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Ortho_rotation > General > Flashcards

General Flashcards

1
Q

What are some questions that should be asked when gathering history from an ortho visit?

A

What’s your profession? Should there be work restrictions? How much time till retirement? How long do you work every week? Is workers comp involved?

Describe the pain (type, where and when, deep or superficial, how often, aggravating and alleviating, was there an injury and when)

How’s therapy going? How far along are you in therapy? How many times per week?

Any numbness or tingling in the extremities?

What’s your hand/arm/leg dominance?

What made you come in today?

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2
Q

RC insertions include:

A

Supraspinatous = sup > post aspect of greater trochanter
Infraspinatous = post aspect of greater trochanter
Teres Minor = post aspect o greater trochanter (inf to infra)
Subscapularis = anterior aspect of lesser trochanter

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3
Q

How do you test the strength of the rotator cuff?

A

Supraspinatous = empty can test (pt abd to 90 deg at 60 deg, have pt resist as you push down)

Infraspinatous = external rotation (arm at side and elbow flexed at 90 deg, resist pt’s external rotation)

Subscap (sup) = hand on stomach (have pt resist you pushing AP on their elbow)
Subscap (inf) = hand on back (resist pt lifting off back)

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4
Q

What can arthritis in joints lead to?

A

Bone spurs

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5
Q

Who determines heart health prior to surgery?

A

PCP, assesses medical history (vascular and cardiac dx) and an ECG, if the patient has a cardiologist they may be contacted for final approval

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6
Q

What may cause a bone cyst?

A

Tendon rupture, the bone is no longer stressed at the insertion point allowing the bone to weaken, this makes that area of bone susceptible to an infiltration

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7
Q

What type of drugs should be avoided in orthopedic repair procedures?

A

NSAIDs

  • tNSAIDs (traditional, COX inh, reversible) = ibuprofen, Naproxen (Aleve), Diclofenac (Voltaren gel), Indomethacin
  • Coxibs (COX-2 specific inh) = Celecoxib
  • Salicylates = ASA (COX inh, irreversible)
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8
Q

Should slings be worn when sleeping?

A

Yes! This is a period where the body may move without conscious input, which endangers a non-secured healing shoulder or knee, etc.

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9
Q

A repaired tendon that looks very healthy is referred to as what?

A

“Native tendon”

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10
Q

What are the insertions of the biceps tendons?

A

Long head: inserts into the labrum surrounding the glenoid after passing through the intertubercular groove of the humerus

Short head: coracoid process of the scapula

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11
Q

What’s a duplex scan?

A

Painless ultrasound exam that captures images of the major arteries in the arms, legs, and neck

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12
Q

What is a popliteal cyst also called?

A

Baker’s Cyst

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13
Q

What’s dull/throbbing pain in the knee most likely? Painful?

A

Arthritis

Meniscal tear

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14
Q

What’s the most popular muscle relaxant prescribed?

A

Cyclobenzaprine (10mg) po TID PRN

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15
Q

What’s generally more effective in an orthopedic setting for NSAID delivery?

A

Gels > oral

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16
Q

What should be done with leftover opioids/narcotics?

A

Drop-offs at police stations

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17
Q

What is a physician always looking to achieve?

A

Standard of care

Ex: the standard of care is that you have a better knee brace

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18
Q

What disease state can cause someone to not get bone surgery?

A

Osteoporosis

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19
Q

If a shoulder is crunchy it’s? If a shoulder isn’t crunchy it’s?

A

Arthritis

Adhesive capsulitis (Frozen shoulder)

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20
Q

What is the goal of therapy in some cases?

A

To reduce the swelling of a joint

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21
Q

How long after a work-related injury can a person re-open a case for surgery? What’s the risk?

A

7 years

Risk is that a work-related injury may receive more push-back the longer out someone chooses to address it

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22
Q

What does lateral pain usually indicate?

A

A meniscal tear

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23
Q

What should a physician always be considering?

A

I’d like to be responsible with both your money and time

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24
Q

What’s a treatment that can restore the lubrication within the knee? What is it? Is it a permanent fix? What’s it treat?

A

Orthovasc, synthetic lubricant injection that can decrease pain d/t friction, 3 injections one every week for 3 weeks

Not a permanent fix, buys time till knee replacement
- replacing the engine oil

DJD treatment

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25
Q

What are the 4 xray views for knees? Shoulders?

A

Knee: standard AP (PA pref for chest xrays), lateral, Rosenberg (good for looking at joint lines), sunrise

Shoulder: GH-AP, xanca (for AC joint), outlet (shape of acromion/Bagliani classification), axillary (AC joint)

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26
Q

When is it too late for a tendon repair?

A

When there’s no tendon left to work with, must do surgery while tissue is still present

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27
Q

What causes tendonopathy?

A

Poor blood supply causing holes to form and generalized tissue breakdown

DM, smoking, other disease states that damage the microvasculature

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28
Q

Pain in the front means what? Lateral? Shoulder?

A

Front = biceps, labrum, adhesive capsulitis

Lateral = rotator cuff

Shoulder/neck? Probably involves the c-spine (especially if there’s tingling or weakness)

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29
Q

What pain must always be a consideration if no etiology is found?

A

Pain resulting from psychiatric complications, conversion disorder

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30
Q

90% of shoulder external rotation d/t?

A

Infraspinatous

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31
Q

45% of shoulder abduction d/t?

A

Supraspinatous

32
Q

What is chondromalacia?

A

Damage to the cartilage underneath the kneecap

33
Q

What is the primary component of articular cartilage?

A

Water

34
Q

What space does the supraspinatous sit in/origin?

A

Supraspinous fossa

35
Q

What are the 4 types of collagen and what do they make?

A

Type 1: bone, skin, tendons, organ, nails, hair
Type 2: cartilage
Type 3: vasculature
Type 4: basement membane

36
Q

What are the 3 shoulder spaces?

A

Glenohumeral joint space
Subacromial space
AC joint

37
Q

What is tendinosis?

A

Degeneration of the tendon

38
Q

What are sutures made of?

A

Ultra high molecular weight polyethylene

39
Q

Can you use NSAIDs for revisions?

A

Yes, just not repairs

40
Q

What’s the anterior vasculature to avoid when establishing an anterior-mid glenoid portal?

A

Cephalic v

41
Q

What’s the nerve in danger during inferior frozen shoulder/adhesive capsulitis release?

A

Axillary n

  • C5/6
  • 4 and 8 o’clock
42
Q

What does cartilage damage look like on imaging?

A

White amidst a grey border, fluid filling that space is more dense than the cartilage

43
Q

Arthritis behind the patella is called what? What are the grades?

A

Chondromalacia

Grade 1-4

  • 1: cartilage is soft
  • 2: cartilage is fissured slightly
  • 3: cartilage is fissured greatly
  • 4: little to no cartilage present
44
Q

What’s a radiculopathy?

A

Disease of the root of a nerve (pinched or d/t mass effect)

45
Q

What type of strength does the long head of the biceps provide?

A

Screwing-type motion

46
Q

What muscles are the primary elbow flexors?

A

Short head of the biceps, brachialis

47
Q

What muscles are the primary wrist supinators?

A

Short head of the biceps, brachialis, supinator

48
Q

What’s the older treatment for a SLAP tear?

A

Tenotomy, tenodesis is new

49
Q

What nerve is in danger of being injured in shoulder dislocations? What’s the PE finding with it?

A

Axillary n

The ipsilateral deltoid muscle lacks tone d/t irritated axillary n that won’t fire

50
Q

What does a complex fracture pattern require?

A

A trauma specialis

51
Q

What does cortisone do to tissues?

A

Kills them

52
Q

Is therapy standard or individualized?

A

Individualized, nothing that can be explained in less than 15 minutes

53
Q

How can age be reflected in tendon health?

A

As a person ages, their blood supply (microvasculature especially) diminishes causing weakened tendons

54
Q

What does a palm-up examination of the shoulder test? What’s it called?

A

Speeds test, biceps strength

55
Q

Can folks get “goose egg” bumps on the tibial tuberosity?

A

Yes

56
Q

What findings are relayed in an x-ray report?

A

GHJ normal? Spacing

Any arthritis?

57
Q

What two activities can relieve back pain?

A

Quite smoking

Exercise

58
Q

Why is the empty can performed the way it is?

A

Internal rotation (thumbs down) removes the middle deltoid muscle from the abduction equation; the supraspinatous is singled out

59
Q

What’s thicker bone of the radius, dorsal or ventral?

A

Ventral

60
Q

What’s the benefit of topical NSAIDs versus oral? Drawback?

A

No GI distress

Insurance may not cover

61
Q

What’s the difference between tennis elbow and golfer’s elbow? What’s the tx?

A

Tennis is lateral elbow pain, associated with extension

Golfer’s elbow is medial, associated with flexion

“el mofo”, extension lateral, medial flexion

Tx: betamethasone + lidocaine inj, PT

62
Q

What is Meloxicam?

A

Oral anti-inflammatory

  • NSAID
  • not generic, MOA may be different from other NSAIDs
63
Q

What type of cast can be locked? What are other features of it?

A

EXOS cast

  • must be heated to soften it and allow for form fitting
  • comes with key for cast lock
64
Q

What’s the healing process for soft tissue injuries?

A

Can be long process, takes a while for them to calm down, bones heal faster

65
Q

Describe presentation and cause of a Trigger Finger.

A

Finger snaps to flexion as tendon gets caught in the tunnel across the metacarpals (between the superficial transverse and deep transverse metacarpal ligs)

66
Q

What straps are used to keep fingers stabilized? What clinical scenario is this associated with?

A

Buddy straps

Base of the phalanx is weak next to the growth plates, fractures common there in kids

67
Q

What is os acromiale?

A

Acromion process fails to fuse properly on scapula, and the unused piece can impinge the rotator cuff, often bilateral

  • PA: pre-acromion
  • MSA: meso-acromion
  • MTA: metaacromion
68
Q

Subscapularis muscle is innervated by what?

A

Upper and lower subscapular n

69
Q

Where does the long head of the biceps insert?

A

Superglenoid tubercle and superior aspect of the labrum

70
Q

What’s the first space entered in arthroscopic surgery?

A

GH joint, anterior-mid glenoid portal

71
Q

What are the branches of the axillary artery?

A 
Have -- high thoracic
That -- thoraco-acromial (acromial, deltoid, pectoral, clavicular)
Lady -- lateral thoracic
Suck -- subscap
Penis -- post-ant circumflex
72
Q

What does KISS stand for?

A

Keep it simple stupid

73
Q

What are the dangers/risks of having a patient sit during arthroscopic surgery vs lateral recumbent?

A

Vertebral a can be stretched and compressed with head positioning which can lead to blindness d/t occipital lobe blood starvation, sitting patient must also work against gravity to provide adequate blood pressure to the head (not so if pt is in LR)

74
Q

What ligament is a concern during a mumford procedure?

A

Coracoclavicular ligament tear which causes an iatrogenic shoulder separation

75
Q

What space through the anterior-mid glenoid portal is the target for instrument insertion?

A

Rotator interval, triangular space between the tendons of subscapularis and supraspinatus and base of coracoid process

76
Q

What’s the Bigliani classification of acromion morphology?

A

Flat (12%)
Curved (56%): parallel to humeral head
Hooked (29%): ant portion of acromion is hooked, associated w/ inc incidence of shoulder impingement
Convex (3%)

Ortho_rotation (5 decks)

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