MSK Pathophys Flashcards
(110 cards)
1
Q
Spinal Pathologies
lower spine vertebral column anatomy
A
- lumbar: 5 vertebral bodies; L1-L5
- sacrum: 5 segements (fused w/out discs)
- coccyx: 3-4 fused segments
2
Q
Spinal Pathologies
label anatomy of vertebrae
A
okay
3
Q
Spinal Pathologies
ligaments of spine
A
- anterior longitudinal ligament: connects vertebral bodies anteriorly
- posterior longitudinal ligament: connects vertebral bodies posteriorly
- ligamentum flavum: yellow ligament; connects lamina posteriorly
4
Q
Spinal Pathologies
anatomy of lumbar discs
A
- purpose: cushioning between vertebral bodes
- named by vertebral body above/below (L4-5 disc is between L4/L5)
- Annulus Fibrosis: fibrous outer ring of disc
- Nucleous Pulposus: soft inside of disc
5
Q
Spinal Pathologies
anatomy/phys of spinal cord
A
- purpose is to transmit information to and from rest of body
- begins at craniocervical junction and ends between T12-L2
- end of sinal cord: conus medullaris (conus)
- cauda equina: end of conus there are spinal nerves that go to LE and bowel/bladder
6
Q
Spinal Pathologies
nerve roots of spinal cord numbering
A
- cervical: nerve roots exiting are name based on vertebral body below foramen (except C8 which exits in C7-T1 forament)
- Thoracic/Sacral: named for vertebral body above foramen
7
Q
Spinal Pathologies
describe spurling test of cervical spine
A
- dx cervical HNP or spondylosis
- pt seated, laterally flex head, apply pressure downward to increase axial load & cause pain down ipsilateral arm
8
Q
Spinal Pathologies
describe hoffman reflex for cervical spine
A
- tests for long tract spinal cord involvement in neck
- pathologic reflex (indicates abnormality w/in cervical spinal cord or higher like UMN lesion or pyramidal sign) for ALS< MS, spinal cord compression
- pos reflex: flexion and adducting the thumb/index finger after flicking the middle finger
9
Q
Spinal Pathologies
lumbar spine tests
A
- gait (barefoot) look at Trendelenburg (pelvis level on one foot = normal hip abductor)
- heel-toe walking (tests L4-5, S1 innervated muscles)
- calf/thigh circumfrence/atrophy (asymmetric or atrophy = weakness)
10
Q
Spinal Pathologies
lumbar SLR tests
A
- seated SLR: pos test causes pt to lean back
- Supine SLR (lesegue): pos test is radicular pain in leg, not back (HNP or compression) sx at 20deg or less is suggestive of sx amplification
- Slump test: seated, hands behind back, then slump in relaxed position w/ chin to chest; extend leg, dorsiflex fully. examiner gives slight pressure to back of head. pos test is impingement on dura, spinal cord, nerve roots
11
Q
Spinal Pathologies
red flags in HPI/PE
8
A
- fever/chills/wt loss (malignancy)
- hx of IV drug use
- progressive weakness; decreasing pain in face of increasing deficit; paraparesis
- bowel/bladder dysfunction; distended/palpable bladder
- trauma
- increasing pain not controlled by simple analgesia
- saddle anesthesia
- unexplained neuro deficits
12
Q
distended/palpable bladder
lordosis vs kyphosis vs scoliosis
A
- lordosis: increased lumbar curvature
- kyphosis: increased thoracic curvature
- scoliosis: abnormal sideways curves
13
Q
Spinal Pathologies
myelopathy vs radiculopathy vs stenosis
A
- myel: injury/compression of spinal cord
- radi: injury/compression of nerve root
- stenosis: narrowing of passage for spinal cord/nerve root
14
Q
Compartment Syndrome
causes of compartment syndrome
4
A
- long bone fractures (tibia or humerus)
- severe contusion/crash injuries
- reperfusion injury after vascular repair
- restrictive cast/dressing
15
Q
Compartment Syndrome
compartments of LE
A
- anterior
- lateral
- superficial posterior
- deep posterior
Contents
* each compartment covered by fascia (resistant to expansion and stretch)
* each compartment contains muscles, blood vessels, nerves
16
Q
Compartment Syndrome
pathogenesis
A
- interruption of hemostatic pressure gradient causes a disruption in flow and capillary perfusion pressure
- build up of fluid outside of the capillaries increases pressure w/in myofascial compartment
- distribution of oxygen/nutrients and CO2 removal disrupted leading to muscle ischemia and necrosis
17
Q
Compartment Syndrome
reversibility of sx based on duration?
A
- < 4 hrs: reversible muscle injury
- > 8 hrs: irreversible muscle injury
- nerve conduction loss: 2 hrs
- irreversible nerve injury: > 8 hrs
18
Q
Compartment Syndrome
describe procedure of emergency fasciotomy
A
- long incision to release pressure in affected compartment and adjacent compartments
- wounds are left open and a 2nd procedure for debridement is performed w/in 48-72 hrs
- wound closure w/in 7-10d +/- skin grafting
19
Q
Osteomyelitis
common bacteria of non-hematogenous vs hematogenous
A
- Non-Hematogenous Polymicrobial (S. aureus, S.epidermidis, streptococcus spp, gram neg, anaerobes)
- Hematogenous monomicrobial (S. aureus, streptococcus, gram neg, p. aeruginosa, serratia, candida)
20
Q
Osteomyelitis
bacterial causes due to specific risk factors
A
- no risk factors: s. aureus
- sexually active: n. gonorrhoeae
- cat/dog bites: p. multocida
- IVDU: p. aeruginosa, s. aureus, candida
- sickle cell: salmonella
- neonates: group b strep
21
Q
Osteomyelitis
pathophys
A
- overall poorly understood
- several factors: host immune status, underlying disease, virulence of organisms, vascularity and location of bone
22
Q
Osteomyelitis
which part of bone most commonly affected in hematogenous spread?
A
- metaphysis
- due to rich vascular supply of growth plates
23
Q
Osteomyelitis
XR findings/limitations
A
- 1st line imaginge, but may not show chagnes in the first 2wks (so normal XR cannot r/o dz)
- disease must extend at least 1 cm and compromise 30-50% of bone mineral content to produce noticeable changes in plain radiographs
- findings: regional osteopenia, loss of trabecular architecture, bone destruction, soft tissue gas, new bone apposition (cortical thickening; increase in diameter of bone)
24
Q
Septic Arthritis
bacteria associated w/ infection
A
- S. aureus most common overall
- s. epidermidis
- streps: pyogenes, pneumoniae, agalactiae)
- gram neg: p. aeruginosa, e. coli, k. kingae, n. gonorhoeae (sexually active young pt), h. flu, salmonella (sickle cell)
25
# DeQuervain's Tenosynovitis
Finkelstein tests
place thumb into palm and ulnar deviate
pain is pos result (expected w/ DeQuervain's)
26
# Arthritis
purpose of articular cartilage
lings bones, allows for protection and gliding movement
27
# Arthritis- Wrist
what bones are removed w/ proximal row carpectomy
scaphoid, lunate, triquetrum
28
# Trigger Finger
why don't you release A1 pulley in RA
can cause further ulnar drift
29
# Common Fractures
metacarpal fractures- describe when rotational deformity may be present
* most common in oblique and spiral fracture types
* PIP joints at 90deg flexion normally converage at a point in the proximal carpal bones (scaphoid)
* deviation of 1+ lines suggests a metacarpal fracture
30
# Common Fractures
components of neurovascular for fractures
* repetitively evaluate motor + sensory nerve function and assess for vascular insufficiency
* neuro exam: assess median nerve, AIN, and radial nerve
* vascular exam: temp, color, cap refill
31
# Common Fractures
specifics of neuro exams
* Median: assess for abduction of thumb or flexion of distal phalanx of thumb
* Ant. Interosseous Nerve (AIN): assess for flexion of distal phalanx (OK sign)
* Radial: extension of wirst
32
# Common Fractures
specifics of vascular exam
* eval for color, warmth, cap refill
* eval both radial and ulnar arteries
* emergent surg if: cold, pale, pulseless
33
# Common Fractures
Weber Classification
* describe fibular fracture relative to syndemosis
* A: below syndesmosis
* B: level of syndesmosis
* C: above level of syndesmosis
34
# Common Fractures
Bohler Angle (calcaneal)
* formed by intersection of 2 lines
* Line 1: drawn from superior aspect of post calcaneal tuberosity to the superior subtalar articular surface
* Line 2: drawn from the superior subtalar articular surface to the superior aspect of anterior calcaneal process
35
# Shoulder Disorders
types of shoulder separations
| 6
* Type I: ligament stretched
* Type II: partial rupture of AC ligaments
* Type III: complete rupture of AC/CC ligaments
* Type IV: clavicle displaced posteriorly over acromion
* Type V: clavicle displaced up (just under skin)
* Type VI: clavicle underneath coracoid (rare, but serious)
36
# Shoulder Disorders
Subacromial impingement/bursitis: describe Neer and Hawkins tests
* **Neer Impingement Sign**: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear.
* **Hawkin Impingement Test**: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!)
37
# Shoulder Disorders
rotator cuff muscles & their jobs
* supraspinatus: abduction
* infraspinatus: external rotation
* teres minor: external rotation
* subscapularis: internal rotation
38
# Shoulder Disorders
Pos PE tests for rotator cuff tears + describe them all
| 4
* **Neer Impingement Sign**: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear.
* **Hawkin Impingement Test**: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!)
* **Drop Arm Test**: from fully abducted position, slowly lower the arm to the side, noting pain starting at approx 90deg followed up sudden drop of arm.
* **Empty Can Test**: supraspinatus muscle isolation; with arm straight and shoulder abducted to 90deg and forward flexed 30deg, point thumb at ground and lift arm against resistance
39
# Shoulder Disorders
Pos PE tests for labral tear
* **Apprehension Test**: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt's face
40
# Shoulder Disorders
Pos PE tests for shoulder dislocation
* **Apprehension Test**: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt's face
41
# Shoulder Disorders
dislocated shoulder appearances on XR
* **posterior**: humeral head appears superior to glenoid cavity on AP film
* **anterior**: humeral head appears inferior to glenoid cavity on AP film (MUCH MORE COMMON)
42
# Shoulder Disorders
posterior approach for shoulder joint aspiration
* palpate posteior lateral edge of acromion process
* mark spot 2cm inferior to edge
* inject shoulder w/ 10mL of anestetic targeting coracoid process
43
# Shoulder Disorders
ways to reduce anterior shoulder dislocations
* Stimson
* Scapular Manipulation
* Leidelmeyer
* Milch
* Traction-counter traction
44
# Shoulder Disorders
describe Stimson reduction
* Prone position
* Arm hanging
* Traction in forward flexion using 5, 10 or 15 pound weight (15-30 min)
* Use with scapular manipulation
45
# Shoulder Disorders
describe scapular manipulation
* Stimson technique
* Scapular tip medially
* Slight dorsal displacement of scapular tip
* Reduction may be subtle
46
# Shoudler Disorders
describe Leidelmeyer reduction
* Supine
* Arm adducted
* Elbow flexed 90°
* Gentle external rotation
47
# Shoulder Disorders
describe Milch reductions
* Forward flexion or abduction until arm is directly overhead
* Longitudinal traction
* Slight external rotation
* Manipulate humeral head upward into glenoid fossa
48
# Shoulder Disorders
Traction- Countertraction Reduction
* Supine
* Bed sheets tied
* Slight abduction of arm
* Continuous traction
* Gentle external rotation
* Gentle lateral force to humerus
* Change degree of abd
49
# Shoulder Disorder
Pos PE test for Bicepital Tendonitis
* **speed's test**: with elbow fully extended and palm forward, flex shoulder against resistance
50
# Knee Disorders
most common location for OCD of the knee?
| PPP
70% in the posterior lateral aspect of the medial femoral condyle
51
# Knee Disorders
PE differences for patellar and quad tendon ruptures
* **patellar**: difficulty w/ knee flexion, patella alta)
* **quad**: difficulty w/ SLR, can't extend knee, patella baja
52
# Knee Disorders
bursa of the knee
1. suprapatellar
2. pre-patellar
3. infrapatellar
4. pes anserine
53
# Knee Disorders
location of pes anserine bursa
deep to the gracilis, sartorius, and semitendinosus tendons at the lower medial knee
54
# Knee Disorders
pos special tests for ACL tear
* **Anterior Drawer Test**: for ACL tear; flex knee to 90 deg and sit on pt's foot; attempt to pull tibia anteriorly toward you (ACL tear = anterior tibia shift); and then repeat with the tibia in internal rotation to test posteriolateral joint capsule and in external rotation to test posteriomedial joint capsule
* **Lachman Test**: for ACL tear; flex knee to approx 20 deg; grasp lower leg, with one hand, use other hand to grasp thight; pull tibia foward while pushing femur back
55
# Knee Disorders
pos special tests for PCL tear
* **Posterior Drawer Test**: for PCL tear- flex knee to 90 deg and sit on pt's foot; attempt to push tibia posteriorly away you (PCL tear = posteior tibia shift)
* **Sag Sign for PCL tear**: inspect if tibia sags posteriorly when knee is relaxed at 90 deg flexion
56
# Knee Disorders
pos special tests for meniscus tears
* **Medial McMurray Test**: fully flex knee, then hold foot in external rotation and apply valgus force to knee while extended knee
* **Lateral McMurray Test**: fully flex knee, hold foot in internal rotation and apply varus force to knee while extending knee
* **Apley's Meniscal Compression Test**: with patient prone, grind tibia against femur in rotating motion to see if it elicits meniscal pain
* **Apley's Meniscal Distraction Test**: same as above, except tibia is pulled away from femur; pain may indicate ligamentous injury or malingering rather than meniscal injury.
57
# Scoliosis
differentiate dextroscoliosis and levoscoliosis
* Dextro: spinal curvature to R
* Levo: spinal curvature to L
58
# Scoliosis
describe purpose of and technique for scholiometer
* measures angulation of spine while individual bends forward to determine degree of truncal rotation
* pt bend forward, deviation of teh ball from center is measured
* measurements of >5deg is abnormal, f/u with spinal XR
59
# Raynaud's
pathophys of each phase
* Ischemic: arterial vasospasm causing distal blanching and transient numbness
* Hypoxic: dilation of capillaries and venules containing deoxygenated blood causing cyanosis
* Hyperemic: rewarming and resolution of vasospasm leading to oxygenated blood being delivered to dilated capillaries and venules leading to erythema
60
# Raynaud's
clinical presentation primary vs secondary
* **Primary**: mild cuase, middle 3 fingers most commonly affected, episodic < 20 min
* **Secondary**: more severe, asymmetric or unilateral, trophic changes (scarring, ulceration, gangrene), sclerodactyly (puffy digits w/ skin tightening)
61
# Raynaud's
normal vs abnormal nailfold capillary microscopy
* **Normal**: vessels thin, uniform, evenly spaced, symmetric; capillary loops have hairpin appearance
* **Abnormal**: absent (dropout areas) or dilated capillary loops; vessels are irregular, tortuous, elongated, bizarre, bushy, engorged, corkscrew in appearance; spacing between loops may be uneven
62
# Raynaud's
vasoconstrictive meds to avoid
* nasal decongestants
* amphetamines
* methylphenidate sumatriptan
63
# Radial Head Subluxation
supination/flexion technique
* Warn caregivers that the maneuver will hurt and the child will likely cry
* Child can be seated in parent’s or caregiver’s lap
* Fully extend and supinate elbow and then take elbow into flexion
* This procedure is done while maintaining slight pressure over the radial head; often, the provider will feel a “click” in the elbow
* Typically, the child will be moving the arm normally within 15 minutes
* Immobilization is unnecessary after first episode
64
# Radial Head Subluxation
hyperpronation reduction technique
* Warn caregivers that the maneuver will hurt and the child will likely cry
* Child can be seated in parent’s or caregiver’s lap
* While applying mild pressure over the radial head, the provider holds the elbow in a flexed position and hyperpronates the forearm
* A click may be felt when displacement is reduced
* Typically, the child will be moving the arm normally within 15 minutes
65
anatomy of apophysis
* normal secondary ossifications center
* located in NWB part of bone
* site of tendon or ligament attachment
* AKA traction epiphysis
* eveentually fuses w/ major portion of bone in 2nd decade of life
66
# Ankle Sprain
sprain vs strain
* sprain: injury to ligament caused my tearing of the fibers of a ligament
* strain: injury in which the muscle is stretched too much and tears
67
# Ankle Sprain
ligaments of the ankle
* deltoid (strong, medial ligament)
* anterior/posterior talofibular (lateral ligaments)
* calcaneofibular (lateral ligament)
68
# Ankle Sprain
grading ankle sprains
**1st degree – mild ankle sprain**
* Minimal pain and swelling
* Ankle is weakened and prone to reinjury
* Healing: 1-2 wks
**2nd degree – moderate to severe ankle sprain**
* Swelling often associated with ecchymosis
* Walking produces pain and is often difficult
* Healing: 2-3 wks
**3rd degree – severe ankle sprain**
* Diffuse swelling and ecchymosis
* Unable to bear weight
* Ankle instability
* +/-nerve damage
* Healing: 6-8 wks
69
# Ankle Sprain
Ottawa Ankle Rules- ankle vs foot imaging
**An ANKLE radiograph should be performed if there is pain in the malleolar region with any of the following:**
* Bone tenderness at the posterior edge of the distal 6 cm or tip of the lateral malleolus
* Bone tenderness at the posterior edge of the distal 6 cm or the tip of the medial malleolus
* Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation
**A FOOT radiograph should be performed if there is pain in the midfoot region with any of the following:**
* Bone tenderness at the navicular bone
* Bone tenderness at the base of the 5th metatarsal
* Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation
70
# Ankle Sprains
Ankle Anterior Drawer Test
* Performed to evaluate the stability of the anterior talofibular ligament (differentiate between 2nd and 3rd degree lateral ankle sprains)
* Positive test: anterior movement of the foot = 3rd degree tear
Performing the Test
* place the pt's ankle into 20deg plantar flexion
* with one hand, stabilize the anterior aspect of the distal leg
* cup the calcaneous and attempt to displace it anteriorly detecting the total amount of anterior translation in the lateral part of the ankle
71
# Ankle Sprains
proper use of posterior leg splint
* use with grade 2-3 ankle sprains, isolated fractures of tibia or fibula, lisfranc, or metatarsal fractures
* origin: posterior surface of leg, 2 in below fibular head to avoid common peroneal nerve compression
* insertion: plantar aspect of metatarsal heads
* position: ankle in 90deg dorsiflexion, pt in prone position to prevent shortening of Achilles
72
# Metatarsal Fractures
types of fractures
* **Pseudojones/Dancer's fracture**: occurs in zone I; fracture through base (tuberosity) of 5th metatarsal due to plantar flexion/inversion
* **Jones Fracture**: occurs in zone II; fracture at metaphyseal-diaphyseal junction that occurs w/ ankle sprains; high risk for non-union due to zone being avascular
* **Stress Fracture**: zone III
73
# Bursitis
define bursa
* synovium lined, sac like structure containing small amount of fluid
* found throughout the body
* acts as a cushion and gliding surface to reduce friction
* located near bony prominences or between bones, muscles, tendons, or ligaments
74
# Bursitis
describe olecranon bursitis
* caused by injury or repetitive pressure on elbow
* pain w/ flexion
75
# Bursitis
describe trochanteric bursitis
* caused by injury, overuse, arthritis, surgery
* pain w/ lying or sleeping on affected side
* most common in middle age/older women
76
# Bursitis
describe pre-patellar bursitis
* caused by repetitive pressure on knees
77
# Bursitis
describe retrocalcaneal bursitis
* caused by uphill running or wearing tight fitting shoes
78
# Foot Disorders
anatomy of the foot
* tarsals, metatarsals, phalanges
* arches function to distribute/absorb body wt, provide foot w/ elasticity and resilience, adapt to uneven surfaces, and protect neurovasculature
79
# Elbow Disorders
Elbow anatomy
* synovial hinge joint
* 3 joints which form functional unite w/in single articular capsule: humeroulnar joint, humeroradial joint, proximal radioulnar joint
* motions of elbow: extenion/flexion; pronation/supination
80
# Elbow Disorders
define Cozen and Maudsley tests
* **Cozen**: resisted wrist extension with elbow extended and forearm pronated
* **Maudsley**: resisted extension of middle finger
81
# Elbow Disorders
5 muscles that form the common flexor tendor + their innervations
Innervated by Median Nerve
* pronator teres
* flexor carpi radialis
* palmaris longus
* flexor digitorum superficialis
Innervated by Ulnar Nerve
* flexor carpi ulnaris
82
# Bone Tumors
children vs adult
* **peds**: most are benign; if malignant suspect osteosarcoma, Ewing sarcoma
* **adults**: metastatic 100x more common; metastases commonly from breast, lung, thyroid, prostate, or renal cancers
83
# Bone Tumors
proto-onco genes
* genes that promote normal cell growth
* with mutations, proto-oncogenes become oncogenes which overstimulate cell growth
84
# Bone Tumors
tumor suppressor genes
help balance cell growth by promoting apoptosis of mutated cells
85
# Bone Tumors
primary malignant bone tumors
| 4
* multiple myeloma
* chondrosarcoma
* ewing sarcoma
* osteosarcoma
86
# Bone Tumors
how multiple myeloma destroys bone
* **Lytic Lesions**: plasma cells activate osteoclasts which promote bone destruction
* **Hypercalcemia**: increased bone destruction leads to increased serum calcium
87
# Bone Tumors
osteoma vs osteoblastoma
* osteoma: < 1.5 cm
* osteoblastoma: > 1.5 cm
88
# Osteoporosis
pathophys
* bone is continually being formed and resorbed (formation = resoprtion)
* peak bone mass around age 30 and plateaus for 10 yrs
* bone loss then occurs at a rate of 0.3-0.5% each year until menopause then there is a 3-5% loss in bone density for 5-7 yrs
* osteoporotic bone loss affects cortical and spongy/trabecular bone leading to a fragile/porous bone
89
# Osteoporosis
describe fragility fractures
* occur after less trauma than might be expected to fracture a bone (ex: fall while standing, falling out of bed, coughing)
* common sites: distal radius, spine, femoral neck, proximal humerus, pelvis
90
# Osteoporosis
types of primary osteoporosiss
* overall: 95% of post-menopausal women; 80% of male cases
* Type 1: estrogen deficiency (increased osteoclasts, reduced osteoblasts)
* Type 2: age-related loss of bone mineral density
91
# Osteoporosis
secondary osteoporosis
* overall: 5% of female cases; 20% of male cases
* can be caused by disease (bone marrow/endocrine disorders), deficiency (malabsorption, vit D), drugs
92
# Osteoporosis
biggest med risks for secondary osteoporosis
| 3
steroids, PPIs, aromatase inhibitors (block estrogen)
93
# Osteoporosis
purpose of DEXA scans
* define osteopenia and osteoporosis by providing a quantitative measure of bone loss
* predicts risk of fracture
* monitors patients undergoing tx
94
# Osteoporosis
DEXA T vs Z score
* **T score**: standard deviation differenec between the patient's BMD and reference BMD of younger population of same sex/ethnicity/race
* **Z Score**: standard deviation difference between pt's BMD and that of an age-matched population of the same sex/race/ethnicity
95
# Osteoporosis
interpreting T vs Z scores
T: if -1 to -2.5 SD: osteopenia; if <-2.5 SD: osteoporosis
Z: <-2.0 SD: osteoporosis
96
# Osteoporosis
FRAX Score
* Fracture Risk Assessment Score which predicts the 10 yr probability of major osteoporotic fractures
* Based on: age, gender, race, hx of fragility fracture, RA, family hx hip fracture, low BMI, hx steroid use, EtOH, current smoker, BMD of femoral neck
* Screen all pt >50 w/ FRAX
| do not memorize, just be familiar
97
# Osteoporosis
indications for pharmacotherapy in women and men
| 3 each
* women: hx fragility fracture, T score <-1, elevated 10 yr risk via FRAX
* men: fragility fracutres, FRAX estimations, BMD measurements
98
# Osteoporosis
bisphosphonates overview
* end in "dronate" or "dronic acid"
* bind to hydroxyapatite binding sites on bone (areas w/ active resorption by osteoclasts)
* bone turnover reduced at 3 mo and reduced fx risk at 1 yr
* take on empty stomach w/ 8oz water (can cause esophageal irritation)
99
# Osteoporosis
Hormonal replacement overview
* Estrogen + progesterone: not always given due to risk of thromboembolism, endometrial cancer, CAD, breast cancer
* Testosterone: replace in hypogonadal men
100
# Osteoporosis
Misc Therapies
* **Raloxifene**: estrogen-agonistic effect on bone leading to increased bone mineral density and mass by decreasing bone resorption
* **Denosumab**: monoclonal ab against receptor activator of RANKL which is secreted by osteoblasts
* **Calcitonin**: opposes action of PTH leading to inhibited osteoclast activity and reduced bone resorption
101
# Osteoarthritis
characteristics of synovial joints
* Articular Cartilage: made of hyaline, covers ends of bones, provides shock absorption/stability/lubrication
* Synovial Membrane: loose/vascularized connective tissue, secretes synovial fluid into joint cavity for lubrication
* Joint/Articular Capsule: fibrous connective tissue that surrounds the bony ends forming the joint
102
# Osteoarthritis
primary vs secondary
* Primary: idiopathic
* Secondary: due to obesity, repeated trauma/surgery, infection, congenital abnormalities, metabolic disorders, bone disorders
103
# Osteoarthritis
XR/PE evidence of osteophytes
* DIPs: Heberden's nodes
* PIPs: Bouchard's nodes
* 1st CMC: thumb squaring
104
# Osteoarthritis
Stages of Osteoarthritis
* Stage 0: normal joint
* Stage 1: 10% cartilage loss
* Stage 2: joint space narrowing + osteophyte formation
* Stage 3: moderate joint space narrowing (crepitus) + continued osteophyte formation
* Stage 4: > 60% cartilage loss + severe joint space narrowing + large osteophytes
105
# Pediatric Hip Disorders
describe being breech as a risk factor for DDH
* Frank Breech highest risk: both knees extended (i.e. bent in half)
* if a female baby is born breech, they should ALL undergo US screening for DDH
106
# Pediatric Hip Disorders
DDH hip XR H line
* drawn horizontally through the inferior portion of the iliac bones at the triradiate cartilages
107
# Pediatric Hip Disorders
DDH PE tests as newborn & describe
* **Barlow**: dislocation of hips at rest; child's hips adducted while applying posterior force --> positive when femoral head is felt slipping (posteriorly) our of the acetabulum
* **Ortolani**: reduction of the hips at rest; from an adducted position, the child's hip is abducted while the trochanter is pushed anteriorly --> positive when "hip clunk" is felt or if the hip is reduced
108
# Pediatric Hip Disorders
DDH PE tests as infants age & describe
* **Galeazzi**: child lays supine w/ hips flexed to 45deg and knees at 90deg; pos if one knee is higher than the other (indicates possible posterior displacement of the femur)
* **Klisic**: place a finger on the greater trochanter and the ASIS --> draw "line" through both fingertips --> if the line is below the umbilicus, the test is pos
109
# Pediatric Hip Disorders
endocrine & renal work up for who? includes what?
* children < 10 yrs and wt < 50th percentile
* TSH, free T4, BUN, creatinine
110
# Pediatric Hip Disorders
SCFE Drehmann sign
external rotation w/ passive hip flexion to 90deg
