INTRODUCTION TO ORTHO Flashcards
ulnar collateral ligament injury = needs
TOMMY JOHN SURGERY
increased incidence of carpal tunnel syndrome with
DIABETES
CARPAL TUNNEL SYNDROME
- entrapment / compression of median nerve at the carpal tunnel
- increased incidence with DM***
- Paresthesias & pain of palmar first 3 and 1/2 of 4th digit - especially at night! - due to normal wrist flexion during sleep
- pain may radiate to neck, shoulder, chest
- Thenar muscle wasting is seen if advanced carpal tunnel syndrome
Increased pain = with repeated flexion / extension of wrist. Worse at night**
Decreased pain = when shaking hands
Diagnosis = Tinel’s & Phalen’s sign
Management = volar splint + NSAIDS. Steroid injections. May need surgery in refractory cases
CARPAL TUNNEL SYNDROME vs PRONATOR SYNDROME
- pronator syndrome = median nerve compression in the proximal forearm; may develop paresthesias in same distribution as carpal tunnel
- difference = pronator syndrome associated more with proximal forearm pain than wrist/hand pain
- pronator syndrome = NOT associated with pain at night
overall imaging with ortho
- plain XRAYs = starting point, and usually all that is needed
- CT scan = great for bony detail - can be 3D
- MRI = good for soft tissues, rotator cuff, knee ligaments
- bone scan = for tumors & fractures
LABS involved in ortho
- white count
- ESR
- CRP
- crystals
- cultures
NERVE DYSFUNCTION
may need EMG
if knee pain = always look at the
hip!
and vice versa
RED FLAGS
- fever
- weight loss
- loss of bowel / bladder control
- not improving as expected
FINISHING THE VISIT
FINISHING THE VISIT
⦁ Explain to the patient what you think is going on
⦁ Ask for questions - While seated and looking at the patient not hand on door knob
⦁ Have the patient summarize your thoughts
- What will happen next
- Testing and return visit
- Initial treatment and response
⦁ What to expect, when to worry
⦁ Be sure your note covers what to do on the next visit: Include personal detail
TREATMENT OPTIONS
- Reassurance
- Activities
- PT & OT
- Braces
- Medications
- Injections
- Surgery
neck issues
⦁ Degenerative disc disease
⦁ Nerve entrapment
⦁ Cord syndromes
low back issues
⦁ Muscle strain ⦁ Degenerative disc disease ⦁ Herniated disc ⦁ Spinal stenosis ⦁ Non-orthopedic conditions
mechanical low back pain
- 2nd most common reason for seeking medical care in US
- usually resolves in 2-4 weeks; rarely needs more than conservative treatment
- leading cause of disability in the US & worldwide
shoulder issues
⦁ rotator cuff tendonitis
⦁ AC joint arthritis
⦁ Glenohumeral arthrtitis
