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128 Cards in this Set
- Front
- Back
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What is the MC form of joint disease dt cartilage degeneration?
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Osteoarthritis
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Features of OA
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*decreased ROM
*joint crepitus *joint pain *AM stiffness <15min *JOINT ENLARGEMENT |
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Sites for OA
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*DIP (Heberden's nodes)
*PIP (Bouchard's nodes) *hip *knee (MC = medial) *spine |
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Tests for OA
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*X-ray
-asymmetric narrowing -bony sclerosis -misalignment -osteophytes (spurs) |
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Tx for OA
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*decrease wt & exercise
*APAP *ASA/NSAIDS *Steroids *arthrodesis (fusion), osteotomy (removal) *arthroplasty (replace) |
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What is chronic inflammation with synovitis that causes joint destruction?
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Rheumatoid Arthritis
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Features of RA
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*swell *heat *deformity
*pain w/ PROM *AM stiffness *SubQ nodules *systemic (vasculitis, pericarditis, pulm dz, neuropathy, scleritis, splenomegaly) |
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Sites of RA
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*knee *wrist *elbow *shoulder *ankle *subtalar *neck
*ulnar deviation *MCP *PIP *Swan neck deform (hyperextend PIP, flex DIP) |
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Dx of RA
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Need 5 of 7 (1st 4 for >6wks)
*AM stiff >1hr *arthritis >3jts w/ soft tissue swell *swelling in wrists/PIP/MCP *symmetrical jt swelling *SubQ nodules *+ rheumatoid factor test *XR changes (erosions --> osteopenia) |
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Tests for RA
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*Increased ESR/CRP
*+ (sometimes) Rheumatoid factor *XR: osteopenia, erosions, narrowing |
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Tx for RA
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*Refer to rheumatologist
*PT *NSAIDS/ASA *DMARDS (methotrexate, hydroxychloroquine) *TNF-alpha inhibitor: Etanercept |
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What causes monosodium urate cyrstals to deposit in tissue leading to arthritis and tophi (possibly neprholithiasis/nephropathy)?
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Gout
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Features of Gout
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*pain *swelling *Redness
*tenderness suddenly @ joint *tophi (soft tissue masses of urate) *lasts 3-10d *rarely polyarticular |
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Sites of Gout
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*MC in men
*MC = MTP of great toe *other jts: feet, ankles, knees *TOPHI = ears, olecranon, cornea, aorta, spine, intracranial |
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Tests for Gout
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*joint fluid analysis = dx
-parallel, yellow urate, needle shaped *serum uric acid >7 (can be low during attack) *XR: rat bite/punched out |
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Tx for Gout
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*rest, ice, elevation
*NSAIDS *allopurinol for chronic |
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Salter Harris Fx Classifications of Type 1-5
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*Type 1 (S): slipped (physis only)
*Type 2 (A): above (P + M) *Type 3 (L): Lower (P + E) *type 4 (T): through (M + E + P) *type 5 (R): ruined (compressed physis) |
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1. What is the MCC of facial pain?
2. What are some causes? 3. Sx 4. Tx |
1. TMJ (temporomandibular jt ds)
2. neuropsych, joint capsilitis, hypermobility syndrome 3. pain/tender, dec. ROM, click/pop, assoc. HA, earache 4. NSAIDS |
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What is the MC neuropathy & MCC of peripheral nerve compression?
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Carpal TunneSyndrome
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What nerve is involved in Carpal Tunnel Syndrome?
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Median Nerve (compressed by transverse carpal ligament)
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1. What causes carpal tunnel syndrome?
2. who is it MC in? |
1. repetitive movements
2. MC in women, dominant hand, Pg, RA, post-menopause |
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Sx of carpal tunnel
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*burning/tingling (esp @ night)
*better by shaking/rubbing hand *worse w/ repetitive maneuvers |
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Exam for Carpal Tunnel
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*Tinels test (tap over median n)
*phalens (palmar flex x1min) *wasting of hypothenar and thenar muscles (late sign) |
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Tx for carpal tunnel
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*splint (no flexion)
*NSAIDS *steroids *surgical decompression |
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What is the MC distal radius fx?
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Colle's fx
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Describe Colle's fx
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*distal radius fx
*DORSAL angulation *Dt FOOSH |
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Colle's Fx
1. Sx 2. Dx 3. Tx |
1. pain, swelling, deformity
2. XR 3. reduction if displaced, splint (slight flex/ulnar deviation), XR to confrim alignment in 6wks |
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Describe the following Fx:
1. Colle's 2. Smith's 3. Barton's |
1. Colles: dorsal angulation
2. Smith: palmar (volar) angulation (fall hyperflexed wrist) 3. intrarticular (dorsal or volar angulation) |
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What results from a FOOSH injury and is the MC fx of carpal bones?
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Scaphoid Fx
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What are two issues surrounding schapoid fx?
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*high rate of non/mal-union dt decreased blood
*may not show fx on XR initially |
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Scahoid Fx
1. Sx 2. Dx 3. Tx |
1. pain in snuffbox
2. XR (may be nl @ 1st), CT 3. cast 6-12wks, splint if sx + even w/ nl XR, surgery for non-union |
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What causes inflammation of the tendon sheath containing extensor pollicus longus, extensor pollicus brevis, abductor pollicus longus?
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DeQuervain's tenosynovitis
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What is the mnemonic to remember the tendons that make up the snuffbox?
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*every peanut lover (EPL) eats peanut butter (EPB), all party long (APL, A = abductor)
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DeQuervain's Tenosynvitis
1. Cause, MC in who 2. Sx 3. Dx 4. Tx |
1. cause = overuse w/ insidious onset, MC = F
2. Sx = radial side wrist pain, crepitus w/ movement, dec ROM in thumb 3. Finkelstein's test 4. Spica splint + NSAIDs, steroids/surgery (later) |
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What is a Bennett's Fx?
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*MCbone fx of thumb
*Base of 1st MC *needs surgical repair |
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What is the MC fx in the hand?
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Boxer's fx
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Boxer's Fx
1. Cause 2. Features |
1. injury to distal metaphysis of 5th MC dt closed fist striking object
2. lose prominence of 5th knuckle, pain, swell, dec ROM |
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Boxer's Fx
1. Dx 2. Tx |
1. XR: volar (palmar) distal fragment angulation
2. Splint |
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Define:
1. Mallet Finger 2. Boutonniere Finger 3. Jersey Finger 4. Trigger Finger |
1. Mallet: rupture extensor DIP (dt forced flexion/jam)
2. Boutonniere: flex PIP, hyperextend DIP 3. Jersey: rupture flexor DIP 4. Trigger: can't extend finger dt inflamm (power tools) |
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What is another name for lateral epicondylitis?
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Tennis elbow
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What causes inflammation of wrist extensors/supinators @ origin on the lateral epicondyle?
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Lateral epicondylitis (tennis elbow)
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Features of Lateral epicondylitis
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*unilateral
*dull ache that increases w/ grasping/turning *tenderness @ insertion pt *increased pain w/ extension of wrist |
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Tx of Lateral epicondylitis
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*RICE
*NSAIDS *PT *elbow straps *steroids *surgery (refractory) |
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What is another name for subluxation of radial head?
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Nursemaid's elbow
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Cause of nursemaid's elbow (sublux radial head)
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*pull on forearm w/ elbow extended & forearm pronated
*annular ligament slips |
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Nursemaid's Elbow
1. Sx 2. Tx |
1. child cries --> pain subsides --> don't use arm, hold arm by side; XR = nl
2. Reduction: 1st supinate, 2nd flex (success = child uses arm in 2-3min), APAP/Ibu for pain, |
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What are other names for medial epicondylitis?
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Golfer's elbow, pitcher's elbow, bowler's elbow
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What causes inflammation of wrist flexors/supinators @ origin (medial epicondyle)
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*Medial epicondylitis
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Features of medial epicondylitis
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*unilater, pain w/ gripping, tenderness at medial epicondyle, increased pain w/ flexion of wrist
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Tx of medial epicondylitis
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*RICE, NSAIDS, elbow strap, PT, steroids, surgery
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Olecranon bursitis
1. Cause 2. Sx 3. Tx |
1. trauma, inflamm, infxn
2. inflamm, pain, large mass at elbow, red/heat 3. observe, rest, sling, NSAIDS, aspirate (dx + tx), septic = abx |
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Cubital tunnel syndrome
1. Describe 2. Sx 3. dx 4. tx |
1. Truck driver's elbow or ulnar nerve entrapment
2. parestthesias of forearm, 4th, 5th fingers 3. Froments (pinch paper), pope's blessing ((index/middle finger extended) 4. prompt reduction, NSAIDS, splint, modify activities, CS, decompresion surgery |
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Radial Nerve Entrapment
1. AKA 2. Sx 3. Tx |
1. Saturday night palsy
2. weak finger extensors, wrist drop 3. rest, ice, splint, NSAIDS, PT, surgical decompression |
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Radial Head Fx
1. Cause 2. Sx 3. Dx 4. Tx |
1. FOOSH
2. pain, dec ROM, swell 3. XR = + fat pad 4. reduce, splint, analgesics (no NSAIDS), RICE, PT |
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Fat Pad signs
1. Anterior 2. Posterior |
1. Anterior: radial head fx in adults
2. Posterior: supracondylar fx in kids |
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What is the MC type of shoulder dislocatoin?
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*Anterior (presents ER & Abducted)
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Features of Shoulder Dislocation:
1. Anterior 2. Posterior |
1. Anterior MOI & present = ER & abducted
2. Posterior: IR & ADduction |
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Shoulder dislocation
1. X-ray views 2. Tx |
1. AP, axillary, Scapular Y view
2. reduce, check CMS, immobile --> ROM |
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Define & describe causes of Impingement Syndrome
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*repetitive impingment of Rotator cuff --> tendonopathy/tears
*narrow supraspinatus outlet, subacromial bursitis, calcified supraspinatus |
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Impingement Syndrome
1. Features 2. Tx |
1. gradual, pain w/ overhead move, ant/lat pain, pain @ night
2. conservative: heat/ice, rest, no action > 90degrees, NSAIDS, PT, surgery |
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Dx of Impingement Syndrome
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*NEER (forward flex) = supraspinatus
*HAWKINS (IR in 90 degress forward flex) = subscapularis |
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What is the MC bony injury?
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*Clavicular fx
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Clavicle Fx
1. MC location 2. Features 3. Dx 4. Tx |
1. midshaft
2. can't lift arm, deformity, tender/grind w/ palpation 3. XR, check CMS 4. sling/figure 8 strap, PROM @ 2-3 wks as tolerable |
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What muslces make up the Rotator Cuff?
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*SITS = supraspinatus, infraspinatus, teres minor, subscapularis
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What is the MC type of shoulder dislocatoin?
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*Anterior (presents ER & Abducted)
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Rotator cuff injuries
1. MC muscle involved 2. MC shoulder pain in what age |
1. supraspinatus
2. MC > 30yo |
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Features of Shoulder Dislocation:
1. Anterior 2. Posterior |
1. Anterior MOI & present = ER & abducted
2. Posterior: IR & ADduction |
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Shoulder dislocation
1. X-ray views 2. Tx |
1. AP, axillary, Scapular Y view
2. reduce, check CMS, immobile --> ROM |
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Define & describe causes of Impingement Syndrome
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*repetitive impingment of Rotator cuff --> tendonopathy/tears
*narrow supraspinatus outlet, subacromial bursitis, calcified supraspinatus |
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Impingement Syndrome
1. Features 2. Tx |
1. gradual, pain w/ overhead move, ant/lat pain, pain @ night
2. conservative: heat/ice, rest, no action > 90degrees, NSAIDS, PT, surgery |
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Dx of Impingement Syndrome
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*NEER (forward flex) = supraspinatus
*HAWKINS (IR in 90 degress forward flex) = subscapularis |
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What is the MC bony injury?
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*Clavicular fx
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Clavicle Fx
1. MC location 2. Features 3. Dx 4. Tx |
1. midshaft
2. can't lift arm, deformity, tender/grind w/ palpation 3. XR, check CMS 4. sling/figure 8 strap, PROM @ 2-3 wks as tolerable |
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What muslces make up the Rotator Cuff?
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*SITS = supraspinatus, infraspinatus, teres minor, subscapularis
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Rotator cuff injuries
1. MC muscle involved 2. MC shoulder pain in what age |
1. supraspinatus
2. MC > 30yo |
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Rotator Cuff Injury
1. Sx |
1. worse w/ repetitive overhead activity, dec. motion, insidious onset, progressive pain (dull/achy), weakness
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Rotator Cuff Injury
1. Dx 2. Tx |
1. Empty can (supraspinatus), ER = teres minor, IR = subscapularis
2. PT, NSAIDS, CS, surgery |
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AC (acromioclavicular) separation1
1. Describe 2. Sx |
1. Common, MOI= fall onto tip of shoulder
2. pain to top of shoulder/AC jt, worse w/ cross body adduction, pain w/ lift |
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AC separation
1. Dx 2. Tx |
1. X-ray - AP, bilateral shoulder, AP w/ weights
2. RICE, analgesics (NSAIDS), PT, CS, surgery |
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Low Back Pain (LBP)
1. MCC 2. Features |
1. MCC = strain (muscle) or herniation
2. pain/tension/stiff |
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Low Back Pain Red Flags
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*>50yo *<20yo *Hx CA
*NIght sweats/wt loss *saddle anesthesia/bowel or bladder incontinence (Cauda Equina) *pain supine *recent bacterial infxn *trauma Hx |
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Low back pain
1. Dx 2. Tx |
1. Straight leg raise = LBP w/o leg pain (radicular)
2. self-limit x6wks, educate, NSAIDS, exercise, PT, bed rest NOT recommended |
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Spinal Stenosis
1. Describe 2. MCC 3. MC area |
1. degenerative narrowing/choking of spinal cord --> LBP
*compresses spine dt disc degeneration, osetophytes & hypertrophy of ligaments |
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Spinal stenosis
1. MCC 2. MC area |
1. MCC = spondylosis (arthritis)
2. L4-5 |
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Spinal Stenosis Features
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*worse stand/walk
*better sit/rest (Grocery cart sign) *LBP --> butt & LE pain *neurogenic claudication (better flexion) *dec ROM/strength *insidious onset |
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Spinal Stenosis
1. Dx 2. Tx |
1. MRI
2. analgesics, surgery for bad sx |
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Disk Herniation
1. MC in what age? 2. Describe |
1. MC 30-40yo
2. rips/tears in annulus --> leaks out |
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Disk Herniation
1. Features |
*sharp/shooting pain
*MC Lumbar (L4/5, L5/S1) *+/- radicular *+/- reflexes impaired |
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Disk Herniation
1. Dx 2. Tx |
1. straight leg raise = pain b/t 30-60degress w/ pain radiating down affected leg
2. 90% resolve on own (1st 3mo), short term = bed rest, PT, yoga, analgesics |
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Define spondylosis
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arthritis of spine
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Define Spondylolysis
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*fx of spine (stress)
*Sx = LBP w/ extension *MCC = LBP in child *common in football player or gymnast |
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Define Spondylolisthesis
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*scotty dog fx
*forward slippage of lumbar vertebral body *MC = 4th/5th lumbar |
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Hip Fx
1. Causes 2. Sx |
1. femoral neck = twist, intertrochanteric = direct fall, acetab/pelvic ring = trauma
2. pain in hip or knee, ER/abducted |
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Hip Fx
1. Risks 2. XR 3. Tx |
1. female, increased age, sedentary, tobacco, EtOH, dementia, meds
2. lateral, AP, judet (good for acetabulum) 3. emergent, pain control, surgery |
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HIp Dislocation
1. MC type 2. Cause |
1. MC posterior
2. dt high energy trauma (MVA, fall from height) |
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Hip Dislocation
1. Features |
*pain *can't move LE
*anterior = flex, ER, aBduction *posterior = flex, IR, aDduction |
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Hip Dislocation
1. Dx 2. Tx |
1. XR: posterior = head of femur smaller, anterior = head of femur larger
2. emergent reduction, 6 wks crutches, complication = avascular necrosis of femoral head |
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Collateral Ligament Injury
1. MC type 2. features 3. Dx 4. Tx |
1. MC = MCL tear
2. pain, swell, stiff 3. valgus or varus laxity 4. rest, usu non-surgery, PT |
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Difference b/t MCL tear & LCL tear causes
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*MCL = valgus force
*LCL = varus force |
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What makes up the unhappy or terrible triad (knee)
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*torn ACL, MCL, medial meniscus
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ACL injury
1. MOI |
1. twisting, non-contact = sudden deceleration, change in direction, land from jump in extension
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ACL injury risk factors
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*female athletes
*soccer, b-ball, skiing *tear = increased risk of early knee OA |
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ACL injury
1. Features 2. Labs 3. TX |
1. pop/snap, pain/gives way, decreased ROM/wt. bear, joint= unstable, effusion
2. MRI 3. RICE, NSAIDS, knee, immobilizer, PT, surgery |
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ACL PExam tests
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*Lachman's (shuck knee)
*Anterior Drawer Test |
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PCL
1. MOI 2. Features |
1. fall on flexed knee, blow to anterior knee (dashboard injury)
2. effusion w/in 24hrs, decreased ROM, instability |
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PCL
1. Dx 2. Tx |
1. Sag sign, Posterior drawer test, MRI
2. PT, decreased swelling, increase ROM...strength & fx bracing; bad sx = surgery |
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What PExam sign suggests patellar instability
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*J sign
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Meniscus
1. Fx in knee 2. MC part teared 3. MOI |
1. wt bearing, stabilize, absorbs energy, jt lube
2. MC = medial tear 3. acute, degenerative, twist |
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Meniscus Tear Features
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*swelling for days, LOCKING, pop/click, limp/unable to bear wt, decreased ROM, jt line tenderness, assess co-existing ligament injury
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Meniscus tears
1. Dx 2. Tx |
1. McMurray's test (feel for pop/click), Apley's Grind
2. RICE, NSAIDS, PT, surgery |
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What is the MC fx tarsal bone? How does this fx occur?
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*Calcaneus fx = MC
*dt trauma (fall from height) |
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Proximal 5th Metatarsal Fx
1. describe 2. MOI 3. tx |
1. MC metatarsal fx, avuslsion fx
2. usu inversion injury (ankle sprain) = peroneus brevis tendon tears away piece of 5th MT 3. immobile |
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Jones Fx
1. Describe 2. Tx |
1. proximal diaphysis of 5th metatarsal fx (NO avulsion)
2. extensive immobilization, may result in non/delay-union |
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Plantar Fasciitis
1. cause 2. describe |
1. usu dt overuse
2. pain on plantar surface/passive dorsiflexoin/calcaneus |
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Plantar fasciitis features
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*pain w/ wt bear, in AM, "pebble in shoe," w/ prolonged stand/walk, limp w/ excessive toe walk, numb/burn of medial hindfoot w/ post. tibial N. compression, point tenderness on calcaneu @ insertion
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Plantar Fasciitis tx
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*wt loss, NSAIDS x 3wks prn, supportive footwear, arch support, ice, massage
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Achilles Tendon Rupture
1. Cause 2. Sx 3. Dx 4. Tx |
1. dt dorsiflexion of ankle, weekend warrier
2. pain = "direct hit" 3. thompson test 4. splint in plantar flex + slight inversion |
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What is the difference b/t a 5th proximal MT fx and a Jones fx?
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*5th proximal MT fx = avulsion
*Jones = diaphysis (NO avulsion) |
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Define metatarsalgia
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*nagging metatarsal foot pain
*dt faulty wt distribution, repetitive stress, biomechanical dysfx |
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Define Morton's Neuroma
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*fibrosis/inflammation of digital nerve b/t 3rd/4th toes, MC in women
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Descsribe Hallux Valgus
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*bunions
*great toes point lateral = displace other toes |
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What is the MCC of ankle injury?
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*Ankle sprain
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Ankle Sprain
1. MC ligament injured 2. Types |
1. MC = anterior talofibular ligament (ATF)
2. lateral, medial, syndesmotic (high sprain) |
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Ankle Sprain
1. features 2. Dx 3. Tx |
1. inversion, felt/heard pop/snap, rapid onset of pain/swell, ecchymosis, weak, bad wt. bear, talar tilt
2. tender over ATF, anterior drawer test, talar tilt 3. RICE, splint, brace/tape for sports, early mobilization |
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Ottawa Ankle Rules
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*XR w/ malleolar pain AND
-tenderness distal 6cm tib/fib -tender @ 5th MT -can't bear weight immediately or at ED |
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Ankle Fx
*Weber Classes A-C |
*A = fibula fx BELOW syndesmosis, mortise intact
*B = fibula fx AT LEVEL of syndesmosis, often tears ligament *C = fibula fx ABOVE syndesmosis, always tears ligament, unstable |
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Ankle Fx
1. Features 2. Dx |
1. pain, swell, can't bear weight, +/- deformity, check CMS
2. X-ray |
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Ankle Fx Tx
1. Early 2. Later |
1. immediated mgmt, splint, don't reduce fx/dislocation unelss neurovasc. compromise apparent, analgesics
2. reduce fx, plaster spling, cast 6-8wks, elevate *surgery for Weber B or C |
