Musculoskeletal injury clinical correlations Flashcards
If radiographs come back negative, what is the best next test to look for pathology?
MRI (avoids radiation, good to look for soft tissue injury)
What is the pneumonic helpful in forming a differential diagnosis?
**vindicate;
- vascular
- infection
- neoplasm
- drugs
- inflammation/idiopathic
- congenital
- autoimmune
- trauma
- endocrine/metabolic
In what joints are effusions easily diagnosed (via xray)?
- knee
- elbow
- ankle
- wrist
- fingers
Contrast inflammatory arthritis and osetoarthritis
- inflammatory arthritis
- rheumatoid arthritis
- seronegative syndromes (ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
- deposition diseases (gout)
- osteoarthritis
- **degenerative
- osteophytes
- asymmetric joint loss
- predictable pattern
When is it best to order a radiologic test?
When the results will potentially change management options
What are the important characteristics to include when describing a fracture?
- location/orientation
- displacement
- apposition (amount of contact between the fragmented parts)
- angulation (displacement from normal axis)
- intraarticular involvement (involves joint space?)
- comminution (degradation)
- open or closed?
- associate injuries
What are the results of acute and chronic injury?
- acute= inflammation
- chronic= degeneration
What are the problems in ligament, muscle, and tendon injuries?
- ligament= stability issues
- muscle/tendon= active joint motion
Contrast traumatic, pathologic, and stress fractures
- traumatic= high force exceed normal bone strength
- pathologic= normal force exceed damaged bone strength
- stress= repetitive submaximal forces gradually damages bone (“overuse” injury)
What are two major clinical findings that point towards a bone injury?
Point tenderness on exam and pain with indirect loading
What is usually the diagnosis when a patient complains of “joint locking”?
“Joint mice”/ loose body within the joint
What clinical finding points towards a cartilage injury?
Pain with both passive and active motions (just active pain is usually muscle)
**cartilage injuries have poor healing
Define dislocation
Complete displacement of a joint
Define subluxation
Transient, partial displacement of a joint
Define laxity
Normal variation in “joint looseness”
What is a maisonneuve fracture?
A fracture in the proximal fibula from rolling your ankle (force travels up the bone and fractures near the knee)
**positive squeeze test (hurts at the knee) and pain with external rotation
What do the squeeze test and external rotation test look for?
Should both be negative for a lateral ankle sprain (Anterior TibioFibular Ligament tear)
**external rotation hurts with medial or high (tibiofibular syndesmosis) ankle sprains
**squeeze test hurts high ankle sprain or maisonneuve fracture
What exam findings will be present for a peroneal ankle sprain?
**evulsion of the peroneal tendon at the base of the 5th metatarsal (tenderness of the tendon)
**pain with resisted eversion
When are NSAIDs a helpful option in the treatment of inflammation?
When the inflammation is ACUTE (also Rest Ice Compression Elevation)
What are three major requirements for the healing of a ligament?
- good blood supply
- damaged section approximated/guided to the correct area
- relative rest
**can just brace (cast if concerned about taking brace off)
Contrast an acute and chronic injury
- Acute
- know exact time of injury
- gets worse with use
- inflammation (NSAIDs helpful)
- treat with RICE
- Chronic
- vague onset
- pain gets better after warming up (for awhile)
- degeneration
What is the difference between compression and distraction loading?
- compression= test joint surfaces and structures between surfaces (articular cartilage, menisci, labrum)
- PUSH on a joint
- distraction= to test structures surrounding joint (e.g. capsule and ligaments)
- PULL on joint
**also shift stress (moving a joint as it’s meant to)
What is capsulitis?
- capsular thickening (inflammation and scarring)
- idiopathic or post injury
- risk factors= diabetes and thyroid disease
What will the exam findings be for capsulitis?
- limited/decreased range of motion
- painful with decreasing ROM (freezing phase)
- non-painful, stable ROM (frozen phase)
- non-painful, improving ROM (thawing phase)
Describe 3 common fractures of the 5th metatarsal
- avulsion (peroneus brevis)
- jones (metaphyseal-diaphysis junction)
- dancer’s (spiral fracture mid to distal diaphysis)
What is Sever’s condition?
A type of bone injury in which the growth plate in the lower back of the heel, where the Achilles tendon attaches becomes inflamed and causes pain
What is apophysitis?
**pain and inflammation of ossification centers from repetitive tension
- before/during/after activity (all the time) pain
- treat with activity as tolerated, stretching, ice, NSAIDs
- complications= bony hypertrophy fracture
- Osgood Schlatter (tibial tubercle)
- Sever’s (calcaneal apophysitits)
Describe indirect loading tests
- axial loading (pressure on bone… e.g. push on straight finger)
- bump test (pressure on area that hurts)
- fulcrum test (loads the middle of the bone; press on opposite end without any joint involvement)
- hop test (patient jumps)
What is the best treatment of a bone fracture?
Immobilization
**avoid NSAIDs and tobacco
Define enthesopathy
disorder of muscular or tendinous bony attachment
e.g. epicondylitis or shin splints
Define tendinosis
chronic degenerative condition of tendon
(tendinitis= technically acute inflammation)
Descibe lateral epicondylitis
- “tennis elbow”
- pain with resisted wrist and middle finger extension
- pain with supination
What is DOMS? When does it occur and what is its mechanism?
- delayed onset of muscle soreness
- 24-72 hours after new physicial activity
- lasts 5-7 days
- disruption of sarcolemma results in influx of intracelllar calcium (causes a proteolytic enzyme mediated myoprotein degradation)
What are the three tests for impingement testing?
- empty can test
- hawkin’s test
- neers test
Describe the three grades of AC injury
**acromioclavicular sprain;
- grade I= AC ligament stretch/sprain
- grade II= AC ligament tear and coracoclavicular (CC) ligament stretch
- grade III= AC and CC tear
Define bursitis
Bursa= synovial lined sac that contains fluid and acts to reduce friction between structures
**bursitis= bursa inflammation (common in achilles, olecranon, subacromial, prepatellar and other knee locations)
What is a joint ganglion?
Fluid filled soft tissue mass filled with collection of synovial or peritendinous fluid that arises from a joint or tendon sheath
**common location= wrist
How can you distinguish between effusions, bursitis, and ganglions?
- effusions
- uniform and diffuse around joint
- “attached” to joint; non-mobile
- bursitis
- localized, mobile
- “squishable”
- ganglion
- usually relatively small near joints
- fairly tense; described “like a marble”
