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PHA 522 > Musculoskeletal/Rheumatology > Flashcards

Musculoskeletal/Rheumatology Flashcards

1
Q

Cervical Strain/Sprain: etiology

A

combined injury (ligamentous + musculature)

  • forced movement past end range
  • violent high velocity movement
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2
Q

Cervical Strain/Sprain: clinical presentation

A 
pain (non radicular, non focal)
stiffness, limited ROM
cervicogenic HA pattern
tender to palpation (muscle, facet joint, transverse process)
no pain w/ axial loading 
normal neuro exam (C5-T1)
Spurling's neg for radicular pain
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3
Q

Indications for Cervical Spine X-rays: non trauma related

A 
age >50 w/ new sx
constitutional sx
mod-sev neck pain >6wks
progressive neurological findings
infectious risk (IVDU, IM)
hx of malignancy
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4
Q

Indications for Cervical Spine X-rays: trauma related: nexus low risk criteria

A

(no x-rays if all 5)

absence of posterior midline cervical tenderness
normal level of alertness
no evidence of intoxication
no abnormal neurologic findings
no painful distracting injuries
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5
Q

Indications for Cervical Spine X-rays: trauma related: canadian C spine rule

A

YES: high risk factors
age 65+
dangerous MOI
paresthesias in extremities

NO: low risk factors
simple rear end MVA
sitting position in ED
walking
delayed onset neck pain
absence of midline cervical spine tenderness

NOT able to actively rotate neck 45deg L and R

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6
Q

C Spine Views

A

lateral
AP
dens

oblique

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7
Q

What type of injury is associated with sharp pain?

A

muscle strain/ligament sprain

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8
Q

What type of injury is associated with tightness followed by pain?

A

muscle spasm

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9
Q

Whiplash Injury: MOI

A

acceleration deceleration of neck w/ rapid flexion extension

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10
Q

Whiplash Injury: clinical presentation

A 
delayed onset of cervical pain/stiffness
pain peaks at 3-5d
pain/stiffness w/ flexion and extension
tender to palpation (muscle, facet joint, ligaments)
ROM limitations
no pain w/ axial loading
normal neuro exam
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11
Q

Whiplash Injury: radiographic finding

A

straightening of cervical spine (loss of lordotic curve)

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12
Q

Whiplash Injury: treatment

A 
soft cervical collar
analgesics
muscle relaxers
cervical pillow
heat/ice
PT
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13
Q

Cervical Facet Dysfunction: definition

A

shift in vertebral alignment –> locking of facet join

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14
Q

Cervical Facet Dysfunction: etiology

A

prolonged positional stress

traumatic injury

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15
Q

Cervical Facet Dysfunction: clinical presentation

A

insidious onset
unilateral pain (sharp in c spine, achey in referral zone)
focal facet TTP
ROM limitation

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16
Q

Cervical Facet Dysfunction: treatment

A

analgesics
muscle relaxants
referral (PT, DC, DO) (cervical spine manipulation)

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17
Q

Cervical Manipulation: complication

A

cerebral artery occlusion/dissection

  • cervical/suboccipital pain
  • dizziness
  • N/V
  • vision loss
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18
Q

Cervical Radiculopathy: definition

A

neurogenic pain in distribution of cervical roots

w/ or w/out associated numbness, weakness, loss of reflexes

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19
Q

Cervical Radiculopathy: etiology, populations

A

cervical disc bulge/herniation (young, older adults)

cervical foraminal narrowing (older adults)

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20
Q

Spurling’s Test:

  • what it tests for
  • steps
  • positive test
A

helps diagnose cervical disc herniation/spondylosis

rotates + laterally flexes to affected side + apply axial compression (+cervical extension)

positive: reproduction of/inc radicular arm pain

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21
Q

Cervical Radiculopathy: presentation

  • onset
  • hallmark sx
  • diagnostic test
A

onset:
- young/old: abrupt
- old: gradual

cervical pain inc w/ rotation/ lat flexion, extension to involved side –> inc radicular pain (positive Spurling’s test)

neurologic deficits

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22
Q

Cervical Radiculopathy: radiographs

  • optimal view
  • findings
A

oblique view

osteophyte formation

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23
Q

C5 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

lower lateral upper arm

shoulder ABduction
elbow flexion

biceps

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24
Q

C6 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

lateral forearm

wrist extensors

brachioradialis

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25
Q

C7 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

middle finger

elbow extension
wrist flexion

triceps

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26
Q

C8 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

medial forearm

finger flexion

none

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27
Q

L1 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

groin

hip flexion

cremaster

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28
Q

L2 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

anterior thigh

hip flexion
hip ADduction

cremaster

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29
Q

L3 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

medial knee

hip flexion
knee extension
hip ADduction

patellar

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30
Q

L4 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

medial calf

foot inversion
knee extension

patellar

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31
Q

L5 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

later lower leg
dorsum of foot

toe extension
ankle dorsiflexion

none

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32
Q

S1 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

lateral foot

ankle plantar flexion

ankle jerk

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33
Q

S2 Root Injury:

  • dermatome pain
  • movement reflex
  • reflex involved
A

posterior thigh

ankle plantar flexion
toe flexion

none

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34
Q

Cervical Radiculopathy: imaging

A

radiographs (AP, lateral, odontoid, R+L oblique)

MRI

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35
Q

What findings on imaging can explain the etiology of cervical radiculopathy?

A

bulge

uncinate hypertrophy

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36
Q

Cervical Radiculopathy: treatment

A

analgesics (NSAIDs, APAP, steroidal anti inflammatory (prednisone))
PT, OT

epidural injection
ant cervical decompression + fusion

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37
Q

Cervical Spondylosis:

  • disease components
  • MC cervical levels
A

degenerative disease:

  • osteophyte formation
  • ligamentum flavum thickening
  • disc space narrowing
  • vertebral subluxation

C5-C6
C6-C7

**compression of spinal cord (not roots)

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38
Q

Cervical Spondylosis: presentation

A

progressive ROM loss/stiffness
intermittent pain –> chronic (deep, aching neck/shoulder)
crepitus
tenderness

myelopathy

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39
Q

Cervical Spondylosis: myelopathy

A 
sensory impairment
weak hands/muscle atrophy
leg weakness
unsteady gait
bowel/bladder dysfunction
hyperreflexia (LE)
Lhermitte's sign
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40
Q

Cervical Spondylosis: Lhermitte’s Sign

A

neck flexion –> electric shock like sensation down the center of the back

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41
Q

Cervical Spondylosis: diagnostics

A

radiographs

MRI

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42
Q

Cervical Spondylosis: treatment

A 
NSAIDs
duloxetine 
amitriptyline 
neurontin (gabapentin)
cervical pillow
cervical traction
PT
surgical fixation

**avoid narcotics

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43
Q

What are the 4 alterations of thoracic kyphosis?

A

congenital
developmental
postural
degenerative

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44
Q

Congenital Kyphosis

  • age
  • alteration
A

pediatric

failure of segmentation (fusion of multiple vertebrae)
failure of formation (wedge shaped vertebrae)

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45
Q

Developmental Kyphosis

  • age
  • alteration
A

adolescent

presents during periods of rapid growth
altered development of vertebrae (wedge shape)

**scheuermann’s disease

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46
Q

Postural Kyphosis

  • age
  • alteration
A

adolescent, adult

altered strength balance bt muscles – body adapts to posture (cellphone, laptop, obesity)

can correct!

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47
Q

Degenerative Kyphosis

  • age
  • alteration
A

adult

with age:

  • disc narrow
  • vertebral bodies collapse
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48
Q

Kyphosis: complications

A

limited ROM of UE

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49
Q

Scheuermann’s Kyphosis:

  • epidemiology
  • definition
A

M, 12-15yrs

rigid structural kyphosis
wedge shaped vertebrae
rapid bone growth

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50
Q

Scheuermann’s Kyphosis: diagnostics

A

lateral imaging:

  • anterior wedging (>/=5deg in at least 3 adjacent vertebrae)
  • cobb angle (guides tx)
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51
Q

Scheuermann’s Kyphosis: treatment

A

stretching/strengthening

> 55-60deg: brace (until skeletally mature)

surgery

  • skeletal maturity
  • rigid deformity
  • > 75deg
  • unresponsive pain
  • unacceptable appearance
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52
Q

Costovertebral Dysfunction: what is it

A

rib hypomobility/subluxation

disruption of costovertebral and costosternal articulations

alterations of rib mechanics w/ insp and exp

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53
Q

Costovertebral Dysfunction: presentation

A 
sharp stabbing pain
upon waking
unilateral
ANT AND POST PAIN
may radiate along dermatome
inc w/ deep breathing, coughing, sneezing, laughing, TRUNK MVMT
reproduction of pain w/ palpation
PA mobilization
protective muscle spasm
restricted trunk ROM
sudden reduction in pain w/ pe --> rib relocation
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54
Q

Costovertebral Dysfunction: management

A

analgesics (NSAIDs, APAP)
muscle relaxants
PT, chiropractic, massage

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55
Q

Costochondritis:

  • epidemiology
  • etiology
A

> 40yo

idiopathic (preceding illness w/ coughing, recent strenuous exercise)

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56
Q

Costochondritis:

  • what is it
  • MC ribs
A

inflammation of costochondral/costosternal junction

  • unilateral
  • > 1 level
  • MC: 2nd-5th ribs
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57
Q

Costochondritis: presentation

A 
sharp aching or pressure pain
ANTERIOR PAIN
may radiate laterally
inc pain w/ deep breathing, coughing, sneezing, laughing, UPPER BODY MVMT
reproduction of pain w/ palpation
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58
Q

Tietze Syndrome:

  • epidemiology
  • etiology
A

<40yo

idiopathic (preceding illness w/ coughing)

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59
Q

Tietze Syndrome: what is it

A

inflammation of costochondral or costosternal junction

  • unilateral
  • 1 level only
  • MC ribs: 2nd-3rd
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60
Q

Tietze Syndrome: presentation

A

sharp aching pressure pain

  • anterior
  • may radiate laterally
  • inc pain w/ deep breathing, coughing, sneezing, laughing, upper body mvmt
  • reproduction of pain w/ palpation
  • SWELLING OVERLYING INVOLVED JOINTS
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61
Q

Costochondritis and Tietze Syndrome: treatment

A

analgesics (NSAIDs, APAP)
activity modification

lidocaine/corticosteroid injection

**course: wks-mos

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62
Q

Acute Low Back Pain: definition

A

new onset low back pain < 12 wk duration

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63
Q

Acute Low Back Pain: injured structures

A

MC: facet joints

ligamentous structures
paravertebral spinal muscles

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64
Q

Acute Low Back Pain: risk factors

A 
Age
Obesity
Physically strenuous work
Repeated twisting or bending
Job dissatisfaction
Prolong static posture (sedentary work)
Poor posture
Anxiety / depression
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65
Q

Acute Low Back Pain: MOI

A

MC: poor lifting technique

carrying excessive load
sudden mvmt
fall

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66
Q

Acute Low Back Pain: presentation

A 
TTP (facet joint)
pain w/ extension, rotation
tightness+pain w/ forward flexion
difficulty arising from seated position
normal neuro exam (L1-L5)
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67
Q

Low Back Pain: indications for radiographs

A 
>70yo
recent significant trauma (milder trauma if >50)
constitutional sx
mod-sev LBP >6wks
focal neuro deficit
infx risk (IVDU, IM)
hx of malignancy
prolonged corticosteroid use/osteoporosis
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68
Q

Acute Low Back Pain: management

A

avoid complete bedrest
ice/heat
stretching
analgesics (NSAIDs, ketorolac, short course oral prednisone, APAP)
muscle relaxers (cyclobenzaprine, metaxolone, carisoprodol)
PT

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69
Q

Lumbar Radiculopathy: what is it

A

dysfunction/irritation of nerve root –> pain, sensory impairment, weakness, diminished DTR

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70
Q

What is the key to determining the involved nerve root in lumbar radiculopathy?

A

distribution

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71
Q

Supine Leg Raise:

  • what it tests for
  • steps
  • positive test
A

evaluates for sciatic nerve/lumbar nerve root irritation

passive hip flexion + knee extension –> sx –> lower leg until pain relieved –> dorsiflex foot

reproduction of radicular pain w/ dorsiflexion

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72
Q

Seated Straight Leg Raise:

  • what it tests for
  • steps
  • positive test
A

evaluates for sciatic nerve/lumbar nerve root irritation

seated, passive knee extension

not tolerating full knee extension (reflexively lean back/reproduction of radicular pain)

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73
Q

Lumbar Radiculopathy: diagnostics

A

straight leg raise (positive) seated straight leg raise (positive)
neuro exam (L1-L5)
xray
MRI

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74
Q

Lumbar Radiculopathy: management

A

NSAIDs
PT

lumbar epidural
laminotomy + disectomy
laminectomy

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75
Q

Cauda Equina Syndrome: presentation

A 
B sciatica
B LE weakness
saddle anesthesia
sphincter dysfunction
bowel/bladder dysfunction
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76
Q

Cauda Equina Syndrome: treatment

A

emergent neurosurgery consult

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77
Q

Lumbar Spinal Stenosis: what is it

A 
disc degeneration 
arthritic changes
ligamentum flavum thickening
narrowing of lumbar spinal and nerve root canals 
compression of spinal cord, nerve roots

**aging population

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78
Q

Lumbar Spinal Stenosis: presentation

A

> 50yo
insidious onset
LBP, leg pain (LBP, morning stiffness –> pain expands to buttocks, LE)
neurogenic claudication w/ walking/prolonged standing
SHOPPING CART SIGN
numbness, tingling

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79
Q

Lumbar Spinal Stenosis: diagnostics

A

xrays
MRI

arterial doppler US to r/o vascular claudication

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80
Q

Spondylolisthesis: what is it

A

forward translation of 1 vertebra on another

**often during growth spurt

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81
Q

Spondylolisthesis: grading

A

Grade 1 - < 25% translation
Grade 2 - < 50% translation
Grade 3 - < 75% translation
Grade 4 - < 100% translation

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82
Q

Lumbar Spinal Stenosis: treatment

A 
analgesics (APAP, NSAIDs, duloxetine, amitriptyline, neurontin)
weight loss
PT/OT
epidural injections
radiofrequency ablation
surgery (spinal cord stimulator, fusion)
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83
Q

Spondylolysis: what is it

A

defect in pars interarticularis of lumbar vertebra (stress fracture/overloading)

**F>M

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84
Q

Spondylolysis: MOI

A

trunk extension + hyperextension/rotation

high risk sports: ballet, gymnastics, figure skating, football linemen, diving

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85
Q

Spondylolysis: complications

A

persistent pain

progression to spondylolisthesis

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86
Q

Spondylolysis: diagnostics

A

xray: AP, lateral (sn), latearl oblique (sp)

MRI

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87
Q

Spondylolysis: treatment

A

wk1-4: activity restriction
wk5-12: PT
wk9-12: gradual activity progression
return to activity, consider bracing

surgery (grade III-IV)

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88
Q

Stress Reactions

A

repetitive mechanical stress

Osteoclastic activity surpasses osteoblastic activity

Production of microfractures
Initiation of an inflammatory response
Bone stress injury → stress fracture

Grade I: Periosteal edema
Grade II-III: Varying severity bone marrow edema
Grade IV: Cortical fracture line

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89
Q

AC Joint Injury: MOI

A

MC: direct force (fall on AC joint w/ arm at side, acromion forced inf med)

indirect force (FOOSH, humeral head forced sup)

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90
Q

AC Joint Injury: Type I

A

AC ligament sprain
pain w/o deformity

AC joint intact
CC ligaments intact

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91
Q

AC Joint Injury: Type II

A

AC joint disrupted
<50% vertical displacement
CC ligament sprain
pain + deformity

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92
Q

AC Joint Injury: Type III

A

AC + CC ligaments disrupted
AC joint dislocated – inferiorly displaced shoulder complex
>CC interspace
pain w/ deformity

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93
Q

AC Joint Separation: presentation

A

step deformity (II, II, V)
other deformity (IV, VI)
swelling
trapezius muscle spasm

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94
Q

AC Joint Separation: functional tests

A

cross arm ADduction

traction test

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95
Q

AC Joint Sprain: diagnostics

A

xray: 10deg cephalic tilt (+/- weights)

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96
Q

AC Joint Injury: treatment (I,II)

A

non operative:

  • ice, sling (7-10d)
  • return to ADLs/sports as pain allows (1-3wks)
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97
Q

AC Joint Injury: treatment (III)

A

non operative:

  • sling+harnes (10-14d)
  • return to sports/ADLs (3-4wks)

acute surgery indicated:

  • throwing athletes
  • overhead workder
  • AVOID: contact athletes
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98
Q

AC Joint Injury: complications and management

A

OA of AC joint
osteolysis of dist clavicle
dec functional level

surgical tx: dist clavicular excision

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99
Q

Shoulder (Glenohumeral) Dislocation: direction

A

MC: anterior (subcoracoid)

posterior
inferior (subglenoid)

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100
Q

Posterior Shoulder Dislocation: associated conditions

A

seizures
electrical shock

lesser tuberosity fx

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101
Q

Anterior Shoulder Dislocation: MC MOI

A

ABduction + external rotation

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102
Q

Anterior Shoulder Dislocation: neurologic injury: affected nerves + presentation

A

MC: axillary nerve

radial nerve (weakness w/ extension)
median nerve (weakness in hand)
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103
Q

Anterior Shoulder Dislocation: presentation

A

flattened deltoid
ant chest fullness
prominent acromion
guarding

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104
Q

What position would the patient be holding their arm in with an ANTERIOR dislocation?

A

slight ABduction

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105
Q

What position would the patient be holding their arm in with an POSTERIOR dislocation?

A

full ADduction

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106
Q

Shoulder Dislocation: evaluation

A 
neuro exam (C5-T1)
xray (AP, axillary, Y views)

MRI arthrogram (identify bankart lesion)

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107
Q

Shoulder Dislocation: treatment

A
  1. conscious sedation (oxygen+fentanyl)
  2. reduction (anterior)
    - hippocratic (inf traction)
    - stimson (weights)
    - hennipen (external rotation)
  3. confirm w/ xray
  4. sling
  5. ortho consult

recurrent:
ant shoulder reconstruction + bankart repair

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108
Q

Shoulder Dislocation: provocative tests

A

apprehension
jobe relocation
surprise (release)
sulcus sign

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109
Q

Shoulder Dislocation: complications

A

brachial plexus injury
recurrent dislocation

anterior:

  • bankart lesion (glenoid labral avulsion)
  • hill sachs lesion (post lat humeral head fx)
  • capsular laxity
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110
Q

Shoulder Dislocations: outcome

  • <30
  • > 45
  • 1st time >40
A

<30: high recurrence (bc bankart)

> 45: recurrence less common

1st > 40: associated w/ rotator cuff tear

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111
Q

Subacromial Impingement Syndrome (SAIS): primary impingement:

  • etiology
  • epidemiology
A

degenerative changes (bone spurs, calcific deposits)

hooked acromion (inc risk of RC tear)

> 35yo

“true/classic impingement”

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112
Q

What is the most frequent cause of atraumatic shoulder pain?

A

SAIS

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113
Q

Subacromial Impingement Syndrome (SAIS): secondary impingement:

  • etiology
  • epidemiology
A

repetitive overhead movement (ABduction, external rotation)

forward head, inc thoracic kyphosis –> muscle imbalances (ant tilting, protraction)

<35yo
overhead athlete (swimmer, volleyball, baseball)

faulty scapular posture

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114
Q

Subacromial Impingement Syndrome (SAIS): what is it

A

inflammation –> inc compression w/in subacromial space

repetitive microtrauma:

  • MC: supraspinatus tendon
  • subacromial bursa
  • long head of biceps

bursal inflammtion
tendon degeneration

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115
Q

Subacromial Impingement Syndrome (SAIS): presentation

A 
gradual onset
ant + lat shoulder pain (exacerbated w/ overhead activity)
night pain
TTP 
referred pain down to deltoid
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116
Q

Subacromial Impingement Syndrome (SAIS): special tests

A 
Neers (int rotation + flexion)
Hawkins 
Painful arc (45/60-120)
Strength testing (resistance, empty can, lift off)
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117
Q

Subacromial Impingement Syndrome (SAIS): treatment

A

NSAIDs
avoid offending activities
modify sleeping position
PT (postural correction)

no improvement in 6wks:
subacromial corticosteroid injection

surgery (subacromial decompression)

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118
Q

Rotator Cuff Tear: etiology

A

MC: overuse (age related degeneration, chronic mechanical impingement)

traumatic

MC: supraspinatus tendon

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119
Q

Rotator Cuff Tear:

-epidemiology

A

full thickness tear:
-inc incidence >40 (esp >60)

**uncommon under 40

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120
Q

Rotator Cuff Tear: presentation

A 
sev mos of rec shoulder pain
subacromial pain
pain localized to deltoid tuberosity
night pain
weakness, catching, grating
TTP
dec AROM
normal PROM
(+) drop arm test
pain/weakness w/ isolation of involved RC
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121
Q

Rotator Cuff Tear: diagnostics

A

xray
MRI (gold standard)

** + arthrogram if concern for partial tear and chronic injury

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122
Q

Rotator Cuff Tear: treatment

A

nonsurgical (<50% thickness tear):

  • NSAIDs
  • PT
  • avoid overhead activities
  • steroid injection

surgery (chronic injury, acute traumatic):

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123
Q

What is the timeline for surgical intervention with and acute traumatic RC tear?

A

best done acutely or no later than w/in 6wks of injury

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124
Q

Adhesive Capsulitis:

  • aka
  • what is it
  • epidemiology
A

frozen shoulder

idiopathic loss of BOTH active and passive motion

inflammatory process involving the glenohumeral capsule

40-60yo

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125
Q

Adhesive Capsulitis: related conditions

A

MC RF: DM type 1

Hypothyroidism
Dupuytren contracture
C5 disk herniation
Parkinson’s disease

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126
Q

Adhesive Capsulitis: presentation

A

gradual ROM loss (pt unaware) (EXT ROTATION, ABduction, flexion)

pain

  • at rest: dull, achy
  • end range: sharp

diffuse shoulder tenderness

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127
Q

Adhesive Capsulitis: diagnostics

A

xray

MRI (contracted capsule, loss of inf pouch)

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128
Q

Adhesive Capsulitis: course/phases

A

freezing phase: pain, progressive loss of motion

thawing phase: dec discomfort w/ slow/steady inc in ROM

6mo-2yr to resolve

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129
Q

Adhesive Capsulitis: treatment

A

wait it out

intra-articular steroid injection
PT (+ tramadol)

no improvement x 9-12mo: surgery

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130
Q

Lateral Epicondylitis:

  • aka
  • what is it
  • etiology
A

tennis elbow
point and click elbow

overuse inflammatory injury involving common extensor tendon

repetitive wrist extension or wrist + finger extension

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131
Q

Lateral Epicondylitis: presentation

A

sig pain + 3/5 strength w/ 3rd digit resisted extension

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132
Q

Tendonitis

A

tendon overuse injury
inflammation (4-8wks)
fiber disruption/degeneration

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133
Q

Tendonosis

A

stalled inflammatory process (6-8wks)
fiber disorganization
pronounced degeneration

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134
Q

Lateral Epicondylitis: treatment (tendonitis)

A 
NSAIDs
activity modification
ice
stretch + strengthen
supportive bracing
steroid injection
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135
Q

Lateral Epicondylitis: treatment (tendonosis)

A

activity modification
PT/OT
stretch + strengthen
supportive bracing

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136
Q

Steroid Injection: ADEs

A

dimpling
hypopigmentation (resolves 3-6mo)
tendon rupture

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137
Q

Tendonosis Treatment Components

A

modify aggravating activity

correct biomechanics

address degeneration

  • ASTYM
  • graston
  • dry needling
  • PRP injections

therapeutic exercise

  • stretching
  • strengthening
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138
Q

Medial Epicondylitis:

  • aka
  • presentation
A

golfer’s elbow

pain w/ flexion
med elbow pain
weakness w/ wrist/finger flexion
TTP

ulnar neuropathy

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139
Q

Distal Biceps Tendon Rupture: epidemiology

A

M >40yo w/ preexisting degenerative changes

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140
Q

Distal Biceps Tendon Rupture: MOI

A

rapid eccentric contraction –> distal tendon tear at radial insertion

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141
Q

Distal Biceps Tendon Rupture: diagnostics

A

initial: xray

gold standard: MRI

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142
Q

Distal Biceps Tendon Rupture: treatment

A

nonsurgical:

  • partial tear: brace + limit ROM x 4wks
  • complete tear: older pts w/ sedentary lifestyle

surgical: (young active individuals)
- complete rupture
- elective partial tears

**need to do surgery w/in 10d

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143
Q

Ulnar Collateral Ligament Injury: special tests

A

valgus stress
milking maneuver
moving valgus stress

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144
Q

Ulnar Collateral Ligament Injury: diagnostics

A

xray (r/o avulsion fx –> MC <18yo)

MR arthrogram of elbow (gold standard)

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145
Q

Non-Inflammatory Bursitis: what is it

A

repeated trauma –> excess fluid develops w/in bursa –> swelling/enlarge

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146
Q

Non-Inflammatory Olecranon Bursitis: presentation

A

swelling at tip of elbow
NO pain, redness, warmth
full, painless ROM

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147
Q

Inflammatory Olecranon Bursitis:

  • etiology
  • presentation
A

result of infx

swelling at tip of elbow
marked warmth, redness, pain w/ palpation
limited flexion

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148
Q

Olecranon Bursitis: treatment

A

small effusion:

  • ice
  • compression sleeve
  • NSAIDs
  • activity modification

large effusion/infected:

  • aspiration
  • abx
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149
Q

Elbow Dislocations: MOI

A

FOOSH

**posterior dislocation + coronoid process fx = common

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150
Q

What is the MC joint dislocation in children?

A

elbow

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151
Q

Elbow Dislocations: evaluation

A

NV exam (radial, median, ulnar nerves)

152
Q

Lunate and Perilunate Dislocation:

  • etiology
  • associated fx
  • treatment
A

hyperdorsiflexion (hyperextension)

scaphoid, radial styloid fx

surgical repair

153
Q

DeQuervain’s Tenosynovitis: what is it

A

inflammation of the sheath that surrounds the ABductor pallucis longus and extensor pollucis brevis tendons

thickened tendon sheath –> constricted tendons

154
Q

DeQuervain’s Tenosynovitis: presentation

A

pain, tenderness in 1st dorsal extensor compartment – aggravated w/ thumb movement, make a fist
swelling
crepitus
(+) finklestein test

155
Q

DeQuervain’s Tenosynovitis: Finklestein Test

A

thumb in palm –> deviate wrist towards ulna –> reproduction of pain

156
Q

DeQuervain’s Tenosynovitis: management

A

NSAIDs
thumb spica splint
avoid offending activity
steroid injection

157
Q

Ulnar Collateral Ligament Sprain:

  • aka
  • what is it
  • MOI
A

gamekeeper’s/skier’s thumb

UCL injury at 1st MCP joint

acute (MC)/chronic valgus stress

158
Q

Ulnar Collateral Ligament Sprain: presentation

A

pain, swelling to ulnar aspect of thumb

mild: no laxity
mod: partial laxity
complete: sig laxity

159
Q

Ulnar Collateral Ligament Sprain: treatment

A

mild-mod: brace (2-4wks)

surgical:

  • complete tear
  • avulsion fx w/ 25% of articular surface
160
Q

Collateral Ligament Injuries:

  • aka
  • MOI
  • presentation
A

jammed fingers

forced lateral deviation of IP joints

pain over ligament
valgus/varus stress w/ PIP at 30 deg

161
Q

Collateral Ligament Injuries: treatment

A

buddy tape
continue participation
refer children

162
Q

Dislocation of IP Joints: etiology

A

forced hyperextension of PIP/DIP

163
Q

Trigger Finger:

  • what is it
  • MC location
  • MOI
A

nodular thickening of flexor tendon

MC at MCP joint

MC: idiopathic
RA, DM

164
Q

Trigger Finger: treatment

A 
steroid injection (2 max)
surgical release
165
Q

Dupuytren’s Contracture:

  • aka
  • epidemiology
  • MC location
A

palmar fibromatosis
viking disease

M >50, N European descent

MC: ring finger

166
Q

Dupuytren’s Contracture:

-what is it

A

nodular thickening + contraction of palmar fascia

flexion of finger at MCP –> PIP

167
Q

Dupuytren’s Contracture: treatment

A

xiaflex injection + manipulation

168
Q

Ganglia of Wrist, Hand:

  • aka
  • epidemiology
  • MOI
  • common locations
A

synovial/mucous cyst

15-40yo

idiopathic, repetitive wrist loading activities

dorsum of wrist
volar aspect of wrist

169
Q

Ganglia of Wrist, Hand: what is it

A

cystic swelling overlying tendon sheath

herniation of synovial tissue from tendon sheath

170
Q

Ganglia of Wrist, Hand: management

A

asymptomatic: reassurance

acute, sev sx:

  • immobilization
  • needle aspiration
  • surgical excision
171
Q

Mucous Cyst (Mucocele)

A

develops off of a joint (MC: DIP)

172
Q

Arthritis of the Hand: MCC

A

osteoarthritis

secondary degenerative joint disease

173
Q

Osteoarthritis of the Hand:

  • MC location
  • presentation
A

DIP, PIP

stiffness, loss of motion of fingers
heberden nodes (DIP)
bouchard nodes (PIP)
174
Q

Iliotibial Band “Friction” Syndrome: what is it

A

friction irritation due to repetitive AP mvmt of iliotibial band over lat femoral condyle (cross country running, cycling)

175
Q

Iliotibial Band “Friction” Syndrome: predisposing factors

A 
tight IT band
genu varum (bowlegged)
foot pronation --> internal tibial rotation
176
Q

Iliotibial Band “Friction” Syndrome: presentation

A

localized tenderness over lat femoral condyle
pain w/ active knee flexion/extension (walk w/ stiff knee)
localized swelling, crepitus

177
Q

Iliotibial Band “Friction” Syndrome: special test

A

noble compression test

178
Q

Iliotibial Band “Friction” Syndrome: treatment

A

NSAIDs
ice w/ motion
activity modification
therapy

corticosteroid injection

179
Q

Prepatellar Bursitis: etiology

A 
repetitive trauma (carpet/tile laying, wrestling)
trauma (fall, forceful contact w/ coffee table)
180
Q

Prepatellar Bursitis: presentation

A

+/- pain
tightness at end range w/ flexion (active and passive)
restricted ROM (pain free)
ballottement (fluid on top of patella)

181
Q

Prepatellar Bursitis: treatment

A

aspiration/injection (3 max)
NSAIDs
ice
compression

surgical excision

182
Q

Prepatellar Bursitis: prevention

A

knee pads

183
Q

Non-Gonococcal Infectious Arthritis: etiology

A

MC: hematogenous (MC: S aureus)

184
Q

Non-Gonococcal Infectious Arthritis: risk factors

A 
IM
DM
sickle cell anemia
prosthetic joint
previous arthritis
trauma
bacteremia
185
Q

Non-Gonococcal Infectious Arthritis: presentation

A

acute onset
monarticular

MC joint: knee

warmth, swelling, erythema, pain
limited function
+/- fever, leukocytosis

186
Q

Non-Gonococcal Infectious Arthritis: diagnosis

A

synovial fluid analysis (bacterial infx)
blood culture
imaging (not helpful)

187
Q

Non-Gonococcal Infectious Arthritis: polyarticular:

  • epidemiology
  • MC joints
  • MC pathogens
A

> 60yo
high prevalence of RA

knee, hip, shoulder, elbow (~4 joints)

staph, strep

188
Q

Non-Gonococcal Infectious Arthritis: IVDU:

  • MC joints
  • MC pathogens
A

sternoclavicular, costochondral, pubic symphysis

#1: S aureus
#2: pseudomonas
189
Q

Non-Gonococcal Infectious Arthritis: treatment

A

aspiration + irrigation
IV abx (empiric: vancomycin + 3rd gen cephalosporin - ceftriaxone)
serial synovial fluid analyses

190
Q

Gonococcal Infectious Arthritis:

  • what is it
  • epidemiology
A

infx caused by N gonorrhoeae
migratory arthritis in sexually active adults

health
F>M
menses, pregnancy

191
Q

Gonococcal Infectious Arthritis: presentation

A

migratory, non symmetric polyarthralgias (wrist, elbow, knee, ankles) (1-4d)
tenosynovitis
necrotic pustules (palms, soles)

fever, GU sx, purulent arthritis (knee)

192
Q

Gonococcal Infectious Arthritis: diagnostics

A

synovial fluid analysis
blood culture
cultures (urethra, throat, cervix, rectum)
imaging (not helpful)

193
Q

Gonococcal Infectious Arthritis: treatment

A

single dose: azithromycin PO + ceftriaxone IM

7-14d: daily ceftriaxone IM

194
Q

Patellar/Quadriceps Tendonitis/osis: etiology

A

overuse/repetitive stress (jumping – basketball, volleyball)
microtrauma, chronic inflammation
imbalance bt loading and short term healing

195
Q

Patellar/Quadriceps Tendonitis/osis: presentation

A

pain/TTP
persistent aching after activity
pain w/ resisted extension
pain w/ active and passive flexion at end range

196
Q

Patellar/Quadriceps Tendonitis/osis: treatment (tendonitis vs tendonosis)

A

tendonitis: NSAIDs, activity mod, ice, patellar tendon strap, PT
tendonosis: PT, activity mod, patellar tendon strap

197
Q

Patellar/Quadriceps Tendon Rupture:

  • epidemiology
  • etiology
A

30-60yo

Rapid eccentric overload – fall on partially flexed knee
Rapid concentric overload – basketball player jumping

198
Q

Patellar/Quadriceps Tendon Rupture: presentation

A

instability/giving way
pop

sig pain at injury --> min-no pain w/ quad contraction
rapid large effusion
palpable defect
INABILITY TO EXTEND KNEE AGAINST GRAVITY
INABILITY TO PERFORM STRAIGHT LEG RAISE

*do NOT assess prone passive knee flexion

199
Q

Patellar/Quadriceps Tendon Rupture: diagnostics

A

xray (r/o fx, assess tendon rupture)

MRI (confirm diagnosis)

200
Q

What is the radiographic finding for a quadriceps tendon rupture?

A

low position of patella

201
Q

What is the radiographic finding for a patellar tendon rupture?

A

high position of patella

202
Q

Patellar/Quadriceps Tendon Rupture: treatment

A

non surgical (<50% tear): straight leg immobilizer, non weight bearing

surgical repair (complete rupture)

203
Q

Patellofemoral Pain Syndrome: etiology

A

overuse

repetitive activity w/ faulty biomechanics:

  • VMO weakness (lat tracking patella)
  • inc Q angle
  • hyperpronation (internal tibial rotation)
  • poor technique (squat)
204
Q

Patellofemoral Pain Syndrome: presentation

A 
movie theater sign
pain w/:
-ascending/descending stairs
-rep deep knee flexion
-end range passive/active flexion
-resisted extension

J sign
patellar grind sign

205
Q

Patellofemoral Pain Syndrome: treatment

A 
activity modification
NSAIDs
weight loss (if obese)
VMO strengthening
gluteal strengthening 
evaluate/correct technique
206
Q

Patellofemoral Pain Syndrome: Q angle:

  • what is it
  • value for F
  • value for M
A

quadriceps angle
line from ASIS to patella
line from tibial tuberosity to patella

F: =22 in full extension
M: =18 in full extension

207
Q

Patellar Dislocation:

  • etiology
  • epidemiology
A

twisting knee injury

16-20yo (uncommon over 30)
F>M

208
Q

Patellar Dislocation: risk factors

A

shallow patellofemoral articular surface
patella alta (high riding patella)
excessive Q angle
generalized ligamentous laxity

209
Q

Patellar Dislocation: presentation

A 
sev pain
pop 
knee held in flexed position 
hemarthrosis
loss of knee motion

post reduction: diffuse peri-patellar tenderness

210
Q

Patellar Dislocation:

  • special test
  • diagnostics
A

patellar apprehension sign
post reduction xray (lateral tilt)
MRI

211
Q

Patellar Dislocation: treatment

A

reduction (gentle extension of tibia)
* avoid forceful med pressure on patella

post reduction: knee immobilizer
post immobilization: stabilization brace
PT

surgical repair

  • loose body
  • hx of rec dislocations
212
Q

MCL Injury: MOI

A

force directed to the lateral aspect of the knee –> instability

213
Q

What are the components of the unhappy triad?

A

ACL tear
MCL tear
med meniscal tear

214
Q

MCL Injury:

-special tests

A

valgus stress test (0 and 30 deg)

215
Q

MCL Avulsion:

  • aka
  • what is it
A

steida’s fx

femoral avulsion fx

216
Q

LCL Injury: MOI

A

forced directed to the medial aspect of the knee –> instability

217
Q

LCL Injury: special tests

A

varus stress test (0 and 30 deg)

check neuro function

218
Q

Collateral Ligament Tears: presentation

A

pain w/ palpation
swelling
loss of ROM

219
Q

Collateral Ligament Tears: grade 1

  • presentation
  • treatment
A

interstitial
pain w/ stress testing
no laxity

RICE
short course NSAIDs
crutches PRN

220
Q

Collateral Ligament Tears: grade 2

  • presentation
  • treatment
A

partial
pain w/ stress testing
mild laxity

hinged knee brace
weight bearing as tolerated
PT

221
Q

Collateral Ligament Tears: grade 3

  • presentation
  • treatment
A

complete
significant laxity
+/- pain w/ stress testing

ortho surgery consult
hinged knee brace
gradual return to full weight bearing over 4-6wks
PT

222
Q

ACL Tear: MOI

A

non contact (rotational):

  • plant + pivot
  • valgus load + int rot of femur + ext rot of tibia

contact (hyperextension):
-force to the ant knee while foot is planted

223
Q

ACL Tear: presentation

A 
sudden pain/giving way 
rapid effusion
pop
sig ROM limitation
instability w/ weight bearing
pain
(+) lachmann
(+) ant drawer
224
Q

ACL Tear: diagnostics

A

xray

MRI

225
Q

ACL Tear: treatment

A 
rest
ice
NSAIDs
aspiration
knee immobilizer/hinged knee brace w/ crutches
ACL reconstruction (young, active)
PT (older, less active)
226
Q

PCL Tear: MOI

A

dashboard injury
fall on flexed knee w/ plantar flexed foot
hyperextension injury

** MC combined w/ ACL tear

227
Q

PCL Tear: presentation

A

effusion w/in 24 hrs
limited AROM/PROM
pain, instability w/ weight bearing

(+) sag test
(+) posterior drawer

228
Q

PCL Tear: diagnostics

A

xray (r/o fx)

MRI (confirm dx)

229
Q

PCL Tear: treatment

A

rest, ice, NSAIDs
knee immobilizer –> hinge brace w/ crutches
PT
functional bracing for return to activity

PCL reconstruction (rec instability, subsequent meniscal tears)

230
Q

Knee Dislocation: diagnostics

A
  1. xray
  2. arterial/venous doppler US + ankle brachial index
  3. arteriogram (if abnormalities w/ 2)
  4. MRI
231
Q

Meniscal Tears: MOI (traumatic vs. degenerative)

A

traumatic tear: rotational injury

degenerative tear: min-no trauma

232
Q

Meniscal Tears: classification

A 
horizontal cleavage
flap
radial
degenerative
bucket handle 
longitudinal
233
Q

Meniscal Tears: traumatic tear: presentation

A

sp incident
mod swelling + stiffness over 1-2d
LOCKING, catching, popping
Joint line pain w/ twisting or squatting
Tenderness over medial or lateral joint line
Motion limited secondary to pain, effusion and/or mechanical block

234
Q

Meniscal Tears: degenerative tear: presentation

A

insidious onset (inc activity level)
mild swelling+stiffness over sev months
catching, popping
Joint line pain w/ twisting or squatting
Tenderness over medial or lateral joint line
Motion limited secondary to pain, effusion and/or mechanical block

235
Q

Meniscal Tears: special tests

A

mcmurray’s

thessaly’s

236
Q

Meniscal Tears: treatment: traumatic tear (young, active)

A

sports activity restriction until MRI

surgical debridement/repair

237
Q

Meniscal Tears: treatment: degenerative tear

A

RICE
NSAIDs
activity modification

  • delay MRI while treating sx
  • respond well to surgical debridement BUT inc risk for OA
238
Q

Knee Arthritis: epidemiology

A

> 55yo
hx of trauma
obesity

compartments: med > lat > PF

239
Q

Knee Arthritis: presentation

A 
insidious onset
pain w/ weight bearing
buckling/giving way
difficulty ascending/descending stairs
stiffness upon waking/prolonged sitting
intermittent swelling
diffuse tenderness
crepitus
joint narrowing, osteophytes
240
Q

Knee Arthritis: Kellgren Lawrence Classification

A

grade 1: min osteophytes
grade 2: >/= 1 well defined marginal osteophyte
grade 3: definite joint space narrowing and marginal osteophytes
grade 4: bone-to-bone contact, complete obliteration of the joint space, marginal osteophytes

241
Q

Knee Arthritis: treatment

A 
weight loss 
activity modification
analgesics (topical capsaicin)
intra-articular injections 
neoprene sleeve
shoe insoles
nonimpact exercise
cane, walker
surgery (total knee replacement)
242
Q

Popliteal Cyst:

  • aka
  • presentation
A

baker’s cyst

swelling/fullness in popliteal fossa (can dissect down calf)
pain, tenderness
no hx of trauma

rupture –> sev calf pain, dec ROM at ankle

243
Q

Popliteal Cyst: associated conditions

A

degenerative meniscal tear
OA
systemic inflammatory condition (RA)

244
Q

Popliteal Cyst: treatment

A

aspiration (transient relief)

treat underlying condition

245
Q

Snapping Hip Syndrome:

-site

A

MC: IT band + greater trochanter
iliopsoas bursa + ant acetabulum

snap/clunk palpated as tendon slides over bony landmark

246
Q

Snapping Hip Syndrome: snapping associated w/ pain

A

bursitis

labral pathology

247
Q

Trochanteric Bursitis: presentation

A

pain, tenderness (greater trochanter) - radiates along lat thigh
worse w/ first rising, prolonged walking
night pain

248
Q

Trochanteric Bursitis: treatment

A

NSAIDs
activity modification
stretching
corticosteroid injection

249
Q

Iliopsoas Bursitis: presentation

A

anterior thigh pain
radiates to the groin
worse w/ sitting, prolonged walking

250
Q

Iliopsoas Bursitis: treatment

A

NSAIDs
activity modification
stretching
corticosteroid injection

251
Q

Snapping Hip Syndrome: treatment

A

patient education
stretching
corticosteroid injection

252
Q

Snapping Hip Syndrome: when to consider radiographs

A

mechanical locking

failure w/ conservative care

253
Q

Femoroacetabular Impingement (FAI):

  • what is it
  • deformity types
A

hip impingement bt femoral head/neck and acetabulum

cam (femoral deformity)
pincer (acetabular deformity)
cam and pincer (combined)

254
Q

Femoroacetabular Impingement (FAI):

  • etiology
  • epidemiology
A

SCFE
legg calve perthes dz
anatomical variants
repetitive loading

inc risk w/ athletes/active

255
Q

Femoroacetabular Impingement (FAI): impingement inc risk of …

A

labral tear
chondral injury
early onset OA

256
Q

Femoroacetabular Impingement (FAI): presentation

A 
insidious onset
internal ROM loss
rest, post activity: achy groin pain
turning, twisting, squatting: sharp pain
crepitus, catching, locking
257
Q

Femoroacetabular Impingement (FAI):

  • special test
  • diagnostics
A

impingement test (flexion+adduction+int rotation)

xray
MRI w/ arthrogram
marcaine (+/- kenalog) injection test

258
Q

Femoroacetabular Impingement (FAI): treatment

A

NSAIDs
activity modification
PT

surgical tx (open, arthroscopic)

259
Q

Hip Dislocations:

  • MOI
  • MC direction
A

high energy injury (MVA)

  • axial load along femoral shaft (MC)
  • forced mvmt past end range

posterior > anterior

260
Q

Posterior Hip Dislocation: MOI

A

force exerted at knee through femoral shaft

head of femur driven posteriorly (dashboard injury)(MC)

261
Q

Posterior Hip Dislocation: presentation

A 
scissor position (hip: int rot+ADducted +flexed, knee: flexed)
thigh appears shorter
262
Q

Anterior Hip Dislocation: MOI

A

forced ABduction+external rotation past end range

263
Q

Anterior Hip Dislocation: presentation

A

helpless eversion (ext rot+ABducted+slightly flexed)
flattened lateral hip
extremity may

264
Q

Hip Dislocations: complications

A

fractures (acetabulum, femoral head)
sciatic nerve injury
avascular necrosis of femoral head (ligamentum teres artery)

265
Q

Hip Dislocations: diagnostics

A

xray

CT

266
Q

Posterior Hip Dislocation: reduction technique

A

allis method:

  • stabilize hip
  • hip, knee flex to 90
  • ant force (forearm behind knee)
  • internal rotation + ADduction
267
Q

Anterior Hip Dislocation: reduction

A

modified allis method:

  • posterior pressure
  • hip ABducted, flexed to 90
  • traction + ADduction
  • internal rotation
268
Q

Avascular Necrosis:

  • what is it
  • epidemiology
A

loss of blood supply –> destruction of femoral head

30-50yo

269
Q

Avascular Necrosis: risk factors

A 
hx of trauma
long term corticosteroid use
EtOH abuse
radiation therapy
RA
SLE
270
Q

Avascular Necrosis: kids

  • disease name
  • epidemiology
  • etiology
A

legg calve perthes disease

2-11yo M

idiopathic

unilateral

271
Q

Avascular Necrosis: presentation (adult vs peds)

A 
insidious
ROM loss (int rotation, ABduction)

adult:

  • groin pain
  • pain w/ weight bearing/limp

peds:

  • PAINLESS limp
  • groin, thigh, knee pain
272
Q

Avascular Necrosis: Ficat Stages

A

I: normal
II: sclerotic/cystic lesions
III: subchondral collapse (crescent sign)
IV: osteoarthrosis (articular cartilage loss, osteophyte formation)

273
Q

Avascular Necrosis: diagnostics

A

xray (crescent sign)

MRI (definitive diagnosis)

274
Q

Avascular Necrosis: treatment

A

adults:
- core decompression w/ bone graft
- total hip replacement

peds:

  • bed rest
  • progressive weight bearing
275
Q

Hip Osteoarthritis: what is it

A

degeneration of cartilage from the femoral head and/or the acetabulum

276
Q

Hip Osteoarthritis: etiology

A 
Primary (idiopathic)
Trauma
Infection
Femoroacetabular Impingement (FAI) 
Slipped capital femoral epiphysis (SCFE)
Legg-Calvé-Perthes disease
Pediatric developmental dysplasia of the hip
Avascular necrosis
277
Q

Hip Osteoarthritis: presentation

A

groin/ant thigh pain
dec, painful ROM loss (flexion, int rotation)
difficulty crossing legs/putting on shoes/socks
referred pain to knee

278
Q

Hip Osteoarthritis: treatment

A 
analgesics (NSAIDs, APAP, duloxetine)
weight reduction
lifestyle modification
intra articular corticosteroid injection
joint arthroplasty
279
Q

Compartment Syndrome:

-what is it

A

acute rapid rise in intracompartmental pressure

280
Q

Compartment Syndrome: MOI

A

trauma to anterolateral leg
premature cast application
excessive exercise

281
Q

What is the MC compartment affected in compartment syndrome? How will they present?

A

anterior compartment

weak DF and toe extensors
dec sensation over dorsum of foot

282
Q

Compartment Syndrome: presentation

A 
pain w/ passive stretch
paresthesia
pulselessness
pallor 
paralysis
shiny skin
283
Q

Compartment Syndrome: compartmental pressure testing

A

needle inserted into compartment providing pressure measurement

normal: 0-10mmHg
fasciotomy: delta pressure <30mmHg

delta P = diastolic BP - compartment P

284
Q

Compartment Syndrome: treatment

A

fasciotomy

285
Q

Achilles Tendonitis(-osis): etiology

A

overuse/repetitive stress (long distance running)
poot footwear
poot biomechanics

286
Q

Achilles Tendonitis(-osis): presentation

A

pain
morning pain/stiffness
swelling/thickening of the tendon
palpable crepitus
pain, ROM loss w/ achilles tendon stretching
pain +/- weakness w/ resisted plantarflexion

287
Q

Achilles Tendonitis(-osis): treatment

A 
relative rest
ice
NSAIDs
stretching
correct footwear/biomechanics
therapy
288
Q

Haglund’s Deformity: what is it

A

boney exostosis –> irritation from footwear –> pump bump

289
Q

Haglund’s Deformity: risk factors

A

improper footwear
pes cavus
tight achilles tendone

290
Q

Haglund’s Deformity: presentation

A

asymptomatic
pain w/ palpation, tight footwear
erythema
swelling

291
Q

Haglund’s Deformity: treatment

A 
modify footwear
achilles tendon stretching
analgesics
ice
injection
surgery
292
Q

Achilles Rupture: MOI

A

explosive/rapid contraction

  • change in direction
  • rapid eccentric load
293
Q

Achilles Rupture: contributing factors

A 
weekend warriors
racquet sports
age
dominant extremity
underlying tendinosis
hx of corticosteroid injections
294
Q

Achilles Rupture: presentation

A 
"kicked in calf"
audible snap
observable/palpable gap
sev swelling, ecchymosis
pain/weakness on resisted plantar flexion
(+) thompson test
295
Q

Achilles Rupture: diagnostics

A 
clinical
MRI (definitive diagnosis)
296
Q

Achilles Rupture: management

A

non-surgical (non-athletes, older pts):

  • cast immobilization (4-6wks)
  • walking boot progression (4-6wks)

surgery

297
Q

Lateral (Inversion) Ankle Sprain: MOI

A

inversion

combined inversion/plantarflexion

298
Q

Lateral (Inversion) Ankle Sprain: injured ligament

A

MC: ATFL
CFL
PTFL

299
Q

Lateral (Inversion) Ankle Sprain: special tests

A 
anterior drawer
talar tilt (prone)
talar tilt (seated)
300
Q

Lateral (Inversion) Ankle Sprain: grade 1

  • presentation
  • disability
  • recovery
A

mild stretch

mild pain w/ weight bearing
min swelling
point tenderness w/ involved ligaments
pain but NO laxity w/ special tests

mild limp
min functional loss

2-10d

301
Q

Lateral (Inversion) Ankle Sprain: grade 2

  • presentation
  • disability
  • recovery
A

partial tear

mod pain w/ weight bearing
mod swelling
point tenderness w/ involved ligaments
pain + mild-mod laxity w/ special tests

limp w/ walking
unable to toe raise

10-30d

302
Q

Lateral (Inversion) Ankle Sprain: grade 3

  • presentation
  • disability
  • recovery
A

complete tear

sig swelling
sig pain w/ weight bearing
point tenderness w/ involved ligaments
pain+sig laxity w/ special tests

unable to FWB
sig pain inhibition

30-90d

303
Q

Medial (Eversion) Ankle Sprain: MOI

A

forced eversion/ext tibial rotation

**excessive pronators more susceptible

304
Q

Medial (Eversion) Ankle Sprain: injured ligament

A

deltoid ligament

305
Q

Medial (Eversion) Ankle Sprain: presentation

  • grade 1
  • grade 2
  • grade 3
A

grade 1: mild stretch of zone 1 +/- 2

grade 2: partial tear of zone 1 +/- 2

grade 3: complete tear of zone 1 +/- 2

306
Q

Medial (Eversion) Ankle Sprain: special test

A

eversion talar tilt

307
Q

Syndesmotic Ankle Sprain: MOI

A

forced external rotation of ankle

hyperdorsiflexion

308
Q

Syndesmotic Ankle Sprain: structures involved

A

ant tib fib
post tib fib
interosseous membrane

309
Q

Syndesmotic Ankle Sprain: presentation

A

sev pain + loss of function
TTP
(+) kleiger’s test

310
Q

Ottawa Foot and Ankle Rules

A

X-ray series is required if:
-Inability to bear weight for more than 4 steps both immediately and at time of evaluation

Ankle

  • Pain in malleolar zone and
  • Bony tenderness over the distal 6cm of the posterior edge of the fibula or the tip of the lateral malleolus OR
  • Bony tenderness over the distal 6cm of the posterior edge of the tibia or the tip of the medial malleolus

Foot

  • Pain in midfoot zone and
  • Boney tenderness at the base of the fifth metatarsal OR
  • Boney tenderness at the navicular
311
Q

Pull Off Fracture

A

avulsion fx

horizontal fx line

312
Q

Push Off Fracture

A

oblique or vertical fx line

313
Q

Inversion Sprain

A

avulsion fx of lat malleolus

push off fx of med malleolus

314
Q

Eversion Sprain

A

avulsion fx of med malleolus

push off fx of lat malleolus

315
Q

Ankle Sprain: treatment (grade 1)

A

RICE
NSAIDs
consider ankle brace

316
Q

Ankle Sprain: treatment (grade 2)

A

NWB –> PWB –> FWB as tolerated
Walking boot 10-14 days followed by bracing
Therapy

317
Q

Ankle Sprain: treatment (grade 3)

A 
refer to ortho
NWB --> PWB --> FWB as tolerated
Walking boot 3-4 weeks followed by bracing
Therapy
Surgery
318
Q

Chronic Lateral Ankle Instability: what is it

A

persistent mechanical disability of the talocrural joint

319
Q

Chronic Lateral Ankle Instability: presentation

A

frequent sprains
diff running on uneven surfaces
diff jumping or cutting

320
Q

Chronic Lateral Ankle Instability: treatment

A

supervised rehab program

surgery (ligament reconstruction)

321
Q

Hallux Valgus: what is it

A

lateral dev of great toe at MTP joint

may lead to bunion

322
Q

Hallux Valgus: presentation

A

pain, swelling
2nd toe overrides great toe
HA angle >/= 20deg

323
Q

Hallux Valgus: treatment

A

asymptomatic: no tx

patient education
shoe wear modifications

disability: surgery

324
Q

Plantar Fasciitis: what is it

A

degenerative microtearing of fascial origin from the calcaneus –> tendinosis-type reaction (plantar fasciosis)

325
Q

What is the MCC of heel pain in adults?

A

plantar fasciitis

326
Q

Plantar Fasciitis: epidemiology

A

F
overweight
runners

327
Q

Plantar Fasciitis: presentation

A

insidious
focal pain, tenderness
most intense upon rising from resting position (especially in the morning)
worse w/ prolonged standing and walking

328
Q

Plantar Fasciitis: diagnostics

A

xray (heel spur)

329
Q

Plantar Fasciitis: treatment

A

takes 6-12mo to resolve

silicone/rubber heel pad
ice
analgesics
shock absorbing soles
stretching exercises
night splint
steroid injection
partial surgical release of plantar fascia
330
Q

Interdigital (Morton) Neuroma: what is it

A

inflammation of common digital nerve as it passes bt MT heads

secondary to repetitive irritation of nerve

331
Q

Interdigital (Morton) Neuroma:

  • epidemiology
  • MC location
  • etiology
A

F

MC bt 3rd and 4th toes

MCC: nerve compression by tight shoes

332
Q

Interdigital (Morton) Neuroma: presentation

A

plantar pain in forefoot
“walking on a marble”/”wrinkle in my sock)
relieved by removing shoe, rubbing foot
aggravated by high heeled/tight shoes
pain w/ direct plantar pressure+squeezing MT together

333
Q

Interdigital (Morton) Neuroma: treatment

A

low heeled, well cushioned shoe w/ wide toe box
MT/orthotic pads
steroid injection
surgical excision

334
Q

MSK Tumor: work up

A 
xray
CT scan/MRI
biopsy (definitive diagnosis)
bone scan/PET (metastases)
labs
335
Q

MC locations for metastatic tumors

A 
prostate
breast
kidney
thyroid
lung
336
Q

MC symptom of metastatic bone lesions

A

persistent pain

337
Q

What type of lesions are typically associated w/ prostate and breast cancer?

A

osteoblastic lesions

338
Q

What type of lesions are seen with metastases of lung, kidney and thyroid CA and bone involvement from multiple myeloma?

A

lytic lesions (punched out/moth eaten appearance)

339
Q

Unicameral Bone Cyst (UCB):

  • what is it
  • MC location
A

benign, fluid filled, expansile lesion

long bones (prox femur, prox humerus)

340
Q

Unicameral Bone Cyst (UCB): treatment

A

may resolve spontaneously

surgery for rec fx (aspiration+injection vs curettage + bone graft)

341
Q

Unicameral Bone Cyst (UCB): xray findings

A

FALLEN LEAF SIGN

well circumscribed
adjacent to physis
eccentric

advanced: cortical thinning

342
Q

Aneurysmal Bone Cyst:

  • what is it
  • MC locations
  • epidemiology
A

benign, aggressive bone lesions
blood filled cyst in bone

femur, humerus, fibia, fibula, skull, posterior spine

under 12/20

343
Q

Aneurysmal Bone Cyst: treatment

A

curettage, electrocautery, bone grafting

may recur

344
Q

Aneurysmal Bone Cyst: xray findings

A 
eccentric
lytic
aggressive features
expansile
cortical thinning

MC in the metaphysis

PERIOSTEAL ELEVATION

345
Q

Non Ossifying Fibroma (NOF):

-treatment

A

surgery if >50% diameter of bone (curettage, bone grafting, +/- internal fixation)

346
Q

What is the MC benign tumor in children?

A

non ossifying fibroma

347
Q

Non Ossifying Fibroma (NOF): xray findings

A 
eccentric
lobulated margin
metaphyseal 
lytic 
sclerotic rim + cortical erosion
348
Q

Giant Cell Tumor:

  • what is it
  • MC locations
A

rare, benign, aggressive tumor

knee (MC), dist radius, prox femur, prox humerus

349
Q

Giant Cell Tumor: treatment

A

radiation
curettage, bur, electrocautery, bone grafting

high recurrence

350
Q

What is unique to the giant cell tumor, compared to the other MSK tumors?

A

giant cell tumors present with localized pain and possible weakness

other msk tumors are typically asymptomatic

351
Q

Osteochondroma: what is it

A

benign abnormal growth of bone and cartilage along surface of bone

peak incidence: 2nd and 3rd decade

352
Q

Osteochondroma: xray findings

A

sessile/pedunculated appearance (mushroom)

1-20cm

353
Q

Osteochondroma: presentation

A

abnormal bone growth

impingement of surrounding structures –> pain, restricted ROM, tingling, numbness

354
Q

Osteochondroma: treatment

A

observation w/ radiological monitoring

  • asymptomatic: q6mo
  • stable: q12mo until skeletally mature
  • > 50% growth in 6mo/symptomatic: MRI

excision + biopsy

**risk of recurrence if resected pre skeletal maturity

355
Q

Osteoid Osteoma: what is it

A

small benign bone tumor w/ a nidus

develop in the cortex

356
Q

Osteoid Osteoma:

  • MC location
  • presentation
A

long bones

dull aching pain (at night)
dramatic reduction in pain w/ NSAIDs

357
Q

Osteoid Osteoma: treatment

A

watchful waiting
-NSAIDs

radiofrequency ablation

  • *resolve:
  • pain: 3yrs
  • lesion: 5-7yrs
358
Q

Chondrosarcoma:

  • what is it
  • epidemiology
A

MALIGNANT tumor of cartilage producing cells

M 60-80yo (>40yo)

359
Q

Chondrosarcoma:

  • MC locations
  • presentation
A

pelvis, ribs, humerus, tibia, femur (EPIPHYSEAL)

pain, weakness

360
Q

Chondrosarcoma: treatment

A

surgical excision

+/- radiation, chemotherapy

361
Q

What is the benign tumor with a similar radiographic appearance to chondrosarcomas?

A

enchondroma

362
Q

Osteomyelitis: what is it/MOI

A

infx of bone via:

  • hematogenous spread
  • contiguous infx (surgical hardware, open fx)
  • vascular insufficiency (diabetic ulcer)
363
Q

Osteomyelitis:

  • epidemiology
  • pathogens
A

MC in children

MC: S aureus (MSSA>MRSA)
S epidermis (MC post surgical)
E coli
Salmonella (sickle cell anemia)

364
Q

Osteomyelitis: distribution (adult vs peds)

A

adult: MC: vertebrae
peds: MC long bones (femur>tibia>humerus)

365
Q

What is a Brodie’s abscess? What disease is it associated with?

A

an abscess that is walled off by fibrosis and bone sclerosis (no drainage tract)

osteomyelitis

366
Q

Osteomyelitis: presentation

A

gradual onset (d-wks)
dull unrelenting pain
subjective fever, chills
draining sinus tract

Tenderness
Warmth
Erythema
Soft tissue swelling
ROM / functional loss

PAIN WHILE TRYING TO SLEEP

367
Q

Osteomyelitis: diagnostics

A

labs (elevated ESR, CRP, acute WBC; normal chronic WBC)

xrays (early: demineralization, late: sequestra, involucrum)
blood culture
bone biopsy
gadolinium enhanced MRI (gold standard) (alt: bone scan, CT)

368
Q

Osteomyelitis: treatment

A

empiric IV abx (vancomycin +FQ) –> no improvement 48-96hrs __> surgical debridement

369
Q

Gout: what is it

A

METABOLIC dz

altered purine metabolism –> Na urate crystal deposition in synovial fluid –> rec, acute arthritis attacks

hyperuricemia + crystals

370
Q

Gout:

  • epidemiology
  • etiology
A

M >30yo

primary (genetic alterations)

secondary

  • diuretics
  • low dose ASA
  • cyclosporine
  • niacin
  • myeloproliferative disorders
  • hypothyroidism
  • alcohol
371
Q

Gout: risk factors

A 
M
age
genetics
obesity
alcohol
high purine diet
high fructose/sucrose diet
HTN
CKD
thiazide/loop diuretics
372
Q

Gout: presentation (acute flare)

A 
acute onset
intense pain (at night)
swollen tender joint w/ overlying red, warm skin
MONOARTICULAR
low grade fever

MC: 1st MTP joint (podagra)
feet, ankles, knees

373
Q

Gout: presentation (chronic)

A

tophaceous gout

10+ yrs
urate deposits in subQ tissue, bone cartilage, joints (TOPHI)
granulomatous inflammation
deforming polyarthritis

374
Q

Gout: diagnostics

A

labs:

  • acute: normal serum uric acid
  • elevated WBC

synovial fluid analysis:

  • MONOSODIUM urate crystals
  • NEEDLE LIKE
  • NEGATIVELY birefringent
  • inflammatory

imaging:

  • new onset acute: no findings
  • established dz: rat bite (sm punched out erosins w/ overhanging edges)
375
Q

Gout: treatment (acute attack)

A

elevation, rest
dietary modifications
reduce inflammation (NSAIDs (naproxen, indomethacin), colchicine (<24-36hrs), PO/IV corticosteroids, corticosteroid injection)

376
Q

Gout: treatment (prophylaxis)

A

weight loss
alcohol avoidance
dietary purine restriction
avoid thiazides, loop diuretics, niacin, low dose ASA
colchicine, allopurinol, febuxostat, probenecid
dietary modifications

377
Q

Gout: complications

A

nephrolithiasis

chronic urate nephropathy

PHA 522 (2 decks)

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