Orthopedics 1

Apply inferior traction with arm at side. Positive for AC joint instability if there is a gap between humeral head and acromion

Arm at 90 deg forward flexion, passive IR Pain is positive for impingement/RC tendonitis

start with arm at 90 deg forward flex and pronation, hold scap and passively forward flex to overhead. Pain is pos. for supraspinatus impingement.

Have patient horizontally ADD arm. Pain is positive for AC injury

IR with hand on back. If pt cannot lift hand off back pos for weakness/tear of subscapularis

With pt supine and arm at side with elbow flexed to 90, place your finger on biceps tendon. Externally Rotate. Pos for biceps tendonitis if pain or feel tendon slip out of groove

Pt arm starts in forward flexion and supination, resist this motion, pain is pos for biceps tendonitis

Shoulder AB to 90, elbow flexed to 90. Apply pressure behind humeral head and ER shoulder. Pos for anterior instability if pain.

Tapping on volar aspect of wrist over carpal tunnel will reproduce pain/paresthesias in median nerve distribution. Pos for carpal tunnel syndrome.

Place dorsum of hands together for 1 min. Pos for carpal tunnel syndrome if pain/paresthesias in median nerve distribution.

radial head fx in adults, supracondylar fx in kids

usually normal, sail sign

Test for disc herniation. Pt lies supine and leg is elevated. Pos is radicular pain below the knee.

Essentially place foot of affected leg on pt's unaffected knee (Flexion, Abduction, ext. rotation). Hold opposite ASIS and apply downward pressure to affected knee. Pain is pos for problem with SI joint.

Test for lumbar nerve root irritation. Pt sitting, passively extend affected leg. Pain is pos test (patient will put hands on table and arch backward)

Gold standard for ACL tear. Knee flexed 15 deg. stabilize femur with one hand and tibia with other. Move tibia forward. Pos for ACL tear if movement and soft end point

Knee flexed 90 deg. stabilize foot on table, pull tibia forward. Laxity can indicate ACL injury

Test for ACL dysfunction-Apply valgus stress, IR force and extend the knee. Maintain valgus stress and IR, and flex knee to 30 deg. ACL deficient knee will anterolaterally sublux on distal femur.

For chronic PCL tear. Flex knee to 90 deg, stabilize heel on table. Tibia will droop at knee joint.

Knee flexed to 90 deg, stabilize foot on table. Move tibia posterior. Laxity can indicate PCL injury

Test for LCL injury, apply stress to medial knee while stabilizing lower leg.

Test for MCL injury, apply stress to lateral knee while stabilizing lower leg

Test for meniscus injury. One hand on joint line and the other on the sole of the foot. Flex knee to 90 deg. IR/ER and extend the knee. Palpable or audible click

Test for meniscal tears. Pt in prone position, flex knee to 90 deg, apply load through foot and IR/ER rotate. Pain is pos test.

Cup hand around superior patella. Have pt contract quads while applying pressure. Pain is pos sign for patellar injury.

Draw line from ASIS to tibial tubercle. Draw straight line from tibial tubercle up. Measure angle. Females less than 17, males less than 14 is normal.

Pt lying on side. Hold hips in neutral and cradle affected leg. Bring pt into hip flexion then adduction and extension. Let leg drop, if leg stays elevated positive for IT band tightness.

put foot into 10 deg plantar flexion, stabilized tibia, other hand on heel and move ankle mortis forward on tibia. Pain and laxity pos for lateral ankle sprain. Tests ATF.

Dorsiflex foot to 10 deg. Hold heel and invert talus/calcaneous on tibia while supporting tibia with other hand. Pain and laxity pos for lateral ankle sprain (CF).

evert talus/calcaneus on tibia while supporting tibia with other hand. Pain and laxity pos for medial ankle sprain (deltoid lig.)

With both hands press tibia and fibula together. Pain indicates injury to syndesmosis.

Pt in prone position, squeeze calf. Lack of plantar flexion indicative of Achilles tendon rupture.

Fusiform swelling of fingers, significant tenderness along the course of the tendon, marked pain on passive extension, flexed finger at rest. Positive for septic tenosynovitis.

Cervical disc degeneration

cervical sprain

C1 burst fx

C2 fx/dislocation from hyperextension and distraction

C7 spinous process fx

An injury to the glenoid labrum that can be described as Superior Labrum Anterior to Posterior.

95% of all shoulder dislocations

cortical depression in the head of the humerus bone.from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.

An avulsion of the anteroinferior glenoid labrum at its attachment to IGHL complex.

Dislocation caused by an anterior force, seizure, or electric shock, and is fairly uncommon

This injury can damage the radial nerve.

Medial epicondylitis

Lateral epicondylitis

dislocation of the elbow joint caused by a sudden pull on the extended pronated arm. The head of the radius slips out of the annular ligament

90% of elbow dislocations are in this direction

Most common elbow fracture in kids

Ulnar shaft fracture with proximal radius dislocation.

Radial fracture with distal ulna dislocation

Isolated ulna fracture caused by direct blow to the forearm

90% of distal radial fractures. Usually from a FOOSH. Dorsal angulation of distal fragment

Distal radial fracture from a fall on the back of the hand. Causes a volar angulation of the distal fragment.

Most common carpal fracture, at an increased risk for avascular necrosis

fracture of the distal 5th metacarpal

Forced flexion of the finger from an axial load, causing rupture of extensor digitorum to DIP.

Thickened palmar fascia forms nodules over the flexor tendons causing a flexion contracture. Most common at ring and pinky finger.

occurs when the motion of the tendon that opens and closes the finger is limited, causing the finger to lock or catch

Caused by abduction stress at the thumb. UCL injury

bony growths on the terminal (DIP). interphalangeal joints of the fingers

hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints

flexion of DIP and hyperextension of PIP

Loss of central slip insertion on proximal dorsal middle phalanx. Flexion fo PIP and hyperextension of DIP.

Seen on oblique view, a defect in the pars interarticularis puts a collar on the scotty dog.

MVA injury where the lap belt immobilizes pelvis and the thorax is forcefully flexed forward. seen on AP as a crack through the owl's eyes (pedicles), or an open beak (cracked spinous process)

Collapse of anterior vertebral body with intact posterior wall from hyperflexion or osteoporosis

vertebral slipping

lateral curvature of the spine

classification system used for grading hip fractures

90% of hip fractures are in this direction

Occurs at the origin og the sartorius, and is caused by knee flexion and hip hyper-extension.

Occurs at the origin of the hamstring, and is caused by vigorous hip flexion with knee extension.

Occurs in obese adolescent boys. Will cause a limp and hip, thigh or knee pain, loss of IR, flexion and abduction

avulsion fragment of the lateral tibial plateau associated with ACL or meniscus tear

Gastrocnemius tendon sesamoid

Proximal 1/3 fibula fracture associated with medial ankle fracture.

Tibial tubercle apophysitis common in adolescents

Holds tibia and fibula together

indications for getting imaging after ankle injury

85% of all ankle sprains are in this direction, and are from a plantar flexion inversion injury.

Fracture of proximal 5th metatarsal, from an inversion injury

most common fracture of the ankle

Usually seen in deconditioned athletes, and is caused by quick plantar flexion

AKA shin splints

Calcaneal apophysis, very common in 7-15 year olds

pain on plantar aspect of calcaneus, will result in but are not caused by heel spurs

disruption of tarsometatarsal joint

Perineural fibrosis of digital nerve between 3rd and 4th web space, caused by walking on hard surfaces or wearing tight shoes.

Urate crystals in 1st MTP joint

flat foot

first mtp joint sprain from excessive force of dorsiflexion or plantarflexion

Childhood fracture in which the physis is widened. Growth disturbances are uncommon.

Childhood fracture that involves the metaphysis as well as the physis. Rarely results in functional deficits. The most common type.

Childhood fracture that involves both the epiphysis as well as the physis. There is damage to the growth plate but prognosis is relatively favorable.

Child hood fracture that involves the epiphysis, physis, and metaphysis. Can result in chronic disability.

Childhood fracture that is a compression of the physis caused by an axial load. Poor functional prognosis.

As seen on a lateral radiograph of the cervical spine a widened predental space (greater than 2.5 mm)idicates what type of injury.

Can occur from a blow to the top of the head and affects C1.

Tip of the dens, usually stable

Base of the dens, most common

Through C2 body, unstable

Commonly occur at proximal 2/3 and distal 1/3 of the involved bone.

When the humeral head slightly overlaps the glenoid in a normal AP radiograph.

AP view of the shoulder shows the humeral head to lie medial to the glenoid and inferior to the coracoid

On an AP radiograph the humeral head is lateral to the glenoid so that there is no overlap.

These are the three cardinal signs for what; joint space narrowing, bony overgrowth at edge of joint, sclerosis along articular surface

A focal area of avascular necrosis

Most common site of osteochondritis desiccans

Loose body in a joint

Avascular necrosis of the lunate

Oblique fracture through the base of the radial styloid

Buckle fracture with intact periosteum, common in children

Fracture of the thumb metacarpal base from an axial blow or adduction stress to thumb

Comminuted Bennet's fracture

This part of a carpal bone can get fractured from a direct impact of a racquet, baseball, golf club.

Forceful extension of the DIP, patient now unable to flex DIP due to FDP avulsion.

Acetaminophen (Tylenol)

Aspirin

Ibuprofen (Motrin, rufen, Nuprin, Advil)

Naproxen(Naprosyn)naproxen Na (Anaprox, Aleve)

Ketorolac (Toradol)

Celecoxib (Celebrex)

Diclofenac patch (Flector)

Diclofenac gel (Voltaren)

Tramadol

Meperidine (Demerol/demonal)

Nalbuphine

Butorphanol

Dexacine

Buprenorphine

Pentazocine

Propoxyphene (Darvocet/darvocrap)

Used for neuromuscular conditions. Little evidence for use in musculoskeletal conditions

Used for musculoskeletal spasms related to injury. Evidence supports SHORT TERM use

Cyclobenzaprine (Flexeril)

Methocarbamol (Robaxin)

Tizanidine (Zanaflex)

Carisoprodol (soma)

Chlorzoxazone (Parafon forte)

Tizanidine (Zanaflex)

Pregabalin (Lyrica)

Gabapentin (Neurontin)

Seldom warranted for back pain

Amitriptyline

duloxetine (Cymbalta)

venlafaxine (Effexor)

Neck flexion

Neck lateral bending

Shoulder shrug

Shoulder abduction/elbow flexion

Wrist extension

Elbow extension

Finger flexion

Finger abduction

Sensory-upper neck

Sensory-lower neck

Sensory-tip of shoulder

Sensory-thumb

Sensory-lateral arm

Sensory-middle finger

Sensory-little finger

DTR-biceps

DTR-brachioradialis

DTR-triceps

Brachial plexus

Hip flexion

Hip adduction

Knee extension

Ankle dorsiflexion

Hallices longus extension

Hallices longus flexion

Sensory-upper outer thigh

Sensory-mid anterior thigh

Sensory-below patella

Sensory-medial ankle

Sensory-first web space foot

Sensory-lateral ankle

DTR-knee

DTR-ankle

Hand grip

Sensory-first dorsal web space hand

Sensory-palmar middle pad

Sensory-palmar small pad

Sensory-groin

Sensory-upper thigh

Sensory-outer thigh at knee

Sensory-lateral ankle

Sensory-buttock

Sensory-perianal

Grade 0 DTR

Grade 1 DTR

Grade 2 DTR

Grade 3 DTR

Grade 4 DTR

Strength testing 0/5

Strength testing 1/5

Strength testing 2/5

Strength testing 3/5

Strengths testing 4/5

Strength testing 5/5

Hand-CMC flexion

Hand-CMC extension

Hand-MCP

Hand-PIP

Hand-DIP

Elbow flexion

Elbow pronation/supination

Wrist-dorsiflexion

Wrist-palmar flexion

Wrist-ulnar deviation

Wrist-radial deviation

Shoulder flexion

Shoulder extension

Shoulder abduction

Shoulder adduction

Shoulder external rotation

Shoulder internal rotation

Hip flexion

Hip extension

Hip abduction

Hip adduction

Hip internal rotation

Hip external rotation

Knee

Ankle dorsiflexion

Ankle plantarflexion

Ankle inversion

Ankle eversion

Cervical spine flexion

Cervical spine extension

Cervical spine lateral flexion

Cervical spine rotation

Thoracolumbar spine flexion

Thoracolumbar spine extension

Thoracolumbar spine lateral flexion

Thoracolumbar spine rotation

Diflunisal

Celecoxib

Diclofenac

Ibuprofen

Ketorolac

Meloxicam

Naproxen

Naproxen Sodium

Oxaprozin

Piroxicam

Sulindac

Carisoprodol

Chlorzoxazone

Cyclobenzaprine

Dantrolene

Metaxalone

Methocarbamol

Orphenadrine

Tizanidine