Common Ortho Probs

Question 1

Management for acute lower back pain

Answer 1

• NSAIDs
• Remain active Likely benefits: muscle relaxants, tramadol, superficial heat, physical therapy

***Most resolves within in 6 weeks

Question 2

Mnagement for chronic low back pain

Answer 2

• nsaids
• tramadol
• duloxetine - 60 days
• tylenol
• topiramate - for short term treatment

***most studies showed that opioids are not more beneficial than nsaids***

Question 3

Common causes of low back pain

Answer 3

• strain
• sprain
• degenerative joint disorder
• disc herniation

^^^ these account for 80% ^^^

• lumbar stenosis

Question 4

What is treatment for disc herniation?

Answer 4

remain active

conservative mgmt for 6 weeks w/o red flags

consider surgery if no improvement

Question 5

sx associated with lumbar stenosis

Answer 5

• improve with flexion
• worse when walking
• wax and wanes
• usually in older adults

Question 6

imaging for lumbar stenosis

Answer 6

MRI

treat: physical therapy and NSAIDs

Question 7

Tennis elbow:

• other name
• presentation
• treatment

Answer 7

lateral epicondylitis

lateral elbow pain

eccentric stretching & steroid injection can help with pain

Question 8

Other treatment for overuse injuries / tendonopathies

Answer 8

autologous blood injection

nitroglycerin patch

Question 9

Tests for shoulder tendon impingement

Which rotator cuff tendon is most commonly impinged?

Answer 9

Neers + Hawkins

Neers = arm up and neer the body

Hawkins = like a hawks wing

+ if pain with test

supraspinatus

Question 10

How to treat shoulder impingment?

Answer 10

• subacromial shoulder injection
• physical therapy

*often exercise/PT showed better outcomes

*some studies showed better outcomes at 1 month with injection + exercise / PT

Question 11

Which disorders are associated with adhesive capsulitis?

Answer 11

• DM
• Parkinsons
• cardiac disease
• thyroid disorder

Question 12

Treatment for adhesives capsulitis

Answer 12

Oral prednisone

Steroid injection

***these help short-term

Question 13

Exam findings and treatment for anterior knee pain aka patellofemoral

Answer 13

+patellar findings

physical therapy and modify activity

Question 14

Carpel tunnel

• nerve affected
• presentation
• treatment

Answer 14

1. median nerve
2. sensory = radial 3.5 digits
3. motor: intrinsic thumb and radial lumbricals (weak abduction and thenar atrophy

treatment: wrist splints, steroid injections, surgical release (prevent progression)

Question 15

Plantar fasciitis

• nerve affected
• presentation
• treatment

Answer 15

heal pain - worse in the AM or prolonged immobilication

burning

tenderness on medial calcaneal tubercle

treat: rest, ice, strecthing, orthotics / night splint

Question 16

mortons neuroma

• presentation
• treatment

Answer 16

more common in women

BURNING pain between 3rd and 4th toe

treat: wide shoes, orthotics, low heels, injections

Question 17

Tarsal Tunnel

• nerve affected
• presentation
• treatment

Answer 17

posterior tibial n.

burning pain - can be confused with plantar

no tenderness at medial calcaneal tubercle

treat: correct biomechanics - subtalar pronation

Question 18

Trigger finger

• presentation
• treatment
• epi

Answer 18

painful lump in palm of hand and flexion of digit

treat: splinting, injections >>> surgical

more common in young patient, diabetic patients - more likely to have again