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Block 3: MSK > Clin Med: Msk 2 - Lower Body > Flashcards

Clin Med: Msk 2 - Lower Body Flashcards

(89 cards)

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1
Q

Hip Fractures Dx

A

x-ray

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2
Q

What type of hip fractures are commonly seen?

A

subcapital & intertrochanteric fractures

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3
Q

Hip Fractures Tx

A

Surgery almost always indicated, exceptt:
–> Severely debilitated, at end of life, medical illness that cannot be corrected for surgery
–> Surg w/n 48 hrs assoc. w/ decr mortality

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4
Q

Hip Dislocations Tx

A
  • reduction under sedation
  • if unable - OR
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5
Q

Pelvis Fractures Dx

A

x- ray

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6
Q

Pelvis Fractures Tx

A

Surg

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7
Q

Legg Calve Perthe Disease Dx

A
  • x-ray,
  • MRI more sensitive for severity & staging
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8
Q

Legg Calve Perthe Disease Tx

A
  • Conservative tx (NSAIDS, PT)
  • Depending on degree of necrosis, may req surgery
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9
Q

Slipped Capital Femoral Epiphysis Dx

A

x-ray

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10
Q

Slipped Capital Femoral Epiphysis Tx

A

Surgery (screw fixation)

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11
Q

Femoral Shaft Fractures Dx

A

X-rays
- Femur: AP & lateral views
- Hip: AP, lateral, frog leg lateral views
- Knee: AP & lateral views

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12
Q

Femoral Shaft Fractures Tx

A
  • In line traction (EMS or ER)
  • Intramedullary nailing
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13
Q

Distal Femur Fracture Dx

A
  • x-ray
  • CT to further describe the fracture, used for pre-op planning
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14
Q

Distal Femur Fracture Tx

A
  • ORIF
  • Intramedullary nail
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15
Q

MCL and LCL Injuries Dx

A
  • x-ray
  • MRI provides ligament injury
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16
Q

Describe Ottawa Knee Rules/criteria for MCL/PCL films

A
  • pt >55yo
  • tenderness at head of fibula
  • isolated tenderness of patella
  • can’t flex knee to 90 degrees
  • can’t transfer weight for 4 steps immediately after & in the ED
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17
Q

MCL/LCL Injuries Conservative Tx

A
  • NSAIDS
  • Ice/elevation
  • Early ROM
  • Hinged knee brace (varus/valgus constrained) 3-4 weeks
  • WBAT, crutches if needed 3-4wks
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18
Q

MCL/LCL Injuries Surgical Tx

A
  • After 4 wks
  • Surgery indicated for complete tears, tears w/ meniscus or ACL injury, knee instability
  • Repair or reconstruction of MCL
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19
Q

ACL injury Dx

A

MRI

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20
Q

ACL injury acute stage Tx

A
  • reduce pain, edema & hemarthrosis w/ NSAIDS
  • aspiration of blood may be used to reduce symptoms
  • delay of 2-4 wks b/t acute phase of injury & surgical correction is common
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21
Q

Who can be considered for PT for an ACL injury?

A
  • older individuals
  • pts w/ sedentary lifestyle
  • pts who are willing to modify their sports activity & participate in swimming, running & cycling
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22
Q

ACL injury surgical Tx

A

Autograft or allograft replacement of the tendon

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23
Q

PCL Injury Dx

A

MRI

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24
Q

PCL Injury Tx

A
  • RICE, NSAIDS, hinged knee brace, PT
  • Surg rarely needed &often not very successful
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25
Meniscus Tears Dx
MRI
26
Meniscus Tears Conservative Tx
- RICE - knee sleeve or brace - crutches as needed - PT
27
Who can get conservative Tx for Meniscus Tears?
- Degenerative tear - Poor surg candidate - Acute tear (conservative tx for 6 wks)
28
Meniscus Tears Surg Tx if
- conservative tx fails - up to 6 wks - symp &/or displaced meniscal body tears, in knees free from severe degenerative knee OA - symp meniscal root tears w/ goal of preventing/slowing progression of OA
29
What is the surgery for Meniscal tears?
Knee arthroscopy w/ meniscal repair or meniscectomy
30
Patella Fracture Dx
- x-ray - CT if x-ray (-) & high suspicion
31
Patella Fracture Tx
- immobilization if non displaced - surgery if displaced
32
Patellar Tendon Rupture Dx
- X-ray - MRI if suspicion of more injury
33
Patellar Tendon Rupture Tx
- Place in knee immobilizer - Immediate operative repair (by 3 days)
34
Quadriceps Tendon Rupture Dx
- X-ray - MRI if suspicion of more injury
35
Quadriceps Tendon Rupture Tx
- Place in knee immobilizer - Immediate operative repair (by 3 days)
36
Patella Dislocation Dx
x-ray
37
Patella Dislocation Tx
- Closed reduction - Knee immobilizer - Crutches - PT - Some pts may develop chronic/recurrent patella subluxation & require surg
38
Knee Dislocation Dx
- X-ray - ABI - arteriography - if concern for vascular injury
39
Knee Dislocation Tx
- Closed reduction - Emergent vascular surg consult if --> Diminished pulses --> ABI <0.9 --> Abnormality on angiography
40
Osgood Schlatter Disease Dx
- clinical - X-ray can confirm
41
Osgood Schlatter Dz conservative Tx
- Activity modification - NSAIDS - PT
42
Osgood Schlatter Dz surgical Tx
if conservative tx fails (must wait for the growth plate to close)
43
Bakers Cyst Dx
clinical
44
Bakers Cyst Tx
- Conservative tx (RICE, NSAID) - correction (poss. surgery) of underlying knee pathology
45
Knee Bursitis Dx
- clinical - if sepsis concern: CBC, ESR/CRP
46
Non-septic prepatellar bursitis Tx
- supportive care & avoidance of recurrent injury - Occasionally, steroid injection
47
Septic prepatellar bursitis Tx
- Abx - May req repeat aspiration, if bursal effusion persists - In severe or refractory cases, pts can be referred for surgical I&D or bursectomy
48
Pes Anserine Bursitis Tx
- RICE, PT - Steroid Injection - Rarely, surgery is req
49
Chondromalacia Dx
- clinical - x-ray can help (lat view)
50
Chondromalacia Tx
- Acute care: RICE, refrain from high impact activities, NSAIDS - PT - Knee taping/foot orthotics (pronated feet) - Surg rarely performed, but may be done if 6-12 mos of conservative tx fails (arthroscopy & removal of damaged cartilage)
51
Iliotibial Band Syndrome Dx
clinical
52
Iliotibial Band Syndrome Tx
- ice, NSAIDS, stretching, activity mod (bicycle modification, foot orthotics) - Surgical release of ITB rarely needed
53
Tibial Plateau Fractures Dx
- X-ray - CT: further info/surg planning - MRI look for ligamentous injury
54
Tibial Plateau Fractures Tx that is stable & minimally displaced
- splint - long leg cast - cast brace for 8-12 wks
55
Tibial Plateau Fractures surg indicated for intra-articular fractures with...
- > 2 mm joint depression/separation - open injuries - fractures w/ vascular injury - fractures w/ assoc. ligamentous injuries req stabilization
56
Tibial Plateau Fracture Surg Tx
Depending on fracture: - external fixation - ORIF - screw fixation
57
Maisonneuve Fracture Dx
- x-ray
58
Maisonneuve Fracture Tx
- Immediate reduction of ankle w/ long leg splint, NWB & referral to ortho - Definitive tx: surgery --> Fixation of ankle w/ screws --> Fibula fracture doesn't req surgical fixation
59
Ankle Sprain Dx
- x-rays indicated if bony tenderness or if the pt is unable to bear weight - MRI may also be used in pts w/ persistent symp or if suspected --> high-grade ligament injuries --> osteochondral defects --> occult fracture
60
Ankle Sprain Grade 1 (minimal impairment) Tx
- weight bear as tolerated - PT
61
Ankle Sprain Grade 1 (moderate impairment) Tx
- Immobilize w/ air splint - PT
62
Ankle Sprain Grade 3 (severe impairment) Tx
- Immobilization - PT - Poss. surg reconstruction
63
Achilles Tendonitis Dx
- testing usually unnecessary, but consider imaging studies when hx & PE are not sufficient for dx - imaging in pts w/ insertional tendinopathy --> x-ray findings may include calcaneal spurs or calcific tendinosis at tendon insertion - magnetic resonance imaging
64
Achilles Tendonitis Tx
- Conservative tx: RICE, NSAIDS, activity mod - PT - Surg as a last resort (removal if inflamed tendon)
65
Achilles Tendon Rupture Dx
- x-rays may be used to rule out concomitant fractures, calcific tendon changes, or other abnormalities
66
Achilles Tendon Rupture Tx
- Splint in slight plantar flexion, NWB - Surg repair
67
Ankle Dislocation Dx
x-ray
68
Ankle Dislocation Tx
- reduced quickly to avoid neurovascular compromise w/ post reduction films - Splint - Likely req surg due to instability & concomitant injuries
69
Ankle Fracture Dx
- X-ray - CT if complex fracture or suspicion of talus fracture
70
Ankle Fracture Tx
- Isolated lateral malleolus fracture: --> Boot or cast, NWB - All others likely req surg
71
Stress Fractures Dx
- x-ray as the initial test; however, this test is often normal for ≥ 3 months from symptom onset - MRI if not visible on x-ray
72
Stress Fractures Tx
- 6-8 wks of NWB w/ immobilization for incomplete fractures or complete fractures that are nondisplaced - Displaced fractures or fractures at high risk of malunion (metatarsals) may req surg
73
Plantar Fasciitis Dx
- clinical - x-ray may show calcaneal bone spur
74
Plantar Fasciitis Tx
- NSAIDS - Ice - Stretching - Steroid injection - If no relief after 6-12 mos, may consider plantar fascia release
75
Bunions Dx
- based on PE - x-ray can help determine severity
76
Bunions Tx
accommodative shoes, orthoses, surgery if needed
77
Hammer Toes Tx
Initial tx goal: relieve pressure on deformity --> shoe mod, padding, splinting, or orthotics - Surgery as a last resort
78
Charcot Foot Dx
- Foot x-ray w/ weight bearing views - MRI if x-ray inconclusive or if there is concern for osteomyelitis - Bone biopsy if dx is unclear after imaging (can differentiate b/t neuropathic arthropathy & osteomyelitis)
79
Charcot Foot Tx
- Offloading (w/ total contact cast)- designed for NWB foot 6-8 wks, then… - Orthosis or Charcot specific shoes - Surgery indicated if: --> Non healing ulcers --> Un-braceable deformity --> Osteomyelitis --> Amputation sometimes unavoidable
80
Morton Neuroma
- clinical - X-rays not helpful - MRI can show inflammation, but usually not needed
81
Morton Neuroma Tx
- Avoid compressive shoes - Steroid injection - Last resort is surg removal
82
Jones Fracture
x-ray
83
Jones Fracture Tx
Operatively or non operatively Non operative - Short leg cast (NWB) for 6-8 wks Operative tx (in active individuals) - Screw fixation
84
Lisfranc Injury Dx
- X-ray Widening of the space b/t the 1st & 2nd metatarsal base > 2mm - If dx unclear w/ x-ray--> CT
85
Lisfranc Injury Tx
Acute tx: - Immobilization (short leg splint) - NWB - URGENT orthopedics consult Req surgery (ORIF)
86
Phalanx Fracture Dx
x-ray
87
Phalanx Fracture Tx
- If stable & non-displaced, can be splinted (“buddy taped) & placed in a hard sole shoe - If displaced, closed reduction & splinting- if unable to reduce will req operative fixation
88
Calcaneus Fracture Dx
- X-ray - CT - characterize fracture & operative planning
89
Calcaneus Fracture Tx
- Most req operative tx, as they are intraarticular &/or displaced - Non displaced, non intraarticular fractures--> immobilized for 6-8 wks - Initial splinting should be very bulky to allow for swelling

Block 3: MSK (10 decks)

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