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Emergency Medicine > Ortho/Rheum > Flashcards

Ortho/Rheum Flashcards

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1
Q

Back Strain

eti, sxs

A

Thoracic and Lumbar MCC

D/t lifting, twisting or strenuous activity

Stiffness A

xial back pain

Difficulty bending

No radicular sxs,

No neuro changes (below knee)

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2
Q

Back strain

Tx

A
  • Bed Rest < 2 days
  • NSAIDs
  • +/- muscle relaxant - cyclobenzaprine or short term Benzo Re-eval if no improvements in 4 wks
  • Resume activities as tolerated
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3
Q

Bicep Tendonitis

sxs

A
  • Pain at bicep groove
  • Ant shoulder pain - r-> biceps
  • Pain w/ resisted supination of elbow
  • Popeye deformity
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4
Q

Bicep Tendonitis

tx

A
  • NSAIDs
  • PT strengthening
  • Steroid injections
  • Surgical release
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5
Q

Cervical Sprain

eti, sxs

A

Headache

Stiffness in Neck

Paraspinal muscle

Tenderness and spasms

Numbness and tingling in extremities

+ Spurling test

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6
Q

Cervical Strain

tx

A

Rest

NSAIDs

muscle relaxants - cyclobenzaprine

PT = gental ROM

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7
Q

Costochondritis

eti, sxs

A

Acute inflammation of the costochondral, costosternal or sternoclavicular joints

Common after viral infx or MSK trauma

sxs:

  • Pleuritic chest pain - sharp, stabbing
  • Worse with inspiration, coughing, & certain mvmts
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8
Q

Costochondritis

dx, tx

A

Dx:

  • localized tenderness and pain 2-5th costochondral junction
    • no edema
  • pain reproducible with palpation
    • Tietze’s Syndrome is at 2-3rd ICS
  • R/o cardiac and PE =
  • EKG, Trop, echo

Tx:

  • NSAIDs, tylenol
  • heating pads
  • PT, and Steroids
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9
Q

Patellar tendinitis dx, tx

A

Dx:

  • Radiographs - nl, can show inferior traction spur (enthesophyte) for chronic
  • US/MRI - tendon thickening and hypo echoic areas

Tx:

  • Ice/rest activity mods -> PT
  • Surgical excision and suture repairs
  • CS injection C/I d/t patellar tendon rupture
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10
Q

Patellar tendinitis

eti, sxs

A

anterior knee pain - activity related @ focal patellar tendon Jumper’s knee

Swelling over tendon tenderness at inferior border of patella

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11
Q

Bassett’s Sign

A

a/w patellar tendonitis tenderness to distal pole of patella during full extension but not full flexion

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12
Q

Prepatellar Bursitis

dx, tx

A

Septic bursitis - aspiration Gram stain and culture

Tx:

  • Compressive wraps
  • NSAIDs +/- aspiration and immobilization
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13
Q

Prepatellar Bursitis

eti, Sxs

A

MC in wrestlers

Pain w/ direct pressure on knees (kneeling)

Swelling over patella

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14
Q

Speed’s Test

A

pain in bicep groove when elevate shoulder against examiner’s resistance

For bicep tendon or sprain patho

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15
Q

Subacromial Bursitis

eti, sxs

A

Btwn superior surface of supraspinatus tendon & coracoacromial ligament, acromion, and coracoid (acromial arch)

Pain on motion and at rest - fluid to accumulate Not a/w trauma

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16
Q

Subacromial Bursitis

tx

A
  • Prevention of precipitating factors
  • NSAIDs
  • Rest Brace/support
  • Steroid injections
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17
Q

Yergason’s Test

A

elbow flexed at 90degrees, wrist supination against resistance

+ if pain produced

For bicep tendon or sprain patho

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18
Q

Red flag signs of Herniated Disc

A
  • fecal/urinary incontinence
  • Saddle anesthesia
  • Urinary retention
  • IVDU
  • Fevers
  • Chronic steroid use
  • focal neuro deficitys
  • hx of Cancer
  • weight loss
  • no improvements after 6 wks of conservative management
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19
Q

Gout

eti, sxs

A
  • altered purine metabolism
  • uric acid accumulation in soft tissues and bones
  • >30yo
  • M>W (9:1) until menopause (1:1)

Sxs:

  • Podagra attack (great toe)
  • pain, swelling, redness, exiquisite tenderness
  • tophi in chronic gout
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20
Q

Gout

dx and tx

A

Arthrocentesis & joint fluid analysis

Negative, bifrigent needle shaped crystals

Serum Uric acid > 8 - dont measure during accute attack

tx:

  • LSMs - less purine foods
  • NSAIDs - Indomethacin for acute attack
  • Management with colchicine or allopurinol
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21
Q

Herniated Disc - Cervical

eti, sxs

A

MC C5-C6 or C6-C7, nerve root irritation or impingement

Posterolateral

Sxs:

  • pain into arms/shoulders
  • tingling with pain at rest, +/- numbness
  • Loss of reflexes
  • C7 is nerve root
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22
Q

Herniated Disc - Cervical

dx, tx

A

Dx:

  • lateral X-Ray - must see all 7 vertebrate
  • Spurling’s test
    • Compression Test (head pressed backwards towards spine) = Pain reproduced
    • Cervical distraction = pain relieved
  • MRI - soft tissue, nerves

Tx:

  • Rest - immobilization
  • NSAIDs/ analgesics
  • CS and PT
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23
Q

Herniated Disc - Lumbar

eti, sxs

A

Compression of nerve caused by disc

pain in dermatomal region

incr pain with coughing, straining, sitting, bending

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24
Q

Herniated Disc - Lumbar

Dx, tx

A
  • MRI - non contrast
    • Straight leg raise
  • red flags of back pain

Tx:

  • Rest
  • NSAIDs
  • CS injection - epidural steroid injections
  • PT
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25
Q

Red Flags of Back Pain

A
  • Fever
  • wt loss
  • morning stiffness
  • IVDU/steroid hx
  • trauma
  • cancer
  • saddle anesthesia
  • loss of anal sphincter tone
  • motor weakness
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26
Q

Low Back Pain

Eti, sxs

A

MCC prolapsed intervertebral disk and low back strain - occurs w/in 24 hrs of injury/overuse

  • pain in back & r-> down leg
  • sciatic in buttocks, posterior thigh, posterolat asp of leg to lat malleolus and lat dorsum of foot
  • unilat LB and butt pain - worse with standing –> SI Joint involvement
  • Pain in elderly incr with walking, better with rest and leaning forward - spinal stenosis (Hoffman’s sign)
27
Q

Low Back Pain

Dx, tx

A
  • Red Flags for LBP (fever, wt loss, IVDU/steroid use, hx of cancer etc)
  • Special Tests
    • ​Straight Leg Raise = + if numbess and tingling
      • ​15-30 degrees = severe
      • 30-60 degrees = mild to moderate
  • XRay not needed if nl hx and PE
  • CT - bony stenosis & lateral nerve root compression
  • MRI - tumors, HND, stenosis, cord patho, infx

tx:

  • Short term rest < 2d, support under neck & knees - NSAIDs
  • PT, rehab
  • Imaging > 6wks if no improvement
28
Q

Osteomyelitis

eti, sxs

A

Infection and inflammation of bone and bone marrow

d/t hematogenous spreading or inoculation from trauma/surgery

  • S aureus MC
  • Pasteurella - dog/cat bites
  • Human bites - mixed anaerobes
  • Staph epidermis - prosthesis
  • Mycobacterium TB - vertebral involvement

Sxs:

  • fever
  • throbbing pain and mvmt restriction over sight
  • refusal to bear weight
29
Q

Osteomyelitis

dx, tx

A

dx

  • Bone aspiration and bx - gold std
  • Blood cultures and needle aspiration
  • XR (lags 7-10d after sxs) triad - demineralization, bone destruction, periosteal rx​
  • ele CRP 4-6 wks, ESR, WBC

tx

  • Empiric abx for targeted organism
    • Amox-Clauv (Augmentin) = Dog/cat and human bites
  • Targeted after cultures
  • IV Abx 4-6 wks for acute OM, > 8 wks for chronic OM or MRSA
30
Q

Septic Arthritis

eti, sxs

A

Direct bacterial invasion of joint space MC knees and hips

MCC - S aureus, N gonorrhea in sexually active YA, streptococcus; Pseudomonas

sxs:

  • Single, swollen, warm, painful joint
  • tender to palpation +
  • constitutional sxs (fever, sweats, myalgia, malaise, pain)
31
Q

Septic Arthritis

dx, tx

A

Dx:

  • Arthrocentesis - joint fluid aspirate - gold std
  • WBC > 50k, primarily PMNs
  • WBC > 1000 is + for prosthetic joints

tx:

  • 2-4 wks of abx + arthrotomy w/ joint drainage
  • S aureu - vanco/Nafcillin (vanco or clindamycin if pcn allergic)
  • Gonorrrhea - ceftriaxone
  • IVDU - cipro/levaquin
32
Q

Humerus Shaft fracture

A

MOI - direct blow

MCC radial n. injury, posterior fat pad/sail sign

  • pain, swelling, deformity, shortened extremity
  • motion at fracture site

Tx with sugar tong splint

ortho f/u in 24-48 hrs

33
Q

Supracondylar Fracture

eti, sxs

A

MC Peds elbow frx - FOOSH

Gartland Classification:

  • I, II, III - Extension Type
  • IV - Flexion Type

*Anterior Interosseous Nerve (AIN) MC injured in Type I-III

Brachial Artery MC Vascular Structure Damaged → Volkmans Contracture (Radial nerve contracture)

  1. Type I - FOOSH, non-displaced, posterior fat pad sign
  2. Type II - FOOSH, angulated fx w/ distal posterior segment
  3. Type III - FOOSH, complete frx through cortext and posterior displacement of distal frx
  4. Type IV - Flexed frx, fall on flexed elbow, anterohumeral line falls posteriorly to capitulum
34
Q

Supracondylar Fracture

Dx, tx

A

Lateral X Ray

Type I:

  • Without NV compromise
  • Cast in flexion <90 degrees for 3wks
  • Re-evaluate & x-ray

Type II:

  • Refer same day
  • Closed Reduction and +/- pinning/fixation
  • Casting

Type III:

  • Refer same day
  • Reduction and Internal Fixation
  • Casting

Type IV:

  • Refer same day
35
Q

Radial Head Fracture

A

Pain and tenderness along lateral asp of elbow

limited elbow/forearm ROM - pronation and supination

MCC - FOOSH

Sling or long arm splint at 90 degrees

ORIF

36
Q

Radial head Subluxation (Nursemaid’s Elbow)

A

MC young children < 4yo

MOI - pulling upwards motion

Lateral elbow pain

hold elbow in slight flexion and forearm pronated

Pain and tenderness in lateral asp of elbow

37
Q

Nightstick Fracture (ulna)

A

MCC Direct blow to midshaft of ulna

Pain and bruising at site

eval for abuse victims

Tx

  • functional brace w/ good interosseous mold for isolated/nondisplaced
  • ORIF for displaced
38
Q

Monteggia Fracture

A

Proximal 1/3 ulnar shaft fracture w/ radial head dislocation d/t FOOSH

sxs

  • elbow pain and swelling
  • tenderness to palp along elbow
  • decreased elbow ROM

tx

radial n injury

ORIF

39
Q

Galeazzi Fracture

A

Distal radial shaft fracture, dislocation of ulna d/t FOOSH on pronated hand

sxs:

  • wrist pain
  • swelling
  • pain with extension/flexion

Radial n injury

ORIF

40
Q

Colle’s Fracture

Dx, tx

A

FOOSH - distal radius fracture

  • Dorsal angulation extra-articular
  • dinner fork deformity

Dx - lateral xray

Tx

  • Conservative
    • close reduction
    • sugar tong splint, immobilization with cast for 4-6 wks
  • Surgery
    • ORIF followed by cast/splint immobilization for 4-6 weeks
41
Q

Smith’s fracture

eti

A

Fracture of distal radius w/ volar angulation and displacement

garden spade deformity - fall w/ palm closed, hands flexed, blow to back of wrist

Median n injury –> develop carpal tunnel over time

42
Q

Scaphoid Fracture

A

FOOSH

Sxs:

  • pain on radial surface of wrist at anatomical snuffbox
  • leads to avascular necrosis - radial artery

Dx:

  • X-Ray = Fracture may not be evident for >2wks, if no frx on Xray - tx as fracture and immobilize. Repeat Xray in 2 wks

Tx:

  • Non-displaced = Long vs short thumb spica 10-12wks
  • Displaced = surgical fixation
43
Q

Boxer’s Fracture

A

Fracture of neck of 5th/4th metacarpal

  • Punch with clenched fist
  • no knuckle sign

Tx:

  • Reduce to anatomic position
  • Abx if skin breakdown - with Augmentin
  • Ulnar gutter split w/ joints in 60 degree flexion
  • Immobilization 4-6 wks
  • Surgical repair => cast immobilization
44
Q

Shoulder Fracture (Proximal Humerus)

A

MC in elderly for low velocity

complications = adhesive capsulitis/RC Tear

Sxs:

  • inability to hold wrist up = radial n palsy aka wrist drop

Dx:

  • Xray

Tx

  • immobilize 4-6 wks - sling and swathe
  • then begin gentle passive ROM and modalities
  • Progress to light strengthening after 6 wks
  • Surgery if displaced or rotated
45
Q

Shoulder Dislocation (Glenohumeral Joint)

A

MC anterior - arm is abducted and externally rotated

Posterior - arm is adducted and interally rotated

Sxs:

  • Pain, deformity, loss of function

Dx:

  • XRay - AP, Axillary and Y-view
  • Special Tests
    • Apprehension test
    • Relocation test
    • Sulcus test
    • Obriens Test

Tx:

  1. Reduce
  2. postreduction films
  3. Sling and swath
  4. PT
46
Q

Shoulder Dislocation Complications

A

Bankart Lesion - fracture of anterior inferior glenoid frm impaction of humeral head against glenoid

47
Q

Acromioclavicular Joint Sprains

A

Direct blow to tip of shoulder or upward force on long axis of radius

Sxs:

  • Pain/point tenderness over tip of shoulder
  • +/- deformity

Dx:

  • weight X ray

Tx

  • Sling
  • analgesics
  • PT
  • +/- Surgery
48
Q

Rotator Cuff Injuries

A

Stabilizes the shoulder; Comprised of Four muscle groups

  1. Supraspinatus - MCC of tears
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis - internal rotation

Eti:

  • <40 yo = Impingement, tendonitis
  • >40 yo = cuff tears

Sxs:

  • Can’t abduct arm above horizontal plane
  • pain when elbow higher than shoulder

Dx:

  • Special tests
    • ​Drop Arm
    • Empty can
    • Neer Impingement Test
  • Radiographs - shoulder series
  • MRI - gold standard

Tx

  • Conservative - NSAID, PT, Rest, Steroid
  • Surgical - arthroscopic vs open
49
Q

Olecranon Bursitis

A

Painless inflammation of bursa; swelling dev’s gradually or acutely

Dx:

  • X ray if trauma
  • Aspirate and culture if septic

Tx:

  • RICE
  • elbow pad
50
Q

Carpal Tunnel Syndrome

A

Compression of Median Nerve, dt overuse, repetitive motions

SxS:

  • numbness thumb to mid of ring finger
  • tingling
  • thenar wasting

Dx:

  • Tinnel’s
  • Phalen’s
  • Electrodiagnostic studies
51
Q

deQuervain’s Tenosynovitis

A

W 30-50yo

Sxs:

  • pain, swelling, point tenderness along dorsal aspect of wrists

Dx:

  • +Finkelstein’s

Tx:

  • Rest
  • Thumb spica/splint immbolization
  • NSAIDs, PT, CS
52
Q

Hip Osteoarthritis

A

breakdown, loss of articular cartilage btwn bones - age, injury

Sxs:

  • pain in groin region
  • decrease ROM, abduction
  • pain with ambulation, climbing stairs

Dx:

  • X-ray

Tx

  • Activity mod
  • Shoewwear
  • NSAIDs
  • Wt loss
  • joint CS injection
  • Total joint replacement
53
Q

Hip Dislocations

A

High impact trauma - usu from MVA dashboard => 90% posterior

Sxs:

  • limbed shortened
  • internally rotated

Dx:

  • XR and CT r/o frx

Tx:

  • Reduction promptedly
54
Q

Hip Fractures

A

Subcapital/Femoral Neck = wary of avascular necrosis of femoral neck

intertrochanteric; Subtrochanteric

Sxs:

  • Pain
  • inability to wb
  • shortened leg - external rotation

Dx:

  • XR

Tx - ORIF

55
Q

Anterior Cruciate Ligament Tear

A

Twisting motion - change in motion/speed

Sxs:

  • Pain with instability - knee giving out
  • Hemarthrosis

Dx:

  • Anterior drawer
  • Lachman’s

Tx:

  • RICE, PT, bracing, Progressive return to activity
  • Surgical reconstruction w/ patellar tendon or hamstring or cadaver’s tendon
56
Q

Meniscus Injury

A

Traumatic vs degenerative

Sxs:

  • Twisting injry
  • Triad
    • joint line pain
    • effusion - 6-24 hrs post injury
    • locking

Dx:

  • MRI- Gold ****
  • McMurray’s - knees flexed and
    • Tibial Externally rotated - medial meniscus
    • Tibia Internal rotated - lateral meniscus
  • Apley’s Compression
    • ​axial loading = pain

Tx:

  • Rest
  • Activity Mod
  • NSAIDs
  • PT
  • CS
  • Surgery
57
Q

Collateral Injury

A

Medial and Lateral CL

Knee forced into VALGUS - hit on outside of knee L

  • MCL tear

Knee forced into VARUS - hit on inside of knee (inner thigh)

  • LCL tear

Dx - MRI gold ***

Tx

  • RICE
  • Brace
  • WBAT - crutches
  • PT/surgery
58
Q

Ankle Sprain

A

Inversion sprain - Lateral malleolus strain AFTL

Ecchymosis and edema

Xray to r/o fracture

Tx:

  • RICE
  • Splinting and casting
  • PT
  • acute vs chronic
59
Q

Plantar Fasciitis

A

Plantar heel pain - worse in morning, better with moving stretching - overuse activity

Dx - XRay

Tx:

  • Stretching
  • PT
  • NSAID
  • CS injection
  • Patience
60
Q

Lisfranc Injury

A

Fracture/dislocation of 1st/2nd TMT joint

MOI - MVA, fall from height

Low energy - stepping off curb or hole

Swelling in mid foot, non WB

Dx:

  • X ray
  • CT

Tx:

  • Displacement > 2mm not good = surgery ORIF
  • Non-displaced NWB cast immobilization x 4-6wks
61
Q

Fifth Metatarsal Fracture vs Jones

A

heels and twisting ankle inversion

Jones Fracture

  • base of 5th MT at metaphyseal diaphyseal junction
  • ORIF = high risk of avascular necrosis
62
Q

Osgood-Schlatter Syndrome

A

Pain at tibial tuberosity d/t growth spurt

Self limiting

ice

quad strengthening

Knee patellar strap

63
Q

Slipped Cap Femoral Epiphysis

A

Obese kid, adolescent

Xray - slipped femoral cap

Tx - ORIF

Emergency Medicine (13 decks)

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