Orthapedics Lecture

Front 1

CARPAL TUNNEL SYNDROME
PE

Back 1

CARPAL COMPRESSION TEST
PHALAN’S TEST
TINEL’S TEST
SENSORY EXAM
CHECK FOR THENAR ATROPHY

Front 2

CARPAL COMPRESSION TEST

Back 2

press on palm over median nn , ilicits pain in 1st three fingers

Front 3

PHALEN’S
TEST

Back 3

pt presses backs of hands togehter w/ fingers pointing down. Paresthesias in median nerve distribution is positive test

Front 4

what is the gold standard for diagnosing carpal tunnel dz

why?

what are the drawbacks

Back 4

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

Front 5

CARPAL TUNNEL SYNDROME
TX

Back 5

SPLINTING
ACTIVITY MODIFICATION
NSAIDS
VIT B6
STEROID INJECTION
ENDOSCOPIC VS. OPEN RELEASE

Front 6

What is a typical hx of an ACL injury

Back 6

varus or valgus stress added to rotatory stress on the knee

Patient will report a feeling of a “pop” or giving way

Front 7

with ACL injury is int. or external rotation usually more detrimental

Back 7

internal rotation

Front 8

Anterior Cruciate Ligament Injuries (ACL)
PE shows

Back 8

swelling

Aspiration yields bloody fluid

Front 9

ACL injury
In PE what should you look for?

Back 9

Examine for ROM, joint line tenderness, ecchymosis, and stability

Lachman’s test, anterior/posterior drawer, posterolateral spin, pivot shift, & varus/valgus stress

Front 10

lachmann test

Back 10

knee flexed 20–30° you pull on tibia, end point should not be soft and not too much displacement

Front 11

pivot shift test

Back 11

w/ pts leg extended, pull internally rotate and abduct

Front 12

anterior drawer

Back 12

pt bends leg to like 90* and you pull on tibia

Front 13

posterior drawer

Back 13

pt bends leg to like 90* and you pushon tibia

Front 14

valgus stress test

Back 14

try to put knee into valgus

Front 15

verus stress test

Back 15

try to put knee into verus

Front 16

what will imaging studies often show with ACL

Back 16

patella alta

Front 17

Upon inversion of the ankle what is the most common ligament to be injured (give 3 in deceding order)

Back 17

1) anterior talofibular
2) calcaneofibular
3) posterior talofibular (rare)

Front 18

signs (lesions) of shoulder dislocation

Back 18

BANKAHRT LESION - head of humerus knocks off ANTERIOR INFERIOR portion of labrum

HILSACK LESION - imprint on humoral head

Front 19

younger individual presents with shoulder pain -- more likely rotator cuff injury or injury to labrum

Back 19

injury to labrum

Front 20

older people are more likely to have what with shoulder pain?

tendon most likely to be injured?

Back 20

rotator cuff tears

supraspinatus

Front 21

test for rotator cuff disfx

Back 21

drop arm test

Front 22

drop arm test

Back 22

have pt abduct arm and if can't sustain a tap, test is positive

Front 23

Slipped Capital Femoral Epiphysis (SCFE)

Presents with

Back 23

pain and antalgic gait

Front 24

Slipped Capital Femoral Epiphysis (SCFE)

Risk factors

Back 24

most common hip disorder in adolescents

age 10-15

2X male

often black

overweight

sex hormone inbalance

Front 25

Legg-Calve-Perthes’ Disease

what is it

Back 25

flattening of the weight bearing surface of the femoral head

self-limiting, non-inflammatory condition

Front 26

Legg-Calve-Perthes’ Disease

what age range

Back 26

Age 4 to 8 years

Front 27

Legg-Calve-Perthes’ Disease

Etiology

Back 27

related to disruption of the blood supply to the femoral head

Front 28

Osteoarthritis of the knee- Treatment

Back 28

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)

Front 29

compartment syndrome

what is it

Back 29

elevated tissue PRESSURE within a closed fascial space, resulting in REDUCED CAPILLARY BLOOD PERFUSION & COMPROMIZED NEUROVASCULAR FX

Front 30

acute compartment syndrome is usually secondary to

Back 30

tibial fracture
crush injury
muscle rupture

Front 31

chronic compartment syndrome is usually induced by

Back 31

exercise

Front 32

Upon inversion of the ankle what is the most common ligament to be injured (give 3 in deceding order)

Back 32

1) anterior talofibular
2) calcaneofibular
3) posterior talofibular (rare)

Front 33

signs of shoulder dislocation

Back 33

BANKAHRT LESION - head of humerus knocks off ANTERIOR INFERIOR portion of labrum

HILSACK LESION - imprint on humoral head

Front 34

younger individual presents with shoulder pain -- more likely rotator cuff injury or injury to labrum

Back 34

injury to labrum

Front 35

older people are more likely to have what with shoulder pain?

tendon most likely to be injured?

Back 35

rotator cuff tears

supraspinatus

Front 36

test for rotator cuff disfx

Back 36

drop arm test

Front 37

drop arm test

Back 37

have pt abduct arm and if can't sustain a tap, test is positive

Front 38

Slipped Capital Femoral Epiphysis (SCFE)

Presents with

Back 38

pain and antalgic gait

Front 39

Slipped Capital Femoral Epiphysis (SCFE)

Risk factors

Back 39

most common hip disorder in adolescents

age 10-15

2X male

often black

overweight

sex hormone inbalance

Front 40

Legg-Calve-Perthes’ Disease

what is it

Back 40

flattening of the weight bearing surface of the femoral head

self-limiting, non-inflammatory condition

Front 41

Legg-Calve-Perthes’ Disease

what age range

Back 41

Age 4 to 8 years

Front 42

Legg-Calve-Perthes’ Disease

Etiology

Back 42

related to disruption of the blood supply to the femoral head

Front 43

Osteoarthritis of the knee- Treatment

Back 43

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)

Front 44

compartment syndrome

what is it

Back 44

elevated tissue PRESSURE within a closed fascial space, resulting in REDUCED CAPILLARY BLOOD PERFUSION & COMPROMIZED NEUROVASCULAR FX

Front 45

acute compartment syndrome is usually secondary to

Back 45

tibial fracture
crush injury
muscle rupture

Front 46

chronic compartment syndrome is usually induced by

Back 46

exercise

Front 47

treatment for either acute or chronic compartment syndrome

Back 47

urgent fasciotomy

Front 48

Developmental Dysplasia of the hip: aka: Congenital Dysplasia of the Hip (CDH)

What is it?

Back 48

Abnormal development or dislocation of the hip secondary to capsular laxity and mechanical factors

Front 49

Developmental Dysplasia of the hip: aka: Congenital Dysplasia of the Hip (CDH)

INCIDENCE:

Back 49

Female 85%, First born, Left hip 67%, breech 30-50%( decreased intrauterine positioning), family history 20 +%

Front 50

Congenital Dislocation of the Hip

Clinical Presentation

Back 50

Dislocated
Dislocatable
Asymmetric Skin Crease
Asymmetric Knee Height (Allis)
Asymmetric Abduction (Hart’s)
Ortolani’s Maneuver
Barlow’s Maneuver

Front 51

Barlow’s maneuver

Back 51

Dislocation maneuver
-Patient placed supine
-Physician attempts to push femur posteriorly with knees at 90 degrees
-Back-Barlow

Front 52

Ortolani’s sign

Back 52

Reduction maneuver
-Patient placed supine
-Rotate hip to relocate

Front 53

Congenital Deformity of the Hip (CDH)

CONTAINMENT: 0-6 Months

Back 53

Pavlik Harness
Spica Cast

Front 54

Congenital Deformity of the Hip (CDH)

CONTAINMENT: 6-24 Months

Back 54

Traction
Adductor Tenotomy
Reduction and Cast

Front 55

Congenital Deformity of the Hip (CDH)

CONTAINMENT: 2-5 Years

Back 55

Traction, Open Reduction
Pelvic or Femoral Osteotomy

Front 56

Salter Harris Classification
Type I
Type II
Type III
Type IV
Type V

Back 56

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

Front 57

Slipped Capital Femoral Epiphysis

What is it

Back 57

Disorder of the proximal femoral epiphysis (caused by weakness of the perichondral ring and slippage through the hypertrophic zone of the growth plate)

Front 58

Slipped Capital Femoral Epiphysis

At Risk?

Back 58

Age 10-15, Overweight, African-American, Family history. Up to 25% are bilateral

Front 59

Slipped Capital Femoral Epiphysis

Presentation:

Back 59

Vague hip and groin pain

C/O hip, thigh, or knee pain, Externally rotated gait, decreased internal rotation, thigh atrophy,

Front 60

Abnormalities of the Physis or Epiphysis
Radiology:

Back 60

Physeal slip best seen on the lateral x-ray

Front 61

Abnormalities of the Physis or Epiphysis
Treatment:

Back 61

Epiphysiodesis

Front 62

Slipped Capital Femoral Epiphysis

Acute

Back 62

< 3 Usually no previous Symptoms

Front 63

Slipped Capital Femoral Epiphysis
Chronic

Back 63

>3 Insidious onset

Front 64

Slipped Capital Femoral Epiphysis
Stable slips

Back 64

able to weight-bear

Front 65

Slipped Capital Femoral Epiphysis
Unstable slip

Back 65

not able to weight-bear without severe pain – 50% develop osteonecrosis.

Front 66

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?

Back 66

Developmental Dysplasia of the hip: aka: Congenital Dysplasia of the Hip (CDH)

Front 67

What tests do you do?

Back 67

Barlow’s
Ortolani’s

Front 68

Barlow’s

Back 68

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.   

Front 69

Ortolani’s:

Back 69

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.

Front 70

What type of treatment should be done?

Back 70

palvic harness -- infant has legs flexed ( not too much) and abducted

Front 71

Septic Arthritis
Etiology:

Back 71

Hematogenous, Contiguous, Direct

Front 72

Septic Arthritis
Organism:

Back 72

S. aureus (70%), Pseudomonas (puncture through shoe,IVDA), H. influ.,Strep, TB

Front 73

Septic Arthritis
Presentation

Back 73

Fever, Malaise, Severe Joint Pain

Front 74

Septic Arthritis
Findings:

Back 74

Swelling, Effusion, Circumferential Tenderness, Intolerance to Joint Motion!!

Front 75

Septic Arthritis
Treatment:

Back 75

Urgent Arthrotomy
I.V. Antibiotics 7 – 10 days

Front 76

Discitis / Vertebral Osteomyelitis
Etiology:

Back 76

Hematogenous, Contiguous, Direct

Front 77

Discitis / Vertebral Osteomyelitis
Organism:

Back 77

S. aureus, Strep etc.

Front 78

Discitis / Vertebral Osteomyelitis
At Risk:

Back 78

Diabetics, IVDA, RA, CRF, Steroids

Front 79

Discitis / Vertebral Osteomyelitis
Presentation:

Back 79

fever, wt. Loss, malaise, mechanical back pain, possible neurologic deficits.

Front 80

Discitis / Vertebral Osteomyelitis
best imaging study

Back 80

bone scan

Front 81

Discitis / Vertebral Osteomyelitis
Treatment:

Back 81

I.V. Antibiotics 6 weeks
Surgery:
-Biopsy for culture, Drainage of abscess, Stabilization, Failure of medical management

Front 82

Benign Bone Tumors
Characteristics:

Back 82

Slow growing
Well cicumscribed
Non-invading

Front 83

Benign Bone Tumors
Types:

Back 83

Aneurysmal Bone Cyst
Enchondroma
Osteochondroma
Osteoid Osteoma
Unicameral Bone Cyst

Front 84

Malignant Bone Tumors
Characteristics:

Back 84

Rapidly Growing
Invasive
Poorly Circumscribed

Front 85

Malignant Bone Tumors
Types:

Back 85

Chondrosarcoma
Osteosarcoma
Ewings Sarcoma
Multiple Myeloma
Chordoma

Front 86

Compartment Syndrome:
Definition:

Back 86

Pressure in a compartment substantial enough to stop perfusion

Front 87

Compartment Syndrome
Etiology:

Back 87

Crush injuries, Fractures, Vascular injuries,Toxic / Infectious Insult, Coagulopathies

Front 88

Compartment Syndrome:

Signs / Symptoms:

Back 88

Pain out of proportion
Pain with passive stretch
Pressure within the compartment
Paresthesias, Pallor, Pulselessness

Front 89

Compartment Syndrome:
Treatment:

Back 89

Emergent Fasciotomy

Front 90

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?

Back 90

C6