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156 Cards in this Set

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Duchenne Muscular Dystrophy -
What is it
What is Becker's
XLR
def. of dystrophin -
cytoskeletal protein
MC muscular dystrophy
most lethal
ages 2-6

Becker -
milder
XLR
abnormal-sized dystrophin
Duchenne Muscular Dystrophy -
Hx/PE
Hx -
axial and proximal before
distal muscles
progressive clumsiness
fatigability
hard to stand or walk
hard to walk on toes
waddling gait
Gower's maneuver

PE -
pseudohypertrophy of
gastrocnemius
possible MR
Duchenne Muscular Dystrophy -
Dx
CK - always high
EMG
muscle Bx
DNA
diagnostic -
immunostain for dystrophin
Duchenne Muscular Dystrophy -
Tx
No cure
Tx supportive
physical therapy
achilles tendon release
wheelchair by 13 y/o
death in 20s
Ankylosing Spondylitis -
What is it
Risk factors
Chronic inflammatory disease
of spine and pelvis
sacroilitis
=> fusion of affected joints
20's - 30's
seronegative
HLA-B27

risk factors -
male
family Hx
Ankylosing Spondylitis -
Hx/PE
Hx -
hip and low back pain
worse with inactivity
worse in mornings
better with activity, thru day

PE -
hip pain and stiffness
limited chest expansion
loss of lumbar lordosis
pos. Schober test -
dec. spine flexion

may have anterior uveitis,
3rd degree heart block
aortic insufficiency => CHF
Ankylosing Spondylitis -
Dx
Dx based on clinical & XR

HLA-B27
ESR - may be elevated
RF & ANA - neg.
spine and pelvic XR -
"bamboo spine"
Ankylosing Spondylitis -
Tx
NSAIDs
exercise
physical therapy
Reiter's -
What is it
"Can't see, can't pee,
can't climb a tree"
conjunctivitis
uveitis
urethritis
arthritis
may also have -
keratoderma blennorrhagicum
circinate balanitis

after infection with -
campylobacter
shigella
salmonella
chlamydia
ureaplasma

seroneg.
HLA-B27
young men
Psoriatic Arthritis -
What is it
Chronic inflammatory arthritis
psoriasis of skin
psoriatic nail lesions
DIP joints
sausage-shaped digits
"mushroom caps"
HLA-B27
seroneg.
Gout -
What is it
Recurrent attacks -
acute monoarticular arthritis
monosodium urate crystals
middle-aged, obese men
Pacific Islanders
hyperuricemia -
secondary to uric acid
underexcretion

other causes -
Lesch-Nyhan
diuretics (furosemide, HCTZ)
trauma
surgery
infections
steroid withdrawal
cyclosporin
malignancy
excessive red meat or red wine
hemoglobinopathies
Pseudogout -
What is it
Dx
Tx
MC - elderly or
preexisting joint damage

if < 50 y/o -
metabolic abnorm
hyperparathyroidism
hypophosphatasia
hypomagnesemia
hemochromatosis

knee - #1
also ankle, wrist, shoulder

Dx -
fluid aspiration
Pos. birefringent
rhomboid crystals
XR - chondrocalcinosis

Tx -
same as gout
low dose of colchicine -
prevents recurrence
Gout -
Hx/PE
1st episode - awakened from sleep
sudden onset of joint pain
podagra
usu. 1st MTP joint
knee
ankle
DIP & PIP

joint -
erythematous
swollen
tender

as becomes chronic -
multiple joints involved
urate crystals deposited in
connective tissue (tophi)
kidneys
Gout -
Dx
Joint-fluid aspirate -
needle-shaped,
neg. birefringent crystals
yeLLow when paraLLel to
condenser
inc. WBC

advanced -
"rat bite" =
punched-out erosions -
of long-standing tophus
"overhanging margin"
Gout -
Tx
Acute -
decrease inflammation
NSAIDs (indomethacin)
IV colchicine
or steroids - if elderly

maintenance -
decrease uric acid level
■ probenecid
if underexcrete,
inhibs reabsorb of uric acid
■ allopurinol
if overproduce
or have RF
or have kidney stones
can precip acute attack
Osteoarthritis -
What is it
Risk Factors
Degen joint disease
deterioration of
articular cartilage of
moveable, wt-bearing joints

MCC- idiopathic
secondary -
any dis. that causes stress
or trauma to joint

knee OA -
MCC of chronic disability
in elderly in West

risk factors -
obesity
family Hx
h/o joint trauma -
esp. intra-articular fractures
repetitive stress
Osteoarthritis -
Hx/PE
Hx -
joint stiffness - insid onset
pain -
insidious onset
worse by activity & wt-bearing
relieved by rest
crepitus
dec. ROM

PE -
wt-bearing joint involved
DIP - heberden nodes
PIP - bouchard nodes
MTP joint of 1st toe
cervical spine
Osteoarthritis -
Dx
Based on clinical & XR

XR -
irreg joint space narrowing
osteophytes
subchondral sclerosis
subchondral bone cysts

ESR normal
synovial fluid aspiration -
straw-colored fluid
normal viscosity
WBC < 3000
Osteoarthritis -
Tx
Weight reduction
physical therapy
NSAIDs
intra-articular corticosteroid
injections
elective joint replacement -
total hip/knee arthroplasty
Rheumatoid Arthritis -
What is it
Chronic autoimmune dis.
periph joints -
symmetrically inflamed
progressive destruction
of articular tissue
erosion of -
cartilage, bones, tendons
systemic Sxs
atlanto-axial subluxation
ruptured Baker's cyst
MC females 35-50
HLA-DR4

T cell activation -
why HIV improves pre-existing
why RA rare if have HIV
Rheumatoid Arthritis -
Hx/PE
Insidious onset of
morning stiffness > 1 hr
painful, warm swelling of
mult. symmetric joints > 6 wks
MC - wrist, MCP, PIP
any joint may be involved
axial rare except
upper cervical spine
ulnar deviation
MCP joint hypertrophy
swan-neck
boutonniere
subq, painless Baker's cysts
Rheumatoid Arthritis -
Dx
RF (anti-Fc IgG Ab)
ESR
XR
synovial fluid aspiration -
slightly turbid
dec. viscosity
WBC 3,000-50,000
Rheumatoid Arthritis -
Tx
NSAIDs
COX-2 inhib

severe -
corticosteroids
methotrexate
hydroxychloroquine sulfate
gold
azathioprine
operative may be nec.
Felty's Triad -
What is it
RA
splenomegaly
neutropenia
Juvenile Rheumatoid Arthritis-
What is it
Nonmigratory
nonsuppurative
mono- and poly-arthropathy
bony destruction
< 16 y/o
lasts > 6 wks
95% - dis. resolves by puberty
Juvenile Rheumatoid Arthritis-
Hx/PE
3 patterns
all patterns may have -
fever
nodules
erythematous rashes
pericarditis
fatigue

pauciarticular -
MC form
< 4 joints
weight-bearing joints
■ ANA type -
MC subtype
asymm involvement of lg. joint
iridocyclitis -
insidious
if not treated => blind
■ RF type -
poor prognosis
HLA-B27 -
boys also have
spondyloarthropathies

polyarticular -
> 5 joints
similar to adult RA
symmetric
may dev. iridocyclitis

Still's disease (systemic) -
least common
daily high spiking fever
evanescent salmon-colored rash
hepatosplenomegaly
serositis
Juvenile Rheumatoid Arthritis-
Dx
No diag tests
XR
RF - pos. in 15%
ANA - may be pos.
RBC dec.
elevated -
ESR
WBC
platelets
normal ESR doesn't exclude Dx
Juvenile Rheumatoid Arthritis-
Tx
NSAIDs
corticosteroids
ROM and strength exercises
methotrexate
monitor iridocyclitis
Scleroderma -
What is it
Progressive systemic sclerosis
multisys disease
thickening of skin from
accumulation of connective tissue
MCC of death - pulmonary
CREST - better prognosis
MC - females 30-50
Scleroderma -
Hx/PE
■ All have thick skin & Raynaud's

■ Lung -
pulmonary fibrosis
=> restrictive lung disease
and cor pulmonale

■ GI -
esoph dismotility
achalasia
dec. motility of small intestines
dilation of lg. intestines
lg. diverticula

■ renal -
malignant HTN => ARF

■ CREST -
limited form
CREST -
What is it
Calcinosis
Raynaud's
esoph dysmotility
sclerodactyly
telangiectasias
Scleroderma -
Dx
RF
ANA
eosinophilia
anticentromere Ab - CREST
anti-Scl-70 - systemic
Scleroderma -
Tx
Systemic glucocorticoids
penicillamine - skin changes
Ca2+ ch blockers - Raynaud's
ACE inhib - renal dis, HTN
SLE -
What is it
Multisys autoimmune
women - esp. Black
Ab-mediated cellular attack
deposits of Ag-Ab complexes

lupus-like syn -
drug-induced lupus
hydralazine
penicillamine
procainamide
INH
methyldopa
rash only
anti-histone Ab
resolves when drug discont.
SLE -
Hx/PE
DOPAMINE RASH
Discoid rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immunologic criteria
Neuro Sxs -
lupus cerebritis, seizures
Elevated ESR
Renal dis.
ANA pos.
Serositis
Hematologic abnorm

Sxs exacerbated -
sun exposure
pregnancy
SLE -
Dx
Anemia
leukopenia
TCP
ANA
anti-dsDNA
anti-Sm Ab

■ active attacks -
dec. C3 and C4
■ antihistone Ab -
drug-induced
■ anti-Ro (SSA) -
neonatal lupus
neonatal congen heart block
if pregnant, screen
■ antiphospholipid Ab -
hypercoagulability
thromboembolic dis.
recurrent spontan abortions
stillbirths
Tx - LMWH
SLE -
Tx
Arthritis - NSAIDs
major organ involvement - steroids
flare-ups - steroids
antimalarials - rash
nephritis - cytotoxics
cyclophosphamide
azathioprine
SLE -
Complications
■ Infections
■ progressive impairment of -
brain
heart
lungs
kidney
■ inc. risk - spontaneous abortion
(antiphospholipid Ab)
■ neonates -
inc. risk of congenital
complete heart block
(anti-Ro/SSA)
Temporal Arteritis -
What is it
Giant cell arteritis
women 2x's > men
> 50 y/o
subacute granulomatous inflamm
■ large vessels -
aorta
ext. carotid - esp. temporal
vertebral
■ blindness -
occlusion of central retinal
■ polymyalgia rheumatica - 50%
Temporal Arteritis -
Hx/PE
Headache
temporal tenderness
scalp pain
jaw claudication
fever
monocular blindness -
transient or permanent
wt loss
malaise
myalgia
arthralgia
Temporal Arteritis -
Dx
ESR
ophthalmologic eval
Bx - temporal artery
Temporal Arteritis -
Tx
If suspect TA -
start steroids before Bx
hi-dose prednisone -
1-2 mos. before taper

monitor eye exams
Henoch-Schönlein Purpura -
What is it
Immune-mediated vasculitis
IgA immune complexes
small arteries -
GI tract
skin
joints
kidney
2-11 y/o
degree of renal involvement
det. prognosis
Henoch-Schönlein Purpura -
Hx/PE
Palpable purpura -
buttocks and legs
asymm, migratory
periarticular swelling
abdom pain
preceding URI
Henoch-Schönlein Purpura -
Tx
Usu self-limited
Tx supportive
steroids - Sxs
Henoch-Schönlein Purpura -
Complications
GI bleeding
intussusception
glomerulonephritis
Polymyalgia Rheumatica -
What is it
Elderly females
close association with
temporal arteritis
Polymyalgia Rheumatica -
Hx/PE
Pain and stiffness -
shoulder
pelvic girdle
esp. severe in morning or
after inactivity
minimal joint swelling
fever
malaise
wt. loss
hard to -
get out of chair
lift arms above head
muscles not weak
pain limits muscle effort
Polymyalgia Rheumatica -
Dx
Clinical
anemia
ESR high
Polymyalgia Rheumatica -
Tx
Low-dose prednisone
Osteosarcoma -
What is it
2nd MC primary malignant
bone tumor
metaphyses -
distal femur
prox. tibia
prox. humerus
can metas to lungs
men
20s-30s
Paget's can precede dev. of
secondary osteosarcoma
Osteosarcoma -
Hx/PE
Progressive pain
=> intractable pain
worse at night
constitutional Sxs
at site of tumor -
erythema
enlargement
Osteosarcoma -
Dx
MRI
CT
XR -
Codman's triangle
sunburst pattern
Osteosarcoma -
Tx
Limb-sparing surgical proc
pre- and postop chemo -
methotrexate
doxorubicin
cisplatin
ifosfamide
amputation - may be nec if big
Paget's (Osteitis Deformans) -
What is it
Osteoclasts accelerate
bone turnover in local areas
=> hyper osteoblastic repair
=> abnorm structure that
weakens bone
may be assoc. with
paramyxovirus infection
mainly dis. of elderly
Paget's (Osteitis Deformans) -
Hx/PE
Often asymp
if Sx occur, dev. insidiously
deep bone pain
bone softening =>
tibial bowing
kyphosis
freq fractures

inc. in cranial diameter -
(frontal bossing)
deafness - CN8 compressed
Paget's (Osteitis Deformans) -
Dx
Alk phos
inc. urinary hydroxyproline
serum Ca2+ & phosphate- normal
XR -
bony cortex very expanded
jigsaw/mosaic bone pattern
thick trabeculae
Paget's (Osteitis Deformans) -
Tx
NSAIDs
calcitonin
alendronate
Paget's (Osteitis Deformans) -
Complications
Fracture
hi-output cardiac failure
arthritis
deafness
secondary osteosarcoma
vertebral collapse
=> spinal cord compression
Inflammatory Myopathies -
What Are They
Inflammatory muscle diseases
progressive muscle weakness

polymyositis
dermatomyositis
inclusion body myositis
Inflammatory Myopathies -
Hx/PE
• Difficulty with proximal muscles -
lifting objects
combing hair
getting up from chair

• difficulty with distal later -
writing

• dermatomyositis -
heliotrope rash
Grottron's papules
Inflammatory Myopathies -
Dx
Most sensitive test -
CK - elevated
aldolase - elevated

anti-jo-1 autoAb
EMG
mus Bx - confirms
Inflammatory Myopathies -
Tx
Steroids -
polymyositis
dermatomyositis

inclusion body myositis -
resistant to immunosuppressives
Fibromyalgia -
What is it
Connective tissue d/o
myalgia
weakness
fatigue
no inflammation
associated with -
depression
anxiety
IBS
MC women > 50
Fibromyalgia -
Hx/PE
Pain when palpate at least
11 of 18 tender points
palpate "trigger point"=> pain
body aches
fatigue
sleep disorders
Fibromyalgia -
Dx
Dx of exclusion

myofascial pain syndrome -
< 11 tender points or
nonfibromyalgia-associated
tender points
Fibromyalgia -
Tx
Stretching
heat application
hydrotherapy

transcutan electrical
nerve stimulation
pt. education
stress reduction
low-dose antidepressants
Compartment Syndrome -
What is it
Inc. pressure in a
confined space
compromises nerve, muscle
& soft tissue perfusion

MC - ant. compartment of
lwr leg & forearm

causes -
fractures
crush injuries
burns
ischemic-reperfusion after
an injury
casts
Compartment Syndrome -
Hx/PE
The 6 P's:
Paresthesias
Palpation - tense compartment
Pallor
Poikilothermia
Pulselessness
Paralysis
Pain -
out of proportion
with passive motion of
fingers & toes
Volkmann's contracture
Compartment Syndrome -
Dx
Measure compartment pressure -
> 30 mmHg not good

delta pressure -
diastolic minus compartment
should be > 30 to be OK
Compartment Syndrome -
Tx
Surgical emergency
immediate fasciotomy of
all compartments
do in < 6 hrs.
Low Back Pain -
What is it
Paraspinous
strains - mus injury
sprain - ligament injury
Low Back Pain -
Hx/PE
If malignancy -
pain worse at nite
pain not relieved by rest
pain not relieved by
changing positions

if point tenderness over
vert. body -
osteomyelitis
fracture
malignancy

cauda equina syndrome -
bladder or bowel dysfunction
saddle-area anesthesia
impotence
surgical emergency
Low Back Pain -
L4 Associated Deficits:
Motor
Reflex
Sensory
Motor -
foot dorsiflexion
tibialis anterior

reflex -
patellar

sensory -
medial aspect of leg
Low Back Pain -
L5 Associated Deficits:
Motor
Reflex
Sensory
Motor -
big toe dorsiflexion
extensor hallucis longus

reflex -
none

sensory -
medial forefoot &
lateral aspect of leg
Low Back Pain -
S1 Associated Deficits:
Motor
Reflex
Sensory
Motor -
foot eversion
peroneus longus/brevis

reflex -
achilles

sensory -
lateral foot
Low Back Pain -
Dx
Mainly clinical
XR
MRI
electrodiagnostic studies -
n. conduction velocity test
Low Back Pain -
Tx
Sprains & strains -
NSAIDs
physical therapy
continue activities
as tolerated
rest > 1-3 days unnec.
90% recover spontan in 6 wks

surgery - if correctable
spinal dis.

cauda equina syndrome -
surgical emergency
immediate decompression
laminectomy
Herniated Disk -
What is it
Nucleus pulposus herniates
posteriorly
=> n. root or cord compression
neck/back pain
sensory & motor deficits

causes -
degen changes
trauma
neck/back strain
neck/back sprain

middle-aged & older men
after strenuous activity
L4-L5 & L5-S1
Herniated Disk -
Hx/PE
Sev. months of aching pain
=> sudden onset of severe,
electricity-like LBP
pain exacerbated by straining
sciatica
tingling - lwr ext
numbness - lwr ext
mus weakness
atrophy
contractions
spasms
pain inc. by -
passive straight leg
crossed straight leg raises
large midline herniations
=> cauda equina syndrome
Herniated Disk -
Dx
MRI
Herniated Disk -
Tx
Most cases -
bed rest
NSAIDs
physical therapy
localized heat
resolved in 2-3 wks

if no neuro deficit -
bed rest not advised
early mobilization
muscle relaxant
NSAIDs

diskectomy -
if persistent or
disabling Sxs
Spinal Stenosis -
What is it
Stenosis of cervical or
lumbar spinal canal
=> compression of n. roots
usu from degen joint dis.
middle-aged or elderly
Spinal Stenosis -
Hx/PE
■ Neck pain

■ back pain -
radiates to butt & legs
leg numbness
leg weakness
"spaghetti legs"
"walks like a drunken sailor"
■ leg cramping -
at rest
standing
walking

■ sitting gives relief
leaning forward gives relief
(flexing at hips dec. pain)
Spinal Stenosis -
Dx
XR
MRI or CT
Spinal Stenosis -
Tx
■ Mild to moderate -
NSAIDs
abdom mus strengthening
■ advanced -
epidural steroid injection
■ surgical laminectomy -
short-term
will recur
Developmental Dysplasia of Hip
What is it
Congen hip dislocation
=> dislocated femoral heads
due to -
lax musculature
excessive uterine packing
(breech)
=> poor dev of acetabulum, hip
will progress if not corrected
MC - 1st born breech females
Developmental Dysplasia of Hip
Hx/PE
■ Barlow's - hip adducted
■ Ortolani's - thighs abducted
■ Allis' (Galeazzi's) sign -
knees unequal when hip
& knees flexed
dislocated side is lower
■ asymm skin folds
■ limited abduction of
affected hip
Developmental Dysplasia of Hip
Dx
Early detection
eval clinical
US - if after 10 wks old
XR -
unreliable until 4 mos. old
neonatal femoral head
radiolucent
Developmental Dysplasia of Hip
Tx
Start Tx early
< 6 mos. - Pavlik harness
6-15 mos. - spica cast
15-24 mos. - open reduction
if no Tx started by 24 mos. -
signif defect
Developmental Dysplasia of Hip
Complications
Complications -
joint contractures
AVN of femoral head
Limp -
What is it
1 of the MC musculoskel d/o
of kids
MC cause - trauma
Limp -
Hx/PE
■ May be assoc. with
pain or fever
■ ask about -
h/o trauma
recent infections
contact with TB-pos. pts.
■ young kids & toddlers -
infected joint
■ adolescent & teens -
JRA
slipped capital femoral
epiphyses (SCFE)
Legg-Calve-Perthes (LCP)
■ disruption in normal gait -
Trendelenburg
antalgic gait
■ infection -
erythema
edema
limited ROM
■ trauma or tumor -
point tenderness
■ always eval for -
fever
signs of systemic infection
neuro involvement -
reflexes
mus atrophy
changes in sensation
bowel & bladder function
Limp -
Differential Dx
STARTSS HOTT
Septic joint
Tumor
Avascular necrosis
(LCP)
RA/JRA
TB
Sickle cell disease
SCFE
HSP
Osteomyelitis
Trauma
Toxic synovitis
Limp -
Dx
Thorough H&P
XR
CBC
ESR
CRP
bone scan
nerve conduction studies
joint aspirate & culture -
if suspect septic joint
Limp -
Tx
Depends on cause
Legg-Calve-Perthes -
What is it
AVN of femoral head
UNK etiology
boys 4-10
can be b/l
Legg-Calve-Perthes -
Hx/PE
Usu asymp at first
=> painless limp or
=> pain, referred to knee
limited abduction
limited internal rotation
atrophy
Legg-Calve-Perthes -
Tx
■ Self-limited
■ observation
■ if dis. extensive or
ROM impaired -
brace
hip abduction with Petrie cast
osteotomy
■ prognosis dep on -
age
ROM
extent of involvement
joint stability
Slipped Capital
Femoral Epiphysis -
What is it
Separation of prox. fem
epiphysis thru growth plate
=> fem head displaced
med. & post. to fem neck
can be b/l
obese Black 11-13 y/o boys
if < 11 y/o, may be assoc.
with endocrinopathies
may be due to imbalance
bet. GH & sex hormones
Slipped Capital
Femoral Epiphysis -
Hx/PE
Thigh or knee pain
painful limp
acute or insidious
acute - restricted ROM,
inability to bear wt.
limited int. rotation
limited abduction
hip tenderness
flexion =>
obligatory ext. rotation
Slipped Capital
Femoral Epiphysis -
Dx
TSH
XR both hips -
AP
frog-leg lat
Slipped Capital
Femoral Epiphysis -
Tx
Start promptly
no wt. on limb until
surg. stabilized with screws
acute slip -
gentle closed reduction
Slipped Capital
Femoral Epiphysis -
Complications
Chondrolysis
AVN of fem head
premature hip OA
=> hip arthroplasty
Shoulder Dislocation -
Mechanics
■ MC -
ant. dislocation
axillary artery & nerve
hold arm in ext. rotation
■ post. dislocations
radial artery
seizures & electrocutions
hold arm in int. rotation
Shoulder Dislocation -
Tx
Closed reduction
followed by sling & swath
recurrent - surgery
Hip Dislocation -
Mechanics
■ MC -
post. dislocation
sciatic n.
can cause AVN
post. directed force on
int. rotated, flexed,
adducted hip
"dashboard injury"
■ ant. dislocation -
obturator n.
Hip Dislocation -
Tx
Closed reduction
followed by abduction
pillow/bracing
CT after reduction
Colles' Fracture -
Mechanics
MC wrist fracture
distal radius
fall onto outstretched hand
=> dorsally displaced/angle Fx
elderly (osteoporosis)
kids
Colles' Fracture -
Tx
Closed reduction
then long arm cast
intra-articular -
open reduction
Scaphoid (Carpal Navicular) Fx
Mechanics
MC fractured carpal bone
can be 1-2 wks for XR to show
assume if tenderness in
anatomical snuff box
prox. 3rd scaphoid fxs -
can => AVN
Scaphoid (Carpal Navicular) Fx
Tx
Thumb spica cast
open reduction -
displacement
nonunion
Boxer's Fracture -
Mechanics
Fx of 5th metacarpal neck
forward trauma of closed fist
Boxer's Fracture -
Tx
■ Closed reduction &
ulnar gutter splint
■ excessive angulation -
percutan pinning
■ skin broken -
assume infection by
human oral pathogens
"fight bite"
surgical irrigation
debridement
IV ABx to cover Eikenella
Humerus Fx -
Mechanics
Direct trauma
radial n.
wrist drop
loss of thumb abduction
Humerus Fx -
Tx
Hanging arm cast
or coaptation splint & sling
functional bracing
Nightstick Fx -
Mechanics
Ulna shaft fx
from self-defense -
arm against blunt object
Nightstick Fx -
Tx
ORIF
open reduction & int. fixation
Monteggia's Fx -
Mechanics
Diaphyseal Fx
prox ulna
subluxation of radial head
Monteggia's Fx -
Tx
ORIF - shaft fx
closed reduction - radial head
Galeazzi's Fx -
Mechanics
Diaphyseal Fx
radius
dislocation of
distal radioulnar joint
from direct blow to radius
Galeazzi's Fx -
Tx
ORIF - radius
cast forearm in supination
Hip Fx -
Mechanics
MC in osteoporotic women
who fall
shortened, ext rotated leg
at risk for DVTs
displaced fem neck fxs -
high risk of AVN
fx nonunion
Hip Fx -
Tx
ORIF
parallel pinning of fem neck
anticoag
> 80 y/o -
may need hip hemiarthroplasty
Femur Fx -
Mechanics
Direct trauma (MVA)
fat emboli
fever
scleral & axillary petechiae
confusion
dyspnea
hypoxia
Femur Fx -
Tx
Intramedullary nailing
open fxs -
thorough irrigation
debridement
Tibial Fx -
Mechanics
Direct trauma
car bumper & pedestrian injury
compartment syndrome
Tibial Fx -
Tx
Casting vs.
intramedullary nailing
Open Fx -
Mechanics
Orthopedic emergency
must go to OR in < 6 hrs.
(risk of infection)
Open Fx -
Tx
OR emergently to repair
ABx
Achilles Tendon Rupture -
Mechanics
MC in unfit men in sports
hear sudden "pop"
sounds like rifle shot
limited plantar flexion
pos Thompson test -
pressure on gastrocnemius
doesn't => ft plantar flexion
Achilles Tendon Rupture -
Tx
Long-leg cast for 6 wks
ACL Injury -
Mechanics
From forced hyperflexion
pos. anterior drawer sign
Lachman's test
r/o meniscal or MCL injury
ACL Injury -
Tx
Surgery
graft from patellar or
hamstring tendons
PCL Injury -
Mechanics
From forced hyperextension
pos. posterior drawer test
PCL Injury -
Tx
Operative PCL repair -
for highly competitive athlete
Meniscal Tears -
Mechanics
Clicking or locking
joint line tenderness
pos. McMurray's test
Meniscal Tears,
MCL/LCL Injuries -
Tx
Conservative
unless assoc. with Sxs or
ligament injuries
Clavicular Fx -
What is it
MC fractured long bone in kids
birth-related (lg infants)
brachial n. palsies
usu middle 3rd of clavicle
prox end displaced superiorly
from pull of sternocleidomast
Clavicular Fx -
Tx
Figure-of-8 sling
vs. arm sling
Greenstick Fx -
What is it
Incomplete fx
cortex of one side of bone
Greenstick Fx -
Tx
Reduction with casting
order films at 7-10 days
Nursemaid's Elbow -
What is it
Radial head subluxation
from being pulled
or lifted by hand
kid will not bend elbow
Nursemaid's Elbow -
Tx
Manual reduction -
gentle supination of elbow
at 90 degrees of flexion
no immobilization nec.
Torus Fx -
What is it
Buckling of cortex of
long bone
secondary to trauma
usu distal radius or ulna
Torus Fx -
Tx
Cast immobilization
3-5 wks - dep. on age
Supracondylar Humerus Fx -
What is it
5-8 y/o
proximal to brachial a.
risk of Volkmann's contracture
Supracondylar Humerus Fx -
Tx
Cast immobilization
closed reduction
percutan pinning -
if signif displaced
Osgood-Schlatter Dis. -
What is it
Overuse apophysitis
of tibial tubercle
localized pain
esp with quadriceps Ctx
active young boys
Osgood-Schlatter Dis. -
Tx
Dec. activity 1-2 yrs
neoprene brace
Salter-Harris Fxs -
What are they
Fxs of growth plate of kids
classified by fx location

I - physis
II - metaphysis & physis
III - epiphysis & physis
IV - epi-, meta- & physis
V - crush injury of physis
Salter-Harris Fxs -
Tx
I & II - nonoperatively

others & unstable fxs-
operatively
prevents leg-length inequality
Sjogren's -
What is it
Chronic autoimmune disease
lymphocytes infiltrate exocrine glands
can become progressive
=> systemic
=> lymphoproliferative
(malignant lymphome)
Sjogren's -
Hx/PE
Xerostomia
dry eyes
keratoconjunctivitis sicca
"sandy feeling under eyes"
dental caries
parotid enlargement
Sjogren's -
Dx
• Schirmer's test -
dec. tear production
• rose bengal stain -
corneal ulcers
• anti-Ro (SSA) & anti-La (SSB)
• Bx -
lymphocytes infiltrate salivary gland
Sjogren's -
Tx
None
symptomatic Tx - artificial tears