Periosteal Tears, Stress Fx

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Author:
agatton
ID:
11272
Filename:
Periosteal Tears, Stress Fx
Updated:
2010-03-27 18:20:42
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General Orthopedics OP
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OP study cards
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  1. Definition + Etiology
    Microfractures in normam bone caused by overuse and repetitive actions. Can be caused by redistributing of impact force through a focal oint of bone, or by the pull of MM on a bone.

    • High physical fitness
    • Hard training surface, poor shoe choice
    • Excessive pronation, mid/forefoot hypomobility or rigid cavus arch
    • + amenorrheeic women
  2. CIs and Precautions
    • NSAIDs =bad for bone healing
    • Frictions/extreme hydro if inflamed
    • Early return to full activity
  3. S&S
    • Local pain and tenderness over Fx site - Horizontal orientation
    • Gradual onset of pain (often exercise not redused)
    • Initially, pain during activity, reduced when stopped
    • Pain increases during activity, more deep+constant, eventually at rest and at night
    • Pain increased w/ weight bearing (downhill run, deccelaration)
  4. H
    • Nature and behavior of pain
    • Changes in exercise, shoes, other physical stress activities
    • Health, diet, menstruation
  5. O
    • Local swelling
    • Erythema, foot biomechanics, lower leg, knee
  6. P
    • Tenderness (often severe) on deep pressure to bony surface a couple cm both above and below site
    • No pain a few cm away
    • Pain on superficial/moderate pressure on site of suspected Fx
  7. M
    No change, unless swelling or pain interferes
  8. N
    Usually not
  9. R
    Maybe as bone Fx, sclerotomic
  10. S
    • Snap test - snap DIST+PROX (or tuning fork)
    • + (suspicion) = deep sclerotomic Pain
  11. Tx Goals
    • pt edu (lay off it, shoes, biomechanics)
    • Decr inflammation (shunt)
    • Prevent adhesions (stretch)
  12. Tx
    • Elevate
    • Shunt
    • Stretch
    • Comps
  13. Hydro
    • Acute
    • Ice to CBAN for inflammation
    • Sub-Acute
    • Contrasts
    • Chronic
    • DMH, parafin waxx
  14. RemEx
    • Acute
    • Cycle w/o pain
    • Sub-Acute
    • Cross training
    • Chronic
    • Stretching, Cross training

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