MSK Flashcards
(225 cards)
1
Q
definition lisfranc injury
A
spectrum of injury from sprain to complete disruption of tarso-metatarsal joints in midfoot, usually occuring at base of 2nd metatarsal
2
Q
mechanism of injury associated with lisfranc injury
A
foot being caught in a hole; falling off horse with foot caught in stirrup; MVC, foot planted in hole, awkward step off curb; bunk bed fracture (leaps onto bunk bed, landing on toes with axial load on plantar flexed ankle
3
Q
MOA of lisfranc injury
A
plantar flexion with ER of ankle
4
Q
Physical Exam findings for lisfranc fracture dislocations
A
unable to weight bear, hemtama/ecchymosis on plantar aspect of foot
5
Q
X-Ray orders for LisFranc fracture
A
3 views - AP, later, standard 45 degrees oblique of foot
6
Q
XRay findings for Lisfranc injury
A
widening between bases of 1st and 2nd or 2nd and 3rd metatarsal bases; > 2mm = surgical intervention
7
Q
Normal alignment of metatarsals and tarsal bones in midfoot
A
AP view: edge of base 2nd metatarsal lining up with medial edge of medial cuniform; oblique: medial edge of 3rd and 4th metatarsal should line up with medial edges of middle and lateral cuniforms
8
Q
Pathognomonic for lisfranc injury on XRay
A
fleck sign: small bony fragment avulsed from second metatarsal base or medial cuniform
9
Q
Indications for surgery for lisfranc
A
displaced fracture or subluxation > 2 mm
10
Q
If highly suspicious for lisfranc despite normal Xrays…
A
- 30 degrees oblique XRay (eliminate overlap of metatarsals), 2. weight-baring stress views following nerve block, 3. CT of foot
11
Q
ED MGMT of LisFranc injury
A
posterior back slab
12
Q
carpal bones (5) list them
A
scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, trapezium
13
Q
(3) Physical tests to r/o scaphoid injury
A
- palpate scaphoid on palmer aspect with wrist radially deviated; 2. thumb axial load tenderness at scaphoid location 3. snuffbox tenderness
14
Q
what is the watson test?
A
identifies scapholunate ligament injury or scaphoid fracture; start with palmer aspect on scaphoid wrist deivated ulnar and flexed, then move wrist radially with slight extension; (+) if pain, apprehension or clunk/subluxation
15
Q
MOI for perilunate injuries
A
FOOSH
16
Q
definition of perilunate dissociation
A
capitate dislocated from lunate
17
Q
definition of lunate dissociation
A
lunate dislocated from capitate (more proximal one)
18
Q
definition of scapholunate dissociation
A
terry thomas/madonna sign: visible gaps between teeth; gap of > 3 mm between scaphoid and lunate
19
Q
FOOSH + acute carpal tunnel syndrome =
A
perilunate dissociation until proven otherwise
20
Q
Xray finding for lunate dissociation
A
spilled tea cup - lunate is out of the seat of the capitate
21
Q
ED MGMT of perilunate dislocation
A
90 degrees flexed at elbow with finger traps placed 10 - 15 lbs of longitudinal traction for 10 mins, if dorsally displaced, extend wrist and apply traction, then flex with volar/palmer pressure applied to lunate until clunk heard; volar/palmer slab!
22
Q
DRUJ
A
distal radial ulnar joint injury
23
Q
MOI of DRUJ
A
FOOSH injury +/- distal radial fracture
24
Q
Physical findings for DRUJ
A
more prominent ulnar styloid, crepitus or blocking with pronation or supination, piano key sign, ulnar fovea sign
25
definition of piano key sign
ability to ballot the ulnar styloid (push ulna up and down like piano); + if painful or ulnar laxity
26
definition of ulnar fovea sign
point tenderness over ulnar capsule palmar to extensor carpi ulnaris tendon
27
XRay findings of DRUJ
can have normal XRay; widening of ulnar/radial joint of > 2 mm, lateral view: displacement or subluxation of distal ulnar compared to radius
28
ED MGMT DRUJ
reduction (supination and pressure over ulnar head), above elbow splint similar to smith fracture with forearm supinated and wrist in slight extension
29
pelvic apophyseal avulsion fracture sites
most common: ischial tuberosity, other sites: iliac crest, ASIS, AIIS, greater trochanter, lesser trochanter
30
MOI of pelvic apophyseal avulsion fractures
sudden forceful concentric or eccentric muscle contraction during running, jumping, kicking
31
RFs for pelvic apophyseal avulsion fractures
young athletes, hip pain or buttock/groin pain
32
MGMT for pelvic apophyseal avulsion fracture
non weight bearing using crutches then weaned; longer healing than sprains
33
Definition of Trivial Head Injury (pediatric)
GCS 15, no LOC, low mechanism, small frontal hematoma, older than 1 yo
34
Definition of Minor Head Injury (pediatric)
GCS 14 - 15, LOC/amnesia/confusion, disorientation, vomiting/HA, impact seizure
35
Definition of Moderate-Severe Head Injury (pediatric)
GCS < 13 or deteriorating GCS, penetrating head injury, focal neurological findings, late seizures (not impact), known child abuse
36
Glasgow Coma Scale Definition
Eyes (4): closed, responds to pain, responds to voice, spontaneous; Voice (5): no response, sounds, inapproprpiate words, confused, oriented to person/place/time; Motor (6): no response, abnormal extension, abnormal flexion, withdraws from pain, moves to localize pain, obeys commands
37
RFs for TBI in pediatric patients with head trauma
scalp hematoma > 2 cm that is not frontal, skull fracture in < 2 yo
38
Tool to use for risk of TBI in patients < 2 yo
PECARN study
39
Tool to use for CT head imaging in pediatric patients
CATCH Study
40
Cushing's Triad
hypertension, bradycardia, abnormal breathing
41
Agent for sedation in raised ICP patients (pediatric)
etomidate, ketamine
42
"Red zone" Period for observation in head injury
first 6 hours
43
"yellow zone" for observation in head injury
next 24 hours
44
T or F; children have less seizures following HI
false; they have more seizures
45
T or F; children are more likely to have TBI following head trauma
false; they are less likely to have TBI after head trauma as their skulls are not closed
46
T or F; children sustain fewer mass lesions and hemorrhagic contusions following a HI
true
47
T or F; children sustain less diffuse brain swelling following a HI
false; they have more diffuse swelling and can talk and deteriorate with edema alone
48
T or F; children sustain less diffuse axonal injury in HI
false
49
T or F; children sustain more hypoxia in HI
true
50
ACL injury MOI
rotation of knee against immobile foot with sudden deceleration (i.e., basketball), classic pop heard
51
Physical Exams for ACL injury
pivot shift test, lachman test, anterior drawer (poor sensitivity)
52
Ottawa Knee rule criteria
not weightbearing more than 4 steps, older than 55 yo, pain at fibular head, isolated patellar tenderness, inability ti flex knee to 90 degrees
53
Fractures associated with ACL injuries
Segond fracture, tibial spine fracture
54
definition of Segond fracture
vertical oriented avulsion fracture of the lateral proximal tibia
55
ED MGMT of ACL injuries
removable splint, crutches, ROM exercises, follow-up in sports clinic
56
Indications to consult ortho for ACL injuries
displaced fracture or fracture with impaired extensor mechanism associated with ACL injury
57
DDx for limping child
fracture, septic arthritis, systemic illness; transient synovitis, Legg-Calves-Perthes disease, Slipped capital femoral epiphysis, toddler's fracture
58
definition of transient synovitis
self-limited inflammation of synovial lining preceeded by viral infection, resolving 3 - 10 days
59
definition of toddler's fracture
spiral fracture seen in ages 9 - 36 months, usually at distal tibia
60
Signs with toddler's fracture
pain with ankle dorsiflexion or calf rotation
61
MGMT of toddler's fractures
above-knee immobilizing splint with knee in slight flexion, outpt follow-up, can consider not splinting if mild symptoms
62
definition of Legg-Calves Perthes disease
avascular necrosis of femoral head; ages 4 - 10 , normal or subtle changes in XRay
63
Slipped Capital Femoral Epiphyses (SCFE)
pain radiating to thigh or knee; Overweight children, pain worst at IR of hip
64
sign on xray for SCFE
Kline's line is abnormal (line from external part of femoral neck intersecting part of femoral head)
65
Kocher's Criteria for Septic Arthritis in Pediatric Pts
not weight bearing, ESR > 40, fever, WBC > 12000
66
Red Flags for non-accidental trauma
delay in presentation, vague or inconsistent mechanism, injury inconsistent with developmental stage
67
Ottawa Ankle Rules age cut off
older than 5 yo
68
SALTER criteria for ankle fractures
I: slipped, II: above growth plate, III: lower of the growth plate, IV: through growth plate and metaphysis and physis, V: rammed: growth plate is crushed
69
Tillaux fracture definition
Salter III - intra-articular with avulsion of anteriorlateral tibial epiphysis
70
Definition of triplanar fracture
combination of salter I, II, III requiring operation, seen in adolescents
71
Definition of buckle fracture
incomplete fracture of the long bone identified by bulging of cortex
72
Definition of Greenstick fracture
cortex broken on one side, other side is intact
73
Acceptabe degrees of angulation for pediatric radial fractures
< 5yo: 30 degrees, 5 - 10 yo: 20 degrees, 10 - 12: 10 degrees
74
Supracondylar fracture major risk
neurovascualr injury (brachial artery, median/anterior interosseus nerve), compartment syndrome
75
figure of eight in elbow Xray
confirms lateral position
76
radiocapitellar line on elbow xray
should bisect capitellum of humerus, if not think fracture
77
anterior humeral line on elbow xray
line along anterior border of humerus bisecting middle 1/3 of capitellum; if disrupted, think fracture
78
"CRITOE" approach to elbow xrays
capitellum, radial head, internal epicondyle, trochlea, olecranon, externa epicondyle
79
ED MGMT of supracondylar fractures
immobilize in above-elbow splint at > 90 degrees flexion; consult ortho immediately if displaced
80
Test for sensory and motor of radius
webspace (dorsal) 1st thumb and thumbs up with resistance
81
Test for sensory and motor for median
2nd finger tip, peace sign with resistance
82
Test for sensory and ulnar
5th finger palmer, OK sign
83
levels of accepted angulation of metacarpal neck fractures
5th: 40 degrees, 4th: 30 degreed, 3rd: 20 degrees, 2nd: 10 degrees
84
definition of fight bite
laceration + boxers fracture
85
ED MGMT of fight bite
Xray to r/o fracture and tooth fragments, high flush irrigation, antibiotics (clavulin), healing by secondary intent, close follow-up; admit if extensor tendon injury or few days after injury
86
indications for abx for lacerations
hand bites, bites over joints, immunocompromised
87
boxer fracture definition
4th or 5th MTC neck fracture
88
MGMT Of boxer fracture
Abx, 2ndary intention if open, if angulated > 45 degrees or rotation > 20 degrees refer to hand surgeon/ortho, reduce with splint
89
Contraindications to tendon repairs
flexor tendons, contaminated wounds, partial tendons > 50% torn
90
ED MGMT of tendon repair
can repair if it is partial extensor tendon: thorough washing, loosely close skin, apply splint to avoid tension
91
(2) flexor tendons in the fingers
flexor digitorum profundas (FDP) - DIP, flexor digitorum superficialis (FDS) - PIP
92
Method to examining extensor tendon injury
start with palpation for tenderness, then with gradual resistance: gradual resistance test to avoid converting partial tear into complete tear. if normal motor but pain, consider partial laceration
93
gamekeeper thumb definition
injury to ulnar aspect (medial) of 1st MCP
94
MOI of gamekeeper thumb injury
commonly skier thumb (lateral or valgus stress to abducted thumb)
95
Physical exam for gamekeeper thumb
Maximal tenderness on ulnar aspect of 1st MCP, pincer grasp is painful
96
XRay finding for gamekeeper thumb
avulsion fracture of proximal phalynx
97
Definition of Stener's Lesion
displaced proximal end of ulnar collateral ligament of 1st MCP being trapped in adductor aponeurosis, thus not allowing healing
98
ED MGMT of Gamekeeper thumb
partial injury: 6 week splint; complete tear: surgery, thus requiring thumb spica splint with f/u within 7 days
99
Complications of gamekeeper thumb
nonunion, reconstruction
100
Key findings suggesting gamekeeper thumb
weak pincer grasp, tenderness at volar ulnar aspect of MSP, >40 degrees deviation in extension or 20 degrees in flexion
101
Risk with high-pressure injuries of hand
compartment syndrome: amputation due to ischemia, infections;
102
Sx of compartment syndrome in hand
pain out of proportion, hand in claw position ( MCP extended PIP flexed), XRay showing subcutaneous air
103
definition of flexor tenosynovitis
inflammation of synovium due to infection or inflammatory
104
Kanavel's 4 Cardinal Signs for Flexor Tenosynvitis
finger held in slight flexion, fusiform swelling, flexor tendon sheath tenderness, pain with passive extension
105
Complications with flexor tenosynovitis
scarring, necrosis, disability, infection
106
ED MGMT of flexor tenosynovitis
IV antibiotics, immobilize, elevate; can consider I&D if delayed
107
paronychia definition
a nail infection where the nail and skin meet at the side or the base of a finger or toenail.
108
mild paronychia MGMT
soaking finger, PO antibiotics
109
abscessed paronychia MGMT
blunt dissection with point of surgical blade so lateral nail fold is elevated and sulcus between plate and epithelium is entered, drain pus and irrigate cavity with syringe
110
abscessed paronchyia MGMT with finger or pulp involvement
can consider additional incision of finger tip pad to drain
111
Back pain ddx to r/o in th ED
cauda equina (disc herniation), bone mets, spinal abscess, leaking or ruptured AAA, retroperitoneal bleed, spinal bleed
112
Red flags for back pain
age > 50, history of cancer, fever, IVDU, immunocompromised, trauma, cauda equina/SCC symptoms (erectile dysfunction)
113
Suspicious back pain signs in the ED
constant back pain that is worse with lying down
114
Dx to r/o with renal colic
AAA
115
Dx to r/o with pyelonephritis
spinal infection
116
Physical examination for cauda equina or SCC
gait, palpation, neurological, abdomen for AAA and bladder distension, DRE
117
PVR cut off for cauda
< 100 is negative predictive value for 99%
118
winking owl sign
missing pedicle on PA view of spine, concerning for mets spinal fracture (blastic lesions)
119
CT vs MRI for spinal fractures/bony mets
CT >> MRI for vertebral fracture and mets; MRI >> CT for spinal infections, malignancy and cauda equina
120
Indications for urgent MRI in the ED
sudden or rapid change in back pain WITH new or pgoressive signs of SCC, suspected mets with stable symptoms (within 24 hours), back pain + Xray finding of mets but no neurological deficits (within 3 -7 days)
121
Bragard sign
specific for sciatica: SLR until point of radiating pain, leg then lowered slightly and ankle is dorsiflexed, if pain returns then it is (+) for sciatica (specific)
122
Slump test sign
pt sits at edge of bed, slumps forward while flexing neck, knee extended; if +, sciatica
123
Inv to order in spinal epidural abscess
ESR, CRP
124
Sx of leaking AAA
groin pain, syncope, paralysis, flank fullness, pulsatile, abdo mass, femoral neuropathy; + Psoas sign: retroperitoneal irritation
125
Sx of spontaneous retroperitoneal bleed
similar to AAA, low back pain radiating to groin, hip, anterior thigh, RF: anticoagulants
126
5 initial tests in the ED for LBP
PVR, ESR/CRP, XRay, POCUS, calcium
127
Talus fracture MOI
axial loading with dorsiflexed ankle and everted, seen in snowboarders
128
Sx of talus fracture
tender anterior talofibular ligament (like ankle sprains)
129
DDx for talus fracture
ankle sprain, distal fibular fracture, clcenus fracture, posterior talar fracture, talar dome fracture, achilles tendon rupture
130
XRay findings in talus fracture
normal often; can consider Broden's View Xray (mortise ankle view with plater foot flexed), or CT
131
MGMT of talus fracture
if non displaced or < 2 cm involving lateral talus, immobilization with back slab and non-weight bearing; if > 2 mm displaced ortho!
132
mimics of ankle sprain
lateral talus fracture (snowboarder fracture), anterior calcaneus fracture, posterior talar fracture, talar dome fracture, achilles tendon rupture
133
Sx of occult hip fracture
groin pain, tenderness in groin, inability to SLR, painful limitation of rotation of hip, pain on axial loading of limb
134
Percussion test for hip fracture
stethescope on pubis symphysis and percuss patella on each side; if decreased, consider fracture
135
XRay of the hip: lines to look for
Shenton's Line: arc from medial aspect of femoral neck to obturator foramen
136
occult knee dislocation mechanism
MVC- jammed knee
137
key thing to r/o with knee dislocation
RULE OUT VASCULAR INJURY = ALWAYS ORDER CT ANGIO
138
(3) key maneuvers for scaphoid fractures
palpation of snuffbox, axial loading of thumb with pain in the anatomical snuffbox, palpation of palmar aspect of scahpoid with wrist radially deviated
139
imaging for suspected scpahoid fracture
scaphoid views, clenched fist view, CT
140
complications with scaphoid fractures
avascular necrosis and fracture nonunion the more proximal
141
ED MGMT of scaphoid fracture
colles splint, immobilization, consider ortho referral in the ED if > 1 mm displacement
142
DDx for posterior shoulder dislocation
electrocution, epilepsy, EtOH
143
Xray view for posterior dislocation
axillary view is key! look for lightbulb sign in AP view
144
ED MGMT of posterior dislocation
reduction if < 50% displaced and within 6 weeks of injury; consult ortho if > 6 weeks of injury or greater than 50% of humeral surface is involved
145
MSK injuries associated with fall from height
vertebral fractures, calcaneus fracturs, ankle fractures, lisfranc dislocation
146
calcaneal fracture mechanism
fall from height
147
physical findings for calcaneal fractures
plantar ecchymosis
148
Imaging for suspected calcenal fractures
Xray - look for Bohler's angle, harris view of the ankle (45 degrees), CT if unsure
149
Definition of bohler's angle
posterior tuberosity to the apex of the posterior facet + apex of posterior to apex of anterior process; normal is 20 - 40 degrees; abnormal if < 20 degrees
150
Hard signs of penetrating vascular injury (5)
arterial bleeding, shock, large pulsatile and expanding mass, new palpable thrill or audible bruit, distal ischemia
151
soft signs of penetrating injury
minor bleeding, small stable hematoma, injury to nerve, proximity of tract to major vessels
152
MGMT for penetrating extremity injury
if + hard signs, immediate OR exploration; if soft signs, CT angio
153
definition of syndesmosis orthopedic injuries
sydnesmosis tear between tibia and fibula
154
MOI for syndesmosis injuries
rotational force where ER of ankle +/- hyper dorsiflexion, overstretching this area between distal tibia and fibula
155
physical exams for syndesmosis injuries
toe walking (prevent painful dorsiflexion), squeeze/hopkin test: tibia and fibula squeezed together at mid calf-level, if +, pain is felt at syndesmosis located at distal tibia and fibular junction; ER test: knee flexed at 90 degrees, hold pt's foot and ER with small amount of dorsiflexion, if pain elicited + test
156
xray findings for syndesmosis injuries
normal, can have decreased tibio-fibular overlap (< 6 mm in AP or < 1 mm on mortise); increased medial clear space (> 4mm)
157
ED MGMT of syndesmosis injuries
non weightbearing aircast or backslab, ortho follow-up; r/o associated ankle injuries, 5th metatarsal injuries, proximal fibular fracture (maisonneuve)
158
MOI distal biceps tendon rupture
construction workers or weightlifters with chronic repetitive microtrauma causing weakning tendon + sudden massive eccentric contraction
159
Physical findings for bicep rupture
"popeye sign" - bulge in elbow flexion, ecchymosis on anterior aspect of elbow, decreased force of supination +/- pain with supination, Hook sign: use index finger, go lateral to insertion of biceps and hook finger around; if not able to, likely rupture
160
MOI proximal biceps tendon rupture
seen in elderly patients due to age-related tendon and RC symptoms, no acute injury
161
ED MGMT of biceps rupture
immobilization, refer to ortho
162
ED MGMT of proximal biceps injury
physiotherapy
163
quadriceps rupture sx
triad of acute knee pain, inability to extend knee, suprapatellar gap
164
associated injuries with quads tendon rupture
patellar fracture, patellar tendon rupture
165
Physical findings with quadriceps tendon rupture
failed SLR (unable to lift leg up), palpable gap betwen tendon and above the knee (suprapatellar gap)
166
Xray findings for quadriceps rupture
patella baja (patella rides lower than usual); patellar alta (patella rides higher than usual - seen with patellar tendon rupture
167
ED MGMT for quadriceps injuries
zimmer splint (knee immobilizer) with orthopaedics follow-up in few days
168
injuries not requring zimmer splint
meniscal tears, ACl, MCL and PCL injuries
169
gastrocnemius tears MOI
jumping or running from hill, weekend warrior
170
difference between gastroc tear vs. DVT
swelling isolated to medial aspect of leg (DVT is entire leg), palpable divot bewteen junction of gastrocnemius and tendon with complete tear, bruising seen
171
physical findings with gastroc tears
maximal tenderness at medial musculotendinous junction, van see visible defect in medial aspect of gastrocs; + calf raise test
172
calf raise test
patient stands and plantar flexes one ankle so they can stand up on their tiptoes with one leg; if + but can complete the test, then it is likely gastroc tear; if unable to complete test, consider achilles tear
173
imaging for gastroc tears
none, ultrasound as outpt
174
ED MGMT for gastroc tears
conservative, early weight bearing, can consider ankle stirrup for comfort
175
bloody airway approach in trauma
use direct with bougie; do not use video!
176
definition of rapid sequence induction
paralytic and sedative at the same time
177
vasopressors in trauma
no role unless neurogenic shock
178
high-risk factor of mortality in trauma
hypotension! just one episode can result in poor outcome thus take hypotension seriously even if it normalizes
179
metabolic acidosis in trauma etiology
secondary to hypo-perfusion (lactate and bicarb); decrease of acidosis can be quantified by base deficit; the greater base deficit, the higher the risk!
180
"CRUMP" factor for need for operative intervention in trauma
sBP < 105, +FAST, and base deficit > 6
181
continuous care of trauma patients
serial BW: hematocroit, lactate, EtCO2; hematocrit is surrogate for occult bleeding
182
occult shock sources
retroperitoneum, chest, abdo, pelvic fractures
183
"seatbelt sign"
contusion corresponding to seatbelt, increased risk for intestinal and intraabdominal injuries
184
investigations for occult bleeding
CXR, FAST, pelvic xray
185
FAST Exam drawbacks
< 200 cc of blood, mesenteric or bowel hematoma, diaphragmatic and pncreatic injuries
186
FAST Exam sensitivity and specificity
good specificty, poor sensitivity
187
5 Key Componenets of damage control in trauma resuscitation
hypothermia (bair huggers, level 1 infuser), permissive hypotension (allow for thrombus formation of injured vessels; target sBP 90- 100 except for head injuries (1 episode of hypotnestion associated with mortality), early use of blood products (only 1L if possible), rapid and early correction of coagulopathy, damage control surgery (abdomenpacking, etc.)
188
indications for MTP
if you need 3+ units of blood, base deficit > 5, INr > 1.5, hemoperitoneum
189
CRASH-2 Trial results
TXA reduced massive transfusion and reduced mortality (1%); TXA 1 g given over 10 min then 1g infusion IV over q8hrs
190
CSpine injury guidelines in trauma
DO NOT USE ANY OF THEM! these guidelines are only for non-high risk mechanisms; CT C-spine if concerned, can consider MRI if normal CT but pain
191
CT chest in trauma indications
only if suspicious of aortic or thoracic injuries as CXR isssensitive for hemothorax and PTX
192
indication for pan scan in trauma
if intubated and cannot be assessed
193
thoracic aortic injuries MOI in trauma
high-energy, lateral pevlic fractures, fall from height, anterior-posterior deceleration
194
blunt cardiac injury in trauma
myocardial contusion, free wall rupture, valvular injury, peicardial injury
195
rib fractures in eldery patients approach
associatd with high mortality if > 65yo, complications of atelectasis PNA; ED MGMT: observe in ED, repeat CXR, consider admission
196
pelvic stability exam
gentle inward compression of iliac crest; if mobile, do not let go
197
sx of pelvic trauma
groin/scrotal pain, suprapubic swelling/hematoma, tenderness at symphysis pubis, blood at urethral meatus, distal peripheral neuropathy, +FAST pelvic fluid
198
Classification for pelvic fractures
young-bruges classification; A-P compression: open book fracture ( widened pubic symphysis); higher risk of posterior pelvic structures involved (SI joint), lateral compression, vertical shear (MOI of fall from height, worst prognosis)
199
Physical exam findings for
| Anterior shoulder dislocation
Internally rotated, abducted, squaring of
| Shoulders
200
3 views for shoulder dislocation
AP View, scapula Y View, axillary
201
Complications of anterior shoulder dislocation
Hills Sachs lesion (humeral head fracture), bankcroft (Glenoid ant-inf fracture)
202
complications of compartment syndrome - name 2
1. rhabdomyolysis --> renal failure form myoglobinuria 2. Volkmann's contracture - ischemic necrosis of muscle resulting in fibrosis and calcification, seen in supracondylar fracture of humerus
203
XRay findings for osteomyelitis (seen 10-12 days after)
soft tissue swelling, lytic bone destruction, periosteal reaction
204
XRay findings for septic joint
early: normal, can show soft tissue swelling, joint space widening from localized edema; late: joint space narrowing and destruction of cartilage
205
order of most common to least for septic joint
knee, hip, elbow, ankle, sternoclavicular joint
206
findings for septic arthritis in joint aspirate
cloudy yellow fluid, WBC > 50 000, > 90% neutrophils, high protein (4.4+), +glucose is low
207
RF for septic arthritis
age, prosthetic joint, recent joint surgery, skin infection/ulcer, IVDU, corticosteroid injection, immunocompromised (cancer DM, alcohol, RA)
208
name 4 joints in shoulder
GH, AC, sternoclagicular, scapulothoracic
209
passive ROM shoulder normal
forward flexion: 180; extension: 45; abduction 180, adduction: 45; IR - T4, ER: 45
210
MGMT clavicle fractures
medial/middle third #: displaced > 2 cm, an consider ORIF; distal third: if displaced: ORIF
211
complication of clavicle fractures
associated rib fractures, brachial plexus injuries, subclavian vessel, shoulder stiffness
212
frozen shoulder "adhesive capsulitis" definition
progressive pain and stiffness of shoulder, usually self-resolves after 18 months
213
MOI frozen shoulder
primary: idiopathic, associated with DM, resolves in 9 - 18 months; secondary: due to prolonged immobilization, trauma/MI/stroke
214
what is CRPS
complex regional pain syndrome: painful conditions characterized by continuing regional pain that is disproportionate in time or degree to lesion/trauma; sx: pain, swelling, limited ROMthen changes in skin and bones
215
Sx of frozen shoulder
diffuse shoulder pain and BOTH decreased active and passive ROM; pain worse at night preventing sleeping on the side, stiffness as pain subsides
216
MGMT frozen shoulder
freezing phase: AROM, PROM with PT, NSAIDs, steroids; thawing phase: manipulation under anesthesia and early physiotherapy, arthroscopy for debridement/decompression
217
RF for adhesive capsulitis
prolonged immobilization, female, age 50+, DM, cervical disc disease, hyperthyroidism, stroke, MI, trauma and surgery, autoimmune
218
stages of adhesive capsulitis
freezing phase: gradual onset, diffse pain (6-9 months), frozen phase: decreased ROM impacts function (lasts 4-9 months), thawing phase: gradual return of motion
219
proximal humeral fracture test/investigation
axillary nerve - deltoid contraction and skin over deltoid, XRays, CT scan
220
classification of proximal humeral fractures
neers: 4 fracture locations/parts, displacement > 1 cm or angulation > 45 degrees,
221
MGMT proximal humeral fractures
if nondisplaced and minimally displaced, broad arm sling immobilization, begin ROM on day 14 to prevent stiffness
222
indications for operation for proximal humerus fractures
anatomic neck fractures, displaced, irreducible GH joint dislocation
223
complications of humerus fractures
AVN, nerve palse (axillary), malunion, post-trauma arthritis, persistent pain and weakness, adhesive capsulitis
224
MGMT humeral shaft fractures
generally non-operative; hanging cast with collar and cuff sling immobilization until swelling subsides then sarmiento functional brace, followed by RMOM
225
complication of humeral shaft fractures
radial nerve palsy (usually recovers in 3-4 months), nonunion, decreased ROM, compartment syndrome
