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CM 4 > MSK Treatments > Flashcards

MSK Treatments Flashcards

1
Q

Spinal stenosis?

A

Pain control, PT, steroid injections, decompression laminectomy.

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2
Q

Ankylosing spondylitis?

A

NSAIDs, PT, TNF inhibitors.

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3
Q

Herniated disc?

A

NSAIDs, PT, muscle relaxers/oral steroids.
If fails conservative tx, corticosteroid injection.
If pain for >6 wks, laminectomy & discectomy.

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4
Q

Compression fracture?

A

Orthopedic/neuro consult.

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5
Q

Spondylolysis?

A

Low grade or symptomatic: Observe
Symptomatic: PT & activity restriction
Acute or failed PT: Bracing

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6
Q

Spondylothisthesis?

A

Mild: PT and activity restriction.
Severe: Surgery.

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7
Q

Cauda equina?

A

Call ortho/spine/neuro immediate.

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8
Q

RA?

A

Exercise, NSAIDs for pain. Corticosteroids if NSAIDs don’t work.

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9
Q

What is the best initial DMARD?

A

Methotrexate.

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10
Q

Side effects of methotrexate?

A

GI upset, oral ulcers, mild alopecia, bone marrow suppression (must give WITH folic acid), hepatocellular injury.

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11
Q

Leflunomide?

A

Alternative to methotrexate or can be used as an adjunct to therapy with a DMARD.

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12
Q

Hydroxychloroquine?

A

Alternative first line DMARD, but usually not as effective as methotrexate and used in less severe cases

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13
Q

What do pts require of they are on hydroxychloroquine?

A

Eye exam every 6 months because of risk of visual loss due to retinopathy.

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14
Q

Sulfasalazine?

A

Alternate first line agent, but less effective than methotrexate.

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15
Q

What do you prescribe if first line agents do not work for RA?

A

Antitumor necrosis factor (anti-TNF) inhibiting agents (etanercept, infliximab).

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16
Q

Reactive arthritis/Reiter Syndrome?

A

NSAIDs. If no response, sulfasalazine and immunosuppressive agents like Imuran. NO ABX.

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17
Q

Polyarteritis nodosa?

A

Glucocorticoids.

Refractory: add cyclophosphamide.

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18
Q

Polymyalgia rheumatica?

A

Corticosteroids to suppress inflammation.

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19
Q

Polymyositis and Dermatomyositis?

A

First line: High dose corticosteroid.
If refractory: immunosuppressive agents like methotrexate.
Hydroxychloroquine useful for skin lesions.

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20
Q

Fibromyalgia?

A

Low intensity exercise.
First Line: Amitriptyline.
For trigger points: Local anesthesia.Also Milnacipran and Pregabalin.
CBT.

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21
Q

Sjorgen Syndrome?

A

Increase mucosal secretions: Artificial tears to prevent corneal ulcers; Increase fluid intake; sugar free gum; artificial saliva and fluoride treatments.
Cholinergic drugs: Pilocarpine or Cevimeline -> increased secretions
Adverse effects = diaphoresis, flushing, sweating, bradycardia, diarrhea, nausea, vomiting.

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22
Q

Scleroderma?

A 
Treatment is organ-specific:
GERD = PPIs
Raynaud = vasodilators (CCBs)
Severe disease = DMARDS
Pulmonary fibrosis: Cyclophosphamide
Pulmonary hypertension: Bosentan, Sildenafil
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23
Q

Lupus?

A

AVOID SUN!
Mild: Hydroxychloroquine w/ or w/o NSAIDS and/or short-term low dose glucocorticoids.
Mod: Hydroxychloroquine plus short-term glucocorticoid therapy. Belimumab (Benlysta)- Usually reserved for active cutaneous or MSK disease unresponsive to glucocorticoids or other immunosuppressive agents.
Severe: High dose glucocorticoids or intermittent IV “pulses” of methylprednisolone with other immunosuppressive agents (Cyclophosphamide, Mycophenolate, Rituximab).

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24
Q

Antiphospholipid syndrome?

A

Asymptomatic = no treatment

Recurrent thrombosis may require lifelong Warfarin or other type of anticoagulant.

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25
Q

Juvenile (Idiopathic) RA?

A

First line: NSAIDs
If NSAIDs not effective, Steroids.
PT.
Severe/2nd line: Anakinra, methotrexate, leflunomide.
If ANA positive, routine eye exam every 3 months (b/c uveitis).

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26
Q

Hip dislocation?

A

Closed reduction over conscious sedation or ORIF surgery.

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27
Q

Hip fracture?

A

Prophylactic antithrombotic therapy for DVT.

Surgical- ORIF.

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28
Q

Trochanteric bursitis?

A

Rest & NSAIDs.
Steroid injections.
Surgery as last resort with resection of bursa.

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29
Q

Slipped capital femoral epiphysis (SCFE)?

A

Non weight bearing w/ crutches followed by internal fixation.

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30
Q

Legg-Calve-Perthes Disease?

A

Activity restriction (non bearing first) w/ ortho follow up. Revascularization within 2 years. PT. Brace/cast. Surgery in advanced cases.

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31
Q

Femoral Shaft fracture?

A

Surgery within 24-48 hours with ORIF.

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32
Q

Tibial and fibular fractures?

A

Nondisplaced and closed: Full leg cast for 4-6 wks then below knee walking cast for another 4-6 wks.
Comminuted or displaced: ORIF.

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33
Q

Popliteal (Baker’s) Cyst?

A

Ice & NSAIDs.
Intraarticular corticosteroid injection for knee pain and swelling.
If cyst gets large, needle drainage.
Surgical excision for refractory.

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34
Q

LCL and MCL?

A 
Sprained or incompletely torn (Grades 1 or 2): Pain control, PT, RICE, NSAIDs, knee immobilizer. 
Complete tear (Grade 3): Surgery
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35
Q

ACL?

A

Surgery in younger athletes.

Conservative vs. surgery.

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36
Q

PCL?

A

Conservative unless other injuries then surgery.

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37
Q

Meniscal tear?

A

Conservative and PT. Surgery (arthroscopic repair or partial mensicectomy if refractory.

38
Q

Patellofemoral syndrome (Chondromalacia)?

A

Conservative + PT.

Elastic knee sleeve for patellar stabilization.

39
Q

Patellar dislocation?

A

Closed reduction- Push anteromedially on patella while gently extending leg.
Post reduction films, knee immobilizer (full extension), quads strengthening.

40
Q

Patellar fracture?

A

Non displaced: knee immobilizer, leg cast.

Displaced: surgery.

41
Q

Femoral condyle fracture?

A

Immediate ortho consult (needs surgery bc of perineal nerve and popliteal artery); ORIF.

42
Q

Tibial plateau fracture?

A

Conservative: Non weight bearing, hinged knee brace, ortho follow up.
If displaced: Surgery.

43
Q

Tibial Femoral dislocation?

A

Immediate ortho consult for prompt reduction. Emergent surgical intervention. Check pulses.

44
Q

Osgood-Schlatter Disease?

A

Conservative: RICE, NSAIDs, knee immobilization (resolve in 12-24 months).
Refractory: Surgery after growth plate closes.

45
Q

Ankle sprain?

A

RICE, NSAIDS, crutches for the first few days, ACE wrap for support.

46
Q

Achilles Tendon Rupture?

A

Conservative: Splint/Cast

Surgery.

47
Q

What DRUG has a BLACK BOX WARNING about Achilles Tendon Rupture?

A

Fluoroquinolones.

48
Q

Ankle fracture?

A

Stable w/ no displacement: Splint/cast w/ or w/o crutches.

Unstable and displaced: Surgery.

49
Q

Stress/March Fracture?

A

Rest, avoidance of high impact activities, ice, splint, analgesia.
Surgery if high risk area.

50
Q

Plantar fasciitis?

A

Rest, ice, NSAIDs, heel/arch support in shoes (orthotics), PT (plantar stretching exercises.
If no relief: Steroid injection. Can take up to one year to fully heal. If not better after one year, surgery.`

51
Q

Tarsal Tunnel Syndrome?

A

First: Conservative (rest, NSAIDs, properly fitted shoes & orthotics).
Refractory: Corticosteroids.
Severe: Surgical tunnel release.

52
Q

Hallux Valgus (Bunion)?

A

First: Wide toed shoes.
Refractory: Surgery.

53
Q

Charcot Joint/ Neuropathic arthropathy?

A

Conservative: rest, non weight bearing, accommodative footwear.

54
Q

Morton’s Neuroma?

A

First: Metatarsal support or pad, broad toes shows w/ firm soles.
If fails: Steroid Injection.
Refractory: Surgery.

55
Q

Jones Fracture?

A

Non weight bearing in short leg cast for 6-8 weeks.

Often complicated by nonunion or malunion, which frequently requires surgical repair.

56
Q

Lisfranc Injury?

A

ORIF, then non-weight bearing cast for 12 weeks.

57
Q

Anterior glenohumeral dislocation?

A

Reduction and immobilization

MUST check axillary nerve for injury before AND after reduction.

58
Q

Posterior glenohumeral dislocation?

A

Reduction and immobilization.

59
Q

Acromioclavicular joint dislocation/seperation?

A

Type 1, 2, 3: Conservative (ice, brief, sling immobilization, rest). Early rehab for ROM preservation.

Type 4, 5, 6: Surgical Reattachment of ligaments.

60
Q

Impingement Syndrome?

A

Conservative w/ PT.

61
Q

Adhesive capsulitis?

MC in?

A

Shoulder stiffness due to inflammation.

40-60 y/o, DM, hypothyroidism.

62
Q

Adhesive capsulitis?

A

Rehab ROM therapy = mainstay

Anti-inflammatories; intraarticular steroid injection & heat.

63
Q

Rotator Cuff Injury?

A

Nonoperative: PT, NSAIDs, steroid injections if pt fails NSAIDs.
Operative: If fail conservative within 6 months or complete tears.

64
Q

Humeral Head Fracture?

A

Sling Immobilizations, analgesics, PT.

65
Q

Humeral Shaft Fracture?

A

Coaptation splint/sling w/ prompt ortho follow up.

If open fx or vascular/brachial plexus injuries, surgery.

66
Q

Thoracic Outlet Syndrome?
Caused by?
MC in men or women of what age?
Secondary to?

A

Positional, intermittent compression of the brachial plexus and/or subclavian artery and vein.
Hypertrophied scalene muscles compress the vessels and nerves against the clavicle and between the 1st rib.
Women 20-50 y/o.
Neck trauma, sagging of shoulder girdle (from aging, obesity, or pendulous breasts). Also occupation, faulty posture, or thoracic muscle hypertrophy from activities like weightlifting, baseball pitching.

67
Q

Thoracic Outlet Syndrome?

A

Conservative for 95% of cases: PT, pain relief, avoid activities that compress neuromuscular bundle.
Refractory: Surgery decompression.

68
Q

Olecranon bursitis?

A

Olecranon bursitis = padding to area; NSAIDs; ACE wrap for compression.
Septic bursitis = drainage and ABX (Dicloxacillin or Clindamycin).

69
Q

Olecranon fracture?

A

Nondisplaced: Reduction and posterior long arm splint (90 degrees flexion).
Displaced: ORIF.

70
Q

Elbow dislocation?

A

Stable: Emergent reduction w/ long arm splint at 90 degrees w/ ortho follow up.
Unstable: ORIF.

71
Q

Radial Head Fracture?

A

Nondisplaced: immobilization (sling, long arm splint 90 degrees).
Displaced: surgical (ORIF).

72
Q

Ulnar Shaft (Nightstick) Fracture?

A

Nondisplaced distal 1/3: short arm cast.
Nondisplaced mid-proximal 1/3: long arm cast.
Displaced (>50%): ORIF.

73
Q

Monteggia Fracture?

A

Unstable fractures require ORIF.

74
Q

Galeazzi Fracture?

A

ORIF.

Long arm/sugar tong splint temporarily.

75
Q

Lateral epicondylitis (tennis elbow) and Medial epicondylitis (Golfer’s elbow)?

A

Conservative: activity modification, RICE, NSAIDS, counterbalance braces; intraarticular steroid injections for short-term relief. Can take up to 6 months to fully heal.
Surgery if refractory to conservative management.

76
Q

Cubital Tunnel Syndrome?

A

Wrist immobilization especially with sleep, NSAIDS.

If chronic, intraarticular steroids.

77
Q

Scaphoid (navicular) fracture?

A

Nondisplaced fracture or snuffbox tenderness: thumb spica splint.
Displaced > 1mm: ORIF or pin placement.

78
Q

Scapholunate Dissociation?

A

Initial: radial gutter splint.

Surgical repair of the scapholunate ligament usually required to prevent degenerative arthritis.

79
Q

Colles Fracture?

A

Stable: closed reduction followed by sugar tong splint/cast.

ORIF if comminuted or unstable.

80
Q

Lunate Dislocation?

A

Emergent closed reduction & splint followed by ORIF - ORTHO EMERGENCY.

81
Q

Lunate Fracture?

A

Immobilization with orthopedic referral / follow up.

82
Q

Mallet (baseball) Finger?

A

Nonoperative: uninterrupted extension splint of the DIP for 6-8 weeks.
Closed reduction & percutaneous pinning if needed.

83
Q

Boutonniere Deformity?

A

Splint PIP in extension for 4-6 weeks with hand surgeon follow-up.

[name: French for “button hole” – head of proximal phalanx pops through gap like a finger through a button hole]

84
Q

Swan Neck Deformity?

A

Surgery.

85
Q

De Quervain Syndrome?

A

Thumb spica splint initial management, NSAID, PT.

Corticosteroid injection if initial treatment is unsuccessful.

86
Q

Carpal Tunnel Syndrome?

A

Initial/Conservative: volar splint, NSAIDS/
Corticosteroid injections
Surgery in refractory cases.

87
Q

Dupuytren Contracture?

A

Intralesional collagenase and/or corticosteroid injection.

Surgical correction for advanced or refractory cases.

88
Q

Boxer’s Fracture?

A

Initial:ulnar gutter splint.
ORIF.
Check for bite wounds (punched in the teeth) and give ABX Augmentin.

89
Q

Radial Head Subluxation?

A

Closed reduction – pressure on radial head with supination of elbow, followed by flexion of elbow.

90
Q

Clavicular Fracture?

A

Group 1 – sling immobilization (with sling or figure 8 splint)

If lateral or proximal, get an ortho consult.

Surgery is typically indicated for any open fractures, displaced fractures, etc.

CM 4 (9 decks)

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