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Block 3: MSK > Clin Med: MSK 2 - Upper Body > Flashcards

Clin Med: MSK 2 - Upper Body Flashcards

1
Q

Define Orthopedics

A

branch of surgery concerned w/ conditions involving the musculoskeletal system

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2
Q

Define Sports Medicine

A

a branch of medicine that deals w/ physical fitness & the tx & prevention of injuries related to sports & exercise

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3
Q

Define Rheumatology

A

Branch of medicine devoted to the diagnosis & therapy of rheumatic diseases

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4
Q

Osteoarthritis affected joints

A
  • knees
  • hips
  • hand
  • spine
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5
Q

Osteoarthritis RFs

A
  • older Age
  • female Gender
  • Obesity
  • Occupation
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6
Q

What forms during the different stages of Osteoarthritis?

A
  • Narrowed joint space (loss of cartilage)
  • Osteophytes
  • Fissures in the cartilage
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7
Q

Osteoarthritis Dx

A

X-ray–> joint loss space, osteophytes, subchondral bone cysts, bone sclerosis

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8
Q

Osteoarthritis Tx

A
  • Acetaminophen (NO pts w/ liver dz)
  • NSAIDS (use caution in the elderly- GI bleed & CV risk & kidney dz)
    —> Ibuprofen, Naproxen, Diclofenac, Meloxicam, Cox-2 inhibitors, Topical NSAIDS
  • Joint injections
    –> Corticosteroid
    –> Sodium hyaluronate
  • Glucosamine/chondroitin
  • Joint replacement
  • Avoid high impact exercises
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9
Q

Causes of spine pain

A
  • injuries or trauma
  • neoplasm
  • infection
  • degeneration
  • overuse
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10
Q

What is radicular pain/radiculopathy?

A
  • Pain that originates in a nerve root & radiates along a dermatome
  • Dermatome: area of skin supplied by a specific nerve
  • Pain + paresthesias
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11
Q

What is myelopathy?

A

an injury to the spinal cord due to severe compression that causes more severe symptoms

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12
Q

What is a strain?

A

a stretch or tear in muscle or tendon

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13
Q

What is a sprain?

A

a stretch or tear in ligament

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14
Q

Red flag that would suggest life threatening condition instead of mechanical neck pain?

A
  • numbness
  • tingling
  • difficulty moving
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15
Q

Mechanical Neck Pain Dx

A

How do you know if you need x-rays?
- For acute injury: NEXUS or Canadian C-spine rule
- For chronic pain: usually no x-ray needed
- MRI if neurologic deficits or if pain not improved after 4-6wks of conservative therapy
- X-ray may show straightening of the cervical spine due to muscle spasm

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16
Q

Who can we use the NEXUS criteria for?

A

pts under 65 yo to rule out spinal injury

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17
Q

Describe NEXUS criteria

A
  • No posterior midline tenderness
  • No evidence of intoxication
  • Normal level of alertness
  • No focal neurologic deficit
  • No painful distracting injuries

** YES to all these NO IMAGING**

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18
Q

Who automatically gets imaging according to Canadian C-spine Rule?

A
  • > /= 65
  • dangerous mechanism
    paresthesias
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19
Q

Canadian C- spine criteria

A

less than 65yo, has safe ROM, able to rotate neck actively

YES to all these NO IMAGNIG

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20
Q

Mechanical Neck Pain: what do we know about treatment

A
  • early motion is good
  • NO OPIATES
  • NO cervical collars
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21
Q

Mechanical Neck Pain Tx

A
  • Decr irritants
  • Proper posture
  • Gentle ROM
  • NSAIDS
  • +/- Muscle relaxers
  • Opiates
  • PT
  • Acupuncture
  • Massage therapy
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22
Q

Torticollis Tx

A
  • muscle relaxers
  • botulinum toxin
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23
Q

Cervical Spine fracture Imaging?

A

CT

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24
Q

Cervical spine fractures Tx

A

surgery (neuro)

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25
Q

When do we used the Spurling test?

A

To test cervical disc herniation

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26
Q

Describe the Spurling test?

A
  • neck extended w/ head rotated to affected shoulder while axially loaded
  • shoulder or arm pain suggests cervical spinal nerve root compression
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27
Q

Describe disc herniation is C4-C5
- root injured:
- weakness:
- numbness:

A
  • root injured: C5
  • weakness: deltoid
  • numbness: shoulder
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28
Q

Describe disc herniation is C5-C6
- root injured:
- reflex:
- weakness:
- numbness:

A
  • root injured: C6
  • reflex: biceps
  • weakness: biceps brachii
  • numbness: thumb
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29
Q

Describe disc herniation is C6-C7
- root injured:
- reflex:
- weakness:
- numbness:

A
  • root injured: C7
  • reflex: Triceps
  • weakness: wrist extensors (wrist drop)
  • numbness: 2nd & 3rd digits
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30
Q

Describe disc herniation is C7-T1
- root injured:
- weakness:
- numbness:

A
  • root injured: C8
  • weakness: Hand intrinsics
  • numbness: 4th & 5th digits
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31
Q

When do we used the Straight leg raise?

A

to test for lumbar disc herniation

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32
Q

Describe the straight leg raise.

A
  • with pt in supine position & legs straight, elevate affected leg by the heel slowly w/o rotation of hip or abduction or adduction of the leg
    test (+) if radiating pain in affected leg reproduced at 30-70 degrees of hip flexion
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33
Q

Disc herniation Dx

A

MRI

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34
Q

General Disc Herniation Tx

A

Conservative management
- Oral analgesics
- short course steroids
- avoid provocative activities
- PT w/ exercise & gradual mobilization
- cervical tractions

Epidural steroid injection (via fluoroscopy)

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35
Q

Indications for surgery in cervical disc herniation

A
  • S/S of cervical radiculopathy (ie, nerve root dysfunction, pain, or both)
  • Evidence of cervical nerve root compression by MRI
  • Progressive motor weakness
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36
Q

Indications for surgery in lumbar disc herniation

A
  • cauda equina syndrome
  • severe & progressive neurologic deficits
  • no improvement after 6 wks of conservative tx if nerve root compression on MRI
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37
Q

Spondylolysis/Spondylolisthesis
Dx:

A
  • X-ray
  • MRI if more info needed on soft tissues or if dx unclear
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38
Q

Spondylolysis/Spondylolisthesis Tx

A
  • rest
  • NSAIDS
  • PT
  • Surgery if no improvement w/ conservative tx
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39
Q

Spinal stenosis Dx

A

MRI

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40
Q

Spinal Stenosis Tx

A
  • Conservative:
    –> Oral analgesics
    –> Avoidance of provocative activities
    –> PT w/ exercise & gradual mobilization
  • Epidural Corticosteroid Injections
  • Surg if conservative tx fails
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41
Q

Incidence of spinal epidural abscesses appears to be rising due to higher rates of:

A
  • Incr rates of spinal anesthesia
  • spinal surg & other interventions
  • use of indwelling IV catheters & assoc. bloodstream infxs
  • IV drug use*
  • iatrogenic immunosuppression
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42
Q

4 stages of Epidural abscess

A
  • Stage 1: back pain, fever, & local spine tenderness
  • Stage 2 spinal irritation, including radicular pain, hyperreflexia & nuchal rigidity
  • Stage 3 the bowel & bladder, w/ symp of fecal or urinary incontinence, also neurologic deficits such as motor weakness
  • Stage 4, paralysis
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43
Q

What does a neuro exam consist of?

A

check motor & sensation, rectal tone, saddle anesthesia, reflexes

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44
Q

What % of people will have 3 ER visits before Dx

A

75%

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45
Q

Epidural Abscess Dx

A
  • MRI w/ gadolinium (contrast) - test of choice
  • CBC (incr WBC & ESR), CRP, blood cultures
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46
Q

Epidural Abscess Tx

A
  • Start BSAbx STAT (after blood cultures)
  • Consult neurosurgery
  • Conservative tx: abx only or abx & CT guided drainage
  • Surg tx: laminectomy w/ evacuation of abscess
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47
Q

RFs for vertebral osteomyelitis

A
  • immunosuppression
  • DM
  • hepatic dz
  • renal failure req hemodialysis
  • coronary heart dz
  • malignancy
  • IV drug use
  • prior surgical procedures (including spine surgery & organ transplantations)
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48
Q

Discitis Dx

A
  • MRI most sensitive
  • CBC, CRP, blood cultures
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49
Q

Discitis Tx

A
  • IV Abx typically for 2-6 weeks
  • May req. surgery if…
    –> Not responding to IV Abx (track w/ ESR/CRP)
    –> Assoc. w/ hardware
  • Surg includes debridement of any infected soft tissue & bone
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50
Q

Transverse Myelitis Dx

A

MRI of entire spine w/ & w/o IV gadolinium
- Labs to assess for autoimmune or infectious dz
- CSF analysis

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51
Q

Transverse Myelitis Tx

A
  • stop progression & accelerate resolution
  • new-onset myelitis –> admit for observation & management
    Meds:
  • High dose steroids
  • Immunosuppressive drugs
  • Tx underlying condition
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52
Q

Define acute low back pain

A

nonspecific pain lasting <4 wks

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53
Q

Define subacute pain

A

lasts 4 - 12 wks

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54
Q

Define chronic low back pain

A

pain lasting >12 wks

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55
Q

Low back sprain/strain RFs

A
  • age > 30 years
  • physical inactivity
  • obesity
  • arthritis
  • osteoporosis
  • pregnancy
  • smoking
  • psychosocial factors, including
  • stress or depression
  • occupational factors
  • poor posture
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56
Q

Low back sprain/strain Dx

A
  • no red flags–> conservative tx for 4-6 wks w/o imaging
  • X-ray may be obtained 1st, but MRI is the imaging of choice when conservative tx fails
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57
Q

Low back sprain/strain red flag symptoms

A
  • s/s of cauda equina syndrome
  • fecal incontinence or saddle anesthesia
  • neurologic deficits
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58
Q

Low back sprain/strain conservative Tx

A
  • Heat
  • Massage
  • Acupuncture
  • Spinal Manipulation
  • Exercise & PT
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59
Q

Low back sprain/strain pharm Tx

A
  • NSAIDS
  • APAP (limited utility)
  • Muscle relaxers
  • Opiates (limited utility)
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60
Q

Sciatica nerve root L4 involvement suggested by…

A
  • weak quadriceps extension
  • positive squat & rise test
  • diminished knee-jerk reflex
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61
Q

Sciatica nerve root L5 involvement suggested by…

A
  • weak dorsiflexion of great toe & foot
  • impaired heel walking, foot drop
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62
Q

Sciatica nerve root S1 involvement suggested by…

A
  • weak plantar flexion of great toe & foot
  • impaired toe walking
  • diminished ankle-jerk reflex
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63
Q

Sciatica Dx

A
  • Further dx testing recommended if radicular pain & any of the following:
  • incapacitating pain > 2 wks
  • advancing neurologic symptoms
  • no symptom improvement after 6 wks of conservative tx (reassurance, edu, analgesics, heat, activity, exercise, etc)
  • MRI is the test of choice
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64
Q

Sciatica Conservative Tx

A

Conservative management:
- Heat
- Exercise as tolerated
- NSAIDS
- Muscle relaxers
- Opiates (lowest effective dose, 2 wks max)

  • Epidural injections
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65
Q

Sciatica Surg referral if…

A
  • progressive or moderately severe neuromotor deficit, such as foot drop or functional muscle weakness
  • persistent neuromotor deficit after 4-6 wks of conservative tx
  • uncontrolled radicular pain w/ defined lesion on imaging
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66
Q

Most sciatic pain resolves w/n

A

2-4 weeks

67
Q

Most herniations that cause sciatica regress or reabsorb by__ weeks after symptom onset

A

8 weeks

68
Q

Describe a wedge fracture

A
  • compression of the anterior segment of the vertebral body
  • usually occur in the midthoracic or lumbar region of the spine
69
Q

Describe a biconcave/concave fracture

A

collapse of the middle portion of vertebral body, while the anterior & posterior walls remain intact

70
Q

Describe a burst (crush) fracture

A
  • collapse of entire vertebral column, including anterior, posterior & central elements
  • assoc. w/ high-energy trauma, (MVA, fall from great height, or sports trauma)
71
Q

Thoracolumbar Compression Fracture Dx

A
  • X-rays–> thoracic & lumbar spine
  • burst fracture may req CT
  • MRI’s usually not needed
  • If pt doesn’t have an underlying dz &there is a wedge fracture, be sure to consider osteoporosis or cancer
72
Q

Thoracolumbar Compression Fracture Tx

A
  • Pain management & manage underlying dz
  • Refer to spine surgeon
  • Observation if neurologically intact (in wedge fractures)
  • May req kyphoplasty or percutaneous vertebroplasty (biconcave)
  • Bracing
73
Q

Cauda Equina Syndrome: Stage 1

A

bilateral radicular pain

74
Q

Cauda Equina Syndrome: Stage 2 (incomplete)

A

urinary difficulties, including:
- altered urinary sensation
- loss of desire to void
- weak urinary stream
- need to strain to micturate

75
Q

Cauda Equina Syndrome: Stage 4 (complete)

A
  • Bowel & bladder incontinence
  • Saddle anesthesia
  • Loss of rectal tone
76
Q

Cauda Equina Syndrome: Stage 3 (retention)

A

painless urinary retention & overflow incontinence where the bladder is no longer under executive control

77
Q

Cauda Equina Syndrome Dx

A

MRI

78
Q

Cauda Equina Syndrome Tx

A
  • Urgent neurosurgical consult
  • Surgical lumbar decompression
    –> The sooner, the better
    –> Must be done w/n 48 hrs
79
Q

Conus Medullaris Syndrome Tx

A

urgent surgical decompression

80
Q

Conus Medullaris Syndrome Dx

A

MRI

81
Q

Scoliosis causes:

A
  • Idiopathic (80%)
  • Congenital
  • Neuromuscular (Cerebral palsy, spina bifida)
  • Syndromic (Genetic syndromes like Marfans)
82
Q

Scoliosis Dx

A
  • X-ray C7 to iliac crest w/ pt standing
  • Lateral curvature (Cobb Angle) > 10 degrees is diagnostic
83
Q

Scoliosis Tx

A
  • Observe for curves < 25 degrees
  • Bracing for 25-45 degrees
  • Surgery if over 45 degrees
84
Q

Function of the rotator cuff

A

stabilize shoulder & allow for extensive ROM

85
Q

What are the joints of the shoulder?

A
  • Scapulothoracic joint
  • Sternoclavicular
  • Acromioclavicular
  • Glenohumeral
86
Q

Rotator Cuff Syndrome/Tear Dx

A
  • initial imaging–> x-ray
  • definitive dx–> MRI
87
Q

What provocative tests are used in suspected Rotator cuff syndrome/tear?

A
  • Hawkins Impingement
  • Neer Impingement
  • Empty Can
  • Drop arm test
88
Q

Rotator Cuff Syndrome/Tear initial non-operative Tx

A
  • Pts w/ partial thickness tears
  • Older pts w/ full-thickness tears but lower demands
  • Activity modification for 1-2 wks (don’t immobilize the shoulder)
  • NSAIDS
  • PT
89
Q

Rotator Cuff Syndrome/Tear operative Tx

A
  • Partial thickness tear & no improvement for 3-6 months
  • Pts w/ significant functional deficit & full thickness tear
90
Q

Shoulder Dislocations Tx

A
  • Reduction w/ post reduction films
  • immobilizer for 1-3 weeks
  • Can then assess for soft tissue injury
  • PT for shoulder instability
91
Q

Adhesive Capsulitis Tx

A

Non operative tx:
- tx of choice: PT, ROM exercises

  • If that fails, a manipulation under anesthesia may be performed
92
Q

Biceps Tendon Rupture Dx

A

Clinical
- MRI if complicating factors

93
Q

Biceps Tendon Rupture Tx

A
  • Proximal tendon rupture: usually conservative tx: NSAIDS & PT
  • Distal tendon rupture: surgical referral required
94
Q

Clavicle Fracture Dx

A

X-ray

95
Q

Clavicle Fracture Tx

A
  • Sling for 3-4 weeks, then gentle ROM exercises
  • Comminuted mid & proximal clavicle fractures may req ORIF
96
Q

AC Joint Separation Type I & II Tx

A
  • Brief sling immobilization, rest, ice, PT
97
Q

AC Joint Separation Type III Tx

A
  • Surg if athlete or if req for occupation
  • If failed conservative tx
98
Q

AC Joint Separation Type IV & V

A

Surg

99
Q

Thoracic Outlet Syndrome Dx

A
  • Clinical
  • Imaging Studies
    –> CXR IDs presence of cervical rib
    –> MRI w/ arms held in different positions
  • Angiography confirms intra-arterial or venous obstruction
100
Q

Thoracic Outlet Syndrome Tx

A
  • analgesic therapy(NSAIDs, muscle relaxants, antidepressants, SSRIs)
  • PT
  • anticoag/thrombolysis
  • surg to remove compressive structure
101
Q

Scapula Fractures Dx & Tx

A
  • X- ray
  • Usually tx non surgically (sling, ice, analgesia)
102
Q

Proximal Humerus Fractures Dx

A
  • X-ray
  • May need CT to further characterize fracture & operative planning
103
Q

Proximal Humerus Fractures Tx

A
  • Most are handled conservatively- sling, ice, analgesia
  • early ROM
  • displacement or comminuted = surg
104
Q

Humeral Shaft Fracture Dx

A
  • X-ray
  • always include joint above injury & joint below
105
Q

Humeral Shaft Fracture Tx

A
  • Most tx non operatively
    –> Coaptation splint followed by brace
  • Surgery if….
    –> Severe angulation
    –> Open fracture
    –> Nerve or vascular injury
106
Q

Supracondylar Fractures Dx

A

x-ray

107
Q

Supracondylar Fractures Tx

A
  • Non-displaced fractures w/ no neurovascular compromise can be casted (long arm cast)
  • Any displacement or non-displaced w/ neurovascular compromise req urgent closed reduction as percutaneous pinning
108
Q

Lateral Epicondylitis Dx

A

Clinical

109
Q

Lateral Epicondylitis Tx

A

Conservative tx:
- Rest, Ice, NSAIDS, “tennis elbow brace”, PT

  • Corticosteroid injections
  • Surg if pain doesn’t resolve after 6-12 mo
    –> Damaged tendon removed & healthy tendon anchored to bone
110
Q

Medial Epicondylitis Dx

A

clinical

111
Q

Medial Epicondylitis Tx

A

Conservative tx:
- Rest, Ice, NSAIDS, “tennis elbow brace”, PT

  • Corticosteroid injections
  • Surg if pain doesn’t resolve after 6-12 mo
    –> Damaged tendon removed & healthy tendon anchored to bone
112
Q

Olecranon Bursitis Dx

A
  • imaging if injury
  • if septic bursitis suspected:
    –> Aspirate bursa& send fluid
    *Gram stain & culture
    *CBC w/ diff
    *crystal analysis
  • obtainblood tests, including
    –> CBC w/ diff
    –> CRP/ESR
113
Q

Aseptic Olecranon Bursitis Tx

A

initial tx
- rest, ice, compression & elevation
- activity mod & elbow protection
- NSAIDs
- needle aspiration w/ compression wrap

  • If conservative tx fails, can do steroid injection
  • If all else fails, bursectomy
114
Q

Septic Olecranon Bursitis Tx

A
  • drainage of bursa fluid + systemic Abx
    –> empiricabxafter bursa fluid for C&S (MRSA or staph)
    –> IV Abx if severe, or if signs of systemic illness, or if oral tx fails
115
Q

Elbow Dislocation Dx

A

x-ray

116
Q

Elbow Dislocation Tx

A
  • Closed Reduction w/ post reduction films
  • Posterior Long Arm Splint for 3 days, then gentle ROM & PT
117
Q

Nursemaid Elbow Dx

A

based on classic presentation

118
Q

Nursemaid Elbow Tx

A
  • Closed reduction w/ post reduction films
  • If recurrent, refer to pediatric ortho
119
Q

Radial Head Fracture Dx

A

x-ray
(anterior & posterior fat pad)

120
Q

Radial Head Fracture Tx

A
  • Adult pts w/ a (+) fat pad sign & traumatic elbow pain should be tx having a nondisplaced radial head fracture, despite no fracture on x-ray
  • Almost all pts can be managed as outpt
    –> Posterior Long Arm Splint
  • Surg if displacement
121
Q

Both Bone Forearm Fractures Tx

A

Depends on angulation

122
Q

Cubital Tunnel Syndrome Dx

A

EMG: electromyography, a nerve conduction test

123
Q

Cubital Tunnel Syndrome Tx

A
  • NSAIDS
  • Elbow pad
  • If conservative tx fails, surg
    –> the nerve is repositioned
124
Q

Carpal Tunnel Syndrome Dx

A

clinical
EMG to confirm

125
Q

Carpal Tunnel Syndrome Tx

A

Conservative tx first
- NSAIDS
- Wrist splint (esp at night)
–> Cockup splint
- Decr provocative activity

Steroid injection
Surgery

126
Q

DeQuervain Syndrome Dx

A

clinical based on Finkelstein test

127
Q

DeQuervain Syndrome Tx

A

Conservative tx:
- Thumb Spica splint
- Avoid provocative movements/lifting
- Steroid Injection
- Surgery (rarely needed)

128
Q

Scaphoid Fracture Dx

A

x-ray

129
Q

Scaphoid Fracture Tx

A
  • If non-displaced, immobilization 6 wks
  • Imaging obtained at 6 wks & if not healed, another 6 wks of immobilization
  • If displaced, surg
  • If high suspicion of fracture (+) snuffbox, but x-ray (-), immobilize & recheck x-ray in 10-14 days
130
Q

Scapholunate Dissociation

A

x-ray will show widening

131
Q

Scapholunate Dissociation Tx

A
  • splinting
  • may req surg, referral
132
Q

Colles Fracture Dx

A

x-ray

133
Q

Colles Fracture Tx

A

Stable frax (< 20 degrees angulation, not displaced, not intraarticular)–> tx w/ immobilization

  • Unstable frax (angulated, intraarticular, or displaced)–> req immediate reduction/immobilization & poss surg
134
Q

Smith Fracture Dx

A

x-ray

135
Q

Smith Fracture Tx

A

Stable frax (< 20 degrees angulation, not displaced, not intraarticular)–> tx w/ immobilization

  • Unstable frax (angulated, intraarticular, or displaced)–> req immediate reduction/immobilization & poss surg
136
Q

Mallet finger Dx

A

X-ray

137
Q

Mallet finger Tx

A
  • Finger splint- full extension 6-8 wks
  • Surgery if significant displacement
138
Q

Boutonniere Deformity Tx

A
  • Finger splint- full extension 6-8 wks
  • Surgery if displaced
139
Q

Gamekeepers Thumb Dx

A

Imaging not usually indicated, but MRI may be used if conservative treatment fails

140
Q

Gamekeepers Thumb Tx

A
  • Immobilization in cast or splint
  • Surgery if joint very unstable
141
Q

Boxer’s Fracture Dx

A

X-ray

142
Q

Boxer’s Fracture Tx

A
  • minimal angulation–> immobilization
  • mod angulation–> closed reduction & splinting
  • severe angulation–>ORIF
143
Q

Thumb Fractures Dx

A

x-ray

144
Q

Thumb Fractures Tx

A
  • depends on severity and intraarticular involvement
    Thumb spica splint/cast
    Surgery
145
Q

Phalangeal Fractures

A

x- ray

146
Q

Phalangeal Fractures Tx

A
  • Depends on angulation, articular involvement
  • Splinting (finger splint w/ buddy taping)
  • Surgery
    –> Closed reduction/pinning
    –> ORIF
147
Q

Phalangeal Dislocation Dx

A

x-ray

148
Q

Phalangeal Dislocation Tx

A

reduce & splint

149
Q

Metacarpal Fractures Dx

A

x-ray

150
Q

Metacarpal Fractures Tx

A
  • Tx depends on angle, rotation
    –> Splinting
    –> Closed reduction then splint
    –> Surgery (ORIF, pinning)
151
Q

Flexor Tendon Injuries Dx

A
  • X-ray: assess for assoc. fracture/FB
  • Actual tendon injury is diagnosed based on exam
152
Q

Flexor Tendon Injuries Tx

A
  • tendon > 60% lacerated = surg req
  • < 60%, splint
  • These ALWAYS require referral to hand surgery
153
Q

Trigger Finger Dx

A

based on S/S & exam

154
Q

Trigger Finger Tx

A
  • Splint first
  • Then steroid injection
  • Then surgical release of A1 pulley
155
Q

Flexor Tenosynovitis Dx

A

X-rays
can help rule out FB, but of flexor tenosynovitis is clinical

156
Q

Flexor Tenosynovitis Tx

A
  • Surgery: I&D
  • IV antibiotics
  • Hand immobilization
157
Q

NOTE

A

any hand laceration requires prophylactics ABx

158
Q

What is Dupuytren’s Contracture often associated with?

A

Peyronie’s Dz

159
Q

Dupuytren’s Contracture Tx

A

Can try ROM exercises but will often require surgery

160
Q

Felon Tx

A

bedside I&D, antibiotics

161
Q

Costochondritis Dx

A
  • Clinical dx of exclusion
  • Be sure to rule out other causes of chest pain
    –> EKG
    –> CXR
162
Q

Costochondritis Tx

A
  • reassure pt that costochondritis is a benign condition w/ a SL course that may req wks - mos for resolution
  • conservative tx is typically recommended & initial options include
    –> analgesics
    –> local heat or ice compresses
    –> limiting or avoiding aggravating activities
163
Q

Rib Fractures Dx

A
  • CXR, be sure to look for pneumothorax
164
Q

Rib Fractures Tx

A
  • pain management (NSAIDS, opiates, lidocaine patches, ice)

Block 3: MSK (10 decks)

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