Orthopedics Flashcards
What is the first line treatment for osteoarthritis?
Exercise, ROM, and strengthening
What are heberdens nodes associated with?
Osteoarthritis
What type of arthritis affects the metacarpal joints?
Rheumatoid arthritis
What is the test for impingement syndrome (shoulder pain)
Painful arc test & Hawkins-Kennedy test
What is the McMurray’s test for?
Torn meniscus (knee)
Where is the lateral epicondyle?
Elbow
Lateral epicondylitis is tennis elbow
Where is the scaphoid?
Inner aspect of wrist bone
Common injury to wrist during fall?
Scaphoid fracture
What is the diagnostic test for a scaphoid fracture?
Snuffbox tenderness
What is the lower back pain test that is positive for radiculopathy?
Straight leg raise
What is an overreaction during physical exam with inappropriate physical signs?
Waddell’s signs
What type of lower back pain is from L5-S1 and radiates down leg, foot, or ankle?
Sciatica
What is the diagnostic test for sciatica?
Straight leg raise
What is the hip bone?
Trochanter
Osteoarthritis in a patient causes what type of hip joint pain?
Anterior hip/groin pain
When a patient complains of heel pain or tenderness, they have…
Plantar fasciitis
What test is for an acl in knee?
Anterior draw test
What condition is associates with a positive MTP squeeze test?
Mortons neuroma
What condition is associated with a positive finkelstein test?
DeQuervain’s tensosynovitis
Burning pain between the 3rd and 4th toes.
Morton’s neuroma
Positive tinel’s test & positive Phalen’s test
Carpal Tunnel Syndrome
Type of fracture secondary to systemic disease?
Pathologic fracture
Common cause of posterior knee pain
Bakers cyst
Overuse injury of a bone
Stress fracture/ takes 4-6 weeks to heal
Dorsal thumb pain is a classic symptom of
DeQuervains tenosynovitis
Injury to a bone that does not result in a fracture
Contusion
Injury to a muscle is a
Strain
Injury to a ligament is a
Sprain
What are the nodes on the PIP nodes secondary to arthritis?
Bouchnard’s nodes
Joint stiffness lasts <60 minutes usually
Osteoarthritis
RICE is acronym for treatment for
Sprain
Term that describes compression of the spinal cord
Cauda equine syndrome
Loss of bowel/bladder function
The Lachman maneuver is used to detect what
Knee instability
Heberden’s node’s are commonly seen in
Degenerative joint disease
The drawer sign is performed on the knee or ankle to assess for
Instability of the knee
What test is used to identify inflammation of the median nerve as seen with carpal tunnel syndrome
Phelan test
Wrist pain on palpation of the anatomic snuffbox. Pain on axial loading of the thumb. History of falling forward with outstretched hand to break the fall. Initial x-ray of the wrist may be normal, but a repeat x-ray in two weeks will show the scaphoid fracture. High-risk of a vascular necrosis and non-union. Splint rest and referred to a hand surgeon.
Navicular fracture (scaphoid bone fracture)
What is an important stabilizer of the metacarpal joint
Scaphoid
An injury to bone is a
Contusion
If a patient has a positive snuff box tenderness test, what should be done
Treat as a fracture until proven otherwise. If x-ray is negative, consider MRI or CT as definitive exams. Splint thumb
Fracture of the distal radius of the forearm along with dorsal displacement of wrist. History of falling forward with outstretched hand. This fracture is also known as the dinner fork fracture due to the appearance of arm and wrist after the fracture. The most common type of wrist fracture.
Colles fracture
History of slipping or falling. Sudden onset of one sided hip pain. Unable to walk and bear weight on affected hip. If mild fracture, may bear weight on affected hip. If displaced fracture, presence of severe hip pain with external rotation of the hip/leg and leg shortening. More common in elderly. Elderly have a one year mortality rate from 12% to 37%.
Hip fracture
If a patient has hip pain, at night, what must be ruled out
Malignancy, inflammatory process, osteomyelitis
If a patient has lateral hip pain that is aggravated by direct pressure what is a diagnostic consideration
Trochanteric bursitis
If a patient has hip pain with use, that is better with rest what diagnostic consideration
Structural joint problem or Osseo arthritis
If a patient has constant hip pain, especially at night what must be considered
Infectious, inflammatory, neoplastic
If a patient has anterior hip/groin pain, what diagnosis should be considered
Hip joints,osteo arthritis
If a patient complains of posterior hip pain what diagnosis should be considered
S I joint, LBP
History of significant or high energy trauma such as a motor vehicle or motorcycle accident. Signs and symptoms depend on degree of injury to the pelvic bones and other pelvic structures such as nerves, blood vessels, and pelvic organs. Look for ecchymosis and swelling in the lower abdomen, the hips, groin, and/or scrotum. May have bladder and/or fecal incontinence, vaginal or rectal bleeding, hematuria, numbness etc. may cause internal hemorrhage, which can be life threatening. Check airway, breathing, and circulation first
Pelvic fracture
Acute onset of saddle anesthesia, bladder incontinence, fecal incontinence. Accompanied by bilateral leg numbness and weakness. Pressure on a sacral nerve root results in inflammatory and ischemic changes to the nerves. A surgical emergency. Need spinal decompression. Refer to ED.
Cauda Equina Syndrome
Acute and sudden onset of tearing severe low back/abdominal pain. Presence of abdominal bruit with abdominal pulsation. Patient with signs and symptoms of shock. More common in elderly males atherosclerosis, white rice, and smokers.
Low back pain from a dissecting abdominal aneurysm
What conditions outside of the spine can cause back pain
Pancreatitis, nephrolithiasis, prostatitis, Pyelonephritis , AAA, herpes zoster
When a patient presents with lower back pain what are some clues to systemic disease
History of cancer i.e. breasts, prostate, lung, fibroid, kidney. Age over 50 years old. Unexplained weight loss. Duration of pain greater than four weeks. Nighttime pain. Only get lumbar x-ray in these situations.
What test do you perform for a patient that presents with lower back pain
Straight leg raise is positive it is radiculopathy
Inappropriate physical signs on physical exam, faking illness or pain, overreaction during exam
Waddell’s signs
Nerve root irritation at L5 through S1. Sharp or burning pain radiating down the leg to foot or ankle. May occur as numbness or tingling.
Sciatica
Examiner raises patients extended leg with the ankle Dorsiflexed. Positive if sciatica is reproduced between 10 and 60° in the affected leg. May confirm radiculopathy
Straight leg raise
What imaging is done for a patient that complains with lower back pain
Plain radiographs AP and lateral of lumbar spine; trauma, suspected malignancy, infection add ESR and CRP he.
When is an MRI indicated in a patient that presents with lower back pain
It is the gold standard test for disc disease. Demonstrates discs, ligaments, nerve roots, epidural that, shape and size of the spinal canal. Looks at soft tissue.
If cloudy synovial fluid is found what must be done
Order culture and sensitivity because this can be indicative of an infection
Damage to what joint may cause locking of the knees and knee instability
Meniscus
Connects muscle to the bone.
Tendon
Connects bone to bone
Ligaments
Saclike structures located on the anterior and posterior areas of the joints that act as padding. Filled with synovial fluid when inflamed.
Bursae
When bursae is filled with synovial fluid and is inflamed it os bursitis
What is the gold standard imaging study for injuries of the cartilage, meniscus, tendons, ligaments, or any joints of the body
MRI
What imaging study and emits radiation and detects bleeding, aneurysms, masses, pelvic and bone trauma and fractures
CT scan
Metal implants, pacemakers, aneurysm clips, and metallic joints are contraindicated in what diagnostic imaging study
MRI
What is Venus recurvatum
Hyper extension or backward curvature of the knees
What is genu valgum
Knock knees
Think of “gum stuck between the knees”
What is genu varum
Bow legs
When should RICE be initiated after musculoskeletal trauma
48 hours
When should isometric exercise be introduced after musculoskeletal trauma
It is useful during the early phase of recovery before regular active exercises performed. Defined as the controlled and sustained contraction and relaxation of a muscle group. Less stressful on joints than regular exercise. Usually done first before exercise post injury. Nonweightbearing exercises.
What is a test for knee stability
Drawer test. And diagnostic sign of a torn or ruptured ligament.
What causes DeQuervain’s tensovitis and where is it located in my hand
It is caused by inflammation of the tendon and it’s sheath and is located at the base of the thumb
What is the screening test for DeQuervain’s tendinitis
Finkelstein’s test
Which is positive if there is pain and tenderness on the wrist upon ulnar deviation
Knee pain and the click sound upon manipulation of the knee is positive. Suggests injury to the medial meniscus.
McMurray’s test
