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Orthopaedics Yr 2

Ortho flash cards

Orthopaedic investigations: ESR Erythrocyte Sedimintation Rate, marker of inflamation
Orthopaedic investigations: CRP C-reactive protein, acute phase protein, general marker of inflammation/infection
Orthopaedic investigations: Bone scan (what does is it used in) Used to detect areas of high bone turnover; Paget's disease, bone metastisis
Orthopaedic investigations: Synovial fluid aspiration Need to request gram stain, microscopy and culture; suspected sepsis, gout/pseudogout - microscopy used to ID crystals, inflammatory arthropathy. Used to treat: OA/inflammatory arthropathy, haemarthorosis
Treatments: fractures, dislocation Broad arm sling, collar and cuff, cast, splintage, and traction
Management for fracture - cast Fresh fractures are molded using plaster slab (which allows for swelling and expansion)around 70% of the limb; this is completed using further rolls in 2-3 days or in exchange for a synthetic materials cast (more water resistant and more opaque for xrays)
Consent steps required DIAPER D: diagnosis explained I: indications of treatment discussed A:alternative to treatment discussed P: proceedure explained Expected outcome: explained Risks: risks explained
What disorder is associated with a reduction in bone? Osteoperosis: must be a reduction of normal composition of bone; associated with predisposition to fractures
Causes of osteoperosis? Primary: age-related; predominantly post-menopausal women Secondary: endocrine (early steroid use), malabsorption/ anorexia, bone marrow disease, chromosomal Idopathic: not related to age, no known cause
Symptoms of osteroperosis Symptoms due to associated fractures: spin pain due to fracture, loss of height, kyphosis, scoliosis
Management of osteoperosis: Part I Maximise peak bone mass: regular load-bearing expercise; calcium supplementation in youth Diagnose OP and fracture: DEXA (at least 2.5SD below peak bone mass), xray of spine for fractures, MRI spine exlude metastases, blood investigation-exclude myloma
Management osteoperosis: Part II Reduce bone loss: avoid immobilization, excessive alcohol, smoking
complications of ortho surgery and fracture surgery Infection(wound) Resp infection MI Neurovascular injurt DVT PE Compartment Syndrome Bleeding Malunion
What are the types of muscle Skeletal: striated muscle controlled by nervous system, most common type Cardiac: striated muscle of the heart Smooth muscle: non-striated, controlled by chemical mediators - important in function of blood vessels, GI and reproductive tracts
What is cartilage? Resilent tissue that provides semi-rigid support in parts of the skeleton; also part of some types of joint
What are ligaments? Flexible bands that connect bones or cartilage together, strengthening and stabilizing joints
What are tendons? Connections between muscle and bone
Presenting symptoms: pain-paraesthesiae in the thumb, index and middle fingers often at night; sometimes relieved by hanging arm out of bed Carpal tunnel syndrome
Treatment for carpal tunnel syndrome -Plaster back-slab to immobilize the wrist - Steriod injection - Operative decompression
Main types of fracture - Transverse - Spiral/oblique - Greenstick - Crush - Burst - Avulsion - Subluxation
This type of fracture usually occurs in children Greenstick fracture
This type of fracture usually involves a joint and results in malalignment of the joint surfaces Subluxation
What is the most common classification system for fractures Salter and Harris
Name the Salter and Harris classifications Type I, II, III Type I: fracture passes along epiphyseal line with no metaphyseal fragment; occurs in young children Type II: most common, epiphyseal line and then oblique with a small part triangle of metaphysis Type III: vertical split of epiphysis and fragment displ
Dupuytren's contracture 4x associations Manual Labour Epilepsy Alcoholism Diabetes
Finding on a positive Tinel's sign Median nerve distribution sensation, i.e. radial side of palm
Nail clubbing: 3x Cardiac causes Myxoma R-L shunt Endocarditis
Nail clubbing: 5x Resp causes Bronc CA Mesothelioma CHRONIC suppurative dz Fibrosis CF
After activity, an OA joint will be? Less stiff, but more painful.
X-ray sign of OA x4 Reduced joint space Subchondral sclerosis Cyst formation Osteophytes
Colle's fracture x5 characteristics Impacted Laterally angulated Dorsally angulated Displaced Supinated
Septic arthritis (not osteomyelitis) treatment + why important? S. aureus can destroy a joint in 24hrs (it is cartilage not bone like osteomyelitis). Tx: Flucloxacillin + Fusidic acid IV 2/52 + 4/52 PO.
What are the 6xPs of compartment syndrome (ischaemia) Pain Pallor Pulselessness Paresthesia Paralysis Perishingly cold
Compartment syndrome Dx. Why 30mmHg? Because capillaries require 25mmHg to supply muscles, else necrosis.
Bone mets come from x5 Breast Bronchus Thyroid Renal Prostate
Alcohol's role in gout. What are the two mechanisms and which is the principal mechanism? Inhibited urate excretion. Increased purine ingestion (principal mechanism).
Systemic symptoms in pseudogout? Confusion Fever
Pseudogout deposits where? Fibrocartilage
OA and RA common finding reduced joint space
OA/RA? Erosions RA only
OA/RA? Subchondral cysts OA only
OA/RA? Subchondral sclerosis OA only
Dx: Bilat butt/thigh claudication relieved by rest Spinal stenosis
To Dx Spinal stenosis, what must you rule out? Vascular dz
Differentiate septic and reactive arthritis of the knee Arthrocentesis: organisms Also systemic symptoms septic > reactive NB Pus and WBC don't help
DEXA: explain 2x scores T-score: is the value compared to control subjects who are at their peak BMD Z-score reflects a value compared to patients matched for age and sex.
What is a 'normal' DEXA T-score? Within 1 standard deviation (SD) of the mean BMD value in a healthy young adult.
Ranges for 'abnormal' DEXA T-scores x3 -1 to -2.5 SD: osteopenia < -2.5 SD: osteoporosis <-2.5 SD & fragility fracture(s): severe osteoporosis
What are the four muscles that make up the rotator cuff? SITS = supraspinatus, infraspinatus, teres minor, subscapularis
Define thenar eminence. muscles found on palmar surface at base of thumb
Define hypothenar eminence. muscles found on palmar surface at base of little finger
List the grading scale for muscle strength. 5 = full ROM against gravity, full resistance 4 = full ROM against gravity, some resistance 3 = full ROM against gravity, no resistance 2 = passive ROM 1 = trace movement 0 = no movement
What is a swan neck deformity? hand deformity characterized by hyperextension of PIP joint and hyperflexion of DIP joint
What is the ddx for swan neck deformity? congenital trauma RA
Which is more common, anterior or posterior shoulder dislocation? anterior (98%)
What is scoliosis? lateral curvature of the spine associated with rotation of involved vertebrae (usually thoracic or lumbar, rarely cervical)
What is the diagnostic workup of anterior/posterior shoulder dislocation? AP and lateral radiographs
What is the common name for medial epicondylitis? golfer's elbow
What is the common name for lateral epicondylitis? tennis elbow
What is the etiology of medial/lateral epicondylitis? unknown direct blow overuse → repetitive use of flexors or extensors of forearm leads to degeneration (tendinosis)
What is the clinical presentation of medial/lateral epicondylitis? gradual onset, dull ache, pain with rotation medial epicondyltis → pain at common flexor tendon, increases with flexion of hand against resistance lateral epicondylitis → pain at common extensor tendon, increases with extension of hand against resista
What is the diagnostic workup of medial/lateral epicondylitis? none
What is the management of medial/lateral epicondylitis? 1. usually self-limited 2. NSAIDs 3. rest 4. ice after activity 5. avoid offending activity 6. exercise program of gentle stretching and strengthening as pain subsides 7. steroid/lidocaine injection 8. surgery if refractory to treatment
What is mallet finger? avulsion of the extensor tendon where it inserts at the base of distal phalanx (or possibly associated avulsion fracture)
What is the mechanism of injury for mallet finger? flexed distal phalanx swelling and tenderness of dorsal DIP joint lost of active extension of distal phalanx if long-standing injury, hyperextension of PIP joint may occur → swan neck deformity
What is trigger finger? catching, locking or snapping of involved finger flexor tendon
What is the mechanism of injury for trigger finger? swelling of flexor tendon and sheath if child + thumb → think congenital if multiple fingers → think rheumatoid disease
What is the clinical presentation of trigger finger? nodular thickening, swelling and tenderness near MCP joint finger may lock in flexion or extension if locked in flexion, manipulation to unlock it may produce palpable snap worse with rest, better with activity
What is the most common complication of a humeral fracture? radial nerve injury
What is hallux valgus? lateral deviation of great toe at MTP joint
What is a bunion? bony and soft tissue enlargement over medial aspect of head of 1st MTP associated with hallux valgus
What is a Baker's cyst? enlargement of semimebranous bursa normally present in medial aspect of popliteal fossa
What is the etiology of a Baker's cyst? secondary to intra-articular knee disorder (posterior tear of medial meniscus, OA, or RA) which causes increase in joint fluid → fluid fills bursa
What is the clinical presentation of Baker's cyst? cyst in medial aspect of popliteal fossa associated knee effusion if ruptures, may resemble thrombophlebitis or venous thrombosis!
What are 4 important ligaments of the knee? medial collateral ligament (MCL) lateral collateral ligament (LCL) anterior cruciate ligament (ACL) posterior cruciate ligament (PCL)
Which is more common, medial or lateral meniscus tear? medial meniscus 10x more common because its more firmly attached
Where do 95% of lumbar disc lesions occur? L4 and L5 disc spaces
List the parts of an intervertebral disc. outer portion → annulus fibrosus inner portion → nucleus pulposus
Does a lumbar disc herniation affect the spinal root above or below it? below
What is the clinical presentation of lumbar disc herniation? ower back pain → localized near disc, one-sided, deep, aching, refer to iliac crest or buttock, exacerbated with lateral flexion toward affected side if nerve root compression, radicular pain → radiates over buttock, down posterior or posterolateral leg
What is "bamboo spine"? complication of ankylosing spondylitis characterized by fusion of vertebrae
List the number of each type of vertebra. cerivcal → C1-C7 (C1 atlas, C2 axis, C7 vertebra prominens) thoracic → T1-T12 lumbar → L1-L5 sacral → S1-S5 (fused) coccyx
DDX Bruising (ortho) - vasculitis (infection) - diabetes - corticosteroid therapy - connective tissues dx
DDX calf swelling (venous/lymphatic/soft tissue/musculoskeletal) - DVT - Suferficial throbophlebitis -Varicose veins -Calf haematoma/trauma -Ruptured Baker's cyst - Cellulitis
DDX Chest Pain (ortho) - Ankylosing spondylitis -Cervical/thoracic spin disease
Cubital fossa contents (anatomy) Mnemonic: Please Remember Be Brave Medically From lateral to medial: Posterior interosseus nerve Radial nerve Biceps tendon Brachial artery Median nerve
Adductor muscles of thigh (anatomy) Mnemonic: Post-Graduates Love their Bachelor Of Medicine Pectineus Gracilis Adductor Longus Adductor Brevis Obturator nerve innervates all these muscles expect for the pectineus(femoral nerve). Part of the adductor magnus --> sciatic nerve Adductor
What are the muscles of the rotator cuff? Mnemonic:SITA S supraspinatus (abductor) I Infraspinatus (external rotator) T Teres minor (external rotator) S Subscapularis (internal rotator)
Latissimus dorsi position? Lady Diedre between Two Majors - Between pectoralis major and teres major
Carpal bones? From lateral to medial: Some Lovers Try Positions That They Cant Handle -Scaphoid -Lunate -Triquetrium -Pisiform -Trapezium -Trapezoid -Capitate -Harnate
What is the different between Osteoblast v osteoclast? OsteoBlast Builds bone OsteoClast Consumes bone
Radial nerve supplies which muscles? Radial nerve supplies all the BEST muscles -Brachioradialis -Extensors -Supinator -Triceps
Ulnar nerve supplies which musles? MAFFIA -Medial two lumbricals -Adductor pollicis -Flexor carpi ulnaris -Flexor digitorum profundus -Interossei -Abductor digiti minimi and hypothenar eminence
What are some of the hand nerve lesions? Dr. Cumar wrist Drop = Radial nerve Claw hand = Ulnar nerve Median nerve = Ape hand (or Religious person's hand, ie preacher)
Supination v.pronation SOUP and POUR SOUPination = turn your arm palm up, as if holding a bowl of soup POURnation = pronation is to turn your arm with the palm down, as if pouring soup out of a bowl
What muscles make up the lateral rotators? Please Go Out, Gus Operates Quietly Piriformis Gemellus superior Obterator internus Gemellus inferior Obturator externus Quadratus femoris
Posterior compartment of thigh By Tonight Memorise Map Biceps femoris semiTendionosus semiMembranosus adductor Magnus (hamstring portion)
What structures form the medial and lateral boundaries of the anatomical snuffbox? 1. Medial boundary: tendon of extensor pollicis longus 2. Lateral boundary: Tendon of extensor pollicis brevis
What does tenderness in the anatomical snuffbox signal? - Sign that the scaphoid bone has been fractures
What movements normal occur at the wrist? Which are the most restricted? - Felxion and extension (main movements) - Abduction and adduction (more restricted)
What type of joint is the interphalangeal jt of the thumb? movemement? - Hinge - Flexion/extension
What type of jt is the metacarpophalangeal jt of the finger? -Ellipsoidal -Flexion/extension + abduction/adduction
What muscle of the forearm attaches to the carpal bone? What is the muscle and the bone it directly attaches to? - Flexor carpi ulnaris - Attaches to pisiform
Explain how a fracture heals? (part I) 1. Formation of fracture haematoma with necrosis of bone immediately adjecent to fracture 2. Fibroblasts infiltrate the blood clot (organisation) 3. Subperiosteal and endosteal cellular proliferation with cellular tissues forming from each side of #
Explain how a fracture heals? (part II) 4. The blood clot is absorbed and take little or no part in the repair process 5. Callus formation when osteoprogenitor cells are stimulated to proliferate and become osteoblasts 6. Osteoblasts lay osteoid that is calcified + becomes woven bone(callus)
Explain how a fracture healls (part III) 7. Consolidation when osteoblasts continue the repair process, replacing woven bone with lamellar bone 8. Remodelling - bone is resorbed and lamellar bone is deposited thus restoring bone to near normal form 9. Osteoclasts are important in remodelling
Define diaphysis Diaphysis is the shaft of a long bone or the part of a long bone formed from the primary centre of ossification
Define metaphysis The region of most recently laid down bone or the part of the diaphysis adjacent to the epiphyseal plate
Which spinal nerves are involved in knee-jerk reflexes? -L2 -L3
Which spinal nerves are involved in ankle jerk? -S1 -S2
Which component of the intervertebral disc is it that prolapses? - The nucleus pulposus prolapses through the annulus fibrosis
List two acute complications that may follow fractured neck of femur 1. Fat embolism 2. Avascular necrosis 3. Hypovolaemic shock - massive bleeding
What is the main source of arterial blood supply of the head of the femur? - The Trochanteric anastomosis
What are the retinacular fibres of the hip joint capsule? - Fibres that are reflected from the femoral part of the capsular attachment of the neck of the femur within the capsule
Which muscle is the principal flexor of the hip? Psoas major
Which three individual muscles are the principle flexors of the knee? 1. Biceps femoris 2. Semitendinosus 3. Semimembranosus (hamstrings)
What marker is raised in serum of Paget's disease? Alk.Phos.
What biochemical abnormalities are detectable in blood of osteoperosis patient? - None - Osteoporosis is such slow progression that no biochemical abnormalities are detectable
How do bisphosphonates work? - Decrease rate of bone turnover - Inhibits recruitment and function of osteoclasts - Promotes apoptosis of osteoclasts
At what vertebral level does the spinal cord end? L1-L2
What is the name of the collection of nerve roots? Cauda equina
At each spinal level, a pair of spinal nerves emerges from the intervertebral foramina. What connects each of these spinal nerves to the spinal cord? 1. Dorsal root 2. Ventral root
What type of senses is the dorsal (posterior) root responsible for? -Sensory (afferent) fibres
What type of senses is the ventral (anterior) root responsible for? - Motor (efferent) fibres
How is BMI calculated? mass (kg)/heights (m)2
What is underweight BMI? <18.5 kg/m2
What is normal BMI? 18.5-24.9kg/m2
What is overweight BMI? 25-29.9kg/m2
What is obese BMI? >30kg/m2
Created by: lrwingfield