Orthopedics: Bone Structure and Growth

Orthopedics

• Primary roles of bones: protect and support soft tissue, attachment site for muscles, store minerals, and produce red blood cells in bone marrow.
• Bone growth is influenced by nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones).

Bone Growth and Hormones

• Excess insulin growth hormone (hGH) can lead to gigantism, while a deficiency can cause short stature.
• Hormones involved in bone growth: insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones.

Soft Tissue Basics

• Atrophy: wasting away of muscles due to disuse or denervation (muscle loses nerve connection).
• Hypertrophy: muscles increase in number and diameter.
• Skeletal muscle starts to convert to connective or adipose tissue starting at 30, leading to:
  • Slowing of reflexes
  • Reduction of maximum strength
  • Decreased flexibility with age

Abnormal Contraction

• Spasm: involuntary contraction of a single muscle
• Cramp: painful, spasmodic contraction due to a lack of potassium and/or water
• Tic: involuntary twitch of muscles, often in the face or eyelid
• Tremor: rhythmic, involuntary, purposeless co-contraction of contracting muscles
• Fasciculation: involuntary twitch of multiple motor units, visible beneath the skin, often seen with ASL (Amyotrophic Lateral Sclerosis)
• Fibrillation: involuntary twitch of a single motor unit, not visible beneath the skin

Abnormal Curves of the Spine

• Kyphosis: anterior to posterior thoracic curvature (“hunchback”)
• Lordosis: extreme exaggeration of the lumbar curvature, often seen in pregnant women
• Scoliosis: S-shaped curve in the thoracic spine
• Rotoscoliosis: torsion couple with curve

Etiology

• Causes of orthopedic conditions:
  • Traumatic injuries
  • Sports
  • Falls (leading cause)
  • Rheumatic diseases
  • Aging

Orthopedic Conditions

Rickets

• Cause: lacking calcium and vitamin D in childhood
• Symptoms:
  • Soft bones
  • Deformities of the skull, legs, rib cage, pelvis, and teeth
  • Muscle cramps
  • Stunted growth (epiphyseal plates close too soon)
• Treatment: calcium-rich diet to correct deformities

Osteomalacia

• Cause: lacking calcium and vitamin D in adulthood
• Symptoms:
  • Soft bones
  • Prone to fractures
  • Bone pain in lower extremities
  • Muscle weakness
• Treatment: increased vitamin D in the diet (e.g., from salmon) and increased sun exposure

Paget's Disease

• Cause: unknown, possibly viral, with issues in the recycling process and bone formation
• Symptoms:
  • Excessive bone formation and breakdown
  • Located in the spine, femur, or skull
  • High ratio of spongy to compact bone
• Treatment: calcitonin and bisphosphonates

Osteopenia

• Cause: unknown, possibly genetic, malnourishment, or associated conditions
• Symptoms:
  • Reversible weakening of bone
• Treatment:
  • Calcium-enriched diet and supplements
  • Weight-bearing activities
  • Bone density screens

Osteoporosis

• Cause: progressive osteopenia that is irreversible
• Symptoms:
  • Initially, none
  • Later, pain, kyphosis, height loss, and skeletal dysfunction
• Treatment: none

High-Risk Factors

• Women
• History of falls
• Quadriceps weakness
• Postural instability

Incidence

• 1 in 2 women will have a fracture related to osteoporosis, while 1 in 4 men will have one
• Higher incidence in women due to decreased estrogen during menopause

Heterotopic Ossification

• Cause: unknown, with abnormal bone formation in soft tissues, possibly due to trauma or surgery
• Symptoms:
  • Pain
  • Warmth at the joint
  • Edema
  • Redness
  • Induration (changes to tissues beneath the surface)
  • Decreased range of motion with a bony end feel
• Treatment:
  • Iontophoresis
  • Range of motion
  • Pain management
• Comorbidities: neurological issues

Prevalence

• Elbow fracture: 90% chance of developing HO
• Hip fracture: 50% chance of developing HO
• Only 1/3 of individuals with HO have functional limitations

Spina Bifida

• Cause: birth defect due to incomplete closure of bone/membrane around the spinal cord
• Symptoms:
  • Myelomeningocele: leg weakness/paralysis, orthopedic issues, bladder/bowel issues, neurological issues
  • Meningocele: small sac or gait immobility
  • Occulta: may have no issues

Fractures

• Classification:
  • Bone ends: displaced or nondisplaced
  • Complete or incomplete break
  • Linear or transverse break on the long axis
• Types:
  • Closed (simple): bone does not break the skin
  • Open (compound): bone breaks the skin
  • Transverse: complete, occurs at a right angle to the bone
  • Comminuted: multiple bone fragments
  • Greenstick: incomplete, bend that causes the other side to break off
  • Stress: repetitive use
  • Hairline: incomplete, small
  • Spiral: from torsional force or twisting

Symptoms

• Localized pain at the site
• Deformity
• Edema (swelling)
• Ecchymosis (discoloration, a few days after the incident)

Incidence

• Falls are the leading cause of fractures in older adults
• Falls are the leading cause of nonfatal injuries
• Most common fractures from falls: hip, wrist, and humerus
• 44% of all fractures involve a distal radius

Hip Fractures

• Primary cause of disability and mortality in older adults
• Chance of not returning to baseline after a hip fracture
• Avulsion: possibility of muscle being pulled off the bone

Symptoms

• Referred pain in the knee
• Unable to bear weight on the affected leg
• Leg-length discrepancy

Treatment

• Surgery:
  • Closed reduction and immobilization
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty (replace the femoral neck and head with a metal prosthesis)
  • Total hip replacement (replace the acetabulum and resurface, replace the ball of the femur, lasts 10-25 years)

Precautions

• Hip flexion should not be more than 90 degrees
• No hip rotation
• No hip adduction
• Sleep on back with a pillow between legs
• Keep leg extended when going from sitting to standing

Humeral Fractures

• 20% have a loss of wrist extension or loss of feeling due to damage to the radial nerve
• 70-90% regain function after 4 months

Causes

• Osteoporosis
• Aging
• Injury

Symptoms

• Humeral displacement and location
• Distal end: supracondylar fracture (elbow, can lead to HO)
• Loss of wrist extension and dorsum hand sensation in around 1/5 cases

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Sling
• Immobilization and mobilization schedule varies

Distal Radius Fracture

• Cause: falling on an outstretched hand

Symptoms

• Loss of sensation, strength, and range of motion
• Classified based on articular and/or ulnar involvement, soft tissue involvement, and displacement

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Splint or cast
• Immobilization and mobilization schedule varies based on the physician

Scaphoid Fracture

• Cause: wrist hyperextension greater than 90 degrees and radial deviation, common in sports injuries

Symptoms

• Pain and tenderness that intensify when trying to pinch or grasp objects
• Vascular necrosis

Treatment

• Non-displaced: non-surgical and requires a thumb spica splint for 10 weeks
• Displaced: surgical and requires bolts, screws, and a splint for 2-4 weeks

Post-operative Fracture Considerations

• Edema
• Range of motion and tightness
• Nerve compression (numbness, tingling, decreased function)
• Tendon rupture

Complex Regional Pain Syndrome (CRPS)

• Cause: issues in communication between the limb, brain, and spinal cord
• Must be chronic (longer than 6 months) post-injury affecting one limb
• Symptoms:
  • Burning, throbbing, aching pain
  • Changes in skin color, temperature, and swelling in the affected area
• Types:
  • CRPS-I: no confirmed nerve injury
  • CRPS-II: known nerve involvement### Shoulder and Chest Muscles
• Weakened shoulder and chest muscles can cause the clavicle to slip down, compressing blood vessels and nerves in the superior thoracic outlet.
• Symptoms: pain in shoulders and neck, numbness and tingling, and coldness in fingers, weakened grip, thumb atrophy.
• Non-surgical treatment: rest, activity modification, OT/PT.
• Surgical treatment: anatomical difference, muscle is cut away to make more space; may cause brachial plexus injury.

Elbow

Medial Epicondylitis (Golfer's Elbow)

• Cause: inflammation of medial tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, radiating pain from medial elbow down forearm, weakness, pain, stiffness.
• Treatment: NSAIDs, rest, ice, ROM, taping, OT/PT.
• Risks: playing throwing sports, playing instrument, painting.
• Triggers: shaking hands, turning doorknob, picking up object with palm down.

Lateral Epicondylitis (Tennis Elbow)

• Cause: inflammation of lateral tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, pain or burning on lateral side of elbow, weak grip strength.
• Treatment: NSAIDs, rest, ice, ROM, brace, steroid injections, OT/PT.
• Risks: plumbers, carpenters, painters, mechanics, chefs, butchers.
• Triggers: shaking hands, turning wrench, holding racket/garden hose.

Ulnar Collateral Ligament (UCL) Rupture

• Cause: repetitive use, fall on outstretched arm.
• Symptoms: pain at medial elbow, "pop" after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers.
• Treatment: Non-surgical: NSAIDs, ice, rest.
• Surgical: Tommy John Surgery, takes tendon from somewhere else.
• Types: Partial or complete (pain in medial part of elbow).

Posterior Olecranon Osteophyte

• Cause: formation of bone spurs on posterior olecranon.
• Symptoms: pain in elbow with no mechanism of injury, decreased ROM, catching or locking of elbow joint with movement.
• Treatment: Surgery to remove bone spurs and debridement of osteophytes, PT/OT.
• Risks: manual labor jobs, athletes.

Elbow Dislocation

• Cause: fall on outstretched arm.
• Symptoms: Partial - pain with ROM, "shifting", tingling/numbness.
• Symptoms: Complete - deformity, extreme pain, NO ROM (arm can't flex or extend).
• Treatment: Non-surgical - relocation and possible immobilization.
• Surgical - repair ligaments, external hinge.
• Types: Partial - relocates on its own; Complete - does not relocate on its own; has to be manually set.

Radial Head Fracture

• Cause: fall on outstretched arm or in conjunction with elbow fx, damage to the bone itself.
• Symptoms: pain on lateral elbow, swelling, decreased ROM, decreased supination & pronation.
• Treatment: Type I - non-surgical, rest + sling for days; Type II - surgery to remove bone fragments + sling for weeks; Type III - surgery to remove bone & repair ligaments + OT/PT.

Olecranon Bursitis

• Cause: direct injury, prolonged pressure, infection, other medical problems (gout, RA).
• Symptoms: painful elbow, edema, redness, warm skin.
• Treatment: Non-surgical - antibiotics for infection; suck out fluid; modify activities, NSAIDs.
• Surgical - takes bursa out, use splint.
• Risks: jobs or activities that require prolonged prop on elbows; elbow arthritis.

Elbow Arthritis

• Cause: breakdown of cartilage on articulating surfaces of bones.
• Symptoms: pain, decreased ROM, locking/grating sensation, edema.
• Treatment: Non-surgical - NSAIDs, OT/PT, corticosteroids.
• Surgical - arthroscopy or joint replacement.

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

• Cause: subluxed nerve, prolonged pressure, swelling, direct injury; ulnar nerve gets pinched/trapped.
• Symptoms: pain, numbness in elbow, hand or wrist, weakened grip, atrophy of hand musculature, reduced FM coordination.
• Treatment: Non-surgical - special pillow, brace, NSAIDs.
• Surgical - cubital tunnel release, transposition ulnar nerve, medial epicondylectomy.

Wrist and Hand Orthopedics

Pediatric Deformities

• 1/20 kids are born with orthopedic differences in their hand.
• Syndactyly: some fingers/toes united; webbing.
• Thumb duplication: second complete or partial thumb.
• Hypoplastic thumb: thumb is underdeveloped.
• Radial club hand: wrist radial deviation; missing all or part of fingers.
• Failure of formation of upper limb.

Radiocarpal Joint Disorders

Carpal Tunnel Syndrome

• Cause: increased pressure or entrapment of the median nerve at wrist; genetics, pregnancy.
• Symptoms: numbness, tingling, and pain in fingers, hand and arm; gradual onset, often complaints at night, lose proprioception and can't realize what their hand is doing.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - NSAIDs, bracing/splinting, steroids, activity modifications, nerve glides.
• Surgical - cut the ligament to create more space.
• Risks: repetitive hand use, hand/wrist positioning, pregnancy, genes.

De Quervain's Tenosynovitis

• Cause: overuse of wrist causes irritation of sheath around APL and EPB tendons to your thumb, or scar tissue; comorbid with rheumatoid arthritis.
• Symptoms: pain and swelling at base of thumb, deceased thumb movement, trouble grasping objects.
• Assessment: Positive Finkelstein Test.
• Treatment: Non-surgical - NSAIDs, splint full time, steroids, activity modifications, ice/heat.
• Surgical - cut sheath around tendon, then OT/PT.
• Risks: child rearing, pregnancy, carpenter, mechanic.

Ganglion Cysts

• Cause: unknown.
• Symptoms: small lump, painless, noncancerous lump often by tendons/joints in wrist or hand, becomes painful when a nerve is compressed.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - typically resolves on its own.
• Surgical - may need to be drained or removed.

MCP Joint Disorders

• Swan-Neck Deformity: MCP joint flexed, PIP joint extended, DIP joint flexed (not seen in the thumb because there aren't three joints).
• Cause: rheumatoid arthritis.
• Symptoms: mallet finger at DIP, limited mobility, pain.
• Treatment: Non-surgical - splinting, HEP, ROM, OT/PT, NSAIDs.
• Surgical - soft tissue surgery or finger joint fusion for stability.
• Boutonniere Deformity: MCP joint extended, PIP joint flexed, DIP joint extended (not seen in the thumb because there aren't three joints).
• Cause: forceful blow to dorsum of bent PIP or slicing of central slip tendon, arthritis.
• Symptoms: PIP can't be straightened, DIP can't be bent, swelling & pain at PIP.
• Treatment: Non-surgical - splinting, HEP.
• Surgical - if there is a tendon that is severed or a compound fracture or splinting doesn't work.

Dupuytren Contracture

• Cause: unknown, but something triggers the fascia of the palm to thicken and it eventually tightens, reducing hand function.
• Symptoms: lumps, nodules, and cords which leads to contractures that pull fingers inward, toward the palm.
• Treatment: Non-surgical - splinting, steroids.
• Surgical - fasciotomy or subtotal palmar fasciectomy.
• Risks: diabetes, alcoholism, epilepsy.

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(Note: This is a long response, and I've tried to format it to make it easier to read. Let me know if you'd like me to make any changes!)### Rheumatoid Arthritis (RA)

• Goals of treatment: reduce pain and joint stiffness, reduce edema, preserve normal joint function and musculature, minimize medication interactions, promote normal growth and development, maintain ADL independence • Disease process: + Acute: fever, decreased range of motion and strength, stiffness, gel phenomenon, weight loss + Subacute: mild fever, decreased range of motion and strength, morning stiffness, decreased endurance, gel phenomenon + Chronic active: decreased range of motion, strength, poor endurance + Chronic inactive: decreased range of motion, muscle atrophy, worse endurance, contractures • Treatment: NSAIDs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Osteoarthritis (OA)

• Cause: genetics and environmental, aging, chondropenia (lose cartilage faster than the body can replace it), non-inflammatory • Symptoms: localized pain, palpable edema, point tenderness, stiffness, inflammation of bones and joints, asymmetrical involvement, weight-bearing joints and hands most affected, crepitus during ROM • Prevalence: 10-15% worldwide • Assessment: patient history, MRI/x-ray, leg length discrepancy, anatomical bony abnormalities • Onset: gradually over years • Types: primary (general wear and tear, no known cause), secondary (external injury or disease) • Prognosis: “silent” or traumatic, joint location • Treatment: NSAIDs, CINODs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Fibromyalgia

• Cause: unknown • Symptoms: widespread chronic severe pain, tender points, no inflammation, headaches, malaise, poor sleep, abdominal cramps, mood disorder, from the waist up • Prevalence: 1-5% worldwide, women more affected than men (US is 3:1) • Assessment: patient history, physical examination, no genetic or blood test can be done, WPI and SSS scores • Onset: widespread or unilateral, can start unilateral then go bilateral • Types: unilateral or bilateral • Prognosis: unclear • Treatment: NSAIDs, opioids, antidepressants • Risks: aging • Comorbidities: OA, RA, depression

Gout

• Cause: crystallization and buildup of uric acid in the joint (hyperuricemia) • Symptoms: rapid onset, joint-specific pain, warmth, swelling, reddish discoloration, tenderness, “attacks” that last hours to days, intermittent, tophi • Prevalence: 1-4% worldwide, 8.3 million in US • Assessment: medical history, physical exam, blood work, MRI/x-ray/CT • Onset: 30-50 years old • Types: most common in big toe, 1st metatarsal • Treatment: diet low in purines, NSAIDs, xanthine oxidase inhibitors (XOI), comprehensive planning (diet) • Risks: men, African American • Comorbidities: insulin resistance syndrome, hypertension, renal damage, depression

Burns

Skin Anatomy

• Epidermis: thin, nonvascularized, epithelial cells, 25% of skin, top layer, body temperature regulation, erection of waste, makes vitamin D • Dermis: 75% of skin, blood vessels, hair follicles, sweat glands, nerve endings, barrier for bacteria, prevents moisture loss • Subcutaneous tissue: fat, below dermis

Wound Healing Process

1. Hemostasis: stop bleeding (clot)
2. Inflammatory: cells come to clean up the wound
3. Proliferative: a. Connective tissue deposits b. Contraction (rebuild tissue) c. Epithelium is rebuilt
4. Maturation: collagen reorganizes itself

Zones of Burns

• Coagulation: brunt of the heat, innermost, most damage, irreversible • Stasis: decreased perfusion, surrounding coagulation, moderate damage, can be saved but effort is needed • Hyperemia: decreased perfusion, outermost, minimal damage, has potential to survive

Types of Burns

• Superficial Burn (1st degree): epidermis only, redness, dry, blanches, no blisters, painful and sensitive to air and light touch, heals in 3-4 days, no scarring • Superficial Partial-Thickness Burn (2nd degree): epidermis and papillary dermis, weeping, wet skin, blanches, clear blisters, painful to touch, heals in 2-3 weeks, no scars but pigment changes • Deep Partial-Thickness Burn (2nd degree): epidermis and entire dermis, white, no blanching, bloody blisters, moist skin, very painful to touch, heals in more than 3 weeks, scarring and contractures • Full-Thickness Burn (3rd degree): epidermis, entire dermis, and subcutaneous tissue, charred black, bright red, tan, or pearly white, fragile blisters, dry, leathery, insensate but can feel deep pressure, high risk of contractures, requires skin graft, months to years, body can’t heal on its own • Deep Full-Thickness Burn (4th degree): all skin layers and tendon, muscle, or bone, charred or mummified, eschar (dead skin/tissue), insensate, but can feel deep pressure, difficult to heal, may require amputation, contractures, and functional impairment

Additional Issues

• Burn shock: loss of fluid or plasma in the blood, occurs within 48-72 hours of initial injury, due to loss of fluid or plasma in the blood • Hypermetabolism: prolonged stress response, increase of cytokines, insulin, and catecholamines in the body • Inhalation injury: facial burns, singed nose hair, hoarse voice, wheezing, dark oral mucosa, hypoxia, cough • Scars and contractures: formation begins when the wound begins to close, hypertrophic (raised and red, stay within the borders of burn), keloid (raised and red, tender and painful, extend beyond the borders of the burn) • Treatment: primary goal is oxygenation, ideal oxygen is 100%, interventions: bronchial hygiene therapy, chest PT, airway suctioning, early mobility, mechanical ventilation, escharotomy (slit in the burn to release pressure), toxicities

Orthopedics

• Primary roles of bones: protect and support soft tissue, attachment site for muscles, store minerals, and produce red blood cells in bone marrow.
• Bone growth is influenced by nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones).

Bone Growth and Hormones

• Excess insulin growth hormone (hGH) can lead to gigantism, while a deficiency can cause short stature.
• Hormones involved in bone growth: insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones.

Soft Tissue Basics

• Atrophy: wasting away of muscles due to disuse or denervation (muscle loses nerve connection).
• Hypertrophy: muscles increase in number and diameter.
• Skeletal muscle starts to convert to connective or adipose tissue starting at 30, leading to:
  • Slowing of reflexes
  • Reduction of maximum strength
  • Decreased flexibility with age

Abnormal Contraction

• Spasm: involuntary contraction of a single muscle
• Cramp: painful, spasmodic contraction due to a lack of potassium and/or water
• Tic: involuntary twitch of muscles, often in the face or eyelid
• Tremor: rhythmic, involuntary, purposeless co-contraction of contracting muscles
• Fasciculation: involuntary twitch of multiple motor units, visible beneath the skin, often seen with ASL (Amyotrophic Lateral Sclerosis)
• Fibrillation: involuntary twitch of a single motor unit, not visible beneath the skin

Abnormal Curves of the Spine

• Kyphosis: anterior to posterior thoracic curvature (“hunchback”)
• Lordosis: extreme exaggeration of the lumbar curvature, often seen in pregnant women
• Scoliosis: S-shaped curve in the thoracic spine
• Rotoscoliosis: torsion couple with curve

Etiology

• Causes of orthopedic conditions:
  • Traumatic injuries
  • Sports
  • Falls (leading cause)
  • Rheumatic diseases
  • Aging

Orthopedic Conditions

Rickets

• Cause: lacking calcium and vitamin D in childhood
• Symptoms:
  • Soft bones
  • Deformities of the skull, legs, rib cage, pelvis, and teeth
  • Muscle cramps
  • Stunted growth (epiphyseal plates close too soon)
• Treatment: calcium-rich diet to correct deformities

Osteomalacia

• Cause: lacking calcium and vitamin D in adulthood
• Symptoms:
  • Soft bones
  • Prone to fractures
  • Bone pain in lower extremities
  • Muscle weakness
• Treatment: increased vitamin D in the diet (e.g., from salmon) and increased sun exposure

Paget's Disease

• Cause: unknown, possibly viral, with issues in the recycling process and bone formation
• Symptoms:
  • Excessive bone formation and breakdown
  • Located in the spine, femur, or skull
  • High ratio of spongy to compact bone
• Treatment: calcitonin and bisphosphonates

Osteopenia

• Cause: unknown, possibly genetic, malnourishment, or associated conditions
• Symptoms:
  • Reversible weakening of bone
• Treatment:
  • Calcium-enriched diet and supplements
  • Weight-bearing activities
  • Bone density screens

Osteoporosis

• Cause: progressive osteopenia that is irreversible
• Symptoms:
  • Initially, none
  • Later, pain, kyphosis, height loss, and skeletal dysfunction
• Treatment: none

High-Risk Factors

• Women
• History of falls
• Quadriceps weakness
• Postural instability

Incidence

• 1 in 2 women will have a fracture related to osteoporosis, while 1 in 4 men will have one
• Higher incidence in women due to decreased estrogen during menopause

Heterotopic Ossification

• Cause: unknown, with abnormal bone formation in soft tissues, possibly due to trauma or surgery
• Symptoms:
  • Pain
  • Warmth at the joint
  • Edema
  • Redness
  • Induration (changes to tissues beneath the surface)
  • Decreased range of motion with a bony end feel
• Treatment:
  • Iontophoresis
  • Range of motion
  • Pain management
• Comorbidities: neurological issues

Prevalence

• Elbow fracture: 90% chance of developing HO
• Hip fracture: 50% chance of developing HO
• Only 1/3 of individuals with HO have functional limitations

Spina Bifida

• Cause: birth defect due to incomplete closure of bone/membrane around the spinal cord
• Symptoms:
  • Myelomeningocele: leg weakness/paralysis, orthopedic issues, bladder/bowel issues, neurological issues
  • Meningocele: small sac or gait immobility
  • Occulta: may have no issues

Fractures

• Classification:
  • Bone ends: displaced or nondisplaced
  • Complete or incomplete break
  • Linear or transverse break on the long axis
• Types:
  • Closed (simple): bone does not break the skin
  • Open (compound): bone breaks the skin
  • Transverse: complete, occurs at a right angle to the bone
  • Comminuted: multiple bone fragments
  • Greenstick: incomplete, bend that causes the other side to break off
  • Stress: repetitive use
  • Hairline: incomplete, small
  • Spiral: from torsional force or twisting

Symptoms

• Localized pain at the site
• Deformity
• Edema (swelling)
• Ecchymosis (discoloration, a few days after the incident)

Incidence

• Falls are the leading cause of fractures in older adults
• Falls are the leading cause of nonfatal injuries
• Most common fractures from falls: hip, wrist, and humerus
• 44% of all fractures involve a distal radius

Hip Fractures

• Primary cause of disability and mortality in older adults
• Chance of not returning to baseline after a hip fracture
• Avulsion: possibility of muscle being pulled off the bone

Symptoms

• Referred pain in the knee
• Unable to bear weight on the affected leg
• Leg-length discrepancy

Treatment

• Surgery:
  • Closed reduction and immobilization
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty (replace the femoral neck and head with a metal prosthesis)
  • Total hip replacement (replace the acetabulum and resurface, replace the ball of the femur, lasts 10-25 years)

Precautions

• Hip flexion should not be more than 90 degrees
• No hip rotation
• No hip adduction
• Sleep on back with a pillow between legs
• Keep leg extended when going from sitting to standing

Humeral Fractures

• 20% have a loss of wrist extension or loss of feeling due to damage to the radial nerve
• 70-90% regain function after 4 months

Causes

• Osteoporosis
• Aging
• Injury

Symptoms

• Humeral displacement and location
• Distal end: supracondylar fracture (elbow, can lead to HO)
• Loss of wrist extension and dorsum hand sensation in around 1/5 cases

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Sling
• Immobilization and mobilization schedule varies

Distal Radius Fracture

• Cause: falling on an outstretched hand

Symptoms

• Loss of sensation, strength, and range of motion
• Classified based on articular and/or ulnar involvement, soft tissue involvement, and displacement

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Splint or cast
• Immobilization and mobilization schedule varies based on the physician

Scaphoid Fracture

• Cause: wrist hyperextension greater than 90 degrees and radial deviation, common in sports injuries

Symptoms

• Pain and tenderness that intensify when trying to pinch or grasp objects
• Vascular necrosis

Treatment

• Non-displaced: non-surgical and requires a thumb spica splint for 10 weeks
• Displaced: surgical and requires bolts, screws, and a splint for 2-4 weeks

Post-operative Fracture Considerations

• Edema
• Range of motion and tightness
• Nerve compression (numbness, tingling, decreased function)
• Tendon rupture

Complex Regional Pain Syndrome (CRPS)

• Cause: issues in communication between the limb, brain, and spinal cord
• Must be chronic (longer than 6 months) post-injury affecting one limb
• Symptoms:
  • Burning, throbbing, aching pain
  • Changes in skin color, temperature, and swelling in the affected area
• Types:
  • CRPS-I: no confirmed nerve injury
  • CRPS-II: known nerve involvement### Shoulder and Chest Muscles
• Weakened shoulder and chest muscles can cause the clavicle to slip down, compressing blood vessels and nerves in the superior thoracic outlet.
• Symptoms: pain in shoulders and neck, numbness and tingling, and coldness in fingers, weakened grip, thumb atrophy.
• Non-surgical treatment: rest, activity modification, OT/PT.
• Surgical treatment: anatomical difference, muscle is cut away to make more space; may cause brachial plexus injury.

Elbow

Medial Epicondylitis (Golfer's Elbow)

• Cause: inflammation of medial tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, radiating pain from medial elbow down forearm, weakness, pain, stiffness.
• Treatment: NSAIDs, rest, ice, ROM, taping, OT/PT.
• Risks: playing throwing sports, playing instrument, painting.
• Triggers: shaking hands, turning doorknob, picking up object with palm down.

Lateral Epicondylitis (Tennis Elbow)

• Cause: inflammation of lateral tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, pain or burning on lateral side of elbow, weak grip strength.
• Treatment: NSAIDs, rest, ice, ROM, brace, steroid injections, OT/PT.
• Risks: plumbers, carpenters, painters, mechanics, chefs, butchers.
• Triggers: shaking hands, turning wrench, holding racket/garden hose.

Ulnar Collateral Ligament (UCL) Rupture

• Cause: repetitive use, fall on outstretched arm.
• Symptoms: pain at medial elbow, "pop" after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers.
• Treatment: Non-surgical: NSAIDs, ice, rest.
• Surgical: Tommy John Surgery, takes tendon from somewhere else.
• Types: Partial or complete (pain in medial part of elbow).

Posterior Olecranon Osteophyte

• Cause: formation of bone spurs on posterior olecranon.
• Symptoms: pain in elbow with no mechanism of injury, decreased ROM, catching or locking of elbow joint with movement.
• Treatment: Surgery to remove bone spurs and debridement of osteophytes, PT/OT.
• Risks: manual labor jobs, athletes.

Elbow Dislocation

• Cause: fall on outstretched arm.
• Symptoms: Partial - pain with ROM, "shifting", tingling/numbness.
• Symptoms: Complete - deformity, extreme pain, NO ROM (arm can't flex or extend).
• Treatment: Non-surgical - relocation and possible immobilization.
• Surgical - repair ligaments, external hinge.
• Types: Partial - relocates on its own; Complete - does not relocate on its own; has to be manually set.

Radial Head Fracture

• Cause: fall on outstretched arm or in conjunction with elbow fx, damage to the bone itself.
• Symptoms: pain on lateral elbow, swelling, decreased ROM, decreased supination & pronation.
• Treatment: Type I - non-surgical, rest + sling for days; Type II - surgery to remove bone fragments + sling for weeks; Type III - surgery to remove bone & repair ligaments + OT/PT.

Olecranon Bursitis

• Cause: direct injury, prolonged pressure, infection, other medical problems (gout, RA).
• Symptoms: painful elbow, edema, redness, warm skin.
• Treatment: Non-surgical - antibiotics for infection; suck out fluid; modify activities, NSAIDs.
• Surgical - takes bursa out, use splint.
• Risks: jobs or activities that require prolonged prop on elbows; elbow arthritis.

Elbow Arthritis

• Cause: breakdown of cartilage on articulating surfaces of bones.
• Symptoms: pain, decreased ROM, locking/grating sensation, edema.
• Treatment: Non-surgical - NSAIDs, OT/PT, corticosteroids.
• Surgical - arthroscopy or joint replacement.

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

• Cause: subluxed nerve, prolonged pressure, swelling, direct injury; ulnar nerve gets pinched/trapped.
• Symptoms: pain, numbness in elbow, hand or wrist, weakened grip, atrophy of hand musculature, reduced FM coordination.
• Treatment: Non-surgical - special pillow, brace, NSAIDs.
• Surgical - cubital tunnel release, transposition ulnar nerve, medial epicondylectomy.

Wrist and Hand Orthopedics

Pediatric Deformities

• 1/20 kids are born with orthopedic differences in their hand.
• Syndactyly: some fingers/toes united; webbing.
• Thumb duplication: second complete or partial thumb.
• Hypoplastic thumb: thumb is underdeveloped.
• Radial club hand: wrist radial deviation; missing all or part of fingers.
• Failure of formation of upper limb.

Radiocarpal Joint Disorders

Carpal Tunnel Syndrome

• Cause: increased pressure or entrapment of the median nerve at wrist; genetics, pregnancy.
• Symptoms: numbness, tingling, and pain in fingers, hand and arm; gradual onset, often complaints at night, lose proprioception and can't realize what their hand is doing.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - NSAIDs, bracing/splinting, steroids, activity modifications, nerve glides.
• Surgical - cut the ligament to create more space.
• Risks: repetitive hand use, hand/wrist positioning, pregnancy, genes.

De Quervain's Tenosynovitis

• Cause: overuse of wrist causes irritation of sheath around APL and EPB tendons to your thumb, or scar tissue; comorbid with rheumatoid arthritis.
• Symptoms: pain and swelling at base of thumb, deceased thumb movement, trouble grasping objects.
• Assessment: Positive Finkelstein Test.
• Treatment: Non-surgical - NSAIDs, splint full time, steroids, activity modifications, ice/heat.
• Surgical - cut sheath around tendon, then OT/PT.
• Risks: child rearing, pregnancy, carpenter, mechanic.

Ganglion Cysts

• Cause: unknown.
• Symptoms: small lump, painless, noncancerous lump often by tendons/joints in wrist or hand, becomes painful when a nerve is compressed.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - typically resolves on its own.
• Surgical - may need to be drained or removed.

MCP Joint Disorders

• Swan-Neck Deformity: MCP joint flexed, PIP joint extended, DIP joint flexed (not seen in the thumb because there aren't three joints).
• Cause: rheumatoid arthritis.
• Symptoms: mallet finger at DIP, limited mobility, pain.
• Treatment: Non-surgical - splinting, HEP, ROM, OT/PT, NSAIDs.
• Surgical - soft tissue surgery or finger joint fusion for stability.
• Boutonniere Deformity: MCP joint extended, PIP joint flexed, DIP joint extended (not seen in the thumb because there aren't three joints).
• Cause: forceful blow to dorsum of bent PIP or slicing of central slip tendon, arthritis.
• Symptoms: PIP can't be straightened, DIP can't be bent, swelling & pain at PIP.
• Treatment: Non-surgical - splinting, HEP.
• Surgical - if there is a tendon that is severed or a compound fracture or splinting doesn't work.

Dupuytren Contracture

• Cause: unknown, but something triggers the fascia of the palm to thicken and it eventually tightens, reducing hand function.
• Symptoms: lumps, nodules, and cords which leads to contractures that pull fingers inward, toward the palm.
• Treatment: Non-surgical - splinting, steroids.
• Surgical - fasciotomy or subtotal palmar fasciectomy.
• Risks: diabetes, alcoholism, epilepsy.

---

(Note: This is a long response, and I've tried to format it to make it easier to read. Let me know if you'd like me to make any changes!)### Rheumatoid Arthritis (RA)

• Goals of treatment: reduce pain and joint stiffness, reduce edema, preserve normal joint function and musculature, minimize medication interactions, promote normal growth and development, maintain ADL independence • Disease process: + Acute: fever, decreased range of motion and strength, stiffness, gel phenomenon, weight loss + Subacute: mild fever, decreased range of motion and strength, morning stiffness, decreased endurance, gel phenomenon + Chronic active: decreased range of motion, strength, poor endurance + Chronic inactive: decreased range of motion, muscle atrophy, worse endurance, contractures • Treatment: NSAIDs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Osteoarthritis (OA)

• Cause: genetics and environmental, aging, chondropenia (lose cartilage faster than the body can replace it), non-inflammatory • Symptoms: localized pain, palpable edema, point tenderness, stiffness, inflammation of bones and joints, asymmetrical involvement, weight-bearing joints and hands most affected, crepitus during ROM • Prevalence: 10-15% worldwide • Assessment: patient history, MRI/x-ray, leg length discrepancy, anatomical bony abnormalities • Onset: gradually over years • Types: primary (general wear and tear, no known cause), secondary (external injury or disease) • Prognosis: “silent” or traumatic, joint location • Treatment: NSAIDs, CINODs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Fibromyalgia

• Cause: unknown • Symptoms: widespread chronic severe pain, tender points, no inflammation, headaches, malaise, poor sleep, abdominal cramps, mood disorder, from the waist up • Prevalence: 1-5% worldwide, women more affected than men (US is 3:1) • Assessment: patient history, physical examination, no genetic or blood test can be done, WPI and SSS scores • Onset: widespread or unilateral, can start unilateral then go bilateral • Types: unilateral or bilateral • Prognosis: unclear • Treatment: NSAIDs, opioids, antidepressants • Risks: aging • Comorbidities: OA, RA, depression

Gout

• Cause: crystallization and buildup of uric acid in the joint (hyperuricemia) • Symptoms: rapid onset, joint-specific pain, warmth, swelling, reddish discoloration, tenderness, “attacks” that last hours to days, intermittent, tophi • Prevalence: 1-4% worldwide, 8.3 million in US • Assessment: medical history, physical exam, blood work, MRI/x-ray/CT • Onset: 30-50 years old • Types: most common in big toe, 1st metatarsal • Treatment: diet low in purines, NSAIDs, xanthine oxidase inhibitors (XOI), comprehensive planning (diet) • Risks: men, African American • Comorbidities: insulin resistance syndrome, hypertension, renal damage, depression

Burns

Skin Anatomy

• Epidermis: thin, nonvascularized, epithelial cells, 25% of skin, top layer, body temperature regulation, erection of waste, makes vitamin D • Dermis: 75% of skin, blood vessels, hair follicles, sweat glands, nerve endings, barrier for bacteria, prevents moisture loss • Subcutaneous tissue: fat, below dermis

Wound Healing Process

1. Hemostasis: stop bleeding (clot)
2. Inflammatory: cells come to clean up the wound
3. Proliferative: a. Connective tissue deposits b. Contraction (rebuild tissue) c. Epithelium is rebuilt
4. Maturation: collagen reorganizes itself

Zones of Burns

• Coagulation: brunt of the heat, innermost, most damage, irreversible • Stasis: decreased perfusion, surrounding coagulation, moderate damage, can be saved but effort is needed • Hyperemia: decreased perfusion, outermost, minimal damage, has potential to survive

Types of Burns

• Superficial Burn (1st degree): epidermis only, redness, dry, blanches, no blisters, painful and sensitive to air and light touch, heals in 3-4 days, no scarring • Superficial Partial-Thickness Burn (2nd degree): epidermis and papillary dermis, weeping, wet skin, blanches, clear blisters, painful to touch, heals in 2-3 weeks, no scars but pigment changes • Deep Partial-Thickness Burn (2nd degree): epidermis and entire dermis, white, no blanching, bloody blisters, moist skin, very painful to touch, heals in more than 3 weeks, scarring and contractures • Full-Thickness Burn (3rd degree): epidermis, entire dermis, and subcutaneous tissue, charred black, bright red, tan, or pearly white, fragile blisters, dry, leathery, insensate but can feel deep pressure, high risk of contractures, requires skin graft, months to years, body can’t heal on its own • Deep Full-Thickness Burn (4th degree): all skin layers and tendon, muscle, or bone, charred or mummified, eschar (dead skin/tissue), insensate, but can feel deep pressure, difficult to heal, may require amputation, contractures, and functional impairment

Additional Issues

• Burn shock: loss of fluid or plasma in the blood, occurs within 48-72 hours of initial injury, due to loss of fluid or plasma in the blood • Hypermetabolism: prolonged stress response, increase of cytokines, insulin, and catecholamines in the body • Inhalation injury: facial burns, singed nose hair, hoarse voice, wheezing, dark oral mucosa, hypoxia, cough • Scars and contractures: formation begins when the wound begins to close, hypertrophic (raised and red, stay within the borders of burn), keloid (raised and red, tender and painful, extend beyond the borders of the burn) • Treatment: primary goal is oxygenation, ideal oxygen is 100%, interventions: bronchial hygiene therapy, chest PT, airway suctioning, early mobility, mechanical ventilation, escharotomy (slit in the burn to release pressure), toxicities

Orthopedics

• Primary roles of bones: protect and support soft tissue, attachment site for muscles, store minerals, and produce red blood cells in bone marrow.
• Bone growth is influenced by nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones).

Bone Growth and Hormones

• Excess insulin growth hormone (hGH) can lead to gigantism, while a deficiency can cause short stature.
• Hormones involved in bone growth: insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones.

Soft Tissue Basics

• Atrophy: wasting away of muscles due to disuse or denervation (muscle loses nerve connection).
• Hypertrophy: muscles increase in number and diameter.
• Skeletal muscle starts to convert to connective or adipose tissue starting at 30, leading to:
  • Slowing of reflexes
  • Reduction of maximum strength
  • Decreased flexibility with age

Abnormal Contraction

• Spasm: involuntary contraction of a single muscle
• Cramp: painful, spasmodic contraction due to a lack of potassium and/or water
• Tic: involuntary twitch of muscles, often in the face or eyelid
• Tremor: rhythmic, involuntary, purposeless co-contraction of contracting muscles
• Fasciculation: involuntary twitch of multiple motor units, visible beneath the skin, often seen with ASL (Amyotrophic Lateral Sclerosis)
• Fibrillation: involuntary twitch of a single motor unit, not visible beneath the skin

Abnormal Curves of the Spine

• Kyphosis: anterior to posterior thoracic curvature (“hunchback”)
• Lordosis: extreme exaggeration of the lumbar curvature, often seen in pregnant women
• Scoliosis: S-shaped curve in the thoracic spine
• Rotoscoliosis: torsion couple with curve

Etiology

• Causes of orthopedic conditions:
  • Traumatic injuries
  • Sports
  • Falls (leading cause)
  • Rheumatic diseases
  • Aging

Orthopedic Conditions

Rickets

• Cause: lacking calcium and vitamin D in childhood
• Symptoms:
  • Soft bones
  • Deformities of the skull, legs, rib cage, pelvis, and teeth
  • Muscle cramps
  • Stunted growth (epiphyseal plates close too soon)
• Treatment: calcium-rich diet to correct deformities

Osteomalacia

• Cause: lacking calcium and vitamin D in adulthood
• Symptoms:
  • Soft bones
  • Prone to fractures
  • Bone pain in lower extremities
  • Muscle weakness
• Treatment: increased vitamin D in the diet (e.g., from salmon) and increased sun exposure

Paget's Disease

• Cause: unknown, possibly viral, with issues in the recycling process and bone formation
• Symptoms:
  • Excessive bone formation and breakdown
  • Located in the spine, femur, or skull
  • High ratio of spongy to compact bone
• Treatment: calcitonin and bisphosphonates

Osteopenia

• Cause: unknown, possibly genetic, malnourishment, or associated conditions
• Symptoms:
  • Reversible weakening of bone
• Treatment:
  • Calcium-enriched diet and supplements
  • Weight-bearing activities
  • Bone density screens

Osteoporosis

• Cause: progressive osteopenia that is irreversible
• Symptoms:
  • Initially, none
  • Later, pain, kyphosis, height loss, and skeletal dysfunction
• Treatment: none

High-Risk Factors

• Women
• History of falls
• Quadriceps weakness
• Postural instability

Incidence

• 1 in 2 women will have a fracture related to osteoporosis, while 1 in 4 men will have one
• Higher incidence in women due to decreased estrogen during menopause

Heterotopic Ossification

• Cause: unknown, with abnormal bone formation in soft tissues, possibly due to trauma or surgery
• Symptoms:
  • Pain
  • Warmth at the joint
  • Edema
  • Redness
  • Induration (changes to tissues beneath the surface)
  • Decreased range of motion with a bony end feel
• Treatment:
  • Iontophoresis
  • Range of motion
  • Pain management
• Comorbidities: neurological issues

Prevalence

• Elbow fracture: 90% chance of developing HO
• Hip fracture: 50% chance of developing HO
• Only 1/3 of individuals with HO have functional limitations

Spina Bifida

• Cause: birth defect due to incomplete closure of bone/membrane around the spinal cord
• Symptoms:
  • Myelomeningocele: leg weakness/paralysis, orthopedic issues, bladder/bowel issues, neurological issues
  • Meningocele: small sac or gait immobility
  • Occulta: may have no issues

Fractures

• Classification:
  • Bone ends: displaced or nondisplaced
  • Complete or incomplete break
  • Linear or transverse break on the long axis
• Types:
  • Closed (simple): bone does not break the skin
  • Open (compound): bone breaks the skin
  • Transverse: complete, occurs at a right angle to the bone
  • Comminuted: multiple bone fragments
  • Greenstick: incomplete, bend that causes the other side to break off
  • Stress: repetitive use
  • Hairline: incomplete, small
  • Spiral: from torsional force or twisting

Symptoms

• Localized pain at the site
• Deformity
• Edema (swelling)
• Ecchymosis (discoloration, a few days after the incident)

Incidence

• Falls are the leading cause of fractures in older adults
• Falls are the leading cause of nonfatal injuries
• Most common fractures from falls: hip, wrist, and humerus
• 44% of all fractures involve a distal radius

Hip Fractures

• Primary cause of disability and mortality in older adults
• Chance of not returning to baseline after a hip fracture
• Avulsion: possibility of muscle being pulled off the bone

Symptoms

• Referred pain in the knee
• Unable to bear weight on the affected leg
• Leg-length discrepancy

Treatment

• Surgery:
  • Closed reduction and immobilization
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty (replace the femoral neck and head with a metal prosthesis)
  • Total hip replacement (replace the acetabulum and resurface, replace the ball of the femur, lasts 10-25 years)

Precautions

• Hip flexion should not be more than 90 degrees
• No hip rotation
• No hip adduction
• Sleep on back with a pillow between legs
• Keep leg extended when going from sitting to standing

Humeral Fractures

• 20% have a loss of wrist extension or loss of feeling due to damage to the radial nerve
• 70-90% regain function after 4 months

Causes

• Osteoporosis
• Aging
• Injury

Symptoms

• Humeral displacement and location
• Distal end: supracondylar fracture (elbow, can lead to HO)
• Loss of wrist extension and dorsum hand sensation in around 1/5 cases

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Sling
• Immobilization and mobilization schedule varies

Distal Radius Fracture

• Cause: falling on an outstretched hand

Symptoms

• Loss of sensation, strength, and range of motion
• Classified based on articular and/or ulnar involvement, soft tissue involvement, and displacement

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Splint or cast
• Immobilization and mobilization schedule varies based on the physician

Scaphoid Fracture

• Cause: wrist hyperextension greater than 90 degrees and radial deviation, common in sports injuries

Symptoms

• Pain and tenderness that intensify when trying to pinch or grasp objects
• Vascular necrosis

Treatment

• Non-displaced: non-surgical and requires a thumb spica splint for 10 weeks
• Displaced: surgical and requires bolts, screws, and a splint for 2-4 weeks

Post-operative Fracture Considerations

• Edema
• Range of motion and tightness
• Nerve compression (numbness, tingling, decreased function)
• Tendon rupture

Complex Regional Pain Syndrome (CRPS)

• Cause: issues in communication between the limb, brain, and spinal cord
• Must be chronic (longer than 6 months) post-injury affecting one limb
• Symptoms:
  • Burning, throbbing, aching pain
  • Changes in skin color, temperature, and swelling in the affected area
• Types:
  • CRPS-I: no confirmed nerve injury
  • CRPS-II: known nerve involvement### Shoulder and Chest Muscles
• Weakened shoulder and chest muscles can cause the clavicle to slip down, compressing blood vessels and nerves in the superior thoracic outlet.
• Symptoms: pain in shoulders and neck, numbness and tingling, and coldness in fingers, weakened grip, thumb atrophy.
• Non-surgical treatment: rest, activity modification, OT/PT.
• Surgical treatment: anatomical difference, muscle is cut away to make more space; may cause brachial plexus injury.

Elbow

Medial Epicondylitis (Golfer's Elbow)

• Cause: inflammation of medial tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, radiating pain from medial elbow down forearm, weakness, pain, stiffness.
• Treatment: NSAIDs, rest, ice, ROM, taping, OT/PT.
• Risks: playing throwing sports, playing instrument, painting.
• Triggers: shaking hands, turning doorknob, picking up object with palm down.

Lateral Epicondylitis (Tennis Elbow)

• Cause: inflammation of lateral tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, pain or burning on lateral side of elbow, weak grip strength.
• Treatment: NSAIDs, rest, ice, ROM, brace, steroid injections, OT/PT.
• Risks: plumbers, carpenters, painters, mechanics, chefs, butchers.
• Triggers: shaking hands, turning wrench, holding racket/garden hose.

Ulnar Collateral Ligament (UCL) Rupture

• Cause: repetitive use, fall on outstretched arm.
• Symptoms: pain at medial elbow, "pop" after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers.
• Treatment: Non-surgical: NSAIDs, ice, rest.
• Surgical: Tommy John Surgery, takes tendon from somewhere else.
• Types: Partial or complete (pain in medial part of elbow).

Posterior Olecranon Osteophyte

• Cause: formation of bone spurs on posterior olecranon.
• Symptoms: pain in elbow with no mechanism of injury, decreased ROM, catching or locking of elbow joint with movement.
• Treatment: Surgery to remove bone spurs and debridement of osteophytes, PT/OT.
• Risks: manual labor jobs, athletes.

Elbow Dislocation

• Cause: fall on outstretched arm.
• Symptoms: Partial - pain with ROM, "shifting", tingling/numbness.
• Symptoms: Complete - deformity, extreme pain, NO ROM (arm can't flex or extend).
• Treatment: Non-surgical - relocation and possible immobilization.
• Surgical - repair ligaments, external hinge.
• Types: Partial - relocates on its own; Complete - does not relocate on its own; has to be manually set.

Radial Head Fracture

• Cause: fall on outstretched arm or in conjunction with elbow fx, damage to the bone itself.
• Symptoms: pain on lateral elbow, swelling, decreased ROM, decreased supination & pronation.
• Treatment: Type I - non-surgical, rest + sling for days; Type II - surgery to remove bone fragments + sling for weeks; Type III - surgery to remove bone & repair ligaments + OT/PT.

Olecranon Bursitis

• Cause: direct injury, prolonged pressure, infection, other medical problems (gout, RA).
• Symptoms: painful elbow, edema, redness, warm skin.
• Treatment: Non-surgical - antibiotics for infection; suck out fluid; modify activities, NSAIDs.
• Surgical - takes bursa out, use splint.
• Risks: jobs or activities that require prolonged prop on elbows; elbow arthritis.

Elbow Arthritis

• Cause: breakdown of cartilage on articulating surfaces of bones.
• Symptoms: pain, decreased ROM, locking/grating sensation, edema.
• Treatment: Non-surgical - NSAIDs, OT/PT, corticosteroids.
• Surgical - arthroscopy or joint replacement.

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

• Cause: subluxed nerve, prolonged pressure, swelling, direct injury; ulnar nerve gets pinched/trapped.
• Symptoms: pain, numbness in elbow, hand or wrist, weakened grip, atrophy of hand musculature, reduced FM coordination.
• Treatment: Non-surgical - special pillow, brace, NSAIDs.
• Surgical - cubital tunnel release, transposition ulnar nerve, medial epicondylectomy.

Wrist and Hand Orthopedics

Pediatric Deformities

• 1/20 kids are born with orthopedic differences in their hand.
• Syndactyly: some fingers/toes united; webbing.
• Thumb duplication: second complete or partial thumb.
• Hypoplastic thumb: thumb is underdeveloped.
• Radial club hand: wrist radial deviation; missing all or part of fingers.
• Failure of formation of upper limb.

Radiocarpal Joint Disorders

Carpal Tunnel Syndrome

• Cause: increased pressure or entrapment of the median nerve at wrist; genetics, pregnancy.
• Symptoms: numbness, tingling, and pain in fingers, hand and arm; gradual onset, often complaints at night, lose proprioception and can't realize what their hand is doing.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - NSAIDs, bracing/splinting, steroids, activity modifications, nerve glides.
• Surgical - cut the ligament to create more space.
• Risks: repetitive hand use, hand/wrist positioning, pregnancy, genes.

De Quervain's Tenosynovitis

• Cause: overuse of wrist causes irritation of sheath around APL and EPB tendons to your thumb, or scar tissue; comorbid with rheumatoid arthritis.
• Symptoms: pain and swelling at base of thumb, deceased thumb movement, trouble grasping objects.
• Assessment: Positive Finkelstein Test.
• Treatment: Non-surgical - NSAIDs, splint full time, steroids, activity modifications, ice/heat.
• Surgical - cut sheath around tendon, then OT/PT.
• Risks: child rearing, pregnancy, carpenter, mechanic.

Ganglion Cysts

• Cause: unknown.
• Symptoms: small lump, painless, noncancerous lump often by tendons/joints in wrist or hand, becomes painful when a nerve is compressed.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - typically resolves on its own.
• Surgical - may need to be drained or removed.

MCP Joint Disorders

• Swan-Neck Deformity: MCP joint flexed, PIP joint extended, DIP joint flexed (not seen in the thumb because there aren't three joints).
• Cause: rheumatoid arthritis.
• Symptoms: mallet finger at DIP, limited mobility, pain.
• Treatment: Non-surgical - splinting, HEP, ROM, OT/PT, NSAIDs.
• Surgical - soft tissue surgery or finger joint fusion for stability.
• Boutonniere Deformity: MCP joint extended, PIP joint flexed, DIP joint extended (not seen in the thumb because there aren't three joints).
• Cause: forceful blow to dorsum of bent PIP or slicing of central slip tendon, arthritis.
• Symptoms: PIP can't be straightened, DIP can't be bent, swelling & pain at PIP.
• Treatment: Non-surgical - splinting, HEP.
• Surgical - if there is a tendon that is severed or a compound fracture or splinting doesn't work.

Dupuytren Contracture

• Cause: unknown, but something triggers the fascia of the palm to thicken and it eventually tightens, reducing hand function.
• Symptoms: lumps, nodules, and cords which leads to contractures that pull fingers inward, toward the palm.
• Treatment: Non-surgical - splinting, steroids.
• Surgical - fasciotomy or subtotal palmar fasciectomy.
• Risks: diabetes, alcoholism, epilepsy.

---

(Note: This is a long response, and I've tried to format it to make it easier to read. Let me know if you'd like me to make any changes!)### Rheumatoid Arthritis (RA)

• Goals of treatment: reduce pain and joint stiffness, reduce edema, preserve normal joint function and musculature, minimize medication interactions, promote normal growth and development, maintain ADL independence • Disease process: + Acute: fever, decreased range of motion and strength, stiffness, gel phenomenon, weight loss + Subacute: mild fever, decreased range of motion and strength, morning stiffness, decreased endurance, gel phenomenon + Chronic active: decreased range of motion, strength, poor endurance + Chronic inactive: decreased range of motion, muscle atrophy, worse endurance, contractures • Treatment: NSAIDs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Osteoarthritis (OA)

• Cause: genetics and environmental, aging, chondropenia (lose cartilage faster than the body can replace it), non-inflammatory • Symptoms: localized pain, palpable edema, point tenderness, stiffness, inflammation of bones and joints, asymmetrical involvement, weight-bearing joints and hands most affected, crepitus during ROM • Prevalence: 10-15% worldwide • Assessment: patient history, MRI/x-ray, leg length discrepancy, anatomical bony abnormalities • Onset: gradually over years • Types: primary (general wear and tear, no known cause), secondary (external injury or disease) • Prognosis: “silent” or traumatic, joint location • Treatment: NSAIDs, CINODs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Fibromyalgia

• Cause: unknown • Symptoms: widespread chronic severe pain, tender points, no inflammation, headaches, malaise, poor sleep, abdominal cramps, mood disorder, from the waist up • Prevalence: 1-5% worldwide, women more affected than men (US is 3:1) • Assessment: patient history, physical examination, no genetic or blood test can be done, WPI and SSS scores • Onset: widespread or unilateral, can start unilateral then go bilateral • Types: unilateral or bilateral • Prognosis: unclear • Treatment: NSAIDs, opioids, antidepressants • Risks: aging • Comorbidities: OA, RA, depression

Gout

• Cause: crystallization and buildup of uric acid in the joint (hyperuricemia) • Symptoms: rapid onset, joint-specific pain, warmth, swelling, reddish discoloration, tenderness, “attacks” that last hours to days, intermittent, tophi • Prevalence: 1-4% worldwide, 8.3 million in US • Assessment: medical history, physical exam, blood work, MRI/x-ray/CT • Onset: 30-50 years old • Types: most common in big toe, 1st metatarsal • Treatment: diet low in purines, NSAIDs, xanthine oxidase inhibitors (XOI), comprehensive planning (diet) • Risks: men, African American • Comorbidities: insulin resistance syndrome, hypertension, renal damage, depression

Burns

Skin Anatomy

• Epidermis: thin, nonvascularized, epithelial cells, 25% of skin, top layer, body temperature regulation, erection of waste, makes vitamin D • Dermis: 75% of skin, blood vessels, hair follicles, sweat glands, nerve endings, barrier for bacteria, prevents moisture loss • Subcutaneous tissue: fat, below dermis

Wound Healing Process

1. Hemostasis: stop bleeding (clot)
2. Inflammatory: cells come to clean up the wound
3. Proliferative: a. Connective tissue deposits b. Contraction (rebuild tissue) c. Epithelium is rebuilt
4. Maturation: collagen reorganizes itself

Zones of Burns

• Coagulation: brunt of the heat, innermost, most damage, irreversible • Stasis: decreased perfusion, surrounding coagulation, moderate damage, can be saved but effort is needed • Hyperemia: decreased perfusion, outermost, minimal damage, has potential to survive

Types of Burns

• Superficial Burn (1st degree): epidermis only, redness, dry, blanches, no blisters, painful and sensitive to air and light touch, heals in 3-4 days, no scarring • Superficial Partial-Thickness Burn (2nd degree): epidermis and papillary dermis, weeping, wet skin, blanches, clear blisters, painful to touch, heals in 2-3 weeks, no scars but pigment changes • Deep Partial-Thickness Burn (2nd degree): epidermis and entire dermis, white, no blanching, bloody blisters, moist skin, very painful to touch, heals in more than 3 weeks, scarring and contractures • Full-Thickness Burn (3rd degree): epidermis, entire dermis, and subcutaneous tissue, charred black, bright red, tan, or pearly white, fragile blisters, dry, leathery, insensate but can feel deep pressure, high risk of contractures, requires skin graft, months to years, body can’t heal on its own • Deep Full-Thickness Burn (4th degree): all skin layers and tendon, muscle, or bone, charred or mummified, eschar (dead skin/tissue), insensate, but can feel deep pressure, difficult to heal, may require amputation, contractures, and functional impairment

Additional Issues

• Burn shock: loss of fluid or plasma in the blood, occurs within 48-72 hours of initial injury, due to loss of fluid or plasma in the blood • Hypermetabolism: prolonged stress response, increase of cytokines, insulin, and catecholamines in the body • Inhalation injury: facial burns, singed nose hair, hoarse voice, wheezing, dark oral mucosa, hypoxia, cough • Scars and contractures: formation begins when the wound begins to close, hypertrophic (raised and red, stay within the borders of burn), keloid (raised and red, tender and painful, extend beyond the borders of the burn) • Treatment: primary goal is oxygenation, ideal oxygen is 100%, interventions: bronchial hygiene therapy, chest PT, airway suctioning, early mobility, mechanical ventilation, escharotomy (slit in the burn to release pressure), toxicities

Orthopedics

• Primary roles of bones: protect and support soft tissue, attachment site for muscles, store minerals, and produce red blood cells in bone marrow.
• Bone growth is influenced by nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones).

Bone Growth and Hormones

• Excess insulin growth hormone (hGH) can lead to gigantism, while a deficiency can cause short stature.
• Hormones involved in bone growth: insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones.

Soft Tissue Basics

• Atrophy: wasting away of muscles due to disuse or denervation (muscle loses nerve connection).
• Hypertrophy: muscles increase in number and diameter.
• Skeletal muscle starts to convert to connective or adipose tissue starting at 30, leading to:
  • Slowing of reflexes
  • Reduction of maximum strength
  • Decreased flexibility with age

Abnormal Contraction

• Spasm: involuntary contraction of a single muscle
• Cramp: painful, spasmodic contraction due to a lack of potassium and/or water
• Tic: involuntary twitch of muscles, often in the face or eyelid
• Tremor: rhythmic, involuntary, purposeless co-contraction of contracting muscles
• Fasciculation: involuntary twitch of multiple motor units, visible beneath the skin, often seen with ASL (Amyotrophic Lateral Sclerosis)
• Fibrillation: involuntary twitch of a single motor unit, not visible beneath the skin

Abnormal Curves of the Spine

• Kyphosis: anterior to posterior thoracic curvature (“hunchback”)
• Lordosis: extreme exaggeration of the lumbar curvature, often seen in pregnant women
• Scoliosis: S-shaped curve in the thoracic spine
• Rotoscoliosis: torsion couple with curve

Etiology

• Causes of orthopedic conditions:
  • Traumatic injuries
  • Sports
  • Falls (leading cause)
  • Rheumatic diseases
  • Aging

Orthopedic Conditions

Rickets

• Cause: lacking calcium and vitamin D in childhood
• Symptoms:
  • Soft bones
  • Deformities of the skull, legs, rib cage, pelvis, and teeth
  • Muscle cramps
  • Stunted growth (epiphyseal plates close too soon)
• Treatment: calcium-rich diet to correct deformities

Osteomalacia

• Cause: lacking calcium and vitamin D in adulthood
• Symptoms:
  • Soft bones
  • Prone to fractures
  • Bone pain in lower extremities
  • Muscle weakness
• Treatment: increased vitamin D in the diet (e.g., from salmon) and increased sun exposure

Paget's Disease

• Cause: unknown, possibly viral, with issues in the recycling process and bone formation
• Symptoms:
  • Excessive bone formation and breakdown
  • Located in the spine, femur, or skull
  • High ratio of spongy to compact bone
• Treatment: calcitonin and bisphosphonates

Osteopenia

• Cause: unknown, possibly genetic, malnourishment, or associated conditions
• Symptoms:
  • Reversible weakening of bone
• Treatment:
  • Calcium-enriched diet and supplements
  • Weight-bearing activities
  • Bone density screens

Osteoporosis

• Cause: progressive osteopenia that is irreversible
• Symptoms:
  • Initially, none
  • Later, pain, kyphosis, height loss, and skeletal dysfunction
• Treatment: none

High-Risk Factors

• Women
• History of falls
• Quadriceps weakness
• Postural instability

Incidence

• 1 in 2 women will have a fracture related to osteoporosis, while 1 in 4 men will have one
• Higher incidence in women due to decreased estrogen during menopause

Heterotopic Ossification

• Cause: unknown, with abnormal bone formation in soft tissues, possibly due to trauma or surgery
• Symptoms:
  • Pain
  • Warmth at the joint
  • Edema
  • Redness
  • Induration (changes to tissues beneath the surface)
  • Decreased range of motion with a bony end feel
• Treatment:
  • Iontophoresis
  • Range of motion
  • Pain management
• Comorbidities: neurological issues

Prevalence

• Elbow fracture: 90% chance of developing HO
• Hip fracture: 50% chance of developing HO
• Only 1/3 of individuals with HO have functional limitations

Spina Bifida

• Cause: birth defect due to incomplete closure of bone/membrane around the spinal cord
• Symptoms:
  • Myelomeningocele: leg weakness/paralysis, orthopedic issues, bladder/bowel issues, neurological issues
  • Meningocele: small sac or gait immobility
  • Occulta: may have no issues

Fractures

• Classification:
  • Bone ends: displaced or nondisplaced
  • Complete or incomplete break
  • Linear or transverse break on the long axis
• Types:
  • Closed (simple): bone does not break the skin
  • Open (compound): bone breaks the skin
  • Transverse: complete, occurs at a right angle to the bone
  • Comminuted: multiple bone fragments
  • Greenstick: incomplete, bend that causes the other side to break off
  • Stress: repetitive use
  • Hairline: incomplete, small
  • Spiral: from torsional force or twisting

Symptoms

• Localized pain at the site
• Deformity
• Edema (swelling)
• Ecchymosis (discoloration, a few days after the incident)

Incidence

• Falls are the leading cause of fractures in older adults
• Falls are the leading cause of nonfatal injuries
• Most common fractures from falls: hip, wrist, and humerus
• 44% of all fractures involve a distal radius

Hip Fractures

• Primary cause of disability and mortality in older adults
• Chance of not returning to baseline after a hip fracture
• Avulsion: possibility of muscle being pulled off the bone

Symptoms

• Referred pain in the knee
• Unable to bear weight on the affected leg
• Leg-length discrepancy

Treatment

• Surgery:
  • Closed reduction and immobilization
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty (replace the femoral neck and head with a metal prosthesis)
  • Total hip replacement (replace the acetabulum and resurface, replace the ball of the femur, lasts 10-25 years)

Precautions

• Hip flexion should not be more than 90 degrees
• No hip rotation
• No hip adduction
• Sleep on back with a pillow between legs
• Keep leg extended when going from sitting to standing

Humeral Fractures

• 20% have a loss of wrist extension or loss of feeling due to damage to the radial nerve
• 70-90% regain function after 4 months

Causes

• Osteoporosis
• Aging
• Injury

Symptoms

• Humeral displacement and location
• Distal end: supracondylar fracture (elbow, can lead to HO)
• Loss of wrist extension and dorsum hand sensation in around 1/5 cases

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Sling
• Immobilization and mobilization schedule varies

Distal Radius Fracture

• Cause: falling on an outstretched hand

Symptoms

• Loss of sensation, strength, and range of motion
• Classified based on articular and/or ulnar involvement, soft tissue involvement, and displacement

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Splint or cast
• Immobilization and mobilization schedule varies based on the physician

Scaphoid Fracture

• Cause: wrist hyperextension greater than 90 degrees and radial deviation, common in sports injuries

Symptoms

• Pain and tenderness that intensify when trying to pinch or grasp objects
• Vascular necrosis

Treatment

• Non-displaced: non-surgical and requires a thumb spica splint for 10 weeks
• Displaced: surgical and requires bolts, screws, and a splint for 2-4 weeks

Post-operative Fracture Considerations

• Edema
• Range of motion and tightness
• Nerve compression (numbness, tingling, decreased function)
• Tendon rupture

Complex Regional Pain Syndrome (CRPS)

• Cause: issues in communication between the limb, brain, and spinal cord
• Must be chronic (longer than 6 months) post-injury affecting one limb
• Symptoms:
  • Burning, throbbing, aching pain
  • Changes in skin color, temperature, and swelling in the affected area
• Types:
  • CRPS-I: no confirmed nerve injury
  • CRPS-II: known nerve involvement### Shoulder and Chest Muscles
• Weakened shoulder and chest muscles can cause the clavicle to slip down, compressing blood vessels and nerves in the superior thoracic outlet.
• Symptoms: pain in shoulders and neck, numbness and tingling, and coldness in fingers, weakened grip, thumb atrophy.
• Non-surgical treatment: rest, activity modification, OT/PT.
• Surgical treatment: anatomical difference, muscle is cut away to make more space; may cause brachial plexus injury.

Elbow

Medial Epicondylitis (Golfer's Elbow)

• Cause: inflammation of medial tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, radiating pain from medial elbow down forearm, weakness, pain, stiffness.
• Treatment: NSAIDs, rest, ice, ROM, taping, OT/PT.
• Risks: playing throwing sports, playing instrument, painting.
• Triggers: shaking hands, turning doorknob, picking up object with palm down.

Lateral Epicondylitis (Tennis Elbow)

• Cause: inflammation of lateral tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, pain or burning on lateral side of elbow, weak grip strength.
• Treatment: NSAIDs, rest, ice, ROM, brace, steroid injections, OT/PT.
• Risks: plumbers, carpenters, painters, mechanics, chefs, butchers.
• Triggers: shaking hands, turning wrench, holding racket/garden hose.

Ulnar Collateral Ligament (UCL) Rupture

• Cause: repetitive use, fall on outstretched arm.
• Symptoms: pain at medial elbow, "pop" after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers.
• Treatment: Non-surgical: NSAIDs, ice, rest.
• Surgical: Tommy John Surgery, takes tendon from somewhere else.
• Types: Partial or complete (pain in medial part of elbow).

Posterior Olecranon Osteophyte

• Cause: formation of bone spurs on posterior olecranon.
• Symptoms: pain in elbow with no mechanism of injury, decreased ROM, catching or locking of elbow joint with movement.
• Treatment: Surgery to remove bone spurs and debridement of osteophytes, PT/OT.
• Risks: manual labor jobs, athletes.

Elbow Dislocation

• Cause: fall on outstretched arm.
• Symptoms: Partial - pain with ROM, "shifting", tingling/numbness.
• Symptoms: Complete - deformity, extreme pain, NO ROM (arm can't flex or extend).
• Treatment: Non-surgical - relocation and possible immobilization.
• Surgical - repair ligaments, external hinge.
• Types: Partial - relocates on its own; Complete - does not relocate on its own; has to be manually set.

Radial Head Fracture

• Cause: fall on outstretched arm or in conjunction with elbow fx, damage to the bone itself.
• Symptoms: pain on lateral elbow, swelling, decreased ROM, decreased supination & pronation.
• Treatment: Type I - non-surgical, rest + sling for days; Type II - surgery to remove bone fragments + sling for weeks; Type III - surgery to remove bone & repair ligaments + OT/PT.

Olecranon Bursitis

• Cause: direct injury, prolonged pressure, infection, other medical problems (gout, RA).
• Symptoms: painful elbow, edema, redness, warm skin.
• Treatment: Non-surgical - antibiotics for infection; suck out fluid; modify activities, NSAIDs.
• Surgical - takes bursa out, use splint.
• Risks: jobs or activities that require prolonged prop on elbows; elbow arthritis.

Elbow Arthritis

• Cause: breakdown of cartilage on articulating surfaces of bones.
• Symptoms: pain, decreased ROM, locking/grating sensation, edema.
• Treatment: Non-surgical - NSAIDs, OT/PT, corticosteroids.
• Surgical - arthroscopy or joint replacement.

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

• Cause: subluxed nerve, prolonged pressure, swelling, direct injury; ulnar nerve gets pinched/trapped.
• Symptoms: pain, numbness in elbow, hand or wrist, weakened grip, atrophy of hand musculature, reduced FM coordination.
• Treatment: Non-surgical - special pillow, brace, NSAIDs.
• Surgical - cubital tunnel release, transposition ulnar nerve, medial epicondylectomy.

Wrist and Hand Orthopedics

Pediatric Deformities

• 1/20 kids are born with orthopedic differences in their hand.
• Syndactyly: some fingers/toes united; webbing.
• Thumb duplication: second complete or partial thumb.
• Hypoplastic thumb: thumb is underdeveloped.
• Radial club hand: wrist radial deviation; missing all or part of fingers.
• Failure of formation of upper limb.

Radiocarpal Joint Disorders

Carpal Tunnel Syndrome

• Cause: increased pressure or entrapment of the median nerve at wrist; genetics, pregnancy.
• Symptoms: numbness, tingling, and pain in fingers, hand and arm; gradual onset, often complaints at night, lose proprioception and can't realize what their hand is doing.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - NSAIDs, bracing/splinting, steroids, activity modifications, nerve glides.
• Surgical - cut the ligament to create more space.
• Risks: repetitive hand use, hand/wrist positioning, pregnancy, genes.

De Quervain's Tenosynovitis

• Cause: overuse of wrist causes irritation of sheath around APL and EPB tendons to your thumb, or scar tissue; comorbid with rheumatoid arthritis.
• Symptoms: pain and swelling at base of thumb, deceased thumb movement, trouble grasping objects.
• Assessment: Positive Finkelstein Test.
• Treatment: Non-surgical - NSAIDs, splint full time, steroids, activity modifications, ice/heat.
• Surgical - cut sheath around tendon, then OT/PT.
• Risks: child rearing, pregnancy, carpenter, mechanic.

Ganglion Cysts

• Cause: unknown.
• Symptoms: small lump, painless, noncancerous lump often by tendons/joints in wrist or hand, becomes painful when a nerve is compressed.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - typically resolves on its own.
• Surgical - may need to be drained or removed.

MCP Joint Disorders

• Swan-Neck Deformity: MCP joint flexed, PIP joint extended, DIP joint flexed (not seen in the thumb because there aren't three joints).
• Cause: rheumatoid arthritis.
• Symptoms: mallet finger at DIP, limited mobility, pain.
• Treatment: Non-surgical - splinting, HEP, ROM, OT/PT, NSAIDs.
• Surgical - soft tissue surgery or finger joint fusion for stability.
• Boutonniere Deformity: MCP joint extended, PIP joint flexed, DIP joint extended (not seen in the thumb because there aren't three joints).
• Cause: forceful blow to dorsum of bent PIP or slicing of central slip tendon, arthritis.
• Symptoms: PIP can't be straightened, DIP can't be bent, swelling & pain at PIP.
• Treatment: Non-surgical - splinting, HEP.
• Surgical - if there is a tendon that is severed or a compound fracture or splinting doesn't work.

Dupuytren Contracture

• Cause: unknown, but something triggers the fascia of the palm to thicken and it eventually tightens, reducing hand function.
• Symptoms: lumps, nodules, and cords which leads to contractures that pull fingers inward, toward the palm.
• Treatment: Non-surgical - splinting, steroids.
• Surgical - fasciotomy or subtotal palmar fasciectomy.
• Risks: diabetes, alcoholism, epilepsy.

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(Note: This is a long response, and I've tried to format it to make it easier to read. Let me know if you'd like me to make any changes!)### Rheumatoid Arthritis (RA)

• Goals of treatment: reduce pain and joint stiffness, reduce edema, preserve normal joint function and musculature, minimize medication interactions, promote normal growth and development, maintain ADL independence • Disease process: + Acute: fever, decreased range of motion and strength, stiffness, gel phenomenon, weight loss + Subacute: mild fever, decreased range of motion and strength, morning stiffness, decreased endurance, gel phenomenon + Chronic active: decreased range of motion, strength, poor endurance + Chronic inactive: decreased range of motion, muscle atrophy, worse endurance, contractures • Treatment: NSAIDs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Osteoarthritis (OA)

• Cause: genetics and environmental, aging, chondropenia (lose cartilage faster than the body can replace it), non-inflammatory • Symptoms: localized pain, palpable edema, point tenderness, stiffness, inflammation of bones and joints, asymmetrical involvement, weight-bearing joints and hands most affected, crepitus during ROM • Prevalence: 10-15% worldwide • Assessment: patient history, MRI/x-ray, leg length discrepancy, anatomical bony abnormalities • Onset: gradually over years • Types: primary (general wear and tear, no known cause), secondary (external injury or disease) • Prognosis: “silent” or traumatic, joint location • Treatment: NSAIDs, CINODs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Fibromyalgia

• Cause: unknown • Symptoms: widespread chronic severe pain, tender points, no inflammation, headaches, malaise, poor sleep, abdominal cramps, mood disorder, from the waist up • Prevalence: 1-5% worldwide, women more affected than men (US is 3:1) • Assessment: patient history, physical examination, no genetic or blood test can be done, WPI and SSS scores • Onset: widespread or unilateral, can start unilateral then go bilateral • Types: unilateral or bilateral • Prognosis: unclear • Treatment: NSAIDs, opioids, antidepressants • Risks: aging • Comorbidities: OA, RA, depression

Gout

• Cause: crystallization and buildup of uric acid in the joint (hyperuricemia) • Symptoms: rapid onset, joint-specific pain, warmth, swelling, reddish discoloration, tenderness, “attacks” that last hours to days, intermittent, tophi • Prevalence: 1-4% worldwide, 8.3 million in US • Assessment: medical history, physical exam, blood work, MRI/x-ray/CT • Onset: 30-50 years old • Types: most common in big toe, 1st metatarsal • Treatment: diet low in purines, NSAIDs, xanthine oxidase inhibitors (XOI), comprehensive planning (diet) • Risks: men, African American • Comorbidities: insulin resistance syndrome, hypertension, renal damage, depression

Burns

Skin Anatomy

• Epidermis: thin, nonvascularized, epithelial cells, 25% of skin, top layer, body temperature regulation, erection of waste, makes vitamin D • Dermis: 75% of skin, blood vessels, hair follicles, sweat glands, nerve endings, barrier for bacteria, prevents moisture loss • Subcutaneous tissue: fat, below dermis

Wound Healing Process

1. Hemostasis: stop bleeding (clot)
2. Inflammatory: cells come to clean up the wound
3. Proliferative: a. Connective tissue deposits b. Contraction (rebuild tissue) c. Epithelium is rebuilt
4. Maturation: collagen reorganizes itself

Zones of Burns

• Coagulation: brunt of the heat, innermost, most damage, irreversible • Stasis: decreased perfusion, surrounding coagulation, moderate damage, can be saved but effort is needed • Hyperemia: decreased perfusion, outermost, minimal damage, has potential to survive

Types of Burns

• Superficial Burn (1st degree): epidermis only, redness, dry, blanches, no blisters, painful and sensitive to air and light touch, heals in 3-4 days, no scarring • Superficial Partial-Thickness Burn (2nd degree): epidermis and papillary dermis, weeping, wet skin, blanches, clear blisters, painful to touch, heals in 2-3 weeks, no scars but pigment changes • Deep Partial-Thickness Burn (2nd degree): epidermis and entire dermis, white, no blanching, bloody blisters, moist skin, very painful to touch, heals in more than 3 weeks, scarring and contractures • Full-Thickness Burn (3rd degree): epidermis, entire dermis, and subcutaneous tissue, charred black, bright red, tan, or pearly white, fragile blisters, dry, leathery, insensate but can feel deep pressure, high risk of contractures, requires skin graft, months to years, body can’t heal on its own • Deep Full-Thickness Burn (4th degree): all skin layers and tendon, muscle, or bone, charred or mummified, eschar (dead skin/tissue), insensate, but can feel deep pressure, difficult to heal, may require amputation, contractures, and functional impairment

Additional Issues

• Burn shock: loss of fluid or plasma in the blood, occurs within 48-72 hours of initial injury, due to loss of fluid or plasma in the blood • Hypermetabolism: prolonged stress response, increase of cytokines, insulin, and catecholamines in the body • Inhalation injury: facial burns, singed nose hair, hoarse voice, wheezing, dark oral mucosa, hypoxia, cough • Scars and contractures: formation begins when the wound begins to close, hypertrophic (raised and red, stay within the borders of burn), keloid (raised and red, tender and painful, extend beyond the borders of the burn) • Treatment: primary goal is oxygenation, ideal oxygen is 100%, interventions: bronchial hygiene therapy, chest PT, airway suctioning, early mobility, mechanical ventilation, escharotomy (slit in the burn to release pressure), toxicities

Orthopedics

• Primary roles of bones: protect and support soft tissue, attachment site for muscles, store minerals, and produce red blood cells in bone marrow.
• Bone growth is influenced by nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones).

Bone Growth and Hormones

• Excess insulin growth hormone (hGH) can lead to gigantism, while a deficiency can cause short stature.
• Hormones involved in bone growth: insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones.

Soft Tissue Basics

• Atrophy: wasting away of muscles due to disuse or denervation (muscle loses nerve connection).
• Hypertrophy: muscles increase in number and diameter.
• Skeletal muscle starts to convert to connective or adipose tissue starting at 30, leading to:
  • Slowing of reflexes
  • Reduction of maximum strength
  • Decreased flexibility with age

Abnormal Contraction

• Spasm: involuntary contraction of a single muscle
• Cramp: painful, spasmodic contraction due to a lack of potassium and/or water
• Tic: involuntary twitch of muscles, often in the face or eyelid
• Tremor: rhythmic, involuntary, purposeless co-contraction of contracting muscles
• Fasciculation: involuntary twitch of multiple motor units, visible beneath the skin, often seen with ASL (Amyotrophic Lateral Sclerosis)
• Fibrillation: involuntary twitch of a single motor unit, not visible beneath the skin

Abnormal Curves of the Spine

• Kyphosis: anterior to posterior thoracic curvature (“hunchback”)
• Lordosis: extreme exaggeration of the lumbar curvature, often seen in pregnant women
• Scoliosis: S-shaped curve in the thoracic spine
• Rotoscoliosis: torsion couple with curve

Etiology

• Causes of orthopedic conditions:
  • Traumatic injuries
  • Sports
  • Falls (leading cause)
  • Rheumatic diseases
  • Aging

Orthopedic Conditions

Rickets

• Cause: lacking calcium and vitamin D in childhood
• Symptoms:
  • Soft bones
  • Deformities of the skull, legs, rib cage, pelvis, and teeth
  • Muscle cramps
  • Stunted growth (epiphyseal plates close too soon)
• Treatment: calcium-rich diet to correct deformities

Osteomalacia

• Cause: lacking calcium and vitamin D in adulthood
• Symptoms:
  • Soft bones
  • Prone to fractures
  • Bone pain in lower extremities
  • Muscle weakness
• Treatment: increased vitamin D in the diet (e.g., from salmon) and increased sun exposure

Paget's Disease

• Cause: unknown, possibly viral, with issues in the recycling process and bone formation
• Symptoms:
  • Excessive bone formation and breakdown
  • Located in the spine, femur, or skull
  • High ratio of spongy to compact bone
• Treatment: calcitonin and bisphosphonates

Osteopenia

• Cause: unknown, possibly genetic, malnourishment, or associated conditions
• Symptoms:
  • Reversible weakening of bone
• Treatment:
  • Calcium-enriched diet and supplements
  • Weight-bearing activities
  • Bone density screens

Osteoporosis

• Cause: progressive osteopenia that is irreversible
• Symptoms:
  • Initially, none
  • Later, pain, kyphosis, height loss, and skeletal dysfunction
• Treatment: none

High-Risk Factors

• Women
• History of falls
• Quadriceps weakness
• Postural instability

Incidence

• 1 in 2 women will have a fracture related to osteoporosis, while 1 in 4 men will have one
• Higher incidence in women due to decreased estrogen during menopause

Heterotopic Ossification

• Cause: unknown, with abnormal bone formation in soft tissues, possibly due to trauma or surgery
• Symptoms:
  • Pain
  • Warmth at the joint
  • Edema
  • Redness
  • Induration (changes to tissues beneath the surface)
  • Decreased range of motion with a bony end feel
• Treatment:
  • Iontophoresis
  • Range of motion
  • Pain management
• Comorbidities: neurological issues

Prevalence

• Elbow fracture: 90% chance of developing HO
• Hip fracture: 50% chance of developing HO
• Only 1/3 of individuals with HO have functional limitations

Spina Bifida

• Cause: birth defect due to incomplete closure of bone/membrane around the spinal cord
• Symptoms:
  • Myelomeningocele: leg weakness/paralysis, orthopedic issues, bladder/bowel issues, neurological issues
  • Meningocele: small sac or gait immobility
  • Occulta: may have no issues

Fractures

• Classification:
  • Bone ends: displaced or nondisplaced
  • Complete or incomplete break
  • Linear or transverse break on the long axis
• Types:
  • Closed (simple): bone does not break the skin
  • Open (compound): bone breaks the skin
  • Transverse: complete, occurs at a right angle to the bone
  • Comminuted: multiple bone fragments
  • Greenstick: incomplete, bend that causes the other side to break off
  • Stress: repetitive use
  • Hairline: incomplete, small
  • Spiral: from torsional force or twisting

Symptoms

• Localized pain at the site
• Deformity
• Edema (swelling)
• Ecchymosis (discoloration, a few days after the incident)

Incidence

• Falls are the leading cause of fractures in older adults
• Falls are the leading cause of nonfatal injuries
• Most common fractures from falls: hip, wrist, and humerus
• 44% of all fractures involve a distal radius

Hip Fractures

• Primary cause of disability and mortality in older adults
• Chance of not returning to baseline after a hip fracture
• Avulsion: possibility of muscle being pulled off the bone

Symptoms

• Referred pain in the knee
• Unable to bear weight on the affected leg
• Leg-length discrepancy

Treatment

• Surgery:
  • Closed reduction and immobilization
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty (replace the femoral neck and head with a metal prosthesis)
  • Total hip replacement (replace the acetabulum and resurface, replace the ball of the femur, lasts 10-25 years)

Precautions

• Hip flexion should not be more than 90 degrees
• No hip rotation
• No hip adduction
• Sleep on back with a pillow between legs
• Keep leg extended when going from sitting to standing

Humeral Fractures

• 20% have a loss of wrist extension or loss of feeling due to damage to the radial nerve
• 70-90% regain function after 4 months

Causes

• Osteoporosis
• Aging
• Injury

Symptoms

• Humeral displacement and location
• Distal end: supracondylar fracture (elbow, can lead to HO)
• Loss of wrist extension and dorsum hand sensation in around 1/5 cases

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Sling
• Immobilization and mobilization schedule varies

Distal Radius Fracture

• Cause: falling on an outstretched hand

Symptoms

• Loss of sensation, strength, and range of motion
• Classified based on articular and/or ulnar involvement, soft tissue involvement, and displacement

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Splint or cast
• Immobilization and mobilization schedule varies based on the physician

Scaphoid Fracture

• Cause: wrist hyperextension greater than 90 degrees and radial deviation, common in sports injuries

Symptoms

• Pain and tenderness that intensify when trying to pinch or grasp objects
• Vascular necrosis

Treatment

• Non-displaced: non-surgical and requires a thumb spica splint for 10 weeks
• Displaced: surgical and requires bolts, screws, and a splint for 2-4 weeks

Post-operative Fracture Considerations

• Edema
• Range of motion and tightness
• Nerve compression (numbness, tingling, decreased function)
• Tendon rupture

Complex Regional Pain Syndrome (CRPS)

• Cause: issues in communication between the limb, brain, and spinal cord
• Must be chronic (longer than 6 months) post-injury affecting one limb
• Symptoms:
  • Burning, throbbing, aching pain
  • Changes in skin color, temperature, and swelling in the affected area
• Types:
  • CRPS-I: no confirmed nerve injury
  • CRPS-II: known nerve involvement### Shoulder and Chest Muscles
• Weakened shoulder and chest muscles can cause the clavicle to slip down, compressing blood vessels and nerves in the superior thoracic outlet.
• Symptoms: pain in shoulders and neck, numbness and tingling, and coldness in fingers, weakened grip, thumb atrophy.
• Non-surgical treatment: rest, activity modification, OT/PT.
• Surgical treatment: anatomical difference, muscle is cut away to make more space; may cause brachial plexus injury.

Elbow

Medial Epicondylitis (Golfer's Elbow)

• Cause: inflammation of medial tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, radiating pain from medial elbow down forearm, weakness, pain, stiffness.
• Treatment: NSAIDs, rest, ice, ROM, taping, OT/PT.
• Risks: playing throwing sports, playing instrument, painting.
• Triggers: shaking hands, turning doorknob, picking up object with palm down.

Lateral Epicondylitis (Tennis Elbow)

• Cause: inflammation of lateral tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, pain or burning on lateral side of elbow, weak grip strength.
• Treatment: NSAIDs, rest, ice, ROM, brace, steroid injections, OT/PT.
• Risks: plumbers, carpenters, painters, mechanics, chefs, butchers.
• Triggers: shaking hands, turning wrench, holding racket/garden hose.

Ulnar Collateral Ligament (UCL) Rupture

• Cause: repetitive use, fall on outstretched arm.
• Symptoms: pain at medial elbow, "pop" after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers.
• Treatment: Non-surgical: NSAIDs, ice, rest.
• Surgical: Tommy John Surgery, takes tendon from somewhere else.
• Types: Partial or complete (pain in medial part of elbow).

Posterior Olecranon Osteophyte

• Cause: formation of bone spurs on posterior olecranon.
• Symptoms: pain in elbow with no mechanism of injury, decreased ROM, catching or locking of elbow joint with movement.
• Treatment: Surgery to remove bone spurs and debridement of osteophytes, PT/OT.
• Risks: manual labor jobs, athletes.

Elbow Dislocation

• Cause: fall on outstretched arm.
• Symptoms: Partial - pain with ROM, "shifting", tingling/numbness.
• Symptoms: Complete - deformity, extreme pain, NO ROM (arm can't flex or extend).
• Treatment: Non-surgical - relocation and possible immobilization.
• Surgical - repair ligaments, external hinge.
• Types: Partial - relocates on its own; Complete - does not relocate on its own; has to be manually set.

Radial Head Fracture

• Cause: fall on outstretched arm or in conjunction with elbow fx, damage to the bone itself.
• Symptoms: pain on lateral elbow, swelling, decreased ROM, decreased supination & pronation.
• Treatment: Type I - non-surgical, rest + sling for days; Type II - surgery to remove bone fragments + sling for weeks; Type III - surgery to remove bone & repair ligaments + OT/PT.

Olecranon Bursitis

• Cause: direct injury, prolonged pressure, infection, other medical problems (gout, RA).
• Symptoms: painful elbow, edema, redness, warm skin.
• Treatment: Non-surgical - antibiotics for infection; suck out fluid; modify activities, NSAIDs.
• Surgical - takes bursa out, use splint.
• Risks: jobs or activities that require prolonged prop on elbows; elbow arthritis.

Elbow Arthritis

• Cause: breakdown of cartilage on articulating surfaces of bones.
• Symptoms: pain, decreased ROM, locking/grating sensation, edema.
• Treatment: Non-surgical - NSAIDs, OT/PT, corticosteroids.
• Surgical - arthroscopy or joint replacement.

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

• Cause: subluxed nerve, prolonged pressure, swelling, direct injury; ulnar nerve gets pinched/trapped.
• Symptoms: pain, numbness in elbow, hand or wrist, weakened grip, atrophy of hand musculature, reduced FM coordination.
• Treatment: Non-surgical - special pillow, brace, NSAIDs.
• Surgical - cubital tunnel release, transposition ulnar nerve, medial epicondylectomy.

Wrist and Hand Orthopedics

Pediatric Deformities

• 1/20 kids are born with orthopedic differences in their hand.
• Syndactyly: some fingers/toes united; webbing.
• Thumb duplication: second complete or partial thumb.
• Hypoplastic thumb: thumb is underdeveloped.
• Radial club hand: wrist radial deviation; missing all or part of fingers.
• Failure of formation of upper limb.

Radiocarpal Joint Disorders

Carpal Tunnel Syndrome

• Cause: increased pressure or entrapment of the median nerve at wrist; genetics, pregnancy.
• Symptoms: numbness, tingling, and pain in fingers, hand and arm; gradual onset, often complaints at night, lose proprioception and can't realize what their hand is doing.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - NSAIDs, bracing/splinting, steroids, activity modifications, nerve glides.
• Surgical - cut the ligament to create more space.
• Risks: repetitive hand use, hand/wrist positioning, pregnancy, genes.

De Quervain's Tenosynovitis

• Cause: overuse of wrist causes irritation of sheath around APL and EPB tendons to your thumb, or scar tissue; comorbid with rheumatoid arthritis.
• Symptoms: pain and swelling at base of thumb, deceased thumb movement, trouble grasping objects.
• Assessment: Positive Finkelstein Test.
• Treatment: Non-surgical - NSAIDs, splint full time, steroids, activity modifications, ice/heat.
• Surgical - cut sheath around tendon, then OT/PT.
• Risks: child rearing, pregnancy, carpenter, mechanic.

Ganglion Cysts

• Cause: unknown.
• Symptoms: small lump, painless, noncancerous lump often by tendons/joints in wrist or hand, becomes painful when a nerve is compressed.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - typically resolves on its own.
• Surgical - may need to be drained or removed.

MCP Joint Disorders

• Swan-Neck Deformity: MCP joint flexed, PIP joint extended, DIP joint flexed (not seen in the thumb because there aren't three joints).
• Cause: rheumatoid arthritis.
• Symptoms: mallet finger at DIP, limited mobility, pain.
• Treatment: Non-surgical - splinting, HEP, ROM, OT/PT, NSAIDs.
• Surgical - soft tissue surgery or finger joint fusion for stability.
• Boutonniere Deformity: MCP joint extended, PIP joint flexed, DIP joint extended (not seen in the thumb because there aren't three joints).
• Cause: forceful blow to dorsum of bent PIP or slicing of central slip tendon, arthritis.
• Symptoms: PIP can't be straightened, DIP can't be bent, swelling & pain at PIP.
• Treatment: Non-surgical - splinting, HEP.
• Surgical - if there is a tendon that is severed or a compound fracture or splinting doesn't work.

Dupuytren Contracture

• Cause: unknown, but something triggers the fascia of the palm to thicken and it eventually tightens, reducing hand function.
• Symptoms: lumps, nodules, and cords which leads to contractures that pull fingers inward, toward the palm.
• Treatment: Non-surgical - splinting, steroids.
• Surgical - fasciotomy or subtotal palmar fasciectomy.
• Risks: diabetes, alcoholism, epilepsy.

---

(Note: This is a long response, and I've tried to format it to make it easier to read. Let me know if you'd like me to make any changes!)### Rheumatoid Arthritis (RA)

• Goals of treatment: reduce pain and joint stiffness, reduce edema, preserve normal joint function and musculature, minimize medication interactions, promote normal growth and development, maintain ADL independence • Disease process: + Acute: fever, decreased range of motion and strength, stiffness, gel phenomenon, weight loss + Subacute: mild fever, decreased range of motion and strength, morning stiffness, decreased endurance, gel phenomenon + Chronic active: decreased range of motion, strength, poor endurance + Chronic inactive: decreased range of motion, muscle atrophy, worse endurance, contractures • Treatment: NSAIDs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Osteoarthritis (OA)

• Cause: genetics and environmental, aging, chondropenia (lose cartilage faster than the body can replace it), non-inflammatory • Symptoms: localized pain, palpable edema, point tenderness, stiffness, inflammation of bones and joints, asymmetrical involvement, weight-bearing joints and hands most affected, crepitus during ROM • Prevalence: 10-15% worldwide • Assessment: patient history, MRI/x-ray, leg length discrepancy, anatomical bony abnormalities • Onset: gradually over years • Types: primary (general wear and tear, no known cause), secondary (external injury or disease) • Prognosis: “silent” or traumatic, joint location • Treatment: NSAIDs, CINODs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Fibromyalgia

• Cause: unknown • Symptoms: widespread chronic severe pain, tender points, no inflammation, headaches, malaise, poor sleep, abdominal cramps, mood disorder, from the waist up • Prevalence: 1-5% worldwide, women more affected than men (US is 3:1) • Assessment: patient history, physical examination, no genetic or blood test can be done, WPI and SSS scores • Onset: widespread or unilateral, can start unilateral then go bilateral • Types: unilateral or bilateral • Prognosis: unclear • Treatment: NSAIDs, opioids, antidepressants • Risks: aging • Comorbidities: OA, RA, depression

Gout

• Cause: crystallization and buildup of uric acid in the joint (hyperuricemia) • Symptoms: rapid onset, joint-specific pain, warmth, swelling, reddish discoloration, tenderness, “attacks” that last hours to days, intermittent, tophi • Prevalence: 1-4% worldwide, 8.3 million in US • Assessment: medical history, physical exam, blood work, MRI/x-ray/CT • Onset: 30-50 years old • Types: most common in big toe, 1st metatarsal • Treatment: diet low in purines, NSAIDs, xanthine oxidase inhibitors (XOI), comprehensive planning (diet) • Risks: men, African American • Comorbidities: insulin resistance syndrome, hypertension, renal damage, depression

Burns

Skin Anatomy

• Epidermis: thin, nonvascularized, epithelial cells, 25% of skin, top layer, body temperature regulation, erection of waste, makes vitamin D • Dermis: 75% of skin, blood vessels, hair follicles, sweat glands, nerve endings, barrier for bacteria, prevents moisture loss • Subcutaneous tissue: fat, below dermis

Wound Healing Process

1. Hemostasis: stop bleeding (clot)
2. Inflammatory: cells come to clean up the wound
3. Proliferative: a. Connective tissue deposits b. Contraction (rebuild tissue) c. Epithelium is rebuilt
4. Maturation: collagen reorganizes itself

Zones of Burns

• Coagulation: brunt of the heat, innermost, most damage, irreversible • Stasis: decreased perfusion, surrounding coagulation, moderate damage, can be saved but effort is needed • Hyperemia: decreased perfusion, outermost, minimal damage, has potential to survive

Types of Burns

• Superficial Burn (1st degree): epidermis only, redness, dry, blanches, no blisters, painful and sensitive to air and light touch, heals in 3-4 days, no scarring • Superficial Partial-Thickness Burn (2nd degree): epidermis and papillary dermis, weeping, wet skin, blanches, clear blisters, painful to touch, heals in 2-3 weeks, no scars but pigment changes • Deep Partial-Thickness Burn (2nd degree): epidermis and entire dermis, white, no blanching, bloody blisters, moist skin, very painful to touch, heals in more than 3 weeks, scarring and contractures • Full-Thickness Burn (3rd degree): epidermis, entire dermis, and subcutaneous tissue, charred black, bright red, tan, or pearly white, fragile blisters, dry, leathery, insensate but can feel deep pressure, high risk of contractures, requires skin graft, months to years, body can’t heal on its own • Deep Full-Thickness Burn (4th degree): all skin layers and tendon, muscle, or bone, charred or mummified, eschar (dead skin/tissue), insensate, but can feel deep pressure, difficult to heal, may require amputation, contractures, and functional impairment

Additional Issues

• Burn shock: loss of fluid or plasma in the blood, occurs within 48-72 hours of initial injury, due to loss of fluid or plasma in the blood • Hypermetabolism: prolonged stress response, increase of cytokines, insulin, and catecholamines in the body • Inhalation injury: facial burns, singed nose hair, hoarse voice, wheezing, dark oral mucosa, hypoxia, cough • Scars and contractures: formation begins when the wound begins to close, hypertrophic (raised and red, stay within the borders of burn), keloid (raised and red, tender and painful, extend beyond the borders of the burn) • Treatment: primary goal is oxygenation, ideal oxygen is 100%, interventions: bronchial hygiene therapy, chest PT, airway suctioning, early mobility, mechanical ventilation, escharotomy (slit in the burn to release pressure), toxicities

Orthopedics

• Primary roles of bones: protect and support soft tissue, attachment site for muscles, store minerals, and produce red blood cells in bone marrow.
• Bone growth is influenced by nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones).

Bone Growth and Hormones

• Excess insulin growth hormone (hGH) can lead to gigantism, while a deficiency can cause short stature.
• Hormones involved in bone growth: insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones.

Soft Tissue Basics

• Atrophy: wasting away of muscles due to disuse or denervation (muscle loses nerve connection).
• Hypertrophy: muscles increase in number and diameter.
• Skeletal muscle starts to convert to connective or adipose tissue starting at 30, leading to:
  • Slowing of reflexes
  • Reduction of maximum strength
  • Decreased flexibility with age

Abnormal Contraction

• Spasm: involuntary contraction of a single muscle
• Cramp: painful, spasmodic contraction due to a lack of potassium and/or water
• Tic: involuntary twitch of muscles, often in the face or eyelid
• Tremor: rhythmic, involuntary, purposeless co-contraction of contracting muscles
• Fasciculation: involuntary twitch of multiple motor units, visible beneath the skin, often seen with ASL (Amyotrophic Lateral Sclerosis)
• Fibrillation: involuntary twitch of a single motor unit, not visible beneath the skin

Abnormal Curves of the Spine

• Kyphosis: anterior to posterior thoracic curvature (“hunchback”)
• Lordosis: extreme exaggeration of the lumbar curvature, often seen in pregnant women
• Scoliosis: S-shaped curve in the thoracic spine
• Rotoscoliosis: torsion couple with curve

Etiology

• Causes of orthopedic conditions:
  • Traumatic injuries
  • Sports
  • Falls (leading cause)
  • Rheumatic diseases
  • Aging

Orthopedic Conditions

Rickets

• Cause: lacking calcium and vitamin D in childhood
• Symptoms:
  • Soft bones
  • Deformities of the skull, legs, rib cage, pelvis, and teeth
  • Muscle cramps
  • Stunted growth (epiphyseal plates close too soon)
• Treatment: calcium-rich diet to correct deformities

Osteomalacia

• Cause: lacking calcium and vitamin D in adulthood
• Symptoms:
  • Soft bones
  • Prone to fractures
  • Bone pain in lower extremities
  • Muscle weakness
• Treatment: increased vitamin D in the diet (e.g., from salmon) and increased sun exposure

Paget's Disease

• Cause: unknown, possibly viral, with issues in the recycling process and bone formation
• Symptoms:
  • Excessive bone formation and breakdown
  • Located in the spine, femur, or skull
  • High ratio of spongy to compact bone
• Treatment: calcitonin and bisphosphonates

Osteopenia

• Cause: unknown, possibly genetic, malnourishment, or associated conditions
• Symptoms:
  • Reversible weakening of bone
• Treatment:
  • Calcium-enriched diet and supplements
  • Weight-bearing activities
  • Bone density screens

Osteoporosis

• Cause: progressive osteopenia that is irreversible
• Symptoms:
  • Initially, none
  • Later, pain, kyphosis, height loss, and skeletal dysfunction
• Treatment: none

High-Risk Factors

• Women
• History of falls
• Quadriceps weakness
• Postural instability

Incidence

• 1 in 2 women will have a fracture related to osteoporosis, while 1 in 4 men will have one
• Higher incidence in women due to decreased estrogen during menopause

Heterotopic Ossification

• Cause: unknown, with abnormal bone formation in soft tissues, possibly due to trauma or surgery
• Symptoms:
  • Pain
  • Warmth at the joint
  • Edema
  • Redness
  • Induration (changes to tissues beneath the surface)
  • Decreased range of motion with a bony end feel
• Treatment:
  • Iontophoresis
  • Range of motion
  • Pain management
• Comorbidities: neurological issues

Prevalence

• Elbow fracture: 90% chance of developing HO
• Hip fracture: 50% chance of developing HO
• Only 1/3 of individuals with HO have functional limitations

Spina Bifida

• Cause: birth defect due to incomplete closure of bone/membrane around the spinal cord
• Symptoms:
  • Myelomeningocele: leg weakness/paralysis, orthopedic issues, bladder/bowel issues, neurological issues
  • Meningocele: small sac or gait immobility
  • Occulta: may have no issues

Fractures

• Classification:
  • Bone ends: displaced or nondisplaced
  • Complete or incomplete break
  • Linear or transverse break on the long axis
• Types:
  • Closed (simple): bone does not break the skin
  • Open (compound): bone breaks the skin
  • Transverse: complete, occurs at a right angle to the bone
  • Comminuted: multiple bone fragments
  • Greenstick: incomplete, bend that causes the other side to break off
  • Stress: repetitive use
  • Hairline: incomplete, small
  • Spiral: from torsional force or twisting

Symptoms

• Localized pain at the site
• Deformity
• Edema (swelling)
• Ecchymosis (discoloration, a few days after the incident)

Incidence

• Falls are the leading cause of fractures in older adults
• Falls are the leading cause of nonfatal injuries
• Most common fractures from falls: hip, wrist, and humerus
• 44% of all fractures involve a distal radius

Hip Fractures

• Primary cause of disability and mortality in older adults
• Chance of not returning to baseline after a hip fracture
• Avulsion: possibility of muscle being pulled off the bone

Symptoms

• Referred pain in the knee
• Unable to bear weight on the affected leg
• Leg-length discrepancy

Treatment

• Surgery:
  • Closed reduction and immobilization
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty (replace the femoral neck and head with a metal prosthesis)
  • Total hip replacement (replace the acetabulum and resurface, replace the ball of the femur, lasts 10-25 years)

Precautions

• Hip flexion should not be more than 90 degrees
• No hip rotation
• No hip adduction
• Sleep on back with a pillow between legs
• Keep leg extended when going from sitting to standing

Humeral Fractures

• 20% have a loss of wrist extension or loss of feeling due to damage to the radial nerve
• 70-90% regain function after 4 months

Causes

• Osteoporosis
• Aging
• Injury

Symptoms

• Humeral displacement and location
• Distal end: supracondylar fracture (elbow, can lead to HO)
• Loss of wrist extension and dorsum hand sensation in around 1/5 cases

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Sling
• Immobilization and mobilization schedule varies

Distal Radius Fracture

• Cause: falling on an outstretched hand

Symptoms

• Loss of sensation, strength, and range of motion
• Classified based on articular and/or ulnar involvement, soft tissue involvement, and displacement

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Splint or cast
• Immobilization and mobilization schedule varies based on the physician

Scaphoid Fracture

• Cause: wrist hyperextension greater than 90 degrees and radial deviation, common in sports injuries

Symptoms

• Pain and tenderness that intensify when trying to pinch or grasp objects
• Vascular necrosis

Treatment

• Non-displaced: non-surgical and requires a thumb spica splint for 10 weeks
• Displaced: surgical and requires bolts, screws, and a splint for 2-4 weeks

Post-operative Fracture Considerations

• Edema
• Range of motion and tightness
• Nerve compression (numbness, tingling, decreased function)
• Tendon rupture

Complex Regional Pain Syndrome (CRPS)

• Cause: issues in communication between the limb, brain, and spinal cord
• Must be chronic (longer than 6 months) post-injury affecting one limb
• Symptoms:
  • Burning, throbbing, aching pain
  • Changes in skin color, temperature, and swelling in the affected area
• Types:
  • CRPS-I: no confirmed nerve injury
  • CRPS-II: known nerve involvement### Shoulder and Chest Muscles
• Weakened shoulder and chest muscles can cause the clavicle to slip down, compressing blood vessels and nerves in the superior thoracic outlet.
• Symptoms: pain in shoulders and neck, numbness and tingling, and coldness in fingers, weakened grip, thumb atrophy.
• Non-surgical treatment: rest, activity modification, OT/PT.
• Surgical treatment: anatomical difference, muscle is cut away to make more space; may cause brachial plexus injury.

Elbow

Medial Epicondylitis (Golfer's Elbow)

• Cause: inflammation of medial tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, radiating pain from medial elbow down forearm, weakness, pain, stiffness.
• Treatment: NSAIDs, rest, ice, ROM, taping, OT/PT.
• Risks: playing throwing sports, playing instrument, painting.
• Triggers: shaking hands, turning doorknob, picking up object with palm down.

Lateral Epicondylitis (Tennis Elbow)

• Cause: inflammation of lateral tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, pain or burning on lateral side of elbow, weak grip strength.
• Treatment: NSAIDs, rest, ice, ROM, brace, steroid injections, OT/PT.
• Risks: plumbers, carpenters, painters, mechanics, chefs, butchers.
• Triggers: shaking hands, turning wrench, holding racket/garden hose.

Ulnar Collateral Ligament (UCL) Rupture

• Cause: repetitive use, fall on outstretched arm.
• Symptoms: pain at medial elbow, "pop" after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers.
• Treatment: Non-surgical: NSAIDs, ice, rest.
• Surgical: Tommy John Surgery, takes tendon from somewhere else.
• Types: Partial or complete (pain in medial part of elbow).

Posterior Olecranon Osteophyte

• Cause: formation of bone spurs on posterior olecranon.
• Symptoms: pain in elbow with no mechanism of injury, decreased ROM, catching or locking of elbow joint with movement.
• Treatment: Surgery to remove bone spurs and debridement of osteophytes, PT/OT.
• Risks: manual labor jobs, athletes.

Elbow Dislocation

• Cause: fall on outstretched arm.
• Symptoms: Partial - pain with ROM, "shifting", tingling/numbness.
• Symptoms: Complete - deformity, extreme pain, NO ROM (arm can't flex or extend).
• Treatment: Non-surgical - relocation and possible immobilization.
• Surgical - repair ligaments, external hinge.
• Types: Partial - relocates on its own; Complete - does not relocate on its own; has to be manually set.

Radial Head Fracture

• Cause: fall on outstretched arm or in conjunction with elbow fx, damage to the bone itself.
• Symptoms: pain on lateral elbow, swelling, decreased ROM, decreased supination & pronation.
• Treatment: Type I - non-surgical, rest + sling for days; Type II - surgery to remove bone fragments + sling for weeks; Type III - surgery to remove bone & repair ligaments + OT/PT.

Olecranon Bursitis

• Cause: direct injury, prolonged pressure, infection, other medical problems (gout, RA).
• Symptoms: painful elbow, edema, redness, warm skin.
• Treatment: Non-surgical - antibiotics for infection; suck out fluid; modify activities, NSAIDs.
• Surgical - takes bursa out, use splint.
• Risks: jobs or activities that require prolonged prop on elbows; elbow arthritis.

Elbow Arthritis

• Cause: breakdown of cartilage on articulating surfaces of bones.
• Symptoms: pain, decreased ROM, locking/grating sensation, edema.
• Treatment: Non-surgical - NSAIDs, OT/PT, corticosteroids.
• Surgical - arthroscopy or joint replacement.

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

• Cause: subluxed nerve, prolonged pressure, swelling, direct injury; ulnar nerve gets pinched/trapped.
• Symptoms: pain, numbness in elbow, hand or wrist, weakened grip, atrophy of hand musculature, reduced FM coordination.
• Treatment: Non-surgical - special pillow, brace, NSAIDs.
• Surgical - cubital tunnel release, transposition ulnar nerve, medial epicondylectomy.

Wrist and Hand Orthopedics

Pediatric Deformities

• 1/20 kids are born with orthopedic differences in their hand.
• Syndactyly: some fingers/toes united; webbing.
• Thumb duplication: second complete or partial thumb.
• Hypoplastic thumb: thumb is underdeveloped.
• Radial club hand: wrist radial deviation; missing all or part of fingers.
• Failure of formation of upper limb.

Radiocarpal Joint Disorders

Carpal Tunnel Syndrome

• Cause: increased pressure or entrapment of the median nerve at wrist; genetics, pregnancy.
• Symptoms: numbness, tingling, and pain in fingers, hand and arm; gradual onset, often complaints at night, lose proprioception and can't realize what their hand is doing.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - NSAIDs, bracing/splinting, steroids, activity modifications, nerve glides.
• Surgical - cut the ligament to create more space.
• Risks: repetitive hand use, hand/wrist positioning, pregnancy, genes.

De Quervain's Tenosynovitis

• Cause: overuse of wrist causes irritation of sheath around APL and EPB tendons to your thumb, or scar tissue; comorbid with rheumatoid arthritis.
• Symptoms: pain and swelling at base of thumb, deceased thumb movement, trouble grasping objects.
• Assessment: Positive Finkelstein Test.
• Treatment: Non-surgical - NSAIDs, splint full time, steroids, activity modifications, ice/heat.
• Surgical - cut sheath around tendon, then OT/PT.
• Risks: child rearing, pregnancy, carpenter, mechanic.

Ganglion Cysts

• Cause: unknown.
• Symptoms: small lump, painless, noncancerous lump often by tendons/joints in wrist or hand, becomes painful when a nerve is compressed.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - typically resolves on its own.
• Surgical - may need to be drained or removed.

MCP Joint Disorders

• Swan-Neck Deformity: MCP joint flexed, PIP joint extended, DIP joint flexed (not seen in the thumb because there aren't three joints).
• Cause: rheumatoid arthritis.
• Symptoms: mallet finger at DIP, limited mobility, pain.
• Treatment: Non-surgical - splinting, HEP, ROM, OT/PT, NSAIDs.
• Surgical - soft tissue surgery or finger joint fusion for stability.
• Boutonniere Deformity: MCP joint extended, PIP joint flexed, DIP joint extended (not seen in the thumb because there aren't three joints).
• Cause: forceful blow to dorsum of bent PIP or slicing of central slip tendon, arthritis.
• Symptoms: PIP can't be straightened, DIP can't be bent, swelling & pain at PIP.
• Treatment: Non-surgical - splinting, HEP.
• Surgical - if there is a tendon that is severed or a compound fracture or splinting doesn't work.

Dupuytren Contracture

• Cause: unknown, but something triggers the fascia of the palm to thicken and it eventually tightens, reducing hand function.
• Symptoms: lumps, nodules, and cords which leads to contractures that pull fingers inward, toward the palm.
• Treatment: Non-surgical - splinting, steroids.
• Surgical - fasciotomy or subtotal palmar fasciectomy.
• Risks: diabetes, alcoholism, epilepsy.

---

(Note: This is a long response, and I've tried to format it to make it easier to read. Let me know if you'd like me to make any changes!)### Rheumatoid Arthritis (RA)

• Goals of treatment: reduce pain and joint stiffness, reduce edema, preserve normal joint function and musculature, minimize medication interactions, promote normal growth and development, maintain ADL independence • Disease process: + Acute: fever, decreased range of motion and strength, stiffness, gel phenomenon, weight loss + Subacute: mild fever, decreased range of motion and strength, morning stiffness, decreased endurance, gel phenomenon + Chronic active: decreased range of motion, strength, poor endurance + Chronic inactive: decreased range of motion, muscle atrophy, worse endurance, contractures • Treatment: NSAIDs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Osteoarthritis (OA)

• Cause: genetics and environmental, aging, chondropenia (lose cartilage faster than the body can replace it), non-inflammatory • Symptoms: localized pain, palpable edema, point tenderness, stiffness, inflammation of bones and joints, asymmetrical involvement, weight-bearing joints and hands most affected, crepitus during ROM • Prevalence: 10-15% worldwide • Assessment: patient history, MRI/x-ray, leg length discrepancy, anatomical bony abnormalities • Onset: gradually over years • Types: primary (general wear and tear, no known cause), secondary (external injury or disease) • Prognosis: “silent” or traumatic, joint location • Treatment: NSAIDs, CINODs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Fibromyalgia

• Cause: unknown • Symptoms: widespread chronic severe pain, tender points, no inflammation, headaches, malaise, poor sleep, abdominal cramps, mood disorder, from the waist up • Prevalence: 1-5% worldwide, women more affected than men (US is 3:1) • Assessment: patient history, physical examination, no genetic or blood test can be done, WPI and SSS scores • Onset: widespread or unilateral, can start unilateral then go bilateral • Types: unilateral or bilateral • Prognosis: unclear • Treatment: NSAIDs, opioids, antidepressants • Risks: aging • Comorbidities: OA, RA, depression

Gout

• Cause: crystallization and buildup of uric acid in the joint (hyperuricemia) • Symptoms: rapid onset, joint-specific pain, warmth, swelling, reddish discoloration, tenderness, “attacks” that last hours to days, intermittent, tophi • Prevalence: 1-4% worldwide, 8.3 million in US • Assessment: medical history, physical exam, blood work, MRI/x-ray/CT • Onset: 30-50 years old • Types: most common in big toe, 1st metatarsal • Treatment: diet low in purines, NSAIDs, xanthine oxidase inhibitors (XOI), comprehensive planning (diet) • Risks: men, African American • Comorbidities: insulin resistance syndrome, hypertension, renal damage, depression

Burns

Skin Anatomy

• Epidermis: thin, nonvascularized, epithelial cells, 25% of skin, top layer, body temperature regulation, erection of waste, makes vitamin D • Dermis: 75% of skin, blood vessels, hair follicles, sweat glands, nerve endings, barrier for bacteria, prevents moisture loss • Subcutaneous tissue: fat, below dermis

Wound Healing Process

1. Hemostasis: stop bleeding (clot)
2. Inflammatory: cells come to clean up the wound
3. Proliferative: a. Connective tissue deposits b. Contraction (rebuild tissue) c. Epithelium is rebuilt
4. Maturation: collagen reorganizes itself

Zones of Burns

• Coagulation: brunt of the heat, innermost, most damage, irreversible • Stasis: decreased perfusion, surrounding coagulation, moderate damage, can be saved but effort is needed • Hyperemia: decreased perfusion, outermost, minimal damage, has potential to survive

Types of Burns

• Superficial Burn (1st degree): epidermis only, redness, dry, blanches, no blisters, painful and sensitive to air and light touch, heals in 3-4 days, no scarring • Superficial Partial-Thickness Burn (2nd degree): epidermis and papillary dermis, weeping, wet skin, blanches, clear blisters, painful to touch, heals in 2-3 weeks, no scars but pigment changes • Deep Partial-Thickness Burn (2nd degree): epidermis and entire dermis, white, no blanching, bloody blisters, moist skin, very painful to touch, heals in more than 3 weeks, scarring and contractures • Full-Thickness Burn (3rd degree): epidermis, entire dermis, and subcutaneous tissue, charred black, bright red, tan, or pearly white, fragile blisters, dry, leathery, insensate but can feel deep pressure, high risk of contractures, requires skin graft, months to years, body can’t heal on its own • Deep Full-Thickness Burn (4th degree): all skin layers and tendon, muscle, or bone, charred or mummified, eschar (dead skin/tissue), insensate, but can feel deep pressure, difficult to heal, may require amputation, contractures, and functional impairment

Additional Issues

• Burn shock: loss of fluid or plasma in the blood, occurs within 48-72 hours of initial injury, due to loss of fluid or plasma in the blood • Hypermetabolism: prolonged stress response, increase of cytokines, insulin, and catecholamines in the body • Inhalation injury: facial burns, singed nose hair, hoarse voice, wheezing, dark oral mucosa, hypoxia, cough • Scars and contractures: formation begins when the wound begins to close, hypertrophic (raised and red, stay within the borders of burn), keloid (raised and red, tender and painful, extend beyond the borders of the burn) • Treatment: primary goal is oxygenation, ideal oxygen is 100%, interventions: bronchial hygiene therapy, chest PT, airway suctioning, early mobility, mechanical ventilation, escharotomy (slit in the burn to release pressure), toxicities

Orthopedics

• Primary roles of bones: protect and support soft tissue, attachment site for muscles, store minerals, and produce red blood cells in bone marrow.
• Bone growth is influenced by nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones).

Bone Growth and Hormones

• Excess insulin growth hormone (hGH) can lead to gigantism, while a deficiency can cause short stature.
• Hormones involved in bone growth: insulin growth-like factor, human growth hormone, thyroid hormones, and sex hormones.

Soft Tissue Basics

• Atrophy: wasting away of muscles due to disuse or denervation (muscle loses nerve connection).
• Hypertrophy: muscles increase in number and diameter.
• Skeletal muscle starts to convert to connective or adipose tissue starting at 30, leading to:
  • Slowing of reflexes
  • Reduction of maximum strength
  • Decreased flexibility with age

Abnormal Contraction

• Spasm: involuntary contraction of a single muscle
• Cramp: painful, spasmodic contraction due to a lack of potassium and/or water
• Tic: involuntary twitch of muscles, often in the face or eyelid
• Tremor: rhythmic, involuntary, purposeless co-contraction of contracting muscles
• Fasciculation: involuntary twitch of multiple motor units, visible beneath the skin, often seen with ASL (Amyotrophic Lateral Sclerosis)
• Fibrillation: involuntary twitch of a single motor unit, not visible beneath the skin

Abnormal Curves of the Spine

• Kyphosis: anterior to posterior thoracic curvature (“hunchback”)
• Lordosis: extreme exaggeration of the lumbar curvature, often seen in pregnant women
• Scoliosis: S-shaped curve in the thoracic spine
• Rotoscoliosis: torsion couple with curve

Etiology

• Causes of orthopedic conditions:
  • Traumatic injuries
  • Sports
  • Falls (leading cause)
  • Rheumatic diseases
  • Aging

Orthopedic Conditions

Rickets

• Cause: lacking calcium and vitamin D in childhood
• Symptoms:
  • Soft bones
  • Deformities of the skull, legs, rib cage, pelvis, and teeth
  • Muscle cramps
  • Stunted growth (epiphyseal plates close too soon)
• Treatment: calcium-rich diet to correct deformities

Osteomalacia

• Cause: lacking calcium and vitamin D in adulthood
• Symptoms:
  • Soft bones
  • Prone to fractures
  • Bone pain in lower extremities
  • Muscle weakness
• Treatment: increased vitamin D in the diet (e.g., from salmon) and increased sun exposure

Paget's Disease

• Cause: unknown, possibly viral, with issues in the recycling process and bone formation
• Symptoms:
  • Excessive bone formation and breakdown
  • Located in the spine, femur, or skull
  • High ratio of spongy to compact bone
• Treatment: calcitonin and bisphosphonates

Osteopenia

• Cause: unknown, possibly genetic, malnourishment, or associated conditions
• Symptoms:
  • Reversible weakening of bone
• Treatment:
  • Calcium-enriched diet and supplements
  • Weight-bearing activities
  • Bone density screens

Osteoporosis

• Cause: progressive osteopenia that is irreversible
• Symptoms:
  • Initially, none
  • Later, pain, kyphosis, height loss, and skeletal dysfunction
• Treatment: none

High-Risk Factors

• Women
• History of falls
• Quadriceps weakness
• Postural instability

Incidence

• 1 in 2 women will have a fracture related to osteoporosis, while 1 in 4 men will have one
• Higher incidence in women due to decreased estrogen during menopause

Heterotopic Ossification

• Cause: unknown, with abnormal bone formation in soft tissues, possibly due to trauma or surgery
• Symptoms:
  • Pain
  • Warmth at the joint
  • Edema
  • Redness
  • Induration (changes to tissues beneath the surface)
  • Decreased range of motion with a bony end feel
• Treatment:
  • Iontophoresis
  • Range of motion
  • Pain management
• Comorbidities: neurological issues

Prevalence

• Elbow fracture: 90% chance of developing HO
• Hip fracture: 50% chance of developing HO
• Only 1/3 of individuals with HO have functional limitations

Spina Bifida

• Cause: birth defect due to incomplete closure of bone/membrane around the spinal cord
• Symptoms:
  • Myelomeningocele: leg weakness/paralysis, orthopedic issues, bladder/bowel issues, neurological issues
  • Meningocele: small sac or gait immobility
  • Occulta: may have no issues

Fractures

• Classification:
  • Bone ends: displaced or nondisplaced
  • Complete or incomplete break
  • Linear or transverse break on the long axis
• Types:
  • Closed (simple): bone does not break the skin
  • Open (compound): bone breaks the skin
  • Transverse: complete, occurs at a right angle to the bone
  • Comminuted: multiple bone fragments
  • Greenstick: incomplete, bend that causes the other side to break off
  • Stress: repetitive use
  • Hairline: incomplete, small
  • Spiral: from torsional force or twisting

Symptoms

• Localized pain at the site
• Deformity
• Edema (swelling)
• Ecchymosis (discoloration, a few days after the incident)

Incidence

• Falls are the leading cause of fractures in older adults
• Falls are the leading cause of nonfatal injuries
• Most common fractures from falls: hip, wrist, and humerus
• 44% of all fractures involve a distal radius

Hip Fractures

• Primary cause of disability and mortality in older adults
• Chance of not returning to baseline after a hip fracture
• Avulsion: possibility of muscle being pulled off the bone

Symptoms

• Referred pain in the knee
• Unable to bear weight on the affected leg
• Leg-length discrepancy

Treatment

• Surgery:
  • Closed reduction and immobilization
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty (replace the femoral neck and head with a metal prosthesis)
  • Total hip replacement (replace the acetabulum and resurface, replace the ball of the femur, lasts 10-25 years)

Precautions

• Hip flexion should not be more than 90 degrees
• No hip rotation
• No hip adduction
• Sleep on back with a pillow between legs
• Keep leg extended when going from sitting to standing

Humeral Fractures

• 20% have a loss of wrist extension or loss of feeling due to damage to the radial nerve
• 70-90% regain function after 4 months

Causes

• Osteoporosis
• Aging
• Injury

Symptoms

• Humeral displacement and location
• Distal end: supracondylar fracture (elbow, can lead to HO)
• Loss of wrist extension and dorsum hand sensation in around 1/5 cases

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Sling
• Immobilization and mobilization schedule varies

Distal Radius Fracture

• Cause: falling on an outstretched hand

Symptoms

• Loss of sensation, strength, and range of motion
• Classified based on articular and/or ulnar involvement, soft tissue involvement, and displacement

Treatment

• Closed reduction (manual)
• Open reduction and internal fixation (ORIF)
• Splint or cast
• Immobilization and mobilization schedule varies based on the physician

Scaphoid Fracture

• Cause: wrist hyperextension greater than 90 degrees and radial deviation, common in sports injuries

Symptoms

• Pain and tenderness that intensify when trying to pinch or grasp objects
• Vascular necrosis

Treatment

• Non-displaced: non-surgical and requires a thumb spica splint for 10 weeks
• Displaced: surgical and requires bolts, screws, and a splint for 2-4 weeks

Post-operative Fracture Considerations

• Edema
• Range of motion and tightness
• Nerve compression (numbness, tingling, decreased function)
• Tendon rupture

Complex Regional Pain Syndrome (CRPS)

• Cause: issues in communication between the limb, brain, and spinal cord
• Must be chronic (longer than 6 months) post-injury affecting one limb
• Symptoms:
  • Burning, throbbing, aching pain
  • Changes in skin color, temperature, and swelling in the affected area
• Types:
  • CRPS-I: no confirmed nerve injury
  • CRPS-II: known nerve involvement### Shoulder and Chest Muscles
• Weakened shoulder and chest muscles can cause the clavicle to slip down, compressing blood vessels and nerves in the superior thoracic outlet.
• Symptoms: pain in shoulders and neck, numbness and tingling, and coldness in fingers, weakened grip, thumb atrophy.
• Non-surgical treatment: rest, activity modification, OT/PT.
• Surgical treatment: anatomical difference, muscle is cut away to make more space; may cause brachial plexus injury.

Elbow

Medial Epicondylitis (Golfer's Elbow)

• Cause: inflammation of medial tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, radiating pain from medial elbow down forearm, weakness, pain, stiffness.
• Treatment: NSAIDs, rest, ice, ROM, taping, OT/PT.
• Risks: playing throwing sports, playing instrument, painting.
• Triggers: shaking hands, turning doorknob, picking up object with palm down.

Lateral Epicondylitis (Tennis Elbow)

• Cause: inflammation of lateral tendon of elbow due to repetitive use of wrist and forearm.
• Symptoms: usually in dominant hand, pain or burning on lateral side of elbow, weak grip strength.
• Treatment: NSAIDs, rest, ice, ROM, brace, steroid injections, OT/PT.
• Risks: plumbers, carpenters, painters, mechanics, chefs, butchers.
• Triggers: shaking hands, turning wrench, holding racket/garden hose.

Ulnar Collateral Ligament (UCL) Rupture

• Cause: repetitive use, fall on outstretched arm.
• Symptoms: pain at medial elbow, "pop" after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers.
• Treatment: Non-surgical: NSAIDs, ice, rest.
• Surgical: Tommy John Surgery, takes tendon from somewhere else.
• Types: Partial or complete (pain in medial part of elbow).

Posterior Olecranon Osteophyte

• Cause: formation of bone spurs on posterior olecranon.
• Symptoms: pain in elbow with no mechanism of injury, decreased ROM, catching or locking of elbow joint with movement.
• Treatment: Surgery to remove bone spurs and debridement of osteophytes, PT/OT.
• Risks: manual labor jobs, athletes.

Elbow Dislocation

• Cause: fall on outstretched arm.
• Symptoms: Partial - pain with ROM, "shifting", tingling/numbness.
• Symptoms: Complete - deformity, extreme pain, NO ROM (arm can't flex or extend).
• Treatment: Non-surgical - relocation and possible immobilization.
• Surgical - repair ligaments, external hinge.
• Types: Partial - relocates on its own; Complete - does not relocate on its own; has to be manually set.

Radial Head Fracture

• Cause: fall on outstretched arm or in conjunction with elbow fx, damage to the bone itself.
• Symptoms: pain on lateral elbow, swelling, decreased ROM, decreased supination & pronation.
• Treatment: Type I - non-surgical, rest + sling for days; Type II - surgery to remove bone fragments + sling for weeks; Type III - surgery to remove bone & repair ligaments + OT/PT.

Olecranon Bursitis

• Cause: direct injury, prolonged pressure, infection, other medical problems (gout, RA).
• Symptoms: painful elbow, edema, redness, warm skin.
• Treatment: Non-surgical - antibiotics for infection; suck out fluid; modify activities, NSAIDs.
• Surgical - takes bursa out, use splint.
• Risks: jobs or activities that require prolonged prop on elbows; elbow arthritis.

Elbow Arthritis

• Cause: breakdown of cartilage on articulating surfaces of bones.
• Symptoms: pain, decreased ROM, locking/grating sensation, edema.
• Treatment: Non-surgical - NSAIDs, OT/PT, corticosteroids.
• Surgical - arthroscopy or joint replacement.

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

• Cause: subluxed nerve, prolonged pressure, swelling, direct injury; ulnar nerve gets pinched/trapped.
• Symptoms: pain, numbness in elbow, hand or wrist, weakened grip, atrophy of hand musculature, reduced FM coordination.
• Treatment: Non-surgical - special pillow, brace, NSAIDs.
• Surgical - cubital tunnel release, transposition ulnar nerve, medial epicondylectomy.

Wrist and Hand Orthopedics

Pediatric Deformities

• 1/20 kids are born with orthopedic differences in their hand.
• Syndactyly: some fingers/toes united; webbing.
• Thumb duplication: second complete or partial thumb.
• Hypoplastic thumb: thumb is underdeveloped.
• Radial club hand: wrist radial deviation; missing all or part of fingers.
• Failure of formation of upper limb.

Radiocarpal Joint Disorders

Carpal Tunnel Syndrome

• Cause: increased pressure or entrapment of the median nerve at wrist; genetics, pregnancy.
• Symptoms: numbness, tingling, and pain in fingers, hand and arm; gradual onset, often complaints at night, lose proprioception and can't realize what their hand is doing.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - NSAIDs, bracing/splinting, steroids, activity modifications, nerve glides.
• Surgical - cut the ligament to create more space.
• Risks: repetitive hand use, hand/wrist positioning, pregnancy, genes.

De Quervain's Tenosynovitis

• Cause: overuse of wrist causes irritation of sheath around APL and EPB tendons to your thumb, or scar tissue; comorbid with rheumatoid arthritis.
• Symptoms: pain and swelling at base of thumb, deceased thumb movement, trouble grasping objects.
• Assessment: Positive Finkelstein Test.
• Treatment: Non-surgical - NSAIDs, splint full time, steroids, activity modifications, ice/heat.
• Surgical - cut sheath around tendon, then OT/PT.
• Risks: child rearing, pregnancy, carpenter, mechanic.

Ganglion Cysts

• Cause: unknown.
• Symptoms: small lump, painless, noncancerous lump often by tendons/joints in wrist or hand, becomes painful when a nerve is compressed.
• Assessment: Positive Tinel Sign.
• Treatment: Non-surgical - typically resolves on its own.
• Surgical - may need to be drained or removed.

MCP Joint Disorders

• Swan-Neck Deformity: MCP joint flexed, PIP joint extended, DIP joint flexed (not seen in the thumb because there aren't three joints).
• Cause: rheumatoid arthritis.
• Symptoms: mallet finger at DIP, limited mobility, pain.
• Treatment: Non-surgical - splinting, HEP, ROM, OT/PT, NSAIDs.
• Surgical - soft tissue surgery or finger joint fusion for stability.
• Boutonniere Deformity: MCP joint extended, PIP joint flexed, DIP joint extended (not seen in the thumb because there aren't three joints).
• Cause: forceful blow to dorsum of bent PIP or slicing of central slip tendon, arthritis.
• Symptoms: PIP can't be straightened, DIP can't be bent, swelling & pain at PIP.
• Treatment: Non-surgical - splinting, HEP.
• Surgical - if there is a tendon that is severed or a compound fracture or splinting doesn't work.

Dupuytren Contracture

• Cause: unknown, but something triggers the fascia of the palm to thicken and it eventually tightens, reducing hand function.
• Symptoms: lumps, nodules, and cords which leads to contractures that pull fingers inward, toward the palm.
• Treatment: Non-surgical - splinting, steroids.
• Surgical - fasciotomy or subtotal palmar fasciectomy.
• Risks: diabetes, alcoholism, epilepsy.

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(Note: This is a long response, and I've tried to format it to make it easier to read. Let me know if you'd like me to make any changes!)### Rheumatoid Arthritis (RA)

• Goals of treatment: reduce pain and joint stiffness, reduce edema, preserve normal joint function and musculature, minimize medication interactions, promote normal growth and development, maintain ADL independence • Disease process: + Acute: fever, decreased range of motion and strength, stiffness, gel phenomenon, weight loss + Subacute: mild fever, decreased range of motion and strength, morning stiffness, decreased endurance, gel phenomenon + Chronic active: decreased range of motion, strength, poor endurance + Chronic inactive: decreased range of motion, muscle atrophy, worse endurance, contractures • Treatment: NSAIDs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Osteoarthritis (OA)

• Cause: genetics and environmental, aging, chondropenia (lose cartilage faster than the body can replace it), non-inflammatory • Symptoms: localized pain, palpable edema, point tenderness, stiffness, inflammation of bones and joints, asymmetrical involvement, weight-bearing joints and hands most affected, crepitus during ROM • Prevalence: 10-15% worldwide • Assessment: patient history, MRI/x-ray, leg length discrepancy, anatomical bony abnormalities • Onset: gradually over years • Types: primary (general wear and tear, no known cause), secondary (external injury or disease) • Prognosis: “silent” or traumatic, joint location • Treatment: NSAIDs, CINODs, joint replacement surgeries • Risks: Caucasian, women, obesity • Comorbidities: depression, GI issues (from medication)

Fibromyalgia

• Cause: unknown • Symptoms: widespread chronic severe pain, tender points, no inflammation, headaches, malaise, poor sleep, abdominal cramps, mood disorder, from the waist up • Prevalence: 1-5% worldwide, women more affected than men (US is 3:1) • Assessment: patient history, physical examination, no genetic or blood test can be done, WPI and SSS scores • Onset: widespread or unilateral, can start unilateral then go bilateral • Types: unilateral or bilateral • Prognosis: unclear • Treatment: NSAIDs, opioids, antidepressants • Risks: aging • Comorbidities: OA, RA, depression

Gout

• Cause: crystallization and buildup of uric acid in the joint (hyperuricemia) • Symptoms: rapid onset, joint-specific pain, warmth, swelling, reddish discoloration, tenderness, “attacks” that last hours to days, intermittent, tophi • Prevalence: 1-4% worldwide, 8.3 million in US • Assessment: medical history, physical exam, blood work, MRI/x-ray/CT • Onset: 30-50 years old • Types: most common in big toe, 1st metatarsal • Treatment: diet low in purines, NSAIDs, xanthine oxidase inhibitors (XOI), comprehensive planning (diet) • Risks: men, African American • Comorbidities: insulin resistance syndrome, hypertension, renal damage, depression

Burns

Skin Anatomy

• Epidermis: thin, nonvascularized, epithelial cells, 25% of skin, top layer, body temperature regulation, erection of waste, makes vitamin D • Dermis: 75% of skin, blood vessels, hair follicles, sweat glands, nerve endings, barrier for bacteria, prevents moisture loss • Subcutaneous tissue: fat, below dermis

Wound Healing Process

1. Hemostasis: stop bleeding (clot)
2. Inflammatory: cells come to clean up the wound
3. Proliferative: a. Connective tissue deposits b. Contraction (rebuild tissue) c. Epithelium is rebuilt
4. Maturation: collagen reorganizes itself

Zones of Burns

• Coagulation: brunt of the heat, innermost, most damage, irreversible • Stasis: decreased perfusion, surrounding coagulation, moderate damage, can be saved but effort is needed • Hyperemia: decreased perfusion, outermost, minimal damage, has potential to survive

Types of Burns

• Superficial Burn (1st degree): epidermis only, redness, dry, blanches, no blisters, painful and sensitive to air and light touch, heals in 3-4 days, no scarring • Superficial Partial-Thickness Burn (2nd degree): epidermis and papillary dermis, weeping, wet skin, blanches, clear blisters, painful to touch, heals in 2-3 weeks, no scars but pigment changes • Deep Partial-Thickness Burn (2nd degree): epidermis and entire dermis, white, no blanching, bloody blisters, moist skin, very painful to touch, heals in more than 3 weeks, scarring and contractures • Full-Thickness Burn (3rd degree): epidermis, entire dermis, and subcutaneous tissue, charred black, bright red, tan, or pearly white, fragile blisters, dry, leathery, insensate but can feel deep pressure, high risk of contractures, requires skin graft, months to years, body can’t heal on its own • Deep Full-Thickness Burn (4th degree): all skin layers and tendon, muscle, or bone, charred or mummified, eschar (dead skin/tissue), insensate, but can feel deep pressure, difficult to heal, may require amputation, contractures, and functional impairment

Additional Issues

• Burn shock: loss of fluid or plasma in the blood, occurs within 48-72 hours of initial injury, due to loss of fluid or plasma in the blood • Hypermetabolism: prolonged stress response, increase of cytokines, insulin, and catecholamines in the body • Inhalation injury: facial burns, singed nose hair, hoarse voice, wheezing, dark oral mucosa, hypoxia, cough • Scars and contractures: formation begins when the wound begins to close, hypertrophic (raised and red, stay within the borders of burn), keloid (raised and red, tender and painful, extend beyond the borders of the burn) • Treatment: primary goal is oxygenation, ideal oxygen is 100%, interventions: bronchial hygiene therapy, chest PT, airway suctioning, early mobility, mechanical ventilation, escharotomy (slit in the burn to release pressure), toxicities