1. Ortho Overview Flashcards
(64 cards)
1
Q
T in OPQRST?
A
Timing:
- event specific
- chronic/constant = overuse
- Night (OMINOUS)
Treatment:
- RICE
- Adequate rest > 6 weeks
- PT > 6 weeks
- Bracing
2
Q
PE includes?
A
Inspection Palpation ROM (active and passive) Neuro exam Review of diagnostic adjuncts
3
Q
Edema vs effusion
A
Edema - superficial swelling
Effusion - in the joint
4
Q
What is zero degrees for a joint?
A
Typically it aligns with anatomical position
5
Q
Manual muscle testing
- oxford scale
A
0 - no contraction present 1 - flicker contraction 2 - full ROM w gravity eliminated/counter balance 3 - full ROM against gravity 4 - full ROM w added resistance 5 - muscle functions normally
6
Q
C5 - roots
A
Deltoid and Biceps
- High five
7
Q
C6 - roots
A
Extensor carpi radialis longus and brevis
- six shooter
8
Q
C7 - roots
A
Triceps
Flexor carpi radialis (FCR)
Extensor digitorum communis (EDC)
- Hand makes a 7
9
Q
C8 - roots
A
Flexor digitorum
- profundis
- sublimis
Interossei
10
Q
T1 - roots
A
Interossei
11
Q
L1-L2 - roots
A
Iliopsoas
12
Q
L3 - roots
A
Quadriceps
13
Q
L4 - roots
A
Tibialis anterior
- toes to the nose
14
Q
L5 - roots
A
Extensor hallicus longus
Extenosr digitorum longs
Gluteus medius
- big toe flex
15
Q
S1 - roots
A
Gastrocsoleus Peroneus longus Peroneus brevis Gluteus maximus - gas pedal
16
Q
S2-S4 - roots
A
Rectal exam
17
Q
DTR scale
A
0 - absent 1+ (+) - hypoactive 2+ (++) - normal 3+ (+++) - hyperactive w/o clonus 4+ (++++) - hyperactive w clonus
18
Q
Tests for C5
A
Strength:
- deltoid
- bicep
Reflex
- biceps tendon
Sensation
- bicep region
19
Q
Test for C6
A
Strength
- biceps
- wrist extension
Reflex
- radial
Sensation
- thumb and forefinger (6 shooter)
- lateral forearm
20
Q
Test for C7
A
Strength
- tricep
- wrist flexor
- finger extensor
Reflex
- tricep
Sensation
- middle finger
21
Q
Test for C8
A
Strength
- fingers out
- fingers in
- finger flexors
Reflex
- none
Sensation
- ring and pinky
- medial forearm
22
Q
Test for T1
A
Strength
- fingers out
- fingers in
Reflex
- none
Sensation
- elbow
- distal 1/2 of tricep
23
Q
Test for L4
A
Strength
- tibialsis anterior
- (foot inversion)
Reflex
- patellar tendon
Sensation
- Fahrenheit 451 (4is medial)
24
Q
Quadricep muscles are innervated by?
A
4 muscles
- L4
25
tests for L5
Strength
- extensor digitorum longus (toes to nose)
Reflex
- none
Sensation
- Fahrenheit 451
26
Tests for S1
Strength
- peroneus longus and brevis
- eversion
Reflex
- achilles tendon
Sensation
451
27
Testing for S2, S3, S4
Principal nerve supply for
- bladder
- intrinsic muscles of feet
Tested by rectal exam
28
What is the osinski reflex?
Bulbocavernosus reflex
29
Differentiating spinal shock from complete spinal cord injury?
1st to return is the bulbocavernosus reflex (Osinski reflex)
Lack of motor and sensory function after the reflex has returned indicates complete spinal cord injury
30
ABI
ABI = SBP affected extremity / SBP upper extremity
<0.90 = good (so lower extremety must be lower than the upper)
31
Vascular injury w extremity trauma
| - s/s
Hard and soft signs
hard signs:
1. 5 P’s
- pulslessness
- pallor
- paresthesis (pins and needles)
- pain out of proportion
- paralysis
2. Rapidly expanding hematoma
3. Massive bleeding
4. Palpable/audible bruit
Soft signs:
1. Hx of bleeding in transit
2. Proximity-related injury
3. Neuro finding from nerve adjacent to a named artery
4. Hematoma over a named artery
32
How to handle vascular injury w extremity trauma?
Hard signs
- immediate ortho consult
Soft signs
- get ABIs
- these help track inj progression
Soft signs = 3-35% chance of vascular injury
33
Indications for ABI?
Lower extremity fx
Knee dislocations
Lower extremity trauma
34
Knee dislocations
1 in 5 have vascular injury
(16%)
86% amputation rate if missed
35
With trauma/injury your x rays should include?
Joint above and below
| - assess for dislocations and associated fx
36
Who should always get an x-ray?
Pain directly over the bone
Hx of trauma
Placing ortho consult
37
Ottawa ankle criteria?
Pain in maleolar zone?
X ray if:
1. Bone tenderness @ posterior tip of lateral maleolus (6cm)
2. Bone tenderness @ posterior edge or tip of lateral malleolus (6cm)
3. Unable to
bear weight
```
Pain in mid foot zone?
X ray if
1. Bone tenderness @ base of 5th metatarsal
2. Bone tenderness @ navicular
3. Unable to bear weight
```
38
Ottawa criteria knee
```
Knee:
Can’t bear weight
No flex to 90
>55
TT patella
TT Fibular head
```
39
When is IV contrast for CT contraindicated?
Renal disease
| Allergy to dye
40
Things that x-rays are not good for and you should just get a CT?
Bones
- Carpal bones
- Ankle/tarsal bones
- Spine
- Scapula
Evaluation of bone loss
Eval of intra-articular fx
- pilon/planfond
- tibia plateau
- glenoid fx
41
MRI T1 and T2
T1 - anatomy
- fat white guys weigh a ton
T2 - pathology
42
Ferromagnetic metal and MRI
May
- heat up
- Malfunction (pacemaker)
- dislodge (aneurysm clips in brain)
Titanium is G2G
43
Best way to visualize scaphoid fx?
MRI
44
What is arthrograpy?
Injection of contrast into joint before imaging
- fluoro
- CT
- MRI
Uncommon but can be used for assessment of a joint inside the capsule
45
When are bone scans particularly good?
Stress fx when there may be several in different places
Evaluating infections
46
Gold standard for bone mineral density (BMD)?
DEXA
47
BMD testing is recommended for? (women)
Post menopause under 65 w 1+ of:
- fx of osteoporosis
- hx of low-trauma fx (over 45)
- current tobacco
- low body weight (<127)
All women over 65 regardless of risk factors
48
BMD testing is recommended for? (men)
Hx of low trauma fx w GnRH agonist (prostate ca)
Primary hyperparathyroidism undergoing glucocorticoid tx
Disease/condition or use of meds that cause bone loss
49
Indications for nerve conduction study’?
Peripheral neuropathies
- Carpal tunnel
- Cubital tunnel
Myopathies
- muscular dystrophies
- myotonia
Ridiculopathies (disc herniations)
Neuromuscular d/o
- myasthenia gravis
- Guillain-barre syndrome
50
Standard ortho treatment options?
```
RICE
Rest x 6 weeks
PT x 6 weeks
Bracing
Corticosteroid inj
Profile
```
Surgery
51
Rehab is intended to?
The principal to restoring full function is regaining:
- ROM
- Strength
- Coordination
Begins w ROM
52
Rehab methods of promoting healing?
```
Cryotherapy
decrease
- swelling
- inflammation
- pain
```
Thermotherapy
- increase blood flow
- promote healing
- muscular relaxation
53
US (therapy)
Used for
- chronic inflammation
- increased ROM
54
Phonophoresis
US to deliver topical meds
55
Iontophoresis
Electrical stim to increase med uptake
56
Electrical stim is used for?
- Decreasing pain/edema
- Regaining strength
- Preventing atrophy
57
Corticosteroids will?
Suppress inflammation
Decrease collagenase and PE formation
- (dont use in young pts)
Decrease formation of granulation tissue
58
Common indications for corticosteroids?
RA
Degenerative arthritis
Acute gouty arthritis
Shoulder bursitis
59
AE of corticosteroids
```
Transient hyperglycemia
Lipodystrophy
Loss of skin pigmentation
Tendon/nerve inj
Infection
```
60
Major nerves of the lower extremity
```
Obturator
Femoral
Peroneal
- deep
- superficial
Tibial
```
61
Obturator nerve
Muscle
- adductors-hip abduction
Sensory
- medial aspect of mid thigh
62
Femoral nerve
Muscle
- quadriceps - knee extension
Sensory
- proximal to medial malleolus
63
Peroneal deep/superficial nerve
Muscle
- deep - extensor hallicus longus (great toe extension)
- superficial - peroneus brevis (foot eversion)
Sensory
- deep - dorsum of fist web space
- superficial - dorsum of later foot
64
Tibial nerve
Muscle
- flexor hallicus longus (great toe flexion)
Sensory
- plantar aspect of foot
