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244 Cards in this Set
- Front
- Back
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A complete or partial tear of ligaments occuring either within the ligaments themselves, or when they are torn from thier attachment at the bone
a. sprain b. strain c. fracture d. subluxation |
A. sprain
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A partial disruption of a musculotendious unit short of complete rupture
a. dislocation b. Sprain c. Avulsion d. Strain |
Starin ( Muscletendinous)
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What is the definition of closed fracture?
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skin is not broken, and there is no wound communicating with the fracture site.
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What is bone broken in more than two places/
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comminuted fracture
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What is the defiintion of Non displaced fracture?
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Hairline fractre without loss of anatomic configuration
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What is the definition of Articular fracture?
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involves joint surfaces and may be associated with ligament injuries and with complete or partial dislocations
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A bending or angular deformity may result from separation of fracture fragments or from asymmetric impaction of cancellous bone fragments?
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Angulated fx
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What is the defintion of Subluxation?
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partial removal of a bone end from its joint causing a stretching of ligaments or tendons
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Inflammation of tendons and tendon muslces attachments points?
a. Subluxation b. dislocation c. tendonitis d. fracture |
Tendonitis
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What is the inflammation of tendon sheath and its synovial membrane?
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Tenosynovitis
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What is the etiology of Fractures?
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Trauma
Pathological (bone cyst) Stress |
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Pt has a fracture, at what area would they have Paresthesia?
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distal to the extremity
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What could be some complications of Fractures?
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Neurologic deficit
Vascular injury Compartment syndrome Mal uniont, Non union Arthritis Osteomyelitis |
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What does a pt need for fracture to make a definitive diagnosis?
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Radiological studies
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What is the most common site of fracture of the clavicle?
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middle third 80% in this location.
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What are some s/s and exam findings of clavicle fx?
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Swelling, dec. function
E/E/E, localized tenderness ARM slumped inward and down ward |
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What is the treatment for clavicle fx?
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sling (immobilization is usually d/c 3-4 wks
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What is the disposition with pt who fx the clavilce?
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No duty 24-48 hrs
LD 6 wks |
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What could be some potential complications of Clavicle fracture?
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Non union
Mal union Cosmetic deformity Pneumothrox |
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What are the 4 major type of vertebral fx?
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COmpresson
Burst Flexion-distraction Fracture-displacment |
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What are some exam findings for Vertebral fx?
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Extremity weakness
Variable sensory changes below level of lesion Bowel and Bladder dysfunction Radicular signs |
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What is the treatment for Vertebral Fx?
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C-spine
Airway assessment and Managment high flow Oxygen IV access Consultation with neurology and orthpedics |
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What are some medications you can give to pt with Vertebral fx?
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Methylprenisolone 30mg IV over 15 min follow by 45 minutes with no medi
Opiods NSAIDS |
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Whta is the most important prognositc factor in pt with Vertebral fx?
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initial neurological status
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What is the etiology of Pelvic bond fx?
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violent MOI (MVA, MCA, GSW or falls
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What should you be thinking about when you suspect a pelvic fx?
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multisystem injuries
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What are some symptoms of Pelvic fx?
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pain
Limited ROM displacement or deformity Perineal edeam/ecchymoses |
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What will you find on exam with Pelvic fx?
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Pain
Creptius Instability on palpatiion of pelvis hematoma over inguinal ligament or perinueum Gross hematuria Vaginal/rectal bleeding |
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What could be a differntial dx of Pelvic fx?
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dislocation
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What is the treatment plan for Pelvic fx?
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unstable wrapped circumferentially with a bed sheet that is pulled providing necessary tension to reduce pelvic volume and stem hemorrhage
Treat for shock |
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What is the etiology of Lower and upper extremity fractures?
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Direct trauma or rotational or torsion stress
FOOSH injury Upper Pathological (osteoma, osteoporosis) |
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What are some differential diagnosis of lower/upper ext fx?
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Sprains
contusions dislocations |
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What are some Indepedents operational labs/test that we can do for pts with Lower/upper ext frx?
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UA dipstakc
HCT |
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What are some treatment procedures for Lower/upper ext fx?
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splint (hare traction)
RICE Orthopedic consultation |
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When should a pt f/u after lower/upper ext fx?
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after orthopedics eval and cast
3-4wks for eval then 1-2 wks for cast/s;ong removal PRN for pain mang. |
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Some complication of lower/upper ext fx?
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Loss of ROM
Non union Arthritis |
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What is the most common carpal bone fracture?
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Navicular or Scaphoid bone
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What is the Scaphoid bone fx?
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FOOSH or by axial load directed along the thumb's metacarpal
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What is the most common fracture of the hand?
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boxers fx 4th 5th metacarpal
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What are some S/S and exam findings for Boxer fx?
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Pain, swelling deformity
Decrease ROM Tenderness of area Edema over site Involved finger may appear shorten KNuckle may be depressed |
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What is the treatment plan for Boxers fx?
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Ulnar gutter splint for 3-6wks
RICE Pain mang (opiods, antibiotics) |
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What are some complications Boxer fx?
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Secondary infection (Fight bite)
Mal union |
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What is a transverse fracture through the base of the 5th metatarsal, one of the most common fx of all metatarsal fx?
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Jones fracture
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What is the etiology of Jones fracture?
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trauma(direct, twisting, falls from signinifant height)
"Fatigue fx" (recruits) |
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What are some S/S and exam findings of Jones fx?
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Pain on wt bearing
Swelling Pain over middle and outside of foot Edeam/ecchymosis/tenderness over the fracture metatarsal/Possible deformity |
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What is the defintion and etiology of Flexor/achilles tendon lacerations/
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Injuries to tendons usually resulting from lacerations trauma or crushing injury.
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What are some symptoms of Flexor /achilles tendon lacerations?
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swelling
Numbness to each side of finger (flexor) Acute onset of pain Loss flexion/extenstion (achilles) Unable to stand on toes, run or climb Loss of ROM distal to injury |
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Exam findins of laceration to flexor or achilles tendon?
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Loss planatar flexion (+thompson test)
Gap or depression about 2" above the heel Edema to area Flexor (Loss of hand/flinger flexion MOI (crushing, laceration) |
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Treatment plan for pt with Flexor /achilles tendon lac?
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Refer to Hand specialist/orthopedics
Repair would and splint in postion of function (flexor) Splinting in plantar flexion, nonwt bearint (achilles) |
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Complication of flexor/achilles lac?
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Loss of flexion/full functioning
Flexor contractures |
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Most common dislocated joint in the body?
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shoulder
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What is a definition of Dislocations?
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Complete separation of the contact btw two bones in a joint.
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What type of shoulder dislocation is approx 95-98% of all dislocation?
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combination of abduction, extension, and external rotation with sufficient force will cause an anterior dislocation
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What will you find for shoulder dislocation?
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slight abduction an external rotation
shoulder is "Squared off", lacking the normal rounded contour Affected hand may appear to be touching the knee even though standing erect. Tenderness to palpation |
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Whta is the Treatment procedure for Shoulder dislocation?
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Shoulder reduction (water or sandbag)
sling and swathe 3-6 weeks |
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What are some complications of dislocation?
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Recurrent dislocation
Fractures Neurovascular injury |
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What type of xray will you order for a individual with Shoulder dislocation?
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y-view, axillary, AP
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What is a Posterior dislocations (accounts for 90% of hip dislocations?
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knee and hip are flexed and a posterior force is applied at the knee
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What are some symptoms of Hip dislocation?
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Pain in hip and buttock area
loss of sensation in the posterior leg and foot Inability to walk and adduct the leg Local hematoma formation (ant. dislocaiton) Deformity |
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What are some signs and findings ofr Pos. dislocation of hip?
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affected limb is shortened , adducted , and internally rotated, with the hip and knee held in slight flexion
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What is an Anterior dislocation?
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Leg is externally rotated, abducted , and extended at the hip (snow ski fall)
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What is the treatment plan for Hip dislocations?
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IV access
Simple reduction (allis/stimson) Consult an orthopedic specialist |
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Class of medications for Hip dislocation?
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Anxiolytics (valium)
Opiods (morphine) sedative hypnotics |
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What are some complications of hip dislocations/
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Osteoarthritis
Avascular necrosis recurrent dislocation |
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What is the etiology of Patellar dislocation?
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twisting injury on the extended knee
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What would you finding on exam for Patellar dislocation?
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pain
deformity tenderness to palpation Sorenss (post reduction) |
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What is the treatment plan for Patellar dislocation?
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Reduction is accomplished by flexing the hip, hyperextending the knee, and sliding the patella back into place
2. Knee immobilization |
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What is the disposition and education we will give to pt with patellar dislocation
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Light duty
limited duty Medevac Treatment, condition and diagnosis Quadriceps strengthening exercies |
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What is a grade I AC separation?
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no tear of AC ligaments
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If pt completes tears a AC joint what type of grade would you call it?
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Grade III
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What are some causes of AC separation?
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MOI is usually direct trauma to the AC joint from fall with arm adducted as typically may occur or
Indirect mechanism is a fall on the outstrectched hand with tramsimssin for foce to th eAC joint |
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What are some symptoms of AC sep?
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Pain
deformity Restricted shoulder movement Numbness and tingling |
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Treatment for AC sep?
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SLing for 1-2 wks or until symptoms suside
ICE (first 48hrs) PT (ROM exercies) |
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Increased intersitial pressure within a closed facial compartment can obstruct microciruclation to the nerves and muslces lying within the involved space.
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Compartment syndrome
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What are some signs and exam findings of compartment syndrome?
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Palpation of compartment, active contraction and passive stretching will exacerbate pain
Sensory changes precede motor weakness or paralysis Absent pulses, pallor and excessive coolness appear much later after pain and neurologic compromise |
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What is the treatment plan for Compartment syndrome?
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PT (exertional compartment syndrome)
Fasciotomy (pressures 30-40mmHg are generally considered grounds for emergent fasciotomy) |
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What are some complications of Compartment syndrome?
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Irreversible tissue ischemia (with late diagnosis
Permanent muscle and nerve damage Chronic pain |
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When does tissue necorsis becomes irreversible for Compartment syndrome?
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4-8hrs
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What is the definitive treatment for Compartment syndrome?
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fasciotomy
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A partial disruption of a musculotendionous unit short of complete rupture?
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Muscle strain
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What are S/S and findings of muscle strain?
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Pain
swelling tearing, snap and grabbing sensation Tenderness to palpation Limited ROM Edema Ecchymosis |
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What is the treatment plan for Muscle strain?
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RICE
ROM, stretching, strengthening NSAIDS Light duty Pteduc with handouts |
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What are some complications of Muscle strain?
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Chronic exertional compartment syndrome
Tendon rupture DVT |
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If pt complains of twisting his ankle and its swollen, pain and ecchymosis has develop in 23-48 hrs with joint laxity, what would you think he had?
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Sprain
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How many grades are there for sprain?
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3
1. minor, incomplete tear 2. significant incomplete tear 3. total failure of the ligment |
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what are the most common ankle injury?
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Lateral ankle
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What are some diffs for Sprain?
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STI (strain)
Fracture |
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What is the treatment for Sprain?
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RICE
ROM, stretching, strenghening Ankle brace (stable joint) Posterior splint (unstable joint) |
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what is the prognosis for sprain?
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4-8wks for complete recovery longer for more severe sprains
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This is a direct, blunt compressibve force to a muslce?
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contusion
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Is contusion one of the most common sports-related injuries?
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yes
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What can we do for operational labs/test?
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CBC (may benenifical to track the sequelae of the disease)
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What is the treatment for Contusion?
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RICE for the first 24-48 hrs
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What can be some potential complications of Contusion?
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Compartment syndrome
Internal bleeding |
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This condition has etiology of being overuse as the most common?
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Tendonitis
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What is TEndoitis?
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inflammation of tendons and tendon muscle attachment points
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What are the s/s and findings of Tendonitis?
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Pain with or without movement
Dec. ROM Tenderness to area Pain with palpation Localized Pain LROM Crepitus |
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What are some differential dx of Tendonitis?
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STI
Bursitis Tennosynovitis |
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What is the treatment plan for pt with Tendonitis?
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RICE
Splint and immob with sling NSIADS Corticosteriods (kenalog) |
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What are some leading causes of Tenosynovitis?
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Overuse and hx of recent trauma
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What are some s/s of tenosynovitis?
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pain, slight swelling,
fever (infectious tenosynovitis) Tenderness over affected area Decrease ROM Crepitus |
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What is the treatment plan for Tenosynovitis?
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Rest/ice
Splint NSAIDS Corticosteriod inj Antibiotics |
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What are some differential for Tenosynovitis?
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Scaphoid fracture
Osteoarthritis |
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What is dispostion, ptedu, f/u, and prognosisi for pt with Tenosynovitis?
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Light duty
Treatment and PT f/u 1-2 wks or as needed Secondary to treatment modalitis Extremely good with conservation treatments |
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What are some complications for Tenosynovitis?
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Secondary to treatment modalitis
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What is the caues of LBP?
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typical mechanism is usually minor exertion or lifting, the pt may not recall any remarkable etiology
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What are some s/s and findings for LBP?
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Pain with mvt (mild/mod/severe)
Hx of urinary incontinence (neurological deficit) Weakness , numbness, paresthesias altered gait Palpable muscle spasms scoliosis Decreased Strength (neuro deficit Tenderness to affected area |
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what is some diff for LBP?
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Renal calculi
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What is the treatment plan for LBP?
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ROM and strengthening exercises (core)
NSAIDS Muscle relaxants Analgesics OPiods Light duty maybe limited duty |
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What are some complications of LBP?
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Sciatica
Skeletal anomalies |
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Pt comes complaining of pain with Stair climbing and rising from the chair, You notice mild edema, Dec. ROM, +Aprehension test, Crepitus, what is your dx?
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Chondromalacia patellae
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What is the differntial for Chondromalacia patellae?
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PFPS
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What is the treatment plan for Chondromalacia Patellae?
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Improving quad strength and stamina
Knee orthotics NSAIDS Light duty Wt loss PT (strengthening F/u in 1-2 wks for reval |
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What is the definition of Bursitis?
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acute or chronic inflammatory process involving one of the more 150 bursae thorughout the body
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What causes Bursitis?
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Usually causes consist of trauma, crystal induced, rheumatoid and idiopathic forms
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What are some s/s and findings of rBursitis?
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Pain
localized pain/tenderness Dec. movement History of repetitive movement Findings (edema, tenderness erythema, warmth, Limited ROM |
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What are some DIfferential Diagnosis for Bursitis?
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Cellulites
Tendonitis Gout |
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What is the treatment plan for Bursitis?
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RICE
NSIADS Antibiotics Corticosteriods Light duty F/u in 24 hrs to observe edema |
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Complications of bursitis?
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Septic bursitis
tendonitis |
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What is the definitionof STress fractures?
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microscopic breaks in the cortex of the long bones that have exposed to mechincal strain due to overuse
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Where do stress fractures occur?
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Pelves
Femoral neck tibia, navicular and metatarsals |
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What is female atheletes have a higher prevalence of stres fractures/
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Poor nutrition, low bone density, and a history of menstrual distrubance
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What is a frequent complaint of pt with Stress fx?
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Night pain**
Muscle fatigue Hx of recent inc. in activity Limiting participation in sports activites and exercise |
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What are some exam findings for Stress fractures?
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Localized edeam and erythema
pain with palpation or percussion of affected area HOP test (hop on one leg for 10mins usually pt can hop Fulcrum test (place your leg underneath the pt leg and push down) and turning fork. |
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What is some Differntial of Stress fx?
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Shin splints
Plantar fascitis Strains |
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What is the treatment for Stress fx?
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Rest, ice and avoidiance of high impact activiteis
Immoblize if indicated NSAIDS Analgesics Light duty (4-10 days) No high impact sports Muscle strenthing and generalized conditioning |
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What is the leading cause of shoulder pain and dysfunction?
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Impingment syndrome
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What is the cause of Impingment syndrome?
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Prolonged repetivie overhead activity or direct trauma to area
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What are some findings for Impingement test?
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TTP along bicep tendon and greater tuberosity of the humerus
+Impingment tests (neers, hawkins-kennedy Weakness with "Empty Can test" external rotation |
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What are some diff for impingement?
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Ant. Shoulder instility
Bicep tendonits Rotator cuff injury |
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What is the treatment plan for Impingment?
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PT
1% lidocaine w/o epi and injectable corticosteriods NSAIDS Analgesics Corticosteriods Light duty May take up 6-12 wks f/u q 1-2 months initially to assess progess |
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Complications for Impingment?
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Rotator cuff tear
Adhesive capsulitis |
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What are some Differntial dx of Epicondyotiits (lateral and medial)
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Cervical radiculopathy
Stress fx |
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What is the treatment plan for Epicondylitis?
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Tehrap with flexiblity and strength
Elbow brace NSAIDS Corticosteriods |
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What are some complication for Epicondylitis?
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Muscle rupture
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What is the most common cause of foot pain in outpatient medicine?
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Plantar facitis
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What is Plantar faciits?
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inflammation of the plantar aponeurosis
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What is the s/s and exam finding of Plantar facitis?
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Pain most severe in am with the first steps upon arising
pain prolonged ambulation or standing Numbness and buring medial hindfoot Limp with excessive toe walking findings (area of max tenderness along the plantar medial aspect of the heel Pain along plantar fascia with foot dorsiflexion |
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What is the diff for Plantar faciitis?
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Calcaneal stress fx
Fat pad syndrome Heel spur |
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What is the treatment for Plantar faciitis?
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RICE massage
stretching exercise Night splint Heel and arch support shoe inserts Nsaids Corticosterods after 8wks of conserative txment Light duty stretching exercies |
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What are the complication of Plantar faciitis?
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rutpure
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Pain over the medial or anterior tibia that occurs with exertion and is relievd by rest
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Shin splints
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What is the S/S and findings for shin splints?
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Diffuse pain to ant. tibialis
Pain before and after exercise then begins to becomes continous Mild swelling TTP diffuse pain HOP test negative or inconclusive Mild edema |
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What is the treatment plan for shin splints?
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RICE
Analgesics NSAIDS Light duty Walk/run program Weekly monitor progress |
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What is the complications of Shin splints?
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Excertional compartent syndrome
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What is the most common upper extermity compressive neuropathy?
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Carpal tunnel
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what is th etiology of Carpal tunnel?
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Idiopathic
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What are som complaints a pt might have with Carpal tunnel?
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Numbness in thumb, index, middle fingers
Pain awakens the pt from sleep after a number of hrs Finger stiffness upon arising in the morning Discomfort and pain may radiate from the hand up the arm to the shoulder or neck |
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what will you find on exam?
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Weakness of resisted thumb abduction
Loss of 2pt discrimintaion in median nerve + tinels sign + phalen sign |
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what is the treatment plan for Carpal tunnel?
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Splint immoblization (volar splint)
PT REfer to hand specialist NSAIDS Corcitsteriods Light duty (limited duty) |
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What is the most common knee pain foundin adolescents?
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Osgood schlatter dx
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What ist he cause of Osgood schlatter?
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repetitive injury and small avulsions injuries at the bone tendon junction of the patellar tendon into tibial turbersoity
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What is the Symptoms of Osgood schlatter?
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Pain excerbated by running, jumping and kneeling activities
pain after prlonged sitting with knee flexed Bilat knee pain 25% cases |
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What are some finding for Osgood schlatter?
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Tenderness at tibial tuberosity
Edema at tibial tuberosity May present with quardriceps atrophy Absence of effusion |
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What should you tell your patient about Osgood Schalatter disease?
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Pts should avoid sports that involve heavy quadrieps loading
Pt should inc. hamstring and quadriceps flexibility Diagnosis and treatment |
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Complications of Osgood-schlatter disease?
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Nonunion of the tibial tubercle
Patellar tendon avulsion |
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Point tenderness is noted upon palpation of the lateral femoral epicondyle with abnormal gait and +Ober's test?
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ITBS
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Differentials for ITBS?
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Tendonitis
Femoral stress fx. |
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Fluids from damaged intracellura spaces inundating extracellur space of the tissue?
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Swelling
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Localized sensation of discomfort, distress or agony orm the stimulation of specialized nerve endings, a protective mechanism?
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Pain
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Hairline fracture without loss of anatomic configuration
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Non displaced fx
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Refers to constellation of problems characterized by diffuse aching anterior knee pain that increases with activities?
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PFPS
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What is the main cause of PFPS?
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Excessive use of joint, either in frequency of loading or excessive loading
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What are some common signs and symptoms of PFPS?
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Pain behind kneecap
"theatre pain" prolonged sitting TTP along facuets of patella Crepitus Quad strenght, tone and bulk reduced |
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Waht are some things we can do to help pt with PFPS?
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Quad strength and excercise
Brace Wt loss |
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What are some complications of PFPS?
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Persistent pain and dysfunction
Recurrent effusions |
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Cause is unknown and cure is unavaible and is more common in females and males the has chronic generalized pain?
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Fibromyalgia
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What are some s/s of Fibromyalgia?
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Fatigue worse in AM
Duration of pain (>3months) Feeling swollen, tingling in ext. |
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What are the diagnosis crtiteria for Fibromyalgia?
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1st. presence of pain in all 4 quadrants of th ebody as well as axial skeleton on contionous basis for 3months
2nd. at least 11-18 anatomically specific tender pts. |
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Differential Dx for firbromyalgia?
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Hypothyroidism
Muscle strain/sprain |
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What class of medication can be give to pt with Fibromyalgia?
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Antidepressants
Muscle relaxants Nonbenzodiazepine |
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What should we tell these pt with fibromyalgia?
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No cure
sleep Proper nutrition Exercise |
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What type of MSK scenarios require IMMEDIATE phone call message or referral?
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Open fx
Any fx or suspected fx with neuro problems ANy fx with obvious deformity Compartment syndrome Any other MSK disorder as the IDC deems necesary |
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what are some complications of Spacial Infection?
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Sepsis
Gangrene/necorsis Compartment syndrome |
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Is inflammation of a synovial membrane with purulent effusion into the joint capsule, usually due to bacterial infection
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Septic arthiritis
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Infection caused by bacterial seeding from the blood?
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Heatogenous
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Most septic arthritis cases are caused by what two infections?
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Staphylococcus aureus and strept
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What is the differntial of Septic arthiritis?
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Cellulitis
Burstits |
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What is the treatment plan for Septic arthritis?
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Aspiration of join
Orthopedica consult |
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What type of medications will you give for Septic arthirtis?
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IV antibiotics
Vanco cipro Analgesic antipyrectics |
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Complications of Septic arthritis?
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Bone abscess
Sepsis Death |
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Cause is unknown and uncurable. with generliazed pain and fatigue that worse in the AM and late day. Pain last longer than 3months?
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Fibromyalgia
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What is Osteomyelitis?
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Acute or chronic inflammatory process of the bone and its strcuture secondary to infection with pyogenic orgamins
W |
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What is the most common bacterium affecting Osteoyelitis?
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Staphylococcus aureus
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What is the differntial diagnosis of Osteomyelitis?
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Septic arthritis
Stress fx |
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What class of medications are used for Osteomyelitits?
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IV antibiotics
Fluoroquinolne Cipro antipyretics Analgesics |
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Whatis a bengin protrusion in the synovial lining, devleoping into a closed puch filled with physiclogoic lubrincant fluid of joints an tendons?
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Ganglion cyst
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What are the three most common locations for ganglion cysts to appear?
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wrist
digital flexor sheath and distal DIP |
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What is the idea behinad the formation of cyst?
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mucoid degeneration of collagen and connective tissue
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What are some findings and symptoms of ganglion cyst?
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non-painful palpable mass noted to affected site.
Dec. ROM Paresthesias and weakness |
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Treatment plan for Ganglion cyst?
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Aspiration of cyst using syringe/needle and injection of mild steriod into the remaining sac, (triamcinolne (kenalog)
surgical excision by a hand surgeon |
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Nerve swelling and inflammation of the digital nerve most commonly btw the 2nd and 3rd metatarsal interspaces?
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Morton's neuroma
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What causes Morton's neuroma?
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excessive stress of teh forefoot, repetitive trauma, or congentially enlarged plantar digital nerve
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What are some symptoms of Morton's Neuroma?
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Plantar pain in forefoot
Cramping or numbness of the forefoot with wt bearing Feels like I am walking on a marble Radiation of pain to the toes |
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What are some exam findings of Mortions neuroma?
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Palpable painful nodule in teh metatarsal interspaces
+mulder's sign Intense pain on pressure btw metatarsal heads |
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What is the treatment plan for Mortion's neuroma?
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Flat shoes with roomy toe box
Metatarsal pads- placed immediately proximal to the two involved metatarsal heads |
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What is the class of medications for :Mortions Neuroma?
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NSAIDS (temp)
Corticosteriod /lidocaine/ w/o epi |
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Pt comes to clinic complaining of intense pain, low grade fever, enlarged great toe. Labs shoes increased serum uric acid levels >7.6m/dl, what is your diagnosis?
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Gout
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Whatis Gout?
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metabolic disorder characterized by abnormally high levels of urates (uric acid) in the body, resulting in a recurring arthritis
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What are the phases of Gout?
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acute (intense pain to affected site. Dec. ROM
Great toe most susceptible Chornic phase (inflammatory signs are generally absent, progessive functional loss of ROM/mobility Palpable tophi(uric acid crystals) |
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Whatis the differential dx of Gout?
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cellulitis
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What are some class of medications for Gout?
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Indocin (nsaids)
Colchicine (Anit inflammatory) Allopuriniol (Xanthine oxidase) Corticosteriods (if NSAIDS no tolerated) |
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What is the pt educ and dispostion of pt with gout?
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bed rest x 24hrs
Light duty Diet (eliminate high purine rich food (sardines, anchoives, liver, ETOH) |
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What happens if Gout is untreated?
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lead to severe joint destruction
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What is Pseudo gout?
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Calcium phosphate dihydrate crystals may be found in deposits in and around joints are are characterizied by calcification of articular cartilage, menisci, synovium,
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What is generally affected by Pseudogout?
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elderly
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What is the findings of pseudogout?
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Acute pain < than gout
E/E Swelling hot to touch LROM Can produce fever, chills, malaise |
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Acute attacks of Pseudogout resolves when?
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within 10days with prognosis be excellent
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Chronic systemic inflammatory chiefly affecting synovial membranes of multiple joints?
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RA
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What is the etiology of RA?
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unknown
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What are some symptoms and findings of RA?
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Insidious onset
Stiffness more prominent in AM Prodromal malaise, wt loss and vague polyarticular joint pain or stifness Pain on motion "swan neck deformitys skin Atrophy or thinning of skin and muslces is common |
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What are some differentials of RA?
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Lyme dz
Osteoarthritis Fibromyalgia |
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Treatment plan for RA?
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Passive and active ROM
Heat/cold applications NSAIDS LIMIT duty or MEdBOARD |
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What is Osteoarthritis?
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Degeneration of cartilage and by hypertrophy of bone at the articular margins
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Osteoarthriits is the most common type of arthritis and affects oftens associated with whom?
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Age
Obesity previous trauma or other disorders that change the mechanics of the joint |
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What is the symptoms of OsteoArthititis?
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Joint stiffiness
Pain with ROM Possible deformities Joint effusion Osteophytes in later stage Mild effusion DEC/LIMTED ROM Crepitus |
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Whatis the treatment plan for Osteoarthritis?
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Non wt Bearing exercise
pain mangament NSAIDS Analgesics Corticosteriods Light duty, Limited duty, Medboard |
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What do we tell our pts with Osteoarthitis?
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Wt loss
Protection for continued overuse injuries managment optinos |
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How many levels of sprained ankle grades are there?
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3
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What grade is patient ankle sprain if they experience pain when ligament is stressed, but no increase in laxity?
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Grade 1
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What is Grade 3 ankle sprained?
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experiences no pain when ligament is stressed
Laxity with no detectable end point indicating complete tear |
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What are the primary stabiliizers of a joint?
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Muscle and ligaments
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What are the main functions of muscles and ligaments combined?
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m/t alignment of the articulating surfaces
Prevent instablity episodes (subluxations and luxations) |
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Sufficient stress placed on the muscle causes what type of injuries?
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Strain
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The synovial membrane consists of synovial cells that are of two types?
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Type A (secretory)
Type B (Phagoocytic) |
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Type A synovial cells perform what type of role in joints?
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produce the synovial fluids that serves as a lubricant for the joint
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Type B synovial cells prefrom what function in joints?
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Remove wast material by phagocytosis
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The bone covered by the articular cartilage is referred to ?
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Subchondral bone
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Articular cartilage consists of hyaline cartilage that is composed primarily of what two things?
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chondrocytes and water
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How does synovial fluid enter and exit the articular cartilage?
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microscopic pores on the articular surface
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Changes to the articular cartilage do occur and are typically classified into two groups?
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1. primary (idiopathic)
2. Secondary |
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The menisucs is a shim taking up space in tibiofemoral joint which indirectly bears appx. how much of the force transmitted through to the subchondral bone?
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50%
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Meniscal tears occur in the what area of the meniscus in the vast majority of cases?
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posterior horn
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If paitent has theri knee lock up do to meniscal tear getting caught b/w femoral condyle and tibial plateau, how can they unlock the knee?
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reducing the weight on the lower ext and shaking the repeatedly
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The vast majority of knee effusions in the office enviroment consists of either what two substances?
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synovial fluid(synovial effusion)
hemaarthrosis( blood) |
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What is the etiology of hemaarthrosis of the knee effusions?
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ACL sprain
Dislocated patella Peripheral tear of meniscus- blood from vascular peripheral 1/3 of menscius |
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How can you determine b/w blood in the knee vs. synovial fluid?
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Time, if acute injury in short period of time within 1-6 hrs.
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What is the time frame if synovial fluid accumulates in the knee?
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longer period time 18-24 hrs
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Body response to years of impact to the subchondral surface, responds with Hypertrophic changes at the margins of the bones, this formation is called?
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bony exostoses or Bone spurs
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At least 25% to 50% of the cases of NonTraumatic degenerative changes of the hips and knees can be reduced by controlling what?
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obesity
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What three pieces of info with help give insight regarding which anatomical structurs are most likely to be injuried and the severity of the injury?
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1. MOI
2. Symptoms experienced by the pt 3. Extent of disability at the time of the injury and shortly after |
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What is the Aronen Axiom?
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severity of a MSK injury is directly related to the extent of disability experienced by the individual at the time of injury and shortly after
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What is the MOI of ACL sprain?
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rotation of the body on fixed wt bearing foot or sudden hypertension of the knee
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Symptoms of ACL strain or tear?
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pt "felt my knee go out of place and back in/
POP was heard Increasing discomfort is noted first 1-6hrs f/w injury as blood accumlates in the knee |
