Ortho Flashcards
what is this and what is the treatment?
clavicle fx
tx- immobilization
* < 12- 3-4 wks
* > 12- 4-6 wks
no contact sports for 6-12 wks
what is this and what is the treatment?
scapula fx
treatment- sling w/ ROM 1-2 wks post injury
> 2 cm separation–> refer
what 2 structures may be damaged in a proximal humerus fx?
brachial plexus
axillary artery
what is this and what is the treatment?
proximal humerus fx
treatment
* < 1 cm displaced- sling for 1 wk then ROM
* > 1 cm displaced- surgery
(Also has shoulder dislocation)
mechanism of trauma for anterior shoulder dislocation
trauma to abducted and externally rotated arm
s/s of anterior shoulder dislocation
pt holds arm externally rotated
what 3 views should be used to evaluate for shoulder dislocation on XR?
AP
Lat
Y
this is a complication of a shoulder dislocation where there is a humeral head compression fx
hill sachs lesion
this is a complication of a shoulder disloaction where the labrum pulls away from the glenoid
bankart lesion
what is this and what is the treatment?
shoulder dislocation
immediate reduction
chronic- PT, activity modification
what ligament is responsible for horizontal stability of the AC joint?
acromioclavicular ligament
what ligament is responsible for vertical stability of the AC joint?
coracoclavicular ligament
mechanism of trauma of AC joint separation
fall on adducted shoulder
(contact sports)
XR views of AC joint separation
bilateral AP views
zanca view (15 degrees cephalic)
what is this and how do you treat it?
AC joint separation
type 1-3- sling
type 3+- surgery
name the 4 RTC muscles
supraspinatus
infraspinatus
teres minor
subscapularis
s/s of RTC injury
weakness and pain
decreased AROM
night pain
special tests- + hawkins, neer, empty can and drop arm
dx of RTC injury
MRI
what is this and how do you treat it?
RTC tear
tx- PT and NSAIDs, RICE
steroid injection
surgery (active pts and full tear)
s/s of impingement syndrome
catching/ clicking
anteriolateral shoulder pain
pain with overhead and internal rotation motions
special tests- + heer and hawkins
* empty can positive for pain but not weakness
dx of impingement syndrome
diagnostic lidocaine injection (may add steroid)
XR may show bone spur
tx of impingement syndrome
NSAIDs
stretch posterior capsule
subacromial injections
s/s of shoulder arthritis
anterior and posterior pain
decreased ROM
atrophy
crepitus
dx of shoulder arthritis
joint space narrowing
osteophytes
subchondral cysts
tx of shoulder arthritis
NSAIDs
ice/heat
ROM and activity mods
steroid injections
replacement
who most commonly is affected by frozen shoulder
middle aged women
(DM or hypothyroidism)
s/s of frozen shoulder
pain and inability to move arm
tx of frozen shoulder
NSAIDs and PT
3 mo failed conservative–> surgical malipulation
what 2 things is bicep tendon rupture related to?
impingement syndrome
RTC tear
tx of bicep tendon rupture
PT
< 40 or very active–> MRI and surgery
what nerve is most commonly injured in a distal humerus fx?
ulnar nerve
what is this and what is tx?
sling and early ROM
may require surgery
what is this and how do you treat it?
radial head fx
tx- immobilization with early ROM
types 2-3 may need surgery
what is this and how do you treat it?
elbow dislocation
tx- immediate reduction and ROM 5-7 days later
block terminal extension w/ brace
NSAIDs to decrease ectopic bone formation
lateral epicondylitis is due to inflammation of _______ ______ _______ ______ while medial epicondylitis affects the _____ ______ _______ _______ _______
lateral- extensor carpi radialis brevis
medial- pronator teres-flexor carpi radialis
cause of lateral epicondylitis
repetitive pronation of forearm and wrist extension
s/s of lateral epicondylitis
pain with forearm supination and wrist extension (gripping, lifting, shaking hands)
cause of medial epicondylitis
excessive wrist flexion and pronation
tx of epicondylitis
stretching and strengthening
NSAIDs and RICE
counterforce bracing
steroids
6 mo failed conservative–> surgery
cause of cubital tunnel
entrapment of ulnar nerve between medial epicondule and olecranon
s/s of cubital tunnel
numbness and tingling of little and ring finger
medial elbow pain
numbness at night
PE- + Tinel’s and Froment
tx of cubital tunnel
night splinting
avoid bending
NSAIDs
nerve decompression via surgery
s/s of olecranon bursitis
boggy feeling
swelling
redness
warmth
tx of olecranon bursitis
mild- NSAIDs, activity mods
symptomatic- aspiration, compression
> 3 recurrences- surgery
distal radius fx where distal fragment is dorsally placed
colles fx
tx of colles fx
reduction and cast
comminuted or unstable- surgery
distal radius fx where distal fragment is displaced ventrally
smith fx
tx of smith fx
reduction and cast
comminuted or unstable- surgery
what is this and what is the treatment?
scaphoid fx
tx- immobilize in spica cast and follow up
what is this and how do you treat it?
kienbock disease
tx- immobilize and NSAIDs
what is this and how do you treat it?
bennett fx
tx- surgery
this is an oblique fx of the base of the thumb metacarpal that enters joint and a small fragment remains attached to the carpal
bennett fx
this is a fx of the 5th metacarpal neck
boxer’s fx
what is this and how do you treat it?
boxer’s fx
tx- ulnar gutter cast
surgery if displaced > 40 degrees
what is this and how do you treat it?
dupuytren’s contracture
tx- splints, steroid injections
surgery if interferes with function
what 2 structures are affected in dequervain’s tenosynovitis?
abductor pollicis longus
extensor pollicis brevis
PE findings of dequervain’s tenosynovitis
+ finkelstein
tx of dequervain’s tenosynovitis
immobilize wrist and thumb
2 wks of NSAIDs
injections
surgery
this condition is inflammation of the flexor tendon leading to finger being “locked” in position
trigger finger
what is this and how do you treat it?
trigger finger
tx- splinting, casting, injection, surgery
this injury is a rupture of the extensor tendon at the base of the distal phalanx which leads to the inability to extend the DIP joint
mallet finger
what other injury is mallet finger commonly associated with?
avulsion fx
what is this and how is it treated?
mallet finger
tx- full time splint to keep DIP in extension for 6-8 wks
this deformity is a tear of the central portion of the extensor ligament at the PIP joint–> PIP flexion and DIP hyperextension
boutonniere deformity
what is this and how do you treat it?
boutonniere deformity
tx- splint PIP in extension
carpal tunnel occurs due to compression of the _____ nerve and impacts these fingers ______
median nerve
thumb, index and middle
s/s of carpal tunnel
burning, tingling, numbness of thumb, index and middle fingers
thenar atrophy
+ Phalen’s, Tinel’s and 2 point discrimmination
tx for carpal tunnel
splinting
steroid injection
surgery for decompression
s/s of RA in the hands
MCP and wrist most affected
ulnar drift of fingers
swan neck deformity
s/s of OA in the hands
DIP, PIP and thumb metocarpal most affected
Bouchards- PIP
Heberden’s- DIP
tx of arthritis in the hand
NSAIDs
splinting
PT
surgery- OA
this is fluid accummulation form synovial sheath or joint cavity and transilluminates
ganglion cyst
tx of ganglion cyst
reassurance
immobilization
aspiration
> 3 recurrences–> surgical removal
this injury occurs due to forced radial deviation of the thumb
ulnar collateral ligament tear/ gamekeeper’s thumb
XR for gamekeeper’s thumb
stress view of MCP joints with comparison views (> 30 degrees is complete tear)
tx of gamekeeper’s thumb
splint
complete (> 30 degrees)- surgery
tx of animal bites to the hand
I&D
abx prophylaxis for all cat bites and all hand bites with augmentin
admit all infected hand bites or deep bites
