Orthopedics 6

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HuskerDevil
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94440
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Orthopedics 6
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2011-07-18 16:08:39
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DPAP2012 Orthopedics
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Orthopedics flashcards made by previous students
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  1. Boutonniere Deformity =
    Loss of central slip insertion on proximal dorsal middle phalanx
  2. Boutonniere Deformity S/S
    Flexion of PIP & hyperextension of DIP
  3. Boutonniere Deformity Rx:
    Surgical
  4. Acute Boutonniere Deformity =
    Central slip rupture of extensor tendon over PIP causing PIP flexion contracture with DIP extension contracture; Forced flexion of actively extended PIP
  5. Acute Boutonniere Deformity: PE:
    TTP over dorsal PIP, loss of motion, & extensor lag
  6. Acute Boutonniere Deformity: Rx:
    Serial casting, static extension splint
  7. Swan Neck Deformity =
    Joint Synovitis secondary to RA
  8. Swan Neck Deformity =
    Flexion of the DIP & hyperextension of the PIP
  9. Swan Neck Deformity: Rx:
    Surgical correction
  10. Skiers Thumb AKA:
    Gamekeepers thumb
  11. Skiers Thumb =
    UCL injury: Abduction stress
  12. Skiers Thumb: consider:
    X-Ray prior to exam
  13. Skiers Thumb: S/S
    Non-displaced fx or mild laxity
  14. Skiers Thumb: Tx
    Immobilize 3-6 weeks; thumb Spica Cast
  15. Skiers Thumb: Tx: Avulsion fx >1 mm displaced:
    surgical fixation
  16. Skiers Thumb: 3rd degree, complete tear:
    Significant laxity; Stener lesion; surgical fixation
  17. Skiers Thumb: Stener lesion =
    Aponeurosis interposed between ligament
  18. Bennet Fx =
    Fx of thumb metacarpal base
  19. Bennet Fx: MOA
    Axial blow or adduction stress to thumb; APL inserts into base of thumb causing displacement of fragment
  20. Bennet Fx: Tx: Unstable fx
    must have ORIF
  21. Bennet Fx: Tx: Comminuted =
    Rolando fx
  22. Metacarpal Fx: 5th MC neck fx =
    Boxers fx
  23. Metacarpal Fx: MC Neck: may have:
    loss of prominence of MCP head
  24. Metacarpal Fx: MC Neck: Tx: with > 40 degree angulation or extension lag:
    CRPP
  25. Metacarpal Fx: MC Neck: necks other than Boxers fx:
    Index 10, middle 20, ring 30
  26. Metacarpal Fx: Metacarpal shaft & base: Tx Nondisplaced:
    cast for 4 wks, then functional splint
  27. Metacarpal Fx: Metacarpal shaft & base: Tx
    Displaced fx may angulate, rotate, or shorten & s/b evaluated for CRPP
  28. Hook of Hamate Fx =
    Direct impact from racquet, baseball bat
  29. Hook of Hamate Fx: PE:
    TTP over hamate, check ulnar n.
  30. Hook of Hamate Fx: XRay:
    CT view; may need CT scan
  31. Hook of Hamate Fx: Rx:
    Excision of fragment vs 4-6 wks casting
  32. Phalanx Fx: Distal Phalanx: Tx: Non-displaced:
    Rx w/ protective DIP splint symptomatically
  33. Phalanx Fx: Distal Phalanx: Tx Displaced:
    consider CRPP
  34. Middle / Proximal Phalanx fx: Assess:
    stability (rotation, displacement, shortening)
  35. Middle / Proximal Phalanx fx: Rx:
    Splint or buddy tape stable fx for 3-4 wks
  36. Middle / Proximal Phalanx fx: Tx: Displaced/unstable:
    ORIF; Protect w/ activity for 8 wks
  37. Metacarpal Fx: MC Neck: Tx: < 40 degree angulation & no extension lag
    Ulnar gutter splint or cast for 3-4 wks, then functional splint
  38. Collateral Ligament Tears =
    Varus or valgus stress to PIP
  39. Collateral Ligament Tears: PE:
    assess stability passively & actively
  40. Collateral Ligament Tears: Tx: If no laxity active testing:
    may buddy tape 4 wks w/ protected ROM
  41. Collateral Ligament Tears: Tx: If unstable w/ active ROM:
    surgery indicated
  42. Mallet Finger =
    Rupture of extensor tendon distal to DIP
  43. Mallet Finger: MOA
    Axial load causing forced flexion
  44. Mallet Finger: PE:
    Unable to actively extend DIP
  45. Mallet Finger: PE: Stable if:
    < 50% of articular surface involved
  46. Mallet Finger: Rx:
    Stax splint or DIP extension splint 24/7 for 6 wks; mallet finger protocol
  47. Jersey Finger =
    Forceful extension of DIP; FDP avulsion
  48. Jersey Finger: S/S
    Pt unable to flex DIP; most common to ring finger
  49. Jersey Finger: Tx
    Surgical repair
  50. Most common PIP Dislocation:
    Dorsal
  51. Dorsal PIP Dislocation: MOA
    Disruption of volar plate a&nd collateral ligaments
  52. Dorsal PIP Dislocation: xray
    to R/O fx
  53. Dorsal PIP Dislocation: Rx:
    Reduce; splint w/ PIP in 30 degree flexion for 2-4 wks
  54. Dorsal PIP Dislocation: Volar: MOA
    (Rare); disruption of collateral ligs & central slip
  55. Dorsal PIP Dislocation: dx/tx
    X-ray, Reduction; extension splint 4-6 wks
  56. PIP Fx Dislocation: presentation
    Similar to dislocations
  57. PIP Fx Dislocation: Rx: Unstable:
    (>30% of volar plate articular surface); Surgical fixation
  58. PIP Fx Dislocation: Rx: Stable:
    Splint 3-4 weeks, early ROM exercises; may play buddy taped
  59. Tib/fib: which one is weight bearing?
    Tibia
  60. Knee Hx:
    MOI ( twist, blow to knee, trauma); Pain; Instability, pops, clicks, grinding; swelling; pain hip/ ankle/ foot; prior
  61. Inspxn: Note:
    contralateral joint (cf)
  62. Immediate swelling:
    Within first few hrs; Hemarthrosis
  63. Immediate swelling: Big 4:
    ACL Tear; Patella Dislocation; Fx; Meniscus tear (not always)
  64. Knee: DDx: Ant. Knee Pain
    Patellofemoral dysfxn; Patellar tendinitis; Plica/ Fat Pad irritation
  65. Knee: DDx: Medial
    Meniscus, DJD, MCL; Pes Anserine Bursitis; Chondral lesion
  66. Knee: DDx: Lateral
    Meniscus, LCL, ITB; Posterolateral corner (PLC); Chondral lesion
  67. Knee: DDx: Instability
    ACL, PCL, PLC, ITB
  68. Knee: DDx: Swelling ( immediate):
    ACL, fx, dislocation, meniscus
  69. Knee: DDx: Swelling (Intermittent)
    Meniscus, gout, chondral lesions
  70. Knee: DDx: Other
    Infection, arthritis, referred pain, neoplasm
  71. Knee PE: inspection
    Swelling/Effusion (1+ to 3+ ; Local vs diffuse; Acute vs Chronic); Bruising; Deformity (fx; prior surg); Scars; Quad atrophy
  72. Knee PE: Palpation: medial
    Joint line (Menisc ); Condyle (Chondral lesion); Plica; Pes Ans bursa; MCL; Medial retinaculum (patella dislocn)
  73. Knee PE: Palpation: lateral
    Joint line (Menisc); LCL; Iliotibial Band (Gerdy tub.; Bursa); Condyle (Chondral lesion; Patella dislocation); Femoral head (Peroneal n. Sx); PLC (posterior)
  74. Knee PE: Palpation: posterior
    Bakers cyst (Menisc); Meniscus tears; Poplit art; Poplit mx; Gastrocnemius tear; Hamstring tear (distal)
  75. Knee PE: ROM
    Flexion (135-140; goniometer); ext 0 degree (some: 5-10 degree natl hypertext); cf to nml knee; Squat (ltd ? Menisc tear)
  76. Patella Tests
    Med/Lat glide; Apprehension (instability); Inhib test (PFS); Q angle; J Tracking; Poplit Angle (Hamstring tightness); Modified Thomas Test (Quad/ hip flexor tightness)
  77. Q angle
    angle formed by line: ASIS to ctr of patella & line fr ctr of patella thru tibial tubercle; <20 degrees = nl
  78. Medial knee tests
    MCL or Valgus; McMurray;
  79. MCL or Valgus test
    O & 20-30 degrees flexion
  80. MCL or Valgus test: instability at 0 degrees =
    Concomitant ACL
  81. MCL or Valgus test: Concomitant ACL Grade I =
    no opening, but pain
  82. MCL or Valgus test: Concomitant ACL Grade II =
    opening with endpoint
  83. MCL or Valgus test: Concomitant ACL Grade III =
    no endpoint
  84. McMurray test: sensitivity =
    Only 65%
  85. McMurray test: medial (ME) =
    Ext rotation w/ flexion & valgus
  86. McMurray test: lateral
    Internal rotation w/ flexion & varus
  87. McMurray test: true positive =
    A click (not pain)
  88. McMurray test: Apleys compression =
    Not usually helpful
  89. Lateral knee tests
    Ober; Nobles compression; PLC; reverse pivot; posterolateral drawer; dial
  90. Lateral knee tests: Varus testing for LCL: grading =
    Same grade as for MCL
  91. IT Band tests
    Obers; Nobles compression test
  92. Obers
    Inability for Up Leg to go down to table (= tight lateral structures)
  93. Nobles compression test
    Pain over lat. Fem condyle at 20 deg knee flexion
  94. PLC injury usu occurs:
    in ACL and/ or multi-ligament knee injuries
  95. PLC tests
    Recurvatum (with PCL); dial test at 30 degrees flexion; reverse pivot shift
  96. ACL Tests
    Lachman; ant drawer (unreliable); Pivot shift (difficult)
  97. ACL Tests: gold std =
    Lachman
  98. PCL Tests
    Post drawer & recurvatum; sag sign; quad active; dial test at 90 degrees flexion
  99. PCL Tests: problem w/ dx
    easily missed or mistaken for ACLs (Hx important)
  100. PCL Tests: Posterior drawer
    Much better than ant. Drawer
  101. Knee Films
    AP, Lateral; Merchant; Tunnel view (look for OCD)
  102. Knee Films: AP/ Lateral
    Tumors; Fx; DJD; Surgeries/ Hardware
  103. Knee Films: Merchant
    Patella (Instability; DJD; Chondral lesions)
  104. Knee DJD: Fairbanks Changes
    Flattened Tib. plateau; cec. joint space; Osteophytes; Subchondral cysts
  105. MRI: excellent for:
    • soft tissue
    • MRI in ortho: for:
    • ACL ( >95%); Menisc (>85%); chondral lesion (cannot quantify size); MCL,LCL,PLC,PCL; Bone Contusions/ Edema; tumors; fx?
  106. CT: excellent for:
    fracture characterization
  107. CT: not good for:
    evaluating soft tissue injuries
  108. Quad active test:
    When quad mx is activated, pulls tibia forward; when it relaxes, tibia sags
  109. Recurvatum test:
    Pulling up on toe to about 15 degrees of hyperextension, then just falling back (as if not attached properly at knee)
  110. Lachman test:
    At 20 degrees flexion; stabilize femur, pull up on tibia
  111. Ant drawer test:
    knee is flexed to 90, then pull on tibia
  112. Thomas test:
    If hip flexors are tight, when pull one leg up, other leg also pulls up somewhat
  113. MCL: typical Hx:
    Valgus injury (Soccer, ice hockey)
  114. Most common lig. Tear =
    MCL
  115. MCL: PE:
    Medial pain (on joint line, above & below); Grade I,II,III; Valgus stress
  116. MCL: Tx:
    conservative; NSAIDs; Ice; Rest; Bracing; PT; RTP?; Surgical: Rare
  117. MCL: Tx: RTP (Gr I,II):
    symptomatic tx
  118. MCL: Tx: RTP (Gr III):
    4-6 weeks, start in extension
  119. Medial Meniscus Tear: Hx
    Twisting injury (Acute); Degenerative; Swelling +/- ; Locking/ catching
  120. Medial Meniscus Tear: PE:
    MJL tenderness; McMurray; Apley; Cyst
  121. Medial Meniscus Tear: Tx:
    conservative vs surgical
  122. OCD =
    Osteochondritis Dissecans
  123. OCD & Chondral Defects: Hx:
    Intermittent swelling after exercise, locking, catching, vague pain
  124. OCD & Chondral Defects: PE:
    small effusion, TTP MFC or LFC
  125. OCD & Chondral Defects: Tx:
    NWB, progress slowly over 6 weeks or more
  126. Plica Syndrome: Hx:
    snapping, esp with squats (can also be MMT)
  127. Plica Syndrome: PE:
    palpable plica, localized swelling; Imaging (r/o other injuries)
  128. Plica Syndrome: Tx:
    PT, ice post exercise; iontophoresis; NSAIDs; Injection; Surgical excision
  129. Lateral Knee Pain: DDx
    Lat Meniscus Tear; LCL Tear; IT Band; Patella disloc/ subluxation; PLC; OCD; Hamstring strain/ tear; PFSS
  130. ITB Syndrome AKA
    Runners Knee
  131. ITB Syndrome Sx
    Snapping knee or hip; Occasional instability
  132. ITB Syndrome: Look at:
    biomechanics, flexibility; Mileage
  133. ITB Syndrome: Tx:
    PT, local distal injection, orthotics, different shoes or surfaces
  134. LCL Tear = type of injury
    Varus injury (do varus stress test)
  135. LCL Tear: Varus test Grade I-II:
    conservative; 1-2 wks(I), 4-6 wks (II)
  136. LCL Tear: Varus test Grade III:
    consider surgical repair/ reconstruction; assess for concomitant injuries (PLC)
  137. Patellar Dislocation: Hx:
    visual sublux/ dislocation, twisting motion; previous occurrence? Brace? N/V status
  138. Patellar Dislocation: PE:
    Ant Knee exam; biomechanics
  139. Patellar Dislocation: Radiographs:
    AP/Lat, Merchant view
  140. Patellar Dislocation: Tx:
    extension brace 1-2 wks; quad strengthening; RTP w/ buttress brace
  141. Patellar Dislocation: Tx: If multiple:
    consider surgical repair
  142. ACL Tx
    Extension Post-op brace locked at 0 deg or knee immobilizer for very short term (until referred); mostly for protection; ACE for swelling; NSAIDs; PT (Prehab); Refer; consider brace
  143. ACL: dx tests
    MRI to R/O other injuries
  144. ACL: recovery time if reconstructed:
    9-12 mos
  145. PCL Injuries: tests
    Posterior drawer; sag sign; Recurvatum; Quad active test
  146. Theater sign
    seated, kneecap pushes into articular cartilage (spongy, water is displaced); sit up, kneecap pushes into waterless sponge space: pain.
  147. PFD Tx
    PT; Short course of NSAIDs; open patella brace optional; footwear/ orthotics ; modify activity; Surgery (Last Resort)
  148. PFS: Tx: PT for:
    VMO (vastus medialis obliqus) (co-contract with adductors); hip abductors/ ext rotators
  149. Low Back Pain: lifetime prevalence:
    60-80%
  150. Leading cause of work related disability =
    Low Back Pain
  151. Low Back Pain Risk factors
    obesity, sedentary, improper biomechanics
  152. Low Back Pain: Prognosis
    70% improved in <1 week & asymptomatic in <1 month; 90% asymptomatic in 6-12 wks
  153. Vertebral Disk contains:
    central nucleus pulposus; peripheral annulus fibrosis
  154. Disc degeneration MOA:
    degeneration overloads facet joints in verts
  155. Disc herniation MOA:
    herniation impinges nerve roots
  156. Anterior Mxs:
    Abdominal & Psoas
  157. Posterior Mxs: Superficial:
    Erector Spinae, Iliocostal, longissimus & spinalis
  158. Posterior Mxs: Middle:
    Multifida
  159. Posterior Mxs: Deep:
    Intersegmental
  160. Anterior & posterior muscles alternate to:
    control trunk movement
  161. Sensory Dermatomes: Lumbar & sacral n. innervate:
    lower extremities
  162. Pain: Simple sprains & strains =
    Nonspecific pain in lower back or one or both buttocks
  163. Nerve root pain:
    Brief, sharp, shooting, increased by cough, standing, & sitting.
  164. Pain: Neoplasm, Infection:
    Severe, constant pain persisting at night
  165. Pain: Red Flags
    > 50 y.o.; kids; Night Pain; Fever, malaise, wt loss; Bladder/ bowel dysfunction; Progressive deficit; Prior ca; Pain > 1 month
  166. LBP Hx:
    C/C, meds, allergies
  167. LBP HPI:
    Initiating event, MOA; Site of pain; OLDCARTS; priors, tx, studies
  168. LBP: PE: Inspection:
    Gait; Posture; Deformity
  169. LBP: PE: Palpation:
    Bony; Soft Tissue; Pulses
  170. LBP: PE: ROM:
    Flex, ext, lateral flex, rotation
  171. LBP: PE: Other Tests:
    SLR; FABER test; Neuro Exam (Sensory, Motor, DTRs)
  172. SLR test:
    Pain on straight leg flexion reproduces radicular pain
  173. Bragards test:
    Foot dorsiflexion increases pain
  174. Cross SLR test:
    Raising contralateral leg causes radicular pain on ipsilateral leg
  175. FABER test:
    Pain in SI joint
  176. LS Spine Exam: inspection:
    Symmetry/ Deformity/ Scars
  177. LS Spine Exam: motor: L1:
    Hip flexion
  178. LS Spine Exam: motor: L2:
    Hip adductors
  179. LS Spine Exam: motor: L3:
    Knee extension
  180. LS Spine Exam: motor: L4:
    Ankle dorsiflexion
  181. LS Spine Exam: motor: L5:
    Hallicus Longus extension
  182. LS Spine Exam: motor: S1:
    Hallicus Longus flexion
  183. LS Spine Exam: sensory: L1:
    Upper outer thigh
  184. LS Spine Exam: sensory: L2:
    Mid anterior thigh
  185. LS Spine Exam: sensory: L3:
    Below patella
  186. LS Spine Exam: sensory: L4:
    Medial ankle
  187. LS Spine Exam: sensory: L5:
    First web space
  188. LS Spine Exam: sensory: S1:
    Lateral ankle
  189. LS Spine Exam: DTRs: Knee:
    L2,3,4
  190. LS Spine Exam: DTRs: Ankle:
    S1
  191. Waddell Signs =
    Non-organic Physical Signs in LBP
  192. Waddell Signs: Tenderness:
    Superficial skin tenderness over wide area; Non-localized deep tenderness
  193. Waddell Signs: Simulations Tests:
    Axial load should not cause LBP
  194. Waddell Signs: Distraction Tests:
    Flip test
  195. Waddell Signs: Regional Disturbances:
    Widespread muscle pain in various groups
  196. Waddell Signs: Over-reaction:
    Pain out of proportion
  197. Lumbar Strain: Hx:
    MOI; site of pain
  198. 70% of LBP =
    Lumbar Strain
  199. Lumbar Strain: PE:
    Tender paravertebral or erector spinae mx; min radiation
  200. Lumbar Strain: Rx :
    Pain relief, modified activity, exercise, education, & encouragement; Injection with trigger point pain; PRICEMMM
  201. HNP =
    Herniated Nucleus Pulposus
  202. HNP: most common =
    L4-5, L5-S1
  203. 4% of LBP =
    HNP
  204. HNP: MOI:
    Flexion & rotation; Tears in annulus
  205. HNP: Sx:
    Sciatica (radiating pain, numbness & weakness to LE)
  206. HNP: Signs:
    Pos SLR, Flip sign, Pain worse on back ext
  207. HNP: DDx:
    Infection, tumor
  208. HNP: Evaluation:
    MRI / CT
  209. HNP: MRI/CT: asymptomatic disc herniation found in:
    17-36%
  210. HNP: Lumbar nerve root compression: L1-3 nerve roots:
    5%, pain & numbness above knee
  211. HNP: Lumbar nerve root compression: L4 nerve root (L3-4 disk space):
    5%, numbness to shin, weak ankle dorsiflexion
  212. HNP: Lumbar nerve root compression: L5 root:
    67%, weakness of EHL & numbness top of foot and 1st web space
  213. HNP: Lumbar nerve root compression: S1 root:
    28%, numb lateral foot, weak plantarflexion
  214. HNP: Lumbar nerve root compression: Rx:
    Conservative, NSAIDs, mx relaxants, Exercise & Education
  215. HNP: Lumbar nerve root compression: 10% require:
    surgery d/t progressive neurologic deficit

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