AAFP Ortho Flashcards
Low back pain for which imaging needed?
History Findings Exam Findings
* Cancer metastatic to bone (breast, lung,
thyroid, renal, prostate)
* Urinary or fecal incontinence
* Urinary retention
* Progressive lower extremity motor
or sensory loss
* Significant trauma related to age
* Severe pain and lumbar spine
surgery in the prior 12 months
Exam Finding:
* Major motor weakness or
sensory loss
* Saddle anesthesia
* Loss of anal sphincter tone
These are all STRONG findings and the presence
Acute LBP treatment
- Beneficial Therapies
NSAIDs (A)
Advice to remain active (A)
Chronic LBP treatment
Beneficial
2nd NSAID, tramadol, duloxetine
1st: Mindfulness-based stress reduction
- Acupuncture
- Exercise therapy (walking prgm = PT)
- Yoga
- Massage
- Superficial heat
- Physical therapy
Intensive multidisciplinary
Role of Duloxetine in LBP
Similar to Cox-2 inhibitor, tramadol, opioids
Role of opioids in LBP
there is uncertainty about the efficacy of opiates in chronic or acute LBP
Short term treatment for LBP
Topiramate effective
Lumbar Disc Herniation
80% resolves within 90 days
90% resolves by 12 weeks
Steroids and NSAID weak evidence
Conservative management up to 6 weeks.
Lumbar Spinal Stenosis findings?
Pain improve with lumbar flexion
Worsen with walking
Relief with sitting
Overuse Injuries?
Tendinosis
Tendinopathy
Lower extremity tendinopathy treatment
Patellar tendinosis (Jumper’s Knee)
Achilles Tendinosis
Both eccentric strengthening
Upper extremity tendinopathy treatment
Lateral epicondylosis
Eccentric strengthening
Chronic tendopathies
Topical nitroglycerin (1/4 of a 5 mg patch)
Tests for shoulder impingement
- Neer’s
- Hawkin’s
Shoulder Impingement treatment?
[SA CSI + exercise + manual therapy] vs. [exercise + manual
therapy] resulted in similar outcomes at 3 months but with less
pain in the CSI group
SA: Subacromial
CSI: Corticosteroid injection
PT: Physical therapy
Limited ROM with pain at end ranges of motion. Dx?
Adhesive Capsulitis
Adhesive Capsulitis associated with?
- Diabetes
- Parkinson’s
- Thyroid dysfunction
- Cardiac disease
Adhesive Capsulitis treatment?
3-4 week of oral prednisone 20 mg or CSU provided short-term relief
Anterior knee pain after recently started running. Dx?
Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome treatment
PT and modification of activity are best
Bracing in runners
Carpal tunnel syndrome associated with?
- Thyroid disease
- Diabetes
- Pregnancy
- Alcoholism
- RA
Most sensitive PE test in carpal tunnel?
Flick sign
Carpal tunnel syndrome treatment
wrist splint
Heel pain worse with first steps?
Plantar Fasciitis
Plantar Fasciitis management
- Initiate patient-directed therapies
Relative rest, ice massage, analgesics, stretching, weight loss - Initiate physician-directed therapies
Physical therapy, stretching, deep myofascial massage
Night splint use for up to 3 weeks (B)
OTC orthotics (B)
Corticosteroid injection (B) – for short term pain relief
Autologous blood injection (B)
Extracorporeal shock wave therapy can be used in recalcitrant plantar fasciitis (B)
Morton’s neuroma?
3rd and 4th web space most common
- Mulder’s sign
Treatment: Shoes with wide toe box and low heels, orthotics, injection
Tarsal Tunnel Syndrome?
Entrapment of posterior tibial nerve posterior to medial malleolus
- Provoked by subtalar pronation
Tarsal Tunnel Syndrome VS Plantar Fasciitis?
On TTS nontender medial calcaneal tubercle
Trigger finger
- 40-60 yo
- Seen in DM, RA and repetitive hand activities
- Stuck finger. Tender lump in palm of hand.
- Splinting the finger in a neutral position
- Dexamethasone preferred over triamcinolone with lower recurrence at 3 months
Chronic exertional compartment syndrome
Chronic anterior leg pain
Risk: Anabolic steroids, creatine use, eccentric exercise, military recruits.
Tx: Resolve with 2–30 min rest
Definitive: Fasciotomy
Orthopedic Milestones
- 6 months - Sits with support.
- 9 months - pulls to standing.
- 12 months - walks independently or with hand support.
- 2 years - climbs steps
- 3 years - stands on 1 foot for a few seconds.
What causes unable to move the shoulder but able to move fingers?
Erb’s Palsy
Polydactyly treatment age?
Surgery at 1-2 year
Developmental Dysplasia of the hip
- Left hip most common
- Clunk is positive not the click
- Tx: Pavlik harness: birth to 6 month
Spica casting: 6 month to 2 years
Pavlik harness position of hip?
Hips in flexion and abduction.
Club foot treatment?
- Serial casting
- Surgical correction: 9-12 months if needed
Most common childhood bone cancer?
1st Osteosarcoma: At physis of long bone (Knee and shoulder). <19 year old.
2nd Ewing’s sarcoma: At long bone. In teenage years
Most common benign bone tumor in children?
1st Nonossifying fibroma
2nd Osteochondroma
Nonossifying fibroma treatment?
Common in distal femur or distal tibia
Resolves with skeletal maturity.
Osteochondroma treatment?
- Solitary or multiple
- Grows as child grows
- Monitor and treat symptomatically.
Intoeing in children?
- Metatarsus adductus: MC congenital foot deformity. Resolve by 1 year
- Internal tibial torsion: MC intoeing. Patella facing forward and feet intoeing. Resolve by age 8.
PT, orthotics, splints are not effective.
- Femoral anterversion: Both knee and feet point inward. Improve by 9-10 years. Surgery at age 9-10 if more severe.
Risk from SCFE?
AVN is 30%
Little league elbow tx?
Rest for 3-6 weeks
Proper throwing mechanics
Transient synovitis vs Septic Hip?
Patient presents with fever, hip pain, and limp. Temp, x-ray, CBC, labs
recommended
- T> 38.1
- CRP >2.0
- ESR >40
- WBC >12
- Non-weight bearing
Types of Apophysitis?
What is Osgood schlatter’s?
Tibial tuberosity
Bilateral anterior knee pain
What is sever’s disease?
Calcaneus
Achilles
Posterior heel pain
Cramping pain that often awakens from sleep in children?
Growing pain.
Benign Noctural Limbs Pains
No LIMP
Reassurance, heat, massage, warm baths, exercise to non-aggravating levels, mild analgesics.
Scoliosis with Cobb angles?
- Cobb angles 30-40: Brace
- Cobb angles >40: Surgery
MC congenital hand deformitiy?
Syndactyly
Most common congenital foot deformity.
Metatarsus adductus
