Ortho Flashcards
(314 cards)
1
Q
Spondylosis
A
Age related degeneration of spine (spinal arthritis)
2
Q
Spondylolisthesis
A
Anterior slippage of vertebra on top of the other
3
Q
Retrolisthesis
A
Posterior slippage of vertebra on top of the other
4
Q
Subluxation
A
Partial dislocation
May be related to compromised ligamentous structures
5
Q
Dislocation
A
Complete separation of two bones from articulation associated with ligamentous injury
6
Q
Burst fracture
A
Comminuted vertebral body fracture due to compressive forces
7
Q
Compression fracture
A
Collapse of vertebral body due to bone fracture
8
Q
Displacement
A
Abnormal position of distal bone fragment in relation to proximal bone
9
Q
Translocation
A
Movement of articulating bones away from each other
10
Q
Angulation
A
Abnormal positino of distal bone fragment in relation to proximal bone measured in degrees
11
Q
Cervical spondylosis
A
Most common form of spinal cord dysfunction in >55yo
12
Q
Cervical spondylosis clinical findings
A
Pain with neck extension
Occipital headache worse in the morning
Decreased ROM
Pain radiates to intrascapular region and proximal arm
Myelopathy
13
Q
Radiculopathy
A
Compression of nerve roots caused by disc herniation or osteophytes
LMN signs
14
Q
Myelopathy
A
Sompression of spinal cord caused by disc herniation, spinal tumor, spondylosis
UMN signs
15
Q
Cervical spondylosis initial imaging
A
Radiograph
16
Q
Cervical spondylosis diagnostic imaging
A
MRI
17
Q
Cervical spondylosis nonoperative management
A
Soft collar immobilization
NSAIDs
Steroid injection
18
Q
Cervical spondylosis operative management
A
If no response to conservative treatment or if have deteriorating radiculopathy or myelopathy
Discectomy with fusion
Cervical disc replacement
19
Q
Cervical sprain
A
Sprain of cervical spine ligaments or Strain of cervical paraspinous muscles caused by hyperextention or hyperflexion
20
Q
Cervical sprain clinical findings
A
Diffuse pain
No localized tenderness to palpation
Pain radiates down back and into shoulders
Decreased ROM
Occipital headache
Neck stiffness
21
Q
Spurling maneuver
A
Neck compression test testing for cervical sprain
22
Q
Cervical sprain treatment
A
Rest
Soft collar
NSAIDs
ROM exercise
23
Q
How long will cervical sprain symptoms last
A
8-10 weeks
24
Q
What to do if cervical sprain symptoms last more than 8-10 weeks
A
Lateral radiographs to check for late instability
25
Jefferson fracture
C1 (atlas) burst fracture
Axial compression fom occipital condyles being drien into atlas ring
Lateral masses driven outwards
Fracture of anterior and posterior ring
Transverse ligament displacement >7mm
ADI >4mm
26
Jefferson fracture imaging
Radiograph with open-mouth view
CT of spine without contrast
27
Hangman fracture
Traumatic spondylolisthesis of C2 (axis
Forced hyperextensio and distraction
Bilateral fracture of pars interarticularis
Fracture goes through neural arch of axis
High ration of spinal canal and cord size
28
Odontoid fracture
Fracture of odontoid process of axis (C2) from forcefull flexion or extension
29
Type 1 odontoid fracture
Avulsion fracture through tip of odontoid
Blood supply maintained
No ligament involvement
30
Type 2 odontoid fracture
Unstable fracture through base of odontoid at junction of vertebral body
31
Type 3 odontoid fracture
Fracture through body of axis
Blood supply maintained
Malunion possible (limits cervical rotation)
32
What classifies a spinal fracture as unstable
Three column involvement
Loss of vertebral body height >25%
Radiographic or neurologc eveidence of spinal cord involvement
Neurologic evidence of nerve root damage
33
Anterior wedge compression fracture
Compression fracture of anterior portion of vertebral body
34
Flexion tear drop fracture
Posterior longitudinal ligament disruption
Often unstable
35
Extension tear drop fracture
Disruption of longitudinal ligament
Usually stable
36
Vertebral compression burst fracture
VCS III
Fragments can extend into spinal canal
Unstable
37
Cervical spine trauma imaging
Flexion and extension views of lateral, AP, open mouth, right oblique, left oblique
Rule out neuro injury
CT without contrast is preferred but not everyone is stable enough
38
Cervical traction
Closed reduction of cervical spine with Gardner-Wells tongs
Only for complete or significant incomplete neurologic injury from traumatically malaligned cervical spine
39
Cervical unstable injury treatment
Halo-vest immobiliization
Skeletal traction
Surgical decompression
40
Thoracic disc disease symptoms
Back and/or lower extremity pain
Radicular - Extremity weakness/numbness and bowel/bladder dysfunction
Myelopathy - Spastic Gait with long-tract signs (hyperrreflexia and babinski/Hoffman's sign)
41
Thoracic disease initial imaging
Radiographs
Then conservative measures (NSAIDs and heat)`
42
Thoracic disease diagnostic imaging
MRI
CT myelogram if can't get MRI bc of metal implant
43
Thoracic disc disease treatment
NSAIDs, rest, PT
Myelopathy
44
Pectus excavatum
Concave chest
Associated with NOonan and Marfan
45
Pectus excavatum diagnostics
PFT
Echocardiography
Cardiac MRI
46
Haller index
Used to assess cardiac MRI for pectus excavatum
Normal is <2
consider surgery if over 3.25 and cardiopulmonary symptoms
47
Ravitch repair
Pectus excavatum
Bar sits under sternum pushing it outward as they are developing
48
Pectus carinatum
Chest portrudes out (pigeon breast)
Associated with Noonan and Marfan
49
Pectus carinatum treatment
FMF dynamic compressor presses on it
50
Jeune syndrome
Narrow and elongated thorax
Ribs shortened and horizonal
Limited chest movement with breathing
51
Poland syndrome
Missing or udnerdeveloped chest muscles
Shoulder, arm, and hand can be involved
52
Jarcho-levin syndrome
Thoracic spine vertebrae and multiple ribs fused
Thorax has crab-like shape
Spondylocostal dysplasia and spondylothoracic dysplasia
53
Sternal fracture symptoms
Antrior chest wall pain
Painful breathing/cough
54
Sternal fracture PE
Point tenderness
Ecchymoses
Palpable deformity
Soft tissue swelling
Flail chest
55
Sternal fracture initial imaging
AP and lateral CXR
56
Sternal fracture secondary imaging
Chest CT for secondary injuries
57
Sternal fracture treatment
Pain management
ORIF (open reduction internal fixation) for unstable (flail chest) or if not healing
58
Rib fracture causes
Trauma
Cancer
Severe cough
59
Rib fracture symptoms
Chest wall pain
Painful breathing
Painful cough
60
Rib fracture PE
Point tenderness
Ecchymoses
Palpable deformity
Soft tissue swelling
61
Rib fracture initial imaging
CXR
62
RIb fracture diagnostic imaging
Chest CT but often not needed
63
Rib fracture treatment
Pain management
INtercostal nerve block for pain
Incentive spirometry
Surgery or ORIF rarely needed
64
Thoracic kyphosis
Hunchback
65
Kyphosis treatment
Exercise rehab
Back brace
Postural taping
Alendronate for symptoms
Surgery for cases causing severe pain or pulmonary dysfunction
66
Thoracic outlet syndrome
Compresssion of blood vessesl or neves in space between clavicle and first rib caused by repetitive use, injury, or posture.
67
Thoracic outlet syndrome
Numbness and paresthesia of arm on effected side
Reproducile symptoms with overhead activity
Shoulder and neck pain
Weakened grip
Discoloration f hand
Diminished pulse
Adson's teast
68
Adson's test
Test for thoracic outlet syndrome
Testing for tight scalene
Monitor pt pulse while pt turns head toward same side.
If pulse goes away when head turns, sign of arterial throacic outlet syndrome
69
What to do if Adson's test is positive
Get arterial doppler
Vascular doppler
70
Throacic outlet syndrome diagnostic studies
Ultrasound
EMG
Vascular doppler studies (if Adson's test is positive)
71
Thoracic outlet treatment
DVT prophylaxis
PT
Catheter-directed thrombolysis
72
Chance fracture
Traumatic fracture of thoracic/lumbar spine rseulting from flexion-distraction injury.
Associated with GI injuries
Unstable
73
Chance fracture initial treatment
AP and lateral flexion/extension radiograph
74
Chance fracture diagnostic imaging
CT
75
Chance fracture treatment
Thoracolumbar spine orthosis (brace)
76
Lumbar strain physical findings
Tenderness to palpation
Pain radiating into gluteal region
Stiffness and pain with inactivity
pain relieved with light physical activity
Decreased ROM due to pain
77
Lumbar strain
Radiographs only if red flags
78
Lumbar strain treatment
pain management
Heat, creams, medications
79
Disc herniation clinical findings
Prodromal low back pain tha changes radiculopathy
Unable to bear weight on ipsilateral leg
Symptoms worsened by forward flexion and when sitting
Symptoms alleviated by extension
Pain down leg when elevating extremity
Lumbar radiculopathy
80
Disc herniation initial imaging
Radiograph
81
Disc herniation diagnostic imaging
MRI
82
Disc herniation treatmtent
Physical therapy
Pain management
Nerve root decompression surgery if won't heal, persistent neuropathy, or profound progressive motor deficit
83
Cauda equina syndrome clinical findings
Urinary retention
Incontinence
Saddle anesthesia
Decreased anal sphincter tone
Bilateral lower extremity weakness
84
Cauda equina syndrome diagnostic imaging
Emergent MRI
85
Cauda equina management
Emergent surgical decompression
86
Spinal infection cliniclal findings
Back pain worse at night
Usually non nero deficits unless spread to epidural surface and forms abscess
Fever
Malaise, fatigue
Weight loss
87
Spinal infection lab studies
ESR
CRP
CBC with differential (leukocytosis with left shift)
Blood cultures before abx
88
Spinal infection initial imaging
Radiograph
Radiolucency visible after 3-4 weeks
89
Spinal infection diagnostic imaging
MRI with contrast
90
Spinal infection treatment
Debridement and instrumented fusion
ABx specific to culture
91
Spinal tumor clinical findings
Constant back pain worse at night
Fevers, night sweats, weight loss
Localized tenderness to palpation
92
Spinal tumor diagnostic imaging
MRI
93
Spinal tumor treatment
Radiation and chemo
Palliative care (die in three months)
Surgery if beneficial
94
Degenerative disc disease
Age-related decline in water content of vertebral disc causing tears in annulus
95
Degenerative disc disease clinical findings
Discogenic back pain worsened with flexion (sitting) and improves with extension.
Axial back pain radiating to butt, thigh, and groin, usually not below the knee
96
Degenerative disc disease initial imaging
Radiographs
97
Degenerative disc disease diagnostic imaging
MRI
98
Degenerative disc disease treatment
PT
Anti-inflammatories
Muscle relaxers
NO surgery
99
Spinal stenosis
Degenerative and arthritic changes of neural foramen causing narrowing of spinal cord.
Usually >50yo but could be younger
Cooper Manning
100
Spinal stenosis clinical findings
Neurogenic back pain radiating to legs
Pain worsened with extension
Pain releived with flexion.
Feels better when leaning like pushing a shopping cart
101
Spinal senosis diagnostic imaging
MRI
102
Spinal stenosis treatment
Symptom management
Decompressive laminectomy if persistent pain or neuro deficitis
103
Sciatica
Impingement of L4, L5, S1 nerve roots.
Piriformis syndrome
104
Sciatic clinical findings
Radicular pain extending from gluteal region to posterolateral leg into the foot.
Numbness, tingling in sciatic nerve distribution
Symptoms worsened by sitting from copmpression of sciatic nerve
105
Sciatica management
Symptomatic treatment
PT
Trigger point injections
106
Spondylolisthesis
Slippage of vertebra
Result of spinal age-related degeneration
107
Spondylolisthesis clinical findings
Degenerative
Low back and leg pain improved with rest and worsened with standing or walking
Radicular symptoms
108
Spondylolisthesis diagnostic imaging
Radiographs
109
Spondylolisthesis treatment
Symptomatic treatment
Surgical decompresssion
110
Vertebral body compression fracture prevention
Maximizing bone density prior to bone loss
Osteoporosis screeening
Vitamin D and calcium supplementation
Bisphosphonates
111
Vertebral body compression fractures clinical findings
Many asymptomatic
Axial pain localized to fracture level
No history of trauma
No neurologic dysfunction
112
Vertebral body compression fracture diagnostic imaging
Radiographs
113
Vertebral body compression fracture treatment
Brace
Pain management
114
Best imaging to see torn labrum
MR arthrogram
115
Anterior Glenohumeral joint dislocation
Forced abduction and external rotation
Arm held in abduction on presentation
116
Posterior glenohumeral joint dislocation
Forced adduction and internal rotation
Arm held in adduction on presentation
117
Most common nerve injured in glenohumeral dislocation
Axillary
118
Glenohumeral dislocation imaging
Radiographs (Axillary, AP, Y)
119
Hill-Sachs lesion
Cortical depression of humeral head from glenoid rim during anterior dislocation
120
Bankart lesion
Inferior labrum torn from glenoid anteriorly in anterior dislocation
121
Glenohumeral dislocation management
Immediate reduction
Postreduction radiographs adn NV exam
Put arm in sling
Pain management
122
Contraindication to closed shoulder reduction
Greater tuberosity fracture with >1cm displacement
Hill Sachs
Surgical neck fracture
Bankart fracture
Proximal humerus fracture of 2 or more parts
123
Orhtopedic follow up after closed shoulder reduction
Sling for 3-6 weeks
Three phases over 9 weeks
124
Glenohumeral dislocation complications
Axillary nerve injury
Rotator cuff tear
Hill Sachs lesion
Bankart lesion
Recurrent instability
Proximal humerus fracture
125
Gold standard imaging for axillary nerve palsy after dislocation of glenohumeral dislocation
EMG
126
Quadriilateral space syndrome
Axillary nerve and/or posterior circumflex artery entrapped
Causes shoulder pain, paresthesias in axillary nerve dermatome (C5/C6)
Point tenderness
Treat with PT
127
Multidirectional glenohumeral joint instability cause
Repetitive microtrauma
Hypermobility disorders: marfans, eds, osteogenesis imperfecta
128
Multidirectional glenohumeral joint instability presentation
Activity related shoulder pain
+sulcus sign
+apprehension test
129
Multidirectional glenohumeral joint instability treatment
PT
Possibly surgery
130
AC separation cause
Direct trauma at superior or lateral aspect of shoulder with arm adducted
131
AC separation clinical presentation
Pain over AC joint or trapezius
Holding arm close to chest
AC joint/lateral clavicle tenderness
Asymmetrical contour to contralateral shoulder
Step-off deformity
Crossover adduction test checking for pain in AC joint in passive adduction
132
AC separation imaging diagnosis
Bilateral and AP radiographs
Axillary view for type IINcrease in coracoid distance (usually 1-3mm)
133
Rockwood classification of AC joint
1. Sprain or partial tear to AC ligaments
2. Complete tear of AC ligaments with increased CC distance
3. COmplete tears of both AC and CC ligaments and increased CC distance
4. Complete tears of AC and CC ligaments with displacement of distal clavicle into or through trapezius
5. Complete tears of AC and CC ligaments along with disruption of muscular and fascial attachments of distal clavicle.
6. Rae and involve several dislocations of AC joint which distal clavicle forced into cub-coracoid postition
134
AC separation types 1 and 2 management
Rest, ice , sling
PT
Return in 3 days - 4 weeks
135
AC separatoin type 3 treatment
Rest, ice, pain management, sling
Maybe surgery
Return 6-12 weeks
136
AC separations types 4-6
Surgery
137
Sternoclavicular joint separation imaging
X-ray serendipity view
CT with 3D reconstruction
MRI if ligament concern
CT angiograph if concern for subclavian compression
138
Sternoclavicular joint separation treatment
Closed reduction followed by sling for 4 weeks
139
Clavicle fracture cause
FOOSH
140
Clavicle fracture clinical presentation
Localized pain exacerbated by moving arm
Swelling
Snap sound at time of injury
Bruising
Tenderness
141
Exams to do on clavicle fractrue
NV exam
Respiratory exam
142
Clavicle fracture imaging
Radiographs (AP, Zanca,)
CT for pre-op or SC joint dislocation
CTA to check vasculature
143
Clavicle fracture management
Pain control
SLing for 3-4 weeks
Surgery for mid and proximal with lots of displacement or for distal fractures
144
Scapula fracture imaging
Radiographs (True AP, Y, axillary)
CT with 3D reconstruction is diagnostic
145
Scapula fractrue tretment
Sling for 1-2 weeks
Surgery if shoulder unstable, displaced scapular neck, open fx, loss of rotator cuff function, coracoid fx with >1cm displacement
146
Proximal humerus fracture cause
Falls
Direct blow
Dislocations
Pathologic
147
Proximal humerus fracture presentation
Pain and swelling
Decreased ROM
Exxhymosis
Holding arm in fixed position
Tender
Pucker sign
148
What exams to perform for proximal humerus fracture
NV
Chest and lung
Axillary nerve injury very common
149
Proximal humerus fracture imaging
Radiographs (AP, axillary, Y)
CT for pre-op or intra-articular comminution
MRI rare
150
Proximal humerus fracture treatment
Sling for non-operative
151
Muscle most likely to be involved in rotator cuff injury
Supraspinatus
152
Impingement syndrome
Symptoms from compression of structures in subacromial space caused by AC joint, acromion, or CA ligament
153
Impingement syndrome treatment
Rest 4-8 weeks
PT
NSAIDs
Heat
Steroid injection
Arthroscopy
154
Rotator cuff tendinitis cause
Inflammation of rotator cuff tendons and bursa
Repetitive motion at or above shoulder
155
Rotator cuff tendinitis rpresentatoin
Pain with overhead reaching
Crepitus
Locking sensation with certain movements like abduction
Pain with abduction
+neer test
+hawkings kennedy t4est
+empty can test
+lift off test
156
Rotator cuff tendinitis imagine
Usually just clinical
Radiograph if suspect co-existing problem
MRI if therapy fails
157
Rotator cuff tendinitis treatment
Rest 4-8 wekks
PT
NSAIDS
Heat
Steroids
Surgery if conservative doesn't work and after MRI
158
Most common muscle involved in rotator cuff tear
Supraspinatous
159
Rotator cuff tear clinical presentation
Pop/snap before pain
Shoulder weakness
Night pain
Weak with abduction and external rotation
+drop-arm test
+empty can test
160
Rotator cuff tear DIAGNOSTIC imaging
MRI
161
Rotator cuff tear treatment
Pain management for partial tears.
Surgery for full tears or failed other management
162
Rotator cuff tear post-op
Sling for 6 weeks
163
Labral tear cause
Athletes that do overhead stuff (baseball, twnnis, swimming)
164
Labral tear mechanism
Shulder abduction and external rotation with biceps tendon twist causing tear
165
Labral tear clinical presentation
Pop in shoulder at time of injury
Anterior shoulder pain
Catching sensation
+Obrien's sign or +compression test
Usually +apprehesnsion test
166
O'Brien test
Tests for SLAP lesion (labral tear)
Shoulder flexed to 90 and adducted 15º
Downward pressure form examiner with shoulder internally and externally rotated.
Pain with internal rotation that decreases with external rotation with clicking is positive sign
167
Labral tear DIAGNOSTIC imaging
MRI
168
Labrum tear treatment
Rest, ice, NSAIDs
PT
Arthroscopic debridement if conservative doesn't work
169
Adhesive capsulitis
Frozen shoulder
Assocaited with T2DM
Can occur after bicipital tenosynovitis and rotator cuff tendinitis
170
Three phases of adhesive capsulitis
1. Freezing - Disabling shoulder pain (2-9 months)
2. Frozen - Stiffness and loss of shoulder motion (4-6 months)
3. Thawing - Gradual return of motion (6-24 months)
171
Adhesive capsulitis clinical presentation
Shoulder pain radiating down deltoid and anterior aspect of arm
Arm held close to chest
Atropny
Tenderness
Decreased AROM and PROM
172
Adhesive capsulitis diagosis
Clinical
173
Adhesive capsulitis treatment
Pain management
Manupulation under anestehsia
174
Calcific tendinitis
Similar presentation as adhesive capsulitis, but cuse is calcium deposits within tendon
Treated by steroid injection
175
Glenohumeral arthritis
Degenrative joint disease with articular cartilage of glenoid and/or humeral head
176
1º glenohumeral arthritis pathophys
Degeneration of articular cartilage and subchondral sclerosis
Humeral head flattening, osteophyte formation, joint space narrowing
177
2º glenohumeral arthritis pathophys
Post-traumatic
Rotator cuff arthropathy
Dislocation arthropathy
Rheumatoid arthritis
Avascular necrosis
178
Glenohumeral arthritis presentation
Shoulder pain worse with ROM better with rest
Difficulty sleeping
Stiffness
179
Glenohumeral arthritis imaging
Radiographs (true AP, axillary) showing joint space narrowing, osteophyte formation, high humeral head
MRI to check rotator cuff for surgery
180
Glenohumeral arthritis treatment
1. PT, NSAIDs, steroid injections
2. Arthroscopic debridement
181
Biceps tendonitis clinical presentation
Anterolateral shoulder pain down radiating down anterior arm
Muscle spasms
Pain increased with exercise
Decreased ROM
+Yergason's test
+speed test
182
Wrist pain clinical presentation
Pain, swelling, bruising, maybe popping
Tender
Erythema
Edema
Echymosis
183
What time makes wrist pain chronic
>3months
184
Most common cause of wrist sprain
FOOSH
185
Wrist sprain imaging
PA, lateral, and oblique radiographs
186
Sprain grades
1. stretching and small tears
2. larger tear
3. complete rupture
187
Grade one wrist sprain treatment
Rest
Ice
Compression
Elevation
188
Grade 2 wrist sprain treatment
Splint 1-2 weeks
PT
189
Grade 3 wrist sprain treatemtn
Surgery
Immobilization for 6-8 weeks
PT
190
Ganglion cyst
Benign fluid filled swelling over joint or tendon shift.
Most commmon on dorsal wrist
191
Ganglion cyst diagnosis
Transillumination
Ultrasound
MRI
192
Ganglion cyst treatment
Observation
Aspirate if bothersome
Surgery for persistant or reccurent
193
Ganglion cyst complications
Median or ulnar nerve compression
Hand eschemia
194
Carpal tunnel syndrome
Compression of median nerve
195
Where does median nerve come from
C6-T1
196
Carpal tunnel clincical features
Pain and paresthesia of median nerve distribution (lateral three digits and lateral half of fourth)
Provoked by prolonged flexion or extension of wrist
197
Carpal tunnel physical exam
Phalen maneuver
Tinel test
Durkan test
Thenar atrophy
Increased two point discrimination
Decreased strength in opposition of thumb and grip stringth
198
Phalen meneuver
Bring pts dorsal surfaces of hands against each other and flex wrists while elbows flexed
Symptoms = + test for carpal tunnel syndrome
199
Tinel test
Percussion over median nerve just proximal to carpal tunnel
Symptoms = + test for carpal tunnel syndrome
200
Durkan test
Apply pressure over transverse carpal ligament over 30 seconds
Symptoms = + test for carpal tunnel syndrome
201
Carpal tunnel syndrome diagnosis
Nerve conduction study
202
Carpal tunnel syndrome treatment
Splinting at night
Glucocorticoids
Surgery for severe
203
De Quervain's tenosynovitis
Stenosis tenosynovitis inflammation of first dorsal compartment of wrist.
Affects abductor pollicis longus and extensor pollicis brevis tendons
Common in golfers and racket sports
204
De Quervain's tenosynovitis clinical features
Pain at radial side of wrist worsened with thumb movement
Pain holding or gripping objects
205
De Quervain's tenosynovitis physical exam
Normal wrist motion
Pain with resisted radial deviaiton
Finkelstein test
206
Finkelstein test
Pt makes fist over thumb and ulnar deviates
207
De Quervain's tenosynovitis treatment
Forearm thumb spica splint
NSAIDs
Ice
Glucocorticoid
Surgery for severe
208
Most common fracture site in upper extremity
Distal radius fracture
209
Distal radius fracture mechanism of injury
FOOSH
210
DIstal radius fracture presentation
Wrist pain
Swelling
Possible deformity
211
Distal radius fracture presentation
Assess neurovascular
Check motor and sensory of medial, radial, and ulnar
ROM of wrist
Palpate snuffbox
212
Distal radius fracture diagnosis
PA and lateral radiographs
213
Colles fracture
Distal radius fracture with dorsal angulation
FOOSH injury
214
Smiths fracture
Distal radius fracture volar angulation
Fall on flexed wrist
215
Distal radius fracture treatment
Take rings off
Reduction
Elevation
Ice
pain management
Sugar tong splint
Open reduction internal fixation (ORIF - screw stuff in bone)
216
Distal radioulnar joint dislocation cause
FOOSH
217
Distal radial ulnar joint dislocation symptoms
Pain with supination and pronation of wrist
218
Distal radioulnar joint dislocation imaging
AP and lateral radiographs
219
Disstal radioulnar joint dislocation treatment
Reduction and cast for 6 weeks
If fracture of radial shaft, need surgery
220
Scaphoid fracture cause
FOOSH
221
Scaphoid fracture complications
Avascular necrosis and nonunion from lack of blood supply from dorsal carpal branch of radial artery
222
Scaphoid fracture presentation
Pain in radial aspect of wrist (anatomical snuffbox)
Swelling
Reduced grip strength
223
Scaphoid fracture imaging
PA, lateral, oblique, and scaphoid view radiographs
224
Scaphoid fracture treatment
Treat like fracture even if radiograph negative
Thumb spica splint
Pain control
Surgery for severe (percutaneuous screw fixation
225
Scaphoid fracture follow-up care
DIstal - -4-6 weeks
Waist (midbody) - 12-20 weeks
Nondisplaced fractures need radiographs every two weeks
PT and OT
Follow up every three months for a year
226
Dupuytren contracture
Progressive fibrosis of palmar fascia forming noules
Leads to joint stiffness and loss of full extension
227
Dupuytren contracture presentation
Painless loss of motion of affected fingers
Flexion contracture
What papa had
228
Dupuytren contracture treatment
ROM exercise
lostridium, hiistolyticum, collagenase injections
Glucocorticoid injection for persistent
Surgery (papa)
229
1st metacarpal joint arthritis symptoms
Pain in joint
Weakened pinch strength
Stiff thumb
Swelling, edema
Deformity of thumb
230
1st metacarpal joint arthritis imaging
AP, lateral, and robert's view radiographs
231
1st metacarpal joint arthritis treatment
Splinting
Pain management
Rest
Surgery for sever (fusion/arthrodesis/joint replacement/arthroplasty)
232
Ulnar collateral ligament injury mechanism
Forced abduction of thumb causing ligament to tear
233
Ulnar collateral ligament injury presentatoin
Thumb pain worsened with extension or abduction
Swelling of ulnar aspect of thumb and MCP joint
Increased passive ROM of thumb
234
Ulnar collateral ligament treatment
Immobilization with thumb spica for 4-6 weeks
Surgery in pts with instability wven with splinting
235
Bennet fracture
Most common thumb fracture
Ulnar-volar metacarpal base
Needs surgery
236
Rolando fracture
Thumb fracture
Commminuted intra-articular base fracture
Y or T shaped fracture of first metacarpal
Needs surgery
237
Bennet and rolando fractures treatment
Closed reduction
Put thumb in spica splint and refer to hand specialist for surgery
238
Metacarpal fracture physical exam
Painful and limited ROM
Cap refill
Sensation
INtreinsic muscle movement (abduction and adduction)
239
Boxer fracture
Fracture to fifth metacarpal neck
240
Metacarpal fracture treatment
Closed reduction and splinting
Surgery if bad
241
Finger dislocation diagnosis
AP, lateral, and oblique views
V sign
242
Finger dislocation treatment
Closed reduction
Splint for 1-2 weeks
243
Trigger finger
Stenosing flexor tenosynovitis
Isssue with flexor tendons and surounding pully system (A1)
244
Trigger finger presentation
Painless snapping, catching, or locking of finger durnig flexion
Can lead into painful episodes
245
Trigger finger presentation
Glucocorticoid injection
Ultrasound guided surgery if other treatment fails
246
Mallet finger
Traumatic disruption of terminal extensor tendon distal to DIP joint
247
Mallet finger mechanism of injury
Jamming finger on football
248
Concurrent avulsion fracture clinical presentation
Usually middle or ring finger
Pain over dorsum of DIP joint
Swelling, echymosis, deformity
Inability to extend DIP joint
DIP joint flexed at rest
249
Concurrent avulsion fracture imaging
AP, lateral, and oblique views
250
Concurrent avulsion fracture treatment
Extension splinting of DIP joint for 6-8 weeks 24/7
251
Jersey finger cause
DIP jiong suddenly and forcefully hyperextended
Leads to rupture of flexor digitorium profundus tendon at insertion of distal phalynx
252
Jersey finger presentation
Usually ring finger
Inability to flex DIP joint
Pain and swelling over DIP joint
Affected finger is slightly more extended at rest
253
Jersey finger imaging
AP, lateral, oblique views
May have associated avulsion fracture
254
Jersey finger treatment
Surgery
255
Swan neck deformity
Hyperextension of PIP joint
Flexion of DIP
Common in rheumatoid arthritis
256
Swan neck deformity treatment
Splinting of PUP to prevent hyperextension
257
Boutonniere deformity
Deformity of fingers characterized by PIP flexion and DIP extension
Common in rheumatoid arthritis
Rupture or injury to central slip of extensor tendon (check with Elson's test)
258
Cubital tunnel syndrome
Entrapment and compression of ulna nerve
Between two head s of flexor carpiulnaris and aponeurosis
OR medial intermuscular septide and thickening of brachial fasica
OR Osborns ligament and medial collateral ligament
259
Cubital tunnel sydnrome presentation
Paresthesia in ulnar nerve distribution (pinky and medial half of ring and medial half of dorsal hand
Pain in elbow and forarm worse with elbow flexion
Weakened grip
Claw hand
Interosseous and first web space atrophy
260
Cubital tunnel syndrome treatment
NSAIDs
Elbow padding
Night brace that puts arm at 45º
NO CCS injection
Decompressive surgery if other treatment doesn't work for three months
261
Olecranon bursitis presentation
Swelling over olecranon/elow
Erythema
Tender to palpation
Full ROM
No pain with movement
If septic, warm, tender, erythematous drainage
262
Olecranon bursitis diagnosis
Radiographs to rule out olecranon fracture
CBC, CRP, ESR, gram stain when expecting septic bursitis
CT to check for osteomyelitis
263
Olecranon bursitis treatment
Heat, rest, NSAIDs
CCS
Elbow padding
Elective bursectomy if needed
264
Septic bursitis treatment
Systemic Abx (vanc)
Incisino an ddrainage
Immobilization in splint for wound healing
265
Proximal bicep tendon rupture clinical findings
Sharp pain at anterior shoulder and antecubital fossa
SNap or pop
Edema, ecchyosis
Popeye sign
266
Distal biceo tendon rupture clinical findings
Sharp pain at antecubital fossa
Palpable defect
Edema and echymosis
Reverse popeye sign
Weak flexion and supination
267
Hook test
Check for bicep tendon rupture
Pt flexes elbow to 90
Provider can hok indecx finger icm below tendon
Tendon not there if torn
268
Bicep tendon rupture treatment
Sling immobilization for elderly and partial tears
Surgery for complete tears or young that still use arm a lot
269
Ulnar collateral ligament
Stabilizes elbow at medial aspect of joint
270
Ulnar collateral ligament tear physical exam
Tenderness around medial elbow
Pain with valgus stress test
271
Valgus stress test
Tests for Ulnar collateral ligament tear
Flex elbow between 20-30º and externally rotate humerus and externally rotate humerus and apply valgus stress
272
Ulnar collateral ligament tear imaging
Elbow radiographs
MRI arthrogram is DIAGNOSTIC
273
Ulnar collateral ligament tear treatmetn
Rest 8-12 weeks
NSAIDs
Ice
PT 12 weeks after pain goes away
Tommy John if that doesn't work
274
Elbow dislocation Immaging
AP, lateral, an doblique views
CT scans if fragmentation
275
Elbow dislocation treatment
Urgent reduction with conscious sedation
Assess neurovascular and get post-reduction radiographs
Long arm splint 90º
PT
ORIF if closed reduction can't be done
276
Most common nerve trapped after elbow reduction
Ulnar nerve
277
Lateral epicondylitis
Tennis elbow
Inflammation of extensor carpi brevis tendon at lateral epicondyle
Overuse of wrist extension
278
Medial epicondylitis
Golfer's elbow
INflammation of pronator and flexor tendon at medial epicondyle.
Overuse of wrist flexion and pronation
Pronator teres
Flexor carpi radialis
279
Lateral epicondylitis findings
Lateral ellbow pain worsened by physical activity
Pain radiates to dorsal forearm
Tenderness to palpation of lateral epicondyle
Diminished grip strength
Cozen t4est - fresisted wrist extension
280
Medila epicondylitis clinical findings
Medial elbow pain worsened by repetitive wrist flexion
Tenderness to palpation of medial epicondyle
Pain elicited with resisted wrist flexion and forearm pronation
Tinel sign negative
Varus and valgus testing
281
Lateral epicondylitis treatment
Limited activity for 6-12 weeks
Lateral counterforce bracing
PT
Steroid injection short term
Surgical debridement of extensor carpi radialis brevis
282
Medial epicondylitis treatment
Limited activity for 6-12 weeks
Lateral counterforce bracing
PT
Steroid injection short term
Consider ulnar nerve injury
Surgical debridement of flexor-pronator group
283
Humeral shaft fracture clinical findings
Shortened limb
Pain, swelling
extremity weakness
Neurovascular exam
Radial nerve injury possible
284
Humeral shaft fracture imaging
AP and lateral radiographs showing extremity above and below
MRI for suspected pathologic fracture
285
Humeral shaft fracture treatment
Spint then sarmiento brace
ORIF if needed (obese, pts who need arms to use walker)
286
Distal humerus fracture cause
FOOSH
Most traumatic fracture in children
287
Distal humerus fracture clinical findings
Elbow pain and swelling
Instability
Neurovascular exam
ROM limited due to pain
288
Distal humerus fracture imaging
AP, lateral, and oblique radiographs
CT for surgery
289
Distal humerus fractue treatment
Posterior long arm spling and follow up
Cast immobilization
Closed reduciton and percutaneous pinning
290
Radius fracture imaging
Elbow AP, lateral, and oblique
Forearm AP and lateral
291
Radial head and neck fracture cause
FOOSH
292
Radial head and neck fracture treatment
Immobilization 3-7 days
or ORIF
293
Terrible triad
Radial head fracture
Posterolaterla elbow dislocation
Coronoid fracture
Poor stability even following surgery
Can lead to post-traumatic arthrtis
294
Galeazzi fracture
Distal 1/3 of radial shaft fracture
Distal radioulnar joint injury widening
295
Galeazza fracture cause
Direct wrist trauma
FOOSH
Forearm pronation
296
Galeazzi fracture findings
Pain, swelling, deformity, tenderness, ecchymosis
Decreaseed supination/pronation due to pain
Distal radioulnar joint stress exicits laxity
297
Galeazzi fracture diagnosis
3 view s of elbow
2 views of forearm
3 views of wrist
Widening of distal radioulnar joint
298
Galeazzi fracture treatment
ORIF
299
Olecranon fracture clinical findings
Pian or swelling over elbow
Loss of extensor mechanism
Pain localized posterior elbow
Palbable defect over olecranon
300
Olecranon fracture treatment
Immobilization in long arm splint
Begin ROM at 1 week
Operative: tension band, intramedullary fixation, open reduction internal fixation
301
Nightstick fracture cause
Blocking direct blow to head
302
Nightstick fracture
Isolated racture of ulnar shaft
303
Monteggia fracture
Proximal 1/3 ulna fracture
Radial head dislocation
Common in children
304
Monteggia fracture mechanism
FOOSH
305
Monteggia fracture clinical findings
Pain, swelling, deformity, tenderness, echymosis
Decreased felxion, extension, supination, pronation due to pain
Posterior interosseous nerve problems
306
Monteggia fracture treatment
Closed reduction and immobilization
Cast in supination
307
Both bone forearm fracture
Mid shaft fracture of radius and ulnar
308
Both bone forearm fracture clinical findings
Pain, swelling
Loss of hand and forearm function
Obvious deformity on inspection
Neurovasculalr exam
309
Both bone forearm fracture imaging
Forearm AP and lateral
Elbow AP lateral and oblique
Wrist AP lateral and oblique
310
Both bone forearm fracture treatment
Closed reduction and immobilization for children
Open reduction in internal fixation for adults
311
Compartment syndrome
Trauma causing soft tissue ditruction, bleeding, edema, increased interstital pressure, vascular occlusioin, myoneural ischemia
312
Compartment syndrome clinical findings
Piain, paresthesia, pallor, paralysis, pulselessness, poikilothermia
Pain with passive stretch of fingers
Paresthesia
Too late has palpable swelling, peripheral pulse abscence, poikilothermia
313
Compartment syndrome diagnosis
Intercompartmental pressure within 30mm Hg or less diastolic BP
Need fasciotomy if positive
314
