Musculoskeletal System Flashcards
1
Q
osteoporosis - definition and risk factors
A
loss of bone matrix and mineral - leads to fx w/ little trauma
Primary: post menopausal (due to loss of estrogen) and senile (calcium deficiency and dec. vit. D intake)
Secondary: chronic corticosteroid use, hyper and hypo thyroids, hyperparathyroidism, DM, Cushing’s dz
RFs:
- Caucasian or Asian
- small, thin
- smoking hx, ETOH
- low calcium intake
- corticosteroid use
2
Q
osteoporosis - dx
A
DEXA scan (get T score) - screening begins at 65 (F) and 70 (M) unless have risk factors
normal: T score w/in 1 SD of young adult reference
osteopenia: 1-2.4 SD below reference
osteoporosis: 2.5 or more SD below reference
3
Q
osteoporosis - most common fx sites
A
vertebral bodies
- most common
hip, pelvis, distal radius
4
Q
osteoporosis - lifestyle changes
A
weight-bearing exercise intake of Ca++ and it D use walk or cane for balance balance exercise stop smoking and ETOH healthy diet
5
Q
osteoporosis - medications
A
calcium and vit. D
- Ca++: 1000 mg/day
- Vit D: 800-2000 IU daily
bisphosphanates
- e.g. fosamax, boniva
- take in am, drink w/ H2O, avoid eating for 30 min (avoid esophagitis)
- only take for 2-3 yrs
denosumab: inhibits maturation of bone absorbing cells
- dosed Q 6 mo
teriparatide: parathyroid hormone analog
- good but expensive
- only use for 2 yrs due to risk of osteosarcoma
6
Q
compartment syndrome - definition
A
increased pressure in area with limited space
- something surrounded by facia
- compromises circulation and tissue fx
7
Q
compartment syndrome - causes
A
bleeding or edema in closed compartment
- usually trauma or crush injury
8
Q
compartment syndrome - sxs and tx
A
6 P's Pain (severe and out of proportion) Paresthesia Paralysis Pallor Pulselessness Poikilothermic (cant regulate core temp)
tx: urgent fasciotomy
9
Q
osteoarthritis - definition and sxs
A
idiopathic, non-inflammatory arthritis
Sxs:
- jt stiffness in am (relieved w/ activity)
- pain w/ wt bearing
- crepitus, jt swelling, dec. ROM
- Heberden’s (DIP) nodes - common
- Bouchard’s (PIP) nodes
10
Q
osteoarthritis - nodes
A
Heberden’s (DIP) nodes
- common
Bouchard’s (PIP) nodes
- less common
11
Q
osteoarthritis - dx and tx
A
Dx: x-ray - narrow jt space, osteophytes, bone cysts
Tx: acetaminophen, NSAIDs, topical diclofenac, steroid injections, visco-supplementation
- surgery if QOL is diminished
12
Q
acute osteomyelitis - definition and sxs
A
bacterial spread to bone via blood
- S. aureus most common
- < 2 weeks
- affects long bones of children and spine of older adults
Sxs:
- fever, chills, malaise, irritability
- local warmth and swelling
- refusal to use affected limb (kids)
13
Q
acute osteomyelitis - Dx and Tx
A
Dx:
- inc. WBC, ESR, CRP, + blood cx
- bone biopsy to confirm bacteria
- bone scan and MRI help early
Tx:
- IV ABX 4-6 wks, then oral 6-8 wks (oxacillin/cefazolon/Vanco if MRSA)
- surgical debridement if no improvement or if spine involved
14
Q
chronic osteomyelitis - definition and sxs
A
untreated blood infection or exogenous/untreated trauma or infection (e.g. DM ulcer now infecting bone)
- > 2 weeks
- bacterial spread to bone via blood
Sxs:
- mild fever, mild inc. in ESR and CRP
- inflammation or cellulitis
- persistent drainage, sequestrum or dead bone or walled-off pus
15
Q
chronic osteomyelitis - Dx and Tx
A
Dx:
- x-ray shows bone destruction
- may confirm with MRI
Tx: long-term IV ABX (bacterial specific - oxacillin/Vanco most common)
- surgical I&D, possible amputation
16
Q
septic arthritis - definition and sxs
A
bacterial spread from blood to joint
- kids: N. gonorrhea
- older, IV drug use, DM, prosthetic jt: S. aureus
sxs:
- fever, jt swelling, redness, painful/limited ROM
- N. gonorrhea - lesions on palms and soles of feet
17
Q
septic arthritis - Dx and Tx
A
Dx:
- inc. WBC, ESR, CRP
- confirm with + blood or joint cx
- jt fluid: WBC, polys, dec. glucose (bacteria eat)
Tx:
- rest, ice, elevation
- arthroscopic I&D
- IV ABX 4-6 wks (ceftriaxone/vanco)
18
Q
ganglion cysts - definition, sxs, dx, tx
A
collection of synovial fluid
- most benign tumor of wrist
sxs: painless, fluid filled mass usually at wrist
Dx: clinical
Tx: wrist splinting, aspiration, surgical excision
19
Q
bone tumors - benign vs. malignant (x-ray findings)
A
benign:
- well-defined margins
- sclerotic band around tumor
- slow growing
malignant:
- painful
- palpable mass
- permeative lesion w/ lytic destruction
- poor margins with suggest rapid growth
20
Q
bone cysts - definition, sxs, dx, tx
A
cavity in bone filled w/something besides bone (usually fluid or blood)
- found in 5-20 y/o
sxs: asymptomatic until pathological fx
dx: found on routine x-ray, confirm w/ biopsy
tx: aspirate/inject w/ steroid or bone marrow to encourage growth
21
Q
osteoid osteoma
A
most common benign bone tumor
- usually in spine or long bones
- M>F, young adults
sxs: aching, night pain relieved w/ NSAIDS (since prostaglandins in tumor)
dx: x-rays
tx: symptomatic or surgical removal if bothering
22
Q
osteosarcoma - definition and sxs
A
most common primary malignant tumor (except MM)
- 15-25 y/o (M>F)
- most around knee
- metaphyseal (ball of bone)
NOTE: retinoblastoma assoc w/ 500x risk!!
sxs:
- persistent night pain (wakes) and swelling
- palpable mass
- no known trauma
23
Q
osteosarcoma - Dx and Tx
A
Dx:
- x-ray shows destruction (SUN RAY or SUNBURST appearance)
- bone or soft tissue biopsy
- alk phos inc. 2-3 x
Tx:
- chemotherapy and surgical resection: 70% 5-yr survival rate
24
Q
Ewings sarcoma - definition and sxs
A
malignant bone tumor
- most often in pelvis, distal femur, proximal tibia
- involved diaphysis of bone (shaft)
- 10-20 y/o, M>F
sxs: pain, palpable mass, fever, elevated ESR and WBC, increased LDH
25
Ewings sarcoma - Dx and Tx
Dx:
- x-ray shows lytic, destructive lesion
- ONION SKIN appearance
Tx:
- surgical resection, chemo, radiation
- 60-70% survival rate w/o METS
26
fibromyalgia - demographic and sxs
age 20-50, F>M, associated w/ hypothyroidism, RA (in women) or OSA (in men)
- dx of exclusion
sxs:
- MSK pain around neck, shoulders, low back, hip
- fatigue, numbness, H/As
- depression, sleep problems
PE: None, except trigger pt pain
27
fibromyalgia - tx
patient education:
- it is a chronic dz, but does not progress
moderate exercise, CBT
Meds:
TCAs, SSRIs/SNRIs, pregabalin and gabapentin, acetaminophen (better then NSAIDS)
- trigger pt injections
28
gout - etiology and population at risk
caused by under excretion or over production of uric acid
- 90% male
- usually in small joints (big toe)
At risk:
- thiazide or loop diuretic, beta-blockers, ACE-I, ARBs
- obesity
- high ETOH intake
- high purine diet
29
gout - sxs and dx
sxs:
- fever, sudden onset on monoarticular jt swelling
- exquisite PAIN, warm and red skin
- may develop TOPHI (uric-acid deposits) on ears, hands, elbows, and feet if not treated
dx:
- uric acid > 7.5, inc. WBC
- synovial fluid: + sodium urate crystals, negatively birefringent and needle-like
30
gout - tx (acute and chronic)
acute:
- NSAIDS, corticosteroids (must r/o septic arthritis), colchicine
Chronic:
- undersecretion: probenicid
- overproduction: ALLOPURINOL
chronic management: weight loss, increase dairy, limit ETOH, red meat, sardines, lentils, oatmeal, spinach, mushrooms, and drugs that cause gout
31
pseudogout - definition, sxs, dx, tx
recurrent arthritis in large joints (knee, wrist)
- M=F, > 50 y/o
- aka CPPD (calcium pyrophosphate dihydrate)
sxs: same as gout (fever, pain, swelling and warm)
dx:
- normal uric acid levels
- synovial fluid shows RHOMBOID shaped crystals that are POSITIVELY birefringent
tx:
- acute: NSAIDS, corticosteroids (must r/o septic arthritis)
- chronic: colchicine or NSAIDS (w/ GI protection)
32
juvenile idiopathic / rheumatoid arthritis - demographic
F>M, peaks 1-3 yr and 8-12 yr
| if RF + (15%), more likely to progress to adult RA
33
juvenile idiopathic / rheumatoid arthritis - 3 types
systemic (Still's disease)
- fever, salmon-colored rash, lymphadenopathy, carditis, splenomegaly, arthritis
polyarticular
- low-grade fever, arthritis 5 or more joints
oligo/pauciarticular
- synovitis in 1-4 joints, NO systemic sxs
- inc. incidence of iridocyclitis/anterior uveitis (F/U w/ opthamologist)
34
juvenile idiopathic / rheumatoid arthritis - dx
wt. loss, myalgias, fatigue, lymphadenopathy
intermittent fevers, morning stiffness, salmon colored rash
ESR and CRP elevated
- 10% + ANA, RF usually neg, anti-CCP may be + (high specificity for JRA)
35
juvenile idiopathic / rheumatoid arthritis - classification criteria
age < 16 y/o
arthritis in 1 or more joints
sxs > 6 weeks
other causes excluded
NOTE: dx of exclusion
36
juvenile idiopathic / rheumatoid arthritis - tx
NSAIDS: 1st line
DMARS: if no response to NSAIDS but long-term effects unknown
75% resolve w/o serious disability
- RF + have highest risk of persistent, severe dz
37
polyarteritis nodosa - definition and sxs
necrotizing arteritis of medium-sized vessels
- rare, 50-70 y/o
- 5% of cases cause by HEPATITIS B
- causes aneurysms of vessels
sxs:
- fever, malaise, wt loss
- extremity pain, foot drop, livid reticular (lacy red rash), nodules, digital gangrene (fingers and toes), abdominal pain N/V
38
polyarteritis nodosa - dx and tx
Dx:
- tissue biopsy or angiogram
- HTN if blood supply to kidneys is compromised
Tx:
- high dose corticosteroids
- also treat Hep B if they have it
Note: survival only 10% if not treated
39
polymyositis / dermatomyositis - definition and sxs
systemic disorder of unknown cause
- peaks in 5-6th decade, F>M, blacks > whites
- associated with malignancy in up to 20%
sxs:
- progressive neck and proximal muscle weakness or UE and LE
- 20% have dysphagia (due to weakness of neck)
- fever, wt. loss, fatigue
Reddish-purple maculopapular rash
- eyelids: heliotroph rash (red)
- knuckles: gottron papules (red, scaly rash)
40
polymyositis / dermatomyositis - dx and tx
Dx:
- muscle biopsy (inc. CPK, aldolase, LDH)
- serum marker: anti-JO 1 antibodies
Tx:
- corticosteroids (oral for muscle dx and topical for skin dz)
- screen for malignancies
41
reactive arthritis (Reiter syndrome) - definition and demographic
tetrad: conjunctivitis, urethritis, aseptic arthritis, and oral lesions
- occurs after gastroenteritis or STI (M:F is 9:1 if STI)
42
reactive arthritis (Reiter syndrome) - sxs, dx, tx
sxs:
-fever, arthritis (knee/ankle), urethral d/c, conjunctivitis, mucocutaneous lesions
dx:
- anemia, leukocytosis, thrombocytosis
- inc. ESR, HLA-B27 + (50-80%)
- x-ray: joint destruction
tx: NSAIDS, PT
- less likely to develop in future if original infection treated with ABX
43
rheumatoid arthritis - definition and demographic
idiopathic, chronic systemic inflammatory dz
- affects SYNOVIAL MEMBRANES
- 30-40 y/o, F 3:1
- Pannus develops and erodes articular cartilage
44
rheumatoid arthritis - sxs
early: malaise, wt loss, fever
- nodules in PIP and MCP of hand
- Sjogren's syndrome (dry eyes and mouth)
late:
- ulnar deviation
- Boutonniere and Swan Neck deformities
45
rheumatoid arthritis - dx
at least 6 out of 10 of criteria:
- # joint involvement
- serology (RF and Anti-CCP)
- duration of sxs (< or > 6 wks)
- acute phase reactants (ESR and CRP)
x-ray: soft tissue swelling, juxta-articular demineralization (more lucent), jt space narrowing
46
rheumatoid arthritis - what are they prone to?
C1-2 subluxation
| - must image if complains of neck pain
47
rheumatoid arthritis - tx
Tx goals: dec. inflammation/pain, preserve function, prevent deformity
Tx:
- education, PT, rest, splints
- NSAIDS and DMARDS right away!
48
systemic lupus erythematosus (SLE) - definition and demographic
inflammatory autoimmune dz that affects multiple organs
- can be caused by meds (procainamide, isoniazid, quinidine)
- F:M is 8:1, more common in blacks
- relapsing and remitting
49
systemic lupus erythematosus (SLE) - sxs
Initial:
- fever, anorexia, malaise, butterfly rash, arthralgias (jt pain - 90%)
Later (effects organs):
- pleurisy, seizures, psychosis, pericarditis, kidney (glomerulonephritis, interstitial nephritis)
50
SLE - dx
must meet 4 of the 11 criteria:
- malar (butterfly) rash
- discoid rash
- photosensitivity
- oral ulcers
- hematologic d/o
- arthritis
- serositis (heart or lungs)
- positive ANA
- renal dz
- neurological d/o
- immuno abnormalities (anti double-stranded DNA antibody and anti-Smith antibody)
51
SLE - two serum markers
anti double-stranded DNA antibody and anti-Smith antibody
52
SLE - tx
education and emotional support
hydroxychloroquine:minor jt and skin issues
NSAIDS: sparingly for minor jt issues
corticosteroids: if organs are involved
- recall side effects of prolonged use = accelerated atherosclerosis, osteoporosis, AVN of bone
53
scleroderma (systemic sclerosis) - definition and 2 types
chronic dz characterized by diffuse fibrosis of skin and internal organs (connective tissue d/o)
- adults 30-50 y/o
Limited: CREST syndrome and hardening of skin of face, neck, distal extremities
Diffuse: skin hardening of face,e hands, trunk, limbs and internal organs
- more severe
54
CREST
associated with limited form of scleroderma
```
C: calcinosis cutis (Ca++ in skin)
R: Raynauds phenomenon
E: esophageal motility disordered
S: sclerodactaly (tightening of skin of fingers and toes)
T: teleangiectasias
```
55
scleroderma - sxs
Initial:
- polyarthalgia, fevr, malaise, Raynaud's, esophageal dysmotility
- skin seems thickened and loss of normal skin folds
Late:
- pulmonary fibrosis, pericarditis, heart block, myocardial fibrosis, renal failure
56
scleroderma - dx and tx
Dx:
serum markers:
- anti-centromere (limited type)
- anti-topoisomerase (diffuse type)
Tx:
- symptomatic and supportive
- Raynaud's: Ca++ channel blockers
- HTN crisis due to renal failure: ACE-I
Note: avoid steroids due to renal failure!!
57
Sjogren's syndrome - definition and sxs
autoimmune dz that results from dysfunction of exocrine glands
- assoc. w/ RA
- females>males
Sxs:
- dry eyes and mouth
- inc. risk of dental caries
- loss of taste/smell
- parotid enlargement (chipmunk cheeks)
58
Sjogren's syndrome - dx and tx
Dx:
- anti SS-A (Ro) and SS-B (La)
- Schirmer's test (for tears in eyes)
- lip biopsy
Tx:
- symptomatic and supportive
59
acromioclavicular injury - sxs, dx, tx
young, active person with direct fall onto shoulder
sxs:
- tender, swollen AC joint
- positiv crossover test
Dx: clinical
Tx:
- ice, sling 2-4 wks, NSAIDS
- grades IV-VI f/u with orthopedic surgeon
60
grading of AC injury
I: contusion/sprain of AC joint
II: rupture of AC ligament
III: rupture of AC and CC ligament w/ minor displacement of clavicle
IV-VI: both ligs ruptured, significant displacement of clavicle
61
clavicle fracture -sxs, dx, tx
most common bone fractured in children
- direct trauma or fall on outstretched hand
sxs: pain over clavicle, possible deformity
- most fractured at middle 1/3
dx: x-ray
tx: sling or figure of 8 splint
- ROM in 3-4 wks
62
rotator cuff - muscles and attachment
```
S: supraspinatus
- most common injured
I: infraspinatus
T: teres minor
S: subscapularis
```
- top 3 attach to greater tuberosity
63
rotator cuff disorders - sxs, dx, tx
chronic, overhead work
- pain begins as inflammation, impingement, progresses to tear
sxs:
- pain at greater tuberosity, lateral shoulder
- pain w/ abducting arm
- positive Neer impingement and Hawkins
Dx: MRI if tear suspected
Tx:
- rest, ice, NSAIDS, PT, steroid injection
- surgery if no better in 6-12 wks
64
biceps tendonitis
overuse of biceps muscles, usually by heavy lifting
sxs:
- anterior shoulder pain
- bicipital groove tenderness
- pain w/ resisted supination
dx: clinical
tx:
- rest, ice, NSAIDS
- steroid injection (but not into sheath)
65
proximal humerus fracture
fall on outstretched hand
- common in elderly women w/ osteoporosis
sxs:
- pain, swelling of proximal humerus w/ dec. ROM
- evaluate axillary artery/nerve
Dx: x-ray
- Y-view to r/o dislocation
Tx:
- sling 4 wks, early ROM
- surgery if head displaced or compound fx
66
shoulder dislocation
fall on externally rotated, abducted arm
- most dislocated anterior
sxs:
- present w/ arm abducted in ER
- shoulder appears "squared off"
- evaluate axillary artery/nerve
dx: x-ray (A/P, lateral, Y view to determine anterior v. posterior)
tx:
- IMMEDIATE closed reduction (post-reduction x-ray)
- sling, start ROM 2 wks
67
lateral epicondylosis (tennis elbow) - sxs, dx, tx
overuse injury due to repetitive supination and wrist extension
sxs:
- tender over lateral epicondyle
- pain on resisted wrist extension
dx: clinical
- x-ray r/o arthritis or loose body
tx:
- rest, ice, NSAIDS, counter force strap, steroid injection
68
medial epicondylosis (golfer's elbow, pitcher's elbow) - sxs, dx, tx
overuse injury due to repetitive pronation and wrist flexion
sxs:
- tender over medial epicondyle
- pain on resisted wrist flexion
dx: clinical
- x-ray r/o arthritis or loose body
tx:
- rest, ice, NSAIDS, steroid injection, stretching
69
supracondylar fracture - sxs, dx, tx
common in children - direct blow or FOOSH
sxs:
- pain/swelling over distal humerus
dx:
- x-ray shows posterior FAT PAD (radiolucency in back of elbow)
- note: normal to see fat pad in anterior elbow
tx:
- non-displaced: long arm cast
- displaced: surgeon
70
radial head fracture - sxs, dx, tx
result of FOOSH
sxs:
- present w/ elbow in flexion
- pain and swelling over lateral elbow
dx:
- x-ray shows posterior FAT PAD (radiolucency in back of elbow)
- note: normal to see fat pad in anterior elbow
Tx:
- non-displaced: sling (2-4 wks)
71
colles fracture (distal radius fracture) - sxs, dx, tx
elderly person, fall on outstretched hand (fx of wrist)
sxs: swelling, pain over distal radius/ulna
- called a "SILVERFORK" deformity
dx:
- x-ray: distal radius fx w/ dorsal angulation (towards back of hand)
- NOTE: if angled towards palm of hand = Smith's fx
tx:
- closed reduction and cast (6-8 wks)
72
gamekeeper's thumb - sxs, dx, tx
thumb forced into radial deviation
- skier with abrupt pool plant
- stresses ulnar collateral ligament
sxs:
- pain w/ radial stress of thumb
dx: radial deviation of thumb > good side
tx:
- partial lig rupture: thumb spica cast
- complete lig rupture: ORIF
73
ORIF
open reduction internal fixation
| -surgical correction
74
scaphoid fracture - sxs, dx, tx
most common carpal fx
- due to FOOSH
sxs:
- SNUFF BOX TENDERNESS
- pain w/ ulnar deviation of wrist
Dx:
- x-ray: HIGH INDEX OF SUSPICION W/ NEGATIVE X-RAY
- bone scan or MRI will confirm
tx:
- non-displaced: thumb spica cast (6-20 wks)
- if suspect (but do not see on x-ray): treat as fx and repeat x-ray in 1 wk
NOTE: high rate of non-union due to poor blood supply
75
boxer fracture - sxs, dx, tx
closed first injury
- usually wall or person
sxs: swelling/pain over 4th /5th metacarpals
dx:
- fracture of neck of 4th or 5th metacarpal w/ solar angulations (towards palm)
tx:
- closed reduction and ulnar gutter splint
- close f/u for loss of reduction
Note: closed fist syndrome is from punch to teeth and open wound
- tx as bite
- OR + IV ABX
76
de Quervain's tenosynovitis - sxs, dx, tx
overuse due to repetitive gripping
- seen in new mom's
sxs:
- pain along radial aspect of wrist
- positive Finkelstein test
dx: clinical
tx:
- thumb spica for rest, NSAIDS, steroid injection
77
trigger finger - sxs, dx, tx
stenosing tenosynovitis (tendon has trouble moving through sheath and finger gets stuck bent)
sxs:
- PAINLESS nodule in flexor tendon
- "snap" when tendon passed through sheath
dx: clinical
tx:
- activity modification, splinting, NSAIDS
- steroid injection into tendon sheath
- surgical release
78
carpal tunnel syndrome - sxs, dx, tx
median nerve compression
- due to repetitive wrist flexion
sxs:
- numbness and night-time pain in thumb, index, middle finger
- positive PHALEN AND TINEL sign
Dx: clinical
Tx:
- night-time splint, steroid injection (within carpal tunnel but NOT in tendons or nerve), surgical release
79
cervical fracture -sxs, dx, tx
most due to MVA
sxs:
- posterior midline tenderness
- focal neuro deficits
dx:
- LATERAL x-ray picks up 90%
- most occur at C4-6
tx:
- immobilization, surgical fixation
80
ankylosing spondylitis - sxs, dx, tx
chronic inflammatory dz affecting spine and pelvis
- M>F
- presents in early adulthood
sxs:
- initial: diffuse back pain w/ am stiffness, negative exam
- later: dec. spine mobility, limited chest expansion
dx:
- x-ray shows BAMBOO SPINE
- HLA-B27 + (90%)
tx:
- PT for flexibility, pt education, posture
- NSAIDs or TNF inhibitors
81
2 diseases associated with HLA-B27 +
Reiter's syndrome (reactive arthritis)
Ankylosing spondylitis
82
kyphosis - causes, sxs, dx, tx
progressive increase in dorsal curve of T-Spine
- due to collapse of vertebrae
causes:
- osteoporosis, cancer, trauma, fracture
sxs:
- pain from acute fracture
- gradual height loss
- hunchback deformity
dx: clinical
tx:
- PT for strengthening
83
scoliosis
idiopathic lateral curvature of spine > 10 degrees
- dx in pre-adolescent girls
sxs:
- asymptomatic
- paraspinal hump, uneven shoulders and iliac crests
dx:
- clinical
- x-ray to measure Cobb angle
Tx: depends on angle
- observe (< 20 degrees), brace, surgery (if > 40 degrees)
84
low back pain
COMMON - 80% of US population will have this
- usually overuse
Sxs:
- pain that may radiate down butt or leg
- worse with standing
- tender over paraspinal muscle
- dec. lumbar ROM
- normal neuro exam
dx: clinical (x-ray of persistent)
tx:
- relative rest, ice/heat, NSAIDS, PT
- narcotics and muscle relaxants for ST period
85
herniated disc
nucleus comes out of vertebral disc
- usually DDD or trauma
sxs:
- pain in nerve distribution
- may have weakness and diminished reflexes
- lumbar disc = + strait leg raise
dx: MRI
Tx:
- rest, ice, NSAIDS, PT, epidural stored injections
- surgery if sxs persist 6-12 wks
86
cauda equina syndrome - definition and causes
sudden compression of L2-S4 nerve roots
- MEDICAL EMERGENCY
causes: central disc herniation, epidural abscess, hematoma, tumor
87
cauda equina syndrome - sxs, dx, tx
sxs:
- LE radicular pain and numbness
- saddle anesthesia, bowel and bladder dysfunction
- LE motor and sensory loss
- loss of sprinter tone
dx: MRI to determine cause
tx: emergency neurosurgery to find cause and relieve pressure
88
spinal stenosis - causes
narrowing of spinal canal
- can cause conversion of nerve root of theca sac
- typically in older people
causes: hypertrophy of ligament flavor, facet hypertrophy, spondylolisthesis, osteophytes or bulging discs
89
spinal stenosis - sxs, dx, tx
sxs:
- insidious onset of buttock and leg pain
- numbness with ambulating or prolonged sitting
- relief with sitting or flexion (opens canal)
- c/o poot balance, unsteady gait
dx: MRI best
Tx:
- rest, PT, NSAIDS, weight loss
- surgery when QOL impaired
90
avascular necrosis (aka aseptic necrosis) - definition, causes, and sxs
loss of blood supply to femoral head (hip)
causes:
- trauma
- alcoholism
- steroid and anti-retroviral use
sxs:
- dull, ACHING GROIN PAIN
- ANTALGIC gait
- pain on IR and ER, dec. hip ROM
91
avascular necrosis - dx and tx
Dx: MRI
- x-rays are negative in early dz
Tx:
- refer to orthopedic surgeon (may need hip replacment)
92
hip fracture - sxs, dx, tx
usually due to fall in elderly women with osteoporosis
- femoral neck or inter-trochantreic (b/t greater and lesser trochanter) most common
sxs:
- leg shortened
- pain on ROM of hip
Dx: x-ray
Tx: ORIF
93
hip dislocation - sxs, dx, tx
high impact trauma (90% MVAs)
- most dislocate posterior
sxs:
- SHORTENED LIMB, INTERNALLY ROTATED
- often also get knee or sciatic nerve injury
Dx: x-ray, CT to see if acetabulum is involved
Tx: immediate reduction w/ post-reduction films
94
tibial plateau fracture - sxs, dx, tx
occurs with axial load injury (fall of jump from high place)
sxs:
- knee pain and swelling
- unable to ear weight
dx: x-ray (confirm tibial depression w/ CT or MRI)
tx:
- immobilization, non-wt bearing
- cast immobilization or surgery
95
patellar fracture - sxs, dx, tx
caused by direct blow or forced flexion of quads muscle
sxs:
- pain/swelling over patella
- inability to actively extend knee (quad mechanism is not working)
dx: PE and x-ray
Tx:
- <3mm displaced = 8 weeks immobilization
- >3mm displaced or step-off = ORIF
96
ACL injury - sxs, dx, tx
forced internal rotation of knee w/ planted foot
- skier, basketball, soccer
sxs:
- pt hears pop
- sudden swelling (acute hemarthrosis)
- instability
- + LACHMAN test and anterior drawer sign
dx: clinical
- confirm with MRI
tx:
- initial: rest, ice, NSAIDS, brace, PT
- arthroscopic surgery for most
97
meniscal injury - sxs, dx, tx
mot common knee injury (medial more than lateral)
- hx of knee trauma, but vague
- usually twisting or slipping
sxs:
- joint line tenderness, effusion (develops overnight), locking or clicking
- + McMurray and Apley grind test
Dx: clinical
- confirm with MRI
Tx:
- RICE, NSAIDS, PT
- arthroscopy for persistent sxs
98
prepatellar bursitis (aka housemaid's knee)
caused by excessive kneeling or trauma to knee
sxs:
- palpable boggy swelling over patella
- if red and painful, worry about infection
Dx: clinical
Tx:
- RICE, NSAIDS
- usually self-limiting
99
ankle sprains
most common MSK injury
- 85% are INVERSION with PLANTAR FLEXION
- ATF (anterior talofibular ligg - lateral ankle) most often injured
sxs:
- pt hears "pop" followed by swelling and bruising
- PAIN OVER LIGAMENTS (not bone)
- palpate 4 ligaments (3 lateral and deltoid ligg medial) as well as medial and lateral malleoli
dx: clinical
Tx: RICE, NSAIDS, supportive brace
100
RICE
rest, ice, compression, elevation
101
Ottawa Ankle Rules
x-ray is required if:
- there is pain anywhere in the malleolar zone (medial or lateral malleoli)
- inability to bear weight immediately or in ED (4 steps)
102
Ottawa Foot Rules
x-ray is required if:
- there is pain anywhere in the midfoot zone
- pain at base of 5th metatarsal
- inability to bear weight immediately or in ED (4 steps)
103
ankle fracture - causes and sxs, dx, tx
caused by eversion, inversion, or lateral rotation of ankle
- deltoid ligg more likely injured since lateral rotation
- Fibula most likely fractured
sxs:
- pain, swelling,ecchymosis, instability
- pain over BONE
Note:
- check proximal fibula for tenderness to R/O fibular head fx (near knee)
- check peroneal nerve (foot drop)
Dx: x-ray (A/P, lateral, mortise view)
- mortise is space around ankle - should be equal
Tx:
- stable: 4-6 wks immobilization
- unstable: ORIF
104
achilles tedon rupture
caused by pushing off or forcible plantar flexion
- common 30-50 y/o, weekend warrior
- "I was jumping and felt like someone kicked me in the calf"
sxs:
- pop, deformity noted
- POSITIVE THOMPSON TEST (squeeze calf and foot should plantar flex)
dx: clinical (MRI if going for surgery)
tx: surgery (less re-rupture)
105
avulsion fracture
avulsion (chip) fx of 5th metatarsal
- occurs with inversion of foot
sxs:
- pain/ecchymosis at base of 5th metatarsal
Dx: x-rays
Tx: hard shoe or cast w/ rapid return to wt bearing
- good healing rate
106
stress fractures
repetitive stress leads to bony resorption before new bone is replaced and bone breaks
- young, active, starting new activity
- e.g. "shin splints"
sxs:
- pain over bone with no hx of trauma
- usually in tibia, metatarsals, calcaneus, sacrum
dx: clinical
- x-ray often not + for 3-4 wks
- bone scan confirms early suspicion
tx:
- rest, modification of activity, non wt-bearing for 4-8 wks
- may need cast
107
Jones fracture
fracture across 5th metatarsal
