Term
| What injury is often missed in wrist pain? |
|
Definition
|
|
Term
| What type of shoulder dislocation is most commonly missed? |
|
Definition
|
|
Term
| What would you be worried about if a patient says they have a split head? |
|
Definition
|
|
Term
| What are you worried about in patients with black eyes? |
|
Definition
|
|
Term
| What boney injury are you worried about in patients that have fallen during a stroke? |
|
Definition
|
|
Term
| If someone has knee pain, what are you concerned about? |
|
Definition
| slipped capital epiphysis |
|
|
Term
| How can an ischaemic limb present? |
|
Definition
|
|
Term
| What type of limb problem must you be worried about even if pulses are present? |
|
Definition
|
|
Term
| Give 3 infections that can cause deformity |
|
Definition
| Poliomyelitis / TB / Leprosy |
|
|
Term
| Give 3 congenital forms of derformity |
|
Definition
| CDH / Scoliosis / Club foot |
|
|
Term
| What 2 main surgical options are available for the treatment of arthritis? Define each |
|
Definition
Arthroplasty: Joint replacement
Arthrodesis: Artificial joint fusion |
|
|
Term
| In diagnosis of pain, what are the 3 potential sites of origination? |
|
Definition
| Local / Referred / Neurological |
|
|
Term
| Give 7 ways in which a # may present |
|
Definition
1. Pain
2. Tenderness
3.Swelling
4.Laceration
5.Crepitus
6.Loss of function
7.deformity |
|
|
Term
| Give 7 possible complications of # |
|
Definition
1.haemorrhage
2.fat embolism
3.infection
4.non-union (avascularity)
5.degenerative arthritis
6.joint stiffness
7.closed compartment syndrome |
|
|
Term
| What is the basic pathway for treatment of #s? |
|
Definition
| Pain relief --> splint --> reduction? --> splint --> rehabilitation |
|
|
Term
| How is an open # treated? |
|
Definition
1.debridement
2.antibiotics
3.internal fixation |
|
|
Term
| What are the reasons behind the use of internal fixation in open #s? |
|
Definition
1. protect blood vessel
2.repair/replace skin
3.restore skin surface fracture
4.allow early mobilisation |
|
|
Term
| What is a pathological #? |
|
Definition
| A # of abnormal (weak) bone |
|
|
Term
| Give 4 things that may cause a pathological # |
|
Definition
1.Osteoporosis
2.Tumour
3.Paget's disease
4.Cyst |
|
|
Term
| What 2 things should you think of if a tumour is the cause of a pathological #? |
|
Definition
1. obtaining histological diagnosis
2. internal fixation is recommended for palliation |
|
|
Term
| What is a stress fracture and give an example of one? |
|
Definition
# cause by abnormal demand on normal bone.
e.g. March # - metatarsal # common in soldiers |
|
|
Term
| What is the main cause of pain in a dislocation? |
|
Definition
| Stretching of nerve bundles |
|
|
Term
| How would you treat a simple dislocation? |
|
Definition
|
|
Term
| What is the main problem with fracture-dislocations and how is it managed? |
|
Definition
|
|
Term
| What is a sprain and what type of ankle sprain is most common? |
|
Definition
= partial rupture of a ligament
lateral side of ankle most common |
|
|
Term
| What type of wound involves bone? |
|
Definition
|
|
Term
| Give 3 types of nerve injury |
|
Definition
1. neurapraxia
2. axonotmesis
3.neurotmesis |
|
|
Term
| What is neurapraxia and how does it recover? |
|
Definition
= concussion
Recovers rapidly (hours) |
|
|
Term
| What is axonotmesis and how does it recover? |
|
Definition
= Nerve stretching/compression (severe)
Recovers slowly (1inch/month) |
|
|
Term
| What is neurotmesis and how does it recover? |
|
Definition
| = nerve laceration needs repair |
|
|
Term
| What are the features of an ischaemic limb? |
|
Definition
6P's
1.Paraesthesia
2Pallor
3.Pain
4.Pulseless
5.Perishingly cold
6.Paralysis |
|
|
Term
| What is compartment syndrome? |
|
Definition
= increased swelling in a compartment - so that blood dupply/tissue function is compromised.
Any muscular compartment affected |
|
|
Term
| What can cause compartment syndrome? |
|
Definition
Open/closed #
Crush injury
Reperfusion injury |
|
|
Term
| Describe the pathology of compartment syndrome |
|
Definition
1. increased swelling = increased pressure
2. if kpa > than venous kpa = no blood exit
3.if kap> than arterial kpa = no blood entry = ischaemia/muscle&nerve necrosis
4. subsequent rhabdomyolysis - ARF |
|
|
Term
| What are the clinical features of compartment syndrome. |
|
Definition
1. Pain (out of proportion)
2. Paraethesia
3. Loss of function (foot drop)
4. Loss of pulses |
|
|
Term
| What 2 tests for compartment syndrome |
|
Definition
1. Passive flexion - push toes up - worsen pain
2. Not relieved by opiate analgesia |
|
|
Term
| MAnagment of compartment syndrome? |
|
Definition
Split open cast
Fasciotomy |
|
|
Term
| Complications of compartment syndrome? |
|
Definition
Fibrosis
Volkmann's ischaemic contracture
Motor/sensory neuropathy |
|
|
Term
| What is volkmann's ischaemic contracture? |
|
Definition
- permanent flexion contracture
- e.g. in wrist = claw hand
- from acute ischaemia to forearm muscles |
|
|
Term
|
Definition
| Muscle breakdown from crush/hypoxia |
|
|
Term
| What is reperfusion syndrome? |
|
Definition
| An increase in cell death after restoration of blood flow to previously ischaemic tissues. |
|
|
Term
| what are the clinical features of septic arthritis? |
|
Definition
hot/swollen joint
loss of function
associated systemic symptoms |
|
|
Term
| How do you manage septic arthritis? |
|
Definition
urgent aspiration if wet joint
IV antibiotics - flucloxacillin
Culture - may require change of antibiotics
Splints/physio |
|
|
Term
| Describe the 2 types of osteomyelitis. |
|
Definition
ACUTE
-acute bone pain
-associated joint effusion
-systemic symptoms
CHRONIC
-chronic sepsis following surgery/open#/penetrating injury |
|
|
Term
| What should you look for in septic arthritis? |
|
Definition
| A septic focus - e.g. boil/impetigo |
|
|
Term
| What are the characteristic changes seen in osteomyelitis? |
|
Definition
1. Sequestrum = dead bone surrounded by granulation tissue
2. Involucrum = new bone forming around old sequestrum |
|
|
Term
| What are the classical features of a #NOF? |
|
Definition
1. lying on floor unable to get up
2.Foot rolls into external rotation |
|
|
Term
| What is the most common cause of pathological #? |
|
Definition
secondary malignancy
-breast
-kidney
-lung
-prostate
-thyroid |
|
|
Term
| What 3 things do you consider in a child with bone pain? |
|
Definition
1. infection
2. Fracture
3. Cancer - leukaemia/sarcoma |
|
|
Term
| What are you thinking of if you see a limping child? And what are your findings on examination? |
|
Definition
Congenital dislocation of the hip
-1 leg shorter than other
-decreased range of motion - poor abduction |
|
|
Term
| What is perthe's disease? And what are the clinical features? |
|
Definition
= osteochondritis of femoral head
-typically boys 4-8yrs
-recurrent infarcts disrupt b/s to fem head
-self-limitinf after 3-4yrs
- NSAIDs when pain |
|
|
Term
| Describe the pathology and clinical features of a slipped upper femoral epiphysis. |
|
Definition
1. Epiphysis slips between femoral head and neck as bone grows.
2. 12-14 hypogonadal obese boys
3. Pain in knee (also hip/groin)
4. Foot in external rotation
5. Internal rotation limited
6.Affected leg shorter
7.Avascular necrosis/prem arthritis |
|
|
Term
| What are worrying features of lumps? |
|
Definition
1. Rapid growth
2. Deep origin
3. Fixed |
|
|
Term
| What is a Thomas Splint used for? |
|
Definition
|
|
Term
| What are the nerves roots of the brachial plexus? |
|
Definition
|
|
Term
| What 5 nerves exit the brachial plexus? |
|
Definition
Axillary
Musculocutaneous
Median
Radial
Ulnar |
|
|
Term
| What does the musculocutaneous nerve do? and from which nerve roots does it arise? |
|
Definition
C5-C7
Cutaneous supply to forearm
Bends elbow |
|
|
Term
| What does the median nerve do? |
|
Definition
Sensory supply to thumb and fore fingers (2 1/2)
Motor supply to 4 hand muscles (LLOAF) |
|
|
Term
| what does the ulnar nerve do? |
|
Definition
Sensory to little finger and 1/2 of ring finger.
Motor = intrinisc muscles of the hand |
|
|
Term
| What does the axillary nerve do? |
|
Definition
Sensory over deltoid (Badge area)
Motor to deltoid |
|
|
Term
| What does the radial nerve do? |
|
Definition
| Extends elbow/wrist and open hand |
|
|
Term
| What nerve is compromised in carpal tunnel syndrome? |
|
Definition
|
|
Term
| What nerve might be involved in a wrist drop? |
|
Definition
|
|
Term
| Point out the dermatomes of the upper arm |
|
Definition
|
|
Term
| What moytomes are responsible for the biceps reflex? |
|
Definition
|
|
Term
| What myotomes are responsible for brachioradialis reflex? |
|
Definition
|
|
Term
| What myotomes are responsible for the triceps reflex? |
|
Definition
|
|
Term
| Give 3 causes of shoulder pain |
|
Definition
From shoulder directly
Referred pain from e.g diaphragm
Neuropathic pain |
|
|
Term
| Where in the range of movement of the shoulder does painful arc syndrome occur? |
|
Definition
|
|
Term
| Give 5 causes of painful arc syndrome |
|
Definition
Supraspinatous tendonitis
Calcifying tendonitis
Rotator cuff tear
Subacromial bursitis
# of greater tuberosity |
|
|
Term
| What is the cause of frozen shoulder? |
|
Definition
Idiopathic
Reactive inflammation and adhesions within joint |
|
|
Term
| Describe a passive test for frozen shoulder. What movement is limited? |
|
Definition
Elbow flexed at 90degrees, elbow into side
Painful restriction of EXTERNAL ROTATION |
|
|
Term
| Describe the treatment of frozen shoulder |
|
Definition
Self limiting - 6months recovery
BUT
NSAIDS/Physion/MUA |
|
|
Term
| Give 3 orthopaedic causes of shoulder tip pain |
|
Definition
Torn rotator cuff
Impingement
Tendonitis |
|
|
Term
| Give 4 non-orthopaedic causes of shoulder tip pain |
|
Definition
| Ectopic pregnancy, MS, cholecystitis, Pancreatitis |
|
|
Term
| What 4 muscles does the median nerve supply in the hand? |
|
Definition
Lateral umbricles,
Opponens pollicis
Abductor pollicis
Flexor pollicis |
|
|
Term
| What is the most likely cause of back pain in a young person? |
|
Definition
|
|
Term
| What is the most common cause of back pain in older people? |
|
Definition
Men - Metastatic disease
Women - Osteoporotic # |
|
|
Term
| What investigations should be carried out in a patient with back pain? |
|
Definition
| ESR / CRP / WCC / Calcium / Phosphate / Albumin / Globulins (dipstick and electrophoresis |
|
|
Term
| Why do protein electrophoresis in a patient with back pain? |
|
Definition
| Check for Bence-Jones proteins seen in multiple myeloma |
|
|
Term
| What is a differential diagnosis for carpal tunnel syndrome? |
|
Definition
| C6 nerve root compression at cervical spine |
|
|
Term
| Give 2 tests for carpal tunnel syndrome |
|
Definition
Press over nerve
Inverse prayer sign 1min (Phalens test) |
|
|
Term
| How many nerve roots go into lumbosacral plexus? |
|
Definition
|
|
Term
| What nerves come out of lumbosacral plexus? |
|
Definition
| Femoral / sciatic / obturator / superior gluteal / inferior gluteal |
|
|
Term
| What does the femoral nerve supply? |
|
Definition
Sensory - Thigh
Motor - QUADS |
|
|
Term
| What does the sciatic nerve supply? |
|
Definition
| All motor and sensory function below the knee |
|
|
Term
| What does the obturator nerve do? |
|
Definition
|
|
Term
| What do the superior and inferior gluteal nerves do? |
|
Definition
Allow you to stand on one leg
Abduction |
|
|
Term
| Damage to which nerve of the lower limb is responsible for the trendelenburg gait? |
|
Definition
|
|
Term
| Which muscle is solely supplied by the inferior gluteal nerve? |
|
Definition
|
|
Term
| What is ankylosing spondylitis? |
|
Definition
| Sero-ve inflammatory arthritis |
|
|
Term
| Who does ank spond typically affect? |
|
Definition
|
|
Term
| What triad of symptoms is associated with ank spond? And what disease is it associated with? |
|
Definition
LBP / Uveitis / Stiffness
Associated with IBS |
|
|
Term
| What treatment advice should you give to patients with ank spond? |
|
Definition
|
|
Term
| What is often the major feature of a slipped lumbar disc? |
|
Definition
|
|
Term
| What are the 2 orthopaedic causes of neck pain. Describe them |
|
Definition
1. CERVICAL SPONDYLOSIS
degenerative / osteophytes and joint space narrowing / impingement
2.RHEUMATOID ARTHRITIS
atlanto-axial subluxation
ondontoid proximal migration
slippage of cervical vertebra |
|
|
Term
| What are the red flags for back pain? |
|
Definition
| Extremes of age / previous existing cancer / steroids / wt loss / neurological symps / persistant night pain |
|
|
Term
| What are the red flags for cauda equina syndrome? |
|
Definition
| Saddle anaesthesia / bladder/bowel symps / new bilateral sciatica |
|
|
Term
| What 2 processes cause narrowing of the tunnel in carpal tunnel syndrome? |
|
Definition
| Fluid retention and bony compression |
|
|
Term
| Give 7 causes of carpal tunnel syndrome |
|
Definition
- Pregnancy
- Repetitive strain injury
- RA
- Colles # distal radius
- Myxoedema
- Diabetes
- Idiopathic |
|
|
Term
| What are the clinical features of carpal tunnel syndrome? |
|
Definition
| Numbness / tingling / pins and needles / burning pain / typically worse at night / in distribution of median nerve |
|
|
Term
| What are the treatment options for carpal tunnel syndrome? |
|
Definition
Spints/diuretics/steroid injection
Surgical decompression |
|
|
Term
| What nerve palsy produces a claw hand? |
|
Definition
|
|
Term
| What nerve palsy produces wrist drop? |
|
Definition
|
|
Term
| Point to the dermatomes of the lower limb |
|
Definition
|
|
Term
| What indicates a positive trendelenburg test? |
|
Definition
| Hip drops to affected side - insufficient abduction (inf glut nerve) |
|
|
Term
| What are the causes of a positive trendelenburg test? |
|
Definition
| Osteoarthritis / RA / non union of #NOF / weak,paralysed abduction (polio) |
|
|
Term
| What does a Thomas's Test test for? |
|
Definition
| Fixed flexion deformity of hip |
|
|
Term
| What are the causes of a fixed flexion deformity of hip? |
|
Definition
| Osteoarthritis / previous #NOF |
|
|
Term
| What is the sign of a positive Thomas's test? |
|
Definition
| Lordosis space disappears and leg flexes |
|
|
Term
| What is Klumpke's palsy and what causes it? |
|
Definition
| Palsy of distal brachial plexus (includ T1) caused by traumatic vaginal delivery (shoulder dystocia) |
|
|
Term
| What is Erb-Duchennes palsy and what causes it? |
|
Definition
| Palsy of proximal brachial plexus (C5-C7) caused by difficult childbirth - pulling on head/neck |
|
|
