Shared Flashcard Set

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Orthopedics
PA Class 2011 Clinical Medicine
63
Medical
03/14/2010

Additional Medical Flashcards

 


 

Cards

Term
Emergency Evaluation of MSK Injury
Definition

1. Assess airway - CXR immediately

2. Stabilize cervical vertebrae

3. Assess breathing w/ ABG's

4. Assess circulation

5. Survey head, cervical spine, chest, abdomen, pelvis, extremity exam

Term
Orthopedic Emergencies (5)
Definition

1. Open fractures

2. dislocated hips or spine

3. compartment syndrome

4. cauda equine syndrome

5. extremities w/ neurological or vascular compromise

Term
Initial evaluation of a fracture must include:
Definition

1. location in bone -distal, middle, proximal thirds

2. open**(compound) or closed

3. pattern- transverse, oblique, spiral, comminuted

4. displacement - minimal, partial, full

5. angulation - varus or valgus 

Term
Varus 
Definition

Inward angulation of distal segment of bone or joint 

"Bow-legged"

Term
Valgus 
Definition

Outward angulation of the distal segment of a bone or joint.

"Knock-kneed"

Term
Type I Open Fracture
Definition
Wound <1cm with no evidence of contamination
Term
Type II Open Fracture
Definition
Wound >1 cm with no evidence of soft tissue stripped from the bone.
Term
Type IIIA Open Fracture
Definition
Large wound w/ adequate soft tissue coverage of bone.
Term
Type IIIB Open Fracture
Definition
Large wound with periosteal stripping and bone exposed.
Term
Type IIIC Open Fracture
Definition
Large wound with significant arterial injury.
Term
Definition of Compartment Syndrome
Definition

-many etiologies (fractures**, trauma, burns)

-elevated pressure within a closed fascial space

-reduced tissue perfusion resulting in ischemia and necrosis

**Grade III open fracture, most common cause

Term
Clinical Presentation - Compartment Syndrome
Definition

-pain out of proportion & on passive motion

-palpably tense compartment

Later symptoms:

-paresthesia, hypoesthesia

-paralysis

-pulselessness/pallor 

Term
Most common orthopedic problems
Definition

1. Low back pain

2. Knee injury/pain

3. Shoulder

4. Foot and ankle

5. Carpel tunnel 

Term
How long after open fracture injury should pt. get to OR?
Definition
6 hours!
Term
Scaphoid Fracture Description & Management
Definition

-can be caused by falling on an outstretched hand

-often occurs in younger people

-can be missed on x-ray 

-bone may not be swollen due to low blood supply

-even if x-ray is unremarkable, is snuffbox is tender, treat as if fracture 

 

Term
Colle's Fracture
Definition

-fracture of the distal radius

-usually elderly due to fall

-causes distal fragment to displace dorsally with dorsal angulation

-carpal tunnel syndrome can accompany if medial nerve is disrupted

Tx: elderly - percutaneous pins; young pt - set with locking anatomical plates to push wrist back

Term
ORIF
Definition
-open surgery with internal fixation of structures with screws, pins etc. 
Term
Closed reduction
Definition
manipulation of a fracture without surgical incision
Term
Smith's Fracture
Definition
Distal fragment is displaced volarly; opposite of Colle's fracture 
Term
Galleazi Fracture
Definition

-short oblique or transverse fracture of the radius with associated dislocation of the distal ulna

-adults need surgery and plating for management 

Term
Hip Fractures (2)
Definition

Intertrochanteric/subtrochanteric 

Femoral head fracture 

Young pt: can be reduced and pinned

Elderly: femoral head removed, hemiarthroplasty 

Term
Lateral Malleolus fracture
Definition

-most common ankle fracture

-caused by external rotation of the foot

-boot (6 weeks) for management

Term
Calcaneous Fracture
Definition

-foot fracture of calcaneous (heel) bone

-caused by landing on heel

-appears like eggshells 

-presents w/ very swollen foot

-bleeds a lot 

Term
Hip Pain in pt. 40-50 without previous trauma or falls needs to be evaluated for...
Definition
cancer
Term
Most common metastases to bone are:
Definition
Lung, renal, thyroid, breast, prostate
Term
Evaluation of Shoulder Pain
Definition

Need to identify whether the pain is from visceral causes, nerve damage, or intrinsic shoulder problems 

-take good history (radiation, intensity, ROM, mechanism of injury)

-surface anatomy for asymmetry, atrophy, lesions

-supraspinatous and infraspinatous for atrophy

-scapular winging or muscle fasciculations 

-AP view of glenohumeral joint, possible MRI

Term
Rotator Cuff Tendonitis 
Definition

-results from repetitive overuse, acute strain, overhead sports

-presents w/ greater tuberosity tenderness

-full range of motion and good strength

-positive impingement sign (internal rotation of shoulder)

**Supraspinatous most often involved

Term
Rotator Cuff Tear
Definition

-can be from trauma, direct fall, dislocation, degenerative

-presents w/ pain and weakness in deltoid area or pos. deltoid

-positive impingement sign 

-active motion limited by weakness

-passive motion usually preserved

-weakness of external rotation against resistance

-positive "Drop-arm" test in massive tears**

Term
AC Synovitis 
Definition

-direct palpation on PE will cause pain

-swollen compared to other shoulder

-crossing arm in front of body will cause pain

Term
Glenohumeral & Rheumatoid Arthritis 
Definition
rule out on DDX for shoulder pain w/ X-rays
Term
Bicipital Tendonitis
Definition

-pain is localized to proximal humerus and shoulder joint with resisted supination of forearm aggravating pain

-pain may occur on manual flexing of elbows and palpation of tendon itself

**Yergason test used to detect instability  

Term
Bursitis of Shoulder 
Definition

-inflammation of subacromial bursa 

-shows mildest signs of pain/impingement

-active ROM is limited by pain

-positive Neer's impingement (internally rotated shoulder is moved into forward flexion) 

Term
Avascular Necrosis of Shoulder
Definition

-loss of articular surface

-in severe cases, needs treatment with shoulder replacement

-more common in hip

Term
Adhesive Capsulitis 
Definition

"Frozen shoulder"

-often spontaneous, but can follow trauma, tendonitis

-loss of passive and active ROM

-Tx: NSAIDS, injections, PT 

Term
Anterior Shoulder Dislocation
Definition

-most common type

-occurs when falling on an outstretched arm; humeral head forced into glenoid cavity 

-shoulder is extended, abducted, and externally rotated 

-on PE: humeral head prominence is lost, step-off anterior to acromion, + apprehension test

-results in recurrent instability in younger patients and older patients can have as associated acute rotator cuff tear 

Term
Posterior Shoulder Dislocation
Definition

-only small amount of cases but often missed

-PE: pt. won't be able to externally rotate arm to neutral (mechanism is that the arm is internally rotated and humeral articular surface gets stuck behind glenoid cavity)

-can happen in falls and seizures

-X-ray: Ice cream cone sign 

Term
Fracture of Radial Head
Definition

-elbow fracture

-results from a fall on outstretched hand

-tender over radial head

-pain w/ attempted rotation including supination and pronation

Term
Fracture of Olecranon
Definition

-results from fall directly on elbow 

-olecranon is very swollen 

-palpable gap 

-loss of movement 

Term
Elbow Dislocations
Definition

-common in 10-20 year olds

-most are posterior

-most due to hyperextension of joint or a valgus force (force from outside to in)

-PE: swollen and deformed 

-check neurovascular supply here as well

Term
Olecranon Bursitis
Definition

-usually from trauma, infection, inflammation

-appears as "egg sac" of fluid

-aspirate and look at fluid

-infections may help with inflammation or infections 

Term
Lateral Epicondylitis 
Definition

-"tennis elbow"

-more common in non-athletes than tennis players

-caused by strain or overuse

-PE: tender and may be swollen; pain with grip or resisted wrist dorsiflexion 


Term
Carpel Tunnel Syndrome - Epidemiology 
Definition

-most common compressive neuropathy of UE

-effects median nerve of wrist 

-females > males, ages 40-60

-results from trauma, occupational, DM, RA, thyroid disease, pregnancy, fracture


Term
Carpel Tunnel Syndrome Signs/Sx, Dx
Definition

-paresthesias in distribution of median nerve

-pain in fingers, wrist, forearm

-weakness and clumsiness

-night pain

+ Phalen's test, + Tinel's test

-loss of sensation

-thenar atrophy 

Term
Management of Carpel Tunnel
Definition

-rest

-activity modification

-splinting at work, at night

-steroid injection

-surgery 

Term
Evaluation of Knee Injury
Definition

-mechanism of injury

-locking/clicking/catching

-ability to bear weight

-ability to continue with activities

-swelling, onset of swelling

-palpation, ROM, effusion, strength, special tests

Term
Mechanism and Diagnosis of ACL Injury
Definition

-most commonly caused by non-contact twisting

-also caused by hyperextension, direct blow

Sx: hear a pop, swelling develops over hours, may have effusion

-instability w/ lateral movement 

Dx: anterior drawer tests, pivot twist test, Lachman's test

*Segung fracture is pathognomonic for ACL tear


Term
Mechanism and Diagnosis of PCL Injury
Definition

-caused by hyperextension of knee, or direct blow

-could fall onto flexed knee with plantar flexed foot

Dx: posterior drawer test, posterior sag test, dial test, quadriceps action test

Term
Mechanism and Diagnosis for MCL Injury
Definition

-valgus force to the knee (direct blow from outside)

-Grade 1: microscopic tear; pain but no laxity

-Grade 2: attenuation; detectable laxity & tenderness

-Grade 3: frank rupture; joint is grossly unstable

Dx: Valgus stress testing at 30 degree flexion and in full extension

Term
Mechanism and Diagnosis of Meniscal Injury 
Definition

-degenerative causes, more commonly medial meniscus; arthritic older people; acute usually medial

-lateral meniscus, commonly assoc. with ACL tears

-assoc. with rapid loading and twisting movements 

-swelling comes over several days

Sx: clicking, effusion

Dx: McMurray's test (make the pop come about)


Term
Plantar Fasciitis 
Definition

-strain at calcaneal insertion 

-associated with heel pain

-"heel spur" can be seen on X-ray

-caused by running, repetitive strain, overweight 

-have pt. get orthotics, stretch, NSAIDS

-takes several months to heal

Term
Metatarsalgia
Definition

-pain associated w/ overuse in the ball of foot

-especially occurs in people w/ high arches

Term
Stress Fractures
Definition

-point tenderness

-usually in 2nd or 3rd metatarsal 

-X-rays commonly negative, but can rule out neuroma

-later x-ray may show small line or callus (boney growth)

Term
Shin Splints 
Definition

-diffuse tenderness @ attachment of anterior tibialis tender to tibia, causes anterior pain

-can also occur posteriorly 

-restrict running

-NSAIDS, orthotics 

Term
Achilles Tendonitis
Definition

-occurs at insertion

-need surgery to remove osteophytes 

-stretches, NSAIDS, heel lifts can help

-takes a long time to recover

Term
Achilles Rupture
Definition

-pt. will hear pop or snap

-commonly no hx. of achilles problems

-occurs with acute plantar flexion in older individuals

-Dx: Thompson test; normally, calf squeeze would plantar flex foot, if ruptured, no movement occurs

Term
Ankle Sprain 
Definition

-usually occurs on lateral side as a result of inversion injury

-Dx: AP, lateral and mortise X-rays

**Don't miss serious fractures that present the same way

-RICE

-aircast and rehab 

Term
Neuroma
Definition

-will cause pain between the metatarsals

-X-ray will help rule this out 

-Tx: orthotics, pads, cushions 

Term
Legge-Calve Perthes Disease
Definition

-idiopathic juvenile avascular necrosis of femoral head

-most common: boys ages 4-8 (whites & smoking in home)

-painless limp followed by loss of motion

-episodic (periods of normalcy in between limps)

-PE: asymmetric rotation, flexion contracture, waddling gait

-most resolve spontaneously w/in 1-2 years 

Dx: X-ray

Term
Septic Arthritis (children)
Definition

-infection of joint space

-usually monoarticular 

-characterized as gonococcal or non-gonococcal 

-usually bacterial

-presents as painful, swollen joint, +/- fever, poor ROM

-may accompany osteoarthritis 

-urgent action needed with parenteral antibiotics, surgical drainage and/or aspiration 

Term
Scoliosis
Definition

-primary, lateral curvature of the spine

-genetic

-usually not assoc. with pain

-treatment depends on curve, skeletal maturity, risk of progression

-bracing needed is child is still growing

-surgery if severe enough curve

Term
Hip Dysplasia
Definition

-1 in 100 babies born with this

-characterized by asymmetric knee heights, abduction, and buttock creases 

-Dx: Barlow maneuver makes hip pop out; Ortolani makes it pop back in 

-causes lots of pain early in life; child can't walk or run

-if caught early, child can wear a harness to correct problem

Term
Osteomyelitis (children)
Definition

-infection of bone; progressive, inflammatory

-most often in metaphysis of long bones 

-usually result of bacteria spread from blood to bone

-acute: local pain, redness, toxemia, fever

-chronic: indolent, less specific

-Dx: X-ray; biopsy to determine causative agent 

Tx: prolonged antibiotic use; surgery for chronic 

Term
Slipped Capital Femoral Epiphysis 
Definition

-failure to close of upper femoral epiphysis allowing displacement of femoral head on neck

-onset may be acute or chronic

-may have referred knee pain

-african american children* and overweight children

-surgical emergency

-toes point out