Ortho Conditions

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BostonPhysicianAssist
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146395
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Ortho Conditions
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2012-04-08 23:52:20
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Ortho
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This deck tests the ortho conditions presented in class please feel free to add questions that you think are important from your own presentation, as these flashcards are very bare bones
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  1. Shoulder pain, difficulty raising hands over head and pain with active and passive motion are all symptoms of ___
    Impingement Syndrome
  2. Test of choice for impingement syndrome
    MRI
  3. Eitiolgy of impingment syndrom
    Injury of the rotator cuff mucles swelling/ and/or calcification between acromion and bursa and structures of the shoulder
  4. Specialty tests for Impingment Syndrome
    • Neer Impingement sign and Test: (raise arms up causese pain then inject lidiocaine no more pain)
    • Hawkin's Impingment sign: (shoulder 90 degrees forarm parallel to floor then passively flexed down to pointing at the floor)
    • Drop Arm Test: Pt has arm stright out and is asked to hold arm straight out to side but cant
    • Jobe's Test: Hands held out like pts gonna give you a hug! thumbs up for full can thumbs down for empty can push lightly on arms see if pt can hold position
    • Passive Painful Arc maneuver
  5. Treatment for Impingment Syndrome
    • Limit overhead activity
    • NSAIDs
    • PT
    • Hot/Cold compress
    • Subachromial Steroids
    • Surgery if failed conservative for 3 months (roto rooter cleaning out of joint space)
  6. Rotator cuff tear of the Supraspinatus muscle would result in ______
    • Loss of abduction
    • (most common tendon injured)
  7. Rotator cuff tear of the Infraspinatus muscle would result in loss of this movement...
    External rotation
  8. Rotator cuff tear of the Teres Minor muscle would result in loss of this function....
    External rotation
  9. Rotator cuff tear of the Subscapularis muscle would result in loss of this function ___
    Internal rotation
  10. A pt with a rotator cuff tear who has lost the ability to internally rotate damaged what muscle?
    Subscapularis muscle
  11. A pt with a rotator cuff tear who cannot externally rotate the arm has lost what muscle (s)
    • Teres Minor
    • Infraspinatus
  12. The most common muscle/tendon injured in a rotator cuff tear is the ____ which causes loss of ability to abduct the arm
    Supraspinatus
  13. What are some ways to get a rotator cuff tear?
    Trauma, hockey, Degeneration of one or more of the tendons of the SITS muscles, FOOSH, Jerking motions
  14. What tests can you do for a rotator cuff tear?
    • Drop Arm Test: tests supraspinatus, Inability to lower arms smoothly after provider passively raises it to 90 degrees
    • Hawkins' Impingement sign: Pain with internal rotation of the arm with hawkins (can be supraspinatus impingment, roatator cuff tear or rotator cuff tendonitis
    • Neer Impingment sign: if pt unable to actively flex arm above head after lidocaine injection think tear
    • Jobes Test: Weakness or pain with full can or empty can Indiates supraspinatus tear, full can is better than empty cans ; )
    • Subscapularis lift off: Inability to push against provider with hand that is behind back, Subscapularis tear
    • Posterior Impingment sign: Shoulder is maximally internally rotated, pain in posterior shoulder, Posterior labral or rotator cuff tear
    • Belly press test: Pts hand is placed on Abdomen examiner places their hand in between pts palm and belly and provides resistance weakness indicates a Subscapularis lesion
    • Horn Blowers Test: Having to raise elbow well above head to bring hand to mouth- Teres Minor lesion
  15. You suspect a Supraspinatus rotator cuff tear/tendonitis in a pt what tests will you perform?
    • Drop Arm Test: tests supraspinatus, Inability to lower arms smoothly after provider passively raises it to 90 degrees
    • Hawkins' Impingement sign: Pain with internal rotation of the arm with
    • hawkins (can be supraspinatus impingment, roatator cuff tear or rotator
    • cuff tendonitis
    • Neer Impingment sign: if pt unable to actively flex arm above head after lidocaine injection think tear
    • Jobes Test: Weakness or pain with full can or empty can Indiates supraspinatus tear, full can is better than empty cans ; )
    • Posterior Impingment sign: Shoulder is maximally internally rotated,
    • pain in posterior shoulder, Posterior labral or rotator cuff tear
  16. Test the infraspinatus
  17. Subscapularis lift off: Inability to push against provider with hand that is behind back, Subscapularis tear
    • Belly press test: Pts hand is placed on Abdomen examiner places their
    • hand in between pts palm and belly and provides resistance weakness
    • indicates a Subscapularis lesion
  18. Test the Teres Minor
  19. Horn Blowers Test: Having to raise elbow well above head to bring hand to mouth- Teres Minor lesion
  20. Test of Choice for Rotator cuff tear
    MRI
  21. Treatment for Chronic Rotator cuff tear
    • Motion
    • PT
    • NSAIDs
    • Subacromial steroids
    • Surgery if failed tx aftet 3 months
  22. Tx for acute Rotator cuff tear
    • Stabilizatinon
    • Surgery within 6 wks of injury
  23. Pt presents with shoulder pain anteriorly, it radiates distally over the biceps muscle. It is worse with lifting. There is point tenderness over the humoral head. What is it?
    Bicepts Tendonitis
  24. How do you get bicepts tendonitis?
    Overuse
  25. 2 Tests for Bicepts tendonitis
    • Yergason's: Pt tries to supinate hand against resistance, will have pain in bicipital groove
    • Speeds: Pt holds hand out in front of them palms up arms extended examiner = downward force pt resists pain in anterior shoulder with BT
  26. Tx for Bicepts Tendonditis
    • NSAIDs
    • PT
    • Subacromial steriods
  27. gradual onset of pain in shoulder. Worse with overhead reaching and horizontal adduction. Joint instability, Clicking popping or locking of the shoulder. What disease?
    SLAP lesion
  28. What does SLAP stand for?
    Superior Labral tear Anterior to Posterior
  29. How does one get a SLAP lesion?
    • Throwing sports
    • Swimming
    • Shoulder dislocation
  30. Ortho test for a SLAP lesion
    • O'Brien's Test: Arms directly out in front of pt then thumbs up or down for empty or full, Test will show deep pain, clicking, weakness with downward force during internal rotation and relief of pain or less pain with downward force and external rotation (thumbs down=pain, thumbs up = relief of pain)
    • Pt will describe pain that is in the shoulder and point to the axilla
    • Also Jerk, AP loading, and posteior impingement
  31. Diagnostic imaging for a SLAP lesion
    MRI or Arthroscopy
  32. Tx for a SLAP lesion
    • NSAIDs
    • PT
    • Surgery
  33. 45 y.o. M pt comes in describing a painful sholder following a few repetative injuries sustained during a Rec Lacrosse season. He stated that activity did not make the pain any worse but that it "hurt all the time". He says that continued for several months after the season ended and that although the pain is finally starting to resolve he came to see you today because it is starting to become stiff and fixed and his ROM is "not what it used to be" What shoulder condidtion do you think he has?
    Frozen shoulder
  34. In a pt whom you suspect frozen shoulder what other two conditions do you want to rule out?
    • Impingment syndrome (Neer and Hawkins)
    • Bicipital Tendonitis (Speeds and Yegarson)
  35. Tx for Frozen shoulder
    • PT
    • NSAIDS
    • Movement
    • Steroid injections
    • Surgical manipulation
    • Arthroscopy
    • Surgical release
  36. Pt presents after attempting to curl 90lbs, with sudden sharp pain in the antecubital foss that is now becomming a dull ache. He has popeye sign, and the arm shows swelling echymosis and tenderness to palpation. Dx?
    Distal Bicepts Tendon rupture
  37. Mechanism of injury in a Distal bicepts tendon rupture
    Forced extension applied to a partially flexed and supinated arm
  38. Specialty test for Distal bicepts tendon rupture
    Hook Test: provider tries to hook finger into the distal bicepts tendon. If provider cannot then this is a complete rupture
  39. Tx for a acute complete distal bicepts tendon rupture
    Surgery to reattach tendon
  40. Tx for a partial Distal bicepts tendon rupture
    Conservative, controll swelling and inflammation with rest and NSAIDs
  41. Pt presents with pain in lateral elbow that radiates to the forearm. There is pain with extension and radial deviation. there is Pain and weakness with grip. Pt presents with these symptoms after exessive repetative motion... Dx?
    Lateral Epicondylitis "tennis elbow"
  42. 76 y.o. avid bowler presents with pain with active wrist flexion and pronation. Also pain with gripping. States that he bowls everynight with the crew, and golfs on Fri, Sat, Sun. Dx?
    Medial Epicondylitis "Golfer's elbow"
  43. Specialty test for Lateral epicondylitis
    • Resisted wrist extension
    • Resisted middle finger extension
    • Weakness or pain with either of these
  44. Specialty test for Medial Epicondylitis
    • Resisted Wrist Flexion
    • Resisted wrist pronation
    • Grip strength
    • Weakness or pain with these motions +
  45. Tx for Lateral Epicondylitis
    • Limit aggravating motion
    • NSAIDs
    • Counterforce brace
    • IA steroids
    • Surgical debridement
  46. Tx for medial epicondylitis
    • NSAIDs
    • RICE
    • PT
    • Astym
    • IA steroid
    • Surgery- release of flexor origin and scar
  47. Pt presents with tenderness and localized pain over the olecranon. It is swollen and large. Pt is a PA student and frequently rests elbows on desk during class and studying late at night. What do you supect?
    Olecranon bursitis
  48. You have a pt with suspected olecranon bursitis what diagnostic tests do you want to do?
    • Palpate elbow to rule out gout, pseudogout and epicondylitis or infectious process
    • Fluid aspiration
    • Culture
    • CRP
    • ESR
    • Rh Factor
  49. Tx for olecranon bursitis
    Drainage and NSAIDs
  50. Pt has pain 4-5 cm distal and anterior to lateral epicondyle and along the course of the radial nerve down the forearm. You also suspect compression of the PIN is involved. What disese from class could it be?
    Radial Tunnel Syndrome
  51. Tests for Radial Tunnel Syndrome
    • Radial Tunnel compression
    • Long finger extension
    • Diagnosis is clinical
  52. Tx for Radial Tunnel syndrome
    • Splint wrist in extension for 4-6 wks
    • NSAID
    • PT/OT
    • Corticosteroid injections
    • Surgery
  53. Pt presents with pain/tenderness over the radial aspect of the wrist. They have pain with movement of the thumb and pain with gripping and making a fist. The pain shoots up their arm. This pt has repetative use of the thumb and wrist. (it is also common in new moms (baby's wrist))
    Dequarvain's Tenosynovitis
  54. Two specialty tests for Dequairvains tenosynovitis
    • Finkelsteins test
    • Hitchhicker's sign
  55. Tx for Dequairvains Tenosynovitis
    • NSAIDs
    • IA steroids
    • Surgery (open the sheath of the first dorsal compartment)
  56. Pt complains of pain and burnign paresthesia in the distribution of the median nerve. Weakness of thumb abduction and atrophy of the thenar eminence. They also mention that they type alot and have alot of repetative motions, and were recently diagnosed with Acromegally. (yea your pt used to be a Doctor and they are pretty much awesome at spelling it out for you)
    Carpal Tunnel Syndrome
  57. What Tests would you perform to confirm a diagnosis of Carpal Tunnel Syndrome?
    • Phalen Test
    • Tinnels sign
    • Manual Carpal compression
  58. What is the Tx for Carpal Tunnel?
    • Splint in slight extension especially at night
    • NSAIDs
    • IA injections
    • PO steroids
    • PT/OT
    • Surgical release of the transverse ligament
  59. Pt has an asymptomatic palpably occasionally achy lump in their forearm. (note: this condition can also cause numbness of the median nerve distribution like carpal tunnel secondary to median nerve impingement)
    Ganglion Cyst
  60. Diagnostic tests for Ganglion Cyst
    Transilluminate, Ultrasound
  61. Treatment for Ganglion cyst
    • Spontaneous resolution usually
    • Manual compression (book to the forearm I would suggest using Harrison's or Cecils)
    • Aspiration
    • Surgery
  62. Pt has pain or tenderness in the radial side of the wrist, and swelling of the radial aspect of the hand following a FOOSH. Upon further inspection you find there is pain in the anatomical snuffbox
    Scaphoid fracture
  63. What exam do you want to perform on a pt with suspected scaphoid fracture and what imaging do you want?
    • Pain in the anatomical snuffbox (palpate it! you have no excuse!)
    • Imaging: XRay AP and lateral, (could also MRI and bonescan but really not common) Get second X-ray a few weeks later to look for necrosis do not withold Tx if there is snuffbox pain but a negative X-Ray!
  64. Tx for an Acute Scaphoid fracture
    • Long arm thumb spica
    • Pain meds
    • Then switch to short arm thumb spica and evaluate for if surgery may be nessisary
  65. Pt presents after jamming finger in a basketball game (direct blow to the tip of the finger with axial load and flexion of the DIP). They have diffuse swelling and inability to extend the DIP
    Mallet Finger
  66. PE tests and diagnostic studies/imaging for Mallet Finger
    • XR (AP/Lat/Oblique)
    • Stabilize PIP in full extension
    • Check active DIP extension
  67. Tx for Mallet finger
    Immobilize the DIP in full extension for 6-8 wks
  68. Pt has neck and radicular pain that is dull to severe, Pain with extension or lateral beding of the head to the affected side. They have compression of the nucleus palposis. Dx?
    • Cervical radiculopathy
    • (could also be cervical burner or cervical sprain they are very similar)
  69. Specialty tests for Cervical Radiculopathy
    • Spurling
    • Distraction
    • Lhermitte
    • Bakody's sign: relieved pain with shoulder abducton and placement of hands on the head
  70. Diagnostic tests/imaging for a cervical radiculopathy
    • XR
    • CT meylograph
    • MRI
    • electromyography
    • Selective diagnostic nerve root block
  71. Treatment for Cervical radiculopathy
    • Acute: Rest, ice NSAIDs, PO steroids
    • Subacute: intralaminar epidural injection, transforaminal epidural steroid injection PT
    • Surgical Tx: Cervical laminectomy, discectomy, cervical laminoforaminoectomy, disc replacement
  72. Pt with hx sig for whiplash from a MVC 2 wks ago presents with cervical pain, instability, tender points and occipital headache. pt states the x-rays she had in the ER when the crash happened were negative for fracture
    Acute cervical sprain
  73. Specialty tests for Acute Cervical sprain
    • Spurlings
    • O'Donoughe
    • Spinal percussion test
    • Stress test of the cervical spine
  74. What imaging would you get for a Cervical sprain?
    • Clear C-Spine
    • X-ray
    • CT
  75. Tx for Acute Cervical spine injury
    NSAID, Rest, Cervical collar, Early ROM, PT, Exercise
  76. Throracic outlet syndrome specialty tests
    • Adson's test
    • wright's test
    • Roos test
    • Military brace
    • way to remember: (were you alone when you got arrested (military brace)? no i was with Addison, Wright and Roo one short one fat one new)
  77. Diagnostic studies/imaging for Thoracic Outlet syndrome
    • EMG
    • CT angiongram
    • MRI to rule out other stuff
    • Nerve conduction velocity study
    • X-ray for extra cervical vertebrae
  78. Neurogenic symptoms of Thoracic outlet syndrome
    Pain in the neck, shoulder and arm of affected side
  79. Venous Sx of Thoracic outlet syndrome
    Pain, cyanosis, finger fatigue
  80. Arterial Sx of Thoracic outlet syndrome
    Pain, Ishemia, pallor
  81. Pathophysi of thoracic outlet syndrome
    Compression of the neurovascular bundles by various structures above the first rib and behind the clavical (ex. cervical rib, pancost tumor, injury/inflammation etc)
  82. Tx for Thoracic outlet syndrome
    • Neurogenic: PT
    • Venous: Anticoagulation and surgery
    • Arterial: Remove arterial compression
  83. Football player presents with burning/tingling sensation down the right arm after being tackled on the field. He reports it went away 1-2 mins after it happened.
    Cervical Burner syndrome
  84. 3 mechanisms of injury in cervical burner
    • Traction injury with lateral flexion
    • Direct blow to the supraclavicular fossa
    • Hyperextension and ipsilateral lateral flexion
  85. 2 specialty ortho tests for Cervical Burner syndrome
    Spurling and Tinels
  86. Tx for Cervical Burner syndrome
    • Spontaneous resolution
    • D/C play or participation in sports
    • PT
    • Better protective equipment during sports
    • NSAIDs/Narcotics for pain
    • Proper form when tackling/playing
  87. 14 y.o. female presents with painless to mild backpain wth uneven limbs and high hip
    Scoliosis
  88. Specialty tests for Scoliosis
    • Adam's Forward Bend: Pt faces provider and bends forward at the weight if scoliosis is present the scapulae will be uneven
    • Scoliometer: measures scapular discrepancy during adam's forward bend
  89. Diagnostic imaging for scoliosis
    • Xray AP and lateral
    • MRI or CT myelogram
  90. Tx for scoliosis
    • Mild: observation and PT
    • Moderate: 20-40 degrees, bracing
    • Severe: surgery
  91. 35 y.o. pt who was in helicopter crash several months ago presents with sudden lower back pain that radiates down the leg to the lateral ankle, they report muscle weakness and paresthesia
    Lumbar Radiculopathy
  92. 3 Tests for Lumbar radiculopathy
    • Flip Sign
    • Straight leg raise
    • Hip extension
  93. Tx for Lumbar radiculopathy
    • Bed rest for less than 2 days
    • PT/exercise
    • NSAIDs
    • PO or epidural steroids
    • Surgery if there is progressive deterioration or cauda equina syndrome
    • Microdisection or hemilaminectomy
  94. Pt has lower back pain with 'neurogenic claudication' and Leg neruopathy
    Spinal stenosis
  95. What is the cause of spinal stenosis
    Narrowed spinal canal at lumbar vertebrae L4 or L5 with a space occupying lesion like a bulging disk, tumor etc
  96. Diagnostic studies for Spinal stenosis
    • MRI
    • CT myelography
  97. Tx for Spinal Stenosis
    • NSAIDs
    • PT
    • Surgery- decompressive or laminectomy
  98. Pt has hip pain and trouble ambulating ever since a total hip dislocation a few months ago
    Osteonecrosis of the Hip
  99. 79 y.o. F has hip pain, morning stiffness, and trouble ambulating secondary to pain.
    Osteoarthritis of the hip
  100. Pt has lower back pain, and buttocks pain that radiats wlong the course of the sciatic nerve. It worsens with sitting, running, climbing stairs and pressing on the area
    Piriformis syndrome
  101. 3 specialty tests for osteonecrosis of the hip
    • Faber Test
    • Anvil Test
    • Lageurres
  102. Imaging studies for Osteonecrosis of the hip
    • X-ray
    • or MRI for more subtle disease
  103. Tx for osteonecrosis of the hip
    • Surgery
    • Resurfaceing
    • total hip replacement
  104. 3 risk factors for the development of osteoarthritis of the hip
    • Female
    • over forty
    • Fat
  105. 3 specialty tests for osteoarthritis of the hip
    • External and internal rotation
    • Faber Test
    • Hip scour
  106. Diagnostic/imaging studies for osteoarthritis of the hip
    • X-Ray
    • CT scan
    • ESR
    • Rh factor
  107. Tx for Osteoarthritis of the hip
    • Acute:
    • APAP, NSAID, IA injections
    • Defininitve:
    • Total hip replacement or hip resurfaceing
  108. What is the eitiology of piriformis syndrome?
    Compression and irritation of the sciatic nerve from the piriformis muscle
  109. What are 5 tests for piriformis syndrome
    • piriformis test
    • freiberf test
    • beatty test
    • lasegue sign
    • assess neuro L4,L5,S1
  110. Tx for piriformis syndrome
    • Stretching
    • Activity modification
    • Muscle relaxants
    • Steroid injections
    • Anesthetic injection
    • Botox injection
    • Surgery: removal of piriformis muscle or tendon near insertion
  111. Obese male pt with huge belt buckle and tight genes comes in with dystesia, paresthesia, and hypesthesia of the anterolateral thigh that extends from the around the ASIS to just above the knee on the lateral aspect of the right leg
    Meralgia Paresthetica
  112. 2 specialty exams for meralgia paresthetica
    • Tinel's test
    • Sharp/dull test
  113. Tx for Meralgia paresthetica
    • Conservative: NSAIDs, avoid tight clothes, wt loss
    • Failed Conservative: Carbamazepine, phenytoid
    • Surgery: Surgical release of the LFCN at the ASIS or resection of the nerve
  114. Female smoker on OCPs presents after 3 days post knee surgery with Leg pain, tenderness, erythema, discoloration and venous distention of the right leg
    DVT
  115. What is virchow's triad?
    • Alteration of blood flow (stasis or turbulence)
    • Injury to the endothelium
    • Hypercoaguability
    • (factors that lead to thrombosis)
  116. Tx for DVT
    • LMWH
    • Heparin
    • Coumadin
  117. Pt presents with knee pain after an audible "pop" they have swelling, tenderness, decreased ROM and decreased stability. most probably this happened with direct blow during a sport. What 4 Ligaments ae you worried about?
    • Anterior cruciate ligament
    • Posterior cruciate ligament
    • Medial collateral ligament
    • Lateral collateral ligament
  118. This Ligament tear is caused by a direct blow to the knee causing hyperextension or valgus stress or can be caused by running or jumping of an athlete causing pivoting of the knee
    Anterior cruciate ligament
  119. 3 specialty tests for ACL tear
    • Lachman Test
    • Pivot shift test
    • Anterior drawer test
  120. Imaging for an ACL, MCL, PCL or LCL sprain or tear
    • XR to rule out bony fracture
    • MRI to rule out fracture and grade tear
  121. Tx for ACL tear
    • RICE, NSAIDs Crutches
    • Surgery: for the terrible driatd, athlete or active lifestyle
    • Post surgery PT
  122. What is the Terrible triad of the knee?
    ACL, MCL an meniscus
  123. This knee ligament rupture is also called a "dashboard injury"
    Posterior cruciate ligament
  124. 2 specialty tests for PCL tear
    • Posterior drawer test
    • Posterior sag test
  125. Tx for a PCL tear
    • PT
    • PCL recontsruction if there are also other injuries with it
  126. This Ligament tear of the knee is caused by a direct blow with valgus (force from the side)
    an indirect version is caused by abduction or rotation of the lower leg into hyperextension
    Medial collateral ligament
  127. 2 specialty tests for the MCL in the knee
    Valgus stress test: Grade I less than 5 mm, grade II 5-9 mm grade 3>10mm

    Apley grind test
  128. Tx for an MCL tear
    • Grade 1: RICE and Hinged Brace
    • Grade 2: Hinged Brace
    • Grade 3: Hinged brace and Pt
    • or surgery if multiple ligaments or displaced fracture
  129. This ligamentous tear is caused by a direct blow with varus stress to the medial aspect of the knee with the leg in extension
    Lateral collateral ligament
  130. Specialty test for the lateral collateral ligment of the knee
    Varus stress test: Grade I less than 5mm, Grade II partial tear, Grade III more than 10mm
  131. Tx for a Lateral collateral ligament tear
    • Grade I and II: Hinged brace and RICE and NSAID
    • Grade 3: surgical repair, Brace and PT
  132. Pt with knee pain, swelling, popping, and joint line tenderness. they state that they feel as though their knee just "gives way". They also have coopers sign (joint line tenderness when they role over at night)
    Medial meniscus tear
  133. Medial meniscus tears in pts over 40 are usually (Traumatic or atraumatic?) and are associated with degeneration
    Atraumatic
  134. 5 tests for medial meniscus tear
    • McMurray test
    • Apley compression
    • Bounce home test
    • Childress test
    • Thessaly test
  135. Tx for a medial mensiscus tear
    • RICE
    • NSAIDs
    • Immobilization
    • PT
    • Surgery: partial meniscectomy for trauma pts or total meniscal repair for pts over 40 with ligament involvement
  136. 3 tests for lateral meniscus tear
    • McMurray
    • Apley Grind
    • Joint line tenderness
  137. Tx for lateral meniscus tear
    • RICE, NSAIDs Crutches and knee brace
    • Surgery: for locked knee with young pt with significant tear unresolving symptoms
    • meniscectomy or meniscal repair
  138. This condition presents with "tearing" or popping in the knee with difficulty ambulating and inability to extend the knee.
    Patellar Tendon rupture
  139. This Condition can be caused by... Sudden contraction of the quadricepts on the flexed knee, Proximal rupture more common avulsion tear possible
    Patellar tendon rupture
  140. Tx for patellar tendon rupture
    Surgery if there is only a partial tear then immobilization
  141. Marathon runner presents with sudden severe pain behind the ankle with swelling, a palpable defect and trouble weight bearing
    Achilles tendon rupture
  142. What specialty tests do you perform for an achilles tendon rupture?
    Thompson test and Matles test
  143. Tx for achillies tendon rupture
    RICE, immobiliztion, surgery
  144. Pt presents with pain/tenderness over the plantar surface fo the foot. they state it feels like they are "walking on a marble". The pain is relieved when you take off their shoes and have them wal around. (may also cause hyperesthesia, numbness and burning from metatarsal to 3rd and 4th toe)
    Mortons neuroma
  145. 2 Specialty tests for morton's neuroma
    • Morton's test
    • Mulders sign
  146. Tx for morton's neuroma
    new shoes

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