MSK/derm Flashcards
Rotator cuff muscle functions
Subscap- internal rotation
infraspinatus/teres minor- externatl rotation
supraspinatus/deltoid- abduction
Indication for surgical release of Dupuytren’s contracture
MCP contracture 30 deg –OR– any degree of contracture of PIP
**intralesional injection may reduce need for surgery in grade I disease
Best test for ACL tear
Lachman more sens/spec than ant drawer
management of achilles tendonopathy
eccentric calf strengthening
When to refer for scoliosis
Cobb angle >20
-potential for future growth, female sex are other considerations
nursemaids elbow
subluxation of head of radius from annular ligament
mgmt of 5th metatarsal fracture
non-displaced tuberosity – aircast, weight bare, exercises
avulsion fracture <3mm displaced – short boot
avulsion >3mm displaced – ortho ref
Dx SI joint dysfunction
+FABER w/ pain in SI joint, lumbar spine, post hip
Dx piriformis syndrome
+ log roll test (passive supine internal and external rotation)
Dx femoroacetabular impingement
+ faber with pain in GROIN
Injection location for rotoator cuff tendonitis
subacromial space– only if interferes with pain and function despite NSAIDs
scabies
likes folds of skin/web spaces eczematous
bed bugs
diffuse, areas oof body where you are not clothed like limbs
T/f steroids can be curative of trigger finger?
TRUE, but not always
not curative for long trm mgmt of other joints
Fibromyalgia tx
SSRI = tricyclics for pain
no effect on sleep or fatigue
cubital tunnel syndrome
peripheral ulnar neuropathy
Causes ulnar nerve dist parasthesias and intrinsic muscle weakness –> difficulty with coordination and weakness
Wartenberg’s syndrome
compression of superficial radial nerve
pronator syndrome
proximal median nerve neuropathy
mgmt of minimally displaced mid clavicular fracture
sling 2-6 weeks, passive ROM when no pain, PT at 4 weeks
**refer if significantly displaced
pharm treatment of ACUTE low back pain (evidence based)
Nsaids OR muscle relaxants (no benefit for both)
Or nonpharm tx- heat, acupuncture, massage, chiro
gottron’s sign
non-palpable macules over extensor surface of joints seen in DERMATOMYOSITIS
jones fx mgmgt
metadiaphyseal fracture of 5th metatarsel
-active patients have shorter healing time and return to activity with surgery
-if non op, then post splint 3-5 days, short walking cast 6 weeks, reimage
immobilization after shoulder dislocation?
3week <30
1 week>30
at risk for adhesive capsulitis
tx of shingles vs post herpetic neuralgia
singles = val/acyclovir
post herpetic neuralgia= gabapentin, can do nerve blocks if two weeks from rash
tx of dequervains tenosynovitis
NSAIDs and thumb spica for 1-4 weeks
- use injection if refractory to above
- pain CAN last up to one year if not tx’d early
when to image low back pain
concern for:
- cauda equina
- cancer (hx of cancer that mets to bone)
- fracture
- infection
HS can be associated with what GI condition
Chrons
dermatitis herpetiformis associated with what GI condition
Celiac disease (and maybe UC)
pruritic grouped vesicles on knees and elbows
Fixed drug eruption
T cell mediated reaction to bactrim or anti-convulsant.
Difference between that and EM is that EM presents as multiple lesions
OA hands vs RA hands
OA: Heberden/Bouchard nodes
RA: MCPs/PIP, ulnar deviation, subcutaneous nodules
Apophysitis diseases
Traction injury to the cartilage and bony attachments of tendons in growing children.
Osgood-Schlatter disease- ant tibial tubercle
Sever’s disease- heel
Sinding-Larsen-Johansson- patella
Tx: stretching, activity modification, icing, NSAIDs.
osteochondrosis disease
Legg calves perthes
effects ossification of femoral head, should avoid weight bearing until heals
generalized hyperpigmentation with insideous onset with accompanying weakness, malaise, nasuea, tc
Addisons
1st and 2nd step for diagnosis of scoliosis in office
1: scoliometer with patient bent at 90 degree
2: if >7 degrees, do Cobb angle on radiograph with patient standing upright
management of NON-displaced radial head fractures
cast for 3 days and early return to ROM
axillary nerve injuries
presentation: shoulder dislocation, humeral neck fracture, crutches
Dec sensation/pain over the lateral shoulder, weakness with shoulder external rotation, abduction, and extension.
first line for tinea versicolor
pityariasis antifungals like selenium sulfade or topical terbinafine
Ottawa knee rule
- > 55
- <4 steps immediately after
- inability to flex to 90 deg
- pain of head of fibula
- isolated patellar tenderness
Pharm for CHRONIC low back pain
NSAIDS, tramadol, duloxetine
Duloxetine= tramadol at 12 mo
Non-pharm tx chronic low back pain
mindfulness based stress reduction, excersice, etc
when to consider surgry for low back pain with radiculopathy
<6 weeks = conservative management
> 6 weeks can consider surgery
Surgery has better outcomes in first 2 years, but equal after that
tx of lumbar spinal stenosis
Apap > Nsaids
PT
associations with adhesive capsulitis
DM, parkinsons
tx of patellofemoral pain syndrome
acitivity modification and PT»_space;» brace
Most sensitive test for capral tunnel
flick sign
(assciations thyroid dz, diabetes, pregnancy, alcoholism, rheumatoid arthritis)
when to do surgery for carpal tunnel
> 6 months of splinting
tarsal tunnel syndrome
-mimics plantar fascitis but no pain on physical exam
-entrapment of post tibial nerve at medial mall
- medial heel pain, burning
- provoked by subtalar pronation
plantar fasciitis tx
night splint for 3 weeks or TC orthotics are best
(PT, stretch, massage, steroid injc, etc)
highest rate of injury and knee injury in highschool sports
football
best test meniscal tear
thessaly
best test MCL
valgus stress
who is most at risk for ACL tar
females, neuromuscular training prevention program is effective
mgmt of ankle sprain
-early mobility is best
-ankle bracing is both primary and secondary prevention
-proprioceptive training is good
cubital tunnel vs guyon’s canal
cubital= ulnar nerve, DORSAL, pitchers
guyons= ulnar nerve, VOLAR, cyclists
xray is the first test but CT is better than MRI for….
tibial plateau
displaced intraarticular distal radial head fracture
management by saltar harris
I + II = immobilization
***II= most common
III= eval for ORIF
IV+ V = surgery because growth arrest
Supracondylar fracture (peds FOOSH): pres, nerves, management
- cant fully extend elbow
-anterior interossueous (“OK”), median, radial - long arm cast x3 weeks > xray»_space; surgery if still displaced
fat pad signs elbow
ant= probable fracture
post= definite fracture
buckle fracture
- MOA= 50% of peds FOOSH
- removable splint/brace for 3 weeks, ok if they don’t follow up
evidence based approach for nurse maids
hyperpronation of forearm
when to refer clavicle fracture
-skin tenting
- NV compromise
- significant displacement
- overriding by >2cm
nerve compromised in scaphoid/distal radius fracture
median nerve, “ok” sign
(displaced ones should be surgically repaired because prone to non-union)
jersey finger
- avulsion of FDP from distal phalynx
- can’t flex DIP
- needs surgery
boutonneire deformity
“jammed finger”
splint PIP in extension for 6 weeks, then night splints 4-6 weeks
ottawak ankle
malleolar pain or navicular/5th met pain
AND
inability to take 4 steps
mgmt oof AC joint injury
I-III= non op in sling for comfort
IV-VI= surgery
