Musculoskeletal Flashcards
(111 cards)
1
Q
What are the physical exam findings associated with neuromuscular injury with fractures.
A
Pain over fracture site Deformity Crepitus Swelling Bruising Decreased range of motion
2
Q
Open fracture
A
“compound” skin is not intact
-most likely will need surgery, debridement and antibiotics
For first 24 hours- cefazolin or vancomycin for PCN allergy
3
Q
Fracture care
A
Splinting- Watch for compartment syndrome from splint
Pain control
Tetanus- open fractures
4
Q
Typical findings with fracture and who they are present in
A
*
5
Q
Gustilo classification for open fractures type 1
A
Open fracture with a skin wound < 1 cm in length and clean
6
Q
Gustilo classification for open fractures type II
A
Open fracture with laceration > 1 cm in length without extensive soft tissue damage, flaps, or avulsions
7
Q
Gustilo classification for open fractures type III
A
Open segmental fracture wound with extensive soft tissue injury
8
Q
Gustilo classification for open fractures type IIIa
A
Adequate soft tissue coverage
“Adequate”
9
Q
Gustilo classification for open fractures type IIIb
A
Significant soft tissue loss with exposed bone that requires soft tissue transfer to achieve coverage
“Bone”
10
Q
Gustilo classification for open fractures type IIIc
A
Associated vascular injury that requires repair for limb preservation
“Circulation”
11
Q
Closed fracture
A
“simple” skin is intact
12
Q
Nondisplaced fracture
A
The bones remain aligned
13
Q
displaced fracture
A
The bones are no longer aligned
14
Q
Transverse fracture
A
Across the bone
Often caused by tension
15
Q
Oblique fracture
A
At an angle across the bone
Often caused by compression
16
Q
Butterfly fracture
A
Transverse which fractures into a wedge
Often caused by bending
17
Q
Spiral fracture
A
Fracture around the bone
Often caused by torsion
18
Q
Longitudinal fracture
A
Fracture occurs along the axis of the bone
19
Q
communinuted fracture
A
Break of bone or splinter into more than two fragments
20
Q
Segmental
A
Two fracture lines which together isolate a portion of the bone
Usually affect the diaphysis
21
Q
Impacted
A
When one portion is driven into another portion of the bone
22
Q
Astelette
A
When the lines of the break radiate from the site of injury
i.e. skull fracture
23
Q
Avulsion
A
Injury to the bone where a tendon or ligament attaches to the bone and is torn off with injury
24
Q
Mal-union
A
Healing in an unsatisfactory position
25
Non-union
Failure to heal
26
Subluxation
Partial dislocation
27
Pathologic
Weakened areas of bone
28
Stress
Occur in lower extremity with repetitive trauma
29
Greenstick
Usually in children- incomplete fracture
| Angulated fracture on only one side of bone
30
Torus
buckling of the cortex
31
Dislocations
Disruption of the normal relationship of the articular surfaces of the bone that make up a joint
32
Subluxation
Is an incomplete dislocation
33
Neuromuscular checks with fractures includes
Checking distal pulses
Checking capillary refill
Checking the motor function of the extremity
Testing the sensation of the extremity include two point discrimination distal to the site
34
You should splint the fracture "where it lies" unless...
The limb is neurovascularly compromised then you should splint it after you reduce it
35
Compartment syndrome diagnosis
6 P's
Pain (out of proportion to injury, with passive stretching)
Pallor
Pulselessness
Parasthesias
Paralysis
Poikilothermia (inability to regulate temperature)
Most are late findings
36
Compartment syndrome Care
```
Consult surgery
May check compartment syndrome
Fasciotomy (definitive treatment)
Decrease restriction
Limb positioning at the heart
Pain control
NV checks
```
37
Why does compartment syndrome occur?
Compromised blood flow causing increased hydrostatic pressure in closed spaces, ischemia develops because of inability to meet catabolic demands, this leads to compartment pressure increase. Venous return decreased, pressure rises. Blood shunting away from intracompartmental tissue, This causes arterial collapse which leads to increased edema
38
Other findings in compartment syndrome
Elevated WBC > 14000
Elevated CK, CRP
Myoglobinuria
Elevated LDH (cell damage)
39
What is the delta pressure?
Diastolic blood pressure- compartment pressure
| If this is less than 30 than you have Acute compartment syndrome
40
You have capillary compromise when
Tissue pressure is within 25-30 of MAP
41
How to diagnose a shoulder dislocation?
Xray
42
Brachial Plexus nerves originate from...
C5-T1
43
Humerus fracture PE findings
Referred shoulder pain
Hold arm adducted
Possible crepitus
Mid shaft arm pain
44
Axillary nerve damage manifests as
Deltoid weakness
| Diminished sensation over deltoid region
45
Suprascapular nerve damage manifests as...
Supraspinadous (abduction) or infraspinadous (external rotation) muscle weakness
46
If you see wrist drop you should be thinking...
Midshaft humerus fracture
| radial nerve dysfunction
47
How to test for radial nerve dysfunction
Thumbs up sign
Thumbs up sign against extension resistance
Check the dorsum of the hand between the thumb and finger for sensory loss
48
How to test for median nerve dysfunction
Try to maintain an OKAY sign against resistance
| rare
49
How to test for ulnar nerve dysfunction
Peace sign, try to push fingers together
50
How to test for ulnar nerve dysfunction
Peace sign, try to push fingers together
| Check for sensation of the palmar aspect of the fifth finger
51
Humerus fracture treatment
Splint
Ortho follow up in 3-4 days
young patients or multiple fractures may need ORIF
52
Elbow injury is at risk for...
Medial, Ulnar, Radial nerves
| Brachial artery injury
53
Presentation of elbow injury
Arm will be at flexion
| Moderate amount of swelling
54
Radial head fractures presentation
Pain with supination or pronation
Limited range of motion
Pain over radial head
55
Elbow dislocation presentation
Holding the elbow at 45 degrees with visible deformity
56
Elbow dislocation are at risk for
Brachial artery injury
| Median nerve injury
57
Lateral epicondylosis symptoms
Pain with arm and wrist extended
| "tennis elbow"
58
Medial epicondylosis symptoms
Pain during repetitive wrist pronation
| "golfers elbow"
59
Bursitis can occur..
Over any bony prominence (joint) with a bursa
| Can be inflamed due to trauma, infection, arthritis
60
Bursitis presentation
Focal tenderness
swelling
not likely to have ROM difficulty
Can have septic bursitis in afebrile patient
61
Septic bursitis is ruled out with
Aspiration of fluid
Gram stain and culture
High WBC
Staph aureus most common
62
Treatment for bursitis is..
Rest
Heat
NSAIDS
local corticosteroid injections
63
Mechanism of forearm fractures..
direct blow
| fall onto outstretched arm
64
Findings for different locations
Proximal fracture- swelling, inability to flex or extend the elbow
Midshaft fracture- some swelling, tenderness on pronation and supination
Distal fracture- deformed wrist with inability to flex or extend
65
Treatment nondisplaced
Conservative treatment splints and ortho follow up
66
Carpel tunnel syndrome mechanism
entrapment of the medial nerve
67
Carpel tunnel symptoms
pain, burning and tingling in the distribution of the median nerve
68
Treatment of carpel tunnel symptoms
Trial splinting
Trial NSAIDS
Need release surgery if EMG test is positive
69
When to refer for carpel
Muscle atrophy or weakness
Pain that persists after conservative treatment
Symptoms > 3 months
70
Risk factors for osteonecrosis
```
Steroids
alcohol
sickle cell
Lupus
Prior trauma
decompression disease
```
71
Trendelenberg test for hip
Tests for weakness or instability
| Balance on one leg, raise non standing leg to chest
72
Hop or jump test
Try to hop or jump on the leg
73
Internal rotation
most sensitive for articular pathology
74
MCL purpose
Stabilize for stress towards the midline
75
LCL purpose
Stabilizes for forces away from the midline
76
ACL and PCL purpose
anterior and posterior displacement of the knee
77
Meniscus injury
Pain with deep squatting
78
Lachman test
Patient lays supine
| with knee in neutral position hold femur steady and lift tibia anteriorly
79
Anterior draw test
Lay supine
knee 90 degrees
sit on foot, grab foot and pull forward
80
Pivot shift test
Lay supine
Knee in full extension
slowly flex while you apply internal rotation
81
Valgus stress
Supine
outside of patient
MCL
82
Varus stress
*
83
Posterior drawer test
*
84
McMurray test
*
85
Knee dislocation
Can not be manually reduced, patient will need to go to the OR
86
Ottawa ankle rules
A series of ankle radiograph films is required if there is any pain in the malleolar zone and any of these findings:
Bone tenderness at the the posterior edge of the lateral or medial malleolus
inability to bear weight
87
Talar fractures are at higher risk for...
Osteonecrosis
infection
arthritis
problems with healing
88
L1 radiculopathy
Rare and uncommon
89
L2,L3,L4
Weakness of hip flexion, knee extension, and hip adduction
90
L5
Most common
| Decreased strength in foot dorsiflexion, toe extension, foot inversion, and foot eversion
91
S1
Weakness of leg extension and knee flexion
| Decreased sensation of the posterior leg
92
S2,S3,S4
Less common
Minimal weakness but could have urine or fecal incontinence
Bowel and bladder incontinence
93
Straight leg test
Can determine nerve root compression
and if the symptoms are radicular in nature
L5-S1
94
Risk factors for OA
Disease of aging
| Obesity (knee)
95
Risk factors for RA
*
96
Risk factors for gout
Men 90% of time
Recurring arthritis from uric acid deposits
Hyperuricemia
Meds- diuretics, aspirin, cyclosporin, niacin
Diseases- sickle cell, CKD, hyperthyroid, sarcoidosis, lead poisoning
97
Risk factors for osteoporosis
*
98
Characteristics of OA
Joint stiffness
Pain worse with activity
Affects small distal joints most in asymmetrical pattern
Spares the wrist
99
Characteristics of RA
*
100
Characteristics of Gout
Inflammatory reaction to uric acid crystals
Sudden onset
Happens at night
101
Synovial fluid finding based on disease
*
102
PE findings of OA
Limited ROA
crepitus
Negative ESR
103
Imaging findings of OA
Osteophyte formation
| Joint space narrowing
104
Treatment and prevention of OA
Prevention: weight loss, vitamin D
Treatment: Exercise, weight loss, tylenol, NSAIDS, Topical capsaison (best in hand), intra-articular joint injections
surgical options
105
PE findings of RA
*
106
Treatment of RA
*
107
PE findings of Gout
```
HOT
Tender
Red
Systemic fever common
Pruritis with recovery
```
108
Prevention and treatment of gout
```
NSAIDS
Colchicine
Corticosteroids
Diet- No beer, steaks
Med changes
Reduction in uric acid
Colchicine prophylaxis
```
109
OA
Degenerative disorder with minimal inflammation
no systemic symptoms
pain relieved by rest, morning stiffness
Narrow joint space and osteophyte formation
110
Diagnostics in gout
```
Labs:
Uric acid levels- not always elevated
Leukocytosis- Inflammatory response
Sodium urate crystals on arthrocentesis
Radiograph:
No changes early in disease
```
111
Pseudogout
Looks like gout but you find calcium pyrophosphate crystals on arthrocentesis
