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Clin Med II > Ortho > Flashcards

Ortho Flashcards

1
Q

Mrs Hauschildt’s fracture top 10

A
  1. 2 views at 90
  2. 2 joints
  3. 2 limbs for comparison
  4. correct angular and rotational alignment
  5. if negative follow up in two weeks
  6. look for more injuries
  7. reduce fracture ASAP
  8. avulsion injuries should be worked up for joint and tendon issues
  9. joint function should correlate with xray
  10. if you can’t reduce the fracture there might be a soft tissue injury
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2
Q

why do an open reduction

A

displaced joint fx

close reduction didn;t work

if there would be significant benefit to being mobile early

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3
Q

why would you do a closed reduction

A

to prevent devasularization and decrease infection reisk

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4
Q

two things needed for an adequate reduction

A

correction of rotational and angular deformity

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5
Q

T/F no angulation is accepted when reducing a pediatric fracture

A

false, some angulation is ok they will lay down new bone to correct it

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6
Q

why spint vs cast

A

rapid treatment

allow for swelling

allow movement

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7
Q

what sort of fractures will require a sling

A

humeral head an clavicular fractures

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8
Q

week to week healing of fractures

A

wk1: inflammation and hematoma

wk2-3: fibrous callous

wk 4-16: bony callous

wk17: remodeling

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9
Q

what is the most common sports injury

A

ankle sprains

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10
Q

most ankle sprains will involve what lateral ankle ligaments

A

the anterior/posterior talofibular and the calcaneofibular

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11
Q

T/F an avulsion fx of the tibia is treat just like an ankle sprain

A

treu

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12
Q

grades of ankle sprain

A
  1. no instability
  2. mild laxity
  3. severe, rupture of the calcaneofibular and anterior talofibular ligament
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13
Q

ottawa ankle rules for ankle sprains

A

bony tenderness along the distal 6cm of the lateral or medial malleolus

inabilty to bear weight for 4 steps

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14
Q

what is the anterior drawer test used for and how to do you do it

A

to test the anteriot talofibular ligment

stabilize the shin, grab the heel, pull forward

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15
Q

describe the talar tilt test

A

inversion in neutral foot positon and in plantarflexion

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16
Q

describe how to test the deltiod ligament

A

stabilize the shin and evert the foot at the heel, if there is gaping at the mortise then there is a rupture

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17
Q

describe how to test the talofibular syndesmosis

A

squeeze the shin with both hands with the leg hanging and the foot dorsflexed

external rotation of the foot while in dorsiflexion

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18
Q

Phase I treatment of an ankle sprain

A

rice, stabilization, weight bearing as tolerated, NSAIDs

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19
Q

phase 2-3 treatment of an ankle sprain

A

2-8 wks of PT

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20
Q

when is surgical treatment of an ankle sprain indicated

A

almost never, conservative treatment is better even in chronic cases (PT, bracing)

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21
Q

when is ankle fracture most common

A

with outward rotation and eversion

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22
Q

what is the difference between a stable and unstable ankle fracture

A

stable = only one side of the joint with an intact deltoid ligament

unstable = both sides of ankle joint

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23
Q

four important points for acute treatment of ankle fracture

A

reduction and splinting ASAP

precise aposition of fracture ends is important

joint motion should start early if possible

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24
Q

Tx for a stable ankle fracture of the distal fibula

A

4-6 wks weight bearing cast or pneumatic walker

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25
Q

Tx for an unstable ankle fracture

A
  • refer
  • nondisplaced = nonweight bearing cast for 6-8wks
  • unstable displaced = ORIF > closed reduction
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26
Q

widening of the ankle joint would indicate what

A

ruptured syndesmosis

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27
Q

general predisposing factors for achilles fractures

A

middle aged male rec sports

steroids, cipro/levo, gout, hyperthyroid

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28
Q

typical MOI for achilles rupture

A

mechanical over load from eccentric contraction or forceful dorsiflexion against an contracted gastroc

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29
Q

thompson test for achilles rupture

A

squeeze calf
↓
no foot movement
↓
torn achilles

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30
Q

hammer toe

claw toe

mallet toe

A

hammer = plantar flexed PIP

claw = extend MTP and flexed PIP and DIP

Mallet = flex DIP on the second toe

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31
Q

TX for hammer/claw/mallet toe

A

flexible deformity = pads

fixed deformity = force the toe flat with a k wire

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32
Q

what is the gender bias of plantar fasciitis

A

women 2:1 men

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33
Q

Tx for plantar fasciitis

A

weight bearing lateral if they need a shot

ice, NSAIDs, night splints, short case

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34
Q

what is a lisfranc fx

A

a fx to the head of the 2nd metatarsal

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35
Q

MOI for a lisfranc

A

axial load on a plantarflexed foot

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36
Q

signs other than pain and edema that there is a lisfranc fx

A

AP xray should show the 2nd metatarsal lined up witth the middle cuneiform

oblique should show the 4th MT line up with the cuboid

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37
Q

Tx for a lisfranc fx

A

nondisplaced = immobilize for 6-8 wks, progress to weigh bearing

displaced = closed reduction or ORIF, immobilize for 6 wks, progress to weight bearing

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38
Q

what is the most common cause of charcot foot

A

diabetes

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39
Q

what is happening with charcot foot

A

intact blood supply w/ decreased sensation
↓
leads to multiple fractures and infections
↓
development of a rocker bottom foot

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40
Q

what is the goal of treatment in charcot foot

A

to preserve normal foot structure

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41
Q

what is a jones fx

A

fx of the 5th metatarsal diaphysis caused, can be acute or chronic

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42
Q

tx for jones fx

A

non-weight bearing for 6-8 wks

walking boot for 2-4

surgery if refractory

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43
Q

describe a march fx

A

a distal 1/3 metatarsal fx, typically caused by stress, that is common in young people and more common in women

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44
Q

tx for a march fx

A

short cast, boot

restricted weight bearing for 3-4 wks

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45
Q

general tx of any metatarsal shaft fx

A

nondisplaced = hard shoes or walking cast, partial weight bearing

displaced = reduce and cast, maybe surgery

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46
Q

general treatment of a metatarsal head/neck fx

A

usually heal without intervention, you can close them with a kwire

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47
Q

describe a jones fx

A

a fx of the 2nd/3rd/4th metatarsal head, typically caused by high arches or bad shoes

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48
Q

jones fx are commonly associated with what other conditions

A

hammer toe, claw toe, hallux valgus

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49
Q

special risk for a jones fx

A

it is a low bloodflow area so risk for nonunion is high

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50
Q

ss of a jones fx

A

burning or cramping around the 2/3/4 metatarsal heads

worse with activity, better with rest

malaligned toes

callous over the middle of the foot

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51
Q

xrays for a jones fx

A

weight bearing lateral and AP

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52
Q

Tx for a jones fx

A

low heeled shoes, metatarsal pads behind the metatarsal heads

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53
Q

describe mortons neuroma

A

fibrosis of the plantar nerve between in the 3rd web space, more likely in women than men

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54
Q

SS of morton neuroma

A

walking on a marble

pain in the 3rd and 4th toe that gets better when you push on it

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55
Q

Tx for mortons neuroma

A

better shoes

pads

local injection

resection

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56
Q

what is the most common reason for hospitalization in a diabetic pt

A

foot issues

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57
Q

pathogenic factors related to diabetic foot issues

A

poorly fitting shoes

neuropathy

↓blood flow

inflammation

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58
Q

tx of diabetic foot ulcers

A

proper shoes

superficial: dression
deep: debridement, Abx, aggresive wound care
abscess: admit, ID, tertiary wound healing

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59
Q

how long does it take for osteomyleitis to show up on xray

A

up to two weeks

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60
Q

empiric abx for suspected osteomyleitis

A

IV beta lactams or vanc for MRSA

rifampin + levo = to IV meds

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61
Q

describe hallux rigidus

A

arthritis of the 1st MTP joint

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62
Q

SS/DX hallux rigidus

A

pain with push off

stiffness

loss of ext

Dx xray with narrow MTP and OA

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63
Q

Tx of hallux rigidus

A

modified footwear

NSAIDs, ice

fusion

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64
Q

What is hallux valgus

what are some predisposing factors

A

bunions

tight shoes, severe flat foot, RA

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65
Q

SS/Dx of hallux valgus

A

medial eminence pain

plantar first metatarsal pain

deformity

Dx weight bearing AP, lateral, oblique angle >15deg

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66
Q

tx hallux valgus

A

better shoes

surgery for older people, conservative tx for kids (severe limitations to activity)

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67
Q

descrive trigger finger

A

a swollen flexor tendon catching on the A1 pulley most common in diabetics on the ring, middle finger, or thumb

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68
Q

SS for trigger finger

A

tenderness at the base of the finger

catching with flexion

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69
Q

tx for trigger finger

A

cortisone injetions

surgical release

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70
Q

describe dequervains tenosynovitis

A

a repetative disorder common in post partum women that involves inflamation of the 1st dorsal tendons and sheath

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71
Q

SS/Dx for dequervain tenosynovitis

A

pain on the distal radius when lifting, swelling, tenderness

fincklestein test

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72
Q

describe the finkelstein test

A

grasp thumn
↓
move wrist down
↓
positive = pain

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73
Q

Tx for dequervains tenosynovitis

A

thumb splint

voltaren

steroid shots

suergery

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74
Q

describe a swan neck deformirt

A

flexed DIP, extended PIP with a loss of terminal ex

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75
Q

describe a boutoneire deformity

A

hyperextended DIP with a flexed PIP

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76
Q

what condition are swann neck and boutoneire deformities related to

A

RA

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77
Q

Tx for swann neck or boutoneire deformity

A

splint or surgical repair

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78
Q

what is the profundus test for a flexor tendon laceration

sublimus

A

stabilize the PIP, flex the DIP = intact profundus

stabilize uninjured fingers into ext, flex finger = intact sublimus

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79
Q

Tx for flexor tendon laceration

A

time to repair is key

6-8 weeks of rehab

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80
Q

describe mallet finger

A

a drooping DIP following a direct blow to an extended digit

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81
Q

TX for mallet finger

A

extension splint for 8 weeks, surgery if there is joint subluxation

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82
Q

describe gamekeepers thumb

A

tear of the ulnar collateral ligament of the thumb, often caused by a blow or fall

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83
Q

SS/DX for gamekeepers thumb

A

severe MP joint pain, swelling

laxity with valgus tress

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84
Q

Tx for game keepers thumb

A

laxity = surgery

partial tears get splinted for 8 weeks

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85
Q

ingeneral which type of phalanx fx are non-operative

A

distal phalanx, middle phalanx fx are usually unstable

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86
Q

Tx for a displaced, intra-articular, or malrotated phalanx fx

non-displaced

A

ORIF

splint only as much is needed to immobilize the fx

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87
Q

SS for a jammed finger/pip fx

A

swollen PIP, stiff

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88
Q

how does one distinguish a jammed finger from a pip fx

A

lateral xray

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89
Q

how are jammed fingers and pip fx treated differently

A

jammed fingers are occasionally splinted but need early rom

PIp fx need a closed reduction

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90
Q

describe a boxer fx

A

fracture of the 5th metacarpal, typically from a blow

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91
Q

SS for a boxer fx

A

depressed knuckle

local pain and swelling

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92
Q

Tx for boxer fx

A

splint with 45deg of angulation

ORIF rarely

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93
Q

general treatment for a metacarpal shaft fx

A

splint if nondisplaced

ORIF if displaced or rotated

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94
Q

describe bennetts fx

A

unsrtable intra-articular fx to the base of the thmub

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95
Q

tx for bennetts fx

A

ORIF

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96
Q

two types of distal radius fx

A

colles = dorsal tilt of the displaced fragment

smiths = volar tilt of displaced fragment

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97
Q

what is the most common adult upper extremity injury

what is the most common cause

A

colles fracture

fall on out stretched hand (Foosh)

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98
Q

what is the MOI in a smith fx

tx

A

fall on a flexed wrist

closed reduction

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99
Q

what is the most common carpal fx

MOI

A

scaphoid fx

FOOSH

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100
Q

SS/DX of scaphoid fx

A

snuff box tenderness

FOOSH

Dx with xray (scaphoid view)

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101
Q

tx of scaphoid fx

A

nondisplaced = 6-12 weeks in a splint

displaced = ORIF

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102
Q

risk of scaphoid fx

A

nonunion is common

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103
Q

describe a scapholunate dissociated

A

ligament tear between the two bones, usually presents with a swollen, tender wrist

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104
Q

DX and Tx of a scapholunate dissocation

A

4-5mm gap between the bones (david letterman sign)

surgery

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105
Q

when will a bite wound show infection

A

48-72 hours

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106
Q

what is the most common organism in fight bites

A

staph and eikenella

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107
Q

Abx for fight bites

A

augmentin or cephalexin 7-10 days

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108
Q

what are the most common organisms present in animal bites

A

strep and pasturella

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109
Q

treatment for animal bites

A

augmentin, don’t suture the wound, if there is a deep infection drain it

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110
Q

felon vs paronychia

A

felon is an infection around the pad of the finger, paronychia is around the nail

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111
Q

85% of osteoarthritis will involve what joint

second most common joint

A

DIP

thumb CMC

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112
Q

T/F wrist arthritis is common

A

false

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113
Q

conservative management for OA

A

rest, splinting

NSAIDs/ASA/tylenol

cortisone

glucosamine

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114
Q

surgical options for DIP, PIP/MP, and CMC OA

A

DIP: fusion

PIP/MP: can replace

CMC: fusion, problematic because it can decrease ROM

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115
Q

describe carpal tunnel

A

a median nerve dysfunction caused by compression at the wrist

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116
Q

common causes of carpal tunnel

A

inflammation, edema, pregnancy

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117
Q

T/F loss of motor function associated with carpal tunnel is irreversible

A

true

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118
Q

Dx for carpal tunnel

A

thenar atrophy

loss of 2pt discrimination

tinels and phalen

EMG

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119
Q

Tx for carpal tunnel

A

splints, NSAIDs, PT

steroids

surgical release

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120
Q

what is the treatment of choice for a ganglion cyst

A

none, aspiration works 1/2 the time and there is a 10% chance of recurring with excision

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121
Q

describe dupuytren’s contracture

A

a contracture formed by a painless nodule that gets trapped under thick palmar fascia

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122
Q

in what demographic is dupuytren’s contracture most common

A

men >40 from northern europe

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123
Q

when is surgical release of dupuytren’s contracture indicated

A

when the contracture is at >30° flexion

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124
Q

dupuytren’s contracture is also related to a contracture of the penis called what

A

peyronie disease

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125
Q

7 P’s of compartment syndrome

A

pain

polar

parethesia

paralysis

pulseless

pressure

pallor

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126
Q

Dx of compartment syndrome

A

high clinical suspicion warrants treatment

check pulses

palpation

direct pressure monitoring >/= 30mmHg

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127
Q

describe volkman’s ischemic contracture

A

a contracture caused by an untreated arterial injury secondary to swelling in a cast

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128
Q

volkmans contracture is most common with what types of injuries

in what locations

A

trauam, crush, fracture

elbow, tibial, metarsal

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129
Q

T/F volkman’s contracture is considered to be a non-emergent referral

A

false, it is a surgical emergency

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130
Q

describe the process of volkman’s ischemia contracture

A

trauma with casting
↓
swelling
↓

prolonged hypoperfusion
↓
nerve and muscle injury
↓
fiber shortening
↓
persistent contracture

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131
Q

what is the most common type of shoulder dislocation

A

anterior

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132
Q

what is the most common MOI for an anterior shoulder dislocation

A

forced abduction on externally rotated and extended arm

OR

forced horizontal abduction

OR

blow to the posterior shoulder

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133
Q

what nerve and artery should you pay special attention to when treating and anterior shoulder dislocation

A

axillary nerve and brachial artery

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134
Q

SS of anterior shoulder dislocation

A

slight abduction and external rotation

prominent acromion

loss of senstation in a shoulder badge distribution

some amount of axillary nerve dysfunction

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135
Q

when is reduction of an anterior shoulder dislocation contraindicated

A

in the elderly

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136
Q

external rotation is the most common method of reducing a dislocated shoulder

describe the method

A

arm adducted, elbow flexed

slow external rotation

if there is a clunk then it worked

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137
Q

post reduction care for an anterior shoulder dislocation

A

1-3 wks of immobilization and slowly progressive ROM

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138
Q

posterior shoulder dislocations are less common than anterior

what is the most common MOI

A

falling on a flexed arm or a blow to the front of the shoulder

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139
Q

why are posterior shoulder dislocations easy to miss

A

normal contour is maintained

xrays miss 50%

the patient keeps the arm internally rotated and adducted

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140
Q

three xray findings that indicate a posterior shoulder dislocation

A

trough (anterior humeral head impacted against the posterior glenoid fossa)

rim

light bulb (humeral head clearly visible)

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141
Q

best view for a posteior shoulder dislocation

A

scapular Y

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142
Q

what is the least common type of shoulder dislocation

MOI

what nerve is commonly injured

A

inferior

overhead pulling

axillary nerve

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143
Q

what is the most common shoulder injury in family practice

A

shoulder impingement

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144
Q

describe the pathophysiology of shoulder impingement

A

compromised subacromial space
↓
bursa/tendon microtrauma
↓
inflammation, edema, pain

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145
Q

MOI for shoulder impingement

A

frequent overhead activity, muscle imbalance, or trauam

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146
Q

describe the three types of acromions that can contribute to shoulder impingement

A

Type 1 flat

type 2 curved

type 3 hooked

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147
Q

SS of shoulder impingement

A

subacromial pain on palpation

pain on rotation

mild nocturnal ache

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148
Q

Dx tests for impingement

A

neers to the ears

hawkins (90° with internal rotation)

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149
Q

Tx for shoulder impingement

A

NSAIDs, PT, Rest

subacromial injection (1 depo, 2 lido, 2 sensorcaine)

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150
Q

describe the pathophysiology of rotator cuff tendinosis

A

overuse and trauma lead to the accumulation of thin, loose collagen
↓
cell metaplasia and death

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151
Q

SS rotator cuff tendonosis

A

pain with overhead movements or rotation

may localize to lateral delt

similar to impingement

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152
Q

Dx rotator cuff tendinosis

A

mild str deficits

painful ROM

atrophied supraspaintus/infraspinatus

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153
Q

two chronic conditions that can result in rotator cuff tears

A

tendinosis and impingement

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154
Q

MOI for an acute rotator cuff tear

A

violent pull

abnormal hyperrotation

fall on an outstretched arm

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155
Q

SS rotator cuff tear

A

weakness

increased nocturnal ache

referred pain to the lateral biceps

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156
Q

Dx rotator cuff tear

A

drop arm test

MRI or CT arthrogram

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157
Q

Tx rotator cuff tear

A

small or partial thickness tears get rest, NSAIDs, injections

large tears get surgery with 3-6 mo of rehab

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158
Q

describe bankart and SLAP labral tears

A

bankart = anterior

SLAP = superior labrum anterior to posterior

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159
Q

what is the least common kind of labral tear

A

posterior

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160
Q

MOI of a labral tear

A

subluxation, dislocation, OH injury, microtrauma

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161
Q

SS labral tear

A

younger pts, throwers

mechanical symptoms like creptitus and catching

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162
Q

describe the crank test for dx of a SLAP labral tear

A

abduct the shoulder 160° while keeping the arm in the plane of the scapula
↓
elbow flexed 90°
↓
push arm into shoulder, internally and externally rotate

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163
Q

Obrien test for a SLAP labral tear

A

flex shoulder 90° with the elbow extended
↓
abduct 10°
↓
internally rotate and push arm down
↓
repeat supinated
↓
pain on supination, relief on pronation

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164
Q

Tx for labral tear

A

refer

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165
Q

bicepital tendonitis is most common in what age group

what about tendinosis

A

tendonitis = younger

tendinosis = older

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166
Q

SS bipetal tendonitis/osis

A

pain in the front of the shoulder

can radiate down bicep

difficult with resisted supination

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167
Q

yergason test for bicipetal tendinopathy

A

flex and pronate the arm 90° with the arm stabil against the torso
↓
resist supination and external rotation

168
Q

speeds test for biciptal tendinopathy

A

resist shoulde flexion with hand supinated and elbow extended

169
Q

Tx for bicep tendinopathy

A

rice, injections, severe cases should get referred

170
Q

MOI for a proximal bicep tear

A

forced flexion or long standing tendinopathy

171
Q

where does a it most commonly occur

A

at the insertion to the glenoid labrum

172
Q

SS of a biceps tear

A

pain at insertion or in the muscle belly, ecchymosis

173
Q

Dx biceps tear

A

popeye sign (bulge in the muscle)

weak flexion

US or MRI

174
Q

Tx biceps tear

A

refer

older less active patients can be treated conservatively

175
Q

MOI for an AC sprain/separation

A

blow to the tip of the shoulder

fall on an outstretched arm

176
Q

most common age groups for AC sprain/separation

A

men in the 20;s

177
Q

how does an AC sprain separation evolve from type 1 to type 3

A

type 1 has mild pain and no instability

type 2 adds a ruptured AC ligament and movement of the distal clavicle

type 3 piano key sign

178
Q

Dx for AC sprain/separation

A

crossover arm test

xray

179
Q

tx for Ac sprain/separation

A

sling, rice, NSAIDs, early ROM

Type II and III get referred

180
Q

T/F OA of the AC joint is uncommon

A

false, it is common but usually not symptomatic

181
Q

SS AC joint arthritis

A

pain at the AC, delt, trap

worse with activity

creptitus

182
Q

Dx for AC arthritis

A

enlarged joint

reproducible pain

xray with OA

183
Q

Tx for AC joint Oa

A

activity modification, RICE, NSAIDs, injection, refer if refractoy

184
Q

glenohumeral OA is uncommon and usually comes after a trauma. If it is primary OA, who does it usually affect

A

women >60

185
Q

SS glenohumoral OA

A

gradual onset shoulder pain and stiffness

worse with activity

night pain

186
Q

DX glenohumeral OA

A

GH joint line pain

decreased ROM, esp external rotation

crepitus

xray: PA, external rotation, y, axillary

187
Q

TX for glenohumeral OA

A

NSAIDs, PT, injections, referra;

188
Q

what is usually the first movement to be lost in adhesive capsulitis

A

internal rotation

189
Q

adhesive capsulitis is usually secondary to what things

A

injury, DM, hypothyroid, autoimmune disease

190
Q

SS of adhesive capsulitis

A

severe, nagging pain

progressive stiffness with restricted ADLs

191
Q

Dx adhesive capsulitis

A

decreased ROM

firm, painful end to passive ROM

anesthetic injections don’t help frozen shoulder

192
Q

Tx adhesive capsulitis

A

start with conservative therapy

consider steroid injections

referral for manipulation or surgery

193
Q

rank these in order of most likely to be injured

proximal clavicle

distal

middle

A

Middle

distal

proximal

194
Q

SS of clavicle fx

A

bulge, hematoma

ecchymosis

pain on palpation

cephalic AP

195
Q

Tx for open clavicular fx, one with NV compromise, or skin tenting

A

urgent

196
Q

Tx for displaced, communited, or shortened clavicle

A

refer but not urgent, consider splinting

197
Q

what is the the 3rd most common Fx of the elderly

A

proximal humerus fx

198
Q

what demographic is most likely to have a proximal humerus fx

A

females between 73 and 78

199
Q

SS proximal humerus fx

A

pain, swelling, ecchymosis

axillary nerve issues (delt weakness, lost sensation over the mid delt)

suprascapular nerve weakness (supra/infraspinatus)

200
Q

Dx proximal humerus fx

A

AP, lateral, Y xray

201
Q

classification of proximal humerus fx

A

1 = no displaced fragments

2 = one displaced fragment

3 = 2 displaced fragments and the humeral head is in contact with the glenoid fossa

4 = 3 displaced fragments and dislocation

202
Q

most humeral shaft Fx come from high impact injuries

what should be suspected in low impact fx

A

underlying pathology

203
Q

what is the most common nerve injury associated with a humeral shaft Fx

(inability to extend hand or wrist, sensory loss on the back of the hand)

A

radial nerve

204
Q

Tx for a humeral shaft fx

A

close: reduce, casting
open: external fixation

205
Q

scapular fractures are rare and require high force but rarely get surgical repair unless what

A

the glenoid is involved

206
Q

lateral epicondylitis (tennis elbow) usually involves what msucle

A

extensor carpi radialis

207
Q

risk factors for lateral epicondylitis

A

smoking, fat, 40-50, with repetative stress

208
Q

SS lateral epicondylitis

A

swelling/localized tenderness

pain with resisted extension w/ elbow extension

pain with passive wrist flexion and full ext

209
Q

Tx for lateral epicondylitis

A

observation

splints/braces

NSAIDs

NOT STEROIDS

210
Q

when to refer lateral epicondylitis

A

pain lasting 6 months despite conservative treatment

211
Q

is medial epicondylitis (golfers elbow) or lateral epicondylitis (tennis elbow) more common

A

tennis elbow

212
Q

SS of medial epicondylitis

A

pain over medial condyle

pain with resisted wrist flexion and elbow flexion

pain with passive wrist ext extension

213
Q

Tx for medial epicondylitis (same as tennis elbow)

A

RICE, brace/splint, NSAIDS, NOT STEROIDS

refer after 6 months of conservative treatment

214
Q

causes of olecranon bursitis

A

trauma

pressure

overuse

infection

215
Q

SS olecranon bursitis

A

inflammation/edema

can be painful or painless

216
Q

is imaging needed for olecranon bursitits

A

not unless there was an injry

217
Q

why would you aspirate olecranon bursitis

A

relief

look for crystals

infection

218
Q

most common bacteria in olecranon bursitis

what percent will culture negative

A

staph

50-60%

219
Q

mild infectious olecranon bursitis can be treated with what

severe gets what

A

clinda, bactrim, doxy

vanc+zosyn or ancef

220
Q

when would surgery be needed for olecrannon bursisits

A

unable to aspirate

refractory

foreign body

infection/sepsis

221
Q

MOI distal biceps tear

A

forceful lifting

222
Q

Dx distal biceps tear

A

tenderness over the radial tubercle

pain/weakness on resisted flexion/supintaion

223
Q

squeeze test for distal biceps tear

A

squeeze the bicep and see how loose it is

224
Q

hook test for distal biceps tear

A

hook your finger under tha loose tendon

225
Q

Tx distal biceps tear

A

refer to orttjh

226
Q

MOI elbow dislocation

A

axial force on an extended elbow

227
Q

SS elbow dislocation

A

short limb that is slighted flexed

228
Q

Tx elbow dislocation

A

splint in flexion and pronation after reducing and refer

229
Q

cubital tunnel syndrome is caused by compression of what never

A

urlnar nerve

230
Q

common causes of cubital tunnel

A

swelling, trauma, pregnancy

231
Q

SS cubital tunnel

A

numbness over the 4th and 5th fingers

medial elbow pain

nocturnal weakness

worse with elbow or wrist flexion

232
Q

Dx cubital tunnel

A

hypothenar, FCU wasting

tinels at the elbow

pain with hyperflexion (elbow flexion test)

NCV

233
Q

Tx cubital tunnel

A

pad/splint

PT/OT

surgical transposition

234
Q

Dx of olecranon fx

A

trauma (high impact in young people)

inability to extend elbow

lateral xray or Ct

235
Q

Tx for olecranon Fx

A

nondisplaced with intact extensor function = immobilize

ORIF otherwise

236
Q

describe a concussion

A

a functional congnitive impairment caused acutely by trauma

237
Q

physical SS concussion

A

LOC

loss of balance

N/V

238
Q

behavior SS concussion

A

irritable

aggressive

amnesia

sleep

239
Q

why is it important to have baseline concussion testing before the season

A

so you can accurately determine whow altered they are and how well they com back

240
Q

described the staged return to activity in concussion recovery

A

24-48 hrs
↓
Light aerobic
↓
Sport specific skills
↓
Non-contact
↓

Full contact
↓
No restriction

241
Q

factors that would determine progression through concussion recovery

A

age

sz

depression

extended LOC

amnesia

242
Q

MOI radial head fx

A

FOOSH

243
Q

Tx radial head Fx

mason classification 1 (nondisplcaed)

A

non-surgical, early ROM

244
Q

Tx radial head Fx

mason classification 2 (single, large, displaced fx)

A

<2mm displacement and no other injuries = non surgical

245
Q

Tx radial head Fx

mason classification 3 (comminuted)

A

fragment excision, maybe prosthetic

246
Q

Tx radial head Fx

mason classification 4 (fx associated with elbow dislocation

A

fragment excision, maybe prosthesis

247
Q

a night stick fracture is an isolated ulnar fx most commonly caused by what

A

a blow rather than a fall

248
Q

criteria for a non-operative night stick fx

A

<50% displacement

<10­° angulation

no radial head dislocation

in the distal 2/3 ulna

249
Q

SS of hip burisitis

A

point tenderness over the greater trochanter

unable to lay on that side

pain worse with active abduction or adducton+internal rotation

250
Q

Tx for hip bursitis

A

RICE

PT

NSAIDs

steroid injections

refer if refractory

251
Q

what test would be used for a flexion contracture

A

thomas test

252
Q

most common muscles injured in hip strain

A

abdominal, hip flexor, or adductor

253
Q

Dx for hip strain

A

AP and frog leg

254
Q

Tx hip strain

A

rice

crutches

NSAIDs

PT

return to activity 4-6 wks

255
Q

most comonly muscle injured in a thigh strain

what is the most common in a truma

A

hamstring

thigh

256
Q

Dx thigh strains

A

clinical (pain, pop, bruising) unless avulsion is suspected

257
Q

chronic conditions caused by a hamstring strain

A

myositis ossificans

chronic hamstring pulls

258
Q

hip impingment is most common in what age group

A

younger people

259
Q

hip impingement is more likely to chronic or acute

A

chronic

260
Q

SS hip inpingment

A

deep pain over the lateral hip (c sign)

pain is worse with long sitting or getting up from a deep squat

decreased internal or external rotation

261
Q

Dx hip impingement

A

positive flexion, adduction, internal rotation (FADIR)

deep hip socket

MRI arthrography or CT to look for labral tear

262
Q

tx hip impingement

A

conservative treatment

NSAIDs

refer to orther

263
Q

describe the pathogeneis of avascular necrosis

A

ischemia and necrosis
↓
collapse/fragmentation of the femoral head
↓
deformity and arthritis

264
Q

AVN typically occurs in both hips and between what ages

A

30 and 50

265
Q

risk factors for AVN

A

trauma

ETOH

steroids

smoking

266
Q

SS AVN

A

gradual onset pain in the groin, lateral hip, butt

short stance with atalgic gait

decreased internal rotation

267
Q

Dx AVN

A

sclerosis (cresent sign), lucency, collapse of the femoral head on xray or MRI

268
Q

Tx AVN

A

refer to ortho

mild cases can be treated with rest to allow bone degeneration

severe disease needs a hip replacement

269
Q

SS hip OA

A

gradual onset unlateral or bilateral groin or anterior thigh pain

intially only weight bearing

better with activity

decreased ROM

gait changes

270
Q

gait changes associated with hip arthritis

A

atalgic gait

abductor lurch over the bad hip

271
Q

Dx hip OA

A

xray can be used to confirm but the symptoms often don’t match the xray

272
Q

Tx for hip OA

A

conservative, total hip if refractory

273
Q

MOI hip dislocation

A

direct trauma to the knee while the hip and knee are flexed drives the femoral head out of the acetabulum and fractures the posterior wall

274
Q

SS hip dislocation

A

painful movement

unable to move leg

additional injury

posterior vs anterior posturing

275
Q

how will an anterior hip dislocation (blow to the knee with the hp abducted and internally rotated) present

A

short leg with flexed hip held in adduction and internal rotation

276
Q

how will a posterior hip dislocation present

A

leg held in flexion, abduction, external rotation

277
Q

Dx hip dislocation

A

AP pelvis/femur including knee

CT to evaluate acetabular fx

278
Q

Tx for hip dislocation

A

closed reduction asap (make sure to get pre and post films)

pre and post neuro check

if it works they can go on crutches for 2-4 weeks

if it doesn’t then they get an open reduction

279
Q

hip fractures have a 30-50% one year mortality and are most common in what age group

A

over 50 (2x increase in risk each decade after 50)

280
Q

risk factors associated with hip fx

A

age

falls

white women

ETOH

281
Q

Tx hip fx

A

semi urgent surgery within 24-48 hours

hemiarthroplasty if the capsule is disrupted

pins and screws if it nondisplaced/impacted

intertrochanteric = ORIF or IM nail

282
Q

high impact pelvic fx often results in what

A

massive blood loss

283
Q

what is the difference between a stable and unstable pelvic fracture

A

stable fx only one side of the pelvic ring, unstable does both

284
Q

SS pelvic Fx

A

low impact: groin, lateral hip, butt pain

high impact: pelvis swelling, deformity, GU issues

285
Q

Tx low impact/high impact pelvic fx

A

low impact: analgesics, walker, look for osteoporosis

high impact: hip binding with a sheet, urgent surgery

286
Q

what is the difference between acute and chronic osteomyelitis

A

acute is usually shows symptoms in 2 weeks

chronic will have necrotic bone 6 weeks after infection and is generally secondary to sepsis or fx

287
Q

what is the most common pathogen to cause osteomyleitis by hemogenous spread

wjhere does its spread

what demographic

A

staph A or strep

long bones

kids under 5

288
Q

osteomyelitis caused from a diabetic ulcer is most commonly poly microbial

what are two clues you can use to determine if a lesion is causeing osteomyelitis

A

you can pass a probe through the ulcer to bone

the ulcer is larger than 2 cm

289
Q

osteomyelitis from IV drug use is most likely to be from what two pathogens and go to what bones

A

staph or psuedo

the spine

290
Q

SS osteomyelitis in neonates

A

vague symptoms, pseudo paralysus

291
Q

SS osteomyelitis in older kids

A

pain, fever, swelling

292
Q

SS osteomyelitis in adults

A

hematogenous: back pain, pertinent Hx, chancer, CKD, IV drugs

from an ulcer: DM, chronic pain, wound drainage

293
Q

when aspirating a wound for osteomyelitis should you culture before or after abx

A

before

294
Q

important labs for osteomyelitis

A

CBC for leukocytosis acutely

ESR/CRP

295
Q

if you see osteopenia, swelling, bone deformity associated with osteomyelitis on xray, how long can it take for those findings to show up

what if you used an MRI?

CT?

Bone scan?

A

xray can take 2 weeks

MRI shows marrow changes in 3-5 days

bone scan is sensitive but not specific

296
Q

empiric Tx for osteomyelitis

(rifampin + quinolones are just as effect as IV meds)

A

beta lactam or vanc for MRSA

foot ulcer or PCN allergy = quinolones

297
Q

CAVE mnemonic for talipes equivarus (club foot)

A

cavus

adductus

varus

equinus

298
Q

club foot is commonly found with what other pediatric ortho issue

A

torticollis

299
Q

T/F pez planus (flat feet) are normal

A

true

300
Q

Tx for club foot

A

serial casting

301
Q

typical causes of high arches (pez cavus)

A

charcot, polio, pain in shoes and boots

302
Q

physical exam signs of developmental hip dysplasia

A

unilateral will limp, bilateral will have excessive lordosis

303
Q

when doing the ortalani and barlow tests for hip dysplasia, which do you do first

A

ortilani to see if the hip is already out

304
Q

palvik harnesses work to correct hip dysplasia 90% of the time if they are subluxed, what about if they are dislocated

A

50%

305
Q

what is the highest predictor of infection in a pediatric septic hip

A

CRP

306
Q

what is the risk of a septic joint in a child with clinical presentation but no predictive markers

A

17%

307
Q

gower’s sign is indicative of what

A

musclar dystrophy

308
Q

horner’s sign + flaccid arm = what

A

total brachial plexus injury

309
Q

most important thing to remember about a nursemaids elbow

A

don’t reduce it without an xray because you don’t know th eudner lying pathology

310
Q

what is considered to be clinical scoliosis

A

greater than 10° curvature

311
Q

25° scoliosis gets what treatment

45° scoliosis gets what

A

25 gets a brace

45 gets surgery

312
Q

pressure sores are the most common sequella from the ER

what should be done to prevent them

A

mold casts around bony prominences

pad them throughly

313
Q

salter harris classification (SALTR)

A

Type I: separated

Type II: above

typel III: below

Type IV: through

Type V: ram

314
Q

SS for subcapital femoral fx

A

referred pain from the obturator nerve

obligate external rotation when the femur is flexed

315
Q

why is it important to keep patients with subcapital femoral head fx off their feet even if they haven’t slippled

A

a small slip can turn into a big slip and lead to avascular necrosis

316
Q

Tx for a femur fx

A

>11 long rod

<100lbs, flexible nails

<5, spica cast

317
Q

why do you have to surgically fix a patella sleeve fx

A

because it will heal elongated and cause issues

318
Q

in a proximal tibia fx what artery is at risk

A

popliteal artery

319
Q

what is the last growth plate to heal

why is this important to know

A

the sternoclavicular

because if there is a posteriorly displaced Fx then it can impinge on the subclavian

320
Q

pt presents with a broken clavicle that was splinted and now has a blanched, tented area

what is the next step in tx

A

they need surgery to keep that tissue from dying

321
Q

when is surgery indicated in a pediatric pt with a clavicle fx

A

when there is >2cm of shortening or they are close to physical maturity

322
Q

T/F in a pediatric patient almost any amount of displacement can be corrected without surgery in a proximal humerus fx

A

treu

323
Q

what makes elbow fx complicated in pediatric pts

A

the growth plates fuse in parts

324
Q

what is the most common type of supercondylar humerus fx in peds

what is the most commonly injured nerve

A

extension type

anterior interosseus

325
Q

why is it important to xray an elbow disllocation in a peds pt before reducing

A

because they can almost always be reduced, but if the medial condyle has broken off and is in the joint then you are in deep shit

326
Q

describe the differences in prestation, dx, and rx in compartment syndrome in kids vs adults

A

kids are more likely to present with anxiety before pain

the dx is clinical

if you have a high enough suspicion to test compartment pressure then just do the surgery

327
Q

identifiers of child abuse

A

MOI changes that don;t match injury

femur fx in a non-ambulatory child

multiple Fx in different stages of healing

classical metaphyseal lesion (bucket handle fx)

328
Q

describe os good schlatter

A

bony growth at the junction between the patella ligament and the tibial tubercle

329
Q

osgood schlatters is suspected when

A

in a patient 12-14 with repetative strain

330
Q

SS osgood schlatter

A

pain, sweling, tenderness around the tibial tubercle

releived by rest

331
Q

dx osgood schlatter

A

irregular ossifications or fragmentation of the tibial tubercle on xray

332
Q

tx osgood schlatters

A

avoid triggers

ice

immobilization

rarely surgical

333
Q

nursemaids elbow is wha

A

dislocation of the radial head usually caused by pulling on a kids arm

334
Q

what is the most common position of torticolis

A

right sided lateral flexion and rotation

335
Q

conditions associated with congenital torticolis

A

birth trauma (SCM fibrosis)

clavicle fx

tumor (fibromatosis coli)

336
Q

tx for torticolis

A

PT, exercise, botox, surgery

337
Q

causes of acquired torticolis

A

cervical dystonia

idiopathic

huntingtons

parkinsons

338
Q

describe legg calve perthe

A

congenital AVN of the femoral head in children, usually presenting before age 10

339
Q

should you suspect legg calve perthe in a pediatric pt with bilateral AVN

A

no, because its very rare to start and rarely effects both hips

340
Q

MOI for ACL injury

A

significant twisting injury

341
Q

SS ACL injury

A

usually has a pop

hemarthrosis is rapid and common

knee buckling

342
Q

lachmans for ACL

A

: hold the thigh and calf with thumb on the medial tibia and pull

343
Q

pivot shift test for acl

A

valgus and upward force on an extended knee

344
Q

tx for ACL

A

RICE

immobilization, reduction in weight bearing

NSAIDs

therapy

surgery

345
Q

MOI for PCL

A

direct trauma to the tibia while the knee is flexed

346
Q

Tx for PCL

A

most likely refer for surgery

347
Q

test for MCL

LCL

which is more common

A

MCL gets valgus

LCL gets varus

MCL is more common

348
Q

when doing varus and valgus for LCL and MCL, what two positions do you use

A

extended and 30° of flexion

349
Q

when would you refer an MCL/LCL injury for surgery

A

severe hemarthrois or instability

350
Q

SS/Dx of patellar dislocation

A

knee gives out or pops out

spontaneous reduction on knee extension

positive apprehesion test

351
Q

Tx for patellar dislocation

A

aspirate tense hemarthrosis

immobilize

full weight bearing

PT for quad strength

352
Q

MOI patellar fx

A

direct blow to the quad while under tension

353
Q

SS patellar fx

A

unable to extend knee

hemarthrosis

open fx

354
Q

dx patellar fx

A

AP and lateral

355
Q

why would a patient with a patellar fx have an intact extensor mechanism

A

because the fractured ends are less than 6mm appart

356
Q

Tx for patellar fx

A

immobilize in ext for 6 wks

>5mm separation or 2mm daplcement = referal

357
Q

SS patellar tendonitis

A

anterior knee pain

pain with squatting or sitting

pain with stair climbin

358
Q

Dx patellar tendonitis

A

pain on palpation

quad atrophy

MRI if refractory

359
Q

tx patellar tendonitis

A

rest

knee immobility

NSAIDs

NO STEROIDS

360
Q

describe osteochondritis dessicans

A

fractured bone immediately underneath cartiliage typically caused byt blood loss

361
Q

T/F meniscal injury is the most common cause of knee pain

A

true

362
Q

SS meniscal injury

A

joint line tenderness

swelling

loss of ext

363
Q

Dx meniscal injury

A

McMurray (figure 8)

Apley (push down and twist)

standing xray

MRI/CT arthography

364
Q

why is the apley test important to do with mcmurry in testing for meniscus tear

A

because apley will distinguish between meninucus vs collateral ligament injury

365
Q

Tx for mensical injury

A

rice

PT

NSAIDs

scope

366
Q

when to refer a meniscal injury

A

locking

lack of full ROM

persistent symptoms

367
Q

what is the most common cause of ANTERIOR knee pain

A

chrondomalacia of the patella

368
Q

SS chondromalcia of the patella

A

worse with sitting and goiung down stairs

negative xrays

patellar compression and entrapment

369
Q

patellar chondromalacia tx

A

NSAIDs, RICE, PT

surgery if refractory

370
Q

Hx/SS that would indicate LB sprain/strain

A

repeated twisting or lifting

can radiate to butt but not down leg

cant stand up straight

371
Q

Dx low back strain

A

tenderness/spasm

limited ROM

normal DTRs and strength

+SLR

372
Q

spinal stenosis is most common in what age group

A

>50

373
Q

spinal stenosis lumar will cause nerve issues at what level

A

the level below

374
Q

Motor, reflex, sensory for L4

A

motor: anterior tub
reflex: patellar
sensory: medial ankle

375
Q

motor, sensory, reflex for L5

A

motor: extensor hallucis longus
sensory: top of the foot
reflex: none

376
Q

motor, sensory, reflex for S1

A

motor: peroneus
sensory: lateral/posterior ankle
reflex: achilles

377
Q

Dx lumbar spinal stenosis

A

↓DTRs

↓Str

+ SLR

xrays, CT myelogram, MRI

378
Q

Tx Lumbar spinal stenosis

A

injection, NSAIDs, surgical decompression

379
Q

when to refer a pt with lumbar stenosis

A

failed conservative treatment or bowel/bladder issues

380
Q

what would describe a fatigue fracture of the pars interarticularis that doesn’t heal

A

spondylolysis

381
Q

what is the most common cause of spondylolisthesis (anterior slipping of a vertebra)

A

spondylolysis

382
Q

SS spondylolisthesis

A

maybe none

LBP with posterior radiculopathy

pain worse standing or with lumbar ext

383
Q

Dx Spondylolisthesis

A

loss of lordosis

step off defect

pain with ext

normal STR and DTR

Xray, CT, MRI

384
Q

in what age groups are herniated discs most common

A

<50

385
Q

SS herniated lumbar disc

A

acute onset

worse bending, sitting, coughing

hard time sitting still

386
Q

a how will neuro deficits from a central lumbar herniation differ from a far lateral

A

central stenosis causes symptoms at the level below, lateral stenosis causes symptoms at the same level

387
Q

Dx lumbar disc herniation

A

+ SLR

+ bowstringing (pushing on the pop fossa after SLR reproduces symptoms

388
Q

what is the most common level for a lumbar disc herniation

A

L4-5

389
Q

Tx for herniated disc

A

PR

injected/oral steroids

muscle relaxer

analgesic

surgery

390
Q

when to refer a herniated disc

A

cauda equina syndrome, declining neuro funtion, paralysis, failed tx

391
Q

describe Potts disease

A

TB of the spine

392
Q

T/F all compression fx require kyphoplasty

A

false, all of them will heal in time and most feel better with simple bracing

393
Q

important sensory roots for the cervical spine

A

C6 = thumb

C7 = index

C8 = pinkie

394
Q

important motor nerve roots for the cervical spine

A

c5 = delt

C6 = bicep, ecr

C7 = tricep, fcr

C8 = flexor digitorum

T1 = FDI

395
Q

important DTRs for the cervical spine

A

C5-6 = biceps, brachioradialis

C7 = triceps

396
Q

when would a cervical fracture be considered unstable

A

when two of the three columns of the spine are fractured

397
Q

describe the anterior, middle, and posterior columns of the spine

A

anterior = anterior longitudinal ligament, anterir body and disk

middle = posterior ligament, body, disk

posterior = pedicles, facet joints and processes, neural arch

398
Q

describe TX of an odontoid Fx by type

A

I = avulsion, usually a stable brace

II = the waist, high non-union risk needs halo or sx

III = into the body of C2, brace

399
Q

what is the most common cervical fx (Hangmans)

A

pars fracture at C2

400
Q

cause of a hangmans fx

A

extreme hyper ext

401
Q

Dx and Tx for hangmans fx

A

Dx is CT

Tx is a brace or surgery if displaced

402
Q

name the fx: C1, diving, type of burst fx

A

jefferson fx

403
Q

name the fracture: flexion injury from lap belt, usually includes abdominal injuries

A

chance fx

404
Q

what level is most common to have a cervical disc herniation

A

C5, 6, 7

405
Q

spurling test for cervical disc herniation (specific but not sensitive)

A

with head in slight ext and lateral flexion apply axial force

406
Q

distraction test for cervical disc herniation

A

traction relieves the pain

407
Q

preferential dx for cervical herniation

A

MRI, but xray or CT will work

408
Q

Tx cervical hernation

A

90% can be treated conservatively

surgery if high pain, unstable, ↑neuro deficit, myelopathy

409
Q

carpal tunnel, cubiutal tunnel, radiculoparhy, brachial plexus injury can all present like what

A

thoracic outlet syndrome

410
Q

risk factors for thoracic outlet

A

poor posture, chest/clavicle trauma, overhead athletes

411
Q

which is more common, neurogenic of vascular thoracic outlet

what are the most common symptoms

A

neurogenic

anterior shoulder pain, N/T/W in the arm

412
Q

addson test for thoracic outlet

A

extend, abduct, externally rotate affected arm, take a deep breath, extend neck and rotate head to affected side

413
Q

roos test for thoracic outlet

A

•: sit up with good posture, arms up at 90 with external rotation, open and close fsits for 1 minute

414
Q

MOI for cervical sprain

A

acute = whiplash

can be chronic or a product of bad posture

415
Q

tx cervical sprain/strait

A

xray, MRI

cervical collar 1-2 wks

416
Q
A

Clin Med II (6 decks)

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