General Terminology

Lytic

reduced bone density

Sclerotic

increased bone density

Exostosis

extra growth of bone that extends outward from existing bone

Nidus

atypical bone completely enclosed within a well vascularized stroma and a peripheral sclerotic reaction zone

Pedunculated Osseous Spur

looks like a mushroom

Synovial Fluid Analysis

arthrocentesis

CBC with differential

ESR and CRP

Blood cultures x2

Synovial Fluid: Arthrocentesis

best initial study

gram stain

culture and sensitivity

crystal analysis

Normal Synovial Fluid: clarity

transparent

Normal Synovial Fluid: color

clear or straw yellow

Normal Synovial Fluid: WBC count

<200

Normal Synovial Fluid: % neutrophils

<25%

Normal Synovial Fluid: crystal examination

none

Normal Synovial Fluid: stain and culture

negative

Noninflammatory Synovial Fluid: clarity

transparent

Noninflammatory Synovial Fluid: color

straw yellow

Noninflammatory Synovial Fluid: WBC count

<2,000

Noninflammatory Synovial Fluid: % neutrophils

<25%

Noninflammatory Synovial Fluid: crystal examination

none

Noninflammatory Synovial Fluid: stain and culture

negative

Inflammatory Synovial Fluid: clarity

cloudy

Inflammatory Synovial Fluid: color

straw yellow

Inflammatory Synovial Fluid: WBC count

20,000-50,000

Inflammatory Synovial Fluid: % neutrophils

50-75%

Inflammatory Synovial Fluid: crystal examination

positive

Inflammatory Synovial Fluid: stain and culture

negative

Septic Synovial Fluid: clarity

cloudy/opaque

Septic Synovial Fluid: color

yellow/green to red

Septic Synovial Fluid: WBC count

>50,000

Septic Synovial Fluid: % neutrophils

>75%

Septic Synovial Fluid: crystal examination

negative

Septic Synovial Fluid: stain and culture

usually positive

Malunion

healing of a fracture in an abnormal way

Nonunion

fracture fails to heal

Pathologic Fracture

fracture caused by disease

Tendonitis

first 4-8 weeks

inflammation with pain

fiber disruption or degeneration

Tendinosis

great than 4-8 weeks

mucoid degeneration

fiber disorganization

Terrible Triad

elbow dislocation with fractures of radial head and coronoid

Hindfoot Valgus

forefoot abduction and lower midfoot

Night Pain, <30

biomechanical

rotator cuff inflammation

Night Pain, >45

rotator cuff tear

Painful Arc Abduction 60-120

subacromial impingement

Painful Arc Abduction >120

AC joint

Catching, Popping, Clicking

GH or AC joint arthritis

labral tear/instability

Shoulder Reduction: External Rotation

patient supine with elbow flexed to 90

hold elbow with one hand and hold wrist with the other

have pt let arm fall to the side (externally rotate) over 5-10 minutes

hold position where patient reports pain

Shoulder Reduction: FARES

patient supine and stand on involved side

have pt put arm in adduction with elbow extended and forearm neutral

hold pt wrist and apply axial traction

oscillate vertically throughout reduction

slowly abduct the arm

externally rotate when 90 degrees of abduction

Shoulder Reduction: Stimson

pt prone with arm hanging off of bed

apply downward traction with weights

occasionally externally and internally rotate shoulder

Shoulder Reduction: Traction-Countertraction

pt supine

person 1 place sheet under axilla of injured arm and provide countertraction across the patient

person 2 apply longitudinal traction to involved arm at wrist (pull inferior at 45 degrees)

Posterior Shoulder Reduction

patient seated

axial traction on adducted arm with elbow flexed

internally rotate and adduct the arm during traction

Inferior Shoulder Reduction

person 1 stand on affected side of supine pt

apply axial traction inline with abducted arm

person 2 apply parallel countertraction using a sheet over affected shoulder

person 1 increase abduction and apply cephalad pressure to humerus