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Adult Part II > Ortho > Flashcards

Ortho Flashcards

1
Q

Traumatic

A

Result of injury to joint or limb, symptoms develop immediately or soon after and are considered 1-4 weeks

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2
Q

Chronic

A

Develop gradually, often caused by degenerative changes and anything after going on for 3 months are considered chronic

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3
Q

Strain

A

Over stretching of muscles and tendons

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4
Q

Sprain

A

Results from tearing of ligaments

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5
Q

Tendonitis

A

Caused by series of small stresses that repeatedly aggravate the tendon, redness heat and swelling and pain

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6
Q

Bursitis

A

Repeated small stresses and overuse cause the bursa to swell

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7
Q

Sprains and strains presentations

A

Localized pain,
Limited ROM
Will have supporting MOI

Positive ligament stability will reproduce the pain

Strains - strength decrease

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8
Q

Ice

A

1 after injury

Vasoconstrictor
Decrease blood flow
Best for acute inflammatory process

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9
Q

Heat

A

2

Vasodilator
Increases relieve stiffness
Contraindicated in acute inflammation

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10
Q

Osteoarthritis (OA)

A

A progressive disease, most common form of arthritis

Degeneration of the articulations cartilage at the end of bones and thickening and sclerosis of bone plate

Asymmetric presentation

Often affects previously injured joints of hands, feet, knees, hip

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11
Q

OA risk factors

A

Age, obesity, genetics, repetitive activities, metabolic disorders, nuero dx, hematologic conditions

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12
Q

OA presentation

A

No known MOI
Long period of time for symptoms
Deep aching joint pain upon awakening
- worsens after exercise or weight bearing and relieved by rest
- increased pain during humid moist or cold weather
- limited joint movement
- muscle weakness

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13
Q

OA - radiological view

A

X-ray of the joint with OA will show a narrowing of the space between the bones of joint and where the cartilage has worn away

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14
Q

OA dx and management

A

Look for other causes
DX: X-ray ( symptoms often do not correlate to degree of degeneration on X-ray )

DX is made by exclusion

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15
Q

OA non pharmacological interventions

A

Balanced diet
- swimming ( non weight bearing )
Heat and ice

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16
Q

OA med

A 
Tylenol
Motrin 
Cox -2 - low dose short term ( increase risk of heart attack)
Topical capsaicin 
Intra-articular glucocorticoids
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17
Q

OA surgery

A

Athroscopy - debridment
Arthrodesis - fusion
Athroplasty - prosthetic joint

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18
Q

Septic arthritis

A

Direct inoculation of joint space by bacteria, virus, or fungi

bacteria :

  • gonoccal infection most common in sexual active adults
  • staph aures - most common in older adults as a result of RA, SLE SCD
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19
Q

Presentation of SA

A

Acute onset of pain
Recent illness
Knee most common joint

Pain is monoarticular or polyartiular

  • staph aures - 90 % mono
  • GC, Lyme - poly

Redness, edema, warmth, effusion, ROM d/t pain, fevers

Joint aspiration

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20
Q

Low back pain

A

Second most common symptom related office visit

Rare that acute back pain is a serious medical illness

Chronic low back pain - decrease QOL

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21
Q

LBP - physical exam

A

Pain w/ flexsion indicates strain, injured and herniated disk

Pain w/extension indicates degenerative changes

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22
Q

Lumbarsacral strain

A

Pain is located in back, buttocks or in one or both legs

Pain is aggravated by standing and relieved with w/ rest and reclining

20-40 years of age
After injury 12-36 hours

Heals in 4 weeks

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23
Q

Herniated disk with sciatica

A

More common in young and middle aged adults

Characterized by radicular pain described as shooting, sharp, w/ foot and leg pain , may have numbness

Most common L5 - S1
Improve within 6 weeks

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24
Q

Dengerative process of LBP

A

Often have a gradual onset of pain, accompanied by morning stiffness or stiffness after prolonged immobility

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25
Q

Osteoporotic compression fractures

A

Cause chronic pain and fatigue , in middle back

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26
Q

Spondylolysis

A

Often occurs from a stress fracture or hyperextending

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27
Q

Straight leg raise

A

To evaluate for disc herniation

28
Q

Stork test

A

Pain in lumbar region = stress fracture

29
Q

LBP - management

A

Tylenol, NSAIDS, muscle relaxants , massage, acupuncture, gradual walking

30
Q

LBP - imaging

A

Imaging not indicated for the first 4-6 weeks

MRI is preferred for s/s and c/w radiculopathy, sciatica, soft tissue visualization

Mild degenerative findings are very common and may not be source of problem

31
Q

Neck Pain

A

Can be related to many joints, fascia, ligaments, tendons, muscles and nerves that comprise the neck

Pain can be referred pain

32
Q

Neck pain goal

A

To modify pain and restore strength and function

33
Q

Neck imaging

A

Refer for worsening symptoms

  • xrays - to detect fracture or tumor
    • disc herniations, cord tumor, can be undetected
  • EMG for nerve root or spinal cord compromise
34
Q

Trigger finger

A

Disorder of the flexor tendon of fingers or thumb

Middle finger most affected

Symptoms: finger stiffness in morning, popping or clicking sensation in finger, tenderness or bump

Management : splinting, NSAIDs

35
Q

Wrist Fracture

A

Colles fracture a common fracture of the distal radius that occurs when a persons falls on out stretched hand

Common with people with osteoporosis

36
Q

Carpal tunnel syndrome

A

Numbness in the hand and in the wrist due to the compression of the median nerve. Associated with short, repetitive movements

PE: positive tinel test, and phalen’s maneuver

RX: wrist splint in neutral positions, proper body mechanics,

If not improved in 3 weeks refer to ortho

37
Q

De Quervain’s Tenosynovitis

A

Sub acute or chronic inflammation of the extensor tendon of the wrist. Incidence more frequent in middle age women

ROS: painful with movement of wrist, grasping of mocking a fist, use of thumb

PE: Finkelstein Test

Management: Thumb splint, NSAIDS, no improvement > 4 weeks ortho

38
Q

Ganglion cyst

A

Out pouching if the wrist capsule, fluid filled cyst

Painless, pain if pressure placed on nerves

PE: soft mobile, mildly painful

Management:
Might resolve spontaneously
Immobilize if movement causes pain
Ortho referral to aspirate

39
Q

Lateral and medical epicondylitis

A

Inflammation of tendons

Risk : tennis, golf, and other sports payers, repetitive motion

40
Q

L and medical epicondylitis

A

Affects dominant arm,
Pain can be sudden or gradual
Pain in elbow that spreads along into the upper arm or down to the forearm - weakness too

41
Q

Tennis elbow

A

Lateral epicondylitis

Strained and inflamed

42
Q

Golfers elbow

A

Medial epicondylitis

43
Q

Lateral and medial epicondylitis management

A

Goal to reduce inflammation, strengthen involved muscles and avoid further injury

Rest, Ice, Tylenol, NSAIDS
PT, stretching
After a month consider injection

44
Q

Olecranon bursitis

A

Affects men btw 30-60
Usually occurs with trauma or repeated small injuries lead to bleeding into the bursa

HPI: pain, swelling, inflammation

Management: education, NSAIDs, steriod injection

Concern for septic joint - cover joint for staph ( dicloxacillin)

45
Q

Rotator cuff strain

A

Caused by tendinitis, bursitis, impingement

\+ drop arm test 
    - will be unable to slowly drop the arm 
\+ full and empty can test 
    - if weakness or pain
Indicates a tear

Impingement test
- + sharp cat aches of pain when raising arm quickly overhead

46
Q

Frozen shoulder - stages

A

Freezing - gradual increase in pain and loss of ROM
- 6 weeks- 9 months

Frozen - pain symptoms begin to improve but stiffness remains
- 4-6months

Thawing - should motion slowly improves
- complete return to normal

47
Q

Lachman’s

A

ACL

48
Q

McMurray

A

Meniscus

49
Q

Draw

A

PCL, ACL

50
Q

Patella tap

A

Fluid

51
Q

Ligament sprains

A

1-3 scale

  1. Fibers still attached
  2. Fibers are partially avulsion
  3. Fibers are completely ruptured
52
Q

Meniscus injuries caused

A

Usually from twisting motion, often not caused by contact injury

53
Q

Pre patella bursitis

A

Inflammation of the bursa, pain w/ activity, swelling, relieved w/ rest ice, elevation

54
Q

Popliteal cysts ( bakers cyst)

A

As a result of DJD in knee, fluid filled sac, REST, ice, elevation, medication, assistive device for ambulatory, may need aspiration and corticosteriods

55
Q

ACL sprain

A

Contact injury in valgus or hyper extension direction

May hear or feel a pop

W>M

TESTS:

  • Lachman’s test
  • anterior drawer
  • MRI
56
Q

PCL strain

A

Hyperflexsion “ dashboard knee”

Less likely full thickness tears

57
Q

Meniscus injuries

A

Twisting on weight bearing knee
Often with ACL tear

Chronic repetitive stress

+ valgus stress test at 0, 30 degrees

Pain along the joint line

- pseudo locking or true locking 
- mcmurrays test
- Apleys compression

Refer

58
Q

Patella Femoral Syndrome

A

Generalized pain around patella
Increases with running, squatting

Causes :
Overtraining, poor patella alignment

PT

59
Q

Ankle sprain

A

Injury to ligaments of ankle due to a sudden stress

Pain is noticed immediately swelling occurs within 1 hour of injury

Inability to weight bear immediately

Sensation of pop, snap, locking of joint might indicate partial or full tendon rupture

60
Q

Achilles’ tendon rupture

A

Sudden shooting pain in calf followed by weakness in leg, inability to walk on toes

Increased rupture after age 30

+ positive Thompson test = refer to ortho

61
Q

Thompson test

A

Patient prone, squeeze calf, foot should passively plantar flex

62
Q

Ankle sprain - overview

A

Lateral more common than medial

Inversion mechanism - lateral ligaments

Eversion mechanism - medial ligaments
- in general stronger

63
Q

Grade 1 ankle sprain

A

Minimal tenderness and swelling

Microscopic tearing of collagen fibers

Weight bearing as tolerated, no splinting/casting

Isometric exercises, FROM

64
Q

Grade 2 sprain

A

Moderate tenderness and swelling , decrease ROM

Complete tears of some but not all collagen fibers

Immobilizes with air splint, PT with ROM

65
Q

Grade 3 sprain

A

Significant swelling, and tenderness instability

Complete tear / rupture of ligament

Immobilization, PT, possible surgical

66
Q

Ottawa Ankle Rules

A

Ankle films:
Pain in malleolar zone plus any of these findings - bone tenderness at posterior edge of lateral malleolus - bone tenderness at posterior edge medial malleolus

Foot films:
Any pain in mid foot and any of these findings
- bone tenderness at base of the fifth metatarsal - bone tenderness at navicular or inability to walk after event and in the ED

67
Q

Plantar Fasciitis

A

Inflammation of thick tissue that is located on bottom of the foot

Risk factors : foot arch, long distance running, tight Achilles’ tendon, obesity

Pain and stiffness in bottom of heel, may be dull or sharp

Pain worse in morning with steps, after standing or sitting, climbing stairs

Adult Part II (6 decks)

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