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MSK Pathophys Flashcards

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1
Q

Spinal Pathologies

lower spine vertebral column anatomy

A
  • lumbar: 5 vertebral bodies; L1-L5
  • sacrum: 5 segements (fused w/out discs)
  • coccyx: 3-4 fused segments
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2
Q

Spinal Pathologies

label anatomy of vertebrae

A

okay

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3
Q

Spinal Pathologies

ligaments of spine

A
  • anterior longitudinal ligament: connects vertebral bodies anteriorly
  • posterior longitudinal ligament: connects vertebral bodies posteriorly
  • ligamentum flavum: yellow ligament; connects lamina posteriorly
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4
Q

Spinal Pathologies

anatomy of lumbar discs

A
  • purpose: cushioning between vertebral bodes
  • named by vertebral body above/below (L4-5 disc is between L4/L5)
  • Annulus Fibrosis: fibrous outer ring of disc
  • Nucleous Pulposus: soft inside of disc
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5
Q

Spinal Pathologies

anatomy/phys of spinal cord

A
  • purpose is to transmit information to and from rest of body
  • begins at craniocervical junction and ends between T12-L2
  • end of sinal cord: conus medullaris (conus)
  • cauda equina: end of conus there are spinal nerves that go to LE and bowel/bladder
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6
Q

Spinal Pathologies

nerve roots of spinal cord numbering

A
  • cervical: nerve roots exiting are name based on vertebral body below foramen (except C8 which exits in C7-T1 forament)
  • Thoracic/Sacral: named for vertebral body above foramen
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7
Q

Spinal Pathologies

describe spurling test of cervical spine

A
  • dx cervical HNP or spondylosis
  • pt seated, laterally flex head, apply pressure downward to increase axial load & cause pain down ipsilateral arm
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8
Q

Spinal Pathologies

describe hoffman reflex for cervical spine

A
  • tests for long tract spinal cord involvement in neck
  • pathologic reflex (indicates abnormality w/in cervical spinal cord or higher like UMN lesion or pyramidal sign) for ALS< MS, spinal cord compression
  • pos reflex: flexion and adducting the thumb/index finger after flicking the middle finger
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9
Q

Spinal Pathologies

lumbar spine tests

A
  • gait (barefoot) look at Trendelenburg (pelvis level on one foot = normal hip abductor)
  • heel-toe walking (tests L4-5, S1 innervated muscles)
  • calf/thigh circumfrence/atrophy (asymmetric or atrophy = weakness)
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10
Q

Spinal Pathologies

lumbar SLR tests

A
  • seated SLR: pos test causes pt to lean back
  • Supine SLR (lesegue): pos test is radicular pain in leg, not back (HNP or compression) sx at 20deg or less is suggestive of sx amplification
  • Slump test: seated, hands behind back, then slump in relaxed position w/ chin to chest; extend leg, dorsiflex fully. examiner gives slight pressure to back of head. pos test is impingement on dura, spinal cord, nerve roots
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11
Q

Spinal Pathologies

red flags in HPI/PE

8

A
  • fever/chills/wt loss (malignancy)
  • hx of IV drug use
  • progressive weakness; decreasing pain in face of increasing deficit; paraparesis
  • bowel/bladder dysfunction; distended/palpable bladder
  • trauma
  • increasing pain not controlled by simple analgesia
  • saddle anesthesia
  • unexplained neuro deficits
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12
Q

distended/palpable bladder

lordosis vs kyphosis vs scoliosis

A
  • lordosis: increased lumbar curvature
  • kyphosis: increased thoracic curvature
  • scoliosis: abnormal sideways curves
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13
Q

Spinal Pathologies

myelopathy vs radiculopathy vs stenosis

A
  • myel: injury/compression of spinal cord
  • radi: injury/compression of nerve root
  • stenosis: narrowing of passage for spinal cord/nerve root
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14
Q

Compartment Syndrome

causes of compartment syndrome

4

A
  • long bone fractures (tibia or humerus)
  • severe contusion/crash injuries
  • reperfusion injury after vascular repair
  • restrictive cast/dressing
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15
Q

Compartment Syndrome

compartments of LE

A
  • anterior
  • lateral
  • superficial posterior
  • deep posterior

Contents
* each compartment covered by fascia (resistant to expansion and stretch)
* each compartment contains muscles, blood vessels, nerves

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16
Q

Compartment Syndrome

pathogenesis

A
  • interruption of hemostatic pressure gradient causes a disruption in flow and capillary perfusion pressure
  • build up of fluid outside of the capillaries increases pressure w/in myofascial compartment
  • distribution of oxygen/nutrients and CO2 removal disrupted leading to muscle ischemia and necrosis
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17
Q

Compartment Syndrome

reversibility of sx based on duration?

A
  • < 4 hrs: reversible muscle injury
  • > 8 hrs: irreversible muscle injury
  • nerve conduction loss: 2 hrs
  • irreversible nerve injury: > 8 hrs
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18
Q

Compartment Syndrome

describe procedure of emergency fasciotomy

A
  • long incision to release pressure in affected compartment and adjacent compartments
  • wounds are left open and a 2nd procedure for debridement is performed w/in 48-72 hrs
  • wound closure w/in 7-10d +/- skin grafting
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19
Q

Osteomyelitis

common bacteria of non-hematogenous vs hematogenous

A
  • Non-Hematogenous Polymicrobial (S. aureus, S.epidermidis, streptococcus spp, gram neg, anaerobes)
  • Hematogenous monomicrobial (S. aureus, streptococcus, gram neg, p. aeruginosa, serratia, candida)
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20
Q

Osteomyelitis

bacterial causes due to specific risk factors

A
  • no risk factors: s. aureus
  • sexually active: n. gonorrhoeae
  • cat/dog bites: p. multocida
  • IVDU: p. aeruginosa, s. aureus, candida
  • sickle cell: salmonella
  • neonates: group b strep
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21
Q

Osteomyelitis

pathophys

A
  • overall poorly understood
  • several factors: host immune status, underlying disease, virulence of organisms, vascularity and location of bone
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22
Q

Osteomyelitis

which part of bone most commonly affected in hematogenous spread?

A
  • metaphysis
  • due to rich vascular supply of growth plates
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23
Q

Osteomyelitis

XR findings/limitations

A
  • 1st line imaginge, but may not show chagnes in the first 2wks (so normal XR cannot r/o dz)
  • disease must extend at least 1 cm and compromise 30-50% of bone mineral content to produce noticeable changes in plain radiographs
  • findings: regional osteopenia, loss of trabecular architecture, bone destruction, soft tissue gas, new bone apposition (cortical thickening; increase in diameter of bone)
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24
Q

Septic Arthritis

bacteria associated w/ infection

A
  • S. aureus most common overall
  • s. epidermidis
  • streps: pyogenes, pneumoniae, agalactiae)
  • gram neg: p. aeruginosa, e. coli, k. kingae, n. gonorhoeae (sexually active young pt), h. flu, salmonella (sickle cell)
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25
# DeQuervain's Tenosynovitis Finkelstein tests
place thumb into palm and ulnar deviate pain is pos result (expected w/ DeQuervain's)
26
# Arthritis purpose of articular cartilage
lings bones, allows for protection and gliding movement
27
# Arthritis- Wrist what bones are removed w/ proximal row carpectomy
scaphoid, lunate, triquetrum
28
# Trigger Finger why don't you release A1 pulley in RA
can cause further ulnar drift
29
# Common Fractures metacarpal fractures- describe when rotational deformity may be present
* most common in oblique and spiral fracture types * PIP joints at 90deg flexion normally converage at a point in the proximal carpal bones (scaphoid) * deviation of 1+ lines suggests a metacarpal fracture
30
# Common Fractures components of neurovascular for fractures
* repetitively evaluate motor + sensory nerve function and assess for vascular insufficiency * neuro exam: assess median nerve, AIN, and radial nerve * vascular exam: temp, color, cap refill
31
# Common Fractures specifics of neuro exams
* Median: assess for abduction of thumb or flexion of distal phalanx of thumb * Ant. Interosseous Nerve (AIN): assess for flexion of distal phalanx (OK sign) * Radial: extension of wirst
32
# Common Fractures specifics of vascular exam
* eval for color, warmth, cap refill * eval both radial and ulnar arteries * emergent surg if: cold, pale, pulseless
33
# Common Fractures Weber Classification
* describe fibular fracture relative to syndemosis * A: below syndesmosis * B: level of syndesmosis * C: above level of syndesmosis
34
# Common Fractures Bohler Angle (calcaneal)
* formed by intersection of 2 lines * Line 1: drawn from superior aspect of post calcaneal tuberosity to the superior subtalar articular surface * Line 2: drawn from the superior subtalar articular surface to the superior aspect of anterior calcaneal process
35
# Shoulder Disorders types of shoulder separations | 6
* Type I: ligament stretched * Type II: partial rupture of AC ligaments * Type III: complete rupture of AC/CC ligaments * Type IV: clavicle displaced posteriorly over acromion * Type V: clavicle displaced up (just under skin) * Type VI: clavicle underneath coracoid (rare, but serious)
36
# Shoulder Disorders Subacromial impingement/bursitis: describe Neer and Hawkins tests
* **Neer Impingement Sign**: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear. * **Hawkin Impingement Test**: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!)
37
# Shoulder Disorders rotator cuff muscles & their jobs
* supraspinatus: abduction * infraspinatus: external rotation * teres minor: external rotation * subscapularis: internal rotation
38
# Shoulder Disorders Pos PE tests for rotator cuff tears + describe them all | 4
* **Neer Impingement Sign**: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear. * **Hawkin Impingement Test**: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!) * **Drop Arm Test**: from fully abducted position, slowly lower the arm to the side, noting pain starting at approx 90deg followed up sudden drop of arm. * **Empty Can Test**: supraspinatus muscle isolation; with arm straight and shoulder abducted to 90deg and forward flexed 30deg, point thumb at ground and lift arm against resistance
39
# Shoulder Disorders Pos PE tests for labral tear
* **Apprehension Test**: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt's face
40
# Shoulder Disorders Pos PE tests for shoulder dislocation
* **Apprehension Test**: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt's face
41
# Shoulder Disorders dislocated shoulder appearances on XR
* **posterior**: humeral head appears superior to glenoid cavity on AP film * **anterior**: humeral head appears inferior to glenoid cavity on AP film (MUCH MORE COMMON)
42
# Shoulder Disorders posterior approach for shoulder joint aspiration
* palpate posteior lateral edge of acromion process * mark spot 2cm inferior to edge * inject shoulder w/ 10mL of anestetic targeting coracoid process
43
# Shoulder Disorders ways to reduce anterior shoulder dislocations
* Stimson * Scapular Manipulation * Leidelmeyer * Milch * Traction-counter traction
44
# Shoulder Disorders describe Stimson reduction
* Prone position * Arm hanging * Traction in forward flexion using 5, 10 or 15 pound weight (15-30 min) * Use with scapular manipulation
45
# Shoulder Disorders describe scapular manipulation
* Stimson technique * Scapular tip medially * Slight dorsal displacement of scapular tip * Reduction may be subtle
46
# Shoudler Disorders describe Leidelmeyer reduction
* Supine * Arm adducted * Elbow flexed 90° * Gentle external rotation
47
# Shoulder Disorders describe Milch reductions
* Forward flexion or abduction until arm is directly overhead * Longitudinal traction * Slight external rotation * Manipulate humeral head upward into glenoid fossa
48
# Shoulder Disorders Traction- Countertraction Reduction
* Supine * Bed sheets tied * Slight abduction of arm * Continuous traction * Gentle external rotation * Gentle lateral force to humerus * Change degree of abd
49
# Shoulder Disorder Pos PE test for Bicepital Tendonitis
* **speed's test**: with elbow fully extended and palm forward, flex shoulder against resistance
50
# Knee Disorders most common location for OCD of the knee? | PPP
70% in the posterior lateral aspect of the medial femoral condyle
51
# Knee Disorders PE differences for patellar and quad tendon ruptures
* **patellar**: difficulty w/ knee flexion, patella alta) * **quad**: difficulty w/ SLR, can't extend knee, patella baja
52
# Knee Disorders bursa of the knee
1. suprapatellar 2. pre-patellar 3. infrapatellar 4. pes anserine
53
# Knee Disorders location of pes anserine bursa
deep to the gracilis, sartorius, and semitendinosus tendons at the lower medial knee
54
# Knee Disorders pos special tests for ACL tear
* **Anterior Drawer Test**: for ACL tear; flex knee to 90 deg and sit on pt's foot; attempt to pull tibia anteriorly toward you (ACL tear = anterior tibia shift); and then repeat with the tibia in internal rotation to test posteriolateral joint capsule and in external rotation to test posteriomedial joint capsule * **Lachman Test**: for ACL tear; flex knee to approx 20 deg; grasp lower leg, with one hand, use other hand to grasp thight; pull tibia foward while pushing femur back
55
# Knee Disorders pos special tests for PCL tear
* **Posterior Drawer Test**: for PCL tear- flex knee to 90 deg and sit on pt's foot; attempt to push tibia posteriorly away you (PCL tear = posteior tibia shift) * **Sag Sign for PCL tear**: inspect if tibia sags posteriorly when knee is relaxed at 90 deg flexion
56
# Knee Disorders pos special tests for meniscus tears
* **Medial McMurray Test**: fully flex knee, then hold foot in external rotation and apply valgus force to knee while extended knee * **Lateral McMurray Test**: fully flex knee, hold foot in internal rotation and apply varus force to knee while extending knee * **Apley's Meniscal Compression Test**: with patient prone, grind tibia against femur in rotating motion to see if it elicits meniscal pain * **Apley's Meniscal Distraction Test**: same as above, except tibia is pulled away from femur; pain may indicate ligamentous injury or malingering rather than meniscal injury.
57
# Scoliosis differentiate dextroscoliosis and levoscoliosis
* Dextro: spinal curvature to R * Levo: spinal curvature to L
58
# Scoliosis describe purpose of and technique for scholiometer
* measures angulation of spine while individual bends forward to determine degree of truncal rotation * pt bend forward, deviation of teh ball from center is measured * measurements of >5deg is abnormal, f/u with spinal XR
59
# Raynaud's pathophys of each phase
* Ischemic: arterial vasospasm causing distal blanching and transient numbness * Hypoxic: dilation of capillaries and venules containing deoxygenated blood causing cyanosis * Hyperemic: rewarming and resolution of vasospasm leading to oxygenated blood being delivered to dilated capillaries and venules leading to erythema
60
# Raynaud's clinical presentation primary vs secondary
* **Primary**: mild cuase, middle 3 fingers most commonly affected, episodic < 20 min * **Secondary**: more severe, asymmetric or unilateral, trophic changes (scarring, ulceration, gangrene), sclerodactyly (puffy digits w/ skin tightening)
61
# Raynaud's normal vs abnormal nailfold capillary microscopy
* **Normal**: vessels thin, uniform, evenly spaced, symmetric; capillary loops have hairpin appearance * **Abnormal**: absent (dropout areas) or dilated capillary loops; vessels are irregular, tortuous, elongated, bizarre, bushy, engorged, corkscrew in appearance; spacing between loops may be uneven
62
# Raynaud's vasoconstrictive meds to avoid
* nasal decongestants * amphetamines * methylphenidate sumatriptan
63
# Radial Head Subluxation supination/flexion technique
* Warn caregivers that the maneuver will hurt and the child will likely cry * Child can be seated in parent’s or caregiver’s lap * Fully extend and supinate elbow and then take elbow into flexion * This procedure is done while maintaining slight pressure over the radial head; often, the provider will feel a “click” in the elbow * Typically, the child will be moving the arm normally within 15 minutes * Immobilization is unnecessary after first episode
64
# Radial Head Subluxation hyperpronation reduction technique
* Warn caregivers that the maneuver will hurt and the child will likely cry * Child can be seated in parent’s or caregiver’s lap * While applying mild pressure over the radial head, the provider holds the elbow in a flexed position and hyperpronates the forearm * A click may be felt when displacement is reduced * Typically, the child will be moving the arm normally within 15 minutes
65
anatomy of apophysis
* normal secondary ossifications center * located in NWB part of bone * site of tendon or ligament attachment * AKA traction epiphysis * eveentually fuses w/ major portion of bone in 2nd decade of life
66
# Ankle Sprain sprain vs strain
* sprain: injury to ligament caused my tearing of the fibers of a ligament * strain: injury in which the muscle is stretched too much and tears
67
# Ankle Sprain ligaments of the ankle
* deltoid (strong, medial ligament) * anterior/posterior talofibular (lateral ligaments) * calcaneofibular (lateral ligament)
68
# Ankle Sprain grading ankle sprains
**1st degree – mild ankle sprain** * Minimal pain and swelling * Ankle is weakened and prone to reinjury * Healing: 1-2 wks **2nd degree – moderate to severe ankle sprain** * Swelling often associated with ecchymosis * Walking produces pain and is often difficult * Healing: 2-3 wks **3rd degree – severe ankle sprain** * Diffuse swelling and ecchymosis * Unable to bear weight * Ankle instability * +/-nerve damage * Healing: 6-8 wks
69
# Ankle Sprain Ottawa Ankle Rules- ankle vs foot imaging
**An ANKLE radiograph should be performed if there is pain in the malleolar region with any of the following:** * Bone tenderness at the posterior edge of the distal 6 cm or tip of the lateral malleolus * Bone tenderness at the posterior edge of the distal 6 cm or the tip of the medial malleolus * Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation **A FOOT radiograph should be performed if there is pain in the midfoot region with any of the following:** * Bone tenderness at the navicular bone * Bone tenderness at the base of the 5th metatarsal * Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation
70
# Ankle Sprains Ankle Anterior Drawer Test
* Performed to evaluate the stability of the anterior talofibular ligament (differentiate between 2nd and 3rd degree lateral ankle sprains) * Positive test: anterior movement of the foot = 3rd degree tear Performing the Test * place the pt's ankle into 20deg plantar flexion * with one hand, stabilize the anterior aspect of the distal leg * cup the calcaneous and attempt to displace it anteriorly detecting the total amount of anterior translation in the lateral part of the ankle
71
# Ankle Sprains proper use of posterior leg splint
* use with grade 2-3 ankle sprains, isolated fractures of tibia or fibula, lisfranc, or metatarsal fractures * origin: posterior surface of leg, 2 in below fibular head to avoid common peroneal nerve compression * insertion: plantar aspect of metatarsal heads * position: ankle in 90deg dorsiflexion, pt in prone position to prevent shortening of Achilles
72
# Metatarsal Fractures types of fractures
* **Pseudojones/Dancer's fracture**: occurs in zone I; fracture through base (tuberosity) of 5th metatarsal due to plantar flexion/inversion * **Jones Fracture**: occurs in zone II; fracture at metaphyseal-diaphyseal junction that occurs w/ ankle sprains; high risk for non-union due to zone being avascular * **Stress Fracture**: zone III
73
# Bursitis define bursa
* synovium lined, sac like structure containing small amount of fluid * found throughout the body * acts as a cushion and gliding surface to reduce friction * located near bony prominences or between bones, muscles, tendons, or ligaments
74
# Bursitis describe olecranon bursitis
* caused by injury or repetitive pressure on elbow * pain w/ flexion
75
# Bursitis describe trochanteric bursitis
* caused by injury, overuse, arthritis, surgery * pain w/ lying or sleeping on affected side * most common in middle age/older women
76
# Bursitis describe pre-patellar bursitis
* caused by repetitive pressure on knees
77
# Bursitis describe retrocalcaneal bursitis
* caused by uphill running or wearing tight fitting shoes
78
# Foot Disorders anatomy of the foot
* tarsals, metatarsals, phalanges * arches function to distribute/absorb body wt, provide foot w/ elasticity and resilience, adapt to uneven surfaces, and protect neurovasculature
79
# Elbow Disorders Elbow anatomy
* synovial hinge joint * 3 joints which form functional unite w/in single articular capsule: humeroulnar joint, humeroradial joint, proximal radioulnar joint * motions of elbow: extenion/flexion; pronation/supination
80
# Elbow Disorders define Cozen and Maudsley tests
* **Cozen**: resisted wrist extension with elbow extended and forearm pronated * **Maudsley**: resisted extension of middle finger
81
# Elbow Disorders 5 muscles that form the common flexor tendor + their innervations
Innervated by Median Nerve * pronator teres * flexor carpi radialis * palmaris longus * flexor digitorum superficialis Innervated by Ulnar Nerve * flexor carpi ulnaris
82
# Bone Tumors children vs adult
* **peds**: most are benign; if malignant suspect osteosarcoma, Ewing sarcoma * **adults**: metastatic 100x more common; metastases commonly from breast, lung, thyroid, prostate, or renal cancers
83
# Bone Tumors proto-onco genes
* genes that promote normal cell growth * with mutations, proto-oncogenes become oncogenes which overstimulate cell growth
84
# Bone Tumors tumor suppressor genes
help balance cell growth by promoting apoptosis of mutated cells
85
# Bone Tumors primary malignant bone tumors | 4
* multiple myeloma * chondrosarcoma * ewing sarcoma * osteosarcoma
86
# Bone Tumors how multiple myeloma destroys bone
* **Lytic Lesions**: plasma cells activate osteoclasts which promote bone destruction * **Hypercalcemia**: increased bone destruction leads to increased serum calcium
87
# Bone Tumors osteoma vs osteoblastoma
* osteoma: < 1.5 cm * osteoblastoma: > 1.5 cm
88
# Osteoporosis pathophys
* bone is continually being formed and resorbed (formation = resoprtion) * peak bone mass around age 30 and plateaus for 10 yrs * bone loss then occurs at a rate of 0.3-0.5% each year until menopause then there is a 3-5% loss in bone density for 5-7 yrs * osteoporotic bone loss affects cortical and spongy/trabecular bone leading to a fragile/porous bone
89
# Osteoporosis describe fragility fractures
* occur after less trauma than might be expected to fracture a bone (ex: fall while standing, falling out of bed, coughing) * common sites: distal radius, spine, femoral neck, proximal humerus, pelvis
90
# Osteoporosis types of primary osteoporosiss
* overall: 95% of post-menopausal women; 80% of male cases * Type 1: estrogen deficiency (increased osteoclasts, reduced osteoblasts) * Type 2: age-related loss of bone mineral density
91
# Osteoporosis secondary osteoporosis
* overall: 5% of female cases; 20% of male cases * can be caused by disease (bone marrow/endocrine disorders), deficiency (malabsorption, vit D), drugs
92
# Osteoporosis biggest med risks for secondary osteoporosis | 3
steroids, PPIs, aromatase inhibitors (block estrogen)
93
# Osteoporosis purpose of DEXA scans
* define osteopenia and osteoporosis by providing a quantitative measure of bone loss * predicts risk of fracture * monitors patients undergoing tx
94
# Osteoporosis DEXA T vs Z score
* **T score**: standard deviation differenec between the patient's BMD and reference BMD of younger population of same sex/ethnicity/race * **Z Score**: standard deviation difference between pt's BMD and that of an age-matched population of the same sex/race/ethnicity
95
# Osteoporosis interpreting T vs Z scores
T: if -1 to -2.5 SD: osteopenia; if <-2.5 SD: osteoporosis Z: <-2.0 SD: osteoporosis
96
# Osteoporosis FRAX Score
* Fracture Risk Assessment Score which predicts the 10 yr probability of major osteoporotic fractures * Based on: age, gender, race, hx of fragility fracture, RA, family hx hip fracture, low BMI, hx steroid use, EtOH, current smoker, BMD of femoral neck * Screen all pt >50 w/ FRAX | do not memorize, just be familiar
97
# Osteoporosis indications for pharmacotherapy in women and men | 3 each
* women: hx fragility fracture, T score <-1, elevated 10 yr risk via FRAX * men: fragility fracutres, FRAX estimations, BMD measurements
98
# Osteoporosis bisphosphonates overview
* end in "dronate" or "dronic acid" * bind to hydroxyapatite binding sites on bone (areas w/ active resorption by osteoclasts) * bone turnover reduced at 3 mo and reduced fx risk at 1 yr * take on empty stomach w/ 8oz water (can cause esophageal irritation)
99
# Osteoporosis Hormonal replacement overview
* Estrogen + progesterone: not always given due to risk of thromboembolism, endometrial cancer, CAD, breast cancer * Testosterone: replace in hypogonadal men
100
# Osteoporosis Misc Therapies
* **Raloxifene**: estrogen-agonistic effect on bone leading to increased bone mineral density and mass by decreasing bone resorption * **Denosumab**: monoclonal ab against receptor activator of RANKL which is secreted by osteoblasts * **Calcitonin**: opposes action of PTH leading to inhibited osteoclast activity and reduced bone resorption
101
# Osteoarthritis characteristics of synovial joints
* Articular Cartilage: made of hyaline, covers ends of bones, provides shock absorption/stability/lubrication * Synovial Membrane: loose/vascularized connective tissue, secretes synovial fluid into joint cavity for lubrication * Joint/Articular Capsule: fibrous connective tissue that surrounds the bony ends forming the joint
102
# Osteoarthritis primary vs secondary
* Primary: idiopathic * Secondary: due to obesity, repeated trauma/surgery, infection, congenital abnormalities, metabolic disorders, bone disorders
103
# Osteoarthritis XR/PE evidence of osteophytes
* DIPs: Heberden's nodes * PIPs: Bouchard's nodes * 1st CMC: thumb squaring
104
# Osteoarthritis Stages of Osteoarthritis
* Stage 0: normal joint * Stage 1: 10% cartilage loss * Stage 2: joint space narrowing + osteophyte formation * Stage 3: moderate joint space narrowing (crepitus) + continued osteophyte formation * Stage 4: > 60% cartilage loss + severe joint space narrowing + large osteophytes
105
# Pediatric Hip Disorders describe being breech as a risk factor for DDH
* Frank Breech highest risk: both knees extended (i.e. bent in half) * if a female baby is born breech, they should ALL undergo US screening for DDH
106
# Pediatric Hip Disorders DDH hip XR H line
* drawn horizontally through the inferior portion of the iliac bones at the triradiate cartilages
107
# Pediatric Hip Disorders DDH PE tests as newborn & describe
* **Barlow**: dislocation of hips at rest; child's hips adducted while applying posterior force --> positive when femoral head is felt slipping (posteriorly) our of the acetabulum * **Ortolani**: reduction of the hips at rest; from an adducted position, the child's hip is abducted while the trochanter is pushed anteriorly --> positive when "hip clunk" is felt or if the hip is reduced
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# Pediatric Hip Disorders DDH PE tests as infants age & describe
* **Galeazzi**: child lays supine w/ hips flexed to 45deg and knees at 90deg; pos if one knee is higher than the other (indicates possible posterior displacement of the femur) * **Klisic**: place a finger on the greater trochanter and the ASIS --> draw "line" through both fingertips --> if the line is below the umbilicus, the test is pos
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# Pediatric Hip Disorders endocrine & renal work up for who? includes what?
* children < 10 yrs and wt < 50th percentile * TSH, free T4, BUN, creatinine
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# Pediatric Hip Disorders SCFE Drehmann sign
external rotation w/ passive hip flexion to 90deg
CMT
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