-
OTTOWA ANKLE RULES
DETERMINE OF X-RAY NEEDED
- ANKLE
- --PAIN IN MALLEOLAR ZONE
- --EITHER MEDIAL OR LATERAL POSTERIOR EDGE OR TIP
- --CAN'T BEAR WEIGHT (4 steps) IMMEDIATELY AFTER AND AT ER
- FOOT
- --PAIN IN MID-FOOT ZONE
- --PAIN AT EITHER BASE OF 5TH METATARSAL OR NAVICULAR
- --CAN'T BEAR WEIGHT
-
LATERAL ANKLE PAIN
DX -- LAT ANKLE SPRAIN
H&P -- INVERSION OF FOOT w ACUTE LAT PAIN & SWELLING. TTP OVER LAT LIGs. PAIN w PASSIVE INVERSION AND ACTIVE EVERSION
IMAGING -- OTTAWA ANKLE RULES
Tx -- RICE
-
MEDIAL ANKLE PAIN
- Dx
- -- DELTOID LIG SPRAIN
- --UNCOMMON, DON'T MISS HIGH ANKLE SPRAIN OR MALLEO FRACT
- H&P
- --EVERSION OF FOOT w MEDIAL PAIN AND SWELLING
-
POSTERIOR HEAL PAIN and/or MORNING STIFFNESS
ACHILLES TENDONITIS
- H&P
- --EXAMINE w ANKLE DORSIFLEXED AND FLEX/EXT AT KNEE
- --EXAMINE ARCHES
- IMAGING
- --LATERAL WT-BEARING HEAL RAD
- Tx
- --ACUTE: RICE, NSAIDs, MAYBE HEAL LIFTS
- --CHRON or UNRESPONSIVE: SURG EVAL
-
ACUTE ONSET POSTERIOR HEAL PAIN w SWELLING IN TENDON AREA and CAN'T PLANTARFLEX
ACHILLES RUPTURE
- H&P
- --OFTEN A GAP PALPATED ALONG BACK OF LEG
- IMAGING
- --NOT NEEDED IF GAP PALP
- --US or MRI if SURG ANTICIPATED
- Tx
- --NON OPERATIVE (dm, transplant): BOXER BOOT
- --OPERATIVE: wi 3 WEEKS
-
ANTERIOR HIP PAIN THAT RADIATES TO GROIN. SLOWLY PROGRESSIVE w ACTIVITY
OSTEOARTHRITIS
- H&P
- --PAIN w ACTIVITY
- --SLOWLY PROGRESSIVE
- --RROM
- --RADIATES TO GROIN
- Tx
- --ANALGESICS
- --MOIST HEAT
- --STRENGTHENING EXER
- --JOINT REPLACE
-
ANTERIOR HIP PAIN w NUMBNESS IN WELL DEFINED AREA OF THIGH
MERALGIA PARASTHETICA
- H&P
- --NUMBNESS IN WELL DEFINED AREA OF ANT THIGH
- --CAN CAUSED BY TIGHT CLOTHING
- --OBESITY
- --CONSTANT FLEXION AT HIP
- Tx
- --REASSURANCE
- --WT LOSS
- --LOOSE CLOTHING
- --IF PAIN, CAN REFER FOR NERVE BLOCK
-
LATERAL HIP PAIN & CAN'T LAY ON SIDE
TROCHANTERIC BURSITIS
- H&P
- --CAN'T LAY ON SIDE
- --PAIN CROSSING LEGS
- --POINT TENDERNESS OVER TROCH
- --RADIATES ONLY TO KNEE
- Tx
- --95% CAUSED BY GAIT ABN
- --AVOID DIRECT PRESSURE
- --STRETCH
- --STEROID INJ INTO BURSA
-
POSTERIOR HIP PAIN w PAIN IN UPPER BUTTOCK REGION
SACROILIITIS
- H&P
- --PAIN IN U.BUTTOCK REGION
- --TTP OVER SI JOINT
- --PAIN w PATRICK'S TEST (flex knee of affected side and place foot on other knee. hold hip in place while pushing down on knee)
- Tx
- --CORRECT ANY GAIT ABN
- --SI BELT to prevent joint rub
- --PT FOR STRETCHING
- --ANTI-INFLAM MEDS
- --MOIST HEAT
-
ANTERIOLATERAL HIP PAIN w Hx OF TRAUMA OR OSTEOPOROSIS
HIP FRACTURE
- H&P
- --Hx OF TRAUMA or OP
- --UNABLE TO BEAR WT
- --WON'T PASSIVELY ROTATE HIP
-
SLOW PROGRESSIVE PAIN IN MEDIAL OR LATERAL KNEE. WORSE w ACTIVITY
OSTEOARTHRITIS
- H&P
- --SLOW PROG PAIN
- --WORSE WHEN ACTIVE
- --RELIEVED BY REST
- --JOINT LINE TENDERNESS
- --VARUS DEFORMITY (inward angulation of distal bone or joint seg. valgus is outward)
- Dx TESTS
- --WT BEARING PLAIN FILMS
- Tx
- --ANALGESICS
- --PT
- --WT CONTROL
- --POSS INTRA-ARTIC STEROID INJ
- --TOTAL JOINT REPLACE
-
MEDIAL OR LATERAL KNEE PAIN w KNEE LOCKING
MENISCAL TEAR
- H&P
- --AFTER TWISTING MOTION
- --Hx OF OA
- --EFFUSION OCCURS hrs LATER
- --JOINT LINE TENDERNESS
- --KNEE LOCKING / CATCHING
- Dx TESTS
- --MRI ONLY IF ABN FUNC AND SURG IS A CONSIDERATION
- Tx
- --PT
- --ANALGESICS
- --KNEE BRACE
- --LOCKING: ORTH EVAL FOR SURG
-
LOCALIZED TENDERNESS OVER MEDIAL TIBIAL PLATEAU
ANSERINE BURSITIS
- H&P
- --TENDERNESS OVER MEDIAL TIB PLATEAU
- --POSS ASSOC w OA or LARGE EFFUSION
- Tx
- --ANTI INFLAMMs
- --ICE
- --AVOID DIRECT PRESSURE
- --CONSIDER STEROID INJ IN CHRON
-
LOCALIZED KNEE PAIN w VALGUS STRESS
MCL STRAIN
VALGUS -- OUTWARD ANGULATION OF DISTAL BONE OR JOINT
- H&P
- --LOCALIZED PAIN w VALGUS STRESS
- Dx TESTS
- --USUALLY NOT NEEDED
- Tx
- --RICE
- --BRACE
- --ANTI INFLAMs
- --IF UNSTABLE: GRADE 3 ORTHO CONSULT
-
ANTERIOR KNEE PAIN WHEN CLIMBING STAIRS AND RETROPATELLAR PAIN ON EXAM
PATELLOFEMORAL PAIN SYND
- H&P
- --PAIN WHEN CLIMBING STAIRS
- --WALKING UP HILL
- --RISING FROM SEATED POSITION
- --RETROPATELLAR PAIN ON EXAM
- --PAIN w COMPRESSION OF PAT ON FEMUR
- Tx
- --PT FOR QUAD STRENGTH
- --ANALGESICS
- --PAT STABILIZING BRACE
-
ANTERIOR KNEE PAIN w Hx OF KNEELING AND SWELLING ON TOP OF PATELLA
PREPATELLAR BURSITIS
"HOUSMAID'S KNEE"
- H&P
- --Hx OF KNEELING
- --SWELLING ON TOP OF PAT
- --ROM PRESERVED
- --GOUT
- --INFECTION
- Tx
- --ASPIRATE TO DETERMINE ETIOLOGY
- --COMPRESSION
- --ANTI INFLAMs
- --AVOID DIRECT PRESSURE
-
FULLNESS IN POSTERIOR KNEE AND CAN'T FULLY FLEX
POPLITEAL CYST
"BAKER'S CYST"
- H&P
- --FULLNESS IN KNEE
- --CAN'T FULLY FLEX
- --UNDERLYING OA
- Tx
- --TREAT UNDERLYING DISORDER
-
ACUTE ONSET, WARM, PAINFUL KNEE. WORSE w ACTIVITY AND ERYTHEMATOUS
SEPTIC ARTHRITIS
- Dx TESTS
- --JOINT ASPIRATION
- Tx
- --ANTI BIOTICS
- --JOINT WASHOUT BY ORTHO
-
EXQUISITELY TENDER, SWOLLEN, RESTRICTED KNEE
GOUT / PSEUDOGOUT
- H&P
- --SELF LIMITED
- --WARM
- --EXQUISITELY TENDER
- --SWOLLEN
- --RROM DURING FLARE
- Dx TESTS
- --JOINT ASPIRATION
- Tx
- --COLCHICINE
- --STEROIDS
- --ALLOPURINOL ONCE RESOLVED
-
RAPID SWELLING AFTER TRAUMA OF KNEE w SEVERE INSTABILITY
LIGAMENTOUS TEAR
- H&P
- --RAPID SWELLING
- --TRAUMA USUALLY
- --SEVERE INSTABILITY
-
DIFFERENTIAL FOR KNEE EFFUSION
SEPTIC ARTHRITIS
GOUT / PSEUDOGOUT
LIG TEAR
MENISCAL TEAR
-
SHARP FOOT PAIN w FIRST STEP OF THE DAY. LOCAL POINT TENDERNESS ANLONG BOTTOM OF FOOT.
PLANTAR FASCIITIS
- H&P
- --SHARP PAIN w FIRST STEP OF DAY
- --LOCAL POINT TENDERNESS ALONG BOTTOM
- Tx
- --OFTEN RESOLVES SPONT
- --STRETCHES
- --ORTHOTICS
- --ICE
- --CUSHIONED SHOES
-
PAIN TO LAT SHOULDER AND ARM w OVERHEAD ACTIVITY. CAN'T SLEEP ON THAT SIDE. TTP OVER LAT HUMERAL HEAD
IMPINGEMENT SYNDROME
- aka
- --SUBACROMIAL BURSITIS
- --SUPRASPINATUS BURSITIS
- --TENDINITIS
- H&P
- --PAIN TO LAT SHOULDER & ARM w OVERHEAD ACT
- --CAN'T SLEEP ON SIDE
- --TTP OVER LAT HUMERAL HEAD
- --PAINFUL ARC
- --HAWKINS & NEER TEST
- Tx
- --ICE
- --AVOID OVERHEAD ACT
- --PT
- --ANTI INFLAM
- --STEROID INJ
-
SHOULDER STIFFNESS and CAN'T MOVE ARM FULLY. ABN PASSIVE ROM
ADHESIVE CAPSULITIS
aka FROZEN SHOULDER
- H&P
- --STIFFNESS
- --ABN PASSIVE ROM
- --SIMILAR TO IMPINGEMENT SYND BUT ABN PASSIVE ROM
- Tx
- --18 months PT
- --STEROID INJ
- --POSS SURG IF REFRACTORY
-
FALLING DIRECTLY ONTO SHOULDER w ANTERIOR PAIN, POPPING OR GRINDING. TTP OF AC JOINT
ACROMIAL-CLAVICULAR SEPARATION
- Tx
- --UP TO GRADE 3 SEPARATION: ANALGESICS AND PT
- -- > GRADE 3: POSS SURGERY
-
ANTERIOR SHOULDER PAIN w LIFTING AND OVERHEAD REACHING.
BICEPS TENDINITIS
- H&P
- --PAIN w LIFTING
- --OVERHEAD REACHING
- --ANTERIOR PAIN
- --TTP OF BICEPS GROOVE
- --YERGASONS AND SPEEDS SIGN
- Tx
- --REST
- --AVOID LIFTING
- --ICE
- --ANTI INFLAM
- --PT
-
VAGUE SHOULDER LOOSNESS w EXCESSIVE ROM esp ROTATION
SHOULDER INSTABILITY
- H&P
- --VAGUE LOOSNESS
- --SWIMMERS & THROWERS
- --YOUNG WMN w POOR MUSC MASS
- --EXCESSIVE ROM esp ROTATION
- --APPREHENSION TEST
-
PAIN IN LATERAL ELBOW w TTP OF LATERAL EPICONDYLE. PAIN w WRIST DORSIFLEXION
EPICONDYLITIS
aka TENNIS ELBOW
- H&P
- --PAIN IN LAT ELBOW / ARM WHEN OPENING JARS, GRIPPING, LIFTING
- --TTP OVER LAT EPICONDYLE
- --PAIN w WRIST DORSIFLEXION
- Tx
- --ELBOW STRAP
- --ICE
- --AVOID AGG ACT
-
PAIN IN MEDIAL ELBOW AND TTP OVER MEDIAL EPICONDYLE
EPICONDYLITIS
aka GOLFER'S ELBOW
PAIN w VOLAR WRIST FLEXION
MEDIAL EPICONDYLE TTP
PAIN IN ELBOW / ARM WHEN OPENING JARS, GRIPPING, LIFTING
- Tx
- --ELBOW STRAP
- --ICE
- --AVOID AGG ACT
-
PAIN WHEN LEANING ON ELBOW. OLECRANON SWELLING
OLECRANON BURSITIS
- Tx
- --ASP FOR CRYSTALS OR INFECTION
- --AVOID PRESSURE
-
NUMBNESS AND TINGLING IN FINGERS 1-3.5. AGGRAVATED IN WRIST FLEXION
CARPAL TUNNEL SYND
- H&P
- --SHAKES HANDS TO RESTORE FEELING
- --MORE COMMON IN DM, PREGOs, OBESITY, HYPOTHYROIDISM
- --PHALEN (flex wrists and push together & TINEL (tap ventral wrist) TESTS
- --THENAR ATROPHY
- --DEC 2-POINT DESCRIMINATION
- --DEC THUMB OPPOSITION
- Dx TESTS
- --EMG/NCS
- --DM, THYROID Dz
- Tx
- --COCK UP WRIST SPLINTS
- --ANTI INFLAMS
- --CARP TUN INJ
- --SURG
-
PAIN IN RADIAL WRIST w TENDERNESS IN SNUFF BOX
DE QUERVAINS TENOSYNOVITIS
- H&P
- --REPETITIVE MOV OF WRIST
- --RADIAL SIDE PAIN
- --TTP OVER SNUFF BOX
- --FINKELSTEINS SIGN (thumb in fist then actively stretch)
- Tx
- --SPICA SPLINT
- --ICE
- --AVOID AGG ACT
- --ANTI INFLAM
- --STEROID INJ
-
BLUNT TRAUMA TO WRIST w TTP OVER ULNAR SIDE
TRIANGULAR FIBROCARTILAGE COMPLEX INJURY (TFCC)
- H&P
- --BLUNT TRAUMA TO WRIST
- --TTP OVER ULNAR SIDE
- TESTS
- --MRI IN INTRACTABLE
- Tx
- --SPLINT
- --ICE
- -ANTI INFLAMs
-
FALL ONTO OUTSTRETCHED HAND w TTP OF DISTAL RADIUS
DISTAL RADIAL FRACTURE
- H&P
- --FOOSH
- --TTP +/-
- --DEFORMITY OF DISTAL RADIUS
- Tx
- --IMMOBILIZATION
- --SURG IF DISPLACED
-
FOCAL, DORSAL, USUALLY NON-TENDER SWELLING OF WRIST
DORSAL WRIST GANGLION
- H&P
- --USUALLY NONTENDER SWELLING
- --FOCAL DORSAL SWELLING
- Tx
- --LEAVE ALONE UNLESS CAUSING MECH PROBS
- --SURG
|
|
