Orthopedic

  • Adhesive Capsulitis
  • Costochondritis
  • Cauda Equina
  • Compartment Syndrome

Adhesive Capsulitis

  • Background
    • Commonly known as ‘frozen shoulder’, it involves inflammation of the glenohumeral joint causing capsular fibrosis and severe restriction in range of motion.
    • Follows progressive “freezing” and “thawing” stages over the course of 15-24 months.
  • Signs/Symptoms
    • Diffuse shoulder pain w/ progressive stiffness
    • Limited ROM
  • Diagnosis
    • Clinical diagnosis
  • Treatment
    • Analgesia (NSAIDS, PO steroids, intra-articular corticosteroid)
    • Encourage physical therapy and frequent mobilization. 
Video Credit: Nabil Ebraheim

*Deep Dive: Adhesive Capsulitis (Ortho Bullets)



Costochondritis

  • Background
    • Inflammation of costal cartilages or sternal articulations, typically origination from trauma or rheumatological conditions
    • Common cause of non-cardiac chest pain
  • Signs/Symptoms
    • Reproducible chest wall pain
    • May be sharp, dull, pleuritic
  • Diagnosis
    • Clinical diagnosis
    • EKG and CXR helpful and ruling out more serious pathology
  • Treatment
    • Rest, ice/heat, stretching, PT
    • Analgesia (NSAIDS, acetaminophen, diclofenac cream)
Video Credit: JJ MedEd

*Deep Dive: Costochondritis (Physiopedia)



Cauda Equina Syndrome

  • Background
    • This condition occurs due to compression of the cauda equina, which is the last segment of the spinal cord. It can be caused by disc herniation, epidural abscess or tumor. In a patient with back pain, findings concerning for cauda equina include bowel or bladder dysfunction, lower extremity weakness or loss of sensation
    • Most commonly caused by herniated disk. May also be caused by spinal cord infection or spinal epidural abscess (IV drug use is large risk factor)
  • Signs/Symptoms
    • Acute low back pain
    • Saddle anesthesia, decreased rectal tone, urinary incontinence/retention
  • Diagnosis
    • Clinical diagnosis
    • Confirmed with emergent MRI (first-line) or CT myelogram 
  • Treatment
    • High-dose methylprednisolone
    • Consult neurosurgical for emergent operative decompression
Video Credit: Medmastery

Deep Dive: Cauda Equina Syndrome (Orthobullets)



Compartment Syndrome

  • Background 
    • Syndrome that occurs due to increased tissue pressure within a closed fascial space, resulting compromised blood flow and tissue ischemia
    • Most commonly occurs in the anterior compartment of the leg following a tibial fracture.
  • Signs/Symptoms
    • Progressive worsening pain
    • “5 P’s” (pain, paresthesia, pallor, paralysis, pulselessness)
  • Diagnosis
    • Compartment pressure measurement ( >30 suggestive of compartment syndrome)
  • Treatment
    • Provide analgesia and maintain limb at level of the heart
    • Fasciotomy is the definitive management
Video Credit: Armando Hasudungan

*Deep Dive: The Dreaded Acute Compartment Syndrome (emDOCs)


Brandon Simpson, PA-C
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