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NUR: 718 > Musculoskeletal Disorders > Flashcards

Musculoskeletal Disorders Flashcards

1
Q

Rheumatoid Arthritis - key characteristics

A
  • insidious onset with morning stiffness + joint pain
  • SYMMETRIC
  • inflammatory polyarthritis
  • extraarticular manifestations (nodules, pulmonary fibrosis, serositis)
    • serum rheumatoid factor
  • suspected RA dx in pts with systemic arthritis in 3+ joints
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2
Q

Rheumatoid Arthritis - symptomatology

A
  • Joints (predominent sympotms): insidious, chronic, progressive, SYMMETRIC, multiple joints, morning stiffness, usually begins in small joints
  • Rheumatoid nodules: extensor surfaces and over bony prominences
  • Ocular: dry eyes and mucous membranes
  • Other: palmar erythema, vasculitis (appears as tiny hemorrhage infarcts in nail folds)
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3
Q

Rheumatoid Arthritis - Deformities

A
  • ulnar deviation
  • boutonniere
  • swan-neck
  • hammertoe
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4
Q

Rheumatoid Arthritis - Diagnostics/workup

A

Lab - rheumatoid factor, anti-CPP antibodies (most specific for RA), ANA, ESR, CRP, CBC

  • XR = most specific for RA!
  • XR may look normal for first 6 months. Earliest changes noticed in hands and feet. Later imaging shows UNIFORM joint space narrowing + juxta-articular erosions!
  • Arthrocentesis - to rule out other conditions like septic arthritis
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5
Q

Rheumatoid Arthritis - Management (Pharmacologic)

A
  • DMARDS
  • Methotrexate start at 75mg PO 1x/week and increase weekly (first-line), see results in 2-6 weeks. Large side effect profile (GI, cytopenia, hepatotoxicity)
  • Sulfasalazine (second-line)
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6
Q

Rheumatoid Arthritis - acute vs. subacute vs. chronic

A

Acute - joint protection, pain relief, proper joint positioning, splinting, heat
Subacute - gradual increase in ROM
Chronic - protection, preserve ability to do ADLs, splits, orthotics, mobility aids, consult PT

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7
Q

Rheumatoid Arthritis - Referrals?

A

Rheumatologist - early, halt progression and initiate timely interventions
Surgery - advanced, improve function of damaged joints and relieve pain, last resort

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8
Q

Osteoarthritis - Key Characteristics

A
  • deterioration of articular cartilage
  • formulation of reactive new bone on articular spaces
  • NO systemic symptoms
  • Non-inflammatory arthritis
  • pain RELIEVED BY REST, any morning stiffness is brief
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9
Q

Osteoarthritis - Risk Factors

A
  • obesity (knee, hand, hip)
  • contact competitive sports
  • repetitive jobs
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10
Q

Osteoarthritis - Symptomatology

A
  • insidious
  • joint pain (exacerbated by activity)
  • decreased ROM
  • common joints: distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, carpometacarpal of thumb, hip, knee, metatarsal phalangeal (MTP) of big toe, cervical lumbar spine
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11
Q

Osteoarthritis - Exam Findings

A
  • findings mostly limited to affected joint
  • most don’t involve erythema or warmth
  • may have limited ROM
  • may palpate crepitus
  • Heberden nodes: palpable osteophyte in DIP joints
  • Bouchard nodes: hard outgrowths or gelatinous cysts on PIP joints
  • NO SYSTEMIC MANIFESTATIONS!
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12
Q

Osteoarthritis - Diagnostics/workup

A

XR - joint space narrowing, unequal joint spaces, osteophyte formation/ lipping of marginal bone, thickened/dense subchondral bone
Arthrocentesis - to exclude other diseases

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13
Q

Osteoarthritis - Management (non-pharm)

A
  • prevention! - weight reduction, normal vitamin D levels, focus on bone health
  • heat and ice
  • routine exercise
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14
Q

Osteoarthritis - Management (pharm)

A
  • Acetaminophen (first line for mild) up to 4mg/day

- NSAIDs (interfere with platelet function and prolong bleeding)

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15
Q

Osteoarthritis - referral

A

Ortho - when you think pt is failing conventional, non-operative management. Surgery = last resort
Physiatrist (rehab/pain specialists) to help form non-pharm plan
Nutritionist - overweight and struggling to lose weight

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16
Q

Gout vs. pseudogout

A

gout - caused by monosodium urate monohydrate crystals

pseudogout - caused by calcium pyrophosphate crystals

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17
Q

Gout - phases

A

Initial - asymptomatic hyperuricemia (uric acid level in blood is high)
Acute gouty arthritis/ gout attack
Chronic arthritis

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18
Q

Gout - Primary vs. Secondary

A

Primary - hereditary

Secondary - acquired causes (diuretics, low dose ASA, CKD, hypothyroidism, etoh abuse)

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19
Q

Gout - Manifestations

A
  • recurrent acute arthritis
  • monarticular
  • hyperuricemia (uric acid > 6.8 mg/dL)
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20
Q

Gout - Symptomatology

A
  • acute onset, recurring, often nocturnal
  • monarticular
  • pedagra - MTP joint, most susceptible
  • worsening pain as attack progresses
  • fever
  • swelling and redness
  • tophi (crystal containing nodules)
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21
Q

Gout - Exam findings

A
  • erythematous, edematous, hot, very tender joint

- tophi possible

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22
Q

Gout - Diagnostics/ workup

A
  • Labs: uric acid > 6.8, WBC increased during acute attack
  • arthrocentesis - if crystals are seen it is diagnostic for gout
  • XR - may show findings consistent with gout but isn’t diagnostic
  • Late XR - punched out erosions or lytic areas with overhanging edges
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23
Q

Gout - Management (non-pharm)

A
  • activity, use as able, no bedrest
  • dietary modifications (avoid high purine foods) - organ meats
  • moderate high purine = seafood, veal, bacon, turkey, alcohol, soda, cheese
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24
Q

Gout - Management (pharm)

A
  • NSAIDs (idomethacin 25-50 mg PO q8h (TID)

- Xanthine oxidase inhibitors (maintenance, chronic) = allopurinol 300-400 mg/day

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25
Q

Septic Joint/Arthritis - Key features

A
  • ACUTE onset (hours)
  • inflammatory monarticular arthritis
  • commonly large weight-bearing joints
  • large joint effusions
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26
Q

Septic Joint/Arthritis - risk factors

A
  • bacteremia (IV drug use, endocarditis, other infection), damaged joints (RA), immunocompromised (DM, CKD, etoh, cirrhosis)
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27
Q

Septic Joint/Arthritis - common causative organism

A
  • staphylococcus aureus
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28
Q

Septic Joint/Arthritis - symptomatology

A
  • acute swelling, heat (hours)
  • knee most common, hip, wrist, shoulder, ankle
  • fever/chills
  • impaired ROM
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29
Q

Septic Joint/Arthritis - Diagnostics/ workup

A
  • arthrocentesis - rule out gout, always gram stain and culture, infected fluid usually yellow/green
  • blood cultures x2 to rule out bacteremic origin
  • CBC
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30
Q

Septic Joint/Arthritis - Management

A
  • IV ANTIBIOTICS! -
  • empiric, IV for 2 weeks
  • Non-gonococcal: Vanco 1g q12h + 3rd gen. cephalosporin such as cephtriaxone 1-2g daily
  • gonococcal: azithromycin 1g PO once + 3rd gen. cephalosporin such as cephtriaxone 1-2g/day
  • MRSA/MSSA at least 4 weeks
  • will need opioids early and taper to non-opioids
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31
Q

Septic Joint/Arthritis - Referrals

A
  • PT for early PT and joint immobilization
  • Surgery - effective drainage needs to occur
  • infectious disease
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32
Q

Ankylosing Spondylitis - key characteristics

A
  • MULTISYSTEM INFLAMMATORY DISORDER INVOLVING SI JOINTS AND AXIAL SKELETON
  • progressive limitation of back motion and chest expansion
  • young adults < 40
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33
Q

Ankylosing Spondylitis - Symptomatology

A
  • insidious onset of low back pain (months)
  • presence of symptoms > 3 months
  • pain worse in morning/ with inactivity
  • pain better with activity
  • stooped posture, kyphosis (advanced)
  • extra-articular manifestations (advanced)
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34
Q

Ankylosing Spondylitis - Workup

A
  • Lab: serologic testing negative for rheumatoid factor and anti-ACC
  • XR: most helpful in dx
  • XR enthesitis - inflammation of enthuses (sites where ligaments and tendons inset into bone)
  • XR Bamboo spine - seems to be fused vertically by briding of syndesmophytes
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35
Q

Ankylosing Spondylitis - Management (pharm)

A

NSAIDS (first line)

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36
Q

Ankylosing Spondylitis - Management (non-pharm)

A

PT - maintain function, postural training, exercise program

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37
Q

Ankylosing Spondylitis - Referrals

A

Rheumatology, ophthamology, GI, Cardio, surgery (ortho)

Surgery - tx focuses on fracture stabilization, fusion, joint replacements

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38
Q

Neuropathic Arthropathy - key characteristics

A
  • progressive joint and soft tissue destuction of weight-bearing joints
  • characterized by deformities, dislocations, fractures
  • ankle and foot are most common
  • normal muscle tone and reflexes are lost
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39
Q

Neuropathic Arthropathy - symptomatology

A
  • enlarged, boggy (relatively) painless joint
  • if pain, significantly less than one would expect
  • instability and decreased ROM
  • erythema, hot, joint effusion
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40
Q

Neuropathic Arthropathy - Workup

A
  • ESR and CBC (help differentiate between this and osteomyelitis)
  • XR used to stage, determine joint stability, identify osteopenia dislocations, fractures, etc.
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41
Q

Neuropathic Arthropathy - Management

A
  • directed at primary disease (DM)
  • acute phase - immobilization, stress reduction
  • surgery (mainly for deformity management or amputation (deformity/destruction of tissues and DM)
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42
Q

Osteoporosis - key characteristics

A
  • systemic skeletal disease
  • characterized by low bone mass and deterioration of bone + increase in bone fragility
  • hallmark = reduction in skeletal mass caused by an imbalance of bone formation and resorption
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43
Q

Osteoporosis - RISK FACTORS

A

Modifiable - smoking, low body weight, estrogen deficiency, low lifelong calcium intake, alcoholism, recurrent falls, inadequate physical activity, poor health/ frailty
Non-modifiable - personal hx of fracture as adult, white race, advanced age, female, dementia, malignancy

44
Q

Osteoporosis - Terms (osteomalacia vs. osteoporosis)

A

Osteoporosis - bone matrix and bone mineral are both decreased
Osteopenia - bone matrix is intact but bone mineral is decreased

45
Q

Osteoporosis - Symptomatology

A
  • asymptomatic until fracture occurs

- acute pain caused by fall/ minor trauma

46
Q

Osteoporosis - exam findings (vertebral fx)

A
  • point tenderness
  • vertebral muscle spasms
  • T-kyphosis, C-lordosis
  • height may decreased 2-3 cm with episode of vertebral compression
47
Q

Osteoporosis - exam findings (hip fx)

A
  • diminished ROM

- external rotation

48
Q

Osteoporosis - exam findings (colles fx)

A
  • distal radial fx
  • pain with ROM of wrist
  • dinner fork (bayonet deformity)
49
Q

Osteoporosis - exam findings (pubic/sacral fx)

A
  • marked tenderness with ambulation

- tenderness to palpation

50
Q

Osteoporosis - Workup

A
  • Labs: CBC, CMP, thyroid, vitamin D level, biochemical markers (monitoring therapy response)
  • XR
  • Bone densitometry (DXA) - criterion standard for evaluation
51
Q

Osteoporosis - DXA Score

A

T score >/= - 1.0 is normal
T score -1- -2.5 = indicates osteopenia
T score < -2.5 indicates osteoporosis
T score < -2.5 with fragility fx(s) indicates severe osteoporosis

52
Q

Osteoporosis - Management (non-pharm)

A
  • Prevention!
  • dietary modification (adequate calcium 1-2g/day) and vitamin D intake
  • smoking cessation
  • PT/OT/exercise
53
Q

Osteoporosis - Management (pharm)

A
  • Biphosphonates (first line): Alendronate (weekly)
  • Biphosphonate side effects: acute phase responses = fever, chills, flushing, n/v, diarrhea, and other nonspecific symptoms
54
Q

Osteoporosis - Referral

A

Rheumatologist or endocrinolost for anyone who is in therapeutic or diagnostic phase for monitoring and tx

55
Q

Osteoporosis - DXA Scan recommendations

A
  • FEMALES 65+ YEARS OLD, males 70+ years old
  • men 50-69 with clinical risk factors
  • comorbid conditions (RA)
  • immunosuppressed populations (ex: steroid therapy)
56
Q

Osteomyelitis - types

A
  • Hematogenous (IV drug users, sickle cell, DM, older adults) - high fever, chills, pain, tenderness
  • Contagious (post-trauma, joint replacement, pressure ulcers) - localized signs of inflammation
  • Vascular insufficiency (DM, foot and ankle) - bone pain absent/muted, fever commonly absent, wounds > 2 cm or ability to probe bone
57
Q

Osteomyelitis - Workup

A
  • ESR, CRP (will be high, useful when looking at how tx is going)
  • bone biopsy - definitive dx
  • XR - periosteal thickening, irregularitis of bone, new bone formation
  • CT - helpful for guiding needle biopsies
    MRI - most useful
58
Q

Osteomyelitis - Management

A
  • Antibiotics! Empiric IV (clindamycin, Bactrim, fluoroquinolones)
  • ID referral
  • surgical debridement and drainage
59
Q

Low Back Pain/Injuries - red flags

A
  • unexplained weight loss
  • failure to improve with tx
  • severe pain > 6 weeks
  • night/rest pain
  • Cauda quina syndrome (bowel or bladder problems, retention, incontinence, saddle parasthesias, decreased anal sphincter tone = emergency!)
  • if cauda equina is suspected, a rectal exam needs to happen
60
Q

Low Back Pain/Injuries - Symptomatology

A
  • good hx is most important
  • pain of varying degrees/ descriptions
  • paraspinal tenderness
  • loss of normal lumbar lordosis
  • muscle wasting
  • decreased motor strength
  • leg raise test (extension of legs)
61
Q

Low Back Pain/Injuries - Diagnosics

A
  • weak associated between imaging and symptoms
  • XR indications: possible fracture (major trauma, minor trauma > 50 years, long-term corticosteroid use, osteoporosis, > 70) or possible tumor or infection (> 50, < 20, hx of cancer, constitutional symptoms, recent bacterial infection, injection drug use, immunosuppression, supine pain
    MRI - method of choice for symptoms not responding to conservative tx or who have red flag symptoms
62
Q

Low Back Pain/Injuries - Management (non-pharm)

A

Step wise

  • pain control
  • restoration of ROM
  • improve muscle strength
  • coordination retraining
  • CV conditioning
  • maintenance exercises
63
Q

Low Back Pain/Injuries - Management (pharm)

A

Acetaminophen!
NSAIDs!
Opioids (short term, acute flares only)
Muscle relaxants such as baclofen (only if you can palpate spasm on exam)

64
Q

Knee Pain - Varus/Valgus grading

A

Grade 1: pain with stress test but no instability
Grade 2: pain, instability at 30 degrees flexion
Grade 3: marked instability but not much pain, often unstable at 30 degrees and 0 degrees flexion

65
Q

Knee Pain - Diagnostics

A

XR - helpful if you suspect fracture only

MRI - best method, can see soft tissues

66
Q

MCL injury

A
  • most commonly injured knee ligament
  • commonly injured when ACL is injured
  • sudden valgus (medial) stress to knee
  • may report “pop” sensation
  • medial knee pain
  • localized swelling over 1-4 hours
  • tenderness
67
Q

LCL injury

A
  • direct blow to medial aspect of knee (varus)
  • similar to MCL but lateral)
  • tenderness over LCL
  • varying degree of joint laxity
68
Q

Treatment of MCL/LCL injuries

A
  • Early PT
  • Grades 1-2: patient can usually bear weight with full ROM
  • Grade 3 MCL: requires long leg brace, up to 6-8 weeks
  • Always refer LCL injuries! - usually require urgent surgery because they are usually associated with other injuries that don’t heal well without it
69
Q

ACL injuries

A
  • pain and almost immediate edema following sudden deceleration, jumping
  • weight bearing difficult d/t sense of knee instability
  • instability when going side to side or down stairs
  • effusion
  • hemarthrosis
  • pain/tenderness
  • Drawer and Lachman testing
70
Q

PCL injuries

A
  • strongest knee ligament
  • forced hyperextension of knee
  • direct blow to anterior proximal knee
  • mild to moderate effusion
  • high risk for neurovascular injury!
  • Drawer and Lachman testing
  • “Sag sign”
71
Q

What is the “Sag Sign”

A
  • in PCL injuries
  • patient supine, both hips and knees flexed 90 degrees
  • because of gravity, injured knee will have an obvious “set off” at anterior tibia, sagging posteriorly
72
Q

Drawer Test

A
  • patient supine with hips and knees flexed, feet flat on exam table
  • examiner places hands on both sides of the knee. they will put gentle pressure behind your knee and attempt to move tibia forward
  • if tibia moves forward, indicates ACL injury
73
Q

Lachman test

A
  • patient supine with knees flexed 30 degrees
  • examiner places one hand behind tibia and other on patient’s thigh
  • examiner attempts to pull tibia forward. If tibia moves forward, it indicates ACL injury
74
Q

ACL/PCL diagnostics

A

MRI - most helpful for dx

XR - will be negative but can help rule out fractures

75
Q

ACL/PCL Treatment

A
  • bracing
  • referral to PT and ortho (surg)
  • reconstruction: most young and active patients will require surgery within 5 months
  • non-op: older adults or sedentary lifestyle patients (bracing and PT only)
76
Q

Meniscus tear - symptomatology

A
  • pain with twisting of the knee (getting in/out of car) and painful gait
  • sense of knee “locking” or “giving away”
  • more difficult to go down stairs than up
  • edema within first 24 hours (rarely immediate)
  • tenderness
  • most symptomatic tears cause the most pain with any deep squat or “duck walk”
  • McMurrays and Thessaly tests
77
Q

McMurrays test

A
  • patient supine and examiner holds knee and palpates the joint line with one hand, thumb on one side and fingers on the other
  • other hand supports the sole of foot and supports limb through motion
  • from point of maximal flexion, extend knee with internal rotation of tibia and varus stress
  • then return to maximal flexion and extend knee with external rotation of tibia and valgus stress
  • positive test when there is a thud or click that can sometimes be hear but always felt
78
Q

Thessaly test

A
  • patient stands on one leg while examiner supports patient with out-stretched hand
  • patient flexes knee to 5 degrees and rotates femur on the tibia medially and laterally 3x while maintaining flexion
  • test uninjured leg first
  • test is then repeated at 20 degrees flexion
  • test is positive if patient experiences pain or sense of locking/catching in the knee
79
Q

Meniscus tear - treatment

A
  • conservative
  • analgesics
  • PT
  • referral to ortho/surg for arthroscopic surgery
  • arthroscopic surgery - tears in young and active patients with signs of internal derangement (“catching”, swelling) and without signs of arthritis on imaging
80
Q

Shoulder Pain/ Injuries - acute vs. chronic

A 
Acute = typically young adults
Chronic = progression of age, degenerative changes, inflammation
81
Q

Shoulder Pain/ Injuries - risk factors (chronic)

A
  • repetitive overhead activity
  • RA or osteoarthritis
  • previous shoulder injury
82
Q

Shoulder Fracture characteristics

A
  • proximal humerus
  • fall directly onto shoulder or outstretch arm
  • localized pain, edema
  • decreased ROM
83
Q

Shoulder Fracture Tx

A
  • refer to ortho, follow-up with ortho, serial x-rays
  • shoulder immobilization (sling) + early ROM (in 7-10 days)
  • PT (3 weeks after surgery)
  • surgery - depends on type, location, displacement, and fracture segments (most are non-op)
84
Q

Shoulder Dislocation characteristics

A
  • relies heavily on rotator cuff muscles
  • most occur in anterior direction and usually from fall on outstretched arm
  • sensation of shoulder slipping out of joint
  • “popping” or clicking of joint
  • positive apprehension test
85
Q

Apprehension Test

A
  • passively externally rotate humerus to end range with shoulder at 90 degrees of abduction
86
Q

Shoulder dislocation tx

A
  • reduction!
  • sling for comfort
  • refer for repeated dislocations
87
Q

Rotator cuff tear characteristics

A
  • > 50 years
  • pain may radiate into deltoid area
  • “pop” or “something gave”
  • night pain
  • weakness or inability to externally rotate arm
88
Q

Rotator cuff imaging

A

XR + MRI
XR-AP view: look for high-riding humoral head which is indicative of supraspinatus tear
MRI: will show you what you’re looking for as well

89
Q

Rotator Cuff maneuvers

A

Empty can test: arms out ahead, rotate arm so thumb points down, examiners places downward force on arms (indicates supraspinatous tear)
Drop arm test: if patient’s can’t fold arm out fully abducted at shoulder level (indicates supraspinatous injury)

90
Q

Rotator cuff tx

A
  • conservative - PT!
  • referral +/- surgery (full thickness tear = ASAP surgery)
  • ortho: > 50% tear on MRI, full thickness tear, older/sedentary pts with full thickness who haven’t responded to conservative tx
91
Q

Separated shoulder (AC joint injury) grading

A

1 - slight displacement of AC joint, most common
2 - partial dislocation, potential displacement, AC ligament completely torn, separation < 1 cm
3 - complete separation of joint, ligaments and capsule obviously torn, falls under weight of arm, clavicle pushed up causing palpable “bump” on shoulder, > 1 cm on imaging
4-6 = ortho territory

92
Q

Separated shoulder (AC joint injury) tx

A

Conservative - sling, MICE, PT/ROM
Grades 1-2 do well with non-op sling support and can return to work in 1-2 weeks (grade 2 may need a longer longer if a complete tear), no heavy lifting
Referral: +/- surgery, refer if > grade 2 to ortho-surg

93
Q

Adhesive capsulitis (“frozen shoulder”) characteristics

A
  • pain out of proportion to clinical findings during acute phase
  • acute phase (4-6 months), then followed by 4-6 months of stiffness/freezing phase, then resolution/thaw phase which can take up to 1 year
  • progressive loss of motion
  • clinical dx
94
Q

Adhesive capsulitis (“frozen shoulder”) tx

A

NSAIDs and PT!
Refer to surgery (rarely indicated) if not improvement after 6 months of conservative tx or no progress/ worsening ROM after first 3 months

95
Q

Compartment syndrome

A
  • when pressure within a closed muscle compartment exceeds the perfusion pressure and results in muscle and nerve ischemia and eventual death of muscle
  • PAIN (especially out of proportion)
  • PARESTHESIA
  • pallor (very late sign)
  • poikilothermia (tissue takes on temp. of environment, very late sign)
  • pulselessness - very late sign
  • paralysis - very late site
  • common areas: LOWER LEG, forearm, wrist, hand
  • a strong pulse does NOT rule out compartment syndrome
  • Tx = OR for fasciotomy!
96
Q

Fracture - management (non-pharm)

A
  • immobilization/rest
  • PT/OT
  • ice/heat
97
Q

Fracture - management (pharm)

A
  • acetaminophen: good for mild pain
  • opioids: common to give these for this type of pain
  • muscle relaxants (benzos): ex: femur fracture spasms are common
  • antibiotics? - compound or open fx
  • if wounds open and contaminated: I&D, washouts, wound vacs, serial debridements
  • refer to ortho
  • +/- surgery depending on nature of fracture
98
Q

Ankle sprain - eversion (high ankle sprain) characteristics

A
  • more severe and prolonged pain
  • more difficulty with weight-bearing
  • involves anterior tibiofibular ligament
  • foot usually turned outward/ externally rotated and everted
  • make sure to palpate proximal fibia
  • associated fracture called Maisonneuve fracture
  • document circulation, sensation, and movement before doing any testing!
99
Q

Ankle sprain - inversion (plantar flexion sprain) characteristics

A
  • common
  • injury to anterior talofibular ligament
  • localized pain and swelling
  • usually results from forced inversion like turning ankle or landing wrong
  • document circulation, sensation, and movement before doing any testing!
100
Q

Ankle strengh testing

A
  • test resisted ankle dorsiflexion, plantar flexion, inversion, and eversion strength
101
Q

Ankle anterior drawer test

A
  • clinician keeps foot and ankle in neutral position with patient sitting
  • one hand to fix tibia and other to hold patient’s heel and draw ankle forward
  • normally, there is approximately 3 mm of translation until endpoint is felt
  • a positive test includes increased translation
102
Q

Subtalar tilt test

A
  • foot in neutral position with patient sitting
  • clinician uses one hand to fix tibia and other to hold and invert calcaneus
  • normal inversion at subtalar joint is approximately 30 degrees
  • a positive test consists of increased subtalar joint inversion > 10 degrees on affected side
103
Q

External rotation test

A
  • clinician fixes tibia with one hand and grasps the foot with the other while ankle is in neutral position and dorsiflexes and externally rotates the ankle, reproducing patient’s pain
104
Q

Grading of Ankle Sprains

A

Grade 1: stretching but no tearing. local tenderness, minimal edema, ecchymosis typically insignificant or absent
Grade 2: partial (incomplete) tearing of ligament, some joint instability but definite end-point to laxity. Pain immediately upon injury, localized edema and ecchymosis, significant pain with weight bearing
Grade 3: complete ligamentous tearing, joint unstable with no definitive end-point to ligament stressing, severe pain immediately upon injury, significant edema, profound ecchymosis d/t hemorrhage (worsens over several days)

105
Q

Ankle Sprain - Diagnostics

A
  • XR: use Ottawa ankle rules, want AP lateral or Mortis view
106
Q

Ankle sprains - management

A
  • Non-pharm: MICE, may need crutches to modify activities, ROM, +/- PT
  • Eversion (more conservative): CAM boot for 4-6 weeks then crutches until patient can walk free from pain
  • Pharm: NSAIDs
  • Refer - concomitant fracture, chronic ligamentous instability, no response after 3 months of tx, widening of Mortis on Mortis view

NUR: 718 (8 decks)

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