Musculoskeletal/Sports injuries Flashcards
-the growth plate
Physis
-the end of the long bone, adjacent to the growth plate or physis
metaphysis
-when the distal part of the deformity points inward
Varus
-when the distal part of the deformity points away from midline
Valgus
Pain Paresthesias Pallor Paralysis Pulselessness
Compartment Syndrome
- 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
- 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
- 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
- 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
- head tilt with UMN findings (increased DTRs)
- Dx: MRI
Posterior fossa tumor
- fusion of the cervical vertebrae
- short neck and low occipital hairline
- scoliosis, spina bifida, renal probs, Sprengel deformity, deafness
Klippel-Feil Syndrome
- the convex alignment of the thoracic spine in the sagittal plane
- 20-40 degrees is normal
- < 60 degrees: no intervention
- > 60 degrees: PFTs
Kyphosis
- bad posture, back pain, and kyphosis in a teenager
- presents at puberty
- Tx: NSAIDs, PT
Scheurmann disease
- -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
- 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
-adduction of the hip with downward pressure
Barlow
-abduction of the hip with attempt at relocating a dislocated femoral head
Ortolani
- 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
- 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
-migratory arthritis coupled with a rash
Rheumatic fever
-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
- 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
- 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
- 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
- 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
