Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Okay. Welcome, everyone. Oh, good evening. Thank you all for coming. I'm on. Um, I'm president off Orthopedic society here. Cardiff on auto. Eventually need for surgery Society on one of the teachers here. I ate it. So today we've got our orthopedics session. Um, these are all those sessions that we've got coming up after today's session. Our next one will be your family. Gee, which is on Thursday on. We have a whole host of other, uh, specialties to get you or fishing ready for the upcoming progress test exam. So his everything will be covering today, um, on. But yeah, if my wife is a bit dodgy. So if I do cut out Teo, take my apologies. And if the is that committee, just give me a room if anything is to occur, but fingers crossed to touch with nothing along should go smoothly. So on to our first sp of the day, she'll read. So I'll just read about a six year old child. Comes to the GP with mother, complaining of the pain in his hip and having a limp. He has a temperature of 38 1 on a clinical examination or findings on all. However, his mother, of course, you've recently recovered from a recent viral infection. What is the most likely cause? So can people see the whole of the movement? Okay. Whole should be, You know, you know, another 10 seconds. Okay. Seems like majority of you floated, so Yeah, most of you got the cancer right now, which is a transient synovitis. Um, so yeah. So here the correct answer is transient sinusitis, mostly due to the but they had a fever. A recent rider infection on it's acute onset DTH eyes more common in girls and mostly found in newborns. Septic arthritis possible. But the child would follow that. They should have seen a bit more point us to say that the child was unwell in history, on juvenile arthritis, painless can have an acute presentation, but not really. That common would be a chronic kind of condition. So here are all there are different pills for a limp in a child. So we have developmental displeasure of the hip. So also known as do th risk factors are being overweight at birth, so way more than 5 kg. Um, while ago Ha hydramnios breach presentation. Being female is Well, there's also a risk factor. Um, the investigation of choice. If the baby is more reply, 0.4 point five months and then X ray on it, it's less than 4.5 months, then ultrasound. The follow and it'll only tests are used are what we use clinically. So if any of you have done your pediatric placements or on GP, you might see, um, the doctor's performing this clinical exam during baby checks either at birth or at the developmental more stones. So the Barlow test that attempts to desiccating articulated for more head on the It'll only attempts to relocate it dislocated from or head. So be it. They might, too. Just, Well, information's quite so important to know these actors transit. So no writers as that in the DEA has an acute onset recent viral infection, always more effected. So that's type of boys more affected than girls on. You might have a temperature. Well, uh, sent it off, for it is also in my life. Just high fever on the child will be systemically and well juvenile idiopathic operators. Painless, limp on chronic concept. Sufi slipped off a poke them all, uh, purposes. Um also known a Sufi more common in boys obesity. So, in the stem of the question, almost likely, say, a beast, you know, 10 to 15 year old boy. And that's your big other way on purpose is more common in boys on. It's caused by a vascular necrosis, other from all head investigation of choice. For this is X ray on its most common in 48 4 to 8 year old year olds on. Do you have some complications later in life? It is well, such as osteoarthritis on provincial fusion, Of course, states. So want to our second s p a. A 74 year old woman fell over on the way to the bathroom in the middle of the night. She has a past medical history of osteoporosis type two diabetes and hypertension. She normally mobilizes with a frame. A hip X ray shows a displaced intracapsular fracture of the neck of the femur. What is the most likely management? Um, and huh Daniel have these sort of typical. Yes, I think we have. Thank you. Okay. Cool. Yeah. Should Yeah. Yeah, all right. Whilst the police running, could you feel with juvenile ideopathic again? Someone past the juvenile. It a pack. Arthritis is a sin. The name off writers in the used with unknown cause. So it usually has a chronic presentation on, you know, present as similar to the arthritis. You know, so pain in the joints, stiffness, difficulty on activity on things and such really. So most of you have gone for option B, which is indeed the correct answer Hemi offer past due. I'm sorry. This is a bit but extra SPH on, so Yeah, same lady. But the question essentially is what classifications system is most likely to be used in a patient who has had a hip fracture. So which of these clinical scoring systems do we use? Um, for intracapsular hip fractures. Really? Yeah. Okay. So sleeping, like most of you have done it on. Most of you have gone for garden. Correct. So on our But we used to live with him. A what? A while we use for uncle Garden we use for the hips. Do you use for colorectal cancer on brochure? Used it again. The type that strike in the hospital. We, uh yes, over here for a hospital shrink on. Just just for actual knowledge fast is will be used in the community strike. So I want to check a femur fractures. So first step when you have a neck and femur fracture is on in the stomach question the presentation will be shortened and externally rotate that. That's your massive give away for neck of the femur fractures. Risk factors for this include, you know, female gender, frequency of falls. Um, Austria process. I just listed them all in our cheat sheets at the end of the slide. So someday where eso the first question to ask is intracapsular or extracapsular if it's extra capsule. Oh, you want to know? Is a truck intercourse? Subtrochanteric If it's intracapsular, is it just space or is it um so when Yeah. So this is how we manage introductory. Um, I think you cut our for a few seconds that you want to just go on repeats the worst. Thank you. Uh, what did I call up from? If extracapsular maybe. Yeah, I think that that was it. Your assay? This one? Yes s Oh, I just told her. And so Yeah, And shortened and externally rotated as common, most commonest presentation of neck of femur fracture on. That's what will be most likely resting in the SBA stem. Uh, first question you want to ask yourself, Is this fracture intracapsular or is it extracapsular? If his extracapsular is a trochanter it or is it subdural control? It was intracapsular. Is it displaced, or is it undisplaced on the way? You've find out this information is either an X ray will be given to you in the question, and you have to see it. So an extra capsule Oh, is below the greater trochanter. Um on and intracapsular is above the greater trochanter. So yeah, either they'll tell you up right in the SBA, or they'll give you an X ray and you have to kind of deduct it yourself on. I've labeled here chocolate type fracture and subtrochanteric. Actually, it's both. So this is how we manage on intracapsular fracture. So, as I said, if you haven't intracapsular Proctor, the two questions you want to ask is, is it undisplaced? Or is it this place? Does the patient have significant co morbidities so in my lady in the stem, she had talked to diabetes and high potential. Every so, um, you would could say yes and this, and I think she had an undisplaced a swell on. She had significant claim ability. So that's why the answer was hemiarthroplasty in that question. On some things that you This is very useful growth chart to answer these questions. And hopefully you'll get all these questions right next time. If it's a displaced, interactive the fracture. If there are significant co abilities, Um, you go for help me if there aren't any significant co morbidities good when you go for a total, So think of if a young I don't know, rugby player. So he's young. He doesn't have any equipment. Bities. You want to replace the whole hip, but then think, If you know there's an elderly lady, it's it's being a bit of a trauma situation. Um, doing a full hip replacement is gonna be very risky. It's a good for me. Extra perhaps nose far easier if it's into treatment. Eric, you go for a dynamic hip screw or more supportive, like to call it DHS, Um, a subtrochanteric you go straight for or a nail. It's a very cool procedure to see this. It feel everyone of surgical placement. I definitely recommend getting in to see one right onto our next topic, which is shorter. So a decent capsulitis still start off with a common presentation. So this is also known as frozen shoulder eso, your most common presenting place as obvious shoulder pain and stiffness. Key respect is for this are diabetes on adults in middle age, it's a clinical diagnosis. Eso imaging is not quiet, although if you were to do an ultrasound, a CT and an emery, it will show us that the joint capsule you manage it with analgesia because the therapy steroid injections on hydro if indicated, hydrodilation so super spinous tendon apathy. So this is when you have impingement off the Super Spinous tendon. When it passes between the humeral head and the Caribbean Onda, you can see the doctor here in the picture. She's doing the empty can test. Teo. Basically, that's when you stretch out your hand. You put your thumb down a bit like you're pouring can. That's kind of the what is called that on. The doctor will press on the rest if that elicits pain, think that's what we call a positive jobs test. Um, and that's, uh will help with the diagnosis off Super spinous tendon off. You also have painful arc. A bit of abduction between 60 and 120 degrees, um, and course tenderness over the anterior chromium. Secondly, Acromioclavicular joint arthritis. So this is the scarf test. So imagine you're putting a scarf on the opposite side opposite shoulder, so you're rocking a scarf around your body like that's patients. Doing that on that will be very painful for a person with a C joint. Arthritis. So that's what we use for that on pain on 1 70 degrees off the shoulder abduction. So carpet in its own room service. We should all be expert, so there's some sure we will cover this in here your pre clinical years, but you're presenting complaint is pain, numbness, paresthesia and the median nerve and distribution of the hunt. Ah, weakness of thumb movements, weakness of grip, strength. Some movements on atrophy of the you know muscles risk factors for carpal tunnel. Well, the majority of them have it unknown cause, but some factors are straining obesity. Menopause on rheumatoid. Even diabetes can help on just a tip. If you are presented with carpal tunnel syndrome to really stand out and make yourself seem about polish. You can just say, you know, this patient has carpal tunnel, but I would investigate for the possible causes off carpal tunnel. So whenever you see your nerve damage or something, just say to your risk your your skin is on there. I would investigate causes for this just to make you sound a bit clever. Even if you don't know the course, you just say I would investigate it. Um, so you use failings and Tinel's test clinically, um, you use also this questionnaire to predict the diagnosis that come up with a slot for carpal tunnel. Question on in order to fully make a diagnosis and confirm it s So this is what you would do in the GP setting. Um, no. Of conduction studies can be used to fully make a diagnosis so often, If you are worried about this patient and you know you're thinking they might need surgery, you would do no conduction studies. So management rest for we explained steroid injections. And last, uh, if none of those work, then you to surgery. So on two s being about four, a 40 year old man presents the GP with elbow pain is a keen tennis player on has increased pain on wrist extension. Which clinical tests May 8 in the diagnosis. Thank you. Four went to the pool. Give another 10 seconds time. What makes of you have to get so most of you got that right. It is indeed mills test. So Phalen's and tunnels is carpal tunnel follow. And ordinarily DTH. So Yeah, Mills test was quiet and I was quite nice about one because yeah, I just told you the other tests, but yes, so until elbows. So a lateral epicondyle itis This is quite a favor on past mid and progressed us also known as tennis elbow. So tennis players in the stomach My question. I said that patient was 18 tennis players. Pain. So this is where you have pain and tenderness. Localized to the lateral epicondyle you use the mills text on the coast is test which I've on the images. So this first image here is the mills test. So this is where the doctor is palpating the lateral epicondyle whilst the forearm is being stretched on it. Thoughtless. It's pain. Back and show battle Epicondylitis on the Cozaar is test so you'll wrist is extended over. Even see. The patient has called their respect on triggers pain to the natural aspect of the muscle meeting epicondyle lighters. So this is good for his elbow on, um, the Sinus. Quite nice. The test that I golfer's elbow test. That's where you apply pressure to the medial condyle. So 12 or next day, um, 45 year old man presents to his GP with intermittent tingling in his 4th and 5th finger. He finds this pain to be worse. When the elbow is resting on his desk at work for long periods of time, which nerve is most likely affected? Okay. Okay. Um Yep. So most of you got that right? Indeed. It waas. Oh, none of this is cubital tunnel syndrome on and another one's for. It's, um, not going to party. Um, a 45 year old man presents, too. Is she pee with always pain. He has swelling over the posterior aspect of the elbow. Swelling is warm to touch on erythematous in the parents. What of thumb is likely diagnosis. There's a bit of more of a tricky one. Been on 10 seconds. You can Yeah. you ordered really Well on that one. So yeah, indeed. So cubital tunnel, you'd have a tingling on the 4th and 5th finger. Not taking the just in the previous S p A. Um, these are two conditions. I just spoke about residual tunnel pain, appreciating forearm on the criminal bursitis, swelling over the posterior aspect of the elbow. So here's some other differential sort elbow pain. We talked about tennis elbow and golfer's elbow, and these are also differentials to consider. So age or Thompson drink. This is when the interosseous branch of the radio nervous, compressed, you usually have paying 45 centimeters distal to the lateral epicondyle. Um, pain is worse on elbow extension on forearm protein, a shin cubital tunnel syndrome. So that was in the SBA before the last one. That's just a compression of the older nerve. I get tingling the 4th and 5th finger, which is a later followed by associating numbness on weakness. It's worse when the elbow is on hard surfaces and rest for a period of time. Do you remember the FDA? I said that the guy, the pain is worse when his elbows on his a desk so that was a clue on. It's also worse when flexible period of time on early chronic bursitis and I was in the just the SP There you have a swelling on. You have everything like readiness on wolf pain. Also associate it on Middle aged males are most commonly affected. We'll get almost there making progress. SBA seven So a 50 year old white boy constant any due to pain in his wrist, he fell over on outstretched hand Hospital football? Yes, tenderness over the anatomical snuffbox, um, which he describes as being tennis or 10 X rays Review ALS and undisplaced actual. This stuff called What is the best management? Okay, so, mister, you went for a cost for 60 weeks, which is correct. So this was a scaffold fracture? Um, it's most commonly caused by a fall or to an outstretched hand on on exam. In clinical examination, you're noticed Loss of grip pain on the base of the thumb. Pain on over. Owner deviation of the rest. You might see some infusion around the joint itself on some maximal tenderness over the anatomical snuffbox. Um, MRI will give the definitive diagnosis, but x rays on you need four views of the x ray. That's not enough to have one. You need a full. And I have just written it is probably more detail than you need, but these are the views that you would like to request. So the way you manage to them. So indeed, this was an understated fracture of the scaphoid. So the management of choice would be your cast for 6 to 8 weeks if it was displaced or if it was a step forward call. You need surgical fixation. Okay? Don't back pain eso just to introduce the topic. Just some red flags that you should look helpful. You know, if you get back pain history, an exam. Oh, in your own clinical practice, make sure to look out for these trauma. Explain what lost neurological symptoms. Age of 50. Be there. I would. Jockeys, storied use and cancer. Uh, here are why these are red flags. So fractures a major trauma. You're concerned about damage to vessels on nerves? On go. Uh, yeah. Ah, fractures as well. You'll be worried about in that situation. Affections. I would drug use or pyrexia. It's a risk factor for, uh, due to possibility of infections if they young, then you know, that is quite a bit for respect, because young people normally shouldn't have back pain if they are younger than I am. Closes wonder lighters. Um and, you know, see that some of the others I've only likely written in here quarter acquiring it might be more covered in the neurological are zeros, but just to the capital side of anesthesia and nor cardiogenic cortication always in your skin's make sure to mention I would do a PR exam to check for a nose victor. Contraction Teo without cold or quinoa. So it's one a stenosis. So this is a pain or gradual onset. Uh, this is where the pain is relieved by sitting down really going forwards. Um, it can give you unilateral bilateral leg pain on. The pain usually gets better when you sit down. Might not. You might not find anything or clinical examination, but MRI's got standard. Uncles. This model right? Er services your bamboo spine it cause and you know, young males. Um, pain is worse in the mornings but improves the next slice on clinical examination, you might notice, reduce stress it crunch in. You'll troopers just sort of got to print image in. But basically, if you imagine, uh, putting two fingers on your back and then ask the patient you lean forwards, the two fingers should ideally increase more more than five centimeters. And if sugars test shows and closes bundle itis those fingers would not, uh, separate. Uh, so you have a juice lateral flexion. This is quite high yield of nickel on past minute. A few times. These are all the associated condition, which isis a lot very, uh, convenient. Be begin with a, um so fibrosis writers regurgitation, Achilles tendonitis. Maybe new book on a low dose is on peripheral lunches. Plain x room s so you would have this square, remember, First break from the spine said is muscle. It's, um, sac. Really, Artists of quality, of the reasons. Sclerosis. You manage it with NSAID snuffbox eyes. Naproxen is first line busy therapy on if it is performed joint involvement on disease, modifying drugs. What you see. So on to some no interest since our media nerve Andrews. We covered it briefly in, uh, when we did a cop tunnel, but can be caused by super condo, fracture of the humerus or distantly, it can be caused by the carpal tunnel compression of your wrist laceration motor loss. It causes inability to abduct thumb on also inability to make the okay sign sensory loss. You have sensory loss of Palmer aspect of the firm Index Middle a natural think finger. It's very nice of injury. So this couple caused by compression, for example, thing a massive the axilla could be caused by fracture of surgical neck, the humerus or anterior short of dislocation. Um, motion loss. It could be a deltoid. Prices can cause impaired arm abduction. Terry's mind practices cocoles impaired external rotation. Um, on sensory loss, it will cause, uh, loss in the regimental badge area and apologies. Oh, of course. I had an image in there, but mental large area is basically that area around your shoulder. So read another injury. So cause is actually not close. E um Mid shot humor proctor. So exhausting our clothes, You know, they call it up because students when they go on a Saturday night, they tend to injure those belts on subsequently caused damage to the nerve in this area. Motor loss in hers forearm extension on rest drop Central Los daughter aspect, Um, off the the, um and middle fingers Natural ring finger. And no, I haven't image of arms to the regiment of Barger is basically here. So on to a pill a practice. So Colin's fracture it's caused by a few sh! Which you know is a four on an outstretched hand transfer. This often cause water by the transverse fracture of a regis um, which can be one inch blocks were to the radio cop of joint on It's on X ray will see dorsal displacement on ANGULATIONS. Smith's fracture. This's where you seeing voter ambulation of the distal radius fragment. Also during his garden spayed deformity. Uh, we're taking this fracture. So this is dislocation of the proximal radio, all the joint which is associated with only fractures and golly artsy fracture. This is ah, Rachel shot fracture with associated dislocation off the distal. Really? Okay, I think we're towards the latter, and I think there's that might be one or two more after this. So 32 year old presents to any with sudden severe pain in his right, Me off the road, Me much with some friends mentioned that he was tackled from behind and then suddenly felt part of the sudden, uh, 10 out of 10 pain on examination. There is right sided, newer fusion. Blackman tests positive. What is the most likely diagnosis? Hope. Sorry. Accident. Okay. Yeah. Sorry about that. I'm absolutely well the answer. But yes, it was indeed ACL. Russia. Uh, yes. So your anterior cruciate ligament shown here? That's when you get when you're tackled from behind. So ruptured ACLU Very common in sports. High twisted force when you apply it to the bed knee. So that's why I, Robbie football those kind of sports where you're kind of tackle on behind very common symptoms. You have a loud crack, a non a rapid joint swelling, uh, instability. It will. The knee will give one on terror drug test on you. Manage it with intense physiotherapy. Posterior cruciate ligament. Often caused by hyper extension injuries on the tip. Realize back with FEMA, it gives a positive you'll drug test. Um, paradoxically, one interiors Your test this month, Miss School test. So this is usually drawing rotational sports. So, for example, in the nipple when you suddenly have to turn, you might might indicate a meniscal tear on this on, like on a C l. Where you have swelling. Suddenly you'll have a bit of a delayed new swelling on, and the joint will lock this. Mom, I'm, uh, that have recurrent episodes of pain in infusions. So I want you on a course. So we used the Ottawa uncle rules the sister turn to determine whether you need an X ray or not. So just look up. You know where the patient is able to wait there on whether there's Boniva tendered us from in the areas shown here so important A on appointment be behind the ankle on the weather classification. This is what we used to cost it by the type of ankle injury. But, um hum. So this is how you manage, uh, the ankle injury. So first up, we haven't ankle injurious. Apply the bottom wall. If the auto horrible says you need to do an x ray, do X rays in three. Beause if the also rule says I actually don't need to X ray, you just discharged him for the rice. Uh, arrest, um, ice compression and elevation so they don't need an X ray. They just develop price on x ray. if it's a union, are you a fracture? And there's no evidence of ligamentous injury. You can discharge them with a cost and then for make sure to do follow up X rays. If on X ray, it shows a bio, try Maliana fracture. It's unstable. You need to do surgery on it. You need to do close reduction on refer for surgical fixation. I think that's is actually it. So I've got here just some summary slides, which you can have Look at your own time. Just help to summarize some investigations, but might be useful for your skin exams on, um, something I didn't cover, but it feel free to reading. The only time all stimulation osteoporosis, osteoarthritis, um, might you might go sit in in the escape. That's Ah, quite company tested in the purpose test. Yes. Thank you very much. Um, we have the feedback form like here. Um, which I think Daniel will post in the trash. Is mom on on? Excellent will be on Thursday. Just stay with me. I'm just going to get the feedback link now, so if you will just wait around and I'll post, that's so well, don't put time on uneven absolutely goes through this. I, uh I do a port. Just so it did go through to pick me, But we will beginning this light so you could go out. Thank you. Thank you, everyone for calling. We hope you find these sessions useful. And as I say, we got some about five know sessions together. There we go. So the feedback, like, is up. So if you just follow that fill in the link on But we'll be uploading the slides on metal, Assume as possible, uh, the previous sessions, they respond. Lasting how you acquire slides. So this morning, you feel in the feet bunk. I believe the slides get uploaded to meddle. And then you'll should get, um, anymore to say that Contin is being a polluted. And it should be. You should be able to download the slides while but the mail buckets and told S O. G. J says if there's no scuffled work John X ray, but they have a clinical symptoms. Do you just cost a re X ray in two weeks? Ah, yes. Thank you. Well, we asked We watched with boiling. Yes. I think there will be approved. Sure give it a little, like, a minute or two extra and then call it a day. Yeah, that's fine. That sounds good. Um, yeah. Thank you for coming. Thank you. So we'll upload it on to meddle. So if you follow the feedback link, um, well, prompt you to make a, um, adult currently having cancer already through that, you'll be able to access the slides for this session on then and the other previous sessions that's are available. Okay. Stop recording. Okay. I'm just very quickly on strict Daniel. Someone questions on the Q and A. Yeah, that's fine. Yeah, well, today, thank you so much for helping with the polls. All right, well, somebody else. A very good question is, um what do you get? A limp. But if the if the hip is paying us in a gym pocket around fortunes, I think I'm I'm I'm always, you know, the next business. I don't think I limp would be the most common cause, but you're it can be a chronic one sets so chronically the child might don't wait there and and you do pathogen arthritis street to increase friction between the hip joint and then something else can you repeat briefly And what situation where you need to surgically fix this. Couple of fracture. So that was this stuff Would pull fracture on a displaced scuffled fracture. No. Yeah. Cut. I think that's all done. Okay, so we'll end the call. Their Thank you again. Everyone. Thank you very much. Dot your mom meds on a beer for your help. And thank you all for coming. Great. And see you on it, all right.