Ortho Flashcards

Question

Weber classification?

Answer 1

Related to the level of the fibular fracture. Type A is below the syndesmosis Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis Type C is above the syndesmosis which may itself be damaged

Answer 2

* All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis * Younger patients - usually require surgical repair often using a compression plate * Elderly fare better with conservative management as their thin bone doesn't hold metalwork well

Answer 3

* stretching, partial or complete tear of a ligament * Can be divided into high ankle sprains involving the syndesmosis and low ankle sprains involving the lateral collateral ligaments

Answer 4

Iversion injury the most common mechanism * Pain, swelling, tenderness over affected ligaments, sometimes bruising * Usually able to weight bear unless severe

Answer 5

RICE Cast and cruches

Answer 6

are and severe * external rotation of the foot causing the talus to push the fibula laterally * frequently find weight bearing painful in comparison to low ankle sprains * pain when tibia and fibula are squeezed together at the level of the mid calf - hopkins * Radiograph show widening of the tibiofibular joint or ankle mortise

Answer 7

If no diastasis then non-weight-bearing orthosis or cast until pain subsides. If diastasis or failed non-operative management then operative fixation is usually warranted.

Answer 8

Long term steroids, alcohol, trauma, chemotheray

Answer 9

Initially asymptomatic Pain in the affected joint

Answer 10

Plain XRAY may be normal initally Osteopenia and microfractures may be seen early Collapse of articular surface - crest sign MRI

Answer 11

- popliteal cysts. * A Baker’s cyst is a fluid-filled sac in the popliteal fossa, causing a lump. * NOT A TRUE CYST - distention of the gastroceminus semimebranosus bura

Answer 12

Meniscal tears Osteoarthrtiis Knee injuries Inflmamatory arthritis e.g. RA

Answer 13

* Pain or discomfort * Fullness * Pressure * A palpable lump or swelling * Restricted range of motion in the knee (with larger cysts) * On examination, the lump will be most apparent when the patient stands with their knees fully extended. The lump will get smaller or disappear when the knee is flexed to 45 degrees (Foucher’s sign). * Oedema may occur if the cyst compresses the venous drainage of the leg.

Answer 14

Ruptured Baker’s cyst causes inflammation in the surrounding tissues and calf muscle, presenting with: Pain Swelling Erythema

Answer 15

he key differential diagnoses of a lump in the popliteal fossa are: Deep vein thrombosis Abscess Popliteal artery aneurysm Ganglion cyst Lipoma Varicose veins Tumour

Answer 16

* No treatment is required for asymptomatic Baker’s cysts. * Non-surgical management for symptomatic Baker’s cysts include: ‣ Modified activity to avoid exacerbating symptoms ‣ Analgesia (e.g., NSAIDs) ‣ Physiotherapy ‣ Ultrasound-guided aspiration ‣ Steroid injections * Surgical management typically involves arthroscopic procedures to treat underlying knee pathology contributing to the cyst, such as degenerative changes or meniscal tears. Resection of the cyst is difficult, and the cyst is likely to recur, particularly when another knee pathology is present. * Typically resolve quickly in children

Answer 17

Compression of the median nerve in the carpal tunnel

Answer 18

Thenar muscles

Answer 19

Thumb, index middle finger Palmar cutaenous branch DOES NOT go through the carpal tunnel = not affected by carpal tunnel syndrome

Answer 20

most cases its idiopathic * Repeitive strain * Obesity * Perimenopause * Rheumatoid * Diabetes * Acromegaly * Hypothyroidism

Answer 21

*sensory symptoms- pain/pins and needles in thumb, index, middle finger- palmar digit cutaneous branch of median nerve *motor symtpoms - affect hte thenar muscles - weakness of thumb movements, weakness of grip strength, difficulty with fine movements involign the thumb, wasting of the thenar muscles * unusually the symptoms may 'ascend' proximally * patient shakes his hand to obtain relief, classically at night

Answer 22

* weakness of thumb abduction (abductor pollicis brevis) * wasting of thenar eminence (NOT hypothenar) * Tinel's sign: tapping causes paraesthesia * Phalen's sign: flexion of wrist causes symptoms

Answer 23

* idiopathic * pregnancy * oedema e.g. heart failure * lunate fracture * rheumatoid arthritis

Answer 24

Electrophsyiology - prolongation of the action potential Carpal tunnel questionnaire

Answer 25

6 week trial of conservative treatments if symptoms are ild to moderate Corticosteroid injection Wrist splint at night * if- there are severe symptoms or symptoms persist with conservative management: surgical decompression (flexor retinaculum division)

Answer 26

Surgical emergency where the nerve roots of cauda equina are compressed l2/l3 Requires emergency decompression surgery

Answer 27

Sensation to the lower limbs, perineum, bladder, rectum Motor innervation to the lower limbs and anal/urethral sphincters Parasympathetic innervation of bladder and retum

Answer 28

* Herniated disc (the most common cause) * Tumours, particularly metastasis * Spondylolisthesis (anterior displacement of a vertebra out of line with the one below) * Abscess (infection) * Trauma

Answer 29

Saddle anaesthesia (loss of sensation in the perineum – around the genitals and anus)- does it feel normal when you wipe after opening your bowels? Loss of sensation in the bladder and rectum (not knowing when they are full) Urinary retention or incontinence Faecal incontinence Bilateral sciatica Bilateral or severe motor weakness in the legs Reduced anal tone on PR examination

Answer 30

mmediate hospital admission ◦ Emergency MRI scan to confirm or exclude cauda equina syndrome ◦ Neurosurgical input to consider lumbar decompression surgery * Surgery should be performed as soon as possible to increase the chances of regaining function. Even with early surgery, patients can be left with bladder, bowel or sexual dysfunction. Leg weakness and sensory impairment can also persist.

Answer 31

When a metastatic lesion compresses the spinal cord Presents similarly to cauda equina, with back pain and motor and sensory signs and symtpoms Wrose on coughing/straining

Answer 32

High dose dexamethasone (to reduce swelling in the tumour and relieve compression) Analgesia Surgery Radiotherapy Chemotherapy

Answer 33

Cauda equina presents with lower motor neuron signs (reduced tone and reduced reflexes). The nerves being compressed are lower motor neurons that have already exited the spinal cord. When the spinal cord is being compressed higher up by metastatic spinal cord compression, upper motor neuron signs (increased tone, brisk reflexes and upping plantar responses) will be seen.

Answer 34

Swelling na dinflammation in the tendon sheaths in the wrist

Answer 35

APL tendon EPB tendon

Answer 36

It is a type of repetitive strain injury and results in pain on the radial side of the wrist. Notable cause of bilateral De Quervain’s tenosynovitis is in new parents repetitively lifting newborn babies in a way that stresses the tendons of the thumb. - sometimes referred to as mummy thumb

Answer 37

* Patients present with symptoms at the radial aspect of the wrist near the base of the thumb. Typical symptoms include: Pain, often radiating to the forearm Aching Burning Weakness Numbness Tenderness Positive finkelsteins/eichhoffs test

Answer 38

Adduction towards the midline Abduction lateral

Answer 39

Involves the patient making a fist with their thumb inside their fingers. Then, the wrist is adducted (ulnar deviation), causing strain on the APL and EPB tendons. If this movement causes pain at the radial aspect of the wrist, the test is positive, indicating De Quervain’s tenosynovitis.

Answer 40

Rest and adapting activities Using splints to restrict movements Analgesia (e.g., NSAIDs) Physiotherapy Steroid injections - Rarely, surgery may be required to release (cut) the extensor retinaculum, releasing the pressure and creating more space for the tendons.

Answer 41

When fascia of the hand becomes thickened and tight leading to finger contracctors Finger in a flexed position

Answer 42

Palmar fascia of hte hand forms a triangle of connective tissue on the palm Fascia becomes thicker and tighter and develops nodules Cords of dense connective tissue can extend into the fingers, pulling them into flexion possibly an inflammatory process in response to micro trauma

Answer 43

* Age, family history (autosomal dominant), male, manual labour - vibrating tools, diabetes( more with t1), epilepsy, smoking, alcohol

Answer 44

* Development of hard nodules on the palm * Skin thickening and pitting * Thick nodular cord can be palpated from the palm into affected finger * Ring finger most likely to be affected, index least likely * Can affect function of hand, no pain usually though * Table top test - tries to position their hands flat on a table, if cant = positive = dupuytrens

Answer 45

onservative * Needle fasciotomy - needle through the skin to divide and loosed the cord * Limited fascietomy - removing abnormal fascia and cord to release contracture * Dermofasciectomy - removing the abnormal fascia and cord as well as associated skin

Answer 46

Infection of the intervertebral disc space Can lead to sepsis/epidural abscess

Answer 47

Back pain General features e.g. pyrexia, rigors and sepsis neurological features eg. if abscess forms

Answer 48

Bacterial - staph aureus Viral TB Aseptic

Answer 49

MRI CT biopsy

Answer 50

* 6-8 weeks IV ABX * Assess for endocarditis with e.g. TOE - usually due to haematogenous seeding of the vertebrae implying bacteraemia = seeding could have occured elsewhere

Answer 51

SEPSIS Epidural abscess

Answer 52

Inflammation at the point where the tendons of the foreaem insert into the epicondyles at the elbow Repetitive strain injury

Answer 53

Medial - flex wrist Lateral - extend wrist

Answer 54

Tennis wlbow Pain and tenderness at lateral epicondyle Pain often radiates down the forearm Can lead to weakness in grip strength Mills test positive

Answer 55

Stretching the extensor muscles of the forearm while palpating the lateral epicondyle/ Elbow is extended, forearm pronated and wrist is flexed. Pressure put on the lateral epicondyle ... if it causes pain - test is positive= lateral epicondylitis

Answer 56

Golfers elbow Pain and tenderness at the medial epicondyle ( inenr elbow) Pain often radiates down forearm and weakness ing rip strength like in lateral Golfers elbow test

Answer 57

stretch the flexor muscles of the forearm while palpating the medial epicondyle ‣ Elbow is extended, forearm supinated, wrist and fingers extended. Hold pateints elbow with pressure on the medial epicondyle. If it causes pain, test positive

Answer 58

Often self limiting and resolves with time Rest, analgesia, physio, orthotics, steroid injections, platelet rich palsma injectinos, surgery to debride, release or repair damaged tendons

Answer 59

* Sacs of synovial fluid originating from the tendon sheaths or joints * Commonly occur in the wrists are fingers but can occur anywhere there is a joint or tendon sheath * occur when the synovial membrane of the tendon sheath or joint herniates, forming a pouch. Synovial fluid flows from the tendon sheath or joint into the pouch, forming a cyst

Answer 60

* Can appear rapidly or gradually * Visible and palpable lump * Not usually painful * Rarely, they compress nerves = motor/sensory symptoms * 0.5cm to 5cm or more ( usually less than 2cm) * Firm and non tender, well circumscribed. * TRANSILLUMINATES

Answer 61

Clinical Xrays show normal bones and joints USS to confirm

Answer 62

Often disappear spontaneously - conservative management Active management:needle aspiration, surgical excision if severe symtpoms

Answer 63

Pain over lateral side of hip Tenderness on palpation of the greater trochanter Due to repeated movement of fibroelastic illiotibial band

Answer 64

Pain, shortened and externally rotated leg, patients with non displaced or incomplete neck of femur fractures are able to weight bear

Answer 65

Intracapsular - from edge of the femoral head ot the insertin of the capsule of the hip joint Extracapsular - etiher trochanteric or subtrochanteric - lesser trochanter is the dividing line

Answer 66

Retrograde blood supply Medial and lateral circumflex femoral arteries join the femoral neck proximal to the intertrochanteric line

Answer 67

Break in the femoral neck * Affects the area proximal to the intertrochanteric line * Garden classification

Answer 68

◦ Grade I: incomplete frature and non displaced ◦ Grade II- complete fracture and non displaced ◦ Grade III- partial displacement - trabeculae at an angle ◦ Grade IV- full displacement - trabeculae are parallel

Answer 69

Non displaced - may have an intact blood supply to the femoral head= Internal fixation Displaced: arthroplasty to all Hemiarthroplasty- replacing the head but leaving the acetabulum( socket) in place. ◦ generally offered to patients with limited mobility or significant co-morbities Total hip replacement - offered if - able to walk independently, fit for procedure etc

Answer 70

* leave the blood supply to the head of the femur intact * Stable Intertochanteric ( between greater and lesser trochanter) : dynamic hip screw * Subtrocheanteric (distal to the lesser trochanter) : intramedullary nail

Answer 71

AP and lateral XRays Disurpion of shentons line is a key sign of fractured NOF

Answer 72

Muscle or ligament sprain Facet joint dysfunction Sacroiliac joint dysfunction Herniated disc Spondylolisthesis (anterior displacement of a vertebra out of line with the one below) Scoliosis (curved spine) Degenerative changes (arthritis) affecting the discs and facet joints

Answer 73

Muscle or ligament strain (e.g., poor posture or repetitive activities) Torticollis (waking up with a unilaterally stiff and painful neck due to muscle spasm) Whiplash (typically after a road traffic accident) Cervical spondylosis (degenerative changes to the vertebrae)

Answer 74

Spinal fracture (e.g., major trauma) Cauda equina (e.g., saddle anaesthesia, urinary retention, incontinence or bilateral neurological signs) Spinal stenosis (e.g., intermittent neurogenic claudication) Ankylosing spondylitis (e.g., age under 40, gradual onset, morning stiffness or night-time pain) Spinal infection (e.g., fever or a history of IV drug use)

Answer 75

* l4-s3 form the sciatic nerve * Unilateral pain from the buttock radiating down the back of the thigh to below the knee or foot Electric/shooting pain Parasestheisa, numbness, motor weakness Reflexes may be affeted

Answer 76

herniated disc, spondylolisthesis( anterior displacement of a vertebra out of the line with the one below), spinal stenosis

Answer 77

* Exits the posterior part of the pelvis through the greater sciatic foramen, ravel sdown the back of the leg, at hte knee divides into the tibial nerve and common. peroneal nerve * Supplies sensation to the lateral lower leg and foot and motor function to the posterior thigh, lower leg and foot

Answer 78

Cauda equina

Answer 79

Bilateral neurological motor or sensory signs (cauda equina) Bladder distention implying urinary retention (cauda equina) Reduced anal tone on PR examination (cauda equina)

Answer 80

: patient lies on their back with their leg straight. Examiner lifts one leg from the ankle with the knee extended until the limit of hip flexion is reached. Then dorsiflex the ankle- sciatic type pain indicates sciatic nerve root irritation. Symptoms improve on flexing the knee

Answer 81

* Po- prostate * R- renal * Ta- thyroid * b- breast * Le - lung

Answer 82

* Emergency MRI in suspected cauda equina * Xray and CT for spinal fractures

Answer 83

Risk of developing chronic back pain 9 questions that assess patients function and physiological response to back pain

Answer 84

Self-management Education Reassurance Analgesia Staying active and continuing to mobilise as tolerated

Answer 85

Physio CBT

Answer 86

* NSAIDs frist line * codeine as an alterantive * Benzodipeines for muscle spasm - SHORT TERM, UP TO 5 DAYS * Radio-frequency denervation - chronic lower back pain originating in the facet joint. ‣ Target and damage the median branch nerves that supply sensation to the facet joints associated with the back pain

Answer 87

* DO NOT use gabapentin, pregabalin, diazepam or oral corticosteroids, do not use opiods for chronic sciatica * Amityptiline and duloxetine * Specialist management options: epidural corticosteroid injections, local anaesthetic injections, spinal decompression, radio frequency

Answer 88

A prolapsed lumbar disc usually produces clear dermatomal leg pain associated with neurological deficits. Features leg pain usually worse than back pain often worse when sitting1

Answer 89

NSAIDs analgesia, physio, exercise If persists- MRI

Answer 90

Localised sensory symptoms of the outer thigh caused by compression of the lateral femoral cutaneous nerve MONOneuropathy - one nerve

Answer 91

Presentation * Patients present with abnormal sensations (dysaesthesia) and loss of sensation (anaesthesia) in the lateral femoral cutaneous nerve distribution. The skin of the upper-outer thigh is affected. * Burning * Numbness * Pins and needles * Cold sensation * There may also be localised hair loss. Symptoms are aggravated by walking or standing for a long duration and improve when sitting down. Symptoms are often worse with extension of the hip on the affected side. This can be used to reproduce symptoms on examination.

Answer 92

Supplies sensory innervation to the upper-outer thigh. Pressure, deformity or trauma to the nerve can occur at several places. * The lateral femoral cutaneous nerve only carries sensory signals. Therefore, there are no motor symptoms with meralgia paraesthetica.

Answer 93

Supplies sensory innervation to the upper-outer thigh. Pressure, deformity or trauma to the nerve can occur at several places. * The lateral femoral cutaneous nerve only carries sensory signals. Therefore, there are no motor symptoms with meralgia paraesthetica.

Answer 94

* Rest * Looser clothing (tight clothes such as belts may add pressure to the nerve) * Weight loss * Physiotherapy Medical management is based around analgesia if pain is a feature, such as: Paracetamol NSAIDs Neuropathic analgesia (e.g., amitriptyline, gabapentin, pregabalin or duloxetine) Local injections of steroids or local anaesthetics Surgical management may involve: Decompression – removing pressure on the nerve Transection – cutting the nerve Resection – removing the nerve

Answer 95

Sensory loss over anterior thigh for l3 and knee and medial malleolus for l4 reduced knee reflex, positive femoral stretch test, weak hip extension and adduction

Answer 96

Sensory loss dosum of foot Weakness in foot and big toe dorisflexion Reflexes intact Positive sciatic nerve stretch test

Answer 97

Sensory loss posterolateral aspect of leg and lateral aspect of foot Weakness in planat flexion of foot Reduced ankle reflex Positive sciatic nerve stretch test

Answer 98

Locking/ giving way! Typically from twisting injuries Pain worse on straightening the knee, swelling, stiffness Knee may give way Pop sound Pain may be referred to the hip or lower back Displaced meniscal tears may cause knee locking Tenderness along the joint line

Answer 99

McMurrays Thessaleys Apley Grind

Answer 100

weight bearing at 20 degrees on knee flexion, patient supported by doctor, positive if pain on twisting knee

Answer 101

cMurray’s test involves the patient lying supine. The examiner takes the leg and flexes the knee. While internally rotating the tibia (by turning the foot inwards) and applying varus pressure to the knee (applying outward pressure to the inside of the knee), carefully extend the knee. Pain or restriction indicates lateral meniscal damage. Repeating the flexed to extended movement with external rotation of the tibia and valgus (inward) pressure on the knee tests for medial meniscal damage.

Answer 102

nvolves the patient lying prone and flexing the knee to 90 degrees with the thigh flat on the couch. Downward pressure is applied through the leg into the knee, and the tibia is internally and externally rotated at the same time. Pain indicates a positive result, suggesting meniscal damage. The pain is localised to the area of damage (e.g., medial or lateral meniscus).

Answer 103

* XRAY if acute knee injury... + any of the following ◦ age 55 or above ◦ Patella tenderness ◦ Fibular head tenderness ◦ Cannot flex the knee to 90 degrees ◦ Cannot wait bear

Answer 104

* MRI commonly first line to establish diagnosis * Arthroscopy is gold standard, visualise the meniscus; can also be used to repair or remove damaged sections of meniscus

Answer 105

* URGENT REFERRAL if acute onset knee pain + symptoms suggestive of an acute meniscal tear ie pop, rapid onset swelling, instability, locking * RICE * Physiotherapy * Surgery may be required: ‣ arthroscopy and either repairing meniscus or resecting the affected portion

Answer 106

Infalmmation in the tibial tuberosity Occurs in patients aged 10-15 and more common in males

Answer 107

* Presents gradually ‣ Visible or palpable hard and tender lump at the tibial tuberosity ‣ Pain in anterior aspect of the knee ‣ Pain exacerbated by physical activity, kneeling and on extension of the kne e

Answer 108

* Supportive usually * Nsaids * Stretching and physiotherapy resolves over time, patient usually left with bony hard lump on the knee

Answer 109

* Inflammation and swelling of the bursa over the elbow thickening of synovial membrane and increased production of fluid Students elbow

Answer 110

* Friction fro repetitive movements or leaning on elbow * Trauma * Inflammatory conditions e.g. RA or GOUT * Infection= septic bursitis * Students elbow!

Answer 111

Typically a young/middle aged man with an elbow that is: swollen, warm, tender, fluctuant

Answer 112

◦ hot to touch ◦ more tender ◦ erthyema spreading around surrounding skin ◦ Features of sepsis e.g. tachycardia, hypotension, confusion

Answer 113

* Pus indicates infecction * Straw coloured indicates infection less likely * Blood stained - trauma, infection of inflammaotyr causes * Milky indicates gout or psuedogout

Answer 114

* Rest, ice, compression * Analgesia * Protect elbow * Aspiration of fluid to relieve pressure * Steroid injections if infection has been excluded * ABX if infection: flucloaxacillin first time, clarithroymycin as alternative

Answer 115

* inflammation in the bone and bone marrow, usually cause by bacterial infection

Answer 116

* Haematogenous osteomyelitis = pathogen is carried through the blood and seeded in the bone. most common mode of infection. Most common form in children ◦ Risk factors: sickle cell anaemia, IVDU, immunosupression, infective endocarditis ◦ Often monomicrobial * OR on haematogenous osteomyelitis can be caused from e.g. orthopaedic operation or direct injury ◦ Often polymicrobial ◦ Risk factors: diabetic foot ulcers, diabetes, peripheral arterial disease

Answer 117

* Can be non specific e.g. fever, letahrgy, nausea, muscle aches * Pain, erythema, tenderness, swelling

Answer 118

* MRI * Blood cultures for causative organism * XRAY: typically doesn't show changes but may show: periosteal reaction, localised osteopenia, destruction of areas of the bone

Answer 119

* Surgical debridement of the infected bone and tissues * Antibiotic therapy 6 weeks of fluclox, possibly with rifampicin or fusidic acid added for first 2 weeks Clindamycin in penicillin allergy Vancomycin or teicoplanin when treating MRSA Chronic osteomyelitis - usually requires 3 months or more of abx

Answer 120

Inflammation of the plantar fascia

Answer 121

Plantar fascia - thick connective tissue. Attaches to the calcaneus at the heel, travels along the sole of the foot and branches out to connect to the flexor tendons of the toes

Answer 122

gradual onset of pain on the plantar aspect of the heel. Worse with pressure, particularly when walking or standing for prolonged periods. There is tenderness to palpation

Answer 123

: rest, ice, analgesia, insoles, heel pads, good arch support, physiotherapy, steroid injections : specialist management may be required with: extracorporeal shockwave therapy and surgery

Answer 124

Wasting away of fat pad over heel of hte foot

Answer 125

similar to plantar fasciitis, with pain and tenderness over the plantar aspect of the heel. Symptoms are worse with activities, particularly when barefoot on hard surfaces.

Answer 126

Thickness can be measured with an USS local steroid injections, comfortable shoes, insoles, adpating activities, weight loss

Answer 127

Dysfunction of a nerve in the intermetatarsal space towards the top of the foot Abnormal nerve usually located betwen the third and forth metatarsal Caused by irritation of the nerve relating to the biomechnaics of te foot

Answer 128

Pain at the front of the foot at the location of the lesion The sensation of a lump in the shoe Burning, numbness or “pins and needles” felt in the distal toes

Answer 129

* Deep pressure applied to the affected intermetatarsal space on the dorsal foot causes pain Metatarsal squeeze test – squeezing the forefoot with one hand to create a concave shape to the plantar aspect while using the other hand to press the affected area on the plantar side of the foot causes pain * Mulder’s sign – a painful click is felt when using two hands on either side of the foot to manipulate the metatarsal heads to rub the neuroma

Answer 130

Ultrasound or MRI can be used to confirm the diagnosis. Management options include: Adapting activities (e.g., avoiding high heels) Analgesia (NSAIDs if suitable) Insoles Weight loss if appropriate Steroid injections Radiofrequency ablation Surgery (e.g., excision of the neuroma)

Answer 131

Bony lump created by a deformity at the metatarsophalangeal joint (MTP) at the base of the big toe. The first metatarsal becomes angled medially, the big toe (hallux) become angled laterally (towards the other toes), and the MTP joint becomes inflamed and enlarged. Over time, additional stress on the joint can result in osteoarthritis.

Answer 132

Develop slowly Cause unclear Can be painful esp when walkign and wearing tight shoes

Answer 133

* Weight-bearing x-rays can be used to assess the extent of the deformity. * Conservative management is with wide, comfortable shoes and analgesia. Patients can use bunion pads to protect the bunion from friction inside their shoes. * Surgery is the definitive treatment. The aim is to realign the bones and correct the deformity.

Answer 134

refer to injury to the tendons of the rotator cuff muscles. The tendon may be partially or fully torn.

Answer 135

S – Supraspinatus – abducts the arm I – Infraspinatus – externally rotates the arm T – Teres minor – externally rotates the arm S – Subscapularis – internally rotates the arm

Answer 136

They may be related to overhead activities, such as playing tennis or overhead construction work.

Answer 137

* Rotator cuff tears may present either with an acute onset of symptoms after an acute injury, or with a gradual onset of symptoms. Patients typically present with: ◦ Shoulder pain ◦ Weakness and pain with specific movements relating to the site of the tear (e.g., abduction with a supraspinatus tear)

Answer 138

Ultrasound or MRI

Answer 139

* Patients with degenerative rotator cuff tears may be managed conservatively, particularly where they are at increased risk of complications from surgery. * Active or young patients and those with acute or full-thickness tears are more likely to be managed with surgery. Surgery may be used where physiotherapy fails. Non-surgical options are: * Rest and adapted activities * Analgesia (e.g., NSAIDs) * Physiotherapy

Answer 140

Soft tissue irritation, microtrauma and strain resulting from repetitive activities Can affect the muscles, tendonds nad neres E.g. tennis elbow

Answer 141

Usually, there will be a history of repetitive activities, often related to work. Symptoms will be located in an area related to the activity. They can include: Pain, exacerbated by using the associated joints, muscles and tendons Aching Weakness Cramping Numbness

Answer 142

RICE, analgesia, physiotherapy, steroid injections in specific scenarios

Answer 143

Sarcomas are cancers originating in the muscles, bones or other types of connective tissue.

Answer 144

* Osteosarcoma – the most common form of bone cancer * Chondrosarcoma – cancer originating from the cartilage * Ewing sarcoma – a form of bone and soft tissue cancer most often affecting children and young adults

Answer 145

Rhabdomyosarcoma – originating from skeletal muscle Leiomyosarcoma – originating from smooth muscle cancer Liposarcoma – originating from adipose (fat) tissue Synovial sarcoma – originating from soft tissues around the joints Angiosarcoma – originating from the blood and lymph vessels Kaposi’s sarcoma – cancer caused by human herpesvirus 8, most often seen in patients with end-stage HIV, causing typical red/purple raised skin lesions but also affecting other parts of the body

Answer 146

The presenting symptoms of sarcoma will vary dependent on the location and size of the lesion. The key features that should raise suspicions are: * A soft tissue lump, particularly if growing, painful or large * Bone swelling * Persistent bone pain

Answer 147

* X-ray is the initial investigation for bony lumps or persistent pain. * Ultrasound is the initial investigation for soft tissue lumps. CT or MRI scans may be used to visualise the lesion in more detail and look for metastatic spread (particularly a CT thorax, as sarcoma most often spreads to the lungs). Biopsy is required to look at the histology of the cancer.

Answer 148

Most common metastatising location is the lungs

Answer 149

Surgery (surgical resection is the preferred treatment) Radiotherapy Chemotherapy

Answer 150

narrowing of part of the spinal canal, resulting in compression of the spinal cord or nerve roots. This usually affects the cervical or lumbar spine. LUMBAR = MOST COMMON ..... More likely to occur in patients older than 60 years- relating to degenerative changes in the spine.

Answer 151

Central stenosis – narrowing of the central spinal canal Lateral stenosis – narrowing of the nerve root canals Foramina stenosis – narrowing of the intervertebral foramina

Answer 152

Congenital spinal stenosis Degenerative changes, including facet joint changes, disc disease and bone spurs Herniated discs Thickening of the ligamenta flava or posterior longitudinal ligament Spinal fractures Spondylolisthesis (anterior displacement of a vertebra out of line with the one below) Tumours

Answer 153

* Gradual onset * Severity of symptoms depends on degree of narrowing and spinal cord. Symptoms may be subtle with mild compression * . Severe compression can present with features of cauda equina syndrome (saddle anaesthesia, sexual dysfunction and incontinence of the bladder and bowel), requiring emergency management. * Intermittent neurogenic claudication is a key presenting feature of lumbar spinal stenosis with central stenosis. It is sometimes referred to as pseudoclaudication. Typical symptoms are: * Lower back pain * Buttock and leg pain * Leg weakness * The symptoms are absent at rest and when seated but occur with standing and walking. Bending forward (flexing the spine) expands the spinal canal and improves symptoms. Standing straight (extending the spine) narrows the canal and worsens the symptoms. * Lateral stenosis and foramina stenosis in the lumbar spine tends to cause symptoms of sciatica.

Answer 154

MRI to diagnose Investigations to exclude peripheral arterial disease e.g. ABPI and CT angio

Answer 155

* Exercise and weight loss (if appropriate) * Analgesia * Physiotherapy * Decompression surgery where conservative treatment fails (with variable results) -Laminectomy = removal of part or all of the lamina from the affected vertebra.

Answer 156

Trigger finger is a condition causing pain and difficulty moving a finger. (also known as stenosing tenosynovitis) Caused by nodule on the tendon - as the finger is extended the nodule can get stuck at teh entrance to teh a1 pulley = finger locks or gets stuck in the bent position

Answer 157

In their 40s or 50s Women (more often than men) People with diabetes (more with type 1, but also type 2) rheumatoid arthritis

Answer 158

Is painful and tender (usually around the MCP joint on the palm-side of the hand) Does not move smoothly Makes a popping or clicking sound Gets stuck in a flexed position * Symptoms are typically worse in the morning and improve during the day.

Answer 159

CLINICAL Based on history and examination

Answer 160

◦ Rest and analgesia (a small number resolve spontaneously) ◦ Splinting ◦ Steroid injections ◦ Surgery to release the A1 pulley- if dont respond to steroid injections

Answer 161

Across the growth plates ONLY occur in children

Answer 162

Transverse fracture of the distal radius near the wrist Dorsally displaced distal radius ---> dinner fork deformity USuallyfrom a foosh

Answer 163

Early ---> median nerve injury- can get acute carpal tunnel, compartment syndrome, vascular compromise, malunion, rupture of extensor pollicus longus tendon Late---> osteoarthritis and compelx regional pain syndrome

Answer 164

* manipulation to reduce the fracture

Answer 165

Often caused by FOOSH Tenderness in the anatomical snuffbox Wrist joint effusion Pain on longitudinal compression- telescoping of the thumb Pain on ulnar deviation

Answer 166

Treatment? Immobilisation with a futuro splint or standard below elbow back-slab Clinic review 7-10 days later when initial radiographs are inconclusive Undisplaced = cast for 6-8 weeks Displaced = surgical fixation Proximal scaphoid pole = surgical fixation

Answer 167

talus,navicular,scaphoid,lunate,5th metatarsal,proximal femoral

Answer 168

The Weber classification can be used to describe fractures of the lateral malleolus (distal fibula) Type A – below the ankle joint – will leave the syndesmosis intact Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn Type C – above the ankle joint – the syndesmosis will be disrupted

Answer 169

Dependent on whether or not the syndesmosis has been disrupted C=requires open reduction and internal fixation

Answer 170

Pelvis is a ring Whne one part breaks, so will an other Significant intra-abdominal bleeding, either due to vascular injury or from the cancellous bone of the pelvis Can lead to shock and deaht

Answer 171

Swelling and bruising, pain and tenderness AP and lateral XRAYS

Answer 172

* Un-displaced = managed non operatively with a hinged knee brace for 6 weeks and allowed to fully weight bear * Displaced = operative and then put in hinged knee brace for 6 weeks and allowed to fully weight bear

Answer 173

Po – Prostate R – Renal Ta – Thyroid B – Breast Le – Lung

Answer 174

FRAX score Bone mineral density using DEXA scan

Answer 175

Pus in teh illiopsoas compartment

Answer 176

Primary: staph aureus, haematogenous spread of bacteria Secondary: Crohns, diverticulitis, UTI, colorectal cancer, endocarditis, IVDU

Answer 177

Fever, back/flank pain, limp, weight loss, pain on stretching/ contracting CT abdo

Answer 178

ABX and percutaneous drainage

Answer 179

De quervains

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