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NURS 502 > Exam 2 - Ortho (need to know) > Flashcards

Exam 2 - Ortho (need to know) Flashcards

1
Q

Causes of lower back pain

A
  • Cumulative trauma disorders
  • Repetitive strain injuries
  • Repetitive motion injuries
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2
Q

Lower back pain: physical exam components

A
  • 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
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3
Q

Lower back pain: diagnostic testing

A
  • Straight leg test
  • Axial stimulation
  • MRI
  • Labs
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4
Q

What is the straight leg raise test?

A

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
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5
Q

Lower back pain: treatment

A

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
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6
Q

Lower back pain: treatment when pain is due to trauma or has associated neurological changes

A

Referral to ER for evaluation

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7
Q

Lower back pain: treatment when pain is chronic, disabling, or shows no improvement

A
  • Refer to pain management
  • Refer to orthopedics
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8
Q

Criteria suggesting need for imaging of back pain

A
  • 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
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9
Q

What does a positive straight leg raise test indicate?

A

Nerve root impingement from herniated disk (e.g. sciatica)

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10
Q

What does the empty can test assess for?

A

Shoulder function

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11
Q

Empty can test technique

A
  • 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)
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12
Q

What indications would the provider suspect if there is pain with the empty can test? Weakness?

A

Pain = rotator cuff tendinitis

Weakness = tear

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13
Q

What is epicondylitis? What causes it?

A

Inflammation at the tendon origin

Cause:

  • Repetitive strain injury
  • Repetitive motion injury
  • Heavy lifting, hammering, screwing, gripping
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14
Q

Epicondylitis: physical exam findings

  • Lateral and medial
A

Lateral - pain reproduced by resistive wrist extension

Medial - pain reproduced by resistive wrist flexion

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15
Q

Medial versus lateral epicondylitis

A

Lateral: “tennis elbow”, radial tunnel and posterior nerve syndrome

Medial: “golfers elbow”, ulnar collateral ligament injury

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16
Q

Epicondylitis: diagnostic testing

A
  • Lateral elbow pain with passive wrist flexion and active wrist extension = lateral
  • Pain with resisted wrist flexion, forearm pronation, and passive wrist extension = medial
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17
Q

Epicondylitis: treatment/management

A
  • 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
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18
Q

What is ulnar neuritis?

A

Cubital tunnel syndrome - compression of ulnar nerve causing numbness or tingling in nerve’s distribution

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19
Q

Patient presentation: ulnar neuritis (cubital tunnel syndrome)

A
  • 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
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20
Q

Ulnar neuritis: diagnostic studies

A

EMG

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21
Q

Ulnar neuritis: management

A
  • PRICE
  • Elbow pads, wrist-elbow splint, support in neutral position
  • Oral or topical NSAIDs
  • PT
  • Referral to orthopedics (conservative measures rarely effective)
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22
Q

What factors has been associated with the development of septic olecranon bursitis?

A
  • Male gender
  • Manual labor
  • Certain sports
  • Military population
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23
Q

Presentation of septic olecranon bursitis

A
  • Tenderness
  • Erythema
  • Warmth
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24
Q

Risk factors for developing septic olecranon bursitis

A
  • Diabetes
  • Immunocompromised
  • Alcoholism
  • Psoriasis
  • Crystalline disease (e.g. gout and pseudogout)
  • RA
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25
Q

Septic olecranon bursitis management

A
  • Fluid for culture
  • Start antibiotics to cover s. aureus
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26
Q

What are ganglion cysts of the wrist?

A

Fluid filled sacs that appear, disappear, or change in size

  • Occur around joints, tendon sheaths
  • Most commonly in dorsal carpal area and volar surface of wrist
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27
Q

Wrist ganglion cyst: symptoms

A
  • Pain with activity or pressure
  • Weakness
  • Bone changes
  • Interfering with joint function
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28
Q

Ganglion cyst: physical exam findings

A
  • Smooth and rubbery
  • Translluminate with light
  • Pain may or may not be present with palpation
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29
Q

Imaging for ganglion cysts

A
  • X-ray (to r/o fracture, dislocation, bony abnormality)
  • Ultrasound
  • MRI
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30
Q

Ganglion splint: treatment/management

A
  • Splinting/immobilization
  • Aspiration
  • Surgical excision
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31
Q

What is de quervain tenosynovitis?

A

Painful inflammation of abductor pollicis longus and extensor pollicis brevis tendons along dorsal aspect of wrist

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32
Q

De quervain tenosynovitis: risk factors

A
  • Women aged 30-40 (especially postpartum r/t care of newborn)
  • Motions: pinching, lifting, wringing, grasping, activities such as gardening and knitting
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33
Q

De quervain tenosynovitis: diagnostic testing

A

History and physical exam

  • Finkelstein test
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34
Q

De quervain tenosynovitis: treatment/management

A
  • Rest, ice
  • Immobilization (splints or braces)
  • NSAIDs
  • PT
  • Cortisone injections
  • Surgery
35
Q

What is carpal tunnel syndrome?

A

Caused by compressive neuropathy of median nerve

36
Q

Carpal tunnel syndrome: symptoms

A
  • Burning, tingling, numbness of palm, thumb or index and middle fingers
  • Hand weakness
  • Shock-like sensation
37
Q

Carpal tunnel syndrome: risk factors

A
  • Repetitive maneuvers
  • Obesity
  • Pregnancy
  • Female gender
  • Systemic disease (DM, hypothyroidism)
38
Q

Carpal tunnel syndrome: diagnostic studies

A

Tinel sign, phalen test

  • EMG
  • X-ray
  • Ultrasound
  • MRI
39
Q

Carpal tunnel syndrome: treatment/management

A
  • Splinting in neutral position (esp at night) to prevent provocative maneuvers
  • NSAIDs
40
Q

What classification of medications can be given to patients if they have muscle spasms associated with neck pain?

A

Muscle relaxants

  • Tizanidine
  • Cyclobenzaprine
  • Baclofen
41
Q

What is trochanteric bursitis? What makes it worse?

A

Pain over the greater trochanter or ischial spines

  • Worse with activities, lying on the affected side, hip rotation
  • May have associated swelling, redness, warmth
42
Q

Trochanteric bursitis: causes

A
  • Injuries
  • Overuse
  • Incorrect posture
  • Previous surgeries (total hip replacement)
  • Other conditions: RA, OA, gout, runners
43
Q

Trochanteric bursitis: components of physical exam

A
  • Hip, back, knee, abdomen, vascular, neurological
  • Gait analysis and stance assessment
  • ROM
    • Hip flexion and rotation can ilicit pain
44
Q

Trochanteric bursitis: treatment/management

A
  • NSAIDs
  • PT
  • Cortisone injections (limit to 3 times/year)
  • Surgery for OA, joint infection, avascular necrosis, progressive loss of function or refactory pain
45
Q

What is Osgood-Schlatter disease?

A

Microtrauma in the deep fibers of the patellar tendon at its insertion on the tibial tuberosity

  • Often seen in adolescents after patient has undergone growth spurt
  • Tendon pulling on growth place of the shinbone (tibia)
46
Q

Osgood-Schlatter disease: symptoms

A
  • Recent physical activity (soccer, football, running)
  • Pain increases during and immediately after activity
  • Running, jumping, kneeling, squatting, going up/down stairs makes pain worse
47
Q

Osgood-Schlatter disease: physical exam findings

A
  • Pain reproduced by extending knee against resistance, stressing quads, squatting with knees in full flexion
  • Focal swelling, heat, point tenderness at tibial tuberosity
  • Full ROM of knee
48
Q

Osgood-Schlatter disease: diagnostic studies

A

History and physical exam

49
Q

Osgood-Schlatter disease: treatment/management

A

Self-limiting, symptom management

  • Rest, avoid activities that cause pain
  • Ice
  • Knee brace and NSAIDs or acetaminophen
  • PT
50
Q

What is slipped capital femoral epiphysis (SCFE)?

A

Salter-Harris type I fracture through proximal femoral physis

  • Stress around hip causes sheer force to be applied to growth plate
  • Intrinsic weakness in physeal cartilage
51
Q

SCFE: risk factors

A
  • Onset of puberty (adolesence)
  • Overweight/obese
  • Male gender (skeletally immature)
  • African American, Pacific Islander, latinos
  • History of radiation therapy or trauma
52
Q

SCFE: physical exam findings

A
  • Pain in groin or diffusely over knee or anterior thigh
  • Pain and decreased internal rotation
  • Limp with short leg component, externally rotated while walking
  • Unstable SCFE, unable to bear weight
53
Q

SCFE: diagnostic studies

A

X-ray

54
Q

SCFE: treatment/management

A

Aimed to prevent further slippage by stabilizing epiphysis and avoiding complications

  • Immediate referral to orthopedic surgeon
  • Non weight bearing, bed rest
55
Q

ACL injuries: history, mechanism of injury

A

Most commonly injured in sports during rapid deceleration or quickly changing directions

  • Twisting or hyperextension while foot is planted and knee extended
  • Report of a “popping”, knee shifting, pulling apart
56
Q

ACL injuries: clinical findings

A
  • Swelling/effusion and pain
  • Instability with lateral movement
  • Autonomic symptoms (dizziness, sweating, faint)
57
Q

ACL/PCL injuries: diagnostic studies

A

ACL - Lachman and anterior drawer test

PCL - posterior drawer test

58
Q

ACL injuries: management

A
  • Following injury, knee brace or immobilizer until swelling and pain subsides
  • Rest, ice
  • NSAIDs
59
Q

How would the provider perform the Lachman test to assess ACL injuries?

A
  • Knee flexed to about 15-30 degrees
  • One hand below the knee on posterior and other on anterior aspect of femur
  • Lift lower leg while pushing down on upper leg
  • If ACL intact, after few mm of movement examiner should feel a “knock” or firm “stop” as ACL prevents tibia from sliding forward
60
Q

How would the provider perform the anterior drawer test to assess for ACL injuries?

A
  • Knee flexed to 90 degrees with foot kept flat
  • Sit on patients foot and grasp lower leg
  • Place fingers above popliteal space and thumbs on tibial tuberosity
  • Pull on tibia attempting to slide it foward
  • “Soft” or absent endpoint indicates tear
61
Q

Meniscus injuries: symptoms

A
  • Popping ‘sensation’
  • Pain
  • Swelling
  • Stiffness
  • Difficutly straightening the knee
  • Knee locking or buckling
62
Q

Meniscus injuries: causes

A
  • Twisting or deep bending
  • Sports
  • Degenerative changes (wear and tear)
63
Q

Meniscus injuries: diagnostic studies

A
  • Thessaly test
  • McMurray test
64
Q

How would the provider perform the McMurray test to diagnose meniscus injuries?

A
  • Patient lies supine with legs straight
  • Place one hand on heel/ankle and the other on knee joint
  • Flex knee while rotating tibia internally and externally on femur
  • Apply valgus stress on lateral side of knee
  • Hold valgus stress while extending leg and palpating medial joint line
  • If click or pop heard/felt, medial meniscus torn
65
Q

What is patellofemoral pain syndrome (runner or jumper’s knee)?

A

Most common overuse injury of the knee

  • Knee pain that is localized to the anterior portion of the knee, around, and behind the patella
66
Q

Which patient populations is patellofemoral pain syndrome most common?

A
  • Women
  • Young active athletes
  • Runners
67
Q

Patellofemoral pain syndrome: causes

A
  • Abnormal tracking of the patella related to weak quadriceps
  • Poor flexibility
  • Patellar hypermobility
  • Tight iliotibial band
  • Anatomic malalignment
  • Overuse
68
Q

Patellofemoral pain syndrome: symptoms

A
  • Bilateral knee pain that is limited to anterior portion of knee
  • Pain worse with squatting, kneeling, climbing stairs, hill running
  • Feeling like knees are “giving out”
  • Cracking or popping sounds
69
Q

Patellofemoral pain syndrome: physical exam components

A
  • Gait observation
  • Palpation while sitting
  • Orthopedic tests: patellar compression-grind, patellar tilt, patellar glide (elicits pain)
  • May have lateral tracking of patella when in seated position
70
Q

Patellofemoral pain syndrome: management

A
  • RICE
  • Orthotics
  • NSAIDs
  • PT
71
Q

What is a popliteal cyst?

A

Also known as a Baker cyst - inflammatory and degenerative disorder of the knee

  • Cause of knee pain
72
Q

What conditions are popliteal cysts (Baker cysts) associated with?

A
  • RA
  • OA
  • Internal derangements of the knee
73
Q

Are popliteal cysts (Baker cysts) dangerous?

A

Benign condition

  • As cyst increases, possibility of rupture increases
  • Ruptured cyst can drain into calf causing pain, erythema, swelling
    • Mimics phlebitis
74
Q

Popliteal cyst (Baker cyst): imaging

A

Ultrasound to determine location/extent of cyst

75
Q

What is plantar fascitis?

A

Plantar fascia becomes irritated from overuse, trauma, shoes with poor arch support

  • Individuals with flat or cavus feet are vulnerable
76
Q

Plantar fascitis: symptoms

A
  • Pain with weight bearing first thing in the morning or after rest periods
  • Pain in bottom of foot, along arch, in heel
  • Pain with standing for long periods, rising up on toes
77
Q

Plantar fascitis: physical exam findings

A

Point tenderness at insertion of fascia to calcaneus

78
Q

Plantar fascitis: treatment/management

A
  • Rest from high-impact activities (first line)
  • Supportive shoes/inserts (arch support)
  • NSAIDs and ice massage
  • Stretches
  • Weight loss

If doesn’t respond to conservative therapy, refer to ortho or podiatry

79
Q

What is morton neuroma?

A

Perineural fibrosis of plantar nerve at point where medial and lateral branches of plantar nerve converge

80
Q

Morton neuroma: risk factors

A
  • Middle aged women (wearing high heels)
  • Trauma
  • Ischemia
  • Impingement
  • Intermetatarsal bursitis
  • Conditions such as claw toes and bunions
81
Q

Morton neuroma: symptoms

A
  • Severe pain and burning in third webspace (between 2nd and 3rd toes)
  • Aggravated by foot elevation
  • Relieved by going barefoot and undergoing foot massage
82
Q

Morton neuroma: physical exam findings

A
  • Point tenderness and edema over third webspace (between 3rd and 4th metatarsal)
  • Mulder sign
    • Compression of medial and lateral side of foot with one hand and squeezing 3rd and 4th metatarsal bones with the other
    • Will hear palpable or audible click
83
Q

Morton neuroma: treatment/management

A
  • Wear wider toed shoes, insole adjustments, separate toes with small pads
  • NSAIDs
  • Cortisone injections (short term)

NURS 502 (43 decks)

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