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DSE > Ortho > Flashcards

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
Q

Dx of elbow dislocation

A

AP and lateral X-ray films

Anterior and posterior fat pad signs suggest occult radial head fx and/or elbow effusion

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26
Q

Tx of elbow dislocation

A

Reduction of elbow
Hold elbow flexed at 45 degrees and apply slow, steady downward traction
Splint in posterior long arm splint and cling

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27
Q

Radius fx

A

Often d/t FOOSH

Should get elbow X-rays along with wrist X-rays to r/o elbow pathology

28
Q

PE of radius fx

A

Pain over radial head, shaft of radius, or distal radius

Pain with rotation of forearm

29
Q

Dx of radius fx

A

Plain film X-rays may be nl except pos fat pad sign in case of radial head fxs

30
Q

Epicondylitis

A

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
Q

Presentation of lateral epicondylitis

A

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
Q

Presentation of medial epicondylitis

A

Pain with active wrist flexion and forearm pronation (golf swing or throwing motion)
Pain with palpation over the medial epicondyle

33
Q

Dx of epicondylitis

A

Often clinical

X-rays to r/o fx

34
Q

Tx of epicondylitis

A

NSAIDs
Rest and modification of activity causing sx
PT
Tennis elbow wrap may be helpful

35
Q

Nursemaid elbow

A

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
Q

PE of nursemaid elbow

A

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
Q

Dx of nursemaid elbow

A

Most often by hx and clinical findings

X-rays will be nl but must be done if hx does not support MOI

38
Q

Tx of nursemaid elbow

A

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
Q

Carpal tunnel syndrome

A

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
Q

Presentation of carpal tunnel syndrome

A

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
Q

PE of carpal tunnel syndrome

A

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
Q

Dx of carpal tunnel syndrome

A

Median nerve conduction is abnl on EMG

43
Q

Tx of carpal tunnel syndrome

A

Splinting and modification of activities that cause injury
NSAIDs then steroid injection if tx fails
Surgery for muscle atrophy and refractory cases

44
Q

de Quervain’s tenosynovitis

A

Inflammation of sheath around abductor pollicis longus and extensor pollicis brevis tendons

45
Q

PE of de Quervain’s tenosynovitis

A

Pain and swelling with abduction or opposition of thumb

Pain over radial styloid with movement of thumb

46
Q

Dx of de Quervain’s tenosynovitis

A

Finklestein positive- pain with flexion of thumb into palm and ulnar deviation of wrist
Dx made clinically

47
Q

Tx of de Quervain’s tenosynovitis

A 
Immobilization with thumb spica splint
NSAIDs
Modification of activities that cause injury
Steroid injections
Surgery for refractory cases
48
Q

Buckle fracture

A

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
Q

PE of buckle fracture

A

Pain over long bone where injury occurred
Most commonly the distal radius
Pain with flexion and extension of wrist

50
Q

Dx of buckle fracture

A

Plain film X-rays shows subtle cortex changes, maybe only angulation

51
Q

Tx of buckle fracture

A

Immobilization with splint (sugar tong)
Pain control
F/u with X-rays

52
Q

Colles fx

A

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
Q

PE of Colles fx

A

Dinner fork deformity of the wrist

54
Q

Dx of Colles fx

A

Plain film X-rays

55
Q

Tx of Colles fx

A

Closed or open reduction and sugar tong splint

Pain control

56
Q

Boxer’s fx

A

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
Q

Presentation of boxer’s fx

A

Hx of punching hard object
Obvious deformity, swelling, ecchymosis over lateral hand
Finger malrotation

58
Q

Dx of boxer’s fx

A

Plain film X-rays

59
Q

Tx of boxer’s fx

A

Splinting with ulnar gutter splint and/or surgical percutaneous pinning

60
Q

Game keeper’s thumb

A

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
Q

Presentation of game keeper’s thumb

A

Pain and swelling following injury
Instability of the MCP joint of first phalanx
Weakness with pinching or opposition

62
Q

Dx of game keeper’s thumb

A

Plain film X-rays to evaluate for avulsion injury

63
Q

Tx of game keeper’s thumb

A

Surgical tx for complete ulnar collateral ligament tears
Thumb spica splints for partial tears
Pain control

64
Q

Scaphoid fractures

A

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
Q

PE of scaphoid fxs

A

Pain over anatomic snuff box and with movements of thumb, axial load of thumb, or direct palpation
Decreased ROM of thumb and wrist

66
Q

Dx of scaphoid fxs

A

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
Q

Tx of scaphoid fxs

A

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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