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Acromioclavicular joint sprain
Clinical assessment Investigations Xray: Referral and management Type AC ligament CC ligament Exam Radiographs Reducibility Treatment Type I Sprain Normal AC tendernessNo AC instability Normal Reducible Sling Type II Torn Sprain AC horizontal instability AC joint disruptedIncreased CC distance < 25% of contralateral Reducible Sling Type III Torn Torn AC joint disruptedIncreased CC distance…
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Adhesive capsulitis (Frozen shoulder)
What is frozen shoulder? Symptoms Clinical phases of frozen shoulder (each phase is overlapping) Clinical phase Description Clinical details Phase one Painful phase or pain-predominant phase Lasts 2–9 monthsProgressive stiffening and increasing pain on movement and at nightNo history of shoulder trauma Phase two Stiffening, freezing or stiffness predominant phase…
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Anterior shoulder instability
. Presentation Signs and Symptoms Clinical assessment Imaging Management Reduction of acute dislocation Post initial reduction: Reduction following recurrent dislocations: When to refer: Following surgery: Physiotherapy
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Back Pain
Low back pain (LBP) Differential Diagnosis of Acute Low Back Pain Diagnosis Key clinical clues Intrinsic spine Compression fracture – History of trauma (unless osteoporotic)– point tenderness at spine level– pain worsens with flexion, and while pulling up from a supine to sitting position and from a sitting to standing…
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Back Pain Conditions
Mechanical low back pain Pathology: Reflex activity from a minor intervertebral derangement (MID) in the intervertebral motion segment. Lumbar radicular pain Radicular pain should not be confused with radiculopathy Feature Radicular pain Somatic referred pain Distribution Entire length of lower limbButbelow knee > above knee Anywhere in lower limbButproximal >…
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Bowed legs – genu varum
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Buckle Fractures
Etiology and Mechanism of Injury Epidemiology Clinical Presentation and Physical Examination Evaluation and Diagnosis Management Strategies Differential Diagnosis Sure, here’s a detailed table covering various types of fractures, their definitions, symptoms/signs, and potential complications: Fracture Type Definition Symptoms/Signs Complications Buckle (Torus) Fracture Incomplete fracture where one side of the bone…
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Carpal Tunnel Syndrome
Risk factors and causes of CTS Fluid retention Inflammation of structures within/around the carpal tunnel Space occupying lesions Other conditions Pregnancy Menopause Obesity Repetitive strain injury causing tendinopathy (overuse in jobs such as gardening, assembly line work and use of vibrational power tools) Inflammatory arthropathy (e.g. rheumatoid arthritis) Ganglion cysts…
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Chest Wall pain
Musculoskeletal causes of chest wall pain Isolated musculoskeletal painMore common– Costochondritis– Lower rib pain syndromes– Pain from thoracic spine/costovertebral joints– Sternalis syndromeLess common– Stress fractures– Tietze’s syndrome– Xiphoidalgia– Spontaneous sternoclavicular subluxation Rheumatic diseasesMore common– Fibromyalgia– Rheumatoid arthritis– Axial spondyloarthritis (including ankylosing spondylitis)– Psoriatic arthritisLess common-Sternoclavicular hyperostosis– Systemic lupus erythematosus– Septic…
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Cubital tunnel syndrome
Introduction Ulnar Nerve Anatomy Etiology Epidemiology Pathophysiology History and Physical Presenting Complaint: Physical Examination Findings: Motor Symptoms: Evaluation Treatment / Management Differential Diagnosis Prognosis Complications Postoperative and Rehabilitation Care Deterrence and Patient Education Pearls and Other Issues
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de Quervain’s tenosynovitis
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Developmental dysplasia of hip
– How to Treat article “ A GP guide to paediatric orthopaedics” Dec 2019, SCHP notes = spectrum of conditions where the femoral head has abnormal relationship to acetabulum 🡪 unstable hip Diagnosis Clinical examination Other: Neuro (movement of all limbs, spasticity, ROM, foot abnormality) Risk factors: Other: underlying NM…
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Distal Radius Fractures
directly from : https://coreem.net/core/distal-radius-fractures/ written by – Mark Mikhly, MD Definition: Fracture at the metaphysis or the articulation of the distal radius Mechanism: Most common mechanism is a fall on an outstretched wrist that is dorsiflexed Epidemiology Physical Exam Colles’ Fracture (studyblue.com) Fracture Classification X-Ray Fracture Patterns: Lateral and AP x-ray of a…
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Dupuytren’s Disease
possible causes:
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elbow pain
causes of lateral elbow pain include: causes of medial elbow pain include: Golfers elbow Tennis Elbow Cubital tunnel syndrome
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Flat feet
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FOOT AND ANKLE
March fractures Sever’s Disease Cracked heels Charcot’s foot Management Plantar fasciitis Hallux rigidus Hallux Valgus Pes planus (flat feet) Pes cavus (claw foot) Osteochondritis/aseptic necrosis Kohler’s disorder (Navicular) Freiberg’s disorder Morton’s Neuroma Sesamoiditis Stress fractures Ingrown Toenail Sprained ankle Tarsal tunnel syndrome Tarsal Coalition Achilles tendonitis Achilles tendon rupture Lisfranc…
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Ganglia
Ganglia are the most common soft tissue tumours of the wrist. Around 60% to 70% occur on the dorsal aspect, the vast majority of these arising from the dorsal scapholunate ligament. Occult dorsal ganglia are difficult to diagnose. An MRI scan may be required for their detection. Conservative management often involves aspiration…
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Glenoid labrum injuries (SLAP and non-SLAP)
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Hallux Valgus (bunion)
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HAND FRACTURES
Fracture management Fracture Period of full immobilisation Position of immobilisation Criteria for referral Important notes Proximal phalanx Up to 3 weeks Safe position Intra-articular surface involvement >30%Unstable fractures– rotation– excessive angulation– Multiple fingers Review X-ray in 1 week Begin active exercise early Middle phalanx Up to 3 weeks Interphalangeal joints…
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Hip Exam
Figure 1. Gait testing. (A) C sign. Patients often localize pain by cupping the anterolateral hip with the thumb and forefinger in the shape of a “C.” (B) Gait analysis. The patient is observed while walking to evaluate for limp or antalgic gait characteristics. (C) Modified Trendelenburg test (single leg…
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HIP msk conditions
Intra-articular Hip Pain Femoroacetabular Impingement (FAI) Conservative Management for Femoroacetabular Impingement (FAI) Syndrome Recommendations Evidence from Randomised Controlled Trial Surgical Procedure Physiotherapy Protocol Surgery with a Post-Operative Physiotherapy Programme Summary of the Protocol Labral Tears Femoral Neck Stress Fractures Avascular Necrosis Hip Fractures Gluteus medius tendonitis Avulsion bony injury OA…
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HIP PAIN
RACGP Words of wisdom Critical Causes of Hip Pain (not to miss) Causes: Timing in the Elderly (acute versus insidious) Causes: Anterior or Anterolateral Hip Pain or Groin Pain Causes: Lateral Hip Pain Causes: Posterolateral or Posterior Hip Pain worsened by sitting for long periods or climbing stairs. Causes: Groin…
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Impingement syndrome
the subacromial bursa and supraspinatus tendon become compressed between the humeral head, the acromion and the coraco-acromial ligament.
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Intoeing
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Joint pains/ swellings – kids
DDx
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Knee problems
KNEE SUMMARY Osgood-Schlatter disease 🡪 Consider in prepubertal child with knee pain Patellofemoral syndrome 🡪 Tracking problem. Commonest type of anterior knee pain. Quad mx Referred pain to the knee 🡪 Lumbosacral spine, especially L3-S1 nerve root, and hip joint (L3) Systemic conditions 🡪 OA, RA, spondyloarthropathies, gout, pseudo-gout, lyme…
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Knocked knees – genu valgum
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limp (kids)
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NECK PAIN
Epidemiology Classification Causes of Neck Pain ASSESS FOR RED FLAG SYMPTOMS Also assess for yellow flags (psychosocial factors). Imaging Do not routinely refer for neck imaging unless there are concerns of red flags, or if the patient is having ongoing pain > 6 weeks. Imaging choices: Treatment Non-pharmacological Pharmacological Torticollis…
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Olecranon bursitis
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Osgood-Schlatter disorder
Clinical history Symptoms Physical exam Investigations GP management Indications for specialist referral
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Osteochondritis dissecans
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Out-toeing
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Perthes disease
How to Treat article “ A GP guide to paediatric orthopaedics” Dec 2019; Orthobullets; RCH ortho fact sheet = idiopathic avascular necrosis of epiphysis of the femoral head Epidemiology 4 Stages of disease Stage Appearance 1. Sclerosis Femoral head appears dense & smallerMedial joint space widening 2. Fragmentation Subchondral lucencyMottled…
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Pulled elbow
NB: do not normally need XR if there is reliable history of traction of elbow, clinical examination suggestive of pulled elbow & child is < 5yrs age XR if there is atypical history or examination Reduction manoeuvres Either of the following methods may be effective Hyperpronation manoeuvre Sit the child…
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Rotator cuff Disease
There is a wide spectrum of disease, from tendinosis, partial tears to complete tears. Anatomy Note: adduction is done by latissimus dorsi, teres major, and pectoralis major Epidemiology Pathomechanics There is a wide spectrum of disease, from tendinosis, partial tears to complete tears. Disease can be acute (usually traumatic tears)…
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Scaphoid Fracture
Anatomy and Ossification: Prevalence and Causes: Classification: Clinical Examination: anatomic snuffbox tenderness dorsally scaphoid tubercle tenderness volarly Radiological Investigations: X-Ray Appearance: Other Investigations: Reduction Requirements: Orthopedic Referral: ED Management: Immobilization Options: Parental Advice: Potential Complications:
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Shoulder Dislocation
directly from: https://coreem.net/core/shoulder-dislocation/ Shoulder Dislocation Classifications (www.backandbodyclinic.co.uk) Definition: Separation of the humerus from the scapula at the glenohumeral joint Epidemiology: Classification: Mechanism: Physical Examination: Netter’s Concise Orthopaedic Anatomy, Second Edition X-Ray Imaging (All Images in Gallery Below): Shoulder Dislocation X-Rays Anterior Glenohumeral Dislocation: AP View (www.emrms.com) Anterior Glenohumeral Dislocation: Scapula Y…
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Shoulder Hx and Exam
Classification and natural history Articular classification of shoulder injuries Extra-articular rotator cuff lesionsimpingement: functional anatomical adhesive capsulitis (stiffness) Intra-articular instability/labral tearsosteoarthritis Referred painRed flags Stabiliser classification of shoulder injuries Joint stability (revolves around static stabilisers) adhesive capsulitis (stiffness)joint instability/labral tear Joint control/anatomy (revolves around dynamic stabilisers) rotator cuff lesions scapulothoracic…
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Slipped capital femoral epiphysis (SCFE aka SUFE)
– = physeal disruption & slippage of femoral neck in relation to the femoral head, which remains enlocated in acetabulum Aetiology Symptoms Signs Investigation Management Complications
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Thoracic outlet syndrome
Systematic causes of brachial plexus pain include:
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Toddler fracture
A toddler fracture is a minimally displaced or undisplaced spiral fracture, usually of the tibia, typically encountered in toddlers. It is a potentially difficult diagnosis to establish on account of both the symptoms and imaging findings being subtle The term has sometimes also been used to describe occult fractures of…
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Toe walking
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Triangular fibrocartilage complex (TFCC)
Introduction Etiology Epidemiology History and Physical Examination Tests: Evaluation Treatment/Management
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Trigger finger