100 CASES in Orthopaedics and Rheumatology This Page Intentionally Left Blank 100 CASES in Orthopaedics and Rheumatology

100 CASES in Orthopaedics and Rheumatology This page intentionally left blank 100 CASES in Orthopaedics and Rheumatology Parminder J. Singh MBBS MRCS FRCS(Tr&Orth) MS Consultant Orthopaedic & Trauma Surgeon and Senior Lecturer, Maroondah Hospital, Monash and Deakin University, Melbourne, Australia Catherine Swales MRCP PhD Arthritis Research UK Clinical Research Fellow and Clinical Lecturer in Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK 100 Cases Series Editor: Professor P John Rees MD FRCP Professor of Medical Education, King’s College London School of Medicine at Guy’s, King’s and St Thomas’ Hospitals, London, UK CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2012 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130419 International Standard Book Number-13: 978-1-4441-4996-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com CONTENTS ORTHOPAEDICS Case 1 A painful knee in a neonate 1 Case 2 Atraumatic painful joints in a boy 5 Case 3 An atraumatic painful hip 7 Case 4 An expanding mass in the leg of an adolescent 11 Case 5 A boy with a swollen mass in his thigh 13 Case 6 A painful collarbone 17 Case 7 A painful proximal humerus in an elderly woman 21 Case 8 A boy with a painful elbow 23 Case 9 A painful distal radius following a fall 25 Case 10 A painful thumb following a fall 27 Case 11 A painful hip following a fall 29 Case 12 Knee pain following a traffic accident 31 Case 13 A painful swollen elbow in a young girl 35 Case 14 A painful thigh following a violent fall 39 Case 15 Groin pain following a fall 41 Case 16 A swollen painful leg after a sporting incident 45 Case 17 A painful and swollen knee following an accident 49 Case 18 A crushed leg 53 Case 19 A painful foot following a traffic incident 57 Case 20 A hindfoot injury following a fall from height 59 Case 21 Curvature of the spine 61 Case 22 Severe low back pain 63 Case 23 A clicky hip in a toddler 65 Case 24 Hip and thigh pain in a 7-year-old boy 69 Case 25 A painful hip in an adolescent 71 Case 26 Groin and buttock pain in an elderly man 73 Case 27 Lateral hip pain 77 Case 28 A painful red swollen knee 79 Case 29 Swelling in the back of the knee 81 Case 30 A mildly swollen knee in a young man 83 Case 31 An atraumatic painful knee in an elderly woman 87 Case 32 An unstable knee in a young man 91 Case 33 An injured ankle 95 Case 34 Deformed feet in a newborn child 97 Case 35 High-arched feet in a young girl 99 Case 36 Flat feet in a young girl 101 Case 37 A painful and swollen ankle 105 Case 38 Deformed feet in an elderly woman 107 Case 39 A stiff great toe 109 Case 40 Misshapen toe in a middle-aged woman (1) 111 v Contents Case 41 Misshapen toe in a middle-aged woman (2) 113 Case 42 Foot pain following a riding fall 117 Case 43 A deformed, swollen and ulcerated foot 121 Case 44 A stiff shoulder 123 Case 45 Elbow pain (1) 125 Case 46 Elbow pain (2) 127 Case 47 A painful wrist 129 Case 48 A deformed finger 131 Case 49 A painless contracture deformity of a hand 133 Case 50 A painful wrist following a fall 135 RHEUMATOLOGY Case 51 A swollen joint and fever 137 Case 52 Painful hands in a young woman 139 Case 53 Back pain in a young man 143 Case 54 Clumsiness 147 Case 55 Back pain and thirst in an elderly man 150 Case 56 Acute back pain 155 Case 57 Painful bones and a waddling gait 159 Case 58 Hip pain and abnormal blood tests 163 Case 59 Knee pain in an athlete 165 Case 60 Painful hands and a rash 167 Case 61 Hypermobility and a pneumothorax 171 Case 62 Pins and needles in a young woman 173 Case 63 Joint pains, skin changes and muscle weakness 175 Case 64 An acutely painful knee 177 Case 65 Recurrent abdominal pain and fevers 181 Case 66 Painful hands and oral ulcers 183 Case 67 Painful hands and breathlessness 187 Case 68 Persistent ulceration in an elderly woman 191 Case 69 A sore throat, painful knees and facial movements 195 Case 70 A lumpy rash and a swollen knee 197 Case 71 Rash and swollen ankles 199 Case 72 A breathless rheumatoid patient 201 Case 73 Pleuritic chest pain 203 Case 74 Fever, rash and joint pains 207 Case 75 Pain and stiffness in shoulders and hips 209 Case 76 Painful ears and nose 211 Case 77 Weakness and a rash 215 Case 78 Diarrhoea, rash and a stiff back 219 Case 79 Headache and weight loss 221 Case 80 A painful swollen hand following a fracture 225 Case 81 Diarrhoea and painful joints 227 Case 82 Chronic extensive muscle pain 229 Case 83 Intractable synovitis 231 Case 84 Haemoptysis and renal failure 233 Case 85 Diarrhoea and a swollen knee 237 Case 86 Swollen ankles and a rash 241 Case 87 Rash, testicular pain and arthralgia 245 Case 88 Painful hands and dry eyes 247 Case 89 Genital ulcers and a rash 249 vi Contents Case 90 Rash, arthralgia and facial weakness 253 Case 91 Rash and abdominal pain in an adolescent 255 Case 92 Weight loss and claudication in a young woman 257 Case 93 Swollen cheeks in an elderly man 259 Case 94 A swollen knee 261 Case 95 A child with a swollen knee 263 Case 96 Acne, arthralgia and chest pains 265 Case 97 A breathless patient with lupus 267 Case 98 Anaemia and weight loss in a patient with rheumatoid arthritis 269 Case 99 A breathless patient with dermatomyositis 271 Case 100 Asthma, rhinitis, foot drop and a rash 273 Index 275 vii ACKNOWLEDGEMENTS CS would like to thank colleagues in the Rheumatology, Radiology and Respiratory departments for their expertise, advice and invaluable contributions. PJS: I would like to dedicate this book to my wife Rowena and children Kieran and Angelina Singh who have been as committed as I have in completing this book. Without their support and abundance of love none of this would be possible. I thank them enormously for their support. I would like to acknowledge my mother Gurbaksh Kaur for her lifetime support and love in making this all possible. I am very grateful for the opportunity to write this book and thank Professor Christopher Bulstrode in Oxford for this. Finally I would like to acknowledge two of my dearest and closest friends Richard and Lisa Field for their expert support and guidance throughout my professional life.

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