Orthopedics Flashcards
Fibromyalgia: eti and s/sx
Eti: unknown, central sensation disorder
S/sx: widespread MSK pain: bilateral, above and below waist, neck, shoulders muscles more than joints
- Fatigue: most prominent when arising from sleep
- cognitive disturbance “fibro fog”, attention difficulty
- psych: depression, anxiety
- HA: greater than 50 of patients
- paresthesias: numbness, tingling, crawling in arms and legs
PE findings: “trigger points” of pain: often trapezius, medial fat pad of knee, lateral epicondyle of elbow
Fibromyalgia: tx
First line: Tricyclic antidepressant (Amitryptilene)
2nd: SNRI (Cymbalta) or anticonvulsant (Lyrica)
Most patients need combo therapy, can also try gabapentin
Exercise for all
No narcotics, NSAIDs, Steroids
Linked to mood disorders: can be improved with sleep hygiene
Septic arthritis
Eti: Hematogenous seeding of single joint from a distant source of infection, often iatrogenic (injection etc.). Most common pathogens: staph, strep, N. gonorrhoeae most common in adolescents.
S/sx: tender, warm, swollen, red joint, systemic symptoms vary in freq.
PE findings: joint inflam, decrease ROM, majority febrile.
Labs: Blood cultures, synovial fluid analysis, WBC, ESR, CRP, Xray for osteomyelitis
Tx: if gram +: use vanco, if gram neg: use 3rd gen ceph, and gentamycin if pseudomonas suspected.
Gonoccal arthritis
Eti: disseminated infection with Neisseria gonorrhoeae
PE findings same as for septic joint
S/sx: Young sexually active person present with:
- triad: tenosynovitis, dermatitis (painless pustular, often found on finger), polyarthritis (non-symetrical, migratory) w/o purulence.
- Purulent monoarthritis: Knee or wrist without skin lesion
Labs: CBC w/ leukocytosis, blood cultures, mucosal swab, synovial fluid, urinary nucleic acid amplication
Tx: cefriaxone IV or IM plus azithromycin oral
viral arthritis
Eti: parovirus B19 (5th disease), rubella, Hep B/C, EBV
S/sx: symmetrical polyarticular disease, sudden onset and short duration
Dx: PE and viral serologies
Tx: NSAIDs to decrease inflammation, joint aspiration in severe inflam
Lyme disease: eti and s/sx
Eti: Spirochete Borrelia burgdorferi from tick which must be in for 24-48 hours
S/sx:
3-30 days post bite: fever, malaise, HA, arth/myalgias, bulls eye rash w central clearing (erythema migrans)
Early disseminated: debilitating fatigue, fever, migratory asymmetric polyarthralgias, pain stiffness in tendons, AV block,CN7 nerve palsy
Late: Continued arthritis (one main joint, many sporadic), subtle cog dysfunction
Lyme disease: tx
Tx: Early dx!! A single dose of doxy 200 mg within 72 hours of tick bite
Or: Doxy or Amox for 14-28 days
Comp: post lyme disease syndrome: chronic arthritis, fatigue, memory loss
Osteomyolitis
Eti: bone infection caused by bacteria, virus or fungus.
S/sx: pain, swelling. May stem secondarily from soft tissue injury, abscesses, cellulitis, or injection sites.
Dx: H&P, blood cultures, XR or MRI before deciding to do biopsy
Tx: debridement and abx
Adverse effects of corticosteroids
- Cushinoid apparence
- Eye: cataracts, glaucoma
- Heart: Increased LDL
- GI: gastritis, ulcer, GI bleed
- Renal: fluid retention, HTN
- MSK: osteoperosis
- Endocrine: increased glucose
- Increased risk of infection
Intra-articular injection of corticosteroids
Localized to 1 or 2 joints, can be done up to 4 times a year, and will not have major systemic impact.
Spondylosis
Eti: narrowing of spinal canal w/ impingement of nerve roots & cauda equina
S/sx: neurogenic claudication, pain worse with activity, better with sitting, standing, or leaning forward
Special test: straight leg raise
Tx: NSAIDs, PT, surgical decompression (laminectomy)
Spondylolisthesis
Eti: facet joint arthritis, malorientation of facet joint, degenerative disk disease, trauma
S/sx: LBP and tenderness, sciatica or other radicular Sx, restricted straight leg raise (sometimes), increased lumbar lordosis, step-off may be felt if significant
Spondylosis
Eti: a specific defect in the connection between vertebrae, the bones that make up the spinal column. This defect can lead to small stress fractures (breaks) in the vertebrae that can weaken the bones so much that one slips out of place
Special test: single leg hyperextension (stork test)
Thoracic outlet syndrome
Eti: neurovasc bundle compressed between the anterior or middle scalene muscles and first thoracic rib or a cervical rib.
S/sx: gradual onset of pain, numbness, weakness, swelling. Vascular sx: pallor of extremity with elevation
Special test: Adson’s sign: lost of radial pulse with arm straight out inhale and turn head toward the arm
Complication: gas gangrene or venous obstruction
Adhesive capsulitis
Painful shoulder with limited ROM, most commonly in women 40-65.
S/sx: 3 stages
