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NP 801 NP Theory 2 > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Common causes of elbow pain

A
  • Ligamental sprains, fracture, bursitis, epicondylitis
  • Atraumatic elbow pain d/t overuse + repetitive movements
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2
Q

PE exam for elbow pain

A

Assess for trauma!
Full joint, ROM, motor, + neurovascular exam

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3
Q

Imaging and labs

Elbow pain diagnostics

A

Imaging
* x-ray commonly ordered
* U/S
* MRI

Labs
* CBC w/diff
* ESR
* uric acid
* RF
* ANA
* Lyme testing
Joint aspiration

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4
Q

Definition

Epicondylitis

A

“Tennis elbow”
Lateral elbow inflammation
“golf elbow”
Medial elbow inflammation
Pain at origin tendon that can be acute, mild, or severe

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5
Q

Objective findings with MEDIAL epicondylitis

A
  • Tenderness over medial area
  • Pain w/resisted wrist FLEX AND pronation w/elbow in full EXT
  • Pain w/ passive terminal wrist EXT w/elbow in full EXT
  • ROM + neurovascular PE NORMAL
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6
Q

Objetive findings with LATERAL epicondylitis

A
  • Tenderness over lateral
  • Pain w/resisted wrist EXT w/elbow in FULL EXT
  • Pain w/passive term wrist FLEX
  • ROM + Neurovascular PE NORMAL
  • NORMAL ROM W/O PAIN
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7
Q

Imaging necessary for epiondylitis?

A

NO
clinical dx

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8
Q

Epicondylitis differentials

A

Ligamental sprain
Radial head fracture

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9
Q

Epicondylitis pharmacological treatment

A

NSAIDs x 2 weeks
w/o contraindication

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10
Q

Epicondylitis nonpharmacological txs

A

PRICEMM
* Protect
* Rest
* Ice
* Compress
* Elevate
* Meds
* Modalities

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11
Q

Epicondylitis Risk Factors

A
  • Tobacco use
  • Obesity
  • Age 45-54
  • Repetitive movements > 2hrs/day, heavy lifting
  • Occupational RFs
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12
Q

Epicondylitis referral

A

PT or OT

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13
Q

How is it different from epicondylitis

Ligamental sprain objective findings

A

Tenderness overlying affected ligament
Pain w/ROM

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14
Q

Ligamental sprain treatments

Pharm and non-pharm

A
  • NSAIDs PO/topical
  • PRICE
  • Sling if in significant pain
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15
Q

Ligamental sprain clinical findings

A

May or may not have known injury
Pain

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16
Q

Radial head fracture clinical findings

A

Weakness d/t ↓ strength
Pain

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17
Q

Radial head fracture objective findings

A
  • Tenderness overlying radial head
  • Limited ROM
  • Local or diffuse edema
  • Neurovascular PE NORMAL
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18
Q

Radial head fracture tx and referral

A

PRICE
Ortho → surgery for displaced or complicated fracture + managment

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19
Q

Definition

Ulnar neuritis

A
  • Compression of ulnar nerve
  • Compression d/t
    • RA
    • Ganglion cysts
    • Fracture
    • Repeated irritation/pressure to area
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20
Q

Ulnar neuritis clinical findings

A
  • Numbness or tingling
  • Pain may radiate
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21
Q

Ulnar neuritis objective finding

A

May have sensory loss of 5th digit + ↓ motor strength in 4th + 5th digits

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22
Q

Ulnar neuritis treatments
and referrals

Pharm + nonpharm

A
  • NSAIDs
  • PRICE
  • Elbow pad
  • Splint

PT/OT referral
Neuro referral

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23
Q

Definition + etiologies

Olecranon bursitis

A
  • Swelling or bursal sac under olecranon process
  • Acute, chronic, or septic
  • Etiologies
    • Trauma
    • RA
    • Crystal arthropathy
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24
Q

Olecranon bursitis
Acute vs chronic
Clinical findings

OBJ findings

A
  • Acute: Painful and edematous elbow
  • Chronic: Soft, edematous nonpainful elbow
  • Full ROM + normal neuro findings
  • Chronic: rough nodular consistency noted
  • Look for systemic s/s for secondary to infection
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25
Q

Olecranon bursitis diagnostic imaging

A

X-ray

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26
Q

Olecranon bursitis treatments

Pharm and nonpharm

A

NSAIDs
Aspiration of joint

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27
Q

Olecranon bursitis
Patient education + referrals

A
  • Avoid direct pressure
  • Ortho referral
  • Hospitalization if concern for infectious process
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28
Q

Definition

Plantar fascitis

A
  • Overuse condition involving degenerative changes
  • NOT INFLAMMATORY
  • Common in primary care
  • Peak incidence in 40-60y.o.
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29
Q

Plantar fasciitis clinical findings

A
  • May be bilateral
  • Pain in proximal foot
  • Worse in AM when stepping out of bed after long period of inactivity
  • Worsens to later in day after being active all day
  • Non-radiating pain
  • Paresthesia UNCOMMON
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30
Q

Plantar fasciitis objective finding

A
  • Tenderness to palpation of proximal medioplantar fascia
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31
Q

Plantar fasciitis diagnostics

A
  • Mainly clinical dx: Hx + exam
  • Labs not indicated
  • ESR + CRP normal
  • No imaging needed for DX
  • X-ray for bony lesion, bone spur, other bony abnormalities
  • MRI + U/S to see thickening of plantar fascia on scans
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32
Q

Plantar fasciitis pharmacologic txs

A
  • NSAIDs x 2 weeks
  • Corticosteroid INJs for refractory (treatment resistant) cases
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33
Q

Plantar fasciitis nonpharmacological txs

A

Typically conservative + nonoperative txs
* Activity modification
* Ice massage
* Stretching + strengthening exercises
* Heel padding
* Orthotics
* Taping
* Acupuncture
* Plantar fasciotomy for refractory cases post 6-12 months

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34
Q

Plantar Fasciitis Risk Factors

A
  • Limited ankle dorsiflexion
  • ↑ BMI
  • Extended periods of standing
  • Occupations
  • Athletes
  • Sedentary lifestyle
  • Pes cavus or pes planus
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35
Q

Plantar fasciitis patient education + referral

A
  • Avoid flat shoes or walking barefoot
  • Encourage athletic or arch-supporting shoes
  • Referral to physiatry/ortho
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36
Q

Plantar fasciitis differential diagnoses

A

Neurologic
* Nerve entrapment
* Tarsal tunnel syndrome

Skeletal
* Fracture
* Bone tumor

Soft Tissue
* Achilles tendonitis
* Plantar fascia rupture
* Retrocalcaneal bursitis

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37
Q

Tarsal tunnel syndrome + nerve entrapment clinical findings

A

Burning
Paresthesia

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38
Q

Plantar fracture
Bone tumor
clinical findings

A
  • Hx of injury, inability to bear weight
  • Deep pain at night and does not improve
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39
Q

Achilles tendonitis
Plantar fascia rupture
Retrocalcaneal bursitis
Clinical findings

A
  • Tenderness over achilles
  • Sudden onset p! + “pop” noise
  • Swelling + p! in area
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40
Q

Definition

Gout
Three stages

A
  • Most common inflammatory arthritis
  • Accumulation of monosodium crystals (MSU)
  • Uric acid from purine metabolism
  • Kidney issues → ↓ renal excretion or overprod rate
    1. Acute flare
    2. Intercritical gout (between flares)
    3. Chronic gouty arthritis + tophaceous gout
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41
Q

Gout clinical findings

A
  • 1st attack typically affects one joint/monoarticular
  • Polyarticular less common
  • Joint pain comes on + progresses rapidly (12-24hrs) often starting at night
  • Skin desquamation (peeling)
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42
Q

Gout objective findings
Common gout sites

A
  • Sensitive to palpation - hypersensitivity (bed sheets sensation
  • Joint is warm, red, tender, maybe effusion
  • Chronic = tophi (stone like deposits)
  • Low-grade fever

Most common sites of gout
* 1st MTP
* Ankle
* Knees
* Wrists
* Fingers
* Elbows

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43
Q

Uric acid level of MSU crystal deposition

A

> 6.8
At increased risk

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44
Q

Should you measure uric acid level during acute gout attack?

A

Not reliable during the attack itself

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45
Q

Gout lab diagnostics
What is the gold standard?

A

Arthrocentesis w/synovial fluid analysis → establish diagnosis + r/o others GOLD STANDARD
* ESR + CRP
* CBC w/diff → shows ↑ WBC + ↓ PLT (maybe)
* BMP
- Renal fx for renal dosing
- Blood sugar for corticosteroid use
* LFTs: meds dose dependent

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46
Q

Gout Imaging diagnostics

A
  • X-ray most common
  • MSK U/S, CT, Dual energy CT, MRI (not common)
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47
Q

Gout prediction tool

A
  • Male sex (2pts)
  • Previous patient-reported arthritis (2pts)
  • Onset within one day (0.5pts)
  • Joint redness (1pt)
  • 1st MP joint involvement (2.5pts)
  • HTN or at least 1 CV disease (1.5pts)
  • Serum urate level > 5.88 (3.5pts)

Based upon total score
* Low (≤ 4 pts)
* Intermediate (> 4 to < 8 pts)
* High (≥ 8 pts) probabiltiy of gout

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48
Q

Gout differentials

A
  • Septic arthritis
  • Trauma
  • Calcium pyrophosphate crystal deposition (CPPD)
    • Pseudogout
  • Cellulitis
  • RA
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49
Q

Acute gout flare pharmacological txs

A
  • NSAIDs (not in pts w/Hx of GI bleed, CKD, > 65 y.o.)
  • Corticosteroids (1st line)
    • Know that blood sugar level can increase
  • Colchine (w/in 36hrs of attack)
  • IL-1 inhibitors (not FDA approved)
  • INJ glucocorticoids (ortho/Rheum referral)
50
Q

Chronic Gout pharmacological txs

A
  • Allopruinol 1st line (xanthine oxidase INHi)
  • Risk for allergy rxn
  • Febuxostat
  • Urate lowering therapy started at LOW DOSE + titrated until level at < 6
  • Probenecid 2nd line = can be used w/xanthine class
  • AVOID OPIOID USE
51
Q

Gout nonpharmacological txs

A
  • Complete resolution w/in several days to weeks w/o tx
  • Ice during acute attacks
  • ↓ purine food intake (meat, seafood, etc)
  • Avoid EtOH
  • Encourage weight loss
52
Q

Gout risk factors

A
  • Age - peak onset 40-50 (M); > 60 (W - related to ↑ in uric acid post menopause
  • M > W
  • Meds
  • High purine diet (red meat, shellfish, high fructose corn syrup)
53
Q

Gout patient education

A
  • Continue taking meds during gout flare
  • Anti-inflamm tx x 6mos (post starting meds until uric acid < 6)
  • Do a full medication reconcilliation
  • Losartan, amlodipine, + fenofibrate can lower uric acid levels)
  • Most untreated pts w/gout will experience 2nd episode w/in 2 yrs
54
Q

Definition/etiology

Septic arthritis

A
  • Infectious cause of joint inflammation
  • Caused by bacteria, fungi, parasites, viruses
  • S. aureus most common bacterial arthritis
  • Gonorrhea, gram (-)
  • Most commonly cause in sexually active adolescents
  • MRSA most common
55
Q

Why should we be concerned with septic arthritis?

A

MEDICAL EMERGENCY
* If left untreated → 5-7d poor prognosis

56
Q

Septic arthritis clinical findings
Most common sites

A
  • Acute onset of painful, swollen joint
  • Painful at ALL times (not alleviated at rest)
  • Knee + hip common sites
  • Monoarthritic
  • Effusion often present (inflamm)
57
Q

Septic arthritis objective findings

A
  • Knee + hip at ↑ risk for infection
  • +/- fever
  • ↓ ROM
  • Mm spasms, apprehension
  • Lymphadenopathy (depending on joint affected)
58
Q

Septic Arthritis definitive diagnostic

A

Aspiration of joint for isolation or causative organism

59
Q

Septic arthritis diagnostics
Imaging

A

Consider in pts w/acute of subacute monoarticular pain that does not respond to anti-inflammatory tx
* CBC w/ diff (leukocytosis)
* ESR + CRP
* Peripheral blood cultures
* X-ray not as heplful
* MSK U/S, bone scan, CT, MRI

60
Q

Septic Arthritis differentials

A
  • Cellulitis
  • Bursitis
  • Osteomyelitis
  • Gout
  • RA
61
Q

Septic Arthritis Pharmaclogic txs

A
  • Conside INJ use in cases when located in unusual site
  • SI joints
  • Sternoclavicular joint
  • Symphysis pubis
  • Early initiation of broad spectrum abx until joint aspiration results + blood cultures received
  • Nafcillin, oxacillin, cafazolin (S. aureus)
  • Cefepime (if gram (-) suspected)
  • Duration of 2-3 wks
62
Q

Septic arthritis nonpharmacologic txs

A

Daily drainage of joint until resolution
Risk of relapse if initial infxn insufficiently tx

63
Q

Septic arthritis Risk factors

A
  • Joint trauma hx
  • Inflamm states (RA)
  • Degeneration
  • Immunocompromised
  • Hx of prosthetic joint
64
Q

Septic arthritis patient education + referral

A
  • Want to search for OG source pf infxn (abscesses, urethritis, PNA, UTI
  • Initially, adhere to strict non-weight bearing activities
  • Referral if ID, rheumatology, ortho sx, PT
65
Q

SA - Gonococcal arthritis
TRIAD S/S

A
  • Dermatitis
  • Tenosynovitis
  • Migratory polyarthritis
66
Q

Gonococcal arthritis common in which population?

A

Sexually active adolescents

67
Q

Gonococcal arthritis labs

A
  • Blood cultures NEGATIVE
  • Consider culture of pharynx, cervix, urethra + rectum - sites of sex will be (+)
68
Q

Gonococcal arthritis pharmacological txs

A
  • Ceftriaxone 1g/day IM for 7-10d or IV q24hrs
  • Azithromycin 1mg once - DX med
69
Q

Prosthetic joint infection
(all sections

A
  • Categorized early (w/in 3 mos), delayed (3 to 24 mos), + late (> 24 mos)
  • Early + delayed have infectious start at time of surgery
  • X- ray may show loosening of prosthesis
  • Prosthetic joint is typically removed → 6 wks of IV abxs → reimplantation of new joint
70
Q

SA: Lyme disease
(different types)

A
  • Early localized disease (1 to 30d), early disseminated disease (d to 10 mos), + late disease (mos-yrs) after tick exposure
71
Q

SA: Lyme disease clinical findings
(two types)

A

Early/localized
* Arthralgias
* Migratory arthritis
* Erythema migrans
* H/A
Late
* Migratory polyarthritis, can be chronic

72
Q

SA: lyme disease OBJ findings

A
  • Fever
  • Early: cardiac PE, Neuro PE, MSK PE
73
Q

SA: Lyme disease lab diagnostic

A

ELISA or PCR (high false +)

74
Q

Definition

Osteoarthritis
stages

A
  • Degenerative joint disease (of articular cartilage/hyaline layer) → ↑ thickening + sclerosis of bone plate
  • 4 stages: doubtful, mild, moderate, severe
75
Q

Osteoarthritis clinical findings
Age of onset
Site s/s
Most common sites

A
  • Asymptomatic in 20/30s; onset > 40 yrs
  • Symptomatic w/radiologic changes by 40s
  • Cervical/lumbar: Neuropathy, Radiculopathy
  • Hip: Groin/buttock pain radiating to knee
  • Knee: Joint line pain, Effusion
  • Hands: Heberden + Bouchard nodes

Most common sites: hips, knees, feet, spine, hands

76
Q

Osteoarthritis symptom findings

A
  • Pain
    • affects one of few joints at a time
    • Insidious onset - slow progression over years
    • Variable intensity
    • Increased by joint use and relieved by rest
    • Night pain in severe osteoarthritis
  • Stiffness
    • Short-lived (< 30mins) and early morning or inactivity related
  • Swelling
    • Some swelling or deformity (nodal)
77
Q

Osteoarthritis PE findings

A
  • Swelling (bony overgrowth + fluid/synovial hypertrophy)
  • Attitude
  • Deformity
  • Mm wasting (global - all mm acting over joint)
  • Palpation
    • No warmth
    • Swelling - effusion
    • Joint line tenderness
    • Periarticular tenderness (knee/hip)
  • ROM
    • Crepitus (knee, thumb bases)
    • Reduced ROM
    • Weak local mms
  • Hip: Trendelenberg gait
  • Knee: Varus deformity
78
Q

Osteoarthritis diagnostics (imaging and labs)

A
  • DX made w/radiographic imaging
  • Can DX based on presentation (< 30m)
  • Look at history
  • Labs: typically none
    • ESR, CRP ,RF, synovial fluid analysis to r/o inflamm arthritis
  • Imaging: X-ray
    • Shows joint space narrowing, osteophytes, subchondral sclerosis
79
Q

Osteoarthritis differentials

A
  • Collagen vascualr disease
  • Gout/pseudogout
  • Trauma
  • Septic arthritis
  • Ankylosing spondulitis
  • Psoriatic arthritis
  • RA
80
Q

Osteoarthritis pharmacological txs

A

Overall 2nd line tx
* Topical/PO NSAIDs
* Topical safer than PO
* Duloxetine
* Topical Capsaicin
* Intra-articular glucocorticoids
* Opioids unsafe, last line of tx
* Can use for ACUTE PAIN; post-surgery
* Hyaluronic INJs = ineffective

81
Q

Goals of osteoarthritis tx

A
  • Minimize pain
  • Maximize function
  • Modify process of joint damage
    Treatment will NOT change disease progression, only symptom management
82
Q

Osteoarthritis nonpharmacological tx

A

Overall 1st line tx
* Exercise
* Weight management
* Braces
* Orthotics
* Education
* Assistive devices

  • Arthroscopy
  • Total joint replacement
83
Q

Osteoarthritis risk factors
Referral

A
  • Age, Female
  • Overwight, obese
  • Prior trauma
  • Genetics/FMHx
  • Repetitive activities/impact (work/sports)
  • Metabolic disorders
  • Neuro diseases
  • Hematologic conditions

PT/OT (physiatry can give corticosteroid INJs)

84
Q

Hip pain History

A

HPI:
* Age, location, onset, duration, severity, setting, timing, associated symptoms, aggravating/alleviating factors

PMH: surgeries, trauma, hx/o cancer

Medications
* Long-term use INC risk for osteoporosis

FHx: orthopedic concerns, cancer

Social: vocation, recreational activity

85
Q

Hip Pain PE

A
  • VS for systemic symptoms
  • Back, SI joint, hips, knees, ankles
  • Gait
    • Antalgic gait (Limp)
    • Trendelenburg gait
  • Palpation: crepitus, point tenderness
  • ROM (passive/active)
    • flexion, extension abduction, adduction, internal, external rotation
      pain, muscle spasm, guarding
  • Strength
  • Neuro
86
Q

4 of them

Hip Pain diagnostic PE tests

A
  • FABER
  • Single leg standing/Trendelenberg gait
  • FADDIR
  • FLIP/Seated SLR
87
Q

FABER test

Purpse

A
  • Determines SIJ vs. Lumbar spine injury
88
Q

FABER
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?

A
  • Internal hip, SIJ vs Lumbar spine
  • Position leg so that foot of test leg is on top or adjacent to opposite leg → slowly lower test leg towards exam table
  • Figure 4 configuration at start
  • (+) = hip joint may be affected, illopsoas may be shortened, or SIJ affected
89
Q

Single leg standing/ Trendelenberg Sign
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?

A
  • Lateral hip weakness, Glute Med injury
  • Pt stands on one lower limb, normally pelvis on opposite side should elevate
    • Drop in non-standing pelvis is a positive test
  • (+) = Weak Glute Med or unstable hip joint
90
Q

FADDIR
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?

A
  • Impingement (FAI) femoral-acetabular impingement
  • In supine, bring hip to 90 degrees flexion → adduct + IR hip
  • (+) = reproduction of anterior hip/groin pain
  • Hip impingement, Hip labral tear, hip loose bodies, hip chrondral lesion
91
Q

FLIP/Seated SLR
Test for what injury?
How to perform?
Finding/diagnosis?
(+) test indicate?

A
  • Neural tension-Lumbar Spine Radiculopathy
  • Seated pt in neural position → pt slumps body w/arms behind back → Slowly flex head → examiner slowly extends knee + dorsiflex foot
    • Test ceased when pain reproduced
  • Pain, shooting pain, or burning pain reproduced → (+)
92
Q

Hip pain diagnostics

A
  • R.o inflammation: CBC + ESR, RF, Uric acid
  • X-ray: AP + Lateral views of hip
  • MRI: soft tissue causative
  • Intra-articular joint aspiration/INJ
  • Weight bearing to assess extent of joint degeneration + joint space narrowing
93
Q

Hip pain differentials

A
  • Bursitis
  • OA
  • RA
  • Psoriatic arthritis
  • Gout + Pseudogout
  • Avascular necrosis, lupus: immediate referral + tx
  • Fractures (low-impact fragility fxs) → bone density/endo referral
  • Hip discloation
  • Infxn
  • Neoplasm
  • Referred pain
94
Q

What are the indications for an urgent referral for hip pain?

A
  • Infection
  • Fracture
  • Dislocation
95
Q

Hand + wrist pain
Acute + chronic

A
  • Acute: fractures, contusions, strains, instability
  • Chronic: arthritis of hands/fingers, overuse, old injuries, neurologic disorders
    • Cumulative trauma disorders, ergonimic work-related injuries
96
Q

Hand/wrist pain treatment
Pham + nonpharm

A
  • NSAIDs
    • PRN, lowest effective dose
    • Topical 1st line for adults
  • Cortisone INJs (surgical delay, R/F depigmentation; tendon/fat atrophy
  • Splinting/rest
  • Cold in acute phase OR heat to promote relaxation (15-20m)
97
Q

Hand + Wrist pain
Risk Factors

A
  • Age
  • Medical conditions
  • Diabetes
  • Pregnancy + obesity
98
Q

Hand + Wrist pain referral

A

Ortho (suspected fxs, conservative tx failures, OR surgery)
Sports med
Surgery

99
Q

Definition

Hand + Wrist pain: Ganglion cysts

A
  • Fluid-filled sacs, around joints + tendon sheath that appear, disappear, + change size
  • Found on dorsal, radial, or volar surface of wrist
100
Q

Hand + Wrist pain: Ganglion cysts clinical findings

A
  • Pain w/activity or pressure
  • Can be asymtpomatic
  • Weakness
  • Numbness
  • Tingling
101
Q

Hand + Wrist pain: Ganglion cysts
Objective findings

A
  • Bone changes → loss of function
  • Smooth, firm, round, rubbery subdermal growth
  • Could be tender
  • Transilluminate with light
102
Q

Hand + Wrist pain: Ganglion cysts
Risk Factors

A
  • Age (20s-40s)
  • Female sex
  • Surgery referral
103
Q

Definition

Hand + Wrist pain: Stenosing Tenosynovitis

A
  • “Trigger finger”
  • Idiopathic, irritation of flexor tendon sheath → thickening + stenosis minimizing passage of associated tendon
104
Q

Hand + Wrist pain: Stenosing Tenosynovitis
Clinical findings
Common sites

A
  • Common sites: thumb, middle, or ring finger
  • BL
  • Painless snapping, catching, clicking of 1+ fingers during flexion of affected digit → > pain
  • SEVERE: LOCKED IN FLEXION → secondary contracture @ PIP joint
105
Q

Hand + Wrist pain: Stenosing Tenosynovitis
Objective findings

A
  • Can appear w/o prior HX of trauma or change in activity
  • Localized pain ver volar aspect of MCP joint radiating to palp or distal finger
106
Q

Hand + Wrist pain: Stenosing Tenosynovitis
Treatment: PHARM + nonPHARM

A
  • Corticosteroid INJs
  • 4-6wks splinting of MCP joint @ 10-15 degrees of FLEX w/PIP/DIP joints free
107
Q

Hand + Wrist pain: Stenosing Tenosynovitis Risk Factors

A
  • W > M
  • 40-60 y.o.
  • DM
  • Arthritis (RA) + gout may ↑ incidence
  • Surgery referral
108
Q

Definition

Hand + Wrist pain:
De Quervain Tenosynovitis

A
  • Painful inflamm of Abductor pollicis longus + extensor pollicis brevis tendons along dorsal aspect of wrist
109
Q

Hand + Wrist pain:
De Quervain Tenosynovitis
Clinical findings

A
  • Pain w/repeated thimb ABD + EXT in combo w/wrist radial + ulnar deviation
  • Can be UNL or BL
  • Swelling
110
Q

Hand + Wrist pain:
De Quervain Tenosynovitis
Objective finding

A
  • Notable tender nodule over radial stylus
111
Q

Hand + Wrist pain:
De Quervain Tenosynovitis
Diagnostic test

A
  • (+) Finklestein test
  • Place thumb in closed fist
  • Tilt hand down
  • Pain felt during rest (+)
112
Q

Hand + Wrist pain:
De Quervain Tenosynovitis PHARM + nonpharm txs

A
  • Cortisone INJs
  • Wrist splinted in slight EXT + thumb ABD (thumb spica)
113
Q

Hand + Wrist pain:
De Quervain Tenosynovitis
Risk Factors

A
  • W 30-40 y.o. + postpartum (4-6wks)
  • A/w carrying infant
  • A/w wringing, grasping things p!, gardening, knitting, pouring from pitcher/carton
114
Q

Definition

Hand + Wrist pain:
Palmar Fibrosis

A
  • Inflammation of fibrotic nodules
  • “Dupuytren contractures”
115
Q

Hand + Wrist pain:
Palmar Fibrosis
Clinical findings

A
  • Painless nodule
  • Swelling on palmar fascia at base of digit (feels like band=like cord under skin) → FLEX contracture of ring finger
  • UNL/BL contractures on hands
116
Q

Hand + Wrist pain:
Palmar Fibrosis
Objective Findings

A
  • Skin puckering 1st sign
  • Garrod nodules “knuckle pads” along dorsum of hand
117
Q

Definition

Hand + Wrist pain:
Carpal Tunnel Syndrome

A
  • Compresssive neuropathy of medican nerve as it passes through carpal tunnel
  • Caused be repetitive motion + overuse
118
Q

Hand + Wrist pain:
Carpal Tunnel Syndrome
Clinical findings

A
  • Inability to hold items, tendency to drop → pincer grasp/loss
  • Intermittent wrist pain
  • Paresthesia along median nerve distrbution
    • Can originate. in wrist → hand
    • ↑ w/activity
119
Q

Hand + Wrist pain:
Carpal Tunnel Syndrome
Objective findings

A
  • Atrophy of thenar eminence
  • ↑ tenderness
  • Diminished motor strength + sensory deficits
  • Abnormal 2 point discrimination test
  • Phalen maneuver (+)
  • Tinel (+)
  • Durkan (+)
  • Edema +/-
120
Q

Hand + Wrist pain:
Carpal Tunnel Syndrome
Diagnostics

A
  • No labs needed
  • X-rays: fracture, acute dislocation, bony abnormalities
  • U/S or MRI - confirm ganglion cyst, tenosynovitis, tendon rupture or pre-surgical evl
  • Trust hx + provocative maneuvers
  • Electrodiagnostic testing w/nerve conduction + needle electromyography - CTS
121
Q

Hand + Wrist pain:
Carpal Tunnel Syndrome
Txs

A
  • Cortisone INJs
  • Splinting in neutral position (1st line)
122
Q

Hand + Wrist pain:
Carpal Tunnel Syndrome
Risk Factors

A
  • Female
  • Older Age
  • Obesity
  • DM
  • OA/RA
  • Hypothyroidism
  • Pregnancy
  • Trauma
  • Aromatase INHi
  • Repetitive movements
  • PT/OT surg referral

NP 801 NP Theory 2 (7 decks)

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