MSK Flashcards
What are the functions of the skeletal system
Support
Protection
Movement
Mineral homeostasis
Blood cell production
Triglyceride storage
Where does blood cell production occur within
Red bone marrow
Where does triglyceride storage take place within
Yellow bone marrow
What bones are longer than wide such as thighs, legs, arms, fingers, toes
Long bones
What bones are almost cube shaped such as most wrist and ankle bones
Short bones
What bones are thin and extensive surface such as cranial bones, sternum, ribs and scapulae
Flat bones
What bones do not fit in the above categories such as vertebrae, and facial bones
Irregular bones
What are the parts of a long bone
Diaphysis - the shaft
Epiphyses - ends of the long bone
Metaphyses - contains the “growth plate” and is located BETWEEN the shaft and and end of bone
What cells make up the microscopic structure of the bone
Osteoblasts - bone building cells
Osteocytes - maintain bone, exchange nutrients and waste within the blood
Osteoclasts - digest bone matrix for normal bone turnover
What type of joint has no cavity, just dense irregular connective tissue
Fibrous joints
What type of joints have no cavity and the bones are held together by cartilage
Cartilaginous joints
What type of joints have synovial cavities and many other components such as ligaments
Synovial joints
What is located in the skull between bones of the skull and add strength to the joints
Sutures: example of fibrous joints
What is a dense irregular tissue between long bones such as the radius-ulna, and tibia-fibula
Interosseous membrane: examples of fibrous joints
What allows articulating bones fit more tightly
Articulate discs (menisci)
What are sacs that contain synovial fluid and are located where friction can occur (decreases friction)
Bursae
What are the functions of ligaments
Composed of connective tissue
Found throughout the skeletal system
Function to connect bone to bone
Ligaments are commonly injured by spraining or tearing of ligaments
What is the function of tendons
Tough band of fibrous connective tissue
Functions to connect muscle to bone: skeletal muscle contracts and moves bones via tendons, very dense and more capable of withstanding tension
What are the different types of muscular tissue in the body
Skeletal muscle
Cardiac muscle
Smooth muscle
What are the functions of the different types of muscles together
Produce body movement
Stabilize body positions
Store and move substances
Produce heat
What is the decrease in the angle between articulating bones
Flexion
What is the increase in angle between articulating bones
Extension
What is the bending beyond 180 degrees, such as moving humerus backwards behind the anatomical plane
Hyperexenstion
What is the movement of the bone away from the midline
Abduction
What is the movement of bone toward the midline (add to the body/move closer)
Adduction
What is the movement of distal end in a circle
Circumduction
What is when the bone revolves around it’s an longitudinal axis
Rotation
What is the movement of the soles of the foot medially
Inversion
What is the movement of the soles laterally
Eversion
What is bending the foot toward the dorsum (standing on heels)
Dorsiflexion
What is bending the foot toward the plantar surface (standing on toes)
Plantarflexion
What is important family history information to gather in the HPI
Congenital abnormalities
Scoliosis or back problems
Joint disorders: arthritis and/or gout
Genetic disorders: skeletal dysplasia
What is important exam equipment to have for an MSK patient
Tape measure
When assessing range of motion, passive range of motion should meet what standards
Passive range of motion typically exceeds active range of motion by 5 degrees, and should be the same as the contralateral side
What does zero represent on the grade strength scale
No evidence of muscle function (including muscle twitch, 0/5)
What does trace represent on the grade strength muscle scale
Muscle contraction but no or very limited joint motion (1/5)
What does poor represent on the grade strength scale
Complete range of motion with gravity eliminated (2/5)
What is fair on the grade strength scale
Complete range of motion against gravity (3/5)
What does good represent on the grade strength scale
Complete range of motion against with some resistance (4/5)
What does normal represent on the grade strength scale
Complete range of motion with full or normal resistance (5/5)
What are the regions of the vertebral column
Cervical - 7 vertebrae
Thoracic - 12 vertebrae
Lumbar - 5 vertebrae
Coccyx - 4 fused vertebrae
What is lordotic
Cervical and lumbar vertebrae
What is kyphotic
Thoracic and sacral curves
Which vertebrae is larger than cervical vertebrae
Thoracic vertebrae
Which vertebrae are the largest and strongest
Lumbar vertebrae
What provides foundation for the pelvic girdle
The sacrum
What does the manubrium, body and symphonies process make up
The sternum
What are true ribs
R1-R7
Costal cartilage articulates directly with the sternum
Which ribs are false ribs
R8-R10
Articulate with the sternum bi cartilage of rib 7
Which ribs are floating ribs
R11-R12
Do NOT articulate with the sternum at all
What articulates with the sternum medially and the acromion laterally
The clavicle
What bones make up the pectoral girdle
Clavicle
Scapula
Acromion
Coracoid
What is the part of scapula that forms the “tip of the shoulder”
The acromion
What are the ligaments of the pectoral girdle
Acromioclavicular ligament
Coracoclavicular ligament
Coracoacromial ligament
What is shallow, allowing only about 25% of numeral head to make contact
The glenoid cavity
What articulates with the head of the numerous to form the shoulder joint
The glenoid cavity
What forms a ring around the glenoid cavity
The glenoid labrum
What deepens the glenoid and provides more stability to the joint
The glenoid labrum
What are the muscles of the rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
What assists deltoid in abduction of the humerus at the shoulder
Supraspinatus
What provides external rotation of the humerus at the shoulder joint
Infraspinatus
What extends arm at shoulder and rotation of the arm externally
Teres minor
What provides internal rotation of the arm at the shoulder
Subscapularis
What abducts, flexes, and rotates arm at shoulder joint
Deltoid
Multiple fibers in this large muscle move the scapula multi-directionally
Trapezius
Elevates scapula and rotates downward
Levator scapula
Elevates and adducts scapula and rotates downward as well as stabilizes the scapula
Rhomboid major
Adducts and rotates arm medially at the shoulder and flexes arm at the shoulder joint
Pectoralis major
Extends, adducts, and rotates arm medially at the shoulder joint, draws arm downward and backward
Latissimus dorsi
Extends arm at the shoulder joint, assists with adduction and rotation of arm medially
Teres major
Flexes and adducts arm at shoulder
Coracobrachialis
What are their bones of the elbow
Humerus
Radius
Ulna
What is the olecranon
The medical term for elbow
What additional movement occurs in the elbow other than flexion and extension
Supination - moving the palm up
Pronation - moving the palm down in the opposite direction
*pronation and supination occur ONLY at the elbow
What flexes arm at the shoulder, flexes and supinates forearm at the elbow
Bicep brachii
What flexes forearm at the elbow joint
Brachialis
Brachioradialis
What extends forearm at the elbow joint and extends arm at shoulder
Tricep brachii
What supinates forearm
Supinator
What pronates the forearm
Pronator teres
What are the bones of the hand
Carpals
Metacarpals
Phalanges
What flexes and abducts hand at the wrist
Flexor carpi radialis
What flexes and adducts hand at the wrist
Flexor carpi ulnaris
What weakly flexes hand at the wrist joint
Palmaris
What flexes hand at wrist and flexes phalanges of each finger at the PIP joint
Flexor digitorum superficialis
What flexes hand at wrist and flexes phalanges at the DIP joint
Flexor digitorum profundus
What extends and abducts hand at the wrist joint
Extensor carpi radialis longus
Extends and adducts hand at the wrist joint
Extensor carpi ulnaris
What extends hand at wrist joint, extends phalanges of each finger
Extensor digitorum
Which nerve is responsible for motor supply to most of the intrinsic hand muscles and provides sensation to little finger and 1/2 of ring finger
Ulnar nerve
Which nerve provides sensation to the palmar and dorsal aspect of first 3 and a half fingers
Median nerve
Which nerve provides sensation to dorsum of the hand and lateral first three fingers and half of the 4th finger
Radial nerve
What special test is used to diagnose shoulder impingement or rotator cuff tears
Neer’s impingement sign
What test reinforces a positive Ne’er sign for impingement
Hawkin’s Impingement Sign
How does a positive empty can test present
Pain focal to the middle aspect subacromial space
What special test detects tears in the rotator cuff
Drop arm test
What special test evaluates the teres minor and weakness indicates a positive sign
Hornblower’s test
What test is helpful in diagnosing bicep tendonitis
Speed’s test
What special test evaluates the Subscapularis strength and possible tendon rupture
Gerber /lift-off test
What does a positive Jobe Relocation test/Relocation test of Jobe indicate
Test is positive if relief of pain and apprehension occurs/ suggest anterior glenohumeral instability
What is a a positive sulcus sign
A positive sulcus suggest that the patient has inferior shoulder instability
What does a positive Obrien’s test present as and suggest
Pain is worse with thumbs down, relieved with forearm supinated
Suggest labra pathology
What is the vagus stress test assessing
The stability of the medial ligamentous structures
What is the varus stress test assessing
The stability of the lateral collateral ligament in the lateral capsule
If pain is present during the long finger test, what does that indicate
Pain to the lateral epicondyle is positive for lateral epicondyle
Inability to flex the DIP may indicate what
Injury to the profundus or median ulnar nerve injury
A positive tinel sign suggests what
Carpal tunnel syndrome
Pain in the dorsalradial aspect of the wrist indicates a stenosis tenosynovitis of the abductor pollicis longus and extensor brevis can be detected by what special test
Finkelstein
What can the Phalen maneuver suggest
Carpal tunnel syndrome
What can Froments sign suggest
Ulnar nerve paralysis
What special test can observe inability to actively extend the distal interphalangeal joint, suggesting extensor tendon avulsion
Mallet Finger Test
What is a type I AC injury described as
No superior separation of clavicle from acromion
What is a type II AC injury described as
Partial separation of the clavicle from acromion
What is type III AC injury described as
Complete separation of the clavicle from the acromion
What is a type IV AC injury described as
Completely disrupted with superior and prominently posterior displacement
What is a type V AC injury described as
Completely disrupted with CC interspace more than twice as large as opposite shoulder
What is a type VI AC injury described as
UNCOMMON
Clavicle lies in either the subacromial space or subcoracoid space
What is the treatment for an AC injury
Type I and II:
Sling x24-48 hours, ice, analgesics, HEP that focuses on ROM , RTFD as pain permits (usually within 4 weeks)
Type III:
Ortho consult, sling x 24-48 hours, ice, analgesics, HEP that focuses on ROM, LLD until evaluated
Type IV - VI:
Ortho consult, MEDEVAC
What is the most common bony injury
Fracture of the clavicle
What special test can be performed to detect a fracture of the clavicle
Cross-body test with possible grinding is a positive test
What is the treatment of a clavicle fracture
Ice
Analgesics
Ortho consult
Mid-shaft fracture with minimal displacement and no neuron vascular injury: figure-of-8 strap for 6-8 weeks
All fractures require referral - MEDEVAC/ painful nonunion after 4 months of treatment
What are the sx for impingement syndrome of the shoulder
Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
Night pain and difficulty sleeping on affected side
What is the treatment for impingement syndrome of the shoulder
NSAIDS
Ice
LLD and HEP for shoulder stretching and strengthening
PT consult if failed local management
*Ortho consult if failed conservative management after 2-3 months or other pathology is suspected
What are the synonyms of rotator cuff tear
Musculotendinous cuff rupture
Rotator cuff rupture
Rotator cuff tendinitis
What are the sx of rotator cuff tear
Chronic shoulder pain
Specific injury that triggered pain
Night pain and difficulty sleeping on the affected side
Complaints of weakness, catching and grating especially with overhead activities
What is the tx for rotator cuff tear
NSAIDs
Ice
LLD and HEP
PT consult if failed local management
Ortho consult if failed rehab over 3-6 months
What is the clinical presentation of someone with a bicep tendon injury
Anterior shoulder pain that radiates distally down the arm over bicep muscle and aggravated by lifting, pulling, or overhead activities
What is the tx for bicep tendon injury
NSAIDS, ice, duty/activity modification, PT/HEP
*if rupture is suspected then ortho consult
What some synonyms for shoulder instability
Dislocation
Multidirection instability
Recurrent dislocation
Subluxation
Define instability of the shoulder
Anterior, posterior, inferior or multidirectional glenohumeral laxity due to traumatic or atraumatic pathology
Define subluxation of the shoulder
Humeral head partially slips out of socket with spontaneous reduction
Define dislocation of the shoulder
Humeral completely slips out of glenoid fossa with spontaneous reduction or sometimes requiring manual manipulation
What are the specific instability patterns of the shoulder
TUBS: traumatic unilateral dislocations with a Bankart lesion that can be successfully treated with surgery
AMBRI: atraumatic multidirectional instability that is commonly bilateral and is often treated with rehab and occasionally an inferior capsular shift (surgery)
What is a sx of shoulder instability
Patient with anterior instability will describe the sensation of the shoulder slipping out of the joint when arm is abducted and externally rotated.
What special tests can be performed for as patient with shoulder instability
Sulcus test - positive with inferior laxity
Apprehension test - positive with anterior instability
Anterior/posterior drawer test - anterior/posterior laxity
Jerk test - posterior instability
What is the treatment for shoulder instability
Reduce acute shoulder dislocations: Stimson technique or longitudinal traction
Immobilize arm in a sling in neutral position
Light duty to include no active use of arm for 2-3 weeks
Begin rotator cuff strengthening 2-3 weeks post reduction
PT consult
Ortho consult
What lesions involve injury to the superior glenoid labrum and the biceps anchor complex
Superior labrum anterior posterior (SLAP)
What are some MOI’s for Labrum tears/SLAP lesion
Falling back onto an outstretched arm
Tries to prevent falling by grabbing hold of an object
Suddenly tries to lift a heavy object
Forceful throwing, excessive overhead activity
Chronic overuse vs acute injury
What is a concern for adhesive capsulitis that is raised when a patient with history of shoulder injury complains of:
Severe pain that is worse at night
Nagging pain
What is the treatment for adhesive capsulitis
Early mobilization for those with shoulder injuries must avoid slings when possible
Shoulder motion exercises - PT consult
NSAIDs
Tylenol
Consider referral for steroid injection
What are the synonyms for lateral and medial epicondylitis
Lateral tendinosis: tennis elbow
Medial tendinosis: golfer’s elbow/bowler’s elbow
What are the clinical sx of LATERAL epicondylitis
Gradual onset of pain in lateral elbow and forearm during activities involving gripping and wrist extension
Lifting
Turning screwdriver
Hitting backhand in tennis
Excessive typing
What are the clinical sx of MEDIAL epicondylitis
Gradual onset of pain at medial aspect of the elbow, exacerbated by activities that involve wrist flexion and forearm pronation
Golf swing
Baseball pitching
Pull-through stroke of swimming
Weight-lifting
Bowling
Many forms of manual
What is the treatment for olecranon bursitis
Mild cases: NSAIDs, pressure wrap, ice
Moderate - severe cases: should undergo aspiration of fluid - refer for orthopedic evaluation
Septic olecranon: requires organism specific antibiotics - refer for treatment
What are the more common nerve compression symptoms
Cubital tunnel syndrome
Median nerve compression
What is the treatment for ulnar nerve compression
Splint elbow or wrap towel around elbow to avoid greater than 90 degree flexion at night
Surgical decompression and transposition of ulnar nerve if 3-4 months of conservative management failed
What are the symptoms of a patient with ligamentous injury
Acute onset patient will describe a “pop” while throwing
Most commonly patients experience a gradual onset of sx with progressive medial elbow pain with valgus stresses
What diagnostic tests can be performed for ligamentous injury
AP and lateral radiographs are needed to rule out fracture
MRI with contrast is a reasonable diagnostic tool for ulnar collateral ligament pathology
What is the treatment for a patient with ligamentous injury
Light duty-activity modification
Ice for acute injury
NSAIDs
Pain free elbow and wrist stretching and strengthening activities
What is a result from a fall on an outstretched hand (FOOSH)
Elbow dislocation
*most common dislocation in children and third most common in adults
What is the treatment for an elbow dislocation
Ice
Appropriate pain management
Splint
Consider emergency reduction if delayed MEDEVAC time or neuromuscular compromise
Repeat neurovascular check after reduction
*reduction should be performed as soon as possible by an orthopedic surgeon - refer for treatment ASAP
*patients with neurovascular compromise or bony injury require immediate referral/MEDEVAC
What is the most common neuropathy of the upper extremity and caused by any condition that reduces the size or space of the carpal tunnel resulting in median nerve entrapment
Carpal tunnel syndrome
What special test can be used to dx carpal tunnel syndrome
Phalen maneuver and tinel sign
What is the treatment for carpal tunnel syndrome
Splint wrist in neutral position - especially at night
NSAIDs
Light duty for activity modification
Ergonomic modifications
Ortho consult if failed conservative management
What special test can be used to dx de quervain tenosynovitis
Positive finklestein test
What is the treatment for de quervain tenosynovitis
NSAIDs
Thumb spica splint
light duty-activity modification
*ortho consult with failed conservative management
What diagnostic testing an be used for a patient with a suspected scaphoid fracture
Scaphoid series radiographs should be obtained at time of injury
If normal but pain persists for 2-3 weeks, then studies should be repeated
If radiographs are still normal, an MRI should be ordered
What is the treatment for a suspected scaphoid fracture
Thumb spica splint
Light duty - no use of affected hand
Consult to ortho
Analgesics as needed
What age group is most affected by ganglion of the wrist
Affects ages 15-40 years old
What occurs through degeneration or tearing of the joint capsule or tendon sheath, a connection to the joint or tendon sheath with a one way valve established - synovial fluid can enter but flow freely back into synovial cavity
Ganglion of the wrist
What special test can be performed to test presence of a ganglion of the wrist
Ganglion will transilluminate
Solid tumors will not
What is the treatment for a ganglion of the wrist
Splint wrist or finger
NSAIDs
Consult to ortho for aspiration or surgical excision
*persistence of a painful or bothersome cyst that recurs after aspiration requires referral
What is a rupture of the flexor digitorum profundus tendon from its distal attachment, common in contact sports and often overlooked as “jammed” finger
Jersey finger
What is the inability to actively flex the DIP joint and requires you to obtain plain films to rule out avulsion fracture or MRI if the dx is still in question
Jersey finger
What is the treatment for Jersey finger
Splint the finger with PIP and DIP joint slightly flexed and all cases require referral to ortho
What is a rupture, laceration, or avulsion of the insertion of the extensor tendon and base of distal phalanx/ usually occurs with a direct blow to the finger causing sudden forced flexion of the DIP or distal phalanx and pain in the DIP joint
Mallet finger
What is the inability to extend the DIP joint fully
Mallet finger
What is the treatment for Mallet finger
Maximize function, minimize discomfort
Splint the finger in full extension for 6-8 weeks
What is an extensor tendon rupture at insertion on middle phalanx causing a painful PIP joint, deformity for up to 3 weeks
Boutonnière Deformity
What is the treatment for Boutonnière Deformity
Splint PIP joint in extension for 3-6 weeks and allow DIP to move freely
What do the hip bones consist of
Ilium
Ischium
Pubis
What forms the socket for the head of the femur
Acetabulum
What is the largest foramen in the body and formed by articulation of the ischium and pubis
Obturator foramen
What flexes and rotates thigh laterally
Psoas major
Iliacus
What extends and rotates thigh laterally and helps lock knee in extension
Gluteus maximus
What abducts and rotates thigh medially
Gluteus medius
What flexes and abducts thigh at hip joint and helps lock knee in extension
Tensor fascia latae
What adducts, rotates, and flexes thigh at hip joint
Adductor longus
What adducts, flexes, rotates, and extends thigh at the hip joint
Adductor magnus
What does the external rotation of thigh laterally and abducts
Piriformis
What flexes and adducts thigh
Pectineus
What is very large and heavy, the strongest bone in the body and its head articulates with the acetabulum
Femur
What is the projection from femur at the side of the hip
Greater trochanter
What develops in the tendon of the quadriceps femur is muscle and functions to provide leverage for the quadricep muscle as well as to protect the knee
Patella
What is larger, medial, weight bearing bone of the lower leg and forms the medial malleolus at the distal end
Tibia
What is the attachment site for the patella ligament
Tibial tuberosity
What is the non-weight bearing bone lateral to the tibia
Fibula
What extends from the patella to the tibial tuberosity and strengthens the anterior surface of the knee
Patellar ligament
What strengthens the medial aspect of the knee
Medial Collateral Ligament (MCL)
What strengthens the lateral aspect of the knee
Lateral Collateral Ligament (LCL)
What extends posterior LH and laterally from the tibia to femur and limits hyper extension of the knee and prevents anterior sliding of the tibia on the femur
Anterior Cruciate Ligament (ACL)
What extends anteriorly and medially from the tibia to the femur and prevents posterior sliding of the tibia on the femur
Posterior Cruciate Ligament (PCL)
What are fibrocartilage discs that fit between tibial and femoral condyles and allow the bones to “fit” together more appropriately as they are irregular in shape
Menisci
What are sac filled structures filled with fluid and reduce friction
Bursae
What are the anterior bursae of the knee
Prepatellar
Pes anserine
Infrapatellar
Suprapatellar
What adducts and medially rotates thigh and flexes leg at the knee
Gracilis
What adducts the femur
Adductor magnus
Adductor longus
Pectineus
What extends the knee, flexes the hip and located anterior to other quadriceps muscles
Rectum feoris
What only extends the knee
Vastus lateralis
Medial is
Intermedius
What flexes the knee, weakly flexes the hip, abducts and laterally rotates the thigh
Sartorius
What extends thigh at the hip and flexes the leg at the knee joint
Biceps femoris (hamstrings)
What extends the thigh at the hip and flexes leg at the knee
Semitendinosis
Semimembranosis
What is formed by the distal end of tibia and fibula
Ankle mortis
What are the bones that form the ankle
Large talus (ankle bone)
Calcaneus (heel bone)
Cuboid (lateral)
Navicular (medial)
Cuneiforms (numbered 1-3 medial to lateral)
Metatarsals
Phalanges
What extends from talus to fibula
Connects talus and anterior fibula
Anterior talofibular ligament (ATFL)
What extends from calcaneus to fibula
Calcaneofibular ligament (CFL)
What connects the tibia to the talus, calcaneus, and navicular bones and are four ligaments fused into one
Deltoid ligaments = Medial ankle
What dorsiflexes and inverts the foot
Tibialis anterior
What dorsiflexes and everts the foot and extends the toes
Extensor digitorum longus
What plantarflexes and everts the foot
Fibularis longus
What plantarflexes foot and flexes leg at the knee
Gastroneumius
What only plantarflexes the foot
Soleus
What plantarflexes and inverts the foot
Tibialis posterior
What plantarflexes the foot and flexes toes
Flexor digitorum longus
What special test detects gluteus medius muscle weakness
Trendelenburg test
What detects hip and sacroiliac pathology
Fabre test
What test can illicit pain in the hip or groin, particular with internal rotation is positive
Log roll test
What tests for a tight piriformis impinging the sciatic nerve
Piriformis test
What tests for labra pathology, loose body, or other internal derangement of the hip
Scour test
What test detects flexion contractures or tightness of the hip and is positive if the hip does not fully extend or lumbar curve arches (lordosis)
Thomas test
What test for patellar instability
Patellar apprehension test
What evaluates the health of the menisci
McMurray test
The varus stress test evaluates the integrity of what
Lateral collateral ligament
The valgus stress test evaluates the integrity of what
The medial collateral ligament
What detects instability of the anterior Cruciate ligament
Lachmans
What test indicates if the PCL is injured the proximal tibia falls back
Posterior drawer
What test determines if the PCL is lax then the tibia will sag down when the knee is at rest
Sag test
What detects iliotibial band contractures or tightness
Ober test
What detects anterior instability of the ankle joint
Anterior drawer test
What assesses the integrity of the Achilles’ tendon
Thompson test
What tests for tibiofibular sydesmosis injury
Tib/Fib squeeze
What presents with the affected limb short, hip is fixed in ADDUCTED and internally rotated position
Posterior hip dislocation
What presents as hip held in ABDUCTION and external rotation
Anterior hip dislocation
What is the treatment for any hip dislocation
MEDEVAC
Reduction performed ASAP to reduce osteonecrosis or if blood supply is disrupted
What is mostly caused by high energy trauma and clinical sx of severe pain in thigh, and unable to bear weight
Fracture of the femoral shaft
What is the treatment for a fracture of the femoral shaft
Immediate splinting and traction
MEDEVAC
What often occurs in patients who undergo repetitive impact such as military recruits, athletes, runners and have vague pain in anterior groin or thigh
Stress fracture of the femoral neck
What is the treatment for stress fractures of the femoral neck
Analgesics
Ortho eval
Activity modification
What presents with clinical sx of pain in groin area with attempted weight bearing, sensation of “coming apart” at the hip with bearing weight and presents with distracting injuries, shock, multi system trauma
Pelvic fracture
What is the treatment for a pelvic fracture
MEDEVAC
Hemodynamic resuscitation
Activity modification - no weight bearing
Pain management - narcotics
Pelvic binder
What results from acute or overuse injury with pain over injured muscle and it’s exacerbated by activity
Hip strain
What is the treatment for hip strain
NSAIDs
Duty modification
Send to ortho if failed conservative management
What presents with a “pop” that may have been perceived at the onset of pain and the posterior thigh muscles are injured more often than the anterior thigh muscles
Thigh strain
What is the treatment for thigh strain
Prevention of further swelling and hemorrhage by having the patient rest and elevate the limb while applying ice and compressive wraps as needed
NSAIDs
What is inflammation and hypertrophy of the greater trochanteric bursa that may develop without apparent cause and can be the cause of lateral hip pain
Trochanteric bursitis
What dx presents with patients usually have pain and tenderness over the greater trochanter, pain may radiate distally to the knee or ankle, worse when going from sit to stand, may decrease after warming up but return after 30 to 1 hour of walking and unable to lie on affected side
Trochanteric bursitis
What is the treatment for trochanteric bursitis
NSAIDs
Duty modification
Hip strengthening and stretching
Refer to ortho if conservative management failed
What results from rotational or hyper extension force and limits anterior translation of the tibia on the femur
Anterior Cruciate Ligamentous tear of the knee
What special tests are done for a patient with ligamentous tear of the knee
Anterior drawer test and Lachman (negative in many patients who have an ACL tear)
What is the treatment for an anterior cruciate ligament tear
RICE
Duty modification
Ortho consult
PT consult
A knee immobilizer or ROM brace
What dx could be provided to a patient who has suffered a dashboard injury, a pure hyperflexion injury to the knee, a hyperextension injury to the knee or fall onto a flexed knee with the foot in plantar flexion
Posterior cruciate ligament tear
What special test can be performed for a PCL tear
Posterior drawer test
Sag test
What is the treatment for a PCL tear
RICE
NSAIDs/Tylenol
Duty modification
Ortho Consult
PT consult
What is the treatment for an MCL tear
Usually non-operative and heal within 4-6 weeks
Contact MO
What is pain focal to the anterior lateral aspect of the knee that worsens with activity (worse downhill running, mostly heel strike) and discomfort or complete resolution at rest
IT band syndrome
What special test is performed for patients with IT band syndrome
Obers
What presents with mechanical sx such as locking, catching, and popping can then develop and patients will usually experience pain with twisting or squatting
Meniscal tear
What special test is performed for a patient with a suspected meniscal tear
McMurray test will be positive
What has anterior knee pain as a hallmark and patients often point to a tender spot where sx concentrate and location depends on site of insertion site involved (superior/inferior pole of the patella), pain is exacerbated by exercise, prolonged sitting, squatting, kneeling, climbing or descending stairs, running or jumping
Quadricep/patellar tendinitis
What presents with clinical sx of diffuse aching anterior knee pain, exacerbated by prolonged sitting, climbing stairs, jumping, squatting with no typical pre-existing trauma
Patellofemoral pain
What is another name of popliteal cyst
Bakers cyst
What presents with clinical sx swelling/fullness in the popliteal fossa, posterior knee pain, knee stiffness
Popliteal cyst
What presents with anterior knee pain that increases gradually over time, exacerbated by direct trauma, kneeling, running, jumping and relieved with rest (typically asymmetric, occasionally bilateral)
Osgood Schlatter Disease
What is characterized by pain and swelling at the tibial tubercle with insertion site of the patellar tendon
Osgood Schlatter Disease
What is the treatment for Osgood Schlatter Disease
Usually benign and self-limited (leave that shit alone)
What presents with clinical sx of gradual onset of pain with prolonged walking or running activity, pain is localized to the distal third of the medial tibia, increase in training intensity, pace or distance
Shin splints
What presents with tenderness along posterior medial crest of tibia in the middle to distal third of the leg
Shin splints
What is the treatment for shin splints
NSAIDs
Ice
Duty modification
Pain free return to running
Weight loss if needed
Proper running shoes
What presents with initial sx similar to shin splints, gradual increase in pain related to physical activity, pain at rest, pain that suddenly increases in intensity around site of more mild sx
Tibial stress fractures
What is the treatment for stress fractures
Rest/duty modification
Expect duty modification for roughly 12 weeks
What presents with severe leg pain out of proportion to apparent injury, persistent deep ache or burning pain, parasthesias
Compartment syndrome
What physical exam findings will indicate compartment syndrome
Seven P’s:
Pain, pallor, parasthesias, paresis, poikilothermia, pressure, pulselessness
What is the treatment for compartment syndrome
Medical emergency: requires fasciotomy
Place limb in neutral position
*ice is contraindicated
What is the largest tendon in the body
Chilled tendon
Achilles’ tendon rupture has what personnel as risk factors
Athletes
Age (30-40 years old)
Male gender
Obesity
Running mechanics issue
Fluoroquinolone antibiotic use associated
Rheumatologist diseases
What special test can better examine Achilles’ tendon rupture
Thompson test
What is the treatment for Achilles’ tendon rupture
Light duty
Ice
NSAIDs
Consider Achilles’ tendon support
Physical therapy
What extends from talus to fibula
Connects talus and posterior fibula
Posterior Talofibular ligament (PTFL)
What has four separate divisions, is large, strong and less commonly injured
Deltoid ligament = medial ankle ligaments
What is the most common ankle sprain
Inversion injury
What special test can be performed on an ankle sprain
Anterior drawer test - ATFL
Tamar tilt - CFL
Tib/fib squeeze
What is a critical injury that involves the second tarometatarsal joint and may occur in athletics or as a result of tripping
Lisfranc fracture
What has clinical sx of patients often reporting a sprain, pain localized to the dorsum of the midfoot and relatively mild swelling
Lisfranc fracture
What is the treatment for a Lisfranc fracture
Ortho consult
Non-displaced injuries are treated with 6-8 weeks of non-weight bearing cast immobilization
Fractures or dislocations that are displaced require surgery
NWTB
Analgesics
MEDEVAC
What presents with pain and swelling, aggravated by shoe wear, are the principal complaints/the great toe pronates with resulting callus on the medial aspect
Bunion
What is the treatment for a bunion
The initial treatment is patient education and shoe wear modification
Light duty
Ice
Refer if persistent pain despite shoe modifications
What condition is most common between the third and fourth toes and presents with plantar pain in the forefoot is the most common presenting sx, dysesthesias into the affected two toes or burning plantar pain that is aggravated by activity is common
Morton neuroma
What presents with pain that is often most severe on awakening or when rising from a resting position because. The first few steps stretch the plantar fascia
Plantar fasciitis
What has clinical sx of “pump bump” that is irritated by shoe wear, start-up pain, pain after activity, natal gif gait and can originate at the insertion of the Achilles’ tendon at the calcaneous, retrocalcaneal bursa, prominent process of the calcaneus impinging on the retrocalcaneal bursae or Achilles’ tendon or inflammation of the bursa between the skin and the Achilles’ tendon
Posterior heel pain
What is the treatment for posterior heel pain
Duty modification
Heel lift or open back shoes
Ice massage
Achilles stretch
Casting for 6 weeks in extreme cases
What is a hyperextension injury of the first metatarsal
Turf toe
What is the treatment for turf toe
RICE
NSAIDs
Stiff shoe inserts
Severe injury requires protective weight bearing or immobilization for 1-2 weeks and with 4-6 week period of rest from sports
*intra-articular fractures can require open reduction/urgent surgical intervention is necessary for an irreducible dislocation
What is a clinical condition that involves neck, shoulder, or arm pain, muscle weakness, sensory changes, diminished deep tendon reflexes
Cervical Radiculopathy
What is a nucleus purposes prolapse from intervertebral disc and will irritate nerve root if compression occurs
Disc herniation
What is a ligamentous, facet joints, muscular, disc injury, usually self-limiting, commonly from whiplash mechanism or may have no mechanism of injury
Neck sprain. = cervical strain
What is the treatment for neck sprain/cervical strain
Soft cervical collar for 1-2 weeks and reassurance
NSAIDs
What is the second most common primary care complaint and is the most common cause f disability in people under 45
Lower back pain
What is the specific time frame for acute vs chronic in regards to lower back pain
Acute: up to 4 weeks
Subacute: 4-12 weeks
Chronic: over 12 weeks
What are the red flags for lower back pain
Saddle anesthesia
Loss of bowel/bladder function
Lower extremity weakness
What special test can be done for lower back pain
Seated/supine straight leg raise
What is the treatment for lower back pain
Control pain
Activity modification
Early mobility (if acute)
Core stabilization through rehab
What presents with abrupt or gradual onset, unilateral radicular leg pain, aggravated by various activity, possible neurological involvement and the pain is from mechanical compression or chemical irritation of nerve root
Herniated disc
What is the treatment for herniated disc
Control pain
Activity modification
Rehab
Consider chiro/PT
What would be reasons to MEDEVAC a patient presenting with lower back pain or a herniated disc
Cauda equina syndrome sx
Severe nerve rot paralysis
Radicular sx that persist more than 6 weeks without severe sx
What may be from spinal degeneration or from childhood, mostly minor deviations from normal and asx, sx patients disqualified from service
Scoliosis
What is chest pain that is said to be reproducible
Chostochondritis
What affects the knee joint from approximately 80% of cases but can also affect the hand, spine, and hip, and presents with pain that is exacerbated with use, alleviated with rest, pain is aching, deep in later stages and has sharp pain in beginning stages
Osteoarthritis
What is the treatment for osteoarthritis
Control pain
Stop insult to cartilage
Rehab
What can occur from autoimmune disorders in mostly small joints and bilateral: hands, finger, wrists, feet, ankle with an insidious onset and in the distal joints first
Rheumatoid arthritis
What is the treatment for a patient with rheumatoid arthritis
Medadvice with GMO or refer to internal medicine
Control with NSAID/Tylenol, DMARD
What is preceded and precipitated by infection in the body along with UTI’s STI’s, or diarrheal illness
Reactive arthritis
What is the treatment for reactive arthritis
Treat infection if active
Sx are self-limiting but may last up to 6 months
NSAIDs for pain
What is a common inflammatory skin disease with a most common manifestation of well-demarcated erythematous plaques with silver scale
Psoriatic arthritis
What is the treatment for a patient with psoriatic arthritis
Do not attempt to manage these patients:
Refer to rheumatology and derm
Treat sx in the interim with NSAIDs
DMARDs to be considered by specialist
What presents as back pain in almost all patients, “bamboo spine” severe restriction in back mobility seen in about half of patients in later stages of disease progression
Ankylosis spondylitis
What is the treatment for ankylosing spondylitis
These patients must be recognized and rerferred
What presents with intense pain, redness, swelling and common sites are the 1st toe, ankle, knee, wrist, fingers, elbow and is a mono sodium urate crystal deposition in joints and tissues
Gout
What is the treatment for Gout
Acute episode: NSAID (indomethacin), Colchicine, steroids
Prophylaxis: Allopurinol (overproducers), Probenecid (underexcretors)
diet modification: avoid meat, seafood, alcohol, high-fructose corn syrup
What presents with normal urine acid levels, intensely painful, joint swelling, erythema, large joints such as the knees are often affected and has a treatment of only NSAID and no preventative treatment
Pseudogout
What is an infection of the joint space that occurs with direct inoculation, hematogenous spread, from a bone infection, staphylococcus aureus is the most common cause and presentation is severe pain, swelling, decreased mobility, difficulty bearing weight, fever, tachycardia, post-surgical patients
Septic arthritis
What is the treatment for septic arthritis
MEDEVAC
IV antibiotics
Supportive if having shock
What is virchows triad
Hypercoagulability
Venous stasis
Endothelial damage
What is venous clot formation that often occurs in the lower extremities
Deep vein thrombosis
What is a disruption in the bone from repetitive or forceful trauma that presents with pain, swelling, decreased mobility, limited weight-bearing, numbness, tingling, pallor, ecchymosis, and deformity
Fracture
What type of fracture is in a atomic alignment
Non-displaced
What type of fracture is not in an anatomical alignment, described as a percentage
Displaced
What type of fracture is distal fragment overlaps proximal fragment
Bayonetted
What type of fracture are the fragments separated
Distracted
What type of fracture has a deviation at an angle
Angulation
What is the treatment of a fracture
Recognition
Reduction
Retention of reduction while achieving union
Rehab
MEDEVAC
What factors decrease healing in a fracture
Smoking
Skeletal maturity
Oblique/comminuted/segmental fractures
Marked displacement
Intraarticular fracture
