Ortho/Rheum

Question 1

Compartment syndrome
Path:
Pt:
Dx:
Tx:

Answer 1

Path: Muscle/nerve ischemia (dec tissue perfusion)
MC after fracture of long bones

Pt: Pain, pallor, paresthesias, poikilothermia, pressure, pulselessness (late sign)

Dx: Inc intracompartmental pressure >35-40mmHg

Tx: Fasciotomy

Question 2

ACL tear
Path:
Pt:
Dx:
Tx:

Answer 2

Path: Twisting/hyperextension injury

Pt: Sudden pain w/ immediate significant swelling, instability, “giving out”

Dx:
Lachman’s: increase anterior translation of tibia in respect for femur
Anterior drawer: tibia slides anteriorly
MRI

Tx:
NSAIDs, rest/ice, knee brace
Surgery: young athletes, continued instability

Question 3

Ankylosing spondylitis

Answer 3

Path: Chronic inflammatory arthropathy of axial skeleton and sacroiliac joints w/ progressive stiffness

Pt: Back pain worse w/ rest, improved with activity

Dx:
Inc ESR, +HLA-B27
Bamboo spine on x-ray-> squaring of vertebral bodies
Schober maneuver-> loss of spinal flexion

Tx:
NSAIDs
DMARDs (methotrexate, sulfasalazine), anti-TNF alpha (infliximab, etanercept, adalimumab)