Clin Med Flashcards
s/s of bursitis/subacromial impingement
pain in superior shoulder, posterior or radiating to lateral arm; worse after overhead activity, onset after repetitive activity; wake up at night in certain positions
why pain after overhead activity for bursitis?
subacromial bursa = pinch b/w greater tuberosity and acromion
how to test for bursitis?
Hawkins sign (pain w/ internal rotation of humerus); full/empty can for supraspinatus; + arc sign in 70°-120° and then moves easier there
plan for bursitis?
XR, antiinflamm, PT
what is RC tear/tendonitis? S/s? Dx?
bursitis can progress to RC tear over time –> longer lasting bursitis sxs. Wake up at night d/t pain in any position. Hawkins sign, supraspinatus atrophy
Grade I vs II vs III bursitis
edema and hemorrhage vs fibrosis, thickening, partial tuff tearing vs thickness tendon tear, bony changes, tendon rupture
s/s of osteoarthritis
pain, morning stiffness, reduced ROM, muscular atrophy
s/s vs dx vs tx of proximal humerus shoulder fx/little leaguer’s shoulder
overuse d/t repetitive throwing; pain at supero-lateral shoulder and lateral deltoid vs XR showing widening proximal humeral growth plate vs sling and rest, PT, pain ctrl
s/s of adhesive capsulitis/frozen shoulder
BOTH limited active & passive ROM, progressive pain; assoc w/ DM, thyroid, mastectomy, RA, lung ca/TB/COPD
how to tx adhesive capsulitis
pain ctrl (calcitonin nasal spray, steroids, NSAIDs, intraarticular injection), PT, Spencer’s technique
anterior dislocations = subclassifed into:
subcoronoid (85%), subglenoid, subclavicular, intrathoracic
imging for anterior dislocation/instability
Hill-Sachs lesion: posterolateral humeral head compresses/fx as it impact anterior inferior glenoid rim; Bankart fx: anterior inferior glenoid rim fx as humeral head dislocates –> labrum pulls bone away as part of tear
how to tx anterior dislocation
surgery if <25yo, rehab if >25yo; pain ctrl, immobilization. closed reduction w/ sedation or open reduction in OR
SLAP lesions
superior labral tear in ant-post plane. most common cause of dislocation; labrum = separated from glenoid
how to tx SLAP lesion?
antiinflam, PT, MR arthrogram, orthopedic surgeon
how to test vs tx AC joint separation
observe, palpate, Chuck Norris test vs ice, sling and rest, NSAIDs
how to dx vs tx clavicle fx?
observe, palpate, pain w/ any ROM above 90 degrees, XR vs surgery if bones overlap
3 types of clavicle fx: I/middle 1/3 fx vs II/lateral fx vs III/medial fx
72-80% of all clavicle fx vs 25-30% of all clavicle fx vs 2% of all clavicle fx
bicep tendon rupture
“Popeye” muscle; anterior pain but painless “pop”, pain at bicipital groove, weak supination = complication
Major risk factors of osteoporosis
Menopause, thin frame, steroids/meds, inactivity/smoking, fhx, DM/hypogonad, fx w/ bone loss
Bone remodeling: bone formation vs resorption
Blasts and stromal cells release OPG —> binds and sequesters RANKL —> inhibits clasts vs PTH binds to blasts —> blasts secrete RANKL and M-CSF —> clast precursor to mature clasts; 1,25 vit D stimulates RANKL; PGE2 activates adenylyl cyclase —> resorption; IL6 and MIP1A activated for myeloma
Molec for osteoclast inhibition
Blasts and stromal cells release OPG —> OPG binds and sequesters RANKL —> inhibit clast activation and differentiation; calcitonin interacts w/ clasts via cell-surface receptors —> dec RANKL; estrogen inc bone formation and inhibits activation of adenylyl cyclase —> dec resorption; TGFB and IL10 suppress clasts
Primary vs secondary osteoporosis
D/t age or loss of gonad fxn; not assoc w/ other dz vs microarchitectural alterations d/t other dz or med
How does vit D let Ca2+ defic and secondary hyper parathyroidism contribute to osteoporosis?
Aging skin + dec sun exposure —> dec 7-dehydrocholesterol to cholecalciferol —> vit D defic —> dec Ca2+ absorption —> inc PTH to main serum Ca2+ —> bone resorption
Meds causing/ osteoporosis
Steroids, excess thyroid hormones, GnRH agonists (br and prostate ca), cyclosporine, methotrexate, pheno-, heparin
Recs to prevent osteoporosis
Calcium (1200mg) and vit D (400-800IU/d regardless of sun), wt bearing exer/axial loading (start light and inc), stop tobacco and alc
DEXA vs FRAX
Measures femoral neck, hip, spine vs fx risk assessment tool to predict 10yr probabilities of osteoporotic and hip fxs; takes nicotine, alc, and glucocorticoids into account; rec for 40-90yo
How to tx osteoporosis?
Use preventive measures, bisphosphonates, SERMS, calcitonin
Bisphosphonates: alendronate vs residronate vs etidronate
Inc bone density of spine and hip, dec vertebral fx rate; GI side effects: esophagitis, dyspepsia, N/V/D, MSK pain vs inc bone density of spine and hip, dec vertebral fx rate; GI side effects vs not approved tx for osteoporosis —> use for idiopathic osteoporosis if other meds don’t work
Instructions for taking bisphosphonates
1st thing in morning before eating/drinking, take w/ at least 8oz of water upright sitting or standing and stay upright for 30min after ingestion; don’t eat/drink after 30min ingestion
How do bisphosphonates work? What’s one contraindication?
Stop bone resorption. Osteonecrosis of jaw —> don’t give to pts w/ oral dz, make sure pts have dental exam before rx
Teriparatide
Recombinant PTH1-34 inc bone density of spine after 3mo and hip after 6-12mo; trabecular bone inc first then cortical bone after a year
Selective estrogen receptor modulators (SERM)
Estrogen agonist in bone and heart —> inc blast activity; estrogen antagonist in br and ut —> dec br and ut ca
SERM: raloxifene
For post menopausal women; dec bone turnover, dec vertebral fx, dec br ca, dec total chol and LDL; side effects: flu like sxs, hot flashes, leg cramps, peripheral edema
Prolia/Denosumab
Monoclonal ab that protects healthy cells from dmg —> for postemenopausal women and men who have high fx risk, for pts w/ prostate or br ca to tx bone loss
Calcitonin
Inc BMD, dec vertebral fx, no stats on hip fx; possible analgesic effect in women w/ compression fx
Asx vs sx of vertebral fx
Dx by radiographs, inc kyphosis, dec height, chronic back pain d/t vertebral compression vs pain lasts 2-4wks, debilitating
How to tx vertebral fx?
NSAIDs, calcitonin; narcotics for pain ctrl; OMT or PT for acute and chronic pain; postural exer; education, support groups
What’s percutaneous vertebroplasty?
If pts don’t respond to conservative tx or cont to have pain —> inject acrylic cement into collapsed vertebra to stabilize and strengthen fx and vertebral body (DOES NOT restore shape or height of compressed vertebra)
What’s kyphoplasty?
Cement = injected into cavity by high pressure balloon; being eval and could restore height to collapsed vertebra
Paget’s dz
Localized bone d/o when you have high clast activity then high blast activity to compensate —> unorganized bone pattern; larger, weaker, more vascular, less compact bone —> more fx
How to dx Paget’s?
XR, blood test (high serum ALP), bone scan
3 phases of Paget’s: lytic vs mixed vs sclerotic
High clast activity —> inc bone turnover vs high blast activity to compensate —> unorganized bone formation —> resorption + formation —> inc bone turnover vs inc blast activity —> unorganized bone formation, infiltrated by fibrous connective tissue —> hyper vascular
Sxs of Paget’s
Bone pain, secondary arthritis, bone deformity, excess warmth (d/t hyper vascular), neurological complications (d/t nerve compression)
If pt comes in with acute monoarthritis case w/ fever 101, what would you do?
If infxn —> labs (CBC —> high WBC, ESR and CRP = inflamm; joint aspiration to look at fluid —> gram stain vs crystals). If bone at risk —> XR (usually first test ordered)
Noninflamm vs inflammatory s/s for RA
No morning stiffness, pain worsens w/ activity (nml CRP) vs morning stiffness, “gel” phenomenon (high CRP), warmth or erythema
Labs for rheumatic dzs: ESR vs C reactive protein
Blood drawn into long thin tube and set for 1hr; Rate = dependent on conc of igG and fibrinogen vs IL1, IL6, TNF alpha activate acute phase response —> inc liver proteins —> inflamm
Criteria for RA dx
6wks of: Morning stiffness 1hr+, swelling of 3+ joints, swelling of hand joints (PIP, MCP, wrist), symmetric swelling; subq nodules; labs: serum RF, ANA
Rheumatoid Factor (RF) vs Anti-nuclear ab (ANA) vs Anti-Citrullinated Protein Antibodies (ACPA)
Mult proteins bind to Fc portion of IgG, nonspecific vs Targets nml nuclear proteins; if pos —> autoab = present, nonspecific (found in 95% of lupus, scleroderma, polymyositis) vs tested by ELISA, antiCCP dx RA
6 diffuse connective tissue dzs
RA, systemic lupus erythematosus, systemic sclerosis/scleroderma, polymyositis, dermatomyositis, Sjogren’s
Anti-ribonucleoprotein (anti-RNP)
Assoc w/ mixed connective tissue dz > SLE > scleroderma > RA
Scleroderma markers
Anti-SCL70 —> diffuse scleroderma, anti-topoisomerase1; anti-centromere (ACA) —> correlates w/ CREST syndrome
Inflammatory myopathy aka myositis
Dzs involving chronic muscle inflam w/ muscle weakness; high ESR and CK, anti-Jo1 ab targets histidine-tRNA ligase (assoc w/ cracked hands, Raynaud’s phenomenon, arthritis)
Anti-neutrophil cytoplasmic ab
C-ANCA; p-ANCA —> autoimmune liver dz, RA, inflamm bowel dz. If pos —> do titer (higher titer —> more ab in blood)
When to do XR vs CT vs MRI vs MR arthrogram vs myelogram vs electromyogram vs nerve conduction test for MSK pain?
Good for trauma not stress fx; picks up mass/tumor; usually first study done vs good for fx vs for muscle/soft tissue problems like RC or labra tears vs MRI w/ contrast w/in joint, for instability and can find fluid leaks vs MRI CT w/ contrast in spinal canal for spinal problems vs measures electrical activity of muscles at rest and ctx vs measures how fast and well nerves send electrical signals
OA/DJD
Slow progressive joint dz where articular cartilage breaks down d/t high loads on joint surfaces —> loss of proteoglycans and chondrocytes in the cartilage; most common form of arthritis
Cartilage vs joint capsule vs synovium vs synovial fluid
Lubricating surface at end of bone, “shock absorber” vs tough membrane sac holding bones and joints together vs thin membrane inside joint capsule vs fluid lubricating joint and keeping cartilage smooth and healthy
Primary vs secondary vs erosive osteoarthritis
D/t age (55-60yo) b/c the longer you use joints the more likely to develop OA vs d/t previous joint injuries or fx (45-50yo), inactivity (weaker muscles/tendons surrounding joint), genetics, other dz vs more severe; combo of cartilage degeneration w/ inflamm synovial changes; more in women post menopause
Why does articular cartilage degenerate?
Poor access to nutrients for chondrocytes deep in cartilage —> dec water and more small cavities in matrix —> calcification of cartilage —> chondrocytes die; adult chondrocytes can’t keep up pace of regen
Components of cartilage: water vs collagen vs proteoglycans vs chondrocytes
65-80% vs fibrous protein in connective tissue vs combo of proteins and sugars that weave w/ collagen to make mesh —> shock absorber fxn of cartilage vs cells that maintain cartilage’s health
OA of knee may involve?
Medial or lateral femorotibial compartment —> genu varus/bowleg or genu valgus/knock knee, patellofemoral compartment, small effusions, crepitus
OA of hands may involve?
Bouchard’s nodes at PIP, Heberden’s nodes at DIP (most common of idiopathic OA); pain, redness, swelling of joints
What do radiographs show for OA?
Joint space narrowing in medial compartment, osteophytes, subchondral sclerosis
How to tx for OA?
Reduction of joint loading, exer/PT, drug therapy, intraarticular therapy (corticosteroids, hyaluronic acid), surgery (if meds fail)
Types of exer to tx OA
Strength: add resistance; aerobics: lungs and circ in shape; ROM activities: limber joints; agility: maintain daily living skills; neck and back strength: stronger and limber spine
Types of meds for OA
Analgesics, NSAIDs, opioids, CAM, gemmotherapy
Risk factors of OA
Age, women, race, genetics, joint trauma, repetitive stress, obesity
Pathology of OA
Thicker cartilage —> joint surface thins, cartilage softens, integrity = breached —> vertical clefts develop => fibrillation —> deep cartilage ulcers, becomes hypocellular
Spine OA: apophyseal joint vs spondylosis vs spondylolysis vs spondylolisthesis vs spondylitis
Joint around bone that has no independent ossification; 2+ bones join w/ spine vs ankylosis/stiffening of vertebrae vs degen of articulating part of vertebrae vs forward movement of body of one lower vertebrae on vertebrae below it vs inflam of 1+ vertebral bodies
Spinal stenosis
Narrowing of spinal canal —> compresses spinal cord in neck, cauda equina nerve roots in low back —> back pain, radiating pain, numb, muscle weakness in limbs (better when sitting, worse when walking), bladder/bowel disturbances
How to tx spinal stenosis?
OMT/PT, wt loss, posture change, pain meds, laminectomy
Risks vs complications of laminectomy
depends on # of lvls compressed, other medical conditions, difficult anatomy, marked stenotic canal vs wound infxn, hematoma, dural tears, risk of meningitis, nerve root dmg, postoperative spinal instability
Scoliosis. What are the 4 types?
Spine curvature in coronal plane >10degrees; dextroscoliosis (thoracic) levoscoliosis (lumbar, thoracic —> likely tumor). Congenital, neuromuscular, compensatory, idiopathic
Congenital scoliosis
Spinal curvature from asymmetric spinal growth, implies failure of segmentation or formation of vertebral elements assoc w/ fused ribs and spinal cord anomalies; partial or complete failure of segmentation —> unsegmented bar —> spine = fused, partial or complete failure of vertebral formation —> hemivertebra/wedging —> growth centers
Congenital scoliosis: VACTERL vs Klippel-Feil syndrome
Vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula, renal defects, limb defects vs variable fusion of C2-6 —> AA instability; triad: limited neck motion, low hair line, short neck; deaf, GU abnlities, CV abnlities, Sprengel’s deformity = congenital elevation of scapula
Neuromuscular scoliosis
In children w/ cerebral palsy, muscular dystrophy, SMA, congenital myopathies or neuromuscular conditions, spina bifida, spinal cord injuries; nonambulatory pts at risk; rapid progression of curvature than idiopathic
Compensatory scoliosis
D/t body’s compensatory mechanisms (ex: leg length discrepancy); tx = shoe lifts
Idiopathic scoliosis. Complications?
Curvature w/o identifiable cause; most common type; females > males; early onset = infant (<3yo) or juvenile (4-10yo), late onset = 12yo multifactorial. Thoracic insufficiency syndrome - deformed thoracic rib cage —> impaired and restricted lung growth and fxn —> restrictive lung dz (thoracic curve > 70degrees —> compromised resp fxn, thoracic curve = 75-80degrees —> cardiopulmonary comproomise
How to screen scoliosis?
US Preventative Services Task Force and American Academy of Family Physicians rec AGAINST screening asx adolescents; American Academy of Orthopedic Surgeons & Peds and Scoliosis Research Society rec screening girls 10-12yo & boys 13-14yo; Bright Futures rec screening >8yo
How to dx scoliosis?
Shoulder and waist asymmetry, unilateral scapular prominence; PA spine radiograph to assess coronal curvature, lateral spine radiograph to assess sagittal alignment, pelvic radiograph to chk iliac crests (all radiographs should be done standing)
Cobb angle
Determine end vertebra of curve (based on ends of con cavity of curve) —> draw 2 perpendicular lines, one from top and bottom —> meet the 2 lines so you have right angles from each —> measure angle in b/w
risser sign for scoliosis
Grade 0-2: substantial growth remaining
Grade 3: little growth remaining; monitor q6-12mo till 1 yr after skel maturity
Grade 4 in girls and Grade 5 in boys: skel maturity
How to tx scoliosis?
Cobb angle </= 10 degrees: rpt imaging if curve progresses
Cobb angle 11-19 degrees: observation w/ f/u q 6-8mo
Cobb angle 20-29 degrees: refer to ortho and f/u q 6mo
Cobb angle >30 degrees or progressing >5 degrees in 3-6mo period: bracing
Cobb angle >50 degrees: surgery
Scoliosis indications for referral
Cobb angle = 20-29 degrees in premenarchal girls and boys 12-14yo, Cobb angle >30 degrees for any pt, progression of >5 degrees for any pt; scoliometer >/= 7 degrees in pts w/ BMI <85th percentile, scoliometer >/=5 degrees in pts w/ BMI >85th percentile; sig back pain w/ presentation; L sided curve = high incidence of intraspinal pathology (syrinx or tumor)
How can OMT help scoliosis?
Optimize mobility, improve musculature strength (psoas, abd muscles), stretch tight tissues, correct somatic dysfxns (ME, MR, HVLA = good for fxnal but not for structural)
Kyphosis. Causes vs tx
Spine curvature in sagittal plane (nml thoracic curve = 25-50 degrees). Congenital vertebral anomalies, spinal growth disturbance (Scheuermann dz), neuromuscular afflictions, metabolic dz, skel dysplasia, posture vs none if mild curve and skel mature; exer and education to dec complications; bracing, surgery if >70 degrees w/ back pain
Scheurmann dz
Most common cause of FIXED kyphosis deformity; 13-16yo, boys > girls; presents w/ h/o poor posture, thoracic curve, hyperlordosis of lower spine, +/- hamstring tightness; can be assoc w/ spondylosis
OI/brittle bone dz
Auto doom mutation in COL1A1/2 in type I collagen
4 types of OI: I vs II vs III vs IV
Blue sclerae for all (in dec severity). most common and mildest; nml stature, no bone deformity, recurrent childhood fx vs most severe —> lethal; short; intraut fx vs most severe if survive neonatal; short, mod to severe bone/pectoral deformity, hearing loss, in utero fx vs moderate; short, bone deformity/bowing, hearing loss, in utero fx
What labs to do for OI?
Collagen seq, XR, CBC w/ diff, coag panel (PT, PTT/INR), CMP, electrolytes, child abuse team consults (ortho, ophtho, hem/onc, genetics)
Complications vs tx of OI
Recurrent PNA, cor pulmonale for adults, brain stem compression from basilar skull defects, hydrocephalus vs no cure; reduce freq of fx, prevent long bone deformity and scoliosis, minimize pain; PT, calcium and fluoride supplements, bisphosphonates —> inhibit resorption, GH (experimental at this time)
Non accidental trauma
Inconsistent hx, retinal or subdural hemorrhage, fx in mult healing stages, spiral or long bone fx, delay in care
achondroplasia/short limb dwarfism
Auto dom mutation in FGFR3 gene —> Short limbs, nml trunk, large head w/ prominent forehead and mid face hypoplasia
How to dx ACH?
Skel surgery, fhx, PE: short stature and limbs, large head w/ frontal bossing and mid face hypoplasia, brachydactyly/short digits, limited elbow extension, lumbar lordosis, genu varum/bow legs; gross motor delay
Complications vs tx for ACH
Failure to thrive, recurrent otitis media, quadriparesis, spinal cord compression, urinary and bowel incontinence, obstructive sleep apnea, SIDS d/t cervical medullary compression vs multidisciplinary supportive care (PCP, endo, ortho, PT/OT, neuro, plum), GH, surgical limb extensions
rickets
Dec bone mineralization of growth plate d/t vit D defic b/c of vit d receptor d/o, malabsorption, renal d/o, inadeq intake
S/s of rickets
Craniotabes/ping pong skull, Harrison sulcus - groove at lower thorax caused by pulling diaphragm on ribs, rachitic rosary - enlargement of costochondral jxn, metaphysical cupping on XR: widening of growth plates at wrists & ankles, delayed fontanelle closure
How to dx vs lab findings for rickets
Diet, pmhx, PE, imging, labs like CMP/UA/PTH/vit ADEK/coat. Inc ALP, PTH and dec Ca2+, PO43-
How to tx rickets?
Vit D rich foods (milk, cheese, soy, egg yolk, fatty fish), vit D supplementation (2000-5000IU)
Scurvy/Barlow dz
Vit C defic —> can’t hydroxylate pro/lys —> no collagen synthesis —> bruising/Pete hair, gingivitis w/ bleeding, impaired wound healing, anemia, subperiosteal hemorrhage, muscle weakness/tenderness
How to dx vs tx scurvy?
Horizontal lines of calcification (white line of Frankel), osteopenia, wimburger’s sign (rimmed circle) vs vit C supplement (100-200mg daily)
S/s of scapular winging
FOOSH, posterior shoulder dislocation, long thoracic nerve palsy, thoracic/rib dysfxn
indications for nonoperative care vs operative care for fx
- Nondisplaced fractures
- Acceptable angulation
- Closed reduction with manipulation
vs
closed reduction fails, articular surfaces are displaced (“step-off”), fracture is secondary to tumor metastasis, multiple injuries present; Emergency –> open fractures and unstable fractures and dislocations
translation vs angulation vs shortening
sideways motion of the fracture; % of movement when compared to the diameter of the bone vs amount of bend at the fracture described in degrees; Described with reference to position of distal part vs amount a fracture has collapsed; Fractures can only shorten with 100% displacement
Salter Harris: I vs II vs III vs IV vs V
only in children w/ growth plates. thru physis –> won’t show on XR –> clinical dx vs thru physis and metaphysis; MOST COMMON vs thru physis and epiphysis vs thru epi/meta/physis –> surgery vs crush injury to physis –> premature growth plate closure (distal ulnar plate dmged –> 50-60% chance closure, distal radial plate dmged –> 8-10% chance closure); CLASSIC GYMNAST WRIST
when do growth plates stop growing in children?
girls 14yo, boys 16yo
types of hip fxs
intertrochanteric –> tx w/ cephalomedullary nail; subtrochanteric, fx of greater trochanter, fx of lesser trochanter, femoral neck
how can you get anterior vs posterior vs inferior shoulder dislocation?
abduction, external rotation vs adduction, internal rotation, sz; light bulb sign vs hyperabduction, levering on acromion, ELECTROCUTION
complications for shoulder dislocation?
o Recurrent dislocation: age at first dislocation
o Rotator cuff tear: elderly
o Axillary nerve injury
o Axillary artery injury
o Shoulder stiffness – prolonged immobilization
o Unreduced (undiagnosed) dislocation
what’s a stable fx?
fracture that does not have a tendency to displace after it has been reduced and immobilized
Allen’s test
- Used for volar ganglion cyst, checks volar radial artery
- The hand is elevated and the patient/person is asked to make a fist for about 30 seconds
- Pressure is applied over the ulnar and the radial arteries to occlude both of them
- The hand is then opened → it should appear blanched
- Radial or ulnar pressure is released → the color should return within 5 seconds
common forearm fx: Colle’s vs Smith’s vs Barton’s vs Chauffeur’s
d/t FOOSH. extra-articular, oblique, dorsally displaced, fracture of the distal radius vs extra-articular, oblique, volarly displaced, fracture of the distal radius requires surgery vs intraarticular fracture of the distal radius with dislocation of the radio-carpal joint – dorsal or volar, carpal bones displace with the fracture fragment → always needs surgery vs nondisplaced radial styloid fracture
Essex-Leprosti lesion
- Comminuted radial head fracture, longitudinal radio-ulnar dissociation with disruption of the forearm interosseous ligament
s/s vs tx of hook of hamate fx
: pain at hamate hook, ulnar neuropathy, weakness, often negative x-ray findings → must get a CT scan vs cast – high nonunion, ORIF – risk of ulnar nerve injury, excision of hook of hamate – fastest recovery
s/s vs dx vs tx of scaphoid fx
from FOOSH, MOST COMMON WRIST FX; swelling of anatomical snuffbox vs XR vs splint 7-10d then rpt XR, get CT if neg XR, cast if nondisplaced but otherwise ORIF
scaphoid fx: Presier’s disease vs Keinbock’s disease
avascular necrosis of scaphoid vs avascular necrosis of lunate
Scapholunate ligament tear gives what sign?
Terry Thomas sign (think gap teeth example); if left untxed –> slack wrist due to scaphoid lunate advanced collapse
perilunate dislocation of wrist
- Lunate is not articulating with capitate → disruption of Gilula lines
- Double density
- If lunate is in carpal tunnel → surgical emergency, urgent ORIF
Bennet’s fx vs Rolando’s fx
intraarticular, oblique, displaced fx of ulnar base at 1st metacarpal vs intraarticular, comminuted, displaced fx of ulnar base at 1st metacarpal
Stener lesion (“Gamekeeper’s Thumb, Skier’s Thumb”)
Adduct aponeurosis prevents reduction of the ulnar collateral ligament
distal phalangeal fx
open fx but not txed like any other open fx –> Irrigate in ER, gentle approximate skin, and cover with antibiotics, and splint. do surgery if ligaments = severely displaced
how to tx Mallet fx?
Stax splinting 24/7 for 6 wks; do surgery if:
o Joint surface > 50% involved
o Incongruent DIP joint
o Irreducible piece
o Drooping finger malunion
fingernail infxns: felon vs Paronychial infection
- Infection of fingernail pulp
- Aka “finger compartment syndrome”
- Needs urgent I&D, usually done in the ER or urgent care
- oral antibiotics
vs - I&D and nail removal
- Oral antibiotics and soaks
how to tx Dorsal fracture/dislocation of the PIP joint
splint dorsal side;
o Nonoperative
o Volar plate arthroplasty
o Pin fixation
o External fixation
o Fusion
Indications for surgery for fxs
open fx, unstable fx, irreducible fx, mult fx, fx w/ bone loss, fx w/ tendon involvement
nml double density examples
pisiform on triquetrum, hook of hamate, trapezium on trapezoid
