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Flashcards in Final Exam Deck (40):
1

Knee Red Flags: Septic Arthritis

  • Joint pain
  • edema
  • tenderness
  • Recent injection
  • infection
  • surgery,
  • open wound
  • Compromised immunity

2

Knee Red Flags: Compartment Syndrome

  • Overuse
  • Cumulative trauma
  • History of blunt trauma
  • Firmness to palpation
  • Exquisite tenderness
  • Reduced pulse
  • Paresthesia

3

Femoral Nerve Lesion presentation

4

Sciatic Nerve Lesion Presentation

5

Tibial Nerve Lesion Presentation:

6

Fibular Nerve Lesion Presentation:

7

Early Medical Attention: Knee

  • DVT
  • Unreduced dislocation
  • Acute Fracture
  • Undiagnosed severe pain

8

Functional Arrangements of the foot:

Medial (WB, flexible)

  • Talus, calcaneus, navicular, 1st metatarsal, medial cuneiform

9

Functional Arrangements of the foot:

Central (Rigid)

  • Intermediate and lateral cuneiforms
  • 2nd and 3rd metatarsal

10

Functional Arrangements of the foot:

Lateral (WB, flexible)

  • Calcaneus
  • Cuboid
  • 4th and 5th metatarsals

11

Evaluative divisions of foot: Hindfoot

  • Distal tib/fib joint
  • talocrural joint
  • subtalar joint
  • supportive soft tissue

12

Evaluative divisions of foot: Forefoot

  • Midtarsal joints
  • Intertarsal joints
  • tarsometatarsal joints
  • interphalangeal joints (DIP, PIP)
  • supportive soft tissue

13

Special Tests: What Ligament?

  • Anterior Drawer (Ankle)

  • Anterior Talofibular Ligament

14

Special Tests: What Ligament?

  • Talar Tilt

  • Calcaneofibular Ligament

15

Special Tests: What Ligament?

  • Klieger Test

  • Deltoid Ligament

16

Special Tests: Knee ACL

  • Lachman’s Test
  • Anterior Drawer Test

17

Special Tests: Knee PCL

  • Posterior Drawer

18

Special Tests: Knee MCL

  • Valgus Test

19

Special Tests: Knee LCL

  • Varus Test

20

Special Tests: Knee Menisci

  • Apley's
  • McMurray's

21

Special Tests: Patellar Instability

  • Patellar Apprehension Test

22

Presentation: Spinal Accessory Nerve Palsy

  • Inability to abduct shoulder beyond 90
  • Pain on Abduction
  • Involved Muscles:
    • trapezius muscle

23

Presentation: Suprascapular Nerve Palsy

  • Pain on forward flexion

  • Shoulder weakness and loss of humeral control

  • Pain with scapular abduction

  • Pain with cervical rotation to opposite side

  • Persistent rear shoulder pain and paralysis of the supraspinatus (suprascapular notch) and infraspinatus (suprascapular notch and spine of scapula), leading to decreased strength of abduction (supraspinatus) and lateral rotation (infraspinatus) of the shoulder. Wasting may also be evident in the muscles over the scapula.
  • Involved muscles:
    • Supraspinatus

    • Infraspinatus

24

Presentation: Axillary Nerve Palsy

  • Motor loss:

    • inability to abduct the arm (deltoid),

      • although the patient may attempt to laterally rotate the arm and use the long head of biceps to abduct the arm (trick movement).

    • In some cases, a patient is asymptomatic, although he or she may demonstrate early fatigue with strenuous activities.

    • There is weakness of lateral rotation owing to the loss of teres minor.

      • The patient may attempt to use scapular movement (i.e., trapezius or serratus anterior) to compensate for the muscle loss (trick movement).

    • Atrophy of the deltoid leads to loss of the lateral roundness (flattening) of the shoulder.

    • Sensory loss is over the deltoid with the main loss being a small, 2 cm to 3 cm (1 inch) circular area at the deltoid insertion

25

Presentation: Long Thoracic Nerve Palsy

  • Pain on flexing fully extended arm and inability to do so
  • Winging starting at 90 degrees forward flexion
  • Magee Text
    • paralysis of the serratus anterior, causing winging (medial border) of the scapula and pain and weakness on forward flexion of the extended arm.

    • Abduction above 90° is difficult because of scapular winging.

    • Stabilization of the scapula by the examiner enables the patient to further abduct the arm.

26

Cyriax Release:

  • Thoracic Outlet Syndrome

  • The patient is seated or standing.
  • The examiner stands behind patient and grasps under the forearms, holding the elbows at 80 degrees of flexion with the forearms and wrists in neutral.
  • The examiner leans the patient’s trunk posteriorly and passively elevated the shoulder girdle. This position is held for up to 3 minutes.
  • The test is positive when paresthesia and/or numbness (release phenomenon) occurs, including reproduction of symptoms.

27

Presentation: Median Nerve Palsy/Damage (C6-T1)

  • Motor:
    • Pronation weak or lost
    • Weak wrist flexion and abduction
    • Radial deviation at wrist lost
    • Inability to oppose or flex thumb
    • Weak thumb abduction
    • Weak grip
    • Weak or no pinch (ape hand deformity)
  • Sensory
    • Palmar aspect of hand with thumb, index, middle, and lateral half of ring finger

    • Dorsal aspect of distal third of index, middle, and lateral half of ring finger

28

Presentation: Ulnar Nerve Injury (C7, C8, T1)

  • Motor:
    • Weak wrist flexion
    • Loss of ulnar deviation at wrist
    • Loss of distal flexion of little finger
    • Loss of abduction and adduction of fingers
    • Inability to extend second and third phalanges of little and ring fingers (benediction hand deformity)
    • Loss of thumb adduction
  • Sensory
    • Dorsal and palmar aspect of little and medial half of ring finger

29

Presentation: Radial nerve (C5 to C8,T1) Palsy

  • Motor:
    • Loss of supination
    • Loss of wrist extension (wrist drop)
    • Inability to grasp
    • Inability to stabilize wrist
    • Loss of finger extension
    • Inability to abduct thumb
  • Sensory:
    • Dorsum of hand (lateral two- thirds)
    • Dorsum and lateral aspect of thumb
    • Proximal two-thirds of dorsum of index, middle, and half ring finger

 

30

Raynaud's Phenomenon

  • Raynaud disease produces a cold, mottled, painful hand.
  • It is an idiopathic vascular disorder characterized by intermittent attacks of pallor and cyanosis of the extremities brought on by cold or emotion.

31

Complex Regional Pain Syndrome

  • History of traumatic event
  • Hypersensitivity
  • Pitting edema
  • Trophic changes including brittle nails, course hair growth, erythema
  • Poor response to analgesics

32

If the lunate is palmarly rotated more than 15 degrees

  • VISI

33

If the lunate is extended more than 10 degrees

  • DISI

34

Clinical Prediction Rule: Knee Osteoarthritis

  • Must Have:
    • Knee Pain
    • Radiographic osteophytes
  • Must also have at least one of these
    • age over 50
    • morning stiffness less than 30 minutes
    • crepitus with motion

35

Wrist extension synergists

  • Extensor carpi radialis longus
  • extensor carpi radialis brevis
  • extensor carpi ulnaris
  • extensor digitorum
  • extensor indicis

36

Wrist extension antagonists (wrist flexors):

  • Flexor Carpi Radialis
  • Flexor Carpi Ulnaris
  • Palmaris Longus
  • Flexor Digitorum Superficialis
  • Flexor Digitorum Profundus (assists)
  • Flexor Pollicis Longus (assists)

37

Femoral Nerve Palsy/Damage

  • Motor:

    • The patient is not able to flex the thigh on the trunk or extend the knee. The deep tendon knee reflex is also lost. Wasting of the quadriceps is most evident.

  • Sensory loss:

    • medial aspect of the distal thigh (anterior femoral cutaneous nerve)

    • medial aspect of the leg and foot (saphenous nerve)

38

Obturator Nerve Palsy/Damage

  • Motor:

    • hip adduction is affected, as are knee flexion (gracilis) and hip lateral rotation (obturator externus).

  • Sensory:

    • deficit is small, involving a small area in the middle medial part of the thigh, although the patient may complain of pain from the symphysis pubis to the medial aspect of the knee.

39

Sciatic Nerve Palsy/Damage

  • Motor:
    • If it is injured in the pelvis or upper femur area (e.g., posterior hip dislocation), the hamstrings and all muscles below the knee can be affected. The result is a high steppage gait with an inability to stand on the heel or toes.
    • There is sensory alteration in the entire foot except the instep and medial malleolus, along with muscle atrophy. Usually, the symptoms are primarily in the common peroneal branch of the sciatic nerve.
  • In the hip region, the sciatic nerve may be compressed by the piriformis muscle (piriformis syndrome).
  • If piriformis is affected, there is pain and weak- ness on abduction and lateral rotation of the hip (sign of Pace and Nagel). The pain on passive medial rotation of the extended hip (Freiberg sign) is also elicited, because this action stretches the piriformis.
  • Sensory: Burning pain and hyperesthesia may be felt in the sacral and/or gluteal region as well as in the sciatic nerve distribution. Medial rotation with flexion of the hip accentuates the problem.

40

  • Saphenous Nerve Injury

  • Motor Weakness:
    • none
  • Sensory
    • medial knee pain (burning) that is aggravated by walking, standing, and quadriceps exercises