Most effective medication for fibromyalgia?
TCAs
Proper treatment for Boxer's fracture (fracture of 5th metacarpal head)
ulnar gutter splint
... [Show More] (immobilizes the wrist, hand and fourth/ fifth digits). Wrist is positioned in slight extension; x 3-4 weeks of continuous splinting
Goal for vertebral compression fractures?
early mobilization; no not need to keep recumbent in bed until back brace is made
cubital tunnel syndrome risk factors
having elbow be bent for long periods of time (hairdresser) or having damage to elbow or "funny bone".
Sx: similar to carpal tunnel but ulnar distribution, at worst, may start causing weakness of ring and little finger
Cure rates for trigger finger after steroid injection:
54-86% CURED after injection for this musculoskeletal condition
Which solution for cleansing a pressure ulcer?
tap water
saline
(nothing else!!)
which dressing for pressure ulcer?
non-adherent: hydrocolloid, foam or other non-adherent dressing
which therapeutic modality is contraindicated for muscle injuries until growth plate is closed?
Therapeutic ultrasound is C/I on growth plate. Growth plate closes at age 15
First line for gout in patient with CKD IV?
Steroids only, Colchicine and NSAIDs not used if renal dysfunction
Which supplements to give at which age for breastfed babies?
- 400 IU of Vitamin D per day starting in the first few days of life. Do not need vit D supplementation when baby is comusming at least 500 cc of formula or milk with Vit D per day
- need to start iron supplementation at 4 months of age
PCL tear symptoms
posterior knee pain and pain when kneeling; painful limitation of flexion and posterior drawer sign on exam
Treatment for lateral patellar dislocation:
medial pressure to patella and then gently extend knee fully
If patient presents after leg injury with exceptionally severe pain that is worse with stretching the calf muscles, think of ____. Which test to find out?
Compartment syndrome clinical presentation?
Tests to confirm compartment syndrome are tissue pressure studies
Where to give corticosteroid injection for rotator cuff tendonitis vs for shoulder osteoarthritis?
- Rotator cuff tendonitis steroid injection if pain interfering with sleep or function despite adequate analgesia, give injection into subacromial space
- Shoulder OA steroid injection into the AC joint (intra-articular)
Mechanism of most common neurological deficit related to Paget's disease?
Most common deficit in Paget's disease is hearing loss. Not caused by CN 7 compression but is due to cochlear damage.
Which herbal remedy helpful for joint pain?
SAMe most helpful (Glucosamine and chondroitin not as effective)
Alpha lipoic acid and gamma linolenic acid are helpful for:
neuropathy symptoms helped with which herbal remedies?
Ottawa Ankle Rules
Includes:
The examiner should order x-rays when the patient has ankle (within 6 cm of distal, posterior tibia or fibula) or midfoot pain + (bone tenderness at the base of the 5th metatarsal OR pain in navicular bone (between heel and ankle) OR is unable to bear weight (for four steps) when examined)
Little league shoulder refers to:
proximal humeral epiphysitis (usually seen in baseball pitchers age 11-16)
Male with normal labs but osteoporosis, think:
hypotestosteronism
Hip Labral Tear Etiology
Often occurs due to repetitive movements such as running or pivoting, resulting in degeneration or breakdown of the labrum
Can also occur acutely due to a hip dislocation
Signs of Hip labral tear:
clicking sound with activity and pain in anterior groin with extreme abduction and adduction
Back pain that awakens children at night differential is:
osteomyelitis, diskitis (can be viral or bacterial), osteoid osteoma, osteoblastoma and spinal cord tumors
Mallet finger (torn extensor tendon/ dorsal aspect of finger)
avulsion of the terminal tendon (or fracture of distal interphalangeal joint) and is splinted in full extension for 8 weeks
- need to consult ortho if fracture > 30% of intraarticular surface
When to start bisphosphonates in those with osteoporosis?
when 10 year risk of hip fracture is > 3% and patient has had osteoporosis related fractures.
- Treat those with less risk factors with approximately 1200 mg of calcium and 800 IU of Vit D daily
When to do surgical fixation of great toe fracture:
when > 25% involvement of the joint surface (intra-articular fracture); use toe plate and short leg walking cast x 2-3 weeks if < 25% intra-articular involvement
child limping with no clear preceeding injury, next step?
X Ray of hip
Acute lumbar pain with radiculopathy does not need imaging unless:
cauda equina syndrome, suspected cancer, infection or fracture; conservatively manage x 6 weeks
Proximal muscle weakness in elderly female with normal ESR and normal DTRs, think of:
statin-induced myopathy
- Polymyalgia rheumatica with elevated ESR
- Guillian Barre with hyporeflexia
Treatment of mildly displaced mid-clavicular fracture:
- sling x 2-6 weeks, passive mobilization as tolerated when pain is decreased, PT starting at 4 weeks
- cumbersome and not recommended: figure of 8 bandage [Show Less]