Term
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Definition
the study of the musculoskeletal:
bones
muscles
ligaments
tendons
joints
+/-nerves |
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Term
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Definition
| subspecialty of internal medicine & pediatrics, devoted to the diagnosis & therapy of rheumatic disease |
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Definition
| the leading chronic condition reported by the elderly |
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Term
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Definition
| epiphysis, metaphysis, diaphysis |
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Definition
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Term
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Definition
| wider portion of bone between diaphysis & epiphysis, cartilaginous "physis" until ossified, zone of growth |
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Definition
| long portion of the bone (shaft) |
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Definition
| are the living unit of bone |
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Definition
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Definition
| break down bone tissue, skeleton is constantly remodeling throughout life |
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Definition
| facilitates smooth movement between 2 bones (found at joint space) |
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Term
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Definition
| is found on the outside of all bones, except joint articulation (where articular cartilage is located) has pain receptors, which make bone injuries sensitive. Provides nourishment to bone through blood supply |
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Term
Diarthrodial (synovial)
freely moving, mobile joints |
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Definition
ball & socket joints (hip & shoulder)
hinge joint (elbow)
condyloid (knee)
saddle (thumb)
pivot (radius/ulna articulation) |
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Term
| Amphiarthrodial (fibrocartilagenous) |
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Definition
| joints allow some movement (costasternal, symphysis pubis, acrominoclavicular) |
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Term
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Definition
| joints have no movement (cranial sutures) |
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Term
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Definition
| bending of a joint or shortening of a flexor muscle |
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Term
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Definition
| straightening of joint or lengthening of an extensor muscle |
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Term
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Definition
| rotating palm downward or feet rotating inward |
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Term
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Definition
| rotating palm upward or feet rotation outward |
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Definition
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Definition
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Definition
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Definition
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Definition
| (bowlegged) distal extremity is "inward" |
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Term
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Definition
| (knock-kneed) distal extremity is "outward" |
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Term
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Definition
disruption of cortex of bone resulting in cracking, splintering, or bisecting
characterized by whether they are open/closed, the bone involved, type of fracture, displacement, & location of fracture |
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Term
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Definition
| occurs when the joint between 2 bones separate, usually from excessive tension to or disruption of supporting ligaments |
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Term
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Definition
| stretching ligaments from excessive force |
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Term
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Definition
| Grad I partial tear but stable to Grade III severe & instable |
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Term
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Definition
| stretching o partial tearing of the muscle tendon unit fro excessive force |
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Term
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Definition
| perpendicular to long axis of the bone |
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Term
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Definition
| diagonal to the long axis of the bone |
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Term
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Definition
| caused by a twisting injury (often difficult to differentiate from oblique fracture) |
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Term
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Definition
| fracture though one cortex |
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Definition
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Term
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Definition
| caused by a tendon or ligament pulling a piece of bone off |
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Term
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Definition
| caused by a non-traumatic cumulative overload on a bone |
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Term
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Definition
| crushed x-ray looks like a spider web |
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Term
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Definition
| bone exposed through skin (formerly "compound") |
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Term
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Definition
physeal injuries
normal to V, progression on class correlates w/growth arrest |
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Term
| salter harris classification I |
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Definition
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Term
| salter harris classification II |
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Definition
| through physis w/extension to metaphysis |
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Term
| salter harris classification III |
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Definition
| through physis w/extension to epiphysis |
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Term
| salter harris classification IV |
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Definition
| through metaphysis, physis, & epiphysis |
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Term
| salter harris classification V |
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Definition
| crush injury to the physis |
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Term
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Definition
| elevated pressure in a closed muscle compartment |
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Term
| 7 p's of compartment syndrome |
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Definition
| P's: pain, pallor, parasthesias, paresis, poikilothermia, pressure, pulselessness |
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Term
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Definition
painful inflammation of a tendon and/or the synovial tissue around the tendon
associated w/overuse injuries (repetitive movements) or acute injuries
common in shoulder (RC) elbow (medial/lateral epicondyles), wrist (DeQuervain's), knee (patellar), ankle (achilled) |
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Term
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Definition
bursa are fluid filled sacs that cushion muscles & tendons during movement
overuse injuries can cause inflammation of the bursa, which leads to pain & swelling
local trauma can cause swelling/inflammation of bursa
common around shoulder, hip, elbow, & knee |
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Term
| Corticosteroid injections |
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Definition
| mainstay in treatment of many musculoskeletal conditions, decreases inflammation of synovial tissue w.in joints, can also be used in extra-articular areas like bursae, tendon sheathes, epidural spaces. |
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Term
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Definition
is blood borne
untreated leads to chronic osteolyelitis |
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Term
| acute osteomyelitis in children |
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Definition
presents as bone pain & fever
Associated w/blunt trauma
starts in the metaphysis of the bone |
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Term
| acute osetomyelitis in adults |
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Definition
often immune-compromised
diabetics or patients on chronic steroids |
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Term
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Definition
bacteria are implanted & grow in non-vital tissue
open fracture w/dead bone & muscle
surgically at the time of bone surgery:
very long surgery, compromised host, breaks in technique
also seen when acute osteomyelitis is missed or undertreated |
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Term
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Definition
| new bone forming in response to the infection process |
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Term
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Definition
| dead bone fragments, macro or micro, that are in the zone of the bone infection |
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Term
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Definition
| localized cystic oseto, usually metaphyseal |
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Term
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Definition
| may only see loss of fat planes indicating edema |
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Term
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Definition
| sensitive to any new bone growth, but not specific |
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Term
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Definition
| gives marrow & soft tissue info |
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Term
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Definition
| dye injected into site of drainage |
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Term
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Definition
| reveal bone destruction & repair |
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Term
| Acute hematogenous osteomyelitis (AHO) |
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Definition
bacteria brought to the bone via the blood stream, as opposed to exogenous source
bacteremia is common, AHO occurs in only about 2 cases per 10,000 children, 1:1000 neonates
osteaomyelitis requires a host & inflammatory response |
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Term
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Definition
can be confused w/osetoid or osteoma, a painful benign tumor causing a hole in the bone
bone scan, CT & tomograms may aid in diagnosis |
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Term
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Definition
group B strep
Staph Aureus
E coli |
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Term
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Definition
Staph Aureus
Strep pyogenes
H Flu |
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Term
| predisposing factors influencing AHO |
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Definition
large inoculation of organisms
blunt trauna to bone prior to bacteremia
foreign body
compromised host defeneses |
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Term
children >1year
infected joints |
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Definition
| growth plate is avascular & prevents infection from spreading into the epiphysis |
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Term
children >1year
infected joints |
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Definition
| metaphyseal infection of the hip, proximal humerus & elbow can still enter the joint the same way of intracapsular extension |
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Term
children >1year
infected joints |
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Definition
symptoms: fever, irritabilty, lethargy, pseudoparalysis, local inflammation
only 50% will have high fever |
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Term
| unique anatomy of the body |
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Definition
nutrient artery ends as a capillary loop in the metaphysis
blood enters a large venous sinusoid where flow decreases
these lack phagocytic lining cells
minor trauma may further decrease flow by hematoma or edema, allowing bacteria to get a hold |
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Term
managing infected joints
infants |
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Definition
| may not require surgery, but need to establish the bacteria for correct Abx, may need intraarticular or intra osseous aspiration |
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Term
managing infected joints
children |
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Definition
| should have the subperiosteal abscess aspirated to establish the organism |
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Term
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Definition
| surgical debridement depends on the quality of response to medical management |
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Term
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Definition
pus on aspiration
signs & symptoms persist >36 hrs on IV Abx |
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Term
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Definition
bone & joint destruction
growth arrest
chronic osteomyelitis
death |
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Term
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Definition
acute form is blood borne, usually kids
chronic form is typically due to inoculation of bacteria thru an open wound
a variety of organisms can cause bone infection
IV Abx are a mainstay of treatment
surgery is necessary to irradiate chronic osteomyelitis
have high index of suspicion in child w/fever & bone pain |
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Term
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Definition
the gross anatomy of a bone tumor, the better defined the x ray border, the better the prognosis
GOOD tumors stay w/in the bone envelope (or soft tissue)
BAD tumors escape the normal anatomic boundaries |
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Term
| non-ossifying fibroma (NOF) |
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Definition
may heal spontaneously if observed long enough
lesions are eccentric in metaphyseal bone
well marginated |
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Term
treatment of NOF
observation |
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Definition
| annually if they remain asymptomatic until healing assured |
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Term
treatment of NOF
currettage & grafting |
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Definition
| w/bone graft substitute for a large painful lesion |
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Term
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Definition
| occasional pathologic fracture may require internal fixation |
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Term
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Definition
usually seen in children
found when pathologic fx occurs
the path frx heals the cyst shrinks, but then enlarges again
some cysts are active & have increased intraosseous pressure
the active type may respond to steroid injections into the cyst
older children respond to curettage & bone grafting |
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Term
features of exostoses
Osteochondroma |
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Definition
the marrow cavity of the stalk is in continuity w/the parent bone marrow
the cap is slow growing cartilage
as cap thickens it outgrows its nutrition, becomes calcified, & then mineralizes
cartilage cap>1 cm thickness, is thought to be malignant |
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Term
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Definition
benign but painful, especially at night
relieved but ASA, can be anywhere
nidus (hypervascular area) stimulates the hypertrophic bone, the indues needs to be removed or destroyed to stop the pain
be by radiofrequency ablation |
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Term
Enchonroma
cartilage w/in bone marrow space |
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Definition
alarming due to size
shouldn't cause any endosteal (internal) scalloping of the cortex
may not appear "hot" in scan
shouldn't occupy more marrow than one can see on the x-ray |
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Term
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Definition
usually in young growing teens
very aggressive & rapidly grow outside bone origin
sarcomas tend to metastasize to lung, or bone
therapies multi-modal surgery, chemo, XRT |
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Term
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Definition
seen in teens
chemo then surgery
>80% mortality usually from lung mets
prognosis improved w/aggressive chemotherapy
limb salvage possible in many cases |
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Term
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Definition
ONION SKIN
preteens-teens
c/o bone pain
associated w/soft tissue swelling
mimics osteomyelitis b/c of pattern of bone destruction |
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Term
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Definition
usually slow growing
adults
occasionally in patients w/mult. exostosis
safely treated by resection
NOT responsive to chemo or XRT |
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Term
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Definition
round cell tumor
usually seen in adults >50
X-ray may be solitary lytic, permeative, or soap like bubble
solitary lesions can be treated w/moderate doses of XRT
plasma & urine electrophoresis used to dx |
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Term
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Definition
older adults
presents w/bone pain or path frx
common organs that mets to bone: breasts, prostate, lung, kidney, thyroid, colon
use ABD Ct & lung CT to look for primary tumor |
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Term
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Definition
older adults
presents w/bone pain or path frx
common organs that mets to bone: breasts, prostate, lung, kidney, thyroid, colon
use ABD Ct & lung CT to look for primary tumor |
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Term
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Definition
elderly
may or may not cause pain
monostotic
can cause hypermetabolic heart failure
can contribute to deafness
bone hard & vascular
labs elevated alkaline phosphate |
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Term
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Definition
most useful fro evaluating bones
minimum of 2 views at right angles to rule out frx or subluxation |
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Term
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Definition
more sensitive delineation of frx
eval bone tumors
may help guide operative planning
increased expense & radiation compared to plain film |
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Term
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Definition
no ionizing radiation, but expensive
soft tissue injuries:muscle, tendons, ligaments |
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Term
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Definition
CT>plain films
naturally occurring, 3mSv/year
No radiation w/MRI |
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Term
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Definition
plain films helpful in dx penetrating injuries, linear, or depressed skull frx
CT preferred it gives info both skull & brain |
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Term
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Definition
frontal evals frontal & ethmoid sinuses
"waters view" is frontal w/head tipped back, allowing for max sinuses to be evaluated
lateral view evaluates sphenoid sinus
look for air-fluid level or complete opacification of sinus in sinusitis |
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Term
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Definition
evaluates upper airway obstruction (epiglottitis, retropharyngeal abscess)
airway is generally well seen |
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Term
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Definition
epiglottis is thickened "thumbprint sign"
normal is <7mm at C2 |
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Term
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Definition
| prevertebral soft tissue swelling |
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Term
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Definition
standard 5 view series
lateral view (90% frx seen on this view)
open mouth odontoid view
AP view
2 oblique views
*most traumas use 3 views, no obliques |
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Term
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Definition
| should be able to C1 to top of T1 |
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Term
| C-spine eval of lateral view |
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Definition
4 lines: anterior/posterior spinal (longitudinal) line, spinolaminal, spinous process
+ anterior soft tissue line |
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Term
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Definition
| allows visualization of C7-T1 when not adequately visualized on routine lateral |
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Term
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Definition
10% frx found in this view
looking for frx through odontoid
alignment of lateral masses of C1 w/C2
symmetry of C1-C2 |
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Term
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Definition
| standard views are in internal rotation & external rotation. |
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Term
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Definition
oblique "Y" view, scapula forms Y
humeral head should lie over the intersecting arms of the Y
Y view is best for dislocation |
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Term
elbow films
radial head frx |
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Definition
| note pronounced anterior fat pad "sail sign" & visible posterior fat pad (not normally seen) |
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Term
wirst films
distal radial frx |
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Definition
"Colle's" frx, most common wrist bone frx!!
usually FOOSH, distal radius is dorsally displaced |
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Term
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Definition
vasculature runs retrograde, usually FOOSH
sx:pain in snuff box, sometimes swelling
frx may be subtle, if negative repeat in 2-3 weeks |
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Term
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Definition
| pelvis bony ring, it is difficult to break in one place w/out disrupting another. |
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Term
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Definition
| tangential view of flexed knee allows evaluation of patella for fracture or dislocation |
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Term
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Definition
standard3 views: A/P, lateral, Oblique (Mortise view)
mortise smooth black (joint) line |
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Term
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Definition
Brachialis, biceps, brachioradialis
Innervation C5-C6 |
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Term
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Definition
triceps, anconeus
innveration C7-C8 |
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Term
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Definition
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Term
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Definition
biceps, supinator
innveration C5-C6 |
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Term
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Definition
pronator quadratus C7, C8 T1
pronator teres C6 |
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Term
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Definition
70 degrees pronation
85 supination |
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Term
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Definition
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Term
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Definition
indicates effusion
seen along humerus w/elbow frx |
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Term
lateral epicondylitits
"tennis elbow" |
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Definition
inflammatory-of the extensor origin @insertion onto the lateral epicondyle
may present as dull ache on the outer aspect of the elbow that increases w/grapsing, twisting, & resisted extension of the wrist & fingers
oain can cause "guarded" motion perceived as weakness
degenerative |
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Term
lateral epidondylitis
tennis elbow
physical exam |
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Definition
tenderness over insertion of extensor tendon on lateral elbow
increasing pain w/extension/supination of wrist against resistance |
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Term
lateral epidondylitis
tennis elbow
physical exam XRAY |
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Definition
| generally normal but useful in ruling out other causes of pain, specifically radio-capitellar arthritis |
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Term
lateral epidondylitis
tennis elbow
treatment |
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Definition
rest, avoidance of aggravation activites like gripping
ice if acute trauma or repetitive injury
PT iontophoresis/friction massage
compression, ace wrap? (beware of tennis elbow bands)
anit-inflammatories- NSAIDs +/- injection w/steroid & marcaine or lidocaine
surgery |
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Term
Medial epicondylitis
golfers, pitchers, bowler's elbow |
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Definition
| microtrauma tot he flexor carpi radialis tendon insertion on the medial epicondlye |
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Term
Medial epicondylitis
golfers, pitchers, bowler's elbow
ohysical findings |
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Definition
tender topalpatation on the medial epicondyle
increased pain w/resistance to flexion & pronation of the wrist |
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Term
Medial epicondylitis
golfers, pitchers, bowler's elbow
treatment |
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Definition
rest, avoid aggravating activity
+/-ice
NSAIDs
PT iontophoresis
refer for resistant cases
use caution when considering injections (ulnar nerve) |
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Term
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Definition
| inflammation, swelling & +/- pain over the olecranon process |
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Term
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Definition
trauma
infection-puncture wounds, microscopic
inflammation-gout, pseudogout, RA, uremia in renal failure |
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Term
olecranon bursitis
risk factors |
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Definition
diabetes
chronic EToH abuse
occupation/hobbies
gout |
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Term
olecranon bursitis
diagnosis |
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Definition
x-ray if trauma or suspicion of foreign body &+/- gout
CBC if suspicion of significant infection
ESR, CRP & serum uric acid if gout?
Aspiration is controversial, consider specialist consult |
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Term
olecranon bursitis
treatment |
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Definition
1st line for non-infectious is "nothing"
rest-avoid direct trauma-elbow padding may be effective
NSAIDs
Aspiration (specialist) gram stain & culture >5000WBC indicates infection (s. aureus most common)
DO NOT use injection steroids unless you are absolutely sure NO infection
typically spontaneously resolves
consider follow up after steroid injection |
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Term
| Ulnar nerve entrapment syndromes |
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Definition
maybe from acute trauma like fracture or dislocation
initial treatment requires prompt reduction
document neurovascular status before & after reduction |
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Term
| Ulnar nerve entrapment syndromes |
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Definition
cunital tunnel syndrome
"truck drivers elbow"
chronic pressure on the ulnar nerve where it passes between bone, tendons, ligaments at the elbow
can be entrapment of the nerve from hypertrophy of the triceps or flexor/pronator musculature
maybe remote result of trauma
"tardy ulnar palsy" ulnar neuropathyremotely after an injury at the condylar groove |
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Term
Ulnar nerve entrapment syndromes
symptoms |
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Definition
parasthesias in the ring & small fingers
weakness of the intrinsic muscles of the hand
weakness of abduction of 5th digit
chronic entrapemtn, pope's blessing sign
positive Froment's sign |
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Term
Ulnar nerve entrapment syndromes
diagnosis/treatment |
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Definition
Clinical
EMG
trmt-splinting, NSAIDs, surgery |
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Term
| radial nerve entrapment syndromes |
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Definition
radial nere palsy "Saturday night Palsy"
wrist drop & loss of sensation in dorsal web space between thumb & index finger
cock-up splint for wrist
orthopedic follow up
OT
claw hand in non-resolving cases |
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Term
| radial nerve entrapment syndromes |
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Definition
radial tunnel syndrome
actually posterior interosseous nerve in forearm
use caution w/tennis elbow straps |
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Term
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Definition
subluxation of radial head-noncalcified radial head is pulled out from under the annular ligament
usually around 2 years old
peak age 1-4
-20% of all upper extremity injuries in children
sudden longitudinal pull on arm w/forearm pronated |
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Term
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Definition
arm usually held in slight flexion & pronation
child will not want to use arm to grab toy, candy, etc
x-ray 1st if any question of frx
reduction technique is supinate the forearm & flex the elbow. feel over radial head for click
re-examine ~10 minutes |
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Term
nursemaids elbow
follow up |
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Definition
a sling might be helpful for pain 1-2 days
get them out ASAP
APAP or ibuprofen for pain
generally child will begin using the arm immediately but will be sore for 3-5 days
educate parents on mechanism & what to avoid |
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Term
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Definition
most common posterior
associate w/fall on nearly extended elbow or other similar energy applied to joint |
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Term
elbow dislocation
treatment/eval |
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Definition
immobilize in sling, posterior splint, or pillow splint
narcotic analgesics
X-rays for eval |
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Term
elbow dislocation
reduction |
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Definition
IV conscious sedation
stabilize upper arm
inline traction of lower arm
FLexion of elbow
push toward hand on olecranon
long arm posterior splint
post-reduction x-rays
record CMS in hand
specialist referral |
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Term
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Definition
| FOOSH, radial head driven into capitellum |
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Term
fracture of radial head
symptoms/PE |
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Definition
elbow pain, +/- swelling
PE-tenderness over radial head
limitation of motion, especially in extension & pro-supination |
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Term
fracture of radial head
diagnosis |
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Definition
AP, lateral & oblique x-ray series
there are specialized radial head views if necessary
positive fat pad sign-fluid in the anterior joint capsule |
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Term
fracture of radial head
treatment |
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Definition
sling for comfort
ice for swelling pain
analgesics, avoid NSAIDs in frx
encourage early AROM
follow x-rays week 1,3,6 |
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Term
fracture of radial head
radial neck |
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Definition
long arm posterior splint
refer to specialist |
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Term
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Definition
effusion (blood) in joint capsule
anterior & posterior fat pat sign suggest intraarticular frx
post. fat pad sign or "sail"sign suggests supracondyllar frx |
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Term
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Definition
usually fall backward on partly extendedelbow
be suspicious for vascular compromise, esp of the brachial artery
besuspicous for nerve injury of median, ulnar, or radial nerve
not a primary care frx-specialist referral indicated |
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Term
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Definition
| initial treatment may be closed reduction or opn & internal fixation by orthopedist |
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Term
supracondylar fracture
complications |
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Definition
loss of ROM/joint comtracture
post traumatic arthritis if articular surface is disrupted
non-union of fracture site
tardy ulnar palsy
nerve or vascular injury |
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Term
supracondylar fracture
rehab |
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Definition
| very important as even "minor" injuries can lead to stiffness & loss of AROM |
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Term
elbow arthritis
post traumatic |
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Definition
most common
arthoplasty is becoming better but not a great option
injection technique is difficult |
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Term
elbow arthritis
rheumatoid |
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Definition
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Term
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Definition
| plantar (flexion) & dorsal(extension) flexion |
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Term
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Definition
| allows lat/med movement inversion/eversion |
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Term
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Definition
ant.talo fibular
calcaneo-fobular
post. talo-fibular |
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Term
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Definition
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Term
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Definition
AKA interosseus or syndesmotic
joins distal tibia-fibula
maintains integrity of mortisse joint |
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Term
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Definition
dorsiflexor
pass ant to ankle |
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Term
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Definition
pass post. to medial malleolus
Tom Dick Harry tendons (tib post, extensor digitorum, flexor hallicus) |
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Term
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Definition
evertors of ankle
pass post to lateral malleous |
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Term
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Definition
arises from gastric & soleus
incerts on calcaneus
plantar flexes foot |
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Term
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Definition
| fibrous bands that hold tendons in place |
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Term
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Definition
90% lateral inversion injury, tear in sequence ant to post
deltoid lig sprain eversion mechanism, usually associated w/ fibula frx |
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Term
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Definition
pain swelling +/- inability to bear weight
foot maybe inverted (talar tilti)
passive inversion increased pain
stress manuever: drawer test, inversion stress |
|
|
Term
|
Definition
xray-nrml
Ottawa ankle rules: X-ray only required
Bony tenderness along distal 6cm of tibia & fibula
bony tenderness at base of 5th metatarsal
inability to bear weight both immediately after injury & in emergency department |
|
|
Term
| ankle sprain classification |
|
Definition
1st degree-ligament stretching, local tenderness, minimal swelling
2nd degree-severe stretching/partial tearing
more tenderness & swelling
abnormal stress test
Third degree- complete rupture, can't bear weight |
|
|
Term
|
Definition
ice/elevation
immobilize w/plastic or plaster splint
consider crutches:if moderate to severe, difficulty bearing weight w/splint
3rd degeree sprain may need surgery (rare) |
|
|
Term
|
Definition
may be malleolar, bimalleolar, trimalleolar
often disrupt tib-fib ligament & thus disrupts mortise joint
tib-fib (syndesmotic) ligament normally maintains integrity of mortise, exception distal fibula fx |
|
|
Term
Ankle fracture
weber classifications |
|
Definition
| Weber C Fib frx ABOVE syndemosis, ALWAYS tearing ligament disrupting the mortise ALWAYS INSTABLE |
|
|
Term
ankle fracture
Weber classification |
|
Definition
| Weber A- fib frx BELOW syndesmosis, mortise usually intact |
|
|
Term
ankle fracture
WEber classification |
|
Definition
| Weber B- Fib frx AT level of syndesmosis, often tearing ligament, may disrupt mortise |
|
|
Term
|
Definition
pain swelling bruising inability to bear weight
significant deformity if dislocation present as well |
|
|
Term
| ankle fracture management |
|
Definition
reduce frx-dislocation
immobilize in splint
elevate
surgery needed if mortise disrupted:need to restore anatomic position of talus on mortise, ensure smooth articular surface
cast 6-8 weeks
arthritis likely poorly aligned joint surface |
|
|
Term
|
Definition
most common frx tarsal bone
mech usually due to compression:fall from height, 10% associated w/lumbar frx
26%associated w/other extremity injury |
|
|
Term
calcaneus frx
clinical/xray/treatment |
|
Definition
swelling pain,ecchymosis
standard foot films, consider calcaneal views
surgical need to restore anatomy |
|
|
Term
|
Definition
due to foot hyper-plantar flexion
frx may involve dome, neck, or body
talus covered by cartilage, blood supply tenous-may lead to avascular necrosis |
|
|
Term
|
Definition
usually due to crushing injury
associated w/ navicular or cuneiform
pain/swelling/tenderness
foot X-ray
conservative rx, if non-displaced
ORIF if displaced |
|
|
Term
midfoot
proximal 5th metatarsal frx |
|
Definition
the most common metatarsal frx, often w/lateral sprain
ALWAYS check for tenderness at base of 5th MT when evaluating ankle sprain
ankle X-rays must visualize these area |
|
|
Term
midfoot
proximal 5th metatarsal frx |
|
Definition
| usually due to inversion/avulsion of prox. bone by peroneus brevis tendon |
|
|
Term
midfoot
proximal 5th metatarsal frx treatment |
|
Definition
conservative
immobilize
crutches |
|
|
Term
|
Definition
NOT an avulsoin frx
involves a DIAPHYSIS of 5th MT
has higher incidence of non-union or delayed union |
|
|
Term
| jones fracture VS. 5th MT avulsion frx |
|
Definition
| Jones difference it goes thru the shaft or diaphysis of the bone rather than a piece that avulses off |
|
|
Term
| forefoot fracture stress frx |
|
Definition
stress frx of midshaft MT, usually 2nd-3rd MT which are relatively fixed:1st, 4th & 5th relatively mobile
due to excessive stress over time
may not appear on X-ray for 2-3wks
if suspected bone scan, repeat X-ray 2-3wks
RX: rest, possible immobilize |
|
|
Term
| forefoot fractures:complete |
|
Definition
complete midshaft MT, usually crushing mech.
occasionally due to twisting mech.
often more than 1 MT is frx
RX: ice, immobilize w/plaster/fiberglass |
|
|
Term
forefoot fractures
phalanges |
|
Definition
phalanges (toes) common often see fracture/dislocation
usually due to direct trauma or hyper-extension |
|
|
Term
forefoot fractures
phalanges RX |
|
Definition
reduce frx and/or dislocation
immobilize w/dynamic splinting "buddy tape"
stiff soled shoes
great toe bears 1/3 of wt of body on that side: may require a walking cast
if unable to reduce, may require internal fixation (rare) |
|
|
Term
|
Definition
nagging, forefoot pain over middle metatarsal heads TRX-symptomatic, directed at cause
usually due to faulty wt distribution
ie. weight gain, hallux in valgus, flat foot
transverse arch becomes depressed
MT heads bear disproportionate wt
Also:gout, RA |
|
|
Term
|
Definition
a neuropathy of interdigital nerve, usually prox to bifurcation
usually nerve supplying 2nd & 3rd toes
nonspecific inflammation of nerve w/proliferative connective tissue
usually mid-aged women
unilateral |
|
|
Term
|
Definition
sudden attacks of sharp or burning pain, radiating to toes
1st pain only w/walking
later pain at rest
localized webspace tenderness, reproduces pain
may palpate small mass in webspace |
|
|
Term
morton's neuroma
management |
|
Definition
initial: steroid/lidocaine injection
definitive: surgical excision |
|
|
Term
|
Definition
stiffness of MTP joint of great toe
caused by arthritis, local trauma, gout
more in men |
|
|
Term
|
Definition
pain w/walking
tender at MTP joint pain w/dorsiflexion
XRAY; artritic changes: osteoephytes arrowed joint space
Management: rocker soled shoes, NSAIDs, poss surgery (joint replacement vs. fusion) |
|
|
Term
|
Definition
most common foot deformity
great toe angled "inward" valgus
more in females, often familial
obvious deformity:prominent bunion, red swollen |
|
|
Term
|
Definition
conservative, wide padded shoes
surgical : corrective osteotomy |
|
|
Term
|
Definition
PIP joint fixed in flexion, DIP extended
most in 2nd toe |
|
|
Term
|
Definition
shoe pressure may produce corns/calluses on dorsum of toe
treatment-operative:joint excision |
|
|
Term
|
Definition
due to collapsed medial arch
may be congenital or acquired (polio, RA, tendon rupture)
Flexible-most common
rigid-due to congenital vertical talus or spasmodic peroneal muscles |
|
|
Term
pes planus (flat foot)
clinical |
|
Definition
aching feet w/standing/walking
shoes wear badly esp over arch
on exam medial border of foot almost touches ground when standing |
|
|
Term
|
Definition
small children-usually none
older kids-arch support
in underlying condition (RA, congent vertical talus) may need surgical correction |
|
|
Term
|
Definition
overuse injury
-runners, standing occupations, RA & gout
strain of fascial fibers, friction causes periostitis of calcaneus |
|
|
Term
plantar fasciitis
clinical & management |
|
Definition
pain over plantar surface-increased w/walking running, relief w/rest
tender to palpatation over ant calcaneus
pain w/passive dorsiflexion
mgmt-rest, NSAIDs, heel & arch supports, if refractory, steroid injection |
|
|
Term
| posterior tibial tendonitis |
|
Definition
post tib tendon is plantar flex of foot, passes post to medial malleous
overuse injury
rest/NSAIDs possible immobilize, posse steroid injection |
|
|
Term
|
Definition
passes post to lateral mallelous
overuse injury
rest/NSAIDs, poss immobilize, poss steroid injection |
|
|
Term
|
Definition
entrapment of post tibial nerve by flexor retinaculum
due to inflammation-repetitive activity, RA, pregnancy, actue trauma Frx dislocation, soft tissue swelling |
|
|
Term
tarsal tunnel syndrome
clinical & management |
|
Definition
numbness, pain of sole of foot
mgmt-rest, NSAIDs, immobilization, poss surgery |
|
|
Term
| subluxing peroneal tendons |
|
Definition
occurs after injury that disrupts peroneal retinaculum
acute or chronic
tendons sublux or actually dislocate over lateral mallelous
seen best w.foot eversion
treatment:surgicial |
|
|
Term
|
Definition
due to overuse of calf muscles
tenderness, increased pain w.dorsiflexion
acute mgmt: ice, rest NSAIDs, immobilize
chronic mgmt: may need surgery divide fascia |
|
|
Term
|
Definition
usually due to forced dorsiflexion of ankle-initatin sprint, slipping on stairs
also seen w/direct trauma-blow to taut tendon, laceration
maybe partial or complete
most common in middle aged men |
|
|
Term
|
Definition
sudden pain, pt may hear snap, difficulty stepping off
exam:swelling of distal calf, palpable tendon defect
mays still be able to flees (toe flexors=tib post & peroneals)
positive Thompson test |
|
|
Term
Thompson test
achilles tendon rupture |
|
Definition
most sensitive
pt lies prone w/knees flexed at 90, squeeze calf, foot should plantar flex against gravity
achilles rupture:foot doesn't flex |
|
|
Term
achilles tendon rupture
management |
|
Definition
splint in equinus, non weight bearing
refer to ortho
conservative-casting x8wks
PT
surgical- rec. for younger or athletes |
|
|
Term
|
Definition
2 bursae: between calcaneus & achilles tendon, between achilles tendon & skin
overuse injury-poorly fitting shoes
inflammation pain on motion
management-rest NSAIDs proper fitting shoes, consider steroid injections |
|
|
Term
|
Definition
strongest bone in the body
longest bone in body
composed of body & 2 extremities |
|
|
Term
|
Definition
triangularbone
sesamoid (in quad femoris)
articulates w/femur |
|
|
Term
|
Definition
condyles
tubersoity
medial location of pec Acinus bursitis
Medial area where you can put IV in trauma |
|
|
Term
|
Definition
thin long bone lateral to tibia
biceps femoris & LCL attachments |
|
|
Term
|
Definition
flexors
extensors
adductors brevis, longus, magnus
abductors IT band |
|
|
Term
|
Definition
|
|
Term
|
Definition
| fluid sacs & synovial pockets |
|
|
Term
|
Definition
|
|
Term
|
Definition
suprapatellar
prepatellar
deep infrapatellar
pretibial |
|
|
Term
|
Definition
gastrocnemius
fibular
fibulopopliteal
subpopliteal |
|
|
Term
|
Definition
medial gastroc
anserine bursa-foot of goose
semememranosa |
|
|
Term
|
Definition
|
|
Term
|
Definition
rectus femoris L2,L3, L4
vastus intermedius L2, L3, L4
Vastus lateralis L3, L2, L4
Vastus medialis L3, L2, L4 |
|
|
Term
|
Definition
LCFA
lateral circumflex femoral artery (ascending transevere, descending) |
|
|
Term
|
Definition
| medial genicular arteries penetrate the joint FEEDS THE MENISCUS |
|
|
Term
|
Definition
|
|
Term
|
Definition
| sprain (MCL, LCL, ACL, PCL) |
|
|
Term
|
Definition
|
|
Term
nomenclature
sagittal plane |
|
Definition
| being a plane parallel to the sagittal suture |
|
|
Term
|
Definition
| or frontal plane divides the body into dorsal & ventral (back & forth) |
|
|
Term
nomenclature
transeverse plane |
|
Definition
| also known as an axial plane divides the body into cranial & caudal (head & tail) portions |
|
|
Term
|
Definition
MCL restrains valgus stress tot he knee
place knee off table & load to find instability |
|
|
Term
|
Definition
X-rays may w/chronic MCL sprains show calcification
MR is rarely needed but helpful if injury to ACL suspected w/MCL |
|
|
Term
|
Definition
resists varus stress
test w/30 degrees of flexion to negate ACL & PCL resistance of varus stress |
|
|
Term
|
Definition
conservative if mild
complete disruptions can need allograft reconstruction |
|
|
Term
|
Definition
rest, ice, immobilize
non-operative care
scar heals in 6wks to one year
combined ACL/MCL injuries will require MR & possible repair |
|
|
Term
|
Definition
bucket handle
horizontal
longitudinal
radial |
|
|
Term
|
Definition
more common medially
freq. assoc w/ACL tear
can lock the knee |
|
|
Term
| bucket handle presentation |
|
Definition
intermittently lock, cannot get full extension
can "come & go" |
|
|
Term
|
Definition
often missed
"double PCL sign" |
|
|
Term
bucket handle tear
treatment |
|
Definition
closed reduction
arthroscopic resection |
|
|
Term
|
Definition
| normal fluid from communicating bursa herniates through joint capsule |
|
|
Term
|
Definition
Inflammed synovial fluid
treatment: ice, rest, modalities (US), & cortisone injection
make sure its not septic bursitis |
|
|
Term
|
Definition
|
|
Term
|
Definition
direct trauma
get 2 view x-ray
some may require CT or MRI but usually unecessary |
|
|
Term
|
Definition
| non-operative care it not open, not displaced more than 3mm, not transverse, extension preserved |
|
|
Term
|
Definition
operate if extensor mechanism compromised
displaced fracture or transverse (avulsion) frx
OCD (osteochondral chondrotin dessicans) |
|
|
Term
|
Definition
complex topic that requires another lecture IMO
get X-ray check for open frx & CMS distally |
|
|
Term
|
Definition
proximal frx of fibula can be seen w/trauma
check distal neurologic deficits
can be seen in severe ankle external rotation injuries (Maisonneuve fracture) |
|
|
Term
| patellar dislocation/subluxation |
|
Definition
different from :knee dislocation"
freq. in kids
males=females
assoc w/osteochonral frx |
|
|
Term
| patellar sublet risk factors |
|
Definition
patella alta
laxity of ligaments
increased q angle
femoral anteversion of gnu valgum |
|
|
Term
| patellar sublux treatment |
|
Definition
sedation
reduction
post reduction x-ray/immobilize
CT & MRI in f/u if OCD or bone bruise causing gait distrubance |
|
|
Term
|
Definition
most common
MRSA
MSSA
gram neg bacilli |
|
|
Term
knee infections
special situations |
|
Definition
diabetic pediatris-salmonella
arthroplasty-S pyogenes, GroupA, B, G strep
tick bourne disease-lymes
sexually active-N Gonorrhea
Rheumatoid-TB, fungal 2 TNF inhibitor
Endemic TB area-TB |
|
|
Term
|
Definition
important to get good history
details like age, surgical history, location help refine
emperic therapy after collection of blood & joint fluid for culture |
|
|
Term
|
Definition
antibiosis
culture (joint aspiration & blood cultures)
biopsy bone-certain situations |
|
|
Term
|
Definition
| conclusion steroids are useful adjunct in the management of patients w/arthritic joints. this study shows no increased incidence of infection in patients given steroid injections prior to arthoplasty" |
|
|
Term
|
Definition
patellofemoral syndrome
instability
chondromalacia patella
plica
bursitis
tendonosis |
|
|
Term
| what percent of all this needs surgery? |
|
Definition
for patellar problems less than 10%
vast majority respond well to non-operative treatment |
|
|
Term
|
Definition
| rarely necessary for managing patellar issues |
|
|
Term
| conservative cares for knee |
|
Definition
rest
icing
NSAIDs (some argue tylenol & ice only avoiding ibuprofen & cousins)
taping
bracing |
|
|
Term
|
Definition
stretching hamstrings
strengthening medial vastus |
|
|
Term
|
Definition
lateral release (loosening)
medial repair (tightening)
tibial tuberosity transfer (U of M) |
|
|
Term
|
Definition
| C1-C7 neck problem cause neck pain and/or arm pain |
|
|
Term
|
Definition
| T1-T12 these vertebrae attach to the ribs & sternum giving this area greater stability: therefore less problems |
|
|
Term
|
Definition
| L1-L5 this section bears the majority of the body's weight therefore this are is associated w/the most spine related problems |
|
|
Term
|
Definition
| the sacrum is composed of 5 bony segments fused together 4 bones extend down from the sacrum to form the coccyx |
|
|
Term
|
Definition
spinal discs are located in between each of the vertebral bodies each disk is named according to which 2 vertebral bodies it lies between
disc are fibrocartiliginous cushions serving as the spine "shock absorbers" the discs allow for some vertebral motion. this motion includes flexion/extension as well as some rotation |
|
|
Term
|
Definition
cervical-c4-traps, rhomboids
C5- deltiods. bicpes
C6= wrist extensors
C7 triceps, wrist flexors
C8- finger flexors
T1- intrinsics |
|
|
Term
|
Definition
L1-Iliopsoas'L2- iliopsoas
L3- quads
L4-tibialis anterior
L5- EHL, gluts medius
S1- gastrocs, peronei
S2-5 rectal examination |
|
|
Term
|
Definition
0/5 no funciton
1/5 minimal contraction
2/5 moves w/ gravity eliminated
3/5 resists gravity
4/5 moves against gravity
5/5 normal strength |
|
|
Term
|
Definition
Biceps C5
brachioradialis C6
triceps C7 |
|
|
Term
|
Definition
|
|
Term
| spondylogenic causes of back pain |
|
Definition
disc degenaration
spondylolisthesis
fractures
infection
tumor |
|
|
Term
| non spondylogenic causes of back pain |
|
Definition
vasculogenic
viscerogenic
neurogenic |
|
|
Term
| pathology of disc degernation |
|
Definition
"dehydration"
nucleosis pulpolsus-desicaated
annulus fibrosis-fissures |
|
|
Term
| aggravating factros-symptomatic disc degeneration |
|
Definition
repetitive bending, lifting twisting
vibration
smoling
osteoporosis
genetic
occupational
anxiety/stress/depression |
|
|
Term
|
Definition
compression fracture
tumor
infection |
|
|
Term
|
Definition
tumor
infection
spondylolysis
Scheurman's disease |
|
|
Term
|
Definition
rare compared to adults
must be evaluated
painful scoliosis is a red flag (SCOLIOSIS IS TYPICALLY NOT PAINFUL) |
|
|
Term
|
Definition
| is characterized by pain which seems to radiate from the spine to extend outward to cause symptoms away from the source of the spinal nerve root irritation |
|
|
Term
|
Definition
is common problem that results when a nerve root is compromised or irritated
complaints vary from oain, numbness, tingling, or weakness |
|
|
Term
| Acute low back sprain/strain |
|
Definition
| a back strain usually occurs when the muscles surrounding the spine are asked to stretch too far, lift too much weight, or move in such a way that they sustain very small tears. b/c if the tearing of the muscles small microscopic bleeding occurs which in turn results in pain & muscle spams |
|
|
Term
|
Definition
diagnostic veal includes a complete & thorough history & physical exam. if readily accessible a plain radiograph (A/P & lateral) may be warranted
majority of back strains can be manages w/ a course of anti-inflammatory meeds, a brief period of rest, & then a gradual return to full activity |
|
|
Term
|
Definition
herniation describes an abnormality of the intervertebral disc that is also know as"
slipped disk
buldging disk
ruptured disk
torn disk |
|
|
Term
|
Definition
most herniations occur in age group 30-40 years
patient typically describes "sharp shooting" pain
most common location is in the lumbar spine L4-5 or L5-S1 |
|
|
Term
|
Definition
diagnosis includes a complete H&P w/ emphasis in the neurologic exam
deep tendon reflexes
specific motor group testing
sensory deficit to specific dermatome patterns-light touch and pin prick
nerve root tension sign-straight leg raise |
|
|
Term
|
Definition
| if pain is severe and/or neurologic deficit is found, advanced imaging/diagnostics is warranted: MRI, CT scan, CT mylogram, EMG |
|
|
Term
disk herniation
treatment |
|
Definition
85-90% of 1st time disk herniations will resolve w/in the 1st 3 months of onset of symptoms w/out any treatment modalities
initially treated w/short term bed rest w/gradual return to normal activites
others: PT, chiro, acupuncture, pilots, Yoga
surgical treatment is warranted when all conservative measures fail or neurologic deficit is presnt |
|
|
Term
|
Definition
| degenerative process of the spine, "arthritis of the spine" |
|
|
Term
|
Definition
| this occurs when 1 vertebrae slips forward on another |
|
|
Term
|
Definition
| defect that occurs in the posterior aspect of the spine known as the pars intraarticularis. this disorder is essentially a stress raptures in the vertebral body |
|
|
Term
|
Definition
common cause of low back pain in children
5% of the general population has this condition w/the vast majority being symptomatic
most common in football lineman & young gymnasts |
|
|
Term
|
Definition
typical sx include low back pain especially when involved in actives that place the spine in an extended position
complete H&P (BACK PAIN IN KIDS RED FLAG!!!)
dx is made w/imaging studies including:plain X-rays (oblique views) MRI scan, CT scan, bone scan |
|
|
Term
|
Definition
initial treatment is rest & possible bracing w/hopes of the fracture healing
progress into exercise w/emphasis in trunk & ab strengthening
return to normal activity |
|
|
Term
|
Definition
this occurs when 1 vertebrae slips forward on another. this produces a gradual deformity of the spine but also a narrowing of the vertebral canal
know as the "Scotty Dog" frx |
|
|
Term
| vertebral compression fracture |
|
Definition
fracture of the vertebrae causes may include osteoporosis, trauma, infection & tumors
compression frx affect 25% of postmenopausal women
only 33% of frx in elderly women are diagnosed often misdiagnosed as "arthritis" remember RED FLAGS FOR THIS POPULATION |
|
|
Term
|
Definition
presentation is an elderly female w/ acute onset of mid back pain. this may be traumatic or non traumatic
dx is typically made by plain X-ray studies. other imaging studies may include: MRI, CT, Bone scan |
|
|
Term
compression fractures
treatment |
|
Definition
majority of mild to moderate compression frx are treated w/immobiliation in a brace or corset for a period of 6-12 weeks
Surgery: balloon Kyphoplasty/vertebroplasty
surgical stabilization |
|
|
Term
metabolic bone disease:
osteoporosis |
|
Definition
compression frx; common cause of spine pain in elderly, malnutrition, those on corticosteroids, EToH abuse
sudden onset of spine pain w/out trauma
usually w/muscle spasm
increased w/standing, walking, bending
often improved w/recumbency
takes at least 3 months to heal |
|
|
Term
|
Definition
primary bone tumors are uncommon
75% of the cases, the vertebral body tumors are malignant:multiple myeloma (most common), chondroma, osteosarcoma, hemangioma
Metastatic lesion: lung, breast, & prostate are the most common
LABS: CBC, ESR, CRP |
|
|
Term
spine tumors
radiographic imaging |
|
Definition
plain x-rays
radionuclide bone scan
MRI
CT guided biopsy for diagnosis |
|
|
Term
|
Definition
means "choking" lumbar stenosis, the SPC or spinal nerve roots are compressed & this can produce sx of pain, tingling, & weakness that radiates into the buttocks & down legs
patients say sx are made worse w/standing & walking are relieved when they sit & rest
the "grocery cart" sign is tell tale |
|
|
Term
|
Definition
means "limp" typically die to peripheral vascular disease which causes lower extremity ischemia & pain in the legs
must be able to differentiate between vascular claudication& neurogenic claudication (spinal stenosis)
patient s will have pain in the lower extremities while walking/exercising & have relief of sx when they simply stop their activity |
|
|
Term
spinal stenosis
non-surgical treatment |
|
Definition
activity modification. avoid activites or motion that put the spine in extension
NASIDs or other oral analgesics
epidural steroid injections. no more than 3/calendar year
PT should consist of exercises that emphasize "flexion" type exercises & pelvic tilts |
|
|
Term
spinal stenosis
surgical treatment |
|
Definition
surgical decompression of the stenotic neuroaliments. goal is "take the pressure off the nerves"
surgical intervention for spinal stenosis is successful & rewarding |
|
|
Term
|
Definition
frx of 1 or more cervical vertebrae "broken neck" involves muscle sprain, dislocation of intervertbral disks & damage to the spinal cord
this is a medical emergency & prompt veal & treatment is essential
cervical spine injuries cause an estimated 6000 deaths & 5000 new cases of quadriplegia/year |
|
|
Term
cervical fracture
treatment |
|
Definition
immobilization of the cervical spine
various forms of diagnostic imaging X-ray, MRI, CT
minor frx may require a simple soft collar bracing w/observation
severe frx/dislocation may require halo traction & surgical stabilization |
|
|
Term
spinal potpourri
quada equina syndrome |
|
Definition
occurs when there is severe compression on the caudal equine
medical emergency requiring surgical decomppression |
|
|
Term
|
Definition
LBP, pain radiating into the legs, numbness or paralysis in the legs, saddle anesthesia, & bowel & bladder incontinence
ohysical findings: localized tenderness in the low back diminished deep tendon reflexes in the lower extremities decreased sensation to light touch in the perineal area & loss of rectal tone |
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Term
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Definition
curvature of the spine
scoliosis affects 2-3% of the population or est. 6 million US
scoliosis affects infants, kids, adults
primary age on onset is between 10-15 years
85% of the cases are classified as idiopathic |
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Term
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Definition
diagnosis made H&P plain films, if underlying neurologic cause is suspected advanced imagining, MRI scan is warranted
obtain full-spine P/A & lateral views & observe or refer to specialty clinic
guidelines: curves less than 20 degress+observe
20-40 degrees=bracing
+40 degrees= surgical correction |
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Term
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Definition
infection of the cuticle
common in poor hygiene, biting nails, pulling hang nails, pathogens S Aureus & strep epidermis (think MRSA)
bacterial superinfection of fungal onchyomycosis is poss. esp. w/pseudomonas
recurrent infection thing fungal like candida |
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Term
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Definition
oral Abx and/or surgical I&D
Marsupialization |
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Term
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Definition
infection "locked in" between fibrous septa of distal phalanx
Abscess usually confined to 1-2 septal compartments
Felon may point prior to draining spontaneously
exquisitely painful
requires I&D |
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Term
human bites
AKA Fight bites |
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Definition
commonly involve joint &/or articular surface
usually polymicrobial & require urgent surgical I&D
beware of occult extensor tendon injury |
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Term
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Definition
common organism is pasteurella multocida
rapid onset of lymphangitis is common
beware of retained foreign body (tooth fragments) |
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Term
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Definition
unclear etiology
grows out of a joint, similar to balloon on a stalk, occurs when the tissue surrounding a joint or tendon buldges out of place |
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Term
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Definition
inside the cyst is a thick sticky fluid similar to that found in joints or around tendon (synovial fluid)
cosmetic in nature
surgical excision if painful, spontaneously draining , impairing ROM, or pt elects excision
recurrent rate is 15% |
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Term
ganglion cyst
common sites |
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Definition
common areas are over dorsal scapholunate joint, the volar scapholunate joint, the DIP joint of finger & on the pulleys of the flexor tendons of the fingers
DIP joints "mucous cyst" can cause nail deformities & can spontaneously drain, leading to increased risk of infection |
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Term
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Definition
wrist ganglions used to be called "bible bums"
treatment is not likely effective & likely harmful |
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Term
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Definition
localized formation of scar tissue beneath the skin of the palm
as it progresses more fascia becomes thickened & shortened
dimpling & puckering of the skin over the area eventually occurs
the contractor causes MP joints & in later stages involves DIP joints
it is autosomal dominant condition |
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Term
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Definition
more common in men over 40 & people of northern european descent
no evidence that hand injuries or occupational exposure lead to higher risk of developing
more in diabetes, epilepsy, & alcoholism
histologically related to Peyroine's disease |
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Term
dupuytran's contracture
treatment |
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Definition
| contrastive until pt is nab;e to put hand flat on table top then surgical fasciotomy is indicated |
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Term
cubital tunnel syndrome
"truck drivers elbow" |
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Definition
caused by chronic compression of the ulnar nerve at the elbow
occasionally on occult ganglion of the elbow compresses the nerve
Hypertrophy of the flexor muscles or the triceps can increase symptoms
EMG is test of choice, but is frequently unequivocal
most distal sx are ulnar sided hand pain, parasthesias, diminished grip & pinch strength
late stage weakness of ring & small finger extensors |
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Term
cubital tunnel syndrome
"truck drivers elbow" treatment |
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Definition
| surgical decompression & "transposition" of the nerve is indicated in most cases |
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Term
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Definition
entrapment of the median nerve beneath the transverse carpal ligament
only in adults
dominant hand 1st, & more severe pain
diabetics or other metabolic disorders that affect the body's nerves more susceptible to compression are at high risk
in some cases no cause can be identified |
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Term
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Definition
combo of factors that increase pressure on the median nerve & tendons in the carpal tunnel, rather than a problem w/the nerve itself
congenital disposition, the tunnel is simply smaller than in others |
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Term
carpal tunnel syndrome
contributing factors |
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Definition
| contributing factors include trauma or injury to wrist that causes swelling, ie. sprain or fracture, over activity of the pituitary gland: hypothyroidism, RA, mechanical problems in the wrist joint work stress, repeated use of vibrating hand toss, fluid retention during pregnancy or menopause, or the development of a cat or tumor in the canal |
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Term
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Definition
women are 3x more likely than men
3x more likely among assemblers than data entry personnel
heavy up to 7hrs/day computer use did not increase risk of developing |
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Term
| dequervain's tenosynovitis |
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Definition
women 8-10x more than men
unknown cause, but overuse. blow to thumb, repetitive grasping & certain inflammatory conditions ie. RA can trigger the disease
gradening, racquet sports, & various workspace tasks may aggravate the condition |
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Term
dequervain's tenosynovitis
treatment |
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Definition
conservative, ice, rest, NSAIDs, & splinting the thumb spica splint
PT
steroid injection
poss surgical intervention |
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Term
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Definition
common injury to DIP
caused by forced flexion of the DIP joint while in extension. jamming finger, getting hit w/ball, falling on finger |
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Term
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Definition
strict splinting in full extension for 8-10 weeks
if fracture is present or pt non-compliant, refer
swan neck deformity is a potential complication of mallet finger |
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Term
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Definition
similar to mallet finger, a rupture, usually traumatic of central slip of the extensor tendon mechanism
rupture causes extensor mech to slide to side of the PIP joint-leading to flexion deformity of the PIP w/a secondary hyper-extension of the DIP joint |
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Term
boutonniere finger
treatment |
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Definition
includes strict splinting of the PIP joint in full extension for 8-10wks
permanent stiffness of the pIP joint often occurs
referral to hand surgery & occupational hand therapy indicated |
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Term
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Definition
swelling of flexor tendon unit (tendon or synovium) that doesn't allow smooth gliding through the normal pulley mech of the finger
powerful flexors pull the "knot" thru pulley, but weaker extensors can't pull back thru
finger gets stuck in flexion at the PIP joint
usually passively reducible |
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Term
trigger finger
risk factors |
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Definition
patients who routinely grip an item ie. powertool or musical instrument for extended periods of time may be more prone to develop this
pts w/RA. arthritis, diabetes, hypothyroidism, amyloidosis, & certain infections, such as TB |
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Term
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Definition
| corticosteroid injection or surgical release of the affected pulley |
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Term
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Definition
acute traumatic rupture of the FDP tendon from the DIP joint
occurs from forced flexed DIP joint
common in football players trying to grab jersey
mostly rig finger or dominant hand
surgical repair within 1 week |
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Term
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Definition
FOOSH
energy is absorbed by wrist w/fall & dictates injury sustained
DON'T forget elbow, examine FOOSH can cause radial head & elbow joint injuries |
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Term
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Definition
Colle's most common
Barton's & scaphoid frx as well as sprains
FOOSh mech can cause frx of metacarpals & phalanges |
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Term
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Definition
autoimmune disease that causes chronic inflammation of the joints (& inflammation of the tissue around the joint)
common disease, 3x women than men all races equally |
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Term
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Definition
any age but usually after 40 before 60
genetic basis
diagnostic studies include ESR, CRP, FANA &rheumatiod factor |
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Term
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Definition
| 2 classes of meds, fast-acting 1st line drugs ie. ASA, NSAIDs, or corticosteroid & slower-acting 2nd line DMARDs |
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Term
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Definition
| slower acting 2nd line ie. gold, MTX, hydroxychloroquine (Plaquenil) promote disease remission & prevent progressive joint destruction, but they are not anti-inflammatory agents |
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Term
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Definition
| newer 2nd line include ARava, Enbrel, remicade, humira these work by inhibiting TNF |
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Term
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Definition
| develops prematurely due to trauma, especially frx of the articular surface of the joint |
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Term
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Definition
| in contrast to RA which primarily affects the larger joints of the wrist & PIP joints, OA favors the smaller PIP & DIP joints |
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