Musculoskeletal Applications (9/15) Flashcards
Pain from overuse causing bony breakdown faster than repair
Stress fractures ( Pain worsens through activity)
Common Location for stress frx
Common locations – tibia, metatarsals Locations with slow healing (& high non-union rates) – navicular, femoral neck, anterior tibia, tension side of femoral neck
Abnormal bony metabolism and remodeling. c. Most common locations: pelvis, femur, skull and lower lumbar vertebrate
Paget’s–
Pagets has what type of effect on bone: both function and structure
May cause affected bone to be structurally weak, painful, misshapen and /or arthritic.
Teenager comes in with pain and swelling in her knee, it sometimes will lock. Has been going on for a few months… No history of trauma. Dx?
Osteochondritis dissecans (OCD)
Who is usually affected by OCD?
a. Occurs mostly in children & adolescents (although it may not become symptomatic until adulthood in some patients.
Tx options for Osteochontritis Disease
Most common locations knee, elbow and joints e. Treatment in young patients –relative rest for 2-4 months i. Surgery for loose fragments and large fragments in older patients
Cause of Osteochondritis Disease
Theoretical etiology – interruption of blood supply to a bony segment of causes it to separate from the surrounding area. This may result in bone section and the cartilage covering it begin to crack and loosen
Young man comes in comes in with pain in his finger. He can’t flex it at the DIP. He was play capture the flag with some ‘bros’ at the park and things go a little rough as he explained he was ‘accidentaly’ grabbing at someones shirt to try and get the flag. Dx?
Finger injuries Jersey finger: Traumatic avulsion of flexor digitorum profundus from distal phalanx
Mechanism of a jersey finger injury?
Mechanism of injury (MOI) - forced passive extension of dorsal interphalangeal (DIP) joint during active flexion of DIP joint
Tx for avulsion of flexor digitorum profundus at distal phalanx?
Treatment – surgical repair
Woman comes in with pain and swelling in the DIP of her index finger. She can no longer actively extend her finger: Pt states she was playing basketball and as she was going up for a rebound and her finger got jammed. What is the Dx?
Mallet finger Traumatic avulsion of terminal extensor tendon from distal phalanx
Mechanism of Injury in a mallet finger?
MOI - forced flexion of the DIP during extension (e.g. ball jamming fingertip)
Tx for mallet finger?
iv. Treatment – immobilization; large displacement or joint involvement may require surgery
Central extensor slip insertion ruptures/Boutonniere deformity Initially causes: Chronically causes:
-loss of full active PIP extension -adjacent lateral band tendons migrate palmarly resulting in characteristic boutonniere deformity – PIP flexion and DIP hyperextension
Patient with history of RA comes to clinic. You are on rotations and you Attending points out that the patient has a Boutonnier deformity of her middle finger. She asks you to explain the tendon and joint involvement and what is the cause:
Disruption of central extensor slip insertion at the base of middle phalanx PIP flexion and DIP hyperextension
What do you see on exam with a pt that has central extensor slip?
With finger bent over table at the PIP and the proximal phalanx held down, the patient attempt to extend finger; normally DIP can be passively extended; abnormal test cannot extend finger and decreased passive DIP flexion
MOI of central extensor slip insertions
iv. MOI – forced passive PIP flexion against active extension (commonly from dorsal PIP dislocation) – resulting in avulsion of central slip
TX options for central extensor slip/Boutonneir deformity
Treatment 1. Closed injury - early PIP splinted in I extension with active DIP exercises 2. Laceration – surgical repair
Common causes of swan necking in fingers:
ii. Usually caused by volar plate disruption iii. Often related to rheumatoid arthritis
