Term
MR arthrograms: get a dye injected and then an MR.
Bone scan: hot areas show stress fractures
Fluoroscopy: now utilized a lot
EMG: for nerve conduction problems, neuropathy, diabetics, helps determine if proximal or distal injury of nerve damage |
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Definition
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Term
| Xray can’t tell you soft tissue injuries> can’t see meniscus tears on X-ray, order an MRI if you suspect meniscus tear. |
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Definition
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Term
| I use x-rays to rule out a fracture/bony abnormalities, and even soft tissue injuries (ie. AC separations, ankle syndesmotic injuries) |
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Definition
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Term
| XRAYS CAN BE USED FOR BONY ABNORMALITIES AND OFTEN SOFT TISSUE ABNORMALITIES. CAN SEE LIGAMENTS ON XRAY JUST NOT MENISCAL TEARS. |
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Definition
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Term
| Patellar Femoral syndrome: more common in females than males. Will see patella telted towards the outside. |
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Definition
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Term
Open vs. Closed
Comminuted (>2 pieces)
Impacted (collapse of one fragment of bone onto another)
Transverse(fx at right angle to long axis of the bone)
Oblique (fx line with angle other than right angle)
Spiral (fx line encircles bone secondary to rotational forces)
Avulsion (lig. or tendon pulls fragment)
Pathologic (weakened areas) – if minimal trauma consider pathologic problem
Stress (usually lower ext. and occur with repetitive trauma) |
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Definition
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Term
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Definition
| new bone formation where there was a slight fracture before |
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Term
Clavicle fractures: bayonetted is common
Can determine whether or not to fix fracture depending on angulation. The more angulation you have> function affected. |
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Definition
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Term
| May see spiral fracture in child abuse. So if kid with spiral fracture and history doesn’t make sense> flag that. |
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Definition
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Term
| Compression fracture: elderly b/c of osteoporosis in spine (xrays on this on exam). |
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Definition
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Term
| Torus fracture aka __ __. Common in __. |
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Definition
- buckle fracture
- children |
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Term
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Definition
| - type of impaction fracture in the knee that occurs when the femoral condyle strikes the softer tibial plateau |
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Term
| Femoral neck fractures have a propensity to cause __ __ due to interference with the __ __. |
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Definition
- avascular necrosis (AVN)
- circumflex artery |
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Term
| Risk factors for AVN and osteonecrosis: |
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Definition
- heavy drinking
- long term steroid use
- HIV positive
LONG TERM PREDNISONE> HUGE RISK FACTOR |
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Term
| What do you order if you suspect AVN? |
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Definition
| MRI (won't show up on xrays right away, so have to order MRI) |
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Term
| Letournel classifications are for __ fractures. |
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Definition
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Term
| Most common mechanism of injury for Acromial Clavicular separations (AC separations): |
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Definition
| falling and landing on tip of shoulder |
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Term
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Definition
Type I: tender but no abnormality
Type II: separation but ligaments still intact
Type III: total displacement of ligaments
Type IV, V, VI: surgery |
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Term
| A conventional athrogram is when __ __ contrast dye is injected into a __ and shows up __ on a plain ___. |
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Definition
- radiopaque iodine
- joint
- white
- radiograph |
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Term
| Arthrograms are done when pts can't have __ or __. |
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Definition
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Term
| Arthrograms can pick up rotator cuff tears. |
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Definition
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Term
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Definition
- AVN
- Soft tissue abnormalities: Rotator cuff tear or meniscal tear
- Tumors
DO NOT ORDER FOR ARTHRITIS AS A PCP, SEND TO ORTHOPEDICS |
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Term
| MRIS great for looking at bone and soft tissue. |
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Definition
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Term
| DO NOT ORDER MRIS ON PATIENTS THAT ARE BONE ON BONE (ARTHRITIS), THESE PTS JUST NEED A NEW KNEE, SO DON’T WASTE AN MRI ON THAT, ITS REALLY EXPENSIVE, THEY HAVE MENISCAL TEARS . KNOW THE SECOND BULLET. TEST. INSTEAD REFER THE PATIENT TO AN ORTHOPAEDIC SPECIALIST. |
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Definition
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Term
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Definition
- Internal defibrillator
- Internal pacemaker
- Cochlear implant
- Some types of clips for brain anerysms
- Wait 12-18 months after knee replacement
- Artificial heart valves
- Implanted drug infusion ports
- Artificial limbs/metallic joints
- Implanted nerve stimulators
- Metal pins/plates/screws/stents/surgical staples |
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Term
| In general, metal objects used in orthopedic surgery pose no risk during MRI. However, a recently placed artificial joint may require the use of another imaging procedure. If there is any question of their presence, an x-ray may be taken to detect the presence of and identify any metal objects. |
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Definition
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Term
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Definition
Injection of a radiopaque (iodine) substance into a joint that shows up white on an MRI
(dye is expensive and lots of insurances won't pay for it) |
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Term
| The only way to see a labral tear is with a __ __. |
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Definition
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Term
| If you suspect a __ __,have to order an MR Arthrogram. |
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Definition
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Term
I use CT scans if I suspect a fracture even if plain films are normal (ie. Lisfranc fractures/dislocations)
A trauma patient usually undergoes a full body CT scan, especially if he/she is unresponsive and cannot communicate where they hurt
We use CT scans for spinal injury and pelvic injury |
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Definition
| CT scans = lots of radiation |
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Term
| If you suspect a fx and plain films are normal, order a __ __. |
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Definition
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Term
| CT scans are used on __ and __ injuries. |
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Definition
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Term
| Bone scans measure __ activity with the __ __, __ __. If there is increased bone formation, a __ __ will occur. |
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Definition
- osteoblast
- radioactive tracer
- technetium-99
- hot spot |
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Term
| Bone scans can rule out __ vs __ bone lesions. |
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Definition
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Term
| Bone scans are used a lot for __ ___, __ of __ __, and suspicion of __. |
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Definition
- stress fractures
- loosening of prosthetic devices
- suspicion of malignancy (METs) |
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Term
| A "hot" bone scan suspicious of malignancy, should be followed up by a __. |
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Definition
| MRI (to see soft tissue involvement of malignant tumor) |
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Term
| EMG can differentiate b/w __ __ __ and __. |
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Definition
| - primary muscle diseases and neuropathies |
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Term
| EMGs help to differentiate b/w what three things? |
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Definition
- peripheral nerve disorders
- muscle diseases
- anterior horn cell abnormalities |
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Term
| EMGs can be used to dx __ and __. |
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Definition
| radiculitis and paresthesias |
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Term
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Definition
ESR
CRP
ANA
URIC ACID LEVEL
RHEUMATOID FACTOR
CBC with DIFF
ASPIRATE ANALYSIS |
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Term
| Elevated ESR or CRP may indicate: |
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Definition
- inflammatory process
- infection
- malignancy
- rhematologic disorder |
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Term
| When ESR and CRP are negative, a __ cause can be ruled out. |
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Definition
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Term
| __ can be used to monitor autoimmune inflammatory disease therapy. |
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Definition
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Term
| ESR is __ for any particular organ disease or injury. |
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Definition
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Term
| ESR is elevated in __ and normal in __. |
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Definition
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Term
| ANA is used to detect __ __ __. It is a __ __ that reacts against __ __ __. |
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Definition
- autoimmune rheumatic diseases
- protein antibody
- cellular nuclear material |
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Term
ANA is sensitive in detecting systemic lupus erythematosis (SLE). 95% of patients with SLE are positive for ANA.
There are drugs and other rheumatic diseases that can produce false positives |
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Definition
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Term
Negative for ANA: still a chance that they may have lupus. 95% of pts with lupus will have positive ANA, 5% will have a negative ANA.
If they have positive ANA and LE cell prep> suggeset SLE. Read this slide. |
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Definition
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Term
| A positive __ and __ __ __ strongly suggests lupus. |
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Definition
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Term
| If pt has negative ANA, prob don't have lupus, but __ can give a false negative ANA and LE cell prep. |
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Definition
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Term
| Uric acid is a __ compound that is a product of __ catabolism. It is excreted primarily in the kidneys and less so in the GI tract. It is a good indication of __. |
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Definition
- nitrogenous
- purine
- gout |
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Term
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Definition
- Beer and other EtOH
- Anchovies
- Sardines in oil
- Herring
- Yeast
- Organ meat (liver, kidneys)
- Sweet breads
- Legumes (dried beans, peas)
- Meat extracts, gravies
- Mushrooms
- Spinach
- Asparagus
- Cauliflower |
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Term
| 80% of pts with RA have a positive __. |
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Definition
Rheumatoid Factor
A negative rheumatoid factor does not mean patient does not have RA
Elderly patients often have a false-positive result |
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Term
Synovial fluid analysis is important to analyze the components of an aspirate
You can check a cell count with differential for infection; crystal analysis for gout; anaerobic and aerobic bacteria for culture and sensitivity (to determine antibiotic sensitivity of the organism); gram stain; acid fast bacilli (AFB); fungal
In sexually active patients I will often check for a gonococcal infection
If infection suspected also can perform a protein level and glucose level of the aspirate (Inc. protein and dec. glucose suggest infection)
Only 50% of patients with septic joint, however, have low glucose levels, and can also occur in RA |
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Definition
KNOW ABOUT THE SYNOVIAL FLUID ANALYSIS.
YOUNG PT THAT IS SEXUALLY ACTIVE, WANT TO MAKE SURE THEY DON’T HAVE AN STD IN THE KNEE. |
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Term
| You do a synovial fluid analysis b/c suspect infection in a joint, if there is an infection, what do expect of the protein and glucose levels of the aspirate? |
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Definition
- high protein
- low glucose |
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Term
| This is a hemarthroses- blood in the joint. Hemarthroses in the knee usually bc ACL tear. Mensiscus don’t’ really have blood supply except on periphary so less likely to get hemarthroses with torn meniscus |
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Definition
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