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Clin Med I > arthritis and shoulder injuries > Flashcards

arthritis and shoulder injuries Flashcards

1
Q

hypertrophic arthritis

A
  • bone formation at site of involved joint
  • within confines of bone
  • protrusion of parent bone
  • commonly OA
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2
Q

erosive arthritis

A
  • indicates inflammation
  • tiny, irregularly shaped lytic lesions in or around joint surface
  • usually RA, gout, psoriasis
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3
Q

infectious arthritis

A
  • joint swelling, osteopenia, destruction of long contiguous segments of articular cartilage
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4
Q

psoriatic arthritis

A
  • 30% of pts with psoriasis
  • RF seronegative
  • enthesis and marginal bone erosions
  • “pencil in cup” deformity
  • joint subluxation and interphalangeal ankylosis
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5
Q

ankylosing spondylitis

A
  • chronic and progressive
  • RF seronegative
  • young males
  • symmetric fusion of SI joint and ascending involvement of spine -> decreased ROM and kyphosis
  • “bamboo sign” on x-ray
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6
Q

infectious arthritis

A
  • destructive
  • d/t seeding of synovial membrane from infectious source
  • prompt treatment required
  • either septic or nonpyogenic
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7
Q

common causes of septic infectious arthritis

A
  • staph

- gonococcal

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8
Q

common causes of nonpyogenic infectious arthritis

A
  • mycobacterium
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9
Q

risk factors for infectious arthritis

A
  • IV drug use
  • chronic steroids
  • joint replacement
  • recent joint trauma
  • DM
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10
Q

symptoms of infectious arthritis

A
  • monoarticular pain and swelling
  • decreased PROM and AROM
  • fever
  • will look VERY ill
  • purulent synovial fluid
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11
Q

diagnostic studies for infectious arthritis

A
  • CBC with diff
  • ESR, CRP
  • cultures
  • x-ray
  • MRI
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12
Q

treatment of infectious arthritis

A
  • I&D
  • abx
  • remove infecting source i.e. prosthesis
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13
Q

osteoarthritis

A
  • aka DJD
  • most common form of hypertrophic arthritis
  • primary, secondary, or erosive
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14
Q

modifiable risk factors for OA

A
  • muscle strength
  • physical activity/ occupation
  • joint injury
  • joint alignment
  • leg length inequality
  • obesity
  • diet
  • bone metabolism
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15
Q

non-modifiable risk factors for OA

A
  • age
  • sex
  • genetics
  • ethnicity
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16
Q

treatment for OA

A
  • pain control
  • PT
  • bracing
  • assistive device
  • viscosupplemetation
  • risk factor modification i.e. weight loss
  • surgery- arthroplasty or osteotomy
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17
Q

pain control options for OA

A
  • NSAIDs
  • APAP
  • steroids
  • bracing
  • topical options i.e. diclofenac
  • narcotics don’t have much of a role- short term use only
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18
Q

why does bracing help with pain in OA?

A
  • reduces muscle co-contractions and joint compression

- improves stability and function

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19
Q

when would you get an MRI for hip arthritis

A
  • if avascular necrosis is suspected d/t pain out of proportion to arthritic changes
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20
Q

viscosupplementation

A
  • hyaluronic acid found normally in synovial fluid and cartilage to act as lubricant and shock absorber
  • only FDA approved for knee “lubrication”
  • only give to physiologically young pts with less disease
  • synvisc or euflexxa
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21
Q

where do most clavicle fx occur?

A
  • middle third of clavicle

- rarely results in NV injury

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22
Q

clinical manifestation of clavicle fx

A
  • +/- deformity
  • TTP over fx site
  • pain with AROM and PROM especially in abduction and flexion
  • doesnt impact flex/ext of wrist
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23
Q

treatment of clavicle fx

A
  • sling
  • ice and NSAIDs
  • passive ROM at day 3
  • PT once fx healed
  • if displaced fx need ORIF
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24
Q

AC joint injury

A
  • usually d/t lateral force to lateral aspect of shoulder with arm adducted
  • acromion driven inferiorly and medially
  • high occurance in hockey
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25
clinical manifestations of AC joint injury
- pain and decreased ROM - TTP over AC joint - deformity depends on grade - cross arm test- elevate affected arm to 90 degrees then adduct; pain is pos
26
treatment of AC joint injury
- depends on age/life style and grade of injury - grade I and II conservative tx - grade III +/- surgery grade IV-VI - surgery - joint stabilization with fixation at origin/insertion of ligament
27
grade I AC joint injury
- sprain of AC ligament
28
grade II AC joint injury
- tear of AC ligament
29
grade III AC joint injury
- tear of AC and coracoclavicular ligament
30
sternoclavicular joint dislocation
- uncommon - usually fall on abducted and extended arm - SCM pain/spasm - may not dislocate until days later - anterior more common than posterior - posterior requires surgery
31
proximal humerus fx
- mainly in elderly - mostly impacted or nondisplaced d/t fall from standing - anterior or posterior dislocation of humeral head can occur (less common)
32
clinical presentation of proximal humeral fx
- mod/ severe shoulder pain exacerbated by movement - swelling and ecchymosis - hold affected arm adducted - NV injury can occur if displacement occurs
33
treatment of proximal humeral fx
- mainly conservative - sling - ice, analgesics - sleep in semi-recumbent chair - gentle ROM after 2 weeks - ROM of wrist/ elbow asap - if unstable ORIF or reverse TSR
34
what is the most common type of shoulder joint dislocation?
- anterior (95% of the time)
35
shoulder joint dislocations
- can lead to chronic instability (usually in younger pts) - atraumatic dislocations usually d/t laxity and repetitive - if it is posterior dislocation d/t fall from height, epileptic seizures, electric shock
36
imaging for shoulder dislocations
- AP - Axillary - Scapular Y
37
clinical presentation of shoulder dislocations
- deformity with humeral head dislocated anteriorly - shoulder adducted and IR - shoulder loses roundness - axillary nerve assessment
38
treatment for shoulder dislocation
- reduce ASAP - sling immobilization X 2 weeks with gentle ROM early PT to maintain ROM and strengthen RTC
39
impingement syndrome
- RTC tendonitis - pain d/t compression of tissues btwn humeral head and coracoacromial arch - usually recent hx of over activity - onset of pain with AROM, overhead movement - partial RTC tear is one of the most common reasons
40
clinical presentation of impingement syndrome
- pain sleeping on shoulder - pain with IR - TTP over greater tuberosity - +/- atrophy of supraspinatuous m
41
hawkins test
- tests for impingement syndrome - have pt in 90/90 flexion - stabilize top of shoulder while internally rotate shoulder - positive= pain
42
imaging for impingement syndrome
- AP - Lateral - Grashey - Scap Y - usually appears normal
43
treatment for impingement syndrome
- activity modification and PT - NSAIDs - steroids - surgery- arthroscopic acromioplasty with coracoacromial ligament release, bursectomy, debridement, RTC repair
44
partial RTC tear
- damaged RTC but not completely severed | - often heal by scarring
45
full thickness RTC tear
- separates all of tendon from bone - dont heal well - increase in size with time - usually require sx
46
muscles of RTC and functions
- supraspinatous- abduction - infraspinatous- ER - teres minor- ER - subscapularis- IR
47
etiology of RTC tears
- acute- FOOSH or pulling on shoulder | - chronic- repetitive over head movement or lifting
48
clinical presentation of RTC tear
- full thickness tear more symptomatic - weakness** or pain with overhead mvmt - pain at rest and night - crepitus - limited AROM - acute tears cause intense pain
49
most commonly torn muscle of RTC
supraspinatous
50
imaging for RTC tears
- AP - Lateral - grashy - Scap Y - MRI
51
partial RTC tear tx
- 80% are nonsurgical | - PT
52
full thickness RTC tear tx
- usually sx | - PT for older sedentary pts
53
indications for RTC sx
- sx 6-12 mo - pt does overhead work/sports - large tear > 3 cm - significant weakness and loss of fn - tear d/t recent acute injury
54
rehab after RTC sx
- immobilization with no AROM 4-6 weeks - PROM at PT with start of AROM - strengthening 8-12 weeks - functional ROM and adequate strength usually by 4-6 months
55
slap lesions
- injury of glenoid labrum at point of attachment of long head of biceps - usually d/t FOOSH or throwing sports - type I- usually asymptomatic - type II and III- requires surgery
56
study of choice for slap lesions
- MRI
57
adhesive capsulitis
- minimal/ no trauma - pain out of proportion to clinical findings during inflammatory phase - stiffness during freezing phase - usually perimenopausal women - common with endocrine disorders
58
clinical presentation of adhesive capsulitis
- pain and decreased PROM and AROM - strength is normal but may appear decreased d/t pain - lasts about 24 mo
59
treatment of adhesive capsulitis
- NSAIDs - frequent PT - intra-articular steroid inj - +/- PO prednisone - surgery- manipulation and arthroscopic release
60
calcific tendonitis
- d/t deposition of calcium hydroxyapatite within tendon - usually middle aged women - diabetics at higher risk - most often in supraspinatus
61
clinical presentation of calcific tendonitis
- VERY painful shoulder - minimal/ no trauma - acute onset - pt looks in pain and tired
62
imaging for calcific tendonitis
- AP - Grashey - Scapular Y
63
treatment for calcific tendonitis
- analgesics/ anti- inflammatory - local steroid injection - PT - arthroscopy with aspiration of Ca deposit
64
midshaft humerus fx
- bimodal age distribution - males in 30s d/t high velocity trauma - females in 70s d/t low velocity falls - typically d/t direct blow or bending force
65
clinical presentation of midshaft humerus fx
- severe pain in mid arm - must assess for other injuries "distracting injury" - may have referred pain to shoulder/ elbow - swelling and ecchymosis - shortening of UE - assess for radial N
66
radial nerve injury
- weakness of wrist, finger, thumb ext - weakness of elbow supination - sensory loss on dorsum of hand - test motor fn by thumbs up and resisted thumb test
67
treatment of midshaft humerus fx
- may be nonsurgical in older pts- functional bracing | - ORIF if displacement or young pt
68
elbow fx
- usually d/t FOOSH - radial head fx, olecranon fx, or supracondylar humerus fx - marked by pain and decreased ROM - fat pad or sail sign on xray
69
radial head fx
- FOOSH with abducted arm and flexion of elbow joint
70
radial head fx views
- AP - external oblique - lat
71
treatment for radial head fx
- long arm splint 3-4 days - sling 1-2 weeks and gentle ROM - analgesics - serial xray 2 weeks post - PT
72
olecranon fx
- bimodal age distribution - high energy injury in young - low energy injury in old - direct blow -> comminuted fx - direct blow from FOOSH -> transverse or oblique fx
73
olecranon fx presentation
- pain in posterior elbow with palpable defect | - unable to extend elbow
74
olecranon fx tx
- ORIF with tension band | - plate and scrw
75
elbow dislocation
- mostly closed and posterior | - usually d/t FOOSH with hyperextension or posterolateral rotary mechanism
76
treatment for elbow dislocation
- simple- closed reduction - complex fx dislocation- ORIF - long arm posterior splint/ sling for 1-2 weeks - analgesia - PT
77
lateral epicondylitis
- tennis elbow - extensor tendons - pain with resisted wrist ext
78
medial epicondylitis
- golfer's elbow - flexor tendons - pain with resisted wrist flexion
79
epicondylitis clinical presentation
- extra- articular elbow pain - insidious onset - pain can be minimal to debilitating
80
treatment for epicondylitis
- rest - ice massages - brace - NSAIDs - PT - cortisone
81
both bones forearm fx
- ratio of open to closed very high - direct trauma- protecting head - indirect trauma- MVA, fall from height, sports - gross deformity, pain and swelling
82
treatment of both bones forearm fx
- sugar tong splint in ED - casting if non-displaced (not common) - ORIF
83
colles fx
- fx of distal radial metaphyseal region - dorsal angulation - d/t FOOSH - extra-articular
84
conservative tx for colles fx
- closed reduction - sugar tong splint immobilization - long or short arm cast 4-6 weeks
85
surgical tx for colles fx
- ORIF then splint/cast 4-6 weeks
86
smith fx
- fx of distal radius with volar angulation - extra-articular transverse fx - reverse colles - d/t fall on flexed wrist - volar (cock- up) forearm splint

Clin Med I (16 decks)

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