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Clinical Medicine I > MSK Treatments > Flashcards

MSK Treatments Flashcards

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1
Q

Principles of Immobilization

A 
Maintain Anatomic Position
Prvent movement of fracture
Protect from further injury
Limit neuro injuries
Pain control
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2
Q

Methods of Immobilization

A 
Splinting
Casting
CRPP
Open Reduction Internal Fixation (ORIF)
External Fixator
Intramedullary Rodding
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3
Q

Strain/Sprain

A 
RICE
Splinting
NSAIDs
Early ROM
PT
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4
Q

Dislocation

A 
Analgesia
Reduce
Splint for Pain relief
Gentle ROM
Follow up for further evaluation
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5
Q

Tendinitis

A 
Rest and avoid strenuous activity
Ice cube massages for 15 min.
Brace
Naproxen (NSAID)
PT
Cortisone
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6
Q

Ligament Rupture

A 
Splint/immobilization
Ice
NSAIDs
Repair/Reconstruction
Early ROM
PT
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7
Q

Orthopedic Pain Management

A 
Splint/cast
Ice/Cryocuff
NSAIDs
Acetaminophen
Narcotics
Steroids
Topicals
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8
Q

What is the dose for Acetominophen?

A

325-650 mg every 4-6 hours

Max dose is 4g/day and 3g/day if alcoholic or liver disease

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9
Q

What is the best NSAID to use?

A

naproxen 220 mg PO twice a day

Take with food

Analgesic effects begin in 1-2 hours and anti-inflammatory effect begins in 2 weeks of use

2 blue pills, two times a day, for 2 weeks and then PRN

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10
Q

What are the topical analgesics most commonly used?

A

Diclofenac Rx

Absorbine OTC

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11
Q

What is the dose of corticosteroid injection for large joint?

A

1 mL of 80mg Depo-Medrol, 2mL of 1% lidocaine without epi, and 2mL of 0.25% Marcaine

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12
Q

What is the dose of corticosteroid injection for medium joint?

A

1 mL of 80mg Depo-Medrol, 1mL of 1% lidocaine without epi, and 2mL of 0.25% Marcaine

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13
Q

What is the dose of corticosteroid injection for small joint?

A

0.5 mL of 80mg Depo-Medrol and 0.5mL of 1% lidocaine without epi

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14
Q

Clavicle Fracture

A 
Nondisplaced:
Sling
Ice
NSAIDs
Analgesics
Passive ROM within 3 days --> pendulum
PT after heals

Displaced:
ORIF with plate and screw
Sling
ROM ASAP
Analgesics --> narcotics 
PT
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15
Q

AC Joint Injury

A

SLing and RICE
Grades 1 and 2 = conservative
Grade 4 or higher = surgery
Surgery –> AC joint stablization with fiation present at origin/insertion of CC ligament

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16
Q

SC Joint Dislocation

A

Posterior –> Repair

Anterior –> None

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17
Q

Proximal Humerus Fracture

A 
Nondisplaced --> conservative
Sling/collar
Ice
Analgesics
Gentle ROM within 2 weeks
ROM of elbow/wrist ASAP

Unstable –> ORIF with IM rodding or severe would require total reverse shoulder replacement

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18
Q

Shoulder Dislocation and Instability

A

Acute –> Reduce ASAP
Sling for 2 weeks with pendulum exercises
Early pT

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19
Q

Impingement Syndrome

A 
Conservative:
Activty modification
PT
NSAIDs
Corticosteroid injections

Surgical:
Arthroscopic acromioplasty with coracoacromial ligament release
Bursectomy
Debridement or repair of RC tears

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20
Q

Rotator Cuff Tear

A

PT
Partial tears will heal on own

Full thickness –> Surgery
Immobilization
Passive ROM by PT
Active ROM may begin after 4-6 weeks

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21
Q

SLAP Lesion

A

1 –> none

2 and 3 –> surgery

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22
Q

Adhesive Capsulitis

A

NSAIDs to decrease inflammation
Frequent PT
Intra-articular corticosteroids
Surgery –> manipulation under anesthesia and arthroscopic release

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23
Q

Calcific Tendonitis

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A

Analgesics/Anti-inflammatory meds
PT with US therapy
Arthoscopy with aspiration of mineralized materal but then need to repair rotator cuff tear that was just created

24
Q

Midshaft Humerus Fracture

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A

Non-surgery in older patients
Surgery required in emergent cases –> ORIF but no IM rod
Initial placement of sugar tong splint

25
Radial Head Fracture
Treat as non-displaced if fracture cannot be identified but patient has effusion ``` Long arm posterior splint for 3-4 days Sling for 1-2 weeks Analgesics Gentle ROM Serial radiographs every 2 weeks PT ```
26
Olecranon Fracture
ORIF with tension band | ORIF with plate and screw fixation
27
Elbow Dislocation
``` Closed Reduction for simple dislocation ORIF for complex fracture dislocation Long arm posterior splint/sling for 1-2 weeks Analgesics PT ```
28
Epicondylitis
``` Rest and avoid strenuous activity Ice Cube massages Brace at m. bellies NSAIDs PT Cortisone is last resort ```
29
Both Bones Forearm Fracture
Sugar-tong splint in ED Casting for nondisplaced ORIF for displaced
30
Colles Fracture
Conservative --> Closed Reduction and Sugar tong splint followed by long/short arm cast for 4-6 weeks Surgery --> ORIF followed by cast/splint for 4-6 weeks CRPP can also be used
31
Hip Arthritis
NSAIDs and/or Tylenol Activity modification PT Ambulatory assistive devices like cane or brace Intra-articular cortisone injection under Fluoro Total Hip arthroplasty
32
Knee Arthritis
Same as hip except it is total knee arthroplasty
33
Hip Fractures
Surgery within 48 hours Cannulated Screws for nondisplaced femoral neck--> WB time will depend on patient Hemiarthroplasty for displaced femoral neck or subcapital hip fracture IM Nail/Compression Screw for intertrochanteric or subtrochanteric hip fractures --> WB next day
34
Grade I and II stable femoral neck fracture
Internal fixation with head preservation
35
Stage III and IV femoral neck fracture
Arthroplasty
36
Intertrochanteric Hip fracture
IM Nailing | DHS Compression Screw
37
Subtrochanteric Hip fracture
IM Nailing/Rodding
38
Greater Trochanteric Bursitis
Ice NSAIDs PT Corticosteroid Injection under fluoro
39
Femur Fracture
Address life threatening injuries --> may need Ex-fix first IM nailing NARCOTICS and anticoagulation PT
40
Tibial Plateau Fracture
Stable: Hinged knee brace and crutches NWB but can do active ROM from seated/lying position Some may use long-cast Unstable: ORIF with side plate and screws if > 5mm step-off
41
Segond Fracture
Cancellous screw | Correct anterior rotational instability of ligaments
42
Patella Fracture
ORIF with tension band wiring NWB in hinged knee brace locked in extension May open brace to 20 degrees to allow patient to swing leg through durign crutch walking Active ROM in brace after 4 weeks and only during PT
43
Quad Tendon Rupture
SURGERY Then hold leg to 20 degrees extension and be NWB in locked hinge knee brace Can transition to partial WB after 6 weeks Can take up to 1 year to return to normal
44
Patella Tendon Rupture
Conservative: Partial diruption only Immobilization in hinged knee brace for 4-6 weeks Complete tears require surgery
45
Maisonneuve Fracture
Stabilize the knee and fix ankle fracture
46
ACL Tear
Reconstruction with ACL graft from cadaver, or patients own hamstring or achilles Patient may defer surgery
47
Medial Collateral LIgament Tear
RICE Gentle, NWB ROM 3-5 days afer Hinged knee brace to protect medial/lateral ambulation + crutches for 4-6 weeks PT
48
Patella Femoral Syndrome
Activity modification with PT NSAIDs Patella brace (doesn't have bars) resolves within 4-6 weeks
49
Meniscus Tear
Arthroscopy of knee Protected WB with gentle ROM 6 weeks after surgery if young patient Menisectomy in older patients --> WB after surgery
50
Tibia Fracture
Midshaft = unstable and needs IM Nail fixation Multi-trauma = Ex-fix then surgery Fibula is not treated if Maisonneuve
51
Ankle Fracture
Stable --> Tall walking boot or cast with crutches | Unstable --> ORIF
52
Ankle Sprain
``` RICE for first couple of days NSAIDs Early ROM PT Splint in ER or office and send to ortho ```
53
Calcaneous Fracture
Well padded posterior splint to lower extremity Protected WB with crutches or WC Analgesics ORIF delayed 7-10 days to allow for swelling to reduce
54
5th Metatarsal Avulsion Fracture
Conservatively Short boot Oxycodone and supplement with OTC Tylenol
55
Jones Fracture
2 + months to heal Displacement --> NWB cast for 6-8 weeks Internal fixation or bone graft may be required if non-union occurs
56
Plantar Fasciitis
``` Night Splint Ice NSAIDs PT Corticosteroid Injections ```
57
Achilles Tendon Rupture
Non-operative --> sedentary/frail patient; heel lift and short boot Operative --> end to end achilles repair

Clinical Medicine I (15 decks)

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