Musculoskeletal injury clinical correlations Flashcards
(38 cards)
If radiographs come back negative, what is the best next test to look for pathology?
MRI (avoids radiation, good to look for soft tissue injury)
What is the pneumonic helpful in forming a differential diagnosis?
**vindicate;
- vascular
- infection
- neoplasm
- drugs
- inflammation/idiopathic
- congenital
- autoimmune
- trauma
- endocrine/metabolic
In what joints are effusions easily diagnosed (via xray)?
- knee
- elbow
- ankle
- wrist
- fingers
Contrast inflammatory arthritis and osetoarthritis
- inflammatory arthritis
- rheumatoid arthritis
- seronegative syndromes (ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
- deposition diseases (gout)
- osteoarthritis
- **degenerative
- osteophytes
- asymmetric joint loss
- predictable pattern
When is it best to order a radiologic test?
When the results will potentially change management options
What are the important characteristics to include when describing a fracture?
- location/orientation
- displacement
- apposition (amount of contact between the fragmented parts)
- angulation (displacement from normal axis)
- intraarticular involvement (involves joint space?)
- comminution (degradation)
- open or closed?
- associate injuries
What are the results of acute and chronic injury?
- acute= inflammation
- chronic= degeneration
What are the problems in ligament, muscle, and tendon injuries?
- ligament= stability issues
- muscle/tendon= active joint motion
Contrast traumatic, pathologic, and stress fractures
- traumatic= high force exceed normal bone strength
- pathologic= normal force exceed damaged bone strength
- stress= repetitive submaximal forces gradually damages bone (“overuse” injury)
What are two major clinical findings that point towards a bone injury?
Point tenderness on exam and pain with indirect loading
What is usually the diagnosis when a patient complains of “joint locking”?
“Joint mice”/ loose body within the joint
What clinical finding points towards a cartilage injury?
Pain with both passive and active motions (just active pain is usually muscle)
**cartilage injuries have poor healing
Define dislocation
Complete displacement of a joint
Define subluxation
Transient, partial displacement of a joint
Define laxity
Normal variation in “joint looseness”
What is a maisonneuve fracture?
A fracture in the proximal fibula from rolling your ankle (force travels up the bone and fractures near the knee)
**positive squeeze test (hurts at the knee) and pain with external rotation
What do the squeeze test and external rotation test look for?
Should both be negative for a lateral ankle sprain (Anterior TibioFibular Ligament tear)
**external rotation hurts with medial or high (tibiofibular syndesmosis) ankle sprains
**squeeze test hurts high ankle sprain or maisonneuve fracture
What exam findings will be present for a peroneal ankle sprain?
**evulsion of the peroneal tendon at the base of the 5th metatarsal (tenderness of the tendon)
**pain with resisted eversion
When are NSAIDs a helpful option in the treatment of inflammation?
When the inflammation is ACUTE (also Rest Ice Compression Elevation)
What are three major requirements for the healing of a ligament?
- good blood supply
- damaged section approximated/guided to the correct area
- relative rest
**can just brace (cast if concerned about taking brace off)
Contrast an acute and chronic injury
- Acute
- know exact time of injury
- gets worse with use
- inflammation (NSAIDs helpful)
- treat with RICE
- Chronic
- vague onset
- pain gets better after warming up (for awhile)
- degeneration
What is the difference between compression and distraction loading?
- compression= test joint surfaces and structures between surfaces (articular cartilage, menisci, labrum)
- PUSH on a joint
- distraction= to test structures surrounding joint (e.g. capsule and ligaments)
- PULL on joint
**also shift stress (moving a joint as it’s meant to)
What is capsulitis?
- capsular thickening (inflammation and scarring)
- idiopathic or post injury
- risk factors= diabetes and thyroid disease
What will the exam findings be for capsulitis?
- limited/decreased range of motion
- painful with decreasing ROM (freezing phase)
- non-painful, stable ROM (frozen phase)
- non-painful, improving ROM (thawing phase)
