Treatment - MSK & Rheum Flashcards
acromioclavicular joint dislocation “shoulder separation”
brief sling immobilization class 3 (AC & CC ligaments ruptured) may need sx
clavicle fractures
- mid 1/3 –> arm sling 4-6 wks adults, figure 8 sling kids
- proximal 1/3 –> ortho consult
suppurative flexor tenosynovitis
I&D w/ irrigation + IV abx
olecranon bursitis
- rest, NSAIDs, local steroid injection
- if septic bursitis - aspirate + abx
ulnar shaft / nightstick frx
nondisplaced distal 1/3 –> short arm cast
nondisplaced mid-proximal 1/3 –> long arm
displaced –> ORIF
monteggia frx or galeazi frx
UNSTABLE! Needs ORIF
gamekeeper’s (skier’s) thumb
thumb spica and referral to hand surgeon (bc affects pincer function)
bite wounds (human) abx
augmentin
dupuytren contracture
- intralesional corticosteroid injection, PT
- sx correction if contracture >30 deg @ MCP joint of any PIP contracture
legg-calve-perthes disease
- idiopathic avascular osteo in kids
- observation bc self-limiting w/ revascularization (2 yr) with activity restriction
LCL/MCL grades tx
Grade 1 - sprain
Grade 2 - incomplete tear –> conservative, PT, RICE, knee immobilizer
Grade 3 - compete tear –> +/- surgical repair
patellar and quad tendon ruptures
sx repair w/in 7-10 days
acute osteomyelitis
abx 4-6 weeks (at least 2 wks IV) +/- debridement
newborn <4mo –> Group B strep –> Nafcillin or Oxacillin + 3rd gen ceph
children –> staph aureus / MSSA –> Nafcillin or Oxacillin or Cefazolin/Ancef (clinda or vanc if allergic)
-vanc or linezolid if MRSA
sickle cell dz –> salmonela, staph –> 3rd gen ceph or FQ
puncture wound –> pseudomonas –> CIPRO or levoflox
chronic osteomyelitis
more refractory –> SX debridement + cultures –> ABX (not empiric)
septic arthritis
2-4 wk course guided by gram stain (arthrocentesis)
gram pos cocci - nafcillin (vanc if MRSA suspected or PCN allergy)
gram neg cocci or gonococcus - ceftriaxone (cipro if allergy)
gram neg rods - ceftriaxone (3rd gen ceph) + anti-pseudomonal aminoglycoside (gentamicin)
no organism seen - nafcillin or vanc + ceftriaxone (+/- anti-pseudomonas)
paget disease
BISPHOSPHONATES or calcitonin
raynaud’s phenomenon
CCB, prostacyclin
-vasospasm-induced change of fingers, toes, ears, nose, tongue, worse w/ cold, smoking or emo stress (face, neck and distal elbows/knees)
scleroderma
DMARDs, corticosteroids
SLE
sun protection, hydroxychloroquine for lesions; NSAIDs/tylenol for arthritis, +/- pulse dose corticosteroids
cytotoxic drugs: methotrexate, cyclophosphamide
sjogren’s
-pilocarpine - cholinergic, inc lacrimation and salivation (SE diaphoresis, flush, sweat, bradycardia, D/N/V, incontinence, blurred vision)
polymylagia rheumatica
low dose corticosteroids
pseudogout
INTRAARTICULAR CORTICO 1ST LINE; colchicine for prophylaxis
rhabdo
- IV saline 4-6L/day
- MANNITOL to induce osmotic diuresis
- BICARB to alkalinize urine
- calcium gluconate if hyperK w/ ECG findings
RA
- DMARDs - promptly reduces permanent damage
- METHOTREXATE 1st LINE (leflunomide, hydroxychloroquine/plaquenil, sulfasalazine)
- NSAIDs first line for pain control; CORTICO 2nd line if no relief w/ nsaids
kawasaki syndrome
IV immune globulin + high dose ASA
-cortico if refractory
psoriatic arthritis
NSAIDs 1st LINE –> methotrexate –> TNF-inhib
ankylosing spondylitis
NSAIDS + REST/PT 1st LINE –> TNFa inhibitor –> steroids
reactive arthritis
NSAIDs –> methotrexate –> sulfasalazine, steroids
