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T&O Progress T est Revision ‘A game of 20 questions’Overview of the session 20 MCQ Questions Polls Learning Points • Taken from PassMedicine • Will show the question on • Once the correct answer is screen, along with a poll to shown, we’ll walk through • Covers the major themes put your answer why this is the case •will have 80 seconds tost, you • from each question will be answer the question shown • I won’t pick anyone out to answer any questions!Location of Fracture Treatment Undisplaced intracapsular Internal fixation fracture If mobile (not using more than a stick) - Total hip Displaced intracapsular replacement (THR) fracture If non-mobile - Hemiarthroplasty Intertrochanteric fracture Dynamic hip screw (DHS) Subtrochanteric fracture Intramedullary nail (IM nail) Empty can test - Done for supraspinatus muscles as part of shoulder exam McMurray's test - Done for meniscus tears - Presents very similarly to this - difference is the time for swelling to occur - ACL tear: Immediate - Meniscal: Over time Posterior draw test Lachman’s test - Best test for ?ACL tear - This is done for PCL tears - Mechanism of injury does not suggest PCL tear - Slightly better than anterior draw test - difference is LT is done at Sweep test 20-30 degrees, ADT is at 90 - This checks for effusions around the knee - Whilst it will be positive, it won’t give you a cause Avascular necrosis of the femur - This can be a complication of the initial fracture - Patient has had THR meaning there is no femoral head anyway Iliotibial band syndrome - Presents with hip pain and tight sensation of lateral aspect of the thigh - Typically affects younger people who do long distance running Infection of the joint replacement Aseptic loosening of THR - This is typically an acute complication, unlikely to - Most common reason that THR need to present 18 months later be revised - Presents with hip pain radiating to knee Periprosthetic fracture - Fracture involving the new replacement - Unlikely as patient is able to weight bear and can walk Bony mets - Worth thinking of for OSCE’s, but wouldn't explain infective picture as easily Inflammatory spondyloarthropathy - Can present as back pain with raised CRP, but more likely to involve multiple joints - Would also have joint pain and stiffness that’s worse in the morning and improves with activity Lumbar disc herniation Discitis - Typically acute onset pain following strenuous exercise, associated with neurological deficits at - Low grade fever, elevated WBC + CRP - History of IV drug use the associated spinal level Spinal fracture - Associated with either trauma or osteoporosis - No fracture on MRI - Wouldn’t explain infective picture Lateral epicondylitis - Does not involve ulnar nerve Median nerve entrapment syndrome - Does not involve ulnar nerve Radial tunnel syndrome - Does not involve ulnar nerve Cubital tunnel syndrome Medial epicondylitis - Compression of ulnar nerve - Tendinitis of common flexor tendon - This is made worse with flexion of the - Can involve ulnar nerve elbow - This is made worse with flexion and pronation of the wrist Routine referral to neurosurgery - 2nd line management is referral to spinal surgery for an injection/operation Start oxycodone - Opiates should not routinely be given for back pain (poor efficacy + dependence) Emergency admission to neurosurgery NSAIDs + physiotherapy - Patient is stable and no signs of cauda equina syndrome - Patient has sciatica along L5 distribution - Conservative management of NSAIDs, physio is 1st line, and successful in 90% of Reassurance and discharge cases - Small risk of worsening symptoms and progression to cauda equina syndrome Femoral nerve - Loss of sensation in anterior and medial aspect of thigh - Weakness in hip flexion and extension Obturator nerve - Associated with anterior hip dislocations - Weakness with thigh abduction - Loss of sensation of anterior aspect of thigh Pudendal nerve - Sensory impairment to external genitalia Sciatic nerve - Bladder and bowel dysfunction - Common complication of posterior hip dislocations Tibial nerve - Foot drop is explained by a damaged - Altered sensation in the foot common peroneal nerve, which comes off the sciatic nerve Rotator cuff tears - No weakness of the rotator cuff muscles Glenohumeral instability - Can lead to impingement type syndrome but history is classical for subacromial impingement AC degeneration - Associated with popping, swelling, clicking, grinding and a positive scarf test Subacromial impingement - Pain with shoulder abduction from 90-120 Calcific tendonitis degrees is typical of impingement - Extreme pain on palpation, prohibiting examination Biopsy - Will cause damage to local area - Cannot tell you the depth of the infection CT - Appropriate as a second-line investigation if MRI is unavailable Repeat examination - Will not provide any further information MRI Ultrasound - 1st line investigation for osteomylitis - Poor method for imaging the boneLocation of Fracture Treatment Undisplaced intracapsular Internal fixation fracture If mobile (not using more than a stick) - Total hip Displaced intracapsular replacement (THR) fracture If non-mobile - Hemiarthroplasty Intertrochanteric fracture Dynamic hip screw (DHS) Subtrochanteric fracture Intramedullary nail (IM nail)Thank you! Any questions → joshua.williams@student.manchester.ac.uk luqman.aizan@student.manchester.ac.uk Please fill out the feedback form! Final session is next tuesday on vascular disease and vascular disorders of the upper limb.Thank you! Any questions → joshua.williams@student.manchester.ac.uk Please fill out the feedback form! Will be repeating this teaching session again for the May exam Look out for other T&O related events in the meantime!