Ortho Block 2 Cram Flashcards

1
Q

Define the 6 types of AC joint sprains

A

1- ligament sprain

2- joint widening w/ less than 100% elevation of AC joint

3- 100% superior displacement clavicle w/ inc CC interspace

4- superior and posterior clavicle displacement

5- 100-300% superior displacement clavicle w/ increased CC interspace

6- distal clavicle is in subacromial/subcoracoid space from arm abduction during injury causing clavicle to get stuck under short head of bicep

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2
Q

What images are ordered for AC joint injuries?

What are the adverse outcomes of this injury?

A

Bilateral AP to confirm Type 2-6
Weighted bilateral for Type 1-2

Deformity
Weakness
Pain
Numbness

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3
Q

What are the 4 types of shoulder arthritis?

A

Primary- age w/out trauma/Fx
Secondary- Hx of trauma/Fx
Rhematoid- bilateral, multiple joints across midline
Crystaloid- unicorn of shoulder

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4
Q

Define Shoulder arthritis

What type of ostephyte is associated w/ shoulder arthritis?

A

Destruction of joint cartilage w/ pain, loss of space and function

Goats beard- inferior spur in glenoidhumeral ligament

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5
Q

What will be seen on x-rays of shoulder arthritis?

Superior migration of the humeral head develops in associated w/ ? which leads to ?

A

Flattened humeral head
Inferior osteophyte
Posterior glenoid erosion
Superior migration

Rotator cuff tears
Causes loading of glenoid leading to rotator arthropathy

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6
Q

What would be seen on x-ray of RA in the shoulder?

How are shoulder arthritis cases Tx non-surgically?

A

Periarticular lesions
Osteopenia
Central glenoid wear

RICE, NSAID, Heat/Ice
CCS injection w/ posterior approach, max of 3

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7
Q

What are adverse outcomes of shoulder arthritis surgical Tx?

When are they referred to Ortho?

A

Thrombophlebitis
Emoblus

Intolerable pain
Dec functional range of motion after 3mon of non-surg Tx

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8
Q

What is the most common MOIs of transient brachial plexy?

A

Upper/middle trunks (C5-7): Traction force on shoulder w/ head tilted to opposite direction
Post-ganglionic

Lower trunks (C8-T1):
Nerves stretched w/ arm abducted/ hanging
Pre-ganglionic, poor prognosis

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9
Q

What is a unique finding of pre-ganglionic brachial plexy?

What is the cornerstone of an accurate diagnosis of Burners/Stingers?

A

Horners- ipsilateral myosis, anhidrosis, enophthalmos

Neuro exam

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10
Q

What type of images are ordered for burners/stingers?

What unique presenting Sxs can post-ganglionic burner PTs present w/ ?

A

X-rays of C-spine and shoulder girdle

Painful rhomboids and anterior serratus muscles

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11
Q

What is the first step to management of PTs w/ burners presenting with bilateral upper/lower extremity radicular Sxs?

What are 4 things required prior to a person returning to sports/duty after having a burner?

A

Treat as spinal cord injury until proven otherwise

Resolution of pain/neuro Sxs
Normal neuro exam
Full cervical ROM

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12
Q

How are brachial plexus burners Tx non-surgical

What additional study could be ordered to assess nerve function?

A

Strength/stretch
Splint to maintain PROM

Nerve conduction study:
Electromyogram- motor function
Velocity- tests speed of signals

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13
Q

What do recurrent episodes of burners/stingers suggest?

What are the adverse outcomes of this condition?

A

Cervical stenosis
Inc risk for spinal cord injury

Pain
Sensation loss
Weakness
Amputation

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14
Q

What is an indication to refer a PT w/ a burner/stinger to Ortho?

Frozen shoulder is AKA ? and defined as ?

A

Worsening neuro Sxs

Adhesive capsulitis
Idiopathic (non-traumatic) loss of A/PROM

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15
Q

What is the are most common risks of adhesive capsulitis?

Where is the pain located for these PTs?

A

Type 1 DM
Hypothyroid
Dupuytren Dz

At deltoid insertion

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16
Q

How is Frozen Shoulder movement limitations different than arthritis limitations?

What term is pathognomonic of this condition?

A

Worse w/ external rotation

Contracture of coracohumeral ligament which limits external rotation

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17
Q

What findings would be see on MRI of a frozen shoulder?

How are these cases Tx nonsurgically?

A

Contracted capsule
Loss of inferior pouch

NSAID, heat, stretching

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18
Q

How are frozen shoulders Tx w/ surgery?

How long does it take for a shoulder to freeze and release?

A

Arthroscopic capsule release

Freeze in 48hrs
Thaw in 6-24mon

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19
Q

What happens to frozen shoulder PTs who take therapy too aggressively?

When do these PTs need to be referred?

A

Fx of humerus

No pain/movement improvement after 3mon

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20
Q

What muscle is the primary raiser of the arm?

This muscle is pulled under what structure during movement?

A

Supraspinatus

Under coracoacromial arch

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21
Q

What are the two causes impingement?

Where do these PTs have their pain localized to?

A

Loss of blood supply and mechanical damage

Lateral shoulder under acromium
Worse w/ abduction between 90-120* and lowering arm

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22
Q

PTs with impingement usually have what 3 positive tests during PE?

These 3 tests only indicated there’s an issue where?

A

Neers, Hawkins, Jobes

Supraspinatus

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23
Q

What tests are done during PE to differentiate between impingement, rotator cuff or AC joint origin?

What is the goal of PT for these PTs?

A

Drop arm- r/o rotator
Cross arm- r/o AC joint

Perform overhead movements w/out pain

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24
Q

What is the non-traumatic trifecta leading to rotator cuff tears?

What type of motion changes will be seen?

A

Degeneration, impingement, dec blood supply

Normal PROM, dec AROM

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25
How quickly do traumatic rotator tears need to be surgically repaired? PTs w/ rotator cuff tears will have pain localized where?
W/in 6wks Insertion of supraspinatus on lateral arm
26
What are the goals of PT for rotator cuff tears? The term 'torn rotator cuff' includes a tear to what 2 muscles?
Reduce pain Inc strength, ROM Restore function Supra and Infraspinatus
27
Acute roator tears are often associated with a ? tear When are these PTs referred to Ortho for surgery?
Splitting- parallel to tendon fibers Acute tears, less than 6wks
28
What type of PT is more likely to have a proximal bicep tear? Where will these PTs have TTP?
Older w/ rotator cuff dz Over bicep groove
29
What movement can be done to accentuate proximal bicep tendon tears? What is an adverse outcome of this condition?
Ludington test Loss of 10% of elbow flexion/forearm supination (screwdriver)
30
When are PTs with proximal bicep tendon tears considered for surgery? Which head of bicep is the long/short head?
Under 40y/o athletes Older PT w/ concomitant rotator tear and persistent Sxs Lateral- long Medial- short, attaches to coracoid
31
What image is ordered after a + Lundington test? Where is a ruptured proximal bicep tendon screwed back into the arm during surgery?
MRI ASAP Distal to surgical neck of humerus
32
What are the most common directions of shoulder dislocation? What does TUBS and AMBRI stand for?
Anterior and Multidirectional Traumatic Unidirectional Bankart lesion Tx w/ surgery Atraumatic, Multidirectional, Bilateral, Rehab preferred, Infierior capsule shift
33
Bankart lesion is a tear of ? How is the arm placed in order for a posterior dislocation to occur?
Anterior glenoid labrum Adduction and internally rotated
34
PTs that can voluntarily dislocate shoulders are indicative of ? Subluxation of the shoulder is more associated w/ ?
Multidirectional instability Poor surgical Tx prognosis AMBRI
35
What nerve needs to be assess before and after shoulder dislocation/reductions? What type of force creates a Hill-Sachs lesion?
Axillary- assessed for deltoid dysfunction and lateral arm numbness Compression Fx from posterior humeral head pressing on anterior edge of glenoid
36
Ant, Post, Inf disloactions are associated w/ ? What are the adverse outcomes from this type of injury and who is more likely to have this outcome?
Ant- most common Inf- multi-directional instability Post- seizure, shock Axillary dysfunction Osteoarthritis Persistant dislocation- younger PT or w/ multiple episodes
37
What kind of x-rays are ordered to assess shoulder dislocations? First time dislocations are Tx ?
Scapular Y-views 3wk immobilization in neutral rotation PT w/ supraspinatus strengthening
38
How should PTs w/ AMBRI be Tx? When do these PTs need to be referred to Ortho?
Nonsurgical w/ aggravation avoidance Two or more dislocations inside of 3mon of shoulder rehab program Intolerable multi-directional Sxs
39
What makes the bicep anchor? What tests are done during PE for suspected SLAP tears?
Long head tendon confluency w/ labrum at superior glenoid labrum Speeds Resisted Supin/Rotation
40
What is the gold standard for viewing SLAP tears? How are they Tx non-surgically?
MRA w/ gadolinium NSAID Rotator/periscapular stabilization Capsule stretches Strengthening
41
What is the only surgical option for SLAP tears that don't respond to non-surgical Tx? What is the most common outcome of Tx?
Dx shoulder arthroscopy Shoulder stiffness
42
What can cause TOS? This can present mimicking ?
Compression of brachial plexus/subclacian vessels from cervical rib, large C7 transverse process, anomalous fibromuscular band Ulnar nerve entrapment w/ paresthesia of little/ring finger
43
What images are ordered for TOS? What are two rare outcomes of this syndrome?
AP/Lat- assess ribs/processes PA/Lat- r/o apical tumor/infxn Ulcers Raynaud's
44
What types of activities need to be avoided when Tx TOS at home? What are the 4 types of arthritis in the elbow?
Avoid overhead activities Strenuous aerobics Sleeping on affected side Primary OA- age Secondary OA- trauma/Fx Rheumatoid- most common cause of elbow destruction Crystaloid- gout/pseudogout
45
Most PTs with rheumatoid elbow arthritis will also have ? Which one will present with swelling and warmth?
Bilateral shoulder, wrist, and hand in 90% of PTs Non-rheumatoid inflammatory arthritis
46
If effusions are present in elbow arthritis, what are they aspirated and tested for? How is RA of the elbow Tx?
WBC, Culture, Gram, Crystals DMARDs CCS injections Rehab/Surgery
47
What will be seen on x-ray of Primary OA in the elbow? What will be seen x-ray of RA in the elbow? What will be seen in crystaline arthropathy?
Narrowed joint space Sub- chondral cyst Articular bone spur Osteopenia Erosion at bone margins at synovium Sub-chondral erosion Peripheral bone spurs
48
What are the primary reasons to refer elbow arthritis PTs to Ortho? What muscle originates at the site of Lateral Epicondylitis?
Loss of ability to self care/daily activity completion Extensor Carpi Radialis Brevis
49
How do PTs w/ lateral epidcondylitis present? How do PTs present w/ medial epicondylitis?
Pain in lateral elbow with gripping and wrist extension Pain in medial elbow w/ wrist flexion and forearm pronation
50
What are the non-surgical Tx options for epicondylitis? What mis-diagnosed nerve entrapment syndromes can lead to surgical Tx failures of epicondylitis?
Modify/stop movement is most important Protein Rich Plasma injection w/ buffy layer Dry needling PIN w/ lateral Ulnar w/ medial
51
What are the 4 stages of humeral epicondylitis Tx? What is the most common adverse outcome of surgical Tx?
Reduction of overload Promotion of strength Return to activity Maintenance Incomplete pain relief
52
What is the difference in Tx of Medial and Lateral epicondylitis? Why is the olecrananon easily irritated and inflamed?
Medial Txs done by Ortho Superficially located on extensor side of elbow
53
How are different size olecranon bursitis cases Tx?
Small/mild Sxs- NSAID, activity modification Sxs- aspiration for Dx and therapeutic relief Non-septic- elastic compression bandage Septic- ABX w/ PCN resistant Staph A coverage and decompression
54
When do olecranon bursitis cases need to be referred? Define the Cubital Tunnel
Recurrence w/ 3 or more drainage Passage of the ulnar nerve on the posterior side of medial epicondyle between humeral and ulnar heads of flexor carpi ulnaris muscle
55
# Define the Radial tunnel Define Pronator Syndrome
Spit of radial nerve at lateral elbow, most common is PIN compression Compression of median nerve at elbow
56
What are the top two most common nerve entrapments of the upper extremity? What can cause ulnar palsy?
Carpal tunnel syndrome Ulnar nerve compression Repetitive subluxation or dislocation of ulnar nerve on elbow flexion
57
PIN causes ? Sx and is commonly mis-Dx as ? What does the PIN innervate?
Lateral elbow pain Lateral epicondylitis Thumb, finger, extensor carpi ulnaris
58
Where is the PIN most commonly compressed and what usually compresses it? What causes Pronator syndrome to be Dx late?
Fibrous bands between supinator muscle heads of radial tunnel Vague Sxs Frequently w/ workers com claims
59
What is the most common cause of Cubital Tunnel Syndrome? What are two common causes?
Hyperflexion of elbows Sleeping on elbows Resting arm while driving for long periods
60
How is radial compression Sxs different than lateral epicondylitis Sxs? What is a late Dz issue?
Radial compression TTP distal to condyle Weak extension of fingers
61
What tests are done when evaluating median nerve compression? What Sxs will not be associated w/ this compression syndrome?
Pronation movements Nerve is motor only, no numbness/tingling
62
What special tests are done for nerve compression syndromes of the elbow? What further studies can help differentiate these?
Tinels Elbow flexion test Middle finger resistance test for radial tunnel Electromyographic/conduction study
63
What is the most important step of elbow nerve compression syndrome Tx? When are PTs w/ ulnar compression syndrome referred for surgery?
Modifying activities/reducing pressure Bothersome Sxs after 3-4mon of non-surgical Tx
64
When are PTs w/ radial/pronator compression syndromes referred for surgery? What are the red flags for referral of the compression syndromes?
Discomfort after 3-6mon of non-surgical Tx Weakness/atrophy of intrinsic muscles Inc numbness Persistent/debilitating Sxs
65
What are the adverse outcomes of a distal bicep tendon rupture? What PTs are not Tx w/ surgery?
15% loss of strength 50% loss of supination Older/sedentary lifestyle not requiring flexor/supinator strength
66
What are the adverse outcomes of distal bicep tendon rupture surgical Tx? How quickly does surgical repair have to be done?
Damaged radial nerve Hetertropic ossification Chronic pain 1-2wks from injury
67
What is the primary elbow structure that resists valgus stress? What is a common Sx seen?
Ulnar collateral ligament Paresthesia along ulnar nerve during throwing motion
68
What PE finding during assessing ulnar collateral ligament tear can mislead to a Dx of Primary Ulnar Neuritis? What imaging is used for Dx?
+ ulnar nerve Tinel sign MRI w/ contrast
69
What is a rare adverse outcome of an ulnar collateral ligament? What Otho Tx step needs to be avoided?
Hindered daily living UCL tear
70
What is the name of the procedure used to correct a torn UCL? What is the most common cause of wrist arthritis?
Tommy John Previous trauma- Fx RA
71
Typical OA findings of wrist arthritis What would be seen w/ RA?
Joint narrowing, subchondral sclerosis, bone spurs Osteopenia, Erosion at capsule
72
What is a unique lab ordered when working up wrist arthritis depending on geography? What lab tests are done to test for RA in the wrist?
Lyme Dz titer ESR, Rheumatoid factor, Anti-nuclear Abs, Uric acid
73
When are wrist arthritis PTs surgical candidates? When are these PTs referred for red flags?
Dec hand function Unstable joint Failed non-surgical Tx Infection in wrist Advanced Dzs Non-surgical Tx failure
74
What is the most common compression neuropathy of the upper extremity? What are common precipitating issues that can lead to this common syndrome?
Carpal tunnel syndrome Tenosynovitis of adjacent flexor tendons Pregnancy (bilateral) DM Thyroid dysfunction
75
How do PTs w/ carpal tunnel present? What is the most useful Dx test but is rarely used?
Numbness in thumb, index, long finger Pain worse at night Thenar atrophy Electophysiologic testing
76
What tests can be done during PE for carpal tunnel? Define de Quervain tenosynovitis
Reverse/Phalen test Carpal compression test Tinel's Swelling of sheath around abductor pollicis longus and extensor pollicis brevis
77
How is de Quervain tenosynovitis Dx'd? What images need to be done?
+ Finklestein test PA/Lat x-ray to r/o radial styloid deformity
78
How is de Quervain tenosynovitis Tx non-surgically? What is the most common soft tissue tumor of the hand?
Splint- forearm/thumb spica NSAID CCS injection- max of 3 Wrist ganglion
79
What type of fluid is inside of ganglion cysts? What is a key factor to distinguish a ganglion from other soft tissue tumors?
Thick, clear, mucinous identical to joint fluid Variation in size
80
Where do mucus cysts usually grow? What is the most common site for ganglions to grow?
Extensor tendon at DIP Palmar side near A1 pulley near MCP joint
81
When is a MRI ordered for ganglion cysts? Define Kienbeck Dz
Volar cyst near radial nerve/artery and prior to surgery Osteonecrosis of lunate, usually in men 20-40y/o
82
What type of ganglion cyst should never be aspirated? How do PTs w/ Kienbeck Dz present?
Dorsal cysts on fingers Inability to grasp heavy objects Stiffness/swelling
83
What will be seen on x-rays early/late in Kienbock Dz? What imaging is usually used to stage the Dz?
Early- inc density (white) Late- fragmentation/collapse of bone MRI
84
When are Kienbock wrists splinted for Tx? What is the top 3 most common benign soft tissue tumors?
Normal radiograph/significant sclerosis w/ NSAIDs Ganglia, Giant Cell tumor, Epidermal inclusion cyst
85
What is the most common benign neoplasm of the hand bones? What is the most common malignant neoplasm of the hand?
Enchondroma- cartilage didn't change into bone development Squamous cell carcinoma
86
What are the most common primary malignant bone tumor of the hand? Where/why are malignant melanomas seen?
Chondrosarcomas Upper arm from sun exposure
87
Most tumors of the hand are painless w/ ? exception? How can you differentiate ganglions, inclusion, giant, glomus cysts on PE?
Glomus tumor- pain w/ pressure or cold Ganglion- transilluminate Inclusion- swelling/white tuft at end of finger Giant- firm, non-tender at IP joint of first 3 fingers Glomus- finger nail changes
88
Where are lipomas most commonly seen? Where are enchondromas most commonly seen?
Thenar emminence Proximal phalynx associated w/ patholgical Fx
89
Where would a carpal boss be seen? What types of x-rays need to be ordered for hand/finger masses?
Immovable mass on dorsal hand PA/Lat- finger PA/Lat/Oblique- hand
90
When do PTs w/ hand masses need to be referred? What usually causes ulnar entrapment of the hand?
Painful/expanding mass Interferes w/ function Pigmented subungual lesion Lipoma, ganglion, ulnar artery aneurysm or muscle anomaly
91
What is the path of the ulnar nerve through the hand? What is innervated from this nerve?
Wrist, past psiform, under hamate hook and branches to senosry/motor branch Sensor- to pinkly Motor- thenar muscles
92
What special test is done during PE of ulnar nerve entrapment? What are the most common animal bites but which ones are more likely to cause infection?
Allen's test Dog, then cat Cat causes more infection due to deeper/sharper injury
93
What type of microbe is most commonly associated with dog/cat bite infection? What are the other microbes that can cause an infection?
Pasteurella multocida A-hemolytic strep Staph A Anaerobics- Bacteroides and Fusobacterium
94
If an animal bite presents w/ purulent drainage, this indicates the bite is at least ?hrs old What makes dog or cat bites characteristic?
10-12hrs Dogs grab and tear Cats puncture and let go
95
Red streaks seen days after an animal bite indicate ? What lab tests are usually ordered for animal bites?
Lymphangitis CBC, ESR, CRP, Gram stain, Culture
96
How are animal bites that don't have nerve, tendon or bone injury managed? How are bites on a finger managed?
Debridment, Irrigate w/ 500-1000mL NS, out patient ABX Anesthetic block for debridement
97
How are animal bites on the back of a hand managed? What is the standard ABX for animal bites?
3-10mL of anesthetic infiltrated into the wound Amoxicillin-Clavulanate 875mg PO BID
98
What IV ABX are used for infected animal bites? When are PTs w/ animal bites referred?
Empiric IV ampicillin sulbactam 1.5-3g q6hrs Tendon, nerve, joint capsule or Fx
99
What are the most common causes of arthritis of the hand and wrist? What would be seen on on x-ray for the 2 major ones?
2* OA from FxHx RA Pseudogout 1* OA- dec ROM, pain, swelling OA- Narrowing, Spurs, Sclerosis RA- Osteopenia, erosion @ capsule/bone margin
100
When are wrist arthritis PTs T non-surgical and surgical/red flag referred? What lab tests can be done to confirm a Dx of hand arthritis?
Non Surg= splint Surg- dec function, unstable joint, non-surg failure Red- infection, advanced degeneration, splint/NSAID Tx failure ESR, CRP, RF, Anti-nuclear Ab, Anti-cyclic Citrulinated peptide Ab
101
What meds can be used for hand RA? What joints are more likely impacted by OA and RA?
NSAID Etanercept/Infliximab CCS injections OA: DIP, PIP, CMC RA: wrist, MCP
102
What PT population is more likely to have thumb CMC arthritis? What is the most common Sx they present with?
Female 40-70y/o Opposition: pain at base of thumb w/ grip/pinch activities
103
What is the hallmark of thumb CMC arthritis? What test can be done during PE for this?
Tenderness over palmar/radial joint aspects Grind test- palm facing up and back of hand on table, thumb is pushed down with other joints extended
104
How are thumb CMC cases Tx non-surgically? Define Boutonniere deformity
NSAID Spica cast OT Central portion of extensor tendon rupture at insertion in middle phalynx causing PIP to extend/DIP hyperflex
105
What PE finding is indicative of a rupture of the central slip of the extensor tendon? What movement will accentuate/worsen the deformity
PT lacking 15-20* extension at PIP Palm closer to volar surface (wrist flexion)
106
What is the adverse outcome of an untreated Boutonniere? How are these Tx non-surgically?
Flexion contracture of PIP and extension of DIP joints Young PT- splint extended x 6wks Older PT- splint extended x 3wks
107
# Define Dupuytren contracture Since this is usually a dominant genetic issue, who is it seen in?
Nodular thickening/contraction of palmar fascia Northern European men +50y/o in the ring finger
108
What are the associated risk factors with a Dupuytren contracture? How are they Tx?
DM, Epilepsy, Pulmonary Dz, Alcoholism, Vibration trauma Splints will slow progression Collagenese injections is FDA approved Tx
109
When are Dupuytren cases considered for surgery? What are the 3 fingertip infections?
30* flexion of MCP towards palm 10* deformity of PIP Both in pulp of finger: Felon- bacteria infxn Whitlow- viral infxn Paronychia- either side of nail
110
What usually causes fingertip infections? Why is correctly identifying felons/whitlows important?
Staph Aureus Whitlow- HSV I&D of whitlows are c/i I&D of felons is recommended
111
What preceding factor usually causes the development of a paronchyia? Felons and paronchyia usually have what 3 Sxs with them?
Manicure or hangnail Tender, Red, Fluctuance
112
Felons and paronchyia usually stop at the distal digit crease, but if they pass that crease what issue is considered? Felons can be drained w/ block and tourniquet through what 2 types of incisions?
Infectious flexor tenosynovitis Central volar longitudinal Dorsal midaxial UNLESS- puncture causing the felon is in the finger pulp, then incision includes puncture hole
113
How are finger amputations in kids under 6y/o managed? When is replantation a consideration?
Composite grafting w/ 4 or 5 chromic/plain gut sutures Thumb amputation at/proximal to IP joint Amputation proximal to middle of middle phalanx Multiple fingers amputated
114
What two injuries immediately cause a loss of flexion in PIP and DIP? Where doe the flexor tendons of the fingers insert and what kind of movement is allowed if one is cut?
Flexor digitorum sublimis Flexor digitorum profundus FDP in distal phalanx FDS in middle phalanx Cut FDP= PIP, MCP flexion Cut FDS= DIP, PIP, MCP flexion
115
What happens in the traumatic rupture of the FDP in a finger? These ruptures are often missed because they resemble ?
Ring finger caught and profundus tendon avulses from insertion Jammed finger
116
What is the first and second test done during assessment of a flexor tendon injury? Flexor tendons of the fingers are enclosed in sheath that extends from ? to ?
Active flexion Strength of flexion Distal palm DIP
117
What tracking method is used for flexor tendon infections?
``` Kanavel signs 1- swollen finger (sausage digit) 2- held in passive flexion 3- pain to percussion/palpation of sheath 4- pain w/ passive extension ```
118
What kind of ABX are used for flexor tendon infections? What microbe is most common in human bite infections?
Staph and Strep coverage Eikenella corrodens A-hemolytic strep Staph A
119
If drainage is present in a human bite wound, what needs to be collected for lab? What procedure is done if there is a possibility of joint infection?
A/naerobic cultures, WBC, ESR, CRP Arthrotomy to irrigate
120
What type of ABXs should be sued for human bite infections? Define Mallet Finger
PCN, 1st Gen Cephalosporins Deformity of insertion of extensor tendon at base of distal phalynx causing PT to present w/ resting in flexed position and lack of extension
121
When are Pts w/ mallet finger referred to Ortho?
Subluxation of joint, suggesting collateral ligament involvement Avulsion Fx larger than 1/3 of surface area of distal phalynx
122
How are subungual hematoma, nail bed lacerations and nail avulsions Tx?
Subungual- decompression Bed- only remove nail if it's floating and ready for removal Avulsion- replace and suture in place through poximal fold to pull nail bed through
123
When do nail bed injuries need to be sent to ortho? Trigger finger is AKA ?
Complex lacerations, Loss of tissue, Injury to germinal matrix, Open Fx Stenosing tenosynovitis of flexor tendons
124
What causes trigger finger? What are these often seen in conjunction with?
Thickening of flexor tendon near A1 pulley most commonly of long/ring finger Middle aged women w/ RA*, DM, Hypothyroid Higher association w/ Carpal tunnel and De quervains
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What finger do kids develop trigger finger? If they develop trigger finger anywhere other than this finger it's usually due to ?
Thumb Metabolic d/o
126
What happens during the creation of a nurse maid elbow? What is done during PE?
Axial pull on radius Radius head pulled out from annular ligament Annular ligament becomes trapped in radiocapitellar joint Neurovascular Pronation/supination TTP
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How are nurse maid elbows reset? Define Congenital Deficiency Define Congenital Deformity
Full supination Push on radial head medial Flex hand to head Ficiency- missing parts (hypoplasia, congenital d/os) Formity- psindactyle,
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# Define Little League elbow Define Osteochondritis dissecans
Traction apophysitis of medial epicondyle/olecrenon Osteonecrosis of capitellum, rarely the radial head
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# Define Panner Dz What imaging modality is used to confirm OCD, Panner or UCL injuries?
Under 12y/o w/ focal avascular lesion of capitellum MRI
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Neonatal brachial plexus palsy is AKA and what is the most common pattern? What type of movement issues are seen?
Obstetric palsy C5-6 Erbs Palsy Weak elbow flexion, shoulder abduction, flexion and external rotation
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# Define Klumpke Palsy PTs with this have poor prognostic factors that include ?
Neonate brachial palsy at C8-T1 Entire plexus Horner (preganglionic, sympathetic) Root avulsions
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What happens during Torticollis? What can cause ocular torticollis?
SCM contraction pulls head to affected side and rotated to unaffected side Mandibular flattening on affected side Occipital flattening on unaffected side Nystagmus Superior oblique palsy
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What is the most common bony injury? What type of x-ray is needed to confirm this?
Clavicle Fx AP and 10* cephalic
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What type of image is needed to confirm Fx/dislocations of the medial end of clavicles? How are most midshaft clavicle Fx treated?
CT Non-surgically
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What type of PT exercises are started with clavicle Fx? When are these Fxs referred for surgery?
Pendulum swings at 2wks Shortened Open Neurovascular compromise Painful nonunion at 4mon
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What nerve is injured with Fx of humerus? How many degrees of angulation is acceptable for non-surgical Tx?
Radial- inability to extend wrist/fingers, loss of sensation on back of hand at first dorsal web space Less than 20* of apex anterior/lateral angulation Less than 2cm of shortening w/ U-shaped coaptation splint
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# Define Floating Elbow PTs in a Sarmiento Splint need to have what education piece upon release?
Distal humerus Fx Proximal forearm Fx Sleep upright, will feel sensation of suffocation if not upright
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When are humeral Fxs referred to ortho? What are the 4 segments of a proximal humerus Fx?
Non-union at 3mon Greater tuberosity- supra, infra, teres minor Lesser tuberosity- subscapularis attachment Humeral head Shaft
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What is the most common Fx of the proximal humerus? How does these Fx usually occur?
Two part Fx of the surgical neck, distal to tuberosities Motion w/ torsion
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What unique view of x-ray is needed for proximal humerus Fx? How are these type of Fxs Tx?
Scapular Y-view Sling for full 6wk healing period ROM at 3wks
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When are proximal humerus Fxs Tx non-surgical? When are these Tx w/ surgery?
Less than 1cm displaced >1cm of displacement >45* of angulation
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When are proximal humerus Fxs referred to ortho? What are scapula Fxs associated w/?
Displaced 2 part Fxs All 3 and 4 part Fxs Polytrauma due to high energy MOI
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Injuries to the Superior/Lateral aspect of the scapula need to go to ? for assessment? How are they Tx?
CT Sling and ROM at 1wk
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What type of scapula Fx has the PT admitted for observation? When are scapula Fxs Tx w/ surgery?
Body Fx Displaced >2mm of articular step off Neck of scapula w/ >30* angulation Acromiom Fx w/ impingement
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What are the most common elbow dislocations? What structure is always torn?
Posterolateral LCL
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What is the terrible triad of the elbow? What is the MOI for these injuries?
Radial collateral ligament Dislocation Coronoid/radial head Fx FOOSH w/ elbow partially bent
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What step must be done after elbow dislocation reduction? What position are these arms splinted in after reduction?
CT to assess coronoid Elbow 90* w/ arm fully pronated
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If there are no Fxs/Terrible Triad, how long after elbow dislocations can they start PT? When are these PTs referred to Ortho?
1wk Terrible triad Instability Neurovascular injury
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What are the 3 landmarks of the lateral elbow for introducing needles? Which bone is screwed when surgically correcting a Terrible Triad?
Radial head Lateral epicondyle Tip of olecranon Coronoid
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What is a bad type of elbow Fx to occur in Peds? How is this Fx assessed and cleared?
Supracondylar Fx Bilateral x-rays w/ normal arm used for assessment
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What step do all PTs w/ distal humerus and olecranon Fxs receive? What is the MOI for olecranon Fxs?
Refer to Ortho Fall onto flexed elbow
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PTs w/ olecranon Fxs will get repeat x-rays to assess the amount of tricep pull every ? days? How are these PTs Tx non-surgically?
1-2 Splinted w/ elbow at 45* ROM at 2-3wks
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What is the classification system used for Fx of radial head?
Mason 1- non displaced 2- >2mm displaced or angled enough to create mechanical block 3- severely comminuted Fxs of radial head and neck
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# Define a Lessex Lopresti Fx What x-ray view is used to view the radial head?
Proximal radial head Fx dislocation down interosseous membrane to distal radial/ulnar joint w/ medial ulnar dislocation/deviation Greenspan
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When are radial head Fxs referred for surgery? Define a Bennett Fx Define a Rolando Fx
Mechanical block >2mm step off at articular surface B: oblique Fx of thumb metacarpal as it enters CMC joint w/ one small and one large piece R: Y shaped intra-articluar Fx at base of thumb metacarpal
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What is the primary concern of Bennet/Rolondo Fxs? What causes Hook of Hamate Fx?
Secondary CMC OA Holding objects and forces hitting the object
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What PE finding is seen w/ Hook of Hamate Fxs? What view is used on x-ray to assess the bones?
Ulnar compression Sxs Carpal tunnel view
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What type of cast are used on hamate Fx? Define Colles Fx
Short arm cast (no thumb component) x 6wks Most common Fx of distal radius when distal radisu Fx fragment tilts dorsally
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# Define Smith Fx Define a Barton Fx
Opposite of Colles Fx Distal radius Fx fragment tilted volarly Fx of intra articular Fx associated w/ subluxation of carpus w/ displaced fragment of radius
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# Define Chauffeurs Fx Define a Die-Punch Fx
Oblique Fx through base of radial styloid Depressed Fx of articular surface opposite the lunate/scaphoid bone
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When are Fxs of the distal radius sent for surgery?
>5* dorsal angulation >15* radial angulation >2mm articular step off
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# Define Boxers Fx What Fx is this the most common of?
Fx of distal end of 5th metacarpal MC Fx of hand
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What type of phalangeal Fx is the most commonly injured? When are Boxer's Fxs sent to surgery?
Distal >40* angulation
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When are metacarpal Fxs sent to surgery?
Multiple Fxs Shortening Intra-articular Fx >1mm >40% of articular surface involved
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Where are the 3 scaphoid Fxs more likely to occur? This is the most common ? Fx
60%- waist/middle 20% at proximal/distal pole Carpal Fx
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Since scaphoid Fxs are usually occult, when do they f/u? What is done if they're f/u is normal but w/ pain?
7-10 days for x-rays Spica thumb cast
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What is Gamekeeper's Thumb What is it AKA?
Torn thumb ulnar collateral ligament from hyper extension Skier thumb
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How are hand collateral ligement injuries Tx? How are volar plate injuries Tx?
Splint/thumb spica cast x 6wks Refer to ortho
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What is the 4 most common elbow Fxs in kids? What bone connects w/ the radius in the elbow?
Supracondylar Lateral condyle Medial epicondyle Capitellum
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What finding is useful for pediatric occult elbow Fxs? When can peds elbow Fxs be treated w/ casts?
Posterior fat pad- hemearthrosis indication Radial neck Fx w/ less than 30-45* angulation and kid is under 10y/o
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What type of pediatric elbow Fx requires repeat x-rays? What is the most common type of proximal humerus Fx in peds?
Condylar SALTAR 2
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How are neonatal clavicle Fxs treated? How are proximal humerus Fxs Tx?
Left alone Swath and pinned
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How are young kids w/ clavicle/proximal humerus Fxs treated? How are adolsecents Tx?
Under 5, <70* 5-12, 40-70* +12, <40* More than 2cm shortening= surgery Humerus angulation 30-40* w/ <50% apposition
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# Define Galeazzi Fx Define Torus/Greenstick Fx
Distal radius Fx w/ ulnar dislocation Fx of distal forearm
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Define Monteggia Fx
Radial head dislocation w/ Fx of ulna
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How are replaced finger nails post-sutures wrapped and wound cared? Flexor tendons of the fingers glide under ? annular and ? cruciform pulleys which keep them from ?
Ointment, non-adhesive gauze, sterile gauze, splint 4A, 3C Keep tendons from bowstringing
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What digits are more likely to be affected by trigger finger? In pediatric UE x-rays, the radial head should be directed towards the ? on all views?
Ring, long Capitellum
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What type of x-ray can be useful when searching for subtle Fxs of the UE in a Peds PT? Kids who have a positive posterior fat pad but no evidence of a Fx only have a ?% chance of having a bony injury and need ? support
Comparison view of uninjured elbow 80% Posterior long arm splint/long arm cast
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What is the most common elbow injury to kids under 5? What can happen to the medial epicondyle in kids 8-12 compared to what can happen when they're 12-14y/o?
Nurse maid's elbow Fragmentation: 8-12 Avulsion: 12-14
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In Peds UEs, the medial side of the humerus is AKA the ? side and the lateral side is AKA the ? side? What is the most common physical finding in little league elbow?
Medial- tension Lateral- compression TTP
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Babies w/ brachial plexus palsy tend to have a poor prognosis if what 3 findings are seen? What are signs that Erb's palsy occurred at a pre-ganglionic location?
Panplexus palsy Horner syndrome Nerve root avulsion Horner Syndrome Phrenic nerve paralysis Long thoracic, Dorsal scapular, Suprascapular, Thoracodorsal nerve involvement (TDSL)
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What is the cornerstone of neonatal brachial plxus palsy treatment? What must be suspected in infants that present with sudden loss of function in an extremity that was functioning at birth?
Assessment and monitoring Sepsis Abuse
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What is the most common error when assessing a Fx of the proximal hymerus? How are these types of Fx Tx non-surgically?
Missed Dx of shoulder dislocation Less than 1cm displaced w/ sling and PT at 3wks
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When do proximal humeral Fxs need surgical repair?
More than 0.5cm separation of tuberosity 2 parts through humeral neck All 3 and 4 part Fxs
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What do 4 part proximal humeral Fxs need surgery?
Interrupted blood supply, need prosthetic replacement