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exam 1 Flashcards

1
Q

Subjective

A

includes history, which includes MOI, sounds/sensations @ TOI, location, onset, description, and duration of symptoms, factors that change symptoms, past medical history (congenital/ acquired) bilateral comparison, general med health. (obviously include age, sport, etc.)

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2
Q

objective

A

includes observation (referenced for symmetry and color of superficial tissues), palpation (referenced for bilateral symmetry of bones, alignment, tissue temperature and other deformities), special tests (includes ROM, ligamentous/capsular tests, and neurological tests)

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3
Q

differential diagnosis

A

the determination of which of two or more injuries/diseases/conditions with similar symptoms is the one from which the patient is suffering from

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4
Q

diagnosis by exclusion

A

diagnosis made by excluding those diseases/injuries to which some of the symptoms belong, leaving only one to which all the symptoms point

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5
Q

primary goal of orthopedic physical exam is

A

to obtain a clinical diagnosis. Also to obtain sufficient information to determine a plan of care that will improve the patient’s health related quality of life

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6
Q

Nagi theoretical framework purpose

A

helps us understand how a patient’s pathology creates abnormalities (“impairments”), how these impairments influence functional ability and finally how these functional limitations influence a person’s life.

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7
Q

components of Nagi

A

active pathology, impairment, functional limitation, disability

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8
Q

active pathology (def. and ex.’s of assessment techniques)

A

interruption or interference of normal bodily processes or structure. EX of assessm. include diagnostic imaging or blood analysis.

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9
Q

impairment (def. and ex.’s of assessment techniques)

A

anatomical, physiological, mental, or emotional abnormalities. EX medical history, pain questionnaires, goniometry, and MMT, special tests

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10
Q

functional limitation

A

restriction or lack of ability to perform an action or activity in a manner considered to be normal. EX observation during ADLs

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11
Q

disability

A

an inability or limitation in performing socially-defined activities and roles expected of individuals within a social and physical environment. EX question patient regarding the impact of injury/illness on quality of life

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12
Q

mechanics

A

the branch of science that deals with the effects of forces and energy on the body

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13
Q

microtrauma definition

A

the slow, progressive breakdown of soft tissues or bone over a period of weeks/months; AKA repetitive motion injuries

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14
Q

pain assessments

A

needs to be both subjective and objective. Sub (part of history) includes location, duration, type, timing, with activity. obj measures the changes in the level or type of pain, EX visual analog scale, numeric rating scale, McGill pain questionnaire

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15
Q

pain scale type?

A

numeric rating scale

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16
Q

pain scale type?

A

McGill pain questionnaire

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17
Q

pain scale type

A

visual analog scale

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18
Q

observation

A

gait, posture, obvious deformity, asymmetry, soft tissue contours (muscle wasting), skin color/texture, scars, inflammation, attitude, crepitus?

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19
Q

palpation

A
  1. start with uninvolved limb
  2. tell patient what you plan to do next
  3. always compare bilaterally.
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20
Q

range of motion and manual muscle testing order

A
  1. active ROM: patient moves body part
  2. passive ROM: clinician moves body part
  3. resistant ROM:clinician resists movement of specific body part

resisted isometric muscle testing done in an anatomical neutral or resting position.

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21
Q

neurological examination

A
  • cranial nerves
  • peripheral nerves (motor functions AKA myotomes, and sensory functions or dermatomes which is an area of skin)
  • deep tendon reflexes
  • special tests

ALSO NOTE: when testing myotomes each isometric contraction must be held for > or = 5 seconds in order to allow for any myotomical weakness to become evident.

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22
Q

vascular screening

A
  • evaluate major pulses in region of affected body part
  • check capillary refill
  • observe skin color
  • note temperature of skin
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23
Q

Chapter 1 table references

A

Table 1-2 referral alerts. 1-3 potential medical effects on musculoskeletal healing. 1-4 possible causes of changes in bone density. 1-7&8 normal and pathological end-feels to PROM.

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24
Q

Clinical pearl

A

always look at at least one joint proximal when considering the pathogenensis of a particular injury or condition

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25
Q

findings that warrant an immediate referral to MD

A
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26
Q

Evidence based practice

A

is the incorporation of 3 elements into the decision making process of patient care: best available evidence, clinical expertise, and the needs and values of the individual patient.

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27
Q

means of deciding whether diagnostic test/medical treatment is effective in order from least to most reliable

A
  1. superstition
  2. intuition
  3. method of authority
  4. method of philosophy
  5. empiricism
  6. scientific method
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28
Q

how to practice EBM

A
  1. Identify and define clinically-relevant questions. AKA: PICO. Patient population? Intervention/treatment? Comparison group? Outcome of interest?
  2. Search for best evidence. EX MEDLINE.
  3. Critical appraisal of evidence. Types of studies? Trusted source?
  4. applying the evidence. REMEMBER each patient handled individually, consider their preferences, cost, and convenienve
  5. evaluate the performance of EBM
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29
Q

hierarchy of research methods

A
  1. Randomized clinical trial
  2. Prospective/Cohort study: used when quantification of risks is of interest, takes longer and more $.
  3. Case control studies: two groups, similar in every way except trait/condition being studied, commonly retrospective in nature.
  4. Cross-sectional study: “snapshot”. describes a particular group of patients/athletes at a given instant of time.
  5. single case report
  6. expert opinion
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30
Q

sensitivity

A

tests ability to detect those patients who actually have the disorder. True Positive rate, also relative to gold standard test.

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31
Q

specificity

A

ability of a test to correctly detect those patients who do not have the disorder. True negative rate.

also tests ability to detect absence of a lesion.

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32
Q

intra-rater reliability

A

extent to which the same examiner obtains the same results on the same patient.

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33
Q

inter-rater reliability

A

describes the extent to which different examiners obtain the same results for the same patient.

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34
Q

optimal sports medicine research study

A

cohort (injured and non injured studied), conducted with many teams/athletes, prospective (longitudinal data collected), one data-recorder wherever possible (intra-rater reliability), uniformity of injury across sports, specific definitions of injury severity, exposure hours used to express incidence rates, acknowledgement of limitations.

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35
Q

accuracy of clinical examination and MRI has been established by comparison to findings in

A

arthroscopic surgery. It is considered to be the diagnostic gold standard.

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36
Q

accuracy

A

ability of a test to correctly detect the presence or absence of a lesion.

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37
Q

PPV

A

positive predictive value: Frequency of an initial diagnosis being confirmed postoperatively.

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38
Q

NPV

A

negative predictive value: frequency of a negative initial diagnosis being confirmed postoperatively.

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39
Q

musculotendinous injuries

A

muscle strain, tendonitis, heterotropic ossification, compartment syndromes

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40
Q

articular surface injuries

A

osteochondral defects, osteochondritis dessicans, osteoarthritis

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41
Q

joint structure injuries

A

sprains, joint subluxation/dislocation, synovitis, bursitis

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42
Q

bony structure injuries

A

exostosis, apophysitis, fractures

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43
Q

Load

A

external force acting on body that causes internal reactions within the tissues. Measured in Newtons.

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44
Q

Deformation

A

the change in dimension of a tissue, commonly measured in mm

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45
Q

mechanical stress

A

the load per unit of area, commonly measured in Pascals (1 N per meter area)

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46
Q

mechanical strain

A

the change in tissue dimensions, as a result of loading. scalar quantity (%).

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47
Q

compressive force

A

two forces applied toward one another that result in the crushing of tissue. EX intervertebral disc herniation

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48
Q

tensile force

A

two oppositely directed forces that pull apart/stretch tissue. EX ligament rupture.

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49
Q

shear force

A

two oppositely directed forces that occur perpendicularly across the long axis of a structure. EX humerus

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50
Q

bending force

A

two force pairs act at opposite ends of a structure. (one might be compression and one tensile). EX greenstick fracture.

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51
Q

torsion force

A

loads caused by twisting in opposite directions from opposite ends. Shear stress encountered will be perpendicular and parallel to the loads.

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52
Q

stress strain curves

A

describes the amount of tensile load specific tissues can tolerate before damage results. hysteris loop representing heat loss. WE CAN LEARN: magnitude of load structure can withstand before failing, amount of deformation a structure can sustain before failing, and amount of energy the material can store before falling

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53
Q

toe region

A

tissue slack is being taken up and there is relatively little change in strength.

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54
Q

elastic region

A

collagen fibers are being stretched as elastic region begins. Fibers require substantial tension to deform and will return to original shape after stretch.

55
Q

plastic region

A

beginning, application causes a residual change in tissue structure (fibers will not return to original length, partial tearing). continuation of load may cause tissue to rupture at its ultimate failure point.

56
Q

soft tissue pathology

A

contusions, strains (muscle/tendon), tendonopothy (tendonitis/tendinosis), heterotropic ossification, bursitis.

57
Q

Strain severity

A
  • 1st degree (mild): no sig tissue damage or loss of muscle function (<5% of tissue affected).
  • 2nd degree (moderate): partial tearing of muscle and/or tendon
  • 3rd degree (severe): complete rupture of muscle and/or tendon, no function.
58
Q

heterotropic ossification

A

AKA myositis ossificans. Formation of bone within a muscle belly’s fascia or other soft tissues. Etiology: Trauma (#1 cause), neurological disease, genetic origin. common locations in deltiod and biceps

59
Q

olecranon bursitis

A

inflammation of a fluid filled sac that serves to buffer muscles, tendons, and/or ligaments from other friction-causing structures. May be due to aseptic (traumatic) or septic (staph infection) causes. IOW, micro or macro. ice and rest

60
Q

sprains

A

ligaments.

  • 1st degree (mild)=no sig damage, no joint instability,
  • 2nd (moderate)= partial tearing of ligament, increased joint laxity.
  • 3rd (severe)=complete rupture, no end point (end feel)
61
Q

shoulder separation

A

acromioclavicular ligament and coracoclavicular ligament tear, NOT disclocation subluxation

62
Q

sprain involves ___ which is ____ to ____

A

ligaments; bone to bone

63
Q

strain involves ____ and/or ____, which is ____ to ____

A

muscles; muscle to bone

64
Q

OCD’s

A

osteochondral defects. damage to articular cartilage surface can happen gradually/instantly, and can be partial or full thickness OCD’s.

65
Q

osteoarthritis

A

wearing away of hyaline cartilage as a result of normal use. Changes in joint mechanics lead to joint degeneration. commonly affects weight bearing joint but can also impact shoulders and cervical spine. Sx- pain, stiffness, prominent morning pain, localized tenderness, creaking, grating

66
Q

neurovascular pathologies

A

spinal cord injury, peripheral nerve injury, regional complex pain syndrome (RSD)

67
Q

nerve injury

A

MOI:

  1. laceration via cervical fx/dislocation
  2. hemorrhage may lead to spinal cord degeneration/death of nerve
  3. contusion may ^ swelling & ^ pressure on nerve
  4. shock due to mild contusion of neural tissue

incomplete lesion: partial loss of motor function, full recovery possible.

complete lesion: loss of motor function/sensation, full recovery unlikely.

68
Q

nerve injuries classification

A
  1. neuropraxia: injury to nerve resulting in paralysis w/o degeneration of axon, followed by rapid & complete recovery of function.
  2. axonotmesis: damage to nerve cells that destroys axons but that does not destroy the supporting structures of the cells, making regeration possible
  3. neurotmesis: partial/complete severance of a nerve with disruption of axon and its myelin sheath and connective tissue elements.
69
Q

name for degeneration that occurs after axonotmesis and neurotmesis.

A

Wallerian degeneration.

70
Q

radioulnar joint

A

allows 1 degree of freedom: pronation/supination. Uniaxial pivot joint

71
Q

radiocarpal joint

A

ellipsoid joing, allows 2 deg freedom (flexion/extension, and radial/ulnar deviation)

72
Q

sexy lovers try positions that they can’t handle

A
73
Q

the carpal tunnel

A
  • roof: transverse carpal ligament
  • floor: proximal carpal bones
  • contents: MEDIAN NERVE, flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus
  • compression results in paresthesia in 2nd, 3rd, and 4th fingers and decreased grip strength
74
Q
A

bordered on radial side by abductor pollicis longus, and extensor pollicis brevis. bordered on ulnar side by extensor pollicis longus. Contains scaphoid. Radial artery runs along floor of snuff box

75
Q

another name for scaphoid bone

A

navicular

76
Q

triangular fibrocartilage complex

A

lies between radius and ulna and ulna and proximal carpals. functions similar to knee meniscus: increases stability at distal radioulnar joint, and absorbs and distributes forces. Injured with FOOSH, Lift off test.

77
Q

scaphoid anatomy

A

bridges proximal and distal rows of carpals. Major blood supply (70-80%) is a branch of the radial artery, entering at or distal to the “waist” of the bone. Fx of proximal 1/3rd can disrupt the blood supply to the proximal pole, which enters at or distal to the middle third. MOI of scaphoid is hyperextension load to the radial side of the palm.

78
Q

scaphoid fractures

A

are the most commonly fractured carpal bone. fractures to distal 3rd is 5-10% incidence, to middle third is 65-75% incidence, and proximal 3rd is 15-30%. Complications include delayed union fx, non-union fx, and Preisser’s disease (avascular necrosis)

79
Q

Lunate dislocation

A

most common carpal dislocation. Very subtle/not easily recognized. Special test: Murphy’s sign. Kienbock’s disease (avasc. necrosis)

80
Q

hamate fracture

A

Hook of the hamate. check for ulnar nerve involvement!

81
Q

metacarpophalaneal joints

A

larger head of metacarpals articulates with smaller base of proximal phalange, “knuckles”. CONDYLOID joints, which allow 2 degrees of freedom. (flexion/extension, and abduction/adduction). ***thumb can be abducted at any point, fingers can only when extended.

82
Q

phalanges

A

14 long bones. collateral ligaments- 1. restrain valgus/varus motion, 2. when fingers are in flexion, they tighten and limit abd/adduction. Volar plate: thick fibrocartilage plate on palmer surface of the joint that helps prevent hyperextension.

83
Q

interphalangeal joints

A

uniaxial hinge joints. Proximal and distal interphalangeal j. ONE degree of movement. flexion/extension. Collateral lig resist valgus/varus. *** Grip of fingers in flexion is tighter ulnarly than radially.

84
Q

volar plate injury

A

thick fibrocartilage plate on the palmar surface of the joint that helps prevent hyperextension of PIP and DIP joints. (so due to hyperextension)

85
Q

Lister’s tubercle

A

AKA radial tubercle, in line with lunate (which is in line with capitate and 3rd metac.

86
Q

movements at the wrist in sagittal plane

A

flexion/extension

87
Q

movements at the wrist in the frontal plane

A

radial flexion/deviation or ulnar flexion/deviation

88
Q

primary wrist flexors (3)

A

flexor carpi radialis, flexor carpi ulnaris, palmaris longus.

**** PALMARIS LONGUS absent in 10-15% of population

89
Q

primary wrist extensors (3)

A

extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris

90
Q

primary radial flexors

A

extensor carpi radialis longus and brevis, flexor carpi radialis

91
Q

primary ulnar flexors

A

extensor carpi ulnaris, flexor carpir ulnaris

92
Q

primary finger extensors

A

extensor digitorum communis (longus) (extends MCP and IP joints); extensor indicis (extends the index finger); extensor digiti minimi (extends little finger)

93
Q

primary finger flexors

A
  1. flexor digitorum superficialis: origin- common flexor tendon at medial epicondyle, medial aspect of coronoid process and oblique line of radius. insertion- at sides of middle phalanges of 2nd-5th digits. action- flexes the PIP joints and assists flexion of MCP and wrist joints. innervation- median nerve
  2. flexor digitorum profundus: origin- anteromedial proximal ulna. insertion- bases of distal phalanges (anteriorly) of 2nd-5th digits. actions-**flexes the DIP joints **and assists in flexion of PIP and MCP jts. innervation=median and ulnar nerves
94
Q
A

Dupuytren’s contracturea: idiopathic flexion contracture of finger flexor tendon. Tx: surgical debridement/release

95
Q
A

Swan neck deformity

96
Q

major muscles of the thumb

A

**extensor pollicis longus, extensor pollicis brevis. **actions= EPL extends distal phalanx of thumb at carpometacarpal and interphalangeal joints. EPB- extends proximal phalanx of thumb at carpometacarpal joint. Innervation=radial nerve

97
Q

thenar eminence

A

abductor pollicis brevis and flexor pollicis brevis. innervation= median nerve

98
Q

hypothenar eminence

A

abductor digiti minimi, flexor digiti minimi, flexor digiti minimi brevis. Ulnar nerve inn.

99
Q

paresthesia in median nerve dermatome

A

median nerve is compressed at wrist, resulting in numbness or pain. (symptoms are associated with Carpal Tunnel Syndrome)

100
Q

common injuries of hand

A
  • carpal bone fx account for 18% hand fractures
  • of carpal elements, bones in proximal row are more frequently fractured (think FOOSH)
  • scaphoid most common fx, 70% of fx in carpal group and 10% all hand fx’s.
  • triquetrum is second most comm carpal fx, 14% of all wrist injuries
  • incidence of isolated fx of any remaining carpal bones is very low
101
Q

scaphoid fx

A
  • 70% of all carpal fx’s.
  • Clinical course: 4-6 months in cast,
  • tends towards delayed/nonunion fx, especially in >40 yr patients.
  • commonly requires ORIF/vascularized bone graft to heal
  • Preisser’s disease=avascular necrosis of scaphoid
  • distal/middle/proximal pole (prox most sensitive bc of blood flow
102
Q

triquetral fx

A
  • 2nd most comm carpal fx,
  • most frequently in dorsal corticle.
  • MOI: forced hyperflexion (compression)/avulsion.
  • if not displaced, can be treated successfully w/ cast for 4-6 wks.
  • displaced might require ORIF.
103
Q

lunate fx

A

3rd most common carp fx. Kienbock’s disease is a common complication=AVN of lunate. Macro/Micro, with multiple microfractures possible. Tenderness with direct dorsal palpation. Patient might report central dorsal wrist pain, loss of motion @ wrist, and diminished grip strength.

104
Q

hook of hamate fx

A

common in baseball/softball. possible complication= damage to terminal branch of ulnar nerve

105
Q

boxer’s fx

A

fx of neck of 5th metacarpal

106
Q

Bennet’s fx/dislocation

A
  • involves an intra-articular fx at base of 1st carpometacarpal joint of thumb.
  • most frequent of all thumb fxs
  • involves an oblique intra-articular metacarpal fx (known as palmar beak fragment) which remains attached to the palmar beak ligament.
107
Q

extensor tendon injuries

A
  • mallet finger: rupture of extensor tendon at distal phalanx. DIP is splinted at 0 deg. May produce a swan neck def.
  • boutenniere deformity: rupture of central slip of extensor tendon. results in MCP hyperextension, PIP flexion, DIP hyperextension. PIP IS SPLINTED A 0 deg.
108
Q

contusions

A

radius most commonly effected

109
Q

wrist tenosynovitis

A

AKA deQuervain’s disease. typically involves abductor pollicis longus and extensor pollicis brevis. Finkelstein’s test is not particularly sensitive/specific to deQuervain’s.

110
Q

wrist sprains

A

ulnar collateral lig and radial collateral lig.

111
Q

ganglion

A

herniation of the synovial sheath. not typically removed unless symptomatic. surgery not 100% effective

112
Q

Colles fx

A

distal radius displaced posteriorly.

113
Q

smith’s fx

A

reverse of Colles’ fx. (radius displaced anteriorly) “flexion fx of radius”

114
Q

scapholunate dissociation

A
  • scapholunate lig is most imp lig @ wrist.
  • Etiology: Hx of a fall or direct blow to hyperextended wrist
  • x-rays taken in a clenched fist position
  • SLD is when gap is 2-3 mm between scap. and lun.
115
Q

carpal tunnel syndrome

A
  • most common repetitive motion injury.
  • involves 10 structures that reside in the CT: median nerve, flexor pollicis longus, flexor digitorum superficialis (4 tendons), and flexor digitorum profundus (4 tendons).
  • ST: median nerve dermatomal/myotomal tests, Phalen’s/Tinel’s test, nerve conduction velocity test
116
Q

cyclist/handlebar palsy and cyclist palsy.

A

handlebar palsy is compression of ulnar nerve. cyclist palsy is compression of median nerve

117
Q

epidemiology of wrist injuries

A
  • abnormally high intensity stress (tennis)
  • direct blow in contact sports (football/hockey)
  • wrist used as a weight bearing joint (gymnastics)
  • repetitive heavy loading
118
Q

radial sided wrist pain

A

scapholunate interrosseous lig injury is most common of radial-sided injuries.

  • coordinates normal wrist motion, and bridges proximal and distal rows of carpals to control position of lunate.

MOI: typically hyperextension loading.

119
Q

ulnar sided wrist pain

A

typically involves the lunotriquetral ligament or TFCC or both. TFCC plays role in stabalizing the distal radioulnar joint.

120
Q

wrist injury/pain treatment options.

A

NSAIDS, Immobilization, steroid injections, rehab, surgery.

121
Q

Herbert screw

A

used in internal fixation of scaphoid fxs.

122
Q

gamekeepers/skiers thumb

A
  • valgus stress (abduction while MCP joint is extended), pain arising from ulnar side of 1st MCP joint.
  • MCP joint swelling and ecchymosis
  • decreased grip strength
  • valgus stress test reveals pain + instability
  • grade 1 +2= ulnar gutter or thumb spica splint.
    • 3- surgical repair/reconstruction
123
Q

treatment of metacarpal fx

A
  • observation: deformity, swelling, ecchymosis maybe, knuckle asymmetry. fingernail malalignment may be noted.
  • decreased ROM/grip strength
  • metacarp palpation may reveal crepitus and deformity, pain also radiates through affected finger.
  • short arm cast (difficult to immobilize these fxs)
  • ORIF for intra-articular + severely angulated fxs.
  • percutaneous pinning with K-wires.
124
Q

extensor tendon avulsion treatment

A

mallet finger treatment.

  • popping sensation in fingertip may be reported from forced flexion
  • distal phalanx swelling, and DIP remains flexed
  • unable to extend
  • little/no force produced during resisted ROM testing of DIP joint
  • finger splinted CONTINUOUSLY for 8-9 wks. surgery indicated for patient who cannot/will not wear splint.
125
Q

distal phalanx fx

A

mallet finger w/ and avulsion fx… mallet finger splint

126
Q

finger sprains/dislocation treatment.

A
  • unreduced dislocation, deformity is obvious. sprain results in swelling + possible ecchymosis.
  • joint palpation and ROM produce pain. varus/valgus tests may reveal instability.
  • Splinting with PIP joint in 30 deg flexion for 2 wks.
  • buddy taping for an additional 2-4 wks
  • ORIF for unreducable dislocations (volar plate tear?)
127
Q

delayed union fx?

A

suspect avascular necrosis.

128
Q

changes in tissue feels to spongy

A

synovitis

129
Q

possible change in tissue feel to hard/warm

A

blood accumulation

130
Q

possible changes in tissue feels to dense, thickening

A

scar tissue formation

131
Q

possible change in tissue feels to dense/viscous

A

pitting edema

132
Q

increased muscle tone

A

muscle spasm/ muscle hypertrophy

133
Q

change in tissue feel to hard

A

exostosis (bone or bony outgrowth)

upper eval (9 decks)

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