Case Study: Leg Pain Flashcards Preview

Skin MS: Week 6 > Case Study: Leg Pain > Flashcards

Flashcards in Case Study: Leg Pain Deck (26):
1

Differential Diagnosis "Shin Splints"

•Stress fractures

•Medial tibial syndrome

•Compartment syndromes

  Anterior

  Deep Posterior

2

•Occurs when muscles become fatigued and unable to absorb shock. Muscle overload shock is transferred to weight bearing bones

stress fractures

3

Stress fractures are _______ injury

overuse

4

Stress fractures most occur in __________

bones of lower leg and foot

5

Sxs stress fractures

pain w/ activity, subsides w/ rest

6

STress fractures dx

xray, MRI, bone scan

7

stress fractures tx

rest

8

Medial Tibial Syndrome

•Most common site is ______ of the _____ border of the _____

•Generally felt to be the insertion of the _____

•Pathology is an area of _______

•Most common site is distal one-third of the medial border of the tibia

•Generally felt to be the insertion of the soleus

•Pathology is an area of tibial periostitis

9

Medial Tibial Syndrome Dx

•physical exam, pain on palpation of the distal tibia over a length of 5 cm.

10

Medial tibial syndrome tx

rest

11

  A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space.

Compartment syndrome

12

Compartment syndrome complications

•Reduces tissue perfusion - ischemia

•Results in cell death - necrosis

•True Orthopedic Emergency

13

Compartment Syndrome Etiology

•Fractures-closed and open

•Blunt trauma

•Cast/dressing

•Burns/electrical

•Exertional states

•Gunshot

•IV/A-lines

•Hemophiliac/coag

•Intraosseous IV(infant)

•Snake bite

•Arterial injury

14

Most common cause of compartment syndrome

Fracture (incidence of accompanying CS 9.1%)

15

CS incidence is directly proportional to the __________

degree of injury to soft tissue and bone (fracture)

16

Most common fracture occurence --> CS

•occurred most often in association with a comminuted, grade-III open injury to a pedestrian

17

2nd most common cause of CS

blunt trauma (about 23% of CS)

25% d/t direct blow

18

CS tissue survival

•Muscle

– 3-4 hours - reversible changes

–6 hours - variable damage

–8 hours - irreversible changes

•Nerve

–2 hours - looses nerve conduction

–4 hours - neuropraxia

–8 hours - irreversible changes

19

CS dx

•Pain out of proportion

•Palpably tense compartment

•Pain with passive stretch

•Paresthesia/hypoesthesia

•Paralysis

•Pulselessness/pallor

20

CS pain

most important. Especially pain out of proportion to the injury (child becoming more and more restless /needing more analgesia)

 

Pain on passive stretching and palpation of involved compartment

21

22

CS Pain vs other Ps

•Other features like pallor, pulselessness, paralysis, paraesthesia etc. appear very late and we should not wait for these things.

23

CS tx

fasciotomy - all compartments

24

CS wound management

•After the fasciotomy, a bulky compression dressing and a splint are applied.

•Incision for the fasciotomy usually can be closed after three to five days

25

Medial tibial syndrome is from the insertion of the:

soleus

26

The initial treatment of compartment syndrome is:

Fasciotomy