MSK Treatments Flashcards
Principles of Immobilization
Maintain Anatomic Position Prvent movement of fracture Protect from further injury Limit neuro injuries Pain control
Methods of Immobilization
Splinting Casting CRPP Open Reduction Internal Fixation (ORIF) External Fixator Intramedullary Rodding
Strain/Sprain
RICE Splinting NSAIDs Early ROM PT
Dislocation
Analgesia Reduce Splint for Pain relief Gentle ROM Follow up for further evaluation
Tendinitis
Rest and avoid strenuous activity Ice cube massages for 15 min. Brace Naproxen (NSAID) PT Cortisone
Ligament Rupture
Splint/immobilization Ice NSAIDs Repair/Reconstruction Early ROM PT
Orthopedic Pain Management
Splint/cast Ice/Cryocuff NSAIDs Acetaminophen Narcotics Steroids Topicals
What is the dose for Acetominophen?
325-650 mg every 4-6 hours
Max dose is 4g/day and 3g/day if alcoholic or liver disease
What is the best NSAID to use?
naproxen 220 mg PO twice a day
Take with food
Analgesic effects begin in 1-2 hours and anti-inflammatory effect begins in 2 weeks of use
2 blue pills, two times a day, for 2 weeks and then PRN
What are the topical analgesics most commonly used?
Diclofenac Rx
Absorbine OTC
What is the dose of corticosteroid injection for large joint?
1 mL of 80mg Depo-Medrol, 2mL of 1% lidocaine without epi, and 2mL of 0.25% Marcaine
What is the dose of corticosteroid injection for medium joint?
1 mL of 80mg Depo-Medrol, 1mL of 1% lidocaine without epi, and 2mL of 0.25% Marcaine
What is the dose of corticosteroid injection for small joint?
0.5 mL of 80mg Depo-Medrol and 0.5mL of 1% lidocaine without epi
Clavicle Fracture
Nondisplaced: Sling Ice NSAIDs Analgesics Passive ROM within 3 days --> pendulum PT after heals
Displaced: ORIF with plate and screw Sling ROM ASAP Analgesics --> narcotics PT
AC Joint Injury
SLing and RICE
Grades 1 and 2 = conservative
Grade 4 or higher = surgery
Surgery –> AC joint stablization with fiation present at origin/insertion of CC ligament
SC Joint Dislocation
Posterior –> Repair
Anterior –> None
Proximal Humerus Fracture
Nondisplaced --> conservative Sling/collar Ice Analgesics Gentle ROM within 2 weeks ROM of elbow/wrist ASAP
Unstable –> ORIF with IM rodding or severe would require total reverse shoulder replacement
Shoulder Dislocation and Instability
Acute –> Reduce ASAP
Sling for 2 weeks with pendulum exercises
Early pT
Impingement Syndrome
Conservative: Activty modification PT NSAIDs Corticosteroid injections
Surgical:
Arthroscopic acromioplasty with coracoacromial ligament release
Bursectomy
Debridement or repair of RC tears
Rotator Cuff Tear
PT
Partial tears will heal on own
Full thickness –> Surgery
Immobilization
Passive ROM by PT
Active ROM may begin after 4-6 weeks
SLAP Lesion
1 –> none
2 and 3 –> surgery
Adhesive Capsulitis
NSAIDs to decrease inflammation
Frequent PT
Intra-articular corticosteroids
Surgery –> manipulation under anesthesia and arthroscopic release
Calcific Tendonitis
Analgesics/Anti-inflammatory meds
PT with US therapy
Arthoscopy with aspiration of mineralized materal but then need to repair rotator cuff tear that was just created
Midshaft Humerus Fracture
Non-surgery in older patients
Surgery required in emergent cases –> ORIF but no IM rod
Initial placement of sugar tong splint
Radial Head Fracture
Treat as non-displaced if fracture cannot be identified but patient has effusion
Long arm posterior splint for 3-4 days Sling for 1-2 weeks Analgesics Gentle ROM Serial radiographs every 2 weeks PT
Olecranon Fracture
ORIF with tension band
ORIF with plate and screw fixation
Elbow Dislocation
Closed Reduction for simple dislocation ORIF for complex fracture dislocation Long arm posterior splint/sling for 1-2 weeks Analgesics PT
Epicondylitis
Rest and avoid strenuous activity Ice Cube massages Brace at m. bellies NSAIDs PT Cortisone is last resort
Both Bones Forearm Fracture
Sugar-tong splint in ED
Casting for nondisplaced
ORIF for displaced
Colles Fracture
Conservative –> Closed Reduction and Sugar tong splint followed by long/short arm cast for 4-6 weeks
Surgery –> ORIF followed by cast/splint for 4-6 weeks
CRPP can also be used
Hip Arthritis
NSAIDs and/or Tylenol
Activity modification
PT
Ambulatory assistive devices like cane or brace
Intra-articular cortisone injection under Fluoro
Total Hip arthroplasty
Knee Arthritis
Same as hip except it is total knee arthroplasty
Hip Fractures
Surgery within 48 hours
Cannulated Screws for nondisplaced femoral neck–> WB time will depend on patient
Hemiarthroplasty for displaced femoral neck or subcapital hip fracture
IM Nail/Compression Screw for intertrochanteric or subtrochanteric hip fractures –> WB next day
Grade I and II stable femoral neck fracture
Internal fixation with head preservation
Stage III and IV femoral neck fracture
Arthroplasty
Intertrochanteric Hip fracture
IM Nailing
DHS Compression Screw
Subtrochanteric Hip fracture
IM Nailing/Rodding
Greater Trochanteric Bursitis
Ice
NSAIDs
PT
Corticosteroid Injection under fluoro
Femur Fracture
Address life threatening injuries –> may need Ex-fix first
IM nailing
NARCOTICS and anticoagulation
PT
Tibial Plateau Fracture
Stable:
Hinged knee brace and crutches
NWB but can do active ROM from seated/lying position
Some may use long-cast
Unstable:
ORIF with side plate and screws
if > 5mm step-off
Segond Fracture
Cancellous screw
Correct anterior rotational instability of ligaments
Patella Fracture
ORIF with tension band wiring
NWB in hinged knee brace locked in extension
May open brace to 20 degrees to allow patient to swing leg through durign crutch walking
Active ROM in brace after 4 weeks and only during PT
Quad Tendon Rupture
SURGERY
Then hold leg to 20 degrees extension and be NWB in locked hinge knee brace
Can transition to partial WB after 6 weeks
Can take up to 1 year to return to normal
Patella Tendon Rupture
Conservative:
Partial diruption only
Immobilization in hinged knee brace for 4-6 weeks
Complete tears require surgery
Maisonneuve Fracture
Stabilize the knee and fix ankle fracture
ACL Tear
Reconstruction with ACL graft from cadaver, or patients own hamstring or achilles
Patient may defer surgery
Medial Collateral LIgament Tear
RICE
Gentle, NWB ROM 3-5 days afer
Hinged knee brace to protect medial/lateral ambulation + crutches for 4-6 weeks
PT
Patella Femoral Syndrome
Activity modification with PT
NSAIDs
Patella brace (doesn’t have bars)
resolves within 4-6 weeks
Meniscus Tear
Arthroscopy of knee
Protected WB with gentle ROM 6 weeks after surgery if young patient
Menisectomy in older patients –> WB after surgery
Tibia Fracture
Midshaft = unstable and needs IM Nail fixation
Multi-trauma = Ex-fix then surgery
Fibula is not treated if Maisonneuve
Ankle Fracture
Stable –> Tall walking boot or cast with crutches
Unstable –> ORIF
Ankle Sprain
RICE for first couple of days NSAIDs Early ROM PT Splint in ER or office and send to ortho
Calcaneous Fracture
Well padded posterior splint to lower extremity
Protected WB with crutches or WC
Analgesics
ORIF delayed 7-10 days to allow for swelling to reduce
5th Metatarsal Avulsion Fracture
Conservatively
Short boot
Oxycodone and supplement with OTC Tylenol
Jones Fracture
2 + months to heal
Displacement –> NWB cast for 6-8 weeks
Internal fixation or bone graft may be required if non-union occurs
Plantar Fasciitis
Night Splint Ice NSAIDs PT Corticosteroid Injections
Achilles Tendon Rupture
Non-operative –> sedentary/frail patient; heel lift and short boot
Operative –> end to end achilles repair
