A 16-year-old boy comes to the Emergency Department following a football game. He reports being tackled with a boot to the lateral side of his upper leg. X-ray examination shows a fracture at the neck of the fibula.
What is the structure that is most likely impacted by this injury?
A 65-year-old woman presents with backache over the past 5 days, which did not respond to over-the-counter analgesics. Pain is increasing in the night and is constant. It is not subsiding with rest. There is no history of trauma. She is a known diabetic and hypertensive. She had an episode of deep vein thrombosis 1 month ago and was on heparin for 3 weeks. She had no children and her husband passed away a year ago. Her current medications include captopril, metformin, warfarin, atorvastatin and aspirin 375 mg. X-ray of the spine shows a fracture of C6 vertebra.
Which one of the following is the most likely underlying disease causing the fracture at this vertebral level?
After a weekend of hiking, a 50-year-old man finds that he is having difficulty raising his right arm. The weakness is found to be of abduction of the right shoulder with particular difficulty initiating the movement. The movement at the shoulder that can be elicited is not particularly painful and there is no loss of cutaneous sensation.
Which one of the following structures is most likely to have been damaged?
An 80-year-old man complains of stiffness and pain in his right shoulder. During the examination, it is observed that he cannot internally or externally rotate or abduct the shoulder. The patient has a history of diabetes. What is the most probable diagnosis?
A 50-year-old retired tennis professional presents to the doctor’s office with complaints of right shoulder pain over the past few months. He reports that the pain increases with overhead movement of the shoulder. Upon examination, the patient displays weakness and pain during abduction and forward flexion of the shoulder. Which rotator cuff muscle is most likely affected?
A 25-year-old woman suffered a severe crushing injury to her left upper leg in a motor vehicle accident. She sustained a severe contusion around the neck and head of the fibula.
Which nerve is susceptible to compression at the lateral head and neck of the fibula?
A 24-year-old typist presents with pain and weakness of the right hand. The patient notes that she also has symptoms of numbness and tingling of her right hand and wrist, which seem to be worse at night, but improve when she hangs her arm down by the side of the bed. She has also had some difficulty gripping objects and finds it increasingly difficult opening bottles and jars. The clinician suspects that she may have carpal tunnel syndrome.
These clinical features of carpal tunnel syndrome are due to compression of which structure?
You are an orthopaedic senior house officer and are seeing a patient referred by her general practitioner. He has stated in his letter that the patient has vertebral tenderness at the level of the spine of her scapula, which you confirm by examination.
What level is this vertebrae if the patient is in her 60s?
A 28-year-old woman who works in a factory presents with lower back pain. She says that she has had the pain for past two years and that it started gradually. The patient has no past medical history. There is no evidence or history of trauma. Upon examination the patient has normal power in the lower and upper limbs, and sensation is intact. She denies any fever or weight loss and has no significant family history. She is discharged with analgesia.
What is the most appropriate next step?
A 48-year-old woman is brought to the Emergency Department (ED) after being involved in a car accident. She is alert and receives initial resuscitation in the ED. She has an open fracture of the left tibia and is seen by the orthopaedic surgery team.
Later during the day, she undergoes an intramedullary nailing procedure for fixing her fractured tibia. Seven days after the surgery, the patient complains of gradually worsening severe pain in the left leg.
Upon examination, she is found to be febrile and the wound area is not markedly erythematosus and there is no discharge from the wound site. There is no left calf tenderness and no swelling. Blood tests reveal a raised white cell count and inflammatory markers, and a blood culture grows Staphylococcus aureus. An X-ray and leg Doppler ultrasound imaging reveal no subcutaneous gas. An urgent magnetic resonance imaging (MRI) report prompts the surgeon to take this patient urgently back to theatre.
Which one of the following is the most likely diagnosis for this patient?