2/22/99

Orthopedics III

 

Sprain/strain injury

·         Car accidents

·         Falling

·         Subluxation

·         Muscle spasm

·         Inflammation

·         Bruising

·         Decreased ROM

·         Difficulty breathing

·         Pain—dull, sharp stabbing

·         Tightness

·         Discomfort

·         Written down exactly what the patient says in Subjective findings using quotes

·         Tx:

·         Acute inflammation—ice for first 48 hrs, heat after

·         Spinal adjustment

·         Physical therapy to reduce muscle spasm

 

 

Sprain

·         Ligamentous tearing

·         Varying grades of severity

·         Worse is full ligamentous tearing that requires surgical intervention

·         Takes 6-8 wks to heal

·         Adjustments help a little bit

 

Fractures

·         Periodically will be seen

·         Rib fractures

·         Dx:  spinous percussion, where does it hurt (can point exactly where it hurts

·         Sharp stabbing esp. w/ inhalation and expiration

·         Sleeping will cause pain

·         Decrease ROM

·         Palpate muscle spasm

·         Decrease chest expansion

·         Tuning fork (vibration) causes severe pain

·         Periosteum swelling and irritation

·         Orthopedic test

·         Sternal Compression

·         Supine

·         Doc on the side

·         Knife edge

·         Start at the bottom of the sternum and go up

·         Most common location of fracture is at mid axillary line (apex of curve of rib)

·         Pain at the mid axillary line

·         Definitive Dx is x-ray

·         Dx w/stethoscope over a fracture site, inhale or exhale will hear a grinding sound

·         Difference b/w rib involvement and chest pain and subluxation

·         Chest pain is complaint

·         Rule out cardiac pathology

·         True heart pain patient will feel crushing of chest—large area of involvement (elephant sitting on the chest) diffuse, dull pain

·         Rib subluxation—anterior parasternal, posterior paraspinal

·         Can pin point area of pain

·         Acute trauma to area—rib involvement

·         Vertebral body (not common)—whiplash

 

Nerve Root Lesion

·         Dx:  orthopedic tests

·         Will follow dermatome pattern distribution

·         Intercostal spaces for the thoracic spine—wrap around from back to front

·         T1 medial arm

·         T2 axilla—bugs crawling in arm pit

·         What affects nerve roots

·         SOL—disc lesion (herniation)

·         Fracture w/ acute inflammation

·         Bony tumor—breast cancer metastasize to the thoracic region

·         Spinal cord tumor

·         Anything that compresses or irritates the nerve root

·         Mainly irritated by inflammation

·         Arthritis—bone spur, osteophytes

·         Parathesia along dermatome

·         Reflexes

·         Myotomes—1/2 sit up, Beevor’s sign, superficial abdominal reflexes

·         Treat 2-3 wks and then re-evaluate (every other day)

·         After 3^rd visit, decrease—re-evaluate for other problems

·         If have bladder/bowel problems—cauda equina syndrome—refer out for more help

·         If are getting worse through treatment (hyperflexia, hyporeflexia, areflexia)

·         Have 2-3 wks to make Dx, after that can be liable if have missed Dx

·         X-ray is only necessary when clinically warranted —acute trauma and expect fracture, pain w/neurologic complications

·         Pregnancy test—10 day rule safe time frame to x-ray female

·         Day 0 is start of menses and 10 days after

·         Most dangerous time for the fetus is during the first month