Orthopedics 7

  1. Pharma Tx of Acute LBP: Pain relief:
    NSAID; Cox-2, Celebrex; Narcotic; Lidoderm patch; Anti-inflammatory; mx relaxants; Steroids
  2. Pharma: LBP: Pain: NSAID:
    Ibuprofen 800 q6-8h pc; Naprosyn 500 BID
  3. Pharma: LBP: Pain: Narcotic:
    Percocet 5/325 q4-6h Vicodin 5/500 q 4-6h
  4. Pharma: LBP: Pain: Anti-inflammatory:
    NSAID, Cox-2
  5. Pharma: LBP: Pain: Muscle relaxants:
    Flexeril; Skelaxin; Soma, Robaxin
  6. Pharma: LBP: Pain: Steroids:
    Hold NSAIDs; Burst of oral steroids; consider trigger point
  7. Sacroiliac Dysfn:
    Acute or chronic injury to SI joint
  8. Sacroiliac Dysfn: Sx:
    Pain in SI area, Pos FABER, No discogenic pain
  9. Sacroiliac Dysfn: Lab:
    consider CBC, ESR, ANA, RF, HLA-B27
  10. Sacroiliac Dysfn: RX:
    Ice, Stretch, NSAIDs, injection
  11. Cauda Equina Syn: affects:
    L2-L4 nerve roots
  12. Cauda Equina Syn: Mechm:
    Compression of nerve roots causes paralysis without spasticity (LMN)
  13. Cauda Equina Syn: Etiology:
    Central disc herniation, abscess, hematoma
  14. Cauda Equina Syn: Sx:
    Loss of bladder/ bowel control, bilateral LE weakness & sensory deficits
  15. Cauda Equina Syn: Rx:
    Emergent Surgical Decompression
  16. Lumbar Spinal Stenosis =
    Progressive degeneration of disc & facet joints; Narrowing of canal; Compression of n. roots
  17. Lumbar Spinal Stenosis: Signs:
    Neurogenic claudication, radicular sx; Pain increased w/ sitting or spinal ext; Pain relieved w/ flexion, pt walks stooped-over
  18. Lumbar Spinal Stenosis PE:
    Sensory changes, dec DTR, mild weakness
  19. Lumbar Spinal Stenosis: Course:
    Deficits may progress
  20. Lumbar Spinal Stenosis: Xray:
    may show narrowing of the IVD, old burst fx; MRI demonstrates stenosis
  21. Lumbar Spinal Stenosis: Rx:
    PT, core strength, NSAIDs, dec impact & bending, surgical decompression for progressive dz
  22. Spondylolysis =
    Pars interarticularis stress fx
  23. Spondylolysis: Prevalence
    5%-8 % of population; Dancers, gymnasts, lifters
  24. Spondylolysis: occur most often at:
  25. Spondylolysis: S/S
    Pain adjacent to midline, inc with extension & rotation
  26. Spondylolysis: xray
    Scotty dog collar only on oblique xray
  27. Spondylolysis: Rx:
    modify activity, core exercise, gradual RTP
  28. Spondylolisthesis =
    Vertebral sliding (Dancers, gymnasts)
  29. Spondylolisthesis: PE:
    Step-off, may be asx.
  30. Spondylolisthesis: Grading
    Grade I – V (25 to >100%); Isthmic, degenerative
  31. Spondylolisthesis: xray
    Lateral film shows slip
  32. Spondylolisthesis: Rx: Asx:
    no restriction, core exercise
  33. Spondylolisthesis: Rx: Symptomatic:
    no restriction, core exercise, consider brace; Surgery for progressing slips or deficit
  34. Piriformis Syndrome =
    Irritation of sciatic n. (L4,5, S1,2,3) beneath piriformis mx
  35. Piriformis Syndrome: etiology
    Trauma, spasm, anatomic
  36. Piriformis Syndrome: PE:
    FROM of lumbar spine; Sciatic notch tenderness
  37. Piriformis Syndrome: DDx:
  38. Piriformis Syndrome: RX:
    Rest, ice, meds, stretch, injection
  39. Lateral spine curvature =
  40. Scoliosis: < 10 degree: tx
  41. Scoliosis: < 20 defree: tx
    conservative Rx
  42. Scoliosis: Occurs where:
    T or L spine
  43. Scoliosis: most common cause:
  44. Scoliosis: prevalence
    Girls 7x > than males
  45. Scoliosis: Adults:
    secondary dz & pain
  46. Scoliosis: Surgical Rx:
    Fusion & Rod
  47. Scoliosis: Exam:
    Forward flexion; Look for spine, scapula or hemi-thorax asymmetry
  48. Scoliosis: Xray Cobb angle:
    Measure angle from tilted vertebrae above & below apex of curve
  49. 50% of pts with solid tumors have:
    mets to spine
  50. Tumor: Highest prevalence:
    BrCa, lung, prostate, colon, thyroid, kidney ca (hematogenous spread)
  51. Tumor: Sx:
    Night pain, n. root compression
  52. 10% of spinal bone tumors are:
  53. Spinal bone tumors: in children, 20% are:
  54. Spinal bone tumors: Primary malignant:
    Osteosarcoma, Ewing Sarcoma, Chondrosarcoma
  55. Degenerative joint dz =
    loss of articular cartilage & growth of new bone around facet joint
  56. Facet Syndrome =
    n. root compression by loss of disc height & facet hypertrophy
  57. Osteoarthritis: X-ray:
    joint narrowing, sclerosis, osteophytes
  58. Osteoarthritis: Rx:
    Wt reduction, pt education; Pain relief
  59. Ankylosing Spondylitis: involves:
    SI joint, and spine
  60. Seronegative spondyloarthropathy:
    HLA-B27 usually positive
  61. Ankylosing Spondylitis: Sx:
    Chronic low back pain in young adults; morning stiffness, improves with movement; 20% peripheral joint sx (Enthesopathies common; 25% with anterior uveitis)
  62. Ankylosing Spondylitis: PE:
    Schobers test (normal is 5 - 7 cm movement)
  63. Ankylosing Spondylitis: X-ray:
    Erosion & sclerosis on plain films
  64. Ankylosing Spondylitis: Rx:
    PT, NSAIDs, Sulfasalazine, Infliximab
  65. Testing Spinal Mobility:
    Schobers Test
  66. Schobers Test:
    2 midline marks 10 cm apart starting at PSIS (dimple of Venus); remeasure w/ lumbar spine at maximal flexion
  67. Schobers Test: Less than 5 cm difference suggests:
  68. Ankylosing Spondylitis =
    Calcification btw vertebral bodies at edge of discs; gives appearance of bamboo stalk; sclerosis of SI joint
  69. Osteoporosis =
    Reduction in bone mass (Low peak mass; inc bone loss; hyperparathyroid, chronic steroids)
  70. Osteoporosis: DEXA Scan:
    T score of < -2.5
  71. Osteoporosis: Clinical Features:
    vertebral compression fracture
  72. Osteoporosis: prevalence in LBP
    Causes 4% of LBP
  73. Osteoporosis: Rx:
    Oral Ca & Vit D; exercise, SMK cessation; Estrogen in postmen reduces bone reabsorption; Bisphosphonates augment bone density; Raloxifene inc bone density & dec total & LDL-C
  74. Infection: prevalence in LBP
    Only .01% of all causes of LBP
  75. Infection: clin features
    Fever, leukocytosis; hx of other infections, hematogenous spread
  76. Infection: includes:
    Osteomyelitis; Septic Discitis; Paraspinous abscess; Shingles
  77. Visceral Causes: prevalence in LBP
    2% of LBP
  78. LBP: Visceral Causes: Referred pain from:
    GB; Pancreas; AAA; Endometriosis; Chronic PID; Prostate CA; Renal stones or pyelonephritis
  79. LBP: Need for imaging
    Rarely needed in nontraumatic, recent onset ALBP
  80. LBP: Imaging: when
    Plain films approp: trauma/ longstanding sx ; if conservative Rx fails
  81. LBP: Imaging: Order:
    AP / Lateral; Obliques; Flex & Ext
  82. LBP: MRI study of choice for:
  83. LBP: Tc 99m bone scan for:
    primary tumors, metastatic disease, or infection
  84. Reading Spine Films: looking for:
    Fx; Disc space changes; Arthritic changes; Listhesis; Tumors
  85. Spine Film: Frontal View: each vert resembles:
    an owls head, straight on; each eye = pedicle; beak = spinous process
  86. Spine Films/ Frontal: Horizontal displacement may =
    fx or dislocation
  87. Spine Films/ Frontal: Decreased intervertebral space =
    Fx, DDD, HNP
  88. Spine Films/ Frontal: Vert body (owl head) for:
    Missing eye (destrn); pedicle
  89. Spine Films/ Frontal: Vert body: Crack in owls eye: in =
    Chance fx (seat belt fx)
  90. Spine Films/ Frontal: Vert body: Inc space btw owls eyes: in =
    Burst fx
  91. Spine Films/ Frontal: Vert body: Dec head height: in =
    Burst fx
  92. Spine Films/ Frontal: Vert body: Open bea, or inc distance btw 2 beaks: in =
    Chance fx or spinous process fx
  93. Spine Films: Oblique: each vert = Scotty Dog: look for:
    a collar
  94. Spine Films: Oblique: Scotty Dog: front & hind legs =
    inf intervertebral articular processes
  95. Spine Films: Oblique: Scotty Dog: Ears & tail =
    superior intervertebral articular processes
  96. Spine Films: Oblique: Scotty Dog: Dog body =
    the lamina
  97. Spine Films: Oblique: Scotty Dog: dogs eye =
    a pedicle
  98. Spine Films: Oblique: Scotty Dog: nose =
    a transverse process
  99. Spine Films: Oblique: Scotty Dog: Neck =
    the pars interarticularis
  100. Spine Films: Oblique: Scotty Dog: If the tail is to your right, you are looking at:
    right lamina (& vice versa for left)
  101. DDD =
    degenerative disc dz
  102. Spine Film: Lateral View: Vert alignment: displacement seen in:
    fx & listhesis.
  103. Spine Film: Lateral View: decreased intervert disc space in:
    fx, DDD, & HNP
  104. Spine Film: Lateral View: Cf ant & post vert body cortex for:
    changes in ht cf to the others (Burst or wedge fx)
  105. Spine Film: Lateral View: fx lines in spinous processes =
    black (lucent) fx lines
  106. Spine films: stable fxs =
    Wedge fx; spinous process fx
  107. Spine films: unstable fxs =
    Burst fx; Chance fx
  108. Chance fx: Unstable: best seen on what film?
  109. Chance fx: MOI
    MVA: lap belt immobilizes pelvis & thorax is forcefully flexed forward
  110. Chance fx: Seen on AP =
    crack thru eyes (pedicles), or open beak (crack through spinous process)
  111. Burst fx: Unstable =
    Collapse of vert body
  112. Burst fx: Unstable: seen on lateral view as:
    smaller vertebral body
  113. Burst fx: Unstable: on AP =
    inc distance btw pedicles
  114. Burst fx: MOI:
    fall from a ht, landing on feet or buttocks
  115. Burst fx: Fragments:
    may extend into spinal canal causing neuro S/S
  116. Wedge fx: Stable =
    Collapse of ant vert body w/ an intact posterior wall
  117. Wedge fx: Stable: result of:
    hyperflexion injury and / or osteoporosis.
  118. Spinous Process fx: Stable: on lateral view =
    Lucency thru spinous process
  119. Most common Spinous Process fx found in:
    C-spine (Clay Shovelers fx)
  120. Spinous Process fx: MOI:
    sudden forceful ligamentous traction on spinous process, or a direct blow to the process
  121. Coccyx fx: MOI
    Fall on coccyx
  122. Coccyx fx: PE: Do:
    rectal to R/O hematoma, displaced fx
  123. Coccyx fx: mild trauma: xray =
    Radiographs not indicated
  124. Lower Back Rehab to:
    Ctrl pain; Reduce inflame; relative rest; Pain free ROM; correct inflexibilities & strengthen core mx; aerobic conditioning; wt reductn; correction of biomechanics; prevent recurrence
  125. PRICE-MMM =
    protection, rest, ice, compression, elevation, modalities, activity/ modification, meds
  126. LBP Prevention
    Regular strength/ flexibility exer; correct lifting & moving tech; posture standing/ sitting; proper body wt
  127. Hip Exam: Hx
    Trauma, OA, infection
  128. Hip Exam: Inspection
    Gait; Scars; Swelling
  129. Hip Exam: Palpation
    Iliopsoas bursa; Gr trochanter/ bursa; Ant iliac spine; Ischial tuberosity/ bursa
  130. Hip Exam: ROM / Strength
    Hip flex/ ext; Abd/ addn; Int / ext rotation; resisted ROM for strength
  131. Gait Analysis: Width of the gait:
    Normal =2-4 in heel to heel; Wide based gaits = instability
  132. Gait Analysis: Ctr of gravity:
    Normal gait oscillates no more than 2 in. vertically; pain & mx weakness => pt shifts COG over affected hip
  133. Gait Analysis: Knee position:
    S/B flexed in all phases of stance ex. heel strike; pt hikes up affected leg or swings it out & around to front
  134. Gait Analysis: Pelvic shift:
    pelvis & trunk shift laterally 1 in. to wt bearing side
  135. Gait Analysis: Pelvic shift: in gluteus mx weakness:
    lateral shift is accentuated to the side involved
  136. Gait Analysis: Length of step:
    Ave length is 15 in. With age/ fatigue/ pathology: step is shortened
  137. Gait Analysis: Cadence:
    Ave cadence is 90-120 steps/ min. With age/ fatigue/ pain: cadence is decreased to conserve energy
  138. Gait Analysis: Pelvic rotation:
    Normal during swing phase = 40 degrees in leg that is moving forward; if pain or stiffness in hip, pelvis will not rotate normally
  139. Antalgic gait:
    Limp from pain
  140. Wide based gait =
    Instability from cerebellar disease or peripheral neuropathy
  141. Steppage gait =
    Weak ankle dorsiflexors results in increase knee & hip flexion
  142. Flat foot gait =
    Gastrocnemius/ Soleus weakness (S1-S2 radiculopathy)
  143. Back Knee gait =
    Quadriceps weakness forces pt to push on thigh w/ hand to try to lock knee in stance phase
  144. Trendelenberg (abduction lurch) gait =
    Gluteus medius weakness (L5); pt lurches toward weak side to place COG over hip
  145. Extensor lurch =
    Gluteus max weakness (S1); pt thrusts thorax posteriorly to maintain hip extension
  146. Foot Drop =
    Weakness of tibialis anterior (L4)
  147. Pelvic Films: Pelvic ring fx is commonly:
    disrupted in 2 places
  148. Pelvic Films: AP view: Inspect:
    inner & outer main ring cortices; 2 small obturator rings; acetabulum for step off; SI joint spaces s/b equal; symph pubis should align, < 5mm joint space
  149. Pelvic Films: CT if:
    fx identified or suspected
  150. High energy pelvis fx assoc with:
    organ & vascular laceration
  151. Hip Films: Order:
    AP pelvis w/ both hip joints; Lateral of affected hip
  152. Hip Films: Femoral Neck
    Smooth cortex w/ no buckle, step or ridge; Normal trabecular pattern; No transverse sclerotic lines
  153. Hip Films: Intertrochanteric Region
    Cf to other hip; No lucency across the bone; No cortical defect
  154. Hip fx: prevalence
    90% in > 65 y.o. pt
  155. Hip fx: Sx:
    Pain, shorter, rotated leg
  156. Hip fx: Causes:
    Falls, MVA
  157. Hip fx: Risk factors:
    Age, sex, nutrition, meds
  158. Hip fx: Complications:
    PE, pneumonia
  159. Femoral neck fx & hip dislocations prone to:
  160. Hip fx: Rx:
    Screws, partial or total hip replacement
  161. Hip fx: Prevention:
    Calcium, activity, exercise, safety
  162. Femoral Neck fx: Garden type I
    Incomplete fx w/ valgus impaction; ORIF
  163. Femoral Neck fx: Garden type II
    Complete fx w/o displacement; ORIF
  164. Femoral Neck fx: Garden type III
    Complete fx / partial displacement; Prosthetic replacement
  165. Femoral Neck fx: Garden type IV
    Complete fx w/ total displacement; Prosthetic replacement
  166. Femur fx: tx: Femoral neck
  167. Femur fx: tx: Intertrochanteric
  168. Femur fx: tx: Subtrochanteric
    Open or closed reduction; Interlocking nail or screw
  169. Femur fx: tx: Femoral shaft
    Closed reduction & Nail
  170. Femur fx: tx: Distal Femur
    ORIF with plate & screws
  171. Femoral Stress fx: prevalence
    Thin, female endurance athletes (AAO)
  172. Femoral Stress fx: Sx
    Groin pain with running, progressing to ADL pain
  173. Femoral Stress fx: PE:
    Pain limits extremes of int. & ext. rotation
  174. Femoral Stress fx: Dx:
    Xray may be negative; Bone scan pos in 2-8 days
  175. Femoral Stress fx: most common area =
    Femoral neck
  176. Femoral Stress fx: Rx: All displaced fx:
  177. Femoral Stress fx: Rx: Non displaced medial fx:
    NWBA 6-8 weeks
  178. Femoral Stress fx: Rx: All lateral fx:
  179. Hip Dislocation: prevalence
    90% are posterior
  180. Hip Dislocation: PE:
    hip flexed, adducted & internally rotated
  181. Hip Dislocation: Dx/ tx:
    Xray, pain relief, reduction; Poss N/V entrapment
  182. Hip Dislocation: Allis Maneuver
    Anesthesia; Assistant stabilizes pelvis w/ pressure on iliac sp; Gently flex hip to 90; apply progressive traction to extremity; apply adduction/ internal rotation
  183. Hip Osteoarthritis: Sx
    Achy pain over hip & ant groin; Loss of ROM
  184. Hip Osteoarthritis: Xray
    Decreased Joint space; Sclerosis; Osteophytes
  185. Hip Osteoarthritis: RX
    NSAIDs; Intraarticular injection; Hip replacement
  186. Pelvic Apophyses =
    Separation or widening of apophysis
  187. Avulsion fx of Hip: ASIS: MOI
    knee flexed & hip hyper-extended
  188. Avulsion fx of Hip: ASIS: locus =
    origin of Sartorius
  189. Avulsion fx of Hip: ASIS: PE:
    Pain over ASIS & with resisted hip flexion
  190. Avulsion fx of Hip: ASIS: Dx:
    Xray may reveal avulsion fx
  191. Avulsion fx of Hip: ASIS: Rx:
    RICE, progressive wt bearing, splint with knee flexed, ORIF for displaced fx
  192. Avulsion fx of Hip: Ischial Tuberosity: locus =
    Origin of hamstring
  193. Avulsion fx of Hip: Ischial Tuberosity: MOI:
    Vigorous hip flexion/ knee extension
  194. Avulsion fx of Hip: Ischial Tuberosity: Sx:
    Pain in buttock
  195. Avulsion fx of Hip: Ischial Tuberosity: PE:
    TTP at ischial tuberosity
  196. Avulsion fx of Hip: Ischial Tuberosity: Rx:
    RICE, progressive wt bearing, ORIF for displace fx
  197. Groin Pull: MOI
    Forced abduction during fall or collision
  198. Groin Pull: Sx
    Pain at origin of adductors
  199. Groin Pull: PE:
    Increased pain on resisted adduction
  200. Groin Pull: DDx:
    Hernia, torsion
  201. Groin Pull: Rx:
    Rest, ice, meds, stretching & strengthening
  202. Hip Pointer injury: MOI
    Direct blow to iliac crest
  203. Hip Pointer injury: PE:
    Swelling, tenderness, ecchymosis at iliac crest
  204. Hip Pointer injury: Dx
    Xray to R/O fx
  205. Hip Pointer injury: Rx:
    Ice, compression, pain meds; Progressive stretching
  206. Legg-Calve-Perthes Dz: MOI
    Avascular necrosis of the femoral head
  207. Legg-Calve-Perthes Dz: prevalence
    Child 2-11 y.o.
  208. Legg-Calve-Perthes Dz: Sx
    Insidious groin/ thigh pain; Limp
  209. Legg-Calve-Perthes Dz: PE:
    Loss of int / ext rotation
  210. Legg-Calve-Perthes Dz: Xray =
    Mottled femoral head
  211. Legg-Calve-Perthes Dz: Rx:
    Containment of femoral head with bracing / casting
  212. Legg-Calve-Perthes Dz: Outcome:
    self limiting, revascularization occurs in some
  213. Slipped Capital Femoral Epiphysis: prevalence
    Obese, pre-pubescent boys & girls; 40% are bilateral; most are idiopathic
  214. Slipped Capital Femoral Epiphysis: Sx
    Limp & hip, thigh, or knee pain; loss of IR, flexion, & abduction
  215. Slipped Capital Femoral Epiphysis: Rx:
    surgical fixation & non wt bearing
  216. Snapping Hip Syndrome: MOI
    1: ITB snaps over Gr trochanter; 2: Iliopsoas tendon snaps over ASIS
  217. Snapping Hip Syndrome: Sx:
    Hip pain worse with activity; Snapping with hip flexion
  218. Snapping Hip Syndrome: PE:
    Pain with resisted hip flexion; Pain lateral with ITB, anterior with ASIS
  219. Snapping Hip Syndrome: Rx:
    Ice, meds, activity modification, S&S, injection
  220. Trochanteric Bursitis: Sx
    Pain over Gr trochanter when moving hip into full flexion; Extreme point tenderness; Pain at night lying on affected side
  221. Trochanteric Bursitis: PE:
    Moving hip from extension to flexion reproduces pain; poss crepitus over trochanter; TTP over affected greater trochanter
  222. Trochanteric Bursitis: Rx:
    Hip stretches, meds, injection
  223. Transient Hip Synovitis: Sx
    Benign, non traumatic, self limiting hip pain; lasts 3-7 days
  224. Transient Hip Synovitis: must R/O:
    septic hip; Legg-Calve-Perthes
  225. Transient Hip Synovitis: Etiology
    Inflam immune response to URI; inc synovial fluid in hip joint causing pain
  226. Transient Hip Synovitis: PE:
    Painful ROM; Joint held in flex, abd & ext rotation
  227. Transient Hip Synovitis: Xray:
    Capsular swelling
  228. Transient Hip Synovitis: Lab:
    WBC & ESR normal; Joint fluid aspiration is normal
  229. Transient Hip Synovitis: Rx:
  230. Septic Joint & Osteomyelitis: frequently following:
  231. Septic Joint & Osteomyelitis: Common Organisms: Bone:
    GAS, S. aureus
  232. Septic Joint & Osteomyelitis: Common Organisms: Joint:
    H. flu, GAS, E. coli, N. gono
  233. Septic Joint & Osteomyelitis: Sx:
    Fever, joint or bone pain, leukocytosis
  234. Septic Joint & Osteomyelitis: Dx:
    Bone scans localize osteomyelitis; Joint aspiration to ID organism
  235. Septic Joint & Osteomyelitis: Rx:
    Parenteral Abx, I&D
  236. Meralgia Paresthetica =
    Lateral femoral cutaneous n. entrapment; Exits pelvis near ASIS
  237. Meralgia Paresthetica: Sx:
    Pain & burning over lateral thigh
  238. Meralgia Paresthetica: Etiology:
    Obesity, tight clothing, repetitive trauma/ activity
  239. Meralgia Paresthetica: Rx:
    Correct offending source; pain relief; chronic pain may need injection or surgical release
  240. DDH =
    developmental dysplasia of the hip
  241. Hip Pain: Other Causes
    DDH (Peds); Tumor; Osteosarcoma; Ewing; Metastatic dz; Multi myeloma
Card Set
Orthopedics 7
Orthopedics flashcards made by previous students