Module 3 Musculoskeletal Flashcards
Torticollis
-chin rotates to opposite side of spasm while the head tilts toward the spasm
-SCM muscle has been damaged or there is underlying disease process
-TX: Passive stretching
TX torticollis
Passive stretching
Congenital deformities
-more common in upper or lower limbs?
-what else is more likely?
-TX
-upper
-other congenital problems
-Prosthetics: early fitting is key
For prosthetics, when are lower limbs typically fitted? (at what age)
12 months
For prosthetics, when are upper limbs typically fitted? (at what age)
mitten type as young as 6 months
Metatarsus adductus:
-type of deformity
-how to correct deformity
-congenital foot deformity: inward deviation of forefoot
-often resolves spontaneously; serial casting along with stretching
Talipes equinovarus
-definition
-more common in boys or girls?
-highly______________.
-TX
-Clubfoot
-boys
-idiopathic, NEUROGENIC or related to arthrogryposis or Larsen syndrome
-Ponseti technique
what is the ponseti technique?
-used to treat talipes equinovarus (clubfoot)
-manipulation and stretching of the foot/tissue
-serial casting
-once a week for at least 6-8 weeks
Night brace is required for long term management
what hip is it more common to have development dysplasia of the hip?
LEFT
why does developmental dysplasia of the hip occur?
Femur and acetabulum are underdeveloped
How do you diagnose developmental dysplasia of the hip?
-ortolani sign
-barlow sign
ortolani sign
Lie infants supine
-using gentle pressure, life the greater trochanter forward A(BDUCT)
–> does the femoral head slip?
barlow sign
=adduct the medial side of the thigh
Listen for a “clunk” as the femoral head “pops” out of the joint
how is hip dysplasia diagnosed? (what method?)
US if under 6 weeks old
Plain films if 6 weeks or older
treatment of congenital hip dysplasia
pavlik harness: places hip in flexed, abduct position
-used within first 4 months of life
can do surgery
slipped capital femoral epiphysis
-emergency or no?
-age group
-more common in males or females?
-what is this associated with?
-emergency!
-11-16years
-males > females
-rapid growth (slow insidious onset)
slipped capital femoral epiphysis
-how does patient present (S/S)?
-Present with groin, thigh, or knee pain/often accompanied by limp
-Pain with ROM; limited internal rotation; obligatory external rotation when hip is flexed
slipped capital femoral epiphysis
-allowed to weight bear?
NO! No weight bearing period!!!! Immediate ORTHO eval!
what can happen if hip dysplasia not addressed/fixed?
permanent painless limp if not corrected by age 5yrs
Marfan syndrome
-what type of tissue disorder?
-common abnormalities
-
-connective tissue disorder
-arachnodactyly (long fingers/toes), hypermobility of joints, enlarged hands/very tall/flat feet; scoliosis, cardiac involvement (thoracic aortic aneurysm; mitral/aortic valve disorders)
what common cardiac disorder is present in Marfan’s syndrome?
thoracic aortic aneurysm
aortic and mitral valve disorders
treatment for Marfan’s syndrome
-screen for cardiac abnormalities
-Symptomatic tx (scoliosis, flat foot, pain management)
Gigantism
-stagnant, accelerated, or linear growth pattern?
-definition
-linear
-the excess growth hormone production occurs BEFORE puberty
In gigantism, when does excess growth hormone production occur?
BEFORE puberty
Scoliosis
-definition
-age
-more common in males or females?
-lateral curvature of spine
-occurs at any age
-more common in females
Scoliosis
-Adam’s Forward Bend Test
-familial?
-at what degree of scoliosis do you use brace?
-does surgery correct problem?
-Look at shoulder and hip heights while standing
-YES, familial
->45 degrees
-it can help: rods, screws, hooks; physically repositions spine; spinal fusion
Genu Varum
-def
-when is it normal?
bowlegged
-infancy to about 3 years
Genu Valgum
-when is it normal?
-causes
Knock knee
-up to 8 years old
-skeletal dysplasia (dwarfism), rickets
Flat footed
-normal or abnormal?
-resolves with or without tx?
-TX
-normal in infants
-most often will spontaneously resolve
-arch support and inserts
Degenerative problems: Acute bursitis
-common in adults or children?
-how to dx
-adults
-must rule out other issues first (injury, infection, inflammatory)
Cavus foot
-low or high arch?
-idiopathic or hereditary?
-definition
-high
-hereditary
-claw toe deformity
Hallus valgus (bunions)
-common or not?
-idiopathic or genetic?
-tx
-common
-genetic
-surgery (only due to high recurrence rate)
Degenerative problems: arthritis
-when can this develop?
-may develop in late adolescence (more adulthood) after infection, trauma, avascular necrosis, or hemathroses
Degenerative problems: tenosynovitis
-where is this most common (what body parts?)?
-TX
-knees and feet
-tx with rest; limit NSAIDS
Sprain
ligament
strain
muscle or tendon
Ligaments connect:
bone to bone (sprain)
Tendons connect:
muscle to bone (strain)
Inversion ankle sprain
more common; injury to lateral ligament
Eversion ankle sprain
medial ligament
are collateral and cruciate ligaments common in children?
NO
Nursemaid’s elbow
-population
-presents with:
-painful?
-how is this fixed?
-XRAYs normal?
-infants
-“elbow will not bend”
-YES
-can be reduced in ED
-Yes, normal
Patellar dislocation
-medial or lateral dislocation?
-painful?
-how to resolve
-lateral dislocation
-severe pain
-can be reduced
Fractures: epiphyseal fracture
-definition
-DX
-TX
-open vs closed reduction
-separation rather than a true fracture
-XRAYs are indicated
-Reduction
-open; elbow; closed: shoulder, wrist, fingers, and lower extremities
torus fracture
-def
-what commonly occurs to obtain this injury
-TX
-repeat DX testing?
-“buckling” or the cortex due to compression of the affected bone; protuberance of swelling
-Falling onto outstretched hand
-wear soft bandage or short cast for 3 weeks or so
-reXRAY to see if splinting needs to continue or if fracture has resolved
Greenstick fracture
-Def
-how to reduce fracture
-TX
-one side is obviously broken while opposite side is intact
-putting into normal alignment
-Snug fitting cast; repeat XRAYS 7-10 days
Greenstick fractures: what is an important consideration when determining if therapy will work?
the distance from the growing end of the bone (growth plate) is a major consideration when determining if therapy will work
how do you know if greentsick fracture is fixed?
-no tenderness at site
-bony callus on film(s)
clavicular fractures
-common or uncommon?
-TX
-common
-treatment through immobilization –> put arm in sling
supracondylar fractures of the humerus
-common in children or adults?
-what is this break commonly close to (close proximity with)?
-TX
-children
-brachial artery –> always check for brachial and radial pulses
-closed reduction with pinning is usual tx
Nursemaid’s elbow
-common in families?
-yes
Hip fractures:
-where is pain?
-most commonly occurs due to?
-how quickly does surgery take place?
-groin, may radiate to the lateral hip, buttock, or knee
-fall
-within 24 hours
Hip fracture:
-can patient bear weight?
NO
Hip fracture: stress fracture
-displaced?
-tx
-non-displaced
-may require surgery; rest
Hip fracture
-which treatment is very common?
-hemiarthroplasty or total hip replacement
Hip fracture: peritrochanteric hip fracture
-type of reduction
open reduction internal fixation
is open or closed reduction more common in children?
closed reduction
is open or closed reduction more common in adults?
open reduction
Osteomyelitis:
-where does it usually start?
-where does it usually move into?
-typically preceded by what?
-upper or lower extremities more commonly effected?
-spongy or medullary bone
-compact or cortical bone
-some type of trauma
-lower extremity
Osteomyelitis
-What is the most common pathogen?
-how to clean wound
-staph, then strep and pseudomonas
-debride when necessary and often
Osteomyelitis: SX
pain with movement, soft tissue swelling, elevated ESR and CRP, WBC count may be normal or slightly elevated in infants
-ESR >50mm/hr typically
Osteomyelitis:
-is ESR elevated?
-is CRP elevated?
-are WBC elevated?
-yes, elevated
-yes, elevated
-normal or slightly elevated in infants
Osteomyelitis: DX
-Culture ASAP
-Bone scans may be indeterminant
Osteomyelitis: TX
-broad spectrum antibiotics initially then change based on culture results
-IV antibiotics first; transition to oral antibiotics when acute sx decrease
-course of tx is 4-6 weeks, may even be 3 months (use probiotic)
Osteomyelitis: how long will patient be on antibiotics?
4-6 weeks, sometimes 3 months
Legg-Calve-Perthes Disease
-def
-ages with highest incidence
-sx
-necrosis due to lack of blood flow to proximal femur
-4-8yrs
-persistent pain, limp or limited movement of affected leg
Legg-Calve-Perthes Disease
-DX
-lab values normal
-XRAY: serial film needed to distinguish between inflammation, infection, dysplasia, synovitis, and necrosis
Legg-Calve-Perthes Disease
-are lab values normal or abnormal? If abnormal, which ones?
Lab values are normal.
Legg-Calve-Perthes Disease
-occur in females or males more often?
-unilateral or bilateral?
-TX
-males
-unilateral
-rest, minimize trauma/work/use
Sports Medicine
-at what age can strength training begin?
-what Tanner stage must patient meet before moving to maximum weightlifting or powerlifting?
-7-8
-Tanner stage V
What is the fitness goal for any individual (how much time a day)?
60 minutes
Sports physicals: PRICE
protect from further injury
rest injured area
Ice
Compression
Elevate immediately
TX for sports injuries
NSAIDS, PT/OT, cold/heat/massage/electrical stimulation/hydrotherapy/iontrophoresis, US
Common sports injuries and how soon you can participate: infectious disease
-bacterial dermatoses (impetigo, furuncles, cellulitis, folliculitis, abscesses)
no new lesions for 48hr, no moist or draining lesions, completed abx for at least 72 hrs
Common sports injuries and how soon you can participate: infectious disease
-MRSA
No new lesions for 48hrs, no moist or draining lesions, has been on oral abx for at least 72hr
Common sports injuries and how soon you can participate: infectious disease
-herpes
Free of systemic sx, no new lesions for 72hr, oral antiviral tx for 120hr
Common sports injuries and how soon you can participate: infectious disease
-diarrhea, infectious
No participation
Common sports injuries and how soon you can participate: infectious disease
-fever
no participation
Common sports injuries and how soon you can participate: infectious disease
-hepatitis, infectious
May participate if health allows
Common sports injuries and how soon you can participate: infectious disease
-HIV
may participate if health allows
Common sports injuries and how soon you can participate: infectious disease
-warts
appropriate covering for participation
Common sports injuries and how soon you can participate: infectious disease
-molloscum contagiousum
appropriate covering for participation
Common sports injuries and how soon you can participate: infectious disease
-strep pharyngitis
Resume activity once tx has been provided for 24h + afebrile
Common sports injuries and how soon you can participate: infectious disease
-URI
as tolerated, afebrile, “neck check”
Common sports injuries and how soon you can participate: infectious disease
-COVID
14 days quarantine + 72 hr without sx
Concussions
-how long does it take to resolve?
7-10 days
Concussion
-management/follow-up (6 step process)
- no sx at rest for 24 hours
- light aerobic exercise
- sport specific exercise
- non contact drills
- contact practice drills
- release
Concussion
-if S/S recur at any stage, what should be done?
rest for 24 hours and drop back a step
Atlantoaxial instability
-what population is this most common?
-where is there increased mobility
-children with down’s syndrome
-increased mobility at C1 and C2
Atlantoaxial instability
-when is a child restricted from sport in regards to C1 and C2?
any child with score of >4.5mm between C1 and C2 must be restricted from sports that are at risk for contact or collision activities and from sports that require significant neck flexion/extension
cervicalgia (neck pain)
-cause
-test used to determine dx
-tx
-poor posture, whiplash, degenerative joint disease, radiculopathy is usually triggered from C5-C7 involvement
-Spurling test
-stretching, NSAIDs, therapy, muscle relaxers (short term), massage, chiropractic treatments, cervical traction
-what disease process if the spurling test used for?
-how is the test conducted?
-cervicalgia (neck pain) –> assesses for pinched nerve
-hyperextend the neck and move it laterally to the affected side; apply gentle pressure to axial load. If radiculopathy is reproducible = + test
*The patient rotates their head to the affected side
The patient extends their neck
The examiner applies downward pressure to the top of the patient’s head
Burners and stingers
-where do sx occur?
-unilateral or bilateral?
-duration is long or short?
-tx
-prevention
-on same side as injury
-unilateral
-short
-remove from play and observe; if repetitive burners/stingers in single day or season, consider restricting for rest of the day
-proper fitting gear, appropriate clothing, and use proper technique for sports activity
what is a positive spurling test?
if limb pain or paresthesias are produced = positive
if production of neck pain alone in response to test without specific features = negative
Burners and stingers
-is this pain bilateral or unilateral?
unilateral
Spondylolysis:
-definition (where is injury? what causes pain?)
-common among what people?
-does bracing help?
-injury to pars interarticularis; presents as pain with low back extension
-those with repetitive overload (gymnasts, wrestlers, dancers, divers, trampolines)
-may help, but no change outcome in studies
Spondylolysis:
-what should these patients avoid?
-when can patient return to sports?
-avoid hyperextension of back and high impact sports
-when asymptomatic
Spondylolisthesis
-def
-what causes back pain?
-tx
-bilateral pars injury with vertebral slippage
-back pain with extension
-treat sx; brace may help (may help to strengthen spine)
**if surgery is required, cannot return to sports activity for at least one year
Spondylolisthesis
-what is the shape of the back?
hyperlordosis
Low back pain
-what should be considered if leg pain is greater than back pain?
-interventions for relief
-what things should be checked in assessment?
-consider nerve root impingement
-Nothing, Rest, Antiinflammatories
-motor strength and DTR
Low back pain: cauda equina syndrome
-sx
-emergency or nonemergency?
-bowel or bladder sx; “saddle anesthesia,” loss of anal sphincter tone or incontinence, LE weakness
-EMERGENCY
Low back pain: what is concerning for malignant process?
-weight loss, severe pain for >6 weeks, nocturnal or pain at rest
**refer URGENTLY!
Spinal stenosis
-def
-worse with what action?
-most common in what population?
-TX
-narrowing of the spinal canal; may be due to large herniation with compression
-worse with extension
-older patients (typically) > 50yrs
-Epidurals, stretching; surgery but can come back after surgery (spinal decompression, nerve root decompression)
Disc herniation
-sx
-what part of spine is typically affected?
-what test is used to diagnose?
-back pain that is exacerbated by flexion and sitting; may have radiculopathy (greater in adults)
-typically L4-L5 and L5-S1
-Will have a positive straight leg lift test
Disc herniation
-TX
conservative tx: rest, PT
-if still persistent sx, brief steroid taper
-surgery for those with failed conservative tx and have impaired quality of life/progressive neurological deficits
Spinal stenosis vs lumbar herniated disc
-when does pain increase?
-Spinal stenosis: increases when lower back is straightened
-Lumbar herniated disc: increases when lower back is bent
Spinal stenosis vs lumbar herniated disc
-sx
-Spinal stenosis: lower back pain, tightness of hip and legs
-Lumbar herniated disc: lower back pain, numbness of legs
Spinal stenosis vs lumbar herniated disc
-when does pain decrease?
-Spinal stenosis: when seated
-Lumbar herniated disc: when lying down
Spinal stenosis vs lumbar herniated disc
-what aggrevates?
-Spinal stenosis: numbness of legs after long walking
-Lumbar herniated disc: pain increases in movement
What is a straight leg test used to dx?
disc herniation
Acromioclavicular separation
-def
-test used to confirm (and how test is completed)
-tx
-tenderness and edema at AC joint
-cross arm test: elevate arm to 90 degrees of flexion and then at maximum horizontal adduction, a positive test will produce pain on top of shoulder near AC joint
-rest, support, immobilization (1-6 weeks) and rehab
fractured humerus
-sx
-what other things should you assess for damage?
-tx (for how long)
-severe pain and swelling in proximal humerus; may have obvious deformity
-assess brachial plexus as well as radial nerves for any damage
-sling for 6-8 weeks; rehab with strengthening of muscle and extension
Acute traumatic anterior shoulder instability
-def
-sx
-tx
-anterior shoulder dislocation/subluxation
-severe shoulder pain, abducted and externally rotated arm –> “squared off” appearance (box of wine story)
-immediate reduction in ED or OR
Rotator cuff injury
-acute or chronic?
-what age is this common in?
-sx (what exacerbates it)
-tx
-acute OR chronic
-over age 40 yrs
-night pain if common in adults; pain is anterior, lateral, or diffuse; exacerbated by overhead activities and posterior reach
-PRICE, surgery, REHAB is very IMPORTANT!!
Adhesive capsulitis
-other name for this disorder
-phases
-“frozen shoulder”
1. inflammatory phase: 4-6 months; painful shoulder without findings of trauma
2. freezing phase: 4-6 months; shoulder is stiff, pain may decrease but ROM limited
3. thawing phase: may last a year as movement gradually returns
Adhesive capsulitis
-common age
-men vs women
-what elicits pain?
-when to refer?
-40-65yrs
-women > men (perimenopausal, diabetes, thyroid disorders (hyper or hypo)
-external rotation of elbow while at side
-when not responding to rest in 6 months or if ROM declines after 3 months (surgical manipulation under anesthesia or arthroscopic release may be needed)
Lateral epicondylitis
-def
-what exacerbates?
-TX
-tendinopathy of lateral epicondyle
-wrist extension
-NSAIDS, rest from repetitive movements, stretching/strengthening of forearm muscles; forearm brace
Olecranon bursitis
-def (trigger)
-sx
-tx
-inflammation of olecranon bursa (triggered by repetitive trauma)
-hot, red, inflamed, painful
-NSAIDS, possibly injections, stop offending habit
osteoarthritis
-systemic S/S?
-inflammation?
-how is pain relieved?
-when is pain most commonly felt?
-no
-minimal
-relieved with rest
-brief morning stiffness followed by improvement in S/S
osteoarthritis
-primary sites
-secondary sites
-Weight bearing joints
*DIP (Heberden nodes) and PIP (Bouchard nodes) of fingers, carpometacarpal joint of thumb
–> nodules that stick out; no swan neck or curved fingers)
*Metatarsophalangeal (MTP) joint of great toe (think GOUT!)
*cervical and lumbar spine
-any joint after intra or extra-articular injury
osteoarthritis
-TX
-assistive devices
-exercise
-medication: acetaminophen 3g/24hr; NSAIDS, Cox-1 and Cox-2 inhibitors, topical treatments; intra-articular injections (triamcinolone up to 4x yearly)
osteoarthritis
-are steroid injections recommended for hands?
no
osteoarthritis
-surgical intervention
-Arthroscopic surgery (not helpful for OA in knees)
-total hip
-total knee
osteoarthritis
-after surgical intervention, what is important for the patient to do?
REHAB
Carpal tunnel syndrome-
-sx
-when are sx worse?
-where are sx worse?
-what causes sx to worsen?
-pain, burning, and tingling along medial nerve
-worse at night (sleeping)
-first 3 digits (thumb, first and second fingers)
-repetitive activities
Carpal Tunnel Syndrome
-TX
Splint for 3 months, NSAIDS
-steroids provide temporary relief
-decompressive surgery resolves the issue
Phalen test
-compress backs of both hands against each other so that the wrists are flexed a full 90 degrees
-carpal tunnel syndrome suspected if maneuver reproduces patient’s sx and causes aching or tingling in the distribution of the median nerve within a minute
-positive test: eliciting tingling and numbness in hands
Tinel Test
-light percussion or tapping over medial nerve at the flexor retinaculum elicits a tingling sensation (“pins and needles”) in the distribution of the nerve
Carpal Compression Testing (Durkans Test)
-Apply direct pressure with thumb on carpal tunnel for 1 min
-positive test: paresthesia in median nerve distribution
Dupuytren’s Contracture
-def
-idiopathic or genetic?
-common in what population?
-what digits are most commonly affected?
-hyperplasia of the palmar fascia; nodule formation = contracture
-genetic
-Caucasian males over age 50 years
-4th and 5th digits
Dupuytren contracture
-stages
-tx
- nodule
- fibrous cord cross metacarpophalangeal (MCP) joint –> leads to contracture at MCP
- fibrous cord cross proximal interphalangeal (PIP) joint –> leads to contracture at MCP and PIP (flexion of digit)
-splint, stretching; injections (triamcinolone or callagenase ie Xiaflex); surgery
Xiaflex
medication - collagenase clostridium histolyticum - used via injection to help relieve dupuytren contracture
Hamstring strain
-require surgery?
-cause
-TX
-NO
-created by forced extension of knee or abrupt directional change; pain upon tearing/popping sensation in posterior leg; resists knee extension on exam due to pain (won’t extend knee d/t pain)
-ice, compression ASAP; get up and moving as soon as patient can tolerate and rehab by gentle stretching
IT band syndrome (illiotibial band syndrome)
-where is pain located?
-what population is this injury most common?
-def
-over lateral knee or hip
-associated with runners
-inflammation of the trochanger bursa and IT band
IT band syndrome
-what test is used to dx?
-tx
-Ober test: side lying position, abduct straightened leg up and backwards; then move leg down –> if leg stays in air and does not fall to table = positive
-change activity that caused problem; stretching program; massage; steroid injections
Osgood-schlatter disease
-cause (exacerbated by?)
-common in what population?
-location of pain?
-tx
-activity related anterior knee pain; exacerbated by running and jumping
-boys 12-15yrs; girls 11-13yrs
-localized to the tibial tubercle
-spontaneous correction when skeletal maturity is met; stretching, ice, and PT may be helpful
Meniscal injuries
-common or uncommon?
-patient presents with what sx?
-what triggers discomfort?
-common
-“locked” or “my knee gave out”
-Triggered by abrupt directional change
McMurray test
-what is this test used to dx?
-how is it used?
-Meniscal injuries
-laying supine, move knee from flexion to extension; laterally rotate tibia (medial aspect) –> positive test = pain, clicking, popping (tests lateral and medial meniscus)
Medial collateral ligament
-sx
-dx
-tx
-tenderness along medial collateral ligament
-“pop” or loss of sensation + mild effusion develops; valgus stress test: abduct hip and flex knee proximally 30 degrees to remove the affected joint capsule on medial knee stability; with one hand, cup underneath the lateral aspect of the ankle, then with your distal hand, create a valgus stress on the medial compartment assessing for integrity of the ligament
-ICE asap, brace
Lateral collateral ligament
-sx
-dx
-tx
-tenderness along lateral collateral ligament
-“pop” or loss of sensation + mild effusion develops; varus stress test: abduct hip and flex the knee to 30 degrees; with one hand medially and the other hand around the ankle on posterior aspect, provide varus stress on knee and assess for ligament laxity compared to other side
-ICE asap, brace
Anterior cruciate ligament injury
-cause
-sx
-test used for dx
-tx
-not usually due to contact; abrupt deceleration, twisting, and/or cutting motion; knee hyperextention can cause injury
-“pop”, pain, swelling, knee giving way
-Lachman Test
-surgery + PT
Lachman Test
-used to dx ACL tear
1. Patient should be lying supine and completely relaxed
2. Make sure that pt’s hip muscles, quadriceps, and hamstring muscles are all relaxed
3. Bend the knee to about 20-30 degrees
4. Stabilize the femur with one hand and with the other hand, pull the tibia anteriorly and posteriorly against the femur
5. Examiner should feel a firm end point
6. With a rupture, the ACL will be lax and the examination will feel softer with no end point
7. The tibia can be pulled forward more than normal (anterior translation)
-Lachman’s test is the best examination test to diagnose a tear in the ACL
Posterior Cruciate Ligament Injury
-sx
-when is pain increased?
-cause
-dx test
-tx
-pain and edema
-increased pain with knee flexion
-may have fallen with knee flexed and ankle in plantar flexion
-Posterior drawer test
-usually nonsurgical unless bony avulsions of PCL from femur or tibia
Posterior drawer test
-what does this test help dx?
-how is this test performed?
-PCL injury/tear
-supine with knee flexed approx 90 degrees; examiner sits on foot of patient with both thumbs over anterior joint line and fingers over back of upper tibia (feel for relaxed hamstrings); give posterior force on upper tibia to assess abnormal backward movement
*positive test if posterior displacement of tibia more than 5mm, or “soft” end point
Baker’s Cyst
-location of pain
-sx
-when is pain worse?
-dx
-semimembranosus gastrocnemius bursae; fluid filled cyst in posterior popliteal region
-painful, “tight” - may be edematous in area, UNILATERAL EDEMA; can mimic DVT if bursts
-worse with standing, flexing, extending knee
-ultrasound
Is a Baker’s cyst unilateral or bilateral edema?
UNILATERAL!
What can a ruptured Baker’s cyst mimic?
DVT
Ottawa Rules for Ordering XRAYS
Malleolar area/midfoot area with tenderness at point A/B and can’t bear weight = just one has to be positive to get ankle XRAY
-Don’t use on everybody
>=2yrs old with ankle or midfoot tenderness in the setting of trauma
Ankle Sprain
-cause
-sx
-typically lateral or medial?
-when are films warranted?
-tx
-inversion or plantar flexion
-swelling and pain over ligament, bruising
-typically lateral than medial
-if medial ankle edema noted, films are warranted
-immediate ortho referral; compression, ice, elevation, NSAIDS, BRACE
Plantar fasciitis
-sx (when is it worse)
-population this is common among?
-if untreated, how long can sx last?
-tx
-heel pain worse when standing and taking first few steps
-runners who average more than 30 miles a week, flat feet, overweight
-12-18 months
-massage, stretching, NSAIDS, arch supports, local steroid injections; plantar fasciitis boot
TMJ disorder
-def
-when is it worse?
-TX (surgical?)
-inflammation of joint itself or surrounding muscles; may or may not radiate
-worse with chewing
-NSAIDS, gentle stretching, muscle relaxers, antidepressants, splints (short term use) (NOT A SURGICAL PROBLEM)
