Intro to Orthopedics Flashcards
tenorrhaphy:
suture of a tendon / tendon grafts (plantaris /
palmaris longus)
Factors affecting healing:
- Vascularity
- Extent of injury
- Age
- Nutrition
- Comorbidities
- Stress
ligament grade II healing time:
3 weeks to 3 months
RESPECT NATURE, immobilization may be necessary sometimes. What may be some side effects from bed rest?
- Atrophy
- osteoporosis,
- thrombosis
- pressure sores
What diagnostic test is good for for identifying failing THR/TKR. (More bone formation to protect the prosthesis)?
Bone scan
Cancellous bone is less dense than cortical bone and thus appears_____ than the cortical bone on the radiograph
darker
Gold standart diagnostic test for pulmonary embolism?
Computed Tomography (CT scan)
left upper quadrant pain that begins as abdominal pain and radiates to mid-back (L2 region). Pain is sudden in onset and intensifies with time.
pancreatitis (high morbidity & mortality)
Inflammation of connective tissue under skin + fever, headache, nausea, redness around infected area:
cellulitis
Three infectious diseases:
- Acute Hematogenous Osteomyelitis (AHO)
- Septic Arthritis
- Cellulitis
Fasciotomy:
cut fascia
GI/GU (genitourinary) RED FLAGS:
- Abdominal pain,
- heartburn,
- nausea,
- vomiting,
- changes with bladder function,
- menstrual cycle
ligament graft healing time:
2 months to 2 years
What is the Dx of osteorthritis?
(diagnosis)
- Swelling,
- pain,
- crepitus,
- limited ROM,
- X- ray films,
- stiffness.
What is the Tx of cellulitis?
- rest,
- cleaning of wound if present
- and antibiotics.
- Rarely surgery
HISTORY AND PHYSICAL EXAM
2 main purposes
-Most important aspect of the healthcare provider/patient interaction
-Establishes a rapport with the patient
-History provides important clues that subsequently guides the clinical exam
What are the risks of surgery?
- Infection
- Fracture
- DVT/PE
- Anesthesia
- Arthritis
- Loss of reduction
- Nerve damage
Etiology of Acute Hematogenous Osteomyelitis:
- staphylococcus,
- streptococcus,
- pneumococcus
How strong is the link between tissue damage and
impairment and impairment and function?
Poor.
- Ex: some with massive knee destruction due to OA have little pain; whereas others with minimal OA have major pain
- Ex: spinal ROM is not correlated to overall function
CARDIOVASCULAR red flags:
- Shortness of breath,
- dizziness,
- chest pain,
- pulsating pain,
- swelling of the feet
- painful or discolored feet.
Which are the two most common laboratory tests in orthopedics?
What does a negative result of these test mean?
- C-reactive protein (levels rise in response to inflammation)
- Erythrocyte sedimentation rate (help detect inflammation)
- Negative result can usually rule out systemic origin (like lupus)
billateral swelling without injury in a 40 y/o female:
could be remauthoid arthritis
older person and unillateral: osteoarthritis
could also be the first sign of lupus.
Perceived pain is often at
a site distal or adjacent to injury site
What does a bone scan detects?
Osteoblastic activity
Other red flags:
- Fever or night sweats
- Severe emotional disturbances
- joint sweling wihtout injury
- pregnancy
Cardinal signs vertebral artery dysfunction (Stroke):
(5D’s, 3N’s)
- Dizziness
- Dysarthria
- Dysphagia
- Diplopia
- Drop attack
- Nystagmus
- Numbness
- Nausea
what is the Tx of osteoarthritis?
- Psychological support (loosing indepence?)
- Meds
- Splints/braces
- PT
- Surgery: osteotomy, arthroplasty, arthrodesis, mosaicplasty, microFx
Which diagnostic test is the gold standard for pulmonary embolism?
CT Scans
Treatment of DVT:
- Anti-coagulants
- NSAIDS
- Compression stockings, movement
Stress decreases healing?
yes
evaluation is the level of judgment necessary to make sense of the findings in order to identify a relationship between the
symptoms reported and the signs of disturbed function.
Ligamentous reconstruction:
use graft to make new ligament
Ex. ACL reconstruction
MRI is Predominantly used for what?
Shot tissue lesions:
- Rotator cuff tears
- Meniscal tears
- ACL tears
Degeneration of articular cartilage disease:
osteoarthritis, AKA degenerative joint disease
Tenolysis:
free tendon from scar tissue
What is smudging of the homunculus?
The homunculus for the painful region expands into adjacent regions
Neurological red flags:
- preoblems with hearing, swallowing, or speech
- severe headaches
- blurry vision
- problems with balance
- drop attacks
- sudden weakness
degenerative joint disease AKA
Osteoarthritis (OA)
Pain not altered by position or motion may come from where?
a visceral source
Tendinitis healing time:
3 to 7 weeks
Which infection can extend the periosteum causing elevation
Acute Hematogenous Osteomyelitis (AHO)
bone healing times:
5 weeks to 3 months
Complications of AHO:
- death
- abscess formation
- septic arthritis
- chronic osteomyelitis
- pathological Fx
Treatment of AHO
- Immediate Tx
- Antibiotics
- Rest, analgesics
- IV fluids
- Surgical decompression after 24 hr
- Antibacterial Tx for 3-4 weeks
Computed tomography (CT Scan) provides 3-D info that radiographs can not and is extremely useful for detecting which Fx?
- Tibial plateaus Fx
- Scapula fractures
- Ankle fractures
- Spine
MRI is useful for which bony lesions?
- Ostemyelitis
- Osteonecrosis
- Stress fractures (gold standart)
What is Septic Arthritis?
Tx?
- Cartilage destruction, capsule thinning
- Usually the result of osteomyelitis or surgery
- Tx: arthroscopy or arthrotomy and irrigation combined with drainage
Clinical and medical diagnosis of DVT:
- Clinically – Homan’s sign, Wells CPR
- Medically – Doppler, CT, Venogram
A Doppler ultrasound is a noninvasive test that can be used to estimate your blood flow through blood vessels
Tendon rupture healing time:
5 weeks to 6 months
Which imaging tool is good for identifying loos THR/TNR?
bone scan
Tenotomy:
tendon lengthening: cut tendon
MRI T1 weighted and T2 weighted are used for what?
- T1 for anatomy
- T2 for pathology
Gold standart diagnostic test for stress fractures:
MRI
CANCER red flags:
- night pain (constant)
- constant pain,
- weight loss,
- appetite loss,
- fatigue,
- history of Ca (single best predictor)
What is the sensitivity of Homan’s sign?
- 40%
- 60% chance of getting a false negative
What is the difference between ligamentous repair and ligamentous reconstruction?
- Ligamentous repair: suture ligament
- Ligamentous reconstruction: use graft to make new ligament
Do PT treat pts with cellullitis?
no, only after cellullitis resolves and have sweeling and decreased ROM
Redness, swelling, heat, pain, loss of function:
S & S of infection
Choose diagnostic tests (imaging studies) that are…
- Safe for the pt
- Cost effective
- diagnostic
tendon transfer:
move tendon
Ligamentous repair:
suture ligament
POSTOPERATIVE CARE:
- Distal neurologic and vascular exam
- Pain management
- Deep vein thrombosis/pulmonary embolus (check this)
- Immobilization/healing times (explain times)
Pathology of Acute Hematogenous Osteomyelitis:
- Infection spreads causing osteolysis, enters circulation (septicemia: malaise, anorexia, fever)
- When the infected area is within the synovium results to septic arthritis
Grade I ligament time:
4 days to 4 weeks
single best predictor of cancer?
a previous history of cancer
ligament grade III healing time:
5 weeks to 6 months
Osteoarthritis results from what? (why do you get OA?)
- overuse,
- injury,
- idiopathic (genetic)
- obesity,
- joint infections,
- congenital abnormalities,
- malalignment
The most common type of osteomyelitis, an infection of bone, that occurs in children?
acute hematogenous osteomyelitis.
Bed rest for low back pain?
“No, no” Dr. M
activity as tolerated is better than bed rest.
Most common form of inflammatory arthritis; polyarticular, symmetrical involvement:
Rheumatoid arthritis
Upper cervical spine is commonly involved in RA. Sometimes ca result in:
- brain stem compression
- Tx: protection during exacerbation, activity during remission, C1-C2 arthrodesis
RA - Pathology:
- Synovial membrane
- Pannus leads to cartilage necrosis
- Ankylosis
- Rheumatoid nodules
- Morning stiffness
- Joint effusion, deformity
Clinical features of RA:
- Pain, swelling, limited ROM , progressive deformities, loss of function
- Morning stiffness, stiffness with inactivity
- Generalized malaise and fatigue can be present at onset of disease
- Diagnosis based on at least 4/7 findings that continue 6 weeks (ARA)
- No laboratory study is diagnostic but 80% will have elevated Rh factors of
IgM IgG
Medical management of RA:
- NSAIDS: GI and renal complications
- Disease modifing RA drugs: prevent activation of inflammatory processs
- Glucosamine: safe
- Injections: cortisone, hyaluronic acid (improves synovial viscosity)
- Braces
Pain, swealing in the foot due to accumulation of uirc acid:
Gout
Gout leads to
osteoarthritis
