What are the causes of a scaphoid fracture?
FOOSH + sports + car accident
- FOOSH: fall onto an outstretched hand (axial compression of scaphoid w/ Wrist hyperextended & radially deviated)
- Contact sports: football
- Road traffic accidents: holding steering wheel
what are the symptoms & clinical exam presentations of a scaphoid fracture?
- Pain: radial aspect, base of thumb, anatomical snuffbox (between extensor pollicis longus & extensor pollicis brevis tendons)
- Clinical exam: tenderness at anatomical snuffbox, pain when telescoping/ longitudinal compression of thumb, loss grip & pinch strength of thumb
How is scaphoid fracture investigated & diagnosed?
- Clinical exams: longitudinal compression, loss of grip & strength at the thumb
- Plain film X-ray: anterior-posterior view, lateral views
- MRI: diagnosis but not used commonly in the UK
What is the initial & orthopedics management for scaphoid fractures?
- Futuro splint or standard below elbow backslab Refer to orthopedic
- Undisplaced fracture of scaphoid waist : cast for 6-8 weeks
- Displaced fracture of scaphoid waist: surgical fixation
- Proximal scaphoid pole fracture: surgical fixation
What are the 2 main complications of scaphoid fracture?
- Avascular necrosis of scaphoid due to blood supply interruption of dorsal carpal branch of radial artery
- Non-union: bone fails to heal-> pain & early osteoarthritis
where does carpal tunnel syndrome occur? (what other structure does the carpal tunnel contain)
- median nerve inside the carpal tunnel surrounded by carpal bones & flexor retinaculum
- tunnel also contain flexor pollicis longus (pollicis= thumb), the four flexor digitorum superficialis and the four flexor digitorum profundus
What are the causes of carpal tunnel syndrome?
- Compression of the median nerve in the carpal tunnel
- Pregnancy, oedema from HF, Rheumatoid arthritis can lead to bilateral carpal tunnel due to expansion of interstitial space with soft tissue growth or fluid (acromegaly due to bone growth as well but after age 50)
- Lunate fracture
What are the symptoms of carpal tunnel syndrome?
- Pain, tingling, pins and needle in thumb, index, middle finger
- Symptoms worse at night, patient wake up to “ shake their hand”
What are the examination findings of carpal tunnel? What clinical exam test is used?
- Wasting of thenar eminence (3 muscles supplied by median nerve)
- Tinel’s sign: tapping cause paraesthesia
What are the treatment options for carpal tunnel?
- 6 week conservative treatment for mild-moderate symptoms (ie, Corticosteroid injection, Wrist splints at night)
- Severe symptoms-> surgical decompression through flexor retinaculum division
What does the extensor mechanism of the knee consist of ? What injuries can occur?
quadriceps tendon-> patella-> patellar tendon-> tibial tuberosity
Patellar tendon and quadricep tendon can rupture
Patella can fracture and dislocate
What are the causes, age group, and symptoms of extensor mechanism rupture?
- Rapid Contractile force, trauma, heavy weight lifting
- Patellar in 40-, quadriceps in 40+
- can’t do straight leg raise w/ knee pain + effusion & palpable gap in extensor mechanism
What are the investigation & management for extensor mechanism rupture?
- X-ray showing patella sitting high in patella rupture & low in quadricep rupture
- Urgent surgery, physio to increase range of motion
What are the causes, target group for patella dislocation?
- high force impact or direct twist causing lateral dislocation
- Teenage females w/ high riding patella
(High chance of recurrence)
what are the symptoms and clinical exams for patella dislocation
- medial pain and haemarthrosis/ effusion
- lateral patella apprehension test is positive
What is the investigation & treatment for patella dislocation?
- X ray: lipo-haemathrosis
- Self-relocating when knee straightened or manually put it back
- splintage, aspirate for severe pain & swollen
What is the cause & symptom of dupuytren’s contracture
- Inherited (autosomal dominant)
- Secondary to cirrhosis, SE of phenytoin treatment
- Hyperplasia of palmar fascia forming nodules and cords progressing to contractures at the MCP and PIP joints (pinky & ring finger bend towards you)
How is Dupuytren’s contracture treated? (under what condition)
- if MCP cannot be straightened when they place palm flat on surface
- Surgery: removal of disease tissue or division of chords
What is the cause and presentation of ACL rupture?
- twisting/ internal rotation of tibia or Awkward landing
- Popping sound
- Knee pain w/ swelling from haemoarthrosis or effusion
What is the clinical diagnosis of ACL rupture? How is it done
- Anterior draw test: knee bent at 90, hands around tibia and pull it forward, check for anterior/ forward translation
- Lachman’s test: knee bent at 20-30, one hand hold femur, one hand hold tibia, check is there is anterior/ forward translation
(uninjured ACL should hold femur and tibia intact and NOT allow forward translation)
What is the treatment for ACL rupture?
Physiotherapy
Surgical reconstruction
What are the causes of medial and lateral collateral ligament rupture?
Medial: valgus stress and medial blow to the knee (close)-> Skiing
Lateral: varus/ lateral blow to knee (open), isolated LCL injury is uncommon
What is the treatment for medial and lateral collateral ligament rupture?
Medial: brace and physio
Lateral: reconstruction surgery
What are the 2 types of hip dislocation? What are the diff causes?
- Congenital: DDH (developmental dysplasia of the hip) due to shallow acetabulum from failure to develop
- Acquired dislocation: 90% is posterior dislocation, caused by trauma (car accident or fall from height), complication of total hip replacement or hemiarthroplasty
