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
elbow issues
⦁ tennis elbow
wrist / hand issues
⦁ carpal tunnel
⦁ trigger finger
⦁ RA & joint deformities
⦁ OA - base of thumb
hip issues
⦁ arthritis
⦁ greater trochanter bursitis
knee issues
⦁ Meniscal injuries
⦁ Ligament injuries
⦁ Patello-femoral syndrome
⦁ Arthritis
ankle / foot issues
⦁ sprains
⦁ tendonitis
⦁ plantar fasciitis
⦁ bunions & neuromas
SYSTEMIC CONDITIONS WITH ORTHO INVOLVEMENT
- RA (rheumatoid arthritis)
- OA (osteoarthritis)
- Gout
- Infections
- Osteoporosis
Legg-Calve Perthes disease
In Perthes disease the blood supply to the growth plate of the bone at the end of the femur (called the epiphysis) becomes inadequate. As a result the bone softens and breaks down (a process called necrosis).
A condition causing asymmetrical head or neck position due to a problem in the neck muscles.
TORTICOLLIS
PEDIATRIC CONDITIONS - NEWBORNS
⦁ limb anomalies, club feet
⦁ congenital hip dysplasia
PEDIATRIC CONDITIONS - TODDLERS
⦁ septic hip
⦁ know knees, bow legs, flat feet, in-toeing, nurse maid’s elbow
PEDIATRIC CONDITIONS - CHILDREN
⦁ Perthe’s
⦁ calcaneal apophysitis (Sever’s)
⦁ torticollis
PEDIATRIC CONDITIONS - ADOLESCENTS
⦁ Overuse injuries , patellar dislocation, shin splints
⦁ slipped capital femoral epiphysis, snapping hip, crest apophysitis
⦁ back pain, scoliosis, kyphosis
SPORTS MEDICINE
o UPPER EXTREMITY
⦁ shoulder dislocations
⦁ throwing injuries: shoulder, elbow (UCL)
o LOWER EXTREMITY ⦁ ACL injuries ⦁ other knee injuries ⦁ ankle sprains (ligaments) ⦁ fractures
o OVERUSE INJURIES
⦁ shin splints
⦁ stress fractures
injuries
o MUSCLE INJURIES
⦁ overuse & tears (strain!)
⦁ bruises & hematomas
o LIGAMENT & TENDON
⦁ knee / ankle ligaments
⦁ elbow / AC injuries
o DISLOCATIONS
⦁ shoulder
⦁ fingers
o FRACTURES
⦁ spine
⦁ extremities
benign tumors that create bone
⦁ osteochondroma
⦁ osteoid osteoma
⦁ osteoblastoma
benign tumors that destroy or replace bone
⦁ unicameral bone cyst ⦁ giant cell tumor ⦁ aneurysmal bone cyst ⦁ non-ossifying fibroma ⦁ fibrous dysplasia ⦁ enchondroma - speckled appearance - reassure
PRIMARY BONE MALIGNANCIES
⦁ Multiple Myeloma
⦁ Osteosarcoma
⦁ Ewing’s
⦁ Chondrosarcoma
bone mets = 3rd most common site of mets after
lungs & liver
majority of skeletal mets comes from
prostate / breast cancer
bone mets most common in which bones
vertebrae pelvis ribs proximal femur proximal humerus
soft-tissue tumors
⦁ lipoma
⦁ myositis ossificans
⦁ heterotropic ossification
when to order an MRI
⦁ rarely the initial imaging of choice
⦁ back, knee, shoulder, tumors
