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152 Cards in this Set
- Front
- Back
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Open fx surgical treatment
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irrigation & debridement
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what are the 3 important things to look for in restoring fxs?
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length
alignment rotation |
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what is important in the outcome of a tibial plateau fixation?
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restoration of the articular surface using medial and lateral plate fixations
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what is the management of an orthopedic trauma?
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perform secondary survey
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Prior to elbow surgery, its important to obtain a __________
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traction film
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3 causes of a single hot joint
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trauma
infxn crystals |
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Patello-Femoral Sydrome (PFS)
______ knee pain worse on stairs and jumping pain after being ________ for a while pain prior to ________ |
anterior
seated instability |
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PFS Exam:
knee _______ patellar facet tnederness, shrug, grind, tilt ________ mobility _________ tightness ___ angle - b/w femer & tibia when knee is flexed 90 degrees foot architecture - look for _________ hip motion - look for _________ quad strength (iliopsoas strength) |
extension
patellar hamstring Q pes planus (flat foot) anteversion |
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PFS Tx:
________ & ________ stretch work in terminal extension ?______ ?______ ?McConnell taping |
hamstring & quad
NSAIDs Brace |
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Meniscal injury:
usually a _______ injury _______ related pain & swelling possible locking, w/ firm block to motion and easily identifiable unlocking either at free edge or bucket handle *meniscus can only be repaired _________ b/c of blood supply (otherwise remove)* can remove 1/2 of meniscus before pt has problems |
twisting
activity peripherally |
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Meniscus injury Exam:
________ tenderness (seated) _______ (supine) meniscal compression - combo of flexion & tibial rotation looking to stress a particular part of a particular meniscus not random ___________ |
joint line
effusion circumduction |
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Meniscus injury Tx:
_____ ______ ? injections (elderly) Patience Surgery (not always needed) |
RICE
NSAIDs |
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"I planted my left foot & twisted to the right. I felt a pop, shift, & pain. I fell to the ground & could not walk away. My knee swelled in a hour. Since that time, I have had pain, swelling, locking, popping and giving way"
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ACL tear
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ACL tear exam:
________ _________, not anterior drawer if cant examine, RICE & NSAIDs and come back in a wk Xray: Std series _________ lateral plateau avulsion (________ fx) |
effusion
Lachman hemarthrosis Segond |
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ACL tear Tx:
______ rehab +/- brace not all need surgery in young people - reconstruction to preserve meniscus surgery - reconstruct w/ BTB (bone-tendon-bone), HS, quad tendon, allograft |
quad
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MCL injury:
usually valgus Grade 1 - ________ Grade 2 - ________ Grade 3 - ________ Tx: brace, motion, NSAIDs |
strain
partial tear complete tear |
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Arthritis:
activity related pain & swelling night pain, weather pain ask how far the pt can walk effusion _________ tenderness loss of _______ TX: NSAIDs, cane in the _________ hand injection (__________), arthroscopy TKA |
joint line
motion contralateral cortisol |
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Ilio-tibial Band Syndrome:
activity related _______ knee pain no _________ or _________ pain is usually at 30 degrees flexion, coming from flexion Tx: stretch, rest NSAIDs rarely surgery |
lateral
effusion or locking |
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change in training routine
excessive downhill work worn out shoes always running the same direction on a cambered road or track crossover gait |
ITB triggers
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Patellar tendonitis:
pain during or after activity ________ pole tenderness Tx: RICE quad, HS, achilles stretch modalities quad strength sleeve or strap progression to activity most important is ________ |
inferior
rest |
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Baker's cyst:
swelling _______ the knee changes in size pain, fullness/stiffness Tx: treat the source of intra-articular irritation and cyst should go away ________ in young pts ________ in elderly pts |
behind
meniscal tear arthritis |
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Loose Body:
________ or bony pieces that have broken off may have mechanical sx - _________ needs to be removed if causes sx |
cartilage
locking |
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Osteochondritis Dissecans:
________ of the lateral aspect of the medial __________ pain and swelling Xray (cant make dx w/o it) - ______ view MRI Tx: age dependent |
AVN
femoral condyle Tunnel |
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Degenerative Arthritis:
common in middle aged & elderly articular cartilage ________ pain is often located in _______ decreased ROM of hip Xrays Tx: NSAIDs, ____ ______ loss total _________ |
thinning
groin GCS (glucosamine condroitin sulfate) weight hip replacement |
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Avascular Necrosis (AVN):
occurs in 3rd to 5th decade chronic _______ use prior hip injury bone necrosis in wt bearing portion of ________ pain often located in groin w/ wt bearing Xrays Tx: NWB vascularized graft hip replacement |
steriod
femoral head |
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Trochanteric Bursitis:
pt complains of pain and cant sleep on their ______ pain located over ___________ during int rotation & abduction Tx: NSAIDs, ice, heat, stretching injections, PT |
side
greater trochanter |
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Hip Dislocation:
always from a __________ must reduce hip quickly to prevent _____ (<6 hrs) |
high energy trauma
AVN |
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Slipped capital femoral epiphysis:
________ w/ activity related groin pain sudden onset or acute increase in pain always need _______ |
overweight teenagers
surgery |
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Hip Fractures:
very common tx w/ surgery ________ fractures - can be replaced if displaced fractures below neck are tx w/ ____ |
femoral neck
pins |
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Femoral neck fractures:
activity related _____ pain most stress fractures are on ______ side of femoral neck |
groin
dorsal |
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During the inflammatory phase of a fracture, do not give _______
Growth around the metaphysis occurs at the _________ Children don't sprain, they break at the ___________ Always Xray the underside of the bone |
NSAIDs
Ring of LaCroix Growth plate |
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Adults cannot have incomplete fractures
_________ is most common _________ & plastic deformation are very uncommon |
torus/buckle
Greenstick |
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Zone of Calcification - ________ injury
Distal ________ fx is the worst |
physeal
tibial |
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Distal _______ Torus - very common
shows as a little bubble on Xray Point tenderness at fx site only clinically healed = ________ in 6 wks radiographically healed = ____________ |
Radial
non-tender bridging calcifications |
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fat pad - _______ densities on Xray
blood accumulates under pad & pushes it out anterior pad in ________ is normal |
black
flexion |
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Bone ossification
female - _____ male - ____ |
1 yr
2 yr |
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Lateral elbow Xray:
lines through humerus & capitellum is _____ ant humeral line should go straight thru ________ (middle 1/3) line thru ant humerus should sweep smoothly with ______ (coronoid process) *________ should always point at capitellum in every view* |
30 degrees
capitellum ulna Radial head |
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post fat pad on elbow film is ______ in kids
in adults is a ________ fx |
Supracondylar Fx of Humerus
radial head |
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Both Bone Forearem (BBFA) fx - xray joint ______ & _______
adults should not be put in a ________ cast |
above & below
forearm |
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evaluating reductions:
same ______ = good reduction bones are oval so different sizes means _______ = bad |
size
rotation |
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Corner/Buckethandle fx - usual fx is _______ & _______
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torsion & compression
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Clubfoot:
______ - high arch ______ - forefoot ______ - foot is swong over ______ - foot hangs like a hoof |
cavus
adductus varus equinus |
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Metatarsus adductus:
usually ______ no ______ or ______ put pt in special shoes Last shoes - medial contour use straight or reverse Last shoes for tx |
flexible
cavus or varus |
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Flatfoot:
_____ is by bony anomalies no ______ hindfoot is ______ Intoeing: Etiology metatarsus adductus internal _______ torsion excessive _______ anteversion (points forward) |
rigid
arch valgus tibial femoral |
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Knee:
cross from bow-legged to knock-kneed at age ____ adult alignment by age ____ _______ dz: problem w/ medial tibial physis needs surgery |
2
6-7 Blounts dz |
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Osgood-Schlatter dz:
point tenderness at _______ (apophysitis) Always look at ______ Tx of Shin Splints: _____ |
tibial tubercle
hips none |
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Congenital Dysplasia of Hip:
now thought to be a __________ problem hip exam - always have pt ______ int/ext rotation is usually ____ degrees total dysplasia can produce _________ *_______ line* - curve along femoral neck & obturator line _______ line - transverse _______ line - vertical look at where all lines cross *________ sign* - pt is supine, knees flexed, if at different heights the femur is pushed posterior extra skin folds in thighs? |
development
lie flat 110 degrees dislocation *Shenton's* Hilgerener's Perkin's *Galeazzi's* |
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______ Dz:
vascular insult - toxic synovitis ~ septic hip from _____ infxn head dies but will come back & remodel in children short neck, fat trochanter |
Perthes
viral |
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Slipped Capital Femoral Epiphysis (SCFE):
usually _______ in ________ pts head slips off the neck put pin in to stop physis from growing |
bilateral
African American |
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ER Hands:
dont take of dressing do __________ in fingers on each side laterally ____ mm is normal _____ in the hand is where tendons run together in the sheath ____ side - back of hand ____ side - palm fingertip injury goes to the OR next day |
2 pt discrimination
5-6 Zone 2 ER OR |
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Carpal Tunnel:
> 35 yrs _______ women women > ___ ______ > 40 yrs ichemia from ________ 9 tendons, 1 nerve - tendons get bigger as person ages NO numbness in _______ ________ is early sign _______ is late sign (means regeneration) TX: injections |
pregnant
50 smokers compression small finger Median nerve compression test Tinnel's sign |
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CTS Tx:
nerve studies - dependent of wt, BMI, sweat ______ should be worn at night surgery - carpal tunnel release with local anesthetic, not ________ |
splints
endoscopy |
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Cubital Tunnel:
_____ stretches & squeezes *_______ sign* - flexion of thumb when squeezing wrap hand towel around arm at night |
ulnar nerve
*Fromont's sign* |
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most movement in spine is from _______ areas
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lumbar/cervical
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Anatomy
50% of Flex/ext and rotation comes from C1-C2 ______ responsible for largest % motion Little motion in T-Spine C5-6 HNP likely compresses C6 L4-5 HNP compresses ____ |
L4-5
L5 |
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Low Back Pain
Benign Symptom Self-Limiting Disease Very Common ___% of Adults 15% of all Patient Visits 80% of Acute LBP Resolves Within 4 Weeks |
84
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Cervical Degenerative Disc Disease
Not related to ______ Most people develop to some degree No good classification system ________of the disc ________- bone spur, disc space narrowing |
pain
Dehydration Spondylosis |
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Herniated Nucleous Pulposus (HNP) is disc herniation > __mm
(a BULDGE is less than this) |
> 3mm
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SPINAL STENOSIS
From the Greek word “Choking” Can be produced by a combination of changes Cervical Myelopathy -decrease in _______ skills -spastic ________ -hyperreflexia |
fine motor
gait |
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Cervical Strain (>3 wks pain)
________injury ________ injury Ligament, tendons, muscles Self-limiting Conservative care: (_____, muscle relaxants, physical therapy ) |
Whiplash
Soft tissue NSAIDS |
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Cervical Dislocation/Subluxation
Spinal Cord Injury 42% **____ 24% Violence 22% Falling 8% Sports Most often treated with closed reduction |
**MVA
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Rheumatiod Arthritis
Affects 2 million Americans _________Disorder _____ and Facet joints affected ________ C-Spine |
Seropositive
C1-2 Step-ladder |
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Rheumatoid Arthritis
________Key Labs ____with Diff, ANA, ____, CRP, Sed Rate Treatment Medication, Low impact ______ Early treatment improves long term outcome |
Early Diagnosis
CBC RF exercise |
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Thoracic Spine
Thoracic discs protected by ______ _______motion DDD/HNP not as common HNP may have mixed presentation |
ribs/cage
Little |
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ANKYLOSING SPONDYLITIS
______ Sero______ ________4 times more likely “_________” HLA-B27 |
Hereditary
Seronegative Males Bamboo Spine |
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ANKYLOSING SPONDYLITIS
Treatment Symptomatic relief ________ NSAIDs Surgery Fusion Higher probability of _______ injury in fractures |
Physical Therapy
cord |
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Thoracic Kyphosis
Scheuermann’s ________thoracic kyphosis Anterior wedging of __ degrees involving ____consecutive bodies Treatment with NSAIDs, ______, exercise, surgery |
Juvenile
5 3 Bracing |
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Thoracic Kyphosis
Other Causes -Congenital -Neuromuscular Disorders -Trauma, tumor, infection ________ Surgery -Progressive Deformity -_________symptoms |
Cobb Angle
Neurological |
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Scoliosis
Types -___________,idiopathic(F>M), De Novo Early Dx again key -Cobb angle -________ classification (III-most common) Thorough exam important |
Congenital
King |
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Idiopathic Scoliosis
Defined as curve >____degrees Most common in ________ Must R/O other causes; Tethered cord Time of most concern before ______ Brace at ____or > degree |
10
girls menses 20 |
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Idiopathic Scoliosis
Bracing to limit degree of progression Surgery indicated at >__degree curve Correction after puberty to avoid ________ effect |
40
crank-shaft |
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Congenital Scoliosis
Result of abnormal vertebral formation Must assess ________ function Treatment depends on type of vertebral malformation |
kidney
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Lumbar Degenerative Disc Disease
Classification? ___% of Americans experience LBP Early return to normal activity key Watch for red flags Treatment |
80
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DDD - Treatment
Be patient, symptoms are likely to improve ________and Muscle Relaxants PT - _________ Exercises Surgery indicated for intractable pain or progressive neurological weakness |
NSAIDs
Williams Flex |
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Lumbar Strain
Similar treatment to ____ Early activity again key R/O other causes Red Flags Self-limiting |
DDD
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Discogenic Pain
________Pain Malfunction of the disc Dehydration on MRI, _______ Diagnosed by ________ |
Mechanical
Annular tear Discography |
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Discogenic Pain
Treatment -Conservative Care -Surgery: 1 Fusion 2 ____ 3 ____ 4 Dynamic Stabilization 5 Satellite |
ADR (art. disc replacement)
IDET (intradiscal electrothermal therapy) |
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____________
Anterior slip of one vertebral body onto another Two main types _________ _________ Symptoms related to mechanical pain, leg pain due to foraminal narrowing |
Spondylolisthesis
Isthmic Degenerative |
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Isthmic Spondylolisthesis
Fracture of vertebrae causing it to slip Result of defect in _______ Most common at _____ Occurs in 7% population Seen in football lineman and _______ |
pars interarticularis
L5-S1 gymnast |
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Degenerative Spondylolisthesis
Due in large part to _________ failure Most common at _____ Frequently causes L5 radiculopathy Conservative treatment with ________, flexion exercises Surgery to decompress and stabilize |
facet
L4-5 NSAIDs |
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__________
__________ patients Intractable LBP CBC, CRP, Sed rate MRI, Bx Treatment with 6 wks IV abx |
Discitis
Immunocompromised |
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Fractures
_________Fx most common Trauma in young pt w/wo trauma in elderly _______ exam ______, X-rays, bone scan Conservative Tx with _____ Vertebroplasty/ Kyphoplasty |
Compression
Neuro MRI TLSO (Thoracic Lumbar Sacral Orthosis) |
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_______Fracture
Compression fracture with retropulsion of posterior elements 50% patients develop ________ Better prognosis with surgical decompression and stabilization within 1st __hrs |
Burst
neurological deficits 48 |
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________ DYSFUNCTION
Very small joint Does not move much Dx difficult to make Make Dx by H&P, imaging studies Tx with PT, SI mobility, injections |
SACROILIAC
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LBP Treatment in Primary Care
Complete H&P Self-limiting Treatment with ________, NSAIDs, Muscle Relaxants Watch for Red Flags |
exercise
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LOW BACK PAIN
Red Flags Age <__, >__ Pain -_________ -Radiating pain: 1 Leg 2 Abdomen 3 ______ |
<18, >55
Nocturnal Testicular |
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Low Back Pain
Red Flags History -______ -Weight _____ -Morning stiffness -________ -HIV -Drug Abuse -Systemic Illness |
Fever
loss Cancer |
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Low Back Pain
PHYSICAL EXAM -________DEFICIT -SEVERE LIMITATION OF MOTION -STRUCTURAL DEFORMITY -________DISTURBANCES -EDEMA, , POOR PULSES |
NEUROLOGICAL
GAIT |
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What bone is involved
Location of the fracture Pattern of the fracture Amount of anatomic disruption |
Fracture Classification
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______ - shaft of long bones
______ - flared end of a long bone b/w diaphysis & physis ______ - cartilaginous growth plate, only in growing bone ______ - end of a long bone |
diaphysis
metaphysis physis epiphysis |
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closed/open - goes to OR
simple/comminuted intra/extra articular transverse oblique spiral impacted - usually humoral/femoral pathologic stress - needs MRI (can't see on xray) greenstick torus - buckle avulsion - Jersey finger |
pattern of fractures
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Anatomic Disruption (3)
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displacement
angulation rotation |
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Salter-Harris Fxs:
SH 1 - fx thru ______ SH 2 - fx thru physis & ______ SH 3 - fx thru physis & ______ SH 4 - fx thru _______ SH 5 - _______ injury |
physis
metaphysis epiphysis P/E/M crush |
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Fracture Healing:
1.________ - bleeding, hematoma, osteoblasts/fibroblasts 2.________ - callus w/in 2 wks 3.________ of union 4.________ - begins in middles of repair phase & continues after clinically healed |
inflammatory phase
repair restoration remodeling |
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________ fx - fell of outstretched hand, tender in anatomical snuff box (could also be a sprain)
immobilize for 7-10d only _______ fx - thumb is adducted _______ fx - 5th knuckle is depressed _______ fx - radial mid-shaft fx that disrupts radial/ulnar joint |
distal radial fx
Bennentt's fx Boxer's fx Galeazzo's fx |
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_______ fx - distal humerus fx
_______ fx - abducted arm is dislocated ant, back of humerus drags across glenoid causes shoulder instability _______ fx - proximal ulnar fx _______ fx - buckle fx in peds |
Holstein Lewis fx
Hill-Sachs fx Montaggis's fx Torus fx |
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Hip Fractures Locations:
Grade 1 Grade 2 Grade 3 |
femoral neck
trochanteric subtrochanteric |
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_______ fx - 5th metatarsal fx, common in overweight women
_______ fx - ankle inversion _______ fx - medial collateral ligament of knee is displaced |
Jones fx
Maisonneuve's fx Stieda's fx |
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Femoral Neck Fx TX:
displaced- nondisplaced- |
replacement
sugical screws |
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_________ - more common in tibial fx but also in radial fx
increase in pressure in compartments causing nerve compression & death pain w/ passive range of motion >40 is diagnostic |
compartment sydnrome
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Fx Mnemonic:
"Break the forearm of the MUGR (mugger)" 5 Ps |
Monteggia=Ulna
Galeazzi=Radius pain pallor paralysis parasthesias pulselessness |
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work, sport, MVA
onset (trauma, insidious) location aggravating/alleviating factors night pain others (cardiac, metastaic dz...) |
fx history
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inspection
palpation range of motion (active & passive) rotator cuff provocative tests instability |
physical exam
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*SITS muscles* of Rotator Cuff
________ on xray is a tear |
supraspinatus
infraspinatus teres minor subscapularis lucency |
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_______ - pain at night & w/ overhead activity
_______ - also w/ bursitis, presents same as calcific tendonitis _______ - weakness _______ - subacromial impingement 1. flat 2. curve 3. beak curve |
Calcific tendonitis
Tendonitis Tears Impingement |
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Adhesive Capsulitis (________):
idiopathic or cuff tendonitis initially gradual or sudden onset usually in *_______ women* S/S - pain, decreased ______ TX - no steroids if diabetic, PT, pain meds may take 6 months to get back ROM |
frozen shoulder
diabetic ROM |
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Shoulder Instability:
Traumatic - _______ acute or chronic TX ~ ________, rehab to strengthen cuff muscles after 2nd dislocation there is a _____ chance of redislocation Multidirectional Instability TX ~ focus on cuff strengthening, ____ |
dislocation
conservative 90% PT |
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Acromioclavicular Joint Separation:
Grades I - ligaments b/w acromion & _______ is torn, xrays are negative, base dx on hx II - small amount of ______ on xray in distal clavicle III - all ligaments are _____, sits up high, if asx then no sx IV - always requires _______ *most are non-surgical except for symptomatic grades _____* |
clavicle
elevation torn surgery III & IV |
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Clavicle fx: is there _____ of the skin?
*abduction & ext rotation is common for ____ dislocation* _____ fx - part of gleniod is torn off |
tenting - mid-shaft fx pokes up making a tent
anterior Bankart fx |
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_______ pathology:
adult hallux valgus hallux rigidis hammer toes Morton's neuroma stress fracture _______ pathology: Lis Franc injuries |
forefoot
midfoot |
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_______ pathology:
plantar fasciitis Achiles pathology _______ pathology: PTT dysfunction peroneal tendon pathology sprain fracture arthritis |
hindfoot
ankle |
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____________:
forefoot deformity characterized by lateral deviation (valgus) of the great toe (hallux) Etiology: shoes hindfoot ________ herecitary _____ instability |
Hallux Valgus (bunion)
pronation MTC (metatarsocuneiform) |
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Hallux Valgus:
+/- _____ deformity difficulty w/ shoes 2nd toe pain (transfer lesion) Surgical correction is indicated in _______ pts only |
pain
symptomatic (pain) |
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Hallux Valgus:
Non-operative tx - _______ modification shoe stretching toe ______ Operative tx - proximal/distal osteotmies soft-tissue procedures arthrodesis |
shoewear
spacers |
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_________:
degenerative arthritis of the 1st MP joint characterized by restricted dorsiflexion Etiology - unclear ______ 1st metatarsal elevation |
Hallux Rigidus
trauma |
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Hallux Rigidus:
1st MP pain _______ (restricted dorsiflexion) dorsal ____ (synovitis, osteophytes) +/- swelling Diagnostic Studies - ______ |
stiffness
mass xray |
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Hallux Rigidus:
Non-operative tx - ______ & activity modification _______ shoes orthotics with rigid shand injections in early dz Operative tx: 1st MTP _______ |
NSAIDs
stiff-soled fusion |
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_________:
acquired deformity characterized by flexion contracture of the PIP joint Etiology- shoewear long ______ trauma neuropathic ______ imbalance idiopathic |
Hammertoes
metatarsal muscle |
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Hammertoes:
Conservative tx- elastic toe sleeves wide/deep toe box Surgical tx- PIP resection arthroplasty refer for surgery only if: _______ pts rigid hammertoes in _______ impaired pts no tx if ______ |
rigid symptomatic
sensory flexible |
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_________:
inability of boen to withstand repetitive physiologic forces Etiology- increased _______ decreased _____ stock |
Metatarsal Stress Fracture
activity bone |
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Metatarsal Stress Fracture:
insidious onset aching, burning sharper w/ ______ anticedent increase in activity DDX- metatarsalgia midfoot ______ neoplasm MP pathology |
weight
OA/RA |
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Metatarsal Stress Fracture: diagnostic studies
_______- all suspected cases + only in reparative stage ____- if xray is neg & dx is in doubt with stress fractures in middle-aged & elderly women ~ check bone mineral density w/ a _____ scan |
Radiographs
MRI DEXA |
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Metatarsal Stress Fracture: tx
walking ____ protected weight bearing crutches hard-soled shoes ______ modification with gradual resumption |
boot
activity |
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__________:
an entrapment neuropathy of an interdigital nerve underneath the transverse metatarsal ligament Etiology- _______ nerve increased ______ of the nerve ______ formation trauma |
Interdigital Neuroma
thickened mobility bursa |
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Morton's Neuroma:
sharp/radiating plantar _______ pain worse w/ walking, alleviated w/ rest _______ numbness and paresthesias ______ onset |
forefoot
Webspace Insidious |
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Mortons neuroma: Diagnosis
___ Webspace tenderness Mulder’s _____ Diagnostic/Therapeutic-__________- injection If the pathology isn’t in the ________ webspace, it’s probably not a Neuroma |
3rd
click lidocaine/steriod second or third |
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Morton’s neuroma:
Non-operative tx- First Line ~ ______ & accommodative orthotics with proximal metatarsal pad under involved two metatarsals Second Line ~ _______ Injection Third Line ~ Time & ______ |
NSAIDs
Steroid surgery |
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Midfoot Sprains/LisFranc Injuries: radiographs
look for _______ AP - Lateral border of 1st metatarsal and Lateral border of medial cuneiform 1st intermetatarsal Space and 1st Intercuneiform space Internal Oblique- Medial border of 4th metatarsal and Medial border of cuboid Lateral border of 3rd metatarsal and Lateral border of lateral cuneiform If any question obtain ______________ |
separation
COMPARISON WEIGHTBEARING VIEWS |
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__________:
inflammation and probable microscopic tearing of the origin of the plantar fascia (medial) Etiology- Soft tissue _________ Overuse _______ old age Trauma |
Plantar Fasciits
contractures overweight |
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Plantar Fasciitis:
_______ heel pain First-step / ________ pain Worsens as day progresses ____- Entrapment neuropathy Tarsal tunnel syndrome Calcaneal stress fracture (squeeze heel, elicits pain) Achilles Pathology Fat pad atrophy Neoplasm Plantar fibroma Plantar fascia rupture |
Inferior
morning DDX |
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Plantar Fasciitis: Non-operative tx
First Line- Shoewear modification (soft over the counter inserts) Home achilles / plantar fascia ________ Home ________ stretching _______ Second Line- Night ______ Formal ___ ~ Iontophoresis (deep tissue massage)Strapping/taping Third Line- ______ cast/boot ______ injection(s)??????? Refer for Re-evaluation if symptoms persists after _____ of treatment |
stretching
hamstring NSAID’s splint PT Walking Steroid 3 months |
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Heel Spurs:
Heel spurs are in the _____ muscle, not the plantar fascia Present in many (80-88%) ________ individuals Heel spur ______ in conjunction with fasciotomy is controversial can do ________ therapy but 44% have unsuccessful treatment |
FHB (flexor hallicus brevis)
asymptomatic excision shockwave |
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________: largest tendon in the body
terminal gastrocs/soleus muscles fibers internally rotate hypovascular zone is 4 cm proximal to insertion |
Achilles tendon
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Achilles tendon rupture:
History- acute, sharp pain in back of leg or ankle immediate difficulty with _______ audible ____ "i turned around to see if someone had kicked me" PE- _____ can be almost normal palpable ____ diminished but not absent ______ _________ test is positive |
walking
pop gait gap strength Thompson |
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Achilles tendon rupture: tx
______ - significant rise of re-rupture acceptable in select pts - elderly, sedentary, informed ______ - risk of wound complications & infection (smaller yet potentially catastrophic) |
casting
surgical repair |
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________:
tendonopathy and/or pertendonitis of the Achilles tendon Etiology: hypovascularity tendon rotation overuse/age constrictive shoes inflammatory arthropathy |
Achilles Tendonitis
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Achilles Tendonitis:
the term "________" is used loosely but generally applies to a Haglund's process or swelling associated with insertional achilles tendonitis Clinical Presentation- _______ heel pain & swelling ______ stiffness posterior prominence |
pump bump
posterior ankle |
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Achillies Tendonitis: TX
Non-operative - ___________ measures heel lift (1/4 in) Achilles stretching night splint When considering _______ injections - DONT DO IT |
Biomechanical
steriod |
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____________:
inflammatory tendinopathy secondary to chronic degeneration of the posterior tibial tendon Etiology- age hindfoot pronation hypovascularity __________ arthropathy in young males |
Posterior Tibial Tendon (PTT) Dysfunction
seronegative |
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PTT Dysfunction: exam
_______ hindfoot inflammation/edema _______ deformity- “pes planovalgus” hindfoot valgus/eversion forefoot abduction Medial/lateral hindfoot ______ |
medial
flat foot pain |
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PTT Dysfunction: staging
Stage I - _________ w/ deformity Stage II - ________ hindfoot valgus Stage III - _______ hindfoot valgus |
inflammation
flexible rigid |
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PTT dysfunction: diagnostic studies
Radiographs- Make sure to order _________ views _______ view ~ collapse of longitudinal arch & negative talar neck-first metatarsal angle AP view ~ talar head uncoverage Check for arthrosis/coalition _____- Confirm diagnosis Check for arthrosis/coalition Rule out other pathology |
weight-bearing
Lateral MRI |
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PTT dysfunction: tx
Non-operative Treatment- _______ Air stirrup Arizona brace, Articulated AFO _______ with medial hindfoot posting |
NSAID’s
Orthotics |
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_________:
traumatic injury of the stabilizing ligaments of the tibiotalar joint *__________ is the most common ligament torn* |
Ankle Sprains
*Ant talofibular ligament* |
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Ankle Sprains: presentation
Acute pain/sensation of “______” Audible “____” May be able to bear weight initially Immediate or delayed _________ _____: Ankle fracture Lateral process of talus fracture Anterior process of calcaneus fx Fifth metatarsal fracture Peroneal tendon dislocation Osteochondral defect (OCD) Superficial peroneal neuralgia |
giving way
pop swelling |
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Ankle Sprains: dx
Tenderness directly over the ________, not the bone ______ if the patient has bony tenderness or is unable to bear weight ______ ankle sprain - do an External Rotation Test & a Squeeze Test |
ligament
X-rays High |
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Ankle Sprains: tx
Non-operative Treatment- _____ Bracing Protected weight-bearing as dictated by symptoms Early functional ______ ~ peroneal strengthening proprioceptive exercises conditioning range-of-motion (avoid inversion) |
RICE
rehab |
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Ankle Sprain
Top Reason for Persistent Pain Following Ankle Sprains is *__________* |
*inadequate rehab*
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Ankle Fractures: types
________ - fracture fragments are out of place and don’t line up anymore _________ - fracture fragments remain in place and stay in line _____ - fracture fragments come through the skin and become contaminated with bacteria (“compound fracture”) ________ - fracture fragments remain inside the body __________ - non-displaced fractures caused by repetitive stress, weak bone, or a combination of the two |
displaced
non-displaced open closed stress fractures |
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Ankle Fractures: Diagnosis
Tenderness directly over the _____, not the ligament ______ are essential |
bone
X-rays |
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*Ankle Fractures: tx*
Weber A - fx _____ the ankle joint, no surgery unless ________ Weber B - fx at level of ankle joint, probably needs _______ Weber C - fx ______ ankle joint, always needs surgery |
below
displaced surgery above |
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Ankle replacements will come loose in _____ years
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7-11
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