Pathology/Injuries to Know Flashcards
Colle’s Fracture
-FOOSH -Distal dorsal radius fracture Treatment: sling/splint, rest and ortho follow up
Septic arthritis
-More common with: Diabetes, old people, intravenous drug use -Joint swollen, red, warm and painful -PATIENTS WON’T BEAR WEIGHT or ALLOW ROM test -Diagnostic -Aspiration of synovial fluid -elevated WBCs
Patellar Dislocation
-dislocated patella —- no other issues result -Treatment is knee immobilizer, crutches and intervention to put patella back
Osteochondritis dissecans
bone beneath cartilage dies (osteonecrosis) due to lack of blood. Bone cartilage can break loose, impairing joint movement — degeneration and calcification of articular cartilage can occur
Tibial Apophysitis (Osgood-Schlatter)
In 9-14 year olds. Repetative strain/avulsion to secondary ossification center of tibial tuberosity. Occurs during rapid growth spurt usually. Low-grade pain that gets worse, worsened by squatting, kneeling, running, etc. Tenderness of tibial tuberosity. Rest, Ice and NSAIDs.
ACL Injury
MOST COMMON KNEE INJURY. Contact (30% – fixed lower leg) and Non-contact (70% - deceleration with change in direction). a. Symptoms – effusion, popping sensation and knee instability – osteoarthritis 10-20 years after ACL tear b. Treatment – RICE (rest, ice, compression, elevation of leg). Surgery only in young or athletes
Meniscal Injuries
a. Etiology i. Acute - sudden change in direction while knee rotated ii. Chronic – degenerative changes in the older people b. Symptoms – swelling, pain relative to tear severity, locking of catching of knee, MEDIAL OR LATERAL JOINT TENDERNESS, Common to tear ligament as well c. Treatment – RICE (rest, ice, compression, elevation of leg)
Pes Anserinus Pain Syndrome (PAPS) aka Pes Anserine Bursitis
a. Etiology – unknown but maybe from mechanical knee pain (obesity) v true bursitis b. Symptoms – medial knee pain worsened by repetative knee flexion c. Treatment – weight loss, quad-strengthening exercises, NSAIDs, glucocorticoid injections
Iliotibial Tract Syndrome (ITBS)
a. Etiology – overuse injury usually due to running when heel strikes b. Symptoms – slow onset lateral knee pain c. Diagnosis – NOBLE TEST! – press over lateral fermoral condyle with bent knee at 60 degrees. Extend knee — +Test = pain d. Treatment – Rest, ice, NSAIDs, IT Band Streching
Popliteal Cyst (Bakers’ Cyst)
a. Etiology – gastrocnemius-semimembranous bursa (osteoarthritis, RA) b. Symptoms – asymptomatic typically but can present with pain, mass behind knee c. Diagnosis – Foucher’s Sign!! – Cyst softens or disappears with 45 degree knee flexion d. Treatment – i. Asymptomatic = no treatment ii. Symptomatic = treat underlying joint issue, rarely need surgery
Plantar Fasciitis
a. Epidemiology – VERY COMMON IN ADULTS, soldiers, anything where you run on hard surfaces, have high-arches
b. Etiology – Microtears in plantar fascia from inflammation
c. Symptoms – sharp, stabbing pain in medial bottom foot. Bad for a few steps then improves
d. Diagnosis i. Tenderness to palpation ii. Pain worse with passive dorsiflexion (V. IMPORTANT)
e. Treatment – i. Self-limited condition ii. Rest, ice, NSAIDs iii. ROLL STRETCH WITH WATER BOTTLE
Ankle Sprain
a. Lateral ankle sprains most common/reason for ER trip b. Classification i. Lateral – ATF & Calcaneofibular L. second to foot inversion ii. Medial – Deltoid L. complex secondary to forced eversion iii. Syndesmotic sprain (high ankle) – dorsiflexion/eversion with external rotation Symptoms – swelling and ecchymosis (skin discoloration due to bleeding) possible Diagnosis i. Various specialty tests ii. MRI e. Treatment – RICE, NSAIDs, splint, immobilization for high-ankle
Gout Flare
a. Most common inflammatory arthropathy – can occur in ANY JOINT but the 1st metatarsophalangeal joint is most common b. Cause – build-up of monosodium urate leading to inflammation c. Symptoms – Joint pain, swelling, redness d. Diagnosis i. Negative birefringent needle-shaped crystals on polarized light 1. If not needle-shaped, then it’s PSEUDOGOUT e. Treatment – Allopurinol
Morton’s Neuroma
What: Inflammation and thickening of nerve tissue between toes (3rd and 4th toe) Symptoms: Feel like walking on marble, burning pain in webbing, radiation of pain and toe numbness Test: Mulder’s Sign —– clicking sensation while palpating third web space and compressing transverse arch
Turf Toe
What: Inflammation/pain at base of 1st metatarsal joint (sprain)
Cause: hyperextension of big toe, damaging joint capsule (associated with activities on hard surface
Diabetic Neuropathy
What: Complication from diabetes - gradual loss of nerve fibers, impaired sensation
Test: Pressure = monofilament, vibration = tuning fork, pain = pinprick
+Test = cannot feel stimulus
Olecranon Bursitis
aka student’s elbow
- Most commomn burtsitis
- Septic (infected) or Aseptic
- Commonly seen after trauma from leaning on elbow
Diagnosis
-only if suspected infection – FLUID ASPIRATION
Treatment
-Ice, compression, antibiotics (septic bursitis), BURSECTOMY (severe)
Ulnar Nerve Entrapment
aka cubital tunnel syndrome
Epidemiology – 2nd most common n. entrapment (Carpal tunnel is first)
–60% of patient with golf. elbow have this
Etiology — compression of Ulnar N. anywhere but usually through cubital tunnel
Symptoms —- medial elbow pain, numbess in ulnar border of forearm, hand, 4th, 5th digits
Diagnosis – TINEL TEST, Elbow MRI
Treatment — splinting, elbow pads, surgical decompression
Carpal Tunnel Syndrome
MOST COMMON CLINICAL COMPRESSION NEUROPATHY
Risk Factors —– female, obesity, pregnancy, diabetes, repetaive workplace movment
Symptoms – wrist pain with parasthesia in hand, FLICK SIGN (shake hand to relieve pain — +Test = resolution of symptoms)
Diagnosis – Phalen’s Sign, Tinels sign
Treatment
mild - nocturnal splinting, steroid injections
severe – carpal tunnel release
DeQuervain’s Tenosynovitis
Etiology — Inflammation of the tendon and synovial sheaths covering extensor pollicis brevis and abductor pollicis longus
Risk – fmale, age 30-50, repetative activites, new mothers
Symptoms — radial wrist pain at thumb base, worses with gripping
Diagnosis — Finkelstein Test
treatment — NSAIDs, thumb spica splint, steroid injection
Rheumatoid Arthritis
Etiology — autoimmune inflammatory arthritis
Risk – female, smokers, obesity, family history
Symptoms
1) Symmetric joint pain (BILATERAL!!!), stiffness, swelling in HANDS, WRISTS, and FEET
2) Commonly involved Joints: Wrists, MCP (metacarpophalangeal) and PIP (proximal interphalangeal) Joints
3) Edema, synovitis, ulnar deviation, boutonneire deformities
Diagnosis
- Rheumatoid Factor (RF) in blood
- Anti-CCP antibodies
- Seronegative RA
Treatment
- Disease modifying antirheumatic drugs (DMARDS)
- Methotrexate, anti-TNF drugs, T-cell inhibitors
Extra-articular manifestations — Felty Syndrome (severe form of RA, neutropenia, spelomegaly)
Osteoarthritis Arthritis (OA)
KEY CLINICAL PEARLS
-Asymmetric joint pain in DIP, PIP
-Joint stiffness lastijng <1 hour after waking up
-Most common form of arthritis in adults
Risk Factors — female, over 50, joint trauma
Diagnosis – X-Rays, Heberden’s Nodes, Bouchard’s Nodes
Treatment – weight loss, NSAIDs, joint replacment, glucocorticoid injections
Ganglion Cyst
Common soft tissue conditon of wrist/hand
-Smooth, potentially painful, rubbery cystic lesion on hand, wrist, feet
Diagnosis – MRI/ultrasound, transillumination to see if tumor
Treatment
- Asymptommatic = 50% spontaneously resolve
- Ganglion Cyst aspiration (fluid drainage) = >50% will recur
- Surgical removal
Scaphoid (Navicular) Fracture
Key:
-Most commonly fractured carpal bone, cause by FOOSH, blood supply to scaphoid is POOR (avascular necrosis)
Symptoms — Wrist pain near snuffbox and swelling, decreased grip strength
Diagnosis – XRAY (but may not see)
– MRI, CT if XRay is unclear
Treatment
–Displaced —-Can be emergency, immediate surgeon referral
–Non-displaced — Thumb casting
Distal Radial Fracture (Colle’s)
- FOOSH
- 16% of fracture in ER
- Common in young patient (high-energy impacts) and older people with osteoporosis
Symptom – dinner-fork-looking deformity
Diagnosis — XRay
Treatment (Depends on extent of fracture)
- Surgical referral (open fracture (compound fracture))
- Splinting
Trigger Finger
aka Stenosing Felxor Tenosynovitis
Cause: difference in size of flexor tendon to surrounding sheath (impaired gliding)
Symptom: painless to painful snapping, catching or locking of fingers during flexion (typically ring finger and thumb)
Associated: Diabetes, RA, repetative movement
Treatment: Splinting MCP slightly flexed
Dupuytren’s Contracture
Caused by thickening (fibrosis) of the palmar fascia, leading to gradual joint stiffness and INABILITY TO FULLY EXTEND FINGER
Treatment: using gloves with padding acrossm the palm, surgery, corticosteorid injection
