Musculoskeletal/Sports injuries Flashcards by Danielle Paulin

-the growth plate

Physis

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-the end of the long bone, adjacent to the growth plate or physis

metaphysis

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-when the distal part of the deformity points inward

Varus

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-when the distal part of the deformity points away from midline

Valgus

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Pain 
Paresthesias
Pallor
Paralysis
Pulselessness

Compartment Syndrome

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blue sclerae
fractures during preschool years
autosomal dominant
hearing loss (both kinds)
bad teeth associated with Type 1B
type 2 is the most severe form and is usually lethal (bag of bones stillborn delivery)
type 3 is the progressive deforming type, born with fractures, macrocephaly and short stature

Osteogenesis Imperfecta

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macrocephaly, frontal bossing, midface hypoplasia, and proximal shortening of the limbs
MC cause of sudden death is cervicomedullary junction compression
80% of cases occur as a spontaneous mutation

Achondroplasia

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infant with head tilted to one side
mass in the SCM
facial asymmetry
Tx: daily stretching and PT, then surgery
can be associated with hip dysplasia

Congenital Torticollis

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infants with repeated attacks of head tilting which only last for minutes at a time.
often accompanied by vomiting, irritability, and pallor
require no intervention

Paroxysmal Torticollis

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head tilt with UMN findings (increased DTRs)

- Dx: MRI

Posterior fossa tumor

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fusion of the cervical vertebrae
short neck and low occipital hairline
scoliosis, spina bifida, renal probs, Sprengel deformity, deafness

Klippel-Feil Syndrome

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the convex alignment of the thoracic spine in the sagittal plane
20-40 degrees is normal
< 60 degrees: no intervention
> 60 degrees: PFTs

Kyphosis

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bad posture, back pain, and kyphosis in a teenager
presents at puberty
Tx: NSAIDs, PT

Scheurmann disease

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-results from poor fetal development and the failure of the scapula to descend to its normal position
affected side of neck will seem broader and shorter
mimics torticollis

Sprengel Deformity

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MC on the left
Dx: US
asymmetric gluteal folds
Tx: Pavlik harness (not double diapering)
Risks: breech, FHx, female, first born

Developmental Dysplasia of the Hip

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-adduction of the hip with downward pressure

Barlow

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-abduction of the hip with attempt at relocating a dislocated femoral head

Ortolani

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recent URI
some passive ROM of the painful joint
normal ESR
negative gram stain
normal or slightly elevated temperature
Dx of exclusion
Tx: reassurance

Toxic synovitis

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MC hematogenous spread
high fever, joint warm to touch, little or no PROM
positive gram stain, elevated ESR
increased joint space on Xray
MC younger than 2yo
Tx: aspiration, Abx to cover S. aureus

Septic joint

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-migratory arthritis coupled with a rash

Rheumatic fever

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-avascular necrosis of the femoral head
-MC boys 4-8 yo
-Xray: one femoral head smaller than the other
-hip pain may be referred to the knee
(Forrest Gump)

Legg Calve Perthes Disease

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infection of the bone
MC S. aureus
MRI is most sensitive (but not specific)
Bone scan is most specific
begins with an episode of bacteremia seeding to the metaphysis
can spread by local extension
Dx: direct aspiration of the metaphysis
Xray findings do not usually appear until 10-14 days after infection
Tx: PO meds can be used when there is a good response to IV meds and an organism is identified

Osteomyelitis

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chronic knee pain that locks and swells
MC in adolescent boys
necrosis of the articular surface of a joint
Dx: MRI
Tx: immobilization and surgical removal of fragments

Osteochondritis Dessecans

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results from the stress at the insertion of the patellar tendon at the anterior tibial tubercle from excessive activity
adolescent who presents with pain just below the knee
Tx: couple weeks rest with gradual resumption of activity, NSAIDs

Osgood-Schlatters

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- teenager with asymmetry of the hips or scapula | - 40 deg: surgery

Scoliosis

- infantile cortical hyperostosis - first 6 mo of life - swelling of the bone shafts (cortical bone) - Xrays: progressive corrtical thickening - periosteum is NOT involved (as opposed to NAT)

Caffey Disease

- child pulled by the arm and is now not using that arm - no swelling or discoloration - Tx: reduction

Nuremaids Elbow

- foot is internally rotated and Achilles is contracted | - Tx: stretching, serial casting, and surgical release of the tendon

Club feet

- usually just requires reassurance - requires intervention when it is unilateral, worsens after age 1, or does not resolve by age 2 - Xray findings of epiphyseal distortion - consider Rickets or Blounts disease if persists after age 2

Genu Varus (bow legged)

- pathology of the proximal tibial physis and epiphysis - infantile does not require intervention - adolescents are usally overweight and requires bracing or surgery

Blount's disease

- high arches | - associated with Freidrich ataxia and Hurlers

Pes Cavus

- flat feet | - special inserts or arches for symptomatic pts

Pes Planus

- fx Straight thru the physis, separation of the epiphysis and metaphysis - Xray may be negative with only tenderness - casting for 2-3 weeks

Salter Harris Type 1

- fx Above the growth plate (metaphysis) | - closed reduction casting for 3-6 wks

Salter Harris Type 2

- fx through the Lower portion (epiphysis) into the joint space - may require open reduction

Salter Harris Type 3

- fx Totally through the metaphysis, growth plate, and epipsysis - reduction in the OR to avoid growth disruption

Salter Harris Type 4

- cRush fx/compRession Fx - causes microvascular compromise - high rate of poor growth following the injury

Salter Harris Type 5

-pain over the anatomic snuff box

Scaphoid Fx

-posterior fat pad

Elbow Fx

- teenage male, obese, with knee pain (referred hip pain) - Ext and ER hip - Dx: Xray: ice cream scoop falling off the cone - may be an underlying endocrine disorder - Tx: immobilization, NWB, stabilization with pins and/or bone grafts

Slipped Capital Femoral Epiphysis

- one of the causes of in-toeing | - MC resolves with time by school age

Tibial Torsion

- temp >105 F - hot dry skin (no perspiration) - CNS depression (confusion and lethargy) - leads to end organ damage bc of release of endotoxins and cytokines - Tx: Ice packs to groin, neck, axilla, evaporation, cool to 101-102F

Heat stroke

- pupil irregularity - significantly reduced visual acuity - decreased EOM - orbital fracture

Reasons to refer to ophthalmology

- collection of blood between the cornea and the iris following trauma - blood in the anterior chamber with possible visual impairment without diplopia - Tx: refer to ophthalmology or bed rest with HOB at 30 degrees - eye shield

Hyphema

- fracture of the orbital wall or floor - blunt trauma to the eye - double vision when looking to one side - dysconjugate gaze to one side - pupillary reflexes intact

Blowout fracture

-severe pain with no diplopia or dysconjugate gaze

corneal abrasion

-pain and severe photophobia without diplopia

Traumatic iritis

- visual deficit in the peripheral field, described as curtain like - no dysconjugate gaze

Detached retina

-when to return to play after an ankle injury

- Full ROM - Full strength - No swelling - No pain - No joint instability

- acute knee injury with the patient describing a pop - significant knee effusion - positive drawer sign - Dx: MRI

ACL tear

- pulseless - pain - pallor - paresthesia - paralysis

Compartment syndrome

- confusion w/o amnesia or LOC - Tx: remove from game and examine immediatlely and every 5 min for development of amnesia or HA - if no symptoms persist, they can return to the game after at least 20 minutes of rest

Grade 1 Concussion

- confusion with amnesia, but no LOC - Tx: remove from game and examine frequently for development of severe symptoms, 24 hr follow up, return to practice if symptoms free for 1 week

Grade 2 concussion

- LOC | - take to ED and cannot return to play until symptom free for 2 weeks

Grade 3 Concussion

-sports which require mouth guards

``` football soccer basketball hockey wrestling shot putting discus throwing ```

-conditions that mandate refraining from participating in sports

Splenomegaly Hepatomegaly One functioning paired organ (testes, kidneys, eyes) Repeated concussions

- hirsutism and low voice | - early closure of epiphyseal plates

Anabolic steroid use in females

- severe acne - gynecomastia - high pitched voice - hypogonadism

Anabolic steroid use in males

- elevated LFTs - lower HDL - increased LDL - oligospermia and azoospermia - hypertension

Lab abnormalities with steroid use

-weight loss guidelines

No more than 3 pounds/week or 1.5% of body weight per week