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156 Cards in this Set
- Front
- Back
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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 |
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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 |
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Duchenne Muscular Dystrophy -
Dx |
CK - always high
EMG muscle Bx DNA diagnostic - immunostain for dystrophin |
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Duchenne Muscular Dystrophy -
Tx |
No cure
Tx supportive physical therapy achilles tendon release wheelchair by 13 y/o death in 20s |
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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 |
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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 |
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Ankylosing Spondylitis -
Dx |
Dx based on clinical & XR
HLA-B27 ESR - may be elevated RF & ANA - neg. spine and pelvic XR - "bamboo spine" |
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Ankylosing Spondylitis -
Tx |
NSAIDs
exercise physical therapy |
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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 |
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Psoriatic Arthritis -
What is it |
Chronic inflammatory arthritis
psoriasis of skin psoriatic nail lesions DIP joints sausage-shaped digits "mushroom caps" HLA-B27 seroneg. |
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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 |
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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 |
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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 |
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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" |
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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 |
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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 |
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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 |
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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 |
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Osteoarthritis -
Tx |
Weight reduction
physical therapy NSAIDs intra-articular corticosteroid injections elective joint replacement - total hip/knee arthroplasty |
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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 |
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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 |
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Rheumatoid Arthritis -
Dx |
RF (anti-Fc IgG Ab)
ESR XR synovial fluid aspiration - slightly turbid dec. viscosity WBC 3,000-50,000 |
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Rheumatoid Arthritis -
Tx |
NSAIDs
COX-2 inhib severe - corticosteroids methotrexate hydroxychloroquine sulfate gold azathioprine operative may be nec. |
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Felty's Triad -
What is it |
RA
splenomegaly neutropenia |
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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 |
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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 |
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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 |
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Juvenile Rheumatoid Arthritis-
Tx |
NSAIDs
corticosteroids ROM and strength exercises methotrexate monitor iridocyclitis |
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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 |
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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 |
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CREST -
What is it |
Calcinosis
Raynaud's esoph dysmotility sclerodactyly telangiectasias |
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Scleroderma -
Dx |
RF
ANA eosinophilia anticentromere Ab - CREST anti-Scl-70 - systemic |
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Scleroderma -
Tx |
Systemic glucocorticoids
penicillamine - skin changes Ca2+ ch blockers - Raynaud's ACE inhib - renal dis, HTN |
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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. |
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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 |
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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 |
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SLE -
Tx |
Arthritis - NSAIDs
major organ involvement - steroids flare-ups - steroids antimalarials - rash nephritis - cytotoxics cyclophosphamide azathioprine |
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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) |
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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% |
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Temporal Arteritis -
Hx/PE |
Headache
temporal tenderness scalp pain jaw claudication fever monocular blindness - transient or permanent wt loss malaise myalgia arthralgia |
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Temporal Arteritis -
Dx |
ESR
ophthalmologic eval Bx - temporal artery |
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Temporal Arteritis -
Tx |
If suspect TA -
start steroids before Bx hi-dose prednisone - 1-2 mos. before taper monitor eye exams |
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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 |
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Henoch-Schönlein Purpura -
Hx/PE |
Palpable purpura -
buttocks and legs asymm, migratory periarticular swelling abdom pain preceding URI |
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Henoch-Schönlein Purpura -
Tx |
Usu self-limited
Tx supportive steroids - Sxs |
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Henoch-Schönlein Purpura -
Complications |
GI bleeding
intussusception glomerulonephritis |
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Polymyalgia Rheumatica -
What is it |
Elderly females
close association with temporal arteritis |
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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 |
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Polymyalgia Rheumatica -
Dx |
Clinical
anemia ESR high |
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Polymyalgia Rheumatica -
Tx |
Low-dose prednisone
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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 |
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Osteosarcoma -
Hx/PE |
Progressive pain
=> intractable pain worse at night constitutional Sxs at site of tumor - erythema enlargement |
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Osteosarcoma -
Dx |
MRI
CT XR - Codman's triangle sunburst pattern |
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Osteosarcoma -
Tx |
Limb-sparing surgical proc
pre- and postop chemo - methotrexate doxorubicin cisplatin ifosfamide amputation - may be nec if big |
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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 |
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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 |
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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 |
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Paget's (Osteitis Deformans) -
Tx |
NSAIDs
calcitonin alendronate |
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Paget's (Osteitis Deformans) -
Complications |
Fracture
hi-output cardiac failure arthritis deafness secondary osteosarcoma vertebral collapse => spinal cord compression |
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Inflammatory Myopathies -
What Are They |
Inflammatory muscle diseases
progressive muscle weakness polymyositis dermatomyositis inclusion body myositis |
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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 |
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Inflammatory Myopathies -
Dx |
Most sensitive test -
CK - elevated aldolase - elevated anti-jo-1 autoAb EMG mus Bx - confirms |
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Inflammatory Myopathies -
Tx |
Steroids -
polymyositis dermatomyositis inclusion body myositis - resistant to immunosuppressives |
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Fibromyalgia -
What is it |
Connective tissue d/o
myalgia weakness fatigue no inflammation associated with - depression anxiety IBS MC women > 50 |
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Fibromyalgia -
Hx/PE |
Pain when palpate at least
11 of 18 tender points palpate "trigger point"=> pain body aches fatigue sleep disorders |
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Fibromyalgia -
Dx |
Dx of exclusion
myofascial pain syndrome - < 11 tender points or nonfibromyalgia-associated tender points |
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Fibromyalgia -
Tx |
Stretching
heat application hydrotherapy transcutan electrical nerve stimulation pt. education stress reduction low-dose antidepressants |
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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 |
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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 |
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Compartment Syndrome -
Dx |
Measure compartment pressure -
> 30 mmHg not good delta pressure - diastolic minus compartment should be > 30 to be OK |
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Compartment Syndrome -
Tx |
Surgical emergency
immediate fasciotomy of all compartments do in < 6 hrs. |
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Low Back Pain -
What is it |
Paraspinous
strains - mus injury sprain - ligament injury |
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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 |
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Low Back Pain -
L4 Associated Deficits: Motor Reflex Sensory |
Motor -
foot dorsiflexion tibialis anterior reflex - patellar sensory - medial aspect of leg |
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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 |
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Low Back Pain -
S1 Associated Deficits: Motor Reflex Sensory |
Motor -
foot eversion peroneus longus/brevis reflex - achilles sensory - lateral foot |
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Low Back Pain -
Dx |
Mainly clinical
XR MRI electrodiagnostic studies - n. conduction velocity test |
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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 |
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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 |
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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 |
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Herniated Disk -
Dx |
MRI
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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 |
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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 |
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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) |
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Spinal Stenosis -
Dx |
XR
MRI or CT |
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Spinal Stenosis -
Tx |
■ Mild to moderate -
NSAIDs abdom mus strengthening ■ advanced - epidural steroid injection ■ surgical laminectomy - short-term will recur |
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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 |
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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 |
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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 |
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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 |
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Developmental Dysplasia of Hip
Complications |
Complications -
joint contractures AVN of femoral head |
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Limp -
What is it |
1 of the MC musculoskel d/o
of kids MC cause - trauma |
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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 |
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Limp -
Differential Dx |
STARTSS HOTT
Septic joint Tumor Avascular necrosis (LCP) RA/JRA TB Sickle cell disease SCFE HSP Osteomyelitis Trauma Toxic synovitis |
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Limp -
Dx |
Thorough H&P
XR CBC ESR CRP bone scan nerve conduction studies joint aspirate & culture - if suspect septic joint |
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Limp -
Tx |
Depends on cause
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Legg-Calve-Perthes -
What is it |
AVN of femoral head
UNK etiology boys 4-10 can be b/l |
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Legg-Calve-Perthes -
Hx/PE |
Usu asymp at first
=> painless limp or => pain, referred to knee limited abduction limited internal rotation atrophy |
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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 |
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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 |
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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 |
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Slipped Capital
Femoral Epiphysis - Dx |
TSH
XR both hips - AP frog-leg lat |
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Slipped Capital
Femoral Epiphysis - Tx |
Start promptly
no wt. on limb until surg. stabilized with screws acute slip - gentle closed reduction |
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Slipped Capital
Femoral Epiphysis - Complications |
Chondrolysis
AVN of fem head premature hip OA => hip arthroplasty |
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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 |
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Shoulder Dislocation -
Tx |
Closed reduction
followed by sling & swath recurrent - surgery |
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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. |
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Hip Dislocation -
Tx |
Closed reduction
followed by abduction pillow/bracing CT after reduction |
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Colles' Fracture -
Mechanics |
MC wrist fracture
distal radius fall onto outstretched hand => dorsally displaced/angle Fx elderly (osteoporosis) kids |
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Colles' Fracture -
Tx |
Closed reduction
then long arm cast intra-articular - open reduction |
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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 |
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Scaphoid (Carpal Navicular) Fx
Tx |
Thumb spica cast
open reduction - displacement nonunion |
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Boxer's Fracture -
Mechanics |
Fx of 5th metacarpal neck
forward trauma of closed fist |
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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 |
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Humerus Fx -
Mechanics |
Direct trauma
radial n. wrist drop loss of thumb abduction |
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Humerus Fx -
Tx |
Hanging arm cast
or coaptation splint & sling functional bracing |
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Nightstick Fx -
Mechanics |
Ulna shaft fx
from self-defense - arm against blunt object |
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Nightstick Fx -
Tx |
ORIF
open reduction & int. fixation |
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Monteggia's Fx -
Mechanics |
Diaphyseal Fx
prox ulna subluxation of radial head |
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Monteggia's Fx -
Tx |
ORIF - shaft fx
closed reduction - radial head |
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Galeazzi's Fx -
Mechanics |
Diaphyseal Fx
radius dislocation of distal radioulnar joint from direct blow to radius |
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Galeazzi's Fx -
Tx |
ORIF - radius
cast forearm in supination |
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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 |
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Hip Fx -
Tx |
ORIF
parallel pinning of fem neck anticoag > 80 y/o - may need hip hemiarthroplasty |
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Femur Fx -
Mechanics |
Direct trauma (MVA)
fat emboli fever scleral & axillary petechiae confusion dyspnea hypoxia |
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Femur Fx -
Tx |
Intramedullary nailing
open fxs - thorough irrigation debridement |
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Tibial Fx -
Mechanics |
Direct trauma
car bumper & pedestrian injury compartment syndrome |
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Tibial Fx -
Tx |
Casting vs.
intramedullary nailing |
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Open Fx -
Mechanics |
Orthopedic emergency
must go to OR in < 6 hrs. (risk of infection) |
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Open Fx -
Tx |
OR emergently to repair
ABx |
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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 |
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Achilles Tendon Rupture -
Tx |
Long-leg cast for 6 wks
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ACL Injury -
Mechanics |
From forced hyperflexion
pos. anterior drawer sign Lachman's test r/o meniscal or MCL injury |
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ACL Injury -
Tx |
Surgery
graft from patellar or hamstring tendons |
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PCL Injury -
Mechanics |
From forced hyperextension
pos. posterior drawer test |
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PCL Injury -
Tx |
Operative PCL repair -
for highly competitive athlete |
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Meniscal Tears -
Mechanics |
Clicking or locking
joint line tenderness pos. McMurray's test |
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Meniscal Tears,
MCL/LCL Injuries - Tx |
Conservative
unless assoc. with Sxs or ligament injuries |
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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 |
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Clavicular Fx -
Tx |
Figure-of-8 sling
vs. arm sling |
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Greenstick Fx -
What is it |
Incomplete fx
cortex of one side of bone |
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Greenstick Fx -
Tx |
Reduction with casting
order films at 7-10 days |
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Nursemaid's Elbow -
What is it |
Radial head subluxation
from being pulled or lifted by hand kid will not bend elbow |
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Nursemaid's Elbow -
Tx |
Manual reduction -
gentle supination of elbow at 90 degrees of flexion no immobilization nec. |
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Torus Fx -
What is it |
Buckling of cortex of
long bone secondary to trauma usu distal radius or ulna |
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Torus Fx -
Tx |
Cast immobilization
3-5 wks - dep. on age |
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Supracondylar Humerus Fx -
What is it |
5-8 y/o
proximal to brachial a. risk of Volkmann's contracture |
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Supracondylar Humerus Fx -
Tx |
Cast immobilization
closed reduction percutan pinning - if signif displaced |
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Osgood-Schlatter Dis. -
What is it |
Overuse apophysitis
of tibial tubercle localized pain esp with quadriceps Ctx active young boys |
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Osgood-Schlatter Dis. -
Tx |
Dec. activity 1-2 yrs
neoprene brace |
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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 |
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Salter-Harris Fxs -
Tx |
I & II - nonoperatively
others & unstable fxs- operatively prevents leg-length inequality |
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Sjogren's -
What is it |
Chronic autoimmune disease
lymphocytes infiltrate exocrine glands can become progressive => systemic => lymphoproliferative (malignant lymphome) |
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Sjogren's -
Hx/PE |
Xerostomia
dry eyes keratoconjunctivitis sicca "sandy feeling under eyes" dental caries parotid enlargement |
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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 |
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Sjogren's -
Tx |
None
symptomatic Tx - artificial tears |
