Orthopedics 5

  1. Lateral Epicondylitis: Hx:
    Elbow pain from repetitive wrist extension
  2. Lateral Epicondylitis: Anatomy:
    Site of origin of wrist extensors-supinators
  3. Lateral Epicondylitis: PE:
    Pain over lateral epicondyle with resisted wrist extension & supination
  4. Lateral Epicondylitis: Other Care:
    Ice, stretch, strap, iontophoresis, surgical release
  5. Lateral Epicondylitis: Injection:
    At the tender pt at lateral epi.; Marcaine, Kenalog, 25 g needle, down to the bone
  6. Radial Head Subluxation AKA
    Nursemaids Elbow
  7. Radial Head Subluxation =
    Annular ligament entrapment
  8. Radial Head Subluxation MOA:
    Traction (swinging kids by wrists)
  9. Radial Head Subluxation Presentation:
    Flexed and IR
  10. Radial Head Subluxation Rx:
    Tx x-ray; Hyper-pronation; Flexion/ supination/ extension; Feel a pop; Quick relief
  11. Elbow Instability:
    UCL sprain or tear (UCL primary valgus stabilizer)
  12. Elbow Instability: Seen in:
    throwing athletes
  13. Elbow Instability S/S:
    Pop while throwing & medial elbow pain & hand paresthesia; Pain on valgus testing
  14. Elbow Instability tests:
    X-ray, MRI
  15. Elbow Instability Rx:
    Rest, NSAIDs, PT, slow return to sports; poss Tommy John Surgery; education
  16. Olecranon Bursitis: Hx:
    May be traumatic or insidious
  17. Olecranon Bursitis: Diff Dx:
    Infection, Gout, triceps rupture
  18. Olecranon Bursitis: PE:
    Red, swollen joint, + pain
  19. Olecranon Bursitis: Other Care:
    Compressive sleeve; ant. splint if recur; Bursectomy if chronic
  20. Olecranon Bursitis: Caution:
  21. Olecranon Bursitis: Aspiration
    (high threshold for this): 18g needle, poss 60 ml syringe
  22. Olecranon Bursitis: Aspiration: if cloudy:
    suspect infection; send for crystal, cx, gm stain
  23. Olecranon Bursitis: Injection (high threshold for this):
    Marcaine/ Kenalog
  24. TEA =
    Total elbow arthroplasty
  25. Distal Humerus Fx: use ____ Classification
    Mehne & Matta
  26. Distal Humerus Fx: Location
    Supracondylar; Transcondylar; Intracondylar; T condyle fracture; lateral, medial condylar fractures
  27. Stable, non-displaced fx may be tx with:
    splinting for 10 days, then protected ROM
  28. Distal Humerus Fx: stability
    Most are unstable and require ORIF
  29. Most common elbow fracture in children
    Supracondylar Fx
  30. Supracondylar Fx: MOA
    Extension, distal fragment posterior; N/V injury common
  31. Supracondylar Fx: Tx
    Casting vs. ORIF vs. CRPP
  32. 3rd most common child fx =
    Medial epicondyle fx
  33. Epicondyle Fx: which is uncommon?
    Lateral epicondyle fx
  34. Epicondyle Fx: Rx: Non displaced
    Cast immobilization
  35. Epicondyle Fx: Rx: Displaced (>30 degree angulation, or 1mm)
    CRPP vs. ORIF
  36. CRPP =
    closed reduction & percutaneous pinning
  37. Radial Head Fx: Hx
    FOOSH, valgus force
  38. Radial Head Fx: PE
    Swelling lateral elbow; Pain over radial head; Limited pronosupination & extension
  39. Radial Head Fx: Radiographs:
    AP, lat, obliq
  40. Radial Head Fx: Mgmt: Type I (non-displaced)
    Posterior splint/sling for 3-5 days; Early ROM exercises
  41. Radial Head Fx: Mgmt: Type II (displaced)
    Tx as in Type I if < 30% head displaced (Otherwise: ORIF)
  42. Radial Head Fx: Mgmt: Type III (comminuted)
    Excision of frags or complete radial head
  43. Radial Head Fx: Mgmt: Type IV (dislocated)
    Same as III
  44. Olecranon Fx: Check:
    N/V function; Ulna n.
  45. Olecranon Fx: Rx: Non-displaced:
    Posterior splint @ 45 degrees; Re-image 1 week; ROM at 2 wks
  46. Olecranon Fx: Rx: Displaced:
  47. Olecranon Dislocation: MOA
  48. Olecranon Dislocation: 90% are:
  49. Olecranon Dislocation: May also have
    radial head or distal humerus fracture
  50. Olecranon Dislocation: Check:
    N/V status
  51. Olecranon Dislocation: Tx
    Reduction / fx care
  52. Dorsal Wrist Compartment I
    APL & EPB
  53. Dorsal Wrist Compartment II
  54. Dorsal Wrist Compartment III
  55. Dorsal Wrist Compartment IV
    extensor digitorum comunis (four tendons) & extensor indicis (EDC, EI)
  56. Dorsal Wrist Compartment V
    extensor digiti minimi (EDM)
  57. Dorsal Wrist Compartment VI
    extensor carpi ulnaris (ECU)
  58. Median nerve: Motor
    Wrist flexors, thumb opposition
  59. Median nerve: Sensory
    Volar thumb, radial 2 ½ digits
  60. Ulna nerve: Motor
    Intrinsics, Adductor Pollicis
  61. Ulna nerve: Sensory
    Ulnar 1 ½ digits volar & dorsal
  62. Radial nerve: Motor
    Wrist extensors, APL, EPB
  63. Radial nerve: Sensory
    Dorsal thumb & radial half of hand
  64. Wrist Hx: includes:
    Handedness; Occupation; trauma; location of pain; numbness, paresthesias
  65. Wrist Exam: Inspect for:
    swelling, scars, masses
  66. Wrist Exam: Specific tests
    Tinel, Phalen; Finkelstein; Foveal; Watson
  67. Watson Test for S-L dissociation:
    Stabilize volar scaphoid w/ thumb & bring wrist from ulnar to radial deviation; there will be a clunk or pain
  68. Wrist Radiographs: clenched fist:
    Scapholunate dissociation
  69. Wrist Radiographs: Scaphoid
    Ulnar deviation
  70. Wrist Radiographs: Carpal Tunnel
    Hamate, pisiform injuries
  71. Wrist Radiographs: Comparison views
    Growth plate injuries
  72. Wrist Radiographs: Lateral View:
    Check 2-20 degree palmar tilt of articular surface of radius; dorsal aspect of distal radius is smooth; capitate sits in lunate
  73. Wrist Radiographs: PA View:
    Check radius lies distal to ulna; radial border of Scaphoid is intact; No more than 2mm of intercarpal joint space; no abnormalities of radius or ulna cortex;
  74. Wrist Radiographs (PA): Impact fx may only show:
    increased density at radial metaphysis
  75. Wrist Radiographs: beak, bulge or density at fused epiphyseal line is:
    not a fracture; IS a physeal scar
  76. Gilula Arcs: articular surfaces of carpal bones s/b:
    parallel, joint spaces similar width & parallel cortical margins
  77. Gilula Arcs: any break in the lines or overlapping of normally parallel joint spaces suggestive of:
    joint injury
  78. De Quervain Tenosynovitis: Hx:
    Radial wrist pain
  79. De Quervain Tenosynovitis: Anatomy:
    1st Dorsal compartment; APL & EPB tendon moves over radial styloid
  80. De Quervain Tenosynovitis: Dx:
    Pos Finkelstein
  81. De Quervain Tenosynovitis: Tx:
    Ice, thumb spica, rest, ionto
  82. De Quervain Tenosynovitis: Injection:
    Marcaine/ Kenalog In 1st dorsal compartment; directed toward radial styloid
  83. De Quervain Tenosynovitis: last intervention:
    Surgical release
  84. CTS: Hx:
    Pain, numbness, paresthesia in median n. distn
  85. CTS: Anatomy:
    10 structures pass through carpal tunnel (9 tendons, 1 (median) n.)
  86. CTS: PE:
    Positive Tinel’s and Phalen’s
  87. CTS: Consider:
    EMG, Neurometrics
  88. CTS: Tx:
    Splinting, ergonomics
  89. CTS: Injection:
    1ml Marcaine/40mg Kenalog; ulnar to palmaris longus at proximal wrist crease at 30 degrees
  90. CTS: Surgical release
    cut transverse carpal ligament
  91. Tinel Sign
    Percuss over median n. carpal tunnel; tingling or pain in median n. distn = Pos
  92. Phalen Test
    Acute flexion of wrists for 60-90 sec => numbness & tingling over median n. distn
  93. Ganglion Cysts: Hx:
    Swelling at wrist; Leak of joint fluid
  94. Ganglion Cysts: Sx:
    Painful or painless
  95. Ganglion Cysts: Distribution:
    65% Dorsal (SL joint), 25% radio-volar, 10% other flexor tendon sheaths (retinacular), occult
  96. Ganglion Cysts: Aspiration:
    18 g needle & 10 cc syringe; instill 40 mg Kenalog; compressive bandage; surg excision for recurrence
  97. Ganglion Cysts: recurrence
    10 % recurrence after excision
  98. Scapholunate Dissociation =
    Traumatic SL ligament tear; >2mm space at SL joint
  99. Scapholunate Dissociation: S/S
    Wrist pain & instability; Letterman sign; Watson Test
  100. Scapholunate Dissociation: dorsal rotary subluxation leads to:
    dorsal intercalated segment instability (DISI) & SL advanced collapse (SLAC)
  101. SL dissociation: Rx:
    SL ligament repair, PRC, Arthrodesis
  102. TFCC Tear =
    Triangular Fibrocartilage Complex
  103. TFCC fn:
    Stabilizes distal radioulnar joint
  104. TFCC Tear: MOA =
    Acute or repetitive overuse
  105. TFCC Tear: PE:
    TTP over TFCC; (+) Foveal sign
  106. TFCC Tear: dx tests
    X-Ray (Look for ulnar variance); MRI / Arthrogram
  107. TFCC Tear: Rx:
    Splint, NSAIDs, PT; injection; arthroscopic repair
  108. Ulna Impaction Syndrome S/S:
    Ulnar wrist pain, swelling & weakness
  109. Ulna Impaction Syndrome MOA:
    Ulna head impinges carpi
  110. Ulna Impaction Syndrome: X-ray shows:
    cystic or sclerotic changes of the lunate &/ or triquetral
  111. Ulna Impaction Syndrome: leads to:
    lunotriquetral ligament attrition
  112. Ulna Impaction Syndrome: Rx:
    Ulna shortening
  113. Kienbock Dz =
  114. Kienbock Dz: MOA
    Repetitive microtrauma => lunate collapse secondary to vasc insuff & avascular necrosis
  115. Kienbock Dz: S/S
    Radiating wrist pain & swelling over lunate; pain on middle finger dorsiflexion
  116. Kienbock Dz: Rx:
    Surgical unloading, fusion, vascular implantation
  117. Monteggia fx =
    Ulna shaft fx; Proximal radius dislocation
  118. Monteggia fx: tx
    ORIF vs long arm cast for 6 weeks
  119. Galeazzi fx =
    Radial fracture; distal Ulna dislocation
  120. Galeazzi fx: tx
    ORIF vs long arm cast 6 weeks
  121. MUGR =
    monteggia = ulna; Galeazzi = radial
  122. Greenstick fx =
    Incomplete fx
  123. Greenstick fx: MOA
    thick periosteum in children prevents displacement; dorsal cortex intact
  124. Greenstick fx: tx
    Reduction (if needed) & short arm cast for 3-4 weeks
  125. Night Stick fx =
    Isolated Ulna fracture
  126. Night Stick fx: tx =
    Cast or splint for 4 wks; then functional splint for several wks
  127. Both Bone Forearm Fx: MOA
    Fall or direct hit
  128. Both Bone Forearm Fx: Displacement or angulation > 10 degrees:
    needs ORIF
  129. Both Bone Forearm Fx: Non displaced, non-angulated fx:
    may be put in long arm cast 6 wks
  130. 90% of distal radial fractures are:
    Colles Fx
  131. Colles Fx: MOA
    FOOSH injury; dorsal angulation of distal fragment
  132. Colles Fx : if < 15 degrees angulation:
    acceptable; short arm cast for 4-6 wks
  133. Colles Fx : if > 15 degrees or sig displaced:
    reduction, CRPP, ORIF
  134. Smith Fx: MOA
    Fall on back of hand; Hyperflexion injury; volar angulation of distal fragment
  135. Smith Fx: minor angulation =
    acceptable; short arm cast 4-6 wk
  136. Smith Fx: significant angulation =
    Reduction, CRPP, ORIF
  137. Barton Fx =
    Intra-articular fracture; displaced radial articular fragment
  138. Barton Fx: tx
  139. Chauffeur Fx: MOA
    Oblique fx through the base of the radial styloid
  140. Chauffeur Fx: Tx
    Long arm cast for 1 mo. followed by short arm cast for 2 wks
  141. Torus Fracture =
    Buckle fracture with intact periosteum
  142. Torus Fracture: Common in:
  143. Torus Fracture: Tx
    3-4 weeks immobilization in a short arm cast; young kids need long arm cast (lest they take cast off)
  144. Most common carpal fx =
    Scaphoid Fx
  145. Scaphoid Fx: MOA
    FOOSH injuries
  146. 80% of scaphoid fx occur at:
  147. Scaphoid Fx: 1/3 will develop:
  148. Scaphoid Fx: Healing time: Distal
    6 weeks
  149. Scaphoid Fx: Healing time: Waist
    3 months
  150. Scaphoid Fx: Healing time: Proximal
    4 months
  151. Scaphoid Fx: Healing time: RX:
    Percutaneous screw fixation; ORIF w/ bone graft
  152. Scaphoid Fx: Imaging:
    AP, Lat, oblique, scaphoid views; MRI; Bone scan 72 hrs post injury
  153. Scaphoid Fx: If initial imaging neg:
    Immobilize in thumb spica or cast; repeat radiographs in 10-14 days
  154. Hand Hx: sig parts
    Handedness; Trauma; Numbness, paresthesias; Triggering
  155. Hand Exam: Inspection
    Swelling, nodules, masses
  156. Hand Exam: Palpation:
  157. Hand Exam: ROM
    Symmetry; Triggering; FDP and FDS
  158. Hand Exam: Strength testing
    Grip, abduction
  159. Hand Exam: Neurovascular
    Sensation; 2 pt discrim; Capillary refill
  160. Hand ROM
    Flexion; Extension; Abduction; Adduction
  161. Hand Radiographs
    AP. Lateral, Oblique; Order specific thumb or finger films
  162. Hand: Check films for:
    Alignment of joints; Cortical defects; Joint space narrowing; periarticular bony erosions, sclerosis, or spurring
  163. CMC Osteoarthritis: S/S
    Pain over Thumb CMC
  164. CMC Osteoarthritis PE:
    Compression test; Grind test
  165. CMC Osteoarthritis: Compression test
    moving CMC Joint w/ longitudinal load applied
  166. CMC Osteoarthritis: Grind test
    grab the metacarpal base & rotate thumb
  167. CMC Osteoarthritis: Radiographs show:
    marginal osteophytes, joint space narrowing, & sclerosis
  168. CMC Osteoarthritis: Tx
    Trial of thumb spica & NSAIDs; Corticosteroid injection; CMC arthroplasty with tendon interposition
  169. Dupuytren Contracture =
    Thickened palmar fascia forms nodules over flexor tendons causing flexion contracture
  170. Dupuytren Contracture: most common at:
    Ring & Small fingers
  171. Dupuytren Contracture: more common in:
    men over 40 yo (get FH)
  172. Dupuytren Contracture: Rx
    No conservative Rx; Surgery indicated for fixed contracture of more than 30 degree
  173. Trigger Finger =
    Stenosing Tenosynovitis
  174. Trigger Finger: Sx:
    Finger will lock, hurt, or be stiff
  175. Trigger Finger: more common in:
    RA, OA & DM
  176. Trigger Finger: Etiology
  177. Trigger Finger: PE:
    Painful thickened flexor tendon or nodule at the A1 pulley
  178. Trigger Finger: Injection:
    At site of tenderness/ nodule; Marcaine/ Kenalog; 25 g needle into sheath, not tendon
  179. Trigger Finger: If recurrence after 2-3 injections:
    surgical release is indicated
  180. Trigger Finger: sequelae
    Pt prone to triggers in other fingers
  181. Hand Lacerations: Check:
    tendon integrity
  182. Hand Lacerations: No Mans Land =
    btw distal palmar crease & PIP joint crease
  183. Hand Lacerations: S/B repaired:
    by hand surgeon
  184. Hand Lacerations Prone to:
  185. Septic Tenosynovitis =
    Bacterial infection of a tendon & tendon sheath
  186. Septic Tenosynovitis: Hx
    puncture, bite, or tooth wound (fight bite); progressive swelling & pain over 24-48 hr; Kanavel Sx:
  187. Kanavel Sx:
    Fusiform swelling of finger; sig tenderness along course of tendon; marked pain on passive extension; flexed finger at rest
  188. Septic Tenosynovitis: Etiology:
    Staph, Strep, MRSA
  189. Septic Tenosynovitis: Rx:
    IV Abx, I&D if progressing; consider tetanus & rabies prophylaxis
  190. Most common digital infection =
    Infection: Paronychia
  191. Infection: Paronychia =
    Localized staph cellulitis in gutter along fingernail
  192. Infection: Paronychia Rx:
    Soaks, PO antibiotics; digital block & I&D when abscess is organized
  193. Infection: Felon =
    Abscess of pulp space of distal phalanx
  194. Infection: Felon S/S:
    Localized erythema, swelling & throbbing pain
  195. Infection: Felon: Requires:
    I & D, PO or IV antibiotics
  196. Subungual Hematoma: MOA
    Crush injury
  197. Subungual Hematoma: Tx
    Evacuate hematoma; trepanation (burr hole into nail); X-ray
  198. Subungual Hematoma: If > 50% of nail is affected:
    nail s/b removed & laceration sutured
  199. Osteoarthritis: Heberdens nodes:
    DIP joint
  200. Osteoarthritis: Bouchards nodes:
    PIP joint
  201. Osteoarthritis: Sx
    Hard & painless; Bony overgrowth; Thumb CMC early sx in women
  202. Osteoarthritis: Rx:
    NSAIDs, injections, arthrodesis, arthroplasty
  203. Rheumatoid: Sx
    Ulnar deviation of fingers; chronic swelling, decreased ROM; Rheumatoid nodules
  204. Rheumatoid: deformities seen
    Swan neck deformity; Boutonniere deformity
  205. Rheumatoid: Rx:
    DMARDs, surgery
Card Set
Orthopedics 5
Orhopedics flashcards made by previous students