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PANCE Review > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

osteoporosis - definition and risk factors

A

loss of bone matrix and mineral - leads to fx w/ little trauma

Primary: post menopausal (due to loss of estrogen) and senile (calcium deficiency and dec. vit. D intake)

Secondary: chronic corticosteroid use, hyper and hypo thyroids, hyperparathyroidism, DM, Cushing’s dz

RFs:

  • Caucasian or Asian
  • small, thin
  • smoking hx, ETOH
  • low calcium intake
  • corticosteroid use
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2
Q

osteoporosis - dx

A 
DEXA scan (get T score)
 - screening begins at 65 (F) and 70 (M) unless have risk factors

normal: T score w/in 1 SD of young adult reference
osteopenia: 1-2.4 SD below reference
osteoporosis: 2.5 or more SD below reference

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3
Q

osteoporosis - most common fx sites

A

vertebral bodies
- most common

hip, pelvis, distal radius

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4
Q

osteoporosis - lifestyle changes

A 
weight-bearing exercise
intake of Ca++ and it D
use walk or cane for balance
balance exercise
stop smoking and ETOH
healthy diet
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5
Q

osteoporosis - medications

A

calcium and vit. D

  • Ca++: 1000 mg/day
  • Vit D: 800-2000 IU daily

bisphosphanates

  • e.g. fosamax, boniva
  • take in am, drink w/ H2O, avoid eating for 30 min (avoid esophagitis)
  • only take for 2-3 yrs

denosumab: inhibits maturation of bone absorbing cells
- dosed Q 6 mo

teriparatide: parathyroid hormone analog
- good but expensive
- only use for 2 yrs due to risk of osteosarcoma

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6
Q

compartment syndrome - definition

A

increased pressure in area with limited space

  • something surrounded by facia
  • compromises circulation and tissue fx
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7
Q

compartment syndrome - causes

A

bleeding or edema in closed compartment

- usually trauma or crush injury

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8
Q

compartment syndrome - sxs and tx

A 
6 P's
Pain (severe and out of proportion)
Paresthesia
Paralysis
Pallor
Pulselessness
Poikilothermic (cant regulate core temp)

tx: urgent fasciotomy

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9
Q

osteoarthritis - definition and sxs

A

idiopathic, non-inflammatory arthritis

Sxs:

  • jt stiffness in am (relieved w/ activity)
  • pain w/ wt bearing
  • crepitus, jt swelling, dec. ROM
  • Heberden’s (DIP) nodes - common
  • Bouchard’s (PIP) nodes
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10
Q

osteoarthritis - nodes

A

Heberden’s (DIP) nodes
- common
Bouchard’s (PIP) nodes
- less common

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11
Q

osteoarthritis - dx and tx

A

Dx: x-ray - narrow jt space, osteophytes, bone cysts

Tx: acetaminophen, NSAIDs, topical diclofenac, steroid injections, visco-supplementation

  • surgery if QOL is diminished
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12
Q

acute osteomyelitis - definition and sxs

A

bacterial spread to bone via blood

  • S. aureus most common
  • < 2 weeks
  • affects long bones of children and spine of older adults

Sxs:

  • fever, chills, malaise, irritability
  • local warmth and swelling
  • refusal to use affected limb (kids)
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13
Q

acute osteomyelitis - Dx and Tx

A

Dx:

  • inc. WBC, ESR, CRP, + blood cx
  • bone biopsy to confirm bacteria
  • bone scan and MRI help early

Tx:

  • IV ABX 4-6 wks, then oral 6-8 wks (oxacillin/cefazolon/Vanco if MRSA)
  • surgical debridement if no improvement or if spine involved
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14
Q

chronic osteomyelitis - definition and sxs

A

untreated blood infection or exogenous/untreated trauma or infection (e.g. DM ulcer now infecting bone)

  • > 2 weeks
  • bacterial spread to bone via blood

Sxs:

  • mild fever, mild inc. in ESR and CRP
  • inflammation or cellulitis
  • persistent drainage, sequestrum or dead bone or walled-off pus
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15
Q

chronic osteomyelitis - Dx and Tx

A

Dx:

  • x-ray shows bone destruction
  • may confirm with MRI

Tx: long-term IV ABX (bacterial specific - oxacillin/Vanco most common)
- surgical I&D, possible amputation

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16
Q

septic arthritis - definition and sxs

A

bacterial spread from blood to joint

  • kids: N. gonorrhea
  • older, IV drug use, DM, prosthetic jt: S. aureus

sxs:
- fever, jt swelling, redness, painful/limited ROM
- N. gonorrhea - lesions on palms and soles of feet

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17
Q

septic arthritis - Dx and Tx

A

Dx:

  • inc. WBC, ESR, CRP
  • confirm with + blood or joint cx
  • jt fluid: WBC, polys, dec. glucose (bacteria eat)

Tx:

  • rest, ice, elevation
  • arthroscopic I&D
  • IV ABX 4-6 wks (ceftriaxone/vanco)
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18
Q

ganglion cysts - definition, sxs, dx, tx

A

collection of synovial fluid
- most benign tumor of wrist

sxs: painless, fluid filled mass usually at wrist

Dx: clinical

Tx: wrist splinting, aspiration, surgical excision

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19
Q

bone tumors - benign vs. malignant (x-ray findings)

A

benign:
- well-defined margins
- sclerotic band around tumor
- slow growing

malignant:

  • painful
  • palpable mass
  • permeative lesion w/ lytic destruction
  • poor margins with suggest rapid growth
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20
Q

bone cysts - definition, sxs, dx, tx

A

cavity in bone filled w/something besides bone (usually fluid or blood)
- found in 5-20 y/o

sxs: asymptomatic until pathological fx
dx: found on routine x-ray, confirm w/ biopsy
tx: aspirate/inject w/ steroid or bone marrow to encourage growth

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21
Q

osteoid osteoma

A

most common benign bone tumor

  • usually in spine or long bones
  • M>F, young adults

sxs: aching, night pain relieved w/ NSAIDS (since prostaglandins in tumor)
dx: x-rays
tx: symptomatic or surgical removal if bothering

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22
Q

osteosarcoma - definition and sxs

A

most common primary malignant tumor (except MM)

  • 15-25 y/o (M>F)
  • most around knee
  • metaphyseal (ball of bone)

NOTE: retinoblastoma assoc w/ 500x risk!!

sxs:
- persistent night pain (wakes) and swelling
- palpable mass
- no known trauma

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23
Q

osteosarcoma - Dx and Tx

A

Dx:

  • x-ray shows destruction (SUN RAY or SUNBURST appearance)
  • bone or soft tissue biopsy
  • alk phos inc. 2-3 x

Tx:
- chemotherapy and surgical resection: 70% 5-yr survival rate

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24
Q

Ewings sarcoma - definition and sxs

A

malignant bone tumor

  • most often in pelvis, distal femur, proximal tibia
  • involved diaphysis of bone (shaft)
  • 10-20 y/o, M>F

sxs: pain, palpable mass, fever, elevated ESR and WBC, increased LDH

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25
Q

Ewings sarcoma - Dx and Tx

A

Dx:

  • x-ray shows lytic, destructive lesion
  • ONION SKIN appearance

Tx:

  • surgical resection, chemo, radiation
  • 60-70% survival rate w/o METS
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26
Q

fibromyalgia - demographic and sxs

A

age 20-50, F>M, associated w/ hypothyroidism, RA (in women) or OSA (in men)
- dx of exclusion

sxs:

  • MSK pain around neck, shoulders, low back, hip
  • fatigue, numbness, H/As
  • depression, sleep problems

PE: None, except trigger pt pain

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27
Q

fibromyalgia - tx

A

patient education:
- it is a chronic dz, but does not progress

moderate exercise, CBT

Meds:
TCAs, SSRIs/SNRIs, pregabalin and gabapentin, acetaminophen (better then NSAIDS)
- trigger pt injections

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28
Q

gout - etiology and population at risk

A

caused by under excretion or over production of uric acid

  • 90% male
  • usually in small joints (big toe)

At risk:

  • thiazide or loop diuretic, beta-blockers, ACE-I, ARBs
  • obesity
  • high ETOH intake
  • high purine diet
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29
Q

gout - sxs and dx

A

sxs:
- fever, sudden onset on monoarticular jt swelling
- exquisite PAIN, warm and red skin
- may develop TOPHI (uric-acid deposits) on ears, hands, elbows, and feet if not treated

dx:
- uric acid > 7.5, inc. WBC
- synovial fluid: + sodium urate crystals, negatively birefringent and needle-like

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30
Q

gout - tx (acute and chronic)

A

acute:
- NSAIDS, corticosteroids (must r/o septic arthritis), colchicine

Chronic:

  • undersecretion: probenicid
  • overproduction: ALLOPURINOL

chronic management: weight loss, increase dairy, limit ETOH, red meat, sardines, lentils, oatmeal, spinach, mushrooms, and drugs that cause gout

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31
Q

pseudogout - definition, sxs, dx, tx

A

recurrent arthritis in large joints (knee, wrist)

  • M=F, > 50 y/o
  • aka CPPD (calcium pyrophosphate dihydrate)

sxs: same as gout (fever, pain, swelling and warm)

dx:
- normal uric acid levels
- synovial fluid shows RHOMBOID shaped crystals that are POSITIVELY birefringent

tx:

  • acute: NSAIDS, corticosteroids (must r/o septic arthritis)
  • chronic: colchicine or NSAIDS (w/ GI protection)
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32
Q

juvenile idiopathic / rheumatoid arthritis - demographic

A

F>M, peaks 1-3 yr and 8-12 yr

if RF + (15%), more likely to progress to adult RA

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33
Q

juvenile idiopathic / rheumatoid arthritis - 3 types

A

systemic (Still’s disease)
- fever, salmon-colored rash, lymphadenopathy, carditis, splenomegaly, arthritis

polyarticular
- low-grade fever, arthritis 5 or more joints

oligo/pauciarticular

  • synovitis in 1-4 joints, NO systemic sxs
  • inc. incidence of iridocyclitis/anterior uveitis (F/U w/ opthamologist)
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34
Q

juvenile idiopathic / rheumatoid arthritis - dx

A

wt. loss, myalgias, fatigue, lymphadenopathy

intermittent fevers, morning stiffness, salmon colored rash

ESR and CRP elevated
- 10% + ANA, RF usually neg, anti-CCP may be + (high specificity for JRA)

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35
Q

juvenile idiopathic / rheumatoid arthritis - classification criteria

A

age < 16 y/o
arthritis in 1 or more joints
sxs > 6 weeks
other causes excluded

NOTE: dx of exclusion

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36
Q

juvenile idiopathic / rheumatoid arthritis - tx

A

NSAIDS: 1st line

DMARS: if no response to NSAIDS but long-term effects unknown

75% resolve w/o serious disability
- RF + have highest risk of persistent, severe dz

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37
Q

polyarteritis nodosa - definition and sxs

A

necrotizing arteritis of medium-sized vessels

  • rare, 50-70 y/o
  • 5% of cases cause by HEPATITIS B
  • causes aneurysms of vessels

sxs:

  • fever, malaise, wt loss
  • extremity pain, foot drop, livid reticular (lacy red rash), nodules, digital gangrene (fingers and toes), abdominal pain N/V
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38
Q

polyarteritis nodosa - dx and tx

A

Dx:

  • tissue biopsy or angiogram
  • HTN if blood supply to kidneys is compromised

Tx:

  • high dose corticosteroids
  • also treat Hep B if they have it

Note: survival only 10% if not treated

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39
Q

polymyositis / dermatomyositis - definition and sxs

A

systemic disorder of unknown cause

  • peaks in 5-6th decade, F>M, blacks > whites
  • associated with malignancy in up to 20%

sxs:

  • progressive neck and proximal muscle weakness or UE and LE
  • 20% have dysphagia (due to weakness of neck)
  • fever, wt. loss, fatigue

Reddish-purple maculopapular rash

  • eyelids: heliotroph rash (red)
  • knuckles: gottron papules (red, scaly rash)
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40
Q

polymyositis / dermatomyositis - dx and tx

A

Dx:

  • muscle biopsy (inc. CPK, aldolase, LDH)
  • serum marker: anti-JO 1 antibodies

Tx:

  • corticosteroids (oral for muscle dx and topical for skin dz)
  • screen for malignancies
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41
Q

reactive arthritis (Reiter syndrome) - definition and demographic

A

tetrad: conjunctivitis, urethritis, aseptic arthritis, and oral lesions
- occurs after gastroenteritis or STI (M:F is 9:1 if STI)

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42
Q

reactive arthritis (Reiter syndrome) - sxs, dx, tx

A

sxs:
-fever, arthritis (knee/ankle), urethral d/c, conjunctivitis, mucocutaneous lesions

dx:

  • anemia, leukocytosis, thrombocytosis
  • inc. ESR, HLA-B27 + (50-80%)
  • x-ray: joint destruction

tx: NSAIDS, PT
- less likely to develop in future if original infection treated with ABX

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43
Q

rheumatoid arthritis - definition and demographic

A

idiopathic, chronic systemic inflammatory dz

  • affects SYNOVIAL MEMBRANES
  • 30-40 y/o, F 3:1
  • Pannus develops and erodes articular cartilage
44
Q

rheumatoid arthritis - sxs

A

early: malaise, wt loss, fever
- nodules in PIP and MCP of hand
- Sjogren’s syndrome (dry eyes and mouth)

late:

  • ulnar deviation
  • Boutonniere and Swan Neck deformities
45
Q

rheumatoid arthritis - dx

A

at least 6 out of 10 of criteria:

  • # joint involvement
  • serology (RF and Anti-CCP)
  • duration of sxs (< or > 6 wks)
  • acute phase reactants (ESR and CRP)

x-ray: soft tissue swelling, juxta-articular demineralization (more lucent), jt space narrowing

46
Q

rheumatoid arthritis - what are they prone to?

A

C1-2 subluxation

- must image if complains of neck pain

47
Q

rheumatoid arthritis - tx

A

Tx goals: dec. inflammation/pain, preserve function, prevent deformity

Tx:

  • education, PT, rest, splints
  • NSAIDS and DMARDS right away!
48
Q

systemic lupus erythematosus (SLE) - definition and demographic

A

inflammatory autoimmune dz that affects multiple organs

  • can be caused by meds (procainamide, isoniazid, quinidine)
  • F:M is 8:1, more common in blacks
  • relapsing and remitting
49
Q

systemic lupus erythematosus (SLE) - sxs

A

Initial:
- fever, anorexia, malaise, butterfly rash, arthralgias (jt pain - 90%)

Later (effects organs):
- pleurisy, seizures, psychosis, pericarditis, kidney (glomerulonephritis, interstitial nephritis)

50
Q

SLE - dx

A

must meet 4 of the 11 criteria:

  • malar (butterfly) rash
  • discoid rash
  • photosensitivity
  • oral ulcers
  • hematologic d/o
  • arthritis
  • serositis (heart or lungs)
  • positive ANA
  • renal dz
  • neurological d/o
  • immuno abnormalities (anti double-stranded DNA antibody and anti-Smith antibody)
51
Q

SLE - two serum markers

A

anti double-stranded DNA antibody and anti-Smith antibody

52
Q

SLE - tx

A

education and emotional support

hydroxychloroquine:minor jt and skin issues

NSAIDS: sparingly for minor jt issues

corticosteroids: if organs are involved
- recall side effects of prolonged use = accelerated atherosclerosis, osteoporosis, AVN of bone

53
Q

scleroderma (systemic sclerosis) - definition and 2 types

A

chronic dz characterized by diffuse fibrosis of skin and internal organs (connective tissue d/o)
- adults 30-50 y/o

Limited: CREST syndrome and hardening of skin of face, neck, distal extremities

Diffuse: skin hardening of face,e hands, trunk, limbs and internal organs
- more severe

54
Q

CREST

A

associated with limited form of scleroderma

C: calcinosis cutis (Ca++ in skin)
R: Raynauds phenomenon
E: esophageal motility disordered
S: sclerodactaly (tightening of skin of fingers and toes)
T: teleangiectasias
55
Q

scleroderma - sxs

A

Initial:

  • polyarthalgia, fevr, malaise, Raynaud’s, esophageal dysmotility
  • skin seems thickened and loss of normal skin folds

Late:
- pulmonary fibrosis, pericarditis, heart block, myocardial fibrosis, renal failure

56
Q

scleroderma - dx and tx

A

Dx:
serum markers:
- anti-centromere (limited type)
- anti-topoisomerase (diffuse type)

Tx:

  • symptomatic and supportive
  • Raynaud’s: Ca++ channel blockers
  • HTN crisis due to renal failure: ACE-I

Note: avoid steroids due to renal failure!!

57
Q

Sjogren’s syndrome - definition and sxs

A

autoimmune dz that results from dysfunction of exocrine glands

  • assoc. w/ RA
  • females>males

Sxs:

  • dry eyes and mouth
  • inc. risk of dental caries
  • loss of taste/smell
  • parotid enlargement (chipmunk cheeks)
58
Q

Sjogren’s syndrome - dx and tx

A

Dx:

  • anti SS-A (Ro) and SS-B (La)
  • Schirmer’s test (for tears in eyes)
  • lip biopsy

Tx:
- symptomatic and supportive

59
Q

acromioclavicular injury - sxs, dx, tx

A

young, active person with direct fall onto shoulder

sxs:
- tender, swollen AC joint
- positiv crossover test

Dx: clinical

Tx:

  • ice, sling 2-4 wks, NSAIDS
  • grades IV-VI f/u with orthopedic surgeon
60
Q

grading of AC injury

A

I: contusion/sprain of AC joint
II: rupture of AC ligament
III: rupture of AC and CC ligament w/ minor displacement of clavicle
IV-VI: both ligs ruptured, significant displacement of clavicle

61
Q

clavicle fracture -sxs, dx, tx

A

most common bone fractured in children
- direct trauma or fall on outstretched hand

sxs: pain over clavicle, possible deformity
- most fractured at middle 1/3

dx: x-ray

tx: sling or figure of 8 splint
- ROM in 3-4 wks

62
Q

rotator cuff - muscles and attachment

A 
S: supraspinatus
 - most common injured
I: infraspinatus
T: teres minor
S: subscapularis
  • top 3 attach to greater tuberosity
63
Q

rotator cuff disorders - sxs, dx, tx

A

chronic, overhead work
- pain begins as inflammation, impingement, progresses to tear

sxs:
- pain at greater tuberosity, lateral shoulder
- pain w/ abducting arm
- positive Neer impingement and Hawkins

Dx: MRI if tear suspected

Tx:

  • rest, ice, NSAIDS, PT, steroid injection
  • surgery if no better in 6-12 wks
64
Q

biceps tendonitis

A

overuse of biceps muscles, usually by heavy lifting

sxs:
- anterior shoulder pain
- bicipital groove tenderness
- pain w/ resisted supination

dx: clinical

tx:

  • rest, ice, NSAIDS
  • steroid injection (but not into sheath)
65
Q

proximal humerus fracture

A

fall on outstretched hand
- common in elderly women w/ osteoporosis

sxs:
- pain, swelling of proximal humerus w/ dec. ROM
- evaluate axillary artery/nerve

Dx: x-ray
- Y-view to r/o dislocation

Tx:

  • sling 4 wks, early ROM
  • surgery if head displaced or compound fx
66
Q

shoulder dislocation

A

fall on externally rotated, abducted arm
- most dislocated anterior

sxs:

  • present w/ arm abducted in ER
  • shoulder appears “squared off”
  • evaluate axillary artery/nerve

dx: x-ray (A/P, lateral, Y view to determine anterior v. posterior)

tx:
- IMMEDIATE closed reduction (post-reduction x-ray)
- sling, start ROM 2 wks

67
Q

lateral epicondylosis (tennis elbow) - sxs, dx, tx

A

overuse injury due to repetitive supination and wrist extension

sxs:

  • tender over lateral epicondyle
  • pain on resisted wrist extension

dx: clinical
- x-ray r/o arthritis or loose body

tx:
- rest, ice, NSAIDS, counter force strap, steroid injection

68
Q

medial epicondylosis (golfer’s elbow, pitcher’s elbow) - sxs, dx, tx

A

overuse injury due to repetitive pronation and wrist flexion

sxs:

  • tender over medial epicondyle
  • pain on resisted wrist flexion

dx: clinical
- x-ray r/o arthritis or loose body

tx:
- rest, ice, NSAIDS, steroid injection, stretching

69
Q

supracondylar fracture - sxs, dx, tx

A

common in children - direct blow or FOOSH

sxs:
- pain/swelling over distal humerus

dx:

  • x-ray shows posterior FAT PAD (radiolucency in back of elbow)
  • note: normal to see fat pad in anterior elbow

tx:
- non-displaced: long arm cast
- displaced: surgeon

70
Q

radial head fracture - sxs, dx, tx

A

result of FOOSH

sxs:
- present w/ elbow in flexion
- pain and swelling over lateral elbow

dx:

  • x-ray shows posterior FAT PAD (radiolucency in back of elbow)
  • note: normal to see fat pad in anterior elbow

Tx:
- non-displaced: sling (2-4 wks)

71
Q

colles fracture (distal radius fracture) - sxs, dx, tx

A

elderly person, fall on outstretched hand (fx of wrist)

sxs: swelling, pain over distal radius/ulna
- called a “SILVERFORK” deformity

dx:

  • x-ray: distal radius fx w/ dorsal angulation (towards back of hand)
  • NOTE: if angled towards palm of hand = Smith’s fx

tx:
- closed reduction and cast (6-8 wks)

72
Q

gamekeeper’s thumb - sxs, dx, tx

A

thumb forced into radial deviation

  • skier with abrupt pool plant
  • stresses ulnar collateral ligament

sxs:
- pain w/ radial stress of thumb

dx: radial deviation of thumb > good side

tx:

  • partial lig rupture: thumb spica cast
  • complete lig rupture: ORIF
73
Q

ORIF

A

open reduction internal fixation

-surgical correction

74
Q

scaphoid fracture - sxs, dx, tx

A

most common carpal fx
- due to FOOSH

sxs:

  • SNUFF BOX TENDERNESS
  • pain w/ ulnar deviation of wrist

Dx:

  • x-ray: HIGH INDEX OF SUSPICION W/ NEGATIVE X-RAY
  • bone scan or MRI will confirm

tx:

  • non-displaced: thumb spica cast (6-20 wks)
  • if suspect (but do not see on x-ray): treat as fx and repeat x-ray in 1 wk

NOTE: high rate of non-union due to poor blood supply

75
Q

boxer fracture - sxs, dx, tx

A

closed first injury
- usually wall or person

sxs: swelling/pain over 4th /5th metacarpals

dx:
- fracture of neck of 4th or 5th metacarpal w/ solar angulations (towards palm)

tx:

  • closed reduction and ulnar gutter splint
  • close f/u for loss of reduction

Note: closed fist syndrome is from punch to teeth and open wound

  • tx as bite
  • OR + IV ABX
76
Q

de Quervain’s tenosynovitis - sxs, dx, tx

A

overuse due to repetitive gripping
- seen in new mom’s

sxs:

  • pain along radial aspect of wrist
  • positive Finkelstein test

dx: clinical

tx:
- thumb spica for rest, NSAIDS, steroid injection

77
Q

trigger finger - sxs, dx, tx

A

stenosing tenosynovitis (tendon has trouble moving through sheath and finger gets stuck bent)

sxs:

  • PAINLESS nodule in flexor tendon
  • “snap” when tendon passed through sheath

dx: clinical

tx:

  • activity modification, splinting, NSAIDS
  • steroid injection into tendon sheath
  • surgical release
78
Q

carpal tunnel syndrome - sxs, dx, tx

A

median nerve compression
- due to repetitive wrist flexion

sxs:

  • numbness and night-time pain in thumb, index, middle finger
  • positive PHALEN AND TINEL sign

Dx: clinical

Tx:
- night-time splint, steroid injection (within carpal tunnel but NOT in tendons or nerve), surgical release

79
Q

cervical fracture -sxs, dx, tx

A

most due to MVA

sxs:
- posterior midline tenderness
- focal neuro deficits

dx:

  • LATERAL x-ray picks up 90%
  • most occur at C4-6

tx:
- immobilization, surgical fixation

80
Q

ankylosing spondylitis - sxs, dx, tx

A

chronic inflammatory dz affecting spine and pelvis

  • M>F
  • presents in early adulthood

sxs:

  • initial: diffuse back pain w/ am stiffness, negative exam
  • later: dec. spine mobility, limited chest expansion

dx:
- x-ray shows BAMBOO SPINE
- HLA-B27 + (90%)

tx:

  • PT for flexibility, pt education, posture
  • NSAIDs or TNF inhibitors
81
Q

2 diseases associated with HLA-B27 +

A

Reiter’s syndrome (reactive arthritis)

Ankylosing spondylitis

82
Q

kyphosis - causes, sxs, dx, tx

A

progressive increase in dorsal curve of T-Spine
- due to collapse of vertebrae

causes:
- osteoporosis, cancer, trauma, fracture

sxs:

  • pain from acute fracture
  • gradual height loss
  • hunchback deformity

dx: clinical

tx:
- PT for strengthening

83
Q

scoliosis

A

idiopathic lateral curvature of spine > 10 degrees
- dx in pre-adolescent girls

sxs:
- asymptomatic
- paraspinal hump, uneven shoulders and iliac crests

dx:
- clinical
- x-ray to measure Cobb angle

Tx: depends on angle
- observe (< 20 degrees), brace, surgery (if > 40 degrees)

84
Q

low back pain

A

COMMON - 80% of US population will have this
- usually overuse

Sxs:

  • pain that may radiate down butt or leg
  • worse with standing
  • tender over paraspinal muscle
  • dec. lumbar ROM
  • normal neuro exam

dx: clinical (x-ray of persistent)

tx:

  • relative rest, ice/heat, NSAIDS, PT
  • narcotics and muscle relaxants for ST period
85
Q

herniated disc

A

nucleus comes out of vertebral disc
- usually DDD or trauma

sxs:

  • pain in nerve distribution
  • may have weakness and diminished reflexes
  • lumbar disc = + strait leg raise

dx: MRI

Tx:

  • rest, ice, NSAIDS, PT, epidural stored injections
  • surgery if sxs persist 6-12 wks
86
Q

cauda equina syndrome - definition and causes

A

sudden compression of L2-S4 nerve roots
- MEDICAL EMERGENCY

causes: central disc herniation, epidural abscess, hematoma, tumor

87
Q

cauda equina syndrome - sxs, dx, tx

A

sxs:

  • LE radicular pain and numbness
  • saddle anesthesia, bowel and bladder dysfunction
  • LE motor and sensory loss
  • loss of sprinter tone

dx: MRI to determine cause
tx: emergency neurosurgery to find cause and relieve pressure

88
Q

spinal stenosis - causes

A

narrowing of spinal canal

  • can cause conversion of nerve root of theca sac
  • typically in older people

causes: hypertrophy of ligament flavor, facet hypertrophy, spondylolisthesis, osteophytes or bulging discs

89
Q

spinal stenosis - sxs, dx, tx

A

sxs:
- insidious onset of buttock and leg pain
- numbness with ambulating or prolonged sitting
- relief with sitting or flexion (opens canal)
- c/o poot balance, unsteady gait

dx: MRI best

Tx:

  • rest, PT, NSAIDS, weight loss
  • surgery when QOL impaired
90
Q

avascular necrosis (aka aseptic necrosis) - definition, causes, and sxs

A

loss of blood supply to femoral head (hip)

causes:

  • trauma
  • alcoholism
  • steroid and anti-retroviral use

sxs:

  • dull, ACHING GROIN PAIN
  • ANTALGIC gait
  • pain on IR and ER, dec. hip ROM
91
Q

avascular necrosis - dx and tx

A

Dx: MRI
- x-rays are negative in early dz

Tx:
- refer to orthopedic surgeon (may need hip replacment)

92
Q

hip fracture - sxs, dx, tx

A

usually due to fall in elderly women with osteoporosis
- femoral neck or inter-trochantreic (b/t greater and lesser trochanter) most common

sxs:
- leg shortened
- pain on ROM of hip

Dx: x-ray

Tx: ORIF

93
Q

hip dislocation - sxs, dx, tx

A

high impact trauma (90% MVAs)
- most dislocate posterior

sxs:

  • SHORTENED LIMB, INTERNALLY ROTATED
  • often also get knee or sciatic nerve injury

Dx: x-ray, CT to see if acetabulum is involved

Tx: immediate reduction w/ post-reduction films

94
Q

tibial plateau fracture - sxs, dx, tx

A

occurs with axial load injury (fall of jump from high place)

sxs:
- knee pain and swelling
- unable to ear weight

dx: x-ray (confirm tibial depression w/ CT or MRI)

tx:

  • immobilization, non-wt bearing
  • cast immobilization or surgery
95
Q

patellar fracture - sxs, dx, tx

A

caused by direct blow or forced flexion of quads muscle

sxs:

  • pain/swelling over patella
  • inability to actively extend knee (quad mechanism is not working)

dx: PE and x-ray

Tx:

  • <3mm displaced = 8 weeks immobilization
  • > 3mm displaced or step-off = ORIF
96
Q

ACL injury - sxs, dx, tx

A

forced internal rotation of knee w/ planted foot
- skier, basketball, soccer

sxs:

  • pt hears pop
  • sudden swelling (acute hemarthrosis)
  • instability
    • LACHMAN test and anterior drawer sign

dx: clinical
- confirm with MRI

tx:

  • initial: rest, ice, NSAIDS, brace, PT
  • arthroscopic surgery for most
97
Q

meniscal injury - sxs, dx, tx

A

mot common knee injury (medial more than lateral)

  • hx of knee trauma, but vague
  • usually twisting or slipping

sxs:

  • joint line tenderness, effusion (develops overnight), locking or clicking
    • McMurray and Apley grind test

Dx: clinical
- confirm with MRI

Tx:

  • RICE, NSAIDS, PT
  • arthroscopy for persistent sxs
98
Q

prepatellar bursitis (aka housemaid’s knee)

A

caused by excessive kneeling or trauma to knee

sxs:
- palpable boggy swelling over patella
- if red and painful, worry about infection

Dx: clinical

Tx:

  • RICE, NSAIDS
  • usually self-limiting
99
Q

ankle sprains

A

most common MSK injury

  • 85% are INVERSION with PLANTAR FLEXION
  • ATF (anterior talofibular ligg - lateral ankle) most often injured

sxs:

  • pt hears “pop” followed by swelling and bruising
  • PAIN OVER LIGAMENTS (not bone)
  • palpate 4 ligaments (3 lateral and deltoid ligg medial) as well as medial and lateral malleoli

dx: clinical

Tx: RICE, NSAIDS, supportive brace

100
Q

RICE

A

rest, ice, compression, elevation

101
Q

Ottawa Ankle Rules

A

x-ray is required if:

  • there is pain anywhere in the malleolar zone (medial or lateral malleoli)
  • inability to bear weight immediately or in ED (4 steps)
102
Q

Ottawa Foot Rules

A

x-ray is required if:

  • there is pain anywhere in the midfoot zone
  • pain at base of 5th metatarsal
  • inability to bear weight immediately or in ED (4 steps)
103
Q

ankle fracture - causes and sxs, dx, tx

A

caused by eversion, inversion, or lateral rotation of ankle

  • deltoid ligg more likely injured since lateral rotation
  • Fibula most likely fractured

sxs:

  • pain, swelling,ecchymosis, instability
  • pain over BONE

Note:

  • check proximal fibula for tenderness to R/O fibular head fx (near knee)
  • check peroneal nerve (foot drop)

Dx: x-ray (A/P, lateral, mortise view)
- mortise is space around ankle - should be equal

Tx:

  • stable: 4-6 wks immobilization
  • unstable: ORIF
104
Q

achilles tedon rupture

A

caused by pushing off or forcible plantar flexion

  • common 30-50 y/o, weekend warrior
  • “I was jumping and felt like someone kicked me in the calf”

sxs:

  • pop, deformity noted
  • POSITIVE THOMPSON TEST (squeeze calf and foot should plantar flex)

dx: clinical (MRI if going for surgery)
tx: surgery (less re-rupture)

105
Q

avulsion fracture

A

avulsion (chip) fx of 5th metatarsal
- occurs with inversion of foot

sxs:
- pain/ecchymosis at base of 5th metatarsal

Dx: x-rays

Tx: hard shoe or cast w/ rapid return to wt bearing
- good healing rate

106
Q

stress fractures

A

repetitive stress leads to bony resorption before new bone is replaced and bone breaks

  • young, active, starting new activity
  • e.g. “shin splints”

sxs:

  • pain over bone with no hx of trauma
  • usually in tibia, metatarsals, calcaneus, sacrum

dx: clinical
- x-ray often not + for 3-4 wks
- bone scan confirms early suspicion

tx:

  • rest, modification of activity, non wt-bearing for 4-8 wks
  • may need cast
107
Q

Jones fracture

A

fracture across 5th metatarsal

PANCE Review (16 decks)

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