orthopedics and rheumatology

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orthopedics and rheumatology
2011-01-30 23:49:51
bones mccqe

from the purple book
Show Answers:

  1. define dislocation
    complete loss of contact b/w the articular surfaces of a joint
  2. define subluxation
    incomplete dislocation, results in nonconcentric joint surface
  3. define reduction
    a maneuver whereby a fracture or dislocation is returned to anatomic alignment
  4. define nonunion
    • failure of the bony edges to unite
    • (hypertrophic, atrophic)
  5. define malunion
    healing of the bony fragments in a faulty position --> causing an imperfect alignment, deformity or rotation
  6. what causes a traumatic #
    normal bone + abnormal force = traumatic fracture
  7. what causes a pathological #
    abnormal bone + normal force = pathological fracture
  8. what causes a stress #
    normal bone + repetitive force = stress fracture
  9. what do we need to include in any description of a #
    • 1. location
    • 2. fracture pattern (may be more than 1)
    • 3. open vs. closed
    • 4. displacement
    • 5. angulation
  10. what may cause a pathological fracture
    • 1. generalized bone disease (paget, metabolic - osteoporosis - hyper PTH - osteomalacia, EtOH, poor diet
    • 2. local disease (cyst, chronic infection)
    • 3. malignancy (met, sarcoma, multiple myeloma)
  11. which malignancies metastasize to bone?
    • breast
    • lung
    • prostate
    • kidney
    • thyroid
  12. what do we require for adequate x-ray of a fracture
    • minimum 2 views
    • joints above and below
    • before and after reduction
  13. what are the principles of fracture treatment
    • obtain reduction
    • maintain reduction
    • early mobilization
    • pain management
  14. what complications may arise from casting
    • compartment syndrome
    • soft tissue/skin injury
    • pressure sores
    • chaffing/pruritus
    • swelling
    • muscle atrophy
  15. what investigations are recommended for pathologic fractures
    • serum Calcium, phosphate, alk phos, PTH, TSH, T3/T4
    • serum protein electrophoresis
    • bone density
    • bone scan
    • bone biopsy
  16. how is compartment syndrome diagnosed
    • ***pain out of proportion to the injury
    • loss of muscle function followed by pain with passive stretch
    • use intracompartmental pressure readings for obtunded pts
    • pulselessness, paresthesia, pallor, paralysis, pain are LATE signs
  17. how are stress fractures treated
    • avoidance of the painful activity (immobilization if pain present at rest)
    • surgical treat in rare cases (nonunion, fracture propagation...)
  18. name the rotator cuff muscles
    • SITS
    • subscapularis
    • infraspinatus
    • teres minor
    • supraspinatus
  19. name the 4 articulations of the shoulder
    • sterno-clavicular
    • acromio - clavicular
    • gleno - humeral
    • scapulothoracic
  20. how to r/o referred pain as source of shoulder pain
    • poorly localized
    • full ROM w/o pain
  21. treatment of an open fracture
    • remove gross debris
    • splint extremity
    • start Abx
    • check Tetanus status
    • NPO, prep for OR
  22. what components of a closed fracture indicate need for open reduction/consult ortho?
    • neurovascular compromise
    • intra-articular fracture
    • salter harris II-V
    • non-union obtained
    • compartment syndrome
  23. which conditions are associated with
    trauma + shoulder pain
    • fractures - clavicle, humerus, scapula
    • dislocation - AC joint, GH joint
  24. which conditions are associated with
    shoulder pain + GH joint
    • frozen shoulder (adhesive capsulitis)
    • GH arthritis (OA, RA, crystalline)
    • GH instability
    • SLAP lesion (injury to the glenoid labrum - Superior Labral tear from Anterior to Posterior)
  25. which conditions are associated with shoulder pain + periarticular
    • AC arthritis
    • rotator cuff injury (impingement, tendiopathy, tear)
    • biceps tendinopathy/rupture
    • subacromial bursitis
  26. which conditions are associated with referred shoulder pain
    • neurologic - disc herniation/stenosis, brachial plexus injury
    • abdo - splenic injury, hepatobiliary
    • thoracic - apical lung tumour, upper lobe pneumonia
    • cardiac - MI (left shoulder only)
  27. etiology of a GH dislocation
    85% are anterior - abduction and external rotation of th earm or hyperextension (usually traumatic)

    • 15% are posterior - high energy force when an arm in adduction and internal rotation
    • associated with the Es (epilepsy, EtOH, electrical shock, encephalitis)
  28. signs and symptoms of an anterior GH dislocation
    • "squared off shoulder"
    • arm held in abduction/internal rotation
    • humeral head may be palpable
    • may/not be nerve injury
  29. signs and symptoms of posterior GH dislocation
    • flattening of anterior shoulder
    • prominent coracoid
    • arm held in adduction/internal rotation
    • limited abduction/external rotation
  30. treatment of a clavicle fracture
    proximal and middle fractures: sling 2-3 wks, rehab to increase ROM, strengthening

    distal third - if unstable may need ORIF
  31. what should you suspect with posterior shoulder pain
    • (not common)
    • usually from rotator cuff tendinopathy or referred pain from the cervical spine
  32. what is rotator cuff impingement
    • compression of the rotator cuff tendons (and the subacromial bursa) between the acromion and the humeral head
    • related to narrowing of supraspinatus outlet or muscular dysfunction/capsular tightness
  33. signs and symptoms of rotator cuff impingement
    • shoulder pain with overhead activities
    • painful arc (60' to 120')
    • positive impingement tests - Neer, Hawkins
    • atrophy of muscles around the joint if chronic
  34. risk factors for rotator cuff impingement
    • acromial morphology
    • rotator cuff dysfunction
    • repetitive overhead activities
  35. how is rotator cuff impingement treated
    • NSAIDs
    • physio
    • subacromial decompression
  36. what are the signs and symptoms of rotator cuff tendinopathy
    • pain along lateral deltoid with over head activity (reaching, pulling)
    • positive painful arc test
    • increased pain when sleeping on the affected side
  37. how is rotator cuff tendinopathy treated
    • NSAIDs
    • steroid injection
  38. signs and symptoms of a rotator cuff tear
    • anterolateral pain
    • night pain
    • shoulder weakness (unable to reach overhead)
    • popping/catching of shoulder with movement
    • positive drop arm test if tear is complete
  39. treatment of rotator cuff tear
    • acutely:
    • heat
    • exercise
    • local anesthetic injection

    • after 3 weeks:
    • young/active --> surgical repair
    • elderly/sedentary --> conservative tx
  40. what is a SLAP lesion
    tear of labrum at the point of biceps tendon attachment leading to labrum and biceps tendon tear
  41. what conditions can lead to adhesive capsulitis
    • rotator cuff injury (most common)
    • DM
    • use of sling
    • stroke
    • axillary surgery
  42. signs and symptoms of capsulitis
    • stiffness
    • decrease ROM (external rotation > abduction > internal rotation)
    • unable to reach up/put on clothes
    • may have pain w mov't or direct pressure
    • predictable stages (freezing, frozen, thawing)
  43. what is the tx for capsulitis (frozen shoulder)
    • NSAIDs
    • local heat
    • PT to increase ROM and prevent further stiffening (NOT in freezing stage)
    • may use injection of local anesthetic/corticosteroids
    • arthroscopic release prn
  44. signs and symptoms of acromioclavicular OA
    grinding/popping sensation when reaching overhead or across the chest
  45. signs and symptoms of glenohumeral OA
    chronic and progressively worsening stiffness and pain (esp w abduction and external rotation)
  46. treatment of glenohumeral OA
    • NSAIDs
    • PT to increase ROM
    • steroid injections
    • shoulder replacement prn