JL Musculoskeletal > Week 3 > Flashcards

Week 3 Flashcards

(69 cards)

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1
Q

Give two risk factor for a developmental dislocation dysplasia?

A

Breech position in utero or at deliver

Club foot, torticollis

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2
Q

When examining a patient for DDH what is down in LOOK, FEEL and MOVE?

A

LOOK - asymmetry
FEEL - click/clunk
MOVE - check abduction

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3
Q

Name two instability tests for diagnosing DDH?

A
  1. Barlow - attempt to dislocate/sublux a hip that is in joint by flexion adduction
  2. Ortolani - attempt to relocate a dislocated hip by abduction
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4
Q

When diagnosing DDH - what should be looked for on x-ray?

A

Calcified epiphysis > 3-6m

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5
Q

What are three treatment principles for DDH?

A
  1. relocate hip
  2. splint it while it stabilises
  3. monitor acetabular development
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6
Q

Give four suspicious history features (red flags) for back pain?

A
  1. Non-mechanical pain
  2. Systemic upset
  3. New neurological deficit
  4. Saddle anaesthesia +/- bladder upset
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7
Q

Give two examples of nerve irritation tests you would do when neurologically examining a patients back?

A

Straight leg raise

Femoral stretch test

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8
Q

What are the myotomes for hip flexion?

A

L1/L2

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9
Q

What are teh myotomes for knee extension?

A

L3/L4

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10
Q

What are the myotomes for foot dorsiflexion and EHL?

A

L5

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11
Q

What are the myotomes for ankle plantarflexion

A

S1/S2

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12
Q

How do you test hip flexion L1/L2?

A

Ask patient to push up against your hand

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13
Q

How do you test knee extension L3/4?

A

Ask patient to straighten knee against your hand

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14
Q

What myotome is extension of the great toe?

A

L5

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15
Q

How do you test the patients plantar flexion of foot S1/2?

A

Ask patient to stand on tip toes

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16
Q

What back pain conditions can x-rays be useful in?

A

Spinal stenosis or spinal claudication

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17
Q

What is the main first line investigation for back pain?

A

MRI

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18
Q

Name four more investigations for back pain other than MRI?

A
  1. Diagnostic facet injection
  2. Contrast enhanced CT
  3. Provocation discography
  4. Selective nerve block/ablation
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19
Q

In back pain - what are myelograms useful for detecting?

A

Spinal stenosis

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20
Q

What is sciatica?

A

Any sort of buttock or leg pain not obviously coming from hip, knee or ankle

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21
Q

What problems result from a slipped disc - disc prolapse?

A

Back and leg problems (pain) often accompanied by neurological disturbances

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22
Q

What presents commonly with episodic back pain, onset of leg pain +/- neurology, leg pain becoming dominant and can affect myotomes and dermatomes?

A

Disc prolapse

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23
Q

When does a prolapsed disc become a surgical emergency?

A

When cauda equina symptoms/signs

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24
Q

How are normal disc prolapses treated?

A

Settle in a few months on their own

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25
How is back pain managed conservatively?
1. Short bed rest 2. Anti-inflammatory +/- muscle relaxant 3. Mobilise thereafter 4. Return to normal activity
26
Name three adverse factors in spinal surgery?
1. Litigation 2. Dispute with DSS 3. Chronic pain syndrome/behaviour
27
What type of syndromes are back pain, chronic fatigue syndrome, fibromyalgia,IBS, migraine?
Dysfunctional syndromes
28
What are these symptoms: pain at tip of coccyx, whole leg pain, numbness and giving away, absence of pain free spells, intolerance of treatment and emergency admission?
Behavioural symptoms
29
Name 4 features of the deformity scoliosis?
1. Rotational component 2. Lateral bend component 3. Rib deformities 4. Visceral abnormalities
30
Name four common congenital scoliosis subtypes?
1. Wedge vertebra and hemivertebra (defects of formation) | 2. Unilateral bar and block vertebra (defects of segmentation)
31
What is Heuter - Volkmann's law in scoliosis?
Increased pressure across an epiphyseal plate inhibits growth
32
What genetic fault is there in scoliosis?
Melatonin receptors
33
Name three conditions that produce a secondary scoliosis?
1. Neuromuscular 2. Tumours 3. Spina bifida
34
What management type are serial corrective casts, bracing, corrective exercises and electrical stimulation in scoliosis?
Non-operative
35
What spinal condition involves the centre of gravity anterior to spine with a high pre-load?
Kyphosis
36
What is spondylolysis?
A defect in the pars interarticularis of the vertebra
37
What is spondylolisthesis?
Forward slippage on one vertebra on another
38
What grade is spondyloptosis?
5
39
In spondylolisthesis what is grade 1 or 2?
Abnormal neighbouring discs
40
In spondylolisthesis what is grade 3 +?
Combined discogenic + nerve root problem
41
Is history of cancer a red flag in back pain?
Yes
42
Give two features of cauda equina symptoms?
Various urinary upsets | Painless retention with overflow
43
What must be done in the initial assessment of a spinal fracture?
Immobilise and x-ray
44
After initial assessment of a spinal fracture - what is involved in neurological examination?
Establish motor and sensory level (attention to saddle area)
45
Where is the most common thoracolumbar injury occuring?
T12 or L1
46
Name three incomplete patterns of spinal cord injury?
1. Central cord 2. Brown-Sequard 3. Anterior cord
47
What incomplete pattern of spinal cord injury is typically hyperextension injury, arms worse than legs and the prognosis is variable but generally good?
Central cord
48
Give two features of Brown-Sequard paralysis?
1. Paralysis on ipsilateral side | 2. Hypaesthesia on contralateral side
49
What incomplete pattern of spinal cord injury involves motor loss, loss of pain and temperature sense, deep touch, position and vibration is preserved, may have traumatic or vascular cause and the prognosis is poor?
Anterior cord
50
What spinal condition occurs in 50+, historically involves manual workers, obesity, limited walking capacity and heavy or tired legs?
Spinal claudication
51
Give three features on spinal claudication?
1. Relieved by flexing 2. Uphill often not bad 3. Cycling easy
52
Gives three features of vascular claudication?
1. Relieved by standing 2. Uphill bad 3. Cycling bad
53
What spinal condition involves stiffness in the morning, difficulty sitting, driving and standing, worse with extension and better with activity?
Facet arthropathy
54
Name three ways to increase growth in bones?
1. Periosteal release 2. Fractures 3. Blood flow
55
What is a result of loss of medial longitudinal arch of foot?
Flat feet
56
Give three forms of intoeing?
1. Femoral neck anteversion 2. Internal tibial torsion 3. Metatarsus adductus
57
What form of inteoing occurs in >4 years, has ligamentous laxity and unwinds slowly?
Femoral neck anteversion
58
What form of intoeing occurs in
ITT
59
After 2 years of age is significant bow legs a problem
Yes
60
At what age does knock knees peak?
3.5
61
Is > 8cm standing intermalleolar at distance 11 years a sign of knock knees?
Yerp
62
What must you examine if a patient has anterior knee pain?
Knee and HIP
63
Name 4 congenital orthopaedic conditions?
1. Clubfoot 2. Congenital vertical talus 3. Neurofibromatosis 4. Skeletal dysplasias
64
Name 4 neuromuscualr orthopaedic conditions?
1. CP 2. Tip toe walking 3. DMD 4. Cavus foot
65
What is the known genetic mutation for NF 1?
17q11.2
66
What orthopaedic condition involves cage au lait spots, neurofibromas, axillary/groin freckling, Lisch nodules, pseudoarthrosis, kyphoscoliosis?
NF1
67
What condition is defined by frontal bossing, midface hypoplasia, rhizomelic disproportion, genu varum, trident hand and motor delay?
Achondroplasia
68
What condition is a persisting qualatative motor disorder appearing before the age of three years, due to non progressive damage to the encephalon occurring before the growth of the CNS is complete?
CP
69
What condition is x-linked recessive, occurs in boys 2-5, involves dystrophin gene and is progressive?
DMD
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