunnel syndrome
Compression of ulnar nerve Post-trauma, direct pressure from tumours etc, males
49
Symptoms of cubital tunnel syndrome
Early Ulnar Pins & Needles Pain Clumsiness Late Numbness Weakness e.g. affects night, leaning
50
Clin signs of cubital tunnel
Hypothenar & interosseous atrophy Clawing of ring & small finger Altered sensation weakness Abd Dig minimi Weakness of grasp & pinch Wartenberg’s sign – abducted small finger
51
Tests for cubital tunnel
Tinnel's Modified Phalen's Froment's
52
Tests for cubital tunnel
Tinnel's Modified Phalen's Froment's
53
Management of cubital tunnel
Mild/moderate Elbow Splintage Physiotherapy nerve gliding NSAIDs Severe Ulnar Nerve Decompression
54
Describe clin pres of mucous cyst of hand
Outpouching of synovial fluid from DIPJ OA Painful/fluctuate/discharge May deform nail, cause ridge
55
Management of hand mucous cyst
Leave alone Excision/rotation flap
56
Describe ganglionic cyst of the hand
Outpouchings of synovial cavity *eg. wrist Filled with synovial fluid Fluctuate / trans-illuminate Painless, but may feel tight Resolve with time/aspiration/excision
57
Describe the pathology behind trigger finger
Swelling of tendons in flexor tendon sheath Tendon catches on A1 pulley Causes sticking of finger in flexion
58
Tendon issue definition
-opathy - pain -iyis - inflam -osis - degeneration -synovitis - swelling from repeated joint movement -enthesopathy - inflam of insertion into bone
59
Management of trigger finger
Splinting to prevent flexion Tendon sheath steroid injection (2x) Surgery to divide AI pulley
60
Typical clin pres of CarpTS
Radial 3.5 fingers Worse at night Relieve by shaking hand Palm spared Female Diabetes/preg/arth/etc.
61
Clin pres of DeQuervain's tenosynovitis
*spontaneous *painful! *swollen / red *Finklestein’s test
62
4 main surgeries for tendon disease management
Debridement Decompression Synovectomy Tendon transfer
63
Management of DeQuervain's
*NSAIDS *splint *rest *steroid injection *surgery- decompression
64
Define Dupuytren's contracture
- thickening and contracture of subdermal fascia leading to - fixed flexion deformity of fingers - painless/gradual preogression/starts as palmar pit or nodule
65
Clin pres of rotator cuff problems
Athletes/manual labourer Achy pain down arm Can't sleep on affected side Pain on reaching overhead/lifting Painful arc, weakness Positive impingement test Manage w physio/decomp
66
Treatment of Dupuytren's
Physio/activity mod Surgery - (segmental/dermo) fasciectomy - amputtation Collagenase injection/perc needle asp
67
Describe paronychia
Infection within nail fold <<
68
Clin pres of tendon sheath infection
Infection in sheath/up palm/arm Limited active and passive extension/v painful Positive Kanavel's cardinal signs
69
Mangement of flexor tendon sheath infection
Wash out tendon sheaths/AI and AS pulleys
70
How can RA result in extensor tendon rupture?
AI attack on synovium -> tendon degeneration -> rupture
71
Which tendon rupture is assoc with Colles fracture?
EPL
72
Which structure does Osgood-Schlatter's affect?
Insertion of patellar tendon into tibial tuberosity

Musculoskeletal (8 decks)

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