Musculoskeletal injuries Flashcards
1
Q
acute fracture
A
bone fracture due to sudden impact of large force exceeding strength of the bone
2
Q
stress fracture
A
bone fracture due to repetitive sub maximal stresses; bone gradually breaks down more quickly than the body can repair it
3
Q
pathologic fracture
A
bone fracture due to normal forces acting upon diseased bone
4
Q
red flag signs for fracture
A
bleeding with/without bone fragments (open fracture - orthopedic emergency), bony point tenderness, pain with loading bone
5
Q
hot, swollen, red, extremely painful (esp. with passive motion) joint - r/o?
A
septic joint
6
Q
night pain - r/o?
A
tumor
7
Q
deformity/loss of motion - r/o?
A
dislocation and/or fracture
8
Q
rapidly progressing neurologic changes in forearm or leg - r/o?
A
compartment syndrome, esp. when accompanied by pallor, weak/absent pulse, pain with passive motion
9
Q
pain with passive motion - r/o?
A
septic joint, compartment syndrome
10
Q
significant, sudden onset of limb swelling, pain, and bluish skin changes - r/o?
A
deep vein thrombosis
11
Q
point bony pain and bleeding - r/o?
A
open fracture
12
Q
morning stiffness, better with rest - suspect?
A
arthritis
13
Q
pain only with active motion (or resistance) - suspect?
A
muscle or tendon injury
14
Q
pain with both active and passive motion - suspect?
A
articular injury/damage
15
Q
weakness - suspect?
A
muscle or tendon injury
16
Q
joint instability - suspect?
A
ligament injury
17
Q
joint locking - suspect?
A
loose body or cartilage injury
18
Q
basic strength grading scale
A
5 = normal 4 = weak 3 = can only move against gravity 2 = can move, but not against gravity 1 = muscle contraction, but no motion 0 = no contraction
19
Q
basic reflex grading scale
A
4+ = clonus 3+ = hyperactive, but no clonus 2+ = normal 1+ = hypoactive 0 = absent
20
Q
pulse intensity grading scale
A
0 = absent 1+ = faint, but detectable 2+ = diminshed 3+ = normal 4+ = bounding
21
Q
shoulder abductors
A
deltoid, supraspinatus
22
Q
shoulder adductors
A
pec major, latissimus dorsi
23
Q
shoulder flexors
A
deltoid, coracobrachialis
24
Q
shoulder extensors
A
latissimus dorsi, teres major, deltoid
25
shoulder external rotators
infraspinatus, teres minor
26
shoulder internal rotators
pec major, latissimus doors, teres major, subscapularis
27
scapular elevators
trapezius, levator scapulae
28
scapular retractors
rhomboids
29
scapular protractors
serratus anterior
30
painful arc of abduction - suspect?
pain during 80-150 deg. - rotator cuff injury
| pain after 150 deg. - AC injury
31
full can test
tests supraspinatus
32
liftoff test
tests subscapularis
33
apprehension test
tests for joint laxity/dislocation of shoulder
34
sensory innervation of lateral shoulder
axillary n.
35
sensory innervation of lateral forearm
musculocutaneous n.
36
elbow valgus stress test
tests ulnar collateral ligament
37
Tinel's sign
tapping over the median nerve in the carpal tunnel; replicates radicular pain in carpal tunnel syndrome
38
Phalen's sign
holding wrists back-to-back in full flexion; replicates radicular pain in carpal tunnel syndrome
39
AC sprain signs
pain with overhead motions, deformity of superior shoulder, positive cross-chest test, painful arc of abduction over 150 deg.
40
AC ligament injury grading
grade I - AC ligament stretch
grade II - AC ligament tear and CC ligament stretch
grade III - complete tears of both AC and CC ligaments (may or may not require surgery)
grade IV+ - complete tears of both AC and CC ligaments and clavicular displacement (requires surgery)
41
shoulder dislocation treatment
usually sling, surgery for adolescent/high-level athletes; early mobilization and physical therapy for recurrent, non-traumatic dislocations
42
signs of rotator cuff injury
positive impingement tests (Neer's test, empty can test, Hawkins test), abduction weakness, painful arc of abduction (80-120 deg.), tender at insertion of supraspinatus on greater tuberosity of humerus; non-operative for minor injuries, surgical for large tear or youth/athlete
43
signs of adhesive capsulitis
AKA frozen shoulder; painful, stiff shoulder, previous shoulder injury, limited passive and active ROM (esp. on external rotation)
44
signs of medial epicondylitis
AKA "golfer's elbow"; caused by overuse of wrist flexors; painful medial elbow with secondary weakness, tenderness over medial epicondyle, pain with resisted wrist flexion and forearm pronation
45
signs of lateral epicondylitis
AKA "tennis elbow"; caused by repetitive extension; pain over lateral elbow radiating into forearm, weakness (advanced), tenderness over lateral epicondyle, pain with resisted wrist dorsiflexion and middle finger extension
46
signs of scaphoid fracture
FOOSH, tenderness in anatomic snuffbox; may require MRI, CT, or bone scan
47
signs of carpal tunnel syndrome
tingling and pain in median nerve distribution, worse at night, positive Tinel's sign, positive Phalen's sign, sensory loss of radial 3 1/2 fingers, thenar eminence atrophy, weakness of abductor policies braves and opponens, loss of 2-point discrimination
48
signs of wrist ganglion
caused by overproduction of fluid by a joint/tendon sheath; firm, mobile lump, occasional pain
49
apophysitis
irritation (rarely, avulsion) due to overuse/repetitive stress of growth plate; occurs because tendon/ligament is stronger than growth plate; may occur on patellar tendon insertion (Osgood Schlatter), achilles insertion (Sever's), patellar tendon origin on inferior patellar pole (Sinding-Larsen-Johansson), sartorius/ASIS, rectus femoris/AIIS, medial epicondyle (little leaguer's elbow); treated with relative rest
50
signs of ankle sprain
forced ankle inversion, positive anterior drawer test, squeeze test (squeeze tibia and fibula together mid-shaft, pain at ankle is positive for high ankle sprain, pain at knee is positive for proximal fibula fracture associated with ankle injury), external rotation test
51
signs of ulnar collateral ligament sprain
pain on valgus stress in 20 deg. of flexion (throwing athletes more common)
52
back pain with history of cancer - r/o?
malignancy
53
back pain with unexplained weight loss - r/o?
malignancy
54
back pain with loss of bowel or bladder control - r/o?
myelopathy or stenosis
55
back pain with significant weakness - r/o?
myelopathy or radiculopathy
56
back pain with saddle anesthesia - r/o?
myelopathy or cauda equina syndrome
57
back pain with hx of trauma - r/o?
fracture
58
back pain with chronic corticosteroid use - r/o?
compression fracture
59
back pain with immunosuppression - r/o?
infection
60
back pain with fever - r/o?
infection
61
back pain with IV drug use - r/o?
infection
62
back pain with prior spine surgery - r/o?
hardware failure, adjacent segment disease, recurrent disc herniation
63
back pain with weakness and/or numbness - suspect?
nerve involvement
64
back pain with morning stiffness that improves with activity but not with rest (pt
spondyloarthropathy
65
spondylolysis
fracture of the pars interarticularis
66
spondyloisthesis
anterior displacement of one vertebrae on another
67
spinal level landmarks
```
hyoid bone - C3
thyroid cartilage - C4-5
first cricoid ring - C6
most prominent spinous process - C7
top of iliac crest - L4-5
PSIS - S2
```
68
Hoffman sign
passive rapid flexion of middle finger distal phalanx; positive test is flexion of thumb, index finger; sign of upper motor neuron process (pathological reflex)
69
straight leg raise test
lying supine, leg is raised with knee extended; positive test is reproduction of radicular symptoms with hip flexed between 30-70 deg.
70
femoral stretch test
lying prone, knee is flexed to 90 deg. and thigh elevated; positive test is reproduction of anterior thigh radicular symptoms
71
Spurling test
neck is placed in extension and rotation away from affected side; positive test is reproduction of ipsilateral radicular symptoms with axial pressure
72
Lhermitte test
positive test is production of electrical shock sensation in limbs with cervical flexion
73
signs and treatment of lumbar strain
low back pain after acute injury (lifting/twisting), localized muscle tenderness, reduced ROM; treatment includes rest, NSAIDs, muscle relaxant, PT
74
signs and treatment of facet joint osteoarthritis
low back pain with gradual onset (cervical is worse with extension, lumbar is worse with standing/walking), pain provoked with active extension/relieved with flexion; treatment includes NSAIDs, mild analgesics, PT, possibly facet joint injections; either no imaging or plain X-rays
75
signs and treatment of radiculopathy
pain/numbness/weakness in limb (lumbar: worse sitting/flexion, better standing/extension), SLR or Spurling positive, neurologic deficits, commonly caused by herniated disc; treatment includes relative rest, physical therapy, surgical discectomy (if progressive/severe), NSAIDs, oral or epidural corticosteroids, limited opioids, neuromodulators
76
signs and treatment of lumbar stenosis
progressive back and leg pain (worse when standing/walking, better when sitting), shopping cart sign, flexed standing posture, reduced lumbar lordosis; caused by narrowing of the spinal canal; treatment includes NSAIDs, neuromodulators, PT, use of walker, epidural steroids, surgery for lumbar decompression (MRI, possibly CT or EMG)
77
signs and treatment of cervical myelopathy
caused by cervical canal stenosis with spinal cord compression; pain, numbness, weakness in arms and/or legs, balance and gait difficulties, bowel/bladder dysfunction, upper motor neuron signs; treatment includes MRI, surgical decompression
78
signs and treatment of compression fracture
usually anterior vertebral body wedge fracture of T10, T11, T12, or L1; sudden thoracic or lumbar pain, little to no trauma, hx of osteoporosis, tender over spinous processes, paraspinals, worse in lumbar flexion/better in extension; r/o malignancy/multiple myeloma in young pts; treatment includes plain X-rays, MRI, or CT, consider bracing, PT
79
signs and treatment of ankylosing spondylitis
80
signs and treatment of cauda equina syndrome
leg pain, numbness, weakness, saddle anesthesia, bowel/bladder dysfunction, reduced/absent reflexes, decreased rectal tone; may be caused by large herniated disc compressing cauda equina, epidural tumor, abscess, or hematoma; treatment is surgical emergency
81
lower extremity inability to bear any weight - r/o?
fracture or dislocation
82
hip adductors
adductor longus, adductor brevis, adductor magnus, gracilis
83
hip abductors
gluteus medius, gluteus minimus, tensor fascia latae
84
hip flexors
iliopsoas, rectus femoris, sartorius
85
hip extensors
gluteus maximus, biceps femoris, semimembranosus, semitendinosus
86
hip internal rotators
adductor longus, adductor brevis, adductor magnus, tensor fasciae latae, gluteus medius, gluteus minimus
87
hip external rotators
gluteus maximus, piriformis, gemellus superior, gemellus inferior, obturator internus, quadratus femorus, obturator externus
88
signs and treatment of slipped capital femoral epiphysis
overweight early adolescent, groin/knee/anteromedial thigh (may be bilateral, but not simultaneously), worse with activity; treatment includes plain x-rays, surgical fixation
89
signs and treatment of transient synovitis of the hip
kids age 3-10, viral/post-vaccine/drug-induced, pt holds hip slightly flexed and refuses to bear weight, any motion causes pain; treatment includes labs (sed rate and mild leukocytosis), NSAIDs for 1-3 weeks
90
signs and treatment of septic joint
caused by gonorrhea or skin flora; swollen, extremely painful knee, passive and active ROM very painful, red/hot knee, systemic signs (may be absent in diabetic or immunosuppressed pt); treatment includes surgical I&D followed by IV Abx
91
signs and treatment of patellar dislocation
cutting with active quadriceps contraction, immediate pain and swelling, ecchymosis, effusion, positive apprehension test; usually lateral dislocation; treatment includes PT, eventual surgery if recurrent
92
signs of ACL strain
twisting, non-contact, deceleration or hyperextension injury, pop and rapid effusion acutely, instability, positive Lachmann (drawer test at 20-30 deg. of flexion)
93
signs and treatment of meniscal tear
twisting on a loaded knee, degenerative tears in older pts, locking and effusion, pain over joint line, pain with circumduction tests (i.e. McMurray); treatment includes PT and rest if no locking occurs, surgery if locking occurs
94
signs of compartment syndrome
6 P's: pain out of proportion, paresthesia, poikilothermia (coolness), paralysis, pallor, pulselessness; compartment pressure > 30 mmHg is diagnostic, compartment release usually required with pressure > 40 mmHg, definitely required with pressure > 60 mmHg
95
signs and treatment of achilles tendon rupture
middle-aged male injured while playing basketball, heard "pop," difficulty walking, defect in achilles, pain and weakness with plantar flexion; treatment includes immobilization or surgery
