Term
| :restriction of motion in a joint |
|
Definition
|
|
Term
| :gait which the weight is quickly removed from the affected extremity due to pain |
|
Definition
|
|
Term
| :ortho term for normal gait |
|
Definition
|
|
Term
| :surgery to restore motion and function to a joint |
|
Definition
|
|
Term
|
Definition
|
|
Term
| :extravasation of blood into a joint cavity, usually by a ligament injury or fraction |
|
Definition
|
|
Term
| :the broad vascular part of a bone near a joint |
|
Definition
|
|
Term
|
Definition
|
|
Term
| :anterior surface of the hand |
|
Definition
|
|
Term
| :inflammation involving the spinal column |
|
Definition
|
|
Term
| :slipping of the vertebra |
|
Definition
|
|
Term
| :dissolution or loosening of a vertebra |
|
Definition
|
|
Term
| :disease, degenerative of a vertebrae |
|
Definition
|
|
Term
| :injury to joint ligament or capsule |
|
Definition
|
|
Term
| :injury to muscle or tendon |
|
Definition
|
|
Term
| :hollow, abnormally high arch |
|
Definition
|
|
Term
| :curvature of the spine w/ posterior convexity |
|
Definition
|
|
Term
| :curvature of the spine w/ anterior convexity |
|
Definition
|
|
Term
| :flat, abnormally low arch |
|
Definition
|
|
Term
| :loose jointedness – “double jointed” |
|
Definition
|
|
Term
| :abnormally lateral curvature of the spine |
|
Definition
|
|
Term
| :fracture that the distal part angulates away from the midline of the body |
|
Definition
|
|
Term
| :fracture where the distal part angulates towards the midline of the body |
|
Definition
|
|
Term
| :small fracture (fx) near a joint that usually has a ligament or tendon attachment |
|
Definition
|
|
Term
| :fracture with multiple fragments |
|
Definition
|
|
Term
| :fracture not associated with an open wound to the skin |
|
Definition
|
|
Term
| :fracture whose ends are separated |
|
Definition
|
|
Term
| :fracture of the growth plate, usually long bone |
|
Definition
| Epiphyseal fracture (Salter-Harris fx) |
|
|
Term
| :incomplete fracture, usually in children |
|
Definition
|
|
Term
| Which fractures must be sent to ortho? |
|
Definition
| Open fractures, displaced intra-articular fractures, all femoral fractures and fractures involving both the tibia and fibula. |
|
|
Term
| :fracture where the ends are driven into each other |
|
Definition
|
|
Term
| :fracture that involves the joint surface of a bone |
|
Definition
|
|
Term
| :clinical condition that suggests a fracture but does not show on x-ray until 2-3 weeks after injury |
|
Definition
|
|
Term
| :fracture where there is an open wound of the skin to the fx |
|
Definition
|
|
Term
| :rotational or angular position of a fracture |
|
Definition
|
|
Term
| :amount of end-to-end contact of a fracture |
|
Definition
|
|
Term
| :when a fracture heals slower than normal |
|
Definition
|
|
Term
| :disruption in the continuity of a joint |
|
Definition
|
|
Term
| :fracture that heals in an unsatisfactory position |
|
Definition
|
|
Term
| :failure of bone healing after fracture |
|
Definition
|
|
Term
| How are x-rays usually taken with a suspected fracture? |
|
Definition
| 2 views that are 90 degree to each other, views from above and below the fracture site, and x-ray of opposite side for comparison in children or if there is confusion. |
|
|
Term
| What are CT scans best suited to visualize? MRIs? Bone scans? |
|
Definition
CT - excellent for bone visualization.
MRI - better for soft tissue.
Bone scan - good for detection of subtle bone changes. |
|
|
Term
| When should plain films be repeated after injury? |
|
Definition
| Repeat plain films 2 weeks after injury. |
|
|
Term
| :fracture that proceeds directly across the bone |
|
Definition
|
|
Term
| :fracture that proceeds across the bone in a diagonal fashion |
|
Definition
|
|
Term
| :fracture due to limb torsion |
|
Definition
|
|
Term
| :fracture that isolates a central segment from the blood supply |
|
Definition
|
|
Term
| :fracture through the epiphyseal plate (physis) causing sliding |
|
Definition
|
|
Term
| :epiphyseal plate (physis) fracture with associated metaphyseal fracture |
|
Definition
|
|
Term
| :epiphyseal plate (physis) fracture that has an assoicated epiphyseal fracture |
|
Definition
|
|
Term
| :epiphyseal plate (physis) fracture that includes epiphyseal and metaphyseal fracture |
|
Definition
|
|
Term
| :epiphyseal plate (physis) crush or impaction fracture |
|
Definition
|
|
Term
| What are the 4 most commonly missed fractures? |
|
Definition
| Scaphoid, talar neck, radial head and tibial plateau. |
|
|
Term
| What nerve injuries are associated with closed fractures? Open fractures? |
|
Definition
Closed fractures = nerve contusion or crush (complete recovery).
Open fractures = nerve transection (usually permanent neurological damage). |
|
|
Term
| How long does it take for type 1 (contusion), type 2(crush) and type 3(transection) nerve injuyries to recover? |
|
Definition
Type 1 = 2-3 months.
Type 2 = 95% by 6 months (2cm/month).
Type 3 = may not ever recover. |
|
|
Term
| What is a common complication of a spiral fracture of the humerus? |
|
Definition
| Radial nerve injury leading to wrist drop. |
|
|
Term
| What is a common complication of a fracture to the neck of the fibula? |
|
Definition
| Peroneal nerve injury leading to foot drop. |
|
|
Term
| Describe the initial care (as scene) for immobilization and fracture reduction of a fracture. How long can field splints be used? |
|
Definition
| Reduction refers to putting the bone back where it is supposed to be before splinting. Then splint the fracture above and below the fracture site before transporting. Elevate the extremity above the level of the heart and use ice to control the swelling. Field splints should be used for only a few hours max. |
|
|
Term
| What is external fixation of a fracture? Internal? |
|
Definition
External = holes are drilled into uninjured parts of the bone on opposite ends of a fracture and bolts are put in the bone and are connected externally by a piece of metal and are incorporated into a cast.
Internal = Fractured bone is supported by inserted mechanical devices such as metal plates, pins, rods, wires or screws. |
|
|
Term
| What are the benefits of internal fixation? |
|
Definition
| Useful in weight bearing joints, fractures that cannot be reduced, and to allow earlier activity. |
|
|
Term
| What is the purpose of continuous traction? |
|
Definition
| It allows alignment and maintains reduction. |
|
|
Term
| What is a closed reduction of a fracture? |
|
Definition
| It is a procedure for setting a broken bone without making an incision (cut) in the skin. |
|
|
Term
| Describe the closed reduction technique used in epiphyseal, transverse and oblique fractures. |
|
Definition
Epiphyseal = the distal fracture is pushed back into place.
Transverse = reduced by simple traction.
Oblique = requires complex manipulation. |
|
|
Term
| Who can administer closed reduction? |
|
Definition
| Only trained and credentialed providers. |
|
|
Term
| What will prevent overreduction in closed reduction techniques? |
|
Definition
|
|
Term
| What types of deformities always need to be adequately reduced? What kind of deformity can correct itself in children due to growth spurts? |
|
Definition
| Rotational in any age and angular deformities in adults. Angular deformities can self-correct in children if sufficient growth remains. |
|
|
Term
| Do you always need perfect apposition for normal healing? |
|
Definition
| No, only weight bearing joints require exact reduction. |
|
|
Term
| What is the advantage of plaster casts and fiberglass casts? What causes them both to set faster? |
|
Definition
| Plaster casts are easier to apply and fiberglass are lighter weight. The warmer the water the faster it sets. |
|
|
Term
| When do you splint vs. cast? |
|
Definition
| Splint in the beginning until swelling subsides and then cast for long term. |
|
|
Term
| What is involved in the aftercare of long and short arm splints/casts? |
|
Definition
| Keep extremity elevated above the heard and apply ice for 48-72 hours, watch for compartment syndrome, Volkmann's ischemic contracture (due to too tight of a cast) and if pain subsides (tissue necrosis). |
|
|
Term
| How long does it take to regain strength after removal of a long/short arm cast? How long before you can return to sports? |
|
Definition
Strength = 4-6 weeks.
Can return to sports in 2 months. |
|
|
Term
| What are some considerations that should be taken into account when long and short arm splinting/casting? What degree should the elbow be casted? |
|
Definition
The cast should not extend beyond the distal palmer creases and the MCP joint should be able to completely flex and fan their fingers.
Elbows should be casted at 90 degrees. |
|
|
Term
| What degree is the ankle casted? Knee? |
|
Definition
Ankle is casted at 90 degrees.
Knee is casted at 30 degrees. |
|
|
Term
| Describe some of the characteristics of proper casting in regards to the roll and overlap of each turn. |
|
Definition
| The roll should remain in contact with the limb as you roll it and there should be a 50% overlap with each turn. |
|
|
Term
| Can you x-ray through fiberglass and plaster casts? Should you x-ray a fracture before you remove a cast? |
|
Definition
| Yes, you can x-ray through both. You should x-ray before you remove a cast to protect yourself. |
|
|
Term
| Describe the technique with cast sawing? |
|
Definition
| You pick up and move the saw as it cuts through the cast. You do not move it as you saw. |
|
|
Term
| Will a fracture of the midshaft in children realign naturally? What about a bayonet apposition in the long bones in children? |
|
Definition
Nope.
Bayonet apposition may heal naturally. |
|
|
Term
| What is a tender growth plate until proven otherwise? How many days do you have before a growth plate fracture can no longer be manipulated without damage to the growth plate? |
|
Definition
It is a fracture until proven otherwise.
Malposition may not be correctable after 7-10 days. Manipulate at this point may damage growth plate |
|
|
Term
| :acute infection of bone or bone marrow |
|
Definition
|
|
Term
| What is the most common site of acute Osteomyelitis? |
|
Definition
| Metaphyseal end of a long bone near the knee joint. |
|
|
Term
| What is the most common pathogen of acute osteomyelitis? |
|
Definition
|
|
Term
| How long does it take for acute osteomyelitis to show up on x-ray? What test can detect it earlier? |
|
Definition
Can take up to 2-4 weeks in adults for x-ray.
Bone scan can detect it earlier. |
|
|
Term
|
Definition
| It is TB of the spine that leads to fractures. |
|
|
Term
| What is the typical first Sx seen with acute osteomyelitis? |
|
Definition
| Decrease in joint mobility. |
|
|
Term
| What is the treatment for acute osteomyelitis? |
|
Definition
| IV antibiotics for 5 days, then oral antibiotics for 4-6 weeks. |
|
|
Term
| Describe grades 0-5 of diabetic foot ulcers and the treatment for each grade. |
|
Definition
0 = No open lesion.
1 = Superficial ulcer affecting only the skin. Tx = outpatient dressing changes and would care.
2 = Deep ulcer taht involves the underlying tendons, bones or ligaments. Tx = surgical debridement and IV antibiotics.
3 = Abscess that reaches the bone. Tx = Emergency drainage of infection where the wound is left open with dressing and is closed or amputated later.
4 = Gangrene present in the toes and forefoot. Tx = amputation.
5 = Gangrene of the entire foot. Tx = amputation. |
|
|
Term
| What is the most common cause of chronic osteomyelitis? What are the cellular changes and how does it appear on x-ray? |
|
Definition
MCC = an open fracture.
It has dead bone that is surrounded by a shell of new bone, appears on x-ray as sclerotic bone with several areas of radiolucentcy. |
|
|
Term
| What is the treatment for chronic osteomyelitis? Preventative measures? |
|
Definition
Tx = I&D, radical debridement and antibiotics for 4-6 weeks.
Prevention = clean any open fractures. |
|
|
Term
| Describe the Jones Criteria for ARF. |
|
Definition
Need a positive group A strep culture plus 2 major or 1 major and 2 minor.
Major = carditis, polyarthritis, chorea, erythema marginatum and SQ nodules.
Minor = arthralgia, fever, prolonged PR interval and elevated ESR/CRP. |
|
|
Term
| What joints are most commonly affected by septic arthritis? What is the most common pathogen in adults? Children? IV drug users? |
|
Definition
MC joint = knee or hip.
MC pathogen in adults = S. aureus.
MC pathogen in children = H. flu.
MC pathogen in IV drug users = Gram negative rods. |
|
|
Term
| How is septic arthritis seen on x-ray? CBC? What is the definitive test and how does it look? |
|
Definition
X-ray = distention of joint capsule.
CBC = markedly elevated WBC.
Definitive test = Joint aspiration (fluid appears cloudy, purulent, decreased glucose and increased WBC count) |
|
|
Term
| What is the treatment for Septic Arthritis? |
|
Definition
| Ortho referral and IV antibiotics. |
|
|
Term
| What are the major differences between regular septic arthritis and Gonococcal (N. gonorrhoeae) Septic Arthritis? How do you treat gonococcal septic arthritis? |
|
Definition
Regular septic arthritis is usually monoarticular and Gonococcal septic arthritis is usually polyarticular and has symptoms of tenosynovitis (inflammation of the lining of the sheath that surrounds a tendon) and dermatitis.
Tx = antibiotics (Rocefen) and NSAIDs. |
|
|
Term
| What is the most common benign bone tumor? What are the most common sites of this tumor? |
|
Definition
Osteochondroma.
MC site = metaphysis of the distal femur or proximal tibia. |
|
|
Term
| :benign tumor that is the most common tumor of the hand and usually affects the small bones of the hands or feet. |
|
Definition
|
|
Term
| :most common soft tissue mass of the hand that is found most commonly on the dorsum of the hand adjacent to the joint of tendon sheath. |
|
Definition
|
|
Term
| What is the treatment of a ganglion cyst? |
|
Definition
Tx = Aspirate with 18 gauge needle and compression for 48-72 hours, steroid injections or excision.
40-50% may resolve spontaneously. |
|
|
Term
| :malignant tumor that most commonly originate in the metaphysis around the knee in 10-20 year olds and may be associated with Paget's disease. |
|
Definition
|
|
Term
| :Bone disorder w/ repeated episodes of bone destruction and excessive bone repair most commonly affecting the hips, pelvis and spine and is characterized by pain, bowing of the long bones, pathologic fractures and skull enlargement. |
|
Definition
|
|
Term
| :malignant bone cancer of the midshaft of a long bone most commonly affecting 10-15 year olds and characterized by painful soft tissue mass, weight loss, fever and lethargy |
|
Definition
|
|
Term
| What are the bony landmark levels of the mandible, hyoid bone, thyroid cartilage and 1st cricoid ring? |
|
Definition
Mandible = C2.
Hyoid = C3.
Thyroid = C4-5.
1st cricoid ring - C6. |
|
|
Term
| What are the nerve roots that make up the Brachial Plexus? |
|
Definition
|
|
Term
| What brachial plexus cord leads to the musculocutaneous nerve? Axillary nerve? Radial nerve? Median nerve? Ulnar nerve? |
|
Definition
Musculocutaneous N. – from lateral. cord
Axillary N. – from posterior cord.
Radial N. – from posterior cord.
Median N. – from medial & lateral cord.
Ulnar N. – from medial cord. |
|
|
Term
| Describe where you find C6-T1 dermatomes on the posterior and anterior arm. |
|
Definition
Anterior - C6 is the lateral forearm and first 2 digits. C7 is the middle finger. C8 is the medial forearm and 4th/5th digits. T1 is the medial elbow area.
Posterior - C6 is the lateral forearm and 1st/2nd digits. C7 is the middle finger. C8 is the medial forearm and 4th/5th digits. T1 is the medial elbow area. |
|
|
Term
| What tests are involved with neurologic testing? |
|
Definition
| Motor strength testing, reflex testing, light sensation, sharp/dull discrimination, vibratory sensation and 2 point discrimination. |
|
|
Term
| Which muscles and reflexes are tested at the C5 neurologic level? |
|
Definition
Deltoid and biceps muscles.
Biceps reflex. |
|
|
Term
| Which muscles and reflexes are tested at the C6 neurologic level? |
|
Definition
Biceps and wrist extensor muscles.
Branchioradialis reflex. |
|
|
Term
| Which muscles and reflexes are tested at the C7 neurologic level? |
|
Definition
Triceps, wrist flexor and finger extensor muscles.
Triceps reflex. |
|
|
Term
| Which muscles and reflexes are tested at the C8 neurologic level? |
|
Definition
Interossei and finger flexor muscles.
No reflexes. |
|
|
Term
| Which muscles and reflexes are tested at the T1 neurologic level? |
|
Definition
Interossei muscles.
No reflex. |
|
|
Term
| Describe the distraction test in examination of the spine. |
|
Definition
| Decompression of vertebrae to see if symptoms are resolved. |
|
|
Term
| Describe the compression test of spinal examination. |
|
Definition
| Push straight down on the head and see if symptoms are increased. |
|
|
Term
| Describe Spurling's test of spinal examination. |
|
Definition
| Head is tilted towards the effected side and you push down to see if the symptoms are increased. |
|
|
Term
|
Definition
| Used to test the vascular system. Find the radial pulse and then abduct and move the arm posterior, then rotate the head towards the affected side. If they pulse disappears, that is a positive test. |
|
|
Term
| What are the S&S of Torticollis? |
|
Definition
| Tilting of the head to one side, decreased neck ROM, neck pain, vertigo. |
|
|
Term
| What are the 2 etiologies of Torticollis? |
|
Definition
Spasmodic torticollis - muscle or nerve.
Torticollis - skeletal dysplasias. |
|
|
Term
| What are the treatment options for Torticollis? |
|
Definition
| PT (stretching), soft or hard collar (keep head in position and stretch SCM), NSAIDs, and possible surgery to release the SCM or fuse C1-C2. |
|
|
Term
| What are the S&S of Fibromyalgia syndrome? |
|
Definition
| Pain at trigger points, insidious onset, chronic headache, depression, decreased social interaction, pain increases in the morning, with weather changes, anxiety, stress or decreased sleep, and pain is improved with PT and decreased stress, . |
|
|
Term
| What are the treatment options for Fibromyalgia Syndrome? |
|
Definition
| Hot packs, NSAIDs, stress management, PT, increased social interaction, sleep and Rheumatology/Psych consult. |
|
|
Term
| How is a Herniated Cervical Disc seen on PE? |
|
Definition
| Positive Spurling's test (Head is tilted towards the effected side and you push down to see if the symptoms are increased), possible positive Babinski's reflex, decreased sensation and decreased reflexes. |
|
|
Term
| What plain film views should you order with a possible herniated disc? What imaging study shows the disc bulge? |
|
Definition
Plan film: AP, lateral, oblique, flexion, extension views.
MRI: disc bulge. |
|
|
Term
| What are the treatment options for a herniated disc? |
|
Definition
| PT (traction and exercise), NSAIDs, muscle relaxants, rest and possible surgery. |
|
|
Term
| What is the cause of whiplash? What is a sprain vs a strain? |
|
Definition
Hyperextension of the neck followed by flexion.
Sprain = ligaments.
Strain = muscles/tendons. |
|
|
Term
| What are the S&S of a cervical sprain/strain (whiplash)? |
|
Definition
| S&S = neck pain, headache, dysphagia, hoarseness, hemorrhage, edema, tinnitus, blurred vision and dizziness. |
|
|
Term
| What should be the next step if someone was in a MVA and complains of dysphagia and hoarseness? |
|
Definition
| Order an MRI to evaluate the soft tissue of the neck. |
|
|
Term
| What images should be ordered for a cervical sprain/strain (whiplash)? |
|
Definition
Plain film: AP, Full lateral, open mouth (C1 & C2), swimmer’s view (C7) (must see all the cervical vertebrae) – R/O fracture.
CT/bone scan – R/O fracture.
MRI – not indicated for vertebrae fracture. |
|
|
Term
| What are the treatment options for a cervical sprain/strain? |
|
Definition
| Rest, soft collar, NSAIDs, muscle relaxants, ice x48 hours then heat, ROM exercises and PT consult. |
|
|
Term
| Describe a C2 Type I-III and Hangmans' fracture? Which is most common? |
|
Definition
C2 Type I Fx = tip of the odontoid.
C2 Type II Fx = base of the odontoid.
C2 Type III Fx = body of the axis.
Hangmans' Fx = neural arch (posterior arch). |
|
|
Term
| What is the treatment for a cervical fracture? |
|
Definition
| Cervical collar and emergency ortho consult. |
|
|
Term
| What are the S&S, PE findings and imaging tests to order for cervical osteoarthritis? |
|
Definition
S&S = neck pain with movement, stiffness and loss of function.
PE = decreased ROM, joint effusion and deformity.
Imaging = AP/lateral x-rays and MRI to r/o neoplasm. |
|
|
Term
| How do you treat cervical osteoarthritis? |
|
Definition
| NSAIDs, PT(ROM exercises), and ortho/neuro consult. |
|
|
Term
| What are the S&S, imaging studies ordered, and treatment for cervical stenosis? |
|
Definition
S&S = calcium buildup on vertebrae leading to neck/UE pain and decreased ROM.
Imaging = AP and lateral x-rays.
Tx = PT (ROM exercises) and ortho/neuro consult. |
|
|
Term
| What are some causes of atraumatic C-spine dislocation? S&S? Best imaging views? Tx? |
|
Definition
Atraumatic causes = RA and Down's syndrome.
S&S = neck pain after trauma and muscle parasthesias.
Best views = AP and lateral.
Tx = cervical collar and emergency ortho/neuro consult. |
|
|
Term
| Which muscles and reflexes are tested at the L4 neurologic level? |
|
Definition
Tibialis anterior muscle.
Patellar reflex. |
|
|
Term
| Which muscles and reflexes are tested at the L5 neurologic level? |
|
Definition
Extensor hallucis longus muscle.
Reflexes = none. |
|
|
Term
| Which muscles and reflexes are tested at the S1 neurologic level? |
|
Definition
Peroneus longus and brevis muscles.
Achilles tendon reflex. |
|
|
Term
| Describe where you find L4-S1 dermatomes on the anterior leg and S1-S2 of the posterior leg. |
|
Definition
Anterior leg = L4 is the medial lower leg, L5 is the anterior lower leg and 1st-3rd digits, S1 is the lateral foot and 4th/5th digit.
Posterior = S1 is the lateral and posterior lower leg and S2 is the medial lower leg and posterior upper leg. |
|
|
Term
| What are the treatment options for back pain? |
|
Definition
| Rest, heat, NSAIDs x 4-6 weeks (drug of choice), muscle relaxers, PT, and lifting/back care training. |
|
|
Term
| What are Waddell's signs of back pain? |
|
Definition
| Nonanatomic weakness, nonanatomic sensory disturbances, superficial tenderness, nonanatomic tenderness, inconsistent test findings when distracted, pain on simulation stress test, and overreaction. |
|
|
Term
| What does the TUNAFISH acronym of red flags for back pain stand for? |
|
Definition
Trauma
Unexplained wt loss of night sweats
Neurological signs
Age over 50
Fever
IV drug use
Steroid use
Hx of cancer |
|
|
Term
| What is the Cauda Equina Syndrome? |
|
Definition
| A surgical emergency due to spinal cord compression. Characterized by low back pain, bowel/bladder incontinence and saddle anesthesia. |
|
|
Term
| What is Brown-Sequard's Syndrome? S&S? |
|
Definition
Emergency spinal cord compression characterized by an injury to half of the spinal cord.
S&S = low back pain, loss of motor function and sensation on the affected side and loss of sharp touch and temperature on the opposite side. |
|
|
Term
| What is the normal kyphotic curve range for thoracic vertebrae? What are some characteristics of kyphosis on x-ray? What are the treatments of kyphosis based on the angle? |
|
Definition
Nl = 20-49 degrees.
Characteristics = flattened discs, thickened anterior longitudinal ligament, wedged vertebral bodies and Risser's sign (calcification of the iliac crest).
Tx for 50-70 degrees = exercise and stretching with use of a back brace.
Tx for over 70 degrees = surgery. |
|
|
Term
| What are the treatments for scoliosis based on the degree of rotation? |
|
Definition
10-25 degrees = PT and monitor.
25-45 degrees = Brace and PT.
Over 45 degrees = Surgery and PT. |
|
|
Term
| Which test confirms the diagnosis of a herniated disc? |
|
Definition
|
|
Term
| How do you treat a herniated disc? |
|
Definition
| Rest, NSAIDs, muscle relaxants, PT, epidural steroids and surgery if pain persists longer than 6 weeks. |
|
|
Term
| Describe grades O-V for Spondylolisthesis. |
|
Definition
Grade 0 = 0% slipped.
Grade I = <25% slipped.
Grade II = 25-50% slipped.
Grade III = 51-75% slipped.
Grade IV = 76-99% slipped.
Grade V = complete displacement. |
|
|
Term
| Which plain films are used to see Spondylolisthesis? How does it appear on oblique films? |
|
Definition
| AP, lateral, oblique, flexion and extension. Oblique shows "Scotty dogs" with fractures through their necks. |
|
|
Term
| What are the S&S seen with Ankylosing Spondylitis? |
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Definition
| Pain longer than 3 months, occurs in the hips or buttocks first, morning pain that improves with exercise, fatigue and kyphosis. |
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Term
| What lab findings will be present with Ankylosing Spondylitis? Plain film findings? Treatment? |
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Definition
Labs = elevated ESR and positive HLA-B27.
Imaging = "Bamboo spine".
Treatment = Rheumatology consult, PT, diet and Indomethacin (NSAID). |
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Term
| What imaging studies should be ordered with spinal stenosis? What is the treatment? |
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Definition
AP and lateral plain film and a CT myelography to evaluate the spinal cord.
Tx = brace and ortho referral. |
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Term
| What are the S&S of Osteoarthritis (DJD)? Which films should be ordered? Treatment? |
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Definition
S&S = pain with weight bearing or joint motion, joint stiffness and loss of function.
Images = AP and lateral plain films.
Tx = NSAIDs, PT and surgery. |
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Term
| What imaging study is used to diagnose osteoporosis? What are the treatment options? |
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Definition
Imaging = DXA scan.
Tx = calcium/vit D supplements, estrogen, calcitonin and Bisphosphonates. |
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Term
| What is the action and innervation of the Rotator Cuff muscles? |
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Definition
Supraspinatus = Abduction (C5-C6).
Infraspinatus = External rotation (C5-C6).
Teres minor = External rotation (C5).
Subscapular = Internal rotation (C5-C6). |
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Term
| Which muscle is tested in the Empty Can (Jobe) test? |
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Definition
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Term
| What is the Neer Impingment Test? |
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Definition
| The examiner performs maximal passive forward flexion with internal rotation while stabilizing the scapula. A positive test elicits pain on the acromion process or sub-acromial space. |
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Term
| What is the Hawkins-Kennedy Impingement Test? |
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Definition
| The patient is examined in sitting with their arm at 90° and their elbow flexed to 90°, supported by the examiner to ensure maximal relaxation. The examiner then stabilises proximal to the elbow with their outside hand and with the other holds just proximal to the patient's wrist. They then quickly move the arm into internal rotation. Positive test is when there is pain elicited in the sub-acromial space. |
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Term
| What is the Anterior Apprehension Test? |
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Definition
| The problem shoulder of a supine or sitting patient is passively abducted and rotated then fully stressed, while the examiner studies the patient's face for apprehension and examines the shoulder muscle for muscle spasm. |
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Term
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Definition
| a diagnostic test for a tear in the supraspinatus tendon. The result is positive if the patient is unable to lower the affected arm slowly and smoothly from a position of 90 degrees of abduction. |
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Term
| What are the imaging studies and sensitivities used to diagnose rotator cuff tears? |
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Definition
MRI - 95% sensitive for partial/full thickness tears.
US - 91% sensitive for full thickness tears.
Arthrography - 99% sensitive for full thickness but useless for partial thickness tears. |
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Term
| Which tendon is most commonly affected with calcific tendonitis? Cause? Treatment? |
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Definition
MC tendon is supraspinatus tendon due to microtears, common in weight lifters.
Tx = Rest, decrease weights, NSAIDs and ortho consult. |
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Term
| :tendonitis characterized by pain in the antero-lateral aspect of the shoulder |
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Definition
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Term
| How do you treat bicipital tendonitis? |
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Definition
| Tx = Rest, ROM, heat, NSAIDs, or ortho referral for steroid injection or surgery. |
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Term
| What are the S&S of Adhesive Capsulitis (frozen shoulder)? What is the treatment? |
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Definition
Loss of internal rotation (hallmark), decreased overall ROM, pain and deltoid/spinatus atrophy.
Tx = PT, steroid injections and ortho consult. |
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Term
| Describe grade I-IV AC separation. |
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Definition
I - Strain to ligament, but no displacement.
II - Torn AC ligament but intact coracoclavicular ligament (clavicle is mildly displaced upward).
III - disruption of all ligaments w/ full dislocation.
IV - disruption to all ligaments w/ full dislocation w/ deltoid & trapezius disruption. |
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Term
| What are the S&S of an AC separation? What is the treatment for an AC separation? |
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Definition
S&S = sagging scapula, lateral clavicular tenderness, and painful shoulder movement.
Tx =
Grade I-III = NSAIDs, arm sling, PT and no sports for 6 weeks.
Grade IV = Ortho referral for surgery. |
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Term
| What is the most common type of shoulder dislocation? |
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Definition
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Term
| What is the diagnostic imaging test for shoulder dislocations? S&S? Treatment? |
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Definition
Imaging = scapular Y view.
S&S = severe pain w/ movement, middle deltoid numbness and a possitive apprehension test.
Tx = send to ortho for reduction. |
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Term
| Which imaging techniques are utilized for shoulder fractures? Treatment? |
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Definition
Images = Plain films - AP, lateral and scapular Y-view and CT scan.
Tx = Send to ortho for surgery. |
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Term
| What is the treatment for a clavicular fracture? How long does it need to be protected in children and adults? |
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Definition
| Ortho referral and protect the clavicle for 4-6 weeks in children and 8 weeks in adults. |
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Term
| What tests can be used to detect thoracic outlet syndrome? Treatment? |
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Definition
Adson test - turn your head toward the symptomatic shoulder while you extend your arm, neck and shoulder slightly away from your body. While you inhale, your doctor will check for a pulse on the wrist of your extended arm. If your pulse is diminished or if your symptoms are reproduced during the maneuver, your doctor considers this a positive test result, which may indicate thoracic outlet syndrome.
Roos test - hold both elbows at shoulder height while pushing your shoulders back. You will then repeatedly open and close your hands for several minutes. If your symptoms are present after the test, or if you feel heaviness and fatigue in your shoulders, this can indicate the presence of thoracic outlet syndrome. Halstead test - In a seated position, palpate the radial pulse, and then pull traction on the patient’s arm downward while the patient extends their head backwards. A positive test is the reproduction of symptoms such as paresthesias which indicates thoracic outlet syndrome.
Tx = vascular surgery consult. |
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Term
| What is the treatment regimen for a humeral fracture? Do these typically need surgery? |
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Definition
Ice, closed reduction, sugar tong splint, sling, NSAIDs and ortho consult.
Most are managed non-operatively. |
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Term
| What is Medial Epicondylitis? S&S? Tx? |
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Definition
It is little league or golfer's elbow.
S&S = medial elbow pain, usually the dominant arm, may or may not have swelling and there is a hx of repetitive use.
Tx = splint for 1-2 weeks w/ severe pain, rest for 4-6 weeks, NSAIDs, PT after 6 weeks of rest and occasional steroid injections. |
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Term
| What is lateral epicondylitis? S&S? Tx? |
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Definition
It is tennis elbow.
S&S = aching, burning pain in the lateral elbow that is increased with activity and decreased with rest.
Tx = counterforce brace, rest, ice, NSAIDs, PT and steroid injections occasionally. |
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Term
| What are the S&S of Olecranon Bursitis? Tx? |
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Definition
S&S = fluxuant SQ tissue over the olecranon with full range of motion.
Tx = aspirate fluid and give antibiotics if infected. |
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Term
What is the etiology of Nursemaid's elbow?
How do you treat it? |
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Definition
Etiology = a pulled elbow causing the annular ligament to become entrapped between the radial head and the humerus.
Tx = the way the arm has to be situated for x-ray usually reduces it (supinate hand & then flex it to the shoulder). |
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Term
| How do you treat an elbow fracture? |
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Definition
| sling or sling w/ posterior splint for 7-10 days, ice, NSAIDs, PT and ortho referral for surgery if there is any neuro/vascular compromise. |
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Term
| What does a fat pad/sail sign usually indicate in adults? Children? |
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Definition
| It will hide fractures on x-ray but it is usually indicative of a subtle radial head fracture in adults and a supracondylar fracture of the humerus in children. |
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Term
| What is a Monteggia fracture? What is the treatment in children? Adults? |
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Definition
It is a fracture to the proximal 1/3 of the ulna and dislocation of the radial head.
Tx in children = closed reduction.
Tx in adults = open reduction w/ internal fixation. |
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Term
| What causes a gunstock deformity? |
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Definition
| An old fracture of the distal humeral epicondyle that healed with malunion. |
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Term
| What is a Galeazzi fracture? |
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Definition
| Fracture to the distal 1/3 of the radius. |
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Term
| Describe a Colle's fracture. Tx? |
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Definition
Distal radius fracture with dorsal displacement of the radial head (posterior displacement) due to falling on an outstretched hand. AKA "silver-fork deformity".
Tx = Cast for 6 weeks, ice and follow up in 1-2 weeks to repeat x-ray due to an occasional loss of reduction. |
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Term
| What is a Smith's fracture? |
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Definition
| Opposite of a Colles fracture. Distal radial head fractures anteriorly, seen with falling on a hand in flexion. |
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Term
| Describe DeQuervain's Tenosynovitis. What test is good for confirming? Treatment options? |
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Definition
It is a common repetitive use injury seen commonly in racquetball, fly fishing, golf, horseback riding and mail sorting. It has characteristic pain/tenderness to the posterior lateral aspect (radial) of the wrist. It will have a positive Finkelstein's test (make a fist with thumb tucked and medially deviate).
Tx = thumb spica splint, rest, NSAIDs, ice, possible steroid injection and possible surgery. |
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Term
Which nerve is affected in Carpal Tunnel Syndrome? Which positive tests are indicative of Carpal Tunnel Syndrome? What other condition can lead to these tests being positive?
Tx? |
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Definition
The median nerve distribution is affected.
It will have a positive Tinel's sign (tap over the median nerve with a bent hand posteriorly) and a positive Phalen's test (posterior aspects of hands are pressed against each other and held for 1 minute). They can also be positive with a bone spur in the cervical vertebrae.
Tx = occupational therapy consult, cock-up wrist splint, NSAIDs, and ortho referral for possible steroid injection or surgical release. |
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Term
| Which anatomical site is tender with a scaphoid fracture? What imaging study is good for showing am acute phase scaphoid fracture? |
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Definition
| Anatomical "snuffbox" is tender and a bone scan is a good test to see the fracture in the acute phase. |
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Term
| What is the S&S of a Game Keeper's Thumb (Skier's thumb)? Treatment options? |
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Definition
S&S = thumb pain, decreased ROM and possible neurovascular compromise.
Tx = closed reduction or possible surgery. |
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Term
| What is a Boxer's fracture? What are the treatment options? |
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Definition
It is a fracture to the distal aspect of the 5th metacarpal head.
Tx = closed or open reduction and an ulnar gutter cast. |
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Term
| Describe the Boutonniere deformity? |
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Definition
| The PIP joint is stuck in flexion and the DIP joint is stuck in extension. |
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Term
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Definition
| The DIP joint is flexed and is unable to extend. |
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Term
| What are the treatment options for a finger fracture that is undisplaced or displaced? |
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Definition
| Give NSAIDs, ice and occupational therapy consult. Undisplaced can be buddy taped to neighboring finger. Displaced needs to be sent to a hand surgeon. |
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Term
| What is Trigger Finger? What is the treatment? |
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Definition
Painful locking or snapping of the finger with extension caused by a nodule that moves under the palmar crease in a straight finger and causes the finger to be stuck in flexion or extension.
Tx = steroid injection into the tendon sheath and possible surgical release. |
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Term
| What is Dupuytren's Contracture? What positive test is indicative of this? |
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Definition
| It is painful nodules common in the 4th and 5th digits, often bilaterally, characterized by web space contracture and a positive Hueston's table top test (cannnot put hand flat on the table with palmer aspect down). |
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Term
| What is Ehlers-Danlos Syndrome? Tx? |
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Definition
Genetic disorder characterized by connective tissue laxity, joint instability and scoliosis.
Treatment = PT for muscle training and cardiology referral to check for possible aneurysm. |
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Term
| What is a Felon vs a Paronychia? What is the treatment? |
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Definition
Felon is an infection of the distal phalanx. Paronychia is an infection of the nail.
Both are treated with a digital block, I&D and antibiotics. |
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Term
| What is the treatment for a bite? |
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Definition
| Irrigate copious normal saline, augmentin for 7-10 days and do not suture bites. |
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Term
| What is Reflex Sympathetic Dystrophy? Describe the Acute Phase vs the dystrophic/atrophic phase? How do you treat it? |
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Definition
Persistent burning pain after an injury that is out of proportion to the injury.
Acute = 6-12 weeks characterized by pain and hypersensitivity.
Dystrophic/Atrophic = joint becomes restricted, cool and muscle starts to atrophy.
Tx = difficult to treat, send to ortho if pain is high after injury. |
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Term
| :dead bone surrounded by a shell of new bone |
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Definition
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