Ortho Flashcards
For ligamentous instability
or ruptured cruciate
ligaments (ACL, PCL).
* Abnormal forward or
backward sliding of the tibia
with respect to the femur
indicating laxity or tear of
the anterior (forward slide)
or posterior (backward slide)
cruciate ligament of the
knee.
Drawer Sign
Testing integrity of ACL. More
sensitive than anterior drawer
test.
* With the patient supine and the
knee flexed to 20 degrees, the
tibia is pulled anteriorly. A
“give” reaction or mushy end
point indicates a torn A
Lachman’s sign
- Testing for meniscal tear.
- Occurrence of a cartilage click during manipulation of the knee; indicative of meniscal injury.
- Gold standard test: MRI
McMurray Test
Testing for meniscal injury.
* Tibial rotation on femur with traction or compression with the patient prone and knee flexed
Apley test, aka “compression test, grinding”
Tests De Quervain’s tenosynovitis, aka: radial styloid
tenosynovitis.
* Swelling of thumb tendons caused by repetitive motion.
* Examiner grasps the thumb and ulnar deviates the hand sharply. Positive test if sharp pain occurs
along the distal radius
Finkelstein test
lightly tapping (percussing) over the nerve to
elicit a sensation of tingling or “pins and needles” in the distribution of the nerve
Test for carpal tunnel syndrome, aka: median nerve compression
Tinel’s sign
Firmly hold the backs of your hands
together with your fingers pointing down, while keeping your arms parallel to the floor. If within a minute, you experience numbness, tingling, pain or a combination, you likely have nerve involvement
Test for carpal tunnel syndrome, aka: median nerve compression.
Phalen’s maneuver
test done to determine whether a patient with low
back pain has an underlying nerve root
sensitivity, often located at L5 (sciatic
nerve pain).
* With the patient lying down on their
back on an examination table or exam
floor, the examiner lifts the patient’s
leg while the knee is straight
straight leg raise
To diagnose a distal biceps tendon
rupture, avulsion, or a tear
Hook test
Best for bone injuries such as fractures
To diagnose: disease of bone degeneration
(OA), dislocations, fractures, tumors,
infections
Xray
Used primarily to diagnose conditions in
organs and soft tissues
Takes a 360-degree image, uses radiation
To diagnose: appendicitis, cancer, trauma,
heart disease, musculoskeletal disorders
infectious diseases
CT
Used primarily to scan the spine, brain,
breasts, muscles, abdomen, and neck
No radiation
Best for soft tissue injuries such as tendons and
cartilages.
MRI
Wrist pain on palpation of the
snuffbox.
* Usually from fall, landing on a
hyperextended wrist.
* Initial X-ray normal, repeat 2 weeks Xray shows scaphoid fracture.
* Thumb spica splint, refer to hand surgeon.
Navicular fracture
Cause: high impact injuries (MVA, trauma, falls).
* More common/dangerous in elderly, immobility =
pneumonia, DVT.
* S&S: depend on degree and location. Sudden onset
one-side hip pain. Unable to bear weight.
Ecchymosis, swelling, bladder and or fecal incontinence, vaginal or rectal bleeding, hematuria,
numbness, unequal leg length, etc.
* Internal hemorrhage. Check ABCs
Pelvic/Hip fracture
- Aka: shin splints.
- Causes: microtears in muscle and bone tissue.
Pain caused by overuse along shinbone.
Generally brought on by high-impact exercise
that overloads the tibia, excessive physical
activity (runners, flat foot). - Tx: RICE, NSAIDS, PT.
Medial Tibial Stress Syndrome or Fracture
torn ligament
sprain
torn muscle or tendon
strain
Most commonly occur on ankle, knee, wrist.
* Acute: abrupt force beyond its functional ROM
(sports).
* Chronic: repetitive movements= overuse.
* S&S: pain, swelling, bruising, joint instability,
difficulty bearing weight
Sprain (torn ligament)
Mild. Able to bear weight and
ambulate.
Strain 1 sprain
-Moderate. Ecchymosis, swelling,
pain. Painful ambulation and
bearing weight.
-Consider Xray, referral.
grade 2 sprain
-Referral to ED. Inability to bear
weight, not able to ambulate, severe
bruising.
grade 3 sprain
Microtears on a tendon(s) cause inflammation
and pain.
* S&S: shoulder pain with certain movements.
Intensified with arm elevation and abduction
(reaching to the back pocket). Local tendon
tenderness on anterior area of shoulder.
* Common: athletes that participate in overhead
sports (volley, handball, tennis, baseball).
* Tx: RICE, NSAIDS, PT.
Supraspinatus tendinitis, aka: cuff tendinitis
An irritation of the tissue connecting the forearm muscle to the elbow.
Lateral Epicondylitis (tennis elbow)
Serena Williams hitting a backhand
A condition that causes pain on
the inner side of the elbow
Medial Epicondylitis (golfers’ elbow)
Condition that occurs when the bundle of nerves
below the end of the spinal cord are damaged.
* S&S: saddle anesthesia, low back pain, numbness
around anus, loss of bowel and bladder control,
pressure (bulging disc).
* SURGICAL EMERGENCY (spinal decompression)
Cauda Equina Syndrome
Acute onset of tearing, severe lower back
pain
Abdominal bruit or abdominal pulsation, signs of
shock.
* More common elderly male, hx smokers,
atherosclerosis.
dissecting abdominal aneurysm
- emergency
aka bowlegg, outward deformity.
* Most common cause
is rickets
Genu Varum (Val-Rum)
aka knock-knees, inward
deformity.
* Most common cause
OA, other injuries,
physical damage or
overgrowth
Genu Valgum
Bottom foot pain, aggravated with walking.
Usually felt with 1st steps and worsens with
walking.
* Cause: Microtears in plantar fascia due to
tightness of the Achilles tendon.
* Higher risk: obesity, aerobics, flat foot,
prolonged standing.
* Tx: NSAIDs, orthotics, stretching, weight loss.
Plantar Fasciitis
Inflammation/pain/burning of the digital nerve of
the foot between the 3rd and 4th metatarsals.
Affects the ball of the foot.
* Feels like you are ”stepping on a pebble”.
* Increased risk: high heels, tight shoes, obesity,
dancers, runners.
* Tx: rest, massage, ice packs, good shoes, loose
weight, stop what is causing stress
Morton’s Neuroma
- Aka: popliteal cyst, bursitis. Fluid
collection behind the knee. - Affects active patients (runners), ball
like mass behind the knee that is soft
and smooth. - Symptoms: usually asymptomatic,
can cause pressure. - Imaging: MRI
- Tx: RICE, NSAIDs, bursa can be
drained with syringe.
Baker’s cyst
- Compression of the median nerve as it travels through the wrist (carpal tunnel).
- Symptoms: pain, numbness, tingling, weakness.
- Tx: RICE, wrist splints, cortisone injections, surgery.
Carpal Tunnel Syndrome
- Spasms of small arteries cause episodes of reduced blood flow to the end arterioles. Digits turn white, blue, red (American flag).
- Cause: cold, emotional stress.
- Risk factors: smoking, meds,
other medical conditions. - Tx: dress warmer, don’t stress, stop smoking, CCB.
Raynaud’s phenomenon
Caused by the breakdown of cartilage between the joint bones. Bones rub together. Most often hips and knees. Slow, gradual
Age of onset: >50
Joint pattern: asymmetric
Movement: often worse
AM stiffness: present with inactivity <15min.
Hand joints: Heberden’s (DIP), Bouchard’s (PIP)
Systemic symptoms: not present
Joint swelling: bony
Tx: weight loss, stop smoking, isometric exercises, weight bearing
(walking, lifting weights).
1st line tx: acetaminophen Q4-6hrs.
2nd line tx: NSAIDs (for long term GI protection add PPI)
Osteoarthritis
Caused by chronic inflammation (autoimmune disease). Swollen inflamed synovial membrane. Usually involves fingers/hands,
elbows, wrists, feet.
Age of onset: 30-50
Joint patter: bilateral, symmetric
Movement: often better
AM stiffness: >1hr
Hand joints: Bouchard’s (PIP)
Systemic symptoms: present
Joint swelling: effusion, red, warm, tender, swollen joints
Tx: referral rheumatologists.
1st line: NSAIDs.
Then: steroids, DMARDs (methotrexate, sulfasalazine, cyclosporine,
hydroxychloroquine.
Biologic agents: TNF, alpha inhibitors.
Anti-TNF biologics: Humira, Enbrel, Remicade
Rheumatoid arthritis
- Deposits of uric acid crystals inside joints/tendons. Most common middle-aged man. Tophi (white nodules full of urate)
- Gold standard diagnosis: joint aspiration
- Symptoms: painful, hot, red, swollen great toe. Precipitated by ingestion of alcohol. Meats, seafood, asparagus, spinach, cauliflower, mushrooms.
- Labs: leukocytosis, elevated ESR.
Gout
Tx for gout (1st line, 2nd line, prevent)
- 1st line: NSAIDs (Indocin, naproxen)
- 2nd line: NSAIDs + colchicine
- Allopurinol: to prevent future attacks
Interprets if patient has normal, or low bone
density = osteopenia vs osteoporosis.
* Predicts chance of future bone braking.
* Helps determine if bone med is working.
* Results:
* T-score -1.0 or greater is normal.
* T-score between -1 and -2.5= osteopenia
* T-score below -2.5= osteoporosis
