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Module 2 - ortho (mostly) (some of the classics (carpal tunnel…

- - - - tender at common extensor origin at lateral epicondyle
      - pain exacerbated by resisted wrist extension
    - - tender at common flexor origin at the medial epicondyle
      - pain exacerbated by resisted wrist flextion
  - - - inflammatory arthritis
      - trauma
    - - pain at site
      - swollen tender and crepetations
      - REST, splinting, local corticosteroid injection
      - 'patient releases triggered digit with other hand'
  - - - excessive friction at elbow
      - pain on flexion if septic
      - distended and tender bursa
      - aspirate to check for infection
        
        infective = antibiotics
        
        noninfective = steroid injection
    - - located lateral to greater trechanter of femur
      - pain over effected trochanter, exacerbated by movement
      - physio, then steroids, then surgery
    - - kneeling jobs - common
      - hot red swelling, painful active knee extension
      - aspirate to exclude infection and gout
        
        avoid serial aspiration
      - rest or if repeated surgical excision of bursa
  - - - flection contractures of the metocarpalphalangeal and interphalageal joints > 1 finger
      - ulnar side more commonly effected
      - not painful
      - progressive or stable
      - positive table top test
      - surgery - palmar faciectomy
- - - - medial more common than lateral
      - two methods
        
        degenerative
        
        older people
        
        abnormal cartilage
        
        traumatic
        
        fine then injury
        
        associated with ACL tear
      - 4 types
        
        bucket handle
        
        radial
        
        horizontal cleavage
        
        flap/parrot beak
      - more peripheral = closer to vacular supply = more likely to heal
      - injury whilst playing sport
        
        twisting
      - joint line tenderness
    - - normally restrains anterior tibial translation and rotation
      - twisting injury in football or skiing
      - anterior draw test, lachman and pivot shift
      - RICE, physio, surgery
      - associated with immediate swelling - heamarthrosis
    - - primary restraint to posterior movement of the tibia on femur
      - rare
      - road traffic accidents, goalkeepers injury
      - check distal vasculature
      - rehab to treat
    - - MCL
        
        common
        
        valgus strain (hit on outside)
        
        opening up of joint on valgus stress
      - LCL
        
        rare
        
        varus strain (hit on inside)
      - physiotherapy and bracing
    - - prevented from dislocating by
        
        large lateral femoral condyle
        
        insertion of vastus medialis oblique and medial patella femoral ligament insertion
      - uncommon
        
        habitual
        
        young women
        
        traumatic
        
        sort, flexed knee, side impact
      - clinical
        
        very painful
        
        later - patella apprehension and J-sign
        
        do an Xray
        
        reduction and physio, pssibly surgery
  - - - clincial
        
        rugby player
        
        loss of normal contour
        
        papable glenoid
        
        complete loss of movement
        
        AXILLARY NERVE
      - 98% anterior
      - posterior - light bulb sign
      - treatment
        
        reduce dislocation then collar and cuff
        
        physio
        
        rarely sugery
      - reoccuranc e is commom
    - - Supraspinatus
      - infraspinatus
      - teres minor
      - subscapularis
  - - - inversion = lateral ligament
        
        talus tilts in varus
      - eversion = medial ligament
        
        talus lilts in valgus