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90 Cards in this Set

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CARPAL TUNNEL SYNDROME
PE
CARPAL COMPRESSION TEST
PHALAN’S TEST
TINEL’S TEST
SENSORY EXAM
CHECK FOR THENAR ATROPHY
CARPAL COMPRESSION TEST
press on palm over median nn , ilicits pain in 1st three fingers
PHALEN’S
TEST
pt presses backs of hands togehter w/ fingers pointing down. Paresthesias in median nerve distribution is positive test
what is the gold standard for diagnosing carpal tunnel dz

why?

what are the drawbacks
ELECTROMYOGRAPHY

OBJECTIVE EVIDENCE

DOESN’T CORRELATE WITH TX OUTCOMES
VERY OPERATOR DEPENDENT
SENSORY LATENCY IS MOST SENSITIVE
SENSORY LATENCY >3.5
MOTOR LATENCY >4.5
CARPAL TUNNEL SYNDROME
TX
SPLINTING
ACTIVITY MODIFICATION
NSAIDS
VIT B6
STEROID INJECTION
ENDOSCOPIC VS. OPEN RELEASE
What is a typical hx of an ACL injury
varus or valgus stress added to rotatory stress on the knee

Patient will report a feeling of a “pop” or giving way
with ACL injury is int. or external rotation usually more detrimental
internal rotation
Anterior Cruciate Ligament Injuries (ACL)
PE shows
swelling

Aspiration yields bloody fluid
ACL injury
In PE what should you look for?
Examine for ROM, joint line tenderness, ecchymosis, and stability

Lachman’s test, anterior/posterior drawer, posterolateral spin, pivot shift, & varus/valgus stress
lachmann test
knee flexed 20–30° you pull on tibia, end point should not be soft and not too much displacement
pivot shift test
w/ pts leg extended, pull internally rotate and abduct
anterior drawer
pt bends leg to like 90* and you pull on tibia
posterior drawer
pt bends leg to like 90* and you pushon tibia
valgus stress test
try to put knee into valgus
verus stress test
try to put knee into verus
what will imaging studies often show with ACL
patella alta
Upon inversion of the ankle what is the most common ligament to be injured (give 3 in deceding order)
1) anterior talofibular
2) calcaneofibular
3) posterior talofibular (rare)
signs (lesions) of shoulder dislocation
BANKAHRT LESION - head of humerus knocks off ANTERIOR INFERIOR portion of labrum

HILSACK LESION - imprint on humoral head
younger individual presents with shoulder pain -- more likely rotator cuff injury or injury to labrum
injury to labrum
older people are more likely to have what with shoulder pain?

tendon most likely to be injured?
rotator cuff tears

supraspinatus
test for rotator cuff disfx
drop arm test
drop arm test
have pt abduct arm and if can't sustain a tap, test is positive
Slipped Capital Femoral Epiphysis (SCFE)

Presents with
pain and antalgic gait
Slipped Capital Femoral Epiphysis (SCFE)

Risk factors
most common hip disorder in adolescents

age 10-15

2X male

often black

overweight

sex hormone inbalance
Legg-Calve-Perthes’ Disease

what is it
flattening of the weight bearing surface of the femoral head

self-limiting, non-inflammatory condition
Legg-Calve-Perthes’ Disease

what age range
Age 4 to 8 years
Legg-Calve-Perthes’ Disease

Etiology
related to disruption of the blood supply to the femoral head
Osteoarthritis of the knee- Treatment
includes NSAID’s, physical therapy, possible steroid injections, possible Synvisc injections, possible arch supports, possible knee brace, surgical intervention (arthroscopic debridement, synovectomy, possible osteotomy, knee arthroplasty and less commonly, knee fusion)
compartment syndrome

what is it
elevated tissue PRESSURE within a closed fascial space, resulting in REDUCED CAPILLARY BLOOD PERFUSION & COMPROMIZED NEUROVASCULAR FX
acute compartment syndrome is usually secondary to
tibial fracture
crush injury
muscle rupture
chronic compartment syndrome is usually induced by
exercise
Upon inversion of the ankle what is the most common ligament to be injured (give 3 in deceding order)
1) anterior talofibular
2) calcaneofibular
3) posterior talofibular (rare)
signs of shoulder dislocation
BANKAHRT LESION - head of humerus knocks off ANTERIOR INFERIOR portion of labrum

HILSACK LESION - imprint on humoral head
younger individual presents with shoulder pain -- more likely rotator cuff injury or injury to labrum
injury to labrum
older people are more likely to have what with shoulder pain?

tendon most likely to be injured?
rotator cuff tears

supraspinatus
test for rotator cuff disfx
drop arm test
drop arm test
have pt abduct arm and if can't sustain a tap, test is positive
Slipped Capital Femoral Epiphysis (SCFE)

Presents with
pain and antalgic gait
Slipped Capital Femoral Epiphysis (SCFE)

Risk factors
most common hip disorder in adolescents

age 10-15

2X male

often black

overweight

sex hormone inbalance
Legg-Calve-Perthes’ Disease

what is it
flattening of the weight bearing surface of the femoral head

self-limiting, non-inflammatory condition
Legg-Calve-Perthes’ Disease

what age range
Age 4 to 8 years
Legg-Calve-Perthes’ Disease

Etiology
related to disruption of the blood supply to the femoral head
Osteoarthritis of the knee- Treatment
includes NSAID’s, physical therapy, possible steroid injections, possible Synvisc injections, possible arch supports, possible knee brace, surgical intervention (arthroscopic debridement, synovectomy, possible osteotomy, knee arthroplasty and less commonly, knee fusion)
compartment syndrome

what is it
elevated tissue PRESSURE within a closed fascial space, resulting in REDUCED CAPILLARY BLOOD PERFUSION & COMPROMIZED NEUROVASCULAR FX
acute compartment syndrome is usually secondary to
tibial fracture
crush injury
muscle rupture
chronic compartment syndrome is usually induced by
exercise
treatment for either acute or chronic compartment syndrome
urgent fasciotomy
Developmental Dysplasia of the hip: aka: Congenital Dysplasia of the Hip (CDH)

What is it?
Abnormal development or dislocation of the hip secondary to capsular laxity and mechanical factors
Developmental Dysplasia of the hip: aka: Congenital Dysplasia of the Hip (CDH)

INCIDENCE:
Female 85%, First born, Left hip 67%, breech 30-50%( decreased intrauterine positioning), family history 20 +%
Congenital Dislocation of the Hip

Clinical Presentation
Dislocated
Dislocatable
Asymmetric Skin Crease
Asymmetric Knee Height (Allis)
Asymmetric Abduction (Hart’s)
Ortolani’s Maneuver
Barlow’s Maneuver
Barlow’s maneuver
Dislocation maneuver
-Patient placed supine
-Physician attempts to push femur posteriorly with knees at 90 degrees
-Back-Barlow
Ortolani’s sign
Reduction maneuver
-Patient placed supine
-Rotate hip to relocate
Congenital Deformity of the Hip (CDH)

CONTAINMENT: 0-6 Months
Pavlik Harness
Spica Cast
Congenital Deformity of the Hip (CDH)

CONTAINMENT: 6-24 Months
Traction
Adductor Tenotomy
Reduction and Cast
Congenital Deformity of the Hip (CDH)

CONTAINMENT: 2-5 Years
Traction, Open Reduction
Pelvic or Femoral Osteotomy
Salter Harris Classification
Type I
Type II
Type III
Type IV
Type V
Type I : through physis
Type II: M only
Type III: E only
Type IV: M & E
Type V : (worst) compression through physis

reduce w/in 48 hrs can cause growth arrest
Slipped Capital Femoral Epiphysis

What is it
Disorder of the proximal femoral epiphysis (caused by weakness of the perichondral ring and slippage through the hypertrophic zone of the growth plate)
Slipped Capital Femoral Epiphysis

At Risk?
Age 10-15, Overweight, African-American, Family history. Up to 25% are bilateral
Slipped Capital Femoral Epiphysis

Presentation:
Vague hip and groin pain

C/O hip, thigh, or knee pain, Externally rotated gait, decreased internal rotation, thigh atrophy,
Abnormalities of the Physis or Epiphysis
Radiology:
Physeal slip best seen on the lateral x-ray
Abnormalities of the Physis or Epiphysis
Treatment:
Epiphysiodesis
Slipped Capital Femoral Epiphysis

Acute
< 3 Usually no previous Symptoms
Slipped Capital Femoral Epiphysis
Chronic
>3 Insidious onset
Slipped Capital Femoral Epiphysis
Stable slips
able to weight-bear
Slipped Capital Femoral Epiphysis
Unstable slip
not able to weight-bear without severe pain – 50% develop osteonecrosis.
Today you are on rotation in the new born nursery and you are asked to exam a 1 day old baby girl. You notice a funny sensation when you move the left hip and upon examination of the child from the posterior you notice asymmetrical skin folds
What do you suspect?
Developmental Dysplasia of the hip: aka: Congenital Dysplasia of the Hip (CDH)
What tests do you do?
Barlow’s
Ortolani’s
Barlow’s
adducted, while pushing posteriorly in line of the shaft of femur, causing femoral head to dislocate posteriorly from acetabulum.
    - dislocation is palpable as femoral head slips out of acetabulum.   
Ortolani’s:
flex infant's hips & knees to 90 deg
    - thigh is gently abducted & bringing femoral head from its dislocate posterior position to opposite the acetabulum, hence reducing femoral head into acetabulum.
    - in positive finding, there is a palpable & audible clunk as hip reduces.
What type of treatment should be done?
palvic harness -- infant has legs flexed ( not too much) and abducted
Septic Arthritis
Etiology:
Hematogenous, Contiguous, Direct
Septic Arthritis
Organism:
S. aureus (70%), Pseudomonas (puncture through shoe,IVDA), H. influ.,Strep, TB
Septic Arthritis
Presentation
Fever, Malaise, Severe Joint Pain
Septic Arthritis
Findings:
Swelling, Effusion, Circumferential Tenderness, Intolerance to Joint Motion!!
Septic Arthritis
Treatment:
Urgent Arthrotomy
I.V. Antibiotics 7 – 10 days
Discitis / Vertebral Osteomyelitis
Etiology:
Hematogenous, Contiguous, Direct
Discitis / Vertebral Osteomyelitis
Organism:
S. aureus, Strep etc.
Discitis / Vertebral Osteomyelitis
At Risk:
Diabetics, IVDA, RA, CRF, Steroids
Discitis / Vertebral Osteomyelitis
Presentation:
fever, wt. Loss, malaise, mechanical back pain, possible neurologic deficits.
Discitis / Vertebral Osteomyelitis
best imaging study
bone scan
Discitis / Vertebral Osteomyelitis
Treatment:
I.V. Antibiotics 6 weeks
Surgery:
-Biopsy for culture, Drainage of abscess, Stabilization, Failure of medical management
Benign Bone Tumors
Characteristics:
Slow growing
Well cicumscribed
Non-invading
Benign Bone Tumors
Types:
Aneurysmal Bone Cyst
Enchondroma
Osteochondroma
Osteoid Osteoma
Unicameral Bone Cyst
Malignant Bone Tumors
Characteristics:
Rapidly Growing
Invasive
Poorly Circumscribed
Malignant Bone Tumors
Types:
Chondrosarcoma
Osteosarcoma
Ewings Sarcoma
Multiple Myeloma
Chordoma
Compartment Syndrome:
Definition:
Pressure in a compartment substantial enough to stop perfusion
Compartment Syndrome
Etiology:
Crush injuries, Fractures, Vascular injuries,Toxic / Infectious Insult, Coagulopathies
Compartment Syndrome:

Signs / Symptoms:
Pain out of proportion
Pain with passive stretch
Pressure within the compartment
Paresthesias, Pallor, Pulselessness
Compartment Syndrome:
Treatment:
Emergent Fasciotomy
During a neuro exam you find that a person has weakness to wrist extensor, numness to thumb and index finger, & brachioradialis reflex loss.
What nn root are we looking at?
C6