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Clinical Medicine I > MSK Treatments > Flashcards

MSK Treatments Flashcards

1
Q

Principles of Immobilization

A 
Maintain Anatomic Position
Prvent movement of fracture
Protect from further injury
Limit neuro injuries
Pain control
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2
Q

Methods of Immobilization

A 
Splinting
Casting
CRPP
Open Reduction Internal Fixation (ORIF)
External Fixator
Intramedullary Rodding
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3
Q

Strain/Sprain

A 
RICE
Splinting
NSAIDs
Early ROM
PT
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4
Q

Dislocation

A 
Analgesia
Reduce
Splint for Pain relief
Gentle ROM
Follow up for further evaluation
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5
Q

Tendinitis

A 
Rest and avoid strenuous activity
Ice cube massages for 15 min.
Brace
Naproxen (NSAID)
PT
Cortisone
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6
Q

Ligament Rupture

A 
Splint/immobilization
Ice
NSAIDs
Repair/Reconstruction
Early ROM
PT
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7
Q

Orthopedic Pain Management

A 
Splint/cast
Ice/Cryocuff
NSAIDs
Acetaminophen
Narcotics
Steroids
Topicals
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8
Q

What is the dose for Acetominophen?

A

325-650 mg every 4-6 hours

Max dose is 4g/day and 3g/day if alcoholic or liver disease

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9
Q

What is the best NSAID to use?

A

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

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10
Q

What are the topical analgesics most commonly used?

A

Diclofenac Rx

Absorbine OTC

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11
Q

What is the dose of corticosteroid injection for large joint?

A

1 mL of 80mg Depo-Medrol, 2mL of 1% lidocaine without epi, and 2mL of 0.25% Marcaine

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12
Q

What is the dose of corticosteroid injection for medium joint?

A

1 mL of 80mg Depo-Medrol, 1mL of 1% lidocaine without epi, and 2mL of 0.25% Marcaine

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13
Q

What is the dose of corticosteroid injection for small joint?

A

0.5 mL of 80mg Depo-Medrol and 0.5mL of 1% lidocaine without epi

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14
Q

Clavicle Fracture

A 
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
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15
Q

AC Joint Injury

A

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

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16
Q

SC Joint Dislocation

A

Posterior –> Repair

Anterior –> None

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17
Q

Proximal Humerus Fracture

A 
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

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18
Q

Shoulder Dislocation and Instability

A

Acute –> Reduce ASAP
Sling for 2 weeks with pendulum exercises
Early pT

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19
Q

Impingement Syndrome

A 
Conservative:
Activty modification
PT
NSAIDs
Corticosteroid injections

Surgical:
Arthroscopic acromioplasty with coracoacromial ligament release
Bursectomy
Debridement or repair of RC tears

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20
Q

Rotator Cuff Tear

A

PT
Partial tears will heal on own

Full thickness –> Surgery
Immobilization
Passive ROM by PT
Active ROM may begin after 4-6 weeks

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21
Q

SLAP Lesion

A

1 –> none

2 and 3 –> surgery

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22
Q

Adhesive Capsulitis

A

NSAIDs to decrease inflammation
Frequent PT
Intra-articular corticosteroids
Surgery –> manipulation under anesthesia and arthroscopic release

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23
Q

Calcific Tendonitis

A

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

24
Q

Midshaft Humerus Fracture

A

Non-surgery in older patients
Surgery required in emergent cases –> ORIF but no IM rod
Initial placement of sugar tong splint

25
Q

Radial Head Fracture

A

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
26
Q

Olecranon Fracture

A

ORIF with tension band

ORIF with plate and screw fixation

27
Q

Elbow Dislocation

A 
Closed Reduction for simple dislocation
ORIF for complex fracture dislocation 
Long arm posterior splint/sling for 1-2 weeks
Analgesics
PT
28
Q

Epicondylitis

A 
Rest and avoid strenuous activity
Ice Cube massages
Brace at m. bellies
NSAIDs
PT
Cortisone is last resort
29
Q

Both Bones Forearm Fracture

A

Sugar-tong splint in ED
Casting for nondisplaced
ORIF for displaced

30
Q

Colles Fracture

A

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

31
Q

Hip Arthritis

A

NSAIDs and/or Tylenol
Activity modification
PT
Ambulatory assistive devices like cane or brace
Intra-articular cortisone injection under Fluoro
Total Hip arthroplasty

32
Q

Knee Arthritis

A

Same as hip except it is total knee arthroplasty

33
Q

Hip Fractures

A

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

34
Q

Grade I and II stable femoral neck fracture

A

Internal fixation with head preservation

35
Q

Stage III and IV femoral neck fracture

A

Arthroplasty

36
Q

Intertrochanteric Hip fracture

A

IM Nailing

DHS Compression Screw

37
Q

Subtrochanteric Hip fracture

A

IM Nailing/Rodding

38
Q

Greater Trochanteric Bursitis

A

Ice
NSAIDs
PT
Corticosteroid Injection under fluoro

39
Q

Femur Fracture

A

Address life threatening injuries –> may need Ex-fix first
IM nailing
NARCOTICS and anticoagulation
PT

40
Q

Tibial Plateau Fracture

A

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

41
Q

Segond Fracture

A

Cancellous screw

Correct anterior rotational instability of ligaments

42
Q

Patella Fracture

A

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

43
Q

Quad Tendon Rupture

A

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

44
Q

Patella Tendon Rupture

A

Conservative:
Partial diruption only
Immobilization in hinged knee brace for 4-6 weeks

Complete tears require surgery

45
Q

Maisonneuve Fracture

A

Stabilize the knee and fix ankle fracture

46
Q

ACL Tear

A

Reconstruction with ACL graft from cadaver, or patients own hamstring or achilles

Patient may defer surgery

47
Q

Medial Collateral LIgament Tear

A

RICE
Gentle, NWB ROM 3-5 days afer
Hinged knee brace to protect medial/lateral ambulation + crutches for 4-6 weeks
PT

48
Q

Patella Femoral Syndrome

A

Activity modification with PT
NSAIDs
Patella brace (doesn’t have bars)
resolves within 4-6 weeks

49
Q

Meniscus Tear

A

Arthroscopy of knee
Protected WB with gentle ROM 6 weeks after surgery if young patient
Menisectomy in older patients –> WB after surgery

50
Q

Tibia Fracture

A

Midshaft = unstable and needs IM Nail fixation
Multi-trauma = Ex-fix then surgery
Fibula is not treated if Maisonneuve

51
Q

Ankle Fracture

A

Stable –> Tall walking boot or cast with crutches

Unstable –> ORIF

52
Q

Ankle Sprain

A 
RICE for first couple of days
NSAIDs
Early ROM
PT
Splint in ER or office and send to ortho
53
Q

Calcaneous Fracture

A

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

54
Q

5th Metatarsal Avulsion Fracture

A

Conservatively
Short boot
Oxycodone and supplement with OTC Tylenol

55
Q

Jones Fracture

A

2 + months to heal
Displacement –> NWB cast for 6-8 weeks
Internal fixation or bone graft may be required if non-union occurs

56
Q

Plantar Fasciitis

A 
Night Splint
Ice
NSAIDs
PT
Corticosteroid Injections
57
Q

Achilles Tendon Rupture

A

Non-operative –> sedentary/frail patient; heel lift and short boot

Operative –> end to end achilles repair

Clinical Medicine I (15 decks)

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