Orthopedics Flashcards
OA characteristics
Pain exacerbated by activity, relieved with rest
AM stiffness improves within 1 h
crepitus
OA diagnosis
joint space narrowing and/or osteophyte on XR
OA treatment non pharm
exercise
weight loss
OA pharm tx
use only if symptoms
NSAIDs
RA characteristics
auto immune
symmetric, periph polyarthritis
criteria for RA dx
- 3 involved joints
- serologic abnormality (RF or anti CPP)
- elevated ESR or CRP
- Symptoms present >6 weeks
fibromyalgia
Chronic widespread musculoskeletal pain >3 months;
accompanied by fatigue, sleep disturbances, and multiple somatic
complaints (HA, bowel irritability, cognitive disturbances)
fibromyalgia has
no abnormalities on PE (outside of pain)
no evidence of tissue inflammation
Fibromyalgia tx
Sleep hygiene
* Treat comorbids: mood, sleep disorders
* Exercise: aerobic conditioning, stretching, strengthening
* Med for pain: amitriptyline, duloxetine, pregabalin, others
Supraspinatus Test (Empty Can Test)
- Shoulder abducted 90 degrees
- Shoulder is internally rotated and angled forward 30
degrees, thumb pointing to floor, then resist
(+) sign is pain/weakness
If pain is orthopedic in etiology, it should be
reproducible!
lateral epicondylitis aka
tennis elbow
lateral epicondylitis
overuse is common cause
rest, but keep joints moving
nsaids
ice/heat
steroid
pt
scaphoid fracture identified with
snuffbox tenderness
snuffbox tenderness
- Common complaint of a fracture is deep, dull pain in wrist, worse with gripping
or squeezing
low back pain symptoms that suggest systemic dx
CA hx
>50
unexplained wt loss
pain lasting longer than 4 weeks
nighttime pain
Sciatica
- Nerve root irritation manifests as sciatica (radiculopathyfocus on L5-S1)
- Sharp or burning pain radiating down leg to foot or ankle
- May occur as numbness or tingling
- Sciatica due to herniation is worse with coughing, sneezing,
Valsalva
Straight Leg Raise
- Examiner raises patient’s extended leg with the ankle
dorsiflexed - Positive if sciatica is reproduced between 10 and 60 degrees
in the affected leg - May confirm radiculopathy
- General rule: Avoid lumbar X-rays unless
trauma, suspected systemic disease, or pain >4 weeks
Lateral hip pain, aggravated by direct pressure suggests
trochanteric bursitis
hip pain with use, better with rest
structural joint problem, OA
Anterior hip/groin pain suggests
Hip joint: OA,
posterior hip pain suggests
SI joint, LBP
grades of sprain
I: minimally torn ligament, stable joint (stretch)
II: incomplete tear, painful wt bearing (partial rupture)
III: completely torn ligament; severe pain, swelling, tenderness (complete
rupture)
management for sprain
RICE
early mobility
analgesics
last resort to treat gout flare
colchicine
you do not use allopurinol during
flare
positive MTP test associated with
morton’s neuroma
nodes of DIP joints secondary to arthritis
heberden nodes
positive finkelstein’s test
dequervain’s tenosynovitis
dorsal thumb pain is classic symptom
positive tinels, allen, phallen sign
carpal tunnel syndrome
common cause of posterior knee pain
baker’s cyst
stress fracture
overuse injury of bone
heals in 6 weeks
nodes on PIP joints secondary to arthritis
bouchards nodes
