PAP-591 Orthopedics

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  1. anatomy of a bone
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  2. intra-articular
    The part of the bone covered with cartilage that articulates with another bone.
  3. extra-articular
    The rest of the bone that is non-articulating
  4. diaphysis
    • Shaft of a long bone
    • Can be divided into thirds to indicate location of pathology:
    • ie - proximal third, middle third, distal third
    • As well as the intersection of those thirds
  5. adhesive capsulitis
    • (frozen shoulder)
    • a painful stiffness in a shoulder joint
  6. anterior drawer test
    • Anterior Drawer Sign
    • With the patient supine, hips flexed and knees flexed to 90° and feet flat on the table, cup your hands around the knee with the thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings. Draw the tibia forward and observe if it slides forward (like a drawer) from under the femur. Compare the degree of forward movement with that of the opposite knee.
  7. apex of the curve
    In scoliosis this refers to the vertebra that is located at the farthest point out laterally from the midline of the body (convex side).
  8. apophysitis
    an inflammation of an outgrowth, projection, or swelling, especially a bony outgrowth that is still attached to the rest of the bone. Apophysitis occurs most frequently as a disorder of the foot caused by disease of the epiphysis of the calcaneus.
  9. apposition
    • the amount of end to end contact of the fracture
    • the placement or position of adjacent structures or parts so that they can come into contact.
  10. atrophy
    • a wasting away; a diminution in the size of a cell, tissue, organ, or part.
    • atrophy, bone,
    • n 1. the bone resorption internally (in density) and externally (in form) (e.g., of residual ridges).
    • n 2. a loss of bone substance or volume. Atrophy of bone ordinarily occurs without a corresponding change in the volume or external dimensions of bone, but the mass of bone tissue may be reduced by as much as 75%. The internal architecture of the bone gradually becomes attenuated and finally disappears. Atrophied bone is brittle and has a more spongy consistency than normal bone. In cross-section the cortex is thin, and the periosteal surface is smooth and unchanged, but the intramedullary substance is composed of a yellow, fatty, cancellous bone tissue. Bone atrophy may be systemic, regional, or local.
  11. avascular necrosis
    the consequence of temporary or permanent cessation of blood flow to the bones. The absence of blood causes the bone tissue to die, resulting in fracture or collapse of the entire bone
  12. ballottement
    Ballotting the patella. To assess large effusions, you can also compress the suprapatellar pouch and “ballotte” or push the patella sharply against the femur. Watch for fluid returning to the suprapatellar pouch.
  13. Bankhart lesions
    An avulsion fracture of the anteroinferior glenoid labrum, often accompanied by an anterior dislocation of the humeral head; the detachment of the inferior glenohumeral ligament complex from the inferior glenoid, accompanied by stretching of the remaining fibers, leads to shoulder laxity.
  14. boutonniere deformity
    A popular term for flexion of the proximal interphalangeal PIP joint and hyperextension of the DIP, caused by the detachment of the extensor tendon from the middle phalanx, volar displacement and resultant action as a flexor, associated with SLE, Jaccoud’s—post-rheumatic fever arthritis, rheumatoid arthritis, and camptodactyly
  15. bursitis
    Bursitis is the painful inflammation of the bursa, a padlike sac found in areas subject to friction. Bursae cushion the movement between the bones, tendons and muscles near the joints. Bursitis is most often caused by repetitive movement and is known by several common names including weaver's bottom, clergyman's knee, and miner's elbow, depending on the affected individual's occupation and area of injury.
  16. capitellum
    The rounded protuberance at the lower end of the humerus that articulates with the radius.
  17. carpal tunnel syndrome
    • a disorder caused by compression at the wrist of the median nerve supplying the hand, causing numbness and tingling.
    • The median nerve is responsible for both sensation and movement in the hand, in particular the thumb and first three fingers. When the median nerve is compressed, an individual's hand will feel as if it has "gone to sleep."
    • pain and burning or tingling paresthesias in the fingers and hand, sometimes extending to the elbow, due to compression of the median nerve in the carpal tunnel.
  18. cauda equina syndrome
    • Cauda equina syndrome is defined as a loss of lower extremity motor and sensory function, loss of bladder and bowel control, and perineal sensory deficit ("saddle anesthesia") due to severe compression of the nerve roots within the thecal sac below the level of the spinal cord.
    • Signs and symptoms of cauda equina syndrome include a progression of neurologic deficits over time. Normal urinary output over 8 hours exceeds bladder capacity, so urinary retention is often the first perceived symptom of a cauda equina syndrome. Although cauda equina syndrome is usually the result of an acute herniated disk, fracture, or expanding mass (e.g., tumor or hematoma), severe long-standing lumbar stenosis can rarely result in an insidious onset of cauda equina symptoms.
  19. central cord syndrome
    injury to the central part of the cervical spinal cord resulting in disproportionately more weakness or paralysis in the upper limbs than in the lower; pathological change is caused by hemorrhage or edema.
  20. compartment syndrome
    a condition in which increased tissue pressure in a confined anatomic space causes decreased blood flow leading to ischemia and dysfunction of contained myoneural elements, marked by pain, muscle weakness, sensory loss, and palpable tenseness in the involved compartment; ischemia can lead to necrosis resulting in permanent impairment of function.
  21. compression
    • Anatomically, the most common site for vertebral compression fractures (VCFs) is the tho-racic spine where compression of the anterior vertebral body is more likely due to the normal thoracic kyphosis. With progressive collapse of the fractured vertebra, the kyphosis becomes even more pronounced, which may leave the patient more prone to additional fractures. The upper lumbar and lower lumbar spine, respectively, are the next most common regions for VCFs.
    • Thoracic or lumbar spine pain is the predominant presenting symptom, and neurologic symptoms are infrequent. In cases of thoracic compression fractures with nerve root impingement, patients may report pain radiating anteriorly along the costal distribution of the affected spinal nerve. Spinal cord compression is rare and should suggest a more ominous diagnosis such as tumor or infection. 
    • Osteoporosis-related VCFs are most common in postmenopausal Caucasian women who lead a sedentary lifestyle.
    • A history of prior VCFs significantly increase the risk for future VCFs.
    • The thoracic spine is the most common location of VCFs.
    • The primary symptom of VCFs is activity-related back pain, usually without a history of significant trauma.
  22. coxa vera
    • deformity of the hip with decrease in the angle of inclination between the neck and shaft of the femur.
    • coxa magna - broadening of the head and neck of the femur.
    • coxa plana - osteochondrosis of the capitular epiphysis of the femur.
    • coxa valga - deformity of the hip with increase in the angle of inclination between the neck and shaft of the femur.
  23. deep tendon reflexes
    a brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap by a finger or rubber hammer on the tendon of insertion of the muscle. Absence of the reflex may be caused by damage to the muscle, peripheral nerve, nerve roots, or spinal cord at that level. A hyperactive reflex may indicate disease of the pyramidal tract above the level of the reflex arc being tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism.
  24. delayed union
    • A delay in the healing of the ends of a fracture
    • Fracture healing is slower than normal time, may indicate underlying problem causing delayed healing, eg poor nutrition/altered bone healing
  25. displacement
    separation or dislocation of the surfaces of a joint
  26. Dupuytren's contracture
    • Complaints of stiffness of involved fingers are common.
    • The ulnar side of both hands is usually affected.
    • Disease may be inherited or acquired.
    • Dupuytren contracture is a relatively common disorder of the hand that is characterized by progressive fibrosis and contracture of the palmar fascia. It most commonly affects middle-aged men of northern European descent and has been associated with tobacco use and alcohol intake, diabetes mellitus, and epilepsy. Although most cases are sporadic, an autosomal dominant form with variable penetrance exists. Patients with inherited forms are typically younger and may also present with plantar fibromatosis (Lederhosen disease) and penile fibrosis (Peyronie disease).Initially, there is painless thickening of the palmar fascia that may go unnoticed. This thickening progresses to form nodules, which may cause transient pain that is usually self-limited. They coalesce into thick, longitudinal cords, causing a progressive loss of full extension and joint stiffness. The scarring process results in the formation of thick cords in the pretendinous bands of the palmar fascia that extend into the digits, skin dimpling, and flexion contracture at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The ulnar side of both hands is involved in most patients, with the ring and small fingers usually affected earliest. Web space contractures can also occur, predominantly the thumb–index web space. Patients usually complain of finger stiffness of the involved fingers. They may have difficulty placing their hand into a pants pocket or grabbing large objects.
  27. ecchymosis
    a small hemorrhagic spot in the skin or a mucous membrane, larger than a petechia, forming a non-elevated, rounded, or irregular blue or purplish patch
  28. epicondylitis
    a painful and sometimes disabling inflammation of the muscle and surrounding tissues of the elbow, caused by repeated strain on the forearm near the medial or lateral epicondyle of the humerus. The strain may result from violent extension or supination of the wrist against a resisting force, such as may occur in playing tennis or golf, twisting a screwdriver, or carrying a heavy load with the arm extended. Treatment usually includes rest, injection of procaine with or without hydrocortisone, stretching and strengthening of the muscle, and, in some cases, surgery to release part of the muscle from the epicondyle.
  29. epiphysis
    The end of a long bone that is originally separated from the main bone by a layer of cartilage but that later becomes united to the main bone through ossification.
  30. eversion
    a turning inside out; a turning outward
  31. Finkelstein test
    • Test the thumb function if there is wrist pain by asking the patient to grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation (commonly called Finkelstein’s test).
    • Pain during this maneuver identifies de Quervain’s tenosynovitis from inflammation of the abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths. This condition, like carpal tunnel syndrome, is more common in women.
  32. foot drop
    paralysis/weakness of all or some extensor/dorsiflexor lower-leg muscles (i.e. tibialis anterior, extensor hallucis longus, extensor hallucis brevis, peroneus tertius) due to upper or lower motor neurone lesions, or traumatic severance of common peroneal nerve at neck of fibula, causing loss of dorsiflexion during gait; deceleration at heel contact is lost, the foot 'flaps' into contact with the ground surface, and toes drag against the floor during swing phase of gait; ambulation is assisted by use of an ankle-foot orthosis (AFO), preventing uncontrolled ankle joint plantar flexion
  33. frozen shoulder
    Inflammation between the joint capsule and the peripheral articular shoulder cartilage that causes pain whether in motion or at rest.
  34. ganglion cyst
    • Encapsulated mobile mass near joint or tendon sheath
    • Risk factors – repetitive movements, arthritis
    • Wrist (70%), foot, and knee
    • Filled with gelatinous, mucoid material
    • Often asymptomatic
    • Aspiration --> recurrence 15-20%
    • Excision
  35. heel spur
    calcaneal spur; heel spur syndrome osteophytosis of posterior or plantar calcaneum secondary to inflammation and chronic local soft-tissue traction (i.e. enthesiopathy); heel spur may be symptomatic (painful) or asymptomatic, or symptomatic during its formation and asymptomatic once fully formed; plantar heel spur formation is associated with chronic plantar fasciitis, sero-negative and sero-positive inflammatory joint diseases; may be treated by heel spur injection; posterior heel spur is associated with ankylosing spondylitis and Forrestier's disease
  36. hemarthrosis
    extravasation of blood into a joint or its synovial cavity.
  37. high sprain
    • syndesmotic injuries, also known as high ankle sprains
    • For ankle sprains involving the syndesmosis, the patient will be tender specifically on the anterolateral aspect of the ankle. Tenderness over the lateral malleolus, ATFL, or CFL can be minimal or nonexistent. Medial malleolar tender-ness is not uncommon in the setting of a syndesmotic sprain. Furthermore, palpation of the proximal fibula is essential in the setting of medial tenderness and syndesmotic injury.
  38. idiopathic
    Of unknown origin, as in a symptom or syndrome that appears without apparent cause.
  39. inversion
    a turning inward, inside out, or other reversal of the normal relation of a part.
  40. joint instability
    • an abnormal increase in joint mobility
    • Unusual flexibility of the joints, allowing them to be bent or moved beyond their normal range of motion.
  41. kyphosis
    extreme curvature of the upper back also known as a hunchback
  42. Lachman test
    Place the knee in 15° of flexion and external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, simultaneously pull the tibia forward and the femur back. Estimate the degree of forward excursion.
  43. Legg-Calve-Perthes disease
    • osteochondritis deformans juvenilis.
    • Osteochondrosis of the upper end of the femur. Also called Calvé-Perthes disease, coxa plana, Legg-Calvé-Perthes disease, Perthes disease.
    • osteochondrosis of the capitular epiphysis of the femur.
  44. lordosis
    • the anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side.
    • An abnormal forward curvature of the spine in the lumbar region. Also called hollow back, saddle back.
  45. lumbar disc disease
    • Lumbar disc disease is the drying out of the spongy interior matrix of an intervertebral disc in the spine. Many physicians and patients use the term lumbar disc disease to encompass several different causes of back pain or sciatica.
    • Pain, loss of muscle strength and loss of touch sensation may occur if this herniation causes the compression of the most proximal part of the nerve closely neighbouring the intervertebral disc material. Pain is in the distribution of the nerve compressed, usually down the back of the leg, side of the calf and inside of the foot (sciatica). Most commonly, the nerve root between the fourth and fifth lumbar vertebrae or between the fifth lumbar vertebra and first sacral segment are impinged.
    • In symptomatic cases the diagnosis should be confirmed by an MRI scan. However, in cases with slight symptoms, a faster and cheaper CT scan (although it is inferior to MRI scan) may be recommended. While a CT scan can show the bony structures in more detail, an MRI scan can better portray soft tissue.
  46. malunion
    • healing in poor position
    • Can result in continued pain or poor function
    • An imperfect union of previously fragmented bone or other tissue. Causes of bone malunion include osteomyelitis and improper immobilization of a fracture.
  47. McMurray test
    • A test for injury to meniscal structures of the knee in which the lower leg is rotated while the leg is extended; pain and a cracking in the knee indicates meniscal injury.
    • With the patient supine, grasp the heel and flex the knee. Cup your other hand over the knee joint with fingers and thumb along the medial joint line. From the heel, externally rotate the lower, then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, slowly extend the lower leg in external rotation.
    • The same maneuver with internal rotation of the foot stresses the lateral meniscus.
    • If a click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assess the meniscus for a posterior tear.
    • A click or pop along the medial joint with valgus stress, external rotation, and leg extension suggests a prob-able tear of the posterior portion of the medial meniscus. The tear may displace meniscal tissue, causing “locking” on full knee extension.
    • A McMurray sign and locking make a medial meniscus tear 8.2 and 3.2 times more likely.
  48. meralgia paresthetica
    Meralgia paresthetica is a relatively uncommon condition that is characterized by the symptom complex of pain, numbness, tingling, and paresthesias localized to the antero-lateral region of the thigh. The diagnosis is primarily clinical, as it is based upon the characteristic location of pain or dysesthesia, sensory disturbance on exam, and the absence of any other abnormal neurologic findings. The condition can be classified into one of two categories: spontaneous or iatrogenic. Spontaneous meralgia paresthetica takes form in the absence of any previous surgical procedure that may have led to inadvertent injury of the lateral femoral cutaneous nerve (LFCN) along its anatomic course. Iatrogenic meralgia paresthetica is secondary to mechanical factors, most notably compression of the nerve along its anatomic course. Previous surgery can predispose the LFCN to direct traumatic injury or entrapment secondary to postoperative scarring. Various reports of external compression due to obesity, pregnancy, abdominal ascites, tight garments, seat belts, braces, direct trauma, and pelvic tumors have been documented. The nerve may also be entrapped in a retroperitoneal location or at the precise location where it penetrates the fascia lata.
  49. metastasis
    • Transmission of pathogenic microorganisms or cancerous cells from an original site to one or more sites elsewhere in the body, usually by way of the blood vessels or lymphatics.
    • A secondary cancerous growth formed by transmission of cancerous cells from a primary growth located elsewhere in the body.
  50. metatarsalgia
    a painful condition around the metatarsal bones caused by an abnormality of the foot or by recalcification of degenerated heads of metatarsal bones.
  51. Mortise view
    • one of three x-ray views of the ankle
    • Necessary studies to be obtained when evaluating a suspected fibular fracture should always include radiographs. Standard radiographs include the anteroposterior, mortise, and lateral non–weight-bearing views.
    • Mortise view puts lateral and medial malleoluses inline with each other, the lateral malleolus is slightly posterior
  52. multiple myeloma
    • Most common tumor of bone
    • Plasma cell dyscrasia
    • Older adults – 50 to 80 y/o
    • Systemic process, solitary lesion less common
    • Anorexia, weight loss, bone pain (spine & rib)
    • Back pain common – due to destructive skeletal lesions
    • Anemia, renal insufficiency, bacterial infections, amyloid deposition
    • Bence Jones protein in urine
    • Dysproteinemia on serum protein electrophoresis
    • Pattern suggestive of a monoclonal gammopathy
    • Rouleaux formation in peripheral blood smear
    • Hypercalcemia (nl alk phos)
    • "Punched out" lesions with sharp edges
    • Diffuse osteoporosis or pathologic fractures
    • Multiple myeloma is a cancer in which antibody-producing plasma cells grow in an uncontrolled and invasive (malignant) manner.
    • Multiple myeloma, also known as plasma cell myeloma, is the second-most common cancer of the blood. It is the most common type of plasma cell neoplasm. Multiple myeloma accounts for approximately 1% of all cancers and 2% of all deaths from cancer. Multiple myeloma is a disease in which malignant plasma cells spread through the bone marrow and hard outer portions of the large bones of thebody. These myeloma cells may form tumors called plasmacytomas. Eventually, multiple soft spots or holes, called osteolytic lesions,form in the bones.
    • Bone marrow is the spongy tissue within the bones. The breastbone, spine, ribs, skull, pelvic bones, and the long bone of the thigh all are particularly rich in marrow. Bone marrow is a very active tissue that is responsible for producing the cells that circulate in the blood. These include the red blood cells that carry oxygen, the white blood cells that develop into immune system cells, and platelets, which cause blood to clot.
  53. neurogenic claudication
    • Spinal Stenosis
    • Complaints of leg pain, but often proximal - buttock and hip
    • Frequency of pain may be intermittent
    • Patient may find relief by hunching forward which tends to stretch open the spinal canal and make more room for the neural elements.
    • PE is usually normal, peripheral pedal pulses are palpable.
    • Confirm with MRI of the lumbar spine.
    • Neurogenic claudication is at times designated "pseudoclaudication" to distinguish it from "classic claudication," which is a similar condition of leg pain caused by vascular insufficiency. Because spinal stenosis and vascular insufficiency are both associated with aging, it is not unusual for a patient to have both conditions. Distinguishing neurogenic from vascular claudication is clinically important because treatment options differ for each condition.
  54. nursemaid's elbow
    • Toddlers may acquire nursemaid’s elbow or subluxation of the radial head from a tugging injury.
    • Pulled elbow
    • Subluxation of the radial head, caused by a longitudinal 'yank' on the forearm - by a nursemaid, etc, forcing the child's elbow into extension; the subluxation is reduced by firm supination at 90° and extension, followed by immobilization with a posterior splint or sling.
  55. Osgood-Schlatter's disease
    • osteochondrosis of the tuberosity of the tibia.
    • Pt. is 10-15 years old, complains of anterior knee pain, usually involved in athletics
    • Overuse injury, basically a stress fracture of the growth rate
    • Due to rapid growth combined with high activity level
  56. osteoblastoma
    • rare, benign neoplasm with aggressive growth pattern
    • 80% of patients are 10-30 y/o; M>F
    • 40-50% spine - posterior (dorsal) elements; long bones
    • Signs/Symptoms:
    • Pain, less severe and less pronounced at night, may or may not be relieved by aspirin or NSAID
    • Spinal lesions may be accompanied by muscle spasms, scoliosis and neurological manifestations
    • Plain x-ray:
    • Circumscribed lesion usually around 4-6 cm in size.
    • Expansion of bone, cortical thinning and cortical breakthrough. A soft tissue mass may accompany this lesion but is usually contained by the periosteum
    • May be entirely radiolucent but usually shows some degree of mineralization.
    • Bone Scan:
    • Increased uptake at the site of the lesion
    • CT Scan:
    • More useful for detecting mineralization and evaluating extent of bone destruction than plain X-ray (Egg Shell Rim of Calcification)
    • MRI:
    • Also useful in determining extent
    • Extensive edema around the tumor in the surrounding bone and soft tissues can lead to a misdiagnosis of a malignant tumor.
  57. osteochondroma
    • Most common benign bone tumor
    • Minimally symptomatic
    • Metaphysis of long bones (distal femur, proximal tibia)
    • X-ray - Stalk directed away from growth plate (pedunculated), Flat without stalk (sessile), Cartilaginous cap
    • Commonly regress when growth ceases
    • Signs/Symptoms:
    • Hard swelling for many years - surface of metaphyseal portions of long tubular bones
    • Symptoms dependent on location/size
    • May cause mechanical symptoms from compression of adjacent structures such as tendons, nerve or blood vessels
    • Overlying bursa may form and result in a bursitis
    • Male>Female, presents by third decade of life
    • Sites: femur (30%) tibia (20%) humerus (2%) hand and foot (10%) pelvis (5%) scapula (4%)- knee 35% of cases
    • Treatment – simple excision for cosmetic purposes, or due to pain or impingement of nearby structures
  58. osteomyelitis
    • bone infection, almost always caused by a bacteria. Over time, the result can be destruction of the bone itself.
    • Hematogenous spread with bacteremia
    • Children, Males>Females
    • Bimodal age dist: <2, 8-12 - Rare after physes close
    • Risk factors:
    • Localized trauma
    • Chronic illness
    • Malnutrition
    • Inadequate immune system
    • Bone infections may occur at any age. Certain conditions increase the risk of developing such an infection, including sickle cell anemia, injury, the presence of a foreign body (such as a bullet or a screw placed to hold together a broken bone), intravenous drug use (such as heroin), diabetes, kidney dialysis, surgical procedures to bony areas, untreated infections of tissue near a bone (for example, extreme cases of untreated sinus infections have led to osteomyelitis of the bones of the skull).
    • Staphylococcus aureus, a bacterium, is the most common organism involved in osteomyelitis. Other types of organisms include the mycobacterium which causes tuberculosis, a type of Salmonella bacteria in patients with sickle cell anemia, Pseudomonas aeurginosa in drug addicts, and organisms which usually reside in the gastrointestinal tract in the elderly. Extremely rarely, the viruses which cause chickenpox and smallpox have been found to cause a viral osteomyelitis.
    • Staph. aureus - Most common except in neonates (Streptococcus B)
    • Haemophilus influenzae – common in the 6 month to 5 year range
    • Gram negative bacilli in vertebral bodies of adults
    • TB & fungal causes can be traced to pulmonary pathology
    • Salmonella common in individuals with sickle cell
    • Pseudomonas aeruginosa common in the setting of IVDU
    • Dead bone can then get surrounded and a sequestrum is formed.
    • Unexplained fever with bone pain in a child is osteomyelitis until proven otherwise.
    • Pathophysiology:
    • Bacterial seeding in small arterioles of the metaphysis where there is sluggish blood flow
    • Infection elevates pressure, creating pain
    • Pus lifts periosteum, causing cortical necrosis, which leads to development of sequestrum
    • Local reaction with inflammation and abscess formation
    • Presentation:
    • Local pain & tenderness, heat, soft tissue swelling
    • Signs of systemic disease or general sepsis may precede (anorexia, nausea, malaise, irritability)
    • Evidence of overlying infection may be present
    • Lower extremity involvement common - refusal to bear weight or move extremity
    • Possible fever 100-102° F (acute)
    • Onset less acute and constitutional symptoms less marked in adults
    • Evaluation:
    • WBC may be normal
    • ESR/CRP to monitor disease
    • X-rays --> changes appear after 10-15 days
    • Soft tissue swelling
    • Periosteal elevation
    • Bone infarct & collapse
    • Bone scan --> confirms in 24-48 hrs
    • Focal increased activity
    • Blood culture to confirm diagnosis & organism (+ in 50% of children)
    • Bone aspiration for cultures
    • MRI or CT scan more sensitive
    • Treatment:
    • Antibiotic therapy for minimum four to six weeks – based on culture
    • Parenteral antibiotics can be administered on an outpatient basis
    • Correct dehydration and anemia, diet high in vitamins & protein
    • Surgery:
    • Drainage & debridement with management of resultant dead space
    • Stabilization of bone
  59. Subacute osteomyelitis
    • Insidious onset over 2 weeks
    • Increased host resistance and decreased virulence
    • Staph. aureus, Strep. epidermidis
    • Systemic symptoms unlikely
    • WBC normal
    • ESR elevated in ~50%
    • X-rays and bone scans (+)
    • Difficult to differentiate from primary bone tumor
  60. Chronic osteomyelitis
    • Difficult to eradicate, often polymicrobial
    • Common in lower extremities of diabetic patients
    • Follows trauma, or post-op
    • Fever, pain, mild systemic symptoms, minimal soft tissue inflammation
    • Infected bone is walled off by fibrous tissue, preventing antibiotic penetration
    • Minor trauma may reactivate
    • X-ray shows small dense areas of dead bone (sequestra) surrounded by new shell of bone called the involucrum
    • Treatment – I&D, radical debridement, sequestrectomy, antibiotics for 4-6 weeks
  61. osteopenia
    • A condition of bone in which there is a generalized reduction in bone mass that is less severe than that in osteoporosis, caused by the resorption of bone at a rate that exceeds bone synthesis.
    • Reduction in bone mass, usually caused by a lowered rate of formation of new bone that is insufficient to keep up with the rate of bone destruction. Osteopenia often occurs together with amenorrhea and eating disorders in female athletes. It can lead to premature osteoporosis if left untreated.
  62. osteophyte
    • Also referred to as bone spur, it is an outgrowth or ridge that forms on a bone.
    • a bony outgrowth, usually found around a joint. It is commonly seen in degenerative joint disease.
  63. osteosarcoma
    • Second most common primary malignant tumor of bone
    • Malignant cells produce immature woven bone, or osteoid
    • More common in children than adults, M>F
    • Long bones (70-80%) - distal femur, proximal tibia, proximal humerus (50-60% knee area)
    • Mild pain for weeks-months
    • Pain gradually becomes more severe & accompanied by swelling and limitation of motion
    • Weight loss is correlated with disseminated disease
    • Blood tests may demonstrate a high serum alkaline phosphatase
    • X-ray:
    • Aggressive lesion in metaphysis
    • Lytic and blastic
    • "Codman's triangle", "Sunburst"
    • MRI --> extent of lesion
    • Bone scan --> extent of lesion, mets
    • CT chest --> mets, staging
  64. Codman triangle
    • a distinctive triangular form of periosteal reaction seen when an aggressive bone lesion grows faster than new periosteum can be ossified. Only the periosteum at the very margin of the lesion has time to ossify creating a triangular lip of new bone.
    • The most common causes of a Codman triangle are osteosarcoma, Ewing sarcoma and osteomyelitis
  65. Ewing's Sarcoma
    • Small, round-cell sarcoma, “blue cells”
    • Children and young adults; >5 y/o
    • Occurs primarily in long bones - distal femur, proximal tibia, femoral diaphysis; and flat bones – pelvis, ribs
    • Consistent presence of chromosomal abnormality - translocation t(11;22)(q24;q12) that results in EWS/FLI-1 chimeric protein
    • Mass & localized pain
    • ↑ WBC, leukocytosis
    • Increased sedimentation rate, fever, anemia, malaise -indicative of metastatic disease
    • 10% of patients present with multiple bony lesions
    • May have elevated LDH
    • Imaging:
    • Permeative or moth eaten bone destruction, ill defined and malignant appearing
    • Soft tissue mass in 90% of cases
    • Periosteal reaction in 50% of cases (Onion Skin, Hair on End (sunburst))
    • Pathologic fracture in 10-15%
  66. Ottawa rules
    • The decision to obtain radiographic evaluation of the acutely injured ankle should follow the guidelines of the Ottawa Ankle Rules. Based on the Ottawa Ankle criteria, radi-ographs are only required for patients with tenderness at the posterior edge or tip of the medial or lateral malleolus, inabil-ity to bear weight at presentation (four steps in the emergency room or clinic), or pain at the base of the fifth metatarsal. The standard three views of the ankle include an AP, lateral, and mortise view.
    • Image Upload
    • X-ray required if pain in the Malleolar zone AND
    • Bone tenderness at A or B OR
    • Inability to bear weight immediately and in ED
    • X-ray required if pain in the Midfoot zone AND
    • Bone tenderness at C or D OR
    • Inability to bear weight immediately and in ED
  67. paresthesias
    A prickly, tingling sensation.
  68. patellar femoral grinding test
    • The Apley grind test can also be performed to assess for meniscal pathology. This test is performed with the patient lying prone on the examination table with the knee flexed to 90°. Downward pressure is applied to the foot and leg while rotating, flexing, and extending the knee. A positive test will elicit pain and popping along the joint line.
    • Patients with chronic, degenerative meniscus tears may have fewer positive physical findings. Anatomically, degenerative tears involve more meniscal fraying and fissuring; such tears do not often have large pieces of torn meniscus in the knee joint space that can produce mechanical symptoms. Therefore, tests such as the McMurray and Apley may not be positive. The absence of such positive provocative tests does not rule out chronic meniscus tear. Patients will consistently demonstrate medial or lateral joint line tenderness. Patients with chronic tears will also often have some degree of coexisting degenerative joint disease (DJD).
  69. patellofemoral syndrome
    • anterior knee pain due to a structural or functional disturbance in the relation between the patella and distal femur.
    • Degenerative condition affecting the articular cartilage of the patella caused by abnormal compression or shearing forces at the kneejoint; may cause patellalgia.
  70. periosteal reaction
    production of new bone by the periosteum in response to injury or irritation.
  71. Phalen's sign
    Test Phalen’s sign for median nerve compression by asking the patient to hold the wrists in flexion for 60 seconds. Alternatively, ask the patient to press the backs of both hands together to form right angles. These maneuvers compress the median nerve.
  72. Tinel's sign
    Test Tinel’s sign for median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel as shown.
  73. pivot-shift test
    a maneuver to detect a deficiency of the anterior cruciate ligament of the knee; when the knee is moved into a position near full extension, a subluxation of the lateral tibial condyle upon the distal femur is positive.
  74. plantar fasciitis
    • Heel spur syndrome
    • The most common cause of inferior heel pain, usually of the medial aspect of the plantar fascia as it attaches to the inferior medial calcaneal tuberosity; the pain is usually worse in the morning and persists as a dull, toothache-like pain, exacerbated by ↑ activity, lasting up to 6-12 months; the medial insertion of the plantar fascia on the calcaneus may be tender; extension of the great toe can cause Sx; cavus feet or pronation on gait may be evident on exam
    • Management:
    • Cross-friction ice massage, arch exercises, stretches, heel cups, NSAIDs, arch pads/orthotics, night splints, physical therapy
  75. plantar fibromatosis
    fibromatosis of plantar fascia, with single or multiple nodular swellings, sometimes with pain but usually without contractures.
  76. posterior drawer sign
    With the patient supine, hips flexed and knees flexed to 90° and feet flat on the table, cup your hands around the knee with the thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings. Push the tibia posteriorly and observed the degree of backward movement in the femur.
  77. pseudoarthrosis
    • a pathological entity characterized by a nonosseous union of bone fragments of a fractured bone due to inadequate immobilization leading to existence of the 'false joint' that gives the condition its name.
    • The non-union of 2 fractured ends of a long bone, in which the bone is covered by fibrous tissue or fibrocartilage; in extreme cases, the false joint is surrounded by a bursal sac containing synovial fluid; congenital PAs may occur in von Recklinghausen's disease or osteogenesis imperfecta; acquired PA usually follows trauma or, less commonly, tumor-related osteolysis and fibrous dysplasia.
  78. radicular pain
    Pain along the pathway of a spinal nerve.
  79. radiolucency
    a radiographic representation of decreased density of hard and soft tissue structures.
  80. reflex sympathetic dystrophy
    • the feeling of pain associated with evidence of minor nerve injury.
    • Historically, reflex sympathetic dystrophy (RSD) was noticed during the civil war in patients who suffered pain following gunshot wounds that affected the median nerve (a major nerve in the arm). In 1867 the condition was called causalgia form the Greek term meaning "burning pain." Causalgia refers to pain associated with major nerve injury. The exact causes of RSD are still unclear. Patients usually develop a triad of phases. In the first phase, pain and sympathetic activity is increased. Patients will typically present with swelling (edema), stiffness, pain, increased vascularity (increasing warmth), hyperhydrosis, and x-ray changes demonstrating loss of minerals in bone (demineralization). The second phase develops three to nine months later, It is characterized by increased stiffness and changes in the extremity that include a decrease in warmth and atrophy of the skin and muscles. The late phase commencing several months to years later presents with a pale, cold, painful, and atrophic extremity. Patients at this stage will also have osteoporosis.
    • It has been thought that each phase relates to a specific nerve defect that involves nerve tracts from the periphery spinal cord to the brain. Both sexes are affected, but the number of new cases is higher in women, adolescents, and young adults. RDS has been associated with other terms such as Sudeck's atrophy, post-traumatic osteoporosis, causalgia, shoulder-hand syndrome, and reflex neuromuscular dystrophy.
  81. Salter-Harris classification
    • The classification of epiphysial fractures into five groups (I to V), according to different prognoses regarding the effects of the injury on subsequent growth and subsequent deformity of the epiphysis.
    • Mneumonic = SALTR
    • *Requires viewing the bone with epiphysis at the base*
    • I - S = Slipped or Separated. Involves the cartilage of the physis (growth plate) only, with no bony fracture.
    • II - A = Above. The fracture lies above the physis, in the metaphysis.
    • III - L = Lower. The fracture is below the physis, in the epiphysis.
    • IV - T = Through. The fracture is through the metaphysis, physis, and epiphysis.
    • V - R = Rammed or Ruined. The physis has been crushed or destroyed.
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  82. SCFE
    • Slipped capital femoral epiphysis
    • Represents a displacement of the proximal femur relative to the capital femoral epiphysis, which occurs through the physis. Both anatomic and biomechanical abnormalities may render the physis more susceptible to shear stresses, including retroversion of the hip, a posterior inclination at the proximal femoral physis, and weakening of the perichondrial ring associated with the adolescent growth spurt. Mechanical factors are also felt to play an important role, as most patients are above the 95th percentile for weight. A slipped epiphysis most commonly occurs in boys from 13 to 15 years of age and in girls from 11 to 13 years of age. Bilateral involvement will occur in 25% to 60% of patients. The incidence is approximately 1/100,000 and may well be increasing given the fact that childhood obesity has become a public health concern in the United States.
    • While SCFE may be seen in association with endocrinopathies and metabolic disorders, the vast majority of patients will have a normal endocrinologic evaluation. An underlying endocrinopathy should be suspected when the diagnosis is made in a thin patient or when the age is atypical for a slipped epiphysis (<10 years or >16 years). Underlying diagnoses associated with a slipped epiphysis include hypothyroidism, growth hormone deficiency (with or without replacement therapy), panhypopituitarism, hypogonadism, and renal disease (secondary hypoparathyroidism). Patients who have received pelvic irradiation are also susceptible. An early diagnosis is essential, and referred pain is one cause of delay in diagnosis. Patients commonly present with pain in the groin, but the discomfort may also be referred to the thigh or the knee. The pain is dull in character, worsened by activity, and progressive in nature. A small subset of patients will present with the acute onset of severe pain, often following a minor injury. In these cases, the slipped epiphysis may be likened to an acute physeal fracture. Most patients have an externally rotated gait even before developing a slipped epiphysis, and external rotation or out-toeing will be increased further in the presence of a slipped epiphysis.
    • There have been two schemes used to classify SCFE. The clinical classification of stable versus unstable is perhaps most useful. Patients with a stable SCFE are able to bear weight (with or without crutches), and those with an unstable SCFE are unable to bear weight. While patients classified as stable have approximately a 1% risk of avascular necrosis, those with an unstable slip (approximately 5%) have a much higher risk of avascular necrosis (15%–47%). Avascular necrosis is commonly complicated by premature joint degeneration. A temporal classification has also been proposed, including acute (<3 weeks duration of symptoms), chronic (>3 weeks duration), and acute on chronic (recent exacerbation of symptoms that have been present for weeks to months). The long-term outcome relates to the degree of displacement (malalignment at the junction of the femoral head and neck) at the time of stabilization or at closure of the physis and whether or not complications such as chondrolysis or avascular necrosis occur. Patients with residual deformity may develop impingement (metaphyseal prominence strikes the acetabulum), resulting in pain and/or mechanical symptoms such as popping or locking. Those with moderate to severe malalignment will develop early osteoarthritis, often in the third or fourth decade.
  83. sclerotic
    • Stage II description of radiographic findings with respect to Ficat-Arlet Classification of Osteonecrosis of the Femoral Head
    • "Sclerotic or cystic lesions without subchondral fracture"
    • (Table 12-2 p 53 of Lippincott's Primary Care Orthopaedics)
    • Bone tumours:
    • Bone metastases may be seen on abdominal X-rays. These can be lytic (low density - black) or sclerotic (higher density - white). The most frequently encountered bone metastases are prostate cancer in men which is sclerotic, and breast cancer in women which can be sclerotic or lytic.
  84. septic arthritis
    • suppurative arthritis
    • a form marked by purulent joint infiltration, chiefly due to bacterial infection but also seen in Reiter's disease.
    • Hematogenous, direct injection, contiguous spread
    • Young children/elderly
    • Usually monoarticular, large peripheral joints (knee, hip)
    • Most cases are bacterial, but viral, fungal possible
    • Organisms – S. aureus, N. gonorrhoeae, H. flu, gram negative rods (IVDU)
    • Risk factors - Underlying chronic disease, immunosuppressed state
    • Presentation - Acute onset, Pain, Refusal to bear weight, Fever, Warm, swollen, diffusely tender joint, Joint held in slight flexion, ROM painful
    • X-ray findings minimal – distention of joint capsule
    • Marked elevation of WBC
    • Blood cultures may be positive
    • ESR/CRP elevated
    • Confirmation of diagnosis is by joint aspiration:
    • Cloudy, purulent, WBC, glucose
    • Gram stain, culture, look for crystals
    • Treatment:
    • Joint adequately drained (arthroscopically)
    • Decrease intraarticular pressure, evauation of exudate, and prevent articular destruction
    • Empiric IV antibiotics, then culture specific
    • Rest & immobilization of joint in stable position
    • DDX - inflammatory arthritis (RA, Gout, Psuedogout, Lyme), Lupus, Osteoarthritis
    • Treat with broad spectrum IV antibiotics (empiric) until culture specific can be used.
  85. sequestrum
    • A fragment of dead tissue, usually bone, that has separated from healthy tissue as a result of injury or disease.
    • The new shell of bone that surrounds it is called a involucrum.
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  86. spinal stenosis
    • Spinal stenosis is any narrowing of the spinal canal that causes compression of the spinal nerve cord. Spinal stenosis causes pain and may cause loss of some body functions.
    • When the spinal canal narrows, nerve roots in the spinal cord are squeezed. Pressure on the nerve roots causes chronic pain and loss of control over some functions because communication with the brain is interrupted. The lower back and legs are most affected by spinal stenosis. The nerve roots that supply the legs are near the bottom of the spinal cord. The pain gets worse after standing for a long time and after some forms of exercise. The posture required by these physical activities increases the stress on the nerve roots. Spinal stenosis usually affects people over 50 years of age. Women have the condition more frequently than men do.
    • Cervical spinal stenosis is a narrowing of the vertebrae of the neck (cervical vertebrae). The disease and its effects are similar to stenosis in the lower spine. A narrower opening in the cervical vertebrae can also put pressure on arteries entering the spinal column, cutting off the blood supply to the remainder of the spinal cord.
    • Spinal stenosis causes pain in the buttocks, thigh, and calf and increasing weakness in the legs. The patient may also have difficulty controlling bladder and bowel functions. The pain of spinal stenosis seems more severe when the patient walks downhill. Spinal stenosis can be congenital, acquired, or a combination. Congenital spinal stenosis is a birth defect. Acquired spinal stenosis develops after birth. It is usually a consequence of tissue destruction (degeneration) caused by an infectious disease or a disease in which the immune system attacks the body's own cells (autoimmune disease). The two most common causes of spinal stenosis are birth defect and progressive degeneration of the tissue of the joints (osteoarthritis). Other causes include improper alignment of the vertebrae as in spondylolisthesis, destruction of bone tissue as in Paget's disease, or an overgrowth of bone tissue as in diffuse idiopathic skeletal hyperostosis. The spinal canal is usually more than 0.5 in (12 mm) in diameter. A smaller diameter indicates stenosis. The diameter of the cervical spine ranges is 0.6-1 in (15-12 mm). Any opening under 0.5 in (13 mm)in diameter is considered evidence of stenosis. Acquired spinal stenosis usually begins with degeneration of the intervertebral disks or the surfaces of the vertebrae or both. In trying to heal this degeneration, the body builds up the spinal column. In the process, the spinal canal can become narrower.
  87. spondylolisthesis
    forward displacement of a vertebra over a lower segment, usually of the fourth or fifth lumbar vertebra due to a developmental defect in the pars interarticularis
  88. spondylolysis
    Degeneration of the articulating part of a vertebra.
  89. spondylosis
    • A degenerative disease of the spinal column, especially one leading to fusion and immobilization of the vertebral bones.
    • Arthritis of the spine.
  90. squeeze test
    The Thompson test for continuity of the gastrocnemius–soleus complex. Without rupture of the Achilles tendon, squeezing the calf causes active plantar flexion of the foot. With rupture, squeezing the superficial posterior compartment of the leg does not induce plantar flexion of the foot.
  91. straight leg raise
    • The straight leg raise, also called Lasègue's sign, Lasègue test or Lazarević's sign, is a test done during the physical examination to determine whether a patient with low back pain has an underlying herniated disk, often located at L5 (fifth lumbar spinal nerve).
    • With the patient lying down on his or her back on an examination table or exam floor, the examiner lifts the patient's leg while the knee is straight.
    • If the patient experiences sciatic pain when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disc is likely to be the cause of the pain.
  92. stress fracture
    • caused by unusual or repeated stress on a bone.
    • Fracture that occurs when weak bone is stressed normally aka insufficiency fracture or when normal bone is stressed excessively—fatigue fracture
  93. styloid
    • Of or relating to any of several slender pointed bone processes, especially the spine that projects from the base of the temporal bone.
    • Radial styloid tenosynovitis - de Quervain tenosynovitis at anatomical snuff box
    • Ulna styloid - common fracture site
  94. subluxation
    Incomplete or partial dislocation, as of a bone in a joint.
  95. syndactyly
    persistence of webbing between adjacent digits of the hand or foot, so that they are more or less completely fused together
  96. syndesmotic sprain
    see high sprain
  97. tenosynovitis
    Inflammation of a tendon and its enveloping sheath. Also called tendinous synovitis, tenovaginitis.
  98. thenar
    The fleshy mass on the palm at the base of the thumb. Also called thenar prominence.
  99. trabecular bone
    • (spongy bone)
    • Bone in which the spicules form a latticework, with interstices filled with embryonic connective tissue or bone marrow. Also called cancellous bone, spongy substance, trabecular bone.
    • bone composed of thin intersecting lamellae, usually found internal to compact bone.
  100. trigger finger
    • Trigger finger is the popular name of stenosing tenosynovitis, a painful condition in which a finger or thumb locks when it is bent (flexed) or straightened (extended).
    • Problems start when a tendon sheath narrows (stenosis) and the outer covering of the tendon becomes inflamed (tenosynovitis). The tendon swells because of the constriction, sometimes forming a nodule, and is no longer able to move smoothly through its sheath. As a result, a finger may lock in an upward position as the person tries to straighten it. The condition usually happens in the ring and middle fingers and is more common in women, typically over age 30. In infants and small children, the condition generally occurs in the thumb.
    • Trigger finger is often an overuse injury because of repetitive or frequent movement of the fingers. Trigger finger may happen because a person performs the same manipulation over and over on a job, from squeezing and gripping during a weekend of heavy pruning and gardening, or from such hobbies as playing a musical instrument or crocheting. Trigger finger may also result from trauma or accident. The symptoms of trigger finger are pain in the fingers and "popping" sensations. Sometimes the finger may lock down into the palm or lock out straight. Symptoms are usually worse in the morning and improve during the day.
  101. trochanteric bursitis
    pain over the greater trochanter - the bony prominence on the femur on either side of the thigh. Caused by inflammation of the bursa between the bone and the overlying muscle. Occurs as a result of repeated friction due to poor running gait or technique, altered biomechanics or poor muscle co-ordination. Management is as for bursitis elsewhere, including analgesia and identification of the underlying cause.
  102. unicameral bone cyst
    • unicameral = simple/solitary
    • fluid-filled cystic lesion of growing bone
    • most common age 8-14, M>F
    • proximal humerus/femur, foot
    • unknown etiology
    • Asymptomatic, but often diagnosed following pathologic fracture - Immediate pain at site and pain with movement
    • X-ray characteristics:
    • Large radiolucent mass
    • Wider at growth plate, narrow at diaphysis
    • Cortex expanded & thin
    • Lesion does not penetrate into soft tissue
    • Matures over time - Migrates away from growth line, Shrinks in size, May disappear completely
    • Treatment:
    • Treat fracture – sling, avoid sports
    • If recurrent – aspirate, inject steroid (methylprednisilone); autologous bone marrow injection; multiple drill holes
  103. valgus
    bent out, twisted; denoting a deformity in which the angulation is away from the midline of the body
  104. varus
    bent inward; denoting a deformity in which the angulation of the part is toward the midline of the body
  105. arthrocentesis
    the puncture of a joint with a needle and the withdrawal of fluid, performed to obtain samples of synovial fluid for diagnostic purposes. It may also be used to instill medications and to remove fluid from joints to simply relieve pain. A local anesthetic is usually administered; surgical asepsis is observed in the procedure. Normal synovial fluid is a clear, straw-colored, slightly viscous liquid that forms a white, viscous clot when mixed with glacial acetic acid; if inflammation is present, as in rheumatoid arthritis, the fluid is watery and turbid, and its mixture with glacial acetic acid results in a flocculent, easily broken clot. The number of leukocytes, especially polymorphonuclear cells, and the protein content are increased, and the glucose level is decreased if inflammation is present. Synovial fluid samples are also cultured and examined microscopically to diagnose a septic process, such as bacterial arthritis.
  106. arthrogram
    Imaging of a joint following the introduction of a contrast agent into the joint capsule to enhance visualization of the intraarticular structures.
  107. bone scan
    • An x-ray study in which patients are given an intravenous injection of a small amount of a radioactive material that travels in the blood. When it reaches the bones, it can be detected by x ray to make a picture of their internal structure.
    • A method in which a radioactive compound—e.g., 99mTc IDA—is administered and its distribution in the body analysed by a scintillation camera for increased or decreased uptake in bone. Uptake in the bone is usually increased in infection, fractures and malignancy.
  108. C & S
    • culture and sensitivity
    • Aspiration of knees with effusions can provide significant relief to the patient and can give valuable diagnostic information. Aspirated fluid may be sent for the following analyses - white blood cell count with differential, anaerobic and aerobic culture and sensitivities, and crystals. If there is any suspicion for sepsis, aspiration is paramount.
  109. CBC
    Provides information about 3 types of cells - WBC, RBC and platelets
  110. DEXA
    • (Dual Energy X-ray Absorptometry)
    • Low dose X-rays are generated and passed through the patient’s spine, hip(s) and/or forearm(s).
    • The differing energies of radiation which passed through the patient are received by sensitive detectors within the scan arm.
    • This information is then sent to a computer which determines the structures relative bone mass which is reported in cubic cm.
    • This becomes the patients Bone Mineral Density (BMD) value.
    • This numeric BMD value is then converted into T & Z scores, which are then compared to a reference table and classified as normal, osteopenia or osteoporosis. These tables are most often based on studies performed by the WHO or NOF.
    • DEXA used to evaluate:
    • Osteopenia/Osteoporosis
    • Recent advancements allow capable DEXA units to classify and grade types of spinal compression fractures and determine total body mass indices (BMI).
  111. ESR
    • erythrocyte sedimentation rate
    • The rate at which red blood cells settle out in a tube of unclotted blood, expressed in millimeters per hour; elevated sedimentation rates indicate the presence of inflammation.
  112. Gallium scan
    a nuclear scan of the total body performed after an IV injection of radioactive gallium, a radionuclide that concentrates in areas of inflammation and infection, abscess, and benign and malignant tumor. It is useful in detecting metastatic tumor, especially lymphoma.
  113. gram stain
    a staining procedure in which microorganisms are stained with crystal violet, treated with strong iodine solution, decolorized with ethanol or ethanol-acetone, and counterstained with a contrasting dye; those retaining the stain are gram-positive, and those losing the stain but staining with the counterstain are gram-negative.
  114. isotope-labeled WBC scan
    • A labeled WBC scan is used for detection of abscesses and infection in soft tissues, skeleton, or fever of unknown origin.
    • A nuclear medicine procedure in which white blood cells (mostly neutrophils) are removed from the patient, tagged with the radioisotope Indium-111, and then injected intravenously into the patient. The tagged leukocytes subsequently localize to areas of relatively new infection. The study is particularly helpful in differentiating conditions such as osteomyelitis from decubitus ulcers for assessment of route and duration of antibiotic therapy.
  115. joint aspiration
    see arthrocentesis
  116. MRI
    • The patient is placed into a powerful, enclosed or open magnetic environment (at least 30,000x greater than Earth’s magnetic field)
    • This field causes uniform alignment of charged ions inside the cell into positive and negative poles. The ions are usually randomly aligned in haphazard fashion in the cells.
    • Hydrogen atoms are highly influenced by magnetic fields and all the cells in our bodies have H+ atoms within them.
    • When the magnet is turned on and off the cells resonate and this resonation can be detected by sensors in the unit.
    • Tissues within our bodies resonate differently. These differing resonations are then captured by detectors and a powerful & sophisticated computer interprets the information thereby creating an image.
    • Contraindications to MRI:
    • Pacemakers
    • AICD's
    • Cerebral aneurysm clips prior to 1990.
    • Neuro-stimulators
    • Metal joint replacements degrade the image greatly making scanning in or around these objects difficult.
    • Any other inplantable and/or non-removable metallic device is suspect. Ask the MRI technologist at the medical imaging center if you have any questions concerning a potentially hazardous foreign body or device.
    • Metformin and contrast - nephrogenic systemic fibrosis (NSF)
    • MRI used to evaluate:
    • Brain & Spinal Cord
    • Nerves
    • Skeletal System & Joints.
    • Abdomen/Pelvis
    • Chest
    • Soft tissues of the extremities.
    • Blood vessels (MRA)
    • Gallbladder and bile ducts. (MRCP)
    • Breast
    • Prostate
    • Heart
    • Joints post arthrography
  117. CT scan
    • Computerized Axial Tomography (CAT Scan)
    • X-ray’s travel through the patient as the X-ray tube spins in 360° circles around the body (Called Tomography).
    • Detectors at the opposite end of the tube capture the x-rays that have traveled through the patient and interpret their differing wavelengths or strengths.
    • A powerful computer then interprets these wavelengths and digital, cross sectional type images are constructed.
    • Tumors suck up contrast to show whiter on CT due to increased blood flow to it.
    • Don't use contrast for kidney stones (looking for white horse in a snow storm)
    • CT used to evaluate:
    • Brain
    • Sinuses
    • Organs & tissues of the face & neck
    • Chest
    • Abdomen
    • Pelvis
    • Soft tissues of the extremities
    • Joints (especially following arthrography)
    • Blood vessels or heart using a technique known as CT-angio (CTA)
    • Spinal cord following myelography.
    • Limitations of CT:
    • CT has limitations detecting the presence of small to moderate sized intra-luminal lesions within the GI tract.
    • CT is also somewhat limited when trying to decipher between purely cystic versus solid lesions.
  118. plain X-ray
    • A powerful electric current is applied to a negatively charged cathode which "boils" off high energy electrons.
    • These electrons are then attracted by, and impact a positively charged anode at high speed. A large amount of energy is released as a result of this impact, some of which is in the form of X-radiation.
    • The X-rays produced then travel out of the "tube" and through the patient.
    • The radiation that penetrates the patient is then captured by a device(s) designed to produce an image.
    • The varying wavelengths or "strength" of the penetrating radiation, making it through the patient, is key to how the collection device will determine the images appearance.
    • X-ray used to evaluate:
    • Chest - Infiltrative processes, infectious processes, pulmonary neoplasms, pulmonary emboli, atelectasis, Heart size and diaphragmatic position.
    • Abdominal - Bowel OBS., perforated viscous ("free air"), organomegally, large abdominal masses or fluid collections/ascites.
    • Skeletal - Bony fractures, dislocation, arthritic processes, bony neoplasms, growth and/or malalignment disorders.
  119. stress radiographs
    positioning to intentionally place stress on structures being radiographed; most commonly used in the diagnosis of spinal disorders such as atlantoaxial instability, wobbler syndrome and lumbosacral instability. Also used for x-ray studies of the knee.
  120. analgesics
    • a medicine that relieves pain
    • The primary classes of analgesics are the narcotics, including additional agents that are chemically based on the morphine molecule but have minimal abuse potential; nonsteroidal anti-inflammatory drugs (NSAIDs) including the salicylates; and acetaminophen. Other drugs, notably the tricyclic antidepressants and anti-epileptic agents such as gabapentin, have been used to relieve pain, particularly neurologic pain, but are not routinely classified as analgesics. Analgesics provide symptomatic relief, but have no effect on the cause, although clearly the NSAIDs, by virtue of their dual activity, may be beneficial in both regards.
  121. antibiotics
    any of various chemical substances, such as penicillin, streptomycin, chloramphenicol, and tetracycline, produced by various microorganisms, esp fungi, or made synthetically and capable of destroying or inhibiting the growth of microorganisms, esp bacteria
  122. muscle relaxants
    an agent that reduces the contractility of muscle fibers. Curare derivatives and succinylcholine compete with acetylcholine and block neural transmission at the myoneural junction. These drugs are used during anesthesia, in the management of patients undergoing mechanical ventilation, and in shock therapy, to reduce muscle contractions in pharmacologically or electrically induced seizures. Several drugs that relieve muscle spasms act at various levels in the central nervous system: baclofen inhibits reflexes at the spinal level; cyclobenzaprine acts primarily in the brainstem; and the benzodiazepines reduce muscle tension, chiefly by acting on mechanisms that control muscle tone. Dantrolene acts directly on muscles in reducing contraction and apparently achieves its effect by interfering with the release of calcium from the sarcoplasmic reticulum.
  123. NSAIDs
    • A nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen.
    • used for reducing inflammation and pain in rheumatic diseases. Possible adverse effects include gastric ulceration
  124. systemic corticosteroids
    • refer to corticosteroids that are given orally or by injection and distribute throughout the body. It does not include corticosteroids used in the eyes, ears, or nose, on the skin or that are inhaled, although small amounts of these corticosteroids can be absorbed into the body.
    • Corticosteroids belonging to the glucocorticoid class influence the body system in several ways, but they are used mostly for their strong anti-inflammatory effects and in conditions that are related to the immune system function such as:
    • arthritis (for example, rheumatoid arthritis),
    • colitis (ulcerative colitis, and Crohn's disease),
    • asthma,
    • bronchitis,
    • some situations involving skin rashes,
    • allergic or inflammatory conditions involving the nose and eyes
  125. arthroplasty
    surgery to relieve pain and restore range of motion by realigning or reconstructing a joint.
  126. arthroscopy
    the examination of a joint, specifically, the inside structures. The procedure is performed by inserting a specifically designed illuminated device into the joint through a small incision. This instrument is called an arthroscope. The procedure of arthroscopy is primarily associated with the process of diagnosis. However, when actual repair is performed, the procedure is called arthroscopic surgery.
  127. bursal aspiration
    The insertion of a needle in a bursa to withdraw fluid (for diagnostic purposes) or inject drugs (corticosteroids or local anaesthetics).
  128. closed reduction
    the manipulative reduction of a fracture without incision.
  129. open reduction
    reduction of a fracture after incision into the fracture site.
  130. debridement
    • the process of removing nonliving tissue from pressure ulcers, burns, and other wounds.
    • used in joint repair by removing necrotic tissue from the articulating surfaces of the joint.
  131. elbow strap
    • Tennis Elbow Band
    • Treatment:
    • Tennis elbow, medial and lateral epicondylitis
    • Comment:
    • This is a band that can be placed over the fore-arm for symptomatic relief of epicondylitis/tennis elbow. It should only be used during activity and offers relief of symptoms during activity. It should not be worn for prolonged periods of time.
  132. heel cups
    • moulded or casted thermoplastic within-shoe heel covers, to cushion plantar aspect of heel, control rearfoot pronation or treat plantar heel pain.
    • Heel Cushion
    • Treatment:
    • Achilles tendinitis, plantar fasciitis, heel bone bruise
    • Comment:
    • The soft insert can be placed into the sole of the shoe at the level of the heel in order to cushion against repeated injury. Can be used for short- or long-term painful heel problems.
  133. internal fixation
    any method of holding together the fragments of a fractured bone without the use of appliances external to the skin. After open reduction of the fracture, smooth or threaded pins, Kirschner wires, screws, plates attached by screws, or medullary nails may be inserted through an appropriate incision to stabilize the fragments. In some instances the device is removed at a later operation, but it may remain in the body permanently
  134. intra-articular injection
    introduction of steroid (e.g. hydrocortisone) and/or local anaesthetic into a joint cavity to reduce inflammation and/or pain
  135. joint aspiration
    see arthrocentesis
  136. joint splinting
    the application of a splint to reduce a fracture or to restrict movement.
  137. metatarsal bar
    • adhesive padding applied to the plantar forefoot or an insole, to realign metatarsal sagittal-plane angulation; metatarsal angle of inclination can be reduced by applying the full pad thickness at plantar aspects of metatarsophalangeal joints; body weight can be redistributed away from metatarsophalangeal joints by applying the full pad thickness just proximal to the metatarsal heads.
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  138. nerve block
    regional anesthesia by injection of anesthetics close to the appropriate nerve.
  139. neurontin
    • A trademark for the drug gabapentin
    • Pharmacologic class:
    • 1-amino-methyl cyclohexoneacetic acid
    • Therapeutic class:
    • Anticonvulsant
    • Pregnancy risk category C
    • Action:
    • Unknown. Possesses properties resembling those of other anticonvulsants, which appear to stabilize cell membranes by altering cation (sodium, calcium, and potassium) transport, thereby decreasing excitability and suppressing seizure discharge or focus.
  140. over-and-under taping
    • Treatment for hammer toe:
    • Flexion deformity at proximal interphalangeal joint
    • Results in depressed tip of toe deformity
    • Due to improperly fitting shoes
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  141. RICE
    abbreviation for rest, ice, compression, elevation, referring to the treatment for sprains and strains.
  142. steroid injection
    see intra-articular injection
  143. stretching exercises
    gym-/home-based daily exercise programme, practised over months/years, to lengthen tight muscle groups and improve function
  144. surgical debridement
    see debridement
  145. ultrasound
    • Ultrasound is produced by what is known as the piezoelectric effect.
    • A special crystal (called a piezoelectric crystal) is within the ultrasound probe and when excited by an electric current vibrates thus, producing sound.
    • The sound is produced in a frequency range much higher then the human ear can hear (>20,000 Hz). This is called ultrasound.
    • Sound waves travel from the probe through the patient and back to the probe again through a coupling gel applied to the patient’s body.
    • The returning sound waves varying speeds are interpreted by a sophisticated computer and "real-time" images are produced.
    • Ultrasound waves are disrupted when they come into contact with air and are completely attenuated when they come into contact with bone. Therefore, ultrasound is unable to image structures surrounded or associated with air and/or bone.
    • Ultrasound waves travel through water and soft tissue well. Therefore, any structure made up of these is potentially "fair game" for ultrasound provided they are not affected by air or bone.
    • Ultrasound used to evaluate:
    • Abdomen - All abdominal organs and structures with the exception of bowel.
    • Pelvis - Both male and female GU organs.
    • Heart/Vessels - Most arteries and veins of moderate and substantial size throughout the body. This is done by a means called doppler which allows us to see & measure blood flow within the vessel and diagnose vascular diseases. Referred to as a duplex scan.
    • Thyroid gland.
    • Neonatal brain through fontanel
    • Fluid Collections - Including the abd., chest & extremities.
    • Breast - Including axillary lymph nodes. *Not to be used as a screening tool for the breast.
    • Obstetrical - To asses the proper development and anatomical structure of the fetus.
Card Set:
PAP-591 Orthopedics
2014-10-07 15:10:54

FCM II Orthopedics
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