Surgery-MSK/Rheumatology Flashcards
Examination for MCL injury
- Valgus stress test
Examination for ACL injury
- Anterior drawer test
- Lachman test
Examination for Meniscal tear
- Thessaly test
- McMurray test
Place knee at 30 degrees flexion, stabilize distal femur with 1 hand & pull proximal tibia anteriorly with the other laxity of tibia- what test is this & evaluate what injury
- Lachman test
- ACL injury
Passive knee flexion and extension while holding the knee in internal or external rotation, pain, clicking, or catching indicates __________, what test is it?
- McMurray test
- Meniscal tear
Pt stands on 1 leg with knee flexed 20degrees, pt then internally and externally rotates on flexed knee. What test is it? to test what injury?
- Thessaly test
- Meniscal tear
Stabilize lateral thigh, apply abduction force to lower leg laxity indicates ______ injury & called
- MCL injury
- Valgus stress test
Risk factors for stress fracture (5)
- repetitive activites
- abrupt increase in physical activity
- inadequate calcium and vit D intake
- decreased caloric intake
- Female athlete triad: low caloric intake, hypomenorrhea/amenorrhea, low bone density
Clinical presentation of stress fracture (3)
- insidious onset of localized pain
- point tenderness at fracture site
- possible neg x-ray in the first 6 weeks
Management of stress fracture
- 1st tx- rest and simple analgesics
- reduce weight bearing for 4-6 weeks
- referral to orthopedic surgeon for fracture at high risk of malunion (eg. anterior tibial cortex, 5th metatarsal)
Caused by repeated tension or compression without adequate rest and occur most commonly in athletes or other who suddenly increase their activity & x-ray is usually normal
Tibial stress fractures
Pt with uncomplicated MCL tear can be managed?
nonoperatively with rest, ice, compression, elevation (RICE measures) and analgesics
The most sensitive test for MCL tear diagnosis is
MRI
Cause of meniscal tears in younger pt
rotational force on planted foot
Cause of meniscal tears in older pt
degeneration of meniscal cartilage
Acute “popping” sensation, catching, locking, reduced ROM, Slow onset joint effusion, joint line tenderness
Meniscal tears
Diagnostic for meniscal tears (2)
MRI & Arthroscopy
Management for mild meniscal tears in older pt
rest, activity modification
Management for meniscal tears with persistent symptoms and impaired activities
Surgery (in younger pt)
Pain with abduction, external rotation of shoulder
Rotator cuff impingement or tendinopathy
Subacromial tenderness
Rotator cuff impingement or tendinopathy
Physcial examination for rotator cuff impingement or tendinopathy
Neer
Hawkins
Weakness with external rotation of shoulder in >40 years old
Rotator cuff tear
Decreased passive and active range of motion with more stiffness than pain of the shoulder
Adhesive capsulitis (frozen shoulder)
Anterior shoulder pain, pain with lifting, carrying or overhead reaching
Biceps tendinopathy/rupture
Usually caused by trauma, gradual onset of anterior or deep shoulder pain, decreased active and passive abduction and external rotation
Glenohumeral osteoarthritis
DDX for hip pain in middle-aged adult (5)
- Infection
- trauma
- arthritis
- bursitis
- radiculopathy
Middle-aged adult with superficial unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh (as when lying on the affected side in bed) suggests
Trochanteric bursitis
A synovial sac that alleviates friction at bony prominence and ligamentous attachments
Bursa
Anterior knee pain, tenderness, erythema and localized swelling, and common in occupations requiring repetitive kneeling
Prepatellar bursitis “housemaid’s knee”
Common bacteria that infect the bursa via penetrating trauma, repetitive friction or extension from local cellulitis in prepatellar bursitis
Staphlococcus aureus
Complications of Supracondylar fracture of the humerus (4)
- Brachila artery injury
- Median nerve injury
- cubitus varus deformity
- compartment syndrome/Volkmann ischemic contracture
Most common way to cause supracondylar fracture of the humerus
Fall on an outstretched hand (more in pediatric)
Ischemia and infarction from compartment syndrome in the arm can lead to
Volkmann contracture
Fracture of marrow-containing bone (femur), orthopedic surgery and pancreatitis can lead to
Fat embolism syndrome
Clinical triad: Respiratory distress, neurologic dysfunction and petechial rash
Fat embolism syndrome
Pt with clavicle fracture should get
Angiogram;
To evaluate neurovascular (brachial plexus and subclavian artery) involvement
The most commonly injured muscle due to degeneration of the tendon with age and repeated ischemia induced by impingement between the humerus and the acromion during abduction
Supraspinatus
+ drop arm test indicates
Supraspinatus tear - weakness of abduction
Test used to confirm supraspinats tear
MRI
Tx- surgery
