EM-Ortho/Rheum

Positive Tinel's test

"pins and needle feeling" elicited by tapping on a nerve proximally, with resulting paresthesia (numbness/tingling) experienced in the corresponding distal cutaneous distribution of an injured peripheral nerve

septic brusitis

A 32-year-old man presents with right-sided elbow swelling and pain. He works as a plumber and has no specific injuries. The elbow pain and swelling developed rapidly and became worse over the last 2 days despite applying ice and using over-the-counter anti-inflammatory medications. His vital signs are HR 104 bpm, BP 110/60 mm Hg, RR 18/min, and T 100.2°F (37.9°C). On physical exam, his right elbow is swollen and tender to touch, with redness and fluctuance isolated to the posterior tip of the elbow. He refuses full flexion of the elbow on exam due to pain but allows passive pronation and supination. What is the most likely diagnosis?

Staphylococcus aureus

A 4-year-old boy presents to the emergency department with a limp and fever. His parent states that he began limping 2 days ago, and it has gotten progressively worse. He will no longer walk. His fever started today. His parent reports no known injuries. On physical examination, his temperature is 39°C with a heart rate of 130 beats per minute. His right hip is warm to the touch with overlying erythema present. He has limited range of motion of the right hip due to pain. Laboratory analysis reveals a leukocytosis with elevated erythrocyte sedimentation rate and C-reactive protein. X-ray of his right hip reveals periosteal thickening. An ultrasound of the right hip reveals a hip effusion. Which of the following is the most common cause of the patient's presentation?

Straight leg raise, crossed straight leg raise

A 40-year-old man presents to the emergency department with sudden-onset back pain after lifting a box. The pain radiates down to the mid-thigh and is worse with bending and walking. Physical exam reveals left paralumbar muscular tenderness without spasm. Which of the following exam maneuver(s) has the highest sensitivity and specificity for sciatica, respectively?

MRI

A 47-year-old man presents to the emergency department with a nonhealing ulcer on his heel. Past medical history is significant for uncontrolled diabetes. The patient states that the ulcer has been present for the past couple weeks but is now worsening in appearance. His vital signs are unremarkable. Physical examination demonstrates a left heel ulcer with purulent discharge and surrounding erythema. You are concerned for osteomyelitis of the calcaneus. Which of the following is the most sensitive test for suspected osteomyelitis?

NSAIDs, activity medication, nighttime bracing

Cubital/ulnar tunnel syndrome tx

activity modification, counterforce bracing, PT, steroid injection, surgery for failed PT 4-6mo

Lateral epicondylitis tx

activity modification, PT, steroid injection, surgery for pt who failed PT for 4-6 mo

Medial epicondylitis tx

-will lack significant tenderness and erythema overlying the bursa -will not have a fever. -Passive range of motion should be normal.

Olecranon bursitis can be distinguished from septic bursitis

PT, rest, ice, NSAIDs, steroids, operative

Olecranon bursitis nonseptic tx

False

T/F: positive birefringence on crystal analysis is consistent with gout.

Lateral epicondylitis and medial epicondylitis

What are 2 tendinopathies that affect the distal humerus?

periosteal reaction, periosteal elevation, and lytic lesions or sclerosis.

What are the characteristic findings of osteomyelitis on plain radiographs?

Acute pericarditis

What is caused by inflammation of the pericardium, the sac surrounding the heart. The associated pain is typically substernal, sharp, constant, improved with leaning forward, and worsened with laying back. The exam may reveal a pericardial friction rub, and ECG will sometimes show diffuse ST segment elevation with PR depression.

results when cortical bone reacts to one of many possible insults. Tumor, infection, trauma, certain drugs, and some arthritic conditions can elevate the periosteum from the cortex

What is periosteal reaction/elevation

splint at night, steroid injection / oral, surgical decompression for severe

What is the tx for carpal tunnel?

ulnar nerve is decompressed

When is cubital/ulnar tunnel syndrome operative

straight leg raise

Which of the two has the highest sensitivity? Crossed straight leg raise or straight leg raise

Crossed straight leg raise

Which of the two has the highest specificity? Crossed straight leg raise or straight leg raise

Cubital/ulnar tunnel syndrome

caused by ulnar nerve compression at wrist; sx = paresthesia over small finger and ulnar @ half of 4th finger and ulnar dorsum of hand; worse with cell phone use, @night sx caused by sleeping with arm in flexion, Tinel sign positive;

Septic bursitis

elbow swelling + pain + fever

Olecranon bursitis - nonseptic

elbow swelling = acute trauma / repetitive trauma;

Medial epicondylitis

golfer's/pitchers elbow

Finkelstein Test Positive

make a fist with thumb inside finger doctor holds forearm and turns wrist *in direction of ulnar side* +: numbness and tingling develop over *palmar surface* of thumb, index, and part of ring finger

Staphylococcus aureus (S. aureus)

most common cause of osteomyelitis in children

Medial epicondylitis-def

overuse syndrome; pain with resisted wrist flexion and pronation, pain at medial elbow may radiate to wrist;

Lateral epicondylitis

overuse syndrome; pain with wrist extension and forearm supination;

carpal tunnel

pain / paresthesia in median nerve distribution (first 3 digits and radial half of 4th digit; sx worse at night); +phalen and tinel;

De Quervain's Tenosynovitis:

pain and swelling at base of thumb that radiates into radial aspect of forearm;

Olecranon bursitis

scholar's elbow

Lateral epicondylitis

tennis elbow

nerve conduction studies

what is the confirmatory diagnostic tool use to dx carpal tunnel?