Week 5 Orthopedics Flashcards
physical exam of musculoskeletal condition using the acronym..?
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
indication for imaging
- Suspicion of non MSK etiology
- Neoplasm
- Trauma plus functional loss
- Failed conservative measures
- RICE, rested, iced
- Patient insistence
What is X-ray good for?
acute injuries to identify bone or tendon involvement and bone tumors
next best step after hx & PE; #1 imaging
what is CT good for?
- shows extent of bone destruction and exact extent of bone lesion
- quantitate risk fo pathologic fractures from lesion
- high radiation exposure
what is MRI good for?
- shows soft tissue lesions or non-bone forming bone tumors
- planning surgery for bone tumors (detects bone tumors)
what does the ultrasound NOT do? and what does it rule out?
- does not penetrate bone and doesn’t differentiate benign/malignant
- can r/o tendon rupture
what is a bone scan good for?
- 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
Spurling’s Maneuver detects what?
detect cervical radiculopathy
pt extends neck and laterally tilt head to affected side. I apply downward force top of head.
empty can test
- 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
neers sign test
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
hawkins test
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.
phalen test
detects carpal tunnel syndrome
tinel’s test
detects carpal tunnel syndrome
tingling sensation if tap injured nerve or distal to lesion
drop arm test
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
crossover test
detects AC joint pathology
thompson test
detects achilles tendon rupture
squeeze calf and should see flexion of foot. if don’t see flexio, then it’s a + test
Lachman test
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
Mc Murray test
detects tear in the meniscus
Patrick FABER test
FABER: Flexion, Abduction and External Rotation
+ meaning pain at hip or groin region and means sacroiliac joint involved; dysfunction within hip joint
Straight leg raise
detects lumbar disc herniation/radiculopathy
Adsons test
detects thoracic outlet syndrome (compression of subclavian artery)
indications for physical therapy
- Traumatic disorders with mild to moderate functional loss
- Chronic postural pain disorders
- Recurrent pain disorders
- Mechanical MK disorders
- Early nerve entrapment
- Symptomatic joint degeneration
indications for orthopedic referral
- 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
sprain
overstretching or tearing of ligaments (connect bone to bone)
**bruising around joint
both have pain, swelling, limited ROM
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
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)
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.
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
degenerative disk disease (low back pain)
nerve impingement from osteophytes with aging and degenerative (arthritis on spine)
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
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
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.
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
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
inflammation of abductor policies and extensor pollicis breves tendons along dorsal wrist
+ Finkelstein test
de quervain tendosynovitis
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
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
