Ortho Flashcards
DDx for neck and upper back pain
- Cervical radiculopathy
- Cervical sopndylosis or stenosis
- Herpes zoster
- Angina pectoris
- SAH
- Meningitis
- Epidural abscess
Sx of a mechanical injury
Poor posture/sleep: HA, stiffness, tightness, spasm, rarely weakness, sometimes paresthesias
Forced hyperflexion/extension (rear end collision): occipital HA, sometimes malaise, dizziness, fatigue
Sx radiculopathy / nerve root compession (foraminal stenosis, C6, C7 common)
Sharp, burning, tingling w/associated unilateral weakness often in a myotomal pattern
C6: weak biceps, brachioradialis, wrist ext
C7: weak triceps, finger flex/extensors
Sx cord compression (spondylosis, stenosis, disc herniation)
BL weakness/paresthesias UE LE
Cervical flexion often exacerbates
DDx for shoulder pain
- Rotator cuff tendinopathy
- Adhesive capsulitis
- Biceps tendinosis/tendonitis
- Calcific tendonitis
- Subacromial bursitis
- Septic arthritis
- Lyme
- Gout, pseudogout
- Arthritis
- Dislocation
- Referred pain (gallbladder, MI, etc)
DDx hand pain
- Traumatic: sprain, fracture, repetitive movement/overuse syndrome, mallet deformity, dislocation, depuytren’s contracture, fight bites
- Non-traumatic: ganglion cyst, arthritis (osteo, gouty, rheumatoid), infection, radiculopathy
Concern if tenderness at snuffbox
Scaphoid fracture
Risk of avascular necrosis
DDx wrist pain
Scaphoid fracture, dequervain’s, overuse, sprain, carpal tunnel
What is avulsion?
such a bad sprain that it pulls piece of bone off.
DDx elbow pain
- Lateral / medial epicondylitis
- Cubital tunnel syndrome (ulnar nerve entrapment)
- Olecranon bursitis
- Septic arthritis
- Local cellulitis
- Biceps tendon strain/rupture
- OA
What is neuropraxia?
- Saturday night palsy
- disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery. Common after falling asleep on one’s outstretched arm
Etiology of low back pain
- Musculoligamentous strain, DDD or facet arthritis (usually responds to symptomatic tx)
- Disc dz – spondylosis, spondylitis, spondylolisthesis (recurring mild lumbar discomfort & episodes severe back pain w/sciatica (or any radicular sx))
- Occasionally problems outside spinal axis (renal, MI, AAA, statin, electrolyte imbalance)
If patient has lateral curve of spine when trying to stand, this indicates…
Muscle spasm
Sx of mechanical low back pain
- Stiffness, Tightness, Spasm, Rarely Weakness, Sometimes Paresthesias.
- Forced Hyperflexion/Extension (Rear End Collision) Common Cause.
Sx of radiculopathy as cause of low back pain
- Nerve root compression (l4-5, l5-s1 common). Sharp, burning, tingling with associated unilateral weakness often in a myotomal pattern, deep.
- Cord compression (spondylosis, stenosis, disc herniation) pain
- with bilateral weakness/paresthesias both le. Often exacerbates.
Diagnostic tests for AAA
CT, U/S ED eval
Diagnostic tests for MI
EKG, ED eval
Diagnostic tests for spinal epidural abscess
MRI w/contrast
Diagnostic tests for metastatic dz
LS plain film
Diagnostic tests for renal colic
UA, CBC, BUN, Cr, CT abd/pelvis w/o contrast, ED eval
What is spondylosis
- Degenerative OA of joints between center of spinal vertebrae and / or neural foraminae
- Also refers nonspecifically to any and all degenerative conditions affecting discs, vertebral bodies, and/or associated joints of lumbar spine
- Bone on bone
What is spondilolisthesis ?
- Vertebral bodies not lined up, shift forward
- Can happen acutely or overtime
- May be assoc w/spondylolysis, a break in vertebra typically in region of pars interarticulus
What is ankylosing spondylitis
- Chronic process that causes inflammation of various vertebral joints and joints between the spine and pelvis
- Eventually, affected spinal bones join – lordotic curve is straightened
Image of disc problems