• Clinical science

Collection of orthopedic conditions

Popliteal (Baker) cyst

Rupture of a popliteal cyst may mimic a deep vein thrombosis!

Bursitis

Meniscal cyst

  • Definition: a collection of synovial fluid in or around the meniscus
  • Etiology: secondary to a meniscal tear synovial fluid becomes encysted
  • Clinical features
    • Pain and swelling
    • Decreased range of motion of the knee
    • Chronic meniscal tears → locking (decreased extension of the knee) and popping (knee joint laxity)
  • Diagnostics
    • Clinical diagnosis
    • MRI can aid in management if surgical intervention is indicated.
  • Treatment [1]
    • Conservative management with rest, pain control, and crutches
    • Surgical intervention is indicated in refractory cases that do not respond to conservative management, or if there are mechanical symptoms (locking, popping) or tears in an avascular zone.

Stress fracture

  • Definition: complete bone fracture caused by repetitive stress without underlying bone pathology or disease affecting the bone
  • Etiology: Increased load or frequency of physical activity can facilitate bone resorption.
  • Risk factors
    • Repetitive high-intensity physical activity
    • Improper technique during physical activity
    • Ill-fitting footwear
    • Caloric restriction; , especially in patients with anorexia nervosa
    • Decreased bone density (e.g., bisphosphonates use)
    • Calcium deficiencies
    • Female sex
  • Clinical features
  • Diagnostics
    • Clinical diagnosis
    • Conventional x-rays can appear normal in the first 2–3 weeks.
    • MRI for definitive diagnosis: detects fracture line , surrounding tissue damage, and edema
  • Treatment

Genu valgum

  • Definition: valgus (lateral) misalignment of the knee, resulting in a knocked knee deformity
  • Etiology
  • Clinical features of pathological valgus
    • Unilateral valgus that is progressive (after 4–5 years of age) or persistent (after 7 years of age)
    • Severe valgus
    • Gait abnormalities and congenital flat feet
    • Features suggestive of an underlying disease (e.g., unilateral deformity, short stature, fever, knee or foot pain, abnormal swelling)
  • Diagnostics: if pathological valgus is suspected, imaging and/or metabolic evaluation to determine underlying disease
  • Treatment
    • Physiological valgus may improve by the age of 7 years and should be managed with close observation and reassurance.
    • Medical treatment of the underlying pathology
    • For persistent symptoms in patients older than 10 years, surgery is indicated.

Genu varum

  • Definition: varus (medial) misalignment of the knee, resulting in a bowleg deformity
  • Epidemiology: common in children
  • Etiology
    • Physiological
      • Normal at birth
      • Associated with normal stature, bilateral symmetry, and no clinical symptoms
    • Pathologic varus: result of Blount disease, metabolic disorders (e.g., rickets; ), skeletal dysplasias, or neoplasms
  • Clinical features of pathological varus
    • Bowing that is progressive or persistent (after 3 years of age)
    • Severe bowing
    • Gait abnormalities
    • Features suggestive of an underlying disease (e.g., unilateral deformity, short stature, fever, knee or foot pain, abnormal swelling)
  • Diagnostics: if pathological varus is suspected, imaging and/or metabolic evaluation to determine underlying disease
  • Treatment
    • Physiological varus usually improves by 24 months and should be followed by close observation.
    • Treatment of the underlying pathology
    • For persistent symptoms; that do not respond to medical management, surgery is indicated.

Greater trochanteric pain syndrome

Forearm fractures

Colles and smith fractures

Monteggia fracture

Galeazzi fracture

Other forearm fractures

Ganglion cyst

  • Definition: benign mucin-filled cyst that develops along tendons or joints and has no true epithelial lining
  • Epidemiology: most common type of hand mass
  • Location: : wrist and fingers (most common at the dorsal wrist)
  • Pathophysiology: herniation of connective tissue; associated with repetitive trauma and mucoid degeneration of periarticular structures → sac that is lined with synovial cells and contains paucicellular connective tissue (typically mucin)
  • Clinical features
    • Usually asymptomatic but can occasionally cause joint pain
    • Fluctuant, transilluminant swelling
    • Can lead to nerve compression, which may cause numbness, weakness, or tingling (e.g., Guyon tunnel syndrome)
  • Differential diagnoses: epidermoid cysts, lipoma, rheumatoid nodules, infectious tenosynovitis, soft tissue tophus
  • Treatment

References:[5]

Plantar fasciitis

  • 1. Jeong HJ, Lee SH, Ko CS. Meniscectomy. Knee Surg Relat Res. 2012; 24(3): pp. 129–136. doi: 10.5792/ksrr.2012.24.3.129.
  • 2. Williams BS, Cohen SP. Greater trochanteric pain syndrome: A review of anatomy, diagnosis and treatment. Anesth Analg. 2009; 108(5): pp. 1662–1670. doi: 10.1213/ane.0b013e31819d6562.
  • 3. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. Am J Roentgenol. 2013; 201(5): pp. 1083–1086. doi: 10.2214/ajr.12.10038.
  • 4. Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. Journal of orthopaedics. 2016; 13(1): pp. 15–28. doi: 10.1016/j.jor.2015.12.006.
  • 5. American Society for Surgery of the Hand. Ganglion cysts. https://handcare.assh.org/Anatomy/Details-Page/articleId/27970. Updated January 1, 2018. Accessed March 18, 2020.
  • Stone CK, Humphries R. CURRENT Diagnosis and Treatment Emergency Medicine. Lange; 2011.
  • Le T, Bhushan V, Sochat M, Chavda Y. First Aid for the USMLE Step 1 2017. McGraw-Hill Education; 2017.
  • Young CC. Plantar Fasciitis. In: Plantar Fasciitis. New York, NY: WebMD. http://emedicine.medscape.com/article/86143-overview#showall. Updated November 28, 2016. Accessed February 18, 2017.
  • Kaplan, Kaplan Medical. USMLE Step 2 CK Lecture Notes 2018: Surgery. Kaplan Publishing; 2017.
  • Buchbinder R. Plantar fasciitis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/plantar-fasciitis. Last updated May 10, 2019. Accessed September 11, 2020.
last updated 11/24/2020
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