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159 Cards in this Set

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SPURLING TEST*********
turn head left or right and add compression,
neck and radicular pain with associated numbness and parasthesia. +/- UE weakness, spasm and occipital HA.

reduced cervical lordosis and decreased neck ROM
1. Cervical radiculopathy
eval for cevical lumbar radiculopathy
Spurling test (extension and axial rotation of neck), MRI, assess motor/sensory C5-T1.
abrupt LBP followed by unilateral pain radiating from butt down the back of LE. Pain aggravated by sitting, walking, standing, coughing, sneezing
lumbar radiculopathy
lumbar radiculo eval*** and manage
EVAL: +SLR*****/crossed SLR, MRI

MANAGE: rest, NSAIDS, PT if needed, epidural steroids for more severe radiculopathy
avoid cervical collar-causes neck atrophy, makes things worse************
2. Cervical/ Lumbar Strain s/p MVA
dx for cervical strain
Diagnosis:
- General appearance
- Physical exam- spinal and neuro exam
- MRI** gold standard for discs, ligaments, and muscles
Fowler’s position
reclined with knees bent to restore lordosis for cervical strain
Presentation:
- Local tenderness, stiffness, spasm and loss of lordosis
- Decrease ROM
- Possible weakness and sensory changes
- Co-morbid headache with concussion
- Typically no radicular symptoms
Diagnosis:
- General appearance
- Physical exam- spinal and neuro exam
- MRI gold standard for discs, ligaments, and muscles
Treatment
- Rest in Fowler’s position ( reclined with knees bent to restore lordosis)
- Limit activity
- Limit use of soft collar*****************
- NSAIDS and muscle relaxants
- Refer for Physical Therapy
- Ice then moist heat
Prognosis
- Potential to worsen underlying degeneration
- Recovery expected in 8 weeks
- 20% may have symptoms that are chronic and relapsing
Red Flags
- Numbness or tingling on one side
- Asymmetry of rotation
- Unrelenting neck pain
- Pain over single spinous process
2. Cervical/ Lumbar Strain
Loss of ability to abduct
rotator cuff tear
Neer Test, Hawkin’s Test ******
rotator cuff tear
NEERS WRITE OUT*****************
pt in anatomical position
examinor stands laterally
examinor secures one side of the shoulder with one hand while grasping pts arm distal to elbow joint in anatomical position
with joint stable, humerus is placed in internal rotation
forarm is pronated
glenohumeral joint is moved through forward flexion as the scapula is stabalized
+ test pain with motion
rotator muscle group
mt of test impinges between greater tuberocity of humerus and the inferior acromion process

(elevating humerus and medial rotation forcefully, while depressing scapula)
HAWKINS WRITE OUT ***********
pt with shoulder in anatomical pos examiner in front
grasp elbow and wrist , elbow and shoulder flexed to 90*
humerus is passively internally rotated
+ pain with motion esp near end of ROM
rotator cuff pathology
motion of test between greater tuberocity of humerus and inferior acromion processs
(flex elbow and shoulder 90 degrees and then internal rotation)
Hx of painful tearing or popping sensation in shoulder; pain at rest and weakness overhead or with abducting arm; also, pain with overhead activity; perhaps night pain and difficulty sleeping on affected side.
rotator cuff injury
eval of rotator cuff*****
weakness of supraspinatus (pain on external rotation); shrug sign (inability to abduct arm to 90 degrees w/out involvement of shoulder girdle or scapula); + impingement signs (Neer - elevating humerus and medial rotation forcefully, while depressing scapula or Hawkins sign - flex elbow and shoulder 90 degrees and then internal rotation) any pain signifies impingement; limited ROM; could be assx w/popeye muscle (note: with small tear of cuff, will only have difficulty with abduction on resistance, not passive; with complete tear, they cannot initiate abduction or lower arm to side smoothly (drop arm test)); back of shoulder may appear sunken due to atrophy of supra- and infraspinatus.
supraspinatus
external rotation
shrug sign
inability to abduct arm to 90 degrees w/out involvement of shoulder girdle or scapula
test eval for rotator cuffs
X-ray - to show spurs form inferior surface of acromion, hooked acromion or high-riding humerus relative to glenoid
MRI arthrogram w/contrast (test of choice) - if diagnosis is equivocal or surgical candidate (provides info on size of tear)
man rotator cuff tear
nsaids pt surg if wont heal
Adhesive capsulitis”, elderly most at risk, caution with slings***********
frozen shoulder
- Pain over the Acromioclavicular joint, Pain lifting the arm
- +/- cosmetic deformity
- Pt holds arm in ADducted position
ac tear, separation
- Tender to palpation over AC joint
- Distal end of clavicle may be prominent
- Elevating arm or depressing the clavicle may be prominent
ac separation bc clavicle not stablized by ligament
dx ac tear
xray ap
tx for ac tear 1/2*******
3-6
1/2 nsaids, rest
3/6 surg replace ligament
I ac tear ****
Class I: AC ligamentous partially or completely disrupted; CC ligaments intact; No superior separation of clavicle from acromion
II ac tear**********
Class II: AC ligaments torn; CC ligaments partially disrupted; Partial separation of clavicle from acromion - “ 50-100% displacement
III ac tear*********
Class III : AC ligaments torn; CC ligaments completely disrupted Complete separation of clavicle from acromion - “200% displacement”
IV tear - 6 ac tear**********
Class IV: Periosteum of clavicle and/or deltoid and rapezius muscle are also torn “clavicle out/against skin”
-inflammation of the tendon of the extensor carpi radialis brevis EXTENSORS
Presentation:
-may present as burning pain, gradually progressing over weeks/months,
-wrist weakness, tender to palpation of lateral elbow, usually made worse by lifting, gripping, and pushing against resistance with fingers or wrist.
PE:
-cause of injury is usually repetitive use of forearm muscle (not always tennis),
-pain on palpation localized to area just below the lateral epicondyle,
LATERAL EPICONDYLE
-decreased strength in wrist
Treatment:
- conservative, ice, NSAIDS, rest and if necessary, PT.
-Should heal in 4-6 weeks... next step - corticosteroid injection, next step - surgery for patients with incapacitating pain and who do not get better within 6 months.
6. Lateral Epicondylitis(Tennis Elbow
LATERAL EICONDYLE itits
extensor weakness
6. Lateral Epicondylitis(Tennis Elbow
typically an overuse syndrome resulting in pain over the medial side of the elbow with radiation into the forearm
Clinical Presentation:
-Age: >35
-Can occur with work-related repetitive activities but typically seen in connection to hobbies such as GOLF or throwing a baseball
Physical Exam:
-Tenderness just distal to the medial epicondyle oer the origin of the forearm flexors
-Pain reproduced by resisting wrist flexion and pronation with the elbow extended
Diagnostics:
-X-Rays are Normal
Treatment:
-Rest – at least 1 month
-NSAIDs
-Friction Massage
-Ultrasound
- Icing
-Glucocorticoid Injections at the painful site may be effective
- Physical Therapy once pain has resolved
-For chronic debilitating medial epicondylitis that is unresponsive to treatment after at least 1 year, surgical release of the flexor muscle at its origin may be necessary and is often successful.
Medial Epicondylitis (Golfers Elbow)
medial epicodylitis
flexors affected
pain just below medial epicondyle
7. Medial Epicondylitis (Golfers Elbow)
Description:
-Long head biceps tendon irritated as it courses below supraspinitus tendon to its attachment at the superior sulcus of the glenoid.
Mechanism of Injury: overhead exertion involving repetitive motions
CP:
-Pain to proximal shoulder/humerus with resisted supination, pain/tenderness on palpation
Exam:
-Yergason exam - external rotation with flexed elbow, tests for stability of biceps tendon in the bicipital groove
Treatment:
-NSAIDS, restrict activities and eventually restrengthen
If no improvement for months, steroid injection helpful
suboccipital tendonitis
biceps tendonitis
yergason test ** secures long head of biceps tendon in its groove
BICEPS TENDONITIS --
secures long head of biceps tendon in its groove---

shoulder impingement wosening of pain with resisted supination while the elbow is flexed to 90* arm adducted
huge ball at end of elbow
olecranon bursitis
Presentation:
-Swelling is often the first symptom. This causes pain . The swelling may grow large enough to restrict motion of the elbow.
If the bursitis is infected, the skin becomes red and warm.
Diagnosis:
-An X-ray may be taken to look for a foreign body or a bone spur. Bone spurs are often found on the tip of the bone of the elbow in patients who repeatedly have elbow bursitis.
Treatment
Nonsurgical Treatment
Infectious: aspirate fluid for C&S and start antibiotics
Non-infectious :
-elevate and ice.
-NSAIDS
-An elbow pad may be used to cushion the elbow but do not use direct pressure to the swollen elbow
-If no improvement, aspirating and injecting corticosteroids is the next option
Surgical Treatment
-If bursitis does not improve with medications or by removing fluid from the elbow, surgery may be needed to remove the bursa
olecranon bursitis
swelling
xray
nsaids
aspirate
/abx if infx
Signs and Symptoms:
- mucinous fluid usually in the dorsal wrist (most common), palmar wrist, or flexor sheath of fingers
- etiology unknown, may be due to repetitive motion
- usually painless unless there's local swelling (dull ache at dorsal and tenderness in fingers)
- flexion accentuate dorsal wrist ganglion cyst
- tenderness to pressure

Diagnosis:
- x-ray to rule out other osteogenic pathology
- aspiration of cyst confirms diagnosis
Treatment:
- 28 -58% resolve
- 1st: supportive care (diet, rest, stop repetive motions) with wrist splint
- 2nd: aspirate and compress cyst if above doesn't work
- 3rd: aspirate and compress and cortecosteroids injections if 2nd doesn't work
- 4th: no improvements after 12 weeks, surgical referral
ganglion cyst

tender mass, unknown etio
xray
rest,>> aspirate,>> surg
- Inflammation involving the abductor pollicis longus and the extensor pollicis brevis; these tendons pass through a fibrous sheath at the radial styloid process.
Etiology - The usual cause is repetitive twisting of the wrist. It may occur in pregnancy, and it also occurs in mothers who hold their babies with the thumb outstretched.
S/S - Pain on grasping with the thumb, such as with pinching. Swelling and tenderness are often present over the radial styloid process.
Evaluation - The Finkelstein sign is positive, which is elicited by having the patient place the thumb in the palm and close the fingers over it. The wrist is then ulnarly deviated, resulting in pain over the involved tendon sheath in the area of the radial styloid.
Treatment - initially splinting the wrist and an NSAID. If severe or refractory to conservative treatment, glucocorticoid injections can be very effective
*Pain and inflammation over tendons of snuff box
**Finkelstein’s Test
11. DeQuervain’s Tendonitis
Inflammation involving the abductor pollicis longus and the extensor pollicis brevis; these tendons pass through a fibrous sheath at the radial styloid process.
deQuevarain tendonitis
*************____ sign is positive, which is elicited by having the patient place the thumb in the palm and close the fingers over it. The wrist is then ulnarly deviated, resulting in pain over the involved tendon sheath in the area of the radial styloid.
Finkelstein*********
snuff box tenderness tendon, inflamation
Finkelsteins + deq tendonitis
**tap over median nerve tunnel, creates shooting pain
*****-extension of wrists, will feel tingling in median nerve distribution
******TINELS TEST
*****PHALENS
carpal tunnel sx worse what time of day
night
wake up at night with pain, shake hand to try to overcome pain, use nighttime splinting
carpal tunnel
finger pops with clicking cant straighten out
trigger finger
tx for trigger finger *********
steroidssplintingtendon release
- pain over the lateral aspect of the hip that occassionally radiates downt the leg,
-pain worse when sleeping on that side at night, often eperience stiffness after long sitting
trochanteric bursitis
most efx tx for trochanteric bursitis
MOST EFFECTIVE TX IS STEROID INJECTION directly into the bursa
-rarely requires bursectomy
Presentation:
- Retropatellar aching pain/ Diffuse anterior knee pain
- Worse with stairs, prolonged flexion, resisted extension
- (May be associated with patellar malalignment or instablilty)
Diagnosis:
- History and Physical Exam
- Patellofemoral grid/compression test
- AP, Lat, and Axial patellofemoral X-rays
- Assess for: quadriceps atrophy, patellar malalignment, crepitus.
Treatment:
- Quadriceps strengthening
- Patellar brace
- NSAIDs
15. Patellofemoral Pain (runners

*** grouped with chongromalasia
indurated joint, fluid within, ballotment test, bulge test, recognize difference between red, inflamed, and septic joint
knee joint effusions
wbs >50k septic
Traumatic-ACL, PCL, collateral ligaments (MCL, LCL), Meniscus tears,Intra-articular fracture
Clinical Presentation:
-Pain, swelling, erythema
Physical Examination and Management:
-Tense effusion, deformity, crepitation and ecchymosis – fracture (examine hip & ankle) TX – Displaced intra articular – require reduction
- Effusion, + Lachman test, + anterior drawer test, Pivot Shift test – ACL tear
TX – reconstruction especially in younger and athletic people
-Effusion, + posterior sag test, + posterior drawer – PCL tear
TX – Isolated – bracing, Grade III- reconstruction
-Localized lateral, medial tenderness with ligamentous laxity, Valgus (MCL), Varus
(LCL) – collateral ligament injury TX – majority heal without surgery, combined require surgery
-Joint tenderness, inability to squat of hop, + McMurray test, extension lag – Meniscus tear TX – majority require surgery
Non-traumatic – Polyarthritis, Infection, Gout, Tumor, Benign-cysts, osteomas
Clinical Presentation:
-Joint pain, erythema, swelling and fever (infection)
Diagnostics:
-Plain films – 3 views
-MRI
-Aspiration (not all requite aspiration)
-CBC, ESR
Management:
-Aspiration
*****-Tx of underlying cause
knee joint effusions
ballotments test
*******
joint effusion
bulge test********
joint effusio
most common cause is degernation; injury may be trivial
Signs/symptoms:
-joint line tenderness (most specific finding)
-knee pain
-swelling of the knee(+/-)
-popping or clicking within the knee
Evaluation:
-McMurray's Test: knee flexed to 90 degress w/ examiners hand on jt line, other hand externally rotates tibia +/- slight valgus stress as knee is extended; + test = jt line pain or click
-x-ray: helps determine if there is evidence of degenerative or arthritic changes to the joint
-MRI: helps in actually visualizing the meniscus
Treatment:
-Rest, ice, wrapping the knee w/ elastic banage, PT, NSAIDS
-if continue to be symptomatic, consider surgery:
--meniscus repair
--meniscectomy: removal of portion of meniscus
menisus tear
joint line tenderness, McMurray’s test, Thesally test-high specificity **************************
meniscus tear
-Constant friction or trauma irritates the bursa on top of the patella. It gets inflamed and painful.
Signs/Symptoms:
-painful w/ activity (usually not at night), rapid swelling, tender/warm
Evaluation:
-X-ray to rule out fracture
Management:
-Rest, Ice, Elevation, NSAIDS.
-In severe cases- drain bursa w/ needle or surgical removal of bursa.
big ball on knee
patellar bursitis
carpeters,
overuse
xray
nsaids rest/draining
Presentation (3 Degrees):
Mild (1st Degree): Little disability, Local tenderness, Little/no pain on ROM, normal ROM, Able to walk, Little/no swelling
Moderate:
Loss of function in at least 1 ROM, Pain on normal ROM in at least 1 ROM, Able to bear weight but can’t walk, Swelling/Tenderness
Severe:
Complete loss of function, Unable to bear weight, Abnormal ROM, Swelling/Discoloration, R/O fx
Evaluation:
Palpate for tenderness, Drawer test, Talar Tilt, Sqeeze Test and external rotation test (for high ankle sprains), Check dorsalis pedis and Posterior tibial pulses, Examine feet, Check head of fibula, X-ray
Management:
1st 2 weeks:
NSAIDS, RICE,AIR stirrup or cast,WBAT (crunches if needed), Contrast hot/cold bathes
Avoid excess
Heat
Weeks 2-4:
Continue Brace, Begin dorsiflexion exercise (to increase strength), Work on full ROM and 80% strength in dorsiflexion, No plantar flexion or contact sports
Weeks 4-6:
Functional conditioning, Proprioception, Agility and endurance training, Wean from stirrup/brace, Consider tape/brace for pivot sports, *Refer if progression absent*
High ankle Sprain (involves syndesmosis):
RICE, Analgesics, NSAIDS, Normal X-Ray: Treat as above, Widening on X-Ray: Surgery (ORIF)
ankle sprain
most commonly affected ligament-talo fibular, inversion mechanism**********************************
ankel sprain
Thompson’s test****************
squeeze calf belly, flexion plantr of foot
achilles tendon rapture
**********plantar fashiatis tx most helful
steroid iject
Clinical Presentation:
- Pain just distal to heel pad
- Painful first steps in the morning
Evaluation:
- Assess risk factors – occupation, footwear, foot alignment
- Exam – localized tenderness of plantar medial heel
- X-Rays – may show calcaneal spur but no link b/t the two, so don’t worry about spur unless it’s fractured
Management:
- Activity modification – no walking barefoot, avoid aggravating activity
- Orthotics – arch support, heel wedge
- Physical therapy – stretching: Achilles/gastroc/soleus
- NSAIDS
- Night splints
plantar fashitis
Symptoms:
-History of fall onto outstretched hand or the shoulder
-Pain and decreased ROM at the shoulder
-One of the most common fractures, and very common in children.
Signs:
– Palpable deformity and crepitus common over bone.
-Patient supporting arm on injured side
-Shoulder displaced anteriorly and inferiorly
Evaluation:
–Thorough NV exam of entire upper extremity. Examine the entire shoulder. Shoot plain film of both clavicles. A/P and angled (15-30 degree cephalic tilt) views.
Management:
– If severely displaced, reduce by elevating the arm and lateral fragment so they line up with the medial fragment.
-Simple sling to support affected side.
-Narcotics or NSAIDS for pain.
Surgical management indicated with open fx, NV compromise.
clavicle fx
26. Humeral Head and Surgical Neck Fx tx ************************
sling let gravity heal
from abrupt flexion injury (in normal people) or from insignificant injury in elderly with osteoporosis, myeloma, mets, or hyperparathyroidism
PRESENTATION:
-acute severe pain at level of fracture (middle and lower thoracic and upper lumbar) with local radiation across back and around trunk (rarely into legs)
-restricted spinal movement, loss of height, kyphosis deformity if multiple fractures
EVALUATION:
-Tenderness over vertebrate = presence of fracture
-X-ray necessary to confirm diagnosis (may not localize fracture)
-Bone scan – localize and determine whether single or multiple fractures
- CT/MRI if neurological deficits
MANAGEMENT:
-Supportive – rest, analgesia, and gradual ambulation once free from severe pain
-Medical – intranasal calcitonin to control pain
-Surgical – Kyphoplasty (percutaneous injection of cement into collapsed vertebral body) – pain relief and restoration of vertebral body height
vertebral fx ]
pain tenderness
xray bone scan mri
rest, kyphoplasty
Presentation:
- gradual onset pain distal 1/3 of tibia
-increases with exercise, hill training, running on hard surface, duration, intensity, pace and distance
Evaluation:
- tenderness to palpation of the medial 1/3 of distal tibia
Management
- mild = rest, NSAID, PT, massage, analgesic creams
-Mod= no running
-Severe = no weight bearing activity
tibial stress fx
pain in distal 1/;3 tibia, tender middle 1/3
tx nsaids, rest, massage PT
*************biggest complication of FELON
osteomyelitis of distal phalanx
an infection usually from S. areus of the pulp space of the distal finger
-Septa run vertically between the skin and bone creating compartments within the pulp space - this is where the infection is.
Presentation:
-Patient complains of severe throbbing pain, tenderness, erythema, and swelling of the distal phalynx, with possible pus accumulations. The swelling won't go down because the pus is trapped, which means increased pressure and possible compromised blood flow which can lead to necrosis
Evaluation:
-No evaluation needed unless it's very severe or in immunocompromised patients.
Management:
-Incision and drainage: Use a central longitudinal incision that doesn't go past the DIP joint to drain completely. Pack the space, splint, and elevate. Give antibiotic coverage for staph and strep, and possible MRSA. Packing can be removed 1-2 days later. Recovery is fine if it is recognized early and treated promptly
felon
Usually presents in growing children and is due to reptitive stress and overuse
Presentation:
-anterior knee pain exacerbated by running, jumping, and kneeling activities;
-pain after prolonged sitting with knees flexed
PE:
-tenderness and swelling and visible prominence at the tibial tubercle (may present bilaterally, but one side may be worse than the other)
Diagnostic test:
-AP and lateral x-ray may appear normal or show evidence of some ossification anterior to the tibial tuberosity
Treatment:
-no sports for 3-6 weeks, when return to sports ice after, NSAIDs, stretching exercises to maintain quadricep flexibility and use a brace during activities.
osgood shlatter dz
overuse syndrome at growth plate tibial tuberosity***********
osgood shlatter dz
Etiology/Pathology
-Softening of articular cartilage; can happen at any joint but mostly in the patellar region
Clinical Presentation
-Presents just like patellofemoral pain mostly
-Young athletic people
-Subacute onset
-Localized, retro-patellar “aching” pain
-Worsens with prolonged flexion like climbing stairs, and resisted extension
Evaluation
-History
-Physical exam
-Can be mildly swollen and inflamed due to irritation but not much
-Pain when patella is pushed into femoral condyles
-Actively – ask pt to flex quads while you press on patella into trochlea
-Passively – “Grind” patella into trochlear groove
X-rays
-Normal in most cases
Management
-Conservative
 Rest for a few weeks and gradually increase activity as tolerated
 NSAIDS
 PT – concentrate on Quads
 Patellar brace
-Surgical (usually only if pain > 6-12 months)
 Athroscopic chondroplasty
 Debridement/Decompression
 Tibial Osteotomy if due to underlying malalignment
chondromalacia
**painful limp, radiating pain to knee, differentiate from leg calf perthes (painless limping, thigh pain)
Slipped capital femoral epiphysis
fracture through the epiphyseal growth plate
-most common in young teenagers. boys > girls.
-Rapid growth and an imbalance of hormones during adolescence may cause a slipped capital femoral epiphysis.
-An injury or a rapid increase in body weight or height may trigger symptoms.
Symptoms:
-usually begin between 10 and 16 years of age.1 They may begin earlier in girls than in boys.
-Hip tenderness and decreased movement during the early stages of the condition.
-Increased pain when the toes are turned in toward midline (internal rotation of the hip).
-Mild discomfort in the groin, thigh, or knee while walking or running. Rest relieves this discomfort.
-Knee pain. Sometimes knee pain is the first symptom.
-Stiffness and a limp, especially when tired.
-Muscle spasms.
-Mild to severe pain.
Evaluation:
-X-Ray
-CT/MRI
Management: Prevent further slippage, restore the normal position of the bones, and reduce complications of the condition. This often involves surgery to secure the growth plate (physis) with a single screw or with pins. Osteotomy may be used in a severe case, but this is rare. In an osteotomy, the doctor cuts the bone at the top of the leg near the hip joint, moves the bone to a more normal position, then uses metal pins to hold it in place. The pins are usually left in the bone after it heals.
Crutches may be used to take weight off the hip. Before surgery this prevents further slippage and helps decrease pain. After surgery it decreases pain and helps keep the hip stable and in good position as it heals.
A slipped capital femoral epiphysis may lead to early degenerative arthritis of the hip if not detected early and treated properly
slipped capital femoral epiphysis
*************flexed–PIP, extended–DIP vs. swan neck deformity flexed-DIP, extended-PIP
buttoniers
*********in people who wear high heel shoes, pain/numbness b/t 3rd and 4th web space
mortons neuroma

pain in 34 space
eval: press on area, lidocane
tx steroids , nsaids
surg curative
Clinical presentation:
-middle aged men, stop & go sports (tennis/b-ball)
-sudden severe calf pain ("gunshot wound")
-may resolve quickly (can be misdiagnosed as ankle sprain)
-hx of Achilles' tendonitis could be pre-rupture state
Evaluation:
-Dx based on hx and physical exam-- need to do ASAP or can lead to impairment of ambulation
-physical exam shows lower calf swelling, difficulty bearing weight, palpable tendon defect, (+) Thompson test
Management:
-immobilize, rest, ice, compression, elevation x 5-6 days post-injury, followed by home exercise program, nonsurgical (plantar flexion casting, PT) vs. surgical based on degree of tendon retraction and pt's level of activity/age/medical condition/surgical risk
achilles rupture
mc stretched ligament foot
talofibular
flex elbow
c6
extend elbow
c6-8
dorsiflex
l5
plantar flex
s1
abduct fingers
c8-t1
ROMS Passive exceeds active by _ deg
5
bicipital groove tendinitis tx
do injections
patient unable to hold arm fully abducted at shoulder level; indicates rotator cuff tear
drop arm test
surprasipinatus
test adduct the patient’s arm across chest – (+) tenderness or pain which suggests
crossover test

inflamation
arthritis
**** OTTAWA KNEE RULES
pt >55
tender fibula head
tender patella
inability to flex 90
inability to ambulate 4 steps
weight bearing
***** ottawa ankle rules
tenderness to post lateral malleolus
-tenderness to post med malleolus
-unable to walk 4 steps
** ottwawa foot xray
pain in midfoot
base 5tgh metatarsal (JONES FX)
tenderness of navicular
inability to bear weight
45 yo male c/o getting his thumb jammed and twisted by a die cutting maching. PE- ***Marked swelling of the hand and tenderness at the anatomical snuff box.
SPLINT navicular/scaphoid
navicular fx
THUMB SPICA

SPLINT ALL WRISTS
navicular scaphoid snuff box
***** TQ ****78 y.o. female fell while going down a flight of stairs. CC- Severe pain and swelling. PE- marked deformity, N-V intact
SPLINT colles fracture
TQ: COLLES FX "SILVER FORK DEFORMITY" distal radius fx

SUGAR TONG SPLINT, SLING
needs closed or ORIF
TQ*****tong splint
"silver fork deformity, colles, forarm fx
- humeral fx"
thumb spika
navicular, scaphoid, jammed thumb, bennets, thumb dislocation
posterior short leg splint
tibia fibula fx
ankle fx
metatarsal fx
stirrup splint
ankle fx
ankle sprain strain
ulnar gutter splint
45th metacapral fx for boxers fx
**********9 yo female(5th degree Black Belt) with and injured elbow in a karate match with Chuck Norris.
CC- severe pain and inability to move elbow
Elbow swollen and generally tender, very limited ROM

anterior and posterior fat pad - bad
lateral elbow
posterior

supracondylar or salter class fx
LONG ARMPOSTERIOR SPLINT sling
immediate consult
*****long arm posterior splint
supracondylar fx
elbow strains fsprains
volar splint
wrist strains, carpal tunnel, lacerations
KNOW THESE *******
Anterior Fat Pad if seen= NORMAL
Accentuated Anterior Fat Pad= “Sail Sign”=ABNORMAL
Most Important Elbow Fact To Ever Remember= POSTERIOR FAT PAD SIGN=PATHOLOGIC
Splint, Sling and urgent Peds Ortho referral if pediatric !
anterior fat pad -sail and sign
4 yo male with right arm pain after his sister yanked him by the arm out of his playpen for throwing mushed pea baby food on the visiting neighbors
CC- Right arm pain, crying with any attempts at movement, holding arm at side, motionless…………..
classic pulled by arm::************************
sublaxation of radial head NURSE MAID ELBOW
TQ unhappy triad***********8
ACL, medial meniscal tear, medial colateral legament
TQ: ABNORMAL FLUID **********
URIC ACID --
CALCIUM PYROPHOSPATE
uric acid - gout
psuedogout -cal pyroPhos
TQ: ***** HIGH RISK POOR HEALING FX 5
vavicular scaphoid hand
distal 1/3 tibia
femoral head
talus
2nd metatarsal
gamekeepers thumb**** TQ inability to pinch
cant miss real lax, sometimes aulsion rips ulnar collateral ligament of thumb pain over
stirrup splint
ankle fx sprains
medial lateral long leg splint
ligamentous injury
of knee
tibia and fibula fxs
C5 root
P: neck, shoulder,
S: numb in deltoid
M: deltoid, biceps
R: biceps
C6 root
P: neck shoulder, medial scapula, lateral arm,
S: index finger, thumb
M: bicepts, extensors pollicis longus
R biceps, brachioradialis
C7 root
P neck shoulder medial scapula, lateral arm, dorsum of forearm
S: index long fingers, dorsum of hand
M: tricepts finger extensors
Reflex: triceps
L4
M: antterior tibialis
R: patellar tendon
L5 *********** TQ
M: dorsiflex hallucis longus
S1
gastrocnemius , toe raises
achilles tendon
A 42 year old woman presents with pain over her right upper arm with tenderness, myalgia, fever and some swelling.
X-ray shows lesion with a moth-eaten appearance in the humerus of the painful arm. The most likely diagnosis is:

A. Cellulitis
B. Osteoma
C. Osteomyelitis
D. Lupus
c
The most common etiology for Osteomyelitis is: (answer A)

A. Staph
B. TB
C. Fungus
D. N. Gonorrheoeae
a
A 45 year old man comes to the urgent care center complaining of severe pain in his right knee. The pain began suddlenly and upon examination, the joint is swollen, red, tender and the patient has decreased range of motion. He denies any trauma. What is the most likely diagnosis?

A. Osteomyelitis
B. Septic Arthritis
C. Rheumatoid Arthritis
D. Osteoarthritis
b
An 18 y.o Sexually Active Male presents to your clinic for pain and swelling of his left knee. After history and physical you are confident he has Acute Septic Arthritis of his Left knee. What is the most likely pathogen responsible for this infection?
A) Pseudomonas
B) E. coli
C) Staph. aureus
D) N. gonorrhoeae
d
1) A 70 y/o seemingly healthy woman presents for an annual check-up. Her BP is 127/83, P 82, height 5'3, weight 120 lbs. She has a 20 pack year hx of smoking but claims no ETOH use. Her only current medication is for BP control. She does have a hx of thoracic vertebral compression fx at the age of 60. What is a diagnostic study you would like to have? (b is correct answer)
a. CT scan
b. dual energy x-ray absorption (DEXA)
c. MRI
d. x-ray
b
A 75 y/o female pt comes to your clinic complaining of back pain. She has a hx of a previous fx and on physical exam you notice that she has a spinal deformity and that her height has decreased by >1cm since the last time you saw her. Based on this presentation, how would you manage her underlying bone disease?
a. naproxen sodium (Aleve)
b. alendranate (Fosamax)
c. calcium carbonate (Tums)
d. prednisone (Pred-Forte)
b
1. A 55 year old woman presents to the ER after falling at work. After taking her history you learn that she has had constant deep pain in her thigh as well as "flu-like" symptoms for the last 2 weeks. Her x-ray reveals a pathologic fracture and a lytic lesion in the metaphyseal/diaphseal junction of her left femur. What is your initial diagnosis?

A. benign tumor
B. primary malignant tumor
C. metastatic tumor
D. osteomyelitis
c
2. After an initial bony tumor is discovered, what is the diagnostic study to determine the extension of the lesion into soft tissue?

A. x-ray
B. MRI
C. bone scan
D. CT
B
::::::TQ?::::: intra vs extra articular
extends into joint vs not
::::::TQ?::::: Fx description
fx weaken by dz or malignancy
osteomyelitis virtually disintegrated
elderly hip or spine
pathologic
::::::TQ?::::: avulsion fracture description
portion of bone pulled off from orgin
like wall not dry paint comes up ligament pulls bone with it
snuff box tendernes
navucular has bad tendency to heal bloody suppoly poor
SALTR
::::::TQ?:::::
slipped
above epiphysis
lower than physis
through physis
rammed epiphysis
::::::TQ?::::: base of 5th metatarsal zone 2 (zone 3 also)
jones fx jones + avulsion

further you get the worse it heals zone 1 not as important
buckle or torus fx
cortical disruption on one side or biotg
PEDS
nondisplaced radial / ulnar fx
boxers
VOLAR ANGULATION 5th meta tarsal VOLAR BENT FORWARD
::::::TQ?::::: massoneuve fx
significant ankle injury
torsional forces break fibula proximal fibular fx with medial malleolus fx
::::::TQ?::::: GRADING MUSCLE SCLAE 0-/5/5
::::::TQ?:::::
::::::TQ?::::: fx healing
UNION
CLINICAL UNION
RADIOGRAPHIC UNION
fx is healed with clinically and radio correct
no tenderness to palpation no movement
- no fx line, bridging bone trabeculae or fx callus
::::::TQ?::::: compartment sx 5 Ps
slice open do fashiotomy
pain
pressure <MAP less than 30
parathesia
pulslessness
paralysis
::::::TQ?::::: tumors bones metastize from where
PbKTL
prostate
bone
kidney
thyroid
lung
::::::TQ?::::: sarcoma
hypodense lytic lesion tumor looks darker
::::::TQ?::::: osteosarcoma
tumor looks bigger buildp loks whiter
pelvic fx pubic symphasis
anterior pelvic trauma / horse / parachute xray
<2.5 cm conservative
>2.5 ORIF
pubic ramus
MVAs running hard military
xray
REST
acetabulum fx
head through roof
xray ORIF get acetabulum back 6 weeks healing
pelvic avulsion
athletes pple running piece falls off
palpate hip flexors
xray
rest
Hip fx - old - ambulation becomes impossivle
FEMORAL NECK
stable or not
xray, MRI if hard to see
AVN complcation
stable femoral neck
closed reduction and pinning
no displacement no avn
unstable displaced femoral neck
TX: BIPOLAR HEMIARTHROPLASTY replace entire neck bc avn
acetabulum ok so no total replacement
intertrochanteric fx
nondisplaced or 4 part,
XRAY
surgical fixation
IM ROD
hip dislocation - sever trauma MVA
posterior dislications
MOST COMMON
avn, fx of acetabulum
closed reduction if nothing is fractured
"ADDUCTED INTERNALLY ROTATED MODEST"
anterior hip dislocations
leg extended and external rotated sports
closed reduction
fx not common
calve perthes
young kids AVN painless limp
xray
collapse in femoral head
femur fx

proxima shaft
distal
xray
IM RODS for proximal and shaft
RETROGRADE IM ROD - distal femur goes through mknee w
djd of hip
bones start to spur, limp, stiffness, avn, smoking,
conservative and NSAIDS

total hip replacement
pain over lateral hip down lef
worse when stepping
worse at night
xray
MOST EF is STEROID INJECTION!
greter trochanteric bursitis
AC separation eval
xray
1-2 sling, nsaids, return to activit in 4 weeks
4-6 surg
most common osseous injury
where
hx of bad fall
clavicle
middle

xray
CT at medial end if hard to see
sling
high energy shoulder injury MVA
fall
associated fx is RIBS
PNEUMOTHORAX
PULM CONTUSION
other injuries
scapula fx
moving arm causes much pain


XRAY
CT if cant see or glenoid

SLING
most common shoulder dislocation
anterior
- trauma
- can be recurrent
TUBS
treaumatic unidirectional bankart lesion with surgery
AMBRI multidirectional shoulder disloc
AMBRI - atraumatic
multi
bilateral laxity
rehab
inderior capsulat shift
dislocation asx with seizure
posterior disloc of shulder


ER not possible
posterior fx comression of posterior humeral had
HILL SACHS FX
SLAP

* reppetative activity
traction
compression
direct blow
superior labrum anterior posterior
overhead activity
pain layng down
DX of SLAP
MR arthrography and arthroscopy - gold standard