Orthopedics Flashcards
(122 cards)
1
Q
Common causes of elbow pain
A
- Ligamental sprains, fracture, bursitis, epicondylitis
- Atraumatic elbow pain d/t overuse + repetitive movements
2
Q
PE exam for elbow pain
A
Assess for trauma!
Full joint, ROM, motor, + neurovascular exam
3
Q
Imaging and labs
Elbow pain diagnostics
A
Imaging
* x-ray commonly ordered
* U/S
* MRI
Labs
* CBC w/diff
* ESR
* uric acid
* RF
* ANA
* Lyme testing
Joint aspiration
4
Q
Definition
Epicondylitis
A
“Tennis elbow”
Lateral elbow inflammation
“golf elbow”
Medial elbow inflammation
Pain at origin tendon that can be acute, mild, or severe
5
Q
Objective findings with MEDIAL epicondylitis
A
- Tenderness over medial area
- Pain w/resisted wrist FLEX AND pronation w/elbow in full EXT
- Pain w/ passive terminal wrist EXT w/elbow in full EXT
- ROM + neurovascular PE NORMAL
6
Q
Objetive findings with LATERAL epicondylitis
A
- Tenderness over lateral
- Pain w/resisted wrist EXT w/elbow in FULL EXT
- Pain w/passive term wrist FLEX
- ROM + Neurovascular PE NORMAL
- NORMAL ROM W/O PAIN
7
Q
Imaging necessary for epiondylitis?
A
NO
clinical dx
8
Q
Epicondylitis differentials
A
Ligamental sprain
Radial head fracture
9
Q
Epicondylitis pharmacological treatment
A
NSAIDs x 2 weeks
w/o contraindication
10
Q
Epicondylitis nonpharmacological txs
A
PRICEMM
* Protect
* Rest
* Ice
* Compress
* Elevate
* Meds
* Modalities
11
Q
Epicondylitis Risk Factors
A
- Tobacco use
- Obesity
- Age 45-54
- Repetitive movements > 2hrs/day, heavy lifting
- Occupational RFs
12
Q
Epicondylitis referral
A
PT or OT
13
Q
How is it different from epicondylitis
Ligamental sprain objective findings
A
Tenderness overlying affected ligament
Pain w/ROM
14
Q
Ligamental sprain treatments
Pharm and non-pharm
A
- NSAIDs PO/topical
- PRICE
- Sling if in significant pain
15
Q
Ligamental sprain clinical findings
A
May or may not have known injury
Pain
16
Q
Radial head fracture clinical findings
A
Weakness d/t ↓ strength
Pain
17
Q
Radial head fracture objective findings
A
- Tenderness overlying radial head
- Limited ROM
- Local or diffuse edema
- Neurovascular PE NORMAL
18
Q
Radial head fracture tx and referral
A
PRICE
Ortho → surgery for displaced or complicated fracture + managment
19
Q
Definition
Ulnar neuritis
A
- Compression of ulnar nerve
- Compression d/t
- RA
- Ganglion cysts
- Fracture
- Repeated irritation/pressure to area
20
Q
Ulnar neuritis clinical findings
A
- Numbness or tingling
- Pain may radiate
21
Q
Ulnar neuritis objective finding
A
May have sensory loss of 5th digit + ↓ motor strength in 4th + 5th digits
22
Q
Ulnar neuritis treatments
and referrals
Pharm + nonpharm
A
- NSAIDs
- PRICE
- Elbow pad
- Splint
PT/OT referral
Neuro referral
23
Q
Definition + etiologies
Olecranon bursitis
A
- Swelling or bursal sac under olecranon process
- Acute, chronic, or septic
- Etiologies
- Trauma
- RA
- Crystal arthropathy
24
Q
Olecranon bursitis
Acute vs chronic
Clinical findings
OBJ findings
A
- Acute: Painful and edematous elbow
- Chronic: Soft, edematous nonpainful elbow
- Full ROM + normal neuro findings
- Chronic: rough nodular consistency noted
- Look for systemic s/s for secondary to infection
25
Olecranon bursitis diagnostic imaging
X-ray
26
Olecranon bursitis treatments
| Pharm and nonpharm
NSAIDs
Aspiration of joint
27
Olecranon bursitis
Patient education + referrals
* Avoid direct pressure
* Ortho referral
* Hospitalization if concern for infectious process
28
# Definition
Plantar fascitis
* Overuse condition involving degenerative changes
* NOT INFLAMMATORY
* Common in primary care
* Peak incidence in 40-60y.o.
29
Plantar fasciitis clinical findings
* May be bilateral
* Pain in proximal foot
* Worse in AM when stepping out of bed after long period of inactivity
* Worsens to later in day after being active all day
* **Non-radiating pain**
* Paresthesia UNCOMMON
30
Plantar fasciitis objective finding
* Tenderness to palpation of proximal medioplantar fascia
31
Plantar fasciitis diagnostics
* Mainly clinical dx: Hx + exam
* Labs not indicated
- ESR + CRP normal
* No imaging needed for DX
- X-ray for bony lesion, bone spur, other bony abnormalities
- MRI + U/S to see thickening of plantar fascia on scans
32
Plantar fasciitis pharmacologic txs
* NSAIDs x 2 weeks
* Corticosteroid INJs for refractory (treatment resistant) cases
33
Plantar fasciitis nonpharmacological txs
Typically conservative + nonoperative txs
* Activity modification
* Ice massage
* Stretching + strengthening exercises
* Heel padding
* Orthotics
* Taping
* Acupuncture
* Plantar fasciotomy for refractory cases post 6-12 months
34
Plantar Fasciitis Risk Factors
* Limited ankle dorsiflexion
* ↑ BMI
* Extended periods of standing
* Occupations
* Athletes
* Sedentary lifestyle
* Pes cavus or pes planus
35
Plantar fasciitis patient education + referral
* Avoid flat shoes or walking barefoot
* Encourage athletic or arch-supporting shoes
* Referral to physiatry/ortho
36
Plantar fasciitis differential diagnoses
Neurologic
* Nerve entrapment
* Tarsal tunnel syndrome
Skeletal
* Fracture
* Bone tumor
Soft Tissue
* Achilles tendonitis
* Plantar fascia rupture
* Retrocalcaneal bursitis
37
Tarsal tunnel syndrome + nerve entrapment clinical findings
Burning
Paresthesia
38
Plantar fracture
Bone tumor
clinical findings
* Hx of injury, inability to bear weight
* Deep pain at night and does not improve
39
Achilles tendonitis
Plantar fascia rupture
Retrocalcaneal bursitis
Clinical findings
* Tenderness over achilles
* Sudden onset p! + "pop" noise
* Swelling + p! in area
40
# Definition
Gout
Three stages
* Most common inflammatory arthritis
* Accumulation of monosodium crystals (MSU)
- Uric acid from purine metabolism
- Kidney issues → ↓ renal excretion or overprod rate
1. Acute flare
2. Intercritical gout (between flares)
3. Chronic gouty arthritis + tophaceous gout
41
Gout clinical findings
* 1st attack typically affects one joint/**monoarticular**
* Polyarticular less common
* Joint pain comes on + progresses rapidly (12-24hrs) often **starting at night**
* Skin desquamation (peeling)
42
Gout objective findings
Common gout sites
* Sensitive to palpation - hypersensitivity (bed sheets sensation
- Joint is warm, red, tender, maybe effusion
- Chronic = tophi (stone like deposits)
* Low-grade fever
**Most common sites of gout**
* 1st MTP
* Ankle
* Knees
* Wrists
* Fingers
* Elbows
43
Uric acid level of MSU crystal deposition
> 6.8
At increased risk
44
Should you measure uric acid level during acute gout attack?
Not reliable during the attack itself
45
Gout lab diagnostics
What is the gold standard?
**Arthrocentesis w/synovial fluid analysis** → establish diagnosis + r/o others **GOLD STANDARD**
* ESR + CRP
* CBC w/diff → shows ↑ WBC + ↓ PLT (maybe)
* BMP
- Renal fx for renal dosing
- Blood sugar for corticosteroid use
* LFTs: meds dose dependent
46
Gout Imaging diagnostics
* X-ray most common
* MSK U/S, CT, Dual energy CT, MRI (not common)
47
Gout prediction tool
* Male sex (2pts)
* Previous patient-reported arthritis (2pts)
* Onset within one day (0.5pts)
* Joint redness (1pt)
* 1st MP joint involvement (2.5pts)
* HTN or at least 1 CV disease (1.5pts)
* Serum urate level > 5.88 (3.5pts)
Based upon total score
* Low (≤ 4 pts)
* Intermediate (> 4 to < 8 pts)
* High (≥ 8 pts) probabiltiy of gout
48
Gout differentials
* Septic arthritis
* Trauma
* Calcium pyrophosphate crystal deposition (CPPD)
* Pseudogout
* Cellulitis
* RA
49
Acute gout flare pharmacological txs
* NSAIDs (not in pts w/Hx of GI bleed, CKD, > 65 y.o.)
* **Corticosteroids (1st line)**
* Know that blood sugar level can increase
* Colchine (w/in **36hrs of attack**)
* IL-1 inhibitors (not FDA approved)
* INJ glucocorticoids (ortho/Rheum referral)
50
Chronic Gout pharmacological txs
* **Allopruinol 1st line** (xanthine oxidase INHi)
- Risk for allergy rxn
* Febuxostat
* Urate lowering therapy started at LOW DOSE + titrated until level at **< 6**
* Probenecid 2nd line = can be used w/xanthine class
* AVOID OPIOID USE
51
Gout nonpharmacological txs
* Complete resolution w/in several days to weeks w/o tx
* Ice during acute attacks
* ↓ purine food intake (meat, seafood, etc)
* Avoid EtOH
* Encourage weight loss
52
Gout risk factors
* Age - **peak onset 40-50 (M); > 60 (W - related to ↑ in uric acid post menopause**
* M > W
* Meds
* **High purine diet** (red meat, shellfish, high fructose corn syrup)
53
Gout patient education
* **Continue taking meds during gout flare**
* Anti-inflamm tx x 6mos (post starting meds until uric acid < 6)
* Do a full medication reconcilliation
- Losartan, amlodipine, + fenofibrate can lower uric acid levels)
* **Most untreated pts w/gout will experience 2nd episode w/in 2 yrs**
54
# Definition/etiology
Septic arthritis
* Infectious cause of joint inflammation
* Caused by bacteria, fungi, parasites, viruses
* **S. aureus most common bacterial arthritis**
- Gonorrhea, gram (-)
* Most commonly cause in sexually active adolescents
* MRSA most common
55
Why should we be concerned with septic arthritis?
**MEDICAL EMERGENCY**
* If left untreated → 5-7d poor prognosis
56
Septic arthritis clinical findings
Most common sites
* Acute onset of painful, swollen joint
* Painful at ALL times (not alleviated at rest)
* **Knee + hip common sites**
* Monoarthritic
* Effusion often present (inflamm)
57
Septic arthritis objective findings
* Knee + hip at ↑ risk for infection
* +/- fever
* ↓ ROM
* Mm spasms, apprehension
* Lymphadenopathy (depending on joint affected)
58
Septic Arthritis definitive diagnostic
**Aspiration of joint for isolation or causative organism**
59
Septic arthritis diagnostics
Imaging
Consider in pts w/acute of subacute monoarticular pain that does not respond to anti-inflammatory tx
* CBC w/ diff (leukocytosis)
* ESR + CRP
* Peripheral blood cultures
* X-ray not as heplful
* MSK U/S, bone scan, CT, MRI
60
Septic Arthritis differentials
* Cellulitis
* Bursitis
* Osteomyelitis
* Gout
* RA
61
Septic Arthritis Pharmaclogic txs
* Conside INJ use in cases when located in unusual site
- SI joints
- Sternoclavicular joint
- Symphysis pubis
* Early initiation of broad spectrum abx until joint aspiration results + blood cultures received
- Nafcillin, oxacillin, cafazolin (S. aureus)
- Cefepime (if gram (-) suspected)
- Duration of 2-3 wks
62
Septic arthritis nonpharmacologic txs
Daily drainage of joint until resolution
Risk of relapse if initial infxn insufficiently tx
63
Septic arthritis Risk factors
* Joint trauma hx
* Inflamm states (RA)
* Degeneration
* Immunocompromised
* Hx of prosthetic joint
64
Septic arthritis patient education + referral
* Want to search for OG source pf infxn (abscesses, urethritis, PNA, UTI
* Initially, adhere to strict non-weight bearing activities
* Referral if ID, rheumatology, ortho sx, PT
65
SA - Gonococcal arthritis
TRIAD S/S
* Dermatitis
* Tenosynovitis
* Migratory polyarthritis
66
Gonococcal arthritis common in which population?
Sexually active adolescents
67
Gonococcal arthritis labs
* **Blood cultures NEGATIVE**
* Consider *culture* of pharynx, cervix, urethra + rectum - *sites of sex will be (+)*
68
Gonococcal arthritis pharmacological txs
* Ceftriaxone 1g/day IM for 7-10d or IV q24hrs
* Azithromycin 1mg once - **DX med**
69
Prosthetic joint infection
(all sections
* Categorized early (w/in 3 mos), delayed (3 to 24 mos), + late (> 24 mos)
* Early + delayed have infectious start at time of surgery
* X- ray may show loosening of prosthesis
* Prosthetic joint is typically removed → 6 wks of IV abxs → reimplantation of new joint
70
SA: Lyme disease
(different types)
* Early localized disease (1 to 30d), early disseminated disease (d to 10 mos), + late disease (mos-yrs) after tick exposure
71
SA: Lyme disease clinical findings
(two types)
Early/localized
* Arthralgias
* Migratory arthritis
* Erythema migrans
* H/A
Late
* Migratory polyarthritis, can be chronic
72
SA: lyme disease OBJ findings
* Fever
* Early: cardiac PE, Neuro PE, MSK PE
73
SA: Lyme disease lab diagnostic
ELISA or PCR (high false +)
74
# Definition
Osteoarthritis
stages
* Degenerative joint disease (of articular cartilage/hyaline layer) → ↑ thickening + sclerosis of bone plate
* 4 stages: doubtful, mild, moderate, severe
75
Osteoarthritis clinical findings
Age of onset
Site s/s
Most common sites
* Asymptomatic in 20/30s; onset > 40 yrs
* Symptomatic w/radiologic changes by 40s
* Cervical/lumbar: Neuropathy, Radiculopathy
* Hip: Groin/buttock pain radiating to knee
* Knee: Joint line pain, Effusion
* Hands: Heberden + Bouchard nodes
Most common sites: hips, knees, feet, spine, hands
76
Osteoarthritis symptom findings
* Pain
* affects one of few joints at a time
* Insidious onset - slow progression over years
* Variable intensity
* Increased by joint use and relieved by rest
* Night pain in severe osteoarthritis
* Stiffness
* Short-lived (< 30mins) and early morning or inactivity related
* Swelling
* Some swelling or deformity (nodal)
77
Osteoarthritis PE findings
* Swelling (bony overgrowth + fluid/synovial hypertrophy)
* Attitude
* Deformity
* Mm wasting (global - all mm acting over joint)
* Palpation
* No warmth
* Swelling - effusion
* Joint line tenderness
* Periarticular tenderness (knee/hip)
* ROM
* Crepitus (knee, thumb bases)
* Reduced ROM
* Weak local mms
* Hip: Trendelenberg gait
* Knee: Varus deformity
78
Osteoarthritis diagnostics (imaging and labs)
* **DX made w/radiographic imaging**
* Can DX based on presentation (< 30m)
* Look at history
* Labs: typically none
* ESR, CRP ,RF, synovial fluid analysis to r/o inflamm arthritis
* Imaging: X-ray
* Shows joint space narrowing, osteophytes, subchondral sclerosis
79
Osteoarthritis differentials
* Collagen vascualr disease
* Gout/pseudogout
* Trauma
* Septic arthritis
* Ankylosing spondulitis
* Psoriatic arthritis
* RA
80
Osteoarthritis pharmacological txs
Overall 2nd line tx
* Topical/PO NSAIDs
* Topical safer than PO
* Duloxetine
* Topical Capsaicin
* Intra-articular glucocorticoids
* Opioids unsafe, last line of tx
* Can use for ACUTE PAIN; post-surgery
* Hyaluronic INJs = ineffective
81
Goals of osteoarthritis tx
* Minimize pain
* Maximize function
* Modify process of joint damage
**Treatment will NOT change disease progression, only symptom management**
82
Osteoarthritis nonpharmacological tx
Overall 1st line tx
* Exercise
* Weight management
* Braces
* Orthotics
* Education
* Assistive devices
* Arthroscopy
* Total joint replacement
83
Osteoarthritis risk factors
Referral
* Age, Female
* Overwight, obese
* Prior trauma
* Genetics/FMHx
* Repetitive activities/impact (work/sports)
* Metabolic disorders
* Neuro diseases
* Hematologic conditions
PT/OT (physiatry can give corticosteroid INJs)
84
Hip pain History
HPI:
* Age, location, onset, duration, severity, setting, timing, associated symptoms, aggravating/alleviating factors
PMH: surgeries, trauma, hx/o cancer
Medications
* Long-term use INC risk for osteoporosis
FHx: orthopedic concerns, cancer
Social: vocation, recreational activity
85
Hip Pain PE
* VS for systemic symptoms
* Back, SI joint, hips, knees, ankles
* Gait
* Antalgic gait (Limp)
* Trendelenburg gait
* Palpation: crepitus, point tenderness
* ROM (passive/active)
* flexion, extension abduction, adduction, internal, external rotation
pain, muscle spasm, guarding
* Strength
* Neuro
86
# 4 of them
Hip Pain diagnostic PE tests
* FABER
* Single leg standing/Trendelenberg gait
* FADDIR
* FLIP/Seated SLR
87
FABER test
| Purpse
* Determines SIJ vs. Lumbar spine injury
88
**FABER**
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?
* Internal hip, SIJ vs Lumbar spine
* Position leg so that foot of test leg is on top or adjacent to opposite leg → slowly lower test leg towards exam table
* Figure 4 configuration at start
* (+) = hip joint may be affected, illopsoas may be shortened, or SIJ affected
89
**Single leg standing/ Trendelenberg Sign**
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?
* Lateral hip weakness, Glute Med injury
* Pt stands on one lower limb, normally pelvis on opposite side should elevate
* Drop in non-standing pelvis is a positive test
* (+) = Weak Glute Med or unstable hip joint
90
**FADDIR**
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?
* Impingement (FAI) femoral-acetabular impingement
* In supine, bring hip to 90 degrees flexion → adduct + IR hip
* (+) = reproduction of anterior hip/groin pain
* Hip impingement, Hip labral tear, hip loose bodies, hip chrondral lesion
91
**FLIP/Seated SLR**
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?
* Neural tension-Lumbar Spine Radiculopathy
* Seated pt in neural position → pt slumps body w/arms behind back → Slowly flex head → examiner slowly extends knee + dorsiflex foot
* Test ceased when pain reproduced
* Pain, shooting pain, or burning pain reproduced → (+)
92
Hip pain diagnostics
* R.o inflammation: CBC + ESR, RF, Uric acid
* X-ray: AP + Lateral views of hip
* MRI: soft tissue causative
* Intra-articular joint aspiration/INJ
* Weight bearing to assess extent of joint degeneration + joint space narrowing
93
Hip pain differentials
* Bursitis
* OA
* RA
* Psoriatic arthritis
* Gout + Pseudogout
* Avascular necrosis, lupus: immediate referral + tx
* Fractures (low-impact fragility fxs) → bone density/endo referral
* Hip discloation
* Infxn
* Neoplasm
* Referred pain
94
What are the indications for an urgent referral for hip pain?
* Infection
* Fracture
* Dislocation
95
Hand + wrist pain
Acute + chronic
* Acute: fractures, contusions, strains, instability
* Chronic: arthritis of hands/fingers, overuse, old injuries, neurologic disorders
* Cumulative trauma disorders, ergonimic work-related injuries
96
Hand/wrist pain treatment
Pham + nonpharm
* NSAIDs
* PRN, lowest effective dose
* **Topical 1st line for adults**
* Cortisone INJs (surgical delay, R/F depigmentation; tendon/fat atrophy
* Splinting/rest
* Cold in acute phase OR heat to promote relaxation (15-20m)
97
Hand + Wrist pain
Risk Factors
* Age
* Medical conditions
* Diabetes
* Pregnancy + obesity
98
Hand + Wrist pain referral
Ortho (suspected fxs, conservative tx failures, OR surgery)
Sports med
Surgery
99
# Definition
Hand + Wrist pain: Ganglion cysts
* Fluid-filled sacs, around joints + tendon sheath that appear, disappear, + change size
* Found on dorsal, radial, or volar surface of wrist
100
Hand + Wrist pain: Ganglion cysts clinical findings
* Pain w/activity or pressure
* Can be asymtpomatic
* Weakness
* Numbness
* Tingling
101
Hand + Wrist pain: Ganglion cysts
Objective findings
* Bone changes → loss of function
* Smooth, firm, round, rubbery subdermal growth
* Could be tender
* Transilluminate with light
102
Hand + Wrist pain: Ganglion cysts
Risk Factors
* Age (20s-40s)
* Female sex
* Surgery referral
103
# Definition
Hand + Wrist pain: Stenosing Tenosynovitis
* **"Trigger finger"**
* Idiopathic, irritation of flexor tendon sheath → thickening + stenosis minimizing passage of associated tendon
104
Hand + Wrist pain: Stenosing Tenosynovitis
Clinical findings
Common sites
* Common sites: thumb, middle, or ring finger
* BL
* Painless snapping, catching, clicking of 1+ fingers during flexion of affected digit → > pain
* SEVERE: LOCKED IN FLEXION → secondary contracture @ PIP joint
105
Hand + Wrist pain: Stenosing Tenosynovitis
Objective findings
* Can appear w/o prior HX of trauma or change in activity
* Localized pain ver volar aspect of MCP joint radiating to palp or distal finger
106
Hand + Wrist pain: Stenosing Tenosynovitis
Treatment: PHARM + nonPHARM
* Corticosteroid INJs
* 4-6wks splinting of MCP joint @ 10-15 degrees of FLEX w/PIP/DIP joints free
107
Hand + Wrist pain: Stenosing Tenosynovitis Risk Factors
* W > M
* 40-60 y.o.
* DM
* Arthritis (RA) + gout may ↑ incidence
* Surgery referral
108
# Definition
Hand + Wrist pain:
De Quervain Tenosynovitis
* Painful inflamm of Abductor pollicis longus + extensor pollicis brevis tendons along dorsal aspect of wrist
109
Hand + Wrist pain:
De Quervain Tenosynovitis
Clinical findings
* Pain w/repeated thimb ABD + EXT in combo w/wrist radial + ulnar deviation
* Can be UNL or BL
* Swelling
110
Hand + Wrist pain:
De Quervain Tenosynovitis
Objective finding
* Notable tender nodule over radial stylus
111
Hand + Wrist pain:
De Quervain Tenosynovitis
Diagnostic test
* **(+) Finklestein test**
* Place thumb in closed fist
* Tilt hand down
* **Pain felt during rest (+)**
112
Hand + Wrist pain:
De Quervain Tenosynovitis PHARM + nonpharm txs
* Cortisone INJs
* Wrist splinted in slight EXT + thumb ABD (**thumb spica**)
113
Hand + Wrist pain:
De Quervain Tenosynovitis
Risk Factors
* W 30-40 y.o. + postpartum (4-6wks)
* A/w carrying infant
* A/w wringing, grasping things p!, gardening, knitting, pouring from pitcher/carton
114
# Definition
Hand + Wrist pain:
Palmar Fibrosis
* Inflammation of fibrotic nodules
* "Dupuytren contractures"
115
Hand + Wrist pain:
Palmar Fibrosis
Clinical findings
* **Painless nodule**
* Swelling on palmar fascia at base of digit (feels like band=like cord under skin) → FLEX contracture of ring finger
* UNL/BL contractures on hands
116
Hand + Wrist pain:
Palmar Fibrosis
Objective Findings
* **Skin puckering 1st sign**
* **Garrod nodules "knuckle pads" along dorsum of hand**
117
# Definition
Hand + Wrist pain:
Carpal Tunnel Syndrome
* Compresssive neuropathy of medican nerve as it passes through carpal tunnel
* Caused be repetitive motion + overuse
118
Hand + Wrist pain:
Carpal Tunnel Syndrome
Clinical findings
* Inability to hold items, tendency to drop → pincer grasp/loss
* Intermittent wrist pain
* Paresthesia along median nerve distrbution
* Can originate. in wrist → hand
* ↑ w/activity
119
Hand + Wrist pain:
Carpal Tunnel Syndrome
Objective findings
* Atrophy of thenar eminence
* ↑ tenderness
* Diminished motor strength + sensory deficits
* Abnormal 2 point discrimination test
* **Phalen maneuver (+)**
* **Tinel (+)**
* **Durkan (+)**
* Edema +/-
120
Hand + Wrist pain:
Carpal Tunnel Syndrome
Diagnostics
* No labs needed
* X-rays: fracture, acute dislocation, bony abnormalities
* U/S or MRI - confirm ganglion cyst, tenosynovitis, tendon rupture or pre-surgical evl
* Trust hx + provocative maneuvers
* Electrodiagnostic testing w/nerve conduction + needle electromyography - CTS
121
Hand + Wrist pain:
Carpal Tunnel Syndrome
Txs
* Cortisone INJs
* **Splinting in neutral position (1st line)**
122
Hand + Wrist pain:
Carpal Tunnel Syndrome
Risk Factors
* Female
* Older Age
* Obesity
* DM
* OA/RA
* Hypothyroidism
* Pregnancy
* Trauma
* Aromatase INHi
* Repetitive movements
* PT/OT surg referral
