Orthopedic - 8% Flashcards
(55 cards)
1
Q
Acromioclavicular Joint Sprains
A
Direct blow to tip of shoulder or upward force on long axis of radius
Sxs:
- Pain/point tenderness over tip of shoulder
- +/- deformity
- can’t reach above head
Dx:
- weight X ray
Tx
- Sling
- analgesics
- PT
- +/- Surgery
2
Q
Ankle Sprain
A
Inversion sprain - Lateral malleolus strain AFTL
Ecchymosis and edema
Xray to r/o fracture
Dx - Canadia-Ottawa ankle to get X ray
- Pain in malleolar zone +
- pain in lateral malleolus (tip or posterior edge)
- pain in medial malleolus (tip or posterior edge)
- inability to bear weight immediately or in EM for 4 steps
Tx:
- RICE
- Splinting and casting
- PT
- acute vs chronic
3
Q
Back Strain/Sprain
A
Thoracic and Lumbar MCC
Sxs:
- D/t lifting, twisting or strenuous activity
- worse with activity, better with rest
- Stiffness, Axial back pain, Difficulty bending
- No radicular sxs, No neuro changes (below knee)
Tx
- Bed Rest < 2 days
- NSAIDs
- +/- muscle relaxant - cyclobenzaprine or short term Benzo Re-eval if no improvements in 4 wks
- Resume activities as tolerated
4
Q
Bicep Tendonitis
A
Sxs
- Pain at bicep groove
- Ant shoulder pain - r-> biceps
- Pain w/ resisted supination of elbow
- Popeye deformity
Dx
- Speed’s + pain in bicep groove when elevate shoulder against examiner’s resistance
- Yergason’s - elbow flexed at 90degrees, wrist supination against resistance, + if pain produced
Tx
- NSAIDs
- PT strengthening
- Steroid injections
- Surgical release
5
Q
Carpal Tunnel Syndrome
A
Compression of Median Nerve, dt overuse, repetitive motions
SxS:
- numbness thumb to mid of ring finger (no pinky)
- tingling
- thenar wasting
Dx:
- Tinel’s
- Phalen’s
- Electrodiagnostic studies - gold standard
Tx
- wrist splint - cock up
- NSAID
- ergonomic adjustments
- PT, steroid
- Surgery
6
Q
Cervical Radiculopathy
A
MC C5-C6 or C6-C7, nerve root irritation or impingement
Posterolateral
Sxs:
- pain into arms/shoulders
- tingling with pain at rest, +/- numbness
- Loss of reflexes
- C7 is nerve root
Dx:
- lateral X-Ray - must see all 7 vertebrate
- Spurling’s test - Compression Test (head pressed backwards towards spine) = Pain reproduced
- Cervical distraction = pain relieved
- MRI - soft tissue, nerves
Tx:
- Rest - immobilization
- NSAIDs/ analgesics
- CS and PT
7
Q
Cervical Sprain/Strain
A
Sxs
- Headache, Stiffness in Neck
- Paraspinal muscle
- Tenderness and spasms
- Numbness and tingling in extremities
Dx
- Spurling test for cervical radiculopathy
- Lateral X ray - 7 vertebrae
Tx
- Rest
- NSAIDs
- muscle relaxants - cyclobenzaprine
- PT = gental ROM
8
Q
Compartment Syndrome
A
Pressure incr in compartment - EMERGENCY
MC anterior compartment in Lower leg
Sxs
- 5 P-s
- Volkman’s contracture
Dx
- Normal pressure < 10mm Hg
- Delta pressure - diastolic BP - measured compartment pressure - if > 30 mmhG, fasciotomy
Tx
- Fasciotomy
9
Q
Costochondritis
A
Acute inflammation of the costochondral, costosternal or sternoclavicular joints
Common after viral infx or MSK trauma
sxs:
- Pleuritic chest pain - sharp, stabbing
- Worse with inspiration, coughing, & certain mvmts
Dx:
- localized tenderness and pain 2-5th costochondral junction
- no edema
-
pain reproducible with palpation
- Tietze’s Syndrome is at 2-3rd ICS
- R/o cardiac and PE = EKG, Trop, echo
Tx:
- NSAIDs, tylenol
- heating pads
- PT, and Steroids
10
Q
deQuervain’s Tenosynovitis
A
W 30-50yo
Sxs:
- pain, swelling, point tenderness along dorsal aspect of wrists
Dx:
- +Finkelstein’s
Tx:
- Rest
- Thumb spica/splint immbolization
- NSAIDs, PT, CS
11
Q
Epicondylitis
Medial and Lateral
A
Lateral Epicondylitis - Tennis Elbow
overuse of injury of extensors and supination
Medial Epicondylitis - Golfer’s / Litter league
Pronator and flexor muscles groups
Tx
- ICe/Heat
- NSAID, PT
- Elbow scrap
- Steroid injection
12
Q
Fifth Metatarsal Fracture vs Jones
A
heels and twisting ankle inversion
Jones Fracture
- base of 5th MT at metaphyseal diaphyseal junction
- ORIF = high risk of avascular necrosis
13
Q
Boxer’s Fracture
A
Fracture of neck of 5th/4th metacarpal;
Eikenella, Staph and Strep
- Punch with clenched fist
- no knuckle sign
Tx:
- Reduce to anatomic position
- Abx if skin breakdown - with Augmentin
- Ulnar gutter split w/ joints in 60 degree flexion
- Immobilization 4-6 wks
- Surgical repair => cast immobilization
14
Q
Colle’s Fracture
A
FOOSH - distal radius fracture
- Dorsal angulation (top of hand) extra-articular
- dinner fork deformity
Dx - lateral xray
Tx
- Conservative
- close reduction
- sugar tong splint, immobilization with cast for 4-6 wks
- Surgery
- ORIF followed by cast/splint immobilization for 4-6 weeks
15
Q
Shoulder Fracture (Proximal Humerus)
A
MC in elderly for low velocity
complications = adhesive capsulitis/RC Tear
Sxs:
- inability to hold wrist up = radial n palsy aka wrist drop
Dx:
- Xray
Tx
- immobilize 4-6 wks - sling and swathe
- then begin gentle passive ROM and modalities
- Progress to light strengthening after 6 wks
- Surgery if displaced or rotated
16
Q
Scaphoid Fracture
A
FOOSH
Sxs:
- pain on radial surface of wrist at anatomical snuffbox
- leads to avascular necrosis - radial artery
Dx:
- X-Ray = Fracture may not be evident for >2wks, if no frx on Xray - tx as fracture and immobilize.
- Repeat Xray in 2 wks
Tx:
- Non-displaced = Long vs short thumb spica 10-12wks
- Displaced = surgical fixation
17
Q
Smith’s fracture
A
Fracture of distal radius w/ volar angulation and displacement
garden spade deformity - fall w/ palm closed, hands flexed, blow to back of wrist
Median n injury –> develop carpal tunnel over time
Sugar tong Splint
18
Q
Supracondylar Fracture
eti, sxs
A
MC Peds elbow frx - FOOSH
Gartland Classification:
- I, II, III - Extension Type
- IV - Flexion Type
*Anterior Interosseous Nerve (AIN) MC injured in Type I-III
Brachial Artery MC Vascular Structure Damaged → Volkmans Contracture (Radial nerve contracture)
- Type I - FOOSH, non-displaced, posterior fat pad sign
- Type II - FOOSH, angulated fx w/ distal posterior segment
- Type III - FOOSH, complete frx through cortext and posterior displacement of distal frx
- Type IV - Flexed frx, fall on flexed elbow, anterohumeral line falls posteriorly to capitulum
19
Q
Supracondylar Fracture
Dx, tx
A
Lateral X Ray
Type I:
- Without NV compromise
- Cast in flexion <90 degrees for 3wks
- Re-evaluate & x-ray
Type II:
- Refer same day
- Closed Reduction and +/- pinning/fixation
- Casting
Type III:
- Refer same day
- Reduction and Internal Fixation
- Casting
Type IV:
- Refer same day
20
Q
Radial Head Fracture
A
Pain and tenderess along lateral aspect of elbow; limited ROM elbow/forearm
MCC FOOSH
- Usu see anterior fat pad sign/sail sign
- Posterior Fat pad sign - occult elbow fracture
Tx
- Splint, sling
- Analgesic
- PT
21
Q
Galeazzi Fracture
A
Distal radial shaft fracture, dislocation of ulna d/t FOOSH on pronated hand
sxs:
- wrist pain
- swelling
- pain with extension/flexion
Radial n injury
ORIF
22
Q
Ganglion Cyst
A
Painless, swelling on wrist and hand, dorsal MC
Dx - transilluminate
Tx
- observe and reassurance
- Surgical excision if pt really bothered
23
Q
Hip Dislocations
A
High impact trauma - usu from MVA dashboard => 90% posterior
Sxs:
- limbed shortened
- internally rotated
Dx:
- XR and CT r/o frx
Tx:
- Reduction promptedly
24
Q
Hip Fractures
A
Subcapital/Femoral Neck = wary of avascular necrosis of femoral neck
intertrochanteric; Subtrochanteric
Sxs:
- Pain
- inability to wb
- shortened leg - external rotation
Dx:
- XR
Tx - ORIF
25
Hip Osteoarthritis
breakdown, loss of articular cartilage btwn bones - age, injury
Sxs:
* pain in **groin region**
* decrease ROM, abduction
* pain with ambulation, climbing stairs
Dx:
* X-ray
Tx
* Activity mod
* Shoewwear
* NSAIDs
* Wt loss
* joint CS injection
* Total joint replacement
26
Humerus Shaft fracture
MOI - direct blow
MCC radial n. injury, posterior fat pad/sail sign
- pain, swelling, deformity, shortened extremity
- motion at fracture site
Tx with sugar tong splint
ortho f/u in 24-48 hrs
27
Anterior Cruciate Ligament Tear
Twisting motion - change in motion/speed, direction
Sxs:
* **Pain with instability - knee giving out**
* Hemarthrosis - swell up with blood
Dx:
* Anterior drawer
* Lachman's
Tx:
* RICE, PT, bracing, Progressive return to activity
* Surgical reconstruction w/ **patellar tendon or hamstring** or cadaver's tendon
28
Medial and Lateral Collateral Ligament Injury
Knee forced into **VALGUS** - hit on outside of knee L
* MCL tear
Knee forced into **VARUS** - hit on inside of knee (inner thigh)
* LCL tear
Dx - **MRI gold \*\*\***
Tx
* RICE
* Brace
* WBAT - crutches
* PT/surgery
29
Meniscus Injury
Traumatic vs degenerative
Sxs:
* **Twisting injury**
* Triad
* joint line pain
* effusion - 6-24 hrs post injury
* locking
Dx:
* **MRI- Gold \*\*\*\***
* **McMurray's** - knees flexed and
* Tibial Externally rotated - **medial** **meniscus**
* Tibia Internal rotated - **lateral meniscus**
* **Apley's Compression**
* ****axial loading = pain
Tx:
* Rest
* Activity Mod
* NSAIDs
* PT
* CS
* Surgery
30
Lisfranc Injury
Fracture/dislocation of **1st/2nd TMT joint**
MOI - MVA, fall from height
Low energy - stepping off curb or hole
**Swelling in mid foot**, non WB
Dx:
* X ray
* CT
Tx:
* Displacement \> 2mm not good = surgery ORIF
* Non-displaced NWB cast immobilization x 4-6wks
31
Lumbar Radiculopathy
Compression of nerve caused by disc
pain in dermatomal region
incr pain with coughing, straining, sitting, bending
Dx
* MRI - non contrast
* Straight Leg Raise = + if numbess and tingling
* 15-30 degrees = severe
* 30-60 degrees = mild to moderate
* red flags of back pain
Tx:
* Rest
* NSAIDs
* CS injection - epidural steroid injections
* PT
32
Monteggia Fracture
Proximal 1/3 ulnar shaft fracture w/ radial head dislocation d/t FOOSH
sxs
* elbow pain and swelling
* tenderness to palp along elbow
* decreased elbow ROM
tx
radial n injury
ORIF
33
Nightstick Fracture (ulna)
MCC Direct blow to midshaft of ulna
Pain and bruising at site
eval for abuse victims
Tx
* functional brace w/ good interosseous mold for isolated/nondisplaced
* ORIF for displaced
34
Olecranon Bursitis
**Painless** inflammation of bursa;
swelling dev's gradually (chronic) or acutely (infx)
Dx:
* X ray if trauma
* Aspirate and culture if septic
Tx:
* RICE
* elbow pad\*\*\*
35
Osgood-Schlatter Syndrome
Pain at tibial tuberosity d/t growth spurt
## Footnote
Self limiting
ice
quad strengthening
Knee patellar strap
36
Osteomyelitis
Infection and inflammation of bone and bone marrow
d/t hematogenous spreading or inoculation from trauma/surgery
**MCC S aureus**, Pasteurella for dog/cat bites, Mycobact TB - vertebral involvement; **human bites mixed anaerobes**
Sxs:
* Fever
* Throbbing pain, mvmt restriction
Dx
* **Bone aspiration and bx - gold std**
* MRI
* XR (lags 7-10d after sxs) triad - demineralization, bone destruction, periosteal rx
* ele CRP 4-6 wks, ESR, WBC
Tx
* Empiric abx for targeted organism
* **Amox-Clauv (Augmentin)** = Dog/cat and human bites
* Targeted after cultures
* IV Abx 4-6 wks for acute OM, \> 8 wks for chronic OM or MRSA
37
Osteoporosis
Body loses too much bone or doesn't make enough
F \> M, White and Asian, smoking, etoh, underlying dz
Sxs
* more likely to have compression fractures
Dx
* Radiographs
* DEXA - bone mineral density, bone loss, risk of fracture
* \< -2.0 is osteoporosis
Tx
underlyiing patho
38
Patellar tendinitis
eti, sxs
anterior knee pain - activity related @ focal patellar tendon Jumper's knee
Swelling over tendon tenderness at inferior border of patella
39
Plantar Fasciitis
Plantar heel pain - worse in morning, better with moving stretching - overuse activity
Dx - XRay
Tx:
* Stretching
* PT
* NSAID
* CS injection
* Patience
40
Prepatellar Bursitis
MC in wrestlers
Sxs:
* Pain w/ direct pressure on knees (kneeling)
* Swelling over patella
Dx
* Septic bursitis - aspiration Gram stain and culture
Tx:
* Compressive wraps
* NSAIDs +/- aspiration and immobilization
41
Radial head Subluxation (Nursemaid's Elbow)
MC young children \< 4yo
MOI - pulling upwards motion
Lateral elbow pain
hold elbow in slight flexion and forearm pronated
Pain and tenderness in lateral asp of elbow
42
Red flag signs of Herniated Disc
* fecal/urinary incontinence
* Saddle anesthesia
* Urinary retention
* IVDU
* Fevers
* Chronic steroid use
* focal neuro deficitys
* hx of Cancer
* weight loss
* no improvements after 6 wks of conservative management
43
Rotator Cuff Injuries
Stabilizes the shoulder; Comprised of Four muscle groups
1. **Supraspinatus - MCC of tears - ext rot, abdc**
2. Infraspinatus - ext rot, abd
3. Teres minor - ext rot, abd
4. Subscapularis - internal rotation
Eti:
* \<40 yo = Impingement, tendonitis
* \>40 yo = cuff tears
Sxs:
* Can't abduct arm above horizontal plane
* pain when elbow higher than shoulder
Dx:
* Special tests
* **Drop Arm**
* **Empty can**
* **Neer Impingement Test**
* Radiographs - shoulder series
* **MRI - gold standard**
Tx
* Conservative - NSAID, PT, Rest, Steroid
* Surgical - arthroscopic vs open
44
Sciolosis
Lateral curvature of spine - F MC, R side more common than left
paravertebral humping
20 \< PT and bracing
40 degress + typically surgical
45
Septic Arthritis
EMERGENCY
Direct bacterial invasion of joint space **MC knees and hips**
MCC - S aureus, N gonorrhea in sexually active YA, streptococcus; Pseudomonas
sxs:
* Single, swollen, warm, painful joint, TTP
* constitutional sxs (fever, sweats, myalgia, malaise, pain)
Dx:
* Arthrocentesis - **joint fluid aspirate - gold std**
* WBC \> 50k, primarily PMNs
* WBC \> 1000 is + for prosthetic joints
Tx:
* 2-4 wks of abx + arthrotomy w/ joint drainage
* S aureu - **Vanco/Nafcillin** (vanco or clindamycin if pcn allergic)
* Gonorrrhea - ceftriaxone
* IVDU - cipro/levaquin
46
Shoulder Dislocation (Glenohumeral Joint)
**MC anterior** - arm is **abducted and externally rotated**
Posterior - arm is adducted and interally rotated
Sxs:
* Pain, deformity, loss of function
Dx:
* XRay - AP, Axillary and Y-view
* Bankart Lesion - tear on shoulder; anterior inferior labrum
* Hill-Sachs Lesion - divet in humerus - prev shoulder d/l
* Axillary nerve assessment
**Special Tests - to dx prev shoulder d/l**
* Apprehension test
* Relocation test
* Sulcus test
Tx:
1. Reduce
2. postreduction films
3. Sling and swath
4. PT
47
Slipped Cap Femoral Epiphysis
Obese kid, adolescent
Bilateral within 18 mos
Xray - slipped femoral cap
Tx - ORIF
48
Spinal Stenosis
narrowing of spinal canal w/ impingement on nerve root; \>60yo
Sxs
* Back pain w/ paresthesias in one or both extremities
* R-\> thighs
* Pain worse with extension - prolonged standing/walking
* relieve with flexion - sitting, walking uphill/on cart (**Hoffman's**)
Tx
* Rest, NSAIDs, PT
* epidural injection of CS
* decompression laminectomy
49
Subacromial Bursitis
Btwn superior surface of supraspinatus tendon & coracoacromial ligament, acromion, and coracoid (acromial arch)
**Pain on motion and at rest** - fluid to accumulate
Not a/w trauma
Tx
* Prevention of precipitating factors
* **NSAIDs**
* Rest Brace/support
* Steroid injections
50
Thoracic Outlet Syndrome
Idiopathic compression of bracial plexus, subclavian vein, or subclavian artery as they exit out shoulder girdle and 1st rib
MC Young F 20-50
Sxs
* Nerve compression - pain/paresthesia to forearm, arm, or ulnar side of hand
* Vascular compression - swelling/discoloration of arm, w/ abduction of arm
* **+adson test** = loss of radial pulse w/ head rotated to affected side
Dx - MRI
Tx
* ortho consult +/- surgery
51
Torticollis
Wry neck - unilat contraction of Sternocleidomastoid muscle (shorten)
Breech deliveries, and adults and slept weird
Sxs - r/o radicular sxs
Dx - XR to r/o bone abn
Tx
* passive stretching
* self limited in 2-4 wks
52
Legg Calve-Perthes Syndrome
Interruption of blood to proximal femoral epiphysis
3-12 yo (young kids, ~5yo)
Painless limp but knee pain
decr internal rotation and abduction
Tx
* Rest
* PT
* Bracing/casting
* Sx
53
Developmental Hip Dysplasia
Barlow
adduct - dislocation hip
Ortolani
abduct - reduce the hip
54
Salter Harris Fracture
Type II is more common
I - physis
II - Metaphysis + physis
III - Physis + epiphysis
IV - physis + metaphysis + epiphysis
V - compressed
55
Osteoarthritis
Loss of cartilage from old age causing bone breakdownf rom friction
MC in hips, knees, hands; a/w Baker's cyst
Sxs
* pain worse with weight bearing, better w/ rest
* **pain & stiffness lasting \< 30 mins**
* **Heberden** (DIP) and **Bouchard** (PIP) Nodes
Dx
* XRay - narrowing of joint, **osteophytes**
* **normal CRP/ESR**
Tx
* Acetaminophen or NSAID
* definitive - Total joint replacement
