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AHN 577 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What are the physical exam findings associated with neuromuscular injury with fractures.

A 
Pain over fracture site
Deformity
Crepitus
Swelling
Bruising
Decreased range of motion
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2
Q

Open fracture

A

“compound” skin is not intact
-most likely will need surgery, debridement and antibiotics
For first 24 hours- cefazolin or vancomycin for PCN allergy

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3
Q

Fracture care

A

Splinting- Watch for compartment syndrome from splint
Pain control
Tetanus- open fractures

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4
Q

Typical findings with fracture and who they are present in

A

*

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5
Q

Gustilo classification for open fractures type 1

A

Open fracture with a skin wound < 1 cm in length and clean

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6
Q

Gustilo classification for open fractures type II

A

Open fracture with laceration > 1 cm in length without extensive soft tissue damage, flaps, or avulsions

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7
Q

Gustilo classification for open fractures type III

A

Open segmental fracture wound with extensive soft tissue injury

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8
Q

Gustilo classification for open fractures type IIIa

A

Adequate soft tissue coverage

“Adequate”

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9
Q

Gustilo classification for open fractures type IIIb

A

Significant soft tissue loss with exposed bone that requires soft tissue transfer to achieve coverage
“Bone”

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10
Q

Gustilo classification for open fractures type IIIc

A

Associated vascular injury that requires repair for limb preservation
“Circulation”

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11
Q

Closed fracture

A

“simple” skin is intact

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12
Q

Nondisplaced fracture

A

The bones remain aligned

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13
Q

displaced fracture

A

The bones are no longer aligned

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14
Q

Transverse fracture

A

Across the bone

Often caused by tension

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15
Q

Oblique fracture

A

At an angle across the bone

Often caused by compression

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16
Q

Butterfly fracture

A

Transverse which fractures into a wedge

Often caused by bending

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17
Q

Spiral fracture

A

Fracture around the bone

Often caused by torsion

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18
Q

Longitudinal fracture

A

Fracture occurs along the axis of the bone

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19
Q

communinuted fracture

A

Break of bone or splinter into more than two fragments

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20
Q

Segmental

A

Two fracture lines which together isolate a portion of the bone
Usually affect the diaphysis

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21
Q

Impacted

A

When one portion is driven into another portion of the bone

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22
Q

Astelette

A

When the lines of the break radiate from the site of injury

i.e. skull fracture

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23
Q

Avulsion

A

Injury to the bone where a tendon or ligament attaches to the bone and is torn off with injury

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24
Q

Mal-union

A

Healing in an unsatisfactory position

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25
Q

Non-union

A

Failure to heal

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26
Q

Subluxation

A

Partial dislocation

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27
Q

Pathologic

A

Weakened areas of bone

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28
Q

Stress

A

Occur in lower extremity with repetitive trauma

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29
Q

Greenstick

A

Usually in children- incomplete fracture

Angulated fracture on only one side of bone

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30
Q

Torus

A

buckling of the cortex

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31
Q

Dislocations

A

Disruption of the normal relationship of the articular surfaces of the bone that make up a joint

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32
Q

Subluxation

A

Is an incomplete dislocation

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33
Q

Neuromuscular checks with fractures includes

A

Checking distal pulses
Checking capillary refill
Checking the motor function of the extremity
Testing the sensation of the extremity include two point discrimination distal to the site

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34
Q

You should splint the fracture “where it lies” unless…

A

The limb is neurovascularly compromised then you should splint it after you reduce it

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35
Q

Compartment syndrome diagnosis

A

6 P’s
Pain (out of proportion to injury, with passive stretching)
Pallor
Pulselessness
Parasthesias
Paralysis
Poikilothermia (inability to regulate temperature)

Most are late findings

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36
Q

Compartment syndrome Care

A 
Consult surgery 
May check compartment syndrome
Fasciotomy (definitive treatment)
Decrease restriction
Limb positioning at the heart
Pain control
NV checks
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37
Q

Why does compartment syndrome occur?

A

Compromised blood flow causing increased hydrostatic pressure in closed spaces, ischemia develops because of inability to meet catabolic demands, this leads to compartment pressure increase. Venous return decreased, pressure rises. Blood shunting away from intracompartmental tissue, This causes arterial collapse which leads to increased edema

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38
Q

Other findings in compartment syndrome

A

Elevated WBC > 14000
Elevated CK, CRP
Myoglobinuria
Elevated LDH (cell damage)

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39
Q

What is the delta pressure?

A

Diastolic blood pressure- compartment pressure

If this is less than 30 than you have Acute compartment syndrome

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40
Q

You have capillary compromise when

A

Tissue pressure is within 25-30 of MAP

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41
Q

How to diagnose a shoulder dislocation?

A

Xray

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42
Q

Brachial Plexus nerves originate from…

A

C5-T1

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43
Q

Humerus fracture PE findings

A

Referred shoulder pain
Hold arm adducted
Possible crepitus
Mid shaft arm pain

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44
Q

Axillary nerve damage manifests as

A

Deltoid weakness

Diminished sensation over deltoid region

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45
Q

Suprascapular nerve damage manifests as…

A

Supraspinadous (abduction) or infraspinadous (external rotation) muscle weakness

46
Q

If you see wrist drop you should be thinking…

A

Midshaft humerus fracture

radial nerve dysfunction

47
Q

How to test for radial nerve dysfunction

A

Thumbs up sign
Thumbs up sign against extension resistance
Check the dorsum of the hand between the thumb and finger for sensory loss

48
Q

How to test for median nerve dysfunction

A

Try to maintain an OKAY sign against resistance

rare

49
Q

How to test for ulnar nerve dysfunction

A

Peace sign, try to push fingers together

50
Q

How to test for ulnar nerve dysfunction

A

Peace sign, try to push fingers together

Check for sensation of the palmar aspect of the fifth finger

51
Q

Humerus fracture treatment

A

Splint
Ortho follow up in 3-4 days
young patients or multiple fractures may need ORIF

52
Q

Elbow injury is at risk for…

A

Medial, Ulnar, Radial nerves

Brachial artery injury

53
Q

Presentation of elbow injury

A

Arm will be at flexion

Moderate amount of swelling

54
Q

Radial head fractures presentation

A

Pain with supination or pronation
Limited range of motion
Pain over radial head

55
Q

Elbow dislocation presentation

A

Holding the elbow at 45 degrees with visible deformity

56
Q

Elbow dislocation are at risk for

A

Brachial artery injury

Median nerve injury

57
Q

Lateral epicondylosis symptoms

A

Pain with arm and wrist extended

“tennis elbow”

58
Q

Medial epicondylosis symptoms

A

Pain during repetitive wrist pronation

“golfers elbow”

59
Q

Bursitis can occur..

A

Over any bony prominence (joint) with a bursa

Can be inflamed due to trauma, infection, arthritis

60
Q

Bursitis presentation

A

Focal tenderness
swelling
not likely to have ROM difficulty
Can have septic bursitis in afebrile patient

61
Q

Septic bursitis is ruled out with

A

Aspiration of fluid
Gram stain and culture
High WBC
Staph aureus most common

62
Q

Treatment for bursitis is..

A

Rest
Heat
NSAIDS
local corticosteroid injections

63
Q

Mechanism of forearm fractures..

A

direct blow

fall onto outstretched arm

64
Q

Findings for different locations

A

Proximal fracture- swelling, inability to flex or extend the elbow
Midshaft fracture- some swelling, tenderness on pronation and supination
Distal fracture- deformed wrist with inability to flex or extend

65
Q

Treatment nondisplaced

A

Conservative treatment splints and ortho follow up

66
Q

Carpel tunnel syndrome mechanism

A

entrapment of the medial nerve

67
Q

Carpel tunnel symptoms

A

pain, burning and tingling in the distribution of the median nerve

68
Q

Treatment of carpel tunnel symptoms

A

Trial splinting
Trial NSAIDS
Need release surgery if EMG test is positive

69
Q

When to refer for carpel

A

Muscle atrophy or weakness
Pain that persists after conservative treatment
Symptoms > 3 months

70
Q

Risk factors for osteonecrosis

A 
Steroids
alcohol
sickle cell
Lupus
Prior trauma
decompression disease
71
Q

Trendelenberg test for hip

A

Tests for weakness or instability

Balance on one leg, raise non standing leg to chest

72
Q

Hop or jump test

A

Try to hop or jump on the leg

73
Q

Internal rotation

A

most sensitive for articular pathology

74
Q

MCL purpose

A

Stabilize for stress towards the midline

75
Q

LCL purpose

A

Stabilizes for forces away from the midline

76
Q

ACL and PCL purpose

A

anterior and posterior displacement of the knee

77
Q

Meniscus injury

A

Pain with deep squatting

78
Q

Lachman test

A

Patient lays supine

with knee in neutral position hold femur steady and lift tibia anteriorly

79
Q

Anterior draw test

A

Lay supine
knee 90 degrees
sit on foot, grab foot and pull forward

80
Q

Pivot shift test

A

Lay supine
Knee in full extension
slowly flex while you apply internal rotation

81
Q

Valgus stress

A

Supine
outside of patient
MCL

82
Q

Varus stress

A

*

83
Q

Posterior drawer test

A

*

84
Q

McMurray test

A

*

85
Q

Knee dislocation

A

Can not be manually reduced, patient will need to go to the OR

86
Q

Ottawa ankle rules

A

A series of ankle radiograph films is required if there is any pain in the malleolar zone and any of these findings:
Bone tenderness at the the posterior edge of the lateral or medial malleolus
inability to bear weight

87
Q

Talar fractures are at higher risk for…

A

Osteonecrosis
infection
arthritis
problems with healing

88
Q

L1 radiculopathy

A

Rare and uncommon

89
Q

L2,L3,L4

A

Weakness of hip flexion, knee extension, and hip adduction

90
Q

L5

A

Most common

Decreased strength in foot dorsiflexion, toe extension, foot inversion, and foot eversion

91
Q

S1

A

Weakness of leg extension and knee flexion

Decreased sensation of the posterior leg

92
Q

S2,S3,S4

A

Less common
Minimal weakness but could have urine or fecal incontinence
Bowel and bladder incontinence

93
Q

Straight leg test

A

Can determine nerve root compression
and if the symptoms are radicular in nature
L5-S1

94
Q

Risk factors for OA

A

Disease of aging

Obesity (knee)

95
Q

Risk factors for RA

A

*

96
Q

Risk factors for gout

A

Men 90% of time
Recurring arthritis from uric acid deposits
Hyperuricemia
Meds- diuretics, aspirin, cyclosporin, niacin
Diseases- sickle cell, CKD, hyperthyroid, sarcoidosis, lead poisoning

97
Q

Risk factors for osteoporosis

A

*

98
Q

Characteristics of OA

A

Joint stiffness
Pain worse with activity
Affects small distal joints most in asymmetrical pattern
Spares the wrist

99
Q

Characteristics of RA

A

*

100
Q

Characteristics of Gout

A

Inflammatory reaction to uric acid crystals
Sudden onset
Happens at night

101
Q

Synovial fluid finding based on disease

A

*

102
Q

PE findings of OA

A

Limited ROA
crepitus
Negative ESR

103
Q

Imaging findings of OA

A

Osteophyte formation

Joint space narrowing

104
Q

Treatment and prevention of OA

A

Prevention: weight loss, vitamin D
Treatment: Exercise, weight loss, tylenol, NSAIDS, Topical capsaison (best in hand), intra-articular joint injections
surgical options

105
Q

PE findings of RA

A

*

106
Q

Treatment of RA

A

*

107
Q

PE findings of Gout

A 
HOT
Tender
Red
Systemic fever common
Pruritis with recovery
108
Q

Prevention and treatment of gout

A 
NSAIDS
Colchicine
Corticosteroids
Diet- No beer, steaks
Med changes
Reduction in uric acid
Colchicine prophylaxis
109
Q

OA

A

Degenerative disorder with minimal inflammation
no systemic symptoms
pain relieved by rest, morning stiffness
Narrow joint space and osteophyte formation

110
Q

Diagnostics in gout

A 
Labs: 
Uric acid levels- not always elevated
Leukocytosis- Inflammatory response
Sodium urate crystals on arthrocentesis
Radiograph:
No changes early in disease
111
Q

Pseudogout

A

Looks like gout but you find calcium pyrophosphate crystals on arthrocentesis

AHN 577 (4 decks)

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