Ortho Upper Exam 3 Review PDF

Ortho Exam Study Guide (Mon, Dec 9, 10AM-12PM) CHAPTER 14 BONY ANATOMY - VERTEBRAE - 2 or 3 matching vocab terms - Cervical vertebrae: C1-C7 - Spinal cord is most vulnerable in the C-spine - Injury can have catastrophic results BONY ANATOMY - C1/C2 VERTEBRAE - Atlas (C1) -...

Ortho Exam Study Guide (Mon, Dec 9, 10AM-12PM) CHAPTER 14 BONY ANATOMY - VERTEBRAE - 2 or 3 matching vocab terms - Cervical vertebrae: C1-C7 - Spinal cord is most vulnerable in the C-spine - Injury can have catastrophic results BONY ANATOMY - C1/C2 VERTEBRAE - Atlas (C1) - Has no vertebral body and supports the weight of the skull - No true spinous process - Articulates with the occiput of the skull - Atlanto-occipital joint (C0-C1) - Flexion-extension “yes” - Axis (C2) - Articulation between the Dens and the anterior arch of the atlas - Atlanto-axial joint (C1-C2) - Rotation “no” BONY ANATOMY - VERTEBRAE - Thoracic spine (T-spine): T1-T12 - Vertebral bodies begin to widen and thicken to assist in managing the weight of the torso - T1-T10 articulate with ribs - Costovertebral joints NEUROLOGICAL ANATOMY - 8 pairs of spinal nerve roots exit between the 7 cervical vertebrae - First 7 nerve roots exit above the corresponding vertebrae - The “odd” cervical nerve, C8, exits below the 7th cervical vertebrae - Carry sensory and motor information CHAPTER 20 ACUTE PATHOLOGY IN THE HEAD AND NECK - The potential for catastrophic head or cervical spine injuries and their life ending/altering consequences creates necessity for a clear for evaluation and management - Injury rate is relatively low, but the outcomes can be fatal or life-altering CLINICAL BONY ANATOMY - Frontal, parietal, occipital, temporal (mastoid process, zygomatic arch), sphenoid THE MENINGES - Support and protect the brain and spinal cord  - Dura mater - Outermost meningeal covering - Meningeal arteries provide blood supply to the cranial bones - Arachnoid mater - Separated by subdural space - Subarachnoid space contains cerebrospinal fluid - CSF is a fluid buffer around the brain and spinal cord - Pia mater - Innermost layer, follows contours of the brain CLINICAL EXAMINATION - HEAD INJURIES - Level of consciousness - History - Previous hx of injury, head pain, neck pain, MOI - Observation - Deformity, posturing, consciousness, MOI - Palpation - Functional assessment - AROM, PROM - Special tests - ALL unconscious athletes must be managed as if worst case scenario happened, until injuries can be ruled out - In-line stabilization, monitoring vitals, EAP OBSERVATION** - Starts as soon as you see the athlete either walking toward you or when you see MOI on the field - If you know the athlete, you can tell if they’re themselves - Nystagmus: involuntary shaking of the eyes - Pressure on eyes motor nerve (CN4) - Horizontal, vertical, and rotary nystagmus is which way they’re shaking - Pupil size: equality of pupils - PEARL (pupils equal, accommodating, and reactive to light) - Anisocoria: unilaterally dilated pupil - Pressure on CN3 (intracranial hemorrhage) - Bleeding from the ears - Skull fx - Raccoon eyes - Nasal or skull fx - Bleeding from the nose - Skull fx - Posturing FUNCTIONAL ASSESSMENT  - Don’t worry about knowing actual cranial nerves, know why we do it - Involves systematic review of the athletes memory, cognition, balance (vestibular system), coordination (motor function), and cranial nerve function - 12 pairs of cranial nerves - Must be tested within 15-20 min of injury until intracranial bleeding has been ruled out - This is the most effective time to identify conditions - Romberg test - Testing for vestibular and motor dysfunctions - Tandem walking test - Modified balance error scoring system - Double leg, single leg, tandem stance on firm ground, double leg, single leg, tandem stance on soft surface MEMORY - Retrograde amnesia - Cannot recall event before injury - Anterograde amnesia - Cannot recall events after injury CONCUSSION - Concussion heavy exam - A concussion is a mild traumatic brain injury that affects brain function at a cellular level - Causes an energy crisis in the brain by increasing energy demand, decreasing energy supply, and altering metabolic resources - MOI: direct or indirect trauma to the brain, jarring, whiplash, collisions, etc. - S&S: confusion, headache, nausea, dizziness, LOC, amnesia, fogginess, etc. - Multiple symptoms must be present to diagnose a concussion - Use of baseline testing will lead to easier diagnosis - Testing: SCAT 5, sx checklist, VOMS (vestibular ocular motor screening) SCAT 5 - Know of this, don’t need to know contents, know why it’s useful - Sport concussion assessment tool for evaluating concussions - Gives immediate screening, baseline comparison, reduces risk of RTP prematurely - Immediate on field assessment - Step 1: Red flags - neck pain, seizure, LOC, vomiting, double vision - Step 2: Observable signs - balance off, blank look, facial injury after head trauma - Step 3: Memory assessment - where are we, what day is it - Step 4: Exam Glasgow coma scale - eye, verbal, motor response from 1-5 - Office or off field assessment - Step 1: Athlete background - Step 2: Symptom evaluation  - Step 3: Cognitive screening and concentration - Step 4: Neurological screen - Step 5: Delayed recall - Step 6: Decision TREATMENT - Athletes are removed from participation - Cognitive rest (if applicable) refraining from sensory stimuli - Low stimulus walks (nature walks) - Vestibular rehab - Memory activities - Creatine supplementation - Consistent with creatine’s cellular role, supplementation reduced neuronal damage, protected against the effects of cellular energy crisis and improved cognitive and somatic symptoms - Once symptoms subside, pt will be able to return to play (RTP) protocol RETURN TO PLAY (RTP) - 1. Symptom limited activity: 10-15 min warm up with team - 2. Light aerobic exercise: 20-25 min of stationary bike or treadmill with light resistance - 3. Sport specific exercise: 30 min of sport specific drills, NO contact allowed - 4. Non-contact training drills: Full practice but NO contact - 5. Full contact practice - You should be asymptomatic before starting steps - 1 step each day, so a 5 day process DECORTICATE POSTURE - Pathology: lesion above the brainstem (severe brain trauma) - Flexion of the elbows and wrists, clenched fists (extended fingers), and extension of lower extremity - Decorticate is arms up to the “core”, decerebrate is arms down - Decerebrate is a possible secondary to heat stroke, lesion of brainstem - More severe SHAAKE - Spontaneous Headshake After a Kinematic Event - Most common reasons for exhibiting SHAAKE were: - Disorientation or confusion, feeling the need to jumpstart the brain, changes to the perception of space or perception of one’s body in space - If there was SHAAKE a concussion was reported 92% of the time for football - New concussion sign 6 TYPES OF CONCUSSIONS - Cognitive/fatigue  - Vestibular - Ocular - Post-traumatic migraine - Cervical - Anxiety/mood INTRACRANIAL HEMORRHAGE - Rupture of the blood vessels supplying the brain - Hematoma formation within the cranium places pressure on the brain and may have catastrophic results - MOI: collision, acute mechanisms to the head - S&S: [onset varies - arterial or venous] LOC, lucid consciousness, confusion, extreme fatigue, extreme headache, vomiting, cranial nerve disruption, disorientation, (concussion sx) - Tx: activate EAP, refer immediately, possible surgery to reduce pressure EPIDURAL VS. SUBDURAL HEMATOMA - Epidural - Arterial bleed between the dura mater and the skull - Rapid onset of symptoms, LOC, sx of concussion - Sx may subside and a lucid state may be present - As the hematoma increases, condition deteriorates (extreme fatigue, headache) - Subdural (below dural) hematoma - Venous bleed between the brain and dura mater - Slow onset of symptoms due to low pressure (hours or even days) - Concussion type symptoms with slow build up over time - Importance of home instructions SKULL FRACTURES - MOI: collision or direct blow to the head (athletes with no gear - rugby, women’s lacrosse, soccer, etc.) - Classified as: linear, comminuted, or depressed - S&S: palpable deformity, leakage of CSF (ethmoid or temporal fx), ecchymosis beneath eyes (raccoon eyes) and over mastoid (battle’s sign), concussion sx - Special tests: Halo test - Tx: refer, x-ray, possible surgery, concussion RTP CHAPTER 19 TEMPOROMANDIBULAR JOINT (TMJ) - Synovial articulation located between the mandible and the temporal bones - Allows for chewing of food - Articular disc allows for smooth articulation between joint - Can degrade with age, can sustain trauma THE EAR - Composed of 3 sections - External, middle, inner ear - External = pinna, ear canal - Middle = malleus, incus, stapes - Inner = cochlea, semicircular canals, vestibular and auditory nerve - Focuses acoustic energy and transform it into electrical signals that can be interpreted by the brain EXTERNAL EAR - Shape functions as a funnel, collecting a focusing sound waves through the external auditory canal TEETH - 32 teeth, equally divided into upper and lower rows - Tooth - Root, neck, and crown OBSERVATIONS - Auricular hematoma - Tympanic membrane - Shiny, translucent, and smooth - Laceration - Bleeding - Ecchymosis (black eye) - Breathing patterns - Tooth fracture - Deformity AURICLE HEMATOMA “CAULIFLOWER EAR” - MOI: repetitive blunt trauma or shearing forces to the external ear - Pooling of blood between the skin and the cartilage, separating the two - Can scar down over time and create deformity - Tx: aspirate the hematoma with a needle TYMPANIC MEMBRANE RUPTURE - MOI: sudden change in air pressure caused by blunt trauma or inability to regulate inner ear pressure (i.e. loud music, ear trauma) - S&S: tinnitus, hearing loss, muffled hearing, ear pain that may subside quickly, vertigo - Direct trauma (q-tip) - Diagnosed using otoscope, should be smooth shiny - Tx: conservative, ear plugs to avoid water, antibiotics (healed within a few weeks) NASAL FRACTURE - MOI: direct trauma - Most fractured facial bone - S&S: palpable pain, nosebleed, pain, some crepitus - Check air flow in both nostrils - Tx: x-ray to examine septum, deviated septum or gross displacement require reduction or realignment MANDIBULAR FRACTURE - MOI: high velocity impact to the jaw - Second most common facial fx behind nasal fx - S&S: pain in jaw with movement, crepitus, malocclusion of the jaw - Special test: tap test, tongue blade test - Tx: x-ray, refer, possible surgery - LeFort fractures are midface fractures, normally extremely rare, displaces jaw forward TOOTH FRACTURES - MOI: impact to tooth - Range from simple chips to full avulsion of the crown from the root - Class 1 is best case, class 4 is worst possible case - S&S: sensitivity to extreme temperatures of food or drink, gross deformity, extreme discomfort - No immediate danger - Avulsion should be found and implanted back into socket if possible (trying to preserve the periodontal ligament) - Tx: dentist referral, crown implant - Veneer - cosmetic - Crown - deeper chips unseen from the front TEMPOROMANDIBULAR JOINT INJURIES - Blow to the jaw may injure the TMJ and cause dislocation - May cause malocclusion of the jaw - Tx: remove athlete from participation and refer - Chronic TMJ disorder - Masseter muscle dysfunction creates malalignment at the TMJ - Tx: night mouth guards, physical therapy, soft tissue mobilization - Mouth guards help relax the jaw at night and maintain proper alignment CHAPTER 18 BONY ANATOMY - ORBIT/PERIORBITAL AREA - No specifics, just regions - Roof of the orbit: Frontal bone, sphenoid bone - Medial orbit: Lacrimal, ethmoid, sphenoid bone  - Floor of the orbit: Maxillary, zygomatic, palatine bone ANATOMY OF THE GLOBE - Lens: clear elastic structure, focuses light onto the retina at the back of the eye - Iris: serves to sharpen and focus visual rays onto the retina, color of the eye - Aperture in a camera - Cornea: clear outer layer of the eye, protection of foreign objects - Anterior chamber is filled with a liquid, between iris and sclera - Glaucoma - cloudy vision after liquid gets trapped - Sclera: white of the eye, fibrous tissues that extends from the cornea to the optic nerve - Pupil: the opening at the center of the iris through which light passes - Retina: contains rods and cones to interpret visual data FUNCTIONAL ASSESSMENT - Visual acuity: Snellen chart - Emmetropia: 20/20 vision - Ability to read on the 20 font size line when standing 20 feet away - Myopia: nearsightedness - Light rays are focused on the front of the retina, can see near - Hypermetropia: farsightedness - Light rays are focused behind the retina, can see far - Shape usually dictates function (genetic) ORBITAL FRACTURES - MOI: blow to the periorbital region from an object that is larger than the orbit itself - Weak point in the orbit: medial wall or floor - Blow out fracture: fx that occurs in this weak area, medially or on the floor of the orbit - Blow up fracture: fx of the roof of the orbit - S&S: sunken globe or medially displaced, inability to look upward, may be locked into downward gaze, impaired ROM - Special tests: (blow out fx) pinch nose gently and blow air through nose, may escape through medial orbit past the eye - Tx: refer, conservative or surgical - Surgery to repair a blow out fx is usually not performed immediately, and can be delayed for up to two weeks to allow swelling to go down CORNEAL ABRASIONS - MOI: external force directly striking the eye: sand, dirt, contact lenses, nail, stick, etc. - Cornea is highly innervated creating pain, scratched eye - S&S: pain, scratching sensation, excessive tears, photophobia (sensitivity to light), excessive blinking, sensation of “something in the eye” - Tx: remove object with wet cotton swab, rinse with eye wash, antibiotic eye drops CORNEAL LACERATION - MOI: external force directly striking the eye that may cause partial or full thickness tears of the cornea - Partial thickness tears are similar S&S to abrasions - Full thickness tears penetrate the anterior chamber - S&S: observable disruption in the normal translucent appearance of the cornea, obvious opening and spilling of its contents - Tx: if object is embedded in eye, then should be left in place until ER/ophthalmologist can remove object HYPHEMA - MOI: blunt eye trauma causing a tear in iris - Blood pooling in the anterior chamber of the eye (space between cornea and iris) - Usually visible to the unaided eye - 70-75% of injuries happen from the ages of 10-20 years old - Tx: Patching and shielding eye with immediate referral - Patient will be encouraged to keep head above heart, no strenuous activity, use of antalgic and avoidance of anti-inflammatories - Typically resolves in 5-7 days RETINAL DETACHMENT - MOI: jarring force to the head can cause detachment of the retina away from the choroid, may happen with a sneeze, can also happen spontaneously - Severe myopic (nearsighted) individuals are at higher risk for spontaneous detachment - S&S: curtain closing in, flashes of light, excessive floaters - Tx: cover the eye, referral to ER, surgical correction - Dolphins coach - Can be spontaneous, have to lay face down for 90% of the time because the air bubble that sits in the eye, you want to keep that toward the back where it detached to hold it in place while it heals RUPTURED GLOBE - Most catastrophic injury to the eye - MOI: severe blunt trauma to the globe itself, ruptures the cornea or sclera, subsequently spilling its contents - Commonly occur behind the eye where the sclera is thinnest, may not be visible - S&S: pain, partial or total loss of vision, globe may be disoriented in the orbit, pupil may be elliptical, or teardrop shaped - Tx: medical emergency, immediate ER referral, cover eye - Surgery by an ER ophthalmologist within 24-48 hours for best results Know difference between signs and symptoms