Musculosckeletal Flashcards
Presentation of hip fracture
Shortened and externally rotated leg
also seen with femoral fracture
Treatment of Hip fracture
Open reduction and internal fixation with parallel pinning of the femoral neck
how do fat emboli present and what causes them
Caused by femoral fracture
presentation: fever, AMS, dyspnea, hypoxia, PETECHIA, THROMBOCYTOPENIA
Presentation of anterior and posterior shoulder dislocation
anterior dislocation= Axillary artery and nerve: ABduction and external rotation of arm
posterior dislocation= Radial artery and nerve: ADDuction and internal rotaion
colle’s fracture
Fall on an outstretched hand.
involves the distal radius
Tx: closed reduction + long arm cast
Scaphoid fracture
tenderness in the anatomical snuff box
Tx: thumb spica cast/ open reduction
Boxers fracture
fifth metacarpal neck injury
closed reduction + ulnar gutter splint
humerus fracture
radian nerve injury: wrist drop and loss of thumb abduction
achilles tendon rupture presentation and physical exam
sudden “pop” like a rifle shot
exam shows: limited plantar flexion
treatment of Achilles tendon rupture
treat surgically followed by long leg cast for six weeks
femoral fracture: treament
primary arthroplasty (due to increased risk of AVN) open reduction and internal fixation
bursitis: presentation and treatment
presents with localized tenderness, decreased ROM, edema and erythema
Tx: rest, heat and ice, NSAIDs and steroid injections
tendinitis presentation
presents with swelling and impaired function, pain and the site of insertion.
worse with repetitive stress and resisted strength testing of the affected muscle group.
tendinitis: most common location
supraspinatus, Biceps, wrist extensors, patella, achilles tendons
tendinitis: treatment
rest, NSAIDs, ice
splinting or immobilization
if no improvement: steroid/lidocaine injections
Antibiotics that cause tendinitis and tendon rupture
Fluoroquinolones
herniated disk diagnosis
positive straight leg test
MRI used for confirmation
spinal stenosis presentation
neck and back pain that radiates to the buttocks and legs
+ leg numbness and weakness
worse with sitting, standing and walking uphill
spinal stenosis: diagnosis
MRI/ CT of spinal cord
spinal stenosis treatment
NSAIDs and abdominal muscle strengthening
Epidural corticosteroid injections
surgical laminectomy
most common site of osteosarcoma
distal femur and proximal tibia
osteosarcoma is a risk factor for what disease?
Paget’s Disease
diagnosis of osteosarcoma
Codman’s triangle
sunburst pattern
what is the most common benign bone tumor?
osteochondroma
radiographic findings in OA
joint space narrowing
osteophytes
subchondral sclerosis
subchondeal bone cyst
duchenne muscular dystrophy: diadnosis
negative dystrophin immunostain and increased CK level
EMG: polyphasic potentials
most accurate: muscle biopsy (necrotic muscle fibers)
duchenne muscular dystrophy: treatment
PT
Tendon release surgery
complications of duchenne muscular dystrophy
Pulmonary congestion
high output cardiac failure
cardiac fibrosis = arrhythmias
nursmaids elbow presentation
pain with flexion
radial head subluxation
nursemaid’s elbow treatment
Manual reduction by supination of the elbow at 90 deg of flexion
supracondylar humerus fracture: treatment
cast immobilization and closed reduction
Diagnosis of developmental dysplasia of the hip
mostly through PE
Ultrasound may be helpful
developmental dysplasia of the hip: treament
<6months: splint with a pelvic harness (maintain hip flexed and abducted)
6-15months: Spica cast
15-24months: open reduction followed by spica cast
complications of developmental dysplasia of the hip
joint contractures and AVN of the femoral head
what is Legg-calve-Perthes Disease
AVN of the femoral head
H/P of legg-calve-perthes disease
- painless limp
- if pain in present: usually in the grin and anterior thigh
- limited abduction and internal rotation
treatment of leg-calve-perthes disease
usually self limited (observation)
racing if there is decreased ROM
differential diagnosis of pediatric limp (STARTSS HOTT)
septic joint tumor Legg-calve-perthes RA/JRA tuberculsis sicke cell disease slipped capital femoral epiphysis Henoch-Schonlein purpura osteomyelitis trauma toxic synovitis
what is slipped capital femoral epiphysis (SCFE)?
medial and posterior displacement of the femoral head
due to imbalance between GH and sex hormones
risk factors for SCFE
obesity
age 11-13
male ender
African american
what disorder is SCFE associated with?
Hypothyroidism
H/P: SCFE
- acute thigh and knee pain and PAINFUL limp
- restricted ROm and inability to bear weight
- BILATERAL in 40-50%
- limited internal rotation and abduction of the hip
diagnosis of SCFE
Radiographs: posterior and medial displacement of the femoral head
NEED TO R/O HYPOTHYROIDISM WITH TSH
SCFE: treatment
no weight bearing
closed reduction
scoliosis: treatment
curvature:
50 degees: surgical correction
complication of scoliosis
restrictive lung disease
risk factors for baker’s cyst
osteoarthritis and RA
presentation of Baker’s cyst
swollen calf
palpated cyst behind the knee
Baker’s cyst treatment
NSAIDs and steroid injections
4 muscles involved in rotator cuff injury
Suprapinatus (highest risk of being injured)
infraspinatus- injury causes loss of external rotation
teres minor- injury causes loss of external rotation
subscapularis
presentation of rotator cuff injury
difficulty abducting arm between 60-120 degrees
positive drop test
