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Ortho Flashcards

1
Q

Muscles of the rotator cuff

A 
SITS:
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
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2
Q

Scapular winging

A

Indicates weakness of the serratus anterior muscle

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3
Q

Yergason test

A

Tests if the biceps tendon is stable in the bicipital groove
Grasp flexed elbow in one hand while holding the wrist in the other, externally rotate patients arm as they resist.
Positive test: the tendon will pop out of the groove

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4
Q

Drop arm test

A

Will indicate if any tears in the rotator cuff

Patient will not be able to lower their arm smoothly from 90 degree ABDuction

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5
Q

Salter-Harris classification

A

Type 1: Seperation at epiphyseal plate straight accross
Type 2: Partially at epiphyseal plate but also into metaphysis
Type 3: Horizontal in epiphseal plate and also into the epiphysis
Type 4: Metaphysis through the epiphyseal plate and into the epiphysis.
Type 5: Crush, erasure of growth plate

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6
Q

Ottawa rules for ankle

A

X-ray are required if:

  • any pain in the malleolar zone and
  • bone tenderness along distal 6 cm of the posterior edge of the tibia or tip of medial malleolus
  • bone tenderness along the distal 6 cm of posterior edge of the fibula or tip of the lateral malleolus
  • an inability to bear weight both immediately and in the ED
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7
Q

Ottawa rules for the knee

A

X-ray is indicated if have acute knee pain and at least one of the following:

  • Age 55 or greater
  • Tenderness at the head of fibula
  • Isolated tenderness of patella
  • Inability to flex to 90 degrees
  • Inability to bear weight both immediatedly and in the ED (4 steps)
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8
Q

Describe indications, CI, AE, etc. for muscle relaxants

A

Indication: muscle spasms
CI: Felxeril: hyperthyroidism, arrhytmias, acute MI, with MAOIs
Valium: preggo cat D, myasthenia gravis, actue ETOH WD, respiratory depression, avoid grapefruit juice
Soma: hx of porphyria
Skelaxin: hepatic/renal impairment, hx of drug induced hemolytic anemia
Robaxin: renal impairment

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9
Q

Name types of muscle relaxants and their MOA

A

cyclobenzaprine (Flexeril): similar to TCA
Diazepam (Valium): modulates postsynaptic effects of GABA transmission, also acts for calming (anxiety, seizures, status epilepticus, ETOH withdrawl
Carisoprodol (Soma): unknown
Metaxolone (Skelaxin): CNS depression
Methocarbamol (Robaxin): unknown (also used for tetanus)

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10
Q

Describe MOA, indications, CI, AE, etc. for Colchicine

A

MOA: decreases leukocyte mobility, reduces deposition of urate crystals
Indication: treat w/in 36 for gout attack
CI: pts w/ blood dyscrasias, hepatic or hepatobiliary dysfucntion
AE: GI 50-80% (N/V/D), and more
Interactions: CYP 3A4 inhibitors
Patient ed: narrow therapeutic range

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11
Q

Describe MOA, indications, CI, AE, etc. for Probenecid (Benemid)

A

MOA: promotes renal clearance of uric acid by inhibiting urate-anion exchanger in the proximal tubule
Indications: gout and to increase Beta-lactam ABX (prolongs plasma levels)
CI: Blood dyscrasias, young children, salicylates, uric acid kidney stones
Initiate treatment once attack has subsided
Pt. ed: hydrate

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12
Q

Describe MOA, indications, CI, AE, etc. for Allopurinol

A

MOA: lower production of uric acid
Indications: 2 weeks after gout attack, calcium renal calculus, hyperuricemia
CI: GFR less than 50, monitor CBC, serum uric acid
AE: acute gout attacks during the first months of tx, etc
Pt ed: keep taking during gout attack, start low go slow

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13
Q

Hyperextension/Hyperflexion of cervical spine

A

Hyperextension of C spine: (due to high force injury, aka MVA)
- acute onset of pain; can occur hours after injury: neck/jaw pain, stiffness, muscle spasm
Hyperflexion of C spine: (due to high force injury, aka MVA)
- acute onset of pain
- workup: teardrop fracture or compression fracture seen on x-ray
- managment: rest, possible neck brace, NSAIDs, ice

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14
Q

Intervertebral disc herniation

A

MOA: due to degenerative disease (bending, lifting, causing herniation and extrusion of disc contents)
- pain in dermatomal pattern (increased pain with coughing, straining, bending, sitting).
- most common L5-S1
Work up: straight leg test, cross over test, can have strength, relex and sensibility deficits; MRI diagnostic
Mgmt: NSAIDs, ice, PT, possible referral

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15
Q

Acute lumbosacral strain

A

Acute strain or tear of paraspinal muscles especially after twisting/lifting injuries
- back muscle spasms, loss of lordotic curve, decrease ROM, no neurologic changes
Workup: not much
Tx: very brief bed rest (less than 2 days), NSAIDs, muscle relaxants

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16
Q

Bicipital tenosynovitis

A

Eti: overuse injury or trauma (friction of head of biceps along the bicipital groove)
S/sx: anterior shoulder pain that can radiate down the bicep, abduction/external rotation painful, tendon can rupture (very painful)
Dx: yergason test, MRI, or exploratory surgery
Tx: NSAIDs, steroid injection, ortho surgery if rupture

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17
Q

Rotator cuff tendonitis/rupture

A

Eti: Fall on outstretch arm; also repetitive overuse movements
S/sx: Most commonly torn muscle (supraspinatus), difficulty lifting arm, limited ROM (especially overhead), pain when sleeping, anterior deltoid region
Dx: drop arm test, Neer/Hawkings test (help rule out bursitis), empty can test (tests supraspinatus), MRI, PROM greater than AROM
Tx: partial tears usually heal on own, full thickness need surgery

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18
Q

Subacromial bursitis

A

Eti: inflammation of bursa, can be due to autoimmune dx (RA), crystal deposition (gout), infection, etc.
S/sx: often presents as pain along front and side of shoulder (gradual or acute onset), pain when sleeping on affected shoulder
Dx: physical exam tests, MRI diagnostic
Tx: NSAIDs, PT, cryotherapy, steroid injection, ortho referral

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19
Q

Epicondylitis, lateral

A

Tennis elbow
Eti: inflammation of tendon insertion of extensor carpi radialis brevis due to repetitive pronation of forearm and wrist extension
Dx: Wrist extension against resistance, pain over lateral epicondyle and can radiate down the arm
Tx: Ice, NSAIDs, stretching/strengthening, steroid injection, PT

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20
Q

Epicondylitis, medial

A

Golfers elbow
Eti: inflammation over pronator teres, carpi radialis due to repetitive stress at tendon insertion of flexor forearm muscle
Dx: pain with wrist flexion against resistance
Tx: Ice, NSAIDs, stretching/strengthening, steroid injection, PT

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21
Q

Olecranon bursitis

A

Inflammation of bursa over the elbow
Eti: gout, inflammation, direct trauma, infections
S/sx: abrupt gooses egg swelling (boggy, tender, red), can be painless or painful
Dx: limited ROM with flexion, evaluate for skin breaks, aspirate. If septic bursitis: bursa aspiration shows WBC greater than 5000
Tx: rest, NSAIDs, local steroid injection, padding, motion restriction

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22
Q

Carpal tunnel syndrome

A

Eti: median nerve entrapment/compression at carpal tunnel
S/sx: paresthesias/pain of palmer 1st 4 digits especially at night
- pain can radiate to neck, shoulder, chest
- advanced: thenar muscle wasting (can cause weakness in the thumb)
Dx: tinel’s and phalen’s (30-60 seconds)
Tx: volar splint, NSAIDs, corticosteroids, surgery if refractory

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23
Q

Ganglion cysts

A

Most common soft tissue tumor of the hand and wrist
S/sx: palpable/visable lump, common on wrist, digital flexor sheath or DIP, no pain
Dx: clinical
Tx: leave alone, if removed high recurrence rate

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24
Q

De Quervain’s tenosynovitis

A

Eti: Stenosing tenosynovitis of abductor pollicus longus and extensor pollicus brevus. Due to repetitive thumb action
S/sx: pain along radial aspect of the wrist radiating to the forearm especially with thumb extension or gripping
Dx: finkelstein test
Tx: thumb spica splint x 3 weeks, NSAIDs, steroid injection, PT, surgery

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25
Ulnar nerve entrapement
Eti: ulnar nerve compressed and irritated S/sx: numbness and tingling in hands and fingers (5th and 1/2 of 4th digit), weak grip, muscle wasting if advanced Dx: ? Tx: avoid activities that keep the elbow bent over long time, NSAIDs, bracing/splinting, PT, surgery?
26
Dupuytren's contracture
Most common in men 40-60 yo, genetic predisposition (NW Europeans). Contractures of palmar fascia due to nodules/cords; fixed flexion deformity at MCP S/sx: nodules over distal palmar crease or proximal phalynx (ring, middle finger); nodules often painful Dx: exam Tx: intra-lesional steroid injection, collagease injection, PT, surgery if contracture greater than 30 degrees
27
Trochanteric bursitis
Eti: acute trauma (fall/tackle), repetitive trauma (ITB during running or walking) S/sx: pain in the greater trochanteric region of lateral hip, can radiate down lateral aspect of ipsilateral thigh, but not down to the foot, hip movements may make symptoms worse Dx: MRI, aspiriation Tx: rest, ice, steroid injections, NSAIDs, surgery if refractory
28
Medial meniscus injuries
Eti: degenerative from squating, twisting, compression or trauma with rotation and axial loading S/sx: locking, popping, giving away, effusion post activities, swelling along the joint line, antalgic gait, difficulty squating Dx: McMurry sign (pop or click while tibia externally and internally rotated), Apley test, joint line tenderness, effusion, xrays, MRI confirmatory Tx: NSAIDs and partial weight bearing until ortho eval - ROM exercises, cryotherapy, steroid injections, bracing, surgery
29
Chondromalacia patellae
Idiopathic softening/fissuring of patellar articular cartilage (most common in runners) S/sx: anterior knee pain behind or around the patella worse with prolonged sitting (knee bent), running, jumping, climbing stairs Dx: apprehension sign (push laterally on the patella when knee is 30 degree in flexion) Tx: Strengthen vastus medialis oblique, weight loss, NSAIDs, sleeve for patellar stabilization
30
Pre-patellar bursitis
Eti: inflammation of bursa in front of patella, pressure of constant kneeling (plumbers etc.), direct blow to the knee S/sx: pain with activity, swelling of front of kneecap, tender and warm to touch Dx: aspiration, xray, MRI Tx: RICE, NSAIDs, aspiration if regractory
31
Baker's cyst
Eti: synovial fluid effusion (ex from meniscal tear) is displaced to form cyst S/sx: popliteal mass, aching, knee effusions, clicking, buckling, locking of the knee. - cyst usually not painful, but rupture can mimic a DVT Dx: US (helps rule out DVT) Tx: Ice, assisted weight bearing, NSAIDs, intraarticular injections, surgical excision if refractory
32
Anterior cruciate ligamentous injuries
Most common knee ligament injured, usually sports injury. Non-contact pivoting injury, deceleration, hyperextension, internal rotation. S/sx: associated with "pop and swelling", hemarthrosis,, knee buckling, inability to bear weight Dx: Lachman, anterior drawer, xray, MRI Tx: RICE, crutches, NSAIDs, sometimes repair, PT always
33
Posterior cruciate ligamentous injury
Associated with dashboard injury, or direct blow injury, fall on flexed knee S/sx: hemarthrosis, large effusion, inability to bear weight, instability of joint, antalgic gait Dx: Posterior drawer test, MRI Tx: Almost all treated operatively (RICE, NSAIDs)
34
Medial/ lateral collateral ligamentous injuries
MCL: VALGUS force, LCL: VARUS force S/sx: effusion, tenderness, localized swelling, ecchymosis, stiffness Dx: Valgus varus stress applied, MRI Tx: RICE, NSAIDs, grade 1 and 2: conservative, grade 3: surgical repair
35
Hallux valgus
``` Aka: bunion Medial deviation of the first metatarsal Lateral deviation of the hallux Eti: Biomechanical instability? S/sx: Pain with 1st metatarsal lateral deviation Dx: clinical Tx: Footwear, surgery... ```
36
Types of ankle sprains
``` Type 1: no laxity Type 2: anterior drawer laxity, no tilt Type 3: laxity and tilt Dx: squeeze test (compress tibia against fibula), external rotation test, anterior drawer foot, talar tilt test, xray, MRI Tx: RICE, NSAIDs, PT, tx varies by type ```
37
Stress fractures of the foot
Eti: microscopic fracture from repetitive stress S/sx: gradual worsening of pain over forefoot, swelling - tenderness of particular metatarsal with palpation, axial loading of metatarsal head produces pain at fracture Dx: radiographic evidence 2-6 weeks after onset of sxs Tx: RICE, NSAIDs, activity modification, can do casting or boot - metatarsal fractures respond well to cessation of inciting activity
38
Plantar fascitis
Inflammation of plantar aponeurosis due to overuse S/sx: heel pain, tenderness of platar fascia of medial foot, pain worse after period of rest especially 1st steps in AM, decreases throughout the day Dx: xray, MRI Tx: RICE, NSAIDs, heel/arch support, plantar stretching, PT
39
Morton's neuroma
degeneration/proliferation of plantar digital nerve producing painful mass near tarsal heads S/sx: lancing pain with ambulation (most common 3rd metatarsal head), can have numbness/ paresthesias of toes, TTP Dx; ? Tx: wide shoes, steroid injections, surgical resection
40
Compartment syndrome: 5 P's
``` Pain (out of proportion to injury) Palor (pale skin tone) Paresthesia (numbness) Pulselessness (faint pulse) Paralysis (weakness with movement) ```
41
Define: anklyosis
stiffness/immobility of a joint due to fusion/abnormal rigidity, can be due to disease or trauma
42
Define: antalgic gait
occurs when patient attempts to avoid bearing weight on one leg due to pain; to assess have patient walk a straight line.
43
Define: arthrodesis
surgical fusion of a joint
44
Define: arthroplasty
surgical reconstruction/replacement of a joint
45
Define: crepitus
grating/grinding sound/sensation when moving a joint, often felt/hear in DJD
46
Define: diaphysis
shaft of long bone
47
Define: effusion
fluid in or around a joint space
48
Define: metaphysis
wide portion of long bone between epiphysis and diaphysis
49
Define: osteonecrosis
death of bone due to lack of/disruption of blood supply
50
Define: paresthesia
abnormal sensation (numbness or tingling), often due to peripheral nerve injury
51
Define: Radicular
Pain that radiates in upper or lower extremity along a dermatone (coarse of a spinal nerve root). Caused by compression, inflammation or irritation/injury of a spinal nerve root.
52
Define: spondylitis
inflammation of the spine or backbone
53
Define: spondyloslisthesis
anterior displacement of a vertebral bone which causes pinching of the spinal cord
54
Define: Spondylosis
umbrella term used to describe degenerative changes of the spine
55
Define: sprain
stretching or tearing of ligaments
56
Define: strain
stretching or tearing of tendons/muscle
57
Define: subluxation
partial dislocation of a joint, articular surfaces still connect somewhat
58
Define: synovitis
inflammation of the synovial membrane
59
Define: kyphosis
exaggerated rounding of the spine "humpback"
60
Define: lordosis
excessive inward curvature of the back, typically lumbar or cervical spine
61
Define: varus
angulation of bone in which distal part is more medial (bow leg)
62
Define: valgus
angulation of bone in which distal part is more lateral (knock knees)
63
Define: flexion
decreasing the angle between two lines
64
Define: extension
increasing the angle between two lines
65
Define: avulsion
fragment of bone is torn away due to excess pressure of the muscle it is attached to
66
Define: comminuted
fracture in pieces
67
Define: displaced
where the tow ends of bone are out of alignment with each other.
68
Define: epiphyseal
Fracture involving the growth plate
69
Define: greenstick
In children, where one side of the bone is broken and the other side is curved
70
Define: torus
aka. buckle, one side of the bone buckles without disturbing the other side
71
Which fractures require ortho consult?
- All open fractures - All intra-articular fractures - Displaced, angulated, unstable fractures - Unreduced fractures - Both bone fractures - Malunion - Delayed union
72
Gout: eti, signs and symptoms etc.
Eti: monosodium urate deposition in soft tissue, joints and bone (secondary to longstanding hyperuricemia) - Characteristically monoarticular Risks: Purine rich foods (Etoh, liver, fish, yeasts), meds S/sx: acute gouty arthritis, erythema (podagra = 1st MTP joint most common) Dx: Very tender of affected joint, - Arthrocentesis: negatively birefiringent needle shaped urate crystals - Serum uric acide increased X-rays: show rate bite punched out erosions if severe possibly with radiolucent tophi
73
Acute management of gout
Acute: bed rest, early abulation can cause an acute attack - NSAIDs (indomethacin, naproxsyn, no ASA these increase uric acid levels) - Colchicine - Oral steroids reserved if no response for NSAIDs or severe renal disease
74
Chronic management of gout
Allopurinol (reduces uric acid production) Febuxostat (uloric): reduces uric acid production Uricosuric drugs: probenecid (promotes renal uric acid secretion) Colochicine (continue) Never start chronic management during an attack. - most patients are men over 30.
75
Pseudogout: eti, s/sx, imaging...
Eti: calcium pyrophosphate dihyrate deposition in joints and soft tissue. Often associated with other diseases such as OA, hyperT, DM S/sx: Sudden, painful swelling in one or more joints (knee most common). - arthrocentesis: positively birefringent, rhomboid shaped CCP crystals Imaging: chondrocalcinosis Tx: no tx if asymptomatic - Acute: steroids (intraarticular), NSAIDs, colchicine - Chronic: NSAIDs (with colchicine), total joint replacement if debilitating
76
Osteoarthritis basic characteristics?
Degenerative disorder with minimal articular inflammation - No systemic symptoms - Pain relieved by rest, morning stiffness is brief - Xray findings: narrowed joint space, osteophytes, increaseddensity of subchondral bone, bony cysts.
77
Which two diseases frequently cause prominent involvement of the DIP joint?
Osteoarthritis and psoriatic arthritis
78
Which rheumatologic disorders are accompanied by a fever?
Gout, still disease, endocarditis
79
Which rheumatologic disorders are accompanied by a rash?
systemic lupus erythematosus psoriatic arthritis still disease
80
Which rheumatologic disorders are accompanied by nodules?
rheumatoid arthritis | gout
81
Which rheumatologic disorders are accompanied by neuropathy?
polyarteritis nodosa | granulomatosis with polyangiitis (Wegener's)
82
Which rheumatologic disorders are accompanied by inflammation?
RA, SLE, gout
83
Which joint disorders are typically monoarticular?
Gout, trauma, septic arthritis, lyme disease, OA
84
Which joint disorders are typically oligoarticular (2-4)?
Reactive arthritis, psoriatic arthritis, inflammatory bowel disease
85
Which joint disorders are typically polyarticular (5 or more)?
RA, SLE
86
Which joint disorders are typically involve the metacarpophalangeal joints and/or wrist?
RA, SLE, psuedogout
87
Which joint disorders a typically involve the first metatarsal phalangeal joint?
Gout, OA
88
RA vs OA in the hands?
OA: DIP (Heberden's nodes) and PIP joints (Bouchard's nodes) RA: Wrists and MCP joints
89
Treatment of OA?
1st line: Acetaminophen - NSAIDs are more effective but have greater toxicity Intra-articular injections: - Triamcinolone, but not recommended for use in the hand - Sodium hyaluronate (moderate results in some patients)

Clinical review (18 decks)

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