MSK Flashcards
AC injury
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
clavicle fx
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
rotator cuff disorders
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
biceps tendonitis
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
proximal humerus fx
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.
shoulder dislocations
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
tennis elbow ( lateral epicondylosis)-
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
medial epicondylosis
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
suprcondylar fx
-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
radial head fx
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
colles fx
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
scaphoid fx
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
boxer fracture
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
de Quervains tenosynovitis
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
trigger finger
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
carpal tunnel syndrome
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
cervical fx
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
ankylosing spondylitis
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
kyphosis
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
scoliosis
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
LBP
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
herniated disc
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.
cauda equina syndrome
sudden compression of l2-s4 nerve roots
disc herniation, epidural abscess, hematoma
s/s: saddle anesthesia
dx: MRI
tx: emergency tx
spinal stenosis
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
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.
hip fx
d/t fall in elderly woman
femoral neck or IT fx
s/s: leg will be shortened
dx: xray
TX: ORIF
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
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
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
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
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
pre patellar bursitis
housemaid’s knee
s/s: palpable boggy swelling over patella
dx: clinical
tx: RICE, NSAIDS, usually self-limited
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
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:
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
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
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
