UE & LE INJURIES Flashcards by Aquino, Charline

Direct Trauma: Shearing w/ twist, pivot, fall
Pain: groin
Clicking &amp; catching
Hypermobility, dysplasia (abno dvpt cells)
Morphologic abnos
8-72yrs; F>M
22-55%
Surg/Non: 6w
Athletes: 2-6mos
Hip arthroscopy
Surg recover: 4-6mos
Untreated = mech irritant
PT, NSAIDs, rest

LABRAL INJURIES

How well did you know this?

Not at all

Perfectly

Displacement frm disrup of physis
Injury to physeal plate w/ med displ - acute or microtrauma
MOI: Trauma = stress by WEIGHT
Adols: Hip pain &amp; diff walking
Acute: hip, groin, thigh pain
Loss IR &amp; obligatory ER 
Most common among ADOLS; M>F
Bilat: 50%
Endo &amp; renal
Crutches: 6-8w
Follow-up: 3-4mos
Very Good
No weight bear (Protected WB after surg: 6-8w)
Surg: w/n 24-48hrs
Goal: STABILIZE slip - avoid LT comp: avas nec, rotational deform, OA
NO CLOSED REDUCTION
ORTHOPEDIC EMERGENCY

SLIPPED CAPITAL FEMORAL EPIPHYSIS

How well did you know this?

Not at all

Perfectly

MOI: Repetitive stress by FRICTION frm run/cycling
Pain, inflam, SNAPPING sound
Recov: 4-8w
VG
RICE

ITB SYNDROME

How well did you know this?

Not at all

Perfectly

Injury to pt of hip: falling, bumping, lying, etc
Infection: open wound
Pain outside hip; lying affected side; worse during ax; SWELLING
Both active or seden
Unilat: 15; 8.5%
Bilat: 6.6; 1.9%
F>M: 80%
2-8w
Stretching &amp; strengthening
Good
Anti-inflam: a week
Goal: pain, inflam, mobility, prevent recurrence
Rest, splint, HOT &amp; COLD
Advanced: NSAID, cortico inj, surg

TROCHANTERIC BURSITIS

How well did you know this?

Not at all

Perfectly

Ischemia = osteocytes death &amp; marrow = microfx = collapse
Trauma, corticos, alcohol, SYSTEMIC dse
Similar to hip OA: GROIN pain increased w/ wb
LOM: IR, F, ABD
Core decomp - crutches
Bone graft - conjunc w/ comp - LONGER
Osteotomies - few mos
Dep on stage; 50% - surg w/n 3yrs 
Weight off, pain meds
Collapse: jt replace surg

AVASCULAR NECROSIS

How well did you know this?

Not at all

Perfectly

Childhood: 4-10
UK cause
Groin or thigh pain
Antalgic gait
LOM: ABD &amp; IR
Bilat: 10%
Orthosis vs Osteotomy
18-24mos
Revascularization &amp; remodeling
Good outcomes: age <6 nonsurg: brace (Scottish Rite Orthosis)
Surg: Osteotomy

LEGG-CALVE-PERTHES DISEASE

How well did you know this?

Not at all

Perfectly

Internal forces - overpowered by large energy
Acute POST: pain &amp; hold in F, IR, ADD
ANT (less common): E, ER, ABD
Obvious deform
Not tolerate ROM or resist test d/t PAIN
Risk: Acetabular fx
Sports: high impact/contact
2-3mos
Comps: Sciatic n injury, Posttrauma OA, Avas. Nec - 10%
Orthopedic Emergency
Closed reduc under anesth
Non WB: 3-4w --> Protected: 3w

HIP DISLOCATION

How well did you know this?

Not at all

Perfectly

Forceful contraction w/ foot planted
Unstable knee
MOI: Heavy load on leg w/ knee partial bent (BB-Athletes)
Open K.C.: forceful KICK
Result of: Injury, jt weakness, chronic cond
Complete: rare
Patellar: <40
Quads: >40
4mos
Most: 6mos (or LONGER)
Most return to ax
Half: thigh weakness &amp; soreness
Brace &amp; PT
Immob
Early repair: prevent scar &amp; tighten

QUADS STRAIN/RUPTURE

How well did you know this?

Not at all

Perfectly

Traumatic: sudden, acute

Acute course dep on: type, severity, rehab, sports

G1&2 MCL & LCL: 2-4w

Others: 4-12mos

KNEE LIG INJURIES (GEN.)

How well did you know this?

Not at all

Perfectly

Med condyle –> Prox med tibia
Valgus w/ foot planted
Localize pain to med side

Aggressive ice & elevate
Immob: 1-2w - stab & repair scar tiss.
Early Gentle knee F&E: 1-2w
Gradual return to ax: 1-4w
G1: Firm EF; no tearing
G3: Jt line opens w/o restraint; complete disrup
RARELY req surgery

MCL INJURY

How well did you know this?

Not at all

Perfectly

Fibular collat lig
Rare in isolation; torn in multilig injuries
Varus
Pain & tender on lat side

RICE, crutches, gradual walk w/ more weight
Brace, strengthen mms for more stab
Surg: REPLACE tiss rather than stitch - deceased donor or from back of thigh or heel

LCL INJURY

How well did you know this?

Not at all

Perfectly

Most fxn devastating - bcs of dynamic stab (side-to-side or cutting)
Med wall of lat condyle –> Ant spine of tibial plateau
Tears: dynamic stab
Contact/non-con injuries
Restraints ANT displ & IR
MOI: Rotated/twisting on planted w/ knee F
“Pop”; knee instab

Aggressive I.C.E
Immob or crutches
Early Gentle knee F&amp;E
Quads inhib.
Straight leg raises in immob
LT treatment: desired ax lvl
Lig reconstruction: Young, sporty
Aggressive rehab: seden or straight ahead ax; when no instab
Wait 2-3w before recons.

Impossible return to sports w/ repeated episodes of instab
Acute: pain not prominent
Pain = assoc injury (i.e. bone contusion, med menis tear)

ACL INJURY

How well did you know this?

Not at all

Perfectly

Less common
Post & Inf intercon notch –> Post tib spine
MOI: Forceful blow to Prox Ant leg; SHIN (Dashboard injury)
Pain w/ swelling (quickly); Limp

Isolated = less sig fxn limits.
Can return to FULL ax

I.E. Pain control, Early gentle ROM
Immob: 1-2w
Rare: surg recon (if unstable)

PCL INJURY

How well did you know this?

Not at all

Perfectly

Traumatic: Rotation/Twist w/ planted foot
Acute trauma or Gradual degen
Varus/valgus to F knee
Slow onset of Swelling
Pain w/ weight &amp; twist
Some clicking
Locking - bucket handle
I.E.NSAIDs, Bracing
Arthroscopy
Repair or debridement w/ meniscectomy
~3mos
Meniscectomy: 3-4 weeks
Simple = greater healing (Red zone)
Vascular zone tears - younger; arthroscopic repair
Older: 3-6w rest &amp; rehab
Arthroscopic repair: limited fxn, persistent mech, recurrent epis.

MENISCAL INJURIES (GEN)

How well did you know this?

Not at all

Perfectly

Valgus f to F knee

MED M.T.

How well did you know this?

Not at all

Perfectly

Varus f to F knee w/ femur ER

LAT M.T.

Kneeling
Ant patella: pain &amp; swell
Tender, warm
Infected - fluid, fever, chills
I.C.NSAIDs
Aspiration
Recovery dep on: age, health, prev injury, severity
Open injury = goes away own
Swelling - slow; drain

PREPATELLAR BURSITIS

Traumatic or degen (most severe)
Puncture, laceration, eversion sprains
Diabetes, arthritis, obesity
Tendon hypovascularity
4 Types
Acute: pain and swell
Chronic: appearance - collapsed arch; too many toes
Apropulsive gait
No inversion
Conservative mgt: older/sedentary; modalities
6-8 w
Non-comp: double recovery time
Flat feet

POST TIBIALIS TENDINITIS

Inversion injury
Pain: tendons at diff areas
PB Tendonitis: 5th MTT
Pain: ankle inferior to lat mall
Increased cutting/turning on ball of foot
Cuboid or lat calcaneus
Swelling
Ice pops
Deep transverse friction massage
Eversion w/ R &amp; TheraBand
Tenosynovectomy
Groove deepen
2-4w
Takes time (dont rush to ax)

PERONEAL TENDINITIS

Hyper- pron or sup
Overuse or poor foot biomech
Forefoot equinus
DF compensation
Subtalar jt
Varus deform.
Rigid PF or Cavovarus
Mid pain w/ fusiform swell
R.I.Anti-inflam. Night splint, DTFM, 1/4 in heel lift
Shoes w/ lower heel
DF stretch: 30s 10x 2x a day
Weeks-mos
Most: ~12mos

ACHILLES TENDINITIS

Heavy, flatfoot, high arch
Stress on fascia
Poor biomechs
Increased subtalar jt pron, pes planus, limited DF
Pes cavus - rigid
Pain out of bed; lessen when walk
Tender med plantar aspect
Discomfy: midcalcaneal
Conservative treatment
~6-8mos
VG

PLANTAR FASCIITIS

Most common: 25%
Heels, unstable ankle
Traumatic
MOI: INVERSION +PF
Diffuse pain &amp; edema
RICE
Surgery: rare; Grade 3
Mild: 1-3w
Mod: 3-4w
Severe: 3-6mos
Grades 1-3
Fxnl rehab prog

ANKLE SPRAIN

Trauma +immob
Idiopathic
Internal derangement
Multiplanar loss: ER &amp; ABD
Progressive loss; diffuse pain
Pendulum exercises
Jt immob - ultrasound
Injection of anes &amp; steroid
Self-limiting: 1-3yrs
20-50% long-term ROM defs.
Painful to treat
Recovery: up to 2yrs

ADHESIVE CAPSULITIS

Physically active
After SH dis
Trauma: sudden/repetitive
Subluxation
Acute, reversible
2-3w
Open surgery

GH JT INSTABILITY

Overhead mvts Palpation & pain on resisted Sup w/ elbow F Resistance w/ forward elbow F; E & Sup Swollen tendon, Stenotic @transverse lig; freq hemorrhagic Discomfort --> Painful snap Resolve: 3mos Surgery > conservative treatment - Young

BICIPITAL TENDINITIS

``` Risk: Older people Traumatic or degen FOOSH; jerking Pain along tuberosity Painful arc Drop arm test 4-6w Partial: debridement Complete: stitching ```

ROTATOR CUFF TENDONITIS/TEAR

MOI: Repetitive stress d/t overuse of Extensor FA mm's = Varus Localized tenderness over FA Extensor tendon Discomfy radiohumeral jt & annular lig Pain: resisted wrist & mid finger E; Gripping Reversible Good

LAT EPICONDYLITIS

``` Overuse injuries - musculocutaneous strucs Flexor communis & Pron teres Topsin forehand Localized pain w/ radiation Resisted F & Pron PASSIVE E & Sup Chronic: Soft tissue contractures + loss of full E & Sup Valgus REST b4 strengthen ```

MED EPICONDYLITIS

``` MOI: Repetitive trauma on elbow or Injury at elbow tip Acute: swell, NORMAL ROM, pain w/ passive F >90 Chron: NO PAIN; thick & boggy Weight lifting; no protection Acute, reversible Good 3-6w Cryotherapy Aspiration ```

OLECRANON BURSITIS

``` Multimodal Prolonged gripping (wide) F: DIP E: MTP, PIP Clicking to frank locking Pain: EXTENSION @nodule (MCP) Repetitive stress Occupational Acute, reversible Excellent - Cortisone injecs. Goal: restore norm gliding 1st line: REST - 4-6w Splints: MCP @10deg w/ active IP motion Sx >6w: Steroid inj. @A1 Surgery: simple outpx ```

TRIGGER FINGER

3-fold Mgt of Trigger Finger

Reduce inflam Decrease local pressure Worksite changes

``` Inflam/entrapment of tendons in 1st DORSAL compartment: EPB & APL Repetitive: buffing, wringing Thumb F + UD Pain in radial styloid Crepitus along radial FA - fluid Waitress Acute, reversible Excellent Curtailing ax - shear force Ice: 15mins every 6hrs Acute stage: Steroid inj - quiet tenosynovitis Refractory case: surg decompression - 90% cure ```

DE QUERVAIN SYNDROME

``` FOOSH + UD (Wrist E & Pron) Scaphoid F Lunate & Triquet - E Wrist edema, ecchymosis (discolor), restricted ROM Tenderness Common: frm Lig injury 8-12w Desk: 2-4 Phys work: 3mos Contact sports: 3-6mos Progressive wrist arthrosis & SL collapse If tear = DO NOT HEAL ON OWN LT effect: ARTHRITIS - Surg Acute & Chron: Surg Partial wrist arthrodesis: chronic Proximal row carpectomy: advanced ```

SCAPHOLUNATE INSTAB.

DISI pattern & where?

dorsal intercalated segmental instability | SCAPHOLUNATE INSTAB

Avascular: Central art disc Vascular: Dors & Palmar R-U ligs Primary stab of DISTA R-U JT. Acute, trauma: FOOSH or microtrauma (gymnast) Axially loading: 18% TFCC | 82% Radiocarpal jt +Ulnar variance = Increase load bearing of TFCC Wrist catching/locking Tenderness & hollow bet FCU & ECU tendon Insidious or traumatic Young vs old No surgery: 12w heal (3mos XD) After surg: 3mos Central art - Surg DEBRIDEMENT

TFCC INJURIES

Obligatory ER in Slipped CFE

ER + Passive Hip F

Prognostic factors of LCP Dse

Age of onset Deg of deform Percent involv.

Unhappy triad of o'donoghue

MCL ACL Med Menis