ortho

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Author:
Mat
ID:
85971
Filename:
ortho
Updated:
2011-08-18 09:26:20
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GIM
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Joint and bone in GIM
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  1. What is the characterisitic of rotator cuff tendinitis?
    Lateral shoulder pain aggravated by reaching, raising arm overhead, lying on side. Subacromial pain on palpation and with passive/resisted abduction.
  2. What is the characteristic of Rotator cuff tear?
    • Shoulder weakness, loss of function, tendinitis symptoms, nocturnal pain. Similar to tendinitis examination plus weakness with abduction and external rotation, positive drop-arm test.
    • If the pain is relieved by a subacromial lidocaine injection in the affected shoulder and the strength is normal, the diagnosis is nearly confirmed.
    • During the acute phase (2 weeks), patients may be treated with corticosteroid injection, NSAIDs, and rest; physical therapy can be added in the subacute phase. Subacromial corticosteroid injections are effective for rotator cuff tendinitis for up to 9 months. These injections have been found more effective in higher doses and are probably more effective than NSAIDs.
  3. What is the characteristic of Bicipital tendinitis?
    Anterior shoulder pain with lifting, overhead reaching, flexion; reduced pain after rupture. Bicipital groove tenderness, pain with resisted elbow flexion, “Popeye” lump in antecubital fossa following rupture.
  4. What is the characteristic of adhesive capsulitis?
    Progressive decrease in range of motion, more from stiffness than pain. Loss of external rotation, abduction: unable to scratch lower back or fully lift arm straight overhead.
  5. What is the characteristic of acromioclavicular syndromes?
    Anterior shoulder pain/deformity, usually from trauma or overuse. Localized joint tenderness and deformity (osteophytes, separation), pain with adduction.
  6. What is the characteristic of Glenohumeral arthiritis?
    Gradual onset of anterior pain, stiffness. Anterior joint-line tenderness, decreased range of motion, crepitation.
  7. What is the Hawkin's test and what is it for?
    • for shoulder impingement
    • The patient holds the arm extended anteriorly at 90 degrees with the forearm bent to 90 degrees (at 12 o’clock), as if holding a shield. The scapula should be stabilized by the examiner. The arm is then internally rotated to cross in front of the body. A positive test elicits pain in the shoulder.
  8. What is the Apprehension test and what is it for?
    • In order to determine the stability of a shoulder, the apprehension test is performed
    • If the patient has pain or apprehension of possible dislocation of the shoulder, the test is positive and indicative of a loose shoulder, as seen in weak musculature or in rotator cuff tears.
    • The patient is placed supine on a table. With the arm abducted at 90 degrees and the forearm flexed, the examiner stands at the bedside facing the patient and places one hand under the affected shoulder. With the other hand, gentle pressure is placed on the forearm. Pain or apprehension constitutes a positive test.
  9. Explain the Rotator cuff tendon assessment maneuvers and what is it for?
    • To assess rotator cuff function, the examiner stands across from the patient and assumes a posture of shaking hands with the patient, holding the patient’s elbow with the other hand. Pain with resistance in these directions may indicate tendinitis: (1) resisted internal rotation (subscapularis); (2) resisted external rotation (infraspinatus); (3) resisted abduction (supraspinatus).
  10. What is the impingement syndrome?
    • a special category of supraspinatus tendinitis caused by irritation of the subacromial bursa or rotator cuff tendon from mechanical impingement between the humeral head and the coracoacromial arch, which includes the acromion, coracoacromial ligament, and the coracoid process
    • Chronic overhead activity may contribute to narrowing of this space, which can lead to recurrent microtrauma and chronic local inflammation of rotator cuff tendons.
    • Pain on the Hawkins test that resolves with injection of lidocaine into the subacromial space helps establish the diagnosis. Initial treatment is similar to rotator cuff tendinitis
    • persistence of symptoms after 3 months, which occurs in 10% to 25% of patients, may warrant an orthopedic referral.
  11. Epicondylitis

    What is it?
    What is tennis elbow?
    What is golfer's elbow?
    What are the treatment options?
    • Epicondylitis is caused by microtearing of the tendons resulting from repetitive motions
    • Lateral epicondylitis, or tennis elbow, is the most common cause of elbow pain. Symptoms are tenderness of the lateral epicondyle and pain on resisted wrist extension and hand gripping.
    • Medial epicondylitis, or golfer’s elbow, is less common. There is tenderness in the medial epicondyle and pain with wrist flexion.
    • Treatment options for epicondylitis include NSAIDs, corticosteroid injection, and physiotherapy. Corticosteroid injection achieves a faster resolution of symptoms than NSAIDs. Although corticosteroid injection provides rapid improvement in pain, physiotherapy provides better long-term results.
  12. What is olecranon bursitis?
    • Olecranon bursitis, or carpet-layers elbow, occurs when the olecranon bursa develops an effusion, either from trauma, an inflammatory process, or infection.
    • On examination, an inflamed bursa does not cause restriction or pain withrange of motion of the elbow, providing evidence that the joint is not involved. However, the bursa can be extremely tender to palpation. An effusion should be aspirated for Gram stain, culture, and crystal analysis to rule out infection or gout.
  13. What is the Cubital Tunnel Syndrome?
    • Cubital tunnel syndrome, or ulnar nerve entrapment, is a common cause for pain and sensory and motor loss in the ulnar region and for paresthesias in the ulnar aspect of the arm and hand.
    • Electromyography (EMG) is useful for differentiating the level of the ulnar nerve lesion (cubital tunnel, wrist, thoracic outlet, cervical disk), assessing the severity, and determining the need for surgery.
    • Treatment is avoidance of any pressure to the area, NSAIDs, and surgical decompression when severe.
  14. What is patellofemoral pain syndrome?
    the most common cause of knee pain in active adults younger than 45 years. The exacerbation of the pain by going down steps and the development of knee stiffness and pain at rest when the knee is flexed for an extended period are clues to the diagnosis. Reproducing the pain by firmly moving the patella along the femur confirms the diagnosis. Patellofemoral pain syndrome is self-limited and responds to rest and NSAIDs.
  15. What is Pes anserine bursitis?
    • Pes anserine bursitis is another common overuse injury characterized by tenderness directly over the pes anserine bursa on the medial aspect of the leg just below the knee.
  16. What is prepatellar bursitis?
    • Prepatellar bursitis is nearly always unilateral and often asymptomatic. Typically, there is a history of knee trauma or repetitive or extended kneeling preceding the knee pain. On palpation, there is tenderness over the entire bursal sac and a collection of fluid directly over the patella

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