Ortho Flashcards
Deltoid Myotome
C5-Abduction
Biceps Myotome
C6-Flexion
Triceps Myotome
C7-Extension
Interossi Myotome
C8-PAD & DAB
Bicep DTR
C5 and part of C6
Brachioradialis DTR
C6
Triceps DTR
C7
What is Spurling Test?
Compression Test (press down on head) -positive test is a recreation of cervical radiculopathy symptoms
What is Jefferson Fracture?
Disruption of C1 Ring
- may be a burst type w/ comminution
- *best seen on odontoid view**
What is Hangman’s Fx
C2 vertebral body fracture w/ anterior subluxation
not usually compatible w/ life
Pain in pt w/ scoliosis?
PAINLESS: if pain then should do MRI
Tx of scoliosis
20 degrees or less = conservative
40 degrees or more = surgical
About compression fractures
Most common at T10-L2 levels
- wedge shaped and stable
- pain w/ movement but better w/ rest
- suspect if 2in height loss in elderly
First thing to order w/ acute lower back pain
X-ray
Tests for Lumbar radiculopathy
- -Straight leg raise
- Laseagues Sign (worse w/ ankle dorsiflexion)
- Cross over straight leg raise (predicts disc hern)
L3-L4 level causing radiculopathy = nerve and symp
L4
- sensory to posterolateral thigh, ant knee, medial leg
- motor to quads, hip abductors
L4-L5 level causing radiculopathy = nerve and symp
L5
- sensory to anterolateral leg, dorsum of foot, big toe
- motor EHL, EDL, EDB, gluteus medius
L5-S1 level causing radiculopathy = nerve and symp
S1
- sensory lateral malleolus, lateral foot, heel
- motor: peroneals, gastroc soleus, glut maximus
Quad myotome
L4 - extension of knee
Anterior tibialis myotome
L5 - heel walking
Gastrocnemius myotome
S1 - toe walking
Patellar reflex nerve?
L4
Achilles reflex nerve?
S1
What is spondylolysis
Pars interarticularis defect or stress fracture
- *gymnasts and football linemen**
- scotty dog on x-ray w/ collar fx
What is spondylolisthesis
Anterior slippage of vertebral body on inferior counterpart
- most likely fatigue fracture as adolescent that didn’t heal
- Degenerative slip
- *if <50% slippage = conservative tx successful
What nerve do you assess when shoulder dislocation
Axillary (C5,C6) paralysis of trees minor & deltoid w/ loss of sensation of lateral upper arm
Bankart Lesion
Detachment of anterior inferior labrum from glenoid rim
occurs in dislocation of shoulder
Hill Sachs Lesion
Defect to posterolateral human head when the humal head is abraded by the anterior rim of the glenoid
(occurs in dislocation of shoulder)
What positioning causes shoulder dislocation?
Abduction and extension
AC joint separation aka sprain
point tenderness over tip of shoulder
can lift arm above shoulder but painful
Rotator Cuff Muscles =
Supraspinatus (Ext Rot and abd) most commonly inj
Infraspinatus (Ext Rot and abd)
TERES MINOR (ext rot and abd)
Subscapularis (INTERNAL rotation)
Yergason’s test
popping and grinding w/ supination
Occurs in biceps tendonitis
Most common peds fx
Clavicle fx (figure 8 brace)
Lateral Epicondylitis =
Overuse injury to extensor supinator muscle group (LES)
Medial Epicondylitis =
Overuse injry to flexor pronator muscle group (MFP)
Radial head fracture PE
decreased pronation and supination
Median nerve =
- Sensory to 1st-4th digits
- Motor to thenar muscle
DeQuervain Tenosynovitis =
Stenosing tenovitis of 1st dorsal compartment of wrist
+ finkelsteins test
Tx: thumb spica cast and splint immobilization
Smith’s Fracture
Flexion fracture of radius (volar)
Tx: sugar tong splint (need ORIF more often)
Colles Fracture
Extension fracture of radius
Tx: sugar tong splint (don’t need surgery as often)
Monteggias Fracture
Remember MUGR
=proximal ulnar fracture; dislocation of radial head
Galeazzi’s Fracture
Remember MUGR
=distal radius fracture; radioulnar subluxation
Blood supply to scaphoid
Retrograde flow vi a branch from the radial artery
Tx of anatomical snuff box pain
treat as fracture and immobilize; repeat x-ray in 2 weeks
Boxer’s Fracture =
Fracture through neck of 5th metacarpal neck
(rotational deformity is not acceptable)
Tx: Ulnar gutter immobilzation
Jersey Finger =
DIP joint force into extension
- inability to flex DIP joint
- no resistance to passive extension
Mallet Finger =
Inability to actively extend DIP joint
- caused by axial load compression
- ruptures thin extensor tendor
Boutonniere Deformity
Inability to extend PIP joint; secondary hyperextension at DIP joint
Swan Neck Deformity
Hyperextension of PIP joint w/ flexion of DIP joint
Gamekeeper’s Thumb
Injury to ulnar collateral ligament of thumb at MCP joint resulting in instability of MCP joint and decreased thumb grip strength
About trochanteric bursitis
Area where gluteus medius inserts and IT band passes over
-point tnderness, pain w/ walking or running, inability to sleep on side
Hip Dislocation Presentation
Limb shortened and internally rotated
90% posterior
Hip Fracture Presentation
Shortened leg, typically in external rotation
Tests for Meniscal Injury
McMurray Apley (prone and press down/axial loading) Triad = joint line pain, effusion, locking
Patellofemoral Pain Synd Presentation
Pain w/ stair walking, standing from seated position (women)
- *vastus medialis weakness**
- *x-ray to include sunrise/merchant view
LisFranc Injury
Fracture/dislocation of 1st/2nd TMT joint (mid foot swelling/pain)
(MVA, fall from height, stepping off curb, stepping into hole)
Test for Achilles tendon injury
Thompson Test
-prone and squeeze calf muscle
March Fracture
Stress reaction/fracture of metatarsal (usually the 3rd)
-caused by vertical and/or medial-lateral force when foot inverted w/ heel raised
Most common primary malignant tumor
Osteosarcoma
- 10 to 25y/o
- affects long bones (B>G)
What is a chondrosarcoma
Cartilage based tumor
- 35-50y/o
- Males> females