E1 Ortho- Intro

What is the job of a tendon?

connects muscle to bone

What is the job of a ligament?

connects bone to bone

Review your bone anatomy

🙂

What type of synovial joint permits movement in 1 axis?

hinge joint

What type of synovial joint are: elbows, knees, ankles, IP joints?

hinge joint

What type of synovial joint allows for 2 axes of movement?

condyloid joint

What type of synovial joint is found between radius and carpal bones of wrist?

condyloid joint

What type of synovial joint is found as the articulation between 2 bones that are saddle shaped?

saddle joint

What type of synovial joint is found between the trapezium and 1st MCP of thumb?

saddle joint

What type of synovial joint allows for a gliding joint movement between bones that are flat and similar size?

planar joint

What type of synovial joint is found at intercarpal/intertarsal joints and AC joint?

planar joint

What type of synovial joint allows for articulation within a ligamentous ring between the round end of 1 bone and another bone?

pivot joint

What type of synovial joint is the atlantoaxial joint between C1 and C2 which allows for side to side head motion and the proximal radioulnar joint which allows for pronation and supination?

pivot joint

What type of synovial joint allows for movement of flexion/extension, abduction/adduction, and rotation?

ball and socket joint

What type of synovial joint are the shoulders and hip joints?

ball and socket joint

What synovial fluid analysis would you make based on the following:

Clear to pale yellow, transparent

WBC < 200

Normal

What synovial fluid analysis would you make based on the following:

Slightly deeper yellow, transparent

WBC < 2000

Osteoarthritis

What synovial fluid analysis would you make based on the following:

Darker yellow, cloudy, translucent, blurred

WBC < 80,000

Inflammatory

What synovial fluid analysis would you make based on the following:

Purulent, dense, opaque

WBC > 50,000

Septic

What synovial fluid analysis would you make based on the following:

Red, opaque

Hemarthrosis

Why synovial fluid analysis are seen in children?

normal, inflammatory, septic

What is the normal knee ROM?

0-130 degrees

If a joint is in hyperextension, what precedes the degree?

negative sign

What grade of muscular response is the following:

No contraction detected

0

What grade of muscular response is the following:

Barely detectable flicker or trace of contraction

1

What grade of muscular response is the following:

Active movement with gravity eliminated

2

What grade of muscular response is the following:

Active movement against gravity

3

What grade of muscular response is the following:

Active movement against gravity and some resistance

4

What grade of muscular response is the following:

Active movement against resistance without evident fatigue, "normal"

5

What is Scintigraphy?

bone scan

Which form of imaging provides the most detail for evaluating soft tissue?

MRI

When should an MRI not be ordered?

in the presence of metal (pacemaker, aneurysm clips)

Which form of imaging offers 3D models giving a more detailed exam of bones and structures?

CT scan

Which form of imaging gets images of a joint using a contrast medium?

Arthrography

Why should you be careful when ordering an arthrogram?

invasive and increases risk of join infxn

Which form of imaging uses a radioactive agent and gamma rays?

Scintigraphy

Which form of imaging is highly utilized in the US due to its low cost and safety?

Ultrasonography

What are ultrasounds variable?

highly technician dependent

Which form of imaging provides real-time Xrays and used in interventional procedures?

Fluoroscopy

What are the 2 main side effects with NSAIDs?

GI ulcers/bleeds & Kidney problems

Which inhibitors (COX-1/COX-2) is better for the GI system? (less likely to cause ulcers and bleeding)

COX-2 inhibitors

What are adverse effects to watch for with COX-2 inhibitors?

inc risk of stroke and MI (USE CAUTION), renal and hepatic complications, more expensive

What are corticosteroid injections used for?

decrease pain and inflammation (typically in arthritis pts)

Do corticosteroids work provide longer pain relief for pts with RA or OA?

RA

What pre op antibiotic is the drug of choice for ortho procedures?

Ancef

Which ASA status classification:

normal healthy pt

P1

Which ASA pt classification:

pt with mild systemic disease

P2

Which ASA pt classification:

pt w/ severe systemic disease

P3

Which ASA pt classification:

pt w/ severe systemic disease that is a constant threat to life

P4

Which ASA pt classification:

moribund pt who is not expected to survive w/o the operation

P5

Which ASA pt classification:

declared brain-dead pt whose organs are being removed for donor purposes

P6

What needs to be done prior to surgery?

signed consent form

What is arthroscopy?

a pencil-sized, flexible, fiberoptic instrument is used to make 2-3 small incisions to remove bone spurs, cysts, damaged lining, or loose fragments in the joint, clear joints

What is an Osteotomy?

when the long bones of the arm or leg are realigned to take pressure off of the joint

What is Joint fusion?

surgeon eliminates the join by fastening together the ends of bone using pins, plates, rods, etc. -eliminates joint’s flexibility

What is Joint replacement (Arthroplasty)?

surgeon removes parts of the bones and creates an artificial joint w/ metal or plastic

What is an Open reduction internal fixation (ORIF)?

surgeon reduces the fracture and reinforces it with instrumentation inside the patient. Plates and screws or an intramedullary rods are used

What is an Open reduction external fixation?

surgeon reduces the fracture and applies instrumentation through the skin and reinforced with a metal frame. Utilized when a cast does not allow for proper alignment of a fracture

What is Manipulation under anesthesis (MUA)?

surgeon manipulates a pt’s joint under anesthesia

What is Manipulation under anesthesia (MUA) typically used for?

"frozen shoulders", total knee arthroplasty (TKA), and total shoulder arthroplasty (TSA)

5 Ps associated with compartment syndrome:

Pallor, Pulselessness, Poikilothermia, Pain, Paresthesias, Paralysis

What is the best tx for DVT?

prevention is key

What is Virchow’s triad?

stasis, hypercoaguability, endothelial injury

What can you use to evaluate if a pt has a DVT?

Wells criteria

How does a DVT present?

unilateral leg swelling, leg pain/calf tenderness, low-grade fever

What testing is done for DVT?

duplex U/S

What is the tx for a DVT?

LMWH (lovenox), vascular consult

What does the Axillary nerve control?

Lateral arm: deltoid (should abduction)

What does the Musculocutaneous nerve control?

Lat. prox forearm: biceps (elbow flex)

What does the Median nerve control?

Tip of thumb, volar aspect: FPL (thumb flex)

What does the Ulnar nerve control?

Tip of pinky, volar aspect: 1st dorsal (abd fingers)

What does the Radial nerve control?

dorsum thumb/web: EPL (thumb extension)

What does the Obturator nerve control?

medial thigh: adductor hip muscles (adduction)

What does the Femoral nerve control?

prox. -medial malleolus: quads (knee extension)

What does the Peroneal-deep branch nerve supply?

dorsum 1st web: EHL (great toe extension)

What does the Peroneal-superficial branch control?

dorsum lat. foot: Peroneus brevis (foot eversion)

What does the tibial nerve control?

plantar aspect of foot: FHL (great toe flex)

What is the purpose of Rehab?

return the pt to optimal function as quickly and safely as possible

What is an isometric contraction?

produces muscle contraction w/o moving the joint angle; length of muscle does NOT change

What is an isotonic contraction?

manual/mechanical resistance applied as muscle moves through the ROM; length of muscle changes

What is concentric movement?

muscles shortens

What is eccentric movement?

muscle lengthens

What is an isokinetic contraction?

muscle shortens and contracts, occurs at a constant rate of speed

What are absolute contraindications to exercise?

recent MI, ischemic EKG changes, unstable angina, uncontrolled arrhythmia, 3rd degree heart block, acute CHF

What is cryotherapy?

use of cold modalities for the purpose of vasoconstriction to produce a decrease in inflammation, pain, muscle spasm

What is Electrical modalities of rehab?

use of electrical current for contraction of muscle, reduction of pain, dx purposes, wound healing, dec spasticity

Which form of electrical modality:

stimulates muscles for strength/rehab

electrical stimulation

Which form of electrical modality:

drug (DEXA) delivered through ultrasound

iontophoresis

Which form of electrical modality:

stimulates nerves to relieve pain

TENS unit

What is Continuous Passive Motions (CPM)?

machines utilized immediately after surgery to maintain and improve mobility of joints (usually ones not used)

Which DME is usually given first?

walker (more stable)

Which walker type is best for pts w/ UE fxs?

walker w/ platform attachments

Which walker is best for stroke pts?

hemiwalker

Which walker is best for pts w/ Parkinson’s?

rolling walker

Which offers more support crutch or cane

crutches

Which crutches are best for pts w/ fxs?

platform crutches

Which type of crutches are best for pts w/ long-term disabilities?

lofstrand (forearm) crutches

What type of crutches are best for pts w/ temporary disabilities?

axillary crutches

Which type of cane offers more support (quad vs single)?

Quad cane