Term
| Most common site for acute osteomyelitis |
|
Definition
| metaphyseal end of a long bone, near knee joint. |
|
|
Term
| most common pathogen in acute osteomyelitis |
|
Definition
|
|
Term
| antibiotics used in acute osteomyelitis |
|
Definition
| oxacillin or cefazolin or clindamycin |
|
|
Term
| how long does it take for xray findings to show up in acute osteomyelitis |
|
Definition
| normally 7-12 days, can take up to 2-4 weeks in adults |
|
|
Term
| first sign on acute osteomyelitis in adults |
|
Definition
| insidious onset, limitation of joint movement |
|
|
Term
| tx for acute osteomyelitis |
|
Definition
ortho consult - aspiration of pus, bone eval (resorption)
likely IV antibiotics for 6-12 weeks |
|
|
Term
| indications for surgery in acute osteomyelitis |
|
Definition
evidence of fluid filled abscess on imaging
failure of response to IV antibiotics
involvement of a major joint |
|
|
Term
| Grade 0 Diabetic Foot Ulcer |
|
Definition
"at risk"
Tx = proper foot wear, surgical correction of bone |
|
|
Term
| Grade 1 Diabetic Foot Ulcer |
|
Definition
skin only.
Tx - outpatient dressing changes, PT wound care |
|
|
Term
| Grade 2 Diabetic Foot Ulcer |
|
Definition
involves underlying tendons, bones, or ligaments
Tx - surgical debridement, hospitalization, aggressive wound care, IV antibiotics |
|
|
Term
| Grade 3 Diabetic Foot Ulcer |
|
Definition
abscess osteitis.
Tx - surgical emergency for drainage of acute infection. Wound left open w/ dressing changes. Closure or amputation later. |
|
|
Term
| Grade 4 Diabetic Foot Ulcer |
|
Definition
gangrene forefoot.
Tx - appropriate amputation (transmetatarsal) |
|
|
Term
| Grade 5 Diabetic Foot Ulcer |
|
Definition
entire foot gangrene
Tx - appropriate amputation |
|
|
Term
| MCC of chronic osteomyelitits |
|
Definition
| open fx or wound of lower extremity |
|
|
Term
|
Definition
| dead bone surrounded by new shell of bone |
|
|
Term
| treatment of chronic osteomyelitis |
|
Definition
| consult ortho. preventive - clean and debris open fx I&D, radical debridement |
|
|
Term
| MC pathogens of septic arthritis |
|
Definition
Adults - Staph Aureus
Kids - H. Influenzae
IV Drug Users - Gram Negative Rods |
|
|
Term
| Lab findings in septic arthritis |
|
Definition
CBC = markedly elevated WBC
Joint aspiration = fluid is cloudy, purulent, decreased glucose levels, increase WBC count, crystals
X-Ray = distention of joint capsule |
|
|
Term
| Gonococcal Septic Arthritis presentation |
|
Definition
young, sexually active individuals. Most common polyarthralgias/polyarthritis.
Pathogen = N. Gonorrhoeae |
|
|
Term
|
Definition
fibrous or catilaginous.
fibrous cortical defect (small nonossifying fibroma)
Nonossifying fibroma (takes up more than half of the internal medullary canal) |
|
|
Term
| most common tumor of the hand |
|
Definition
| enchondroma. Age 10-50 yo |
|
|
Term
| most common benign tumor. |
|
Definition
|
|
Term
| most common site of osteochondroma |
|
Definition
| metaphysis distal femur or proximal tibia |
|
|
Term
| Soft tissue lesion found in the extremities, adjacent to joint or tendon sheath |
|
Definition
|
|
Term
| most common soft tissue mass of the hand |
|
Definition
|
|
Term
| most common site of ganglion cysts |
|
Definition
|
|
Term
| marrow aspirate shows abnormal B-Cell type plasma cells.... |
|
Definition
|
|
Term
| most common primary tumor of bone |
|
Definition
|
|
Term
|
Definition
|
|
Term
| xray shows lytic destruction w/ cortical lesions |
|
Definition
|
|
Term
| bone disorder w/ repeated episodes of bone destruction and excessive bone repair |
|
Definition
|
|
Term
| Symptoms of Paget's Disease |
|
Definition
Pain (first)
painful bowing of long bones
pathologic fractures
skull enlargment
common sites = hips, pelvis, spine |
|
|
Term
| painful soft tissue mass at midshaft of long bone |
|
Definition
|
|
Term
| Most common noninflammatory arthritis |
|
Definition
|
|
Term
| radiologic findings of osteoarthritis |
|
Definition
joint space narrowing
spur formation
sclerosis
subchondral cysts |
|
|
Term
| decrease in bone mineral density |
|
Definition
|
|
Term
T score of 1.
T score 1-2.5
T score greater than 2.5 |
|
Definition
normal.
osteopenic
osteoperosis |
|
|
Term
| treatment of osteoperosis |
|
Definition
lifestyle/diet
HRT
Clacitonin (inhibits resorption)
Bisphosphonates (inhibitors of bone mineralization and resorption) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| brachial plexus, musculucutaneous nerve....what cord? |
|
Definition
|
|
Term
| brachial plexus, Axillary nerve....what cord? |
|
Definition
|
|
Term
| brachial plexus, Radial nerve....what cord? |
|
Definition
|
|
Term
| brachial plexus, Median nerve....what cord? |
|
Definition
|
|
Term
| brachial plexus, ulnar nerve....what cord? |
|
Definition
|
|
Term
|
Definition
motor - deltoid m. biceps m.
reflex - biceps
sensation - lateral arm |
|
|
Term
|
Definition
motor - biceps m. wrist extensors
reflex - brachioradialis
sensation - lateral forearm and 1st digit |
|
|
Term
|
Definition
motor - triceps m. wrist flexors, finger extensors
reflex - triceps
sensation - 3rd digit |
|
|
Term
|
Definition
motor - interossei m. finger flexors
sensation - medial forearm and 5th digit |
|
|
Term
|
Definition
motor - interossei m.
sensation - medial arm |
|
|
Term
|
Definition
| lifting up on the chin and occiput in an attempt to relieve symptoms of radiculopathy |
|
|
Term
|
Definition
| pushing straight down on top of the head in an attempt to recreate symptoms |
|
|
Term
|
Definition
| neck extended and rotated toward affected side, pressure placed straight down on top of head in attempt to recreate symptoms |
|
|
Term
|
Definition
| feel radial pulse while pt moves their arm down, away, and behind their body, takes a deep breathe in and looks down and toward to affected side. positive test = obliteration of the radial pulse |
|
|
Term
| what is affected in spasmodic toricollis |
|
Definition
|
|
Term
| what is affected in torticollis |
|
Definition
|
|
Term
| Pt's head is tilted to one side w/ limited ROM, can rotate head away from midline but not towards. |
|
Definition
|
|
Term
| Tx for spasmodic torticollis |
|
Definition
| PT - stretching exercises soft or hard collar surgery - fuse C1 and C2, release SCM NSAIDS NO contact or vigorous sports |
|
|
Term
| risk factors for herniated disc |
|
Definition
| smoking, frequent heavy lifting, diving |
|
|
Term
| Pt has + Spurling's test, possible + Babinski reflex, decreased sensation, decreased reflexes |
|
Definition
|
|
Term
Cervical Sprain
Cervical Strain |
|
Definition
|
|
Term
|
Definition
| hyperextension of the neck flexors - MVA rear end collision |
|
|
Term
|
Definition
| pillows, working at computers |
|
|
Term
| imaging for cervical sprain/strain |
|
Definition
| AP, full lateral, open mouth (C1, C2), swimmer's view (C7) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| other names of C2 fracture |
|
Definition
| Hangman's fx, neural arch |
|
|
Term
| Pt presents w/ neck discomfort w/motion, stiffness, loss of function, decreased range of motion, joint effusion, deformity |
|
Definition
|
|
Term
| what do you need to view w/ cervical stenosis |
|
Definition
|
|
Term
| causes of cervical spine dislocaton |
|
Definition
traumatic - MVA, diving, blunt trauma
atraumatic - RA, Down's syndrome |
|
|
Term
| spinous process "step off" in the area of C4-T1 |
|
Definition
Cervical spine dislocation.
C4 = diaphragm
DO NOT remove collar.
Emergency Ortho/Neuro Surgery consult |
|
|
Term
|
Definition
motor - tibialis anterior (inversion and dorsiflexion)
reflex - patellar reflex
sensation - medial leg and medial malleolus |
|
|
Term
|
Definition
motor - extensor hallucis longus (dorsiflexion of great toe)
sensation - lateral leg, dorusm of the foot, and great toe |
|
|
Term
|
Definition
motor - peroneus longus and brevis (eversion and plantar flexion)
reflex - achilles
sensation - lateral leg, plantar surface, lateral malleolus, 5th digit |
|
|
Term
| most common musculoskeletal condition |
|
Definition
|
|
Term
|
Definition
rest 1-2 days, then light activity
Heat
NSAIDS x 4-6 weeks - Drug of Choice
muscle relaxants
PT - walking, recumbant bike, swimming
Lifting and back care training (sitting and lumbar support) |
|
|
Term
| test to identify a malingering patient |
|
Definition
|
|
Term
| Red Flags of back pain - TUNA FISH |
|
Definition
Truama - loss of strength or balance
Unexplained weight loss/night sweats
Neurologic Signs: incontinence, night pain
Age > 50yo
Fever, malaise
Intravenous drug use
Streoids for long time
History of cancer or malignancy |
|
|
Term
| most common cause of Cauda Equina Syndrome |
|
Definition
| penetrating trauma - MVA or GSW |
|
|
Term
| symptoms of Cauda Equina Syndrome |
|
Definition
loss of motor function, position, vibratory, and light touch of the affected side.
loss of sharp and temp. on opposite side
Tx - SURGICAL EMERGENCY! |
|
|
Term
|
Definition
| Scheuermann's Kyphosis, Senile Kyphosis |
|
|
Term
|
Definition
| 20-49 degrees posterior convexity |
|
|
Term
| Radiographic signs of kyphosis |
|
Definition
discs are flattened & irregular
anterior longitudinal ligament - thickened
vertebral bodies are wedged
iliac crest - Risser's sign |
|
|
Term
| tx for 50-70 degrees angle (kyphosis) |
|
Definition
PT consult, exercises & stretching
Brace |
|
|
Term
| tx for >70 degrees angle (kyphosis) |
|
Definition
|
|
Term
|
Definition
| lateral curvature of >10 degrees |
|
|
Term
| in what condition do we see a "rib hump" |
|
Definition
|
|
Term
| tx 10-25 degrees (scoliosis) |
|
Definition
|
|
Term
| tx 25-45 degrees (scoliosis) |
|
Definition
|
|
Term
| tx >45 degrees (scoliosis) |
|
Definition
|
|
Term
| what do we treat with epidural steriods? |
|
Definition
Herniated Disc
tx > 6 weeks = surgery |
|
|
Term
|
Definition
| one vertebrae gradually slips over another most common cause = long standing spondylosis |
|
|
Term
classification of spondylolisthesis:
FMHx, gymnastics, football lineman
spina bifida occulta
cancer METS
6th - 7th decades, L4-L5 level |
|
Definition
isthmic
congenital
pathologic
degenerative
no example - traumatic, iatrogenic |
|
|
Term
|
Definition
Grading of spondylolisthesis:
Grade 0 = o%
Grade 1 = < 25%
Grade 2 = 26-50%
Grade 3 = 51-75%
Grade 4 = 76-99%
Grade 5 = 100%, complete displacement |
|
|
Term
| imaging for spondylolisthesis |
|
Definition
Plain film: AP, Lateral, Obique: scotty dog w/ broken neck, flexion & extesion shows stability
CT myelography to evaluate spinal cord
MRI to evaluate spinal cord and disc |
|
|
Term
|
Definition
|
|
Term
| pain hips and buttocks. pain in AM that impoves with exercise |
|
Definition
|
|
Term
| marie Strumpell Arthritis |
|
Definition
|
|
Term
| drug of choice for ankylosing spondylitis |
|
Definition
|
|
Term
| lab results in ankylosing spondylitis |
|
Definition
ESR - eleveated
+ HLA - B27 |
|
|
Term
| back pain increased with sitting, sciatica, flexion decreases pain |
|
Definition
|
|
Term
| pain with weight bearing or joint motion, stiffness, loss of function |
|
Definition
| osteoarthritis AKA degenerative joint disease |
|
|
Term
|
Definition
Calcium (1000-1500 mg/day)
Vitamin D
consider estrogen within 6 years of menopause
calcitonin
bisphosphonates |
|
|
Term
|
Definition
shoulder abduction
innervated by C5 & C6 |
|
|
Term
|
Definition
shoulder external rotation
innervated by C5 & C6 |
|
|
Term
|
Definition
shoulder external rotation
innervated by C5 |
|
|
Term
|
Definition
Shoulder internal rotation
innervated by C5 & C6 |
|
|
Term
|
Definition
Neer's - forward flexion = pain
Hawkins-Kennedy - arm flexed at 90 degrees = pain |
|
|
Term
| supraspinatus muscle test |
|
Definition
|
|
Term
| signs and symptoms of rotator cuff syndromes |
|
Definition
shoulder pain increases at night
catching during use |
|
|
Term
| signs of a full thickness rotator cuff tear |
|
Definition
night pain
abduction and lateral rotator weakness
loss of ROM |
|
|
Term
| Most common location of calcific tendonitis |
|
Definition
|
|
Term
|
Definition
| calcification of a none bone structure |
|
|
Term
pain at antero-lateral aspect of the shoulder.
young athletes or pt older than 40yo |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
surgical if biceps tendon rupture.
biceps muscle can't be repaired w/ surgery |
|
|
Term
| hallmark of adhesive capsulitis |
|
Definition
| loss of internal rotation |
|
|
Term
| insidious pain, deltoid and spinatus atrophy, decreased active and passive ROM |
|
Definition
| adhesive capsulitis (frozen shoulder) |
|
|
Term
| AC separation grading scale: |
|
Definition
Grade 1 - strain to ligament, but no displacement
Grade 2 - tear AC ligament but no disruption of the coracoclavicular ligament. clavical mildly displaced upwards.
Grade 3 - distruption to all ligament w/ full dislocation
Grade 4 - disruption to all ligaments w/ full dislocation w/ deltoid & trapezius disruption |
|
|
Term
|
Definition
Grade 1 -3 = NSAIDS, sling, PT, No sports x 6 weeks
Grade 4 = surgery |
|
|
Term
| most common cause of posterior shoulder dislocation |
|
Definition
|
|
Term
| elderly FOOSH, pain and swelling around shoulder joint w/ ecchymosis elbow to neck. pain w/ ROM. Pt supporting/ guarding arm |
|
Definition
|
|
Term
|
Definition
protected 4-6 weeks for children, 8 weeks for adults
ortho consult |
|
|
Term
| indications for surgery in clavicular fractures |
|
Definition
tenting of the skin
nonunion
cosmesis
manual laborer/athlete
significant separation of fragments |
|
|
Term
| 3 components of Thoracic Outlet Syndrome |
|
Definition
Nerve - numbness, tinling, burning, decreased muscle strength
artery - pallor, decreased pulses, claudcation in the forearm
vein - abnormal swelling of affected side vs. other side |
|
|
Term
| tests of thoracic outlet syndrome |
|
Definition
Adson's Test
Roos Test
Halstead test |
|
|
Term
| when do you use a sugar tong splint |
|
Definition
|
|
Term
| what is at risk of neurovascular compromise with a humeral fracture |
|
Definition
radial nerve
brachial artery |
|
|
Term
| surgical indications with humeral fracture |
|
Definition
NV compromise
significant displacement
bilateral fractures
pathologic fractures
floating elbow |
|
|
Term
| other names of medial epicondylitis |
|
Definition
| Little League or Golfer's Elbow |
|
|
Term
| symptoms of medial epicondylitis |
|
Definition
medial elbow pain
common flexor/pronator origin |
|
|
Term
| symptoms of medial epicondylitis |
|
Definition
medial elbow pain
common flexor/pronator origin |
|
|
Term
| tx of medial epicondylitis |
|
Definition
severe pain = splint 1-2 weeks
rest: 4-6 weeks
NSAIDS = drug of choice
PT after 6 weeks of rest
ulnar nerve compression is common
surgical tx is risky secondary to elbow stability |
|
|
Term
| other name of lateral epicondylitis |
|
Definition
Tennis Elbow
Extensor Carpi Radialis Brevis (ECRB) |
|
|
Term
| sx of lateral epicondylitis |
|
Definition
aching, burning lateral elbow pain
pain with resisted wrist extension |
|
|
Term
|
Definition
| aspirate fluid, antibiotics if infected, steroid injection, surgical excision |
|
|
Term
| posterior fat pad/ sail sign |
|
Definition
subtle radial head fx - adults
supracondylar fx of humerus - kids |
|
|
Term
| fx of proximal 1/3 of ulna with dislocation of the radial head |
|
Definition
Monteggia Fx
tx - kids = closed reduction
adults = open reduction w/ internal fixation |
|
|
Term
| Fx of distal 1/3 of radius with disruption of the DRUJ |
|
Definition
|
|
Term
| fx of distal radius w/ dorsal displacement and shortening |
|
Definition
| Colle's fx AKA silver fork deformity |
|
|
Term
|
Definition
|
|
Term
| fx of distal radius w/ volar displacement |
|
Definition
|
|
Term
pain/tenderness to the psoterior lateral aspect of the wrist
+ Finkelstein's test |
|
Definition
De Quervain's Tenosynivitis
Tx = thumb spica splint |
|
|
Term
| paresthesia of the median nerve distribution, + Tinnel's sign, + Phalen's sign |
|
Definition
|
|
Term
|
Definition
|
|
Term
| sprain of the ulnar collateral ligament |
|
Definition
Game Keeper's thumb
AKA Skier's thumb, MCP dislocation |
|
|
Term
| fx of distal head of the 5th metacarpal w/ hx of fist fight. |
|
Definition
|
|
Term
|
Definition
|
|
Term
loss of active extension secondary to central slip tear.
unopposed finger flexion with migration of lateral bands |
|
Definition
|
|
Term
forceful finger flexion
DIP flexed and unable to extend |
|
Definition
|
|
Term
PIP hyperextension
DIP flexion
PIP volar plate related - volar plate unable to prevent hyperextension |
|
Definition
|
|
Term
painful locking or snapping w/ extension.
Nodule distal to palmar crease that moves |
|
Definition
|
|
Term
|
Definition
steroid injection into tendon sheath, avoid tendon itself - rupture.
surgical release |
|
|
Term
1 or more painful nodules in palm 4th and 5th digit
often bilateral
web space contracture
+ Hueston's table top test |
|
Definition
|
|
Term
genetic disorder w/ connective tissue laxity.
skin laxity, joint hypermobility, joint instablity, scoliosis |
|
Definition
|
|
Term
infection of the tendon sheath
Kanavel Signs (4 cardinal signs - talon grip, palpable cord on tendon sheath, painful extenion, pallor) |
|
Definition
| Suppurative Tenosynovitis |
|
|
Term
| infection of the distal phalanx |
|
Definition
|
|
Term
| infection of the edge of the nail |
|
Definition
|
|
Term
|
Definition
irrigate w/ copious amounts of normal saline.
DO NOT suture bites
augmentin x 7-10 days |
|
|
Term
| most common types of bites |
|
Definition
|
|
Term
| buring pain after injury. pain out of proportion to injury |
|
Definition
| Reflex Sypmathetic Dystrophy (RSD) |
|
|
Term
|
Definition
6-12 weeks
pain is localized to area of injury.
spreads throughout extremity.
hypersensitivity to light touch.
extremity - swollen, warm, excessive perspiration. |
|
|
Term
| dystrophic and atrophic phase RSD |
|
Definition
| joint becomes restricted, becomes cool, skin and muscle atrophy |
|
|
Term
|
Definition
difficult!
best treatment = prevention |
|
|
