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Musculoskeletal 1 > Primary Care Ortho > Flashcards

Primary Care Ortho Flashcards

1
Q

Define physis

A

growth plate at each end of a long bone

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2
Q

Define epiphysis

A

on joint side of physis

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3
Q

Define metaphysis

A

on shaft side of physis

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4
Q

Where do kids tend to fracture and why?

A

through the PHYSIS because it’s generally weaker than the shaft of the bone

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5
Q

Salter Harris fractures involve the…

A

physis

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6
Q

SH 1 fracture

A

through the physis only

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7
Q

How should you treat any significant injury around the physis?

A

splint and re-x-ray in 10 to 21 days

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8
Q

SH 2 fracture

A

through the physis and metaphysis

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9
Q

SH 3 fracture

A

through the physis and epiphysis

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10
Q

SH 4 fracture

A

through the metaphysis, physis and epiphysis

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11
Q

Which SH fractures are the worst?

A

SH III and IV are worse that I and II because the joint is involved

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12
Q

SH 5 fracture

A

d/t crush or burn injury of the growth plate - will get closure of growth plate

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13
Q

Greenstick fracture

A

incomplete fracture- may have to complete the fracture to realign

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14
Q

Torus fracture

A

bone is bent and fracture can be minimal buckle in cortex

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15
Q

Peds fractures vs. fractures in adults

A

Children will heal and remodel a fracture much better and faster than an adult

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16
Q

Hip dysplasia can be…

A

one or both hips dislocated or dislocatable

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17
Q

Hip dysplasia is associated with…

A

oligohydramnios and large babies (Diabetic Mother?)

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18
Q

Hip dysplasia tests (2)

A
  1. Ortolani (out or dislocated)- clunk as hip reduces.

2. Barlow- clunk as hip dislocates

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19
Q

Hip dysplasia tx

A

Pavlic harness in newborns with frequent follow up exams.

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20
Q

Fracture principles

A
  • open fractures go to the OR (Most)
  • always check neurologic status
  • always check distal vascular status
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21
Q

What are the 5 P’s of compartment syndrome?

A

Pain, Pallor, Paresthesias, Pulselessness, and Paralysis

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22
Q

What is the MC site of fractures?

A

Tibial plateau

**medical emergency

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23
Q

Fat emboli d/t fracture

A
  • Fx of long bones,(femur, tibia and humerus, or pelvis)

- Pt presents with mental confusion, tachypnea, tachycardia and hypoxia.

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24
Q

DVT s/p fracture

-how to dx?

A
  • increased chance of clot with immobilization, bedrest.
  • Dx with doppler venous studies or venogram
  • CT Angio of chest for suspected PE
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25
Q

Tx of DVT

A

IV heparin bolus then drip, switch to Coumadin for several months

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26
Q

Tx of DVT or PE in fracture patients

A
  • includes Factor X A inhibitors.
  • Finn PA-C prefers apixaban - can use to bridge patients on Coumadin.
  • should hold for 48 hours before surgery.

NEVER use in neurosurgery***

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27
Q

Shoulder impingement

-involved anatomy

A
  • tendonitis of rotator cuff muscles

- usually involves the Supraspinatus muscle

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28
Q

S/sx of shoulder impingement

A

weakness, pain (night), minimum of injury

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29
Q

Exam of shoulder impingement

A
  • (+) impingement test (neer, hawkin’s, empty can)

- get MRI to visualize? -discouraged, you should be able to diagnosis via simple tests

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30
Q

Adhesive capsulitis

A

AKA frozen shoulder

  • decreased ROM
  • pain often perceived as severe
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31
Q

Adhesive capsulitis cause

A

disuse of shoulder because of pain of injury.

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32
Q

Adhesive capsulitis tx

A

injection, ROM stretching exercises

33
Q

Other shoulder problems

-posterior dislocation

A
  • associated with seizures and electrical shock

- commonly missed on routine x-rays in OP setting

34
Q

Epicondylitis of the elbow

-lateral

A

“tennis elbow”

-extensor tendonitis

35
Q

Epicondylitis of the elbow

-medial

A

“golfer’s or pitcher’s elbow”

-flexor tendonitis

36
Q

Epicondylitis of the elbow

-tx

A

-both medial and lateral d/t overuse

TX:
-stretching exercises, NSAIDS, brace, steroid injections.

37
Q

Wrist fractures

-Colles

A

common with elderly and falls onto outstretched hand (FOOSH)

38
Q

Wrist fractures

-Scaphoid

A

fall onto outstretched wrist

-pt c/o pain at snuff box

39
Q

Tx of wrist fractures

A

any wrist with hx. of fall and snuff box tenderness is immobilized in splint including the thumb and then re-x-rayed in 10 to 21 days.

40
Q

Wrist tendonitis

A

-can occur anywhere in wrist.
-Dequarvain’s- 1st extensor compartment. Extensor Pollicis Brevis and Abductor Pollicis Longus tendons.
(+ Finklestein test)

*EPL tendonitis/rupture common after Colles fracture.

41
Q

Carpal Tunnel in the wrist

  • sx
  • causes
A

SX’s- numbness/tingling of thumb, index, long, and radial half of ring fingers.

Causes- synovitis, tendonitis or acutely with fracture.

**All reduce space in the carpal tunnel causing the compression of Median Nerve.

42
Q

Carpal Tunnel exam & tx

A

Exam-

  • (+) Tinel’s and Phelan’s, Thenar muscle atrophy.
  • Adductor policis weakness

TX:
Rest, brace, NSAIDS, steroid injection, surgical release.

43
Q

What joint is avascular necrosis commonly seen in?

A

the hip

44
Q

Avascular necrosis

  • cause
  • s/sx
A
  • bone dies d/t loss of blood supply

- pain, antalgic gait, decreased ROM

45
Q

What is Perthes disease?

A
  • rare childhood condition where blood supply is cut off to the hip
  • occurs in kids 3-8 y.o. primarily
  • unknown etiology
  • the older the child, the worse the prognosis
46
Q

Avascular necrosis can be seen in patients who…

A
  • have Sickle cell
  • use steroids
  • drink ETOH
  • are scuba divers

**or can be idiopathic

47
Q

Tx for avascular necrosis

A
  • limit activities
  • NSAIDs
  • core decompression to bring more blood supply to joint
  • total hip replacement
48
Q

What imaging should you use for avascular necrosis?

A

MRI

49
Q

Hip fracture etiology

A
  • typically occur in femoral neck, intertrochanteric or sub-trochanteric
  • females > males
  • 35% die within a year after hip fracture
  • osteoporosis is common
  • pts often break their hip before they fall
50
Q

Hip fracture tx

A
  • stabilize or replace
  • mobilize ASAP after surgery
  • treat underlying osteoporosis
51
Q

Slipped capital epiphysis etiology

A
  • young males (10-15 y.o.)
  • 25% occur bilateral
  • commonly presents as knee pain
  • xray shows slip but may need MRI
52
Q

Slipped capital epiphysis tx

A

stabilize surgically

53
Q

Knee - patellofemoral pain is commonly d/t

A
  • chondromalacia (softening of the cartilage)

- patellar tracking problems

54
Q

Patellofemoral pain

  • sx
  • tx
A

Sx:

  • pain
  • gelling?
  • increased pain arising from chair or using stairs

Tx:

  • short arc quad sets (to realign the patella)
  • arthroscopic debridement of patella
55
Q

Knee - ACL tear etiology

A
  • frequent injury from sudden deceleration
  • effusion: rapid onset, grade III, and bloody
  • (+) Lachman test, (+) pivot shift

*MCL and meniscus injury common

56
Q

ACL tear tx

A
  • immobilizer
  • gradual return to normal activities
  • 1/3 need reconstruction of ligament
57
Q

Knee - meniscal tear etiology

A
  • caused by extension and twisting motion of knee during weight bearing
  • effusion: mild to moderate + or - blood; occurs slowly (> 1 - 2 hrs)
58
Q

Meniscal tear sx

A

-joint margin tenderness
-locking
-popping
(+) or (-) McMurray test

59
Q

Meniscal tear tx

A

arthroscopic resection

60
Q

Foot and ankle sprain

  • etiology
  • sx
A

-tear of one or more lateral ankle ligaments

Sx:
-pain, ecchymosis, high amount of swelling

61
Q

Foot and ankle sprain tx

A
  • air or gel splint until asymptomatic

- RICE: rest, ice, compression, elevation

62
Q

Foot and ankle infection

A
  • seen in patients who step on a nail with shoes on - the glue contains Pseudomonas
  • start on anti-pseudomonal abx
63
Q

Neck injury

  • etiology
  • imaging
A
  • car wrecks, diving injuries, etc.
  • must get lateral x-ray see all 7 cervical vertebrae to clear accident victim for battery of x-rays and removal of brace
64
Q

Spine injury

-sx

A

Clonus signifies upper motor neuron injury.

65
Q

When do you see increased deep tendon reflexes in spine injuries?

A

with spinal cord lesion above that level

66
Q

When do you see decreased deep tendon reflexes in spine injuries?

A

radiculopathy, lesion below the level

67
Q

Imaging for spine injuries

A

CT, MRI, or Myelogram

68
Q

Sprain of the lumbar spine

  • sx
  • tx
A
  • back pain, but NO radiculopathy (no pain in the buttocks or legs)
  • tx with rest, NSAIDs, non-narcotic analgesics, +/- lumbar support
  • long-term tx: aerobic exercises, back strengthening, work hardening, and spine education
69
Q

Lumbar spine herniated discs MC occur in level…

A

L4-L5

L3-L4 is 2nd MC

70
Q

Lumbar spine herniated disc tx

A
  • is the same as sprain early.
  • PO or epidural steroids are added
  • tx conservatively for at least 6 weeks
71
Q

When should you consider surgery in lumbar spine herniated disc?

A

as last resort if it does not get better with conservative tx

72
Q

Lumbar spinal stenosis

-etiology

A

compression of nerve roots due to arthritic changes

73
Q

Lumbar spinal stenosis

-sx

A
  1. neurogenic claudication- similar to vascular claudication with pain with ambulation, relieved with rest
  2. must differentiate between +/- neuro changes
  3. if minimal neuro. changes - most pt c/o back and leg pain (bilateral)
74
Q

Lumbar spinal stenosis

-tx

A
  • same as for herniated disc
  • epidural steroid injections
  • PT for 6 weeks
  • decompressive laminectomy
75
Q

Nerve injuries

-humerus

A

radial N located just behind the humerus and injured with a fracture

76
Q

Nerve injuries

-fibula

A

peroneal N located just behind the head of fibula

77
Q

Nerve injuries

-radius

A

median N located volar to distal radius

78
Q

Nerve injuries

-hip

A

sciatic N can be injured d/t fracture or dislocation (MC)

Musculoskeletal 1 (14 decks)

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