Finals - Summer 2014 Flashcards
Pain associated w rotator cuff tendinitis and the treatment
Pain in shoulder that radiates to upper arm (but not past elbow), worse w/ overhead activity and lying on it
Conservative tx
If fails –> steroid injection
DO NOT USE SLING
How to dx calcific tendinitis and what is it’s first line tx?
Dx via x-ray showing calcium deposits overlying the supraspinatus
1st line tx: steroid injection
The most common cause of shoulder pain
Impingement Syndrome
What are the 3 stages of impingement syndrome and which is most common?
Stage 1: edema & hemorrhage
Stage 2: Fibrosis and tendinitis
Stage 3: Rotator cuff tear (MOST COMMON)
What is the definitive tx for impingement syndrome?
Surgical subacromial decompression
Gold standard imaging for rotator cuff tear
MRI
A pt comes into the ER w/ a partial rotator cuff tear. What is the initial tx?
It may heal itself in 6 weeks
If not healed in 6 weeks –> surgery
Gold standard imaging for SLAP and Bankart Tears
MRI
Phases of Adhesive Capsulitis/Frozen Shoulder
- Initial painful phase: severe disabling pain lasting 2-9 months
- Intermediate phase: stiffness and severe loss of ROM, pain is lessened; lasts 4-12 mos
- Recovery Phase: grad return of ROM that takes 5-24 months
Diagnostic of frozen shoulder:
Clinical basis: reduction in active AND PASSIVE ROM in 2 or more planes w/ ER and abduction being most effected
Define tendonitis/tenosynovitis of the bicep
Inflammation of the long head of biceps tendon
What is the Yergason’s Test? What does a postitive test mean?
Elbow flexed at 90 degrees and forearm is supinated. Pain = tendonitis (bicipital long head)
Biceps Tendon Rupture
Males > 50
Results from heavy lifting
MUST HAVE HX OF CHRONIC TENDINITIS
“Popeye” muscle
For who would you consider non-surgical tx for the biceps tendon rupture? Surgical tx?
Non-surgery: elderly and inactive pts
Surgical: reattach muscle; long recovery time
A patient points to their AC joint saying that it is painful and x-ray findings show osteolysis of the distal clavicle. What is the tx?
Osteolysis of AC Joint
tx: inject lidocaine & steroid directly into AC joint. This is diagnositc
Definitive tx is distal clavicle resection
Most common organism found in septic olecranon bursitis and what do you treat it with?
Staph/MRSA
Tx w/ Doxy, Bactrim, Keflex
–> In unresponsive, aspirate and C&C to identify pathogen and specifically treat it
What is the best tx for trigger finger?
Steroid injections are most successful
Surgery is last option: done if pt fails two steroid injection treatments
Pt has a fixed flexed 4th finger with nodular thickening of the palmar fascial cords. Tx?
Surgical release
A pt w/ a positive finklestein’s test and pain in the anatomical snuff box has _____ and will be treated how?
DeQuervian’s Tendonitis
Thumb spica splint, NSAIDs, ice, rest
- -> If fails then steroid injection
- -> surgery if all else fails
Gold standard dx for Carpal Tunnel Syndrome
EMG
Cubital Tunnel Syndrome is compression of what nerve?
Ulnar Nerve
A _____ can occur w/ wooden splinter or minor cuts and is usually effected by staph/MRSA. Tx?
Felon
Tx: I&D w/ longitudinal incision that does not cross the DIP joint…pack w/ gauze and change q2-3 days…abx to cover staph
5 P’s of Acute Compartment Syndrome
Pain Pallor Paresthesia (early sign) Pulselessness (late sign) Paralysis (late sign)
What is a compartment pulse pressure in acute compartment syndrome and what is the tx?
> 30 mmHg
Surgical decompression via fasciotomy (opening of fascia)
An obese pt who wears tight fitted clothing comes in complaining of pain over the front of her thigh and upon exam has diminshed pin prick sensation. Dx? Tx?
Meralgia Paresthetica
Tx: wear loose clothing and lose weight
Cortisone if no improvement
Grade I-III MCL injuries
I: Little-no laxity (0-5mm), no ecchymosis, small amt of swelling
II: 5-10 mm laxity, delayed ecchymosis, swelling
III: >10 mm laxity, swelling and ecchymosis…pain w/ initial injury but resolves more quickly
When can a patient return to full activities/sports?
- No MCL tenderness w/ palpation or valgus stress
- No functional laxity
- Full ROM and ADL’s
- Normal endurance and good strength
Mechanism of Injury: ACL v. MCL
MCL: lateral or valgus stress often w/ a planted foot
ACL: hyperextended knee in IR or valgus force applied to an externally rotated knee w/ the foot planted…often pts feel a pop w/ ACL tear
Dashboard injury to knee
PCL tear
Gold standard imaging for meniscal injuries
MRI
+ McMurray’s sign and + Apley’s grind test w/ tenderness upon joint line palpation
Meniscal injury
A mensicus that is too big and not C-shaped is called ______ meniscus and is corrected with ______.
Discoid Meniscus
Corrected with arthroscopy
A female comes in complaining of achy anterior knee pain and it is especially worse when she goes down the stairs. Upon exam you notice she has a large Q angle, crepitus, + squeeze test and a + apprehension sign w/ lateral displacement of the patella. What do you suspect and what is your initial tx?
Patellofemoral Disorders
Conservative tx w/ knee brace or McConell taping technique
- Can do rehab to stregthen VMO and ham’s
- Avoid leg extension machines at gym
How do you reduce a patellar dislocation?
Flex the hip, lift the heel and extend the knee
Can you inject steroids in a pt diagnosed w/ patella tendinitis?
NOOOOOO!
Patella alta v. patella baja
Patella alta: patella tendon rupture
Patella baja: quadriceps tendon rupture
A pt comes in w/ a traumatic injury over the patella that is causing pain and tightness. You collect the fluid over the patella and r/o septic bursitis. What is your tx plan?
Conservative tx initially. If infection cover w/ 7-10 days of abx (cover staph…so Doxy/Bactrim) and if no improvement then aspirate fluid for C&C…if no infection give cortisone shot
What is the definitive tx of OA of the knee and what is the best x-ray view to get?
AP view standing
TKA is the definitive tx
Does a high ankle sprain need an x-ray?
Yes, to r/o fracture
Post-op care after a total hip arthroplasty
All pts get anticoagulation (warfarin) 2-6 weeks
Always abx prophyalxis w/ dental work
Rehab facility…maybe but not usually
MOI: Whiplash
First, acute hyperextension and then 2nd head recoils into flexion
If you expect a C1 fracture then what kind of imaging would you get?
Open mouth odontoid view xray
Odontoid fx and hangman’s fx are both fractures of what vertebrae?
C2
A fx of the pedicle of the axis resulting from hypextension is called….
Hangman’s Fracture
Types of cervical compression fractures (5)
Type I: Simple wedge fx; stable
Type II: “teardrop”, isolated anterior vertebral body fx w/ intact posterior elements
Type III: Posterior intact but bony fragments may be displaced into spinal meduallary canal resulting in neurological injury
Type IV&V: complex vertebral fx involving posterior elements
Most common type of kyphosis and the least common type of kyphosis?
MC: Postural Kyphosis
Least common: Congenital kyphosis
When do you image if a pt comes in w/ lower back pain?
50+ yo and < 20 yo Major trauma neuro deficiets weight loss/fever bowel dysfunction fx of CA, AAA, ectopic pregnancy
A shopping cart sign suggests
lumbar spinal stenosis
Bamboo spine appearance…what is tx
Ankylosing Spondylitis… tx: NSAIDs, DMARDs, anti-TNFs, refer to rheum and PT
Loss of bladder/bowel function and saddle anesthesia suggests _____ and needs to be tx how?
Cauda Equina Syndrome
tx: surgical decompression
