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Phys: Bone & Gen Med: Ortho > Bone and Joint Disorders > Flashcards

Bone and Joint Disorders Flashcards

1
Q

What are ex of bone and joint disorders?

A
  1. Tendinitis
  2. Bursitis
  3. Epicondylitis
  4. De Quervain’sTenosynovitis
  5. Flexor tenosynovitis
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2
Q

Define Tendonitis

A

Painful inflammation of tendon(s)

Muscle attaches to bone

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3
Q

What is the etiology of tendonitis?

A
  1. Overuse – Most common
  2. Inadequate warm-ups
  3. Injury – falling, throwing
  4. OA
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4
Q

What is the pathophys of tendonitis?

A
  1. Intrinsic & Extrinsic Mechanisms
    A. Inflammation usually results from strain
    -Sudden forceful contraction of muscle under stretch overloads its tensile strength  muscle / tendon micro-tears  inflammation
    -Granulation tissue & collagen grow in area of injury
    -New tissue fuses with surrounding tissue
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5
Q

Define strain

A

muscle or tendon injury

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6
Q

Define sprain

A

ligament injury

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7
Q

What are the extrinsic mechanisms of injury for tendonitis?

A

Compressive forces exerted by surrounding structures can injure rotator cuff
Acromion, coracoacromial ligaments, acromioclavicular joint, osteoarthritis

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8
Q

What are the most common areas of tendonitis?

A 
1. Shoulder
A. Rotator cuff: supraspinatus
2. Biceps brachii
3. Achilles tendon
4. Patellar tendon
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9
Q

What are the risk factors for supraspinatus tendinitis?

A
  1. Repetitive overhead activity
    A. Swimming, tennis, throwing, weight lifting, gymnastics, painting, electricians
  2. Older age
    A. Aging tendons develop microtears, calcification and fibrovascular proliferation
  3. Instability GHJ
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10
Q

What is the function of the supraspinatus?

A
  1. Abd & ER of shoulder
    A. compresses humeral head in glenoid fossa
    B. assisted by subscapularis and teres minor
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11
Q

What are the sxs of rotator cuff tendinitis?

A
  1. Shoulder pain w/ overhead activity
  2. Painful daily activities
  3. Pain @ nite, esp. when lying on affected shoulder
  4. Atrophy supraspinatus / infraspinatus muscles
    A. Chronic
  5. Asymmetric movement of scapula
  6. Tenderness overlying affected muscles
  7. Painful AROM and dec ROM
  8. Normal PROM w/ pain
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12
Q

What is a painful arc sign?

A
  1. Pain w/ Active abduction beyond 90deg (ie, painful arc sign) -> rotator cuff tendinopathy

A. Most useful when combined w/ other rotator cuff tests

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13
Q

What is the empty can sign? What does it assess?

A
  1. Assess Supraspinatus function
    A. Straight arm in ~90deg abduction & 30deg forward flexion , then internally rotate shoulder completely
    B. Attempt to adduct the arm while the patient resists
    C. Pain w/o weakness: tendinopathy
    D. Pain w/ weakness: tendon tear
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14
Q

What are 2 tests for shoulder impingement?

A
  1. Neer test: PROM
  2. Hawkins-Kennedy Test
  3. Cross Arm test
  4. Apley scratch test
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15
Q

What diagnostic tests are used to assess shoulder tendinitis?

A
  1. X-ray shoulder
    A. Oblique, lateral, AP
  2. +/- MRI
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16
Q

What is the rx for shoulder tendinitis?

A
  1. Avoid overhead reaching/lifting and behind back
  2. NSAIDs
  3. PT
  4. +/- glucocorticoid steroids
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17
Q

What is the rx for a rotator cuff tear?

A

Right shoulder arthroscopy, rotator cuff repair

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18
Q

Define bicipital tendinitis?

A
  1. Inflammation of long head of biceps tendon -> bicipital groove proximal humerus
  2. Usually occurs with rotator cuff inflammation
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19
Q

What is the function of the biceps brachii muscle?

A
  1. Flexes and supinates the forearm @ elbow

2. Long head of tendon stabilizes superior aspect of GHJ

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20
Q

How can the pain from a rotator cuff injury and biceps tendinitis be differentiated?

A
  1. Sxs of biceps tendonitis pain radiating to biceps, pain w/ IR
  2. Pain over bicipital groove
  3. Yergason’s test
  4. Speed’s test
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21
Q

What are the sxs of bicipital tendinitis?

A 
1. Anterior shoulder pain aggravated by:
A. Lifting
B. Carrying objects like shopping bags
C. Overhead reaching
2. Dramatic lump just above antecubital fossa suggest long head biceps tendon rupture
A. Proximal biceps tendon
B. Distal biceps tendon
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22
Q

What are the dx tests for bicipital tendinitis?

A
  1. MRI to differentiate tendinitis from tear
    A. Used to confirm ruptured tendon
    -Absence of biceps tendon in groove
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23
Q

How is bicipital tendinitis treated?

A

RICE

Avoid aggravating activity

24
Q

How is bicipital tear treated?

A
  1. Referral to Orthopedics
  2. Proximal- no treatment, become asymp. After 4-6wk
  3. Distal- Surgery
25
Q

What is lateral epicondylitis?

A
  1. “Tennis elbow”
  2. Most common overuse injury of elbow
  3. Involvement of tendinous insertion of extensor carpi radialis brevis (ECRB)
26
Q

What are the sxs of lateral epicondylitis?

A
  1. Pain on lifting objects
    A. Primarily when arm is in prone position
  2. Tenderness lateral epicondyle
27
Q

When is imaging performed for lateral epicondylitis?

A
  1. Not necessary unless tendon disruption suspected

A. MRI

28
Q

How is lateral epicondylitis treated?

A 
1. Stop aggravating activity
A. MOST IMPORTANT TREATMENT !
2. Modify lifting
3. Tennis elbow braces
4. PT / OT
5. NSAIDs
6. Steroid injection
29
Q

Define medial epicondylitis

A
  1. Golfer’s elbow or baseball elbow

2. Affects flexor-pronator muscles at origin, ant. to medial epicondyle

30
Q

What are the sxs of medial epicondylitis?

A
  1. Hx repetitive stress to joint
  2. Tenderness medial epicondyle
  3. Pain is reproduced by resisted pronation or flexion of wrist
31
Q

When is imaging performed for medial epicondylitis?

A

Not indicated unless suspected ulnar nerve entrapment

32
Q

What is the rx for medial epicondylitis?

A 
1. Avoid aggravating activity
A. MOST IMPORTANT TREATMENT !
2. Elbow Compression strap
3. NSAIDs
4. PT / OT
5. Steroid injection
33
Q

Define tenosynovitis

A

Inflammation of the lining of the sheath that surrounds tendons

34
Q

What is the etiology of tenosynovitis?

A
  1. Overuse
  2. Injury
  3. Infection
35
Q

Define De Quervain’s Tenosynovitis. Who gets it?

A
  1. Middle-aged women, new moms, grandmothers
  2. Inflammation of synovial sheath surrounding tendons in addition to those tendons
    A. The first dorsal compartment of the wrist includes the tendon sheath that encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomic snuffbox.
36
Q

Define trigger finger. Who gets it?

A
  1. Volar flexor tenosynovitis
  2. Any finger, commonly, thumb or ring fingers
  3. Most common
    A. Middle-aged women
    B. Diabetic pts
  4. Locking of involved finger in flexion is followed by sudden release – “Trigger Finger”
    A. Hand pain radiates to fingers
  5. May require passive manipulation to re-gain extension
37
Q

What are the sxs of De Quervain’s tenosynovitis?

A 
1. Hx repetitive pinching motion of thumb & fingers
A. Assembly line work
B. Driving in screws
C. Weeding
2. Pain in radial aspect wrist
A. Worse w/ activity
B. Better w/ rest
3. Pain with PROM thumb
A. Finklestein's test
38
Q

What is the treatment for De Quervain’s tenosynovitis?

A
  1. Thumb spica splint
  2. NSAIDs
  3. Peritendinous lidocaine/corticosteroid injection
  4. Refer to Orthopedics if conservative treatment fails
39
Q

What are the volar flexor tenosynovitis sxs?

A
  1. Tenderness @ proximal end of tendon sheath in distal palm

2. Catching of tendon when finger is flexed

40
Q

How is volar flexor tenosynovitis treated?

A
  1. NSAIDs
  2. Peritendinous lidocaine/corticosteroid injection
  3. Splinting
  4. Refer to Orthopedics if conservative tx fails
41
Q

Define bursitis

A

bursal sac w/ small amounts synovial fluid that facilitate motion/reduces friction of muscles and tendons over bony prominences

42
Q

What is the pathophys of bursitis?

A

Inflammation leads to excessive fluid production in bursal sac -> bursa becomes gritty and rough -> presses on sensory nerve endings -> painful and irritating to area

43
Q

What are common types of bursitis?

A
  1. Subacromial
  2. Olecranon
  3. Trochanteric
  4. Semimembranous-Gastrocnemius
    A. popliteal bursitis/ Baker’s cyst
  5. Prepatellar (most common)
    A. “housemaid’s knee”
44
Q

What is the etiology of bursitis?

A
  1. Repetitive overuse injury
  2. Often blunt trauma
  3. Arthritic conditions
    A. OA, RA, Gout
  4. Infection (septic bursitis)
45
Q

How is bursitis different from arthritis?

A

Bursitis is more likely than arthritis to cause focal tenderness and swelling and less likely to affect ROM of adjacent joint

46
Q

What are the sxs of bursitis?

A
  1. Focal tenderness & swelling over bursa
  2. Site specific:
    A. Subacromial bursitis – limited arm abduction
    B. Prepatellar bursitis – pain when climbing stairs, knee flexion
    C. Trochanteric bursitis – pain when climbing, squatting, crossing legs, lying on affected side
  3. May have co-existing infection- more common:
    A. Olecranon
    B. Pre-patellar
47
Q

How is subacromial bursitis treated?

A
  1. Avoid repetitive reaching overhead and above shoulder level
  2. NSAIDs
  3. +/- cortisone injection into subacromial space
48
Q

How is olecranon bursitis treated?

A
  1. R/O co-existing infection- septic olecranon bursitis
  2. Avoid leaning on elbows
  3. Compression wrap / Heelbo
49
Q

What are the sxs of trochanteric bursitis?

A 
1. Point tenderness
over greater trochanter
2. May radiate to lateral
knee down to ankle, 
confused with sciatica
3. External snapping hip syndrome
50
Q

What is the treatment for trochanteric bursitis?

A
  1. Avoid lying on affected side
  2. Iliotibial band stretching exercises
  3. Foam roller
  4. If exquisitely tender to palpate, responds excellent to lidocaine/cortisone injection into bursa (very painful injection for patient)
51
Q

What is a “Baker’s cyst”?

A

Not a real cyst;
Semimembranosus
bursa

52
Q

What is the treatment for Baker’s Cyst/Semimembranosus bursitis?

A
  1. Tx underlying cause, usually OA of knee
  2. NSAIDs
  3. +/- lidocaine/cortisone injection into knee joint
53
Q

What is the treatment for prepatellar bursitis?

A
  1. Avoid kneeling
  2. NSAIDs
  3. Aspiration of bursal area NOT DONE
54
Q

True/False: Imaging is always necessary for bursitis

A

False, imaging is NOT necessary

55
Q

What is the general tx for bursitis?

A
  1. NSAIDs
  2. Compression wrap
  3. If swelling is large, can aspirate and inject lidocaine & corticosteroid into bursal sac
    A. Swelling still may return shortly thereafter
  4. I&D and Abx if co-existing infection
    A. Septic bursitis- bursal fluid findings?

Phys: Bone & Gen Med: Ortho (14 decks)

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