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Ortho Flashcards

1
Q

Anterior vs posterior shoulder dislocation

A

Anterior- more common, often d/t direct trauma from fall onto shoulder
Posterior- posterior trauma or force, d/t posteriorly directed force with arm internally rotated

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2
Q

PE of shoulder dislocation

A 
Severe pain with movement
Supporting arm with other arm
Pos apprehension test
Palpable defect and loss of contour
Careful NV exam to assess brachial plexus and axillary nerve
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3
Q

Dx of shoulder dislocation

A

AP X-rays of shoulder including Y view

Post-reduction X-rays

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4
Q

Tx of shoulder dislocation

A

Reduction and immediate shoulder immobilization
PT to strengthen rotator cuff muscles
Possible surgery

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5
Q

Rotator cuff injury

A

Composed of supraspinatus, infraspinatus, teres minor, and subscapularis
Tendinitis common in middle aged d/t repeated mechanical injury to tendon and impingement of supraspinatus tendon under subachromial arch
Tear more common in older adults and often d/t acute injury

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6
Q

PE of rotator cuff injury

A

Overhead activity causes pain often described as “dull and achy”
Pain over greater tuberosity of the humerus
Atrophy may be present
Passive ROM often nl but active ROM decreased
Pos drop arm test- difficulty holding arm at 90 degrees

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7
Q

Dx of rotator cuff injury

A

X-rays are often completely nl, may see high riding humerus

MRI needed to evaluate

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8
Q

Tx of rotator cuff injury

A

Rest, sling, PT, NSAIDs
Steroid injections offer short term relief
Surgery indicated for failed rehabilitation and with significant sx

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9
Q

Acromioclavicular joint separation

A

Fall on tip of shoulder and sports collisions

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10
Q

Classification of AC joint separation

A

Type 1- AC ligaments partially/completely torn but the joint is capsule intact
Type 2- AC ligaments torn and capsule is damaged
Type 3- clavicle is completely separated from acromion d/t ligaments completely disrupted

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11
Q

PE of AC separation

A

Pain over AC joint and with abduction and flexion at shoulder
Pt supports arm in adducted position

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12
Q

Dx of AC separation

A

AP clavicle X-rays displays type 2 and type 3

Weighted X-rays may show increased separation on film

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13
Q

Tx of AC separation

A

Sling
NSAIDs
Surgery for type 3

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14
Q

Clavicle fractures

A

MC fx in children and adolescents

Commonly caused by FOOSH, bicycle accidents, skateboarding, and football injuries

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15
Q

Presentation of clavicle fxs

A

Shoulder slumped downward, forward, and inward
Can be seen with visible deformity or tenting
Arm supported by other arm

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16
Q

PE of clavicle fxs

A

Make sure pt is neurovascularly intact (brachial plexus injury)
Palpate from sternoclavicular joint across clavicle

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17
Q

Dx of clavicle fxs

A

AP clavicle X-rays

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18
Q

Tx of clavicle fxs

A

Typically heals in 6 wks without complications
Sling
NSAIDs or pain control
F/u X-rays
Surgical if severe (comminuted) or neurovascular injury

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19
Q

Humeral head fxs

A

Commonly d/t FOOSH or direct impact
Common with osteoporosis
Women > men 2:1
Occurs at surgical neck and anatomic neck of humerus

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20
Q

Presentation of humeral head fxs

A

Pt holds arm against body and resists movement

Pain over greater tuberosity

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21
Q

Dx of humeral head fxs

A

Plain film X-rays of shoulder

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22
Q

Tx of humeral head fx

A

Sling or shoulder immobilizer
ORIF for significantly displaced fx
Pain control

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23
Q

Elbow dislocation

A

Often d/t FOOSH injury
Most commonly posterior dislocation
May have concomitant radial head fx

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24
Q

Presentation of elbow dislocation

A

Present with severe pain, inability to flex at elbow, and swelling
May have weakness with wrist flexion, finger adduction d/t median nerve injury
May have weakeness with finger abduction with ulnar nerve injury

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25
Dx of elbow dislocation
AP and lateral X-ray films | Anterior and posterior fat pad signs suggest occult radial head fx and/or elbow effusion
26
Tx of elbow dislocation
Reduction of elbow Hold elbow flexed at 45 degrees and apply slow, steady downward traction Splint in posterior long arm splint and cling
27
Radius fx
Often d/t FOOSH | Should get elbow X-rays along with wrist X-rays to r/o elbow pathology
28
PE of radius fx
Pain over radial head, shaft of radius, or distal radius | Pain with rotation of forearm
29
Dx of radius fx
Plain film X-rays may be nl except pos fat pad sign in case of radial head fxs
30
Epicondylitis
Lateral aka "tennis elbow" pain and swelling at lateral epicondyle at origin of extensor carpi radialis brevis muscle Medial aka "golfer's elbow" pain and swelling at the medial epicondyle at origin of pronator and flexor muscles
31
Presentation of lateral epicondylitis
Gradual onset of pain over the lateral elbow and forearm Pain with activities of wrist extension (turning a screwdriver or backhand in tennis) Pain over the lateral epicondyle of elbow
32
Presentation of medial epicondylitis
Pain with active wrist flexion and forearm pronation (golf swing or throwing motion) Pain with palpation over the medial epicondyle
33
Dx of epicondylitis
Often clinical | X-rays to r/o fx
34
Tx of epicondylitis
NSAIDs Rest and modification of activity causing sx PT Tennis elbow wrap may be helpful
35
Nursemaid elbow
Common injury in small children Longitudinal traction often a pull on forearm, lifting child by arm, or swinging Subluxation of radial head d/t ligament laxity and annular ligament slips between radial head and ulna
36
PE of nursemaid elbow
Pain noted immediately after the injury Pt resists using the arm and arm is held at side, slightly bent, and hand pronated Tenderness over the radial head and pain with elbow flexion/extension or supination
37
Dx of nursemaid elbow
Most often by hx and clinical findings | X-rays will be nl but must be done if hx does not support MOI
38
Tx of nursemaid elbow
Often reduced by X-ray Reduction is performed by placing thumb on radial head, supinate arm, flex, and extend Sling and parent counseling on risk recurrence Child will almost immediately begin using the arm
39
Carpal tunnel syndrome
Median nerve entrapment under transverse carpal ligament More common in middle aged women Common in pregnancy d/t fluid retention Often d/t repetitive use or trauma (typing or assembly line work)
40
Presentation of carpal tunnel syndrome
Pt complains of aches in wrist, hypothenar, and fingers Numbness in the 1st, 2nd, 3rd, and medial aspect of 4th digits Pain worse at night Severe cases may have thenar atrophy
41
PE of carpal tunnel syndrome
Phalen test -Wrist in flexion against each other elicits pain over median nerve Tinel Sign -Tingling along median nerve with tapping over median nerve
42
Dx of carpal tunnel syndrome
Median nerve conduction is abnl on EMG
43
Tx of carpal tunnel syndrome
Splinting and modification of activities that cause injury NSAIDs then steroid injection if tx fails Surgery for muscle atrophy and refractory cases
44
de Quervain's tenosynovitis
Inflammation of sheath around abductor pollicis longus and extensor pollicis brevis tendons
45
PE of de Quervain's tenosynovitis
Pain and swelling with abduction or opposition of thumb | Pain over radial styloid with movement of thumb
46
Dx of de Quervain's tenosynovitis
Finklestein positive- pain with flexion of thumb into palm and ulnar deviation of wrist Dx made clinically
47
Tx of de Quervain's tenosynovitis
``` Immobilization with thumb spica splint NSAIDs Modification of activities that cause injury Steroid injections Surgery for refractory cases ```
48
Buckle fracture
Common fx in children d/t FOOSH Incomplete fx resulting in "buckle" or bulge of cortex d/t axial load of long bone Also called torus fx
49
PE of buckle fracture
Pain over long bone where injury occurred Most commonly the distal radius Pain with flexion and extension of wrist
50
Dx of buckle fracture
Plain film X-rays shows subtle cortex changes, maybe only angulation
51
Tx of buckle fracture
Immobilization with splint (sugar tong) Pain control F/u with X-rays
52
Colles fx
MOI is d/t FOOSH Transverse fx of the distal radius with displacement dorsally of the distal fragment Transverse fx of the distal radius with volar displacement is called Smith Fracture
53
PE of Colles fx
Dinner fork deformity of the wrist
54
Dx of Colles fx
Plain film X-rays
55
Tx of Colles fx
Closed or open reduction and sugar tong splint | Pain control
56
Boxer's fx
Axial force load on 5th metacarpal caused by a direct blow of closed fist onto unforgiving object Fx often distal end of the fifth metacarpal May involve 4th metacarpal
57
Presentation of boxer's fx
Hx of punching hard object Obvious deformity, swelling, ecchymosis over lateral hand Finger malrotation
58
Dx of boxer's fx
Plain film X-rays
59
Tx of boxer's fx
Splinting with ulnar gutter splint and/or surgical percutaneous pinning
60
Game keeper's thumb
Ulnar collateral ligament injury at base of the proximal phalanx of thumb Often d/t FOOSH with hyperextension or extreme abduction of thumb Named after injury sustained for injury of game keepers but aka skier's thumb d/t fall holding ski pole
61
Presentation of game keeper's thumb
Pain and swelling following injury Instability of the MCP joint of first phalanx Weakness with pinching or opposition
62
Dx of game keeper's thumb
Plain film X-rays to evaluate for avulsion injury
63
Tx of game keeper's thumb
Surgical tx for complete ulnar collateral ligament tears Thumb spica splints for partial tears Pain control
64
Scaphoid fractures
Most commonly fractured carpal bone May result in AVN and malunion Missed on initial radiographs 10-15% of the time Delayed dx greatly increased risk of complication Blood supply enters at distal end of bone and proximal fractures have greater risk of necrosis D/t forcibly hyperextending the wrist Often accompanied by distal radial fx Often misdiagnosed as wrist sprain
65
PE of scaphoid fxs
Pain over anatomic snuff box and with movements of thumb, axial load of thumb, or direct palpation Decreased ROM of thumb and wrist
66
Dx of scaphoid fxs
Plain 4 view wrist X-rays including scaphoid view (wrist prone with ulnar deviation) Pay close attention to the middle 3rd or waist of scaphoid (70%)
67
Tx of scaphoid fxs
Thumb spica splint if any snuff box tenderness Repeat X-rays in 7-10 days Pain control with NSAIDs All scaphoid or suspected scaphoid fx should be referred to ortho

DSE (14 decks)

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