Week 5 Orthopedics Flashcards
1
Q
physical exam of musculoskeletal condition using the acronym..?
A
SMART
- S: scan region (redness, swelling, palpate joint above and below); sensation
- M: motion done by pt (active ROM); muscle strength
- A: assisted motion by me (passive ROM)
- R: resisted testing; reflexes
- T: tests that are special
2
Q
indication for imaging
A
- Suspicion of non MSK etiology
- Neoplasm
- Trauma plus functional loss
- Failed conservative measures
- RICE, rested, iced
- Patient insistence
3
Q
What is X-ray good for?
A
acute injuries to identify bone or tendon involvement and bone tumors
next best step after hx & PE; #1 imaging
4
Q
what is CT good for?
A
- shows extent of bone destruction and exact extent of bone lesion
- quantitate risk fo pathologic fractures from lesion
- high radiation exposure
5
Q
what is MRI good for?
A
- shows soft tissue lesions or non-bone forming bone tumors
- planning surgery for bone tumors (detects bone tumors)
6
Q
what does the ultrasound NOT do? and what does it rule out?
A
- does not penetrate bone and doesn’t differentiate benign/malignant
- can r/o tendon rupture
7
Q
what is a bone scan good for?
A
- technetium 99m bone scan good for detection of bone lesions invisible on X-rays
- occult fractures
- detect silent bone metastasis and avoid understating and overt errors
8
Q
Spurling’s Maneuver detects what?
A
detect cervical radiculopathy
pt extends neck and laterally tilt head to affected side. I apply downward force top of head.
9
Q
empty can test
A
- dx: supraspinatus trauma (tear, tendonitis or tendinosis)
- Pt holds out affected arm as if offering examiner a can of soda (abduction to 90 degrees), and then have patient turn arm to empty the contents (internal rotation).
- Pt resists downward pressure
- if pain or weakness
10
Q
neers sign test
A
detects rotator cuff tear or impingement syndrome
Raise and pull on straightened arm forcibly from the side to full abduction above the head.
+ if painful
11
Q
hawkins test
A
detects rotator cuff tear or impingement syndrome
Flex the elbow to 90 degrees and raise the upper arm to 90 degrees of abduction (parallel to the floor). Then rotate the arm internally across the front of the body, causing compression of the rotator cuff and subacromial bursa between the head of the humerus and coracoacromial ligament.
12
Q
phalen test
A
detects carpal tunnel syndrome
13
Q
tinel’s test
A
detects carpal tunnel syndrome
tingling sensation if tap injured nerve or distal to lesion
14
Q
drop arm test
A
detects thickness tear of supraspinatus (rotator cuff tear)
Have patient hold affected extremity in a fully abducted position, then ask patient to slowly lower arm to side
+ if drops arm quickly with pain
15
Q
crossover test
A
detects AC joint pathology
16
Q
thompson test
A
detects achilles tendon rupture
squeeze calf and should see flexion of foot. if don’t see flexio, then it’s a + test
17
Q
Lachman test
A
detects partial or complete disruption of ACL
left hand supports thigh holding it down and right hand pulls upwards
+ if excessive movement or the lack of a firm end-feel
18
Q
Mc Murray test
A
detects tear in the meniscus
19
Q
Patrick FABER test
A
FABER: Flexion, Abduction and External Rotation
+ meaning pain at hip or groin region and means sacroiliac joint involved; dysfunction within hip joint
20
Q
Straight leg raise
A
detects lumbar disc herniation/radiculopathy
21
Q
Adsons test
A
detects thoracic outlet syndrome (compression of subclavian artery)
22
Q
indications for physical therapy
A
- Traumatic disorders with mild to moderate functional loss
- Chronic postural pain disorders
- Recurrent pain disorders
- Mechanical MK disorders
- Early nerve entrapment
- Symptomatic joint degeneration
23
Q
indications for orthopedic referral
A
- Obvious tissue disruption
- Trauma with significant loss of function
- Continued functional deficit or pain after 6 weeks
- Recurrent dislocation or subluxation
- Need for joint injection
- Failure of conservative measures
- Patient insistence
24
Q
sprain
A
overstretching or tearing of ligaments (connect bone to bone)
**bruising around joint
both have pain, swelling, limited ROM
25
strain
overstretching of **muscles** or **tendons** (connect bone to muscle)
think s*T*rain are *T*endons
**\*\*muscle spasms**
both have pain, swelling, limited ROM
26
when is the best time to examine an injury?
immediately after or else it'll become too swollen and bruised; or you can wait 4-5 days after
27
Ottawa foot/ankle rules is used when? and what is it?
“44-55-66-PM”
determines if an x-ray is needed
* 4: unable to do 4 steps immediately AND unable to do 4 steps at ED
* OR
* has pain of 5th metatarsal
* has pain at the 5caphoid
* OR
* 6: tenderness in 6 cm tip or posterior edge of lateral malleolus or medial malleolus
28
anterior cruciate ligament tear sx's, maneuvers, imaging
* Pivot and “Pop”/"snap" sound and immediate pain and swelling
* Anterior draw test
* Lachman test
* MRI confirms diagnosis but may not be necessary if hx is clear
29
meniscus tear causes and sx's
weight-bearing knee is twisted while partially flexed
normal wear and tear in older pts; obesity
twist/pivoting injury
* knee are “locking/buckling", popping, pain, swelling, stiffness
30
meniscus tear maneuver, imaging, and tx
* Mc Murray (to elect pop)
* Thessaly test
* joint tenderness
* Apley compression test
* MRI confirms
* conservative tx or PT (surgery if athlete)
31
patellofemoral pain syndrome (runner or jumpers knee)
causes & sx's
* Pain anterior portion of the knee, around and behind the patella
* Most common in women and younger active athletes
* Cause: abnormal tracking of the patella r/t weak quadriceps, poor flexibility, patellar hypermobility, tight iliotibial band, anatomic malalignment, or overuse.
* “knees giving out”
* Sx: pain when bending the knee (sitting for long periods of time, climbing stairs, jumping, squatting) and cracking or popping sounds.
32
patellofemoral pain syndrome exam & treatment
* patellar compression-grind
* patellar tilt
* patellar glid
* diagnostic: hx, PE, xray
* tx: RICE, orthotics, NSAIDs, PT
33
osteoarthritis
* progressive degenerative joint process
* asymmetric
* risk factors: age, obesity, prior trauma, genetics, repetitive activities, metabolic disorders, neurologic diseases, and hematologic conditions
34
lower back pain diagnostics
DON'T recommend routine imaging for acute or non specific back pain unless concern for fracture or red flags (age, weightless, fever, new weakness, bowel/bladder dysfunction)
35
criteria for imaging for back pain
* Bowel or bladder dysfunction - cauda equina
* New onset erectil dys
* Fever or night sweats (infxn, malignancy)
* Unintentional weight loss
* Night pain
* Personal history of cancer
* Saddle anesthesia
* History of recent trauma (e.g., fall or direct blow, NOT twisting or lifting)
* Age \>50 or \<18 years
* Patient with current or recent use of steroids
* Any suspicion of an infectious or neoplastic cause for low-back pain
* Pain for \>6 weeks
36
lumbar spinal stenosis (lower back pain) sx's and maneuver
* Narrowing of foramina which causes inflammation of nerve root and surrounding area
* back pain and neurogenic claudication (thigh/calf pain worsen when standing or walking and alleviated with sitting)
* legs feel ‘heavy’ or ‘wooden’
* causes radicular pain (pain shoots down leg from L5 after nerve)
* straight leg raise
37
degenerative disk disease (low back pain)
nerve impingement from osteophytes with aging and degenerative (arthritis on spine)
38
what is radicular pain and red flags for it?
from direct compression of the spinal nerve roots with resulting structural, biochemical, and vascular changes in and around spinal nerve
red flags: urinary retention, saddle anesthesia, fecal incontinence = cauda equine syndrome
39
medial vs lateral epicondylitis
maneuver?
* medial: golfers elbow (pain with wrist extension)
* pain with wrist flexion, forearm pronation, passive wrist extension
* lateral: tennis elbow (pain with wrist flexion)
* pain with passive wrist flexion & active wrist extension
* resisted extension of wrist for pain
40
epicondylitis treatments
* NSAID
* MRI if not improving but refer to ortho bc should be getting better with conservative management
* Oral or topical NSAIDs
* Splints
* Exercise
* Cortisone injection
* Surgery
41
tendonitis causes
* cell-mediated degenerative changes with advancing age, overhead or repetitive activities, heavy lifting, weakened rotator cuff, and muscle strain.
* deep ache in the shoulder, worse on abduction and internal rotation.
42
bursitis sx's, causes
* Inflamed and painful bursa: subacromial bursitis is the most common type.
* Causes: overuse
* Abrupt with pain felt at the tip of the shoulder or along the upper third of the humerus.
* Pain referred down the deltoid muscle into the upper arm.
* Pain when lifting the arm overhead or twisting it.
* Pain may be continuous and disrupt sleep.
* Impingement: Neer and Hawkins’ signs.
* Treatment: rest, ice, NSAIDs, cortisone injection, PT, and surgery.
43
rotator cuff consists of what muscle? and which one most commonly injured?
* Supraspinatus
* most commonly injured
* Infraspinatus
* Subscapularis
* Teres minor
44
frozen shoulder vs rotator cuff tear
pain with only active ROM: rotator cuff tear
pain with both active and passive ROM: frozen shoulder
45
nurse maid elbow aka Annular ligament displacement
* displacement of annular ligament between radius and ulna from swinging child from pulling kids arm
* NOT painful and non specific
* sx's:
* Reluctant to move arm
* Tenderness over radial head
* Resistance to supination with arm
46
Pain over the greater trochanter or ischial spines; worse with activities and lying on the affected area
Trochanteric bursitis
* Causes:
* Injuries
* Overuse
* Incorrect posture
* Previous surgeries
* Other conditions: RA, OA, gout
* Examination:
* Hip, back, knee, abdomen, vascular and neurological systems
* Gait analysis
* ROM
* Treatment:
* NSAIDs
* PT
* Cortisone injection
* Surgery
47
avascular necrosis (osteonecrosis)
death of bone tissue d/t lack of blood supply
risk factors: fractures, dislocations, LT steroids, etoh, 30-50 yrs, radiation, SCA, SLE
48
Osgood schlatter disease
* Caused by tendon pulling on growth plate of the shinbone (tibia)
* Growth spurs in children and adolescents
* Symptoms:
* Pain and swelling just below the patella
* Pain worsens with activities such as running, kneeling, jumping
49
slipped capital femoral epiphysis (SCFE)
* Damaged growth plate causing the proximal femoral head (epiphysis) to slip off of the metaphysis
* Symptoms: pain in the groin, hip, thigh or knee; inability to ambulate or limp;
* Risk factors:
* Adolescence
* Male \>
* Obesity
* African-Americans, Pacific Islanders and Latinos
* H/O radiation therapy or trauma
50
ankle sprains
* Ligamentous injury caused by an abnormal motion, a sudden change in direction, or a misstep on an uneven surface.
* women, adolescents \>
* joint pain and swelling, ecchymosis, decreased ROM, inability to bear weight.
* Diagnostic: x-rays to exclude fracture, CT scan or MRI if indicated
* Treatment: R.I.C.E, oral or topical NSAIDs, non-weight bearing
51
achilles tendon rupture
sudden weakness in the ankle, inability to raise up on the toes, limp and pain.
* Diagnostic: history and physical exam, Thompson test, US, MRI
* Treatment: mobilization (brace, long-leg cast or rigid boot x 6 weeks) or surgery
52
morton neuroma
* Perineural fibrosis of the plantar nerve at the point where the medial and lateral branches converge
* Symptoms: severe pain and burning in the region of the third web space, pain aggravated by foot elevation.
* Risk factors:
* Women (middle-aged)
* Trauma
* Ischemia
* Impingement
* Intermetatarsal bursitis
* Conditions such as claw toes and bunions
* Diagnostic: Mulder sign, US, MRI
* Treatment: wider toe shoes, insoles, separation of toes with a small pad
* NSAIDs, cortisone injection, surgery.
53
Ottawa knee rules
* \> 55 yrs old
* tenderness head of fibula
* tenderness patella
* inability to bear weight
* inability to flex knee \> 90 degrees
*younger children more likely to have fractures d/t open growth plates than sprains*
54
adult pt with tenderness and swelling over olecranon
olecranon bursitis
tx: xray if indicated, aspiration, oral, topical NSAIDs, oral antibiotic, elbow pads, cortisone injection)
Refer if - infxn, joint involvement, decreased ROM
55
fluid filled sac that can change in size, around joints/tendon sheets in carpal or surface of wrist
pain, weakness, bone changes, interferes with joint fun
ganglion cysts
xray, US, MRI, immobilize or aspirate
56
inflammation of abductor policies and extensor pollicis breves tendons along dorsal wrist
+ Finkelstein test
de quervain tendosynovitis
57
avascular necrosis (osteonecrosis) / Legg Calve Perthes Femur
* Death of bone tissue due to lack of blood supply
* Risk factors:
* Fractures and dislocations
* Long-term use of high-dose steroids
* ETOH
* Ages 30 -50
* Radiation, sickle cell anemia, SLE, hyperlipidemia, organ transplant
* Diagnostic: x-rays, MRI and CT scan, bone scan
* Treatment: rest, exercise, NSAIDs, osteoporosis drugs, antihyperlipidemic drugs, blood thinners, electrical stimulation, and surgery
58
Patellar swelling and pain from
repeated stress causes
inflammation below the patellar
tendon where it attaches to the
tibia. New bone growth can
occur where the tendon pulls
away from the tibia, resulting in
a bony lump.
pain below patella, worsens with running, kneeling, jumping
osgood schlatter disease
growth spurs in children/adolescents
tx: rest, ice, knee brace, analgesics
59
ottawa knee rules
“WAIT”
* **W**eight bearing for 4 steps NOT possible
* **A**ge _\>_ 55 yrs
* **i**nability to flex knee to 90 degrees
* **t**enderness isolated to patella or head of fibula
60
osgood schlatter disease diagnosis and intervention
* - xray
* -NSAID and PT
* -resolves after growth spurt ends
61
-abrupt knee pain with tenderness/swelling
-ROM full but limited by pain
- joint overuse, trauma, infection, arthritis
- affects those contantly on knees (plumbers, carpet layers) or atheletes with direct blows or falls to the knees
prepatellar bursitis
62
prepatellar bursitis diagnosis and intervnetion
- Hx & PE
- #1: bursal aspiration
- ice x 15 mins 4xday
- if no improvements after 4-8 wks, intrabursal corticosteroid injection
