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PHA 522 > Musculoskeletal/Rheumatology > Flashcards

Musculoskeletal/Rheumatology Flashcards

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1
Q

Cervical Strain/Sprain: etiology

A

combined injury (ligamentous + musculature)

  • forced movement past end range
  • violent high velocity movement
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2
Q

Cervical Strain/Sprain: clinical presentation

A 
pain (non radicular, non focal)
stiffness, limited ROM
cervicogenic HA pattern
tender to palpation (muscle, facet joint, transverse process)
no pain w/ axial loading 
normal neuro exam (C5-T1)
Spurling's neg for radicular pain
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3
Q

Indications for Cervical Spine X-rays: non trauma related

A 
age >50 w/ new sx
constitutional sx
mod-sev neck pain >6wks
progressive neurological findings
infectious risk (IVDU, IM)
hx of malignancy
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4
Q

Indications for Cervical Spine X-rays: trauma related: nexus low risk criteria

A

(no x-rays if all 5)

absence of posterior midline cervical tenderness
normal level of alertness
no evidence of intoxication
no abnormal neurologic findings
no painful distracting injuries
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5
Q

Indications for Cervical Spine X-rays: trauma related: canadian C spine rule

A

YES: high risk factors
age 65+
dangerous MOI
paresthesias in extremities

NO: low risk factors
simple rear end MVA
sitting position in ED
walking
delayed onset neck pain
absence of midline cervical spine tenderness

NOT able to actively rotate neck 45deg L and R

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6
Q

C Spine Views

A

lateral
AP
dens

oblique

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7
Q

What type of injury is associated with sharp pain?

A

muscle strain/ligament sprain

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8
Q

What type of injury is associated with tightness followed by pain?

A

muscle spasm

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9
Q

Whiplash Injury: MOI

A

acceleration deceleration of neck w/ rapid flexion extension

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10
Q

Whiplash Injury: clinical presentation

A 
delayed onset of cervical pain/stiffness
pain peaks at 3-5d
pain/stiffness w/ flexion and extension
tender to palpation (muscle, facet joint, ligaments)
ROM limitations
no pain w/ axial loading
normal neuro exam
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11
Q

Whiplash Injury: radiographic finding

A

straightening of cervical spine (loss of lordotic curve)

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12
Q

Whiplash Injury: treatment

A 
soft cervical collar
analgesics
muscle relaxers
cervical pillow
heat/ice
PT
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13
Q

Cervical Facet Dysfunction: definition

A

shift in vertebral alignment –> locking of facet join

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14
Q

Cervical Facet Dysfunction: etiology

A

prolonged positional stress

traumatic injury

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15
Q

Cervical Facet Dysfunction: clinical presentation

A

insidious onset
unilateral pain (sharp in c spine, achey in referral zone)
focal facet TTP
ROM limitation

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16
Q

Cervical Facet Dysfunction: treatment

A

analgesics
muscle relaxants
referral (PT, DC, DO) (cervical spine manipulation)

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17
Q

Cervical Manipulation: complication

A

cerebral artery occlusion/dissection

  • cervical/suboccipital pain
  • dizziness
  • N/V
  • vision loss
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18
Q

Cervical Radiculopathy: definition

A

neurogenic pain in distribution of cervical roots

w/ or w/out associated numbness, weakness, loss of reflexes

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19
Q

Cervical Radiculopathy: etiology, populations

A

cervical disc bulge/herniation (young, older adults)

cervical foraminal narrowing (older adults)

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20
Q

Spurling’s Test:

  • what it tests for
  • steps
  • positive test
A

helps diagnose cervical disc herniation/spondylosis

rotates + laterally flexes to affected side + apply axial compression (+cervical extension)

positive: reproduction of/inc radicular arm pain

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21
Q

Cervical Radiculopathy: presentation

  • onset
  • hallmark sx
  • diagnostic test
A

onset:
- young/old: abrupt
- old: gradual

cervical pain inc w/ rotation/ lat flexion, extension to involved side –> inc radicular pain (positive Spurling’s test)

neurologic deficits

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22
Q

Cervical Radiculopathy: radiographs

  • optimal view
  • findings
A

oblique view

osteophyte formation

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23
Q

C5 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

lower lateral upper arm

shoulder ABduction
elbow flexion

biceps

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24
Q

C6 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

lateral forearm

wrist extensors

brachioradialis

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25
C7 Root Injury: - dermatome pain - movement reflex - reflex involved
middle finger elbow extension wrist flexion triceps
26
C8 Root Injury: - dermatome pain - movement reflex - reflex involved
medial forearm finger flexion none
27
L1 Root Injury: - dermatome pain - movement reflex - reflex involved
groin hip flexion cremaster
28
L2 Root Injury: - dermatome pain - movement reflex - reflex involved
anterior thigh hip flexion hip ADduction cremaster
29
L3 Root Injury: - dermatome pain - movement reflex - reflex involved
medial knee hip flexion knee extension hip ADduction patellar
30
L4 Root Injury: - dermatome pain - movement reflex - reflex involved
medial calf foot inversion knee extension patellar
31
L5 Root Injury: - dermatome pain - movement reflex - reflex involved
later lower leg dorsum of foot toe extension ankle dorsiflexion none
32
S1 Root Injury: - dermatome pain - movement reflex - reflex involved
lateral foot ankle plantar flexion ankle jerk
33
S2 Root Injury: - dermatome pain - movement reflex - reflex involved
posterior thigh ankle plantar flexion toe flexion none
34
Cervical Radiculopathy: imaging
radiographs (AP, lateral, odontoid, R+L oblique) | MRI
35
What findings on imaging can explain the etiology of cervical radiculopathy?
bulge | uncinate hypertrophy
36
Cervical Radiculopathy: treatment
analgesics (NSAIDs, APAP, steroidal anti inflammatory (prednisone)) PT, OT epidural injection ant cervical decompression + fusion
37
Cervical Spondylosis: - disease components - MC cervical levels
degenerative disease: - osteophyte formation - ligamentum flavum thickening - disc space narrowing - vertebral subluxation C5-C6 C6-C7 **compression of spinal cord (not roots)
38
Cervical Spondylosis: presentation
progressive ROM loss/stiffness intermittent pain --> chronic (deep, aching neck/shoulder) crepitus tenderness myelopathy
39
Cervical Spondylosis: myelopathy
``` sensory impairment weak hands/muscle atrophy leg weakness unsteady gait bowel/bladder dysfunction hyperreflexia (LE) Lhermitte's sign ```
40
Cervical Spondylosis: Lhermitte's Sign
neck flexion --> electric shock like sensation down the center of the back
41
Cervical Spondylosis: diagnostics
radiographs | MRI
42
Cervical Spondylosis: treatment
``` NSAIDs duloxetine amitriptyline neurontin (gabapentin) cervical pillow cervical traction PT surgical fixation ``` **avoid narcotics
43
What are the 4 alterations of thoracic kyphosis?
congenital developmental postural degenerative
44
Congenital Kyphosis - age - alteration
pediatric failure of segmentation (fusion of multiple vertebrae) failure of formation (wedge shaped vertebrae)
45
Developmental Kyphosis - age - alteration
adolescent presents during periods of rapid growth altered development of vertebrae (wedge shape) **scheuermann's disease
46
Postural Kyphosis - age - alteration
adolescent, adult altered strength balance bt muscles -- body adapts to posture (cellphone, laptop, obesity) can correct!
47
Degenerative Kyphosis - age - alteration
adult with age: - disc narrow - vertebral bodies collapse
48
Kyphosis: complications
limited ROM of UE
49
Scheuermann's Kyphosis: - epidemiology - definition
M, 12-15yrs rigid structural kyphosis wedge shaped vertebrae rapid bone growth
50
Scheuermann's Kyphosis: diagnostics
lateral imaging: - anterior wedging (>/=5deg in at least 3 adjacent vertebrae) - cobb angle (guides tx)
51
Scheuermann's Kyphosis: treatment
stretching/strengthening >55-60deg: brace (until skeletally mature) surgery - skeletal maturity - rigid deformity - >75deg - unresponsive pain - unacceptable appearance
52
Costovertebral Dysfunction: what is it
rib hypomobility/subluxation disruption of costovertebral and costosternal articulations alterations of rib mechanics w/ insp and exp
53
Costovertebral Dysfunction: presentation
``` sharp stabbing pain upon waking unilateral ANT AND POST PAIN may radiate along dermatome inc w/ deep breathing, coughing, sneezing, laughing, TRUNK MVMT ``` ``` reproduction of pain w/ palpation PA mobilization protective muscle spasm restricted trunk ROM sudden reduction in pain w/ pe --> rib relocation ```
54
Costovertebral Dysfunction: management
analgesics (NSAIDs, APAP) muscle relaxants PT, chiropractic, massage
55
Costochondritis: - epidemiology - etiology
>40yo idiopathic (preceding illness w/ coughing, recent strenuous exercise)
56
Costochondritis: - what is it - MC ribs
inflammation of costochondral/costosternal junction - unilateral - >1 level - MC: 2nd-5th ribs
57
Costochondritis: presentation
``` sharp aching or pressure pain ANTERIOR PAIN may radiate laterally inc pain w/ deep breathing, coughing, sneezing, laughing, UPPER BODY MVMT reproduction of pain w/ palpation ```
58
Tietze Syndrome: - epidemiology - etiology
<40yo idiopathic (preceding illness w/ coughing)
59
Tietze Syndrome: what is it
inflammation of costochondral or costosternal junction - unilateral - 1 level only - MC ribs: 2nd-3rd
60
Tietze Syndrome: presentation
sharp aching pressure pain - anterior - may radiate laterally - inc pain w/ deep breathing, coughing, sneezing, laughing, upper body mvmt - reproduction of pain w/ palpation - SWELLING OVERLYING INVOLVED JOINTS
61
Costochondritis and Tietze Syndrome: treatment
analgesics (NSAIDs, APAP) activity modification lidocaine/corticosteroid injection **course: wks-mos
62
Acute Low Back Pain: definition
new onset low back pain < 12 wk duration
63
Acute Low Back Pain: injured structures
MC: facet joints ligamentous structures paravertebral spinal muscles
64
Acute Low Back Pain: risk factors
``` Age Obesity Physically strenuous work Repeated twisting or bending Job dissatisfaction Prolong static posture (sedentary work) Poor posture Anxiety / depression ```
65
Acute Low Back Pain: MOI
MC: poor lifting technique carrying excessive load sudden mvmt fall
66
Acute Low Back Pain: presentation
``` TTP (facet joint) pain w/ extension, rotation tightness+pain w/ forward flexion difficulty arising from seated position normal neuro exam (L1-L5) ```
67
Low Back Pain: indications for radiographs
``` >70yo recent significant trauma (milder trauma if >50) constitutional sx mod-sev LBP >6wks focal neuro deficit infx risk (IVDU, IM) hx of malignancy prolonged corticosteroid use/osteoporosis ```
68
Acute Low Back Pain: management
avoid complete bedrest ice/heat stretching analgesics (NSAIDs, ketorolac, short course oral prednisone, APAP) muscle relaxers (cyclobenzaprine, metaxolone, carisoprodol) PT
69
Lumbar Radiculopathy: what is it
dysfunction/irritation of nerve root --> pain, sensory impairment, weakness, diminished DTR
70
What is the key to determining the involved nerve root in lumbar radiculopathy?
distribution
71
Supine Leg Raise: - what it tests for - steps - positive test
evaluates for sciatic nerve/lumbar nerve root irritation passive hip flexion + knee extension --> sx --> lower leg until pain relieved --> dorsiflex foot reproduction of radicular pain w/ dorsiflexion
72
Seated Straight Leg Raise: - what it tests for - steps - positive test
evaluates for sciatic nerve/lumbar nerve root irritation seated, passive knee extension not tolerating full knee extension (reflexively lean back/reproduction of radicular pain)
73
Lumbar Radiculopathy: diagnostics
straight leg raise (positive) seated straight leg raise (positive) neuro exam (L1-L5) xray MRI
74
Lumbar Radiculopathy: management
NSAIDs PT lumbar epidural laminotomy + disectomy laminectomy
75
Cauda Equina Syndrome: presentation
``` B sciatica B LE weakness saddle anesthesia sphincter dysfunction bowel/bladder dysfunction ```
76
Cauda Equina Syndrome: treatment
emergent neurosurgery consult
77
Lumbar Spinal Stenosis: what is it
``` disc degeneration arthritic changes ligamentum flavum thickening narrowing of lumbar spinal and nerve root canals compression of spinal cord, nerve roots ``` **aging population
78
Lumbar Spinal Stenosis: presentation
>50yo insidious onset LBP, leg pain (LBP, morning stiffness --> pain expands to buttocks, LE) neurogenic claudication w/ walking/prolonged standing SHOPPING CART SIGN numbness, tingling
79
Lumbar Spinal Stenosis: diagnostics
xrays MRI arterial doppler US to r/o vascular claudication
80
Spondylolisthesis: what is it
forward translation of 1 vertebra on another **often during growth spurt
81
Spondylolisthesis: grading
Grade 1 - < 25% translation Grade 2 - < 50% translation Grade 3 - < 75% translation Grade 4 - < 100% translation
82
Lumbar Spinal Stenosis: treatment
``` analgesics (APAP, NSAIDs, duloxetine, amitriptyline, neurontin) weight loss PT/OT epidural injections radiofrequency ablation surgery (spinal cord stimulator, fusion) ```
83
Spondylolysis: what is it
defect in pars interarticularis of lumbar vertebra (stress fracture/overloading) **F>M
84
Spondylolysis: MOI
trunk extension + hyperextension/rotation high risk sports: ballet, gymnastics, figure skating, football linemen, diving
85
Spondylolysis: complications
persistent pain | progression to spondylolisthesis
86
Spondylolysis: diagnostics
xray: AP, lateral (sn), latearl oblique (sp) | MRI
87
Spondylolysis: treatment
wk1-4: activity restriction wk5-12: PT wk9-12: gradual activity progression return to activity, consider bracing surgery (grade III-IV)
88
Stress Reactions
repetitive mechanical stress Osteoclastic activity surpasses osteoblastic activity Production of microfractures Initiation of an inflammatory response Bone stress injury → stress fracture Grade I: Periosteal edema Grade II-III: Varying severity bone marrow edema Grade IV: Cortical fracture line
89
AC Joint Injury: MOI
MC: direct force (fall on AC joint w/ arm at side, acromion forced inf med) indirect force (FOOSH, humeral head forced sup)
90
AC Joint Injury: Type I
AC ligament sprain pain w/o deformity AC joint intact CC ligaments intact
91
AC Joint Injury: Type II
AC joint disrupted <50% vertical displacement CC ligament sprain pain + deformity
92
AC Joint Injury: Type III
AC + CC ligaments disrupted AC joint dislocated -- inferiorly displaced shoulder complex >CC interspace pain w/ deformity
93
AC Joint Separation: presentation
step deformity (II, II, V) other deformity (IV, VI) swelling trapezius muscle spasm
94
AC Joint Separation: functional tests
cross arm ADduction | traction test
95
AC Joint Sprain: diagnostics
xray: 10deg cephalic tilt (+/- weights)
96
AC Joint Injury: treatment (I,II)
non operative: - ice, sling (7-10d) - return to ADLs/sports as pain allows (1-3wks)
97
AC Joint Injury: treatment (III)
non operative: - sling+harnes (10-14d) - return to sports/ADLs (3-4wks) acute surgery indicated: - throwing athletes - overhead workder - AVOID: contact athletes
98
AC Joint Injury: complications and management
OA of AC joint osteolysis of dist clavicle dec functional level surgical tx: dist clavicular excision
99
Shoulder (Glenohumeral) Dislocation: direction
MC: anterior (subcoracoid) posterior inferior (subglenoid)
100
Posterior Shoulder Dislocation: associated conditions
seizures electrical shock lesser tuberosity fx
101
Anterior Shoulder Dislocation: MC MOI
ABduction + external rotation
102
Anterior Shoulder Dislocation: neurologic injury: affected nerves + presentation
MC: axillary nerve ``` radial nerve (weakness w/ extension) median nerve (weakness in hand) ```
103
Anterior Shoulder Dislocation: presentation
flattened deltoid ant chest fullness prominent acromion guarding
104
What position would the patient be holding their arm in with an ANTERIOR dislocation?
slight ABduction
105
What position would the patient be holding their arm in with an POSTERIOR dislocation?
full ADduction
106
Shoulder Dislocation: evaluation
``` neuro exam (C5-T1) xray (AP, axillary, Y views) ``` MRI arthrogram (identify bankart lesion)
107
Shoulder Dislocation: treatment
1. conscious sedation (oxygen+fentanyl) 2. reduction (anterior) - hippocratic (inf traction) - stimson (weights) - hennipen (external rotation) 3. confirm w/ xray 4. sling 5. ortho consult recurrent: ant shoulder reconstruction + bankart repair
108
Shoulder Dislocation: provocative tests
apprehension jobe relocation surprise (release) sulcus sign
109
Shoulder Dislocation: complications
brachial plexus injury recurrent dislocation anterior: - bankart lesion (glenoid labral avulsion) - hill sachs lesion (post lat humeral head fx) - capsular laxity
110
Shoulder Dislocations: outcome - <30 - >45 - 1st time >40
<30: high recurrence (bc bankart) >45: recurrence less common 1st > 40: associated w/ rotator cuff tear
111
Subacromial Impingement Syndrome (SAIS): primary impingement: - etiology - epidemiology
degenerative changes (bone spurs, calcific deposits) hooked acromion (inc risk of RC tear) >35yo "true/classic impingement"
112
What is the most frequent cause of atraumatic shoulder pain?
SAIS
113
Subacromial Impingement Syndrome (SAIS): secondary impingement: - etiology - epidemiology
repetitive overhead movement (ABduction, external rotation) forward head, inc thoracic kyphosis --> muscle imbalances (ant tilting, protraction) ``` <35yo overhead athlete (swimmer, volleyball, baseball) ``` faulty scapular posture
114
Subacromial Impingement Syndrome (SAIS): what is it
inflammation --> inc compression w/in subacromial space repetitive microtrauma: - MC: supraspinatus tendon - subacromial bursa - long head of biceps bursal inflammtion tendon degeneration
115
Subacromial Impingement Syndrome (SAIS): presentation
``` gradual onset ant + lat shoulder pain (exacerbated w/ overhead activity) night pain TTP referred pain down to deltoid ```
116
Subacromial Impingement Syndrome (SAIS): special tests
``` Neers (int rotation + flexion) Hawkins Painful arc (45/60-120) Strength testing (resistance, empty can, lift off) ```
117
Subacromial Impingement Syndrome (SAIS): treatment
NSAIDs avoid offending activities modify sleeping position PT (postural correction) no improvement in 6wks: subacromial corticosteroid injection surgery (subacromial decompression)
118
Rotator Cuff Tear: etiology
MC: overuse (age related degeneration, chronic mechanical impingement) traumatic MC: supraspinatus tendon
119
Rotator Cuff Tear: | -epidemiology
full thickness tear: -inc incidence >40 (esp >60) **uncommon under 40
120
Rotator Cuff Tear: presentation
``` sev mos of rec shoulder pain subacromial pain pain localized to deltoid tuberosity night pain weakness, catching, grating ``` ``` TTP dec AROM normal PROM (+) drop arm test pain/weakness w/ isolation of involved RC ```
121
Rotator Cuff Tear: diagnostics
xray MRI (gold standard) ** + arthrogram if concern for partial tear and chronic injury
122
Rotator Cuff Tear: treatment
nonsurgical (<50% thickness tear): - NSAIDs - PT - avoid overhead activities - steroid injection surgery (chronic injury, acute traumatic):
123
What is the timeline for surgical intervention with and acute traumatic RC tear?
best done acutely or no later than w/in 6wks of injury
124
Adhesive Capsulitis: - aka - what is it - epidemiology
frozen shoulder idiopathic loss of BOTH active and passive motion inflammatory process involving the glenohumeral capsule 40-60yo
125
Adhesive Capsulitis: related conditions
MC RF: DM type 1 Hypothyroidism Dupuytren contracture C5 disk herniation Parkinson's disease
126
Adhesive Capsulitis: presentation
gradual ROM loss (pt unaware) (EXT ROTATION, ABduction, flexion) pain - at rest: dull, achy - end range: sharp diffuse shoulder tenderness
127
Adhesive Capsulitis: diagnostics
xray | MRI (contracted capsule, loss of inf pouch)
128
Adhesive Capsulitis: course/phases
freezing phase: pain, progressive loss of motion thawing phase: dec discomfort w/ slow/steady inc in ROM 6mo-2yr to resolve
129
Adhesive Capsulitis: treatment
wait it out intra-articular steroid injection PT (+ tramadol) no improvement x 9-12mo: surgery
130
Lateral Epicondylitis: - aka - what is it - etiology
tennis elbow point and click elbow overuse inflammatory injury involving common extensor tendon repetitive wrist extension or wrist + finger extension
131
Lateral Epicondylitis: presentation
sig pain + 3/5 strength w/ 3rd digit resisted extension
132
Tendonitis
tendon overuse injury inflammation (4-8wks) fiber disruption/degeneration
133
Tendonosis
stalled inflammatory process (6-8wks) fiber disorganization pronounced degeneration
134
Lateral Epicondylitis: treatment (tendonitis)
``` NSAIDs activity modification ice stretch + strengthen supportive bracing steroid injection ```
135
Lateral Epicondylitis: treatment (tendonosis)
activity modification PT/OT stretch + strengthen supportive bracing
136
Steroid Injection: ADEs
dimpling hypopigmentation (resolves 3-6mo) tendon rupture
137
Tendonosis Treatment Components
modify aggravating activity correct biomechanics address degeneration - ASTYM - graston - dry needling - PRP injections therapeutic exercise - stretching - strengthening
138
Medial Epicondylitis: - aka - presentation
golfer's elbow pain w/ flexion med elbow pain weakness w/ wrist/finger flexion TTP ulnar neuropathy
139
Distal Biceps Tendon Rupture: epidemiology
M >40yo w/ preexisting degenerative changes
140
Distal Biceps Tendon Rupture: MOI
rapid eccentric contraction --> distal tendon tear at radial insertion
141
Distal Biceps Tendon Rupture: diagnostics
initial: xray | gold standard: MRI
142
Distal Biceps Tendon Rupture: treatment
nonsurgical: - partial tear: brace + limit ROM x 4wks - complete tear: older pts w/ sedentary lifestyle surgical: (young active individuals) - complete rupture - elective partial tears **need to do surgery w/in 10d
143
Ulnar Collateral Ligament Injury: special tests
valgus stress milking maneuver moving valgus stress
144
Ulnar Collateral Ligament Injury: diagnostics
xray (r/o avulsion fx --> MC <18yo) | MR arthrogram of elbow (gold standard)
145
Non-Inflammatory Bursitis: what is it
repeated trauma --> excess fluid develops w/in bursa --> swelling/enlarge
146
Non-Inflammatory Olecranon Bursitis: presentation
swelling at tip of elbow NO pain, redness, warmth full, painless ROM
147
Inflammatory Olecranon Bursitis: - etiology - presentation
result of infx swelling at tip of elbow marked warmth, redness, pain w/ palpation limited flexion
148
Olecranon Bursitis: treatment
small effusion: - ice - compression sleeve - NSAIDs - activity modification large effusion/infected: - aspiration - abx
149
Elbow Dislocations: MOI
FOOSH **posterior dislocation + coronoid process fx = common
150
What is the MC joint dislocation in children?
elbow
151
Elbow Dislocations: evaluation
NV exam (radial, median, ulnar nerves)
152
Lunate and Perilunate Dislocation: - etiology - associated fx - treatment
hyperdorsiflexion (hyperextension) scaphoid, radial styloid fx surgical repair
153
DeQuervain's Tenosynovitis: what is it
inflammation of the sheath that surrounds the ABductor pallucis longus and extensor pollucis brevis tendons thickened tendon sheath --> constricted tendons
154
DeQuervain's Tenosynovitis: presentation
pain, tenderness in 1st dorsal extensor compartment -- aggravated w/ thumb movement, make a fist swelling crepitus (+) finklestein test
155
DeQuervain's Tenosynovitis: Finklestein Test
thumb in palm --> deviate wrist towards ulna --> reproduction of pain
156
DeQuervain's Tenosynovitis: management
NSAIDs thumb spica splint avoid offending activity steroid injection
157
Ulnar Collateral Ligament Sprain: - aka - what is it - MOI
gamekeeper's/skier's thumb UCL injury at 1st MCP joint acute (MC)/chronic valgus stress
158
Ulnar Collateral Ligament Sprain: presentation
pain, swelling to ulnar aspect of thumb mild: no laxity mod: partial laxity complete: sig laxity
159
Ulnar Collateral Ligament Sprain: treatment
mild-mod: brace (2-4wks) surgical: - complete tear - avulsion fx w/ 25% of articular surface
160
Collateral Ligament Injuries: - aka - MOI - presentation
jammed fingers forced lateral deviation of IP joints pain over ligament valgus/varus stress w/ PIP at 30 deg
161
Collateral Ligament Injuries: treatment
buddy tape continue participation refer children
162
Dislocation of IP Joints: etiology
forced hyperextension of PIP/DIP
163
Trigger Finger: - what is it - MC location - MOI
nodular thickening of flexor tendon MC at MCP joint MC: idiopathic RA, DM
164
Trigger Finger: treatment
``` steroid injection (2 max) surgical release ```
165
Dupuytren's Contracture: - aka - epidemiology - MC location
palmar fibromatosis viking disease M >50, N European descent MC: ring finger
166
Dupuytren's Contracture: | -what is it
nodular thickening + contraction of palmar fascia flexion of finger at MCP --> PIP
167
Dupuytren's Contracture: treatment
xiaflex injection + manipulation
168
Ganglia of Wrist, Hand: - aka - epidemiology - MOI - common locations
synovial/mucous cyst 15-40yo idiopathic, repetitive wrist loading activities dorsum of wrist volar aspect of wrist
169
Ganglia of Wrist, Hand: what is it
cystic swelling overlying tendon sheath | herniation of synovial tissue from tendon sheath
170
Ganglia of Wrist, Hand: management
asymptomatic: reassurance acute, sev sx: - immobilization - needle aspiration - surgical excision
171
Mucous Cyst (Mucocele)
develops off of a joint (MC: DIP)
172
Arthritis of the Hand: MCC
osteoarthritis | secondary degenerative joint disease
173
Osteoarthritis of the Hand: - MC location - presentation
DIP, PIP ``` stiffness, loss of motion of fingers heberden nodes (DIP) bouchard nodes (PIP) ```
174
Iliotibial Band "Friction" Syndrome: what is it
friction irritation due to repetitive AP mvmt of iliotibial band over lat femoral condyle (cross country running, cycling)
175
Iliotibial Band "Friction" Syndrome: predisposing factors
``` tight IT band genu varum (bowlegged) foot pronation --> internal tibial rotation ```
176
Iliotibial Band "Friction" Syndrome: presentation
localized tenderness over lat femoral condyle pain w/ active knee flexion/extension (walk w/ stiff knee) localized swelling, crepitus
177
Iliotibial Band "Friction" Syndrome: special test
noble compression test
178
Iliotibial Band "Friction" Syndrome: treatment
NSAIDs ice w/ motion activity modification therapy corticosteroid injection
179
Prepatellar Bursitis: etiology
``` repetitive trauma (carpet/tile laying, wrestling) trauma (fall, forceful contact w/ coffee table) ```
180
Prepatellar Bursitis: presentation
+/- pain tightness at end range w/ flexion (active and passive) restricted ROM (pain free) ballottement (fluid on top of patella)
181
Prepatellar Bursitis: treatment
aspiration/injection (3 max) NSAIDs ice compression surgical excision
182
Prepatellar Bursitis: prevention
knee pads
183
Non-Gonococcal Infectious Arthritis: etiology
MC: hematogenous (MC: S aureus)
184
Non-Gonococcal Infectious Arthritis: risk factors
``` IM DM sickle cell anemia prosthetic joint previous arthritis trauma bacteremia ```
185
Non-Gonococcal Infectious Arthritis: presentation
acute onset monarticular MC joint: knee warmth, swelling, erythema, pain limited function +/- fever, leukocytosis
186
Non-Gonococcal Infectious Arthritis: diagnosis
synovial fluid analysis (bacterial infx) blood culture imaging (not helpful)
187
Non-Gonococcal Infectious Arthritis: polyarticular: - epidemiology - MC joints - MC pathogens
>60yo high prevalence of RA knee, hip, shoulder, elbow (~4 joints) staph, strep
188
Non-Gonococcal Infectious Arthritis: IVDU: - MC joints - MC pathogens
sternoclavicular, costochondral, pubic symphysis ``` #1: S aureus #2: pseudomonas ```
189
Non-Gonococcal Infectious Arthritis: treatment
aspiration + irrigation IV abx (empiric: vancomycin + 3rd gen cephalosporin - ceftriaxone) serial synovial fluid analyses
190
Gonococcal Infectious Arthritis: - what is it - epidemiology
infx caused by N gonorrhoeae migratory arthritis in sexually active adults health F>M menses, pregnancy
191
Gonococcal Infectious Arthritis: presentation
migratory, non symmetric polyarthralgias (wrist, elbow, knee, ankles) (1-4d) tenosynovitis necrotic pustules (palms, soles) fever, GU sx, purulent arthritis (knee)
192
Gonococcal Infectious Arthritis: diagnostics
synovial fluid analysis blood culture cultures (urethra, throat, cervix, rectum) imaging (not helpful)
193
Gonococcal Infectious Arthritis: treatment
single dose: azithromycin PO + ceftriaxone IM | 7-14d: daily ceftriaxone IM
194
Patellar/Quadriceps Tendonitis/osis: etiology
overuse/repetitive stress (jumping -- basketball, volleyball) microtrauma, chronic inflammation imbalance bt loading and short term healing
195
Patellar/Quadriceps Tendonitis/osis: presentation
pain/TTP persistent aching after activity pain w/ resisted extension pain w/ active and passive flexion at end range
196
Patellar/Quadriceps Tendonitis/osis: treatment (tendonitis vs tendonosis)
tendonitis: NSAIDs, activity mod, ice, patellar tendon strap, PT tendonosis: PT, activity mod, patellar tendon strap
197
Patellar/Quadriceps Tendon Rupture: - epidemiology - etiology
30-60yo Rapid eccentric overload – fall on partially flexed knee Rapid concentric overload – basketball player jumping
198
Patellar/Quadriceps Tendon Rupture: presentation
instability/giving way pop ``` sig pain at injury --> min-no pain w/ quad contraction rapid large effusion palpable defect INABILITY TO EXTEND KNEE AGAINST GRAVITY INABILITY TO PERFORM STRAIGHT LEG RAISE ``` *do NOT assess prone passive knee flexion
199
Patellar/Quadriceps Tendon Rupture: diagnostics
xray (r/o fx, assess tendon rupture) | MRI (confirm diagnosis)
200
What is the radiographic finding for a quadriceps tendon rupture?
low position of patella
201
What is the radiographic finding for a patellar tendon rupture?
high position of patella
202
Patellar/Quadriceps Tendon Rupture: treatment
non surgical (<50% tear): straight leg immobilizer, non weight bearing surgical repair (complete rupture)
203
Patellofemoral Pain Syndrome: etiology
overuse repetitive activity w/ faulty biomechanics: - VMO weakness (lat tracking patella) - inc Q angle - hyperpronation (internal tibial rotation) - poor technique (squat)
204
Patellofemoral Pain Syndrome: presentation
``` movie theater sign pain w/: -ascending/descending stairs -rep deep knee flexion -end range passive/active flexion -resisted extension ``` J sign patellar grind sign
205
Patellofemoral Pain Syndrome: treatment
``` activity modification NSAIDs weight loss (if obese) VMO strengthening gluteal strengthening evaluate/correct technique ```
206
Patellofemoral Pain Syndrome: Q angle: - what is it - value for F - value for M
quadriceps angle line from ASIS to patella line from tibial tuberosity to patella F: =22 in full extension M: =18 in full extension
207
Patellar Dislocation: - etiology - epidemiology
twisting knee injury 16-20yo (uncommon over 30) F>M
208
Patellar Dislocation: risk factors
shallow patellofemoral articular surface patella alta (high riding patella) excessive Q angle generalized ligamentous laxity
209
Patellar Dislocation: presentation
``` sev pain pop knee held in flexed position hemarthrosis loss of knee motion ``` post reduction: diffuse peri-patellar tenderness
210
Patellar Dislocation: - special test - diagnostics
patellar apprehension sign post reduction xray (lateral tilt) MRI
211
Patellar Dislocation: treatment
reduction (gentle extension of tibia) * avoid forceful med pressure on patella post reduction: knee immobilizer post immobilization: stabilization brace PT surgical repair - loose body - hx of rec dislocations
212
MCL Injury: MOI
force directed to the lateral aspect of the knee --> instability
213
What are the components of the unhappy triad?
ACL tear MCL tear med meniscal tear
214
MCL Injury: | -special tests
valgus stress test (0 and 30 deg)
215
MCL Avulsion: - aka - what is it
steida's fx femoral avulsion fx
216
LCL Injury: MOI
forced directed to the medial aspect of the knee --> instability
217
LCL Injury: special tests
varus stress test (0 and 30 deg) | check neuro function
218
Collateral Ligament Tears: presentation
pain w/ palpation swelling loss of ROM
219
Collateral Ligament Tears: grade 1 - presentation - treatment
interstitial pain w/ stress testing no laxity RICE short course NSAIDs crutches PRN
220
Collateral Ligament Tears: grade 2 - presentation - treatment
partial pain w/ stress testing mild laxity hinged knee brace weight bearing as tolerated PT
221
Collateral Ligament Tears: grade 3 - presentation - treatment
complete significant laxity +/- pain w/ stress testing ortho surgery consult hinged knee brace gradual return to full weight bearing over 4-6wks PT
222
ACL Tear: MOI
non contact (rotational): - plant + pivot - valgus load + int rot of femur + ext rot of tibia contact (hyperextension): -force to the ant knee while foot is planted
223
ACL Tear: presentation
``` sudden pain/giving way rapid effusion pop sig ROM limitation instability w/ weight bearing pain (+) lachmann (+) ant drawer ```
224
ACL Tear: diagnostics
xray | MRI
225
ACL Tear: treatment
``` rest ice NSAIDs aspiration knee immobilizer/hinged knee brace w/ crutches ``` ``` ACL reconstruction (young, active) PT (older, less active) ```
226
PCL Tear: MOI
dashboard injury fall on flexed knee w/ plantar flexed foot hyperextension injury ** MC combined w/ ACL tear
227
PCL Tear: presentation
effusion w/in 24 hrs limited AROM/PROM pain, instability w/ weight bearing (+) sag test (+) posterior drawer
228
PCL Tear: diagnostics
xray (r/o fx) | MRI (confirm dx)
229
PCL Tear: treatment
rest, ice, NSAIDs knee immobilizer --> hinge brace w/ crutches PT functional bracing for return to activity PCL reconstruction (rec instability, subsequent meniscal tears)
230
Knee Dislocation: diagnostics
1. xray 2. arterial/venous doppler US + ankle brachial index 3. arteriogram (if abnormalities w/ 2) 4. MRI
231
Meniscal Tears: MOI (traumatic vs. degenerative)
traumatic tear: rotational injury degenerative tear: min-no trauma
232
Meniscal Tears: classification
``` horizontal cleavage flap radial degenerative bucket handle longitudinal ```
233
Meniscal Tears: traumatic tear: presentation
sp incident mod swelling + stiffness over 1-2d LOCKING, catching, popping Joint line pain w/ twisting or squatting Tenderness over medial or lateral joint line Motion limited secondary to pain, effusion and/or mechanical block
234
Meniscal Tears: degenerative tear: presentation
insidious onset (inc activity level) mild swelling+stiffness over sev months catching, popping Joint line pain w/ twisting or squatting Tenderness over medial or lateral joint line Motion limited secondary to pain, effusion and/or mechanical block
235
Meniscal Tears: special tests
mcmurray's | thessaly's
236
Meniscal Tears: treatment: traumatic tear (young, active)
sports activity restriction until MRI | surgical debridement/repair
237
Meniscal Tears: treatment: degenerative tear
RICE NSAIDs activity modification * delay MRI while treating sx * respond well to surgical debridement BUT inc risk for OA
238
Knee Arthritis: epidemiology
>55yo hx of trauma obesity compartments: med > lat > PF
239
Knee Arthritis: presentation
``` insidious onset pain w/ weight bearing buckling/giving way difficulty ascending/descending stairs stiffness upon waking/prolonged sitting intermittent swelling diffuse tenderness crepitus joint narrowing, osteophytes ```
240
Knee Arthritis: Kellgren Lawrence Classification
grade 1: min osteophytes grade 2: >/= 1 well defined marginal osteophyte grade 3: definite joint space narrowing and marginal osteophytes grade 4: bone-to-bone contact, complete obliteration of the joint space, marginal osteophytes
241
Knee Arthritis: treatment
``` weight loss activity modification analgesics (topical capsaicin) intra-articular injections neoprene sleeve shoe insoles nonimpact exercise cane, walker surgery (total knee replacement) ```
242
Popliteal Cyst: - aka - presentation
baker's cyst swelling/fullness in popliteal fossa (can dissect down calf) pain, tenderness no hx of trauma rupture --> sev calf pain, dec ROM at ankle
243
Popliteal Cyst: associated conditions
degenerative meniscal tear OA systemic inflammatory condition (RA)
244
Popliteal Cyst: treatment
aspiration (transient relief) | treat underlying condition
245
Snapping Hip Syndrome: | -site
MC: IT band + greater trochanter iliopsoas bursa + ant acetabulum snap/clunk palpated as tendon slides over bony landmark
246
Snapping Hip Syndrome: snapping associated w/ pain
bursitis | labral pathology
247
Trochanteric Bursitis: presentation
pain, tenderness (greater trochanter) - radiates along lat thigh worse w/ first rising, prolonged walking night pain
248
Trochanteric Bursitis: treatment
NSAIDs activity modification stretching corticosteroid injection
249
Iliopsoas Bursitis: presentation
anterior thigh pain radiates to the groin worse w/ sitting, prolonged walking
250
Iliopsoas Bursitis: treatment
NSAIDs activity modification stretching corticosteroid injection
251
Snapping Hip Syndrome: treatment
patient education stretching corticosteroid injection
252
Snapping Hip Syndrome: when to consider radiographs
mechanical locking | failure w/ conservative care
253
Femoroacetabular Impingement (FAI): - what is it - deformity types
hip impingement bt femoral head/neck and acetabulum cam (femoral deformity) pincer (acetabular deformity) cam and pincer (combined)
254
Femoroacetabular Impingement (FAI): - etiology - epidemiology
SCFE legg calve perthes dz anatomical variants repetitive loading inc risk w/ athletes/active
255
Femoroacetabular Impingement (FAI): impingement inc risk of ...
labral tear chondral injury early onset OA
256
Femoroacetabular Impingement (FAI): presentation
``` insidious onset internal ROM loss rest, post activity: achy groin pain turning, twisting, squatting: sharp pain crepitus, catching, locking ```
257
Femoroacetabular Impingement (FAI): - special test - diagnostics
impingement test (flexion+adduction+int rotation) xray MRI w/ arthrogram marcaine (+/- kenalog) injection test
258
Femoroacetabular Impingement (FAI): treatment
NSAIDs activity modification PT surgical tx (open, arthroscopic)
259
Hip Dislocations: - MOI - MC direction
high energy injury (MVA) - axial load along femoral shaft (MC) - forced mvmt past end range posterior > anterior
260
Posterior Hip Dislocation: MOI
force exerted at knee through femoral shaft | head of femur driven posteriorly (dashboard injury)(MC)
261
Posterior Hip Dislocation: presentation
``` scissor position (hip: int rot+ADducted +flexed, knee: flexed) thigh appears shorter ```
262
Anterior Hip Dislocation: MOI
forced ABduction+external rotation past end range
263
Anterior Hip Dislocation: presentation
helpless eversion (ext rot+ABducted+slightly flexed) flattened lateral hip extremity may
264
Hip Dislocations: complications
fractures (acetabulum, femoral head) sciatic nerve injury avascular necrosis of femoral head (ligamentum teres artery)
265
Hip Dislocations: diagnostics
xray | CT
266
Posterior Hip Dislocation: reduction technique
allis method: - stabilize hip - hip, knee flex to 90 - ant force (forearm behind knee) - internal rotation + ADduction
267
Anterior Hip Dislocation: reduction
modified allis method: - posterior pressure - hip ABducted, flexed to 90 - traction + ADduction - internal rotation
268
Avascular Necrosis: - what is it - epidemiology
loss of blood supply --> destruction of femoral head 30-50yo
269
Avascular Necrosis: risk factors
``` hx of trauma long term corticosteroid use EtOH abuse radiation therapy RA SLE ```
270
Avascular Necrosis: kids - disease name - epidemiology - etiology
legg calve perthes disease 2-11yo M idiopathic unilateral
271
Avascular Necrosis: presentation (adult vs peds)
``` insidious ROM loss (int rotation, ABduction) ``` adult: - groin pain - pain w/ weight bearing/limp peds: - PAINLESS limp - groin, thigh, knee pain
272
Avascular Necrosis: Ficat Stages
I: normal II: sclerotic/cystic lesions III: subchondral collapse (crescent sign) IV: osteoarthrosis (articular cartilage loss, osteophyte formation)
273
Avascular Necrosis: diagnostics
xray (crescent sign) | MRI (definitive diagnosis)
274
Avascular Necrosis: treatment
adults: - core decompression w/ bone graft - total hip replacement peds: - bed rest - progressive weight bearing
275
Hip Osteoarthritis: what is it
degeneration of cartilage from the femoral head and/or the acetabulum
276
Hip Osteoarthritis: etiology
``` Primary (idiopathic) Trauma Infection Femoroacetabular Impingement (FAI) Slipped capital femoral epiphysis (SCFE) Legg-Calvé-Perthes disease Pediatric developmental dysplasia of the hip Avascular necrosis ```
277
Hip Osteoarthritis: presentation
groin/ant thigh pain dec, painful ROM loss (flexion, int rotation) difficulty crossing legs/putting on shoes/socks referred pain to knee
278
Hip Osteoarthritis: treatment
``` analgesics (NSAIDs, APAP, duloxetine) weight reduction lifestyle modification intra articular corticosteroid injection joint arthroplasty ```
279
Compartment Syndrome: | -what is it
acute rapid rise in intracompartmental pressure
280
Compartment Syndrome: MOI
trauma to anterolateral leg premature cast application excessive exercise
281
What is the MC compartment affected in compartment syndrome? How will they present?
anterior compartment weak DF and toe extensors dec sensation over dorsum of foot
282
Compartment Syndrome: presentation
``` pain w/ passive stretch paresthesia pulselessness pallor paralysis shiny skin ```
283
Compartment Syndrome: compartmental pressure testing
needle inserted into compartment providing pressure measurement normal: 0-10mmHg fasciotomy: delta pressure <30mmHg delta P = diastolic BP - compartment P
284
Compartment Syndrome: treatment
fasciotomy
285
Achilles Tendonitis(-osis): etiology
overuse/repetitive stress (long distance running) poot footwear poot biomechanics
286
Achilles Tendonitis(-osis): presentation
pain morning pain/stiffness swelling/thickening of the tendon palpable crepitus pain, ROM loss w/ achilles tendon stretching pain +/- weakness w/ resisted plantarflexion
287
Achilles Tendonitis(-osis): treatment
``` relative rest ice NSAIDs stretching correct footwear/biomechanics therapy ```
288
Haglund's Deformity: what is it
boney exostosis --> irritation from footwear --> pump bump
289
Haglund's Deformity: risk factors
improper footwear pes cavus tight achilles tendone
290
Haglund's Deformity: presentation
asymptomatic pain w/ palpation, tight footwear erythema swelling
291
Haglund's Deformity: treatment
``` modify footwear achilles tendon stretching analgesics ice injection surgery ```
292
Achilles Rupture: MOI
explosive/rapid contraction - change in direction - rapid eccentric load
293
Achilles Rupture: contributing factors
``` weekend warriors racquet sports age dominant extremity underlying tendinosis hx of corticosteroid injections ```
294
Achilles Rupture: presentation
``` "kicked in calf" audible snap observable/palpable gap sev swelling, ecchymosis pain/weakness on resisted plantar flexion (+) thompson test ```
295
Achilles Rupture: diagnostics
``` clinical MRI (definitive diagnosis) ```
296
Achilles Rupture: management
non-surgical (non-athletes, older pts): - cast immobilization (4-6wks) - walking boot progression (4-6wks) surgery
297
Lateral (Inversion) Ankle Sprain: MOI
inversion | combined inversion/plantarflexion
298
Lateral (Inversion) Ankle Sprain: injured ligament
MC: ATFL CFL PTFL
299
Lateral (Inversion) Ankle Sprain: special tests
``` anterior drawer talar tilt (prone) talar tilt (seated) ```
300
Lateral (Inversion) Ankle Sprain: grade 1 - presentation - disability - recovery
mild stretch mild pain w/ weight bearing min swelling point tenderness w/ involved ligaments pain but NO laxity w/ special tests mild limp min functional loss 2-10d
301
Lateral (Inversion) Ankle Sprain: grade 2 - presentation - disability - recovery
partial tear mod pain w/ weight bearing mod swelling point tenderness w/ involved ligaments pain + mild-mod laxity w/ special tests limp w/ walking unable to toe raise 10-30d
302
Lateral (Inversion) Ankle Sprain: grade 3 - presentation - disability - recovery
complete tear sig swelling sig pain w/ weight bearing point tenderness w/ involved ligaments pain+sig laxity w/ special tests unable to FWB sig pain inhibition 30-90d
303
Medial (Eversion) Ankle Sprain: MOI
forced eversion/ext tibial rotation **excessive pronators more susceptible
304
Medial (Eversion) Ankle Sprain: injured ligament
deltoid ligament
305
Medial (Eversion) Ankle Sprain: presentation - grade 1 - grade 2 - grade 3
grade 1: mild stretch of zone 1 +/- 2 grade 2: partial tear of zone 1 +/- 2 grade 3: complete tear of zone 1 +/- 2
306
Medial (Eversion) Ankle Sprain: special test
eversion talar tilt
307
Syndesmotic Ankle Sprain: MOI
forced external rotation of ankle | hyperdorsiflexion
308
Syndesmotic Ankle Sprain: structures involved
ant tib fib post tib fib interosseous membrane
309
Syndesmotic Ankle Sprain: presentation
sev pain + loss of function TTP (+) kleiger's test
310
Ottawa Foot and Ankle Rules
X-ray series is required if: -Inability to bear weight for more than 4 steps both immediately and at time of evaluation Ankle - Pain in malleolar zone and - Bony tenderness over the distal 6cm of the posterior edge of the fibula or the tip of the lateral malleolus OR - Bony tenderness over the distal 6cm of the posterior edge of the tibia or the tip of the medial malleolus Foot - Pain in midfoot zone and - Boney tenderness at the base of the fifth metatarsal OR - Boney tenderness at the navicular
311
Pull Off Fracture
avulsion fx | horizontal fx line
312
Push Off Fracture
oblique or vertical fx line
313
Inversion Sprain
avulsion fx of lat malleolus | push off fx of med malleolus
314
Eversion Sprain
avulsion fx of med malleolus | push off fx of lat malleolus
315
Ankle Sprain: treatment (grade 1)
RICE NSAIDs consider ankle brace
316
Ankle Sprain: treatment (grade 2)
NWB --> PWB --> FWB as tolerated Walking boot 10-14 days followed by bracing Therapy
317
Ankle Sprain: treatment (grade 3)
``` refer to ortho NWB --> PWB --> FWB as tolerated Walking boot 3-4 weeks followed by bracing Therapy Surgery ```
318
Chronic Lateral Ankle Instability: what is it
persistent mechanical disability of the talocrural joint
319
Chronic Lateral Ankle Instability: presentation
frequent sprains diff running on uneven surfaces diff jumping or cutting
320
Chronic Lateral Ankle Instability: treatment
supervised rehab program surgery (ligament reconstruction)
321
Hallux Valgus: what is it
lateral dev of great toe at MTP joint may lead to bunion
322
Hallux Valgus: presentation
pain, swelling 2nd toe overrides great toe HA angle >/= 20deg
323
Hallux Valgus: treatment
asymptomatic: no tx patient education shoe wear modifications disability: surgery
324
Plantar Fasciitis: what is it
degenerative microtearing of fascial origin from the calcaneus --> tendinosis-type reaction (plantar fasciosis)
325
What is the MCC of heel pain in adults?
plantar fasciitis
326
Plantar Fasciitis: epidemiology
F overweight runners
327
Plantar Fasciitis: presentation
insidious focal pain, tenderness most intense upon rising from resting position (especially in the morning) worse w/ prolonged standing and walking
328
Plantar Fasciitis: diagnostics
xray (heel spur)
329
Plantar Fasciitis: treatment
takes 6-12mo to resolve ``` silicone/rubber heel pad ice analgesics shock absorbing soles stretching exercises night splint steroid injection partial surgical release of plantar fascia ```
330
Interdigital (Morton) Neuroma: what is it
inflammation of common digital nerve as it passes bt MT heads secondary to repetitive irritation of nerve
331
Interdigital (Morton) Neuroma: - epidemiology - MC location - etiology
F MC bt 3rd and 4th toes MCC: nerve compression by tight shoes
332
Interdigital (Morton) Neuroma: presentation
plantar pain in forefoot "walking on a marble"/"wrinkle in my sock) relieved by removing shoe, rubbing foot aggravated by high heeled/tight shoes pain w/ direct plantar pressure+squeezing MT together
333
Interdigital (Morton) Neuroma: treatment
low heeled, well cushioned shoe w/ wide toe box MT/orthotic pads steroid injection surgical excision
334
MSK Tumor: work up
``` xray CT scan/MRI biopsy (definitive diagnosis) bone scan/PET (metastases) labs ```
335
MC locations for metastatic tumors
``` prostate breast kidney thyroid lung ```
336
MC symptom of metastatic bone lesions
persistent pain
337
What type of lesions are typically associated w/ prostate and breast cancer?
osteoblastic lesions
338
What type of lesions are seen with metastases of lung, kidney and thyroid CA and bone involvement from multiple myeloma?
lytic lesions (punched out/moth eaten appearance)
339
Unicameral Bone Cyst (UCB): - what is it - MC location
benign, fluid filled, expansile lesion long bones (prox femur, prox humerus)
340
Unicameral Bone Cyst (UCB): treatment
may resolve spontaneously surgery for rec fx (aspiration+injection vs curettage + bone graft)
341
Unicameral Bone Cyst (UCB): xray findings
FALLEN LEAF SIGN well circumscribed adjacent to physis eccentric advanced: cortical thinning
342
Aneurysmal Bone Cyst: - what is it - MC locations - epidemiology
benign, aggressive bone lesions blood filled cyst in bone femur, humerus, fibia, fibula, skull, posterior spine under 12/20
343
Aneurysmal Bone Cyst: treatment
curettage, electrocautery, bone grafting may recur
344
Aneurysmal Bone Cyst: xray findings
``` eccentric lytic aggressive features expansile cortical thinning ``` MC in the metaphysis PERIOSTEAL ELEVATION
345
Non Ossifying Fibroma (NOF): | -treatment
surgery if >50% diameter of bone (curettage, bone grafting, +/- internal fixation)
346
What is the MC benign tumor in children?
non ossifying fibroma
347
Non Ossifying Fibroma (NOF): xray findings
``` eccentric lobulated margin metaphyseal lytic sclerotic rim + cortical erosion ```
348
Giant Cell Tumor: - what is it - MC locations
rare, benign, aggressive tumor knee (MC), dist radius, prox femur, prox humerus
349
Giant Cell Tumor: treatment
radiation curettage, bur, electrocautery, bone grafting high recurrence
350
What is unique to the giant cell tumor, compared to the other MSK tumors?
giant cell tumors present with localized pain and possible weakness other msk tumors are typically asymptomatic
351
Osteochondroma: what is it
benign abnormal growth of bone and cartilage along surface of bone peak incidence: 2nd and 3rd decade
352
Osteochondroma: xray findings
sessile/pedunculated appearance (mushroom) 1-20cm
353
Osteochondroma: presentation
abnormal bone growth | impingement of surrounding structures --> pain, restricted ROM, tingling, numbness
354
Osteochondroma: treatment
observation w/ radiological monitoring - asymptomatic: q6mo - stable: q12mo until skeletally mature - >50% growth in 6mo/symptomatic: MRI excision + biopsy **risk of recurrence if resected pre skeletal maturity
355
Osteoid Osteoma: what is it
small benign bone tumor w/ a nidus develop in the cortex
356
Osteoid Osteoma: - MC location - presentation
long bones dull aching pain (at night) dramatic reduction in pain w/ NSAIDs
357
Osteoid Osteoma: treatment
watchful waiting -NSAIDs radiofrequency ablation * *resolve: - pain: 3yrs - lesion: 5-7yrs
358
Chondrosarcoma: - what is it - epidemiology
MALIGNANT tumor of cartilage producing cells M 60-80yo (>40yo)
359
Chondrosarcoma: - MC locations - presentation
pelvis, ribs, humerus, tibia, femur (EPIPHYSEAL) pain, weakness
360
Chondrosarcoma: treatment
surgical excision | +/- radiation, chemotherapy
361
What is the benign tumor with a similar radiographic appearance to chondrosarcomas?
enchondroma
362
Osteomyelitis: what is it/MOI
infx of bone via: - hematogenous spread - contiguous infx (surgical hardware, open fx) - vascular insufficiency (diabetic ulcer)
363
Osteomyelitis: - epidemiology - pathogens
MC in children MC: S aureus (MSSA>MRSA) S epidermis (MC post surgical) E coli Salmonella (sickle cell anemia)
364
Osteomyelitis: distribution (adult vs peds)
adult: MC: vertebrae peds: MC long bones (femur>tibia>humerus)
365
What is a Brodie's abscess? What disease is it associated with?
an abscess that is walled off by fibrosis and bone sclerosis (no drainage tract) osteomyelitis
366
Osteomyelitis: presentation
gradual onset (d-wks) dull unrelenting pain subjective fever, chills draining sinus tract ``` Tenderness Warmth Erythema Soft tissue swelling ROM / functional loss ``` PAIN WHILE TRYING TO SLEEP
367
Osteomyelitis: diagnostics
labs (elevated ESR, CRP, acute WBC; normal chronic WBC) xrays (early: demineralization, late: sequestra, involucrum) blood culture bone biopsy gadolinium enhanced MRI (gold standard) (alt: bone scan, CT)
368
Osteomyelitis: treatment
empiric IV abx (vancomycin +FQ) --> no improvement 48-96hrs __> surgical debridement
369
Gout: what is it
METABOLIC dz altered purine metabolism --> Na urate crystal deposition in synovial fluid --> rec, acute arthritis attacks hyperuricemia + crystals
370
Gout: - epidemiology - etiology
M >30yo primary (genetic alterations) secondary - diuretics - low dose ASA - cyclosporine - niacin - myeloproliferative disorders - hypothyroidism - alcohol
371
Gout: risk factors
``` M age genetics obesity alcohol high purine diet high fructose/sucrose diet HTN CKD thiazide/loop diuretics ```
372
Gout: presentation (acute flare)
``` acute onset intense pain (at night) swollen tender joint w/ overlying red, warm skin MONOARTICULAR low grade fever ``` MC: 1st MTP joint (podagra) feet, ankles, knees
373
Gout: presentation (chronic)
tophaceous gout 10+ yrs urate deposits in subQ tissue, bone cartilage, joints (TOPHI) granulomatous inflammation deforming polyarthritis
374
Gout: diagnostics
labs: - acute: normal serum uric acid - elevated WBC synovial fluid analysis: - MONOSODIUM urate crystals - NEEDLE LIKE - NEGATIVELY birefringent - inflammatory imaging: - new onset acute: no findings - established dz: rat bite (sm punched out erosins w/ overhanging edges)
375
Gout: treatment (acute attack)
elevation, rest dietary modifications reduce inflammation (NSAIDs (naproxen, indomethacin), colchicine (<24-36hrs), PO/IV corticosteroids, corticosteroid injection)
376
Gout: treatment (prophylaxis)
weight loss alcohol avoidance dietary purine restriction avoid thiazides, loop diuretics, niacin, low dose ASA colchicine, allopurinol, febuxostat, probenecid dietary modifications
377
Gout: complications
nephrolithiasis | chronic urate nephropathy

PHA 522 (2 decks)

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