1
Q
What shape does the menisci appear from above?
A
- C shaped
2
Q
Meniscal tears tend to be a result from a ____ injury
A
- sporting injury
3
Q
What percentage of ACL ruptures also have a meniscal tear?
A
- 50%
4
Q
What are the symptoms of a meniscal tear?
A
- pain and tenderness localised to the joint
- sudden pain when getting up from squatting
- Effusion
- Pain on tibial rotation
5
Q
What investigation should be done for a suspected meniscal tear?
A
- MRI
- Effusion
6
Q
Meniscal tears have a poor healing potential
TRUE / FALSE
A
TRUE
- only the peripheral 1/3 has blood supply
7
Q
Acute locked knee is what type of meniscal tear?
A
- Bucket handle meniscal tear
8
Q
What may occur is a bucket handle meniscal tear isn’t repaired?
A
- FFD
- Fixed flexion deformity
9
Q
What is the treatment of a bucket handle meniscal tear?
A
- Urgent surgery
10
Q
MCL resists ___ stress
A
- resists valgus stress
11
Q
LCL resists ____ stress
A
- resists varus stress
12
Q
ACL resists ____
A
- anterior subluxation of the tibia
- internal rotation of the tibia in extension
13
Q
PCL resists ____
A
- posterior subluxation of the femur
14
Q
MCL rupture may lead to ____ instability
A
Valgus instability
15
Q
What is the symptom of an MCL rupture?
A
- Pain and laxity of valgus stress
16
Q
Playing football, tackled and pop heard in knee. What ligament?
A
- ACL
17
Q
What investigations for an ACL rupture?
A
- anterior drawer test
- Lachmans
18
Q
Motorbike accident. What ligament?
A
- PCL
19
Q
What are serious risks of a knee dislocation?
A
- risk of popliteal artery injury
- nerve injury
- compartment syndrome
20
Q
Patellar dislocations are always ___medially/laterally___
A
- lateral
21
Q
Extensor mechanism rupture may occur when?
A
- fall onto flexed knee
- rupture quads or patellar tendon
22
Q
Explain osteochondritis dissecans?
A
- during growth area of knee loses blood supply
23
Q
Explain osteoarthritis?
A
- imbalance between wear and repair of articular (hyaline) cartilage
24
Q
What is hyaline cartilage?
A
- covers surfaces of bone in synovial joints
- decreases friction
- avascular, nutrients received from synovial fluid
25
What are the conservative management of osteoarthritis of the knee?
- analgesics
- NSAIDs
- weight loss
- physio
- steroid injection for flare up
26
How many steroid injections can be given per year for a flare up of osteoarthritis?
- 3 per year
27
What is the ideal candidate for a TKR (total knee replacement)?
- over 60 years
- no underlying conditions
- not obese
- no chronic pain
- severe - end stage arthritis
28
Explain unicompartmental knee replacement?
- only worn part of knee is replaced
29
Explain knee osteotomy
- surgical realignment of the knee joint
| - redistribute forces
30
When might a knee osteotomy be preferred over a TKR?
- active patient
31
Another term for flat foot?
- Pes Planus
32
Explain flexible flat feet?
- Arch forms when patient tip-toes
33
What is the most common cause of acquired flatfoot deformity in adults?
- Tibialis posterior dysfunction
34
Who gets tibialis posterior dysfunction (typically)?
```
o Obese middle aged female
o Increases with age
o Hypertension
o Diabetes
o Seronegative arthropathies
```
35
Symptoms of tibialis posterior dysfunction?
- pain and swelling posterior to the medial malleolus
36
Explain pes cavus?
- high arch
| - clawing of toes
37
Explain plantar fasciitis?
- Inflammation of the plantar fascia on heel of foot
38
What are the symptoms of plantar fasciitis?
- pain worse after exercise
- swelling plantar medial aspect
- tenderness
39
What investigations are done of plantar fasciitis?
- Tinel's test positive for Baxter's nerve
40
Treatment of plantar fasciitis?
- NSAIDS
- night splints
- taping
41
Explain hallux valgus?
- bunion
42
Explain Morton's neuroma?
- degenerative fibrosis of digital nerve near its bifurcation
43
What is a possible cause of Morton's neuroma?
- high heels
44
Symptoms of Morton's neuroma?
- forefoot pain
| - burning and tingling in toes
45
Investigations for Morton's neuroma?
- Mulders test
| - characteristic click when squeezing forefoot
46
Investigations of tendo-achilles tendinitis?
- USS
| - Clinical
47
What test is performed for tendo-achilles tendinitis?
- Simmond's test
| - no plantarflexion of foot is seen when squeezing calf
48
What ligament is typically affected in an ankle sprain?
- lateral ligaments
49
What criteria is done for ankle sprains?
-o Ottowa criteria
♣ X-ray or not?
♣ Severe localised tenderness
♣ Inability to weight bear for 4 steps
50
Treatment of a calcaneal fracture?
- ORIF
| - Open reduction, internal fixation
51
Explain femoracetabular impingement syndrome
- altered morphology of femoral neck and/or acetabular
52
Explain a CAM type FAI?
- Femoral deformity
| - athletic males
53
Explain a PINCER type FAI
- Acetabular deformity
| - usually seen in females
54
Which type of femoracetabular impingement syndrome (FAI) is most common in females?
- PINCER
| - Acetabular deformity
55
What are the longer term consequences of femoracetabular impingement syndrome
o Damage to labrum and tears
o Damage to cartilage
o Osteoarthritis in later life
56
What are symptoms of femoracetabular impingement syndrome
o Activity related pain in the groin
o Difficulty sitting
o C sign positive
o FADIR provocation test positive
57
Diagnosis of femoracetabular impingement syndrome
- Radiograph
- CT
- MRI
58
Management of femoralacetabular impingement syndrome?
- observation in asymptomatic patients
| - arthroscopic or open surgery to remove CAM
59
Explain avascular necrosis of femoral head
- Failure of the blood supply to the femoral head
60
What are the risk factors for avascular necrosis?
- idiopathic
- trauma
- haematological disease
- long term steroid usage
61
What are the symptoms of avascular necrosis?
- insidious onset of groin pain over months
62
Management of avascular necrosis of femoral head?
- based on stage of disease may be reversible (bishosphonates, core decompression)
- total hip replacement
63
Explain idiopathic transient osteonecrosis of the hip (ITOH)
- Transient local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure
64
Symptoms of idiopathic transient osteonecrosis of the hip?
- progressive groin pain over several weeks
| - usually unilateral
65
Diagnosis of idiopathic transient osteonecrosis of the hip?
- diagnosis of exclusion
- elevated ESR
- MRI
66
Treatment of idiopathic transient osteonecrosis of the hip?
- self limiting
- analgesia
- protected weight bearing to avoid stress fracture
67
Explain trochanteric bursitis?
- repetitive trauma caused by iliotibial band tracking over trochanteric bursa
- inflammation to bursa
68
Symptoms of trochanteric bursitis?
- pain on lateral aspect of hip
| - pain on palpation of greater trochanter
69
Treatment of trochanteric bursitis?
- self-limiting
- analgesia
- NSAIDs
70
What are some extrinsic causes of tendinopathies?
- trauma
- repetitive injury
- drugs (steroids/antibiotics)
71
General management of tendinitis?
- rest
- physiotherapy
- analgesics
- injections
- splinting
72
When conditions should steroid injections be avoided in?
- achilles tendon
- extensor knee mechanism
Can lead to tendon rupture
73
What is the most commonly affected muscle in rotator cuff disease?
- supraspinatus
74
What are the 4 muscles of the rotator cuff?
- supraspinatus
- infraspinatus
- subscapularis
- teres minor
75
What are the symptoms of rotator cuff disease
- achy pain down arm
- difficulty sleeping on affected side
- tenderness over glenohumeral joint and AC joint
76
What surgical managements may be considered if conservative management fails in rotator cuff?
- subacromial decompression
77
What may cause biceps tendiopathy
- overuse
- instability
- impingement
- trauma
78
What head of the biceps is most commonly affected in biceps tendiopathy?
- long head
79
Symptoms of biceps tendinopathy
- pain anterior shoulder radiating to elbow
| - aggravated by shoulder flexion
80
Distal or proximal biceps tendinopathy is most likely to require surgery?
- Distal
81
Popeye sign and extensive bruising may be what?
- biceps tendon rupture
82
Lateral epicondylitis is also known as?
- tennis elbow
83
What are the symptoms of tennis elbow?
- pain and tenderness over lateral epicondyle
| - pain worse when stretching the muscle
84
What investigations can be performed for lateral epicondylitis (tennis elbow)
- Mills test
| - pain in wrist extension with palm pronation)
85
Treatment of tennis elbow?
- rest
- physio
- injection
86
Golfers elbow is also known as?
- medial epicondylitis
87
Symptoms of golfers elbow
- medial elbow pain
| - worse upon grasping
88
What are the symptoms of de quervains tenosynovitis?
- pain over radial styloid process
89
Investigations for de quervains tenosynovitis?
- Finklesteins test
| - USS
90
What pulley is involved in trigger finger?
- A1 pulley
91
Traction apophysitis at tibial tubercle is also known as?
- Osgood-Schlatter's disease
92
What population is Osgood-schlatter's disease often seen in?
- adolescent active boys
93
What are the 2 main causes of an EPL (Extensor pollicis longus) rupture?
- Rheumatoid arthritis
| - Colles fracture
94
What is the treatment of an EPL rupture?
- Tendon transfer
95
What 2 tendons are involved in de quervains tenosynovitis?
- APL (Abducter pollicis longus)
| - EPB (Extensor pollicis brevis)
96
Unable to straight leg rise??
- Quads or patellar tendon injury
97
What is most common? An anterior or a posterior shoulder dislocation?
- Anterior
98
What are some reduction by manipulation techniques?
- kocher method
- hippocratic method
- Stimson method
99
Neer's classification can be used for what?
- Cuff disease (impingement)
| - Humeral head fractures
100
What age group is a cuff tear most likely seen in?
- ages 50-60
101
What are some risk factors and associations for a frozen shoulder?
- diabetes
- lipid and endocrine disease
- duputrytren
102
Explain duputytren's contracture?
- progressive thickening of the fascia on the palm
| - eventually creating a thick cord that can pull one or more fingers into a bent position.
103
Clawing of the ring finger and little finger may be a sign of what?
- cubital tunel syndrome
104
Describe the appearance of a mucous cyst?
- outpouching of synovial fluid
- raised swelling
- may be painful
105
Symptoms of trigger finger?
- finger tight going into flexion
106
What are the LOAF muscles (carpal tunnel)
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
107
What is an example of a carpal tunnel syndrome questionnaire?
- Kamath and stothard
108
What causes dupuytren's contracture?
- genetics + environment (alcohol, diabetes)
109
Differences between dupuytrens and de quervians
- dupuytrens = not sore, table top test
| - de quervains = sore, finklesteins test
110
What is the name given to infection of the nail bed?
- Paronychia
111
Treatment of flexor tendon sheath infection
- surgical emergency
| - washout tendon sheath (a1 and a5 pulley)
112
Symptoms of flexor tendon sheath infection
- limited extension
- painful to percuss
- affected finger held in fixed flexion
113
Explain the potential treatment option for a painful subungual haematoma?
- trephine
| - releases pressure
114
What is the treatment of a boxer's fracture?
- buddy strap
115
Treatment of a PIPJ dislocation?
- pull to reduce
| - buddy strap
116
Explain a Bennett's fracture?
- fracture to base of thumb
117
How do you examine the FDP tendon?
- hold finger in middle phalanx and see if patient can flex at the DIP joints.
118
How do you examine the FDS tendon?
-hold all fingers straight, except the one examining. Ask patient to flex the finger examining
119
Why can it be difficult to examine the FDS tendon?
- FDP tendon has mass involvement over the 4 fingers
| - Must immobilise the other fingers to ensure it is just the FDS you are examining
120
What are the principles in treatment of a mutilating injury?
- Preserve amputated parts on ice
- Early debridement
- Establish bony support
- Establish vascularity
- Establish skin cover
- Prevent/treat infection
121
What is eschar?
- Post burn injury
- Thick, leathery, inelastic skin which can form after burns
- May require surgical release to allow movement
122
What is the commonest bacteria involved in cellulitis?
- s.aureus
123
What is an abscess?
- collection of pus
124
How will an abscess present?
- well defined
- erythema
- pain
125
Treatment of an abscess?
- surgical incision and drainage
| - antibiotics
126
What is septic arthritis?
- bacterial infection of the joint
127
What are the causes of septic arthritis?
- trauma
| - haematogenous spread
128
What is the affect on cartilage by septic arthritis?
- irreversible damage
129
Management of septic arthritis?
- urgent joint aspiration
- culture
- arthroscopic or open washout
130
Management of a ganglia?
- based upon symptoms
| - don't advise aspiration
131
What is a baker's cyst?
- ganglia in the popliteal fossa
132
What is a baker's cyst associated with?
- Osteoarthritis
133
Explain bursitis?
- fluid filled cushion
| - can become inflammed or infected
134
What would aspiration of grotty crystals appear as?
- negative birefringent monosodium urate crystals
135
Chronic treatment of gout?
- allopurinol
136
Where might rheumatoid nodules appear?
- extensor regions of forearm/elbow
137
Management of dyputren's disease?
- needle fasciotomy
| - collagenase injection
138
Where is a giant cell tumour of tendon sheath found?
- volar aspects of digits
139
Lipoma is __benign/malignant__
- benign
140
Ewing's sarcoma is a malignant primary bone tumour that affects people aged ______
- 10-20 years
141
Explain myositis ossificans?
- post trauma
- haematoma in muscle
- haematoma calcifies
- noted on x-ray or MRI
