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exam 2 - ortho Flashcards

1
Q

Ankle injury - Ottawa Rules

A

XRAY if…

  • malleolar pain
  • can not bear weight immediately after injury and/or 4 steps in office
  • pain at 5th metatarsal base
  • pain at navicular bone
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2
Q

Sprain - most common sprain

A

Lateral ankle sprain

- inversion injury

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3
Q

Sprain - medial ankle sprain + clinical presentation + assessment + treatment

A 
Eversion injury
- refer to ortho
Presentation:
- pop during injury, immediate swelling (grade 1-3)
Assessment: 
- always palpate midfoot/navicular bone, malleoli, and 5th metatarsal
- Xray if point tenderness
Tx
- PRICE
- Ortho referral if > grade 2
- walk/jog program
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4
Q

Achilles Tendinopathy/Rupture

Clinical Presentation

A

heel/tendon pain w/ or w/out swelling, worse in AM or when climbing stairs

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5
Q

Achilles Tendinopathy/Rupture Imaging

A
  • US to r/o rupture

- MRI if ruptured

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6
Q

Clinical Presentation of Achilles Rupture

A
  • unable to rise up on toes, sudden ankle weakness
    • Thompson test
  • visible/palpable gap overlying tendon
  • Immediate referral to ortho
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7
Q

Achilles Tendinopathy/Rupture Treatment + education

A
  • NSAIDS
  • strict tendon rest
  • May last 8+ weeks
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8
Q

Pediatric ankle pain

A
  • more likely fx vs. sprain

- Salter-harris classification for growth plate fx

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9
Q

Salter-Harris classification

A

Fractures

  • S
    Type I - Straight across
  • A
    Type II - Above
  • L
    Type III - Lower
  • T
    Type IV - Through
  • ER
    Type V - Erosion
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10
Q

Elbow pain - immediate referral

A

Fracture, dislocation, vascular/neuro findings

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11
Q

Medial epicondylitis

A

golfer’s elbow

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12
Q

medial epicondylitis wrist pain presentation + confirmation

A
  • pain with ACTIVE wrist FLEXION
    + pain with PASSIVE wrist EXTENSION
  • confirmed with local anesthetic block
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13
Q

Lateral epicondylitis

A

tennis elbow

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14
Q

Lateral epicondylitis wrist pain presentation

A
  • Pain with ACTIVE wrist EXTENSION

- Pain with PASSIVE wrist FLEXION

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15
Q

Olecranon bursitis presentation

A

posterior pain/swelling/redness

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16
Q

Elbow sprain

A
  • pain after throwing, overhead or weight-bearing activity

- tenderness overlying affected ligaments

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17
Q

Elbow - Radial head fx presentation

A
  • Fall onto outstretched hand
  • Pain waxing and waning agter injury
  • Splint at 90 degrees and ortho referral (typically surgical repair)
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18
Q

Low back pain: red flags

A
  • > 50 y.o
  • recent unexplained weight loss
  • failure to improve after 1 month tx
  • fever
  • new lower extremity
  • weakness
  • bowel/bladder dysfunction
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19
Q

Low back pain: red flags,

consider infection…

A
  • in IV drug users
  • recent spinal surgery
  • recent skin/urine infection
  • immunocompromised states
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20
Q

Low back pain: red flags, priority dDx

A
  • spinal cord compression/cauda equina
  • fracture
  • inflammatory disease
  • neoplasm
  • infection
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21
Q

Low back pain: red flags, imaging

A
  • XRAY/MRI
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22
Q

Lumbar Radiculopathy presentation

A
  • Severe pain w/ or w/out neuropathic pain, exacerbated by sitting/coughing/valsalva/bending
  • improved with positional shift
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23
Q

Lumbar Radiculopathy, Improved by…

A
  • positional shifts
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24
Q

Lumbar Spinal Stenosis

A
  • back pain with neurogenic claudication
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25
Lumbar Spinal Stenosis, alleviate by...
- sitting/leaning forward
26
Sciatica clinical presentation
- Radiculopathy into the leg/foot, sharp pain
27
Sciatica - exam test and positive results
Straight leg test - pain/paresthesia with straight leg @ 20-70 degrees of flexion
28
Cauda Equina - clinical presentation
- saddle anesthesia - bowel/bladder incontinence - lower extremity weakness - medical emergency - xray
29
Cauda Equina - treatment
- non-pharm management
30
Hip pain - refer to ortho
- hip dislocation - fracture - end stage degenerative joint disease
31
Hip pain - adolescent presentation
Legg-calve-perthes disease of SCFE
32
Hip pain - adolescent presentation, Legg-Calve-Perthes Disease
- occurs between ages of 4 and 8 - young overweight male, no trauma - children tend to be shorter in stature - deformity of female head - treatment primarily conservative - MRI can r/o
33
Hip pain - adolescent presentation SCFE
- slipped capital femoral epiphysis - can be with or without trauma - more common during periods of rapid growth - occurs between 10 and 15 - children tend to be overweight - displacement of femoral neck - treatment is operative
34
Hip pain - trauma r/o
- r/o avascular necrosis (MRI)
35
Hip pain - bursitis
- lateral hip pain to palpation and on ambulation at night
36
Hip pain - OA
- breakdown or degeneration of the cartilage within the joint, causing bone ends to rub - refer to ortho (hip fx vs. dislocation vs. avascular necrosis)
37
Hip pain - bilateral presentation
- RA - inflammatory, autoimmune, destructive joint process that affects multiple joints and causes synovitis, pain, and stiffness
38
Hip pain - avascular necrosis
- loss of blood supply and subsequent tissue death - trauma, ETOH intoxication, sickle cell anemia, or steroid use - can be bilateral
39
Femoral neck fx - presentation + gait type
- groin/anterior thigh pain + abnormal gait | - trendelenburg gait
40
Knee pain/injury: Ottawa Knee Rule of Radiography: XRAY only if
- 55 or older OR - isolated patellar tenderness OR - tenderness of the head of the fibula OR - cannot flex to 90 degrees OR - unable to bear weight
41
Knee pain/injury: MCL clinical presentation + test
- most common ligament injury - Presentation: medial knee pain, usually not swollen/unstable Test: Valgus stress test + laxity
42
Valgus vs. Varus
Varus: (out) - lateral | Valgus (in) - medial
43
Knee pain/injury: LCL clinical presentation + test
- rare, typically MVA related Presentation: lateral knee pain with instability - Varus test + laxity
44
Knee pain/injury: ACL clinical presentation + test
- most common severe knee injury - presentation: "pop" w/ rapid swelling/pain/instability Test: Lachman and Anterior Drawer * immediate ortho referral
45
Knee pain/injury: PCL clinical presentation + test
- mild swelling compare to ACL | - Test: Posterior Drawer + laxity
46
Knee pain/injury: Meniscus clinical presentation + test
- third most common knee injury - presentation: joint effusion, tenderness at joint line, instability, "locking" - often a/w ACL tear Test: Thessaly Test, McMurray Test, Apley Compression
47
Knee pain/injury: Patellofemoral clinical presentation + test
- most common overuse injury | - Presentation: bilateral pain behind patella, "giving out" sensation, pain during squatting/palpation
48
Knee pain/injury: Prepatellar bursitis/housemaids knee clinical presentation + test
- swelling superficial to the patella | - pain with direct pressure
49
Osteoporosis joints affected
fingers, foot joints, cervical spine, lumbar spine, knee, hip
50
Osteoporosis presentation
- progressive pain/stiffness in one or more joints, aggravated by weight bearing activities - may be a/w crepitus, swelling, and decreased ROM - if lumbar or cervical spine, may be a/w radiculopathy
51
OA of the hands presentation
- Bouchard (proximal) - Herbenden (distal) - responds better to Tylenol than NSAIDS
52
Neck pain, axial neck pain presentation
- whiplash | - normal motor strength, localized pain to neck
53
Neck pain, radicular neck pain clinical presentation + test
- cervical spondylosis/stenosis - arm pain > neck pain - neuropathic sx - pain worse with extension, alleviated by specific arm movements - Test: Spurling maneuver, Lhermitte sign
54
Neck pain, emergency clinical presentation
- Cervical Myelopathy | - Neck pain + radiculopathy
55
Radiculopathy - s/sx
- range of symptoms produced by the pinching of a nerve root in the spinal column - pinched nerve can occur at different areas along the spine (cervical, thoracic, or lumbar). - Sx: pain, weakness, numbness, and tingling
56
Wrist pain - immediate referral
- fracture, dislocation
57
Wrist pain - Ganglion cyst tx
splinting/rest
58
Wrist pain - stenosing tenosynovitis clinical presentation + test
- "trigger finger" - thumb is most commonly involved digit - ring/middle finger thickening of tendon sheath - edema at distal palm, palpable/tender nodule - Test: palpate affected MCP while patient extends --> palpable pop
59
Wrist pain - stenosing tenosynovitis treatment
- splint at 10-15 degrees, cortisone injection
60
Wrist pain - De Quervain Tenosynovitis clinical presentation, test, and treatment
- pain/inflammation of the dorsal wrist - test: Finklestein - Tx: splint at slight extension/abduction, cortisone injection
61
Wrist pain - Palmar Fibrosis/Dupuytren Contracure
- painless nodule/hereditary
62
Wrist pain - Carpal tunnel syndrome clinical presentation, test, treatment, and risk factors
- median nerve neuropathy - pain/numbness radiating to thumb, index finger, and medial ring finger - test: thumb abduction, Phalen maneuver, Tinel sign - tx: neutral splinting, rest - risk factors: repetitive maneuvers, obesity, pregnancy, DM, hypothyroidism, and older female gender
63
Scoliosis - structural vs. non structural
- functional scoliosis, no cove of vertebrae
64
Scoliosis - Cobb method
- curvature of the spine > 10 degrees | - females more likely to develop curve > 30 degrees vs. males
65
Scoliosis: curve < 20 degrees
observe
66
Scoliosis: curve 20-45 degrees
early intervention with bracing
67
Scoliosis: surgical intervention indications
curve 45-50 + not responsive to bracing
68
Scoliosis: Adams test
- bend forward, screening for scoliosis | - > 5-7 degrees by scoliometer indicates need for further testing
69
Neck pain: risk factors
- manual labor - female gender - headaches - smoking - poor job satisfaction - poor biomechanics
70
Neck pain: chronic
greater than 12 weeks
71
Neck pain: PE
- neck alignment - ROM - skin, muscle, vasculature - Neuro exam - Sensations - Reflexes
72
Neck pain: maneuvers
- spurling maneuver - ULTT/Elvey test - shoulder abductino test - Lhermitte sign
73
Shoulder pain: Labral Tear: causes, sx
- lesions of the superior glenoid labrum and biceps anchor - trauma, overuse, repetitive motion - deep shoulder pain with specific shoulder positions - pain during overhead maneuvers, a catching sensation, a loss of shoulder strength, crepitus
74
Shoulder pain: labral tear | test + treatment
- labral shear test | - arthroscopic surgery
75
Shoulder pain: subacromial impingement syndrome | causes and tx
- inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space, resulting in pain, weakness, and reduced range motion within the shoulder Causes: acute trauma, repetitive OH activities, pushing and pulling activities - subtle or overt instability of the glenohumeral joint, and degernative and inflammatory disorders of the tendon and bursa Tx: ICE, NSAIDS, Pt/Stretching surgery
76
Shoulder dislocation =
Instability
77
Shoulder (dislocation) instability types
- traumatic, unidirectional - atraumatic, multidirectional, bilateral, inferior capsule shift. - more responsive to rehab
78
Shoulder instability (dislocation) tx
- closed reduction - NSAIDS - activity modification/immobilization - surgery
79
``` Adhesive capsulitis (frozen shoulder) - characteristics ```
Complications of chronic pain | - characteristics: gradual progressive decline of shoulder mobility (active and passive ROM) and diffuse aching pain
80
Adhesive capsulitis (frozen shoulder) treatment
- Corticosteroid injections - PT - Manipulation - Stretching
81
Elbow pain: Sprains, causes and tx
Tearing or stretching of lateral or medial ligaments Causes: throwing, OH or WB activity (medial), or fall onto extended elbow (lateral) Tx: RICE, sling or splint, oral or topical NSAIDS
82
Elbow: Radial head fractures | FOOSH + presentation
fall onto outstretched hand - pain decreasing 30 min after injury, then recurring several hours later (bleeding in joint) - local or diffused edema, tenderness over radial head, limited ROM
83
Elbow: Radial head fractures tx
- PRICE = posterior splint or sling for immobilization, rest, ice, compression and elevation - ortho referral - surgery (displaced or complicated fx)
84
Elbow: Ulnar neuritis (cubital tunnel syndrome) path and presentation
- compression of the ulnar nerve causing numbness or tingling in nerve's distribution - presentation: tenderness of ulnar groove, sensory loss of 5th digit, diminished motor strength of 4th and 5th digits - if severe, forearm motor weakness and muscle atrophy
85
ulnar neuritis (cubital tunnel syndrome) management
- PRICE - elbow pads, wrist-elbow sprints - oral or topical NSAIDS - PT - Referral to ortho or neuro

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