Orthopedics
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| Acromion process Type I: | Flat, smooth acromion at clavicular joint; normal subacromial space
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| Acromion process Type II: | Hooked acromion; subacromial space mildly decreased
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| Acromion process Type III: | Hooked acromion with spur; subacromial space significantly decreased
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| Night pain: may indicate | Rotator cuff injury, Impingement, Frozen
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| Scapular winging/trauma = | Serratus or Trapezius dysfxn
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| Unable to externally rotate = | Posterior dislocation
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| Supra/infraspinatus wasting = | RCT or suprascapular n. palsy
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| Pain or “clunk” w/ motion = | Labral tear
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| Rotator cuff: tests for impingement | Neer; Hawkins (both passive)
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| Test of AC joint | crossover (passive)
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| Tests for biceps tendonitis | Speeds; Yergason (both active)
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| Tests for anterior shoulder instability | Sulcus; apprehension & relocation (both passive)
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| Tests for labral tears | Obrien; anterior slide; crank
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| Circulation tests | Adson; Allen; Roos
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| Shoulder imaging: Standard views: | AP and axillary
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| Imaging: Can get Y view if: | suspected dislocation or scapular fx (trauma)
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| Best imaging for RCT | CT arthrogram good, but MRI is better (invasive)
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| Posterior SC Dislocations: Concern | Can be life-threatening; immediate referral and CT
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| Posterior SC Dislocations: Mgmt | Closed reduction or surgical reduction
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| 95% of shoulder dislocations are: | Anterior Dislocations
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| Biceps Rupture: usually involves: | long head of biceps (short head rupture rare)
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| Avulsion of the antero-inferior glenoid labrum = | Bankart lesion
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| Compression fx of posterior humeral head = | Hill-Sachs lesion
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| Shoulder dislocation: xray & reduction maneuvers (3): | Rowe (opposite ear over head), Stimson (prone), Hippocratic (traction)
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| Most common cause of shoulder pain | Impingement
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| Single most sensitive and specific physical exam finding in rotator cuff tears | weakness with resisted external rotation and or abduction
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| Posterior fat pad on elbow x-ray = | Always pathologic
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| Posterior fat pad sign in adults may indicate: | radial head fx
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| Posterior fat pad sign in kids = | supracondylar fx
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| Radial Head Subluxation AKA | Nursemaids Elbow
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| Radial Head Subluxation = | Annular ligament entrapment
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| Distal Humerus Fx: use ____ Classification | Mehne & Matta
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| Most common elbow fracture in children | Supracondylar Fx
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| Radial Head Fx: Mgmt: Type I (non-displaced) | Posterior splint/sling for 3-5 days; Early ROM exercises
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| Radial Head Fx: Mgmt: Type II (displaced) | Tx as in Type I if < 30% head displaced (Otherwise: ORIF)
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| Radial Head Fx: Mgmt: Type III (comminuted) | Excision of frags or complete radial head
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| Radial Head Fx: Mgmt: Type IV (dislocated) | Same as III
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| Olecranon Fx: Check: | N/V function; Ulna n.
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| Gilula Arcs: articular surfaces of carpal bones s/b: | parallel, joint spaces similar width & parallel cortical margins
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| Gilula Arcs: any break in the lines or overlapping of normally parallel joint spaces suggestive of: | joint injury
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| Tinel Sign | Percuss over median n. carpal tunnel; tingling or pain in median n. distn = Pos
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| Phalen Test | Acute flexion of wrists for 60-90 sec => numbness & tingling over median n. distn
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| Scapholunate Dissociation: S/S | Wrist pain & instability; Letterman sign; Watson Test
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| Ulna Impaction Syndrome: leads to: | lunotriquetral ligament attrition
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| Kienbock Dz = | Lunatomalacia
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| Monteggia fx = | Ulna shaft fx; Proximal radius dislocation
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| Monteggia fx: tx | ORIF vs long arm cast for 6 weeks
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| Galeazzi fx = | Radial fracture; distal Ulna dislocation
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| Galeazzi fx: tx | ORIF vs long arm cast 6 weeks
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| Both Bone Forearm Fx: Non displaced, non-angulated fx: | may be put in long arm cast 6 wks
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| Smith Fx: MOA | Fall on back of hand; Hyperflexion injury; volar angulation of distal fragment
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| Smith Fx: minor angulation = | acceptable; short arm cast 4-6 wk
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| Smith Fx: significant angulation = | Reduction, CRPP, ORIF
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| Barton Fx = | Intra-articular fracture; displaced radial articular fragment
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| Barton Fx: tx | ORIF
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| Chauffeur Fx: MOA | Oblique fx through the base of the radial styloid
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| Chauffeur Fx: Tx | Long arm cast for 1 mo. followed by short arm cast for 2 wks
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| Torus Fracture = | Buckle fracture with intact periosteum
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| Scaphoid Fx: 1/3 will develop: | osteonecrosis
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| 90% of distal radial fractures are: | Colles Fx; FOOSH injury; dorsal angulation of distal fragment
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| Most common carpal fx = | Scaphoid Fx (2/2 FOOSH)
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| CMC Osteoarthritis: Compression test | moving CMC Joint w/ longitudinal load applied
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| CMC Osteoarthritis: Grind test | grab the metacarpal base & rotate thumb
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| Dupuytren Contracture: Rx | No conservative Rx; Surgery indicated for fixed contracture of more than 30 degree
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| Trigger Finger = | Stenosing Tenosynovitis
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| Trigger Finger: Injection: | At site of tenderness/ nodule; Marcaine/ Kenalog; 25 g needle into sheath, not tendon
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| Hand Lacerations: No Mans Land = | btw distal palmar crease & PIP joint crease
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| Septic Tenosynovitis = | Bacterial infection of a tendon & tendon sheath
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| Septic Tenosynovitis: Hx | puncture, bite, or tooth wound (fight bite); progressive swelling & pain over 24-48 hr; Kanavel Sx:
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| Kanavel Sx: | Fusiform swelling of finger; sig tenderness along course of tendon; marked pain on passive extension; flexed finger at rest
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| Septic Tenosynovitis: Etiology: | Staph, Strep, MRSA
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| Septic Tenosynovitis: Rx: | IV Abx, I&D if progressing; consider tetanus & rabies prophylaxis
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| Most common digital infection = | Infection: Paronychia
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| Infection: Paronychia = | Localized staph cellulitis in gutter along fingernail
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| Infection: Paronychia Rx: | Soaks, PO antibiotics; digital block & I&D when abscess is organized
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| Infection: Felon = | Abscess of pulp space of distal phalanx
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| Subungual Hematoma: Tx | Evacuate hematoma; trepanation (burr hole into nail); X-ray
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| Subungual Hematoma: If > 50% of nail is affected: | nail s/b removed & laceration sutured
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| Osteoarthritis: Heberdens nodes: | DIP joint
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| Osteoarthritis: Bouchards nodes: | PIP joint
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| Boutonniere Deformity = | Loss of central slip insertion on proximal dorsal middle phalanx
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| Boutonniere Deformity S/S | Flexion of PIP & hyperextension of DIP
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| Swan Neck Deformity = | Joint Synovitis secondary to RA
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| Swan Neck Deformity on physical exam: | Flexion of the DIP & hyperextension of the PIP
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| Skiers Thumb AKA: | Gamekeepers thumb
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| Skiers Thumb: Stener lesion = | Aponeurosis interposed between ligament
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| Bennet Fx = | Fx of thumb metacarpal base
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| Bennet Fx: Tx: Comminuted = | Rolando fx
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| Metacarpal Fx: 5th MC neck fx = | Boxers fx
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| Metacarpal Fx: MC Neck: Tx: with > 40 degree angulation or extension lag: | CRPP
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| Hook of Hamate Fx = | Direct impact from racquet, baseball bat
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| Mallet Finger = | Rupture of extensor tendon distal to DIP
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| Mallet Finger: PE: | Unable to actively extend DIP
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| Jersey Finger = | Forceful extension of DIP; FDP avulsion
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| Jersey Finger: S/S | Pt unable to flex DIP; most common to ring finger
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