Orthopedic Flashcards
Name the Salter-Harris fracture:
1) Halfway through the growth plate
2) Straight through the growth plate
3) Breaks the epiphyseal plate in half
4) Crush injury - crushing the growth plate
5) Breaks halfway through the growth plate into the epiphysis and metaphysis
1) Type II (M)
2) Type I
3) Type III (E)
4) Type V
5) Type IV (ME)
Name the cervical spine fracture:
1) Result of flexion injury in the lower cervical spine in which the spinous process is broken or fractured.
2) Occurs frequently in a motor vehicle accident or in hangings. It is a bilateral pedicle fracture with anterior displacement of C2.
3) Caused by heavy object falling directly on head or hitting head while diving. Consists of at least two fractures of C1.
1) Clay Shoveler’s
2) Hangman’s
3) Jefferson’s
Name the thoracolumbar spine fracture:
1) Horizontal fracture of a vertebra, usually result of a motor vehicle accident where the seat belt immobilizes the pelvis but the upper body is thrust forward.
2) Horizontal fracture of a vertebra, usually result of a motor vehicle accident where the seat belt immobilizes the pelvis but the upper body is thrust forward.
3) Defect in the pars interarticularis, appears as a collar on the “Scottie dog”. Best seen on oblique view.
4) Bilateral pars interarticularis defect.
1) Chance
2) Burst/Compression
3) Spondylolysis
4) Spondylotisthesis
Name the wrist fracture:
1)Distal radial fracture posteriorly displaced.
2)Distal radial fracture anteriorly displaced.
3)Most common fractured carpal bone, may give rise to avascular necrosis.
Pain in the anatomical snuffbox!
1) Colles’
2) Smith’s
3) Scaphoid
Name the hand fracture:
1) Fracture of the base of the proximal phalanx of the thumb.
2) Fracture through the base of the first (thumb) metacarpal
3) Fracture of the 5th metacarpal.
4) Fracture of the 3rd metacarpal.
1) Gamekeeper’s Thumb or Skier’s Thumb
2) Bennett’s Fracture
3) Boxer’s Fracture
4) Bar room/Brawler’s Fracture
Name the Pelvis fracture:
1) Fracture through ischiopubic rami on one side and fracture of SI joint on the other side.
2) Fracture through the ischiopubic rami and SI joint on the same side.
3) A small piece of bone is separated from the origin or insertion site of a tendon.
1) Bucket Handle Fracture
2) Malgaine Fracture:
3) Avulsion Fracture
Name the Elbow fracture:
1) difficult to see, but look for anterior and posterior fat pad signs.
2) Caused by receiving a blow when protecting onself, dislocation of radial head and fracture of the ulna.
3) Caused by falling on outstretched hand and dislocating the distal radio-ulnar joint and fracturing the distal radius.
1) Radial Head fracture
2) Monteggia Fracture-dislocation (night-stick)
3) Galeazzi Fracture-dislocationElbow
Mnemnonic:
Policeman Radii Galeazzi tried to hit thief Ulna Monteggia for stealing his bike. Ulna Monteggia blocked the blow to his forarm and tripped Policeman Radii Galezzi who fell on his outstretched hand.
Name the Upper Limb injuries:
1) Diagnosed with X-ray taken with patient holding weights, 3 grades.
2) occurs most frequently in the middle third of the bone.
1) AC Joint Separation
2) Clavicular fracture
Indications for a bone scan - radiographic tracer Tcn99m phosphate or gallium 67 citrate
Osteomyelitis
Bony neoplasm/METS
Occult vertebral fracture
What are the disadvantages of bone scan?
False pos in older people w/ OA
False neg with diffuse bony METS and mult myeloma
What are the disadvantages of bone scan?
False pos in older people w/ OA
False neg with diffuse bony METS and mult myeloma
What is the MC muscular dystrophy in children? MC in adults?
Duchenne’s
Myotonic
What are SSX of Duchenne’s MD?
Muscle replaced by fat/pseudo-hypertorphy of calves.
Gower’s sign +
What test is used to diagnose Myasthenia gravis?
Tensilon test
Antibodies to ACH receptors
What test is used to diagnose Myasthenia gravis?
Tensilon test
Antibodies to ACH receptors
MC benign bone tumor
Osteochondroma - risk of chondrosarcoma w/ multiple lesions
Osteitis deformans or Paget’s dz presents with what SSX?
Lytic mixed with sclerotic areas - esp skull, bowing femur/tibia, OA, pathological fracture
Term: Demineralization of bone
Osteomalacia
What is the MC primary malignant bone tumor (age)? What is the second MC primary malignant bone tumor (age)? What is the more common bone tumor in the young?
Chondrosarcoma (middle age)
Osteosarcoma (elderly)
Ewing’s sarcoma
With unilateral joint inflammation, what two conditions are high on your DDX?
Gouty and infectious arthritis
Which arthritis conditions are HLA B27+?
Psoriatic, Enteropathogenic, and Reactive arthritis
What are some ominous signs of bone/musculoskeletal pain?
Pt > 50 yo Hx of CA Trauma Systemic symptoms of inflammation Not better lying down/rest Osteoporosis Neurological ssx (bowel/bladder incontinence) Referred pain
What is mandatory in a febrile pt with joint effusion?
Arthrocentesis
What is the work-up for suspected RA?
RF and ANA antibody
What does Adam’s sign detect?
Scoliosis
Have patient bend forward
What does Adson’s test detect?
TOS
Taking radial pulse and lifting arm to see if pulse is still detected
What does Braggard’s test detect?
Sciatica
During SLR - flex foot
What does Betcherew’s test detect?
Sciatica
Extending knees while seated
What does East or Roos’ test detect?
TOS
Hands up, open/close hands for 3 min
What are two test for Malingering?
Hoover’s and Burn’s Bench tests
What does Kemp’s test detect?
Disc Herniation
Rotate, extend flex, push on lumbar SP
What does Kernig’s test detect?
Meningitis
Flex knee then extend
What does SLR test detect?
Disc herniation or sciatica
What does Linder’s test detect?
Sciatica
Supine, flex neck
What does Milgram’s test detect?
Disc herniation
Supine, raise extended legs for 30 sec
What does Minor’s sign detect?
Sciatica
Sit then stand and put one hand on back
What does Shoulder depression test detect?
Brachial plexus lesion
Apply pressure down on shoulder, flex the head
What does Soto-Hall’s test detect?
Disc herniation
SLR + flex head
What does valsalva detect?
space occ lesion
bear down
What does Wright’s test detect?
TOS
Palpate both radial pulses, raise arm
What does Apley’s scratch test detect?
Rot cuff tear, tendonitis
Touch fingertips to middle of back
What does drop arm test detect?
Rot cuff tear
abduct both arms to 180, adduct
What does Glenohumoral apprehension test detect?
Disloc shoulder
Cross painful arm, push elbow toward painful shoulder
What does Impingement test detect?
Shoulder lesion
Abduct arm, rotate medially + passively elevate it
What does Lippman’s scratch test detect?
Bicip tendonitis
Palpate bicipital groove
What does speed’s test detect?
Bicip tendonitis
Resisted shoulder flexion
What does Yergason’s test detect?
Bicip tendonitis
Flex elbow, resist supination/lat rot
What does Cozen’s test detect?
Lat epicondylitis/ext tendonitis (tennis elbow)
Resist wrist extension in prontated/flexed arm
What does Finkelstein’s test detect?
De quervain’s
Hold thumb in hand and ulnar deviate
What does Mill’s test detect?
Lat epicondylitis/ext tendonitis (tennis elbow))
Palpate lateral epicondyle
What does Phalen’s test detect?
Carpal tunnel
Backwards prayer
What does Retinacular’s test detect?
Tight retinacular lig or capsule
Hold PIP, flex DIP - Fled Pip, fled DIP
Likely to be a distractor
What does Tinel’s sign detect?
Carpal tunnel
Tap on median n
What does valgus/varus stress test detect?
Med/lat collateral lig instability
Valgus = Medial (6 letters each)
Varus = Lateral
What does Ely’s test detect?
Tight rec fem, lumbar lesion, contracture of TFL, osseus hip lesion
Prone, flex knee to butt
What does Gaenslen’s test detect?
SI lesion, hip path, likely L4 lesion
Supine, one leg off table, bring other knee to chest
What does Hibb’s test detect?
Spondylolisthesis, facet syndrome, SI lig sprains
Prone, flex knee, move leg laterally
What does Nachla’s test detect?
Tight rect fem, upper lumbar lesion
Prone knee bending
What does Ober’s test detect?
Contracture of TFL
Lateral decubitus, affected leg up, flex knee, raise leg, let if fall
What does Ortolani click test detect?
Congenital hip dislocation
What does Patrick Faber’s test detect?
Hip arthritis, bursitis, leg sprain
Cross legs
What does Pelvic rock test detect?
SI lesion
Rock the pelvis
What does telescoping test detect?
Congenital hip dislocation
Move legs like you’re adjusting a telescope
What does Thomas’ test detect?
Tight hip flexor
Bring knee to chest while supine
What does Trendelenburg test detect?
Gluteus medius weakness
Stand, flex one knee
What does Yeoman’s test detect?
SI joint dysfunction
Prone, extend hip with knee extended/flexed
What does Yeoman’s test detect?
SI joint dysfunction
Prone, extend hip with knee extended/flexed
What does Anterior/Posterior drawer test detect?
ACL/PCL Tear
Sit on foot, pull push flexed eg
What does Apley’s compression/distraction test detect?
Med/Lat Meniscus tear
Compression = meniscus
Distraction = ligament
Push ankle while knee is flexed in prone
What does Apprehension test detect?
Patellar dislocation
Press patella laterally
What does Bounce home’s test detect?
Torn meniscus
Passively extend knee “bounce home”
What does Lachman’s test detect?
ACL injury
Move tibia toward femur
What does McMurray test detect?
Meniscus fragment in joint
Flex patient hip/knee, internally/externally rotate the knee
What does Patellar femoral grinding test detect?
Chondromalacia patella
Press on patella while patient contracts quad
Younger/growing pts
What does reduction click detect?
Menisci fragment in joint (same as McMurray)
What does valgus/varus stress test detect?
MCL/LCL sprians
Valgus = Medial
Varus = Lateral
What does ballot and bulge tests detect?
Bulge - minor effusion
milk medial side of patella, then stroke lateral side
Ballot - major effusion
What does anterior/posterior drawer test detect?
Med/Lat Talofibular lig lesion
Excess motion on side the ankle turns away from
What does Forefoot adduction test detect?
Structural foot detect (INFANTS only)
Excessive forefoot adduction, try to bring foor to neutral position
What does Dorsiflexion test detect?
Gastrocnemius/soleus hypertonicity
Dorsiflex ankle
What does Forefoot squeeze test detect?
Stress fracture or neuroma
Squeeze metatarsal bones together
What does Homan’s sign detect?
DVT
Dorsiflex pt foot
What does talor tilt test detect?
Torn calcaneofibular ligament
Talus is tilted from side to sdie
What does test for rigid or supple flat feet detect?
Obs in 3 pos: stand, sit, standing on toes
Rigid: no arch present
Supple: arch present while standing
What does Thompson’s test detect?
Ruptured achilles tendon
Squeeze gastroc toward midline
What does Tibial torsion test detect?
Measures angles between malleoli
Toe-in or toe-out torsion
Alpha stim indications and contraindications?
Chronic pain, cranial for depression/insomnia/addiction
CI: pacemaker, CA lesion, uterus
Electroacupuncture indications and contraindications?
Pain
CI: pacemaker, arrhythmia, seizures, anxiety attacks
TENS indications and contraindications?
Pain, ST use
CI: eyes, fractures, metallic implants, uterus
Sine wave indications and contraindications?
LMN lesions, spasm, other nerve problems
Constitutional hydrotherapy tx
Interferential indications and contraindications?
Deep/large joint problems, muscles spasms
Infrared phototherapy indications and contraindications?
Arthritis, infection, spasm, inc circulation
CI: CA
Iontophoresis indications and contraindications?
Calcium - adhesive capsulitis
CuSo4 - fungal infx
MgSo4 - bursitis, edema, OA, RA, spasms
Low voltage galvanism indications and contraindications?
Denervated muscle, LMN lesion, decreased motion, pain
High voltage galvanism indications and contraindications?
Pain (neuralgia, sciatica strain/sprain)
Phonophoresis indications and contraindications?
Inflammation (anti-inflammatory substances)
Therapeutic ultrasound indications and contraindications?
Micromassage, adhesions, chronic inflammation
Penetrates deeply, does not affect adipose
Diathermy indications and contraindications?
Inflammation/infections
(Bursitis, tendinitis, bronchitis, prostatitis)
CI: Long-term use, areas of low vascularity
Ultraviolet phototherapy indications and contraindications?
Psoriasis or other skin issues
CI: Eye, genitals, sunburns, CA
Colon irrigation indications and contraindications?
Constipation, detox
CI: Active UC, diverticulitis, children
Hyperthermia baths indications and contraindications?
Immune booster, inc circulation
Contrast hydrotherapy indications and contraindications?
Immune, inflam, infection, arthritis
Very safe, good for many conditions
Constitutional hydrotherapy indications and contraindications?
Immune boost, nourishing, healing
External cold application indications and contraindications?
Acute inflammation
External heat application indications and contraindications?
Chronic inflammation
Osseous manipulations indications and contraindications?
Specific body part has pain or fixation
CI: CA, fracture, osteoporosis
