E1: Ortho - intro

what are cordlike structures that function to attach muscle to bone?

tendons

tendonitis vs tendonosis

tendonitis = inflammation

tendonosis = degenerative process "chronic" W/O inflammation

what structure connects bone to bone, is densely packed connective tissue that consists largely of directionally oriented, high-tensile strength collagen and contributes to stability of joint function by preventing excessive motion?

ligament

review 6 types of synovial joints

:)

synovial fluid analysis:

clear to pale yellow, transparent

WBC < 200

normal

synovial fluid analysis:

slightly deeper yellow, transparent

WBC < 2000

osteoarthritis

synovial fluid analysis:

dark yellow, cloudy, translucent, blurred

WBC < 80,000

inflammatory

synovial fluid analysis:

purulent, dense, opaque

WBC > 50,000

septic

synovial fluid analysis:

red, opaque

hemarthrosis

what is the normal ROM of the knee?

0-130 degrees

what is extensor lag of the knee?

knee lacks 10 degrees to full extension

- seen w AROM

what is flexion contracture?

maximum extension measurement

- seen in PROM

if the joint is in hyperextension, how is ROM measured?

the degree is preceded by a negative sign

(ex = hyperextension of the elbow is -3 degrees)

manual muscle test grading scale

what muscle does the axillary nerve supply, what is the action and what is the area of sensory?

muscle = deltoid

action = shoulder ABduction

sensory = lateral arm

what muscle does the musculotaneous nerve supply, what is the action and what is the area of sensory?

muscle = biceps

action = elbow flexion

sensory = lateral proximal forearm

what muscle does the median nerve supply, what is the action and what is the area of sensory?

muscle = FPL

action = thumb flexion

sensory = tip of thumb, volar aspect

what muscle does the ulnar nerve supply, what is the action and what is the area of sensory?

muscle = first dorsal interosseous

action = ABduction of fingers

sensory = tip of pinky, volar aspect

what muscle does the radial nerve supply, what is the action and what is the area of sensory?

muscle = EPL

action = thumb extension

sensory = dorsum thumb web space

what muscle(s) does the obturator nerve supply, what is the action and what is the area of sensory?

muscle = adductors

action = hip ADDuction

sensory = medial aspect of mid-thigh

what muscle(s) does the femoral nerve supply, what is the action and what is the area of sensory?

muscle = quads

action = knee extensors

sensory = proximal to medial malleolus

what muscle does the perineal- deep branch supply, what is the action and what is the area of sensory?

muscle = EHL

action = great toe extension

sensory = dorm first web space

what muscle does the perineal - superficial branch supply, what is the action and what is the area of sensory?

muscle = peroneus brevis

action = foot eversion

sensory = dorsum of lateral foot

what muscle does the tibial nerve supply, what is the action and what is the area of sensory?

muscle = FHL

action = great toe extension

sensory = plantar aspect of foot

what is considered a "live" x-ray?

fluoroscopy

what is a CT pyelography used for?

evaluates spinal cord or nerve root pathology

what are contraindications to a CT? (we should know this by now)

renal disease

allergy to IV contrast

shellfish allergy

what test provides the MOST detail for evaluating soft tissue?

MRI

is a CT or MRI better for tumor staging?

MRI

(a CT is good to evaluate of you have a tumor but not the best for staging)

what are the major risks of a fluoroscopy?

radiation-induced "burn" and possibility of radiation-induced cancer later in life

commonly used drugs: NSAIDs

blocks prostaglandins via COX1 and COX2

anti-inflam, analgesic, antipyretic

SE = GI ulcers/bleeds; kidney problems

commonly used drugs: COX 2 inhibitors

Celebrex & Meloxicam

- less likely to cause GI ulcers/bleeds

- have ↑ risk of stroke and MI

what diseases are corticosteroid injections used for?

OA, RA, gout, SLE and post traumatic arthritis

- ↓ pain and inflammation

when do you seen effectiveness of a corticosteroid injection?

1-13 wks

what are extra-articular injections used for?

overuse syndromes, athletic injuries, neuropathies, bursitis and tendonitis

what are the most common sites of corticosteroids injections?

subacromial shoulder

lateral epicondylitis

trigger finger

carpal tunnel

what are contraindications of corticosteroid injections?

pyarthrosis

non septic inflam of joint

signs of infection

what are adverse reactions of corticosteroid injections?

joint pain

joint infection

tendon rupture

facial flushing

local skin discoloration

subQ lipodystrophy (fat atrophy)

are narcotics contraindicated in peds fractures?

YES!!!!!!!!!!!

ASA Physical Status Classification System

used to classify the stage of disease and morbidity

if you do not get consent for a surgery, it is considered __________

battery

what does pre-op consent include?

- warnings/risks of procedure and anesthesia

- planned procedure and alternatives

- permission to perform procedure

- general complications

what are pre-op screening tests?

EKG

stress test (ST changes)

nuclear stress test (ischemia)

dobutamine stress test (mobility of walls w risk of ischemia)

what is general anesthesia used for? what are benefits and risks?

major joint/spine sx

- ↓ need for opiods

- risk of respiratory depression & post sedation

what is epidural & spinal anesthesia used for? what are benefits and risks?

lower extremity sx

- ↓ post sedation in elderly

- risk of epidural hematoma

what are peripheral nerve blocks used for?

UE and LE sx

what is IV regional anesthesia used for?

short procedures of forearm, wrist and hand (aka Bier Block)

which drugs have a risk factor of liver disease and chronic EtOH abuse?

tylenol

acetam/codeine (Tylenol 3)

aceta/hydrocodone (Norco)

acetam/oxy (Percocet)

acetam/tramadol (ultracet)

which drugs have risk factors of GI symptoms?

ASA

ASA/hydrocodone (Lortab ASA)

calcium

ibuprofen

what is a risk factor of enoxaparin?

renal failure

what is a risk factor of fentanyl transdermal?

respiratory depression

head injury

hepatic or renal impairment

what is a risk factor for heparin sodium?

blood dyscrasias

dont give IM

monitor coag hemoccult

what are risks of morphine?

respiratory depression & brain injury

- caution in opioid dependent pts and elderly

what are risks of tramadol?

respiratory depression & brain injury

- caution in opioid dependent pts

what is the drug of choice for pre-op ABX for ortho procedures?

Ancef

what classification system is used to classify open fractures?

Gustilo Classification

which type of open fracture:

skin wound < 1 cm in length and clean

type 1

does a type 1 open fracture require surgery?

no

which type of open fracture:

laceration > 1 cm in length w/o extensive soft tissue damage, flaps or avulsions

type 2

which type of open fracture:

open segmental fracture w > 10 m wound w extensive soft tissue injury or traumatic amputation

type 3

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

arthroscopy

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

osteotomy

procedure where a surgeon eliminates the joint by fastening together the ends of the bone via pins, plates, screws or rods

- eliminate the joint's flexibility

joint fusion

procedure where a surgeon removes parts of the bone and creates an artificial joint w metal or plastic components

joint replacement

procedure where a surgeon reduces the fracture and reinforces it with instrumentation INSIDE the pt via plates, screws or rods

open reduction internal fixation (ORIF)

procedure where a surgeon reduces the fracture and applies instrumentation through the skin and reinforced w a metal frame

- utilized when a cast doesnt allow for proper alignment

open reduction external fixation

procedure where a surgeon manipulates. pt's joint under anesthesia

- common for "frozen shoulders", TKA and TSA

manipulation under anesthesia (MUA)

what are post-op complications?

DVT

Pulm elmbolism

fever

compartment syndrome

foot drop

excessive drainage

chest pain

hypo/HTN

dyspnea

renal oliguria or anuria

virchow's triad for DVT

stasis

hypercoagulability

endothelial injury

what criteria is used to diagnose a DVT?

Well's criteria

diagnostic test for DVT

duplex US or venogram

treatment for DVT

levonox

what are internal causes of compartment syndrome?

bleeding or tissue edema into facial compartments

what is an external cause of compartment syndrome?

cast is too tight

what are the 5 P's of compartment syndrome?

pain out of proportion

pallor

paresthesias

poikiothermia

paralysis

pulseless

what is the treatment for compartment syndrome?

remove tight dressing

if > 30 mmHg = fasciotomy

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

isometric contraction

which type of contraction has manual or mechanical resistance applied as the muscle moves through the ROM, the length of the muscle DOES change. May be concentric(shortens) or eccentric (lengthens)

isotonic contraction

which type of contraction does the muscle shorten and contract, occurring at a constant rate of speed?

isokinetic contraction

open chain vs closed chain exercises

open = distal segment is free, contraction is mainly concentric

closed = distal segment is not free, movements are functional

absolute contraindications to exercise

recent MI

ischemic EKG changes

UA

uncontrolled arrythmia

3rd deg AV block

acute CHF

type of walkers

platform = pts w UE fxs

hemiwalker = stroke pts

rolling walker = Parkinson's pts

types of crutches

platform = fxs

Lofstrand (forearm) = long-term disabilities

axillary = temporary diasbilities

which limb should a cane be used on?

opposite side of injured limb (it reduces stress)