A thirty five year old, right hand dominant, self-employed carpenter presents with a two year history of increasing pain and stiffness of the right elbow. He is finding it increasingly difficult to use a hammer. He was an adopted child and has no knowledge of his family history. He played senior rugby football as a front row forward until twenty-seven years of age. The right elbow flexes from 350 to 1150, the left from 00 to 1400. There is a 30 varus deformity of the fight elbow and x-rays of the elbow show coronoid osteophytes and some loss of joint space in the humero-ulnar joint. On examining the right upper limb, it is noted there is marked wasting of the triceps and biceps musculature, marginal weakness of finger-palm grip and reduction of his triceps reflex.
Question (30 Minutes)
A thirty-three year old housewife presents with a three year history of pain in the right popliteal fossa. She was seen six months prior to presentation by her general practitioner and referred to a sports medicine physician who diagnosed a Baker’s Cyst.
There was no history of injury.
Physical examination revealed firm mass, seven centimetres in diameter, in the middle of the popliteal fossa, a 1130 fixed flexion contracture of the knee, wasting of the quadriceps and no knee effusion.
A high quality lateral x-ray showed no abnormality other than soft tissue calcification which appears to be within the lesion.
Question 4. (30 Minutes)
A thirty-three year old, insulin dependent (Type 1) diabetic squash player, presents with a rupture of his fight tendo Achilles, one week after the accident.
He has been told by an elite squash player, who had been treated operatively after a similar injury, that surgery offers the best chance of an excellent functional outcome.
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