Extremities Red Flags Flashcards
positioning/purpose of the olecranon-manubrium percussion test
elbows flexed at 90 across the chest
stethoscope over manubrium
olecranon percussed
UE fx
findings associated with radial head fx
elbow jt effusion
tender to palpation
elbow in loose packed position (70° flex and 10° supination)
restricted, painful supination/pronation
what are the amsterdam wrist rules
determines a pt’s need for radiographs
characteristics of a distal radius fx
increased age
swelling in wrist
visible deformation
painful to palpation
pain on ballottement test
what decreases the likelihood of a distal radius fx
pain in ulnar deviation
what is the ballottement test
stabilization of either the radius or ulna
moving the other bone
what are characteristics of a wrist fx
increased age
male
swelling of wrist / snuffbox
tender palpation
pain on radial deviation
carpal bone most often fx
scaphoid
imaging for carpal bone fx
radiographs - can miss 5-20%
MRI - hidden fx or avascular necrosis
CT
what is a big concern for scaphoid fxs
avascular necrosis due to the retrograde nature of blood supply
who is most at risk for a pancoast tumor
males over 50 who smoke
findings of a pancoast tumor
horner’s
shoulder/scapula pain
– may radiate into head, neck, chest
mimicking thoracic outlet syndrome
weakness/atrophy of hand muscle
what can cause Horner’s syndrome
carotid artery dissection
pancoast tumor
cervical spine injury
signs of horner’s
ptosis - drooped eyelid
miosis - pupil constriction
anhidrosis - no sweating
enophthalmos - sinking of eyeball
what causes CRPS-1? what type of pain is present?
injury w/o nerve involvement
after MI, CVA, disease of abdominal or thoracic viscera
nocioceptive pain
what causes CRPS-2? what type of pain will be present?
after injury with nerve involvement
neuropathic pain
sensory changes associated with CRPS1
allodynia
hypo/hyperalgesia
hypo/hyperesthesia
trophic changes from CRPS
changes to the
skin
hair
nail
autonomic changes due to CRPS
swelling
edema
sweating
motor changes due to CRPS
weakness
contractures
atrophy
causes of acute compartment syndrome
trauma or exertional
what can acute compartment syndrome lead to
permanent muscle / nerve damage
findings of acute compartment syndrome
palpable tenderness/tension
severe pain out of proportion
paresthesia, paralysis, pulselessness
– more later
history of septic arthritis
insidious onset of pain localized at a joint
IV drug use / infection
diabetes
trauma
findings of septic arthritis
tenderness over jt
limited mvmt at jt
swelling at jt
fever
symptoms of periprosthetic infection
local erythema
intense, persistent pain
non-healing incision
sudden change in <ROM and/or >pain
is a referral warranted for
septic arthritis
periprosthetic infection
yes - immediate
what is the female athlete triad
changes in energy levels w or w/o ED
changes in menstrual cycle
osteoporosis
history of femoral head osteonecrosis
long-term corticosteroid use
hx of avascular necrosis in contra hip
hx of trauma
findings of femoral head osteonecrosis? what motions would be restricted?
gradual onset of pain that is worse with weight bearing
restrictions of IR, Flex, add @ hip
typical pt hx of femoral neck fx
older females (>70)
female athletes
findings of femoral neck fx
severe, constant pain / > mvmt
stress fx
displaced fx
what would make you suspect a femoral neck fx to be a stress fx
- discomfort with hip A/PROM
- pain with percussion over greater trochanter
what would make you suspect a femoral neck fx to be a displaced fx
leg held in abduction and ER
with shortening
types of stress fx
insufficiency fx
fatigue fx
what is an insufficiency fx
abnormal bone broken under normal force
what is a fatigue fx
normal bone put under extreme force
difference in populations when comparing insufficiency and fatigue fx?
insufficiency - older people
fatigue - those partaking in high intensity activities
common sites for stress fx
tibia
femur
pelvis
tests for femoral stress fx
fulcrum test
patellar pubic percussion
characteristics of legg-calve perthes disease
5-8 y/o
male > female
insidious onset of hip, groin, thigh pain
antalgic gait
decreased abduction, IR
what causes legg-calve perthes
avascular necrosis
characteristics of a SCFE
10-16 y/o
male > female
obese
antalgic gait
leg held in ER, prefer to sit with affected limb across the other
what is SCFE
slipped capital femoral epiphysis
what is a klein line
line drawn along the superior edge of femoral neck
should intersect the lateral aspect of superior femoral epiphysis
how does the energy of trauma effect imaging in those with pelvis/hip fx
high - CT
low - routine radiograph with advanced imaging
what are the names of the knee fx rules
ottawa
pittsburgh
ankle portion of the ottawa foot and ankle rules
bone tenderness at posterior edge of lateral and/or medial malleolus
foot portion of the ottawa foot and ankle rules
bone tenderness at either:
base of 5th metatarsal
navicular
what is used to assess DVT
Well’s Test
gold standard of DVT diagnosis
contrast venography
