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IPAP JUNIOR SEM. > Osteo Block 2 > Flashcards

Osteo Block 2 Flashcards

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1
Q

What is a type 1 AC injury

A

No seperation

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2
Q

What is a type IL AC seperation

A

Sepeartion at the Acromion Claviluar ligament only

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3
Q

What is a type III AC injury

A

Seperation of the AC ligament and Coracoid ligmanets

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4
Q

What is type IV AC shoulder joint ligament

A

Coracoid ligament seperation only

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5
Q

What is a grade V AC injury

A

Coracoid ligament tear with Anterior Displacement of the Clavicle

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6
Q

What is an type VI AC injury

A

AC displacemtn with posterior displacemtn of the clavicle

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7
Q

Which AV types will have an obvious deformity

A

Types III-VI

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8
Q

What are the ADE of AC injuries

A 
Deformity 
Weakness with aBduction 
Chronic Pain 
Arm numbness 
Arthiritis
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9
Q

What pain will the patient present with in an AC injury

A

Pain with abduction of the arm

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10
Q

What are two imagin studies you order for AC injury

A

Plain fims- Bilateral weighted

MRI non-contrast

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11
Q

What is the TX approach to AC injuries

A

Type 1-2 Non op rehab, goal: to decrease pain, prevent further injury, and restore function

Type 3: based on work field, may require surgery

Type 4-6 surgical

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12
Q

What are the two ADE of AC injury TX outcomes

A

Stiffness from sling- immobility

AC joint arthritis

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13
Q

What is a Burners/ Stingers Brachial Plexus

A

C5-C6 nerve root ( brachial plexus injury)

From a traction force

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14
Q

Which has better prognosis, a preganglionic or postganglionic brachial plexus injury

A

Preganglionic poor prognosis

Postganglionic better prognosis

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15
Q

A pt with Burners/ Brachial plexus presents with what clinical S/s

A

Upper trunk C5-6-7 shoulder depression with a lateral tilt of the head away from the injury

Lower trunk: C8-T1 Sharp burning shoulder pain with stretch with arm in abduction

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16
Q

What must be ruled out in a brachial plexus injury

A

R/ o C spine- injury

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17
Q

What is Horners syndorme

A

(ipsilateral ptosis, myosis, anhidrosis, enophthalmos)

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18
Q

Upper trunk brachial plexus affects what the most

A

Most commonly postganglionic

Rhomboids and serratus anterior

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19
Q

Lower trunk brachial plexus most commonly effects

A

Most commonly preganglionic

Horner’s syndrome (ipsilateral ptosis, myosis, anhidrosis, enophthalmos)

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20
Q

What is the TX approach to Burners/ Brachial plexus injury

A

Order Plain films of spine and shoulder,

If films AbNML then oder MRI
(Or with persitent S/s)

Tx:
Non OP; C spine precautiong

Normal Exam : RTD
Decreased Functional Impact: Rehab

Operative: neurosurgery

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21
Q

What is the referal critera for Brachial Plexus injuries

A

Persisnet, recurrent, bilateral S/s with concominant injuries or a severe worse PE

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22
Q

What is frozen shoulder

A

Adhesive capsulitis

Idiopathic loss of AROM,PROM

Women, 40-60 years old

Diabetes

(hypothyroid, Dupuytren disease, cervical disc herniation, Parkinson disease, cerebral hemorrhage, tumors)

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23
Q

What are the clinical findings of Frozen shoulder

A

Idiopathic pain and decreased ROM

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24
Q

How will Frozen shoulder present on plain flims and MRI

A

Plain film-NML

MRI- Contracted joint apsule and loss of inferior pouch

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25
What is the Tx approach to Frozen shoulder
Initial Tx for ALL pts in NSAIDS, moist heat, and a gentle stretching program Operative: Arthroscopic capsular release (only for conservative Tx failure)
26
What are the ADE of humerus Fx
Tendon tear or humerus Fx
27
What is the Referral critera for Frozen shoulder
No improvement after 3 months of Tx
28
What is the definition of Shoulder impingment
Wither suprspinatus or subacromial bursa inflammation
29
What are the clincial S/s of shoulder impingment
Ant/Lat shoulder pain | And deceased overhead ROM
30
What are the ADE of a shoulder impingment
Chronic pain Rotator cuff tear
31
What are the special tests for shoulder impingment
Neer Hawkins And Jobe test
32
Pts with shoulder impingment will have pain when the shoulder is abducted at what degree
At 90 -120 degrees of abduction
33
What is the Tx apprach to Shoulder Impingment
Non operative : Nsaids, stretching, and Inj to subacromical bursa (Diagnotstic and thearputic) Operative Tx only after non op Tx failure
34
What is the most common and most imporatnt muscle in rotator cuff injureis
The supraspinatus
35
What are the 4 muscles of the rotator cuff
Supra and Infrspinatus Subscapularis And teres minor
36
What are the three fxs that lead to shoulder rotator cuff injuries
Age related, External impingemtn, or decreased blood supply
37
What are the clinical S/s of a rotator cuff injury/ tear
Pain, w/ difficult sleeping of the affected side Weakness with overhead ROM
38
What are 4 ADE of a Rotator Cuff Tear
Decreased ROM Chronin Pain Weakness of the joint Glenohemeral OA
39
What are the special test for a Roator Cuff injury
Drop arm test and Jobe Test
40
A pt presents with atrophy to the shoulder, with decreased ROM over the shoulder yet full passive ROM, +tenderness to the greater tuberosity What special tests should be done, what do you suspect
Drop arm test, and Jobe Test Suspect: Rotator Cuff injuries
41
How will Rotator cuff injuries present on Plain films and MRI
Plain films will show Acromial variations, with a high ridinig humerus Order and MRI! MRI will show: detachment of the tendons
42
What is the Tx approach to Rotator cuff injuries
Non-operative- NSAIDS, rehabilitation Injection (Subacromial = glenohumeral) Operative- Acute, traumatic tears
43
What are the referral critera for R. Cuff Tears
Failure of 6 weeks of non-operative treatment Acute, traumatic tear (<6 weeks)
44
Older pts with RTC Dz at an increased RSK of what bicep D/o
Proximal biceps tendon rupture
45
A pt presents with a bicep deformity with an audible snap and pain, + popeyes deformity
Proximal Biceps Tendon Rupture
46
What is the precentage of foreamr supination strenght loss with a proximal biceps tendon rupture
10 %
47
What is the TX approach to Proximal Biceps Rupture
Plain flims will be normal Order MRI ASAP NonOP: ROM/ Streghtening OP: Young athletes and Young Laborers
48
What is the referral critera for a Proximal Biceps Tendon Rupture
Young athlestes Young laboreres Concominat Rotator cuff tear
49
What is the most common postion for shoulder dislocation/ instability
Anterior Dislocation
50
What does TUBS mean
Trumatic, unilateral, bankart lesion, surgery
51
What does AMBRI mean
Atruamatic, multidirectioanal, | Bilateral, rehabilitate, inferior capsule (surgery procedure)
52
What are the most common causes of posterior displacement of the shoulder
SZR and electric shock
53
What are the ADE of shoulder instability
Axial nerve injury Insabitliy Blenohumeral OA
54
A pt presents with an adducted and internally rotated shoulder position …
Posterior dislocation of the shoulder
55
How will a pt with chronic shoulder instabiltuy present?
Hypermobile W/ + sulcus sign, +Apprehension test, + Jerk Test
56
What imaging views should be ordered for a shoulder instability
Y view on X ray MRI w/ Anthrogram
57
What is a slap tear
Superior Labrum, Anterior to Posterior
58
A pt presents with a positve Obrian test, Crank test, Clunk Test, and Speeds test With tenderness at the bicpital groove
SLAP tear
59
What is the gold standard imaging for a SLAP test
MRI arthrogram
60
What is the Tx approach to a SLAP tear
Non-operative- Initial treatment (NSAIDS, rehab) Limit bench press, overhead press and curls Limit throwing Operative- Non-operative treatment failure High level athletes
61
What are two anatomical malformations that lead to thoracic outlet syndrome
Cervical rib at C7 or a Long transerve process of C7
62
A pt presents with ulnar neuropathy + diffuse non specific complaints of the entire UE, edmea, discoloration, with fatige, weakness worse with arm overhead, think..?
Thoracic outlet syndrome
63
What are the ADE of Thoracic outlet syndrome
Weakness, Chronic Headache, loss off overhead ROM
64
What is the PE exam test for thoracic outlet syndrome
Roos test
65
A pt that presents with carotid bruit, mass in the neck or shoulder, with distal pulses differnent between arms, and ulnar nerve nueropathy.. think?
Thoracic outlet syndorme, will have a postive roos test
66
What is the Tx approach to thoracic outlet syndome
Non op: 3-6 month of PT and activity modificaiton Op: removal of antomical variant or tumor
67
What are the ADE of thoracic outlet syndrome
Complex regional pain syndrome, intercostal neuroma frozen shoulder brachial plexus injury pneumothorax
68
What is the referral critera for thoracic outlet syndrome
Neuro-vasc changes Anatomical variant Or failure of nonop tx
69
What is neonatal brachial plesux palsy
Typically from injury at birth UE motor and senory deficit
70
What is Erbs palsy
Most common neonateal brachial plexus palsy at C5-C6
71
What is Klumpke palsy
A neonatal brachial plexus injury at C8-T1
72
What 3 things would signal a poor prognosis of a neonatal brachial plexus injury
Entire plexus involment Horner Syndrome Nerve Root Avulsion
73
An infant presents with pseudoparalysis and irratabilty ( may have waiters tip sign)
Neontal brachial plexus
74
An infant with erbs brachial plexus injury will have what postion
Waiter tips position
75
Neonatal brachial plexus injury with signs outside of the UE signal ..
Poor prognoisis
76
What is the Dx and Tx approach to Neonatal Brachial Nerve Plexus
Dx: radiogrpahs to r/o clavicle and humerus fracture Nerve conduction studies Tx: monitor nerve funtion, prevent contractures and deformiteis and physical therapy Op: surgical to address imbalances
77
What is congenital torticollis
Unilateral sternocleidomastoid contracture at birth
78
An infant with nystagmus, superior oblique palsy (CNIV) | Atlantoaxial rotary displacment of the spine +- truama +- infection +- neoplasms think?
Acquired torticollis
79
What is the imaging and Tx approach to torticollis
C spine rads + nuero signs= MRI Tx Non op: Congenital- stretching Acquired- treat underlying reason Op: only for acquired
80
Referral criteria for Torticollis
All pts with Acquired
81
What is tennis elbow
Lateral epicondylitis
82
A pt presents with pain with resisted flexion, and pain with index finger extenstion, +tenderness at the lateracl 1cm distal joint of the elbow (orgin of the extensor carpi radiallis brevis) think’./
Lateral epicondylitis
83
What is golfers elbow
Medial Epicondylitis
84
A pt presents with pain with resisted flexion, and index finger flexion + tenderness 1cm distal to the joint at the tendinous orgin of the felxor and pronator muscels of the medial elbow think>?
Medial epicondylitis
85
What is the Tx approach to epicondylitis
Activity modification NSAIDS Rehab Steroid injections
86
What are the causes of olecranon bursitis
Acute= fall/direct blow or septic bursitis Chronic= propping
87
A pt presents with a red hot swollen elbow think?
Toxic joint or olecranon bursitis Investigate with transillumination And measure the area
88
What is the Dx approach and Tx approach to olecranon bursitis
Plain films- r/o fx Labs: aspirate- Dx and Tx Tx: compresion, aspiration Operative: in non op tx fails or chronic
89
What is the referral criteria for olcranon bursitis
Septic | Or recurrance after multipe aspirations
90
What is cubital tunnel syndrome
Ulnar nerve compression | 2nd most common UE entrapment
91
What is PIN compression
Radial nerve compression
92
What is pronator syndomre
Median nerve compression at the elbow
93
A pt presents with small finger dysesthesias, hypothena ache think?
Ulnar nerve comression at the elbow
94
A pt that present with lateral epicondylitis s/s 4-5 cm more distal think..
Radial tunnel compression
95
A pt with vague discomfort and numbness in the medial nerve.. think
Pronator compression
96
What is the Dx test for nerve compression syndoromes
NCS/EMG
97
What is the Tx approach to nerve compression syndromes of the elbow
Non-operative Initial treatment- activity modifications, splinting, NSAIDS Operative Non-operative treatment failure Decompression, transposition
98
Where does the long head of the biceps insert
Radial tuberosity
99
What age group of men are more likely to have distal biceps tendon ruptures
Men older than 40
100
What is the loss of supination and loss of flexion with a distal biceps tendon rupture
Loss of supination 50%, loss of flexion 15%
101
What does the hook test at the elbow evaluate
Distal biceps insertion
102
What is the Dx (imaging) and Tx approach to distal beicps tendon ruptures
Plain films may be NML or show an avulsion Order a MRI ASAP will show avulsion vs rupture at the junction of the elbow Tx: operative within 2 weeks (Can be non op if older sedentary pt)
103
What are the ADE of distal biceps tendon ruptures
Decreased strenght, Radial nerve injury, Chronic pain Heterotpic ossification
104
What is the function of the Ulnar colateral ligament
Resist valgus stress in the elbow
105
A pt presents with elbow instability and medial elbow pain, +/- ulnar nerve distribution dysestheias think?
Ulnar collateral ligament tear
106
What is the Dx and Tx approach to Ulnar collateral ligament tears
Plain films r/o fracture and ossification MRI with Arthrogram Dx Tx: Non op: no throwing mod and NSAIDs with Rehab OP: for competitive throwers
107
What is nurse maids elbow
Elbow injury in a pt younger than 5 (most common elbow injury in children) Radial head subluxed out of the annular ligamnet
108
What is the Tx approach to nursmaids elbow
Full supination and press at the radial head then fully flex (SOS) Option sling for comfort
109
What is little leagers elbow
A throwing injury in kids aged 8-14 8-12 is usually a fragmentation 12-14 usually an avulsion Greater than 12 years old usalaly has capitellar OCD w loose bodies
110
What is panner dz
Avulsion lesion in less than a 12 year old child (little leagers elbow)
111
What is the Tx appraoch to little leaguers elbow
Non op 2-6 months restriction from throwing OCD= 12 month restriction with physical therapy Operative: if loose bodies
112
What is the the common pathogen in animal hand bites
Pasteurella multocida Possible rabies
113
What are the ADE of animal hand bites
``` Septic arthritis Abscess, Septic teosynovitis, Osteomyelitis, Rabies ``` Possible decreased ROM and weakness, decreased sensation, and lymphedema
114
What is the Tx approach to hand animal bites
Non op: tx for rabies Wash with 1L fluids under block, oral ABX DO NOT SUTURE CLOSED If infected: IV ABX ( ppossible tetanus) OP: infection related
115
What are the ADE of hand animal bites after Tx
Infection after closure, or allergy to ABX
116
What are the ADE of Animal hand bites
Tendon or nerve violation joint capsule violation Fractures Infections
117
What is a boutonniere deformity
Rupture of the central postion of the extensor tendon at the PIP
118
A finger that is flexed at the PIP and extended at the DIP is
A boutonniere deformity
119
What are the ADE of boutonniere deformites
Contracture
120
What is the DX and Tx approach to a boutonniere deformtity
Plain films r/o avulsion fx Tx: Nonop: PIP in full extension for 6 weeks And referral to OT
121
What is the most common UE compression neuropathy
Carpal tunnel syndrome
122
What is Carpal tunnel syndrome
Median nerve compression in the wrist
123
What are common causes of carpal tunnel syndrome
Space competition in the tunnel - Tenosynovitis - RA - Tumors - Pregnancy - DM - Thyroid issues
124
A pt presents with numbness in the thumb, 1st and 2nd fingers, thenar ache, that is worse at night.. think/
Carpal tunnel sydrome
125
What is the PE test for carpal tunnel syndrome
Phalens and Tinels sign
126
A pt with carpal tunnel has 2 point discrimintion greater than
5mm
127
What is the Tx approach to Carpal tunnel syndrome
Initial treatment: splinting, ergonomics, and steroid injections
128
What is de querains tenosynovitis
Lateral wrist tendonopathy (Swelling of the sheath) Effects the abductor pollicis longus and extenson pollicis brevis Common is women that are postpartum
129
A pt with lateral wrist pain at the radial styloid Pain with thumb extension and abduction (Sometimes is a mother with young children)
De quervains tenosynovitis
130
What is finklesteins test
A test for Dequervains tenosynovits Make a fist with thumb inside hand and felx the tumb tendon
131
Dequervains present with tenderness in what comparmtent
In the dorsal first comparment
132
What is the Tx approach to De quervains tenosynovitis
Non op: NSAIDs, splint, and steroid injectios No op: only after Tx failure
133
What is the ADE of Dequervians tenosynovitis
Radial sensory nerve injury
134
What is a dupuyterns contracture
Nodular thickening and contraction of the palmar fascia Common in men over 50 Associated with ``` Epilepsy Diabetes Pulmonary disease Alcoholism Smoking Repetitive trauma ```
135
A pt presents with MCP contracture and deformity with limits in extension and grasp of the hand Most common in the ring finger Think
Dupuytrens contracture
136
What is the Tx approach to Dupuytrens contracture
Nonop: night splints, collangenase injections Operative: If greater than 30 degress fixed flexsion at the MCP or greater than 10 degrees at the PIP
137
What are the common infectious agents of finger tip infections
S. Aureus or Herpes ( autoinfection)
138
What is paronychia
Inflation around the nail bed
139
What is the felon/ whitlow portion of the finger
Pulp
140
Whitlow infections are..
From herpes and are clear vesicles on a red base found on the fingers
141
What are the ADE of fingertip infections
Osteomylitis | And Septic Tenosynovitis
142
What are the Tx approaches to Fingertip infections
Non op: Felon involvmentL digit bloc and drainage, clean and pack, DONT Suture ParonychiaL Soaks and oral ABX If severe remove nail
143
What are the ADE of fingertip infeciton Tx
Neuroma, nail deformity, continured/ repeated infection
144
What are the Referral criteria for fingertip infections
+osteomylitis | +septic tenosynovitis
145
What is the Tx approach to fingertip amputations
Goals= soft tissue coverage, sensation, conserve length Subungal hematoma : Drain by drilling through nail ``` No bone= Irrigation and debridement Suture NO tension or leave open Wet to dry dressing with splint ROM, OT ``` Bone= Ortho Tetanus? Oral ABX
146
What are the referral criteria for fingertip amputations
Younger that 6 years old Thumb at or proximal to the IP joint Proximal to middle of the middle phalanx Multiple finger amputations
147
What is the most common flexor tendon injury
Jersey finger to the ring finger
148
What is the Tx approach to flexor tendon injuries of the hand
Non op Splint with ends together Irrigation or superfical closure (if laceratin) repair within 1 week
149
What is the referral criterai for flexor tendon injuries
All ruputres and lacs Add description of the zone 1-2-3-4-5
150
Where does the flexor tendon sheath of the hand extend to
Extends from the DIp to the MCP joint
151
A pt that presents wtih 24-48hr of severe pain post punture, with flexor sided finger pain.. think?
Flexor tendon infection | ( limb threatening)
152
What are the kanavel signs
1: sausage digit- uniform swelling along enitre finger 2: pain to percussion/ palpation to the flexor tendon sheath 3: finger held in passive flexion 4: pain with passive extension
153
What is the Tx approach to a flexor tendon infection
Washout URGERNT! IV ABX for staph and strep Reeval in 12-24 hrs Continue 24-72 then Oral ABX for 7-14 days
154
What is the most common bacteria from human hand bites
Eikenella Corrodens More common is Alpha hemoyltic Strep and S. Aurues
155
What are the ADE of Human hand bites
``` Tendon ruptures Abcess formation Osteomyliteis Septic Arthritis Septic Tenosynovitis ```
156
What must be R/o in a human hand bite
R/o ascending infection
157
What is the Tx apprach to a human hand bite
Non op: (no joint, no tendon involment and less than 8 hours post bite) Block, irrigate, debride, explore, DO NOT SUTURE, dress and oral ABX Reeval in 24hr Operative: IF INFECTED Surgical I&D, IV ABX
158
What are the ADE of human hand bite Tx
Infections, amputation, ABX allergy
159
When should you refer a human hand bite
infection Joint capsul involvment Tendon rupture Bone involvement
160
What is keinbock disease
Osteonecrosis of the lunate bone Common in men 20-40 years old With a Hx of trauma
161
A male pt comes in with Hx of truama to the hand/ wrist (punching) With dorsal wrist pain, stiffnes or diffuse swelling +weakness and inability to grasp heavy items Think..?
Keinbock disease
162
What are the ADE of keinbock
Secondary OA
163
What is the Tx approach to Keinbock disease
Non op: splint and referral NSAIDS for pain Operative: Manage secondary OA and Necrosis
164
What is mallet finger
Rupture, lac, or avulsion of the extensor tendon at the DIP
165
What is a swank neck deformity
Hyperextended at the PIP and flexed at the DIP | Opposite of boutenires
166
How will a mallet finger present on plain films
+/- avulsion fx | Volar displacemtn on the flexor pully
167
What is the Tx appraoch to mallet finger
No op: continuous splint x 6 wks OpL occupations with repitive tasks
168
What is the ADE of wearing a finger splint for 6 wks
Skin breakdown at the proximal nail
169
What is the referral criteria for a mallet finger
DIP subluxation or avulsion greater than 1/3 the surface of the finger
170
A fx involving the nail bed is what type of Fx
OPEN
171
What is the Tx approach to nail bed injuries
Non op: subungal hemotoma= drill through the nail Nail bed lac: block, I&D, explore, absorbale suture, dress, splint Nail avulsion= germinal matrix under fold
172
What is the referral criteria for nail bed injuries
Physeal injuries or Open fxs
173
What is trigger finger
Thickening at the A1 pulley Limtis tendon excursion (Catching)
174
What fingers are most commonly affected by trigger finger
Long and ring fingers
175
What Dz are assoc. with trigger finger
RA, DM, hypothyroid
176
A pt presents with pain, locking, and “catching” with finger flexion, +/- a nodule a the finger Think?
Trigger finger
177
TTP at the MCP think
Trigger finger
178
What is the Tx approach to trigger finger
No op: splinting, steroid injections Op: only for non op tx fail
179
What are the ADE of trigger finger Tx
Tendon ruptures, nerve injury, infection
180
What is the referral critera for trigger finger
Contracture or comorbid RA (increased flexor tendon rupture risk)

IPAP JUNIOR SEM. (43 decks)

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