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60 Cards in this Set

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describe plantar fasciitis
inflamed plantar fascia band originating from the medial calcaneal tuberosity, which fans and inserts on the flexor mechanism of the toes at the metatarsal heads
who commonly gets plantar fasciitis?
1. inflammatory condition common in runners and dancers
2. common in pts who use repetitive, maximal plantar flexion of the ankle and dorsiflexion of the metatarsophalangeal joints
what are si/sx of plantar fasciitis?
1. pain in heel with first morning step (dorsiflexion)
2. irritated and inflamed fascia is stretched, causing sever pain
what is the tx for plantar fasciitis?
1. OMT!!!
2. morning stretches/exercises
3. NSAIDS
4. rarely steroid injection or surgery
what % of people will experience low back pain?
1. 80%
2. second m/c complain in primary care (next to common cold)
what % of LBP cases will recur within the subsequent 3 years/
50%!!!
what are the majority of LBP cases attributed to?
1. muscle strains
2. always consider disk herniation
what are si/sx of disk herniation?
1. shooting pain down leg (sciatica)
2. pain on straight leg raise (>90% sensitive)
3. pain on crossed straight leg raise (>90% specific, not sensitive)
how do you dx LBP?
1. r/o RED FLAGS!!!!!
2. if no red flags, presume dx is m. strain and not serious--no radiologic testing is warranted
3. is dz is not remitting after 4 wks of conservative tx, consider further evaluation c/ repeat h and p and radiologic studies
what is the tx for LBP with no red flags?
1. conservative c/ acetaminophen (safer) or NSAIDS
2. m. relaxants have NOT been shown to help
3. AVOID narcotics
4. strict bed rest is NOT warranted (extended rest shown to be debilitating, esp in older pts)
5. encourage return to normal activity, low-stress aerobic and back exercises
what % of LBP cases resolve within 4 wks c/ conservative tx?
90%!!!!
what are the red flags of LBP?
1. fracture--surgical consult
2. tumor--urgent radiation/steroid (to decrease compression), then excise
3. infection--abscess drainage and abx per pathogen
4. cauda equina syndrome--emergent surgical decompression
5. spinal stenosis--complete laminectomy
6. radiculopathy--antiinflammatories,
nerve root decompression c/ laminecotmy or microdiscectomy only if:
a. sciatica is severe and disabling
b. sx persist for 4 wks or worsening progression
c. strong evidence of specific nerve root damage c/ MRI correlation of level of disc herniation
describe a subluxation of the shoulder
subluxation=symptomatic translation of humeral head relative to glenoid articular surface
describe a dislocation of the shoulder
dislocation=complete displacement out of the glenoid
what is the m/c form of a shoulder dislocation?
anterior instability (approx 95% of cases) usually as a result of subcoracoid dislocation
what are the si/sx of shoulder dislocation?
1. pain
2. joint immobility
3. arm "goes dead" c/ overhead motion
what is the dx for shoulder dislocation?
1. clinical
2. assess axillary nerve function in neurologic exam
3. look for signs of rotator cuff injury
4. confirm c/ xrays if necessary
what is the tx for shoulder dislocation?
1. initial reduction of dislocation by various traction-counter traction techniques
2. 2-6 wk period of immobilization (longer for younger pts)
3. intense rehab
4. rarely is surgery required
what are the si/sx of fracture c/ LBP?
1. hx of trauma (fall, car accident)
2. minor trauma in elderly (strenuous lifting)
3. dx c/ spine xrays
what are the si/sx of tumor c/ LBP?
1. pt age >50 yr (accounts for >80% of cancer cases) or <20 yr
2. prior hx of CA
3. constitutional sx (fever, chills, wt loss)
4. pain worse when supine or at night
5. dx c/ spinal MRI is gold standard, can also get CT
what are the si/sx of infection c/ LBP?
1. immunosuppressed pts
2. constitutional sx
3. recent bacterial infection or IV drug abuse
4. get blood cultures and a spinal MRI to r/o abscess
what are the si/sx of cauda equina syndrome c/ LBP?
1. acute urinary retention
2. saddle anesthesia
3. lower-ext wekaness or paresthesias and decreased reflexes
4. decreased anal sphincter tone
5. dx with spinal MRI
what are the si/sx of spinal stenosis c/ LBP?
1. pseudoclaudication (neurogenic) c/ increased pain from walking and standing
2. pain relieved by sitting or leaning forward
3. dx with spinal MRI
what are the si/sx of radiculopathy (herniation compressing the spinal nerves) c/ LBP?
radiculopathy (herniation compressing the spinal nerves):
1. sensory loss (L5--Large toe/medial foot, S1--Small toe/lateral foot)
2. weakness: (L1-L4--quadriceps, L5--foot dorsiflexion, S1 plantar flexion)
3. dx: clinical--MRI may confirm, but false positive results are common
describe the neruologic testing for nerve root L4:
1. motor=dorsifexion of foot
2. reflex=knee jerk
3. sensory=medial calf
describe the neruologic testing for nerve root L5:
1. motor: dorisiflexion of Large toe (L5--Large toe)
2. reflex--none
3. sensory--medial forefoot
describe the neruologic testing for nerve root S1:
1. motor=eversion of foot
2. reflex=ankle jerk
3. sensory=S1--Small toe/ lateral foot
does radiculopathy=herniation?
NO!!!
radiculopathy indicates an evolving spinal nerve impingement and is a more serious dx than simple herniation indicated by straight leg testing and sciatica
how do most clavicle fractures occur?
clavicle fractures primarily as a result of contact sports in adults
what are si/sx of clavicle fracture?
1. pain and deformity at clavicle
how do you dx a clavical fracture
1. clinical
2. confirm fracture c/ standard AP view xray
what must you r/o c/ a clavical fracture?
1. subclavian artery injury!!!!=r/o by checking pulses
2. brachial plexus injury!!!=r/o c/ neurologic exam
3. pneumothorax!!!=r/o c/ checking breath sounds
how do you tx a clavical fracture?
use a sling utnil ROM is painless (usually 2-4 wks)
which pts do you find lateral epicondylitis?
1. tennis elbow
2. tennis players (>50%), racquetball, squash, fencing
3. over-use of wrist extensor m.!!!!
what are si/sx of lateral epicondylitis?
tennis elbow:
1. over use of extensor m.
2. pain 2-5 cm distal and anterior to lateral epicondyle reproduced c/ wrist extension while elbow is extended
which pts do you find medial epicondylitis?
1. golfer's elbow
2. golf, racquet sports, bowling, baseball, swimming
3. over-use of wrist flexor m.
what are si/sx of medial epicondylitis?
1. over use of flexor m.
2. acute onset of medial elbow pain and swelling localized 1-2 cm distal to medial epicondyle
3. pain usually reproduced c/ wrist flexion and pronation against resistance
how do you tx epicondylitis (tendinitis)--medial and lateral?
1. ice
2. rest
3. NSAIDS
4. counterforce bracing
5. rehab
what is an olecranon fracture?
usually a direct blow to elbow c/ triceps contraction after fall on flexed upper extremity
how do you tx an olecranon fracture?
1. tong arm cast or splint in 45-90 degree flexion for >3 wks
2. displaced fracture requires open reduction and internal fixation
what is the m/c dislocated joint in children and second most in adults?
the elbow joint!! (nest to shoulder in adults)
what kind of dislocation occurs with a fall onto an outstretched hand with fully extended elbow?
posterolateral dislocation
what kind of dislocation occurs with a direct blow to posterior elbow?
anterior dislocation!!!
what may be seen in a child after child's arm is jerked by hurried parent or guardian?
nursemaid's elbow=sudden forceful traction dislocates the elbow joint
what else should you look for in an elbow dislocation?
1. nerve injury (ulnar, median, radial, or anterior interosseous nerve)
2. vascular injury (brachail artery)
3. other strucural injury (associated coronoid process fracture is common)
what other fracture is common with an elbow dislocation?
an associated coronoid process fracture!!!
how do you tx a dislocated elbow?
1. reduce the elbow by gently flexing a supinated arm (OMT!!)
2. long arm splint
3. bivalved cast applied at 90 degree flexion
what is olecranon bursitis?
1. inflammation of bursa under the olecranon process
2. seen with direct blow to elbow by collision or fall on artificial turf
what are si/sx of olecranon bursitis?
1. swollen and painful posterior elbow c/ restricted moint
2. dx clinically, confirm c/ bursa aspiration to r/o septic bursitis
how do you tx olecranon bursitis?
1. bursa aspiration
2. compression dressing and pad
which pts do you see achilles tendonitis?
1. secondary to overuse
2. runners
3. gymnasts
4. cyclists
5. volleyball players
what are si/sx of achilles tendonitis?
1. swelling or erythema along area of Achilles tendon
2. tenderness 2-5 cm proimal to calcaneus
how do you evaluate an achilles tendon for rupture?
Thompson test!!!=squeezing the leg with passive plantar flexion
*positive only with complete tear
how do you tx an achilles tendonitis?
1. rest, ice, NSAIDs, taping or splinting to decrease stress and increase support
how do you tx a ruptured achilles tendon?
1. long leg casting for 4 wks
2. short leg walking cast for 4 wk
3. then wear heel lift for 4 wk
4. open repair speeds recovery and is recommended with complete tears in younger pts
how do 90% of lateral ankle sprains occur?
when the ankle is plantar-flexed!!!
what position is the foot in during the anterior drawer sign?
foot in 10-15 degree plantar flexion
which sprain is rare (10%) b/c the ligaments are stronger?
medial sprain!!!
how do you dx an ankle sprain?
multiple view xrays both free and weight bearing
how do you tx an ankle sprain?
1. RICE:
R=rest (limit activity and crutches)
I=ice
C=compression (ACE bandage)
E=elevation above level of heart to decrease swelling
2. severe sprains may benefit from casting, open repair is rarely indicated