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532 > exam 2 - ortho > Flashcards

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
Q

Lumbar Spinal Stenosis, alleviate by…

A
  • sitting/leaning forward
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26
Q

Sciatica clinical presentation

A
  • Radiculopathy into the leg/foot, sharp pain
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27
Q

Sciatica - exam test and positive results

A

Straight leg test - pain/paresthesia with straight leg @ 20-70 degrees of flexion

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28
Q

Cauda Equina - clinical presentation

A
  • saddle anesthesia
  • bowel/bladder incontinence
  • lower extremity weakness
  • medical emergency
  • xray
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29
Q

Cauda Equina - treatment

A
  • non-pharm management
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30
Q

Hip pain - refer to ortho

A
  • hip dislocation
  • fracture
  • end stage degenerative joint disease
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31
Q

Hip pain - adolescent presentation

A

Legg-calve-perthes disease of SCFE

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32
Q

Hip pain - adolescent presentation, Legg-Calve-Perthes Disease

A
  • 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
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33
Q

Hip pain - adolescent presentation SCFE

A
  • 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
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34
Q

Hip pain - trauma r/o

A
  • r/o avascular necrosis (MRI)
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35
Q

Hip pain - bursitis

A
  • lateral hip pain to palpation and on ambulation at night
36
Q

Hip pain - OA

A
  • 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
Q

Hip pain - bilateral presentation

A
  • RA
  • inflammatory, autoimmune, destructive joint process that affects multiple joints and causes synovitis, pain, and stiffness
38
Q

Hip pain - avascular necrosis

A
  • loss of blood supply and subsequent tissue death
  • trauma, ETOH intoxication, sickle cell anemia, or steroid use
  • can be bilateral
39
Q

Femoral neck fx - presentation + gait type

A
  • groin/anterior thigh pain + abnormal gait

- trendelenburg gait

40
Q

Knee pain/injury: Ottawa Knee Rule of Radiography: XRAY only if

A
  • 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
Q

Knee pain/injury: MCL clinical presentation + test

A
  • most common ligament injury
  • Presentation: medial knee pain, usually not swollen/unstable
    Test: Valgus stress test + laxity
42
Q

Valgus vs. Varus

A

Varus: (out) - lateral

Valgus (in) - medial

43
Q

Knee pain/injury: LCL clinical presentation + test

A
  • rare, typically MVA related
    Presentation: lateral knee pain with instability
  • Varus test + laxity
44
Q

Knee pain/injury: ACL clinical presentation + test

A
  • most common severe knee injury
  • presentation: “pop” w/ rapid swelling/pain/instability
    Test: Lachman and Anterior Drawer
  • immediate ortho referral
45
Q

Knee pain/injury: PCL clinical presentation + test

A
  • mild swelling compare to ACL

- Test: Posterior Drawer + laxity

46
Q

Knee pain/injury: Meniscus clinical presentation + test

A
  • 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
Q

Knee pain/injury: Patellofemoral clinical presentation + test

A
  • most common overuse injury

- Presentation: bilateral pain behind patella, “giving out” sensation, pain during squatting/palpation

48
Q

Knee pain/injury: Prepatellar bursitis/housemaids knee clinical presentation + test

A
  • swelling superficial to the patella

- pain with direct pressure

49
Q

Osteoporosis joints affected

A

fingers, foot joints, cervical spine, lumbar spine, knee, hip

50
Q

Osteoporosis presentation

A
  • 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
Q

OA of the hands presentation

A
  • Bouchard (proximal)
  • Herbenden (distal)
  • responds better to Tylenol than NSAIDS
52
Q

Neck pain, axial neck pain presentation

A
  • whiplash

- normal motor strength, localized pain to neck

53
Q

Neck pain, radicular neck pain clinical presentation + test

A
  • cervical spondylosis/stenosis
  • arm pain > neck pain
  • neuropathic sx
  • pain worse with extension, alleviated by specific arm movements
  • Test: Spurling maneuver, Lhermitte sign
54
Q

Neck pain, emergency clinical presentation

A
  • Cervical Myelopathy

- Neck pain + radiculopathy

55
Q

Radiculopathy - s/sx

A
  • 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
Q

Wrist pain - immediate referral

A
  • fracture, dislocation
57
Q

Wrist pain - Ganglion cyst tx

A

splinting/rest

58
Q

Wrist pain - stenosing tenosynovitis clinical presentation + test

A
  • “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
Q

Wrist pain - stenosing tenosynovitis treatment

A
  • splint at 10-15 degrees, cortisone injection
60
Q

Wrist pain - De Quervain Tenosynovitis clinical presentation, test, and treatment

A
  • pain/inflammation of the dorsal wrist
  • test: Finklestein
  • Tx: splint at slight extension/abduction, cortisone injection
61
Q

Wrist pain - Palmar Fibrosis/Dupuytren Contracure

A
  • painless nodule/hereditary
62
Q

Wrist pain - Carpal tunnel syndrome clinical presentation, test, treatment, and risk factors

A
  • 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
Q

Scoliosis - structural vs. non structural

A
  • functional scoliosis, no cove of vertebrae
64
Q

Scoliosis - Cobb method

A
  • curvature of the spine > 10 degrees

- females more likely to develop curve > 30 degrees vs. males

65
Q

Scoliosis: curve < 20 degrees

A

observe

66
Q

Scoliosis: curve 20-45 degrees

A

early intervention with bracing

67
Q

Scoliosis: surgical intervention indications

A

curve 45-50 + not responsive to bracing

68
Q

Scoliosis: Adams test

A
  • bend forward, screening for scoliosis

- > 5-7 degrees by scoliometer indicates need for further testing

69
Q

Neck pain: risk factors

A
  • manual labor
  • female gender
  • headaches
  • smoking
  • poor job satisfaction
  • poor biomechanics
70
Q

Neck pain: chronic

A

greater than 12 weeks

71
Q

Neck pain: PE

A
  • neck alignment
  • ROM
  • skin, muscle, vasculature
  • Neuro exam
  • Sensations
  • Reflexes
72
Q

Neck pain: maneuvers

A
  • spurling maneuver
  • ULTT/Elvey test
  • shoulder abductino test
  • Lhermitte sign
73
Q

Shoulder pain: Labral Tear: causes, sx

A
  • 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
Q

Shoulder pain: labral tear

test + treatment

A
  • labral shear test

- arthroscopic surgery

75
Q

Shoulder pain: subacromial impingement syndrome

causes and tx

A
  • 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
Q

Shoulder dislocation =

A

Instability

77
Q

Shoulder (dislocation) instability types

A
  • traumatic, unidirectional
  • atraumatic, multidirectional, bilateral, inferior capsule shift.
  • more responsive to rehab
78
Q

Shoulder instability (dislocation) tx

A
  • closed reduction
  • NSAIDS
  • activity modification/immobilization
  • surgery
79
Q 
Adhesive capsulitis (frozen shoulder)
- characteristics
A

Complications of chronic pain

- characteristics: gradual progressive decline of shoulder mobility (active and passive ROM) and diffuse aching pain

80
Q

Adhesive capsulitis (frozen shoulder) treatment

A
  • Corticosteroid injections
  • PT
  • Manipulation
  • Stretching
81
Q

Elbow pain: Sprains, causes and tx

A

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
Q

Elbow: Radial head fractures

FOOSH + presentation

A

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
Q

Elbow: Radial head fractures tx

A
  • PRICE = posterior splint or sling for immobilization, rest, ice, compression and elevation
  • ortho referral
  • surgery (displaced or complicated fx)
84
Q

Elbow: Ulnar neuritis (cubital tunnel syndrome) path and presentation

A
  • 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
Q

ulnar neuritis (cubital tunnel syndrome) management

A
  • PRICE
  • elbow pads, wrist-elbow sprints
  • oral or topical NSAIDS
  • PT
  • Referral to ortho or neuro

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