Orthopaedic notes detailing orthopaedics pathologies and conditions. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
Look at specialty section and content list for the summary contents of this file.
Neck and Orthopaedics in General
Imaging - Bone contour (Fractures)
- Imaging Modalities o Obs: Intervertebral; Pedicles; Vertebral body
o CT: 1L if there is a clear spinal cord injury - Cartilages
o MRI: Fractures; Subluxation; Disc injury o Obs: Disc margins
o Evaluate: ABCS Acronym - Soft tissues
- Alignment o Obs: Retropharyngeal shadows
o Obs: Vertebral bodies; Spinal canal; Spinous process
o NB: 40 % <7 YO have pseudosubluxation of C2-3
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Cervical Spondylosis (see neurology notes)
Description Presentation
- Prevalence: 90 % of Men >60 YO + Women >50 YO - Asx: Usually asymptomatic
- Path: Degenerative changes in cervical spine - Nerve: Paraesthesia; Pain in neck and arms
- NB: Narrows spinal canal and intervertebral foramina - Cc: 10 % of Sx develop cervical myelopathy
Cervical Spondylolisthesis
Causes Description
- Odontoid process - Path: One vertebrae slips forward over one below
o Congenital: Failure in fusion of dens with axis - NB: Result of untreated cervical spondylosis
o Dens: Fracture (skull, atlas and dens slip forward) Management
- Transverse ligament of atlas - Basic: Immobilisation in plaster jackets
o Inflammation: RA; Complicating throat infection Complications
o NB: Inflammation softens ligament - Instability: Can increase in severity post-trauma
Cervical Rib
Description Investigations
- Incidence: 1:500 have cervical rib abnormality - Exam: Weak radial pulse ± Forearm cyanosis
- Congenital: Development of costal process of C7 - Arteriography: Subclavian compression
Presentation - XR: May or may not show abnormality
- Scalenus / 1st Rib Syndrome - NB: Fibrous bands may cause sx so XR not useful
o Features: Similar Sx; No radiological abnormality Management
o NB: May be caused by fibrous band - Physio: May improve symptoms
- Thoracic Outlet Compression (TOC) - Surgery: Rib removal or fibrous band division
o Features: See below
- UL Pain or Paraesthesia
o Features: Often affects ulnar side
o NB: hand muscle weakness / wasting LT
, Thoracic Outlet Syndrome
Description Investigations
- Age: AOO peaks at 40 YO - Adson Manoeuvre: Extend + rotate neck
- Path: Compression at thoracic outlet - NB: ↓ RA Pulse on inspiration
- NB: Affects Brachial plexus; Subclavian artery/vein - Rule Out: Cervical spondylosis; Carpal tunnel
Classifications - XR: Osseus abnormalities
- Soft Tissue: 70 % of TOC; Scalenus m. banding - CT/MRI: Rules out tumours and cervical lesions
- Osseous: 30 % of TOC; Cervical rib - Vascular: Venography; Arteriography
- Neurogenic: 90 % of TOC presentations Management
- Vascular: 10 % of TOC presentations - 1L: Physiotherapy + Rehabilitation if neurogenic
Presentation - Surgery: If there is a physical abnormality
- Trauma: Preceding neck trauma Hx
- Neurogenic: Numbness; Paraesthesia; Cold hands
- Vein: Arm swelling; Distended veins
- Artery: Arm claudication (Pain); Ulcers; Gangrene
- NB: Worse on arm abduction
Spasmodic Torticollis (Cervical Dystonia)
Description Management
- Prevalence: Commonest adult focal dystonia - Medical: Botox; Deep brain stimulus
Presentation - Surgical: Selective ramisection
- Features: Episodes of a sudden stiff painful neck Prognosis
Causes - Recovery: Spontaneous recovery in 20 % in 5 yrs
- Torticollis: Sternocleidomastoid or Trapezius spasm - Life-long: Generally a life-long condition
Infantile Torticollis
Description Management
- Age: Typically affects 1-36 MO - Limiting: Self-limiting in 97 %
- Path: birth damage to sternocleidomastoid - Persistent: Physiotherapy if persistent
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