WARREN

1. DDH: Female Breech infant; Unilat Left (80%), >37 Hilgrener angle. Dx: Barlow (post), Ortolani (ant), Galeazzi test, glut fold asymmetry
2. Screening: ULTRASOUND Newborns (dynamic); XRAY 3-6 Months old. Tx: PAVLIK Harness+weekly ultrasound;
3. If Pavlik Fails: <6 mo bracing; 6mo-2yr closed reduction; 2-3 yrs open reduction; 3-4 yrs femoral shortening; 4+ yrs acetabular surgery
4. Legg-Calve-Perthes: (Male. Age 4-8, Unilat 75%) AVN femur head--> collapse frags--> prog deform w/o tx. Initial- knee/thigh pain,
limited mobility, limp. Waldenstrom stages-initial/fragmentation/reossification/healed. Best progtx serial cast/brace until ossifies. Worst prog
>50% fem head, >7yrs oldtx surgical pinning/reconstruction.
5. Slipped Capital Femoral Epiphysis: Obese Adolescent Male; hypogonad/thyroid/pituitarism. EXTERNAL ROTATED HIP. Stable slip <30
deg, wt bearing ok=best prog. Tx: get Ortho consult.
KUEHN
1. 4th wk=MIGRat; 5th wk=CONDens; 6th wk=CHONDrif; 7th-12th wk=PRIMARY OSS (@ diaphysis); Birth-Age 9=SECONDARY OSS
(@ epiphysis); lastly, Age 18-25=epiphys plate fusion
2. SOMITE: MYOTOME [Wnt/BMP4]-Skeletal Muscle (hypaxial=limb/abd/pelv mm, epaxial=deep back mm);
SCLEROTOME [SHH]-Vertebrae, skull base, annulus fibrosis, ribs, clav
3. LATERAL PLATE [mesoderm; SHH]-SOMATOPLEURE-Appendicular Skeleton, Limbs. UE-lat rot, LE-med rot
4. Vertebrae devel: 2 somites-2 separate sclerotomes-->4 parts (anteromed/posteromed) make 1 vertebral segment. (@ Sacrum: arch/TPs fuse
age 2-5. bony centrum fuses age 8. low seg fusion then high seg fusion-Puberty)
5. Muscle devel pattern (prox then dist): 1. hypomere mesoderm migrates (Ant=preaxial/flexors, Post=postaxial/extensors); 2. superficial/deep
grp separation; 3. horizontal grp separation.
6. Pelv/prox femur devel (6th wk): chondrification; precartilage of ileum, ischium, pubis; perichondrium-joint capsule/synovial membrane
7. Femur dev: 2nd bone to begin ossifying (7th wk-SHAFT; Birth-femoral head; Age 4-Grtr troch; Age 13-lessr troch) --> femur
head/greater/lesser troch fuses Age 19
8. OS COXA: 1' ossif centers: 9th wk-Ilium; 3rd month-Ischium; 4th month-Pubis
9. Acetabulum fuses Age 9 --> 2' Ossif sites form TRIRADIATE "Y-shaped" cart. --> Puberty Acetabulum DEEPENS*--> Triradiate
fuses Age 19 (*if fem/acetab disarticulate @ dev=shallower acetab than norm)
REGA [4 hrs]
1. BONE is WEAKEST under TENSION/SHEAR (oblique/transverse/torsional forces)
2. Stages of bone remodeling: 1) -CYTES sense mech load 2) Activation phase-pre-BLASTs secrete collagenase-digest surface osteiod 3)
Resorption phase-exposed surface attracts pre-CLASTs express RANKL/differentiate into mature -CLASTs & form sequestrum/resorb/release
Ca2+ 4) Coupling phase-BLASTs recruited to site ~wks later 5) Formation phase (3 months) -BLASTs line up on surface, secrete OSTEOID
within lamellae in circumferential pattern 6) Mineralization phase-begins day 10, takes 3-6 months.
3. OSTEOPOROSIS: EXCESSIVE osteoCLAST activity --> bone mass (OSTEOPENIA). esp spongy/cancellous/TRABECULAR bone.
(screen pt's to r/o hyperparathyroidism). Affects both MINERAL & OSTEOID. DEXA scan for mineral density. Tx: Bisphosphonates for
inhibiting -CLASTs--CAUTION: hypocalcema or jaw necrosis after dental extractions!
4. HYPOCALCEMIA (LOW bone minerals) RICKETS-children vit D def, low hydroxyapatite, leg bowing, . OSTEOMALACIA-adults vit
D/Ca def.
5. FEMORAL BUTTRESSING: xray "stop-gap" @ neck of femur in Pts w osteopenia. Compensatory bone deposition in areas of high fx
risk/most compression forces. Hyperdense on radiograph.
6. HEALING: 1) SOFT CALLUS-collagen 3 wks; 2) HARD CALLUS-woven 2-4 mo; 3) REMODELING. *Note: ORIF surgery=Direct
Remodeling (no callus formation)
7. COMPRESSION Fx: common @ Epiphysis (cancellous/spongy bone). Types: comminuted/Butterfly/Buckle.
8. A fracture site w surgical hardware is susceptible to iatrogenic osteoporosis due to relieved bone stress caused by surgical hardware.
9. CARTILAGE: type II collagen, proteoglycan, GAGs, ECM, Chondrocytes, Perichondrium, avascular,
10. ARTICULAR CARTILAGE: No perichondrium, 4 regions w diff fibril orientations. LOADING is req for nutrient supply "water wash"
for chondrocytes. However, Art Cart dehydrates during activity.
11. SYNOVIAL FLUID: plasma filtrate (electrolytes+ small molecules)
12. LIGAMENT/TENDON: fibroblasts, ECM, type I collagen, WAVY construction allows for elastic recoil. 3 injuries (most common to least)
1st=MYOTENDON jxn fail *most typical; 2nd=avulsion; 3rd=failure within
BROWN [2 hrs]
1. Test for lumbar radiculopathy? (specific test)= STRAIGHT LEG RAISE (dorsiflex foot, raise leg to as close to 90 as possible)
2. CERVICAL: (1) Spurling's test-nerve root imping (2) Distraction test-stenosis (3) Compression test
3. SHOULDER: 1) Biceps Load-GH joint 2) Apprehension-GH joint 3) Drop Arm Test-Rotator cuff muscles 4) Empty Can Test-supraspinatus
4. Extend & radially deviate wrist, and put counterforce on hand so they are extending the arm muscle=COZEN'S TEST for lateral
epicondylitis. (note: radial head moves Posteriorly on Pronation)
5. De Quervain's Tenosynovitis? (thumb ligament tenosynovitis) do FINKELSTEIN'S. Adduct thumb and cover with four fingers, bring
elbow to 90 degree flexion, and ulnar deviation of wrist.
6. TOMAS TEST for hip flexure contractions (flex opposite knee and having the affected leg stay as straight as possible) A positive test is
when the leg that is supposed to be straight can't fully extend and will start to left up due to a tight psoas or femoris rectus muscle.
7. Knee tests: Lachman (best for acute ACL), Ant/Post drawer, McMurray, Patellar ballotment (infection), Varus/Valgus stress test

BROWNELL [4 hrs]
1. Muscle motor proteins: myosin, kinesin, dyneins
2. Energy for contraction: (1) Glycolysis; (2) Oxid Phos; (3) Creatine Phosphate Shunt. *Note: MUSCLE FATIGUE after 30% of ATP has
been depleted. (rigor mortis is when 100% is depleted)
3. Ca bind troponin C, moves tropomyosin out of the way on actin. Myosin releases Pi and ADP--> displaces myosin on the actin filament
(power stroke, shortens H, I bands) --> ATP comes to release myosin from actin-->ATP hydrolysis re-cocks the myosin head
4. SLOW TWITCH (Type I) Red Oxidative. Lots of Mito and Myoglobin. Small diameter, longest, Posture. vs FAST TWITCH (Type II)
White glycolytic, anaerobic. shorter, larger diameter. for Wt training, reflexes.
5. Nitric Oxide Synthase @ dystrophin complex. Vasodilates around stretched muscle so it can ease circulation to the muscle. *In dystrophies,
dystrophin scaffolding is DISLODGED and there is REDUCED local vasodilation!! (NOS not as efficient)
7. OSTEOBLAST: from STROMAL MARROW stem cells, OSTEOID secreting. express RANKL. 15% will mature into osteoCYTEs and
embed in lacunae for load sensing.
8. SERUM CALCIUM: (Bone resorption, osteoCLASTs) PTH, Vitamin D, FSH, Leptin, T3 & T4
9. CONNECTIVE TISSUE: GAGs (hyaluronic acid), collagen, glycoprotein, proteoglycans
10. BASAL LAMINA (type IV collagen) acts as major deterrent to tumor metastasis.
11. INTEGRINS: cell surface receptors that link ECM to cytoplasm. Required for cell growth. (fibronectin, laminin, fibrinogen eg)
PARSA [2 hrs]
1. NEUROGENIC muscle pathology: TYPE GROUPING & GROUP ATROPHY
2. Rhabdomyosarcomas: (1) Embryonal @ head/neck. Sarcoma Botyroides-grapes @ groin of Baby, best prog. (2) Alveolar-AdoLEsence
LEs. (3) Pleomorphic-adults >45 yo worst prog.
3. DERMATOMYOSITIS: PARANEOPLASTIC. Perivascular infiltrate CD4+ & MAC, heliotrope rash, gottron pappules (IPs)
4. MCARDEL DISEASE-exercise intolerance. myophophorylase deficiency (glyc storag dz V), no lactate, defective anaerobic metabolism.
5. INCLUSION BODY MYOSITIS: (>50 yrs old) Tau & Amyloid inclusions w rimmed vacuoles. distal mms.
6. CONGENITAL MYOPATHIES: (1) Rod, (2) Central Core (RyR & Malig Hypertherm), (3) Centronuclear
7. Mitochondrial Myopathy. RAGGED RED FIBERS. Maternal inheret. Young Pt w Stroke & muscle weakness. biopsy cytochrome oxydase.
8. Myotonic Dystrophy-Auto Dom. CTG repeats (DMPK gene mutation). Positive "Grip Test"-unable to release grip. Facial weak, gait abn.
9. Lambert-Eaton-AutoAb vs presynaptic Ca channels (paraneoplastic--assoc w small cell LUNG CANCER)
SAVIOLA [1 hr]
1. BONE INFECTION IN CHILDREN-stays in bone bc the growth plate contains infection (does NOT infect joint in children--but can
spread to ADULT joints via Extension thru PERIOSTEUM, pyogenic. may also invade venous sinuses & rupture thru skin)
2. BIOFILMS colonize manmade prosthetics/catheters; hard to culture, often antiobiotic resistant & evades host immune response.
3. DGI manifestations: (1) classic triad: Synovitis, Dermatitis (pustules), Polyarthralgias or (2) Purulent arthritis. Culture=Thayer Martin Sel
Agar, Ox+, Gram neg diplococci. Pili, lack Opa, LOS.
4. S. aureus VIRULENCE: w CAPSULE can survive within OsteoBlasts "parasites". resist antibiotics. induce apoptosis/inflammation.
5. Viral Arthritis via Hep B, Rubella (German Measles) or Parvovirus B19
LIN [3 hrs]
1. PAGET DISEASE- (Elderly) BLAST & CLAST activity. ALK PHOSPHATASE & urine hydroxyproline. (Normal Ca, PTH, P). hat
size/calvarium. "Mosaic pattern" of woven/lamellar. May cause high-output CARDIAC FAILURE. Risk of OSTEOSARCOMA. (may be due
to paramyxovirus)
2. FIBROUS DYSPLASIA-(median 8 yrs old) replacement of normal bone w fibrous tissue=solid/cystic bone lesions. McCune-Albright
Syndrome. precocious puberty, cafe-au-lait spots, short, very young females.
3. OSTEOCHONDROMA (exostosis)-most common BENIGN bone tumor. Mostly males < 21 yrs old. capped metaphysis projection,
continuous w medullary canal.
4. GIANT CELL TUMOR OF BONE-Benign (age 20-40). "soap bubble" lytic lesion @ epiphyseal-metaphyseal jxn of long bone, esp prox
tibia/distal femur. NORMAL Labs. If recurr, more likely malign & mets to lung
5. OSTEOSARCOMA-2nd common malignant bone tumor. (bimodal age 10-20; 60-70-assoc w Paget's). @ Metaphysis. raised periosteumCodman Triangle. Alkaline Phosphatase. Poor Prog. METS to LUNGS.
6. HYPERPARATHYROIDISM-Primary=Parathyroid Adenoma (90%); Secondary=Renal Osteodystrophy (chronic renal insufficiency,
Hypovitaminosis D due to phosphate retention). Osteitis Fibrosa; Brown tumors.
7. ENCHONDROMA-benign cart neoplasm @ metaphysis/medullary cavity of small bones hand/foot. Find masses of blue/white hyaline cart
w calcific. Ollier's & Maffucci.
YASMER [2 hrs]
1. NUCLEAR MEDICINE "Bone Scan" = PHYSIOLOGIC IMAGING. Tc99m radioactive isotope injection. Uses: tumor, infection, stress fx,
problem-solving
2. [HAND XRAY]=RA. symmetric erosive changes, juxta-articular osteopenia
3. [ANKLE XRAY/SCAN]=BRODIE'S ABSCESS
4. [SPINE XRAY] bamboo spine or vertical syndesmophyes of Ankylosing spondylitis. also [SI JOINT XRAY] if symmetrical.

PUMERANTZ [2 hrs]
1. DGI- 85% monoarticular. Gram neg diplo. females. Drain; start empirical therapy based on gram stain/ CEFTRIAXONE I.V. 7-14 days +
DOXYCYCLINE 7 days for CHLAMYDIA coverage
2. Prosthetic Joint Infection: COAG NEG STAPHYLOCOCCI. Biofilms. S. epidermidis. MSSA=NAFCILLIN or CEFAZOLIN or
Fluroquinolone (Levofloxacin)+Rifampin. MRSA (& empirical therapies)=VANCOMYCIN+RIFAMPIN PO 2 wks then add fluoroquinolone,
co-trimoxzole or linezolid. Also, want to preserve function!
3. LYME DISEASE: negative gram stain. NE US travel, low-grade fever. Tx: CEFTRIAXONE.
4. Phase 1 of vertebral osteomyelitis tx: Clear up Acute infection w Nafcillin or Vanco. Phase 2: Prevent the progression to chronic!
5. CHRONIC OSTEOMYELITIS: incurable. risk of osteosarcoma. Sinus Tracts risk Squamous Cell Carcinoma of overlying skin.
6. Bone Penetration Antibiotics chart.
MOELLMER [2 hrs]
1. In-Toeing: number one cause= TIBIAL TORSION. (also: hip capsule "W sitting", Femoral anteversion or Metatarsus Adductus.
2. Adult Heel Pain=PLANTAR FASCIITIS. worst w 1st step in the AM or after prolonged sitting/standing (POST-STATIC DYSKINESIA),
better w activity, worse by end of day
3. Adolescent Heel Pain=SEVER'S DISEASE/APOPHYSITIS. inflamm/shearing of growth plate. B/L pain. Tx: Heel Lifts (very effective)
4. Weight Bearing Xrays-very important for lisfranc ligament injury & stress fx of base of 5th metatarsal dx.
5. CHARCOT (typically a diabetic pt). T-99m bone scan is only way to dx charcot vs arthritis. Charcot shows ease in all 3 phases: blood
flow, pooling and metabolism.
6. POSTERIOR TIBIAL TENDONITIS- middle age females. unilateral arch flattening & medial ankle swelling w eversion ("too-manytoes" sign). Dx: cannot do single heel lift. Tx: rest, ice, NSAIDs, cast, PT.
MATA [2 hrs]
1. BISPHOSPHONATES "-DRONATE" - inhibits pyrophosphate synthase/INHIBITS OSTEOCLAST activity, easing bone resporption.
Adverse: Corrosive Esophagitis (sit upright for 30 mins), Osteonecrosis of jaw.
2. DENOSUMAB- monoclonal Ab vs RANKL, interrupts -CLAST cycle. Subcutaneous injection. Also for CA. Don't d/c abruptly.
3. RILOXIFENE-SERM. Partial estrogen agonist. bone mineral density LDL. Adverse: hot flash, arthralgia, sinusitis, DVT risk.
4. COLCHICINE- inflammation after 5-7 days. binds tubulin, inhibits MT polymerization (mitotic poison). N/V/D, marrow dmg, anemia.
CONTRAIND w strong CYP3A4 inhibitors (eg clarithromycin)
5. ALLOPURINOL/FEBUXOSTAT-inhibits Xanthine Oxidase, thus inhibiting uric acid synthesis. Prevention of CHRONIC gout.
6. CAPSAICIN-for arthritis. desensitizes the receptor to pain thru overstimulation. topical analgesic. Pain may cont after the tx is stopped.
7. CELECOXIB (selective COX2 inhibitor NSAID)-Adverse= risk of MI & Stroke!
8. METHOTREXATE: inhibits S-phase/DNA synthesis via folate pathway interruption
FINLEY [3 hrs]
1. RHEUMATOID ARTHRITIS: morning stiffness, symmetric, RF, nodules, hallux valgus, baker's cyst, PANNUS, boutonniere's/swan neck
deformities. MCPs & PIPs. Labs: Anti-CCP Ab. Tx: DMARD-Methotrexate.
2. Rheumatologic exams: Gait, Arms, Legs, Spine (GALS). Ask: Stiffness? (indicates inflammation), Dressing? Stairs?
3. Rheumatoid Factor (RF): Ab, usually IgM, that binds to Fc portion of IgG. Sensitive, but non-specific.
4. RA classif criteria 4 factors: 1) joint dist; (2) serology (3) sympt duration (4) Acute phase reactants. > 6 is definite RA.
5. Better prognosis with early treatment (median=15 d) vs delayed treatment for RA
KATSAROS [3 hrs]
1. OA: hyaline cart loss, osteophyte form, wt bearing, bouchard (pip), Heberden (Dip). Normal Labs. 1st line: Acetaminophen.
2. GOUT: NEG birefringent crystals yellow parallel. Podagra. Tophi. Cloudy synovial fluid w 5K-60K leukocytes. ACUTE tx= NSAIDs,
Colchicine. CHRONIC tx=Allopurinol/febuxostat
3. CPDD "Pseudogout": calcium pyrophosphate crystals, chondrocalcifications on Xray. positive birefringent crystals Blue when Parallel. @
large joints. >50 yrs old. assoc w hyper- or hypo-parathyroid/hemochromatosis.
4. ANKYLOSING SPONDYLITIS: HLA B27 B/L SI joints. 23 yr male. Dull LBP improves w exercise. Syndesmophytes. Bamboo Spine.
Tx: Greatly improves with NSAIDs!
5. REACTIVE ARTHRITIS: HLA B27 Asymmetric SI joints & Additive. Conjunctivitis/anterior uveitis, urethritis, arthritis. Spurs @ plantar
fascia. Tx: Sulfasalazine. but self-limiting 3-5 months.
6. PSORIATIC ARTHRITIS: HLA B27 DIPs, Spine/SI joints. onchynosis. Morning stiffness improves w exercise. "pencil-in-cup" deformity
@ hands/feet xrays
7. SCLERODERMA: LIMITED=Anti-Centromere, Pulmonary HTN, low DLCO, Taut Skin, Raynaud's. DIFFUSE=Anti-SCL 70, Interstitial
Fibrosis, Renal Crisis, GERD, Pericarditis,
8. SJOGREN'S SYNDROME: inflamm/destruction of exocrine glands. Sicca, B/L Parotid enlargment. COPD. risk of LYMPHOMA! Antinuclear Antibodies SSA Anti-Ro, SSB Anti-La. Schirmer test & Rose Bengal sign. Ocular Sx.
LEE [3 hrs]
1. SLE: Female, age 14-45. HLA DR3. Jaccoud's arthritis (nonerosive) Synovitis, Serositis, Pericarditis, atherosclerosis. LUPUS NEPHRITIS
(proteinuria), Anti-Sm Antibody. *Neonate=heart conduction block

2. ANTI-PHOSPHOLIPID SYNDROME: Hypercoaguability+Thrombocytopenia. CAPS=Emergency.

3. DERMATOMYOSITIS: symmetric proximal musc weakness. CD4+. Heliotrope rash/gottron papules. Assoc w CANCER. Blood vessel
target. (Ped Pts have Calcinosis)
4. POLYMYOSITIS: symmetric proximal musc weakness. CD8+. Endomysial inflamm. Most sensitive CPK; most specific LDH. get biopsy.
5. BEHCET'S: recurrent oral/tongue ulcers, genital ulcers, eye lesions, +pathergy test.
6. GRANULOMATOSIS w POLYANGITIS (WEGERNER'S): nasal/oral inflamm, abn CXR-nodules, cavities. Upper airway sx. C-ANCA,
P-ANCA. Saddle-nose deformity
7. GIANT CELL (TEMPORAL) ARTERITIS, GCA: (>50 yrs old) new HA, inflamm infiltrate in Temporal A. on biopsy. jaw claudication.
diplopia "cotton wool spots" if Ophthalmic A affected/retinal ischemia.
8. POLYMYALGIA RHEUMATICA: (>50 yrs) Pelv/shoulder girdle aching, morning stiffness. rapidly respond to low-dose steroids. 10% of
patients will develop GCA!
AVIK [2 hrs]
1. Displaced Fx=emergency, urgent ORIF to avoid AVN damage.
2. Most common stress fx= TIBIAL fx
3. Salter Harris I&II: Closed Reduct+immobilize. III&IV: intraarticular & physeal step-off, ORIF. *Note: IV results in growth disturbance.
4. Compartment syndrome: 1st sx=pain out of prop, palpably tense compartments, pain w passive stretch. Tx: fasciotomy within 24-48 hrs.
5. Growth plate fracture disrupts ZONE OF HYPERTROPHY.
FAERBER [2 hrs]
1. GH dislocation-95% ANTERIOR=arm slightly ABD w Ext Rot. Bankart Lesion-ant inf GH labrum avulsion; assoc w lig laxity-sx repair.
2. Lateral epicondylitis (tennis)-ECRB tendon. vs Medial epicondylitis (pitcher's) pronator teres & FCR, Ulnar Neuritis.
3. Subacromial Bursitis (impingement)-Neer/Hawkin sign. I-bursitis/edema, II-tendonitis/fibrosis, III-RTC rupture/bone spur.
4. Shoulder dislocation- Axillary Nerve compromise. Apprehension test.
5. ACL- avulsion injury. "pop" sound. Acute hemarthrosis. LACHMAN test most sensitive.
6. PCL- "dashboard", mech force injury. posterior drawer test most accurate. Anterior step-off.
7. Causes of acute hemarthrosis/bloody effusion of knee: (1) ACL tear (70%) (2) periph meniscal tear (3) Patella disloc (4) intra-art fx (5) tumor.
8. Lateral Ankle-(inversion injury). Lateral Ligs=ATFL (*most common injured, test w Anterior Drawer), calcaneofibular lig, PTFL.
9. Thompson's Squeeze Test=Achilles tendon rupture.
HOOD [2 hrs]
1. SCOLIOSIS-fixed lateral curvature in coronal plate > 10. Stabilization surgery indicated if >40 in adolescents.
2. ACHONDROPLASIA-Auto Dom. FGFR-3 gene (gly arg substitution). Error of endochondral ossification @ prolif. zone of physis.
3. CLUB FOOT-conservative treatment, serial casting.
4. MRI best for neurological/soft tissue; CT better for bone injuries.
STEINMANN [2 hrs]
1. Lumbar disc herniation (radiation, numbness over dorsal foot, weakness, saddle anesth) cauda equina syndrome emergent discectomy
2. Spondylosis-arthritis of the vertebrae, with aging. Causes LBP. Normal neuro exam.
3. MOTOR STRENGTH exam: 3/5= weak, able to resist gravity.
4. Spondylolisthesis-Degerative type=facet gives way after degeneration; Isthmic type-pars interarticularis fx L5/S1 commonly.
KISBY [2 hrs]
1. CISATRACURIUM-nondepol blocker. Better choice for renal Pts. Surmountable with AChE inhibitory (pyridostigmine eg)
2. PANCURONIUM (long acting Nondepol blocker)-may also act at cardiac muscarinics HRBP, vagolytic. Give Atropine to avoid adverse.
3. SUCCINYLCHOLINE-fasciculations/flaccid. phase I depolarization-AChE inhibitors will POTENTIATE this. Phase II desensitization
-AChE inhibitors can reverse this. CONTRAINDIC-Genetic Pseudocholinesterase disorder prolonged effects of sux, apnea etc.
Adverse=Hyperkalemia, cardiac arrest, Malignant Hyperthermia (give Dantrolene antidote)
4. DANTROLENE blocks RyR. For Malignant Hyperthermia. Adverse: fatal hepatitis.
5. BACLOFEN-GABAb agonist; TIZANIDINE-2 agonist; GABAPENTIN-L-type Ca channel; DIAZEPAM-GABAa agonist.
6. CYCLOBENZAPRENE- centrally acting. Symptomatic relief @ brainstem serotonergic path to muscle tone.
FRAIX [2 hrs]
1. Osgood-Schlatter prominent tibial tuberosity in adolescent sports players.
2. Brachial Plexopathy burning/stinging (contact sports)-stretched upper trunk of brachial plexus.
3. Hill-Sach's deformity/bankart's lesion-GH instability or labral tear. Positive apprehension test.
4. Cervical stenosis/myelopathy-typically secondary to cervical sponylosis/disc degen/herniation.
5. SPONDYLOLISTHESIS-slipped fw vert body. causes cauda equina syndrome. hyper and hypo reflexia.
RICE [4 hrs]
1. eat healthy.
2. exercise.