Exam 2 - Ortho (need to know) Flashcards
Causes of lower back pain
- Cumulative trauma disorders
- Repetitive strain injuries
- Repetitive motion injuries
Lower back pain: physical exam components
- Mechanical pain aggravated by activity
- Pain relieved with lying down
- Pain may radiate to one or both buttocks
- Lumbar or sacroiliac tenderness
- ROM tenderness with turning or bending
Lower back pain: diagnostic testing
- Straight leg test
- Axial stimulation
- MRI
- Labs
What is the straight leg raise test?
Passive test - assesses damage from L5 to S1
- Raise straight leg to 70-90 degrees of hip flexion
- If pain produced at any point when the leg is in 20-70 degrees, the test is positive

Lower back pain: treatment
If patient has stable pain -
- Rest
- Ice to affected area 3-4 times/day
- Compression (back brace)
- Heat after 2-3 days, 3-4 times/day
- PT
- NSAIDs (naproxen, ibuprofen), muscle relaxers
Lower back pain: treatment when pain is due to trauma or has associated neurological changes
Referral to ER for evaluation
Lower back pain: treatment when pain is chronic, disabling, or shows no improvement
- Refer to pain management
- Refer to orthopedics
Criteria suggesting need for imaging of back pain
- Bowel/bladder dysfunction
- New onset of erectile dysfunction
- Fevers or night sweats (suggestive of infection or malignancy)
- Unintentional weight loss
- Night pain
- Personal history of cancer
- Saddle anesthesia
- History of recent trauma (fall or direct blow)
- NOT twisting or lifting
- Age >50 or <18
- Patient with current or recent use of steroids
- Any suspicion of an infectious or neoplastic cause
- Pain for >6 weeks
What does a positive straight leg raise test indicate?
Nerve root impingement from herniated disk (e.g. sciatica)
What does the empty can test assess for?
Shoulder function
Empty can test technique
- Have patient hold out affected arm as if offering examiner a can of soda (abduction to 90 degrees)
- Have patient turn arm to empty the contents (internal rotation)

What indications would the provider suspect if there is pain with the empty can test? Weakness?
Pain = rotator cuff tendinitis
Weakness = tear
What is epicondylitis? What causes it?
Inflammation at the tendon origin
Cause:
- Repetitive strain injury
- Repetitive motion injury
- Heavy lifting, hammering, screwing, gripping
Epicondylitis: physical exam findings
- Lateral and medial
Lateral - pain reproduced by resistive wrist extension
Medial - pain reproduced by resistive wrist flexion
Medial versus lateral epicondylitis
Lateral: “tennis elbow”, radial tunnel and posterior nerve syndrome
Medial: “golfers elbow”, ulnar collateral ligament injury
Epicondylitis: diagnostic testing
- Lateral elbow pain with passive wrist flexion and active wrist extension = lateral
- Pain with resisted wrist flexion, forearm pronation, and passive wrist extension = medial
Epicondylitis: treatment/management
- Oral or topical NSAIDs
- Tennis elbow splint
- Exercises - “palms up”, toning of wrist extensors
- Cortisone injections if conservative measures fail
- Ortho referral if treatment continues to fail
What is ulnar neuritis?
Cubital tunnel syndrome - compression of ulnar nerve causing numbness or tingling in nerve’s distribution
Patient presentation: ulnar neuritis (cubital tunnel syndrome)
- Tenderness of ulnar groove
- Sensory loss of fifth digit
- Diminished motor strength of fourth and fifth digits
- Positive Tinel sign
- If severe, forearm motor weakness and muscle atrophy
Ulnar neuritis: diagnostic studies
EMG
Ulnar neuritis: management
- PRICE
- Elbow pads, wrist-elbow splint, support in neutral position
- Oral or topical NSAIDs
- PT
- Referral to orthopedics (conservative measures rarely effective)
What factors has been associated with the development of septic olecranon bursitis?
- Male gender
- Manual labor
- Certain sports
- Military population
Presentation of septic olecranon bursitis
- Tenderness
- Erythema
- Warmth
Risk factors for developing septic olecranon bursitis
- Diabetes
- Immunocompromised
- Alcoholism
- Psoriasis
- Crystalline disease (e.g. gout and pseudogout)
- RA





