Ortho - Test 1(Part 1-10)

Front 1

Carpal Tunnel Syndrome Sxs

Back 1

numbness and tingling in radial 3
Night pain
worse iwth prego, thyroid dz, DM,
Thenar muscle wasting,
slowing of condution

Front 2

Carpal Test

Back 2

Tinels
Phalens
Median Nerve compression test

Front 3

Carpal Tx

Back 3

splinting, change movement,s NSAIDs, steroid injections
Surgical release of the transverse carpal ligament

Front 4

Cubital Tunnel Syndrome description

Back 4

compression of the ulnar nerve at the medial epicondyle
parasthesia of the ring and small fingers.
worse with elbow flesion,
nigh pain
Second most common UE
nerve may sublex anterioly
sensory loss
Positive tinels sing
ULNAR claw deformity

Front 5

Cubital Dx

Back 5

Ulnar nerce compression test
finger abdutiction strength
fromens test

Front 6

Cubital tx

Back 6

extension splinting of the elbow
elbow pat at night
Unlar nerve decompression or trasnposition

Front 7

Ulnar Tunnel Syndome

Back 7

ulnar nerve compressed between the transverse carpal ligament and the volar carpal ligament in Guyon's conal
Unlar numbness
Reproducivble
Tx same as carpal

Front 8

Long thoracic Nerve Palsy

Back 8

serratus anterior muscle dysfunciton
get EMG NCV, and shoulder x-ray for eval

Front 9

Spondylolitheses description

Back 9

forward slippage of one vertebra on antoerh
presents as lower back pain

Front 10

Spondylithises Classifications

Back 10

1-0-25
2-25-50
3-50-75
4-75-100
5-over 100

Front 11

Spondylolitheses treatment

Back 11

1/2- PT,avoid football, lumbar bracing in lordosis, serial xray until mutirity, fusion in situ if not going away.
3,4,5 - bilateral posterolateral fusion w/ o w/o decompression

Front 12

HNP description

Back 12

displacemnt of the central area of the disc resulting in impingment on a nerve root
MC L4 L5 and L5 S1
-Mosty middle aged, radicular and lower back pain

Front 13

HNP findings

Back 13

Motor weakness
L4 - tibilais ant
L5-extensor hallicis longus
S1- achillis
Asymmetic reflexes
Knee jerk -L4
Tibialis post or Medial Hamstring tendong - L5
Ankle Jerk S1
Positive tension sings

Front 14

HNP Dx and Tx

Back 14

Dx - MRI, mylography, Nerve studies
Tx: most resolve with time, pt Nsaids, aerobic, lumbar epidural steroids
if no improvement in 6-12 moths - surgery

Front 15

Prereqs for HNP surgery

Back 15

Failrue of nonop
Predominately lege sxs
enuro
positive tension sings
pos imagin studies
no psychosocial
95% are better right after, but afer 5 years there is no difference between surg and non-surg

Front 16

Cauda Equina Syndrome

Back 16

massive central nerniation of lumbar DISC that causes
progressive motor weakness, numbness
Saddle anesthesia
Retention of pee
SURGICAL emergency

Front 17

Chronic Lumbar Disx Dz

Back 17

Over 40 yo treat sx, thearpy Nsaids, injections, may require fusion

Front 18

Spinal Stensosis

Back 18

narrowing of spinal canal - either central or later
Most are acquired
Sxs: pain and parasthes
cause NEUROGENIC claudication (takes longer for relief of sxs upon sitting

Front 19

Neurogenic Claudication

Back 19

pain and wakness in the muscle of the thighs and calvs
proximal, flexed is better, No bike, longer with upill

Front 20

Vascular Claudication

Back 20

cramping without parasthesisa, sxs more distal, sooner, relieved with standing or lying flat.

Front 21

Spinal Stenosis Tx

Back 21

Non - rest, exercise, NSAIDS, lumbar epidurla steroids,

Front 22

Scolisis Treatment

Back 22

lateral spinal curvature over 10 dagrees
10-13 years old
ido
under 10 needs referall.
0,1 - more risk of it progresses
2,3,4 - less likely to progress

Front 23

Scolosis Dx and Tx

Back 23

Stadning posteranterior and latera radio on 36 casstte - limit number due to radiation exposrue
Tx: young - brace surg
Old - preserve funtion and control pain, PT

Front 24

Kyphosis

Back 24

Forward bending, scheuermans dz - fixed kyphsois
Tx: therapy, treat underlying condition, bracing

Front 25

Ankylosing Spondylitis

Back 25

involves the sacroiliac joints and the spine
onset 15-30, male
LBP, morning stiffness, SI joint, loss of chest expansion
Bamboo - spine
Positive HLA - B27
Tx - sxs NSAIDS and PT

Front 26

Reiter Dz

Back 26

Urethritis, Conjuncitviites, and arthritis
younger pt with reactive sxs within 3-4 weks of infection
knee, sacrolititis, heel pain, plantar fascitis
chlamydia, camp
Posit B27

Front 27

Psoritic Arthtis

Back 27

30-55, DIP, DJD
skin dz usu preceeds joint sxs
nail disorders, pitting, riding, and onycolylsis

Front 28

Arthritis with Inflame bowel dz

Back 28

inflame of tendon, fascia, or joint capsule insertions
paucuticuarl arthris, in LE
extra-articualr inflame involving the eye, skin, mucous membranes, heart, and bowle
assdon attoc with B27

Front 29

Diffuse Idiopathic Skeletal Hyperostosis

Back 29

idiopathic, in men over 60
clacificsaiton of ligament and tendon attachments
thoraci spine is most commonyl affected - stiffness
Fusing of at least four vertebrae, anterior bridging, disck space, and SI joint sparing
Tx: presenting sxs

Front 30

C-Spine Traumat - Criteria for clearing

Back 30

table 264-2

Front 31

Unlikely C-spine

Back 31

nl mental status, no nekc pain, no tenderness on palp, no neuro signs, no other distracting, no hx of loss of consceousness.

Front 32

View for C-spine

Back 32

PA view, a lateral view, an odontoid hx
-DONT just do lateral radio -
most c-spines are missed technically inadquiate.

Front 33

Birth Palsy

Back 33

uncommon - fractures are more common - get x-ray - after 2 years old its not going to change

Front 34

Erb Duchene

Back 34

MC - C5 Dn C6 injury and watiers test - this has a good outcome

Front 35

Whole - arm

Back 35

Flaccid and uncommon

Front 36

Klumpkes

Back 36

Likley clawhand deformity and horners syndrome

Front 37

SHoulder Impingement Syndrome Description

Back 37

Inflame of the subacromial bursa and underlying rotator cuff tendoms, common cause of shoulder pain in middle aged patients
rotator cuff - edema, hemorrhage, chronic inflame, fibrosis to mircorscopic tendon fiber fialure, full thickness teart

Front 38

Impingement syndrome symptoms

Back 38

Anterior and lateral shoulder pain exacerbated by overhead activity, nigh pain,
Palpation over the greater tuberosity and subacromial bursa commonly elicits tenderness and crepitus with serveral months
Posistive neers and haowkins sign

Front 39

How do you tell if it impingment syndrome

Back 39

subacromial injection - it will cause relief, record as %, use posterior approach, 3 injections/yr
Radiograpghs will look nl

Front 40

Impingement Adverse outcomes and Red flags

Back 40

pain can be persistent
rotator cuff tear
wekaness of rotator cuff or failure of 2-3 months of rehabd,
Surgerg - Subacromial decompression SAD,
Consider getting and MRI if you think that there is a tear

Front 41

Impingement treatment

Back 41

Rest from the offending activity, PT, SNAIDs,
3-4x a day for 6 weeks PT
Subacromial corticosterodd injection with stretching
Injections
DO not give injection if there is a rotator cuff tear.

Front 42

Another name for Frozen Shoulder

Back 42

Adhesive Capsulitis

Front 43

Frozen shoulder description

Back 43

Inflmmation and thickening of the shoulder capsule
loss of both active and passive motion
distinct from posttraumatic shoulder stiffness
Affects 40-60, with no clear predispostion
But bwith with DM are a RF - and are refactory to tx,
freezing - thawoing,
Takes 1-2 years to resove

Front 44

Frozen Shoulder PE

Back 44

reduction in both active and passive motion
motion is painfule - especially at the extremes
pain and tenderness at the deltoid insertion

Front 45

Frozen shoulder Diagnositic Tests

Back 45

Radiographs are use dto rule other things out
CT and MRI are NOT indicated becase they will look normla.

Front 46

Frozen shoulder Tx

Back 46

NSAIDS, non-narcoitic, moist heat, streching, intra-articulare injeciton, home stretching,
refer if no improvement with rehab after 3 months

Front 47

Rotator Cuff tear descirption

Back 47

-result of age, chronic use, or altered blood supply
MC - suprapinates - then extends to infraspinatous, teres minor, subscapularis
Full thick are uncommon

Front 48

Rotator Cuff Tear Sxs

Back 48

recurrent shoulder pain for several months after a specific injury
Night pain
weakness cathcing, grating - esp with overhead activty
Supra - unable to hold hand in forward flexsion and abduction
Infa/teres - external rotation
Sub - internal rotation

Front 49

Rotator Cuff Exam

Back 49

back of shoulder is sunken in from atrophy
Passive ROM is nl but activ is limited
large tears - they can only shrug their shoulders
Drop arm test
Supra Test - JOBE
Test for external rotation strength
Internal rotation strength test
Subscapuslaris Liftoff test

Front 50

Rotator Dx test

Back 50

AP - you will see a high-riding humerus relative to the glenoid
May need an MRI - if operative.

Front 51

Rotator Cuff massive tear

Back 51

positive arm drop
external rotation 3+/5

Front 52

Rotator adverse outcomes

Back 52

loss of shoulder motion, especiall the ability to lift arm overhead, chornic pain, wekaness,
long standing - joint dengeration

Front 53

Rotoator Tx

Back 53

NSAIDs, PT, stretching, strengthening, steoir injection, (to many though will increase tear)
3 subacromial injections
failed rehabd - surg
younger then 60 with an acute tear shouwld have surgery within 6 weeks of injury

Front 54

Shoulder Instability desciption

Back 54

Episodes of sublextion
Ant - most common - TUBS (traumatic, uni, bankart lesion - tear in anterior lenoid labrum - surg)
Mulit - AMBRI - atrautamic, mulit, bilat, rehab, indefinately
Post - result of post directed force when the arm is in adduction and internal rotation - seizures and electric shock
REhav is ptest

Front 55

Shoulder instability Sxs

Back 55

AN - shoulder slipping out of joint when the arm is abducted and externally rotated
Ant - initial with traum like throwing, but then it just becomes unstable.

Front 56

Labrum - AP lesions description

Back 56

An injury to the superior glenoid and the biceps anchor complex TUBS
Super Labrum - SLPA

Front 57

labrum Tear sxs

Back 57

SLAP
painful popping or catching sensations
Pain deep inside the shoulder
Overhead sports hx - like volleyball

Front 58

Labrum PE and Diag tests

Back 58

O'brien test - pt internally rotates shoulder from a forwad elevarted position
An increase in pain witht pts tumbs are pointd down - labral tear
Plan film will look Nl
MR anrthrography - GOLD

Front 59

PE for volunary dislocations

Back 59

Anterior disloc - pt supports arm in neutral psostion
pt with Posterior disoclation hold the arm in adductiona dn internal rotation
Neurovasc function - watch expecially the axillary nerve
See how far the fingerst can extend past neutral
(pt with ligamentous laxity are more likely ot have a mutlidirectional instability

Front 60

Diag test - AP and labrum

Back 60

AP and axillary raido
Hill sachs - posteriro humeral head against the anterior edge of gleinoid you know there is a tear
older then 40 with trauma - likley to ahve torn the rotator cufff as well- so do an MRI
post dislciation - missed on AP radio
If no Axillary view attanable do a transscapular lateral view

Front 61

Adverse outcomes of an labrum tear

Back 61

Axillary nerve injury - deltoid dysfunction, and numbness over lateral arm
- risk is greater in younger patientw ith multiple episodes
Osteoarthittis,
DO NOT miss bony bankart

Front 62

Tx for a labrum tear and dislocaitons

Back 62

Reduce in ER
pt first time dislocation put them in PT
if it keeps reoccurring they will need surgery
if AMBRI - then treat non-op
AVOID voluntarilty dislocating

Front 63

Red flags for dislocations

Back 63

failure ot reduce ny closed mainpulation
recurrent dislocation
failure of 3 mo of rehab

Front 64

Biceps Tendon Description

Back 64

proximlal injureis are more common, often caused with impingement

Front 65

Biceps Tendon signs

Back 65

Speed test,
Yergason's Test

Front 66

Biceps tendonitis Tx

Back 66

Limit flexion and supination
NSAIDS,
PT,
iNjeciton - but try to avoid thi
Surg - decompression, biceps tenodesis or rlease
(consider SLAP lesion in bicep tenonitis pt - with positive speed)

Front 67

Biceps tunon rupture description

Back 67

proximal lon head, older adults secondary to hx of shoulder pain and impingment
young- wt lifting or throwing
Sudden pain in upper arm,
audible snap
bulge in lower arm
ecchymosis - tracking downt he middle and lower arm

Front 68

Biceps ruputre Dx tes

Back 68

AP and axilarry
MRI to ro rototor cuff tears

Front 69

Biceps rupture adverse outcomes

Back 69

pt can loss 10% of flesion and foraearm supiatnion strenth,
cosmetically ugly

Front 70

Biceps Rupture Tx

Back 70

non-op - is effective for most pt,
If youn and need extra help with lifting do surgery
Distal bicep rupture is worse and needs surgery in less then 7 days.

Front 71

Thoracic Outlet Syndrome Description

Back 71

compression of the brachial plexus and or subclavian vessels as they exi the spave betweent eh superiro shoudler girdle and the first rib
Types: cervical rib, costoclaviclualr, hyperabduction syndrome

Front 72

Thoracic outlet sx and PE

Back 72

vague, can mimic distal nerve entrapment exp ulnar nerve, aching and paresthesis can extend from shoulder, arm, medial foramr and fingers,
aching fatigue
If lower complex= HORNERS - ptosis, miosis, enopthalmos, anhidrosis
Inspect of swelling of discoloration
compare distal pulses
see sensory and motron funtion
check ulnar nerve, vervical spine, neuro and bascuarl test
(a sense of fatiuge is a negative an inconclusive.

Front 73

Thoracic Outlest tests

Back 73

Adson test - pull arm back, neck in extension, check for radial pulse
Roo's test - both arms up for 60 seconds, pump hands for 3 minutes, any sx?
Wrights test - arm over head - check the radial pulse

Front 74

Thoracic Outlet Dx

Back 74

AP and lwateral of cerpcial spine
PA and lateral - to check apical lung tumor
MRI of cervical spine
EMG and NCV

Front 75

Adverse outcomes of Thoracic Outlet Syndrome

Back 75

wakness or loss of cordination of upper estreme, AH, cant use arms over head,
can cause venous thrombosis, and aneurysnm of the subclavian arterym

Front 76

Tx of Thoracic Outlet

Back 76

Most - 3 mo PT
Avoid strenous acitivy - no straps on arms
nsaids, muscle relasant,
Transcutaneous electrical nerve stimulation TENS
wt reduction
PT, OT, physiatrist,
NON-oper (surg does not help this people.