Ortho Flashcards
1
Q
Unilateral shortening of sternocleidomastoid muscle… results in lateral head tilt ad chin rotation of the side opposite to that head tilt
A
Congenital torticollis
2
Q
specific areas of the infant’s head develop an abnormality, and there’s a flattening of the shape of the skull and appearance ( a positional deformity … how the child lies on their head)
•Risk factors: torticollis, premature birth, multiple gestations and also multiple fetuses.
• Assess: hold on base of neck and look down on top of child’s head to look for asymmetry
•Dx and Tx: History and head assessment-> Helmet therapy
• Prevent by promoting Tummy Time, hold baby during wake hours
A
Positional Plagiocephaly
3
Q
subluxation of radial head
A
Nursemaid elbow
4
Q
how to fix nursemaids elbow
A
- supination and flexion
- hyperpronation
5
Q
- Common in first 6 months of walking but can indicate other problems
- In kids that have this and no neuro prob- should resolve by age 3
- Assess gait and shoes, heel cords, make sure child can flex and extend foot 90 degrees. Good neuro and LE exam
A
toe walking
6
Q
what to assess in kids with limp
A
Trendelenburg sign
7
Q
= assess hip stability
•ask the pt to stand on one leg and to raise the other leg. you want to see if the pelvis drops on the raised leg side. This sign is positive, and it indicates a weak hip adductor muscle.
A
Trendelenburg sign
8
Q
•Occurs when there’s microtrauma in deep fibers of patellar tendon @ insertion site of tibia tuberosity (pain and knee swelling) - athletic kids
- Not red, inflamed, or warm but does have swelling… upon palpation pt will have pain in that specific area
- Tx: typically self limiting… symptom management
A
Osgood-Schlatter
9
Q
•Often seen in adolescents d/t rapid growth spurts (playing sports)
•Will experience pain … usually increases w/ physical activity and stops when they stop physical activity
•PE: Assess all joints, try and reproduce pain
. Prevention is key
A
Osgood-Schlatter
10
Q
- Results from infarction of the bony epiphysis of femoral head = articular cartilage hypertrophies, and a narrowing and necrosis of the bone occurs. Area then revascularized, and the necrotic bone is replaced with new bone.
- Presents as avascular necrosis of the femoral head in 4-8 years olds, (more often boys)
A
Legg-Calve-Perthes
11
Q
disease occurs when too little blood is supplied to the ball portion of the hip joint (femoral head).
limp, pain in groin, anterior hip, greater trochanter, pain in ipsilateral knee
Antalgic gait, Trendelenburg gait
= immediate ortho referral
A
Legg-Calve-Perthes
12
Q
•Salter-Harris type 1 fracture through the proximal femoral epiphysis
•Displaces posteriorly and inferiorly to the metaphysis
•can be caused from stress in the hip region that causes shearing force that is applied around the growth plate (trauma or weak intrinsic muscles / physeal cartilage)
- overweight boys
= immediate referral to ortho
(crutches/ wheelchair?
A
Slipped capital femoral epiphysis
13
Q
inflammation of the bursa (fluid filled sac that facilitates smooth movement of joints)
A
bursitis
14
Q
anterior or lateral shoulder pain with acute or insidious onset. Pain exacerbated by over-head activities; deep aching that interrupts sleep.
Increased pain with active abduction and internal rotation of arm and tenderness below the acromion. Weakness with internal rotation
A
Shoulder bursitis
15
Q
How to test for Shoulder bursitis
A
Neer impingement sign and
Hawkins impingement sign
16
Q
raise and pull on straightened arm forcibly from the side to full abduction above the head→ if this causes pain the patient has impingement
A
Neer impingement sign
17
Q
flex the elbow to 90 degrees and raise upper arm to 90 degrees of abduction (parallel to floor). Then rotate arm internally across the front of the body, causing compression of the rotator cuff and subacromial ligament. → pain= impingement
A
Hawkins impingement sign
18
Q
visible elbow swelling. Assess for erythema, temperature, lymphadenopathy, ROM.
A
Elbow (olecranon) bursitis
19
Q
how to manage Elbow (olecranon) bursitis that may be septic
A
Septic (⅓ of cases are septic): tenderness, erythema, and warmth
•Obtain fluid for culture and start ABX to cover Staphylococcus aureus
•RF: DM, immunosuppression, alcoholism, psoriasis, gout, RA
20
Q
most common reasons people get hip bursitis
A
trochanteric most common; W>M; runners, s/p hip replacement
21
Q
sudden or gradual pain from overuse or trauma. Pain worse at night. Point tenderness, may be accompanied by redness, warmth, and swelling. Hip flexion and rotation may exacerbate pain. Passive joint motion not affected
A
hip bursitis
22
Q
housemaid’s knee”- prepatellar bursitis: caused by excessive kneeling; pes anserine: obese or degernative
oPE: tenderness and edema over patella.
A
knee bursitis
23
Q
mild to moderate pain over anterior and medial knee just below joint line. Active resisted flexion of knee reproduces pain.
A
Pes anserine… knee bursitis
24
Q
differentiates bursal swelling from effusion): apply downward pressure on patella, if click is felt joint effusion is likely, if negative bursitis is present
A
Ballottement test
25
pain and limping
PE: erythema or palpable, swollen bursa that is tender at Achilles tendon insertion site at the posterior heel. Pain by squeezing bursa and compressing side to side.
Heel (Calcaneal) bursitis
26
General Diagnostic tests for bursitis
fluid aspiration if suspect septic bursitis; crystal analysis, WBC count, glucose, ESR, rheumatoid factor, or antinuclear antibodies, uric acid
27
How to Tx bursitis?
Aspiration if septic (completed by ortho). Cold and heat therapy (max 20mins each session). Activity modification. Knee pads, immobilization, elevation, and rest for a few days. Aspiration not infected fluid to provide relief if desired. Should resolve in 3-4 days if not septic.
28
Pharm for bursitis
- NSAIDs. If older than 75 and/or on anticoags use topical NSAIDs and lidocaine patches.
- ABX if septic: cover staphylococcus aureus. Refer to ortho for aspiration; high risk.
- Local Injections: corticosteroids with or without anesthetic. (no more than 3 injections in the same joint over 12 months).
29
(even if x-ray is negative; common area fx are missed)- scaphoid fracture- splint, repeat x-ray in 1-2 weeks. High risk pt.
Snuff box tenderness
30
bone shattered in 3 or more pieces.
Comminuted fracture
31
mild. Can bear weight, mild tenderness and swelling
grade 1 sprain
32
moderate→ parietal tearing. moderate tenderness and swelling. May or may not be able to bear weight. Significant discomfort. Laxity to joint
grade 2 sprain
33
severe → complete tear of ligament. Large amount of swelling and pain, Not able to bear weight. Significant laxity, unstable joint.
grade 3 sprain
34
how to tx a sprain
ensure good footwear, stretching, strengthening. Long recovery. NSAIDs, tylenol, RICE, splint, walking boot, cam boot, aircast splint. Refer to PT. Cryotherapy. Electrotherapy, US.
35
joint overuse - discomfort over inflamed tendon, point tenderness, or nonspecific limb pain.
Tendonitis
36
how to tx Tendonitis?
tylenol, NSAIDs, injections with cortisone, exercises (ROM, PT). F/u in 7-10 days to ensure sx have resolved.
37
Chest pain that is reproducible
| W>M, dx of exclusion (EKG, CXR)
Costochondritis
38
how to tx Costochondritis?
NSAIDs and tylenol, cold/warm compresses; stretching exercises. Refer to orthopedist if no improvement (steroid injections). f/u in 7-10 days. Should resolve on own.
39
stiffness in morning, alleviated with walking/moving. Length discrepancy in legs, loss of internal rotation, mild swelling
arthritis
40
how to tx arthritis ?
: tylenol, NSAIDs, canes/walker, PT, decrease progression and improve QOL
41
pain in neck that does not radiate. Usu d/t sprain or strain or referred. Limited ROM may be present. Motor strength and reflexes are normal
axial neck pain
42
pain greater in the arm than in the neck with neurological sx (weakness, numbness, and tingling). Abrupt onset of pain that worsens with cervical extension and ipsilateral rotation
radicular neck pain
43
→ immediate referral→ caused by spinal cord compression. Weakness in lower extremities, gait disturbance, bowel and bladder dysfunction, or sexual dysfunction.
Cervical myelopathy
44
overstretching or tearing of spinal ligaments and muscles. May occur without identified precipitating event, MVC, trauma (whiplash- includes soft tissues, ligaments, nerves, and disk)
strain
45
common cause of radiculopathy
commonly a herniated cervical intervertebral disc (C6-7 or C5-6)
46
pressing down on head reproduces symptoms down the arm
Radiculopathy
47
(upper limb tension test) → turn head contralaterally with the arm abduction and elbow extended. Reproduction of sx is positive.
Elvey test (Radiculopathy)
48
place palm of affected extremity on top of head while pt is seated. Alleviation of pain is positive.
Shoulder abduction test
| Radiculopathy
49
rapidly flex the neck while pt is seated → electric shock sensation down the spine and into limbs indicates cervical cord disorders (compression, tumor, MS)
Lhermitte sign
| Radiculopathy
50
may happen in a young or middle-aged adult. Usually weight, their occupation, and even genetics can put a patient at risk
• Good history is important
• Some may have radicular pain, radiation, weakness
• L5-S1 most commonly affected
herniated disc
51
anterolateral shoulder pain that does not radiate past the elbow.
Rotator cuff tear
52
+Drop arm test, complete inability to move shoulder if complete tear. Unable to shrug shoulder while abducting arm
Rotator cuff tear
53
how to dx and tx rotator cuff tear
•Diag: x-ray to r/o fracture, MRI to confirm
Tests: Apley Scratch, Drop arm, empty can, lift - off
Tx: NSAIDs, tylenol, ultram or narcotics. Steroids to help with inflammation. Ice/heat. Nonoperative if no weakness. PT. surgery if no improvement after 4-6months of PT\\
54
* RF: trauma, hx of dislocation or subluxation, impact injury (sports)
* CM: mechanism of dislocation,
* PE: 90% are anterior (abducted and internally rotated arm) acromion process palpable. NV exam
AC Dislocation/subluxation
55
how to dx and tx AC Dislocation/subluxation
Dx: x-ray to assess for fracture
Tx: NPO and immobilize shoulder to have joint reduced in ED, surgical intervention if reduction unsuccessful
56
•RF: injury, fall
CM: decreased ROM, mild pain; may be able to palpate separation
Diag: x-ray
Tx: sling, ice, NSAIDs, tylenol, ortho referral if severe. Should resolve in about a week. ROM exercises when pain is resolved
Separation of AC joint
57
active and passive decrease in ROM. Sx 18-24 mos +Apley scratch test
Diag: will be normal, used to r/o fracture
Tx: NSAIDs/tylenol. Corticosteroid injection. ROM exercises- PT.
Frozen shoulder aka Adhesive capsulitis
58
risk factors for frozen shoulder
DM, thyroid dysfunction, hypercholesterolemia. Over 40. Parkinson’s. F>M
59
gradual onset of dull ache/discomfort on inner or outer aspect of elbow. Pain increased with grip and twisting.
Epicondylitis AKA Tennis Elbow
60
Prevention and TX of Epicondylitis AKA Tennis Elbow
* Prevention: rest, avoid exacerbating activities, no prolonged overuse
* Tx: NSAIDs, tylenol, ice, heat, PT, splinting if severe. If no resolution after 3-6 months refer to orthopedist. Do not completely immobilize joint (no sling). 90-95% of cases resolve without surgical tx.
61
2nd-4th decade. W>M
10% report trauma. Nontender mobile area, compressible cyst
x-ray will be normal, MRI study of choice if needed to confirm; Aspiration can be both diagnostic and therapeutic. Cyst may recur
Ganglion Cyst
62
How to tx ganglion cyst?
Tx: steroids after aspiration, compression, refer to sx (if nerve compression) or PT. 50% resolve on own
63
weakness or lack of extension of distal phalanx. No signs of trauma.
Trigger finger/Mallet Finger
64
how to dx and tx Trigger finger/Mallet Finger?
Diag: x-ray
Tx: NSAIDs, tylenol, finger splint (8weeks) in extended or hyperextended position. Refer to orthopedist. RICE. Surgery if displaced fracture or fail splinting with symptoms
CTS
65
north European descent, DM, epilepsy, alcoholism, pulm disease, tobacco abuse
CM: gradual onset stiffness of hands and fingers, painless, palmar dimpling over flexar tendon of finger; ulnar size of both hands
Dupuytren’s Contracture
66
how to tx Dupuytren’s Contracture?
daily passive hyperextensive stretching, refer to orthopedist if severe (contracture >30 degrees- can lead to skin break down and infection), PT
67
Thenar atrophy, hand numbness on thumb and radial aspect, increased pain at night
PE: +Phalen, +Tinnel, +Flick sign
Tenosynovitis
| Carpal tunnel Syndrome
68
how to tx Tenosynovitis?
pain relief (NSAIDs, tylenol, steroid injections), refer to OT, splints/immobilization at night. Limit aggravating factors. Sx should resolve in 3-6 months. Surgical release for severe sx.
69
Risk Factors for Tenosynovitis?
BMI and hand-wrist repetition. Anatomic (distal radius fx, hematoma) or physiologic (DM, alcoholic neuropathy, hypothyroidism), RA, gout, infection, pregnancy, hemodialysis; Positional changes (computer use)
70
Mechanical or systemic (inflammatory, infectious, neoplastic, or visceral sources)
Acute pain = onset n sx -6 weeks, Subacute= 6 weeks- 3 months, Chronic = > 3 months
Back pain
71
radiating pain, weakness, paresthesias, and altered reflexes. Caused by nerve root injury
Radiculopathy
72
isolated to the back at the lumbar spine or lumbosacral junction with varying degrees of gluteal symptoms.
new, acute, disrupts sleep and ADLs. exacerbated by prolonged sitting, standing, leaning, or bending.
Axial pain
73
back pain with tissue damage
Nociceptive pain
74
back pain with minimal or no tissue damage.
Neuropathic pain
75
Tuna Fish Back Pain Red Flags
```
T= Trauma
U= unexplained wt loss
N= neurologic sx.
A= Age >50
F= fever
I= IVUD
S= Steroid use
H= hx of cancer (prostate, renal, breast, lung)
```
76
leg and thigh pain > LBP. numbness, tingling, weakness, reflex changes on PE. symptoms exacerbated by prolonged sitting, coughing, sneezing, Valsalva maneuver, and bending.
Lumbar radiculopathy:
77
Physical exam for back pain
inspect spine, palpate for tumor, heat. Assess ROM (flexion, extension, lateral flexion, and rotation). Anatomic alignment during neutral stance.
78
tests for balance
Romberg (back pain)
79
things to look at when assessing gait and back pain
antalgia, footdrop, spastic or mechanical movement, trendelenberg gait, and widened or narrow steps.
80
things to look at when assessing skin and pulses and back pain
lower extremity pulses → vascular insufficiency
81
things to ask when assessing tone and back pain
loss of bowel/ bladder? Cauda equina?
82
things to look at when assessing neuro back pain
strength and symmetry of hip flexion, knee extension, ankle dorsiflexion, ankle plantar flexion, foot eversion, great toe extension, and hip abduction bilaterally. Walk on heels (L5) and toes (S1)
83
things to look at when assessing sensory back pain
light touch and pinprick→ highly specific for lumbosacral radiculopathy
84
things to look at when assessing babinski back pain
clonus, muscle spasticity, or increased tone→ upper neuron involvement
85
What tests to do with radicular sx and back pain?
straight leg test (assess damage to L5-S1) → patient supine, passively raise leg 30-60 degrees; if this reproduces pain and tingling highly specific for nerve root impingement from disc herniation.
Positive crossed straight leg raise→ symptoms reproduced when testing the unaffected leg (increased specificity for disc herniation)
86
diagnosing back pain
no change in outcome. X-ray (AP/LAT)if no improvement in 4-6 weeks
MRI: degenerative disc disease, disc herniations, spinal stenosis, cord or root compression. Only recommended if severe or progressive neurologic deficits.
87
treating back pain
physical therapy within 6 weeks of symptom onset, best within 14 days of onset (evaluate and treat). 3 visits/week for 4-8 weeks
NO BED REST unless severe limitations!
88
1st line pharm for back pain
NSAIDs, may use muscle relaxants short term if severe. TCAs and mixes SNRIs trial if not responding to other meds. Gabapentin for radiculopathy. No benzos and no systemic corticosteroids.
89
stress fracture through the pars interarticularis of the lumbar vertebrae.
often occurs in athletic child or teen and can lead to spondylolisthesis in older adult.
Spondylolysis
90
Neurologic compression or traction results in back and radicular pain... can occur when there's a stress fracture that weakens the bone so much that it's unable to maintain its proper position within the spine…. vertebrae starts to shift and slips out of space.
•Usually worsens with rest due to stiffness that develops (pain in the AM)
Spondylolisthesis
91
narrowing of the spinal canal with or without compression of the spinal cord
Spinal stenosis
92
LBP and neurogenic claudication (thigh and calf pain worsened by standing or walking and alleviated by sitting). Legs feel heavy or wooden. Walking with shopping cart is well tolerated d/t forward flexed position (expanding spinal canal diameter). * check the pulses to r/o vascular
- Usually have pain with lumbar extension
Spinal stenosis
93
“Shopping cart sign” (flexion posture offers some relief)
Spinal stenosis
94
saddle anesthesia, urinary retention or incontinence, lower extremity weakness, recent-onset erectile dysfunction. Compression of multiple nerve roots; very rare. Urgent surgical referral.
cauda equina syndrome
95
physical exam for hip pain
examine back, sacroiliac joints, hips, knees, and ankles- inspect, palpate, strength and stability
96
Assessing Gait for hip pain
(limp-antalgic gait) or Trendenlenberg gait (limp with exaggerated swaying motion of the upper body toward painful hip while walking). Neurologic exam
97
Assessing ROM for hip pain
restriction of abduction and internal rotation more pronounced. Pain, muscle spasm, or guarding with passive and active ROM.
98
point tenderness over lateral prominence. Hip flexion and internal rotation exacerbates pain.
Greater trochanteric pain syndrome/bursitis
99
How to dx hip pain?
| Placement?
X-ray (AP pelvis and frog-leg and lateral views of hip), taken weight bearing
100
pain in groin of anterior thigh with a pronounced limp. History of fall (older adult). Hip, groin, or thigh pain. Unable to bear weight. Affected extremity shortened and externally rotated
Stress fracture
101
_______at any age should prompt BMD testing and endocrinology eval (vit d deficiency, hyperparathyroidism, anorexia nervosa, female athlete triad)
fracture
102
sudden hip pain... consider....
dislocation
103
lateral hip pain to palpation and on ambulation and at night. Point tenderness
Hip Bursitis
usually over greater trochanter
104
loss of blood supply and subsequent death of subchondral bone tissue. Cartilage remains intact; however, the bone beneath becomes flattened and misshapen
Avascular necrosis
105
breakdown or degeneration of the cartilage within the joint, causing bone ends to rub
progressively worsening pain in groin, buttock, or anterior thigh with activity and improvement with rest.
Osteoarthritis
106
Ottawa knee rules
age 55 and older = 1 pt
isolated tenderness of patella (no bone tenderness of knee other than patella) = 1 pt
tenderness of head of gibula= 1 pt
inability to flex to 90 degrees = 1 pt
inability to bear wt both immediately or walk > 4 steps after = 1 pt
107
What does ottawa knee rules tell us
0 findings = x ray not indicated
| 1-5 = x ray indicated
108
what to do if you suspect ligament damage in knee?
MRI
109
Often injured during sports during rapid deceleration or when quickly changing directions. Direct blow to lateral portion of knee. Rapid swelling occurs (d/t bleeding of torn ligament)
ACL Injury
110
recalls hearing a “pop” with symptoms of dizziness, sweating, or fainting. Swelling within first 2 hours of injury. Difficulty walking; unstable knee “gives way”. +Lachman, +Anterior drawer
ACL Injury
111
PE for ACL Injury
Lachman test and Anterior drawer
112
assesses ACL) → knee flexed to 15-30°. Place one hand below the knee on posterior aspect, other hand is placed on anterior aspect above the knee. Lift the lower leg and push down the upper leg. If ACL is intact examiner will feel a “knock” or firm “stop”. If no firm endpoint is felt an ACL tear is suspected.
Lachman test
113
ACL) flex knee to 90° with foot flat on exam surface. Sit on patient’s foot and grasp the lower leg, placing fingers below the popliteal space and thumbs on tibial tuberosity. Pull gently but firmly on the tibia forward. A “soft” or absent end point indicates a tear.
Anterior drawer test
114
how to tx ACL injury?
NSAIDs and tylenol, immobilize knee. RICE, refer to orthopedist and PT. F/u in 7-10 days to ensure no effusion has occurred. Weight bearing as tolerated. No bending, squatting, anything that will aggravate.
Surgery- active age 18-35 within 5 mos of injury
115
injured when weight bearing knee is twisted while partially flexed (3rd most common knee injury)
Meniscal injury
116
joint effusion, tenderness along joint line, sense of instability, locking, or giving way especially when descending stairs or walking on uneven surfaces. +McMurray, +Apley
Meniscal injury
117
While standing patient flexes affected knee 5° while flexing the unaffected knee and lifting foot off floor so all weight is on affected knee. Patient twists affected knee 3x. Repeat test at 20° of flexion. Joint line pain and locking sensation are positive for meniscus tear.
Thessaly test
118
helps determine if there is tear in cartilage. Patient is supine with legs straight. Place one hand on knee and other on ankle. Flex and extend the knee while internally and externally rotating the leg. Hold stress on the knee while extending and palpate joint line for pop or click
McMurray test
119
patient prone and affected leg flexed 90°. Stabilize back of knee and lean on and rotate heel (squeezes menisci between the femur and tibia). Pain=tear
Apley compression test
120
how to tx meniscal injury?`
NSAIDs, tylenol, ice, immobilize, PT. Possible surgery (only if wishing to return to same level of activity prior to injury)
121
pain (insidious and mild to moderate), stiffness, and decreased function. Resting alleviates pain.
• Tx: muscle strengthening, weight loss, analgesics, NSAIDs. Injections of steroids or hyaluronan. Consider joint replacement if severe- pain at night or at rest.
osteoarthritis/degenerative conditions
122
overuse injury; knee pain localized to anterior portion. AKA runner’s knee, jumper’s knee, retropatellar syndrome, and anterior knee pain.
abnormal lateral tracking of the patella (d/t weak quads, poor flexibility, tight IT band, overuse, or malalignment) More common in women d/t wider pelvis
patellofemoral pain syndrome
123
: bilateral anterior knee pain exacerbated by sports (squatting, running, climbing stairs, kneeling). “Knee is giving out”. Prolonged sitting with knee flexed increases pain (“theater sign”)
patellofemoral pain syndrome
124
PE for patellofemoral pain syndrome
observe gait, palpate knee while sitting and supine (crepitus or tenderness). Lateral tracking of patella in seated position. Examine hips and lumbar spine as well as neurovascular system. Pain on palpation or during squatting?
125
swelling superficial to patella. d/t frequent kneeling. No pain with weight bearing or ROM; direct pressure produces mild pain. PRICE (protection, rest, ice, compression, elevation)
Prepatellar bursitis aka housemaid’s knee
126
pain along IT band with palpation, discomfort in knee. Point tenderness along lateral epicondyle
IT band syndrome
127
how to tx IT band syndrome
tylenol, NSAIDs, ice, orthotics, steroid injections, f/u 4-6 weeks. **Education on RICE, exercise, and stretches, foam rollers** sx should resolve in 4-6 weeks. Surgical management for prolonged pain unresolved with conservative management
128
Foot plantar flexes and internally rotates as the ankle inverts. Injures lateral ligaments and can cause lateral avulsion fracture
Inversion injury
129
: less common; ankle external rotation. Damages the deltoid ligament or syndesmosis
Eversion injury
130
Swollen and painful joint; ecchymosis, decreased ROM. Weight bearing causes pain or patient is unable to bear weight
Palpate fifth metatarsal (if tender consider fracture). Palpate entire limb to r/o further injury
Diag: x-ray
Ankle Sprain
131
pain with or without swelling around the Achilles tendon→ not a sudden onset
intermittent pain that subsides during exercise but increases during rest. Pain at heel or along the length of tendon. Morning stiffness or pain climbing stairs is common. Limp may be present
Achilles tendinopathy
132
(bony prominence on heel)
Haglund deformity
133
how to tx achilles tendinopathy
cessation of activity. Crutches may be needed. NSAIDs and ice (20 mins 3-4x/day). Shoe insert that raises heel ¾ inch may provide relief.
•Education: resolution can take 8 weeks or longer. Begin stretching and strengthening when pain and swelling have subsided. MUST stretch before all exercises to prevent recurrence or rupture.
134
sudden event results from forced stretch on a degenerated tendon. ”; sudden weakness in ankle, impossible to rise up on toes, limp. Pain is not common. Audible “POP”, others nearby can hear, unable to walk on side
Achilles tendon rupture
135
sible and palpable gap where rupture occurred (usu. 1 ½ inches above heel). Decreased anchor plantar flexion. +Thompson test
Achilles tendon rupture
136
patient kneels on a chair or prone with knee flexed. Squeeze calf- if foot plantar flexes the tendon is intact
```
Thompson test
(negative if tendon moves)
```
137
TX of Achilles tendon rupture
immediate referral to orthopedic surgeon
Nonsurgical: long leg cast or rigid boot for 6 weeks, followed by heel lift for 2 months
Surgical: reapproximation of the two ends of the tendon or tendon transplant; followed by long-leg cast for 6 weeks then short-leg walking cast for 4 weeks. Less risk of recurrence with sx rather than nonsurgical tx.
138
joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion
Osteochondritis
139
pain in the bottom of the foot along the arch and heel
| = high impact or stress tears the fascia
Plantar fasciitis
140
point tenderness at the insertion of the fascia to the calcaneus. Early morning heel discomfort that resolves after several minutes but returns later in the day is clinically diagnostic
Plantar fasciitis
141
how to dx Plantar fasciitis
x-ray (to r/o underlying causes- fracture) → may see a bone spur from heel (commonly occurs with PF)
142
How to tx Plantar fasciitis
complete rest from high-impact activities. No walking barefoot or in flat shoes (flip flops). Arch support shoe inserts, heel pad (raises heel ¼ inch). NSAIDs and ice massage. Should resolve in a couple weeks
- Refer to PT for stretching exercises.
- Corticosteroid injection at heel may help.
- Night splints to keep foot dorsiflexed
143
Perineural fibrosis of the plantar nerve- compression of the interdigital plantar nerves leads to inflammation and fibrosis of the nerve sheath
wearing narrow, pointed-toe, or high heeled shoes→ causes entrapment
Morton Neuroma
144
severe pain and burning in the third web space (b/t 3rd and 4th metatarsals). Relief is felt when barefoot and with moot massage. Elevation aggravates the pain
Morton Neuroma
145
compression of the medial and lateral sides of the foot with one hand and squeezing between the third and fourth metatarsal results in a palpable or audible click. May feel acute pain radiating to adjacent toes and up the foot. Paresthesias may occur at reciprocal surfaces of toes.
Mulder sign: (Morton Neuroma )
146
How to tx Mulder Sign
can be resolved by wearing wider shoes (properly fitted) with good arch support and a low or flat heel. Replace shoes when support wears out. Metatarsal arch pad may ease discomfort.
Refer to podiatry
147
Inflammatory degenerative deformity of the first MTP joint r/t flat feet or laxity of first toe
warm pack or soaks, NSAIDs, well fitted shoes with adequate toe space. Podiatry referral for custom protective shield or foot mold; surgical correction if conservative management does not control pain.
Bunions
148
hyperkeratotic lesion caused by pressure or friction. Usually found on the toes or other bone prominence
Hard corn (heloma durum):
149
macerated, interdigital, and painful. Caused by pressure.
Soft corn (heloma molle):
150
Erythematous, painful lesion; patient may also have hammertoes
Tx: avoid tight-fitting shoes, use corn pads to relieve pressure. Routinely pair with file or scalpel. Powder between toes to prevent excess moisture. Referral to orthopedist for orthotic device. Surgical repair of hammertoe if needed. **caution patients with DM prevent corns, calluses, or ulcerations and infection**
Corns
