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111 Cards in this Set
- Front
- Back
Describe the blood supply to the femur |
"1. ligamentum teres |
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Describe the bony anatomy of the femur |
"-head of femur |
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Describe the 3 areas of bone
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"-Epiphysis
-Metaphysis -Diaphysis" //fce-study.netdna-ssl.com/2/images/upload-flashcards/31/26/56/5312656_m.jpg |
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Describe the landmarks of an intracapsular hip fracture
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"below the femoral head -> base of femoral neck
(Fracture @ intertrochanteric line = extracapsular fracture )" //fce-study.netdna-ssl.com/2/images/upload-flashcards/31/26/59/5312659_m.jpg |
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Describe the late changes of OA in the hip
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"-fixed flexion ( w/ Thomas's test ) |
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What X-ray changes are seen in Osteoarthritis
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"(LOSS)
-Loss of joint space -Osteophytes -Subchondral sclerosis -Subchondral cysts" |
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What X-ray changes are seen with Rheumatoid arthritis
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"-Bony erosions
-Periarticular osteopenia -Loss of joint space -Pannus -RA deformities (subluxation ect..)" |
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Characteristics of hip dislocation
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"-Internal rotation
-Shortening of leg" |
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Characteristic of hip fracture
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"-External rotation
-Shortening of leg" |
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What does trendelenburg's test show
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Weak gluteal aBductors ( drooping on the unaffected side-i.e muscles are unable to hold the opposite side )
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If multiple lytic bony lesions on X-ray ...?
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"? bony metastasis
commonly from myeloma/lymphoma, prostate, breast, lung" |
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Describe the nerve supply to the thigh
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"Anterior compartment - Femoral nerve (L2-4)
Posterior compartment - sciatic nerve (L4-S3) (exists from greater sciatic foramen) Medial compartment - Obturator nerve (L2-L4) ( exits from obturator foramen)" |
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What structures are located in the popliteal fossa
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"-Popliteal artery/vein
-Tibial nerve ( arises from sciatic nerve) - divides into the posterior tibial nerve & common peroneal nerve" |
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Describe the nerve supply to the leg
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"Anterior compartment - Deep peroneal nerve (& 1st web space )
Lateral compartment - Superficial peroneal nerve Posterior compartment - posterior tibial nerve" |
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"What injury affects the common peroneal nerve
what does it result in?" |
"Tight cast
Foot drop" |
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What is shenton's line ?
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"Helps to diagnose a neck of femur fracture
line drawn from inferior border of the superior pubic ramus --> medial border of the femur neck" //fce-study.netdna-ssl.com/2/images/upload-flashcards/31/27/10/5312710_m.jpg |
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What is Trethowan's sign?
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"Helps to diagnose SUFE (slipped upper femoral epiphysis )
a straight line superior surface of the femoral neck should pass through the femoral head. If it remains superior/does not touch the femoral head/epiphysis --> trethowan's positive" |
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What is characteristic of a frozen shoulder (i.e adhesive capsulitis)
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no external rotation
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"What does Hawkin's test elicit ?
How do you perform Hawkin's test" |
"Pain- suggest shoulder impingement
-perform passive internal/external rotation of the shoulder" |
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Characteristic of shoulder impingement
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"-Painful arc (60-120 degrees)
-Hawkin's positive -Pain on internal rotation" |
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How do you elicit an isolated movement of the subscapularis muscle?
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internal rotation
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"What is os acromiale ?What can it lead to ?" |
"Unfused area of acromion |
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What are the contrainidications for joint INJ/aspiration ? |
Overlying cellulitis/Dermatitis
Artificial joint |
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For marfan's , what is the
inheritance Mutation? S/S |
Mutation in fibrillin-1 gene Autosomal Dominant
S/S: -Tall + long limbs -Lens dislocation -Scoliosis -Pectus excavatum -Pes planus -Aortic dissection
-Mitral regurgitation -Berry aneurysms |
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For Ehler's danlos. what is the
Defect ? S/S |
Defect in Type I/IV collagen--> weak collagen!
S/S -Blue sclera -Hyperextensible skin -Bruising -Berry aneurysms |
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For Osteogenesis imperfect , describe the
Inheritance Defect S/S
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Autosomal dominant Defect in type I collagen
S/S -Blue sclera -Multiple # -Hearing loss |
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What is the sarcomere composed of ? |
(MHAIZ)
M line H band - Thick filaments A band - Thin + Thick filaments I band - Thin filaments Z line |
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Is type I muscle fibre
Slow/Fast Red/White ? |
Slow - Red |
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Which type of muscle fibre has more mitochondrial/myoglobin ?
Type I or type II |
Type I |
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What type of muscle fibre uses anaerobic respiration? |
Type II |
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Describe endochondrial ossification |
Cartilage formation --> woven bone -> lamellar bone
For longitudinal bone growth |
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Describe membranous ossification |
Woven bone -> lamellar bone
For Flat bone growth |
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Woven bone is found in what? |
Fractures
Paget's disease |
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What do osteoblasts do ?
Where do they originate from? |
Lay down & mineralize bone
From Stem cells in periosteum |
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What do osteoclasts do ?
What are they derived from ? |
Dissolve bone
Macrophages |
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What muscles are involved in shoulder aBduction ? |
Supraspinatous tendon
Deltoid
Serratus anterior |
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What is the serratus anterior innervated by ? |
Long-thoracic nerve |
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Name the rotator cuff muscles |
(SITS)
Supraspinatous Infraspinatous Teres minor Subscapularis |
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What rotator cuff muscles performs internal rotation ? |
Subscapularis |
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What rotator cuff muscle initiates shoulder aBduction ? |
Supraspinatous |
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Which rotator cuff muscle performs external rotation? |
Infraspinatous |
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Name the bones of the hand |
(Some lovers Try Positions That They Can't Handle)
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
-Metacarpals -Phalanges |
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What do the palmar interossei muscles do ? |
(Palmars ADduct =PAD)
aDduction of fingers |
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What muscles oppose the thumb ?
What nerve is it innervated by ? |
Opponens pollicis brevis
Ulnar nerve! (tested by Froment's test) |
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What is froment's test ? |
Finger a piece of paper - if Ulnar nerve injury then the thumb will bend to keep a hold onto the paper |
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How do you Rx DDH ? |
If < 6 months = splint
If 6-18 months = closed reduction
If > 18 months = Open reduction |
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How do you Rx PERTHES |
Rest + cast to maintain aBduction
If > 1/2 femoral head = surgery |
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What x-ray sign is seen in SUFE's |
Trethowan's line |
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What limited hip movement is seen in SUFE's? |
reduced internal rotation
(Hip is externally rotated) |
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What is Transient synovitis ? Ix |
Diagnosis of exclusion!
Post URTI --> Arthritis
Ix: Normal WBC |
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What does the popliteal fossa contain ? |
Popliteal artery & vein
tibial nerve ( Supplying the posterior leg) |
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What is the happy triad ? |
Injury to
ACL MCL Medial menisci |
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What is characteristic of a meniscal injury ? |
pain along joint line
clicking/locking knee
Inability to squat |
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tenderness/swelling over patella + prolonged kneeling + pain worse w/ kneeling/walking ? |
Housemaid's knee (i.e Prepatellar bursitis ) |
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tenderness inferior to patella ? |
Osgood Schlatters |
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Hx of Jumping + Gradual onset knee pain ? |
Patellar tendonitis |
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How do you Rx Baker's cyst ? |
Physio + NSAIDS
(Aspiration, arthroscopy) |
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Name the bones in the foot |
-Talus ( Ankle joint) -calcaneous -Cuboid -Navicular -Cuneiform (3x)
-Metatarsals -Phalanges
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what is Hallux valgus ?
Rx? |
Lateral deviation of the big toe
Rx: Bunion pads, wedges b/w 1st and 2nd toe |
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What is pes planus ? |
Flat feet |
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What is Pes cavus ? |
high arched foot |
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What is quinti varus |
Overriding 5th toe |
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For a ruptured achilles tendon, describe risk factors
S/S Rx |
Risk factors: Badminton , Obesity , trauma
S/S: inability to plantar/stand on toes , Pain @ achilles tendon
Ix:
Simmonds test
Rx: Cast in equinus position |
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What is simmonds test |
Squeezing the gastrocnemius --> Plantar flexion normally |
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For plantar fasciitis, describe
Risk factors S/S Rx |
Risk factors: Running , obesity
S/S: Pain @ heel of foot.
Rx; Steroids INJ |
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What does the long thoracic nerve innervate ?
Injury ? |
serratus anterior
Winged scapula |
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What does the thoracodorsal nerve innervate ?
Injury ? |
Latissimus dorsi
"Can't wipe bottom" -i.e shoulder extension |
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What is the motor function of the musculocutaneous nerve ? |
Forearm flexor & supinator |
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What is the motor function of the axillary nerve ? |
Deltoid |
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What is the motor function of the radial nerve ? |
Extensors of arm |
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what is the motor function of the median nerve? |
Pronation
Flexion of wrist/fingers (i.e lumbricals)
Thenar muscles |
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What is the motor function of the ulnar nerve ? |
Intrinsic muscles of hand ( aBduction & aDuction)
Hypothenar muscles
Opponens pollicis brevis (thumb opposition) |
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Improper use of crutches , what nerve injury ? |
Radial nerve |
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# surgical neck of humarus - what nerve injury ? |
Axillary nerve |
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Suprachondrylar # of humerus , what nerve injury ?
Why is it also important |
Median nerve
Damage vascular supply! - poor radial pulse!!
SURGICAL EMERGENCY |
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Midshaft # of humerus , what nerve injury ? |
Radial nerve |
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Shoulder dislocation - what nerve injury ? |
Axillary nerve |
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Fibular neck #, what nerve injury ? |
Common fibular/peroneal nerve |
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Colles # , , what nerve injury ? |
Median |
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medial epichondylar fracture of humerus , what nerve injury ? |
ulnar nerve |
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Honeymooner's palsy , what nerve injury ? |
Radial nerve |
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Tight leg cast , what nerve injury ? |
Common fibular/peroneal nerve |
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Obturator nerve
What compartment is it located in ? Function? |
medial thigh
Hip adduction |
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Femoral nerve
What compartment is it located in ? Function? |
Anterior thigh
Hip flexion knee extension |
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Sciatic nerve
What compartment is it located in ? Function? |
Posterior thigh
Hip extension Knee flexion |
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What does the sciatic nerve divide into ? |
Common peroneal/fibular -> superficial/deep fibular nerve
Tibial nerve |
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Common peroneal nerve
What compartment is it located in ? Function? |
Anterolateral leg
-Dorsiflexion of foot - Eversion |
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Damage to Common peroneal nerve results in what ? |
Foot drop
high stepping gait |
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What does the tibial nerve innervate ? |
posterior leg |
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Which nerve is purely sensory to the foot ? |
Sural nerve |
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What is important to assess for given a history of a Fracture ? |
Neurovascular bundle
Compartment syndrome
|
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How would you manage a fracture ? |
( 6 A's)
Assessment Analgesia Alignment Anti-septic ABx Anti-tetanus |
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What is characteristic of compartment syndrome ? |
Pain on passive stretch |
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What are the complications of a fracture ? |
Infection, hemorrhage
Compartment syndrome
neurovascular damage
Fat embolism
DVT/PE
Malunion/non union |
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What is rhabdomyolysis ?
risk factors Ix |
breakdown of muscle
Risk factor: Prolonged compression , crushed limbs/compartment syndrome
Ix: ↑ myoglobin/CK , Hyperkalemia |
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What are the complications of rhabdomyolysis ? |
AKI
Hyperkalemia |
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How do you Rx Compartment syndrome |
Fasciotomy |
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when are tension band wires useful ? |
Fractures near ligaments ( since the ligaments can pull it away |
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Fall on an outstretched hand in a kid , what fracture ? |
Supracondylar fracture (damage to median nerve- emergency due to risk of vascular damage!)
Medial epichondylar fracture |
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Pain in the anatomical snuffbox, what fracture is likely ? |
Scaphoid # |
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What X-ray finding is found in a hip fracture ? |
Shenton's line is loss |
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How do you Rx a hip fracture that is
intracapsular Extracapsular Subtrochanteric (i.e shaft) |
Intracapsular --> Hemiarthroplasty
Extracapsular -> Dynamic hip screw
Subtrochanteric -> intramedullary screw
+early mobilization |
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What are the complications of a hip fracture ? |
Hemorrhage, infection , DVT/PE
Fat embolism
malunion/nonunion
Avascular necrosis |
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what is a lisfranc injury ? |
Midfoot injury resulting in metatarsal dislocation |
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What is the DDx for shoulder pain ? |
Impingement - Supraspinatous tendonitis, bursitis , tendon rupture , Os acromiale
Calcific tendonitis
Adhesive capsulitis
Arthritis ect.. |
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What is characteristic of shoulder impingement ? |
Painful arc (10-120 degrees)
worse on internal rotation (i.e Hawkin's sign) |
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What is characteristic of calcific tendonitis ? |
Painful arc + swelling worse on palpation |
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What is characteristic of rotator cuff tear ?
Ix |
No active movements !
Ix: USS , MRI |
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What is characteristic of adhesive capsulitis ?
progresion ? |
Freezing painful phase -> Frozen -> thawing
(months - years)
Limited passive movement + no external rotation
|
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How do you manage shoulder pain ?
how would you manage rotator cuff tear ? |
1. NSAIDS + Physio + analgesia
2. Steroid INJ
If rotator cuff tear > 1 cm -> surgery |
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a shoulder is commonly dislocated in which direction ?
What structures may be damaged ? |
Anterior
Axillary artery + posterior circumflex artery |