Ortho

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Author:
scherk87
ID:
97100
Filename:
Ortho
Updated:
2011-08-15 13:42:16
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Clin Med
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Exam 4
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  1. Mild pain
    some torn fibers
    full ROM
    Grade I Strain
  2. Active contraction painful
    many torn fibers
    palpable divot or depression
    swelling and discoloration
    Grade II strain
  3. Intense pain
    complete muscle rupture
    significant/complete loss of ROM
    Grade III strain
  4. Pain
    Minimal loss of function
    mild point tenderness
    little/no swelling
    no abnormal motion
    Grade I Sprain
  5. Pain
    Poderate loss of function
    swelling
    slight/moderate instability
    Grade II sprain
  6. Extremely painful initially
    loss of function
    severe instability
    tenderness
    swelling and discoloration
    Grade III sprain
  7. Osteochondrosis
    • degenerative changes in epiphyseal ossification centers
    • interrupts blood supply - necrosis
  8. Osteoarthritis
    • Degeneration of cartilage
    • Wear & Tear
    • Pain and stiffness at rest
    • Prominent in the AM
  9. Legg-Calve-Perthes Disease
    • AVN of femoral head normally from trauma
    • Commonly boys ages 4-10
  10. Rotator Cuff Injury
    • + drop arm test
    • + empty can test
    • dull, aching pain over deltoid & arm/back
    • Rarely under 40
  11. Drop arm test
    • Raise arms with help to 90 degrees and then lower slowly on their own
    • + will not be able to slowly drop past 30 degrees
  12. Empty can test
    • Abduct 90 degrees
    • horizontallly adduct 30 degrees
    • internally rotate arm like pouring out a can
    • Apply resistance at 30 degrees
    • + abduction hard, weaker when adducted
  13. Adhesive Capsulitis
    • idiopathic restriction of shoulder movement
    • contracted & thickened joint capsule
    • pain with movement in all directions
    • decreased ROM (A/P)
  14. Tx for Adhesive Capsulitis
    • aggressive joint Mobs
    • relieve discomfort
    • stretch tight muscles
    • Estim for pain/Ultrasound
  15. Thoracic Outlet Syndrome
    • Pain in neck and shoulder
    • numbness/tingling of fingers
    • compression of nerves/vessles in thoracic outlet
  16. S&S of Thoracic Outlet Syndrome
    • Paresthesias
    • Pain
    • Cold sensation
    • Atrophy
    • Radial nerve palsy
    • Decreased circulation in fingers
  17. Tests for Thoracic Outlet Syndrome
    • Adson's test
    • Roo's Test
    • Allen Test
  18. Adson's Test
    • Tests Anterior Scalenes
    • Deep breath, chin towards affected side, neck extended
    • + decreased radial pulse or stimulated pain
    • For Thoracic Outlet Syndrome
  19. Roo's Test
    • Costoclaviculars tested
    • + Unable to maintain position or pain/weakness/tingling
    • For Thoracic Outlet Syndrome
  20. Allen Test
    • + decrease in radial pulse
    • For Thoracic Outlet Syndrome
  21. Biceps Rupture
    • Tear of tendon(s)
    • Commonly long head
    • Excessive loading or sudden stress on tendon
  22. S&S of Biceps Rupture
    • Hear/feel "snap"
    • intense pain @ injury
    • visible mass between shoulder & elbow
    • weak elbow flex/supination
    • Bruising/swelling,
    • decreased ROM (A/P)
    • indentation of bicipital groove on palpation
  23. Tx for Biceps Rupture
    • Ice
    • Sling
    • Eventual surgery
  24. Bicipital Tendonitis
    • Long headl commonly
    • Repeitive overhead motion
    • Tender palpation anter upper arm over groove
    • Crepitus
    • Swelling
    • Warmth
  25. Tx for Bicipital Tendonitis
    • Rest
    • Cold/US therapy
    • NSAIDs
    • PT
  26. Tests for Bicipital Tendonitis
    • Yergason's
    • Speed's
    • Ludington's
  27. Yergason's Test
    • + pain/tender in bicipital groove
    • For Bicipital Tendonitis
  28. Speed's Test
    • Arm supinated, resist shoulder forward flexion and pronation
    • + pain in bicipital groove, rupture/strain if weak
    • For Bicipital Tendonitis
  29. Ludington's Test
    • Hands behind head, flex/relax biceps
    • + non-palpable biceps tendon
    • For Bicipital Tendonitis
  30. Shoulder Dislocation
    • MOI - Abduction Extension Rotation, FOOSH
    • Divot on shoulder
    • Pop
    • Sudden/severe pain
    • Unable to touch opposite shoulder with affected hand
  31. Tx of Shoulder Dislocation
    • Immobilize
    • Sling
    • X-ray
    • Reduction
  32. Clavicle Fx
    • FOOSH, direct impact
    • common in children
    • Protective splinting, pain, deformity, swelling
  33. Tx of Clavicle Fx
    • Sling/swathe
    • Analgesia
    • immobilization
    • limit overhead movement
  34. Humeral Fx
    • Proximal - Low energy fall. Ice cream off cone
    • Mid-shaft - Direct force to UE
    • Distal - FOOSH, direct blow to elbow
  35. Tx of Humeral Fx
    • Stabilize
    • RICE
    • Reduce w/ immobilization
  36. Lateral Epicondylitis
    • Tennis Elbow
    • Repetitive overuse of wrist/finger extensors
    • Pain with wrist extension & forearm pronation
  37. Tx of Lateral Epicondylitis
    • RICE
    • PT
    • Analgesia
    • NSAIDs
    • Steroid injections
  38. Medial Epicondylitis
    • Overuse of flexors/valgus force on elbow
    • Pain with resisted wrist flexion/pronation
  39. Tx of Medial Epicondylitis
    • RICE
    • PT
    • NSAIDs
  40. Olecranon Bursitis
    • From trauma, hemorrhage, sepsis, rheumatic fever
    • Pain, swelling, point tender
  41. Tx of Olecranon Bursitis
    • Cold compress
    • Aspiration
  42. Carpal Tunnel Syndrome
    • Compresion of median nerve with repeated wrist flexion
    • Burning, tingling, pain
    • Bothersome at night
  43. Tests for Carpal Tunnel Syndrome
    • Tinel Sign
    • Phalen Sign
    • Carpal Compression
  44. Tinel Sign
    • Tingling/shock-like pain elicited by tapping the flexor surface of the wrist
    • For Carpal Tunnel
  45. Phalen Sign
    • Pareesthesia when pt flexes wrists to 90 degrees for 1 min
    • For Carpal Tunnel
  46. Carpal Compression
    numbness/tingling induced by pressure over carpal tunnel
  47. De Quervain's Disease
    • Inflammation of sheath surrounding abductor pollicis longus & extensor pollicis brevis
    • pain on radial wrist, pain on ROM, crepitus, tingling/numbness
    • + Finkelstein Test
  48. Tx De Quervain's Disease
    • RICE
    • NSAIDs
    • Immobilization
  49. Finkelstein Test
    • For De Quervain's Disease
  50. Dupytren's Contracture
    • Pope Sign
    • Proliferative disorder of subcutaneous palmar fibrosis
    • Contracture of finger joints, painless, digits 4&5, nodules
    • + Table Test
    • Tx: PT and Splinting
  51. Table Test
    • Placing palm on table and extending fingers
    • + affected digits curve on fingertips
  52. Trigger Finger
    • Later adulthood
    • Catching/snapping/locking of finger flexor tendon
    • Dysfunction & pain
    • Swelling, crepitus, nodule in hand, pain, locking of digits
  53. Colles' Fx/Smith's Fx
    • Distal radius fx when extended/flexed&pronated
    • FOOSH
    • Pain, swelling, ecchymosis, deformity
    • Tx: splint, narcs, reduction, cast
  54. Scaphoid/navicular fx
    • Extension fall
    • "snuffbox" pain
    • Difficulty healing due to thin blood supply - AVN risk
    • not usually visible on xray
    • Pain/clicking w/ ROM, tender palpation
    • Tx: Immobilize, surgical screws if displaced
  55. Boxer's Fx
    • Neck of 5th metacarpal
    • MOI - Direct blow
    • pain, tenderness, swelling, spliting x 3-4 wks
  56. Bennett's Fx
    • fx at base of thumb
    • unstable
    • Thumb is abducted
    • Surgical stabilization & pinning
  57. Rolando Fx
    • Base of thumb - comminuted (crushed)
    • Surgical stabilization required
  58. Tuft Fx
    • commonly middle finger
    • crushing force like from a cleat
    • painful/swollen
  59. Trendelenburg limp
    • pelivic tilt during stance phase
    • + lean to affected side
  60. Osteoarthritis
    • Pain in AM, stiffness, deep groin pain, pain with hip flexion and internal rotation
    • decreased ROM (A/P)
    • XR - decreased joint space, osteophytes
    • Tx: NSAIDs, PT, replacement
  61. Greater Trochanteric Bursitis
    • lateral hip pain
    • tender to palpation
    • pain with resisted hip abduction
    • tx: Ice NSAIDs, steroid injection
  62. Femoral Avascular Necrosis
    • death of femoral head
    • 20-40s and 6-10s
    • Eventually need surgery
    • pain in hip, groin pain, vague pain 4-6 mon prior, pain w/ internal rotation, norma neuro exam
  63. Faber (Patrick's) Test
    • Flex, abduct and externally rotate hip
    • + hip or sacroiliac jt pain
  64. Gaenslen's Test
    • Supine @ edge of table. Opposite leg flexed, pressure on near leg
    • + pain in ipsilateral SI joint
  65. Trendelenburg Test
    • Pt stands on one leg, one leg WB
    • PSIS/Iliac cres on leg lifted will dro = weak gluteal mm.
  66. Slipped Capital Femoral Epiphysis
    • Adolescent, femoral head displaced relative to femur
    • Still in acetabulum
    • M>F, obeses, AA
    • Weakened growth plate with higher than normal stress or endocrine conditions
  67. S&S of Slipped Capital Femoral Epiphysis
    • Pain in groin, thigh, knee
    • decreased internal rotation
    • limp, trendelenburg gait, increased pain with internal rotation
  68. Anterior/Posterior Drawer Test
    • Pt supine knee flexed, sit on foot.
    • Push/pull lower leg while holding hamstrings
    • Tests ACL/PCL
  69. Lachman's Test
    • Grasp femur and proximal tibia. Push femur down, pull tibia up
    • Tests ACL
  70. McMurray's Test
    • For meniscal tears
    • Hold knee and heel
    • Rotate heel @ 90 degrees, 30 degrees and figure 8
    • + pain/click around meniscus
  71. Varus/Valgus Stress
    • Abduct hip, knee @ 30 degrees, apply stress against ligament
    • Tests MCL/LCL
  72. Apley's Test
    • Compression/distraction of menisci and capsule
    • Prone, knee @ 90 degrees
    • Compress tibia into femur and roate
    • Hold thigh down and lift up and rotate
  73. Meniscal Injury
    • Episodic painful popping/locking/givign way
    • focal tenderness to palpation @ affected joint
    • MRI
    • Tx: PT, NSAIDs, surgery
    • Pain, swelling and inability to straighten knee
  74. ACL Injruy
    • Increased in female, typically non contact
    • pain, "pop", swelling, instability
    • + Lachmans, Pivot shift, Ant Drawer
    • MRI to visualize
    • RICE, splint, crutches, PT/OT
  75. PCL injury
    • M > F, young adulte
    • hyperextension injury
    • Possible popliteal artery injury
    • Blow to anterior tibia with knee flexed and foot planted
    • minimal instability, pain, swelling
    • ROM, PT, Surgery if grade 3
  76. MCL/LCL Injury
    • blow to medial/lateral knee
    • pain ando/or laxity @ 0-30 degree valgus/varus stress
    • r/o fx
    • RICE, hinged knee brace, PT
    • LCL - figure 4 position
  77. Osgood-Schlatter Disease
    • Microfractures of the tibial tubercle
    • Repetitive jumping, leg extension. 8-15 y/o M>F
    • Dull, aching pain over patellar tendon - exacerbated by resisted knee extension
    • Tx: rest, ice, PT, gradual activity return
    • NO CORTICOSTEROIDS
  78. Baker's Cyst
    • Herniation of synovium into popliteal region
    • Children & > 55 y/o
    • Meniscal tear/arthritis/rheumatoid
    • Mimics DVT - Duplex US to r/o
    • Asympt normally
    • Symptoms - discomfort/stiffness of knee
  79. Achilles Rupture
    • Rupture of terminal segment of gastroneumis and soleus
    • young adults & 30-40s
    • "snap"/"pop", severe localized pain. Swelling w/ palpable divot
    • r/o fx of calcaneus
    • Splint, RICE, WB @ 4-6 wks w/ PT
  80. Compartment Syndrome
    • Increased interestitial pressure within the closed compartment
    • Swelling, impaired venous & lymphatic return, > 30 mmHg pressure
    • Pain, Pallor, Paresthesias, paralysis, pulses, stryker needle
    • Fasciotomy, NSAIDs, Surgical
  81. Osteomyelitis
    • Bone infection - bacterial/fungal
    • Bone pain, fever, malaise, swelling/redness/warmth
    • IV antibiotics, surgery to remvoe dead tissue
  82. Scoliosis
    • Lateral deviation of spine, most common in girls
    • scapula prominence, waist assymmetry, shoulder/pelvis not level
  83. Tenosynovitis
    • Inflammation of tendon & surrounding synovial sheath
    • pain with passive extension of digit - Hallmark
    • Tenderness, swelling & limited movement
    • worse on awakening, tender sheaths on palpation

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