Orthopedic Procedures Flashcards
what is the most important thing to obtain before an Xray?
A complete history and physical
Describe a Sprain
ligamentous stretching causing tearing, bruising, and possibly a “pop”
Describe a Strain
Occurs when a muscle is stretched and contracted at the same time. Immediate pain and “grabbing” sensation
Ex: sprinter’s hamstring in late swing phase as decelerating leg in prepartion for foot strike,
What are four aspects of the physical exam for an orthopedic complaint?
Palpation
ROM (watch for signs of pain or impairment)
Neurological assessment
Vascular assessment
What should be compared to the injured area when examining an orthopedic complaint?
Compare the injured side to the uninjured side
What are the Ottawa Ankle Rules?
bone tenderness along posterior tibia or tip of medial malleolus
Bone tenderness along posterior fibula or tip of lateral malleolus
inability to bear weight for four steps both immediately after injury and in ER/office
When should a foot series xray be ordered?
bone tenderess at base of fifth metatarsal
bone tenderness at navicular bone
inability to bear weight both four steps after injury and in ER/office
What is the treatment for sprains?
RICE
possibly spint, aircast, brace
What type of sprain requires surgical intervention?
Third Degree
stabilize with splint
ICE and pain control
refer to ortho
What joints are involved in splints/casts?
Generally includes the joints above and below the fracture or injury
can be used for temporary immobilization
Describe the findings with gonococcal arthiritis?
2x more frequent in women
large joints commonly affected
less destructive than nongonococcal
hx of high risk sexual behavior
consider culture from blood/cervix/urethra
Describe the findings of nongonococcal septic arthritis
monoarticular in large joints
gram +
permanent joint destruction can occur in as little as three days
What are the indications for knee and shoulder arthrocentesis?
relieve pain
inject medications (injected ABX not recommended)
estabilish etiology of effusion (infectious/noninfectious)
What are the contraindications for knee and shoulder arthrocentesis?
overlying infections
skin lesions
abnormal coagulation
bacteremia (relative CI)
What are some findings in an arthrocentesis that would indicate the cause as gout?
older men with high purine diet
acute episodic or chronic arthritis
MSU crystals and tophi
worse at night, looks like cellulitis
needle shaped MSU crystals w/ neg. birefringence under polarized light
fingers/toes often affected
well defined erosions with sclerotic margins on xr
Describe the findings of pseudogout
elderly people
pain, redness, warmth, may be asymptomatic
CPPD rarely associated with soft tophi
polyarticular acute sunovitis superimposed on chronically involved joints
small rhomboid/cuboid crystals weakly birifringent
knee most often affected
chondrocalcinosis on xray, no joint damage
Describe the findings of OA?
>50 y/o and increases with age
worse with activity
inflammatory mediators worsen process
weight bearing joints affected
cartialge degenerates
no ab
no other organs affected
Describe the findings of RA?
all ages, peaks in middle-elderly age
pain stiffness in morning, better with activity
autoimmune
cartilage destruction by immune system
small joints
pannus
ACPA, anti CCP, RA ab
affects heat, lungs, etc.
What are the landmarks of a shoulder arthrocentesis?
inferior and lateral to coracoid process and directed posteriorly towards joint space
what are the landmarks for a knee arthrocentesis
the needle enters 1cm medial or lateral to superior third of patella
Regardless of appearance, synovial fluid should be sent to lab for what tests?
Cell count and diff.
crystal analysis
gram stain with culture and sens.
Does the cell count of synovial fluid help differentiate between septic arthritis/crystal arthirits/rheumatic disorders?
No
Cell count and diff, is only an indication of the presence or absence of an inflammatory arthritis
Chem analysis of synovial fluid is/is not routinely ordered?
IS NOT
Does serum uric acid levels help diagnose gouty arthritis?
No
Serum urice acid may actually be low in gout patients
