Orthopedics: Bone Structure and Growth
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Questions and Answers

What are the common areas associated with bursitis?

Rotator cuff and biceps tendon

What are the types of tendon tearing mentioned?

  • Acute (correct)
  • Chronic (correct)
  • Degenerative
  • Sudden

    • Impingement occurs when the Acromion puts pressure on underlying soft tissues when shoulder is ______ or flexed.

    abducted

    Fracture can be caused by floor level falls, sports injuries, and motor vehicle accidents.

    <p>True</p> Signup and view all the answers

    Match the following causes with the related conditions:

    <p>Sudden injury or repetitive use = Instability Trauma, repetitive use, pregnancy, anatomical differences, poor posture = Thoracic Outlet Syndrome</p> Signup and view all the answers

    What are the primary factors for burns?

    <p>Temperature and time exposed</p> Signup and view all the answers

    Burn shock occurs when less than 20% total body surface area is burned.

    <p>False</p> Signup and view all the answers

    _______ is the primary goal of fluid resuscitation in burn treatment.

    <p>Replace fluids loss from burn</p> Signup and view all the answers

    Match the burn degree with its description:

    <p>1st Degree = Epidermis only, redness, dry, painful, no scarring 2nd Degree = Epidermis and papillary dermis, weeping, clear blisters, painful to touch 3rd Degree = Epidermis, entire dermis, subcutaneous tissue, charred black, insensate 4th Degree = All skin layers, tendon, muscle, bone, charred, mummified, insensate</p> Signup and view all the answers

    Which type of arthritis is characterized by chronic inflammation of synovium usually occurring later in life with mechanical breakdown?

    <p>Osteoarthritis</p> Signup and view all the answers

    Juvenile Idiopathic Arthritis carries over into adulthood.

    <p>False</p> Signup and view all the answers

    What is the main cause of Rheumatoid Arthritis?

    <p>untreated synovitis and tenosynovitis with the addition of an infection</p> Signup and view all the answers

    Osteoarthritis involves __________ pain, stiffness, and inflammation of bones and joints.

    <p>localized</p> Signup and view all the answers

    Match the following arthritis types with their description:

    <p>Polyarticular = Involves both sides of body, 5 or more small joints Seropositive = Worse prognosis, have rheumatoid factor Psoriatic = Red, flaky patchy rash, pain/swelling, involves multiple joints Oligoarticular = Involves one side of body, 4 or less BIG joints</p> Signup and view all the answers

    What is the medical term for inflammation of the medial tendon of the elbow due to repetitive use of wrist and forearm?

    <p>Medial Epicondylitis</p> Signup and view all the answers

    Which of the following are common symptoms of lateral epicondylitis (Tennis elbow)?

    <p>Pain or burning on the lateral side of the elbow</p> Signup and view all the answers

    Ulnar Collateral Ligament (UCL) Rupture can result in pain at the ___ elbow.

    <p>medial</p> Signup and view all the answers

    De Quervain's Tenosynovitis is caused by underuse of the wrist.

    <p>False</p> Signup and view all the answers

    Match the following joint disorders with their corresponding features:

    <p>Boutonniere Deformity = MCP joint extended, PIP joint flexed, DIP joint extended Swan-Neck Deformity = MCP joint flexed, PIP joint extended, DIP joint flexed Dupuytren Contracture = Thickening of palmar fascia leading to finger contractures</p> Signup and view all the answers

    What are the primary roles of the skeletal system?

    <p>protect and support soft tissue, attachment site for muscles, store minerals, produce red blood cells in bone marrow</p> Signup and view all the answers

    What can influence bone growth?

    <p>Both Nutrition and Hormones</p> Signup and view all the answers

    What are some common reasons for amputation?

    <p>All of the above</p> Signup and view all the answers

    Atrophy is the result of muscles increasing in number and diameter.

    <p>False</p> Signup and view all the answers

    Which of the following is a type of lower extremity amputation?

    <p>Hip disarticulation</p> Signup and view all the answers

    Phantom limb pain is a rare occurrence following an amputation.

    <p>False</p> Signup and view all the answers

    Rickets is caused by lacking ________ in childhood.

    <p>calcium/vitamin D</p> Signup and view all the answers

    Match the following orthopedic conditions with their descriptions:

    <p>Osteomalacia = Soft bone, prone to fracture, bone pain in lower extremities, muscle weakness Paget’s Disease = Excessive bone formation and breakdown, high ratio of spongy to compact bone Osteoporosis = Progressive irreversible weakening of bone</p> Signup and view all the answers

    What is a common method to manage phantom limb sensations?

    <p>medication management, therapeutic exercise, acupuncture, guided meditation and imagery, massage, relaxation and deep breathing, mirror therapy, TENS, virtual reality</p> Signup and view all the answers

    Chronic pain is defined as any pain lasting more than ________ weeks.

    <p>12</p> Signup and view all the answers

    What are the common areas associated with bursitis mentioned in the content?

    <p>rotator cuff and biceps tendon</p> Signup and view all the answers

    What are the two types of tendon tearing mentioned in the content?

    <p>Acute</p> Signup and view all the answers

    Impingement occurs when the Acromion puts pressure on underlying soft tissues when the shoulder is ______ or ______.

    <p>abducted, flexed</p> Signup and view all the answers

    Match the following causes of shoulder issues with their descriptions:

    <p>Instability = Sudden injury or repetitive use Fracture = Floor level falls, sports injuries, motor vehicle accidents Thoracic Outlet Syndrome = Trauma, repetitive use, pregnancy, anatomical differences, poor posture</p> Signup and view all the answers

    What are the primary roles of orthopedics?

    <p>Protect and support soft tissue, act as attachment site for muscles, store minerals, and produce red blood cells in bone marrow.</p> Signup and view all the answers

    What influences bone growth?

    <p>Nutrition (calcium, phosphorus, and vitamin D) and hormones (insulin-like growth factor, human growth hormone, thyroid hormones, and sex hormones).</p> Signup and view all the answers

    Which abnormal contractor refers to a painful spasmodic contraction often due to a lack of potassium and/or water?

    <p>Cramp</p> Signup and view all the answers

    Osteopenia is a reversible weakening of bone.

    <p>True</p> Signup and view all the answers

    Rickets is caused by lacking ______ and ______ in childhood.

    <p>calcium, vitamin D</p> Signup and view all the answers

    Match the following orthopedic conditions with their causes:

    <p>Osteomalacia = Lacking calcium/vitamin D in adulthood Paget’s Disease = Unknown, may be viral; issue with the bone recycling process Heterotopic Ossification = Unknown, abnormal bone formation in soft tissues Osteoporosis = Progressive osteopenia that is irreversible</p> Signup and view all the answers

    What is the cause of Medial Epicondylitis (Golfer’s elbow)?

    <p>Repetitive use of wrist and forearm</p> Signup and view all the answers

    Which hand is usually affected by Lateral Epicondylitis (Tennis elbow)?

    <p>Dominant hand</p> Signup and view all the answers

    Surgical treatment is typically not recommended for Lateral Epicondylitis.

    <p>True</p> Signup and view all the answers

    Posterior Olecranon Osteophyte is characterized by pain in the elbow with no mechanism of injury, decreased ROM, and catching or locking of elbow joint with movement due to the formation of bone spurs on the _______.

    <p>posterior olecranon</p> Signup and view all the answers

    Match the following types of Elbow Dislocation with their descriptions:

    <p>Partial = Relocates on its own Complete = Does not relocate on its own; has to be manually set</p> Signup and view all the answers

    Which of the following zones of burns indicates the most damage and is irreversible?

    <p>Coagulation</p> Signup and view all the answers

    Superficial Partial-Thickness Burns can lead to scarring.

    <p>False</p> Signup and view all the answers

    What is the primary goal of Hypermetabolism management for burn patients?

    <p>Increased energy consumption/use increased protein turnover</p> Signup and view all the answers

    Too much fluid resuscitation in burn patients may lead to increased __________.

    <p>edema</p> Signup and view all the answers

    What is the main difference in how noninflammatory arthritis and inflammatory arthritis affect the synovium?

    <p>The main difference is that noninflammatory arthritis involves mechanical breakdown of the synovium, while inflammatory arthritis involves chronic inflammation of the synovium.</p> Signup and view all the answers

    Juvenile Idiopathic Arthritis is a group of diseases present for how long?

    <p>Months to years</p> Signup and view all the answers

    Rheumatoid Arthritis always affects joints bilaterally.

    <p>True</p> Signup and view all the answers

    What is the hallmark of Rheumatoid Arthritis in the hands? Ulnar deviation of ______ joints.

    <p>MCP</p> Signup and view all the answers

    Match the following treatments for Rheumatoid Arthritis with their descriptions:

    <p>DMARDs = Disease modifying anti-rheumatic drugs Biological agents = Help suppress immune system Steroids = Act as a 'buffer' between drugs Surgery = Options include joint replacement surgeries</p> Signup and view all the answers

    What is the cause of Gout?

    <p>Crystallization and build up of uric acid in the joint (hyperuricemia)</p> Signup and view all the answers

    What are some reasons for amputation?

    <p>Infection</p> Signup and view all the answers

    What is phantom limb pain?

    <p>Phantom limb pain is pain felt in a body part that has been amputated.</p> Signup and view all the answers

    Chronic pain is defined as any pain lasting less than 12 weeks.

    <p>False</p> Signup and view all the answers

    _______ pain originates from damage to nerves and causes typical pain symptoms.

    <p>Neuropathic</p> Signup and view all the answers

    Match the following types of pain with their descriptions:

    <p>Nociceptive Pain = Damage to body tissues, nerve receptors send pain signals to CNS Radicular Pain = Nerve root irritation, localized pain Neuropathic Pain = Damage to nerves, burning, numbness, and tingling Visceral Pain = Pain originating from internal organs</p> Signup and view all the answers

    What are the common areas associated with bursitis mentioned in the content?

    <p>rotator cuff and biceps tendon</p> Signup and view all the answers

    What are the types of tendon tearing mentioned in the content?

    <p>Chronic</p> Signup and view all the answers

    Impingement occurs when the Acromion puts pressure on underlying soft tissues when the shoulder is ________ or ________.

    <p>abducted, flexed</p> Signup and view all the answers

    Fractures can be caused by floor level falls, sports injuries, and motor vehicle accidents.

    <p>True</p> Signup and view all the answers

    Match the following causes with their associated conditions:

    <p>Sudden injury, degenerative changes, long term use = Tendon Tearing Acromion puts pressure on underlying soft tissues when shoulder is abducted or flexed = Impingement Sudden injury or repetitive use = Instability Trauma, repetitive use, pregnancy, anatomical differences, poor posture = Thoracic Outlet Syndrome</p> Signup and view all the answers

    What is the main difference between inflammatory and non-inflammatory arthritis?

    <p>Mechanical breakdown</p> Signup and view all the answers

    What must occur prior to 16 years old for a diagnosis of Juvenile Idiopathic Arthritis?

    <p>Group of diseases</p> Signup and view all the answers

    Juvenile Idiopathic Arthritis can carry over into adulthood.

    <p>False</p> Signup and view all the answers

    Rheumatoid Arthritis involves an inflammatory response that leads to an __________ reaction.

    <p>immune</p> Signup and view all the answers

    What is a common symptom of untreated Rheumatoid Arthritis?

    <p>Swelling and warmth around joints</p> Signup and view all the answers

    What is the cause of Medial Epicondylitis?

    <p>Inflammation of the medial tendon of the elbow due to repetitive use of wrist and forearm</p> Signup and view all the answers

    Which of the following treatments can be used for Lateral Epicondylitis (Tennis elbow)?

    <p>Steroid injections</p> Signup and view all the answers

    Elbow arthritis is more common than knee arthritis.

    <p>False</p> Signup and view all the answers

    What is the primary symptom of Ulnar Collateral Ligament (UCL) Rupture? Pain at medial elbow, 'pop' after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ______ fingers.

    <p>ring/pinky</p> Signup and view all the answers

    Match the following joint disorders with their respective characteristics:

    <p>Boutonniere Deformity = PIP joint cannot be straightened, DIP joint cannot be bent, swelling &amp; pain at PIP Swan-Neck Deformity = MCP joint is flexed, PIP joint is extended, DIP joint is flexed Dupuytren Contracture = Tender nodule develops in the palm resulting in contractures in MCP and IP joints</p> Signup and view all the answers

    What causes Carpal Tunnel Syndrome?

    <p>Increased pressure or entrapment of the median nerve at the wrist; genetics, pregnancy</p> Signup and view all the answers

    What are the primary factors for burns?

    <p>Temperature and time exposed</p> Signup and view all the answers

    Burn shock occurs when less than 20% of the Total Body Surface Area (TBSA) is burned.

    <p>False</p> Signup and view all the answers

    What are the three zones of burns that indicate the level of damage?

    <p>Coagulation, Stasis, Hyperemia</p> Signup and view all the answers

    ______ burns only affect the epidermis and appear as redness, dry skin with no blisters.

    <p>Superficial Burn</p> Signup and view all the answers

    Match the following burn depth with its description:

    <p>Superficial Burn = Epidermis only, redness, dry, no blisters Deep Full-Thickness Burn = All skin layers and tendon, muscle, or bone with insensate appearance Deep Partial-Thickness Burn = Epidermis and entire dermis, white appearance, moist skin Full-Thickness Burn = Epidermis, entire dermis, and subcutaneous tissue, charred appearance</p> Signup and view all the answers

    What are the primary roles of the skeletal system?

    <p>protect and support soft tissue, serve as attachment sites for muscles, store minerals, produce red blood cells in bone marrow</p> Signup and view all the answers

    What influences bone growth?

    <p>Both nutrition and hormones</p> Signup and view all the answers

    Atrophy is the wasting away of muscles due to overuse.

    <p>False</p> Signup and view all the answers

    ______ can lead to gigantism, while too little of it can cause short stature.

    <p>hGH</p> Signup and view all the answers

    What condition is caused by a lack of calcium and vitamin D in childhood?

    <p>Rickets</p> Signup and view all the answers

    Match the following orthopedic conditions with their causes:

    <p>Osteomalacia = Lacking calcium/vitamin D in adulthood Paget’s Disease = Unknown cause, possible viral etiology Osteopenia = Unknown cause, genetic, malnourishment Osteoporosis = Progressive osteopenia that is irreversible</p> Signup and view all the answers

    What is the primary cause of hip fractures?

    <p>Fall and fracture proximal femur</p> Signup and view all the answers

    What distinguishes an open (compound) fracture from a closed (simple) fracture?

    <p>The bone breaks through the skin</p> Signup and view all the answers

    What are some reasons for amputations?

    <p>All of the above</p> Signup and view all the answers

    What is the preparation requirement for an amputation procedure?

    <p>Spinal anesthesia or general anesthesia</p> Signup and view all the answers

    Phantom limb sensations occur due to issues with the Central Nervous System (CNS).

    <p>True</p> Signup and view all the answers

    _____ Pain is caused by damage to body tissues.

    <p>Nociceptive</p> Signup and view all the answers

    Match the following with their pain types:

    <p>Sharp, stabbing = Neuropathic Pain Aching, constant = Nociceptive Pain Burning, numbness = Neuropathic Pain Throbbing, crushing = Nociceptive Pain</p> Signup and view all the answers

    Which hormone influences bone growth by closing the epiphyseal plates?

    <p>Human Growth Hormone</p> Signup and view all the answers

    Gigantism can result from too much Human Growth Hormone (hGH).

    <p>True</p> Signup and view all the answers

    ______ is the wasting away of muscles by disuse or denervation.

    <p>Atrophy</p> Signup and view all the answers

    Define Kyphosis.

    <p>Anterior to posterior thoracic curvature (hunchback)</p> Signup and view all the answers

    Match the orthopedic condition with its description:

    <p>Osteoporosis = Progressive osteopenia that is irreversible Paget’s Disease = Excessive bone formation and breakdown with high spongy bone ratio Rickets = Lacking calcium/vitamin D in childhood Osteomalacia = Soft bone, prone to fracture, bone pain in lower extremities</p> Signup and view all the answers

    What is the primary role of orthopedics?

    <p>Protect and support soft tissue</p> Signup and view all the answers

    What is the cause of Golfer's elbow (Medial Epicondylitis)?

    <p>Repetitive use of wrist and forearm</p> Signup and view all the answers

    Which of the following are common treatments for Tennis elbow (Lateral Epicondylitis)?

    <p>Rest</p> Signup and view all the answers

    Tendons are cut in Tommy John Surgery for Ulnar Collateral Ligament (UCL) Rupture.

    <p>False</p> Signup and view all the answers

    Posterior Olecranon Osteophyte is characterized by the formation of bone spurs on the _______.

    <p>posterior olecranon</p> Signup and view all the answers

    Match the following back conditions with their descriptions:

    <p>Cervical Degenerative Disc Disease = Wear and tear on cervical spine with decreased cushioning and shock absorption Cervical Herniated Disc = Nucleus pulposus leaks out through a tear in disc's outer layer Spinal Stenosis = Narrowing of spinal canal resulting in compression of the spinal cord</p> Signup and view all the answers

    What are the primary factors for burns?

    <p>Temperature and time exposed</p> Signup and view all the answers

    What determines the healing rate and success of a burn?

    <p>The depth and surface area of the burn</p> Signup and view all the answers

    What are the common areas associated with bursitis?

    <p>Rotator cuff and biceps tendon</p> Signup and view all the answers

    Match the following burn degrees with their characteristics:

    <p>Superficial Burn (1st degree) = Redness, dry, blanches, no blisters Superficial Partial-Thickness Burn (2nd degree) = Weeping, wet skin, clear blisters Deep Partial-Thickness Burn (2nd degree) = White, no blanching, bloody blisters Full-Thickness Burn (3rd degree) = Charred black, fragile blisters, dry, leathery Deep Full-Thickness Burn (4th degree) = Charred or mummified, eschar</p> Signup and view all the answers

    What are the types of tendon tearing? (Select all that apply)

    <p>Chronic</p> Signup and view all the answers

    Hypermetabolism in burn patients is caused by a decrease in hormones.

    <p>False</p> Signup and view all the answers

    What are the causes of impingement?

    <p>Acromion putting pressure on underlying soft tissues when the shoulder is abducted or flexed</p> Signup and view all the answers

    Instability can occur due to sudden injury or repetitive use.

    <p>True</p> Signup and view all the answers

    Fractures in the shoulder can be caused by floor level falls, sports injuries, and motor vehicle accidents. The associated pain, swelling, bruising, and deformity are common at the ______.

    <p>shoulder</p> Signup and view all the answers

    What can cause Thoracic Outlet Syndrome? (Select all that apply)

    <p>Pregnancy</p> Signup and view all the answers

    What is the most common type of amputation?

    <p>Leg above or below the knee</p> Signup and view all the answers

    Which of the following are reasons for amputation? (Select all that apply)

    <p>Infection</p> Signup and view all the answers

    Spinal anesthesia is required for amputation surgery.

    <p>False</p> Signup and view all the answers

    Phantom limb pain often affects the most distal portion of the amputated limb, such as the ___ or ___

    <p>hand, foot</p> Signup and view all the answers

    Match the following pain types with their descriptions:

    <p>Nociceptive Pain = Damage to body tissues that send pain signals to the CNS Neuropathic Pain = Damage to nerves that causes typical pain symptoms</p> Signup and view all the answers

    What is the main difference between inflammatory and non-inflammatory arthritis?

    <p>Type of inflammation</p> Signup and view all the answers

    What is the primary cause of Rheumatoid Arthritis?

    <p>Untreated synovitis and tenosynovitis with the addition of an infection leading to an inflammatory response and immune reaction (autoimmune disorder).</p> Signup and view all the answers

    Juvenile Idiopathic Arthritis carries over into adulthood.

    <p>False</p> Signup and view all the answers

    Osteoarthritis is characterized by ____________ involvement.

    <p>asymmetrical</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Hemostasis = Stop bleeding and form a clot Inflammatory = Cells clean up the wound Proliferative = Rebuilding of cells with connective tissue deposits, contraction, and epithelial repair</p> Signup and view all the answers

    What is the most common amputation location?

    <p>Leg</p> Signup and view all the answers

    What are some reasons for limb amputation? (Select all that apply)

    <p>Infection</p> Signup and view all the answers

    Spinal anesthesia is a requirement for limb amputation.

    <p>False</p> Signup and view all the answers

    Match the following types of amputation with their descriptions:

    <p>Hemipelvectomy = Entire half of the body, take out the pelvis Hip Disarticulation = Preserve pelvis Above the Knee = Lose the joint Shoulder Disarticulation = Whole arm, clavicle, and scapula</p> Signup and view all the answers

    What is phantom limb pain?

    <p>Pain felt as if in an amputated limb</p> Signup and view all the answers

    What is the main difference between inflammatory and non-inflammatory arthritis?

    <p>Type of inflammation in the synovium</p> Signup and view all the answers

    What is a common symptom of Juvenile Idiopathic Arthritis?

    <p>Fever and rash</p> Signup and view all the answers

    Rheumatoid Arthritis primarily affects only one side of the body.

    <p>False</p> Signup and view all the answers

    _______ arthritis involves untreated synovitis and tenosynovitis triggering an immune reaction.

    <p>Rheumatoid</p> Signup and view all the answers

    Match the types of arthritis with their descriptions:

    <p>Osteoarthritis = Noninflammatory, involves chondropenia and aging Rheumatoid Arthritis = Inflammatory, autoimmune response triggered by synovitis Juvenile Idiopathic Arthritis = Group of diseases occurring before 16 years old with various subtypes</p> Signup and view all the answers

    What is associated with bursitis and is common in the rotator cuff and biceps tendon?

    <p>Tendon tearing</p> Signup and view all the answers

    Which type of tendon tearing involves a sudden injury, degenerative changes, or long-term use?

    <p>Acute</p> Signup and view all the answers

    Impingement occurs when the acromion puts pressure on underlying soft tissues when the shoulder is ______ or flexed.

    <p>abducted</p> Signup and view all the answers

    Instability can be caused by sudden injury or repetitive use.

    <p>True</p> Signup and view all the answers

    Match the type of fracture with its common causes and symptoms:

    <p>Fracture = Cause: Floor level falls, sports injuries, motor vehicle accidents; Symptoms: Pain, swelling, bruising at the shoulder, deformity, grinding sensation Thoracic Outlet Syndrome = Cause: Trauma, repetitive use, pregnancy, anatomical differences, poor posture; Symptoms: Varies based on specific condition</p> Signup and view all the answers

    What are the primary factors for burns?

    <p>Temperature and time exposed</p> Signup and view all the answers

    Superficial Partial-Thickness Burn affects the epidermis only.

    <p>False</p> Signup and view all the answers

    What is the primary cause of Burn Shock?

    <p>loss of fluid or plasma in the blood</p> Signup and view all the answers

    ____ occurs from tightening and shortening of the burn scar.

    <p>Contractures</p> Signup and view all the answers

    Match the following burn depths with their descriptions:

    <p>Full-Thickness Burn = Affects epidermis, entire dermis, and subcutaneous tissue Deep Full-Thickness Burn = Affects all skin layers and tendon, muscle, or bone Superficial Burn = Affects Epidermis only Deep Partial-Thickness Burn = Affects epidermis and entire dermis, hair follicle spared</p> Signup and view all the answers

    What are the primary roles of the skeletal system?

    <p>protect and support soft tissue, attachment site for muscles, store minerals, produce red blood cells in bone marrow</p> Signup and view all the answers

    What influences bone growth?

    <p>Both nutrition and hormones</p> Signup and view all the answers

    Too much human growth hormone can cause short stature.

    <p>True</p> Signup and view all the answers

    _________ is the wasting away of muscles by disuse or denervation.

    <p>Atrophy</p> Signup and view all the answers

    Match the abnormal muscle contractions with their descriptions:

    <p>Spasm = Involuntary contraction of single muscle(s) Tic = Involuntary twitch of muscles, often in face or eyelid Tremor = Rhythmic, involuntary, purposeless co-contraction of contracting muscles Fibrillation = Involuntary twitch of multiple motor units visible beneath the skin Cramp = Painful spasmodic contraction due to lack of potassium and/or water Fasciculation = Involuntary twitch of a single motor unit NOT visible beneath the skin None of the above = Rhythmic, involuntary, purposeless co-contraction of muscles</p> Signup and view all the answers

    What condition is characterized by the weakening of shoulder and chest muscles, leading to compression of blood vessels and nerves in the superior thoracic outlet?

    <p>Clavicle slippage</p> Signup and view all the answers

    Which tendon is affected in Medial Epicondylitis (Golfer's elbow)?

    <p>Medial tendon</p> Signup and view all the answers

    Tennis elbow is commonly treated surgically.

    <p>False</p> Signup and view all the answers

    In Ulnar Nerve Entrapment (cubital tunnel syndrome), the ulnar nerve gets ___________ or ___________.

    <p>pinched, trapped</p> Signup and view all the answers

    Match the following joints with their typical disorders:

    <p>Carpal Tunnel Syndrome = Increased pressure or entrapment of the median nerve at wrist De Quervain's Tenosynovitis = Irritation of sheath around APL and EPB tendons to your thumb Ganglion Cysts = Small lump by tendons/joints in wrist or hand</p> Signup and view all the answers

    What causes Cervical Herniated Disc?

    <p>Leakage of the nucleus pulposus through a tear in the disc's outer layer</p> Signup and view all the answers

    Which ligaments are part of the extracapsular ligaments of the knee?

    <p>LCL</p> Signup and view all the answers

    Ankle joint is weakest in dorsiflexion.

    <p>False</p> Signup and view all the answers

    Ankle sprains are most commonly caused by __________.

    <p>inversion</p> Signup and view all the answers

    What is the overarching diagnosis for over 100 arthritic conditions?

    <p>Arthritic diseases</p> Signup and view all the answers

    What is a common area where bursitis is associated with tendon tearing?

    <p>Shoulder</p> Signup and view all the answers

    What are the causes of tendon tearing?

    <p>Sudden injury, degenerative changes, long term use</p> Signup and view all the answers

    Impingement occurs when the Acromion puts pressure on underlying soft tissues when the shoulder is ______ or ______.

    <p>abducted, flexed</p> Signup and view all the answers

    Instability of the shoulder can cause feelings of the shoulder “giving out” or “just hanging there.”

    <p>True</p> Signup and view all the answers

    Match the shoulder condition with its corresponding treatment:

    <p>Non-surgical treatment for tendon tearing = think that it will heal over time on its own, NSAIDs Surgical treatment for impingement = often necessary, have to be immobilized afterward Non-surgical treatment for instability = modifying activities, anti-inflammatories, therapies Non-surgical treatment for fracture = immobilization, NSAIDs</p> Signup and view all the answers

    What are the symptoms of Ulnar Collateral Ligament (UCL) Rupture?

    <p>pain at medial elbow, 'pop' after throwing, point tenderness, swelling, inability to throw/perform activity, numbness in ring/pinky fingers</p> Signup and view all the answers

    Which profession is at risk for developing Lateral Epicondylitis (Tennis elbow)?

    <p>All of the above</p> Signup and view all the answers

    Arthritic diseases encompass over 100 conditions.

    <p>True</p> Signup and view all the answers

    De Quervain's Tenosynovitis is characterized by pain and swelling at the base of the ____.

    <p>thumb</p> Signup and view all the answers

    Match the following ligaments with their functions:

    <p>Ligamentum patellae, MCL, LCL, oblique popliteal = Prevents hyperextension ACL, PCL = Prevents anterior-posterior displacement Anterior talofibular ligament, posterior talofibular ligament, calcaneofibular ligament = Prevents inversion Deltoid ligament = Prevents eversion</p> Signup and view all the answers

    What are the primary roles of orthopedics?

    <p>Protect and support soft tissue, act as an attachment site for muscles, store minerals, produce red blood cells in bone marrow</p> Signup and view all the answers

    What influences bone growth? Select all that apply.

    <p>Nutrition</p> Signup and view all the answers

    Atrophy is the process where muscles increase in number and diameter. Is this statement true or false?

    <p>False</p> Signup and view all the answers

    ______ is an abnormal contraction characterized by involuntary twitch of muscles often seen in the face or eyelid.

    <p>Tic</p> Signup and view all the answers

    Match the abnormal spine curve with its description:

    <p>Kyphosis = Anterior to posterior thoracic curvature ('hunchback') Lordosis = Extreme exaggeration with the lumbar curvature (e.g., seen in pregnant women) Scoliosis = S-shaped curve in the thoracic spine Rotoscoliosis = Torsion couple with curve</p> Signup and view all the answers

    What are the primary factors for burns?

    <p>Temperature and time exposed</p> Signup and view all the answers

    Which zone of burns is characterized by decreased perfusion, surrounding coagulation, and moderate damage, but can be saved with effort?

    <p>Status</p> Signup and view all the answers

    Superficial burns involve damage to the epidermis only.

    <p>True</p> Signup and view all the answers

    What is the healing time for a Deep Full-Thickness Burn?

    <p>Months to years</p> Signup and view all the answers

    Match the burn complication with its description:

    <p>Contractures = Occurs from tightening and shortening of the burn scar, greatly impacts function Scars = Formation begins when the wound starts to close, can be hypertrophic or keloid Infection = Body's biggest protection is compromised, prone to other infections Hypermetabolism = Results in increased energy consumption and breakdown of muscle and fat</p> Signup and view all the answers

    What is the most common type of amputation?

    <p>Below the knee</p> Signup and view all the answers

    Which of the following are reasons for amputation?

    <p>All of the above</p> Signup and view all the answers

    Chronic pain is defined as any pain lasting more than 6 weeks.

    <p>False</p> Signup and view all the answers

    What are some common complications of amputation?

    <p>Joint deformity, Residual limb pain, Phantom limb issues, Hematoma, Infection, Wound opening, Tissue death, DVT, PE</p> Signup and view all the answers

    Neuropathic pain is caused by damage to __________.

    <p>nerves</p> Signup and view all the answers

    What is the main difference between inflammatory and non-inflammatory arthritis?

    <p>Mechanism of synovium breakdown</p> Signup and view all the answers

    Juvenile Idiopathic Arthritis carries over into adulthood.

    <p>False</p> Signup and view all the answers

    What is the male to female ratio for Juvenile Idiopathic Arthritis?

    <p>1:2 to 1:3</p> Signup and view all the answers

    Rheumatoid Arthritis is characterized by the presence of p___ around joints.

    <p>swelling and warmth</p> Signup and view all the answers

    Match the following arthritis categories with their descriptions:

    <p>Oligoarticular = Involves one side of body, most common, 4 or less BIG joints Polyarticular = Involves both sides of body, 5 or more small joints Psoriatic = Red, flaky patchy rash, pain/swelling, involves multiple joints</p> Signup and view all the answers

    What is the main cause of Osteoarthritis?

    <p>Genetics and environmental factors</p> Signup and view all the answers

    Fibromyalgia is characterized by inflammation.

    <p>False</p> Signup and view all the answers

    What is the prevalence of Gout worldwide?

    <p>1-4%</p> Signup and view all the answers

    What type of injury is associated with bursitis and is common in the rotator cuff and biceps tendon?

    <p>Tendon Tearing</p> Signup and view all the answers

    Which type of tendon tearing involves the tendon being pulled away from the bony structure?

    <p>Complete</p> Signup and view all the answers

    Impingement occurs when the acromion puts pressure on underlying soft tissues during shoulder abduction or flexion.

    <p>True</p> Signup and view all the answers

    Instability can cause feelings of shoulder 'giving out' or 'just hanging there' due to frequent _____________.

    <p>dislocation</p> Signup and view all the answers

    Match the shoulder injury with its appropriate cause:

    <p>Fracture = Floor level falls, sports injuries, motor vehicle accident Thoracic Outlet Syndrome = Trauma, repetitive use, pregnancy, anatomical differences, poor posture</p> Signup and view all the answers

    What is the primary role of bones in the body?

    <p>Protect and support soft tissue, attachment site for muscles, store minerals, produce red blood cells in bone marrow</p> Signup and view all the answers

    What influences bone growth?

    <p>Both nutrition and hormones</p> Signup and view all the answers

    Atrophy is the result of muscles increasing in number and diameter.

    <p>False</p> Signup and view all the answers

    ______ is the involuntary contraction of single muscle(s).

    <p>Spasm</p> Signup and view all the answers

    What are the primary factors for burns?

    <p>Temperature and time exposed</p> Signup and view all the answers

    Superficial partial-thickness burns show clear blisters.

    <p>True</p> Signup and view all the answers

    Deep full-thickness burns involve all skin layers and can extend to ____, muscle, or bone.

    <p>tendon</p> Signup and view all the answers

    Match the burn depth with its appearance:

    <p>Superficial Burn = Redness, dry, no blisters Deep Partial-Thickness Burn = White, bloody blisters Full-Thickness Burn = Charred black, leathery Deep Full-Thickness Burn = Charred or mummified</p> Signup and view all the answers

    What is the main difference between inflammatory and non-inflammatory arthritis?

    <p>Inflammatory arthritis involves chronic inflammation of synovium and autoimmune response, while non-inflammatory arthritis typically occurs later in life due to mechanical breakdown.</p> Signup and view all the answers

    Which type of Juvenile Idiopathic Arthritis involves one side of the body and typically affects 4 or fewer big joints?

    <p>Oligoarticular</p> Signup and view all the answers

    Rheumatoid Arthritis primarily affects weight-bearing joints.

    <p>False</p> Signup and view all the answers

    ___ is a common symptom of Osteoarthritis and involves localized pain, stiffness, and inflammation of bones and joints.

    <p>Crepitus</p> Signup and view all the answers

    Match the following diseases with their primary symptoms:

    <p>Fibromyalgia = widespread chronic severe pain, tender points, fatigue, abdominal cramps Gout = rapid onset, joint-specific pain, tophi, build-up of uric acid Burns = skin anatomy, wound healing process</p> Signup and view all the answers

    What are the symptoms of medial epicondylitis (Golfer’s elbow)?

    <p>pain in medial elbow down forearm, weak grip strength, stiffness</p> Signup and view all the answers

    What are the treatment options for lateral epicondylitis (Tennis elbow)?

    <p>Steroid injections</p> Signup and view all the answers

    Is surgery a common treatment option for lateral epicondylitis (Tennis elbow)?

    <p>False</p> Signup and view all the answers

    Which surgery is performed for Ulnar Collateral Ligament (UCL) Rupture? Non-surgical treatment includes NSAIDs, ice, and rest.

    <p>Tommy John Surgery</p> Signup and view all the answers

    Match the following elbow conditions with their respective causes: A. Olecranon Bursitis B. Elbow Dislocation C. Radial Head Fracture D. Posterior Olecranon Osteophyte

    <p>A = direct injury, prolonged pressure, infection B = fall on outstretched arm C = fall on outstretched arm or in conjunction with elbow fx D = formation of bone spurs on posterior olecranon</p> Signup and view all the answers

    What is the most common reason for amputation?

    <p>Circulatory disorders</p> Signup and view all the answers

    What are the two main categories of pain mentioned in the content?

    <p>Nociceptive and Neuropathic</p> Signup and view all the answers

    Match the following terms with their description:

    1. Radicular pain
    2. Visceral pain
    3. Paresthesia
    4. Allodynia

    <p>Radicular pain = Irritation of the nerve root Visceral pain = Pain originating from internal organs Paresthesia = Numbness and tingling sensation Allodynia = Non-painful stimuli causing pain</p> Signup and view all the answers

    Chronic pain is any pain that lasts for less than 12 weeks.

    <p>False</p> Signup and view all the answers

    Study Notes

    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.

    (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.

    (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

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