Musculoskeletal Flashcards
(151 cards)
1
Q
Torticollis: Chin rotates to the which direction?
(Same or Opposite) of the spasm?
A
Opposite
2
Q
You are evaluating an infant and you notice the head and ear are tilted toward the right.
You know this is a (Left or Right) torticollis?
A
Right
3
Q
If there is not an underlying disease process in torticollis, which muscle is likely damaged?
A
Sternocleidomastoid
4
Q
What is the most effective treatment for torticollis?
A
Passive stretching
5
Q
Limb deficiency is rare, but more common in Upper or Lower limbs?
A
Upper limb deficiency is more common
6
Q
If patient has congenital limb deficiency, then other congenital problems are much more likely to be found. Assess which bones?
A
- Femur
- Tibia
- Fibula
7
Q
What is “key” about treatment of congenital deformities with prosthetics?
A
Early fitting is key!
Lower extremities
•Typically fitted around 12 months of age
•Well tolerated- necessary to help balance and walk
Upper extremities
•Mitten type as young as 6 months
•Able to “develop” as the child grows
8
Q
Metatarsus Adductus defined
Do most resolve resolve spontaneously or require surgery?
A
Inward deviation of the forefoot
Most flexible deformities resolve spontaneously
•Due to positioning in the uterus
9
Q
Metatarsus Adductus-
_______ crease in the Medial aspect of the arch if RIGID deformity
A
Vertical
NOTE: If cannot be repositioned past midline, serial casting is used to correct deformity
10
Q
Metatarsus Adductus may be associated with what other deformity?
A
hip dysplasia
Examine hips carefully
11
Q
Talipes Equinovarus
AKA:____________
A
Clubfoot
12
Q
If an infant has clubfoot, check for other abnormalities, esp the ______
A
Spine
13
Q
Treatment of Talipes Equinovarus
A
Clubfoot Tx:
Ponsetti technique
•Manipulation and stretching of the foot/tissue
•Serial Casting
•Once a week for at least 6 to 8 weeks
•Night brace is required for long term management
14
Q
Abnormal growth or development =
A
dysplasia
15
Q
What is:
abnormality between the femur and acetabulum
A
Hip dysplasia
Femur and acetabulum are under developed
16
Q
What is it when:
femoral head is NOT in contact with the acetabulum
A
dislocated hip
17
Q
What is it when:
femoral head may be displaced with movement
A
Subluxatable hip
18
Q
Is hip dysplasia more common in Left or Right Hip?
A
LEFT HIP
19
Q
Will hip dysplasia correct itself?
A
No. does not correct itself unless dislocation is corrected within a few weeks of birth
20
Q
Clinical findings for hip dysplasia:
How to assess?
A
- Lie infant supine, wait until calm
- Place long finger over the greater trochanter and thumb over the inner thigh
- Hips are flexed 90 degrees- slowly Abduct from midline, 1 hip at the time
21
Q
Ortalani sign
A
Using gentle pressure, lift the greater trochanter forward (aBduct)- does the femoral head slip? You are trying to put the hip Back into place.
(Hip Out for Orlanti)
22
Q
Barlow sign
A
ADduct the medial side of the thigh, listen for a ‘clunk’ as the femoral head “pops” out of joint.
(Barlow push Back)
23
Q
______ are the MOST reliable diagnosis of hip dysplasia in the newborn
A
Clinical Signs
24
Q
______ provides more info than _______ in the infant (for hip dysplasia).
What becomes more helpful when the infant becomes 6 weeks??
_______
A
Ultrasound
Plain films (XR)
Plain films are helpful after the infant reaches 6 weeks of age or older
25
After how many days are the symptoms of hip dysplasia less evident?
30 days
NOTE: Painless limp is present after child begins to walk
26
What is Trendelenburg sign for hip dysplasia
dip in the pelvis when standing on affected leg due to weakness in the gluteal muscles-
27
A Pavlik harness can be used to treat hip dysplasia if ___________
It can be used until what age ?
Hip is naturally reducible- with little pressure
Can be used for the first 4 months of life
28
True or false:
| Double or triple placing diapers can help correct hip dysplasia
FALSE
29
Earlier intervention is better if surgery is needed for hip dysplasia. How long should the parent expect the cast to be on after Surg?
Hip cast is used for 3 months after surgery
30
Slipped Capital Femoral Epiphysis (SCFE) presentation
Present with groin, thigh, or knee pain/often accompanied by a limp
Pain with ROM; limited internal rotation; obligatory external rotation when hip is flexed
31
What action/education is needed for Slipped Capital Femoral Epiphysis?
This is URGENT!
NO weight bearing- At All!
Immediate orthopedic eval
NOTE: SCFE is most common in adolescent, obese males
32
Mutation or alteration of the Fibrillin-1 gene
Marfan Syndrome
33
Clinical s/s of Marfan Syndrome
```
Arachnodactyly (Unusually long fingers and toes)
Hypermobility of the joints
Enlarged hands, very tall, flat feet
Eye abnormalities
High-arched palate
Scoliosis- as much as 60% of diagnosed patients
Cardiac Involvement
Up to 90% have cardiac disorders
Thoracic aortic aneurysm – dissection
Aortic and or Mitral valvular disorders
```
34
Symptomatic treatment for Marfan Syndrome (screening and treatment)
Screening for aortic aneurysms and other cardiac disorders
Treatment of scoliosis
and flat foot
Pain management
35
S/S Gigantism
Unusual LINEAR growth
36
________ is an excess of growth hormone production occurs BEFORE puberty
Gigantism
37
What connective tissue disorder can occur at any age AFTER puberty?
Marfan's or Acromegaly
It is more common in 4th and 5th decade of life (but can be any time after puberty)
38
Lateral curvature of the spine that may occur at any age
Scoliosis
39
Scoliosis exam: How to
Examine the back with patient standing
Look at shoulder and hip heights
Then have patient bend over at waist
Look for asymmetry
40
What are the 3 options for scoliosis treatment?
Observation
Bracing
Surgical
41
What is the outcome when using bracing for scoliosis?
Prevents further progression
Does NOT correct problem
42
Observation, PT, exercise, and chiropractic med can be used in adolescents or adults if what is true?
If scoliosis findings are minor in adolescents or LESS than 45 degrees in adults
43
What is the treatment option to Correct scoliosis deformity?
Surgical
Uses rods, screws, etc to reposition the spine
or spinal fusion to hold it in place
44
Genu Varum
AKA ______
Is normal to about age ____
Genu Varum = Bowleg
normal until about age 3
NOTE: consider ortho referral if persists after 3.
Varum may be a greater risk for osteoarthritis - Bracing may be needed
45
Genu Valgum
AKA ________
Lasts until about age ____
Genu Valgum = Knock Knee
| Lasts until about age 8
46
If Valgum is present with _______, you should consult ortho
short stature
Knock Knee + Short stature = ortho eval
```
sketetal dysplasia (dwarfism or 3 SD below mean)
Rickets (impaired VitD, Ca, phos absorption)
```
47
Education for flat foot
Can be a normal finding in infants
Should spontaneously resolve
Suggest high quality sport shoes and arch support/inserts
48
Cavus foot is....
unusually high arch
hereditary or assoc. w/ neurologic conditions
commonly seen with claw toes
49
Which common foot problem may need a neurological eval?
Cavus Foot
progressive cavus foot should get neuro exam, XR, and MRI of spine (workup for neuromuscular disorder)
50
Hallux Valgus
| AKA______
Bunions
Common, familial
Needs wide shoes
Surg only for adults (high recurrance rate)
51
Tenosynovitis is more common at what locations?
How to treat?
Knees and feet
Tx: Rest. Limited NSAIDS
52
True or False:
| Acute bursitis is common in children
False!
Rule out other issues in kids first
53
______ may develop in late adolescence or adulthood after infection, trauma, avascular necrosis, or hemarthroses
Arthritis
54
Sprain is stretch injury to the ______
Strain is stretch injury to the ______
Sprain is injury to the ligament
STrain is injury to the muscle or Tendon
55
When the ankle is "rolled", _____ causes more injury to lateral ligaments
________ causes more injury to medial ligaments
(Inversion or Eversion)
Inversion- more common- injury to lateral ligaments
Eversion- medial ligament
NOTE: Palpation will identify which ligaments are injured
56
Most knee injuries in children are related to _______
Traumatic Injury- football, soccer, basketball.
NOTE: Collateral and cruciate ligaments (Knee Sprains)- NOT COMMON in children - bony injury more common
57
Post Trauma Effusion should get ______
Ortho Eval
58
Non Traumatic Effusion- consider
juvenile RA or patellar disorder
59
Nursemaids elbow presentation
Infant/child
"Elbow will not bend"
Full pronation of elbow- very painful
Tender over radial head *X-Rays may be normal*
60
Patellar disclocation is almost always ______ (lateral or medial)?
Will it show up on XR?
Almost always lateral dislocation
Yes, will show up on films
**Severe Pain
61
Epiphyseal Fractures
Separation rather than a true fracture
More common than a ligament injury (bc ligaments at joints are usually stronger than the growth plate)
62
Epiphyseal Fractures/Separation dx and tx
X-Rays are indicated to differentiate between an epiphyseal separation and dislocation
Films of the opposite side are helpful for comparison
Reduction under anesthesia to prevent deformities/growth issues
63
Torus fracture
| definition and tx
“buckling” of the cortex due to compression of the affected bone
Simple immobilization= Soft bandage or short cast for 3 weeks or so
NOTE: Verify that it is not a greenstick fx (tx is different)
64
Greenstick Fractures
| definition and tx
One side is obviously broken- split away – while opposite side is intact
Tx: Reduce y putting into normal alignment and place in SNUG fit cast. **XR again in 7-10 days
65
What do you for for a clavicle fracture ?
immobilize
66
Supracondylar Fractures of the Humerus
What critical assessment is necessary?
ALWAYS check for brachial/radial pulses - it is close proximity to the brachial artery
Tx: closed reduction with pinning
Note: most common elbow fx in kids, most age 3-6y
67
Hip fracture presentation
Pain in the groin, may radiate to the lateral hip, buttock, or knee
Displaced fracture = cannot bear weight
Internal rotation of the hip – pain = + fracture
68
Stress fracture- from repetitive movements or osteoporosis -
Non-displaced may not require surgery.
When Hip Fractures DO require surgery, it is ideal to be done within what timeframe?
Surg within 24 hours - waiting only increases risk of complications
69
_____ and _______ can reduce many pediatric fractures
Traction and manipulation
Note: Open reduction can be used if alignment is not satisfactory (this method is more common in adults)
70
What would cause a fracture to be suspicious?
Story does not fit injury,
| Poor explanation, changing stories, delay in seeking care, unrealistic
71
Osteomyelitis is usually preceded by_______.
Usually starts in _______ then moves in to compact or cortical bone
Typically preceded by some type of trauma
Usually starts in the spongy or medullary bone
72
Osteomyelitis presentation
Pain with movement, Soft tissue swelling, Localized tenderness over the metaphysis of affected bone, Refusal to bear weight
Lower extremities more likely than upper
73
Osteomyelitis labs. What is elevated?
```
Elevated ESR (>50mm/h is typical) and CRP
WBC count: may be normal or slightly elevated in infants
```
74
Osteomyelitis treatment
Culture ASAP
Broad spectrum antibiotics initially then based on culture results ---IV Abx 1st, then PO as s/s decrease
Course of treatment at least 4-6 weeks- may even be months
Bone scans may be indeterminate- plain films late response
75
Necrosis due to lack of blood flow to proximal femur
Legg-Calve-Perthes Disease
76
Legg-Calve-Perthes Disease presentation
Persistent pain is the most common symptom.
| Patient may present with limp or limited movement of affected leg
77
Legg-Calve-Perthes Disease Treatment
•Minimize trauma/work/use (protect joint by minimizing impact)
NOTE: Excellent prognosis for regrowth of femoral head - BUT may or may not be functional??
78
At what age can a child start strength training?
Can be started as early as 7 or 8 years of age
**Must meet Tanner Stage V before moving to maximum weightlifting or power lifting
79
What is the goal time for fitness and conditioning in sports medicine?
What type(s) should be included?
Goal is 60 minutes of activity a day
Resistance (strength), neuromuscular, and integrative training (COMBO, not just 1)
80
Sports nutrition should focus on?
```
Focus on choices
Adequate hydration
Make healthy choices
Balance intake and output
Carbs are healthy too
Note: Caution with supplements - you don't always know what you get and FDA intervenes after marketed
```
81
Sports Physicals ultimate goal and primary objective
Promote health and safety of athletes
Primary: screening for conditions that may be life threatening or disabling and for conditions that predispose to injury or illness
**ideal timing is 6-8 weeks before training starts
82
Sports physical secondary objective
May provide a medical home
Evaluates fitness level for particular sport
Counseling
Preventing injuries
Seeking treatment
Health promotion
(Maybe only encounter with healthcare provider)
83
PRICE acronym related to injuries
* Protect from further injury
* Rest the injured area
* Ice
* Compression
* Elevate immediately
84
When can athletes with MRSA return to participation?
(Table 27-3, pg 847 Hay)
Suspected MRSA should be cultured and treated with abx. Abscess needs I&D.
*May return when no new lesions x48 hours, NO moist or draining lesions, AND has been on oral abx for at least 72 hours.
85
Concussion usually resolves in 7-10 days. What is the 6 step process to return to play?
```
No symptoms at rest for 24 hours
•Light aerobic exercise x 24h
•Sport specific exercise x24h
•Non contact drills x24h
•Contact practice drills x24h
•Release
```
**If s/s recur at any stage- go back to rest for 24 hours and drop back a step
86
Concussion Symptoms:
Headache •Confusion •Amnesia: classically anterograde •Dizziness •Balance problems •Nausea/Vomiting •Visual disturbances •Light/noise sensitivity •Ringing in the ears •Fatigue/excessive sleepiness/Sleep abnormalities •Memory/concentration problems •Irritability/behavioral changes
87
Atlantoaxial Instability is INCREASED mobility at ___ and ____
(more common in children with Down’s Syndrome)
Increased mobility at C1 and C2
Note: Any child with a score of > 4.5 mm must be restricted from sports that are at risk for contact or collision activities and from sports that require significant neck flexion/extension
88
Cervicalgia: Neck Pain
| Treatment if no trauma or infection
Conservative tx:
| Stretching, NSAIDs, therapy, muscle relaxers (short term), massage, chiropractic treatments, cervical traction
89
Spurling Test
for Neck Pain/Cervicalgia
performed by having the neck extended rotated, and flexed to the ipsilateral shoulder while applying an axial load
90
Burner/Stinger
| key feature
UNILATERAL pain and paresthesia
in the upper extremity
Symptoms on the same side as injury - they need diagnostic workup in pain persists or becomes bilateral
Note: usually Short duration
91
Burner/Stinger Treatment
Remove from play and observe
•If repetitive burners/stingers in a single day or a season, strongly consider restricting for the rest of the day
•Prevention with proper fitting gear, appropriate clothing, and use proper technique for sports activities
Return to game when pain free, full ROM without pain, strength and reflexes normal, and negative spurling test
92
Spondylolysis is an injury to the _______
pars interarticularis of the vertebral complex
| resulting in a stress reaction or an acquired stress fracture
93
(Spondylolysis)
| Examples of Acquired stress fracture due to repetitive overload
Gymnasts, wrestlers, dancers, divers, trampolines
94
Spondylolysis
| Treatment
Avoid hyperextension of the back and high impact sports
Bracing may help symptoms but no change in outcome in studies
May return to sports when asymptomatic
Stretching of ham strings
Work on core and back strengthening
95
Spondylolisthesis
Bilateral pars injury with vertebral slippage
Back pain with extension, Hyperlordosis - exaggerated lumbar curve,
Treat symptoms, brace may help
*If surgery is required, cannot return to sports activity for at least ONE YEAR
96
Low Back Pain
| Consider nerve root impingement IF....
leg pain is > back pain
97
Cauda Equina Syndrome for low back pain
Bowel or bladder symptoms, “saddle anesthesia”, loss of anal sphincter tone or incontinence, LE weakness
**EMERGENCY- REFER ASAP
98
When should you refer low back pain?
Weight loss, severe pain for > 6 weeks, nocturnal or pain at rest
*Refer these s/s urgently
(80% of episodes should resolve spontaneously by weeks, 90% by 6 weeks)
99
Spinal Stenosis
| definition and symptoms
Narrowing of the spinal canal
Worse with extension- better with sitting
Can create claudication type symptoms in LE
100
Spinal Stenosis
| treatment
Epidurals, stretching may help
Surgery:
Spinal decompression; Nerve root decompression
101
Disk Herniation symptoms and treatment
Back pain that is exacerbated by flexion and sitting
(+ straight leg lift)
Conservative treatment: Rest, PT, possible steroids,
surgery if conservative fails
102
Disk Herniation
Mechanism of injury/occurrence
Usually due to bending or heavy loading/lifting w/back in flexion. Also occurs r/t degenerative disk disease in ages 30-50
103
Disk Herniation
| Location most often affected
Typically affects L4-L5 and L5-S1
104
Acromioclavicular Separation
| s/s and tx
s/s: Tenderness and edema at AC joint
+Positive cross arm test
Tx: Rest, support, immobilization (1-6 weeks), and rehab
105
Fractured Humerus
| s/s and tx
s/s: Severe pain and swelling in proximal Humerus
May have obvious deformity
***Assess brachial plexus as well as radial nerves for any damage
Tx: Typically requires a sling for 6-8 weeks
Rehab to strengthen muscles and extension
106
Patient presents with his arm Abducted and externally rotated, has a "squared off" appearance, and complains of severe pain. What diagnosis do you suspect?
Acute Traumatic Anterior Shoulder Instability
Tx: Immediate reduction in the ED or Operating Room
107
Rotator Cuff Injury is exacerbated by what position?
Exacerbated by overhead activities and posterior reach
108
Adhesive Capsulitis
AKA ________
What elicits pain?
"frozen shoulder"
External rotation of elbow while at side elicits pain
109
Adhesive Capsulitis
| Phases (3)
- Inflammatory phase- 4-6 months- painful shoulder without findings of trauma
- Freezing phase- 4-6 months- shoulder is stiff, pain may decrease but ROM limited
- Thawing phase- may last a year as movement gradually returns
110
When to refer Adhesive Capsulitis
Refer if symptoms do not respond after 6 months of treatment
OR
if ROM declines after 3 months
111
Lateral Epicondylitis
AKA ________
Exacerbated by?
Tennis Elbow
-Tendinopathy of lateral epicondyle
exacerbated by wrist extension
112
Olecranon Bursitis
| s/s and tx
Inflammation of the Olecranon bursa is usually trigger by repetitive trauma
s/s: hot, red, inflamed, painful
Tx: NSAID, maybe injections, Stop the cause
113
Lateral Epicondylitis
| Treatment
Conservative: Ice and NSAIDs
•Rest from repetitive movements
•Appropriate stretching and strengthening of forearm muscles to prevent recurrence (PT exercises)
•Forearm brace may be helpful
114
Osteoarthritis
Inflammation?
Systemic s/s?
Minimal inflammation
| NO systemic s/s
115
True or False:
| BREIF morning stiffness followed by improvement is seen in Rheumatoid arthritis
FALSE
BREIF stiffness is seen in Osteoarthritis
116
Osteoarthritis
| Primary sites
Weight bearing joints
DIP and PIP (hands)
MTP of great toe
c-spine and lumbar spine
117
Osteoarthritis
| Treatment
Splinting/compression gloves, Ice/heat, exercise, PT/OT, KT tape
Tylenol, NSAIDS, topical tx advil duoaction (tylenol + Ibu)
Steroid injections MAX 4 times per year (only for knees and hips)
118
TMJ
| s/s and treatment
s/s: Pain at the joint or surrounding area, May or may not radiate, Worse with chewing, May have associated ear pain
Tx: NSAIDS, gentle stretching of the face/mouth, muscle relaxers, anti-depressants (stress related/grinding of teeth), splints (short term use only)
NOT a surgical problem
119
Carpal Tunnel Syndrome typically effects which area of the hand?
s/s?
first 3 digits (thumb, first, and second fingers)
Pain, burning, and tingling along medial nerve; Worse at night (sleep).
Exacerbated by manual activity, especially extremes of volar flexion or dorsiflexion of wrist
120
Carpal Tunnel Syndrome Treatment
Tx is directed at relief of pressure on median nerve
- Nerve Conduction testing
- Splint for up to 3 months (neutral position)
- NSAID or Steroids- temporary relief
- Decompressive surgery resolves issue
121
Phalen sign
| often + in Carpal Tunnel
Phalen sign is pain or paresthesia in the distribution of the median nerve when the patient flexes both wrists at 90 degrees for 60 seconds.
122
Tinel sign
| often + in Carpal Tunnel
tingling or shock-like pain on volar wrist percussion
123
Carpal Compression Test
numbness and tingling are induced by the direct application of pressure over the carpal tunnel
(May be more sensitive and specific than tinel and phalen sign)
124
Dupuytren Contracture
AKA ______
description
"Trigger finger"
Hyperplasia of the palmar fascia (benign fibrosis)
Contracture and nodule formation
Nodular or cord-like thickening of one or both hands- 4 and 5th digits more commonly affected
125
Dupuytren Contracture
("Trigger finger")
Treatment
Splint
Stretching
Can try triamcinolone/steroids or collagenase injections
XIAFLEX® (collagenase clostridium histolyticum)
Refer for surgery for release of contractures
126
Osgood-Schlatter Disease
Localized to______
Exacerbated by_____
Localized to the tibial tubercle
Exacerbated by running and jumping
127
Osgood-Schlatter Disease
Who gets it?
What to do about it?
Adolescents:
Boys: 12 – 15 years
Girls: 11-13 years
Spontaneous correction when skeletal maturity is met
Stretching, ice, and physical therapy may be helpful
128
Hamstring Strain
Mechanism
s/s
Mechanism: forced knee extension or directional change
s/s: PAIN upon tearing/popping sensation in posterior leg (grabs back of leg)
Resists knee extension on exam due to pain
129
Hamstring Strain
Treatment
Ice and Compression- ASAP
Get them up and moving as soon as they can tolerate and rehab by gentle stretching
130
Iliotibial Band Syndrome
What is it?
s/s?
Inflammation of the trochanter bursa and the IT band
Pain over lateral knee or hip
Often runners
+ Ober test
Side lying position- aBduct then move leg down- + pain on movement (measuring IT flexibility)
131
Iliotibial Band Syndrome
Treatment
Change the activity that caused the problem
Stretching program
Work on core and pelvic stabilization
Ultrasound, massage, corticosteroid injections
132
meniscal injuries pain is usually located?
*medial or lateral knee
133
meniscal injuries will present with? how might the pt describe it?
* effusion w joint line tenderness on palpation
| * my knee "locked" or "gave out"
134
meniscal injury is typically triggered by abrupt _______ ?
*directional change
135
what is the McMurray test? and what is it used to test for?
* place fingers across joint lines
* flex knee
* rotate flexed knee and bring out into extension
* pain is elicited and "click or catch" is palpated on the joint line = + test
* meniscal injury
136
medial and lateral collateral ligament injuries
* look up valgus stress test
* may feel "pop" or loss of sensation then mild effusion
* conservative treatment = ice, brace, no weight bearing
137
what does ACL stand for?
anterior cruciate ligament
138
most ACL injuries are or are not due to contact?
ARE NOT
139
ACL injuriews are usually cause by abrupt ______, twisting &/or _____ motion like sliding into home base
* deceleration
| * cutting
140
ACL inury sound ?
pop followed by edema
141
what does PCL stand for?
posterior cruciate ligament
142
PCL will have increased pain with what motion?
*flexion
143
PCL may be inflicted by ?
falling w knee flexed and ankle in plantar flexion
144
baker's cyst
* fluid fill cyst in posterior popliteal region
* painful "tight" may be edematous
* worse with standing, flexing, extending knee
145
bakers cyst is worse with 3 motions
standing
flexing
extending
146
bakers cyst present with unilateral edema.... what should you rule out?
DVT. get ultrasound
147
ankel sprain is typically more ____ than ____
laterla than medial
148
if medial ankle edema is noted in a sprain what do you order
films
149
planta fasciitis pain improves w?
walking
150
treatment for plantar fasciitis?
stretch. roll foot on ball or frozen water bottle
151
ankel sprain is typically more ____ than ____
lateral than medial
