Human Carpentry (Ortho) Flashcards
What type of fracture is pictured below?
Salter Harris Type 4
Tenderness to palpation at the inferior pole of the patella and complaints of pain with jumping activities most likely points to what diagnosis?
Patellar Tendonitis
A positive anterior drawer of the ankle in comparison to the contralateral side is representative of injury to what ligament?
ATF
You see this on Xray of a 70 male with shoulder pain? What is the most likely diagnosis?
Degenerative Rotator Cuff Tear
A positive Finklestein test is indicative of?
DeQuervan’s Tenosynovitis
Lateral Epicondylitis is also commonly referred to as?
Tennis Elbow (tendonitis of the wrist extensor group)
What type of fracture is pictured below?
Salter Harris Type 5
What fracture is pictured below? How would this be treated?
- Jones Fracture
- Short Leg cast for 6-8 weeks
Patient is a 16 year old male seen in your primary care clinic. What is the appropriate course of treatment for the injury shown on the Xray below?
Conservative treatment. Usually in a sling or figure 8 for 4-6 weeks with some limited ROM exerces beginning at 2-4 weeks. Surgery considered in Middle 3rd fractures with > 100% displacement.
What mucle is assessed by performing the empty can test?
Supraspinatous (Most commonly torn rotator cuff muscle)
You are called to the medical floor to consult on a patient who is c/o of hip pain. She is a 35 year old and you have no medical history at this time. You walk in and notice that she is holding her hip in a abducted and ER position and states she is not willing to move the hip. She has no recent MOI. What is the most likely diagnosis?
- Septic Arthritis –> Abduction and ER allow the joint to expand lessening pain. This patient happens to have a long history of IV drug use and is in being treated for heart conditions.
A 24 year old female presents to the office with acute knee pain since yesterday when she states she hurt her right knee playing basketball. She states that the knee got swollen immediately and she was unable to put much pressure on the right leg. No previous Hx of injury. She felt like her knee popped out and back in when she hit the ground. She has an obvous effusion on exam with severely restricted ROM. You aspirate the knee and get 70cc of blood from the knee. She has a negative lachman, posterior drawer, McMurrys, Varus/Valgus. She has a positive apprehension sign. What is the most likely diagnosis? What is athe appropriate course of treatment?
- Patellar Dislocation
- Conservative treatment. PT for 4-6 weeks with reassessment of stability and function at that time.
***Only those with a large Q-angle or continued symptoms with large amounts of laxity need referral for evaluation of potential patellar realignment with lateral release.
A 46 year old man presents to your clinic after injuring his shoulder 2 weeks ago after falling with his arm outstretched? He is a recreational softball player who states that when he throws he has pain in his shoulder as well as recurrent popping and loss of velocity? On PE he has no pain on palpation, full ROM, positive OBrien’s and Speed’s test and negative empty can, apprehension, and Hawkins-Kennedy. What is the most likely diagnosis? What test is most likely to confirm your diagnosis? What is the appropriate course of treatment?
- SLAP Tear
- MRI –> Will confirm but not necessary most of the time
- Treatment is conservative. Surgery in athletes or those with severe symptoms that fail conservative treatment
A 48 year old man presents to the clinic with shoulder pain. He is a lifetime painter who states that the pain has been getting worse for about 1 month. He states that it is a dull ache most of the time but is exacerbated with overhead activity. He denies night pain or weakness but states that if the pain is bad enough he doesn’t use the arm. On PE there is no tenderness to palpation, no deformity, positive Hawkins-Kennedy and Neers with negative empty can, Obriens, apprehension, and speeds. What is his most likely diagnosis and what course of treatment should be pursued?
- Impingement Syndrome/Bursitis
- Conservative treatment consisting of avoidance of overhead activity, NSAIDs, and rotator cuff strengthening
A 35 year old female presents to the clinic c/o shoulder pain. She states that her right shoulder has become increasingly painful over the past few weeks. She is having night pain. She admits to always having some pain for a long time but reports no recent MOI. No tenderness to palpation, ROM limited to < 90 deg of abduction and flexion with marked weakness with supraspinatous testing (empty can). ER/IR 5/5. You avoid Hawkins-Kennedy and Neers because you believe this will be too painful. What diagnosis do you suspect? What diagnostic test would help confirm your diagnosis? How would you treat the patient?
- Calcific tendonitis - Usually very painful (Rotator cuff tendonitis can’t be ruled out completely but pain and decrease in AROM is out of proportion of tendonitis. With no MOI and her age a tear is not likely)
- Xray will help confirm your suspicion or R/O
- Conservative treatment consisting of AC joint injection, avoidance of overhead activity, and NSAIDs. Orthopedic referral for surgery with failure of conservative treatment. (high risk of Adhesive capsulitis in females following surgery for adhesive capsulitis)
What type of fracture is pictured below? How would you treat it?
- Buckle or Torus Fracture
- Splint in wrist immobilizer for 3 weeks and re-examine
What type of fracture is shown below? What is the appropriate course of treatment for this type of fracture?
- Humeral Shaft Fracture
- Conservative - 90% union rate. Splinted for the first 7-10 days follwed by functional bracing for 4-8 weeks (Sarmiento Brace)
***Criteria for conservative management
<20 deg of anterior angulation
<30 deg of varus/valgus
<3cm of shortening
You are seeing a 17 year old in the ER c/o low back pain. He is neurologically intact. You obtain an XR which shows the following? What other studies should be obtained? What is the injury, MOI,and treatment?
- . CT Scan (Probably better than MRI with body injury)
- Chance Fracture
- MVA - Seatbelt (Flexion-Distraction Injury)
- Bracing in TSLO for 6-12 weeks
What type of fracture is shown below?
Bimalleolar Fracture (Need to be splinted until F/U with Ortho. These all require surgery)
A 60 year old male is seen in the clnic with complaints of right shoulder pain. PMHx signficant for bilateral rotator cuff repair. He states that it has been hurting for about 2 weeks and has been getting worse to the point he is now using his left shoulder for everything. He states that pain is in the lateral part of his shoulder. He has no obvious deformity and is tender to palpation over the bicepital groove. ROM WNL. Apley’s scratch test normal. IR 5/5, ER 4+/5, Abuction 5/5. Negative Gerbers lift off, Hawkins-Kennedy, Neers, Crossover tests. Positive Obriens. Patient does have 4/5 strength with empty can but demonstrates a positive break test due to pain. You obtain an X-Ray. What is the most likely diagnosis? What is the best course of treatment for this patient?
- Rotator Cuff Tendonitis (It is possible he has a small tear or some fraying of the cuff)
- Conservative Tx. Subacromial injection and referral to PT for 2-3 weeks with progression to home exercise program. F/U in 3-4 weeks to assess function.
***The positive Obriens test with tenderness to palpation over the bicepital groove may indicate a SLAP lesion or long head biceps tendon etiology. However a large percentage of 60 y/o have some type of labral tear though treatment is not necessarily indicated for this unless it is a significant pain source or it is contributing to instability. His primary debilitating problem is the rotator cuff problem
A 16 year old girl is seen in your office with back pain for 3 months? She was being treated by a chiropractor for the past 3 months without resolution of pain. She states her pain is a 7/10 with activity and 3/10 at rest. It is worse with extension activities. She is currenly in soccer season but has been unable to play due to pain. You obtain an Xray and on the Lateral film you see the following. What is the diagnosis? What is the appropriate course of treatment?
- Spondylolysthesis (Definate anterior slippage of L4 on L5)
- Referral to Orthopedic Surgeon for Surgery
