Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
CS-Y2S1B1
Othropedics
| Orthopedic Disease | Features |
|---|---|
| Toddler Fx of Tibia | child stops walking, tender tibial diaphysis, normal x-ray; cast anyway and check in few wks for callus |
| Child abuse signs | TRANSVERSE fractures can only happen from direct blow; spiral fractures may be suspicious |
| Salter-Harris Grading of Epiphyseal Plate Injuries | I-V: "SALTR" - sliced physis, above epiphysis (met), lower than physis (epi); through entire epiphysis (epi, phy, met); raised d/t compression |
| Limping Child | suspect tumor of infx if child has pain, night pain, or refuses to use joint/limb; sheck spine, leg length, DDH (dev dysplasia of hip); paplate growth plates and ROM; use MRI/CT |
| Pediatric Elbow Ossification Centers | "CRITOE" 1, 3, 5, 7, 9, 11 (Capitellum, Radial head, "internal" medial epicondyle, Trochlea, Olecranon, "External" lateral epicondyle) |
| Polydactyly: Simple vs. Complex | duplication d/t failure of differentiation: skin only vs. skin and bone fusion...not a medical emergency |
| Pediatric Foot deformities that resolve w/o surgery | metatarsus adductus, positional calcaneovalgus |
| Congenital vertical talus (rocker bottom) foot | usually associated with other genetic or neuromuscular disorders |
| Pediatric foot problems d/t casing or bad shoes | skew foot, overriding 5th toe |
| Club Foot (Talipes Equinovarus) | CAVE: Cavus (forefoot), Adduction (forefoot), Varus (subtalar), Equinus (hindfoot) |
| Olecranon bursitis | non-tender mass from falling on elbow; drain and inject lidocane |
| Radial head dislocation | "nursemaid's elbow;" common preventable injury in 1-3yo children d/t sudden yank on arm; Tx: SUPINATION and FLEXION |
| Radial Head Fractures | 1. Non-displaced: positive fat pad, can flex/extend; 2. Displaced: >2mm may need internal fixation of mechanical obstruction limiting ROM |
| Elbow Dislocation | Very common with falls; #1 in kids falling with outstretched arms; Tx: pop it back into place, splint, NSAIDs |
| DIP dislocations | RARE |
| PIP dislocations | 1. DORSAL most common d/t hyperextension; Tx: flex wrist and buddy tape; 2. Volar-keep wrist in neutral with PIP in extension |
| Meniscus | Knee occasionally locks; McMurry Test - rotation of tibia on femur in supine; Apley grind - prone |
| Lateral Collateral Ligament | contols varus motion of knee; isolated injury is RARE; repair if ACL or PCL are injured and knee has ROTATORY instability |
| Medial Collateral Ligament | controls valgus motion/ER of knee; Injury d/t Direct Blow to lateral aspect; Tx: NONSURGICAL |
| PCL | Injury d/t dashboard injuries; Tests: Posterior Drawer, Quad Active, Posterior Sag (best sign); Tx: conservative b/c surgery isn't that good |
| ACL | Most common in women; Tests: Lachman's (30*), anterior drawer, pivot shift (in OR), MRI; Tx: based on ACTIVITY LEVEL and INSTABILITY...surgery only for people who want to twist knee b/c 80% do well conservatively; autograft (patellar tendon)/allograft |
| Patellar femoral syndrome | most common knee injury (pain walking down stairs), unknown cause, dysfunction d/t Q-angle; Tx: VMO, hyaluronic acid injections |
| Patellar tendon rupture | failed extensor mechanism (inferior pole dimple); surgery needed to reattach patella and debride degenerative ends |
| Patellar tendonitis | "jumper's knee;" volleyball/soccer; anteior knee pain w/crepitis and 4 stages: 1. pain after activity; 2. pain at start of activity; 3. pain at rest and w/activity; 4. complete rupture; Tx: PT or reattachment; Osgood-Schlatter's disease in adolescents |
| Quad Rupture | failed extensor mechanism; MORE COMMON than patellar tendon rupture (superior pole dimple); pain/swell knee/thigh; Tx: Conservative and surgery if chronic |
| Knee Bursitis | 1. Prepatellar; 2. Intrapatellar; 3. Pes anserine (goose foot) - sartorius/gracilis/semitendinosis; pain on medial side of knee common w/OA and runners; Tx: aspirate, manage conservatively |
| Tibio-Fibular Somatic Dysfunction | Posterior proximal fibular head causes paresthesias d/t common fibular n.; ER of tibia and dorsiflexion of ankle; posterior lateral malleolus and anterior prox fibular head; Tx: OMT |
| Iliotibial Band Syndrome | friction and irritation; Dx: Obers Test; Tx: RICE, run on flat track |
| 5th Metatarsal Fx | ballet dancers; WBAT in hard shoe unless Jones fx (metaphyseal/diaphyseal jxn) --> ORIF b/c of avascular region |
| Plantar Fasciitis | overuse of flexor tendons on plantar surface (fat female, runners, flat feet); pain in AM w/first steps; Tx: conservative NSAIDs and stretching, night splint, steroid injection |
| Achilles Tendonitis | Thompson test (squeeze calf); MRI; pain after exercise, hill climbing |
| Ankle fracture x-rays | mortise view, lateral view, AP view; cast 6wks NWB if non-displaced; Displaced needs ORIF |
| Ankle Sprain: Grade I | stretched ATFL, Negative anterior drawer/talar tilt; Tx: RICE |
| Ankle Sprain: Grade II | Complete sprain of ATFL/Partial of CFL; some instability; Mild anterior drawer, Negative talar tilt; Tx: RICE and splint |
| Angle Sprain: Grade III | Complete tears of ATFL and CFL; unstable, Postive anterior drawer and talar tilt; Tx: short leg cast 3-4wks, or surgery for chronic sprained ankle |
| High, syndesmodic ankle sprain | pain on squeeze test, dorsiflexion and external rotation; Tx: conservative |
| Avascular Necrosis of Hip | d/t dislocation or fx; Tx: Preservation of hip (decompression and grafting) OR Late stage prosthetic replacement of hip |
| Hip Dislocations | EMERGENCY!! most are posterior dislocations d/t car accidents; thigh is flexed and internally rotated; Reduce w/in 6hrs to avoid vascular injury; x-ray prior and CT after (check for acetabulum fx) |
| Femoral Neck Fx | 1. Subcapital Non-displaced: small surgery w/cannulated screws; 2. Subcapital Diplaced: big surgery; hemiarthroplasty |
| Intertrochanteric femur fx | pain at groin; stable or unstable; surgical fixation w/screws and WBAT as soon as possible; excellent blood supply - heals well |
| Hip fx in general | pain on ROM, asym length and ER of foot when supine; Groin pain (fx, dislocation, OA, infection) or Lat Hip Pain (gr troch bursitis); Tests: Trendelenburg gait (abductor weakness), Oberg test(inflamed/tight ITB); CT or MRI-occult fx; SURGERY d/t blood sup |
| Rotator Cuff Tear | supraspinatus is most often affected (infraspinatus, subscapularis, teres minor); Lidocaine test - pain doesn't resolve; drop arm test; Hx of working overhead or fall; weak abduction/ER; surgery based on activity or >50% torn |
| Rotator cuff DDx | bursitis, calcific tendonitis, subacromial impingement |
| Subacromial impingement syndrome | one of the most common causes of pain in adult shoulder d/t pressure on RC from acomrium when arm is lifted; radiates to deltoid tuberosity/bicep tendon; night pain; Lidocaine test relieves symptoms; Tx: rest, PT, NSAIDs, activity modification |
| Acute back pain workup | get an MRI if myelopathy is progressive; DXM CCsteroid relieves inflam/arthritis/some cancer |
| Spinal cancers | secondary to metastasis of breast and prostate cancer (thyroid, lung, kidney); 1. bone scan (most sensitive), 2. x-ray (look for compression fx), 3. CT/MRI, 4. biopsy |
| Chronic Regional Pain Syndrome | pain out of proportion ot injury; vasospastic (Raynaud's) or related to nerve injury |
| Dupuytren's Disease | associated w/EtOH and genetics; CT disorder causes contracture/nodule of flexor tendon in hand distal to palmar crease; surgery only for fxn not for pain reduction |
| Compression neuropathy: Carpal Tunnel | entrapment/compartment syndrome causes neuro/vascular disease distal to compression; Dx: parasthesia/ischemia; Tinnel's/Phalen's Tests; Tx: splint/OMT |
| Pronator Tunnel Syndrome | proximal median n. compression; resists pronation of forearm; provocation at pronator teres |
| Ulnar tunnel syndrome | at wrist; d/t ganglion cyst, muscle, ulnar a. aneurysm, or hamate hook fx |
| Cubital (funny bone) tunnel syndrome | ulnar n. operative in situ decompression/anterior transposition at elbow |
| Radial tunnel syndrome | pain at lateral elbow, work related, NOT lateral epicondylitis, painful resisted supination |
| Referred back pain | peptic ulcer disease, cholecystitis, pancreatitis, retrocecal appendicitis, AAA (worst back pain in life), pelvic inflammatory disease, prostatitis, endometriosis |
| Neural claudication | comfortable hunched over (sitting/bending/leaning); Tx: PT, aerobic activity and NSAIDs |
| Vascular claudication | comfortable standing, NOT walking (unless downhill) or sitting; hairless extremities, calf pain |
| Night back pain | indication of tumor or infection w/fever, malaise and massive weight loss |
| Spondylolysis | arthritis of spine |
| Spondylolisthesis | forward slippage of vertebral body on the one below or on sacrum; Tx: fusion or disc replacement |
| Spine evaluation | pain (location, axial-myofascial strain, degen disc, instability; radicular-lumbar sciatica); sensory loss (dermatomal? generalized?); weakness (isolated? generalized?) |
| Lesegues sign | straight leg raise w/dorsiflexion of foot causes pain in buttock from sciatica |
| Straight leg raise | + sign for sciatica if pain radiates down past knee; Contralateral leg raise pain is 95% pathognomonic for herniated disc!! |
| Cauda equina syndrome | bowel/bladder incontinence; saddle anesthesia; bilateral LE weakness; usu d/t large disc herniation |
| Compression fx of lumbar spine | non-traumatic wedge-shaped; Tx: bracing, pain management, PT; surgery for instability; x-ray/CT/MRI |
| Metastatic disease of T spine | MOST COMMON region for spinal metastasis; can cause fx, kyphosis, etc...bone scan to look for other mets |
| Compression fx of thoracic spine | vertebral body compressed in stellate pattern d/t significant force in young/osteoporosis in old; Dx: x-ray, dexa scan for osteoporosis; Tx: depends on spinal stability in T/L spine (3 columns: anterior (wedge-stable), middle, posterior); pain/brace/OP |
| Spinal stenosis | can occur in 3 places: central canal/subarticular lateral recess/foraminal nerve root exit; flexion can relieve pain; pseudo neuroclaudication w/pain on standing erect; Tx: PT/NSAIDs, steroids, decompression laminectomy/fusion |
| Herniated nucleus pulposus | check for cauda equina syndrome (anal sphincter tone w/ trauma); Dx: MRI |
| Thoracic outlet syndrome | cold limbs, parasthesia, transient pain, pallor; Tests: 1 Adsons - dec pulse w/ inhalation/cervical rotation; 2. Wrights test - lift arm over head and pulse dec; 3.Costoclavicular maneuver - hyperextend/hyperpronate arm to dec pulse; Tx: PT, sling/stretch |
| Ssheuermann's kyphosis | goose-neck deformity; anterior wedging of 3 consecutive vertebrae w/apex at T6-8 or T10-12; compensatory hyper-lumbar lordosis |
| Scoliosis | idiopathic, congenital, degenerative (osteoporosis), neuro-muscular (never brace); common curves: R-thoracic, L-lumbar, double curve; severe disese causese lung vol restriction (cor pulmonale - Rventricle hypertrophy/pneumonia) |
| Treatment of scoliosis | 52degrees - critical angle=surgery; Skeletally mature: observe/brace (20-50)/surgery (40-50); Skeletally mature: surgery for pain, >60degrees or cosmetics |
| Milwaukee brace | scoliosis apex above T7 |
| TLSO - Boston brace | scoliosis apex below T7 |
| Most common cause of back pain | 1. Muscle spasm, 2. muscle strain, 3. arthritis, ...zebra: herpes zoster |
| Spinal nerves exit below their corresponding vertebral body | herniated discs will NOT irritate the nerve roots at their level, rather the nerve roots from the segment above |
| T-spine has most tumor metastasis | b/c of internal and external venous plexuses...lots of drainage from costal veins |
| Ligaments of spinal column | suprasinous, interspinous, ligamentum flavum, (spinal cord), post longitudinal, anterior longitudinal |
| Most spinal cord injuries are: | crushing injuries that displace material into neural foramen and impinge on nerves or spinal cord; lacerations/transections are very rare |
| Whiplash Associated Disorder (WAD) | commonly d/t acceleration/deceleration injuries; pain develops slowly over several hrs/days; nerve root irritation causes muscle spasm (occasionally torticollis); occiptial headaches; later back pain; MRI may be useful |
| C1-C2 instability | Rheumatoid arthritis, Down syndrome, ankylosing spondylitis (brittle/stiff) |
| Most common Atlas (C1) fracture | Jefferson fracture d/t axial loading; shallow diving; downward force pushes occipital condyles into lateral masses of atlas |
| Most common Axis (C2) fracture | Type II Odontoid fracture; fx at base of odontoid; unstable |
| Physical exam findings for fx of atlas or axis | death, head supported by hands, cannot nod/rotate head, severe occipital headache; MUST BE IMMOBILIZED to avoid death |
| C-spine x-rays: | AP and lateral; Open mouth view - odontoid process of C2; Swimmer's view - C7 on fat people; |
| Soft cervical collars | soft tissue injury |
| Hard cervical collars | isolated fx; SP, TP, lamina; OR vertebral body injuries: extension teardrop or compression fx |
| Immediat stabilization and Halo fixation | Burst fx or compression fx |
| Surgical repair for cervical injuries | 3 Conditions: 1. neurological deficit, 2. Spinal instability, 3. intractable pain; traumatic disc disruption; burst fx; flexion teardrop fx; |
| epiphysis | ends of bone that ossify separately and ankylose later |
| physis | growth plate |
| metaphysis | secondary ossification ctr |
| diaphysis | shaft of long bone |
| x-rays | good for bone; fx, maturity, pathology |
| MRI | softer tissues; tendons, ligaments, cartilage |
| CT | bones and organs |
| bone scan | osteoblastic activity; fx, inflammation, tumor; very sensitive, not specific |
| critical dislocations | compromise blood supply; must be corrected w/in 6hrs |
| Recellularization | packing an injury site w/ bone graft, growth factors, bioactive reagents to encourage cell attachment and function |
| Directionof fractures | transverse, oblique, spiral, longitudinal |
| Type of fractures | avulsion, greenstick, displaced (name displacement and angulation) |
Created by:
bscaryp