Orthopedic

Rapid Review

• 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. 

Pearls

Deep Dive

• Adhesive Capsulitis (Ortho Bullets)

Rapid Review

• 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)

Pearls

Deep Dive

• Costochondritis (Physiopedia)

Rapid Review

• 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

Pearls

Deep Dive

• Cauda Equina Syndrome (Orthobullets)

Rapid Review

• 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

Pearls

Deep Dive

• The Dreaded Acute Compartment Syndrome (emDOCs)