Musculoskeletal conditions wk3

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Musculoskeletal conditions wk3
2011-03-28 19:28:00
block4 wk3

block4 week3 musculoskeletal conditions
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  1. Torus fracture of radius
    • unique to children
    • one side of the bone bends, microfractures, no break
    • falling on outstretched arms
  2. Colles' Fracture
    • distal end of radius
    • falling on outstretched arms
  3. Scaphoid fracture
    • most common carpal fracture
    • falling injury
    • tenderness over snuffbox area
    • people will think wrist is sprained
    • Delay of treatment -> OA, decreased wrist strength
    • more common in young adult athletes
  4. Metacarpal #5 angulated neck fracture
    • aka boxer's fracture
    • collateral ligaments become slack
  5. Salter Harris/Phalanx growth plate injury
    acute event or overuse/physical abuse
  6. Distal phalanx fractures
    • significant soft tissue injury
    • slammed finger, sports injury
  7. Nursemaid's elbow
    • partial dislocation of proximal radioulnar joint
    • annular ligament slides over the head of the radius and becomes entrapped
    • 1-3YO, child may avoid use of arm
    • Tenderness over elbow joint
    • Reduce joint dislocation: supinate and flex forearm until "click" is heard/felt
    • may have recurrence, no long term effects
  8. Hand RA
    • MCP joints most affected
    • Ulnar deviation @MCPs
    • hyperextension of PIPs w/flexion of DIPs (swan-neck)
    • flexion of PIPs w/hyperextension of DIPs (boutonniere deformity)
    • Symmetrical joint swelling, rheumatoid nodules, fusion of carpal bones
    • NSAIDs/antirheumatic agents
  9. Hand OA
    • Narrowed joint spaces @ PIP, DIP, & CMC joint of thumb (most affected)
    • Bony deformity and bony nodules @ PIP (Bouchard's nodes) & DIP (Heberden's nodes), osteophytes
    • Localized pain, gradual onset
    • Accelerated cartilage degeneration if joint is overused
    • Atrophy, decreased ROM due to pain/stiffness
    • NSAIDs, corticosteriods, paraffin wax and contrast baths, protective equipment
  10. Scapholunate dissociation
    • acute or gradual onset
    • intermittent -> constant pain sensation
    • injury, chronic repetitive movement
    • weak wrist, swelling, clicking wrist
    • limited ROM @ wrist
    • gap of >2mm
    • NSAIDs, surgery, temporary immobilization
  11. Medial epicondylitis
    • overuse of wrist flexors/pronators
    • "golfer's elbow"
    • increasing w/lifting or wrist flexion, radiating pain to forearm
    • passive ROM normal, active ROM limited
    • Tenderness on exam
    • Normal xray unless calcified
    • NSAIDs, ice, corticosteroids, rarely surgery
    • good prognosis
  12. Lateral epicondylitis
    • overuse of wrist extensors/supinator muscles
    • common extensors (usually extensor carpi radialis brevis), "tennis elbow"
    • aching pain, increases w/lifting or wrist extension
    • passive ROM normal, active ROM limited
    • NSAIDs, ice, rest, corticosteriod, rarely surgery
  13. olecranon bursitis
    • acute/repetitive trauma (resting elbows on the desk)
    • usually gradual onset of moderate/severe pain w/elbow motion
    • if acute, may radiate to posterior forearm
    • localized swelling/erythema
    • ROM may be limited
    • NSAIDS, PRICE, aspiration if septic bursitis is suspected
    • good prognosis
  14. DeQuervain tenosynovitis
    • Inflammation of extensor pollicis brevis and abductor pollicis longus tendon
    • Repetitive trauma, tendon sheath produces a dense fibrous tissue
    • Often confused w/OA @ CMC joint
    • mild/moderate pain on radial side of wrist
    • Finkelstein's test, tenderness over radial styloid process and CMC joint of thumb, crepitus
    • NSAIDS, PRICE, surgery/corticosteriods
    • good prognosis
  15. trigger finger
    • palpable/audible snapping when flexing & extending fingers
    • inflammation of flexor digitorum superficialis/profundus tendon sheath (tenosynovitis)
    • gradual onset, mild to moderate pain
    • pain increases w/inactivity or repeated activity
    • swelling, small nodule @ MCP joint
    • extension limited due to pain (locked fingers)
    • NSAIDS, PRICE, corticosteriods, surgery can widen tunnel to slide more easily
    • good prognosis
  16. Carpal tunnel syndrome
    • median nerve is compressed beneath transverse carpal ligament
    • Dull, aching pain @wrist, can extend up forearm to arm
    • paresthesias in thumb and index finger, may worsen @ night due to flexed wrist when sleeping
    • decreased sensation @volar pads of thumb, index, middle fingers
    • in chronic conditions: atrophy of pollicis brevis muscle
    • Tinel's sign and Phalen's test, electrodiagnostic
    • NSAIDS, opioids, PRICE, corticosteriod, surgery
  17. Cubital tunnel syndrome
    ulnar nerve in cubital tunnel w/in aponeurosis or between proximal heads of flexor carpi ulnaris
  18. radial tunnel syndrome
    • aka posterior interosseous syndrome
    • compression of radial nerve near lateral elbow
    • weakness during elbow supination and finger extension
    • no sensation changes except dull, aching pain over lateral elbow
  19. Guyon tunnel syndrome
    • ulnar nerve compressed in ulnar tunnel
    • bifurcation into sensory (superficial) and motor (deep) branches
    • either both are affected, or just motor