MSK Flashcards

1
Q

AC injury

A

young active pt
fall on shoulder- bike accident

s/s: pain on top of shoulder radiates to neck,
tender AC joint
dec. ROM of shoulder
pos. crossover test

dx: clinical, X-rays if unsure

tx; ice, sling 2-4 weeks, NSAIDS, early ROM each day

grading : 1-3 tx as above

grade IV-VI- both ligaments ruptures, significant displacement of clavicle- see orthro surgeon

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2
Q

clavicle fx

A

most common fx in kids

s/s: pain over clavicle, tenting of skin
dec shoulder ROM
document pulses, sensation ,strength
fx at middle 1/3

dx: xray
if fx is more close to center of chest - worry about subclavian vein injury
tx: sling or figure of 8 splint, 3-4 weeks,
after 3-4 weeks start ROM

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3
Q

rotator cuff disorders

A

chronic, overhead work or fall on hand. Pain begins as inflame, then becomes impingement then progress to tear

s/s: pain at great tuberosity, lateral shoulder
pain with abducting arm
positive Neer impingement and Hawkin’s sign

dx: MRI

tx: rest, ice, NSAIDS, PT, steroid injection
if no better after 6-12 weeks–> surgery

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4
Q

biceps tendonitis

A

overuse of the beeps mm, usually heavy or excessive lifting

s/s: anterior shoulder pain
bicipitical groove tenderness

dx: clinical, xray to r/o other injury
tx: rest, ice, sling, NSAID, steroid injection ( no to god into sheath of tendon- can get a rupture

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5
Q

proximal humerus fx

A

fall on an out-stretched hand
elderly lady with osteoporosis

s/s: pain, swelling proximal humerus with dec. should ROM
evaluate axillae a. /nerve

dx: xray
tx; sling and swath 4 x early ROM
surgery if head displaced or compound fx.

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6
Q

shoulder dislocations

A

fall on externally, abducted arm

s/s: present with arm abducted and in ER
shoulder appears “ squared off”
evaluate axillary nerve and artery

dx; anterior dislocation
xray AP lateral and Y view
posterior rare ( electric shock or seizures)

tx: immediate close reduction with post reduction X-ray
sling/swath X 4 weeks, start RoM at 2 weeks

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7
Q

tennis elbow ( lateral epicondylosis)-

A

overuse-repetive supination and wrist extension

s/s: point tenderness over lateral epicondyle, pain on resisted wrist extension

dx: clinical, xray to r/o arthritis or loose body
tx: rest, ice, NSAIDS, counter force strap, steroid injection

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8
Q

medial epicondylosis

A

golfer’s/pitchers elbow
s/s: point tenderness over medial epicondyle, pain on resisted wrist flexion

dx: clinical, xray to r/o arthrites or loose body
tx: rest, ice, NSAIDS, steroid injection, stretching exercises

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9
Q

suprcondylar fx

A

-common in children
kid falling off monkey bars

s/s: pain and swelling over the distal humerus,
check pulses and nerves

dx: X-ray look for posterior fat pad signs ( never normal0
bilat X-rays are helpful( hard to distinguish from growth place)

tx: non-diplaced–> long arm cast
displaced–> surgery

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10
Q

radial head fx

A

FOSH injury

s/s: present splinting in flexion
swelling/ diffuse elbow pain over lat elbow

dx: xray- posterior fat pad 9 blood or fluid in joint)
tx: non-displaced or occur–> 2-4 weeks

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11
Q

colles fx

A

distal radius fx

scenario: elderly person, fall FOSH

s/s: swelling/ tenderness/ contusion on distal radius/ulna

“silverfork” deformity
dx: xray-

tx: closed reduction and cast 6-8 weeks
if intra-articular or comminuted fx it requires surgery

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12
Q

scaphoid fx

A

most common carpal fx
s/s: snuff box tenderness

tx: non-displaced-thumb spica cast 6-20 weeks
- if suspect fx: immobilize and repeat X-ray in 1 week or r/o with bone scan

high non-union rate with waist and proximal fracture

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13
Q

boxer fracture

A

5th metacarpal fx

s/s: pain and swelling over the 5th metaphalange

tx: closed reduction and ulnar gutter splint
close f/u for loss of reduction

always suspect” closed fist syndrome” punch to teech= human bite= OR + IV

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14
Q

de Quervains tenosynovitis

A

seen in chef’s, new mothers

s/s: pain along radial aspect of wrist
positive Finkelstein test

dx: clinical
tx: thumb spica splint for rest, NSAiDS, steroid injection

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15
Q

trigger finger

A

s/s: painless nodule in flexor tendon initially but then it hurts

dx: clinically

tx: activity mod, splinting, NSAIDS
- steroid injection into tendon sheath
- surgical release

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16
Q

carpal tunnel syndrome

A

medial nerve compression due to receptive wrist flexion

s/s: paresthesias in the thumb, index, and middle finger

postive Phalen and Tinel sign

dx: clinical, EMG/NCV is unsure of dx

tx: night-time splinting, steroid injection,
surgical release

17
Q

cervical fx

A

50% of all C-spine injuries are due to mVA

s/s: posterior mid-line tenderness, focal neuro deficits

dx: lateral X-rays
most injuries happen at c4-c6

tx: immobilization and surgical fixation

18
Q

ankylosing spondylitis

A

chronic inflame disease in spine and pelvis

s/s: diffuse LBP with morning stiffness
early exam often negative

progresses to dec. spine mobility and limited chest expansion

dx; X-ray early show sacroilitis
late show bamboo spine
increase in ESR

tx: PT for flexibility , pt edu
posture management
NSAIDS or TNF inhibitors

19
Q

kyphosis

A

progressive inc in the dorsal curve of the t-spine

causes: d/t osteoporosis, cancer, trauma, fracture

s/s: pain from acute fx or reconditioning of back mm
loss of ht.
hunchback deformity

dx: clinical
xray

tx: PT, light support
kyphplasty for new fx

20
Q

scoliosis

A

idiopathic lat curvature of spine > 10 degree

s/s: asymptomatic
painless spinal asymmetry
paraspinal hump

dx: clinical and X-ray to measure angle of Cobb
tx: tx depends on angle and age

40 degrees–> surgery

21
Q

LBP

A

s/s: low back pain radiates to buttock or leg, worse with long periods of standing

tenderness on paraspinal mm
dec. ROM
normal neuro

dx: clinical
xray to r/o causes if sxs persist

tx: rest, ice, NSAIDS, pT education
narcotics and mm relaxers for 3 days- bad thing

22
Q

herniated disc

A

s/s: pain in nerve distributing worse with flexion or valsalva
-motor weakness and diminished reflexes

lumbar disc; postive straight leg raise

dx: MRI

tx: rest/ice/NSAIDS, PT deuce epidural steroid injections
consider surgery if sxs no better in 6-12 weeks.

23
Q

cauda equina syndrome

A

sudden compression of l2-s4 nerve roots
disc herniation, epidural abscess, hematoma

s/s: saddle anesthesia

dx: MRI
tx: emergency tx

24
Q

spinal stenosis

A

narrowing of spinal canal or neural foramen

s/s: insidious onset of buttock and leg pain

numbness with ambulation
relief with sitting or flexion of spine

dx: MRI best

tx: rest, PT, NSAIDS, weight reduction
epidural steroids, nerve blocks
surgery when QOL impaired

25
avascular necrosis
loss of blood supply to femoral head causes: trauma, steroids and anti-retroviral use s/s: dull, aching, groin pain pain on IR and ER dx: mRI tx: refer for orthopedic evaluation.
26
hip fx
d/t fall in elderly woman femoral neck or IT fx s/s: leg will be shortened dx: xray TX: ORIF
27
hip dislocation
d/t high impact trauma s/s: limbs shortened and internal rotated dx: xray, CT to r/o fx of acetabulum tx: immediate reduction with post reduction film
28
tibial plateau fx
falling from ladder or window s/s; pre dx: X-ray use CT or MRI if unsure tx: immobilize, non-weight bearing depends on fx--> cast immobilize
29
patellar fx
direct blows or forced flexion of the quad mm s/s: pain and swelling of the soft tissue of anterior knee inability to actively extend knee dx: PE and xray tx: 8 weeks immobilization 3 mm or step off
30
ACL injury
forceful internal rotation of knee with planted foot s/s: pt hears pop, sudden swelling instability acute hemarthrosis + lachman test and anterior drawer sign dx: clinical, confirm with mRI tx: rest, ice, NSAIDS, bracing, PT with activity changes young athletes or those with chronic movement= arthroscopic ACL reconstruction
31
meniscal injuries
s/s : train of joint line pain, effusion an locking and clinics positive McMurray and Apley test dx: clinical, confirm with mRI tx: RICE, NSAiDS and PT arthroscopy for persistent sxs
32
pre patellar bursitis | housemaid's knee
s/s: palpable boggy swelling over patella dx: clinical tx: RICE, NSAIDS, usually self-limited
33
ankle sprain
85% of injuries are inversions ATF most commonly injured ligament s/s: hear a pop following by swelling and contusion pain over ligaments dx: clinical X-ray if boney tenderness or pt unable to weight bear tx: RICE, NSAiDS, supportive brace with WBAT for 4-6 weeks
34
ankel fx
caused by eversion, inversion, or lateral rotation of ankle s/s: pain, swelling, ecchymosis, instability -check fibula for tenderness check perineal nerve ( foot drop) dx: X-ray required if pain one the malleolar zone - follow the Ottawa Ankle Rules xramy if tenderness over the mid foot zone over the 5th metatarsal , navicular bone tx:
35
achilles tendon rupture
caused by pushing off or forcible plantar flexion common 30-40 s/s: report a pop and feel weakness when walking deformity noted proximal to attachment postive Thompson test dx: clinical, MRi for surgical planning tx: plantar flexion cast 8-12 weeks
36
avulsion fx
avulsion of 5th fx, inversion of foot causes a chip fx s/s: pain/ ecchymosis at base of 5th MT dx: xray tx: hard shoe or cast w/ rapid return to wt. bearing
37
stress fx
repetitive stress lead to bony resorption before new bone can be placed. s/s: pain over bone without history of trauma fx usually occur at tibia metatarsal, calcaneus or sacrum dx: clinical X-ray not + for 3-4 weeks bone scan or MRi tx: rest, activity modifiations or not-wt bearing for 4-8 weeks